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A "Frank Statement" for the 21st Century?

October 24, 2017 - 4:34am

The surprise announcement by the former head of the WHO’s Tobacco Free Initiative, Derek Yach, that he would head a newly-established organisation called the ‘Foundation for a Smoke-free World’1 to ‘accelerate the end of smoking’ was met with gut-punched disappointment by those who have worked for decades to achieve that goal. Unmoved by a soft-focus video featuring Yach looking pensively off into the distance from a high-level balcony while smokers at ground level stubbed out Marlboros and discussed how hard it was to quit, leading tobacco control organisations were shocked to hear that the new organisation was funded with a $1 billion, twelve-year commitment from tobacco company Philip Morris International (PMI). PMI, which has been working for decades to rebrand itself as a ‘socially responsible’ company while continuing to promote sales of its top-branded Marlboro cigarettes and oppose policies that would genuinely reduce their use, clearly believes this...

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Worldwide news and comment

October 24, 2017 - 4:34am

In this issue, we look at reactions to the Philip Morris International (PMI) initiative ‘Foundation for a Smoke-Free World’. It is fitting to recall a quote from Robert Kennedy in his address to the first World Conference on Smoking and Health (as it was then called), held in New York in 1967, and sobering to realise these words are as applicable today as they were then:

The cigarette industry is peddling a deadly weapon. It is dealing in people’s lives for financial gain. The industry we seek to regulate is powerful and resourceful. Each new effort to regulate will bring new ways to evade. Still we must be equal to the task, for the stakes involved are nothing less than the lives and the health of millions of people around the world. But this is a battle that can and will be won.

We also examine new developments in...

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Australia's plain tobacco packs: anticipated and actual responses among adolescents and young adults 2010-2013

October 24, 2017 - 4:34am
Background

In December 2012, Australia introduced world-first legislation mandating plain packaging for all tobacco products. To date, there is very little evidence on youth responses to the changed packs.

Aim

To assess attitudes towards, and responses to, tobacco plain packs preimplementation and postimplementation.

Methods

The Tobacco Promotion Impact Study (TPIS) was a yearly cross-sectional telephone survey of adolescents and young adults (12–24 years) from the states of New South Wales (NSW) and Queensland, conducted at three time points preimplementation (June 2010; June 2011; June 2012) and one time point postimplementation (June 2013; total n=8820).

Results

There were significant increases in support for plain packaging from preimplementation to postimplementation for: never smokers (56% in 2012 vs 63% in 2013; OR=0.77, 95% CI 0.65 to 0.90, p=0.001), experimenters/ex-smokers (55% in 2012 vs 72% in 2013; OR=0.51, 95% CI 0.38 to 0.68, p<0.001) and current smokers (35% in 2012 vs 55% in 2013; OR=0.49, 95% CI 0.32 to 0.75, p=0.001). At postimplementation, 18% of never smokers reported that plain packaging made them less likely to try smoking and 16% of experimenters/ex-smokers reported that plain packaging made them less likely to smoke again. Youth were significantly less likely to have anticipated these responses preimplementation (never smokers: 8% in 2011; OR=0.43, 95% CI 0.28 to 0.65, p<0.00; experimenters/ex-smokers: 11%; OR=0.65, 95% CI 0.52 to 0.82, p<0.001). At postimplementation, 34% of smokers reported a quitting-related response to plain packaging (tried to quit or thought about quitting); the proportion who anticipated such a response preimplementation was significantly less (14% in 2011; OR=0.33, 95% CI 0.20 to 0.53, p<0.001). 28% of smokers reported a social denormalisation response at postimplementation (hid their pack from view, used a case to cover their pack, felt embarrassed); the proportion who anticipated such a response preimplementation was significantly less (9% in 2011; OR=0.24, 95% CI 0.14 to 0.42, p<0.001).

Conclusions

The actual response of youth to plain packaging was greater than anticipated prior to their introduction, and support for plain packaging increased from preimplementation to postimplementation among all groups of youth. Jurisdictions planning to implement plain tobacco packaging should be encouraged by these findings.

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Change in public support for the introduction of plain packaging and new, enlarged graphic health warnings in the Australian state of Victoria, 2011-2013

October 24, 2017 - 4:34am
Introduction

Since December 2012, all Australian tobacco products have been supplied in packaging that is a standardised drab brown colour with uniform fonts. The implementation of plain packaging coincided with the introduction of refreshed graphic health warnings (GHWs) that increased in size from 30% to 75% of the pack face, with coverage of the pack rear maintained at 90%.1

A slight rise in opposition to plain packaging among Australian smokers was reported immediately prior to implementation, followed by a significant increase in support, from 28% preimplementation (late 2011 to early 2012) to 49% postimplementation (early 2013).2 No data on the views of former or never smokers have previously been published.

Methods

We undertook cross-sectional telephone surveys in November and early December of 2011, 2012 and 2013 with representative samples of adults who reside within the Australian State of Victoria. The sample frames...

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Analysis of the logic and framing of a tobacco industry campaign opposing standardised packaging legislation in New Zealand

October 24, 2017 - 4:34am
Background

The tobacco industry routinely opposes tobacco control policies, often using a standard repertoire of arguments. Following proposals to introduce standardised packaging in New Zealand (NZ), British American Tobacco New Zealand (BATNZ) launched the ‘Agree–Disagree’ mass media campaign, which coincided with the NZ government's standardised packaging consultations. This study examined the logic of the arguments presented and rhetorical strategies employed in the campaign.

Methods

We analysed each advertisement to identify key messages, arguments and rhetorical devices, then examined the arguments' structure and assessed their logical soundness and validity.

Results

All advertisements attempted to frame BATNZ as reasonable, and each contained flawed arguments that were either unsound or based on logical fallacies. Flawed arguments included misrepresenting the intent of the proposed legislation (straw man), claiming standardised packaging would harm all NZ brands (false dilemma), warning NZ not to adopt standardised packaging because of its Australian origins (an unsound argument) or using vague premises as a basis for claiming negative outcomes (equivocation).

Conclusions

BATNZ's Agree–Disagree campaign relied on unsound arguments, logical fallacies and rhetorical devices. Given the industry's frequent recourse to these tactics, we propose strategies based on our study findings that can be used to assist the tobacco control community to counter industry opposition to standardised packaging. Greater recognition of logical fallacies and rhetorical devices employed by the tobacco industry will help maintain focus on the health benefits proposed policies will deliver.

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Costs, revenues and profits: an economic analysis of smallholder tobacco farmer livelihoods in Malawi

October 24, 2017 - 4:34am
Background

The preservation of the economic livelihood of tobacco farmers is a common argument used to oppose tobacco control measures. However, little empirical evidence exists about these livelihoods. We seek to evaluate the economic livelihoods of individual tobacco farmers in Malawi, including how much money they earn from selling tobacco, and the costs they incur to produce the crop, including labour inputs. We also evaluate farmers' decisions to contract directly with firms that buy their crops.

Methods

We designed and implemented an economic survey of 685 tobacco farmers, including both independent and contract farmers, across the 6 main tobacco-growing districts. We augmented the survey with focus group discussions with subsets of respondents from each region to refine our inquiries.

Results

Contract farmers cultivating tobacco in Malawi as their main economic livelihoods are typically operating at margins that place their households well below national poverty thresholds, while independent farmers are typically operating at a loss. Even when labour is excluded from the calculation of income less costs, farmers' gross margins place most households in the bottom income decile of the overall population. Tobacco farmers appear to contract principally as a means to obtain credit, which is consistently reported to be difficult to obtain.

Conclusions

The tobacco industry narrative that tobacco farming is a lucrative economic endeavour for smallholder farmers is demonstrably inaccurate in the context of Malawi. From the perspective of these farmers, tobacco farming is an economically challenging livelihood for most.

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Cross-country comparison of smokers&#039; reasons for thinking about quitting over time: findings from the International Tobacco Control Four Country Survey (ITC-4C), 2002-2015

October 24, 2017 - 4:34am
Objective

To explore between-country differences and within-country trends over time in smokers' reasons for thinking about quitting and the relationship between reasons and making a quit attempt.

Methods

Participants were nationally representative samples of adult smokers from the UK (N=4717), Canada (N=4884), the USA (N=6703) and Australia (N=4482), surveyed as part of the International Tobacco Control Four Country Survey between 2002 and 2015. Generalised estimating equations were used to evaluate differences among countries in smokers' reasons for thinking about quitting and their association with making a quit attempt at follow-up wave.

Results

Smokers' concern for personal health was consistently the most frequently endorsed reason for thinking about quitting in each country and across waves, and was most strongly associated with making a quit attempt. UK smokers were less likely than their counterparts to endorse health concerns, but were more likely to endorse medication and quitline availability reasons. Canadian smokers endorsed the most reasons, and smokers in the USA and Australia increased in number of reasons endorsed over the course of the study period. Endorsement of health warnings, and perhaps price, appears to peak in the year or so after the change is introduced, whereas other responses were not immediately linked to policy changes.

Conclusions

Differences in reasons for thinking about quitting exist among smokers in countries with different histories of tobacco control policies. Health concern is consistently the most common reason for quitting and the strongest predictor of future attempts.

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Public health benefits from pictorial health warnings on US cigarette packs: a SimSmoke simulation

October 24, 2017 - 4:34am
Introduction

While many countries have adopted prominent pictorial warning labels (PWLs) for cigarette packs, the USA still requires only small, text-only labels located on one side of the cigarette pack that have little effect on smoking-related outcomes. Tobacco industry litigation blocked implementation of a 2011 Food and Drug Administration's (FDA) rule requiring large PWLs. To inform FDA action on PWLs, this study provides research-based estimates of their public health impacts.

Methods

Literature was reviewed to identify the impact of cigarette PWLs on smoking prevalence, cessation and initiation. Based on this analysis, the SimSmoke model was used to estimate the effect of requiring PWLs in the USA on smoking prevalence and, using standard attribution methods, on smoking-attributable deaths (SADs) and key maternal and child health outcomes.

Results

Available research consistently shows a direct association between PWLs and increased cessation and reduced smoking initiation and prevalence. The SimSmoke model projects that PWLs would reduce smoking prevalence by 5% (2.5%–9%) relative to the status quo over the short term and by 10% (4%–19%) over the long term. Over the next 50 years, PWLs are projected to avert 652 800 (327 000–1 190 500) SADs, 46 600 (17 500–92 300) low-birth-weight cases, 73 600 (27 800–145 100) preterm births and 1000 (400–2000) cases of sudden infant death syndrome.

Conclusions

Requiring PWLs on all US cigarette packs would be appropriate for the protection of the public health, because it would substantially reduce smoking prevalence and thereby reduce SADs and the morbidity and medical costs associated with adverse smoking-attributable birth outcomes.

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Decrease in mortality rate and hospital admissions for acute myocardial infarction after the enactment of the smoking ban law in Sao Paulo city, Brazil

October 24, 2017 - 4:34am
Background

Smoking restriction laws have spread worldwide during the last decade. Previous studies have shown a decline in the community rates of myocardial infarction after enactment of these laws. However, data are scarce about the Latin American population. In the first phase of this study, we reported the successful implementation of the law in São Paulo city, with a decrease in carbon monoxide rates in hospitality venues.

Objective

To evaluate whether the 2009 implementation of a comprehensive smoking ban law in São Paulo city was associated with a reduction in rates of mortality and hospital admissions for myocardial infarction.

Methods

We performed a time-series study of monthly rates of mortality and hospital admissions for acute myocardial infarction from January 2005 to December 2010. The data were derived from DATASUS, the primary public health information system available in Brazil and from Mortality Information System (SIM). Adjustments and analyses were performed using the Autoregressive Integrated Moving Average with exogenous variables (ARIMAX) method modelled by environmental variables and atmospheric pollutants to evaluate the effect of smoking ban law in mortality and hospital admission rate. We also used Interrupted Time Series Analysis (ITSA) to make a comparison between the period pre and post smoking ban law.

Results

We observed a reduction in mortality rate (–11.9% in the first 17 months after the law) and in hospital admission rate (–5.4% in the first 3 months after the law) for myocardial infarction after the implementation of the smoking ban law.

Conclusions

Hospital admissions and mortality rate for myocardial infarction were reduced in the first months after the comprehensive smoking ban law was implemented.

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Social disparities in children&#039;s exposure to secondhand smoke in privately owned vehicles

October 24, 2017 - 4:34am
Introduction

Secondhand smoke (SHS) can quickly attain high concentrations in cars, posing health risks to passengers and especially to children. This paper assesses whether there are social disparities in children's exposure to SHS in privately owned vehicles.

Methods

On weekday mornings and afternoons from September to November 2011, trained observers were stationed at 100 selected street intersections in Montreal, Canada. For each car transporting at least one passenger aged 0–15 years travelling through the intersection, observers recorded the estimated age of the youngest child in the car, whether any occupant was smoking and the licence plate number of the car. Licence plate numbers were linked to an area material deprivation index based on the postal code of the neighbourhood in which the car was registered.

Results

Smoking was observed in 0.7% of 20 922 cars transporting children. There was an apparent dose–response in the association between area material deprivation level and children's exposure to SHS in cars. Children travelling in cars registered in the most disadvantaged areas of Montreal were more likely to be exposed to SHS than children travelling in cars registered in the most advantaged areas (unadjusted OR=3.46, 95% CI 1.99 to 6.01).

Conclusions

This study revealed social disparities in children's exposure to SHS in privately owned vehicles.

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Smoking as an &#039;informed choice: implications for endgame strategies

October 24, 2017 - 4:34am
Objective

Tobacco companies often assert that adults should be free to make an ‘informed choice’ about smoking; this argument influences public perceptions and shapes public health policy agendas by promoting educative interventions ahead of regulation. Critically analysing ‘informed choice’ claims is pivotal in countries that have set endgame goals and require new, more effective policies to achieve their smoke-free aims.

Methods

In-depth interviews with 15 New Zealand politicians, policy analysts and tobacco control advocates examined how they interpreted ‘informed choice’ arguments. We used a thematic analysis approach to review and explicate interview transcripts.

Results

Participants thought ‘informed choice’ implied that people make an active decision to smoke, knowing and accepting the risks they face; they rejected this assumption and saw it as a cynical self-justification by tobacco companies. Some believed this rhetoric had countered calls for stronger policies and thought governments used ‘informed choice’ arguments to support inaction. Several called on the government to stop allowing a lethal product to be widely sold while simultaneously advising people not to use it.

Conclusions

‘Informed choice’ arguments allow the ubiquitous availability of tobacco to go unquestioned and create a tension between endgame goals and the strategies used to achieve these. Reducing tobacco availability would address this anomaly by aligning government's actions with its advice.

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Hazards of cigarettes, smokeless tobacco and waterpipe in a Middle Eastern Population: a Cohort Study of 50 000 individuals from Iran

October 24, 2017 - 4:34am
Background

There is limited information about the hazards of cigarettes, smokeless tobacco and waterpipe in the Middle East. The aim of this study was to determine the association between different types of tobacco use and earlier death in the Golestan Cohort Study.

Methods

The Study includes 50 045 adults (aged 40–75 years) from north eastern Iran. The baseline questionnaire (2004–2008) assessed information about use of cigarettes, chewing tobacco (nass) and waterpipe. To assess the use of each type of tobacco compared with never tobacco users, we used Cox regression models adjusted for age, socioeconomic status, area of residence, education and other tobacco used, and stratified by sex, ethnicity and opium use.

Results

17% of participants reported a history of cigarette smoking, 7.5% chewing tobacco (nass) and 1.1% smoking waterpipe, and these figures declined in the later birth cohorts. During a median follow-up of 8 years, 4524 deaths occurred (mean age 64.8+9.9 years). Current (HR=1.44; 95% CI 1.28 to 1.61) and former (HR=1.35; 95% CI 1.16 to 1.56) cigarette smokers had higher overall mortality relative to never tobacco users. The highest cigarette-associated risk was for cancer death among current heavy smokers (HR=2.32; 95% CI 1.66 to 3.24). Current nass chewing was associated with overall mortality (HR=1.16; 95% CI 1.01 to 1.34), and there was a 61% higher risk of cancer death in people chewing nass more than five times a day. We observed an association between the cumulative lifetime waterpipe use (waterpipe-years≥28) and both overall (HR=1.66; 95% CI 1.11 to 2.47), and cancer mortality (HR=2.82; 95% CI 1.30 to 6.11).

Conclusions

Regular use of cigarettes, smokeless tobacco and waterpipe were associated with the risk of earlier death (particularly from cancer) in our cohort.

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Analysing user-reported data for enhancement of SmokefreeTXT: a national text message smoking cessation intervention

October 24, 2017 - 4:34am
Objective

This observational study highlights key insights related to participant engagement and cessation among adults who voluntarily subscribed to the nationwide US-based SmokefreeTXT program, a 42-day mobile phone text message smoking cessation program.

Methods

Point prevalence abstinence rates were calculated for subscribers who initiated treatment in the program (n=18 080). The primary outcomes for this study were treatment completion and point prevalence abstinence rate at the end of the 42-day treatment. Secondary outcomes were point prevalence abstinence rates at 7 days postquit, 3 months post-treatment and 6 months post-treatment, as well as response rates to point prevalence abstinence assessments.

Results

Over half the sample completed the 42-day treatment (n=9686). The end-of-treatment point prevalence abstinence for subscribers who initiated treatment was 7.2%. Among those who completed the entire 42 days of treatment, the end-of-treatment point prevalence abstinence was 12.9%. For subscribers who completed treatment, point prevalence abstinence results varied: 7 days postquit (23.7%), 3 months post-treatment (7.3%) and 6 months post-treatment (3.7%). Response rates for abstinence assessment messages ranged from 4.36% to 34.48%.

Conclusions

Findings from this study illuminate the need to more deeply understand reasons for subscriber non-response and opt out and, in turn, improve program engagement and our ability to increase the likelihood for participants to stop smoking and measure long-term outcomes. Patterns of opt out for the program mirror the relapse curve generally observed for smoking cessation, thus highlighting time points at which to increase efforts to retain participants and provide additional support or incentives.

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Children&#039;s exposure to secondhand smoke at home before and after smoke-free legislation in Taiwan

October 24, 2017 - 4:34am
Introduction

In January 2009, Taiwan broadened smoke-free legislation, requiring mass transportation systems, indoor public areas and indoor workplaces with 3 or more people, to become smoke-free. We investigated the secondhand smoke (SHS) exposure at home for children aged 3–11 years in Taiwan before and after the implantation of the legislation.

Methods

We studied 7911 children from the 2005, 2009 and 2013 National Health Interview Surveys (cross-sectional, nationally representative household surveys). Logistic regression modelling estimated adjusted ORs (AOR) and 95% CIs for children's SHS exposure at home in 2009 and 2013 (2005 as reference) for the overall sample and for each category of household socioeconomic status (SES) and household composition.

Results

Prevalence of children SHS exposure at home decreased from 51% (2005) to 32% (2009) and 28% (2013). Compared to 2005, children in 2009 and 2013 had lower likelihoods of SHS exposure at home with AOR of 0.45 (95% CI 0.41 to 0.51) and 0.41 (95% CI 0.36 to 0.46), respectively. All children had reduced SHS exposure at home after the legislation, irrespective of household SES and compositions. Low household income, low parental education level, living with grandparents or living with other adults was individually associated with increased SHS exposure.

Discussion

The proportion of children exposed to SHS at home in Taiwan declined substantially from 2005 to 2009 after smoke-free legislation, and fell further by 2013, irrespective of SES and household compositions. Still, inequality in SHS exposure at home by SES and household composition warrants future research.

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Childhood secondhand smoke exposure and pregnancy loss in never smokers: the Guangzhou Biobank Cohort Study

October 24, 2017 - 4:34am
Objective

Studies of secondhand smoke (SHS) exposure especially childhood SHS exposure and pregnancy loss are limited. We used baseline data of the Guangzhou Biobank Cohort Study (GBCS) to examine the association of childhood SHS exposure with a history of pregnancy loss.

Methods

Never smoking women aged 50 years or above in GBCS from 2003 to 2008 were included. Propensity score matching (PSM) was used to control for confounding. Negative binomial regression and logistic regression were used to examine the association of childhood SHS, assessed by number of smokers in childhood household and frequency of exposure, with past pregnancy loss.

Results

Of 19 562 women, 56.7% (11 096) had SHS exposure during childhood. In negative binomial regression, after adjusting for age, education, past occupational dust exposure, past home fuel exposure, oral contraceptive, adulthood SHS exposure, age at first pregnancy and age at first menarche, compared to non-exposure, the incidence rate ratio of one more pregnancy loss was 1.20 (95% CI1.05 to 1.37) in those who lived with ≥2 smokers in the same household, and 1.14 (95% CI 1.04 to 1.25) in those exposed ≥5 times/week. After similar adjustment, logistic regression showed that the OR of pregnancy loss ≥2 times (versus 0 to 1 time) was 1.25 (95% CI 1.00 to 1.57) and 1.20 (95% CI 1.03 to 1.40) for high density (≥2 smokers in the same household) and frequency (≥5 times/week) of childhood exposure, respectively.

Conclusions

Childhood SHS exposure was associated with higher risks of pregnancy loss in middle-aged and older Chinese women.

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Uniform rate of cigarette excise under GST in India

October 24, 2017 - 4:34am
Objective

The Government of India's plan to implement a Goods and Services Tax (GST) is a major step towards a modern tax system. It will be important from a public health and fiscal perspective that GST is at least ‘revenue neutral’ with respect to tobacco taxation. In this paper, we calculate revenue neutral central excise rates on cigarettes under different GST scenarios, including the GST Committee's recommended 40% demerit rate.

Methods

We use the WHO Tax Simulation model to estimate total tax revenues from cigarettes in financial year (FY) 2016–2017. This revenue outcome was increased by 5% to set an inflation-adjusted revenue neutral target for FY 2017–2018. We then introduce GST together with a uniform excise on cigarettes to generate this target amount of tax revenue.

Findings

We estimate that tax revenue from cigarettes will amount to Rupees (INR) 368 billion in FY 2016–2017 (INR 149 billion in Value Added Tax and INR 219 billion in excise). The revenue neutral target for FY 2017–2018 is therefore INR 388 billion. If India were to adopt a 40% GST rate on tobacco in FY 2017–2018, then a uniform excise of INR 2225 per 1000 cigarette sticks would be required to generate the target amount of total tax revenue.

Conclusions

The implementation of GST is a golden opportunity for India to adopt best practices in related areas of taxation. A uniform excise on cigarettes as described here would be an essential component of an efficient and effective tax system for India.

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Impact of non-menthol flavours in tobacco products on perceptions and use among youth, young adults and adults: a systematic review

October 24, 2017 - 4:34am
Objective

This systematic review examines the impact of non-menthol flavours in tobacco products on tobacco use perceptions and behaviours among youth, young adults and adults.

Data sources

English-language peer-reviewed publications indexed in 4 databases were searched through April 2016.

Study selection

A search strategy was developed related to tobacco products and flavours. Of 1688 articles identified, we excluded articles that were not English-language, were not peer-reviewed, were qualitative, assessed menthol-flavoured tobacco products only and did not contain original data on outcomes that assessed the impact of flavours in tobacco products on perceptions and use behaviour.

Data extraction

Outcome measures were identified and tabulated. 2 researchers extracted the data independently and used a validated quality assessment tool to assess study quality.

Data synthesis

40 studies met the inclusion criteria. Data showed that tobacco product packaging with flavour descriptors tended to be rated as more appealing and as less harmful by tobacco users and non-users. Many tobacco product users, especially adolescents, reported experimenting, initiating and continuing to use flavoured products because of the taste and variety of the flavours. Users of many flavoured tobacco products also showed decreased likelihood of intentions to quit compared with non-flavoured tobacco product users.

Conclusions

Flavours in most tobacco products appear to play a key role in how users and non-users, especially youth, perceive, initiate, progress and continue using tobacco products. Banning non-menthol flavours from tobacco products may ultimately protect public health by reducing tobacco use, particularly among youth.

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Use of new media to support passage of Vietnam&#039;s national tobacco control legislation

October 24, 2017 - 4:34am
Background

In November 2012, the National Assembly (NA) of Vietnam passed the country's first comprehensive tobacco control legislation.1 Following guidelines of the Framework Convention on Tobacco Control, the legislation was implemented from 1 May 2013 and included smoke-free public places, graphic pack warnings, increased taxes on cigarettes and establishment of a sustainable health promotion fund.1 This public health landmark resulted from a large-scale, long-term policy, advocacy and communication effort, which included the campaign described here. The effort was conducted by the Government of Vietnam and local and international non-governmental organisations, and coordinated by the Vietnam Standing Committee on Smoking and Health (VINACOSH).

In May to June 2012, directly leading up to the NA's vote on the tobacco control law, World Lung Foundation (now Vital Strategies) and VINACOSH developed and implemented a tobacco control mass media campaign to educate the public about the harms of...

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FDAs new plan to reduce the nicotine in cigarettes to sub-addictive levels could be a game-changer

August 22, 2017 - 9:23am

On 28 July 2017, US Food and Drug Administration (FDA) Chief Scott Gottlieb, MD, announced a bold new plan to limit the nicotine allowed in manufactured cigarettes.1 Gottlieb, a Trump appointee revealing C Everett Koop-like potential, pointed out that cigarettes remain the leading preventable cause of death in the USA, killing nearly half a million Americans every year.2 But of course it is the nicotine in cigarettes—kept above some crucial level and potency—that keeps people smoking and ultimately leads to disease, death and the suffering of families. Gottlieb did not specify a level below which nicotine would have to be lowered, but he did say it would have to render cigarettes ‘minimally or non-addictive’.

Gottlieb’s announcement caused a panic on Wall Street, where cigarette stocks took a plunge not seen for decades. Altria’s market value was briefly down nearly 20%, and other cigarette makers suffered significant losses....

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Die Another Day, James Bond&#039;s smoking over six decades

August 22, 2017 - 9:23am

We aimed to examine smoking-related content in all 24 James Bond movies in the Eon Productions series from 1962 to 2015. There were favourable downward trends for any smoking by James Bond (p=0.015 for trend), and for tobacco-related spy-gadgetry (p=0.009). Around 20% of Bond's 60 sexual partners smoked in each decade, and most recently in 2012. There were regular mentions of smoking risks to health (starting from 1967) and product placement of branded packs was present in two movies. Overall, the persisting smoking content remains problematic from a public health perspective, especially given the popularity of this movie series.

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