New Tobacco Products Threaten Efforts to Increase Consumer Demand for Cessation Products and Services

As smoking rates continue to decline and more states and localities implement smoke-free policies, the tobacco industry is responding by developing new products to entice new users and discourage quitting. Tobacco products are being manufactured in more flavors and forms and are being marketed with more unproven health claims than ever before. These new products are making it increasingly difficult for the tobacco control community to increase consumer demand for tobacco cessation products and services.

A recent report details some of these new products and describes how tobacco manufacturers take advantage of the lack of government regulation to recruit new users, create and sustain addiction to nicotine, and discourage current users from quitting. This report, "Big Tobacco's Guinea Pigs: How an Unregulated Industry Experiments on America's Kids and Consumers," was jointly issued by NTCC members the American Cancer Society Cancer, American Lung Association and Campaign for Tobacco-Free Kids, with funding from the Robert Wood Johnson Foundation.

New, Flavored Tobacco Products

In recent years, tobacco companies have significantly increased the introduction and marketing of flavored products. Cigarettes, smokeless tobacco products, and so-called "little cigars" have been introduced in a variety of candy, fruit, and alcohol flavors that mask the harshness of the products and make them more appealing to youth.

R.J. Reynolds' Camel products come in more than a dozen flavors, including Twista Lime, Kauai Kolada, Warm Winter Toffee and Winter Mocha Mint, and alcohol-flavors like ScrewDriver Slots, Blackjack Gin and SnakeEyes Scotch. Flavors and product modifications not only make the product more appealing to new smokers, including youth, but often produce additional carcinogens.

Products with Increased Nicotine Levels and New Products to Sustain Addiction

Tobacco companies have been trying to maintain addiction among smokers and addict a new generation of smokers by increasing nicotine levels in their products. Reports from the Massachusetts Department of Public Health and the Harvard School of Public Health have documented an increase in nicotine levels in cigarettes in recent years.

As smoking rates have declined and a growing number of states and localities have enacted smoke-free laws, tobacco companies have also expanded smokeless tobacco to other forms, including teabag-like pouches and even dissolvable tablets of tobacco, some of which do not require users to spit. In many instances, these products are marketed as ways for smokers to sustain their addiction when smokers cannot smoke, thereby providing a disincentive for smokers to quit.

New Products with Unproven Health Claims

As smokers grow concerned about health risks and consider quitting, tobacco companies are introducing new products that are being marketed with unproven and misleading claims, including that these products are less harmful than traditional cigarettes. These so called "reduced risk" products have slogans like, "All of the taste…Less of the toxins" and "Reduced carcinogens. Premium taste." These claims can discourage smokers from quitting, and possibly entice former smokers or those who have never smoked.

Designing Products to Increase Consumer Demand

Tobacco companies are well aware of the critical role that product design and marketing play in attracting and retaining smokers. This same product design and marketing savvy is critical to the successful implementation of tobacco cessation products and services. Two of the six consumer demand core strategies, addressed in NTCC's 6 Core Strategies for Increasing the Use of Evidence-Based Tobacco Cessation Treatment Report, specifically address this important issue. These are:

• Redesign evidence-based products and services to better meet consumers' needs and wants
• Market and promote cessation products and services in ways that reach smokers, especially underserved smokers, where they are. NTCC aims to support the development of innovative strategies to increase the demand for and use of evidence-based tobacco cessation products and services.

NTCC developed the publication, Consumer Demand Design Principles: 8 IDEO Design Principles and is planning a journal supplement to the American Journal of Public Health in spring 2009 to promote the consumer demand concepts and related research to a wider audience.

For more information and to access the report, "Big Tobacco's Guinea Pigs: How an Unregulated Industry Experiments on America's Kids and Consumers," please visit http://www.tobaccofreekids.org/reports/products/index.php#downloadable_resources.

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Secondhand Smoke Linked to Peripheral Artery Disease in Women

Secondhand smoke significantly increased the risk of women developing peripheral artery disease (PAD) in a Chinese study, researchers reported in Circulation: Journal of the American Heart Association.

In a population-based study of 1,209 women in Beijing, China, researchers found a 67 percent increased risk of PAD in those exposed to secondhand smoke compared to those who were not exposed. The women were 60 years and older and had never smoked. Of these women, 39.5 percent were exposed to secondhand smoke at home or in the workplace.

Secondhand smoke exposure was defined as exposure to another person’s tobacco smoke for at least 15 minutes daily for more than one day every week for at least two years during the past 10 years.

Researchers also found the risk of ischemic stroke increased by 56 percent, while the risk of coronary heart disease (CHD) increased by 69 percent compared to those who were never exposed to secondhand smoke.

“This study broadens the finding about the detrimental health effects of passive smoking on heart disease and stroke,” said Frank Hu, M.D., Ph.D., the study’s senior author and professor of nutrition and epidemiology at the Harvard School of Public Health in Boston, MA.

Hu noted that most studies have shown the adverse effects of both active and passive smoking are not much different in western and Asian populations. Hu suggested that men are likely to have the same deleterious effects from exposure to secondhand smoke as women, although that conclusion cannot be reached from this study.

For more information, see web link:
American Heart Association News Release September 23, 2008

Researchers Profile Teens Who Seek Help to Quit Smoking

Teen smokers who volunteer for programs to help them quit are more hooked on tobacco than other teens who smoke, new West Virginia University research has found. The teens believe quitting is a good idea, but they aren't fully confident they'll be able to kick the tobacco habit.

What's more, teens who volunteer for help are 60 percent more likely to use smokeless tobacco and more than 200 percent more likely to smoke cigars when compared with teen smokers nationally.

The conclusions, published in the journal Tobacco Induced Diseases, come from analysis of data involving almost 6,000 teen smokers who enrolled in Not On Tobacco (N-O-T) between 1998 and 2006. Developed at WVU, N-O-T is the most widely used smoking-cessation program for teens in the nation.

"This is the first time anyone has looked at the characteristics of teens who've joined the school-based N-O-T programs," said Kimberly Horn, Ed.D., lead author of the study. "Knowing more about these students will help us to tailor and market the program. N-O-T has reached thousands of teens, but we can do better."

The study, in highlighting which teen smokers join the program, also will help researchers understand who is not joining. It is important to come up with ways to better entice those missing teens to show up, Horn said.

Researchers may need to develop better motivational messages to reach young pack-a-day smokers who've been hooked for years - such as teens in this study - messages presenting facts about addiction but also building confidence that the teens can be successful at quitting.

"The earlier a teen began smoking, the greater was his or her level of nicotine dependence," Horn said. "The N-O-T teens were not experimental smokers. They were moderately to highly nicotine dependent."

By contrast, previous studies have classified about 80 percent of teen smokers as having low or very low levels of nicotine dependence, Horn said. "We now have strong evidence to show that teens get addicted - quickly."

Horn is director of the Translational Tobacco Reduction Research Program (T2R2), a joint effort of WVU's Mary Babb Randolph Cancer Center and the West Virginia Prevention Research Center.

Almost all N-O-T teens had important people in their social networks who smoke - namely, parents, siblings, friends and boyfriends or girlfriends. "Interestingly, teens reported that parents were less likely to support quitting than were friends," Horn said.

Researchers from the WVU Departments of Psychology, Community Medicine, and Pharmaceutical Systems and Policy collaborated with Horn on the study. Developed by Horn and Geri Dino, Ph.D., director of the Prevention Research Center at WVU, Not On Tobacco is a school-based program that uses small-group settings to teach teens skills in stress management and stimulus control. The young smokers keep a journal as they learn about social influences and relapse prevention. The self-esteem boosting 10 weekly sessions are led by a facilitator who can be a teacher, counselor, school nurse or other trained staff.

For more information, see web link:
MarketWatch September 19, 2008

New Brain Imaging Shows Effects of Withdrawal on Smokers

New research highlighted at a symposium during an annual meeting for family physicians shows how nicotine withdrawal creates functional changes in the brains of smokers trying to quit causing cognitive performance deficits (such as ability to concentrate) that may make it more difficult to quit, and could be a driver of smoking relapse. Further, brain imaging technology shows that when treatment with the Commit® 4 mg nicotine lozenge is introduced, these symptoms of nicotine withdrawal can be reversed. This information is helping physicians better understand addiction and how treatment can help.

"The new research provides powerful new evidence as to why physicians need to intervene and help their patients understand and manage symptoms to help them quit successfully," said Dr. C. Everett Koop, former U.S. Surgeon General. "Physicians should use these new data as reasons to speak with their patients to help them better understand their addiction, including the serious impact of withdrawal and how proven treatments can help reverse nicotine withdrawal symptoms that impact the brain."

Data from two similar studies were highlighted at the symposium. The studies reviewed the impact of nicotine withdrawal on the brain and demonstrated that the Commit 4 mg nicotine lozenge can significantly help reverse nicotine withdrawal symptoms associated with quitting smoking.

Specific areas in the brain, particularly those associated with executive functioning, are impacted during nicotine withdrawal. The Commit 4 mg nicotine lozenge significantly improved cognitive performance compared to placebo and lessened symptoms of withdrawal including craving, difficulty concentrating, irritability and restlessness. Other nicotine withdrawal symptoms including short-term memory deficit, and selective and divided attention deficits were also significantly reduced.

"In withdrawal, a smoker's brain is literally in dysfunction and this can impair the quitter's ability to think and act," said Dr. Jack Henningfield, Professor in the Department of Psychiatry and Behavioral Sciences at Johns Hopkins University School of Medicine and Vice President of Research and Health Policy at Pinney Associates and consultant to GlaxoSmithKline (GSK) Consumer Healthcare. "Research on the brain in withdrawal is important as it helps physicians and smokers trying to quit recognize and manage the symptoms. For smokers who experience withdrawal and can't afford lapse in concentration or judgment, FDA-approved medicines for smoking cessation such as the Commit 4 mg nicotine lozenge may make the difference between success and failure in their smoking cessation efforts."

For more information, see web link:
EurekAlert September 19, 2008

Disparities in Secondhand Smoke Exposure—United States, 1988-1994 and 1999-2004

In the United States, exposure to secondhand smoke (SHS) declined approximately 70 percent from the late 1980s through 2002, most likely reflecting widespread implementation of laws and policies prohibiting smoking in indoor workplaces and public places during this period. Although the major sources of SHS exposure for nonsmoking adults are the home and workplace, the primary source of SHS exposure for children is the home; therefore, eliminating smoking in workplaces and public places is less likely to reduce children's exposure to SHS. A recent report published in the Journal of the American Medical Association examines changes in the prevalence of self-reported SHS exposure at home and changes in any exposure, as measured by serum cotinine (a biologic indicator of SHS exposure), in nonsmoking children, adolescents, and adults.

The analysis was conducted using data from the 1988-1994 and 1999-2004 National Health and Nutrition Examination Surveys (NHANES). The results indicated that self-reported SHS exposure at home and SHS exposure as measured by serum cotinine declined significantly (by 51.2 percent and 44.7 percent, respectively) in the U.S. population from 1988-1994 to 1999-2004; however, the decline was smaller for persons aged 4-11 years and 12-19 years. These results underscore the need to continue surveillance of SHS exposure and to focus on strategies to reduce children's SHS exposure.

The percentage of the U.S. nonsmoking population aged =4 years with self-reported home SHS exposure declined from 20.9 percent in 1988-1994 to 10.2 percent in 1999-2004. Similarly, the percentage of the nonsmoking population with detectable serum cotinine declined significantly, from 83.9 percent in 1988-1994 to 46.4 percent in 1999-2004.

The percentage of nonsmokers with detectable serum cotinine was uniformly high for all age groups during 1988-1994. The percentage decreased for all age groups during 1999-2004, and remained highest for those aged 4-11 years (60.5 percent) and those aged 12-19 years (55.4 percent) compared with those aged =20 years (42.2 percent). The decline in the prevalence of detectable serum cotinine was 28.1 percent for those aged 4-11 years, 35.1 percent for those aged 12-19 years, and 49.5 percent for those aged =20 years.

Although the percentage decrease in home SHS exposure from 1988-1994 to 1999-2004 was seen for persons of all ages, it was smaller in children, especially those aged 4-11 years, compared with those aged =20 years. For SHS exposure in the home, the declines were 37.7 percent, 44.9 percent, and 59.8 percent among those aged 4-11 years, 12-19 years, and =20 years, respectively.

During both periods, prevalence of SHS exposure in the home was highest among non-Hispanic blacks and for persons with lower incomes. For both periods, self-reported home SHS exposure was not significantly different in males than in females, but a higher percentage of males had detectable serum cotinine than did females.

For more information, see web link:
Journal of the American Medical Association Vol. 300 No. 9, September 3, 2008

Newly-Defined Factors May Prevent Postpartum Smoking Relapse

Although many women quit smoking during pregnancy to protect their unborn children from the effects of cigarettes, half of them resume the habit within a few months of giving birth.

By shedding light on the factors that enable the other half to put down that cigarette for good, a study by researchers at the University of North Carolina at Chapel Hill could lead to programs designed to help women quit and stay quit.

According to the study, women with a live-in partner who shared some of the burden of child-rearing were more likely to remain smoke free, while women who were single mothers or who lacked the social and financial resources to deal with being a new parent were more likely to relapse.

The UNC study, which appears in the August issue of the journal Nicotine and Tobacco Research, is the first to examine not only the factors leading to relapse but also those leading to a smoke-free life after pregnancy. Researchers interviewed pregnant women attending prenatal clinics in central North Carolina who had quit smoking before 30 weeks gestation. Of the 94 women enrolled in the study, 43 had remained smoke-free and 51 had relapsed when interviewed at 4 months postpartum.

Researchers asked all women about their decision to quit during pregnancy, how they quit, and what they would do in the future.

Several factors emerged to differentiate the two groups of women. Those who remained smoke-free postpartum were bolstered by strong social support, strong internal belief systems, strong beliefs in postpartum health benefits of not smoking, negative experiences with a return to smoking and concrete strategies for dealing with temptations.

Women who relapsed postpartum were undermined by easy access to cigarettes, reliance on cigarettes to deal with stress, lack of financial resources, lack of resources for childrearing and low self-esteem.

The findings may enable researchers and clinicians to distinguish between pregnant women who will ultimately relapse from those that remain smoke free postpartum. The findings also suggest that any new programs aimed at improving quit rates must be comprehensive in nature – they must give women the tools to acquire new skills, deal with addiction and improve life circumstances, socially and financially.

This research was supported by a grant from the Smoke-Free Families Program of The Robert Wood Johnson Foundation. UNC Study co-authors include Dr. Adam O. Goldstein, professor of family medicine and Dr. Jacob A. Lohr, professor of pediatrics. Lohr is also affiliated with the Governor’s Institute on Alcohol and Substance Abuse, which collaborated on the study.

For more information, see web link:
The University of North Carolina Chapel Hill News Release August 27, 2008

Impact of Tobacco Control Policies and Mass Media Campaigns on Monthly Adult Smoking Prevalence

In a study published in a recent issue of the American Journal of Public Health, researchers found that increases in cigarette costliness and exposure to tobacco control media campaigns significantly reduced smoking prevalence.

Researchers sought to assess the impact of several tobacco control policies and televised antismoking advertising on adult smoking prevalence. They used a population survey in which smoking prevalence was measured each month from 1995 through 2006. Using time-series analysis, they assessed the effect on smoking prevalence of televised antismoking advertising (with gross audience rating points [GRPs] per month), cigarette costliness, monthly sales of nicotine replacement therapy (NRT) and bupropion, and smoke-free restaurant laws.

The researchers found that increases in cigarette costliness and exposure to tobacco control media campaigns significantly reduced smoking prevalence. They found a 0.3-percentage-point reduction in smoking prevalence by either exposing the population to televised antismoking ads an average of almost 4 times per month (390 GRPs) or by increasing the costliness of a pack of cigarettes by 0.03 percent of gross average weekly earnings. Monthly sales of NRT and bupropion, exposure to NRT advertising, and smoke-free restaurant laws had no detectable impact on smoking prevalence.

The researchers suggest that increases in the real price of cigarettes and tobacco control mass media campaigns broadcast at sufficient exposure levels and at regular intervals are critical for reducing population smoking prevalence.

For more information, see web link:
American Journal of Public Health Vol. 98 No. 8, August 2008

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As First Anniversary Approaches, Poll Finds Statewide Smoke-Free Law as Popular as Leading Minnesota Icons

A new survey released by ClearWay Minnesota(SM) found that as the October 1 anniversary of the statewide smoke-free law approaches, its popularity ranks high among some of Minnesota's leading icons. The survey found that an overwhelming 77 percent of Minnesotans support the statewide smoke-free law, with 41 percent indicating strong support. That compares to the popularity rating of walleye dinners (89 percent), Minnesota State Fair (86 percent), Minnesota Twins (83 percent), Minnesota Vikings (77 percent), Mall of America (69 percent) and State Fair Pronto Pups (69 percent). The survey also provides evidence of strong support for the statewide smoke-free law among all leading demographics, including geography, political and ideological affiliation, income, age and gender.

"One year after the smoke-free law went into effect, Minnesotans are happier than ever about it," said David Willoughby, Chief Executive Officer of ClearWay Minnesota.

Other key findings from the survey include:

• A decisive majority of Minnesotans -- 85 percent -- view secondhand smoke as a health hazard.
• By an overwhelming margin -- 86 to 11 percent -- Minnesotans believe that restaurants and bars are healthier for customers and employees now that they are smoke-free.
• Strong majorities in every part of the state support the smoke-free law (75 percent in the Twin Cities; 81 percent in the west metro; 80 percent in the east metro; 73 percent in northern Minnesota; and 79 percent in southern Minnesota).

In March, the University of Minnesota Cancer Center released a study confirming the immediate and positive health impacts of the statewide smoke- free law on bar and restaurant workers. The study found the workers had significantly reduced exposure to a tobacco-specific cancer-causing chemical found in secondhand smoke after the law's implementation.

"The Freedom to Breathe Act has been an unqualified success in its first year," said Willoughby. "Not only is it overwhelmingly popular with Minnesotans, but it has also improved the health of bar and restaurant workers."

To view complete survey results, visit http://www.clearwaymn.org.

For more information, see web link:
MarketWatch September 25, 2008

Underage Smoking in Virginia Drops

The number of children in Virginia who smoke cigarettes has plummeted in this decade, according to a statewide survey recently released.

The percentage of high school students in the state who smoke has declined from 29 percent in 2001 to 15.5 percent in 2007, according to the Virginia Tobacco Settlement Foundation. The state falls well below the national average of 19.2 percent.

"For a state like Virginia, which has been a tobacco-growing state, that is very, very impressive," Gov. Timothy M. Kaine said.

Kaine and other officials credit the Virginia Tobacco Settlement Foundation for spending millions of dollars on education, marketing and other programs to curb youth smoking.

The foundation provides grants to schools, nonprofit groups, and community- and faith-based organizations; advertises on radio, television and the Internet; gives research money to state universities, including George Mason University; and works with the state to determine whether retailers are selling tobacco to underage buyers.

Foundation officials claim to prevent 73,000 children each year from becoming smokers, which they say saves the state $1.25 billion in smoking-related health costs a year.

"We are thrilled that tobacco use among Virginia's youth continues to be on the decline," Foundation Executive Director Marty Kilgore said. "The [survey] shows that tobacco prevention works and that Virginia's kids are choosing healthy lifestyles. However, we must remain ever vigilant in our goal of eliminating underage smoking."

The percentage of middle school students in Virginia who smoke has declined from 11 percent in 2001 to 4.6 percent in 2007, according to the survey.

More than 2,600 public middle school and high school students were surveyed during the 2007-08 school year for the statewide study, conducted by the foundation, Virginia Commonwealth University and the Community Health Research Initiative. Students were asked about topics including tobacco use; accessibility of tobacco products; attitudes toward tobacco use and advertising; and other factors such as secondhand smoke exposure.

The survey also found that 7.6 percent of high school students and 2.5 percent of middle school students report using dip, chewing tobacco or snuff.

As part of a settlement agreement between 46 states and the nation's tobacco manufacturers in 1998, Virginia is expected to receive about $4 billion over 25 years. The foundation receives 10 percent of the money for prevention, and the rest is spent on economic development and health care in the state.

For more information, see web link:
Washington Post September 14, 2008

More Minnesota Smokers Kick the Habit, with Help

A statewide survey of tobacco use shows that 17 percent of adults smoke, down from 22.1 percent eight years before. Minnesota's steady downward trend is a sharp contrast to what has been happening nationally, where the average 20 percent of adults who smoke has not changed since 2004.

Minnesota has the fifth-lowest smoking rate in the country behind California, Utah, Massachusetts and Connecticut, according to the Centers for Disease Control and Prevention.

Reductions in smoking are difficult to achieve. The tobacco industry spends about $238 million a year in Minnesota marketing its products.

That compares to about $30 million a year spent on anti-tobacco efforts, health officials said. The state's spending may increase somewhat next year when a $47 million package of public health grants focused on obesity and tobacco is distributed across the state.

Health officials said that they expected the increase in the cost of cigarettes, as well as other policies, would lead to a drop in smoking, but were startled by some of the findings.

• Since 2003, the smoking rate among young adults dropped a whopping 8.4 points to 28.4 percent. But the rate among those who don't go to college didn't budge, remaining at 41 percent, the highest of any group and nearly twice that of their college-going peers.
• The 75 cent per pack tax passed by the state legislature in 2005 inspired 43 percent of smokers to think about quitting. More than a fourth tried to quit as a result of the tax and 6 percent of them succeeded.
• More than half of all smokers tried to quit in the last year. The rate of those who got help through counseling and medication increased from 3.6 percent four years ago to nearly 15 percent.
• 83 percent of Minnesotans live in homes where smoking is not allowed, up from 65 percent in 1999.

Overall, the survey documents the effectiveness of state-wide policies against smoking, officials said. That included the tobacco tax and widely available programs to help people quit smoking through counseling and medications.

Even people whose health plans don't cover cessation programs can get help for free from ClearWay's Quit Plan program. That is one aspect that makes Minnesota unusual compared to other states, even those such as California with long-standing smoking bans.

New Report Examines Tobacco Use Trends on Campuses

College students are falling victim to aggressive tobacco industry marketing tactics as one in five continue to smoke, according to a new report released by the American Lung Association.

The report provides a comprehensive overview of the current status of tobacco use and policies on college and university campuses. The American Lung Association analyzed published research, surveys and tobacco industry documents to provide a wide-ranging look at the impact tobacco has in today’s college life.

The report found fewer college students are smoking than ever before, but the American Lung Association warned that smoking rates were nearly this low in 1989 and then skyrocketed in the following decade to a new peak high of 30.6 percent. Contributing to that unstable smoking trend is the tobacco industry. In 2005, the tobacco industry spent more than $1 million a day sponsoring events and giveaways targeting college students. The report also notes that of 119 schools surveyed in one study, students at 109 schools reported seeing tobacco promotions in an event on campus.

“The industry’s return on investment is staggering,” said Bernadette A. Toomey, American Lung Association President and CEO. “Nearly 20 percent of today’s college students are regular smokers. Even worse is their continued campaign to increase these numbers. Every college student in America has a target on their back as far as the tobacco industry is concerned.”

The report also notes that the smoking habits of college-age adults are more fluid—switching more easily between daily and occasional smoking—than that of older adults. This characteristic indicates a key opportunity to intervene and reduce smoking rates among young adults.

Review of the tobacco industry’s own archives revealed programmatic campaigns to target young adults during transitional life stages. Moving from high school to college or work has been identified by the industry as a prime time for developing and cementing new behaviors like smoking. Tobacco companies exploit this vulnerability by sponsoring promotions in bars and nightclubs to encourage smoking as a social norm in efforts to move students from “experimental” to pack-a-day smokers.

The American Lung Association calls upon the higher education community to join the Smokefree Air 2010 Challenge, a nationwide movement to eliminate exposure to secondhand smoke in public places and workplaces no later than 2010 and reduce smoking-related illnesses, by implementing the following policies and initiatives in this school year:

• Prohibit tobacco use at all indoor and outdoor facilities, private offices, residence halls and dormitories.
• Stop the sale and advertising of tobacco products on campus and in college controlled publications, properties and events.
• Refuse all research and sponsorship funding from the tobacco industry.
• Provide smoking cessation programs to all students, faculty and staff.

For a copy of American Lung Association’s report on smoking trends on college campuses titled: Big Tobacco on Campus: Ending the Addiction, visit: http://www.lungusa.org. This report is supported by a grant from the Robert Wood Johnson Foundation.

For more information, see web link:
American Lung Association Press Release September 8, 2008

Royal College of Physicians: Ending Tobacco Smoking by 2025

A new report issued by the Royal College of Physicians of London says that if the Government was prepared to take far more radical measures to combat smoking, smoking in Britain could practically be eradicated by 2025.

The report says that the conventional approaches to preventing smoking that have been implemented in the UK - increasing the cost of cigarettes, advertising bans, smokefree public places and workplaces, health promotion campaigns, cessation programmes - will only deliver a drop in smoking prevalence of between 0.5 and 1.0 percentage points per year.

That means it will take between 11 and 22 years for the smoking rates in England to drop even by half from 22 percent to 11 percent - from 10 million to 5 million people.

The report argues that much more could and should be done to make smoking as unappealing and unacceptable as possible, and importantly, to make alternative, less hazardous nicotine products as affordable and attractive as possible. The report therefore calls for the introduction of a wide range of newer and more radical measures on smoked tobacco, existing and new medicinal nicotine products, and non-medicinal smoke-free nicotine products:

Make smoking and smoked tobacco products as unappealing, unattractive, unaffordable and unavailable as possible, as quickly as possible. Proposed measures include:

• Increase the tax on tobacco by 10 percent every year
• License tobacco retailers and prohibit the sale of smoked tobacco in premises where children are admitted

Make existing medicinal nicotine products as available and attractive to smokers as possible, and to encourage smokers to switch as completely as possible to use of medicinal nicotine instead of smoking:

• Encourage sale of low cost single day nicotine packs, available
• Encourage and promote commercial competition to make medicinal nicotine attractive and affordable

Encourage development and marketing of new medicinal nicotine products that are more acceptable and satisfying alternatives to smoking than current products:

• Encourage development of products that deliver doses of nicotine as quickly as cigarettes
• Make these products widely available to smokers at competitive prices

The report also calls for the establishment of a new Nicotine Regulatory Authority, independent from the tobacco and pharmaceutical industries, to implement these changes, monitor their impact on smoking behavior, and tasked to reduce the prevalence of smoking as quickly as possible.

For more information, see web link:
Royal College of Physicians Press Release September 7, 2008

Health Panel in Boston Gives Initial Nod to New Limits on Sale, Use of Tobacco

City health officials gave initial approval to sweeping new tobacco control rules that would ban cigarette sales at Boston pharmacies and on college campuses.

The restrictions, which would give Boston among the toughest antismoking laws in the nation, could take effect early next year.

The rules would also ban smoking on the patios of restaurants and bars with outside service, on loading docks, and in all the city's hotels, inns, and bed and breakfasts. The city banned tobacco use inside restaurants and bars in 2003.

The Boston Public Health Commission also gave preliminary approval to prohibit the sale of "blunt wraps," a tobacco leaf increasingly marketed to youths and Hookah bars, and to impose steeper fines on establishments that violate the city's smoking regulations.

In five years, the rules would ban smoking inside the city's cigar bars, which were exempt from the earlier regulation.

"Smoking and tobacco use is a major cause of preventable illness and death," said Paula A. Johnson, chairwoman of the Public Health Commission. "We feel it's very important as a city that takes the health of its residents seriously [that] we do all we can. We're really working to improve the health and well-being of our residents."

The commission approved the new rules 4 to 0 after an hour-long hearing. The rules will not take effect until the conclusion of a 60-day public comment period that will include a hearing yet to be scheduled.

The rules have been opposed by drugstore chains, tobacco companies, and local cigar bars, which argue the measures unfairly limit their right to sell a legal product.

Barbara Ferrer, executive director of the Public Health Commission, said the new rules would help protect employees who work at cigar bars and other establishments where smoking remains permitted.

"All evidence now indicates that it's very hazardous to allow people to go into a place and be exposed to lots and lots of tobacco products, and unfortunately what we've really seen is marketing to young people," Ferrer said.

The proposed rules in Boston follow action by San Francisco, where later this month residents will no longer be able to buy cigarettes in pharmacies.

Ferrer said the city is targeting sales at the 74 pharmacies in Boston because tobacco, the leading cause of preventable death in the United States, shouldn't be sold in a place where people come for health products.

The rules would increase fines for retailers caught selling to underage smokers, from the current maximum penalty of $400 to $2,000.

For more information, see web link:
Boston Globe September 5, 2008

Maine Outlaws Smoking in Cars with Youths under 16 Present

It is now illegal in Maine to smoke in a car while children are present.

Maine's statewide law outlaws smoking in cars while youths under 16 are present. The law authorizes $50 fines for violations -- but for the first year police may issue only warnings.

Gov. John Baldacci hailed the legislation as a strike against secondhand smoke when he signed it into law in April. He said tobacco use costs too many lives and too much money.

A number of other states, including California, Arkansas and Louisiana, and some Canadian provinces, have similar laws.

For more information, see web link:
NECN August 31, 2008

Teen Smoking in South Carolina Could Jump

Anti-smoking advocates say they fear more teenagers will begin smoking in South Carolina now that state funding has been cut for prevention programs.

South Carolina spent $2 million last year on smoking cessation and prevention. The percentage of youth who smoke cigarettes has dropped by half since 1999. Anti-smoking supporters say that was in part due to a program called "Rage Against the Haze."

The program is now without funding. Organizers and teen volunteers have traveled to football games across the state for the last two years to promote the program, but will no longer be able to do this.

The national Campaign for Tobacco-Free Kids said South Carolina is the only state to completely cut funding for such a program this year.

For more information, see web link:
Education Week August 29, 2008

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