Tobacco Control Update 28 April 2010

We are one month away from the government's budget announcement in which we hope to hear that a substantial increase in tobacco excise tax is part of the fiscal package. Many of us have advocated through our various channels that this increase must be substantial enough to encourage smokers towards a tobacco free lifestyle.

We know that 80 percent of smokers wish to stop. With any behaviour change, there is procrastination and a fear of the unknown. This is why it takes most smokers many quit attempts. They see the grass is greener over on the tobacco-free side of the fence, but the smoking habit is one of biological dependence. It is a colonisation of the brain by tobacco's addictive properties. Something needs to shove them over that threshold, and nothing shoves stronger than an increase in price.

But if loose tobacco isn't taxed higher in order to harmonise its price with tailor-made cigarettes, the entire exercise may be undermined. For many smokers dependency is so high that switching to "rollies", and cutting down a little, will solve the immediate financial problem. That is why we've advocated not simply for substantial tax increases, but for increases that prevent loose tobacco becoming the highly dependent smoker's cheaper option.

Last week at the Māori Affairs Select Committee inquiry hearings Paul Quinn asked the question: won't high-priced tobacco hurt the die-hard smoker? The simple answer is that ANY tobacco hurts the die-hard smoker! That is why, alongside advocacy for tax increases on tobacco, we continually emphasise the need for greater promotion of cessation services!

Today's smokers could pay for the prevention of tomorrow's smoking recruits if more of tobacco's excise tax was targeted toward greater, better health promotion and toward the populations who need it most. Why not write a letter to an editor or MP? There's still one month to have your say.

IN THIS ISSUE:

College of GPs calls for tax increase on tobacco

In a recent letter to the Prime Minister, The Royal New Zealand College of General Practitioners supported increasing the excise tax on tobacco as one measure to reduce smoking rates in New Zealand. The letter also advocates for dedicating extra tax income from the increase to smoking cessation programmes, especially targeting low income earners, Māori and Pacific smokers, at-risk youth and patients with chronic illnesses whose health is further compromised by smoking.

College President Harry Pert said: "There is evidence that those who spend a higher proportion of their income on tobacco are most likely to reduce their tobacco use after a price increase. While there are concerns that a tax increase will hit low income earners, and in particular Māori and Pacific smokers hardest, after consulting with our members and reviewing the evidence we believe that short-term hardships are far outweighed by long-term health gains from expected reduced smoking."

The College was present to show support today for oral submissions on the effect of smoking on Māori to the Māori Affairs Select Committee. The College has been working with the Smokefree Coalition to press for further measures to reduce smoking rates.

Big increase in tobacco tax will help Māori quit

The Public Health Association (PHA) says it's time for the government to get serious about increasing tobacco taxation.

The PHA told the Māori Affairs Select Committee's inquiry on the tobacco industry and Māori tobacco use that efforts to help Māori reduce smoking need to be supported by increases in tobacco taxes.

PHA Māori Policy Analyst Keriata Stuart says for tax hikes to work, they need to be regular, substantial and highly publicised.

"Governments need to stop seeing tobacco tax as a source of pocket money they can spend as they wish and start dedicating a bigger slice of it to initiatives that help Māori quit."

Ms Stuart says the Select Committee hearings have shown that tobacco use has devastated Māori society."

"The current approach isn't working for Māori. Smoking rates aren't reducing, and young Māori are still taking up smoking. It's time to bite the bullet and use taxation as a tobacco control tool."

The PHA is calling for a national Māori tobacco control strategy involving coordinated action right across government.

"The tobacco tax take should be used to support a national leadership team, to train and support the Māori smokefree workforce, and to resource dedicated social marketing and cessation services for Māori."

In its submission, the PHA also called for the government to ban point-of-sale tobacco displays, introduce plain packaging of tobacco products, and tax roll-your- own and loose tobacco to the same level as tailor-made cigarettes.

HSC calls for paradigm shift on smoking policy

The government should present a bold plan to make New Zealand largely smokefree in 10 years, the Health Sponsorship Council (HSC) says.

HSC, a crown entity, was one of many anti-smoking groups at the Māori Affairs Select Committee inquiry into the tobacco industry.

The inquiry was called to look at the consequences of tobacco use for Māori.

Chief Executive Iain Potter told the Committee a 10-year plan counter-attacking cigarette companies' marketing strategies should be adopted to reduce demand and supply of tobacco.

Mr Potter said the plan must encompass all marketing fundamentals – product, place, price, and promotion – instead of slowly implementing changes.

"The historical approach to limit the massively well-documented harms associated with tobacco has been an item-by-item, incremental approach," Mr Potter said.

"If we continue with this item-to-item approach, we will be consigning several more generations of Māori to the ranks and consequently to an early grave. We need a paradigm shift."

Mr Potter suggested the "power of the brand" be diminished by placing cigarettes in plain packaging, and taking displays and other tobacco imagery out of sight.

British American Tobacco New Zealand (BAT NZ) asked the Committee last month for current sale displays to remain the same.

BAT NZ Manager Director Graeme Amey said research showed removing cigarettes and other tobacco products from visibility in retail stores would have little impact on the prevalence of smoking.

Mr Potter, who disagrees, said the industry should also be required to provide full disclosure of all ingredients so they can be regulated.

"Tobacco can be made with less addictive additives, both harmful additives and those that alter the taste, should not be allowed."

HSC also recommended tobacco tax be increased and that roll-your-own tobacco tax should be equal to that of tailor-made cigarettes.

Guide2, 21 April 2010

Dairy backs tobacco display ban

A Palmerston North dairy is backing a ban on the display of tobacco products in retail outlets. Moshim's Discount House in Palmerston North wants its voice to be heard by the government and will make a submission expressing strong support for the ban. They stopped stocking and selling tobacco products in August 2009.

Shop owner Imtiyaz Bukshi says, "There are three schools around our shop and we don't want children seeing these lethal products on display when they come here. We want to protect children and future generations from the product so they don't start smoking."

The store was recently presented with a Smokefree Retailer Award from the Asthma and Respiratory Foundation in recognition of the positive step they have taken in protecting children from tobacco marketing.

Cancer Society Health Promoter Renee Murphy says, "Research shows young people who frequently visit stores with tobacco displays are more likely to experiment and start smoking. Once hooked, it is very difficult for them to quit. The average age of smoking uptake in New Zealand is 14 years."

The tobacco industry claims that point-of-purchase advertising has no impact on non-smokers, particularly young people. Given smokers' legendary brand loyalty, the only logical reason for investing in retail displays is to attract new users to replace the ones who are dying. The most profitable new users and the industry's most valuable source of replacement smokers are children and young people.

A ban on cigarette displays will not stop retailers selling tobacco products, but it will stop tobacco companies from marketing them. It will close a loophole in the law that tobacco companies have been exploiting.

Research on retail tobacco display bans in Canada, Iceland, Ireland and Australia shows there is a minimal economic cost to retailers. The display bans were well accepted by the public and ex-smokers reported that the ban helped them to stay smokefree. No shops were closed and no staff were laid off as a result of the display ban.

Smoking banned outside campus buildings

The days of indulging in a quick cigarette in a sheltered doorway outside a lecture theatre or office will soon be a thing of the past for University of Otago students and staff.

The university was updating its smokefree policy and intended to ban smoking within 6m of any buildings on the Dunedin campus, vice-chancellor Prof Sir David Skegg has announced.

Smoking would be banned from outdoor areas at the university's Wellington, Christchurch and Invercargill campuses. The building it used as a base in Auckland was already smokefree.

But Prof Skegg said it had not been possible to ban smoking altogether on the Dunedin campus because some buildings were located "a considerable distance" from public spaces beyond the campus.

"Smoking in the open area constitutes no risk to other people, but there are frequent complaints about people smoking by doorways and near windows or air vents.

"While we aspire to achieve a completely smokefree environment in the future, it is necessary to consider the rights of a significant number of staff and students who are addicted to smoking...

"It is hoped these measures will be seen as striking an appropriate balance between [smokers] and the preferences of many other members of the university community," he told the University Council.

Tobacco displays submissions

To help it advise on policy matters relating to the display of tobacco products in retail outlets, the Ministry of Health has issued a consultation letter which sets out possible options for removing tobacco products from public display. This shows the issue is being advanced and it is vital support is maintained!

Regardless of whether you've previously made a submission or not, please make a submission this month. By doing so you will send a clear signal that the issue is about health and protecting children from tobacco marketing. It's not just about the impact a display ban may have on retailers.

A simple, short submission will get this point across, and if you have previously submitted then mention this as it shows you are determined to see a tobacco display ban.

This consultation assesses the impact of the display ban on retailers. However, we all know that the biggest impact will be on children if we continue to display tobacco.

If you know a tobacco free retailer who could be encouraged to make a submission, please contact ASH Communications Manager Michael Colhoun: 09 520 8424, mcolhoun@ash.org.nz.

Nurses in perfect position to help smokers

The New Zealand Nurses Organisation (NZNO) has presented to the Māori Affairs Select Committee inquiry into the tobacco industry.

The professional association, which represents 45,000 members, believes nurses have a huge role to play in helping Māori, as well as other Kiwis, quit smoking and NZNO kaiwhakahaere Kerri Nuku says they are on a mission to do just that.

"Nurses see first-hand, on a daily basis, the terrible toll smoking has on our patients, their whānau and the wider community. That's why we are in such a good position to help."

Research shows advice and support from nursing staff can increase people's success in quitting smoking, especially in a hospital setting. It is hoped Māori nurses in particular can play a role in dramatically improving quit rates amongst Māori, who bear the greatest burden of ill health and death caused by smoking.

Kerri Nuku says thousands of nurses have already completed free training courses to give them greater confidence in approaching smokers under their care and offering them help to quit. These nurses can now also issue vouchers for fully subsidised nicotine replacement therapy.

"This is world-leading, and shows the strong role played by New Zealand nursing organisations and the Ministry of Health to equip and empower nurses as frontline educators."

Kerri acknowledged the high proportion of Māori nurses who smoke and said the NZNO called on Government to provide quit programmes specifically for Māori nurses.

"By helping our own workforce to quit, as well as our patients, we can go some way towards undoing the terrible damage caused by the tobacco industry over past decades."

Submitters' impressions about the inquiry

We asked members who presented orally to the Māori Affairs Select Committee to tell us their impressions in just three or four sentences each. In this issue we feature responses from Jan Pearson, Health Promotion Manager, Cancer Society of New Zealand Inc and Iain Potter, Chief Executive, Health Sponsorship Council.

I felt they had heard it all before and the questions were almost as if they felt they needed to ask something because we had made the effort to present. They were really engaged in new info e.g. Iain Potter's presentation on social marketing had them all listening and interested, so perhaps adding to his line on how tobacco companies work to market would be good. Perhaps someone can use the Rhythm and Vines event as an example of what can still happen, as this was mentioned and could be expanded on with more factual detail.

3. Based on these first few days of hearings, do you think the Select Committee is heading in the right direction?

I think they are all convinced. I don't know whether they have sorted the solution though. I get the feeling we are at the point when going over our original submissions is redundant. There needs to be a nimbleness to pick up on their interest and questions form one presenter then the next one speak to that.

See above. Can someone ask some of them what else they need to know and then focus on those issues?

3. Based on these first few days of hearings, do you think the Select Committee is heading in the right direction?

I think they are reasonably convinced about the need to do something – but need convincing on what to do.

Recent research

The impact of cigarette tax increase on smoking behaviour of daily smokers

The objective of this study was to assess the impact of excise tax increase on smoking behaviour of daily smokers aged 15 years and over and to explore the association between smokers' characteristics and smoking behaviour prior and after excise tax increase.

Aboriginal women's efforts to limit second-hand smoke exposure at home

The objective of this study was to explore factors influencing smoking in home environments and Aboriginal women's efforts to minimise exposure for their children and themselves.

A randomised controlled trial of a family-centred tobacco control programme about environmental tobacco smoke to reduce respiratory illness in indigenous infants

Acute respiratory illness (ARI) is the most common cause of acute presentations and hospitalisations of young indigenous children in Australia and New Zealand. Environmental tobacco smoke (ETS) from household smoking is a significant and preventable contributor to childhood ARI. This paper describes the protocol for a study which aims to test the efficacy of a family-centred tobacco control program about ETS to improve the respiratory health of Indigenous infants in Australia and New Zealand.

Worldwide organised cigarette smuggling: an empirical analysis

This article estimates the economic size and the impact on government revenues of cigarette smuggling worldwide and formulates economic policies that can be used to effectively address the problem.

Public place smoking laws and exposure to environmental tobacco smoke in public places

A recent report suggests that laws restricting smoking in public places reduce acute myocardial infarction, presumably by reducing exposure to environmental tobacco smoke (ETS). This study looks at adoption of these laws in Canada using data that include questions about respondents' ETS exposure in bars, restaurants, and other places.

Associations between schools' tobacco restrictions and adolescents' use of tobacco

Schools are an important arena for smoking prevention. In many countries, smoking rates have been reduced among adolescents, but the use of smokeless tobacco is on the rise in some of these countries. This study looked at the associations between schools' restrictions on smoking and snus and on the use of these tobacco products among students in upper secondary school.

Effect of an electronic nicotine delivery device (e cigarette) on desire to smoke and withdrawal, user preferences and nicotine delivery: randomised cross-over trial

The objective of this study was to measure the short-term effects of an electronic nicotine delivery device ("e-cigarette", ENDD) on desire to smoke, withdrawal symptoms, acceptability, pharmacokinetic properties and adverse effects. The setting was the Research Centre at the University of Auckland.

Public health law and public health ethics paper

This paper will equip participants with an understanding of the framework, scope and content of public health law in New Zealand, and the impact of international law. The paper will also analyse concepts of public health ethics and apply them to particular public health topics.

Students will analyse the scope and content of core public health law in New Zealand; discuss ethical issues in international law, and its impact on public health law; and assess and comment constructively on existing public health law in New Zealand and proposals for new law. Areas of public health law that are covered include law relating to: communicable disease, screening, immunisation, environmental health, tobacco, illegal drugs, alcohol, food and radiation.

The paper will run in the second semester of 2010. The paper is distance based, with two block courses at the Wellington campus, each of two days and begins on 12 July.

For more information: contact Louise Delany who will be coordinating the paper, louise.delany@otago.ac.nz.

This paper will be of interest to health workers, public health practitioners, policy staff in government agencies (central and local) and non-government organisation, as well as those lawyers keen on extending their skills in the health sector.

Access to a computer will be required to enable access to Blackboard (through the web). Blackboard participation will not be 'real-time'.

Health Promotion Forum symposium

Annuhānau Oral symposium: Wa, Tamariki Ora – The wellbeing of families and children

Keynote speakers include: Professor Innes Asher – leading Starship Hospital paediatrician, advocate and researcher and Nancy Tuaine – the Manager of the Whanganui River Māori Trust Board and member of the Whānau Ora Taskforce.

Go red for women breakfast invitation

Attend a Go Red for Women Breakfast and be one of the first people in the world to use the Heart Foundation's new Know Your Numbers heart age tool – it could save your life, or the life of someone you love.

Speakers: Heart survivors Dame Jenny Shipley and Judith Ray, and cardiologist Dr Mayanna Lund
Time: 7.30 – 8.45am (arrivals anytime from 7am)
Tickets: are just $50 per person or purchase a corporate table for 10 for $500
Dress: a splash of red.
Bring: friends, family, partners – all are welcome

All net proceeds go to the Heart Foundation charity – to raise awareness of heart disease in women and vital funds for research and cardiac care.

Seats are limited so please book early to avoid disappointment.
Bookings: www.goredforwomen.org.nz.

SMOKEFREE SHORTS

New Zealand

Mark Greenhalgh credits the electronic cigarette with a dramatic improvement in his health.

Now, all he wants is to be able to buy the nicotine cartridges from a local shop rather than having to import them from China through the internet.

His wish may soon be fulfilled. In what may become a test of the Ministry of Health, a Christchurch importer whose nicotine-free e-cigarettes have been sold at malls, now plans to start supplying supply nicotine cartridges within months.

National Party list MP Tau Henare is urging middle-aged Māori to get themselves tested for diabetes after revealing on his Facebook page this week he has been diagnosed with the disease.

Updating Facebook friends on his efforts to give up smoking, Mr Henare said it "was going better then I expected with the aid of Champix and remember I told you all that I had to go for a diabetes test, well that was positive so I've got diabetes, man, sometimes you can't win".

A spokesperson for Māori SIDS says smoking is probably the largest single cause of sudden infant deaths among Māori.

Herena Te Wano says that's why her organisation presented the Māori Affairs Select Committee Inquiry into the tobacco industry with 60 pairs of baby booties, representing the children who die every year of SIDS.

Politicians are leaving kids exposed to smoking, write Helen Wilson and George Thomson.

Smoking kills you, fizzy drinks make you fat, binge drinking is bad for you, and fatty foods cause heart disease. What many public health messages have in common is the expectation that people will make rational decisions, informed by evidence, about how to stay healthy.

New Zealand governments prefer to use public health education rather than legislation, and rely on the assumption that choices about health behaviour will be rational.

But how rational are the policy decisions made by governments when it comes to public health?

International

Chile will raise $8.4 billion to rebuild towns and infrastructure ravaged by a massive Feb. 27 quake by tapping foreign markets, copper-boom savings and hiking taxes on companies, miners and tobacco, President Sebastian Pinera said.

The tobacco industry is prepared to fight hard against a new wave of regulation, writes Nick O'Malley.

The [New Zealand] parliamentary interrogation began badly for the tobacco executive. After the briefest of greetings, the first question was asked: ''I'd just like to read you something,'' he said. "It's a quote. 'We don't smoke this shit, we just sell it. We reserve the right to smoke for the young, the poor, the black and the stupid.' That's a quote attributed to a tobacco company executive. Was that a quote from one of your company executives?"

Tobacco displays will be banned from corner shops next year and from supermarkets two years later under proposals released by the Welsh Assembly Government.

The new rules, which would also ban cigarette vending machines, are meant to stop children taking up smoking and follow the three-year-old ban on smoking in public places.

Ministers plan to introduce the regulations at the same time as the rest of the UK, subject to a three-month consultation which ends on 6 July.

The British Office of Fair Trading (OFT) has fined two tobacco companies and nine retailers a total of £225m for "unlawful" tobacco pricing practices.

Paraguayans can no longer legally light up in restaurants, bars and shopping malls.

The new measure bans smoking in all closed spaces where people gather, including private businesses. Establishments that don't comply can be fined by the Health Ministry.

Japan's smoking rate has fallen to a record low amid rising health awareness and tighter regulations.

WOW! The huge billboard in front of Yokohama Park across the intersections must have cost a bomb. It depicts a picture of a little girl beside a smouldering cigarette held in a man's hand. The caption reads, "For the health of others, do stop smoking while walking."

When my son was a toddler, his hair was nearly singed and my hand almost burnt by the cigarettes of smokers jostling in crowded places. Inhaling the secondary smoke made us cough, too.

Exposure to tobacco smoke could significantly increase the odds of children having learning disabilities, according to a study by lead author Laura Anderko, the Robert and Kathleen Scanlon Chair in Values Based Health Care at Georgetown University's School of Nursing and Health Studies, Washington DC.

In most of the WHO European Region, smoking in pregnancy is the leading cause of poor pregnancy outcome and prenatal death. It can cause serious health problems including ectopic pregnancy, increased risk of miscarriage, complications during labour, preterm birth, stillbirth, low birth weight and sudden unexpected death in infancy. Women smokers are also less likely to breastfeed, tend to wean their babies earlier and have lower milk production than non-smokers.

Researchers have identified a group of genes that are especially active in lung cancer patients – even in healthy tissue – and said they may be used to predict which smokers will eventually develop lung cancer.

And, they said, a natural supplement derived from food that is being tested to prevent lung cancer appears to halt the precancerous changes.

"Even in normal cells or premalignant cells prior to cancer development we see this pathway being turned on," said Andrea Bild of the University of Utah, who worked on the study published in the journal Science Translational Medicine.

There has been a reduction in the number of people who have had heart attacks in Ireland owing to the workplace smoking ban, new Irish research shows.

In countries that restrict smoking in public there is a reduction in the number of heart attacks, as well as an improvement in other indicators of health, according to the review of published research in the online April issue of The Cochrane Library.

Tobacco giants are using Facebook to subvert bans and international conventions against cigarette advertising, a study by University of Sydney researchers published in the British Medical Journal has found.

"We have gathered here to pay homage to Lucky Strike, the bestest cigarette in the whole widest world," says one Facebook page administered by an employee of the tobacco company RJ Reynolds highlighted by the study.

Other Lucky Strike pages, one with tens of thousands of members, had images of old and new tobacco ads and various Lucky Strike tobacco products and merchandise.

Two tobacco giants have paid fines that totalled CN$225 million for their role in cigarette smuggling in the early 1990s – which the federal government says is the largest criminal levies ever imposed in Canada.

JTI-Macdonald Corp. and RJ Reynolds also reached a settlement in a lengthy civil suit with the provincial and federal governments.

QUOTABLE QUOTES

"Using the regression results, a simulation analysis was carried out and policy options were identified to achieve the objectives of both the public health agencies (less consumption, less smuggling) and the governments (less smuggling, more revenue). The simulation results illustrated that increasing cigarette taxes and improving anti-smuggling law-enforcement would significantly increase government revenues while decreasing global cigarette consumption and smuggling activities. Furthermore, the simulations showed that if a tax increase is not accompanied by an improvement in law enforcement, then the level of global smuggling would increase, but governments would still enjoy increased tax revenues."

A Yurekli Sayginsoy, "Worldwide organised cigarette smuggling: an empirical analysis",
Applied Economics, 5 February 2010

"I don't care if we are outside at a cafe. I don't want your second-hand smoke in my eggs benedict. If I did I'd have ordered a side of cancer."

From the Director