tag:theconversation.com,2011:/us/topics/cigarettes-704/articlesCigarettes – The Conversation2023-11-10T15:20:10Ztag:theconversation.com,2011:article/2172212023-11-10T15:20:10Z2023-11-10T15:20:10ZProposed smoking ban would improve UK public health – but tobacco industry opposition could be a major roadblock<p>In his <a href="https://www.gov.uk/government/speeches/the-kings-speech-2023">speech on Tuesday</a>, King Charles III outlined what measures the government plans to introduce to cut smoking rates and create a smoke-free generation in England.</p>
<p>Among the measures the government hopes to introduce as part of its new tobacco and vapes bill are plans to restrict sales of e-cigarettes so they’re less accessible to children and young people, as well as exploring the possibility of a new duty on vapes.</p>
<p>But perhaps the most notable of these measures are plans to introduce a so-called “generational” smoking ban. Current legal smokers would be unaffected but, if the legislation came into force as planned, it would mean that from 2027 anyone aged 14 or under will never be able to <a href="https://www.independent.co.uk/news/uk/home-news/uk-smoking-ban-age-sunak-kings-speech-b2443057.html">legally buy a cigarette</a>.</p>
<p>Prime minister Rishi Sunak claims that not only would eradicating smoking save <a href="https://www.abc.net.au/news/2023-10-05/uk-government-set-to-ban-cigarettes-for-younger-generations/102936224">£17 billion</a> per year, it would also reduce pressure on the NHS. Over roughly the last decade, <a href="https://digital.nhs.uk/data-and-information/publications/statistical/statistics-on-smoking/statistics-on-smoking-england-2020/part-1-smoking-related-ill-health-and-mortality#:%7E:text=In%202019%2F20%20there%20were,an%20increase%20of%2010%25">25%-31% of all hospital admissions</a> were from conditions directly caused by smoking – such as respiratory and circulatory diseases, and cancers.</p>
<p>Smoking is also the <a href="https://www.rcplondon.ac.uk/news/rcp-welcomes-tobacco-and-vapes-bill-kings-speech">leading cause</a> of preventable death and illness in the UK – accounting for around <a href="https://www.rcplondon.ac.uk/news/rcp-responds-khan-review-making-smoking-obsolete">64,000 deaths</a> each year. Smoking even just <a href="https://www.bmj.com/content/360/bmj.j5855">one cigarette a day</a>, when compared to being a non-smoker, can increase the risk of suffering from heart disease by 48% in men and 57% in women. It can also increase the risk of stroke by 25% in men and 31% in women.</p>
<p>It’s clear a smoking ban could have many potential economic and public health benefits. But whether such a ban actually comes to fruition is uncertain – and the tobacco industry will probably do as much as it can to ensure this policy never comes to pass.</p>
<h2>Smoke-free generation</h2>
<p>The proposed smoking ban is being introduced as part of the government’s efforts to phase out smoking and make England <a href="https://commonslibrary.parliament.uk/research-briefings/cbp-9655/">smoke-free by 2030</a>. If this plan goes through, it would make England the second country in the world to introduce such a ban. <a href="https://www.bbc.co.uk/news/uk-scotland-67017093">Sunak reportedly</a> wants to work with the UK’s devolved governments to eventually introduce the ban across the rest of the country.</p>
<p>New Zealand was the <a href="https://www.bbc.co.uk/news/world-asia-63954862">first country</a> to successfully implement a generational smoking ban in January 2023. This means that no one born after January 1, 2009 will ever be legally allowed to purchase cigarettes in New Zealand.</p>
<p>It’s still too early to know exactly what benefits this policy will have on public health. But computer modelling suggests that a well-enforced effort would halve smoking rates <a href="https://www.health.govt.nz/system/files/documents/publications/proposals_for_a_smokefree_aotearoa_2025_action_plan-final.pdf">within 10-15 years</a> after the ban is implemented.</p>
<p>In the UK’s case, the government claims this policy would be the “<a href="https://www.gov.uk/government/news/prime-minister-to-create-smokefree-generation-by-ending-cigarette-sales-to-those-born-on-or-after-1-january-2009">most significant public health intervention</a> in a generation, saving tens of thousands of lives” – and that it has wide support from <a href="https://ash.org.uk/media-centre/news/press-releases/health-leaders-welcome-kings-speech-setting-out-governments-proposals-for-a-smokefree-generation">public health voices</a>.</p>
<p>But for years the tobacco industry has opposed virtually every tobacco control policy that has been proposed – including <a href="https://www.instituteforgovernment.org.uk/sites/default/files/smoking_in_public_places.pdf">smoke-free public places</a> and <a href="https://bmjopen.bmj.com/content/6/10/e012634">standardised tobacco packaging</a>. It should come as no surprise then that the industry could be a major roadblock in the government’s plans to implement a smoking ban.</p>
<p>Research by the <a href="https://www.bath.ac.uk/research-groups/tobacco-control-research-group/">Tobacco Control Research Group</a> at the University of Bath, of which we’re members, has <a href="https://stories.bath.ac.uk/investigating-big-tobacco-s-influence-on-public-health/index.html">highlighted the techniques</a> the tobacco industry uses to undermine such policies. One main strategy they have been accused of using is spreading a false narrative about the effect tobacco control policies will have on society and the economy. </p>
<p>This <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5029800/">narrative is spread</a> using a number of techniques – including producing skewed evidence, sometimes by third parties with undisclosed industry links, and bringing forward litigation. Tobacco industry actors have previously denied interfering in policy change.</p>
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<img alt="A no smoking sign hung on a post." src="https://images.theconversation.com/files/558637/original/file-20231109-15-rjpa5w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/558637/original/file-20231109-15-rjpa5w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/558637/original/file-20231109-15-rjpa5w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/558637/original/file-20231109-15-rjpa5w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/558637/original/file-20231109-15-rjpa5w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/558637/original/file-20231109-15-rjpa5w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/558637/original/file-20231109-15-rjpa5w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">New Zealand is the first country in the world to introduce a generational smoking ban.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/no-smoking-sign-shopping-place-background-180758084">totojang1977/ Shutterstock</a></span>
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<p>Previous attempts to create tobacco-free generations have been blocked using such techniques.</p>
<p>For example, in 2019 the Philippine Tobacco Institute, which represents multiple tobacco companies, <a href="https://www.tobaccocontrollaws.org/litigation/decisions/philippine-tobacco-institute-v-city-of-balanga-et-al">filed two court cases</a> challenging the city government of Balanga in the Philippines. </p>
<p>The city was hoping to introduce regulations which would prevent the legal sale of tobacco products to residents born on or after January 1, 2000. However, the court case went in the industry’s favour – and so the regulation was never implemented.</p>
<p>In the US state of Massachusetts, the town of Brookline is also <a href="https://brookline.news/brooklines-tobacco-free-generation-law-facing-challenge-in-mas-highest-court/#:%7E:text=A%20legal%20challenge%20filed%20by,court%20in%20Massachusetts%20next%20month">facing a similar battle</a> in the state’s Supreme Judicial Court. </p>
<p>The town was hoping to introduce the same policy measure, which would prevent legal sale of tobacco or cigarettes to anyone born after January 1, 2000. This lawsuit was brought to court by local shops whose businesses benefit from selling tobacco.</p>
<p>Litigation was not brought against New Zealand for its generational ban. Only time will tell if this will be the case for the UK, too.</p>
<p>Either way, industry arguments have already appeared in UK media following coverage of the government’s plans. For example, <a href="https://tobaccotactics.org/article/forest">Forest</a> – a smoker’s rights group which <a href="https://www.forestonline.org/about-forest/frequently-asked-questions/">receives funding from tobacco companies</a> – has <a href="https://www.independent.co.uk/news/uk/home-news/uk-phased-smoking-ban-kings-speech-b2443557.html">been quoted</a> in one UK publication, referring to the proposal as “desperate” and stating that it “won’t work”. Their industry links weren’t mentioned in the article.</p>
<p>It’s crucial that any industry attempts to delay, weaken or scrap the policy are strongly resisted. One way to help achieve this is for the UK to adhere to the Framework Convention on Tobacco Control – an international treaty signed by the UK which requires <a href="https://fctc.who.int/publications/m/item/guidelines-for-implementation-of-article-5.3">health policy be protected</a> from the vested interest of the tobacco industry. </p>
<p>There’s also a role to be played by the media to ensure transparency and full disclosure in their coverage of the policy so that when industry-affiliated voices comment, they are clearly identified as such.</p>
<p>Beyond pressure from industry, another potential roadblock for the policy is resourcing to enforce the policy. The policy also stands to be most successful when not viewed in isolation. Other stop smoking measures will continue to have a role to play, given that many current smokers will not be affected by the legislation.</p>
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<p><em>A previous version of this article incorrectly stated that smoking even just one cigarette a day can double a person’s risk of dying from heart disease or stroke.</em></p><img src="https://counter.theconversation.com/content/217221/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Phil Chamberlain is a member of the Tobacco Control Research Group (TCRG) which is part of the global tobacco industry watchdog STOP, funded by Bloomberg Philanthropies. For a list of recent and current research funding within the TCRG, see: <a href="https://www.bath.ac.uk/corporate-information/tobacco-control-research-group-research-projects/">https://www.bath.ac.uk/corporate-information/tobacco-control-research-group-research-projects/</a></span></em></p><p class="fine-print"><em><span>Allen Gallagher is a member of the Tobacco Control Research Group (TCRG) which is part of the global tobacco industry watchdog STOP, funded by Bloomberg Philanthropies. For a list of recent and current research funding within the TCRG, see: <a href="https://www.bath.ac.uk/corporate-information/tobacco-control-research-group-research-projects/">https://www.bath.ac.uk/corporate-information/tobacco-control-research-group-research-projects/</a></span></em></p>A previous attempt to introduce such a ban in the Philippines was struck down by an industry-funded lawsuit.Phil Chamberlain, Deputy Director of the Tobacco Control Research Group, University of BathAllen Gallagher, Postdoctoral Research Associate, Department of Health, University of BathLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2050162023-05-05T07:04:25Z2023-05-05T07:04:25ZNew funds will tackle Indigenous smoking. But here’s what else we know works for quit campaigns<figure><img src="https://images.theconversation.com/files/524535/original/file-20230504-29-jg5f4w.jpg?ixlib=rb-1.1.0&rect=0%2C88%2C1000%2C562&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/beautiful-african-american-girl-breaking-cigarette-2280036417">Studio Romantic/Shutterstock</a></span></figcaption></figure><p>Among all the talk this week about a <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/taking-action-on-smoking-and-vaping">crackdown on vaping</a> – the most significant <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/minister-for-health-and-aged-care-speech-national-press-club-2-may-2023?language=en">tobacco control reforms</a> in a decade – has been the roll-out of another major document.</p>
<p>The <a href="https://www.health.gov.au/resources/publications/national-tobacco-strategy-2023-2030">National Tobacco Strategy 2023–2030</a> was launched this week.</p>
<p>A key priority of the strategy is Aboriginal and Torres Strait Islander smoking and <a href="https://www.closingthegap.gov.au/">Closing the Gap</a>. We heard the Tackling Indigenous Smoking program would be extended and widened – <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/taking-action-on-smoking-and-vaping?language=en">with A$141 million funding</a> – to reduce both vaping and smoking among Aboriginal and Torres Strait Islander people.</p>
<p>Here’s why that’s urgently needed and what needs to happen next to reduce smoking rates among Aboriginal and Torres Strait Islander people.</p>
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Read more:
<a href="https://theconversation.com/we-can-cut-indigenous-smoking-and-save-lives-heres-how-42119">We can cut Indigenous smoking and save lives – here's how</a>
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<h2>Tobacco is still a killer</h2>
<p>Tobacco <a href="https://www.aihw.gov.au/news-media/media-releases/2019/october/tobacco-use-linked-to-more-than-1-in-8-deaths-but">legally kills</a> over 57 Australians a day. That’s equivalent to extinguishing an entire country town of 21,000 every year. </p>
<p>It’s still the single biggest <a href="https://www.aihw.gov.au/reports-data/health-conditions-disability-deaths/burden-of-disease/overview">preventable</a> risk factor for disease and premature death. For Aboriginal and Torres Strait Islander <a href="https://www.aihw.gov.au/reports/burden-of-disease/illness-death-indigenous-2018/summary">people</a>, <a href="https://academic.oup.com/ije/article/50/3/942/6118443">more than a third</a> of all deaths are caused by tobacco. Over the past decade we have lost more than <a href="https://academic.oup.com/ije/article/50/3/942/6118443">10,000</a> Aboriginal and Torres Strait Islander lives due to smoking.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1654018018169753600"}"></div></p>
<p><a href="https://healthbulletin.org.au/articles/review-of-tobacco-use-among-aboriginal-and-torres-strait-islander-peoples/">Multiple policy failures</a> beyond health – from poverty, education, employment, housing, family removals, dislocation and the systematic embedding of tobacco as rations <em>in lieu</em> of wages – mean Aboriginal and Torres Strait Islander people are disproportionately impacted by the harms of Big Tobacco. </p>
<p>So the <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/taking-action-on-smoking-and-vaping?language=en">funding</a> to expand the <a href="https://tacklingsmoking.org.au/">Tackling Indigenous Smoking program</a> is urgently needed to have no more than 27% of Aboriginal and Torres Strait Islander smoking by 2030 (5% of all Australians).</p>
<p>There have been huge achievements in reducing Aboriginal and Torres Strait Islander smoking. In <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/1753-6405.13049">2018–19</a>, 40% of Aboriginal and Torres Strait Islander adults smoked daily, down from 50% in 2004–05. A target of 27% is achievable. But to get there we need something “extra” to accelerate those reductions.</p>
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Read more:
<a href="https://theconversation.com/heres-how-to-close-the-gap-on-indigenous-women-smoking-during-pregnancy-62347">Here's how to close the gap on Indigenous women smoking during pregnancy</a>
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<h2>We know what works</h2>
<p>Tobacco campaigns are one of the most <a href="https://www.tobaccoinaustralia.org.au/chapter-14-social-marketing/14-1-social-marketing-and-public-education-campaig">cost-effective</a> <a href="https://tobaccocontrol.bmj.com/content/tobaccocontrol/21/2/127.full.pdf">interventions</a> when evidence-based, market-tested, sustained and with support services at the end of the call to action. When they are adequately funded, they can <a href="https://tobaccocontrol.bmj.com/content/31/2/284">impact inequities</a>.</p>
<p>Campaigns must be personally relevant and meaningful <a href="https://www.wiley.com/en-au/Health+Behavior%3A+Theory%2C+Research%2C+and+Practice%2C+5th+Edition-p-9781118629000">to be effective</a>. This makes the case for targeted approaches, including local level campaigns, reinforced by general, national activity. Audiences engage with the message when they can see themselves and their community members (sometimes actually) in the advertising.</p>
<p>We saw this nationally with <a href="https://www.youtube.com/watch?v=0yvjBU-E0aw">Break the Chain</a> starring Aboriginal actor and comedian Elaine Crombie. Originally this was a targeted campaign for Aboriginal and Torres Strait Islander people. But it then aired nationally targeting all Australians in 2014.</p>
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<figcaption><span class="caption">The ‘Break the Chain’ campaign featured Aboriginal actor and comedian Elaine Crombie.</span></figcaption>
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<p><a href="https://www.health.gov.au/resources/collections/campaign-resources-dont-make-smokes-your-story">Don’t Make Smokes Your Story</a> was launched in 2016, as part of the Tackling Indigenous Smoking program. This was created by Indigenous agency Carbon Media, starring musician <a href="https://www.youtube.com/watch?v=878H2fkw3L8">Fred Leone</a> alongside real stories <a href="https://www.youtube.com/watch?v=xCX-ZfopeSE">from community members</a>. </p>
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<figcaption><span class="caption">‘Don’t Make Smokes Your Story’ campaign.</span></figcaption>
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<p>One of the <a href="https://www.phrp.com.au/issues/september-2020-volume-30-issue-3/tackling-indigenous-smoking-a-good-news-story-in-australian-tobacco-control/">most successful</a> and innovative Aboriginal and Torres Strait Islander tobacco campaigns, it included a
<a href="https://www.health.gov.au/resources/publications/dont-make-smokes-your-story-toolkit?language=en">toolkit</a> for Aboriginal and Torres Strait Islander communities to use and adapt the national campaign to their <a href="https://tacklingsmoking.org.au/sharing-our-stories/">local contexts</a>.</p>
<p>An excellent example of this is from the <a href="https://www.apunipima.org.au/tackling-indigenous-smoking/#:%7E:text=The%20Apunipima%20Tackling%20Indigenous%20Smoking,to%20culturally%20appropriate%20quit%20support">Apunipima Tackling Indigenous Smoking team</a> with its local campaign <a href="https://www.youtube.com/watch?v=tohg0QEGVU0">Don’t Make Smokes Your Story Cape York</a>.</p>
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<figcaption><span class="caption">Campaigns can be localised, like this one from Cape York.</span></figcaption>
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<p>When Aboriginal and Torres Strait Islander people lead and promote smoke-free behaviours, communities are <a href="https://www.mja.com.au/journal/2015/202/10/predictors-wanting-quit-national-sample-aboriginal-and-torres-strait-islander">more interested in quitting</a>. </p>
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Read more:
<a href="https://theconversation.com/telehealth-has-much-to-offer-first-nations-people-but-technical-glitches-and-a-lack-of-rapport-can-get-in-the-way-201872">Telehealth has much to offer First Nations people. But technical glitches and a lack of rapport can get in the way</a>
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<h2>What works? Product, price, place and promotion</h2>
<p>Social marketing campaigns, like the ones we’ve mentioned, really work well when they take on the <a href="https://www.cdc.gov/nccdphp/dch/programs/healthycommunitiesprogram/tools/pdf/social_marketing.pdf">Four Ps</a> of product, price, place and promotion.</p>
<p>The beautifully produced ads, the “promotion”, can’t have impact on their own. This is where the rest of the National Tobacco Strategy comes in.</p>
<p><strong>1. Product</strong></p>
<p>We’ve reduced product appeal with <a href="https://theconversation.com/world-first-plain-packaging-for-tobacco-products-a-step-closer-to-becoming-law-3053">plain packaging</a> and graphic health warnings. This will be enhanced with new warnings, including on the sticks themselves, plus greater uniformity of standardised packaging and tightened rules around additives and flavours that make smoking palatable.</p>
<p><strong>2. Price</strong></p>
<p>Price increases <a href="https://www.sciencedirect.com/science/article/pii/S2468266719302038">reduce smoking</a> and we’ll see a tax increase of 5% each year for three years across all different tobacco product types. </p>
<p><strong>3. Place</strong></p>
<p>We have known about the harms of commercial tobacco since at least 1950. Yet we still expect individuals to give up nicotine instead of removing this lethal product from sale at pretty much every supermarket, service station and convenience store. </p>
<p>The National Tobacco Strategy is considering a national licensing scheme, removing online sales and delivery services, and potential for reducing the number, type and location of tobacco outlets.</p>
<p>There will also be more action on smoke-free areas and making sure all health professionals (particularly in remote places) are equipped to support quit attempts.</p>
<p>The strategy states it will explore raising the age you can buy cigarettes and monitor how this works overseas. </p>
<p><strong>4. Promotion</strong></p>
<p>The commitment to close any last promotional loopholes for tobacco and e-cigarettes, particularly online is also important, along with local and national anti-smoking campaigns. But we know these are not enough on their own.</p>
<h2>What we also need</h2>
<p>Addressing all four Ps is what comprehensive tobacco social marketing would look like. It’s what’s required to accelerate the declines to get to the 27% target for Aboriginal and Torres Strait Islander peoples, and 5% nationally.</p>
<p>Targeted approaches are critical and can be effective, but they need to be supported by bigger, whole of population structural changes. The community-led campaigns, supported by national activity, will reinforce and amplify the policy changes that will come through on the tobacco product, its cost and its availability. </p>
<p>That’s how we realise our goals and ultimately eliminate tobacco related disease and death.</p><img src="https://counter.theconversation.com/content/205016/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Christina Heris receives funding from the NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame (NHMRC GNT1198301), and the Australian Government Department of Health and Aged Care for the Tackling Indigenous Smoking – Regional Grants Impact and Outcomes Assessment.</span></em></p><p class="fine-print"><em><span>Lisa J Whop receives funding from the National Health and Medical Research Council and the Australian Research Council. She is also a member and incoming chair of Cancer Australia's Leadership Group on Aboriginal and Torres Strait Islander Cancer Control.</span></em></p><p class="fine-print"><em><span>Michelle Kennedy receives funding from the National Health and Medical Research Council, Medical Research Future Fund and the National Heart Foundation. </span></em></p><p class="fine-print"><em><span>Raglan Maddox receives funding from from the NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame (NHMRC GNT1198301), and the Australian Government Department of Health and Aged Care for the Tackling Indigenous Smoking – Regional Grants Impact and Outcomes Assessment.</span></em></p><p class="fine-print"><em><span>Raymond Lovett receives funding from the NHMRC. </span></em></p><p class="fine-print"><em><span>Tom Calma is the National Coordinator, Tackling Indigenous Smoking (TIS). This position is a consultancy to the Commonwealth Department of Health and Aged Care. </span></em></p>If we are to reduce the numbers of Aboriginal and Torres Strait Islander people smoking we need to consider a whole suite or approaches.Christina Heris, Research Fellow, Australian National UniversityLisa J Whop, Senior Fellow, Australian National UniversityMichelle Kennedy, Assistant Dean Indigenous Strategy & Leadership, University of NewcastleRaglan Maddox, Fellow, National Centre for Epidemiology and Public Health, Australian National UniversityRaymond Lovett, Director Mayi Kuwayu Study, Australian National UniversityTom Calma, Chancellor, University of CanberraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2048122023-05-03T05:13:19Z2023-05-03T05:13:19ZCan vaping help people quit smoking? It’s unlikely<figure><img src="https://images.theconversation.com/files/523954/original/file-20230503-14-m0t8hk.jpg?ixlib=rb-1.1.0&rect=81%2C63%2C5925%2C3944&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/many-different-disposable-ecigarettes-hand-delicious-2049512471">Shutterstock</a></span></figcaption></figure><p>Australian Health Minister Mark Butler has announced a <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/taking-action-on-smoking-and-vaping?language=en">major policy shift on vaping</a>. Its two primary objectives are to make it harder for children and non-smokers to access vapes and to allow people trying to quit smoking to access nicotine vapes with a prescription. </p>
<p>Vapes are unquestionably popular, with many who vape saying they are trying to quit or to cut down on cigarettes. “Recreational” vapers of any age with no interest in quitting will find themselves frozen out.</p>
<p>But can vapes actually help significant numbers of people quit smoking? The evidence suggests it’s unlikely. </p>
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<strong>
Read more:
<a href="https://theconversation.com/a-potted-history-of-smoking-and-how-were-making-the-same-mistakes-with-vaping-200708">A potted history of smoking, and how we're making the same mistakes with vaping</a>
</strong>
</em>
</p>
<hr>
<h2>Myth of the ‘hardened smokers’</h2>
<p>First, let’s bust a widely believed myth. With smoking at an <a href="https://www.health.gov.au/sites/default/files/2023-05/national-tobacco-strategy-2023-2030.pdf">all time low</a>, some experts argue today’s smokers are the die-hard addicts: frequently relapsing smokers who just can’t quit. </p>
<p>Whenever this hypothesis has been tested it has been found wanting. In nations where smoking prevalence has fallen most, we would expect (if the hypothesis was true) that indicators of hardened smokers (such as average number of cigarettes smoked per day) would be rising because the remaining smokers would be over-represented by heavy, addicted smokers.</p>
<p>But according to <a href="https://pubmed.ncbi.nlm.nih.gov/30868166/">a 2020 review of 26 studies</a>:</p>
<blockquote>
<p>Some have argued that a greater emphasis on harm reduction or intensive treatment approaches is needed because remaining smokers are those who are less likely to stop with current methods. This review finds no or little evidence for this assumption.</p>
</blockquote>
<p>In other words, there is no evidence long-term smokers are impervious to the suite of tobacco control policies and campaigns that have driven hundreds of millions of smokers around the world to quit. </p>
<figure class="align-center ">
<img alt="Ashtray close up" src="https://images.theconversation.com/files/523958/original/file-20230503-19-71ckwh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/523958/original/file-20230503-19-71ckwh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=385&fit=crop&dpr=1 600w, https://images.theconversation.com/files/523958/original/file-20230503-19-71ckwh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=385&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/523958/original/file-20230503-19-71ckwh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=385&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/523958/original/file-20230503-19-71ckwh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=484&fit=crop&dpr=1 754w, https://images.theconversation.com/files/523958/original/file-20230503-19-71ckwh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=484&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/523958/original/file-20230503-19-71ckwh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=484&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The idea that ‘hardened smokers’ can’t quit is a myth.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/ashtray-full-smoked-cigarettes-extreme-close-1579956118">Shutterstock</a></span>
</figcaption>
</figure>
<h2>Vapes don’t help smokers cut back</h2>
<p>The idea that vaping helps people smoke fewer cigarettes isn’t supported by the evidence. Studies of the number of cigarettes foregone by vapers who still smoke have shown that, compared with smokers who never vape, the average daily cigarette consumption is very similar. </p>
<p>Data from 2019 from the United Kingdom government’s annual <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandlifeexpectancies/methodologies/opinionsandlifestylesurveyqmi">Opinions and Lifestyle Survey</a> also <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/drugusealcoholandsmoking/datasets/ecigaretteuseingreatbritain">show</a> the average number of cigarettes smoked daily by smokers who vape (8 a day) is almost identical to that by smokers who have never vaped (8.1 a day).</p>
<p><a href="https://bmjopen.bmj.com/content/8/6/e016046">A 2018 paper</a> considered the surge in e-cigarette use in England and whether this was reducing the number of cigarettes being smoked at the population level across the country. The authors concluded:</p>
<blockquote>
<p>No statistically significant associations were found between changes in use of e-cigarettes […] while smoking and daily cigarette consumption. Neither did we find clear evidence for an association between e-cigarette use […] specifically for smoking reduction and temporary abstinence, respectively, and changes in daily cigarette consumption. </p>
<p>If use of e-cigarettes […] while smoking acted to reduce cigarette consumption in England between 2006 and 2016, the effect was likely very small at a population level. </p>
</blockquote>
<h2>How effective are vapes in quitting?</h2>
<p>The most recent <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010216.pub7/full">Cochrane review</a> of randomised controlled trials compared vaping with nicotine replacement therapy (such as drugs, gums and patches). It found <a href="https://profglantz.com/2022/11/21/cochrane-collaborative-concludes-e-cigs-as-medical-interventions-help-smokers-quit-again-while-continuing-to-ignoring-stronger-more-relevant-real-world-evidence-that-they-dont/">about 82%</a> of people who vape are still smoking when followed up six or more months later. </p>
<p>This was better than those using nicotine replacement therapy: 90% were still smoking.</p>
<p>Neither nicotine replacement therapy or vapes are hugely disruptive of smoking. You certainly wouldn’t be confident using a drug for any health issue that had a 82-90% failure rate. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/drugs-gums-or-patches-wont-increase-your-chances-of-quitting-89767">Drugs, gums or patches won't increase your chances of quitting</a>
</strong>
</em>
</p>
<hr>
<figure class="align-center ">
<img alt="GP listens to patient" src="https://images.theconversation.com/files/523955/original/file-20230503-26-oc0x2b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/523955/original/file-20230503-26-oc0x2b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/523955/original/file-20230503-26-oc0x2b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/523955/original/file-20230503-26-oc0x2b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/523955/original/file-20230503-26-oc0x2b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/523955/original/file-20230503-26-oc0x2b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/523955/original/file-20230503-26-oc0x2b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Nicotine replacement therapies aren’t very effective at helping people quit.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/female-consultant-meeting-teenage-patient-284516786">Shutterstock</a></span>
</figcaption>
</figure>
<p>Randomised controlled trials also poorly reflect the ways vapes and nicotine replacement therapy are used in the real world and aren’t representative of all smokers wanting to quit. </p>
<p>A <a href="https://pubmed.ncbi.nlm.nih.gov/21212379/">review</a> of 54 randomised controlled trials on quitting smoking, for example, found two-thirds of smokers with nicotine dependence would have been excluded from clinical trials by at least one criterion. This may result in participation biases, which reduce the applicability of the results to smokers at large, or even smokers at large who want to quit. </p>
<p>This, and <a href="https://ses.library.usyd.edu.au/bitstream/handle/2123/28576/Mass%20distraction%20with%20cover.pdf?sequence=3&isAllowed=y">other factors</a>, make randomised controlled trials likely to overestimate effectiveness, as I outline in <a href="https://ses.library.usyd.edu.au/bitstream/handle/2123/28576/Mass%20distraction%20with%20cover.pdf?sequence=3&isAllowed=y">chapter two of my book</a>. </p>
<h2>What does the real-world evidence show?</h2>
<p>The best evidence we have about how vapes perform comes from studies where large numbers of vapers are followed for several years. The <a href="https://tobaccocontrol.bmj.com/content/26/4/371">US Population Assessment of Tobacco and Health (PATH) project</a>, for example, has been collecting national cohort data on 46,000 Americans since 2013.</p>
<p>As the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6202279/pdf/nihms965122.pdf">PATH data</a> below show, when randomly selected groups of vapers are followed up at 12 months, the most common outcome is those who were smoking and vaping at the beginning of the study period will still be vaping and smoking at the end of the 12 months. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/523994/original/file-20230503-16-7qv313.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/523994/original/file-20230503-16-7qv313.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=578&fit=crop&dpr=1 600w, https://images.theconversation.com/files/523994/original/file-20230503-16-7qv313.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=578&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/523994/original/file-20230503-16-7qv313.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=578&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/523994/original/file-20230503-16-7qv313.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=726&fit=crop&dpr=1 754w, https://images.theconversation.com/files/523994/original/file-20230503-16-7qv313.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=726&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/523994/original/file-20230503-16-7qv313.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=726&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The most common outcome is those who were smoking and vaping at the start were still doing both 12 months later.</span>
<span class="attribution"><span class="source">Data from the US Population Assessment of Tobacco and Health (PATH) project</span></span>
</figcaption>
</figure>
<p>I’ve summarised 16 other <a href="https://simonchapman6.com/vaping-research-alerts/#smoking-cessation">reviews and expert group conclusions</a> of the evidence published since 2017. Words like “low quality”, “inconclusive”, “insufficient”, “weak”, “low level” and “limited” abound.</p>
<h2>The upshot?</h2>
<p>The prescription vapes access scheme’s most important population effect is likely to be that it will massively reduce access to vapes by children. State governments will start hitting retailers illegally selling with massive fines and Border Security will do the same with importing suppliers. </p>
<p>Taiwan fines sellers a maximum of <a href="https://en.rti.org.tw/news/view/id/2009188">US$1.65 million, with a minimum of US$330,000</a>. The current maximum fine in New South Wales is currently only A$1,600. Such a fine would barely raise dust in big retailers’ petty cash drawers.</p>
<p>Based on the research, we might expect 10-18% of vapers using the prescription scheme to quit within 12 months (with some relapse expected), but many more will <a href="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1000216">quit unassisted</a>.</p>
<p>Preventing new generations of kids from becoming addicted to nicotine and more likely to start smoking is a huge policy advance that is hugely welcome.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/vaping-and-behaviour-in-schools-what-does-the-research-tell-us-204794">Vaping and behaviour in schools: what does the research tell us?</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/204812/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Simon Chapman does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Many people who vape saying they are trying to quit or to cut down on cigarettes.Simon Chapman, Emeritus Professor in Public Health, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1947132022-12-04T12:36:35Z2022-12-04T12:36:35ZWhy Big Tobacco’s attempts to rehabilitate its image are so dangerous<figure><img src="https://images.theconversation.com/files/497293/original/file-20221124-26-qdjjyu.jpg?ixlib=rb-1.1.0&rect=0%2C319%2C5130%2C3509&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Big Tobacco is still alive and well, despite colossal worldwide efforts for tobacco control measures.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/why-big-tobacco-s-attempts-to-rehabilitate-its-image-are-so-dangerous" width="100%" height="400"></iframe>
<p>In September, Imperial Tobacco Canada, the Canadian subsidiary of <a href="https://www.bat.com/group/sites/UK__9D9KCY.nsf/vwPagesWebLive/DO52AD6H">British American Tobacco</a>, was <a href="https://www.newswire.ca/news-releases/imperial-tobacco-canada-earns-2022-great-place-to-work-r-certification-804619278.html">awarded the “Great Place to Work” certification</a>, one of the leading authorities on workplace culture. </p>
<p>Since then, Imperial Tobacco Canada representatives have met with graduate students across the country, including at the <a href="https://clnx.utoronto.ca/home/slevents.htm?eventId=47253">University of Toronto’s Rotman School of Management</a>, <a href="https://www.linkedin.com/feed/update/urn:li:activity:6975918251058835456?utm_source=share&utm_medium=member_desktop">York University’s Schulich School of Business</a> and <a href="https://www.mcgill.ca/desautels/career/events/jaclyn-fisher-career-day/information-students">McGill University’s Desautels Faculty of Management</a>, urging students to “come join us as we build a better tomorrow.” </p>
<p>As of May 2022, Imperial Tobacco Canada was <a href="https://engage.utoronto.ca/site/SPageServer?pagename=presidents_circle_member_listing#i">listed as a Presidents’ Circle Member on the University of Toronto website</a>, to acknowledge their “vital financial support at the leadership level.” Despite Big Tobacco’s efforts to renormalize itself, we should all be very wary of engaging with the self-described <a href="https://www.bat.com/group/sites/UK__9D9KCY.nsf/vwPagesWebLive/DO8GSFQT">“Bold, Fast, Empowered”</a> corporate culture.</p>
<h2>Suppressing incriminating evidence</h2>
<p>British American Tobacco and other big tobacco companies have <a href="https://www.ucpress.edu/book/9780520270169/golden-holocaust">known about the clear links between smoking and a host of diseases, including cancer,</a> since at least the 1950s. Despite this, they did not disclose their internal damning evidence. </p>
<p>Instead, they aggressively undermined mounting scientific evidence of the public health risks associated with their products through a <a href="https://tobaccotactics.org/">sophisticated array of deceitful strategies and tactics</a>. These included funding dubious research, <a href="https://exposetobacco.org/tobacco-industry-allies/">relying on allies that did not disclose their links</a> to the industry, along with other forms of aggressive lobbying and marketing. </p>
<p>Fast forward 70 years, and tobacco remains the <a href="https://doi.org/10.1016/S0140-6736(22)01438-6">leading cause of cancer worldwide today</a>. Epidemiologist Prabhat Jha <a href="https://www.nejm.org/doi/full/10.1056/NEJMra1308383">estimates that one death results from each million cigarettes sold</a>. </p>
<p>In the first half of 2022 alone, <a href="https://www.bat.com/group/sites/uk__9d9kcy.nsf/vwPagesWebLive/DOCGKBGW/$FILE/medMDCGPNMG.pdf?openelement">British American Tobacco sold 303.4 billion cigarettes globally</a>. Cigarettes kill between <a href="https://www.tobaccofreekids.org/problem/toll-global">one half</a> and <a href="https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-015-0281-z">two-thirds</a> of their users and approximately <a href="https://www.who.int/news-room/fact-sheets/detail/tobacco">eight million people worldwide annually</a>. Big Tobacco is still alive and well, despite the colossal efforts of tobacco control leaders worldwide. This is partly the result of its renormalization strategy.</p>
<figure class="align-center ">
<img alt="Hands holding a box of cigarettes. The box says 'Smoking Causes Mouth Cancer' with a photo of a tongue showing signs of cancer" src="https://images.theconversation.com/files/497294/original/file-20221124-13-d2anaq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/497294/original/file-20221124-13-d2anaq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=388&fit=crop&dpr=1 600w, https://images.theconversation.com/files/497294/original/file-20221124-13-d2anaq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=388&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/497294/original/file-20221124-13-d2anaq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=388&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/497294/original/file-20221124-13-d2anaq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=488&fit=crop&dpr=1 754w, https://images.theconversation.com/files/497294/original/file-20221124-13-d2anaq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=488&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/497294/original/file-20221124-13-d2anaq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=488&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Tobacco remains the leading cause of cancer worldwide today.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Sean Kilpatrick</span></span>
</figcaption>
</figure>
<h2>Big Tobacco’s rebrand</h2>
<p>Big Tobacco companies hit the proverbial rock bottom in the 1990s and early 2000s <a href="https://www.cbc.ca/news/canada/tobacco-firms-to-pay-550m-over-smuggling-1.902510">when facing several</a> <a href="https://www.publichealthlawcenter.org/topics/commercial-tobacco-control/master-settlement-agreement">major</a> <a href="https://www.fightcancer.org/news/department-justice-lawsuit-against-tobacco-industry">lawsuits</a> centred on the massive morbidity and mortality of cigarettes, the industry’s extensive efforts to conceal and manipulate evidence, and its complicity in smuggling its own products around the world.</p>
<p>Another significant blow to the industry was the adoption of the landmark <a href="https://fctc.who.int/publications/i/item/9241591013">World Health Organization Framework Convention on Tobacco Control (WHO FCTC)</a> in 2005, dedicated to reducing tobacco demand and supply. Yet 20 years on, <a href="https://www.theguardian.com/world/2017/jul/11/how-big-tobacco-has-survived-death-and-taxes">Big Tobacco companies continue to</a> <a href="https://www.wsj.com/articles/u-s-tobacco-industry-rebounds-from-its-near-death-experience-1492968698">increase their revenue and profit</a>. </p>
<p>Facing a potential decline post-WHO FCTC, British American Tobacco, Philip Morris International and other Big Tobacco companies <a href="https://doi.org/10.1016%2FS0140-6736(15)60312-9">sought to rebrand themselves from corporate pariahs to socially responsible companies</a> keen on partnering with governments, as well as international organizations, NGOs, and universities. British American Tobacco now claims to “<a href="https://www.bat.com/group/sites/UK__9D9KCY.nsf/vwPagesWebLive/DOBNRDVZ">behave ethically in all we do</a>.” </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/tobacco-industry-rallies-against-illicit-trade-but-have-we-forgotten-its-complicity-38760">Tobacco industry rallies against illicit trade – but have we forgotten its complicity?</a>
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</em>
</p>
<hr>
<p>This rebranding has involved agreements with customs and law enforcement agencies on how to address the illicit trade in tobacco products, <a href="https://www.occrp.org/en/loosetobacco/british-american-tobacco-fights-dirty-in-west-africa">despite significant</a> and <a href="https://www.occrp.org/en/big-trouble-at-big-tobacco/">growing evidence</a> the industry is <a href="https://tobaccotactics.org/wiki/tobacco-smuggling/">still complicit in it</a>. Big Tobacco’s anti-illicit trade efforts have focused on <a href="https://tobaccocontrol.bmj.com/content/28/2/127?rss=1">undermining policy</a>, <a href="https://bat-uncovered.exposetobacco.org/">disrupting competitors and selling more of its own products</a> — not tackling illicit trade per se. </p>
<p>In Canada, Big Tobacco has used the spectre of illicit trade <a href="https://doi.org/10.1080/23311886.2017.1325054">to argue against taxation</a>, <a href="https://www.cmaj.ca/content/188/14/E340">plain packaging</a>, <a href="https://www.cbc.ca/news/canada/new-brunswick/tobacco-menthol-ban-imperial-1.3511069">menthol bans</a> and other effective public health measures, including through third parties (e.g. <a href="https://www.smoke-free.ca/eng_home/2016/Cora-Slides-Annotated.pdf">the National Coalition Against Contraband Tobacco</a>) and <a href="https://lobbycanada.gc.ca/app/secure/ocl/lrs/do/advSrch?V_SEARCH.command=navigate&time=1668615907155">direct lobbying of government officials and parliamentarians</a>.</p>
<h2>Lying about product harms</h2>
<p>Another central part of the tobacco industry’s rebranding focuses on a “smoke-free future” through “risk-reduced products,” notably vaping. However, there are <a href="https://nceph.anu.edu.au/files/E-cigarettes%20health%20outcomes%20review%20summary%20brief%202022.pdf">real health risks associated with vaping,</a> such as exposure to chemicals and increased risk of lung and heart disease. Vaping has a <a href="https://doi.org/10.1016/j.pmedr.2021.101374">particular attraction among young people</a>, putting them more at risk for these diseases. </p>
<figure class="align-center ">
<img alt="Two teenage girls smoking electronic cigarettes in a store." src="https://images.theconversation.com/files/497286/original/file-20221124-16-i9q73o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/497286/original/file-20221124-16-i9q73o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/497286/original/file-20221124-16-i9q73o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/497286/original/file-20221124-16-i9q73o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/497286/original/file-20221124-16-i9q73o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/497286/original/file-20221124-16-i9q73o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/497286/original/file-20221124-16-i9q73o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The chemicals in vapes can result in an increased risk of lung and heart disease. Vaping has become increasingly popular among youths and young adults.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>The tobacco industry has a <a href="https://exposetobacco.org/wp-content/uploads/2019/10/Unsmoke_Brief.pdf">long track record</a> of <a href="https://tobaccotactics.org/wiki/harm-reduction/">blatantly lying about the harms</a> caused by their products. They have repeatedly marketed filtered cigarettes, flavoured cigarettes and other products as tobacco alternatives that present reduced risks to consumers — <a href="https://www.theatlantic.com/health/archive/2017/07/cigarette-filters/533379/">despite evidence later showing this was false</a>. </p>
<p>If anything, vaping products have created a rift within the public health community — an all too familiar “<a href="https://doi.org/10.4337/9781788970464.00010">divide and conquer</a>” strategy of the tobacco industry. Vaping may also serve as a distraction from the continued commercial focus of the industry on deadly cigarettes, which continues to <a href="https://www.bat.com/group/sites/uk__9d9kcy.nsf/vwPagesWebLive/DOCGKBGW/$FILE/medMDCGPNMG.pdf?openelement">account for 84 per cent of British American Tobacco’s revenue</a> worldwide.</p>
<h2>Seeing through the smokescreen</h2>
<p>Given the “fundamental and irreconcilable conflict between the tobacco industry’s interests and public health policy interests,” the WHO has <a href="https://fctc.who.int/publications/m/item/guidelines-for-implementation-of-article-5.3">repeatedly warned state parties to the WHO FCTC</a> — including Canada — against tobacco industry engagement. Yet <a href="https://lobbycanada.gc.ca/app/secure/ocl/lrs/do/cmmLgPblcVw?comlogId=545786">Canadian government officials</a> <a href="https://lobbycanada.gc.ca/app/secure/ocl/lrs/do/cmmLgPblcVw?comlogId=545789">routinely meet with</a> <a href="https://lobbycanada.gc.ca/app/secure/ocl/lrs/do/cmmLgPblcVw?comlogId=500096">tobacco industry representatives</a>. </p>
<p>Experts in Canada consider “renormalization” of tobacco as <a href="https://www.youtube.com/watch?v=RDILWGK0yEs&ab_channel=OntarioTobaccoResearchUnit">one of the great risks to progress in tobacco control</a>. We can’t let ourselves be fooled by the tobacco industry or become indifferent in the face of their attempts to rehabilitate their image.</p>
<p>Instead, we need to demonstrate leadership and make a commitment to hold the tobacco industry to account, and educate the next generation on the Big Tobacco playbook. This means not forgetting that, through the smoke screen, the tobacco industry’s goal remains advancing corporate profit at the expense of public health.</p><img src="https://counter.theconversation.com/content/194713/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Benoît Gomis previously worked on tobacco control research projects funded by the US National Institutes of Health and Bloomberg Philanthropies.</span></em></p><p class="fine-print"><em><span>Jillian Kohler receives funding from SSHRC, the Connaught Global Challenge Award and the WHO and is Director of the WHO Collaborating Center for Governance, Accountability and Transparency in the Pharmaceutical Sector</span></em></p>Big Tobacco’s efforts to rehabilitate its image should not go unchallenged because the tobacco industry’s goal remains advancing corporate profit at the expense of public health.Benoît Gomis, Sessional Lecturer, Munk School of Global Affairs and Public Policy, University of TorontoJillian Kohler, Professor, Faculty of Pharmacy, University of TorontoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1957102022-12-01T06:34:23Z2022-12-01T06:34:23ZBanning menthol cigarettes and more health warnings are only the start. Australia could look to NZ for how to do tobacco control<figure><img src="https://images.theconversation.com/files/498360/original/file-20221130-12-akaqcq.jpg?ixlib=rb-1.1.0&rect=2%2C0%2C1914%2C1279&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/7USMFYqt1NI">Pawel Czerwinski/Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>This week’s <a href="https://www.abc.net.au/news/2022-11-30/government-to-ban-menthol-cigarettes-ugly-colours/101715174">announcement</a> of a raft of new tobacco control measures – including banning menthol products and proposing health warnings on individual cigarettes – are important and welcome.</p>
<p>We applaud Australian Health Minister Mark Butler’s <a href="https://www.croakey.org/wp-content/uploads/2022/12/ButlerSpeechTobacco.pdf">aim</a> to re-establish Australia as a global leader in tobacco control alongside fellow OECD nations, such as New Zealand and Canada.</p>
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<p>His announcement comes <a href="https://theconversation.com/australias-decisive-win-on-plain-packaging-paves-way-for-other-countries-to-follow-suit-140553">a decade after</a> Australia implemented world-leading laws that required all tobacco products to be sold in plain packs.</p>
<p>But there is still scope for more comprehensive action to reduce the burden smoking imposes on Australia and particularly on Australia’s Indigenous peoples.</p>
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Read more:
<a href="https://theconversation.com/we-can-cut-indigenous-smoking-and-save-lives-heres-how-42119">We can cut Indigenous smoking and save lives – here's how</a>
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<h2>We can look to New Zealand</h2>
<p>Aotearoa-New Zealand offers a useful comparison. The NZ parliament aims to pass legislation in mid-December that takes a different approach to the measures Butler outlined this week. </p>
<p>The <a href="https://www.health.govt.nz/our-work/preventative-health-wellness/tobacco-control/smokefree-aotearoa-2025-action-plan">Aotearoa package</a> of measures were developed in close consultation with Māori leaders. These include making cigarettes non-addictive, greatly reducing the number of tobacco retailers, and creating a smoke-free generation. </p>
<p>These policies focus on fundamental drivers of smoking. The measures will also affect everyone in the same way, thus have great potential to reduce pervasive inequities in smoking rates.</p>
<p>Let’s see how Australia’s plans compare with policy reforms under way in New Zealand and Canada.</p>
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Read more:
<a href="https://theconversation.com/forget-tobacco-industry-arguments-about-choice-heres-what-young-people-think-about-nzs-smokefree-generation-policy-193529">Forget tobacco industry arguments about choice. Here's what young people think about NZ's smokefree generation policy</a>
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<h2>New health warnings</h2>
<p>Graphic images on packets of cigarettes were introduced in Australia <a href="https://www.health.gov.au/sites/default/files/evaluation-of-effectiveness-of-graphic-health-warnings-on-tobacco-product-packaging.pdf">16 years ago</a>, and these warnings have encouraged quitting. But they have lost their initial impact. </p>
<p>New and more varied warnings <a href="https://tobaccocontrol.bmj.com/content/28/e1/e71">will refresh</a> this existing policy as will introducing pack inserts providing “how to quit” information, which have been used in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4542677/">Canada since 2012</a>. </p>
<p>In 2023, Canada is set to become the first country to require health warnings to be printed directly on the <a href="https://blogs.bmj.com/tc/2022/07/08/canada-publishes-proposed-regulations-to-require-a-health-warning-directly-on-every-cigarette/">cigarette stick</a>.</p>
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<p>Butler proposes adopting this measure for Australia, but with the addition of making the cigarette paper an <a href="https://tobaccocontrol.bmj.com/content/25/6/699.long">unattractive colour</a>, such as slimy green or faecal yellow-brown. </p>
<p>Like plain packaging, this measure will reduce the appeal of smoking and present smoking as unambiguously harmful and unattractive.</p>
<h2>Tightening up marketing</h2>
<p>Standardising pack size, filters, and banning terms such as “light” and “organic” in brand names will further limit misleading tobacco marketing.</p>
<p>Likewise, measures that eliminate gimmicks – such as flavoured “<a href="https://tobaccocontrol.bmj.com/content/25/3/275">crushballs</a>” inserted in filters that release a burst of flavour when crushed, or packs that include “bonus” cigarettes to offer a better deal – will further limit how tobacco companies promote their products.</p>
<p>Banning some flavouring additives, <a href="https://theconversation.com/the-us-fda-has-moved-to-ban-menthol-cigarettes-australia-should-do-that-and-more-182435">particularly menthol</a>, will reduce the appeal of smoking for some consumers. </p>
<p>When Canada banned menthol cigarettes federally in 2017, this measure <a href="https://tobaccocontrol.bmj.com/content/early/2022/04/27/tobaccocontrol-2021-057227.long">increased quitting</a> among people who smoked menthol cigarettes.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/the-us-fda-has-moved-to-ban-menthol-cigarettes-australia-should-do-that-and-more-182435">The US FDA has moved to ban menthol cigarettes. Australia should do that and more</a>
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<h2>More transparency</h2>
<p>Tobacco companies will need to disclose tobacco sales volumes and pricing, as required in <a href="https://www.health.govt.nz/our-work/preventative-health-wellness/tobacco-control/tobacco-returns">Aotearoa-New Zealand</a>. </p>
<p>Companies will also need to disclose their advertising, promotion and sponsorship activities, as well as product ingredients and emissions. </p>
<p>These moves all reveal important <a href="https://tobaccocontrol.bmj.com/content/early/2022/08/25/tc-2021-057232.info">tobacco company activities</a> that undermine public health efforts. </p>
<p>They will also provide key information about what is in tobacco products, as required by the World Health Organization’s <a href="https://untobaccocontrol.org/impldb/article-10/">Framework Convention on Tobacco Control</a>.</p>
<h2>Vaping ads to be banned</h2>
<p>The final measure will apply tobacco advertising bans to vaping products. This policy will reduce inappropriate promotion of these products, including to young people. </p>
<p>This measure is in addition to, and separate from, the <a href="https://www.tga.gov.au/news/media-releases/tga-consults-potential-nicotine-vaping-product-regulatory-reforms">current review</a> of Australia’s regulation of nicotine vaping products. Addressing the rising problem of vaping among <a href="https://theconversation.com/we-asked-over-700-teens-where-they-bought-their-vapes-heres-what-they-said-190669">young people</a> is a key concern and efforts to reduce youth use are urgently needed.</p>
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Read more:
<a href="https://theconversation.com/we-asked-over-700-teens-where-they-bought-their-vapes-heres-what-they-said-190669">We asked over 700 teens where they bought their vapes. Here's what they said</a>
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<h2>There’s more to do</h2>
<p>These advances in Australian tobacco control policy align with measures implemented a decade ago in Canada or that are soon to start. We welcome such measures that make smoking less appealing and encourage quitting. </p>
<p>However, bigger jumps are required if Australia is to lead on eradicating the harms smoking causes. These initial measures announced also do not have a clear equity focus, such as the measures being implemented in Aotearoa-New Zealand. These have a bolder ambition of rapidly reducing smoking among both Māori and non-Māori peoples to less than <a href="https://www.smokefree.org.nz/smokefree-in-action/smokefree-aotearoa-2025">5% by 2025</a>.</p>
<p>Aotearoa-New Zealand’s proposed law will fundamentally change tobacco products by reducing the nicotine content to <a href="https://doi.org/10.1016/j.drugpo.2021.103436">non-addictive levels</a>. The law also dramatically reduces tobacco availability by decreasing the number of tobacco retailers by at least 90%, and will make it illegal to sell tobacco to anyone born after December 31 2008. </p>
<p><a href="https://theconversation.com/new-zealands-tobacco-endgame-law-will-be-a-world-first-for-health-heres-what-the-modelling-shows-us-187075">Modelling</a> indicates that Aotearoa-New Zealand’s package of measures are likely to achieve their goal of rapidly phasing out tobacco smoking.</p>
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<strong>
Read more:
<a href="https://theconversation.com/new-zealands-tobacco-endgame-law-will-be-a-world-first-for-health-heres-what-the-modelling-shows-us-187075">New Zealand’s ‘tobacco endgame’ law will be a world first for health – here’s what the modelling shows us</a>
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<p>These measures go far beyond those Butler proposes for Australia. In particular, removing the product’s addictiveness and reducing availability means casual experimentation among young people will not lead to addiction, and quitting will become much easier for people who currently smoke.</p>
<p>The package of measures announced this week will continue declines in smoking following the “tried and tested” strategy of incrementally ratcheting up restrictions on tobacco products. </p>
<p>In contrast, the Aotearoa approach is a “Tobacco Moonshot” that aims to finish the job of ending the tobacco smoking epidemic in Aotearoa-New Zealand.</p>
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<p><em>The authors would like to acknowledge Tony Blakely, University of Melbourne, and Andrew Waa, University of Otago, for helpful comments and suggestions.</em></p><img src="https://counter.theconversation.com/content/195710/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Coral Gartner receives funding from National Health and Medical Research Council and Australian Research Council. She is an editor for Tobacco Control, A BMJ journal.</span></em></p><p class="fine-print"><em><span>Janet Hoek receives funding from the Health Research Council of New Zealand and the NZ Cancer Society. She has also received funding from the Royal Society Marsden Fund. She is a member of the Health Coalition Aotearoa's Smokefree Expert Advisory Group and sits on several other advisory groups whose work supports the NZ Aotearoa Government's goal of realising a smokefree nation by 2025. </span></em></p><p class="fine-print"><em><span>Richard Edwards receives funding from the Health Research Council of New Zealand, the NZ Cancer Society, and from the National Institute of Health (USA). He has also received funding from the Royal Society Marsden Fund. He is a member of the Health Coalition Aotearoa's Smokefree Expert Advisory Group and sits on several other advisory groups whose work supports the NZ Aotearoa Government's goal of realising a smokefree nation by 2025.</span></em></p>Australia’s approach is welcome but doesn’t go far enough. New Zealand’s plans are much bolder. Here’s how they compare.Coral Gartner, Director, NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, The University of QueenslandJanet Hoek, Professor of Public Health, University of OtagoRichard Edwards, Professor of Public Health, University of OtagoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1867042022-08-04T12:21:07Z2022-08-04T12:21:07ZThe US government’s call for deep nicotine reduction in cigarettes could save millions of lives – an expert who studies tobacco addiction explains<figure><img src="https://images.theconversation.com/files/476774/original/file-20220730-28629-fb4hod.jpg?ixlib=rb-1.1.0&rect=246%2C49%2C5223%2C3572&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A 95% reduction in the nicotine content of cigars and cigarettes would make these tobacco products largely nonaddictive.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com.mx/detail/foto/cigarette-butts-overflowing-outdoor-ashtray-imagen-libre-de-derechos/520644430?adppopup=true">Robert Recker/The Image Bank via Getty Images</a></span></figcaption></figure><p>The cigarette is the only legal consumer product that – when used as intended – causes the premature death of half of long-term users. </p>
<p>To address this long-standing health threat, in late June 2022, the Biden-Harris administration <a href="https://www.fda.gov/news-events/press-announcements/fda-announces-plans-proposed-rule-reduce-addictiveness-cigarettes-and-other-combusted-tobacco">announced a plan</a> to move forward with a new standard for cigarettes and other combusted tobacco products that would make them minimally or nonaddictive. </p>
<p>A similar nicotine-reduction strategy has also recently been announced by the government of New Zealand and was <a href="https://blogs.otago.ac.nz/pubhealthexpert/removing-the-nicotine-from-tobacco-the-key-component-of-the-current-smokefree-bill/">described as the key component</a> of the country’s new smoke-free plan.</p>
<p>The Biden-Harris proposal was predated by <a href="https://doi.org/10.1056/NEJMp1707409">an earlier plan</a> in 2017 during Trump’s presidency to reduce the permissible nicotine content in cigarettes. <a href="https://www.ted.com/talks/mitch_zeller_the_past_present_and_future_of_nicotine_addiction?language=en">Mitch Zeller</a>, the director of the Food and Drug Administration’s Center for Tobacco Products from 2013 to April 2022, stated in 2019 that “this one rule could have the greatest impact on public health in the history of public health.”</p>
<p>So what does the proposal mean in practice? When implemented – likely not for at least another three years – it would mean that all cigarettes and cigars sold in the United States will have to contain approximately 95% less nicotine than they currently do. As nicotine is the addictive substance in tobacco, this would mean that these tobacco products would become pretty much nonaddictive. No more young people would become addicted to cigarettes and current smokers would find it much easier to quit. </p>
<p>As a <a href="https://scholar.google.com/citations?user=oYyjpUUAAAAJ&hl=en">professor of public health sciences</a> who has been doing research on smoking cessation for over 30 years, I am impressed by any intervention that increases the quit rate among smokers with no plans to quit. In one of our recent randomized clinical trials of very low-nicotine cigarettes, my research team at Penn State, along with colleagues at Harvard, found that those assigned to use them were more than <a href="https://doi.org/10.1101/2022.05.24.22275536">four times as likely to quit smoking</a> as those who smoked normal nicotine cigarettes. </p>
<p>Research suggests that the full public health benefits of a successfully implemented reduced nicotine standard for cigarettes could be enormous. </p>
<p>A 2018 FDA study projected that by the year 2060, a reduced nicotine standard for cigarettes <a href="https://doi.org/10.1056/NEJMsr1714617">could reduce the smoking rate dramatically</a> – from around 13% now to below 2%, preventing 16 million people from becoming regular smokers and preventing more than 2.8 million tobacco-caused deaths. </p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/vUx-b89laPU?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Along with heart disease, stroke and cancer, smoking can cause infertility, erectile dysfunction, cataracts, premature aging, hair loss and tooth loss.</span></figcaption>
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<h2>Not just a ‘light’ or ‘low-tar’ cigarette</h2>
<p>The proposed standard would not simply result in something akin to a “light” cigarette. Light cigarettes, which have been marketed for decades, contain <a href="https://doi.org/10.1136/tc.7.4.369">about the same amount of nicotine</a> as regular cigarettes – about 10 to 15 milligrams per cigarette. To comply with the new standard, a cigarette will likely be required to contain <a href="https://doi.org/10.1093%2Fntr%2Fntz045">less than 0.5 milligrams of nicotine</a>. </p>
<p>So-called “light” or “low-tar” cigarettes have tiny holes in the filter that allow air flow into the filter to dilute the smoke. When smoked by a machine, light cigarettes deliver lower levels of tar and nicotine per puff. However, when held by a human, the holes are often blocked by the fingers, and smokers can easily puff a bit harder to <a href="https://doi.org/10.1158/1055-9965.epi-04-0667">inhale the same amount</a> of nicotine and tar.</p>
<p>Some skeptics of the proposed nicotine reductions have raised the concern that smokers might just smoke reduced-nicotine-content cigarettes more intensely, as they do with “light” cigarettes. However, dozens of research studies have shown that with very low-nicotine-content cigarettes, smokers <a href="https://doi.org/10.1016%2Fj.drugpo.2021.103436">do not increase their smoke intake</a>. </p>
<p>Instead, over a short period of time, smokers learn that the very low-nicotine cigarette is not very satisfying, and <a href="https://doi.org/10.1001/jama.2018.11473">they gradually reduce their smoking</a>. In randomized trials, those using very low-nicotine-content cigarettes are also <a href="https://doi.org/10.1101/2022.05.24.22275536">more likely to quit</a>. </p>
<h2>A role for e-cigarettes</h2>
<p>When nicotine reduction in cigarettes was initially proposed under the Trump administration, Zeller and former FDA director Scott Gottlieb recognized that one of the main challenges to the success of this plan was the possibility that the regulation might give rise to an illicit market for high-nicotine cigarettes. </p>
<p>Zeller and Gottlieb understood that one critical way to keep that from happening is to allow nonsmoked nicotine products – like electronic cigarettes – to remain on the market. E-cigarettes deliver a satisfying amount of nicotine for smokers while exposing the user to significantly <a href="https://nap.nationalacademies.org/resource/24952/012318ecigaretteConclusionsbyEvidence.pdf">lower amounts of toxic substances</a> than regular cigarettes. As a result, e-cigarettes are likely to be significantly less harmful. </p>
<p>New research by our team, along with colleagues at Virginia Commonwealth University, recently found that when smokers with no plans to quit use <a href="https://doi.org/10.1093/ntr/ntab247">electronic cigarettes</a> with cigarettelike nicotine delivery, a greater proportion completely quit smoking than those using zero-nicotine e-cigarettes or no e-cigarette.</p>
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<figcaption><span class="caption">Exercise and support from family and friends – along with the nicotine patch – are a few of the strategies this smoker used to quit.</span></figcaption>
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<h2>The controversy over e-cigarettes</h2>
<p>The potential for e-cigarettes to help replace smoking explains why it came as a surprise to many when – two days after the Biden-Harris announcement in June to drastically reduce the permissible nicotine content in cigarettes – the FDA then announced that it was <a href="https://www.fda.gov/news-events/press-announcements/fda-denies-authorization-market-juul-products">effectively banning all sales</a> of Juul, the enormously popular e-cigarette that has been the biggest selling e-cigarette brand over the past five years. When Juul appealed the decision, the <a href="https://www.statnews.com/2022/06/24/court-rules-juul-can-sell-e-cig-while-challenges-fda-ban/">FDA suspended the denial order until an additional review is completed</a>, which is expected to take months. </p>
<p>And Juul is not the only e-cigarette to be threatened with a ban. Of the millions of e-cigarette applications submitted to the FDA by the deadline in September 2020, more than 99% <a href="https://www.fda.gov/tobacco-products/ctp-newsroom/fda-issues-marketing-denial-orders-fontem-us-myblu-products">have been denied</a>. </p>
<p>The reason the FDA’s e-cigarette ban is so puzzling and counterintuitive in the context of the FDA’s nicotine-reduction efforts in cigarettes is that the availability of e-cigarettes is critical to the feasibility of that plan.
Many researchers, including me, believe that having a variety of legal, regulated high-nicotine e-cigarettes on the market is a critical element in <a href="https://doi.org/10.2105%2FAJPH.2019.305067">reducing consumer demand</a> for illegal high-nicotine smoked products. </p>
<p>Health authorities in other parts of the world, including <a href="https://www.gov.uk/government/publications/the-khan-review-making-smoking-obsolete/making-smoking-obsolete-summary">the United Kingdom</a> and New Zealand, have recognized the important role that e-cigarettes can play in reducing cigarette smoking. New Zealand’s <a href="https://blogs.otago.ac.nz/pubhealthexpert/removing-the-nicotine-from-tobacco-the-key-component-of-the-current-smokefree-bill/">nicotine-reduction plan</a> explicitly includes providing access to alternative nicotine products like e-cigarettes. </p>
<p>Research shows that e-cigarettes are <a href="https://nap.nationalacademies.org/resource/24952/012318ecigaretteConclusionsbyEvidence.pdf">much less harmful</a> than cigarettes, and they are proved to <a href="https://www.cochrane.org/CD010216/TOBACCO_can-electronic-cigarettes-help-people-stop-smoking-and-do-they-have-any-unwanted-effects-when-used">help smokers transition</a> from highly toxic cigarettes. It is therefore highly likely to be appropriate for the protection of public health to keep a variety of e-cigarette brands on the market until after the nicotine reduction plan for cigarettes has been successfully implemented. </p>
<p>As we pass <a href="https://lcfamerica.org/get-involved/events/world-lung-cancer-day/">World Lung Cancer Day</a>, quietly as usual, I believe we now have a plan that could do more than anything else to reduce the number of deaths each year from that horrible disease. It is a plan that has been proposed by Republican and Democratic administrations alike and is supported by the best available science. In my view, implementation of a reduced-nicotine standard for combustible tobacco represents the possibility of finally bringing an end to cigarette addiction within our lifetimes.</p><img src="https://counter.theconversation.com/content/186704/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jonathan Foulds receives research funding from the U.S. National Institutes of Health, and has previously done consulting for pharmaceutical companies that manufacture smoking cessation medicines.</span></em></p>The proposed standard would lower the nicotine content in cigarettes and cigars by 95% – a public health proposal that could prevent millions from becoming smokers in the first place.Jonathan Foulds, Professor of Public Health Sciences and Psychiatry, Penn StateLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1870752022-07-26T05:44:00Z2022-07-26T05:44:00ZNew Zealand’s ‘tobacco endgame’ law will be a world first for health – here’s what the modelling shows us<figure><img src="https://images.theconversation.com/files/475798/original/file-20220725-26-do4gpv.jpg?ixlib=rb-1.1.0&rect=17%2C8%2C5973%2C3898&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Getty Images</span></span></figcaption></figure><p>With the first reading of a new bill in parliament today, Aotearoa New Zealand’s plan to be smokefree by 2025 takes another tangible step forward.</p>
<p>The <a href="https://www.parliament.nz/en/pb/bills-and-laws/bills-proposed-laws/document/BILL_125245/smokefree-environments-and-regulated-products-smoked-tobacco">Smokefree Environments and Regulated Products (Smoked Tobacco) Amendment Bill</a> will now go to the Health Select Committee for submissions and review, and (presumably) return to the House in late 2022 to be passed into law.</p>
<p>Assuming the final legislation looks similar to what is being proposed, it will mean Aotearoa New Zealand leapfrogs all other countries to be at the vanguard of tobacco control, with policy settings aimed at getting smoking prevalence beneath 5% of the adult population within years (not decades).</p>
<p>The bill provides for three key strategies: </p>
<ul>
<li><p>drastically reducing nicotine content in tobacco so it is no longer addictive (known as “denicotinisation” or “very low nicotine cigarettes” (VLNC))</p></li>
<li><p>a 90% to 95% reduction in the number of shops that can sell tobacco</p></li>
<li><p>making it illegal to sell tobacco to people born in 2009 or later (thus creating a “smokefree generation”). </p></li>
</ul>
<p>If implemented effectively this is anticipated to have a profound impact on smoking.</p>
<p><strong>Projected declines in smoking</strong></p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/475749/original/file-20220724-31994-xnouom.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/475749/original/file-20220724-31994-xnouom.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/475749/original/file-20220724-31994-xnouom.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=365&fit=crop&dpr=1 600w, https://images.theconversation.com/files/475749/original/file-20220724-31994-xnouom.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=365&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/475749/original/file-20220724-31994-xnouom.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=365&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/475749/original/file-20220724-31994-xnouom.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=459&fit=crop&dpr=1 754w, https://images.theconversation.com/files/475749/original/file-20220724-31994-xnouom.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=459&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/475749/original/file-20220724-31994-xnouom.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=459&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Projected effects of the combined endgame interventions on smoking prevalence to be introduced in 2023. Likely delays in implementation will shift the curves to the right commensurately.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<h2>Reducing Māori health inequity</h2>
<p>If successful, this would be a monumental achievement for generations of tobacco-control advocates and researchers. The concept of a “tobacco endgame” will move beyond aspiration and into reality.</p>
<p>We’ve got to this point after decades of Māori leadership, research and advocacy, with the proposed legislation having its roots in the aim of reducing health inequities between Māori and non-Māori. This kaupapa (principle or policy) has driven the process and is supported by Māori communities.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/new-zealand-is-introducing-law-to-create-a-smokefree-generation-here-are-6-reasons-to-support-this-policy-186283">New Zealand is introducing law to create a smokefree generation. Here are 6 reasons to support this policy</a>
</strong>
</em>
</p>
<hr>
<p>Much more will be written in coming months about this groundbreaking legislation. Here we focus on the <a href="https://www.medrxiv.org/content/10.1101/2022.07.17.22277571v1">modelling we were commissioned to provide</a> by the New Zealand government in 2021-2022 on the potential health and cost impacts of the <a href="https://www.health.govt.nz/our-work/preventative-health-wellness/tobacco-control/smokefree-aotearoa-2025-action-plan">Smokefree Aotearoa 2025 Action Plan</a>. </p>
<p>Our findings underpinned the <a href="https://www.health.govt.nz/about-ministry/information-releases/regulatory-impact-statements/regulatory-impact-statement-smokefree-aotearoa-2025-action-plan">regulatory impact statement</a> that set out the options to regulate tobacco products as part of the action plan, which Cabinet considered in early 2022.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1468729272575479809"}"></div></p>
<h2>Large reductions in mortality rates</h2>
<p>In our work at Otago University’s <a href="https://www.otago.ac.nz/wellington/departments/publichealth/research/bode3/">BODE3 program</a> and the University of Melbourne’s Scalable Health Intervention Evaluation (<a href="https://mspgh.unimelb.edu.au/centres-institutes/centre-for-epidemiology-and-biostatistics/research-group/shine?referrer=301_redirect">SHINE</a>) we model many potential public health interventions, from dietary counselling and reducing salt in bread to the evaluation of screening programmes and drug treatments. </p>
<p>We tally the likely health gains from these interventions, and how much they might reduce inequities in health. When we do this for the government’s tobacco endgame strategy, the forecasts are breathtaking.</p>
<p>Consider reductions in health inequities between Māori and non-Māori. First, we forecasted what Māori and non-Māori mortality rates will be in 2040 (and beyond) given trends we have seen in recent decades (business as usual in the graph above).</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-fda-and-juul-are-fighting-over-a-vape-ban-but-the-role-of-e-cigarettes-in-the-world-of-tobacco-abuse-is-not-clear-cut-185836">The FDA and Juul are fighting over a vape ban, but the role of e-cigarettes in the world of tobacco abuse is not clear-cut</a>
</strong>
</em>
</p>
<hr>
<p>Second, we estimated how much smoking (and vaping) rates would change into the future for the combined endgame policy (denicotinisation, retail reduction, smokefree generation regulations, augmented by some media promotion of the policy). </p>
<p>Third, allowing for time lags, we modelled future disease rates (for example, lung and heart disease) and then the overall impact on mortality rates.</p>
<p>We then compared the gap between Māori and non-Māori mortality or death rates in 2040 if there were no major policy changes, and under the combined tobacco endgame strategy. For those aged 45 and over, the gap was reduced by a staggering 22.9% for Māori females compared to non-Māori females, and a still very large 9.6% for males.</p>
<p><strong>Projected decline in gap between Māori and non-Māori mortality rates</strong></p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/475750/original/file-20220724-55427-1x8b2z.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/475750/original/file-20220724-55427-1x8b2z.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/475750/original/file-20220724-55427-1x8b2z.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=467&fit=crop&dpr=1 600w, https://images.theconversation.com/files/475750/original/file-20220724-55427-1x8b2z.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=467&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/475750/original/file-20220724-55427-1x8b2z.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=467&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/475750/original/file-20220724-55427-1x8b2z.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=586&fit=crop&dpr=1 754w, https://images.theconversation.com/files/475750/original/file-20220724-55427-1x8b2z.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=586&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/475750/original/file-20220724-55427-1x8b2z.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=586&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Projected effects of the combined endgame interventions on the percentage change in the mortality rate difference between Māori and non-Māori aged 45 and up.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<h2>Longer, healthier lives</h2>
<p>In all our previous research, we have never seen a single health intervention with the potential to reduce health inequities this much. </p>
<p>Why is a tobacco endgame so powerful at reducing Māori and non-Māori health inequities? Because smoking is so bad for health, smoking rates are particularly high among Māori, and Māori also have higher smoking-related disease rates. </p>
<p>Therefore, Māori see more health gains from the dramatic falls in tobacco smoking that will result from the policy. (Non-Māori also see large gains – just not as much per capita as Māori.)</p>
<p>What about overall health gains? Our modelling suggests that, over the remaining lifespan of the New Zealand population alive in 2020, the tobacco endgame strategy will result in an extra 600,000 “health-adjusted life years” lived (a measure of the impact of those interventions on life expectancy, adjusted for quality of life). </p>
<p>To put this in perspective, this amount of health gain – accruing just to those people quitting smoking earlier or not taking it up, a minority of the population – is equivalent to the <a href="https://www.thelancet.com/article/S2468-2667(20)30116-X/fulltext">health gains that would result</a> from a policy taxing sugar, fat and salt in all foods and removing the GST on healthy food. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-can-we-reverse-the-vaping-crisis-among-young-australians-enforce-the-rules-185867">How can we reverse the vaping crisis among young Australians? Enforce the rules</a>
</strong>
</em>
</p>
<hr>
<h2>Major health system savings</h2>
<p>Not only is this endgame policy increasing the health of the nation, it is also reducing future health expenditure. </p>
<p>We estimated NZ$1.3 billion of health system costs would be avoided in the next 20 years. These savings can be used for other things, such as mental health and dementia care.</p>
<p>And while the government will lose tax revenue from drastically reduced tobacco sales, the overall health of the population increases, meaning more people are in work for longer. We estimated an income gain to the New Zealand population of $1.4 billion in the next 20 years, which means more tax revenue as well.</p>
<p>All modelling of the future is uncertain. But even allowing for that uncertainty, the health gains, the health inequity reductions, the savings in health expenditure, and the increased income productivity of New Zealanders that will result from this tobacco endgame strategy will be large.</p><img src="https://counter.theconversation.com/content/187075/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Legislation now entering parliament aims to make Aotearoa New Zealand smokefree by 2025. Forecast effects show huge potential health gains, especially for Māori.Tony Blakely, Professor of Epidemiology, Population Interventions Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of MelbourneAndrew Waa, Lecturer in Public Health, University of OtagoDriss Ait Ouakrim, Senior Research Fellow, Population Interventions Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1858362022-06-29T12:05:04Z2022-06-29T12:05:04ZThe FDA and Juul are fighting over a vape ban, but the role of e-cigarettes in the world of tobacco abuse is not clear-cut<figure><img src="https://images.theconversation.com/files/471462/original/file-20220628-14487-w1q3rk.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C3862%2C2058&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">It is illegal for people under 21 to smoke e-cigarettes like Juuls, but adult use has come under scrutiny, too.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/labs-inc-virginia-tobacco-and-menthol-flavored-vaping-e-news-photo/1241480667?adppopup=true">Patrick T. Fallon/AFP via Getty Images</a></span></figcaption></figure><p><em>On June 23, 2022, the U.S. Food and Drug Administration announced that all Juul products must be removed from U.S. markets. This decision essentially broadened an existing ban on teen use of the company’s nicotine e-cigarettes to include adults as well. The next day, Juul asked a federal appeals court to temporarily block the ban while Juul challenged the decision. The court agreed to the pause, and for now, Juul products are still for sale in the U.S.</em> </p>
<p><em><a href="https://scholar.google.com/citations?user=0xNYzqcAAAAJ&hl=en&oi=ao">Lynn Kozlowski</a> of the University at Buffalo has been studying nicotine and cigarette addiction for decades. He explains how the recent fight over Juul products fits into the larger discussion of e-cigarettes, tobacco use and public health among adults and teens.</em> </p>
<h2>Why does the FDA want to stop the sale of Juul products?</h2>
<p>According to the FDA, <a href="https://www.fda.gov/news-events/press-announcements/fda-denies-authorization-market-juul-products">the decision</a> was a precautionary response due to a lack of “sufficient evidence regarding the toxicological profile of the products” to ensure protection of public health. The FDA also noted that it hadn’t received any information suggesting Juul products were an “immediate hazard.” </p>
<p>In the announcement, FDA commissioner Robert M. Califf commented on the effects Juul products have had on youth vaping. And this decision comes at a time when some have hoped that a new ban on Juul products and other e-cigarettes for adults would <a href="https://thehill.com/policy/healthcare/3533490-advocates-cautiously-optimistic-over-report-of-juul-ban/">help reduce vaping by teens</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/471477/original/file-20220628-14646-f617li.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman exhaling a cloud of vapor while holding a Juul e-cigarette." src="https://images.theconversation.com/files/471477/original/file-20220628-14646-f617li.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/471477/original/file-20220628-14646-f617li.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/471477/original/file-20220628-14646-f617li.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/471477/original/file-20220628-14646-f617li.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/471477/original/file-20220628-14646-f617li.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/471477/original/file-20220628-14646-f617li.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/471477/original/file-20220628-14646-f617li.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">E-cigarettes are not without health concerns, but evidence suggests they are much less harmful to health than tobacco cigarettes.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/JuulUnprovenAds/9385f3bb9b4b430db36127fb491c34b3/photo?Query=19129612472205&mediaType=photo&sortBy=&dateRange=Anytime&totalCount=1&currentItemNo=0">AP Photo/Craig Mitchelldyer</a></span>
</figcaption>
</figure>
<h2>How do the health risks of vaping compare to smoking?</h2>
<p>Cigarettes kill at least 1-in-2 smokers prematurely and <a href="https://doi.org/10.7554%2FeLife.49979">cut smoker’s lives short by an average of 10 years</a> due to cancer, obstructive lung disease and cardiovascular disease. </p>
<p>There is not yet any long-term epidemiological data available on e-cigarettes. But <a href="https://nap.nationalacademies.org/catalog/24952/public-health-consequences-of-e-cigarettes">U.S.</a> and <a href="https://www.rcplondon.ac.uk/projects/outputs/rcp-advice-vaping-following-reported-cases-deaths-and-lung-disease-us">British</a> assessments have concluded that while vaping is likely to be substantially less harmful than cigarettes, it is not risk-free. Potential harms include nicotine addiction as well as <a href="https://doi.org/10.1038%2Fnrcardio.2017.36">some cardiovascular risks</a>, though these are estimated to be lower than risks from cigarettes.</p>
<h2>Could e-cigarettes reduce harm of normal smoking?</h2>
<p>I do not encourage that anyone vape if they do not need to. But if someone would otherwise smoke cigarettes, and vaping helps them stop smoking completely, e-cigarettes <a href="https://doi.org/10.2105/AJPH.2021.306416">can be a useful tool for reducing the smoking and health problem</a>. Quitting cigarettes is unequivocally good for your health. Research shows that if a person stops using cigarettes by age 40, they on average avoid 90% of the increased risk of death compared to if they continued smoking. If a person stops smoking cigarettes by age 30, their health risks are <a href="https://doi.org/10.7554%2FeLife.49979">nearly the same as a person who never smoked</a>. </p>
<p>The CDC says that there is <a href="https://www.cdc.gov/tobacco/sgr/2020-smoking-cessation/fact-sheets/pdfs/adult-smoking-cessation-e-cigarettes-use-h.pdf">limited evidence</a> that vaping <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010216.pub4/full">helps people quit smoking cigarettes</a>. The FDA, in <a href="https://www.fda.gov/tobacco-products/premarket-tobacco-product-applications/premarket-tobacco-product-marketing-granted-orders">approving some e-cigarettes for sale</a>, expresses the view that e-cigarettes can be a beneficial tool for smokers who significantly reduce their cigarette use or stop smoking by switching to e-cigarettes.</p>
<p>Recent studies have also shown that e-cigarettes are <a href="https://doi.org/10.1056/NEJMoa1808779">more effective</a> than <a href="https://doi.org/10.1002/14651858.CD010216.pub4">nicotine replacement medicines</a> in helping people who want to quit smoking. The <a href="https://www.nhs.uk/live-well/quit-smoking/using-e-cigarettes-to-stop-smoking/">National Health Service</a> in the United Kingdom includes vaping as an approved way to quit smoking.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/471479/original/file-20220628-14763-2ssibp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Numerous types of vapes on a desk." src="https://images.theconversation.com/files/471479/original/file-20220628-14763-2ssibp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/471479/original/file-20220628-14763-2ssibp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=396&fit=crop&dpr=1 600w, https://images.theconversation.com/files/471479/original/file-20220628-14763-2ssibp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=396&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/471479/original/file-20220628-14763-2ssibp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=396&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/471479/original/file-20220628-14763-2ssibp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=497&fit=crop&dpr=1 754w, https://images.theconversation.com/files/471479/original/file-20220628-14763-2ssibp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=497&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/471479/original/file-20220628-14763-2ssibp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=497&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Vaping is popular with high school students – as shown in this photo of vapes confiscated at a New York high school – but it is on the decline.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/NewYork-E-Cigarettes/4112231cb80f43afbaef95f1cc537c05/photo?Query=e-cigarette&mediaType=photo&sortBy=&dateRange=Anytime&totalCount=515&currentItemNo=29">AP Photo/Steven Senne,</a></span>
</figcaption>
</figure>
<h2>Is vaping among teens as popular as it once was?</h2>
<p>Teen vaping is on <a href="https://www.nytimes.com/2021/09/30/health/youth-vaping-decline.html#">a downward trend</a>. Data from the CDC showed that in 2019, 27.5% of high school students reported vaping at least once in the previous month. That number fell to 19.6% in 2020 and to 11.3% in 2022. Just over a one-quarter of monthly users – or about 3% of high school students in 2022 – report vaping on a daily basis.</p>
<p>Some of these decreases were likely due to COVID-19, enforcement of restrictions on youth access and <a href="https://doi.org/10.3389%2Ffcomm.2019.00075">government anti-vaping campaigns</a>. </p>
<p><a href="https://doi.org/10.1093/ntr/ntac088">Widespread publicity</a> about a <a href="https://theconversation.com/vaping-likely-has-dangers-that-could-take-years-for-scientists-to-even-know-about-123051">serious lung disease caused by vaping</a>, called EVALI, very likely turned many away from vaping. This was despite the fact that research eventually showed the disease was mostly <a href="https://doi.org/10.1111/add.15108">caused by black market cannabis vaping products</a>. </p>
<h2>Does teen vaping increase teen tobacco use?</h2>
<p>Despite the encouraging drop in teen vaping, an important question to ask is whether vaping directly leads to later cigarette smoking.</p>
<p>Parents are justly concerned that vaping could be a gateway to smoking. But <a href="https://theconversation.com/vaping-as-a-gateway-to-smoking-is-still-more-hype-than-hazard-47399">research doesn’t seem to support a strong causal connection</a>. While vaping surged nationally in recent years, <a href="https://doi.org/10.1001%2Fjamanetworkopen.2020.27465">smoking rates fell</a>.</p>
<p>Using several years of U.S. data from the National Youth Tobacco Survey on almost 40,000 participants, researchers found that less than 1% of those who first used e-cigarettes <a href="https://doi.org/10.1136%2Ftobaccocontrol-2019-055283">went on the become established cigarette smokers</a>. People who vaped first were also less likely to become smokers than those who had tried cigarettes or other tobacco products first.</p>
<p>Another large study of U.S. youth found that a history of e-cigarette use was associated with only <a href="https://doi.org/10.1093%2Fntr%2Fntab243">modest or nonsignificant increases in cigarette smoking</a> once the researchers controlled for general risk-taking behavior.</p>
<h2>How do you balance adult use with teen safety?</h2>
<p>Even if vaping is not a big factor in causing teens to become smokers, teen use of vaping products is a concern despite a ban on the sales of e-cigarettes to people under 21 in 2019. </p>
<p>Completely banning a product that is useful for adult smokers who are looking to quit is not the only way to help reduce youth access. <a href="https://doi.org/10.1056/NEJMp2119107">One proposal</a>, for example, suggests moving the sales of all nicotine and tobacco products to stores that are only accessible to those 21 or older.</p>
<p>While products like Juul deserve study and regulation, it is important to keep in mind the proven deadliness and easy availability of cigarettes – both to adults today and to the many teens who start smoking every year and will become adult smokers. Getting as many smokers as possible off tobacco cigarettes will save lives.</p><img src="https://counter.theconversation.com/content/185836/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lynn T. Kozlowski receives no external funding at the present time.</span></em></p>E-cigarettes are facing calls for complete bans on their sale. A tobacco addiction researcher explores the balance between vaping’s harm to teens and potential use as a tool for quitting smoking.Lynn T. Kozlowski, Professor of Community Health and Health Behavior, University at BuffaloLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1848742022-06-14T13:28:39Z2022-06-14T13:28:39ZSmoking age: here’s what effect raising it to 21 could have in England<figure><img src="https://images.theconversation.com/files/468769/original/file-20220614-24-t1dx6b.jpg?ixlib=rb-1.1.0&rect=0%2C14%2C9504%2C5434&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Raising the smoking age is just one of 15 proposals to help England become smoke-free by 2030.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-hispanic-man-breaking-cigarette-hands-1931685242">Krakenimages.com/ Shutterstock</a></span></figcaption></figure><p>Smoking is one of the leading causes of <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandlifeexpectancies/bulletins/adultsmokinghabitsingreatbritain/2019">preventable death in the UK</a> – accounting for nearly 100,000 deaths each year. In England alone, smoking caused nearly 75,000 deaths in 2020. In economic terms, smoking costs the economy an estimated <a href="https://ilcuk.org.uk/smoking-costs-uk-economy-in-excess-of-19-billion-a-year-new-report-finds/">£19 billion a year</a> – with smoking-related health issues alone costing the NHS around £6 billion per year. Given the significant burden caused by smoking, it’s no wonder the government wants to make England <a href="https://www.gov.uk/government/news/independent-review-published-to-help-meet-2030-smokefree-target">smoke-free by 2030</a>. <a href="https://gov.wales/ambition-make-wales-smoke-free-2030-smoking-remains-leading-cause-premature-deaths">Wales</a> and <a href="https://www.gov.scot/publications/raising-scotlands-tobacco-free-generation-tobacco-control-action-plan-2018/#:%7E:text=Five%20years%20ago%20we%20set,free%20for%20generations%20to%20come.">Scotland</a> have also introduced similar policies. </p>
<p>A recently published independent review has now outlined <a href="https://www.gov.uk/government/publications/the-khan-review-making-smoking-obsolete/making-smoking-obsolete-summary">15 important interventions</a> needed to help achieve this goal. Some of these recommendations include promoting vaping as an alternative to cigarettes and increasing duties on tobacco products. The report also recommends raising the age a person can buy cigarettes from 18 to 21 – then increasing the age of sale by one every year thereafter.</p>
<p>England wouldn’t be the first country to increase the age a person can legally buy tobacco products in a bid to tackle smoking. In 2019, the US introduced legislation that changed the minimum age a person could purchase tobacco products <a href="https://www.fda.gov/tobacco-products/retail-sales-tobacco-products/tobacco-21">from 18 to 21</a>. In 2021, New Zealand also became the first country in the world to implement a “<a href="https://www.bbc.co.uk/news/world-asia-59589775">tobacco-free generation</a>” policy, banning all sales of tobacco to anyone born after 2008. </p>
<p>While it’s still too early to know what impact New Zealand’s new smoking ban has had on rates, when they previously raised the legal age to buy tobacco, <a href="https://www.bmj.com/content/375/bmj.n3057">smoking rates declined</a> across all age groups from 18.2% of the population in 2012 to 13.4% in 2020. In the US, the number of smokers <a href="https://www.fda.gov/tobacco-products/ctp-newsroom/newly-signed-legislation-raises-federal-minimum-age-sale-tobacco-products-21">also declined</a> after the minimum purchasing age was raised. </p>
<p>This also wouldn’t be the first time the UK increased the legal age for buying cigarettes. When the age of sale was increased from 16 to 18 in 2007, there was a <a href="https://www.tandfonline.com/doi/full/10.1080/08870446.2017.1325890">fall in youth smoking rates</a>. Given the knock-on effect that raising the smoking age can have on overall smoking rates, it makes sense for the UK to use this strategy again.</p>
<p>In 2019, around 15% of 18 to 20-year-olds reported smoking. In England, that amounts to around 364,000 people. Though this may only be a fraction of the population, research shows that the earlier a person begins smoking, the more likely they are to <a href="https://www.gov.uk/government/publications/smoking-and-tobacco-applying-all-our-health/smoking-and-tobacco-applying-all-our-health">become dependent</a> and develop <a href="https://www.gov.uk/government/news/children-whose-parents-smoke-are-four-times-as-likely-to-take-up-smoking-themselves">smoking-related health problems</a>. Raising the legal age would both help reduce the likelihood of someone becoming addicted to nicotine and developing health problems later in life. Research also suggests that raising the legal smoking age can <a href="https://discovery.ucl.ac.uk/id/eprint/10120200/1/Beard_add.15421.pdf">prevent young adult smokers</a> transitioning into long-term smokers. </p>
<figure class="align-center ">
<img alt="A young of three young people smoke cigarettes." src="https://images.theconversation.com/files/468771/original/file-20220614-24-52rczj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/468771/original/file-20220614-24-52rczj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/468771/original/file-20220614-24-52rczj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/468771/original/file-20220614-24-52rczj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/468771/original/file-20220614-24-52rczj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/468771/original/file-20220614-24-52rczj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/468771/original/file-20220614-24-52rczj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Raising the legal age could people more young people from continuing to smoke.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-people-smoking-outdoors-sitting-on-1571491495">giuseppelombardo/ Shutterstock</a></span>
</figcaption>
</figure>
<p>Evidence also shows that most smokers who start early in life are <a href="https://elifesciences.org/articles/49979">more likely to die prematurely</a> from smoking-related causes – such as lung cancer. But the <a href="https://elifesciences.org/articles/49979">earlier a smoker quits</a> the less likely this is to happen. Raising the smoking age to 21 (and every year thereafter) would not only prevent more young people from becoming smokers, but it would also prevent the number of people suffering from smoking-related health problems. </p>
<h2>Health benefits for everyone</h2>
<p>Some critics of the recommendation to raise the age of sale for cigarettes from 18 to 21 and then by one year every year often cite this as “an infringement of civil liberties”. Often, people argue that banning cigarette smoking will ultimately lead to a ban of other harmful substances – such as alcohol, or high-sugar foods. But research is clear that while there may be safe consumption levels of alcohol and sugar there’s <a href="https://www.cancer.gov/news-events/press-releases/2016/low-intensity-smoking-risk#:%7E:text=People%20who%20consistently%20smoked%20an,to%20a%20new%20study%20from">no safe level</a> for smoking.</p>
<p>Every cigarette smoked harms nearly every organ and system in the body. Secondhand and <a href="https://thirdhandsmoke.org/what-do-we-know-about-the-health-risks-of-thirdhand-smoke/#:%7E:text=One%20of%20the%20earliest%20animal%20studies%20on%20thirdhand,through%20their%20bedding%20material%20have%3A%20slow%20wound%20healing">thirdhand smoke</a> (being around surfaces that have been exposed to cigarette smoke, such as furniture) can also cause <a href="https://link.springer.com/article/10.1007/s10900-015-0114-1">serious harm to health</a>, even to those who <a href="https://www.monaldi-archives.org/index.php/macd/article/view/108">do not smoke cigarettes</a> – including skin cancers and slower wound healing. Taking steps to reduce the number of people in England who smoke would have major health benefits for smokers and non-smokers alike.</p>
<p>While smoking rates are <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/drugusealcoholandsmoking/bulletins/smokingprevalenceintheukandtheimpactofdatacollectionchanges/2020#:%7E:text=The%20proportion%20of%20current%20smokers%20in%20the%20UK%20decreased%20from,decrease%20was%20not%20statistically%20significant">already declining in the UK</a>, it still remains one of the country’s biggest preventable killers. While it’s unlikely increasing the smoking age will be enough to help the UK become smoke-free by 2030, combining it with other evidence-based measures (such as limiting where people can smoke and raising the cost of tobacco) will be key in achieving this.</p><img src="https://counter.theconversation.com/content/184874/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ray Higginson does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>When the age of sale was increased from 16 to 18 in 2007 in the UK, there was a fall in youth smoking rates.Ray Higginson, Associate Professor, Life Sciences, University of South WalesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1828452022-05-29T14:43:58Z2022-05-29T14:43:58ZCigarette ads were banned decades ago. Let’s do the same for fossil fuels<figure><img src="https://images.theconversation.com/files/465770/original/file-20220527-23-41wpzm.jpg?ixlib=rb-1.1.0&rect=74%2C59%2C4910%2C3263&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Advertising encourages consumption, including products and activities that use large volumes of fossil fuels. </span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/cigarette-ads-were-banned-decades-ago--let-s-do-the-same-for-fossil-fuels" width="100%" height="400"></iframe>
<p>There is no reasonable disagreement that humanity <a href="https://www.ipcc.ch/report/ar6/wg3/figures/summary-for-policymakers/figure-spm-5/">needs to reduce greenhouse gas emissions</a>. People might argue over how large a reduction is necessary or about the best ways to achieve it, but almost everyone agrees it has to be done. </p>
<p>The <a href="https://doi.org/10.1088/1748-9326/ab8589">available science</a> suggests that technological fixes alone will not do the trick. We need to reduce the consumption of high-emission goods and services, those made from fossil fuels or that rely heavily on them.</p>
<p>And yet, advertising for such goods and services is everywhere, encouraging fossil-fuel consumption: flights to Rome, pickup trucks and SUVs, cruises to Alaska, steak from Argentina and so on.</p>
<p>Should such advertising for fossil-fuel-intensive goods and services be prohibited? This would only be consistent with how we deal with other products whose consumption causes serious harm, such as tobacco. For example, the <a href="https://news.cancerresearchuk.org/2017/05/19/this-is-the-end-of-tobacco-advertising/">United Kingdom banned TV advertising of cigarettes in 1965</a>, the <a href="https://www.history.com/this-day-in-history/nixon-signs-legislation-banning-cigarette-ads-on-tv-and-radio">United States banned cigarette ads on TV and radio in 1970</a>, and Canada has banned all forms of tobacco advertising since 1989.</p>
<h2>The harm principle</h2>
<p>A core principle of liberalism holds that individuals should not be constrained in their actions, unless these actions <a href="https://plato.stanford.edu/entries/law-limits/#HarmPrin">cause harm</a> to others. For instance, you are not allowed to drive through a residential neighbourhood at 100 kilometres per hour, because this would put the lives of others at risk.</p>
<p>Now, you might rightly point out that when you take a flight to a sunny beach in Mexico, you are not putting the lives of others at risk, at least not in the same, direct way. However, there is a collective action problem here: If everyone takes a flight to a sunny beach in Mexico, the aggregate emissions from all the flights will lead to a warmer planet, extreme weather events and will not only harm others but put lives at risk.</p>
<figure class="align-center ">
<img alt="Billboards for motorcycles and pickup trucks line a freeway." src="https://images.theconversation.com/files/465771/original/file-20220527-21-izd9v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/465771/original/file-20220527-21-izd9v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/465771/original/file-20220527-21-izd9v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/465771/original/file-20220527-21-izd9v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/465771/original/file-20220527-21-izd9v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/465771/original/file-20220527-21-izd9v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/465771/original/file-20220527-21-izd9v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The emissions from cars, trucks and other gasoline-burning vehicles put lives at risk.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>It is controversial whether this mediated harm from your flight to Mexico is enough to justify stopping you from going to Mexico. Instead, I propose to apply a weaker and less controversial version of the harm principle: When the actions of individuals cause significant harm to others, even indirectly and mediated through aggregate effects, then as a society we should abstain from encouraging these actions.</p>
<p>We know that the emissions from fossil-fuel intensive goods and services put lives at risk. We also know that, overall, <a href="https://us.sagepub.com/en-us/nam/effective-advertising/book11407">advertising encourages their consumption</a>. Therefore, on this version of the harm principle, we should ban advertising for fossil-fuel intensive activities.</p>
<h2>An important precedent</h2>
<p>As the World Health Organization points out, “<a href="https://www.euro.who.int/en/health-topics/disease-prevention/tobacco/publications/key-policy-documents/who-framework-convention-on-tobacco-control-who-fctc/key-areas-of-tobacco-control-policy/banning-advertising,-sponsorship-and-promotion">tobacco kills nearly six million of its users each year</a>.” Because of the harm smoking causes, its proven link to several forms of cancer in particular, states have taken measures to discourage it. </p>
<p>These measures include a comprehensive ban on all advertising for tobacco products under the <a href="https://treaties.un.org/pages/ViewDetails.aspx?src=TREATY&mtdsg_no=IX-4&chapter=9&clang=_en">WHO Framework Convention on Tobacco Control</a>. They are further justified because of the second-hand effects of smoke, that is, the health risks for people other than the smoker themselves.</p>
<figure class="align-right ">
<img alt="A 1950s ad for cigarettes, showing a dentist recommending them." src="https://images.theconversation.com/files/465772/original/file-20220527-17-wlp7s2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/465772/original/file-20220527-17-wlp7s2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=411&fit=crop&dpr=1 600w, https://images.theconversation.com/files/465772/original/file-20220527-17-wlp7s2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=411&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/465772/original/file-20220527-17-wlp7s2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=411&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/465772/original/file-20220527-17-wlp7s2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=516&fit=crop&dpr=1 754w, https://images.theconversation.com/files/465772/original/file-20220527-17-wlp7s2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=516&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/465772/original/file-20220527-17-wlp7s2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=516&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Tobacco kills nearly six million smokers annually.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/clotho98/4459851435">(clotho/flickr)</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span>
</figcaption>
</figure>
<p>The number of people dying from climate change is already comparable to smoking-related deaths. <a href="https://doi.org/10.1016/S2542-5196(21)00081-4">One study estimates that between 2000 and 2019, more than five million people a year died due to the effects of climate change</a>. With the frequency of heat waves, severe storms, floods and other extreme weather events set to increase due to climate change, this number will only grow in the coming years.</p>
<p>Given what societies have done on tobacco, it would only be consistent to ban advertising for fossil-fuel-intensive activities. In addition, the status quo is also inconsistent with the alleged commitment of governments to lower greenhouse gas emissions. </p>
<p><a href="https://www.cfr.org/in-brief/cop26-heres-what-countries-have-pledged">Governments around the world have pledged to reduce their greenhouse gas emissions by 2030</a>, in an effort to meet the Paris Agreement goal to limit warming to 1.5 C. Yet, they tolerate advertising for activities that are clearly counterproductive to achieving this ambitious goal. This is akin to a drug rehabilitation centre putting up posters everywhere telling its patients how great it feels to take drugs.</p>
<h2>Where to start?</h2>
<p>Coming up with a definition of a fossil-fuel intensive activity is a bit more complex than providing a definition of smoking, but it can be done. Here is a plausible starting point: Define a certain threshold of emission-intensity that qualifies the good or service for the ban. </p>
<p>For example, given that an <a href="https://www.epa.gov/greenvehicles/greenhouse-gas-emissions-typical-passenger-vehicle">average passenger vehicle emits about 2.3 grams of carbon dioxide per litre of gasoline</a>, one might ban advertising for any vehicle that emits more than that, and subsequently lower the threshold to further encourage innovation. That same standard would then be applied to other means of transport such as flights, leisure boats, cruises. Similar thresholds for other categories of goods and services such as red meat or construction could also be defined.</p>
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Read more:
<a href="https://theconversation.com/the-fossil-fuel-era-is-coming-to-an-end-but-the-lawsuits-are-just-beginning-107512">The fossil fuel era is coming to an end, but the lawsuits are just beginning</a>
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<p>Politically, the proposal faces two significant challenges: industry pushback and political reluctance to ask voters to rein in their lifestyle. Once again, valuable lessons can be learned from tobacco. </p>
<p>The trigger for change might lie in legal action that gives voice to the fundamental interests of members of future generations — those who are being harmed by fossil-fuel advertising today. We owe it to them not to encourage activities that will kill them.</p><img src="https://counter.theconversation.com/content/182845/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Peter Dietsch receives funding from Social Sciences and Humanities Research Council of Canada (SSHRC) and from the Humboldt Foundation. He is a member of the College of the Royal Society of Canada.</span></em></p>The number of people who die from climate change each year is roughly the same as the number of people who die from tobacco use.Peter Dietsch, Professor, Philosophy, University of VictoriaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1825832022-05-18T12:14:00Z2022-05-18T12:14:00ZWhy is the FDA seeking to ban menthol cigarettes? 4 questions answered<figure><img src="https://images.theconversation.com/files/462846/original/file-20220512-22-4l21fl.jpeg?ixlib=rb-1.1.0&rect=0%2C29%2C4888%2C3635&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Menthol cigarettes were responsible for an estimated 377,000 premature deaths in the U.S. during the past 40 years.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/cigarette-royalty-free-image/465892800">BAKERLY/iStock via Getty Images</a></span></figcaption></figure><p><em>The FDA has opened the <a href="https://www.fda.gov/tobacco-products/products-guidance-regulations/submit-comments-tobacco-products">public comment period</a> for the agency’s <a href="https://www.federalregister.gov/documents/2022/05/04/2022-08994/tobacco-product-standard-for-menthol-in-cigarettes">proposed ban on menthol cigarettes</a>. Epidemiology and global health professor <a href="https://sph.umich.edu/faculty-profiles/meza-rafael.html">Rafael Meza</a> studies data modeling in disease prevention and cancer risk. <a href="https://sph.umich.edu/faculty-profiles/mendez-david.html">David Mendez</a>, who studies smoking cessation and tobacco control policies, is an associate professor of health management and policy. These University of Michigan researchers found that, in a 38-year period, African Americans <a href="http://dx.doi.org/10.1136/tobaccocontrol-2021-056748">suffered most of the harmful effects</a> of menthol cigarettes. Now the researchers have developed a model to simulate the possible benefits of the menthol ban, based on studies of population trends in tobacco use. As experts on the behavioral and public health aspects of smoking, they explain the role of menthol in smoking-related illness and death.</em></p>
<h2>What are menthol cigarettes?</h2>
<p>Menthol is a chemical compound, obtained naturally from peppermint oil or produced synthetically using thymol, a compound in the herb thyme. When added to tobacco cigarettes, menthol produces a cooling sensation in the mouth and throat. Menthol cigarettes have enough of the compound added to give them that characteristic sensation and minty flavor. Instead of tasting like burning tobacco, menthol cigarettes might bring to mind cough drops or strong breath mints.</p>
<h2>Why are menthol cigarettes particularly harmful?</h2>
<p>Menthol reduces the harshness of cigarette smoking, making it more palatable for those new to smoking. Most of the experimenters are teens and young adults, who are vulnerable to long-term effects of <a href="https://doi.org/10.1016/j.pbb.2020.173010">nicotine on still-developing brains</a>. Among youths who are smokers, about <a href="https://doi.org/10.3390/ijerph18157781">60% smoke menthols</a>, with even <a href="https://doi.org/10.1186/s12889-017-4987-z">higher rates among Black adolescents</a>. Every year, menthol cigarettes increase the number of individuals who become regular smokers. Those who start with menthols often continue with them.</p>
<p>Our research shows that the harm of tobacco use continues as well. In addition to providing youths a more palatable introduction to smoking, the menthol flavor appears to keep them smoking. People who smoke menthol cigarettes smoke longer over their lifetimes and are <a href="https://doi.org/10.1136/tobaccocontrol-2020-056256">less likely to quit</a>. That translates into hundreds of thousands of additional premature deaths from lung cancer, emphysema and diseases made worse by smoking, like heart disease. In our study, we estimated that menthol cigarettes were responsible for <a href="http://dx.doi.org/10.1136/tobaccocontrol-2021-056748">377,000 premature deaths</a> among the U.S. population during the past 40 years.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/461648/original/file-20220505-12142-tlfryi.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Against a black background, an unidentified hand with dark skin, dirty nails and a generally unhealthy look holds an unlit cigarette between to fingers." src="https://images.theconversation.com/files/461648/original/file-20220505-12142-tlfryi.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/461648/original/file-20220505-12142-tlfryi.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/461648/original/file-20220505-12142-tlfryi.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/461648/original/file-20220505-12142-tlfryi.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/461648/original/file-20220505-12142-tlfryi.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/461648/original/file-20220505-12142-tlfryi.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/461648/original/file-20220505-12142-tlfryi.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Menthol cigarettes have led to particularly high numbers of negative health outcomes among African Americans.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/cigarette-in-unhealthy-hand-man-on-black-background-royalty-free-image/859367676">BAKERYLY/iStock via Getty Images</a></span>
</figcaption>
</figure>
<h2>Why has there been a backlash to the FDA’s proposed ban?</h2>
<p>Some critics have raised concerns about potential unintended consequences of the proposed ban, particularly for African American menthol smokers. One worry is that banning menthol cigarettes could make Black people subject to arrest for buying or smoking them. Another concern is that a ban might create an illicit market for the cigarettes, particularly in African American neighborhoods.</p>
<p>But the FDA ban is on distributing the cigarettes, not buying, possessing or smoking them. The agency has been clear that it cannot and <a href="https://www.fda.gov/media/158015/download">will not enforce the ban</a> on individual consumers of menthol cigarettes or flavored cigars. And <a href="http://dx.doi.org/10.1136/tobaccocontrol-2021-057227">Canada’s experience with a similar ban</a> suggests that it is unlikely an illegal market would emerge.</p>
<p>Most importantly, any negative consequences would be outweighed by considerable health gains.</p>
<h2>How would a menthol cigarette ban help?</h2>
<p>Cigarette smoking prevalence has <a href="https://doi.org/10.1016/j.pmedr.2020.101227">decreased drastically since the 1960s</a>, thanks to tobacco control interventions like cigarette taxes, smoke-free air laws, marketing restrictions and education campaigns. The prevalence of menthol cigarette smoking, however, has remained <a href="https://doi.org/10.1186/s12889-017-4987-z">relatively constant since 2000</a>, which highlights the need for interventions specifically targeting menthol cigarettes. </p>
<p>We recently estimated that banning menthol cigarettes in the U.S. would translate into a <a href="https://doi.org/10.1136/tobaccocontrol-2021-056604">15% reduction</a> in menthol smoking prevalence and <a href="https://doi.org/10.1136/tobaccocontrol-2021-056604">prevent 650,000 premature deaths</a> by 2060. The gains among the Black population would be particularly considerable, with an estimated <a href="http://dx.doi.org/10.1136/tobaccocontrol-2021-056604">255,000 premature deaths averted</a>.</p>
<p>Under a menthol cigarette ban, it’s important that menthol cigarette smokers have help to quit smoking, and not just switch to nonmenthol cigarettes.</p><img src="https://counter.theconversation.com/content/182583/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David Mendez receives funding from the National Institutes of Health</span></em></p><p class="fine-print"><em><span>Rafael Meza receives funding from the National Institutes of Health. </span></em></p>As the comment period begins for the FDA’s proposed ban, public health experts explain the stakes.David Mendez, Associate Professor of Health Management and Policy, University of MichiganRafael Meza, Professor of Global Public Health, University of MichiganLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1824352022-05-09T01:25:00Z2022-05-09T01:25:00ZThe US FDA has moved to ban menthol cigarettes. Australia should do that and more<figure><img src="https://images.theconversation.com/files/461725/original/file-20220506-22-bccw5d.jpg?ixlib=rb-1.1.0&rect=17%2C8%2C5947%2C3961&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/closeup-many-cigarette-butts-ash-600w-1727470504.jpg">Shutterstock</a></span></figcaption></figure><p>Menthol is the minty cigarette ingredient that conjures up images of beaches, snow-covered ski slopes and glamorous yacht parties, all crisp white and fresh green. Menthol as a deadly additive is under threat at last.</p>
<p>Several countries, including <a href="https://tobaccotactics.org/wiki/flavoured-and-menthol-tobacco/">Canada, Ethiopia, Turkey, Chile, the European Union and the United Kingdom</a>, have <a href="https://tobaccocontrol.bmj.com/content/30/4/373">banned the use of menthol</a> and other flavours in tobacco products.</p>
<p>Late to regulating menthol in tobacco products, the <a href="https://www.theguardian.com/us-news/2022/apr/28/us-fda-menthol-cigarettes-flavored-cigars-ban-rules#:%7E:text=The%20US%20Food%20and%20Drug,dent%20sales%20at%20tobacco%20companies.">US Food and Drug Administration has also announced a ban</a>. </p>
<p>In Australia, we have done little to change what’s inside cigarettes and other smoking products. So we lag even further behind the many other countries that have banned menthol.</p>
<h2>For ‘timid’ ladies</h2>
<p>The marketing of menthol by the tobacco industry in Australia has long been targeted at supposedly sophisticated smokers. In Melbourne in the 1990s, tobacco giant Philip Morris – in its <a href="https://www.industrydocuments.ucsf.edu/tobacco/docs/#id=xqkm0112">personality analysis</a> of smokers of its Alpine menthol brand – found the “Alpine Gal is a physically timid lady”, so the packaging had to be “gentle”, not “dare devil”.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/461730/original/file-20220506-21-8dt8zt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="cigarette advert images with mountain images" src="https://images.theconversation.com/files/461730/original/file-20220506-21-8dt8zt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/461730/original/file-20220506-21-8dt8zt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=350&fit=crop&dpr=1 600w, https://images.theconversation.com/files/461730/original/file-20220506-21-8dt8zt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=350&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/461730/original/file-20220506-21-8dt8zt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=350&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/461730/original/file-20220506-21-8dt8zt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=440&fit=crop&dpr=1 754w, https://images.theconversation.com/files/461730/original/file-20220506-21-8dt8zt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=440&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/461730/original/file-20220506-21-8dt8zt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=440&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The classic ‘fresh’ look of menthol cigarette advertising.</span>
<span class="attribution"><a class="source" href="https://live.staticflickr.com/65535/52005982483_4e4d71a066_c.jpg">Flickr/Keijo Knutas</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>More recently, the industry <a href="https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-021-01297-2">added menthol</a> “crush balls” or capsules in filters in Australian cigarettes, so users get a burst of menthol by biting on the filter. Once again, women and children are the target market. A <a href="https://academic.oup.com/ntr/advance-article/doi/10.1093/ntr/ntac040/6545999">study from Wales</a> showed the fact that:</p>
<blockquote>
<p>[…] three in five 11–16 year-old smokers reported using menthol cigarettes in the past 30 days highlights how appealing these products are to young people, particularly capsule cigarettes, used by 70% of menthol smokers.</p>
</blockquote>
<p>A search of <a href="https://tobaccocontrol.bmj.com/content/20/Suppl_2/ii12?ijkey=7fae4fee8eca39ec8baeb0ea9e7272a313fd682e&keytype2=tf_ipsecsha">millions of tobacco industry documents</a> confirms menthol is <a href="https://truthinitiative.org/research-resources/traditional-tobacco-products/menthol-facts-stats-and-regulations">designed to attract new young smokers</a>, who <a href="https://www.mdpi.com/1660-4601/18/11/5501">incorrectly believe</a> it makes cigarettes somehow less harmful.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/461728/original/file-20220506-16-8t7psr.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="opened up cigarette filter shows blue capsule inside" src="https://images.theconversation.com/files/461728/original/file-20220506-16-8t7psr.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/461728/original/file-20220506-16-8t7psr.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/461728/original/file-20220506-16-8t7psr.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/461728/original/file-20220506-16-8t7psr.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/461728/original/file-20220506-16-8t7psr.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/461728/original/file-20220506-16-8t7psr.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/461728/original/file-20220506-16-8t7psr.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">These days, menthol capsules are used inside cigarette filters.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>In 2012, Australia’s then health minister and Attorney-General Nicola Roxon <a href="https://www.abc.net.au/news/2012-08-27/nicola-roxon-on-australian-story/4225972">regulated</a> the outside of cigarette packets, introducing plain packaging with graphic health warnings. Although significant, the packaging change did nothing to alter what was inside the product.</p>
<p>Nor have subsequent governments.</p>
<p>In other words, we have not yet regulated the most damaging aspects of cigarette design that increase and maintain addiction.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/next-step-for-tobacco-control-make-cigarettes-less-palatable-42549">Next step for tobacco control? Make cigarettes less palatable</a>
</strong>
</em>
</p>
<hr>
<h2>Not really ‘light’ - just dangerous</h2>
<p>Menthol is associated with so-called “light” cigarettes, which the Australian Competition and Consumer Commission (ACCC) has <a href="https://www.accc.gov.au/media-release/accc-resolves-light-and-mild-cigarette-investigation-with-imperial-tobacco">found misleading and deceptive</a> and banned the use of the term. The ACCC did not ban the content or engineering of cigarettes.</p>
<p>It is not just additives in cigarettes, and the smoke emissions, that are harmful. The “<a href="https://theconversation.com/filters-a-cigarette-engineering-hoax-that-harms-both-smokers-and-the-environment-85393">engineering hoax</a>” of filters – which don’t make smoking any safer – <a href="https://theconversation.com/next-step-for-tobacco-control-make-cigarettes-less-palatable-42549">is an even more dangerous</a> <a href="https://tobaccocontrol.bmj.com/content/early/2021/04/26/tobaccocontrol-2020-056245.abstract">fraud</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/filters-a-cigarette-engineering-hoax-that-harms-both-smokers-and-the-environment-85393">Filters: a cigarette engineering hoax that harms both smokers and the environment</a>
</strong>
</em>
</p>
<hr>
<h2>A new era of additives</h2>
<p>Australia’s new <a href="https://consultations.health.gov.au/atodb/national-tobacco-strategy-2022-2030/">National Tobacco Strategy Consultation Draft</a> says it will “explore” regulation of filters, additives – including menthol – and nicotine content, but offers little certainty.</p>
<p>In the UK, <a href="https://www.mirror.co.uk/money/menthol-cigarettes-banned-uk-illegal-22050817">the ban on menthol cigarettes</a> not only triggered a switch to menthol vapes, but also prompted the tobacco industry to <a href="https://blogs.bmj.com/tc/2021/05/05/menthol-tobacco-companies-are-exploiting-loopholes-in-the-uks-characterising-flavours-ban/">invent new products</a> to exploit <a href="https://www.occrp.org/en/investigations/japan-tobacco-international-making-a-mint-by-circumventing-menthol-cigarette-ban">loopholes in the law</a>. </p>
<p>Late last year, the Organised Crime and Corruption Reporting Project – a network of investigative journalists – <a href="https://www.occrp.org/en/investigations/japan-tobacco-international-making-a-mint-by-circumventing-menthol-cigarette-ban">found</a>: </p>
<blockquote>
<p>A key goal of Big Tobacco was to get menthol defined as vaguely as possible.</p>
</blockquote>
<p>So, any attempts at legislative control must be tightly worded. <a href="https://tobaccotactics.org/wiki/promotion-newer-products-uk-menthol-ban/">Big tobacco</a> will drive its legal trucks through anything vague.</p>
<h2>The effects of bans are mixed</h2>
<p><a href="https://tobaccocontrol.bmj.com/content/early/2021/03/31/tobaccocontrol-2020-056259?int_source=trendmd&int_medium=cpc&int_campaign=usage-042019">Canadian research</a> showed a fall in smoking rates followed their menthol ban.</p>
<p><a href="https://www.sciencedirect.com/science/article/abs/pii/S037687162030555X">Other research</a> suggested targeting menthol in cigarettes might cause a switch to vaping, as in the UK. We know that vaping is a <a href="https://www.nature.com/articles/s41533-022-00277-9">global public health problem</a> and that flavourings drive uptake in adolescents. The FDA will not immediately ban menthol in e-cigarettes.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/461729/original/file-20220506-24-8t7psr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="hand with e-cigarette and vapour" src="https://images.theconversation.com/files/461729/original/file-20220506-24-8t7psr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/461729/original/file-20220506-24-8t7psr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=417&fit=crop&dpr=1 600w, https://images.theconversation.com/files/461729/original/file-20220506-24-8t7psr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=417&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/461729/original/file-20220506-24-8t7psr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=417&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/461729/original/file-20220506-24-8t7psr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=525&fit=crop&dpr=1 754w, https://images.theconversation.com/files/461729/original/file-20220506-24-8t7psr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=525&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/461729/original/file-20220506-24-8t7psr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=525&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">In some places, menthol cigarette bans have seen a switch to vaping.</span>
<span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/london-uk-sept-8-2019-600w-1498869299.jpg">Shutterstock</a></span>
</figcaption>
</figure>
<p>Vaping causes <a href="https://pubmed.ncbi.nlm.nih.gov/32726146/">lung damage</a> and <a href="https://newsnetwork.mayoclinic.org/discussion/e-cigarette-users-who-test-positive-for-covid-19-are-more-likely-to-experience-covid-19-symptoms/">exacerbates COVID symptoms</a>. </p>
<p>The sale of heat-not-burn products should <a href="https://www.news.com.au/national/victoria/politics/experts-warn-of-public-health-crisis-for-kids-as-state-leaders-urged-to-ban-illicit-vape-sales/news-story/7c64de9acf72b0a0bc3449b86fec39f4">remain banned</a> in Australia. The current arrangement that permits <a href="https://www.tga.gov.au/nicotine-vaping-products-information-prescribers#:%7E:text=Medical%20practitioners%20do%20not%20need,through%20the%20Personal%20Importation%20Scheme.">non TGA-approved</a> vape products to be <a href="https://adf.org.au/talking-about-drugs/parenting/vaping-youth/vaping-australia/">prescribed</a> by medical practitioners, ostensibly for quitting purposes is <a href="https://www.anu.edu.au/news/all-news/e-cigarettes-are-harmful-and-addicting-youth-report">problematic</a>. <a href="https://tobaccocontrol.bmj.com/content/30/1/108.abstract">Flavours should be regulated</a> or eliminated.</p>
<p><a href="https://www.stuff.co.nz/science/127803331/low-nicotine-cigarettes-could-cut-smoking-significantly">New Zealand</a> has moved to reduce nicotine content, the principal addictive drug in tobacco. But NZ has dropped the ball on e-cigarettes by separating its regulatory framework from other tobacco products. The country is experiencing high rates of <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/1753-6405.13169">teenage vaping uptake</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/a-damning-review-of-e-cigarettes-shows-vaping-leads-to-smoking-the-opposite-of-what-supporters-claim-180675">A damning review of e-cigarettes shows vaping leads to smoking, the opposite of what supporters claim</a>
</strong>
</em>
</p>
<hr>
<h2>Smoking kills</h2>
<p>There are three million smokers in Australia. <a href="https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-015-0281-z">Two-thirds will die</a> from smoking-related diseases. </p>
<p>Most will have health problems, and <a href="https://www.phrp.com.au/issues/july-2016-volume-26-issue-3/tobacco-smoking-by-adult-emergency-department-patients-in-australia-a-point-prevalence-study/">our hospital emergency departments</a> and <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1467-842X.2002.tb00678.x">wards</a> deal with much higher rates of smokers being admitted than the general population. </p>
<p>The crushing burden on the health system and the <a href="https://ndri.curtin.edu.au/NDRI/media/documents/publications/T273.pdf">associated economic cost</a> could be effectively reduced with comprehensive regulatory measures on tobacco.</p>
<h2>Endgame</h2>
<p>The four endgame initiatives that will reduce smoking and vaping to a minimum in Australia are:</p>
<ol>
<li><p>a ban on sales of both combustible and vape tobacco products to <a href="https://tobaccocontrol.bmj.com/content/22/suppl_1/i22">anyone born after the year</a> 2004</p></li>
<li><p>regulation to eliminate flavours (including, but not limited to, menthol) in combustible, vape and emerging tobacco products</p></li>
<li><p>staged <a href="https://www.tobaccoinaustralia.org.au/chapter-18-harm-reduction/18-4-low-nicotine">reduction in nicotine content</a></p></li>
<li><p>a ban on <a href="https://academic.oup.com/jnci/article/109/12/djx075/3836090?login=false">filter ventilation</a> engineering in cigarettes.</p></li>
</ol>
<p>Banning menthol as a standalone reform would make a modest contribution to reducing smoking and vaping rates in Australia. </p>
<p>However, substantive reduction in smoking rates will only occur with a comprehensive suite of measures, already strongly <a href="https://tobaccocontrol.bmj.com/content/early/2022/05/02/tobaccocontrol-2021-057122">supported in the community</a>. These include <a href="https://insightplus.mja.com.au/2020/19/exit-strategy-we-can-do-it-for-covid-19-why-not-tobacco/">phasing out the sale</a> of tobacco products completely.</p>
<hr>
<p><em>Correction: This article has been edited to clarify that vape products containing nicotine are banned in Australia but available via prescription.</em></p><img src="https://counter.theconversation.com/content/182435/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kathryn Barnsley is co-convenor of SmokeFree Tasmania.</span></em></p>Traditionally marketed to women, banning menthol tobacco flavouring would make a moderate impact on smoking harms. Australia is behind many other countries.Kathryn Barnsley, Adjunct researcher, University of TasmaniaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1718312021-12-05T19:12:16Z2021-12-05T19:12:16ZMaking the tobacco industry pay for cigarette litter could stop 4.5 billion butts polluting the Australian environment<figure><img src="https://images.theconversation.com/files/433346/original/file-20211123-15-1f5ydzm.jpg?ixlib=rb-1.1.0&rect=49%2C69%2C6593%2C4352&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Cigarette butts with filters are the most commonly littered item worldwide, with a staggering <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5347528/">4.5 trillion</a> of them tossed into the environment each year. This is a huge problem; many end up on <a href="https://www.sciencedirect.com/science/article/pii/S0013935119300787">beaches and in the ocean</a>, and the tar from burnt tobacco in the filter can be toxic to wildlife. </p>
<p>Fixing the problem has focused on changing the behaviour of people who smoke, but a <a href="https://www.wwf.org.au/ArticleDocuments/353/pub-WWF-Australia-Ending-cigarette-butt-pollution-3Dec21.pdf.aspx">new report</a> shows making the tobacco industry responsible for the litter with a mandatory product stewardship scheme is likely to have a much greater impact.</p>
<p>In Australia alone, it’s estimated up to 8.9 billion butts are littered each year. Under the proposed scheme, we could potentially reduce this by 4.45 billion a year. </p>
<p>So how can it be done in practice? And what would the benefits be from a policy like this? </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/433353/original/file-20211123-15-8zbai4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Three wrens around a cigarette butt" src="https://images.theconversation.com/files/433353/original/file-20211123-15-8zbai4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/433353/original/file-20211123-15-8zbai4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=374&fit=crop&dpr=1 600w, https://images.theconversation.com/files/433353/original/file-20211123-15-8zbai4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=374&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/433353/original/file-20211123-15-8zbai4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=374&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/433353/original/file-20211123-15-8zbai4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=470&fit=crop&dpr=1 754w, https://images.theconversation.com/files/433353/original/file-20211123-15-8zbai4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=470&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/433353/original/file-20211123-15-8zbai4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=470&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Smoked cigarette filters take months or even years to break down.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>Social and environmental costs</h2>
<p>Cigarette filters are made of a bioplastic called cellulose acetate, and they typically take <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0117393">years to break down</a>. Smoked cigarette filters are infused with the same chemicals and heavy metals in the tar that harm humans when they smoke. </p>
<p><a href="https://theconversation.com/cigarette-butts-are-the-forgotten-plastic-pollution-and-they-could-be-killing-our-plants-119958">Research from 2019 found</a> adding cigarette butts to soil reduces the germination of grass and clover seeds and the length of their shoots. Seaworms exposed to used filters have <a href="https://www.nature.com/articles/srep14119">DNA damage and reduced growth</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/cigarette-butts-are-the-forgotten-plastic-pollution-and-they-could-be-killing-our-plants-119958">Cigarette butts are the forgotten plastic pollution – and they could be killing our plants</a>
</strong>
</em>
</p>
<hr>
<p>And exposure to cigarette filters (even unsmoked ones) are toxic to fish – <a href="https://tobaccocontrol.bmj.com/content/20/Suppl_1/i25?utm_source=TrendMD&utm_medium=cpc&utm_campaign=TC_TrendMD-0">research with two fish species </a> found adding two to four smoked cigarette filters per litre of water could kill them.</p>
<p>Currently, the tobacco industry does not have to pay for the clean-up of cigarette butts polluting the environment. Rather, the community bears the cost. Cigarette litter and its management <a href="https://www.wwf.org.au/ArticleDocuments/353/pub-WWF-Australia-Ending-cigarette-butt-pollution-3Dec21.pdf.aspx">costs</a> the Australian economy an estimated A$73 million per year. </p>
<p>Local councils in particular spend large amounts of money cleaning it up. The City of Sydney, for example, has estimated their cleaning crews sweep up <a href="https://campaignbrief.com/the-city-of-sydney-launches-ci/">15,000 cigarette butts daily</a> from city streets. </p>
<p>And volunteers spend countless hours picking up cigarette butts from parks, streets and beaches. In its 2020 Rubbish Report, Clean Up Australia Day found cigarette butts accounted for <a href="https://www.cleanup.org.au/cigarette-butts">16% of all recorded items</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/433349/original/file-20211123-19-1qwxthm.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two smiling men hold bags of rubbish" src="https://images.theconversation.com/files/433349/original/file-20211123-19-1qwxthm.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/433349/original/file-20211123-19-1qwxthm.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/433349/original/file-20211123-19-1qwxthm.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/433349/original/file-20211123-19-1qwxthm.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/433349/original/file-20211123-19-1qwxthm.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/433349/original/file-20211123-19-1qwxthm.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/433349/original/file-20211123-19-1qwxthm.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Volunteers, such as for Clean Up Australia Day, spend countless hours picking up cigarette butts from the enviornment.</span>
<span class="attribution"><span class="source">Glengarry Landcare VIC/Clean Up Australia</span></span>
</figcaption>
</figure>
<h2>Current strategies are ineffective</h2>
<p>The tobacco industry response to product waste has been to focus <a href="https://tobaccocontrol.bmj.com/content/20/2/100">responsibility on the consumer</a>. Tobacco companies have created public education campaigns aimed at increasing awareness of the butt litter problem, supplied consumers and cities worldwide with public ashtrays, and funded anti-litter groups. </p>
<p>But given the amount of cigarettes that continue to be littered, it’s clear these strategies on their own have been ineffective. Many around the world are <a href="https://www.gov.uk/government/news/government-explores-next-steps-to-clean-up-tobacco-litter-in-england">now calling for stronger industry regulation</a>.</p>
<p>There have also been calls to ban cigarette filters completely. For example, lawmakers in <a href="https://calmatters.org/environment/2019/06/california-cigarette-butt-filter-ban-bill-electronic-disposable-vapes/">California</a> and New York have attempted to ban the sale of cigarettes with filters, and New Zealand is finalising their <a href="https://www.health.govt.nz/system/files/documents/publications/proposals_for_a_smokefree_aotearoa_2025_action_plan-final.pdf">Smokefree Aotearoa Action Plan</a>, which may include a cigarette filter ban. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/a-type-of-biodegradable-plastic-will-soon-be-phased-out-in-australia-thats-a-big-win-for-the-environment-156566">A type of ‘biodegradable’ plastic will soon be phased out in Australia. That’s a big win for the environment</a>
</strong>
</em>
</p>
<hr>
<p>Many jurisdictions in Australia and worldwide are starting to ban single-use plastics such as straws and takeaway containers, and have <a href="https://www.bmj.com/content/367/bmj.l5890">been criticised</a> for not including cigarette filters in these laws. </p>
<p>If filters were banned, cigarette butt litter would remain, but without the plastic filter. Although, <a href="https://tobaccocontrol.bmj.com/content/early/2021/11/18/tobaccocontrol-2021-056815">a recent trial</a> of cigarettes without filters found that people smoked fewer of these than when they were given the same cigarettes with filters. More research is needed on the health impact of smoking filterless cigarettes and the environmental impact of filterless cigarette butts. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/433352/original/file-20211123-27-d6ktd4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/433352/original/file-20211123-27-d6ktd4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/433352/original/file-20211123-27-d6ktd4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/433352/original/file-20211123-27-d6ktd4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/433352/original/file-20211123-27-d6ktd4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/433352/original/file-20211123-27-d6ktd4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/433352/original/file-20211123-27-d6ktd4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/433352/original/file-20211123-27-d6ktd4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A pubic cigarette butt disposal facility in Salem, US.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>What would a stewardship scheme look like?</h2>
<p>The federal government’s <a href="https://www.awe.gov.au/sites/default/files/documents/national-plastics-plan-2021.pdf">National Plastics Plan</a>, released in March this year, committed to initiate a stewardship taskforce that would reduce cigarette butt litter in Australia, and would consider a potential stewardship scheme. However, they proposed the stewardship taskforce be industry led. </p>
<p>Product stewardship schemes can be voluntary or written into law. For example, waste from product packaging is managed through a voluntary scheme, the <a href="https://www.awe.gov.au/environment/protection/waste/plastics-and-packaging/packaging-covenant">Australian Packaging Covenant</a>, which sets targets for reducing packaging waste that aren’t written into law. On the other hand, <a href="https://www.awe.gov.au/environment/protection/waste/product-stewardship/products-schemes/television-computer-recycling-scheme">there is a law in Australia</a> requiring companies who manufacture TVs or computers to pay some of the costs for recycling these products. </p>
<p>The <a href="https://www.wwf.org.au/ArticleDocuments/353/pub-WWF-Australia-Ending-cigarette-butt-pollution-3Dec21.pdf.aspx">new research</a>, commissioned by World Wildlife Fund for Nature Australia, considered four regulatory approaches: business as usual, a ban on plastic filters, a voluntary industry product stewardship scheme, and a mandatory product stewardship scheme led by the federal government.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/433344/original/file-20211123-13-tpimfd.jpg?ixlib=rb-1.1.0&rect=0%2C16%2C5442%2C3600&q=45&auto=format&w=1000&fit=clip"><img alt="A hand in blue plastic gloves holds a cigarette butt on the beach" src="https://images.theconversation.com/files/433344/original/file-20211123-13-tpimfd.jpg?ixlib=rb-1.1.0&rect=0%2C16%2C5442%2C3600&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/433344/original/file-20211123-13-tpimfd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/433344/original/file-20211123-13-tpimfd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/433344/original/file-20211123-13-tpimfd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/433344/original/file-20211123-13-tpimfd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/433344/original/file-20211123-13-tpimfd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/433344/original/file-20211123-13-tpimfd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Cigarette litter costs the Australian economy an estimated A$73 million each year.</span>
<span class="attribution"><span class="source">Brian Yurasits/Unsplash</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Each of these options were ranked according to factors such as the regulatory effort required to implement them, their cost, consumer participation and the extent to which they would reduce environmental impacts on land and waterways. </p>
<p>A ban on plastic cigarette filters and a mandatory product stewardship scheme were assessed as having the greatest potential environmental benefit. While uncertainties remain about a filter ban, there is no such barrier to implementing a mandatory product stewardship scheme on cigarette waste.</p>
<p>This scheme could involve a tax that would pay for the recovery and processing costs associated with cigarette butt litter. The study suggested introducing a levy of A$0.004 – less than half a cent – on each smoked cigarette to manage the waste. Other studies from overseas, however, show this cost would need to be <a href="https://tobaccocontrol.bmj.com/content/20/Suppl_1/i36.full">higher</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/filters-a-cigarette-engineering-hoax-that-harms-both-smokers-and-the-environment-85393">Filters: a cigarette engineering hoax that harms both smokers and the environment</a>
</strong>
</em>
</p>
<hr>
<p>We can look to the UK for an example of where to start. The UK is currently considering implementing an extended producer responsibility scheme to address cigarette litter. In November this year, it released a <a href="https://consult.defra.gov.uk/environmental-quality/call-for-evidence-on-commonly-littered-and-problem/supporting_documents/Call%20for%20evidence%20document.pdf">consultation document</a> on different options. </p>
<p>They proposed a mandatory scheme where the tobacco industry would pay for the full costs of cleaning up and processing cigarette waste. Other costs they might be made to pay are for gathering and reporting data on tobacco product waste, provision of bins for cigarette butts, and campaigns to promote responsible disposal by consumers.</p>
<p>It is time for the federal and state governments in Australia to make the tobacco industry pay for the mess they create.</p><img src="https://counter.theconversation.com/content/171831/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kylie Morphett is an affiliate of the NHMRC funded Centre for Research Excellence on Achieving the Tobacco Endgame. Her research has been funded by ARC and NHMRC grants. She is a member of The Society for Research on Nicotine and Tobacco.</span></em></p><p class="fine-print"><em><span>Coral Gartner receives funding from the National Health and Medical Research and the Australian Research Council. She is the Director of the NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, is a member of the Society for Research on Nicotine and Tobacco and the Public Health Association of Australia.</span></em></p><p class="fine-print"><em><span>William Clarke receives funding from the Australian Research Council through the ARC Training Centre in Bioplastics and Biocomposites. </span></em></p>In Australia alone, it’s estimated up to 8.9 billion butts are littered each year. A new report finds a mandatory product stewardship scheme can cut this by around half.Kylie Morphett, Research Fellow, School of Public Health, The University of QueenslandCoral Gartner, Director, NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, The University of QueenslandWilliam Clarke, Professor of waste management, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1679732021-09-29T20:09:07Z2021-09-29T20:09:07ZThe missing ingredient Australia needs to kick its smoking addiction for good<figure><img src="https://images.theconversation.com/files/423268/original/file-20210927-124938-10b5yv6.jpg?ixlib=rb-1.1.0&rect=9%2C0%2C6096%2C4055&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/man-refusing-cigarettes-concept-quitting-smoking-1724010937">Shutterstock</a></span></figcaption></figure><p>From October 1, Australians who use e-cigarettes and other vaping products containing nicotine <a href="https://www.tga.gov.au/blogs/tga-topics/nicotine-vaping-laws-are-changing">will need a doctor’s prescription</a> to buy them from a local pharmacy or to order them from overseas.</p>
<p>But there’s another evidence-based way to help more smokers quit, which Australia is yet to act on: reducing the nicotine in cigarettes to non-addictive levels. And e-cigarettes could play an important role in this policy. </p>
<p>If you know someone who’s ever tried to stop smoking and failed, nicotine addiction is likely the reason they found it so hard. While nicotine itself is not a significant direct cause of the health harms from smoking, it makes tobacco products highly addictive. In 1963, <a href="https://www.who.int/tobacco/media/en/TobaccoExplained.pdf">tobacco industry lawyers wrote</a>:</p>
<blockquote>
<p>We are […] in the business of selling nicotine, an addictive drug.</p>
</blockquote>
<p>So what are other countries doing to reduce nicotine addiction? What role could alternative nicotine products including e-cigarettes play, and how could reducing nicotine in cigarettes backfire if not managed well? And how much potential does a new very low nicotine standard for cigarettes have to end Australians’ addiction to smoking?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/from-october-it-will-be-all-but-impossible-for-most-australians-to-vape-largely-because-of-canberras-little-known-homework-police-167376">From October, it will be all but impossible for most Australians to vape — largely because of Canberra's little-known 'homework police'</a>
</strong>
</em>
</p>
<hr>
<h2>How other countries are tackling a global killer</h2>
<p>Most people know someone who has died or developed serious health problems from smoking. </p>
<p>Even today, smoking remains the <a href="https://www.aihw.gov.au/getmedia/c076f42f-61ea-4348-9c0a-d996353e838f/aihw-bod-22.pdf.aspx">leading preventable cause of early death</a> in Australia, causing the deaths of more than <a href="https://www.aihw.gov.au/getmedia/d2a1886d-c673-44aa-9eb6-857e9696fd83/aihw-bod-30.pdf.aspx?inline=true">20,000 Australians</a> every year. It also costs the Australian economy <a href="https://ndri.curtin.edu.au/NDRI/media/documents/publications/T273.pdf">$136.9 billion annually</a>.</p>
<p>That’s why many countries, including Australia, are setting targets to reduce smoking to very low levels. But new approaches are needed to achieve this goal. </p>
<p>Reducing the nicotine levels in cigarettes to non-addictive levels was <a href="https://www.nejm.org/doi/10.1056/NEJM199407143310212?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed">first proposed</a> by the US Food and Drug Administration in 1994. While it was not implemented at that time, there has been renewed interest in this policy. </p>
<p>New Zealand recently proposed a nicotine reduction strategy as an option for its <a href="https://www.health.govt.nz/publication/proposals-smokefree-aotearoa-2025-action-plan">Smokefree Aotearoa 2025 Action Plan</a>. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/WGAXjziXFuc?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">When you smoke around your pets, they’re twice as likely to get cancer: Quitline New Zealand.</span></figcaption>
</figure>
<p>US President Joe Biden’s administration is also <a href="https://thehill.com/policy/healthcare/public-global-health/549156-biden-administration-eyes-reducing-nicotine-in">considering</a> the US Food and Drug Administration’s <a href="https://www.federalregister.gov/documents/2018/03/16/2018-05345/tobacco-product-standard-for-nicotine-level-of-combusted-cigarettes">proposal</a> to reduce nicotine levels to “give addicted users the choice and ability to quit more easily”. </p>
<p>The World Health Organization supports a <a href="https://apps.who.int/iris/handle/10665/189651">global nicotine reduction strategy</a> and has provided recommendations for implementing it. </p>
<p>The good news is that it’s possible to reduce nicotine levels in cigarettes, and such cigarettes have already been tested in clinical trials. </p>
<p><a href="https://www.sciencedirect.com/science/article/pii/S0955395921003418">Results show</a> people smoke fewer cigarettes when given ones where the nicotine level has been reduced by 95% or more compared to regular cigarettes. They are also more likely to quit smoking. This is because those who smoke regularly find cigarettes with very low levels of nicotine less enjoyable and rewarding. </p>
<p>While it is not ethical to conduct similar studies with young people who do not already smoke, reducing nicotine levels is also expected to reduce the number of adolescents who become addicted to smoking, with promising results from <a href="https://academic.oup.com/ntr/article/18/9/1861/2584023">animal studies</a>. </p>
<h2>How could alternative nicotine products help?</h2>
<p>Allowing only very low nicotine content cigarettes to be sold would require increased investment in smoking cessation services and support, such as nicotine replacement therapies (including patches and gum), prescription medicines, and behavioural support from health professionals. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/423267/original/file-20210927-124768-lf7d0z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/423267/original/file-20210927-124768-lf7d0z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/423267/original/file-20210927-124768-lf7d0z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=434&fit=crop&dpr=1 600w, https://images.theconversation.com/files/423267/original/file-20210927-124768-lf7d0z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=434&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/423267/original/file-20210927-124768-lf7d0z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=434&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/423267/original/file-20210927-124768-lf7d0z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=546&fit=crop&dpr=1 754w, https://images.theconversation.com/files/423267/original/file-20210927-124768-lf7d0z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=546&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/423267/original/file-20210927-124768-lf7d0z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=546&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Vaping devices.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/vaping-device-742830484">Shutterstock</a></span>
</figcaption>
</figure>
<p>A nicotine reduction policy for tobacco products has also been made more feasible by the Australian government’s changes to how smokers can <a href="https://www.tga.gov.au/blogs/tga-topics/nicotine-vaping-laws-are-changing">access nicotine-containing e-cigarettes</a> from October 1 2021.</p>
<p>While not harmless, e-cigarettes are <a href="https://ajph.aphapublications.org/doi/10.2105/AJPH.2021.306416">likely to be significantly less harmful</a> than smoked tobacco products. They can provide an alternative source of nicotine for those who are nicotine dependent, and have been shown to <a href="https://doi.org/10.1016/j.addbeh.2021.106912">increase quitting</a> compared to nicotine replacement therapy.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/e-cigarettes-misconceptions-about-their-dangers-may-be-preventing-people-from-quitting-smoking-166846">E-cigarettes: misconceptions about their dangers may be preventing people from quitting smoking</a>
</strong>
</em>
</p>
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<p>Ensuring access to lower risk forms of nicotine is central to the policies being considered by both New Zealand and the <a href="https://www.nejm.org/doi/full/10.1056/NEJMp1707409">USA</a>. </p>
<p>But there are possible unintended consequences of a nicotine reduction policy. Many people hold <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6939783/">misconceptions about nicotine</a> and one risk is that people may believe reduced nicotine cigarettes are less harmful than regular cigarettes. This could reduce motivation to quit smoking.</p>
<p>That’s why we would also need a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8114736/">health education campaign</a> encouraging people to quit tobacco smoking, and warning of the harms of continued smoking regardless of nicotine content. </p>
<p>Another risk is a growth in the illicit tobacco market, which would need to be monitored with increased enforcement effort. </p>
<p>Policymakers may also be concerned about the tobacco industry mounting legal challenges. However, Australia’s successful defence of <a href="http://www.tobaccoinduceddiseases.org/Plain-packaging-of-tobacco-products-lessons-for-the-next-round-of-implementing-countries,130378,0,2.html">tobacco plain packaging laws</a> show that such industry challenges can be overcome.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/423266/original/file-20210927-125361-kzyexo.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6674%2C4436&q=45&auto=format&w=1000&fit=clip"><img alt="A cigarette butt stubbed out." src="https://images.theconversation.com/files/423266/original/file-20210927-125361-kzyexo.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6674%2C4436&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/423266/original/file-20210927-125361-kzyexo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/423266/original/file-20210927-125361-kzyexo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/423266/original/file-20210927-125361-kzyexo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/423266/original/file-20210927-125361-kzyexo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/423266/original/file-20210927-125361-kzyexo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/423266/original/file-20210927-125361-kzyexo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption"></span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/quit-smoking-world-no-tobacco-day-1934934752">Shutterstock</a></span>
</figcaption>
</figure>
<h2>Making it easier to quit — and stop kids ever getting hooked</h2>
<p>Michael Russell, a founder of medical approaches to help people quit smoking, famously said if nicotine was removed from cigarettes, people would “be little more inclined to smoke cigarettes than they are to blow bubbles or light sparklers”.</p>
<p>Modelling suggests that mandating very low nicotine levels for cigarettes would give New Zealand a <a href="https://www.medrxiv.org/content/10.1101/2021.08.13.21262035v1.full">“realistic chance”</a> of reaching its target of less than 5% of the population smoking. It has been estimated that <a href="https://academic.oup.com/ntr/article/23/3/438/5868042">24 million deaths in the USA would have been prevented</a> if nicotine in cigarettes had been reduced decades ago. </p>
<p>If we make tobacco smoking less addictive, we could prevent a new generation becoming addicted to smoking and help people who currently smoke to quit. And that’s a good thing, given the high cost of cigarettes and their contribution to health inequalities in Australia. </p>
<p>Australia led the world in tobacco policy by introducing tobacco plain packaging laws. Taking a leading role in new tobacco control policies, such as reducing the addictiveness of tobacco products, could help us achieve a smoke-free Australia. </p>
<p>But does Australia have the critical ingredient — political will — to finish the task?</p><img src="https://counter.theconversation.com/content/167973/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kylie Morphett is an affiliate of the NHMRC funded Centre for Research Excellence on Achieving the Tobacco Endgame. Her research has been funded by ARC and NHMRC grants. She is a member of The Society for Research on Nicotine and Tobacco. </span></em></p><p class="fine-print"><em><span>Coral Gartner receives funding from the National Health and Medical Research Council and the Australian Research Council. She is a member of the Society for Research on Nicotine and Tobacco, and is a member of Project Sunset, which is a network of tobacco control researchers and advocates who support phasing out the general retailing of commercial combustible tobacco products. </span></em></p>From October 1, Australians will only be able to buy e-cigarettes containing nicotine if they have a prescription from a doctor. But there’s another evidence-based way to help more smokers quit.Kylie Morphett, Research Fellow, School of Public Health, The University of QueenslandCoral Gartner, Associate Professor, School of Public Health, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1644412021-07-15T11:00:29Z2021-07-15T11:00:29ZLab–grown and plant–based meat: the science, psychology and future of meat alternatives – podcast<figure><img src="https://images.theconversation.com/files/411198/original/file-20210714-15-116nkr0.jpg?ixlib=rb-1.1.0&rect=1189%2C0%2C6990%2C4304&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Would you eat cultured meat?</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/portrait-young-scientist-inspecting-analyzing-tweezers-1424197346">HQuality via Shutterstock</a></span></figcaption></figure><p>How do you mimic meat? We take a look at the science behind plant-based and cultured meat in this episode of <a href="https://theconversation.com/uk/topics/the-conversation-weekly-98901">The Conversation Weekly</a> podcast, and where it might lead. And we hear about new research from Indonesia on cigarette advertising and how it lures in children. </p>
<iframe src="https://embed.acast.com/60087127b9687759d637bade/60eff12e7fe7b1001343da25" frameborder="0" allow="autoplay" width="100%" height="110"></iframe>
<p><iframe id="tc-infographic-561" class="tc-infographic" height="100" src="https://cdn.theconversation.com/infographics/561/4fbbd099d631750693d02bac632430b71b37cd5f/site/index.html" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>Companies have been marketing meat alternatives such as soy or bean burgers at vegetarians and vegans since the 1970s. But in the last few years, a number of companies including Beyond Meat and Impossible Foods have changed the game, launching plant-based products aimed at mimicking real meat.</p>
<p>Mariana Lamas, a research associate at the Centre for Culinary Innovation at Northern Alberta Institute of Technology in Edmonton, Canada, says such efforts are attempting to reverse engineering nature. “They ask what makes meat taste and cook like meat and they go from there.” She talks us through some of the science
involved and the key elements that <a href="https://theconversation.com/how-scientists-make-plant-based-foods-taste-and-look-more-like-meat-156839">make a plant-based meat mimic successful</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-scientists-make-plant-based-foods-taste-and-look-more-like-meat-156839">How scientists make plant-based foods taste and look more like meat</a>
</strong>
</em>
</p>
<hr>
<p>From plant-based products we turn to cultured meat, or what some call “no-kill” or vegan meat. Andrew Stout, PhD candidate in biomedical engineering at Tufts University in Massachusetts, US, explains how he grows meat in a petri dish in a lab. Stout believes cell-line technology like this, which breaks down meat to its individual cells, bring massive potential to add different flavours, nutrients and even medicines to cultured meat. “Once you’re dealing with cells, the whole world opens up to you that isn’t open when you’re dealing with whole animals.” </p>
<p>So far only one country in the world, Singapore, has <a href="https://theconversation.com/singapore-approves-cell-cultured-chicken-bites-who-will-be-the-first-to-try-them-151388">granted a licence to sell cultured meat</a>. But even if more products do start making it onto menus and into supermarket aisles elsewhere in the world, will people eat it? </p>
<p>We talk to Matti Wilks, postdoctoral research associate in psychology at Yale University in Connecticut, US, about her <a href="https://theconversation.com/no-animal-required-but-would-people-eat-artificial-meat-72372">research</a> into people’s readiness to eat cultured meat. While Wilks says people’s attitudes are, for the most part, “cautiously optimistic”, a sizeable group are very against the idea. She says this is down to a mixture of things, such as “concerns about the novelty, naturalness, disgust and probably some sort of unknown and fear in there as well.”</p>
<p>In our second story (25m30), we’re talking about the dangerous effects of cigarette advertising in Indonesia, <a href="https://ourworldindata.org/which-countries-smoke-most">ranked in the top ten countries</a> in the world for the number of adults who smoke. A <a href="https://www.mdpi.com/1660-4601/18/5/2556">couple of recent studies</a> have looked into the relationship between cigarette advertising and smoking in the country – and particularly among children. One of the researchers, Nurjanah, senior lecturer in health promotion at Universitas Dian Nuswantoro in Semarang City, Indonesia, explained <a href="https://theconversation.com/riset-remaja-yang-sekolahnya-dikepung-iklan-rokok-cenderung-lebih-tinggi-merokok-161658">what she and her colleagues found</a> when they mapped the proximity of cigarette advertising to schools.</p>
<p>And Hannah Hoag, deputy editor at The Conversation in Canada, gives us some of her recommended environment stories to dip into this week (34m40).</p>
<p>This episode of The Conversation Weekly was produced by Mend Mariwany and Gemma Ware, with sound design by Eloise Stevens. Our theme music is by Neeta Sarl. You can find us on Twitter <a href="https://twitter.com/TC_Audio">@TC_Audio</a>, on Instagram at <a href="https://www.instagram.com/theconversationdotcom/?hl=en">theconversationdotcom</a>. or via email on podcast@theconversation.com. You can also sign up to <a href="https://theconversation.com/newsletter?utm_campaign=PodcastTCWeekly&utm_content=newsletter&utm_source=podcast">The Conversation’s free daily email here</a>.</p>
<p>News clips in this episode are from the <a href="https://www.bbc.com/news/av/uk-politics-23578179">BBC</a>, <a href="https://www.youtube.com/watch?v=nXBLnETp37I">Reut</a><a href="https://www.youtube.com/watch?v=nXBLnETp37I&t=2s">ers</a> and <a href="https://www.youtube.com/watch?v=2QOxLvLa2Xs&t=58s">Al Jazeera English</a>. </p>
<p><em>You can listen to The Conversation Weekly via any of the apps listed above, download it directly via our <a href="https://feeds.acast.com/public/shows/60087127b9687759d637bade">RSS feed</a>, or find out how else to <a href="https://theconversation.com/how-to-listen-to-the-conversations-podcasts-154131">listen here</a>.</em></p><img src="https://counter.theconversation.com/content/164441/count.gif" alt="The Conversation" width="1" height="1" />
Plus, new research from Indonesia on the relationship between cigarette advertising near schools and children smoking.Gemma Ware, Head of AudioDaniel Merino, Associate Breaking News Editor and Co-Host of The Conversation Weekly PodcastLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1594362021-05-23T20:15:56Z2021-05-23T20:15:56ZVaping is glamourised on social media, putting youth in harm’s way<p>Despite their widespread reputation as a “safer” alternative to cigarettes, e-cigarettes (also known as electronic cigarettes or vapes) are <a href="https://moqc.org/wp-content/uploads/2017/08/Surgeon-General-Report_Use-of-E-cigarettes-Among-Youth-and-Young-Adults-2016.pdf">far from harmless</a>, particularly for adolescents, whose developing brains may suffer lifelong adverse effects from nicotine-containing products.</p>
<p>Yet vaping and e-cigarettes are <a href="https://www.jmir.org/2019/2/e11953/">widely promoted on social media</a> by the industry and influencers, using advertising tactics that were outlawed for tobacco in Australia in the 1980s for traditional media. This blatant promotion is not tolerated offline, so why is it happening on social media?</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/398618/original/file-20210504-15-1fcdw30.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/398618/original/file-20210504-15-1fcdw30.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=699&fit=crop&dpr=1 600w, https://images.theconversation.com/files/398618/original/file-20210504-15-1fcdw30.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=699&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/398618/original/file-20210504-15-1fcdw30.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=699&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/398618/original/file-20210504-15-1fcdw30.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=879&fit=crop&dpr=1 754w, https://images.theconversation.com/files/398618/original/file-20210504-15-1fcdw30.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=879&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/398618/original/file-20210504-15-1fcdw30.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=879&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Twitter image.</span>
</figcaption>
</figure>
<p>On Twitter, YouTube and Instagram, <a href="https://www.jmir.org/2019/2/e11953/">e-cigarettes</a> are frequently depicted as a safe and healthy alternative to cigarettes. This is at odds with the opinion of health authorities such as the <a href="https://e-cigarettes.surgeongeneral.gov/documents/surgeon-generals-advisory-on-e-cigarette-use-among-youth-2018.pdf">Office of the Surgeon General</a>, the <a href="https://www.health.gov.au/health-topics/smoking-and-tobacco/about-smoking-and-tobacco/about-e-cigarettes">Federal Health Department</a>
and the <a href="https://www.who.int/news-room/q-a-detail/tobacco-e-cigarettes">World Health Organization (WHO)</a>. There is substantial evidence e-cigarettes have <a href="https://www.nap.edu/catalog/24952/public-health-consequences-of-e-cigarettes#toc">adverse health effects</a> but because they are relatively new (they were first introduced to the US market in 2007) their long-term effects are less clear.</p>
<p>Yet e-cigarettes are <a href="https://www.jmir.org/2019/2/e11953/">touted online</a> as a harmless recreational activity. Vape juice (which may or may not contain nicotine) is available in flavours such as gummy bear, chocolate treat and cherry crush, while social media influencers demonstrate fun vaping tricks or ways to customise e-cigarette devices. There are even online <a href="https://www.sciencedirect.com/science/article/pii/S095539592100075X">vaping communities</a> offering social support and connectedness.</p>
<p>There is no Australian federal legislation that directly applies to e-cigarettes. Instead, several laws relating to poisons, therapeutic goods and tobacco apply. Across Australian states and territories, it is illegal to sell nicotine-containing e-cigarettes but users can legally import them through a “personal importation scheme” if they have a doctor’s prescription. </p>
<p>Those that do not contain nicotine can be sold in some parts of Australia, provided there are no therapeutic claims. Our research found that despite Australia’s restrictions, the internet is <a href="https://www.sciencedirect.com/science/article/pii/S095539592100075X?via%3Dihub#bib0051">facilitating peoples’ access</a> to nicotine and vaping products. An estimated three-quarters of e-cigarette <a href="https://www.euromonitor.com/smokeless-tobacco-and-vapour-products-in-australia/report">purchases are done online</a>.</p>
<h2>Where on the web is vaping promoted?</h2>
<p>To find this content, all you need is a smart phone and a few relevant hashtags such as product names, or related terms such as: #vape, #vapelife, #vapesale and #ejuice.</p>
<p>Images from Instagram, Twitter and TikTok display a mixture of modern advertising techniques and advertising tropes used for decades by the <a href="https://www.tandfonline.com/doi/full/10.1080/07359683.2011.623087">tobacco industry</a>. There are images of scantily dressed women with e-cigarettes, details of tempting vape juice flavours, and discount offers. The scope of this content is alarming. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/398610/original/file-20210504-21-17g5b4i.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/398610/original/file-20210504-21-17g5b4i.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=396&fit=crop&dpr=1 600w, https://images.theconversation.com/files/398610/original/file-20210504-21-17g5b4i.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=396&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/398610/original/file-20210504-21-17g5b4i.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=396&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/398610/original/file-20210504-21-17g5b4i.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=498&fit=crop&dpr=1 754w, https://images.theconversation.com/files/398610/original/file-20210504-21-17g5b4i.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=498&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/398610/original/file-20210504-21-17g5b4i.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=498&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Old-school advertising tactics on Twitter.</span>
</figcaption>
</figure>
<p>This promotion, coupled with the product diversity and allure, ease of online purchase and lack of appropriate age verification, supports the <a href="https://www.mordorintelligence.com/industry-reports/global-e-cigarettes-market-industry">growth of e-cigarettes</a>, particularly among young people. Young people are the biggest users of social media, and they are being directly targeted. </p>
<p>E-cigarette use has been described as an “<a href="https://www.cdc.gov/tobacco/basic_information/e-cigarettes/surgeon-general-advisory/index.html">epidemic among youth</a>”. In Australia, since 2013, the lifetime use of e-cigarettes has <a href="https://www.tobaccoinaustralia.org.au/chapter-18-harm-reduction/indepth-18b-e-cigarettes/18b-3-extent">significantly increased</a> — doubling in 14-17 year olds (4.3% to 9.6%) and almost tripling in those aged 18-24 (7.9% to 26.1%), while rates of cigarette smoking have declined. </p>
<p>This increased e-cigarette uptake by young Australians is particularly worrying. While promotion and advertising of this product are tightly regulated offline, with age restrictions that are relatively easy to enforce, posing as an adult online is often simply a matter of ticking a box.</p>
<p>Despite the dangers of e-cigarettes, many adolescents have <a href="https://www.sciencedirect.com/science/article/pii/S0749379721000659?via%3Dihub#bib0001">positive opinions</a> about them. Surveys have revealed young people consider e-cigarettes to be a healthier and less addictive alternative to cigarettes, with fewer harmful chemicals and fewer health risks from second-hand vapour. </p>
<p>Tobacco companies have a tradition of infiltrating youth-friendly media. Almost all Australians aged between 18 and 29 <a href="https://www.sensis.com.au/about/our-reports/sensis-social-media-report">use social media</a>, for more than 100 minutes a day on average. The <a href="https://publichealth.jmir.org/2020/4/e15577/">high visibility of e-cigarettes</a> available on social media can foster awareness, encourage experimentation and uptake, and change social norms around vaping.</p>
<p>Social media platforms do have their own policies on tobacco advertising. Facebook and its subsidiary Instagram <a href="https://www.facebook.com/policies/ads/prohibited_content/tobacco">stipulate</a>:</p>
<blockquote>
<p>Advertisements must not promote electronic cigarettes, vaporizers, or any other products that simulate smoking. </p>
</blockquote>
<p>This policy has now been extended to all private sales, trades, transfers or gifting of tobacco products. Any brand that posts content related to the sale or transfer of these products must <a href="https://www.tobaccoinaustralia.org.au/chapter-11-advertising/11-11-internet-promotion">restrict it</a> to adults 18 years or older. Whether this is even possible on social media is still open to question. </p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/398611/original/file-20210504-19-gx9h7q.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/398611/original/file-20210504-19-gx9h7q.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=589&fit=crop&dpr=1 600w, https://images.theconversation.com/files/398611/original/file-20210504-19-gx9h7q.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=589&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/398611/original/file-20210504-19-gx9h7q.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=589&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/398611/original/file-20210504-19-gx9h7q.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=741&fit=crop&dpr=1 754w, https://images.theconversation.com/files/398611/original/file-20210504-19-gx9h7q.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=741&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/398611/original/file-20210504-19-gx9h7q.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=741&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Twitter image promotion.</span>
</figcaption>
</figure>
<p>Twitter’s <a href="https://business.twitter.com/en/help/ads-policies/ads-content-policies/tobacco-and-tobacco-accessories.html">policy on paid advertising</a> “prohibits the promotion of tobacco products, accessories and brands globally”. But this does not extend to the content of individual accounts. </p>
<p>TikTok’s <a href="https://ads.tiktok.com/help/article?aid=9552">advertising policy</a> states: </p>
<blockquote>
<p>Ad creatives and landing page must not display or promote tobacco, tobacco-related products such as cigars, tobacco pipes, rolling papers, or e-cigarettes.</p>
</blockquote>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/398603/original/file-20210504-19-lttuix.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/398603/original/file-20210504-19-lttuix.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=837&fit=crop&dpr=1 600w, https://images.theconversation.com/files/398603/original/file-20210504-19-lttuix.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=837&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/398603/original/file-20210504-19-lttuix.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=837&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/398603/original/file-20210504-19-lttuix.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1052&fit=crop&dpr=1 754w, https://images.theconversation.com/files/398603/original/file-20210504-19-lttuix.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1052&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/398603/original/file-20210504-19-lttuix.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1052&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Vape juice advertising on TikTok.</span>
</figcaption>
</figure>
<p>But on social media, where “influencer” content is king, the boundaries between truly organic content and paid product placements is <a href="https://publichealth.jmir.org/2020/4/e15577">blurred</a>.</p>
<p>In 2012, Australia tried to counter this emerging online situation by introducing <a href="https://www.tobaccoinaustralia.org.au/chapter-11-advertising/11-11-internet-promotion">legislation</a> making it an offence to advertise or promote tobacco products on the internet, unless compliant with existing advertising laws. But that legislation doesn’t ban online sales of tobacco products, including vaping products, and can do very little about advertisements from overseas websites. </p>
<p>It is unclear whether health authorities and regulators are aware of the scale and explicitness of e-cigarette content on social media. It seems clear that more should be done to counter it.</p>
<p>Australia, along with close to 170 other countries, is a signatory to the WHO’s <a href="https://fctc.who.int/who-fctc/overview">Framework Convention on Tobacco Control</a> , which <a href="https://www.who.int/tobacco/control/measures_art_13/en/">calls on nations</a> to outlaw all advertising for tobacco products, including e-cigarettes.</p>
<p>Action is required. Australia, and other nations from which this content originates, need to prioritise public health. There needs to be improved surveillance, monitoring and the curtailing of content that glamourises e-cigarettes, as well as improved age verification practices.</p><img src="https://counter.theconversation.com/content/159436/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jonine Jancey has received funding from Healthway</span></em></p>Despite being widely viewed as a safer alternative to tobacco, e-cigarettes aren’t harmless, especially to adolescents. But social media is rife with glossy content that makes vaping look fun and cool.Jonine Jancey, Academic and Director Collaboration for Evidence, Research and Impact in Public Health, Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1536112021-03-02T13:21:15Z2021-03-02T13:21:15ZTobacco killed 500,000 Americans in 2020 – is it time to control cigarette-makers?<figure><img src="https://images.theconversation.com/files/382886/original/file-20210207-17-1i5uo1y.jpg?ixlib=rb-1.1.0&rect=0%2C27%2C3642%2C2697&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Four Americans die every year for every one person employed in the U.S. tobacco industry.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/cigarette-butts-in-a-public-ashtray-royalty-free-image/957852396?adppopup=true">Julien Fourniol/Baloulumix via Getty Images</a></span></figcaption></figure><p><a href="https://www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/index.htm">Tobacco use killed an estimated 500,000 Americans</a> in 2020, about the same number <a href="https://www.cdc.gov/nchs/nvss/vsrr/covid19/index.htm">the pandemic killed in one year</a>. Although education efforts by government and nonprofits have helped to curb tobacco use, <a href="https://www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/index.htm">14% of American adults still smoke</a>, even with <a href="https://www.samwoolfe.com/2013/10/warning-labels-for-cigarettes-alcohol.html">warning labels on the packages</a>. Tobacco deaths are so high that the <a href="https://www.who.int/tobacco/mpower/2009/en/">World Health Organization</a> calls smoking an epidemic. </p>
<p>A potential solution to tobacco-related deaths is a <a href="https://doi.org/10.3390/socsci8020062">corporate “death penalty”</a> – otherwise known as judicial dissolution – when a judge revokes a corporation’s charter for causing significant harm to society. The legal procedure forces the corporation to dissolve; it ceases to exist. Both management and employees lose their jobs. </p>
<p>Although legal, <a href="https://www.commondreams.org/views/2019/01/08/its-time-bring-back-corporate-death-penalty">corporate death penalties in the U.S.</a> have not been used in years. Yet even the threat of one can be effective. <a href="https://www.tandfonline.com/doi/pdf/10.1179/107735211799031059">For example</a>, simply announcing the intention to revoke the charters of two tobacco industry misinformation groups (the Council for Tobacco Research and the Tobacco Institute, Inc.) resulted in both quietly closing in 1999. </p>
<p><a href="https://scholar.google.com/citations?user=QZ8lPxwAAAAJ&hl=en">I became</a> intrigued with corporate death penalties while researching another topic – alternative energy sources. One statistic stuck with me from my own research: Replacing coal power with solar energy would save <a href="https://doi.org/10.1016/j.rser.2017.05.119">an estimated 50,000 American lives per year</a> because of the air pollution produced by coal-fired power plants. The dead would fill the seats of the Sun Bowl.</p>
<p><a href="https://www.woodmac.com/horizons/how-falling-costs-will-secure-solars-dominance-in-power/">With solar already</a> widely available and less costly than coal, and as coal companies continue <a href="https://www.newsweek.com/eight-coal-companies-have-filed-bankruptcy-since-trump-took-office-1468734">to go bankrupt</a>, there seems no reason to drag out the inevitable. I began to wonder: Is there a way to control an industry that causes unnecessary death?</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/Y18Vz51Nkos?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Cigarette smoke wreaks havoc on the body.</span></figcaption>
</figure>
<h2>Setting the minimum bar</h2>
<p>Building a generalized model for applying a corporate death penalty first requires the comparison of human rights to an industry’s right to existence. <a href="https://doi.org/10.3390/socsci8020062">My model</a> relies on three assumptions, based on the U.N.’s <a href="https://www.un.org/en/universal-declaration-human-rights/">Universal Declaration of Human Rights</a>: </p>
<ul>
<li>Everyone has the right to life. </li>
<li>Everyone has the right to work. </li>
<li>Human law should give corporations the right to exist if they benefit humanity. </li>
</ul>
<p>Put simply, corporations may act as a single legal entity – that is, as a person – to efficiently create jobs and generate profit for the benefit of humans. When corporations create profit and jobs, they can largely be viewed as good, unless they interfere with our right to life.</p>
<p>That last bit is the tricky point. Essentially, it means a company or industry, at the very least, must earn its right to exist by employing more people than it kills each year. Perhaps that sounds a bit arbitrary, but let’s call that the minimum bar for an industry’s existence. (This is the absolute minimum. Most people, including myself, would agree that a single job does not equal the value of one life.)</p>
<figure class="align-center ">
<img alt="Warning labels" src="https://images.theconversation.com/files/384065/original/file-20210212-17-198kzhr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/384065/original/file-20210212-17-198kzhr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/384065/original/file-20210212-17-198kzhr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/384065/original/file-20210212-17-198kzhr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/384065/original/file-20210212-17-198kzhr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/384065/original/file-20210212-17-198kzhr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/384065/original/file-20210212-17-198kzhr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Even though warning labels have been on cigarette packs since 1966, millions of Americans still smoke.</span>
<span class="attribution"><span class="source">Wikimedia</span></span>
</figcaption>
</figure>
<h2>Industries that would be banned</h2>
<p>Imagine the corporate death penalty dealing with a new industry represented by a flagship company: “Lazy Assassins Inc.” Lazy Assassins, under aggressive corporate leadership, estimates it could employ 120,000 professional killers that would eliminate one victim per employee per quarter. That’s 480,000 lives per year. </p>
<p>That’s almost exactly the number of Americans the tobacco industry <a href="http://www.ilo.org/wcmsp5/groups/public/---ed_dialogue/---sector/documents/publication/wcms_329284.pdf">employs</a>, and almost exactly the number of Americans it kills each year: 124,342 jobs and 480,000 deaths, including 41,000 from secondhand smoke. <a href="https://doi.org/10.3390/socsci8020062">To put it another way</a>, four Americans die every year for each tobacco industry employee. </p>
<p>Granted, with tobacco companies, this is an all-or-nothing proposition. If only a handful of companies had their corporate charters revoked, other tobacco companies would simply ramp up production to fill the demand. </p>
<p>But if all the charters were revoked, no tobacco company would exist to fund distribution or advertising. There would be only limited access to tobacco products. They could still be produced and used, just not on an industrial scale. That way, we would still maintain the “rights” of smokers to harm themselves.</p>
<p>We have made major <a href="https://theconversation.com/the-calculus-of-death-shows-the-covid-lock-down-is-clearly-worth-the-cost-137716">changes to our economy to prevent even more COVID-19 deaths</a>. With that in mind, isn’t it reasonable to help 124,342 people find new jobs in exchange for saving 480,000 American lives every year? </p>
<p>[<em>Get the best of The Conversation, every weekend.</em> <a href="https://theconversation.com/us/newsletters/weekly-highlights-61?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=weeklybest">Sign up for our weekly newsletter</a>.]</p><img src="https://counter.theconversation.com/content/153611/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Joshua M. Pearce does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Nearly a half-million Americans die every year from smoking and tobacco use. Might a little-used legal remedy save those lives?Joshua M. Pearce, Wite Professor of Materials Science & Engineering, and Electrical & Computer Engineering, Michigan Technological UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1474092020-10-28T12:26:45Z2020-10-28T12:26:45ZCigarette smoke can reprogram cells in your airways, causing COPD to hang on after smoking ends<figure><img src="https://images.theconversation.com/files/362044/original/file-20201006-14-51yv5o.jpg?ixlib=rb-1.1.0&rect=1107%2C209%2C4036%2C2834&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Chronic obstructive pulmonary disease is the third leading cause of death in the United States.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/illustration-of-a-toxic-smoke-in-lung-cancer-or-royalty-free-image/1179207088">Pascal Kiszon via Getty Images</a></span></figcaption></figure><p>Smoking is the most common cause of chronic obstructive pulmonary disease, an often fatal respiratory condition that <a href="https://www.lung.org/lung-health-diseases/lung-disease-lookup/copd/learn-about-copd">afflicts millions</a> of Americans. But for many patients living with COPD, stopping smoking isn’t the end of the battle.</p>
<p>Cigarette smoke is a complex mixture of gases, chemicals and even bacteria. When it enters the lungs, it generates an inflammatory response much like pneumonia. </p>
<p>Inflammatory cells normally clear from the lungs when an infection ends or a patient quits smoking, but in patients with COPD, these cells may persist for years. Destructive enzymes produced by these cells – intended to destroy bacteria – cause progressive lung damage and respiratory failure characteristic of COPD.</p>
<p>It’s been a mystery why these cells continue triggering inflammation in the lungs after people stop smoking. Now, <a href="https://www.vumc.org/viiii/person/bradley-w-richmond-md-phd">research indicates</a> a defect in the immune system induced by cigarette smoke is to blame. Cigarette smoke <a href="https://pubmed.ncbi.nlm.nih.gov/25078120/">reprograms the cells lining the airways</a>, making the lungs of COPD patients who have quit smoking more susceptible to bacterial invasion.</p>
<h2>Good fences make good neighbors</h2>
<p>The lungs are continuously bombarded by inhaled bacteria and other irritants. At the same time, they are tasked with getting oxygen into the bloodstream, so they can’t have an impermeable physical barrier like skin. </p>
<p>To solve this dilemma, the lungs have developed a multi-pronged defense system. A key component of this system is an antibody called secretory IgA. These antibodies latch on to bacteria to prevent them from invading the lungs. Secretory IgA doesn’t directly kill microbes, but it prevents them from triggering a damaging immune response before they can be cleared by other mechanisms. </p>
<figure class="align-center ">
<img alt="Illustration of how SIgA operates in the lining of a person's airway." src="https://images.theconversation.com/files/361436/original/file-20201002-23-zfx5uq.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/361436/original/file-20201002-23-zfx5uq.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=558&fit=crop&dpr=1 600w, https://images.theconversation.com/files/361436/original/file-20201002-23-zfx5uq.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=558&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/361436/original/file-20201002-23-zfx5uq.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=558&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/361436/original/file-20201002-23-zfx5uq.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=701&fit=crop&dpr=1 754w, https://images.theconversation.com/files/361436/original/file-20201002-23-zfx5uq.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=701&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/361436/original/file-20201002-23-zfx5uq.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=701&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Our airways are lined with a layer of cells called the airway epithelium. When bacteria and other germs are inhaled, one way the airway epithelium protects itself is by transporting secretory immunoglobulin A (SIgA) to the airway surface. SIgA attaches to bacteria to prevent them from invading and causing inflammation. SIgA is made by plasma cells beneath the airway epithelium and transported by polymeric immunoglobulin receptors. People with COPD lack SIgA in their airways, which allows bacterial invasion, inflammation and lung damage.</span>
<span class="attribution"><span class="source">Dayana Espinoza/Vanderbilt University</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>In patients with COPD, lower levels of the <a href="https://pubmed.ncbi.nlm.nih.gov/25078120/">polymeric immunoglobulin receptor</a> and secretory IgA <a href="http://doi.org/10.1164/rccm.201604-0759OC">allow bacteria easier access to the airway surface</a>, triggering <a href="http://doi.org/10.1164/rccm.201612-2509ED">an inflammatory response</a> that persists after the patient quits smoking. </p>
<p>Mice that have been genetically manipulated to lack secretory IgA <a href="https://doi.org/10.1038/ncomms11240">also develop inflammation and a pattern of lung damage</a> resembling patients with COPD. Antibiotics can prevent them from developing lung disease, suggesting bacteria cause continued inflammation after smoking ends.</p>
<h2>The double-edged sword of anti-inflammatories</h2>
<p>Since inflammation is central to COPD, it makes sense that anti-inflammatory therapies might be beneficial. However, patients with COPD are also susceptible to lung infections, and anti-inflammatories run the risk of deactivating the body’s natural defenses against infection. The threat is more than theoretical: A <a href="http://doi.org/10.1183/09031936.00150208">clinical trial</a> studying an anti-inflammatory drug called rituximab was stopped early due to an increased rate of pulmonary infections.</p>
<p>Many antibiotics also have serious side effects when taken chronically, and prolonged use might encourage growth of bacteria resistant to these drugs.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/361994/original/file-20201006-14-1v4fjov.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/361994/original/file-20201006-14-1v4fjov.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=315&fit=crop&dpr=1 600w, https://images.theconversation.com/files/361994/original/file-20201006-14-1v4fjov.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=315&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/361994/original/file-20201006-14-1v4fjov.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=315&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/361994/original/file-20201006-14-1v4fjov.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=396&fit=crop&dpr=1 754w, https://images.theconversation.com/files/361994/original/file-20201006-14-1v4fjov.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=396&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/361994/original/file-20201006-14-1v4fjov.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=396&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://www.nhlbi.nih.gov/health-topics/education-and-awareness/copd-learn-more-breathe-better">National Heart, Lung and Blood Institute</a></span>
</figcaption>
</figure>
<h2>A new target for treating COPD?</h2>
<p>While studying mice lacking secretory IgA, our research team at Vanderbilt University Medical Center and colleagues at the University of Florida recently found these mice have increased numbers of a relatively uncommon type of cell called monocyte-derived dendritic cells, or moDCs, in the lungs.</p>
<p>Dendritic cells don’t directly destroy bacteria, but they ring the alarm that a bacterial infection is brewing and coordinate the subsequent immune response. Unlike typical dendritic cells, moDCs begin their lives as a different cell type, called a monocyte. But when chronic inflammation sets in, they can become a type of dendritic cell.</p>
<p>We showed that in mice genetically engineered to lack secretory IgA, <a href="https://doi.org/10.1038/s41385-020-00344-9">moDCs activate T lymphocytes</a> – white blood cells that fight off viruses and can destroy cells in the process – and those T lymphocytes in turn damage the lungs. These data implied that moDCs might also coordinate a pathologic immune response in patients with COPD who also lack secretory IgA in the airways. </p>
<p>Because moDCs weren’t known to exist in human lungs, we <a href="https://doi.org/10.1038/s41385-020-00344-9">used a cutting-edge technique called mass cytometry</a> to detect them. It allows us to distinguish moDCs from other cell types that appear very similar under a microscope.</p>
<p>Like secretory IgA-deficient mice, we found that human COPD patients lacking secretory IgA had increased numbers of moDCs in their lungs. Together, these data suggest that loss of secretory IgA makes the airways more susceptible to bacterial invasion, which activates moDCs to drive ongoing lung inflammation. Therefore, targeting moDCs through medical treatments might block inflammation and lung damage in patients with COPD.</p>
<h2>New drugs are urgently needed for COPD</h2>
<p>There are still many questions to answer, including how best to target moDCs. It also remains to be seen whether such a strategy would compromise the ability of COPD patients to defend against infection.</p>
<p>However, for a disease as common and debilitating as COPD, potential new drug targets come as a breath of fresh air.</p>
<p>COPD is the <a href="https://www.cdc.gov/nchs/fastats/copd.htm">fourth leading cause of death in the U.S.</a> and the <a href="https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death">third leading cause of death worldwide</a>. While many drugs are available to decrease symptoms and hospitalization rates in patients with COPD, none has been proven to prolong life.</p>
<p>Most patients with COPD don’t die from it, <a href="https://www.lung.org/lung-health-diseases/lung-disease-lookup/copd/learn-about-copd">but those who live with COPD</a> suffer from chronic breathlessness which negatively impacts their quality of life. The burden of COPD is felt not just by individual patients, but by families, workplaces and economies.</p>
<p>Though cigarette smoking rates are <a href="https://www.cdc.gov/media/releases/2019/p1114-smoking-low.html">declining in the United States</a>, they are <a href="https://www.who.int/gho/tobacco/use/en/">increasing in many other countries</a>, making COPD a global health issue.</p><img src="https://counter.theconversation.com/content/147409/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bradley Richmond receives funding from the U.S. Department of Veterans Affairs, the National Institutes of Health, and has an investigator-initiated grant from 4D Medical related to an investigational imaging technology not discussed here.</span></em></p>A new discovery offers hope for ways to treat a debilitating disease that has become a leading cause of death in the US..Bradley Richmond, Assistant Professor of Medicine, Vanderbilt UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1405532020-06-15T20:01:57Z2020-06-15T20:01:57ZAustralia’s decisive win on plain packaging paves way for other countries to follow suit<p>The decision, <a href="https://www.wto.org/english/news_e/news20_e/435_441abr_e.htm">handed down on June 9 by the World Trade Organisation’s appeals body</a>, that Australia’s plain packaging tobacco control policy doesn’t flout WTO laws marks the end of almost a decade of legal wrangling over this landmark public health policy. And more importantly, it paves the way for other nations around the world to follow Australia’s lead.</p>
<p>In 2012 Australia became the first country in the world to implement <a href="https://www.legislation.gov.au/Details/C2011A00148">tobacco plain packaging laws</a>, having recognised that the tobacco industry uses packaging both to market cigarettes and to undermine health warnings. </p>
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<a href="https://theconversation.com/the-olive-revolution-australias-plain-packaging-leads-the-world-8856">The Olive Revolution: Australia's plain packaging leads the world</a>
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<p>The industry has long acknowledged the powerful role of packaging design in attracting consumers and reinforcing brand image. A <a href="https://www.printinnovationasia.com/single-post/2017/01/18/The-Premiumisation-of-Cigarette-Packaging-in-Indonesia">2017 trade article</a> on the “premiumisation” of cigarettes explained the rationale behind glossy packaging:</p>
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<p>Features such as velvet touch, soft touch, etching, rise and relief can be applied across the surface of the packaging to make the product more impactful and raise customer engagement. The look of the packaging such as intense metallics through the use of foil simulation inks can also give cigarette packaging the luxurious effect and adds on to the premium feel of the product.</p>
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<figcaption><span class="caption">A Cancer Research UK video shows how children react to glossy cigarette packs.</span></figcaption>
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<p>The “plain packaging” mandated by Australia’s laws is in fact anything but. It features <a href="https://www.health.gov.au/health-topics/smoking-and-tobacco/tobacco-control/tobacco-plain-packaging">graphic, full-colour health warnings</a> presented on a drab brown background. Brand logos, designs, emblems, and slogans are banned; product brand names remain, but must appear in a standardised font. </p>
<p>The result means tobacco packages can no longer serve as mini billboards that make cigarettes look aspirational and desirable.</p>
<h2>Legal challenges</h2>
<p>The tobacco industry launched three separate legal challenges to the law. First, JT International and British American Tobacco filed a lawsuit in the Australian High Court. Next, tobacco firm Philip Morris sought legal protection for its packaging designs under an existing investment treaty between Australia and Hong Kong. Finally, the industry filed a dispute through the WTO on behalf of four tobacco-producing countries: Cuba, Honduras, Indonesia and the Dominican Republic.</p>
<p>In 2012 the High Court <a href="https://www.tobaccocontrollaws.org/litigation/decisions/au-20121005-jt-intl.-and-bat-australasia-l">ruled in favour of the Australian government</a>, and in 2015 the investment treaty tribunal <a href="https://www.tobaccocontrollaws.org/litigation/decisions/au-20151217-philip-morris-asia-v-australia">dismissed Philip Morris Asia’s claim</a>. The WTO also <a href="https://www.reuters.com/article/us-wto-tobacco-ruling/australia-wins-landmark-wto-ruling-on-plain-tobacco-packaging-idUSKBN1JO2BF">ruled in Australia’s favour</a> in 2018, but the Dominican Republic and Honduras appealed. </p>
<p>That appeal was denied last week, meaning all legal challenges to Australia’s plain packaging laws have now been finally and decisively overruled – more than a decade after the then Prime Minister Kevin Rudd <a href="https://tobaccolabels.ca/australia-announces-plain-packaging/">first announced the policy</a> in April 2010.</p>
<h2>No more industry blocking</h2>
<p>The <a href="https://www.wto.org/english/tratop_e/dispu_e/435_441abr_conc_e.pdf">WTO’s appeal body agreed</a> plain packaging laws are likely to improve public health and that they are not unfairly restrictive to trade. </p>
<p>The appeal was not expected to succeed, so the ruling comes as no surprise. But despite this, legal wrangling has become a <a href="https://untobaccocontrol.org/kh/legal-challenges/court-cases-litigation-policy-brief/">standard tobacco industry practice</a>, particularly through international channels such as the WTO. One reason is because the slow and cumbersome legal process can serve as a deterrent to other countries, who may hold off implementing similar laws until the legal outcome is known.</p>
<p>Encouragingly, this stalling tactic seems to be losing its power. Countries such as France, the United Kingdom, Ireland, Norway, and New Zealand have all forged ahead with plain packaging legislation despite the outstanding appeal. </p>
<p>Now, however, lower-income countries can also confidently pursue plain packaging measures <a href="https://www.mccabecentre.org/news-and-updates/tobacco-plain-packaging-legal-victory-for-australia.html">without fear of falling foul of the WTO</a>. </p>
<h2>What next?</h2>
<p>Australia’s plain packaging law was groundbreaking at the time. But now the tobacco industry has responded with a range of tactics to exploit loopholes and offset the impact on their brands, meaning governments need to come up with yet more countermeasures.</p>
<p>Once plain packaging was implemented, the tobacco industry quickly trademarked new brand names, such as Imperial Tobacco’s <a href="https://open.sydneyuniversitypress.com.au/9781743323977/rtec-the-future.html">Peter Stuyvesant + Loosie</a>, which contains 21 cigarettes instead of 20, and advertises the bonus cigarette within the name.</p>
<p>Canada’s <a href="https://www.cancer.ca/en/about-us/for-media/media-releases/national/2019/plain-packaging-regulations/?region=qc">plain packaging laws</a>, enacted in February 2020, directly control the size and shape of the cigarettes themselves. For example, the law bans slim cigarettes targeted at young women who associate smoking with slimness and fashion. </p>
<p>Widespread plain packaging could also help curb the <a href="https://theconversation.com/big-tobacco-wants-social-media-influencers-to-promote-its-products-can-the-platforms-stop-it-129957">uprise in tobacco marketing via social media influencers</a>. A tobacco pack covered in gruesome disease imagery doesn’t make for inspiring social media content.</p>
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Read more:
<a href="https://theconversation.com/big-tobacco-wants-social-media-influencers-to-promote-its-products-can-the-platforms-stop-it-129957">Big Tobacco wants social media influencers to promote its products – can the platforms stop it?</a>
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<p>The WTO upheld Australia’s plain packaging laws because the government had convincing public health research to show the positive impact of plain packaging on public attitudes to smoking. </p>
<p>Seen in that light, the decision isn’t just a win for public health. It’s also an encouraging sign that evidence-based policies can defeat even the deepest of corporate pockets.</p><img src="https://counter.theconversation.com/content/140553/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Becky Freeman has received funding from NHMRC, WHO, the Australian Government, Australian National Preventive Health Agency, NSW Health, Cancer Council Australia, Cancer Council NSW, NSW National Heart Foundation, Cancer Council Victoria, Healthway WA, Cancer Institute New South Wales, and the Australia-Indonesia Centre.</span></em></p>The World Trade Organisation has thrown out the final legal challenge to Australia’s tobacco plain packaging laws. Now countries across the world can implement this game-changing public health policy.Becky Freeman, Senior Research Fellow, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1352942020-04-14T04:51:23Z2020-04-14T04:51:23ZSmoking increases your coronavirus risk. There’s never been a better time to quit<figure><img src="https://images.theconversation.com/files/327589/original/file-20200414-63518-1xt4cfz.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C4950%2C3705&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption"></span> </figcaption></figure><p>If you’re a smoker, there’s really never been a better time to quit. Coronavirus affects your lungs, causing flu-like <a href="https://www.health.gov.au/resources/apps-and-tools/healthdirect-coronavirus-covid-19-symptom-checker">symptoms</a> such as fever, cough, shortness of breath, sore throat and fatigue. In the most serious cases, sufferers struggle to breathe at all and can die of respiratory failure.</p>
<p>The World Health Organisation <a href="https://www.facebook.com/WHO/photos/a.167668209945237/3015563535155676/?type=3&theater">recommends people quit smoking</a> as it makes them more vulnerable to COVID-19 infection.</p>
<p>Here’s what we know about smoking and COVID-19 risk – and how you can boost your chances of quitting while under lockdown.</p>
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Read more:
<a href="https://theconversation.com/its-safest-to-avoid-e-cigarettes-altogether-unless-vaping-is-helping-you-quit-smoking-123274">It's safest to avoid e-cigarettes altogether – unless vaping is helping you quit smoking</a>
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<h2>Smoking and COVID-19 risk</h2>
<p>Early data from <a href="https://journals.lww.com/cmj/Abstract/publishahead/Analysis_of_factors_associated_with_disease.99363.aspx">China</a> suggests smoking history is one factor that the risk of poor outcomes in COVID-19 patients.</p>
<p>According to the Australian Institute of Health and Welfare, smoking is a leading risk factor for <a href="https://www.aihw.gov.au/reports-data/behaviours-risk-factors/smoking/about">chronic disease and death</a>.</p>
<p>Smokers are more susceptible to developing heart disease, which so far seems to be the highest risk factor for the <a href="https://www.cebm.net/covid-19/global-covid-19-case-fatality-rates/">COVID-19 death rate</a>. The Centre for Evidence-Based Medicine at the University of Oxford <a href="https://www.cebm.net/covid-19/global-covid-19-case-fatality-rates/">reports</a> that smoking seemed to be a factor associated with poor survival in Italy, where 24% of people smoke. </p>
<p>We know that immunosuppressed people are at higher risk if they get COVID-19 and cigarette smoke is an <a href="http://jpet.aspetjournals.org/content/293/1/166.short">immunosuppressant</a>.</p>
<p>And the hand-to-mouth action of smoking makes smokers vulnerable to COVID-19 as they are touching their <a href="https://www.who.int/news-room/q-a-detail/q-a-on-smoking-and-covid-19">mouth and face</a> more often.</p>
<p>We don’t yet know if recent ex-smokers are at higher risk of COVID-19 than people who have never smoked. Given the lungs heal rapidly after quitting smoking, being an ex-smoker is likely to decrease your chances of complications due to <a href="https://www.quit.org.au/articles/faqs-coronavirus-covid-19-and-smoking/">COVID-19</a>.</p>
<h2>Reduce your COVID-19 risks today by quitting</h2>
<p>The benefits of quitting smoking are almost <a href="https://www.hhs.gov/sites/default/files/2020-cessation-sgr-full-report.pdf">immediate</a>. Within 24 hours of quitting, the body starts to recover and repair. Lung function improves and respiratory symptoms become less severe. </p>
<p>You might not notice the changes immediately, but they will become obvious <a href="https://www.tandfonline.com/doi/abs/10.1185/03007990802707642?journalCode=icmo20">within months of quitting</a>. And the improvements are sustained with long-term abstinence. </p>
<p>Tiny hairs in your lungs and airways (called cilia) get better at clearing mucus and debris. You’ll start to notice you’re breathing more easily.</p>
<p>Symptoms of chronic bronchitis, such as chronic cough, mucus production and wheeze, decrease rapidly. Among people with <a href="https://academic.oup.com/ntr/article-abstract/7/1/139/1030253?redirectedFrom=fulltext">asthma</a>, lung function improves within a few months of quitting and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2946703/">treatments</a> are more effective.</p>
<p>Respiratory infections such as bronchitis and pneumonia also decrease with <a href="https://www.hhs.gov/sites/default/files/2020-cessation-sgr-full-report.pdf">quitting</a>. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/smoking-at-record-low-in-australia-but-the-grim-harvest-of-preventable-heart-disease-continues-119169">Smoking at record low in Australia, but the grim harvest of preventable heart disease continues</a>
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<p>People should seek behavioural counselling support to work through motivations to quit, strategies for dealing with triggers, and distraction techniques. </p>
<p>And you can get behavioural support from your doctor or a psychologist via telephone Quitlines in your state or territory or <a href="https://www.icanquit.com.au/">online</a>.</p>
<p><a href="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1000216">Several</a> <a href="https://www.sciencedirect.com/science/article/abs/pii/S0306460313003948">studies</a> suggest that some people quit smoking without assistance. If you feel you need extra help, talk to your doctor about nicotine gum, patches, inhalators, lozenges or prescription medications. If you can’t get in to see a GP, you can try a <a href="https://www.abc.net.au/news/2020-03-24/telehealth-coronavirus-covid-19-medical-appointments-gp-consult/12085094">telehealth</a> consultation or consider over-the-counter products.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/327584/original/file-20200414-53927-4ax4z4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/327584/original/file-20200414-53927-4ax4z4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/327584/original/file-20200414-53927-4ax4z4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/327584/original/file-20200414-53927-4ax4z4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/327584/original/file-20200414-53927-4ax4z4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/327584/original/file-20200414-53927-4ax4z4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/327584/original/file-20200414-53927-4ax4z4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/327584/original/file-20200414-53927-4ax4z4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Calculate how much money you’ll save by quitting.</span>
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<h2>Quitting while in lockdown</h2>
<p>Physical distancing and lockdown measures may make it more challenging to get the support you need to quit smoking – but not impossible. </p>
<p>If <a href="https://blogs.bmj.com/bmj/2020/03/20/sharon-cox-risky-smoking-practices-and-the-coronavirus-a-deadly-mix-for-our-most-vulnerable-smokers/">financial stress</a> is undermining your attempts to stop smoking, <a href="https://www.icanquit.com.au/savings-calculator-results">calculate</a> how much money you can save by quitting (and whatever you do, don’t share cigarettes with someone else). <a href="https://moneysmart.gov.au/covid-19-financial-assistance">Financial support</a> is available if COVID-19 has affected your income.</p>
<p>Social support, even during lockdown, is crucial. Why not organise a group of friends also wanting to quit and support each other via <a href="https://www.businessinsider.com.au/how-to-use-houseparty-to-see-friends-during-coronavirus-outbreak-2020-3?r=US&IR=T">Houseparty</a>, Zoom or Skype?</p>
<p>Pandemic or no pandemic, smoking poses an enormous risk to your health - and hurts your finances, too. </p>
<p>Any effort you put in now to reduce your smoking or stub it out altogether will reduce your risk if you do get COVID-19, help you live longer and enjoy a higher quality of life. We wish you the very best of luck with it.</p><img src="https://counter.theconversation.com/content/135294/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Billie Bonevski receives funding from The National Health and Medical Research Council, Cancer Institute NSW, Cancer Council NSW, Heart Foundation, National Stroke Foundation, Pfizer, Royal Australian College of General Practitioners, NSW Ministry of Health and Victoria Health.
Billie Bonevski is a Board Member of the Society for Research on Nicotine and Tobacco.</span></em></p><p class="fine-print"><em><span>Eliza Skelton receives funding from Hunter Medical Research Institute. She is affiliated with both Hunter Medical Research Institute and Hunter Cancer Research Alliance. She is a member of the Hunter Cancer Research Alliance Community Engagement Committee. </span></em></p><p class="fine-print"><em><span>Caitlin Bialek does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Early data suggests being a smoker might put you at higher risk if you catch coronavirus, so there’s never been a better time to quit. The good news is the benefits are almost immediate.Billie Bonevski, Women in Science Chair, University of NewcastleCaitlin Bialek, Research Assistant, University of NewcastleEliza Skelton, Research Academic, Faculty of Health and Medicine, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1349312020-03-30T15:59:36Z2020-03-30T15:59:36ZSouth Africa’s COVID-19 lockdown: cigarettes and outdoor exercise could ease the tension<figure><img src="https://images.theconversation.com/files/323994/original/file-20200330-146699-yugdce.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There is no documented health benefit that warrants banning cigarette sales for 21 days.</span> <span class="attribution"><span class="source">Getty Images</span></span></figcaption></figure><p>What do South Africa, China, Germany, the UK and the US have in common? That each differs from the other. Ample empirical evidence shows that <a href="https://www.oxfordscholarship.com/view/10.1093/acprof:osobl/9780199841608.001.0001/acprof-9780199841608">economic</a> and <a href="https://www.mailman.columbia.edu/people/our-faculty/qa4">health measures</a> that work sometimes, in some places, don’t always work everywhere.</p>
<p>South Africa’s President Cyril Ramaphosa has been <a href="https://theconversation.com/reality-of-exponential-growth-of-covid-19-shows-south-africas-lockdown-is-right-134572">praised</a> for being decisive in the face of the COVID-19 outbreak. We agree with this positive view. Ramaphosa has demonstrated a quality of leadership matched by disappointingly few leaders globally. But we fear that some of the recently implemented policies are not best for the South African context. South Africa could be charting its own course, for the benefit of the nation and continent. </p>
<p>As matters stand, the South African <a href="http://www.thepresidency.gov.za/speeches/statement-president-cyril-ramaphosa-escalation-measures-combat-covid-19-epidemic%2C-union">lockdown</a> emulates and, in some respects, surpasses restrictions elsewhere. Some of the restrictions are gratuitous, impractical or harmful.</p>
<h2>What is lockdown in South Africa?</h2>
<p><a href="https://businesstech.co.za/news/government/384827/read-the-final-lockdown-regulations-in-full-here/">South African lockdown restrictions</a> are among the most extreme globally. South Africans may not leave their homes except to procure essential goods and services. <a href="https://www.iol.co.za/news/south-africa/coronavirus-in-sa-sale-of-cigarettes-prohibited-during-21-day-lockdown-45566024">This excludes the purchase of cigarettes and alcohol</a>. It also excludes outdoor exercise. </p>
<p>For those living in freestanding properties in the suburbs, and enjoying an uninterrupted salary from a large company or institution, the lockdown is a little like a spiritual retreat. They can stay at home and drink coffee in their pyjamas on the deck without even a passing car to disturb them.</p>
<p>But <a href="https://www.superlinear.co.za/how-many-south-africans-live-in-informal-dwellings-and-other-home-ownership-stats/">most South Africans do not live like this</a>. Even wealthy South Africans often live in complexes or estates without access to non-communal outside space. And many more live in crowded accommodation, whether in poor urban areas, formerly wealthy suburbs, central business districts, or well-spaced rural dwellings that are nonetheless occupied by many people.</p>
<p>It is one thing to stay in a suburban house, with a nice garden for fresh air and sunshine. It is another to spend the day in <a href="https://www.ohchr.org/Documents/Issues/Housing/InformalSettlements/SERI.pdf">a small shack with 10 other people</a>, especially when only “<a href="https://www.gov.za/about-sa/water-affairs">an estimated 46.3% of households had access to piped water in their dwellings in 2018</a>”.</p>
<p><a href="https://theconversation.com/gender-based-violence-in-south-africa-whats-missing-and-how-to-fix-it-78352">Domestic violence, rape and child abuse are serious problems in South Africa</a>. Most of these crimes are committed by people close to the victim. The lockdown measures are likely to place stress on abusers and make it hard for the abused to escape.</p>
<p>It is no surprise that the lockdown restrictions are already being widely violated. This is not about disobedience: it is about the difficulty of complying. If you have to leave your dwelling merely to answer a call of nature, then you are not in a meaningful lockdown. And even with army support, policing will be extraordinarily difficult. Communities would need to fall into line of their own volition, and their circumstances make it hard for them to do so.</p>
<h2>Cigarettes as essential goods</h2>
<p><a href="https://www.medicalnewstoday.com/articles/323012">Nicotine withdrawal causes bad temper, frustration, agitation, anxiety and mood swings</a>. The damaging health effects of smoking are well established, but although <a href="https://www.medicalnewstoday.com/articles/317956#timeline">early stages of lung-recovery are visible a full month after one stops smoking</a>, there is no evidence suggesting that COVID-19 symptoms are alleviated by 21 days of abstinence. There is no documented COVID-19 health benefit within a 21-day window to warrant prohibiting the sale of cigarettes. But there is considerable short-term risk to the mental wellbeing of those who use tobacco as a coping mechanism. </p>
<p>This restriction on civil liberties causes misery for no public health benefit and may increase the risk of domestic violence as people suffer withdrawal in confined and stressful circumstances.</p>
<p>The prohibition of alcohol makes more sense. But behavioural factors must be considered, including the incentive to <a href="https://www.enca.com/news/last-call-alcohol-sa-rushes-stockpile-booze">stockpile</a> and the criminal opportunity for bootlegging. Restricting alcohol purchase prior to the lockdown might have made sense. That window has closed. At this stage the case for putting alcohol on the list of essential goods is weak. The case for including cigarettes, however, is strong.</p>
<h2>Outdoor exercise is essential</h2>
<p><a href="https://www.enca.com/news/no-dog-walking-and-jogging-allowed-during-lockdown">“No jogging. No dog walking. Stay inside.”</a> That is the message from the government. This is a public health problem of note: exercise, even a small amount of it, is essential to stay healthy, <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012424.pub2/full">especially for the elderly</a>, and thus many of those most at risk from COVID-19.</p>
<p>Exercise, including mild exercise such as going for a walk, <a href="https://www.cochrane.org/CD004366/DEPRESSN_exercise-for-depression">appears to alleviate or prevent depression</a>. It is easy to write off the value of mental wellbeing at a time when serious physical disease threatens. But this is a mistake. Mental illness has physical consequences for the sufferer and those around them, and can make life seem not worth living.</p>
<p>When defining “essential goods and services”, we must ask “essential for what?” There is much that is not strictly essential to our survival that nonetheless we value greatly. We may even value some of these things above survival, such as the wellbeing of our children.</p>
<p>The current usage of the word “essential” imposes a value judgement. It makes the avoidance of COVID-19 infection the paramount goal. It implicitly places less value on mental health, and even physical health where that is independent of COVID-19.</p>
<h2>Is a lockdown right in South Africa?</h2>
<p>Context matters. Whether the lockdown works depends on the context in which it is done. The lockdown is worthwhile if it prolongs life for a significant number of people. But some of the measures in South Africa have no health benefit. </p>
<p>South African leaders should consider the full range of responses available to them, and assess the costs and benefits within their context. Regional quarantine arguably failed in Italy, but was apparently more successful in China. <a href="https://www.theguardian.com/cities/2019/oct/21/why-are-south-african-cities-still-segregated-after-apartheid">South Africa was designed by the apartheid government to keep people apart</a>. </p>
<h2>What is to be done?</h2>
<p>We are not advocating inaction or negligence. Reducing the rate of infection is a laudable goal. We would suggest, in particular, the addition of cigarettes to the list of basic goods, and the insertion of a right to exercise out of doors provided physical distance is maintained (along the lines of guidelines elsewhere).</p>
<p>More generally we suggest that, given very different conditions in relatively wealthy suburbs, inner cities, crowded low-income areas and rural areas, restrictions be considered on a provincial or local rather than a national basis. This is in line with the successful practice in China.</p><img src="https://counter.theconversation.com/content/134931/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Benjamin T H Smart receives funding from The National Research Foundation. </span></em></p><p class="fine-print"><em><span>Alex Broadbent has received funding from The National Research Foundation. </span></em></p>Lockdown should be nuanced to the South African context of overcrowded accommodation and high levels of domestic violence. Permitting cigarette purchases and exercise might assist.Benjamin T H Smart, Associate Professor, University of JohannesburgAlex Broadbent, Director of the Institute for the Future of Knowledge and Professor of Philosophy, University of JohannesburgLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1234352019-09-15T12:19:56Z2019-09-15T12:19:56ZVaping: As an imaging scientist I fear the deadly impact on people’s lungs<figure><img src="https://images.theconversation.com/files/292333/original/file-20190912-190021-6z6p58.jpg?ixlib=rb-1.1.0&rect=0%2C44%2C2470%2C1388&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Lung MRI of an ex-smoker of cannabis and tobacco, showing poor lung function and truncated airway tree. In vaping patients, oily substances have also been found inside their lung tissue and airways.</span> <span class="attribution"><span class="source">(Parraga lab)</span>, <span class="license">Author provided</span></span></figcaption></figure><p>Vaping causes severe illness in otherwise healthy young adults and teenagers. It causes a <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1911614">life-threatening, life-shortening and sometimes deadly lung toxicity and injury</a> — with apparently irreversible damage that cannot be cured.</p>
<p>A recent report in the <em>New England Journal of Medicine</em> on 53 confirmed cases of young e-cigarette users hospitalized with severe lung toxicity and injury clearly shows that this is the case. The average age of these patients was 19.</p>
<p>A relatively short history of vaping has led to hospitalization, <a href="https://www.washingtonpost.com/health/2019/09/12/her-temperature-spiked-day-she-decided-stop-vaping-now-shes-life-support/">weeks of intensive care</a>, lung failure, the urgent need for a heart-lung bypass machine and then, after all attempts have failed, <a href="https://www.cnn.com/2019/09/10/health/vaping-outbreak-2019-explainer/index.html">needless deaths in otherwise healthy young people</a>.</p>
<p>As a lung-imaging scientist, I develop new ways to see inside the chest so that <a href="https://onlinelibrary.wiley.com/doi/10.1002/jmri.25010">lung abnormalities can be easily measured and monitored in patients</a>. I see the devastating effects inside the lungs of cigarette and cannabis smokers. I also see how the <a href="https://doi.org/10.1164/rccm.201402-0256PP">airways are destroyed</a> and how millions of air sacs appear demolished or completely wiped out, all of which results in <a href="http://doi.org/10.15326/jcopdf.5.4.2018.0157">severe breathlessness, miserable quality of life and then death</a>.</p>
<p>Because of my experience developing new ways to image the lungs and seeing the impact of inhaled smoke and gases on lung health, I have been disturbed that government and other regulators have taken a hands-off approach to the risk of e-cigarettes. </p>
<p>I am alarmed that e-cigarette marketing is so pervasive, persuasive and widespread, especially when this marketing targets children and teenagers in whom lung growth and development has not yet completed.</p>
<h2>Oily substances found inside the lungs</h2>
<p>In <a href="https://www.nejm.org/doi/full/10.1056/NEJMe1912032">some of the recent reports</a> about patients with vaping-associated lung toxicity, <a href="https://www.nejm.org/doi/full/10.1056/NEJMc1912038">oily substances were found inside their white blood cells, lung tissue and airways</a>. </p>
<p>While these oils may be related to the <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1911614">e-cigarette nicotine and THC mixtures these patients used</a>, it is not clear yet — and remains difficult to understand — how such serious, life-threatening lung disease can be set off by e-cigarette use. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/292334/original/file-20190912-190002-8a9rrk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/292334/original/file-20190912-190002-8a9rrk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/292334/original/file-20190912-190002-8a9rrk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/292334/original/file-20190912-190002-8a9rrk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/292334/original/file-20190912-190002-8a9rrk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/292334/original/file-20190912-190002-8a9rrk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/292334/original/file-20190912-190002-8a9rrk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A patient is prepared for a lung MRI.</span>
<span class="attribution"><span class="source">(Parraga lab)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>I think it’s helpful to visualize this by imagining a pound of butter as a solid and by melting into a liquid and heating again at high temperatures, the butter becomes a gaseous vapour, which can be inhaled. The buttery vapour coating, while delicious on popcorn, forms a solid again when it cools inside the lungs and becomes a toxic initiator of lung inflammation and failure.</p>
<h2>One quarter of high school students vaping</h2>
<p>E-cigarettes have been promoted as a safe, cool alternative to cigarettes. Not surprisingly, this marketing has worked well in children and teens. </p>
<p>During 2017-2018, the <a href="https://www.cdc.gov/mmwr/volumes/67/wr/mm6745a5.htm">rate of high-school students using e-cigarettes in the united States doubled to 21 per cent</a>, which is greater than the rates of tobacco smoking among children and adults alike. Estimates for 2019 suggest that <a href="http://www.safetyandhealthmagazine.com/articles/17921-number-of-teens-vaping-hits-record-high-survey-shows">one quarter of North American high school students use e-cigarettes</a>. </p>
<p>Vaping devices also provide the ultimate flexibility — mixing and matching inserts, oils and active ingredients is relatively easy to do. This means that products are being marketed and sold to kids who have the time and energy to invent new mixtures, have a high tolerance for risk and have a complex need for peer-approval to try them out too. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1172218359510966272"}"></div></p>
<p>What could possibly go wrong? Why are we surprised by the current situation?</p>
<h2>Aggressive marketing, lack of safety testing</h2>
<p>We have known for decades that <a href="https://www.nejm.org/doi/full/10.1056/NEJM200405133502021">lung damage occurs because of chemical exposures in at-risk occupations and from chronic inhalation of gases and smoke</a>, so I wonder why anyone would assume that e-cigarettes would not be dangerous and damaging too? </p>
<p>I wonder why resplendent and aggressive marketing of e-cigarettes is acceptable in corner stores and gas stations everywhere while cigarettes are rightly held, incognito, behind locked, opaque shelves in the same store. </p>
<p>Even worse, small “vape shops” also offer after-market replacement products for free — many of which have dubious origins and no safety testing. This has to be exposed, investigated and stopped.</p>
<h2>Fad-flavoured e-cigarettes must be banned</h2>
<p>For all these reasons, regulation of vaping products, their advertisement and placement in stores need to be reconsidered and tightened up similar to tobacco products. </p>
<p>Fun- and fad-flavoured e-cigarettes that are directly promoted to children should be banned. Health-care professionals and scientists need to shout out about the dangers, outside of their offices, labs and clinics — until things change.</p>
<p>Multinational corporations including Big Vape, Big Cannabis and Big Tobacco have a history of finding — and will continue to find — new and ingenious ways to profit from adults’, teenagers’ and children’s tragic decisions, addictions and mistaken understandings about inhaled product risks. </p>
<p>It is like cigarettes all over again.</p>
<p>[ <em><a href="https://theconversation.com/ca/newsletters?utm_source=TCCA&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=expertise">Expertise in your inbox. Sign up for The Conversation’s newsletter and get a digest of academic takes on today’s news, every day.</a></em> ]</p><img src="https://counter.theconversation.com/content/123435/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Grace Parraga PhD receives funding from the Canadian Institutes of Health Research, the Natural Sciences and Engineering research Council (Canada), Canada Foundation for Innovation and Canada Research Chair program. She is a professor at Schulich School of Medicine & Dentistry, Western University. </span></em></p>Vaping devices cause deadly lung toxicity. Their marketing to children must be banned.Grace Parraga, Professor and Tier 1 Canada Research Chair, Western UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1233042019-09-12T20:44:11Z2019-09-12T20:44:11ZThe next battles against tobacco must be fought in the world’s major cities<figure><img src="https://images.theconversation.com/files/291825/original/file-20190910-190031-olddso.jpg?ixlib=rb-1.1.0&rect=73%2C16%2C5316%2C3473&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Ho Chi Minh City, Vietnam, is one of many emerging global metropolises that are struggling to protect residents against tobacco.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Global cities like New York and London were among the first to pioneer <a href="https://doi.org/10.2105/AJPH.2004.058164">effective tobacco control policies</a> — like smoke-free workplaces, public cessation services and higher tobacco taxes. </p>
<p>These life-saving policies were so successful that an international treaty called the Framework Convention on Tobacco Control was negotiated in 2003 to promote similar evidence-based policies throughout the world. Until recently, <a href="https://www.who.int/dg/speeches/2008/20081117/en/">many assumed</a> the <a href="https://www.who.int/fctc/signatories_parties/en/">181 countries that ratified the treaty</a> had benefitted from it.</p>
<p>This month we published <a href="https://doi.org/10.1136/bmj.l2287">new research in the <em>British Medical Journal</em></a> showing that a pre-existing decline in global cigarette consumption was not accelerated by this international tobacco control treaty. </p>
<p>Worse yet, our depressing findings show that while people are smoking less in richer countries like the United States and the United Kingdom, tobacco consumption is rising by over 500 cigarettes per adult in poorer countries like China, Indonesia and Vietnam.</p>
<p>These unexpected results raise two important questions: what could explain these global disparities in tobacco control, and what can be done to address them?</p>
<h2>Tobacco taxes too low</h2>
<p>Global disparities may largely be explained by shifting economic trends and governments’ different capabilities in implementing tobacco control policies. </p>
<p>Rapidly growing metropolises like Beijing, Jakarta and Ho Chi Minh City have not had the same success in protecting their residents against the dangers of tobacco as the richer early-adopting cities.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/291824/original/file-20190910-190044-ex46mr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/291824/original/file-20190910-190044-ex46mr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=337&fit=crop&dpr=1 600w, https://images.theconversation.com/files/291824/original/file-20190910-190044-ex46mr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=337&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/291824/original/file-20190910-190044-ex46mr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=337&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/291824/original/file-20190910-190044-ex46mr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=423&fit=crop&dpr=1 754w, https://images.theconversation.com/files/291824/original/file-20190910-190044-ex46mr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=423&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/291824/original/file-20190910-190044-ex46mr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=423&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Jakarta, Indonesia. Tobacco consumption is rising by by over 500 cigarettes per adult in poorer countries like Indonesia and Vietnam.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>One major reason is that <a href="https://doi.org/10.1007/s00038-017-0955-8">tobacco taxes in these cities are a fraction</a> of what we know they should be and are <a href="https://www.tobaccofreekids.org/assets/global/pdfs/en/Indonesia_tobacco_taxes_report_en.pdf">not rising as quickly as incomes</a>. </p>
<p>As a result, these cities will <a href="http://dx.doi.org/10.1136/tobaccocontrol-2014-051821">lose billions of dollars</a> in lost productivity and health-care expenditures, and the <a href="https://www.who.int/tobacco/publications/surveillance/rep_mortality_attibutable/en/">number one preventable cause of premature death</a> will grow worse every year for hundreds of millions of people.</p>
<h2>Tax avoidance and smuggling</h2>
<p>Yet these emerging cities are not necessarily themselves to blame. Our research, when combined with <a href="https://doi.org/10.1080/17441692.2016.1273370">past studies on the tobacco industry</a>, provides some of the first quantitative evidence for what economists would call an “equilibrium effect” in the tobacco market — whereby the implementation of tobacco control policies in richer countries incentivized tobacco companies to relocate their lobbying, marketing and promotion activities to poorer countries with far less stringent policies.</p>
<p>In fact, there is a tragic irony to this story: the oligopolies dominating the global tobacco market are all headquartered in the very cities that pioneered the tobacco control policies, and these policies now drive industry operations to emerging cities with far fewer protections against this deadly product.</p>
<p>Phillip Morris in New York. British American Tobacco and Imperial Tobacco in London. Japan Tobacco in Tokyo. Not only are these publicly traded companies leveraging capital from wealthy investors in these cities to worsen the tobacco epidemic abroad, they are repatriating billions of dollars back into these wealthy cities through <a href="https://www.theguardian.com/business/2019/apr/30/tobacco-firm-bat-costs-developing-countries-700m-in-tax">systemic tax avoidance</a> and <a href="https://tobaccocontrol.bmj.com/content/tobaccocontrol/13/suppl_2/ii104.full.pdf">international smuggling</a> coordinated at the highest levels — all while <a href="https://doi.org/10.1016/S0140-6736(15)60312-9">aggressively fighting against effective tobacco control policies</a> around the world.</p>
<h2>One billion expected deaths</h2>
<p><a href="https://doi.org/10.1136/bmj.l2287">Our research</a> demonstrates that the Framework Convention on Tobacco Control has not yet led to equitable protection against the harms of tobacco for the great cities of the world. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/291826/original/file-20190910-190026-72f4sm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/291826/original/file-20190910-190026-72f4sm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/291826/original/file-20190910-190026-72f4sm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/291826/original/file-20190910-190026-72f4sm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/291826/original/file-20190910-190026-72f4sm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/291826/original/file-20190910-190026-72f4sm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/291826/original/file-20190910-190026-72f4sm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Tobacco taxes in cities like Beijing are not rising as fast as incomes.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>By 2044 there will be <a href="https://ourworldindata.org/urbanization">twice as many people living in the world’s cities</a> as in rural areas, meaning we cannot leave any city behind if we have any hope of defeating the global tobacco epidemic.</p>
<p>The next stage of this long war must be fought city by city. Whether that means raising tobacco taxes in Beijing, curtailing industry marketing in Jakarta, requiring plain tobacco packaging in Ho Chi Minh City or taking legal action in New York and London — we all have a role to play in fighting <a href="https://www.who.int/tobacco/mpower/2008/en/">to prevent the one billion deaths</a> that are expected from tobacco in the 21st century.</p>
<p>[ <em><a href="https://theconversation.com/ca/newsletters?utm_source=TCCA&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=expertise">Expertise in your inbox. Sign up for The Conversation’s newsletter and get a digest of academic takes on today’s news, every day.</a></em> ]</p><img src="https://counter.theconversation.com/content/123304/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Steven Hoffman declares support from the Canadian Institutes of Health Research (project 312902) and the Research Council of Norway. He was previously employed by WHO.</span></em></p><p class="fine-print"><em><span>Mathieu JP Poirier does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Rapidly growing metropolises like Beijing, Jakarta and Ho Chi Minh City are struggling to protect residents against tobacco. Life-saving policies in rich countries may be partially to blame.Steven J. Hoffman, Director, Global Strategy Lab and Professor of Global Health, Law, and Political Science, York University, CanadaMathieu JP Poirier, Assistant Professor of Soclal Epidemiology, York University, CanadaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1209612019-08-11T12:19:04Z2019-08-11T12:19:04ZChina’s tobacco industry is building schools and no one is watching<figure><img src="https://images.theconversation.com/files/287207/original/file-20190807-144883-r5d1h4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Reports suggest there are more than 100 tobacco-sponsored schools in China, a country with more than 300 million smokers.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Would you send your child to a school named after a cigarette brand? What if it was one of only two schools in your area and boasting far better infrastructure? What if the school also had an inspirational slogan such as “<a href="https://observers.france24.com/en/20100126-china-tobacco-sponsored-schools">genius is from hard work</a>, <a href="https://www.huffingtonpost.ca/2011/09/26/chinese-cigarettes-sponsor-schools_n_981849.html">tobacco helps you</a> excel” on a sign or its walls, and a tobacco company’s logo on its building? Would you care if the school was built by a tobacco company?</p>
<p>For me, as a person involved in tobacco control research, this is nothing less than a horror story. What is more terrifying, however, is that what I describe above is not conjecture, but reality to many residents of rural China.</p>
<p>The shock and disbelief I experienced when I first found out about these so-called “tobacco schools” drove me to research this issue. I worked with some Chinese colleagues from the Peking Medical Union College to document Chinese <a href="https://www.ncbi.nlm.nih.gov/pubmed/31302606">public perception of these schools for the very first time</a>.</p>
<p>We visited a small village in Yunnan province and interviewed a government official, school principals, teachers, students and parents of three local schools, one of which was sponsored by a local tobacco company. In addition, we also interviewed tobacco control advocates in Beijing. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/287212/original/file-20190807-144873-7ywwdo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/287212/original/file-20190807-144873-7ywwdo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/287212/original/file-20190807-144873-7ywwdo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/287212/original/file-20190807-144873-7ywwdo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/287212/original/file-20190807-144873-7ywwdo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/287212/original/file-20190807-144873-7ywwdo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/287212/original/file-20190807-144873-7ywwdo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Future generations’ health is at risk when indirect marketing of tobacco in schools is permitted.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>Why schools?</h2>
<p>The Chinese tobacco industry is a powerful state-owned enterprise. The commercial arm called the China National Tobacco Corporation (CNTC) is managed by the government arm, the State Tobacco Monopoly Administration. CNTC is <a href="https://doi.org/10.1080/17441692.2016.1241293">the largest tobacco company in the world, producing 40 per cent of the global cigarette supply</a>. The company has a monopoly in China to supply <a href="https://www.who.int/tobacco/about/partners/bloomberg/chn/en/">more than 300 million Chinese smokers</a>, but is virtually unheard of outside of China. All facts combined, CNTC wields significant financial and political power.</p>
<p>As a state-owned enterprise, CNTC is expected to closely follow the government’s policy leads, and to support particular priorities, such as reducing poverty. </p>
<p>The Chinese government’s Project Hope targets rural development and provides education through what it designates as Hope elementary schools. To actively support this government initiative through its corporate social responsibility projects, CNTC has built numerous schools. We find that what tobacco companies such as Hongta promote as <a href="http://www.hongta.com/language/en/duty/back/support/">corporate social responsibility</a> acts as a form of indirect marketing. </p>
<p>It is difficult to predict exact numbers, but reports suggest there are <a href="http://news.ifeng.com/society/2/detail_2011_05/30/6712976_0.shtml">more than 100 such tobacco-sponsored schools</a>, named after tobacco companies or cigarette brands — such as <a href="http://china.zjol.com.cn/05china/system/2009/12/13/016146988.shtml">Sichuan Tobacco Hope primary school</a> or <a href="http://www.huaxia.com/ah-tw/ahyw/2006/00458088.html">Yingkesong Hope primary school</a>. </p>
<p>In particular, many such tobacco schools were built following the devastating <a href="https://www.theatlantic.com/photo/2018/05/10-years-since-the-devastating-2008-sichuan-earthquake/560066/">Sichuan earthquake in 2008</a>. The tobacco industry does not stop here, however. The sponsoring company will often donate school supplies, equipment, stock school libraries and even provide <a href="http://www.nj.yn.gov.cn/nj/72340168526266368/20081023/186491.html">student bursaries and teacher bonuses</a> in some instances.</p>
<h2>Charity vs. propaganda</h2>
<p>We found public perception of locals in the Yunnan village to be overwhelmingly in favour of tobacco corporate social responsibility exercised through projects such as school sponsorships. An education bureau official denied that the tobacco sponsorships constituted tobacco marketing, stating that “this is a company giving back to the community.” </p>
<p>A school principal of one such tobacco Hope elementary school we visited stated that school sponsorship is “to show they are kind and care about the community … Contributing to a public cause is the best way to show kindness and repay locals.” The impact on students was swiftly dismissed by another principal, who said: </p>
<blockquote>
<p>“Sponsorship if purely financial, and not teaching students about tobacco.”</p>
</blockquote>
<p>Teachers employed by the school felt “gratitude to the tobacco company for improvements to our learning and teaching environment,” and have repeatedly mentioned the benefactor to their students. Students as young as Grade 5 expressed a wish “to study hard to repay” the company, and many thought “the tobacco company is kind.”</p>
<p>Some parents, however, were less enthusiastic, having reservations about the school’s name change following tobacco sponsorship. One parent called it “propaganda in disguise.” </p>
<p>While the Chinese tobacco control community agrees such corporate social responsibility projects constitute tobacco promotion, some were more lenient, citing local Chinese context of the tobacco industry’s status and pointing out financial needs the local government may not be ready to meet. </p>
<p>The situation is best summed up by a parent, who pointed out that “tobacco is bad, but money is money.”</p>
<h2>Going global</h2>
<p>Tobacco schools are not unique to China, and the industry’s support for education is present in at least two other countries. </p>
<p>CNTC has been operating a subsidiary in Zimbabwe since 2005. Tian Ze Tobacco Co specializes in tobacco leaf procurement <a href="http://www.chinaembassy.org.zw/chn/xwdt/t1419434.htm">and built an elementary school in 2010</a> in the farming community of Beatrice, and periodically donates school supplies and sports equipment. While referred to as <a href="https://www.herald.co.zw/zim-china-growing-a-forest-of-relations/">Dunnolly Primary School</a> in Zimbabwean media, Chinese sources call the school China Tobacco Ma Bo Hope Primary School, reportedly <a href="http://www.sohu.com/a/199385435_201960">named after a former Tian Ze Tobacco employee, Ma Bo</a>. </p>
<p>While CNTC’s Cambodian subsidiary Viniton Group has not built any schools, it is said to be an <a href="http://www.viniton.com/a/cn/news/20150929/73.html">active supporter of education</a>. In 2013, in the name of friendship, Viniton Group <a href="http://www.viniton.com/a/en/news/20130705/70.html">donated school supplies, desks and chairs to Hun Sen Primary School</a>. Viniton Group also <a href="http://www.viniton.com/a/cn/news/20150929/73.html">supported another school in 2015</a>, located near its new production plant.</p>
<p>CNTC has been <a href="https://blogs.bmj.com/tc/2019/08/01/china-tobacco-and-belt-and-road-initiative-the-new-go-global/">increasingly active on the international market</a> through implementing various strategies. The aim is to further expand global markets and establish more off-shore production facilities. </p>
<p>As CNTC aggressively expands its international presence, will the world be ready for the increasingly global reach of what it frames as its corporate social responsibility?</p>
<p>[ <em>Like what you’ve read? Want more?</em> <a href="https://theconversation.com/ca/newsletters?utm_source=TCCA&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=likethis">Sign up for The Conversation’s daily newsletter</a>. ]</p><img src="https://counter.theconversation.com/content/120961/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jennifer Fang receives funding from the National Cancer Institute, US National Institutes of Health grant R01-CA091021 and the Social Sciences and Humanities Research Council grant 430-2018-00736.</span></em></p>The Chinese National Tobacco Corporation is expanding its international markets through subsidiaries. Is the world ready for tobacco companies sponsoring or supporting schools?Jennifer Fang, Research fellow, Faculty of Health Sciences, Simon Fraser UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1198312019-07-04T12:24:15Z2019-07-04T12:24:15ZE-cigarettes: why I’m optimistic they will stub smoking out for good<figure><img src="https://images.theconversation.com/files/282659/original/file-20190704-51262-rrign9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/vape-cigarettes-585182902?src=0MkwCLbW4CEwEX3hxNGtMw-3-20&studio=1">Shutterstock/Lumen Photos</a></span></figcaption></figure><p>There are over a billion smokers across the world – a habit which causes more than <a href="https://www.who.int/news-room/fact-sheets/detail/tobacco">7m deaths per year</a>. We have known that <a href="https://tobaccocontrol.bmj.com/content/21/2/87">smoking kills for decades</a>, but this simple fact has not been enough to persuade every smoker to quit. </p>
<p>Even more surprising is that the vast amount of evidence about the risks of smoking hasn’t been enough to put people off starting to smoke in the first place. If knowing smoking kills doesn’t stop people from taking up the habit, what will? </p>
<p>I believe e-cigarettes provide real hope. Available since 2007, these devices often contain nicotine, the addictive substance in cigarettes, but without <a href="https://tobaccocontrol.bmj.com/content/23/2/133">many of the harmful toxicants</a>. Consequently, they are proving to be a seriously disruptive technology which is striking fear into the traditional tobacco industry.</p>
<p>Using <a href="https://www.gov.uk/government/publications/e-cigarettes-an-evidence-update">less harmful</a> ways of delivering nicotine to help people quit smoking is a tried and tested method for quitting smoking. Products like nicotine patches, gums and lozenges have been used <a href="https://tobaccocontrol.bmj.com/content/9/suppl_2/ii60#ref-1">since the 1980s</a> with some success. </p>
<p>E-cigarettes differ from these other products by providing a more similar feel to smoking. Users have to inhale a vapour which provides a throat “hit” similar to smoking. They also have to use the familiar motion of putting the product to their mouth, as they would with a cigarette. </p>
<p>Importantly, these products can provide <a href="https://truthinitiative.org/research-resources/emerging-tobacco-products/e-cigarettes-facts-stats-and-regulations">similar amounts of nicotine</a> to cigarettes, meaning they hold great potential for helping people to quit smoking.</p>
<h2>Do they actually help people quit smoking?</h2>
<p>E-cigarettes were originally designed to help people quit smoking, but until recently there has been little evidence to show that they work in this regard. This year, a <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1808779">study was published</a> which explored how effective e-cigarettes are at helping people to quit smoking. </p>
<p>Participants in the study were assigned to one of two groups in which they either used nicotine replacement products of their choice or e-cigarettes. The findings not only showed that e-cigarettes were effective in helping people quit, but that e-cigarettes were more effective than nicotine replacement therapies. Nearly twice as many people in the study were still smoke free one year after quitting if they had used an e-cigarette compared to using nicotine replacement therapies. </p>
<p>Similarly in my own research, I have found that young people who use e-cigarettes to help them quit smoking are more likely to continue using them than continuing to smoke. Using e-cigarettes to quit smoking was the second most common reason the young people gave for why they had used an e-cigarette. </p>
<p>The most common reason was that they were curious. I think this says a lot about the popularity of the products. People are curious because there are so many users around, making smokers wonder whether e-cigarettes could help them too.</p>
<p>Indeed, e-cigarettes have generally proved to be extremely popular, with an estimated <a href="http://ash.org.uk/media-and-news/press-releases-media-and-news/large-national-survey-finds-2-9-million-people-now-vape-in-britain-for-the-first-time-over-half-no-longer-smoke/">2.9m users in the UK</a>, and around <a href="https://uk.reuters.com/article/us-health-ecigs-us-adults/almost-one-in-20-u-s-adults-now-use-e-cigarettes-idUKKCN1LC2DN">10.8m in the US</a>. Since they were introduced, the use of nicotine patches, gums and lozenges has <a href="http://www.smokinginengland.info/latest-statistics/">significantly decreased</a>. </p>
<p>This combination of effectiveness and popularity could spell the end for cigarettes by tempting more smokers to use e-cigarettes and quit smoking. There are still some users who haven’t tried them though, and this could be due to <a href="http://ash.org.uk/wp-content/uploads/2017/05/ASH-Adult-e-cig-factsheet-2018-corrected.pdf">misconceptions</a> that e-cigarettes are more harmful than cigarettes for users. </p>
<p>By dispelling these misconceptions, we could see an even bigger increase in the popularity of e-cigarettes and consequently a reduction in the amount of people smoking.</p>
<h2>An industry up in smoke?</h2>
<p>Even the tobacco industry seems to feel threatened by e-cigarettes, effectively responding to their popularity by trying to jump on the bandwagon. They have been developing their <a href="https://www.bat.com/ecigarettes">own rival products</a>, and buying shares in popular e-cigarette brands as a reaction to losing so much of their traditional customer base. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/282667/original/file-20190704-51288-1xiy4kt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/282667/original/file-20190704-51288-1xiy4kt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/282667/original/file-20190704-51288-1xiy4kt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/282667/original/file-20190704-51288-1xiy4kt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/282667/original/file-20190704-51288-1xiy4kt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/282667/original/file-20190704-51288-1xiy4kt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/282667/original/file-20190704-51288-1xiy4kt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Over and stubbed out?</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/cigarette-stub-quitting-smoking-180744572?src=rntt7zOHxYbWkzjvnFpDRA-1-19&studio=1">Shutterstock/phildaint</a></span>
</figcaption>
</figure>
<p>Some big tobacco companies have even made this part of their sustainability plan. To me, this reiterates that the industry cannot be sustained by the sale of tobacco cigarettes. Less harmful devices are eventually likely to eradicate sales.</p>
<p>I see great potential in e-cigarettes in the fight against tobacco. The evidence suggests that they are less harmful than cigarettes, more effective at helping people quit smoking than traditional nicotine replacement options, and popular. </p>
<p>All of this has the tobacco industry scared enough to invest in e-cigarettes because they fear for the sustainability of their traditional market. This makes me confident that e-cigarettes will be the disruptive technology which sees smoking stubbed out for good.</p><img src="https://counter.theconversation.com/content/119831/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jasmine Khouja does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>They’re effective – and popular.Jasmine Khouja, PhD Candidate, University of BristolLicensed as Creative Commons – attribution, no derivatives.