ACOSH Advocacy in Action - 14 January 2021

Welcome to the first edition of the ACOSH Advocacy in Action e-bulletin for 2021.
We aim to provide topical information on advocacy for tobacco control in Western Australia, Nationally and around the world. Please forward to others who may be interested.
Thank you for your support.

The work of ACOSH is generously supported by Healthway and Lotterywest.

TGA confirms nicotine e-cigarette access by prescription only

“From 1 October 2021, the law for consumers to import nicotine e-cigarettes and liquid nicotine will align with the law for them to buy such products domestically. Closing a gap between Commonwealth and state and territory law, the decision announced by the Therapeutic Goods Administration (the TGA) clarifies that consumers will require a doctor’s prescription to legally access nicotine e-cigarettes and liquid nicotine in Australia.”

“This aligns with current domestic restrictions under State and Territory law that prohibit the supply of nicotine containing e-cigarettes in Australia without a valid medical prescription.

“This decision, announced by the Therapeutic Goods Administration (TGA) today [21 Dec 2020], aims to prevent adolescents and young adults from taking-up nicotine e-cigarettes while allowing current smokers to access these products for smoking cessation on their doctor’s advice.

“There has been a significant increase in the use of nicotine e-cigarettes by young people in Australia and in many overseas countries. There is evidence that nicotine e-cigarettes act as a ‘gateway’ to smoking in youth and exposure to nicotine in adolescents can have long-term consequences for brain development.

“Consumers can continue to import nicotine e-cigarettes to assist with smoking cessation with a doctor’s prescription. Consumers will also be able to obtain nicotine e-cigarettes from local pharmacies and Australian based on-line pharmacies, with a prescription from an Authorised Prescriber or under the TGA Special Access Scheme. The requirement for a prescription will provide an opportunity for consumers to receive advice from their doctor on smoking cessation in the context of their overall health management.”

See also
Notice of final decision to amend the current Poisons Standard – nicotine  – Therapeutic Goods Administration

Preventing nicotine uptake by young Australians with prescription based vaping – Media Release, Hon Greg Hunt, Minister for Health



Majority Senate report makes right call on vaping

The Australian Medical Association (AMA) and the Australian Council on Smoking and Health (ACOSH) united today [18 Dec 2020] to strongly endorse the majority report from Senators Henderson, Urquhart, Sheldon and Griff following the Senate Inquiry into Tobacco Harm Reduction.

“Australia is a world leader in reducing smoking and tobacco-related harm and, like the significant majority of Australia’s leading health organisations, the AMA and ACOSH strongly support a precautionary approach to e-cigarettes,” AMA President Dr Omar Khorshid said.

“Australians, and the Australian Government, have confidence in the ability of the independent Therapeutic Goods Administration (TGA) to make decisions on what medications are safe and effective for Australians.

“At this stage, there is insufficient evidence that nicotine-delivering e-cigarettes actually help people quit smoking, compared to other cessation aids, and there is strong evidence that they increase the risk of young people taking up smoking.

“We don’t know yet what the long-term effects of inhaling heated liquids directly into the lungs are, and we don’t know what is in some of these vaping liquids.

“The Australian Government should continue to restrict access to e-cigarettes unless robust evidence emerges supporting their use as a quit smoking aid.”



The big smoke job: a century of peddling a killer product

“Australia is known as the darkest market for big tobacco. Our laws and regulations are some of the strictest in the world.

“But no matter our laws and policies, big tobacco is always one step ahead. Its current tactic is to rebrand itself as a friend of public health, marketing nicotine-laden “harm reduction” smokeless devices like vapes, e-cigarettes and heated tobacco products as safer alternatives to smoking.

“Tobacco company Philip Morris paid News Corp tens of thousands of dollars to run four pro-vaping science features in The Australian.

“From creating shell associations to represent them, to getting in the ear — and pockets — of politicians, the strategies have stayed the same even as the laws have changed.

“And with a Senate committee into tobacco harm reduction handing down its report today [18 Dec 2020], we thought it might be useful to look at a century of big tobacco tactics…”



Big Tobacco: Trust Us To Solve The Smoking Epidemic

“In April 1999, a full-page color advertisement for Carlton cigarettes appeared in the metro section of The New York Times, featuring a woman in a dark blue suit, listening to vinyl and holding a lit cigarette. “It’s the Ultra ultra light,” it read.

“It would be the last cigarette ad to run in the influential newspaper, as later that month the Times joined other major print outlets in banning tobacco ads. “We don’t want to expose our readers to advertising that may be dangerous to their health,” a Times spokesperson said then.

“But two decades later, apparent loopholes to that policy remain. Now, big tobacco is rebranding itself as the solution to a public health crisis it created and continues to profit from, with ads touting development of “smoke-free,” “better” and “less-risky” alternatives to conventional tobacco products like cigarettes, cigars or chewing tobacco. The ads are everywhere ― including a sizable buy in the Times by tobacco giant Philip Morris International.”



Does the COVID-19 pandemic provide an opportunity to eliminate the tobacco industry?

“Tobacco use is the top modifiable global health problem, but the global tobacco market grows 3% annually. Most anti-tobacco measures to date target demand (eg, higher excise taxes). However, the endgame might require reducing supply.The main counterarguments are financial (eg, economic damage or lost jobs) and defences of personal choice. Most importantly, public health has little experience in enforcing major changes that disrupt markets.The ongoing societal response to COVID-19 offers a precedent for drastic action taken to eliminate the tobacco industry.

“COVID-19 is a natural experiment: expedient public health considerations have led to decisions being made that have important socioeconomic repercussions. The cumulative disease burden of COVID-19 is large but uncertain. However, if COVID-19 actions were deemed defensible, the risk–benefit ratio for actions to eliminate tobacco is far more favourable.”



Tobacco and COVID-19: Understanding the science and policy implications

“There is an urgency to understand the relationship between COVID-19 and tobacco use. Smokers with diseases where tobacco is a major causative factor, e.g. COPD, ischaemic heart disease, cancers and diabetes were all quickly recognized as significant risks for poor prognosis in COVID-19.

“The effect of smoking itself may be more nuanced. There has not appeared to be increased prevalence of the disease, which was surprising as other respiratory viruses were well known to cause more disease in smokers. But published results seemed to show increased severity and increased mortality of COVID-19 in smokers.

“In the background is the worry that Tobacco Control like many other public health priorities would be side-lined during the pandemic despite tobacco causing some seven million deaths per annum. Not only that, but it seemed likely that the tobacco industry would take the opportunity to further its commercial aims amid the current uncertainty and distress and the neglect of Tobacco Control caused by the health emergency. The 18th WCOTH recently took the opportunity to explore these issues in an open-access webinar.”



Youth using e-cigarettes three times as likely to become daily cigarette smokers

“Young people aged 12 to 24 who used electronic cigarettes were three times as likely as non-users to be daily cigarette smokers down the line, according to a four-year study published in the journal Pediatrics.

“The researchers analyzed nationally representative data from the longitudinal Population Assessment of Tobacco and Health (PATH) Study, which conducted interviews with participants for four years starting in 2013 and 2014.

“The start product has changed from cigarettes to e-cigarettes, but the end product has stayed the same,” first study author John Pierce, a professor emeritus at the University of California San Diego, said in a statement. “When users become dependent on nicotine, they are converting to cigarette smoking.”



United States: Youth e-cig use dropped in 2020 but still dominates the youth market

“The CDC recently reported big drops in e-cigarette use between 2019 and 2020 (high school dropped from 27.5% to 19.6% and middle school dropped from 10.5% to 4.7%).

“As the figure above (courtesy of CDC) shows, however, e-cig use is still very high, way above where cigarette smoking and e-cigarette use were nine years earlier in 2011.

“Overall combustible product use, while well below e-cig use, also dropped, although many fewer kids were using combustible tobacco products than e-cigs, which dominate the youth market.

“These data are from the CDC/FDA National Youth Tobacco Survey which was conducted from January-March 2020 just before the COVID-19 shelter-in-place.

“I hope that the FDA will consider these very high levels of youth e-cig use — even after the substantial drop — in assessing whether the thousands of e-cig premarket tobacco applications (PMTA) justify authorizing e-cigs as “appropriate for the protection of public health.” Like the cigarette companies that now control the e-cig industry, the e-cig companies have publicly claimed that that they don’t want kids using them and that they don’t promote them to kids. They are, no doubt, including such claims in their PMTA applications. But the reality, as shown by these new data — collected by the CDC in collaboration with FDA — show that these claims are hollow. FDA needs to look beyond what the applicants say in their PMTAs and consider this reality when assessing the applications,” said Professor Stanton Glantz.

See also
Tobacco Product Use Among Middle and High School Students — United States, 2020 – US Centres for Disease Control and Protection



E-Cigarettes as consumer products do not help people quit smoking, study finds

“In the new study, published Dec. 22, 2020, in the American Journal of Public Health, a team led by UCSF’s Richard Wang, MD, MAS, surveyed the scientific community’s understanding of e-cigarettes and found that, in the form of mass-marketed consumer products, they do not lead smokers to quit.

“In their paper, the authors write, “If e-cigarette consumer product use is not associated with more smoking cessation, there is no population-level health benefit for allowing them to be marketed to adults who smoke, regardless of the relative harm of e-cigarettes compared with conventional cigarettes. Moreover, to the extent that people who smoke simply add e-cigarettes to their cigarette smoking (becoming so-called dual users), their risk of heart disease, lung disease, and cancer could increase compared with smoking alone.”

“The question we explored is of both scientific interest and public health interest,” said Wang, assistant professor of medicine, “and we hope that the FDA will pay attention to our study as they try to make these decisions.” Wang was joined in the study by co–first author Sudhamayi Bhadriraju, MD, a former UCSF postdoctoral fellow who is now a pulmonologist at Kaiser Permanente in Redwood City, Calif., and senior author Stanton A. Glantz, PhD, professor of medicine.”



Light smokers may not escape nicotine addiction, study reveals

“Even people who consider themselves to be casual cigarette smokers may be addicted, according to current diagnostic criteria. Researchers at Penn State College of Medicine and Duke University found that many light smokers – those who smoke one to four cigarettes per day or fewer – meet the criteria for nicotine addiction and should therefore be considered for treatment.

“In the past, some considered that only patients who smoke around 10 cigarettes per day or more were addicted, and I still hear that sometimes,” said Jonathan Foulds, professor of public health sciences and psychiatry and behavioral health, Penn State. “But this study demonstrates that many lighter smokers, even those who do not smoke every day, can be addicted to cigarettes. It also suggests that we need to be more precise when we ask about cigarette smoking frequency.”

“Lighter smoking is correctly perceived as less harmful than heavy smoking, but it still carries significant health risks,” Oliver said. “Medical providers sometimes perceive lighter smokers as not addicted and, therefore, not in need of treatment, but this study suggests many of them may have significant difficulty quitting without assistance.”

The findings were published in the American Journal of Preventive Medicine.



BAT’s new trademarks hint at new vaping promotions

“In the less than 3 years that vaping products have been legal for sale in Canada, British American Tobacco (BAT) has shown itself to be one of the most agressive marketers of vaping products in this country. Its shareholders have been rewarded by these efforts, and the company recently informed them that its VUSE brand had a 40% share of the Canadian vaping market.

“But changes in federal and provincial laws have forced the company to find new ways to encourage Canadians to try vaping devices and liquids – (addiction makes repeat customers easier to recruit.)

“Previous posts have reviewed how BAT is adapting its marketing to these new restrictions. This post looks at recent trademarks registered by the company and what they might suggest about its new marketing stratregies.”



BAT and Imperial tobacco firms profited from child labour, law firm alleges

“British American Tobacco and Imperial Brands profited from child labour, exploitation and dangerous conditions on tobacco farms in Malawi, according to a legal claim launched after a Guardian investigation.

“The British firms, which reported combined earnings of £12.5bn last year, should compensate 7,020 children and adults who work in their supply chain, according to documents filed at the high court by the law firm Leigh Day.

“The claim was triggered by a 2018 Guardian investigation, which found that tobacco farmers were exposed to nicotine poisoning, toxic pesticides and harsh weather conditions during labour-intensive shifts in areas where up to 63% of children were engaged in child labour.

“The leaves harvested on those Malawian farms end up in cigarettes around the world, including the US, which last year suspended imports from the southern African country over child labour allegations.”



Tweet of the week

“What can we anticipate from the #tobacco industry in #2021? More use of #CSR and the #COVID19 crisis to gain favor with governments? More aggressive promotion of novel #tobacco products in ways that attract youth? Find out in our latest blog.”

New Year, Old Tactics: Tobacco Industry Predictions for 2021 – Expose Tobacco



Tobacco Control News

Tasmania could become the first state in Australia to raise smoking age to 21 – ABC News

Legal loophole lets pubs create new smoking areas for gamblers – The Sydney Morning Herald

Names of vape flavors obscure toxic ingredients – Medical Xpress

Current smoking and COVID-19 risk: results from a population symptom app in over 2.4 million people – Thorax

Labeling paid ‘influencer’ vaping posts as ads draws attention – Ohio State University

Landmark for Global Health: With Addition of Paraguay, All of South America Is Now Protected by Comprehensive Smoke-Free Laws – Campaign for Tobacco Free Kids