ACOSH Advocacy in Action - 16 October 2020


Welcome to the latest edition of the ACOSH Advocacy in Action e-bulletin for 2020. 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.


Dear subscribers to the ACOSH Advocacy in Action e-bulletin – Please keep safe during this challenging period for public health.

Graphic attached reproduced with the kind permission of AMA WA.

Smoking cessation guidelines for patients with a cancer diagnosis

“Whilst for some active smokers, a cancer diagnosis is a trigger for smoking cessation, others with a smoking-related cancer may feel that smoking cessation is futile or will remove an important pleasurable activity from their life.

“However, there are powerful clinical reasons for encouraging, supporting and facilitating quitting in active smokers with any cancer diagnosis. The recently released Clinical Oncology Society of Australia Smoking Cessation in Cancer Patients report provides detailed advice to clinicians on why and how we should help our patients quit.

“Continuing smoking after a cancer diagnosis doubles the risk of death – an important and reproducible finding. Indeed, the US Surgeon General noted that “for some cancer diagnoses, the benefit of smoking cessation may be equal to, or even exceed, the value of state-of-the-art cancer therapies”. Those who continue to smoke are at higher risk of recurrence; those who may be cured from their initial cancer but continue to smoke are at higher risk of developing a second primary cancer.”



Would you take a drug that failed with 90% of users? New Cochrane data on vaping “success”

“The Cochrane Library’s Tobacco Addiction Group has just published its third update of the evidence about the usefulness of e-cigarettes (ECs) in quitting smoking. The update considered 50 completed studies, which together had 12,430 participants. Twenty six of these studies were randomised controlled trials (RCTs). However, just four studies were considered at low risk of bias (such as non-randomization) and these four formed the basis for the report’s main comparisons. They considered only reports which assessed smoking status at a minimum of six months from when the participants started using the ECs

“The review concluded that there was “moderate-certainty evidence, limited by imprecision, that quit rates were higher in people randomized to nicotine EC than in those randomized to nicotine replacement therapy (NRT) (risk ratio (RR) 1.69, 95% confidence interval (CI) 1.25 to 2.27; I2 = 0%; 3 studies, 1498 participants). In terms that ordinary folk might better understand “For every 100 people using nicotine e-cigarettes to stop smoking, 10 might successfully stop, compared with only six of 100 people using nicotine-replacement therapy or nicotine-free e-cigarettes, or four of 100 people having no support or behavioural support only.”

“Put another way, if we take 100 smokers participating in an RCT, 90 would still be smoking six months later if they used e-cigarettes, compared with 94 who used NRT, and 96 who just tried to quit alone or got some “behavioural support”, said Emeritus Professor Simon Chapman AO.



Ireland: New Health Research Board evidence shows e-cigarettes are associated with adolescents starting to smoke tobacco cigarettes

“A Health Research Board (HRB) review into e-cigarette use has found that e-cigarettes are associated with adolescents starting to smoke tobacco cigarettes, which could potentially lead to serious harm.

“It shows that those adolescents who had ever used an e-cigarette were between three and five times more likely to start smoking compared to those who never used e-cigarettes.

“Key findings reported by the HRB include:

• E-cigarettes are no more effective than approved and regulated nicotine replacement therapies (NRTs) to help people stop smoking. However, e-cigarettes as a smoking cessation device are not regulated or approved and their safety beyond 12 months is not yet known

•Adolescents who use e-cigarettes are three to five times more likely to start smoking tobacco cigarettes compared to those who never used e-cigarettes

• E-cigarettes acute effects include poisonings, burns, blast injuries, lung injury and asthmatic attacks. Some of the chemicals in e-cigarettes are thought to cause tissue and cell damage and some are agents that may cause cancer in the long-term. The long-term health effects beyond 24 months are not researched

• Dual use of both e-cigarettes and conventional tobacco cigarettes wasn’t less harmful than smoking tobacco cigarettes alone, which raises questions about the smoking reduction benefit of e-cigarettes.”



ACOSH meeting with Celia Hammond MP

ACOSH President Professor Kingsley Faulkner and Chief Executive Maurice Swanson met with Celia Hammond MP, Member for Curtin, on 2 October to discuss tobacco control priorities and the importance of a precautionary approach to e-cigarettes in Australia.


Select Committee on Tobacco Harm Reduction

On 6 October 2020, the Senate resolved to establish a Select Committee on Tobacco Harm Reduction.

The committee will inquire into tobacco reduction strategies, with particular reference to:

• the treatment of nicotine vaping products (electronic cigarettes and smokeless tobacco) in developed countries similar to Australia (such as the United Kingdom, New Zealand, the European Union and United States), including but not limited to legislative and regulatory frameworks;
• the impact nicotine vaping products have had on smoking rates in these countries, and the aggregate population health impacts of these changes in nicotine consumption;
• the established evidence on the effectiveness of e-cigarettes as a smoking cessation treatment;
• the established evidence on the uptake of e-cigarettes amongst non- smokers and the potential gateway effect onto traditional tobacco products;
• evidence of the impact of legalising nicotine vaping products on youth smoking and vaping rates and measures that Australia could adopt to minimise youth smoking and vaping;
• access to e-cigarette products under Australia’s current regulatory frameworks;
• tobacco industry involvement in the selling and marketing of e-cigarettes; and
• any other related matter.

Submissions are due by 5 November 2020.



Tobacco is a sunset industry – time to hasten its decline

“Along with WA’s outstanding success in responding to the COVID-19 pandemic, now is an opportune time to plan for further action to create a tobacco-free WA and nationally by 2030 and save hundreds of thousands of lives in this century.

“There’s now discussion internationally and in Australia about accelerating the decline in smoking by planning to phase out the commercial sale of cigarettes.

“The Australian Council on Smoking and Health recently commissioned a survey of 1000 West Australian adults to assess their attitudes to phasing out the sale of cigarettes and found encouraging levels of support.

“60% of those surveyed thought it would be a good thing if there came a time when it would no longer be legal to sell cigarettes in Australia, while only 14% thought it would be a bad thing.

“67% of survey respondents also thought that the next 10 years would be a fair timeframe in which to phase out the sale of cigarettes.”



E-Cigarette Advocates on Twitter: Content Analysis of Vaping-Related Tweets

Conclusions: Australian Twitter content does not reflect the country’s current regulatory approach to e-cigarettes. Rather, the conversation on Twitter generally encourages e-cigarette use, promotes vaping as a socially acceptable practice, discredits scientific evidence of health risks, and rallies around the idea that e-cigarettes should largely be outside the bounds of health policy. The one-sided nature of the discussion is concerning, as is the lack of disclosure and transparency, especially among vaping enthusiasts who dominate the majority of e-cigarette discussions on Twitter, where it is unclear if comments are endorsed, sanctioned, or even supported by the industry.”


The WHO Framework Convention on Tobacco Control – time for a civil society equivalent?

“Article 5.3 of the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) requires that:

“In setting and implementing their public health policies with respect to tobacco control, Parties shall act to protect these policies from commercial and other vested interests of the tobacco industry in accordance with national law.

“While this sets clear standards for governments, there is no equivalent for health and related organisations and those who work with them. The tobacco industry, now more than ever, seeks the credibility of association with reputable scientists and organisations, as part of a strategy to present itself as part of the solution to a problem it has created and continues to promote. At the same time, it opposes evidence-based action to reduce smoking and its harms. This paper proposes that it is time to establish a civil society equivalent of Article 5.3 to protect reputable organisations from associating with or lending support and credibility to the tobacco industry.”



Civil Society Calls Out Formula 1 Regulator’s Failure to Take Responsibility for Ending Tobacco Sponsorship

“As the World Motor Sport Council gathers for its quarterly meeting on October 9th, 100 civil society organizations have signed a second open letter to the President of the Fédération Internationale de l’Automobile (FIA), Jean Todt, criticizing the FIA’s continued lack of responsibility and action to end growing tobacco sponsorship in Formula 1.

“Signatories state that: “Your failure to address the issue, in effect, advances tobacco industry interests that are in conflict with the SDGs (the United Nations Sustainable Development Goals), and ignores the millions who became addicted to tobacco use and died as a result. This tarnishes the sport’s reputation in the global community and the legacy that you and the FIA will leave behind… It is shameful that you/FIA tout international commitments to improve lives while actively aligning with tobacco companies, whose products take lives and whose activities exploit the most vulnerable in our society.”

ACOSH was one of the 100 organisations to sign the second open letter.



Chemistry at work in e-liquids is still poorly understood, worrying researchers

“Studies on the chemical composition of e-cigarette liquids are raising concern that regulation is lagging behind the data.

“The Yale Tobacco Center for Regulatory Science is a National Institute of Health and US Food and Drug Administration funded research group tasked with investigating the influence of flavours on tobacco addiction. Part of this work involves assessing the composition of e-cigarette liquids being sold to users.

“E-liquids contain mainly nicotine, flavourings and a solvent in which ingredients are dissolved. Flavouring molecules like vanillin, benzaldehyde or cinnamaldehyde are aldehydes that give e-cigarettes their various flavours, while the solvent is an alcohol, usually propylene glycol or glycerine. However, according to Hanno Erythropel, an analytical chemist at the Yale centre, a basic knowledge of chemistry tells you that aldehydes and alcohols readily react to form acetals.”

“This is important for informing regulation, says Neal Benowitz, professor of medicine emeritus at University of California, San Francisco, because it shows that you can’t just measure flavour compounds – you also have to measure potential breakdown or reaction products.”



Tweet of the Week

“Why National Retailers Association is lobbying hard to have corner stores stocking e-cigs? A whole new market…” said Dr Sarah White, Director Quit Victoria.

Convenience Store Access and E-cigarette Advertising Exposure Is Associated With Future E-cigarette Initiation Among Tobacco-Naïve Youth – Journal of Adolescent Health



From the archives: The history of the discovery of the cigarette–lung cancer link: evidentiary traditions, corporate denial, global toll

“Lung cancer was once a very rare disease, so rare that doctors took special notice when confronted with a case, thinking it a once-in-a-lifetime oddity. Mechanisation and mass marketing towards the end of the 19th century popularised the cigarette habit, however, causing a global lung cancer epidemic. Cigarettes were recognised as the cause of the epidemic in the 1940s and 1950s, with the confluence of studies from epidemiology, animal experiments, cellular pathology and chemical analytics. Cigarette manufacturers disputed this evidence, as part of an orchestrated conspiracy to salvage cigarette sales. Propagandising the public proved successful, judging from secret tobacco industry measurements of the impact of denialist propaganda.”

Proctor RN The history of the discovery of the cigarette–lung cancer link: evidentiary traditions, corporate denial, global tollTobacco Control 2012;21:87-91.



Tobacco Control News

Endgame: centre hopes to stamp out smoking in Australia – The University of Queensland

New Zealand First aims to cut price of cigarettes to $20 – RNZ News

Kingston’s foreshores and reserves to be smoke-free zones – The National Tribune

Parents less aware when their kids vape than when they smoke – University of California – San Francisco

Juul to drastically cut workforce, explore exiting some markets – Reuters