ACOSH Advocacy in Action - 29 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.

‘Blood in the water’: Why the next 12 months is critical for vaping regulation

“The Therapeutic Goods Administration (TGA) last month handed down an interim decision that nicotine-containing vaping products would be permitted in Australia on a streamlined prescription-only model for smoking cessation.

“The move – in which doctors prescribe and pharmacists dispense – is aimed at stemming the flow of black market imported nicotine e-liquid, which pro-vaping group Legalise Vaping states is the main way users currently gain access.

‘Most users feel compelled to either import nicotine illegally without a prescription or purchase it from the unregulated black market,’ it states.

“While e-cigarettes are legal in Australia, it is currently not possible to buy nicotine-containing e-liquid. As a result, many young people who vape have been importing the liquid from overseas – either through the TGA’s personal importation scheme or illicitly.”



Deadly news: the downward trend continues in Aboriginal and Torres Strait Islander smoking 2004–2019

“There are almost 50,000 fewer Aboriginal and Torres Strait Islander adult daily smokers today than there would be if smoking prevalence had remained at 2004/05 levels. This is Deadly news.

“Consistent with the FCTC, further opportunities for building on this positive trend exist and accelerating declines in tobacco use will require continued resourcing and sustained policies, programs and action across Aboriginal and Torres Strait Islander specific and general tobacco control initiatives.

“Accelerating progress in urban/regional areas, as well as reducing smoking in remote settings and among ≥55‐year‐olds with tailored programs will lead to major health improvements. This important tobacco reduction work is required alongside reducing historical and contemporary colonial factors that produce inequities. As outlined by the FCTC, tobacco control lessons and trends in prevalence should be shared internationally to better address globalisation of the tobacco epidemic, including among Indigenous peoples.”



New Cochrane review concluding e-cigs used as clinical therapy increase quitting is not relevant to assessing e-cigs in the real world

“On October 14, 2020, the Cochrane Database of Systematic Reviews published Electronic cigarettes for smoking cessation that concluded that e-cigarettes were more effective than nicotine replacement therapy for smoking cessation.  (This was an update of an earlier Cochrane review that drew the same conclusion.)

“The 193 page report followed Cochrane’s rigorous standards for assessing therapies that are grounded on the view that randomized controlled trials are the best way to assess therapies.  As a result, although the review assessed 50 completed studies, representing 12,430 participants, including 26 RCTs, the final analysis that led to the conclusion that e-cigarettes were superior to NRT was only based just three studies involving 1498 participants (Bullen 2013, Hajek 2019, Lee 2018).

“In all of these studies, free e-cigarettes were provided to participants as part of a clinical smoking cessation intervention.  So, the question that the Cochrane review answers is, “When delivered to patients as part of a smoking cessation intervention, are they associated with more quitting than NRT?”

“A positive answer to this question would support the use of e-cigarettes as smoking cessation therapies and suggests that an e-cigarette company might be able to win approval for e-cigarettes as a cessation therapy if they applied to FDA with similar RCT data for their specific product used in a specific group of patients in a specific way.

“To the best of my knowledge, no e-cigarette company has applied for official approval of e-cigarettes as smoking cessation therapies.  Of course, there is also be the issue of what the associated risks are; whether e-cigarettes as cessation aids would have a favorable benefit/risk ratio is a separate question. There is also a high likelihood that if e-cigarettes were approved as smoking cessation therapy, they would only be available by prescription due to their high addiction potential,” said Emeritus Professor Stanton Glantz.



Comprehensive reviews of the published evidence on e-cigarettes that support a precautionary approach

• Australian National University (2020)
• US Surgeon General (2020)
• Irish Health Research Board (2020)
• European Commission (2020)
• Thoracic Society of Australia and New Zealand (2020)
• European Respiratory Society (2019)
• American Academy of Paediatrics (2019)
• American College of Preventive Medicine (2019)
• Australia’s Commonwealth Scientific Industrial Research Organisation (CSIRO) (2018)
• US National Academies of Sciences, Engineering and Medicine (NASEM) (2018)
• World Health Organization (2015)

Fatal levels of nicotine – call to slap import ban on e-cigarette devices

“Tens of thousands of illegal e-cigarette devices and liquids containing nicotine have been seized by state authorities – and many contain the substance at fatal levels.

“Poisons information lines are receiving dozens of calls about nicotine poisoning related to vaping devices and last year a baby died after consuming liquid from an e-cigarette.

“Consumption of the products is soaring, undermining gains in tobacco control.

“Smoking cessation body QUIT on Thursday said it was time for an import ban to be slapped on the products.”



Characteristics of E-cigarette, or Vaping, Products Confiscated in Public High Schools in California and North Carolina — March and May 2019

“Approximately 1,000 e-cigarette or vaping products were collected from 25 high schools in California and North Carolina during the 2018–19 academic year. Pod mods, including JUUL, Suorin, and SMOK, were the three most commonly collected products, but variations in prevalence of collected device types and brands were observed between the two states.

“These differences could be attributed to brand popularity, affordability, or differing legal status of marijuana sales between states. For example, during the time of this study and currently, recreational and medicinal marijuana could be legally sold to persons aged ≥21 years in California and were thus present in society for potential indirect access by youths; in contrast, marijuana sales are currently illegal in North Carolina.

“Some types and brands of pod mod products are intended to be refilled by the user (e.g., Suorin and SMOK), which could include e-liquids containing non-nicotine substances such as marijuana; one-third of current U.S. high school e-cigarette users report using marijuana in an e-cigarette (4).”



PMI’s IQOS: Use, “Switching” and “Quitting”

“Philip Morris International (PMI) has stated that it has a vision of a “smoke-free” future and that it intends to move its business away from combustible tobacco products entirely. In this future, PMI envisages itself and its heated tobacco product (HTP), IQOS, playing a central role. However, independent evidence does not support many of PMI’s claims about its product, including its claims about risk and its effectiveness in helping people to stop smoking. PMI’s commercial goal is not to stop people smoking all tobacco products, but to ensure they continue to buy its products, including IQOS, and to increase the numbers of people doing so.

“This page describes some of PMI’s attempts to enter the ‘cessation space’ with IQOS. It then looks at relevant PMI statements from media interviews, press releases and industry publications, and the evidence it uses to support its claims, including that submitted to the US Food and Drug Administration (FDA). It summarises the independent, peer reviewed academic research relating to the use of IQOS, including prevalence, dual and poly use, and youth initiation (with more detail on a supporting page). Finally, it describes the reaction from the governments of Australia, New Zealand and Mexico in 2020, in response to PMI’s attempts to introduce IQOS to their countries and frame them as cessation products.”



Motivations for use, identity and the vaper subculture: a qualitative study of the experiences of Western Australian vapers

“Few studies have explored vapers motivations for use, reinforcing influences, and association with the vaper subculture, especially within the unique regulatory context of Australia. We found that our sample of vapers largely started vaping to quit smoking and underwent common experiences during their initiation phase.

“Subsequently, vapers tended to adopt one of two vaper identities, that of the ‘cloud chaser’ or the ‘substitute’, which some users moved between during different stages of their vaping career. The social and symbolic meaning of e-cigarettes and vaping were diverse. ‘Cloud chasers’ connected with the vaper subculture in varying degrees and involved concepts of pleasure, community and performance. However, the aesthetic and performance part of the subculture, in particular, had little appeal to ‘substitute’ vapers who largely viewed their use of e-cigarettes as a means to quit smoking, and enjoyment did not play a substantive role in their use.

“Understanding the complexities of vaping, and the nuanced differences of ‘cloud chasers’ and ‘substitute’ vapers may have important implications for health communication, research and policy.

“Our findings add to the understanding of the varying motives for use and provide new insights into the socialisation process and subsequent identity adoption of Western Australian vapers.”



Critique of flawed study on the impact of plain packaging

“This research is fundamentally flawed and incomplete because it does not take account of the fact that tobacco taxes increased significantly each year in New Zealand at the same time Australia was introducing plain packaging, and importantly three years before the start of Australia’s annual tax increases of 12.5%.

“The authors admit their modelling was not able to accommodate the effect of price increases and therefore this is excluded from their analysis, despite increasing tobacco tax being the most potent way of reducing the prevalence of smoking.

“The data they present shows clearly that smoking prevalence, and the numbers of cigarettes smoked per week in Australia fell in the years following the introduction of plain packaging in Australia.

“There is good evidence from Australia and elsewhere that plain packaging works, which is why the tobacco industry opposes it so fiercely.

“Plain packaging has the potential to prevent millions of premature deaths around the globe as part of a comprehensive program. It is most unfortunate that the authors used flawed and incomplete modelling that reached an erroneous conclusion,” said Maurice Swanson, ACOSH Chief Executive.

For a detailed analysis read the Cancer Council Victoria critique of the study.



UK: Legal loophole allows children to get free vape samples

“Health campaigners have expressed alarm after it emerged that a loophole in the law means it is legal for marketing companies to hand out vapes to children for free.

“British American Tobacco (BAT) is investigating after a 17-year-old was offered a free sample of the company’s Vype brand. The minor was not told that the product contained nicotine and was not asked for proof of age.

“Vape companies regularly distribute free samples to adults using paid, third-party promotional companies operating in city centres and at festivals and transport hubs. The promotional teams are young, personable and sport the livery of the vape brand they represent. Some use additional free offers – such as soft drinks – to engage with passersby.”



Statutory Review of the Western Australian Tobacco Products Control Act 2006
The Department of Health (DOH) is conducting a Statutory Review of the Western Australian Tobacco Products Control Act 2006 (the Act).

The review of the Act is being undertaken to ensure that tobacco control legislation in Western Australia remains contemporary, relevant and responsive to new and emerging issues in tobacco control.

A Discussion Paper has been prepared to facilitate the public consultation and is placed on the DOH’s Consultation Hub. You can participate in this consultation by completing an online questionnaire, or submissions can be made by email or post to the DOH.

The closing date for submissions is 5.00 pm, Friday 6 November 2020.

Following the consultation, a report will be prepared by the Department of Health for consideration by the Minister for Health.



Tweet of the Week – Philip Morris-funded Foundation for a Smoke-Free World is a failing ‘front group’

“What has #FSFW accomplished on its 3rd anniversary in Sep 2020?  From major layoffs to public health institution and grantee rejections – things are looking bleak for the #FailingFrontGroup. Read more on “3 Years In: FSFW is a Failing “Front Group”


Tobacco Control News

Lawsuit Aims to Ban Menthols, Big Tobacco’s Bait for Black Smokers – Bloomberg

‘Heat-not-burn’ alternative to e-cigarettes may harm heart – medicalxpress

Institute for Competitiveness (I-Com) – TobaccoTactics

Getting the Marketing Mix Right: A Commentary on NZ’s Forthcoming Vaping Regulations – University of Otago

Tobacco Taxation and Its Prospective Impact on Disparities in Smoking Initiation and Progression Among Young Adults – Journal of Adolescent Health