ACOSH Advocacy in Action - 3 September 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.

GOOD TROUBLE | Tobacco Control Editorial

“Recently, US civil rights icon and Congressman John Lewis died. Many of the elegiac tributes referenced the words ‘good trouble’, his brilliant pairing of two words that initially seemed antithetical. Lewis had for decades led non-violent civil rights protests against injustice. About this he said in 2016, speaking to a younger generation of graduating students: ‘You must find a way to get in the way and get in good trouble, necessary trouble. … Good trouble, necessary trouble … that is your calling. That is your mission. That is your moral obligation. That is your mandate. Get out there and do it. Get in the way’.

“What is Good Trouble in public health? It means calling out governments that fail to act to protect human well-being. It means disrupting the status quo in ways that are hard to ignore and doing it over and over again. This June, the African American Tobacco Control Leadership Council and Action on Smoking and Health filed a lawsuit against the US Food and Drug Administration over its shameful inaction on menthol in tobacco products. This action came only after two scientific reports, a Citizens Petition, and numerous efforts to push forward this issue of great importance to Black communities. While the agency has acted to protect children by regulating other characterising flavours, it has repeatedly and inexplicably failed to regulate menthol, the product flavour with which African Americans have been disproportionately targeted, despite the evidence that it contributes to harm. The agency’s Whiteness is showing. This lawsuit is about getting in the way. Good Trouble.”



TGA ruling based on evidence

“Australia’s independent and evidence-based regulator of medicines, the Therapeutic Goods Administration (TGA), has confirmed its rejection of an application from tobacco company Philip Morris to market in Australia its heated tobacco product.

“The TGA made this decision based on a review of the scientific and medical evidence on these products, and to protect public health from the risks associated with introducing a new nicotine delivery device for non-therapeutic use.

“The TGA does not listen to lobbying from vested interests or from e-cigarette enthusiasts some of whom have accepted funding from the vaping industry.

“Its decision is consistent with the position of Australia’s independent and leading health and medical organisations which have expressed serious concern about the epidemic increase in the use of e-cigarettes by school children in the US, Canada and New Zealand – countries that have allowed these products to be freely available and promoted extensively through social media and other platforms.”



City of Vincent’s health kick to include smoke-free town centres

The City of Vincent draft Public Health Plan includes a target to introduce smoke-free town centres by 2025.

“This plan is all about helping our community members thrive and feel healthy, happy, connected and supported,” said Mayor Emma Cole.

“The COVID-19 pandemic has caused a lot of us to pause and reflect on how much we value our health and the health of our loved ones.

“So it is really timely for us to release this draft plan for our community to comment on how we promote and support a healthy and active lifestyle in Vincent.

“We’re really keen to engage on the issue of passive smoking, with an ambitious target of smoke-free town centres by 2025.

“These are our high-pedestrian main streets where we shop, dine and meet. We want to make our town centres a really welcoming and pleasant environment for people to enjoy.

“Input from our community, businesses and licensed venues on this target is really important as we want to ensure that the support is there.”

Comments are invited until 5 pm Friday 11 September 2020. For more information, visit



The exploitation of the COVID-19 pandemic by e-cigarette marketers

“Over the last decade, a wide variety of e-cigarette advertisements have claimed superior healthfulness compared with cigarettes. Recently, we recognised a novel form of health reassurance advertising, promotion of e-cigarettes via COVID-19 pandemic themes. This led us to systematically explore COVID-19 marketing of e-cigarette brands and vape stores on their websites and Instagram accounts. We have collected over 300 COVID-19 themed e-cigarette promotional images and posted them to our online repository ( These images represent 21 e-cigarette brands and 41 online vaping stores that vend multiple brands. The COVID-19 messaging in these advertisements took several forms…”


How does vaping affect indoor air quality?

“Propylene glycol and glycerol provide the visible clouds of vapor when exhaling. From these substances, which are supersaturated in the respiratory air, fine and ultrafine liquid particles are formed, whose size distribution and number concentrations are similar to those of tobacco smoke. The indoor air concentrations of fine (PM2.5) and ultrafine particles (UFP) increase when e‐cigarettes are used. The ultrafine particles penetrate into the alveoli of the lungs.

“In summary, there is growing evidence describing the nature and magnitude of passive vaping. While secondhand and thirdhand exposures are likely lower than those associated with conventional smoking, e‐cigarettes can still be a significant source of indoor pollution. For that reason, smoke‐free measures that have proved effective to protect against cigarette smoking should also be implemented for vaping.”



E-cigarettes are no better than alternative aids to quit smoking

“Pierce and his colleagues assessed data collected as part of a study that has recruited around 49,000 people across the US. In one piece of research, the team looked at the outcomes of 32,320 adults who were asked about their use of tobacco products. A year later, each person was asked if they had attempted to quit smoking, the methods they had used and whether they had been successful. The following year, they were asked whether they had remained abstinent for 12 months or more.

“Of the 9021 people who initially said they smoked on a daily basis, 2770 had attempted to quit. Around 24 per cent used e-cigarettes as a cessation aid, while about 19 per cent used other aids, such as clinically approved drugs and other nicotine replacement therapies, like patches, sprays and lozenges. The remainder of the group didn’t use any products.

“But the choice of product didn’t seem to make a difference in how successful their attempt to quit was. Only around 10 per cent of people managed to stay abstinent from tobacco products for 12 or more months by the end of the period, regardless of whether they had used e-cigarettes, other products or nothing at all. Around 82 per cent of those who had attempted to quit were still smoking by the end of the study period.”



Association Between the Tips From Former Smokers Campaign and Smoking Cessation Among Adults, United States, 2012–2018

“In 2012, the Centers for Disease Control and Prevention (CDC) launched the national Tips From Former Smokers (Tips) campaign to encourage people who smoke to quit by showing real-life health consequences of tobacco use and promoting evidence-based resources for quitting. To assess the campaign’s impact on quit attempts and sustained-quit estimates (ie, quits lasting ≥6 mos), CDC analyzed data from a nationally representative longitudinal survey of US adults who smoke cigarettes, aged 18 years or older in 2012–2018.

“The Tips campaign was associated with an estimated 16.4 million quit attempts and 1,005,419 sustained quits. Continued implementation of cessation campaigns, including the Tips campaign, could accelerate progress toward reducing rates of smoking-related diseases and death.”



Improved rates of treatment success following alcohol and other drug treatment among clients who quit or reduce their tobacco smoking

Introduction and Aims
“Alcohol and other drugs (AOD) treatment seekers who smoke tobacco are more likely to die of tobacco‐related causes than those attributable to their primary drug of concern (PDOC), yet smoking cessation is frequently overlooked in the context of AOD treatment settings. We explored rates of AOD treatment success among participants who quit or continued smoking 12 months after initiating AOD treatment.

Discussion and Conclusions
“Despite low overall rates of smoking cessation, our findings suggest clients who do successfully quit have a greater likelihood of achieving reductions in PDOC use and dependence severity. These results reinforce efforts to promote more comprehensive, routine provision of smoking cessation care (i.e. counselling and nicotine replacement therapy). AOD treatment presents a crucial opportunity to deliver smoking cessation care to all clients who smoke, particularly those who are unconcerned about their use, as this group may stand to benefit most.”



Nicotine dependence as a risk factor for upper aerodigestive tract (UADT) cancers: A mediation analysis

“This study investigated nicotine dependence as an independent risk factor for upper aerodigestive tract (UADT) cancers, including lung and head and neck cancers (HNC). The study aimed to isolate the direct effect of nicotine dependence, independent of tobacco smoking.”

“A case-control study with a total of 4957 participants was conducted in Ontario, Canada, of which 2964 categorized as either current or former smokers were used in the analysis.”

“Most individual nicotine dependence behaviours showed positive associations with lung cancer with approximately 1.8 to 3.5-fold risk increase, and to lesser extent with 1.4 to 2.3-fold risk for HNC. Nicotine dependence is partially accountable for increased risks of lung cancer (OR = 1.20, 95%CI = 1.13–1.28) and HNC (1.12, 95%CI = 1.04–1.19). Nicotine dependence had a greater effect on the risk of HPV-negative oropharyngeal cancer (OR = 3.06, 95%CI = 1.65–5.66) in comparison to HPV-positive oropharyngeal cancer (OR = 1.05, 95%CI = 0.67–1.65). The direct effects of nicotine dependence remained significant after accounting for cumulative tobacco exposures.”

“Nicotine dependence increases the risks of lung and HNC cancers after accounting for tobacco smoking, suggesting potential toxic effects of nicotine. These results are informative for the safety consideration of nicotine exposures.”



US FDA has “accepted” e-cigarette premarket tobacco product submissions: What does that mean and what should we expect after September 9?

“In the last few days, news reports reveal that the US FDA has accepted several premarket tobacco product applications (PMTAs) for review, including for Juul and for one or more unspecified Vaporesso products, and others have been submitted, including for Reynolds’ Velo Dissolvable Nicotine Lozenges.

“The Juul news report says that FDA accepted Juul’s application less than three weeks after it was submitted on July 30, and the Vaporesso’s website crows that its PMTA was accepted “only three days after submission.”

“FDA’s “acceptance” of a PMTA is not an authorization to sell the product. Rather, it means that the applications were sufficient to advance to FDA’s more substantive review process.”

“Beginning Sept. 9, a majority of vaping products will need verification through a Pre-Market Tobacco Application in order to enter the market or stay on shelves, according to the FDA website. This process stems from a 2016 ruling that classifies vapor products as tobacco products. The PMTA component requires testing to prove that a product meets an FDA standard deemed appropriate for the protection of public health.”



American Lung Association Announces Comprehensive Plan to End Youth Vaping Epidemic for Students, Parents, Schools

“The American Lung Association’s initiative to end the youth vaping epidemic launched on September 1, 2020, with an integrated, multi-component approach to support parents, schools and students.

“The American Lung Association’s plan to end youth vaping encompasses education, advocacy and research, and has four components:

• Public awareness campaign with the Ad Council, to equip parents with the facts about e-cigarettes and support conversations before kids start to vape.
• Vape-Free Schools Initiative to help educators address the surge of youth vaping.
• Targeted advocacy plan to impact e-cigarette policies at local, state and federal levels.
• $2 million research investment to understand the effects of vaping on developing lungs.

“Youth vaping has skyrocketed, placing our children at risk of a lifetime of tobacco addiction and harm to developing lungs and overall health,” said American Lung Association President and CEO Harold Wimmer. “We want to support students, parents and schools who are dealing with this rise in teen and tween vaping. The American Lung Association is leading a response to this public health crisis with a comprehensive plan and proven approaches to ensure a vape-free future for our kids.”



Helen Clark: New Zealand’s smoke-free gains among my proudest achievements, but there’s more work to do

“Smoking remains the single most preventable cause of premature death in New Zealand.

“As I reflect on my years of public service, one of my proudest achievements is leading the passage of New Zealand’s first comprehensive tobacco control legislation.

“As Minister of Health in 1989, I wanted to promote a strengthened response to the tobacco epidemic and the tobacco industry behind it.

“The Smoke-free Environments Act was passed under my leadership as Minister of Health thirty years ago this week in 1990.

“It required things we now take for granted: it banned smoking on public transport, banned sales to under-sixteen year olds, required disclosure of ingredients, restricted smoking in indoor workplaces, banned tobacco advertising and sponsorship, and established the Health Sponsorship Council (now the Health Promotion Agency) to replace tobacco sponsorship.”



Tweet of the Week

“BigTobacco’s #vaping ambitions going exactly to plan in NZ as 48% of teens who vape have never smoked; vaping is on the rise while falls in smoking have stalled or reversed. Never be in any doubt that, just like with tobacco, they see kids as the critical target,” said Emeritus Professor Simon Chapman AO (@SimonChapman6)


ACOSH Advocacy Action 1971 – 1999

ACOSH has published an online resource on advocacy strategies and achievements of ACOSH from its establishment in 1971 to 1999.

The resource aims to assist health professionals, students of public health and other health sciences, in public health advocacy by providing case studies on successful advocacy for tobacco control in WA and nationally.



Tobacco Control News

Nicotine replacement therapy assists homeless hotel guest during COVID-19 pandemic – Cancer Council WA

Flavored cigarettes and e-cigs will soon be banned in California – CBS News

Goodbye ‘banana smash’ cigarillos: Governor quickly signs bill to ban flavored tobacco – Cal Matters

More Than 100 Public Health Organizations Call For FIA and Formula 1 To Ditch Tobacco Sponsorships – Health Policy Watch

1976 – Tobacco advertising banned on Australian radio & television – 2BG Radio