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  1. Karen Evans-Reeves1,
  2. John Baker2
  1. 1 Department for Health, University of Bath, Bath, UK
  2. 2 Community and Allied Health, La Trobe Rural Health School, Flora Hill, Victoria, Australia
  1. Correspondence to Dr Karen Evans-Reeves, Department for Health, University of Bath, Bath, USA; k.a.evans-reeves{at}bath.ac.uk

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All articles written by Karen Evans-Reeves and John Baker unless otherwise attributed. Ideas and items for News Analysis should be sent to k.a.evans-reeves@bath.ac.uk

BAT and Imperial pull out of Russia, while PMI and JTI stay, for now

After initially stating that it would continue sales of its products in Russia, British American Tobacco announced its U-turn on Day 16 of Russia’s invasion of Ukraine. The company stated that it would stop selling its products to the Russian market after all. It claimed that its decision was in line with the company’s ‘ethos and values’. Many have been quick to criticise the company, first for not withdrawing shortly after the invasion began, as other companies did, and second, for its hypocrisy given that the company sells products that kill their consumers.

Imperial Tobacco has also announced it will leave the Russian market, whilst at the time of writing, Japan Tobacco International and Philip Morris International have announced that they will suspend new investments but will continue operating, a move that has provoked criticism from tobacco control advocates. Whilst three of the big four own a relatively small proportion of the Russian market, JTI owns 37% of the market. Japan has reportedly agreed to join the US-led economic sanctions against Russia, but given that 30% of JTI is owned by the state, there is a clear conflict of interest if JTI continues to operate in Russia.

China: WHO report on the global tobacco epidemic 2021

In July 2021, the WHO released its latest global MPOWER report on the tobacco epidemic. These reports review tobacco control progress by countries since 2008, including China.

MPOWER implementation progress is measured as complete, moderate, minimal, and no or weak policies. The WHO report on the global tobacco epidemic 2019 stated that China had not completed any of the six MPOWER policies. However progress was seen in 2021, where China received the following ratings: 1. Monitoring tobacco use and impact of prevention policies (completed); 2. Protecting people from tobacco use (no or weak progress); 3. Offering help to quit tobacco use (moderate progress); 4. Warning about the dangers of tobacco (minimal progress) and creating mass media policies (completed); 5. Enforcing bans on tobacco advertising, promotion and sponsorship (moderate progress); and 6. Raising taxes on tobacco (moderate progress).

One-third of the world’s tobacco was consumed by 341 million Chinese smokers (24% of China’s population) in 2019. Despite this, China has seen a reduction in daily smoking prevalence from 30.5% in 2008 to 23% in 2021, although smoking prevalence decreased less than the global average between 1990 and 2019.

Despite some tobacco control success in China, likely as a result of completing MPOWER’s policies of monitoring tobacco use, introducing prevention policies and introducing mass media policies, the Global Adult Tobacco Survey (GATS) found that smoking cessation attempts have actually decreased from 36.4% of smokers in 2010 to 19.8% in 2018. As a result, China faces significant tobacco-related disease burdens and direct and indirect economic costs, which have been estimated to be between USD$9 billion to USD$57.5 billion per year. From 1990 to 2019, China experienced the largest increase in the number of tobacco-related deaths compared to all other countries. There were approximately 2.4 million deaths caused by tobacco use in China in 2019, which accounted for nearly one-third (31.2%) of the 7.69 million deaths caused by tobacco globally each year.

Raising taxes on tobacco products is one of the most effective strategies to prevent smoking uptake and stimulate smoking cessation in China. A 10% decrease in cigarette affordability could lead to a 1.65% reduction in tobacco use, which would drastically reduce tobacco-related illnesses and deaths in this country. Between 2014 and 2016, taxes on tobacco products increased to make up 36.3% of the total pack price, resulting in an average 11% increase in the retail price of tobacco and a reduction in tobacco sales by 7.8% (from 127 billion to 117 billion cigarette packs).

Currently, China National Tobacco Corporation (CNTC), a government-owned tobacco company, is involved in the enforcement of the WHO FCTC. Researchers and public health advocates strongly recommend that the Chinese Government establish an independent body to fully implement the WHO FCTC to adequately address the significant social and economic costs of tobacco use in their society.

This article is a summary of the Editorial commentary available in Translational Lung Cancer Research.

US: Brookline introduces Tobacco-Free Generation law

Brookline is a town in Greater Boston, Massachusetts that has been at the forefront of tobacco control legislation in the United States, having been a municipal member of the state’s tobacco control program since its inception in 1994. It allows residents to propose new bylaws for voting on at a Town Meeting. In particular, Brookline High School students have been involved in advocating for the introduction of bylaws. Recent bylaws include prohibiting the sale of tobacco products by pharmacies and near schools; increasing the purchasing age from 18 to 19 years old and then to 21; creating a 120m (400ft) no-smoking restriction around schools; and in 2018 banning the sale of flavoured tobacco products (including menthol cigarettes). Northeastern University’s Public Health Advocacy Institute (PHAI) has helped local advocates with legal drafting.

Subsequently, advocates considered an outright sales ban, a limit allowing only existing types of tobacco products (forbidding new products), and a birth-date restriction reflecting the Tobacco Free Generation (TFG) concept. The first two ideas were discarded given the potential for state or federal law conflicts and the potential imposition on local businesses. Attention became focused on TFG as a compromise.

Two Brookline residents, Pharmacist Anthony Ishak and Law Professor Kate Silbaugh, spearheaded the effort to pass a TFG bylaw – to ban tobacco sales to anyone born from a specified date. During the hearing process leading up to the Town Meeting on 19 November 2020, the cut-off birthdate was decided as 1/1/2000 (an administratively simple date) to minimise the impact on any existing purchasers in light of the addictiveness of nicotine, and instead focus on preventing the initiation of tobacco use by youth maturing into young adulthood. One line of objection was that it might be a financial disadvantage for local businesses, particularly with the impacts of the ongoing COVID-19 pandemic, and with the possibility of young adults taking their business to a neighbouring town. The Meeting passed Brookline’s TFG bylaw by a 139–78 vote.

Although the bylaw was approved by the Town Meeting, it required approval by the Massachusetts Attorney General, especially in regard to whether the state’s 2018 tobacco minimum sales age law pre-empted the Brookline measure.

The 2018 state law raising the minimum sales age from 18 to 21 years states that it, “shall pre-empt… any inconsistent, contrary or conflicting… local law related to the minimum sales age to purchase tobacco products.” Letters urging the Attorney General not to approve the Brookline bylaw were submitted by the Business Retail Association of Brookline and by the New England Convenience Store and Energy Marketers Association, while letters urging approval of the measure were submitted by Action on Smoking and Health and by PHAI.

Eight months after the Town passed the TFG law, on 19 July, 2021 the Attorney General approved it and rejected the pre-emption arguments raised by tobacco retailers. Crucially, the decision found that, “the pre-emptive effect of the statute is limited to local laws that would allow tobacco sales to those under the age of twenty-one.” Certainly, Brookline’s TFG bylaw would not allow for any such sales. Brookline began implementation on 1 September, 2021.

On 14 September, 2021, several Brookline tobacco retailers filed a lawsuit in Massachusetts Superior Court challenging the bylaw on the basis that despite the approval by the state attorney general, it is pre-empted under state law, and that it violated the Massachusetts Constitution’s guarantee of equal protection under the law by discriminating against anyone born on or after 1 January, 2000. It is expected that the lawsuit against the Town will be resolved in 12–18 months. The Town has sought to dismiss the complaint, and is now enforcing its first-in-the-nation TFG law.

Following a long history of anti-tobacco initiatives born in Brookline that led others to adopt similar measures, advocates hope the TFG bylaw will provide a pathway for other jurisdictions seeking to end the cycle of new users becoming addicted to tobacco.

Jon Berrick

Emeritus Professor, Yale-NUS College, Singapore

jon.berrick@yale-nus.edu.sg

All of the following individuals, based in the United States, contributed to this article: contributed to this article: Chris Bostic (Action on Smoking and Health), Michael Chou (Harvard Medical School), Richard Daynard (Northeastern University), Lissy Friedman (Public Health Advocacy Institute, Northeastern University), Mark Gottlieb (Public Health Advocacy Institute, Northeastern University), Tamu Green (Equity and Wellness Institute), Anthony Ishak, Kate Silbaugh (Boston University), D J Wilson (Massachusetts Municipal Association).

France: Reaching young smokers with new tools and messages

France has some of the highest rates of youth smoking in Europe. In 2019, 36% of 15–24 year olds reported daily or occasional smoking, the second highest youth smoking rate in Europe. To combat this, urgent changes are required to the country’s prevention approach, which is the main objective of Alliance Contre le Tabac (ACT). This French NGO, financed by the French Ministry of Health and Solidarity, has been implementing denormalization campaigns since 2019, which aim to change perceptions about smoking and the tobacco industry. ACT’s campaigns seek to change the French prevention paradigm by moving away from a purely health-based approach to an overall societal one, engaging young audiences who are usually less receptive to preventive messages based on health warnings.

In February 2022, we launched the ‘Change Their Future’ 360° campaign aimed to raise awareness among the public (specifically, 15–24 year olds) of the harmful effects of tobacco on youth through a holistic campaign that relies on complementary co-occurring strands: a social-media campaign, a public relations plan, and an advocacy strategy targeting policymakers. The public’s awareness of the exploitation of youth by the tobacco industry through this campaign is divided into two main parts: the first is informative and denounces the industry’s economic model which mainly targets young people as replacement smokers. The second is to highlight the widely ignored use of child labour in the tobacco production value chain, which allows its industry to optimise production costs despite tobacco production being extremely dangerous. By approaching prevention from the perspective of causes strongly supported by today’s youth, Change Their Future’ reaffirms tobacco control as a political and societal issue.

One of the major innovations of this campaign is the use of the Snapchat filter %23Behindthepack’, Snapchat being the most consumed social media among the targeted age group of 14–24 year olds. This is the age bracket where most smokers try their first cigarette. When users scan the cigarette pack which usually displays written health warnings, it broadcasts a testimony of a child working in the tobacco fields. According to the United Nations International Labour Organisation (ILO), at least 1.3 million children worldwide are exploited in tobacco production. Through an interactive and innovative tool, we aim to engage young smokers, who will discover the journeys of children employed in the production of the tobacco they smoke. The 30 s video, courtesy of the Guardian and Reuters, features Tyamike living in Malawi and Myriam living in Indonesia and thereby personalises the damage caused by this faceless industry. These children are aged 14 years and under, are taken out of school, and employed in hard and dangerous physical labour to produce tobacco. This is a new way to make younger generations aware of this deadly trade, in the hope that the pack in their hands becomes the last they smoke. Behind the warning messages, we now not only provide information about the many health risks induced by smoking but also learn about the lives of other young people in danger in the tobacco fields who absorb the equivalent of 50 cigarettes per day through their skin.

Snapchat filter alters the health warning from ‘smoking damages your teeth and gums’, to ‘smoking kills children’ Source: TBWA Paris/ACT.

This tool adapts smoking prevention methods by making them available on platforms most used by youth and by the industry to target them, bypassing the advertising ban rules. The tool can also be considered a counter response to the industry’s greenwashing of its business. Tobacco companies boast about their sustainability awards and labels which rehabilitate their image. So far, the campaign has had great engagement, with more than 1.5 million users having already accessed the Snapchat filter.

Ellen de Guiran

Research and Evaluation Manager at Alliance Contre le Tabac, Paris, France

ellen.deguiran@alliancecontreletabac.org

Loïc Josseran

Professor of Public Health, University of Versailles Saint-Quentin-en-Yvelines, France; Assistance Publique des Hôpitaux de Paris, France ; President of Alliance Contre le Tabac

loic.josseran@aphp.fr

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Footnotes

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests No, there are no competing interests.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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