NOT PEER REVIEWED In June 2015 we published our paper "The smoking population in the
USA and EU is softening not hardening" in the journal Tobacco Control. We
showed that as smoking prevalence has declined over time, quit attempts
increased in the USA and remained stable in Europe, US quit ratios
increased (no data for EU), and consumption dropped in the USA and Europe.
These results contradict the hardening hypothesis whi...
NOT PEER REVIEWED In June 2015 we published our paper "The smoking population in the
USA and EU is softening not hardening" in the journal Tobacco Control. We
showed that as smoking prevalence has declined over time, quit attempts
increased in the USA and remained stable in Europe, US quit ratios
increased (no data for EU), and consumption dropped in the USA and Europe.
These results contradict the hardening hypothesis which is often used as
part of the tobacco industry's strategy to avoid meaningful regulation and
protect its political agenda and markets, claiming that there is a need
for harm reduction among those smokers who "cannot or will not quit."
Indeed, rather than "hardening" the remaining smoking population is
"softening."
In February 2016 we received an email from Robert West, editor of the
journal Addiction, informing us that Addiction was about to publish an
article by Plurphanswat and Rodu entitled "A Critique of Kulik and Glantz:
Is the smoking population in the US really softening?" whose sole purpose
was to critique our Tobacco Control paper, and offered to let us respond to
the criticism. (The full collection of emails is available at
https://tobacco.ucsf.edu/addiction-refuses-allow-discussion-industry-ties-
criticism-our-%E2%80%9Csoftening-paper%E2%80%9D)
The fact that Plurphanswat and Rodu sent their paper to Addiction was
unusual because normal scientific procedure would have had them sending a
letter to the editor of the journal that originally published the work
(Tobacco Control).
As detailed below, we did respond, noting that Plurphanswat and
Rodu's paper fits into a well-established pattern of tobacco industry-
funded researchers trying, without any proper scientific justification, to
create controversy about research inconsistent with industry interests,
the fact that Rodu had understated his financial ties to the industry,
and, of course, showing how their criticism was based on statistical error
that they made.
Addiction rejected our response because we would not delete the first
two points and limit our response only to the statistical issue. Here is
our full response:
THE REJECTED RESPONSE
Consider the Source
"Harm reduction" is a key part of the tobacco industry's strategy to
avoid meaningful regulation and protect its political agenda and
markets.[1] This agenda is premised on the existence of "hard core"
smokers who "cannot or will not" quit.[2-4] Our paper, "The smoking
population in the USA and EU is softening not hardening",[5] undermined
this agenda because it showed that, contrary to the hardening hypothesis,
as smoking prevalence has declined over time, quit attempts increased in
the USA and remained stable in Europe, US quit ratios increased (no data
for EU), and consumption dropped in the USA and Europe.
There is a longstanding pattern of tobacco industry-funded experts
writing letters criticizing work that threatens the industry's position,
first described in 1993 by then-JAMA Deputy Editor Drummond Rennie.[6]
Rodu and various co-authors have written several such letters.[7-10]
Another similarity to past efforts is industry-linked experts submitting
critiques of a paper published in one journal to another,[11-15] which is
also the case here, with this critique of our paper published in Tobacco
Control being published in Addiction. One would have expected any
criticism to have been published as a letter in Tobacco Control.
Addiction requires "full disclosure of potential conflicts of
interest, including any fees, expenses, funding or other benefits received
from any interested party or organisation connected with that party,
whether or not connected with the letter or the article that is the
subject of discussion." As with another investigator supported by the
tobacco industry,[16] the conflict of interest statement Plurphanswat and
Rodu provide may not truly reflect the extent of Rodu's involvement with
the tobacco industry. For example:
* Rodu's Endowed Chair in Tobacco Harm Reduction Research at the
University of Louisville is funded by the U.S. Smokeless Tobacco Company
(US Tobacco) and Swedish Match North America, Inc.[17]
* Rodu is a Senior Fellow at the Heartland Institute, which has
received tobacco industry funding.[18-20]
* Rodu is a Member and Contributor to the R Street Institute, which
has received tobacco industry funding.[19,21]
* Before moving to Louisville, Dr. Rodu was supported in part by an
unrestricted gift from the United States Smokeless Tobacco Company to the
Tobacco Research Fund of the University of Alabama at Birmingham.[8]
* Rodu was a keynote speaker at the 2013 Tobacco Plus Expo
International, a tobacco industry trade fair to discuss "How has the
tobacco retail business evolved; where was it fifteen years ago, where is
it today and where is it going".[22]
* Rodu has worked with RJ Reynolds executives between at least 2000
and 2009 to help promote industry positions on harm reduction, including
specific products.[23-26]
The substance of Plurphanswat and Rodu's criticism is that the
statistically significant negative association between smoking prevalence
and quit attempts and the positive association between prevalence and
cigarettes smoked per day both become non-significant when more tobacco
control variables are included in the model (state fixed effects,
cigarette excise taxes, workplace smoking bans and home smoking bans). The
problem with including all these variables is that it results in a
seriously overspecified model, which splits any actual effects between so
many variables that all the results become nonsignificant. The regression
diagnostic for this multicollinearity is the Variance Inflation Factor
(VIF); values of the VIF above 4 indicate serious multicollinearity. For
the United States, adding all the other variables increases the VIF for
the effect of changes in smoking prevalence from 1.8 in our model for quit
attempts to 16.7, and from 1.8 in our model to 17.9 for cigarettes per
day, respectively. Plurphanswat and Rodu's model is a textbook case of why
one has to be careful not to put too many variables in a multiple
regression.
The Plurphanswat and Rodu criticism misrepresents our conclusions. We
did not argue that drops in prevalence caused increased quit attempts and
reduced consumption; we simply present the observation that, as prevalence
falls, quit attempts increase or remain constant and consumption falls,
which is the exact opposite of what the hardening hypothesis predicts.
Funding
This work was supported by National Cancer Institute Grants CA-61021
and CA-113710. The sponsor played no role in the conduct of the research
or preparation of the manuscript.
REFERENCES
1. Peeters S, Gilmore AB (2015) Understanding the emergence of the
tobacco industry's use of the term tobacco harm reduction in order to
inform public health policy. Tob Control 24: 182-189.
2. Abrams DB (2014) Promise and peril of e-cigarettes: can disruptive
technology make cigarettes obsolete? JAMA 311: 135-136.
3. Polosa R, Rodu B, Caponnetto P, Maglia M, Raciti C (2013) A fresh
look at tobacco harm reduction: the case for the electronic cigarette.
Harm Reduct J 10: 19.
4. Nitzkin JL (2014) The case in favor of E-cigarettes for tobacco
harm reduction. Int J Environ Res Public Health 11: 6459-6471.
5. Kulik MC, Glantz SA (2015) The smoking population in the USA and
EU is softening not hardening. Tob Control doi:10.1136/tobaccocontrol-2015
-052329 Published online 24 June 2015.
6. Rennie D (1993) Smoke and letters. JAMA 270: 1742-1743.
7. Rodu B, Phillips CV (2015) Letter by Rodu and Phillips regarding
article, "Discontinuation of smokeless tobacco and mortality risk after
myocardial infarction". Circulation 131: e422.
8. Rodu B, Cole P (2006) A deficient study of smokeless tobacco use
and cancer. Int J Cancer 118: 1585; author reply 1586-1587.
9. Rodu B, Plurphanswat N, Phillips CV (2015) Discrepant results for
smoking and cessation among electronic cigarette users. Cancer.
121(13):2286-7. doi: 10.1002/cncr.29307. Epub 2015 Mar 4.
10. Rodu B, Heavner KK (2009) Errors and omissions in the study of
snuff use and hypertension. J Intern Med 265: 507-508; author reply 509-
510.
11. Glantz SA, Parmley WW (1992) Passive smoking causes heart disease
and lung cancer. J Clin
Epidemiol 45: 815-819.
12. Mantel N (1992) Dubious evidence of heart and cancer deaths due
to passive smoking. J Clin
Epidemiol 45: 809-813.
13. Glantz SA, Parmley WW (1991) Passive smoking and heart disease.
Epidemiology, physiology, and biochemistry. Circulation 83: 1-12.
14. Jensen RP, Luo W, Pankow JF, Strongin RM, Peyton DH (2015) Hidden
formaldehyde in e-cigarette aerosols. N Engl J Med 372: 392-394.
15. Bates CD, Farsalinos KE (2015) Research letter on e-cigarette
cancer risk was so misleading it should be retracted. Addiction 110: 1686-
1687.
16. Bero LA, Glantz S, Hong MK (2005) The limits of competing
interest disclosures. Tob Control 14: 118-126.
17. University of Louisville. Available at
http://louisville.edu/bucksforbrains/descriptions/tobaccoharmreduction/,
accessed February
2016.
18. The Heartland Institute. Available at
https://www.heartland.org/dr-brad-rodu, accessed February 2016.
19. Nitzkin email string "Dialogue with Tobacco Industry re 3d Party
Research". Available at
https://tobacco.ucsf.edu/sites/tobacco.ucsf.edu/files/u9/Nitzkin-email-
s..., accessed
February 2016.
20. The Center for Media and Democracy. Available at
http://www.prwatch.org/news/2012/07/11671/tobacco-can-cure-smoking-and-
o...
alecs-annual-meeting-salt-lake, accessed February 2016.
21. The R Street Institute. Avaliable at
http://www.rstreet.org/people/brad-rodu/, accessed February 2016.
22. Tobacco Plus Expo 2013. Available at
https://web.archive.org/web/20121219001140/http://tobaccoplusexpo.com/tp...,
accessed February 2016.
23. University of Alabama, Debethizy JD, Doolittle DJ, Rodu B.
Followup from Brad Rodu. 2000 April 26. RJ
Reynolds.https://industrydocuments.library.ucsf.edu/tobacco/docs/hklw0187.
24. RJR, University of Alabama, Burger GT, Lyalls TM, Doolittle D,
Moskowitz SW, Rodu B, Smith C, Williard S. ECLIPSE and Dr. Brad Rodu. 2000
April 20; 2000 April 26. RJ Reynolds.
https://industrydocuments.library.ucsf.edu/tobacco/docs/lklw0187.
25. Hawkins SC. TTM - Brad Rodu for 122006 (20061200).PPT. 2008
December 01. RJ Reynolds.
https://industrydocuments.library.ucsf.edu/tobacco/docs/xrvm0222.
26. Reynolds American, Payne TJ, Rodu B. Thanks. The following
studies (attached) provide almost identical evidence that appropriate
marketing of smokeless products would result in a 10% drop in smoking
prevalence. 2009 February 27; 2009 March 02. RJ Reynolds.
https://industrydocuments.library.ucsf.edu/tobacco/docs/yjpl0222.
NOT PEER REVIEWED
I am writing in response to sight of an article published by you about my work for the International Tax and Investment Center (ITIC).
The ITIC guidebook
published in 2011 "The Illicit Trade in Tobacco Products and How to Tackle
it" makes it clear in the Executive
Summary that it is "a compilation of facts and views from a wide range of
sources including respected academics, private sector consultants,...
NOT PEER REVIEWED
I am writing in response to sight of an article published by you about my work for the International Tax and Investment Center (ITIC).
The ITIC guidebook
published in 2011 "The Illicit Trade in Tobacco Products and How to Tackle
it" makes it clear in the Executive
Summary that it is "a compilation of facts and views from a wide range of
sources including respected academics, private sector consultants,
journalists, international enforcement organizations, government revenue
authorities and industry". It also states in the very first footnote that
the case studies were provided by industry, consultants and academics and
other references include the Framework Convention Alliance, the World Bank
Economic of Tobacco Toolkit, ASH Action on Smoking and Health and the WHO
and Framework Convention Alliance are listed under "Interesting Links". I
wrote this guidebook for ITIC as an independent consultant with academic
freedom to ensure it presented a balanced picture of the issues and
attributed input to the appropriate sources. I have never lobbied on
behalf of an industry or individual company.
As the former UK senior civil servant in a revenue authority who
was privileged to lead the first UK Alcohol and Tobacco Fraud Review in
1997, my motivation in writing this guidebook has been to pass on my
knowledge and experience of the illegal tobacco trade to assist officials
in developing countries in improving their administration of excise
taxation and anti-smuggling controls. I do not work for the tobacco
industry and I have never smoked - in fact, I have suffered from asthma
all my life and was delighted to see workplace smoking bans in the UK. I
have never sought to undermine tobacco control policies. Rather, I have
sought to help the tax and enforcement authorities to reduce opportunities
for illegal trade, reduce demand and detect and prosecute the criminals
and terrorists who profit from illegal trade drawing heavily on the UK
experience in successfully reducing illegal trade in tobacco products from
over 20% in 2000 to around 10% currently whilst maintaining one of the
highest tax rates in the world.
It is undeniable that products that are light, portable and subject to
high levels of tax attract criminals. The guidebook (and the second
edition published in 2013) makes it clear that there are, however, several
drivers and facilitators of illegal trade in tobacco products including
tobacco taxation policy, corruption, protectionist measures, inadequate
legislation such as penalties, inadequate enforcement and public tolerance
though it is my personal view that the economic drivers of supply and
demand are the most important. Whilst advocating balanced tax policies in
the guidebook, I went on to explain that sustaining high tax rates and
maintaining manageable rates of illegal trade can only be achieved through
a comprehensive strategic approach encompassing all legitimate
stakeholders both public and private sector, national and international -
as in the various refreshed versions of the UK Tobacco Strategy. As a
former administrator I was trained and required to treat all taxpayers
fairly without favouring one industry or one company over another. This
has to be a key feature of effective tax and customs administration all
over the world. The tobacco industry is a significant payer of excise
revenue - second only to the hydrocarbon oil industry - and as long as it
sells legal products and complies with legislative requirements it
deserves the same treatment as any other industry. It is a feature of good
tax administration to have dialogue with taxpayers and their
representative associations and I have no hesitation in recommending this
way of working to senior officials in Ministries of Finance and Revenue
Authorities/Customs around the world. Indeed, the UK has long had and
published Memoranda of Agreement with the tobacco industry as well as with
other excise industries.
I am puzzled by the article's criticism of a reference to Codentify in the
2011 edition of the guidebook as I do not see any such reference. The case
study box on page 28 refers to International Track and Trace Standards and
the information attributed to the four major international tobacco
companies but Codentify is not mentioned as this is merely an illustration
of the standards in place among key players in the industry. It is placed
after a much more lengthy page on Article 15 of the WHO Framework
Convention on Tobacco Control which the conclusions in para. 7.5 fully
support but point out that rigorous enforcement, international cooperation
and cooperation with the private sector are essential as legislation alone
cannot eliminate illicit trade. With trillions of movements of tobacco
products across the world daily there are never going to be sufficient
enforcement resources to detect all illicit movements. Seizure rates, even
in those countries that pride themselves on top class enforcement, do not
exceed 20% to 23% and in the EU (see page 9 of the 2013 edition of the
guidebook) were around 7% in 2011. Seizure rates can be expected to be
considerably less in relation to illicit trade in most developing
countries. So, enforcement authorities need all the help they can get
from others in the public sector. This includes health and education
authorities who are best placed to provide awareness campaigns and develop
strategies to reduce demand and it includes help from legitimate industry
who can provide additional intelligence on the markets, trends and those
suspected of undermining their legal sales in the marketplace i.e. the
international criminal organizations and terrorists.
Moving on to the criticism of the WCO for allowing me to present a two day
course on excise taxation policy, administration and enforcement, I
would challenge anyone to present a meaningful course on excise taxation,
administration and enforcement without referring to tobacco taxation or to
illicit trade in excise products. The course included material on alcohol
with input from the Spirits industry and the Beer industry and material on
fuel taxation with input from the Oils industry as well as input on
tobacco taxation from a representative of the tobacco industry. Customs
officials have to deal with numerous products and legislation and their
national training rarely provides them with material on excise taxes which
they are tasked with protecting on imports, exports and transit shipments.
Providing customs officials with basic broad awareness of the key excise
taxes, how they work, good administrative and enforcement practices as
well as stakeholder perspectives is really important in improving the
performance of customs officials around the world. All the course material
was thoroughly vetted by the WCO before the course so delegates were
assured of receiving balanced and useful material.
Any cooperation of municipalities with the tobacco industry is problematic. In Vienna, the capital of Austria, the department responsible for waste made a deal with the tobacco industry. This resulted in the installation of metal tubes for cigarette butts at every tram station, resembling huge cigarettes. Now there are still butts on the floor (usually extinguished by foot), but in addition, smoke is escaping from many of these as...
Any cooperation of municipalities with the tobacco industry is problematic. In Vienna, the capital of Austria, the department responsible for waste made a deal with the tobacco industry. This resulted in the installation of metal tubes for cigarette butts at every tram station, resembling huge cigarettes. Now there are still butts on the floor (usually extinguished by foot), but in addition, smoke is escaping from many of these ash cylinders, contaminating sheltered waiting space for passengers. Because the ash tubes look like an oversize cigarette, they remind smokers waiting for a tram or bus to light up. So the main benefit of this deal was for the tobacco industry an additional form of advertising without warnings.
Conflict of Interest:
unpaid board member of www.aerzteinitiative.at, www.gamed.at, www.oeaw.ac.at/krl/ and www.oeghmp.at
NOT PEER REVIEWED Thanks for Mr. Middleton's information that there are local tobacco
manufacturers in Hong Kong. I made a mistake when reading the materials. I
have amended this in the updated version.
It does not affect the analysis as the government taxes based on
number of cigarettes sold rather than manufactured, but I sincerely
appreciate your valuable advice.
NOT PEER REVIEWED Thanks for Mr. Middleton's information that there are local tobacco
manufacturers in Hong Kong. I made a mistake when reading the materials. I
have amended this in the updated version.
It does not affect the analysis as the government taxes based on
number of cigarettes sold rather than manufactured, but I sincerely
appreciate your valuable advice.
For the analysis part, it is not easy to have an "official figure" of
illicit cigarette consumption. During the peer review stage, I indeed have
discussed with the reviewers which source is preferable. I adopt the
figures provided by the tobacco sellers, but also list the Euromonitor a
reviewer suggested for readers' reference. Noted that these figures lead
to the same result, as the total tobacco consumption (tax + illicit) drops
after the tax increasing, which rebuts the traditional economic view that
tobacco duty is not an effective method because of smuggling.
It is also not an easy job to determine how much price is affordable
for people esp youngsters. However when we find out that smuggling shall
not be a concern when the government increases the tax rate, it is clear that
tobacco duty is a powerful tool to control cigarette consumption.
NOT PEER REVIEWED Pressure the CDC and FDA to pressure state legislatures to outlaw the
sale of filtered cigarettes. As I see it, this is the only viable solution
for ending this litter problem. Cigarette smoking should be made as
unappealing as possible to all concerned.
NOT PEER REVIEWED The author appears to believe that the main problem with the FDA is that it is not doing enough to prevent new niche cigarette products reaching the market. This focus of concern is misplaced, given several thousand cigarette products are readily available and smokers are spoilt for choice with or without these new products. I have no great desire to see new cigarette products coming on the market, but is this...
NOT PEER REVIEWED The author appears to believe that the main problem with the FDA is that it is not doing enough to prevent new niche cigarette products reaching the market. This focus of concern is misplaced, given several thousand cigarette products are readily available and smokers are spoilt for choice with or without these new products. I have no great desire to see new cigarette products coming on the market, but is this really the most pressing agenda?
There are important issues for FDA and Congress to address, but on which the author did not comment. Allow me to suggest five:
1. FDA's governing framework for tobacco, the Tobacco Control Act, is unfit for the purpose of managing reduced risk products. It is designed to raise a high regulatory barrier to entry to a market dominated by worst products and to suppress innovation in better products. At the same time, it has protected the existing cigarette trade by 'grandfathering' the thousands of products that were on the market at 17 Feb 2007 and offering them an easy ride for subsequent modifications. A new legislative framework for recreational nicotine products is required.
2. FDA regulation is unlikely to offer a feasible route to market for most vapour products. ?Its approach will cause chaos in the marketplace, even though these products are helping many to quit smoking. The vapour category would be largely wiped out and confined to the tobacco industry's high volume commodity products if FDA proceeds on its present course. That would provide further protection for the cigarette trade and stimulate a black market. Workarounds, a change in the predicate date or simply doing nothing would be an improvement.
3. FDA's approach does little that supports and a lot that suppresses innovation, regardless of whether particular innovations are desirable for consumers. For example, under the proposed framework for vapour products to access the market, a third generation e-cigarette manufacturer would likely need to go through a new and hugely burdensome authorisation (PMTA) to introduce new safety features like temperature control or to improve nicotine delivery through better aerosol science. A notification regime with an FDA right to intervene if the evidence justifies it would be preferable to a cumbersome authorisation regime.
4. FDA applies a bizarre approach to communicating the far lower risk of products like snus to consumers. This starts with a default FDA-imposed warning that is technically correct but not truthful because it is highly misleading ("this product is not a safe alternative to smoking"). It then requires tobacco companies to calculate if they are rich enough, the data extensive enough and whether it is sufficiently in their commercial interest to go through an arduous process to convince the FDA to allow them to change the warning to something more truthful ("No tobacco product is safe, but this product presents substantially lower risks to health than cigarettes") - and face hostile resistance from tobacco control campaigner such as the author. FDA and CDC should be assessing the relative risks of these products, and communicating them clearly - so that public risk perceptions become, as far as possible, aligned with scientific reality.
5. FDA suffers from mission creep - a regulator should not be involved in campaigning. FDA should function, and be seen to function, as a neutral technocratic regulatory agency, leaving the hype to public health bodies like the CDC. In this case, there is a further problem - the scientific foundations of the new smokeless campaign are very poor and undermine FDA's credibility more generally. FDA should stick to its core mission and do it better.
Matthew L. Myers and his campaign would do better to consider the important issues in nicotine regulation, not expend time, money and credibility on marginal issues with negligible public health value.
Conflict of Interest:
I am a long-standing advocate for tobacco harm reduction and run the Counterfactual blog. I have no competing interests with respect to any relevant industry.
In a smaller sample of older teenagers, I recently extended and
replicated some of Vasiljevic and colleagues' findings [1]. In line with
their results, I found that e-cigarette advertisements did not increase
interest in tobacco smoking, interest in using e-cigarettes or
susceptibility to either behaviour.
In this experimental study, 65 UK non-smokers aged 16-19 years were
randomised to viewing either six e-ci...
In a smaller sample of older teenagers, I recently extended and
replicated some of Vasiljevic and colleagues' findings [1]. In line with
their results, I found that e-cigarette advertisements did not increase
interest in tobacco smoking, interest in using e-cigarettes or
susceptibility to either behaviour.
In this experimental study, 65 UK non-smokers aged 16-19 years were
randomised to viewing either six e-cigarette advertisements cleared for
television broadcast in the UK in 2014/15 or recent nicotine replacement
therapy (NRT) adverts. The e-cigarette adverts featured five different
brands and varied in content, setting, people portrayed, type of e-
cigarette and whether flavours were a focus. Participant completed a
baseline survey, watched the three-minute videos and completed a
distractor task and a post-exposure survey in their own time on individual
computers using headphones.
The main outcome measures were interest in using e-cigarettes and
interest in smoking tobacco cigarettes measured using visual analogue
scales from 0 'no interest at all' to 100 'most interest ever' completed
at baseline and post-exposure [2]. Additionally, at both time-points, four
items measured susceptibility to use e-cigarettes/smoke cigarettes by
asking participants if they would use an e-cigarette/smoke a cigarette if
offered one by a friend and if they thought they would use/smoke in the
next month [3]. Those ticking anything other than 'definitely not' on a 4-
point scale were considered susceptible to e-cigarette use or smoking,
respectively.
Ethical approval was granted from a Research Ethics Subcommittee at
King's College London (PNM 1415 61).
The majority of participants were female (63%), British (83%), and of
non-white ethnicities (65%). The NRT group was on average a few months
older than the e-cigarette group (p=0.02) and the e-cigarette group
indicated higher baseline interest in using e-cigarettes than the NRT
group (p=0.04). Mixed two-way analyses of variance therefore adjusted for
baseline differences between groups.
There was no significant group by time interaction for interest in
using e-cigarettes [F(1,62)=0.81, p=0.372, partial eta-squared=0.013] or
smoking tobacco cigarettes [F(1, 61)=0.30, p=0.86, partial eta-squared
<0.001], indicating that interest was not affected by exposure to the
adverts. Non-parametric tests showed no significant change in the
proportion susceptible to using e-cigarettes or smoking (all p>0.1),
any small changes were towards a reduction in susceptibility.
In conclusion, these results from an older age group of adolescents
and using a different control condition corroborate Vasiljevic and
colleagues' finding that there is no evidence of renormalisation of
smoking due to e-cigarette advertising.
References
1. Vasiljevic M, Petrescu DC, Marteau TM. Impact of advertisements
promoting candy-like flavoured e-cigarettes on appeal of tobacco smoking
among children: an experimental study. Tobacco control 2016 doi:
10.1136/tobaccocontrol-2015-052593.
2. King AC, Smith LJ, McNamara PJ, Matthews AK, Fridberg DJ. Passive
exposure to electronic cigarette (e-cigarette) use increases desire for
combustible and e-cigarettes in young adult smokers. Tobacco control
2015;24(5):501-4 doi: 10.1136/tobaccocontrol-2014-051563.
3. Bogdanovica I, Szatkowski L, McNeill A, Spanopoulos D, Britton J.
Exposure to point-of-sale displays and changes in susceptibility to
smoking: findings from a cohort study of school students. Addiction
(Abingdon, England) 2014 doi: 10.1111/add.12826.
It is enormously helpful when researchers consider new, not-yet-tried
tobacco control interventions (such as this study's consideration of
warning messages on cigarette sticks), especially when researchers figure
out effective ways to evaluate the not-yet-tried interventions.
Some additional possibilities related to new warnings or pack changes
that might be considered:
It is enormously helpful when researchers consider new, not-yet-tried
tobacco control interventions (such as this study's consideration of
warning messages on cigarette sticks), especially when researchers figure
out effective ways to evaluate the not-yet-tried interventions.
Some additional possibilities related to new warnings or pack changes
that might be considered:
(1) Put instructions for use in all cigarette packs that instruct
smokers (with explanations) about how they can minimize the harms and
risks to themselves and to others from their consumption of the
cigarettes, such as:
-- Do not smoke the cigarettes
-- Do not smoke near anyone else
-- Do not smoke in enclosed spaces
-- Do not smoke by inhaling
-- If inhaled, inhale as shallowly as possible
-- Do not smoke more than a few puffs of each cigarette (or do not
smoke more than halfway)
-- Do not smoke in bed or when tired
-- Make sure all smoked cigarettes are fully extinguished before
discarding
-- Discard of all cigarettes carefully (do not litter, do not discard
in waterways, do not leave where children or pets might consume).
(2) Make one cigarette in each pack a rolled-up scroll of information
or instructions for use for smokers (which would also reduce the number of
cigarettes that could be smoked in each pack, perhaps reducing
consumption).
(3) Audio warnings that play each time a pack is opened or a
cigarette is extracted (now possible with available technologies).
NOT PEER REVIEWED This article is manifestly wrong in material content.
Hong Kong has in fact, two current large domestic manufacturers of tobacco products, Hong Kong Tobacco Co Ltd and Nanyang Brothers Tobacco Co Ltd.
Moreover the HK Customs Dept are all over the local dial-up-delivery smuggling syndicates to the extent that the tobacco funded front groups ITIC and Oxford Economics had to produce wildly false and flawed
Inform...
NOT PEER REVIEWED This article is manifestly wrong in material content.
Hong Kong has in fact, two current large domestic manufacturers of tobacco products, Hong Kong Tobacco Co Ltd and Nanyang Brothers Tobacco Co Ltd.
Moreover the HK Customs Dept are all over the local dial-up-delivery smuggling syndicates to the extent that the tobacco funded front groups ITIC and Oxford Economics had to produce wildly false and flawed
Information on the supposed level of illicit product availability (suitably decimated by the following reports).
The HK Government gauges smoking prevalence from its Thematic Household survey reports; what is lacking in Hong Kong is the absence of questions in these Thematic Household Surveys seeking information
on how many interviewees had purchased and / or used illicit tobacco in the previous year, the price they paid for it and the frequency of such DNP usage and whether they were concerned that the ingredients / nicotine/tar levels would most likely be far more toxic than the excise DP cancer sticks. Only with the incorporation of this relevant data could the claimed 10.7% prevalence levels be accurately gauged.
In Singapore which has a lower cost of living than Hong Kong, a DP packet of Marlboro retails at HK$ 76 whereas the same DP packet in Hong Kong costs only HK$ 50, meaning tobacco remains affordable and available to HKG youth and there is no tobacco retailer license system, no POS display legislation and no onus on liquor /mahjong / sauna licensees to enforce the anti smoking legislation in their premises. The Health Department Policy Bureau failed to seek an excise increase in the last Budget, according to the Financial Secretary in an RTHK radio interview in Feb 2015. The Tobacco Control Office has just over 100 'enforcement' officers to cover Hong Kong, Kowloon, the New Territories and the Islands area over two shifts meaning they have insufficient manpower to patrol.
http://seatca.org/dmdocuments/Asia%2014%20Critique_Final_20May2015.pdf
http://tobaccocontrol.bmj.com/content/early/2015/01/05/tobaccocontrol-2014-051937.full
http://www.legco.gov.hk/yr11-12/english/counmtg/hansard/cm0322-translate-e.pdf
page 7400
http://www.customs.gov.hk/en/publication_press/press/index_current.html
Shows the multiple seizures and arrests.
Hong Kong Tobacco Company Ltd
Address : 3/F Paramount Building, Hong Kong
Tel 25618111
Owner Charles HO Tsu Kwok
https://webb-site.com/dbpub/positions.asp?p=4462
http://www.bloomberg.com/research/stocks/people/person.asp?personId=8075652&ticker=1105:HK
https://webb-site.com/articles/bauhiniafound.asp
Nanyang Brothers Tobacco Co Ltd
http://www.nbt-hk.com/
Location: Tuen Mun Hong Kong
http://www.zigsam.at/B_Peel.htm
http://www.scmp.com/news/hong-kong/law-crime/article/1846318/tobacco-worker-43-dies-industrial-accident-hong-kong
Nan Yang also manufacture flavored tobaccos (PEEL)which are sold in the local market
http://english.caijing.com.cn/2004-03-20/110030213.html
Smuggling arrests
http://www.siic.com/en_service_4.html
Nanyang owners
Nanyang Brothers Tobacco Co., Ltd.
Nanyang Brothers Tobacco (short for "NBT")is the largest cigarette manufacturer in Hong Kong, of which main brand is "Double Happiness " and has a history of more than 100 years. At present, "Double Happiness" has been one of the most valuable trademarks in the tobacco industry. The production base of NBT is located in Tuen Mun, Hong Kong. NBT owns advanced manufacturing techniques, and its process of production is completely under computer control and management in order to guarantee the quality of products. The product of NBT is not only sold to China Mainland, Taiwan, Hong Kong and Macao, but also sold to Singapore, Thailand and Korea and so on. In 2011, its sales revenue and net profit reached 2,473 million HK dollars and 610 million HK dollars respectively.
Cigarettes manufactured by Nanyang Brothers Tobacco
Nanyang Brothers Tobacco Co. Ltd., located at Tuen Mun, New Territories, Hong Kong, China
Nanyang Brothers Tobacco Co. Ltd., located at 9 Tsing Yeung Circuit, Hong Kong, China
Founded in 1906. NANYANG means SOUTH PACIFIC.
Current PRODUCTS:
Alain Delon, Centori, Chunghwa, DJ Mix, Just Above, Peel, Polar Bear, Shuang Xi, Texas 5, (The Globe), Wealth
NOT PEER REVIEWED
The recent endgame review by McDaniel et al1 demonstrates a major
flaw in thinking within the tobacco control community. The industry is
seen as dominated by the "big tobacco" cigarette companies. The real life
industry is intensely competitive and highly fragmented. There are, within
the industry, many who could effectively partner with the public health
community, if given the opportunity to do so. Bec...
NOT PEER REVIEWED
The recent endgame review by McDaniel et al1 demonstrates a major
flaw in thinking within the tobacco control community. The industry is
seen as dominated by the "big tobacco" cigarette companies. The real life
industry is intensely competitive and highly fragmented. There are, within
the industry, many who could effectively partner with the public health
community, if given the opportunity to do so. Because of this flaw in
thinking, the tobacco control community has been unwilling to consider any
role for tobacco harm reduction or electronic cigarettes in any public
health initiative. E-cigarettes have the potential to substantially reduce
smoking-related illness and death and do so without recruiting significant
numbers teens or other non-smokers to nicotine use. .2-5
The McDaniel paper1 lists sixteen end-game proposals, fourteen of
which consist of partial or total bans on aspects of the manufacture or
sale of non-pharmaceutical nicotine delivery products. Only two, one
referencing e-cigarettes and another "advantage cleaner nicotine products
over combustibles" make any reference to tobacco industry participation in
pursuit of tobacco control objectives. Both are discouraged as unproven
and impractical despite substantial scientific evidence to the contrary.
The time has come for the public health community to engage in
dialogue with those stakeholders in tobacco-related industries who are
ready, willing and able to partner with public health in pursuit of shared
public health objectives. The purpose of this dialogue would be to help
secure reductions in tobacco-related illness and death not likely
achievable by other means.
Experience to date with e-cigarettes gives us grounds for optimism
that this could easily be done without recruitment of teens and other non-
users to nicotine use. .2-4
A world in which tobacco-related addiction, illness and death have
been reduced to trivial public health problems could be achieved within our
lifetimes. Achieving this goal will require re-orienting tobacco control
from a crusade against all things "tobacco," to a public health initiative
considering all options for the prevention of addiction, illness and
death. This is a goal not likely achievable by any other means. A
seemingly small change in the wording of our tobacco control goal from "a
tobacco-free society" to "a smoke-free society" would get us most of the
way there.
References
1. McDaniel PA, Smith EA, Malone RE. The tobacco endgame: A
qualitative review and synthesis. Tob Control 2015 28 August; Special
Communication Published On Line:1-11.
2. Nitzkin JL. The case in favor of e-cigarettes for tobacco harm
reduction. International Journal of Environmental Research and Public
Health 2014;11:6459-71.
3. Nitzkin JL. E-cigarettes: A life-saving technology or a way for tobacco
companies to re-normalize smoking in American society? FDLI's Food and
Drug Policy Forum 2014 30 June;4(6):1-17.
4. McNeill A, Brose L, Calder R, Hitchman S. E-cigarettes: An evidence
update. A report commissioned by Public Health England
[https://www.gov.uk/government/publications/e-cigarettes-an-evidence-
update]. A an Evidence Update Plus Policy Implications. London, England,
August, 2015. 19 August 2015.
5. Farsalinos K, Polosa R. Safety evaluation and risk assessment of
electronic cigarettes as tobacco cigarette substitutes: A systematic
review. Therapeutic Advances in Drug Safety 2014;5(20):67-86
Conflict of Interest:
I currently serve as Senior Fellow for Tobacco Policy for the R Street Insitute
NOT PEER REVIEWED In June 2015 we published our paper "The smoking population in the USA and EU is softening not hardening" in the journal Tobacco Control. We showed that as smoking prevalence has declined over time, quit attempts increased in the USA and remained stable in Europe, US quit ratios increased (no data for EU), and consumption dropped in the USA and Europe. These results contradict the hardening hypothesis whi...
NOT PEER REVIEWED I am writing in response to sight of an article published by you about my work for the International Tax and Investment Center (ITIC). The ITIC guidebook published in 2011 "The Illicit Trade in Tobacco Products and How to Tackle it" makes it clear in the Executive Summary that it is "a compilation of facts and views from a wide range of sources including respected academics, private sector consultants,...
NOT PEER REVIEWED Thanks for Mr. Middleton's information that there are local tobacco manufacturers in Hong Kong. I made a mistake when reading the materials. I have amended this in the updated version.
It does not affect the analysis as the government taxes based on number of cigarettes sold rather than manufactured, but I sincerely appreciate your valuable advice.
For the analysis part, it is not easy...
NOT PEER REVIEWED Pressure the CDC and FDA to pressure state legislatures to outlaw the sale of filtered cigarettes. As I see it, this is the only viable solution for ending this litter problem. Cigarette smoking should be made as unappealing as possible to all concerned.
Conflict of Interest:
None declared
NOT PEER REVIEWED The author appears to believe that the main problem with the FDA is that it is not doing enough to prevent new niche cigarette products reaching the market. This focus of concern is misplaced, given several thousand cigarette products are readily available and smokers are spoilt for choice with or without these new products. I have no great desire to see new cigarette products coming on the market, but is this...
In a smaller sample of older teenagers, I recently extended and replicated some of Vasiljevic and colleagues' findings [1]. In line with their results, I found that e-cigarette advertisements did not increase interest in tobacco smoking, interest in using e-cigarettes or susceptibility to either behaviour.
In this experimental study, 65 UK non-smokers aged 16-19 years were randomised to viewing either six e-ci...
It is enormously helpful when researchers consider new, not-yet-tried tobacco control interventions (such as this study's consideration of warning messages on cigarette sticks), especially when researchers figure out effective ways to evaluate the not-yet-tried interventions.
Some additional possibilities related to new warnings or pack changes that might be considered:
(1) Put instructions for use in...
NOT PEER REVIEWED The recent endgame review by McDaniel et al1 demonstrates a major flaw in thinking within the tobacco control community. The industry is seen as dominated by the "big tobacco" cigarette companies. The real life industry is intensely competitive and highly fragmented. There are, within the industry, many who could effectively partner with the public health community, if given the opportunity to do so. Bec...
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