The Framework Convention on Tobacco Control in Slovakia and in Finland: one law, two different practices?

BACKGROUND: The Framework Convention on Tobacco Control (FCTC) was ratified in 2004 in Slovakia and in 2005 in Finland. The aim of this study was to compare the implementation of the FCTC in the national laws and policies regarding smoking in Finland and Slovakia. METHODS: In this case study the following areas are compared: the legal framework; the monitoring system and health promotion; treatment; and policies aimed at reducing tobacco consumption. We report on these in this order after a short historical introduction. RESULTS: The legal frameworks are similar in Slovakia and in Finland. Finland far exceeds the minimum legal requirements. Slovakian regulations reflect the FCTC requirements; however, social tolerance is very high. In Finland the monitoring system and health promotion are aimed more at tobacco consumption. Slovakia does not follow the surveillance plans recommended by WHO so strictly; often there are no current data available. No additional documents regarding the FCTC have been adopted in Slovakia. The financial contribution to treatment is very low. Slovakian tobacco control policy is more focused on repression than on prevention, in contrast to Finland. Smoking bans meet European standards. Excise duties rise regularly in both countries. CONCLUSION: Implementation of the FCTC is at different levels in the compared countries. Finland has a clear plan for achieving the goal of a smoking-free country. Slovakia meets only the minimum standard required for fulfillment of its international obligations. Its policy should become more transparent by making more up-to-date data available.

Tobacco industry and public health responses to state and local efforts to end tobacco sales from 1969-2020.

BACKGROUND: In June 2019, Beverly Hills, California, became the first American city in the 21st century to pass an ordinance ending the sale of most tobacco products, including cigarettes, and it is unlikely to be the last. Knowledge of previous efforts to ban tobacco sales in the US, both successful and unsuccessful, may help inform tobacco control advocates' approach to future efforts. METHODS: We retrieved and analyzed archival tobacco industry documents. We confirmed and supplemented information from the documents with news media coverage and publicly available state and local government materials, such as meeting minutes and staff reports, related to proposed bans. RESULTS: We found 22 proposals to end the sale of cigarettes or tobacco products from 1969-2020 in the US. Proposals came from five states, twelve cities or towns, and one county. Most came from elected officials or boards of health, and were justified on public health grounds. In opposing tobacco sales bans, the tobacco industry employed no tactics or arguments that it did not also employ in campaigns against other tobacco control measures. Public health groups typically opposed sales ban proposals on the grounds that they were not evidence-based. This changed with Beverly Hills' 2019 proposal, with public health organizations supporting this and other California city proposals because of their likely positive health impacts. This support did not always translate into passage of local ordinances, as some city council members expressed reservations about the impact on small businesses. CONCLUSION: Tobacco control advocates are likely to encounter familiar tobacco industry tactics and arguments against tobacco sales ban proposals, and can rely on past experience and the results of a growing body of retail-related research to counter them. Considering how to overcome concerns about harming retailers will likely be vital if other jurisdictions are to succeed in ending tobacco sales.

The 20-year impact of tobacco price and tobacco control expenditure increases in Minnesota, 1998-2017.

INTRODUCTION: Tobacco control programs and policies reduce tobacco use and prevent health and economic harms. The majority of tobacco control programs and policies in the United States are implemented at local and state levels. Yet the literature on state-level initiatives reports a limited set of outcomes. To facilitate decision-making that is increasingly focused on costs, we provide estimates of a broader set of measures of the impact of tobacco control policy, including smoking prevalence, disease events, deaths, medical costs, productivity and tobacco tax revenues, using the experience of Minnesota as an example. METHODS: Using the HealthPartners Institute's ModelHealth™: Tobacco MN microsimulation, we assessed the impact of the stream of tobacco control expenditures and cigarette price increases from 1998 to 2017. We simulated 1.3 million individuals representative of the Minnesota population. RESULTS: The simulation estimated that increased expenditures on tobacco control above 1997 levels prevented 38,400 cancer, cardiovascular, diabetes and respiratory disease events and 4,100 deaths over 20 years. Increased prices prevented 14,600 additional events and 1,700 additional deaths. Both the net increase in tax revenues and the reduction in medical costs were greater than the additional investments in tobacco control. CONCLUSION: Combined, the policies address both short-term and long-term goals to reduce the harms of tobacco by helping adults who wish to quit smoking and deterring youth from starting to smoke. States can pay for initial investments in tobacco control through tax increases and recoup those investments through reduced expenditures on medical care.

Ten Years of FDA Tobacco Regulation: Lessons for Public Health Stakeholders.

In the 10 years that the U.S. Food and Drug Administration (FDA) has been regulating tobacco products, the agency has been plagued with setbacks, some of its own making, and some the result of outside forces. What has been consistently true is that the public health community has not had as much of a voice as it should have until public health groups began filing lawsuits against the FDA. This article examines four areas of FDA regulation over the last decade in an attempt to qualitatively describe the work of the Center for Tobacco Products and identify opportunities for public health groups to have greater advocacy success in the future.

History and Current Trends in the Electronic Cigarette Retail Marketplace in the United States: 2010-2016.

INTRODUCTION: The US market for electronic nicotine delivery systems (ENDS) has grown rapidly in the last decade. There is limited published evidence examining changes in the ENDS marketplace prior to the US Food and Drug Administration's (FDA) deeming rule in 2016. This study describes US ENDS retail market trends from 2010 to 2016. METHODS: National data were obtained from Nielsen retail scanners for five product types: (1) disposables, (2) rechargeables, (3) cartridge replacements, (4) e-liquid bottle refills, and (5) specialty vapor products. We examined dollar sales, volume, price, brand, and flavor. RESULTS: Adjusted national sales increased from $11.6 million in 2010 to $751.2 million in 2016. The annual rate of sales growth rapidly increased before slowing through 2015. The rate of growth spiked in 2016. Market share for menthol products and other assorted flavors increased from 20% in 2010 to 52.1% by 2016. NJOY's early market dominance shifted as tobacco industry brands entered the market and eventually captured 87.8% of share by 2016. Rechargeables and accompanying products comprised an increased proportion of total volume sold over time while disposable volume declined. Specialty vapor products appeared at retail in 2015. CONCLUSIONS: Findings show strong early growth in the ENDS retail market followed by considerable slowing over time, despite a slight uptick in 2016. Trends reflect shifts to flavored products, newer generation "open-system" devices, lower prices, and tobacco industry brands. This study provides a baseline against which to compare the impact of FDA's 2016 deeming rule and future actions on the ENDS marketplace. IMPLICATIONS: This study uses market scanner data from US retail outlets to describe trends in the ENDS retail market from 2010 to 2016, providing a baseline against which to compare the impact of FDA's 2016 deeming rule and future actions on the ENDS marketplace. Understanding historical market trends is valuable in assessing how future regulatory efforts and advances in ENDS technology may impact industry response and consumer uptake and use.

Twenty-year health and economic impact of reducing cigarette use: Minnesota 1998-2017.

BACKGROUND: Adult smoking prevalence in Minnesota fell from 21.8% in 1997 to 15.2% in 2016. This reduction improved heart and lung health, prevented cancers, extended life and reduced healthcare costs, but quantifying these benefits is difficult. METHODS: 1.3 million individuals were simulated in a tobacco policy model to estimate the gains to Minnesotans from 1998 to 2017 in health, medical spending reductions and productivity gains due to reduced cigarette smoking. A constant prevalence scenario was created to simulate the tobacco harms that would have occurred had smoking prevalence stayed at 1997 levels. Those harms were compared with tobacco harms from a scenario of actual smoking prevalence in Minnesota from 1998 to 2017. RESULTS: The simulation model predicts that reducing cigarette smoking from 1998 to 2017 has prevented 4560 cancers, 31 691 hospitalisations for cardiovascular disease and diabetes, 12 881 respiratory disease hospitalisations and 4118 smoking-attributable deaths. Minnesotans spent an estimated $2.7 billion less in medical care and gained $2.4 billion in paid and unpaid productivity, inflation adjusted to 2017 US$. In sensitivity analysis, medical care savings ranged from $1.7 to $3.6 billion. CONCLUSIONS: Minnesota's investment in comprehensive tobacco control measures has driven down smoking rates, saved billions in medical care and productivity costs and prevented tobacco related diseases of its residents. The simulation method employed in this study can be adapted to other geographies and time periods to bring to light the invisible gains of tobacco control.

Tobacco control in Nepal during a time of government turmoil (1960-2006).

BACKGROUND: Nepal was a monarchy, then a dictatorship, then a democracy. This paper reviews how tobacco control progressed in Nepal in the context of these changes in government from 1950 through 2006. METHODS: We triangulated tobacco industry documents, newspaper articles and key informant interviews. RESULTS: Until 1983, the tobacco industry was mostly state owned. Transnational tobacco companies entered the Nepalese market through ventures with Surya Tobacco Company Private Limited (with Imperial Tobacco Company and British American Tobacco) in 1983 and Seti Cigarette Factory Limited (with Philip Morris International [PMI]) in 1985. Seminars and conferences on tobacco, celebrations of World No Tobacco Day (WNTD) and efforts by WHO helped promote tobacco control in Nepal beginning in the 1970s. Tobacco advocates in Nepal pushed the government to issue executive orders banning smoking in public places in 1992 and tobacco advertising in electronic media in 1998, and to introduce a tobacco health tax in 1993. The tobacco industry lobbied against these measures and succeeded in keeping the tobacco tax low by challenging it in court. Tobacco advocates sued the government in 2003 and 2005, resulting in a June 2006 Supreme Court decision upholding the smoking and advertising bans and requiring the government to enact a comprehensive tobacco control law. CONCLUSIONS: Political instability, conflict, weak governance and the dictatorship significantly affect tobacco control activities in low-income and middle-income countries. Nepal shows that tobacco control advocates can take advantage of global events, such as WNTD, and use domestic litigation to maintain support from civil societies and to advocate for stronger tobacco control policies.

Imitating waterpipe: Another tobacco industry attempt to create a cigarette that seems safer.

INTRODUCTION: The use of waterpipe (also known as hookah) increased between 2011 and 2016 in the US and globally, especially among youth and young adults. The aim of this study is to examine the tobacco industry's interest, involvement and role in proliferating waterpipe-like products and its technology. METHODS: We searched the University of California San Francisco Truth Tobacco Industry Documents beginning with the search terms "hookah', 'waterpipe', 'narghile', 'shisha', 'hooka', 'e-hookah', 'electronic hookah', 'water filtration', and 'hubble-bubble' and then expanded the search using snowball sampling. Over 1500 documents were reviewed, and 39 were included in this analysis. RESULTS: This review focuses on several companies' addition of water to the filter of one cigarette holder and to two cigarettes in an attempt to make these products seem safer. In 1954, the Aquafilter Corporation created and patented a filtered cigarette holder named Aquafilter, which the documents reveal was closely monitored by multiple tobacco companies. In 1965, the American Tobacco Company developed the Waterford cigarette. In 1987, Japan Tobacco patented the Rivage cigarette. Waterford and Rivage were very similar products that contained crushable water capsules designed to "wet" the cigarettes' filter. CONCLUSION: Companies have been attempting to incorporate the water filtrating aspect of waterpipe into cigarette products. Ultimately, several tobacco companies adapted the technology from these devices to create cigarettes with crushable flavor capsules. Given the tobacco industry's history of resurrecting products, the industry may attempt to incorporate water filtration and other aspects of waterpipe into future products to attempt to make them appear safer.

Origins of tobacco harm reduction in the UK: the 'Product Modification Programme' (1972-1991).

OBJECTIVE: To better understand the current embrace of long-term nicotine maintenance by British governmental agencies and tobacco harm reduction by several leading British public health organisations, describe the context and deliberations of the UK's first formal tobacco risk reduction programme: 'Product Modification'. METHODS: Analysis of previously secret tobacco industry documents, news archives and Parliamentary debate records. RESULTS: From 1972 to 1991, the British government sought to investigate safer smoking through the 'product modification programme'. The Independent Scientific Committee on Smoking and Health (ISCSH) advised the British government on these efforts and collaborated with the tobacco industry, with which government then negotiated to determine policy. The ISCSH operated from four industry-backed premises, which contributed to the ISCSH's support of safer smoking: (1) reduced toxicity indicates reduced risk; (2) collaboration with the tobacco industry will not undermine tobacco control; (3) nicotine addiction is unavoidable; (4) to curtail cigarette use, solutions must be consumer-approved (ie, profitable). These premises often undermined tobacco control efforts and placed the ISCSH at odds with broader currents in public health. The product modification programme was abandoned in 1991 as the European Community began requiring members to adopt upper tar limits, rendering the ISCSH redundant. POLICY IMPLICATIONS: Endorsements of reduced harm tobacco products share the same four premises that supported the product modification programme. Current tobacco harm reduction premises and policies supported by the British government and leading British public health organisations may reflect the historical influence of the tobacco industry.

Philip Morris research on precursors to the modern e-cigarette since 1990.

BACKGROUND: Use of electronic cigarettes (e-cigarettes) is increasing rapidly. Chinese pharmacist Hon Lik is frequently cited as inventing the modern e-cigarette in 2003. However, tobacco companies have developed electronic nicotine delivery systems since at least 1963. METHODS: We searched the University of California San Francisco Truth (formerly Legacy) Tobacco Industry Documents beginning with the terms 'electric cigarette' and 'electronic cigarettes', 'e-cigarette', 'smokeless cigarettes', 'nicotine aerosol', 'tobacco aerosol', and 'vaping' and then expanded the search using snowball sampling. We focused our analysis on Philip Morris (PM) documents discussing technology that aerosolised a nicotine solution because these devices resembled modern e-cigarettes. Over 1000 documents were reviewed; 40 were included in the final analysis. RESULTS: PM started developing a nicotine aerosol device in 1990 to address the health concerns and decreased social acceptability of smoking that were leading smokers to switch to nicotine replacement therapy. PM had developed a capillary aerosol generator that embodied basic e-cigarette technology in 1994, but in the mid-to-late 1990s focused on applying its aerosol technology to pharmaceutical applications because of uncertainty of how such products might affect potential Food and Drug Administration regulation of tobacco products. In 2001, PM resumed its work on a nicotine aerosol device, and in 2013, NuMark (a division of Altria, PM's parent company) released the MarkTen, a nicotine aerosol device. CONCLUSIONS: Rather than a disruptive technology, PM developed e-cigarette technology to complement, not compete with, conventional cigarettes and evade tobacco control regulations.

El tabaco a la luz de la historia y la medicina / The tobacco in the light of history and medicine

Resumen: Se relata la admirable trayectoria del tabaco desde su primer encuentro con el hombre europeo el 15 de octubre de 1492 hasta la época nuestra. Dicha planta se conoció en Europa gracias a publicaciones del médico sevillano Nicolás Monardes (1574), a las relaciones de fray Andrés Thevet (1575) y al célebre tratado botánico de Charles de l' Écluse (1605). El botánico sueco Karl von Linneo incluyó la planta del tabaco en la familia de las solanáceas y se eliminaron de este grupo otras plantas que quedaban entremezcladas con esta. Su nombre botánico (Nicotiana tabacum) deriva del apellido del embajador francés en Portugal, Jean Nicot de Villemain, quien en 1560 la hizo llegar a la reina madre de Francia Catalina de Médicis. El uso del tabaco se difundió rápidamente por toda Europa, en donde se volvió común en el siglo XVII. Hacia fines del siglo XVIII en la Nueva España, además de los puros, ya se confeccionaban los cigarrillos que se vendían en cajetillas de diferente contenido y precio. La confección de las variadas formas de presentación del tabaco, realizadas en las fábricas tabacaleras de la capital novohispana y de varias ciudades de provincia, originó en 1796 la creación de las primeras guarderías infantiles para los hijos de quienes trabajaban en ellas. Esto gracias a la feliz iniciativa del entonces virrey Marqués de Branciforte. Pero contrariamente a las previsiones del padre Clavijero S.J. y de la señora Calderón de la Barca, esposa del primer representante diplomático español ante el gobierno de la República Mexicana, el uso del tabaco, con el pasar del tiempo, lejos de menguar ha ido aumentando en todas las clase sociales. Y ahora, más que los hombres, fuman las mujeres.

Abstract: Super trajectory is reported of tobacco from his first meeting with the European man October 15, 1492. This plant was known in Europe by the publications of the Sevillan physician Nicolas Monardes (1574), the relations of friar Andrés Thevet (1575) and the famous botanical treatise of Charles de l'Écluse (1605). The Swedish botanist Karl Linnaeus inclused tobacco plant in the family Solanaceae and deleted from this group other plants that were intermixed with it. Its botanical name (Nicotiana tabacum) derived from the surname of the French ambassador to Portugal, Jean Nicot of Villemain, who in 1560 sent it to the Queen Mother of France Cathérine de Medicis. The use of snuff quickly spread throughout Europe, were it became common in the seventeenth century. By the late eighteenth century in New Spain, in addition to cigars, cigarettes and due in packs of different content the tobacco is concocted and price. The preparation of the different presentations of snuff, tobacco made in factories in the capital and several provincial cities, originated in 1796 the creation of the first kindergartens for the children of those working in them. This thanks to the successful initiative of then viceroy Marquis of Branciforte. But contrary to the forecasts of Father F. J. Clavijero and Mrs. F. Calderón de la Barca, wife of the first Spanish diplomatic representative to the government of Mexico, the use of tobacco, with the passage of time, far from waning has been increasing in every social class. And now, more than men, women are smokers.

La ciencia del tabaco en Puerto Rico, 199-1940 / The science of tobaco in Porto Rico, 1900-1940

El tabaco se convirtió en un importante producto de exportación para Puerto Rico después de la ocupación norteamericana de 1898, debido a las inversiones en su estudio científico: el cultivo eficiente, la estructura económica y el mercadeo. La experimentación científica y la aplicación práctica de los descubrimientos en las fincas tabacaleras ofrecieron un campo de saber para establecer relaciones cooperativas significativas entre los cultivadores, los científicos en Puerto Rico y EEUU, y el gobierno insular y federal. El compromiso de los puertorriqueños en la ciencia del tabaco, incluyendo su apoyo por la investigación, las demandas continuas para fondos y una legislación agrícola beneficiosa, así como la adopción de la tecnología agrícola moderna, demuestra que éstos no eran pasivos frente a los rápidos cambios económicos de entonces. Por el contrario, ellos eran activistas políticos, usando las garantías democráticas disponibles dentro de la estructura colonial de los EEUU para mejorar su situación económica (AU)

Tobacco became an important export product in Puerto Rico after the American occupation of 1898, in large part, because of investments in the scientific study of tobacco: its efficient cultivation, its economic structure and its marketing. Scientific experimentation and the practical application of research findings in tobacco farms provided an arena for significant collaborative relationships between tobacco growers, scientists in Puerto Rico and the U.S., and the insular and federal governments. The involvement of Puerto Ricans in the science of tobacco, including their support of scientific inquiry, their continued demands for funding and beneficial agricultural legislation, and their adoption of modern agricultural technology, demonstrate that rather than being observers of rapid economic changes, they were activists, using the democratic guarantees available under the U.S. colonial structure to improve their economic situation (AU)

[The tobacco in the light of history and medicine]. / El tabaco a la luz de la historia y la medicina.

Super trajectory is reported of tobacco from his first meeting with the European man October 15, 1492. This plant was known in Europe by the publications of the Sevillan physician Nicolas Monardes (1574), the relations of friar Andrés Thevet (1575) and the famous botanical treatise of Charles de l'Écluse (1605). The Swedish botanist Karl Linnaeus inclused tobacco plant in the family Solanaceae and deleted from this group other plants that were intermixed with it. Its botanical name (Nicotiana tabacum) derived from the surname of the French ambassador to Portugal, Jean Nicot of Villemain, who in 1560 sent it to the Queen Mother of France Cathérine de Medicis. The use of snuff quickly spread throughout Europe, were it became common in the seventeenth century. By the late eighteenth century in New Spain, in addition to cigars, cigarettes and due in packs of different content the tobacco is concocted and price. The preparation of the different presentations of snuff, tobacco made in factories in the capital and several provincial cities, originated in 1796 the creation of the first kindergartens for the children of those working in them. This thanks to the successful initiative of then viceroy Marquis of Branciforte. But contrary to the forecasts of Father F. J. Clavijero and Mrs. F. Calderón de la Barca, wife of the first Spanish diplomatic representative to the government of Mexico, the use of tobacco, with the passage of time, far from waning has been increasing in every social class. And now, more than men, women are smokers.