New tobacco and nicotine products in Latin America and the Caribbean: assessing the market and regulatory environment.

OBJECTIVE: To document the regulatory environment of new tobacco and nicotine products (NTNPs), including electronic nicotine delivery systems (ENDS) and heated tobacco products (HTPs), in Latin America and the Caribbean (LAC). METHODS: Review of market research reports and databases, regulatory websites, Campaign for Tobacco-Free Kids, relevant published literature and the 2021 WHO Report on the Global Tobacco Epidemic. RESULTS: ENDS entered the LAC market in the 2010s and are now available in most LAC countries. A majority of LAC countries (n=18) have either banned the commercialisation of ENDS (n=7) or regulated ENDS as tobacco products (n=7), medicinal products (n=1) or consumer products (n=3). The remaining LAC countries (n=15) do not regulate ENDS. HTPs were first introduced in 2017 and have been officially launched in five countries (Colombia, Guatemala, Dominican Republic, Mexico and Costa Rica). Few countries have banned HTP commercialisation (n=3) or regulated commercialisation and use (n=7), while the majority of countries have existing legislation that applies to HTPs (n=19). A few countries (n=4) have no tobacco control legislation and therefore do not regulate HTPs. CONCLUSION: NTNPs are emerging products in the LAC region. Governments should follow WHO guidance and the decisions of the Conference of Parties to the WHO Framework Convention on Tobacco Control and ban or regulate NTNPs as tobacco products; otherwise NTNPs could create a new generation of tobacco and nicotine users.

Monitoring compliance with Kenya's shisha ban in select public hospitality venues in Nairobi.

INTRODUCTION: Seven countries in the WHO African Region have banned the sale and/or use of shisha. In 2017, Kenya implemented a comprehensive ban on shisha, including the use, import, manufacture, sale, offer of sale, advertising, promotion, distribution and encouraging or facilitating its use. The objective of this study was to assess compliance with the ban of shisha use in select public hospitality venues in Nairobi, Kenya. METHODS: Observational study that used a purposive sampling to select restaurants, bars and nightclubs where shisha use took place before the ban. A total of 200 venues were visited in seven areas of Nairobi City County, Kenya. Shisha use was defined as at least one person smoking shisha in any indoor or outdoor area of the venue accessible to the public, and indicators of shisha use as the display of any shisha equipment. RESULTS: Overall, 81.5% of the venues visited were in compliance. Shisha smoking was observed in 16.5% of all venues and shisha equipment alone was observed in 2.0%. Among the different venue types, 94.6% of restaurants were compliant, 79.7% of bars and 75.6% of nightclubs. DISCUSSION: The overall high compliance indicates that Kenya's shisha ban is well implemented in Nairobi, and may be explained by the comprehensive nature of the shisha ban and the low prevalence in the general population. The variation in compliance may be due to the higher rates of use in university students and the additional resources required to enforce the ban in areas with high rates of crime.

Monitoring compliance with Senegal's tobacco products packaging and labelling requirements 6 months after implementation of the law.

INTRODUCTION: As of December 2021, 22 countries and one jurisdiction in WHO African Region (AFRO) have adopted pictorial health warning labels on tobacco packaging, but only 13 have implemented them. In 2014, Senegal enacted a comprehensive tobacco control law, which requires strong provisions on tobacco packaging and labelling. The objective of this study was to assess the level of compliance with these provisions in Senegal 6 months after implementation. METHODS: Data collection took place in Senegal's capital city of Dakar across 12 districts in February 2018, following the Tobacco Pack Surveillance System Field Protocol developed by the Institute for Global Tobacco Control at Johns Hopkins Bloomberg School of Public Health. Unique tobacco packs were purchased from a total of 48 tobacco vendors, and compliance with new packaging and labelling provisions was assessed. RESULTS: In total, seven unique cigarette packs were confirmed to be legally available for sale in Dakar, Senegal. All packs complied with all health warning provisions (type, size, location, language and quitline information) as well as bans on quantitative emissions yields. However, no pack complied with the descriptive constituents and emissions statement required on the lateral side, and four of the seven packs violated the ban on misleading brand descriptors. CONCLUSIONS: AFRO countries have made substantial progress in adopting comprehensive tobacco control laws that bring them closer into alignment with the Framework Convention on Tobacco Control. This study found areas of effective implementation of FCTC recommended packaging and labelling requirements, as well as areas in need of stronger enforcement.

Assumption of Risk and the Role of Health Warnings Labels in the United States.

INTRODUCTION: This article provides historical context for understanding how the cigarette industry have manipulated language used in health warning labels (HWLs) to protect them in litigation. METHODS: Review of previously secret internal business records from 1964 discussing the role HWLs on cigarettes. Review of the legal challenges made by cigarette manufacturers surrounding HWLs as mandated in the 2009 Family Smoking Prevention and Tobacco Control Act and the language in corrective statements ordered by US Department of Justice. RESULTS: Within days after the Surgeon General's Advisory Committee issued its 1964 Report the cigarette companies plotted how they could use HWLs on cigarettes as a defense in future litigation. Industry lawyers discussed drafting legislation that would preempt other government agencies from requiring HWLs on cigarette containers and in cigarette advertising with language mirroring the key findings of the Surgeon General's Advisory Committee report. In July 1965, Congress did pass legislation which mandated a single watered-down cigarette pack HWL which excluded cigarette advertising, just as industry lawyers had recommended. Subsequent HWL laws passed by Congress in 1969 and 1984 along with the more recent history of manufacturers opposing updated graphic HWLs and corrective statements reflects a consistent and continuing effort by cigarette companies to insulate themselves from taking responsibility for harms caused by smoking. CONCLUSION: Beginning in the mid-1960s and continuing even through today, lawyers working on behalf of cigarettes companies have worked to manipulate the language of consumer warnings to focus responsibility for the harms caused by smoking on smokers. IMPLICATIONS: In tobacco litigation, juries should be informed about the industry's coordinated effort to draft legislation and water down the original caution statements proposed on cigarette containers and in advertising even though Congress ultimately is responsible for the law that was enacted. In addition, even though the 1992 Supreme Court decision in the Cipollone case preempted post-1969 failure to warm claims against cigarette makers, this protection does not apply on pre-1969 warning claims where the evidence shows that cigarette companies understood they were selling a defective product that when used as intended would harm their customers. Thus, those initiating smoking before 1969 and subsequently harmed by cigarettes can hold cigarette makers responsible for their failure to warn them about health risks.

Hospital admissions for acute myocardial infarction before and after implementation of a comprehensive smoke-free policy in Uruguay: experience through 2010.

BACKGROUND: Comprehensive smoke-free laws have been followed by drops in hospitalisations for acute myocardial infarction (AMI), including in a study with 2 years follow-up for such a law in Uruguay. METHODS: Multiple linear and negative binomial regressions for AMI admissions (ICD-10 code 121) from 37 hospitals for 2 years before and 4 years after Uruguay implemented a 100% nationwide smoke-free law. RESULTS: Based on 11 135 cases, there was a significant drop of -30.9 AMI admissions/month (95% CI -49.8 to -11.8, p=0.002) following implementation of the smoke-free law. The effect of the law did not increase or decrease over time following implementation (p=0.234). This drop represented a 17% drop in AMI admissions following the law (IRR=0.829, 95% CI 0.743 to 0.925, p=0.001). CONCLUSIONS: Adding two more years of follow-up data confirmed that Uruguay's smoke-free law was followed by a substantial and sustained reduction in AMI hospitalisations.

Hospital admissions for acute myocardial infarction before and after implementation of a comprehensive smoke-free policy in Uruguay.

BACKGROUND: Stimulated by the WHO Framework Convention on Tobacco Control, many countries in Latin America adopted comprehensive smoke-free policies. In March 2006, Uruguay became the first Latin American country to adopt 100% smoke-free national legislation, which ended smoking in all indoor public places and workplaces, including restaurants and bars. The objective of this study was to evaluate trends in hospital admissions for cardiovascular disease 2 years before and 2 years after the policy was implemented in Uruguay. METHODS: Reports of hospital admissions for acute myocardial infarction (AMI) (International Classification of Disease-10 I21) from 37 hospitals (79% of all hospital admissions in the country), representing the period 2 years before and 2 years after the adoption of a nationwide smoke-free policy in Uruguay (between 1 March 2004 and 29 February 2008), were reviewed. A time series analysis was undertaken to compare the average monthly number of events of hospital admission for AMI before and after the smoke-free law. RESULTS: A total of 7949 hospital admissions for AMI were identified during the 4-year study period. Two years after the smoke-free policy was enacted, hospital admissions for AMI fell by 22%. The same pattern and roughly the same magnitude of reduction in AMI admissions were observed for patients seen in public and private hospitals, men, women and people aged 40-65 years and older than 65 years. CONCLUSIONS: The national smoke-free policy implemented in Uruguay in 2006 was associated with a significant reduction in hospital admissions for AMI.