Study: Cancers rising around the world
Researchers at the International Agency for Research on Cancer (IARC) have predicted that there will be 18.1 million new cases of cancer and 9.6 million deaths from the disease this year worldwide, up from 14.1 million cases and 8.2 million deaths in 2012.
Lung cancer is now the leading cause of cancer death for women in 28 countries, with the USA, Hungary, China and New Zealand being the worst affected.
George Butterworth, Senior Policy Manager at Cancer Research UK, said: “Tobacco is the single biggest reason why more women across the world are getting lung cancer than ever before. In the UK smoking among women became more prolific later than it did for men, so it’s not surprising that we’re seeing increasing lung cancer rates now. Similarly, cigarettes are now increasingly popular among women in low and middle income countries and the tobacco industry’s aggressive marketing to them is influencing this.”
Source: BBC News, 12 September 2018
See also: IARC Press Release
Public Health England urged to end tie-up with alcohol industry
Over 40 public health experts have written to Public Health England (PHE) to oppose its affiliation with alcohol industry funded charity, Drinkaware.
The letter argues that working with the industry will “significantly damage” PHE’s credibility.
Martin McKee, professor of European public health at the London School of Hygiene and Tropical Medicine and one of the 46 signatories to the letter, said: “The tie-up with Public Health England does give the alcohol industry a lot of credibility. It says we are part of the solution when clearly they are not… [PHE] are creating a climate where other people feel encouraged to do this. Look at the potential tie up between British American Tobacco and Public Health in Birmingham recently, which again produced incredulity. This takes us into an area which we refer to as corporate or commercial determinants of health – the role of large corporations in shaping the agenda and in influencing policy.”
Source: The Guardian, 13 September 2018
US threatens to ban flavoured e-cigarettes
The Food and Drug Administration (FDA) has warned the country’s five largest e-cigarette makers — Juul, Blu, MarkTen, Vuse and Logic — that their products could be banned unless the companies can prove within 60 days that they have effective plans to stop sales to children.
“The disturbing and accelerating trajectory of use we’re seeing in youth and the resulting path to addiction must end,” said Scott Gottlieb, head of the FDA. “It’s simply not tolerable.”
The five brands account for 97% of e-cigarette sales in the United States. The value of all sales reached $2.35 billion in 2016. The announcement marks a shift in the agency’s policy on e-cigarettes, which until recently were seen as a potential tool to wean adult smokers off cigarettes.
Source: The Times, 13 September 2018
Saudi Arabia tells WTO it plans to adopt plain tobacco packaging
Saudi Arabia has notified the World Trade Organization (WTO) that it plans to adopt plain packaging of tobacco products, a public health measure strongly opposed by major tobacco firms.
The move by Saudi Arabia follows a WTO ruling in June in favour of Australian packaging laws in what was seen as a test case for tobacco control. Cuba, Indonesia, Honduras and the Dominican Republic challenged the Australian law on the grounds that the ban on colourful logos and the implementation of standardised packets were a breach of intellectual property rules and unduly restricted trade.
The Australian government described the ruling as a “resounding victory” for the laws it introduced in 2010. The World Health Organization said it expected the WTO ruling to create a domino effect as more and more countries moved towards tough Australian-style tobacco laws.
Source: Reuters News, 12 September 2018
Smoking ban in prisons has led to tobacco becoming part of the prison ‘illicit economy’
Banning smoking in prisons has led to tobacco being smuggled in and becoming part of the illicit economy. In a letter to Bob Neill MP, chair of the Justice Select Committee, Rory Stewart MP, Prisons Minister, wrote: “With regards to the impact on the illicit economy; tobacco has become an additional currency to the current currencies relating to drug use and mobile phones within the illicit economy.”
The smoking ban was fully implemented in prisons this year after being introduced across the prison estate over the previous two years.
Mr Stewart also noted that there appeared to have been a sharp rise in the use of new psychoactive substances, such as Spice, related to the smoking ban but that this did not occur in all prisons. The relationship should be considered a correlation rather than causation, he said. He added: “My initial conclusions are that some of the worst fears about the possible consequences of smoke-free prisons have not been realised.”
Source: The Times, 23 July 2018
Stop smoking: e-cigarette users are still paying higher insurance premiums
Despite being considered a safer alternative, e-cigarette users are paying the same life insurance premiums as smokers. Along with nicotine patches and other nicotine products, e-cigarettes are placed in the same band as regular cigarettes, meaning users still need to pay higher life insurance rates.
The average non-smoker pays an estimated £13.83 a month for life insurance, according to a new analysis, while a smoker could expect to pay almost double at £22.70 a month.
Kevin Pratt, consumer affairs expert at MoneySuperMarket which conducted the analysis, said: “Using nicotine in any form, including patches and gum, means you’ll be regarded as a smoker; you have to be nicotine free for 12 months to get the lower premiums.”
Source: Express, 22 July 2018
PMI’s iQOS device being blamed for poor stock-market performance
Philip Morris International (PMI) recently delivered a ‘disappointing’ earnings report which showed a significant slowdown in their heat-not-burn primary market: Japan. The shares of PMI are down 30% in the past year, a substantial reduction. The relatively poor performance of iQOS is largely what is behind PMI’s large stock market falls.
iQOS is PMI’s flagship heat-not-burn product and it was first introduced in selected Japanese sites in 2014 and rolled out across the country last year. Initially iQOS did well, with unit shipments soon surpassing those of traditional cigarettes. However, the Japanese market is an anomaly in that competition for iQOS is effectively banned. The e-liquids used in electronic cigarettes are regulated as a pharmaceutical ingredient, which effectively prevents sales of e-cigarettes. This has allowed the heat-not-burn iQOS device to be sold with little competition.
The popularity of iQOS in Japan has since waned; PMI said they have reached all the ‘early adopters’ of the new technology and now has to try and convince ‘more conservative’ smokers to switch to the product.
Source: Yahoo Finance, 22 July 2018
Honduras appeals WTO landmark ruling on Australia’s plain tobacco packaging
Honduras has appealed against a World Trade Organisation (WTO) ruling won last month by Australia on its plain packaging requirements for tobacco, a WTO spokesman said on Friday. In a landmark ruling officially passed on the 29th June 2018, the WTO panel said Australia’s law improved public health by reducing the use of tobacco products, rebuffing claims that alternative measures would be equally effective.
It also rejected the argument that Australia had unjustifiably infringed tobacco trademarks and violated intellectual property rights.
Source: Reuters, 20 July 2018
Link of the week
Efforts to cut number of smokers across North East by half are praised in parliament
Work across the North East to almost half the number of smokers has been recognised in Parliament. Public Health Minister Steve Brine and Shadow Public Health Minister Sharon Hodgson discussed the work of Fresh Smokefree North East during a debate to reflect on 70 years of the NHS.
Smoking has fallen in the North East from 29% in 2005 to 17.2% in 2016, with the region also having the highest quit success rates over the past decade and the largest fall in smoking during pregnancy, from 22.2% in 2009/10 down to 16% in 2016.
Source: Sunderland Echo, 18 May 2018
Most women find smokers unattractive and are slightly more likely to date an e-cigarette user, survey finds
Women are more likely to find smoking unattractive than men are, a new survey has found. Around 56 percent of women said they would not date someone who smokes with nearly 70 percent saying they find it unattractive. There was a lesser degree of unwillingness to date someone who vapes, often marketed as a less harmful alternative to traditional cigarettes.
Among the participants, 46 percent of women said they would not date a vaper with around 55 percent saying it was unattractive.
The survey, conducted by Inogen, a supplemental oxygen company, looked at 1,006 single people between the ages of 18 and 76.
Source: Mail on Sunday, 17 May 2018
Hull: Smoking puts 10 people in hospital every day
The latest figures from Public Health England have revealed that in the year 2016 to 2017, there were 3,731 occasions in Hull where people were admitted to hospital for smoking-related diseases. That’s up from 3,650 similar cases seen in the year before, which was the highest number on record.
In total, these cost the NHS nearly £6m to treat people in Hull for these diseases in hospital last year, which works out at £22 for every man, woman and child living here. Across the country, 244,470 people died from smoking between 2014 and 2016-1,681 of those were from Hull.
Hazel Cheeseman, director of policy at Action on Smoking and Health (ASH), said: “These figures demonstrate that the NHS is not doing enough to support smokers to quit. A recent audit found that three out of four hospital patients who smoke are not offered help to stop. If they were, hospitals would not only see fewer smoking related deaths and admissions but also an improvement in the effectiveness of many treatments including chemotherapy and surgery.”
Source: Hull Daily Mail, 17 May 2018
USA: Vast majority of heavy smokers not screened for lung cancer despite USPSTF recommendations
An analysis of 1,800 lung cancer screening sites nationwide found that only 1.9% of more than 7 million current and former heavy smokers were screened for lung cancer in 2016, despite United States Preventive Services Task Force (USPSTF) and ASCO screening recommendations. This study, the first assessment of lung cancer screening rates since those recommendations were issued in 2013, will be presented at the upcoming 2018 ASCO Annual Meeting in Chicago.
“Lung cancer screening rates are much lower than screening rates for breast and colorectal cancers, which is unfortunate,” said lead study author Danh Pham, MD, a medical oncologist at the James Graham Brown Cancer Center, University of Louisville, Kentucky. “It is unclear if the screening deficit is due to low provider referral or perhaps patient psychological barriers from fear of diagnosis. Lung cancer is unique in that there may be stigma associated with screening, as some smokers think that if cancer is detected, it would confirm they’ve made a bad lifestyle choice.”
Source: Medical Xpress, 17 May 2018
European Commission prioritises tobacco and sacrifices global health in trade negotiations with Latin America
The European Public Health Alliance, along with Latin American and global partners, has written to the EU Trade Commissioner Cecilia Malmström and First Vice-President Frans Timmermans to put health ahead of the interests of the tobacco industry in the EU’s trade negotiations with Mexico, Chile and the Mercosur trade bloc (Argentina, Brazil, Paraguay and Uruguay).
The EU is being called to publicly change its stance and to drop tobacco as an EU “Offensive Interest” in its negotiations with Mercosur. Another change being pushed by activists is for the EU to commit to completely exclude tobacco lobbyists from influencing policy positions on international trade.
Source: European Public Health Alliance, 18 May 2018
USA: Shisha responsible for over half of tobacco smoke inhaled by young smokers
Smoking tobacco from a waterpipe, also known as a shisha pipe, accounted for over half of the tobacco smoke volume consumed by young adult shisha and cigarette smokers in the U.S., a new University of Pittsburgh School of Medicine analysis has discovered.
Toxicant exposures – such as tar, carbon monoxide and nicotine – were lower, yet substantial, for those young adults who just smoked shisha pipes, compared to those who smoked both wateripes and cigarettes. The research, funded by the National Cancer Institute, is published today in the journal Tobacco Control.
In the U.S., waterpipe tobacco smoking rates are increasing and cigarette smoking rates are decreasing, especially among young adults.
Source: Science Newsline, 17 May 2018
See also: BMJ Tobacco Control, Waterpipe tobacco use in college and non-college young adults in the USA
Dutch insurer NN group quits tobacco investments
Dutch insurer NN Group will no longer invest in the tobacco industry and said on Thursday it aims to divest all tobacco-related holdings on its own accounts and in the funds of its asset manager within a year.
NN’s step follows similar moves by BNP Paribas Asset Management and insurers AXA, Aviva and Scor, which all decided to sell out of the industry because of the health, social and environmental costs linked to tobacco smoking.
“Tobacco no longer fits with our responsible investment approach,” NN Chief Investment Officer Jelle van der Giessen said. “It is not possible to use tobacco products responsibly.”
Source: Insurance Journal, 17 May 2018
Nigeria: Tobacco consumption contributes to 12% of deaths from heart diseases
The chairman of the Nigerian Heart Foundation, Dr. Olufemi Mobolaji-Lawal, recently addressed journalists in Lagos to discuss tobacco control in the run-up to World No-Tobacco Day. He lamented the low levels of implementation of the WHO Framework Convention on Tobacco Control (FCTC) across African countries. Journalists were told that tobacco consumption contributes to around 12% of heart disease deaths in Nigeria.
Source: All Africa, 17 May 2018
Link of the week
Big Tobacco is desperate to prevent ‘plain packaging’ spreading around the world
Coming up to a year after standardised ‘plain packaging’ was fully implemented in the UK on 20 May 2017, the Tobacco Manufacturers’ Association (TMA) and now Japan Tobacco International (JTI) have claimed that it’s a failure.
Why is Big Tobacco bothering, when it’s clear the UK is tough on tobacco, won its case in the courts and is not going to reverse the legislation? The reason is obvious, this is a last ditch and desperate attempt to delay and discourage the many other governments coming down the same track. Three countries have fully implemented plain packs to date (France, Australia and the United Kingdom), by the end of this year it will be six, with seven more having passed legislation and more following on behind. The dominoes are falling, markets around the world are going dark, and Big Tobacco is running scared. The WTO decision on the legality of plain packs is expected shortly, and the outcome, a defeat for the tobacco industry, has already been leaked.
Source: ASH (on Medium), 18 May 2018
Coming up to a year after standardised ‘plain packaging’ was fully implemented in the UK on 20 May 2017, the Tobacco Manufacturers’ Association (TMA)  and now Japan Tobacco International (JTI)  have claimed that it’s a failure.
Why is Big Tobacco bothering, when it’s clear the UK is tough on tobacco, won its case in the courts and is not going to reverse the legislation? The reason is obvious, this is a last ditch and desperate attempt to delay and discourage the many other governments coming down the same track. Three countries have fully implemented plain packs to date (Australia, France and the United Kingdom), by the end of this year it will be six, with seven more having passed legislation and more following on behind. The dominoes are falling, markets around the world are going dark, and Big Tobacco is running scared. The WTO decision on the legality of plain packs is expected shortly, and the outcome, a defeat for the tobacco industry, has already been leaked .
JTI claim that plain packs aren’t supported by the public, citing a survey commissioned from Kantar TNS which it says is the ‘largest public opinion poll of its kind since plain packaging was introduced’. This is incorrect. The ASH smokefree GB survey undertaken earlier this year had a sample size of 12,767, which is five times bigger than the 2,464 in the JTI Kantar survey. Findings from the ASH survey confirm the levels of support found in previous annual smokefree GB surveys, with just under three fifths of the public supporting standardised plain packaging (58%) while only around one in ten oppose (11%). The public support plain packs, to suggest otherwise is ludicrous.
When it comes to the evidence that the policy has been ineffective, the report JTI commissioned from Europe Economics ignores the fact that it was always known that plain standardised packaging would have the biggest impact on discouraging young people from taking up smoking rather than in helping addicted adult smokers quit. This is a much smaller group than existing adult smokers, so any such effect will be small, particularly in the early years. In the first year or two of implementation most young people at the age of initiation will have been exposed throughout their life to the colourfully branded packaging as it was prior to the introduction of standardised plain packs. As with the advertising ban, it is in future years when young people grow up never having seen such packaging that we expect it to have greatest impact. This effect will be cumulative as young people grow up into adulthood in cohorts with lower smoking rates, and older smokers die off. The Europe Economics report only includes data up to January 2018 so it simply cannot capture any of this.
Furthermore, the ability of standardised packaging to produce immediate effects during the year that the legislation was phased in (i.e. not fully implemented) is predicated on the assumption that the policy was smoothly and quickly brought into effect by all parties. Evidence from the Institute for Social Marketing (University of Stirling), already shows that before, during, and after the implementation of standardised tobacco and the TPD, tobacco companies engaged in activities which may have disrupted and confounded the impact of the legislation on smoking attitudes and behaviour . This included introducing limited-edition fully-branded packs and re-usable tins, changed brand or variant names (e.g. including the addition of a colour descriptor, with colour often used by consumers as an indicator of product strength or harm), and continued innovation of their products (e.g. new filter designs). In essence, they used the implementation period to continue to create interest in their products.
In addition, the UK Government allowed tobacco companies and retailers twelve months, from May 2016 to May 2017, to introduce standardised packaging, which is longer than the two other countries (2 months in Australia, 9 months in France) that have introduced this measure. The report claims that ‘the penetration of TPD2+PP compliant products has increased gradually over the implementation period’. This is not consistent with further findings by researchers at the University of Stirling, analysing real-time data from independent and convenience (small) retailers , which instead shows that tobacco companies and retailers responded to the extended implementation period by continuing to sell fully-branded products for as long as they could, meaning that most of the leading brands of cigarettes and rolling tobacco in the UK were not sold in standardised packs until near the end of the twelve months. It is plausible that this staggered introduction of standardised packaging may have mitigated some of the immediate intended effects of the legislation by desensitising consumers to the new designs and graphic health warnings.
Once the legislation became mandatory for packs at point of sale, which was not until May 2017, the University of Stirling researchers found that 97% of tobacco sales volume  in small retailers was compliant with the TPD and standardised packaging legislation (rising to 99.5% ten weeks after full implementation). Given the aforementioned industry-led disruption during the transition period, research evaluating the impact of standardised packaging should reflect on how trends in smoking attitudes and behaviours change in the years after full implementation, not reactive conclusions based on limited time periods.
Governments need to apply the rule of thumb known as the ‘scream test’, if the industry is campaigning so hard to prevent it, clearly standardised ‘plain’ packaging does work, otherwise Big Tobacco wouldn’t care.
ASH thanks researchers from the Institute for Social Marketing, University of Stirling — part of the UK Centre for Tobacco and Alcohol Studies — for their analysis of the Europe Economics report for JTI.
The studies carried out by the University of Stirling were funded by Cancer Research UK.
 Tobacco Manufacturers’ Association, Plain packaging failing one year after full introduction, 14 May 2018
 Japan Tobacco International, Plain Packaging on Tobacco Backfires Within First Year in the UK, 17 May 2018
 Reuters, Australia wins landmark WTO tobacco packaging case — Bloomberg, 4 May 2017
 BMJ Tobacco Control, How tobacco companies in the UK prepared for and responded to standardised packaging of cigarettes and rolling tobacco, January 2018
 Nicotine and Tobacco Research, Introduction of Standardized Tobacco Packaging During a 12-Month Transition Period: Findings From Small Retailers in the United Kingdom, 12 January 2018
 BMJ Tobacco Control, Did independent and convenience (small) retailers comply with standardised tobacco packaging in the UK?, November 2017
Retail age checks show high pass rate for tobacco sale tests but falling pass rates for e-cigs
New data from Serve Legal, a UK retail age check company, shows that most retailers are strict about age checks for cigarettes. In tobacco sale tests, retailers achieved an 80 per cent pass rate in 2017. Pass rates have improved year on year since 2015. Retailers in the South West achieved the highest pass rate (79 per cent) and London the lowest (60 per cent).
There is less positive news from the e-cigarette age test data. Pass rates have fallen from 91 per cent in 2015 to 70 per cent in 2017. This suggests that there may still be confusion amongst retailers about e-cigarettes being an 18+ product.
Source: Retail Times, 16 May 2018
Tobacco Manufacturers’ Association argues plain packaging has failed to reduce smoking rates
Plain packaging on cigarettes has been branded a failure by pro-smoking campaigners. Drawing on numbers from the Smoking Toolkit Study, campaigners have compared the smoking rate of 17.1 per cent in March 2018 with March last year’s rate of 16.5 per cent – an increase of 0.7 per cent.
The Tobacco Manufacturers’ Association (TMA) said if the same effect was seen across the UK with the same population, there would be approximately 350,000 more adult smokers in March 2018 than a year before the plain packaging was brought in.
Source: The Sun, 15 May 2018
Robert West, Professor of Health Psychology and University College London, said: “The TMA report using our data on smoking is nonsense and their claims are completely unwarranted. The analysis of data from our Smoking Toolkit surveys does not support the TMA’s contention about the impact of plain packaging. Plain packaging was introduced in May 2016, with the first packs appearing in shops shortly after, since then our surveys show an overall decline in adult smoking prevalence. Cherry picking specific months out of the variation shown within our surveys is an inappropriate analysis of the data.”
Philip Morris iQOS patents reveal that the company could harvest users’ data
There are new concerns that Philip Morris could be able to collect massive amounts of data from individual iQOS products.
Ottawa-based TechInsights Inc have studied the device and say the iQOS is equipped with technology which could facilitate the storing of device information that could then be transmitted back to Philip Morris. The data could include details like the number of puffs by a user and how many times a person used the device in a given day.
The initiative, if allowed by regulators, could extract information about a user’s smoking routine from the device and use it for marketing purposes, said a former project manager at Philip Morris.
Gregory Connolly, a professor at Northeastern University in Boston who has studied iQOS technology and patents, said Philip Morris’ ability to gather user data could give the device remarkable power. “What they’re going to have is a mega database of how Americans smoke,” he said. “Then they’ll be able to reprogram the current puffing delivery pattern of the iQOS to one that may be more reinforcing and with a higher addiction potential.”
Source: Reuters, 16 May 2018
More US adults say they’ve tried vaping, but regular use is down
New research shows 1 in 7 U.S. adults have tried electronic cigarettes. This is an increase but it’s offset by a small decline in the number currently using the devices. About 3 percent of adults were current users in 2016, down from almost 4 percent in 2014. Adults who have tried them at least once reached just over 15 percent in 2016.
See also: Journal of the American Medical Association, Changes in Electronic Cigarette Use Among Adults in the United States, 2014-2016
Business Insider UK, 15 May 2018
Qatar: Ministry of Public Health launches national anti-tobacco campaign
The Ministry of Public Health has launched a national campaign to curb the impacts of smoking and tobacco use.
The three-phase, multi-year campaign aims to encourage residents to follow the existing tobacco control laws and to understand the risks associated with tobacco use. It also aims to discourage youth from starting the habit and to direct people to useful resources to help them quit.
Minister of Public Health, H E Dr Hanan Mohamed Al Kuwari, said: “Smoking is a significant public health issue in Qatar. Around 37 percent of the population over the age of 15 say they currently smoke tobacco and we continue to see more young people take up the habit. The National Health Strategy 2018-2022 sets a target of reducing the prevalence of smoking, and to achieve this, it is important that we redouble our efforts to combat tobacco use.”
Source: The Peninsula, 16 May 2018
All week we have been reviewing how cigarette branding influences consumers and explaining why standardised “plain” packaging is so important for public health. For more on the new regulations, see our factsheet here.
Children born in Britain today will never be exposed to the brightly coloured, heavily branded packs their parents grew up with. Why does this matter? Because cigarette packs, unlike other brands such as washing powder or breakfast cereal, are a highly effective and public promotional tool. The pack is on show every time a smoker takes out a cigarette, on average more than ten times a day. To quote pack designer John Digianni, “A cigarette package is part of a smoker’s clothing, and when he saunters into a bar and plunks it down, he makes a statement about himself. When a user displays a badge product, this is witnessed by others, providing a living testimonial endorsement of the user on behalf of that brand and product.”
We’ve already examined many different techniques used by the tobacco industry in their packaging — lipstick packs, sponsorship, use of bright colours, price-marked packaging and deceptive pack sizes.
Today we’re looking at another way tobacco companies have used packaging to influence consumers — to explicitly undermine the health warnings on the packs. A good example is this Benson & Hedges pack which includes the following quotation right by the health warning saying, “I owe my success to having listened respectfully to the very best advice, & then going away and doing the exact opposite.” 
Pack opening mechanisms under the new regulations have been standardised. There can be no variation in the way packs open or close, so the Benson & Hedges Silver Slide pack which included the quote pictured above is now forbidden. This pack design, launched in 2007 was favoured by the manufacturer because it increased the surface area of the pack, giving more space for it to use for such marketing messages. 
The slide packs also became talking points among groups of friends. By making something that was different from regular packaging, smokers would show each other the packs and discuss the brands. This made smokers more likely to switch brands, or at least try them.
Techniques like this are no longer available to tobacco manufacturers in the UK, protecting British consumers from the insidious influence of cigarette packaging. And the evidence from Australia, where such packs have been mandatory since 2012, is that the public display of packs by smokers has declined significantly, that quit attempts have increased and smoking prevalence declined.  Cigarette packs which used to be an object of pride to be displayed, have become an object of shame to be kept out of sight.
References and notes
Tomorrow sees the final implementation of new regulations which mandate that all cigarettes and tobacco must be sold in standardised “plain” packaging. As a part of the countdown, today’s article looks at how hand rolling tobacco is affected. See our factsheet for more information.
During the course of this week we’ve been looking at the influence that cigarette packaging has on consumer behaviour. Hand rolling tobacco is also included in the new regulations on standardised “plain” packaging. There are also new rules governing pack sizes and the use of price marking.
The proportion of smokers using hand rolling tobacco is increasing. In 2013 it was recorded that 40% of male smokers were predominantly using rolling tobacco, along with 23% of female smokers. This was a big increase from 1998 when the figures were 25% of male smokers and 8% of female smokers. 
There are a number of things that will change about this branded, price-marked pack of Amber Leaf hand rolling tobacco, made by Japan Tobacco International.
Firstly, the image branding will go. The Amber Leaf logo, which works hard to imply a natural, positive product (note the green background with shining, luxuriant leaves) will be removed, replaced by larger pictorial health warnings and drab, standard, olive-coloured backgrounds. The branding also works to imply that hand rolling tobacco is less harmful than machine made cigarettes. This is terribly misleading and rolling tobacco is at least as harmful. 
Secondly, the price marking will no longer be allowed. As you may have seen in yesterday’s article, price is a key factor in encouraging people to quit. Removing these price marked packs, which imply economy and good value, will help.
Thirdly, the pack size is too small for the new regulations. From tomorrow, hand rolling tobacco must be sold in a minimum pack size of 30 grams, while cigarettes must be sold in packs of at least 20 sticks. Minimum pack sizes are being introduced to make tobacco less available to children and young people. Smaller packs are cheaper and therefore more likely to be “affordable” for children and young people. Since most smokers become addicted in childhood, everything we can do to #ActOnTobacco and restrict access to this deadly product by children and young people will contribute to ending the tobacco epidemic sooner.
Measures such as visual branding, price-marking and pack sizing are crucial to the tobacco industry, which is why they fought so hard, and at great expense, to do everything they could to prevent the new regulations. Standardised “plain” packaging represents a landmark achievement for public health in the UK.
While the UK is a world leader in tobacco control, it’s important that we work to support similar legislation elsewhere to tackle the global harm caused by the tobacco industry.
This article was published on the 17th May, 2017
This week we are looking at the benefits of standardised “plain” tobacco packaging for public health (see our briefing for more information). Colourfully branded cigarettes are being confined to the dustbin of UK history on Saturday. Today we look at the power of branding.
The tobacco industry was one of the first to adopt the tools of modern marketing nearly a hundred years ago, by associating its products with positive attributes. None of these attributes, such as health, wealth and success were justified by the evidence, but getting doctors, film stars and athletes to promote your products did the trick. Marlboro has been the most successful at this and as a result since 1972 it has been the world’s biggest selling cigarette brand.  Manufactured by Philip Morris International (PMI) Marlboro is one of the world’s most valuable and recognisable brands, worth $86 billion worldwide in 2016.   This ubiquity doesn’t happen by accident. It is the result of endless promotion, sponsorship and marketing.
Sponsorship of sporting events, product placement in films and television shows, glamorous looking people in magazines, all of these and more techniques have been used to promote smoking in general and the company’s own brand in particular. These are intended to create a sub-conscious association in the minds of consumers, and Marlboro’s use of Formula 1 is a good example. The message is simple: Formula 1 racing is glamorous and elite. Marlboro is intimately associated with Formula 1. Therefore, smoking Marlboro cigarettes gives me a chance to share in that glamour.
Philip Morris is still paying Ferrari an estimated US $160 million a year in sponsorship for its formula 1 team, even though it hasn’t been able to put its name on the cars since 2005. Why? Because the visual identity remained a strong link between the pack and the car. This is highly effective. Take a look at this video where children are discussing tobacco packaging. These children are primary school age, and brand names on cars had already been banned for 7 years by the time this video was filmed, yet they still associated Marlboro with Ferrari.
When children so young are associating a cigarette brand with a racing car — we have a serious problem. When a young boy sees a cigarette pack and thinks that it might be fun to play with, and another says that the colours make him happy, it is clear the packaging is an effective promoter of smoking.
When we understand this, we can see the critical importance of these new rules for public health, now and in the future. New regulations on standardised “plain” packaging for all cigarettes means that Marlboro and others can no longer use their instantly recognisable and long-established visual identity to seduce new customers, especially young people, or lead current smokers to switch. It will take time, but as children born today grow up they will never have seen the brightly coloured packs that create such associations.
The UK is now what the tobacco industry calls a ‘dark market’ with all advertising promotion and sponsorship, even on the pack, prohibited. However, most countries are not so fortunate. As the regulatory framework becomes tighter in the UK, the focus of the industry moves to countries without such a strong framework. Increasingly, tobacco companies are concentrating their efforts in Low and Middle Income Countries (LMICs). The Marlboro brand can still be promoted in many countries around the globe using methods of advertising, promotion and sponsorship now illegal here. We must continue to #ActOnTobacco until the whole world is a dark market and stop the tobacco industry exploiting vulnerable people, especially children, with seductive and insidious marketing tactics.
If you saw our article yesterday you’ll be aware that the UK is about to wave goodbye to glitzy tobacco packaging forever. This week we’re explaining why this is a big win for public health. Today’s article looks at price-marked packaging. For more on standardised plain packaging, please see this ASH briefing.
Sterling is currently the best-selling cigarette brand in the UK and is manufactured by Japan Tobacco International (JTI). It has achieved this position through a combination of its branding and its marketing techniques, largely focused on price.
The packet shown is labelled as costing £6.99, which is at the lower priced end of the market. However as with so much in the tobacco industry, things are not as straightforward as they appear. Most smokers would assume that a packet contains 20 cigarettes. Not so in this case. Tucked away on the side of the box, hoping to go unnoticed, is the small announcement that this pack only contains 17 cigarettes.
This is a clear example of the many ways in which the tobacco industry misleads consumers, who receive 15% fewer cigarettes than they may reasonably expect. In this way, they keep the perceived cost of their products down, while the consumer is actually paying more without realising it.
The new laws on tobacco packaging mean that JTI and other tobacco companies are no longer able to use such devious tactics to mislead consumers. From Saturday, pack sizes must contain a minimum of 20 cigarettes and price-marked packs will no longer be allowed.
This is important, not just from a consumer standpoint but from a public health perspective. There is a huge amount of evidence showing that price is a key factor in encouraging people to quit smoking. As long ago as 1993 the Conservative government introduced a tax escalator on cigarettes of 3% above inflation as “the most effective way to reduce smoking”,  and annual tax increases above inflation are still in place today.
Just this year, The National Cancer Institute (NCI) and World Health Organization (WHO) concluded in their 2017 report, The Economics of Tobacco and Tobacco Control:
“A substantial body of research, which has accumulated over many decades and from many countries, shows that significantly increasing the excise tax and price of tobacco products is the single most consistently effective tool for reducing tobacco use. Significant increases in tobacco taxes and prices reduce tobacco use by leading some current users to quit, preventing potential users from initiating use, and reducing consumption among current users.” 
It’s clear from the evidence that if smokers of Sterling cigarettes understood how much more they were paying, they would be more inclined to quit. Price-marked packs are so important to the tobacco industry there have been allegations by a whistle-blower  that they continue to put promotional price stickers on packs in contravention of the laws after the deadline of 20 May 2016.
The new regulations are designed to help people stop smoking and to discourage children and young people from becoming addicted. Pricing is an important part of this battle.
 U.S. National Cancer Institute & World Health Organization, The Economics of Tobacco and Tobacco Control, National Cancer Institute Tobacco Control Monograph 21, NIH Publication №16-CA-8029A, Bethesda, MD: U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute; and Geneva, CH: World Health Organization; 2016, https://cancercontrol.cancer.gov/brp/tcrb/monographs/21/docs/m21_complete.pdf
 Doward J. How tobacco firms flout UK law on plain packaging. Observer. 9 April 2017.
12 May 2017
This image shows packaging compliant with TPD and Standardised Packaging regulations. You are welcome to save and reuse the image but you must credit ASH as the source.
One year after the tobacco companies were required to manufacture all cigarette in standardised “plain” packs the transition period is coming to an end and all packs on sale in shops will also be required to meet these standards. Under the new packaging and labelling regulations cigarettes and tobacco will no longer be sold in bright, glitzy packs, but in drab green packages. They will have large graphic images on the front and back of the packets to highlight the health effects of smoking and health warnings must appear at the top of all packs. [To see the effects of attractive packaging see here for a short video produced by Cancer Research UK.]
The UK was only the second country in the world to pass legislation on standardised packaging following Australia in 2012, with many others following on including France, Ireland, Hungary and Norway. For the fourth year in a row the UK is at the top of the European league table for tobacco policy implementation.  The transition period is slightly different for the Tobacco Products Directive (all packs must be compliant from 12am Saturday 20th May) and for the standardised packs regulations (all packs must be fully compliant from 12 am Sunday 21st May), but in effect all packs will have to be compliant by 20th May.
Deborah Arnott, Chief Executive of health charity ASH, said:
“Getting rid of glitzy heavily branded tobacco packs is the latest in a long line of achievements by the UK which is a global leader in tobacco control. We now have among the fastest declining smoking rates in the world thanks to decades of sound policy, but smoking rates among the poorest and most disadvantaged remain high. If this is to change then a priority for the next Government must be to publish a new tobacco control plan with tough new targets, focused on tackling health inequalities.”
The new packaging rules are contained in two sets of regulations:
1. Regulations requiring cigarettes sold in the UK to be in standardised “plain” packaging” 
2. The Tobacco and Related Products Regulations 2016  bringing into effect the EU Tobacco Products Directive 
Standardised “Plain” Packaging
Standardised or “plain” packaging is tobacco packaging that has had all the attractive features removed. In March 2015 MPs voted overwhelmingly in favour of introducing regulations to standardise the appearance of all tobacco packaging in the UK . This includes:
• The material, size, shape and opening mechanism of the packaging;
• The colour of packaging and cigarettes;
• The font, colour, size, case and alignment of text.
Tobacco Products Directive
The Tobacco Products Directive applies to all tobacco products manufactured and sold within EU member states. With regards to tobacco packaging the revised TPD:
• Requires combined picture and text health warnings to cover 65% of the front and back of cigarette and roll-your-own tobacco packages. 
• Requires health warnings to appear at the top of the packet (as per the illustration).
• Prohibits certain promotional and misleading descriptors on packaging of tobacco products such as “lite”, “natural” and “organic”.
• Requires that cigarettes are sold in packs of a minimum of 20 sticks and Hand Rolling Tobacco in a minimum of 30 gram packets.
The Tobacco Products Directive also:
• Prohibits cigarettes and roll-your-own tobacco with characterising flavours, for example, fruits or chocolate. Menthol tobacco will be prohibited from 20th May 2020.
• Introduces EU-wide tracking and tracing to combat illicit trade of tobacco products. This will apply from 20th May 2019 for cigarettes and hand rolling tobacco and 20th May 2024 for all other tobacco products.
• Electronic cigarettes – the TPD also includes a number of regulations regarding electronic cigarettes (the Medicines and Healthcare products Regulatory Agency is the responsible authority and more information about how the regulations can be found on its website):
o Child resistant/ tamper evident packaging is required for liquids and devices
o The device must be protected against breakage and leakage and capable of being refilled without leakage
o Devices must deliver a consistent dose of nicotine under normal conditions
o Tank and cartridge sizes must be no more than 2ml in volume and nicotine strengths of liquids must be no more than 20mg/ml.
o There must be a 30% health warning ‘This product contains nicotine which is a highly addictive substance’ on front and back of packs
o Cross border advertising is banned, which includes TV, radio, print and internet advertising
The tobacco industry challenged both the Tobacco Products Directive through the European Court of Justice (ECJ) and standardised packaging regulations through the UK courts. On 4th May 2016 the ECJ ruled that the TPD is lawful,  and on the 19th May 2016 the tobacco industry’s legal challenge to standardised packaging was defeated in the UK courts.  On 11th April 2017 the UK Supreme court refused the tobacco industry leave to appeal the decision any further.
PLEASE NOTE: Standardised packs are NOT plain white packs. They carry graphic and text health warnings as above. Print standard images are available from ASH
Notes and Links
Action on Smoking and Health is a health charity working to eliminate the harm caused by tobacco use. For more information see: www.ash.org.uk/about-ash
ASH receives funding for its programme of work from Cancer Research UK and the British Heart Foundation.
 Tobacco Control Scale 2016. Launched at the European Conference on Tobacco or Health March 2017
 The Standardised Packaging of Tobacco Products Regulations, 2015
 2016 No. 507 The Tobacco and Related Products Regulations 2016 (PDF)
 Revision of the Tobacco Products Directive, 2014 (PDF)
 Hansard. 11 Mar 2015: Column 379
 See here for the full picture library of combined health warnings. The Tobacco and Related Products Regulations 2016, consultation draft (PDF)
 ASH press release. European Court of Justice rules Tobacco Products Directive is lawful – gives backing to UK’s policy on standardised packaging. 4th May 2016
 ASH press release. Tobacco Companies’ Legal Challenge to Standardised Tobacco Packaging Fails: Other Countries to Follow UK Lead. 19th May 2016
 Monckton Chambers. Supreme Court stubs out Big Tobacco’s judicial review of UK plain packaging laws. 13th April 2017.
ASH staff are available for interview or comment. ASH has an ISDN line.
Contacts: ASH office 020 7404 0242
Deborah Arnott 07976 935987
Hazel Cheeseman 07754 358593
There are now five days to go until all cigarettes on sale in the UK must be in standardised “plain” packaging. The legislation mandating the change came into force in May 2016, with a one year transitional period to allow retailers and manufacturers to sell old stock. This transitional period comes to an end at midnight on Friday. See the ASH briefing on standardised “plain” packaging here for more information.
Over the next few days we’ll be counting down to the end of this transitional period and highlighting the most egregious sorts of packaging that from Saturday will be illegal. We will also explain why the switch to standardised plain packaging is such a powerful positive step for public health.
The first packet in our rogues’ gallery is this pink packet of 20 Pall Mall cigarettes manufactured by British American Tobacco. This is a good example of how tobacco companies rely on their pack design to promote their products, and also how tobacco products are often made to appear appealing to children. Take a look at this short video created by Cancer Research UK which shows how alluring this pink pack is to young girls (from 40 seconds onwards).
The new legislation means that Pall Mall cigarettes will now be sold in packs like this.
The new packaging rules mean that all cigarettes are sold in drab green packaging with much larger pictorial health warnings. Manufacturers must use standard font, size and colour for any text. Evidence from Australia  shows that not only does standardised “plain” packaging encourage more people to try to quit smoking, it makes cigarette packs much less appealing to children.
Getting rid of glitzy, heavily branded tobacco packs is the latest in a long line of achievements by the UK which is a global leader in tobacco control. We now have among the fastest declining smoking rates in the world thanks to decades of sound policy, but smoking rates among the poorest and most disadvantaged remain high. If this is to change then a priority for the next Government must be to publish a new tobacco control plan with tough new targets, focused on tackling health inequalities.
Tobacco packaging has become one of the tobacco industry’s leading promotional tools. Research suggests that standardised packaging would increase the impact of health warnings, reduce false and misleading messages that one type of cigarette is less harmful than another, and reduce the attractiveness of smoking to young people.ASH Briefing on Standardised Tobacco Packaging
|High Court of Justice
Queen’s Bench Division
BRITISH AMERICAN TOBACCO UK LIMITED
BRITISH AMERICAN TOBACCO (BRANDS) INC.
BRITISH AMERICAN TOBACCO (INVESTMENTS) LIMITED
PHILIP MORRIS LIMITED
PHILIP MORRIS BRANDS SARL
PHILIP MORRIS PRODUCTS S.A.
JT INTERNATIONAL SA
IMPERIAL TOBACCO LIMITED
TANN UK LIMITED
BENKERT UK LIMITED
DEUTSCHE BENKERT GMBH & CO KG
SECRETARY OF STATE FOR HEALTH
ACTION ON SMOKING AND HEALTH (ASH)
ASH is very grateful to Peter Oliver and Ligia Osepciu of Monckton Chambers, and to Sean Humber of Leigh Day, who provided their legal services pro bono.
Summary of Judgement: Please note this summary is provided by ASH for research and media purposes only, and is not to be relied on as a legal document. Key extracts from the judgement are listed from page 3 of this document onwards, they are all direct quotes from the judgement, with page and paragraph numbers.
The full judgement in the case can be read at www.judiciary.gov.uk/wp-content/uploads/2016/05/bat-v-doh.judgment.pdf
Highlights of the High Court of Justice’s ruling on standardised packaging
Highlights of the High Court of Justice's ruling on standardised packaging
A summary of developments around the world. Produced by the Canadian Cancer Society. May 2016Plain Packaging – An International Overview