Stoptober 2018: Public Health England Campaign to quit smoking revealed
PHE’s Stoptober campaign, aimed at helping people to quit smoking, has launched this week.
Launched in 2012, the campaign offers free support and resources for those looking to stop smoking, including through medications, apps, social media groups and personal support from local health services. Today, the campaign is the largest and most popular event in the UK aimed at getting masses of people to give up smoking.
Since launching in 2012, Stoptober has led to more than 1.5 million quit attempts in the UK. In addition, a 2017 report by the University College of London has showed that quitting success rates in the UK are the highest they’ve been in at least a decade, up to 19.8% for the first six months of 2017 and considerably higher than the ten-year average of 15.7%.
See also: Birmingham Mail, Stoptober is here – here’s what happens to your body when you quit smoking
Source: MSN News, 01 October 2018
London: Southwark Council issues shisha warning this Stoptober
There are many misconceptions that surround shisha and this Stoptober Southwark Council is highlighting how smoking shisha tobacco can affect your health.
Research data suggests that the vast majority of people do not realise the dangers of smoking shisha, often seeing it as a safer alternative to regular cigarettes. A 2014 survey of 1,200 people in south east London found that 64% of people did not know that shisha usually contains tobacco. A further 53% of people did not think that shisha represented any danger to their health.
In partnership with ‘It’s Still Tobacco’, a community and advocacy group, Southwark Council will be raising awareness of the health impacts of smoking shisha tobacco on social media and via posters around the borough.
Source: Southwark Council, 01 October 2018
North West: First hospital to offer addiction therapy to all smoking patients
Wythenshawe Hospital in Greater Manchester has become the first in the UK to offer addiction treatment to all of its patients that smoke. Patients admitted to the hospital, which is part of Manchester University NHS Foundation Trust, will be prescribed medication and offered intensive support to stay smokefree. This is part of the CURE programme being launched at the hospital to coincide with the first day of Stoptober.
The CURE is modelled on the Ottawa Model for Smoking Cessation which has helped 35% of smoking patients to quit and led to marked falls in re-admissions and mortality rates in Canada.
CURE forms part of Greater Manchester Health and Social Care Partnership’s Making Smoking History programme. Following an initial six-month phase at Wythenshawe, the programme is due to be rolled out in hospitals across Greater Manchester by 2020. As well as transforming lives, the trust noted that the initiative would free up thousands of hospital beds each year and save the NHS in Greater Manchester an estimated £10m a year.
Source: Nursing Times, 01 October 2018
Daily Bulletin 2: Framework Convention Alliance at the WHO FCTC conference of the parties
The eighth session of the Conference of the Parties (COP8) to the World Health Organisation (WHO) Framework Convention on Tobacco Control (FCTC) is now onto its second day.
Today’s bulletin is titled ‘Global Strategy and IRM – Let’s Shift Gears’. It refers to the proposed ‘Global Strategy to Accelerate Tobacco Control’ which calls for coordinated action on a small number of high-impact interventions in order to reduce tobacco use between now and 2025. According to the bulletin, if endorsed the strategy will be an important tool for raising the visibility of the treaty and for helping to fund tobacco control at the global and national level.
The bulletin goes on to add that the kind of problem-solving and knowledge exchange such a strategy would make possible “is truly valuable and will support implementation of the FCTC.”
Philip Morris sues South Korea over heat-not-burn info disclosure
Philip Morris Korea has filed a lawsuit against the South Korean government, demanding the disclosure of information from recent tests that concluded heat-not-burn products contain harmful substances.
Seoul’s Ministry of Food and Drug Safety said in June after a study that up to five cancer-causing substances were found in the heated smoking devices, and the level of tar discovered in two products, including Philip Morris’ iQOS, exceeded that of regular cigarettes. The ministry’s announcement ran counter to the U.S.-headquartered company’s claim that its heated tobacco product is less likely to cause disease than traditional cigarettes, citing studies conducted in Germany, Japan and China.
Philip Morris said the government study wrongly centered on tar, which is only applicable to smoke created by regular cigarettes, while the electronic devices do not generate smoke.
See also: Financial Times, Philip Morris sues Seoul over e-cigarette information disclosure
Source: Reuters, 01 October 2018
Campaigners urge WHO to give vaping a chance
Seventy public health experts and tobacco control campaigners have urged the World Health Organization (WHO) to adopt a more sympathetic attitude to e-cigarettes and other alternatives to smoking in a letter to the WHO Director General, stating that the devices “have the potential to bring the epidemic of smoking-caused disease to a more rapid conclusion”.
Their joint letter to Tedros Adhanom Ghebreyesus, WHO director-general, is intended to influence this week’s conference of the Parties to the Framework Convention on Tobacco Control.
In their letter, the advocates of harm reduction, most of whom are university or medical school professors, urged the WHO not to let uncertainty about long-term effects of e-cigarettes block their introduction: “It is true we will not have complete information about the impacts of new products until they have been used exclusively for several decades — and given the complex patterns of use, we may never,” they wrote. “But we already have sufficient knowledge based on the physical and chemical processes involved, the toxicology of emissions and exposure markers, to be confident these non-combustion products will be much less harmful than smoking.”
Source: Financial Times, 01 October 2018
Tobacco control measures are working, but too slowly in less-developed countries
“Great progress” has been made in tackling tobacco consumption and saving lives but more needs to be done to challenge the industry’s attempts to “bypass” international regulations, the World Health Organization (WHO) said on Monday.
The 181 Parties to the WHO Framework Convention for Tobacco Control (WHO FCTC) have developed strategies “to prevent tobacco industry interference with tobacco control policies”. As a result of the treaty, countries have increased taxes on tobacco, established smokefree spaces and made it obligatory for manufacturers to show graphic health warnings on their products, as well as using plain packaging.
Despite these advances, “this is not a time to be complacent,” said Dr Vera Luiza da Costa e Silva, head of the WHO FCTC Secretariat. “With astronomical budgets, the tobacco industry continues its furious efforts to undermine the implementation of our treaty.”
See also: Mail on Sunday, Battle for lungs and minds as tobacco control treaty meeting opens
Source: UN News, 01 October 2018
North East: Campaign launched as hospital is set to become a smokefree zone
North Tees and Hartlepool NHS Foundation Trust is raising awareness about smoking cessation services among patients and staff, as part of a pledge to go smokefree by March 2019.
The trust is offering nicotine replacement therapy and a referral to the community stop-smoking service for patients who smoke.
Clare Henry, the trust’s specialist alcohol and tobacco nurse advisor, said: “over the next few months we will be spreading the message to as many people as possible about what we can all do to help go smokefree. We understand there are many reasons why people might choose to smoke outside the hospital… what we are looking to stress to people is the importance to have a healthy environment around our hospital sites… we are here to help smokers to quit.”
Source: Hartlepool Mail, 9 August 2018
Ireland: Casual smokers dangerously unaware of the health risks
A study published by the Royal College of Physicians of Ireland (RCPI) has found that people who only smoke a few cigarettes a week have a 40% greater risk of dying from a smoking-related disease compared with non-smokers.
Casual smokers, who account for one fifth of Irish smokers, are dangerously unaware of the risks associated with casual smoking, particularly over longer time periods. This problem is particularly acute for women aged 35 to 49 who smoke between one and four cigarettes a day, increasing their chances of developing lung cancer by one fifth.
Doctor Des Cox, chairman of the policy group on tobacco at the RCPI, said that casual smokers “carry almost the same risk of cardiovascular disease as daily smokers. While great progress has been made to reduce smoking rates in Ireland, we still have 20 per cent of under-25s taking [it] up. This pattern of smoking is often perceived to have lesser risk and people continue this pattern of smoking over longer periods, increasing their long-term exposure to tobacco smoke.”
Source: The Times, 9 August 2018
China: Xi’an city to ban smoking indoors
Xi’an, capital of Northwest China’s Shaanxi province has announced a ban on smoking indoors in public places.
The ban, which will come into force on 1 November, will also prohibit smoking in some outdoor public venues and will issue fines of up to ¥1000 for venue owners who fail to enforce the regulation.
China currently has around 300 million smokers and has pledged to reduce the smoking rate from 27.7% to 20% by 2030.
Source: China Daily, 8 August 2018
Tariffs on Chinese goods could harm US vaping industry
Proposed levies on US imports from China could increase the price of e-cigarettes by around 15%. The US vape industry imported 91% of its vaping products from China in 2016, leaving them vulnerable to the US government’s proposed tariff on Chinese goods.
According to a study in the Journal of Tobacco Control, this could cause a knock-on reduction in sales of approximately 12% and 19% for disposable and reusable e-cigarettes respectively. The vape industry is particularly sensitive to price increases due to the relative affordability of vaping compared to smoking.
Euromonitor International’s Head of Tobacco Research, Shane MacGuill, said the tariff could have a “significant detrimental impact on the vapour product industry.”
Source: Reuters, 8 August 2018
Journal of Tobacco Control: The impact of price and tobacco control policies on the demand for electronic nicotine delivery systems
Smoking estimated to cost Japan over ¥2 trillion
Japan’s Health Ministry has said that smoking cost the country ¥2.05 trillion in 2015, equivalent to around £14 billion.
Smoker’s medical fees accounted for over half the total at ¥1.26 trillion, with cancer treatment and treatment for passive smoking costing ¥500 billion and ¥330 billion respectively. This is in addition to a further ¥260 billion in nursing care fees for smoking-related diseases and ¥98 billion for smoking-related fires.
Ataru Igarashi, a member of the Health Ministry’s team and a specially appointed associate professor at the University of Tokyo, said: “We have found that smoking not only increases medical costs but also leads to financial losses in a range of areas such as nursing care.”
Source: Japan Today, 9 August 2018
Sunderland: Fire chiefs issue safety advice after suspected vape battery fire
Fire chiefs have issued safety advice after a fire in a family home which is thought to have been caused by a vape battery.
They advised that vapers never overcharge or leave e-cigarettes on charge unattended for long periods, not to mix components of different e-cigarettes and ensure they purchase their e-cigarette from a reputable source. Moreover, they recommend that users check the e-cigarette carries a CE certification, always use the correct charger and follow the manufacturer’s instructions.
National Fire Chief Council, Guidance on e-cigarettes
Source: Sunderland Echo, 6 August 2018
Norfolk: Roadshow will provide information about illegal cigarettes and tobacco
This Thursday, between 9am and 5pm, residents will be able to meet Yoyo the tobacco sniffer dog at Kings Square in Thetford. This visit is part of a bigger illegal tobacco roadshow, which will also be visiting King’s Lynn, Great Yarmouth and Norwich.
The purpose is to help people find out more about illegal cigarettes and tobacco, and the hazards they pose. So far, a two-year clampdown on illicit traders has seen Norfolk County Council’s Trading Standards and Public Health teams seize more than 1.3 million illegal cigarettes in addition to 123kg of illegal hand rolling tobacco, with 11 traders being prosecuted.
Smokefree Norfolk will also be present at the roadshow to provide residents with help on quitting smoking.
Source: Thetford and Brandon Times, 6 August 2018
Former smokers might want to eat more tomatoes
A new study has found that former smokers with diets high in tomatoes and fresh fruit had a slower rate of decline in lung function.
Researchers also found that among all adults, including people who had never smoked or had stopped, those with the highest tomato consumption had the slowest decline in lung function—meaning the benefits may not just be for former smokers. The study offers important evidence for the effect of diet on lung function.
European Respiratory Journal, Dietary antioxidants and 10-year lung function decline in adults from the ECRHS survey
Source: Vice, 6 August 2018
US: Tobacco marketed more heavily in city’s minority neighbourhoods, study finds
Tobacco products in Milwaukee, Wisconsin are more aggressively marketed in stores in African-American and Latino neighbourhoods than in white ones, according to a study led by a public health researcher at the University of Wisconsin-Milwaukee.
Results are in line with other studies, showing that communities with lower incomes, lower educational attainment and more minority residents are targeted with significantly more tobacco promotion.
This study is the first to document the trend in Milwaukee. “The evidence is increasingly clear that children who are exposed to tobacco marketing in stores are more likely to start smoking,” said Linnea Laestadius, assistant professor in the Zilber School of Public Health.
Tobacco Regulatory Science, Identifying Disparities and Policy Needs with the STARS Surveillance Tool
Source: Medical Xpress, 6 August 2018
US: Secondhand smoke is giving teens severe breathing problems, study says
A study has found that young people are missing school due to breathing problems caused by secondhand smoke. Young people who live with a smoker are more likely to report shortness of breath, wheezing and difficulty performing exercise. Those exposed to more than an hour of secondhand smoke had a 1.5 times increased risk of frequently missing school due to being sick. Additionally, they were 3.5 times more likely to have visited an urgent care facility or an emergency department over the past 12 months. The team of researchers from the University of Cincinnati in Ohio, is therefore calling on lawmakers to implement policy changes that further prohibit smoking in public places in all 50 states, to prevent teens from developing a number of health problems including asthma and lung cancer.
Lead author Dr Ashley Merianos, an assistant professor of health promotion and education at the University of Cincinnati, said “There was a [lack] of information about how [secondhand smoke] affects adolescents [without asthma], so we decided to look into this specific group of people.” The young people who took part in the study were part of the Population Assessment of Tobacco and Health Study, a US government study that looks at tobacco use and health among adolescents and adults.
Source: Mail Online, 6 August 2018
South West: More smokers in Poole admitted to hospital this year
Poole has seen a small rise in the number of smoking related hospital admissions in 2017, bucking the regional and national trend which shows steadily decreasing rates of smoking related admissions. NHS figures show that there were 1,665 hospital trips across the borough for diseases linked to smoking, 30 more than in 2016.
Data shows that smoking rates in England are decreasing, with the exception of smoking rates for pregnant smokers which have remained unchanged since 2016.
Deborah Arnott, chief executive of charity Action on Smoking and Health (ASH), said: “ASH supports the government’s vision, set out in the Tobacco Control Plan for England, of a smokefree generation. But smoking must become history for all of society not just for the wealthy. Cuts in public health funding and lack of treatment for smoking on the NHS mean poorer more heavily addicted smokers, including those who are pregnant, are not getting the help they need to quit.”
Source: Daily Echo, 10 July 2018
West Midlands: Fines for smoking on Sandwell Hospital grounds
Sandwell Hospital is aiming to go ‘smokefree’ from next summer, as hospital bosses seek to stop smoking outside hospital entrances.
Penalties will be applied to anyone caught breaking the new rules, which accompany a wider expectation from Public Health England that all hospitals will eventually become smokefree, providing support and treatment to help smokers quit. The trust which runs Sandwell General opted to implement the new policy in 2019 in light of major delays to the opening of the new Midland Metropolitan Hospital.
Toby Lewis, chief executive of the trust said, “We will continue to invest time, care and money to supporting people in our community to quit smoking. We will institute a fining system for anyone, staff, patients or visitors who smoke on our sites after the now agreed date.”
Source: Express & Star News, 10 July 2018
East Midlands: Young adults in West Lindsey giving smoking the red card
Rates of smoking among 18-24 years olds are on the decline as more and more young people choose not to smoke.
Office of National Statistics data shows that in West Lindsey, Lincolnshire, the percentage of the population who have never smoked has risen by 21% since 2011. This is consistent with UK-wide declines in smoking rates among 18-24 year olds, which have dropped from over 25% in 2011 to 17.8% in 2017.
Duncan Selbie, chief executive of Public Health England, said, “Smoking rates have dropped by almost a quarter in five years, a triumphant step in eliminating the nation’s biggest killer…we are tantalisingly close to creating the first ever smokefree generation in England.”
Source: Gainsborough Standard, 10 July 2018
Indonesia: Tobacco control and children’s rights
Indonesia has the highest uptake of smoking among youths in the world. Weak tobacco control policies and the tobacco industries’ aggressive marketing strategies have contributed to a male smoking rate of 67.4%.
The last two decades have seen smoking rates double for 10-14 year olds and triple for 5-9 year olds, culminating in a smoking rate of 41% for Indonesian children aged 13-15. Despite regulations banning smoking on school premises, many schools are surrounded by cigarette advertisements which target young people.
Indonesia also has among the cheapest cigarette prices in Southeast Asia and cigarettes can be purchased in single sticks which are easily affordable for children. The Convention on the Rights of the Child, ratified by Indonesia in 1990, commits the government to protecting children’s right to health. If children are to be protected from the harmful effects of smoking, the tobacco control community must show that smoking undermines this human right.
Source: The Jakarta Post, 11 July 2018
Tony Lloyd MP, Labour, Rochdale
To ask the Secretary of State for Health and Social Care, what steps his Department is taking to reduce lung health inequalities in deprived areas.
Steve Brine, Secretary of State for Health and Social Care
Two of the most significant respiratory health issues that impact deprived areas are poor air quality and smoking.
Minimising health inequalities is a core part of Public Health England’s (PHE’s) Mission and Strategic Vision for 2020. PHE was commissioned by the Department to review the evidence for effective interventions on air quality and provide recommendations that will significantly reduce harm from air pollution and impact on health inequalities at the local level.
PHE (Public Health England) has also published a number of reports on urban design which aim to support reductions in air pollution.
Smoking is a leading cause of a number of respiratory diseases including lung cancer and chronic obstructive pulmonary disease and is the leading cause of health inequalities. The Government’s Tobacco Control Plan for England, published in July 2017, re-emphasises the important role of local areas in providing support for smokers to stop smoking. As part of a comprehensive programme of national and local tobacco control activity, this is an important means of tackling inequalities in lung health in disadvantaged communities.
Source: TheyWorkForYou, 9 July, 2018
Scotland: Health board backs ASH Scotland’s smokefree charter
NHS Greater Glasgow and Clyde (NHSGGC), has signed ASH Scotland’s Charter for a Tobacco-Free Generation, which seeks to make Scotland tobacco free by 2034.
The charter is designed to drive down smoking rates, with smoking remaining the biggest single preventable cause of ill health and premature death in Scotland.
The NHSGGC director of public health and board member John Matthews OBE said, “our work already focuses on key charter principles and by signing the ASH Scotland charter we are committing the board to further sustained action to reduce tobacco-related harm by encouraging people not to start, supporting them to stop or protecting them from tobacco smoke.”
Source: Dumbarton & Vale of Leven Reporter, 18 June 2018
Scotland: Ban on smoking outside South Ayrshire cafes could be removed
Labour Councillor Phil Saxton is to table a motion calling for a rethink of South Ayrshire’s three-year-old ban on smoking outside cafes, which has been labelled a threat to small businesses
Councillor Saxton, who is looking for “compromise” is now expected to lead calls for a mixed smoking zone outside cafes or bars which use council-owned pavements.
That vote is scheduled to take place on the 28th of June when the council holds its last full meeting before the summer recess. It is understood that members are currently divided on the issue.
Source: Daily Record, 18 June 2018
US: Smoking hits another all-time low
About 14% of US adults were smokers last year, down from about 16% in 2016, government figures show. The findings come from a national health survey by the Center for Disease Control and Prevention.
K. Michael Cummings, from the tobacco research program at the Medical University of South Carolina, said “everything is pointed in the right direction,” but that the new figures mean there are still more than 30 million adult smokers in the country.
Experts say a comprehensive suite of tobacco control campaigns, cigarette taxes and smoking bans have contributed to this overall decline. The launch of electronic cigarettes and their growing popularity has also likely played a role, since e-cigarettes heat liquid nicotine into a vapour without the harmful by-products generated from burning tobacco.
Source: The New York Times, 19 June 2018
US: Tobacco companies’ websites to post court-ordered warnings
Tobacco companies must now include statements on their websites that clarify the health impact of smoking and secondhand smoke, the addictive nature of smoking, that cigarettes labelled “low tar” and “light” are no less harmful, and the way in which nicotine delivery has been enhanced by cigarette design.
The statements were ordered on the 1st of May as part of a 2006 federal court decision that found major cigarette manufacturers, including R.J. Reynolds and Philip Morris, had defrauded the public about the health risks of their products. The companies affected are Philip Morris USA and its parent company Altria, R.J. Reynolds Tobacco and Lorillard, which is now owned by Reynolds American.
Robin Koval, CEO and president of the Truth Initiative, a tobacco control nonprofit, has said “the corrective statements are fine, but we would have rather seen corrective action from the tobacco industry.” He also points out that these statements will have little impact on smoking in young people, since such websites are not available to those under 21.
Source: CNBC, 18 June 2018
US: Vermont tobacco control group calls for smokefree area
A tobacco control group in Vermont has urged Montpelier leaders to create a half mile long smokefree zone in the city’s downtown area. The Central Vermont New Directions Coalition will present a petition to the Montpelier City Council later this month, and so far the group has collected about 1,500 signatures.
Coalition member Ann Gilbert says the organisation is trying to protect families and elderly residents who visit the downtown area, claiming that a smoking ban is a big part of creating a health community.
Source: US News & World Report, 18 June 2018
Thailand: Uttaradit province runs tobacco control campaign on social media
A tobacco control campaign is underway in the Uttaradit province of Thailand to encourage community health leaders to create tobacco control video clips for distribution on various social media platforms, such as Facebook and Instagram, highlighting the dangers of cigarettes.
The Uttaradit Mass Communication Club will be working with ASH Thailand and other health and public relations volunteers to discourage smoking and call for strict enforcement of the Tobacco Control Act 2017.
Source: National news Bureau of Thailand, 18 June 2018
Australia: Secret website selling cheap tobacco
Australia is the most expensive place in the world to buy cigarettes, with the average cost at nearly $40 a packet. The Treasurer, Scott Morrison, has also planned the second of four consecutive 12.5% tobacco excise increases for the 1st September. This is expected to add another $3 to the price of a typical packet.
However, some smokers are now using a secret website called ‘Ciggies World’ to buy packets of cigarettes at prices up to 70% lower than retail price. Whilst a packet of Marlboro Gold cigarettes retails for about $30 in Australia, the Ciggies World website sells a pack of 20 for $4.
Although the prices are comparatively cheaper, smokers may have to wait for over a month before they receive their cigarettes, and could be forced to pay unexpected taxes.
Source: Mail Online, 19 June 2018
Smoking is the single biggest avoidable risk factor for cancer. It is estimated that one in two people born after 1960 in the UK will be diagnosed with some form of cancer during their lifetime and that more than one in four will die from the disease. July 2017.04. Smoking and Cancer
There is a strong association between smoking and mental health conditions. However, people with mental health conditions are generally able to quit smoking if they are given evidenced-based support. December 2016.Smoking and Mental Health
Cigarette smoking can affect fertility in both women and men, sexual function in men, pregnant women’s health, the health of an unborn child, and the health of young children. Dec. 2016.07. Smoking and Reproduction
Levels of secondhand smoke in cars can be extremely high due to the restricted space in which the smoke is circulated. August 2018
Exposure to tobacco smoke via both active and passive smoking has been shown to increase the risk of developing meningococcal disease. July 201632. Smoking and Meningococcal Disease
Smoking causes around 80% of deaths from lung cancer, around 80% of deaths from bronchitis and emphysema, and about 14% of deaths from heart disease. More than a quarter of all cancer deaths can be attributed to smoking.FaG: Smoking and Disease
This document was created by ASH in partnership with the Royal College of Surgeons of Edinburgh, the Royal College of Anaesthetists and the Faculty of Public Health. It was endorsed by the Royal College of Surgeons, Royal College of Physicians and the Royal College of General Practitioners. It has been designed for health professionals and commissioners, to provide clear advice and examples of good practice in relation to smoking and surgery.Joint Briefing: Smoking and Surgery
The Mental Health and Smoking Action Report
People with mental health conditions die on average 10-20 years earlier than the general population and smoking is the single largest factor accounting for this difference. Around one third of adult tobacco consumption is by people with a current mental health condition with smoking rates more than double that of the general population.
The Stolen Years, a report by ASH, endorsed by 27 health and mental health organisations, sets out recommendations for how smoking rates for people with a mental health condition could be dramatically reduced. These include improved training of healthcare staff, better access to stop smoking medication and a move towards smokefree mental health settings.
Mental health, smoking and poverty in the UK
Mental health, smoking and poverty in the UK
ASH survey of people with mental health conditions
ASH survey of people with mental health conditions
ASH Factsheet: Smoking and Mental Health
15. Smoking and Mental Health
This briefing explains why smoking is a major contributory factor and what can be done to reduce health inequalities caused by smoking. It examines the relationship between smoking and socio-economic status, and certain social groups such as people with mental health conditions, prisoners, looked-after children and ethnic minorities.ASH Briefing: Health inequalities and smoking
Health policy is largely formulated and implemented by the devolved administrations of each of the member countries of the United Kingdom. However, as tobacco falls within the remit of a number of different government departments: e.g. Treasury, Business, HMRC as well as Health, tobacco control policy is partly determined at UK-wide level and partly by the devolved administrations. The four nations of England, Scotland, Wales and Northern Ireland have responsibility for their own smoking cessation and health education campaigns while UK-wide policy and law applies to taxation, smuggling, advertising, and consumer protection issues such as the provision of health warnings on tobacco packaging. Some of these measures are determined by European Union legislation.UK Tobacco Control Policy and Expenditure: An overview