Category Archives: Tobacco Control

Tobacco Control

image_pdfimage_print

Launch of Heartfile’s Report on status of Tobacco Control Laws Monitoring Report

Heartfile, convened a dissemination event at Margala Hotel Islamabad to disseminate their findings on Status of Tobacco Control Laws (TCLs) compliance in 10 districts of Pakistan. The report aims at assessing the compliance of TCLs with respect to Pakistan’s Framework Convention on Tobacco Control (FCTC) commitments and attempts to identify gaps and challenges in TCLs monitoring framework alongside recommendations on how to overcome these gaps.
Prominent figures from various sectors, including government officials, health and tobacco control experts and civil society representatives from all over Pakistan graced the event.

Launch of Heartfile’s Reports on Smokeless Tobacco and New Nicotine Products.

February 06, 2024: Heartfile convened a dissemination event at Serena Hotel Islamabad to unveil their recently generated evidence on Smokeless Tobacco (SLT) and Tobacco and New Nicotine Products (TNNPs) in Pakistan. Eminent parliamentarians Senator Fawzia Arshad and Senator Seemee Ezdi graced the event. It also gathered prominent figures from various sectors, including government officials, health and tobacco control experts and civil society representatives from all over Pakistan.

Access Press Release from this link.
Heartfile TNNPs Final Report
Heartfile SLTs Final Report
TNNPs Policy Brief

Dr. Saba Amjad Highlights Urgent Need for Comprehensive Tobacco Control Policies at the 13th International Public Health Conference

Islamabad: Heartfile, in collaboration with Pakistan National Heart Association (PANAH) and Global Health Advocacy Incubator (GHAI), participated at the 13th International Public Health Conference held at HSA Islamabad. The event, featuring a scientific session titled “Tackling Non-Communicable Disease Risk Factors” focused on crucial health issues in Pakistan, brought together a panel of experts from government bodies, civil society organizations, and advocacy groups.

Also together with aforementioned partners, Heartfile setup and maintained presence at a stall inside the event venue for increasing networking and the visibility of Heartfile’s past and present work on NCDs alongside partners’ published materials. Heartfile’s documentary films on ,iTFAs, ENDS and ONPs were screened repeatedly.

Heartfile team actively participated in the scientific session. The session explored both Dietary Risk Factors, including industrially produced trans-fatty acids (iTFAs) and sugar-sweetened beverages (SSBs), and non-Dietary Risk Factor of Tobacco use.
In his keynote address, Dr. Khawaja Masuood Ahmed, National Coordinator for Nutrition & National Fortification Alliance of the Ministry of National Health Services, Regulations & Coordination, provided valuable insights into the milestones achieved and challenges faced in Pakistan’s battle against NCDs and appreciated Heartfile’s valuable contributions to the process referring to Heartfile’s iTFA Situational Analysis in Pakistan and National Action Pan for NCDs (NAP-NCD)  for adopting global best practices with regards to iTFAs.

Mr Munawar Hussain, the country coordinator for GHAI in Pakistan, highlighted the NCD dietary risk factor of excessive sugar intake in his talk and demonstrated its linkages with the SSB industry and its products. Mr Munawar presented international best practices at length and the developments thereof particularly the of Front of Pack Labelling (FOPL) policies and standards adopted by various countries.

Mr Sanaullah Ghumman, General Secretary of PANAH gave a detailed chronology of his organization’s direct interactions with parliamentarians to garner political support for NCD related regulations highlighting both the highs and lows of their struggle in this battle.

Dr. Saba Amjad and her team, in their presentation, focused on the non-dietary NCD risk factor of Tobacco. The discussion addressed critical challenges in this domain and presented the latest contextual evidence regarding emerging nicotine-based products, including Electronic Nicotine Delivery Systems (ENDS), Heated Tobacco Products (HTPs), and Oral Nicotine Pouches (ONPs) in Pakistan. Their presentation also highlighted the existing gaps in Pakistan’s regulatory framework to address these products and drew from international experiences in combating this emerging threat. Dr. Amjad concluded her address by proposing key policy recommendations and outlining a strategic way forward to effectively tackle the challenges posed by tobacco and related emerging products.

In her closing remarks the chair of the Scientific session Dr Afshan Tahseen Vice president PANAH summed up the discussion and appreciated the work of all organizations. She seconded the speakers’ opinions & policy recommendations and vowed to continue the advocacy work.

Overall, this session provided a pivotal platform for informed discussions, fostering collaboration between experts and stakeholders to strengthen the nation’s efforts in curbing the adverse impact of tobacco on public health and the dietary risk factor of iTFAs and SSBs.

The Many Faces of Modern Addiction

The tobacco industry uses different avenues to reach consumers, some of which are intentionally obfuscated to remove obvious affiliation with the industry. Faux grassroots organizations lobby against e-cigarette regulation, marketing campaigns masquerade as public health initiatives and high-profile sports sponsorships place tobacco product advertising before millions of fans.

Learn about the ways the tobacco industry hides in plain sight, enabling it to advance its agenda of hooking more users on its deadly products.

Full Article Access Here

Why the Industry Loves—and Protects—Tobacco Flavors

The dangers of flavored tobacco are clear: It’s appealing to young people, makes it easier to start using tobacco and harder to quit. In other words, tobacco flavors are one of the most effective tools the tobacco industry has to hook the next generation.

That’s why the industry fights flavor bans or finds ways to work around them. If flavors aren’t there to cover up the unpleasant taste, smell and sensation of tobacco for young or new smokers, fewer people will become lifelong tobacco users. That means less strain on health systems and economies. Less loss and grief for families and communities. But to tobacco companies, it means only one thing: less profits.

Why the industry loves tobacco flavors

Getting young people hooked on its products is integral to the survival of the tobacco industry. If there were no new tobacco users, tobacco companies would go out of business when current users either quit or die from using their products. So the industry targets young people as “replacement smokers”—a term actually used by an R.J. Reynolds employee in 1984. While that phrase was uttered almost 40 years ago, the tactic of targeting children and young people is still very much in use today.

Many current tobacco users report that the first tobacco product they ever tried was flavored. And data suggests that those who experiment with flavored tobacco are more likely to become lifelong tobacco users. In short, flavors are often a path from experimentation to regular use—one which the industry won’t give up without a fight.

How the industry fights bans or finds ways to work around them

As of 2021, about 40 countries have implemented or plan to implement policies around flavors to protect young people, in line with recommendations in the global health treaty, the WHO Framework Convention on Tobacco Control. In response, the industry takes action to protect its profits.

Knowing that the lack of flavors could reduce the number of young people who start using tobacco, tobacco companies lobby against bans before they go into effect. In 2013, Chile’s Ministry of Health tried to introduce a ban on menthol cigarettes, but the ban was rejected after tobacco industry lobbying. When a new bill to ban menthol was introduced in 2015, British American Tobacco threatened to withdraw its operations in the country.

Tobacco companies also fight bans after they’ve been approved. Just two days after voters in the state of California in the United States voted to ban flavored tobacco, R.J. Reynolds filed a federal lawsuit to block the ban from going into effect. (The Supreme Court denied the company’s request.)

Flavor bans often follow one of two approaches: Governments can ban all flavor additives, or they can ban “characterizing flavors.” With a ban on “characterizing flavors,” tobacco companies can still include flavoring additives as long as the user cannot perceive them—though evidence suggests these additives can still make tobacco more palatable.

Full Article Access Here

Did Tobacco Companies Also Get Us Hooked On Junk Food? New Research Says Yes

The chemically addictive fatty, salty and sweet foods that make up 68% of the American food supply have historically been pushed to consumers by the nation’s leading tobacco sales companies, new research shows, suggesting the same companies responsible for what has been called a “smoking epidemic” could also be partially blamed for a decline in Americans’ health.

KEY FACTS

Food producers owned by tobacco companies like Phillip Morris and RJ Reynolds developed a disproportionately high number of what scientists call “hyper-palatable” foods between 1988 and 2001, a study out Friday by University of Kansas researchers said, “resulting in substantial tobacco-related influence on the U.S. food system.”

In the same way tobacco companies formulated cigarette products to maximize their addictiveness, the study’s authors accuse the food producers of taking the same tactics, pumping edible and drinkable products full of sugar, caffeine, fat, sodium and carbs to “create an artificially rewarding eating experience.”

Foods produced by tobacco-owned companies were 29% more likely to be classified as hyper-palatable—having a certain mix of ingredients designed to be addictive—due to fat and sodium, the study’s authors found, and 80% more likely to be ultrahigh in carbohydrates and sodium than foods that were produced by other companies.

Tobacco companies largely divested from the U.S. food system in the early 2000s, the research published in peer-reviewed journal Addiction says, but “the shadow of big tobacco remained”—those hyper-palatable foods are still mainstays of the American diet, and those who consume them are more likely to be obese and have related health problems.

Food producers that were once tobacco-owned include Kraft-General Foods—merged together by Phillip Morris to become what was then the largest food company in the world—and Nabisco, which together produced products under the brands Oreo, Ritz, Miracle Whip and Oscar Meyer, among others.

CRUCIAL QUOTE

“These foods may be designed to make you eat more than you planned,” lead author Tera Fazzino said in a statement. “It’s not just about personal choice and watching what you eat—they can kind of trick your body into eating more than you actually want.”

Full Article Access Here

Tobacco Taxes Promote Equity: Evidence from Around the Globe

The tobacco industry is intent on keeping its products affordable to people with low incomes, who already face health and economic inequities. Research from around the world reveals that tobacco use makes these inequities worse: Data show that spending money on tobacco—and treating tobacco-related diseases—deepens existing income inequities and worsens financial strain.

Increasing taxes on tobacco products is proven to be an effective way to lower tobacco use, especially among price-conscious consumers with lower incomes, including youth. Learn more about how tobacco taxes promote equity.

Full Article Access Here

FBR seizes cigarettes from a leading manufacturer for alleged tax violations

ISLAMABAD: The Federal Board of Revenue (FBR) has taken action against a well-known cigarette manufacturer, Philip Morris (Pakistan) Limited (PMPKL), allegedly for violating tax regulations.

The operation was triggered when it was discovered that the company had been allegedly distributing cigarettes below the minimum retail price, contravening tax laws.

Under Pakistan’s stringent regulations to control tobacco use, the government has enforced high taxation on tobacco products to discourage smoking.

According to officials at FBR , approximately 650 cartons of cigarettes were confiscated by the FBR in this enforcement action, accompanied by a thorough investigation. The operation was carried out in accordance with the Federal Excise Act, 2005, particularly Section 19, which explicitly prohibits selling cigarettes below the set retail price, which is what PMPKL is accused of doing. In addition to confiscation, the Act empowers authorities to impose fines and penalties on violators.

The location of the raid remains a mystery. Officials from FBR claim that the raid took place in Karachi and the FBR arm of Karachi conducted it. The spokesperson from Philip Morris however denied that the raid took place in Karachi, claiming that the operation in question was conducted in Sahiwal, Punjab, which would fall under the jurisdiction of FBR Punjab.

“This action underscores the government’s commitment to upholding tax laws and safeguarding public health. Violations of these regulations not only undermine public health initiatives but also lead to revenue losses for the government”, explained an FBR official while talking to Profit. 

A spokesperson from Philip Morris responded to the situation, asserting that the company is fully compliant with tax obligations for all its brands, including Marlboro Advance. The spokesperson highlighted that the company is cooperating with the FBR and is dedicated to tackling illicit trade in Pakistan, which poses a significant challenge due to the proliferation of untaxed cigarettes.

Full Article Access Here

Smokers who start below age 20 find it difficult to quit, finds study

Researchers have urged governments to raise the legal age to buy cigarettes to 22 years or higher as a new study has found it becomes less addictive and easier to quit as people get older.

The legal age to purchase tobacco is 18 years old in many countries but in some nations, there are no age restrictions.

It is estimated that nearly 9 out of 10 adults who smoke cigarettes daily first try smoking by age 18, and 99 per cent first try smoking by age 26.

Results showed that starting smoking early is linked with higher nicotine dependency, even in young adulthood, and early starters were 30 per cent less likely to quit the habit compared with late starters.

“The study indicates that increasing the legal age to buy tobacco to 22 years or older could lead to a reduction in the number of people addicted to nicotine and at risk of adverse health consequences,” said study author Dr Koji Hasegawa of the National Hospital Organisation Kyoto Medical Center, Kyoto, Japan.

This study examined the relationship between the age of smoking initiation, nicotine dependence and smoking cessation.

Participants were divided into two groups based on the age they started smoking (less than 20 years old and 20 years or older).

Twenty years was used as the cut-off.

The researchers analysed the associations between nicotine dependency and successful smoking cessation according to the age participants started smoking.

The study included 1,382 smokers, of whom 30 per cent were women. Some 556 smokers started smoking before age 20 (early starters), while 826 smokers were 20 years of age or older when they began smoking (late starters).

Early starters reported a higher number of cigarettes per day (25) compared with late starters, who smoked 22 cigarettes per day.

Those who started early had higher respiratory carbon monoxide levels compared with those who started late.

Less than half of early starters (46 per cent) successfully quit smoking compared with 56 per cent of late starters, indicating that early starters were 30 per cent less likely to successfully kick the habit compared with late starters, said the study presented at ‘ESC Congress 2023’.

Full Articles Access Here

How smoking harms the brain

We know that smoking is bad for our lungs and heart, but now we know that it harms the brain as well.  As part of our Staying Sharp series, Dr Sherif Karama of McGill University, Canada, reveals the evidence.

Lifestyle choices affect brain ageing

People with good cognitive abilities (i.e. thinking skills) in old age tend to be those who have had good cognitive abilities throughout their lives. Nonetheless, in old age, most, if not all, of us exhibit a certain degree of decline in some thinking skills, like learning new information and being able to quickly shift from one mental task to another.

However, some of us show a steeper rate of decline than others. The factors that affect this rate of decline are still being researched but some are already clear and one of them is smoking.


Smoking speeds up brain ageing

While the effect of smoking on cognitive abilities is relatively small and requires large studies to be able to be detected, it is nonetheless present. Recently, we also looked at the effect on the structure of the brain by examining data from the Lothian Birth Cohort 1936 (LBC1936) at age 73.

We found that smokers had a thinner cerebral cortex than non-smokers – in other words, smoking was destroying the grey matter in smokers. This is important because the cerebral cortex is a part of the brain that is crucial for thinking skills including memory and learning, so thicker is better.

The cortex does tend to thin with age naturally but we found that, all else being equal, the more people had smoked, the more they tended to have a thin cortex. These results suggest that smoking accelerates the normal thinning of the cortex that occurs with age.

Why quitting matters

Importantly, people in the LBC1936 who stopped smoking early enough in their life seemed to partially recover with time. However, this recovery can be a long process.

In this group of people, we worked out the average number of cigarettes that they had smoked in their lifetime. This was around 196,000 cigarettes, that is, 20 a day for 26.9 years.

For those who had smoked the average number, it took roughly 25 years for complete recovery of the affected areas of the cortex. Those who had smoked less than the average recovered faster, while those who had smoked the most still had a long way to go to recover at age 73.

Overall, this shows that cognitive and brain ageing is a dynamic lifelong process. It is not something that simply happens in old age and does not appear to be determined simply by one thing that you do or avoid as you reach old age.

Rather, it appears to be the consequence of multiple factors that include genetic and environmental factors and the lifestyle choices we make, that have been playing a role throughout our lives.

Full Article Access Here

More teens blowing away life in puffs of e-cigarettes, study warns

KARACHI: Despite having sufficient knowledge about the potential health risks associated with nicotine exposure, an increasing number of young people are getting hooked on e-cigarettes, smoking devices that are powered by a battery, says a study recently published in an online journal.

Titled ‘Electronic Cigarettes and their Knowledge, Attitude and Practices among Pakistani Population: A Multi-City Study Across Pakistan’, the research is jointly conducted by the Aga Khan University and Multan Medical and Dental College.

Over 800 individuals with mean age 29.6 years participated in the study during which 43.4 per cent respondents reported using e-cigarettes.

“This is significantly higher than a 2017 study conducted among adolescents when prevalence of e-cigarettes was just 24 per cent. The current study also found that the mean age at which people start using e-cigarettes is 17 years and that 58 per cent of people believe smoking makes young people look ‘cool’,” it says.

The study, the first nation-wide research on the subject, also found that more than half of the respondents (55pc) had sufficient knowledge regarding e-cigarette use.

Among the participants, 6pc of the individuals were found to have hypertension, around 0.1pc reported asthma and 35.4pc had a positive history of anxiety, depression, or any other psychiatric illness.

The total income of 79pc of the respondents was greater than Rs60,000.

E-cigarettes, powered by a battery, are portable and can be used repeatedly. These devices utilise a piezo-electric component to convert a solution into vapour that is then inhaled by the user via a refillable cartridge and mouthpiece.

Use of these devices is associated with a risk of dyspnea, lung cancer, chest pain, nausea, vomiting, and a myriad of other ailments, the study says.

Increasing social acceptability

The study indicates increasing promotion and social acceptability of e-cigarettes in recent years in Pakistan. Most participants had learned about e-cigarettes from either their family and friends or the internet.

Furthermore, 58pc of individuals believed that e-cigarette use helped young people ‘fit in’ and 39.3pc admitted that they would probably try e-cigarettes if their friends asked them to do so.

“This deviates from a previous study conducted in Pakistan in which most respondents did not think that people began smoking due to peer pressure and 59.3pc people claimed that they would not smoke for their friends,” the study says.

Wrong perception

The majority of the participants wrongly believed that e-cigarettes were effective in helping people quit regular smoking while 20.5pc of the people thought that it’s extremely effective.

Around 41pc of the people were of the opinion that e-cigarettes had lesser harmful effects as compared to regular cigarettes. At least 31pc of the people thought that e-cigarettes were just as addictive as regular cigarettes while 11pc thought that they were less addictive.

According to the study, the sale of e-cigarettes in Pakistan primarily began in Karachi in 2008 and rapidly spread to various other cities.

Healthcare professionals have struggled to accurately identify trends in the awareness and use of e-cigarettes due to a lack of research conducted on a national scale in the general population.

Tobacco companies, it says, have flaunted the claim that e-cigarettes are a ‘healthier’ alternative to regular cigarettes, and some even ran social media campaigns about the health advantages of their products during the Covid-19 pandemic.

“These companies have been able to target adolescents and young adults in their promotional campaigns due to lack of legislation regarding e-cigarettes in the country,” Dr Javaid Ahmed Khan, senior professor and consultant pulmonologist at the Aga Khan University Hospital and principal investigator of the study, says.

He attributed the use of e-cigarettes by people under 18 years to the misleading promotion of e-cigarettes by influencers and celebrities, describing these devices as harmless to a young audience who perhaps would have otherwise not smoked at all.

“Pakistan does not have any set minimum age of purchase of e-cigarettes, nor do we have any laws regarding the promotion and regulation of such products. This has resulted in online shops operating unregulated companies selling products without any health warnings on the packaging, and a lack of age-verification at vape stores,” Dr Khan shared.

He described the rise in prevalence of these devices as alarming as it indicated a health crisis in coming years like the one caused by tobacco cigarettes in the 20th century.

“In the current study, most participants believed that e-cigarettes were either slightly or extremely effective at smoking cessation. This perception is at odds with WHO’s recommendation that e-cigarettes could only be used for cessation in patients who refuse other treatment options,” he said, adding that studies had found that individuals aged between 14 and 30 years who used e-cigarettes were likely to start smoking regular cigarettes.

Full Article Access Here

Vaping just once raises oxidative stress levels in nonsmokers, increasing disease risk

The risk that both tobacco and electronic cigarettes can pose to regular smokers’ health has been well documented, but a new UCLA study illustrates just how quickly vaping can affect the cells of even healthy younger nonsmokers.

The findings, published today in JAMA Pediatrics, show that a single 30-minute vaping session can significantly increase cellular oxidative stress, which occurs when the body has an imbalance between free radicals — molecules that can cause damage to cells — and antioxidants, which fight free radicals.

“Over time, this imbalance can play a significant role in causing certain illnesses, including cardiovascular, pulmonary and neurological diseases, as well as cancer,” said the study’s senior author, Dr. Holly Middlekauff, a professor of cardiology and physiology at the David Geffen School of Medicine at UCLA.

E-cigarettes, devices that deliver nicotine with flavoring and other chemicals in a vapor rather than smoke, are seen by many as a safer alternative to regular cigarettes, but research by Middlekauff and others has demonstrated that vaping is associated with a number of adverse changes in the body that can presage future health problems.

For the current study, 32 male and female study participants, who ranged in age from 21 to 33, were divided into three groups: 11 nonsmokers, nine regular tobacco cigarette smokers and 12 regular e-cigarette smokers. Middlekauff and her colleagues collected immune cells from each individual before and after a half-hour vaping session to measure and compare changes in oxidative stress among the groups.

The researchers performed the same process during a control session in which participants spent 30 minutes “sham-vaping,” or puffing on an empty straw.

They found that in nonsmokers, oxidative stress levels were two to four times higher after the vaping session than before. The same 30-minute exposure did not lead to an increase in oxidative stress among the regular cigarette and e-cigarette smokers, the researchers noted, most likely because their baseline levels of oxidative stress were already elevated.

“We were surprised by the gravity of the effect that one vaping session can have on healthy young people, “Middlekauff said. “This brief vaping session was not dissimilar to what they may experience at a party, yet the effects were dramatic.”

The results are especially troubling, the researchers say, because the popularity of vaping continues to increase, particularly among teens and young adults. According to a 2020 study, nearly 1 in 3 high school students reported that they had used an e-cigarette during the previous month.

There is still more to be understood about what exactly causes the changes in oxidative stress levels — whether it is the nicotine or non-nicotine elements in e-cigarettes — the researchers say. Middlekauff and her team will continue to explore this question in future research.

“While there’s a perception that e-cigarettes are safer than tobacco cigarettes, these findings show clearly and definitively that there is no safe level of vaping,” Middlekauff said. “The results are clear, unambiguous and concerning.”

Other authors of the study included Dr. Theodoros Kelesidis, Elizabeth Tran, Randy Nguyen, Yuyan Zhang and Grace Sosa, all of UCLA.

The research was supported in part by the Tobacco-Related Disease Research Program of California and the National Institutes of Health.

Full Articles Access Here