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July-August 2017
10 years of the smoking ban celebrated across Europe
2007 marks the 10 years anniversary of the ban on smoking in public places in a number of European countries. In 2007 comprehensive smoke-free laws were introduced in countries such as Estonia, France, Finland, Denmark, Slovenia and the UK.

In England the indoor smoking ban was introduced on 1 July 2007, lining up with similar measures in place in the rest of the UK. The anniversary was widely celebrated this year with highlights of the inspiring ahievements:
  • 98,2% complied with the ban of premises,
  • there has been a sharp decrease in the number of smokers, including the number of young smokers,
  • fewer women smoke during pregnancy,
  • people's attitudes towards smoking bans have improved,
  • and bar workers have become healthier.

Adoption of the ban was reflected in significantly decreased mortality from hearth diseases. The statistics of Public Health England (PHE) showed that the number of smokers aged 35 and over dying from heart attacks and other cardiac conditions has dropped by over 20% since 2007 while fatalities from a stroke are almost 14% down.

More and more people support smokefree laws in England with 83% of respondents in favour; while it was endorsed by 78% back in 2007 when the ban was implemented. The report by ASH, Smokefree: The First Ten Years, states that this increase is explained mainly by growing support by smokers themselves (from 40% to 55%). Moreover, the report clearly demonstrates a switch in the mindset of smokers towards stronger support for further tobacco control measures such as a licensing scheme for tobacco retailers and a levy on the tobacco industry to pay for measures to reduce smoking prevalence.

Read more about the 10 year anniversary celebrations in France, Finland and Denmark (National languages).

ENSP 20th Anniversary Awards

Congratulations to the awardees of the ENSP 20th Anniversary Awards for Outstanding Contribution to Tobacco Control. The Awards were most recently presented to Aurelijus Veryga, Minister of Health of the Republic of Lithuania and former ENSP Board member and Elisabeth Tamang, member of INWAT and former ENSP President.
Prof Aurelijus Veryga, Minister of Health of the Republic of Lithuania, former ENSP Board member

"My heart will always go to ENSP for which we created the Lithuanian coalition to become member"

"ENSP has been endeavouring at improving human health for 20 years already! I am proud to have had the opportunity to be part of this significant organization and to contribute to one of the most important areas of improvement in public health. I have been actively involved with ENSP especially when I was member of the Board between 2007 and 2011. We have fought together many battles to save lives from the harm caused by tobacco use".

Elisabeth Tamang, member of INWAT, former ENSP President and Board member

"At the beginning the strength of ENSP was to unite NGOs effort on Tobacco Control and to support the development of National Coalitions. It was particularly helpful to countries that were struggling to start the tobacco control process and introduce legislations. Then ENSP became a sort of EU incubator of projects on Tobacco Control and organised experts workshops and had the capacity to put together relevant partnerships. ENSP was also strong in disseminating information and good practice and collecting support for tobacco control policy at the European level".

Initiative against tobacco industry interference in Bosnia and Herzegovina endorsed by 54 organisations
On 16-17 June Association PROI from Bosnia and Herzegovina threw light on the fact that a recent summit gathering the officials from Western Balkans in Montenegro was sponsored by JTI. Along with the violation of the FCTC Article 5.3 PROI is concerned with the participation of World Bank representatives in the event.
The summit of ministers of finance, governors and directors of tax administrations of the region, "Regional Financial Stability in a New Global Environment" was held from 16 to 17 June in Bečići in Montenegro. The summit became a tobacco industry platform for lobbying against effective public health policy and cost-effective tobacco control measures and as a result, media reports following the event warned about the "negative effects" of tobacco taxation in Western Balkans and the "need to slow down the increasing excise duties on tobacco in Bosnia".

PROI has already sent appeals to Bosnian officials and on 12 July 2017 the association sent a letter of concern regarding violation of FCTC Article 5.3 to World Bank officials, urging them to address the inappropriate situation and take the necessary steps to uphold the spirit and principles of Article 5.3 of the WHO FCTC in decisions regarding participation in future events and conferences. PROI was supported by 54 public health and tobacco control organisations from across Europe, many of the ENSP members and friends. Thank you all for your support.

Read the full letter.
Track and trace of tobacco products
ENSP factsheet on tracking and tracing of tobacco products: all you need to know on this technical issue
Nearly 10% of the global cigarette trade is illicit; this is significantly higher in low and middle-income countries, reaching up to 50% and above. This makes Illicit tobacco trade a worldwide danger to public health and economy.
Among the negative consequences of illicit trade are:
  1. Severe risks to public health
  2. Support of organised crime
  3. Significant economic harm and loss in government revenue
  4. Destroyed fair trade
  5. Negative ecological consequences

Track and trace systems of tobacco products will become obligatory in the EU by 20 May 2019 due to the implementation of Art. 15 and 16 of the Tobacco Products Directive (2014/40/EU) (10). They are also due for implementation globally based on Art. 8 of the WHO FCTC Illicit Trade Protocol.

Track and trace systems are successfully used to control tobacco production and trade in several countries in the world by determining the current and past locations, the time and status and other information of a unique item. They are shown to significantly increase tax collection, create new legal businesses, improve public health and consequently decrease smoking prevalence.

Read more about track and trace systems and the tobacco industry's internal controlling systems CODENTIFY and INEXTO in the new ENSP fact sheet Tracking and tracing to fight illicit trade in tobacco products.

European Commission report on the strategy to
fight Illicit trade
In June 2013 The European Commission's Joint Research Centre published the report "Stepping up the fight against cigarette smuggling and other forms of illicit trade in tobacco products - a comprehensive EU strategy (Com (2013) 324 final of 6.6.2013)" on the issue of tracking and tracing and the European Commission's strategy to illiminate illicit trade.
Juan Yanez, chair of the International Tax Stamp Association (ITSA), criticises the suggestion made in the report that the European Commission's DG SANTE could take the tobacco industry's tracking & tracing system CODENTIFY as a "starting point" in developing the EU-wide tracking and tracing system. Yanez notes that it is counterproductive that one Commission service seems to endorse a specific system while another works on choosing between different systems. He also criticises the CODENTIFY system itelf as being insufficient for the requirements of the EU Tobacco Products Directive.

Read the full report.
Prof Loïc Josseran, new President of the French Alliance Contre le Tabac
On Wednesday 27 June 2017, Loic Josseran, Professor in Public Health at the Versailles St Quentin University, was elected President of the national French coalition Alliance Contre Le Tabac. Josseran started working in tobacco control in 1998 when he went to the United States on a research stay to study French data on tobacco consumption. Returned to France he set up a staff prevention and smoking cessation service at the Pitié-Salpétrière Hospital in Paris and worked within the smokefree hospitals network.
As President of the Alliance, Prof Josseran is strongly committed to encourage strong partnership amongst all members of the French national alliance, in order to work together to increase efficacy and effectiveness of specific tobacco control policies.

“The civil society needs to remain very active and alert as this is it strength. At the moment the tobacco industry is very offensive and the Alliance needs to stay vigilant, cautious and on its guard. It has the ability to be flexible, quickly responsive and able to mobilise forces at very short notice,” he notes.

Prof Josseran would like to increase the amount of activities at European level in order to benefit from international expertise and to share French experiences. The exchange of knowledge and information between France and the rest of Europe will be vital to progress together towards stronger and better tobacco control.

Read the full interview with Prof Loic Josseran.
Dutch case against tobacco industry goes global
Lawyers in 17 countries are now following Dutch lawyers' lead in suing the tobacco industry for attempted murder or aggravated assault.

The Dutch Cancer Society (KWF) has sued four major tobacco companies for aggravated assault resulting in death and forgery. Until now law suits against tobacco companies have all been civil law cases, where the company was deemed to pay a fine and subsequently allowed to continue its business. In this case, Dutch lawyer Benedicte Ficq wants to take the industry to court on criminal charges for deliberate misinformation to consumers. According to the Dutch newspaper AD, lawyers from 15 countries were present at a meeting recently held in Geneva to examine the Dutch case.

The producers involved in the case are Philip Morris International, British American Tobacco, Japan Tobacco International and Imperial Tobacco Benelux. The Public Prosecutor will decide whether the tobacco industry will actually be prosecuted by end of August.

Dutch Bank ABN Amro goes tobacco free
According to a statement in the Dutch newspaper Trouw, the Dutch bank ABN Amro has decided not to invest in tobacco companies, nor to accept new clients from this sector. The bank will still value current contracts but will not extend them or agree to new ones from the tobacco industry.
Although the bank's portfolio does not involve any major tobacco firms, it is believed that this decision may open the doors for other banks to do the same.

Meet Sanne Heijndijk, from the Dutch Alliantie Nederland Rookvrij
A network is only as strong as the members holding it together. That is why the ENSP board and Secretariat would like to extend our thanks to all members and friends of the ENSP network for your contributions to a tobacco-free Europe, and introduce you to each other, your organisations and current priorities in tobacco control in a series of interviews with ENSP members from across Europe.

This month we are pleased to share a bit of information about Sanne Heijndijk and her work within Alliantie Nederland Rookvrij!, the Tobacco Control Alliance in the Netherlands.

What is you role and how did you get into Tobacco Control?

I started working in tobacco control over four years ago and am now employed as a policy and research consultant at the Dutch Alliance for a Smokefree Society. The Alliance was founded in 2013 by the Dutch Heart Foundation, Cancer Society and Lung Foundation and it is rapidly growing. Recently, we have welcomed our 80th partner! My background is in public administration, law and policy analysis. I am very happy to be able to work in these fields on a daily basis and, by doing so, to contribute, however limited, to achieving the highest attainable standard of health for everyone. My key role is to coordinate and support the political advocacy activities of our partners.

What are the biggest challenges in tobacco control in the Netherlands?

Levels of awareness of the health risks of (passive) smoking are relatively low in the Netherlands. The addictive nature of smoking is not well-known. Hence, the idea that smoking is a free choice and therefore a behaviour that the government and others should not intervene with (especially as far as adults are concerned), still features rather prominently in public opinion and political debates. As is the case in many other countries, another huge challenge is to really make tobacco control work for society as a whole, including those with a lower socioeconomic status. Smoking prevalence is higher in this group and expected to decrease less than among those with a higher socioeconomic status.

What are you proud of (your achievements)?

In the past couple of years, we have seen some positive changes in the Netherlands. Whereas in the early 2010s we were confronted with a Minister of Health that reversed several tobacco control measures, we are now getting back on track. It is great to see so many parties in the Netherlands taking their role and working towards a Smokefree Generation. Public support for initiatives to protect children is increasing and, during the last years, the Dutch government has taken various measures to advance tobacco control (incl. increased efforts to implement article 5.3 FCTC and full implementation of the TPD). Just last week, the government published its proposal for banning the display of tobacco products at practically all points of sales.

What are the next steps/projects?

We have had general elections in March. Negotiations on a new coalition are still ongoing. We hope that the new government will join the social movement towards a Smokefree Generation and take the initiative for a comprehensive plan to get there, in cooperation with local governments and civil society.

Thank you Sanne!

Read more about the work Alliantie Nederland Rookvrij! here

Launch of the TOB.g Tobacco Cessation Guidelines for High-Risk Populations

The final TOB-G Tobacco Cessation Guidelines for High-Risk Populations are now published and available for download.

The guidelines were released and disseminated to particpants of the 2nd ENSP International Conference on Tobacco Control 2017, held in Athens, Greece in May 2017. At the occasion, the guidelines and the TOB-G. project was presented in the round table “TOB-G & Tobacco Dependence Treatment in Special Populations”, with presentations by TOB-G researchers Sophia Papakdakis and Antigona Trofor, along with other leading international experts in tobacco dependence treatment. Read more about the TOB-G presentation.

The Tobacco Cessation Guidelines for High Risk Populations is the main result of the TOB-G partnership, coordinated by the Hellenic Center for Disease Control & Prevention and partners ENSP, CMT Prooptiki, Anlet Med. and TFRI Ireland. During the autumn of 2017 the TOB-G e-learning platform and training course will be launched. Read more about the TOB-G project here.

New study finds DNA marker to predict smoking-related mortality and morbidity
A team of Danish researchers have discovered a way to predict future smoking-related morbidity and mortality based on changes in human DNA. Self-reported smoking behaviour tends to underestimate disease risks and in the study the researchers thus aimed to determine the particular ways that smoking affects DNA methylation in order to provide more precise and clinically relevant predictions of smokers' health in the future.
Using DNA blood samples drawn in 1991–1994 from individuals in the Copenhagen City Heart Study, representing the Danish general population, researchers followed 9234 individuals for COPD exacerbations, lung cancer and all-cause mortality, and found that the marker of smoking behaviour ( AHRR cg05575921 hypomethylation) strongly predicted risks, also after adjustment for self-reported smoking behaviour at the time of blood draw.

Researchers note that the results of the study of the novel objective marker of long-term smoking behaviour could be of clinical value if included in the risk calculation algorithms identifying high-risk smokers for screening or other interventions.

Read the full article.
Electronic cigarettes: new studies
E-cigarettes prove an ineffective quitting tool
An article, co-authored by Giuseppe Gorini from Italian Cancer Research & Prevention Institute (ISPO), explored electronic cigarette use as an aid to quit smoking and compared abstinence rates for different quitting methods in a representative sample of the Italian population.
In the 2014–2015 PASSI survey, the ongoing Italian behavioural risk factor surveillance system, 6112 adults who smoked and made at least one quit attempt in the previous 12 months, were categorized into three groups according to the method used in their most recent quit attempt: e-cigarette only, no aid, other quitting methods (medications; programmes delivered in smoking cessation services; other unspecified methods). The primary outcome was self-reported abstinence for a period ≥ 6 months, adjusted for potential confounders.

One out of ten smokers who attempted to quit in 2014–2015 in Italy used e-cigarettes. E-cigarettes users were as likely to report abstinence as those using no aid, but were less likely to report abstinence than users of established quitting methods. Further studies are needed to understand the relationship between e-cigarette types used to quit and abstinence rates.

Read the full article.
New Study: Vaping increases risk of future smoking in young people
Researchers at Dartmouth Norris Cotton Cancer Center have found that electronic cigarette use increases the risk of cigarette smoking in youth.

For the study, published June 26 in JAMA Pediatrics, researchers analyzed several published studies beginning with non-smoking youth, aiming to identify whether initial e-cigarette use increased the risk of transition to tobacco cigarette use.

The study showed a greater risk between initial e-cigarette use and later cigarette smoking. Of the 17,389 adolescents and young adults aged 14 to 30, e-cigarette use was associated with an increased risk of future cigarette smoking initiation.

Researchers theorized that e-cigarette use leads to regular cigarette smoking both because e-cigarettes mimic smoking behavior and because the aerosol contains nicotine, initiating nicotine addiction.

Read the full report.
Congratulations to Norway:
Plain packaging regulation enforced
Norway's regulation requiring plain packaging of tobacco products came into effect on 1 July 2017, with a one year transition period. The purpose of introducing plain packaging is to prevent children and young people from starting smoking or using snus. Norway thus officially joins the group of countries implementing plain packaging of tobacco products.

In order for manufacturers to have time to change the packages, there is a transition period of one year for products already on the market. New product variants are not covered by the transitional period and should have standardised packaging from the time they are introduced on the market.

After 1 July 2018 all cigarettes, roll-your-own tobacco products and snus sold in Norway must be in plain packaging.

WHO/Europe Tobacco Control Playbook
WHO's Tobacco Control Playbook developed by its Regional Office for Europe aims to provide a single source of information explaining how tobacco industry players proactively misinform the general public, and offers governments as well as the public health community clear evidence-based responses to their deceptive arguments.
To disseminate this important work carried out by WHO Europe, the Network features key arguments from the Playbook of relevance to ENSP members and stakeholders in the tobacco control community. Read more about importance of smoking cessation among people with mental illnesses.
Key Message:

"Quitting smoking improves mental health conditions. People with mental illness are as motivated and able to quit as those without. To improve the physical and mental health of patients, encouraging and supporting smoking cessation should be a priority in the mental health treatment setting." (Vaping360)
There have been claims over the years that people with mental illness benefit from smoking, do not want to or cannot quit, and that this is not a priority area for action.

Key messages explaining why reducing smoking prevalence among people with menthal illnesses is crucial and certainly possible:
  • Action to reduce smoking among people with mental illness should be a very high priority, whether through health systems or by clinicians. There is nothing that would do more to reduce the life expectancy gap.
  • High rates of smoking among people with mental illness bring devastating consequences to their mental and physical wellbeing, and are the largest single contributor to the massive life expectancy gap for this already disadvantaged group.
  • People with mental illness want to quit as much as other smokers and can do so with appropriate help and support.
  • When properly planned and implemented, bans on smoking in mental health facilities work well and do not result in the negative consequences that some predict.
  • Action to reduce smoking in people with mental illness should be a very high priority, consistent with the WHO Framework Convention on Tobacco Control and human rights treaties including the Convention on the Rights of Persons with Disabilities and the Universal Declaration on Human Rights, which state that everyone has a right to health without discrimination.

Read more in the WHO Tobacco Control Playbook.

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ERS International Congress
9-13 September 2017, Milan, Italy

This year ERS International Congress will take place in Milan, Italy on 9–13 September, 2017.

Continuing the standards of previous years and retaining the position as the world’s largest meeting for respiratory physicians, scientists and allied health professionals, the program will feature over 350 scientific sessions, around 75 educational sessions. This edition will also welcome the return of the award-winning live endoscopy.

This year’s event promises something for everyone and will provide all the latest advancements in the respiratory field.

Visit the Congress website to find out more about the registration options and browse the advance programme.

Support future EU action on health: Sign the petition
Earlier this year European Commission President Jean Claude Juncker presented a white paper on the future of Europe, outlining 5 scenarios for the organisation and scope of the European Union. In these scenarios, the option to “do less” on some policy areas is contemplated possibly leading to less EU action on health after 2020.

39 organisations have teamed up to express their concerns in a letter to European Commission President, Jean Claude Juncker. All European and International organisation in health and tobacco control are invited to support the call to action, to increase attention on the need for EU action on health. Read more and sign the petition here.
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