February 2018
Tobacco-free vision in Denmark by 2030:
A national event for a global topic
On 8 February 2018, in collaboration with WHO Europe and ENSP, Røgfri Fremtid (Smokefree Future) - Danish Cancer Society held a conference titled "How to achieve the tobacco-free vision by 2030" which took place in the UN City, Copenhagen.

The conference provided examples of international success stories in tobacco endgame strategies, point out key challenges in the Danish tobacco control environment and presented recommendations for future action in Danish tobacco control.

The programme included many prominent names in tobacco control, in particuar Gauden Galea, Gurli Martinussen, Kristina Mauer-Stender, Søren Brostrøm, Armando Peruga,  Pascal Diethelm, Gerard Hastings, Charlotta Pisinger, Luke Clancy, Sandra Mullin and many others.

The day's programme included expert presentations, lively Q&A sessions and engaging debates involving both the presenters and the audience. 

ENSP President Francisco Lozano delivered a speech on Tobacco-free future for the whole Europe and the importance of European collaboration to achieve this challenging goal.
The Conference gathered an audience of Ministries` representatives, public authorities, members  of  civil society, academics and researchers, health care professionals, European tobacco control experts and other interested stakeholders. More than 130 Danish and international attendees contributed to the success of the event. 

ENSP would like to congratulate Danish Cancer Society and all the partners for organising such an excellent Conference focusing on this timely topic that is Tobacco Endgame!
Capacity Assessment on the Implementation of Effective Tobacco Control Policies in Denmark
Launch of the official report
The "Tobaccofree Vision in Denmark by 2030" Conference was marked by the launch and presentation of the Capacity Assessment on the Implementation of Effective Tobaco Policies in Denmark, which was an joint initiative from WHO Europe, The Danish Cancer Society, Røgfri Fremtid, TrygFonden and ENSP. 

To drive progress in Danish tobacco control, in 2017 the Smokefree Future partnership (Røgfri Fremtid) initiated a collaboration with the WHO Regional Office for Europe and ENSP with the aim of assessing the capacity for advancing implementation of central measures of the WHO FCTC and developing recommendations for future Danish tobacco control. 
A team of national, international and WHO experts conducted interviews with key stakeholders from 40 Danish institutions and organisations involved with tobacco control. Through the interviews and assessment of the implementation of WHO FCTC provisions in Denmark, challenges and recommendations for tobacco prevention in Denmark were identified. 

Read the report...
Meanwhile in the Netherlands...
Criminal Case against tobacco manufacturers
The Netherlands Cancer Institute (NKI) is the first hospital/research institution in the Netherlands to file a report in the ongoing criminal case against tobacco manufacturers. In doing so, the NKI asks the Public Prosecution Service to take steps against the tobacco manufacturers. The NKI believes that it is 'banging its head against a brick wall' and this has to stop.
Figures show that no less than 30% of the NKI patients die as a result of smoking. In the Netherlands, at least 55 people die every day because of smoking. As a result of their smoking behaviour of 20 years ago, women are now more likely to die from lung cancer than from breast cancer.

On 22 February, it is expected that the Public Prosecutor`s Office will announce whether the case is going to run in Court.

See the full list of parties who filed the complaint against tobacco companies [in Dutch]...
Dutch ABP Pension Fund divests from Tobacco
On 11 January 2018, ABP Pension Fund takes the next step in its sustainable and responsible investment policy with the decision to exclude tobacco products and nuclear weapons from its investments. ABP has reached this decision after extensive consultation at Board level, based on the insights shared by participants, employers, and various special interest organisations. 

The pension fund aims to sell within one year all investments (a total of approximately 3.3 billion euros) in tobacco and nuclear weapons manufacturers.

ABP is the industry-wide pension fund for employers and employees of government and educational institutions in the Netherlands. ABP has 2.9 million participants and 405 billion euros in available assets (as at November 30, 2017). 

Read the full press release...
Kruidvat and Trekpleister stop tobacco sales
Budget high street health and beauty stores Kruidvat and Trekpleister are phasing out the sale of tobacco products at their 1,400 shops in the Netherlands and Belgium. According to Gerard van Breen, chief executive of brands owner AS Watson Health & Beauty Benelux, cigarettes no longer fit in the ‘healthy’ image which the shops are trying to promote.
‘Health has an increasingly important role in our shops and tobacco does not fit in with that,’ Van Breen said. 

Tobacco products account for a couple of percent of the group's sales and will be phased out in stages this year and in 2019. The first revamped Kruidvat without tobacco products has already opened its doors. Kruidvat has also joined the Alliantie Nederland Rookvrij, a cancer charity initiative to encourage people to give up smoking.

Read more...  
New Joint Action on Tobacco Control 
HEALTH-EU Newsletter 208 features the Joint Action on Tobacco Control (JATC) that was launched in Athens in December 2017 to help Member States in implementing the Tobacco Products Directive and thereby in reducing the number of tobacco-related deaths and illnesses in the EU.

In the editorial Project Coordinator Prof Panagiotis Behrakis provides the insight of this new collaboration between the European Commission and the EU Member States and its key goals.

What is its main aim?

The general objective is to provide support for the implementation of the TPD throughout the Member States. More specifically, it aims to support the dissemination of information to the target groups; make it easier to access data collected through the EU Common Entry Gate (EU CEG); monitor and provide support to the tasks of tobacco and e-cigarette products regulation; assist Member States networking and collaboration between research institutions and laboratories for tobacco evaluation; support Member States in the process of monitoring, assessing and updating priority additives; and integrate the JATC results into national policies.

Who is participating in the project and what are the target groups?

Thirty-one scientific and governmental institutions from across Europe are active members of the JATC tasks, while 13 more international stakeholders participate as collaborating partners.

The JATC seeks to reach a variety of primary target groups for the project’s outcome and communication activities; EU regulators, EU policy makers, international and national tobacco control stakeholders and researchers, as well as the general public.

What are the expected outcomes?

Apart from the TPD implementation, expected outcomes for the Member States include 1) increased regulators' training, 2) agreement on a common approach on taking tobacco product evidence-based decisions, 3) increased data sharing and collaborations on tobacco product regulatory science, 4) increased literacy on tobacco product design, constituents and toxicity, 5) increased knowledge of e-cigarette design parameters, ingredients and emissions, 6) enhanced laboratory collaboration for ingredient and emission measurements, 7) increased scientific scrutiny regarding potential priority additives, 8) increased general public awareness and 9) enhanced research and policy action.


Changing Public Attitude towards Smoking in Greece:
"We are on the right track!"
In his interview to the Greek Reporter, Prof Panagiotis Behrakis, Director of the Public Health Institute at the American College of Greece and Head of SmokeFreeGreece, said there had been a “cultural shift” in attitudes to smoking.

“It is very positive that three-in-four Greeks express anger at non-compliance with the anti-smoking laws and that 82 percent believe smoking downgrades our culture,” he says.

Prof Behrakis referred to the results of a nationwide survey showing a significant decline in the number of Greeks describing themselves as smokers.


According to the survey, 27.1 percent of the population said they were smokers compared to 36.7 percent in 2012.

Prof Behrakis mentioned the drop was a record in the EU. He also pointed to a significant drop in cigarette sales in Greece.

However, he warns that Greece still gets a “very low mark” in implementing anti-smoking laws in restaurants, bars, cafes and nightclubs. Ηe also highlighted the poor situation on enforcing the smoking ban in public buildings such as courts, ministries, local authority premises and even parliament.

“There is no political will to enforce anti-smoking laws there,” he says. “Images of ministers and other officials smoking in public places send the wrong message and also show there is a lack of political will to enforce the law.”


In the meantime, EURACTIVE.com reports about European Commission calling on Greece to implement smoking ban. The EC spokesperson said generally, “We urge member states to follow the Council Recommendation on smoke-free environments.”

The Council Recommendation on smoke-free environments (November 2009) called on member states to adopt and implement laws to fully protect their citizens from exposure to tobacco smoke in enclosed public places, workplaces and public transport, within three years of its adoption.
Join ASH latest campaign

Video available at 

ASH is America's oldest anti-tobacco organisation, which is dedicated to building a world with ZERO tobacco deaths. 

In line with their mission, ASH released a video 
dedicated to a world with ZERO tobacco deaths. The video not only shows the toll cigarette sales have on our society but it also poses the question of why cigarettes are still an ubiquitous consumer good in the 21st century.

We invite you to watch and share the video and join the associated campaign. 

France keeps on leading the way with ground breaking initiatives and encouraging trends in tobacco control 
CNCT files a complaint againt the tobacco firms in France
complaint of the National Committee Against Smoking (CNCT), dated 24 January,  was launched targets the French branches of Philip Morris, British American Tobacco, Japan Tobacco and Imperial Brands Plc. 

According to CNCT four tobacco companies operating in France manipulated tests to conceal the real level of nicotine and tar contained in cigarettes, endangering the lives of smokers.

The complain elaborates that cigarettes produced by the companies contain tiny holes in the filter that are designed to ventilate the inhaled smoke under test conditions. 

When the cigarette is smoked by a person, however, the holes are compressed and largely covered by the smoker’s fingers or lips, causing the smoker to inhale harder and increasing the intake of nicotine and tar, the CNCT said. 

“Such a device tricks smokers because they are unaware of the degree of risk they are taking,” the complaint states. The anti-smoking organisation discovered real nicotine levels were five times higher than shown in the tests, while actual tar levels are two to 10 times higher.

On 9 February, the CNC filed a lawsuit against the main four tobacco manufacturers accusing them of "putting the lives of others in danger". 


France is strongly committed to price increase of tobacco products
On February 4, the price approval order was announced, which means a significant increase in the price of cigarette packages. This increase is only the first step to reach the symbolic 10-euro-pack by 2020. DNF (Droits de Non Fumeurs) salutes the government's courage for its commitment to fight against smoking and to see the first generation without tobacco appear.

On the 1st March, the price of a pack of 20 cigarettes iwill increase by almost 1 euro (94 cents), reaching the selling price between 7.50 euros and 9.10 euros. Rolling tobacco also increases with an average of 2 euros.

Read more [in French]...
Newly published reports on French youth attitudes towards smoking
On 6 February, the ESCAPAD survey, published by the French Observatory of Drugs and Drug Addiction (OFDT), provides an update on tobacco consumption by 17-year-old French youth.

It comes to a positive conclusion that this new generation who grew up with the smoking ban in place is less exposed to tobacco and overall smokes less. "All indicators of smoking are decreasing between 2014 and 2017," says the ESCAPAD study.

This trend, was previously noted by DNF, but more informally, with the help of the information gathered via the platform www.rentredanslegame.fr and associated Instagram account. Comments on social networks concerning tobacco had become much more negative: "Since when does smoking give style? Smoking is killing!"

Now, only 59% of 17-year-olds experimented with tobacco, compared to 70% in 2014. The age of the first cigarette also declined with an average of 14 years and 5 months. In 2004, the "never the first cigarette" survey established the age of the first cigarette at 11 years and 8 months. In addition, daily use fell 7 points from 32.4% to 25.1%. This is a very significant decrease of adolescent consumption, never seen before, and now lower than that of adults.

The denormalisation work undertaken by the government and the associations begins to bear fruit. The cigarette is no longer appreciated. Shisha or waterpipe use also seems to become less popular decreasing from 64.7% to 49.9%.

DNF actively supports all interventions to protect young people from tobacco, including in the field of litigation, against the establishments that do not comply with tobacco control legislation. Furthermore, the smoking ban in school plays an importnat role in changing the image of tobacco among youth. The first generation without tobacco in 2030 is therefore possible!

Read more [in French]...
The ARAMIS study, another project by the French Observatory of Drugs and Drug Addiction (OFDT), was published earlier this year providing an overview of tobacco use among young adolescents in France.

The study shows a certain level of dislike and the negative identification towards cigarettes, which are perceived as useless and directly associated with the image of death.

Its high price is seen as a discouraging factor, especially among young people with the background from lower-income populations. The only exception to this generally negative perception: young girls from a more privileged background still see smoking as a attractive image.

Read more [in French]...
Tobacco sales drop 2% in France

Tobacco sales in France declined by more than 2% in 2017. This might be a result of a number of tobacco control measures: the past year was marked by an increase in the tax on rolling tobacco, the implementation of plain packaging and a raise of the minimum tax excise.

The sales slowly keep going downhill since 2016. According to Customs Service, legal sales of tobacco products in France fell by 2.2% in 2017, which is twice as fast as it was predicted by the Social Security Accounts Commission in September 2017. There is also good progress in comparison with 2016, when the decrease was only 1.1%.

Read more [in French]...

World Cancer Day, 4 February

On World Cancer Day (4 February), WHO highlighted that cancer no longer needed to be a death sentence, as the capacity existed to reduce its burden and improve the survival and quality of life of people living with the disease.

In May 2017 Member States came together around priority actions to ensure cancer care for all. World Health Assembly resolution WHA A70/A/CONF./9  "Cancer prevention and control in the context of an integrated approach" lays out a clear road map to realise the potential for prevention, early diagnosis, prompt treatment and palliative care for people with cancer.

Since adoption of the resolution, Member States are taking action on its recommendations. Governments are enacting evidence-based risk-reducing strategies such as imposing higher taxes on tobacco and alcohol, promoting healthy diets and physical activity, and advocating for access to HPV vaccination. Approximately 30-50% of cancers can be prevented if these policies are maximally implemented.

Member States will next report on progress in achieving implementation  at the Third High-level Meeting of the UN General Assembly on the Prevention and Control of Noncommunicable Diseases to be held in 2018.

Read Fact Sheet on Cancer 2018...

ENSP strongly warns against PMI funded "Foundation for a Smokefree World"
While the PMI-funded "Foundation for a Smokefree World" announces its leadership team and executive board of Directors, ENSP would like to encourage all its members, partners and stakeholders working in research, prevention and tobacco dependence treatment to reject any partnership or project funding coming from this organisation. 

The Foundation For a Smoke-Free World has sent a letter to 344 public health researchers and groups, offering $1 billion in grants. While this would typically be applauded, ENSP, alongside many of the recipients, is waving a red flag due to the organisation’s ties to big tobacco company Philip Morris International (PMI).

Following the footsteps of WHO, ENSP would like to reiterate the warning sent last year to its entire network to bring to people's attention about the real motivation behind such a foundation. It is absolutely true that WHO FCTC Article 5.3 obliges Parties to act to protect public health policies from the commercial and other vested interests of the tobacco industry. But this only concerns governments. However as experts, advocates, scientists or health professionals, it is important that we do keep away from any research or project funded by a company that has been lying and misleading not only the general public but also governements and the civil society. 

In addition, when an industry had spent - and still does - so much energy and money to challenge and delay every single policy put in place, whether it is on taxation, smokefree public places, ban on tobacco advertising, graphic warning or plain packaging, we have the right to question its motives and to remain sceptical about its true objectives. It also used an aggressive strategy of intimidation and engaged in long and expensive litigation against countries and governments, which are brave enough to put in place ground breaking tobacco control legislations. 

Those examples show how little they care about protecting citizens from the harmful effects of their products, which let us not forget kill 50% of their consumers. Therefore we urge the public health community to keep away from any collaboration with the PMI-funded foundation for the sake of tobacco control. 
US FDA rejects the claim on harm-reduction of iQOS
On 25 January the U.S. Food and Drug Administration concluded that Philip Morris International Inc should not be allowed to claim its iQOS electronic tobacco product is less risky than cigarettes.

"Evidence does not support PMI's claims that its heat-not-burn tobacco product cuts the risk of tobacco-related diseases and is likely to switch adult cigarette smokers", regulatory advisors said.

The panel said Philip Morris had not proven that iQOS reduced harm compared with cigarettes. It did conclude that the product exposes users to lower levels of harmful chemicals but said the company had not shown that lowering exposure to those chemicals is reasonably likely to translate into a measurable reduction in disease or death. 

Philip Morris needs to show both in order to claim in its marketing materials that the product reduces a user’s exposure to harmful chemicals.

Matthew Myers, president of the Campaign for Tobacco Free Kids, said panelists “identified that serious questions remain” about the company’s application. He said it could amend the application and the panel’s recommendation does not rule out an ultimate approval.

The FDA is expected to decide whether Philip Morris can sell iQOS within the next few months. It will decide separately whether to authorize the modified-risk claims. There is no time frame for when that decision might come.

Congratulations to the recipients of 2018 Luther L. Terry Award
The American Cancer Society announced the names of the recipients of the 2018 Luther L. Terry Awards that will be presented on March 8th, 2018 in a lunchtime plenary session at the 17th World Conference on Tobacco OR Health in Cape Town, South Africa.

Distinguished Career

Dr Douglas William Bettcher, MD, MPH, PhD (Canada/Switzerland)

Outstanding Leadership

Professor Elif Dagli (Turkey)

Young Pioneer

Dr. Constantine Vardavas, MD, RN, MPH, PhD. FCCP (Greece)

The Awards are named for the late United States Surgeon General Luther L. Terry, MD, who led the landmark 1964 Surgeon General’s report that connected tobacco use to lung cancer and other illnesses. Dr. Terry’s groundbreaking work established the foundation for public health scrutiny of the dangers of tobacco use.


World No Tobacco Day 2018:
Tobacco and Heart Disease
Every year, on 31 May, WHO and partners mark World No Tobacco Day (WNTD), highlighting the health and other risks associated with tobacco use, and advocating for effective policies to reduce tobacco consumption.

The focus of World No Tobacco Day 2018 is "Tobacco and heart disease." It  will focus on the impact tobacco has on the cardiovascular health of people worldwide.

Cardiovascular diseases (CVD) kill more people than any other cause of death worldwide, and tobacco use and second-hand smoke exposure contribute to approximately 12% of all heart disease deaths. Tobacco use is the second leading cause of CVD, after high blood pressure.

Goals of the World No Tobacco Day 2018 campaign

World No Tobacco Day 2018 aims to:

  • Highlight the links between the use of tobacco products and heart and other cardiovascular diseases.
  • Increase awareness within the broader public of the impact tobacco use and exposure to second-hand smoke have on cardiovascular health. 
  • Provide opportunities for the public, governments and others to make commitments to promote heart health by protecting people from use of tobacco products.
  • Encourage countries to strengthen implementation of the proven MPOWER tobacco control measures contained in the WHO FCTC.


World No Tobacco Day Award:
Submit a nomination
The World Health Organization (WHO) is calling for nominations to the World No Tobacco Day Awards of individuals or organisations in each of the six WHO Regions for their accomplishments in the area of tobacco control.

Call for nominations closes on Friday, 9 March 2018, 17:00 GMT.

Public Consultation: Evaluation of the excise duties applied on manufactured tobacco
The European Commission opened the consultation period for Evaluation of Directive 2011/64/EU of 21 June 2011 on the structure and rates of excise duty applied to manufactured tobacco.

Directorate-General for Taxation and Customs Union will be accepting feedback untill 6 March 2018. Results of the consultation will be summarized and presented to the European Parliament and Council, with the aim of feeding into the legislative debate.

Submit your feedback ...
EC will not apply excise tax on e-cigarettes and novel tobacco products 
On 16 January, EURACTIV.com published an article about the decision of the EC with regards to excise tax on e-cigarettes and novel tobacco products including Heat-Not-Burn. Due to limited data, the European Commission has decided not to propose a harmonised approach for excise taxation of e-cigarettes and other novel tobacco products until further information about these products is available.

The EU executive stated that it would re-examine the situation in the next regular report on tobacco taxation due in 2019.

ENSP provided a comment to EURACTIV.com on the matter, expressing our regret of the delay to the harmonisation of taxes on e-cigarettes and heated tobacco, and referred to a World Health Orgsanisation report (August 2016), which claimed that there were possible risks from active and passive exposure to electronic cigarette vapour.

ENSP also expressed serious concerns that those novel products could serve to initiate young people into smoking:

“However, we know that taxation is the best measure to prevent people from taking up smoking, especially children and vulnerable populations. An EU level harmonisation of excise taxes will decrease the affordability and attractiveness of those products. Therefore ENSP worries that the longer we wait to regulate those novel products, the more opportunities we give the tobacco industry to recruit new consumers.” 

Why governments cannot afford Codentify to support their track and trace solutions

The research paper of Hana Ross, Michael Eads and Michael Yates investigates the efficacy of Codentify and compares it to other track and trace solutions. 

 In anticipation of the Protocol to Eliminate Illicit Trade in Tobacco Products (ITP) entering into force in 2018, there is a growing demand for information on track and trace (T&T) solutions for tobacco products. This article contrasts the efficacy of Codentify from the perspective of authentication with that of material-based multilayered security technologies.

Method To calculate the probability of detecting one fraudulent pack under Codentify, we relied on a modified Bernoulli trial experiment with independent repeated sampling without replenishment. The probability is calculated using a multinomial distribution formula adjusted for the fact that both legitimate and non-legitimate packs may be sold in the market.

Results In a relatively small market, a law enforcement authority would have to inspect over 27 000 (almost 31 000) packs per week to have a 90% (95%) certainty that it did not miss a fraudulent pack under the Codentify system. A material based T&T solution would require only 45 (59) pack inspections a week to have the same level of confidence.

Conclusions This study demonstrates the inefficiency of Codentify compared to other solutions that incorporate material-based security features. Signatories to the ITP should reject Codentify due to both its low efficacy and its clear violation of the ITP’s requirement that T&T shall not be performed by or delegated to the tobacco industry or its front groups.

Read the full article...

Recently adopted Track&Trace legislation is debated in the European Parliament
A few MEPs have threatened to veto new legislation, which puts in place detailed rules on how tobacco manufacturers should agree a contract with companies to store the data of a track-and-trace system for tobacco products.

MEP Omarjee stated that the legislation, if adopted, will be in conflict with a World Health Organization (WHO) treaty (the Protocol to Eliminate Illicit Trade in Tobacco Products), which the EU has signed.

The MEP has asked for an opportunity to veto the text, which would force the European Commission to come up with a new proposal. If the EU parliament wants to veto the delegated act, it needs to do so before 15 April 2018.

Why Universities and the Scientific world should stay away from the tobacco industry.
Journey in Big Tobacco deception
The editirial featured in the 2-4/2017 edition of the "Tabaccologia" (Scientific Journal of SITAB) focuses on a timely issue of the research independence from the tobacco industry.

The authors of the paper (Vincenzo Zagà, M. Sofia Cattaruzza, Francisco Rodriguez Lozano, Antigona Trofor, Marco Mura, Giacomo Mangiaracina, Biagio Tinghino) express the position that University Scientific research should never accept funding from companies operating in the same sector in which it is applied, especially when it applies to such field as tobacco, which damages human health. The researchers who accept such funding are welcoming the "Trojan horse" of the tobacco industry.

Today, thanks to Tobacco Control policies implemented in Western countries, the tobacco industry has a desperate need to involve universities in the deception of non-causality between tobacco smoke and smoking-related diseases.

The article describes multiple examples of  the tobacco industry's deceptive behaviour throughout the years. For over six decades, the tobacco “cartel” has tried in every way to actively challenge the scientific evidence in the media and courtrooms which has proved it to be responsible. Furthermore, the tobacco industry has also resorted to the corruption of leading gurus in the medical scientific field. Likewise, the tobacco industry has bribed politicians and journalists to misrepresent research results whenever they were perceived as threatening to their profits. 

Health institutions in general and academics in particular have a duty of transmitting to future health professionals the ability to treat and prevent smoking and should have a policy statement that specifically prohibits academic bodies from accepting tobacco industry funding including grant funding.

In the U.S.A. there are already several examples (Open Letter signed by Deans of the American Public Health Schools) of this practice and it is to be hoped that this will soon spread all over the world. For example, the European Journal of Public Health will no longer publish tobacco industry-supported research, a practice already adopted by many other medical journals such as BMJ, Heart, Thorax, Plos one and many others.


Latest Report on Electronic Cigarettes: 
 What the evidence says...
The new American report by the National Academies of Sciences, Engineering and Medicine is the most comprehensive analysis of existing research on e-cigarettes.

It concludes that although smokers who switch completely to e-cigarettes are exposed to lower levels of toxic substances, little is known about the long-term health effects of e-cigarette use like devices’ addictive potential or their effects on the heart, lungs or on reproduction. Furthermore, there is only “limited evidence that e-cigarettes may be effective aids to promote smoking cessation.”

A national panel of public health experts also concluded that vaping with e-cigarettes that contain nicotine can be addictive and that teenagers who use the devices may be at higher risk of smoking.

In response to the report, Campaign for Tobacco-Free Kids published the statement of the President Matthew L. Myers:

It demonstrates why the FDA should fully and aggressively implement the overdue e-cigarette regulations that took effect in August 2016. The FDA should reverse a decision it made last year to delay until August 2022 a key requirement that e-cigarettes already on the market undergo scientific review by the FDA. In addition, the FDA should enforce the requirement that manufacturers who introduce new or modified products provide detailed information about these products and undergo FDA review before these products are allowed on the market.

Unless the FDA takes these steps, products that clearly appeal to kids – including many sold in candy flavors like gummy bear and cotton candy – will remain on the market for years to come and new ones will be introduced. In addition, smokers who want to quit will have no idea which, if any, e-cigarettes have been shown to be helpful, and manufacturers will have no incentive to invest in developing products that will actually help smokers quit.

Matthew L. Myers concludes that "effective FDA regulation is key to minimizing the risks and realizing any potential benefits of e-cigarettes".

Read the report...
Read the CTFK statement...

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Meet our members:
George Bakhturidze
(Tobacco Control Alliance - Georgia)
What is you role and how did you get in Tobacco Control?
I’m George Bakhturidze, MD and Lawyer by professions, also received two years special education in economics. I got master degree in Health Promotion at the University of Bergen (Norway), 2010 and PhD at the same University in June 2017. 
I have been engaged in tobacco control field since 1999 when working in Georgian National Counter Tobacco Center. At the beginning I was a head of Programs and after an Executive Director of the Center. One of my duties was to learn about the WHO Framework Convention on Tobacco Control (FCTC) preparation processes and have organized appropriate advocacy work.
What are the biggest challenges in Tobacco Control in Georgia?
Shifting of tobacco industry strategies from smoking to vaping, is the subject which is very new and needs our attention and clear actions not to make mistakes, etc. E-cigarette market is new challenge in Georgia too and we need to rapidly respond to it. 
Smoking related cost to healthcare or beyond sectors are not well studied in Georgia and in our region. Furthermore, what kind of positive impact smoking/ads ban has to the economy, compared to loses in the businesses which are linked to tobacco industry. 
What are you proud of (your achievements)?
Last period, during 2013 I together with my colleagues drafted Tobacco Control National Strategy and Action Plan 2013-2018, which was adopted by the Government in June and November 2013. Also we prepared new amendments on national tobacco legislation to address the FCTC and its guidelines requirements. After 2015 we conducted special studies to support adoption of new amendments in tobacco control legislation. Georgian Parliament adopted new law in May 17, 2017. Now Georgia has one of the strong tobacco control legislation in the region. Since May 1, 2018 all public/working places will be smoke-free (with very few exemptions) and since Sept 1, 2018 Georgia will prohibit all forms of tobacco ads, promotion and sponsorship (including display ban outside). Since Sept 1, 2008 Health warning will cover 65% of both sides of packs including pictographs in front. Stadiums will become smoke free since 2020. Internal display ban will enter into force from 2021 and plain packaging since 2023.  
What are the next steps/projects?
We have interest in learning about endgame policy strategies of developed countries and how we can transfer it to developing countries. We will still have battles between business and health interests. 
We need to work on earmarking tobacco taxes for health interest and introduce it for Georgia to create sustainable financing of tobacco control and health promotion activities, which are not sufficiently funded by the Government. 
We also need to build sustainable smoking cessation and tobacco treatment systems in Georgia and promote their accessibility to smokers. 
Why did you become an ENSP member? 
To share European good practices in different areas of tobacco control, get support form Network members when it is needed, to get technical support and increase our capacity, to have joint projects and programs, to be involved in ENSP daily work, etc. 

We have already received and currently getting appropriate support and we are very grateful to our ENSP colleagues and friends. Their support during of changes in tobacco control law was of great help. In December 2017, we received technical support to learn illicit trade situation in Georgia and waiting for appropriate conclusions and recommendations. We got great support to increase smoking cessation capacity for our HCPs, etc.
There is no safe dose: Even 1 cigarette per day increases the risk of a stroke and heart disease

A large, new meta-analysis published in the BMJ found that smoking even 1 cigarette a day significantly increases the risk of coronary heart disease and stroke. 

Smoking socially, from time to time or reducing the number of cigarettes instead of quitting "cold turkey" is generally seen as “safer” option, compared to people who smoke a pack a day or more.

The authors conducted an extensive review examining 141 prospective cohort studies published in 21 countries between 1946 and 2015. It followed a total of 5.6 million people to see who developed coronary heart disease and 7.3 million people for stroke. The authors only looked at generally healthy individuals, excluding patients taking medication for cardiac related disorders, for example.

They found that men who have about one cigarette per day had a 48 percent higher risk of heart disease and 25 percent higher risk of stroke compared to people who have never smoked. For women, the news is even grimmer, with a 57 percent and 31 percent higher risk for heart disease and stroke, respectively, compared to never smokers.

The authors conclude that smoking one cigarette per day carries a risk of developing coronary heart disease and stroke much greater than expected: around half that for people who smoke 20 per day. Thus, no safe level of smoking exists for cardiovascular disease. Smokers should aim to quit instead of cutting down to significantly reduce their risk of these two common major conditions.

More than 60% of those who tried 1 cigarette become daily smokers

At least three out of five people who experiment with a cigarette end up becoming daily smokers at some point, finds a new study led by Peter Hajek, professor of clinical psychology and director of the Tobacco Dependence Research Unit at Queen Mary University of London.

UK researchers analysed responses from 215,000 people across eight surveys conducted in the UK, the United States, Australia and New Zealand that were included in the Global Health Data Exchange. Of the responses, just over 60% had ever tried a cigarette, and among those, almost 69% reported that they had gone on to become daily smokers.

Prof. Hajek added that this high "conversion rate" to smoking highlights the importance of preventing people trying cigarettes in the first place and that some of the reduction in terms of numbers of smokers in more recent years is probably aided by fewer teens trying it.

Congratulations to Togo on joining the Illicit Trade Protocol

The Togolese Republic has become the latest Party to the Protocol to Eliminate Illicit Trade in tobacco Products. 

Six more parties still need to join the Protocol before the 2nd July 2018 to reach the number of 40 in order for the Protocol to come into force. 

At the moment 9 (plus the EU) countries from the European Union became the parties of the Protocol and 12 (plus the EU) from the WHO Europe region.

WHO FCTC Secretariat publishes a report on the implementation of Article 5.3

This report was produced to reply to the COP7 request to the Convention Secretariat to facilitate sharing of best practices among Parties to implement Article 5.3.

It provides a selection of advanced practices in implementing Article 5.3. Furthermore, the report draws from a variety of Parties’ experiences, including those recommended in the guidelines. While some Parties have taken a whole-of-government approach, which is the ideal, others have adopted measures to protect the ministry/department of health from interference by the tobacco industry as a first step. Others have introduced policies on certain measures recommended in the guidelines, such as transparency. This report also provides examples of the denormalization of the tobacco industry, such as the banning of tobacco-related corporate social responsibility (CSR) activities and divestments from the tobacco business. 

Read the report...
WHO Europe Tobacco Control Playbook

Is there public support for tobacco control measures?

Key Message:
" There is strong public support for tobacco control measures, even from people who smoke. Surveys in various countries show that comprehensive measures such as smoke-free indoor and outdoor areas, bans on point-of-sale tobacco displays, plain packaging and tobacco taxation are welcomed by the public. ."
The tobacco industry often argues that there is public opposition to tobacco restrictions and that people do not want governments to implement measures such as clean indoor air laws, tobacco tax and plain packaging. A common tobacco industry tactic is to create an impression of public opposition to tobacco regulations (including using front groups, generating responses to public consultations etc). While in reality most people, including those who smoke, support tobacco control measures.

Key messages summarising the facts concerning public support of TC measures:

  • The tobacco industry – often via front groups, third parties and fake grassroots organizations – often argues that there is strong public opposition to tobacco regulations. However, this opposition tends to be funded primarily by tobacco companies, and is usually not as 'grassroots' as it appears.
  • Public support is strong, including among those who smoke, even for very comprehensive tobacco control measures such as plain packaging, smokefree outdoor areas, and comprehensive bans on tobacco advertising and promotions including bans on point-of-sale tobacco displays.
  • Public support for any given tobacco control measure can be increased by educating the public on its rationale, making sure the measures are part of a comprehensive approach, and denormalizing the tobacco industry.

Read more in the WHO Tobacco Control Playbook.

New published articles
Obioma Uchendu, Akindele Olupelumi Adebiyi, Oluwapelumi Adeyera

The ‘state’ of tobacco: Perceptions of tobacco among Appalachian youth in Kentucky
Joy L. Hart, Kandi L Walker, Clara G. Sears, Lindsay K. Tompkins, Alexander S. Lee, Delvon T. Mattingly, Allison Groom, Robyn Landry, Aida L. Giachello, Thomas J. Payne, Anshula Kesh, Allison Siu, Courteney Smith, Rose Marie Robertson

Reasons for use, potential use, or discontinued use of hookah among US young adult college students
Shreya Kothari, Carla J. Berg

Acknowledgement of manuscript reviewers 2017

Panagiotis K. Behrakis

A geo-view into historical patterns of smoke-free policy coverage in the USA

Zaria Tatalovich, David G. Stinchcomb, Jeremy A. Lyman, Yvonne Hunt, James E. Cucinelli

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