5 March 2019
Global Forum on Human Rights and a Tobacco-Free World: 26 March 2019, Bucharest, Romania
His Excellency Vytenis Andriukaitis, the European Commissioner for Health and Food Safety, will be in Bucharest on 26 March as an honorary guest of the Global Forum on Human Rights and a Tobacco-Free World to emphasize the direct link between tobacco consumption and the entailed harm, which violates the fundamental right to health of every citizen.

The Forum is hosted by the Romanian Presidential Administration.

For further information please contact office@2035faratutun.ro.
4th ENSP-SRP International Conference on Tobacco Control
Keynote Speaker: Stephen P. Marks

The emphasis of Stephen Marks’s work is on public health and human rights, drawing on the disciplines of international law, international politics, international organizations, and international economics.

Professor Marks’s recent research has focused on the right to health, global health governance,  integrating human rights into sustainable human development; mental health; poverty; tobacco control; and the right to development.


Conference Media Partner
EURACTIV is a European media platform specialising in the online publication of articles focusing on European policymaking, which is present across 12 EU capitals.
Lithuania: Legal response to the challenges of novel tobacco products
On 25 February, an international expert seminar was organised by the ENSP and National Tobacco and Alcohol Control Coalition (NTAKK) in the Lithuanian Parliament in Vilnius. With the presence of Minister of Health Prof. Aurelijus Veriga and participation  of national officials, international experts, representatives of NGOs, legal changes imposed by novel products were discussed.

Information on legal instruments as well as experience from countries such as Italy, Spain, Poland, Greece, the United Kingdom and France have been provided. Many experts have noted that Lithuania is an example of good practice, being among the first countries in the EU to implement the tobacco products directive adopted in 2014. To build on that success, is was very important to clarify that heated tobacco products are not proven to pose lower risk for its users and should be a subject to strict regulation. 
Heated tobacco use among youth in Canada, U.S. and England
Heated Tobacco Products are a sensitive subject among policymakers and tobacco control activists but also among consumers. Very little is known about the perception of these products, but the markets keep growing and the numbers of consumers too. The scariest fact is that a large number of consumers represent the young generation.

The research paper "Awareness and interest in IQOS heated tobacco products among youth in Canada, England and the USA" points out the interest and susceptibility to trying heated tobacco products such as IQOS. The results are, unfortunately, very worrying.

Read the full article...
Welcome to our New Member! 

The Health Association Institute from Turkey joined the ENSP Network and we are glad to introduce the organisation and its activities.

Working on the causes of cancer, heart disease, lung disease, brain-vascular disease, viral diseases, home and work accidents, traffic accidents, they examine the risk factors for health and tackle the issue of prevention. 

They also focus on promotion of comprehensive social transformation, which is necessary for the elimination of health-threatening forces and relations and, to that end, the Institute conducts multidisciplinary advocacy work.

Learn more about the Health Association Institute [TR]...

Call for nominations!
WNTD 2019 - Tobacco and lung health

The World Health Organization (WHO) is calling for nominations to the World No Tobacco Day Awards of individuals or organizations in each of the six WHO Regions for their accomplishments in the area of tobacco control. The objective of these criteria is to facilitate nominations, bearing in mind that the final decision about whether to bestow an award rests with the WHO Regional Directors and the WHO Director-General.
Who can be nominated? How to submit a nomination?


Please note that the deadline for submission of nominations is Friday, 8 March 2019 - 17:00 (GMT).
CHAFEA - Call for tenders published:
studies on the EU system tobacco traceability

Chafea has published on 28/12/2018 the Call for tenders "Chafea/2018/Health/11 for the provision of an experts study on development and configuration of automatic alerts ('alerts') to be generated by the repositories system of the EU system of tobacco traceability".

The objective of the contract is to supply the Commission and the competent authorities of Member States with an expert study on development and configuration of automatic alerts ('alerts') to be generated by the repositories system.

The deadline for submission is 15 March 2019!
Please note that applications are to be submitted electronically.
European Parliament Debate: Where does the parallel trade of tobacco come from? How to end it?
On January 29, Romanian Christian democrat MEP Cristian-Silviu Bușoi organised a seminar discussion titled "Where does the parallel trade of tobacco come from? How to end it?", which focused on firstly finding the cause for the parallel tobacco trade and subsequently, propose solutions on how to end it. The discussion largely focused on proposed tracking and tracing systems to combat parallel and illicit tobacco trade within the European Union, with stakeholders from various organisations such as the European Network for Smoking and Tobacco Prevention, and a representative of the Commission giving interventions on the topic, focusing on the legal framework proposed for tracking and traceability of tobacco products.

Francisco Rodriguez Lozano, President of the European Network for Smoking and Tobacco Prevention (ENSP), offered some introductory remarks. He welcomed everyone to what he hoped would be a fruitful discussion, and he thanked MEP Bușoi for the organisation of the event. Price, he highlighted, was one of the most effective measures of tobacco control. 

The Director of Smoke Free Partnership, Anca Toma Friedlaender, also offered some opening remarks. She thanked for the invitation to the event, and for being allocated time to intervene. Smoke Free Partnership is a partnership of the Belgian Foundation against cancer, Cancer Research UK, the Dutch Cancer Society and the Norwegian Cancer Society with the European Heart Network, Action on Smoking and Health (UK), and La Ligue contre le Cancer, she explained. They coordinate a coalition of 45 organisations all over Europe to advocate for the implementation of the illicit trade protocol. The points that she will be presented have also been endorsed by the European Cancer League, she noted.

The main pannels of discussion were: Legal framework adopted under the TPD and its derived actsArticle 7 and 8 of the WHO-FCTC illicit trade protocolIllicit tobacco tradeTobacco control research and  The legal framework adopted by the European Commission vs. the WHO protocol.

Belgium and Kuwait: the most recent ratifications of the Illicit Trade Protocol
Belgium and Kuwait have ratified the Protocol to Eliminate Illicit Trade in Tobacco Products.

The WHO FCTC Secretariat confirmed the ratification of the Protocol by these two states, that brings the number of Parties up to 50.

World Bank Report on Illicit Trade
A major new World Bank report was launched and puts paid to the tobacco industry argument that when governments raise tobacco taxes it increases the illicit trade in tobacco, damaging government revenues and public health.  

It is developped around the question " Why is illicit trade in tobacco products a problem?" and how different strategies worked for several countries such as:  Australia, Canada, the EU, the UK, Georgia, Ireland, OECS and Trinidad and Tobago, Chile, Colombia, Ecuador, Mexico, Uruguay, Bangladesh, Indonesia, Malaysia, Philippines, Botswana, Lesotho, Namibia, South Africa and Eswatini, Kenya, and Senegal.  

Increasing taxes on tobacco is essential for global health for reducing consumption, reducing the affordability, poverty and at the same time for saving millions of lives. But with higher taxes, increase much more smuggling and many new brands come onto the market to keep alive the interest of the low-income population.

Read the full report...
10 years of Global Bridges!
2019 is an importat year for Global Bridges marking a fantastic progress in raising awareness and building capacity to make tobacco dependence treatment more available worldwide.

A ten-year Milestone Report was published on the Global Bridges website, including the achievements in the past 10 years.

Read the report...
Cigarettes "kill" the Environment
Cigarette filters do not protect consumers from grave health consequences while also poison the environment.

Among plastic straws and plastic bags, cigarettes are a huge contributor to global pollution. Cigarette butts containing plastic filters are actually the most littered item in the world. Smokers may think that cigarette butts will biodegrade, but the ugly truth is that they are made of cellulose acetate and it can take up to a decade to decompose.

Canada: defeat of the tobacco industry in 2 court actions

On Friday March 1, 2019, a unanimous Quebec Court of Appeal with a panel of 5 justices (5-0) dealt the tobacco industry a massive defeat in the two tobacco class actions.  In a compelling 422-page judgment, the Quebec Court of Appeal upheld a May 27, 2015 trial judgment of the Quebec Superior Court.  At trial, the Superior Court had found the 3 major tobacco companies in Canada (which are 100% subsidiaries of BAT, PMI and JTI) liable for $C15.5 billion in damages (US$11.7 billion at current exchange rates).  The total liability has now climbed to about C$17 billion (US$12.8 billion) given accumulating interest.


The tobacco industry has indicated that it will seek permission to appeal to the Supreme Court of Canada.  A decision as to whether or not the Supreme Court of Canada will grant permission to appeal would be made in about 6 months.

Learn more about the historical chronology of the case...

In order to be able to appeal to the Quebec Court of Appeal, two of the tobacco companies had to pay a total C$984 million into court, funds to be available to the plaintiffs should the tobacco companies lose the appeal.


Read the full Quebec Court of Appeal March 1, 2019 judgment (French)...


Read the English summary here...

Swedish Match: the snus FDA case

In June 2014, Swedish Match originally submitted a Modified Risk Tobacco Product Application (MRTPA) to permit it to market eight sub-brands of General Snus with warning label statements different from those required by law for other commercially marketed smokeless tobacco products. The application aimed at leading smokers who would not otherwise quit smoking to switch completely to a Swedish match snus product, and would not lead to dual use or significant use among youth.

Two years later, the FDA denied Swedish Match’s request to remove a currently required warning stating that the products can cause gum disease and tooth loss, and deferred final action on the company’s other requests to remove or revise two additional currently required warnings. It was determined that the MRTPAs did not contain sufficient evidence to demonstrate that, as actually used by consumers, the snus products sold with modified risk claims would significantly reduce harm and the risk of tobacco-related disease to individual tobacco users and benefit the health of the population as a whole.

After 2 more years, in September 2018, Swedish Match submitted an amendment in response to the three deficiencies enumerated in FDA’s December 2016 letter, and submitted a second amendment in November 2018 in response to FDA’s October 2018 Advice and Information Request Letter. Regarding the first two deficiencies, the company’s September 2018 amendment accepted FDA’s recommendations to retain the warnings stating that the product “can cause mouth cancer” and “is not a safe alternative to cigarettes.” In response to the third deficiency, Swedish Match conducted a new consumer perception study entitled “Perceptions and Behavioral Intentions Study” to address the issues with its previous consumer perception study that the FDA identified. Based on the results of this study and other research, Swedish Match proposed the modified risk claim for the General Snus. 

Read more about the requirements for a MRTP order...
Belarus: stricter law covering novel tobacco products
On 24 January, the Belarusian president signed Decree No. 2 to amend Decree No. 28 from 17 December 2002 and Decree No. 4 from 18 October 2007 regulating production, trade and consumption of tobacco products, according to BelTA.
The main goal is to consistently limit access to tobacco products, to reduce the negative effects of smoking on health of people and to envisage legislative regulation of production, sale and use of electronic smoking systems, and also heated tobacco products.

E-cigarettes: an underestimated danger

On 30 of January, Arūnas Vinčiūnas, the Head of the cabinet of EU Health Commissioner Vytenis Andriukaitis was speaking at the EURACTIV event, where many participants asked for a dialogue with policy makers on sensitive health topics such as tobacco. 

Vinčiūnas confirmed once again the Commission’s opposition to consider novel tobacco products and e-cigarettes as healthy saying that  “There are scientific reports saying that e-cigarettes are less harmful than cigarettes (...) but it’s still tobacco". " You can drink less poison, but it is still poison in the end,” he added.

Read more...
Industry risks having e-cigarettes banned

According to the latest U.S. figures, E-cigarettes are lately the top high-risk substance used by teenagers. Juul and similar products have outpaced cigarettes, alcohol or marijuana, substances that have been tracked for more than four decades.

Therefore, E-cigarettes could be banned if they continue to encourage underage smoking.


E-cigarettes in Italy: a tool for harm reduction or a gateway to smoking tobacco?

A new research paper was published in Italy, stressing once again the perpetual danger of smoking, even in its newest and "modern" ways, such as vaping.


Introduction More than a decade after electronic cigarettes (e-cigarette) hit the European market, we are still debating whether they may help or hinder tobacco control. It is therefore useful to explore the potential net effect of e-cigarette use in the general population.

Methods We annually conduct a face-to-face survey on smoking in Italy on a representative sample of the general population aged 15 years or over (52.4 million). A total of 15 406 subjects were interviewed in 2014–2018. We investigated the consequences of using e-cigarettes on tobacco smoking behaviour among ever and regular e-cigarette users.

Results In all, 5.7% of our sample reported ever e-cigarette use. Multivariate analyses showed more use by men, ex-smokers and current smokers. E-cigarette use decreased with age and increased with education and calendar year. Only 1.1% of subjects were regular e-cigarette users. This prevalence rose from 0.4% in 2014–2015 to 1.8% in 2016–2017 and was 1.3% in 2018. Among 522 ever users, 13.2% stopped smoking after trying e-cigarettes and 22.2% started smoking or relapsed after using e-cigarettes. The corresponding estimates among regular users were 24.7% and 28.0%, respectively.

Conclusions Among Italian e-cigarette users, those (re)starting smoking after using e-cigarettes outnumber those who stop smoking after using e-cigarettes. From a public health point of view, e-cigarettes may have an unfavourable net effect. Consequently, if we are not able to prevent sales of e-cigarettes to non-smokers, this product will more likely stimulate smoking tobacco than reduce harm.

Read the full article here...
Cohort study of electronic cigarette use: safety and effectiveness after 4 years of follow-up
What are the effects of using e-cigarettes for a long period of time? The dangers seem to be almost the same for e-cigarettes smokers or dual smokers. Despite the illusion of smokers, the harm wasn't reduced and the long-lasting effects on the health are still very significant. This paper explains the case and provides the conclusion after a four-year study.
OBJECTIVE: More than a decade after e-cigarette (e-cig) market launch, limited information are available on their safety after 24 months of use. In 2013, we started the first observational study assessing e-cig long-term effectiveness and safety, directly comparing tobacco smokers and e-cig users. Here we report the results after four years of follow-up.

PATIENTS AND METHODS: Adults (30-75 years) were included if: smokers of ≥1 tobacco cigarette/day (tobacco smokers); users of any type of e-cig inhaling ≥50 puffs weekly (e-cig users); users of both tobacco and e-cig (dual users). Data were collected by phone and/or internet, and carbon monoxide levels tested in 50% of those declaring tobacco abstinence. Main outcomes were: possibly smoking-related diseases (PSRD; validated through hospital discharge data or visit in 62.6% of the sample); 4-year tobacco abstinence; number of tobacco cigarettes/day.

RESULTS: Data were available for 228 e-cig users (all ex-smokers), 471 tobacco smokers, 216 dual users. A PSRD was observed in 73 subjects (8.0%). No differences emerged across groups in PSRD rates, with negligible variations in self-reported health. Of e-cig users, 63.6% remained tobacco abstinent; dual users and tobacco smokers showed non-significantly different rates of tobacco (33.8% vs. 26.8%) and all-product (20.2% vs. 19.4%) cessation, and a similar decrease in cigarettes/day. Almost 40% of the sample switched at least once (tobacco smokers: 17.2%; dual users: 81.9%).

CONCLUSIONS: After four years, a scarce, non-significant harm reduction was observed among e-cig or dual users. Given the long-lasting health effects of tobacco smoking, the benefits of e-cig use may start being detectable at the next follow-up (six years). The complete switch to e-cig may help tobacco quitters remain abstinent, but e-cig use in addition to tobacco did not increase the likelihood of smoking cessation or reduction.

Read the full paper...

New published articles
Response to Tobacco Free Ireland 2025: SimSmoke prediction for the end-game

Frank Houghton, Diane O' Doherty, Derek McInerney, Bruce Duncan

Acknowledgement of manuscript reviewers 2018
Panagiotis K. Behrakis

Financial strain mediates the relationship between socioeconomic status and smoking
Aaron F. WatersDarla E. KendzorMelanie R. RoysShelby A. StewartAmy L. Copeland

Barriers and supportive factors in certified tobacco cessation counselors in Sweden
Anton Jonatan LandgrenHans Gilljam

Percentage of current tobacco smoking students receiving help or advice to quit: Evidence from the Global Youth Tobacco Survey, 56 countries, 2012–2015
René A. ArrazolaAndrew B. SeidenbergIndu B. Ahluwalia

WHO FCTC Article 14 enforcement in Albania: An urgent issue to tackle
Enkeleint A. MechiliCharis GirvalakiAurela SaliajFilippos T. FilippidisConstantine I. Vardavas

Exposure to secondhand smoke in Iranian pregnant women at home and the related factors
Seyed Saeed Mazloomy MahmoodabadZohreh KarimiankakolakiAshraf KazemiNastaran Keshavarz MohammadiHossein Fallahzadeh

Adolescents notice fewer tobacco displays after implementation of the point-of-sale tobacco display ban in Finland
Jaana M. KinnunenHanna OllilaAnu LinnansaariDavid S. TimberlakeMirte A.G. KuipersArja H. Rimpelä
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