Promoting a tobacco free society



















Speakers Abstracts

Dr Catherine Le Galès-Camus|

Developing and implementing a global response to the tobacco epidemic

Tobacco is responsible for 4.9 million deaths per year and the number of annual deaths will double in 20 years if current trends continue.  Over the last decades, researchers have accumulated an impressive amount of scientific evidence on the dramatic health consequences of tobacco use, the negative effect of tobacco on the economy of individuals, families and governments and the negative impact on the environment. Despite this evidence, the tobacco epidemic continues to grow for two main reasons: first, tobacco is very addictive and it is hard to quit especially with modern cigarettes which have been designed to be even more addictive and, secondly, the tobacco industry has to maintain a business and will use all possible strategies to replace consumers or recruit new ones.

There are cost-effective, evidence-based and well-tested interventions to reduce the consumption of tobacco products and to assist people to quit.  These interventions are based on demand reduction measures including tax increases, banning of advertising, creation of smoke-free places, awareness-raising and treatment of tobacco dependence, and supply reduction measures such as controls on smuggling.

The European Union has been a committed partner in WHO's tobacco control efforts, and was a prominent player during the negotiation of the WHO Framework Convention for Tobacco Control (WHO FCTC).  WHO acknowledges the pioneering role of the European Union through its directives in tobacco control:  prohibition of all forms of advertising on television (1997); product regulation (2001); and banning the advertising and sponsorship of tobacco products and packaging and labelling (2003).

WHO welcomes the European Parliament decision to overwhelmingly support the formal confirmation of the Convention and looks forward to working hand-in-hand with the European Union and its member states in order to make the WHO FCTC a powerful tool at country level to reduce death and disability due to tobacco use.

As of 1 June 2004, 118 countries plus the European Union have signed and 17 have ratified the treaty.  The treaty will enter into force as soon as it has been ratified by 40 countries.

Dr David Madden|

Prof. David Balfour|

Prof. Luke Clancy|

Strategic direction for research in tobacco control in Europe

Research must become the driver for tobacco control in the European Community.  Tobacco smoking is a disease that affects more than a third of our people. Our treatments are very poor and our understanding of the disease is very limited.

Trans-disciplinary research must supply the understanding and information that can be translated and used to control this disease.  We must aim to make Europe a tobacco free zone in the long term but accept that tobacco will not go away quickly or willingly.

There are good networks of like-minded researchers active in this struggle but we lack a coherent plan.  One of our first priorities should be to come together and recognise the rich varieties of disciplines that are involved in this endeavour and agree a strategy.  There is a need to focus our collective efforts, to re-examine our aims and pursue them relentlessly.

We have to overcome the present categorical allocation of resource, which inevitably results in an uneven approach to the problem.  We must foster a literature that is accessible to the various disciplines and which can then be translated into formats that can be communicated to the population.

The medical models of treatment for this condition are found wanting.  We must therefore explore other models and look carefully at interventions at population level.  The new tools of molecular medicine are at least as important in this disease as in any other and the lessons learned must be used so that molecular epidemiology is available and accessible to those who are involved in tobacco control through legislation or litigation.  The concepts of behavioural economics can help to inform our understanding of marketing and sales and hopefully be applied.

Research on the health effects of smoking has probably been the most powerful tool in the fight against tobacco and must continue as such.  But clinical science alone or indeed any discipline alone will not be successful.  In probably no other disease is trans-disciplinary translational research so obviously crucial.

The allocation of adequate resources is vital for the performance of research but it is also crucial in showing that the European Community takes smoking seriously and is resolved to find a solution.

Dr Paolo Boffetta|

Dr Dimitrios Kotzias|

Research on ventilation systems and second-hand smoke

Environmental tobacco smoke (ETS), derived primarily from side-stream cigarette smoke between puffs, is a major contributor to indoor air pollution wherever smoking occurs.  In the frame of activities to evaluate human exposure to ETS in indoor environments, a series of tests were undertaken to investigate the impact of various ventilation rates on the air concentration of ETS-compounds.  The tests were carried out at the European Commission Joint Research Centre’s INDOORTRON facility, a 30m³ walk-in type environmental chamber.  Emphasis is given to the identification and quantification of the main ETS volatile compounds (many of them known to cause serious health effects) at different ventilation rates, rather than to examine available control technologies for environmental tobacco smoke.  A particular feature of our study was the monitoring of the various ETS originated components close (1.5m) to the emission source (cigarette burning) during the smoking period, to evaluate human exposure in the direct proximity of the source.

Preliminary evidence indicates that changes in ventilation rates simulating conditions expected in many residential and commercial environments during the smoking (0.3-4.5ach*), do not have a significant influence on the air nicotine. This suggests that efforts to reduce ETS originated indoor air pollution through higher ventilation rates in buildings, including residential areas and hospitality venues, would not lead to a meaningful improvement of indoor air quality. Moreover, the results show that “wind tunnel” – like rates or other high rates of dilution ventilation would be expected to be required to achieve pollutant levels close to ambient air limit values.

* Air change rate per hour

Dr Shane Allwright|

Health effects of second-hand smoke in the workplace

Ireland introduced the first nationwide ban on smoking in enclosed workplaces in the European Union on 29 March 2004.  The purpose of the new smoke-free law is to protect workers and the public from exposure to second-hand tobacco smoke in workplaces. 

The introduction of the law, and its implementation, were the culmination of a process stretching back many years, including inter-party parliamentary reports.  Previous Irish legislation included restrictions and prohibitions on smoking focussed mainly on public places while including certain categories of workplace.  However, there were notable exceptions, such as pubs, nightclubs and other hospitality premises. 

In 2002, given the increasing concern about the harmful health effects of second-hand smoke (environmental tobacco smoke (ETS)), the Office of Tobacco Control and the Health and Safety Authority commissioned an independent scientific working group to “identify and report on the degree of consensus that exists among leading international scientific authorities on the question of the hazard and risk posed by environmental tobacco smoke to human health in the workplace”.  Subsequent to the launch of this report, in January 2003, the Minister for Health and Children announced a comprehensive ban on smoking in the workplace to be implemented in 2004.

The presentation will outline the findings of the "Report on the health effects of environmental tobacco smoke (ETS) in the workplace".  The principal findings are: that ETS has many adverse health effects, including causing lung cancer and heart disease; that ETS exposure infringes the basic human right to good quality air and that employees need to be protected from exposure to ETS at work; that legislative measures are required to protect workers from the adverse health effects of ETS exposure as current ventilation technology is ineffective; that high risk categories of workers require special consideration e.g. hospitality staff who may be exposed to extreme levels of ETS. 

Ms Isabel Saiz|

Spain’s tobacco control action plan
Tobacco control policies in Spain are within the framework of the National Tobacco Control Action Plan. One third of the Spanish population 16 years of age and older smokes daily. In the last few years, smoking prevalence in Spain has been stable, in spite of gender-related changes. Males, in general, smoke more than females, although during adolescence and early adulthood, the reverse is true. Considering the level of smoking prevalence in Spain and its impact on public health, there is a need for intervention by the administration at central, regional, and local levels.

The Tobacco Control Action Plan was approved in 2003 by the Inter-territorial Council of the National Health System to deal with tobacco control in a comprehensive manner – focusing responsibilities, sharing resources, etc., so the Plan harmonises the activities of these different administrations.

The main objectives of this plan are 1) to reduce tobacco prevalence, 2) to protect the population from environmental tobacco smoke, and 3) to promote co-ordination and participation. Given these objectives, our actions will be directed at preventing new smokers, delaying the starting age of tobacco consumption, and providing smoking cessation as well as avoiding population exposure to ETS, promoting smoke-free places, and encouraging non-smoking as a social norm. Our challenge is to implement new legislation that creates smoke-free workplaces, bans advertising (and promotion and sponsorship), greater control for sales to youngsters, and to define the criteria for financing and providing smoking cessations treatments.

Prof. Witold Zatoński|

Improving Poland’s health through tobacco control

Premature mortality among young and middle-aged adults (15-59 years) in the accession countries is more than double (but in Hungary and Latvia more than 3 times higher) that in the “old” 15 EU countries. This is due to man-made diseases. Tobacco-related diseases account for nearly half of the causes of premature deaths. Efficient tobacco control is therefore the greatest challenge for the accession countries and a prerequisite for closing the gap not only in health but also in economic and productivity terms in the enlarged European Union.

The public health catastrophe in Poland (and other CEE countries) is a Communist legacy. Effective work to improve health could only be started after the return of democracy. In Poland, health advocates worked together with the Parliament to develop and enact comprehensive tobacco control legislation, which was successfully implemented. Over time the national tobacco diseases eradication programme has been taking effect, leading to a considerable improvement in the health of the Polish people in the 1990’s. However, premature death from tobacco is still the number one killer. That is why Poland and the other accession countries expect so much from the European Commission’s policy on public health. We are happy to see that a number of countries (e.g. France) are seeking to ensure a proper place for public health issues in the European Union.

Epidemiological data, e.g. time trends in the incidence of lung cancer (which almost exclusively afflicts tobacco smokers), still demonstrate that eradication of tobacco-related cancer and other tobacco diseases in the enlarged European Union will not be achieved in the near future. Rather, they show that we are actually still at the start of our journey

Public health is the greatest challenge for the EU’s “east lung” (accession countries) and the possibility of pan-European collaboration in this regard appears to be most promising.

Ms Margaretha Haglund|

The Swedish experience

Over the years, Sweden has often been cited as an example of a country with progressive tobacco control policies. For example, Sweden was one of the first countries to take action against tobacco in the 1960´s and continues to invest significant annual funds for tobacco control activities (in place since 1964). The result of implementing these tobacco control policies has been very encouraging resulting in steadily falling smoking rates for some decades.

Recently, there have been several opinions about Sweden’s tobacco control success story that insist the falling smoking rates are mainly explained by the high consumption of snuff in Sweden. It is well documented that the prevalence of snuff has been very stable since the 1980´s and at the same time, smoking has decreased substantially. The decrease in smoking among women has taken place also without the use of oral snuff.  Today, a mere 1-2 percent of women in Sweden are snuff users compared to 20 percent of men.

The presentation will focus on a variety of tobacco control (TC) activities implemented in Sweden over the past thirty years and discuss the importance of the comprehensive strategy for success. In Sweden, there is an impressive range of tobacco control activities being planned and implemented by a coalition representing many levels of society and various groups. Elements within tobacco control activities to be discussed are the step by step legislative approach, the key role of NGOs both within the TC movement and women-focused action including innovative and controversial methods to engage the media and finally the impact of snuff on the Swedish society.

Dr Gregory Connolly|

US tobacco control policies and their impact on tobacco use

This presentation will examine the role that tobacco control policies have had on the decline in cigarette consumption in the state of Massachusetts and the important role that Clean Indoor Air (CIA) legislation has played in the United States in curbing tobacco use. 

Massachusetts has taken a lead among the 50 states in America to curb tobacco use. Policies employed included increased price through taxation, dedication of excise taxes to a comprehensive tobacco control program, litigation against the tobacco industry, promotion of CIA Laws, enforcement of laws preventing the sale of tobacco products to youth and restrictions on advertising. The different policies and their impact on intermediary measures that predict a future decline in adult and youth prevalence will be reviewed.  From 1993 to 2003 overall cigarette consumption fell more than 50% in Massachusetts and over one quarter of a million adults quit smoking preventing an estimated 120,000 premature deaths.

According to the Federal Centers for Disease Control and Prevention, CIA policies are an important component of a comprehensive tobacco control program.  Such laws protect non-smokers from the dangers of second-hand smoke (SHS) and protect workers particularly hospitality workers from lung cancer associated with occupational exposure to SHS.  They also promote positive social norms that discourage youth from smoking and preventing relapses among quitters.  Research shows that smokers who live in smoke-free homes and work in smoke-free worksites are more likely to quit than those who don’t.  Research also found that CIA laws had no effect on business, patrons complied with policies and the levels of toxins in bars and restaurants and worker exposure to nicotine and other toxins was greatly reduced.

Comprehensive CIA policies have been adopted in the US states of Maine, Massachusetts, Connecticut, New York, Delaware and California and in Ireland, Norway, New Zealand and India.  All member states of the European Union should follow Ireland’s lead and enact comprehensive CIA policies to protect public health and make smoking history in Europe.

Prof. Geoffrey T. Fong|

International Tobacco Control Policy Evaluation Survey (ITCPES)
The International Tobacco Control Policy Evaluation Project is a unique international collaboration of tobacco control researchers whose mission is to evaluate the psychosocial and behavioural effects of national-level tobacco control policies throughout the world, particularly those that are contained within the FCTC (e.g., more prominent warning labels, prohibitions on misleading brand descriptors such as “light” or “mild”, restrictions/prohibitions on advertising and promotion of tobacco products, increases in taxation, measures to limit exposure to second-hand smoke).

The initial phase of the ITC Project is a random-digit-dialled phone survey of over 8,000 adult smokers throughout four countries: Canada, United States, United Kingdom, and Australia – the first international cohort study to focus on the effects of tobacco control policies. The study focuses not only on whether a given policy has its desired effect, but also on how and why those policy effects are achieved.

The presentation will describe the methodology of the ITC 4-country survey and initial findings on the evaluation of the two major tobacco control policies that were introduced in 2003 in the United Kingdom: the enhancement of warning labels introduced throughout the European Union through Council Directive 2001/37/EC and the comprehensive ban on advertising and promotion introduced by the UK government. Also discussed will be the expansion of the ITC Project into other countries, in particular, the ongoing evaluation of the March 2004 workplace smoking ban in the Republic of Ireland.

Mr Luk Joossens|