A new report from the US Institute of Medicine (IOM) suggests that increasing the minimum age of legal access to tobacco products will improve the health of Americans across their lifespan and save lives, reports Medical News Today. The report notes that over the past half a century, there have been an estimated 8m fewer premature deaths thanks to increased tobacco control efforts in the US. More than 40m Americans still smoke, however.
Currently, the minimum age of legal access (MLA) for tobacco products is set at 18 years for most states. But because the Food and Drug Administration (FDA) were prohibited from raising the MLA for tobacco products above 18 years of age by the Family Smoking Prevention and Tobacco Control Act of 2009, the FDA commissioned the IOM to produce a report investigating the public health implications of raising the MLA. However, the IOM were told to do so without making a direct recommendation on whether or not the MLA should be raised.
The IOM report finds that raising the MLA of tobacco products to 21 will have "a substantially greater impact" than raising it to 19. The effect of raising the MLA to 25 would be considerably smaller, however, say the authors. Explaining how they arrived at this conclusion, the authors say that it is between the ages of 15 and 17 – when teenagers begin to drive, take on part-time jobs and encounter more people over the MLA who may smoke – when Americans typically first have access to tobacco.
Therefore, raising the MLA may not make enough of a change within social sources to limit tobacco exposure within this age group, whereas a raise to 21 might delay the initiation of smoking. "Initiation of tobacco use" is defined as having smoked 100 cigarettes. Statistics show that 90% of the people who have ever smoked daily tried their first cigarette before the age of 19, with almost all of the remaining 10% trying their first cigarette by the age of 26. This suggests, say the authors, that if a person is not a regular user of tobacco by the age of 25, it is highly unlikely they ever will become a smoker.
Illustrating the impact raising the MLA might have on public health if implemented now, the authors say that by 2100 there would be a decrease in smoking prevalence of 3% for an MLA of 19, with a 12% decrease for an MLA of 21, and a 16% decrease for an MLA of 25.
In terms of how raising the MLA to 21 might affect rates of death and disease, the authors estimate that for people born between 2000 and 2019, there would be 249,000 fewer premature deaths, 45,000 fewer deaths from lung cancer and 4.2 million fewer years of life lost. Also, the report suggests that maternal, foetal and infant outcomes would be significantly improved by raising the MLA to 21.
Modelled projections reveal that by 2100, there would be 286,000 fewer pre-term births, 438,000 fewer cases of low birth weight and 4,000 fewer cases of sudden infant death among mothers aged 15-49. Other health benefits conferred by raising the MLA would be more immediate, such as reduced exposure to second-hand smoke.
Another Medical News Today report says an international group of health and policy experts has called for the UN to lead a "turbo-charged" effort toward a world essentially free from tobacco products.
"The time has come for the world to acknowledge the unacceptability of the damage being done by the tobacco industry and work towards a world essentially free from the legal and illegal sale of tobacco products," states Professor Robert Beaglehole, one of the series' lead authors from the University of Auckland in New Zealand. "A world where tobacco is out of sight, out of mind, and out of fashion – yet not prohibited – is achievable in less than 3 decades from now, but only with full commitment from governments, international agencies, such as the UN and the World Health Organisation (WHO), and civil society."
It has been 10 years now since the WHO introduced the Framework Convention on Tobacco Control (FCTC) – an international treaty designed "in response to the globalization of the tobacco epidemic," with the aim of reducing tobacco use. But success has been mixed. During the past decade, an estimated 50m deaths have been caused by tobacco, suggesting that the FCTC is not enough to achieve the desired reductions in tobacco use.
The authors note in the report that the "big four" tobacco companies utilise a range of tactics to promote their products, including lobbying, covertly maintaining political pressure and through publicity events aimed at women or young people. "Contrary to industry claims, tobacco marketing deliberately targets women and young people," says series author Professor Anna Gilmore. "The tobacco industry continues to interfere with governments' efforts to implement effective tobacco control policies. If the world is to become tobacco free, it's vital that the industry's appalling conduct receives far closer scrutiny and countries which stand up to the industry's bullying tactics receive better global support," she adds.
The series suggests that, if tobacco usage is to be reduced to levels that the WHO are happy with, greater levels of intervention will be required.
Using plain packaging for just one day can change smokers' attitudes towards their cigarette packs. This is according to the first randomised controlled trial into the effects of short-term exposure to plain cigarette packaging on smoking attitudes and behaviour.
These results come two days after politicians in the UK voted to introduce plain cigarette packaging, a measure which will be introduced in May 2016. This new legislation will bring the UK in line with Australia, which is currently the only country to have introduced plain packaging, and Ireland, which passed a similar law earlier this month.
Researchers at the University of Bristol, along with collaborators from the Universities of Stirling and Exeter, asked daily cigarette smokers to use either a branded pack of cigarettes (purchased in the UK) or a plain pack of cigarettes (purchased in Australia, where plain packaging was introduced in 2013) for a single day. Smoking behaviour was measured by asking participants to smoke their cigarettes through a device called a "topography monitor". Participants also rated their attitudes to the packs and to smoking in general.
The results showed that although there were no immediate effects of using the plain pack on how many cigarettes were smoked over the course of the day, daily smokers who used the plain pack reported more negative experiences of using the pack, rated the pack itself as more negative, and reported that the health warning was more impactful, compared with those who used the branded pack. This fits with recent evidence from Australia that smokers are less likely to put their packs on display since the introduction of plain packs.
Dr Olivia Maynard, the lead author of the study explained: "The fact that we did not see any effect of using plain packaging on smoking behaviour is perhaps not surprising, as our participants only used the packs for a day. However, the changes in attitudes that we observed after this short exposure to the packaging are interesting and suggest that plain packaging may impact behaviour over time."
Professor Marcus Munafò, the the senior author on the paper explained: "This is perhaps the closest we can come to looking at the likely impact of introducing plain packaging on current smokers in a country where it has yet to be introduced. Although most of the interest in plain packaging stems from the anticipated impact on the uptake of smoking in young people, our results suggest that there may be immediate effects on the attitudes of established smokers."
[link url="http://www.medicalnewstoday.com/articles/290872.php"]Full Medical News Today report[/link]
[link url="http://www.iom.edu/~/media/Files/Report%20Files/2015/tobacco_minimum_age_report_brief.pdf"]Institute of Medicine report brief[/link]
[link url="http://www.medicalnewstoday.com/articles/290829.php"]Full Medical News Today report[/link]
[link url="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60512-8/abstract"]The Lancet editorial summary[/link]
[link url="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60133-7/abstract"]The Lancet article summary[/link]
[link url="http://www.bristol.ac.uk/news/2015/march/short-term-exposure-to-plain-cigarette-packaging.html"]University of Bristol material[/link]
[link url="http://www.biomedcentral.com/1471-2458/15/240/abstract"]BMC Public Health abstract[/link]