The Estonian Minister of Health and Labour: Alcohol policy should be based on public health

The Estonian Minister of Health and Labour Jevgeni Ossinovski points out that the Nordic and Baltic countries should work together, exchange experiences and learn from each on most effective ways to reduce harms related to alcohol use.

Press release 9.8.2016, Preventive Substance Abuse Network

At a meeting with the Finnish NGOs, minister Ossinovski said, that "Considering the overwhelming scientific agreement that restricting alcohol promotion, limiting its availability and raising the price of alcohol are the most effective measures to reduce consumption, plans to relax the regulation may have adverse effects on public health".

– Finland is considering to relax the measures and Estonia is planning to take the opposite track. According to Minister Ossinovski, public health should be taken into account when considering alcohol related strategies and measures.
"Public health is one of the most important things to any country. Of course this may not affect business interests in a suitable way, but without a doubt, public health will always be a higher priority, says minister Ossinovski.

– Alcohol also contributes to death and disability. The increase of risky drinking behaviours is a worrying trend as it is associated with higher rates of traffic accidents and violence, to name some. A stricter alcohol policy may have a long term effect on the social norms in society: the next generations will consume less. As an example: progress with tobacco policy as already showed us that smoking is not popular among young people anymore.
 
The Finnish NGOs warn about the consequences the currents plans of Finnish alcohol legislation may cause.
– We tend to think that Finland is the only country which strives for less alcohol-related harms. That is far from truth. According to WHO, countries have a responsibility for formulating, implementing, monitoring and evaluating public policies to reduce the harmful use of alcohol. Finland should do the same, says Mervi Hara, the chairperson of the advocacy committee of the Preventive Substance Abuse Network.

– I congratulate Estonia's aim to take health effects of alcohol use into consideration in political decision-making, Hara continues.

Minister Ossinovski met the representatives of The Finnish Association for Substance Abuse Prevention EHYT ry and the representatives of the Preventive Substance Abuse Network in Helsinki. During the meeting current plans of the national alcohol policies were discussed.

Further information:
Mervi Hara, Executive director, ASH Finland,
p. +358 50 460 2324, mervi.hara a suomenash.fi

Oskar Lepik
Meediasuhete nõunik Sotsiaalministeerium
p.+372 626 9321 / +372 5333 7341
press a sm.ee / oskar.lepik a sm.ee

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New Tobacco Act enters into force on 15 August 2016

The purpose of the new Tobacco Act is to prevent young people from starting to use tobacco products and to support people to quit using tobacco products.

All characterising flavours, such as vanilla and menthol, of cigarettes, roll-your-own tobacco and liquids for electronic cigarettes will be prohibited. It will become easier for housing companies to intervene in smoking on balconies. Electronic cigarettes containing nicotine will be subject to the same provisions as other cigarettes in the Finnish market. Smoking in cars with children under the age of 15 will be banned. These are some of the amendments included in the new Tobacco Act which will enter into force on 15 August 2016 in Finland.

The new Act implements the EU Tobacco Products Directive. Some of the amendments are based on Finland's own consideration and legislative needs.

The purposeof the new Tobacco Act is to prevent young people from starting to use tobacco products and becoming addicted to nicotine and to support people to quit using tobacco products. The aim is also to protect non-smoking people from exposure to tobacco smoke.

The Act enters into force on 15 August 2016, but it contains several transitional provisions.

For further information:
Ministry of Social Affairs and Health  

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Tobacco Products Directive enters into force

The EU Tobacco Products Directive enters into force today 20 May 2016. In Finland, the entry into force of Tobacco Act is postponed.

As of today, the EU Tobacco Products Directive (TPD) mandates that all new packets of cigarettes and roll-your-own tobacco manufactured for the EU market carry mandatory graphic warnings covering 65% of the front and the back to illustrate the health damage of tobacco use. Tobacco packs will also have to observe minimum size requirements, and slim packs will disappear from the EU market. The TPD provides for transitional periods (of up to one year, depending on the Member State) to allow existing stock packaged according to the previous regulations to be exhausted.

In addition, all tobacco products with characterising flavours will be banned, with the exception of menthol cigarettes which are still allowed on the market until May 2020. These measures are proven to be effective in reducing the attractiveness and appeal of tobacco products and are expected to reduce the uptake of smoking, particularly among young people, 70% of whom report to have started smoking before their 18th birthday.

The TPD also allows Member States to implement stronger measures, such as plain standardised packaging and point of sale display bans. The UK and France implement plain packaging  as of today; in Ireland implementation is imminent and Slovenia has recently notified this measure. Other governments are also considering implementing plain packaging including Hungary, Belgium and Norway. Point of sale display restrictions are also in force in a number of European Countries, including the UK, Ireland, Croatia, Finland, Iceland and Norway.

On 19 May 2016, the UK High Court delivered its judgment on the case brought forward by tobacco companies against plain packaging. The Court rejected each and every one of their claims, noting in particular the unique deadliness of the product and the historical abuse of evidence conducted by the tobacco industry. 

In Finland, the entry into force of Tobacco Act is postponed. The most important reason for postponing the entry into force of the Tobacco Act is that the government proposal was, at a later stage, supplemented with a proposal to ban smoking in cars with children under the age of 15. More information.

The EU Tobacco Products Directive
EU pictorial warnings
Regulation of graphic warnings on packs

For further information:
The Smoke Free Partnership

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Why electronic cigarettes need to be regulated? 

Professor Pekka Puska, President of ASH Finland, comments on the regulation of electronic cigarettes.

• The nicotine in e-cigarettes leads to a strong addiction.
• Electronic cigarettes are even marketed to children and young people, which may lead to a new generation becoming addicted to nicotine.
• A nicotine addiction often leads to mixed use of different tobacco products, including cigarettes.
• Nicotine is highly toxic and may be fatal to children even in small quantities.
• No solid, scientific evidence is available that e-cigarettes serve as an effective and safe tool for giving up smoking.
• The flavour substances in e-cigarettes may be hazardous to health when inhaled.

In Finland young people’s interest in electronic cigarettes has clearly increased in recent years: only 5% of people aged 12–18 do not know what an electronic cigarette is. Half of the young people who have tried electronic cigarettes have used them with liquids containing nicotine. As a rule, boys pursuing a vocational qualification are the most common users of electronic cigarettes; 7% of them smoke daily and 13% occasionally.

The flavour substances added to e-cigarette liquids (incl. strawberry, chocolate and vanilla) and the appearance of the device are important factors that make the products attractive to young people.
Electronic cigarettes seem to specifically appeal to young people who already use other tobacco products, but also young people who do not smoke, try electronic cigarettes.
  
Electronic cigarettes can hamper giving up smoking


Some users feel e-cigarettes have helped them to give up smoking, but no evidence exists that they would be effective in helping the overall population quit smoking. On the contrary, according to a recent study completed in the United States, electronic cigarettes impair the user’s possibilities to give up smoking. According to another study, young people who try e-cigarettes are more prone to start smoking.
 
Nicotine causes an extremely strong addiction and permanently changes brain structure and functions. If electronic cigarettes are marketed as a tool for giving up smoking, then any e-cigarettes containing nicotine should be regulated by the Medicines Act similarly to other pharmaceutical products containing nicotine. The use and marketing of the products would then be supervised.

E-cigarettes have been studied relatively little compared with nicotine replacement therapy products, such as nicotine gum or patches. We will not have information about the effects of e-cigarette smoking on, for example, lung diseases among the general population and thereby population mortality rates until years and even decades have passed.

The effects of inhaling flavour substances are unknown

E-cigarette liquids require chemicals to create vapour, including glycerol or propylene glycol, which have been classified as safe to use in foodstuffs and hygienic products. However, no systematic data based on long-term research is available on the effects of these substances when they are vapourised and inhaled. There is some indication that the flavour substances used in e-cigarettes have adverse health effects. The vapour of nicotine-free e-cigarette liquids also contains hazardous substances, even though the quantities are low compared with cigarettes.

Electronic cigarettes vs. cigarettes

Nearly any product is safer than a cigarette, because cigarettes kill about every second user. From a general viewpoint, e-cigarettes are a form of smoking and are being intensely promoted by the tobacco industry. Electronic cigarettes are hazardous in many ways and promote a society that condones smoking.

Slightly over a year ago, Public Health England (PHE) published a report according to which e-cigarettes are 95% safer than regular cigarettes and an efficient tool for quitting smoking. However, the conclusion is only based on a single study with links to e-cigarette and tobacco companies.

Many prestigious parties, including medical journals Lancet and the British Medical Journal, the British Medical Association, the National Institutes of Health in the United States, and the World Health Organisation have challenged the report. WHO has also recommended that e-cigarettes not be used before their safety has been ascertained.

For further information:
Pekka Puska
Professor
President, ASH Finland
pekka.puska a thl.fi 

Sources:

Longitudinal study of e-cigarette use and onset of cigarette smoking among high school students in Hawaii. Tobacco Control 25.11.2015
E-cigarettes and smoking cessation in real-world and clinical settings: a systematic review and meta-analysis. The Lancet Respiratory Medicine. 14.1.2016
Nicotine as a Health Risk. Deutsches Krebsforschungszentrum 2.12.2015
UK report claiming e-cigs 95% safer than cigs based on one industry-linked report raises questions PHE’s scientific dredibility. University of California, 16.9.2015
Evidence about electronic cigarettes: a foundation built on rock or sand?The British Medical Journal, 15.9.2015
E-cigarettes: Public Health England's evidence-based confusion, The Lancet, 29.8.2015
E-cigarette industry funded experts who ruled vaping is safe: Official advice is based on research scientists in the pay of manufacturers. London Daily Mail, 28.8.2015
E-cigarettes: an evidence update A report commissioned by Public Health England. PHE 2015.
Sähkösavukkeet eivät ratkaise tupakointiongelmaa. THL. 3.9.2015
Tupakkatuotteiden yhteiskäyttö yläkouluissa ja toisen asteen oppilaitoksissa 2000–2015. Tutkimuksesta tiiviisti 2/2016. THL. Helsinki.
Sähkösavukkeiden terveyteen liittyvät vaikutukset ja teho tupakoinnin lopettamisessa. Tutkimuksesta tiiviisti 19, kesäkuu 2015. THL.
Sähkösavuke-sivut. THL.
12 ways to reduce your cancer risk. IARC 2015.
16th World Conference on Tobacco or Health

Tupakka ja sairaudet. Duodecim 2014.
Nuorten terveystapatutkimus.  The Ministry of Social Affairs and Health 2015.
Nuuska ja sähkösavuke –esite.  ASH Finland.
Luonnos: Hallituksen esitys eduskunnalle tupakkalaiksi ja laeiksi eräiden siihen liittyvien lakien muuttamisesta. The Ministry of Social Affairs and Health, 11.8.2015

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Health organisations outraged by EU’s “possible”
decision to extend agreement with tobacco transnational Philip Morris

Press release, 25.2.2016, The Smoke Free Partnership

The Smoke Free Partnership (SFP) and health organisations across the EU have expressed alarm at the possibility that the European Commissions will try to extend its legal agreement on tobacco smuggling with the major tobacco multinational Philip Morris International (PMI). The renewal could derail global efforts to combat the illicit tobacco trade by delaying the ratification of the only Treaty able to effectively address this problem, the WHO FCTC Protocol to Eliminate Illicit Trade in Tobacco Products. A technical assessment of the Agreement produced by Commission officials fails to provide any convincing reasons for continuing it.

At a plenary session in the European Parliament today, the European Commission refused to say that it would not renew the controversial Agreement, which is due to expire in July 2016. The Agreement was signed 12 years ago, after the EU brought legal proceedings against PMI for cigarette smuggling. It was intended to end the tobacco industry’s complicity in cigarette smuggling, and introduced annual payments to the EU and its Member States as well as fines when genuine PMI products were seized in illicit channels. It is the first of four similar agreements signed with each of the major tobacco companies.  

Health organisations are very concerned that the Commission has not produced any good evidence that the Agreement has been successful. The Impact Assessment admits that “no direct causality can be established” between the Agreement and a fall in PMI products being smuggled. It declines to consider whether the Agreement has established too close a relationship between EU institutions such as OLAF and the tobacco manufacturers, calling this “a matter of political appreciation”. Although it cites figures showing that the amount of PMI products seized in illicit channels has fallen by 85% during the lifetime of the Agreement, it fails to consider figures from the industry’s own funded research, including Project Sun, which appears to show that the level of genuine tobacco company products in the EU illicit market is still well over 50%. Finally, it fails entirely to give any assessment of what would happen to the illicit market if the Agreement was not renewed.  

The illicit tobacco trade does not only hurt the economy (rough estimates show that it amounts about $40.5 billion a year with $17.6 billion loss for governments in high income countries), it is a public health problem and it deprives the health sector of additional financing, deepens health inequalities and encourages smoking among young people. Around 164,000 lives a year could be saved if the illicit trade was tackled properly.    

The Smoke Free Partnership and health organisations in Europe remain strongly committed to promoting effective measures for combating the illicit tobacco trade. Over and above, the Commission should be aware that EU`s close working relationship with tobacco companies will undermine Europe’s credibility and international commitments on the ratification of the Illicit Trade Protocol. 

For further information:

Ms Florence Berteletti
SFP Director
florence.berteletti a smokefreepartnership.eu
+32 496 124 302 

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Smoking is transmitted from grandparents to grandchildren

Press release 19.1.2016 University of Tampere and ASH Finland

Grandparents’ and grandchildren’s smoking, and parents’ smoking as a mediator, have been studied at the University of Tampere, in Adolescent Health and Lifestyle Survey. Paternal and maternal grandparents’ smoking increases grandchildren’s tobacco use. The influence is mainly, but not completely, mediated through parents’ smoking, suggesting an independent role of grandparents in smoking initiation.

Adolescent Health and Lifestyle Survey is a national survey of 12–18-year-old adolescents conducted biennially in Finland. In 2013, there were 3535 respondents. Both boys and girls had higher odds for smoking experimentation, daily smoking and other tobacco or tobacco-like product use if their mother, father or any of the four grandparents were current or former smokers. Approximately two thirds of the total effect of grandparents’ smoking on grandchildren’s tobacco use was mediated through parents’ smoking, and one third was direct effect.

With the increasing life expectancy, children have more possibilities to spend time with their grandparents, explaining why their influence on different aspects of children’s life is likely to be higher than in previous decades.

For further information:

Researcher Jaana M. Kinnunen
University of Tampere
jaana.m.kinnunen a uta.fi 
+358 40 190 1667

Professor Arja Rimpelä
University of Tampere
arja.rimpela a uta.fi
+358 50 569 8285