Human rights and ethical considerations for a tobacco-free generation

How do American and British Nonsmokers Value Secondhand Smoke Health Risks?

Despite concerted efforts to enforce smoke-free laws in various countries, nonsmokers, particularly women and children, continue to be exposed to daily secondhand smoke (SHS), resulting in significant health risks. While existing studies have assessed the health effects of numerous diseases, the quantification of SHS spillovers remains understudied. This research employs choice experiments and contingent valuation techniques to rigorously quantify the attributes of SHS health risks, with a specific emphasis on facilitating cross-country comparisons. Our investigation reveals that nonsmoking individuals in the United Kingdom exhibit an attitude of indifference towards a proposed policy offering increased disposable income as compensation for SHS exposure. Conversely, nonsmoking Americans express a contrary perspective. Furthermore, our study demonstrates that nonsmoking Americans attribute a higher value to SHS health risks compared to their British counterparts. Consequently, this research uncovers a hitherto unexplored dimension of health risk-related behaviors. These findings hold the potential to significantly contribute to the development of future smoke-free policies, offering valuable insights that can inform policy decisions and address the persistent challenges associated with SHS exposure, particularly among vulnerable populations.

Éradiquer sans prohiber ? Évolutions internationales des politiques publiques de contrôle du tabac au xxi e siècle

This article offers an analytical synthesis of international trends in public policies to regulate tobacco in the first quarter of the twenty-first century. It begins with a review of the densification of the repertoire of public action and the affirmation of a strategy that consists of encircling tobacco (designated as an enemy) and attacking it through a variety of material and symbolic tactics. Tobacco regulation is a constantly dynamic process, due to the intensity of the exchanges of blows between protagonists: these agonistic interactions are reflected in framing struggles that lead to a diversification of tobacco qualifications. Tobacco is thus framed as a health issue, but also as an environmental problem and a challenge for social justice. Finally, the article shows how, at the end of a quarter-century of diverse mobilizations, the gradual formulation of a paradigm shift is taking shape, in which the objective of public action is no longer simply to control tobacco, but to eliminate it as a commodity.

Closing the gaps in tobacco endgame evidence: a scoping review

OBJECTIVE

Tobacco endgame policies aim to rapidly and permanently reduce smoking to minimal levels. We reviewed evidence syntheses for: (1) endgame policies, (2) evidence gaps, and (3) future research priorities.

DATA SOURCES

Guided by JBI scoping review methodology, we searched five databases (PubMed, CINAHL, Scopus, Embase and Web of Science) for evidence syntheses published in English since 1990 on 12 policies, and Google for publications from key national and international organisations. Reference lists of included publications were hand searched.

STUDY SELECTION

Two reviewers independently screened titles and abstracts. Inclusion criteria were broad to capture policy impacts (including unintended), feasibility, public and stakeholder acceptability and other aspects of policy implementation.

DATA EXTRACTION

We report the results according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist.

DATA SYNTHESIS

Eight policies have progressed to evidence synthesis stage (49 publications): mandatory very low nicotine content (VLNC) standard (n=26); product standards to substantially reduce consumer appeal or remove the most toxic products from the market (n=1); moving consumers to reduced risk products (n=8); tobacco-free generation (n=4); ending sales (n=2); sinking lid (n=2); tax increases (n=7); and restrictions on tobacco retailers (n=10). Based on published evidence syntheses, the evidence base was most developed for a VLNC standard, with a wide range of evidence synthesised.

CONCLUSIONS

VLNC cigarettes have attracted the most attention, in terms of synthesised evidence. Additional focus on policies that reduce the availability of tobacco is warranted given these measures are being implemented in some jurisdictions.

European progress in working towards a tobacco-free generation

Children have the right to grow up free from the hazards associated with tobacco smoking. Tobacco smoke exposure can have detrimental effects on children's health and development, from before birth and beyond. As a result of effective tobacco control policies, European smoking rates are steadily decreasing among adults, as is the proportion of adolescents taking up smoking. Substantial variation however exists between countries, both in terms of smoking rates and regarding implementation, comprehensiveness and enforcement of policies to address smoking and second-hand smoke exposure. This is important because comprehensive tobacco control policies such as smoke-free legislation and tobacco taxation have extensively been shown to carry clear health benefits for both adults and children. Additional policies such as increasing the legal age to buy tobacco, reducing the number of outlets selling tobacco, banning tobacco display and advertising at the point-of-sale, and introducing plain packaging for tobacco products can help reduce smoking initiation by youth. At societal level, health professionals can play an important role in advocating for stronger policy measures, whereas they also clearly have a duty to address smoking and tobacco smoke exposure at the patient level. This includes providing cessation advise and referring to effective cessation services.Conclusion: Framing of tobacco exposure as a child right's issue and of comprehensive tobacco control as a tool to work towards the ultimate goal of reaching a tobacco-free generation can help accelerate European progress to curb the tobacco epidemic. What is Known: • Tobacco exposure is associated with a range of adverse health effects among babies and children. • Comprehensive tobacco control policies helped bring down smoking rates in Europe and benefit child health. What is New: • Protecting the rights and health of children provides a strong starting point for tobacco control advocacy. • The tobacco-free generation concept helps policy-makers set clear goals for protecting future generations from tobacco-associated harms.

Assessing the links between human rights and global tobacco control through statements made on global fora

BACKGROUND

Increasingly, international health bodies frame public health measures, including tobacco control, in the context of human rights (HR). It is unclear how prevalent is the connection between human rights and tobacco control within global health governance. This paper describes the inclusion of HR in tobacco control governance, and the inclusion of tobacco control in HR treaty oversight. We depict the current reach of HR's normative influence in framing the tobacco epidemic in global, regional, and country-specific contexts.

METHODS

We reviewed documents (agenda, reports) from 2010 to 2019 from the World Health Assembly (WHA); the WHO Western Pacific Regional Committee Meetings (RCM); the WHO Framework Convention on Tobacco Control (WHO FCTC) Conferences of the Parties (COP); and documents provided by Pacific Island Countries party to, or by committees overseeing, HR treaties. We purposively selected the Western Pacific Region, and Pacific Island Countries specifically, to represent countries of varying populations, capacities, and governance.

RESULTS

Tobacco control and HR are infrequently mentioned together in the WHAs, and primarily in only one COP. Tobacco control is mentioned in 47 HR treaty committee documents for Pacific Island Countries, mostly under the Convention of the Rights of the Child recognizing or calling for ratification of the WHO FCTC. HR and tobacco control are connected in WHO Western Pacific RCM, particularly through their two most-recent action plans adopted by respective RCMs.

DISCUSSION

Tobacco control as a HR concern is gaining traction within HR treaty bodies, at least with respect to children's health in the Western Pacific Region.

CONCLUSION

Globally, HR is just emerging as an influence in global health governance for tobacco discussions. Within the Western Pacific Region however tobacco control is seen by some authorities as a HR issue. Similarly, to HR experts, tobacco control is becoming important to how Pacific Island Countries fulfill their treaty obligations, suggesting tobacco control advocates might explore these mechanisms to further influence the development of strong tobacco control measures to implement the WHO FCTC.

Evaluating smoking control policies in the e-cigarette era: a modelling study

Background

In jurisdictions in which electronic cigarettes are currently prohibited, policy makers must weigh the potentially lower risk compared with conventional cigarettes against the risk of initiation of e-cigarettes among non-smokers.

Methods

We simulated a synthetic population over a 50-year time horizon with an open cohort model using data from Singapore, a country where e-cigarettes are currently prohibited, and data from the USA, the UK and Japan. Using the smoking prevalence and the quality-adjusted life year gained calculated, we compared tobacco control policies without e-cigarettes—namely, raising the minimum legal age (MLA), introducing a smoke-free generation (SFG) and tax rises on tobacco consumption—with policies legalising e-cigarettes, either taking a laissez-faire approach or under some form of restriction. We also evaluated combinations of these policies.

Results

Regardless of the country informing the transition probabilities to and from e-cigarette use in Singapore, a laissez-faire e-cigarette policy could reduce the smoking prevalence in the short term, but it is not as effective as other policies in the long term. The most effective single policies evaluated were SFG and aggressive tax rises; the most effective combination of policies considered was MLA plus moderate tax rises and e-cigarettes on prescription.

Conclusion

Policy makers in jurisdictions in which e-cigarettes are not yet established may be advised not to prioritise e-cigarettes in their tobacco end-game strategy, unless their use can be restricted to current smokers seeking to quit.

Carbon Monoxide in the Expired Air and Urinary Cotinine Levels of e-Cigarette Users

OBJECTIVES

The aim of this descriptive study was to determine the sociodemographic characteristics of electronic (e)-cigarette users for clarifying the causes of e-cigarette smoking and to identify the carbon monoxide (CO) and urinary cotinine levels of the volunteers.

MATERIALS AND METHODS

Twenty volunteers who smoked e-cigarettes completed a questionnaire, and their exhaled CO and urinary cotinine levels were measured. An enzyme-linked immunosorbent assay kit was used for cotinine analysis.

RESULTS

Overall, 85% of the participants were males, 60% were married, and 75% were college/university graduates. The median age of participants was 38.5 years. The participants' main reasons for starting to smoke were peer influence and curiosity. The participants' main reasons for smoking e-cigarettes were to quit and reduce smoking the conventional cigarettes and cost effectiveness. Only three people knew that smoking was harmful to health. The participants' CO levels were measured as a median of 3, lowest of 1, and highest of 22. Cotinine levels were "positive" in all samples. A moderate and statistically significant correlation was found between the amount of fluids used by the participants in 1 day (mL) and cotinine levels in urine specimens (Pearson correlation test, r=0.511, p=0.025).

CONCLUSION

The study is an important proof of the country's scientific work on e-cigarettes. Preventive strategies should be very strictly implemented for any tobacco products, including e-cigarettes, as they harm individuals and the community.

The tobacco endgame: The neglected role of place and environment

An increasing number of countries across the world are planning for the eradication of the tobacco epidemic. The actions necessary to realise this ambition have been termed the tobacco endgame. The focus of this paper is on the intersection between the tobacco endgame with place, a neglected theme in recent academic and policy debates. We begin with an overview of the key themes in the literature on endgame strategies before detailing the international landscape of engame initiatives, paying particular attention to the opportunities and challenges of endgame strategies in low and middle income countries. Finally, we critically assess the current endgame debates and suggest a novel agenda for integrating geographical perspectives into research on the endgame that provides enhanced understanding of the challenges associated with this important global health vision.

The Tobacco Industry and Children's Rights

The manufacture, use, and marketing of tobacco present a serious threat to children's right to health. This makes the Convention on the Rights of the Child a potentially powerful tobacco-control tool and the United Nations Children's Fund (UNICEF), which oversees the convention's implementation, a potential leader in tobacco control. UNICEF actively supported tobacco control initiatives in the late 1990s, but since the early 2000s UNICEF's role in tobacco control has been minimal. Using the Truth Tobacco Industry Documents library, an online collection of previously secret tobacco industry documents, we sought to uncover information on the tobacco industry's ties with UNICEF. We found that from 1997 to 2000, when UNICEF was actively promoting tobacco control to support children's rights, the tobacco industry saw children's rights and UNICEF as potentially powerful threats to business that needed to be closely monitored and neutralized. The industry then positioned itself as a partner with UNICEF on youth smoking prevention initiatives as a way to avoid meaningful tobacco control measures that could save children's lives. After UNICEF's corporate engagement guidelines were loosened in 2003, tobacco companies successfully engaged with UNICEF directly and via front groups, including the Eliminating Child Labour in Tobacco Growing Foundation. This was part of an overall tobacco industry strategy to improve its corporate image, infiltrate the United Nations, and weaken global tobacco-control efforts. As part of its mission to protect children's rights, UNICEF should end all partnerships with the tobacco industry and its front groups.

The Convention on the Rights of Persons with Disabilities as a tobacco control tool in the mental health setting

BACKGROUND

Smoking rates remain high among people with mental health conditions, even though smoking contributes to negative mental health outcomes and is a leading cause of mortality. Many mental health facilities are not covered by smoke-free laws or do not encourage smoking cessation, and people with mental health conditions are often targeted in tobacco industry promotions.

OBJECTIVE

To analyse how the Convention on the Rights of Persons with Disabilities (CRPD), to which most countries are a Party, obliges State Parties to review policies and practices for tobacco control in the mental health setting.

METHOD

Analysis of CRPD Articles relevant to smoking and mental health.

RESULTS

The CRPD contains several provisions that oblige State Parties to address the issue of smoking and mental health, particularly in relation to quit services, smoke-free policies in mental health facilities, health education focused on correcting misperceptions about smoking and mental health, and protecting people with mental health conditions from tobacco industry targeting.

CONCLUSIONS

The CRPD is a potentially powerful tool to promote tobacco control in the mental health context.