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** 2 November 2021
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** UK
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** “Impossible to enforce”: Big Tobacco exploiting loopholes in European menthol ban (#1)
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** Large inequalities in pregnancy outcomes between ethnic, socioeconomic groups in England, study finds (#2)
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** Oldham GP reacts to the possibility of e-cigarettes being prescribed to help people quit smoking (#3)
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** International
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** Expected surge in deaths from smoking-related cancers in China (#4)
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** Parliamentary Activity
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** Urgent Question: E-cigarettes and stopping smoking (#5)
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** Debate on Budget Resolutions: Tobacco taxes (#6)
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** Parliamentary questions (#7)
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** UK
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**
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** Tobacco companies are finding loopholes in the Europe-wide menthol cigarette ban to keep selling products that can get new and younger smokers hooked on tobacco. A joint investigation by the Bureau of Investigative Journalism and the Organised Crime and Corruption Reporting Project (OCCRP) can reveal new details of how confusion across Europe means that, almost 18 months after the ban came into force in the EU and UK, nobody knows for sure whether the ban covers certain types of cigarettes. A breach of the ban could potentially be a criminal offence.

“The industry is circumventing the menthol ban for fear that otherwise, menthol smokers may quit, and so it can continue to provide products it knows are easier for new young smokers to inhale,” said Deborah Arnott, chief executive of the health charity Action on Smoking and Health (ASH). The UK and EU banned cigarettes with a “characterising menthol flavour” in May 2020. But this category, Arnott said, is “hard to measure and difficult, if not impossible, to enforce.”

Before the ban, one in five UK smokers bought menthols. In the months before the law came into force, the industry launched several alternative products. Japan Tobacco International (JTI), the world’s third-largest tobacco multinational, rebranded some of its menthol cigarettes under its “New Dual” range. Its claim that these cigarettes contained a new blend of tobacco with lower levels of menthol triggered a slew of investigations across Europe. Most of these inquiries have been hindered by EU rules that prevent multiple member states from investigating the same products simultaneously. Alongside its New Dual cigarettes, JTI started selling menthol cigarillos – short, narrow cigars – in the run-up to the ban as part of its “menthol reimagined” campaign. In a brochure distributed to retailers around the time of the ban and seen by the Bureau, JTI said the “look, feel and smoking experience” of the new cigarillos will be “comfortingly familiar” to menthol cigarette smokers.

By law, what distinguishes a cigar is that it is wrapped in tobacco leaf. Crucially, cigars and cigarillos are exempted from many of the rules applied to cigarettes – including the menthol ban. Researchers at the University of Bath took apart a JTI cigarillo to compare it with a conventional cigarette. The only notable difference was that the cigar was wrapped in the tobacco leaf rather than white paper – but on opening, they found there was also a paper tube within the leaf wrap to hold the tobacco. JTI sales representatives told shopkeepers in the UK to stock the new cigarillos, which have a distinct menthol flavour, ahead of the ban. In May 2020, when the ban came into force, sales of cigars and cigarillos at corner shops in the UK increased significantly, according to data from the New Retail Data Partnership. JTI’s new menthol cigarillos almost entirely drove the bump in sales. Based on analysis by the University of Bath, the Bureau calculated that a pack of 20 cigarillos could be
taxed almost £2 less than a pack of 20 cigarettes.

With Brexit, meaning that the UK is no longer subject to EU tobacco regulations, JTI has taken the opportunity to lobby for a relaxation of the menthol ban. The company claims that the new rules have had “little impact on smoking cessation.” Preliminary data from University College London suggests a quarter of 16 to 24-year-old smokers still smoke menthol tobacco. The researchers conclude that this is likely due to the industry’s variety of alternative products before the ban. Although it is too soon for reliable data on the effect of the menthol ban – described as “not a real ban” by one shopkeeper – Arnott is concerned about what the industry’s efforts to undermine it might mean for efforts to curb youth smoking. “The Government is currently reviewing the regulations, and we’ve strongly recommended that all flavours should be banned in tobacco products, which could be achieved very simply by removing the word ‘characterising’ from the regulations,” she added.

Source: iNews, 2 November 2021
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Read Article ([link removed])


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** A quarter of stillbirths and a fifth of premature births across England have been linked to poverty, race, weight and smoking and could be avoided, research suggests. The NHS has set a target of halving stillbirth and neonatal death rates and reducing levels of premature birth by 25% by 2025. In 2019, around one in 255 births resulted in a stillbirth in England and Wales, alongside around one in 302 in Scotland.

In the new study published in The Lancet, a National Maternity and Perinatal Audit team analysed the birth records of almost 1.2 million women. The experts found that 24% of stillbirths, 19% of live premature births and 31% of live births of smaller babies were attributed to socioeconomic inequality and would not have occurred if all women had the same risks as those in the least deprived group. But when experts adjusted for ethnicity, mothers smoking, and BMI, these statistics were cut (12%, 12%, and 16%, respectively). The authors suggested that these factors may explain a considerable part of the socioeconomic inequalities in pregnancy outcomes.

Co-lead author Dr Jennifer Jardine said: “The stark reality is that across England, women’s socioeconomic and ethnic background are still strongly related to their likelihood of experiencing serious adverse outcomes for their baby.

“While we must continue to encourage healthy behaviours during pregnancy, we also need public health professionals and politicians to strengthen efforts to address the lifelong, cumulative impact of racism and social and economic inequalities on the health of women, families, and communities.”

Source: Sky News, 2 November 2021

See also: News Medical Life Sciences - Study finds large inequalities in pregnancy outcomes between ethnic, socioeconomic groups in England ([link removed] )

The Lancet - Adverse pregnancy outcomes attributable to socioeconomic and ethnic inequalities in England: a national cohort study ([link removed](21)01595-6/fulltext?rss=yes)
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Read Article ([link removed] )


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** E-cigarettes are a step closer to being prescribed onthe NHS for the first time after the Medicines and Healthcare products Regulatory Agency (MHRA) has updated its guidance. The MHRA announced that it would assess applications from vape manufacturers for the prescription of their products in the UK.

National health equalities campaigner Dr Zahid Chauhan OBE, also Oldham Council’s health and social care cabinet member, says the NHS may save costs in paying for emergency treatment long term. He said: “I still think we are some way off seeing e-cigarettes distributed free on the NHS, but any tangible initiative to help wean people off cigarettes has got to be positive. There would be a cost implication, and I hope decision makers see that spending on smoking cessation in the long-term beats paying for the emergency treatment required to help treat patients with problems such as lung cancer, COPD and emphysema.”

He added: “We should also remember that addiction is more prevalent in areas of deprivation and that lifting people out of an anxious and sometimes chaotic lives would definitely help reduce all addictions.”

Source: The Oldham Times, 2 November 2021
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Read Article ([link removed] )


** International
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**
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** Deaths from smoking-related cancers in China are expected to rise by almost 50% over the next 20 years, suggests new research. The researchers used data from various sources, including the China Death Surveillance Database and surveys of smoking patterns in China, to model the likely course of smoking-related deaths over the next 20 years. Between 2002 and 2018, smoking prevalence in China fell from 57.4% to 50.5% in men and from 2.6% to 2.1% in women. If smoking prevalence continues to fall at the same rates, by 2040, smoking prevalence will be 41.3% among men and 2.16% among women.

But when population ageing is factored in, the researchers estimate that deaths from smoking-related cancers will rise between 2020 and 2040 by 44% among men and nearly 53% among women. Over 20 years, there would be 8.6 million excess deaths from smoking-related cancers in China, equal to 117.3 million years of life lost. Almost half (46%) of the life years lost would be from working-age adults (54.1 million); 94% of these (110.3 million) would be lost in men.

The researchers highlight several potential limitations to their study, which likely mean that the future smoking-related deaths are an underestimate.

Source: Medical Xpress, 2 November 2021

See also: BMJ - Smoking-related cancer death among men and women in an ageing society (China 2020–2040): a population-based modelling study ([link removed])
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Read Article ([link removed])


** Parliamentary Activity
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**
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** Yesterday (1 November), Shadow Health Secretary Jon Ashworth MP tabled an urgent question to “ask the Secretary of State for Health and Social Care to make a statement to the House on the Government’s announcement that e-cigarettes will be available on prescription.”

In response, Minister for Vaccines and Public Health Maggie Throup said:
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** that action against smoking was at the heart of the mission to level up and become smokefree by 2030
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** a licensed product would enable e-cigarettes available on prescription and would give health professionals greater confidence on their use
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** if a product was put to the MHRA today there could be an 18 to 24-month process for that product to be licensed
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** we are quite a long way from any e-cigarette being licensed and provided as a prescription medicine
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** the Government supported the use of e-cigarettes as a gateway process to stopping smoking
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** the Government would soon publish a new Tobacco Control Plan with a sharper focus on health disparities.
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** Responding to the Minister, Jon Ashworth MP:
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** welcomed the announcement and asked for a timeframe when the Minister will provide more details on having a licensed product and when to expect the first prescriptions for e-cigarettes to be issued
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** stressed the importance of backing it up with specialist support services and the need to reverse cuts made to public health budgets.
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** asked if the Minister could guarantee there would be no further cuts to smoking cessation services.
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** Bob Blackman MP, chairman of the APPG on Smoking and Health, also welcomed the announcement and reiterated that it was one of the keys asks originally contained in the last Tobacco Control Plan in 2017. Mr Blackman will be leading a backbench debate on the APPG’s recommendations for the upcoming Tobacco Control Plan on 16 November in Westminster Hall.

Source: Hansard, 1 November 2021
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**
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** During a debate on Budget Resolutions yesterday (1 November), Bob Blackman MP, chairman of the APPG on Smoking and Health, welcomed the Chancellor’s commitment to increase tobacco taxes in the budget and called on the Government to introduce a levy on tobacco industry profits to help pay for smoking cessation services.

Mr Blackman said: “Finally, I will just mention one tax increase in the Budget that is extremely welcome: the tax on tobacco. Often, we do not hear that announced from the Dispatch Box, but I am glad the Chancellor went there, increased the tax and carried on with the escalator. The fact is that smoking-related diseases cost the national health service £2.6 billion a year and the care budget £1.2 billion a year. I would like to see a levy put on the profits of the tobacco companies and the money put into smoking cessation services. That would be a welcome tax, and something we could do because we now sit outside the European Union. We would not have to pass that tax on to the smokers; we would hit the profits of the big tobacco companies.”
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**
Source: Hansard, 1 November 2021

See also: ASH response - Budget a small step forward for tobacco but still not enough ([link removed])
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**
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** PQ1: WHO Framework Convention on Tobacco Control

Asked by Mr David Jones, Clwyd West

To ask the Secretary of State for Health and Social Care, if he will set out the positions the Government will advance at Ninth Session of the Conference of the Parties to the WHO Framework Convention on Tobacco Control (COP9) on (a) e-cigarettes, (b) heated tobacco and (c) snus.

Answered by Maggie Throup, The Parliamentary Under-Secretary for Health and Social Care

The Department's policy position on e-cigarettes, heated tobacco, and snus at the ninth Conference of the Parties (COP9) of the Framework Convention on Tobacco Control will be in accordance with the current 2017 Tobacco Control Plan for England, the regulations set out in the Tobacco and Related Products Regulations 2016 and our ambition to be smoke-free by 2030.

The Department continues to support the use of e-cigarettes as a safer alternative to smoking and as a tool to help people to quit and we will continue to monitor the evidence. In 2017, the independent Committee on Toxicity recommended that heated tobacco still poses harm to users but may be less harmful than smoking conventional cigarettes. However, information on the health impacts is limited and therefore we recommend that people quit tobacco use altogether rather than move to these products. Oral tobacco or 'snus‘, remains banned under The Tobacco and Related Products Regulations 2016.

Source: Hansard, 28 October 2021 ([link removed])

PQ2: Smoking: Young people

Asked by Dan Jarvis, Barnsley Central

To ask the Secretary of State for Health and Social Care, what assessment he has made of recent trends in smoking among young people in England; and what steps he is taking to reduce smoking prevalence in young people.

Answered by Maggie Throup, The Parliamentary Under-Secretary for Health and Social Care

Updated figures for the under 15 years old age range will be published in 2022.
The new Tobacco Control Plan will outline plans to protect young people from the harms of smoking in support of our ambition to be smoke-free by 2030.

Source: Hansard, 28 October 2021 ([link removed])

PQ3 and 4: Life Expectancy (Grouped Questions)

Asked by Damian Green, Ashford

To ask the Secretary of State for Health and Social Care, what recent assessment he has made of the progress made on the Government’s commitment to five extra years of healthy life for UK citizens by 2035.

Asked by Damian Green, Ashford

To ask the Secretary of State for Health and Social Care, what steps he is taking to meet the Government’s target to provide five extra years of healthy life for UK citizens by 2035; and if he will make a statement.

Answered by Maggie Throup, The Parliamentary Under-Secretary for Health and Social Care

We regularly review progress against a range of important indicators including life expectancy and healthy life expectancy.

We have already taken a range of actions including implementing an ambitious obesity strategy, supporting interventions to reduce smoking and investing in improving access to health services across the country. On 1 October we launched the Office for Health Improvement and Disparities (OHID) work in partnership with national and local government, the National Health Service, the voluntary sector, industry and the wider public health system to improve in health outcomes and disparities. The OHID will continue publishing the Productive Healthy Ageing profile providing data on a range of indicators including healthy life expectancy and will monitor the commitment to five extra years of healthy life for United Kingdom citizens by 2035.

Source: Hansard, 28 October, 2021 ([link removed])
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ASH Daily News is a digest of published news on smoking-related topics. ASH is not responsible for the content of external websites. ASH does not necessarily endorse the material contained in this bulletin.

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