¿Por qué nosotros no? Acción Ciudadana por la Salud y el cambio de la Ley Española de Tabaco

... said the idea of the guidance was to make sure it became consistent across the health service.

NICE public health director Prof Mike Kelly said the NHS had turned a "blind eye" for too long.

"It has been tolerated by the NHS and it is high time that stopped.

"NHS hospitals and staff have a duty of care to protect the health of people who use or work in their services.

"We need to end the terrible spectacle of people on drips in hospital gowns smoking outside hospital entrances."

In practice, he said, doctors and nurses could provide nicotine replacement therapies and advise patients about counselling to ensure they were not "going up the wall" with nicotine cravings.

He acknowledged that stopping a determined smoker from going outside to light up was "clearly very difficult".

"This is not about imposing some sort of penal regime in which doctors, nurses, administrators spend all their time trying to enforce a series of rules and regulations."

He said it was about a culture shift and removing smoking shelters would help eliminate any subliminal message that it was ok to smoke around a hospital.

Stress relief

Stephen Dalton, of the NHS Confederation, which represents NHS trusts, said the guidance was welcome.

"A total ban on smoking complements the duty of care on healthcare staff and the organisation to protect the health of people in their care and promote healthy behaviour."

Dr John Moore-Gillon, a lung specialist, said there was no doubt that smoking rates fell in environments where it was banned, pointing to smoking bans in pubs, clubs and public buildings.

"And they're actually more likely to give up smoking if they're given this advice when they're in a hospital or other health care setting," he added.

But Simon Clark, of smokers' lobby group Forest, said: "NHS staff have a duty of care to protect people's health, but that doesn't include the right to nag, cajole or bully smokers to quit.

"Tobacco is a legal product and a lot of people smoke to relieve stress.

"It's not only heartless and inhumane to ban patients from smoking outside hospitals and clinics, it's almost impossible to enforce without installing CCTV cameras and employing wardens to monitor the grounds."

... the researchers assessed e-cigarette use among youth in Korea, where the devices are marketed much the way they are in the U.S. The study analyzed smoking among some 75,000 Korean youth.

The study appears online in the current issue of the Journal of Adolescent Health.

“Our paper raises serious concern about the effects of the Wild West marketing of e-cigarettes on youth,” said Glantz.

Despite industry claims that it markets only to adults, e-cigarettes have achieved substantial penetration into the youth market. In the U.S., the federal Centers for Disease Control and Prevention recently reported that the majority of adolescent e-cigarette users also smoke regular cigarettes, and that the percentage of middle and high school students who use e-cigarettes more than doubled from 2011 to 2012. An estimated 1.78 million U.S. students had used the devices as of 2012, said the CDC.

In the UCSF study, the researchers report that four out of five Korean adolescent e-cigarette users are “dual” smokers who use both tobacco and e-cigarettes.

The authors conclude that young e-cigarette smokers “are more likely to have tried quitting smoking, which suggests that, consistent with cigarette marketing messages, some youth may be using e-cigarettes as a smoking cessation aid…Use of e-cigarettes is associated with heavier use of conventional cigarettes, which raises the likelihood that actual use of e-cigarettes may increase harm by creating a new pathway for youth to become addicted to nicotine and by reducing the odds that an adolescent will stop smoking conventional cigarettes.”

The data for the study came from the Korea Youth Risk Behavior Web-based Survey, an annual, nationally-representative survey conducted by the Korea Centers for Disease Control in 2011. The sample included 75,643 youth in grades 7 through 12.

Sungkyu Lee, PhD, lead author of the paper and a UCSF postdoctoral fellow at the time that he conducted the study, noted that e-cigarette use has skyrocketed in Korea: less than one percent of youths had tried the product in 2008 when the device was first introduced, compared to more than nine percent in 2011. Lee is now on the staff of the National Evidence-Based Healthcare Collaborating Agency in Seoul, Korea.

Among students who used e-cigarettes, eight percent were concurrently smoking conventional cigarettes. After adjusting for demographics, current cigarette smokers in the study were found to be much more likely to use e-cigarettes than non-smokers.

The researchers also found that the odds of using e-cigarettes were considerably higher among students who had made an attempt to quit smoking than those who had not. Students no longer using cigarettes were rare among current e-cigarette users, the researchers said.

Rachel Grana, PhD, a UCSF postdoctoral fellow, was a co-author of the study.

The research was funded in part by the National Cancer Institute; the University of California Tobacco Related Diseases Research Program; and the Hellmann Family Fund.

UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. It includes top-ranked graduate schools of dentistry, medicine, nursing and pharmacy, a graduate division with nationally renowned programs in basic biomedical, translational and population sciences, as well as a preeminent biomedical research enterprise and two top-ranked hospitals, UCSF Medical Center and UCSF Benioff Children’s Hospital.

... scientific paper -- led by Jidong Huang and Frank J. Chaloupka of the

University of Illinois at Chicago and Geoffrey T. Fong of the University of Waterloo and the Ontario Institute for Cancer Research in Canada -- assert that the model used by the FDA significantly under-estimated the actual impact of graphic warning labels. Using statistical methods to compare smoking rates in Canada nine years before and nine years after the introduction of graphic warnings, researchers found that:

smoking rates in Canada decreased more sharply after the introduction of graphic warnings, and

the sharper decrease in smoking rates in Canada was greater than the difference in smoking rates during the same two nine-year periods in the United States,where there was no change in the warnings.

This new analysis indicates that the potential reduction in smoking rates is 33-53 times larger than that estimated in the FDA's model and proves the effectiveness of health warnings that include graphic pictures.

Dr. Huang, the lead author of the paper, stated, "These findings are important for the ongoing initiative to introduce graphic warnings in the United States. The original proposal by the U.S. Food and Drug Administration (FDA) was successfully challenged by the tobacco industry, and the court cited the very low estimated impact on smoking rates as a factor in its judgment. Our analyses corrected for errors in the FDA's analysis, concluding that the effect of graphic warnings on smoking rates would be much stronger than the FDA found. Our results provide much stronger support for the FDA's revised proposal for graphic warnings, which we hope will be forthcoming in the near future."

Global importance of graphic warnings

Article 11 of the WHO Framework Convention on Tobacco Control (WHO FCTC) requires Parties to the FCTC to implement large, rotating health warnings. Canada is one of 177 countries, covering nearly 90% of the world's population, which are parties to the FCTC. While Canada has introduced graphic warnings, many other countries have not done so.

Melodie Tilson, Policy Director of the Non-Smokers' Rights Association, said: "Canada was the first country to introduce pictorial warnings, and many other countries have since been inspired to use this powerful method of communicating the harms of cigarettes and other tobacco products. Although the revision of the warnings in 2012 was an important step in bolstering the impact of the warnings, it is important to continue efforts to reduce the use of a product that is by far the leading cause of disease and death in Canada. A critical initiative is for Canada to follow Australia's lead and adopt plain and standardized tobacco packaging. Such a law would eliminate the branding on tobacco packaging and standardize the size and shape, which the tobacco industry has used effectively to promote their products, especially to youth. Evidence shows that plain packaging both reduces the appeal of tobacco products and increases the effectiveness of health warnings."

Dr. Judith Mackay, Senior Advisor at the World Lung Foundation, and a tobacco control leader in Asia and throughout the world, commented: "These new research findings show clearly the value of graphic warnings for countries all over the world, especially low- and middle-income countries, where knowledge about the health harms and awareness of the addictiveness of cigarettes and other tobacco products is lower than it is in high-income countries. It is even clearer now that large graphic warnings that are placed on both the front and the back of the pack constitute a very low cost and very high impact policy for reducing tobacco use."

Professor Fong, co-author of the paper and the Principal Investigator of the International Tobacco Control Policy Evaluation Project (the ITC Project), which provided the data on cigarette prices for the study, stated: "This study adds to the strong and growing number of studies showing the powerful and positive impact of graphic warnings on reducing smoking rates. Over 60 countries have already either introduced graphic warnings or have passed legislation to do so, but in many countries the warnings have been delayed-sometimes for years-before they have been introduced. Our results provide strong evidence showing the public health benefits of large graphic warnings and we hope that this will help to support initiatives to implement more effective health warnings throughout the world. Using graphic warnings to inform smokers and non-smokers alike about the harms of tobacco is a sensible and proven method for increasing knowledge, changing attitudes, motivating smokers to quit, and discouraging youth from initiating smoking."

Why Canada was used as a benchmark for the US

The US FDA and the researchers for this study used Canada as a benchmark because:

culturally and geographically, Canada provides a closer comparison for the US than any other country

Canada was the first country in the world to adopt graphic warning labels and thus there exist more data points over a longer period of time for measuring the impact of the Canadian graphic warning labels than in any other country

Canada's graphic warning label policy is closer to the FDA's proposed graphic warning label regulations than warning label policies that have been adopted in other countries