Australia Brings Tobacco Legislation to Parliament

SYDNEY—Australia’s government introduced into parliament new laws banning advertisements on cigarette packets Wednesday, setting up a legal battle against the world’s biggest tobacco companies.
Under the proposed laws, Canberra wants to be the first government in the world to restrict logos, branding, colors and promotional text on tobacco packets beginning in January 2012. Product names will appear in standard colors and positions in a regular font and size on packets colored a dark olive-brown, which government research has found holds the lowest appeal to smokers.
Health warnings with graphic images of the harmful effects of smoking will have to make up 75% of the front of the packaging and 90% of the back.
“This world first initiative sends a clear message that the glamour is gone from smoking,” Health Minister Nicola Roxon said in a statement.
Philip Morris International Inc., the world’s largest tobacco company by revenue, last month warned Australia’s government it will challenge the decision in the courts and will seek billions of dollars in financial compensation.
British American Tobacco PLC—the biggest cigarette seller in Australia—has also warned it could pursue legal action, while Imperial Tobacco Group PLC is also opposed to the measures.
The new laws have the backing of the center-right opposition coalition and are expected to be passed by both the lower and upper house of parliament.
By Enda Curran
[email protected]

Chantix Raises Heart Attack Risk: Study

A new study led by a Johns Hopkins researcher says the popular anti-smoking drug Chantix significantly increases the risk for a heart attack or other serious heart problem in healthy, middle-aged smokers.
Dr. Sonal Singh, the study’s lead author, is calling for warnings on the drug to be stronger than those currently required by the Food and Drug Administration.
“People want to quit smoking to reduce the risk of cardiovascular disease, but in this case they’re taking a drug that increases the risk for the very problems they’re trying to avoid,” said Singh, an assistant professor of general internal medicine. The study, which said the risk increased by 72 percent for healthy, middle-aged smokers, was released Monday in the Canadian Medical Association Journal.
Singh, who reviewed 14 clinical trials, said the risk is significantly higher than the U.S. FDA indicated in mid-June when it warned about a small increase in cardiovascular impacts for those on the drug, generically known as varenicline. The FDA’s warning was based on a study of 700 smokers who already had cardiovascular disease.
FDA officials responded by saying that more analysis was needed before the agency would change its position. They have also asked the drug’s maker, Pfizer, to conduct another review and to plan its own study.
The FDA also has asked Pfizer to conduct a large, randomized study of possible psychiatric effects. Reports of depression and suicidal thoughts led two years ago to a boxed warning on the drug’s label, its most serious type.
“The recent [Hopkins] analysis is consistent with a concern we have already identified,” wrote FDA spokesman Jeff Ventura in an email response to questions about the study.
In the meantime, the FDA cited studies that found Chantix was effective in helping patients quit smoking for as long as a year.
Pfizer said in a statement that the company “strongly believes in and supports Chantix as an important treatment option” and that it disagrees with the interpretation of the data put forth by Singh’s study. “The analysis contains several limitations; most notably that it is based on a small number of events, which raises concerns about the reliability of the authors’ conclusions,” the release said. “The authors acknowledge that their risk ‘estimates are imprecise owing to the low event rates.’”
For Carolyn Miller, it’s been four years since she quit with the help of Chantix. The echocardiography technician in the cardiology department at Bon Secours Hospital in Baltimore said she’d tried many times over 32 years to kick the habit using nicotine patches and going to smoking cessation meetings.
Once on Chantix, it wasn’t even a week before Miller, 55, lost her desire to smoke. When the cravings ended, she stopped taking the drug and has had no cardiac issues.
“The key was being mentally ready,” she said. “But I really think the Chantix worked. I still don’t have cravings.”
The FDA says Chantix works by blocking the effects of nicotine in the brain, and eases withdrawal symptoms. It also blocks the effects of nicotine from cigarettes if users resume smoking.
Miller said she is breathing and sleeping better, food tastes better, and she has more energy. But she never would have taken Chantix if she’d known about the FDA warning and Hopkins research, she said.
She plans to stop recommending it to her heart patients. “A 70 percent increase in risk is scary,” she said.
Jordan Buescher isn’t as sure what he would have done with the information in the Hopkins study. The 33-year-old probation officer for the state of Michigan took Chantix for months to kick his 15-year cigarette habit.
A friend who worked for a cancer awareness group had persuaded him to undertake a complete makeover, from diet to exercise to smoking. He relied on support from friends and family, ran a half marathon and has been off cigarettes for a year.
He knew that he might have psychological problems from Chantix, and indeed, he had extreme mood swings that sent him to a psychologist and made him hard to be around. But he thought his health was worth the trouble.
“If someone said there is a one in two chance you’re going to die, you wouldn’t take [a drug],” he said. “But sometimes you have to take some risks to live a better life. Maybe that’s easy for me to say because I didn’t have a heart attack and die.”
Knowing about potential risks now, he said, he probably would have done more research, consulted more doctors and tried means of quitting that didn’t involve the “wonder drug” first.
Others might also be seeking alternatives, despite such testimonials about effectiveness. Pfizer reported revenue of $199 million in the first quarter of the year from Chantix, up 5 percent, largely because of international sales. But the company said sales were tempered by labeling in the United States. France also has stopped covering the drug, called Champix in Europe, under its public insurance.
Pfizer says doctors have written 7 million prescriptions for Chantix in the United States and 13 million worldwide since it was approved in 2006. It had a shortened review period because the FDA said it had shown a significant improvement over available therapy.
Singh said he and colleagues from Wake Forest University School of Medicine and the University of East Anglia in the United Kingdom decided to take a closer look at Chantix when one of the doctors reported patients with chest pains.
With a grant from the National Institutes of Health’s National Center for Research Resources and the NIH Roadmap for Medical Research, they reviewed 14 clinical trials involving 8,200 healthy people who took Chantix or a placebo. Singh said the extent of the risk for heart attacks and arrhythmias wasn’t apparent until all the data were reviewed at once.
There weren’t a large number of deaths, according to the study, but the risk for those without heart disease having a cardiac event that required hospitalization was 72 percent higher than for those taking a placebo. The average age of study participants was less than 45.
Singh estimated there have been 62,000 serious cardiac events in the United States from the drug. He now emphasizes the need to quit smoking, but without Chantix.
The FDA says smoking kills 1,200 people a day. The American Heart Association calls it the most preventable cause of premature death in the country. It can lead to several chronic diseases including cancer, lung problems and coronary artery disease.
The association supports both drugs and counseling to help tobacco users quit, as does the U.S. Preventive Services Task Force, an independent panel of prevention experts. Approved drugs include over-the-counter nicotine patches, gum and lozenges, and a prescription nicotine-replacement product, Nicotrol.
Chantix and Zyban, or bupropion, are non-nicotine, prescription pills. Zyban also carries an FDA warning about possible psychiatric problems.
“Combination therapy with counseling and medications is more effective than either component alone,” the task force recommendation reads.
As part of the campaign against smoking, the federal government is turning to new graphic packaging on cigarettes. And states such as Maryland are maintaining free phone lines.
The state established the Tobacco Quitline, 1-800-QUIT-NOW, in 2006 and also offers free nicotine replacement therapy to callers who register for counseling, said Dawn S. Berkowitz, chief of the state’s division of federal and special tobacco control initiatives.
The state reports the percentage of residents who smoke dropped to 15.2 percent in 2010 from 20.5 percent in 2000, and among high school students, the rate dropped to 14.1 percent in 2010 from 23 percent in 2000.
Singh said he encourages his patients to quit through counseling and maybe nicotine patches. He plans to continue lobbying the FDA to increase the warnings for, and insurance companies to no longer fund, Chantix.
“Patients ask for Chantix because the ads are all over TV,” he said. “If they say they want to quit smoking, I’ll spend time and counsel them. … There are too many consequences from this drug.”
By Meredith Cohn, The Baltimore Sun
[email protected]

Santa Monicans react to new graphic cigarette warning labels

MID-CITY — Purchase a pack of cigarettes and get a blackened lung, rotten teeth or an oxygen mask — these are just a few of nine health warninggraphic warning labels the FDA unveiled recently in what was the most significant change to cigarette labels in the last 25 years.
While the bold new warning labels, which will cover 50 percent of cigarette packaging, won’t appear in packs of smokes until 2012, residents are already reacting to them, and those reactions are mixed.
Michael G. saw a sampling of the labels last week shortly after purchasing a Big Gulp at a 7-Eleven on Santa Monica Boulevard.
“I think they’re ridiculous,” he said. “They’re no deterrent. Anyone who smokes already knows what it does to them. I’m hooked, I’m done and I’ve been smoking for a third of my life, so this isn’t going to do anything to me. I already know this.”
While the FDA is implementing these new warnings to help prevent children from smoking and help adults quit, he doesn’t have full hope about its purpose for children.
“It may be a deterrent for children, but unfortunately just like any other kid who started smoking, it’s through peer pressure,” said the 44-year-old carpenter, who was peer pressured into taking his father’s pack of Pall Malls when he was young.
For 29-year-old computer programmer Carlos Montes, the warning labels do exactly what the FDA is aiming for.
“If I were to buy cigarettes, I wouldn’t want to see that and would not buy them. I would not want that to happen to me,” said Montes, reacting to an image of rotten teeth.
Walking on Ocean Park Boulevard with his sandwich and headed back to work, Montes started to lose his appetite on the second disturbing photo he saw.
“I just don’t want to see it. I don’t like them at all. I guess I’m supposed to link that smoking is a cause of their death? I think this is a post-autopsy? Scary,” he said about a warning label depicting a man on his death bed with a stapled chest.
Elizabeth Taubman is less hesitant and quick in her response to the FDA’s image of the man.
“Perfect. That would scare the … out of anyone,” said the 58-year-old musician.
Scaring people straight is the purpose, said Health and Human Services Secretary Kathleen Sebelius.
“These labels are frank, powerful depictions of the health risks of smoking,” she said.
If the labels are real images of the risks of smoking, then the FDA’s mission with these labels fulfills its purpose for Taubman.
“It’s disturbing, extremely disturbing because if that’s what cigarettes do to you, then I would never be interested,” said Taubman.
Store manager Ryan Marker, 32, also believes they are terrifying, but isn’t sure about how effective they may be.
“I think scare tactics are always a problem,” he said. “These facts have always been around for a while, pictures are always effective … granted, but fear tactics, well, they don’t work with me. Personally, I’m horrified by them but I don’t smoke and I don’t know how others will turn around on that.”
Marker is uncertain about the future for this bold measure in the U.S., but other countries like Canada that require these similar labels on cigarette cartons know the positive impact it’s had. Canada required tobacco manufacturers to include graphic warning labels in 2000.
According to a Canadian Community Health Survey from 2009, smoking rates in Canada declined; the smoking rate for men was 23 percent compared with 28 percent in 2001. Among women, the rate was 18 percent, down from 24 percent in 2001.
A Santa Monica worker and Venice resident who used to live in Canada a few years ago attributes the Canadian decline in cigarette smoking to the labels.
Bob, a 35-year-old film editor who didn’t want to give his last name, said he was a smoker before living in Canada and quit during his time there. He credits the labels.
“I think they’re effective,” he said. “I used to smoke when I lived in Canada a few years ago and seeing that versus the warning labels we have, makes a difference.”
In recent years, more than 30 countries or jurisdictions have introduced labels similar to those created by the FDA. The World Health Organization said in a survey done in countries with graphic labels that a majority of smokers noticed the warnings and more than 25 percent said the warnings led them to consider quitting.
The FDA estimates the labels will cut the number of smokers by 213,000 in 2013, with smaller additional reductions through 2031.
By Jessica Jung
[email protected]

As smoking bans grow, it’s adapt or quit

When the urge struck, George Davis walked out of a Delaware City bar, pulled a Newport out of the pack, lit it and inhaled deeply.smoking
Davis has been smoking for 20 of his 36 years and nothing, not even the Clean Indoor Air Act — Gov. Ruth Ann Minner’s signature law, passed in 2002 — made him want to quit.
It just annoyed the Delaware City resident.
“I think you should be able to smoke wherever you want,” said Davis, as he stood outside the old DC Pub, now known as the Delaware City Brew House and Grill. “It’s going to get to the point where you have to buy a ticket to Mars to get to smoke a cigarette.”
The Clean Indoor Air Act made Delaware the first state to adopt a comprehensive statewide smoking ban, which outlawed smoking within most establishments. Since then smoking has been prohibited on beaches, boardwalks and, soon, some public parks.
Health officials from across the nation view the act as not only groundbreaking but habit-breaking. Since 2002, 25 other states and dozens of cities have enacted laws prohibiting smoking in indoor areas of worksites, restaurants and bars.
A ban on smoking in parks, beaches, public plazas and boardwalks in New York City took effect Monday.
In 2001, before the local ban, 25 percent of adults smoked regularly. By 2008, less than 18 percent routinely smoked, according to the most recently available statistics from the annual Behavioral Risk Factor Survey.
Smoking rates have gone down, as has opposition to the ban. Even some of the law’s most vocal opponents — restaurant and bar owners — don’t want to see the law repealed.
“I didn’t like it at all when it started,” said Mark Diamond, owner of Blue Parrot Bar & Grille on Union Street in Wilmington. “But now I think it’s a good law.”
Secondhand smoke, which contains more than 700 chemicals, including 70 carcinogens, is estimated to cause 46,000 deaths from heart disease and an additional 3,400 deaths from lung cancer each year, according to the CDC.
But health reasons aside, numerous studies have found that people are more likely to try to quit smoking if it’s banned indoors.
And while standing out in the cold or rain may not propel smokers to quit, it is often the last straw.
Lauren Faline smokes, yet she said she welcomed the Clean Indoor Air Act. The 30-year-old Wilmington resident said the law may eventually help her quit her half-pack-a-day habit.
“If it’s raining or if it’s cold or if it’s too hot out, I don’t want to get up and go outside to smoke, so I don’t end up smoking as much,” said Faline, a bartender at Scrimmages in Brandywine Hundred. “I guess I’m a lazy smoker because if there’s an ashtray on the bar I’ll smoke but if I have to go outside I’ll smoke less frequently.”
At first, the law spurred restaurant and bar owners to get creative, said Carrie Leishman, CEO of the Delaware Restaurant Association.
Many went through the bureaucratic obstacles to become private clubs to exempt themselves from the law. Diamond, a nonsmoker, built a patio at the Blue Parrot for smokers. Scrimmages — which Diamond previously owned — saw a 40 percent drop in business.
But the ban isn’t a problem anymore.
“I don’t hear complaints from smokers except when it’s below freezing,” Diamond said. “I think smokers have adapted to it.”
That doesn’t mean all opposition has disappeared.
“Now, of course, we’re so accustomed to the new law,” said Donna Kellagher, 58, of Christiana, who has smoked since she was 13. “But I’d rather be nice and snug and warm.”
Smokers will soon have to adapt again.
Pointing to research that shows that secondhand smoke does not dissipate outdoors quickly enough to be safe, smoke-free zones have been established outside.
Bethany Beach adopted a smoking ban on its boardwalk and much of its beach in 2008. This year, eight towns — Delaware City, Bethany Beach, Dover, Georgetown, Milton, New Castle, Seaford and Smyrna — are getting grants of between $2,095 and $10,000 to establish smoke-free zones in certain areas, such as parks. The grants are distributed by the American Lung Association of Delaware.
People who smoke in open defiance at Battery Park in Delaware City, which became a smoke-free zone earlier this month, could be charged with disorderly conduct and receive a $25 fine. That was news to Calvin Parson, who smoked while he fished last week.
“I accept that nonsmokers have rights to have clean air inside a restaurant,” he said. “But when you go outside, that’s God’s green earth. If I want to go outside to smoke, I should be within my rights.”
By Hiran Ratnayake
[email protected]

The dying breed of traditional ‘beedi tasters’

AHMEDABAD: Like father, unlike son. After five decades of tasting and rolling beedis in Nadiad district in Gujarat, 70-year-old Ghanshyambhai Samantsing called it a day last year. In what is still considered a traditional profession, none of his three sons followed him into it. Samantsing didn’t encourage them. “It was not healthy – I used to sometimes smoke 25-100 beedis in a day – and not rewarding,” he says.
The sons saw better options elsewhere. One is a driver, the other a farmer and the third runs a grocery shop. Second son Dharmendra Samantsing, 37, who is a driver by profession, highlights the generational shift. “During our father’s time, the only industry to work in was tobacco companies or farms,” he says. “Now, we have so many options. I work only for eight hours a day in air-conditioned comfort and earn Rs 5,000 a month.”
The next generation opting out is fuelling a labour crisis in the 21,000 crore, labour-intensive beedi industry. The country’s largest agri-based employer, with 6 million workers, is facing a shortage of beedi tasters and rollers. It might be among the oldest and most cash-rich in the country, but it’s also an industry in decline. And one reason is the dropping of the family baton.
Lack of Skilled Labour
There’s a skill to being a beedi taster. A taster smells the tobacco, looks at its colour and feels its weight. He then rolls the tobacco in a beedi and smokes it. “From the swirl of the smoke, we can tell its quality, nicotine level, sugar level, etc,” says Ghanshyambhai.
He recalls the lack of employment choices when he was starting out. “I had the option to work in a farm or in an agro-processing unit of a tobacco company,” he says. He chose the tobacco company, as “there is not much of toiling hard in the fields”. And if one is a taster, as Ghanshyambhai was, you get paid extra. Each tobacco-processing unit has two to three tasters. This sometimes includes the owner. With no fixed retirement age, the tasters continue till their health permits.
It’s valuable experience, says Vijay Patel, who runs a tobacco processor unit in Kaira district of central Gujarat, and processes 7,000-10,000 bags (one bag = 35 kg) of tobacco annually. Patel swears by the skill of the taster and the beedi roller, which have passed down generations. “This is a traditional business and you don’t need certified people. It is a matter of experience to judging tobacco quality,” says Patel, who smokes only for tobacco blend testing.
But unlike, say, the tea and liquor business, there are no professional beedi tasters, says a trader from Kolkata. “People who are from the trade, trustworthy and like smoking are asked to smoke beedis to try and grade the different batches of tobacco before buying them,” he says.
However, the numbers coming into the trade are falling. “It is difficult to get a ‘kaarigar’ (worker) to make beedi,” says Rajnikant Patel, the owner of Prabhudas Kishoredas Tobacco Product. He attributes the slump to the changing economy and the National Rural Employment Guarantee Scheme (NREGS), which assures an individual 100 days of work in a year. “The new generation does not find the job interesting. We are now testing the tobacco blend on our own or asking the broker.” The Ahmedabad-based company, which is about 80 years old, makes and sells 80 million sticks a day under the brand name ‘Telephone’.
The Industry
Patel says beedi production has fallen 10-15% in the last two years. Prices have fallen even more. A bumper crop this year has resulted in processed tobacco prices falling to Rs 35-80 a kg, compared with Rs 80-150 in the same period in 2010. Then, there is the increasing tax burden and regulations, and the increasing health awareness and education that is making consumers shift from beedis to cigarettes and chewing tobacco.
Still, between 700 and 800 billion beedi sticks are consumed annually — about seven to eight times that of cigarettes. As per industry estimates, more than 60% of beedi volumes are in north and west India. “There are more than 2,000 beedi-making units in the country, with 25 to 30 large players,” says Patel, who is also the president of the All India Beedi Industry Federation. “West Bengal and Andhra Pradesh have the maximum number of beedi manufacturing units.” Telephone, Bharat No 30, 502 Pataka and Chota Desai are the top four brands in terms of market share.
Official numbers are unavailable, but it is estimated that about 5,000 people are engaged in tobacco tasting in Gujarat. Like beedi-making companies, tobacco-processing units are unorganised, family-owned and based in remote villages. Interestingly, tobacco tasters work with tobacco processors and decide which blend will suit which brand. Tasters smoke all the brands of beedis their employer (processor) intends to supply. In a way, the taste of the brand depends on the tasters at the field processing level.
Man or Machine?
In some units, machines are doing the work of men. “Large exporters are increasingly feeling the need to have machinery to judge the quality of tobacco, including the levels of nicotine, sugar, chloride and hardness, among other things,” says the trader from Kolkata.
Smaller units, on the one hand, cannot afford this mechanisation in tasting and packaging. On the other, they are finding it difficult to find people, with the current generation disinterested in this profession — a point of view that has the blessings of fathers like 48-year-old Arvindbhai Vajteshe.
Vajteshe, a class ten dropout, works as a manager-cum-beedi taster Vithalbhai Motibhai Patel & Sons, a tobacco-processing unit in Moholel village in Nadiad district. He started smoking beedis on joining the profession 25 years ago. When the senior taster of his unit retired, Vajteshe’s bosses started teaching him the salient points of a good tobacco. “Now from the colour of a tobacco leaf, I can tell its quality,” he says proudly. “Golden-coloured tobacco leaves are the best quality as they give a good taste when blended with sweet Nipani tobacco of South India.”
Yet, Vajteshe is happy to see such intimate knowledge of this profession not being passed on down his family. “My elder son is doing a diploma in civil engineering from Godhra. My second son is in class nine and I want to make him an accountant,” says Vajteshe firmly.
For Patel, the stakes are even higher. “The challenge we foresee is about succession,” he says. “My son is a computer engineer in the US and not interested in the beedi and tobacco business,” says Vijay Patel.

The battle of the butts

Kris Snibbe/Harvard Staff Photographer
Kris Snibbe/Harvard Staff Photographer

To fight tobacco globally, Connolly said, one has to be willing to travel. On a recent May day, he had just gotten off a plane after talking to a small group in Alaska and was anticipating an upcoming trip to Kuwait. Though he lectures extensively, Connolly said that research is key to the center’s activities. In every country, he said, it is important to conduct studies on smoking’s impact and on the effectiveness of interventions to bring the scope of the problem home.
It’s also important to communicate research results effectively, Connolly said, citing one 2006 project that examined air quality levels in Irish pubs around the world. The Irish Pub Study found that air pollutants were 91 percent lower in pubs actually located in Ireland — which has a nationwide smoking ban — than in Irish pubs in parts of the world where smoking was allowed. Released on St. Patrick’s Day, the study received broad media coverage.
More recently, Connolly has been working closely with officials in Greece, which has the world’s highest smoking rate, and in Middle Eastern nations such as Kuwait.
Connolly, whose initial training is in dentistry, has a long history fighting for smoke-free air. Before coming to Harvard’s Department of Society, Human Development and Health in 2005, he worked for 10 years as director of the Massachusetts Tobacco Control Program and then for two years as a scientific adviser to the program. The state program was successful at reducing tobacco consumption in Massachusetts by 60 percent between 1994 and 2004 and in reducing the portion of the state population that smokes from 24 percent to 14 percent.
Statistics from the U.S. Centers for Disease Control and Prevention say that though smoking is declining in this country, tobacco use still is responsible for one in five U.S. deaths each year, killing 443,000 people. Worldwide consumption continues to rise, meanwhile, with 80 percent of smokers now in low- and middle-income countries. Deaths related to tobacco use worldwide are expected to rise from 5 million presently to 8 million by 2030. The global spread of tobacco use falls squarely on this country’s shoulders, Connolly said, calling it “one of the sins of the 20th century.”
“We’re the country that first learned how to smoke. We’re the country that taught the rest of the world to smoke,” Connolly said. “We created the industry and the product that created this burden.”
Connolly, 62, said that when he was a child, lung cancer was a rarity among women. Over the decades since, more and more women took up smoking, and lung cancer rates soared. In April, researchers reported women’s lung cancer rates dropping for the first time, which anti-smoking advocates hope mirrors a trend among men that began a decade ago. Despite that good news, Connolly said he probably won’t live to see lung cancer rates among women return to where they stood when he was born.
In addition to research, Connolly is wielding another weapon in the fight against tobacco: HSPH students. Each year he trains a postdoctoral fellow and three master’s or doctoral students. These students often take leadership positions in public health programs in the United States or elsewhere. One result of the spread of international students whom he has trained is that he has to field phone calls at odd hours of the night, but Connolly said that’s a small price to pay.
There have been several major positive developments in the fight against smoking-related illnesses in recent years. In 2003, 171 nations adopted the Framework Convention on Tobacco Control, which aims to manage tobacco supply and consumption globally. In the United States, the government gave the Food and Drug Administration the power to regulate tobacco for the first time in 2009. With that weapon, Connolly said, the FDA could deal with the tobacco problem once and for all by regulating the addictive ingredient nicotine, reducing it from 7 milligrams to the harmless level found in say, a tomato — 0.3 milligrams.
“If I was head of the FDA, the meeting [to solve the tobacco problem] would take about an hour,” Connolly said.

Iraq Takes Aim at Smoking

BAGHDAD — In a country where the power blinks out several times a day, where filling up a gas tank can take hours and motorists iraq-smokingstew in seemingly endless traffic jams, smoking is one thing that seems blissfully easy.
A pack of cigarettes costs as little as 25 cents. They are ubiquitous, sold from mud-brick huts along highways, from card tables set up on city sidewalks and at countless storefronts throughout Baghdad. And you can light up pretty much anywhere, from buses to elevators to hospitals. Even (or especially) inside the Iraqi Parliament.
But following the lead of New York, London, Paris and scores of other Western cities, Iraqi lawmakers are now trying to push smoking to the margins of public life here, to the frustration of many of their constituents.
On Sunday, they are set to consider a law that would ban smoking from schools, universities, government offices and a wide range of private businesses, including restaurants and cafes. Billboards advertising cigarettes, which wallpaper commercial districts of Baghdad, would be outlawed. And cigarette companies would be forced to print harsher warning labels.
“This is an important issue,” said Jawad al-Bazouni, a member of Parliament’s Health Committee, which is pushing for the restrictions. “The citizen can complain to the smoker. He will get the law on his side, and it will be reflected in the public health.”
But some Iraqis called Parliament’s effort a quixotic waste of time by a legislature that has dithered on questions of greater import, like whether American troops should be allowed to stay past a withdrawal deadline of January 2012.
The prospects for passage of the tobacco ban are, well, cloudy, at best.
In the six months since competing factions quilted together a partnership government, Iraq’s Parliament has passed about 10 laws, none of them highly controversial.
They have passed a budget, canceled some Saddam Hussein-era measures and moved to cut their own salaries and increase some public aid in response to calls for government reform.
Politicians in the Shiite-led government have also spent time on impassioned speeches defending fellow Shiite protesters in Bahrain, and took a day off in solidarity. After a tortured debate, they approved a procedure for selecting vice presidents, but have yet to name one.
Through this, Iraq’s leaders have moved slowly on resolving the status of the disputed northern city of Kirkuk, an oil-rich prize that is one of Iraq’s biggest trouble spots. They have not named ministers to lead the army and police forces, leaving a vacuum that some Iraqis blame for a recent spike in assassinations and other violence.
“There are more important issues they should be considering,” said Aboud al-Dulaimi, who was sitting with two friends outside a tiki-themed hookah bar in downtown Baghdad. “The government needs to pass laws to serve the people. They have more than three million unemployed, and they are busy with such laws.”
Sitting beside him, Abbas al-Janabi took a drag and declared, “It’s stupidity.”
Mr. Janabi, 46, said he had been a pack-a-day smoker in the 15 years before the 2003 American invasion. But in the chaos that followed, as he shut down his once prosperous factory, sold his house and moved abroad, Mr. Janabi said he began smoking more.
Now back in Baghdad after a brief exile in Dubai and Syria and living in a small apartment on Palestine Street, Mr. Janabi said he burned through four packs a day as he scavenged for work. He knows the habit may be his death, but he treats it with a fatalism commonly heard throughout Iraq.
“I know a cigarette will kill me one day, but I can’t do anything about it,” he said. “I may get killed tomorrow. It’s just fate.”
Parliament tried such a move once before, in 2009, but dropped the measure. It was reintroduced in April, and lawmakers have scheduled a second reading for Sunday, a necessary step toward passage.
Although smoking rates in Iraq lag far behind those in China, Russia and much of eastern Europe, few women or devout Muslims smoke, meaning that the rate among men is considerably higher. With Iraq’s cigarette consumption among the highest in the Middle East, smoking is easily Baghdad’s most widespread vice.
Bars and public alcohol consumption have rebounded as Iraq’s streets have become safer to traverse at night, but Islamic prohibitions against drinking and raids of Baghdad’s nightclubs have limited the spread of alcohol. At most cafes and restaurants, Iraqis sip fruit juice or tea instead of liquor, and content themselves with cigarettes and shisha — flavored tobacco from ornate water pipes.
Ali Assan Ali said his shisha cafe would be devastated by an outright ban on smoking in public places. He said he had spent $400,000 to open the business and renovate a second-floor space, and said the proposed smoking restrictions were too broad.
“This is my life, this is my health,” he said.
Nearby sat four friends, who expressed a similarly libertarian view.
“We are Iraqi,” said Rami Sabah, 19. “We like the shisha and the smoking. It’s a good place for young people to just waste time.”
His friend Baraa Ghazi, 27, offered a broader pronouncement as he took a languid drag. “This,” he said, “is freedom.”
Yasir Ghazi and Omar al-Jawoshy contributed reporting.
Published: May 12, 2011

Australia Wants to Be the First State to Introduce Plain Packaging

Recently the Rudd government’s National Preventative Health Taskforce presented a position paper on anti-tobacco measures titled as “Making Smoking History”.
The given title makes clear that behind this plain packaging stands a punitive policy which federal Health Minister Nicola Roxon introduced a few weeks ago.
At present the nanny state is no longer trying to inform people about the risks of unhealthy life-style, it simply punishes those people who infringe nanny’s best efforts.
When will this end? Surely, after years of anti-smoking education.
You can detest tobacco enterprises. You can detest what cigarettes do. But the government wants to create a new Australia, which will be the first country to introduce plain packaging on cigarettes.
Usually smokers are more influenced by the look of packaging. Lighter colors seem to pose less risk. Representative of the Phillip Morris stated that “Smooth” and “silver” also presuppose safer cigarettes.
Therefore the government proposed a new pack design, using unattractive olive color, with unadorned text for the label. But the statistics suggests that package marketing affects the choices of existing smokers.
The government’s objective for packaging is to stop people becoming smokers. Roxon states that bright colors are designed to attract young people. Her intention is to make sure that fewer youngsters are hooked on this habit. And there is no proof that package design attracts non-smokers to start smoking.
The absence of evidence is not surprising. People start smoking because they want to feel the sensation of smoking, and not the sensations of holding a bright package. And what about present smokers? Let’s just present if graphic health warning with pictures of bleeding lungs haven’t forced you to quit smoking, an olive box surely won’t do it.
The tobacco companies are dissatisfied about plain packaging because it will make it complicated to compete for the existing number of customers. They pay attention on packaging design because there is nothing left for them to undertake or invent.
Smokers even won’t be able to see those packages until after purchase, as according to the Victorian laws all tobacco products should be hidden behind the counter. Retailers have the right to display a special sign, provided by the state government, stating “We Sell Tobacco Here” in black lettering on a white background.
All present laws will sap the effectiveness of future anti-smoking policies the government might introduce.
After all, it is one thing to demonstrate that people believe that lighter colors mean lighter cigarettes. But it is quite another picture if after years of anti-smoking campaigns and social disapproval- the color of the package will make a considerable difference to the decision to start smoking.
Notable text warning labels will come first, afterwards the graphic ones.

Navajo president cannot ban smoking in public place

FLAGSTAFF, Ariz. — Navajo President Ben Shelly cannot enforce an executive order to ban smoking in public places on the reservation, his spokeswoman said Thursday, easing concerns that an immediate prohibition would jeopardize a $150 million casino in Arizona.
Shelly signed the order this week, saying he wanted to create a healthier environment for Navajo people who are subjected to second-hand smoke. The tribe’s justice department reviewed the order and found that it was legally insufficient, said Shelly spokeswoman Charmaine Jackson.
“Right now we’re going to hold town halls to see what the Navajo people want,” she said. “We want to hear from them first, and then we will move on.”
Jackson said Shelly was informed that he could prohibit smoking within the executive branch but not enact a widespread ban. She declined to release the legal review, citing attorney-client privilege.
Navajo Attorney General Harrison Tsosie did not return messages left by The Associated Press.
Tribal gaming czar Bob Winter said that the profit projection of the Twin Arrows Casino off Interstate 40 near Flagstaff is based partly on allowing patrons to smoke. If that’s prohibited, financing for the project would fall apart.
The casino could lose up to a quarter of its expected $70 million in annual revenue and be at a disadvantage to other tribal casinos that don’t restrict smoking. The first phase of construction was scheduled to begin this month.
“We would welcome an opportunity to sit down with the president, explain to him the facts as best as we know them so everybody involved can make an informed decision,” Winter said.
The Navajo Nation was having the same debate in 2008 when a proposed smoking ban came before the Tribal Council. The ban gained legislative approval but ultimately was vetoed by the then-tribal president.
Jackson said Shelly was concerned about casino revenues but declined to comment further.
The Navajo Nation operates two casinos in New Mexico, a state that has only one tribal casino that is entirely smoke-free. Other tribal casinos in Arizona and elsewhere offer smoke-free areas but don’t completely prohibit cigarettes, cigars and chewing tobacco.
Health advocates applauded Shelly for signing the order. He encouraged employers to enact programs to help people quit smoking.
Enforcement of Shelly’s executive order would have been the responsibility of employers or whoever owns or leases the public buildings, according to a copy obtained by the AP.
It had a 90-day phase-in period aimed at banning smoking in public places that include hotels, laundry facilities, grocery stores, restaurants and within 25 feet of a public building. It would not have restricted the use of ceremonial tobacco.
Winter said he would push for an exception for casinos if a smoking ban is passed through the Tribal Council or by petition of the Navajo people.
Dr. Patricia Nez Henderson, who has advocated for a smoking ban on the Navajo Nation, said that’s not what health advocates want but that at least they now have Shelly’s support.
“The point has been made in standing with the grass-roots (people) in making sure a safe and health working environment is provided for the people,” she said. “Either way for us, it’s a win-win situation. We know there is someone there at the top of the leadership who is willing who work with us.”
By FELICIA FONSECA, Associated Press

Partial smoking ban on Atlantic City casino floors has little effect

ATLANTIC CITY — Anyone hoping to gamble in a nonsmoking section at one of the Trump casinos earlier this month might have had atlantic city skylineto climb on top of a slot machine or sit in the center of a blackjack table.
Floor maps posted on the walls of the Trump Plaza Hotel and Casino and the Trump Taj Mahal Casino Resort showed smoking was prohibited in the physical space occupied by gaming tables and slot machines, but allowed in the area immediately around them, including the seats.
Within a day of a Press of Atlantic City reporter questioning a Trump executive about the smoking sections and pressure applied by the city and state, the casinos reverted to old floor plans that had larger nonsmoking areas.
The city’s partial smoking ban for casinos — applauded by some but viewed as a handicap to doing business by others — turned 4 years old this month. But enforcement of the rules since 2007 has been virtually non-existent.
A Press review of city records and observation of floor activity in all 11 casinos show there is virtually no enforcement of the ban by city officials and that casino nonsmoking section boundaries are often ignored. The Press observed patrons smoking in nonsmoking sections in all but three gaming halls: Borgata, Bally’s and Hilton.
In four years, only one smoking ordinance violation on a casino floor has been issued by the city’s Department of Health and Human Services.
“It’s a nightmare for the Health Department,” Ron Cash, the department’s director, said of enforcing the city law. “We’re not surprised by the minimal number of violations. The reality is we don’t have enough inspectors. … We don’t have the staffing or the resources.”
City code requires casinos to prohibit smoking “on all employee-staffed portions of the casino floor; however, casino licensee operators are permitted to construct nonstaffed, separately exhausted, enclosed smoking lounges on no more than 25 percent of the gaming floor,” the law reads.
On Sept. 17, 2007, Paulette Simonetti, a city sanitation inspector, filed a notice of violation against the Taj Mahal when she observed three patrons smoking in a restricted area on the casino floor. She also observed three separate smokers in nonsmoking areas in nongaming parts of the casino over a 45-minute period.
However, city inspectors would go more than three years before filing another smoking violation against a casino. Last February, Simonetti issued three separate violations on the same day against the Tropicana, mostly for violations in The Quarter.
The four citations were the only records provided after The Press requested documentation of all anti-smoking complaints in casinos through the Open Public Records Act. City officials confirmed those were the only citations.
“We’re not surprised,” Cash said of the handful of citations. “The only way we can really do this is to rely on the casino industry to enforce it themselves.”
Signs mix messages
There is strong incentive for Atlantic City casinos to allow smoking. The local industry faces growing competition in neighboring states and other locales across the nation.
Smoking is allowed on casino floors in Nevada and Mississippi, and Pennsylvania allows it in half a casino’s gaming space. Smoking is prohibited in all parts of racino properties in Delaware, New York and Maryland, according to the American Gaming Association.
A smoking ban can be bad for business: When Colorado and Illinois completely banned smoking in casinos in 2008, gaming revenue fell by double-digit percentages.
Earlier this month, the New Jersey Division of Gaming Enforcement confirmed it was investigating the Trump properties and their altered smoking sections.
Bob Griffin, chief executive officer of Trump Entertainment Resorts Inc., stood behind the new floor plans in an interview with a Press reporter. “We’re in full compliance,” he said. “We’re never going to violate the statute.”
But a day later, DGE Director Josh Lichtblau requested a conference call with The Press to confirm that Trump officials had agreed to revert to old floor plans that had larger nonsmoking areas clearly set off.
“In light of their meeting with city officials (April 8), they called us to let us know they would be going back to their old smoking sections,” Lichtblau said. “It’s fair to say that the difference in the floor plans did raise concerns.”
Trump spokesman Brian Cahill did not directly answer questions about why the company chose to abandon its new smoking section, referring only to previous comments about the company being in full compliance with the law.
John Donnelly, an attorney representing the Trump casinos in the matter, said: “The only thing I can say … is they made a decision to return to the old methodology to the smoking area.”
Griffin had earlier confirmed that Trump Marina’s floor plans have not been adjusted since the property is in the process of being sold to Landry’s Inc., a gaming, restaurant and entertainment conglomerate.
But in Trump Marina, one pair of slot machines on the floor’s Monte Carlo Casino area sit next to each other, each with a sign above them. One says “Smoking Permitted,” the other reads “No Smoking Permitted.”
The Press observed patrons at all 11 Atlantic City casinos over a week and found customers smoking in nonsmoking areas at all but three of the gaming halls.
Many signs at Resorts Hotel Casino, for example, tell gamblers where they can smoke and not where it’s prohibited. Stickers on numerous slot machines read: “Smoking permitted while playing” accompanied by a picture of a burning cigarette circled in green.
Only one of Resorts’ four gaming-floor entrances features a “no smoking” sign, despite city law requiring casinos to “clearly and conspicuously” post signs at all of its entrances. The one sign is found at the street entrance known as the “Outside Smoking Area.” The area is used mostly by casino employees and is located on Danny Thomas Boulevard, a small side street between Resorts and the Taj Mahal.
The only other nonsmoking signs at Resorts are found on the craps tables. Players are restricted from smoking on one side of the table, but can puff away on the other side of the same table.
Dennis Gomes, who with partner Morris Bailey bought Resorts in December, said he and his staff have recognized the casino’s limited signage and smoking-section layout and intend to make changes. He said some of his executives brought the issue up within the last month, but he has not received their official recommendations yet.
“There are a lot of things that we are trying to fix here. That was one of the things that was brought up,” he said. The smoking sections “really aren’t as clearly defined as they could be.”
Gomes said he expected to implement changes on the casino floor by Memorial Day.
Even where signs are definitively posted on casino floors, smoking in restricted areas is common in many Atlantic City casinos.
Showboat Casino Hotel patrons smoke on the sides of nonsmoking gaming floors where large trash containers with built-in ashtrays sit with extinguished cigarettes.
“I think we do a good job with it,” said Don Marrandino, president of the Bally’s, Caesars, Harrah’s Resort and Showboat casinos owned by Caesars Entertainment Corp. “I mean, are we perfect? Obviously, I don’t think we’re perfect. We certainly try to abide by the law.”
Cash of the city health department said his inspectors could easily manage violations such as Resorts’ lack of signage at its entrances, but monitoring the smoking sections and issuing citations for daily violators is not possible.
“The only way we can do this is depending on the industry to do what they have to do,” he said. “We have to witness it. We can’t even cite Taj Mahal if someone says somebody is smoking if we don’t see it.”
Councilman Dennis Mason, who sponsored the city’s partial smoking restrictions, acknowledged that there are problems with the law, but he also placed much of the blame on the industry.
“It’s an enforcement issue,” Mason said. “I would think the hotels themselves would do more of the regulation. We’re not in there to manage their casinos.”
Before Trump officials rescinded their new smoking sections, Griffin said that the smoking-area changes had come from an overall analysis of the casino’s operation with an eye toward making the company more competitive in the industry.
Through Trump’s analysis, Griffin said, the company realized its smoking sections were not even competitive locally — they accounted for less than 25 percent of the casino floor.
“We were putting ourselves at a competitive disadvantage within our own city limits,” he said.
But outside the city’s boundaries, Atlantic City casino executives have long argued, is where the smoking laws really hurt them.
“It does create a competitive risk, there is no question about it,” said Michael Pollock, managing director of Spectrum Gaming Group, based in Linwood. “The world is ultimately moving toward a nonsmoking world, and gaming is heading in that direction as well. But all things being equal, a casino that allows people to smoke is going to perform better.”

Elsewhere in gaming

Different markets have different policies. In commercial-casino states such as New Jersey, only four of 14 states outlaw smoking entirely. Eight of the 14 states have no smoking restrictions on the casino floors, including Nevada and Indiana.
Among the eight racetrack casino states, half have full bans against smoking, including New York and Delaware, but two of those states have no restrictions at all.
Pennsylvania gaming halls, which are strong competition for Atlantic City, maintain an edge with their smoking restrictions. The laws there restrict smoking on all but 25 percent of casino floors for the first six months of their operation. However, after six months, if the casinos can illustrate that smoking sections are more profitable, executives can expand the sections to as much as 50 percent of the floor.
“All of them are at 50 percent,” said Richard McGarvey, a spokesman for the Pennsylvania Gaming Control Board. “After six months, everybody immediately expanded to 50 percent.”
The Pennsylvania Department of Revenue performed a 90-day analysis three months after the smoking restrictions were enacted to gauge the success of smoking slot machines as opposed to nonsmoking machines. The report is used to determine if a casino can expand its smoking sections and by how much.
All 10 of Pennsylvania’s gaming halls saw more than a 50 percent profit increase in smoking sections compared to nonsmoking slots, according to state statistics. The average daily profit increases at the casinos ranged from 60 percent to 185 percent.
“That kind of thing in Pennsylvania isn’t going away,” said Roger Gros, publisher of the Las Vegas-based Global Gaming Business magazine. “Atlantic City is already at a disadvantage. If they go back to the idea that they need a full ban, it’s only going to get worse.”
But some still believe there’s a market for nonsmoking casinos. Kevin DeSanctis, chief executive officer for Revel Entertainment Group, still plans to keep his to-be-opened casino smoke-free.
DeSanctis has said since 2007 that his casino will be smoke-free. The subsequent downturn of the economy and the company’s own financial troubles have not changed that plan. But Revel officials are still considering ways to accommodate smoking customers.
“We don’t have anything against people who smoke,” he said. “If we can accommodate them, we will. But it creates all kinds of issues.”
His stance on nonsmoking doesn’t come without worry, though.
“I do have concerns,” DeSanctis said. “You have to be concerned about any decision you make when you’re going against … conventional gaming wisdom. But a huge part of society has rejected smoking. We’re going after that same group of people.”
Gros predicted that Revel will eventually cave on its nonsmoking plans as its 2012 opening date gets closer, bowing to the additional profit possibilities.
“Cooler heads will prevail,” Gros said. “I think he was assuming that the full smoking ban would be in effect. I don’t think he thought this would continue the way it has. I would be surprised if he stuck with it.”
Compromised ban
In 2007, Councilman Mason’s 75 percent law was established as a compromise with those fighting for a full smoking ban in the city’s 11 casinos. But smoking opponents’ outrage, along with a lack of casino participation, caused the law to change multiple times over the years.
Resort casino workers, health groups and others have pressed the city and the state for years to prohibit smoking outright.
On April 15, 2006, then-Gov. Richard J. Codey signed The New Jersey Smoke-Free Air Act, which banned smoking in most workplaces in April 2006 but exempted casino gaming floors and simulcasting facilities.
“You have to weigh this on a total basis,” former Republican state Sen. William Gormley said at the time. “When you’re talking about the competition the casino industry faces from other jurisdictions, it’s an exemption you have to consider.”
But the state did leave open the possibility of Atlantic City’s government closing the loophole. Nonsmoking advocates increased pressure on City Council, and soon former Councilmen G. Bruce Ward and Eugene Robinson became vocal proponents of a full ban.
A full ban was proposed in February 2007 but was watered down with amendments shortly afterward, allowing smoking on 25 percent of all casino floors in enclosed sections, while the remaining space would be smoke-free. But the casinos’ slow effort to construct the enclosures angered smoking opponents and City Council, pushing Ward to reignite the full-ban effort.
Council narrowly passed the full ban about a year after approving the partial restrictions, but the vote came as the country began to see national indicators of a recession.
“There were rumors and indications out that the economy was going bad,” said Councilman Mason. “We couldn’t allow it.”
Council members eventually gave in to repealing the full ban after the economic downturn hurt the industry locally, reverting to the partial restrictions.
“Oftentimes, legislators make laws and they don’t think about the consequences of implementing them,” Cash said.
Asked if he warned City Council that his department’s staffing levels would make adequate enforcement near impossible, Cash said he did not.
“This stuff happened so fast,” he said. “There were a whole lot of other public-health issues going on at the time. Could I have gone to every council person and say, ‘No, don’t do that’? I guess possibly. But practically, there’s a lot of other stuff going on.”
City officials pledged to revisit the issue in a year, but delayed that debate until the end of this year.
Adjustments ahead?
City Council had intended to vote on a resolution calling for a review of the city’s smoking restrictions and pledging to collaborate with the DGE to “provide for more effective regulation of casino-floor smoking.”
However, legislators considered the issue dead after Trump’s agreement to revert to its old smoking sections and unanimously voted the measure down this month.
“They submitted a plan that, quite frankly, the city couldn’t support. But both sides talked about the pros and cons of the situation and they’re going to honor the old plan,” said Councilman Marty Small, head of council’s Health Committee.
DGE officials initiated a conversation with the city administration after receiving complaints and reviewing the Trump blueprints.
The city’s Department of Health and Human Services continues to endorse a full ban and has suggested other changes to the law to make it more threatening. Cash said he would like to increase smoking violation fines. City officials can charge a smoker or an establishment with fines ranging from $25 to $250. Cash said he hopes to see them boosted to the fines outlined in state law, which range from $250 to $1,000.
Any potential attempts by the administration to adjust the law could still run into obstacles at the legislative level.
Mason, a smoker, acknowledged he has unknowingly smoked a cigarette in a nonsmoking section at a casino on multiple occasions. Regardless, he supports keeping the law the way it is.
“I think what we have in place works,” Mason said. “I recognize that some people may be turning their heads (to violations), but I think in the long run it works.”
By Michael Clark:
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