The medical journal Pediatrics rang in 2009 with sobering news about cigarettes: Even those who smoke outside to spare loved ones from secondhand smoke do them another disservice. So-called third-hand smoke, the residue of toxic cigarette ingredients, clings to smokers’ hair and clothing long after they snuff out the cigarette. For parents, that means picking up or hugging their children could contaminate them with the likes of hydrogen cyanide, butane, arsenic, and polonium-210, according to the study, led by Harvard Medical School professor Dr. Jonathan P. Winickoff. A New York Times story about the study pointed out that polonium-210 is the same substance “used to murder former Russian spy Alexander V. Litvinenko in 2006.”

“Smokers have a right to breathe in those 4,000 chemicals contained in cigarettes, and nonsmokers have a right not to,” says Danny McGoldrick, vice-president for research at the Campaign for Tobacco-Free Kids in Washington, D.C.
No one’s rights are more relevant than those of children, who have little means to protect themselves from their parents’ hazardous habits. It should be illegal for parents to smoke, period.

And it’s not as though there isn’t already plenty of evidence about the way secondhand smoke endangers the children of smokers. According to the Surgeon General’s findings, secondhand smoke harms children by, among other things: causing bronchitis and pneumonia, aggravating the effects of asthma, and increasing the likelihood of sudden infant death syndrome (SIDS). The American Academy of Pediatrics has reported that childhood exposure to tobacco smoke may lead to the development of cancers during adulthood.
Finally, with the recession upon us and apparently here to stay, spending money on a non-necessity is hardly prudent. In New York City, federal, state, and city taxes inflate the cost of cigarettes to $8 a pack. That means two-pack-a-day smokers are sucking $480 a month out of the family exchequer.

Instead, parents should avail themselves of help from any of the numerous free anti-smoking programs or over-the-counter products to help them wean themselves off cigarettes. Have you ever heard of anyone who regretted quitting smoking or setting a good example for a child?

You can ask. Why is everyone so quick to believe this slight evidence about “third-hand smoke,” and what makes smoking any worse than parents’ other bad behavior?
“A lot of smokers are happy about this third-hand smoke report, because it shows what ridiculous lengths antismoking people will go to,” says Dave Hitt, a smoker who created the opinion site the Hittman Chronicle (www.davehitt.com). “The study was nothing more than a phone survey on what people believe is harmful. The stuff used to kill the Russian spy, the polonium, was a huge dose—you’d have to have a baby licking the floor clean every day for 267 billion years to equal it.”
George Koodray sees the third-hand smoke report as just another excuse for selective finger-pointing. “I find it somewhat hard to believe that your body could discern ‘third-hand smoke’ from all the bad substances you find in carpet and clothing and the air,” says Koodray, who serves as New Jersey state coordinator of the Smokers Club. “Back when secondhand smoke was all the rage, I’d see people jogging for their health right next to eight lanes of highway traffic. I think the effect of secondhand smoke pales in comparison to a lot of the things we’re exposed to.”

Furthermore, smoking cigarettes in general doesn’t qualify as an immediate fatal threat. It takes years or even an entire lifetime to acquire cancer or emphysema from smoking, while one bad fall on an all-terrain vehicle or motorcycle can mean serious injury or death. Why not make it illegal for parents to introduce these sports to their kids? And how about outlawing parental consumption of alcohol while we’re at it? Unlike alcohol, cigarettes have never been linked to domestic violence.
It’s about time to stop persecuting smokers, period. In October 2008 a state trooper arrested a Long Island woman for the misdemeanor charge of tax evasion after she bought five cartons of cigarettes at the Cayuga Indian Reservation. The cigarettes were for herself; she purchased them at the reservation to save money and bought them in volume to save on gas.
Smokers make an easy target for finger pointing, and parents are always quick to cast stones at other parents, hoping their own foibles will be overlooked amid the rock-throwing.

The Technical Advisory Group (TAG) on Tobacco Control in Pakistan has advised the Ministry of Health to issue by May 31, 2009, a notification that makes the printing of picture-based health warnings on cigarette packs and cartons mandatory at the manufacturer, importer and retailer levels with effect from January 1, 2010.

In their fourth meeting held here on Tuesday, TAG members unanimously recommended that “any packages on the market without the package warning and labeling requirements will be subject to be confiscated and forfeited.”

The meeting adopted a series of recommendations that not only have the potential to help reverse the tide of death and disability resulting from rising tobacco use, but also to build Pakistan’s image as a country that can do a lot more than merely bowing to the influence of the powerful tobacco industry.

Director General Implementation of the Framework Convention on Tobacco Control (FCTC) Shaheen Masud, WHO Representative Dr. Khalif Bile Mohamud, senior policy analyst, Canadian Cancer Society, Rob Cunningham, and Dr. Farrukh Qureshi from the Tobacco Free Initiative, Eastern Mediterranean Region, WHO, addressed the meeting.

The members advised the Ministry of Health that in preparing the May 2009 notification, the FCTC Article 11 guidelines adopted at Conference of Parties (COP3) meeting held in Durban, South Africa, in November 2008 should be followed to the maximum extent possible. These guidelines stipulate that health warnings be in the form of culturally appropriate pictures or pictograms; in full colour rather than black-and-white; and on both principal display areas (or on all main faces if there are more than two) of the tobacco products packaging.

TAG recommended that pictures be included as part of tobacco package warnings; that the size of the warnings be at least 50 to 60 percent of the top of the package front and back, with Urdu on the front and English on the back; and that the series of picture warnings should include images that are “shocking” in nature. It was agreed that the above recommendations would apply to all types of tobacco products, as well as the ‘outers’ or cartons of tobacco products.

There was consensus over the need for a series of warnings appearing at the same time, rather than a singular message, so that each time a tobacco consumer picks up a cigarette pack, they have a new health warning to read. Rob told the meeting that Canada has 16 different warnings while some European countries have 14 warnings appearing at the same time.

The TAG members also recommended that a descriptive statement of the harmful emissions in smoke be included on the side panel of cigarette packages; and that there be no requirement to include machine test numbers for tar, nicotine, carbon monoxide or other substances.

Talking to ‘The News’ on the sidelines of the two-day meeting, Rob said, “Picture health warnings are specifically beneficial for Pakistan due to its relatively high rate of illiteracy. A text warning is useless for someone who cannot read.”

Article 11 of the FCTC also favours picture-based warnings because they have the added benefit of potentially reaching people with low levels of literacy and those who cannot read the language in which the text of the health warning in written. Additionally, picture warnings may also disrupt the impact of brand imagery on packaging and decrease the overall effectiveness of the package.

Rob said, “The guidelines adopted by 163 countries at COP 3 are very persuasive about the importance of picture health warnings, for which there is rising worldwide momentum.” He said the tobacco industry is opposed to picture warnings because of the fear of reduced sales, which is precisely the health objective of the intervention.

Rob, who has been involved with package warnings for several years now, informed that 28 countries have already required picture warnings on cigarette packs and cartons, and 57 countries have warnings that are bigger than those in Pakistan. He referred to the introduction of picture-based warnings as an intervention “where the Ministry of Health determines the content and the tobacco industry pays the cost!” “What a wonderful thing for a country of 170 million people,” he remarked in excitement. He said, “If Kyrghzstan can have picture warnings in two languages, covering 52 percent of the front and back of the cigarette pack, Pakistan can do it too. If Djibouti, a small, poor country, can have picture health warnings covering 50 percent of the front and back packing, Pakistan can too.”

Rob was of the view that even though Pakistan has made some progress, it still falls behind the international trend. “For a developing country, where resources are scarce, package warnings reach the entire country every day without costing anything. These mini-billboards are always there; they work 24 hours a day. What a cost-effective way to reach every person - be they in the mountains or deserts. Pakistan must capitalise this tremendous public health education opportunity,” he emphasised, adding that a person who smokes 20 cigarettes a day, is exposed to the package 7,300 times a year.

Rob said the future lies in having a health warning on each cigarette stick, a measure which no country has taken so far, and which is particularly relevant for countries like Pakistan where individual sticks are available for sale to trap young people who cannot afford to buy a whole pack.

Earlier, Dr. Bile emphasised that failures in tobacco control do not signify failure of strategies, but of implementation. “We have a strong opponent that spends billions to lure new targets. These MNCs have on their payroll, senior policy-makers who are supposed to fight tobacco. The amount spent on promotion of tobacco versus that available for health promotion has a ratio of 1:100,” he said, suggesting that a certain chunk of the revenue to the tune of Rs35 billion generated through tobacco sales in Pakistan should be channelled in the direction of health education. “The WHO pursues the government of Pakistan to proceed towards rotational as well as graphical messages, as early as possible,” he stated.

Sharing the progress achieved by Pakistan so far, Shaheen Masud said that for the first time, health warning has been extended from packs to outers as well. The packs with new health warning are required to be printed and sent to market with effect from July 1, 2009. She informed that the Tobacco Control Cell has already ordered picture-based posters and stickers. The meeting will continue today (Wednesday).

The $33 billion bill would raise federal taxes on selling cigarettes, cigars, rolling paper and other tobacco products to help fund the expansion. Cigarette taxes would rise from 39 cents per pack to $1.

Congressional Democrats previously pushed to extend the program to uninsured middle-class children, but efforts were vetoed by President Bush, who wanted the federal program geared toward the poor. President-elect Barack Obama is expected to sign the SCHIP expansion if it gains Senate approval.

House Democrats backed the expansion saying it will bring health insurance to more uninsured children.

The federal tobacco tax increase, however, faces criticism from economic conservatives.

“Tobacco tax increases over the years have resulted in less smoking and therefore a decline in tobacco tax revenue. Tying the expansion of a government program to a declining revenue source is the sort of backward thinking that makes taxpayers scratch their heads,” said Steve Voeller, president of the Arizona Free Enterprise Club.

A group of conservative economic groups wrote members of Congress earlier this month saying continued tobacco tax increases scapegoat smokers and hurt retailers and other small businesses by sending buyers online where they often can avoid such taxes.

Tennessee has scored a C, a D and two F’s in the American Lung Association’s State of Tobacco Control 2008 report, released late Tuesday.

The lung association grades in four categories: tobacco prevention and control, smoke-free air, cigarette tax and cessation coverage.

Despite the 2007 passage of Tennessee’s Nonsmokers’ Protection Act, the state earned a C in the category of smoke-free air because the law exempts bars and restaurants open only to those over 21 years old. The two failing grades were for cessation coverage and tobacco prevention and control spending.

Tennessee fared better than many other states in the region on this year’s report. Kentucky was among seven states that scored all F’s this year. The other six are Alabama, Missouri, North Carolina, South Carolina, Virginia and West Virginia.

“The historical tobacco states like Tennessee are having a hard time keeping up with what some of the other states are doing to address smoking,” says Menisa Marshall, a spokeswoman for the American Lung Association’s Southeast region. “These states tend to take a very short-term view. Change will take time.”

Spending on Tennessee’s year-old cigarette smoking cessation program will be cut in half in 2009, much to the chagrin of some local medical experts and health organizations.

The reduction — from $10 million in 2008 to $5 million next year — will not affect the state’s 24-hour, toll-free hotline that provides personalized support, Tennessee’s Commissioner of Health Susan Cooper said in a November interview with the Business Journal.

“It will take time to see a big drop in the numbers of Tennesseans who smoke,” Cooper said. “Our efforts are still in our infancy.”

At 62 cents a pack, Tennessee’s cigarette tax earned a D. The national average tobacco tax is $1.19 a pack.

Tennessee’s F for tobacco control spending stems from spending less than 10 percent of what the minimum recommended by the Centers for Disease Control and Prevention. Tennessee spends about $6 million, while the CDC suggests about $72 million.

“In the face of budget crises and the slow economy, many states have had to cut their tobacco control spending,” says Margaret Smith, the lung association’s director of advocacy in Tennessee.

Grades in the State of Tobacco report are calculated by comparing policies against standards based on current, recognized scientific criteria for effective tobacco control measures.

“Despite this year’s drop in some grades, we are encouraged by Tennessee’s progress and believe the day will soon come when all our citizens will be protected from the health risks of second-hand smoke,” Smith says.

Currently, 25.5 percent of high school students and 24.3 percent of adults in Tennessee smoke.

Tennessee’s economic cost due to smoking tops $5.1 billion a year, according to the lung association. Tobacco-related illness costs are about $193 billion annually.

Iowa and Nebraska were the only two states to meet the lung association’s Smoke-free Air Challenge in 2008 by passing strong air laws.

Alaska and Delaware received A’s for funding tobacco prevention.

Massachusetts, New York and the District of Columbia raised cigarette excise taxes in 2008, despite evidence linking increased cigarette prices with decreased smoking rates, especially among youth.

Smoking rates nationwide have declined over the past 30 years as a result of various factors including strong smoke-free laws and higher cigarette taxes.

Tobacco use remains the leading cause of preventable disease and premature death in the United States. It kills nearly 393,000 Americans a year, including more than 9,700 in Tennessee.

The full State of Tobacco Control 2008 report with a map and grades for each state can be found at stateoftobaccocontrol.org.