TIME tobacco

Big Tobacco Sues British Government Over Effort to Strip Logos From Cigarette Packaging

New laws would strip logos from cigarette packages

Tobacco companies are fighting a recently passed law that would strip logos and branding from cigarette packages to in order to make them less enticing to consumers in the United Kingdom.

Philip Morris International, which owns the Marlboro band, filed suit Friday in a British court seeking to stop regulators from imposing standardized packaging on cigarettes. Philip Morris argues that such regulations would unlawfully deprive the company of use its own trademarks.

“Countries around the world have shown that effective tobacco control can co-exist with respect for consumer freedoms and private property,” Philip Morris said in a statement.

Under the new law, traditional cigarette logos would be replaced with large, graphic health warnings. Australia enacted a similar law in 2012.

According to Philip Morris, Marlboro was the ninth most valuable brand in the world in 2014 with an estimated value of $67 billion.

TIME Research

The New Science of How to Quit Smoking

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Two studies shed light on promising new ways to make kicking the habit easier, using both biology and behavior

Studies show that most smokers want to quit. So why are some people more successful at cutting out nicotine than others? The latest studies looking at the brains and behavior of smokers may provide some explanations.

Some people may be hardwired to have an easier time giving up their cigarettes, suggests one new trial described in the journal Neuropsychopharmacology. It turns out that some smokers start out with a particularly rich network of brain neurons in an area called the insula, which regulates cravings and urges and communicates cues: like seeing a cigarette or smelling tobacco smoke, then wanting to light up. Joseph McClernon, an associate professor of psychiatry and behavioral sciences at Duke University School of Medicine, ran MRI scans of 85 smokers who puffed more than 10 cigarettes a day. The smokers were then randomly assigned to continue smoking their brand or to smoke low-nicotine cigarettes, along with nicotine replacement therapy, for 30 days. All of the people in the study were then told to stop smoking and given nicotine replacement for 10 weeks.

MORE The Best Way to Quit Smoking Isn’t E-Cigs

Those who relapsed during that time tended to have lower activity in the insula, particularly in the connections between the insula and other motor areas that translate cravings into action, while those who successfully kicked the habit showed more robust activity in this brain region. The pattern remained strong despite how many cigarettes the smokers smoked.

“We’ve known for a while that some people seem to be able to quit and other people can’t,” says McClernon. “This gives us a better sense of what neural mechanisms might underlie those differences.”

The results suggest that it might be possible to identify people who may have a harder time quitting—a quick MRI scan of their brains would reveal how much activity they have in their insula—and provide them with more support in their attempts to quit. “Some smokers might benefit from more intensive, longer duration or even different types of interventions to stop smoking,” says McClernon. “They might need a higher, different level of care to help them make it through.”

But how much this system can be manipulated to help smokers quit isn’t clear yet. Previous studies show how potentially complicated the insula’s connections may be—smoking patients who have strokes and damage to the insula suddenly lose their desire to smoke and quit almost cold turkey. McClernon believes that the richer connections may not only promote interactions between cravings and behavior, but also enhance the connections that can inhibit or suppress those urges as well. Having a more intense communication in the insula may help strengthen the ability to quiet urges and inhibit the desire to smoke, despite cues and the urge to light up.

MORE Taking Medication May Make It Easier to Quit Smoking

But even if you’re not blessed with a brain that’s wired to make quitting easy, you still have options. In another study, published in the New England Journal of Medicine, scientists studied one of the oldest and most reliable ways to motivate people: money. In that trial, Dr. Scott Halpern from the University of Pennsylvania and his colleagues assigned 2,538 employees of CVS Caremark to one of five different smoking cessation programs. All received free access to nicotine replacement and behavioral therapy, and some were also assigned to an individual reward program in which they could earn up to $800 if they remained abstinent at six months. Another group was assigned another individual deposit program which was similar, except they had to pay $150 to participate, which they got back if they remained abstinent. Others were assigned to group versions of the reward and deposit programs so that what they received depended on how many in their group quit successfully.

Not shockingly, more people who were assigned to the reward program (90%) agreed to participate than people who were assigned to the deposit strategy (14%), likely because most people weren’t wiling to put their own money on the line. But when Halpern looked more closely at those who did enroll, the smokers in the deposit programs were twice as likely to be abstinent at six months than those in the reward group and five times as likely to be smoke-free than those who received only free counseling and nicotine replacement.

MORE Paying People Could Help Them Quit Smoking

That’s not entirely surprising, says Halpern, since having some of their own money at risk provided more motivation for the smokers to quit. When it comes to incentivizing smoking cessation, “adding a bit of stick is better than having just a pure carrot,” he says.

Finding the perfect balance of stick and carrot, however, may be more challenging. Halpern believes that from the perspective of an employer, insurer or government, offering even higher rewards than the $800 in the study and lowering the deposit slightly might still provide benefits to all parties. Smokers cost an average of $4,000 to $6,000 more each year in health services than non-smokers, he says, so offering even as much as $5,000 can still result in cost savings for employers, many of whom are now dangling financial incentives in front of their smoking employees to motivate them to quit.

How the financial carrot is proffered is also important, says Halpern. Now, most employers or insurers reward quitting in more hidden ways, with bonuses in direct deposit accounts or with lower premiums. While helpful, these aren’t as tangible to people, and humans respond better to instant gratification. “They’re rewarding people in ways that are essentially blind to the way human psychology works,” he says. “The fact that the benefits occur in the future make them a whole lot less influential than if people were handed money more quickly. Our work suggests that in addition to thinking about the size of the incentive, it’s fundamentally important to think about how to deliver that money.”

Another factor that can make financial incentives more powerful is to make the experience more enjoyable, either by introducing some competition in a group setting or encouraging smokers along the way. In the study, smokers in the group programs were not any more successful than those in the individual regimes, but that may be because the employees didn’t know each other. Grouping colleagues in the same office might have more of an effect, says Halpern. Either way, he says, incorporating such incentives to help more people quit smoking is “really a win-win.”

Read next: The Best Way to Quit Smoking Isn’t E-Cigs

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TIME medicine

The Best Way to Quit Smoking Isn’t E-Cigs

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In the latest in-depth review of studies investigating which smoking cessation methods work best, experts say there isn’t enough evidence to support using e-cigarettes to kick the habit

The U.S. Preventive Services Task Force, a government-convened group of experts, says that if you want to quit smoking, you’re better off with drug-based methods, behavior modification programs or a combination of both—not puffing on e-cigarettes. There isn’t enough evidence to support claims that e-cigs, which have been touted as the latest way to wean people off tobacco, can actually help people quit.

The task force focused on studies that investigated how effective various smoking cessation methods are, for both adults and pregnant women. Drugs that address nicotine’s effects on the body, as well as nicotine replacement options, are better ways to quit, and the data suggest that they are even more effective if used together. In addition, behavioral interventions, including support groups and counseling sessions, can boost quit rates from 7-13% compared to rates of 5-11% among those who don’t use them.

MORE: E-Cigs Are Smokers’ Favorite Quitting Tool

“We have an embarrassment of riches in terms of a menu of things to offer patients who want to quit smoking,” says Dr. Francisco Garcia, director and chief medical officer of the Pima County Health Department in Arizona and member of the task force. “But every individual is different; some might respond better to behavioral therapy, some might respond better to varenicline, some might feel nicotine replacement is important to bridge them away from tobacco use.” For most people, it’s a matter of discussing with the smoker which method has the most appeal, and which one they are more likely to stick with long enough to go smoke-free.

But for certain populations, there isn’t enough data to support one strategy over another. Among pregnant women, for example, there haven’t been many studies to show how drug-based methods might affect the developing fetus, so it’s hard to determine if the benefits of quitting outweigh he risks represented by the medications. So for now, the task force advises that pregnant women rely on behavioral, non-drug strategies to help them stop smoking.

MORE: This Is The New Best Way to Quit Smoking, Study Finds

And for e-cigarettes, the data is sparse. The panel concluded that there was “insufficient” evidence to determine whether e-cigarettes improve or hinder quit rates.

TIME Addiction

Hawaii Set to Become First State to Raise Smoking Age to 21

TIME.com stock photos E-Cig Electronic Cigarette Smoke
Elizabeth Renstrom for TIME

The bill covers both cigarette and e-cigarette use

Hawaii is set to become the first state to pass a law banning the sale, use and possession of cigarettes and e-cigarettes to people under the age of 21.

If a bill approved by Hawaii lawmakers on Friday is signed into law by Governor David Ige, adolescents will be prohibited from smoking, buying and possessing both conventional cigarettes and e-cigarettes. First-time offenders will be fined $10, and after that they can be charged a $50 fine or be required to complete community service, the Associated Press reports.

Some local governments have raised the smoking age to 21 in certain counties and cities — New York City among them — but if the bill becomes law, Hawaii will be the first state to do so.

Though the rates of high-school-age smokers have dropped in recent years, some 2.3 million children and young adults started smoking in 2012. In addition, a recent report from the U.S. Centers for Disease Control and Prevention revealed that e-cigarette use among middle-school and high school students tripled in one year.

If the Hawaii bill passes, it will go into effect Jan. 1, 2016.

[AP]

TIME Baseball

The San Francisco Giants Could Become the First MLB Team to Ban Chewing Tobacco

Minnesota Twins v San Francisco Giants
Brace Hemmelgarn—Getty Images A general view of the exterior of AT&T Park following the game between the San Francisco Giants and the Minnesota Twins on May 23, 2014 in San Francisco, California.

Players have been dipping for as long as anyone can remember, but that could soon change

A San Francisco city ordinance could make the Giants the first team in Major League Baseball to ban chewing tobacco on the field.

City supervisors voted unanimously on Tuesday to ban smokeless tobacco in playing fields throughout the city and specifically targeted baseball—a sport infamous for the player’s use of tobacco, according to a statement from the Campaign for Tobacco-Free Kids, which pushed for the law.

The ordinance must pass one more vote and, if San Francisco Mayor Ed Lee signs, the rule will be implemented on Jan. 1 2016—in time for the MLB baseball season.

Jess Montejano, a legislative aide for the ban’s chief sponsor, Supervisor Mark Farrell, told TIME that legislators began working on the ordinance in the beginning part of 2015 because “it’s a serious health issue” in which “kids are seeing their athletic heroes chewing tobacco on the baseball diamond.”

Montejano also added the San Francisco Giants “are fully aware of the intention” and that proponents of the ban believed the team would support MLB’s stance on the issue of chewing tobacco.

After the law was initially proposed in late Feb., MLB issued a statement saying that it “has long supported a ban of smokeless tobacco at the Major League level” and that it had been seeking “a ban of its use on-field in discussions with the Major League Baseball Players Association.”

A study published April 10 from the University of California San Francisco suggested that seeing players chewing tobacco was akin to product endorsement. It found that “modeling of smokeless tobacco use by…elite athletes is strongly associated with smokeless tobacco initiation among adolescent males.” The study also cited an NCAA statistic that found that 52.3% of collegiate baseball players tried smokeless tobacco at least once in 2012 to 2013.

When asked if the ban would essentially force players to quit, Montejano cited former MLB pitcher Curt Schilling, who blames tobacco for his mouth cancer. “Schilling said it was the worst thing about his life and if he could change one thing from his younger years it would be to quit.”

TIME medicine

Smokers Don’t Think a Few Cigarettes Will Harm Their Health

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Nearly everyone knows that smoking is harmful for your health. But some refuse to admit that their habits may be killing them

Heart disease, lung cancer, throat cancer, diabetes—the list of bad things that smoking does to your health is long and growing longer. Thanks to public health warnings and education campaigns, most of us have heard that cigarettes can be dangerous to your wellbeing and can shorten your life.

But one group who should be getting that message loud and clear may be in a bit of denial. In a study of more than 1,600 French smokers and non-smokers, 34% said that lighting up 10 cigarettes a day would not put them at higher risk of lung cancer. And fewer than 40% knew that their risk of lung cancer wouldn’t disappear if even if they quit smoking. The results were presented at the European Lung Cancer Conference in Geneva, Switzerland.

“The fact that one third of subjects wrongly considered that a daily consumption of up to 10 cigarettes was not associated with any risk of lung cancer is particularly impressive and threatening,” writes study author Dr. Laurent Greillier from Aix Marseille University in response to questions about the findings.

The results were especially worrisome since the participants in the study were 40 years old to 75 years old and therefore spent most of their adult lives hearing strong public health warnings about the dangers of smoking. That means that while anti-smoking campaigns have been effective, they may not have educated people deeply enough about the dangers of tobacco. That’s especially true for people who engage in what they consider to be “safe” or “light” smoking, the study finds. “Our results suggest that public health policies must continue to focus on the tobacco pandemic, and notably initiate campaigns concerning the risk of any cigarette,” says Greillier.

TIME Addiction

FDA Panel Votes Against Smokeless Tobacco Safety Claims

Swedish Match Targets Wall Street Smokers With Snus Tobacco
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The panel's vote was split on some important points

An FDA advisory panel voted on Friday that it does not agree with the evidence and claims put forward by smokeless tobacco manufacturer Swedish Match regarding its application to change warning labels on its tobacco product, called snus.

Snus, pronounced snoose, is a cloth baggie with moist tobacco powder which users stick under their upper lip for a nicotine buzz. As TIME reported on Thursday, Swedish Match wants to remove the required warnings that say snus causes mouth cancer, gum disease and tooth loss, arguing that there isn’t sufficient scientific evidence to support them. The company also wants to change the warning to read: “No tobacco product is safe, but this product presents substantially lower risks to health than cigarettes.”

On Thursday and Friday an advisory committee to the FDA met about the company’s application and voted on a series of questions related to the application. The FDA will use the committee vote as a recommendation that it may or may not adopt. On Friday, the committee largely voted against many of Swedish Match’s claims, with some exceptions.

On certain claims, the panel’s vote was clear cut. The committee unanimously voted that there was not evidence to suggest that snus products do not pose risks to gum disease or tooth loss. The committee was, however, split on the question of whether snus products do not pose risks for oral cancer. Three members voted yes, three members voted no, and two abstained from the vote.

The committee was split on the question of whether there’s evidence to support the statement that the health risks for people who exclusively use snus products are “substantially lower” than the health risks from smoking cigarettes. Four members voted yes and four voted no.

The vote suggests the committee is still unconvinced that solely using the smokeless tobacco product is indeed safer than using cigarettes. A large part of Swedish Match’s argument is that snus has contributed to what’s called the “Swedish experience.” Sweden has similar tobacco consumption rates as other European countries but has the lowest smoking-related mortality rate. Many say that’s because Swedish men tend to choose snus over cigarettes (the product is less popular among women). Members of the public health community watching the vote have been largely divided on whether harm reduction has a place in tobacco control and whether pushing people toward products with lower levels of nicotine is good for public health.

The committee also voted that the proposed warning statement from Swedish Match does not adequately communicate the potential health risks from using snus.

“I am very happy with the vote,” says Shyam Biswal, a professor in the department of Environmental Health Sciences at the Johns Hopkins Bloomberg School of Public Health. “My main concern is [snus attracting] new users who would otherwise not smoke. Saying snus is significantly less harmful [than cigarettes] is a very broad claim.” Biswal adds that he thought the evidence presented by Swedish Match was weak, including studies with small sample sizes. Biswal was not involved in the vote, but has studied modified risk tobacco products.

Swedish Match did not respond to requests for comment by time of publication.

TIME Addiction

How a Big FDA Decision Could Change Tobacco Control

Swedish Match Targets Wall Street Smokers With Snus Tobacco
Ramin Talaie—Bloomberg/Getty Images

A Swedish Company that manufactures snus wants to change its label to indicate it's safer than cigarettes

An upcoming decision from the U.S. Food and Drug Administration (FDA) could have significant implications on U.S. tobacco control.

On Thursday and Friday, an advisory committee to the FDA is meeting to review an application from the smokeless tobacco company Swedish Match. The Stockholm-based company wants to be permitted to legally claim that their tobacco product, called snus (pronounced “snoose”) is safer than cigarettes. The company disagrees with some of the warnings required for its label, and instead wants to use a warning that says “No tobacco product is safe, but this product presents substantially lower risks to health than cigarettes.”

Snus is a small cloth baggie that contains moist tobacco powder. They’ve been described as looking like mini tea bags. Users tuck the small pouches under the upper lip to get a buzz from the nicotine. It’s sort of similar to dip or chew, but without all the spitting.

The company’s argument is that snus is behind what’s called the “Swedish experience.” Sweden has a similar tobacco consumption rate compared to other European countries, but has the lowest smoking-related mortality rate. Snus has credited itself for offering Sweds (it’s used primarily by men) a safer alternative to cigarettes, becoming the country’s predominant product. The company wants to remove the required warnings that say the product causes mouth cancer, gum disease and tooth loss arguing there isn’t evidence to support that for their product and they would like to make the claim that the product safer than conventional cigarettes.

“Given all the science we have, it’s clear to me that the current label is misbranded. The label says a lot of things that there simply is no scientific basis for. We would like to be able to communicate that,” says Dr. Lars Erik Rutqvist, an oncologist and Swedish Match’s vice president of scientific affairs. Rutqvist was a cigarette smoker while in medical school (he says at the time that was still common), but wanted to quit when he decided to become an oncologist. He used snus to do so.

“I think it’s problematic that the only message that American smokers are left with today is you should quit,” he says.

The FDA panel is expected to make a vote after the hearing ends on Friday. The panel’s vote will provide a recommendation to the FDA. The agency could follow that recommendation or decide not to adopt it. If the committee agrees with Swedish Match, experts within the tobacco control community believe it could have some major implications for tobacco control regulation.

“This is a critical decision because of the precedent it sets,” says Kenneth E. Warner, a professor of public health focusing on tobacco control at University of Michigan. “It’s precedent setting in the sense that if this goes through it will be the first product to get this reduced risk authorization from the government. It would allow a tobacco harm reduction message to be placed on a product other than an FDA certified treatment such as nicotine replacement products. So it’s pretty important.”

Smokeless tobacco is considered less dangerous than cigarettes, since it doesn’t have toxic smoke. There are members within the public health community that believe that pushing consumers towards lower nicotine-containing products or products that put less harmful chemicals in buyers’ bodies is good for public health.Warner is among them. Others, including the U.S. Centers for Disease Control and Prevention (CDC), have come down hard against such products like e-cigarettes for example, arguing using the products can lead to dual use instead of cigarette smoking cessation.

“Although there’s evidence snus may have reduced harm, reduced harm products are not the same as safe products,” Dr. Michael Steinberg, director of the Tobacco Dependence Program at Rutgers University told NPR.

Warner says the company will have to prove to the FDA that it can back up it’s claims, and the FDA must be confident that the changes wouldn’t have negative consequences. “If information about how snus lowers harms encourages kids to start using it because they don’t think it’s particularly dangerous, and then they graduate to cigarettes because they want the faster nicotine kick, that’s a bad thing,” says Warner. “If snus were to get former smokers to start using it and it has health hazards, that’s not good. It’s hypothetical. The best evidence we have comes from Sweden.”

What the advisory committee will decide and the reverberations of that decision remains unknown, but it it will further fuel the debate over modified risk tobacco products and whether harm reduction has a place in tobacco control.

TIME Addiction

A New Government Anti-Smoking Campaign Includes E-Cigs

Past campaigns have increased calls to quitlines by 80%

A new federal ad campaign against smoking features e-cigarettes for the first time.

The U.S. Centers for Disease Control and Prevention (CDC) released its latest ad in its ongoing “Tips From Former Smokers” campaign. The campaign features real Americans who have experienced serious health or social consequences from smoking. Often the ads are explicit. On March 30, the first ad about e-cigarettes, as opposed to traditional tobacco, will air.

The ad features a 35-year-old woman named Kristy who picked up e-cigarettes as a way to quit smoking. She ended up using both products. Eventually she had a collapsed lung and was diagnosed with lung disease. She’s a married mother of three who works as a truck driver.

Kristy's Tip Print Full Page Ad
CDC

“Nationally, about 3 in 4 adult e-cigarette users also smoke cigarettes,” the CDC says in a statement. “If you only cut down the number of cigarettes you smoke by adding another tobacco product, like e-cigarettes, you still face serious health risks.”

Other ads focus on side effects like vision loss and colorectal cancer.

In 2014, the CDC says the national quit line received 80% more calls when the ads were on the air, and since 2012 the ads have generated more than 500,000 additional calls. The ads will run for 20 weeks on TV, radio, online, billboards, in theaters and in magazines and newspapers. Kristy’s ads will be on the radio and in print.

The ads encourage smokers to call 1-800-QUIT-NOW or visit www.cdc.gov/tips.

Read next: These 4D Ultrasound Photos Show How Fetuses Respond to Their Mothers’ Smoking

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TIME Addiction

This Is Not a Good Reason to Smoke Cigarettes

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But smoking causes weight loss, a new study says

Anyone who’s considered lighting up knows smoking’s skinny-making reputation, and a new study of 80,000 people shows there’s truth to the claim. Researchers found that smokers weighed about 5 pounds less than people who had never smoked, according to new research in the International Journal of Epidemiology. The cause of that lighter weight, the researchers say, is tobacco.

Those findings are a direct contradiction to several observational studies that have linked smoking to just the opposite: higher body weight and BMI. But researchers at Copenhagen University Hospital wanted to look at the link genetically, in a way that wouldn’t be plagued by confounding lifestyle factors that often go along with smoking. They took weight and BMI measurements of 80,342 people, along with blood samples that they analyzed for DNA.

They looked at a genetic variant associated with higher tobacco consumption, close to a gene called CHRNA3—”the smoking craving gene,” says study author Børge G. Nordestgaard, MD, professor at the University of Copenhagen in the department of clinical biochemistry. Smokers with this genotype weighed almost three pounds less than smokers who didn’t inherit this genetic variant. But in people who had never smoked or formerly smoked, there was no link between CHRNA3 and a lower body weight.

“That’s really the proof that smoking causes it,” Nordestgaard says.

That doesn’t mean that smoking will give you a better figure. In the study, smoking only affected total body weight, not body shape or fat distribution.

The weight loss effect may be due to a laundry list of chemicals in cigarettes, the authors say—some studies have found nicotine to suppress appetite and increase resting metabolic rate. “There’s a possibility that many of these chemicals may influence weight in some pathway we don’t know about yet,” Nordestgaard says.

That’s obviously no reason to start—or continue—smoking, the researchers caution. “From what we know so far, the hazards of smoking much overweigh the slight benefit of having a lower body weight,” Nordestgaard says. “But when smokers tell you they won’t stop smoking because they’re afraid of gaining weight, I think it’s important to know that this is real—so we can try at the same time to help them quit smoking and keep a lower body weight.”

Read next: What Diet Soda Does to Belly Fat

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