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Lindblom EN. Tobacco research and public health messaging needs to be realigned to support more effective FDA rulemaking - A commentary on Shadel, et al., "Doing more with less: A proposal to advance cigarette packaging labeling in the United States". Int J Drug Policy 2024; 126:104361. [PMID: 38417227 DOI: 10.1016/j.drugpo.2024.104361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 02/12/2024] [Indexed: 03/01/2024]
Affiliation(s)
- Eric N Lindblom
- O'Neill Inst. for Nat'l & Global Health Law, Georgetown University Law Center, United States.
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2
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Jawad A, Mulligan C, Savona N, L'Abbé MR. Qualitative analysis of front-of package labeling policy interactions between stakeholders and Health Canada. Front Public Health 2023; 11:982908. [PMID: 37089483 PMCID: PMC10115994 DOI: 10.3389/fpubh.2023.982908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 03/10/2023] [Indexed: 04/08/2023] Open
Abstract
Background Front-of-package labelling regulations proposed by Health Canada in their Healthy Eating Strategy (2016) were finally passed in 2022, but remain unimplemented. This study analyzed interactions that occurred between stakeholders and government related to this policy proposal to identify key themes and policy implications. Methods A qualitative framework analysis was conducted on publicly available documents for stakeholder correspondences related to front-of-package that occurred between 2016 and 2019 in Health Canada's Meetings and Correspondence on Healthy Eating database. Five sequential steps were applied: familiarization, identifying a thematic framework, indexing, charting, and mapping and interpretation. A complex systems (i.e., a dynamic system with multiple interconnecting components) lens was incorporated in the final step to deepen the analysis. Results Hundred and seventy-three documents were included, the majority from industry stakeholders (n = 108, 62.4%). Three overarching themes were identified: industry trying to control the agenda and resist regulation; questioning the evidence supporting the policy and its impact on the agri-food industry; and dismissing the need and effectiveness of the policy. Incorporating a complex system lens found industry and non-industry stakeholders held markedly different perspectives on how cohesive the system defined by the front-of-package labelling policy was, and the policy impact on its stability. Economic and opportunity costs were the main trade-offs, and symbol misinterpretation considered an unintended consequence by industry. Finally, some stakeholders argued for wider policy scope incorporating more products, while others requested a narrower approach through exemptions. Conclusion Interactions with industry stakeholders on health food policy proposals require careful consideration, given it may suit their interests to generate delays and policy discordance. Explicitly setting out the principles of engagement and actively encouraging non-industry stakeholder representation provides a more balanced approach to policy consultation and development.
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Affiliation(s)
- Aalaa Jawad
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Christine Mulligan
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | - Natalie Savona
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Mary R. L'Abbé
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
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3
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Kokole D, Anderson P, Jané-Llopis E. Nature and Potential Impact of Alcohol Health Warning Labels: A Scoping Review. Nutrients 2021; 13:3065. [PMID: 34578942 PMCID: PMC8469468 DOI: 10.3390/nu13093065] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/26/2021] [Accepted: 08/27/2021] [Indexed: 01/16/2023] Open
Abstract
Alcohol is toxic to human health. In addition to providing nutritional information, labels on alcohol products can be used to communicate warnings on alcohol-related harms to consumers. This scoping review examined novel or enhanced health warning labels to assess the current state of the research and the key studied characteristics of labels, along with their impact on the studied outcomes. Four databases (Web of Science, MEDLINE, PsycInfo, CINAHL) were searched between January 2010 and April 2021, and 27 papers were included in the review. The results found that most studies were undertaken in English-speaking populations, with the majority conducted online or in the laboratory setting as opposed to the real world. Seventy percent of the papers included at least one cancer-related message, in most instances referring either to cancer in general or to bowel cancer. Evidence from the only real-world long-term labelling intervention demonstrated that alcohol health warning labels designed to be visible and contain novel and specific information have the potential to be part of an effective labelling strategy. Alcohol health warning labels should be seen as tools to raise awareness on alcohol-related risks, being part of wider alcohol policy approaches.
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Affiliation(s)
- Daša Kokole
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, POB 616, 6200 MD Maastricht, The Netherlands; (P.A.); (E.J.-L.)
| | - Peter Anderson
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, POB 616, 6200 MD Maastricht, The Netherlands; (P.A.); (E.J.-L.)
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX, UK
| | - Eva Jané-Llopis
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, POB 616, 6200 MD Maastricht, The Netherlands; (P.A.); (E.J.-L.)
- ESADE Business School, University Ramon Llull, Avenida de Pedralbes, 60-62, 08034 Barcelona, Spain
- Institute for Mental Health Policy Research, CAMH, 33 Russell Street, Toronto, ON M5S 2S1, Canada
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Stockwell T, Giesbrecht N, Vallance K, Wettlaufer A. Government Options to Reduce the Impact of Alcohol on Human Health: Obstacles to Effective Policy Implementation. Nutrients 2021; 13:2846. [PMID: 34445006 PMCID: PMC8399748 DOI: 10.3390/nu13082846] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 12/25/2022] Open
Abstract
Evidence for effective government policies to reduce exposure to alcohol's carcinogenic and hepatoxic effects has strengthened in recent decades. Policies with the strongest evidence involve reducing the affordability, availability and cultural acceptability of alcohol. However, policies that reduce population consumption compete with powerful commercial vested interests. This paper draws on the Canadian Alcohol Policy Evaluation (CAPE), a formal assessment of effective government action on alcohol across Canadian jurisdictions. It also draws on alcohol policy case studies elsewhere involving attempts to introduce minimum unit pricing and cancer warning labels on alcohol containers. Canadian governments collectively received a failing grade (F) for alcohol policy implementation during the most recent CAPE assessment in 2017. However, had the best practices observed in any one jurisdiction been implemented consistently, Canada would have received an A grade. Resistance to effective alcohol policies is due to (1) lack of public awareness of both need and effectiveness, (2) a lack of government regulatory mechanisms to implement effective policies, (3) alcohol industry lobbying, and (4) a failure from the public health community to promote specific and feasible actions as opposed to general principles, e.g., 'increased prices' or 'reduced affordability'. There is enormous untapped potential in most countries for the implementation of proven strategies to reduce alcohol-related harm. While alcohol policies have weakened in many countries during the COVID-19 pandemic, societies may now also be more accepting of public health-inspired policies with proven effectiveness and potential economic benefits.
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Affiliation(s)
- Tim Stockwell
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC V8P 5C2, Canada;
| | - Norman Giesbrecht
- Centre for Addiction and Mental Health, Toronto, ON M5V 2B4, Canada; (N.G.); (A.W.)
| | - Kate Vallance
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC V8P 5C2, Canada;
| | - Ashley Wettlaufer
- Centre for Addiction and Mental Health, Toronto, ON M5V 2B4, Canada; (N.G.); (A.W.)
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5
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Camp C. Gun Regulation Exceptionalism and Adolescent Violence: A Comparison to Tobacco. J Law Med Ethics 2020; 48:25-31. [PMID: 33404298 DOI: 10.1177/1073110520979398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This article compares the landscape of tobacco regulations to the landscape of gun regulations, with a focus on regulations that target youth. This article argues that guns are significantly less regulated compared to tobacco, despite the frequency with which each product causes significant harm to both self and other.Many of the specific ways tobacco is regulated can be applied analogously to firearms while plausibly surviving potential Second Amendment challenges. This article compares the regulatory landscape of tobacco and firearms across six categories: (a) minimum age for purchase, (b) sale by unlicensed individuals, (c) taxation, (d) advertising, (e) graphic warning labels, and (f) zoning.At one time, tobacco was as central - or more so - to American culture as guns are today. However, many decades of public health advocacy led to historic tobacco regulations. Tobacco's regulatory history provides a valuable blueprint for gun regulation, despite Constitutional differences.
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Affiliation(s)
- Catherine Camp
- Catherine Camp, M.P.H., is a second-year student at Yale Law School and the Yale School of Management. She was formerly a consultant with McKinsey & Company's New York Office and was an early employee of Devoted Health, Inc. She received M.P.H. and B.S. degrees from Yale University
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Affiliation(s)
- Kevin H Franck
- From the Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston
| | - Vinay K Rathi
- From the Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston
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Mitchell D, Critchlow N, Moodie C, Bauld L. Reactions to Standardized Cigarette Packs With Varying Structural Designs, and the Association With Smoking Susceptibility: A Postimplementation Cross-Sectional Survey With Never-Smoking Adolescents in Scotland. Nicotine Tob Res 2020; 22:2041-2050. [PMID: 32577739 DOI: 10.1093/ntr/ntaa109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 06/15/2020] [Indexed: 11/14/2022]
Abstract
INTRODUCTION From May 20, 2017, cigarettes in the United Kingdom must be sold in standardized (plain) packaging. We explore postimplementation reactions to standardized cigarette packaging among never-smokers in Scotland, whether reactions vary in relation to permitted variations in pack structure, and whether reactions are associated with susceptibility. AIMS AND METHODS A cross-sectional survey with 12-17-year-old never-smokers (n = 507) in Scotland, conducted November 2017-November 2018. Participants were shown one "regular" standardized cigarette pack (flip-top lid and straight-edged pack, similar to designs in Australia) and three standardized packs with varied pack structures (beveled-edges, slim pack, and shoulder box), which are permitted postimplementation in the United Kingdom. Participants rated each pack on eight five-point reaction measures (eg, attractiveness). Participants also indicated which pack, if any, they would choose. Smoking susceptibility was the outcome. RESULTS The mean reaction scores for all four packs were mostly negative, however the shoulder box was consistently rated less negatively than the regular, slim, or beveled-edge packs. Most participants (87%) said they would not select any of the four packs, although susceptible participants were more likely to select one than nonsusceptible participants (25% vs. 7%; χ 2 = 29.70; p < .001). For all four packs, not finding them off-putting was associated with susceptibility (Adjusted Odds Ratio range: 2.73-3.69), albeit only a minority of adolescents did not find each pack off-putting. CONCLUSIONS Adolescents have negative reactions to the standardized cigarette packs implemented in the United Kingdom, albeit permitted variations in structure can reduce the extent of negativity. Most reactions to standardized packaging had no association with susceptibility. IMPLICATIONS We provide the first empirical evidence that adolescents find the standardized cigarette packs implemented in the United Kingdom unappealing and that most pack reactions have no association with susceptibility among never-smokers, with the exception of the minority who did not think that they would put them off smoking. This suggests that the legislation is achieving one of its primary aims, to reduce the appeal of packaging. That permitted variations in pack structure (eg, shoulder boxes) somewhat reduce negative reactions suggests that the United Kingdom, and other countries introducing similar legislation, should ensure that all aspects of pack design are fully standardized.
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Affiliation(s)
- Danielle Mitchell
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirlingshire, UK
| | - Nathan Critchlow
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirlingshire, UK
| | - Crawford Moodie
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirlingshire, UK
| | - Linda Bauld
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Stirlingshire, UK
- SPECTRUM Consortium, University of Edinburgh, Edinburgh, UK
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9
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Rincón-Gallardo Patiño S, Zhou M, Da Silva Gomes F, Lemaire R, Hedrick V, Serrano E, Kraak VI. Effects of Menu Labeling Policies on Transnational Restaurant Chains to Promote a Healthy Diet: A Scoping Review to Inform Policy and Research. Nutrients 2020; 12:nu12061544. [PMID: 32466387 PMCID: PMC7352298 DOI: 10.3390/nu12061544] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 01/06/2023] Open
Abstract
There is insufficient evidence that restaurant menu labeling policies are cost-effective strategies to reduce obesity and diet-related non-communicable diseases (NCDs). Evidence suggests that menu labeling has a modest effect on calories purchased and consumed. No review has been published on the effect of menu labeling policies on transnational restaurant chains globally. This study conducted a two-step scoping review to map and describe the effect of restaurant menu labeling policies on menu reformulation. First, we identified national, state, and municipal menu labeling policies in countries from global databases. Second, we searched four databases (i.e., PubMed, CINHAL/EBSCO, Web of Science, and Google Scholar) for peer-reviewed studies and gray-literature sources in English and Spanish (2000–2020). Step 1 identified three voluntary and eight mandatory menu labeling policies primarily for energy disclosures for 11 upper-middle and high-income countries, but none for low- or middle-income countries. Step 2 identified 15 of 577 studies that met the inclusion criteria. The analysis showed reductions in energy for newly introduced menu items only in the United States. We suggest actions for governments, civil society organizations, and the restaurant businesses to develop, implement, and evaluate comprehensive menu labeling policies to determine whether these may reduce obesity and NCD risks worldwide.
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Affiliation(s)
- Sofía Rincón-Gallardo Patiño
- Department of Human Nutrition, Foods, and Exercise, College of Agriculture and Life Sciences, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA; (M.Z.); (V.H.); (E.S.); (V.I.K.)
- Correspondence:
| | - Mi Zhou
- Department of Human Nutrition, Foods, and Exercise, College of Agriculture and Life Sciences, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA; (M.Z.); (V.H.); (E.S.); (V.I.K.)
| | - Fabio Da Silva Gomes
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, World Health Organization, Washington, DC 20037, USA;
| | - Robin Lemaire
- Center for Public Administration and Policy, School of Public and International Affairs, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA;
| | - Valisa Hedrick
- Department of Human Nutrition, Foods, and Exercise, College of Agriculture and Life Sciences, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA; (M.Z.); (V.H.); (E.S.); (V.I.K.)
| | - Elena Serrano
- Department of Human Nutrition, Foods, and Exercise, College of Agriculture and Life Sciences, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA; (M.Z.); (V.H.); (E.S.); (V.I.K.)
| | - Vivica I. Kraak
- Department of Human Nutrition, Foods, and Exercise, College of Agriculture and Life Sciences, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA; (M.Z.); (V.H.); (E.S.); (V.I.K.)
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10
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Affiliation(s)
- Robert S Hoffman
- From the Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York (R.S.H.); the Division of Emergency Medicine, Program in Medical Toxicology, Boston Children's Hospital, Harvard Medical School, Boston (M.M.B.); and Centre Intégré de Santé et de Services Sociaux (CISSS) Montérégie-Centre Emergency Department, Hôpital Charles-Lemoyne, Greenfield Park, QC, the Department of Emergency Medicine, McGill University, Montreal, and Centre Antipoison du Québec, Quebec, QC - all in Canada (S.G.)
| | - Michele M Burns
- From the Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York (R.S.H.); the Division of Emergency Medicine, Program in Medical Toxicology, Boston Children's Hospital, Harvard Medical School, Boston (M.M.B.); and Centre Intégré de Santé et de Services Sociaux (CISSS) Montérégie-Centre Emergency Department, Hôpital Charles-Lemoyne, Greenfield Park, QC, the Department of Emergency Medicine, McGill University, Montreal, and Centre Antipoison du Québec, Quebec, QC - all in Canada (S.G.)
| | - Sophie Gosselin
- From the Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York (R.S.H.); the Division of Emergency Medicine, Program in Medical Toxicology, Boston Children's Hospital, Harvard Medical School, Boston (M.M.B.); and Centre Intégré de Santé et de Services Sociaux (CISSS) Montérégie-Centre Emergency Department, Hôpital Charles-Lemoyne, Greenfield Park, QC, the Department of Emergency Medicine, McGill University, Montreal, and Centre Antipoison du Québec, Quebec, QC - all in Canada (S.G.)
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Roberts K, Thakkar R, Autor D, Bisordi F, Fitton H, Garner C, Garvin M, Honig P, Hukkelhoven M, Kowalski R, Milligan S, O'Dowd L, Olmstead S, Reilly E, Robertson AS, Rohrer M, Stewart J, Taisey M, Van Baelen K, Wegner M. Creating E-Labeling Platforms: An Industry Vision. Clin Pharmacol Ther 2020; 108:716-718. [PMID: 32337707 DOI: 10.1002/cpt.1865] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 04/16/2020] [Indexed: 11/07/2022]
Affiliation(s)
| | | | | | | | - Helen Fitton
- GlaxoSmithKline, Research Triangle Park, North Carolina, USA
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Guillory J, Kim AE, Fiacco L, Cress M, Pepper J, Nonnemaker J. An Experimental Study of Nicotine Warning Statements in E-cigarette Tweets. Nicotine Tob Res 2020; 22:814-821. [PMID: 30820571 PMCID: PMC7171270 DOI: 10.1093/ntr/ntz029] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 02/23/2019] [Indexed: 11/14/2022]
Abstract
INTRODUCTION It is unclear whether warnings on electronic cigarette (e-cigarette) advertisements required by the US Food and Drug Administration (FDA) will apply to social media. Given the key role of social media in marketing e-cigarettes, we seek to inform FDA decision making by exploring how warnings on various tweet content influence perceived healthiness, nicotine harm, likelihood to try e-cigarettes, and warning recall. METHODS In this 2 × 4 between-subjects experiment participants viewed a tweet from a fictitious e-cigarette brand. Four tweet content versions (e-cigarette product, e-cigarette use, e-cigarette in social context, unrelated content) were crossed with two warning versions (absent, present). Adult e-cigarette users (N = 994) were recruited via social media ads to complete a survey and randomized to view one of eight tweets. Multivariable regressions explored effects of tweet content and warning on perceived healthiness, perceived harm, and likelihood to try e-cigarettes, and tweet content on warning recall. Covariates were tobacco and social media use and demographics. RESULTS Tweets with warnings elicited more negative health perceptions of the e-cigarette brand than tweets without warnings (p < .05). Tweets featuring e-cigarette products (p < .05) or use (p < .001) elicited higher warning recall than tweets featuring unrelated content. CONCLUSIONS This is the first study to examine warning effects on perceptions of e-cigarette social media marketing. Warnings led to more negative e-cigarette health perceptions, but no effect on perceived nicotine harm or likelihood to try e-cigarettes. There were differences in warning recall by tweet content. Research should explore how varying warning content (text, size, placement) on tweets from e-cigarette brands influences health risk perceptions. IMPLICATIONS FDA's 2016 ruling requires warnings on advertisements for nicotine-containing e-cigarettes, but does not specify whether this applies to social media. This study is the first to examine how e-cigarette warnings in tweets influence perceived healthiness and harm of e-cigarettes, which is important because e-cigarette brands are voluntarily including warnings on Twitter and Instagram. Warnings influenced perceived healthiness of the e-cigarette brand, but not perceived nicotine harm or likelihood to try e-cigarettes. We also saw higher recall of warning statements for tweets featuring e-cigarettes. Findings suggest that expanding warning requirements to e-cigarette social media marketing warrants further exploration and FDA consideration.
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Affiliation(s)
| | - Annice E Kim
- Center for Health Policy Science and Tobacco Research, RTI International, Research Triangle Park, NC
| | - Leah Fiacco
- Center for Health Policy Science and Tobacco Research, RTI International, Research Triangle Park, NC
| | - Margaret Cress
- Center for Health Policy Science and Tobacco Research, RTI International, Research Triangle Park, NC
| | - Jessica Pepper
- Center for Health Policy Science and Tobacco Research, RTI International, Research Triangle Park, NC
| | - James Nonnemaker
- Center for Health Policy Science and Tobacco Research, RTI International, Research Triangle Park, NC
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Leos-Toro C, Fong GT, Meyer SB, Hammond D. Cannabis labelling and consumer understanding of THC levels and serving sizes. Drug Alcohol Depend 2020; 208:107843. [PMID: 32044091 DOI: 10.1016/j.drugalcdep.2020.107843] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 12/19/2019] [Accepted: 12/20/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE As part of cannabis legalization in Canada and several US states, regulations specify how THC levels should be labelled on products; however, there is little evidence on the extent to which consumers understand and use THC labelling to inform consumption amounts. The current study was designed to assess comprehension of cannabis-related information including communication of dose and strength of product on different labelling designs among young Canadians. METHODS Two experiments were conducted in October 2017 among Canadian youth and young adults aged 16-30 years as part of an online cross-sectional survey (N = 870). Experiment 1 randomized respondents to one of three labelling conditions (1=No Label, 2=mgTHC, 3=Doses). Respondents interpreted a recommended serving and number of servings contained in the package. Experiment 2 randomized respondents to one of four labelling conditions communicating THC level (1=No Label, 2=%THC, 3=mgTHC, 4=Traffic Light System). Respondents determined level of THC in the product. RESULTS Labelling the number of doses per package was associated with the greatest proportion of correct responses (54.1 %) when respondents had to determine a recommended serving compared with the no-label control condition (7.4 %) and THC mg condition (13.4 %). When cannabis products were labelled using a traffic light system, participants were more likely to identify THC level: low THC (85.1 %) or high THC (86.4 %) than the control condition (2.0 % and 5.2 % respectively). CONCLUSION Few consumers can understand and apply quantitative THC labelling; in contrast, THC labels that provide 'interpretive' information, such as descriptors, symbols, or references to servings have greater efficacy.
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Affiliation(s)
- Cesar Leos-Toro
- School of Public Health & Health Systems, University of Waterloo, 200 University Ave. W., Waterloo, N2L 3G1, ON, Canada.
| | - Geoffrey T Fong
- School of Public Health & Health Systems, University of Waterloo, 200 University Ave. W., Waterloo, N2L 3G1, ON, Canada; Department of Psychology, University of Waterloo, 200 University Ave. W., N2L 3G1, Waterloo, ON, Canada; Ontario Institute for Cancer Research, MaRS Centre, 661 University Avenue, Suite 510, Toronto, M5G 0A3, ON, Canada.
| | - Samantha B Meyer
- School of Public Health & Health Systems, University of Waterloo, 200 University Ave. W., Waterloo, N2L 3G1, ON, Canada.
| | - David Hammond
- School of Public Health & Health Systems, University of Waterloo, 200 University Ave. W., Waterloo, N2L 3G1, ON, Canada.
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Stockwell T, Solomon R, O'Brien P, Vallance K, Hobin E. Cancer Warning Labels on Alcohol Containers: A Consumer's Right to Know, a Government's Responsibility to Inform, and an Industry's Power to Thwart. J Stud Alcohol Drugs 2020; 81:284-292. [PMID: 32359059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023] Open
Abstract
Although the World Health Organization (WHO) declared alcohol a Class 1 carcinogen 30 years ago, few governments have communicated this fact to the public. We illustrate how alcohol industry groups seek to keep their customers in the dark about alcohol-related cancer risks. In Canada, a federally funded scientific study examining the introduction of cancer warning labels on containers was shut down following industry interference. We show that the industry complaints about the study had no legal merit. Of 47 WHO member countries with alcohol warning labels, only South Korea requires cancer warnings on alcohol containers. However, industry complaints, supported by sympathetic governments, helped weaken the warning labels' implementation. Ireland has legislated for cancer warnings but faces continuing legal opposition expressed through regional and global bodies. Cancer societies and the public health community have failed to counter industry pressures to minimize consumer awareness of alcohol's cancer risks. Placing cancer warnings on alcohol containers could make a pivotal difference in motivating both drinkers to consume less and regulators to introduce more effective policies to reduce the serious harms of alcohol consumption.
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Affiliation(s)
- Tim Stockwell
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada
| | | | - Paula O'Brien
- Melbourne Law School, University of Melbourne, Victoria, Australia
| | - Kate Vallance
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada
| | - Erin Hobin
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Molin TRD, Leal GC, Müller LS, Muratt DT, Marcon GZ, de Carvalho LM, Viana C. Regulatory framework for dietary supplements and the public health challenge. Rev Saude Publica 2019; 53:90. [PMID: 31644771 PMCID: PMC6802945 DOI: 10.11606/s1518-8787.2019053001263] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 04/01/2019] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE The new regulatory framework for dietary supplements in Brazil prompted this analysis of the current outlook of these products and the challenges posed by the new guidelines. METHODS We conducted a qualitative, observational and descriptive study of dietary supplements commercialized in Brazilian online stores with the help of the Google® search tool. We considered the ingredients on the labels, the effects attributed to these products and the commercial claims used as a means of promoting them to assess the necessary changes for the legal framework in the new guidelines. Finally, with the help of a database, we compared the effects declared by the manufacturers and attributed to certain ingredients with the scientific evidence described in literature. RESULTS In total, we purchased 44 dietary supplements from Brazilian online stores (n = 7). Of the samples studied, 34.2% could not be classified in the category Dietary Supplements, as recommended by the new regulation of the Brazilian Health Regulatory Agency due to the presence of prohibited substances; 16% of products should be commercialized as medicines. Regarding the commercial appeals, 97.7% had banned expressions. Numerous claims of effects attributed to certain products were characterized as consumer fraud because they have no scientific evidence. CONCLUSIONS The necessary changes represent a major regulatory and production challenge due to the wide range of dietary supplements and markets, an effort that aims to protect the consumers' health. Some previous gaps in the regulatory framework were not fully solved.
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Affiliation(s)
- Thaís Ramos Dal Molin
- Universidade Federal de Santa Maria. Programa de Pós-Graduação em Ciências Farmacêuticas. Santa Maria, RS, Brasil
| | - Gabriela Camera Leal
- Universidade Federal de Santa Maria. Programa de Pós-Graduação em Ciências Farmacêuticas. Santa Maria, RS, Brasil
| | - Larissa Sabo Müller
- Universidade Federal de Santa Maria. Programa de Pós-Graduação em Ciências Farmacêuticas. Santa Maria, RS, Brasil
| | - Diana Tomazzi Muratt
- Universidade Federal de Santa Maria. Programa de Pós-Graduação em Química. Santa Maria, RS, Brasil
| | - Gabriela Zanella Marcon
- Universidade Federal de Santa Maria. Programa de Pós-Graduação em Ciências Farmacêuticas. Santa Maria, RS, Brasil
| | - Leandro Machado de Carvalho
- Universidade Federal de Santa Maria. Programa de Pós-Graduação em Química. Santa Maria, RS, Brasil
- Universidade Federal de Santa Maria. Departamento de Química. Santa Maria, RS, Brasil
| | - Carine Viana
- Universidade Federal de Santa Maria. Programa de Pós-Graduação em Ciências Farmacêuticas. Santa Maria, RS, Brasil
- Universidade Federal de Santa Maria. Departamento de Farmácia Industrial. Santa Maria, RS, Brasil
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Nee-Nee J, Sutherland K, Holland R, Wilson M, Ackland S, Bocock C, Cartmell A, Earp J, Grove C, Hewson C, Jefferies W, Keefe L, Lockyer J, Patel S, Quintans M, Robbie M, Teape L, Yang J, Wilson N, Hoek J, Thomson G. Tobacco pack display at hospitality venues after the introduction of standardised tobacco packaging in New Zealand: a field observation study. BMJ Open 2019; 9:e027868. [PMID: 31494599 PMCID: PMC6731942 DOI: 10.1136/bmjopen-2018-027868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES In March 2018, New Zealand (NZ) introduced standardised tobacco packaging that also featured new pictorial warnings, with implementation completed by early June 2018. We evaluated how the new packaging affected tobacco pack displays in outdoor areas of hospitality venues. DESIGN Before-and-after descriptive field observation study. SETTING Central city area of the capital city of NZ (Wellington). PARTICIPANTS Observations of people smoking and tobacco packs were made at 56 hospitality venues with outdoor tables (2422 separate venue observations), after the introduction of standardised tobacco packaging. Comparisons were made with a prior study in the same setting, from a time when tobacco packaging still featured brand imagery. RESULTS A total of 8191 patrons, 1113 active smokers and 889 packs and pouches (522 of known orientation) were observed over 2422 venue observations. There were 0.80 visible packs per active smoker in 2018, compared with 1.26 in 2014 (risk ratio (RR)=0.64, 95% CI 0.60 to 0.67, p<0.0001). The new packs in 2018 were also less likely to be displayed face-up, compared with packs in 2014, which had brand imagery on the front face (RR=0.77, 95% CI 0.72 to 0.83, p<0.0001). Pack and pouch display (RR=3.09 in 2014 and 3.10 in 2018) and active smoking (RR=3.16 in 2014 compared with 3.32 in 2018) were higher at venues without children present, compared with venues with children present (this finding was consistent over time). CONCLUSIONS The reduction in the number of visible packs per active smoker, along with the reduction in face-up positioning of packs, suggests that smokers found the new standardised packs less attractive. Countries introducing standardised packaging should consider evaluating social display of tobacco packaging.
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Affiliation(s)
- Johanna Nee-Nee
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Kirsty Sutherland
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Rebecca Holland
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Miriam Wilson
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Samuel Ackland
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Claudia Bocock
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Abbie Cartmell
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Jack Earp
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Christina Grove
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Charlotte Hewson
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Will Jefferies
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Lucy Keefe
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Jamie Lockyer
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Saloni Patel
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Miguel Quintans
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Michael Robbie
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Lauren Teape
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Jess Yang
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Nick Wilson
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Janet Hoek
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - George Thomson
- Department of Public Health, University of Otago, Wellington, New Zealand
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Moodie C, Hoek J, Scheffels J, Gallopel-Morvan K, Lindorff K. Plain packaging: legislative differences in Australia, France, the UK, New Zealand and Norway, and options for strengthening regulations. Tob Control 2019; 28:485-492. [PMID: 30068563 DOI: 10.1136/tobaccocontrol-2018-054483] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 07/01/2018] [Accepted: 07/16/2018] [Indexed: 11/04/2022]
Abstract
By July 2018, five countries (Australia, France, the UK, New Zealand and Norway) had fully implemented plain (standardised) packaging. Using government documents, we reviewed the key legislative differences between these five countries to identify best practice measures and potential lacuna. We then discuss how governments planning to introduce plain packaging could strengthen their legislation. Differences between countries include the terminology used (either 'plain', 'standardised' or 'plain and standardised'), products covered and transition times (ranging from 2 to 12 months). Myriad differences exist with respect to the packaging, including the dimensions (explicitly stated for height, width and depth vs minimum dimensions for the health warnings only), structure (straight-edged flip-top packs vs straight, rounded and bevelled-edged flip-top packs and shoulder boxes) and size (minimum number of cigarettes and weight of tobacco vs fixed amounts) and warning content (eg, inclusion of a stop-smoking web address and/or quitline displayed on warnings on one or both principal display areas). Future options that merit further analysis include banning colour descriptors in brand and variant names, allowing pack inserts promoting cessation and permitting cigarettes that are designed to be dissuasive. Plain packaging legislation and regulations are divergent. Countries moving towards plain packaging should consider incorporating the strengths of existing policies and review opportunities for extending these. While plain packaging represents a milestone in tobacco-control policy, future legislation need not simply reflect the past but could set new benchmarks to maximise the potential benefits of this policy.
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Affiliation(s)
- Crawford Moodie
- School of Health Sciences and Sport, Centre for Tobacco Control Research, Institute for Social Marketing, University of Stirling, Stirling, UK
| | - Janet Hoek
- Departments of Public Health and Marketing, University of Otago, Dunedin, New Zealand
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van Mourik DJA, Nagelhout GE, van den Putte B, Hummel K, Willemsen MC, de Vries H. Did E-Cigarette Users Notice the New European Union's E-Cigarette Legislation? Findings from the 2015-2017 International Tobacco Control (ITC) Netherlands Survey. Int J Environ Res Public Health 2019; 16:E2917. [PMID: 31416256 PMCID: PMC6720481 DOI: 10.3390/ijerph16162917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 08/06/2019] [Accepted: 08/12/2019] [Indexed: 11/29/2022]
Abstract
This study examined to what extent e-cigarette users noticed the European Union's new legislation regarding e-cigarettes, and whether this may have influenced perceptions regarding addictiveness and toxicity. Data were obtained from yearly surveys (2015-2017) of the International Tobacco Control (ITC) Netherlands Survey. Descriptive statistics and Generalized Estimating Equations were applied. About a third of the e-cigarette users noticed the text warning (28%) and the leaflet (32%). When compared to tobacco-only smokers, e-cigarette users showed greater increases in perceptions regarding addictiveness (β = 0.457, p = 0.045 vs. β = 0.135, p < 0.001) and toxicity (β = 0.246, p = 0.055 vs. β = 0.071, p = 0.010). In conclusion, the new legislation's noticeability should be increased.
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Affiliation(s)
- Dirk-Jan A van Mourik
- Department of Health Promotion, Maastricht University (CAPHRI), Maastricht, 6229 HA Limburg, The Netherlands.
| | - Gera E Nagelhout
- Department of Health Promotion, Maastricht University (CAPHRI), Maastricht, 6229 HA Limburg, The Netherlands
- Department of Family Medicine, Maastricht University (CAPHRI), Maastricht, 6229 HA Limburg, The Netherlands
- IVO Research Institute, The Hague, 2595 AA Zuid Holland, The Netherlands
| | - Bas van den Putte
- Department of Communication, University of Amsterdam (ASCoR), Amsterdam, 1001 NG Noord Holland, The Netherlands
| | - Karin Hummel
- Department of Health Promotion, Maastricht University (CAPHRI), Maastricht, 6229 HA Limburg, The Netherlands
| | - Marc C Willemsen
- Department of Health Promotion, Maastricht University (CAPHRI), Maastricht, 6229 HA Limburg, The Netherlands
- Netherlands Expertise Center for Tobacco Control (NET), Trimbos Institute, Utrecht, 3521 VS Utrecht, The Netherlands
| | - Hein de Vries
- Department of Health Promotion, Maastricht University (CAPHRI), Maastricht, 6229 HA Limburg, The Netherlands
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Abstract
Thirty-four states, the District of Columbia, and Puerto Rico have legalized medical cannabis. While no two state medical cannabis programs are alike, public health concerns related to advertising, packaging and labeling, pesticide use, scientific research, and the role of medical cannabis in the opioid crisis are emerging across the country. This article examines these issues, the policy approaches states are adopting to protect patients and the public, and an assessment of the underlying federal legal landscape.
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Affiliation(s)
- William C Tilburg
- William Tilburg, J.D., M.P.H., is Director, Policy and Government Relations for the Maryland Medical Cannabis Commission. James G. Hodge, Jr., J.D., LL.M., is Professor of Public Health Law and Ethics; Director, Center for Public Health Law and Policy, Sandra Day O'Connor College of Law, Arizona State University; and Director, Western Region Office, Network for Public Health Law. Camille Gourdet, J.D., M.A., is Research Public Health Analyst, RTI International
| | - James G Hodge
- William Tilburg, J.D., M.P.H., is Director, Policy and Government Relations for the Maryland Medical Cannabis Commission. James G. Hodge, Jr., J.D., LL.M., is Professor of Public Health Law and Ethics; Director, Center for Public Health Law and Policy, Sandra Day O'Connor College of Law, Arizona State University; and Director, Western Region Office, Network for Public Health Law. Camille Gourdet, J.D., M.A., is Research Public Health Analyst, RTI International
| | - Camille Gourdet
- William Tilburg, J.D., M.P.H., is Director, Policy and Government Relations for the Maryland Medical Cannabis Commission. James G. Hodge, Jr., J.D., LL.M., is Professor of Public Health Law and Ethics; Director, Center for Public Health Law and Policy, Sandra Day O'Connor College of Law, Arizona State University; and Director, Western Region Office, Network for Public Health Law. Camille Gourdet, J.D., M.A., is Research Public Health Analyst, RTI International
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Skurka C, Kalaji M, Dorf MC, Kemp D, Greiner Safi A, Byrne S, Mathios AD, Avery RJ, Niederdeppe J. Independent or synergistic? Effects of varying size and using pictorial images in tobacco health warning labels. Drug Alcohol Depend 2019; 198:87-94. [PMID: 30889524 PMCID: PMC6662195 DOI: 10.1016/j.drugalcdep.2019.01.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 01/14/2019] [Accepted: 01/15/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Legal challenges have blocked the implementation of large, pictorial health warning labels (HWLs) in the U.S. In light of future legal questions the U.S. Food and Drug Administration may face in proposing alternative HWLs, we examined whether less restrictive HWL versions on the front of packs-smaller HWLs and/or text-only HWLs that do not include pictorial imagery-may be sufficient to promote cognitive and affective outcomes associated with smoking cessation. METHODS We recruited low-income smokers in two separate experiments through field-based recruitment methods (Study 1, N = 497) or Amazon Mechanical Turk (MTurk) (Study 2, N = 495). In both studies, we randomly assigned participants to a no-HWL control condition or one of four HWL conditions in a 2 (pictorial vs. text-only) × 2 (50% vs. 30% size) between-subjects design. RESULTS Relative to text-only HWLs, pictorial HWLs increased negative affect but not risk belief acceptance, cognitive elaboration about smoking harms, or quit intentions. The 50% HWLs increased quit intentions relative to the control condition in both studies. The 50% HWLs also outperformed the 30% HWLs in promoting quit intentions in Study 2. Subsequent analyses revealed that this effect in Study 2 may have been driven by the 50% HWLs strengthening the relationship between risk-related thoughts and intentions, although there was no evidence for this pattern in Study 1. We found no evidence for interaction effects between the pictorial and size manipulations. CONCLUSIONS Our findings suggest that 50% HWLs, whether pictorial or text-only, can encourage low-income smokers to consider quitting under some conditions.
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Affiliation(s)
- Chris Skurka
- Department of Communication, Cornell University, 450B Mann Library Building, Ithaca, NY, 14853, USA.
| | - Motasem Kalaji
- Department of Communication, Cornell University, 450B Mann Library Building, Ithaca, NY, 14853, USA
| | - Michael C Dorf
- Cornell Law School, 247 Hughes Hall, Ithaca, NY, 14853, USA
| | - Deena Kemp
- Stan Richards School of Advertising and Public Relations, University of Texas at Austin, 300 W. Dean Keaton, Austin, TX, 78712, USA
| | - Amelia Greiner Safi
- Department of Communication, Cornell University, 450B Mann Library Building, Ithaca, NY, 14853, USA; Department of Population Medicine and Diagnostic Sciences, Cornell University, S2002 Schurman Hall, Ithaca, NY, 14853, USA
| | - Sahara Byrne
- Department of Communication, Cornell University, 450B Mann Library Building, Ithaca, NY, 14853, USA
| | - Alan D Mathios
- College of Human Ecology, Cornell University, 1300 Martha Van Rensselaer Hall, Ithaca, NY, 14853, USA
| | - Rosemary J Avery
- Department of Policy Analysis and Management, Cornell University, 2301G Martha Van Rensselaer Hall, Ithaca, NY, 14853, USA
| | - Jeff Niederdeppe
- Department of Communication, Cornell University, 450B Mann Library Building, Ithaca, NY, 14853, USA
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Affiliation(s)
- Martin Caraher
- Centre for Food Policy, City, University of London, London, UK
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Kennett G. Time for Change: Stepping Up the FDA's Regulation of Dietary Supplements to Promote Consumer Safety and Awareness. J Law Health 2019; 33:47-78. [PMID: 31841617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
People are often looking for that quick fix when it comes to their health. With dietary supplements so readily available on the market, the public assume that they have been through rigorous testing. Dietary supplements are not tested as much as consumers believe. The Food and Drug Administration (FDA) does not initiate the same type of testing and analysis for supplements as it does for food, drink and medication. Given that people are now choosing supplemental meal replacements and the like, as opposed to whole foods, regulations drastically need to be stepped up in an effort to emphasise public safety. An authoritative body needs to stop manufacturers from taking advantage of an already vulnerable marketplace. I suggest a new form of regulation that takes the pressure away from the FDA and into the hands of someone who wholly focuses on the supplement market. Dietary supplements have revolutionised the "health" world; however, the only way that the market can keep growing is through enacting more stringent rules and regulations--at the same time allowing consumers to maintain their autonomy and freedom when purchasing.
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Food and Drug Administration, HHS. Neurological Devices; Reclassification of Electroconvulsive Therapy Devices; Effective Date of Requirement for Premarket Approval for Electroconvulsive Therapy Devices for Certain Specified Intended Uses. Final order. Fed Regist 2018; 83:66103-24. [PMID: 30596410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The Food and Drug Administration (FDA) is issuing a final order to reclassify the electroconvulsive therapy (ECT) device for use in treating catatonia or a severe major depressive episode (MDE) associated with major depressive disorder (MDD) or bipolar disorder (BPD) in patients age 13 years and older who are treatment-resistant or who require a rapid response due to the severity of their psychiatric or medical condition, which is a preamendments class III device, into class II (special controls). FDA is also issuing this final order to require the filing of a premarket approval application (PMA) or a notice of completion of a product development protocol (PDP) for the preamendments class III ECT devices for all other uses that are not being reclassified to class II (product code GXC).
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Abstract
It is staggering to observe the new normal in America: 37.9 percent of adults are obese, and 70.7 percent are either obese or overweight. One out of every five minors is obese. The real tragedy, of course, is the disability, suffering, and early death that devastates families and communities. But all of society pays, with the annual medical cost estimated at $147 billion. The causal pathways are complex, but if we drill down, sugar is a deeply consequential pathway to obesity, and the single greatest dietary source is sugar-sweetened beverages (SSBs). The copious amount of sugar in the American diet is no accident. Industry practices and regulatory failures have fueled this explosion. Yet there are sensible, effective interventions that would create the conditions for healthier behaviors. What are the key interventions, and how can we overcome the social, political, and constitutional roadblocks? Tobacco control offers a powerful model, suggesting that success requires a suite of interventions working in concert: labeling, warnings, taxation, portion sizes, product formulation, marketing restrictions, and bans in high-risk settings such as schools and hospitals. Each intervention deserves detailed analysis, but I'm kick-starting scholarly and policy conversation by systematically laying out the major legal tools.
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Affiliation(s)
- Cheryl Healton
- From the New York University College of Global Public Health, New York
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Anshari D, Yong HH, Borland R, Hammond D, Swayampakala K, Thrasher J. Which type of tobacco product warning imagery is more effective and sustainable over time? A longitudinal assessment of smokers in Canada, Australia and Mexico. BMJ Open 2018; 8:e021983. [PMID: 30007932 PMCID: PMC6089327 DOI: 10.1136/bmjopen-2018-021983] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE This study examined smokers' responses to pictorial health warnings (PHWs) with different types of imagery under natural exposure conditions. METHODS Adult smokers from online panels in Canada (n=2357), Australia (n=1671) and Mexico (n=2537) were surveyed every 4 months from 2012 to 2013. Participants were shown PHWs on packs in their respective countries and asked about: (1) noticing PHWs; (2) negative affects towards PHWs; (3) believability of PHWs; (4) PHW-stimulated discussions; and (5) quit motivation due to PHWs. Country-specific generalised estimating equation models regressed these outcomes on time (ie, survey wave), PHW imagery type (ie, symbolic representations of risk, suffering from smoking and graphic depictions of bodily harm) and interactions between them. RESULTS In all countries, PHW responses did not significantly change over time, except for increased noticing PHWs in Canada and Mexico, increased negative affect in Australia and decreased negative affect in Mexico. For all outcomes, symbolic PHWs were rated lower than suffering and graphic PHWs in Canada (the only country with symbolic PHWs). Graphic PHWs were rated higher than suffering PHWs for negative affect (all countries), discussions (Canada) and quit motivation (Australia). Suffering PHWs were rated higher than graphic PHWs for noticing PHWs (Canada), believability (all countries), discussions (AustraliaandMexico) and quit motivation (Mexico). Changes in noticing, believability and discussions varied somewhat by imagery type across countries. CONCLUSIONS The different PHW imagery appears to have different pathways of influence on adult smokers. Reactions to specific PHWs are similar over 1-2 years, suggesting that wear-out of PHW effects is due to decreased attention rather than the diminishing effectiveness of content.
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Affiliation(s)
- Dien Anshari
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- Department of Health Education and Behavioral Sciences, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Hua-Hie Yong
- Nigel Gray Fellowship Group, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Ron Borland
- Nigel Gray Fellowship Group, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Kamala Swayampakala
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Jim Thrasher
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
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Spök A, Arvanitakis G, McClung G. Status of microbial based cleaning products in statutory regulations and ecolabelling in Europe, the USA, and Canada. Food Chem Toxicol 2018; 116:10-19. [PMID: 29292023 PMCID: PMC6691958 DOI: 10.1016/j.fct.2017.12.057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 12/22/2017] [Accepted: 12/27/2017] [Indexed: 12/15/2022]
Abstract
Cleaning products containing living microorganisms as active ingredients are increasingly being used in household, professional and industrial cleaning applications. Microorganisms can degrade soiling associated with dirt, food residues, and grease by enzymatic and metabolic action and out-compete microorganisms associated with odor problems. Their potential for odor control seems to result in a competitive advantage over conventional chemically-based cleaning products. Moreover, producers of microbial-based cleaning products (MBCPs) claim that their products are less harmful to the environment. These promising prospects have triggered interest from consumer and environmental organizations, professional users, and regulators in understanding if there are also possible negative health and environmental impacts which require attention and how the safety of these products is ensured. Unfortunately, there is little information on these issues in the public domain. Moreover, regulatory oversight in Europe is essentially limited to pathogenic properties in the context of worker protection. Canada, in contrast, has a regulatory framework in place to assess risks to human health and the environment from the manufacture, import and/or use of new microorganisms contained in MBCPs. In the absence of mandatory standards, safety assessment and hygienic practices seem to vary considerably across companies. Recently developed ecolabelling standards are - for the time being - the only option for transparent compliance to minimum standards in terms of safety as well as assessments of manufacturer information by third parties. These standards highlight in particular the need for precise taxonomic information for assessing the pathogenic properties and the need to ensure the absence of potentially harmful microorganisms as contaminants. Ecolabelling standards are, however, voluntary and do not cover all relevant safety issues. In order to develop a more comprehensive set of mandatory standards for health and safety, a number of areas would benefit from further research (e.g. the role in plant pathogenicity and other environmental properties of the microorganisms used; the relevance of chronic exposure to dusts and aerosols containing vegetative cells and spores; the relevance of strains which belong to species known to include opportunistic pathogens and possible hazards for particularly sensitive risk groups). Improved knowledge in these areas will contribute to a predictable level of product safety.
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Affiliation(s)
- Armin Spök
- Graz University of Technology and Alpen-Adria Universität Klagenfurt, Wien-Graz, Schlögelgasse 2, A-8010, Graz, Austria.
| | - George Arvanitakis
- New Substances Assessment and Control Bureau, Health Canada, 269 Laurier Ave. West123 Slater Street, A.L. 4905B 3505A, K1A 0K9, Ottawa, Ontario, Canada
| | - Gwendolyn McClung
- Office of Pollution Prevention and Toxics, US Environmental Protection Agency, 1200 Pennsylvania Ave., Washington DC, 20460, USA
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Byrom B, Watson C, Doll H, Coons SJ, Eremenco S, Ballinger R, Mc Carthy M, Crescioni M, O'Donohoe P, Howry C. Selection of and Evidentiary Considerations for Wearable Devices and Their Measurements for Use in Regulatory Decision Making: Recommendations from the ePRO Consortium. Value Health 2018; 21:631-639. [PMID: 29909867 DOI: 10.1016/j.jval.2017.09.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 08/07/2017] [Accepted: 09/19/2017] [Indexed: 06/08/2023]
Abstract
BACKGROUND Wearable devices offer huge potential to collect rich sources of data to provide insights into the effects of treatment interventions. Despite this, at the time of writing this report, limited regulatory guidance on the use of wearables in clinical trial programs has been published. OBJECTIVES To present recommendations from the Critical Path Institute's Electronic Patient-Reported Outcome Consortium regarding the selection and evaluation of wearable devices and their measurements for use in regulatory trials and to support labeling claims. METHODS The evaluation group was composed of Critical Path Institute's clinical outcome assessment (COA) scientists and COA specialists from pharmaceutical trial eCOA solution providers, including COA development and validation specialists. The resulting recommendations were drawn from a broad range of backgrounds, perspectives, and expertise that enriched the development of this report. Recommendations were developed through analysis of existing regulatory guidance relating to COA development and use in clinical trials, medical device certification/clearance regulations, literature-reported best practice, and practical experience of wearable technology application in clinical trials. RESULTS We identify the essential properties of fit-for-purpose wearables and propose evidence needed to support their use. In addition, we overview the activities required to establish clinical endpoints derived from wearables data. CONCLUSIONS Using this framework, we believe there is enough current understanding to promote the appropriate use of wearables in study protocols. We hope this will provide a basis for discussion among clinical trial stakeholders and catalyze the development of more robust regulatory guidance.
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Affiliation(s)
- Bill Byrom
- ICON Clinical Research, Marlow, Buckinghamshire, UK.
| | | | - Helen Doll
- ICON Clinical Research, Abingdon, Oxfordshire, UK
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Kozlowski LT. Origins in the USA in the 1980s of the warning that smokeless tobacco is not a safe alternative to cigarettes: a historical, documents-based assessment with implications for comparative warnings on less harmful tobacco/nicotine products. Harm Reduct J 2018; 15:21. [PMID: 29661189 PMCID: PMC5902931 DOI: 10.1186/s12954-018-0228-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 03/28/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Before the 1980s in the USA, smokeless tobacco carried no health warnings, was not judged to cause disease, and was a declining practice. In 1986, the federal government passed legislation requiring rotating warnings on "mouth cancer," "gum disease and tooth loss," and "This product is not a safe alternative to cigarettes." This paper explores the history of the establishment of these warnings with emphasis on the 'not a safe alternative' warning and the bases for claiming that smokeless was 'not safe' (absolute harm) versus 'not safer than cigarettes' (relative harm). METHODS Results of searches of Truth Tobacco Industry Document archives and transcripts of legislative hearings were analyzed. Critical assessments were made of the evidence-base. RESULTS New evidence of oral cancer causation emerged along with a much-publicized case of a teenager dying of oral cancer. Public health concerns also arose over a widespread, successful marketing campaign implying smokeless was a safe alternative to cigarettes. Industry wanted pre-emptive federal warnings, to prevent a diversity of pending state warnings. To avoid an addiction warning, the industry accepted a compromise 'not a safe alternative' warning, which had not been initially proposed and which the cigarette industry may have sought in order to constrain the smokeless tobacco industry. The evidence presented supported smokeless only as 'not safe' and not 'as harmful as cigarette smoking.' CONCLUSIONS The comparative warning was a compromise to prevent an addiction warning and consistent with the preferences of cigarette companies. Prior surveys indicated that the public generally did not view smokeless tobacco as harmless, but they did generally report smokeless as less harmful than cigarettes despite expert interpretations to the contrary. As would not have been appreciated by public health supporters at the outset, subsequent research has shown that the 'not a safe alternative' message is misinterpreted by consumers to indicate that smokeless is 'not safer' than cigarettes-which was not established and has been disconfirmed by subsequent assessments of that question. Though many countries have banned smokeless tobacco (but not cigarettes), where smokeless is legally available accurate information on the nature of harms and differential harms needs to be developed.
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Affiliation(s)
- Lynn T Kozlowski
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, State University of New York, 323 Kimball Tower, 3435 Main Street, Buffalo, NY, 14214-8028, USA.
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Crosbie E, Sosa P, Glantz SA. Defending strong tobacco packaging and labelling regulations in Uruguay: transnational tobacco control network versus Philip Morris International. Tob Control 2018; 27:185-194. [PMID: 28336521 PMCID: PMC5610601 DOI: 10.1136/tobaccocontrol-2017-053690] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 02/15/2017] [Accepted: 02/15/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Describe the process of enacting and defending strong tobacco packaging and labelling regulations in Uruguay amid Philip Morris International's (PMI) legal threats and challenges. METHODS Triangulated government legislation, news sources and interviews with policy-makers and health advocates in Uruguay. RESULTS In 2008 and 2009, the Uruguayan government enacted at the time the world's largest pictorial health warning labels (80% of front and back of package) and prohibited different packaging or presentations for cigarettes sold under a given brand. PMI threatened to sue Uruguay in international courts if these policies were implemented. The Vazquez administration maintained the regulations, but a week prior to President Vazquez's successor, President Mujica, took office on 1 March 2010 PMI announced its intention to file an investment arbitration dispute against Uruguay in the International Centre for the Settlement of Investment Disputes. Initially, the Mujica administration announced it would weaken the regulations to avoid litigation. In response, local public health groups in Uruguay enlisted former President Vazquez and international health groups and served as brokers to develop a collaboration with the Mujica administration to defend the regulations. This united front between the Uruguayan government and the transnational tobacco control network paid off when Uruguay defeated PMI's investment dispute in July 2016. CONCLUSION To replicate Uruguay's success, other countries need to recognise that strong political support, an actively engaged local civil society and financial and technical support are important factors in overcoming tobacco industry's legal threats to defend strong public health regulations.
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Affiliation(s)
- Eric Crosbie
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, California, USA
- Department of Politics, University of California Santa Cruz, Santa Cruz, California, USA
| | - Particia Sosa
- International Advocacy Center, Campaign for Tobacco Free Kids, Washington, DC, USA
| | - Stanton A Glantz
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, California, USA
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Kahan LG, Blatnik JA. Critical Under-Reporting of Hernia Mesh Properties and Development of a Novel Package Label. J Am Coll Surg 2017; 226:117-125. [PMID: 29133265 DOI: 10.1016/j.jamcollsurg.2017.10.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 10/29/2017] [Accepted: 10/30/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND With an array of hernia meshes with varying properties, intraoperative decision making for the optimal mesh is critical. Although meshes are subjected to regulatory review through the Food and Drug Administration, it is unknown whether mesh properties are visually accessible. To facilitate greater knowledge for the surgeon on mesh choice, we aimed to comprehensively analyze hernia mesh packaging and regulations. STUDY DESIGN Labeling guidelines and 510(k) requirements across Food and Drug Administration-regulated products were analyzed and compared with mesh packaging. Packages and Instructions for Use were analyzed for commonly available hernia meshes. Literature review was conducted to understand recommended guidelines for mesh products. A novel hernia mesh packaging label was designed to rectify under-reporting. RESULTS We found that food labels undergo critical scrutiny and detailed specifications, yet medical devices are not subjected to similar guidelines. The highest reported property on packages was the presence of a barrier (80%), and the lowest reported property was barrier composition (33%). For Instructions for Use, the lowest reported properties were mechanics (31%) and thickness (11%), both of which were not reported on packaging. Descriptive terms for pore size and mechanics were reported inconsistently. To overcome this under-reporting of properties, we propose a novel packaging label with properties chosen from regulatory guidelines, packaging analysis, and literature review. CONCLUSIONS Although standardized terminology has been proposed in literature, property knowledge has not adequately permeated surgery, industry, or regulatory guidelines. There is extreme under-reporting and lack of consistency of clinically important mesh properties. Standardized packaging labels will provide accessibility of these properties and aim to bring standardized terminology into practice. With an increase in access to important properties, this can facilitate intraoperative decision making on a case-by-case basis.
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Affiliation(s)
- Lindsey G Kahan
- Department of Surgery, Washington University in St Louis School of Medicine, St Louis, MO
| | - Jeffrey A Blatnik
- Department of Surgery, Washington University in St Louis School of Medicine, St Louis, MO.
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Levy DT, Mays D, Yuan Z, Hammond D, Thrasher JF. Public health benefits from pictorial health warnings on US cigarette packs: a SimSmoke simulation. Tob Control 2017; 26:649-655. [PMID: 27807299 PMCID: PMC5966722 DOI: 10.1136/tobaccocontrol-2016-053087] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 10/01/2016] [Indexed: 11/04/2022]
Abstract
INTRODUCTION While many countries have adopted prominent pictorial warning labels (PWLs) for cigarette packs, the USA still requires only small, text-only labels located on one side of the cigarette pack that have little effect on smoking-related outcomes. Tobacco industry litigation blocked implementation of a 2011 Food and Drug Administration's (FDA) rule requiring large PWLs. To inform FDA action on PWLs, this study provides research-based estimates of their public health impacts. METHODS Literature was reviewed to identify the impact of cigarette PWLs on smoking prevalence, cessation and initiation. Based on this analysis, the SimSmoke model was used to estimate the effect of requiring PWLs in the USA on smoking prevalence and, using standard attribution methods, on smoking-attributable deaths (SADs) and key maternal and child health outcomes. RESULTS Available research consistently shows a direct association between PWLs and increased cessation and reduced smoking initiation and prevalence. The SimSmoke model projects that PWLs would reduce smoking prevalence by 5% (2.5%-9%) relative to the status quo over the short term and by 10% (4%-19%) over the long term. Over the next 50 years, PWLs are projected to avert 652 800 (327 000-1 190 500) SADs, 46 600 (17 500-92 300) low-birth-weight cases, 73 600 (27 800-145 100) preterm births and 1000 (400-2000) cases of sudden infant death syndrome. CONCLUSIONS Requiring PWLs on all US cigarette packs would be appropriate for the protection of the public health, because it would substantially reduce smoking prevalence and thereby reduce SADs and the morbidity and medical costs associated with adverse smoking-attributable birth outcomes.
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Affiliation(s)
- David T Levy
- Department of Oncology, Cancer Prevention & Control Program, Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Darren Mays
- Department of Oncology, Cancer Prevention & Control Program, Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Zhe Yuan
- Department of Oncology, Cancer Prevention & Control Program, Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - James F Thrasher
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina, USA
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Affiliation(s)
- Alan R Shapiro
- Department of Medicine, New York University School of Medicine, New York, New York
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Restrepo BJ. Calorie Labeling in Chain Restaurants and Body Weight: Evidence from New York. Health Econ 2017; 26:1191-1209. [PMID: 27451966 DOI: 10.1002/hec.3389] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 05/21/2016] [Accepted: 06/17/2016] [Indexed: 06/06/2023]
Abstract
This study analyzes the impact of local mandatory calorie labeling laws implemented by New York jurisdictions on body weight. The analysis indicates that on average the point-of-purchase provision of calorie information on chain restaurant menus reduced body mass index (BMI) by 1.5% and lowered the risk of obesity by 12%. Quantile regression results indicate that calorie labeling has similar impacts across the BMI distribution. An analysis of heterogeneity suggests that calorie labeling has a larger impact on the body weight of lower income individuals, especially lower income minorities. The estimated impacts of calorie labeling on physical activity, smoking, and the consumption of alcoholic beverages, fruits, and vegetables are small in magnitude, which suggests that other margins of adjustment drive the body-weight impacts estimated here. Copyright © 2016 John Wiley & Sons, Ltd.
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Gourdet C, Giombi KC, Kosa K, Wiley J, Cates S. How four U.S. states are regulating recreational marijuana edibles. Int J Drug Policy 2017; 43:83-90. [PMID: 28343113 DOI: 10.1016/j.drugpo.2017.01.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 12/15/2016] [Accepted: 01/22/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Sales of edible marijuana products have been strong in Colorado and Washington State since the legalization of recreational marijuana. Initially, these states did not have comprehensive labelling or packaging requirements in place. In response to increases in marijuana-related emergency room visits and poison control centre calls, additional regulations were implemented. Currently, Alaska, Colorado, Oregon, and Washington each have passed into law various labelling and packaging requirements for edibles. METHODS This article presents the primary legal research findings of relevant statutes and regulations for edibles in Alaska, Colorado, Oregon, and Washington. These laws were identified by using Boolean terms and connectors searches in these states' legal databases in LexisNexis. RESULTS Alaska, Colorado, Oregon, and Washington vary greatly in how they regulate labelling and packaging. Colorado, Oregon and Washington require a Universal Symbol to be affixed to edibles, but only Oregon and Washington require that the use of pesticides be disclosed on the label. Only Colorado and Oregon require that the packaging for edibles bear a Nutrition Facts Panel on the label. Δ9-Tetrahydracannabinol (THC) in a single serving or single edible product as Alaska and Oregon. All four states prohibit the manufacture or packaging of edibles that appeal to youth. CONCLUSION State laws governing recreational marijuana edibles have evolved since the first recreational edible products were available for sale. Alaska, Colorado, Oregon, and Washington now require edible product labels to disclose a variety of product information, including risk factors associated with consumption. However, there still remain concerns about the regulatory gaps that exist in each of these states, inherent difficulties in enforcing laws around the labelling, packaging, and manufacturing of edibles, and the outstanding question of whether these edible laws are actually informing consumers and keeping the public safe.
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Affiliation(s)
- Camille Gourdet
- RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC, 27709, USA.
| | - Kristen C Giombi
- RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Katherine Kosa
- RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Jenny Wiley
- RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Sheryl Cates
- RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC, 27709, USA
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Crosbie E, Sosa P, Glantz SA. The importance of continued engagement during the implementation phase of tobacco control policies in a middle-income country: the case of Costa Rica. Tob Control 2017; 26:60-68. [PMID: 26856614 PMCID: PMC4977207 DOI: 10.1136/tobaccocontrol-2015-052701] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 01/08/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To analyse the process of implementing and enforcing smoke-free environments, tobacco advertising, tobacco taxes and health warning labels from Costa Rica's 2012 tobacco control law. METHOD Review of tobacco control legislation, newspaper articles and interviewing key informants. RESULTS Despite overcoming decades of tobacco industry dominance to win enactment of a strong tobacco control law in March 2012 consistent with WHO's Framework Convention on Tobacco Control, the tobacco industry and their allies lobbied executive branch authorities for exemptions in smoke-free environments to create public confusion, and continued to report in the media that increasing cigarette taxes led to a rise in illicit trade. In response, tobacco control advocates, with technical support from international health groups, helped strengthen tobacco advertising regulations by prohibiting advertising at the point-of-sale (POS) and banning corporate social responsibility campaigns. The Health Ministry used increased tobacco taxes earmarked for tobacco control to help effectively promote and enforce the law, resulting in high compliance for smoke-free environments, advertising restrictions and health warning label (HWL) regulations. Despite this success, government trade concerns allowed, as of December 2015, POS tobacco advertising, and delayed the release of HWL regulations for 15 months. CONCLUSIONS The implementation phase continues to be a site of intensive tobacco industry political activity in low and middle-income countries. International support and earmarked tobacco taxes provide important technical and financial assistance to implement tobacco control policies, but more legal expertise is needed to overcome government trade concerns and avoid unnecessary delays in implementation.
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Affiliation(s)
- Eric Crosbie
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, California, USA
- Department of Politics, University of California Santa Cruz, Santa Cruz, California, USA
| | - Patricia Sosa
- International Advocacy Center, Campaign for Tobacco Free Kids, Washington DC, USA
| | - Stanton A Glantz
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, California, USA
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Lindblom EN, Berman ML, Thrasher JF. FDA-Required Tobacco Product Inserts & Onserts–and the First Amendment. Food Drug Law J 2017; 72:1-25. [PMID: 29140651 PMCID: PMC6125716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In 2012, a federal court of appeals struck down an FDA rule requiring graphic health warnings on cigarettes as violating First Amendment commercial speech protections. Tobacco product inserts and onserts can more readily avoid First Amendment constraints while delivering more extensive information to tobacco users, and can work effectively to support and encourage smoking cessation. This paper examines FDA’s authority to require effective inserts and onserts and shows how FDA could design and support them to avoid First Amendment problems. Through this process, the paper offers helpful insights regarding how key Tobacco Control Act provisions can and should be interpreted and applied to follow and promote the statute’s purposes and objectives. The paper’s rigorous analysis of existing First Amendment case law relating to compelled commercial speech also provides useful guidance for any government efforts either to compel product disclosures or to require government messaging in or on commercial products or their advertising, whether done for remedial, purely informational, or behavior modification purposes.
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Affiliation(s)
- Eric N. Lindblom
- Eric N. Lindblom, JD, is a Senior Scholar at the O’Neill Institute for National & Global Health Law at Georgetown University Law Center, and the former Director of the Office of Policy at FDA’s Center for Tobacco Products
| | - Micah L. Berman
- Micah L. Berman, JD, is an Assistant Professor at the College of Public Health and the Moritz College of Law at Ohio State University
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Kuniyoshi RR, Sternick EB, Nadalin E, Hachul DT. Reprocessing of Medical Products in Electrophysiology. Arq Bras Cardiol 2017; 108:169-172. [PMID: 28327869 PMCID: PMC5344663 DOI: 10.5935/abc.20170010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 10/27/2016] [Indexed: 11/20/2022] Open
Affiliation(s)
- Ricardo Ryoshim Kuniyoshi
- Sociedade Brasileira de Arritmias Cardíacas, São Paulo,
SP - Brazil
- Mailing Address: Ricardo Ryoshim Kuniyoshi, Rua Alfeu
Alves Pereira, 60. Postal Code 29050-285, Enseada do Sua, Vitória, ES -
Brazil. E-mail: ,
| | | | - Elenir Nadalin
- Sociedade Brasileira de Arritmias Cardíacas, São Paulo,
SP - Brazil
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Buonocore F, Marques Gomes ACN, Nabhani-Gebara S, Barton SJ, Calabrese G. Labelling of electronic cigarettes: regulations and current practice. Tob Control 2017; 26:46-52. [PMID: 26790924 PMCID: PMC5256311 DOI: 10.1136/tobaccocontrol-2015-052683] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 12/23/2015] [Accepted: 12/29/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Over the past decade e-cigarettes have established themselves in the global market. E-cigarettes triggered much interest in relation to their content and efficacy as smoking cessation tools, but less attention has been paid to users and environmental safety warnings and guidance. Several regulations have been introduced to promote their safe handling and disposal. From May 2016, liquids and cartridges will be regulated by European Community Directives (ECDs) 2001/83/EC and 93/42/EEC, or 2014/40/EU if marketed as tobacco-related products. Currently, manufacturers and distributors must abide by the Chemical (Hazard Information and Packaging for Supply) Regulations 2009 (CHIP) or Classification, Labelling and Packaging Regulations (CLP), the latter replacing CHIP in June 2015. OBJECTIVE In this work, the compliance of marketed e-liquids and e-cigarettes with current European Union and UK legislations is assessed. RESULTS E-liquids and e-cigarettes (21 and 9 brands, respectively) were evaluated. Evidence of non-compliance was found in relation to the CHIP/CLP toxic (13%) and environmental (37%) pictograms, tactile warning (23%), nominal amount of solution (30%), supplier contact telephone number and address (40%). None of the evaluated e-cigarettes displayed information on the correct disposal/recycling of batteries in line with the ECD 2006/66/EC. CONCLUSIONS More stringent enforcement of regulations is needed to ensure not only the user's safety and awareness, but also the safeguarding of the environment.
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Affiliation(s)
- Federico Buonocore
- Department of Drug Discovery, Delivery and Patient Care, School of Pharmacy and Chemistry, Kingston University, Kingston-upon Thames, London, UK
| | - Ana C N Marques Gomes
- Department of Drug Discovery, Delivery and Patient Care, School of Pharmacy and Chemistry, Kingston University, Kingston-upon Thames, London, UK
| | - Shereen Nabhani-Gebara
- Department of Drug Discovery, Delivery and Patient Care, School of Pharmacy and Chemistry, Kingston University, Kingston-upon Thames, London, UK
| | - Stephen J Barton
- Department of Drug Discovery, Delivery and Patient Care, School of Pharmacy and Chemistry, Kingston University, Kingston-upon Thames, London, UK
| | - Gianpiero Calabrese
- Department of Drug Discovery, Delivery and Patient Care, School of Pharmacy and Chemistry, Kingston University, Kingston-upon Thames, London, UK
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Kromka NJ. GMOs, genetically modified organisms or genuinely mixed opinions? A reasonable Consumer’s understanding of the terms "GMO" and "non-GMO," and the struggle to set a Standard. . Seton Hall Law Rev 2017; 48:221-248. [PMID: 29236423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Maynard OM, Misak M, Munafò MR. Variation in health warning effectiveness on cigarette packs: a need for regulation? Eur J Public Health 2016; 26:836-838. [PMID: 27385516 PMCID: PMC5054275 DOI: 10.1093/eurpub/ckw094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The Tobacco Products Directive allows the possibility of strategic placement of health warnings on cigarette packs by manufacturers to reduce overall warning effectiveness. Information regarding health warning effectiveness was assessed in an online survey, and the prevalence of warnings on cigarette packs was assessed in a shop survey. Although we find no evidence of a strong correlation between health warning effectiveness ratings and their frequency on cigarette packs (r = -0.17, P = 0.56), there may be other ways this possibility is exploited. We suggest that this potential loophole is addressed and monitoring of the placement of health warnings on cigarette packs is continued.
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Affiliation(s)
- Olivia M Maynard
- School of Experimental Psychology, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, UK
- UK Centre for Tobacco and Alcohol Studies, UK
| | - Monika Misak
- The City College of New York, The Sophie Davis School of Biomedical Education, New York, NY, USA
| | - Marcus R Munafò
- School of Experimental Psychology, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, UK
- UK Centre for Tobacco and Alcohol Studies, UK
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Food and Drug Administration, HHS. Revisions to Exceptions Applicable to Certain Human Cells, Tissues, and Cellular and Tissue-Based Products. Final rule. Fed Regist 2016; 81:40512-8. [PMID: 27373010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
: The Food and Drug Administration (FDA or Agency or we) is issuing this final rule to amend certain regulations regarding donor eligibility, including the screening and testing of donors of particular human cells, tissues, and cellular and tissue-based products (HCT/Ps), and related labeling. This final rule is in response to our enhanced understanding in this area and in response to comments from stakeholders regarding the importance of embryos to individuals and couples seeking access to donated embryos.
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Food and Drug Administration, HHS. Use of Symbols in Labeling. Final rule. Fed Regist 2016; 81:38911-31. [PMID: 27311137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The Food and Drug Administration (FDA or the Agency) is issuing this final rule revising its medical device and certain biological product labeling regulations to explicitly allow for the optional inclusion of graphical representations of information, or symbols, in labeling (including labels) without adjacent explanatory text (referred to in this document as "stand-alone symbols") if certain requirements are met. The final rule also specifies that the use of symbols, accompanied by adjacent explanatory text continues to be permitted. FDA is also revising its prescription device labeling regulations to allow the use of the symbol statement "Rx only" or "[rx] only" in the labeling for prescription devices.
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Petreas M, Gill R, Takaku-Pugh S, Lytle E, Parry E, Wang M, Quinn J, Park JS. Rapid methodology to screen flame retardants in upholstered furniture for compliance with new California labeling law (SB 1019). Chemosphere 2016; 152:353-9. [PMID: 26991383 DOI: 10.1016/j.chemosphere.2016.02.102] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 02/20/2016] [Accepted: 02/23/2016] [Indexed: 05/07/2023]
Abstract
In response to concerns regarding the widespread use of flame retardants, the California Legislature passed a law (SB1019) requiring labels on furniture products to indicate whether they do or do not contain flame retardants. To support the enforcement of the new law, our laboratory developed a step-wise, screening approach to test for brominated (BFR) and phosphorus-based flame retardants (OPFRs) in several types of furniture components (foam, fabric, batting, plumage, etc.). We used X-Ray Fluorescence (XRF) to screen for the presence of Br (and other elements) and Inductively Coupled Plasma - Optical Emission Spectrometry (ICP-OES) to identify and measure the concentration of P (and other elements). The same samples were also extracted by dichloromethane using sonication and analyzed by a single injection into a Gas Chromatograph - Tandem Mass Spectrometer to obtain concentrations of specific BFRs and OPFRs. Our approach showed excellent screening potential for Br and Sb by XRF and for P by ICP-OES, with both tests having predictive values of a negative equal to 1. To explore and screen for flame retardants in products not included in our current list of target chemicals, we used Liquid Chromatography/Time-of-Flight Mass Spectrometry operated with electrospray ionization, to identify additional flame retardants to be incorporated in quantitative methods. We are making all our methodologies public to facilitate simple and low cost methods that can help manufacturers and suppliers have their products tested and correctly labeled, ultimately benefitting the consumer.
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Affiliation(s)
- Myrto Petreas
- Environmental Chemistry Laboratory, California Department of Toxic Substances Control, Berkeley, CA, USA.
| | - Ranjit Gill
- Environmental Chemistry Laboratory, California Department of Toxic Substances Control, Berkeley, CA, USA
| | - Sayaka Takaku-Pugh
- Environmental Chemistry Laboratory, California Department of Toxic Substances Control, Berkeley, CA, USA
| | - Eric Lytle
- Environmental Chemistry Laboratory, California Department of Toxic Substances Control, Berkeley, CA, USA
| | - Emily Parry
- Environmental Chemistry Laboratory, California Department of Toxic Substances Control, Berkeley, CA, USA; Public Health Institute, Oakland, CA, USA
| | - Miaomiao Wang
- Environmental Chemistry Laboratory, California Department of Toxic Substances Control, Berkeley, CA, USA
| | - John Quinn
- Environmental Chemistry Laboratory, California Department of Toxic Substances Control, Berkeley, CA, USA
| | - June-Soo Park
- Environmental Chemistry Laboratory, California Department of Toxic Substances Control, Berkeley, CA, USA
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Hopkinson NS. What comes after standardised packaging for tobacco? BMJ 2016; 353:i2935. [PMID: 27221158 DOI: 10.1136/bmj.i2935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Nicholas S Hopkinson
- NIHR Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, UK
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Food and Drug Administration, HHS. Deeming Tobacco Products To Be Subject to the Federal Food, Drug, and Cosmetic Act, as Amended by the Family Smoking Prevention and Tobacco Control Act; Restrictions on the Sale and Distribution of Tobacco Products and Required Warning Statements for Tobacco Products. Final rule. Fed Regist 2016; 81:28973-9106. [PMID: 27192730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The Food and Drug Administration (FDA) is issuing this final rule to deem products meeting the statutory definition of "tobacco product,'' except accessories of the newly deemed tobacco products, to be subject to the Federal Food, Drug, and Cosmetic Act (the FD&C Act), as amended by the Family Smoking Prevention and Tobacco Control Act (Tobacco Control Act). The Tobacco Control Act provides FDA authority to regulate cigarettes, cigarette tobacco, roll-your-own tobacco, smokeless tobacco, and any other tobacco products that the Agency by regulation deems to be subject to the law. With this final rule, FDA is extending the Agency's "tobacco product'' authorities in the FD&C Act to all other categories of products that meet the statutory definition of "tobacco product" in the FD&C Act, except accessories of such newly deemed tobacco products. This final rule also prohibits the sale of "covered tobacco products" to individuals under the age of 18 and requires the display of health warnings on cigarette tobacco, roll-your own tobacco, and covered tobacco product packages and in advertisements. FDA is taking this action to reduce the death and disease from tobacco products. In accordance with the Tobacco Control Act, we consider and intend the extension of our authorities over tobacco products and the various requirements and prohibitions established by this rule to be severable.
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50
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Houghton F, Hopkins E. Standardised EU cigarette warnings: one size or colour does not fit all. N Z Med J 2016; 129:98-99. [PMID: 26914428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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