Tobacco control laws and regulations still deficient

Individual smokers, doctors and adults were recognising the ill-effects of smoking and seeking to do something about it, but this was not the case with adolescents.

Among adolescents in 1998, smoking remained at the same level it had been eight years before, Mario R. Sammut writes in a paper on smoking in the June issue of the journal of the Malta College of Family Doctors.

Dr Sammut calls for a health promotion initiative on smoking to accelerate the reduction in smoking among adults and, more importantly, to trigger off a similar reduction among adolescents.

He said local initiatives against smoking were compared to the World Health Organisation 10-point programme for successful tobacco control and to European Union directives and resolutions.

While procedures involving health education, smoking cessation, professionals' smoke-free example and fiscal policies were all being implemented, Maltese tobacco control laws and regulations were still deficient, Dr Sammut said.

In his paper "Tightening tobacco control legislation in Malta: A national health promotion initiative on smoking", Dr Sammut concludes that a health promotion strategy of tightening tobacco control legislation needs to be introduced in Malta forthwith.

This includes strict enforcement, more severe penalties, banning of sales to adolescents and in places frequented by them, the prohibition of smoking in enclosed public places, a total ban on advertising and sponsorship and the introduction of maximum tar-yield levels as well as conspicuous and effective health warnings on all tobacco products.

Dr Sammut insists that the overall priority was the setting up of a coordinating tobacco control authority to effectively manage all efforts.

In Malta, he said, smoking was considered as the foremost preventable cause of premature death and disease.

In his paper, he mentions two objectives - the reduction in the number of smokers by 15 per cent over five years and the reduction of mortality rate from smoking related diseases - respiratory cancer in people under 75 by 20 per cent over 15 years, chronic bronchitis and emphysema in people under 75 by over 30 per cent over 15 years and coronary heart disease in people under 75 by 40 per cent over 15 years.

Direct measures to reduce the number of smokers would include a population survey through the national census which is next due in 2005; and targeted surveys such as repetitions of those of adolescents carried out previously.

According to WHO figures, in the early to mid-1990s, 42 per cent of males and 24 per cent of females in developed countries smoked, while in developing countries the corresponding percentages were 48 per cent and seven per cent respectively.

According to WHO estimates, there are currently four million deaths a year from tobacco, a figure expected to rise to about 10 million by the 2020s or early 2030s.

Based on current trends, tobacco is predicted to be the leading cause of disease in the world, causing about one in eight deaths. Seventy per cent of those deaths will occur in developing countries.

In Malta, while 54 per cent of 25-64 year old men and 20 per cent of women of the same age, smoked in the mid-1980s, in 1995 this percentage for men dropped to 38 per cent with that for women only marginally decreasing to 17 per cent.

Among Maltese adolescents too, cigarette smoking is common: 31 per cent of the 20,815 schoolchildren aged between 11 and 16 who took part in a Caritas/Pride/Discern Survey stated that they had smoked as least one cigarette in 1990.

A follow-up survey in 1998 of a sample size of 1,100 schoolchildren showed that cigarette use was still high at 32 per cent.