Report from the Commission to the Council, the European Parliament, the Economic and Social Committee and the Committee of the Regions - Progress achieved in relation to public health protection from the harmful effects of tobacco consumption
Date: 1999-09-08
Institutions: European Commission
Subjects: EU Member State, EU action, cancer, public health, smoking

COMMISSION  OF THE EUROPEAN  COMMUNITIES 

Brussels, 08.09.1999 
COM(1999) 407 final 

REPORT FROM THE  COMMISSION 

TO THE COUNCIL, THE EUROPEAN  PARLIAMENT, 
THE ECONOMIC AND SOCIAL  COMMITTEE 
AND THE COMMITTEE OF THE REGIONS 

PROGRESS ACHIEVED IN RELATION TO PUBLIC 

HEALTH PROTECTION FROM THE HARMFUL 

EFFECTS OF TOBACCO  CONSUMPTION 

TABLE  OF  CONTENTS 

INTRODUCTION: 

PURPOSE: 

'. 

PAGE 

4 

4 

.THE  NEED FORACTION: 

,..-.L 

:::...'. 

!.'..:'. 

...5 

ACTION  UNDERTAKEN  AT COMMUNITY  LEVEL: 

PRIORITY  GROUPS: 

TOBACCO  ADVERTISING  DIRECTIVE: 

COMMUNITY  TOBACCO  FUND: 

LABELLING  AND CONTENT  OF TOBACCO PRODUCTS: 

NON-SMOKERS  -  SMOKING  IN PUBLIC  PLACES: 

TOBACCO TAXATION: 

7 

7 

8 

9 

10 

10 

11 

COMMUNITY  FUNDED  PROJECTS  UNDER  THE  THIRD  ACTION  PLAN  TO  COMBAT 
CANCER  (1996-2000)  AND  THE  COMMUNITY  FUND  FOR  RESEARCH  AND  INFORMATION 
11 
ON TOBACCO: 

2ND EUROPEAN  CONFERENCE  ON TOBACCO OR HEALTH: 

CONSUMER  COMMITTEE: 

FUTURE  ACTION  AT COMMUNITY  LEVEL: 

12 

12 

13 

EUROPE  AGAINST  CANCER  W E EK  1999  FOCUSING  ON  SMOKING  PREVENTION  AND 
YOUNG  PEOPLE: 

13 

CANCER  EXPERTS  CONSENSUS  CONFERENCE  ON NICOTINE: 

13 

2 

EUROPEAN  SMOKING  PREVENTION  NETWORKS: 

STATISTICS: 

RESEARCH: 

WORK  IN OTHER  INTERNATIONAL  ORGANISATIONS: 

M-- 

. 

COMMISSIONJiEF-ORT CONCLUSIONS: .::: 

...f.. 

'.!. 
'"' 

I'l.-'-' 

I 

ANNEX  1:  ACTION  UNDERTAKEN  AT MEMBER  STATE  LEVEL 

ADDITIVES  IN TOBACCO PRODUCTS: 

TAR  AND NICOTINE  CONTENT  IN CIGARETTES: 

SALES OF CIGARETTES AND TOBACCO TO YOUNG  PEOPLE: 

MINIMUM  AGE  LIMITS: 

SALES  BY VENDING  MACHINE: 

SALES OF CIGARETTES  IN UNIT PACKS OF LESS THAN 20: 

SMOKING  IN PUBLIC  PLACES: 

ANNEX 2:  REFERENCES 

13 

14 

14 

14 

.'i'l; 

15 

16 

16 

19 

22 

22 

25 

27 

29 

34 

INTRODUCTION: 

1.  The  Commission  published 

its  1996  Communication  with 

the  purpose  of 
contributing  to a review of existing  and possible  future  anti-smoking  strategies  both 
at  Community  and  at  Member  State  level,  aimed  at  reducing  the  public  health 
impact  of smoking  on European citizens1. It outlined  existing  Community  measures 
in  this  area  and  set  out possible  options  for  further  action  at  the  Community  level 
and by way  of improved  cooperation  between the Member  States. The Commission 
presents  this  report  to  the  European: Parliament,  the  Council,  the  Economic  arid 
Social  Committee  and  the  Committee  of  the  Regions  on  the  progress  achieved  in 
• this regard, as proposed in the "Follow-Up!Hsection of the Communication. 

2.  The  preparation  of  this  document  has  been  informed  by  a  number  of  written 
consultation  exercises  addressed  to  the  Member  States.  The  Commission  has  in 
recent months requested  information  on the following  subjects:  additives  in tobacco 
products;  tar  and  nicotine  content  in  cigarettes;  sales  of  cigarettes  and  tobacco  to 
minors; sales by automatic vending machines, sale of cigarettes in "Kiddy  Packs" of 
less than  20,  and  smoking  in public places,  (as required  by the  1989 Resolution  of 
the  Council  and  the  Ministers  of  Health  of  the  Member  States  meeting  within  the 
Council on banning smoking in public places open to the public2). 

PURPOSE: 

3.  This  report  serves  to  update  the  European  Parliament,  the  Council,  the  Economic 
and  Social  Committee  and the Committee of the Regions on the work undertaken  at 
a Community level by the Commission  since publication of its Communication. 

4. 

It  also  aims  to  provide  policy  makers  across  the  Union  with  a  synopsis  of  the 
various measures  being employed  by the Member  States to reduce  smoking, and  an 
evaluation  of  their  effectiveness.  This  pooling  of  knowledge  at  a  Community  level 
will  enable  the  dissemination  of  examples  of  best  practice,  which  can  only  be  of 
benefit  in the fight against tobacco consumption. 

5.  These  benefits  do  not  stop  at the  frontiers  of  the  Union  however.  The  information 
gathered  together  in  this,  and  future,  reports  wiil  serve  as  an  important  tool 
elsewhere  in  the  world,  particularly  in  the  context  of  enlargement.  Many  countries 
look to the European  Community  and its Member  States to lead the way in the  field 
of tobacco  control;  actions  at both the  Community  and  the  national  level  can  serve 
as  a  model.  It  is  important  here  to  underline  the  Commission's  commitment  to 
cooperation with other international organisations in the field  of tobacco control. For 
example, there is active Commission participation  in the World  Health  Organisation 
(WHO) Committee for a Tobacco-Free Europe, and in the development  of the WHO 
project  for  a  Framework  Convention  on  Tobacco  Control.  Both  of these  initiatives 
could have an important influence  on tobacco  control  in EU candidate countries and 
also  in  developing  countries.  This  future  Convention  will  be  reinforced  by  the 
activities  of  the  World  Bank  in  the  field  of  smoking  prevention,  with  which  the 
Commission  is  also  closely  associated3.  This  issue  is of  growing  importance  to  the 
EU, in view of the fact that total health care expenditure  in Europe today amounts to 
between  5%  and  10% of  Gross  Domestic  Product.  The  fight  against  smoking  can 

therefore  have  a significance  on two  fronts:  improving the quality  of life  of  citizens 
by  reducing  disease  and  suffering,  and  by  making  a  contribution  to  a  reduction  in 
the health care costs resulting from  smoking-related diseases. 

THE NEED FOR ACTION: 

6.  Tobacco  smoking  is  one  of  the  leading  causes  of  morbidity  and  mortality  in  the 
European  Community4.  It  is  the  major  causative  factor  in  an  estimated  30%  of 
cancers5,  including  lung  cancer  (85%  of  which  is  estimated  to  be  caused  by 
smoking),  cancer  of  the  oral  cavity  (lips,  mouth,  tongue,  throat),  cancer  of  the 
.  pharynx^rlarynx-j oesophagus, bladder and the kidneys. Respiratory  diseases, such  as 
to  and/or 
chronic-bronchitis,  emphysema,  and" asthma,  are  also  attributable 
exacerbated  by  smoking.  Furthermore,  smoking 
to 
cardiovascular  disease,  the  risk  of  developing  ischaemic  heart  disease  being 
approximately  .twice  as  high  among  smokers  as  among  non-smokers6.  Passive 
smoking  is also  considered  a risk  factor  for  a number  of diseases, in particular  lung 
cancer7. 

is  a  major  contributor 

7.  Besides  the  generic  risks  associated  with  smoking,  women  smokers  face  a  number 
of  additional  gender-specific  health  risks  because  smoking  can  influence  their 
hormonal  balance.  Specifically,  smoking may contribute to a reduction  in fertility8  9 
and  increase  the risk of early menopause. Furthermore,  it  is a contributory  factor  to 
calcium  loss  and  consequent  osteoporosis  in  post-menopausal  women.  Smoking 
when  combined  with  oral  contraceptive  use  may  also  appreciably  increase  the  risk 
of  developing  cardiovascular  disease10.  Smoking  during  pregnancy  has  been 
associated  with  increased  risk of spontaneous  abortion,  complications  of pregnancy, 
stillbirth, premature delivery, low birth-weight, and neo-natal death. It also  increases 
the  risk  of  sudden  infant  death  and  is  associated  with  a number  of  other  long-term 
health  consequences  for  the  offspring  (e.g.,  reduced  lung  capacity,  increased 
infection  rates)". 

8.  Half  a million  persons  die  in the  Community  each year  from  the  effects  of  tobacco 
consumption.  The  death rate will  continue to rise  sharply  into  the  next  century  and 
smoking  will  remain  the  biggest  single  form  of  avoidable  death  in the  Community 
according  to  statistics  from  the  World  Health  Organisation  and  the  International 
Centre  for  Cancer  Research.  Deaths  from  smoking  will  rise  substantially  over  the 
coming  decades  as  changes  in  the  population  structure  and  the  delayed  impact  of 
smoking  on health come fully  into effect.  A study by Peto, Lopez et al.12 reveals the 
following  worrying  statistics: 

N° of deaths attributed  to smoking  as a proportion  of total deaths (thousands)  in 

the European Union in 1995 

Males 

Females 

Males + Females 

All Cancer 

202/521 

33/412 

235/933 

(39%) 

( 8 %) 

i :, 

.•;••• 

(25%) 

All.Gauses 

434/1856 

114/186? 

'.in-
•;»:'•%, 

548/3725, 

(23%) 

(6%) 

(15%) 

In middle age (35-69 years), the relative importance of death risk from  smoking  is greater 

still: 

N°  of deaths  attributed  to smoking  as a proportion  of total  deaths  in  middle  age 

(thousands) in the European Union in 1995 

Males 

Females 

Males + Females 

All Cancer 

107/235 

13/152 

120/387 

(45%) 

All Causes 

205/645 

(32%) 

(9%) 

32/333 

(10%) 

(31%) 

237/978 

(24%) 

ACTION  UNDERTAKEN AT COMMUNITY  LEVEL: 

PRIORITY  GROUPS: 

9. 

Since  publication  of  the  1996  Communication,  the  Commission  has  launched  a 
number  of  initiatives  at  Community  level  that  should  result  in  a  reduction  of  the 
public  health  impact  of  smoking  on  European  citizens.  While  some  of  these 
initiatives  are^first  and  foremost,  measures  aimed  at  improving  the  functioning  of 
the  internal  market,  the.. Community  also  has  a  duty,  in  all  its'  activities,  and 
particularly-those  concerned  with the  approximation  of  laws, to  ensure  a high., level 
of human health and consumer protection. 

10.  Three  groups  in  particular  will  benefit  from  the  work  of  the  Commission  in  this 
field,  namely;  young  people,  smokers  who  want  to  quit  and  non-smokers.  Within 
these  three  specific  groups, women  must  be  a particular  priority.  Not  only  are  they 
exposed  to  additional  risks  (smokers  and  non-smokers  alike),  as  set  out  in  the 
previous  section,  but  we  are  also  now  seeing  smoking  prevalence  among  women 
rise while prevalence among men continues slowly to decline. If the prevailing trend 
continues, it is estimated that by 2020, the death toll will double so that more than a 
million  women  around  the  world  will  die  each  year  from  tobacco13.  A  recent 
conference  supported  by  the  "Europe  against  Cancer"  Programme  only  served  to 
highlight the growing problem of smoking among women14. 

11.  Young people must also be a priority  for  prevention  activities, particularly  in an era 
when  more  and more youngsters, and  in particular  young  women,  are taking up the 
habit. One in two teenagers starting to smoke now will die from  tobacco  if he or she 
continues to smoke steadily. The younger a person is when he or she starts smoking, 
the greater the risk of suffering  from  a smoking-related disease and the harder it is to 
stop.  A  smoker  who  starts  at the  age  of  15 years  is  three  times  more  likely  to  die 
from  lung  cancer  than  someone  who  starts  in his  or  her  mid-20s15.  However,  if we 
can succeed  in reversing this trend, we should begin to achieve some real reductions 
in  smoking  prevalence,  as those  people  who  do  not  take  up  smoking  as  a  teenager 
are much less  likely to become  smokers later in life.  In the USA alone for  example, 
approximately  80% of smokers begin before the age of  1816. This figure rises to 82% 
for the UK17. 

12.  Many  smokers would dearly love to quit the habit, not  only to save money, but also 
for  health  reasons.  Stopping  smoking  has  immediate  health  benefits.  For  example, 
only  48  hours  after  stopping  there  is  no  nicotine  left  in the  body,  and  capacity  for 
taste and  smell  are already  greatly  improved.  Blood  circulation  improves  only  2-12 
weeks  after  stopping,  making  walking  and  running  a  lot  easier,  while  breathing 
problems improve inside of a year18. 

13.  In  the  long  term,  the  benefits  can  be  even  greater.  Smoking  cessation  reduces  the 
risk  of  lung  cancer.  Ten  years  after  stopping,  the  risk  is  reduced  by  about  30-50% 
compared to that of a continuing  smoker.  Smoking cessation  also reduces the risk of 
coronary  heart  disease  (CHD)  for  men  and  women  of  all  ages.  One  year  after 
cessation, the risk  of CHD mortality  is halved. It takes about  15 years of  abstinence 
before  the risk  of  CHD becomes  similar  to that  of those who have never  smoked19. 

Those  who  quit  before  the  age  of  35  have  a  life  expectancy  not  significantly 
different  from  that  of  a non-smoker.  For  those  who  stop  later,  the  risk  is  between 
that  of  a  smoker  and  a non-smoker20.  These  statistics  show us that  we must  do  all 
we can to help those smokers who want to quit to achieve their goal. 

14.  Non-smokers  have every right to expect that smokers not impair their health. This is 
especially  the case for persons with respiratory  diseases, pregnant  women,  children, 
and  workers  exposed ,at their place  of work,  all  of whom  are particularly  vulnerable 
to  the  effects  of  environmental  tobacco  smoke  (ETS).  ETS  is  a  major  source  of 
indoor  air  pollution,  containing  over  4000  chemicals  in  the  form  of  particles  and 
gases21.  Some  of  the, immediate  effects  of  passive  smoking  include  eye  irritation, 
headache,  cough,  sore  throat,  dizziness  and  nausea.  Adults  with  asthma  can 
-experience  a significant  decline  in lung function  when1 exposed,  while new cases  of 
asthma may be provoked  in children whose parents smoke. Non-smokers  are also at 
increased  risk  of  heart  attacks22.  In  the  longer  term,  passive  smokers  suffer  an 
increased  risk  of  a  range  of  smoking-related  diseases.  For  example,  non-smokers 
who  are exposed to passive smoking in the home have a 25% increased  risk of heart 
disease  and  lung  cancer23.  Passive  smoking  is causally  associated  with an  increased 
risk  of  lower  respiratory  tract  infections  such  as  bronchitis,  pneumonia  and 
bronchiolitis  in  children.  One  recent  study  found  that,  in  households  where  both 
parents  smoke, young  children  have  a 72% increased  risk  of respiratory  illnesses24. 
Passive  smoking  causes  a  reduction  in  lung  function  and  increased  severity  in  the 
symptoms  of  asthma  in  children,  and  is  a  risk  factor  for  new  cases  of  asthma  in 
children25. 

TOBACCO  ADVERTISING  DIRECTIVE: 

15.  Young  people,  which  are  particularly  exposed  to  the  negative  effects  of  smoking 
will  benefit  from  the  implementation  of  the  Tobacco  Advertising  Directive26, 
adopted  on 6 July  1998. As regards  its basic justification,  the need to ensure  proper 
and  efficient  working  of the Internal  Market  required  the  adoption  of a harmonised 
approach, based on a high level of public health protection and taking account of the 
measures  already  adopted  to  ban  or  restrict  tobacco  advertising  in  many  Member 
States.The  potential  effects  of  this  European-wide 
initiative  should  not  be 
underestimated  not  only  for  the  existing  Member  States, but  also  in the perspective 
of  a  future  enlargement.  Of  significance  here  is  the  fact  that  most  adult  smokers 
began  smoking  before  the  age  of  18  years27.  It  follows  that  efforts  to  recruit  new 
smokers  must  concentrate  on  this  age  group,  to  replace  the  over  500,000  smokers 
who  die  in  the  Union  annually  from  this  habit.  If,  by  means  of  this  Directive, 
promotion  can no longer occur, the introduction of cigarettes to a new generation  of 
children and adolescents will be more difficult  in the  future. 

16.  When transposed  into domestic law, the Directive will: 

•  Prohibit  all  forms  of  commercial  communications  and  sponsorship 
with  the  aim  or  direct  or  indirect  effect  of  promoting  a  tobacco 
product; 

•  Allow  tobacco  advertising  to  continue:  in  communications  intended 
solely  for  the  tobacco  trade;  in  imported  media  from  third  countries 
not primarily  intended for the EU market, and; at point of sale; 

•  Require  that  brand  names  used  for  both  non-tobacco  and  tobacco 
products  prior  to  30.07.98  be  presented  in  a  clearly  distinguishable 
manner; 

•  Exclude the free  distribution of cigarettes; 

.•>  Bring  an  end  to  transitional. arrangements  not  later  tharr-1  October 
'  2006,  allowing  the  affected  sectors  (e.g.  tobacco-sponsored  events, 

publishing  industries etc.) the necessary time to  adjust. 

17.  These  measures  will  complement  and  reinforce  the  existing  1989  Directive28 
banning  the  television  advertising  of  tobacco  products  and  the  sponsorship  of 
television programmes by tobacco companies. 

COMMUNITY TOBACCO FUND: 

18.  The  1996 Communication proposed that the Community  should promote studies and 
pilot projects  under the Community  Fund for  Research and Information  on  Tobacco 
to  improve  understanding  of why young people  commence  smoking;  on the  impact 
of  health  education  programmes  on young  people  in  schools;  on the  factors  which 
motivate  young  people  to  smoke  and  on  the  development  of  a  comprehensive 
smoking prevention approach aimed at adolescents. 

19.  The  Fund  was  set  up  in  1994  by  the reform  of  the  Common  Agricultural  Policy29. 
The  reform  created  a  fund  for  research  and  information  consisting  of  1%  of  the 
premium  paid  to  tobacco  growers.  Half  of  that  is  devoted  to  research  into  less 
dangerous  tobacco  plants  (less  chemical  fertilisers,  less nicotine  and  tar,  less  heavy 
metals)  and  alternative  farming  methods.  The  other  half  is  used  for  information 
projects  on the dangers of smoking, especially for young people. 

20.  Following  a  further  reform  of  the  raw  tobacco  market,  this  area  of  Community-

funded  action was strengthened by: 

• 

increasing  the  contribution  to  the  fund  from  1 % to  2%  of  the  premium  paid  to 
tobacco growers30; 

• 

improving the  objectives. 

This  should  allow  the  information  and  education  elements  set  out  in  the  1996 
Commission  Communication  to  be  carried  out  more  effectively  and  for  projects  to 
be spread more widely across the Community, thus reaching  out to a larger  audience 
of young people and adults alike. Furthermore, delays in opening access to the Fund 
as  well  as  the  tender  and  contract  procedures  involved  could  be  improved  to 
encourage public health agencies to applying. 

LABELLING AND CONTENT OF TOBACCO PRODUCTS: 

21.  All  smokers  (42%  of  the  Community  adult  population  are  smokers31),  many  of 
whom would like to quit, have the right to be as well informed  as possible about the 
health  effects  arising  from  their  use  of  tobacco  products  and  the  ingredients 
contained  within  them.  Furthermore,  consumers  should  be  informed  of  where  they 
can  get  access  to  additional  information  about  that  product  and  its  effects. 
Consumers  expect  these  standards  from  other .products  on  the  Community  market 
and there is no reason why  they  should  not  expect the  same from  tobacco products. 
Indeed,  were these  standards  required  of  the  tobacco  industry,  a greater  number  of 
smokers  could,  armed  with  a  more  complete  picture  of  the  harm  caused  to  their 
^.'health  by  smoking,  be  motivated  to  begin  a  quitting" programme.  Those  product 
information  rules : that  do  exist  only  operate  oh  a  national  level,  leading  to  an 
absence of public health protection in the framework  of the Internal Market. 

22.  The  Community  has  a  duty,  in  all  its  activities,  and  particularly  those  concerned 
with  the  approximation  of  laws,  to  ensure  a  high  level  of  human  health  and 
consumer protection. It is therefore  only right and proper that such benefits  as those 
described  above  are  considered  as  an  integral  part  of  any proposed  legislation  with 
the aim of seeking further  completion of the internal market. 

23.  Since  the  adoption  of  the  tobacco  advertising  Directive,  the  Commission  has  been 
concentrating on a review of the existing Directives on labelling of tobacco products 
and maximum tar yields of cigarettes. Following on from  the proposals made in the 
Communication,  the  opinion  of  the  European  Parliament32,  the  Council,  the 
Economic and  Social  Committee33,  the recommendations  of the High Level  Cancer 
Experts  Committee,  and  in  light  of  comments  received  from  industry  and  non 
governmental  organisations,  this  review  process  is  now  complete.  The  resulting 
proposal will be transmitted to the Parliament and the Council as soon as it has been 
agreed at Commission level. 

NON-SMOKERS -  SMOKING  IN PUBLIC  PLACES: 

24.  The  Resolution  of  the  Council  and  the  Ministers  of  Health  of  the  Member  States 
meeting within the Council on banning smoking in places open to the public, invited 
the  Member  States  to  inform  the  Commission  every  two  years  of  action  taken  in 
response  to  the  text.  The  Commission,  on  the  basis  of  the  information  received, 
presented an interim report on 30.10.9234, and a further  report on  14.11.9635. In order 
to  allow  the  Commission  to  prepare  a  new  report  on  Member  State  action  to 
implement  this  resolution,  and  to  examine  if  further  initiatives  are  specifically 
required  for  smoking  in  the  workplace,  the  Commission  Services  have  written  to 
each of the Member States36 requesting information  on the following areas: 

•> 

• 

• 

Introduction  of  any  n ew 
smoking  in  public  places; 

legislation  or  voluntary  agreements  on 

Amendment  or  withdrawal  of  existing 
agreements on smoking in public places; 

legislation  or  voluntary 

Possible classification  of ETS as a workplace carcinogen; 

10 

*l* 

Introduction  or  intention  to  introduce  legislation  on  smoking  in  the 
workplace; 

25.  The  responses  received  from  the  Member  States  will  enable  the  Commission  to 
produce  a  report  analysing  the  current  situation  with  regard  to  smoking  in  public 
places.  Policy  in this area  is drawing  more  and  more  concern  among  citizens,  with 
most  public  places  also  being  recognised  as places  of work.  The  Community  must 
keep  abreast  of  all  the  latest  research  and  legislative  developments  in  this  area  to 
find  the  best  ways  to  ensure  that  non-smokers  are  not  subjected  unnecessarily  to 
other people's smoke. 

26.  The Commission hopes tcorganise  a seminar 'on smoking  in the workplace  in 2000 
which will  bring together  representatives  of the  social  partners, the Member  States, 
the  World  Health  Organisation  and  other  interested  parties,  to  discuss  possible 
future  action in this field at Community and Member  State level. 

TOBACCO TAXATION: 

27.  The  Council  will  soon adopt a proposal  for  a Council  Directive  amending  Directive 
92/79/EEC  on the approximation of taxes on cigarettes, Directive  92/80/EEC on the 
approximation  of taxes on manufactured  tobacco  other than  cigarettes and  Directive 
95/5 9/EC  on  taxes  other  than  turnover  taxes  which  affect  the  consumption  of 
manufactured  tobacco.  The  Economic  and  Social  Committee  and  the  European 
Parliament have given a favourable  opinion on this proposal. 

28.  This  proposal,  which  mainly  introduces  technical  amendments  to  current  tobacco 
tax  legislation,  also  provides  that  every  three  years,  and  for  the  first  time  not  later 
than 31 December 2000, the Council, acting on the basis of a Commission Report or 
proposal,  shall  examine the rates of  duty, the  overall  minimum  excise  duty  and  the 
structure  of  excise  duties  and  shall  then,  acting  unanimously  after  consulting  the 
European  Parliament,  adopt  the  necessary  measures.  This  process  shall  taken  into 
account the proper functioning  of the internal market and the wider objectives  of the 
Treaty. In this context, health aspects will be taken into account to fix the  minimum 
levels  of  taxation.  The  final  responsibility  to  set  excise  duty  levels  belongs  to  the 
individual  Member  States provided  that they comply with the Community  minimum 
levels.  These  measures  will  be  important  as  part  of  the  overall  plans  to  contain  or 
reduce tobacco consumption. Research has shown that  demand for tobacco  products 
is  closely  related  to  their  price.  High  tobacco  prices  are  particularly  effective  in 
discouraging young people from  smoking due to their limited disposable income. 

29.  Therefore,  the recommendations  contained  in the report  of the High Level  group on 
fraud  in the tobacco  and alcohol  sectors can be used  as a basis to set up  appropriate 
measures to tackle fraud  and smuggling. 

COMMUNITY  FUNDED  PROJECTS  UNDER  THE  THIRD  ACTION  PLAN  TO  COMBAT 
CANCER (1996-2000)  AND THE  COMMUNITY  FUND  FOR RESEARCH  AND  INFORMATION 
ON TOBACCO: 

30.  The Third  Cancer Action Plan37 contains  four  main  action  areas: data collection and 
research,  information  and  health  education,  early  detection  and  screening,  and, 

11 

training  and  quality  control.  Following  the  consultation  and  evaluation  of  all  the 
proposed  projects,  100  projects  were  selected  for  Community  financing  in  1996 
(€10,415,688  distributed  in  total),  66  projects  were  selected  for  Community 
financing  in  1997 (€9,363,281 distributed in total), and 59 projects were selected  for 
Community  financing  in  1998  (€11,732,77  distributed  in  total).  In  the  field  of 
smoking  prevention,  funds  are  channelled  through  two  networks,  details  of  which 
are  given  below  at  paragraph  39.  On  average,  the  funds  devoted  to  smoking 
prevention activities-by the Europe against Cancer Programme amount to €2 million 
per  annum.  Further  details  on  all  these  projects  can  be  found  on  the  European 
Commission website38. 
-

31.-  The  Community. Fund  for  ^Research  and  Information  on  Tobacco39  approved  11. 
information  projects  in  1996'and  7 information  projects  in  1998. Further  details on 
these projects can also be found  on the European Commission website40. 

2ND EUROPEAN CONFERENCE ON TOBACCO OR HEALTH: 

32.  The  European  Commission,  through  the  "Europe  against  Cancer"  Programme, 
provided  funding  for  the  2nd  European  Conference  on  Tobacco  or  Health  for  a 
Smoke-Free  21st Century.  The  conference  took  place  in  Spain  from  the  23rd  to  the 
27th  of February,  1999. It was an occasion to bring together experts from  around the 
world  in  the  field  of  tobacco  control  to  discuss  a  variety  of  topics  including,  new 
ways  to  protect  children  from  becoming  smokers,  new  strategies  on  smoking 
cessation  and the role  of health  professionals  in  smoking  prevention  and  cessation. 
Research  results  on the  effects  on human  health  of tobacco  consumption  were  also 
reviewed. 

CONSUMER COMMITTEE: 

33.  The Commission's  Consumers Committee adopted, on  14 June  1998, an opinion on 
a  Socially responsible  Community  tobacco policy41. This document  sets out a series 
of observations on future  tobacco control policy at the Community level. 

12 

FUTURE  ACTION AT COMMUNITY  LEVEL: 

EUROPE  AGAINST  CANCER  W E EK  1999  FOCUSING  ON  SMOKING  PREVENTION  AND 
YOUNG  PEOPLE: 

34.  In  addition  to  the  body  of  follow-up  work  to  the  Commission  Communication 
detailed  in  the  previous  section,  the  "European  Week  against  Cancer"  in  October 
1999  will  concentrate  on  smoking  prevention  issues.  This  will  further  increase  the 
visibility  of European action in this area, and will enable, the dissemination  of a pan-
;E,uropeari  prevention  campaign.  The  high  profile.^'that  this  will  lend  to  the 
.Community's actions  in the field  of smoking .prevention will  be an  important  factor 
in the overall strategy at both Member  State and Community  level to reduce tobacco 
consumption,  acting  in  liaison  with  the  non-governmental  organisations  concerned 
with this issue. 

CANCER  EXPERTS CONSENSUS  CONFERENCE  ON NICOTINE: 

35.  The  European  Commission  plans to fund  a conference  intended  to reach  agreement 
on  scientific  recommendations  with regard  to the control  and possible  regulation  of 
nicotine,  tar  and  known  carcinogens 
tobacco  smoke.  The 
recommendations  will provide scientific  support for future  Community  action  in the 
field  of  tobacco  control.  The  meeting  will  take  place  under  the  auspices  of  the 
Commission's  Advisory  Committee for Cancer Prevention42. 

in  tobacco  and 

EUROPEAN  SMOKING  PREVENTION  NETWORKS: 

36.  In  order  to  improve  coordination  of  activities  in  the  fight  against  smoking  the 
Commission  Services  have  supported  the  creation  of  the  European  Network  for 
Smoking  Prevention43  (ENSP),  which  has  the  task  of  coordinating  national 
initiatives  in  this  field.  The  work  of  ENSP  is  complemented  by  the  European 
Network  on  Young  People  and  Tobacco44  (ENYPAT).  Tobacco-related  projects 
seeking  funding  from  the Cancer Programme  will are submitted  to the Networks  for 
coordination  and  integration  into  a  global  project.  This  ensures  the  coherency  of 
projects  supported,  and  improves their  Community  added-value by  ensuring  proper 
planning and evaluation of project activities and diffusion  of outcomes. 

STATISTICS: 

37.  Several  developments  of  interest  are underway  as regards  statistical  information  on 

smoking at Community  level: 

•  ECHP (European Community Household Panel) 

In  1998,  questions  about  people's  smoking  habits  were  included  for  the  first 
time in the ECHP. 

13 

This  source  should  be  of particular  interest  since  it  will  be possible  to  analyse 
the  data  according  to  a  wide  variety  of  social  variables,  such  as  income  level, 
educational background and social relations. 

It is foreseen  that data from  the  1998 ECHP will become available some time  in 
2001. 

Eurostat/OECD HIS (Health Interview Survey)  project 

.In  May  1999 Eurostat,  in  partnership  with  OECD,  wrote  to  all  Member  States 
v  with  a request  for  data  on  12  health  topics,  to  be  taken  from  existing  surveys 
i-within  thei'.'Member  States.  Two  of these  topics' are  c'oricerned  with present  and 
'^•former smoking habits. 

^  ••'***>•-" 

As  with  the  ECHP  data,  analysis  will  be  possible  by  a  number  of  variables: 
gender,  age,  educational  level  and  economic  activity.  Data  are  expected  to  be 
available by the end of 1999. 

RESEARCH: 

38.  The  Fifth  Framework  Programme  of  the  European  Community  for  research, 
technological  Development  and  demonstration  activities  (1998  to  2002)45  covers 
research  related  to tobacco  use  both  in the theme  "Quality  of  life  and  management 
of  living  resources"  and  in  the  theme  "Confirming  the  international  role  of 
Community  research". 

In  the  context  of  the  Fourth  Framework  Programme  for  research,  technological 
development  and  demonstration  (1994-1998)46, research  related  to tobacco  use  was 
initiated  under  the  Biomedicine  and  Health  Programme  (BIOMED  2)  and  two 
projects were  funded: 

•  Transnational  variation  in prevalence  of adolescent  smoking: the role of national 
tobacco  control  policies  and  the  school  and  family  environment  (BMH4-CT98-
3721), and 

o  East-West  European  comparison  of  chronic  disease  risk  factors,  related  health 
behaviours  and  effects  of  innovative  antismoking  interventions,  with  special 
reference  to Russian Karelia (BMH4-CT96-1224). 

WORK  IN OTHER INTERNATIONAL  ORGANISATIONS: 

39.  Attention  is particularly  drawn to the work  on  smoking  prevention  underway  in the 
World  Health  Organisation  (WHO). The  52nd  World  Health  Assembly  on  24.05.99 
decided  to establish  an  intergovernmental  negotiating  body to  draft  and  negotiate  a 
proposed  WHO  framework  convention  on  tobacco  control  and  possible  related 
protocols, open to participation  by regional  economic  integration organisations.  The 
first meeting of this body is planned for November,  199947. 

14 

In  the  WHO  European  Region,  support  is  being  given  to  a joint  British  Medical 
Association,  World  Health  Organisation  and  European  Union  project  to  create  and 
manage a tobacco resource centre for health  professionals48. 

The  Commission  is  also  represented  on  the  WHO  Committee  for  a  Tobacco  Free 
Europe, which met for the first time in Copenhagen on 4.06.199949. 

COMMISSION  REPORT  CONCLUSIONS: 

40.  The various initiatives that have been, and will  be, taking place  at Community  level 
can be  even  more-effectivejjools  in the fight  against  smoking, if they  are part  of an 
overall  global ,>sjjategy  of  prevention  and  cessation  measures.  The  wide  range  of 
measures being undertaken  in the Member States on different  tobacco  control  issues 
would  indicate that there are some excellent  opportunities  for  sharing  of knowledge 
and  experience.  The  added-value  of  Community-level  action  would  seem  clear  in 
this  regard,  by  ensuring  that  best  practice  is  identified,  objectives  agreed,  and 
progress  evaluated.  Recommendations  made  at  Community  level,  which  build  on 
examples  of  best  practice  from  the  Member  States,  would  provide  a  basis  for  the 
individual Member States to formulate  a more complete global strategy for  smoking 
prevention, tailored to their own individual needs. 

41.  In  response  to  the  reactions  to  this  Report  from  the  European  Parliament,  the 
Council  and  other  interested  institutions  and parties, the  Commission  will  examine 
the preparation of proposals for Council Recommendations, made under Article  152 
of  the  Treaty,  as  well  as  a  review  and  completion  of  existing  provisions  in  the 
framework  of  the  Internal  Market,  taking  account  in  particular  of  any  new 
development based on scientific  facts. 

15 

ANNEX  1:  ACTION UNDERTAKEN AT MEMBER STATE LEVEL 

ADDITIVES IN TOBACCO PRODUCTS: 

42.  It has been established that tar in tobacco products is a carcinogenic  substance50 and 
that mainstream  and sidestream  smoke is composed of a number of constituents that 
are  harmful  to  human  health51.  It  is  also  known  that  tobacco  manufacturers  add  a 
number of additives to tobacco for flavouring,  aroma and presentation52. What is not 
known  is the extent to which the additives to tobacco contribute to the  carcinogenic 
and other harmful  properties of the product. However, many health professionals  are 
iOf the  opinion  that  additives  to  tobacco  do  play  a  role  in  contributing  to  tobacco' 
related  disease  and are increasingly  calling for regulation and control  of additives to 
tobacco53. 

: 

43.  In  1997,  the  Commission  Services  wrote  to  all  the  Member  States  regarding  their 
policy  on  additives  in  cigarettes54.  The  analysis  of  the  replies  below  indicates  that 
there  is a wide disparity  in the rules on additives in cigarettes between  the Member 
States.  This  analysis  establishes  the  current  system  of  legal  regulation  in  the 
Member  States  governing  tobacco  additives,  and  has  served  as  a  basis  for 
preparations  of  an  appropriate  Community  response,  as  detailed  in  paragraph  27 
above;  to  ensure  that,  in  the  operation  of  the  Internal  Market,  barriers  to  free 
circulation  (such  as  the  existence  of  a  variety  of  different  national  rules)  are 
eliminated, whilst ensuring a high level of public health protection. 

44.  In  particular,  attention  is  drawn  to  the  fact  that  in  some  Member  States,  additives 
rules for tobacco are assimilated to those for foodstuffs.  This appears problematic as 
Directive  92/41/EEC55  amending  Directive  89/622/EEC56  on  the  approximation  of 
the laws, regulations and administrative provisions of the Member  States concerning 
the  labelling  of  tobacco  products  prohibits  the  free  circulation  of  tobacco  for  oral 
use.  The  vast  majority  of  tobacco  products  are,  in  fact,  intended  to  be  burnt  and 
ingested  as  smoke,  with  some  intended  to  be  administered  nasally  in  particulate 
form.  Therefore,  the  relevance  of  rules  which  were  designed  to  cover  additives  in 
foodstuffs  is unclear. 

45.  The  analysis  set  out  below  was  circulated  to  the  Member  States  on  23  October 

199857. 

AUSTRIA 

46.  Paragraph  3  of  the  1995  Austrian  Tobacco  Law  (Tabakgesetzes  -  BGBL.  Nr. 
431/1995) provides that regulations  may be adopted  in the interests of public  health 
to  control  the  use  and  amounts  of  ingredients,  additives,  aroma,  flavourings, 
pesticides and residues in tobacco products. Any regulations adopted are to take into 
consideration  the  international  comparability  of test  results  in  relation  to  other  EU 
Member  States. To date no implementing legislation has been passed. 

16 

BELGIUM 

47.  Article  2  of  the  Royal  Decree  of  13  August  1990  (Arrete  Royal  du  13  aout  1990 
relatif  a la fabrication  et a la mise dans le commerce  de produits  a base  de tabac  et 
de  produits  similaires)  concerning  the  manufacture  and  marketing  of  tobacco 
products prohibits the use of all ingredients and additives in tobacco products  except 
for those listed in Annex  1  of the law. These substances include acid salts, ammonia, 
ethanol, gelatine and colourings. 

DENMARK 

48.  Denmark  has,no  rules  on the  use  of  additives-in tobacco  but  the  law on  foodstuffs 

contains an authorisation for rules on additives in tobacco to be established. 

FINLAND 

49.  Chapter  3  (Composition  and  Quality  Control)  of  the  Act  on  Measures  to  Reduce 
Tobacco  Smoking  (13.8.1976/693) permits the  Council  of  State to  issue  regulations 
on  substances  harmful  to  health  which  tobacco  products  may  not  contain,  and  to 
regulate  the  maximum  permissible  amounts  of  additives  which  may  be  used  in 
tobacco  products.  Chapter  2  of  the  1977  Decree  on  Measures  to  Reduce  Tobacco 
Smoking  (25.2.1977/225)  allows  only  those  ingredients,  colours  and  flavourings 
that are not harmful  to health. 

50.  These  are listed  as: tobacco, tobacco  substitutes originating  from  other plants  which 
are not  dangerous  or harmful  to health, sugars, cocoa and honey, tobacco  leaves  for 
wrapping,  ground  tobacco  and  paper  or man-made  sheets  manufactured  from  other 
plant fibres  and spices, odorants, other additives, glues and colourings which are not 
harmful  to  health.  However,  it  is  the  responsibility  of  the  manufacturers  to  ensure 
that  they  comply  with  the  legislation  and  there  is no  monitoring  of  compliance  on 
this point. The Council  of  State has powers under  section  5 of the Act  on  Measures 
to Reduce  Tobacco  Smoking  to prohibit the use of dangerous  substances  in  tobacco 
but  these  powers  have  not  been  used  so  far  in  connection  with  additives  in 
cigarettes. 

FRANCE 

51.  In June  1994 the Conseil  Superieur d'Hygiene Publique de France issued an opinion 
(Proposition  d'avis  pour  la section  evaluation  des risques de renvironnement  sur la 
sante)  on the  evaluation  of the  risks  to health  of additives  to tobacco.  This  opinion 
recommended  that  a  positive  list  of  additives  for  use  in  tobacco  should  be 
established.  The  Law  of  12  September  1995  (Arrete  du  12 septembre  1995  relatif 
aux produits d'addition autorises dans la fabrication  des produits du tabac et de leurs 
succedanes)  concerning  additives  in  the  manufacture  of  tobacco  products  and 
products  derived  from  tobacco,  sets  out  which  additives  may  be  used.  The  list  of 
approved substances is divided into seven categories, including products that may be 
used  as  humectants,  glues,  preservatives  and  colorants.  The  products  listed  are 
similar  to  those  permitted  under  Belgian  and  German  law.  Maximum  permitted 

17 

amounts  are  given  for  certain  substances.  France  also  has  an  advisory  group  on 
additives in tobacco products. 

GERMANY 

52.  The  German Tobacco  Ordnance  (Tabakverordnung)  of 20 December  1977 contains 
a  positive  list  of  permitted  ingredients  which  was  last  updated  in  February  1998 
.'.-following  the  introduction  of  further  EU  legislation  on  permitted  additives  in 
»s  foodstuffs.  Annex  1 of the law lists the permitted  ingredients-which are divided  into 
""fourteen  categories,  including  generally  permitted  additives  in  the  manufacture  of 
'  tobacco  products;-  humectants;  bonding,  adhesion'and  thickening  ?agents;  ash-' 
-'•-"bleaching agents and combustion  accelerators;  substatices'used  in binder  leaves and 
cigarette  paper;  colouring  agents  and  substances  used  in  cigarette  filters  and  tips, 
cigars, cigar-tips and pipes. Annex 2 lists prohibited odorants and flavouring agents. 

GREECE 

53.  Has no legislation, agreements or standards on additives in tobacco. 

IRELAND 

54.  Ireland  has  enabling  legislation  (Section  5  Tobacco  [Health  promotion  and 
Protection]  Act,  1988)  which  gives  the  Minister  of  Health  the  power  to  make 
regulations  to control  or prohibit  the  use  of  any  material  in tobacco  products  other 
than  water, tobacco  or  reconstituted  sheet  made  wholly  from  tobacco.  To  date,  the 
Minister  has  not  made  use  of  these  powers.  In  the  absence  of  such  legislation,  the 
convention  is  that  the  tobacco  industry  complies  with  the  directions  of  the  UK 
Hunter Committee. This compliance is unsupervised and entirely voluntary. 

ITALY 

55.  There  are  no  national  standards  or  regulations  governing  the  use  of  additives  in 
tobacco  products  in  Italy.  However,  the  State  Monopolies  Administration,  which 
makes its own regulations, uses only those additives listed in the specific  regulations 
applying in France and Germany (see above). 

LUXEMBOURG 

56.  Luxembourg  has  a tobacco  law  but  the  use  of  additives  and  ingredients  in tobacco 

products is not regulated under the legislation. 

THE NETHERLANDS 

57.  The  Netherlands  imposes  no  requirements  and  possesses  no  legislation  concerning 

the use of additives in tobacco products. 

PORTUGAL 

58.  Portugal has no legislation concerning the use of additives in tobacco products. 

SPAIN 

59.  The  additives  used  by  Tabacalera  (the  Spanish  State  tobacco  monopoly)  comply 
with Section 8. of the Spanish Food Code (Point 3.25,.79, Processing operations), and 
with the German legislation on tobacco products  (the Tabakverordnung,  see above). 
Additives  obtained  directly  from  the  USA  for  use  in  Spanish  tobacco  products 
comply  with" the t US  Food  and  Drug  Administration  legislation  and  the  GRAS 
(Generally  Recognised  As  Safe)  provisions.  All  of  them  appear  in  the  list  of 
ingredients  added  to  tobacco  in  the  manufacture  of  cigarettes  by  the  six  largest 
American  cigarette  manufacturing  companies,  as  published  in  "Tobacco  Reporter" 
July  1994. 

SWEDEN 

60.  The  1993 Tobacco  Act  (1993:581)  provides  for  the  prescription  of  limit  values  for 
the harmful  substances that  a tobacco product  may  contain  or  give  rise to. The Act 
authorises  the  government,  or an authority  designated  by the  government,  to  notify 
provisions concerning the declaration of contents and limit values. To date no action 
has been taken in this respect except for tar and nicotine declarations and there is no 
binding  legislation  or  voluntary  agreement  in  respect  of  additives  or  other 
ingredients.  The  same  Act  also  provides  that  the  packaging  of  tobacco  products 
intended  to  be  offered  for  sale  to  consumers  within  Sweden  must  include  a notice 
giving  information  about harmful  substances that the product  contains  or gives rise 
to, known as a declaration of contents. 

UNITED KINGDOM 

61.  The UK has  a Voluntary  Agreement  on the  Approval  and Use of New Additives in 
Tobacco  Products,  which  provides  that  manufacturers  seeking  to  introduce  a  new 
additive  into  their  products  must  seek  approval  from  the  Department  of  Health. 
There is a published list for additives in existing use. Additives that are approved  for 
use  in  another  Member  State  may  also  be  used.  The  Agreement  provides  for  the 
establishment  of usage  limits by the Department  of Health.  Tobacco  manufacturers 
are required to sign a Certificate  of Compliance with the Agreement annually. 

TAR  AND NICOTINE CONTENT IN CIGARETTES: 

62.  Article  2  of  Directive  90/239/EEC58  on  the  approximation  of  the  laws,  regulations 
and  administrative  provisions  of  the  Member  States  concerning  the  maximum  tar 
yield  of  cigarettes  states  that  the  tar  yield  of  cigarettes  marketed  in  the  Member 
States shall not be greater than:  15 mg per cigarette as from  31 December  1992, and, 

19 

12  mg  per  cigarette  as  from  31  December  1997.  A  temporary  derogation  for  the 
Hellenic Republic states the following  limits: 20 mg until 31 December  1992, 18 mg 
until  31  December  1998,  15  mg  until  31  December  2000,  and  12  mg  until  31 
December 2006. 

63.  There  is  currently  no  Community  limit  on  nicotine  levels,  although  Article  3  of 
Directive  89/622/EEC59  on  the  approximation  of  the  laws,  regulations  and 
administrative  provisions  of the Member  States concerning  the  labelling  of  tobacco 
products  (as amended  by Directive  92/41/EEC60) requires  that  both tar  and  nicotine 
yields  be  indicated  on  cigarette  packets.  It  also  requires  the  Member  States  to 
forward  to  the  Commission,  in  January  each  year,  a  list  of  the  tar  and  nicotine 
contents of the cigarettes sold on their markets. The Commission then publishes this 
information61. 

64.  The Commission  wrote to all the Member States62 regarding their policies on tar and 
nicotine ^content  of  cigarettes.  Their  responses  are  set  out  below,  and  this 
information  has  been  used  in  the  preparation  of  the  draft  text  referred  to  in 
paragraph 23 above. 

AUSTRIA 

65.  There  are  no  plans  to  reduce  the  tar  content  beyond  the  requirements  laid  down  in 
Directive  90/239. No  measures  concerning  the  fixing  of  a maximum  nicotine  level 
have been proposed. 

BELGIUM 

66.  There  are  no  plans  to  reduce  tar  content  beyond  the  requirements  laid  down  in 
Directive 90/239. The nicotine level in cigarettes was set at  1.5mg  per cigarette  from 
31.12.92,  and  was  reduced  to  1.2mg  per  cigarette  as  from  31.12.97.  There  are  no 
plans to reduce this level  further. 

DENMARK 

67.  No reply received. 

FINLAND 

68.  There  are  no  national  legal  provisions  on  a  reduction  in  tar  content  beyond  the 
requirements  laid  down  in  Directive  90/239/EEC.  Between  1977  and  1995,  before 
Finland  joined  the  EU,  there  was  national  legislation  in  place  which  prohibited 
levels  of  nicotine  in  cigarettes  above  lmg.  Since  1995  there  has  been  no  limit  on 
levels of nicotine. 

FRANCE 

69.  France  would  welcome  a  further  reduction  in  tar  levels,  and  a  limit  on  nicotine 

levels in cigarettes. 

20 

GERMANY 

70.  There  are no national  level legal provisions on a reduction in tar content beyond  the 
requirements  laid  down  in  Directive  90/239/EEC.  There  are  no  plans  to  introduce 
provisions relating to maximum nicotine yields of cigarettes. 

GREECE 

e 71.  There are no plans  for  a reduction  in tar content beyond the requirements  laid  down 
for  Greece  in  Directive  90/239/EEC.  There  is  no  existing  legislation  regarding 
nicotine yields and there are no plans to pfopose^such measures. 

IRELAND 

72.  There  are  currently  no proposals  to  amend  existing  legislation  or  to  introduce  new 

legislation lowering the tar content of cigarettes. 

ITALY 

73.  There  are  currently  no  proposals  to  introduce  new,  lower  limits  on  tar  or  to 
introduce  maximum  nicotine  levels.  Italy  would  nevertheless  favour  Commission 
proposals  further  restricting  tar  levels  and  introducing  restrictions  on  levels  of 
nicotine. 

LUXEMBOURG 

74.  There are currently no proposals to further  reduce the tar content of cigarettes. 

THE  NETHERLANDS 

75.  At  present,  the  Netherlands  has  no  provisions  regulating  the  maximum  nicotine 
content  or  further  reducing  the  tar  content  at  national  level.  The  Netherlands  has 
nevertheless  indicated  that  it  would  welcome  European  Commission  proposals  for 
amendment  of the existing Directives. 

PORTUGAL 

76.  Portuguese  legislation  limits tar to  12mg and nicotine to  1.3mg. There  are  no  plans 

to make further  reductions. 

SPAIN 

77.  Spain's  national  legislation  regulates  the  maximum  levels  of  nicotine  permitted  in 
cigarettes. The  first  transitional  provision  of Royal  Decree  192/1998  lays down  that 
"as  of 31  December  1992, the  nicotine  content  of all  cigarettes  sold  on the  national 
market  must  not  exceed  1.3  mg".  In  the  case  of  cigarettes  described  as  "low  in 
nicotine  and  tar",  the  nicotine  content  must  not  exceed  0.8mg.  There  are  no 
21 

proposals  to  amend  this  legislation  at  present.  The  tar  content  of  cigarettes  is 
regulated by  Royal  Decree  510/1992. No  changes to this  situation  are envisaged  in 
the short term. 

SWEDEN 

78.  There  are  no  plans  to  amend  existing  legislation  in  this  area,  although  proposed 

amendments to the existing Directive would be welcomed.' 

UNITED KINGDOM 

79.  The  UK  has  no  existing  national  legislation  on  maximum  permitted  levels  of 
nicotine in tobacco products. The UK Government, in its'  White Paper on tobacco63, 
announced  that  it  was  keen  to  help  the  Commission  develop  effective,  practical 
proposals in this area. 

SALES OF CIGARETTES AND TOBACCO TO YOUNG PEOPLE: 

80.  The  Commission  Services  wrote  to  all  the  Member  States64  regarding  their 
legislative  framework  on  sales  of  cigarettes  and  tobacco  to  young  people.  The 
Member States were asked for information  on the following points: 

• 

The minimum age limit, if any, for the purchase of tobacco; 

••• 

The sale of cigarettes from  vending machines, and; 

•I* 

The sale of cigarettes in unit packages of less than 20. 

The responses are set out below. 

MINIMUM AGE LIMITS: 

AUSTRIA 

81.  The  sale of tobacco products  to  young  people  falls  within  the field of protection  of 
minors,  which  means  that  legislation  and  its  enforcement  in  this  area  is  the 
responsibility  of  the  nine  provinces.  In  seven  of  the  nine  provinces,  children  and 
young  people  are  forbidden  to  smoke  and/or  consume  tobacco  products  until  they 
have  reached  the  age  of  16  (in  four  of  the  nine  provinces  this  ban  applies  to 
smoking/consumption in public). In one province, children (defined  as persons up to 
the  maximum  age  of  compulsory  education,  even  if  in  individual  cases  they  are 
exempted from  the requirement to attend  school)  are forbidden  to consume tobacco 
products.  In  the  final  province,  children  and  young  people  are  not  explicitly 
forbidden to smoke. 

22 

82.  None  of  the  provinces  lay  down  a  minimum  age  for  the  purchase  of  tobacco 
products.  Instead,  three  provinces  prohibit  the  sale  (or  the  delivery,  passing  on, 
supply  or provision) of tobacco products (in one province the ban specifically  refers 
to tobacco for personal use) to persons aged under  16. In another province, there is a 
ban  on  the  supply  of  tobacco  products  in  bars/restaurants/hotels  to  persons 
recognisable  as  children  or  young  people.  Five  provinces  currently  have  no  legal 
provisions  on  the  sale  of  tobacco  products,  although  in  two  provinces  detailed 
discussions are currently underway for a ban on the sale and supply of such products 
in-the context of planned amendments to legislation on the protection of minors. 

BELGIUM 

83.  Belgium's  legislation  does not  specify  a minimum  age  for  the  purchase  of  tobacco 

products. 

DENMARK 

84.  Currently  drawing  up  an  action  plan  to combat  smoking  among  young  people. No 

minimum age at present. 

FINLAND 

85.  Finland has had a ban on selling tobacco products to under  18s since  1995. Between 

1976 and  1995 the age limit was set at 16. 

FRANCE 

86.  The  prohibition  of  cigarette  sales  to  under-16s  was  rejected  by  the  French 
Parliament  in  1990,  as  it  was  thought  to  glamorise  the  product  by  making  it 
unattainable, and would also encourage adults to resell packets to young people. The 
current  evaluation  of  the  French  law  regarding  the  fight  against  smoking  and 
alcoholism  will provide an opportunity to consider this issue again. 

GERMANY 

87.  In  Germany,  there  is  no  prohibition  on the  supply  of  tobacco  products  to  children 
and young  people. However,  The Protection  of Young  Persons  in Public  Act  states 
that  children  and  young  people  under  16  years  of  age  shall  not  be  permitted  to 
smoke in public. 

GREECE 

88.  There is no minimum legal age for purchasing tobacco products in Greece. 

23 

IRELAND 

89.  The minimum  age for the purchase of tobacco is  16 years, which is under review at 

present -  possibly  18 years is permitted. 

ITALY 

90.  No reply received. 

LUXEMBOURG  „ 

« 

91.  Smoking  is" prohibited  in  all  educational  establishments  and  in  all  establishments 

intended for use by under  16s. 

THE  NETHERLANDS 

92.  No reply received. 

PORTUGAL 

93.  Portugal  has  no  legislation  banning  the  sale  of  tobacco  to  young  people.  The 
Council  on  Smoking  is  currently  considering  the  possibility  of  putting  forward 
proposals  to  regulate  the  installation  of  automatic  cigarette  vending  machines. 
However,  until  such  regulations  are  introduced,  the  Portuguese  authorities  do  not 
see any practical purpose in banning the sale of tobacco products to young people. 

SPAIN 

94.  It is prohibited  to  sell  or give to persons under  16 years  of age tobacco  products  or 

products which imitate tobacco products or which encourage smoking. 

SWEDEN 

95.  It is prohibited  to sell tobacco to children under  18 years of age. 

UNITED  KINGDOM 

96.  It is prohibited to sell tobacco to children under  16 years of age. 

24 

SALES BY VENDING MACHINE: 

AUSTRIA 

97.  The provinces  do not have any legal provisions  specifically  concerned with the sale 

of cigarettes to young people from  vending machines. 

BELGIUM 

98.  The Royal Decree of  13, August  1990 concerning the manufacture  and marketing of 
tobacco-based  and  similar  products  prohibits  the  sale  of  tobacco  products  via 
automatic  vending  machines,  with  the  exception  of  vending  machines  installed  in 
premises  where  such  tobacco  products  are  simultaneously  sold  in  the  traditional 
way. The aim of this regulation is to prevent such vending machines being installed 
in  places  that  are  easily  accessible  to  children.  It  is  thus  illegal  to  install  cigarette 
vending machines on the streets or in schools. 

DENMARK 

99.  No rules governing the sale of cigarettes from  vending machines. 

FINLAND 

100. Cigarette vending machines are permitted, but they must be located in an area that is 
under  continuous  supervision  by  an  adult.  A  ban  on  vending  machines  has  been 
discussed, and public opinion seems to be in favour  of such a move. 

FRANCE 

101.  Cigarette  vending  machines  have  all  but  disappeared  in  France.  Since  1987  it  has 
been  prohibited  to  install  a  machine  on  the  wall  of  any  premises  on  a  public 
thoroughfare. 

GERMANY 

102. There  is  no  prohibition  on  the  sale  of  cigarettes  to  young  people  from  automatic 
vending  machines.  However,  the  Federal  Association  of  German  Tobacco 
(Bundesverband  Deutscher 
Wholesalers  and  Vending  Machine 
Tabakwaren-Grofihandler und Automatenaufsteller  -  BDTA) is subject  to voluntary 
self-restriction  regarding  the  installation  of  cigarette  vending  machines  within  50 
metres  of  the  entrance  to  schools  or  youth  centres.  This  agreement  was  concluded 
with the BDTA in  1997, at the initiative of the Federal Ministry. 

Installers 

25 

GREECE 

103. The retail  sale of cigarettes is a legally regulated right reserved for certain  categories 
of  individuals  (war  disabled,  war victims  etc.). The retail  sale  of cigarettes  by  such 
persons  via  automatic  vending  machines,  although  not  expressly  prohibited,  does 
not occur in Greece. 

IRELAND 

104.  Restricted, and under review. 

ITALY 

105. No reply  received. 

LUXEMBOURG 

106. There  are  no  specific  regulations  concerning  the  sale  of  cigarettes  from  vending 

machines. 

THE  NETHERLANDS 

107. No reply  received. 

PORTUGAL 

108. The  Council  on  Smoking  is currently  considering  the possibility  of putting  forward 
proposals to regulate the installation of automatic cigarette vending machines. 

SPAIN 

109. Tobacco  products  may  be  sold  from  automatic  vending  machines,  subject  to  the 
following  restrictions: such vending machines must be sited exclusively  in  enclosed 
places;  they  may  not  be  used  by  persons  under  16 years  of  age.  The  owner  of  the 
establishment  in which they are sited is responsible  for  enforcing  this prohibition.  A 
notice warning that tobacco  is harmful  to health must be affixed  to the front  of such 
machines. The notice  must have a surface  area of not  less than  20 cm2 and be  fixed 
in such a way as to prevent its removal. 

SWEDEN 

110. Cigarette  vending machines must either be supervised  or located  in a place to which 
under-18s are not  admitted.  In practice, the  Swedish rules prevent  cigarette  vending 
machines from  being sited outdoors. 

26 

UNITED  KINGDOM 

111. The  sale  of  cigarettes  from  vending  machines  is  permitted,  but  machines  are 
required to carry a notice stating "this machine is only for the use of people  aged  16 
and  over".  It  has  not  been  found  necessary  to  impose  legal  restrictions  on  the 
location  of  vending  machines,  as  in  practice  their  location  has  been  restricted  to 
premises  licensed  to  sell  alcohol  and  access  by  children  is  thus  limited.  . The  UK 
. Government,  in  its'  White  Paper  on  tobacco65,  announced  that  the  National 
Association of Cigarette Machine  Operators had revised  its Code of Practice  so that 
.the primary consideration when siting a vending machine is how the need to prevent 
sales to children. 

. 

SALES OF CIGARETTES IN UNIT PACKS OF LESS THAN  20: 

AUSTRIA 

112. The provinces  do not  have  any  legal  provisions  specifically  concerned  with  sale  of 

cigarettes in individual packs of less than 20. 

BELGIUM 

113. The Belgian  Parliament has adopted  an amendment  to its legislation prohibiting  the 
sale of cigarettes in packs containing fewer  than  19 cigarettes, with the exception  of 
"luxury  cigarettes"  sold  in  smaller  packs  at  or  above  the  price  of  the  standard  20 
packs. The aim is to raise the threshold for the purchase of cigarettes, with a view to 
curbing  tobacco  use  by  young  people.  This  will  come  into  force  following  royal 
assent. 

DENMARK 

114.  It  is  prohibited  to  sell  cigarettes  individually,  but  not  for  example  in  packets  of  5. 

However, cigarettes are sold exclusively in packets of  10 or 20 in Denmark. 

FINLAND 

115. There  are no restrictions  on pack  sizes. Fixing the  size of tobacco packets  is one of 
the  items  on  the  tobacco  control  agenda  of  the  Finnish  Ministry  of  Social  Affairs 
and Health. 

FRANCE 

116. No reply received. 

27 

GERMANY 

117. There  is  no  legislation  in  Germany  governing  the  sale  of  cigarettes  in  individual 

packets of fewer than 20 cigarettes. 

GREECE 

118. The  sale  of  cigarettes  in  packs  of  less  than  20,  although  not  expressly  prohibited, 
does not occur in Greece. Nowadays, cigarette packets contain 20 or 25 cigarettes. 

IRELAND 

119.  No allowed in units of less than  10 cigarettes; under review. 

ITALY 

120. No reply received. 

LUXEMBOURG 

121. There are no specific  regulations  concerning the number of cigarettes contained  in a 
packet.  The  Luxembourg  authorities  are  unaware  of  the  sale  of  any  packets 
containing less than 20 cigarettes. 

THE  NETHERLANDS 

122. No reply received. 

PORTUGAL 

123. No reply received. 

SPAIN 

124. No reply received. 

SWEDEN 

125. Cigarettes  are  usually  sold  in  packs  of  10  in  Sweden.  In  some  cases,  when  new 
brands  are  launched,  the  cigarettes  may  be  in  packs  of  3-5. It  is  prohibited  to  sell 
individual  cigarettes,  as  this  would  conflict  with  tax  legislation.  Packs  must  be 
marked "tax paid" and may not be broken up. 

28 

UNITED KINGDOM 

126. The  sale  of  cigarettes  in  unit  packages  of  less  than  20  is  permitted,  provided  the 

packets are unbroken and they contain at least  10 cigarettes. 

SMOKING  IN PUBLIC PLACES: 

127. The  responses  listed  below  have  been  received  from  the  Member  States  following 
*t,  ,-  the  questions  put  to  them- by  the  Commission  Services in  its  letter  of  15  October 

1998 (see paragraph 28). 

' 

' 

..  . 

' 

. 

. 

AUSTRIA 

128. The  1995  Tobacco  Act  applies  a ban  on  smoking  to  premises  used  for  education, 
further  education, negotiations and school sporting  activities. In multi-purpose halls 
and  premises  not  used  exclusively  for  the  above-mentioned  purposes,  a  ban  on 
smoking  applies  for  the  period  during  which  such  premises  are  used  for  these 
purposes  and  for  a period  prior to  such use  which  is necessary  to properly  ventilate 
the premises  concerned.  There  is no ban  on  smoking  in premises  used  exclusively 
for private  purposes.  Smoking is banned  in rooms accessible to the public in public 
authority  buildings,  educational  or  other  establishments  in  which  children  or 
teenagers  are  supervised,  admitted  or  provided  with  accommodation,  universities 
and vocational training establishments, and establishments used for performances  or 
exhibitions. Rooms may, in establishments  which have  a sufficient  number thereof, 
be  specified  as an area where smoking  is permitted, provided  that  it is ensured  that 
tobacco  smoke  does  not  get  into  the  areas  where  the  smoking  ban  applies.  This 
exemption  does not however  apply  to  educational  or  other  establishments  in which 
children  or teenagers  are  supervised,  admitted  or provided  with  accommodation. A 
sufficient  number  of no-smoking  areas must  be provided  in fixed  location  facilities 
of public and private bus, rail, air and shipping operators. 

129. Environmental tobacco smoke is not classified  as a workplace  carcinogen, and there 

are no plans to do this in the near  future. 

130. Article  30  of  the  Employment  Protection  Act  requires  that  employers  must  ensure 
that  non-smokers  are protected  from  the effects  of tobacco  smoke  in the workplace. 
If,  for  reasons relating to the nature of the business, smokers  and non-smokers have 
to work together in a single room, smoking  is forbidden  unless the non-smokers can 
be  adequately  protected  by  means  of  additional  ventilation.  Article  4  of  the 
Maternity Protection Act states that pregnant women who do not smoke may not be 
employed  in locations within the workplace where they are exposed to the effects  of 
tobacco  smoke.  If  it  is  not  possible  for  employees  to  work  in  separate  areas,  the 
employer must take appropriate measures to ensure that other employees working in 
the  same  area  as pregnant  women  do not  expose the  latter to  the  effects  of tobacco 
smoke. 

29 

BELGIUM 

131. No reply  received. 

DENMARK 

132. Act N° 436 of  14 June  1995 on smoke-free  environments  in public buildings, means 
of  transport  etc.  lays  down  rules  applicable  to  the  public  sector.  The  Act  obliges 
every  local  authority  and  every  county  council  to  establish  regulations  on  smoke-
,  free  environments  in public  sector  workplaces^  institutions  and  means  of  transport. 
No;further,  legislation  has been  introduced  since the previous  Commission  Report66, 
.  but, the  Danish,  authorities  are  involved  in  an  ongoing  dialogue  with  the  social 
partners  concerning  the  introduction  of  smoking  policies  in  private  undertakings. 
Environmental  tobacco  smoke is not classified  as a workplace  carcinogen,  and there 
are no plans to change this situation. 

FINLAND 

133. Finnish  workplaces  have been  totally  smoke-free  since  1995, with  the  exception  of 
restaurants  and  solo  workplaces  without  any  customer  contacts.  This  provision 
forms  part  of  the  Finnish  tobacco  legislation.  Smoking  may  be  allowed  only  in 
separate  smoking  rooms,  from  which  no  smoke  may  disperse  into  smoke-free 
rooms. This means that every smoking room must have independent ventilation. It is 
not  obligatory  for  employers  to provide  smoking  rooms.  The  enforcement  of  these 
controls  is  the  responsibility  of  the  workplace  occupational  health  and  safety 
organisation  and  the  occupational  health  and  safety  authorities.  The  Finnish 
Parliament  adopted  in  February  1999  legislation  providing  progressively  more 
smoke-free  areas in restaurants. The new law enhances the main  rule  of  smoke-free 
working  and  customer  areas  in  all  workplaces,  including  restaurants,  as  it  contains 
provisions  under  which  smoking  may  be  permitted.  By  July  2001,  smoking  may 
only  be permitted  in  50% of the restaurant  area,  at maximum,  on  condition  that  no 
smoke  may  spread  to  the  smoke-free  areas.  Small  restaurants  (less  than  50m2)  are 
exempt. 

134. In  1994,  the  Finnish  Parliament  asked  the  Government 

to  study  whether 
environmental  tobacco  smoke  is  a  carcinogenic  agent.  The  Parliament  has  now 
approved  a provision  classifying  environmental  tobacco  smoke as a carcinogen,  and 
that the Occupational  Health and Safety  legislation applies to it. This will  come into 
force  in the year 2000. 

FRANCE 

135. Law  91-32  of  10 January  1991  introduced  the  principle  of  prohibiting  smoking  in 
public places. Decree 92-478 of 29 May  1992 set out how this prohibition  should be 
applied, the principal  objective being the protection of non-smokers. The decree sets 
out four  categories  of establishment  concerned  by the ban -  public transport,  places 
of  work,  schools,  and  bars  and  restaurants.  Under  certain  conditions,  smokers  may 
smoke  in designated  smoking  areas. With regard  to places  of work,  the  prohibition 
applies  to  all  areas  except  individual  offices.  Shared  offices  or  workshops  must  be 

30 

arranged  in  such  a  way  as  to  allow  smokers  and  non-smokers  to  work  together, 
without non-smokers being bothered by tobacco smoke.  In order to reach  consensus 
on these  arrangements, the employer  is required  to consult  the  company  doctor,  the 
Committee  on Health  and Safety  at Work,  or otherwise, the  staff  representatives.  A 
1995  study  by  the  French  Health  Education  Committee  showed  that  more  than  a 
third  of  companies  had  introduced  new provisions  following  implementation  of  the 
decree.  Slightly  more  than  1 company  in  10  operate  a total  ban  on  smoking,  and 
there is a general respect for such measures. 

136. Environmental  tobacco  smoke  has  not  been  classed  as  a  workplace  carcinogen. 
However,  FAcademie ,de medecine  published  a report  in  19,97 on passive  smoking 
underlining  the  need  both  to  strictly  respect  the  law  on  smoking  in  public  places, 
. and to inform  pregnant women  of the dangers  of active and passive  smoking  during 
pregnancy. 

137. No  further  provisions  on  smoking  in the  workplace  are  envisaged.  Work  continues 
on  ensuring  that  the  current  legislation  is  respected.  Information  and  prevention 
campaigns in the media aim to inform  about the dangers of smoking, both active and 
passive. 

GERMANY 

138. No reply  received. 

GREECE 

139. There have been no developments in Greek  legislation on smoking in the  workplace 
since  1995, and  no  voluntary  agreements  are  in  place.  To  date,  ETS  has  not  been 
classified  as a workplace  carcinogen. 

IRELAND 

140.  A fundamental  review of smoking policy is underway. 

ITALY 

141. No reply  received. 

LUXEMBOURG 

142. Smoking  is prohibited  inside hospitals, establishments  for  elderly people and  public 
buildings, although  specific  smoking rooms may be made available. The Ministry  of 
Health  and  the  Ministry  of  Employment  have  invited  unions  and  employers  to 
integrate  arrangements  on  workplace  smoking  into  their  collective  agreements, 
although  this  is  yet  to  produce  convincing  results.  There  are  no  plans  for  further 
legislation  in  this  area,  or  for  classification  of  environmental  tobacco  smoke  as  a 
workplace  carcinogen. 

31 

THE  NETHERLANDS 

143. No reply received. 

PORTUGAL 

144. On  the  17  September  1998,  legislation  was  published  banning  smoking  in  those 
parts  of the underground  railway  system  that  are accessible to the public. It  should, 
however, be noted that  smoking  on underground  trains has been banned  since  1988. 
None  of  the  existing  regulations  or  agreements  on  smoking  in  public  places  have 
been withdrawn or amended since  1995. 

145. The classification  of ETS as a workplace carcinogen should be considered, given the 

scientific  evidence on the role of tobacco in causing cancer. 

146. There  are no plans in the  short term to  amend  current  legislation  on smoking  in the 
workplace.  Since  1988, smoking  may  be banned  "at  workplaces  where  the  need  to 
protect  non-smokers  and,  for  example,  the  existence  of  alternative  areas  make  a 
smoking  ban  feasible".  Since  1989,  there  has  been  a  ban  on  workplace  smoking 
within the Ministry  of Health  and  in places where non-smoking  persons or  officials 
have  to  spend  time.  Smoking  is  however  permitted  in  the  individual  offices  of 
workers  who  are  smokers,  in  rooms  where  everyone  is  a  smoker  or  in  specially 
designated  areas.  Also  since  1989,  smoking  has  been  banned  in  educational 
establishments,  although  smoking  is  allowed  in  the  staff  room  in  specially 
designated areas. 

SPAIN 

147. There has been no change  in the existing  legislation  on smoking  in public places  in 
Spain  since  the  Commission's  previous  Report67.  There  have  been  legislative 
developments regarding  smoking in the workplace: 

-  annex  5 of Royal  Decree  486/97  laying down minimum health and 
safety  requirements  for  the  workplace  states  that  measures  must  be 
adopted  for  rest  rooms  to  ensure  the  protection  of non-smokers  from 
the  nuisances  arising  from  tobacco  smoke. This  Decree  applies  to  all 
workplaces  excluding  means  of transport  used  outside  the  workplace, 
workplaces  located  within  means  of  transport,  construction  sites,  the 
extraction  industries,  fishing  vessels,  and  land  forming  part  of  an 
agricultural  or forestry  undertaking; 

-  annex  1:13  of Royal  Decree  1216/97 laying down minimum health 
and  safety  requirements  for  work  on  board  fishing  vessels,  states  that 
wherever possible, measures  should  be  adopted  in the crew's  quarters 
to  protect  non-smokers  from  the  nuisances  arising  from  tobacco 
smoke; 

similar provisions  are set out in Royal Decrees  150/96 and  1627/97 
- 
laying  down  minimum  health  and  safety  requirements  for  the 
extraction and construction industries. 

32 

148. Spain  would  be  content 

to 

implement  a  Community  measure  classifying 

environmental tobacco smoke as a workplace  carcinogen. 

SWEDEN 

149. There  has  been  no  change  in  the  existing  legislation  in  Sweden  since  the 
Commission's  previous  Report.  There  are  no  current  plans  to  introduce  additional 
legislation  on this issue, or to classify  environmental  tobacco  smoke as a workplace 
carcinogen. 

UNITED  KINGDOM 

150. There  has  been  no  change  in  UK  legislation  concerning  smoking  in  public  places 
since  the  Commission's  previous  Report.  Legislation  on  smoking  in the  workplace 
has  not  been  introduced,  and  environmental  tobacco  smoke  has  not  been  classified 
as a workplace  carcinogen. 

33 

ANNEX 2:  REFERENCES 

1  COM (96) 609 final 

2  OJC  189, 26.07.89, p. 1 

I  World  Bank: Curbing the Epidemic, Washington  DG, USA  1999 -  Jha Prabhat 

4  Abel-Smith, B., Figueras, J., Holland,  W., McKee, M,  Mossi'alos, E., (1995), Choices in Health  Policy. 

.'*,.  Public health  in Europe, European  Commission  1997. Office  for  Official  Publications  of the  European 

Communities, ISBN  92-828-0390-2 

6  Ministry of Health, Denmark  (1994a) Lifetime  in Denmark 

7  Boffetta  P et al., Multicenter  case-control  study  of exposure  to environmental  tobacco  smoke  and  lung 

cancer  in Europe. Journal  of the National  Cancer Institute, Vol. 90, N°  19, October  7 1998 

8  Sinkkonen,  S. (1996), Finnish  Report on  Women's Health, Kuopio,  unpublished 

0  Thomas, C. (1996), British  Report on Women's  Health, Lancaster,  unpublished 

10  Thomas, C. (1996), British  Report on Women's Health, Lancaster,  unpublished 

II  Thornton,  L.  (1992),  Smoking  in  pregnancy:  behaviour,  belief  and  attitudes  of  women  attending  a 
Dublin  maternity  hospital:  PhD.  Thesis  submitted  for  Membership  of  the  Faculty  of  Public  Health 
Medicine of the Royal  College of Physicians of Ireland (unpublished). 

12  Update  to  1995  of  analyses  of  mortality  from  smoking  in  15  European  Union  countries.  Applies 
methods  used  in the monograph  by  Peto R, Lopez AD, Boreham J, Thun  M & Heath C: Mortality  from 
smoking  in Developed  Countries,  1950-2000, Oxford  University  Press,  1994. 

13  WHO  Factsheet  N°  176:  Smoking  and  Women, 

the  next  wave  of  the 

tobacco  epidemic. 

http://www.who.int/inf-fs 

14  Tobacco  and  Women:  Understanding  the  past,  changing  the  future  -  European  Network  for  Smoking 

Prevention  Conference,  23 & 24 November  1998, Paris. 

15  International Agency  for  Research  on Cancer  (1986) Tobacco  Smoking; Monographs  on  the  evaluation 

of the carcinogenic risk of chemicals to humans 

16  US Centers for  Disease Control and Prevention,  1997 

17  Thomas  M,  Walker  A,  Wilmot  A,  Bennett  N,  Office  for  National  Statistics.  Living  in  Britain:  results 

from  the  1996 General Household  Survey. London, The Stationery Office,  1998 

18  Health  Education  Authority  (England) Smoking Factsheet N° 3: Benefits  of stopping  smoking 

19  US  Department  of  Health  and  Human  Services  (1990)  The  health  benefits  of  smoking  cessation.  A 

report to the  Surgeon  General. Rockville, Maryland: USDHHS 

20  Doll,  R.,  Peto,  R.,  Wheatley,  K.,  Gray,  R.,  and  Sutherland,  I. (1994)  Mortality  in  relation  to  smoking: 

40 years' observations on male British  doctors. British Medical Journal, 309, pp 901-11. 

21  Respiratory  health  effects  of  passive  smoking.  EPA/600/6-90/006F  United  States  Environmental 

Protection  Agency,  1992 

34 

22  Health  effects  of  exposure  to  environmental  tobacco  smoke.  Report  of  the  Office  of  Environmental 

Health Hazards Assessment,  California,  1997. 

23  Law  MR  et  al.  British  Medical  Journal  1997; 315/ 973-80. Hackshaw  AK  et al.  BMJ  1997; 315: 980-

88. 

24  Strachan  DP and  Cook DG. Thorax  1997; 52:905-914. 

23  International.Agency for  Research  on Cancer (1986) Tobacco  Smoking; Monographs  on the  evaluation 
of thccarcinogenic risk of chemicals to humans. US Department  of Health  and Human  Services  (1990) 
The  health J?enefits  of  smpking  cessation.  A  report  to  the  Surgeon  General.  Rockville,  Maryland: 
USDHHS 

26  Directive 98/43/EC (OJ L 213 of 30.07.1998, pp. 9-12) 

27  See endnote  15 

28  Directive  89/552/EEC (OJ L 298,  17.10.1989, p. 23, as last amended  by Directive 97/36/EC  (OJ  L 202 

30.07.1997, p.60) 

29  Council  Regulation  2075/92  EEC,  OJ  L  215,  30.07.92,  p.70  applied  by  Commission  Regulation 

2427/93  EEC, OJ L 223, 02.09.93, p.3 

30  Council  Regulation  1636/98  EC,  OJ  L 210,  28.07.98, p.23  amending  Regulation  2075/92  EEC,  OJ  L 

215, 30.07.92, p.70 applied by Commission  Regulation 2427/93 EEC, OJ L 223, 02.09.93, p.3 

31  COM (96) 609  final 

32  European  Parliament  Report  of 4 November  1997 on the Communication  from  the  Commission  to  the 
Council  and  the  European  Parliament  on  the  present  and  proposed  Community  role  in  combating 
tobacco consumption. OJ C 14, 19.01.98, p. 197 

33  OJ C 296, 29.09.97, p.32 

34  SEC (92)  1976  final 

35  COM (96) 573 final 

36  Letter  of  15  October  1998  from  Director  General  of  DG  V to  the  Permanent  Representatives  of  the 

Member  States 

37  OJL95,  16.04.96, p.9 

38  http://europa.eu.int/comm/dg05/phealth/cancer 
39  Council  Regulation  2075/92  EEC,  OJ  L  215,  30.07.92,  p.70  applied  by  Commission  Regulation 

2427/93 EEC, OJ L 223, 02.09.93, p.3 

40  http://europa.eu.int/comm/dg05/phealth/cancer/tobacco/tfundpro.htm 

41  Available from  DG XXIV; European  Commission; 200, rue de la Loi; B -  1049 Brussels 

42  OJL  192, 02.08.96, p.31 

43  ENSP, 48 rue de Pascale, B-1040 Bruxelles, Belgium. Internet:  http://www.ensp.org 

44  ENYPAT, National  Public Health  Institute (KTL), Department  of Epidemiology  and Health  Promotion, 

Mannerheimintie  166, 00300 Helsinki, Finland. Internet:  http://www.ktl.fi/enypat 

35 

45  Decision  N°  182/1999/EC  of  the  European  Parliament  and  of  the  Council  of  22.12.98  OJ  N°  L26  of 

1.02.99 

46  Decision  n°  1110/94/EC of the  European  Parliament  and  of the  Council  of 26.04.94  OJ N°  L126/1  of 

18.05.94 

47  http://www.who.int/toh 

48  BMA, Tavistock  Square, London  WC1H 9JP, UK and  http://www.tobacco-control.org 

49  http://www.who.dk 

:50  US  Department  of  Health  and  Social  Services.  Reducing  the  Health  Consequences  of  Smoking:  25 
years  of  progress.  A  Report  of  the  Surgeon  General.  Rockville,  Maryland,  Public  Health  Service, 
Office  of the  Assistant  Secretary  for  Health,  office  on  Smoking  and  Health,  1979. DHEW  publication 
(PHS) 79-50066 

51  UK  Department  of Health,  Report  of the  Scientific  Committee  on Tobacco  and  Health. The  Stationery 

Office,  1998 

52  J.  Doull,  JP.  Frawley  &  W. George,  Ingredients  added  to  tobacco  in the  manufacture  of  cigarettes  by 

the six major  American tobacco companies, Tobacco Reporter,  July  1994, p.32 

53  For  example:  J.  Slade,  J.E.  Henningfield,  Tobacco  Product  Regulation:  Context  and  Issues,  Food  and 

Drug Law Journal, vol 53 Supplement  (1998), p. 47 

54  Letter  of  29  April  1997  from  Director  General  of  DG  V  to  the  Permanent  Representatives  of  the 

Member  States 

55  OJ L 158, 11.06.92, p.30 

56  OJL359,  08.12.89, p.l 

57  Letter  of  23  October  1998  from  Director  General  of  DG  V  to  the  Permanent  Representatives  of  the 

Member  States 

58  OJL  137, 30.05.90, p.36 

59  OJL  359, 08.12.89, p.l 

60  OJL  158,  11.06.92, p.30 

61  Doc. CAN  18/98 "Tar and nicotine  contents of the cigarettes  sold on the European  market" is available 

from  DG V/F/2 of the European  Commission, L-2920  LUXEMBOURG 

62  Letter  of  26  February  1998  from  Director  General  of  DG  V  to  the  Permanent  Representatives  of  the 

Member  States 

63  Smoking  Kills -  A White Paper on Tobacco. Published  by The UK Stationery  Office 

64  Letter  of  15  October  1998  from  Director  General  of  DG  V  to  the  Permanent  Representatives  of  the 

Member  States 

65  Smoking  Kills -  A White Paper on Tobacco. Published by The UK Stationery  Office 

66  COM (96) 573  final 

67  COM (96) 573  final 

36 

ISSN  0254-1475 

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