Strengthening Tobacco Regulation to Protect Young People
By Leonardo Jaminola III
During the upcoming May elections, it is imperative to elect leaders that would push for stronger tobacco regulation, boost public health, and work for the benefit of young people rather than forward the interests of tobacco companies.
Tobacco smoking is illegal for minors in the Philippines. However, in reality, the use of tobacco by young people, including children, remains widespread.
Based on the Global Youth Tobacco Survey (GYTS) 2019, 12.5% of students aged 13-15 in the Philippines are current tobacco users [1]. This is equivalent to around 762,000 students who smoke cigarettes and other types of tobacco [2]. While this represents a decline from the 14.5% recorded in 2015, the latest figure still represents a significant proportion of the young people [3]. Among boys, the percentage of tobacco users is even higher at 18.3% as of 2019. For girls, this figure is 6.9%.
But more alarming is the rise in the use of electronic cigarettes among young people. In the age group 13-15 years old, electronic cigarettes recorded the highest prevalence compared to other tobacco products. It is estimated that 14.1% of students in this age group are current users of electronic cigarettes. Meanwhile, the percentage of those who have tried electronic cigarettes increased from 11.7% in 2015 to 24.6% in 2019. The use of electronic cigarettes is especially high among boys. From 15.7% in 2015, boys who have tried electronic cigarettes have more than doubled to 35.2% in 2019 1, 3.
The use of tobacco, especially among young people, is associated with multiple health and developmental risks. This is because tobacco smoke contains at least 250 harmful chemicals like ammonia, carbon monoxide, and hydrogen cyanide. Among these harmful chemicals, more than 69 have been linked to cancer. For example, nicotine in tobacco can narrow veins and arteries which can lead to heart damage [4]. Unsurprisingly, smoking has been linked to different diseases like stroke, diabetes, emphysema, chronic bronchitis, heart disease, and lung diseases, among others [5]. As a result, it has been estimated that smokers die 10 years earlier compared to non-smokers [6]. According to the World Health Organization (WHO), tobacco is responsible for the deaths of more than 8 million persons annually. More than 7 million of these deaths are a result of direct tobacco use while around 1.2 million deaths are due to second-hand smoke exposure [7]. Meanwhile, in the Philippines, around 112,100 die each year due to tobacco-caused diseases [8].
Aside from physical health risks, there is also growing evidence supporting the negative effects of smoking on mental health. According to the WHO, the use of tobacco increases the levels of mental health problems like anxiety and stress, depression, and attention deficit hyperactivity disorder (ADHD), among others. Moreover, smokers who have severe mental health conditions have been observed to have increased psychiatric symptoms. The use of tobacco can also impede the effect of certain medicines used to treat mental health problems [9].
There is also evidence linking nicotine exposure during adolescence with long-lasting effects on brain development. Smoking during adolescent ages has been linked to lasting behavioral and cognitive impairments such as memory and attention problems 6. Moreover, among young people, nicotine addiction develops easily. Adolescent smokers even with low levels of consumption have reported experiencing symptoms of dependence. This is relevant as adolescents that have developed symptoms of nicotine dependence have a higher likelihood of becoming smokers once they reach adulthood [10]. The use of electronic nicotine delivery systems (ENDS), commonly known as electronic cigarettes or vapes, also yields the same effect. According to the WHO Report on the Global Tobacco Epidemic 2021, children and adolescents who use ENDS are twice more likely to smoke cigarettes [11].
As a response to the public health risks of tobacco, rules regulating it have been enacted worldwide. In the Philippines, Republic Act (RA) No. 9211 or the Tobacco Regulation Act of 2003 regulates the packaging, use, sale, distribution, and advertisements of tobacco products. Under this, the use and sale of tobacco products to minors are considered unlawful. Moreover, the law also prevents the sale and distribution of tobacco products within 100 meters of schools, playgrounds, and other places often visited by minors. The law also prohibits smoking in public places including schools, elevators, stairwells, hospitals, and public transportation stations, among others. Furthermore, tobacco advertisements on television, radio, and cinemas as well as sponsorships have been banned. Outdoor advertising of tobacco is also prohibited except inside point-of-sale retail stores. Manufacturers are also required to put warnings on cigarette packages (e.g., Government Warning: Cigarette Smoking is Dangerous to Your Health) [12].
Aside from RA No. 9211, there are also other relevant policies on tobacco regulation. RA No. 10643 or the Graphic Health Warnings Law strengthens the regulation on tobacco packaging by obligating manufacturers and importers to have graphic health warnings that detail the effects of tobacco use and second-hand smoke on tobacco products [13]. Meanwhile, policies aimed at increasing the prices of tobacco products include RA No. 10351 or the Sin Tax Reform Act of 2012 which increased excise taxes on tobacco products. The law charged an excise tax of Php 30 per pack on cigarettes packed by hand[14]. The excise tax on tobacco products was further raised by RA No. 11346. Under this, cigarettes packed by hand will have an excise tax of Php 45 pesos per pack in 2020 and will increase by Php 5.00 each year until reaching Php 60 per pack by 2023. Afterward, the tax rate shall be raised by 5% each year. The law also prescribed tax rates for heated tobacco products and vapor products [15]. More recently, RA No. 11467 further increased taxes on alcohol, tobacco, heated tobacco, and vapor products. The law also established the regulatory framework for heated tobacco and vapor products and designated the Food and Drug Administration (FDA) as the regulatory agency for these products. Under the law, the sale of heated tobacco and vapor products to persons under 21 years old is prohibited. Furthermore, the law bans flavorings except for plain tobacco and plain menthol [16]. However, these regulatory gains are set to be overturned by the Vaporized Nicotine Products Regulation Act, commonly known as the Vape Bill, which has been recently approved by Congress and is awaiting transmittal to and signature of the president. If this becomes a law, the minimum age to access heated tobacco and vapor products will be lowered to 18 years old. The regulation of these products will also be transferred to the Department of Trade and Industry (DTI) [17].
While the Tobacco Regulation Act of 2003 brings about key changes, it is lacking to effectively protect young people against the dangers of tobacco. It should be noted that the law was passed before the Philippines ratified the WHO Framework Convention on Tobacco Control (FCTC), and, as such, failed to consider internationally agreed-upon minimum standards on tobacco regulation. The FCTC is an evidence-based international treaty asserting the people’s right to the highest standard of health. Developed as a response to the global spread of the tobacco epidemic, the framework provides binding commitments and strategies for tackling demand reduction and supply issues [18]. Moreover, the Tobacco Regulation Act of 2003 adopts a “balanced policy” that aims to balance trade and health. This policy is manifested in the structure of the Inter-agency Committee-Tobacco (IAC-T), the body that oversees the implementation of the law. This committee is headed by DTI and even affords a seat to the tobacco industry 12. However, to be effective, tobacco regulation should prioritize public health rather than business interests.
The country’s regulations need to be strengthened to effectively protect young people from the dangers of tobacco. The current data on youth tobacco use in the country indicates that there are lapses both in policy and implementation. Urgent reforms are needed including the expansion of smoke-free environments to attain completely smoke-free public spaces. All indoor public spaces and workplaces should prohibit smoking. Moreover, as exposure to second-hand smoke also brings health risks, there should be no designated smoking areas in public places. The implementation and monitoring of smoke-free environments should also be strictly followed through the set-up of a local task force. Moreover, the legal age for the sale and consumption of tobacco and related products should be increased from 18 to 25 years old to further prevent addiction and dependence among adolescents. The sale of single-stick sale of tobacco products must also be banned because this makes tobacco more accessible and enables smokers to continue despite tax increases. This ban will help deter young people and even low-income households from tobacco use. Given the developmental effects of tobacco on adolescents, there should be more programs aimed at tobacco cessation and treatments to cure tobacco dependence. These programs should be made available to everyone who wishes to stop smoking. It is imperative to have active government initiatives and campaigns to better inform the public regarding the dangers of tobacco use. Social media can be utilized to ensure that promotions are widely disseminated and targeted to young people. Manufacturers should also be required to remove labels on packaging that connote fewer risks like the words mild and light. There is also a necessity to intensify the prohibition of tobacco advertising by including points of sale in the ban. The use of social media and online influencers to market tobacco products must also be restricted [19].
As there is an increase in the use of electronic cigarettes among young people, there must be stricter regulation on these products. One crucial aspect of this is banning the flavors of electronic cigarettes. The introduction of flavors has been used as a key marketing strategy of tobacco companies to target children and youth. This is because the flavors improve the taste of tobacco products making it more appealing to children and youth [20]. One study has concluded that there is a higher probability that an adolescent will report having an interest in electronic cigarettes given by a friend if the product was flavored (e.g., menthol, candy, or fruit). Furthermore, the study also noted that there is a perception that using fruit-flavored electronic cigarettes was less detrimental to health compared to tobacco-flavored ones [21]. All these reforms are critical to deter young people from using tobacco products and emerging trends like electronic cigarettes, both of which have harmful effects on their health and environment.
There is still much to be done to ensure the protection of children and youth against the dangers of tobacco. Currently, there are several bills filed in Congress like the Smoke-Free Environment Bill that aim to implement the aforementioned reforms. However, the current Congress failed to prioritize these bills even though the COVID-19 pandemic highlighted the need to review and amend health-related bills to reinforce the country’s health system. The only tobacco regulation bill that was acted upon by Congress was the Vape Bill and it was the pro-industry version, which seeks to reverse some key gains, that was passed. As such, during the upcoming May elections, it is imperative to elect leaders that would push for stronger tobacco regulation, boost public health, and work for the benefit of young people rather than forward the interests of tobacco companies.
Leonardo Jaminola III is a participant of the Child Rights Network (CRN) Young Leaders Program for Tobacco Control.
[1] Department of Health, World Health Organization Western Pacific Region, & US Centers for Disease Control and Prevention. (2021). Global Youth Tobacco Survey Philippines 2019 Fact Sheet. In Department of Health. Department of Health. https://doh.gov.ph/sites/default/files/publications/Philippines%20GYTS%202019%20Factsheet%20%28Ages%2013-15%29.pdf
[2] Based on the author’s calculation using population of 13, 14, and 15 years old reported in the on 2015 Census of Population, data on out of school children and youth, and the Global Youth Tobacco Survey 2019
[3] Department of Health, World Health Organization Western Pacific Region, & US Centers for Disease Control and Prevention. (2017). Global Youth Tobacco Survey Philippines 2015 Fact Sheet. In Department of Health. Department of Health. https://doh.gov.ph/sites/default/files/publications/2015GYTSFinalFactSheet_1.pdf
[4] Australian Government Department of Health. (2020). What are the effects of smoking and tobacco? Australian Government Department of Health. https://www.health.gov.au/health-topics/smoking-and-tobacco/about-smoking-and-tobacco/what-are-the-effects-of-smoking-and-tobacco#health-effects
[5] Centers for Disease Control and Prevention. (2017, February 9). Health Effects of Smoking and Tobacco Use. Centers for Disease Control and Prevention. https://www.cdc.gov/tobacco/basic_information/health_effects/index.htm#:~:text=Smoking%20causes%20cancer%2C%20heart%20disease
[6] Banks, E., Joshy, G., Weber, M. F., Liu, B., Grenfell, R., Egger, S., Paige, E., Lopez, A. D., Sitas, F., & Beral, V. (2015). Tobacco smoking and all-cause mortality in a large Australian cohort study: findings from a mature epidemic with current low smoking prevalence. BMC Medicine, 13(1). https://doi.org/10.1186/s12916-015-0281-z
[7] World Health Organization. (2021, July 26). Tobacco. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/tobacco
[8] The Tobacco Atlas. (n.d.). Philippines. The Tobacco Atlas. https://tobaccoatlas.org/country/philippines/
[9] World Health Organization Regional Office for Europe. (2021). Tobacco Use and Mental Health. In World Health Organization Regional Office for Europe. World Health Organization. https://www.euro.who.int/__data/assets/pdf_file/0011/516593/fs-tobacco-use-and-mental-health-eng.pdf
[10] Winnall, W., Letcher, T., Greenhalgh, E., & Winstanley, M. (2021). 3.21 Health effects for young people who smoke. In E. Greenhalg, M. Scollo, & M. Winstanley (Eds.), Tobacco in Australia: Facts and issues. Cancer Council Victoria. https://www.tobaccoinaustralia.org.au/chapter-3-health-effects/3-21-health-effects-for-younger-smokers
[11] World Health Organization. (2021a). WHO Report on the Global Tobacco Epidemic 2021: Addressing New and Emerging Products. In World Health Organization. World Health Organization. https://www.who.int/publications/i/item/9789240032095
[12] Republic Act No. 9211. (2003, June 23). Official Gazette of the Republic of the Philippines. https://www.officialgazette.gov.ph/2003/06/23/republic-act-no-9211/
[13] Republic Act No. 10643. (n.d.). The LawPhil Project. https://lawphil.net/statutes/repacts/ra2014/ra_10643_2014.html
[14] Republic Act No. 10351. (2012, December 19). Official Gazette of the Republic of the Philippines. https://www.officialgazette.gov.ph/2012/12/19/republic-act-no-10351/
[15] Republic Act No. 11346. (n.d.). The LawPhil Project. https://lawphil.net/statutes/repacts/ra2019/ra_11346_2019.html
[16] Republic Act No. 11467. (n.d.). The LawPhil Project. https://lawphil.net/statutes/repacts/ra2020/ra_11467_2020.html
[17] Magsambol, B. (2022, March 17). DepEd joins calls for Duterte to junk “anti-health” vape bill. Rappler. https://www.rappler.com/nation/department-education-joins-calls-junk-anti-health-vape-bill/
[18] WHO Framework Convention on Tobacco Control. (n.d.). WHO Framework Convention on Tobacco Control. https://fctc.who.int/who-fctc/overview
[19] Pacariem, S. A. (2021). Creating Smoke-Free Environments: A Primer. In Philippine Legislators’ Committee on Population and Development. Philippine Legislators’ Committee on Population and Development. https://www.plcpd.org.ph/wp-content/uploads/2021/04/Creating-smoke-free-environments-2021.pdf
[20] Ending the Sale of Flavored Tobacco Products. (2022, April 11). Campaign for Tobacco-Free Kids. https://www.tobaccofreekids.org/what-we-do/us/flavored-tobacco-products
[21] Pepper, J. K., Ribisl, K. M., & Brewer, N. T. (2016). Adolescents’ interest in trying flavoured e-cigarettes. Tobacco Control, 25(Suppl 2), ii62–ii66. https://doi.org/10.1136/tobaccocontrol-2016-053174