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WHO Framework Convention on Tobacco Control (FCTC) Article 11: Packaging and Labelling of Tobacco Products

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The World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) requires member countries to implement measures aimed at reducing the demand for tobacco products. FCTC article 11 describes the important forms of health communication and packaging regulations. And this article recommends on large pictorial health warnings and encourages more effective forms of disclosure on constituents and emissions. Furthermore, article 11 recognizes the importance of the package as a promotional vehicle for tobacco companies and requires the removal of potentially misleading packaging information, including the terms "light" and "mild." The Conference of the Parties (COP) adopted guidelines for implementation of article 11 on "Packaging and labelling of Tobacco Products". Some countries, such as Canada, the U.S.A., Australia, EU countries etc. positively promoted tobacco control by implementing countermeasures such as the graphic health warning labels and plain packages. These countermeasures showed the significant effects of decreasing smoking rate and preventing smoking initiation in young people. Furthermore, these warning labels were effective for the literally challenged. However, the Japanese government has not implemented these countermeasures, and only limited texts are shown on Japanese tobacco packaging. Therefore, Japan should emulate approaches taken by other countries, and promote the tobacco control policy in accordance with FCTC.
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24
総  説
1はじめに
「平成 26 年全国たばこ喫煙者率調査」(1) による日本
国内の喫煙率は,成人男性の平均喫煙率が 30.3%,女性
9.8% であり,男性の場合,昭和 41 年以降のピーク
時(83.7%)と比較すると,46 年間で約 1/3 までもの減
少が見られる。これらの要因として,公共の場における
禁煙エリアの設置や禁煙車の増大,たばこの大幅増税,
たばこに関する法制度の確立,禁煙治療の保険適応,さ
らには,「健康日本 21」における禁煙者の増加を目指し
た喫煙率の目標設定等が考えられ,これまで日本国内で
は喫煙率の減少へ向けたさまざまな対策が実施されてき
た。しかしながら,現在の日本国内の喫煙率は,他の先
進国と比較しても非常に高い水準にあり (2),喫煙によ
る有害性が社会的にも広く認識されているアメリカやカ
ナダ等の先進国と比較すると,2倍もの差が生じている
(2)。そのため日本国内においても,今後,人々へ喫煙
受動喫煙の健康被害の認識を高めるための普及啓発を行
日衛誌 (Jpn. J. Hyg.),7024–322015
©日本衛生学会
ミニ特集 たばこの規制に関する世界保健機関枠組条約
「たばこの規制に関する世界保健機関枠組条約」第 11
「たばこ製品の包装及びラベル」について
戸次加奈江,稲葉 洋平,欅田 尚樹
国立保健医療科学院生活環境研究部
WHO Framework Convention on Tobacco Control (FCTC) Article 11:
Packaging and Labelling of Tobacco Products
Kanae BEKKI, Yohei INABA and Naoki KUNUGITA
Department of Environmental Health, National Institute of Public Health
Abstract The World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC)
requires member countries to implement measures aimed at reducing the demand for tobacco products.
FCTC article 11 describes the important forms of health communication and packaging regulations. And this
article recommends on large pictorial health warnings and encourages more effective forms of disclosure on
constituents and emissions. Furthermore, article 11 recognizes the importance of the package as a promotion-
al vehicle for tobacco companies and requires the removal of potentially misleading packaging information,
including the terms “light” and “mild.” The Conference of the Parties (COP) adopted guidelines for imple-
mentation of article 11 on “Packaging and labelling of Tobacco Products”. Some countries, such as Canada,
the U.S.A., Australia, EU countries etc. positively promoted tobacco control by implementing counter-
measures such as the graphic health warning labels and plain packages. These countermeasures showed
the signicant effects of decreasing smoking rate and preventing smoking initiation in young people.
Furthermore, these warning labels were effective for the literally challenged. However, the Japanese govern-
ment has not implemented these countermeasures, and only limited texts are shown on Japanese tobacco
packaging. Therefore, Japan should emulate approaches taken by other countries, and promote the tobacco
control policy in accordance with FCTC.
Key words: tobacco(たばこ)Framework Convention on Tobacco Control(たばこ対策枠組み条約)
warning label(健康被害警告ラベル)plain package(プレーンパッケージ)
受付 2014 822 日,受理 2014 94
Reprint requests to: Naoki KUNUGITA
Department of Environmental Health, National Institute of Public
Health, 2-3-6 Minami, Wako-shi, Saitama 351-0197, Japan
TEL: +81(48)458-6262, FAX: +81(48)458-6270
E-mail: kunugita@niph.go.jp
日衛誌 (Jpn. J. Hyg.)第70 巻 第 1号 2015 1
25
い,喫煙率の減少へ向けた対策をより一層推進させてい
く必要がある。
また,世界保健機関(WHO)は,たばこが公衆の健
康に深刻な影響を及ぼす世界的な問題になっているとの
見解から,たばこの規制に関する世界保健機関枠組条約
WHO Framework Convention on Tobacco Control; WHO
FCTC)を 2005 年に発効した。ここでは,締約国に対し
て,たばこ消費の削減に向けた広告・販売への規制や密
輸対策等が求められている。また,たばこによる健康被
害を食い止めるべく,たばこのパッケージ警告を通じて
行われるヘルスコミュニケーション専用の条項が 2つ含
まれており (3),その一つに,たばこの健康警告につい
てうたった「第 11 :たばこ製品の包装及びラベル」
がある。実際,FCTC 11 条では,160 以上の締約国に
対して「たばこ使用の有害な影響を示す健康警告を表示
すること」と定められており (3),2008 11 月に開催
された COP3(第 3回締約国会議)で採択された第 11
条のガイドラインでは,喫煙を主な要因とする特有の疾
病をパッケージの両面に大きく明確に描いた健康警告の
表示が義務付けられた (4)。さらに,各締約国が WHO
FCTC の義務を履行することを支援するために発行され
たプラン,MPOWER(5, 6) では,たばこ消費を減らす
ための効果的な政策の実施へ向けた国内法の制定を実践
的に支援する方策が述べられ,その中では,喫煙の危険
性を人々に周知させるための健康警告の重要性について
も強調されている。このようなたばこ対策に関する
FCTC が発効されることにより,各国では喫煙に対する
政策が進められ,これにより喫煙率の低下を導くなど,
着実な効果が伺える。
本文では,FCTC 11 条についての具体的な内容を
紹介すると共に,FCTC が示すたばこ対策に関する近年
の国内外での動向について記す。
2FCTC 11 条:たばこ製品の包装及びラベル
11 条,条文を以下に記す(外務省訳文)(7)。
1.締約国は,この条約が自国について効力を生じた後
三年以内に,その国内法に従い,次のことを確保す
るため,効果的な措置を採択し及び実施する。
a)たばこ製品の包装及びラベルについて,虚偽の,誤
認させる若しくは詐欺的な手段又はたばこ製品の特
性,健康への影響,危険若しくは排出物について誤っ
た印象を生ずるおそれのある手段(特定のたばこ製
品が他のたばこ製品より有害性が低いとの誤った印
象を直接的又は間接的に生ずる用語,形容的表示,
商標,表象による表示その他の表示を含む。)を用
いることによってたばこ製品の販売を促進しないこ
と。これらの手段には,例えば,「ロータール」「ラ
イト」「ウルトラ・ライト」又は「マイルド」の用
語を含めることができる。
b)たばこ製品の個装その他の包装並びにあらゆる外側
の包装及びラベルには,たばこの使用による有害な
影響を記述する健康に関する警告を付するものと
し,また,他の適当な情報を含めることができるこ
と。これらの警告及び情報は,
(ⅰ)権限のある国内当局が承認する。
(ⅱ)複数のものを組合せを替えて表示する。
(ⅲ)大きなもの,明瞭(めいりょう)なもの並びに
視認及び判読の可能なものとする。
(ⅳ)主たる表示面の 50 パーセント以上を占めるべき
であり,主たる表示面の 30 パーセントを下回る
ものであってはならない。
(ⅴ)写真若しくは絵によることができ,又は写真若
しくは絵を含めることができる。
2.たばこ製品の個装その他の包装並びにあらゆる外側
の包装及びラベルには,1bに規定する警告に加え,
たばこ製品の関連のある含有物及び排出物であって
国内当局が定めるものについての情報を含める。
3.締約国は,1b)及び 2に規定する警告その他文字
による情報をたばこ製品の個装その他の包装並びに
あらゆる外側の包装及びラベルに自国の主要な一又
は複数の言語で記載することを要求する。
4.この条の規定の適用上,たばこ製品に関する「外側
の包装及びラベル」とは,当該たばこ製品の小売販
売に使用されるあらゆる包装及びラベルをいう。
以上のような内容から,第 11 条では,締約国に,た
ばこ製品の包装とラベルに健康上の警告とメッセージの
表示をさせる具体的で強制力のある義務を課しており,
その厳守すべき達成期限についても明確に述べられてい
る。
3.たばこ包装上の健康警告表示に関する
国内外での動向
1)健康被害警告ラベル
2000 年に世界で最も早く画像による健康被害警告ラ
ベルを導入したカナダをはじめ,現在は,アメリカ,オー
ストラリア,ヨーロッパ,アフリカ,東南アジア等の国々
においても,たばこ規制における政策の手段として,警
告ラベルが取り入れられており (8–12),2010 年に警告
ラベルの表示を実施した国が 34 ヶ国であったのに対し,
2014 年では 63 ヶ国まで増加した。また,これら警告ラ
ベルのたばこ包装上での表示については,「主たる表示
面の 50 パーセント以上を占めるべきであり,主たる表
示面の 30 パーセントを下回るものであってはならない」
11 条で定められていることから,各締約国では,こ
の規定を満たすためのさまざまな対応が取られている
(表 1,項 目 234。各国の包装上の表示面積の割合は,
国ごとでも異なり,アメリカ,カナダ,オーストラリア
などの先進諸国では包装の 50% 以上が警告表示で占め
られている。また,先進国のみでなく,タイやマレーシ
日衛誌 (Jpn. J. Hyg.)第70 巻 第 1号 2015 1
26
アなどの東南アジアの地域でも同様な傾向が見られ,文
字のみでなく,図 1に示すようにタイやカナダなどで取
り扱われる画像入りの健康被害警告表示やプレーンパッ
ケージを取り入れる国も増加傾向にある。しかしながら,
近年,警告表示に関する活動がさらに広まる中で (14),
アメリカでは,警告表示を義務付けたアメリカ薬品食品
局(FDA)に対して,「表現の自由」に反する憲法違反
とのことから,たばこ会社が訴訟を引き起こすなど,警
告表示に反する動きも見られる (15, 16)。
カナダ保健省が国民に対して実施した,健康被害警告
ラベルに対する意識調査によると,たばこの外箱両面に
大きく表示される警告表示は,人々の目に触れやすい情
報源であることからも,小学生などの子供をはじめ,多
くの喫煙者及び非喫煙者が,ラベル表示によりたばこの
有害性に対して高い認識を持つことが可能になるとの結
果が報告されている(17)。また,アメリカやヨーロッパ
等では,画像入りの警告表示が,思春期の若者に対する
喫煙の誘発を抑制する効果を示したことや (9, 18),喫煙
者に対して禁煙を増加させる手段としても有効であり,
また,喫煙率が高く,識字率の低い集団に対して健康情
報を伝える上でも画像入りの健康警告表示は効果的であ
ると,高く評価されている (19–22)。さらに,イギリス,
オランダ,オーストラリア,ブラジル,ニュージーラン
ドで実施された調査結果からは,包装上の健康被害警告
ラベルに国内の禁煙電話相談サービス(クイットライン)
の連絡先を表示することで,その利用者が大幅に増加し,
禁煙に繋がるケースも多く見られた(図 1AE)( 23–26)。
このように,喫煙対策における健康警告表示の取り組
みが進む中,国外で販売される日本のたばこ製品につい
ても,その国の法規制に対応した警告表示が使用されて
いることから,同じ日本のたばこ製品でありながら,海
外で販売する際には,画像入りの警告を表示している国
も多い。
一方,日本国内でも FCTC に対応するため,たばこ事
業法施行規則第 36 条の規定により,別表第一に挙げら
れる次の警告文,
喫煙は,あなたにとって肺がんの原因の一つとなりま
す。疫学的な推計によると,喫煙者は肺がんにより死
亡する危険性が非喫煙者に比べて約 2倍から 4倍高く
なります。
喫煙は,あなたにとって心筋梗塞の危険性を高めます。
疫学的な推計によると,喫煙者は心筋梗塞により死亡
する危険性が非喫煙者に比べて約 1.7倍高くなります。
喫煙は,あなたにとって脳卒中の危険性を高めます。
疫学的な推計によると,喫煙者は脳卒中により死亡す
る危険性が非喫煙者に比べて約 1.7 倍高くなります。
喫煙は,あなたにとって肺気腫を悪化させる危険性を
高めます。
及び第二に挙げられる次の警告文,
妊娠中の喫煙は,胎児の発育障害や早産の原因の一つ
となります。疫学的な推計によると,たばこを吸う妊
婦は,吸わない妊婦に比べ,低出生体重の危険性が約
2倍,早産の危険性が約 3倍高くなります。
たばこの煙は,あなたの周りの人,特に乳幼児,子供,
年寄りなどの健康に悪影響を及ぼします。喫煙の際に
は,周りの人の迷惑にならないように注意しましょう。
人により程度は異なりますが,ニコチンにより喫煙へ
の依存が生じます。
未成年者の喫煙は,健康に対する悪影響やたばこへの
依存をより強めます。周りの人から勧められても決し
て吸ってはいけません。
合計 8種類の警告文が設けられているものの,日本のた
1 各国におけるたばこ包装上の健康警告表示の例(a;健康警告表示,b;ブランド名)A)タイ,B)イタリア,CUK
D)日本,E)カナダ,F)フランス[写真画像及び引用文献 (27) より]
日衛誌 (Jpn. J. Hyg.)第70 巻 第 1号 2015 1
27
1 締約国におけるたばこ包装・健康警告表示に関する規制事項 (13)
たばこ包装上の健康警告表示 オースト
ラリア カナダ タイ マレーシア フランス イギリス 韓国 イタリア アメリカ ドイツ フィリピン 日本
1 包装上の健康被害警告表示の法的な義務はあるか Yes Yes Ye s Ye s Yes Ye s Ye s Yes Ye s Ye s Yes Ye s
2 包装の主要面に占める健康被害警告表示面積の割
合(%82.5 75 55a50 48 48 30 35 50 35 15 30
3 包装の主要面前面に占める健康被害警告表示面積
の割合(%75 75 55 40 43 43 30 30 50 30 30 30
4 包装の主要面後面に占める健康被害警告表示面積
の割合(%90 75 55 60 53 53 30 40 50 40 0 30
5 健康被害警告を包装の主要面上方に表示するよう
法的な規制 があるか Yes Ye s Ye s Yes No No No No Yes No No No
6 健康被害警告の文字の形式,大きさ,色について
の法的な規制があるか Yes Ye s Ye s Yes Ye s Ye s Yes Yes Ye s No No No
7
健康被害警告の効果・持続性を維持させるため,
常に最新の 多様な警告内容を並列的に交替で表示
しているか
Yes Ye s Ye s Yes Ye s Ye s Yes Yes Ye s Yes Yes Ye s
8 健康被害警告は国内の公用語で表示されているか Yes Yes Ye s Ye s Yes Ye s Ye s Yes Ye s Ye s Yes Ye s
9
たばこ警告表示が,納税印紙などの必要不可欠な,
いかなるマーキングによっても隠されてはいけな
いことが,法的に規制されているか
Yes Ye s No Yes Ye s Yes No Yes No No Yes Ye s
10 包装上の健康被害警告表示には写真や図が使用さ
れているか Yes Ye s Ye s Yes Ye s Ye s No No No No NobNo
11
健康警告表示はたばこ製品の個装その他の包装並
びにあらゆる外側の包装及びラベルに表示されて
いるか
Yes Ye s Ye s Yes Ye s Ye s No Yes Yes Ye s Ye s Yes
12
健康警告表示は,国内で製造されるもの,領内に
輸入されるもの,免税品を含む全てのたばこ製品
を対象に規制されているか
Yes Ye s Ye s Yes Ye s Ye s Yes Yes Ye s Yes Yes Ye s
13 たばこ警告表示が,たばこ産業の責務を減免する
ものではないことを法的に言及しているか No Yes No No No No No No No No No No
14 包装上の健康警告表示は,喫煙による健康被害を
表示しているか Yes Ye s Ye s Yes Ye s Ye s Yes Yes Ye s Yes Yes Ye s
15 特定の健康被害警告表示を法的に規制しているか Yes Ye s Ye s Yes Ye s Ye s Yes Yes Ye s Yes Yes Ye s
16 いくつの特定の健康警告表示が法的に義務付けら
れているか 14 16 10 6 16 16 1 16 9 17 4 8
17 健康被害警告に関する違反に関して法的な罰金が
要求または設立されているか Yes Ye s Ye s Yes Ye s Ye s Yes Yes Ye s Yes Yes Ye s
日衛誌 (Jpn. J. Hyg.)第70 巻 第 1号 2015 1
28
1 (続き)
たばこ包装上の健康警告表示 オースト
ラリア カナダ タイ マレーシア フランス イギリス 韓国 イタリア アメリカ ドイツ フィリピン 日本
18
包装上での健康影響に対する誤解を招く可能性の
ある“ロータール”“ライト”“ウルトラライト”
“マイルド”などの情報表示を禁止するよう法的
に規制されているか
Yes Ye s Ye s Yes Ye s Ye s No Yes Yes Ye s No No
19
健康影響に対して誤解を招く可能性のある図やサ
インまたは色や数字を含む包装及びラベルの使用
が法的に規制されているか
Yes No Ye s No Ye s Yes No Yes No Ye s No No
20
たばこの包装やラベル上に香味料を表す表現を使
用することができないことが法的に規制されてい
るか
Yes Ye s Ye s No No No Yes No No No No No
21
銘柄や商標の一部として使われる場合も含め,包
装上にたばこ主流煙の(タール,ニコチン,一酸
化炭素)イールド数値の表示を法的に禁ずること
が規制されているか
Yes
タール,
ニコチン,
CO 6種類
― ―
タール,
ニコチン,
CO
タール,
ニコチン,
CO
タール,
ニコチン
タール,
ニコチン,
CO
タール,
ニコチン,
CO
タール,
ニコチン
22 包装上にたばこの含有物や排出物に関する定量的
な情報を表示することが法的に規制されているか Yes Ye s Ye s Yes No No Yes No No No No No
23
たばこの含有物や排出物に関する定量的な情報を
包装の前後 主要面に記載することが法的に規制さ
れているか
No No No No Yes ―――――
24
包装上にたばこの安全性をほのめかす可能性を持
つ“消費期限”を表示することが法的に規制され
ているか
Yes No No No No No No No No No No No
25 クイットラインを包装上あるは商標と共に記載す
ることを法的に規制しているか Yes Ye s Ye s Yes Ye s No Yes No Ye s No No No
26 プレーンパッケージの使用が法的に規制されてい
るか Yes No No No No NocNo No No No No No
27 無煙たばこの販売を完全に禁ずるための国際的な
法律あるいは規制を取り入れているか No No Yes No No No No No No No No No
Yes の回答数 20 17 17 15 14 13 12 12 12 10 9 9
a 2014 72日に 85% へ変更。
b 2014 722 日に画像健康警告表示の導入に合意。
c 2015 年にプレーンパッケージ導入予定。
日衛誌 (Jpn. J. Hyg.)第70 巻 第 1号 2015 1
29
ばこ会社や特定の販売業者は,これら 8種類の中から各
1種類ずつ,計 2種類をたばこ包装の主要 2面へそれぞ
30% 以上の面積を使って表示することが義務付けら
れているだけである。画像による警告表示,文字や色,
表現などの規制もなく,未だ FCTC で求められる最低限
の条件を満たす警告表示に留まったままであることか
ら,日本のたばこ会社に対する国内外での対応の違いに
ついて反対する意見も多い。
2)外箱上での製品の含有物と排出量の表示
11 条では,たばこの外箱における健康被害警告表
示のラベル化に加え,「たばこ製品の関連のある含有物
及び排出物であって国内当局が定めるものについての情
報を含める」と記載されている (3)。これまで,日本の
財務省が所管するたばこ容器の包装に対する規定では,
パッケージ上にタール及びニコチンの排出量のみ表示す
ることが定められていた。これら値の表示は,他の多く
の国々においてもたばこ容器の包装に表示されており,
そのほとんどは,国際標準化機構(ISO)が定めた統一
された方法で測定されていることから,他国とのたばこ
製品を比較する上では有効な表示である。しかしながら,
これらの表示は,多くの消費者に対し,低いタールとニ
コチンの排出量が,曝露やリスクの低減を意味するなど
の誤った認識を招く危険性も懸念されている (28–32)。
たばこの吸い方は,個々人によってさまざまであり,低
タールと表示されたたばこを吸う場合には,無意識のう
ちに吸い方を変えている可能性も考えられ,他のたばこ
を吸う場合と同程度のニコチンを摂取している可能性も
高い (33)。このように,たばこを吸い込む深さや頻度
等については,個々人によってもさまざまであるため,
タール・ニコチンの排出量の表示のみでは,たばこの有
害性を評価することは不可能である。このようなことか
ら,第 11 条のガイドラインでも,「締約国は,包装及び
ラベルに,タール,ニコチンおよび一酸化炭素などのイー
ルド *の数値を表示することは,ブランド名または商標
の一部として使用される場合も含め禁止するべきであ
る」と勧告されている (4)。これを受け,多くの国々では,
パッケージ上における排出量の表示を取り除く動きが見
られ,特にオーストラリアでは,排出量の表示を禁止す
ることが法的にも規制されている(表 1,項 目 21。また,
代わりに特定の有害成分の情報を,その健康影響の説明
と共に表示することで (34),消費者に対して有害性を
伝える有効な手段として効果を示し (35),さまざまな
たばこブランドにおける相対的リスクに関する誤った認
識を招く危険性も回避できるものとして,高い評価が得
られている (29)。
3)誤解を招く包装情報の禁止
さらに,FCTC の第 11 条では,包装上での健康影響
に対する誤解を招く可能性のある情報表示を禁止するよ
う要求されている。light」,「 mild」,「 low tar」などの用
語は,本質的に消費者に誤解を与え,消費者の多くがこ
れらの製品に対して有害性が低く,禁煙がより容易であ
ると誤って認識する危険性を有していることから,現在
までに,50 ヶ国を超える国々が包装上にこれらの用語
を使用することを禁止してきた。また,マレーシアやタ
イなどの国々では,禁止用語のリストを拡大させる動き
も見受けられ,他の誤解を招くような表現cool」,
extra」,「 special」,「 smooth」,「 premium」,「 natural」)
についても禁止用語として挙げている。
一方,アメリカ,イギリス,カナダ,オーストラリア,
ニュージーランド等の国々では,light」や「 mild」等 の
用語を除くだけでは,たばこに対する人々の誤った認識
を回避させることは難しいと主張する声も多く,実際に,
人々が,たばこの外箱のデザインや色などによって,味
や香りのイメージの印象を受ける傾向が強いことが示さ
れている (36–39)。そのため,用語の禁止と併用して,
たばこのパッケージの統一化や下記に示すプレーンパッ
ケージの導入をより一層推進させる必要性も考えられる。
また,日本国内では,たばこ事業法施行規則 36 2
において,「会社又は特定販売業者は,low tar」 ,「 light」,
ultra light」又は「mild」その他のたばこの消費と健康
との関係に関して消費者に誤解を生じさせるおそれのあ
る文言を容器包装に表示する場合は,消費者に誤解を生
じさせないために,当該容器包装を使用した紙巻等たば
この健康に及ぼす悪影響が他の紙巻等たばこと比べて小
さいことを当該文言が意味するものではない旨を明らか
にする文言を,当該容器包装に表示しなければならない」
とも定められている。そのため,FCTC 11 条において,
誤った印象を生ずるおそれのある手段として使用が禁止
されている用語についても,日本では継続的な使用を認
める記述になっており,このことは,たばこ対策を進め
る上での妨げになる可能性もあることから,今後,使用
の可否について検討が必要と考えられる。
4.たばこプレーンパッケージ
先に述べたように,たばこの有害性に関する誤った認
識は,ブランドのイメージや色など,販売を促進させる
ような外箱表示の情報が関与している可能性が考えられ
る。特に,同系色の色合いや包装上での空白の割合は,
人々に対して,たばこ製品の強度や潜在的リスクの認識
を操作する可能性が高く,実際には,色とブランドイメー
ジを排除することで,各ブランドのリスクに対する誤っ
た確信が低減するという調査結果も報告されている
(38)。また,第 11 条施行のために発効されたガイドラ
インでは,たばこ製品特有の色使い・画像・マークなど
の使用が禁じられた「プレーンパッケージ」に関する勧
* 紙巻たばこのパッケージに表示されているタール○○ mg
ニコチン○○ mg という数字は,紙巻たばこ一本あたりの
「含有量」でなく,スモーキングマシンが一定の方法で吸引
した主流煙に含まれるタールとニコチン量である。正式には
yield(イールド:収量)と呼ばれる (33)。
日衛誌 (Jpn. J. Hyg.)第70 巻 第 1号 2015 1
30
告も含まれており,「締約国は,標準的な色とフォント
スタイルで表示されるブランド名および製品名以外のロ
ゴ,色,ブランドイメージ,または販売促進情報の使用
を制限または禁止する対策の採用を検討すべきである
(プレーンパッケージ)」(4) とされている。
オーストラリアは,2012 年に世界で最も早くプレー
ンパッケージを導入した国であり,オーストラリアのた
ばこのパッケージ表示は,単色無地で,ロゴ等も一切使
用せず,たばこ会社は商品名と社名のみを決まった色,
書体,サイズの文字で決まった場所に表示しなければな
らない。また,パッケージの表 4分の 3と裏全面には
たばこに関連する病気など,健康に対するたばこの害を
訴える警告画像を印刷することが要求されている
(図 2A。実際,このプレーンパッケージの導入は,オー
ストラリア国内の喫煙率の低下へも貢献しており,オー
ストラリアの喫煙率は2010 年から 2013 年の間に
15.1% から 12.8% にまで減少した (39)。このことからも,
プレーンパッケージは,たばこ対策を進める上で非常に
有効な手段と言える。イギリスでは,既に 2015 年から
プレーンパッケージの導入が決定されており,導入に向
けたたばこパッケージの指針案も発表されている
(図 2B。また,ニュージーランドやアイルランド等の
国でも法的な規制の設立を進める動きがあるなど (4),
導入を検討する国も徐々に増えてきている。その他
ASEAN 諸国や香港等のアジア (40),南米 (41) 等でも
試験的にプレーンパッケージを導入することで,若者か
ら成人まで幅広い喫煙者層に対する喫煙率の低下に効果
を示している。一方,オーストラリアでは,たばこ会社
が,プレーンパッケージの導入により不当に会社のト
レードマークを奪われたとして,このことが法律上での
知的財産権の侵害に値するとの理由から,オーストラリ
ア最高裁判所に対して異論を唱えた。結果として,裁判
所によりこれらの異論は受け入れられなかったものの,
たばこ会社は再度訴訟を引き起こし,プレーンパッケー
ジの使用義務への反論はより一層強まっている。
5まとめ
2005 年に WHO よりたばこ対策に関する FCTC が発
効されて以降,先進国をはじめとする世界各国では,喫
煙に対するさまざまなたばこ対策が進められてきた。中
でも,画像健康警告表示やプレーンパッケージ実施の先
駆けとなったカナダやオーストラリアでは,たばこ対策
におけるさまざまな規制を強化することで,喫煙率の低
下にも大きく貢献してきた。また,東南アジア等の途上
国においても,これらに続く対策が急速に進められてい
る。一方,日本国内では,FCTC に対応すべく「たばこ
事業法施行規則」による規制が定められているものの,
それらは FCTC で求められる最低限の条件を満たすのみ
であり,喫煙者の健康影響や禁煙の必要性に対する認識
も浅く,世界的にも高い喫煙率を維持したままである。
そのためにも,さまざまな媒体を通じて FCTC に基づい
たたばこ対策の情報を国民へ広く周知させていくと共
に,喫煙に関する教育・啓発にも力を注いでいく必要が
あり,日本は,経済面や産業面で最先端を進む国である
と共に,健康面や環境面においても先進的な力を発揮し
ていくため,FCTC の批准国として,たばこ対策をより
一層強力に進めていく必要がある。
謝   辞
本総説は,厚生労働科学研究費補助金(循環器疾患・
糖尿病等生活習慣病対策政策研究事業,たばこ規制枠組
み条約を踏まえたたばこ対策に係る総合的研究)の助成
を受けたものである。
本論文に関わる利益相反はない。
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... The effectiveness of health warnings on cigarette packs depends on many variables (e.g., content, placement on pack, presence or absence of pictorial, static vs. rotating messages)— one of which is size. Article 11 of the Framework Convention on Tobacco Control (FCTC), a treaty adopted by the World Health Organization to develop universal standards for tobacco control, emphasized the importance of warnings that cover at least 30% of the area of the two principal display panels [9]. The FCTC also noted the effectiveness of larger health warnings, covering more than 50% of the principal display areas, and urged parties to consider larger warnings [9]. ...
... Article 11 of the Framework Convention on Tobacco Control (FCTC), a treaty adopted by the World Health Organization to develop universal standards for tobacco control, emphasized the importance of warnings that cover at least 30% of the area of the two principal display panels [9]. The FCTC also noted the effectiveness of larger health warnings, covering more than 50% of the principal display areas, and urged parties to consider larger warnings [9]. These recommendations for larger health warnings have been supported with evidence from a recent review noting the effectiveness of larger health warnings [10] and evaluations of countries that have implemented larger health warnings [5, 11, 12]. ...
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A large body of evidence supports the effectiveness of larger health warnings on cigarette packages. However, there is limited research examining attitudes toward such warning labels, which has potential implications for implementation of larger warning labels. The purpose of the current study was to examine attitudes toward larger warning sizes on cigarette packages and examine variables associated with more favorable attitudes. In a nationally representative survey of U.S. adults (N = 5,014), participants were randomized to different warning size conditions, assessing attitude toward “a health warning that covered (25, 50, 75) % of a cigarette pack.” SAS logistic regression survey procedures were used to account for the complex survey design and sampling weights. Across experimental groups, nearly three-quarters (72%) of adults had attitudes supportive of larger warning labels on cigarette packs. Among the full sample and smokers only (N = 1,511), most adults had favorable attitudes toward labels that covered 25% (78.2% and 75.2%, respectively), 50% (70% and 58.4%, respectively), and 75% (67.9% and 61%, respectively) of a cigarette pack. Young adults, females, racial/ethnic minorities, and non-smokers were more likely to have favorable attitudes toward larger warning sizes. Among smokers only, females and those with higher quit intentions held more favorable attitudes toward larger warning sizes. Widespread support exists for larger warning labels on cigarette packages among U.S. adults, including among smokers. Our findings support the implementation of larger health warnings on cigarette packs in the U.S. as required by the 2009 Tobacco Control Act.
... 23 Improving W-L and W-MM from the minimal level to the complete level can reduce smoking prevalence. Japanese cigarette packaging warnings are inconspicuous, 24 in contrast with countries like Australia. Although labelling surface area has improved from 30% to 50% in 2020, the impact is likely small compared with graphic warnings. ...
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Objective This study aimed to quantify the long-term impact of implementing the WHO Framework Convention on Tobacco Control (FCTC) compliant tobacco control measures, MPOWER, on smoking prevalence and mortality in men and women aged ≥20 years in Japan. Design A Stock-and-Flow simulation model was used to project smoking prevalence and mortality from 2018 to 2050 under eight different scenarios: (1) maintaining the 2018 status quo, (2) implementation of smoke-free policies, (3) tobacco use cessation programmes, (4–5) health warning about the dangers of tobacco (labels, mass media), (6) enforcement of tobacco advertising bans or (7) tobacco taxation at the highest recommended level and (8) all these interventions combined. Results Under the status quo, the smoking prevalence in Japan will decrease from 29.6% to 15.5% in men and 8.3% to 4.7% in women by 2050. Full implementation of MPOWER will accelerate this trend, dropping the prevalence to 10.6% in men and 3.2% in women, and save nearly a quarter million deaths by 2050. This reduction implies that Japan will only attain the current national target of 12% overall smoking prevalence in 2033, 8 years earlier than it would with the status quo (in 2041), a significant delay from the national government’s 2022 deadline. Conclusions To bring forward the elimination of tobacco smoking and substantially reduce smoking-related deaths, the government of Japan should fulfil its commitment to the FCTC and adopt stringent tobacco control measures delineated by MPOWER and beyond.
... The article mandates the members to issue sizeable PHW on cigarette packaging in their country. [6] Indonesia is not yet a member of FCTC, but the Indonesian 2013 minister's policy shares the same spirit of the aforementioned article 11 regarding the use of PHW. [7] The depiction of PHW on cigarette packaging is proven effective to communicate the health risks posed by smoking, and the area size of the warning is correlated with its effectiveness. ...
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INTRODUCTION: Smoking is a significant health problem among Indonesian adolescents and adults. The Indonesian government had issued several policies to alleviate this problem, including placement of pictorial health warning (PHW) on cigarette package. There had been several evaluation studies regarding the effectivity of PHW in urban areas but none in rural areas. This study aims to evaluate the effectivity of PHW in motivating smoking cessation in a rural area in Indonesia. MATERIALS AND METHODS: This was a descriptive cross-sectional study conducted in August 2017 in Losari village, Indonesia. Respondents of this study were villagers aged 18–60 years who were active smokers and purchased cigarette with PHW on the package. The research instruments for this study were questionnaire and printout pictures of each PHW approved by the Indonesian government. RESULTS: There were 94 respondents recruited in this study. Among them, only 26 (27.7%) stated that PHW motivated them to stop smoking. From the five figures of PHW, a picture of lung cancer was the most effective PHW to motivate smoking cessation. Eighty-one of 94 respondents affirm that there are other factors besides PHW that might motivate them to stop smoking. Most of them agreed that an increase in cigarette price will force them to stop smoking. CONCLUSIONS: Current PHW used on cigarette package might be ineffective in motivating smoking cessation at Losari village. Further study with larger samples needs to be done to confirm this finding.
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Summary Points • The US states that have legalized retail marijuana are using US alcohol policies as a model for regulating retail marijuana, which prioritizes business interests over public health. • The history of major multinational corporations using aggressive marketing strategies to increase and sustain tobacco and alcohol use illustrates the risks of corporate domination of a legalized marijuana market. • To protect public health, marijuana should be treated like tobacco, not as the US treats alcohol: legal but subject to a robust demand reduction program modeled on successful evidence-based tobacco control programs. • Because marijuana is illegal in most places, jurisdictions worldwide (including other US states) considering legalization can learn from the US experience to shape regulations that prioritize public health over profits.
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The microbial compositions, quality characteristics, and structural changes in fresh brown rice noodles (FBRN) during storage were investigated. Total plate count and mold and yeast counts increased while the pH decreased during storage. Metagenomic sequencing revealed that the microbial composition of FBRN changed throughout storage. A comprehensive investigation of the variation in lipid content demonstrated that hydrolytic rancidity was responsible for lipid deterioration. LF-NMR showed an increase in the proportion of bound water and a decrease in the proportion of free water in FBRN. Moreover, significant changes in edible qualities were observed. The cooking loss increased three-fold and noodles hardness reduced by approximately 23%. Further, the high initial aldehyde content of FBRN diminished almost completely, while that of alcohols and esters increased, leading to significant flavor deterioration. The correlation and factor analysis suggested that the TPC and MY counts could be used as key indicators of FBRN deterioration.
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Japan is a high tobacco burden country with over 20 million smokers in 2017. Tobacco control measures in Japan has been criticised as largely inadequate and ineffective despite ratifying the World Health Organization's Framework Convention on Tobacco Control in 2004. Numerous factors such as pro-tobacco legislators, regulatory oversight of the primary Japanese tobacco company from the Ministry of Finance and industry interference on the policy-making process in Japan have prevented aggressive tobacco control efforts. Given the intricate challenges in Japan, it is important to develop feasible and effective smoking cessation strategies. In this paper, we have analysed the trends in tobacco prices, sale and smoking prevalence, major tobacco/smoking policies and some of the industry-related challenges that have prevented the development of effective tobacco control measures in Japan. We have emphasised the need for stronger implementation of the World Health Organization's Framework Convention on Tobacco Control and its MPOWER policy package and to separate the tobacco industry from the tobacco control policymaking process to promote cessation and abstinence from smoking and better sensitisation against exposure to second-hand smoke.
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Guided by the extended parallel process model (EPPM) and reactance theory, this study examined the relationship between efficacy beliefs, reactance, and adult smokers’ responses to pictorial health warning labels (HWL) on cigarette packaging, including whether efficacy beliefs or reactance modify the relationship between HWL responses and subsequent smoking cessation behavior. Four waves of data were analyzed from prospective cohorts of smokers in Australia and Canada (n = 7,120 observations) over a period of time after implementation of more prominent, pictorial HWLs. Three types of HWL responses were studied: psychological threat responses (i.e., thinking about risks from smoking), forgoing cigarettes due to HWLs, and avoiding HWLs. The results from Generalized Estimating Equation models indicated that stronger efficacy beliefs and lower trait reactance were significantly associated with greater psychological threat responses to HWLs. Similar results were found for models predicting forgoing behavior, although response efficacy was inversely associated with it. Only response efficacy was significantly associated with avoiding HWLs, showing a positive relationship. Higher self-efficacy and stronger responses to HWLs, no matter the type, were associated with attempting to quit in the follow-up period; reactance was unassociated. No statistically significant interactions were found. These results suggest that stronger efficacy beliefs and lower trait reactance are associated with some stronger responses to fear-arousing HWL responses; however, these HWL responses appear no less likely to lead to cessation attempts among smokers with different levels of self-efficacy to quit, of response efficacy beliefs, or of trait reactance against attempts to control their behavior. © 2016 James F. Thrasher, Kamala Swayampakala, Ron Borland, Gera Nagelhout, Hua-Hie Yong, David Hammond, Maansi Bansal-Travers, Mary Thompson, James Hardin
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In Japan, ultralow-nicotine cigarette brands with ventilation holes on the cigarette filters have been widely marketed to smokers. The use of these cigarette brands leads to compensation smoking. Menthol cigarette brands that have a cooling and numbing effect are also sold. In 2013, smokeless tobacco products similar to the Swedish snus, which is banned for sale in the European Union except in Sweden, were released in Japanese markets. These tobacco products have "toxicity," have a "ventilation filter," are "attractive," and promote "dependence." Tobacco smoke and smokeless tobacco are classified into "Group 1: Carcinogenic to humans" by the International Agency for Research on Cancer (IARC). The purpose of Articles 9 and 10 of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) is to regulate the contents of tobacco products as well as to regulate tobacco product disclosures. The implementation of some other articles has gradually advanced in Japan. However, that of Articles 9 and 10 is late. Japanese governmental authorities are being urged to immediately implement Articles 9 and 10.
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Article 11 of the World Health Organization's Framework Convention on Tobacco Control (FCTC) requires countries to implement health warnings on tobacco products. The Article 11 Guidelines advise countries to periodically rotate warnings to prevent "wearout" of the health warnings. This study investigates potential wearout of cigarette health warnings over a period of 9 years in 2 countries: Canada, where larger pictorial warnings were implemented approximately 1 year prior to the study, and in the United States, where small text-only warnings were in place for 17 years at the beginning of the study. Data were drawn from national samples of smokers from the International Tobacco Control (ITC) Surveys in Canada (N = 5,309), and the United States (N = 6,412) recruited originally by telephone using random digit dialing. Changes in 4 measures of health warning effectiveness and in a composite Labels Impact Index were examined over 8 waves of survey data (2002-2011). Analyses were conducted in 2012. The health warning effectiveness measures and the Labels Impact Index indicated that the effectiveness of both the Canadian, and the U.S. warnings declined significantly over time. The Canadian warnings showed greater declines in effectiveness than the U.S. warnings, likely due to the initial novelty of the Canadian warnings. Despite the greater decline in Canada, the Canadian pictorial warnings were significantly more effective than the U.S. text-only warnings throughout the study. Health warnings decline in effectiveness over time. Health warnings on tobacco products should be changed periodically to maintain effectiveness.
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Health warnings on tobacco packages are an effective strategy to inform the public about the harms associated with tobacco use. Most studies investigating the effectiveness of pictorial health warnings (PHWs) on cigarette packages are from high-income countries. This study evaluated the impact of PHWs on smokers' perceptions and behavior in Mauritius, the first country in the World Health Organization African region to implement PHWs. Data were drawn from 3 waves of a nationally representative cohort of adult smokers from the International Tobacco Control (ITC) Mauritius Survey (n = 668). Wave 1 was conducted in 2009, six months prior to the implementation of PHWs. Waves 2 and 3 were conducted 10-12 months and 20-21 months, respectively, postimplementation. Six established indicators of warning effectiveness were used to evaluate the effect of PHWs on smokers' perceptions and behavior. All indicators of warning effectiveness (salience, cognitive, and behavioral reactions) and the Label Impact Index, a weighted combination of 4 indicators, increased significantly between Waves 1 and 2. However, between Waves 2 and 3, there was a significant decline in the proportion of smokers reporting "avoiding looking" at labels. This study found that implementation of PHWs in Mauritius significantly enhanced the effectiveness of warnings, illustrating their value for other countries, particularly in Africa, at an early stage in tobacco control. The study also demonstrates the importance of revising PHWs to counteract wearout. The introduction of PHWs in Mauritius clearly demonstrates the benefits of employing an evidence-based approach to strengthen tobacco control policies.
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In 2011, the Food and Drug Administration published a final rule requiring cigarette packages and advertisements to include graphic health warning labels (HWLs) with new warning statements. Implementation of this rule has been stalled by legal challenge. This study assessed correlates of smoking-related intentions related to graphic HWLs among current cigarette smokers and nonsmokers in a national sample of U.S. young adults aged 18-34. Data were collected from 4,236 participants aged 18-34 using an online panel in January 2012 for the Legacy Young Adult Cohort Study. Analyses were weighted to provide nationally representative estimates. Our main outcome was assessed with a single item: "Do you think that new warning labels with graphic pictures would make you think about not smoking?" Twenty-two percent of the young adults were current cigarette smokers. Fifty-three percent endorsed that new graphic HWLs would make them think about not smoking (40% among current smokers compared with 56% among nonsmokers). Among nonsmokers, those aged 18-24, females, Hispanics, and those who were aware of graphic cigarette HWLs were more likely to report intention to not smoke related to graphic HWLs. Among current smokers, intending to quit within the next 6 months was correlated with intention resulting from graphic HWLs. Hispanic ethnicity and intention to quit within 30 days were strong correlates of intention in light, nondaily, and self-identified social/occasional smokers. This study supports previous findings that graphic HWLs play an important role in preventing smoking, in addition to encouraging cessation in young adults.
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Tobacco endgame policies are increasingly advocated to end tobacco use. This study investigated public support for a total ban on tobacco sales, use and possession in Hong Kong. A telephone survey was conducted among 1537 randomly selected residents in 2012 to assess their support for a total ban on tobacco sales, usage and possession. Information on sociodemographic characteristics, smoking, and second hand smoke exposure were collected. Logistic regression was used to investigate factors associated with support for a total ban. Most of the never smokers (75.3%), ex-smokers (63.9%), and nearly half of current smokers (48.9%) backed some form of a total ban on tobacco. A total ban on tobacco sales was the most popular option among the three groups, with over half (64.8%) of all respondents supporting a ban within 10 years. Current smoking and higher educational attainment were associated with less support for a total ban on tobacco sales. Among current smokers, having quit intentions and attempts to quit were associated with support for a total ban. A total ban on tobacco sales was supported by most respondents. Ex-smokers and current smokers also voiced substantial support, although less than never smokers. A total ban on tobacco sales before 2022 should be the goal as it is supported by most of the respondents. Interim tobacco control measures, such as tax increases, expansion of smoking cessation services and plain packaging should be implemented to help current smokers quit and reduce smoking initiation before implementation of the ban.
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On August 24, 2012, in R.J. Reynolds Tobacco Company v. Food and Drug Administration, the U.S. Court of Appeals for the District of Columbia ruled that the regulations proposed by the Food and Drug Administration (FDA) mandating the inclusion of graphic warnings on cigarette packs (see photo) violated the First Amendment: they would compel companies to express antitobacco messages on their own dime. Seven months later, on March 14, 2013, the Department of Justice announced that the government would not appeal that decision to the Supreme Court. In explaining the decision not to defend the regulations, which had been developed . . .
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In the past, constitutional principle gave the government broad authority to regulate tobacco or pharmaceutical advertising. The state's power to safeguard the public health was strong, and companies' freedom to plug their products was weak. But the Supreme Court has changed course. Whereas it once did not view "commercial" speech as the kind of speech the First Amendment protects, it now gives businesses nearly the same rights to market their goods as it does individuals to speak their minds. And as the Court has broadened corporate freedom to advertise, it has narrowed governmental power to preserve the public's health. Whereas . . .