Packs of 10 cigarettes, considered popular among younger smokers, will also be banned.

Fourteen EU states already have 20 as the minimum, four stipulate a minimum of 19, and in the UK and Italy the minimum is 10.

Smaller than normal packs of roll your own tobacco will still be allowed under the new rules.

It was the European Parliament’s first reading of a draft tobacco directive which could become law in 2014. It would then take two more years to become law in each of the 28 EU member states.

There has been intense lobbying of MEPs by the tobacco industry and health campaigners.

The Commission says almost 700,000 Europeans die from smoking related illnesses each year equal to the population of Frankfurt or Palermo. The costs for healthcare in the EU are estimated to be at least 25.3bn euros ( 20.6bn $33.4bn) annually.

Mixed reactions

Conservative and Liberal MEPs welcomed the amendments made to the original proposal from Labour’s Linda McAvan.

Speaking to the BBC, Ms McAvan said she was disappointed that slim cigarettes were not banned.

But cigarette packaging made to look like lipstick or perfume containers attractive to girls will disappear, she noted.

There will now be further negotiations with the Council the grouping of relevant EU ministers. MEPs may manage to avoid a second vote and fast track the legislation so that it is adopted before the May 2014 European elections.

The proposals also include a ban on words like “light”, “mild” and “low tar”, deemed to be misleading, and a ban on oral tobacco called snus although Sweden would retain its exemption.

EU Health Commissioner Tonio Borg called the vote “positive”. “I am confident that the revised Directive on Tobacco Products can still be adopted within the mandate of the current Parliament,” he said.

But Carl Schlyter MEP, health spokesman for the Greens, called it “a shameful day for the European Parliament, as a centre right majority, led by the EPP group, has done the bidding of the tobacco industry and voted for weaker rules”.

E-cigarettes, hookahs gain popularity among us youth

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The report shows that hookah use among high school students rose to 5.4% in 2012, from 4.1% in 2011. A hookah is a bowl shaped device with a pipe for inhaling tobacco smoke. And it shows electronic cigarette use among middle school students rose to 1.1% in 2012, from 0.6% in 2011, and increased to 2.8% among high school students, from 1.5%. Electronic cigarettes are battery operated devices that look like regular cigarettes. An atomizer heats a solution of liquid, flavorings, and nicotine that creates a mist that is inhaled.

In 2012, the report shows cigars were the most commonly used form of tobacco after cigarettes for middle school students (2.8%) and high school students (12.6%). In addition, African American high school students cigar use in 2012 increased dramatically, to 16.7%, from 11.7% in 2011 and has more than doubled since 2009. Cigars include traditional premium cigars, cigarillos, and “little cigars,” which look like cigarettes, but are more affordable to teens because they are taxed at lower rates and can be sold individually, rather than by the pack. They also appeal to youth because they are often made with fruit and candy flavors that are banned from cigarettes. A CDC study published last month showed more than one third of middle and high school students who smoke cigars smoke flavored little cigars.

Electronic cigarettes, hookahs, cigars and certain other new types of tobacco products are not currently subject to regulation by the US Food and Drug Administration (FDA). According to the CDC, the increase in the use of electronic cigarettes and hookahs could be due to an increase in marketing, availability, and visibility of these tobacco products and the perception that they may be safer alternatives to cigarettes. The FDA has announced it is taking steps to regulate products meeting the legal definition of a “tobacco product” to be subject to the Federal Food, Drug, and Cosmetic Act.

The CDC says its findings indicate that more efforts are needed to monitor and prevent all young people from taking up the use of both conventional and non conventional forms of tobacco.

“A large portion of kids who use tobacco are smoking products other than cigarettes, including cigars and hookahs, which are similarly dangerous”, said Tim McAfee, MD, MPH, director of the CDC s Office on Smoking and Health. “As we close in on the 50th anniversary of the first Surgeon General s report on the dangers of smoking, we need to apply the same strategies that work to prevent and reduce cigarette use among our youth to these new and emerging products.”

Citation Tobacco Product Use Among Middle and High School Students United States, 2011 and 2012. Published November 15, 2013 in Morbidity and Mortality Weekly Report. First author Ren A. Arrazola, MPH, Centers for Disease Control and Prevention, Atlanta, Ga.

Reviewed by Members of the ACS Medical Content Staff

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