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Smoking costs global economy over US$1 trillion a year: study

http://www.ejinsight.com/20170110-smoking-costs-global-economy-over-us1-trln-a-year-says-new-study/

Smoking costs the global economy more than US$1 trillion a year, and will kill one third more people by 2030 than it does now, according to a new report released on Tuesday.

The World Health Organization and the US National Cancer Institute said in a study that the costs from smoking far outweigh global revenues from tobacco taxes, Reuters reports.

“The number of tobacco-related deaths is projected to increase from about 6 million deaths annually to about 8 million annually by 2030, with more than 80 percent of these occurring in LMICs (low- and middle-income countries),” the study said.

Around 80 percent of smokers live in such countries, and although smoking prevalence was falling among the global population, the total number of smokers worldwide is rising, it said.

Health experts say tobacco use is the single biggest preventable cause of death globally.

“It is responsible for… likely over $1 trillion in health care costs and lost productivity each year,” said the study, peer-reviewed by more than 70 scientific experts.

The economic costs are expected to continue to rise. Although governments have the tools to reduce tobacco use and associated deaths, most have fallen far short of using those tools effectively, WHO said in the report.

“Government fears that tobacco control will have an adverse economic impact are not justified by the evidence. The science is clear; the time for action is now.”

Cheap and effective policies include hiking tobacco taxes and prices, comprehensive smoke-free policies, complete bans on tobacco company marketing, and prominent pictorial warning labels.

Tobacco taxes could also be used to fund more expensive interventions such as anti-tobacco mass media campaigns and support for cessation services and treatments, it said.

Governments spent less than US$1 billion on tobacco control in 2013-2014, according to a WHO estimate.

– Contact us at english@hkej.com

The effect of pack warning labels on quitting

The effect of pack warning labels on quitting and related thoughts and behaviours in a national cohort of Aboriginal and Torres Strait Islander smokers

Anna Nicholson, GDipPH, BPhty(Hons) PhD Ron Borland, PhD Pele Bennet, BHSc Maureen Davey, MB BS FAFPHM Jasmine Sarin, BHSci(Indig Hlth) Anke Van der Sterren, MPH MA BA Matthew Stevens, PhD David Thomas, MB BS PhD FAFPHM

https://academic.oup.com/ntr/article-abstract/doi/10.1093/ntr/ntw396/2871245/The-effect-of-pack-warning-labels-on-quitting-and

Abstract

Introduction:

The high prevalence of smoking among Aboriginal and Torres Strait Islander people in Australia (39%) contributes substantially to health inequalities. This study assesses the impact of warning labels on quitting and related thoughts and behaviours for Aboriginal and Torres Strait Islander smokers.

Methods:

Participants were recruited from communities served by 34 Aboriginal Community Controlled Health Services and communities in the Torres Strait, Australia, using quota sampling. A cohort of 642 daily/weekly smokers completed relevant questions at baseline (April 2012-October 2013) and follow up (August 2013-August 2014).

Results:

We considered three baseline predictor variables: noticing warning labels, forgoing cigarettes due to warning labels (‘forgoing’) and perceiving labels to be effective.

Forgoing increased significantly between surveys only for those first surveyed prior to the introduction of plain packs (19% vs. 34%), however there were no significant interactions between forgoing cigarettes and the introduction of new and enlarged graphic warning labels on plain packaging in any model. Forgoing cigarettes predicted attempting to quit (AOR: 1.45, 95% CI: 1.02-2.06) and, among those who did not want to quit at baseline, wanting to quit at follow-up (AOR: 3.19, 95% CI: 1.06-9.63).

Among those less worried about future health effects, all three variables predicted being very worried at follow-up. Often noticing warning labels predicted correct responses to questions about health effects that had featured on warning labels (AOR: 1.84, 95% CI: 1.20-2.82) but not for those not featured.

Conclusions:

Graphic warning labels appear to have a positive impact on the understanding, concerns and motivations of Aboriginal and Torres Strait Islander smokers and, through these, their quit attempts.

IMPLICATIONS

Graphic warning labels are likely to be effective for Aboriginal and Torres Strait Islander smokers as they are for the broader Australian population.

E-cigarette flavours pose unknown harm risk

http://medicalxpress.com/news/2017-01-e-cigarette-flavours-pose-unknown.html

Electronic cigarette users are more at risk of lung damage if they use flavourings such as menthol and butterscotch, according to a new study by scientists at the University of Salford.

Scientists say that ‘vaping’ flavours contain toxins, including harmful substances that are not inhaled by users of standard tobacco cigarettes.

And they claim the huge variety of non-standard vaping liquids is exposing people, particularly younger smokers, to unknown risks.

Studies have shown that vaping liquids contain aldehydes, compounds which can cause damage to lungs, but the Salford study is the first to test flavoured liquids – inhaled as ‘smoke’ – on normal lung tissue.

All proved toxic

“We are talking about flavours which are normally ingested in food where tissue is much different from tissue in the lungs,” explains Dr Patricia Ragazzon of the Biomedical Research Centre at the University of Salford.

“When inhaled, some of the flavours we tested proved to be substantially toxic, with prolonged exposure killing bronchial cells completely.”

The experts, who publish their findings in the journal Scientific Progress, studied 20 liquid refills in nine flavours – cherry, strawberry, ice-mint, menthol, tobacco, blueberry, vanilla, bubble-gum and butterscotch – bought from shops, chemists and over the internet.

In laboratory tests on cell lines of human bronchial tissue, both embryonic and adult cells were exposed to vapour at a range of concentrations over 24, 48 and 72 hours. All proved toxic to the cells varying from less toxic (fruit flavours) to moderately to highly toxic (menthol, bubblegum, coffee, butterscotch and tobacco).

“We showed that cells can recover after 48 hours but not once they were exposed for 72 hours or more, which has serious implications for regular smokers,” said Dr Ragazzon.

Unregulated products

Moreover whilst adult cells were less impacted, the majority of samples proved moderately to highly toxic to the embryonic cells.

Of additional concern, she notes, is the huge variation of flavours and their component ingredients: “The composition of refills is highly irregular – some are natural flavours, some are single compounds, some are synthetic flavours, – there are so many varied products on the market, it’s difficult to gauge their harmfulness,” added Dr Ragazzon.

“Our work supports the opinion that e-cigarettes and especially the ingredients of the e-liquid, which can change in structure after the process of heating, have not been thoroughly characterised or evaluated for safety.”

E-cigarettes ‘slow sperm and kill off cells in a man’s balls – and THESE are the dangerous flavours’

Cinnamon flavour are slowing sperm down and bubblegum flavour is killing off cells in the testes, scientists have revealed

https://www.thesun.co.uk/living/2549322/e-cigarettes-damage-a-mans-fertility-and-these-flavours-are-the-most-dangerous/

E-CIGARETTES could reduce a bloke’s chances of becoming a dad, experts have warned.

Toxic chemicals in the flavourings used in the devices have been found to damage a man’s fertility, new findings suggest.

In particular cinnamon flavoured e-cigs were found to make sperm slower swimmers, the latest study to raise health concerns about the devices found.

And, another popular flavour, bubblegum, kills off cells in the testicles which help produce sperm.

There are more than 2.6 million users of e-cigarettes in the UK, but experts warn the devices are not as safe as people may think.

Researchers at University College London found, even when no nicotine is included, e-cigarette flavourings could affect men’s chances of starting a family, the Daily Mail reported.

It is widely accepted, and backed up by scientific evidence, that regular cigarettes damage the DNA in sperm.

But, until now the dangers posed by e-cigs were not known.

The devices are sold and marketed as a healthier alternative to smoking, and used by many to try and stop their habit.

However, concerns have been raised that while the devices are useful to smokers wanting to quit, they are acting as a gateway, encouraging non-smokers to take up the dangerous habit.

The latest study comes after scientists at the University of Salford found e-cigarette flavourings like butterscotch and menthol kill of bronchial cells in the lungs, increasing the risk of damage.

The experts studied 20 liquid refills in nine flavours – cherry, strawberry, ice-mint, menthol, tobacco, blueberry, vanilla, bubble-gum and butterscotch – bought from shops, chemists and over the internet.

NO SMOKE WITHOUT FIRE

E-cigarettes STILL damage teenage health – even if they don’t lead to tobacco use

In tests on human lung tissue, both embryo and adult cells were exposed to vapour at a range of concentrations over 24, 48 and 72 hours.

All proved toxic to the cells, with fruit flavours having less impact than other flavours, the researchers noted.

Now, scientists fear the devices are harming mens’ fertility.

Dr Helen O’Neill, who presented her findings at the British Fertility Conference in Edinburgh yesterday, said chemicals such as coumarin, a cheaper version of cinnamon bark and found in e-cig liquids, are “damaging to sperm”.

She said: “In terms of motility, progression and concentration of sperm, there was a detrimental effect.

“Vaping is less harmful than conventional cigarettes, but nonetheless they are not without their harmful effects,” the Mail reported.

To arrive at their findings Dr O’Neill and her colleagues took sperm samples from 30 men.

The researchers then exposed the samples to two flavours of e-cig liquid – cinnamon and bubblegum.

They found the bubblegum flavour was found to be most damaging to the testicles, causing a condition called apoptosis, where cells are killed off.

Meanwhile, sperm exposed to high concentrations of the cinnamon flavour chemicals were found to be slower swimmers.

There are currently around 7,000 different e-cigarette flavours available to buy.

Yet, Dr O’Neill and her colleagues warn in their study: “Presently, there are no regulations on the use of these products.”

Many are only regulated as foodstuffs, based on being consumed rather than inhaled.

Public Health England has endorsed the use of e-cigarettes to help smokers to quit the habit with 20,000 citing them as helping them to quit in 2014.

Vaping is less harmful than conventional cigarettes, but nonetheless they are not without their harmful effects

Dr Helen O’NeillUniversity College London

But Action on Smoking and Health has called for e-cigarettes to be treated like other lit tobacco products until there is firm scientific evidence that they are not harmful.

Researchers at the University of Salford found after more than 72 hours of exposure to e cigarette chemicals, cells in the lungs did not recover.

Dr Patricia Ragazzon of the biomedical research centre at the university said: “We are talking about flavours which are normally ingested in food where tissue is much different from tissue in the lungs.

“The composition of refills is highly irregular – some are natural flavours, some are single compounds, some are synthetic flavours, – there are so many varied products on the market, it’s difficult to gauge their harmfulness.

“Our work supports the opinion that e-cigarettes and especially the ingredients of the e-liquid, which can change in structure after the process of heating, have not been thoroughly characterised or evaluated for safety.”

Both studies called for further research into the harmful effects of electronic cigarettes and better regulation of the devices internationally.

Salford study reveals toxicity of different ‘vaping’ flavours on lung tissue

http://www.news-medical.net/news/20170105/Salford-study-reveals-toxicity-of-different-vaping-flavours-on-lung-tissue.aspx

Electronic cigarette users are more at risk of lung damage if they use flavourings such as menthol and butterscotch, according to a new study by scientists at the University of Salford.

Scientists say that ‘vaping’ flavours contain toxins, including harmful substances that are not inhaled by users of standard tobacco cigarettes.

And they claim the huge variety of non-standard vaping liquids is exposing people, particularly younger smokers, to unknown risks.

Studies have shown that vaping liquids contain aldehydes, compounds which can cause damage to lungs, but the Salford study is the first to test flavoured liquids – inhaled as ‘smoke’ – on normal lung tissue.

All proved toxic

“We are talking about flavours which are normally ingested in food where tissue is much different from tissue in the lungs,” explains Dr Patricia Ragazzon of the Biomedical Research Centre at the University of Salford.

“When inhaled, some of the flavours we tested proved to be substantially toxic, with prolonged exposure killing bronchial cells completely.”

The experts, who publish their findings in the journal Scientific Progress, studied 20 liquid refills in nine flavours – cherry, strawberry, ice-mint, menthol, tobacco, blueberry, vanilla, bubble-gum and butterscotch – bought from shops, chemists and over the internet.

In laboratory tests on cell lines of human bronchial tissue, both embryonic and adult cells were exposed to vapour at a range of concentrations over 24, 48 and 72 hours. All proved toxic to the cells varying from less toxic (fruit flavours) to moderately to highly toxic (menthol, bubblegum, coffee, butterscotch and tobacco).

“We showed that cells can recover after 48 hours but not once they were exposed for 72 hours or more, which has serious implications for regular smokers,” said Dr Ragazzon.

Unregulated products

Moreover whilst adult cells were less impacted, the majority of samples proved moderately to highly toxic to the embryonic cells.

Of additional concern, she notes, is the huge variation of flavours and their component ingredients: “The composition of refills is highly irregular – some are natural flavours, some are single compounds, some are synthetic flavours, – there are so many varied products on the market, it’s difficult to gauge their harmfulness,” added Dr Ragazzon.

“Our work supports the opinion that e-cigarettes and especially the ingredients of the e-liquid, which can change in structure after the process of heating, have not been thoroughly characterised or evaluated for safety.”

Starting with e-cigs triples odds of starting cigarettes among college students; the evidence just keeps piling up

Tory Spindle and colleagues at VCU recently published a study, “Electronic cigarette use and uptake of cigarette smoking: A longitudinal examination of U.S. college students,” that followed 3757 students at Virginia Commonwealth University for a year to examine the relationship between e-cigarette use among never cigarette smokers at the beginning and whether they were smoking conventional cigarettes a year later. They found, controlling for a wide range of demographic and behavioral variables, that e-cigarette users at baseline were about 3.4 times as likely to be smoking cigarettes a year later as young adults who were not using e-cigarettes.

This effect is consistent with a similar study of young adult males in Switzerland as well as all the studies of adolescents.

Here are the highlights and the abstract:

HIGHLIGHTS

• E-cig and cigarette use has not been studied in college students longitudinally.
• Ever and current e-cig use increased non-smokers chances of trying cigarettes.
• Historically internalizing/externalizing factors predict cigarette uptake strongly.
• Most internalizing/externalizing factors examined did not predict e-cig uptake.
• Males and marijuana users were more likely to initiate e-cig use.

ABSTRACT

Introduction:

Electronic cigarette (e-cigarette) use prevalence is increasing among U.S. adolescents and adults but recent longitudinal data for college/university students are scarce.

Furthermore, the extent that e-cigarette use is associated with the onset of cigarette smoking and the factors that lead to the uptake of ecigarettes in college students has not been explored.

Methods:

3757 participants from a Mid-Atlantic university (women: 66%; White: 45%; Black: 21%; Asian: 19%; Hispanic/Latino: 6%) were surveyed in 2014 and again in 2015.

Results:

Among participants reporting never smoking at time 1, those who had ever tried e-cigarettes or were currently using e-cigarettes (at least one use in past 30 days) were more likely to have ever tried cigarettes by time 2 relative to individuals who had not used e-cigarettes. Ever use of e-cigarettes (but not current use) also increased participants’ likelihood of being current cigarette smokers at time 2. Among initial never users of e-cigarettes or cigarettes, males and ever marijuana users had an increased probability of trying e-cigarettes by time 2. Furthermore, less perseverance (an index of impulsivity) and ever use of other tobacco products increased initial never users’ chances of trying both cigarettes and e-cigarettes by time 2.

Conclusions:

Given that never-smoking participants who had tried e-cigarettes were more likely to initiate cigarette use later, limiting young adults’ access to these products may be beneficial. As the long-term health implications of e-cigarette use become clearer, predictors of e-cigarette use could help identify future populations likely to use and abuse these products.

Here is the full citation: Spindle, et al. Electronic cigarette use and uptake of cigarette smoking: A longitudinal examination of U.S. college students. Addictive Behaviors 2017; 67:66-72. http://dx.doi.org/10.1016/j.addbeh.2016.12.009

 

The price of Africa’s puff

It is still one of the biggest businesses in Africa despite all the efforts from the government trying to stamp it out. The tobacco industry makes over $700 billion a year and seems to survive advertising bans and restrictions. Part of this business is African children who work for a dollar a day. The article below first appeared in Forbes Africa and is republished with its permission. Subscribe today by contacting Shanna Jacobsen Shanna.Jacobsen@abn360.com

http://www.cnbcafrica.com/news/special-report/2017/01/05/africa-cigarettes-and-smoking/

It’s 5am in the northern hills of Malawi where its tobacco is grown. Chifundo Ndilowe is awake and ready for the day. Dressed in grey shorts and a blue NBA vest, still filthy from yesterday’s long day on the farm, Ndilowe has hours of hard labour ahead. He is just 15 years old and has been planting and picking tobacco since he was 10.

“I came here in 2011 because rural life is hard. We were battling at home and I had to start contributing for us to survive. I stopped going to school to work. It is very tough working under these conditions because it is hot and we easily get tired and I am often sick,” he says.

Ndilowe moved 567 kilometres from Mulanje to Mpherembe, 300 kilometres north of Malawi’s capital, Lilongwe, to work in a tobacco farm five years ago. It means long hours, missing school and breaking the law for little pay. He earns a little more than $140 and $280 a year depending on the harvest. That’s less than $1 a day.

“We work for the year and only get paid after harvest. During the year, we get 20 kilograms of maize for 12 days because we don’t grow crops for consumption. They also give us salt and then we have to figure out the rest ourselves. I get to eat once a day and I take whatever is there,” he says.

Ndilowe is just one of an estimated 800,000 youngsters in the tobacco fields; voices that are seldom heard. One of an army of children who sweat for millions of cigarettes lit all over Africa.

A study on child labour in the tobacco industry in two areas of Malawi, Suza in the Kasungu district and Katalima in the Dowa district, found 57% of all children were being used as child labour in the tobacco fields.

George Kube, an adult tobacco worker, works with Ndilowe and two other children.

“There is no money for the children to go to school and if they don’t work to help we wouldn’t survive. We farm on two acres of land and the produce is auctioned to tobacco companies. You have to be very strong if you are going to do this job because sometimes we have to cut down trees and look for water,” says Kube.

A study, published by the British Medical Association, says contract farmers, like Kube and Ndilowe, cultivating tobacco in Malawi, live below national poverty lines, while independent farmers operate at a loss.

“Even when labour is excluded from the calculation of income less costs, farmers’ gross margins place most households in the bottom income [groups] of the overall population. Tobacco farmers appear to contract principally as a means to obtain credit, which is consistently reported to be difficult to obtain,” says the study.

Tobacco farmers may struggle to make a living but tobacco manufacturers thrive. The world tobacco industry is worth billions of dollars. Cigarette retail values in 2014 were worth US$744 billion and over 5.6 trillion cigarettes were sold to more than one billion smokers according to the Campaign for Tobacco-Free Kids. But, very few farmers make money from it.

The market is controlled by a few international companies; China National Tobacco Corporation, Philip Morris International, British American Tobacco, Japan Tobacco International and Imperial Brands. They buy tobacco from cheap emerging markets, like Malawi, for profit.

For years, governments around the world have been trying to clamp down on smoking because of its health implications, through stringent laws and higher taxes, yet tobacco use is increasing in some countries, says Zambian economist Grieve Chelwa.

“African incomes have been rising over the last couple of years and we know that tobacco consumption responds to rising incomes. Further, tobacco companies have put in place strategies (subtle advertising) to take advantage of rising incomes.”

And they flourish.

In 2016, British American Tobacco (BAT) announced its revenue went up 8.1% at constant rates of exchange, cigarette volume from subsidiaries was 497 billion, up by 2.2%, cigarette market share in key markets increased by 40 basis points and its brands performed exceptionally well with cigarette volume up 9.8% year ending September 30.

BAT plans to merge with its US partner R.J. Reynolds Tobacco Company, the company behind the famous camel cigarette brand, in a deal valued at $47 billion. It hopes to create a stronger global presence and move into new ventures like e-cigarettes.

In its third quarter, Philip Morris International reported net revenues of $19.9 billion, up by 2.6%, net revenues, excluding excise taxes, of $7 billion, up by 0.8%, operating income of $3 billion, up by 0.6%, and operating company’s income of $3.1 billion, up by 1.2%. In Africa, companies thrive because of weak regulation.

The World Health Organization (WHO) has a 75% benchmark of tax on the retail price, yet the African average is way below. Nigeria taxes cigarettes at only 20% of the retail price. Chelwa says ideally increasing taxes to reduce tobacco use should work anywhere because of the law of demand, increasing price reduces demand.

“But, the important point is the increases have to be real-inflation adjusted increments,” he says.

In Africa, high tobacco taxes are rare. WHO says only 33 countries, with 10% of the world’s population, have introduced taxes on tobacco products of more than 75%.

Tobacco tax revenues are on average 269 times higher than spending on tobacco control.

Tobacco companies are also good at finding new markets, with new smokers and weak regulations. According to an article published by The Lancet, a UK medical journal, tobacco use is declining in higher income countries, but nearly 80% of the world’s smokers live in low and middle income countries.

“Tobacco control regulations are not strong across most of the continent. Countries have ratified the Framework Convention on Tobacco Control (FCTC) but that’s all they have done. And sadly the tobacco industry is an important player in the setting of tobacco control policy in most African countries,” says Chelwa.

For years, tobacco companies argue they market merely to convince smokers to switch brands, but evidence published by the National Center for Biotechnology Information shows advertising drives smoking.

According to a WHO study, smoking has increased in 27 countries over the past 15 years. Seventeen of these are in Africa. In Cameroon, smokers more than doubled from 7% in 2000 to 22% last year. Congo-Brazzaville has seen the biggest spike. Nearly half of Congolese men smoke. Last year, 22% of its people admitted to smoking regularly, up from 6% in 2000.

“Only 42 countries, representing 19% of the world’s population, meet the best practice for pictorial warnings, which includes the warnings in the local language and cover an average of at least half of the front and back of cigarette packs,” says WHO.

In South Africa, cigarette advertising is banned. There are also restrictions on point of sale product display, vending machines and sponsorship of events, activities, individuals, organizations or governments. Now, Health Minister Aaron Motsoaledi has pledged to take it further by strengthening the Tobacco Products Control Act.

Motsoaledi says there should be no branding, no logos and no colors on cigarettes to discourage smoking. If the law is introduced, all cigarettes will be in a brown package with graphics that show the damage they can cause.

This is worrying for the tobacco industry. Christo van Staden heads the only primary tobacco processing factory in South Africa, Limpopo Tobacco Processors, that processes 12 million kilograms of tobacco. He says the effects could be catastrophic.

“The biggest impact [of tougher regulations] is the increase in illicit cigarettes which is a huge dent in the business of BAT and in the whole market. About 20 to 30 percent of cigarettes in Gauteng are illicit and they are paid way below the price,” he says.

As we meet, in Rustenburg, a two-hour drive from Johannesburg, Van Staden’s farmers have lost 30 hectors of tobacco to a passing storm. On this day, the sun blazes down from a cloudless azure sky. A sprinkler keeps the glossy lawns and flowers alive. Inside the factory, it is dark and you can hear a pin drop. The silence is almost tangible. There is no bustle and machines that usually crackle stand still. It is not tobacco season. All employees are upstairs in the offices working. Dressed in khaki shorts and shirt, Van Staden says tobacco farming is hard.

“For every hector, you need two people to work there and pick it by hand, it is very expensive. One hector costs about R130,000 ($9,500) to plant and the farmer needs to make at least 20 to 25 percent profit. Last year was a very tough year. There were very tough conditions and an average farmer did not make any profit at all.”

“Now they are supporting the local market but if they don’t get any benefit out of that, they have to compete with everyone else in plain packaging, then there is no reason for them to buy South African tobacco, they will literally walk out of here overnight and source their product from Brazil, India and China where they can buy a lot cheaper.

We are not ready for that. We would close these doors,” he says.

For Van Staden, closing doors means 10,000 farmers lose their income. He thinks there should be more education about the dangers of tobacco and efforts to keep youngsters away from smoking.

“I am a non-smoker and will not advise anyone to smoke. Most of my staff members don’t smoke. Unfortunately, people smoke everyday but see the warning on the packets and turn a blind eye. Because it’s such an unhealthy product, the governments around the world will try and eradicate it but I don’t think it will happen in the next 20 years. There are laws in this country that allow people to smoke and to close down the primary sector is not going to stop smoking overnight,” adds Van Staden.

South Africa will follow the UK, Ireland, Australia and France in banning branded packaging.

In Uganda, 4,800 kilometres from South Africa, it’s even tougher. If you light up in bars, restaurants or hotels, you will be fined $60 or jailed for up to two months.

Smokers must be at least 50 meters away from public spaces, such as schools, hospitals and taxi ranks.

Uganda’s new laws also ban the sale of electronic cigarettes, flavoured tobacco for water pipes, the sale of single cigarettes and tightened rules on labelling, advertising and selling tobacco to under-21s.

“We are strongly opposed to plain packing as we feel that there hasn’t been enough consultation and research on it. Our concern is the serious adverse consequences that it will have on the economy, jobs and investment; as well as potentially making counterfeit easier. It trounces fundamental intellectual property rights and freedoms guaranteed by the constitution,” says Joe Heshu, Acting Head of External Affairs at BAT.

According to Heshu, counterfeit cigarettes are a bigger issue. In 2015, South Africa’s Treasury lost R5.1 billion ($373 million) due to illicit trade. The trade accounts for about 24% of the market.

South Africa has been increasing tobacco taxes since 1994 and the big impact has been the reduction in consumption and prevalence, but Chelwa agrees there has been a minimal impact of the taxes on illicit trade.

“Illicit trade often has to do with tax administration and not taxes. Even if taxes were a cent, you’d still have illicit trade showing that it is not a tax level or tax rate issue but a tax administration issue,” he says.

On jobs, Chelwa argues “there are very few tobacco manufacturing jobs, very few given how mechanized manufacturing of cigarettes is.”

The big worry he says is in the field.

“Governments have to consciously find ways of transitioning tobacco farmers into growing other types of crops. This will require a lot of work,” says Chelwa.

Asked if he thinks cigarettes are killers, Heshu argues his company has launched e-cigarettes, which are supposedly less harmful products, in the UK, France, Germany, Italy and Poland.

“We are committed to the research and development of Next Generation Products (NGPs) and globally have invested over half a billion pounds during the past five years.

There is a growing body of evidence that NGPs do pose significantly fewer risks than cigarettes.”

For now, tobacco companies continue to thrive. Only 29 countries, representing 12% of the world’s population, have completely banned all forms of tobacco advertising, promotion and sponsorship, according to WHO.

Some of Malawi’s tobacco, grown by the likes of Ndilowe and Kube, is shipped 2,000 kilometers south of Mpherembe. In South Africa, 19% of the population, over the age of 15, smokes according to the World Bank. That’s almost one in five people and it is dangerous.

Tobacco is responsible for six million deaths each year. Of those, 600,000 die from the effects of second-hand smoke. This number is expected to increase to eight million by 2030 if current trends continue, says WHO.

Alexandra chain smoker, Mpho Ndlovu, knows this, yet he goes through three packs of cigarettes a day.

“I have been smoking since I was 15. It started as just playing with friends at school because we knew we weren’t allowed to. It was a way of being cool. I got hooked and have been smoking for 40 years,” says Ndlovu.

What started as a game became a habit and then an addiction.

“Smoking helps me when I’m nervous and I just enjoy it. I have tried to stop many times but have failed. I know this might one day kill me but, at this point, there is nothing I can do.”

Ndlovu spends R110.50 ($8) per day on cigarettes. That’s R766.50 ($56) per week and R3,066 ($225) per month and R36,792 ($2,700) per year and R183,960 ($13,500) in five years. If he continues smoking the same number of cigarettes per day for another 40 years, at this current price, he will spend around $100,000 on cigarettes. If invested, he could buy a house.

Ndlovu spends close to half of his R7,000 ($500) salary he makes working as a driver for a logistics company in Sandton.

“By the last week of the month, I would be out of money and sometimes I have to ask people if I can borrow or take some on credit from the spaza shop,” he says.

“When I smoke, especially on weekends, I drink as well. So the money I earn is never enough. My children get angry because they think I should be using the money on them. I don’t know how to stop.”

Ndlovu buys his cigarettes from Ntando Debeza, a hundred metres from his home.

Debeza’s spaza shop sells cigarettes, pipe tobacco, snuff, chewing tobacco, hookah and shisha.

“I make about R6,000 ($440) a month from this small shop. Most of the money comes from tobacco sales but I also sell other day-to-day products like bread and milk.

People come to buy and sometimes on credit and I collect money at the end of the month,” says Debeza.

This means Ndlovu’s debt grows. But, that’s not all. Smoking does not only affect the smoker. High levels of nicotine exposure from handling tobacco leaves may cause nicotine poisoning called Green Tobacco Sickness, with symptoms including nausea and vomiting.

Back in Mpherembe in Malawi, Kube says he is aware of the dangers of working in a tobacco field without protective clothing, and mostly its effects on minors. “I know children can get sick but what can we do? We need a lot of hands on the farm because this isn’t an easy crop to plant and prepare. It needs three times more people than corn but we don’t make enough money at all,” says Kube.

He is one of the few rural farmers who know this. And it gets worse. A 2009 survey in China revealed that only 38% of smokers knew that smoking causes coronary heart disease and only 27% knew that it can cause strokes.

“Among smokers who are aware of the dangers of tobacco, most want to quit. Counselling and medication can more than double the chance that a smoker who tries to quit will succeed. National comprehensive cessation services with full or partial cost coverage are available to assist tobacco users to quit in only 24 countries, representing 15% of the world’s population,” says WHO.

Cape Town-based entrepreneur Gareth Carter saw this crisis as an opportunity. He founded WeDoRecover, a company that helps patients who suffer from psychiatric and addiction problems.

“Finding the right addiction programme to meet someone’s specific needs is a complex process. The crisis and chaos synonymous with active addiction are overwhelming and the multitude of choices in the marketplace adds to the confusion,” says Carter.

According to Carter, people who smoke are more likely to drink alcohol and vice versa. He says alcoholics frequently present with a co-morbid nicotine addiction.

“As many as 80 percent of people addicted to alcohol and other drugs are frequent smokers, but the bulk will die of smoking-related disease rather than alcohol and drug-related disease…”

The damage doesn’t stop there. Carter adds that major depressive episodes among adults are highest in those addicted to nicotine and lowest in those who have quit or never started smoking.

“With nearly 80 percent of the world’s one billion smokers living in low- and middle-income countries, this is a very real public health care problem for us in Africa.

Making nicotine addiction prevention and treatment readily accessible to the youth counteracts a wide range of potential mental, physical and mood-disorder problems with far-reaching ramifications to families, communities and our economy,” he says.

Carter thinks if tobacco was “invented” today it would be classed with other illegal drugs. That’s not the case. The lucrative industry in Africa puffs on unfettered.

Fewer see e-cigarettes as less harmful than cigarettes

The perception that e-cigarettes are less harmful than regular cigarettes fell between 2012 and 2014, a sign that fewer people see them as a safe alternative to smoking tobacco, a new study led by researchers at the Johns Hopkins Bloomberg School of Public Health suggests.

In 2012, the study found, half of those surveyed thought e-cigarettes were less harmful than cigarettes. By 2014, the number had dropped to 43 percent. During this period, advertisers often represented e-cigarettes as a safer alternative to traditional cigarettes, the researchers note. E-cigarettes are battery-operated devices that convert liquid containing nicotine into vapor that consumers inhale.

The study was based on the Health Information National Trends Surveys conducted by the National Cancer Institute. The nationally representative sample included smokers, former smokers and non-smokers. The study appears online in the American Journal of Preventive Medicine.

The researchers were surprised by the findings, given the mixed assessments of e-cigarettes’ risk compared to traditional tobacco products. Since they were introduced to the U.S. market in 2007, the devices have been pitched to consumers as potentially safer alternatives to cigarettes, or even a harmless way to stop smoking, given that e-cigarettes contain no tobacco, a known carcinogen that also causes pulmonary and heart disease.

On the other hand, some in public health fear that e-cigarettes could become a gateway to smoking tobacco for young people. Smoking remains the leading cause of preventable death in the world.

“It’s a good thing that information about e-cigarettes’ possible adverse health effects has gotten out there, especially considering there wasn’t a government or public health push during the study years,” says study leader Eric W. Ford, PhD, MPH, a professor in the Bloomberg School’s Department of Health Policy and Management. “When misinformation about health effects about any substances becomes widespread, it is usually very hard to reverse the trend. That somehow happened here.”

According to the Centers for Disease Control and Prevention, 3.7 percent of U.S. adults were using e-cigarettes in 2014. E-cigarettes were more likely to be used by current cigarette smokers and former smokers who quit smoking within the past year than former smokers who quit smoking more than 1 year ago and those who had never smoked.

There is no overriding consensus among researchers about whether e-cigarettes are indeed harmful to human health. There are, Ford explains, two research knowns. On the one hand, e-cigarettes eliminate many of the carcinogenic elements associated with smoking tobacco. On the other hand, e-cigarettes may include flavorings and other ingredients containing the chemical diacetyl, which can cause bronchiolitis obliterans, or “popcorn lung,” the thickening and narrowing of the airways due to scarring of the lung’s air sacs. (The condition was so named because diacetyl was once used as a butter flavoring for microwavable popcorn.)

Earlier this year, in a much-anticipated move, the Food and Drug Administration announced that it would start regulating e-cigarettes the same way it regulates cigarettes – including banning their sale to anyone under age 18. The FDA has not yet proposed additional regulations around e-cigarettes. Earlier this month, in the government’s strongest warning to date, the U.S. Surgeon General urged young people to avoid e-cigarettes altogether, calling them “unsafe.” Among children, teens and young adults, e-cigarettes are the most commonly used nicotine product.

For the study, the researchers combined three “cycles” of data from the 2012, 2013 and 2014 Health Information National Trends Survey, an annual survey of U.S. households sponsored by the National Cancer Institute. The surveys, which included 3,630 respondents in 2012, 3,185 in 2013 and 3,677 in 2014, were made up of about 60 percent non-smokers, 20 percent former smokers and 20 percent current smokers. The study also found that awareness of e-cigarettes jumped from 77.1 percent in 2012 to 94.3 percent in 2014.

The researchers also looked at whether awareness of e-cigarettes among current smokers influenced their attempts at quitting or intention to quit. They found no association. While some smokers may independently use e-cigarettes to try and quit, doctors are not advising patients to do so. They typically suggest trying nicotine patches or chewing gum.

Smokers who perceived e-cigarettes as less harmful than traditional cigarettes were less likely to have attempted to quit in the previous year.

Another reason not to smoke while pregnant

Kids whose mothers smoked while pregnant were 24 percent more likely to show signs of kidney damage in their urine tests by age three.

http://www.freemalaysiatoday.com/category/leisure/2017/01/01/another-reason-not-to-smoke-while-pregnant/

Women who smoke during pregnancy may be more likely to have children with kidney damage than mothers who steer clear of cigarettes, a study suggests.

Smoking during pregnancy has long been linked to preterm and underweight babies and a wide range of birth defects. The current study offers fresh evidence that the kidneys are among the organs at risk for damage, said lead author Dr. Maki Shinzawa, a public health researcher at Kyoto University in Japan.

“Cigarette smoking releases nicotine and other harmful or potentially harmful substances, such as nitrogen oxide, polycarbonate, and carbon monoxide, some of which cross the placenta,” Shinzawa said by email. “Some of these trans-placental substances may affect fetal programming of the kidney during pregnancy.”

Shinzawa and colleagues examined data from urine tests from 44,595 children to look for elevated levels of protein in the urine, which can indicate impaired kidney function.

Data on maternal smoking was collected during women’s prenatal checkups, and researchers also had records from their children’s health checkups at four, nine, 18 and 36 months of age.

Overall, 79 percent of women said they never smoked and another 4 percent said they stopped smoking during pregnancy. About 17 percent of the mothers said they continued to smoke while they were pregnant.

The absolute risk of kidney damage among the children was low. But compared with children born to nonsmoking mothers, kids whose mothers smoked while pregnant were 24 percent more likely to show signs of kidney damage in their urine tests by age three.

Urine tests showed elevated protein levels in 1.7 percent of children born to smokers, 1.6 percent of kids whose mothers were former smokers and 1.3 percent of children born to women who never smoked. Children exposed to second-hand smoke at home also appeared to have a higher risk of kidney damage than kids who didn’t live with smokers, but the difference wasn’t big enough to rule out the possibility that it was due to chance.

One limitation of the study is its reliance on women to accurately report and recall how much they smoked before or during pregnancy, and a lack of lab tests to confirm smoke exposure, the authors note in the Clinical Journal of the American Society of Nephrology.

Still, the findings add to evidence linking smoking to kidney damage, a connection that some previous research has established for adult smokers and for children who inhale second-hand smoke, said Dr. Paul Fowler, director of the Institute of Medical Sciences at the University of Aberdeen in the UK.

“Maternal smoking has been observed to lead to reduced kidney size in offspring, which is of concern since it is known that retarded kidney development contributes to (high blood pressure) and renal injury in adults,” Fowler, who wasn’t involved in the study, added by email.

“This study highlights one more reason why women should not smoke during pregnancy and why children should be raised in cigarette-free households,” Fowler said. “It is not, in itself, an overwhelming reason, but rather one more nail in the coffin.”

E-CIGARETTE NICOTINE DELIVERY: DATA AND LEARNINGS FROM PHARMACOKINETIC STUDIES

By Ian M. Fearon, PhD; Alison Eldridge; Nathan Gale; Christopher J. Shepperd; Mike McEwan, PhD; Oscar M. Camacho; Mitch Nides, PhD; Kevin McAdam, PhD; Christopher J. Proctor, PhD

Study suggests e-cigarettes can provide effective delivery of nicotine for persons trying to quit smoking.

https://www.heartland.org/publications-resources/publications/e-cigarette-nicotine-delivery-data-and-learnings-from-pharmacokinetic-studies

Abstract

Objectives: E-cigarettes could potentially play a major role in tobacco harm reduction by delivering nicotine in a vapor containing significantly fewer toxicants than cigarette smoke and may aid smoking behavior changes such as reduction or cessation.

Methods: We examined blood nicotine levels in smokers who were non-accustomed to e-cigarette use (Study 1) and accustomed e-cigarette users (Study 2). We compared nicotine levels when participants used a closed modular system e-cigarette to those when participants smoked a cigarette.

Results: In Study 1, Cmax (geometric mean (CV)) during a 5-minute puffing period (10 puffs, 30 seconds apart) was 13.4 (51.4) ng/ ml for a regular cigarette. The e-cigarette Cmax was significantly lower (p .05) at 2.5 (67.8) ng/ml. In Study 2, during a 5-minute ad libitum puffing period, cigarette Cmax was 7.2 (130.8) ng/mL, and it was 7.8 (108.2) ng/mL for the e-cigarette.

Conclusions: Our data demonstrate heterogeneity of nicotine deliveries both between products and also with the same products used by different cohorts, eg, accustomed users versus smokers. Such differences must be taken into account when determining the likely behavioral impact, on smoking reduction and cessation, of nicotine delivery data and when planning e-cigarette nicotine pharmacokinetic studies.