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E-cigarette use and asthma in a multiethnic sample of adolescents

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Possible effects of raising tobacco taxes across the EU

Increasing cigarette prices through taxation could reduce cigarette consumption and smoking related deaths across EU countries. This is according to a study published today in BMC Public Health which modelled a 10% tax increase on tobacco. Here to tell us about the model, how different EU countries would be affected, and the potential policy implications is Christian Schafferer, author of the article.

Christian Schafferer 21 Sep 2017

In the European Union (EU), approximately 700,000 people die of smoking-related diseases every year. The reduction of tobacco consumption has thus become one of the major social policies of the EU.

The tobacco control policies (MPOWER) proposed by the World Health Organization (WHO) in 2008 serve as a guideline for the health authorities of the EU member states. The six MPOWER measures mandate (i) increases in the tobacco tax; (ii) monitoring of tobacco usage; (iii) support for quitters; (iv) creation of a smoking-free environment; (v) warning against the dangers of tobacco; (vi) and banning tobacco advertising, promotion and sponsorship.

Numerous empirical studies have demonstrated that most consumers, when confronted with higher retail prices, indeed reduce consumption.

Among the MPOWER measures, taxation is the most common single policy tool to control tobacco use. Economic theory suggests that increasing tobacco taxes will result in higher direct costs for smokers and thus lower consumption.

Theoretically, the tobacco industry could absorb the additional costs to prevent higher retail prices, but, in reality, increased costs are passed on to the consumers.

Numerous empirical studies have demonstrated that most consumers, when confronted with higher retail prices, indeed reduce consumption, while others switch to lower-priced products or turn to smuggled goods.

Modeling a 10% tax increase

In our study, we estimated the effects of a hypothetical cigarette price increase of 10% on consumption, tax revenues and death toll of smoking in 28 EU countries.

Unlike previous studies, our statistical model also accounted for the fact that income affects the responsiveness of consumers to price changes. Research has shown that smokers with high disposable income are less affected by rising cigarette prices than those with lower income. In other words, the price elasticity of demand changes with income (income threshold effect).

The price elasticity of demand is used to measure changes in demand of goods in response to changes in price. It gives the percentage change in quantity demanded in response to a one percent change in price.

Our statistical model separates the observed 28 countries into three income clusters (regimes), assuming that all of the countries within a cluster have about the same response patterns to price increases. Using data for the years 2005 to 2014, our model estimated the price elasticity of each income cluster.

Nicotine use would be reduced by 12.27% in Bulgaria and Romania; by 8.29% in Latvia and Poland; and by 5.03% in the EU24 countries.

Based on the elasticity figures, we were able to estimate the possible effects of a hypothetical price increase of 10% on consumption, tax revenues and the number of averted smoking-attributable deaths. The latter figure derived from the simulated impact of price increments on the reduction in smokers and was adjusted for the fact that smoking cessation still carries considerable risks of early death.

The results of our study revealed that higher taxation would be considerably more effective in reducing consumption as well as incidences of smoking-related deaths in the two less developed regimes than in the remaining 24 countries (EU24) belonging to the third income regime. Specifically, nicotine use would be reduced by 12.27% in Bulgaria and Romania; by 8.29% in Latvia and Poland; and by 5.03% in the EU24 countries.

Unlike other measures, such as bans on tobacco advertising, taxation not only effectively decreases tobacco consumption but, in general, also has the beneficial side effect of increasing national tax revenues. Our simulation showed that although tax revenues increased by 7.03% in Latvia and Poland, and by 3.15% in the EU24 area, revenues dropped by 1.41% in the least developed countries, Bulgaria and Romania.

Different policies for different countries

What are the policy implications? As the results of the study show, there are three income regimes among the observed 28 European countries. Since each regime is differently affected by cigarette taxation, different policies must be adopted to fight nicotine use. Specifically, other measures to control tobacco use, such as restrictions on advertisements, pictorial warning labels and cessation assistance, are necessary in high-income countries to compensate for the income threshold effect.

Moreover, as the study has shown, higher taxation leads to significant increases in tax revenues in high-income regimes, but in poorer countries it is more likely to lead to considerable losses in tax revenues. Health authorities in less developed countries may thus lack crucial funding to implement anti-smoking measures. External funding (donations from other European countries) would thus be required to ensure success in combating cigarette use.

Illicit trade of tobacco products has not been included in the study, as reliable data could not be obtained for all countries. Moreover, data on cigarette consumption analysed in this study refer to factory-made (FM) cigarettes. Roll-your-own (RYO) tobacco products have become popular in the EU in recent years and may influence consumption behavior. Further research on price effects may thus address the issue of illicit trade and RYO cigarette use.

The effects of a rise in cigarette price on cigarette consumption, tobacco taxation revenues, and of smoking-related deaths in 28 EU countries

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E-cigarette vapour enhances pneumococcal adherence to airway epithelial cells

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Heat-Not-Burn Tobacco Cigarettes: Smoke by Any Other Name

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Revealed: Electronic cigarettes could damage sperm

Electronic cigarettes could damage men’s fertility through toxic chemicals in the flavourings, a study suggests.

Cinnamon-flavoured e-cigarettes in particular make sperm slower swimmers, according to the latest research to raise health concerns about the fashionable devices.

Bubblegum flavouring, another of the most popular, kills off cells in the testes which help to produce sperm, scientists found.

It is well known that cigarettes can damage men’s fertility through DNA damage to the sperm – while e-cigarettes are promoted as a healthier alternative to smoking.

But researchers at University College London found e-cigarette flavourings could affect men’s chances of starting a family, even when no nicotine is included.

It follows research that these flavourings, which are taken into the lungs within vapour from the aerosol, contain cancer-causing chemicals including formaldehyde.

And it comes as scientists at the University of Salford – who found e-cigarette flavourings such as butterscotch and menthol risk lung damage by killing off bronchial cells – call for better safety checks.

The danger to sperm is believed to come from chemicals in the flavourings such as coumarin, which is a cheaper version of cinnamon bark and commonly found in flavourings sold in the UK and made in China.

Lead author Dr Helen O’Neill, who presented the findings to the British Fertility Conference in Edinburgh yesterday, said the results were “shocking”.

“In terms of motility, progression and concentration of sperm, there was a detrimental effect,” she said. “E-cigarettes are promoted as the health alternative to smoking, the healthy thing to do.

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

There are 7,000 different flavours of electronic cigarettes, but those tested were the two most popular – cinnamon and bubblegum – and ‘plain’ devices just containing propylene glycol, a tasteless liquid used in the production of the vapour. Sperm samples were taken from 30 men, tested with concentrations of the flavours similar to the average intake for casual and more habitual e-cigarette users.

Researchers found sperm exposed to the highest concentration of flavourings moved significantly more slowly, while their swimming speed was affected. The biggest impact came from the cinnamon flavour.

The men, who were undergoing IVF but had healthy sperm, were not able to use the devices directly, but the flavourings were inserted directly into the sperm in the concentrations they would be exposed to. No nicotine was included. A second experiment looked at how mice reacted to being exposed to the flavourings – it found cells in the testes were killed off by the chemicals in them.

Bubblegum had the worst effect, with the highest number of dying cells in the testes tissue.

Dr O’Neill said these chemicals may harm men’s fertility through the toxins they produce when heated in e-cigarettes.

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

Dr O’Neill said: “There is very little regulation before they are allowed onto the market.”

When the tax stamp covers the health warning label: conflicting ‘best practices’ for tobacco control policy

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E-cigarette use as a predictor of cigarette smoking

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Just ONE puff of flavoured e-cigarette vapour ‘contains dangerous levels of cancer-causing chemicals’

Flavoured liquids used in the devices exposes smokers to “unacceptably high” levels of aldehydes, produced when a compound decomposes

JUST one drag of a flavoured e-cigarette exposes a smoker to “unacceptably high” levels of cancer-causing chemicals, experts warned today.

They found aerosols – commonly called vapours – produced by the devices contain the dangerous substances.

These toxic aldehydes, including formaldehyde, are produced during the chemical breakdown of the flavoured e-liquid during the rapid heating process that happens inside e-cigs.

Dr Andrey Khylstov, of the Desert Research Institute, Las Vegas, said: “One puff of any of the flavoured e-liquids that we tested exposes the smoker to unacceptably dangerous levels of these aldehydes, most of which originates from thermal decomposition of the flavouring compounds.”

His team found the production of toxic aldehydes “is exponentially dependent on the concentration of flavouring compounds”.

E-cigarette liquids are marketed in nearly 8,000 different flavours, according to a 2014 report by the World Health Organisation.

Recent reports show many of these flavours, such as Gummy Bear, Tutti Fruity, and Bubble Gum, to name a few, are especially appealing to teens and kids – encouraging them to use the devices.

Around 2.8million adults use the devices in the UK and a 2014 study revealed more kids aged 11 to 15 experimented with e-cigs than traditional cigarettes.

In the US, 16 per cent of high school students regularly vape – making them the most commonly used tobacco product in teenagers.

To examine the dangers, Dr Khylstov and his team measured the levels of aldehydes in vapour produced by three common e-cigs.

To determine if flavourings were to blame for producing the cancer-causing chemicals, the researchers tested five flavoured liquids, as well as two control unflavoured liquids.

Researcher Dr Vera Samburov explained: “To determine the specific role of the flavouring compounds we fixed all important parameters that could affect aldehyde production and varied only the type and concentration of flavours.”

She said the devices used in the experiments were three of the most common types of e-cig.

Using a controlled system, the researchers were able to ensure the same level of “puff” each time, simulating common vaping conditions.

All tests revealed the level of cancer-causing chemicals produced by flavoured e-liquids exceeded limits set by American authorities, designed to protect against hazardous chemical exposure.

Dr Khylstov added: “These results demonstrate the need for further, thorough investigations of the effects of flavouring additives on the formation of aldehydes and other toxic compounds in e-cigarette vapours.”

The findings are published in the journal Environmental Science and Technology.

Association of e-Cigarette Vaping and Progression to Heavier Patterns of Cigarette Smoking

E-cigarette vaping is reported by 37% of US 10th-grade adolescents1 and is associated with subsequent initiation of combustible cigarette smoking.2 Whether individuals who vape and transition to combustible cigarettes are experimenting or progress to more frequent and heavy smoking is unknown. In addition, because some adolescents use e-cigarettes as a smoking cessation aid,3 adolescent smokers who vape could be more likely to reduce their smoking levels over time. Therefore, associations of vaping with subsequent smoking frequency and heaviness pattern among adolescents were examined.

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