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Research Paper

Tobacco packaging and labelling policies in countries of the Eastern Mediterranean and Western Pacific Regions

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E-cigarettes as a source of toxic and potentially carcinogenic metals

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Livestream of brain could help smokers quit

Real-time data from smokers’ brains could help them re-programme their minds and stub out cigarettes for good.

It’s one of the options being explored by researchers who are looking into the most successful ways to quit.

Neurofeedback is a brain-training technique that uses electrodes placed on a person’s head to create a live feed of their brainwaves. This information is displayed in front of the person who can then visibly reshape their thoughts.

The Issue

Smoking causes an estimated 650 000 EU citizens to die prematurely each year, but it is also the largest cause of preventable morbidity worldwide.

In 2009 the Council of the European Union called upon all Member States to protect their citizens from tobacco smoke by enhancing smoke-free laws such as encouraging efforts to quit and putting warnings on tobacco packages.

A European Commission follow-up report in 2013 found 17 EU countries have comprehensive smoke-free laws in place.

‘It allows them to control what they see,’ said Professor Panagiotis D. Bamidis from the Aristotle University of Thessaloniki in Greece, who is testing the effectiveness of the technique to help smokers give up.

‘Subjects are asked if they can do specific tasks and their reactions provide a feedback loop that lets them train their own brain.’

The ability of neurofeedback to identify negative thought processes has been used to treat mental illness and memory problems, but this is the first research looking into whether it is an effective technique for breaking an addiction.

‘With neurofeedback we can see what type of brain signals smokers are emitting when they are relaxed, then we ask them to follow specific tasks and record their reactions,’ said Prof. Bamidis.

When the subject encounters something that may trigger an urge to smoke, they will learn what the cause was and what thoughts could help them overcome the craving.

Prof. Bamidis says that smokers would need around twenty hours of treatment before feeling the effects from neurofeedback, but considering it’s a natural, drug-free treatment it could lead to high numbers of smokers willing to give it a try.

‘It’s a non-invasive, pain-free technique with no side effects so it has a lot of promise to change (smokers’) behaviour,’ he said.

Neurofeedback is just one of the quitting techniques being studied by Prof. Bamidis as part of the EU-funded SmokeFreeBrain project, to evaluate the best ways to stop smoking.

Another technique under examination is SoLoMo, which stands for social-local-mobile and focuses on using physical locations to send tailored information to a mobile device.

‘We are going to use social media techniques translated for local populations and ask them to follow healthy lifestyles with reminders and mini-games,’ said Prof. Bamidis.

SmokeFreeBrain will also assess the effectiveness of e-cigarettes, communication campaigns and more classic approaches like nicotine patches. At the end of the project in 2018, the researchers hope to have a guide outlining the best practices in smoking cessation and how these can be applied on a large scale.

‘We will figure out which approach is the most effective and economic,’ said Prof. Bamidis.

‘Our research will then help form tobacco policy at national and international levels.’

While these techniques and policies will help, any smoker knows that quitting is easier said than done. That leaves us with the bigger question – how do we motivate people to stop people smoking in the first place?

Over the last fifty years the number of smokers in Europe has been declining, but more than 20 % of the adult population still smoke.

‘Policies to ban smoking in public places and general social norms have changed and we see smoking rates have declined, but it has been quite slow,’ said Professor Anton Kunst from the University of Amsterdam, the Netherlands. ‘If it continues at this speed, smoking will persist for many decades to come.’

Ability to quit

In recent years smoking has become concentrated in lower socio-economic areas where the ability to quit is harder due to financial and employment circumstances and the subsequent emotional stress. This in turn creates a spiral where following generations are regularly exposed to those who smoke.

‘Among people in lower socio-economic circles, smoking is much more common and that could be related to factors like more emotional problems and being exposed to smoking amongst friends and parents,’ said Prof. Kunst.

Prof. Kunst is the coordinator of the EU-funded SILNE-R project which is examining how antismoking policies in seven European cities affect the smoking behaviour of 16-year-olds.

Through comparison, the project aims to use the data gathered to create better prevention programs.

‘Different countries and municipalities have different tobacco policies,’ said Prof. Kunst. ‘We want to understand why some policies are able to influence young people and why others are not.’

They have already looked at smoke-free policies in schools, which have revealed findings into youth smoking behaviour.

‘If you ban smoking from school premises it changes the way young people look at smoking and raises awareness of the health hazards,’ said Prof. Kunst.

But while these anti-smoking rules can protect some it could make matters worse for others.

‘Such policies may create peer groups that go out of school to smoke which reinforces the habit and attracts others to start smoking who just wanted to be part of the group,’ said Prof. Kunst.

Possible solutions are to ban smoking in places around schools or to discourage kids from leaving by offering more appealing activities like sports or hobby clubs.

At the end of the project in 2018, SILNE-R hopes to present policy makers with concrete suggestions on how to make anti-smoking policies more effective for young people. In the meantime, Prof. Kunst warns any young smoker not to overestimate their willpower.

‘Young people don’t see how addictive smoking can be and are very confident they will stop later in life,’ said Prof. Kunst. ‘They must be told that there is no silver bullet to quit, that they would need to try hard to stop and find help where they can.’

Introduction of plain packaging and new, enlarged graphic health warnings in the Australian state of Victoria

Change in public support for the introduction of plain packaging and new, enlarged graphic health warnings in the Australian state of Victoria, 2011–2013


Since December 2012, all Australian tobacco products have been supplied in packaging that is a standardised drab brown colour with uniform fonts. The implementation of plain packaging coincided with the introduction of refreshed graphic health warnings (GHWs) that increased in size from 30% to 75% of the pack face, with coverage of the pack rear maintained at 90%.1

A slight rise in opposition to plain packaging among Australian smokers was reported immediately prior to implementation, followed by a significant increase in support, from 28% preimplementation (late 2011 to early 2012) to 49% postimplementation (early 2013).2 No data on the views of former or never smokers have previously been published.

Exposure to e-cigarette vapour induces negligible or no oxidative damage to lung epithelial cells

E-cigarette vapour is much less harmful to lung cells than cigarette smoke. Lab tests show that, unlike tobacco smoke, which causes oxidative stress and cell death, e-cigarette vapour does not. Oxidative stress and cell death are driving factors in the development of many smoking-related diseases such as COPD and lung cancer.

Vapour from e-cigarettes has been found to contain significantly lower levels of the toxicants found in cigarette smoke (Chemical Research in Toxicology DOI: 10.1021/acs.chemrestox.6b00188), but suitable lab tests and clinical studies are necessary to understand whether this translates into reductions in biological responses and disease.

Researchers at British American Tobacco have developed a standardized way of measuring and comparing the potential of conventional cigarette smoke and e-cigarette vapour to cause oxidative stress in an in vitro model of lung epithelium.

To do this they bubbled matched amounts of smoke (from a reference cigarette) or vapour (from Vype ePen or Vype eStick) through cell-growth medium to produce a stock that could be diluted into various concentrations. They then exposed lung epithelial cells to the same concentrations of either smoke or vapour extract and, following exposure, used a panel of commercially available assays to measure and compare the stress responses of the cells.

Lung cells exposed to any of the concentrations of cigarette smoke showed signs of oxidative stress and, at higher doses, cytotoxicity. In stark contrast, vapour from e-cigarettes tested had no such effects, even at the highest concentration.

The research is published in a special edition on e-cigarettes of Toxicology Mechanisms and Methods DOI: 10.1080/15376516.2016.1222473.

Desensitisation to cigarette package graphic health warnings

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Researchers find tobacco use linked to most fatal form of stroke

A possible link between a deadly form of stroke and smoking has been discovered by scientists.

Researchers in Finland found a sharp drop in the number of people who suffered a subarachnoid haemorrhage – the most fatal form of stroke – occurred in the same period as a decline in smoking numbers.

Between 1998 and 2012, the number of people who smoked plunged 30% among 15 to 64-year-olds in the country, the study found.

During this time, cases of the killer stroke also went down by 45% among women under 50 and 38% among men under 50, as well as by 16% among women over 50 and 26% among men over 50.

Scientists said they could not establish whether the change in smoking habits caused the drop, but it was “highly likely” Finnish tobacco policies played a role.

A British charity said the findings were a “wake-up call” to smokers.

In recent years, Finland has slashed smoking numbers through a series of public health campaigns and legislative action against the sale of tobacco and its use in public.

Professor Jaakko Kaprio of the University of Helsinki said of the findings, which were published in the journal Neurology: “It is extraordinary for the incidence of any cardiovascular disease to decrease so rapidly at the population level in such a short time.

“Even though we cannot demonstrate a direct causation in nation-wide studies, it is highly likely that the national tobacco policies in Finland have contributed to the decline in the incidence of this type of severe brain haemorrhage.”

Health charity Ash said the findings should motivate smokers in the UK to quit.

Chief executive Deborah Arnott said: “The Finnish study is a wake-up call to smokers.

“They need to know that if they don’t quit smoking they’re twice as likely to die from stroke than non-smokers.

“But stopping smoking can be tough, which is why it is so important to ensure that all smokers are given the best possible support and encouragement to give up.”

Stunning discovery: Marijuana may be harmful

Bad news, marijuana users: a new study claims that the drug isn’t as safe as you might think it is — and in one very key way is just as bad as tobacco smoke. The study, published in the Journal of the American Heart Association, states that second hand marijuana smoke is just as harmful as tobacco smoke on blood vessels, so you might want to think twice before you toke up.

In fact, it was actually a lot worse. Scientists exposed rats to both pot and tobacco smoke for one minute. Their blood vessels narrowed and it took 90 minutes to widen again for rats exposed to tobacco smoke — it took three times as long for rats exposed to marijuana smoke, according to the study.

The researchers decided to conduct this study because of what they felt was a lack of attention on the dangers of the actual smoking of marijuana versus just the drug itself. The study showed that, just like tobacco smoke, chronic marijuana smoking can narrow and harden your arteries which can lead to potentially deadly cardiovascular complications.

The hotter the vape, the more harm to the vapist

New research out of Berkeley Lab shows that not every puff is equal, and clearly outlines the factors that increase risk. Temperature, type, and age of the device all play a role in how much harmful emissions the e-cig produces, but the heat was a main point of interest.

In the paper, researchers detected significant levels of 31 toxic chemicals, including formaldehyde, acrolein, propylene oxide, and previously undetected glycidol present.

Acrolein is used as a herbicide and is found in conventional cigarettes. Glycidol is an irritant that’s a potential carcinogen, as is propylene oxide. Formaldehyde, of course, is the tobacco industry’s most famous carcinogen. These and other toxins increased several-fold after sustained use of the vape, after it heated up around 20 puffs. High temperatures meant more harmful emissions.

Inhaling Fruity Pebble-flavored formaldehyde seems pretty gnarly, as does getting your leg blown up, and having your teeth knocked out of their sockets.

One of the authors on the Berkeley study summed up their findings thusly: “Regular cigarettes are super unhealthy. E-cigarettes are just unhealthy.”

Regular cigarettes are super unhealthy, but to their credit, they don’t spontaneously blow up limbs. Sorry, vapists, but hitting the glazed donut vape juice sounds increasingly more akin to a drone strike than a safer cigarette alternative.

Toxins in e-cig vapor increase with heat and device use

Electronic cigarettes, or e-cigs, have grown in popularity as an alternative to traditional cigarette smoking. But health experts and consumer advocates have raised concerns over their safety. Now scientists report in ACS’ journal Environmental Science & Technology new measurements of potentially toxic compounds in e-cigarette vapor and factors that affect these levels.

Hugo Destaillats and colleagues analyzed vapor from two different kinds of e-cig vaporizers filled with three different refill e-liquids. They identified several vapor components including glycidol — which hadn’t previously been identified in e-cig vapor — formaldehyde and acrolein.

The World Health Organization categorizes glycidol as a probable carcinogen, and acrolein is a powerful irritant. Testing also showed that increasing the voltage and heat in a single-coil vaporizer (as opposed to one with a double-coil) triples the aldehyde emissions per puff and bumped up the acrolein levels by a factor of 10.

Additionally, the release of potentially toxic compounds increased with use. These compounds originate from thermal decomposition of propylene glycol and glycerin, two solvents used to formulate most e-liquids.