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letter sent by the Foundation for a Smoke-Free World founder

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How will Brexit affect health and health services in the UK?

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E-Cigarettes Increase Vital Signs and Arterial Stiffness

By HospiMedica International staff writers

https://www.hospimedica.com/critical-care/articles/294770869/e-cigarettes-increase-vital-signs-and-arterial-stiffness.html

Significant increases in blood pressure (BP), heart rate, and arterial stiffness are seen in the first 30 minutes after smoking electronic-cigarettes containing nicotine, according to a new study.

Researchers at the Karolinska Institutet (KI; Solna, Sweden) recruited 15 young, healthy volunteers (average age 26, 59% female) who were seldom smokers–smoking a maximum of ten cigarettes a month–and who had not used e-cigarettes before the study. Study participants were randomized to use e-cigarettes with nicotine for 30 minutes on one of the study days, and e-cigarettes without nicotine on the other day. The researchers measured BP, heart rate, and arterial stiffness immediately after smoking the e-cigarettes, and then two and four hours later.

The results showed that in the first 30 minutes after smoking e-cigarettes containing nicotine, there was a significant increase in BP, heart rate, and arterial stiffness; no such effect was seen on heart rate and arterial stiffness in the volunteers who had smoked e-cigarettes without nicotine. Importantly, arterial stiffness increased around three-fold in those who were exposed to nicotine containing e-cigarettes. The study was presented at the European Respiratory Society International Congress, held during September 2017 in Milan (Italy).

“The immediate increase in arterial stiffness that we saw is most likely attributed to nicotine; the increase was temporary. However, the same temporary effects on arterial stiffness have also been demonstrated following use of conventional cigarettes,” said senior author and study presenter Magnus Lundbäck, MD, PhD. “Therefore, we speculate that chronic exposure to e-cigarettes with nicotine may cause permanent effects on arterial stiffness in the long term.”

“The marketing campaigns of the e-cigarette industry target current cigarette smokers and offer a product for smoking cessation. However, several studies question the e-cigarette as a means of smoking cessation, and there is a high risk of double use, where people use both e-cigarettes and conventional cigarettes,” concluded Dr. Lundbäck. “Furthermore, the e-cigarette industry also targets non-smokers with designs and flavors that appeal to a large crowd, even the very young, and that carry the risk of a lifelong nicotine addiction.”

Electronic cigarettes consist of a cartridge containing a liquid with a nicotine concentration of 11mg/ml and a battery powered heating element that evaporates the liquid, simulating the effect of smoking by producing an inhaled vapor that is less toxic than that of regular cigarettes. They were first developed by Herbert Gilbert in 1963, but the dawn of the modern e-cigarette is attributed to Chinese pharmacist Hon Lik, who introduced them as a smoking cessation device in 2004.

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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OPEN LETTER TO PMI FROM 121 ORGANIZATIONS

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PMI Sign On Letter

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WHO report gives India high marks for fighting tobacco use

A new report by the World Health Organisation on the global use of tobacco shows India, Bangladesh and Bhutan on top of the list of South East Asian countries that have achieved a high level of tobacco control.

http://www.domain-b.com/organisation/who_collaborating_centre/20170721_tobacco.html

The prevalence of tobacco use in India has fallen from 34.1 per cent to 28.6 per cent over the last seven years, the report says, comparing data from two rounds of the Global Adult Tobacco Survey (GATS) in 2009-10 and 2016-17.

The WHO report titled Global Tobacco Epidemic, 2017: Monitoring Tobacco Use and Prevention Policies, was released in New York on Wednesday on the sidelines of the United Nations High-Level Political Forum on Sustainable Development. The report covers 194 countries, divided into The Americas, South East Asia, Europe, Eastern Mediterranean, Western Pacific, and Africa. There are 11 countries in the South East Asia group, including India.

Though the population worldwide protected by tobacco control measures has grown almost five-fold than ten years ago, the World Health Organisation (WHO) on Wednesday called on countries to do more to prioritise these life-saving policies.

In India, Mumbai, Kolkata, Delhi, Hyderabad, Bengaluru, Pune, Surat, Kanpur, Jaipur, Lucknow and Nagpur are among the top 100 cities across the world named for the strict implementation of policies to prevent tobacco use. The report lists the cities population-wise, using figures published in the UN Statistics Division’s Demographic Yearbook.

Globally, the WHO report said about 4.7 billion people, or 63 per cent of the world’s population, are covered today by at least one comprehensive tobacco control measure. Ten years ago, in 2007, the number was only one billion, or 15 per cent of the world’s population.

However, tobacco use has still become the leading single preventable cause of death worldwide, killing over seven million people each year.

Its economic costs are also enormous, totalling more than $1.4 trillion in healthcare and lost productivity, according to WHO.

Meanwhile, the tobacco industry continues to hamper government efforts to fully implement life- and cost-saving interventions, by, for example, exaggerating the economic importance of the tobacco industry, discrediting proven science, and using litigation to intimidate governments, the report says.

Poor countries ahead
More than half of the top national performers on tobacco control are low- and middle-income countries, showing that progress is possible regardless of economic situation. A tracking of MPOWER measures – introduced by WHO in 2007 to assist in the country-level implementation of measures to reduce the demand for tobacco – has revealed that the number of people protected by at least one best-practice measure has quadrupled to 4.7 billion – or almost two-thirds of the world’s population.

As many as 121 out of 194 countries have introduced at least one MPOWER measure at the highest level of achievement (not including monitoring or mass media campaigns, which are assessed separately).

Thirty-four countries with a total population of 2 billion have adopted large graphic pack warnings. Six countries (Afghanistan, Cambodia, El Salvador, Lao People’s Democratic Republic, Romania and Uganda) have adopted new laws making all indoor public places and workplaces smoke-free. Six countries (El Salvador, Estonia, India, Jamaica, Luxembourg and Senegal) have advanced to best-practice level with their tobacco use cessation services, the report says.

India and Nepal are regional and global leaders in implementing large, pictorial warning labels on tobacco packaging. With the increase in the size of pack warnings to 85 per cent of both front and back panels on all tobacco products, India now has the third largest pack warning label among all countries.

The findings of GATS-2 showed that graphic warning labels depicting throat cancer and oral cancer are a strong tool to discourage the youth from initiating tobacco, and have motivated 275 million current users to quit.

Dr Vinayak Prasad, Geneva-based head of the WHO Tobacco Free Initiative, told The Indian Express that among the many measures to control tobacco in India was the joint WHO-International Telecommunication Union initiative mCessation, launched in 2015 with the Ministries of Health and Family Welfare and Communication and Information Technology. ”The programme to encourage people to quit tobacco use registered more than two million users last year and the initial evaluation showed that more than 7% quit successfully after six months,” Dr Prasad said.

The WHO Framework Convention on Tobacco Control (WHO FCTC), the first international treaty negotiated under the auspices of WHO, was adopted by the World Health Assembly in 2003, and entered into force in 2005. It has since become one of the most widely embraced treaties in UN history.

Raise tax on tobacco and make smokers pay for health costs

I support Gauri Venkitaraman’s plea for bans in public areas where the permeation of cigarette smoke is harmful for passers-by or those trying to enjoy the outdoors (“Smoking in public leaves even non-smokers in Hong Kong facing serious health risks [1]”, July 11).

Non-smokers in proximity risk having their asthma flare up. Curious toddlers could become poisoned by ingesting carelessly discarded butts.

The fire contagion risk posed by still-burning cigarette ends is well known during the height of Australia’s bush-fire-prone sizzling summer and hot summers elsewhere.

Less smoking means fewer discarded butts posing a fire hazard. Another reason to impose smoking bans is to prevent adverse lifestyle role modelling for impressionable children.

From a public health perspective, raising tobacco sales tax is likely to reduce daily cigarette consumption and, more importantly, dissuade adolescents from taking up smoking. The cost disincentive of a higher tax holds the potential to improve the community burden of heart and lung disease that consumes avoidable health-care outlays.

It’s about time smokers who adopt unhealthy life habits subsidised the huge expense incurred in treating the acute exacerbation of chronic lung disease, pulmonary community rehabilitation as well as stents and bypass surgery required to alleviate coronary artery disease. Smokers have an addiction requiring an external agency to help them give up.

Imposing higher taxes on fast food and alcohol offers opportunities to improve public health related to “diabesity” (diabetes plus obesity), alcohol-related trauma and interpersonal violence. If we can extend sales tax disincentives to fast food and alcohol, then claims that a tobacco tax discriminates against smokers cannot be justified.

Joseph Ting, associate professor, School of Public Health and

Social Work, University of Queensland, Brisbane, Australia
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Source URL: http://www.scmp.com/comment/letters/article/2103457/raise-tax-tobacco-and-make-smokers-pay-health-costs