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Psychological well-being and dual-use of cigarettes and e-cigarettes among high school students in Canada

Highlights

•6.3% of Canadian middle and high school students were dual users of cigarettes and e-cigarettes.

•Three times more Canadian youth used e-cigarettes exclusively than used cigarettes exclusively.

•High-frequency dual-users had lower psychological well-being than low-frequency dual-users.

•High-frequency cigarette dual-users had higher autonomy scores than low-frequency dual-users.

https://www.sciencedirect.com/science/article/abs/pii/S0165032719331568

Abstract

Background

Cigarette and e-cigarette use are prevalent among Canadian adolescents. Evidence shows psychiatric comorbidity with adolescent cigarette smoking, but little is known about psychological well-being among dual users of e-cigarettes and cigarettes. This study examined the association between dual-use status and psychological well-being among high school students.

Methods

We used the 2016–2017 Canadian Student Tobacco, Alcohol, and Drugs Survey. Scales of psychological well-being (relatedness, autonomy, competency, prosocial behavior, and social responsiveness) were derived from self-reported data. Dual-use status was categorized into non-users, cigarette-only smokers, e-cigarette-only users, and four types of dual-users. Multivariable linear regression models examined the association between dual-use and psychological well-being.

Results

Among the participants, 6.3% were current dual-users, 4.1% were cigarette-only smokers, 12.6% were e-cigarette-only users, and 77.0% were non-users. Compared to non-users, relatedness and social responsiveness were lower for all users. When compared to e-cigarette users, most other users had lower relatedness (high-frequency dual-users [β=-6.05], high-frequency cigarette dual-users [β=-2.27], high-frequency e-cigarette dual-users: [β=-1.32], low-frequency dual-users [β=-1.91], and cigarette-only smokers [β=-1.66]) and social responsiveness. High-frequency dual-users had lower scores for relatedness and social responsiveness, while high-frequency cigarette dual-users had higher autonomy, compared to low-frequency dual-users.

Conclusion

Dual-users had poorer psychological well-being, which differed among dual-user sub-groups. This study highlights an opportunity for specialized programs to promote psychological well-being and reduce tobacco product use among adolescents.

Limitations

The study is based on respondent self-report, and the use of cross-sectional data precludes us from determining the temporal order between dual-use and psychological well-being.

The maker of Marlboro cigarettes is plowing $1.8 billion into the cannabis producer Cronos

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THE CANADIAN EXAMPLE: TOBACCO COMPANIES CONVICTED OF CONTRABAND

In Canada, in 2008 and 2010, the three major tobacco companies were convicted of contraband and entered civil settlements with federal and provincial governments. The convictions followed guilty pleas and resulted in fines of C$525 million, the largest in Canadian history. Civil payments totalled C$1.175 billion, with fines and civil payments together totalling C$1.7 billion (US$1.3 billion).

These outcomes arose from actions in the 1990s when the three major tobacco companies in Canada exported vast quantities of Canadian made and branded cigarettes tax-exempt to the U.S., knowing that these cigarettes would return to Canada illegally as contraband. The result was that an estimated 25-30 per cent of the Canadian market in 1993 was contraband. At the time, the companies claimed that they were not doing anything illegal.

The contraband situation prompted the federal government and 5 of 10 provincial governments in 1994 to reduce tobacco tax rates (the rates were not fully restored until 2002) . This had a serious adverse impact on smoking prevalence trends, especially among youth. Moreover, government tobacco tax revenue decreased substantially following the reduction in tax rates.

Eventually there were criminal investigations, including Royal Canadian Mounted Police (RCMP) searches and document seizures at tobacco company offices. The three companies that were convicted and entered civil settlements were Imperial Tobacco Canada (British American Tobacco subsidiary); Rothmans, Benson & Hedges (Philip Morris International subsidiary); and JTI-Macdonald (now a Japan Tobacco International subsidiary, but previously, in the 1990s as RJR-Macdonald, an R.J. Reynolds subsidiary). Also, Northern Brands International, a U.S. subsidiary of R.J. Reynolds, was convicted in both Canadian and US courts.

Governments recovered only a small percentage of the total revenue lost. In subsequent court filings, federal and provincial governments estimated that more than C$10 billion was forgone. Adding in the lower revenue following the tax rollback, the forgone revenue would be much, much higher.

The Canadian experience shows not only the importance of high tobacco taxes and contraband prevention, but also demonstrates that the tobacco industry has engaged in illicit trade on a massive scale and cannot be trusted.

Rob Cunningham, Canadian Cancer Society

SETTING THE RECORD STRAIGHT ON TAXATION AND DISPARITIES IN SMOKING

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Canadian health groups respond to Philip Morris International’s $1 billion research fund

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Big tobacco bullies the global south. Trade deals are their biggest weapon

The industry has a long history of using trade to force their products into new markets. This has led to at least a 5% increase in cigarette deaths

https://www.theguardian.com/commentisfree/2017/jul/17/big-tobacco-trade-deals-new-markets-bat

Cigarette packets often carry the warning to “protect children: don’t make them breathe your smoke”. In 2014, the Kenyan government attempted to do just that – banning the sale of single cigarettes, banning smoking in vehicles with a child and keeping the tobacco industry out of initiatives aimed at children and young people.

But as the Guardian reported last week, British American Tobacco, in an effort to keep Kenyans breathing their smoke, fought the regulations on the grounds that they “constitute an unjustifiable barrier to international trade”.

In fact, big tobacco has a long history of using trade and investment rules to force their products on markets in the global south and attack laws and threaten lawmakers that attempt to control tobacco use.

Back in the 1980s, as cigarette consumption fell off in North America and western Europe, US trade officials worked aggressively to grant American companies access to markets in Asia, demanding not only the right to sell their products, but also the right to advertise, sponsor sports events and run free promotions. Smoking rates surged.

In the 1990s, World Trade Organisation agreements led to a liberalisation of the international tobacco trade, with countries reducing import tariffs on tobacco products. The impact, according to a joint study of the World Health Organisation and the World Bank, was a 5% increase in global cigarette consumption and accompanying mortality rates.

Big tobacco’s lawyers were quick to discover the value of “next generation” trade agreements. In the 1990s, Canada dropped a plain packaging initiative after US manufacturers threatened a suit using the first next-gen trade deal, the North American Free Trade Agreement (Nafta). A few years later, Philip Morris threatened Canada again after it prohibited terms such as “light” and “mild” cigarettes. Philip Morris argued it would be owed millions in compensation for damage to its brand identity.

Philip Morris was able to credibly wield this threat because of the extraordinary powers that Nafta grants international corporations: the right to sue governments in private tribunals over regulations that affect their profits.

A toxic combination of far-reaching and poorly defined “rights” for investors, eye-watering legal costs, and tribunals composed of corporate lawyers with the power to set limitless awards against governments makes investment arbitration and the modern “trade” agreement a formidable weapon to intimidate regulators.

And what big tobacco learned in the global north it has been replicating in the global south, where threats carry greater force against poorer countries that may lack the resources to see down a legal challenge.

In 2010, Philip Morris launched a $25m claim against Uruguay after it introduced graphic warnings on cigarette packs. Though Uruguay successfully defended the measure, it still faced millions in legal costs. And Philip Morris effectively won, as Costa Rica and Paraguay held off introducing similar measures.

Such are the fears around big tobacco’s aggressive use of trade and investment rules that the US-negotiated Trans-Pacific Partnership trade deal featured a carve-out excluding big tobacco from investment protections – an explicit admission of the problem.

But this does not go far enough. The important thing to realise is that the problem goes beyond big tobacco. Big oil, big pharma and big mining follow the same playbook, launching investment arbitration cases to defend their business models from governments that would regulate to protect public health, the local environment or the climate.

Rather than target individual companies or sectors, we must push our governments to reform trade and investment rules that grant such extraordinary powers to corporations. That means removing special investor rights and investment courts from trade agreements. It means removing limits on the freedom of governments to protect public health, labour and human rights and the environment.

Of course, this is easier said than done. Robert Lighthizer, US trade representative, served as deputy in a Reagan administration that pressured countries to open their tobacco markets to US exporters in the 1980s.

Vice-President Mike Pence’s record includes opposing smoking regulation, taking huge campaign donations from big tobacco, and denying the causal link between smoking and lung cancer. The EU commission, meanwhile, has been criticized for its meetings with big tobacco while it was negotiating EU-US trade talks.

The good news is that from Brazil to India to Ecuador, countries are stepping away from outdated trade and investment rules. In the UK, the Labour party manifesto opposes parallel courts for multinationals and proposes to review the UK’s investment treaties.

But until we scrap the powers that we grant big tobacco and others to frustrate and bypass our laws, efforts around the world to protect public health will continue to go up in smoke.

E-cigarette fluid poisonings on rise in Maritimes, says expert

IWK Regional Poison Centre received 34 calls related to concentrated nicotine last year, up from one in 2013

http://www.cbc.ca/news/canada/new-brunswick/nicotine-poison-e-cigarette-increase-new-brunswick-1.4141007

The number of poisoning incidents related to the concentrated nicotine cartridges used for electronic cigarettes is increasing, according to the clinical leader of a poison control centre in the Maritimes.

“It’s definitely on the rise as they become more available to the public,” said Laurie Mosher, of the IWK’s Regional Poison Centre in Halifax, which takes calls from health-care professionals in New Brunswick and from citizens in Nova Scotia and P.E.I.

The first call Mosher tracked was in 2013. In 2014, the number jumped to 14, then 21 in 2015, and 34 in 2016, she said.

The incidents involve people of all ages, but children were involved in 12 of last year’s calls, or 35 per cent, said Mosher. That’s up from three calls, or 21 per cent, in 2014.

“As a product becomes more available and more people are using it, and especially people with small children or teenagers in the house, it is likely to go up,” she said.

On Monday, a nine-year-old girl in Fredericton was taken to hospital after drinking an e-cigarette fluid called Unicorn Milk and suffering nausea, chest cramps and dizziness.

The Grade 5 student, who was diagnosed with nicotine poisoning, discovered the vial of concentrated nicotine with her friends on their school playground at É​cole des Bâtisseurs. They all tasted drops from the fluid, which is used for electronic vaping of cigarettes.

The girl’s mother, Lea L’Hoir, said the children were tempted to try the strawberry-flavoured fluid because it smelled good, and its container was decorated with a brightly coloured image of a unicorn.

National total not tracked

The number of such incidents across Canada is unclear. There is no central data collection centre for poisonings, said Mosher.

There are five poison centres across the country that serve all of the provinces, except New Brunswick and Newfoundland, which are covered by 811 and Tele-Care.

New Brunswick’s 811 line has received only one call regarding liquid nicotine poisoning in the past two years, according to the Department of Health.

The call was in November 2016, said department spokesperson Geneviève Mallet-Chiasson.

Mosher worries the numbers will continue to grow. “I think it definitely has potential for concern. So I don’t think we’re making too much of it.”

Even small amounts problematic

The symptoms experienced depend on exposure, said Mosher, who is also a registered nurse. Just a drop or two can lead to nausea or vomiting. It can also be very irritating if the substance gets into the eyes, she said.

“Larger amounts can cause tremors, seizures, and then it can also go the other way and they can have drowsiness,” said Mosher.

“So certainly if a child ingested a mouthful it could be very toxic. We haven’t had any severe toxicity as of now in our centre, but there certainly is potential for that,” she said.

“It could be life-threatening, depending on how much they got a hold of.”

Label guidelines needed

Mosher contends part of the problem is a lack of labelling guidelines for the cartridges.

Health Canada doesn’t regulate the labelling of vape products, but the sale of the products to people 18 or under is banned.

Mosher said the nicotine comes in different concentrations and the labels are not clear. For example, a label might indicate 16 mg, but there’s a big difference between 16 mg per mL and 16 mg in the entire cartridge.

In addition, the packaging is appealing to young children and the flavours appeal to teenagers.

The lack of warning symbols and lack of child-resistant packaging is very concerning, said Mosher.

“I would treat it like any other poisonous product, it should be kept out of reach of children, it should be regulated,” she said. “And it should not be appealing to young children.”

Call for tougher regulations

Earlier this week, the Canadian Cancer Society called on the federal government to move quickly on tougher regulations surrounding the labelling of vaping products.

A federal bill that would regulate the manufacture, sale and labelling of vaping products awaits approval in the Senate.

The bill would also give Health Canada the regulatory authority to enforce policies on childproof caps and to restrict certain flavours that critics say are aimed at a younger market.

The Centres for Disease Control and Prevention in the U.S. reported in 2014 that the number of calls to poison centres involving e-cigarette liquids rose from one per month in September 2010 to 215 per month in February 2014. Almost 52 per cent of the calls involved children under the age of five.

The first four months of this year, poison centres in the U.S. reported 795 calls about exposure to the liquids.

If a child accidentally ingests the fluid, Mosher recommends calling a poison centre or 911​.

ACT Welcomes Tobacco Tax Hike In Federal Budget

The Alliance for the Control of Tobacco welcomes a hike in the federal tobacco tax announced this week by the Trudeau government.

http://vocm.com/news/act-welcomes-tobacco-tax-hike-in-federal-budget/

Executive Director Kevin Coady says they welcome anything to discourage smoking.

He says the surtax the tobacco manufacturer was paying has been removed, and the consumer tax increased, but it should discourage people from picking up the habit, or force them to cut back.

Statistics Canada earlier this week released numbers showing that this province has the highest rate of tobacco use in the country at 24.4 per cent, and marked increase from the previous survey.

Smoking rate continues to decline, survey shows

The latest Canadian Community Health Survey shows a 0.4 percentage point annual decline in the smoking rate and a nearly nine per cent drop since 2000-2001, the Canadian Press reported.

http://www.tobaccojournal.com/Smoking_rate_continues_to_decline_survey_shows.54156.0.html

Some 17.7 per cent of the population 12 years and older smoke daily or occasionally in 2015, compared with 18.1 per cent the year before, the news agency said. The rate was 26 per cent in 2000-2001. About 5.3 people smoke, of which about 3.8 million are daily smokers, Canadian Press said. Male smokers at 20.4 per cent represented a larger group than females at 15 per cent of the population in the latest survey.