Tobacco
Survey stresses role of vaping in tobacco control
https://manilastandard.net/business/biz-plus/321405/survey-stresses-role-of-vaping-in-tobacco-control.html
Results of a first-of-its-kind survey in India highlight the potential of e-cigarettes as an additional option for tobacco control and how vaping can have a substantial impact on public health.
Peter Paul Dator, president of The Vapers Philippines, said the groundbreaking survey in India clearly shows that vaping helps smokers quit or reduce smoking.
“Its results are particularly relevant to the Philippines because like India, our country has a large number of smokers and a low smoking cessation rate. The Department of Health and other local policymakers should look at the evidence for e-cigarettes with an open mind and start making science-based decisions to help reduce smoking in the country,” said Dator.
Dator was referring to the interview-based survey involving 3,000 vapers aged 18 and older from eight of the largest metropolitan cities in India. The vast majority of respondents (71.3 percent) used e-cigarettes to quit (30 percent) or reduce (41.3 percent) smoking.
Similar results were observed in smokeless tobacco users. Most (79 percent) believe that e-cigarettes are less harmful than combustible cigarettes. Survey participants reported minimal side effects (cough, headache, dry mouth/throat) and some health benefits (improved general health, breathing, smell and taste) after they started vaping.
Around 81 percent of survey respondents were men and 19 percent women, with average age of 29 years. The majority (80 percent) were first exposed to nicotine through combustible cigarette smoking, SLT use or both.
Leading tobacco harm reduction expert Dr. Konstantinos Farsalinos and Indian researchers conducted the survey whose results were published on March 30, 2020 in Harm Reduction Journal.
Dator said that India and the Philippines face similar smoking-related public health challenges. The World Health Organization estimates that there are over 120 million smokers in India, accounting for almost 12 percent of the 1.1 billion smokers globally.
The 2016-2017 Global Adult Tobacco Survey revealed that India has the second-lowest quit rate among GATS countries surveyed at the end of 2017. It also showed that India has the second-largest tobacco consuming population in the world, estimated to be over 267 million, which includes at least 100 million tobacco smokers and over 199 million SLT users.
Dr. Farsalinos and his co-authors said that tobacco-related deaths in India are estimated to be over 1 million a year and are projected to rise to 1.5 million by 2020. They also pointed to the prevalence of smoking-related illnesses such as heart disease, lung cancer and chronic pulmonary obstructive disease in India.
Dator cited DOH data, which show that almost 88,000 Filipinos die from smoking-related diseases every year. Healthcare expenditures and lost income due to smoking-related sickness and premature death cost the country P188 billion ($4 billion) yearly.
These figures only cover four of more than 40 smoking-related diseases namely lung cancer, chronic obstructive pulmonary disease, heart disease and stroke.
GATS found that there are currently 16 million Filipino adult smokers. “Like India, the Philippines has a very low smoking cessation rate of 4 percent. This dismal quit rate indicates the ineffectiveness of currently approved smoking cessation strategies in the country such as ‘quitting cold turkey’, counseling, and nicotine replacement therapy,” Dator said.
“We all know that the combustion in cigarettes is what is harmful to the health of smokers. The harm from smoking is caused primarily through the toxins produced by the burning or combustion of tobacco. By contrast, non-tobacco, non-smoked nicotine products such as e-cigarettes are considerably less harmful,” Dator said.
He cited the widespread agreement among organizations such as Action on Smoking and Health, Public Health England, Cancer Research UK, the Royal College of Physicians and the Royal College of General Practitioners that, on the basis of current evidence, e-cigarettes or vapes represent a significantly less harmful alternative to tobacco cigarettes for smokers who are unable or unwilling to stop using nicotine.
“The DOH should pay particular attention to how the study authors described India’s e-cigarette ban as a ‘missed opportunity’ and urged the Indian government to promote additional research and consider revising the regulatory framework if the evidence warrants it,” Dator said.
The Indian government banned the import, manufacture, sale, advertisement, storage and distribution of e-cigarettes in September 2019. According to Dator, India’s vaping ban is a tobacco control approach that other governments should not adopt.
“Such a retrogressive policy will be a major blow to smokers who have switched to vaping. It will likely push them to go back to smoking combustible cigarettes,” he said.
Streaming services flouting India’s regulations banning tobacco imagery in all media
Working with colleagues at HRIDAY (Health Related Information Dissemination Amongst Youth) in New Delhi, and WHO, we just published “Tobacco imagery in on-demand streaming content popular among adolescents and young adults in India: implications for global tobacco control” in Tobacco Control.
https://tobacco.ucsf.edu/streaming-services-flouting-india%E2%80%99s-regulations-banning-tobacco-imagery-all-media
Here is the press release BMJ sent out about the paper:
Streaming services flouting India’s regulations banning tobacco imagery in all media
Stronger enforcement needed, while WHO guidelines should be updated, say researchers
Streaming services that are popular with teens and young people in India are flouting the nation’s regulations on exposure to tobacco imagery in any media platform, reveals an analysis of 10 on-demand streaming series, published online in the journal Tobacco Control.
The rules, which are designed to protect young people, should be more rigorously enforced, and the guidelines for the implementation of Article 13 of the WHO Framework Convention on Tobacco Control should be updated to include streaming services and other new media, conclude the researchers.
Almost 266 million people aged 15 and older use tobacco in India, and the resulting health problems are “substantial,” say the researchers.
In response, India has strengthened its tobacco control efforts, particularly in relation to teens and young people who are highly susceptible to the effects of tobacco imagery, by banning the advertising and promotion of all tobacco products in every media platform.
And since 2012, any film or TV programme containing tobacco imagery must include prominent audio-visual anti-tobacco health warnings for specified periods of time, irrespective of whether it’s produced in India or elsewhere.
On-demand streaming services, such as Netflix, YouTube, Hotstar and Amazon Prime Video, have become increasingly popular among young people in India. The researchers therefore wanted to find out how much tobacco imagery is present in streamed content and how well streaming services comply with Indian tobacco control regulations.
They held focus group discussions with school and college students, aged 15 to 24, in New Delhi, to find out which streaming services they used the most and what they watched.
Based on these discussions, the researchers came up with the 10 most popular series, comprising 188 episodes. All but two of the series were streamed on Netflix; the rest were streamed on Amazon Prime Video. Only two of the series were Indian productions.
The 10 series were: The Marvellous Mrs Maisel (rated 16+); Stranger Things (16+); Bodyguard (16+); Riverdale (13+); Narcos (16+); Sacred Games (18+); Mirzapur (18+); Chilling Adventures of Sabrina (16+); 13 Reasons Why (16+); and The Crown (16+).
The researchers used a validated method (Breathe California) to count the number of tobacco incidents in each series. Incidents were defined as the actual or implied use of a tobacco product by an actor.
The analysis showed that 70% of the series depicted tobacco incidents which ranged from zero to 1652 in The Marvellous Mrs Maisel. More than half of the total number of episodes (57.4%) contained at least one such incident.
Narcos contained 833 incidents; The Crown 599; Stranger Things 233; Chilling Adventures of Sabrina 171; Mirzapur 78; and Sacred Games 67.
The Marvellous Mrs Maisel (18 episodes over two seasons) had the highest average number of tobacco incidents (87.5) per episode for the entire series, followed by The Crown (20 episodes over two seasons) with 29, and Narcos (30 episodes over three seasons) with 26.5.
Indian productions contained fewer tobacco incidents per episode and per hour than those produced elsewhere.
Four out of the 10 series depicted tobacco brands, including Mayburn, Camel, Marlboro, Salem and Newport. All these series were foreign productions.
But none of the series that included tobacco incidents complied with the tobacco-free film and TV rules in India.
Their analysis suggests that the extent of tobacco imagery and brand placement in on-demand streaming service content in India is high, while compliance with the rules is low, say the researchers.
“There is no reason to expect that the effects of exposure to tobacco imagery in streaming shows should be any different than the effects of tobacco imagery in films,” they write.
“On-demand streaming content providers and governments should heed the lessons learnt from the film industry and apply the same rules to include tobacco imagery in the content available through on-demand streaming platforms,” they add.
And it’s clear that the legislation “is blatantly being violated in this new media, indicating the need for better enforcement of existing rules in India and updating the guidelines for implementation of Article 13 of the WHO Framework Convention on Tobacco Control,” they conclude.
Here is the abstract:
Background India implemented tobacco-free film and TV rules (Rules) to protect adolescents and young adults from tobacco exposure.
Objective To assess tobacco imagery in online series popular among adolescents and young adults.
Methods Ten popular online series on streaming platforms were identified after discussions with participants (aged 15–24 years) in New Delhi, and content-coded for tobacco imagery following the Breathe California protocol. Incidents of tobacco use and brand appearances in each series episode were counted, and compliance with Indian Rules was recorded.
Results 188 episodes across 10 series on Netflix and Amazon Prime Video were coded. Seven series were rated age 16+, two were 18+ and one was 13+. The median number of tobacco incidents per episode in foreign productions was as follows: Amazon’s ‘The Marvellous Mrs Maisel’ (87.5, IQR 62.0–116.0) and Netflix’s ‘The Crown’ (29.0, 18.0–36.0) were higher than Indian productions: Netflix’s ‘Sacred Games’ (9.0, 0.5–14.5) and Amazon’s ‘Mirzapur’ (7.0, 4.0–11.0) (p=0.84). Tobacco incidents per hour ranged from 0 (Bodyguard, Riverdale, 13 Reasons Why) to 106.1 (The Marvellous Mrs Maisel). Seven of 10 series had tobacco imagery and none were compliant with the Rules.
Conclusion Contrary to Section 5 of India’s Cigarettes and Other Tobacco Products Act, its Rules are not being complied with by the streaming platforms. US-produced streaming media contains more tobacco incidents than Indian-produced media. There is an urgent need for better enforcement of existing Rules on streaming platforms in India, and modernisation of the WHO Framework Convention on Tobacco Control, Article 13 guidelines to account for new streaming platforms to protect youth from tobacco imagery globally.
What this paper adds
Section 5 of India’s Cigarettes and Other Tobacco Products Act (COTPA) imposes a complete ban on tobacco advertising and promotion in any form of media.
Streaming is a new form of media popular among adolescents and young adults in India.
We found that out of the 188 episodes across 10 on-demand streaming series studied, the US produced series – Amazon’s ‘The Marvellous Mrs Maisel’ and Netflix’ ‘Narcos’ and ‘The Crown’ had higher tobacco imagery compared with Indian produced series – Amazon’s ‘Mirzapur’ and Netflix’ ‘Sacred Games’.
Section 5 of COTPA is blatantly being violated in this new media indicating the need for better enforcement of existing rules in India and updating WHO Framework Convention on Tobacco Control Article 13 guidelines.
The full citation is: Arora M, Nazar GP, Chugh A, Rawal T, Shrivastava S, Sinha P, Munish VG, Tullu FT, Schotte K, Polansky JR, Glantz SA. Tobacco imagery in on-demand and streaming content popular among adolescents and young adults in India: implications for global tobacco control. 2020; epub ahead of print 9 Apr 2020 doi 10.1136/tobaccocontrol-2019-055360. It is available here.
This item is cross-posted from the Smokefree Movies blog entry, which is here.
The Quest for Pharmacotherapies to Treat Tobacco Use Disorder
More than Smoke and Patches: The Quest for Pharmacotherapies to Treat Tobacco Use Disorder
http://pharmrev.aspetjournals.org/content/72/2/527.long
Abstract
Tobacco use is a persistent public health issue. It kills up to half its users and is the cause of nearly 90% of all lung cancers. The main psychoactive component of tobacco is nicotine, primarily responsible for its abuse-related effects. Accordingly, most pharmacotherapies for smoking cessation target nicotinic acetylcholine receptors (nAChRs), nicotine’s major site of action in the brain. The goal of the current review is twofold: first, to provide a brief overview of the most commonly used behavioral procedures for evaluating smoking cessation pharmacotherapies and an introduction to pharmacokinetic and pharmacodynamic properties of nicotine important for consideration in the development of new pharmacotherapies; and second, to discuss current and potential future pharmacological interventions aimed at decreasing tobacco use. Attention will focus on the potential for allosteric modulators of nAChRs to offer an improvement over currently approved pharmacotherapies. Additionally, given increasing public concern for the potential health consequences of using electronic nicotine delivery systems, which allow users to inhale aerosolized solutions as an alternative to smoking tobacco, an effort will be made throughout this review to address the implications of this relatively new form of nicotine delivery, specifically as it relates to smoking cessation.
Significance Statement Despite decades of research that have vastly improved our understanding of nicotine and its effects on the body, only a handful of pharmacotherapies have been successfully developed for use in smoking cessation. Thus, investigation of alternative pharmacological strategies for treating tobacco use disorder remains active; allosteric modulators of nicotinic acetylcholine receptors represent one class of compounds currently under development for this purpose.