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July 22nd, 2009:

Youth Smoking in China

China has the world’s largest smoking population – 350 million – representing one-third of the world’s total. Nearly 60 percent of Chinese males older than 15 smoke regularly Five million people die of smoking-related diseases worldwide, exceeding the combined total deaths from AIDS, tuberculosis and traffic accidents. Among the 5 million, 1.2 million are Chinese nationals.

More seriously, the country’s smoking population is getting younger, according to a national survey. Males started smoking at age 22 in 1984; eight years later, they started at age 18. Females went from 25 to 20 years old within the same period.

Among college students, senior high school students and junior high school students was a smoking population of 46 percent, 45 percent and 34 percent, respectively, according to a recent study by the Ministry of Health.

In 2007, China began implementing a law to protect non-adults from tobacco and alcohol sales. From May 1, 2008, Beijing banned smoking in public areas. Reports say the Chinese government is considering increasing taxes on tobacco products. The plan has been hailed by the public, though it still has to go through a lengthy process before becoming law. Enditem

Evolution of the tobacco industry positions on addiction to nicotine


FDA and Public Health Experts Warn About Electronic Cigarettes


The U.S. Food and Drug Administration today announced that a laboratory analysis of electronic cigarette samples has found that they contain carcinogens and toxic chemicals such as diethylene glycol, an ingredient used in antifreeze.

Electronic cigarettes, also called “e-cigarettes,” are battery-operated devices that generally contain cartridges filled with nicotine, flavor and other chemicals. The electronic cigarette turns nicotine, which is highly addictive, and other chemicals into a vapor that is inhaled by the user.

These products are marketed and sold to young people and are readily available online and in shopping malls. In addition, these products do not contain any health warnings comparable to FDA-approved nicotine replacement products or conventional cigarettes. They are also available in different flavors, such as chocolate and mint, which may appeal to young people.

Public health experts expressed concern that electronic cigarettes could increase nicotine addiction and tobacco use in young people. Jonathan Winickoff, M.D., chair of the American Academy of Pediatrics Tobacco Consortium and Jonathan Samet, M.D., director of the Institute for Global Health at the University of Southern California, joined Joshua Sharfstein, M.D., principal deputy commissioner of the FDA, and Matthew McKenna, M.D., director of the Office of Smoking and Health for the Centers for Disease Control and Prevention, to discuss the potential risks associated with the use of electronic cigarettes.

“The FDA is concerned about the safety of these products and how they are marketed to the public,” said Margaret A. Hamburg, M.D., commissioner of food and drugs.

Because these products have not been submitted to the FDA for evaluation or approval, at this time the agency has no way of knowing, except for the limited testing it has performed, the levels of nicotine or the amounts or kinds of other chemicals that the various brands of these products deliver to the user.

The FDA’s Division of Pharmaceutical Analysis analyzed the ingredients in a small sample of cartridges from two leading brands of electronic cigarettes. In one sample, the FDA’s analyses detected diethylene glycol, a chemical used in antifreeze that is toxic to humans, and in several other samples, the FDA analyses detected carcinogens, including nitrosamines. These tests indicate that these products contained detectable levels of known carcinogens and toxic chemicals to which users could potentially be exposed.

The FDA has been examining and detaining shipments of e-cigarettes at the border and the products it has examined thus far meet the definition of a combination drug-device product under the Federal Food, Drug, and Cosmetic Act. The FDA has been challenged regarding its jurisdiction over certain e-cigarettes in a case currently pending in federal district court. The agency is also planning additional activities to address its concerns about these products.

Health care professionals and consumers may report serious adverse events (side effects) or product quality problems with the use of e-cigarettes to the FDA’s MedWatch Adverse Event Reporting program either online, by regular mail, fax or phone.


FDA: Electronic cigarettes contain toxic chemicals


WASHINGTON — Federal health officials said Wednesday they have found cancer-causing ingredients in electronic cigarettes, despite manufacturers’ claims the products are safer than tobacco cigarettes.

The Food and Drug Administration said testing of products from two leading electronic cigarette makers turned up several toxic chemicals, including a key ingredient in antifreeze.

“Little is known about these products, including how much nicotine is there and what other chemicals may be there,” said FDA’s Deputy Commissioner Dr. Joshua Sharfstein.

FDA scientists said they tested 19 varieties of cigarettes, half of which contained forms of nitrosamine, a carcinogen known to cause cancer in humans. Many products which claimed to contain no nicotine actually had low levels of the stimulant.

Agency officials said the “quality control processes used to manufacture these products are inconsistent or nonexistent.”

Brands tested by the agency included Smoking Everywhere, marketed by a Florida-based company and NJoy Cigarettes, based in Scottsdale, Ariz. The Electronic Cigarette Association, which represents the companies, had no immediate comment Wednesday afternoon.

Public health advocates have complained the products are aimed at young people and can serve as a “gateway” to tobacco smoking. Many come in flavors, including chocolate, bubblegum and mint.

“Tobacco industry research has demonstrated that fruit and candy flavors increase the social acceptance of cigarettes and curiosity to try the product,” said Dr. Jonathan Winickoff, chair of the American Academy of Pediatrics Tobacco Consortium.

Because electronic cigarettes are not covered by federal tobacco laws, they are also often easier for young people to buy.

Electronic cigarettes produce a nicotine mist absorbed directly into the lungs. Most can easily pass as a tobacco cigarette with slim white bodies and glowing amber tips. They even emit what look like puffs of white smoke.

Manufacturers have touted the products as a healthier alternative to smoking because there is no burning involved, and they don’t contain the same hazardous cocktail of cancer-causing chemicals.

Regulators said they have halted 50 shipments of electronic cigarettes at the border since last summer. The FDA said it is authorized to seize the products because — for legal purposes — they are a medical device used to deliver nicotine.

However, the FDA’s enforcement attempts have been challenged in federal court by manufacturers. The products are made primarily in China.

FDA officials declined to comment on whether they would take action against the two manufacturers whose products were tested.

The agency did say it’s “planning additional activities” to address safety issues with the products, which may include recalls or criminal sanctions.

In an effort to move beyond cigarettes, tobacco companies have introduced a number of smokeless products to keep smokers as buyers of other items. They are trying to convert smokers to products such as moist snuff, chewing tobacco and snus — teabag-like pouches that users stick between their cheek and gum.

R.J. Reynolds spokesman David Howard said the company is focused on being the “total tobacco company,” pointing to its products like dissolvable tobacco, rather than technology like e-cigarettes.

Neither Reynolds nor Altria Group Inc.’s Philip Morris USA currently market electronic cigarettes.

Earlier this year, the FDA gained the authority to regulate tobacco products for the first time. However, the agency already could regulate electronic cigarettes because they do not actually contain tobacco.

AP Business Writer Michael Felberbaum in Richmond, Va., contributed to this report.

Copyright © 2009 The Associated Press. All rights reserved.

More councils introduce smoke-free outdoor areas

Louise Hall Health Reporter

THE number of councils in NSW that have introduced smoke-free outdoor areas has more than doubled in the past two years, a Heart Foundation survey has found.

The figures, published today, show 58 of 152 NSW councils had banned smoking in areas such as playgrounds, swimming pools and alfresco-dining areas by May, up from 28 councils in 2007.

The implementation of smoke-free outdoor areas has been higher in metropolitan municipalities, with 65 per cent of 43 councils introducing the bans, compared with 28 per cent of 109 regional councils.

Warringah, Wollongong City, Camden, Hurstville and Port Stephens are the latest councils to approve a smoke-free policy in council-owned outdoor areas.

The Heart Foundation says there is emerging evidence that secondhand smoke in outdoor areas where people tend to congregate,including alfresco-dining areas, sports stadiums and concert venues, can present a health risk to the public and staff.

A recent study of cigarette smoke levels in a variety of outdoor locations showed that a person sitting near a smoker in an outdoor area could be exposed to levels of cigarette smoke similar to those experienced by someone sitting in an indoor pub or club.

There is also evidence to suggest that smoke-free areas support smokers who are trying to quit as well as reduce their overall cigarette consumption.

The chief executive of the Heart Foundation, Tony Thirlwell, said there had been some resistance to the idea in some councils, but complacency was the largest factor in more NSW councils failing to follow suit.

“In the councils which have implemented the policy, there’s largely been a particular councillor that’s felt strongly about the issue and been an advocate for it,” he said.

Of the 58 councils with smoke-free policies, 95 per cent cover playgrounds, making this the most common smoke-free area. Sporting fields (78 per cent), pools (26 per cent), beaches (17 per cent) and alfresco-dining areas (16 per cent) were included to various degrees.

“While there are fines for breaching the policy, we’re not into policing, such as getting council rangers to hunt out smokers,” MrThirlwell said.

“But we do hope it raises awareness in the community, so that people walk away from others if they want to smoke.”

World Expo hands back sponsorship from tobacco firm

Will Clem in Shanghai, SCMP

The Shanghai World Expo 2010 has handed back 200 million yuan (HK$227 million) in sponsorship funds from a tobacco company, state media reports.

If confirmed, the move would be a major coup for anti-smoking activists on the mainland, who have been pressuring authorities to live up to their commitments to international health treaties.

The Southern Metropolis News reported yesterday that the Expo organising committee had decided to return the Shanghai Tobacco Group’s contribution to the China national pavilion to promote a “healthy World Expo”.

The paper quoted anonymous sources in the Expo bureau as saying the decision had been reached in a document ruling out gifts from firms linked to the tobacco industry.

When the Shanghai Tobacco Group made the donation in May, it was the largest single contribution the national pavilion had received since fund-raising began in 2007.

No one at the Expo organising bureau could be reached for comment, and no announcement that the sponsorship money had been returned was on the fair’s website.

However, the company is no longer listed among the fair’s 13 global partners, 12 senior partners or 14 project sponsors on either the Chinese or English versions of the site.

Campaigners submitted a petition to the Expo organisers arguing that the sponsorship was in breach of the World Health Organisation’s Framework Convention on Tobacco Control, the South China Morning Post reported last week.

China ratified the convention in 2005. The 20 signatories included medical experts, prominent anti-smoking activists and health officials.

Jiang Yuan , a tobacco- control official at the Ministry of Health, said she had not heard confirmation that the campaign was successful, but welcomed the news.

“This would be a huge step forward,” she said.

“The Shanghai government has the chance to set a positive example to the rest of the country, to show that a change in attitude is needed.

“This is not just about the Shanghai World Expo. There are many other public events that have received money from tobacco companies, and I am certain the Shanghai government’s decision will have an impact.”

She said she believed that the initial decision by organisers to accept the money had been made “without fully understanding the issues and the implications”.

“The Expo is an international event, and so it should keep with international standards,” she said. “After this, there will be more room for understanding.”

With 350 million smokers, the mainland is the largest tobacco market, accounting for one-third of the world’s smokers.

About a million mainlanders die each year from smoking-related illnesses, Ministry of Health figures show.

The anti-smoking lobby is still in its relative infancy, but has begun making inroads – despite state-run cigarette manufacturers’ political influence.

The mainland has already banned direct tobacco advertising and plans to implement a total ban on promotions in 2011.