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January 6th, 2013:

Particulate mass and polycyclic aromatic hydrocarbons exposure from secondhand smoke in the back seat of a vehicle Hint – applies to everywhere children are seated in cars

1. Amanda L Northcross1,

2. Michael Trinh1,

3. Jay Kim1,

4. Ian A Jones2,

5. Matthew J Meyers3,

6. Delia D Dempsey4,

7. Neal L Benowitz5,

8. S Katharine Hammond1

+ Author Affiliations

1. 1Department of Environmental Health Sciences, School of Public Health, University of California Berkeley, Berkeley, California, USA

2. 2University of California at Los Angles, Los Angeles, California, USA

3. 3The Commonwealth Medical College, Scranton, Pennsylvania, USA

4. 4Department of Clinical Pharmacology and Experimental Therapeutics, University of California at San Francisco, San Francisco, California, USA

5. 5Departments of Medicine and Bioengineering & Therapeutic Sciences, University of California San Francisco, San Francisco, California, USA

1.     Correspondence to Dr Amanda L Northcross, Department of Environmental Health Sciences, School of Public Health, University of California Berkeley, 50 University Hall #7360, Berkeley, CA 94720, USA;

Received 20 March 2012

Accepted 28 August 2012

Published Online First 21 November 2012


Context Exposure to secondhand smoke (SHS) has been reduced in the USA by banning smoking in public places. These restrictions have not had the same effect on children’s exposure to SHS as adults suggesting that children are exposed to SHS in locations not covered by bans, such as private homes and cars.

Objectives Assess exposure to SHS in the backseat of a stationary vehicle where a child would sit, quantify exposures to fine particulates (PM2.5), polycyclic aromatic hydrocarbons (PAH), carbon monoxide (CO) and nicotine. Estimate the impact on a child’s mean daily exposure to PM2.5.

Methods SHS exposures in stationary vehicles with two different window configurations were monitored. A volunteer smoked three cigarettes in a one-hour period for twenty-two experiments. PM2.5, CO, nicotine and PAH where measured in the backseat of the vehicle. 16 PAH compounds were measured for in gas and particle phases as well as real-time particle phase concentrations.

Results The mean PAH concentration, 1325.1 ng/m3, was larger than concentrations measured in bars and restaurants were smoking is banned in many countries. We estimate that a child spending only ten minutes in the car with a smoker at the mean PM2.5 concentration measured in the first window configuration −1697 mg/m3 – will cause a 30% increase to the daily mean PM2.5 personal average of a child.

Conclusions Estimates made using the measured data and previously reported PM2.5 daily mean concentrations for children in California showing that even short exposure periods are capable of creating large exposure to smoke.

Tobacco price increase works for heavy smokers as well as youth

Differential effects of cigarette price changes on adult smoking behaviours

1. Patricia A Cavazos-Rehg1,

2. Melissa J Krauss1,

3. Edward L Spitznagel2,

4. Frank J Chaloupka3,

5. Douglas A Luke4,

6. Brian Waterman5,

7. Richard A Grucza1,

8. Laura Jean Bierut1

+ Author Affiliations

1. 1Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA

2. 2Department of Mathematics, Washington University in St. Louis, St. Louis, Missouri, USA

3. 3Department of Economics, University of Illinois at Chicago, Chicago, Illinois, USA

4. 4Center for Tobacco Policy Research, School of Social Work, Washington University in St. Louis, St. Louis, Missouri, USA

5. 5Thomson Reuters Healthcare, Chicago, Illinois, USA

1.     Correspondence to Dr Patricia A Cavazos-Rehg, Department of Psychiatry, Washington University School of Medicine, Campus Box 8134, 660 South Euclid, St. Louis, MO 63110, USA;

Received 6 March 2012

Accepted 10 October 2012

Published Online First 7 November 2012


Background Raising cigarette prices through taxation is an important policy approach to reduce smoking. Yet, cigarette price increases may not be equally effective in all subpopulations of smokers.

Purpose To examine differing effects of state cigarette price changes with individual changes in smoking among smokers of different intensity levels.

Methods Data were derived from the National Epidemiologic Survey on Alcohol and Related Conditions, a nationally representative sample of US adults originally interviewed in 2001–2002 (Wave 1) and re-interviewed in 2004–2005 (Wave 2): 34 653 were re-interviewed in Wave 2, and 7068 smokers defined at Wave 1 were included in our study. Mixed effects linear regression models were used to assess whether the effects of changes in state cigarette prices on changes in daily smoking behaviour differed by level of daily smoking.

Results In the multivariable model, there was a significant interaction between change in price per pack of cigarettes from Wave 1 to Wave 2 and the number of cigarettes smoked per day (p=0.044). The more cigarettes smoked per day at baseline, the more responsive the smokers were to increases in price per pack of cigarettes (ie, number of cigarettes smoked per day was reduced in response to price increases).

Conclusions Our findings that heavier smokers successfully and substantially reduced their cigarette smoking behaviours in response to state cigarette price increases provide fresh insight to the evidence on the effectiveness of higher cigarette prices in reducing smoking.

Illicit cigarettes and hand-rolled tobacco in 18 European countries: a cross-sectional survey

1. Luk Joossens1,

2. Alessandra Lugo2,

3. Carlo La Vecchia2,3,

4. Anna B Gilmore4,

5. Luke Clancy5,

6. Silvano Gallus2

+ Author Affiliations

1. 1Association of European Cancer Leagues, Foundation against Cancer, Brussels, Belgium

2. 2Department of Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy

3. 3Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy

4. 4Department for Health, University of Bath, Bath, UK

5. 5TobaccoFree Research Institute Ireland, Dublin, Ireland

1.     Correspondence to Luk Joossens, Foundation against Cancer, Chaussée de Louvain 479, Brussels B-1030, Belgium;

Received 18 June 2012

Accepted 10 October 2012

Published Online First 10 December 2012


Objective Little evidence, other than that commissioned by the tobacco industry, exists on the size of the illicit tobacco trade. This study addresses this gap by examining the level and nature of illicit cigarettes and hand-rolled tobacco in 18 European countries.

Design Face-to-face cross-sectional survey on smoking.

Setting 18 European countries.

Participants For each country, around 1000 subjects representative of the population aged 15 and over were enrolled. Current cigarette smokers were asked to show their latest purchased pack of cigarettes or hand-rolled tobacco.

Main outcome measure A comprehensive measure called an Identification of an Illicit Pack (IIP) was used to study the extent of illicit trade, defining a pack as illicit if it had at least one of the following tax evasion indicators: (1) it was bought from illicit sources, as reported by smokers, (2) it had an inappropriate tax stamp, (3) it had an inappropriate health warning or (4) its price was substantially below the known price in their market.

Results Overall, the proportion of illicit packs was 6.5%. The highest prevalence of IIP was observed in Latvia (37.8%). Illicit packs were more frequent among less educated smokers and among those living in a country which shared a land or sea border with Ukraine, Russia, Moldova or Belarus. No significant association was found with price of cigarettes.

Conclusions This study indicates that IIP is less than 7% in Europe and suggests that the supply of illicit tobacco, rather than its price, is a key factor contributing to tax evasion

Plain packaging of tobacco products — plainly a success

In an editorial in the Medical Journal of Australia Professor Mike Daube, Professor Rob Moodie and Professor Simon Chapman discuss how the plain packaging legislation has come about, the resistance of the global tobacco industries to it, and what its impact is likely to be.

This article was originally published in the MJA on November 19, 2012. View the original article here.

From 1 December 2012, Australia will be the first country in which plain packaging is mandatory for all tobacco products. “Plain packaging” is almost a misnomer: packs will have to show government-mandated warnings and images. They can carry only information mandated by the government, will show product names only in understated template form, and will be in “nappy- brown” colouring, chosen (based on research) to be as unattractive as possible.

Plain packaging is an important component of the comprehensive approach required to further reduce smoking among adults and children. It deprives tobacco companies of their last opportunity to promote their products in the community. When the National Preventative Health Taskforce, whose recommendations prompted the introduction of plain packaging, sought public comment, the tobacco industry advised that “there is already a significant amount of regulation on tobacco products and there may now be the risk of too much, with unintended con- sequences of progressing further” and “Australia has passed the limit of the ability of regulations on tobacco advertising, marketing, sales and public smoking to advance health objectives”. Their submissions provided helpful confirmation of the likely impact of plain packaging by identifying it as their greatest concern.

There are four key reasons why the tobacco industry opposed plain packaging more fiercely than any other measure since tobacco advertising was banned. Tobacco packaging is a potent means of promoting industry- preferred messages. Plain packaging will enhance the well-deserved public perception of tobacco companies as less reputable and more harmful than any other industry. Introducing plain packaging will also play an important role in both reducing the uptake of smoking among children and encouraging adults to quit. And the industry is rightly concerned that this measure, once implemented in one country, will be adopted elsewhere. It was clear in further exposure of their industry as so desperate that it created organisations such as the Alliance of Australian Retailers as a front to carry its messages. Industry executives in London, New York and Tokyo, who drive the actions of their Australian subsidiaries, may not appreciate how low their industry’s reputation has sunk here, but presumably concluded that attack was their only option. They will doubtless seek to undermine the plain packaging initiative as best they can, from renaming brands to reducing prices: this ever-ruthless industry may decide that taking a hit in Australia is worthwhile if it helps to counter the impact of plain packaging.

Around the world, six trillion cigarettes are sold each year, causing more than five million deaths — at an estimated profit for tobacco companies of US$6000 per death. Australia’s lead is all the more important as a demonstration of “the art of the possible” — in particular, for governments of developing countries where tobacco companies now aggressively market their wares.

Tobacco company board members and executives know exactly what they are doing, but continue regardless of the consequences — exemplified by the cynical comment from a Philip Morris spokesperson that “There is no doubt that tobacco is a very harmful product that’s addictive and it kills people … It’s very, very sad that people do get sick from smoking …”. Companies and individuals who knowingly promote a lethal product should expect to be treated with as much disdain as those who peddle other drugs.

Despite this powerful industry’s efforts, in Australia there are encouraging trends in tobacco use among children, adults and, importantly, disadvantaged groups — but it is 63 years since the emergence of unequivocal evidence about the dangers of smoking. Since then, a million Australians have died because they smoked. Children are still taking it up, smoking remains the biggest single killer of Aboriginal people and it is the cause of some 15 000 Australian deaths each year. We know how to reduce smoking yet further: plain packaging should not be cause for complacency, but should rather be a trigger for governments at all levels to redouble their efforts. It is barely credible that at this time the governments of New South Wales and Victoria are actually reducing their commitment to tobacco control. We could and should do more. As former federal Health Minister Nicola Roxon said at the launch of the National Preventative Health Taskforce report, “we are killing people by not acting.”

Plain packaging owes much to the efforts over many years of health organisations, campaigners, researchers and bureaucrats; but legislation does not happen without legislators. Great credit rightly belongs to Nicola Roxon for pressing ahead with this landmark measure, and to her Parliamentary colleagues in all parties for supporting her.

December 1 is a landmark in Australian and global public health history. Australia has successfully taken on the powerful and massively resourced global tobacco industry. There is much work ahead, but this is also a time to take pride in a stunning success for public health.

Secondhand smoke exposure levels in outdoor hospitality venues: a qualitative and quantitative review of the research literature

Tob Control doi:10.1136/tobaccocontrol-2012-050493


Secondhand smoke exposure levels in outdoor hospitality venues: a qualitative and quantitative review of the research literature

1. Andrea S Licht1,2,

2. Andrew Hyland2,

3. Mark J Travers2,

4. Simon Chapman3

+ Author Affiliations

1. 1Department of Social and Preventive Medicine, State University of New York at Buffalo, Buffalo, New York, USA

2. 2Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York, USA

3. 3School of Public Health, University of Sydney, Sydney, Australia

1.     Correspondence to Andrea Licht, Department of Health Behavior, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA;

Received 22 February 2012

Revised 5 November 2012

Accepted 7 November 2012

Published Online First 5 December 2012


Objective This paper considers the evidence on whether outdoor secondhand smoke (SHS) is present in hospitality venues at high levels enough to potentially pose health risks, particularly among employees.

Data sources Searches in PubMed and Web of Science included combinations of environmental tobacco smoke, secondhand smoke, or passive smoke AND outdoor, yielding 217 and 5,199 results, respectively through June, 2012.

Study selection Sixteen studies were selected that reported measuring any outdoor SHS exposures (particulate matter (PM) or other SHS indicators).

Data extraction The SHS measurement methods were assessed for inclusion of extraneous variables that may affect levels or the corroboration of measurements with known standards.

Data synthesis The magnitude of SHS exposure (PM2.5) depends on the number of smokers present, measurement proximity, outdoor enclosures, and wind. Annual excess PM2.5 exposure of full-time waitstaff at outdoor smoking environments could average 4.0 to 12.2 μg/m3 under variable smoking conditions.

Conclusions Although highly transitory, outdoor SHS exposures could occasionally exceed annual ambient air quality exposure guidelines. Personal monitoring studies of waitstaff are warranted to corroborate these modeled estimates

Clouding the UK policy debate on plain packaging

Clouding the UK policy debate on plain packaging

20 Nov, 12 | by Marita Hefler, News Editor

Kelley Lee

Associate Fellow, Centre on Global Health Security, Chatham House

In July 2012, Japan Tobacco International (JTI) launched a campaign against the UK Department of Health’s consultation on the plain packaging of tobacco products.  The UK is one of JTI’s top five markets worldwide and there are fears that the UK, and potentially other European Union members, will follow the Australian decision to adopt plain packaging.

JTI’s campaign has so far been undertaken in two phases.  The first phase claimed that the consultation process was ‘a series of individually flawed consumer surveys’, supported by “a panel of ‘experts’ and their subjective views on what smokers might do”.  Plain packaging was described as having “no evidence” to support it and, in an accompanying press release, JTI UK Managing Director Martin Southgate hoped that “the Department of Health will re-think its approach and common sense will prevail”. The second phase of the campaign, rolled out in September 2012, focused on counterfeiting, and the industry’s predicted impact on the livelihoods of local small businesses and the national economy.  In full-page advertisements, cartoon-like images of ‘standardised’ cigarette packets were used to raise concern about how easily they would be copied.

JTI’s criticism of the lack of evidence behind plain packaging, citing the importance of ‘evidence-based policy’, is ironic given the industry’s own track record on the undermining of scientific evidence and policy processes.  This latest campaign narrows the scope of acceptable evidence to a particular type of policy evaluation (post implementation).  Given that Australia will be the first country to adopt plain packaging, the type of evidence demanded is not yet possible.  Importantly, the campaign continues a tradition by the industry of ignoring substantial bodies of unfavourable evidence.  It is well-known, for example, that consumers respond directly to packaging, particularly young people who tend to have a stronger response to colour, logos and images on cigarette packs.  Other evidence shows that plain packaging enhances the impact of health warnings.

When applied to the counterfeiting issue, JTI’s call for evidence-based policy is shown to be even more tenuous.  The company speculates that “standardising packs will make them even easier to fake and cost taxpayers millions more than the £3billion lost in unpaid duty last year.”  If assessed by the company’s own standard of proof (i.e. evidence following policy implementation), this claim hardly stands up.  More importantly, there is substantial evidence suggesting that the illicit cigarette trade is supported by tobacco companies themselves.   Plain packets will still require large pictorial health warnings and covert security markings, making them as difficult to counterfeit as branded packs.  None of this, however, is mentioned in JTI’s campaign.  Its efforts to cloud public debate on the issue are plain.


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