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February 19th, 2015:

Don’t fall for the hype. Nicotine is a poison, no matter how it is delivered

Lobbyists and health campaigners are touting e-cigarettes as a safer version of the real thing, but there’s no evidence to prove that they are

It’s rare for pro-smoking lobbyists and health campaigners to stop bickering with one another – let alone agree on something. But this week, the two groups have come out in unison against a new Scottish health policy.

From April, all Scottish health boards (bar one, NHS Lothian) will ban the use of e-cigarettes on NHS premises. The move makes perfect sense, and falls firmly into line with current NHS policies relating to other nicotine-laden items. But smokers’ rights groups have lambasted the ban as “perverse” – and, believe it or not, anti-smoking campaigners at Ash Scotland seem to agree with them.

According to both camps, e-cigs should be considered a vital tool to help smokers cut down and ultimately kick the habit. By banning both cigarettes and e-cigarettes from hospital grounds, they claim, NHS boards are removing a critical incentive for nicotine addicts to switch over to “less harmful” e-cigs. But should we really be encouraging smokers to make that switch?

Lobbyists have been queuing up for a few years now to push the idea that e-cigs are somehow safer than normal cigarettes. One of the most dangerous aspects of your typical, run-of-the-mill cigarette is the tar-filled smoke you’re inhaling with each puff. That tar may contain up to 7,000 different toxins, which are otherwise found in everything from rat poison to nail polish. E-cigs, on the other hand, produce a light, tar-free vapour. But this doesn’t necessarily make them any safer.

E-cigs don’t contain the same type of nicotine you might find in an ordinary tobacco leaf. They contain liquid nicotine, which can be lethal: doctors say a tablespoon of some e-liquids on the market would be enough to kill an adult; half a teaspoon could kill a child. And the worst part is, you don’t even need to ingest these liquids to end up in hospital. Mere skin contact with concentrated liquid nicotine is enough to cause symptoms of poisoning, such as dizziness, elevated blood pressure and seizures.

That should scare even the most devout e-cig user, because the truth is that nobody’s actually regulating the concentration levels of liquids going into each cartridge. This lack of oversight may change next year, thanks to EU legislation that should see the products slapped with a few crucial safety guidelines. But for now, e-cigarette manufacturers preside over a cowboy industry that’s expanding at breakneck speed.

Bearing that in mind, every puff you take on an e-cig is a roll of the dice. After all, how confident can you be that the unbranded cartridges you’ve been purchasing from your local corner shop were filled by a chemist who actually knows what they are doing?

Sixty years ago, we had doctors telling us that one brand of cigarettes was better for your health than another. Today, we’ve got lobbyists telling us virtually the same thing about e-cigarettes. But as research slowly begins to catch up with emerging technology, chances are we’ll soon be scoffing at the health campaigners of today in the same way that we now roll our eyes at the smoking enthusiasts of the 1950s.

As with most new discoveries, we have absolutely no idea what sort of longterm impact e-cigarettes may have on our health. We probably won’t know for decades. So for now we’re just going to have to make educated decisions based on the information we’ve got at hand: namely, that e-cigs are loaded with unregulated contents. And based on this it makes sense to send them packing in the same direction as their tobacco-laden cousins.

E-cigs may or may not be a potential escape route for smokers looking to kick the habit, and that’s great for them. But NHS Scotland is absolutely right in asking e-cig users to take their habit elsewhere.

No matter how you choose to dress it up, nicotine is nicotine, and public health is public health. Let’s not confuse the two.

Smokers’ reactions to the new larger health warning labels on plain cigarette packs in Australia: findings from the ITC Australia project



This study examined whether larger sized Australian cigarette health warning labels (HWLs) with plain packaging (PP) were associated with increased desirable reactions towards the HWLs postimplementation.


Data were from the International Tobacco Control (ITC) longitudinal cohort survey assessing Australian smokers one wave prior to the policy change in 2011 (n=1104) and another wave after the policy change in 2013 (n=1093). We assessed initial attentional orientation (AO) to or away from warnings, plus other reactions, including cognitive reactions towards the HWLs and quit intentions.


As expected, AO towards the HWLs and reported frequency of noticing warnings increased significantly after the policy change, but not more reading. Smokers also thought more about the harms of smoking and avoided the HWLs more after the policy change, but frequency of forgoing cigarettes did not change. The subgroup that switched from initially focusing away to focusing on the HWLs following the policy change noticed and read the HWLs more, and also thought more about the harmful effects of smoking, whereas the subgroup (5.4%) that changed to focusing away from the HWLs showed opposite effects. We tested the mediational model of Yong et al and confirmed it for predicting quit intentions, with larger effects post-policy.


Increasing the size of HWLs and introducing them on PP in Australia appears to have led to an overall increase in desired levels and strength of some reactions, but evidence of reactance was among a small minority.


Available Evidence Suggests That Possible Regulation of Cigarettes Not Likely to Significantly Change U.S. Illicit Tobacco Market

WASHINGTON — Although there is insufficient evidence to draw firm conclusions about how the U.S. illicit tobacco market would respond to any new regulations that modify cigarettes—for example, by lowering nicotine content—limited evidence suggests that demand for illicit versions of conventional cigarettes would be modest, says a new congressionally mandated report from the National Research Council and Institute of Medicine.

Tobacco use has declined in the past few decades due to measures such as high taxes on tobacco products and bans on advertising, though there are still more than 1 billion people worldwide who regularly use tobacco, including many who purchase their products illicitly. Illicit tobacco markets can undermine public health efforts to reduce tobacco use, while depriving governments of revenue. In the United States, the revenue losses are borne mostly by the states.

As the U.S. Food and Drug Administration considers possible regulations for tobacco products, the agency asked the National Research Council and the Institute of Medicine to examine the U.S. and international markets for illicit cigarettes and the evidence on how illicit markets react to various policies and regulations.

Currently, the U.S. illicit tobacco market primarily consists of bootlegging from Native American reservations and low-tax states, such as Virginia, to high-tax states, such as New York. Bootlegging is the legal purchase of cigarettes in one jurisdiction and their consumption or resale in another, without the payment of applicable taxes or duties in the jurisdictions where they are resold. Large-scale international smuggling, counterfeit cigarettes, and “illicit whites” — cigarettes legally produced under unique brand names or no brand name — which are prevalent in many other countries, are largely absent from the U.S. market, the report says.

The portion of the total U.S. tobacco market represented by illicit sales is between 8.5 percent and 21 percent, or 1.24 billion to 2.91 billion packs of cigarettes annually, concluded the committee that conducted the study. This share has nearly tripled over the past two decades.

The illicit tobacco market is not evenly distributed across states: it may constitute as much as 45 percent of all tobacco sales in high-tax states, such as New York, while it is low in many other states. The committee classified 22 states and the District of Columbia as net exporters, and 28 states as net importers. In 2011 the net importing states lost an estimated $2.95 billion in state and local cigarette excise taxes, with New York accounting for nearly half of this total. The net exporting states gained an estimated $0.82 billion.

The people involved in the segments of the distribution process of illicit tobacco generally do not have serious criminal records, and this market is not associated with violence, either abroad or in the United States, the report says. Although many claims have been made regarding the relationship between illicit tobacco trade and terrorism, the link between the U.S. illicit tobacco market and terrorism appears to be minor, and there is also no evidence of sustained links between the global illicit tobacco trade and terrorism.

Enforcement efforts are challenged by the changing nature of illicit tobacco markets, the need to coordinate across various agencies and levels of government, and the fact that illicit tobacco trade has been a low priority. Law enforcement efforts to investigate the illicit trade tend to be weak and uneven, and criminal prosecution of those involved is a low priority for prosecutors. Although the committee was able to obtain only limited information on enforcement activity and successes by agencies, it concluded that the risks of detection and prosecution for tobacco smugglers are small.

Comprehensive interventions adopted by several countries show that it is possible to reduce the size of the illicit tobacco market through tobacco-specific enforcement resources and collaboration across jurisdictions. For example, Spain reduced the illicit share of its market from 15 percent in 1995 to 2 percent in 2001 through licensing and control measures, enforcement efforts, and legal agreements. The United Kingdom used stamping and marking requirements on cigarettes, agreements with tobacco manufacturers, enhanced enforcement efforts, and public education campaigns to reduce the size of its illicit market from 21 percent in 2000 to 9 percent in 2013.

“In the future, non-price regulation of cigarettes – such as product design, formulation, and packaging – could, in principle, contribute to the development of new types of illicit tobacco markets if incentives for such illicit trade are not controlled or mitigated,” said Peter Reuter, committee chair and professor in the school of public policy and department of criminology at University of Maryland. “However, based on the limited available evidence we reviewed, if new regulations were introduced, any increase in the demand for illicit tobacco may only be modest.”

In trying to assess the possible effects of regulations on the illicit market, the committee examined experimental studies on how modifying cigarettes might affect their product appeal for consumers. Such modifications as reducing ignition capacity–requiring that cigarettes extinguish when not actively puffed–and decreasing filter ventilation have shown only modest impact on product appeal when considered in isolation from other product features. Reducing nicotine levels or mentholation has been shown in experimental studies to have a stronger effect on reducing product appeal. Behavioral responses to reduced nicotine or mentholation have been mixed in short-term studies, with some smokers indicating that they intend to quit while others are able to tolerate product changes with little to no change in individual cigarette consumption.

Cigarette packs with large graphic warning labels or in plain packaging have also been shown to reduce product appeal. In countries that have implemented regulations on packaging, some smokers have been observed to use stickers or branded containers to conceal graphic health warnings – strategies that subvert the intent of the law to reduce tobacco use, but which are an alternative to purchasing illicit products.

In order to better understand the nature of existing illicit tobacco markets and the ways they may evolve in the future, additional research and data are needed across a broad range of areas, including deeper knowledge on the individual and criminal networks that traffic in illicit tobacco in the U.S., an examination of how smokers respond to the permanent loss of specific product features they previously found desirable, and the relationship between e-cigarette use and the use of conventional tobacco products.

The study was sponsored by the U.S. Food and Drug Administration. The National Academy of Sciences, National Academy of Engineering, Institute of Medicine, and National Research Council make up the National Academies. They are private, independent nonprofit institutions that provide science, technology, and health policy advice under a congressional charter granted in 1863. The National Research Council is the principal operating arm of the National Academy of Sciences and the National Academy of Engineering. For more information, visit A committee roster follows.

Dana Korsen, Media Officer
Chelsea Dickson, Media Associate
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