March, 2015:
Harmful substances in e-cigarettes assessed
While e-cigarettes are less harmful to health than tobacco cigarettes, the vapour from an e-cigarette contains substances and chemical impurities in concentrations that could be detrimental to health. This is the result of a recent study carried out by RIVM in the Netherlands .
Electronic cigarettes vaporise a liquid containing nicotine and flavourants. The harmful substances in e-cigarettes include nicotine, propylene glycol and glycerol, aldehydes, nitrosamines and metals. When inhaled, these substances can lead to irritation and damage to the respiratory tract, heart palpitations and an increased risk of cancer. These health impacts are less severe that those associated with smoking tobacco.
Composition e-fluids
The study included measurement, risk assessment and a survey of e-cigarette users. The composition of many e-fluids available in the Netherlands, and the resulting vapour were found to vary considerably. In some cases, the amount of nicotine in the vapour was not in line with that stated on the package. The concentrations of some substances in the vapour were higher than in the fluid, and some substances were only formed when vaporised. Aldehydes, for instance, only formed when the liquid was heated and metals were released from the atomiser. Propylene glycol and glycerol are carrier liquids for nicotine and flavourants.
Use e-cigarette
The study found that people smoke e-cigarettes mainly because they presumed e-cigarettes to be less harmful than tobacco cigarettes and helped them to stop smoking. Refillable cigarettes are the most popular of the main brands and models available in the Netherlands. Virtually all users (vapers) had smoked tobacco before using e-cigarettes and most continued to smoke tobacco as well as e-cigarettes. Large behavioural differences between vapers were reported, for instance, in the number of puffs reported per day.
risks of e-cigarettes
The study was carried out for the Ministry of Health, Welfare and Sport because of the rapid growth in the number of e-cigarette users and uncertainties about the health effects. The risk to users associated with substances in the vapour inhaled was assessed in this study and later in the year, RIVM will assess the potential health effects of substances present in the exhaled vapour. An abridged English version of the study will be published shortly on our website.
http://www.rivm.nl/Documenten_en_publicaties/Wetenschappelijk/Rapporten/2015/maart/De_gezondheidsrisico_s_van_het_gebruik_van_e_sigaretten
(Report in Dutch)
Synopsis
Electronic cigarettes, or e-cigarettes, vaporize a liquid that often contains nicotine and flavorants. Although e-cigarettes are less harmful than tobacco cigarettes, the e-cigarette vapor contains several ingredients and chemical impurities such as nicotine, propylene glycol, glycerol, aldehydes, nitrosamines and metals at concentrations that can be detrimental to health. Inhalation of these substances can lead to irritation of and/or damage to the respiratory tract, palpitations and an increased risk of developing cancer. These health effects are, however, less severe than those associated with smoking tobacco, which include lung cancer, heart attack and stroke, pulmonary emphysema, chronic obstructive pulmonary disease (COPD), and oral, tongue, esophageal, stomach and bladder cancer.
The Dutch National Institute for Public Health and the Environment (RIVM) performed a survey on e-cigarette users, performed measurements and assessed the risks. The study was performed on behalf of the ministry of Health, Welfare and Sport (VWS) because of the substantial increase in e-cigarette users, and the uncertainties surrounding the health effects of e-cigarette use. In this study, the RIVM assessed the possible health risks associated with exposure to the substances in e-cigarette vapor. In 2015, the RIVM will assess the possible health effects resulting from exposure to the compounds present in exhaled vapor.
Findings regarding users
The survey on Dutch e-cigarette users showed that the main reasons for e-cigarette use were that people presumed it to be less harmful than regular cigarettes, and to help them to quit smoking. Of the many brands and models available, refillable e-cigarettes were the most popular. Virtually all users had smoked tobacco prior to using e-cigarettes and most were dual users continuing to smoke tobacco in addition to e-cigarettes. There were large behavioral differences between ‘vapers’, for instance there were large variances in the number of puffs reported per day.
E-liquid and vapor composition Considerable differences were observed in the composition of different kinds of e-liquid available on the Dutch market and that of the resulting vapor. In some cases, the amount of nicotine in the e-liquid did not match the declared amount on the packaging. The concentration of some compounds was found to be higher in the vapor than in the liquid. Aldehydes are formed when the e-liquids are heated, and metals are released from the atomizer. Propylene glycol and glycerol function as a ‘carrier liquid’ for nicotine and flavorants.
Tobacco Industry Profits US$7,000 For Smoking-Related Deaths
http://www.techtimes.com/articles/40936/20150319/tobacco-industry-profits-7-000-for-smoking-related-deaths.htm
Strong tobacco control laws have helped reduce smoking rates, but a lot remains to be done, health campaigners say, noting that tobacco industry profits are still around $7,000 for each tobacco-related death.
The industry remains committed to protecting its profits — $44 billion in 2013 — by delaying or derailing measures to control the sale and use of tobacco, according to The Tobacco Atlas report released by the World Lung Foundation and the American Cancer Society at the 16th World Conference on Tobacco or Health in Abu Dhabi.
In that year, smoking-related illnesses killed 6.3 million people representing a US$7,000 profit for the tobacco industry for each of those deaths, the report said.
“There is a perception that we know everything about tobacco and the harm it causes, but the truth is that every edition of The Tobacco Atlas reveals something new about the industry, its tactics and the real harm it causes,” says Peter Baldini, the chief executive officer of the World Lung Foundation.
Tobacco is the world’s leading preventable cause of lung cancer and chronic conditions, including heart disease, stroke and high blood pressure.
While tobacco use in many of the world’s developed, wealthy nations has been declining or remained stable, it has been increasing in poorer regions.
Of particular concern is China, where an average of more than 2,200 cigarettes were smoked per person in 2014.
“The significant reductions in smoking rates in the United Kingdom, Australia, Brazil and other countries that implement increasingly tight tobacco control laws have been offset by the growing consumption in a single nation: China,” the Atlas report said.
While many countries have instituted measures to curb tobacco use, such as banning advertising and outlawing smoking indoors in restaurants, bars and offices, only around 10 percent of the global population is covered by bans on advertising and just 16 percent by bans on smoking in enclosed indoor spaces, the Atlas shows.
The Atlas also revealed a worrying increase in smoking by women, with the tobacco industry linking it to sophistication and emancipation, which has increased rates of lung cancer to the point where it is killing more women than breast cancer.
The Atlas identified more than 20 countries where girls smoke more often than boys.
“Whether it’s the link between tobacco and increasing rates of lung cancer among women or the ever-increasing number of health conditions and deaths related to tobacco use, the health and economic case for reducing tobacco use has never been clearer,” says John R. Seffrin, the chief executive officer of the American Cancer Society
France to introduce plain packaging on cigarettes
http://www.rivieratimes.com/index.php/provence-cote-dazur-article/items/france-to-introduce-plain-packaging-on-cigarettes.html
The French government has officially passed a number of anti-smoking laws proposed last year by the health minister. As well as neutral cigarette packaging, the country’s smokers can expect a crackdown on smoking in cars with children, ‘vaping’ bans in some public places and sanctions on electronic cigarette flavours.
The amendments to the Health Bill were made at a Parliament meeting held yesterday, Wednesday 18th March, in reflection of the measures proposed by Health Minister Marisol Touraine in September 2014.
The most high-profile – and controversial, given the outcry from tobacco brands and vendors – is the implementation of neutral cigarette packaging.
As of 20th May 2016, all tobacco packaging will be standardised, with all packets made the same shape, size, colour and with the same typeset, reports Le Figaro. Brand logos will also be prohibited, although the printing of brand names is permitted. This concerns not only cigarettes and loose tobacco, but all smoking paraphernalia, including tobacco rolling papers and filters.
France is only the second country in the world to introduce such measures, after Australia ruled in 2012 that all cigarettes must be sold in neutralised, logo-free packaging. However, the UK is following suit and last month MPs voted in favour of making the same move. If passed it would also become effective in May next year.
Smoking in cars with children present will also be banned, with drivers found to be doing so facing a fine. The main objective is to limit children’s exposure to cigarette smoke, with the added aim of fighting against the trivialisation of smoking to young people. A common argument is that the more a child is exposed to the act, the more normal and accepted it becomes to them. It is as yet unclear when this measure will come into effect.
While they don’t officially fall within laws surrounding smoking in public, vaporisers are to be banned in some areas, including schools and public transport. And, according to Marisol Touraine, while they are of course a better alternative to tobacco, vaporisers and e-cigarettes could serve as a “gateway to smoking” for young people.
Finally, the creation of electronic cigarettes in varying artificial flavours is to be forbidden, amid claims that this makes them more appealing to young people.
The main aim of the plan is to reduce the number of smokers to fewer than 20% of the population within 10 years, compared with today’s figure of 28%. Smoking currently causes 78,000 deaths a year in France.
Madeleine Adey
UK Department of Health awarded American Cancer Society “Exemplary Leadership” award for tobacco policy achievements
Clear the Air says :
When can we expect the Hong Kong Government to catch up with the rest of the world on tobacco control and follow the guidelines of the FCTC and Mpower?
When can we expect tobacco excise tax increase to be annual, regular and in excess of inflation , which is currently running at 4.1% per year ?
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http://www.news-medical.net/news/20150319/Department-of-Health-awarded-American-Cancer-Society-e2809cExemplary-Leadershipe2809d-award-for-tobacco-policy-achievements.aspx
In the week that the standardised tobacco packaging regulations passed into law, the UK Department of Health has been recognised as an International Tobacco Control Leader by the American Cancer Society.
During the 2015 Luther L. Terry Awards ceremony at the World Conference on Tobacco or Health taking place in Abu Dhabi, the Department of Health will receive the award for Exemplary Leadership in Tobacco Control.
The Luther L. Terry Award recognises outstanding global achievement in the field of tobacco control in six categories: outstanding individual leadership, outstanding organization, outstanding research contribution, exemplary leadership by a government ministry, distinguished career, and outstanding community service.
This prestigious triennial award by the American Cancer Society honours the UK as a world leader in tobacco control, alongside previous award winners such as Australia, Uruguay, South Africa and the Republic of Ireland. It is the commitment shown by successive UK governments, supported by Parliamentarians, which provides the foundation for this award.
Over the past decade, the Department of Health has steered through important tobacco control legislation including smokefree public places, stopping smoking in cars with children, ending tobacco displays in shops and standardised packaging of tobacco products.
Hazel Cheeseman, Director of Policy for ASH said:
“The steady decline in smoking in England is a tribute to the commitment of the Department of Health to tackle the biggest preventable cause of disease and premature death. The UK is now acknowledged as one of the world leaders of tobacco control. We hope this well-deserved award will inspire the next Government to commit to a new, and even more ambitious, tobacco control strategy.”
John R. Seffrin, Ph.D., chief executive officer of the American Cancer Society said:
“Tobacco-related diseases are the most preventable cause of death worldwide, responsible for the deaths of approximately half of all long-term tobacco users. We are pleased to recognize these exemplary individuals and organizations who carry on the noble and incredibly important work of ending the deadly spread of tobacco around the globe.”
Notes
The awards are named after the late United States Surgeon General Luther L. Terry, M.D., who led the landmark 1964 U.S. Surgeon General’s Report, which identified tobacco use as a cause of lung cancer and other illnesses. This report, coupled with the UK Royal College of Physicians Report in 1962, marked a turning point in addressing the global threat of tobacco use and disease, and has ushered in an era in which smoke-free environments, higher tobacco taxes, more tobacco dependence treatment, severe restrictions on tobacco advertising, and graphic warning labels on tobacco packages are becoming more commonplace.
The award nominations were reviewed by an international selection committee of previous Luther L. Terry Award winners, including: Dileep G. Bal, MD, MS, MPH, United States; Beatriz M. Champagne, PhD, Mexico; Hatai Chitanondh, MD, FICS, FRCS, Thailand; Michael Cummings, PhD, MPH, United States; Stanton A. Glantz, PhD, United States; Professor Mike Daube, Australia; Deborah Arnott, MBA, United Kingdom; Martin Raw, PhD, United Kingdom, Yussuf Saloojee, PhD, South Africa; Prabhat Jha, MD, DPhil, Canada; Melanie Wakefield, PhD, Australia; Mira Aghi, PhD, India; and Stan Shatenstein, Canada. The effort was chaired by Jacqui Drope, and Andrea Lancaster, MPH, as executive director.
According to the American Cancer Society, tobacco use killed 100 million people in the 20th century and will kill 1 billion people in the 21st century if current trends continue. Each year, tobacco use is responsible for almost 6 million premature deaths, 80 percent of which are in low- and middle-income countries. By 2030, this number is expected to increase to 8 million.
About the American Cancer Society
The American Cancer Society is a global grassroots force of more than three million volunteers saving lives and fighting for every birthday threatened by every cancer in every community. As the largest voluntary health organization, the Society’s efforts have contributed to a 22 percent decline in cancer death rates in the U.S. during the past two decades, and a 50 percent drop in smoking rates.
Action on Smoking and Health is a health charity working to eliminate the harm caused by tobacco use. For more information see: www.ash.org.uk/about-ash
ASH receives core funding from Cancer Research UK and the British Heart Foundation.
Cluster bomb of new research explodes tobacco industry lies about plain packs
http://theconversation.com/cluster-bomb-of-new-research-explodes-tobacco-industry-lies-about-plain-packs-38978
There is near-universal agreement that Australia’s implementation of tobacco plain packaging in December 2012 has seen the most virulent opposition ever experienced from the global tobacco industry.
While the industry bravely insisted early in its campaigning that plain packs “would not work” their legal actions, campaign expenditure, lobbying and general apoplexy rather suggests they feared it would be a devastating policy, with long term global ramifications.
Indeed, eleven other nations (Ireland, England, New Zealand, France, Norway, Finland, Chile, Brazil, India, South Africa, Turkey) have either legislated plain packaging or are now warming up to do so.
University of Sydney researcher Becky Freeman and I catalogued the full range of industry lies in our recently released (free) book Removing the Emperor’s Clothes. The Cancer Council Victoria has also published extremely detailed rebuttals to the major industry scuttlebutt.
Now today, the British Medical Journal’s specialist journal Tobacco Control has published a special collection of new research which puts further 10,000 watt arc lights on specious industry claims.
Key industry claims have included that plain packs would:
- Drive prices down, as smokers turn away from buying expensive premium brands because they look exactly the same as cheap brands (other than brand names). More affordable cigarettes, they argued, would cause more smoking, including among children
- Flood Australia with illegal tobacco
- Cause smokers would stop buying cigarettes at small convenience stores
- Prompt smokers to use special covers to conceal the large-scale graphic warnings on packs.
Price falls?
One of the new Tobacco Control papers monitors changes in recommended retail prices RRPs from one year before plain packs were introduced until one year after. Prices were adjusted to 2013 prices, and for inflation and average cigarette price stick and grams of roll-your-own tobacco.
The RRPs of tobacco products were higher in real terms one year after the legislation was implemented. Importantly, these increases exceeded increases resulting from consumer price indexation of duty and occurred across all three major manufacturers for both factory made and roll-your-own brands, all three cigarette market segments and all major pack sizes.
Tobacco prices rose most for leading and premium brands 10.0% and 10.1%, respectively) and among packs of 30s (18.3%) and 50s (12.5%). So far from seeing cigarette prices fall across the board, the industry raised prices.
Floods of illicit tobacco?
The tobacco industry’s most common claim was that plain packs would see smokers turn away from buying the purposefully confronting and unattractive plain packs and seek out illegal products not in plain packs.
Tobacco spokespeople made the outrageous claim that about one in seven of all cigarettes being smoked were such illegally obtained cigarettes. Apparently, while ordinary smokers across the country knew where to buy these easily, the full might and resources of the Australian Federal Police could not work out where these were being sold.
Another study in the collection questioned 8,679 smokers across the country in telephone surveys conducted continuously, from six months before plain packs until 15 months afterwards.
The study found no significant increases in reported purchasing of “cheap whites” (illegally imported Asian sourced brands), of international brands selling for 20% or more less than the normal retail price, or of unbranded loose tobacco (so-called “chop chop”).
Rates of purchase of cheap whites and heavily discounted products were at around half of one per cent of smokers, nothing remotely like one in seven.
Small shops losing customers?
One of the most bizarre claims the industry made was that plain packs would see smokers deserting corner stores for larger retail outlets like supermarkets. This was an appeal designed to tap into wider public sentiment about local corner store owners being crushed under the dead weight of government regulation.
Those making the claim never explained why smokers would abandon small retailers for large ones because of plain packs when the very same packs would be sold in both. Consumer preference for larger retailers is entirely driven by price discounting, something never mentioned in the industry propaganda.
A third paper in the collection examined where smokers purchased their cigarettes. Unsurprisingly, it found no changes from prior to and after the introduction plain packs in where smokers bought their supplies.
Covering up the packs?
In the month that plain packs were introduced, a Queensland small businessman got his 15 minutes of fame from publicity about special pack covers that could block out the unforgettable graphic warnings. Like children covering their eyes from scary scenes in movies, the idea was that many smokers would rush to do the same, outsmarting the hapless bureaucrats who planned the legislation.
A fourth paper which reports on unobtrusive observations of smokers handling their packs in outdoor cafés found that prior to plain packs, just 1.2% of outdoor café smokers used pack covers. This rose to 3.5% in the early months of plain packs and then fell back to 1.9% one year later.
In any event, evidence shows that smokers who actively try to avoid exposure to pack warnings by covering them up, have higher subsequent rates of quit attempts than those who don’t.
Importantly too, these observations recorded that of all café outdoor patrons, one in 8.7 displayed a pack prior to the introduction of plain packs with this reducing to one in 10.3 afterwards. Such a fall is consistent with both a reduction in smoking prevalence and with growing self-consciousness among smokers about showing that they smoke in public.
Impact on adolescents?
There were several principal objectives of the plain packs legislation. But outstanding among these was the goal of making smoking less desirable among young people. This would continue the trend away from smoking, as each successive cohort of children chose not to take up the habit.
A fifth paper used school-based surveys prior to and after plain packs to examine students’ ratings of the “character” of four popular cigarette brands, and variables including perceived harmfulness, look of pack and positive and negative perceptions of pack image.
Positive character ratings for each brand reduced significantly between 2011 and 2013. Significantly fewer students in 2013 than 2011 agreed that “some brands have better looking packs than others” and packs were rated more negatively, with positive ratings decreasing most in smokers.
The tobacco industry and its acolytes can be expected to try to torture these reports to spin yet more denials of the impact it fears will quickly inspire even more countries to follow Australia’s lead.
Australia is fortunate in having some of the very best researchers in the world whose work has contributed to the development of plain packs and now to the evaluation of its impact.