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October, 2015:

Prevent the Renormalizing of Smoking

Oct 16th, 2015
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http://www.modernreaders.com/e-cigarettes-kids-and-the-battle-to-prevent-the-renormalizing-of-smoking-2/32225/larry-kramer

Electronic cigarettes have been all over the news as of late, with supporters of the devices continuing to insist they’re a fundamental good. Evidence suggests that when used carefully and for the purpose for which they were (supposedly) intended, it is possible for an electronic cigarette to make it easier for a smoker to cut down or quit.

Critics on the other hand see the subject quite differently, insisting that the devices have already been responsible for luring an innumerable army of teenagers and children right into the arms of full-blown nicotine addiction. The general consensus among experts is that that long-term health risks associated with e-cigarette are less severe than those of tobacco, but they try in any way to convey the message that ‘vaping’ is safe is wholly irresponsible.

Just like cigarettes, the liquid used in electronic smoking cessation tools contains nicotine. One of the most addictive substances known to mankind, nicotine has an array of detrimental effects on the body that are inflicted regardless of how the stuff is inhaled. It is a powerful stimulant that gets to work on the body’s central nervous system, it causes blood pressure to spike and also puts additional strain on the heart.

Vaping may cut out some of the chemicals and toxins tobacco contains – other harmful elements remain present, which in some cases are even stronger in concentration.

Now, this wouldn’t be the end of the world if e-cigarettes were responsibly marketed toward and used by a proactive adult audience only. Quite to the contrary however, what we’ve instead been bombarded with is an endless array of brightly colored packages with cute and cuddly graphics, the kinds of celebrity endorsements guaranteed to sway the impressionable and a range of flavors that never fail to make the mouths of preteens water. From bubblegum to candy-floss to gummy bear and more, it’s pretty impossible to deny the direct and thus dangerous appeal such sweet vaping liquids have in the eyes of youngsters.

The only realistic solution to what’s already an epidemic is for the FDA to step in and intensify its efforts to better control and restrict access to both the devices themselves and their respective liquids. As it stands, 38 states have made it illegal to supply minors with such product, but the fact that there are still so many states to follow suits is quite frankly astonishing. And even in states where the ban has been enforced, it’s proving ridiculous easy for kids to pick up liquid refills and electronic devices from pretty much anywhere.

Stopping kids from accessing the devices is only one stage of the solution – the other is to stop making the damn things look cool, elegant, sophisticated and downright delicious. They’re none of the above – they’re dangerously addictive habit-formers that technically serve no positive purpose at all, other than for those already facing an expensive and deadly nicotine addiction.

How can we keep letting the e-cigarette giants get way with duping the nation into once again thinking there’s no harm in smoking?

LETTER: Smoke and mirrors

Oct 16th, 2015
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http://www.bdlive.co.za/opinion/letters/2015/10/16/letter-smoke-and-mirrors

DURING the Second World War, the Nazis murdered 10-million people. Those who resisted the Nazis were called partisans and freedom fighters. Tobacco products kill 6-million people per year.

Those who oppose this industry are labelled “nicotine nazis” by the manufacturers and its apologists. They have a perverted set of values.

In his latest column (Nicotine nazis hate one thing: pleasure, October 14), Leon Louw shows his warped understanding of addiction, tobacco control organisations and the history of the tobacco industry. He makes many false and weird assertions.

His rants against the National Council Against Smoking are baseless and do not merit a response.

His suggestion that the industry can help smokers find “freedom and dignity” is uninformed.

Since the 1960s, cigarette manufacturers have tried unsuccessfully to rally smokers to their cause by establishing and secretly funding “smoker’s rights groups”. They failed miserably because the overwhelming majority of smokers regret having started and wish to stop.

Most people smoke not because they want to but because they cannot easily stop. Addiction research shows that few people smoke for pleasure, and the main reason for continuing is to allay withdrawal symptoms.

Smokers crave nicotine not for pleasure, but to ward off irritation, anxiety, restlessness, depression, headaches, constipation and a host of other woes.

Moreover, far from seeing smokers as allies, the industry fears them. After decades of lying to its customers about the dangers of smoking, and manipulating nicotine levels to keep them addicted, the industry is now haunted by the spectre of litigation.

It has paid billions to those harmed by its products and is afraid it will have to pay much, much more.

Mr Louw preaches freedom but what he seeks is freedom to harm, not freedom from harm.

Dr Yussuf Saloojee

National Council Against Smoking

Can E-Cigarettes Save Lives?

Oct 16th, 2015
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http://mobile.nytimes.com/2015/10/17/opinion/can-e-cigarettes-save-lives.html?_r=2&referer

Joe Nocera

Two weeks ago, I received an email from NJOY, a company that sells electronic cigarettes. Its purpose was to introduce the Daily, a new product that NJOY described as “a superior e-cigarette scientifically developed to deliver quick-and-strong nicotine satisfaction at levels close to an actual cigarette.”

One reason many adult smokers haven’t switched to e-cigarettes is that most e-cigarettes don’t provide the same nicotine kick as a real cigarette. With some 42 million American adults still smoking, and 480,000 of them dying each year as a result, this is tragic. Though nicotine is addictive, it is the tobacco that kills.

An e-cigarette that could truly replicate the experience of smoking would dramatically reduce — not eliminate, but reduce — the dangers of smoking. NJOY claims that the Daily comes closer to that experience than anything on the market. When I spoke to Paul Sturman, NJOY’s chief executive, he emphasized not only the nicotine aspect, but also the Daily’s “feel,” and “the intensity of the hit to the back of the throat.” Sturman added that the company’s target market is adult smokers who have tried, but rejected, e-cigarettes. He thinks it’s a huge market.

As Sturman was describing the Daily, I thought to myself, “The tobacco-control community is going to hate this thing.” Most anti-tobacco advocates view replicating the feel and satisfaction of a cigarette as an effort to “renormalize smoking.” And though some believe that smokers should be encouraged to move to e-cigarettes, most refuse even to acknowledge the health benefits of “vaping” over smoking.

Indeed, thanks to this vociferous opposition, an increasing number of Americans view vaping as no safer than smoking, which is absurd. And e-cigarette manufacturers like NJOY can’t set them straight: The law giving the Food and Drug Administration regulatory authority over tobacco products, which passed in 2009, prohibits e-cigarette companies from making reduced-harm claims unless they jump through some near-impossible hoops. Thus, NJOY has no way to convey to adult smokers the critical message that e-cigarettes could save their lives.

The undisputed leader of the tobacco-control community is Matt Myers, who helped found and is the president of the Campaign for Tobacco-Free Kids. Unlike many of his anti-tobacco peers, Myers is on the record as saying that if “responsibly marketed and properly regulated, e-cigarettes could benefit the public health.” But, like many others, he also fears that e-cigarettes may hook a new generation of children on nicotine, and could lead them to start smoking. And in truth, those fears get far more prominence in the Campaign for Tobacco-Free Kids’ various statements about e-cigarettes than its cautious support for them under the right circumstances.

One thing that particularly bothers Myers about e-cigarette companies is their advertising, which he believes employs the same tactics Big Tobacco once used to hook youths on cigarettes. But when I noted that NJOY can’t market the Daily as a reduced-risk product, thanks to the 2009 law — and thus had to find less straightforward ways to induce smokers to try the product — Myers told me that I should blame the F.D.A., which, six years in, has yet to impose a single regulation on e-cigarettes. “I think the F.D.A. deserves to be pilloried,” he said.

He may be right about that. On the other hand, it’s hardly news that government agencies take forever to get things done — and meanwhile, nearly half a million smokers continue to die each year. It seems to me that if the tobacco-control community wants to start saving lives by employing the reduced-harm strategy that e-cigarettes offer, it needs to forget about the F.D.A. and take matters into its own hands.

That means engaging with companies like NJOY that profess to be trying to do the right thing. Instead of demonizing them, the tobacco control community needs to find common ground, and come up with a set of standards — for marketing, manufacturing, and keeping e-cigarettes away from kids — that both sides can agree to. If such a deal were put in place, perhaps with state attorneys general to oversee it, anti-tobacco advocates could talk about the reduced harm potential of e-cigarettes with a clear conscience, without the involvement of the federal government. They then could describe the benefits of e-cigarettes for smokers that the companies themselves can’t.

It’s happened before. Two decades ago, seeing a once-in-a-lifetime opportunity to impose real restrictions on Big Tobacco, Myers engaged in negotiations that included the states’ attorneys general — and Steve Parrish, then a Philip Morris executive. It was an act of tremendous courage — Myers was pilloried when his involvement was revealed — but without his willingness to look the enemy straight in the eye, Big Tobacco would never have been brought to heel.

I believe the time has come for Myers to screw up his courage again. It could be the beginning of the end for one of the greatest scourges on earth

71 tonnes of illicit loose leaf tobacco worth $40 million seized

Oct 16th, 2015
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http://www.stockandland.com.au/story/3427152/71-tonnes-of-illicit-loose-leaf-tobacco-worth-40-million-seized/?cs=4770

Some of the 71 tonnes of illicit tobacco seized by Australian customs officials in June. Photo: Paul Bibby

Some of the 71 tonnes of illicit tobacco seized by Australian customs officials in June. Photo: Paul Bibby

It was, as one observer remarked wryly, “a lot of smokes” – 88 million in fact.

In the largest operation of its kind in Australian history, customs officers have intercepted 71 tonnes of loose leaf tobacco being smuggled into Australia from Indonesia.

The haul has a black market value of $40 million and would have cost Australia more than $27 million in lost tax revenue had it hit the streets.

The seizure was the result of an operation involving co-operation between Australian and Indonesian investigators that had led to 47 tonnes of the illicit product being seized in two containers in Sydney in June, the Minister for Immigration and Border Protection, Peter Dutton, said on Friday.

A third shipment of 24 tonnes was then seized by Indonesian authorities before it could be smuggled into Australia.

Seventy-one tonnes is the equivalent of 88 million cigarettes or 3.5 million packets.

“This tobacco would have cost Australia over $27 million in legitimate tax revenue if it had been successfully smuggled into the country and sold here,” Mr Dutton said.

“There are clear links to organised crime and we know that groups smuggling illicit tobacco into Australia are also involved in other illegal activities such as narcotics.”

He said a new strike force of 16 dedicated officers would be set up to target crime syndicates smuggling illicit tobacco into the country.

Heated Tobacco Products Create Side-Stream Emissions: Implications for Regulation

Oct 15th, 2015
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Expert criticises “harmful” e-cigarette marketing

Oct 15th, 2015
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http://heraldscotland.com/news/health/13847553.Expert_criticises__quot_harmful_quot__e_cigarette_marketing/

A HEALTH academic has criticised “harmful” e-cigarette marketing tactics and called for new guidelines to regulate the industry.

Linda Bauld, Professor of Health Policy at Stirling University, has said there is “cause for concern” in the way companies are pushing their products.
The professor, who is also deputy director of the UK Centre for Tobacco and Alcohol Studies, warns that there are also “no controls” when it comes to alcohol adverts in the UK and she is now calling for tighter regulations across the advertising industry.

E-cigarette companies are currently allowed to advertise their products within a regulatory framework, meaning they cannot make smoking cessation claims or target youngsters.

But Ms Bauld said there was still reason to be wary.

“I’d say that the evidence of marketing being targeted at children is mixed, but there’s definitely a lot of it,” she said. “It’s a cause for concern and we need marketing regulations. The Advertising Standards Authority has a role to protect the public against harmful advertising.

“They brought in regulations last year to allow the public to complain about e-cigarette adverts. There have been a number of complaints and two adverts were forced to be withdrawn, so we do have some controls in place.”

Her comments come after a Scottish Government-commissioned survey found that thousands of pupils had been exposed to e-cigarette marketing, with 60 per cent seeing the products for sale in shops, shopping centres or stalls.
Ms Bauld also criticised the alcohol industry’s approach to advertising.

She said: “We have the same for alcohol adverts and it doesn’t make a difference – they do all the things they aren’t supposed to do.

“We need to crack down on the marketing of alcohol as there are no controls at all in Scotland and it’s so prevalent all across our society.”

New proposals may lead to e-cigarette adverts only being shown at the point of sale – in the shops where they can be bought.

Ms Bauld added: “I have a mixed view about it. I think you need some marketing of e-cigarettes to encourage the adults who want to stop smoking to try it.

“It’s hard to know what to do – whether we take it all away or keep it going in order to aid those wanting to stop smoking.

“I’m in favour of e-cigarettes as a quitting tool for current smokers.”

She also aired her concerns about e-cigarette companies being “bought up” by tobacco giants.

“One of the issues for us is that e-cigarette companies have been increasingly bought up by the tobacco industry,” she said.

“Ideally they should be distributed by independent companies as the objective of the tobacco industry is to keep people smoking. We want to try and keep a lid on some of the tobacco companies’ involvement.”

John Watson, deputy chief executive at Action on Smoking and Health (ASH) Scotland, agreed that the marketing is showing a disturbing trend.

“We’re concerned at some of the marketing we’ve seen around e-cigarettes,” he said. “It’s hard to walk down the street without seeing adverts and some of them are reminiscent to old tobacco adverts.

“We should restrict marketing that’s going to encourage young people to smoke but there is also the potential to help current smokers stop.”

Experts are yet to conclusively determine the health risks of e-cigarettes, which have helped some smokers quit but still contain the highly addictive substance nicotine.

Half of current cigarette smokers reported using e-cigarettes and some 14 per cent of ex-regular smokers used an e-cigarette. The most common methods used to quit smoking were nicotine patches (36 per cent) and e-cigarettes (32 per cent).

Horrifying graphics reveal how smoking REALLY affects the body

Oct 14th, 2015
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Leading Scots academic slams “harmful” e-cig marketing tactics

Oct 14th, 2015
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http://www.deadlinenews.co.uk/2015/10/14/leading-scots-academic-slams-harmful-e-cig-marketing-tactics/

A LEADING Scots health academic has slammed “harmful” e-cigarette marketing tactics.

Linda Bauld, Professor of Health Policy at Stirling University, has said there is “cause for concern” in the way companies are pushing their products.

The professor, who is also deputy director of the UK Centre for Tobacco and Alcohol Studies, warns that there are also “no controls” when it comes to alcohol adverts in the UK.

Professor Bauld has called for tighter marketing controls for e-cigarettes

And she is now calling for tighter regulations across the advertising industry.

Currently, e-cigarette companies are allowed to advertise their products within a regulatory framework, meaning they cannot make smoking cessation claims or target youngsters.

But Professor Bauld suggests there is still reason to be wary.

“I’d say that the evidence of marketing being targeted at children is mixed, but there’s definitely a lot of it,” she said.

“It’s a cause for concern and we need marketing regulations. The Advertising Standards Authority has a role to protect the public against harmful advertising.

“They brought in regulations last year to allow the public to complain about e-cigarette adverts. There have been a number of complaints and two adverts were forced to be withdrawn, so we do have some controls in place.”

However, she warned that the alcohol industry may be bending the rules when it comes to advertising.

She said: “We have the same for alcohol adverts and it doesn’t make a difference – they do all the things they aren’t supposed to do.

Experts are unsure about the long-term health risks of using e-cigarettes

“We need to crack down on the marketing of alcohol as there are no controls at all in Scotland and it’s so prevalent all across our society.”

New proposals may lead to e-cigarette adverts only being shown at the point of sale – in the shops where they can be bought.

Professor Bauld added: “I have a mixed view about it. I think you need some marketing of e-cigarettes to encourage the adults who want to stop smoking to try it.

“It’s hard to know what to do – whether we take it all away or keep it going in order to aid those wanting to stop smoking.

“I’m in favour of e-cigarettes as a quitting tool for current smokers.”

She also aired her concerns about e-cigarette companies being “bought up” by tobacco giants.

“One of the issues for us is that e-cigarette companies have been increasingly bought up by the tobacco industry,” she said.

“Ideally they should be distributed by independent companies as the objective of the tobacco industry is to keep people smoking . We want to try and keep a lid on some of the tobacco companies’ involvement.”

There are also concerns about the way alcohol is advertised

John Watson, deputy chief executive at Action on Smoking and Health (ASH) Scotland, agreed that the marketing is showing a disturbing trend.

“We’re concerned at some of the marketing we’ve seen around e-cigarettes,” he said.

“It’s hard to walk down the street without seeing adverts and some of them are reminiscent to old tobacco adverts.

“We should restrict marketing that’s going to encourage young people to smoke but there is also the potential to help current smokers stop.”

Experts are yet to conclusively determine the health risks of e-cigarettes, which have helped some smokers quit but still contain the highly addictive substance nicotine.

A spokesman for the Advertising Standards Authority said: “The UK advertising rules require e-cigarette ads to be responsible with a particular emphasis placed on protecting young people and non-smokers.

“The ASA will not hesitate to take action against any ad that breaks the rules and if an e-cigarette ad encouraged young people to try vaping it would be banned.

“Similarly, the UK alcohol advertising rules are robust with the strict controls applying equally to Scottish media.

“The evidence to date suggests that the current rules are a proportionate and reasonable response to concerns about the potential for alcohol advertising to encourage irresponsible consumption or under-age drinking.

“If anyone has concerns about ads for these products then they should lodge a complaint with us so that we can ensure the rules are being followed.”

Alternative tobacco products pose a new challenge in the war against tobacco

Oct 14th, 2015
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http://www.news-medical.net/news/20151014/Alternative-tobacco-products-pose-a-new-challenge-in-the-war-against-tobacco.aspx

The increasing use of alternative tobacco products, such as water pipes and e-cigarettes, by children under the age of 18 is a burgeoning public health crisis, researchers from NYU Langone Medical Center write in a commentary in the current issue of the Journal of the American Medical Association (JAMA).

“Alternative tobacco products represent a new challenge in the 75-year-old war against tobacco,” says commentary co-author Michael Weitzman, MD, a professor of Pediatrics and of Environmental Medicine at NYU Langone. “With the increasing numbers of young adults using alternative tobacco products, we have every reason to be concerned.”

In “Alternative Tobacco Products as a Second Front in the War on Tobacco,” Dr. Weitzman and Stephen M. Amrock, MD, a former NYU Langone medical student who is now an intern in internal medicine at the University of Oregon, highlight research on the use of alternative tobacco products by young adults published earlier this year in JAMA Pediatrics by Brian A. Primack, MD, PhD, and colleagues at the University of Pittsburgh School of Medicine.

That paper reported the results of a longitudinal study of 1596 young adults ranging in age from 15 to 23, including 1048 who had never smoked prior to the study. The study authors showed that use of water pipes, also known as
hookahs, and other alternative tobacco products is associated with a 2.5 times increase in later cigarette use.

“The findings in the JAMA Pediatrics paper corroborate what many of us in the public health field are tremendously worried about,” says Dr. Weitzman.

Public health specialists consider cigarette smoking to be a pediatric disease since nine out of 10 adult smokers started smoking as children. Although cigarette use overall has decreased by 33 percent in the past decade in the United States, the use of alternative tobacco products such as hookahs has increased an alarming 123 percent, with nearly 20 percent of high school seniors smoking hookahs. Dr. Weitzman says this increase can be attributed, in part, to a general unawareness of the dangers of alternative tobacco products by the public, the medical community, and the media.

There is a misperception that alternative tobacco products are safer than cigarettes, but the evidence says otherwise. “Other researchers have demonstrated that a typical 45 minute hookah session is equivalent to smoking as many as five packs of cigarettes,” Dr. Weitzman says. In a study published last year in the journal Tobacco Control, Dr. Weitzman and colleagues discovered potentially hazardous levels of second hand smoke and other air pollutants, as well as evidence of nicotine, in New York City hookah bars. And water pipes in particular, Dr. Weitzman says, “are a terrible mechanism for spreading infectious diseases.”

The increasing popularity of alternative tobacco products threatens to undermine the gains seen in the last several years with the decline in cigarette use. The U.S. Food and Drug Administration proposes extending its tobacco authority to additional tobacco products, including e-cigarettes and hookahs, not already under the FDA’s authority. Dr. Weitzman argues that the same tactics used to decrease cigarette smoking in the United States–taxation, education, and restrictions on advertising and sales to minors–need to be applied to alternative tobacco products. And, he says, more research needs to be done to determine what is being burned and inhaled with these products.

“Nicotine is the most addictive substance,” Dr. Weitzman says. “The use of alternative tobacco products by children can be the beginning of an addiction that can lead to later cigarette use. Tobacco use is the leading preventable cause of death worldwide, causing more deaths than HIV, tuberculosis and malaria combined.”

Source:

NYU Langone Medical Center / New York University School of Medicine

Alternative Tobacco Products as a Second Front in the War on Tobacco

Oct 13th, 2015
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http://jama.jamanetwork.com/article.aspx?articleid=2456151

Stephen M. Amrock, MD, SM1; Michael Weitzman, MD2,3,4

1Oregon Health & Science University, Portland
2Department of Pediatrics, New York University School of Medicine, New York, New York
3Department of Environmental Medicine, New York University School of Medicine, New York, New York
4College of Global Public Health, New York University, New York, New York
JAMA. 2015;314(14):1507-1508. doi:10.1001/jama.2015.11394.

This commentary discusses the regulatory implications of the association between early use by youth of alternative tobacco products, such as water pipe tobacco and snus, and later cigarette smoking, as reported in a cohort study published in JAMA Pediatrics.

JAMA Pediatrics

Associations Between Initial Water Pipe Tobacco Smoking and Snus Use and Subsequent Cigarette Smoking: Results From a Longitudinal Study of US Adolescents and Young Adults

Samir Soneji, PhD; James D. Sargent, MD; Susanne E. Tanski, MD, MPH; Brian A. Primack, MD, PhD

Importance Many adolescents and young adults use alternative tobacco products, such as water pipes and snus, instead of cigarettes.

Objective To assess whether prior water pipe tobacco smoking and snus use among never smokers are risk factors for subsequent cigarette smoking.

Design, Setting, and Participants We conducted a 2-wave national longitudinal study in the United States among 2541 individuals aged 15 to 23 years old. At baseline (October 25, 2010, through June 11, 2011), we ascertained whether respondents had smoked cigarettes, smoked water pipe tobacco, or used snus. At the 2-year follow-up (October 27, 2012, through March 31, 2013), we determined whether baseline non–cigarette smokers had subsequently tried cigarette smoking, were current (past 30 days) cigarette smokers, or were high-intensity cigarette smokers. We fit multivariable logistic regression models among baseline non–cigarette smokers to assess whether baseline water pipe tobacco smoking and baseline snus use were associated with subsequent cigarette smoking initiation and current cigarette smoking, accounting for established sociodemographic and behavioral risk factors. We fit similarly specified multivariable ordinal logistic regression models to assess whether baseline water pipe tobacco smoking and baseline snus use were associated with high-intensity cigarette smoking at follow-up.

Exposures Water pipe tobacco smoking and the use of snus at baseline.

Main Outcomes and Measures Among baseline non–cigarette smokers, cigarette smoking initiation, current (past 30 days) cigarette smoking at follow-up, and the intensity of cigarette smoking at follow-up.

Results Among 1596 respondents, 1048 had never smoked cigarettes at baseline, of whom 71 had smoked water pipe tobacco and 20 had used snus at baseline. At follow-up, accounting for behavioral and sociodemographic risk factors, baseline water pipe tobacco smoking and snus use were independently associated with cigarette smoking initiation (adjusted odds ratios: 2.56; 95% CI, 1.46-4.47 and 3.73; 95% CI, 1.43-9.76, respectively), current cigarette smoking (adjusted odds ratios: 2.48; 95% CI, 1.01-6.06 and 6.19; 95% CI, 1.86-20.56, respectively), and higher intensity of cigarette smoking (adjusted proportional odds ratios: 2.55; 95% CI, 1.48-4.38 and 4.45; 95% CI, 1.75-11.27, respectively).

Conclusions and Relevance Water pipe tobacco smoking and the use of snus independently predicted the onset of cigarette smoking and current cigarette smoking at follow-up. Comprehensive Food and Drug Administration regulation of these tobacco products may limit their appeal to youth and curb the onset of cigarette smoking.

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