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November 18th, 2015:

Cancer risk for smokeless tobacco users

Adults in the US who use only smokeless tobacco products have higher levels of biomarkers of exposure to nicotine and NKK – a cancer-causing toxicant – compared with those using only cigarettes, according to research published in Cancer Epidemiology, Biomarkers & Prevention.

Use of smokeless tobacco products is attracting increasing attention from the public health community. Though smokeless tobacco use is less common than cigarettes, it is prevalent among certain population groups, particularly men and young people.

The National Adult Tobacco Survey estimates that 7.1% of American men used chewing tobacco, snuff, dip, snus or dissolvable tobacco products in 2012-13.

Among US high school students, the National Youth Tobacco Survey (NYTS) found that 9.6% of males used chewing tobacco, snuff or dip and 2.7% used snus – a tobacco product that is put in the mouth – in 2013.

Since 2000, cigarette smoking prevalence has declined, but smokeless tobacco use among US youth has remained relatively consistent.

This is a cause for concern because it has been found to have several adverse health effects and has been identified as a cause of cancer.

Smokeless products known to contain carcinogens

Previous small studies have found high levels of toxic constituents, including carcinogens, in smokeless tobacco users, but more analysis of nationally representative data has been needed.

Lead author Brian Rostron, PhD, an epidemiologist in the Center for Tobacco Products at the US Food and Drug Administration (FDA), and colleagues examined data for 23,684 adult participants in the National Health and Nutrition and Examination Survey (NHANES) – a large, nationally representative study of US health behaviors and outcomes from 1999-2012.

They recorded participant-reported cigarette and smokeless tobacco use and categorized individuals into four groups: 16,313 non-tobacco users, 488 exclusive smokeless tobacco users, 6,791 exclusive cigarette smokers and 92 dual cigarette and smokeless tobacco users.

They analyzed biomarkers of exposure to seven tobacco constituents, including nicotine and tobacco-specific nitrosamine.

High levels of cotinine and NKK exposure in smokeless product use

The level of cotinine, the biomarker of nicotine exposure, was higher in exclusive smokeless tobacco users compared with exclusive cigarette smokers. The biomarker of NNK exposure was also higher in exclusive smokeless tobacco users compared with exclusive cigarette smokers.

The analysis confirms that levels of biomarkers of exposure to nicotine and the cancer-causing tobacco constituent NNK are higher among exclusive smokeless tobacco users than exclusive cigarette smokers. This continues to put smokeless tobacco users at risk for adverse health effects, including cancer.

Rostron says the findings confirm the need to continue studying of the toxic constituents of smokeless tobacco and their health effects on the individuals who use them.

The FDA and Centers for Disease Control and Prevention (CDC) are continuing to analyze and monitor biomarker levels among tobacco users.

In addition, the FDA and National Institutes of Health (NIH) are collaborating on the Population Assessment of Tobacco and Health (PATH) Study – a large longitudinal study that involves collection of biospecimens such as blood and urine.

Limitations of the current study include the nature of the data collected in NHANES. Being a general health survey, there is no detailed information on the type of smokeless tobacco product used, the quantity of smokeless tobacco product used and the duration or former use of smokeless tobacco products.

However, Rostron notes that the PATH Study data will allow for more specific analyses of tobacco use and harm.

The authors conclude:

“Our results have shown that smokeless tobacco users have high levels of known harmful and addictive constituents and that in some cases these levels are higher than those observed among cigarette smokers.

This finding is a cause of considerable concern for individual and public health. These results thus demonstrate the need for continuing study of the toxic constituents of smokeless tobacco as well as their health effects on the individuals who use them.”

Nearly a year after outdoor tobacco ad ban went into effect, cigarette billboards go down in Mampang

Yes, this is a real billboard ad that was once used in Jakarta

Yes, this is a real billboard ad that was once used in Jakarta

On January 7, Governor Basuki “Ahok” Tjahaja Purnama signed into law a regulation banning outdoor advertising for cigarettes and other tobacco products. If you were unaware of the new regulation, we wouldn’t be surprised, given the numerous cigarette ads that still seem to be found in every corner of the capital.

But progress is in fact being made on enforcing the regulation, with Civil Service Police Officers (Satpol PP) in Mampang Prapatan, South Jakarta, starting to take down a number cigarette billboards this week.

Mampang Prapatan Satpol PP head Asril Rizal said the cigarette billboards that were being taken down were those whose licenses had already expired. Ahok’s regulation allowed cigarette billboards to stay up until their licenses were up but does not allow them to be renewed.

However, Asril said that even those billboards that still have valid licenses will go down by the end of 2015, as the city should be completely free of outdoor cigarette ads by next year.

“Later at the end of December we will organize [more takedowns] as well. Because according to the governor’s regulation, beginning in January 2016 there should no longer be cigarette billboards in Jakarta,” he said as quoted by Kompas.

100pc duty on tobacco eyed – Bid to curb smoking

KUWAIT CITY, 17: The Gulf Cooperation Council countries have agreed to impose 100 percent customs duty on selective tobacco products, which is part of a strategy to flight smoking and curb its effects on health and economy, reports Al- Shahed daily.

According to reliable sources the agreement came during a meeting in Kuwait of GCC finance and economy ministers.

The last increment of customs duties imposed on tobacco in GCC countries was in the year 2000, something that rendered the GCC countries to be among the last places in the list of countries that implement the taxation of tobacco. Meanwhile, a number of officers from the General Administration of Customs have filed complaints with the Anti-Corruption Commission accusing senior officials of negligence and failing to control smuggling issues and facilitating the release of suspects, reports Al-Qabas daily. A reliable source said that employees have filed complaints in individual capacity and not collectively.

The source noted, everyone has submitted documentary evidence to support their claims and according to one of the staff the evidence submitted by the complainants prove the involvement of a number of officials in the customs smuggling issues which is considered anti-corruption security flaws which can harm public security. The source added all the documents submitted are being examined before referring them to the Public Prosecution after verification

British American to test tobacco/e-cigarette hybrid

LONDON: British American Tobacco, the world’s No. 2 cigarette maker, will test a hybrid product that uses tobacco and e-cigarette technology next week in an unspecified European market, a senior executive said on Wednesday.

The product, called iFuse, will make use of the company’s Kent brand, and be sold in a market where Kent cigarettes are popular. Executives declined to say which market that will be.

The first of its kind, iFuse is a “game-changer,” according to Kingsley Wheaton, BAT’s managing director of “next generation products”.

(Reporting by Martinne Geller in London, editing by Louise Heavens)
– Reuters

Joe Nocera’s contentious e-cigarette crusade

We’re very pleased to feature the following guest post by Paul Raeburn, a journalist and blogger whose writing has appeared in The New York Times Magazine, Discover, Scientific American, and other leading outlets. He’s also the author of five books, including the forthcoming The Game Theorist’s Guide To Parenting: How the Science of Strategic Thinking Can Help You Deal with the Toughest Negotiators You Know–Your Kids (2016). He tweets as @praeburn.

We’re very pleased to feature the following guest post by Paul Raeburn, a journalist and blogger whose writing has appeared in The New York Times Magazine, Discover, Scientific American, and other leading outlets. He’s also the author of five books, including the forthcoming The Game Theorist’s Guide To Parenting: How the Science of Strategic Thinking Can Help You Deal with the Toughest Negotiators You Know–Your Kids (2016). He tweets as @praeburn.

On Nov. 3, Joe Nocera bid farewell to his job as an Op-Ed columnist at The New York Times with what he called “a few last opinions.” One of those opinions was this: “There is no doubt [e-cigarettes] could save lives if adult smokers could be encouraged to make the switch.”

Nocera (who is moving to the sports pages at the Times) wrote about e-cigs in a series of eight columns stretching from December, 2013 to October 17th of this year. In those columns, he argued strenuously that the public health community should embrace the e-cigarette to help stop smoking. “It has the same look and feel as the lethal product…but the ingredients that kill people are absent,” he wrote in that first column in 2013. And his stance has never wavered.

At first glance, Nocera’s position seems obvious: If smokers switch to a safer substitute to satisfy their nicotine craving, fewer will die from smoking. The problem is that this isn’t a matter of opinion. We need the facts: Will e-cigs cut the death rate from lung cancer and heart disease? Nocera is certain the answer is yes, but the truth is that we just don’t know.

The findings so far on the risks and benefits of e-cigs are preliminary, but they raise the possibility that e-cigs might not help smokers quit. There is also evidence that nicotine is harmful to health, even without the other ingredients in tobacco. And preliminary data suggests e-cigs might encourage kids to smoke, a development that could outweigh any advantages for adults, if true. The net result could be that e-cigs lead to more deaths, not fewer.

None of this research is conclusive. But more studies will be done, and the implications of e-cigs for the public health may soon become clear. And that underscores the main problem with Nocera’s reporting: He is expressing opinions on matters of fact. He is not entitled to an opinion on whether e-cigs might save lives any more than he is entitled to an opinion on whether the sky is blue or the sun sets in the west. The research will give us the answers. Until then, opinions on policies are fair game, but not opinions on matters of fact.

E-cigarettes–which can resemble conventional cigarettes or ball-point pens–use a battery-powered heating coil to vaporize liquid nicotine and other additives so they can be inhaled. E-cigs give users a quick nicotine fix without the carcinogens in cigarette smoke.

It’s possible that they will help millions of smokers give up Marlboros. Or maybe they won’t. Or smokers might choose to use both–cigarettes at work, and in the evening, a cocktail with a pomegranate e-cigarette (a flavor offered by e-cig maker NJOY).

“The Nocera fantasy is that the only thing that happens is smokers switch to e-cigarettes, and a bunch of them quit smoking cigarettes,” says Stanton Glantz, a professor of medicine at the University of California, San Francisco, and a leading tobacco researcher and activist. But that’s not the whole story.

According to the Campaign for Tobacco-Free Kids, existing research on the use of e-cigarettes as an aid to quitting “provides mixed results.” Smoking an e-cigarette is less harmful than smoking a conventional cigarette, so substituting an e-cig for a Marlboro is a good step. But “e-cigarettes could ultimately reduce the number of smokers who would otherwise quit if smokers continue to use them in addition to, and not instead of, regular cigarettes.” And light and intermittent smokers are at greater risk for heart disease and lung cancer than non-smokers.

Again, the research is not conclusive–but it challenges Nocera’s certainty about the benefits of e-cigs. The value of e-cigs is not a matter of opinion.

The situation with kids is likewise disturbing, Glantz says. “We know that youth use of e-cigarettes is exploding. That’s well documented,” he says. And preliminary evidence suggests that “a substantial fraction of kids using e-cigs likely would never have picked up a cigarette.” (Researchers can predict with reasonable accuracy which kids are likely to start smoking, considering such factors as whether a best friend smokes.)

In a response to Nocera’s Oct. 17 column, Matthew L. Myers, the president of the Campaign for Tobacco-Free Kids, wrote that e-cigs must be “marketed so they do not re-glamorize smoking among young people…The concern about youth is serious. In 2014, over a quarter of a million youths who had never smoked a cigarette had used e-cigarettes.” Will e-cigs encourage those young people to smoke conventional cigarettes? We don’t know. But we should know before hailing e-cigarettes as a public-health bonanza.

Additionally, although the nicotine vapor from e-cigs has fewer carcinogens than tobacco smoke, it is far from safe. Nocera has written repeatedly, including in his farewell column, that smokers “smoke for nicotine, but they die from the tar.” The implication is that nicotine is relatively safe. But it isn’t.

In addition to nicotine vapor, e-cigs produce formaldehyde, acetaldehyde, acrolein, volatile organic compounds such as toluene, tobacco-specific nitrosamines, and metals like nickel and lead, according to the Campaign for Tobacco-Free Kids. It acknowledges that the levels of these toxins are lower than what’s found in cigarette smoke, but e-cigs still carry health risks.

Finally, while e-cig makers deny they are targeting children, e-cigs “often contain flavorings including fruit and candy flavorings that are not permitted in regular cigarettes,” according to the Campaign for Tobacco-Free Kids. It said that in January, 2014, researchers had identified 7,700 e-cigarette flavors available online. That’s not proof that e-cig makers are targeting kids; far from it. But it does, once again, poke holes in Nocera’s certainty that e-cigs are good for the public health.

The point is that what’s needed here are controlled studies–not reporters’ opinions. Nocera is not the only columnist or commentator who has made the mistake of confusing opinions and facts. Anyone who professes not to “believe” in climate change or evolution is doing the same thing. Climate change can be measured; it’s not a question of belief. Nor is evolution.

Reporters covering medical stories should keep this in mind. It’s fine to speculate, and it’s fine for op-ed columnists to have strong opinions. But it’s not appropriate for columnists to let opinions substitute for facts, just because the facts happen to be murky.

In a lengthy email, Nocera explained his interest in e-cigs. “I don’t smoke, and never have,” he wrote. Two of his grown children smoke, he wrote, and “I dearly want them to quit.” For him, e-cigarettes are the kind of long sought “harm reduction” that can reduce illness and death in smokers even if they are unable to quit.

“There are very few voices in the mainstream media that support the harm reduction potential of e-cigarettes–which is one reason I’ve stayed at it,” he wrote. “I think it is such a huge potential life-saver that I want to shout it from the rafters. I don’t feel apologetic about that.”

Nocera also addressed a question regarding his wife’s affiliation with the tobacco maker Philip Morris. From 2002-2008, according to her LinkedIn profile, she was director of external communications for Altria, the parent company of Philip Morris USA, which launched an e-cigarette brand last year. “She has never had a thing to do with e-cigarettes,” he wrote. “I came by my opinion honestly and honorably.”

This isn’t the first crusade Nocera has mounted. He has written multiple columns critical of the National Collegiate Athletic Association, and from mid-2013 until the middle of 2014 he published The Gun Report, an attempt to tally all of the gun deaths in the country. It’s strong reporting from a respected journalist.

He should use the same care when opining on e-cigs. Reducing smoking-related cancer and heart-disease deaths is a campaign worthy of Nocera’s tenacity. But a more skeptical and careful approach to the risks and benefits of e-cigarettes would serve him well in that campaign.

Regulate but don’t ban e-cigarettes, expert tells Singapore–expert-tells-singapore-104914521.html

Regulating electronic cigarettes is a better option than banning them due to the potential benefits for smokers who are looking to quit their habit, according to a UK expert.

Heneage Mitchell, founder of survey site, was giving his views to Yahoo Singapore about the upcoming ban on the use of e-cigarettes in Singapore after attending a summit in London.

The ban on e-cigarettes, which produce vapour for users to inhale, takes effect on 15 December. Also known as personal vaporisers or electronic nicotine delivery systems, e-cigarettes come in a large variety of flavours (also referred to as juices) and often contain nicotine. The act of using e-cigarettes is commonly referred to as “vaping”.

Mitchell said the Singapore government should instead regulate e-cigarettes to ensure that they are safe to use.

“The government has denied access to a product that is scientifically proven to be much safer than a legal product. To me, that doesn’t make sense.”

Mitchell, who was the former managing editor of Tobacco Asia, added, “They [the government] need to take a step back and ask what are our long term health goals, and it’s definitely to reduce death and disease associated with smoking.”

The e-cigarette summit on 12 November saw university researchers coming together to unveil their survey findings related to e-cigarettes.

Since Singapore banned the import, sale and distribution of e-cigarettes on 28 November 2014, many Singapore smokers have flocked across the Causeway to get their vaping fix. While the products are not banned in Malaysia – the local industry was worth US$639 million in 2014, according to a report by Channel NewsAsia – the authorities are cracking down on juices that contain nicotine.

Many smokers see vaping as effective in helping them to curb or quit the habit, mainly due to the absence of harmful tobacco and smoke in e-cigarettes. The UK’s Public Health Department released survey findings in August this year stating that e-cigarettes are around 95 per cent less harmful than tobacco.

In a joint statement released previously, Singapore’s Ministry of Health, Health Sciences Authority and Health Promotion Board said, “We are aware that e-cigarettes have been marketed as a safer alternative to standard cigarettes or as an effective smoking cessation device. We remain cautious as there is no conclusive scientific evidence to demonstrate the effectiveness of e-cigarettes in helping smokers quit tobacco use.

”E-cigarettes could potentially be a gateway to developing a smoking habit, particularly among the young.”

Concern with unregulated e-cigarette juices in Malaysia

While it’s not difficult to manufacture e-cigarette juices, Mitchell said that smokers should be getting the support from their respective governments so that they can buy products that are safe to use.

During the interview, Mitchell also showed images of an e-cigarette store that he recently visited in Malaysia. The images showed several shelves that were fully stocked with bottles of unregulated juices.

“Unbelievable, it’s totally unregulated. There’s just dozens and dozens of these wholesalers, and all of them had two, three, four people buying chunks of juice… they had no idea what’s in them,” he said.

The ingredients of juices are typically water, propylene glycol, vegetable glycol, and pharmaceutical-grade nicotine, and food grade flavor, and they are easy to make, Mitchell pointed out.

How other countries regulate e-cigarettes

Authorities from around the world have different ways of regulating e-cigarettes.

South Korea taxes e-cigarettes, which are categorised as tobacco products. A milliliter of liquid nicotine is taxed at the same rate as a box of tobacco.

Australia categorises nicotine as poison if not used for therapeutic purposes. E-cigarettes without nicotine are categorised as consumer products.

A full list of countries and their e-cigarette regulations, which was revealed at the summit, is available .