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January 14th, 2016:

Smoke-free legislation reduces hospital admissions for childhood lower respiratory tract infection

Jan 14th, 2016
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http://tobaccocontrol.bmj.com/content/early/2016/01/14/tobaccocontrol-2015-052541.abstract

Abstract

Background

Previous studies showed reduction of hospital admissions for asthma after implementation of comprehensive smoke-free legislation. We aimed to evaluate the impact of comprehensive smoke-free legislation implemented in Hong Kong in 2007 on hospital admissions for childhood lower respiratory tract infection (LRTI).

Methods

We obtained data on 75 870 hospital admissions for LRTI among children ≤18 years of age between January 2004 and December 2012 from all Hospital Authority hospitals. Using a negative binomial regression model, we assessed the impact of smoke-free legislation on admission counts.

Results

After legislation implementation, there was an immediate effect with a change in the admission count of −33.5% (95% CI −36.4% to −30.5%), and a change in time trend to −13.9% per year (95% CI −16.0% to −11.7%). Overall, the legislation was associated with a net 47.4% reduction in admission counts in the first year. We estimated that the legislation was associated with a reduction of 13 635 admissions in the first 6 years after implementation. The immediate reduction and change in time trend was more apparent among school-age than preschool children.

Conclusions

Implementation of comprehensive smoke-free legislation was associated with a significant reduction in hospital admissions for childhood LRTI.

E-cigarettes WON’T help you quit: Smokers using vapers are ‘28% less likely to ditch traditional cigarettes’

Jan 14th, 2016
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http://www.dailymail.co.uk/health/article-3399947/E-cigarettes-WON-T-help-quit-Smokers-using-vapers-28-likely-ditch-traditional-cigarettes.html

  • E-cigarettes do not help smokers quit their habit, a major study concludes
  • People using ‘vaping’ gadgets are in fact 28% less likely to stop smoking
  • Experts say devices ‘should not be recommended to help smokers quit’
  • Comes two weeks after regulators approved first e-cigarette for medical use, meaning doctors in the UK can prescribe them to patients

E-cigarettes do not help smokers to quit tobacco, a major study has concluded.

Researchers found that people who use ‘vaping’ gadgets are in fact 28 per cent less likely to give up smoking traditional cigarettes.

The findings are a major blow to leading health officials in England, who have repeatedly insisted that e-cigarettes are a key tool to reduce smoking rates.

The study – a systematic review of all available data on the issue – is the largest to assess whether e-cigarettes assist smokers in quitting cigarettes.

Published in the Lancet Respiratory Medicine journal, it concluded that e-cigarettes do not help smokers quit – and should not be recommended for the purpose until there is solid proof that they do.

Public Health England, in a landmark report published last summer, claimed that e-cigarettes are ‘95 per cent’ safe – and called for the devices to be rolled out on the NHS.

That report was widely criticised when it emerged that its headline claim originated in research partly conducted by scientists funded by the e-cigarette industry.

Yet plans to prescribe e-cigarettes as a quit-smoking aid have carried on at full tilt, and two weeks ago the Medicines and Healthcare Products Regulatory Agency approved the first vaping device for medical use.

The e-Voke, an e-cigarette produced by British American Tobacco, is now allowed to be marketed for smoking cessation, which means patients can request the device from their GP.

E-cigarettes contain a liquid form of nicotine that is heated into vapour to be inhaled, avoiding the harm caused by tobacco smoke.

While most experts are agreed that vaping is far safer than smoking tobacco, many are concerned about unresolved safety concerns.

The World Health Organisation has warned that they may be toxic to bystanders, many rail companies have banned people from vaping on trains or in stations, and the Welsh Government is planning to prohibit the practice in restaurants, pubs and offices from 2017.

Europe’s highest legal expert, Dr Juliane Kokott, the advocate general to the European Court of Justice, last month warned that e-cigarettes ‘possibly cause risks to human health’ and that they may even provide a ‘gateway’ for teenagers to go on to smoke tobacco.

She said that regulation is needed, including banning one in four of the strongest devices, and putting health warnings on packaging telling people e-cigarettes contain a ‘highly addictive substance’.

The new study, led by the University of California San Francisco, reviewed 38 studies assessing the link between e-cigarette use and cigarette cessation among adult smokers.

Research author Dr Sara Kalkhoran said: ‘As currently being used, e-cigarettes are associated with significantly less quitting among smokers.

‘E-cigarettes should not be recommended as effective smoking cessation aids until there is evidence that, as promoted and used, they assist smoking cessation.’

Co-author Professor Stanton Glantz added: ‘The irony is that quitting smoking is one of the main reasons both adults and kids use e-cigarettes, but the overall effect is less, not more, quitting.

‘While there is no question that a puff on an e-cigarette is less dangerous than a puff on a conventional cigarette, the most dangerous thing about e-cigarettes is that they keep people smoking conventional cigarettes.

‘The fact that they are freely available consumer products could be important.’

The two main authors of Public Health England’s report last night issued a fierce criticism of the new findings.

Professor Peter Hajek, of Queen Mary University of London, called it ‘grossly misleading’.

The work, he said, looked only at current smokers who had at some point used an e-cigarette – thus excluding any former smokers who may have used exactly such a device to quit.

And Professor Ann McNeill, of King’s College London, said the review was ‘not scientific’.

‘I believe the findings should therefore be dismissed,’ she added.

But Steven Bernstein of Yale School of Medicine, writing in a separate editorial published by The Lancet, said that despite concerns over the data, the study did raise questions about the usefulness of e-cigarettes as quitting aides.

E-cigarettes vapour affects driving

Jan 14th, 2016
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http://www.herald.co.zw/e-cigarettes-vapour-affects-driving/

YALE. — A new Yale University study finds that people who used a commercially available electronic cigarette liquid with a relatively high alcohol level had their motor skills significantly impaired — even though they didn’t feel like they were “buzzed” from the vaporised booze.

E-cigarettes have become increasingly popular in recent years as users seek alternatives to traditional tobacco products, which cause cancer.

The battery-operated e-cigs vaporise a liquid, which contains nicotine and often flavourings.

“They didn’t actually know they were under the influence of alcohol,” said Dr Mehmet Sofuoglu, a professor at the Yale School of Medicine who co-authored the study published in the journal Drug and Alcohol Dependence. “It still influenced their performance.”

“In this study, they had motor impairment, but they didn’t know they were intoxicated.”

Several of the study participants ingested enough alcohol via the e-cigs that metabolised booze was detected in their urine.

Sofuoglu said the findings are “worrisome,” particularly on the heels of new data showing a dramatic upward spike in the number of middle school and high school students using e-cigarettes.

There’s also cause for concern, researchers said, because of the popularity among e-cig users of making their own vaping liquids — which can have higher alcohol levels than commercially sold liquids.

Sofuoglu said the study showed how e-cig users, even if they didn’t end up having enough detectable alcohol in their urine to trigger a DUI charge, could end up being “intoxicated” and too impaired to drive because of how much “more quickly and efficiently” alcohol affected the brain after people inhaled vaporised booze compared to drinking it.

E-cig vapours who use liquids high in alcohol content may be on the track to “a faster level of dependence” on both alcohol and nicotine, Sofuoglu said. — CNBC.

Are e-cigs bad for you? We reveal the facts

Jan 14th, 2016
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http://www.thesun.co.uk/sol/homepage/features/6857765/Are-e-cigs-bad-for-you-We-reveal-the-truth.html

VAPING has become a phenomenon among smokers as the most effective way to quit smoking.

So you might not think they are bad for you so since the government last week gave the green light for e-cigs to be prescribed on the NHS to help people stop smoking.

The Medicines and Healthcare Products Regulatory Agency (MHRA) has awarded a licence to British American Tobacco for its e-Voke device to be prescribed to smokers – which could open the door for other vaping brands to be prescribed by GPs too.

According to NHS regulator, Public Health England e-cigs are “95% less harmful than tobacco”.

But researchers from the University of California published a study which said vaping is no safer than smoking.

They found e-cig vapour damages DNA that could lead to cancer.

There is still little research on e-cigs mainly because they are still so new.

They were only invented in 2003 by a Chinese pharmacist and not much data can be collected over this short period.

Their potential risks or benefits are still not fully understood.

We take a look at how e-cigs may be good or bad for you:

Pros

E-liquid is made up of mainly juices mixed with vegetable glycerine, nicotine and flavouring – all considered harmless.

It doesn’t contain tar – the main reason why smoking is harmful.

It’s the most effective way of quitting smoking. Research shows it is 60 per cent more effective than other methods such as nicotine gum, patches, or going cold turkey.

It’s far less harmful to the people around you than traditional cigarettes.

They do not leave a sticky, unpleasant odour and do not stain teeth or fingernails.

They are a cheaper alternative to smoking.

Cons

Most vapes still contain the addictive drug nicotine – causing cravings.

It contains other ingredients which raises questions about the impact it has on your health.

E-cigs use liquid nicotine – a highly dangerous substance even in small doses. Some testing suggests that some vaporizers release toxic metals during use.

The industry is relatively unregulated.

They have not been studied thoroughly enough to understand potential risks.

There are potentially dangerous advertisements to young people – promoting addictive habits to young people and non-smokers.

The act of vaping is habit-forming.

Verdict:

So, are e-cigs bad for you? The answer still remains a mystery.

The Sun’s GP, Dr Carol Cooper said there is a big question mark around the use of e-cigarettes.

She said: “We don’t know if it’s harmful or not as there is not enough evidence to suggest it’s bad for you.”

She suggests we must use caution around this relatively new product as we don’t know everything about it.

E-cigarettes and smoking cessation in real-world and clinical settings

Jan 14th, 2016
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http://www.thelancet.com/pdfs/journals/lanres/PIIS2213-2600(15)00521-4.pdf

Summary

Background

Smokers increasingly use e-cigarettes for many reasons, including attempts to quit combustible cigarettes and to use nicotine where smoking is prohibited. We aimed to assess the association between e-cigarette use and cigarette smoking cessation among adult cigarette smokers, irrespective of their motivation for using e-cigarettes.

Methods

PubMed and Web of Science were searched between April 27, 2015, and June 17, 2015. Data extracted included study location, design, population, definition and prevalence of e-cigarette use, comparison group (if applicable), cigarette consumption, level of nicotine dependence, other confounders, definition of quitting smoking, and odds of quitting smoking. The primary endpoint was cigarette smoking cessation. Odds of smoking cessation among smokers using e-cigarettes compared with smokers not using e-cigarettes were assessed using a random effects meta-analysis. A modification of the ACROBAT-NRSI tool and the Cochrane Risk of Bias Tool were used to assess bias. This meta-analysis is registered with PROSPERO (number CRD42015020382).

Findings

38 studies (of 577 studies identified) were included in the systematic review; all 20 studies with control groups (15 cohort studies, three cross-sectional studies, and two clinical trials) were included in random effects meta-analysis and sensitivity analyses. Odds of quitting cigarettes were 28% lower in those who used e-cigarettes compared with those who did not use e-cigarettes (odds ratio [OR] 0·72, 95% CI 0·57–0·91). Association of e-cigarette use with quitting did not significantly differ among studies of all smokers using e-cigarettes (irrespective of interest in quitting cigarettes) compared with studies of only smokers interested in cigarette cessation (OR 0·63, 95% CI 0·45–0·86 vs 0·86, 0·60–1·23; p=0·94). Other study characteristics (design, population, comparison group, control variables, time of exposure assessment, biochemical verification of abstinence, and definition of e-cigarette use) were also not associated with the overall effect size (p≥0·77 in all cases).

Interpretation

As currently being used, e-cigarettes are associated with significantly less quitting among smokers.

Funding

National Institutes of Health, National Cancer Institute, FDA Center for Tobacco Products.

UK teens heavily exposed to alcohol and tobacco content in YouTube music videos

Jan 14th, 2016
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http://www.economicvoice.com/uk-teens-heavily-exposed-to-alcohol-and-tobacco-content-in-youtube-music-videos/

13-15 year olds and girls most exposed, findings suggest

UK teens are heavily exposed to alcohol and tobacco images and lyrics in digital YouTube music videos, indicates research published in the Journal of Epidemiology & Community Health.

Those exposed the most are 13-15 year olds, and girls, the findings suggest

Relatively little attention has been paid to YouTube content, despite the fact that some music videos contain extensive alcohol and tobacco content, which is often depicted in a positive light, and that these videos tend to be most popular with younger audiences, say the researchers.

They used the results of two nationally representative online surveys of British adults and teens to calculate viewing figures for the 32 most popular music videos of top 40 chart songs in the UK during the 12 weeks of 3 November 2013 to 19 January 2014.

And they analysed the number of 10 second intervals in each of the 32 videos to estimate the total number of images/depictions/lyrics (impressions) of alcohol and tobacco content.

In all, 2068 teens aged between 11 and 18, and 2232 adults from the age of 19 onwards completed the surveys, and the results suggested that the average percentage of viewing across the 32 music videos was 22% for the teens and 6% for the adults.

The videos were available for an average of 7 to 10 months after release. And based on population census data, the researchers calculated that these delivered a total of 1006 million impressions of alcohol and 203 million of tobacco to the British population during the period between release of the video and the point of the survey.

Most of this content was delivered to 25-34 year olds, but levels of individual exposure were almost four times higher among teens, the figures indicated.

Teens aged 13 to 15 received an average of 11.48 tobacco impressions, while those aged 16 to 18 received an average of 10.5. This compares with 2.85 for adults.

Furthermore, exposure was around 65% higher among girls, with the highest numbers of tobacco impressions delivered to 13-15 year olds.

The pattern of exposure for alcohol was similar to that of tobacco, but the overall number of impressions was five times higher.

An estimated 52.11 alcohol impressions were delivered to each teen compared with 14.13 to each adult. Individual exposure levels rocketed to 70.68 among 13-15 year old girls.

“Trumpets” by Jason Derulo, and “Blurred Lines” by Robin Thicke delivered some of the highest number of tobacco impressions, while ”Timber” by Pitbull, and “Drunk in Love” by Beyoncé, delivered the most alcohol content.

“If these levels of exposure were typical, then in 1 year, music videos would be expected to deliver over 4 billion impressions of alcohol, and nearly 1 billion of tobacco, in Britain alone,” write the researchers.

“Further, the number of impressions has been calculated on the basis of one viewing only; however, many of the videos had been watched multiple times, so this number is likely to be much bigger,” they warn.

A ban on paid-for placement of branded tobacco products has been in force since 2002 in the UK, while alcohol promotion is regulated by the Advertising Standards Authority, the Portman Group, and industry voluntary codes of practice.

But while films are classified, and TV content is subject to controls during periods when children are likely to be watching, no such regulations apply to digital music videos. The British Board of Film Classification has consulted on an age rating system for music videos made in the UK, but this does not cover tobacco and alcohol content.

Instead, it includes drug misuse, dangerous behaviour presented as safe, bad language, sex and nudity, threatening behaviour and violence.

The evidence suggests that teens exposed to depictions of alcohol and tobacco content in films are more likely to start smoking or drinking, and the researchers suggest that music videos pose a “significant health hazard that requires appropriate regulatory control.”

They urge: “Owing to the obvious health implications for adolescents, we suggest that overly positive portrayals of both alcohol and tobacco in music videos should be included in both the drug misuse and dangerous behaviour presented as safe rating categories.”

Judge Tosses Big Tobacco Request for His Recusal

Jan 14th, 2016
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http://www.courthousenews.com/2016/01/14/judge-tosses-big-tobacco-request-for-his-recusal.htm

(CN) – A federal judge refused to recuse himself from a Big Tobacco challenge to new labeling rules the industry considers “draconian.”

Philip Morris and other tobacco companies seek to invalidate a Food and Drug Administration “guidance,” issued in September 2015, describing the “FDA’s current thinking on whether and when a change to a tobacco product’s label, product quantity in the package, additives, or specifications renders that later product a ‘new tobacco product’ subject to premarket review.”

Since a tobacco product’s label is now considered “part” of that product, under the amended Tobacco Control Act, the guidance states that a label change to a tobacco product will create a “new tobacco product,” raising a host of other regulatory issues.

Philip Morris asserts the guidance violates its First Amendment rights as well as administrative procedural requirements.

The tobacco companies moved to have U.S. District Judge Amit Mehta recuse himself based on his former law partner’s representation of an anti-tobacco organization, Campaign for Tobacco-Free Kids.

The organization submitted comments to the FDA about the disputed guidance.

Mehta was a partner at Zuckerman Spaeder for four years before his appointment to the bench in December 2014. His wife is presently a partner at the same firm, which has represented other anti-tobacco organizations.

But Mehta disagreed that his personal connections to his former firm created an “appearance of partiality,” as the tobacco plaintiffs claim.

“Although I generally knew that CTFK was a Zuckerman Spaeder client, I was not aware at the time the advice was given that the firm was advising CTFK in connection with the draft guidance,” he said.

And while CTFK naturally has an interest in the outcome of the case, Mehta said it was unlikely to seek to intervene, and at any rate, its interest is not enough to warrant his recusal.

Mehta noted that members of the D.C. bench often had careers with large law firms in the city with extensive legislative and government regulatory practices.

“Given these realities, it is not hard to conceive how litigants could be emboldened to judge-shop if I were to recuse in this case,” Mehta said. “If I accepted plaintiffs’ position, would a judge be required to recuse when her former law partner, unbeknownst to the judge while she was at the firm, lobbied Congress on behalf of a client in favor of a piece of legislation that is later challenged as unconstitutional? Or, instead of lobbying Congress, what if the former partner met on behalf of a client with an Executive Branch official about an executive order that is later challenged as exceeding the President’s authority?”

These situations are not unusual, especially in the nation’s capital, the judge said. He also said his wife has never provided any legal services to CTFK or any of the firm’s other anti-tobacco clients.

“A judge is not required to recuse merely because a litigant has discovered an attenuated connection between the judge’s former law firm and the issues before the court,” Mehta concluded.

Alcohol in e-cigarettes can affect ‘vapers': Study

Jan 14th, 2016
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Are we going to need designated drivers for “vapers” now?

http://www.cnbc.com/2016/01/13/

A new Yale University study finds that people who used a commercially available electronic cigarette liquid with a relatively high alcohol level had their motor skills significantly impaired — even though they didn’t feel like they were “buzzed” from the vaporized booze.

E-cigs have become increasingly popular in recent years as users seek alternatives to traditional tobacco products, which cause cancer. The battery-operated e-cigs vaporize a liquid, which contains nicotine and often flavorings.

“They didn’t actually know they were under the influence of alcohol,” said Dr. Mehmet Sofuoglu, a professor at the Yale School of Medicine who co-authored the study published in the journal Drug and Alcohol Dependence. “It still influenced their performance.”

“In this study, they had motor impairment, but they didn’t know they were intoxicated.” -Dr. Mehmet Sofuoglu, professor, Yale School of Medicine

Several of the study participants ingested enough alcohol via the e-cigs that metabolized booze was detected in their urine.

Sofuoglu said the findings are “worrisome,” particularly on the heels of new data showing a dramatic upward spike in the number of middle school and high school students using e-cigarettes. There’s also cause for concern, researchers said, because of the popularity among e-cig users of making their own vaping liquids — which can have higher alcohol levels than commercially sold liquids.

Sofuoglu said the study showed how e-cig users, even if they didn’t end up having enough detectable alcohol in their urine to trigger a DUI charge, could end up being “intoxicated” and too impaired to drive because of how much “more quickly and efficiently” alcohol affected the brain after people inhaled vaporized booze compared to drinking it.

E-cig vapers who use liquids high in alcohol content may be on the track to “a faster level of dependence” on both alcohol and nicotine, Sofuoglu said.

Of 31 such e-liquids obtained by the Yale researchers for their study, about one-third didn’t have any measurable alcohol in them, a paper on the study noted. Almost 40 percent had 0.75 percent or less alcohol content. And another 23 percent had alcohol levels of 1 to 3 percent.

One of the liquids, organic French vanilla, made by Virgin Vapor of California, had a whopping 23.5 percent alcohol content.

Researchers used that liquid to compare its effects with that of another e-liquid made by Virgin Vapor — organic naked vanilla — which had just a 0.4 percent alcohol content.

The 16 participants in the study, who all were traditional cigarette users and social drinkers, were tested on two separate days: one for each of the two different e-cig liquids.

When they were asked a series of questions after their puffing sessions, none of the participants indicated that they felt intoxicating effects from the higher-alcohol e-liquid, the study found. That was true after an initial five-minute session when they were asked to puff just 10 times, and even after a subsequent 20-minute session when they were allowed to puff as much as they wanted.

But the participants then were given a test designed to measure their motor skills. The test required putting a series of metal pins into holes. Participants were tested on placing the pins with their dominant hands, non dominant hands and then both hands, over 30-second periods.

Participants scored markedly worse when they vaped with the high-alcohol liquid than they did when they used the trace-alcohol liquid, according to the study.

And their scores “did get much worse after the [20-minute] free time,” noted Sofuoglu.

He said that when people drink alcohol, they often are aware that they are becoming impaired. That doesn’t appear to be the case, or is much less so, with vaping e-cig alcohol.

“In this study, they had motor impairment,” he said, “but they didn’t know they were intoxicated.”

Annette Rogers, CEO of Virgin Vapor, said the company uses organic flavors, some of which “come in a base of organic ethyl alcohol as this is commonly used in the flavor industry when extracting flavor from organic base ingredients.”

“When we first started our company in 2010, the only flavors available that were suitable for use in e-liquid were ones extracted using organic ethyl alcohol. Since that time and with the help of our chemist, Dr. Marc Foster, we have developed new and better flavors that do not require organic ethyl alcohol as an extraction method,” Rogers said. “We prefer flavors that do not contain organic ethyl alcohol because we look to create a product with as few ingredients as possible.”

“Due to our ongoing product development and innovation, we only have a few flavors that we still carry that are extracted using organic ethyl alcohol, because of their long-standing popularity but most do not. All of our ingredients are listed on every bottle of Virgin Vapor liquid, including organic ethyl alcohol when present,” she said.

Last week, the federal Centers for Disease Control and Prevention released data showing a very large increase in the number of middle school and high school students using e-cigs, a rise that has tracked, and may be related to an explosion in advertising for the devices, according to the agency.

In 2011, the CDC said, ad spending on e-cigs stood at $6.4 million annually, and 280,000 middle and high school students reported having used the devices in the past 30 days.

As of 2014, the number of such students who reported using the devices had risen to 2.49 million — up from 800,000 in 2013. The ad spending on e-cigs had reached $115 million by 2014.

The CDC noted that “about 69 percent of middle and high school students were exposed to e-cigarette advertisements in retail stores, on the Internet, in magazines/newspapers, or on TV/movies.”

“Exposure to e-cigarette advertisements may be contributing to increases in e-cigarette use among youth,” the CDC said.