Clear The Air News Tobacco Blog Rotating Header Image

May 11th, 2016:

IMA condemns use and sale of e-cigarettes

Electronic cigarettes or e-cigarettes are a type of electronic nicotine delivery system, which are much in rage today as alternatives to cigarettes. The younger generation is increasingly switching to e-cigarettes because they feel that they are safe to use, less harmful than normal cigarette smoking and satisfy their cravings.

The recent regulation on e-cigarettes by the FDA restricting its sale and promotion to the younger generation proves otherwise. Welcoming the move, the Indian Medical Association is running a mass awareness campaign educating the masses about the dangers of e-cigarettes and dispelling common myths, which state that e-cigarettes are safe and nicotine free.

E-cigarettes are battery-operated devices that heat a liquid to produce a vapour that the user inhales. Unlike conventional cigarettes, which burn tobacco and generate smoke, e-cigarettes have a cartridge containing a liquid which contains nicotine and other constituents.

In Focus

The liquid is heated to produce a vapour the user inhales. Unlike conventional cigarettes, e-cigarettes can be sold with flavorings. More than 7000 flavours are available, including candy, fruit, soda, and alcohol flavors. Flavorings may increase the attractiveness of e-cigarettes to youths, especially those who are not already smokers.

Speaking about the same, Dr SS Agarwal, National President IMA & Dr KK Aggarwal, Honorary Secretary General IMA in a statement said, “Nicotine exposure from e-cigarette use, as with cigarette smoking, increases heart rate and produces measurable levels of blood cotinine, a nicotine metabolite. Experienced e-cigarette users tend to take longer puffs and use the device more intensively compared with novice users. As a consequence, they have higher blood nicotine levels that more closely resemble the levels achieved by smoking conventional cigarettes.”

They added, “Similar to cigarette smoke, e-cigarette vapour contains particles. It is not known whether the particles in e-cigarette vapour have any toxicity. IMA, therefore, does not advocate e-cigarettes as an effective way to reduce smoking cessation and believe that they are as harmful as normal cigarettes and must not be promoted.”

Given the concerns that e-cigarette use may be a gateway to nicotine dependence in adolescents, many public health authorities have recommended restricting e-cigarette marketing and advertising to youth, much in the same way that conventional cigarette smoking advertising is restricted. The nicotine in e-cigarette fluid poses a potential for accidental ingestion, especially by children.

E-cigarettes have been banned in some countries (including Brazil, Singapore, Canada, and Uruguay). In Europe, the European Parliament approved a directive that regulates nicotine-containing e-cigarettes with concentrations up to 20mg/mL as tobacco products E-cigarettes with higher nicotine concentrations are regulated as medical devices.

As per WHO, regulations are needed to stop promotion of e-cigarettes to nonsmokers and young people, minimise potential health risks to users and nonusers, stop unproven health claims about e-cigarettes, and protect existing tobacco control efforts.

Vape, e-cigarette regulations ready by year-end, says Dr Subra

PUTRAJAYA: Regulations for vape and e-cigarette products for both manufacturers and end-users will be ready by year-end.

Health Minister Datuk Seri Dr S Subramaniam said his ministry will be one of the regulators for the comprehensive set of regulations which are currently being fined tuned.

“Once the regulations are finalised, we will present it to the Cabinet. Right now the ministry with the help of other agencies under various ministries are drawing up the rules,” Subramaniam told a press conference today.

Meanwhile, commenting on the dengue situation, he said health officers have been monitoring and spraying larvicide at high risk areas.

US man loses an eye after e-cigarette ‘explodes in his face’

A Californian man claims he had to have his left eye removed after an e-cigarette exploded in his face last month.

Joseph Cavins, 63, claims he was using the device at home on April 15 and had just placed it down on his desk when it exploded.

Flying debris from the explosion struck Mr Cavins in the face, damaging his orbital and sinus bones and leaving shrapnel embedded in his eyeball.

“I felt like I was hit on the side of the head and everything went south from there,” he told local broadcaster ABC 7.

The explosion also reportedly peppered the ceiling with shrapnel and started a fire on Mr Cavins’ computer.

Mr Cavins’ attorney Greg Bentley said his law firm, Shernoff Bidart Echeverria Bentley, is currently investigating 60 cases involving e-cigarette batteries exploding and inflicting injuries on their users.

Mr Bentley said battery manufacturers in China are not regulated, resulting in e-cigarettes that are “susceptible to overheating and exploding”.

He believes the battery chargers also lack safety mechanisms to prevent overheating.

“This is becoming all too common, and it’s now a national problem,” Mr Bentley said.

The lawyer plans to file a lawsuit against parties allegedly involved in the manufacture of the faulty e-cigarette.

Mr Cavins meanwhile is expected to undergo further surgeries in the hopes of repairing some of the muscles in his damaged eye.

E-cigarettes deliver nicotine and other chemicals to the user in vapour form, and are often used as a method to wean smokers off tobacco cigarettes.

Children Safety: E-Cigarettes Might Be More Dangerous Than Regular Cigarettes

With the sudden rise in the popularity of electronic cigarettes or E-cigarettes, many teens and adult are inclined to buy the product and use it for themselves as substitute to regular cigarettes. But a new study suggests that ecigarettes are associated with the increase rates of children being poisoned with liquid nicotine.

According to the study published in the journal Pediatrics, the number of children exposed to e-cigarettes and liquid nicotine are increasing rapidly, with several cases of severe outcomes being reported.

For the study, researchers analyzed calls to poison centers regarding nicotine and tobacco product exposures among children younger than 6 years. The National Poison Data System recorded a total of 29, 141 calls for pediatric exposures to nicotine and tobacco products from January 2012 to April 2015, averaging 729 child exposures per month.

Researchers found out that 14.2 percent of the calls were due to e-cigarette exposures. The monthly exposures linked to e-cigarettes have experienced 1492.9 percent monthly increase during the course of the study. Children exposed to e-cigarettes are 5.2 times more likely to be admitted in health care facilities, compared to children exposed to cigarettes. Pediatric exposure to e-cigarette also has 2.6 times higher odds of having severe outcome, including comas and seizures. One death was associated with liquid nicotine exposure.

According to the report from Washington Post, children are attracted to the colorful packaging and flavor of the liquid nicotine.

With the alarming increase of pediatric exposure to e-cigarette, researchers recommend preventive strategies such as public education; appropriate product storage and use away from children; warning labels; and modifications of e-cigarette devices, eliquid, and e-liquid containers and packaging to make them less appealing and less accessible to children.

They are also urging government officials to develop a better strategy in regulating e-cigarette products to prevent child poisoning.

It is also noted that it is the responsibility of adult users to keep their e-cigarettes and all of its accessories to high places, or better yet, on a locked cabinet or case.

Electronic Cigarette Poisoning in Children Growing

Decatur- The amount of young children getting sick from electronic cigarettes has increased almost 1500% since 2012.

That’s according to a new study of poison center calls from 2012 through April 2015. The data was collected by measuring the amount of monthly calls of children ingesting liquid nicotine found in e-cigarettes. The calls went from 14 a month in 2012, to 223 a month by the end of the study in April 2015.

The children most effected were those younger than the age of 2. Professionals attribute the increase in these incidents in the way that liquid nicotine is displayed, often times coming in colorful packages.

Symptoms of nicotine exposure included an increased heart rate, fast breathing, nausea or vomiting. While most of these cases do not end up with the child being seriously harmed, one child has died from the exposure, and several have had serious complications causing comas and seizures.

According to Dr. Terry Balagna, an emergency physician at St. Mary’s Hospital, since this a relatively new epidemic, there has not been a lot of research done on the long term effects.

“Nicotine ingestion is fairly new at this point, especially for pediatrics, there have been a few studies early on, but nothing yet that shows any long term effects at this point.” he said.

Parents who use electronic cigarettes are being told to use caution when storing the liquid nicotine, so a child can not easily access it.

The FDA has recently issued new regulations that will require nicotine exposure warnings and child resistant packaging.

E-cigarettes cannot help smokers to kick the butt as they are not as strong as regular cigarettes

Most smokers who have tried electronic cigarettes have rejected them as less satisfying than regular cigarettes, reducing their potential to be a ‘disruptive technology’ that could help a significant number of smokers to quit, according to a recent study

Most smokers who have tried electronic cigarettes have rejected them as less satisfying than regular cigarettes, reducing their potential to be a ‘disruptive technology’ that could help a significant number of smokers to quit, according to a recent study by a team of researchers at the Tobacco Center of Regulatory Science (TCORS) at Georgia State University. E-cigarettes, also referred to as Electronic Nicotine Delivery Systems or ENDS, ‘need to improve as a satisfying alternative or the attractiveness and appeal of regular cigarette must be degraded to increase the potential of ENDS replacing regular cigarettes,’ according to lead author Dr. Terry F. Pechacek.

The researchers surveyed a nationally representative sample of 5,717 U.S. adults in 2014, asking questions about their awareness of e-cigarettes, use of such products and reasons for using traditional and novel tobacco products. Among the 144 former cigarette smokers who had tried e-cigarettes, nearly 30 percent (or 43 people) continued to use them as a satisfying alternative to regular cigarettes. But among the 585 smokers in the study, nearly 58 percent (or 337 people) reported they found e-cigarettes unsatisfying and stopped using them. Meanwhile, more than 40 percent of the group of smokers (or 248 people) continued to smoke cigarettes and use e-cigarettes, known as dual use. The primary motivations reported by dual users for using e-cigarettes was reducing harm to their health and trying to cut down or quit smoking.

Barack Obama bans e-cigarettes for children but not child labour on tobacco farms

Human Rights Watch says some children working on tobacco farms reported symptoms consistent with acute nicotine poisoning


‘Sofia,’ a 17-year-old, works in a tobacco field in North Carolina Benedict Evans/Human Rights Watch

Children as young as 12 will still be allowed to work on US tobacco farms despite new regulations banning the sale of e-cigarettes to under-18s, Human Rights Watch has said.

Although President Barack Obama’s administration has extended the FDA’s authority to include all tobacco products, including e-cigarettes, 12-year-olds can still work 50 to 60 hours a week outside of school on tobacco farms.

According to HRW, some children working on farms in North Carolina, Kentucky, Tennessee and Virginia have reported vomiting, nausea, headaches and dizziness while working with tobacco leaves.


The group warned the symptoms were consistent with acute nicotine poisoning.

They also suggest some of the pesticides commonly used in tobacco farming are known neurotoxins, which can destroy nerve tissue.

Under US law, children cannot work on farms during school hours, but they can work in the field at other times.

Hours typically increase in the summer, when school is not in session and the tobacco crop season is at its peak.

“If the administration can implement a ban on e-cigarettes for children in 90 days,” a spokesperson for Human Rights Watch said, “it can ban children from working with toxic tobacco plants.”

Tobacco Firms Lose Packet Legal Challenge

The European Court of Justice dismisses the final legal challenge to EU rules which aim to stop youngsters from starting smoking.

Europe’s highest court has rejected a legal challenge by tobacco firms against standardised packaging rules for cigarettes.

The ruling, at the European Court of Justice, essentially dismissed complaints that changes to EU laws went beyond what was necessary on health grounds.

It also paves the way for member states to impose further requirements such as plain packaging measures proposed in the UK, France and Ireland.

In addition, the ruling removes legal barriers to the banning of menthol cigarettes from 2020 and also electronic cigarette advertising.

The updated Tobacco Products Directive will take effect on 20 May though cigarette retailers will have a year to sell off their remaining stocks before the standardised packaging rules take effect.

They are designed to make the cartons less attractive to youngsters – with health warnings more prominent and covering 65% of a packet.

The EU hopes the move will cut smoking numbers by 2.4 million and prevent 700,000 premature deaths.

A separate legal challenge by tobacco firms against UK Government plans to remove all branding from cigarette packs is due to be heard on 18 May at the High Court and could be subject to appeal.

The packaging case against the EU was brought to by Philip Morris International, the maker of Marlboro, and the firm behind Rothmans and Benson & Hedges, British American Tobacco.

They argued that the bloc was abusing its authority.

But the ruling said: “The court finds that, in providing that each unit packet and the outside packaging must carry health warnings … the EU legislature did not go beyond the limits of what is appropriate and necessary”.

The Directive was due to be introduced in 2014 but was held up in the courts.

Deborah Arnott, chief executive of the anti-smoking charity Ash, welcomed the ruling.

She said: “We (now) await the UK court judgement, which is expected shortly, but we are optimistic that the court will confirm that the introduction of standardised packaging in the UK is lawful.

“From 20 May, all packs manufactured for sale in the UK will have to be plain, standardised, in the same drab green colour with the product name on the pack in a standard font”.

A spokesman for British American Tobacco said: “The reality is that many elements of the directive are disproportionate, distort competition and fail to respect the autonomy of member states.”

HIQA to achieve ‘world first’ on e-cigarettes

HIQA’s latest health technology assessment (HTA) on smoking cessation will be the first in the world to include electronic cigarettes among the interventions examined.

“This has not been done by a national HTA agency up to now,” HIQA’s Director of HTA Dr Máirín Ryan told IMT.

Dr Ryan was speaking after the release last week (April 28) of a major new report from the Royal College of Physicians (RCP) in London, which concluded that e-cigarettes were much safer than smoking and likely to be beneficial to public health.

The report, ‘Nicotine without smoke: tobacco harm reduction’, found that e-cigarettes were not a gateway to smoking, nor did they result in normalisation of smoking behaviour. And while the possibility of some harm from long-term e-cigarette use could not be dismissed, this was likely to be very small.

“The available data suggest that [the long-term health risks] are unlikely to exceed 5 per cent of those associated with smoked tobacco products, and may well be substantially lower than this figure,” it suggested.

Reviewing the report in The BMJ (BMJ 2016;353:i1745), Prof John Britton, Chair of the RCP’s Tobacco Advisory Group, and colleagues argued that e-cigarettes and other non-tobacco nicotine products offered the potential to “radically reduce harm from smoking” in society. “This is an opportunity that should be managed, and taken.”

Dr Ryan remarked that this was one of the first endorsements from any clinical advisory body on the use of e-cigarettes, and was probably driven by the fact that E-Voke electronic cigarettes was licensed in the UK last year. She said HIQA’s expert advisory group was to have its first meeting at the start of July, so there was plenty of time to consider this latest report.

The smoking cessation HTA will examine the clinical and cost-effectiveness of a number of different treatments to help people quit smoking. “At the moment we are gathering the clinical effectiveness information in terms of the comparative clinical effectiveness and we will use that then to populate the economic model.

“It is a big budget area, but there is no shortage of evidence,” Dr Ryan added.

A public consultation on a draft HTA report is expected in October before it is finalised and submitted as advice to the Minister for Health and the HSE and published, most likely in December.

Studies are conclusive: plain packaging of tobacco works

An expert commentary on the global tobacco control treaty, the WHO FCTC

Tobacco use kills nearly six million people every year worldwide, according to the World Health Organization.1 In response to this pandemic, WHO developed the Framework Convention on Tobacco Control (WHO FCTC), a comprehensive treaty with 180 Parties.2

The WHO FCTC provides various support tools for countries to develop effective tobacco control policies, such as high taxes on tobacco, advertising regulations and tobacco warnings.

The present article focuses on plain packaging of tobacco, proposed in Articles 11 and 13 of the FCTC, to eliminate the use of tobacco packaging as a marketing tool. Plain packaging means that the brand name is printed in a standardized font and typeface, and trademarks (including logos or any decorative elements) are prohibited. The pack must use unattractive colours and contain no text other than health warnings and information required by law (see photo).

3 more countries

Australia adopted plain packaging in 2012; Ireland, Great Britain and France will implement it in 2016; and New Zealand, Norway, Finland, Sweden, Turkey, and Canada are considering its implementation.

While plain packaging is increasingly gaining the support of governments, the tobacco industry has been lobbying hard to curb its development: actions include a lawsuit filed against Australia and the threat of legal proceedings for other countries planning to introduce it; the launch of anti-plain-pack campaigns and Internet sites, and scaremongering about a rise in counterfeiting and contraband. Such hostility begs the question of why the tobacco industry is so opposed to plain packaging if it claims that it is inefficient or useless.

“Clearly favourable”

An analysis of the research carried out since the early 1990s on the efficiency of plain packaging makes it easier to understand these hostile reactions: it has been proven that plain packs are clearly favourable for public health.

The first benefit is for adolescents: compared with the “branded” pack, the plain pack is less appealing and diminishes the incentive to start smoking. Plain packaging reduces the packet’s attractiveness and the positive image of the smoker, which ultimately diminishes the appeal of smoking. (Minors consider plain packs to be uglier, bland and boring).

Furthermore, the plain pack also has an impact on smokers. Australian smokers who were questioned following the introduction of the plain pack in 2012 said that they were more motived to stop smoking, had made more frequent attempts to stop smoking, and had put out an unfinished cigarette more often (compared to the period in which “branded” packs were used). They also made more telephone calls to the smoking cessation helpline (which experienced a 78 percent increase in calls during and after plain pack implementation) and had the impression that the cigarettes were of lower quality and did not taste as good.

Similar findings elsewhere

Similar findings have been highlighted in studies on perceptions of plain packaging conducted in other countries, including Great Britain, France and New Zealand.<

Plain packs also prevent consumer misinformation. The tobacco industry uses colour codes (light blue, white) to evoke the “mildness” of cigarettes and places reassuring text on the packaging (“100% tobacco”, “0 additives”, “organic”, etc.). This misleads individuals into thinking that harmful effects can differ according to the product, which in turn encourages them to carry on smoking certain brands of cigarettes instead of others. Plain packaging eliminates these false beliefs.

Another benefit of the plain pack is that it increases the impact of tobacco packaging health warning messages. On “branded” packages, these health messages are thwarted by marketing stimuli (logos, colour, images, etc.) that reduce their visibility, credibility and impact on the desire to stop smoking.

‘Denormalize’ smoking

Finally, the Australian experience shows that plain packs reduce the visibility of tobacco products and contribute to denormalizing smoking: given the ugliness of the packaging, smokers are less likely to take out their packet of cigarettes in front of family, children and friends.

To conclude, the numerous published studies on plain packs show that they are effective. Additionally, tobacco industry internal reports and documents have highlighted the importance that packaging and product play in increasing and maintaining market share:3 if tobacco companies no longer have control over their packaging, then they lose an essential means of communication, particularly in countries where advertising is prohibited or limited in the media. To defend this communication space, they have adopted the mantra that the plain pack is ineffective.

However, the Australian experience contradicts their arguments: when the country implemented plain packs, in combination with other measures (large warnings, a rise in the price of tobacco products), the number of smokers dropped and smoking by young people declined.4

– See more at: