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November 5th, 2016:

Ban e-cigarettes from public places, say world health chiefs

Britain is told to outlaw the increasingly popular vaping devices from schools, hospitals and buses amid health concerns

• The WHO is calling for countries to look at a ban due to ‘passive vaping’
• It has been linked to lung damage, heart complications and stillbirths
• Move echoes call from the BMA, which said e-cigarettes should be banned
• WHO’s stance will be controversial among many, including British medics

Britain is being asked by the world’s leading health watchdogs to consider banning electronic cigarettes from public places.

Countries could ban e-cigarettes from all public places where smoking is not allowed, a World Health Organisation report says.

Such a ban would outlaw the increasingly popular vaping devices from schools, hospitals and public transport in the same way as tobacco.

The WHO is calling on countries to look at this because of the dangers of ‘passive vaping’, which growing evidence has linked to lung damage, heart complications and stillbirth in pregnant women.

The move echoes calls from the BMA, which says e-cigarettes should be banned from pubs and restaurants because of just such dangers. The WHO is also supporting potential cigarette-style health warnings about the chemicals e-cigarettes include and information on the danger of addiction.

Its advice, issued before a major meeting on tobacco control in India next week, is expected to stoke a row between health experts.

There is some evidence linking e-cigarettes to cancer and fears they act as a gateway to smoking tobacco.

But British doctors are already using e-cigarettes to help people quit tobacco, with support from Public Health England, if the devices are licensed, to prescribe them on the NHS.

The WHO’s report sums up the latest scientific evidence ahead of next week’s meeting of 180 countries signed up to the Framework Convention on Tobacco Control. Dr Vera Luiza da Costa e Silva, head of the WHO convention secretariat, said: ‘So far there is a clear understanding that e-cigarettes should be regulated. They should not be promoted among young people and pregnant women and other specific groups. They should not be promoted widely – there should be restrictions and regulations.’

The WHO’s stance will be controversial among those – including British medics – who see e-cigarettes as helpful in getting smokers to quit.

A recent study found around 18,000 people in England last year may have given up cigarettes by vaping, which provides nicotine without the tobacco linked to lung cancer.

But the WHO says this is undermined by the number of young people being ‘recruited’ into nicotine dependency by taking up e-cigarettes. It suggests countries consider banning the flavouring of e-cigarettes whose bubblegum and fruit varieties have raised concerns they may be appealing to children. It also says they should not be sold or advertised to young people.

The WHO also highlights health fears over liquid nicotine vapour. It says metals, including lead, chromium and nickel, have been found in e-cigarettes at higher levels than ordinary cigarettes, while nicotine itself may act as a ‘tumour promoter’ in people with cancer, or cause heart disease.

But Professor Kevin Fenton, national director of health and wellbeing at Public Health England, said it will continue to monitor the evidence.

He added: ‘The evidence remains clear, with PHE’s most recent review and the Royal College of Physicians both finding that while not completely risk-free, vaping carries a fraction of the risk of smoking – around 95% less harmful.

‘The real concern is that smokers increasingly believe the inaccurate reports that vaping is as dangerous as smoking and are more likely to continue to smoke.’

Smoking’s effects on genes revealed for the first time ever in horrifying study

Smoking just a pack of cigarettes a day for a year causes 150 genetic mutations – each of which might lead to its own cancer

The full extent of the genetic damage that smoking does to our genes has been revealed for the first time.

Smoking just one pack a day can lead to 150 extra mutations in the lung cells a year. And it does even more damage to other parts of the body, causing huge numbers of mutations throughout other organs.

The study is the first to quantify the degree of damage that smoking does to our DNA. As such, it could help understand more about the kinds of problems that the habits causes, with each of those mutations potentially leading to cancer.

As well as those 150 mutations found in the lungs, scientists found that a pack-a-day habit for a year produced an average 97 mutations in each cell in the larynx (voice box), 39 mutations in the pharynx (top part of the throat), 23 in the mouth, 18 in the bladder and six in the liver.

Smoking, which claims the lives of at least six million people worldwide each year, has been linked to at least 17 different types of human cancer.

The disease is triggered by mutations – changes in the genetic programming written in DNA – that can cause cells to become “immortal” and multiply uncontrollably. Cigarettes contain more than 7,000 different chemicals, of which 70 are known to be carcinogenic, the researchers said, pointing to the complexity of how smoke interacts with the body.

“This study offers fresh insights into how tobacco smoke causes cancer,” said Ludmil Alexandrov of the Los Alamos National Laboratory, one of the study’s main co-authors.

“Before now, we had a large body of epidemiological evidence linking smoking with cancer, but now we can actually observe and quantify the molecular changes in the DNA due to cigarette smoking,” he added.

“With this study, we have found that people who smoke a pack a day develop an average of 150 extra mutations in their lungs every year, which explains why smokers have such a higher risk of developing lung cancer.”

Why Tobacco Companies Are Spending Millions To Boost A Cigarette Tax

Cartons of cigarettes on shelves at Discount Smoke Shop in Ballwin, Mo., in 2012 were much cheaper than cigarettes in most other states. Missouri’s tobacco tax is still only 17 cents per pack, but will rise if either of two state ballot measures passes this month.

For many Missouri health advocates, an increase in the state’s tobacco tax is long overdue. But onlookers might be surprised to hear that tobacco companies are spending a fortune this election year to get one or another increase in that tax passed, while health groups are urging a no vote.

At 17 cents for a pack of cigarettes, Missouri’s tax is the lowest in the country — a fraction of what you’d pay in many states. New York’s tax is the highest at $4.35 a pack, for example, and Florida ranks around the middle of the states at $1.34 a pack. Missouri’s cigarette tax also hasn’t changed since 1993.

Health groups like the American Lung Association say Missouri’s low cigarette prices contribute to one of the highest smoking rates of any state in the country: Twenty-two percent of adults in Missouri smoke, according to data compiled by the Centers for Disease Control and Prevention.

On Nov. 8, Missouri voters will decide whether to approve not one, but two tobacco tax increases. This time, however, health groups are actually urging voters to leave the tax alone, while tobacco companies are lobbying the electorate to vote yes.

The current tobacco tax debate got its start as way to expand early childhood education. In Missouri, just 19 percent of 4-year-olds attend a preschool or a Head Start program.

To Linda Rallo, an early childhood education advocate in St. Louis, a small increase in the tax seemed like an easy way to fund the schooling expansion. But then she took the idea to lawmakers in Jefferson City.

After years of failed attempts to increase the tax in the legislature, lawmakers and others in the capital seemed to consider another attempt to do so almost laughable.

“We had big, right-leaning people mocking us,” Rallo says. “It was rough.”

So Rallo and supporters decided instead to try to create a tax through a ballot measure. Their polling showed voters might approve an additional 60 cents a pack — and that’s the tax increase they’re proposing.

They estimated that their plan, which became Constitutional Amendment 3 on this month’s Missouri ballot, would generate around $300 million a year to fund mostly early education, with some funds going to smoking cessation and to health facilities that provide health care for children.

Rallo says her group reached out to get the help of health organizations like the American Lung Association. But there was a problem with her amendment, some public health researchers told her. Public health data suggest the size of the tax in Rallo’s amendment is too small to make a difference in smoking rates.

“Raising prices of tobacco products, we know, is the most effective way to prevent people from starting to smoke, to help people not get addicted to tobacco products and — for those who are smoking — to help them quit,” explains Dr. Doug Luke, director of the Center for Public Health Systems Science at Washington University, in Saint Louis.

But the size of the tax, research shows, has to be big enough to make people think twice before buying that pack of cigarettes.

Washington University has come out against Amendment 3, as has the American Lung Association, which argues that the amendment’s schedule of gradual increases in tax over four years would also keep it from having a big influence on smoking rates.

Rallo says it was this sort of disagreement over the size of the tax that caused her talks with health groups to break down.

“It was basically, ‘It’s my way or the highway.’ So we took the highway,” Rallo says. “And when you’re going down the highway, you might pick up an interesting companion.”

That “interesting companion” is tobacco giant R.J. Reynolds. Since December of 2015, the company has donated more than $12 million to committees supporting Amendment 3.

In a written statement, R.J. Reynolds said this is the first time the company has supported a cigarette tax increase.

But that’s not the end of the campaign’s complications. Amendment 3 also pits the big tobacco giant against smaller manufactures, known collectively as “Little Tobacco.”

As the result of a national settlement in the late ’90s, big tobacco companies right now must pay the state a special fee that that their smaller competitors don’t face.

Rallo says the fee allows these smaller companies to undercut firms like R.J. Reynolds, in their price per pack.

“You have such a low price on cigarettes — such a discounted price — that it’s very easy for low income people to buy cigarettes,” Rallo says.

Amendment 3 creates an additional tax increase for the little tobacco companies that don’t pay the fee. Rallo says that extra tax is meant to stop the small companies from being able to sell cigarettes at bargain prices.

But little tobacco has fired back. They’ve thrown their weight behind a different ballot measure — Proposition A, which would add a smaller tax (23 cents a pack) on all brands. That way, the smaller producers would still be less expensive than Big Tobacco’s cigarettes.

Two of the smaller manufacturers, Xcaliber International and Cheyenne International, have donated nearly $5 million in support of the smaller tax.

Meanwhile, many education advocates aren’t crazy about how the tax money raised by Rallo’s proposed amendment would be spent. Rather than earmarking it for public schools, the money raised by Amendment 3 would be available as grants that could alternatively go to religious or private education groups.

Rallo says these other institutions provide a lot of pre-K programs in Missouri and are better prepared than public schools to expand in many parts of the state. Proposition A’s money would fund infrastructure projects.

The numerous debates and controversies that have arisen from Amendment 3 have led to some alliances never seen before, and to shifts in many of these groups’ default positions on tobacco and taxes.

“This becomes very confusing to the public,” says Luke. “They see multiple bills on the ballot. They hear that public health groups are arguing about this. And even the tobacco industry is fighting itself, which is very unusual.”

Groups like Tobacco Free Missouri, the Health Care Foundation of Greater Kansas City and Campaign for Tobacco-Free Kids have joined fiscal conservatives in opposing Amendment 3. These anti-smoking groups worry that creating such a small tax now might eliminate the chance of future tax that would be big enough to significantly change smokers’ behavior.

“There is a sense here of, ‘At some point we need to get something passed,’ ” says Luke. “But that’s not how you do sound policy.”

This story is part of a reporting partnership with NPR, KCUR and Kaiser Health News.

Copyright 2016 KCUR-FM. To see more, visit KCUR-FM.


The state of Missouri has the lowest taxes on cigarettes in the country, just 17 cents a pack. On Election Day, Missouri voters will decide on a constitutional amendment to increase the tax. And here’s the interesting twist, Big Tobacco supports the tax hike on smokers. Smaller tobacco companies and health groups oppose it. Here’s Alex Smith from member station KCUR in Kansas City.

ALEX SMITH, BYLINE: A small increase on the state’s low tobacco tax seemed like an easy way to fund early childhood education, says Linda Rallo. So she and her supporters decided to try a petition to create a tax through a ballot measure. Their polling showed voters might be OK with an additional 60 cents a pack. Then they reached out to health groups and hit a wall.

LINDA RALLO: We talked to them so many times, and we wanted to partner with them. We offer them higher amounts, you know, and it just – it was a very frustrating experience.

SMITH: Rallo’s tax, they said, is too small to make smokers actually quit, so talks with the health groups broke down.

RALLO: It was basically it’s my way or the highway. So we took the highway, and, you know, when you’re going down the highway, you might pick up an interesting, you know, companion.

SMITH: That interesting companion is tobacco giant R.J. Reynolds. The company approached her to offer its help and told NPR in a written statement that its support of Amendment 3 marks the first time Reynolds has ever supported a cigarette tax. But this pits Reynolds against smaller manufacturers known as little tobacco. Big tobacco companies have to pay the state a special fee that small companies don’t, so smaller producers can undercut, Rallo says.

RALLO: You have such a low price on cigarettes, such a discount price, that it’s very easy for low-income people to buy cigarettes.

SMITH: The amendment creates an extra tax on those smaller brands that would stop them from being able to sell at bargain prices, so little tobacco is firing back. They’ve thrown their weight behind another ballot measure that would create a smaller tax – 23 cents a pack – on all brands, so they’d still be cheaper than big tobacco cigarettes. This is all pretty confusing for voters, says Doug Luke, a tobacco researcher at Washington University.

DOUG LUKE: They see multiple bills on the ballot. They hear that public health groups are arguing about this. And even the tobacco industry is fighting itself, which is very unusual.

SMITH: Many health groups have joined fiscal conservatives in opposing Amendment 3. They were creating such a small tax now might eliminate the chance of a future tax that would really make people quit, says Luke.

LUKE: There is a sense here of at some point, we need to get something passed. But that’s not how you do sound policy.

SMITH: Meanwhile, R.J. Reynolds has spent more than $12 million on a measure that would more than quadruple the tax on its cigarettes in Missouri. For NPR News, I’m Alex Smith in Kansas City.

Child labor on Indonesia’s tobacco farms

July Eping is one of many children in Indonesia who work with tobacco. It’s dangerous and illegal work. But their families are poor, and everyone has to help with the harvesting, drying and sorting.