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December, 2016:

FDA denies Swedish Match request on tobacco warning label changes

Dec 14th, 2016
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In its first action on so-called modified-risk tobacco products, the U.S. Food and Drug Administration on Wednesday rejected a company’s request to remove some health warning labels from a smokeless product called snus.

http://www.richmond.com/business/local/article_c925fb0e-7932-5521-91ed-c08a6ba949ff.html

Swedish Match, a Swedish-based tobacco company with its North American headquarters in Richmond, applied to the FDA in 2014 to have its snus product designated as modified risk, meaning it could be less risky to health.

Snus (pronounced snoos), is a smokeless tobacco sold in small pouches that the user places between the cheek and gum.

It has been popular in Scandinavian countries for many years, and Swedish Match, which sells snus under the brand name General in the United States, argued in its application to the FDA that it is a less-risky alternative to cigarettes and other tobacco products.

The company said it submitted about 120,000 pages of documents to the FDA to back that claim, including scientific and consumer studies conducted over the past 30 years in Norway and Sweden.

The company wanted to remove mandatory, rotating warning labels on snus packages that say it can cause gum disease, tooth loss and mouth cancer.

It also wanted to change the wording on a warning label that says snus is “not a safe alternative to cigarettes.” The company wanted it to read: “No tobacco product is safe, but this product presents substantially lower risks to health than cigarettes.”

The company did not seek to change a warning that says smokeless tobacco is addictive.

The FDA said it denied the request to remove the gum disease and tooth loss warnings because, based on the scientific evidence, “the products can cause gum disease and tooth loss.”

However, the agency deferred a final decision on the mouth cancer warning and the wording change, giving Swedish Match up to two years to amend its application. The FDA said the application “could be amended to support issuance of modified-risk orders.”

Under a 2009 federal law that gave the FDA authority to regulate tobacco products, companies can apply to the agency to market novel products as modified risk if there is evidence they are less risky to health.

The FDA has not yet authorized any tobacco products as modified risk. In reviewing such requests, the agency has to consider a product’s potential impact on both individual users and the population as a whole.

“The lessons learned through these first applications provide key insights moving forward,” said Mitch Zeller, director for the FDA’s Center for Tobacco Products, in a statement. “For example, companies should carefully consider how they plan to present and substantiate a modified-risk claim.”

“While the FDA is not authorizing modified-risk orders for these products at this time, our guidance to the company will enable it to amend its applications if it chooses,” Zeller said.

Swedish Match called the FDA decision encouraging and noted that the agency previously found that snus contains “significantly lower levels of harmful constituents compared to over 97 percent of the smokeless products on the U.S. market.”

The FDA decision leaves open the possibility that other warning label changes could be approved for snus products eventually, or that Swedish Match could propose other ways of communicating the lower risks of the product, said Jim Solyst, Swedish Match’s vice president for federal regulatory affairs.

“I think there are various ways of looking at this decision,” Solyst said. “Certainly, there are positive elements to the correspondence we received from the FDA. They would like to continue the dialogue. They have given us more guidance as to what is possible.”

Some public health and tobacco-control groups opposed changing the warning labels on snus. For instance, during the FDA’s review of Swedish Match’s application, the American Dental Association urged the agency to make no changes to warning labels without more research on whether smokeless tobacco is “a gateway” to cigarette smoking.

The FDA is considering other applications for modified-risk tobacco products.

Earlier this month, tobacco company Philip Morris International said it submitted an application to the FDA to market a new type of cigarette that heats tobacco instead of burning it as potentially less harmful than conventional cigarettes.

If the product, called iQOS, gets clearance, Henrico County-based Altria Group Inc. — parent of top U.S. tobacco company Philip Morris USA — would have exclusive rights to sell it in the United States under a licensing agreement between the companies.

As pot becomes legal, head shops can drop the smoke screen

Dec 14th, 2016
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Of course it was for marijuana. All of it. The cheapo metal one-hitters that are supposed to look like a cigarette. The glass shelves lined with pocket vaporizers. The $175 Magic Butter machine. All of it.

https://www.bostonglobe.com/metro/2016/12/14/paraphernalia-shops-drop-smoke-screen/PrQgvhT4fBOoX18OoXJlzM/story.html

And at 12:01 a.m. on Thursday in Massachusetts, as recreational marijuana became legal, the shops that have been selling all this paraphernalia could finally end their long public wink, take down the “for tobacco use only” signs, and admit that their glass cases have always been filled with toys for getting high.

“I’m so sick of telling customers they can’t say bong, or marijuana. And I’ll be so glad to not have to say ‘tobacco’ anymore,” said Zelda Feinberg, throwing up huge, dramatic air quotes around the word “tobacco.” Feinberg is one of the cofounders of Buried Treasures, a “smoke shop” that has been pretending it had no idea what you were talking about with this weed stuff in various locations in Boston and Cambridge since 1983.

The “it’s for tobacco” deceit was a thin and often ludicrous charade carried out for decades by shops all over the state. With names like the Trippy Hippy, The Hempest, and Wild Side Smoke Shop, it’s unlikely anybody was fooled. But Massachusetts laws were clear — no sales of drug paraphernalia — and the penalties for violating them stiff, up to two years in prison or fines up to $5,000. So retailers strictly enforced the rules.

Customers who dared drop the “tobacco” ruse at her shop would usually get a warning, Feinberg said, and then the door. No talk of weed. And no using the “b word” — “bong just feels like a drug word,” Feinberg said. Customers were asked to call it a “water pipe” and pretend they were asking about the 4-foot, 4-inch chambered glass tower because they just weren’t getting enough out of their cigarettes.

“Now I don’t care what you call it. Call it a bong. Call it whatever you want,” said Feinberg, who said she stopped pretending about all of it after the ballot measure passed in November. For the first time in the shop’s 33-year history, they brought in apparel featuring the marijuana leaf. “Having that stuff in here feels like a big deal. We always had to be so careful.”

Upholding the “for tobacco use only” façade has always meant that it is somehow plausible that the product be usable for tobacco or some other legal pursuit. Could you use a glass pipe for tobacco? Most definitely. Could you eat a cookie made with tobacco butter? Technically, probably. Could you use the carbon-lined odor-absorbing messenger bag on sale at Buried Treasures for something other than transporting marijuana? Sure. Are there scenarios in which you’d want to disguise a cigarette by using a metal cigarette? Maybe so. And on and on. That has been the drill: Just pretend the items sold by the shop were for tobacco and everything was fine.

And now, well, it’s over. Right? Everyone can drop the act on Thursday? Just up the street from Buried Treasures in Allston, Richard Lamoretti, the owner of Fast Eddie’s Smoke Shop, still wasn’t ready to budge. “I’ve got a copy of the old laws around here somewhere,” he said, sifting through binders behind the counter. “The section on paraphernalia is like four pages long and whoever wrote it was good.”

He asked a Globe reporter to read him the new law, twice, which states that it is not a crime “for possessing, purchasing or otherwise obtaining or manufacturing marijuana accessories or for selling or otherwise transferring marijuana accessories to a person who is 21 years of age or older.”

His face continued to make clear that he was not sold.

“My current story is that this is all for tobacco use only,” he said.

On Thursday, would that change? Would he admit that nearly everything in his shop was for weed?

“You just told me that I can, right?” he asked, still with the suspicious face, triggering another assurance that no one here was a narc.

“I’ll tell you this, though,” he said finally. “We’re not going to have any huge jump in our business.”

And why is that?

“Because I don’t think we have many law-abiding citizens who have been sitting around waiting until it was legal to say the word bong.”

N.J. ranked worst in nation for trying to keep kids from smoking

Dec 14th, 2016
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For the fifth consecutive year, New Jersey will spend no money to deter kids from tobacco use or help smokers quit the habit, according to a public health advocacy organization which ranked the state last in the nation for its lack of effort.

http://www.nj.com/politics/index.ssf/2016/12/nj_tied_for_last_in_nation_for_its_efforts_to_keep.html

Cigarette smoking among middle schoolers and high schools has been on the decline in New Jersey and nationally for the last decade, according to recent surveys.

But by allocating no state funding to discourage tobacco use, New Jersey does nothing to prevent an estimated 11,800 deaths every year that can be directly attributed to smoking, according to the Tobacco Free Kids Campaign.

Meanwhile, New Jersey will take in $944.5 million in taxes and revenue from the 1998 settlement with the tobacco companies, Matthew L. Myers, President of the Campaign for Tobacco-Free Kids.

Young adults under 21 may continue buying tobacco and electronic cigarette products in New Jersey

“New Jersey is putting children’s health at risk and costing taxpayers money by refusing to fund tobacco prevention programs that save lives and health care dollars,” Myers said.

“Because of the tremendous progress our country has made in reducing smoking, it is within our reach to win the fight against tobacco and make the next generation tobacco-free,” Myers said. New Jersey should be doing everything it can to protect kids from tobacco, including raising the tobacco age to 21.”

Gov. Chris Christie vetoed legislation in January that would have raised the smoking age to 21. He did sign a smoking ban in state parks and beaches his year.

State Health Department spokeswoman Donna Leusner said smoking prevention and cessation programs exist in the state, but they are funded by the federal government.

The state uses $2.2 million in federal assistance to run NJ Quitline, 1-866-657-8677, a toll-free hotline and counseling service that offers nicotine replacement therapy such as gum and patches, she said.

The state also operates the Mom’s Quit Connection, linking pregnant women and new mothers who want to quit smoking with trained counselors, and an enforcement program that cracks down on vendors who sell cigarettes to minors 19 and younger.

The trends show smoking is on the decline, especially in New Jersey, Leusner said. “New Jersey’s youth smoking rate has been declining for a decade and is below the national average at 8.2 percent,” according to 2014 data, she said.

New Jersey’s adult smoking rate is well below the national average–15.1 percent vs. 18.1 percent, she added.

On Tuesday, a University of Michigan survey of about 45,000 middle-school and high-school students that found smoking rates have reach historic lows.

From 2015 to 2016, the percentage of youth who smoked in the past 30 days fell from 11.4 percent to 10.5 percent among 12th grader, from 6.3 percent to 4.9 percent among 10th graders, and from 3.6 percent to 2.6 percent among 8th graders, according to the University of Michigan’s Monitoring the Future survey.

New Jersey is tied for last with Connecticut for allocating the least amount of state funds to curb tobacco use, the campaign said.

High school vapers often become heavy smokers

Dec 14th, 2016
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Also worrisome: Teen vaping rates are skyrocketing, according to a new report by the U.S. Surgeon General’s office

https://www.sciencenewsforstudents.org/article/high-school-vapers-often-become-heavy-smokers

E-cigarette use grew an astounding 900 percent among high school students from 2011 to 2015. That’s according to a report by the U.S. Surgeon General’s office, released December 8. It highlights the harmful effects of e-cigarettes, especially to young people.

E-cigarettes first went on sale in the United States in 2007. Back then, companies advertised them as an aid to help adults give up smoking tobacco. But nonsmokers soon took up e-cigs too . Among them have been teens and even preteens. The Surgeon General’s report says the newly recognized drastic leap in e-cig use could lead many teens to try smoking.

And that would put a new generation of Americans at risk of nicotine addiction, says Thomas Wills. He works at the University of Hawaii at Manoa. He’s also an expert on teen smoking rates.

The Surgeon General’s report and other information about the health effects of e-cigarettes can be found at anew website: Know the Risks: E-cigarettes & Young People.

Two additional new studies back up what the Surgeon General’s office is saying. Both also shine some light on why teens choose to vape — and why some young vapers transition to smoking cigarettes.

Studies had shown that teens who vape are more likely to try cigarette smoking. And that’s disturbing because in the United States alone, the number of teen vapers nearly quadrupled between 2013 and 2015 — to more than 3 million. However, it has not been clear whether these kids who move on to tobacco “are just experimenting with smoking or whether they go on to become regular users,” says Adam Leventhal. He’s an addiction scientist at the University of Southern California, in Los Angeles.

The distinction is important, he says. Teens who become regular smokers during high school are more likely to develop a lifelong addiction to nicotine. According to the Surgeon General’s Report, nine out of 10 adult smokers tried their first cigarettes during adolescence.

To dig into why some teens make this transition, Leventhal and his colleagues recruited more than 3,000 Los Angeles-area 10th graders into a study. The students filled out surveys in the fall and spring. Those questions asked the teens about whether they had vaped or smoked. The researchers then looked at whether the answers had differed between early and late in the school year.

And indeed they did. Vaping seemed to up the likelihood that a teen would start smoking, these data showed.

The researchers broke students into groups, based on their answers in the fall to whether and how often they vaped. One group reported never vaping. A second group said they had tried vaping, but not within the past month. A third group reported vaping on one or two days in the past month. The last group said they had vaped even more than that in the last 30 days.

And the likelihood that a student smoked in the spring doubled in each successive group. For instance, by the spring, students who had previously tried vaping were about two times as likely to use cigarettes as were teens who had never vaped. Each jump to a group that vaped more frequently roughly doubled the likelihood that a student would report frequent, heavy cigarette smoking in the spring. (People who smoked cigarettes on three or more days in the past month were deemed frequent smokers. Lighting up two or more cigarettes on any day was considered heavy use.)

Leventhal’s group published its findings online November 8 in the Journal of the American Medical Association.

The share of teens in this study who reported vaping was slightly lower than the national average. One in three students in the study said they had ever tried vaping. That’s about 4 percentage points lower than the national average for 10th graders. Similarly, about 9 percent of the California kids surveyed said they had vaped in the past month. That’s 5 percentage points lower than the U.S. average 10th graders, according to a February 2016 report. It was conducted by researchers at the University of Michigan in Ann Arbor.

One reason for the lower vaping rate in California could be that kids there also are somewhat less likely to smoke than elsewhere in the country, notes Wills.

It still isn’t clear why some teens make the transition from vaping to smoking, he says. Young people who vape might learn to like the feeling of lighting up, holding a cigarette-like device or inhaling. These are behaviors that are common to both electronic and tobacco cigarettes. That might make it easier for teens to transition to tobacco cigarettes. It’s also possible that kids who use e-cigarettes are getting hooked on nicotine, says Wills. This is the chemical that makes tobacco smoking so addictive. It’s also found in most e-cig liquids.

More research is needed, Wills says, to probe the role of nicotine in teens’ transition from vaping to smoking.

The influence of ads

“Use of e-cigarettes has been rising exponentially among youth,” says Hongying Dai. “Little is known about the factors contributing to this rise,” she adds. Dai is an epidemiologist — a scientist who studies disease risk. She works at the University of Missouri-Kansas City. This researcher wondered whether the number of e-cig advertisements that kids see might affect how likely they were to vape. So she analyzed data from a national survey for clues that might confirm this.

More than 22,000 U.S. middle- and high-school students had filled out the survey about their smoking and vaping habits.

Compared to kids who rarely saw e-cig ads, those who saw them at least “sometimes” were much more likely to vape. Students who frequently ran into ads on the internet were about three times as likely to vape as were teens who reported never seeing such online ads. Kids who vaped also reported high exposure to e-cigarette ads in stores, newspapers and magazines, on TV and at the movies.

Family also seemed to play some role. Kids were more likely to vape if someone in their household used e-cigarettes, the researchers showed.

E-cigarette ads that target teens often portray vaping as glamorous or attractive, notes the Surgeon General’s report. Wills says the tobacco industry used these same tactics to encourage cigarette smoking by young people a generation ago.

Still, some questions remain. For instance, Dai asks, how accurately did the teens report encountering e-cigarette ads? And do all kids notice e-cig ads equally? Or are kids who vape just more likely to pay attention to vape ads?

Dai says she expected to see a link between ads and vaping. Tobacco advertising has been linked to increases in youth smoking rates, she notes. It therefore makes sense that exposure to e-cig advertising could affect teen vaping, she says.

Findings from the second study appear in the August Journal of Adolescent Health.

Do the right thing: Tax tobacco!

Dec 13th, 2016
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Both my grandfathers smoked when they were young. My father’s father was a shopkeeper who smoked a pipe and my mother’s father was a smallholder who smoked cigarettes. Both died of heart failure and left my grandmothers as widows. My father grew up as a little boy in an atmosphere of pipe smoke and sometimes I wonder whether this contributed to his asthma and his own heart problems. My mother became a doctor, a cancer specialist, and she always used to tell my brother and me that we should never smoke, because she saw every day what smoking had done to her patients.

http://blogs.worldbank.org/europeandcentralasia/do-right-thing-tax-tobacco

In Moldova, 87 percent of deaths are attributable to diseases associated with tobacco. I am not saying that tobacco caused them all, but these deaths are caused by diseases to which tobacco contributes. Also, in Moldova 43 percent of men smoke, while for women it is 5 percent. The worry is that nowadays a lot of the growth in smoking is among women.

It’s interesting that very many Moldovans begin to smoke when they are children. 30 percent of kids in class 8 or class 9 have already smoked a cigarette. And this is possible because smoking is so easy. It’s so cheap. It’s cheaper than buying a bottle of Coke or a chocolate bar. So obviously smoking is very attractive to young people in Moldova. We can discourage young people from beginning this dangerous and addictive habit by making cigarettes more expensive.

Smoking eats up 5 to 10 percent of the public health budget. That’s our estimate of the cost of treating diseases caused by smoking. The World Bank has looked at many scenarios of how raising tobacco taxes would increase Government revenues. Without going into details, it’s quite possible to raise at least an extra 1 percent of GDP.

So raising tobacco taxes could protect the lives of our children and grandchildren, save on health spending and raise revenues.

If somebody votes against increasing tobacco taxes, it could be for three reasons. Two of them are wrong. Only the third one is solid.

The first one is a fear that there might be political resistance to an increase in taxes. But anybody who opposes tobacco taxation for fear of the political resistance has to answer this question: “Can you find another way to improve the budget by at least one percent of GDP which would create less political resistance?” One could raise VAT or income tax, but that would be politically even more difficult than increasing tax on tobacco.

The second reason for opposition to an increase in tobacco taxes would be for fear of smuggling. We know about smuggling. We know how cigarettes enter Moldova through Transnistria. Maybe two or three years ago this argument would have been convincing. But now, Moldova and Ukraine have made significant progress in border cooperation and have monitoring systems which make this business much more difficult – if there is political will.

There is only one strong reason for opposing an increase in tobacco taxation. And that is because one is influenced by the tobacco lobby. The only real source of resistance to an increase in tobacco taxation is the tobacco industry. I therefore think that it is the obligation of anyone who blocks an increase in tobacco taxation to explain to the population why they are so opposed to it.

From a speech by Alex Kremer, World Bank Country Manager for Moldova, at Moldova’s parliament on 6 December 2016.

BAT Representative Letter on Graphic Health Warnings

Dec 13th, 2016
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Representative of BAT on Proposal to Change Graphic Health Warnings

Dec 13th, 2016
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Seven years of progress in tobacco control

Dec 12th, 2016
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“Findings In total, 88 countries adopted at least one highest level MPOWER policy between 2007 and 2014, resulting in almost 22 million fewer projected SADs. The largest number of future smoking attributable deaths (SADs) averted was due to increased cigarette taxes (7.0 million), followed by comprehensive smoke-free laws (5.4 million), large graphic health warnings (4.1 million), comprehensive marketing bans (3.8 million) and comprehensive cessation interventions (1.5 million).”

http://tobaccocontrol.bmj.com/content/early/2016/12/09/tobaccocontrol-2016-053381

Abstract

Objective

Since WHO released the package of six MPOWER measures to assist nations with implementing the WHO Framework Convention for Tobacco Control (FCTC), 88 countries adopted at least one highest level MPOWER measure. We estimated the subsequent reduction in smoking-related deaths from all new highest level measures adopted between 2007 and 2014.

Methods

Policy effect sizes based on previously validated SimSmoke models were applied to the number of smokers in each nation to determine the reduction in the number of smokers from policy adoption. On the basis of research that half of all smokers die from smoking, we derived the smoking-attributable deaths (SADs) averted of those smokers alive today.

Findings

In total, 88 countries adopted at least one highest level MPOWER policy between 2007 and 2014, resulting in almost 22 million fewer projected SADs. The largest number of future SADs averted was due to increased cigarette taxes (7.0 million), followed by comprehensive smoke-free laws (5.4 million), large graphic health warnings (4.1 million), comprehensive marketing bans (3.8 million) and comprehensive cessation interventions (1.5 million).

Conclusions

These findings demonstrate the immense public health impact of tobacco control policies adopted globally since the WHO-FCTC and highlight the importance of more countries adopting highest level MPOWER measures to reduce the global burden of tobacco use. Substantial additional progress could be made, especially if heavily populated nations with high smoking prevalence were to reach highest level MPOWER measures.

Parliament adopts Standardised packaging to save lives and prevent suffering

Dec 9th, 2016
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Members of Parliament voted in favour of standardised packaging of tobacco products despite intense lobbying by the tobacco industry to sway politicians against the measure.

http://www.smokefreepartnership.eu/partner-news/item/parliament-adopts-standardised-packaging-to-save-lives-and-prevent-suffering

The snowball that was set in motion in Australia in 2012 rolled through Norway today. An overwhelming majority of Parliament endorsed recommendations formulated on 1 December 2016 by the parliamentary Standing Committee on Health and Care Services. The measure will be introduced at the same time as the EU Tobacco Products Directive measures on packaging and labelling.

Tobacco advertising is deadly. It seeks to addict people to a product that kills almost half of its long-term users. Today, Norway becomes one of the first countries in the world to introduce standardised cigarette packs and the first country to standardise smokeless tobacco boxes. Smokeless tobacco use increased dramatically among young people in Norway during the last decade. The new measure will contribute to ensure that children and young people never start with tobacco and thus avoid tobacco-related suffering and death.

Anne Lise Ryel, Secretary General of the Norwegian Cancer Society said: “Norwegian politicians have taken a historic step forward to reduce the consequences of tobacco advertising. Advertising works, especially with children. Norway was the first country in the world to introduce bans on all traditional forms of advertising of tobacco products. Ever since, cigarette packs have become mini billboards for tobacco industry marketing. With this morning’s event, the tobacco industry loses its last vehicle to lure children into addiction, disease and possibly death. This is truly a ground-breaking public health reform, and a landmark day for the cancer cause”.

The Norwegian Cancer Society congratulated Minister of Health and Care Services Bent Høie for his leadership in support of the measure in the face of persistent pressure and campaigning from the tobacco industry.

UK public health experts move to quash e-cigarette fears in wake of US report

Dec 9th, 2016
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https://www.onmedica.com/newsarticle.aspx?id=be447bf6-8e2a-430a-9ba1-7783e5078bd8

UK public health experts have moved to quash fears about the potential dangers of e-cigarettes in the wake of the US Surgeon General’s report* setting out the urgent need to curb the rising popularity of vaping among young people in the US.

Clinicians should not be put off from helping smokers to quit or cut their risk of harm by switching to vaping, they insist.

In his report,* published earlier this week, Dr Vivek Murthy pointed to the evidence on the impact of nicotine on the developing brain, and its ability to trigger lifelong addiction, as well as the potentially harmful additives found in some e-cigarettes.

Use of e-cigarettes among high school students in the US had soared by 900% in the past five years, surpassing all other forms of conventional tobacco use, he said.
“We must protect our nation’s young people from a lifetime of nicotine addiction and associated problems by immediately addressing e-cigarettes as an urgent public health problem. Now is the time to take action,” he urged.

But Professor Kevin Fenton, national director of health and wellbeing at Public Health England, said that while he understood the concern about the rapid uptake of e-cigarettes in the US, attempts to regulate these products in the US had been difficult, and the situation in the UK was very different.

“We have comprehensive regulations in place, including a ban on selling e-cigarettes to under-18s and tough restrictions on advertising, as well as minimum standards for safety, maximum nicotine levels and health warnings on packs,” he said.

“Our review of the evidence found e-cigarette use carries a fraction of the risk of smoking, a conclusion reiterated by the Royal College of Physicians earlier this year. No new evidence has been published to contradict this, however we are closely monitoring any emerging evidence,” he added.

Professor Peter Hajek, Director of the Tobacco Dependence Research Unit at Queen Mary University of London (QMUL), reiterated the findings of the Royal College of Physicians report, which identified vaping “as a great public health opportunity,” rather than a threat.

“The new US report’s conclusions do not tally with what the actual data show. It is simply not true that e-cigarettes are a tobacco product or that vaping lures children to smoking or that it creates dependence in non-smokers,” he insisted.

“The prevalence of smoking among young people is at an all-time low and regular use of nicotine containing e-cigarettes among never-smokers is extremely rare. Ongoing vigilance is needed, but so far, e-cigarettes have acted as a gateway away from smoking, for adults and adolescents alike,” he continued.

The report also ignores the huge benefits of vaping for adult smokers in helping them switch from “deadly smoking,” he added.

“The worst part of the report is its policy recommendations. They may be well meant, but no consideration is given to their likely unintended consequences. Limiting smokers’ access to the much less risky option of vaping is likely to contribute to keeping smokers smoking and smoking-related disease and death going at the current rate,” he said.

Linda Bauld, Professor of Health Policy at the University of Stirling and Co-Chair of the Smoking in Pregnancy Challenge Group, said the evidence presented in the report on the potential harms of vaping during pregnancy had been fundamentally misunderstood, and was based on studies in rats and mice, not people.

“While we need more research on e-cigarettes, pregnant women who find it difficult to stop smoking should not be discouraged from using them. This is the position and current advice in the UK endorsed by a range of organisations,” she pointed out.

The Surgeon General’s report might make clinicians more hesitant about discussing e-cigarettes with pregnant women who smoke. “That would be harmful to maternal and child health and must be avoided,” she insisted.

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