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December 8th, 2016:

Know the Risks: E-cigarettes & Young People

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In Greece’s tobacco culture, passive smoke a serious problem

Nearly two-thirds of Greeks are inhaling someone else’s tobacco smoke on a daily basis, making Greece the worst nation in the European Union in exposing its people to the health risks of passive smoking.

The European Union’s statistical office Eurostat said Wednesday that 64.2 percent of Greeks suffered daily exposure to tobacco smoke indoors. Second in the EU is Croatia with 44.7 percent, followed by Bulgaria with 40.5 percent. At the other end, Sweden best protects its people from secondhand smoke with only 5.9 percent exposed, even better than Finland with 6.3 percent.

In a tally of EU smokers aged 15 and over, Bulgaria tops the rankings with 34.7 percent, ahead of Greece with 32.6 percent. Sweden only has 16.7 percent who smoke, with Britain the second-lowest with 17.2 percent.

Tobacco corporations target Africa’s children

Children in Africa have become a target for tobacco companies‚ research by the African Tobacco Control Alliance (ATCA) has found.

The survey looked at the way in which tobacco companies in five African countries– Burkina Faso‚ Cameroon‚ Benin and Nigeria – get consumers to keep using their product.

It found tobacco use caused about six million deaths yearly‚ with 80% of them occurring in low- and middle-income countries.

Findings show that in Africa‚ smoking prevalence is about 21% among adult men and 3% among women.

About 21% of young boys and 13% of young girls use tobacco products.

“The aggressive sale and marketing strategies of the tobacco industry targeting young people will be among the key contributing factors to the growing epidemic of tobacco use in Africa‚” the report said.

Four strategies were identified as being used to lure children to smoke‚ a concern that was highlighted at the launch of the report in Johannesburg recently.

Advertising and promotion, the sale of single cigarettes, child-friendly flavoured cigarettes and noncompliance with existing tobacco control laws were the main causes for an increase in young children’s interest in smoking.

Sales of single cigarettes were found to be widespread near schools.

Swiss parliament rejects tobacco advertising ban

According to a study published by the Swiss federal office of public health last December1, two thirds of the Swiss public were in favour of banning tobacco advertising, everywhere except at the point of sale. 58% were even in favour of a blanket ban, while one in six wanted to see cigarette price increases. Switzerland’s parliament does not appear to share this view.

A plan put forward by Federal Councillor Alain Berset to restrict tobacco advertising was rejected by parliament today by 101 votes to 75. Those against the plan think it went too far and said there was nothing that proved that banning advertising would reduce tobacco consumption. In addition, they thought a federal ban limited the power of cantons to introduce stricter rules.

A 2013 World Health Organisation report2 said “complete bans on tobacco advertising, promotion and sponsorship decrease tobacco use”. The WHO report also said that the best estimate is that the tobacco industry spends tens of billions of US dollars worldwide each year on tobacco advertising, promotion and sponsorship. In the United States alone, the tobacco industry spends more than US$ 10 billion annually.

Berset’s proposed rules would have banned advertising in public spaces, in cinemas, in the press and on the internet. Distribution of free samples and some promotional price reductions would have also been banned. According to a WHO report these practices are banned in Spain, France, Sweden, Holland, Portugal, the UK and a number of other European countries, but not Switzerland.

Corine Kibora, spokesperson for Addiction Suisse described parliament’s decision as “disappointing” and “proof that the arguments of lobbyists and the economy triumphed over the public’s health”, while adding that as the trend towards favouring individual choice over collective responsibility takes over we seem to have forgotten the central point: business and advertisers are driven to make sales.

According to Swiss federal office of public health, Swiss smokers dropped from 33% of the population in 2001 to 25% in 2015. However, since 2011, the number of smokers has stayed stubbornly high. In addition, it calculates the annual cost of tobacco at tens of billions of francs per year of which CHF 1.7 billion goes on medical treatments and CHF 3.9 billion on compensation for work absenteeism and invalidity. On the other hand, tobacco tax only brings in CHF 2 billion annually.

Surgeon General calls youth vaping a public health threat

E-cigarette use among young people is a major health concern, according to a new report from the U.S. Surgeon General on Thursday.

Surgeon General Vivek Murthy said in the report that not enough research has been conducted to prove that use of e-cigarettes among youth are harmless.

“E-cigarettes went from being rare in 2010 to being the most common tobacco product used by our nation’s youth,” Murthy said during a press conference. “This represents a staggering development in a relatively short period of time, and it threatens 50 years of hard-fought progress we have made curbing tobacco use and puts a new generation at risk for … addiction.”

According to the U.S. Centers for Disease Control and Prevention, e-cigarette use among high school students rose from 1.5% in 2011 to 16% in 2015. Federal health officials estimate that about 3 million middle and high school students use e-cigarettes.

The potential safety of e-cigarettes, devices that heat a liquid consisting of nicotine, flavorings and other chemicals to create a vapor, is hotly debated. Unlike traditional cigarettes, e-cigarettes do not contain tar or other chemicals generated by the combustion of tobacco that are responsible for harmful tobacco-related diseases. Proponents of e-cigarettes say they are a safer alternative to traditional cigarettes and can help people quit smoking.

Nicotine is harmful to the developing brain regardless of whether it’s smoked through a traditional cigarette or an e-cigarette, Benard Dreyer, President of American Academy of Pediatrics, said during the press conference.

“Nicotine… regardless of its source is highly addictive and has clear neurotoxic effects especially on the developing brains of adolescent and even into early adulthood,” Dryer said.

For years, e-cigarettes have been largely unregulated, with many consumers unaware of what chemicals are used in their e-cigarette products. In May, the Food and Drug Administration released a rule that requires electronic cigarettes to be regulated much like tobacco cigarettes. The rule requires nearly every e-cigarette on the market — and every different flavor and nicotine level — to submit a separate application for federal approval.

While many may believe that e-cigarettes emit a harmless aerosol, that’s not the case, Dreyer said.

“Aerosol from e-cigarettes is not harmless, it includes nicotine and other potentially harmful chemicals including heavy metals and carcinogens,” Dreyer said, adding that second-hand inhalation should also be avoided. “Because there is no safe level of exposure, it is extremely important to protect children from these.”

E-cigarette use threatens years of US anti-smoking gains, says report

Top US health officials have war ned that the gr owing use of e-cigarettes among young adults will undo decades of pr ogr ess in ending the ‘tobacco epidemic’

Growing e-cigarette use among young people threatens decades of progress in shrinking tobacco use, top US health officials warned in a report released on Thursday.

The US surgeon general’s report is the first federal government review of the public health impact of e-cigarettes on young people across the country.

“Preventing tobacco use in any form among youth and young adults is critical to ending the tobacco epidemic in the United States,” said surgeon general Vivek Murthy.

E-cigarettes don’t contain tobacco, but do contain nicotine and are considered “tobacco products” by the US government.

Advocates say e-cigarettes could replace traditional cigarettes, while critics are concerned they are a gateway to tobacco use – especially in young people, who are more vulnerable to the addictive impact of nicotine.

The debate over the potential harms and benefits of e-cigarettes is a live one in the US and the UK. Many public health professionals in the UK believe that vaping is the best available option for those who would otherwise smoke tobacco, and that it is saving thousands of lives by enabling hardened smokers to quit. Public Health England has said it is 95% safer, and that the young people experimenting with e-cigarettes are the same people who try smoking tobacco.

“Evidence from the US is the same as in the UK in crucial respects,” said Professor John Britton, director of the UK Centre for Tobacco and Alcohol Studies at Nottingham University. “Children experimenting with e-cigarettes are by and large those who are already experimenting with cigarettes or are smokers.”

The surgeon general’s report said e-cigarettes are the most commonly used tobacco product among the young and are more popular than cigarettes, cigars and hookahs in the US. The use of e-cigarettes and other nicotine products by under-18s has jumped significantly after decades of declining rates of cigarette smoking.

Young people are not using the products for the same reasons as adults, the report said: “Although adults report using e-cigarettes as a cessation device, the evidence supporting the effectiveness of e-cigarettes as an aid for quitting conventional cigarettes remains unproven and nonexistent among youth.”

The most common reasons for young people to use e-cigarettes are curiosity, to avoid indoor smoking restrictions and as a less harmful alternative to conventional cigarettes, according to the report.

In 2014, use of e-cigarettes by young adults aged 18 to 24 surpassed that of adults aged 25 and older.

Sylvia Burwell, the US Department of Health and Human Services secretary, said the US must ensure progress in combatting traditional cigarette use isn’t compromised by the use of new tobacco products like e-cigarettes.

“The findings from this report reinforce the need to support evidence-based programs to prevent youth and young adults from using tobacco in any form, including e-cigarettes,” Burwell wrote. “The health and wellbeing of our nation’s young people depend on it.”

Kevin Fenton, national director of health and wellbeing at Public Health England, said the group recognised the concern in the US, where it had proved difficult to impose restrictions on the marketing of e-cigarettes. By contrast, England had put in place a ban on marketing to under-18s, advertising controls and quality standards. But, 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.”

The US report’s findings pull from existing research on e-cigarette use among people aged between 11 and 24 to show patterns of use and how it affects health.

This report was crafted in a similar vein to earlier surgeon general reports on youth tobacco use. The most recent of those was released in 2012, when e-cigarettes were less popular than they are now.

E-cigarette sales in the US grew to an estimated $3.5bn in 2015, according to Nielsen, but have been falling significantly since the end of last year.

The e-cigarette industry is dominated by traditional tobacco companies, who were targeted in the report for using similar tactics as those used to lure young users to tobacco. “Companies are promoting their products through television and radio advertisements that use celebrities, sexual content, and claims of independence to glamorize these addictive products and make them appealing to young people,” said Centers for Disease Control and Prevention director, Thomas Frieden, in the report’s foreword.

The report concludes with recommendations for combatting e-cigarette use among young people, including incorporating e-cigarettes into smoke-free policies, preventing youth access to e-cigarettes and significant increases to taxes and prices affiliated with e-cigarettes.

Murthy said: “Preventing tobacco use in any form among youth and young adults is critical to ending the tobacco epidemic in the United States.”

The report was launched on Thursday morning in Washington DC at an event where the surgeon general unveiled a new e-cigarette website and public service announcement. Speakers included Murthy, 16-year-old health activist Tyra Nicolay and American Academy of Pediatrics president Benard Dreyer.

Tyra, a member of the Navajo Nation, described how she was first introduced to e-cigarettes with a sour green apple flavored product but has since quit using e-cigarettes.

“Today, I call on my peers to reject tobacco products, including e-cigarettes,” she said.

Dreyer said e-cigarette use “has raised alarm among pediatricians, tremendously”.

In October 2015, the AAP issued recommendations for e-cigarette public policy and regulations and guidance for physicians on how to speak with families about tobacco and “nicotine delivery devices” such as e-cigarettes.

“That’s why this report is so necessary and welcome at this time,” Dreyer said. “Because as you’ve heard, e-cigarettes have the potential to addict the next generation of children. It’s a major public health crisis, as far as we’re concerned.”

The British campaigning organisation Action on Smoking and Health said it was puzzled by the surgeon general’s concerns. “In the US as in the UK, young people are experimenting with e-cigarettes but vaping has not been associated with an increase in smoking, a point which is not made sufficiently clear in the report,” it said.

“While nicotine is not completely harmless, it is smoking that is lethal. In the UK we have a regulatory system that restricts advertising and controls sales to young people.

There is no evidence of significant regular use by nonsmoking children and, as in the US, smoking rates are going down, not up.”

Britton, the Nottingham University academic, attributed a drop in the UK smoking rate, down three percentage points in three years, to people taking up e-cigarettes in order to quit. “It is falling fast in the UK, almost certainly related to e-cigarettes.”