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January 3rd, 2008:

Smoking in Cars Hazardous

Smoking in cars more hazardous than previously thought 2008-01-04 05:56:55

LOS ANGELES, Jan. 3 (Xinhua) — Smoking inside a vehicle is more dangerous to health than previously thought, health experts said on Thursday.

Smoking inside vehicles makes the air 10 times more toxic than the federal government says is hazardous for breathing, said Kimberly Belshe, secretary of the California Health and Human Services Agency.

She was making the remarks in downtown Los Angeles while launching a campaign to ban smoking inside cars.

The city of Los Angeles enacted a newly enacted state law unveiled on Thursday, which bans drivers from lighting up in the presence of children.

“Our efforts to address the dangers of secondhand smoke in California began over a decade ago,” said Belshe.

“Today, our state continues to be a leader by ensuring that children and youth traveling in cars are not exposed to secondhand smoke,” she said.

Under the “Smoke-free Cars with Minors” law, a violation is punishable by a 100-dollar fine.

Children who are exposed to secondhand smoke have a greater risk of asthma attacks, ear infections, bronchitis and pneumonia, according to state health officials.

Long-term exposure has been linked to heart disease and lung cancer in adults.

“Infants and children are especially susceptible to the harmful effects of secondhand smoke,” said Mark Horton, director of the California Department of Public Health.

“Smoking in a car, or any confined space, increases the level of pollution inhaled by children and adults, thereby increasing the likelihood of suffering from the negative health effects of secondhand smoke.”

In 1994, smoking was banned in California workplaces. Four years later, smoking was banned in bars.

Editor: Yan Liang

Electronic cigarettes go up in deep smoke

Thursday, January 3, 2008

Health Ministry suspends the sale of electronic cigarettes, which were imported into the country under the definition of pesticide. Experts dismiss claims that it is a ‘harmless’ way to quit smoking, arguing that it is just as addictive and harmful as regular cigarettes

ISTANBUL – Turkish Daily News

A sales suspension imposed on electronic cigarettes and its cartridges by the Health Ministry due to the high risk of addiction they pose and the possibility of them hampering with efforts to quit smoking has spurred huge debate.

Serious question marks are being raised about the popular anti-smoking device and why it has taken so long for the ministry to intervene.
Health Ministry Deputy Undersecretary Turan Buzgan, speaking at a press conference Tuesday, said the ministry had found that there were certain problems linked to the import of the electronic cigarettes. “They are imported as insecticide even though they need to enter the country as anti-smoking drugs, or if they are medical tools then under the supervision of the Health Ministry. There was a procedural discrepancy which we warned authorities about,” Buzgan said.

Electronic cigarettes, which first entered the Turkish market a year and a half ago, sell for between YTL 200 and 500, with replacement cartridges costing YTL 30-40.

Buzgan said the decision to suspend the sale of electronic cigarettes should not be seen as a step toward banning them, and added, “these products should abide by Health Ministry standards. They should be inspected and the necessary regulations will be passed. There is no ban on the sale or the import of these products.”

He said the nicotine content of the product had to be at an acceptable level, or else it could become an addictive substance.


Industry Minister Zafer Çağlayan, in a written statement regarding the suspension, said the product was currently being inspected and if there was a procedural deficiency, the product, which is sold both in pharmacies and other shops, may be confiscated nationwide.

He said investigation on the claims of deceiving consumers through electronic cigarettes will be assessed at the Advertising Council meeting
Jan. 15.

Causes cardiac disease and high blood pressure:

Health Ministry Drugs and Pharmacy Director Mahmut Tokaç said the electronic cigarettes could cause cardiac disease and high blood pressure due to its high nicotine content, just like regular cigarettes.

Tokaç said the product didn’t have any tar so may not be cancerous, but was just as harmful as regular cigarettes when it came to other diseases, the Anatolia news agency reported.

He said the advertisement that said electronic cigarettes were harmless is false, and added, “nicotine dosages in cartridges used in the cigarettes vary, but it is impossible to accurately adjust the dosage. There is nicotine in this product and it is seriously harmful to health.”

He said one firm had applied to them to get their approval but their application was rejected prior to sending a letter to the Industry Ministry
asking for a ban on the product.

Emphasizing that nicotine is the most dangerous element among 4,800 poisonous chemicals in cigarettes, the vice president of the Foundation Combating Smoking, Kıyas Güngör, argued nothing that contains nicotine can help people quit smoking. “Quitting smoking is possible only if one can stay away from nicotine, but these electronic cigarettes increase addiction,” he said, and added that he supports the Health Ministry’s sales suspension on these cigarettes.

“Apart from the other effects, electronic cigarettes that are used unconsciously is harmful for both the smoker and the people around,” said
Cerrahpaşa Medical Faculty, Pulmonary Diseases professor Ahmet Rasim Küçükusta.

He said the cigarettes contain nicotine, which is indeed a chemical used as an insecticide.

People who are impressed with electronic cigarette advertisements that introduce these cigarettes as “harmless” and smoke it are deceived; moreover they might suffer seriously, according to Küçükusta.

The professor said those who had quit smoking in the past could also be deceived into smoking once again by using electronic cigarettes.

Ankara University Public Health Department Professor, Recep Akdur, said the electronic cigarettes are being presented as a tool for giving up smoking but this claim has not been proved yet. “Presenting the e-cigarettes as a tool of quitting smoking is misleading and unethical,” he said.

Suspension welcomed:

National Tobacco Control Program Coordinator Professor Nazmi Bilir from Hacettepe University welcomed the suspension, noting that addiction to tobacco had two aspects. The addiction to nicotine and the behavioral addiction. “Use of electronic cigarettes entails both these addictions. The smoker both gets the nicotine and also lights and smokes a cigarette.”

He said electronic cigarettes were not an advancement in combating smoking but just the opposite.

Ruyan: There must be imitations:

One producer, Hong-Kong based Ruyan’s Turkey representative, Selahattin Aygüler, released a statement soon after the suspension saying his firm was the creator and sole licensed seller of electronic cigarettes, arguing that their success rate in getting customers to quit stood at 77 percent.

He said that the new suspension must have been aimed at stopping the sale of imitation products, which the firm itself had lodged complaints about.

“No such decision has been communicated to us. Electronic cigarettes are based on World Health Organization (WHO) approved nicotine treatment methods,” he said.

Aygüler said their electronic cigarettes locked themselves once the user puffed on it 16 times in a row. “Ruyan cartridges were tested and approved by Eskişehir Anatolia University. We are establishing an electronic cigarette cartridge factory in Turkey. This will earn Turkey $100 million.

Countries like Italy, Denmark, the Netherlands, Belgium and Germany, which have stringent controls, have told us they would like to purchase these products from us.”

Not so successful:

Writer Hayri Cem is one of those who tried to quit smoking using electronic cigarettes, but he was better at quitting electronic cigarettes than he was with regular cigarettes.

“I smoked electronic cigarettes for a week. It doesn’t make you feel like you are smoking, neither does it stop you from getting the urge to smoke,” Cem said.

He also noted that advertisements promoting the harmlessness of electronic cigarettes made him smoke even more of them. “There is no way that it can help quit smoking. You don’t get the sense of joy you get from smoking normal cigarettes either,” he added.

Electronic cigarette:

It is rod slightly longer than an ordinary cigarette, with a mouthpiece that contains a replaceable cartridge filled with liquid.

The liquid contains nicotine and propylene glycol. When air flows through the device, a microprocessor activates an atomizer, which injects tiny droplets of the liquid into the flowing air. This produces a vapor mist that is inhaled by the user. The addition of propylene glycol to the liquid makes the mist better resemble regular cigarette smoke. It not only simulates cigarette smoke but also the temperature of common cigarette’s smoke (50-60 degrees Celsius).

The units use a rechargeable battery as a power source. Energy produced by the battery is enough to heat the nicotine inside and produce smoke like regular cigarettes do.

Proposed Guidelines for the Implementation of Article 8

China (Hong Kong) has ratified the FCTC treaty, yet its requirements are not being enforced in Hong Kong.

The rationale for protection from exposure to tobacco smoke is clearly stated in Article 8.1 of the FCTC, in which Parties accept the overwhelming scientific consensus that second-hand smoke kills:

Parties recognize that scientific evidence has unequivocally established that exposure to tobacco smoke causes death, disease and disability.

In the time since the Convention was negotiated, the scientific consensus that exposure to tobacco smoke causes death, disease and disability has grown ever stronger, with the publication of important new expert reports, including those by the UK Scientific Committee on Tobacco or Health, 1 the US Surgeon General, 2 the French National Assembly, 3 the California Environmental Protection Agency,4 and others. These authorities further confirm that exposure to tobacco smoke causes a variety of illnesses, including fatal illnesses, in adults and children.

During this time, civil society has played a central role in educating opinion leaders, stakeholders and the general public in many countries about the hazards of exposure to tobacco smoke and the benefits of smoke-free legislation. Advocacy organizations, academic experts and institutions, medical associations and health professionals have all contributed to an ongoing transformation in the world’s understanding of this global problem. As the proposed guidelines acknowledge, civil society has a central role to play in building support for smoke-free measures, and must be an active partner in developing, implementing and enforcing legislation (Proposed guidelines, para 10).

Most importantly, since the negotiation of the FCTC, many national jurisdictions, including several States Parties, have adopted laws that provide almost universal protection against tobacco smoke in all indoor public places and indoor workplaces. The number of subnational jurisdictions with such laws has also grown quickly. Evidence surrounding the implementation of these laws shows a remarkably similar pattern. Smoke-free laws are effective. They are practical, workable, and economically beneficial. They are popular, enjoying exceptionally high levels of public support.

Read more on the Joint Briefing Paper: Proposed Guidelines for the Implementation of Article 8 of the WHO Framework Convention on Tobacco Control

Radioactive compounds

The radioactive compounds found in highest concentration in cigarette smoke are polonium-210 and potassium-40. Other radioactive compounds present include radium-226, radium-228 and thorium-228. Radioactive compounds are well established as carcinogens.(12)

From: James Middleton []
Sent: Thursday, January 03, 2008 14:49
Subject: – constituents of tobacco smoke are already classified as Toxic Air Contaminants by HK EPD

Hong Kong  EPD Report classifies many of the compounds present in tobacco smoke as TOXIC AIR POLLUTANTS

“Toxic Air Pollutants Monitoring Operation
The Air Science Group has installed in July 1997 additional monitoring facilities at the Tsuen Wan and Central/Western stations to measure regularly the levels of Toxic Air Pollutants (TAPs) in Hong Kong.

The TAPs being monitored can be broadly classified as volatile organic compounds (e.g.

benzene, perchloroethylene and


dioxins and furans (e.g.2,3,7,8-TCDF and 2,3,7,8-TCDD), carbonyl compounds (e.g.


polycyclic aromatic hydrocarbons (e.g. benzo(a)pyrene), and

hexavalent chromium.

Five distinct methods were used to analyse the collected samples for target TAPs (please refer to Table B4 for details).
All these methods have stringent QA/QC criteria to ensure the data quality. Sampling media used include stainless steel canisters, Sep-Pak cartridges, polyurethane foams and bicarbonate impregnated filters. TAP samples are analysed by the Government Laboratory.”

Table B4 Sampling and Analysis Methods Used in Measuring Toxic Air Pollutants (on Page B6)

5.1 Constituents of tobacco smoke

Unless otherwise noted, information in this section comes from reference 1.

Tobacco smoke is estimated to contain over four thousand compounds, many of which are pharmacologically active, toxic, mutagenic and carcinogenic. There are 43 known carcinogens in tobacco smoke.(2)

The following major components of tobacco smoke have been identified as most likely to cause disease:


‘Tar’ describes the particulate matter inhaled when the smoker draws on a lighted cigarette. Each particle is composed of a large variety of organic and inorganic chemicals consisting primarily of nitrogen, oxygen, hydrogen, carbon dioxide, carbon monoxide, and a wide range of volatile and semivolatile organic chemicals.(3) In its condensate form, tar is the sticky brown substance which can stain smokers’ fingers and teeth yellow brown. It also stains the lung tissue.

Among the carcinogens or tumour initiators present in cigarette smoke are two major classes of tumour initiators, polycyclic aromatic hydrocarbons (see above EPD TAC) and tobacco-specificnitrosamines. Benzo[a]pyrene, (see above EPD TAC) well established as a carcinogen, is a prominent polycyclic aromatic hydrocarbon found in tar.


Nicotine appears to be the most important acute-acting pharmacological agent in tobacco smoke, and is the drug in tobacco which causes addiction among smokers.(4) Its immediate physiological effects include increased heart rate and blood pressure, constriction of cutaneous blood vessels, and muscular, hormonal and metabolic effects.(4) With prolonged exposure, it may contribute, in combination with carbon monoxide, to increased platelet stickiness and aggregation and damage to the lining of the blood vessels, suggesting a potential role in causing coronary disease. It is also implicated in the causation of reproductive and gastrointestinal disorders.(4) Although nicotine does not appear to possess direct carcinogenic activity itself, it enables the formation of tobacco-specific nitrosamines, which are potent carcinogens.(4)

Nicotine is among the most toxic of all poisons and acts with great speed. The average lethal dose for an adult human is estimated to be between 30 to 60 milligrams (mg). Once relatively common due to its use in insecticides in the 1920s and 1930s, nicotine poisoning is less usual these days.(5) Dosages of nicotine obtained through tobacco smoking are far too low to cause acute poisoning, although there is a serious risk for children who ingest cigarettes (see also Chapter 3, Section 6). Before building up a tolerance to nicotine, the smoker may experience mild effects of nicotine toxicity.

Except where it occurs in tobacco products, nicotine is scheduled as a poison and its availability is controlled by the State Poisons Acts. Products containing nicotine for therapeutic (drug) use are categorised as Schedule 3 and 4 poisons. Included in these Schedules are nicotine chewing gum and transdermal nicotine patches, aids in breaking nicotine addiction. The gum is available in two dosages, in 2 mg and 4 mg of nicotine per gum piece. The 2 mg gum is available without prescription from pharmacists, and classified as a Schedule 3 product. The 4 mg gum, nicotine patches and other products containing nicotine and intended as aids in tobacco withdrawal, are categorised as Schedule 4 products and available on prescription from a medical practitioner. Advertising of Schedule 3 and 4 products is restricted to professional or trade journals, or in publications intended for circulation in the medical, dental, veterinary or pharmaceutical professions or the wholesale drug industry.

All other forms of nicotine (tobacco products excepted) come under Schedules 6 or 7, which apply to highly toxic agricultural, domestic and industrial poisons.(6,7)

It is ironic that except in the case of tobacco products, which are expressly manufactured for self-administration by humans at great loss of life, products containing nicotine are highly regulated.See Chapter 11 for further discussion about nicotine.

Carbon monoxide

Carbon monoxide (CO) is an odourless, tasteless gas, giving no warning of its presence in most circumstances.(8) In large amounts it is rapidly fatal.

CO is formed when a cigarette is lit. It has a number of toxic effects on the body, the most important of which is its impairment of oxygen transportation in the blood. As CO has a chemical affinity for haemoglobin over 200 times greater than that of oxygen, it binds preferentially with the haemoglobin, thereby reducing the amount of oxygenated blood circulated to body organs and tissues.(8)

CO is strongly linked with the development of coronary heart disease. It is thought that this might occur through interference with myocardial oxygenation, increasing platelet stickiness, or promotion of atherosclerosis. Although CO is not in itself a carcinogen, it may contribute to cancers and other diseases of the respiratory tract because of its inhibiting effect on the respiratory tract’s mucus clearance mechanism. Instead of being cleared away, toxic substances contained in cigarette smoke remain in the airways, causing inflammation and damage, impairing lung function, and increasing the likelihood of lung disease.(9) CO may also have a short term effect on vision(10,11) (see also Chapter 3, Section 6).

The factors that influence the CO yield of a given brand of cigarettes depend on the manufacturing process (for example porosity of the paper and filter ventilation) and therefore may vary independently of tar yield. The absorption of CO is more dependent on depth of inhalation than is the absorption of nicotine, and, if a change to lower tar products results in a compensatory increase in depth of inhalation (see Section 5.3 below), smoker exposure to CO may remain unchanged or actually increase compared to dosages from the higher tar brands.

Nitrogen oxides

Cigarette smoke contains oxides of nitrogen in relatively high levels. This gas is known to cause lung damage in experimental animals similar to that noted in smokers, and may be responsible for initiating lung damage leading to emphysema.

Hydrogen cyanide and other ciliatoxic agents

Hydrogen cyanide has a direct, deleterious effect on the cilia, part of the natural lung clearance mechanism in humans. Interference with this cleaning system can result in an accumulation of toxic agents in the lungs, thereby increasing the likelihood of developing disease.(3) Other toxic agents in cigarette smoke which directly affect the cilia include acrolein, ammonia, nitrogen dioxide and formaldehyde. (see above EPD TAC) (9)


Thirty metals have been detected in tobacco smoke, including nickel, arsenic, cadmium,(12)chromium and lead (see above EPD TAC) .(2) Arsenic and arsenic compounds and chromium and some chromium compounds are causally associated with cancer in humans, while nickel and cadmium and their compounds are probably carcinogenic to humans. Arsenic levels in tobacco have been elevated in the past due to the use of arsenical pesticides. Cadmium levels may be related to the presence of cadmium in phosphate fertilisers.(12)

Radioactive compounds

The radioactive compounds found in highest concentration in cigarette smoke are polonium-210 and potassium-40. Other radioactive compounds present include radium-226, radium-228 and thorium-228. Radioactive compounds are well established as carcinogens.(12)