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August 24th, 2015:

Customs seize 920,000 illegal cigarettes in Tin Shui Wai sting

By Coconuts Hong Kong August 24, 2015

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Customs officers broke up a suspected illegal cigarette distribution ring in Tin Shui Wai on Saturday, arresting a 33-year-old man and seizing 920,000 cigarettes.

The goods are worth about HKD2.48 million, and would have given the government HKD1.75 million in tax revenue had they been sold legally.

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Customs suspected that a syndicate was using lorries to distribute illegal cigarettes to peddlers in Tin Shui Wai and Yuen Long.

The authorities believe that this particular syndicate has now been “neutralised”.

Anyone caught dealing with, selling, or buying illicit cigarettes are liable to a fine of HKD1 million and two years in prison.

Tobacco bills fast-tracked to Senate floor

A package of anti-tobacco bills, including one raising the smoking age to 21, was fast-tracked to the Senate floor by the chamber’s Appropriations Committee on Monday.

Some of the bills have costs to the state that normally would have required them to be placed in the suspense file, where they would receive more detailed analysis of the financial implications.

However, Sen. Ricardo Lara (D-Bell Gardens), the committee’s chairman, persuaded the panel to send them all on to the full Senate because they are part of a special session called by the governor on health issues and some had been approved by the Senate during the regular session.

“We want to move all of these bills to the floor as a package to continue the deliberation during the special-session discussion,” Lara said.

Sen. Pat Bates (R-Laguna Niguel) objected to giving the bills special treatment. “We believe that the public has a right to have some time to deliberate rather than going directly to the floor,” said Bates, the committee’s vice chairwoman.

The bills would

-regulate electronic cigarettes the same way regular smoking is restricted in public places,
-bar smoking on all school campuses,
-allow counties to seek voter approval of local tobacco taxes, and
-raise the smoking age from 18 to 21.

Sen. Ed Hernandez (D-West Covina) said he drew up the latter bill because most smokers start before they are 21. “By targeting this population, this bill seeks to stop our youth from experimenting with this addictive and deadly drug,” Hernandez told the panel.

Clashing Views on E-Cigarettes

A British government agency has issued a bullish assessment of the value of electronic cigarettes in helping people to quit smoking. It found that e-cigarettes can reduce the health risks of smoking by 95 percent because they deliver nicotine to satisfy an addiction, but far fewer harmful chemicals than regular cigarettes. It also found little evidence that large numbers of consumers who had never smoked were taking up e-cigarettes. That seemed to challenge the notion that e-cigarettes would be a gateway to more dangerous products.

But the study is hardly definitive; experts in America have drawn different conclusions on usage and on the gateway issue.

The British assessment, commissioned by Public Health England and conducted by academic experts, was cautious in its claims. It noted that the best results are obtained when e-cigarettes are used in combination with professional counseling and smoking-cessation medication.

In the United States, according to the Campaign for Tobacco-Free Kids, e-cigarette use by young people has grown more rapidly than in Britain. The user population includes many children who have never smoked and thus may be vulnerable to being hooked by nicotine and later moving to traditional cigarettes.

By coincidence, a day before the British study was issued, a study tracking more than 2,500 students at 10 Los Angeles schools who had never smoked tobacco, published in the Journal of the American Medical Association, came to the opposite conclusion. It said ninth graders who had tried e-cigarettes were far more likely than other students to start smoking “combustible tobacco” (cigarettes, cigars, hookahs) within a year.

Strong regulation is needed in Europe and the United States to protect young people from advertising and promotions designed to lure them into trying e-cigarettes and perhaps getting hooked on them. America’s Food and Drug Administration needs to issue rules it proposed last year and make them even stronger by banning flavors that appeal to youngsters.

Warrington pub boss fined over smoking ban

A Warrington pub boss has been fined £400 and ordered to pay costs of £725 after admitting failing to stop people smoking in the Cheshire Cheese pub in Latchford.

Denise Cooke was found guilty by Warrington Magistrates Court on Wednesday 19 August for breaching the smoke free rules under the Health Act 2006.

The prosecution was brought by Warrington Borough Council’s regulatory services following the recovery of CCTV evidence from the pub by Cheshire Constabulary.

The CCTV footage from 16 March 2015 revealed Cooke smoking behind the bar while serving customers who were sat at the bar and were also smoking.

Peter Astley MBE, assistant director for regulation and public protection, said: “The smoke free legislation under the Health Act 2007 has been in force since 1 July 2007. Ms Cooke had received previous advisory visits from officers to ensure she fully understood the smoke free rules.

“The legislation was designed to improve the health of those previously at risk from second hand smoke particularly those working in premises like pubs. If you breathe in second hand smoke you are exposed to over 4000 chemical gases and particles, some of which are proven harmful and dangerous poisons.

“This legislation is very popular with those who work in and frequent, pubs and other public spaces due to the health and other benefits and it is inevitable that we will find out very quickly when these laws are being flaunted.”

E-cigarettes just as dangerous

KUALA LUMPUR: Anti-tobacco advocates have called on the Health Ministry to ban e-cigarettes (e-cig) and e-liquids to prevent nicotine addiction among the younger generation.

Universiti Putra Malaysia’s senior consultant of public health medicine Professor Dr Lekhraj Rampal said the increase in e-cig users among adolescents and youth in Malaysia was a critical issue.

“A study overseas revealed that among adolescents, non-smokers who used e-cig showed more willingness to smoke cigarettes compared with those who had never used any tobacco product,” he told the New Straits Times.

He said a Dutch research showed that as well as nicotine, the potentially harmful substances in e-cigs included propylene glycol, glycerol, aldehydes, nitrosamines and metals, which when inhaled, could lead to irritation and damage to the respiratory tract, heart palpitations and increased risk of cancer.

He said propylene glycol was used to produce smoke, or vape, and the process of heating the substance at a voltage of more than five volts would produce formaldehyde, which was carcinogenic or cancer causing.

“Most vaporisers will use 10 to 12 volts to get more vape or smoke. The Dutch study showed that in some cases, the quantity of nicotine in the vapour was not in line with the breakdown on the packaging. In others, the concentrations of some substances were higher in the vapour than in the fluid.

“This substance will give the same or worse effect to people surrounding them. In addition, there are not many studies to prove that other volatile substances are not produced during vaping.”

Dr Lekhraj urged Malaysians not to jump to the conclusion that vaping was safer than smoking cigarettes, and wait for a directive from the World Health Organisation (WHO).

University Malaya Centre of Addiction Sciences addiction medicine specialist Associate Professor Dr Amer Siddiq Amer Nordin said e-cigs were not approved as quit-smoking aids in most countries.

“Without regulation at present, users are using these devices at their own risk. There is no control on quality of devices or more importantly the e-liquid used. Also, nicotine is a Group C Poison under the Poison Act 1952,” he said.

Malaysian Green Lung Association co-founder and president Ho Rhu Yann said if nicotine patches or gum were listed as Group C Poison, e-cigs should also be the same.

A Bernama report said a study on e-cigarette addiction conducted by the Institute of Respiratory Medicine (IPR) since 2013 was expected to be completed next year.

According to IPR’s senior medical consultant Professor Datuk Dr Abdul Razak Abdul Muttalif, the research, currently in the preliminary epidemiology stage, required more time to study.

“The e-cig issue is controversial, and there are pros and cons. We have to wait for the outcome and will also obtain information from WHO, which may take a long time, the latest by next year.”

Razak said e-cig smokers might experience acute effects, such as coughing and tiredness.

Bill to raise minimum tobacco purchase age to 21

The Health Ministry plans to raise the minimum age for purchasing tobacco from 18 to 21 and ban displays of the products in shops, the New Straits Times said.

Smoking in vehicles with children as passengers also would be part of the legislation, the newspaper said on its website. A ministry spokesperson was quoted as saying the ministry has had a tobacco act ready for submission to Parliament since 2009, but unnamed factors prevented submission until this year.

E-cigarettes and health — here’s what the evidence actually says

Stepping into the health debate around electronic cigarettes is a messy and frustrating exercise. Depending on whom you ask, these devices are either the best technological solution to the smoking pandemic or the biggest looming threat to public health.

So to sort through the research and figure out whether e-cigarettes are actually safe, I read through more than 60 studies, articles, and reviews, and interviewed nine researchers and health experts about their work.

The bottom line

What we know:

E-cigarettes are probably better for you than conventional cigarettes, but worse for your health than not smoking or vaping at all.

What we don’t know:

What the long-term health effects of e-cigarettes are, whether they actually help people quit smoking, and how they’ll affect the use of other nicotine products.

What it means for you:

If you’re a chronic smoker, e-cigarettes could be a less destructive way to get your nicotine fix. If you don’t currently smoke at all, stay away from vaping; we still have no idea about its long-term health impact.

This is the first installment of Show Me the Evidence, where we go beyond the frenzy of daily headlines to take a deeper look at the state of science around the most pressing health questions of the day.

Here’s the bottom line: If you’re a chronic smoker looking for a nicotine fix and trying to decide between smoking and vaping, most experts would agree there’s a compelling case that e-cigarettes are less harmful.

But a nonsmoker, or an ex-smoker, should think twice before taking up the habit. Even if e-cigarettes are safer than regular cigarettes, that doesn’t mean they’re totally safe. At this point, we just don’t know. There have been no published long-term studies on the health of e-cigarette users, so the impact of vaping on the body over many years or decades is completely unknown. There are about 500 e-cigarette brands and more than 7,000 flavors on the market, and they work in different ways, delivering varying amounts of nicotine, toxins, and carcinogens. This means it’s hard to say anything concrete about the safety and health impact of all devices based on the research we do have.

Many of the studies out there are also limited in scope or flawed and biased by design. Adding to the uncertainty, in as many as one-third of e-cigarette studies, the authors have declared a conflict of interest, raising questions about bias.

This uncertainty has the research community divided. On one side, there are tobacco-control researchers who have spent their entire careers exposing the evils of the tobacco industry and view e-cigarettes in a negative light almost by default. There are also public health researchers who take a “zero-risk” approach and believe that, given the unknowns, these devices should not be tolerated. Many of these folks remember that it took decades for the tobacco industry to admit to the harms smoking caused, and that until very recently it falsely claimed “light” or “mild” cigarettes were a healthy alternative.

On the other side, there are researchers who view e-cigarettes more favorably for their harm-reduction potential. They think these devices could save the lives of millions of people. For now, researchers and industry representatives are either unlikely bedfellows in a harm-reduction game plan or at odds over the best way forward.

What is the state of the science on e-cigarettes?

The state of the science, in short, is crap. Many of the studies don’t pass basic tests of methodological rigor. There are only two published randomized control trials — considered the gold standard of scientific evidence — on e-cigarettes (this one and this one).

Worse, many of them may be hopelessly corrupted by industry money or bias.

Consider the conclusion of one of the most recent systematic reviews on e-cigarettes (which, unlike some of the others, was not supported by industry funding). This review, published in the American Journal of Preventive Medicine in 2014, looked at 76 of the best available studies on e-cigarettes:

“Due to many methodological problems, severe conflicts of interest, the relatively few and often small studies, the inconsistencies and contradictions in results, and the lack of long-term follow-up no firm conclusions can be drawn on the safety of [e-cigarettes].”

“Most studies were funded or otherwise supported/influenced by manufacturers of e-cigarettes”

The researchers also found that in 26 of the studies reviewed, the authors had declared a conflict of interest. They wrote: “Most studies were funded or otherwise upported/influenced by manufacturers of [e-cigarettes], but several authors had also been consultants for manufacturers of medicinal smoking cessation therapy.”

When I asked one of the review’s authors, Martin Døssing, what he made of the current evidence base on e-cigarettes, he said, “The literature is very poor.” He continued:

“The most worrying aspect of e-cigarettes is that we do not know the long-term health consequences of daily use. Will e-cigarette users come up with unsuspected diseases such as cancers in 10 or 20 years from the start of use 10 years ago? Substances known to be carcinogenic to man have been found in a few brands of e-cigarettes.”
One of the great complexities of research in this area is the fact that e-cigarettes types vary so widely. “What is an e-cigarette?” asks Judith Prochaska, a professor at Stanford’s prevention research center, rhetorically. The devices can hold a wide range of flavors and chemicals, they burn and deliver nicotine differently, and their technology is advancing fast. It’s hard to know whether findings of studies are generalizable at all.

But perhaps the biggest complication is that e-cigarettes are extremely new — and so the most important research hasn’t had time to be conducted. The first peer-reviewed studies only started emerging in 2010, meaning we are still far from the kind of scientific certainty that can give clues about the effects of e-cigarettes over decades.

How do e-cigarettes work?

These battery-powered devices deliver nicotine to the user through a vapor by heating a solution of propylene glycol or vegetable glycerin, flavoring, and other additives. Flavors range from butter rum to caramel macchiato to strawberry lemonade.

E-cigarettes have become increasingly popular in recent years. In 2015, the Centers for Disease Control and Prevention (CDC) reported that the use of e-cigarette devices among middle school and high school students tripled between 2013 and 2014. That means about 13 percent of students now use them — outstripping the number who smoke conventional cigarettes. By 2017, sales of e-cigarettes in the US are expected to surpass those of conventional cigarettes, reaching $10 billion. The three major tobacco companies, through their buying up of small e-cigarette companies, could share 75 percent of these profits over the next 10 years.

The major appeal of e-cigarettes is that they don’t contain tobacco and the exhaled vapor carries no harmful smoke, tar, or carbon monoxide. They also seem to have significantly fewer toxins and carcinogens than regular cigarettes.

Key question #1: How dangerous are e-cigarettes?

We don’t actually know. As an American Heart Association review on e-cigarettes states: “In general, the health effects of e-cigarettes have not been well studied, and the potential harm incurred by long-term use of these devices remains completely unknown.”

Key studies:

The science around e-cigarettes is still fairly new, but here are some of the key studies to date.

2010: Tobacco Control — “Effect of an electronic nicotine delivery device (e cigarette) on desire to smoke and withdrawal, user preferences and nicotine delivery”: The first peer-reviewed e-cigarette study, which showed that the devices can deliver nicotine and possibly reduce withdrawal from regular smoking.

2011: BMJ — “Electronic cigarettes as a method of tobacco control”: Makes the case that these devices can be used as a harm-reduction tool.

2013: The Lancet — “Electronic cigarettes for smoking cessation”: The first randomized trial of e-cigarettes, which showed the devices “were modestly effective” at helping smokers quit, and worked about as well as nicotine patches. (This study was done on early and now out-of-date devices, and had some serious limitations.)

2013: Tobacco Control — “Levels of selected carcinogens and toxicants in vapour from electronic cigarettes”: Researchers compared the levels of toxicants and carcinogens in e-cigarette vapor with tobacco cigarettes. They found they were nine to 450 times less prevalent than in conventional cigarette smoke.

2013: Psychopharmacology — “Acute electronic cigarette use: nicotine delivery and subjective effects in regular users”: This study found there are big individual differences in nicotine levels among e-cigarette users, even when they all vape on the same device.

2014: Tobacco Control — “Four hundred and sixty brands of e-cigarettes and counting: implications for product regulation”: This study found that by January 2014, there were 466 brands and 7,764 unique flavors, making studying and regulating these devices a complex matter.

2015: Morbidity and Mortality Weekly Report — “Tobacco Use Among Middle and High School Students”: The use of e-cigarette devices among middle school and high school students tripled between 2013 and 2014. That means about 13 percent of students now use them — outstripping the number who smoke conventional cigarettes.

Based on the science so far, short-term exposure to e-cigarettes doesn’t appear to carry serious and immediate health effects. As the AHA points out, “The data on health effects to date, studied primarily in healthy people with short-term exposure, reveal little or no evidence of severe adverse events. Respiratory irritation and the bronchial constriction from a propylene glycol aerosol raise concerns about harm to people with asthma and chronic obstructive pulmonary disease, but one small study reports no harm but rather benefit when users quit smoking or smoke fewer cigarettes per day.”

Keep in mind, however, that the research here is still early, and this conclusion on e-cigarettes could change once tens of thousands of people — and not just dozens or hundreds — have been studied.

Bigger questions center on the toxicity of e-cigarette’s aerosol and liquids — and their potential long-term effects. Maciej Goniewicz, of Roswell Park Cancer Institute, is one of the leading researchers in this area. In one study, he looked at 12 brands of e-cigarettes and found that their vapors were mostly composed of nicotine and a nicotine solvent (propylene glycol or vegetable glycerin). Also, the levels of toxicants and carcinogens in e-cigarette vapor were nine to 450 times less prevalent than in conventional cigarette smoke.

Though propylene glycol and glycerin are generally considered safe substances, not a lot is known about the long-term effects of daily inhalation, Goniewicz says. There’s some evidence from theater settings — in which propylene glycol has been used to create fog — that suggests it can be a lung irritant. Goniewicz has also found toxic substances and cancer-causing compounds, such as formaldehyde and acetaldehyde, in e-cigarettes.

Reasons for concern have popped up elsewhere — though, again, nothing conclusive yet. Some research has shown that cells exposed to e-cigarette vapor showed similar genetic changes as cells exposed to conventional cigarette smoke — raising concerns that e-cigarettes could potentially lead to lung cancer.

One big problem here: E-cigarette products vary widely, making them tough to study. “Some had a higher presence of the toxicants, while other products have very low levels or even undetectable levels of toxicants,” Goniewicz said. What’s more, research shows that the heating process in e-cigarettes can change the composition of potentially harmful chemicals. “If the temperature goes too high, then there are more toxicants,” he warned.

Chris Bullen, an e-cigarette researcher and professor at the University of Auckland’s school of public health, noted that newer electronic cigarettes use a heating control mechanism that prevents “cooking” the e-liquid, and reduces the risk of generating harmful aldehydes. He cautioned about drawing conclusions from older studies that may be based on out-of-date technology. But he also added that there’s a lot of inconsistency in manufacturing quality: “Backyard operators” who make e-cigs may run the risk of contamination.

“Then there are the flavors,” he added. “Very little is known about what happens with these when heated and inhaled for weeks, months or years.”

Key question #2: Are e-cigarettes safer than regular cigarettes?

There are nearly 500 brands and more than 7,000 flavors of e-cigs. (Shutterstock)

Most researchers cautiously lean toward “yes” — despite the unknowns.

Because the immediate harms of e-cigarettes appear to be minimal compared with regular cigarettes, many researchers agree that there’s a compelling case to be made for e-cigarettes as a harm-reduction tool for heavy smokers, at least in the short term. (That was the conclusion of an August 2015 Public Health England review of the evidence, which estimated that e-cigarettes are “95 pecent less harmful” than regular cigarettes.)

The tougher question is how the long-term impacts of e-cigarettes compare to the long-term impacts of smoking. “It’s probably fair to say that a long-term e-cigarette user is not going to die from tobacco-caused disease,” says Thomas Eissenberg, co-director of the Center for the Study of Tobacco Products. “But it’s not clear whether they’ll die from an e-cigarette-caused disease and whether their rates of death will be less than, more than, or the same as the rates of death we see from tobacco-caused diseases.”

Key question #3: Do e-cigarettes actually help people stop smoking?

So far, two randomized studies (here and here) have looked into the question of quitting — and both found that e-cigarettes may indeed help smokers quit. Another lower-quality web-based survey came to the same conclusion.

But not everyone’s convinced. As a systematic review by the Cochrane Library noted: “The small number of trials, low event rates and wide confidence intervals around the estimates mean that our confidence in the result is rated ‘low.'” For example, there were weaknesses in the randomized trials. One trial compared e-cigarettes with nicotine patches for helping people quit. But participants had to go out and pick up the patches from the pharmacy, whereas e-cigs were delivered to their doorsteps — a difference that could have biased the results in favor of e-cigarettes.

Other evidence, meanwhile, suggests that e-cigarettes may not be so effective at helping people smoke fewer traditional cigarettes. A study published in JAMA Internal Medicine in 2014 concluded: “E-cigarette use by smokers was not followed by greater quitting, or reduction in consumption one year later.” Another 2015 study in the journal Addiction found that daily use of e-cigarettes seemed to be associated with an increase in the rate of attempts to quit smoking and less smoking, though not increased rates of quitting. These were both observational studies, so lower quality than the randomized trials.

So the evidence on quitting is still limited and has mixed results. And there are lots of harder questions that remain unanswered, as the American Thoracic Society has noted. Could e-cigarettes prolong the process of quitting? Could they make quitting less likely? For now, we don’t know.

Key question #4: Could e-cigarettes “re-normalize” smoking?

The use of e-cigarettes is growing among adolescents, while conventional cigarettes fall out of favor. (NEJM)

This is another concern some public health researchers have. After years of anti-smoking campaigns, rates of traditional cigarette smoking are falling. But what happens if e-cigarettes become more popular?

Could the availability of e-cigarettes entice former smokers to get hooked on nicotine again? Will e-cigarettes be a “gateway” device that carries people who would never have started smoking cigarettes into nicotine addiction? Or, relatedly: If more and more people use e-cigarettes, could that “re-normalize” regular cigarette use?

Those in favor of e-cigarettes say this renormalization is unlikely. They point to recent CDC data showing that the threefold increase in e-cigarette use among youth has been accompanied by a decline in the use of traditional cigarettes. There’s also some research that suggests nonsmokers who try e-cigs don’t progress to daily use — that it’s not a gateway drug.

“Maybe you get a chronic smoker to quit, but what about this next generation coming up?”
“Though we see experimentation,” said Lynne Dawkins, an experimental psychologist at the University of East London (who has received research funding from the industry), “we’re not seeing evidence of people using them regularly.”

On the flip side, researchers less enthusiastic about e-cigarettes note that the absolute use of nicotine products (such as hookah and cigars) has been trending up. There’s also this 2015 study in JAMA, which suggests students who use e-cigarettes are later more likely to report smoking combustible cigarettes compared with non-vapers. This observational study couldn’t prove that vaping caused the cigarette smoking, but while firm evidence on how e-cigarettes are changing behaviors is lacking, some researchers are concerned.

“Maybe you get a chronic smoker to quit,” said Stanford’s Prochaska, “but what about this next generation coming up who would not have picked up a combustible cigarette because it’s a dying behavior, but these devices are so trendy and they’re flavored and marketed to be really appealing to kids?”

Key question #5: Is nicotine, on its own, harmful?

Some researchers — especially those who view e-cigarettes more favorably — argue that nicotine in and of itself doesn’t harm people. The problem, they say, is the tobacco and other chemicals in combustible cigarettes.

The more staunch tobacco-control types argue that nicotine itself is dangerous and addictive and that it should be avoided. That puts e-cigarettes in a less favorable light.

The truth likely lies somewhere in between. As one review stated, “Nicotine is the addictive chemical in tobacco smoke, but its involvement in smoking-related harm (outside pregnancy) is very small, if any, compared to cigarette smoking.” Another systematic review pointed out that nicotine can have a variety of potential health effects, from raising one’s cardiovascular risk to causing birth defects in pregnant women.

There’s also some emerging science that suggests nicotine may confer benefits, from helping to treat Parkinson’s disease to enhancing attention and focus.

The other nicotine question has to do with whether e-cigs even deliver enough to satisfy smokers. We know from this Cochrane systematic review that if you want to help people quit smoking, you need to give them nicotine. Yet what’s clear right now is that not all e-cigarettes deliver the same amount of nicotine.

Some studies, such as this one in Nature, found that the nicotine delivery to the bloodstream from these devices varied, and was still much slower and lower than the concentrations that regular cigarettes give smokers. “Compared to smoking one tobacco cigarette,” the researchers wrote, “the [e-cigarette] devices and liquid used in this study delivered one-third to one-fourth the amount of nicotine after five minutes of use.”

Other more recent studies, like this one from 2015, suggest that at least some e-cigarette users may get nicotine doses similar to those from tobacco cigarettes.

Do these scientific debates matter for policy?

Yes. Right now, regulators are trying to figure out how to deal with e-cigarettes.

While some countries have banned the devices outright, the US federal government doesn’t regulate e-cigarettes, unless they’re being marketed for therapeutic purposes. This is because the Family Smoking Prevention and Tobacco Control Act of 2009 gave the Food and Drug Administration the power to regulate the tobacco industry, but e-cigarettes — along with other tobacco-related merchandise such as cigars and nicotine gels — were left out.

By April 2011, the FDA announced it was going to address this loophole. Then, in April 2014, the agency proposed a draft rule that will redefine e-cigarettes as “tobacco products.” Once finalized and enacted in another few years, e-cigarettes will be FDA-regulated under the Tobacco Control Act. Among other things, this would:

· Ban e-cigarette sales to minors

· Require health warning labels on e-cigarettes, which would warn of the possibility of addiction

· Prohibit vending machine sales of e-cigarettes except in places that don’t allow minors

· Require e-cigarette manufacturers to register a list of their products’ ingredients

· Require an FDA review of marketing plans

· Require FDA approval of any claims about e-cigarettes’ benefits, such as the claim that e-cigarettes can help people quit cigarettes

· Ban free samples of e-cigarettes

The FDA’s rules don’t include some restrictions that health advocates called for: They don’t halt online sales of e-cigarettes, prevent television and radio advertising, or ban the marketing of appealing flavors. They’re concerned because e-cigarette companies have already been targeting children and youth with appealing flavors, celebrity endorsements, and glitzy adverts.

Some public health officials and vaping advocates think that regulating e-cigarettes as tobacco products is overkill; after all, the devices don’t even hold tobacco. They also worry that if e-cigarettes are regulated too heavily or barred from the market, the public could miss out on a device that could have saved lives. Some experts also think heavy regulation could halt innovation, deterring manufacturers from creating more advanced devices with better nicotine delivery systems that could help reduce smoking.

As Peter Hajek, a professor at Queen Mary University of London, put it, “Regulators need to watch out for intended consequences of overzealous regulation, such as stifling such developments or making e-cigarettes more expensive and less attractive to smokers; and also avoid conveying a message that e-cigarettes are regulated as strictly [as] or even more strictly than cigarettes because they are as bad.”

FDA officials are conducting a scientific review of e-cigarettes and their effects. Until then, states, counties, and cities have been enacting their own e-cigarette regulations. The American Nonsmokers’ Rights Foundation tracks which lower levels of government have acted here.

Ages 18 to 21 a critical time to stave off smoking habit

KUALA LUMPUR: If a person remains tobacco-free until they reach age 21, chances are that he or she will never succumb to the habit for the rest of their lives, says medical experts.

Hence, raising the age of buying tobacco to 21 will protect teenagers and youths from the dangers of nicotine addiction, thus, reducing the number of deaths and diseases caused by tobacco usage.

Malaysian Mental Health Association deputy president Datuk Dr Andrew Mohanraj Chandrasekaran said people aged between 18 to 21 were most susceptible to the addictive effects of nicotine because their brains were developing.

“This is why most chronic smokers would have first experimented with cigarettes around this age and not later.

“Experimenting with cigarettes during this age allows the brain to ‘learn’ to be addicted compared with a more resistant ‘mature’ brain at an older age. When such an experiment is delayed, there is less likely for addiction to develop,” he told the New Straits Times.

He said the need to experiment with new things, seeking acceptance in a group or just being “cool” were some of the reasons why young people started smoking. He said some also felt that smoking was a form of social rebellion.

University Malaya Centre of Addiction Sciences addiction medicine specialist Associate Professor Dr Amer Siddiq Amer Nordin said studies had found that raising the minimum age to buy cigarettes was effective in reducing the smoking rate and increasing the quality of life.

He said a study in the United States revealed that enforcing a higher smoking age would reduce the prevalence of smoking among adults in the long term, and might even be as effective as increasing cigarette taxes by 40 per cent.

“Malaysia’s Global Adult Tobacco Survey found the age of initiation to be 17 years. Studies showed that 80 per cent of smokers started smoking before age 20, and 90 per cent of those who purchased cigarettes were below age 21.

“By increasing the age of purchase, we are essentially ensuring that those under age 21 do not start selling cigarettes and tobacco products to their peers.

“In Malaysia, we are considered mature and able to determine the fate of the country by voting at age 21. So why do we allow those below 21 to have access to cigarettes?” said Dr Amer, who is also a Malaysian Council for Tobacco Control committee member and a smoking cessation specialist.

Malaysian Medical Association president Dr Ashok Philip said tobacco was addictive because of the nicotine content that had powerful effects on receptors in the brain that cause increased alertness and a sense of well-being. However, he said prolonged exposure to nicotine would reduce the number of receptors on the nerve cells.

“If the smoker then cuts down or stops smoking, the nicotine stimulation will drop, and the subject feels irritable, fatigued and out of sorts.

“If he or she can tolerate the symptoms for a few weeks, the number of receptors will recover, and the withdrawal symptoms should be alleviated.

“However, the severity of symptoms vary widely, and in some people, it may be so severe that even nicotine replacement with chewing gum or skin patches cannot help them to quit.”

Malaysian Psychiatric Association honorary secretary Associate Professor Dr Muhammad Muhsin Ahmad Zahari said smoking cigarettes could be a gateway to other habits, such as smoking shisha or marijuana, vaping, and even the use of illicit drugs.

“In a recent finding published in Lancet Psychiatry, regular smokers were associated with a higher risk and earlier onset of developing psychosis, which is a mental illness.”

Gynaecologist and Asia Metropolitan University president and chief executive officer Professor Datuk Dr N.K.S. Tharmaseelan said teenage smoking was often an early warning sign of future problems.

For instance, teens who smoked were three times as likely as non-smokers to use alcohol, eight times as likely to use marijuana, and 22 times as likely to use cocaine.

“Studies have shown that the three-year gap (18 to 21 years) makes a ‘huge’ difference in combating smoking among the young.

“Moreover, most countries are gradually raising the age barrier. Thus, Malaysia may be joining an elite group of health conscious nations that are implementing proactive measures to curb the rising mortality and morbidity associated with smoking,” he said.

Mixed smoke signals on e-cigarettes

Long-term impact still not known, but a big U.K. study trumpets lower health risks.

By Jules Johnston

Two major new studies send seemingly conflicting messages about whether e-cigarettes help people quit smoking or are a path right back to the habit.

A U.K. review of multiple studies concluded that e-cigs, which provide controlled doses of nicotine without the majority of harmful substances found in combustible cigarettes, are a drastically less harmful alternative to tobacco. Those results came within hours of the release of a U.S. study into smoking among teenagers that suggested the devices may be a gateway for children to move to traditional cigarettes.

Confused? Here are the main findings of both studies.

The U.K. review

The independent review, commissioned by Public Health England, estimates that smoking e-cigarettes is 95 percent less harmful than combustible smoking, even going so far as to suggest that e-cigarettes may be contributing to falling smoking rates among adults and young people.

Researchers found that nearly all of the U.K.’s 2.6 million adults using e-cigarettes are current or ex-smokers, who mostly started with the aim to quit smoking or to prevent them going back to cigarettes. However, data also showed that an increasing number of U.K. citizens think e-cigarettes are equally or more harmful than smoking.

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Professor Ann McNeill, the report’s lead author from the National Addiction Centre at King’s College London, told POLITICO that there is a need for “a comprehensive tobacco control strategy, and e-cigarettes are part of that.”

Many anti-smoking campaigns have not reached the more vulnerable groups in society, McNeill said, adding that “e-cigarettes are a low-cost, wide-reach option which could do that.”

McNeill said the claim that e-cigarettes are 95 percent less harmful than traditional combustible cigarettes is based on a number of factors.

For one, just a few potentially harmful inhalants have been identified in e-cigarette vapor. By contrast cigarette smoke contains at least 70 known carcinogens as well as many chemicals that are toxic and harmful to health. In e-cigarettes, the few potentially harmful inhalants are at much lower concentrations than those found in tobacco cigarettes.

But she added some caveats to the review’s headline, noting that there have been no studies of people who have used e-cigarettes for a number of years.

The report concludes that “there is no evidence so far that e-cigarettes are acting as a route into smoking for children or non-smokers.”

A study conducted by U.K. health charity showed an increase in the number of young people who have used e-cigarettes: 4 percent in 2013, compared to 10 percent in 2015 (among a test group of approximately 2,000 11-to-18 year olds).

However, the group welcomed the review, with Deborah Arnott, the organization’s chief executive, commenting that “the evidence is clear: electronic cigarettes are very much less harmful than smoking.”


A study published in the Journal of the American Medical Association Network by researchers from the University of Southern California released on the same day linked trying out e-cigarettes to a higher probability of ending up smoking regular cigarettes for teens.

The California study

Conducted in 2013 in 10 public high schools in Los Angeles, the study asked groups of 14-year-old students to chart their experiences with smoking, and followed up at six-month intervals over the next year with self-reported surveys.

At the study’s start, less than 10 percent of the 2,530 students involved reported having used e-cigarettes.

After six months, 31 percent of those who had used e-cigarettes had subsequently smoked combustible tobacco products, compared to just 8 percent of those who had never used the devices.

Do e-cigarettes lead to teens smoking? We just don’t know yet.

Adam M. Leventhal, first author on the study and associate professor and director of the Health, Emotion, & Addiction Laboratory at the Keck School of Medicine at University of Southern California, explained that although “we cannot conclude that e-cigarette use directly leads to smoking, this research raises concerns that recent increases in youth e-cigarette use could ultimately perpetuate the epidemic of smoking-related illness.”

The results concluded that the students who had used e-cigarettes “were more likely to report initiation of combustible tobacco use over the next year.” However it also acknowledges: “Further research is needed to understand whether this association may be causal.”

This is further supported by the U.S. drug regulator’s position. The Food and Drug Administration website notes that “it is not known whether e-cigarettes may lead young people to try other tobacco products, including conventional cigarettes, which are known to cause disease and lead to premature death.”

Big Tobacco weighs in

Tobacco companies have increasingly diversified into e-cigarettes, as global smoking rates generally dropped in recent decades.

Steve Stotesbury, head of regulatory science at Imperial Tobacco, said that “researchers looking at the U.S. data tend to get excited about the numbers of school-age children who use EVPs (electronic vapor products), but fail to see what the (other U.S.) data actually shows.”

He referred to a different study conducted by the U.S. Centers for Disease Control and Prevention, the National Youth Tobacco Survey, which also reports a consistent rise in the use of e-cigarettes in middle school and high school students over the period 2010 to 2014.

While this could suggest that more teenagers are being exposed to small amounts of nicotine, Stotesbury argues that combined with other data showing a drop in teen cigarette smoking, there is evidence backing the use of e-cigarettes as an alternative rather than a gateway drug.

Next steps

On a wider level, the EU is working to clear the air. As part of last year’s tobacco products directive, the European Commission is obliged to conduct further research on the issue, and it is publicizing what it calls a collection of myths on e-cigarettes.

It warns that the long term health effects are not yet known and states that “e-cigarettes simulate smoking behavior and can lead to further experimentation with other nicotine-containing products.”

Consumers will still be able to buy e-cigarettes under the EU directive. For those classified as consumer products, the maximum threshold of nicotine is 20 milligrams per milliliter, with e-cigarettes at higher concentration levels required to go through a more rigorous set of rules.

British American Tobacco to put its first quitting aid Voke on the market

British American Tobacco’s (BAT) first anti-smoking product, Voke, will arrive in shops at the end of the year, marking a victory for BAT over its rivals such as Imperial Tobacco who have similar products in development.

BAT was granted regulatory approval in 2014 by the Medicines and Healthcare Products Regulatory Agency (MHPRA).

The product will be the first approved quitting aid made by a tobacco company.

An MHPRA spokesperson said: “The MHPRA continues to encourage and actively support companies to submit medicines licence applications for electronic cigarettes and other nicotine containing products, which can be used in stop smoking services.”