Clear The Air News Tobacco Blog Rotating Header Image

October, 2015:

Asia-16 Illicit Tobacco Indicator 2014

Download (PDF, 1.79MB)

Role of tobacco warning labels in informing smokers about risks of smoking among bus drivers in Mangalore, India



Smoking tobacco is considered as a leading cause of preventable death, mostly in developing countries like India. One of the primary goals of international tobacco control is to educate smokers about the risks associated with tobacco consumption. Tobacco warning labels (TWLs) on cigarette packages are one of the most common statutory means to communicate health risks of smoking to smokers, with the hope that once educated, they will be more likely to quit the habit.


The present survey was conducted to assess the effectiveness of TWLs in communicating health risks of tobacco usage among 263 adult smokers working as bus drivers in Karnataka State Road Transport Corporation (KSRTC), Mangalore, India. Information was collected on demographic details, exposure and response to health warnings on tobacco products, intention to quit and nicotine dependency.


The majority (79.5%) of the respondents revealed negative intentions towards quitting smoking. Nearly half of the participants had a ‘low’ nicotine dependency (47.5%) and 98.1% of the respondents had often noticed warning labels on tobacco packages. These health warnings made 71.5% of the respondents think about quitting smoking. Respondents who noticed advertisement or pictures about dangers of smoking had better knowledge, with respect to lung cancer and impotence as a consequence of tobacco. A higher exposure to warning labels was significantly associated with lower nicotine dependency levels of smokers among the present study population. A significantly higher number of respondents who noticed advertisement or pictures about the dangers of smoking thought about the risks of smoking and were more inclined to think about quitting smoking. As exposure increased, an increase in the knowledge and response of participants was also observed.


Exposure to tobacco warning labels helps to educate smokers about health risks of tobacco smoking. It may be possible to promote oral health among bus drivers by developing strategies to educate them about these risk factors.

Why using e-cigarettes could be riskier than we thought

E-cigarette use has knock-on effects, like increased alcohol use and exposure to chemicals from aerosol, research suggests

When e-cigarettes first hit the market around 10 years ago, smokers rejoiced at the prospect of being able to replace their cancer-causing cigarettes with a similar but less harmful electronic device to help them quit. E-cigarette use has accelerated since then, leading researchers to investigate its health effects.

But what about the knock-on effects of e-cigarette use on other risky behavior, such as drinking? A new study reveals that such secondary effects could be more serious than we thought.

According to new research published in Addictive Behaviors, using e-cigarettes is related to problematic drinking. The researchers, from Indiana University-Purdue University Indianapolisin the United States, say it’s crucial to consider the knock-on effects of e-cigarette use when evaluating their safety, not just their direct health effects.

Electronic cigarettes, or e-cigarettes, were developed to mimic real cigarettes, giving users the same look, feel and experience as smoking a cigarette. They are widely promoted as a “healthy” alternative to smoking and as support devices for smoking cessation. More than 6 percent of the general population – and 17 percent of people with addictions – use e-cigarettes.

Because of the rapid increase in their use, research has focused on their health effects. However, the new study looks at one of the secondary effects of e-cigarette use and suggests that people need to be aware of the link between e-cigarette use and problematic drinking.

“This area of research is extremely important, and I don’t want it to get pushed to the side,” said lead author Alexandra Hershberger, a PhD student in clinical psychology.

“Establishing the direct health effects of e-cigarette use is important, but it’s vital to look at the secondary effects too.”

Monitoring e-cigarette and alcohol use

Previous studies have revealed a strong link between cigarette smoking and drinking, so the researchers hypothesized that a similar connection may be found with e-cigarette use and drinking. They surveyed two groups of people who drink alcohol using a modified version of the Nicotine and Other Substance Interaction Expectancy Questionnaire (NOSIE) to find out whether people expected to use e-cigarettes and alcohol together.

In both groups, of 692 and 714 people, the survey revealed that drinking alcohol is related to e-cigarette use. E-cigarette users were significantly more likely to drink problematically than non-users in both groups. What’s more, people who expected to use e-cigarettes and alcohol together reported drinking more.

The results suggest that using e-cigarettes to quit smoking could mean people miss out on the benefits of quitting; smoking cessation generally results in people drinking less alcohol, but using e-cigarettes means this decrease may not happen.

Hershberger explained:

If you quit smoking cold turkey, it affects other behaviors associated with smoking, such as drinking. By replacing smoking with e-cigarette use, it could be that you’re at risk of continuing behaviors you don’t want to continue. This is particularly serious for people with alcohol addiction – using e-cigarettes could make it harder to stop drinking.

More women use e-cigarettes socially

The survey also revealed that more women than men use e-cigarettes socially, opposite to patterns seen in regular cigarette smoking. In general, men report more risk-taking behaviors than women, including smoking, drinking and drug use. The findings suggest that women may not perceive e-cigarette use as risky.

“We were surprised to see higher e-cigarette use in women,” Hershberger said. “Generally men tend to report more risk-taking across the board, but in our study, women outnumbered men in terms of e-cigarette use. This could be because women perceive the device differently to other risk-taking behavior; e-cigarettes tend to be viewed more positively than cigarettes. Those views could be driving more use in women than we’d expect.”

Harmful chemicals in one puff

E-cigarettes work by vaporizing a liquid to mimic smoke, which can be inhaled. Although chemical analyses have determined the content of the liquid, so far the aerosol has not been fully characterized. New research published in the Journal of Chromatography A does just that – and reveals compounds not found in the liquid.

The researchers, from Restek Corp. and Juniata College in Pennsylvania, used gas chromatography and mass spectrometry to analyze the liquids and aerosols of four commercially available e-cigarettes. The results revealed more than 115 volatile and semi-volatile organic compounds in a single 40-milliliter puff of the aerosol. In comparison, the liquid contained only 64 compounds.

Some of the compounds found in the aerosol but not the liquid include formaldehyde, acetaldehyde, acrolein and siloxanes. This suggests that the aerosolization process may result in the formation of harmful chemicals that have an implication for human health. The researchers say this stresses “the need for an emphasis on electronic cigarette aerosol testing.”

Read the study

Elsevier has has provided free access to this article until 29 January 2016:
Alexandra R. Hershberger et al: “Combined expectancies of alcohol and e-cigarette use relate to higher alcohol use,” Addictive Behaviors (January 2015).

The Lead Author

Alexandra Hershberger is a PhD student in Clinical Psychology at Indiana University-Purdue University Indianapolis working under the mentorship of Dr. Melissa A. Cyders, whose research focuses on how impulsivity and its neurocognitive underpinnings affect risk-taking behaviors, including alcohol abuse, sexual risk-taking and gambling. Alexandra’s research is interested in examining co-morbid substance use disorders, particularly in adolescents in outpatient care and in the juvenile justice system. Specifically, her recent work examines the relationship between alcohol use and e-cigarette use, behavioral and cognitive underpinnings of the relationship and examining how this relationship is affected by e-cigarette ban legislation, being a former smoker, and individual differences in impulsive personality.

The Journal

Addictive Behaviors is an international peer-reviewed journal publishing high quality human research on addictive behaviors and disorders since 1976. The journal accepts submissions on substance-related addictions such as the abuse of alcohol, drugs and nicotine and behavioral addictions such as compulsive gambling and internet excesses. The journal primarily publishes behavioral and psychosocial research but articles span the fields of psychology, sociology, psychiatry, epidemiology, social policy, medicine, pharmacology and neuroscience.

Teens Say They Are Drawn to Flavored or Fruity Tobacco

New FDA study shows flavored hookahs or e-cigarettes are “gateway” products for children

NEW YORK (Reuters Health) – A survey of teen smokers has added more evidence that flavored tobacco products are particularly attractive to people younger than the legal smoking age.

“Consistent with national school-based estimates, this study confirms widespread appeal of flavored products among youth tobacco users,” the authors, led by Bridget K. Ambrose of the Center for Tobacco Products at the U.S. Food and Drug Administration in Silver Spring, Maryland, wrote in their research letter.

Most tobacco use begins during youth and young adulthood, and although cigarette use has been declining, other products like e-cigarettes and hookah are becoming more common, they wrote.

The researchers used data from a nationally representative study of nearly 46,000 U.S. adults and youth ages 12 to 17 who answered questions about use of cigarettes, e-cigarettes, hookahs, cigars, pipe tobacco, smokeless tobacco, dissolvable tobacco, and other products.

Respondents answered whether or not the first product they ever used had been flavored to taste like menthol, mint, clove, spice, candy, fruit, chocolate, alcohol, or other sweets.

Of 13,651 teens in the survey, 2,900 reported ever using a tobacco product, most commonly cigarettes or e-cigarettes, and 1,152 said they had used tobacco products over the previous month.

Almost 90% of teens who had used hookah, 81% of ever e-cigarette users, 65% of ever users of any cigar type, and 50% of ever cigarette smokers said the first product they used was flavored.

Of the teens who had used any tobacco product over the previous month, 80% had used a flavored one, including 60% of cigarette smokers.

Many youth said flavoring was a reason to use e-cigarettes, hookahs, cigars, smokeless tobacco, and snus pouches, the researchers reported online October 26 in JAMA.

A 2014 study in the journal Tobacco Control found that cigar use is more common among youth age 18 to 25 than any other age group, which may be driven by the popularity of flavored cigars (

“A lot of times they’re bubble gum or chocolate or candy flavored, and in many cases the packages are also framed in a manner to appeal to kids,” Centers for Disease Control and Prevention epidemiologist Dr. Brian King told Reuters Health when the 2014 study was published.

They are also less expensive than cigarettes because they are not subject to the same taxes, despite containing the same carcinogens, said Dr. King, who was not involved in the JAMA research letter.

“In many states these products can be purchased for mere pocket change,” he said.

The Food and Drug Administration continues to monitor new and novel tobacco products, Michael Felberbaum, a press officer for the FDA, told Reuters Health by email.

“The FDA evaluates studies as part of a larger body of evidence aimed at assisting in our mission to protect public health and furthering our understanding on particular issues,” Felberbaum said. “Flavored tobacco products have become increasingly common in the United States and are especially attractive to youth.”

“As such, the FDA is particularly interested in monitoring and assessing the use of flavored tobacco products among youth,” he said.

E-Cigarette Explodes in Man’s Face, Puts Him in a Coma

As a recent e-cig enthusiast, this story is particularly troubling. Perhaps this will help me stop my e-cig habit, therein making me look like less of a douche, and possibly reducing my likelihood of ending up in the hospital in an explosion-induced coma.

A Miami man is now in the hospital after an e-cigarette blew up in his face. “I was laying in bed with my two-year old and I heard an explosion,” Ema Richardson told CBS. “Then I started smelling burning, smoke and fire.”

According to CBS, “Richardson said when she went into another room she found her 21-year old brother Evan Spahlinger on the floor.” His face and the upper part of his body were covered in soot from the e-cig, which had exploded.

“I found my brother not breathing with his whole face burned and his neck burned and trying to throw up a little or maybe he was gasping for air. They said he has internal and external burns and damage to his lungs from the explosion itself and possibly the mouth piece went, when the cigarette exploded it went down his throat and exploded again,” she said.

According to CBS, North Collier Fire Control and Rescue said the explosion was most likely caused by the device’s lithium battery. Richardson said her brother will never use an e-cig again. With all luck, I won’t either.

Iran Nuclear Deal: Big Tobacco Sees Opportunity For Cigarette Market Amid Lagging Revenues Elsewhere

With international sanctions on Iran slated for repeal in the coming months, foreign tobacco companies are positioning themselves to enter a market they view as “a ripe fruit waiting to be plucked.” Above, a member of the Iranian army smokes as he rests at a park in central Tehran in 2009. Reuters/Raheb Homavandi

It’s not just Big Macs, Frappucinos, iPads and other stereotypical Western commercial products that could soon trickle legally into Iran. If sanctions are lifted, Tehranis might eventually have access to legal Marlboros and other Western cigarette brands that are otherwise smuggled into the country.

After the signing of a nuclear accord in July, international sanctions on Iran could be repealed as early as next year, and tobacco companies are jostling for their share in a major untapped market in the Middle East. For the past several years, cigarette sales in developed countries have lagged, spurring tobacco companies to pivot toward emerging markets. The addition of Iran could be a significant boon for these companies – depending on which ones secure a stronger foothold first.

“What it really comes down to is a battle over market share,” Esfandyar Batmanghelidj, who founded the Virginia-based Iran Tobacco Research Group and has published extensively on the political economy of smoking and the cigarette trade in Iran, said. “There’s definitely interest on the part of the traditional major global players in tobacco…in getting back into Iran in a serious way.”

The World Bank classifies Iran as an “upper middle-income” country, and its 80 million people make it the second-largest country in the Middle East by population, after Egypt. By some estimates, Iranians spend $3.3 billion on and smoke about 52.6 billion cigarettes every year. The number of smokers is rising, too, from 7.65 percent of the population in 2010 to 8.55 percent in 2014, according to a report published in August by Euromonitor International, a business intelligence research group based in London. Others have suggested that smoking rates are substantially higher. According to Kenneth Shea, a senior analyst at Bloomberg Intelligence, about 15 percent of Iranians smoke, and “that number has generally edged higher over the years,” he said. Batmanghelidj, meanwhile, estimated that smoking rates in Iran could exceed 20 percent.

The past decade of sanctions has largely closed Iran off from the West and the global economy, a scenario tobacco companies have been waiting to change. “The international cigarette industry has long viewed Iran as a ripe fruit waiting to be plucked,” said Euromonitor’s report. In addition to having rising smoking rates, “Iran is conveniently located, wedged between the tobacco industry’s established smuggling centers in the Middle East and the burgeoning tobacco markets in the Indian subcontinent and Russia,” the report said.

In Iran, a pack of cigarettes costs roughly U.S. $0.50 for a local brand and $1 for an international brand, offering little in the way as a financial deterrent to smoking. Meanwhile, the perception is growing among young women there that smoking cigarettes is a “fashionable way of relaxing,” according to the Euromonitor report. A government ban on public smoking has also hardly been a damper on the habit.

In Iran, the state-owned Iranian Tobacco Company controls 38 percent of the market, according to Encyclopedia Iranica, an academic reference project run by the Center for Iranian Studies at Columbia University in New York. British American Tobacco and Japan Tobacco International control the majority of the remaining 62 percent.

Sanctions in the past decade have prevented foreign tobacco companies from legally importing their cigarettes in a way that was not extremely expensive or strapped with red tape. During the 1970s and 1980s, Western brands, like Winstons, Gauloises or Marlboros, were the most popular among Iranians, according to Batmanghelidj. But with restrictions slated to be scaled back, companies “can cost effectively import a much higher volume of cigarettes into the country and take back their market share,” Batmanghelidj said.

In developed countries, cigarette sales are declining as more people become aware of the health effects of smoking cigarettes. Government regulations have also helped drive down sales and consumption by banning smoking in many places and by imposing hefty taxes on packs of cigarettes. Overall, global cigarette sales declined 0.4 percent from 2013 to 2014. Shea, the Bloomberg analyst, said that the average global smoking rate had decreased slightly in recent years and that cigarette sales by volume had also diminished.

The industry itself has openly acknowledged this decline and its causes. “We think that individual smokers will consume fewer cigarettes each and smaller percentages of populations will smoke,” reads the section titled “The global market” on British American Tobacco’s website. “Regulation of the industry also continues to increase,” it added.

Sanctions on Iran cannot be lifted until the International Atomic Energy Agency, the global nuclear watchdog, finishes a report slated for completion Dec. 15 confirming that the country has fulfilled its obligations under the terms of the international accord, which bars it from developing a nuclear weapons program. But that hasn’t stopped some tobacco companies from making moves, albeit guarded ones.

Japan Tobacco International (JTI) , which along with British American Tobacco is one of two foreign tobacco companies to operate legally in Iran, recently bought Iranian cigarette manufacturer Arian Tobacco Industry for an undisclosed amount, the Financial Times reported in October.

The Financial Times reported that JTI made the move in an apparent effort to gain a foothold in the Iranian market ahead of the rumored entry of industry behemoth Philip Morris International, which according to its website controlled 15.5 percent of the tobacco market outside the U.S. in 2014. But a spokesperson for JTI said otherwise in an email to International Business Times. “We do not speculate on competitors’ commercial moves,” the spokesperson said, adding, “The acquisition was mainly aimed at consolidating our presence [in Iran].”

JTI has operated in Iran since 2002. “We have always believed in the economic potential of this country,” the spokesperson said. “Iran is a significant country with important natural resources and a large population. We have always believed that Iran meets many conditions to grow economically.”

Some tobacco companies have been silent about their post-sanctions ambitions in the Iranian market. Philip Morris International, maker of Marlboros, does not appear to have revealed plans — at least, not publicly — to jump into the Iranian market.

“We are following the developments on sanctions and will consider our business opportunities if and when warranted,” Philip Morris International said in response to emailed questions regarding its prospects in Iran.

But not everyone is looking forward to the possibility of having more tobacco companies in Iran. As of 2009, lung cancer was the fifth most common cancer in Iran, and its rates were increasing, Iranian researchers found in a study published that year. They attributed the increase in part to cigarette smoking. Health advocates fear that the advent of more companies will exacerbate the situation further.

Dr. Gholamreza Heydari, director of the tobacco prevention and control research center at Shahid Behesthi University of Medical Sciences in Tehran, said in an email that even though Philip Morris’ products were already available, albeit illegally, in the country, an increase in tobacco companies that are legally doing business there could lower cigarette prices and therefore increase smoking. He said it would undercut health advocates’ already struggling efforts to raise the price of cigarettes through taxes, setting up a fresh battle in the fight against Big Tobacco.

ITIC’s Excise Tax Manual Undermines Best Practice in Tobacco Taxation

Download (PDF, 293KB)

WTO panel to hear oral arguments on Australia tobacco plain packaging case

Action on Smoking and Health

World Trade Organization panel to hear oral arguments on Australia tobacco plain packaging case from 28 to 30 October 2015

Tuesday 27 October 2015

Tomorrow a World Trade Organization (WTO) dispute settlement panel will begin to hear a second and final round of oral arguments in claims that Australia’s tobacco plain packaging infringes WTO agreements. The hearing will take place at WTO in Geneva from 28-30 October, 2015. An initial oral hearing took place 1-5 June 2015.

The outcome of this case is being watched worldwide by governments, health organizations and tobacco companies alike given the crucial nature of plain packaging as a tobacco control measure. Fiercely opposed by the tobacco industry, plain packaging is recommended by guidelines under the World Health Organization Framework Convention on Tobacco Control, the international tobacco control treaty.

Under plain packaging, health warnings would remain as would product names in a standard size and font, but tobacco company colours, logos and graphics on packages would be banned. The brand portion of package have the same colour (e.g. drab brown) for all brands. Tobacco packages would no longer be mini-billboards promoting tobacco.

Plain packaging was implemented in Australia in 2012, has been adopted in Ireland and the United Kingdom for implementation on 20 May 2016, and is under formal consideration in Norway, Sweden, Finland, Hungary, France, Canada, New Zealand, Singapore, Turkey and South Africa. [1]

There are four complainants that have each brought a claim to WTO: Honduras, Indonesia, Cuba and Dominican Republic. (Another initial complainant, Ukraine, has withdrawn its legal claim). At the October 28-30 hearing, it is only the four complainants as well as Australia that will be entitled to present oral argument.

Tobacco companies have admitted to paying legal costs for two of the current complainants: Philip Morris International for the Dominican Republic, British American Tobacco for Honduras as well as for the previous complainant Ukraine. [2] At WTO, only governments can initiate proceedings, which is why the tobacco industry is paying legal costs of certain countries.

There are 36 Third Parties that are participating in the proceeding, more than in any previous WTO case. The Third Parties were entitled to present their perspective at the June 1-5 hearing, but will not be able to do so at the October 28-30 hearing. The Third Parties are: Argentina, Brazil, Canada, Chile, China, Chinese Taipei, Ecuador, Egypt, European Union, Guatemala, India, Japan, Korea (Republic of), Malawi, Malaysia, Moldova, Mexico, New Zealand, Nicaragua, Nigeria, Norway, Oman, Panama, Peru, Philippines, Russia, Saudi Arabia, Singapore, South Africa, Thailand, Trinidad and Tobago, Turkey, United States, Uruguay, Zambia, Zimbabwe.

The tobacco industry had previously brought a constitutional challenge in Australia to plain packaging, but this was dismissed by the High Court of Australia on August 15, 2012. [3]
Deborah Arnott, Chief Executive of health charity ASH said:

“The claim that Australia’s tobacco plain packaging infringes WTO agreements is ill founded and has little or no chance of success. The sooner all the legal challenges are settled the better. Then the example set by Australia, and followed by the UK and Ireland, will rapidly spread all round the world.”

ASH has been given permission to intervene in the legal challenge brought by tobacco companies to try to stop the introduction of standardised, plain packaging in the UK. The case is due to be heard from 10-17 December. [4]

The importance of plain packaging was recently emphasized by WHO Director General Dr Margaret Chan at the World Conference on Tobacco or Health [5]: “Despite industry’s best efforts to block plain packaging, the train has already left the station. The evidence base is strong, empirical, and comes from well-qualified, respected, and credible sources. I thank all the researchers who have contributed to this evidence base. We know that plain packaging works.”

E-Cig explodes in Wichita man’s hand, blows through wall

WICHITA, Kan. — A Wichita man says he and his family are lucky after his e-cig explodes and pieces of it pierced through walls.

Jonathan Reser says his soon-to-be wife wanted him to stop smoking traditional cigarettes. He purchased an e-cigarette from a store near downtown Wichita.

Reser says he followed the manufactures guidelines on his e-cig, which he says cost around $112.00.

“I went charge the battery and went to put it into my e-cigarette, I heard a sizzling like it was hitting and I hadn’t pushed the button yet. I was on my way to listen to it and when I went to listen to it, it just went bam, like a bullet,” Reser said.

Reser says the e-cig broke into two pieces that penetrated opposite walls on his home and scattered pieces of metal and plastic across his home.

A FEMA report from October of 2014 says that when a lithium-ion battery fails on a e-cig, it can behave like a “flaming rocket.”

Reser says the e-cig exploded with enough force to kill someone and he is thankful he was the only one hurt; he suffered very minor burns to his hand.

He says that he took the e-cig back to the store. Reser says the store’s staff pointed to a sign that read “e-cigarettes can explode” and he says they told him he needed to purchase a small computer chip to keep the battery from exploding. Reser says the store did not offer to sell him the chip when he first purchased the e-cig.

Undermining Global Best Practice in Tobacco Taxation in the ASEAN Region

Download (PDF, 971KB)