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October 13th, 2015:

Alternative Tobacco Products as a Second Front in the War on Tobacco

Stephen M. Amrock, MD, SM1; Michael Weitzman, MD2,3,4

1Oregon Health & Science University, Portland
2Department of Pediatrics, New York University School of Medicine, New York, New York
3Department of Environmental Medicine, New York University School of Medicine, New York, New York
4College of Global Public Health, New York University, New York, New York
JAMA. 2015;314(14):1507-1508. doi:10.1001/jama.2015.11394.

This commentary discusses the regulatory implications of the association between early use by youth of alternative tobacco products, such as water pipe tobacco and snus, and later cigarette smoking, as reported in a cohort study published in JAMA Pediatrics.

JAMA Pediatrics

Associations Between Initial Water Pipe Tobacco Smoking and Snus Use and Subsequent Cigarette Smoking: Results From a Longitudinal Study of US Adolescents and Young Adults

Samir Soneji, PhD; James D. Sargent, MD; Susanne E. Tanski, MD, MPH; Brian A. Primack, MD, PhD

Importance Many adolescents and young adults use alternative tobacco products, such as water pipes and snus, instead of cigarettes.

Objective To assess whether prior water pipe tobacco smoking and snus use among never smokers are risk factors for subsequent cigarette smoking.

Design, Setting, and Participants We conducted a 2-wave national longitudinal study in the United States among 2541 individuals aged 15 to 23 years old. At baseline (October 25, 2010, through June 11, 2011), we ascertained whether respondents had smoked cigarettes, smoked water pipe tobacco, or used snus. At the 2-year follow-up (October 27, 2012, through March 31, 2013), we determined whether baseline non–cigarette smokers had subsequently tried cigarette smoking, were current (past 30 days) cigarette smokers, or were high-intensity cigarette smokers. We fit multivariable logistic regression models among baseline non–cigarette smokers to assess whether baseline water pipe tobacco smoking and baseline snus use were associated with subsequent cigarette smoking initiation and current cigarette smoking, accounting for established sociodemographic and behavioral risk factors. We fit similarly specified multivariable ordinal logistic regression models to assess whether baseline water pipe tobacco smoking and baseline snus use were associated with high-intensity cigarette smoking at follow-up.

Exposures Water pipe tobacco smoking and the use of snus at baseline.

Main Outcomes and Measures Among baseline non–cigarette smokers, cigarette smoking initiation, current (past 30 days) cigarette smoking at follow-up, and the intensity of cigarette smoking at follow-up.

Results Among 1596 respondents, 1048 had never smoked cigarettes at baseline, of whom 71 had smoked water pipe tobacco and 20 had used snus at baseline. At follow-up, accounting for behavioral and sociodemographic risk factors, baseline water pipe tobacco smoking and snus use were independently associated with cigarette smoking initiation (adjusted odds ratios: 2.56; 95% CI, 1.46-4.47 and 3.73; 95% CI, 1.43-9.76, respectively), current cigarette smoking (adjusted odds ratios: 2.48; 95% CI, 1.01-6.06 and 6.19; 95% CI, 1.86-20.56, respectively), and higher intensity of cigarette smoking (adjusted proportional odds ratios: 2.55; 95% CI, 1.48-4.38 and 4.45; 95% CI, 1.75-11.27, respectively).

Conclusions and Relevance Water pipe tobacco smoking and the use of snus independently predicted the onset of cigarette smoking and current cigarette smoking at follow-up. Comprehensive Food and Drug Administration regulation of these tobacco products may limit their appeal to youth and curb the onset of cigarette smoking.

Activists decry tobacco industry incentives

DYING TRADE:A group called on the government to forbid the construction of any more tobacco factories and to close the industry to investment from overseas

Action should be taken to stop foreign firms investing in tobacco factories, activists said yesterday, condemning the Ministry of Economic Affairs for providing economic incentives even as tobacco production in other developed nations has fallen.

The Japan Tobacco International’s (JTI) investment in a new factory in the Tainan Technology Industrial Park comes as the “sun is setting” for the industry in Japan, John Tung Foundation chief executive officer Yao Shi-yuan (姚思遠) said, demanding that the government put the tobacco industry on a list of industries for which foreign investment is forbidden.

John Tung Foundation tobacco control division head Lin Ching-li (林清麗) said that four of Japan’s nine tobacco factories were scheduled to close by the end of the year, with an estimated 1,600 workers losing their jobs.

Because of the prohibitively high cost of producing cigarettes in Japan, the firms are being forced to move production overseas, Lin said.

The incentives the government provides for overseas investors — which include assistance acquiring land and exemptions from property and building taxes — are why Taiwan is seen as a base for expansion, she said.

The foundation called on the Executive Yuan to issue an order forbidding the construction of any more tobacco factories while also placing the industry on a list of industries closed to foreign investment.

It also called for the revocation of JTI’s construction license and the appropriation of Imperial Tobacco’s Miaoli factory, the only other foreign-owned tobacco factory in the nation.