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October 28th, 2015:

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.