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January 27th, 2016:

Teenagers who try e-cigarettes more likely to smoke tobacco

Teenagers who try electronic cigarettes are more likely to try tobacco cigarettes a year later compared with those who don’t use the devices, suggests a study published in Tobacco Control[1] on 25 January 2016.

A total of 2,338 teenagers in Hawaii (average age 14.7 years) were questioned about their tobacco cigarette or e-cigarette use and followed up a year later. Of those who had tried e-cigarettes but not tobacco cigarettes at the start of the study, 20% went on to try cigarettes a year later. In contrast, among teens who had neither smoked tobacco nor used e-cigarettes when they were first questioned, 6% went on to try tobacco cigarettes (adjusted odds ratio [OR] 2.87, 95% CI 2.03 to 4.05; P<0.0001).

However, less than 1% of the teens who had tried only e-cigarettes when first questioned became exclusively tobacco cigarette smokers; 19% were dual users. In comparison, 48% of the teens who had tried tobacco cigarettes and not e-cigarettes became exclusively tobacco cigarette smokers, with 31% becoming dual users.

The authors of the study suggest that public health policies should restrict adolescents’ access to e-cigarettes.

But Deborah Arnott, chief executive of Action on Smoking and Health, says it is not surprising that adolescents who have used e-cigarettes are also likely to try smoking cigarettes. “That’s not proof of causality,” she says. “More significantly, most young people who tried e-cigarettes did not go on to smoke, and youth smoking rates in Hawaii have fallen steadily.”

During the initial survey, 31% of the teens had tried e-cigarettes, rising to 38% a year later; in comparison 15% had smoked cigarettes rising to 21% a year later.

E-cigarettes suppress immune defenses, alter inflammation and boost bacterial virulence

Researchers at the University of California, San Diego School of Medicine and Veterans Affairs San Diego Healthcare System report data suggesting that e-cigarettes are toxic to human airway cells, suppress immune defenses and alter inflammation, while at the same time boosting bacterial virulence. The mouse study is published January 25 by the Journal of Molecular Medicine.

“This study shows that e-cigarette vapor is not benign — at high doses it can directly kill lung cells, which is frightening,” said senior author Laura E. Crotty Alexander, MD, staff physician at the Veterans Affairs San Diego Healthcare System and assistant clinical professor at UC San Diego School of Medicine. “We already knew that inhaling heated chemicals, including the e-liquid ingredients nicotine and propylene glycol, couldn’t possibly be good for you.

This work confirms that inhalation of e-cigarette vapor daily leads to changes in the inflammatory milieu inside the airways.”

Crotty Alexander reported the preliminary results of this work at the American Thoracic Society annual meetings in 2014 and 2015. But now her team has also seen their findings hold up in mice. Inflammatory markers — signs of full-body inflammation — in the airways and blood of mice that inhaled e-cigarette vapors for one hour a day, five days a week, for four weeks were elevated by 10 percent compared to unexposed mice.

“We don’t know specifically which lung and systemic diseases will be caused by the inflammatory changes induced by e-cigarette vapor inhalation, but based on clinical reports of acute toxicities and what we have found in the lab, we believe that they will cause disease in the end,” Crotty Alexander said. “Some of the changes we have found in mice are also found in the airways and blood of conventional cigarette smokers, while others are found in humans with cancer or inflammatory lung diseases.”

Conversely, bacterial pathogens exposed to e-cigarette vapor benefited. Specifically, Staphylococcus aureus bacteria were better able to form biofilms, adhere to and invade airway cells and resist human antimicrobial peptides after exposure to e-cigarette vapor.

E-cigarette vapor extract-exposed bacteria were also more virulent in a mouse model of pneumonia. All mice infected with normal methicillin-resistant S. aureus (MRSA), an antibiotic-resistant “superbug,” survived. Meanwhile, 25 percent of mice infected with MRSA pre-exposed to e-cigarette vapor died.

The results were consistent with e-liquids from seven different manufacturers, demonstrating that the findings are not limited to one formula or brand.

Crotty Alexander and team also recently reported that MRSA bacteria exposed to conventional cigarette smoke are more resistant to killing by the immune system than unexposed bacteria.

University of California – San Diego

Extension of Hong Kong no-smoking areas cut hospital admissions among children by almost half, HKU study finds

Doctor calls for areas close to schools, playgrounds and childcare centres to be made smoke-free

The extension of no-smoking areas has been found to reduce by almost half the number of children admitted to hospital with more severe forms of respiratory infection, a University of Hong Kong study found.

HKU researchers looked into 75,870 hospital admission cases between 2004 and 2012 involving patients aged 18 or younger suffering from lower respiratory tract infections. The number of cases dropped 47.4 per cent in the first year after no-smoking regulations were extended to indoor area of all restaurants, workplaces and public places in 2007.

A sustained reduction of 13.9 per cent was observed in the following five years – meaning an estimated 13,635 fewer admissions in the six years after the new regulations were implemented.

Lower respiratory infections usually refer to more serious forms of illness, including pneumonia, acute bronchitis and excess fluid in the lungs. Acute respiratory infection is a leading cause of death among children aged under five around the world, killing 1.6 million every year.

The effect was more marked among school-age children aged between six and 18, who are believed to spend more time away from home and stand a higher chance of breathing in second-hand smoke compared to preschool children.

Paediatrics professor Lau Yu-lung, who co-authored the study, said smoke can harm lung tissue.

“There are more than 5,000 types of harmful substances in tobacco. When one inhales, lung tissue becomes inflamed easily and immunity is weakened,” said Lau. Some 70 chemicals found in tobacco are carcinogenic.

The study took outdoor air pollution into account and found higher levels of respirable suspended particulates and ozone also led to more admission cases, particularly among preschool children

Dr Lee So-lun, who also worked on the study, said younger children tended to be more vulnerable to air pollution.

“They have weaker immunity and a smaller trachea. The impact of cold is greater than for school-age children,” said Lee.

The researchers acknowledged that other factors including flu epidemics and weather could have affected the results. However, they admitted their study had limitations as they did not assess how legislation was enforced and the time that children spent indoors and outdoors.

No-smoking areas will be further extended to eight bus interchanges on March 31. But Lau said this was not enough as areas close to schools, playgrounds and childcare centres should also be included.

Professor Lam Tai-hing, the university’s chair professor of community medicine who did not take part in the study, said quitting cigarettes was still the best way to reduce health problems.
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Malaysia’s lower house of parliament passes contentious Trans-Pacific Partnership bill

The lower house of Malaysia’s parliament passed a bill allowing the country to participate in the Trans-Pacific Partnership on Wednesday, clearing a crucial hurdle for the government to sign the free trade pact next month.

In the chamber in which the ruling National Front coalition controls nearly two-thirds of the 222 seats, the bill was approved after two days of heated debate, with 127 legislators voting for versus 84 against.

International Trade and Industry Minister Mustapa Mohamad, who tabled the motion on Tuesday seeking approval from the lower house to allow the government to sign and ratify the deal, assured the legislators that Malaysian social agendas will not be compromised.

“The TPP will not change our economic model,” he said in a speech before voting began.

In reference to the mix of capitalism and socialism that Malaysia practices, he said: “We will continue to have the ‘bumiputera’ policy, social enterprises.”

“Bumiputera” or “prince of soil” refers mainly to the ethnic Malays, who make up some 60 per cent of the country’s 29 million population and who enjoy special privileges through the state’s affirmative-action policy due to the perception that they are still weak economically compared to the minority ethnic Chinese.

The “bumiputera” issue is particularly sensitive to Prime Minister Najib Abdul Razak, whose party, the United Malays National Organisation, depends heavily on the Malay voting bloc.

The opposition’s main arguments revolved around fear of the government losing sovereignty especially over the investor-state dispute settlement chapter and the “bumiputera” policy, which comes under the government procurement and state-owned enterprise chapters. They also spoke out over concern that the price of medicine will rise as a result of a longer patent-protection period under the intellectual property rights chapter.

But Mustapa said the TPP recognised the “bumiputera” policy and the country is given a longer transition period and higher thresholds in certain sectors in order to allow the Malays to play catch up.

Outside parliament, a dozen or so activists bearing placards with slogans such as “Malaysia Is Not For Sale” and “TPP Agenda Amerika” camped out overnight in a show of protest against the TPP.

Nashita Md Noor, a 50-year-old social activist, believed Malaysia is not ready for the TPP.

“It is the big companies that will benefit, not the people. Also, the TPP will open the door for big multinational companies to come in and our local small businesses will lose out,” she said.

Although aware she is fighting a futile battle to thwart the deal, Nashita said, “It’s symbolic that there are people brave enough to fight the current government who are not doing anything good.”

According to a World Bank report released earlier this month, Malaysia, Vietnam and Japan will reap significant double-digit bumps in their exports by joining the TPP.

The TPP will open the door for big multinational companies to come in and our local small businesses will lose out

Social activist

It said the TPP will boost Malaysia’s exports by 20 per cent in 2030 while its gross domestic product will rise by 8 per cent. This is in sharp contrast to the United States, the largest economy in the 12-member bloc, which it said will see a gain of only 0.4 per cent in its GDP.

The TPP negotiations were concluded last October after five years of intense wrangling.

Besides Malaysia and the United States, others in the pact are Australia, Brunei, Canada, Chile, Japan, Mexico, New Zealand, Peru, Singapore and Vietnam, which together account for about one-third of global economic output.

With the passage of the deal in the lower house, it will be brought for deliberation and voting in the Senate on Thursday, where it is expected to be easily passed since the National Front also dominates the upper chamber.

The 12 member countries are scheduled to sign the trade pact on February 4 in Auckland, New Zealand. After which, the government has two year to ratify the pact.

Mustapa has said Malaysia still needs to amend 17 laws involving customs, intellectual property rights, labour, among others, to ensure “best practices” under the TPP.

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Berkeley Raises Smoking Age to 21

On January 26th, The City Council of Berkeley voted to raise the smoking age to 21, following in the footsteps of more than 110 municipalities across the nation, including New York City and Boston.

“Berkeley continues to emerge as a public health leader. They recognized that the smoking age should be the same as the drinking age,” said Brittni Chicuata, American Heart Association, Greater Bay Area Advocacy Director. “Studies have shown that over 90% of smokers begin before the age of 21. We support Policies that limit access to tobacco products for youth.”

Recent studies show that raising the smoking age is an effective policy. A recent study of the first city to raise the age of purchase of tobacco products, Needham, MA, in the Journal Tobacco Control showed a significant reduction in tobacco use by Needham high school students. Additionally, an Institute of Medicine report released last year examined raising the age of purchase of tobacco products to 21. The IOM estimates 25% decline in smoking initiation among 15-17 years olds as well as a 12% reduction in smoking prevalence in the long term.

“This action will help remove tobacco from high schools, leading to a healthier future for Berkeley’s youth,” said Henry Philofsky, Western Region Director of the Preventing Tobacco Addiction Foundation.

“Raising the legal age for the sale of tobacco product to 21 will better protect the Berkeley adolescents from continued efforts of the tobacco industry to hook them on a deadly addiction,” said Beverly May, Regional Director of the Campaign for Tobacco-Free Kids.

Raising the smoking age to 21 is also popular. A national study of public support by the Center for Disease Control found 75% of Americans support the policy.

Exploding e-cigarettes? Here’s what Canadians need to know

The case of an Alberta teen who claims an e-cigarette exploded in his face is raising new questions surrounding regulations on a product that’s grown from a niche market to the mainstream.

The father of the 16-year-old Lethbridge teen told Global News his son suffered first and second-degree burns as a result of the explosion.

While explosions or fires from e-cigarettes are extremely rare they are not unheard of.

A report from the U.S. fire administration (USFA) found 25 separate incidents of explosion and fire involving e-cigarettes between 2009 and 2014, injuring nine people. Of those injuries two people suffered serious burns.

In Canada, the issue of who is in charge of regulating the growing use of e-cigarettes has been a challenge for the federal government, says David Hammond, a professor in the school of public health at the University of Waterloo.

“There is no specific federal legislation for e-cigarettes in Canada,” said Hammond. “Let’s be clear: it’s a very small number of devices [exploding/causing fire], but it is a dramatic example of the need for product standards…having some basic rules about how those are designed.”

Kate Ackerman, with the Electronic Cigarette Trade Association of Canada, said in an email to Global News that that e-cigarettes are “not a single product, but a category of thousands of products.”

“Some are not compatible with others,” Ackerman said. “Using non-compatible parts together, as with any electronic or electrical / mechanical device, dependent on battery power, can cause shorts, explosions, fires, or simply not work or work for a short time then develop an issue.”

The USFA report also found that many e-cigarettes come with USB ports for connecting the device to a power adapter provided by the e-cigarette manufacturer.

“Plugging an e-cigarette into a USB port or power adapter not supplied by the manufacturer may subject the battery to higher current than is safe, leading to thermal runaway that results in an explosion and/or fire,” the report read.

E-cigarettes have been touted as a less dangerous alternative for regular smokers trying to kick the habit. The battery-powered devices use a liquid to produce vapour, which is then inhaled. Some of the liquids are infused with nicotine, some aren’t.

Health Canada says on its website that e-cigarettes that are sold with e-juice containing nicotine, or which make health claims, fall under the Food and Drug Act, a law that requires Health Canada’s approval to import, advertise or sell the products.

“No electronic smoking product has yet been authorized for sale in Canada,” according to Health Canada.

But Hammond says there’s a caveat to that.

“If products don’t contain nicotine and they don’t make any sort of health claim about quitting then they can just be sold,” he said.

Instead the responsibility of regulating e-cigarettes has fallen to provincial governments, which means differences from province-to-province.

In Alberta, while there is currently no provincial legislation regarding the sale of e-cigarettes, several city councils, including Edmonton and Calgary, have passed bylaws to ban smoking e-cigarettes, or vaping, anywhere cigarette smoke is not allowed.

Last May, Nova Scotia became the first province to pass legislation treating e-cigarettes the same way as regular cigarettes including banning electronic cigarettes in indoor public spaces, barring anyone under the age of 19 from purchasing e-cigarettes, and prohibiting the display of e-cigarettes visible to minors.

British Columbia, New Brunswick, and Quebec have all passed similar legislation and other municipalities have limited e-cigarette use in public spaces (Vancouver) or municipal offices (Toronto). Ontario has passed legislation banning the sale cigarettes to minors under the age of 19 that went into effect Jan. 1. The Liberal government, however, delayed plans to ban vaping and the use of electronic cigarettes in public places.

The products have not only posed a challenge in terms of regulation but are also divisive amongst anti-tobacco advocates as some believe e-cigarettes perpetuate nicotine addiction, lead to smoking among teens and undermine smoking bans.

David Sweanor, an adjunct professor of law at the University of Ottawa, has spent 30 years as a public health advocate and sees e-cigs as an alternative to cigarettes.

“We’ve ended up with an industry that is largely self-regulated,” Sweanor said. “But it’s becoming a more controlled market over time. If anything the products have become much better.”

Sweanor says there is “no question” that e-cigarettes can be a helpful smoking aide.

“The reality is 37,000 Canadians are going to die this year as a direct result of cigarette smoking, most of them are saying, ‘I wish I didn’t smoke,’ but they are dependent on nicotine,” said Sweanor. “The whole idea of alternatives to cigarettes as a way of getting rid of cigarettes has absolutely enormous public health potential.”

Hammond says the issues with e-cigarette regulation will continue to be contentious.

“E-cigarettes almost certainly have some health risk, but that risk will be substantially lower than smoking cigarettes,” he said. “In terms of the overall health it will be determined by who uses them and for what.”

A statement to Global News from a Health Canada official pointed out the organization is currently investigating the issue.

“Health Canada is committed to moving forward with an evidence-based approach to vaping products that is tailored to the Canadian context. The Department is actively reviewing health and safety data and scientific studies.”