Clear The Air News Tobacco Blog Rotating Header Image

April, 2016:

Marlborough Man 2016: Smoking icon has swapped his horse for a helicopter and become a Stetson-wearing WOMAN in new e-cigarette ad campaign

The old fashioned Marlboro Man has been replaced by a woman

The new face of e-cigarettes is shown using a helicopter to round up cattle

Imperial Tobacco campaign received a boost after a report released by the Royal College of Physicians (RCP) backed E-cigarettes

After using a helicopter to round up a large herd of cattle in the wild west, the Stetson-wearing herder pulls down her bandana and takes a puff from her blue-tipped e-cigarette.

The old fashioned Marlboro Man has been replaced by a woman for the face of the new e-cigarette ad campaign.

However her career was facing an uncertain future with television adverts promoting e-cigarettes set to be banned next month under an EU directive on tobacco.

The World Health Organisation had warned in 2014 that vaping was dangerous but now Imperial Tobacco’s blu e-Cigs campaign received a boost after a report released by the Royal College of Physicians (RCP) backed E-cigarettes.

The RCP’s new report concluded that e-cigarettesbring benefits for public health and said they should be widely promoted to smokers to help them quit tobacco.

In a report likely to further fuel a debate over electronic cigarettes, the influential British doctors group also stressed that tobacco smoking is both addictive and lethal but concluded that e-cigarettes are ‘much safer than smoking’.

E-cigarettes are not a gateway to smoking, the RCP said, and do not lead to the normalisation of the habit – two issues often cited by critics who fear the devices can lure children and young people into smoking habits.

‘None of these products has to date attracted significant use among adult never-smokers, or demonstrated evidence of significant gateway progression into smoking among young people,’ the RCP’s 200-page report said.

E-cigarettes, which heat nicotine-laced liquid into vapour, have rapidly grown into a global market for ‘vaping’ products that was estimated at around $7 billion in 2015.

Tobacco smoking kills half of all smokers, plus at least another 600,000 people a year non-smokers via second-hand smoke.

This makes it the world’s biggest preventable killer, with apredicted death toll of a billion by the end of the century,according to the World Health Organization (WHO).

Many public health experts think e-cigarettes, or vapes,which do not contain tobacco, are a lower-risk alternative to smoking, but some questions remain about their long-term safety.

Linda Bauld, a professor at Stirling University, deputy director of the UK Centre for Tobacco and Alcohol Studies and aco-author of the RCP report, said that unlike tobacco, nicotine does not cause cancer, heart and lung diseases.

‘The ideal is for people to use nothing,’ she said, but when the alternative is smoking, people should be encouraged to use nicotine ‘delivered in a cleaner form than in deadly cigarettes’.

‘This is what tobacco harm reduction is – it reduces the harm from tobacco while recognising that some people will still use nicotine in other safer forms.’

John Britton, chair of the RCP Tobacco Advisory Group which published the report, acknowledged that e-cigarettes were ‘a topic of great controversy’ but said his group’s analysis ‘laysto rest almost all of the concerns over these products’.

The anti-smoking group ASH UK welcomed the report, saying it showed ‘that switching to vaping is a positive and sensible life choice’ for smokers.

‘Electronic cigarette vapour does not contain smoke, which is why vaping is much less harmful,’ said Deborah Arnott, ASH’s chief executive.


With his rugged looks and cool cowboy image, the Marlboro Man was the star of the smoking advertisements until they were scrapped in the late Nineties.

Several actors and models have been the face of Marlboro including David Millar, who died of emphysema in 1987, and David McLean, who died of lung cancer in 1995.

Another who pushed the product, Wayne McLaren, died before his 52nd birthday in 1992 and Dick Hammer – better known for his role as Captain Hammer in the TV show Emergency! – passed away from lung cancer in 1999, aged 69.

It wasn’t until state governments banned the use of humans or cartoons to promote tobacco advertisements in the UK that the role was axed.

Eric Lawson who played the iconic cigarette-puffing cowboy during the late 1970s passed away aged 72 from respiratory failure in January 2014.

Last year Darrell Winfield became the sixth Marlboro man to pass away from an unspecified ‘lengthy illness’ at his ranch in Riverton, Wyoming, while in hospice care.

Winfield was a real-life rancher who worked on a cattle farm in 1968 when he was first discovered by the Leo Burnett advertising agency and transformed into a world-recognized model.

Foreign funders funding anti-tobacco lobby, says ITC’s Y.C. Deveshwar

ITC chairman Deveshwar says certain India-based NGOs are acting at behest of foreign funders based in the US

Guntur: ITC Ltd chairman Y.C. Deveshwar pointed a finger at US-based organizations, whom he accused of “funding” the Indian anti-tobacco lobby, which he said was harming farmers’ interests and indirectly aiding in cigarette smuggling.

Deveshwar did not take any names, but said certain India-based non-governmental organizations (NGOs) were acting at the behest of foreign funders based in the US.

When asked if he had any concrete evidence to back his claims, he said ITC had passed on “some information” to the government.

“This kind of money, where is it is coming from?” Deveshwar asked a group of journalists on Thursday, before answering it himself. “Behind this is vested interests… where money is given into the hands of so-called NGOs, who are being influenced to kill local brands knowing fully well that smuggled cigarettes of some other industry are going to be used here.”

Tobacco companies in the country have stopped cigarette production owing to a lack of clarity on the size of graphic health warnings on cigarette packs. ITC, the maker of brands such as Classic, Gold Flake and Wills Navy Cut, has shut production at all its five cigarette factories since 1 April.

The ministry of health and family welfare said in September that graphic warnings on consumption of cigarettes shall occupy 85% of packing from 1 April. However, in March, a parliamentary committee hearing the issue tabled a report recommending that new pictorial health warnings occupy 50% of front and back panels of a cigarette pack. Previous rules mandated pictorial health warnings to cover 40% of the front face of a cigarette pack.

The ambiguity on the portion of a cigarette pack that should depict graphic warnings on the harmful effects of tobacco consumption has forced cigarette makers to temporarily halt production till unambivalent rules emerge.

“You do not have to terrorize the consumer by covering the whole pack with warning,” Deveshwar said in Guntur, a hub of tobacco sourcing for ITC, the country’s biggest cigarette maker.

Andhra Pradesh, where Guntur is located, accounts for two-thirds of the tobacco sourced by ITC, with Karnataka accounting for the rest.

Deveshwar said the company will invest Rs . 345 crore in Guntur and make it the headquarters of ITC’s agribusiness division, which has a turnover of Rs . 8,000 crore.

ITC will invest Rs . 200 crore in s 0.5 million sq. ft facility that will provide employment to 500 people.

The facility will also house a research division for agri commodities, he said.

Deveshwar said ITC will source chillies, pepper and millets from Andhra Pradesh.

Guntur’s food-safe chillies, or chillies without pesticides and chemicals, have export potential to Europe and the US, Deveshwar said.

The company will also build Guntur’s first five-star hotel by 2019 with an investment of Rs . 145 crore.

The 144-room My Fortune hotel will come up on a 1.44-acre property that earlier was the site of an ITC guest house. “We are taking a leap of faith in anticipation of growth in this region,” Deveshwar said at the media conference.

Ditch tobacco sponsors, health experts warn cultural institutions

1,000 experts sign open letter to London’s leading cultural bodies, including British Museum and Royal Academy, over ‘morally unacceptable’ sponsorship

More than 1,000 healthcare experts, including 57 professors, have signed an open letter calling on some of London’s most respected cultural institutions to abandon their financial links with big tobacco.

The British Museum, the Royal Academy of Arts, the South Bank Centre and the London Philharmonic Orchestra, have long-standing lucrative corporate membership and sponsorship deals with two leading cigarette manufacturers, which are banned from advertising in the UK.

The links have dismayed many in the medical community. “As a doctor specialising in the care of people with emphysema, I see the harm smoking causes every day,” said Dr Nick Hopkinson, reader in respiratory medicine and honorary consultant physician at the National Heart and Lung Institute, who is leading a campaign against the tie-ups.

“Tobacco companies, which rely on getting people addicted to products, which maim and kill, must not be allowed to use arts sponsorship as a way to present [themselves] as respectable.”

Tobacco giant JTI has corporate membership deals with the British Museum, the London Philharmonic Orchestra and the Royal Academy of Arts. JTI pays almost £40,000 a year to the Royal Academy for a premier membership package that sees the company listed in all exhibition catalogues. The company is also a corporate supporter of the Southbank Centre on whose website its logo appears.

British American Tobacco is an associate member of the Royal Academy of Arts and a corporate sponsor of the London Symphony Orchestra.

The Framework convention on tobacco control – to which the UK is a signatory – states that tobacco companies’ investment in corporate social responsibility initiatives should be treated as a form of advertising.

In 2007, Philip Morris International Inc, manufacturer of Marlboro, stopped funding a number of New York art institutions.

In their letter, published in Sunday’s Observer, health experts, including John Moxham, professor of respiratory medicine at King’s College London; Richard Ashcroft, professor of bioethics, Queen Mary University of London; and John Britton, director, UK centre for tobacco and alcohol studies, University of Nottingham; call on cultural organisations to rethink their relationship with big tobacco.

They warn: “Tobacco advertising has now been banned along with sponsorship of sport. However, tobacco companies continue to use sponsorship of some high-profile arts organisations to promote the spurious idea that they are responsible corporate citizens.”

Hopkinson added: “People can’t believe that the galleries, museums, orchestras they love could do this.”

Pressure on the likes of the Royal Academy to drop their links with big tobacco companies comes after BP ended its sponsorship of the Tate after 26 years following anger from environmental groups. The British Museum, National Portrait Gallery and other institutions have also been forced to defend themselves against claims that they accommodated the demands of the oil company, a major sponsor.

In a statement to Hopkinson, Will Dallimore, director of public engagement at the Royal Academy of Arts, said that JTI’s support had “indisputably helped the academy fulfil its endeavours to contribute to the artistic life of the country”.

A spokesman for the London Philharmonic said: “The LPO is grateful to JTI for its support and for providing our organisation with many platforms for us to make classical music more accessible and widen access to the arts.”

A spokesman for the British Museum said: “JTI supports an acquisition fund at the British Museum, which allows us to acquire objects for the museum’s modern Japanese collection. JTI have supported the Museum since 2010. The British Museum is grateful to JTI for their long-term support.”

A spokesman for JTI said: “It seems illogical that in a democratic society like the UK and at a time when funding for cultural and artistic institutions is under pressure, people would want to prevent a legitimate company like JTI from making a contribution to good causes.”

A British American Tobacco spokesman: “Like many other businesses we support art and cultural institutions throughout the UK through corporate memberships. The small amount of corporate memberships we have do not result in our brands being featured anywhere but simply provide the opportunity for our staff, customers and business partners to attend events, concerts and exhibitions alongside other corporate members.”

But Hopkinson suggested that the tobacco firms were using their support for the arts to retain key staff to give themselves a commercial advantage.

“In its annual report, British American Tobacco identifies the difficulty recruiting people because of the industry’s poor reputation, as a risk to its future profits,” Hopkinson said. “Arts sponsorship is one way that the tobacco industry can enable its own employees to deceive themselves about the true nature of what they are doing.”

Antismoking Coalition Gives Big Tobacco a Fight in Indonesia

The densely packed houses along Yogyakarta’s Kali Code River went from drab to a riot of reds, blues, yellows and whites.

Residents did not know who had paid for the elaborate painting job last year. The Yogyakarta press speculated that an unknown company had painted the houses so they would resemble the colorful favelas of Rio de Janeiro.

It turns out the village’s benefactor was Philip Morris International and its “Show Your Colors” advertising campaign. On the side of the Gondolayu bridge that overlooks the settlements sits a giant picture frame, with tag lines hung above it reading, “Create your own story” and “Go ahead.”

The village had been transformed into a giant advertisement for a brand owned by the tobacco company.

The ads were another aggressive marketing attempt by an international tobacco company to gain market share in Indonesia. The country is the second-largest cigarette market in Asia after China, and had the highest male smoking rate in the world — 67 percent, according to a 2011 survey — thanks in part to the popularity of pungent clove cigarettes.

Over the last decade, it has become a last Eden for tobacco companies facing declining smoking rates at home. As late as 2004, international tobacco companies had a marginal presence in the Indonesian market. Today, led by Philip Morris International, they control around 45 percent.

Yet that push has been met by an increasingly potent coalition of mayors, health officials and antismoking groups that has scored some important victories.

In one prominent example, huge cigarette billboards that dominated the highways of Jakarta, the capital, were taken down in 2015, as part of a move to ban outdoor tobacco advertisements by mayors around the country.

Many of the lobbying efforts that led to local regulations, including in Jakarta, were substantially financed by the Bloomberg Initiative to Reduce Tobacco Use, the $600 million fund founded by Michael R. Bloomberg, the former New York mayor.

The Bloomberg Initiative has designated Indonesia one of its five priority countries, and has donated more than $10 million since 2007. The initiative is largely focused on establishing local and regional tobacco control laws in a nation with a highly decentralized government structure.

“It’s a battle — like a war,” Yayi Prabandari, a professor of public health at Gadjah Mada University in Yogyakarta, said of the clash between tobacco companies and tobacco control organizations.

Before the Bloomberg Initiative became active in the country nearly 10 years ago, fewer than 10 cities had laws that restricted smoking in public areas, according to the Campaign for Tobacco-Free Kids, which jointly administers the Bloomberg Initiative’s grant programs in Indonesia. Since then, the group says, more than 170 cities have passed laws heavily restricting smoking in public spaces.

Yet tobacco growing has deep roots here. Indonesia is one of the few countries in Asia that has not signed the World Health Organization’s Framework Convention on Tobacco Control, which mandates strict limits on tobacco advertising and sponsorship.

The Bloomberg Initiative has also created a backlash from smokers’ rights groups, who portray Mr. Bloomberg as a foreign oligarch determined to stamp out Indonesia’s proud tobacco tradition.

“People who smoke today are stigmatized — we’re discriminated against,” said Alfa Gumilang, the chain-smoking secretary general of Komunitas Kretek, a smokers’ rights group that accepts funds from the tobacco industry.

The Indonesian government relies on the tobacco industry for around 10 percent of state tax revenue. Although tobacco is not nationalized, the government issues growth targets; in 2015, the Industry Ministry released a “road map” for the industry calling for expanded cigarette production.

In October, President Joko Widodo visited the United States to promote American investment in Indonesia. While he was there, Philip Morris announced a $1.9 billion expansion of its tobacco factories in the country — the second-largest investment that Mr. Joko secured from an American corporation during his visit.

Philip Morris’s success — it controls 35 percent of Indonesia’s tobacco market through its local subsidiary, Sampoerna — ushered in a new age of foreign expansion. In 2009, British American Tobacco purchased Bentoel, a local tobacco company that is now Indonesia’s fourth largest, with around 7.5 percent market share.

According to Health Ministry officials, Indonesia’s fragmented government ministries often work at cross purposes when tackling the issue.

Because of the difficulty of making sweeping changes to tobacco control laws nationally, Indonesia tobacco control advocates are increasingly pushing for changes at the local and regional levels, where money from the Bloomberg Initiative comes in handy.

Dr. Theresia Sandra, a specialist in chronic lung disease at the Health Ministry, credits the Bloomberg Initiative with helping local governments counter the influence of big tobacco. The group “builds organizations to balance against the strength of industry and opens local governments to the necessity of protecting their communities,” Dr. Sandra said.

In one national success, the Indonesian government, with help from the Bloomberg Initiative, passed a law in 2014 requiring manufacturers to put warning labels on cigarette packaging.

The tobacco fight in Indonesia, the world’s most populous Muslim nation, even extends to the country’s most powerful Muslim organizations, and shows just how central the issue is for society and the economy.

Muhammadiyah, Indonesia’s second-largest Muslim organization, became the first major Muslim group in the country to issue an edict declaring that smoking is forbidden in all circumstances, citing smoking’s devastating consequences to public health.

Today’s Headlines: Asia Edition

Get news and analysis from Asia and around the world delivered to your inbox every day in the Asian morning.

The 2010 decision was significant: Muhammadiyah operates thousands of schools, universities and hospitals around the country. Almost overnight, those places became smoke-free zones.

But the Indonesian media quickly pounced on a funding detail. Posted on the Bloomberg Initiative’s website was a $393,000 grant to Muhammadiyah in 2009. According to Bloomberg’s website at the time, the grant sought “the issuance and dissemination of religious advice on the dangers of tobacco use among Muhammadiyah/Islamic institutions.”

Critics accused Muhammadiyah of seeking to unite Muslim opinion against tobacco in return for the grant money.

Dr. Sudibyo Markus, who led Muhammadiyah’s health department at the time, said there had never been any quid pro quo.

Meanwhile, religious leaders affiliated with Nahdlatul Ulama, Muhammadiyah’s main rival, criticized Muhammadiyah for supposedly bowing to Bloomberg’s money. But Nahdlatul Ulama, which does not view smoking as forbidden in most circumstances, receives funding from the foundation wing of Djarum, Indonesia’s third-largest tobacco company.

The group’s vice chairman, Maksum Mahfudh, said there was “no relationship whatsoever” between the funding and its decision that it would not forbid smoking. He added that moving “drastically” against tobacco would impoverish the farmers and sellers who are “grass-roots people of N.U.”

For now, the two sides appear to have fought to a draw. After steadily rising for a decade, the smoking rate has plateaued, according to the Indonesian Family Life Survey, funded by the United States National Institutes of Health, that was released in April.

Still, Philip Morris International remains optimistic about Indonesia. In a February conference call with investors, André Calantzopoulos, the chief executive officer, said Indonesia remained a good bet.

“We remain optimistic about the profit growth opportunities in this key market thanks to its growing adult population and rising income levels,” he told them

One In Six Children Hospitalized For Lung Inflammation Positive For Marijuana Exposure

A new study to be presented at the Pediatric Academic Societies 2016 Meeting found that one in six infants and toddlers admitted to a Colorado hospital with coughing, wheezing and other symptoms of bronchiolitis tested positive for marijuana exposure.

The study, “Marijuana Exposure in Children Hospitalized for Bronchiolitis,” recruited parents of previously healthy children between one month of age and two years old who were admitted to Children’s Hospital Colorado (CHC) between January 2013 and April 2014 with bronchiolitis, an inflammation of the smallest air passages in the lung. The parents completed a questionnaire about their child’s health, demographics, exposure to tobacco smoke, and as of October 2014, whether anyone in the home used marijuana. Marijuana became legal in Colorado on January 1, 2014.

Of the children who were identified as having been exposed to marijuana smokers, urine samples showed traces of a metabolite of tetrahydrocannabinol (THC), the psychoactive component of marijuana, in 16 percent of them. The results also showed that more of the children were THC positive after legalization (21 percent, compared with 10 percent before), and non-white children were more likely to be exposed than white children.

The findings suggest that secondhand marijuana smoke, which contains carcinogenic and psychoactive chemicals, may be a rising child health concern as marijuana increasingly becomes legal for medical and recreational use in the United States, said lead researcher Karen M. Wilson, MD, MPH, FAAP, an associate professor of pediatrics at the University of Colorado School of Medicine and section head at CHC. Most states with legal marijuana do not restrict its combustion around children, she said.

“Our study demonstrates that, as with secondhand tobacco smoke, children can be exposed to the chemicals in marijuana when it is smoked by someone nearby,” Dr. Wilson said. “Especially as marijuana becomes more available and acceptable, we need to learn more about how this may affect children’s health and development.” In the meantime, she said, “marijuana should never be smoked in the presence of children.”

Whistleblower Stanton Glantz Reflects on Tobacco Control Progress, Emerging Challenges

The name Stanton Glantz is revered by community health advocates and dreaded by the tobacco industry.

The University of California-San Francisco professor and distinguished tobacco control researcher led the movement to call out deceptive marketing messages disseminated by Big Tobacco companies and expose the dangers of tobacco products during the 1990s. His research illuminated the risks associated with secondhand smoke, as well as the correlation between high smoking rates and heart attack deaths in populations. His research has shown the power of strong smoke-free laws in reducing cardiovascular disease.

But despite progress made in the past 20 years to subdue persuasive marketing tactics from the tobacco industry, the work isn’t complete in states like Kentucky, where tobacco-related illness is the leading cause of preventable death. On April 28, Glantz addressed unfinished business in the fight against tobacco and identified modern threats posed by the tobacco industry during his keynote address at the Kentucky Center for Smoke-Free Policy’s annual conference titled “Mobilizing an Army of Smoke-free Advocates.” He commended community advocates in all corners of Kentucky for protecting individual rights to clean air and healthy environments for the more than 70 percent of Kentuckians who aren’t smokers.

“The whole battle is a battle about social norms and social acceptability, and once you win these fights, and you have a law that’s sticking —which takes a while — you don’t go back. And the tobacco companies understand that, and that is why they fight so hard,” Glantz said during his keynote address. “In the end, when you win, you’ve won. And the fight itself is an important part of making these laws work.”

After a stack of papers known as the “cigarette papers” landed at his doorstep in 1994, Glantz analyzed thousands of documents to build evidence against cigarette companies. The documents revealed that tobacco executives were aware of the dangers of their products while using aggressive marketing tactics to put these products in the hands of young adults and adolescents. Glantz published a groundbreaking book, The Cigarette Papers, as an indictment against the tobacco executives and marketers who were misleading the public.

Health experts and smoke-free advocates, including Glantz, have witnessed a resurgence of tobacco industry marketing efforts to target young people and normalize the use of the latest dangerous tobacco product on the market — electronic smoking devices or e-cigarettes. Glantz applied the lessons he learned through exposing the secrets of Big Tobacco in the 90s to the tobacco challenges of today, and said the dangers of tobacco marketing still persist in American society. He also discussed strategies for researchers, activists, and health care workers to resist pro-tobacco sentiments and reduce the burden of tobacco-related illness in their communities.

The KCSP also recognized efforts to promote the health across Kentucky by honoring local communities and municipalities that enacted smoke-free legislation in the past year. The City of Pikeville and the City of Ashland received awards for amending legislation to include e-cigarettes in their smoke-free ordinances. Hazard Community and Technical College received the 2016 Tobacco-free Campus Award. The City of Middlesboro earned the 2016 KCSP Smoke-free Indoor Air Excellence Award for passing a smoke-free workplace ordinance in May 2015.

The 2016 Smoke-free Youth Advocate Award went to the 2015 Middlesboro Destination Imagination Team, a nonprofit group comprising seven fourth- and fifth-graders, their parents, and teachers. The group delivered a presentation about the hazards of secondhand to the Middlesboro City Council and garnered more than 400 signatures for a petition supporting smoke-free legislation, which was adopted in May 2015.

“Embracing this year’s theme of mobilizing an army to end the burden of tobacco, we’re keenly aware of the fact that the tobacco companies have not loosened their grip in Kentucky,” Ellen Hahn, director of the KCSP and the Marcia A Dake Professor in the UK College of Nursing, said. “We’re proud of the communities that are taking a stand against tobacco in all its forms, and it is exciting to see children and adults alike making a big difference in their communities. Still, as Stan Glantz said in his keynote address, our work isn’t finished in Kentucky or across the nation.”

The Kentucky Center for Smoke-free Policy, housed in the UK College of Nursing, conducts research, collects data, and provides resources and strategies to assist advocates working on smoke-free campaigns across Kentucky. The conference was sponsored by UK HealthCare.

Feds look to ban menthol tobacco products

Les Hagen fully supports Ottawa’s plan to end the sale of menthol cigarettes across Canada. He’s the Executive Director of Action on Smoking and Health, and says that menthol and flavored tobacco products are popular among young smokers.

“This is a very very significant measure to keep tobacco companies from targeting youth in this manner. So it’s a very significant step. Obviously Alberta and a number of provinces have already moved on this issue, but we’re delighted to see new national standards.”

Hagen says that smokers are very “brand loyal” and therefore he doesn’t foresee a spike in cross border movement of illegal menthol cigarettes coming up from the U-S.

“Well, some people, if they try hard enough will still be able to get menthol cigarettes, yes, but the experience here in Alberta shows that’s very much the exception to the rule.”

Hagan adds that this move will reposition Canada as a leader in the fight to eliminate tobacco use by being the first nation to ban menthol flavored tobacco.

Can e-cigarette makers stub out addiction concerns?

As vaping culture grows and big tobacco piles in with huge ad budgets, worry over nicotine use lingers

The medical report published this week which finds that vaping could save millions of lives and should be encouraged could be read as a victory for the Marlboro Man of our times, who has swapped his horse for a helicopter and become a woman.

Perhaps you’ve seen the glossy new TV ad, below, and its evocation of an age when cowboys sold a deadly lifestyle. In summary: helicopter corrals cows under big skies, lands next to massive rock; pilot wearing stetson gets out, pulls down bandana and puts an electronic cigarette in her mouth. Its tip glows blue before the setting sun catches the vapour cloud as she exhales.

It’s big-budget and kind of beautiful. But the ad, for Blu eCigs, part of Imperial Tobacco, comes at a tricky time in the rise of an awkward object. Conceived as a nicotine vehicle to deliver the physical, social and chemical appeal of smoking without the aftertaste of death, the electronic cigarette, used by an estimated 2.6 million people in Britain, has rapidly spawned a sub-industry and vaping culture.

But like a curious teenager clutching an Embassy behind a bike shed, we don’t quite seem to know what to do with these new sticks, or what the risks might be. Just as the the Royal College of Physicians (RCP) called on Thursday for the promotion of vaping in the biggest report of its kind, new rules are about to make e-cigarettes harder to buy – and kill off the Blu Woman before she’s even got going.

The EU Tobacco Products Directive, which comes into force on 20 May, will, among other things, outlaw the advertising of electronic cigarettes on TV, radio and in newspapers. It will also set a limit on the nicotine content of the liquid used in the devices, which use a small, battery powered heating element to create the inhalable vapour (the “e-liquid” or “juice” is a blend of organic compounds, natural or synthetic flavourings and nicotine).

The directive follows years of conflicting advice and regulation. There is no public ban on e-cigarettes but local policy varies. You can vape to your lungs’ content inside a Westfield shopping centre, but stray over the carpet into a Starbucks and you’re banned. Doctors haven’t been able to agree either. In 2014, the World Health Organisation said vaping could be dangerous. A year later, Public Health England said it was 95% less harmful than smoking, but its evidence was subsequently doubted in the Lancet.

Perhaps Prof John Britton, chair of the RCP’s tobacco advisory group, which produced the new report, can help navigate this fug of confusion. “A lot of it is psychological,” he says. “There are people who feel sustaining nicotine addiction is wrong. I’ve had those conversations at conferences over coffee, and nobody has seen the irony in it.”

Nicotine isn’t something to seek out but “like caffeine, if it is used in the doses in which smokers use it, it is not significantly hazardous,” Britton adds. “The important thing is to separate it from the smoke, which is what electronic cigarettes do.”

The RCP report “lays to rest almost all of the concerns over these products”, including any suggestion that secondhand vapour can be harmful. But it will be harder to stub out the connotations of smoking. Almost 10 years after the public smoking ban, and more than half a century after the RCP’s pivotal 1962 report, Smoking and Health, which changed our relationship with cigarettes for ever, we are bound to doubt a solution that looks like the problem. Moreover, as the tobacco multinationals catch up with a runaway trend, and sell that solution as a lifestyle, we are understandably wary of the motivations of an industry which has not always welcomed the advice of doctors.

“There’s a suspicion of a commercial, consumer-led rather than medical response,” Britton accepts. “And there are arguments that these products are being used to promote smoking subconsciously … and that the tobacco industry will exploit them to sell more tobacco, particularly in countries with poorer governance.” The professor of epidemiology welcomes proportionate regulation, including the ad ban, as well as theforthcoming move to allow doctors to prescribe licensed vape kits. But while 200,000 children still take up smoking every year in Britain, he believes the participation even of public health villains is a price worth paying if it reduces illness and about 100,000 deaths a year (that’s about one every five minutes).

“We still have nearly 9 million people smoking tobacco every day when we’ve known what to do about it pretty much since 1962,” Britton says. “That’s a reflection of an abject failure of health policy. We’re reducing the number of young people taking up smoking, but we’re not that much better at helping them quit. That’s why the e-cigarette is such a powerful new tool.”

Marc Michelsen is, unsurprisingly, inclined to agree. “We have had an issue with public trust,” admits the public affairs executive at Fontem Ventures, the Dutch firm which owns Blu, and is an “arms-length subsidiary” of Imperial, the British tobacco company. “But a lot of that comes from a lack of scientific understanding.” Blu is delighted with the RCP report, but less keen on the advertising ban. “If you inhibit advertising, fewer people will buy the product and that can’t be good,” adds Michelsen, who denies that Blu’s commerical is a barely veiled Marlboro reboot. “I think it’s pure Mad Max,” he suggests (I must have missed the pastoral scenes in Fury Road). “This campaign is not about the past, we’re looking forward.”

What do vapers think, and who are they anyway? The majority of electronic smokers buy mass-produced products in supermarkets or online, and don’t think a great deal about them beyond their health and financial savings (£200 a month for a 20-a-day smoker, according to vape sites). But a vaping scene has unexpectedly mushroomed to the extent that, for many vapers, nicotine has become a secondary interest.

At the Vape Emporium, a London-based online store with boutiques at Hampstead and Richmond, a vape consultant will talk you through a menu of handcrafted e-pipes and more than 200 flavoured e-liquids. Perhaps you’d like to try the VG by Simple Chocolaccino, which “blends caramel, chocolate, coffee and biscuit for a divine morning vape”. “We now have juices that only contain 1.5mg of nicotine, which is tiny,” says Andy Logan, the emporium’s co-founder. A 24mg/ml mix compares to a strong cigarette, he explains (the new rules will set the maximum at 20mg). “And some people are taking zero nicotine now because they just don’t need it but still enjoy vaping.”

Logan, who set up as an online store in 2013 and is looking for new shopfronts, says vapers follow a familiar path. “At the start they’re adamant they don’t want any funny flavoured rubbish and go for a strong, tobacco-style vape. But after a few weeks they’re trying some crazy flavours and dropping the nicotine because they’ve got their tastebuds back.” Flavour seekers tend to favour fruit, pudding (doughnuts and cakes are popular) or mint and vanilla perfumes, he adds. Some go further, vaping socially in cafes and clubs and discussing equipment and blends. Logan has just exhibited at the second Vape Jam UK, a three-day expo at London’s ExCel centre attended by 300 companies and clubs. “I took my fiancee on the Sunday,” he says. “She had no idea this subculture exists. It’s quite amazing.”

Logan says his customers range from an insanely knowledgable 94-year-old woman to a businessman who comes in for a puff while his driver idles outside in a Bentley.

Vaping is increasingly popular among young people (it is illegal to sell to under-18s), he adds. Meanwhile, the public response to vaping – while still generally somewhere between curious and hostile – is catching up with its rise in popularity. “I still can’t go to a party without facing a barrage of questions, but it is changing,” Logan says.

As a culture emerges and big tobacco piles in with huge advertising budgets, do we risk discouraging nicotine quitting, or even drawing non-smokers into addiction? “Our annual survey of 12,000 adults suggests the level of vaping among non-smokers is steady at about 0.2%, says Hazel Cheeseman, director of policy at Ash, the smoking health charity.

“It’s extremely rare and I don’t think that will ever change,” Logan adds, rejecting the gateway hypothesis. And he doesn’t need it to. “If there are nearly 10 million smokers and only 2 million vapers, we’ve still got a massive, long journey to convert the rest,” he says.

Tobacco Use in the USA

Submitted by Julie Russell, RN Tobacco Prevention Specialist Carter, Fallon, & Powder River County

• High school students who are current (past month) smokers: 15.7 percent (boys: 16.4 percent, girls: 15.0 percent); over 2.6 million
• High school males who currently use smokeless tobacco: 14.7 percent (girls: 2.9 percent)
• Kids (under 18) who try smoking for the first time each day: 2,500+
• Kids (under 18) who become new regular, daily smokers each day: 580
• Kids (3-11) exposed to secondhand smoke: 40.6 percent (Black: 67.9 percent White: 37.2 percent)
• Packs of cigarettes consumed by kids each year: approx. 540 million (nearly $1.2 billion per year in sales revenue)
• Adults in the USA who are current smokers: 16.8 percent (men: 18.8 percent, women: 14.8 percent); approx. 40 million
• Adults in the USA who smoke daily: 12.9 percent Deaths & Disease in the USA from Tobacco Use
• People who die each year from cigarette smoking and exposure to secondhand smoke: approx. 480,000+
• Kids under 18 alive today who will ultimately die from smoking (unless smoking rates decline): 5.6 million
• People in the USA who currently suffer from smoking-caused illness: 16 million+ Smoking kills more people than alcohol, AIDS, car accidents, illegal drugs, murders, and suicides combined, with thousands more dying from spit tobacco use. Of all the kids who become new smokers each year, almost a third will ultimately die from it. In addition, smokers lose a decade of life because of their smoking. For every person who dies from smoking, at least 30 more are suffering from serious smoking-caused disease and disability. Tobacco-Related Monetary Costs in the USA
• Total annual public and private health care expenditures caused by smoking: approx. $170 billion – annual federal and state government smoking-caused Medicaid payments: $39.6 billion (Federal share: $22.5 billion per year. States’ share: $17.1 billion) – Federal government smoking-caused Medicare expenditures each year: $45.0 billion – Other federal government tobacco-caused health care costs (e.g. through VA health care): $23.8 billion
• Annual health care expenditures solely from secondhand smoke exposure: $6.03 billion. Not included above are costs from smokeless or spit tobacco use or pipe/cigar smoking.
• Productivity losses caused by smoking each year: $151 billion (only includes costs from productive work lives shortened by smoking-caused death. Not included: costs from smoking-caused disability during work lives, smoking-caused sick days, or smoking-caused productivity declines when on the job.) Other non-healthcare costs from tobacco use include residential and commercial property losses from smoking -caused fires, tobacco related cleaning and maintenance, and expenditures through Social Security Survivors Insurance for kids who have lost at least one parent from a smoking-caused death.
• Taxpayers yearly fed/state tax burden from smoking-caused government spending: US$960 per household
• Smoking-caused health costs and productivity losses per pack sold in USA (low estimate):US $19.16 per pack
• Average retail price per pack in the USA (including sales tax): US$5.96 Tobacco Industry Advertising & Political Influence
• Annual tobacco industry spending on marketing its products nationwide: US$9.5 billion ($25+ million each day) Research studies have found that kids are three times as sensitive to tobacco advertising than adults and are more likely to be influenced to smoke by cigarette marketing than by peer pressure; and that a third of underage experimentation with smoking is attributable to tobacco company advertising and promotion.
• Tobacco company PAC contributions to federal candidates, 2014 election cycle: More than US$1.8 million
• Tobacco industry expenditures lobbying Congress in 2014: US$22.0 million.

Heterogeneity in the measurement and reporting of outcomes in studies of electronic cigarette use in adolescents

A systematic analysis of observational studies



To examine consistency between cross-sectional studies of conventional and electronic cigarette use among adolescents in terms of the measurement, analysis and reporting of parameters.


A systematic analysis of cross-sectional studies of conventional and electronic cigarette use in adolescents, to identify measured and reported parameters.

Data sources

Studies examining use of electronic and conventional cigarette use in adolescents were identified by searching the SCOPUS database in August 2015.

Study selection

The selection criteria for studies were: cross-sectional studies, in English, on e-cigarette use in adolescents. Two reviewers independently selected relevant studies from the search. 60 abstracts were identified, from which 31 papers were eligible for review (23 unique studies).

Data extraction

Measured and reported parameters were identified and tabulated. These included the prevalence of cigarette and/ or electronic cigarette use, and the definitions of terms. Data were extracted independently by two reviewers.

Data synthesis

With regards basic parameters of ‘ever’ or ‘current’ use of electronic or conventional cigarettes, there were 31 unique measured parameters across 23 studies. Of 16/23 studies in which authors collected information on dual current use, prevalence was reported in 11/16, with six different definitions of ‘dual use’.


There are substantial differences in measurement and reporting of parameters across observational studies of electronic and conventional cigarette use in adolescents. These studies are at risk of reporting bias, and results are difficult to interpret. A core outcome set that should be measured and reported in all observational studies is required, using structured consensus techniques.