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April 12th, 2016:

Snus undermines quit attempts but not abstinence

A randomised clinical trial among US smokers



Observational studies and a few clinical trials suggest that use of low nitrosamine smokeless tobacco (snus) can facilitate smoking cessation. To better understand the real-world impact of snus on smoking behaviour, a large-scale, long-term clinical trial of naturalistic snus use among smokers is needed.

Study design

A nationwide clinical trial compared abstinence outcomes among smokers who were randomised to receive free samples of snus versus not. Participants (N=1236) were recruited throughout the US and assessed for 1 year following a 6-week naturalistic sampling period, with high retention throughout. Primary outcomes included self-reported quit attempts, floating abstinence (any 7-day period of non-smoking) and 7-day point-prevalence abstinence at 6 months and 12 months. Secondary outcomes were changes in smoking, motivation and confidence to quit and adverse events. No tobacco industry support was provided.


Within snus group, 82% used at least once, and 16% were using regularly at end of sampling period. Compared to control participants, smokers in the snus group were less likely to make any quit attempt (RR=0.83; 95% CI 0.70 to 1.00), and any 24 h quit attempt (RR=0.77; 95% CI 0.63 to 0.95). There were no group differences on any measure of abstinence.


Provision of snus in a naturalistic context resulted in minimal uptake, and as a whole, undermined quit attempts and did not increase smoking abstinence. Results do not support the unguided, free provision of snus among smokers not motivated to quit as a means to facilitate quit attempts.

Trial registration number NCT01509586, Results.

Reasons for Electronic Nicotine Delivery System use and smoking abstinence at 6 months

A descriptive study of callers to employer and health plan-sponsored quitlines



Describe cigarette smoking abstinence among employer and health plan-sponsored quitline registrants who were not using Electronic Nicotine Delivery Systems (ENDS), were using ENDS to quit smoking or were using ENDS for other reasons at the time of quitline registration.


We examined 6029 quitline callers aged ≥18 years who smoked cigarettes at registration, and completed ≥1 counselling calls, baseline ENDS use questions and a 6-month follow-up survey (response rate: 52.4%). 30-day point prevalence smoking quit rates (PPQRs) were assessed at 6-month follow-up (ENDS-only users were considered quit). Data were weighted for non-response bias. Logistic regression analyses controlled for participant characteristics and programme engagement.


At registration, 13.8% of respondents used ENDS (7.9% to quit smoking, 5.9% for other reasons). 30-day PPQRs were: 55.1% for callers using ENDS to quit, 43.1% for callers using ENDS for other reasons, and 50.8% for callers not using ENDS at registration. Callers using ENDS for other reasons were less likely to quit than other groups (adjusted ORs=0.65–0.77); quit rates did not significantly differ between non-ENDS users and those using ENDS to quit. Among callers using ENDS to quit at baseline, 40% used ENDS regularly at follow-up.


ENDS users not using ENDS to quit smoking were less successful at quitting at 6-month follow-up compared with callers using ENDS to quit smoking and callers who did not use ENDS at programme registration. Incorporating reasons for ENDS use may be important for future studies examining the role of ENDS in tobacco cessation.

Electronic cigarette marketing tactics in mainland China

China produces 41% and consumes >38% of the world’s cigarettes.1 It is also a global production and export centre of the electronic cigarette (e-cigarette) industry. Around 95% of the world’s e-cigarettes are manufactured in China, mainly in the southeastern metropolis of Shenzhen,2 but the market share of e-cigarettes is tiny within the country.2 According to the most recent data of the International Tobacco Control Survey, only 2% of adult current or former smokers in China had ever used e-cigarettes in 2009.3 However, e-cigarette use has become increasingly popular, particularly among young people.4 The large smoker population and the hardening tobacco control measures (many cities have enacted local smoke-free laws,5 and a nationwide smoke-free law has been drafted6) create a huge potential for the e-cigarette market in the country…

Two retailers’ licences suspended for selling tobacco to minors

Both retailers have had their tobacco retail licences suspended for six months, according to the Health Sciences Authority.

SINGAPORE: The licences of two tobacco retailers have been suspended for six months for selling tobacco products to minors under 18 years of age, the Health Sciences Authority (HSA) announced in a media release on Tuesday (Apr 12).

The retailers are:

• Fair Inn Food Place, located at 806 Woodlands Street 81 #01-115
• H.R Frozen Food and Trading, located at 205 Choa Chu Kang Central #01-K1

Fair Inn Food Place will not be allowed to sell tobacco from Jan 22, 2016, to Jul 21, 2016, while H.R Frozen Food and Trading’s suspension is from Mar 2, 2016, to Sep 1, 2016.

HSA said this was the outlets’ first offence. One of the sellers was an employee, while the other was a co-owner of the retail store. “Both sellers had failed to check the age of the minors before selling tobacco products to them.”

They were apprehended via HSA’s ground surveillance and enforcement activities to deter the illegal sale of tobacco products to minors, the authority said.

HSA said that those caught selling tobacco products to persons below the age of 18 are liable to a maximum S$5,000 fine for a first offence and up to S$10,000 for a second or subsequent offence.

It added that the tobacco retail licence will be suspended for six months for the first offence and revoked for the second offence. However, if any outlet is found selling tobacco products to minors under 18 and wearing school uniform or below 12 years old, the licence will be revoked, even if it is the first offence.

In the last three years, HSA has suspended 25 tobacco retail licences and revoked 21 of them, it said.