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November 23rd, 2016:

What will it take to get China’s 350 million smokers to quit? Public bans, tax hikes on the cards

Promised smoking ban welcome but Margaret Chan urges city mayors to also curb tobacco marketing

China has not done enough to control smoking even though the mainland authorities plan to put a smoking ban into effect within this year, said World Health Organisation Director-General Margaret Chan.

“Tobacco control is very close to my heart and a very important subject for the World Health Organisation,” Chan said at a meeting on the sidelines of the 9th Global Conference on Health Promotion in Shanghai. “The WHO’s member states have developed and adopted the WHO framework convention on tobacco control.”

The world’s largest tobacco market, with 350 million smokers, China has not yet passed a national law to ban smoking in public places. Of more than 600 cities across the country, only 18 have passed their own smoking control regulations.

“I used to say to Chinese officials that you have done well but not enough and there is room for further improvement,” Chan said. “I look forward to seeing the progress of China’s national tobacco control law.”

Mao Qunan, spokesman for the National Health and Family Planning Commission, China’s health authority, said a national law is expected to go into effect within this year.

Chan said she encouraged dozens of mainland city mayors who were attending the conference to introduce regulatory or fiscal measures to prevent the marketing of tobacco products and to stop tobacco sponsorships of sports events.

Mao said the biggest obstacle in the legislation was that the public did not have adequate awareness of the dangers from smoking.

“The Chinese government is beefing up an awareness campaign on smoking control, making laws and reforming the tobacco tax and price system to honour our commitment to the WHO’s framework convention on smoking control,” he said.

The mainland’s tax reform on tobacco products, which began seven years ago, has met strong resistance from tobacco producers and cigarettes sold on the mainland are still among the cheapest in the world, Wu Yiqun, a Beijing-based smoking control campaigner, told the Economic Observer.

The official said that health promotion work, such as smoking control, needed multisector collaboration. “Without support and involvement from other departments, many of our tasks can’t be achieved,” he said.

A Shanghai Declaration on Health Promotion was released at the conference, urging governments across the world to integrate health into their sustainable development agenda.

For a long time, the mainland has been lacklustre in global health rankings for allocating only 5-6 per cent of its gross domestic product to health services. Premier Li Keqiang, in his keynote speech at the conference on Monday, said China’s spending on health services has been increasing year by year over the past few years. He did not give specific figures.

“We will put health in a strategic position and regard it as a priority task. In our development mindset, we should prioritise health and emphasise health goals in our economic and social planning,” Li said. “Public policies should favour health goals and fiscal spending should guarantee the development of health-related causes.”

Nationwide public smoking ban expected by year’s end

A nationwide ban on smoking in public places circulated as a draft two years ago and building upon curbs in nearly 20 Chinese cities is expected to become law by the end of 2016, the Shanghai Daily reported.

Smoking would be prohibited at indoor public venues, on public transportation and outdoors in areas where schools and youth facilities are present, the newspaper said, citing a draft. Smoking in stadiums also would be banned. Mao Qun’an, a senior spokesperson with the National Health and Family Planning Commission, reportedly said the regulation was making its way through the legislative process and would be issued by the end of the year.

A few clarifications about our e-cigeratte study

In the Organic Analytic Laboratory at DRI our main specialty is sampling and detailed chemical analysis of organic air pollutants. Our team has more than 20 years of experience in this area.

E-cigarette research is new for us, but involves similar sampling and analytical techniques. Having seen advertisements for e-cigarettes that claimed they are safe because liquids contain only FDA approved ingredients, we decided to apply our expertise to see what is in e-cigarette vapors. This resulted in publication of the first set of results concerning the role of flavorings in aldehyde formation during vaping.

Following the publication of our paper, we received a lot of attention from media, the blogosphere, and individual vapers. This shows the importance of the problem and we are pleased to have made a contribution to the ongoing discussion of the pros and cons of vaping.

While the news coverage was generally accurate, we noticed some misunderstanding and misrepresentation of the study, especially in comment sections of media articles and on some blogs. For example, we were amazed to see some commenters suggesting that our study was sponsored by the tobacco industry. This is completely untrue. This was an internally funded study. None of us, nor the Desert Research Institute has any connection to the tobacco industry.

A recent blog post by Dr. Farsalinos was also brought to my attention. In his post, Dr. Farsalinos states that our “results contradict previous research on aldehyde emissions” and he makes other assertions that I would like to address here in more detail. By making this statement, Dr. Farsalinos revealed that (a) he is not up-to-date with the current literature, and (b) has not read our paper carefully, because we explicitly compare our results to other studies.

Aldehyde Concentrations

Our paper states (from the top of the right column of page four): “For example, maximal formaldehyde emissions observed in this study are approximately 2−7 times lower than the steady-state emissions measured by Sleiman et al.,9 who reported values ranging from 13000 to 48200 ng/mg. In terms of emissions per puff, our formaldehyde data [0.12−50 μg/puff (Table S3)] are comparable to values of 0.05−50 μg/puff reported by Gillman et al.6 and 30−100 μg/puff reported by Sleiman et al.9”

Yes, the highest observed concentrations in our study, which seem to have caused disbelief in some such as Dr. Farsalinos, are actually several times lower than those reported in another recent study (Sleiman et al.). In Sleiman et al., it is reported that the first few puffs significantly underestimate aldehyde emissions as the coil temperature needs time to come to steady state. Most if not all of the previous studies that reported low aldehyde concentrations did not include warm-up puffs. This is also discussed in our paper.

Flavoring Compounds

Our study also clearly states – “our results do not suggest that PG or VG produces no aldehydes, but that flavoring compounds are responsible for the main part of the emitted toxic aldehydes. Nondetects for unflavored liquids reported in this study are likely due to the small number of puffs that we have used in our measurements. By collecting more puffs per measurement, we could have quantified emissions for unflavored liquids. This quantification, however, is of minor consequence, as the flavored liquids produce significantly more aldehydes than unflavored ones do” (top of the left column on page 5).

We are not contesting the contribution of PG/VG to aldehyde formation. Our point is that flavorings cause significantly higher emissions.

The standard excuse (written about here – of a “dry-puff” to explain aldehyde emissions cannot be applied to our study.

There is only one peer-reviewed paper that asserts that high aldehyde concentrations are due to dry puffs only and that these cause aversion in users. That paper was reviewed in just 11 days and methodological problems have been identified by other researchers – see an review by Shihadeh et al. here

As was discussed above, the evidence is mounting that aldehyde levels in e-cigarette vapors could be dangerously high.


While we do agree with Dr. Farsalinos that the strength of science lies in reproducibility of experimental results and we wish anyone success in reproducing our study, we strongly believe that science requires impartiality and an open mind. Statements such as “I should note that it is impossible to convincingly identify something that went wrong in this study” are derogatory and assume that our study is wrong.

We would also suggest Dr. Farsalinos reproduce studies by Sleiman et al., Gillman et al., and Jensen et al.

It should be also noted that aldehydes and their DNPH adducts are chemically unstable. Experience and outmost care are required to obtain accurate results.

While we are not interested in proving or disproving Dr. Farsalinos’ dry puff study, we have collected some preliminary data that contradicts conclusions of that study regarding high aldehyde levels causing an “unpleasant” sensation during vaping.

We are collecting data for secondary aldehyde exposure associated with vaping. To estimate secondary emissions, we collected exhaled breath from three research volunteers, who were asked to vape as they normally do in a real-life scenario. The results are shown in the unpublished graph below (DO NOT CITE).

The levels are comparable to what we have measured per puff. One volunteer produced higher concentrations, because a different device was used. None of our volunteers complained about anything unpleasant during their vaping.


We continue working on characterizing other pollutants in e-cigarette vapors and have data collaborating the effect of flavoring additives we reported in the ES&T.

Stay tuned for more exciting results and important research findings from our team!

– Andrey Khylstov, Ph.D