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February 1st, 2017:

Bedford lost £14m last year due to smoking breaks

Figures released this week show smoking costs Bedford borough’s economy almost £34million a year.

But the biggest cost to the economy is not early deaths (£8.79million), smoking-related disease (£4.25million) or lost productivity because of sick days (£2.48million), says Action on Smoking and Health (ASH).

Instead the big cost is from people taking smoking breaks – reckoned to have cost Bedford firms nearly £14million last year because of lost productivity.

Councillor Louise Jackson, portfolio holder for public health, said: “Both councils and the NHS are experiencing severe funding pressures so these costs are not sustainable.

“Smoking remains the single largest cause of preventable death and illness in Bedford Borough, and the council provides free advice and support to help smokers to stop.

“People who use the stop smoking service are up to four times more likely to quit and last year we helped more than 700 people to successfully stop.

“For advice and support call 0800 013 0553.”

Deborah Arnott, chief executive of ASH, said: “We know that most local authorities remain committed to reducing smoking but key services are under threat from public health funding cuts.”

One Way e-Cigarettes May Up CV Risk: Altering HR Variability

Habitual e-cigarette use may increase the risk of cardiovascular disease by shifting the cardiac autonomic balance toward greater sympathetic activity and increasing oxidative stress, according to new research[1].

“The central message for cardiologists from our study is that habitual e-cigarette use is associated with altered heart-rate variability in the same pattern seen in tobacco cigarette smokers,” Dr Holly R Middlekauff (David Geffen School of Medicine, University of California, Los Angeles) told heartwire from Medscape.

“This pattern of heart-rate variability has been associated with increased risk of myocardial infarction and sudden death in patients with heart disease, as well as in populations without known heart disease. Furthermore, habitual e-cigarette use is associated with increased susceptibility to oxidative stress, a critical component in the development of atherosclerosis,” she said.

Middlekauff and colleagues conducted a study involving 23 self-identified otherwise-healthy e-cigarette smokers and 19 otherwise-healthy nonusers between 21 and 45 years old in 2015 and 2016.

Using electrocardiography and blood tests, they analyzed heart-rate variability by high-frequency component, which signals vagal activity, low-frequency component, which mixes vagal and sympathetic activity, and the ratio of low frequency to high frequency, which reflects the cardiac sympathovagal balance.

The researchers found the high-frequency component to be significantly decreased in e-cigarette users compared with nonusers (standard error of the mean [SEM], 46.5 nu vs 57.8 nu; P=0.04). They found the low frequency and the low–to–high-frequency ratio to be significantly increased (mean [SEM] 52.7 nu vs 39.9 nu; P=0.03; mean [SEM] 1.37 vs 0.85; P=0.05) in e-cigarette users, which they write as being consistent with sympathetic predominance.

They found plasma cotinine levels to be significantly related with each heart-rate variability components, inversely to high frequency (P =0.04) and directly to low frequency (P=0.03) and low–to–high-frequency ratio (P=0.03).

They also found LDL oxidizability to be significantly increased in 12 e-cigarette users compared with 18 nonusers (mean [SEM] 3801.0 U vs 2413.3 U; P=0.01). Paraoxonase-1 tended to be lower in e-cigarette users, which they write as being consistent with less protection against oxidative stress.

The researchers pointed out that both increased cardiac sympathetic activity and increased oxidative stress are known mechanisms of how tobacco smoking increases the risk of cardiovascular disease.

“We can conclude that habitual e-cigarette use is associated with physiologic effects. Nonetheless, we cannot confirm causality on the basis of this single, small study; further research into the potential adverse cardiovascular health effects of e-cigarettes is warranted,” the researchers write in an article published online February 1, 2017 in JAMA Cardiology.

Middlekauff said cardiologists should be telling their patients, “E-cigarettes have real, physiologic, adverse effects. If you don’t already smoke tobacco cigarettes, don’t start using e-cigarettes. They are not harmless.”

As for further research, she added, “We need to know whether the cardiac risks associated with e-cigarettes are as great as those associated with lethal tobacco cigarettes. We need to know which component of the e-cigarette aerosol is driving these adverse physiologic effects.”

In an accompanying editorial[2], Dr Aruni Bhatnagar (University of Louisville, KY) writes that the nicotine in e-cigarettes “is a strong vasoactive drug that can profoundly affect cardiovascular function and health. . . . It has been shown that smoking e-cigarettes increases heart rate as well as diastolic and systolic blood pressure to levels comparable with those observed with conventional cigarettes.”

He praised the researchers involved in the new study: “Such investigations are critical for evaluating how harmful e-cigarettes are and whether their widespread acceptance will decrease the incidence of cardiovascular disease or, by renormalizing smoking and promoting nicotine addiction, erode public-health gains made by evidence-based tobacco control and regulation.”

Outside supporters of this research included the American Heart Association, the National Institute of Environmental and Health Sciences, and the Irma and Norman Switzer Dean’s Leadership in Health and Science Scholarship program. The authors and editorialist reported no relevant financial relationships.

Stub it out: Smoking challenge for hospitals in Wales

On a crisp afternoon a group of school children stand outside Prince Charles Hospital holding their handmade no smoking posters.

“Please don’t smoke outside our hospitals”, they shout in unison.

As ambulances pull up outside the Merthyr Tydfil A&E department, the 10 and 11 year-olds watch as patients and visitors light up, puffing smoke into the air.

“We’ve seen a number of people smoking next to no smoking signs”, their teacher Kelly-Anne Crane said.

In the last six months alone 783 smokers at Prince Charles and Royal Glamorgan hospitals, in Llantrisant, have been asked to stub it out by security guards.

Cwm Taf University Health Board – who manage the sites – say they are doing everything they can but people have a “total disregard” to the signs plastered across their NHS grounds.

And they are not alone. While all seven health boards in Wales have smoke free policies in place they say they are “powerless” to stop people lighting up, as they are not yet backed by legislation and so smokers are not breaking any laws.

The Public Health Wales Bill – which is currently going through the Assembly for the second time – would make it illegal to smoke on hospital grounds, giving the board’s the much needed legal backing to issue fines to smokers flaunting the rules.

The Welsh Government said the bill will “build on existing voluntary smoking bans in order to aid enforcement”.

Betsi Cadwaladr University Health Board – who manage hospitals across north Wales – said the public “do not respect” requests to not smoke on their sites.

They said that without legislation to back them up they had to rely on the “courtesy and consideration of smokers” not to light up, and despite extensive signage and recorded messages triggered a cigarette is sensed nearby, people still ignored their policy.

A spokesman said: “We do encourage members of staff to challenge smokers who are causing a nuisance but unfortunately this can provoke a negative or aggressive reaction, which understandably makes busy colleagues reluctant to continue asking people to put out their cigarettes or move away from entrances.”

It is not just the contradictory image of patients in dressing gowns smoking outside the place they are being treated which concerns health boards and bodies like the British Medical Association (BMA).

Health boards have concerns about smoke drifting through windows into wards, passive smoking, and the impressionability of the growing number of young people receiving treatment on their sites.

Cwm Taf are now hoping the words of children will make people think twice about smoking outside their buildings.

Local school children like those from Cyfarthfa High, have designed special posters detailing the dangers of smoking.

If the posters fail the board is considering introducing push-button tannoys – which staff, patients and visitors can trigger if they spot someone defying the rules – which could use children’s voices to tell smokers to stub it out.

Dr Chris Jones, chair of Cwm Taf, said: “Hospitals are for people who are sick and smoking causes illness.

“I don’t think the health board is enforcing anything, we are encouraging people do to the right thing.

“We offer support and advice: it is not about being oblivious to the fact that giving up is difficult, but there is evidence that adults listen to children.”

Hywel Dda University Health Board already has a push-button system at the entrances to their acute hospitals, but said it has not stopped some people.

A spokesman said: “Everyone has the right to breathe fresh air, especially when visiting a healthcare facility, and we regularly receive complaints about people smoking on our sites.

“We understand that visiting a hospital can sometimes be a stressful experience but we expect smokers to adhere to our smoke free policy and they should anticipate being asked to leave our hospital sites if they wish to continue smoking.”

Cardiff enforcement officers challenged 6,708 smokers outside the University Hospital of Wales and University Hospital Llandough, in two years.

Trina Nealon, principal health promotion specialist for Cardiff and Vale University Health Board said hundreds of people were challenged every month.

While there have been no reported cases of verbal or physical abuse against staff challenging smokers, the board said it knows some staff feel uncomfortable challenging visitors and patients who are dealing with stressful situations.

“We are not taking away anything from anyone,” Ms Nealon said, adding that patients were given support to try and quit smoking on admission.

“How we see it is smoking is an addiction, and we are giving people an opportunity to actually give up that addiction.

“Generally speaking people are receptive and they put out their cigarette, understanding that they are in a hospital where people are there to get better and are there to get treated.”

‘Culture change’

Aneurin Bevan University Health Board said that while there had been a significant reduction in smoking at their hospitals “disappointingly there are some people who will continue to smoke despite all the messages.”

Powys was the only health board who said they had little difficulty with smoking – “possibly as a result of only having community hospitals”

While there is hope that the new legislation would help health boards to challenge smokers, they appear to be under no illusion that the threat of fines will stub out the problem for good.

“It may not stop them smoking. We are hoping that it will lead to a culture change and people will accept that smoking in a hospital setting shouldn’t be allowed,” said Ms Nealon.

Study adds to evidence that electronic cigarettes are not harmless

A study published in JAMA Cardiology has added to growing evidence that electronic cigarettes (e-cigarettes) are not harmless.1

“Studies like this give further confirmation that e-cigarettes are not harmless,” said European Society of Cardiology cardiovascular prevention spokesperson Professor Joep Perk.

“If I was a minister of health I would put my efforts into public anti-smoking campaigns especially directed towards the younger generation, and not promote e-cigarettes as an alternative to smoking,” he continued. “There are studies also showing that people that start with e-cigarettes have a tendency to become persistent tobacco cigarette smokers as well.”

The 2016 European guidelines on cardiovascular disease prevention flagged up the need for further research on the long-term effects of e-cigarettes.2

The current study included 23 habitual e-cigarette users (used most days for at least one year) and 19 non-users between the ages of 21 and 45 years. It found that habitual e-cigarette users were more likely than non-users to have increased cardiac sympathetic activity (increased adrenaline levels in the heart) and increased oxidative stress – known mechanisms by which tobacco cigarettes increase cardiovascular risk.

The authors said the findings “have critical implications for the long-term cardiac risks associated with habitual e-cigarette use” and “mandate a re-examination of aerosolized nicotine and its metabolites”. They added that causality could not be confirmed on the basis of this single, small study, and that further research into the potential adverse cardiovascular health effects of e-cigarettes is warranted.

“Nicotine stimulates the central nervous system, so it’s not at all surprising that people continuously taking nicotine get this sympathetic stimulation,” said Professor Perk. “This then might lead to irregular heartbeat and raised blood pressure, and probably has long-term deleterious effects on the blood vessel walls.”

“It is too large a step to say that these negative effects are proof that people are going to die early because they used e-cigarettes,” he continued. “To prove this you have to put people on e-cigarettes for 10 to 15 years and see how many die early – a study that will not be done for ethical reasons. The weakness of all studies in this field is that they are observational and small, and they look at indicators of vascular wall damage rather than incidence of cardiovascular disease or death.”

Professor Perk said that, even after this study, e-cigarettes could still be used to help people stop smoking tobacco cigarettes, but they should be used with caution and other methods should preferably be tried first.

He said: “E-cigarettes are one of the tools we have in nicotine replacement therapy but as clinicians we should be cautious of putting people on large amounts of central nervous system stimulant drugs. Other smoking cessation schemes, such as chewing gum or patches, always include the decision to taper off use and eventually stop. This is not in general the case with e-cigarettes, which tend to be seen as a replacement and not a weaning off nicotine addiction. In fact they prolong the addiction.”

“This is an area where we need more knowledge,” continued Professor Perk. “The more data we collect, the more it seems that nicotine replacement strategies that taper off and ultimately end nicotine use are the way to go.”

“At the end of the day the best thing is simply to prevent people ever getting into the vicinity of nicotine,” he concluded.

University seeks heavy smokers for landmark study on e-cigarette safety

A university is seeking smokers to take part in the first study into the long-term safety of switching to e-cigarettes.

Researchers at St George’s, University of London, want to assess the impact on the risk of cancer, brain activity, and quality of life indicators such as sleep.

The pilot study, which is looking for 100 volunteers, is part of the EU’s £3.4 million Smoke Free Brain project.

It is being carried out with Public Health England and its results could help determine whether e-cigarettes are offered on the NHS as a smoking cessation aid.

E-cigarettes have been available for a decade and are used by 2.8 million UK adults.

A report last year from the Royal College of Physicians said the long-term risks of vaping were unlikely to exceed five per cent of those associated with smoking, and called for e-cigarettes to be promoted as a tobacco substitute.

However, PHE says “reasonable concerns” remain about the long-term health risks and public health impacts, with “variable” research and “poorly sourced scare stories” in the media.

There is no e-cigarette product available that can be prescribed on the NHS.

The study will require participants to attend a clinic at St George’s hospital, in Tooting, six times over a month to give blood, saliva and urine samples and undergo electroencephalography, a non-invasive brain monitoring tool.

Those taking part will be “heavy smokers” — more than 10 a day for at least six months. The study aims to find ways to help people quit for good.

Dr Alexis Bailey, senior lecturer in neuropharmacology at St George’s university, said: “We are looking for smokers who want to quit smoking and transition to e-cigarettes for a period of one month.

“E-cigarettes have proved enormously popular, partly because of the harm reduction compared with smoking traditional cigarettes.

However, there is still considerable debate in the scientific community over just how much safer they are and how good they are for smoking cessation.

It is imperative for us to look at the science behind this and get the full toxicological picture.”

The main objective is to monitor how the measures of toxicity change when people switch to e-cigarettes.

Although e-cigarette aerosol does not contain many of the harmful chemicals present in tobacco smoke, it does typically contain nicotine and other chemicals.

The first results are expected in a year. Dr Bailey said: “There are many studies looking at e-cigarette use in terms of smoking cessation and various respiratory disorders and cardiovascular disease.

“What is different from our study is nobody else has measured the effect of transitioning from smoking to e-cigarettes on various toxicity markers which could potentially induce cancer.

“We are expecting to see these markers quite elevated in chronic smokers, and once they transition to e-cigarettes, these carcinogenic markers to reduce.

“I think we are doing a very important study. It has the potential to drive policy.”

Standardised Packaging and Tobacco Products Directive

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Campaign Art: What’s the real cost of smoking?

People, Spaces, Deliberation bloggers present exceptional campaign art from all over the world. These examples are meant to inspire.

The real cost of smoking is high, especially high on your health. According to the World Health Organization (WHO), tobacco kills around 6 million people each year, out of which 600,000 are the results of non-smokers being exposed to second-hand smoke. The cost of smoking is also high on the global economy, as smoking burdens global health systems, hinders economic development, and deprives families of financial resources that could have been spent on education, food, shelter, or other needs.

Tobacco use is the world’s leading underlying cause of preventable death. It contributes to a great number of non-communicable diseases (NCDs), which account for 63% of all deaths. Prevention of tobacco use can significantly decrease the number of preventable deaths worldwide, encourage economic development, reduce poverty, encourage healthy lifestyle choices and support Sustainable Development Goals.

In order to prevent and reduce youth tobacco use, in February 2014 the U.S. Food and Drug Administration (FDA) put forward a national public education campaign titled “The Real Cost.” The following video is a part of this campaign:

It is no surprise that tobacco is made of extremely toxic materials. But did you know that “Tobacco smoke contains more than 7000 chemicals, of which at least 250 are known to be harmful and at least 69 are known to cause cancer?” Here are some of the chemicals contained in tobacco smoke:


What are the global actors doing about this issue?

Many of the international organizations, government agencies, civil society organizations, private sector, communities, and private citizens raising awareness about the negative effects of smoking, funding programs to decrease global tobacco use, and promoting smoke-free lifestyles. Many of them also agree that tobacco tax increases are the single most effective policy to reduce tobacco use. Tobacco tax increases reduce consumption and promote quitting, they are inexpensive to implement, and they are especially effective in reducing tobacco use by vulnerable populations. (Tobacco use is increasingly concentrated in populations with the lowest income and socioeconomic status, and explains a large proportion of socioeconomic disparities in health.)

In the fight against tobacco use, the World Bank Group (WBG) is making its mark. Fully aligned with the WBG’s twin goals of ending poverty by 2030, and boosting shared prosperity, global tobacco control has become a development priority for WBG. Since 1991 the WBG’s policy has been not to lend, invest in, or guarantee investments or loans for tobacco production, processing, or marketing. WBG’s Tobacco Control Program assists selected countries in fostering and implementing tobacco tax reforms to achieve public health goals by reducing tobacco affordability and consumption, and controlling illicit trade on tobacco.

Reducing Smoking Prevalence through Tobacco Taxation in Ukraine

Modeling the Long-Term Health and Cost Impacts of Reducing Smoking Prevalence through Tobacco Taxation in Ukraine

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E-cigarettes and National Adolescent Cigarette Use: 2004-2014



E-cigarette use is rapidly increasing among adolescents in the United States, with some suggesting that e-cigarettes are the cause of declining youth cigarette smoking. We hypothesized that the decline in youth smoking changed after e-cigarettes arrived on the US market in 2007.


Data were collected by using cross-sectional, nationally representative school-based samples of sixth- through 12th-graders from 2004-2014 National Youth Tobacco Surveys (samples ranged from 16 614 in 2013 to 25 324 in 2004). Analyses were conducted by using interrupted time series of ever (≥1 puff) and current (last 30 days) cigarette smoking. Logistic regression was used to identify psychosocial risk factors associated with cigarette smoking in the 2004-2009 samples; this model was then applied to estimate the probability of cigarette smoking among cigarette smokers and e-cigarette users in the 2011-2014 samples.


Youth cigarette smoking decreased linearly between 2004 and 2014 (P = .009 for ever smoking and P = .05 for current smoking), with no significant change in this trend after 2009 (P = .57 and .23). Based on the psychosocial model of smoking, including demographic characteristics, willingness to wear clothing with a tobacco logo, living with a smoker, likelihood of smoking in the next year, likelihood of smoking cigarettes from a friend, and use of tobacco products other than cigarettes or e-cigarettes, the model categorized <25% of current e-cigarette-only users (between 11.0% in 2012 and 23.1% in 2013) as current smokers.


The introduction of e-cigarettes was not associated with a change in the linear decline in cigarette smoking among youth. E-cigarette-only users would be unlikely to have initiated tobacco product use with cigarettes.

EvilBane gives back to the people

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