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Rassegna Stampa Scientifica Luglio 2023
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"Councils are joining paediatricians in calling for a ban on disposable vapes owing to the environmental damage they cause and the soaring number of young people taking up the addictive products. The Local Government Association (LGA), which represents councils in England and Wales, said urgent action was needed to save taxpayers’ money – as single-use e-cigarettes are costly to recycle without going through special treatment – protect the planet and keep children safe. With the EU proposing a ban from 2026 and France due to introduce one this December, there are concerns that more vapes could flood into the UK." [Sarah Marsh, Councils in England and Wales join calls for ban on disposable vapes, The Guardian]
“The British Medical Association (BMA) will review the potential dangers of vaping in a bid to tackle the “growing epidemic” of e-cigarette usage. At its annual representative meeting in Liverpool on Wednesday, [July 5], the BMA was urged to explore the dangers of vaping, as well as calling for plain packaging on e-cigarettes in line with tobacco and cigarettes. The motion, which was approved by members, also urged a ban on flavoured vapes and said more should be done about products being sold to under 18s illegally… Last month, NHS [National Health Service] figures revealed 40 children and young people were admitted to hospital in England last year for “vaping related disorders”, up from 11 two years earlier.” [Storm Newton. Review to tackle ‘growing epidemic’ of vaping, The Independent]
"The number of women diagnosed with lung cancer in the UK is expected to overtake men this year for the first time... Cancer experts said the “very stark” figures reflected historical differences in smoking prevalence, specifically that smoking rates peaked much earlier in men than women. Women should now be as alert to potential lung cancer signs as they were about checking for lumps in their breasts, they said... Ministers must do more to help smokers to quit, [Cancer Research UK’s prevention policy manager Alizée] Froguel said. “Lung cancer causes more deaths in the UK than any other cancer type, and smoking is by far the biggest cause of the disease. But funding cuts have meant that there aren’t enough public health campaigns to encourage people to quit smoking, and many people don’t have access to the services that will support them to do so.”" [Andrew Gregory. Lung cancer diagnoses of UK women to outnumber men’s for first time, The Guardian]
“German Health Minister Karl Lauterbach is pushing for a ban to prevent smoking in cars where minors and pregnant women are passengers, German media group RedaktionsNetzwerk Deutschland (RND) reported on Friday [July 7]… Smoking in cars is not currently illegal in Germany. The plan, which is part of Lauterbach's draft proposal to legalize cannabis, aims to expand the existing Non-Smokers Protection Act… The expansion of the smoking ban, which already applies in public transport, is intended to "ensure the necessary protection from passive smoking for this particularly vulnerable group of people," according to the draft cited by RND. Smoking in cars has been proven to pose higher risks due to the small space volume.” [No author. Germany: Minister plans ban on smoking in cars with children, DW]
“The papers in this issue provide further insight into e-cigarettes and can inform what might be done to maximise their benefits and reduce their harms. Clearly, the heterogeneity of the e-cigarette—for example, the range of design features of the devices and liquids that influence their appeal, the variation in use patterns and the extent to which they deliver nicotine and other chemicals to users—poses many challenges for research as well as for regulation. The continued rapid change in the products that are available and how they are marketed does not help. From a policy perspective, we need to remain open-minded about the interventions that could achieve our policy goals, evaluate their impacts and unintended consequences and remember that policies that address a very circumscribed target may result in a ‘whack-a-mole’ state where our ‘solution’ yields another problem popping up elsewhere.”
Editorial
Broad range of research on e-cigarettes
Tobacco Control 2023;32:e137-e138.
Online issue publication July 19, 2023
Joanna E Cohen
https://tobaccocontrol.bmj.com/content/32/e2/e137
Ed. Note: Virtually all papers in this new e-issue of Tobacco Control (August 2023 - Volume 32 - e2) appeared Online First in 2021-2022 and were highlighted in earlier editions of this bulletin. All papers are now Open Access.
"In 2021, 4.5% of adults aged 18 and over were current e-cigarette users, with people aged 18–24 having the highest levels (11.0%) compared with those aged 25–44 (6.5%) and 45 and over (2.0%). Men had higher percentages of e-cigarette use overall and among adults aged 25–44. E-cigarette use among those aged 18 and over was highest among White adults and those living in families with the lowest level of family income... Dual use of tobacco products is a health concern because it may result in greater exposure to toxins and worse respiratory outcomes than using either product alone. In 2021, most e-cigarette users aged 18–24 had never smoked cigarettes."
Current Electronic Cigarette Use Among Adults Aged 18 and Over: United States, 2021
NCHS Data Brief No. 475, July 2023
Ellen A. Kramarow and Nazik Elgaddal
https://www.cdc.gov/nchs/products/databriefs/db475.htm
https://www.cdc.gov/nchs/data/databriefs/db475.pdf
Note: Open Access.
“Maternally nicotine vaped embryos exhibited histological and transcriptional changes consistent with impaired distal lung development. Embryonic lung gene expression changes mimicked transcriptional changes observed in adult mouse lungs exposed to cigarette smoke, suggesting that the developmental defects may be due to direct nicotine exposure… Nicotine directly binds and inhibits the Kcnj2 potassium channel which is important for bone development… These data indicate that intrauterine nicotine exposure disrupts fetal lung and skeletal development likely through inhibition of Kcnj2.”
Intrauterine exposure to nicotine through maternal vaping disrupts embryonic lung and skeletal development via the Kcnj2 potassium channel
Dev Biol. 2023 Sep;501:111-123. Epub 2023 Jun 22.
Yunus H Ozekin, Maxwell L Saal, Ricardo H Pineda, Kayla Moehn, Madison A Ordonez-Erives, Maria F Delgado Figueroa, Caleb Frazier, Kamryn M Korth, Melanie Königshoff, Emily A Bates, Eszter K Vladar
https://www.sciencedirect.com/science/article/pii/S001216062300101X
Note: Open Access.
“All animals exposed to CC [conventional cigarettes] and EC [e-cigarettes] showed an increase in lipid peroxidation and protein oxidation. There was an increase of IL-6 [Interleukin-6] in males and females exposed to EC. The IL-13 levels were higher in the females exposed to EC and CC. Both sexes exposed to EC and CC presented tissue damage characterized by septal destruction and increased alveolar spaces compared to control. Our results demonstrated that exposure to CC and EC induced pulmonary emphysema in both sexes, and females seem to be more susceptible to EC.”
Long-term e-cigarette aerosol exposure causes pulmonary emphysema in adult female and male mice
Regulatory Toxicology and Pharmacology
Volume 142, August 2023, 105412
Available online 27 May 2023
Andrea Jazel Rodriguez-Herrera, Ana Beatriz Farias de Souza, Thalles de Freitas Castro, Pedro Alves Machado-Junior, Elena Cecilia Marcano-Gomez, Tatiana Prata Menezes, Maria Laura da Cruz Castro, André Talvani, Daniela Caldeira Costa, Sílvia Dantas Cangussú, Frank Silva Bezerra
https://www.sciencedirect.com/science/article/abs/pii/S0273230023000806
“Twelve months after purchasing JUUL, almost all smokers reported either switching or reducing their smoking by 50%+, including those who had recently failed to quit smoking with approved pharmacotherapies. E-cigarettes provide an alternative route to abstinence from smoking for smokers with a history of cessation and cessation treatment failure.”
Switching away from smoking at 12 months among adult JUUL users varying in recent history of quit attempts made with and without smoking cessation medication
Drug Testing and Analysis
First published: 25 July 2023
Saul Shiffman, Michael J. Hannon
Funding Information: Funding for this study was provided by Juul Labs Inc. The sponsor approved the research plan and provided comment on a near-final draft of the paper.
CONFLICT OF INTEREST STATEMENT
Through Pinney Associates, SS and MJH provide consulting services on tobacco harm reduction on an exclusive basis to Juul Labs Inc. The funding for this study was provided by Juul Labs Inc. The sponsor approved the research plan and provided comment on a near-final draft of the paper.
https://analyticalsciencejournals.onlinelibrary.wiley.com/doi/10.1002/dta.3551
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Rassegna Stampa Scientifica Settembre 2023
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“E-cigarette use is the single strongest risk factor for adolescents taking up tobacco smoking, outranking social norms, poor mental health and misperceptions about smoking harms, research published on Wednesday [August 23rd] has found… Published in the Australian and New Zealand Journal of Public Health, it found the strongest factor for susceptibility to future smoking was having ever smoked e-cigarettes. Four other factors – perceiving smokers to be more popular than non-smokers, having at least one close friend that smokes, perceiving smoking one or two cigarettes occasionally as not dangerous, and having symptoms of depression – were also independently associated with vulnerability to smoking.” [Natasha May. Vaping found to be the biggest risk factor for teenage tobacco smoking, The Guardian. Ed. Note: See below for study excerpt and full reference.]
“The UK's second-largest vape company took down social media accounts after sending vapes to reporters in an online giveaway without age verification. Chinese government-owned SKE has seen rapid growth in sales of its Crystal Bar disposable vapes, which have been criticised for appealing to children… SKE also apologised for not signing up to government recycling schemes. In supermarkets, newsagents and vape shops, Crystal Bar disposable vapes are everywhere in the UK. Designed to deliver a few hundred puffs of nicotine-containing vapour and then be thrown away, disposable vapes have seen astonishing growth in recent years.” [Ben King. Crystal Bar vape giant deletes TikTok after giveaway with no age verification, BBC News]
“Inside Big Ash, [a vintage clothing store in New York City], the cigarettes had been set out in a metal dish. The designer Mati Hays was displaying clothing with cigarette-inspired flair: an ashtray had been fashioned into a petite pillbox hat, with a vintage case affixed to a leather strap as a headband, each accompanied by a few Hestia [cigarette] loosies… “Cigfluencing,” a term the blogger Meg Superstar Princess used when she mentioned Hestia in a popular newsletter, isn’t new: Cigarette makers have always relied on creating an aura of coolness around smoking to sell their products. But the old standbys like Marlboro no longer need to buy out full-page magazine spreads or put up billboards just to boost their brand recognition. Nor could they: Today’s tobacco laws restrict outdoor advertising in most of the country, and a majority of social media companies similarly prohibit tobacco-related advertisements.” [Magdalene J. Taylor. A Viral Cigarette Brand? In 2023?, New York Times]
“Boys who smoke in their early teens risk passing on harmful epigenetic changes in the genes of their future children without altering the DNA… [Scientists at the University of Southampton and the University of Bergen] have just published their study in the journal Clinical Epigenetics under the title “Fathers’ Preconception Smoking and Offspring DNA Methylation.” It is the first human study to reveal the biological mechanism behind the impact of fathers’ early teenage smoking on their children.” [Judy Siegel-Itzkovich. Teenage boys who smoke risk respiratory damage to future kids, Jerusalem Post. Ed. Note: See below for study excerpt and full reference.]
“Public health officials in Germany are raising the alarm over an unexpected uptick in cigarette smoking—including among the young—that started in the wake of the Covid-19 lockdowns. The overall smoking rate in Germany was just over 34% in July, according to the most recent findings from Debra, a bimonthly survey funded by the German Health Ministry. In March 2020, the rate was 26.5%. The percentage of Germans between 14 and 17 years old who said they smoked cigarettes jumped to 15.9% in 2022, from 8.7% in 2021, according to Debra... Other European countries, including Sweden, Ireland and the Netherlands, have seen steady decreases in smoking rates, said Rüdiger Krech, director of health promotion for the World Health Organization. “We’re so baffled around this," he said. “In so many areas of public health and health systems, Germany is performing very well. Here, it is an outlier."” [Jimmy Vielkind. Smoking Is a Dying Habit. Not in Germany, Wall Street Journal]
“Ukraine's National Corruption Prevention Agency added the world's leading tobacco companies Japan Tobacco International (JTI) and Philip Morris International to the list of international sponsors of war. According to the agency's website, the companies continue to do business in Russia and support its economy. In particular, Japan Tobacco International is the undisputed leader of the tobacco market in Russia with a market share of almost 35%. The company is represented on the Russian market, in particular, by the Winston, LD, Mevius, Camel, and Sobranie brands… As previously reported on Aug. 17, Ukraine also added China's Alibaba Group Holding Limited, the owner of the AliExpress online store, to the list of international sponsors of the war.” [Uliana Horoshko. Ukraine adds 2 tobacco companies to list of war sponsors, Kyiv Independent]
“Eleven percent of adolescents who had never smoked were susceptible to smoking. Smoking susceptibility was independently associated with ever use of e-cigarettes (adjusted odds ratio [AOR]=3.26, 95% confidence interval [CI]: 1.83-5.81), perceiving those who smoke to be more popular (AOR=2.87, 95% CI: 1.62-5.10), having a close friend/s who smokes (AOR=2.66, 95% CI: 1.61-4.40), not perceiving smoking one or two cigarettes occasionally as personally dangerous (AOR=2.56, 95% CI: 1.61-4.09), and having symptoms of depression (AOR=1.59, 95% CI: 1.06-2.38). Conclusions: The strongest smoking-initiation risk factor identified was ever use of e-cigarettes, with social norms, harm misperceptions around low-rate tobacco use and mental health also linked to smoking susceptibility.”
E-cigarette use and other risk factors associated with tobacco smoking susceptibility among Australian adolescents
Australian and New Zealand Journal of Public Health
Available online 22 August 2023, 100076
In Press, Corrected Proof
Maree Scully, Elizabeth Greenhalgh, Emily Bain, Melanie Wakefield, Sarah Durkin, Victoria White
https://www.sciencedirect.com/science/article/pii/S1326020023052536
Note: Open Access.
Related coverage:
Vaping found to be the biggest risk factor for teenage tobacco smoking
“Broadly, the prevalence of smoking was found to be decreasing over time while the prevalence of vaping was increasing. Despite these general trends, no differences were observed in the likelihood of transitioning from smoking to vaping or from vaping to smoking, indicating that either pathway was equally as likely. Discussion and Conclusions: The current findings demonstrate that vaping appeared to be just as likely to have a gateway effect to smoking as it was to have a cessation effect. This highlights the need for greater consideration regarding vaping-related policies and restrictions.”
Effects of vaping on uptake and cessation of smoking: Longitudinal analysis in Aotearoa New Zealand adults
Drug and Alcohol Review
First published: 27 June 2023
Andre Mason, Benjamin C. Riordan, Taylor Winter, Tamlin S. Conner, Chris G. Sibley, Damian Scarf
https://onlinelibrary.wiley.com/doi/10.1111/dar.13702
https://onlinelibrary.wiley.com/doi/epdf/10.1111/dar.13702
Note: Open Access.
“E-cigarette advertisements often use psychographic targeting strategies, using lifestyles, attitudes, and values. Low-risk young adults (eg, those who currently do not use tobacco and nicotine products) are susceptible to psychographically targeted e-cigarette advertisements. This may result in the initiation of e-cigarette use among young adults who would otherwise be less likely to use tobacco and nicotine products. Stricter marketing regulations for emerging tobacco and nicotine products are required to reduce marketing exposure.”
Young Adult Responses to Peer Crowd-Based Targeting in E-cigarette Advertisements: An Experimental Study
Nicotine & Tobacco Research, Volume 25, Issue 6, June 2023, Pages 1125–1134.
Published: 27 April 2023
Minji Kim, Torsten B Neilands, Steven E Gregorich, Jeffrey W Jordan, Pamela M Ling
https://academic.oup.com/ntr/article-abstract/25/6/1125/7136695
Related coverage:
Study finds e-cigarette manufacturers use targeted marketing to lure in young adults
https://medicalxpress.com/news/2023-08-e-cigarette-lure-young-adults.html
“Father’s preconception smoking, particularly in puberty, is associated with offspring DNA methylation, providing evidence that epigenetic mechanisms may underly epidemiological observations that pubertal paternal smoking increases risk of offspring asthma, low lung function and obesity.”
Fathers’ preconception smoking and offspring DNA methylation: A two generation study
Clinical Epigenetics
Preprint posted January 15, 2023.
Negusse T Kitaba et al.
https://www.biorxiv.org/content/biorxiv/early/2023/01/15/2023.01.13.523912.full.pdf
Note: Open Access.
Related coverage:
Teenage boys who smoke risk respiratory damage to future kids
https://www.jpost.com/health-and-wellness/article-757002
"I have often been asked by media and others which is more important – tobacco, or alcohol, or obesity, or any number of other issues. I have always sought to explain that we aren’t in competition, any more than oncologists, cardiologists or psychiatrists compete with each other. In this complex world we seek to address a wide range of health and social problems. Calling for action on one issue absolutely does not and should not mean playing down the need for action on others."
Mike Daube Early Career Advocacy Series
Public policy and impact – suggestions for researchers who want to make a difference
Health Promotion International, Volume 38, Issue 5, October 2023.
Mike Daube
https://academic.oup.com/heapro/article/38/5/daad096/7256793
Note: Open Access.
“Of all analyzed episodes [in popular streaming series in Germany], 25.1% contained smoking (range = 1 to 36 smoking scenes; median = 4). There was a statistically significant association between episode age rating and the presence of smoking… None of the streaming services meet the recommendations of the WHO Framework Convention on Tobacco Control to reliably restrict young people's access to media content that depicts smoking.”
Smoking in Popular Streaming Shows and Youth Protection in Germany
J Community Health. 2023 Aug 21. Online ahead of print.
Matthis Morgenstern, Stanton A Glantz, Clemens Neumann, Reiner Hanewinkel
https://link.springer.com/article/10.1007/s10900-023-01270-0
“The secondhand smoke cotinine dose for typical flight attendants in aircraft cabins is estimated to have been 6-fold that of the average US worker and 14-fold that of the average person. Thus, ventilation systems massively failed to control secondhand smoke air pollution in aircraft cabins, and led to extreme exposures… Conclusions: In-flight exposure to toxic and carcinogenic tobacco smoke in smoky passenger cabins was the major risk factor leading to the decedent’s multiple smoking-related diseases, and her premature death. This has implications for the extant and future health of the cohort of surviving flight attendants exposed to secondhand smoke on aircraft during the 20th Century Era.”
Quantifying Risk to Flight Attendants from Secondhand Smoke Exposure in Airline Cabins Using Pharmacokinetic Modeling: A Case Report
European Society of Medicine
Vol 11 No 7.2 (2023): July Issue, Vol.11, Issue 7.2
James Repace
https://esmed.org/MRA/index.php/mra/article/view/4157
https://esmed.org/MRA/mra/article/view/4157/99193547119
Note: Open Access.
Vaping: France: Disposable Ban; Scotland: Proposed Ban; UK: Worrying Rise
“Scotland could ban disposable vapes under plans unveiled by the country's first minister. Campaigners have highlighted the environmental impact of the plastic tubes, which are often thrown on the ground after being used. Concerns have been raised around their growing popularity among young people. Humza Yousaf said his government would hold a consultation on a single-use vape ban as he set out his priorities for the coming year… A recent Scottish government report found that 22% of all under-18s - around 78,000 - are believed to have used a vape last year with more young people using them than smoking cigarettes.” [Katy Scott. Scotland to consider ban on disposable vapes, BBC News. See also: Five million vapes thrown away every week - research BBC News; Call for UK ban on single-use vapes as more than 5m discarded each week, The Guardian]
"More people aged 16 to 24 in Britain are using e-cigarettes – with a sharp rise among young women – which experts have called “worrying”. It comes as the number of people smoking cigarettes in the UK has dropped to a record low. The Office for National Statistics (ONS) used data from its Opinions and Lifestyle Survey (OPN), a poll of 16,300 people over the age of 16 in Britain. It found 5.2% of people used e-cigarettes daily in 2022, up from 4.9% in 2021, with a further 3.5% reporting occasional vape use, up from 2.8%... [T]here was a significant rise in younger women vaping, with 6.7% of those aged 16 to 24 using e-cigarettes daily – up from 1.9% in 2021 – and 12.2% using them occasionally, up from 7.1%. The number of people in that age group overall who vaped jumped to 15.5% from 11.1%." [Storm Newton. ‘Worrying’ rise in vaping among teenagers and young adults, data suggests, The Independent. See also: Rise in young women vaping daily in the UK, BBC News; Teenage vaping: ‘I’ll have puffs as I’m falling asleep’, BBC News; Video: Panorama: Teenage Vaping: What’s the Harm?, BBC]
“Disposable vapes will be banned in France as part of a national plan to combat smoking, the prime minister said on Sunday [September 3rd]. Élisabeth Borne told the broadcaster RTL that the government would “soon present a new national plan to fight against smoking with, in particular, the prohibition of disposable electronic cigarettes, the famous ‘puffs’ which give bad habits to young people”. The French government is putting the final touches to its 2024 budget with a wider plan to reduce smoking, which Borne said was the cause of 75,000 deaths a year in the country.” [Lisa O'Carroll. France planning to ban disposable vapes in effort to combat smoking, The Guardian]
“France is to ban disposable vapes, on the basis that they lead to smoking… According to the last Smoking, Drinking and Drug Use Among Young People in England survey from the NHS [National Health Service], the proportion of kids between 11 and 15 who have even tried smoking is about 12 per cent. Whereas back in 1996, they estimate, that figure would have been 49 per cent. When it comes to regular smoking, the figure is now 1 per cent… By contrast, regular vaping among this cohort is obviously going up… Nicotine is fearsomely addictive… Teachers speak of kids unable to concentrate in lessons, and break-time toilets that smell like a bag of Skittles. Vapes can also be headachey and anxiety-inducing. Heart-rates spike, lungs and tongues can burn… Smoking is a rare, miserable evil, and nobody should want to hinder its decline. So let’s not throw the baby out with the bathwater. On the other hand, don’t let the baby vape.” [Hugo Rifkind. Don’t ban vapes, just make them really boring, The Times]
"The London-based maker of Lucky Strike and Camel cigarettes came under fire in March last year after initially continuing to operate in Russia, breaking ranks with global brands such as Nestlé, Unilever, Coca-Cola and McDonald’s. The decision was reversed just two days later, with the company citing its “ethos and values”." [Rob Davies. British American Tobacco to end sales in Russia within a month, The Guardian. Ed. Note: It amounts to stating the obvious, but a tobacco company with an "ethos and values" is an oxymoron, unless you value the ethos of doing grave harm, in which case they should have stayed in Russia and found themselves right at home.]
“Cigarette and EC [E-cigarettes] liquid can increase oxidative stress as well as cause morphological changes in the testicle. To be a safe option in smoking cessation studies, its effect on people needs to be enlightened.”
The effect of smoking and electronic cigarettes on rat testicles
El efecto del tabaquismo y los cigarrillos electrónicos en los testículos de ratas
Revista Internacional de Andrología
Volume 21, Issue 3, July–September 2023, 100365
Hüseyin Saygın, Esat Korgalı, Tülay Koç, Kübra Doğan
https://www.sciencedirect.com/science/article/abs/pii/S1698031X23000250
Related coverage:
Vaping can shrink testicles, cause sperm counts to plummet: new research
https://nypost.com/2023/09/04/vaping-can-shrink-testicles-cause-sperm-counts-to-plummet-study/
Vaping may lower men's sperm counts and shrink their testicles, study suggests
Study: Vaping Can Shrink Testicles And Lower Sperm Counts In Rats
Related study:
“This is the first human study to indicate that not only cigarette smoking but also use of e-cigarettes is associated with lower sperm counts. This could be important knowledge for men trying to achieve a pregnancy, as e-cigarettes are often considered to be less harmful than conventional cigarette smoking.”
Use of e-cigarettes associated with lower sperm counts in a cross-sectional study of young men from the general population
Hum Reprod. 2020 Jul 1;35(7):1693-1701.
Stine Agergaard Holmboe, Lærke Priskorn, Tina Kold Jensen, Niels Erik Skakkebaek, Anna-Maria Andersson, Niels Jørgensen
https://academic.oup.com/humrep/article/35/7/1693/5859935
Note: Open Access.
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Rassegna Stampa Scientifica Novembre 2023
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“An additional 5 million Americans who smoke or used to smoke should undergo annual screenings for lung cancer — the number one cancer killer in the United States — according to an updated guideline issued Wednesday by the American Cancer Society. The broadened recommendations apply to about 19 million people who the cancer group said would benefit from yearly low-dose computed tomography scans… In the biggest change, the new guideline recommends that people continue to get annual scans even if they stopped smoking more than 15 years ago…. The mortality rate for lung cancer has declined sharply in recent decades because of plummeting smoking rates, but the health toll remains high. In 2023, the cancer society estimates, there will be about 238,000 new cases of lung cancer in the United States and more than 127,000 deaths, accounting for 20 percent of all cancer fatalities. Cigarette smoking is the main cause, responsible for about 80 percent of cases.” [Laurie McGinley. Millions more smokers should be screened for lung cancer, group says, Washington Post. Note: See below for full journal reference.]
“Quebec’s changes to its anti-tobacco law come into effect on Tuesday as the province aims to crack down on vaping. The province has officially banned the sale of flavoured vapes, with Health Minister Christian Dubé saying the revamped rules are designed to better protect young people… The crux of the changes comes down to prohibiting the sale of vape products in flavours other than tobacco as of Oct. 31. Vapes that have no flavour or aroma are still permitted, however. It’s also forbidden to sell any vapes in the “form of a toy, a piece of jewelry, a food, an animal or a real or fictional person, or any other form, appearance or function that might be attractive to minors.”… Aside from banning flavoured vapes, Quebec is also putting caps on size and refills. Stores can no longer sell vaping products with a nicotine concentration exceeding 20 milligrams per millilitre and vaping liquid tanks and capsules must be capped at 2 mm.” [Kalina Laframboise. Quebec’s ban on sale of flavoured vapes is now in effect. Here is what you need to know, Global News]
“The US Food and Drug Administration took a “momentous” step Monday [October 16] toward banning menthol in cigarettes and banning flavored cigars, proposing a rule that public health experts say could save hundreds of thousands of lives… The agency has sent the rule to the White House Office of Management and Budget for final review, the last regulatory step before the rule becomes final… Scientists have long understood that menthol flavor can make those cigarettes more addictive than tobacco-flavored ones. Menthol flavoring is attractive, particularly to new smokers, because it masks the harsh taste of tobacco, and a 2015 study found that it makes people want to smoke more.” [Jen Christensen. FDA takes ‘momentous’ step toward banning menthol cigarettes and flavored cigars, CNN]
“Big Tobacco firms including British American Tobacco (BATS.L) are selling heat sticks made from nicotine-infused substances such as rooibos tea, countering an incoming European Union ban on flavoured heated tobacco products. While the sticks mark a new way to inhale the addictive drug, health experts warn that their safety is unclear. The industry has produced "heat-not-burn" sticks containing tobacco for years, aiming to avoid the toxic chemicals released via combustion… Tobacco companies have yet to publish any research showing the health implications of rooibos or other zero-tobacco sticks.” [Emma Rumney. Big Tobacco turns to rooibos tea to counter upcoming ban, Reuters]
“The ACS [American Cancer Society] recommends annual LCS [lung cancer screening] with low-dose computed tomography for asymptomatic individuals aged 50–80 years who currently smoke or formerly smoked and have a ≥20 pack-year smoking history (strong recommendation, moderate quality of evidence). Before the decision is made to initiate LCS, individuals should engage in a shared decision-making discussion with a qualified health professional. For individuals who formerly smoked, the number of YSQ [years since quitting smoking] is not an eligibility criterion to begin or to stop screening. Individuals who currently smoke should receive counseling to quit and be connected to cessation resources.”
Screening for lung cancer: 2023 guideline update from the American Cancer SocietyCA: A Cancer Journal fo CliniciansFirst published: 01 November 2023Andrew M. D. Wolf, Kevin C. Oeffinger, Tina Ya-Chen Shih, Louise C. Walter, Timothy R. Church, Elizabeth T. H. Fontham, Elena B. Elkin, Ruth D. Etzioni, Carmen E. Guerra, Rebecca B. Perkins, Karli K. Kondo, Tyler B. Kratzer, Deana Manassaram-Baptiste, William L. Dahut, Robert A. Smith
Note: Open Access.
After adjustment for confounding, current ENDS [electronic nicotine delivery systems] use was associated with current traditional cigarette use (OR = 39.55; CI:33.44-46.77), current marijuana use (OR = 6.72; CI:5.61-8.05), history of lung cancer (OR = 2.64; CI:1.42-4.92), non-stroke cerebral vascular disease (OR = 1.55; CI:1.21-1.99), and chronic obstructive pulmonary disease (OR = 2.16; CI:1.77-2.63). Current ENDS use was also associated with increased risk of emergency room (ER) visits (HR = 1.17; CI: 1.05-1.30) and death (HR = 1.84; CI:1.02-3.32). Conclusions: Concurrent traditional cigarette use, marijuana use, and comorbidities were prevalent among those who used ENDS, and current ENDS use was associated with an increased risk of ER [emergency room] visits and death.”
Demographic, Clinical, and Behavioral Factors Associated With Electronic Nicotine Delivery Systems Use in a Large Cohort in the United StatesTob Use Insights. 2023 Jan 5:16:1179173X221134855. eCollection 2023.Shauna Goldberg Scott, Heather S Feigelson, John David Powers, Morgan N Clennin, Jason A Lyons, Mark T Gray, Anil Vachani, Andrea N Burnett-Hartman
Note: Open Access.
“Pack color modification may increase uncertainty about several key cigarette risk beliefs, though graphic warnings may attenuate these effects. Regulatory agencies could consider supporting policy changes with information campaigns to maximize public knowledge.”
Effects of cigarette package colors and warning labels on Marlboro smokers’ risk beliefs, product appraisals, and smoking behavior: a randomized trialBMC Public Health volume 23, Article number: 2111 (2023)Published: 27 October 2023Matthew D. Stone, Melissa Mercincavage, E. Paul Wileyto, Andy S.L. Tan, Janet Audrain-McGovern, Andrea C. Villanti & Andrew A. Strasser
Note: Open Access.
“Over 50 review studies, primarily in 2022 and 2023, illustrate some of the latest information on e-cigarette harms. Results show studies of respiratory, neurological, and cardiovascular effects. Researchers call for expanding studies through new methods to elaborate on initial findings of multiple harms emerging in clinical investigations. Since the use of electronic cigarettes for adult cessation is not sanctioned in most countries, it is clear that health authorities see significant costs to the health of the general population if the promotion and use of electronic cigarettes occur worldwide. Regulatory action to control electronic cigarettes should consider the substantial evidence of electronic cigarette harm.”
Electronic Cigarette Harms: Aggregate Evidence Shows Damage to Biological SystemsInt. J. Environ. Res. Public Health 2023, 20(19), 6808Published: 22 September 2023Stephen L. Hamann, Nipapun Kungskulniti, Naowarut Charoenca, Vijj Kasemsup, Suwanna Ruangkanchanasetr and Passara Jongkhajornpong
Also:
Air Pollution inside Vehicles: Making a Bad Situation Worse
Note: Open Access.
“Our current moment in tobacco control can be characterised as a struggle between two competing narratives: (a) tobacco use is a problem of unhealthy individual choices that can only be remedied by offering more choices, a recycled tobacco industry favourite; and (b) the endgame story—tobacco use is a problem of institutional failures to protect the public, highlighting increasingly absurd and unsustainable contradictions. We cannot continue forever to say that cigarettes kill but still sanction sales of the single most deadly consumer product in history as though it is normal to sell death. We cannot continue to claim we care about protecting public health while staying quiet as government agencies whose mission is to protect the public are grotesquely captured or hamstrung by industry influence…
“Regardless of how one feels about the potential of newer products to contribute to true ‘harm reduction’, we must make governments develop plans to end commercial cigarette sales. It will not happen all at once or overnight. There will be problems that must be thought through. But we cannot do it without talking about it and developing concrete plans—and we cannot, must not, continue to accept the status quo of this industrially produced and perpetuated epidemic.”
EditorialNew editor at the most exciting time in tobacco controlTobacco Control 2023;32:677-678.Online issue publication October 19, 2023Ruth E Malone
Note: Open Access. A new issue of the journal Tobacco Control (November 2023, V. 32:6) recently appeared online. Most reports were highlighted in earlier editions of this bulletin and are now Open Access. All others are available upon request. In the Editorial highlighted above, Ruth Malone also writes that “after many joyous, vexing, overloaded and exciting years of editing, I am ready to step down, leaving the top specialty journal in the field in capable hands with longtime Senior Editor and previous News Editor Dr Marita Hefler appointed as the journal’s new Editor-In-Chief.” I can only add my appreciation of Ruth’s extraordinary contribution over the years to both the journal and the field of Tobacco Control writ large. Very best wishes to Marita Hefler in her new duties as Editor-In-Chief.
“A decades-old public-health battle has flared up again, with leading Canadian anti-tobacco advocates from the Canadian Cancer Society, Canadian Lung Association and Physicians for a Smoke-Free Canada fiercely protesting the introduction of a new smoking cessation product. The cheerfully branded Zonnic (sounds like a relaxing “tonic” mixed with some “zing!”) has quietly settled like mist onto convenience store shelves, to be sold as an alternative to vapes and cigarettes. The product has sparked a firestorm of shock and cynicism aimed at British American Tobacco, the multinational corporation that owns Canadian subsidiary and Zonnic distributor Imperial Tobacco. But the ire has also been directed at Health Canada, which rubber-stamped Zonnic as a natural-health product, i.e., nicotine replacement therapy, with no age restrictions attached… Zonnic can also be sold, without penalty or fine, to any age group, including young people, at convenience stores and gas stations.” [Joshua Knelman. Will a new product force Canada to rethink its anti-tobacco strategy, (Toronto) Globe & Mail. See also: Nicotine pouches are raising concerns in Canada. Why experts say it 'boggles the mind', Yahoo! Life]
"Some public health experts are concerned that the playful appearance of these devices — which is neatly in line with the maximalist aesthetic preferences of Gen Z — may offer appealing new cover for nicotine products... In combination with candy- and fruit-inspired flavors — a major focus of anti-tobacco groups — alluring vape packaging could steer young people toward e-cigarettes, several experts said... Some e-cigarettes are being packaged similarly to beauty, cosmetic and skin-care products that line the shelves at Sephora. Their pastel boxes are of a piece with upscale beverage brands like Kin Euphorics or the woozy gradients of Partiful, an event-invitation platform favored by Gen Z... On TikTok, videos tagged #elfbar have more than 2.5 billion views. A Reddit meme account Photoshops joke Elf Bar flavors like Tide Pods and Crab Rangoon. Videos that show people dressed up as Elf Bars for costume parties have amassed millions of views." [Callie Holtermann. Vapes Look ‘Like Toys’ Now. Uh-Oh., New York Times]
“In Brazil, Russia, India, China, South Africa, the UK, and the US in 2020, an estimated… 20.8 million (17.0 million–24.6 million) YLLs [years of life lost] [were attributable] to tobacco smoking… Tobacco smoking contributed the most cancer deaths and YLLs in all seven countries, highlighting its major impact on cancer mortality. The prevalence of tobacco smoking in the UK and US peaked in the 1950s when around 50% of the adult population smoked; this dropped to 13% in the UK and the US in 2020–2021 largely thanks to tobacco control efforts, but the historically high smoking rates are still a driving factor of the cancer burden today. In China and Russia, where ASYRs [age-standardised rates of YLLs] attributable to tobacco smoking were highest, around half of men currently smoke.
“In China, stricter policies including higher excise taxes and restrictions on smoking in indoor public places are needed to meet the nation's Healthy China 2030 objective of reducing smoking prevalence to 20% by 2030. Meanwhile in Russia, ratification of the Framework Convention on Tobacco Control in 2008 has had a modest effect on tobacco prevalence among men and a subsequent small decline in male mortality, yet smoking prevalence among women is increasing and has surpassed that of the UK and the US, as reported in recent surveys…
“In Brazil, tobacco smoking prevalence decreased from 35% in 1989 to 13% in 2019 due to successful control policies including advertising bans, smoke-free laws, and increased taxes. A decline in smoking prevalence in India has also been observed, which could be due to strong tobacco control regulations that have been put in place since the launch of the National Tobacco Control Plan in 2007–08.”
International burden of cancer deaths and years of life lost from cancer attributable to four major risk factors: a population-based study in Brazil, Russia, India, China, South Africa, the United Kingdom, and United States
eClinical Medicine
ONLINE FIRST, 102289
Published: November 15, 2023
Harriet Rumgay, Citadel J. Cabasag, Judith Offman, Marianna de Camargo Cancela, Anton Barchuk, Prashant Mathur, Shaoming Wang, Wenqiang Wei, Peter Sasieni, Isabelle Soerjomataram
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(23)00466-2/fulltext
Note: Open Access.
Related coverage:
Tobacco-related cancers kill 1.3 million annually across seven nations: Study
“We don't know yet what the long-term health consequences are, but I'm very uncomfortable that there are so many flavored and disposable e-cigarettes that are clearly marketed to young people,” [researcher Benjamin] Toll said… “At the beginning of the survey data, young men were vaping more than young women,” [co-lead researcher Naomi] Brownstein said. “And they still were at the end, but young women had a slightly steeper increase, so they were starting to catch up a bit… “We know if combustible tobacco use is becoming less prevalent than e-cigarette use, there are a lot of public health implications about where our efforts need to be in terms of cessation counseling and treatment development,” Sanford said… “A lot of people who vape do want to quit,” [co-lead researcher Brandon] Sanford added. “Even if the health problems associated with vaping aren’t as extreme as smoking, it's still an uncomfortable addiction for a lot of folks.””
Shift From Smoking Cigarettes to Vaping Nicotine in Young Adults
JAMA Intern Med. Published online November 13, 2023.
Brandon T. Sanford, Naomi C. Brownstein, Nathaniel L. Baker, Amanda M. Palmer, Tracy T. Smith, Alana M. Rojewski, Benjamin A. Toll
https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2811339
Related coverage:
Vaping Now Outstrips Smoking Among U.S. Young Adults
Note: A PDF of the study is not yet available but should be shortly. The author quotes are from the related US News coverage.
“From 1997 to 2020, cigarette smoking prevalence among those aged 18–24 years decreased from 29.1% (95% CI 27.4% to 30.7%) to 5.4% (95% CI 3.9% to 6.9%). The decline was highly correlated with a decline in past 30-day smoking among those aged 17–18 years (1997: 36.8% (95% CI 35.6% to 37.9%; 2022: 3.0% (95% CI 1.8% to 4.1%). From 2017 to 2019, both ever-vaping and past 30-day nicotine vaping (11.0% to 25.5%) surged among those 17–18 years, however there was no increase among those aged 18–24 years… Conclusions: Since 1997, a large decline in cigarette smoking occurred in the US population under age 24 years, that was independent of the 2017–19 adolescent surge in past 30-day e-cigarette vaping.”
Declines in cigarette smoking among US adolescents and young adults: indications of independence from e-cigarette vaping surge
Tobacco Control Published Online First: 08 November 2023.
John P Pierce, Man Luo, Sara B McMenamin, Matthew D Stone, Eric C Leas, David Strong, Yuyan Shi, Sheila Kealey, Tarik Benmarhnia, Karen Messer
https://tobaccocontrol.bmj.com/content/early/2023/11/08/tc-2022-057907
https://tobaccocontrol.bmj.com/content/tobaccocontrol/early/2023/11/08/tc-2022-057907.full.pdf
Note: Open Access.
"In 2023, 10.0% of middle and high school students reported current tobacco product use. From 2022 to 2023, current e-cigarette use among high school students declined from 14.1% to 10.0%. E-cigarettes remained the most commonly used tobacco product among youths. Among middle school and high school students who currently use e-cigarettes, 25.2% used e-cigarettes daily, and 89.4% used flavored e-cigarettes... longstanding and proven tobacco prevention policies, such as price increases, comprehensive smoke-free policies (that include e-cigarettes), counter-marketing campaigns, and health care intervention, will continue to reduce youth initiation and tobacco use."
Tobacco Product Use Among U.S. Middle and High School Students — National Youth Tobacco Survey, 2023
MMWR Weekly / November 3, 2023 / 72(44);1173–1182
Jan Birdsey, Monica Cornelius, Ahmed Jamal, Eunice Park-Lee, Maria R. Cooper, Jia Wang, Michael D. Sawdey, Karen A. Cullen, Linda Neff
https://www.cdc.gov/mmwr/volumes/72/wr/mm7244a1.htm
https://www.cdc.gov/mmwr/volumes/72/wr/pdfs/mm7244a1-H.pdf
Note: Open Access.
Related coverage:
Vaping Declines Among High School Students, Survey Shows
https://www.nytimes.com/2023/11/02/health/vaping-teenagers-survey.html
Youth tobacco use rates declined slightly in US, but ‘work is far from over,’ health officials say
https://www.cnn.com/2023/11/02/health/youth-tobacco-rates-decline-survey
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Rassegna Stampa Scientifica Ottobre 2023
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“Plans to phase out the sale of cigarettes in England will be the "biggest public health intervention in a generation", Rishi Sunak has said. The PM told the BBC there was "no safe level of smoking" when asked about restricting people's right to choose. His plan seeks to raise the legal age of smoking every year by a year so that eventually no-one can buy tobacco. Tory MPs will be allowed a free vote while Labour indicated it would back the policy… Mr Sunak told the BBC smoking cigarettes was not the same as eating crisps or a piece of cake because it could not be part of a balanced diet and there was no safe level of smoking. "Smoking is unequivocally the single biggest preventable cause of death, disability and illness in our society," he said. "Everyone recognises this measure will be the single biggest intervention in public health in a generation."…
“The proposal to raise the age of sale of cigarettes is similar to laws being introduced in New Zealand, where buying tobacco products will remain banned for anyone born after 2008.” [James Gregory. Rishi Sunak defends his plan to ban smoking for younger generation, BBC News. See also: Rishi Sunak considers banning cigarettes for next generation, The Guardian; Health charities welcome Sunak’s plan to curb smoking in England, The Guardian; Almost £1bn wiped off tobacco firms after Sunak’s smoking crackdown, Yahoo! News; Boris Johnson’s former food tsar attacks Sunak’s smoking ban: ‘Odd to prioritise cigarettes over fast food’, The Independent]
“Once upon a time, a crafty fag behind the bike sheds was the mark of a teenage rebel. But not any more, which is why the vast majority of British 15-year-olds will be singularly unbothered about becoming the last generation legally allowed to buy cigarettes. A princely 3% of them smoke, a habit now widely regarded as for old people. One in five girls that age, however, use candy-coloured, sweet-flavoured vapes. They’re cheaper, just as easily bought underage, and don’t make your hair smell horrible. So why persevere with raspy throats and ash on the carpet when they can get a nicotine fix that tastes of bubblegum or banana, from a device dinky enough to hide in a school blazer pocket?...
“There’s something both rebellious and oddly innocent-looking about vaping, a perennially appealing combination to teenage girls. They know smoking kills, but puffing on a strawberry e-cigarette seems barely more dangerous than sucking the end of your Hello Kitty pen in primary school, despite the worrying questions hanging over vaping’s unknown long-term effects and over high levels of toxic heavy metals in some cheap devices… Were we to find out decades hence that vaping is worse for you than suspected, by then we’d have a population already too hooked to give it up easily. And if that sounds familiar, it’s roughly what happened with cigarettes….
“Forcing manufacturers to market vapes as the boring, clinical tool for helping adult smokers that they’re actually supposed to be – no sexier than a blister pack of nicotine gum and definitely not mango ice blast-flavoured – seems thoroughly sensible. Combining that with ramping up enforcement and safety checks to disrupt the black market in illegal e-cigarettes, to protect the health of those already hooked, could well make a difference… The longer governments drag their feet, the more kids will take up vaping, sucking chemicals into developing lungs with potential longterm consequences we have yet to understand – and one with which we’re already very familiar: that of being suckered into an expensive lifelong nicotine dependency that may keep them hooked long after they want to be.” [Gaby Hinsliff. Sunak is right to phase out cigarettes – but without tackling vapes his public health strategy will go up in smoke, The Guardian]
“By introducing a tobacco levy, we could make the industry pay for the damage it does to people’s lives, to our economy and to the NHS [National Health Service]. Collecting this money could come from price-capping and profit controlling or from tax increases – either way it is imperative that the tobacco industry should have no say over how this money was spent. The government wants England to be smoke-free by 2030. This is a noble and necessary target, but one it is set to miss by almost a decade. A tobacco levy could help to turn this around. No matter what your political views are, one way or another, tobacco affects us all. The loss of loved ones to smoking-related disease, NHS backlog and waiting lists, economic inactivity due to ill health: none of these are party-political issues, which is why cross-party collaboration and commitment is vital.” [Michelle Mitchell, chief executive, Cancer Research UK. What to do about the tobacco companies still killing millions? Make them pay – and heavily, The Guardian]
"[Ohio Republican Governor Mike] DeWine has a “nanny state” mentality, said Ohio state Rep. Bill Seitz, the state House majority floor leader and fellow Republican who has helped block tobacco tax increases amid aggressive lobbying by industry interests. The 68-year-old Seitz, who smoked for 50 years before developing kidney cancer and having a kidney removed this summer, said he’s unmoved by his own brush with the health system — even if it led him to finally kick the habit. “I’m not going to turn into a smoke Nazi just because I used to smoke and I don’t anymore,” Seitz said... Ohio’s GOP [Grand Old Party, i.e. Republican] lawmakers have also rebuffed multiple efforts to boost cigarette taxes, a public health measure proven to decrease smoking rates — especially among new and young smokers.
“When Gov. John Kasich (R) attempted to raise the cigarette tax by $0.65 per pack in 2017, business lobbyists warned that residents would spend their money elsewhere, with one testifying that “consumers are coming into Ohio to save money on their cigarettes from Pennsylvania.” The tax increase was defeated... Not surprisingly, experts said, Ohio’s smoking rate exceeds that of nearby states with stricter tobacco measures. Almost 21 percent of adults in Ohio smoked in 2019, compared with 17 percent of Pennsylvanians and nearly 13 percent of New Yorkers... There’s also a notable difference in health outcomes: Smoking-related deaths — including from lung cancer, heart disease and chronic lower-respiratory disease — have declined sharply across the country over the last two decades but increased in Ashtabula [Ohio], where middle-aged adults are 55 percent more likely to die of those causes than the national average...
“As nearby states have shown more progress in curbing smoking, Ohio lawmakers have struggled to prioritize tobacco control, a decision telegraphed by how the state has spent billions of dollars from a landmark national settlement with cigarette companies in 1998. That windfall initially led to the creation of a tobacco prevention foundation, ad campaigns to warn against smoking and other initiatives helping users to quit. By 2005, Ohio was spending nearly $55 million that year on tobacco prevention and related activities — close to the CDC’s recommended annual levels... But even as state smoking rates fell, advocates repeatedly warned that lawmakers were raiding the tobacco fund to pay for other priorities... Lawmakers’ decision to shift funding away from public health and toward other investments was “devastating,” said Amy Rohling McGee, president of the Health Policy Institute of Ohio, adding that the loss of the tobacco prevention foundation made it harder to coordinate a statewide strategy. “Those dollars provided an infrastructure we no longer have.”...
“Meanwhile, Ohio’s adult smoking rate rebounded, rising from 20 percent in 2008 to 25 percent in 2011, according to the CDC. The state now has one of the highest smoking rates in the country... Ohio’s tobacco tax has been raised just once since 2005. Public health experts say the state’s relatively low tobacco tax is a key reason it had the fourth-highest adult smoking rate in the country — and ranked near the bottom of states for life expectancy as of 2019. In contrast, Pennsylvania’s middle-of-the-pack smoking rate matched its life expectancy ranking, and New York — whose cigarette tax is now more than three times that of Ohio’s — had one of the lowest smoking rates and ranked third in life expectancy.
“Rob Crane, a family medicine physician and antismoking advocate, said losses in the Ohio legislature despite clear evidence regarding the harmful health effects of smoking left him “scratching my head” — until he learned that more than two dozen lobbyists had worked to defeat efforts to raise the legal age to buy cigarettes in the late 1990s. “It was just an eye-opener to the level of participation by the tobacco industry in the state legislature,” said Crane, who founded a national group that successfully fought to raise the minimum age for tobacco and nicotine sales in the United States to 21 in 2019. The might of the tobacco lobby was also crucial to defeating [Republican Governor John] Kasich’s push for a higher cigarette tax in the 2010s, said Greg Moody, who coordinated that effort. Several Democrats described how their party’s own attempts to raise tobacco taxes stalled out in the GOP-dominated legislature." [Lauren Weber, Dan Diamond, Dan Keating. HOW RED-STATE POLITICS ARE SHAVING YEARS OFF AMERICAN LIVES, Washington Post]
Ed. Note: Although some of the issues are specific to the US, much of this extensive report highlights universal concerns and issues at the intersection of politics and public health. Other health issues are discussed as well but, as can be gleaned from the lengthy excepts above, the biggest focus is on the costs and impact of smoking on individuals’ and public health. If paywalled, you should be able to access the full dossier here. ‘Red-State’ in the headline refers to the colour red associated with the Republican Party, in contrast to blue for the Democrats.
“Calls have been made to ban the sale of vapes and tobacco products in the vicinity of schools in a bid to “protect young people”. The step could work towards “educating a nicotine and tobacco-free generation”, according to The World Health Organisation (WHO). WHO said the “tobacco industry relentlessly targets young people”, with products such as single-use vapes made more affordable. A new guide by the organisation aims to support schools and teachers in making campuses smoke and nicotine-free via a series of policies.” [Storm Newton. Call to ban the sale of vapes and cigarettes near schools, Yahoo! News. See also: Ban smoking and vaping in school to protect young people, WHO]
“Rishi Sunak is considering introducing some of the world’s toughest anti-smoking measures that would in effect ban the next generation from ever being able to buy cigarettes, the Guardian has learned. Whitehall sources said the prime minister was looking at measures similar to those brought in by New Zealand last December. They involved steadily increasing the legal smoking age so tobacco would end up never being sold to anyone born on or after 1 January 2009.” [Pippa Crerar, Rowena Mason. Rishi Sunak considers banning cigarettes for next generation, The Guardian. See also: Sunak considering total ban on cigarettes for future generations, The Telegraph]
“The message that vaping is 95% safer than smoking has backfired, encouraging some children to vape, says a top health expert. Dr Mike McKean treats children with lung conditions and is vice-president for policy at the Royal College of Paediatrics and Child Health. He says the 2015 public messaging should have been clearer - vapes are only for adults addicted to cigarettes. Evidence on the possible health risks of vaping is still being gathered. In an exclusive interview with the BBC, Dr McKean said… the 95% safe messaging was "a very unwise thing to have done and it's opened the door to significant chaos"… "It feels like we have put all our eggs in one basket and said 'this is the way to tackle cigarette smoking' and I feel we have neglected children and young people, by sort of embracing something almost too much without the real proper thought."” [Hugh Pym, Lucy Watkinson. Vapes '95% safer' than cigarettes messaging backfired, BBC News]
Ed. Note: The 2015 messaging should not merely have been “clearer”, it should not have been based on an outright lie. There is absolutely no scientific study ever that has established e-cigarettes as 95% safer or anything close to it. The harm done in terms of youth uptake, environmental damage, the renewed seat at the table fo the tobacco industry and the divisions caused in our tobacco control community can never be matched by any putative, arguable cessation benefits. This excellent blog from the Swiss Association for Tobacco Control makes the case impeccably: “The “95% myth” is a factoid, that is, unreliable information repeated so often that it is accepted as fact.” [Luciano Ruggia. E-cigarettes 95% less dangerous? Myth, scientific lies, and manipulations, Swiss Association for Tobacco Control]
“Women who smoke during pregnancy are 2.6 times more likely to give birth prematurely compared with non-smokers – more than double the previous estimate, research suggests. The University of Cambridge study found smoking meant the baby was four times more likely to be small for its gestational age, putting it at risk of potentially serious complications including breathing difficulties and infections.” [Amy Lewis. Premature birth risk from smoking while pregnant higher than previously thought, ITV]
"Based on objective data, consistent exposure to smoking throughout pregnancy was strongly associated with sPTB [spontaneous pre-term birth] and FGR [fetal growth restriction]. High levels of paraxanthine were not independently associated with any of the studied outcomes and were confounded by smoking."
Objective measures of smoking and caffeine intake and the risk of adverse pregnancy outcomes
International Journal of Epidemiology, dyad123.
Published:28 September 2023
Roshan J Selvaratnam, Ulla Sovio, Emma Cook, Francesca Gaccioli, D Stephen Charnock-Jones, Gordon C S Smith
https://academic.oup.com/ije/advance-article-abstract/doi/10.1093/ije/dyad123/7283200
“Complementing cessation-focused trials, results suggest that unguided e-cigarette use also leads to smoking cessation, allaying the notion that causal effects of e-cigarettes on cessation are not reflective of real-world scenario of self-determined use. For smokers who may not be able to quit using existing pharmacologic approaches, e-cigarettes may be considered to achive (sic) that purpose.”
Effect of unguided e-cigarette provision on uptake, use, and smoking cessation among adults who smoke in the USA: a naturalistic, randomised, controlled clinical trial
eClinicalMedicine 2023; 63: 102142. SEPTEMBER 2023
Published: August 15, 2023
Matthew J. Carpenter, Amy E. Wahlquist, Jennifer Dahne, Kevin M. Gray, K. Michael Cummings, Graham Warren, Theodore L. Wagener, Maciej L. Goniewicz, Tracy T. Smith
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(23)00319-X/fulltext
https://www.thelancet.com/action/showPdf?pii=S2589-5370%2823%2900319-X
Note: Open Access.
“We detected some indications that alternative nicotine products are competing with cigarettes rather than promoting smoking and that regulations that allow their sales are associated with a reduction rather than an increase of smoking, but the findings are inconclusive because of insufficient data points and issues with the assumptions of the pre-specified statistical analyses.”
Effects of reduced-risk nicotine-delivery products on smoking prevalence and cigarette sales: an observational study
Public Health Research Volume: 11, Issue: 7, Published in September 2023
Francesca Pesola, Anna Phillips-Waller, Emma Beard, Lion Shahab, David Sweanor, Martin Jarvis & Peter Hajek.
https://www.journalslibrary.nihr.ac.uk/phr/RPDN7327/#/abstract
Note: Open Access.
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Rassegna Stampa Scientifica Dicembre 2023
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“France’s national assembly has unanimously approved a bill to ban single-use, disposable e-cigarettes. The move is an attempt to protect young people drawn to their flavours, and to mitigate the environmental impact of the disposable products, known in France as “puffs”. Legislators adopted the bill in a late-night vote on Monday with 104 in favour, zero against. The bill, supported by the government, will then move to the senate where it is expected to be adopted as well. It could go into effect by September 2024.” [Neil Shaw. Disposable vapes banned in France by unanimous vote, Wales Online; See also: E-cigarettes: France backs bill to ban disposable vapes, BBC News; En français: Interdiction de la « puff » : l’Assemblée adopte un texte pour bannir les cigarettes électroniques jetables en 2024, L’Obs; Puffs : l’Assemblée nationale vote l’interdiction de ces cigarettes électroniques jetables, Libération]
“The UK tobacco industry is lobbying the Government to raise the smoking age from 18 to 21 instead of the outright ban planned by Rishi Sunak, i can reveal. Multiple industry sources have said they are keen to strike a deal on raising the permitted smoking age as a compromise, replacing the proposed ban on sales to future generations. i can also reveal fierce lobbying of MPs to push back against the prohibition law, in the wake of New Zealand U-turn on its own similar policy… [T]he scale of back-channel influence demonstrates the difficulties the Government faces in getting an outright ban into legislation for England before the next election.” [David Parsley, Richard Vaughan. Inside Big Tobacco’s campaign to block Rishi Sunak’s smoking ban, i News]
"New Zealand's new government says it plans to scrap the nation's world-leading smoking ban to fund tax cuts. The legislation, introduced under the previous Jacinda Ardern-led government, would have banned cigarette sales next year to anyone born after 2008. Smoking is the leading cause of preventable deaths in New Zealand, and the policy had aimed to stop young generations from picking up the habit. Health experts have strongly criticised the sudden reversal. "We are appalled and disgusted... this is an incredibly retrograde step on world-leading, absolutely excellent health measures," said Prof Richard Edwards, a tobacco control researcher and public health expert at the University of Otago... Public health modelling conducted in 2022 had shown the Smokefree policy would have saved New Zealand's health system about NZ$1.3bn (£630m; $790m) over the next 20 years." [Frances Mao. New Zealand smoking ban: Health experts criticise new government's shock reversal, BBC News. See also: New Zealand’s New Government Says It Will Scrap Smoking Ban, New York Times; Tova Podcast: National will have deaths of 8000 Kiwis on their hands – Labour, Stuff (NZ)]
“The UK's leading vape brand Elfbar and its sister brand Lost Mary say they will drop dessert and soft drink flavours, which have been criticised for appealing to children… The government consultation on new rules for vapes closes on 6 December. The dazzling range of flavours have helped to turn disposable vapes into a market worth billions of pounds in a few short years, with Elfbar and Lost Mary taking the lion's share. They're both owned by the Chinese firm Shenzhen iMiracle Technology. Elfbar has already dropped Bubble Gum, Cotton Candy, and Rainbow Candy flavours, with more expected to follow. Gummy Bear was (sic) been renamed Gummy, and is now called Gami… Councils have called for an outright ban on disposable vapes, saying that as well as appealing to children, they cause a litter problem and a fire hazard.” [Ben King. Elfbar: Top vape firm drops sweet flavours over appeal to kids, BBC News; See also: Elf Bar vape adverts banned in UK over ‘greener’ recycling claims, The Guardian]
“Lung cancer kills more than 130,000 Americans a year, more than any other cancer. But that number need not be so high. Health officials could significantly reduce the toll of the disease simply by increasing screening for it. Only about 1 in 4 cases of lung cancer are diagnosed in early stages. Why? A key reason is that the screening rate is abysmally low… Updated guidelines from the American Cancer Society (ACS) seek to increase the number of people who qualify for such screenings… It’s common knowledge that the top risk factor for lung cancer is cigarette smoking, which is linked to 80 to 90 percent of lung cancer deaths… ACS previously recommended annual screenings for 55-to-74-year-olds with at least a 30-pack-year smoking history and who quit smoking less than 15 years ago. The new guidelines made several key changes, including widening the age parameters to between 50 and 80 years, lowering the smoking history to 20 pack-years and eliminating the “years since quitting” metric.” [Leana S. Wen. More people need to be screened for lung cancer, Washington Post]
“Twenty-nine individuals from across the globe participated in the study. They reported several forms of intimidation including attacks in the media; online harassment; legal threats; non-legal threats, including death threats; Freedom of Information requests; perceived or actual surveillance; as well as burglary and theft. Responses included non-action (i.e. ignoring attacks); withdrawal (i.e. abandoning a project, area or field); defensive adaptation, for example through self-censorship; and offensive measures, including exposing attacks or filing complaints.”
“They try to suppress us, but we should be louder”: a qualitative exploration of intimidation in tobacco control
Globalization and Health volume 19, Article number: 88 (2023)
Published: 16 November 2023
Britta K Matthes, Raouf Alebshehy & Anna B Gilmore
https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-023-00991-0
Note: Open Access.
“Of the 134 studies, 56.3% (49/87) of the industry-affiliated studies versus 19.1% (9/47) of nonindustry-affiliated studies concluded that HTPs [Heated tobacco products] were more desirable than CC [conventional cigarettes] (p < .01)… Implications: Tobacco industry advertises HTPs as “reduced-harm” tobacco products compared to CC. HTP users tend to consider HTPs as alternative tobacco products less harmful than CC (ie, products for “harm reduction”). Our results demonstrated that papers written by tobacco industry-affiliated authors concluded that HTPs were more desirable than CC compared to papers by independent authors. However, all their judgments were based on surrogate outcomes. Surrogate outcomes are not necessarily linked to clinically relevant outcomes such as disease occurrence.”
Comparison of Publications on Heated Tobacco Products With Conventional Cigarettes and Implied Desirability of the Products According to Tobacco Industry Affiliation: A Systematic Review
Nicotine & Tobacco Research, ntad205.
Published: 10 November 2023
Harumitsu Suzuki, Naoki Aono, Yan Zhang, Kuniko Yuri, Maggy Audrey Murielle Bassole Epse Brou, Shigeki Takemura, Aya Higashiyama, Takahiro Tabuchi, Akira Fujiyoshi
https://academic.oup.com/ntr/advance-article-abstract/doi/10.1093/ntr/ntad205/7405391
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Rassegna Stampa Scientifica Gennaio 2024
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Cigarette smoking is causally related to lung cancer in men; the magnitude of the effect of cigarette smoking far outweighs all other factors… [I]t is a health hazard of sufficient importance to warrant appropriate remedial action.” [Luther Terry et al. Smoking and Health: Report of the Advisory Committee to the Surgeon General of the Public Health Service, 1964. US Public Health Service. Office of the Surgeon General]
Ed. Note: This past Thursday, January 11, 2024, marked the 60th anniversary of the release of the first US Surgeon-General Report (SGR) on Smoking and Health. Coupled with the 1962 UK report of the same name, Smoking and Health, by the Royal College of Physicians (RCP), these reports led to major if never rapid-enough progress towards declining rates of tobacco use. To mark the anniversary of that first SGR report, Professor Alan Blum, director of the the University of Alabama Center for the Study of Tobacco and Society, “has published a new online exhibit, “Blowing Smoke: The Lost Legacy of the Surgeon General’s Report on Smoking and Health.”” See also: 60 Years After Landmark Report on Smoking, Rates Have Plummeted but Work Remains, U.S. News & World Report; 60th anniversary of surgeon general's report linking tobacco to cancer, Fox17]
"White House officials are wrestling with one of the most consequential public health decisions of President Biden’s term: whether to enact a nationwide ban on menthol cigarettes, which are a leading cause of death among Black Americans... The years-long debate about banning menthol cigarettes has pitted public health officials who say the move would effectively save hundreds of thousands of Black lives in the coming decades against political advisers who warn that Biden could lose support by banning products popular in the Black community, jeopardizing crucial votes ahead of what is expected to be a close election…
"The administration faces time pressure to make a decision, with public health officials seeking to finalize and publish the regulations by Jan. 20 — 12 months before next year’s Inauguration Day — to lock in industry requirements that require a year to take effect, worried that a new administration could reverse them... Officials also said that the fight over menthols reflects the short-term political calculations that interfere with long-term public health goals, such as reversing stalled progress on U.S. life expectancy." [Dan Diamond, Tyler Pager. White House weighs menthol ban amid dueling health, political pressures, Washington Post]
“Do you know what a Zynbabwe is? Or an upper-decky lip pillow? OK, here’s an easier one — how about just Zyn? If you are scratching your head, don’t feel bad: Almost no adult I have spoken to has had any idea either. This is despite the fact that the nicotine pouch Zyn is a jewel in the crown of a multibillion-dollar tobacco company… Parents need to know that when children go online, they are entering a world of influencers, many of whom are hoping to make money by pushing dangerous products. It’s a world that’s invisible to us, because when we log on to our social media, we don’t see what they see…
“Another thing to know about Zyn? The tobacco conglomerate Philip Morris International acquired the Zyn maker Swedish Match in 2022 as part of a strategic push into smokeless products, a category it projects could help drive an expected $2 billion in U.S. revenue in 2024. P.M.I. is also a company that has long denied it markets tobacco products to minors despite decades of research accusing it of just that. One 2022 study alone found its brands advertising near schools and playgrounds around the globe…
“California forbids any tobacco billboards near the middle school by my house in San Francisco, but that law does not prevent unsponsored #Zynbabwe videos from showing up in those students’ feeds at recess… Laws should require tech companies to share data on what young people are seeing on social media and to prevent any content promoting age-gated products from reaching children’s feeds… Let’s stop treating the internet like a monster we can’t control. We built it. We foisted it upon our children. We had better try to protect them from its potential harms as best we can.” [Emily Dreyfuss. Our Kids Are Living in a Different Digital World, New York Times]
“As students at the University of Sydney prepared for their end-of-year exams in late 2023, a trio in brightly coloured jumpsuits pulled up to the campus in a van, armed with tiny bottles labelled “Ryde wellbeing shots”… What was not revealed to students, and is not on the Ryde product label, is that the Water Street Collective is a wholly owned subsidiary of British American Tobacco. The Ryde website only once mentions British American Tobacco, and only as BAT.”… Christina Watts, a tobacco control researcher with the Daffodil Centre (a joint venture of Cancer Council NSW and the University of Sydney), said… “On first glance it’s tempting to think the industry is moving away from deadly and addictive products. But these startup wellness brands and products do not replace tobacco profits, but serve only to expand revenue sources. These products are a thin veneer on what remains a deadly industry.” [Melissa Davey, Natasha May. Australian students handed ‘wellbeing shots’ made by subsidiary of British American Tobacco – as experts fear new front in health wars, The Guardian]
“Vapes should be made prescription only to protect children, leading respiratory doctors have said. In a letter published in The Times [Saturday January 6], 17 practising and retired paediatric specialists call on ministers to take action to curb youth vaping. Rising numbers of children and young people are being treated in NHS hospitals for vaping-related disorders. Vaping rates among teenagers have risen sharply, particularly since disposable vapes came onto the market.” [Kat Lay. Doctors call for prescription-only vapes to protect children, The Times. See also: Vaping is ridiculous and unmanly – yet I still got hooked, The Telegraph]
“We have spent our working lives caring for children and young people with respiratory illnesses and have seen at first hand the problems that smoking and the subsequent addiction to nicotine have caused. The known long-term immorality of the tobacco and the vaping industries and the suggestion by the World Health Organisation that Britain is out of step with the rest of the world impel us to urge the government to stop further consultations and rapidly implement three things: first, rigorous enforcement of the ban on vapes and snus sales to children and young people under 18, with punitive measures for non-compliance; second, ban the sale of snus and vapes to adults except when prescribed for smoking cessation, as, in our experience, wider availability enables them to fall into children’s hands; and third, a total ban on disposable vapes.” [Letter. Professor Warren Lenney et al., Former chairs and previous members of the British Paediatric Respiratory Society executive committee. Call to ban vaping, The Times]
“The National Health Interview Survey (NHIS) data from 2014 to 2021 was used to evaluate the relationship between e-cigarette use and myocardial infarction in subjects who have never smoked cigarettes… The current e-cigarette users had a 2.6-fold increase in the odds of having a myocardial infarction (OR 2.62, 95% CI 1.44-4.77; p <0.01) after adjusting for sex, age, hypertension, diabetes, hypercholesterolemia, and obesity/overweight. Conclusions: This study suggests that current e-cigarette use increases the risks of cardiovascular disease, including myocardial infarction and stroke, in subjects who never smoked cigarettes.”
Electronic Cigarette Use and Myocardial Infarction
Cureus. 2023 Nov 6;15(11):e48402. eCollection 2023 Nov.
Talal Alzahrani
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10700683/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10700683/pdf/cureus-0015-00000048402.pdf
Note: Open Access.
“There is high‐certainty evidence that ECs [e-cigarettes] with nicotine increase quit rates compared to NRT [nicotine replacement therapy] and moderate‐certainty evidence that they increase quit rates compared to ECs without nicotine. Evidence comparing nicotine EC with usual care/no treatment also suggests benefit, but is less certain due to risk of bias inherent in the study design. Confidence intervals were for the most part wide for data on Aes [adverse events], SAEs [serious adverse events] and other safety markers, with no difference in AEs between nicotine and non‐nicotine ECs nor between nicotine ECs and NRT. Overall incidence of SAEs was low across all study arms. We did not detect evidence of serious harm from nicotine EC, but the longest follow‐up was two years and the number of studies was small. The main limitation of the evidence base remains imprecision due to the small number of RCTs [randomised controlled trials], often with low event rates.”
Electronic cigarettes for smoking cessation
Cochrane Database of Systematic Reviews
Version published: 08 January 2024
Nicola Lindson, Ailsa R Butler, Hayden McRobbie, Chris Bullen, Peter Hajek, Rachna Begh, Annika Theodoulou, Caitlin Notley, Nancy A Rigotti, Tari Turner, Jonathan Livingstone-Banks, Tom Morris, Jamie Hartmann-Boyce
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010216.pub8/full
“This was a longitudinal study using data from a nationally representative sample of youth (age 12–17 years) in the Population Assessment of Tobacco and Health Study… After matching, household vaping bans were associated with 56% lower odds of youth vaping (OR = 0.44; 95% CI = 0.33–0.58). Results from hybrid panel models also revealed 37% lower odds of vaping in waves when youth lived in a vape-free household compared to waves when they did not (OR = 0.63; 95% CI = 0.50–0.78)… Conclusions: Household vaping bans appear to be associated with lower odds of past-month vaping among US adolescents, compared with similar youth whose households did not have a ban and to themselves in waves when their households did not have a ban.”
Household vaping bans and youth e-cigarette use
Addiction . 2024 Jan;119(1):74-83. Epub 2023 Sep 15.
Jeremy Staff, Jessica M Mongilio, Jennifer L Maggs, Mike Vuolo, Brian C Kelly
https://onlinelibrary.wiley.com/doi/10.1111/add.16335
“All cigarette use—assessed as ever, occasional, frequent, or daily—among adolescents declined markedly from 1991 to 2021. Specifically, ever use significantly decreased from 70.1% in 1991 to 17.8% in 2021 (P<0.05), an almost 4-fold decline. Occasional use significantly decreased from 27.5% in 1991 to 3.8% in 2021 (P<0.05), a greater than 7-fold decline. Frequent use significantly decreased from 12.7% to 0.7%, a greater than 18-fold decline. Daily use declined from 9.8% in 1991 to 0.6% in 2021, a greater than 16-fold decline… Conclusion: These data show large and significant decreases in cigarette use among US adolescents in high school grades 9 through 12 from 1991 to 2021. Nonetheless, the data also suggest residual clinical and public health challenges that will require targeted interventions.”
Trends in Cigarette Smoking Among United States Adolescents
Ochsner Journal December 2023, 23 (4) 289-295.
Maria C. Mejia, Adedamola Adele, Robert S. Levine, Charles H. Hennekens and Panagiota Kitsantas
https://www.ochsnerjournal.org/content/23/4/289
Note: Open Access.
Related PR:
Dramatic decline in cigarette use among U.S. teens over three decades
https://www.eurekalert.org/news-releases/1030776
“In 2019, the deaths and DALYs [disability adjusted life years] attributed to tobacco-related breast cancer were estimated to be 35,439 (95% UI: 22,179–48,119) and 1,060,590 (95% UI: 622,550–1,462,580), respectively. These figures accounted for 5.1% and 5.2% of the total burden of breast cancer. ASMR [age-standardized mortality rate] and ASDR [age-standardized DALYs rate] increased in low SDI [socio-demographic index] regions, remained stable in low-middle and middle SDI regions and declined in high and high-middle SDI regions… In conclusion, tobacco is one important and modifiable risk factor for breast cancer... In addition, the populations in Low SDI regions would suffer a substantial burden of tobacco-related breast cancer, leading to a persistent challenge to both healthcare and economic sectors in the foreseeable future.”
The global, regional, and national disease burden of breast cancer attributable to tobacco from 1990 to 2019: a global burden of disease study
BMC Public Health volume 24, Article number: 107 (2024)
Published: 06 January 2024
Qiusheng Guo,Yunyan Lu,Weiguo Liu,Gaochen Lan & Tian Lan
https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-023-17405-w
Note: Open Access.
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