Electronic cigarettes need stronger regulation: WHO

Vapers have become increasingly popular,
yet experts worry about health threats.

Governments should ban the use of electronic cigarettes in public places and outlaw tactics to lure young users, the World Health Organization said in a report that calls for some of the toughest measures yet proposed for the increasingly popular devices.

It also expressed “grave concern” about the growing role of the powerful tobacco industry in the e-cigarette market, warning that the financially powerful companies could come to dominate the new business and use the current tolerance of the new products as a gateway to ensnaring a new generation of smokers at a time when the public health authorities seem to be winning the battle against tobacco.

The proposals by the organization, a United Nations agency, are only recommendations that might have little likelihood of being widely adopted. But health experts said they would serve as an important reference point for policy makers, both nationally and locally, as they try to navigate the complex balance of benefits and risks with very little science on which to base conclusions.

Many health experts welcomed the recommendations, which they said would help guide policy makers around the world as they struggle to keep up with a multibillion-dollar industry.

But some experts said they worried that the proposals were so restrictive that they might undermine the potential benefits of e-cigarettes, which, because they use battery-powered heating units to vaporize a liquid nicotine solution rather than burn tobacco, might not expose users to as many hazards as conventional cigarettes.

Some experts have even argued that e-cigarettes have the potential to drastically reduce rates of smoking, one of the biggest causes of preventable death worldwide, and so should not be overregulated.

But in its report, the organization said that because there were still too many uncertainties surrounding e-cigarettes, which have been on the market for less than a decade, their use indoors should be banned “until exhaled vapor is proven to be not harmful to bystanders.”

The report also called for regulation to ensure the products contain a standard dose of nicotine, as the drug content now varies widely among manufacturers. And to stop children from picking up the habit, it said that e-cigarette sales to minors should be banned and that fruity, candy-type flavorings should be prohibited.

The 13-page report, which summarizes the growing body of evidence on the health impact of electronic cigarettes, was prepared by the World Health Organization for the United Nations Framework Convention on Tobacco Control, to be held in mid-October in Moscow.

The organization has no power to enforce its recommendations, but delegates to the meeting could, in theory, endorse the measures for inclusion in the treaty or call for yet more studies before taking further action.

The proposals come from the same organization that successfully pushed for the United Nations tobacco treaty, adopted in 2003, that is intended to reduce illnesses and deaths caused by tobacco.

The rapid growth of the market for e-cigarettes has left national regulatory systems and health policy experts struggling to keep up, as old notions about the dangers of tobacco and smoking are posed in a new light.

The health body said that there were now 466 brands of e-cigarettes globally, in a market valued last year at $3 billion. The market research firm Euromonitor forecasts sales will swell by a factor of 17 by 2030.

Anecdotal evidence suggests that e-cigarettes may hold promise as smoking cessation aids. But the World Health Organization report noted that there was scant evidence for their effectiveness in helping smokers give up the habit.

“Vapers,” as e-cigarette aficionados are known, have become a potent lobby on behalf of the products. Their support helped the tobacco industry defeat a European Commission proposal that the devices be regulated in Europe as medicines. In February, the European Parliament voted to adopt a set of rules that include a ban on advertising. The tobacco industry is lobbying to water down the measures before they are to go into effect in 2016.

In the United States, the Food and Drug Administration proposed in April extending its regulation of tobacco products to include e-cigarettes, with a ban on their sale to people under 18. The proposal remains under consideration.

Source: New York Times
This article has been edited for length.

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Smoking ban shows quick results

Research shows smoke-free public places
improve children's health, even before birth.

The number of premature births and children’s hospital visits for asthma dropped significantly in parts of the United States, Canada, and Europe barely a year after they enacted smoking bans, researchers reported in The Lancet recently.

The new analysis combined the results of 11 studies encompassing more than 2.5 million births and nearly 250,000 asthma attacks.

Experts called it the best evidence to date that legislation creating smoke-free public places and workplaces improves children’s health, even in the womb.

The results are “very impressive,” said Dr. Brian Mercer, chairman of obstetrics and gynecology at MetroHealth Medical Center in Cleveland, who noted that half a million American babies are born prematurely each year.

“If you could prevent 10 percent, you’d prevent nearly 50,000 premature babies in the U.S. alone each year,” said Dr. Mercer, who was not involved in the study.

After an exhaustive review of relevant studies spanning 38 years, the researchers analyzed five that looked at perinatal and child health after local smoking bans in North America and six studies conducted after national bans in Europe.

Hospital visits for childhood asthma and premature births both declined about 10 percent in the year after smoking bans took effect, the researchers found.

The investigators also pooled data from two studies and found a 5 percent reduction in the number of children born very small for their gestational age after the introduction of smoke-free laws.

An earlier analysis of the impact of smoking bans on adult health demonstrated a 15 percent reduction in cardiovascular events.

The new report offers “another very good reason to institute smoking bans in public places,” said Dr. Muktar Aliyu, an associate professor of health policy and medicine at Vanderbilt University who has studied birth outcomes linked to maternal smoking.

Only 16 percent of the world’s population is covered by comprehensive smoke-free laws, and 40 percent of children worldwide are routinely exposed to secondhand smoke.

About half of Americans are protected by complete smoke-free policies in workplaces, restaurants and bars, according to the Americans Nonsmokers’ Rights Foundation, a nonprofit group.

The new analysis did not prove that smoke-free laws caused the improvements in children’s health. And the researchers didn’t evaluate other factors, like taxation of tobacco products and advertisement bans, which could have contributed.

The authors note that further studies are needed to estimate the effect of smoke-free laws on respiratory tract infections in children, a major problem of secondhand smoke. The authors also cite a “pressing need” for studies of tobacco control laws in low- to middle-income countries.

Source: NY Times. This article has been edited for length.

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Smoke warnings saved millions of lives, report shows

Historic smoking report marks 50th anniversary

Fifty years ago, ashtrays seemed to be on every table and desk. Athletes and even Fred Flintstone endorsed cigarettes in TV commercials. Smoke hung in the air in restaurants, offices and airplane cabins. More than 42 percent of U.S. adults smoked, and there was a good chance your doctor was among them.

Cigarette smoke exposure can cause
cancer, health experts say.

The turning point came on Jan. 11, 1964. It was on that Saturday morning that U.S. Surgeon General Luther Terry released an emphatic and authoritative report that said smoking causes illness and death — and the government should do something about it.

In the decades that followed, warning labels were put on cigarette packs, cigarette commercials were banned, taxes were raised, and new restrictions were placed on where people could light up.

"It was the beginning," said Kenneth Warner, a University of Michigan public health professor who is a leading authority on smoking and health.

It was not the end. While the U.S. smoking rate has fallen by more than half to 18 percent, that still translates to more than 43 million smokers. Smoking is still far and away the leading preventable cause of death in the United States Some experts predict large numbers of Americans will puff away for decades to come.

Nevertheless, the Terry report has been called one of the most important documents in U.S. public health history, and on its 50th anniversary, officials are not only rolling out new anti-smoking campaigns but reflecting on what the nation did right that day.

The report's bottom-line message was hardly revolutionary. Since 1950, head-turning studies that found higher rates of lung cancer in heavy smokers had been appearing in medical journals. A widely read article in Reader's Digest in 1952, "Cancer by the Carton," contributed to the largest drop in cigarette consumption since the Depression. In 1954, the American Cancer Society announced that smokers had a higher cancer risk.

But the tobacco industry fought back. Manufacturers came out with cigarettes with filters that they claimed would trap toxins before they settled into smokers' lungs. And in 1954, they placed a full-page ad in hundreds of newspapers in which they argued that research linking their products and cancer was inconclusive.

Cigarette sales rebounded

It was a brilliant counter-offensive that left physicians and the public unsure how dangerous smoking really was. Cigarette sales rebounded.

After Terry's report, health officials realized it would take more than one report.

In 1965, Congress required cigarette packs to carry warning labels. Two years later, the Federal Communications Commission ordered TV and radio stations to provide free air time for antismoking public service announcements. Cigarette commercials were banned in 1971.

The 1970s also saw the birth of a movement to protect nonsmokers from cigarette fumes, with no-smoking sections on airplanes, in restaurants and in other places. Those eventually gave way to complete smoking bans. Cigarette machines disappeared, cigarette taxes rose, and restrictions on the sale of cigarettes to minors got tougher.

Tobacco companies also came under increasing legal attack. In the biggest case of them all, more than 40 states brought lawsuits demanding compensation for the costs of treating smoking-related illnesses. The tobacco industry settled in 1998 by agreeing to pay about $200 billion and curtail marketing of cigarettes to youths.

Smoking today:

43M -- Americans who smoke today.
8.6M -- Americans living with a serious illness caused by smoking.
443,000 -- Americans who die prematurely each year from smoking or exposure to secondhand smoke.

In 1998, while the settlement was being completed, tobacco executives appeared before Congress and publicly acknowledged for the first time that their products can cause lung cancer and be addictive.

Experts agree that the Terry report clearly triggered decades of changes that whittled the smoking rate down. But it was based on data that was already out there. Why, then, did it make such a difference?

For one thing, the drumbeat about the dangers of smoking was getting louder in 1964, experts said. But the way the committee was assembled and the carefully neutral manner in which it reached its conclusion were at least as important, said Dr. Tim McAfee, director of the Office on Smoking and Health at the federal Centers for Disease Control and Prevention.

At the same time, he and others said any celebration of the anniversary must be tempered by the size of the problem that still exists.

Each year, an estimated 443,000 people die prematurely from smoking or exposure to secondhand smoke, and 8.6 million live with a serious illness caused by smoking, according to the CDC.

Source: Tampa Bay / AP

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Smokers impact productivity, study says

Companies benefit from smoke-cessation
programs, study authors say.

A recent report from the Conference Board of Canada claims that employees who smoke have a strongly detrimental effect on their companies’ bottom line.

Smoking Cessation and the Workplace: Benefits of Workplace Programs, which was released on Oct. 29, is the third and last in a series of briefings by the Canadian Alliance for Sustainable Health Care (CASHC) — a program run by the Conference Board — on how smoking affects the work environment.

Among the report’s revelations: a combination of decreased productivity and increased absenteeism resulted in an average yearly loss of $4,256 per daily smoker in Canada in 2012, a figure that is way up from the calculated $3,396 in 2005.

“The research is mostly health-focused, but we also looked at productivity losses, because we were trying to argue that it is in the best interests of the employers to actually do something about this,” explained study co-author Fares Bounajm, an economist with CASHC.

“They do actually have a lot to benefit from this. But the other major goal is obviously to reduce smoking.”

The study analyzed four different categories of costs attributed to smoking employees, putting dollar values on the losses.

Daily smokers increase absenteeism rates

Productivity loss, attributed mostly to unsanctioned smoke breaks, accounted for an average cost of $3,842 per daily smoker in 2012, with an additional $414 lost per daily smoker due to absenteeism. Daily smokers also tend to take about two-and-a-half more sick days a year than nonsmokers do, the study added.

“In a typical Canadian firm with 100 employees, 14 daily smokers and 15 former daily smokers who recently quit, this represents an annual productivity loss of nearly $60,000,” the study said. “The figure can be significantly higher in industries where smoking rates are typically well above average.”

In terms of costs that have a more indirect effect on employers, the Canadian economy lost about $7.1 billion in productivity in 2010 due to people who could not work because of chronic conditions resulting from smoking, including lung and bladder cancer, leukemia, chronic obstructive pulmonary disease and heart disease.

An additional $4.3 billion in long-term economic losses was due to the calculated 26,681 premature deaths attributable to the habit that same year.

Bounajm said that while employers shouldn’t necessarily be seen as responsible for helping their employees quit smoking, they do have a strong financial motivation to establish workplace smoking-cessation programs.

“Smokers do cost their employers money, and we know that a lot of the employees would like to quit,” he said.

“This could be a win-win situation for both the employers and many of the smokers that do want to quit, because the employers can implement a workplace cessation program, and by doing so, they can get a good return on their investment, because they can lower their productivity losses due to smoking. At the same time, the employees benefit because they become healthier and they achieve their goal of quitting smoking.”

Bounajm added that employers could add cessation aids to their company benefits plans. “We know that there are two types of aids that do work. We know that counseling works. We know that certain cessation aids work. And we know that combining them together actually works the best.”

The report estimated that an effective workplace cessation program could cause the prevalence rate of daily smokers in an average Canadian company to decrease by 35 per cent by 2025.

Source: OHS Canada

Keep indoor air healthy to boost productivity

Even with a ban on indoor smoking, smokers bring carconogenic particles and odors back indoors. Workers are also exposed to other indoor air contaminants in most workplaces, including allergens and dust, chemicals, fumes and odors as well as viruses, bacteria and mold.

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Smoking in casinos – time for a ban?

Smoking in casinos is still allowed,
but health concerns spur debates.

Casinos have long been exempt from smoking bans that were implemented in other public places.

Many casino owners and patrons believe smoking and gambling go hand in hand.

Still, ever-mounting evidence of the negative health effects of smoke and exposure to secondhand smoke is causing lawmakers to reconsider their stance on the issue.

In Kansas, smoking has been banned in indoor settings except private residences, adult care homes, up to 20 percent of rooms in hotels, some private clubs, tobacco shops and casinos.

What carries higher costs - a ban or no ban?

A ban on smoking on casino floors could cost the casinos and the state millions of dollars, opponents of the ban say.

But didn’t restaurant owners say exactly the same thing? Most places are thriving now because people still go to restaurants and are not bothered by cigarette smoke.

According to the casinos, a large number of gamblers also smoke – and banning the cigarettes would be like banning popcorn at the movies, they say.

However, smoking does not only affect the smokers themselves, it also puts the casino workers at risk as well as the other non-smoking gamblers.

Tobacco smoke contains thousands of dangerous chemicals that cling to surfaces and constitute serious health risks, including higher risks of lung cancer, heart disease, bronchitis and asthma.

Source: Wichita Eagle

Improve the indoor air quality in casinos

Experts warn that ventilation systems in many casinos are simply unable to handle the tobacco smoke on the casino floors.

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Indoor air quality improves with restaurant smoking bans

A Michigan-wide smoking ban has led to much
better indoor air quality in restaurants, study shows.

Restaurants in Michigan are serving up much cleaner and healthier air these days.

After 18 months of a no-smoking rule, a study found a 93 percent reduction in indoor air pollution from secondhand smoke, the Michigan Department of Community Health says.

The study tested 77 restaurants from 13 cities before the law was passed, in the time between 2005 and 2008.

The cities include Ann Arbor, Detroit, Flint, Grand Rapids, Kalamazoo, Lansing, Marquette, Midland, Novi, Saginaw, Sault Ste. Marie, Traverse City and West Branch.

The law came into effect on May 1, 2010, and the restaurants were then re-tested, the agency said.

The study included three casinos from Detroit. Casinos are exempt from the smoking ban, which is why the study results were not 100 percent reduction of indoor air pollutants, they say.

The agency hopes for better health outcomes because of the ban as well and plans another study to measure hospitalizations and heart problems. Another study is planned to measure the overall impact of the Smoke-Free Air Law and economic results.

Another year-long study by the American Cancer Association showed that more than 90 percent of residents support the ban.

Source: Holland Sentinel

Persistent tobacco smells can be cured with an air cleaner

The cigarettes may be gone, but the smells may still be there.

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