Health New Zealand

Time 2020-09-12 12:03:13

Web Name: Health New Zealand

WebSite: http://www.healthnz.co.nz

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Dr Murray Laugesen Director, Health New Zealand Ltd and Adjunct Professor, Department of Psychology, University of Canterbury. ph 03 358 9329 For peer reviewed publications see www.healthnz.co.nz/Publicnsall.htm Cigarette sales are plunging faster than any time before as smokers turn to alternatives like vaping - with 410 million fewer smokes sold annually than just two years ago. Dr Murray Laugesen, a trustee of the End Smoking NZ charity, analysed tobacco company returns that are published by the Ministry of Health and found a remarkable drop in sales. About 2132 million cigarettes were sold last year - 193 million fewer than 2018, and following a 217 million drop the previous year. The trend is driven by factors including cost (a 25-pack of cigarettes was $16.39 in 2011 and is now about $41.89) and alternative products like vaping e-cigarettes - but needs to be accelerated if the December 2025 goal of less than 5 per cent smoked tobacco prevalence is to be met. Continuation of a 9.5 per cent annual per-capita decline in tobacco use, suggests the goal will still not be met until at least 2029, four years overdue, said Dr George Laking, an oncologist and chair of End Smoking NZ. Success in the goal would imply a further reduction of tobacco imports by 5 per cent per year from 2021 onwards. May 2020 Heat not burn cigarettes versus Combustible cigarettes Risk Analysis 2020 May 1. doi: 10.1111/risa.13482. Online ahead of print. A Method for Comparing the Impact on Carcinogenicity of Tobacco Products: A Case Study on Heated Tobacco Versus Cigarettes Wout Slob 1, Lya G Soeteman-Hern ndez 1, Wieneke Bil 1, Yvonne C M Staal 1, W Edryd Stephens 2, Reinskje Talhout 1 PMID: 32356921 DOI: 10.1111/risa.13482 Abstract Comparing the harmful health effects related to two different tobacco products by applying common risk assessment methods to each individual compound is problematic. We developed a method that circumvents some of these problems by focusing on the change in cumulative exposure (CCE) of the compounds emitted by the two products considered. The method consists of six steps. The first three steps encompass dose-response analysis of cancer data, resulting in relative potency factors with confidence intervals. The fourth step evaluates emission data, resulting in confidence intervals for the expected emission of each compound. The fifth step calculates the change in CCE, probabilistically, resulting in an uncertainty range for the CCE. The sixth step estimates the associated health impact by combining the CCE with relevant dose-response information. As an illustrative case study, we applied the method to eight carcinogens occurring both in the emissions of heated tobacco products (HTPs), a novel class of tobacco products, and tobacco cigarettes. CCE was estimated to be 10- to 25-fold lower when using HTPs instead of cigarettes. Such a change indicates a substantially smaller reduction in expected life span, based on available dose-response information in smokers. However, this is a preliminary conclusion, as only eight carcinogens were considered so far. Furthermore, an unfavorable health impact related to HTPs remains as compared to complete abstinence. Our method results in useful information that may help policy makers in better understanding the potential health impact of new tobacco and related products. A similar approach can be used to compare the carcinogenicity of other mixtures. 2020 The Authors. Risk Analysis published by Wiley Periodicals, Inc. on behalf of Society for Risk Analysis. 8 June 2020 Covid 19: Damage in New Zealand 22 deaths and over 1500 cases reported until today No new cases ..reported for over 16 days. Moves into Stage 1 today. 4 May 2020 Covid-19: Seattle and the EIS versus New York and its Health Commissioners and Mayor Seattle: several hundred deaths; New York 15,000 https://www.newyorker.com/magazine/2020/05/04/seattles-leaders-let-scientists-take-the-lead-new-yorks-did-not 31 January 2020 Tobacco companies required to report 2019 results to Ministry of Health on tobacco consumption in NZ In 2018 BAT reported sales of 722.244 Million Kg of tobacco, and RYO sales of 290.377 million. 21 Jan 2020 Imperial pulling out of tobacco sales factory in NZ 122 jobs are at risk at Imperial's factory in Petone, according to Cameron Smith of NZ Herald.. This is the last factory making combustible tobacco products in NZ. Kirsten Daggar Nickson head of corporate and legal affairs for Imperial Brands said consumer demand was the reason to close the Petone factory. Globally consumer demand for our product has declined, so the proposal to close our Petone cigarette factory is necessary for the future of our business. Philip Morris and British American Tobacco have yet to announce any moves to restrict import of combustible cigarettes into NZ from Australia. Until that happens combustible cigarettes are still sold in NZ. As My Life in Public Health (below) points out, profits for the three major tobacco companies fell 61% between 2015 and 2017. - Murray Laugesen My Life in Public Health - Murray Laugesen QSO a memoir from the frontlines of global disease eradication, children's health, and ending smoking. Foreword by Helen Clark. 344 pp. 70 illustrations. Published Sep 2019 $45. Add $6 by courier within NZ. Send total cost to Health New Zealand PO Box 79283 Avonhead Christchurch 8446. Or to HealthNZ 02 0100 072 3644 000 Or from any leading bookseller. Smoking prevalence 2018-2019 Daily all ethnicities 12.5% Maori 30.9% Pacific 21.4% Asian 7.0% E-cigarettes 3.2% September 1995 Natalie Walker, Varsha Parag, Marjolein Verbiest, George Laking, Murray Laugesen, Christopher Bullen. Nicotine patches used in combination with e-cigarettes (with and without nicotine) for smoking cessation: a pragmatic randomised trial. The Lancet Respiratory Medicine Smoking prevalence 15+ years daily 2017-8 All ages 13.1% Maori 33.2% Pacific 20.0% Asian 6.5% Least disadvantaged 23.2% - Statistics NZ Lung cancer rates for new cases fall in overall population All, Maori, Non-Maori 2015 29.9, 83.5, 25.1 2016 28.9, 80.1, 24.4 2017 27.7, 81.5, 22.6 Total new cases were 2250 in 2015 falling to 2226 in 2017. Ministry of Health 22 May 2019. Data subject to change for 2017. 23 April 2019 Majority of Professionals in NZ support cig alternatives (These are not known to cause lung cancer). A majority of healthcare professionals in New Zealand view Electronic Nicotine Delivery Systems (ENDS), such as e-cigarettes and heated tobacco products, as a viable alternative to cigarettes if they are legalised and regulated appropriately, according to new research conducted by Frost Sullivan. Over 500 adults in New Zealand (including current, former and non-smokers), as well as 60 healthcare professionals (including GPs, medical specialists (such as psychiatrists, surgeons and radiologists), nurses, pharmacists, and allied healthcare professionals) were interviewed as part of an opinion research study to gauge the level of understanding and attitudes towards alternatives to cigarettes . New Zealand has moved to reduce smoking rates in recent decades, and currently boasts one of the lowest smoking rates in the developed world. However, almost 600,000 New Zealanders continue to smoke, with particularly high smoking rates among population groups such as Maori and the most economically-disadvantaged New Zealanders. While the Government has set a target of achieving a Smokefree New Zealand by 2025, with a smoking rate of 5% or less nationwide, achieving this goal is likely to be challenging. Smoking is therefore likely to continue to be a significant health and economic challenge for New Zealanders. Managing Director of Frost Sullivan ANZ, Mark Dougan noted: Smoking is still a key area of concern amongst healthcare professionals, with 90% believing that the government still needs to do more to address smoking. Our research shows that there is broad acceptance that ENDS are significantly less harmful than cigarettes, and widespread agreement amongst healthcare professionals that ENDS should be legalised as long as they are appropriately regulated. Healthcare professionals are largely supportive of the use of ENDS, with 65% agreeing that they would prefer smokers who are unable or unwilling to quit to switch to these instead of smoking cigarettes, with 33% unsure and only 2% opposed. In general, healthcare professionals believe that tobacco harm reduction products such as ENDS can aid in reducing the harm from smoking, Mr Dougan said. Our survey indicates that 60% of smokers overall and 64% of Maori smokers would like to quit, but are facing challenges in doing so, with current smokers who have tried to quit reporting, on average, over six unsuccessful attempts to do so, he added. However, about 40% of smokers do not wish to quit or are not sure. In this case, switching to tobacco harm reduction products is a better option in the long term than continuing to smoke cigarettes, he said. The survey also showed that healthcare professionals believe that greater promotion and raising awareness of the role of ENDS to both healthcare professionals and smokers and their families is necessary. For more information or to download the report, please visit http://frost.ly/3ej This research was commissioned by Philip Morris International, however the analysis contained in this research reflects the views of Frost Sullivan analysts without any bias or influence from any third party. Scoop Media 7 March 2019 PM wants concession on price of Heat Not Burn PM is selling its combustibles and its non-combustibles for the same excise. (over 80 cents per cigarette). This may be fixed up during the select Committee process later this year, but meantime this serious anomaly persists. It is especially so because the Wellington court has ruled that Heat Not Burn is entitled to be sold, and does not contain tobacco, ie it is a non-combustible, and is therefore of no harm, unlike the Marlboro cigarette. 11 January 2019 PMI to stop selling cigarettes in the UK by 2030. With new research from Public Health England suggesting that parts of the UK could be smokefree by as early as 2024, PMI's director of corporate affairs in the UK Mark MacGregor has stated that 2030 seems a realistic time to pull cigarettes from sale. Source: the Daily Star. 11 Jan 2029. 23 November 2018 Vaping and smokeless tobacco products to be regulated Jenny Salesa Associate Minister of Health announced today that vaping and smokeless tobacco products are to be regulated. The Smoke-free Environments Act will be amendedin 2019 to give smokers more confidence in the quality of vaping and smokeless tobacco products, while also protecting children and young people from the risks associated with them. Use of these products will be limited in bars restaurants and workplaces. Advertising will also be restricted. Scoop 4 Sep 2018 Dr Fiona Bruce Vaping the methadone of smoking so let's support patients to use it. Blaming patients for smoking, making them feel like losers , is bullying within general practice. - Report of RNZCGP conference 2018- reported by Fiona Thomas. 12 June 2018 End Smoking NZ welcomes Snus to NZ Dr Penny Truman and Dr George Laking have both recommended snus as used in Sweden for use in NZ, as being much safer than smoking. Stuff NZ 6 June 2018 Ministry says E-cigarettes and Smokeless are legal to sell as a result of recent judicial decision. - www.moh.govt.nz 23 May 2018 End Smoking NZ appoints new chair Dr George Laking of Auckland DHB has now replaced Professor Marewa Glover as chair of ESNZ. 10 May 2018 Ministry to consider risk-proportionate regulation for vaping and heated tobacco products In the court case below, it was found that nearly all tobacco products could be sold lawfully under the Smoke-free Environments Act. This means that largely the same regulatory controls apply to smoked tobacco products, heated tobacco products and vaping products made from tobacco. The Ministry plans to consider how best to apply risk-proportionate regulation to all tobacco and vaping produccts. Ministry of Health 28 Marcch 2018 Heets not part of Section 29. Philip Morris win over Ministry of Health In the Wellington District Court on 12 March the Ministry's claim that S. 29 of the Smoke-free Environments Act included HEETS (the nicotine containing sticks in the Heat Not Burn device) was dismissed. This was not the original design of the 1990 Act, said Judge Patrick J Butler. http://www.districtcourts.govt.nz/assets/unsecure/2018-03-27/2018-NZDC-4478-MOH-v-Morris.pdf 15 March 2018 Cigarette plain packaging comes into force across NZ today Starting today tobacco companies will no longer be able to sell cigarettes in branded packaging. Instead they will sell them in olive green brown packets which retain the graphic health warnings already prominent on current branded packets. The brand is given in small letters on the front of the pack. Deadline for selling the old style is June 6. 8 February 2018 Vaping helps people quit smoking A recent survey of vapers found the majority started smoking e-cigarettes to help them quit smoking. More than 200 people from across New Zealand took part in the online survey in 2016, led by Dr Penny Truman from Massey University s School of Health Sciences. The results, published in the International Journal of Environmental Research and Public Healthyesterday, are of interest internationally because at the time of the survey vaping products containing nicotine were not able to be sold legally in New Zealand. Dr Truman says this study confirms accessing nicotine for vaping was the main problem people had with vaping. We found the main reason for trying vaping was to stop or reduce smoking. Most study participants said they had completely switched from smoking to vaping. Some newer vapers still smoked, but they were still cutting down on cigarettes and some only smoked occasionally, Dr Truman says. 7 February 2018 Public Health England publishes independent expert e-cigarettes evidence review ..... vaping poses only a small fraction of the risks of smoking and switching completely from smoking to vaping conveys substantial health benefits ......e-cigarettes could be contributing to at least 20,000 successful new quits per year and possibly many more .....e-cigarette use is associated with improved quit success rates over the last year and an accelerated drop in smoking rates across the country .....many thousands of smokers incorrectly believe that vaping is as harmful as smoking; around 40% of smokers have not even tried an e-cigarette .....there is much public misunderstanding about nicotine (less than 10% of adults understand that most of the harms to health from smoking are not caused by nicotine) .....the use of e-cigarettes in the UK has plateaued over the last few years at just under 3 million ....the evidence does not support the concern that e-cigarettes are a route into smoking among young people (youth smoking rates in the UK continue to decline, regular use is rare and is almost entirely confined to those who have smoked) Editor: Ann McNeill et al. 16 November 2017 Correction statements on tobacco required by law in the USA As from Nov 27, the media will be required to print on behalf of the tobacco companies, a series of corrective statements, as a result of a court case against US tobacco companies, chaired by Judge Gladys Kessler: : 1. More people die every year from smoking than from murder, AIDS, suicide, drugs, car crashes and alcohol combined. 2. Smoking also causes reduced fertility, low birth weight in newborns, and cancer of the cervix. 3. Smoking is highly addictive. Nicotine is the addictive drug in tobacco. 4. Various companies (US companies) intentionally designed cigarettes to make them more addictive. 5. When you smoke, the nicotine actually changes the brain - that's why quitting is so hard. 6. All cigarettes cause cancer, lung disease, heart attacks and premature death. .. There is no safe cigarrette. 7. Secondhand smoke causes lung cancer and coronary heart disease in adults who do not smoke 8. Children exposed to secondhand smoke are at an increased risk for sudden infant death syndrome (SIDS), acute respiratory infections, ear problems, severe asthma, and reduced lung function. 9. There is no safe level of exposure to secondhand smoke. - Harold Farber, American Thoracic Society. 19 October 2017 Change of Government in New Zealand The dominant parties are now Labour, Greens and NZ First, rather than National. The emphasis on harm reduction and legalisation of e-cigarettes in 2018 is not expected to change. 11 October 2017 NZ Ministry of Health position statement - E-cigarettes In 2011, the Government set a goal for Smokefree 2025. The goal aims to reduce smoking prevalence to minimal levels. The Ministry of Health believes e-cigarettes have the potential to make a contribution to the Smokefree 2025 goal and could disrupt the significant inequities that are present. The potential of e-cigarettes to help improve public health depends on the extent to which they can act as a route out of smoking for New Zealand's 550,000 daily smokers, without providing a route into smoking for children and non-smokers. Recent decisions taken by Government have increased the focus on harm reduction with an aim to support smokers to switch to significantly less harmful products like e-cigarettes. The Ministry of Health encourages smokers who want to use e-cigarettes to quit smoking to seek the support of local stop smoking services. Local stop smoking services provide smokers with the best chance of quitting successfully and should support smokers who want to quit with the help of e-cigarettes. Expert opinion is that e-cigarettes are significantly less harmful than smoking tobacco but not completely harmless. A range of toxicants have been found in e-cigarette vapour including some cancer causing agents but, in general, at levels much lower than found in cigarette smoke or at levels that are unlikely to cause harm. Smokers switching to e-cigarettes are highly likely to reduce their health risks and for those around them. When used as intended, e-cigarettes pose no risk of nicotine poisoning to users, but e-liquids should be in child resistant packaging. E-cigarettes release negligible levels of nicotine and other toxicants into ambient air with no identified health risks to bystanders. Currently there are no mandatory product safety requirements specifically for e-cigarettes in New Zealand, however generic product safety standards apply. The Ministry of Health will continue to monitor the uptake of e-cigarettes, their health impact at individual and population levels, including long term effects and their effectiveness for smoking cessation as products, evidence and technologies develop. The Ministry of Health will also continue to meet its obligations under Article 5.3 of the WHO Framework Convention on Tobacco Control to protect public health policy from commercial and other vested interests of the tobacco industry. August 2017 British Psychological Society Changing behaviour: Electronic cigarettes Lynne Dawkins and Hayden McRobbie. Data on smoking from Eurobarometer 2014 show that of 7.5 million surveyed, 35% of smokers quit.and 32% reduced their smoking. BPS recommends use of e-cigarettes. Drug and Alcohol Nurses of Australasia Electronic cigarettes for Tobacco Harm Reduction September 2017 Position Statement No 3. Darren Smyth President E-cigarettes are not risk free but evidence suggests they are around 95% safer than smoking. Clinical Use. All patients should be encouraged to stop smoking and offered bes practice treatments to assist quitting. Consider E-cigarettes for smokers who are unable to quit with conventional therapies. September 13, 2017 New York Yach heads up Foundation for a Smoke-free World President is Dr Derek Yach, a renowned anti-smoking crusader. . The Foundation has secured funding of approximately US$80 million annually over the next 12 years, beginning in 2018 from Philip Morris International. PMI does not interfere with the workings of Smoke-free World. (www.smoke-freeworld.org ) Initial activities are expected to be focused in four areas of need: 1) Support research into harm reduction and build research capacity through academic centers of excellence 2) Collaboratively build consensus around which interventions can best reduce harm and deaths from smoking and increase smoking cessation 3) Measure and report on global progress towards smoking harm reduction 4) Identify alternative crops and livelihoods for tobacco farmers as the global demand for tobacco declines Dr Derek Yach, studied under Dr Michael Russell, the father of addiction science, at the Institute of Psychiatry in London. At WHO he was a cabinet director and led the development of the Framework Convenrtion on Tobacco Control. He has since been a professor of global health at Yale University. He holds the degrees of MBChB and MPH. 29 September 2017 Comment from WHO When it comes to the Foundation for a Smoke-Free World, there are a number of clear conflicts of interest involved with a tobacco company funding a purported health foundation, particularly if it promotes sale of tobacco and other products found in that company s brand portfolio. WHO will not partner with the Foundation. Governments should not partner with the Foundation and the public health community should follow this lead. Answer to WHO The Foundation is a health foundation with by-laws in place to prevent the sale of tobacco such as Marlboro. 2 June 2017 NZ Med J;130 (1456) Tobacco consumption down 41%, cigarette prices up 230%: lessons from 1985-1988: Life expectancy rises 3.6 years for men. Murray Laugesen and Randolph C. Grace New Zealand men are living much longer due to giving up tobacco smoking in the 1985 1995 period. Diet had an improving effect. In 1988, men were living 3.6 years more than 10 years before, and women 2.8 years more. That is equal to three months gain in life per person over these 10 years. Most of the effect has benefited men. Tobacco consumption per adult fell by 41% in these 10 years. To do that, the price of cigarettes went up 230%, and we started eating more vegetables and fruit and a variety of polyunsaturated fats. Aim. We compared changes in tobacco consumption and diet in relation to changes in life expectancy in 1988 1998 in 22 OECD (Organisation for Economic Cooperation and Development) countries. Method. Between 1985 and 1995 using regression analysis we estimated differences in tobacco consumption per adult and the differences in the sum of atherogenic and thrombogenic indices against life expectancy. Each index was derived from the various fats per gram of food from standard texts, and from the annual measurements of fat in the food balance sheets of each country. Results. In 1985 1995, New Zealand showed the largest decrease in tobacco consumption per adult (41%) and the greatest decrease (except for Switzerland) in the sum of atherogenic and thrombogenic indices (17%) as a measure of diet. New Zealand ranked first for life expectancy increases from 1988 1998 for men (3.6 years), women (2.8 years) and for both sexes combined. Regression analyses revealed that increases in life expectancy across the OECD for males, but not females, were strongly associated with decreases in tobacco consumption, with a weaker effect of diet improvement. Conclusion. These results suggest that reduced tobacco consumption in 1985 1995 likely contributed to New Zealand s gains in life expectancy from 1988 1998. 2 June 2017 NZ Med J 130 (1456) Reduced tobacco consumption, improved diet and life expectancy for 1988-1998: analysis of New Zealand and OECD data. The 3.6 years will be included in an erratum submitted to the NZMJ. 6July 2017 End Smoking NZ Submission to the Inquiry into the Use of Electronic Cigarettes and Personal Vaporisers in Australia Who are we? End Smoking NZ is an independent unfunded charitable trust. Our members collaborate to conduct research and provide up-to-date information to inform public health policy and practice about reducing tobacco smoking in New Zealand (NZ). End Smoking as an organization has no tobacco industry links, nor any commercial interest in electronic cigarettes (e-cigarettes), or in nicotine replacement therapy. End Smoking NZ wasformed in 2006 to raise awareness of, and lobby for, the acceptance of a harm reduction approach to reducing smoking-related morbidity and mortality. At that time we advocated for a law change to enable NZ smokers access to Snus. Switching from smoking tobacco to Snus has regrettably remained an option for Swedish and Norwegian smokers only. Enviably, smoking prevalence in Sweden has dropped to 5% - the rate of New Zealand's 2025 aspiration goal. The lowered incidence of smoking-related disease and life years saved in Sweden and Norway is a buoy marking a lowered risk route all countries could have followed. Instead, we in NZ and Australia have let thousands of people continue smoking instead. Tens of thousands of New Zealanders and Australians have suffered longer and died earlier than they needed to. The Swedish experience stands as a warning not to make the same mistake again! Our experience with electronic cigarettes and vaping Almost 10 years ago we began to investigate the potential of e-cigarettes. Over the intervening years our members have continued to conduct and support a range of studies on e-cigarettes and vaping. On balance the evidence has led us to become more convinced that e-cigarettes present the first real threat to smoked tobacco. E-cigarettes don't just have potential as a smoking cessation tool, they can deliver the Endgame. Basic general points about electronic vaporisers and vaping 1. E-cigarettes are not tobacco products. 2. Whilst nicotine is extracted from tobacco, or can be synthesised, we do not consider nicotine liquid produced for the purpose of vaping to fit the definition of a tobacco product. 3. Electronic vaporisers are not solely, nor necessarily, a smoking cessation device. 4. Electronic vaporisers were created to be a safer alternative nicotine delivery device compared to smoking tobacco products. 5. The use of nicotine replacement products is well established as a safe practice. 6. Vaping nicotine is estimated to be at least 95% safer than smoking tobacco. The estimated risk is as low as many of the established nicotine replacement products. 7. Millions of smokers worldwide have found that vaping, with and without nicotine, has enabled them to achieve sustained abstinence from smoking tobacco. E-cigarettes are very clearly showing their potential to significantly reduce smoking rates. A significant proportion of these people go on to stop vaping as well. Many others enjoy vaping and have no intention to quit in the near future. 8. Vaping nicotine hasn't resulted in sustained abstinence from smoking for all smokers who have tried it. The devices have and continue to vary greatly. Government restrictions are critical to supporting or undermining switching from smoking to vaping. 9. Other alternative nicotine delivery products are in development, or are on the market overseas. No one cessation product or alternative nicotine delivery product will help every smoker either switch off or abstain from smoking tobacco. A range of products are required. We should not limit smokers to just one type of e-cigarette or just one type of greatly harm-reduced alternative to smoking product. Tobacco control has irrevocably changed with the introduction of greatly harm-reduced alternatives to smoking tobacco, particularly the electronic nicotine vaporisers. Smokers now have more alternatives to smoking if allowed. The huge difference between the alternative nicotine delivery devices is that vaping nicotine can (if allowed) provide an equal or better experience than smoking tobacco. This is evidenced by the millions of smokers who have already switched to vaping around the world. Research shows clearly that the huge majority of that use is for smoking replacement or for cessation. Very few never-smokers use e-cigarettes.1 Vaping, even with nicotine, is likely to be less addictive than smoking tobacco. There are good scientific reasons from animal studies to suspect that e-cigarettes should be less addictive than smoking , and some strong indications from cessation trials and observational studies that e-cigarettes will prove less addictive than smoking. Smokers now have an option. They can receive all of the benefits that they enjoyed from smoking tobacco from a significantly less harmful and probably less addictive behaviour. New Zealand's position on e-cigarettes and vaping Following public consultation, the NZ Government has opted to amend the Smoke-Free Environments Act to permit and regulate the import, marketing and sale of nicotine for vaping. The NZ Ministry of Health is also establishing an e cigarette product safety Technical Expert Advisory Group. They are also progressing consultation on what regulatory or other framework to use to determine a NZ position on emerging tobacco and nicotine delivery products. Why Australia should support Australian smokers to switch to vaping nicotine Tobacco control policies have contributed to reducing smoking rates in Australia. But, unacceptable disparities in smoking prevalence by ethnicity remain. Australian Indigenous and Torres Strait Islanders have much higher rates of smoking than non-Indigenous Australians. Some sub-groups, such as mental health consumers also have disproportionately high smoking rates. We believe that nicotine liquid for vaping and vaporisers should be legal to import for sale and distribution in Australia. Further, it would be unethical to delay access to legal nicotine for vaping and instead wait until the market provides pharmaceutically approved nicotine containing e-cigarettes or other alternative products. Vaporisers are already being used in Australia by people who are trying to improve and protect their health. The Australian society should help, not hinder, this trend. Australia and New Zealand have enjoyed a history of alignment on our tobacco control programmes. Since the 1980's, Australia and New Zealand have emulated each other's policies resulting in both our countries being seen to be world leaders in tobacco control. Of relevance to your deliberations, there are various trade and investment agreements between Australia and New Zealand, such as the Australia New Zealand Closer Economic Relations Trade Agreement (1983) (CER) and The Trans-Tasman Mutual Recognition Arrangement which established mutual recognition to labelling and product standards, including those for tobacco products. Divergence on how Australia and New Zealand regulate e-cigarettes needs to be considered in light of the 2013 New Zealand-Australia CER Investment Protocol and the great amount of work that has been done towards New Zealand and Australia's commitment to creating a seamless trans-Tasman business environment, known as the Single Economic Market (SEM). The appropriate regulatory framework for E-cigarettes and personal vaporisers in Australia An appropriate regulatory framework for nicotine vaping products must: 1. Recognise that vaping e-cigarettes is significantly less harmful than smoking tobacco. 2. Ensure it is easier, or at least as easy, to find and buy vaping products as it is to buy tobacco for smoking. 3. Avoid imposing any additional or specific tax over and above GST on vaping products. The initial setup cost for vaping has to be able to be recouped within a short time frame, or people will not switch. 4. Protect the opportunity for Australian and foreign vaping product manufacturers and suppliers who are independent of combustible tobacco product companies to operate in Australia. Policies should not favour established tobacco industry giants. E-cigarettes represent a major threat to the tobacco industry. 5. The primary aim of any regulation should be to enable current smokers to switch to vaping and to have vaping products widely and readily accessible for ex-smokers facing relapse to smoking. Specific recommendations 1. Vaping products should be able to be sold wherever tobacco products are sold and in additional retail outlets that currently do not sell and have no desire to sell tobacco products, such as dedicated vaping product retailers (vape shops). 2. Advertising of vaping products should not be restricted to the same extent as combustible tobacco products. Applying the same type and level of bans on advertising of tobacco products to vaping products sends the misleading message that vaping is as dangerous as smoking tobacco and this will put some people off vaping. The primary purpose of controls on advertising of vaping products should be to avoid the promotion of tobacco products. 3. It is important that independent vape shops be allowed to have a shop-front and/or on-line presence, so people know where to get which products and at what price. Vendors also need to provide information to assist smokers to distinguish between different types of products to ensure that they purchase a vaping kit most likely to speed and assure their complete transition from smoking to vaping. 4. E-cigarettes do not burn tobacco and do not create smoke. There is no evidence of harm to bystanders from exposure to e-cigarette vapour and any risks to their health, if identified, are likely to be extremely low. Bans on smoking should not wholly be applied to vaping. Banning vaping wherever smoking is currently banned contains several risks for vapers. Bans on where people can smoke are extensive in Australia. Despite this, Australia's smoking prevalence has stalled. People who smoke are experiencing sometimes extreme social exclusion, marginalisation and discrimination. If vaping is similarly treated this sends a message that vaping is as dangerous as smoking and that vapers are no different from smokers (e.g. they're still recalcitrant addicts). In this scenario, vapers are also forced to retire to the same limited and increasingly close number of areas that smokers have to go to. As ex-smokers, this puts vapers at risk of relapse to smoking.Anything that inhibits switching to vaping is counterproductive. The ability to vape inside some places, where it is allowed by the organisation or venue offers a valuable advantage of vaping over smoking tobacco.The main argument for banning vaping anywhere that has any claim to a scientifically based theory, though not proven, is that viewing adults vaping might influence a child to initiate smoking. Firstly, vaping is not smoking. Research with NZ children has shown that they can distinguish between smoking and vaping. They also really want their loved ones to stop smoking and they, despite their young age, could see the sense in vaping over smoking. 5. Organisations should be able to set their own policies about vaping. This will enable compassionate employers to allow vapers to vape inside. Hospitals should be allowed to develop policies that provide for vaping as an alternative to tobacco smoking for patients who are unable to, or who are prohibited to, go outside and off the grounds to smoke and potentially for those patients who are not allowed to smoke prior to surgery. Banning vaping in these institutions may disproportionately affect more disadvantaged smokers, such as those with mental health or drug and alcohol conditions. 6. Vaping products should not be required to display graphic health warnings. Vapour is not smoke. The established dangers of tobacco smoking cannot just be extrapolated over to vaping. It has not been established that vaping, even with nicotine is addictive. Our members who are party to this submission include: Chair - Associate Professor Marewa Glover, School of Public Health, Massey University Dr Penny Truman, School of Public Health, Massey University Dr Murray Laugesen, Adjunct Professor Dept. Psychology University of Canterbury, Christchurch. Dr George Laking, Medical Oncologist, Auckland Professor Randolph Grace, University of Canterbury,Christchurch. Greg Town, Medical Editor, Auckland. Smoking biggest risk factor for Sudden unexpected death in infancy Smoking and bed-sharing were now leading risk factors, and mothers doing both at once increased their risk by a factor of 30. The seasonal distribution seen in the 1980s has disappeared. Total rate was 0.76 per 1000 births. Mitchell E. et al. NZ Med J 2 June 2017;130. 2 June 2017 NZ Med J 130 (1456) Very low nicotine content cigarettes would need to be $15 cheaper Trish Fraser, Anette Kira. VLNC cigarettes do not taste as good as the real thing, and would have to be much cheaper, according to smokers tested for this study. 1 May 2017 For publications of Dr Murray Laugesen please see www.healthnz.co.nz/Publicnsall.htm 29 March 2017 Dr Murray Laugesen backs Government move After 10 years of research in Christchurch I fully endorse the government's move to legalise e-cigarettes , he said. 29 March 2017 Chair of End Smoking NZ backs the Government move Legalising nicotine for vaping is a very supportive move by Government, says Dr Glover, chair of End Smoking NZ. Delays may be created meantime with difficulties of importing. 29 March 2017 Philip Morris says it welcomes E-cigarette reforms as a big step towards a Smokefree 2025. says all smokers will need a range of smokefree alternatives, including e-cigarettes and heated tobacco products, and says small and local businesses should be encouraged. Sale of Nicotine e-cigarettes to be legalised in NZ - Associate Minister. The sale of nicotine e-cigarettes will be legalised in New Zealand, the Government has confirmed - and the Associate Health Minister Nicky Wagner even encourages reporters to try vaping. A law change will be needed and is likely to be completed next year, although the Government says it will do so sooner if possible. Today's announcement is a big win for the e-cigarette industry - its products won't be in plain packaging, nor will the hefty taxes on normal tobacco be applied. Associate Health Minister Nicky Wagner said the change came despite the fact scientific evidence of the safety of e-cigarettes was still developing. And despite stressing the low risk approach taken because of that lack of certainty, Wagner encouraged reporters at Parliament to try vaping. I have [tried vaping]. But I'm not very good at it but I don't smoke either. I suggest anyone who smokes here has a go at vaping, too. Around the world we can't get clear research about this. But what we're thinking is they are about 95 per cent less harmful than cigarettes. She said the Government had considered applying the same tobacco excise duties on vaping products but had decided not to. I think that's an important thing so when a smoker goes into the dairy he or she will see cigarettes at a very high price and e-cigarettes much cheaper. Wagner was not concerned that some big tobacco firms were behind many e-cigarette products: I think the important thing is we want the health outcomes. Whoever sells them...I don't think is really important. The new rules for all e-cigarettes, whether they contain nicotine or not, include restricting sales to people 18 years and over, banning vaping in indoor areas where smoking is prohibited, and restrictions on advertising. The Government had already announced its intention to legalise e-cigarette sales, and today's decision comes after consultation. Nicotine patches and gum can be bought now, but nicotine e-cigarette liquid must be bought from overseas. Users vape on an e-cigarette, inhaling its nicotine-containing vapour, in the way that smokers inhale the smoke of a tobacco cigarette, which contains nicotine plus many cancer-causing chemicals. In England, e-cigarettes are the leading form of quit-smoking aid, used by 35 per cent of smokers trying to quit. However, some researchers argue that e-cigarettes risk providing a gateway into smoking for youth. New Zealand's Ministry of Health has been monitoring evidence on the role of e-cigarettes for smoking cessation. Maori Party co-leader Marama Fox this month said the Government should seriously consider subsidising vaping as a tool to help quit smoking. Today, Wagner said if an e-cigarette got approved as a stop-smoking medicine under the Medicines Act the Government may consider subsidising it. About 546,000 Kiwis smoke daily, 15 per cent of the adult population. Every day on average, at least 13 people die from a smoking-related disease - about 5000 a year. Half of smokers die from a smoking-related illness and on average their deaths will be 14 years earlier than if they didn't smoke. - Nicholas Jones, NZ Herald 29 March 2016 MoH site: E-cigarettes to be regulated as consumer products : The Government is planning to change the law regulating e-cigarettes. These changes need to go through Parliament before they can take effect. This will likely happen from the middle of 2018 at the earliest. The proposed changes are to: legalise the sale and supply of nicotine e-cigarettes and e-liquid as consumer products regulate nicotine and non-nicotine e-cigarettes and e-liquid as follows: prohibit sale, and supply in a public place, to under 18 year olds restrict sale via vending machines to R18 settings allow all retailers to display e-cigarettes and e-liquid at point-of-sale allow R18 retail settings to display e-cigarettes and e-liquid in-store (including window display), promote products on the outside of the store, and offer discounts, free samples, loyalty awards etc. prohibit broader advertising, e.g. billboards, radio, TV, Internet (the rules above will apply to retailers' websites) prohibit vaping in workplaces and other areas where smoking is not allowed under the Smoke-free Environments Act 1990 (SFEA) set requirements for product safety (e.g. nicotine concentration, child-resistant closures etc.) In addition to these changes, a regulatory framework will be developed to provide a pathway for emerging tobacco and nicotine-delivery products to be regulated as consumer products in future. Cabinet paper: Improving the regulatory framework for e-cigarettes and emerging tobacco and nicotine-delivery products (Word, 129 KB) Regulatory impact statement - Regulation of e-cigarettes and emerging tobacco and nicotine-delivery products Electronic cigarettes Electronic cigarettes (or e-cigarettes) are electrical devices that heat a solution (or e-liquid), which produces a vapour that the user inhales or 'vapes'. The ingredients of the liquid may vary, but currently most e-liquids contain propylene glycol and flavouring agents. Some e-liquids contain nicotine. E-cigarettes come in a range of styles, from devices that look similar to traditional cigarettes (first generation or cig-a-like) to refillable-cartridge 'tank' systems (second generation) to highly advanced appliances with larger batteries that allow the power to be adjusted to meet an individual's specific vapour requirements (third generation). Second and third generation e-cigarettes generally deliver more nicotine than first generation e cigarettes. Risks with using e-cigarettes There is evidence that e-cigarettes pose fewer health risks to smokers who switch completely from tobacco smoking to e-cigarette use. Tobacco smoking, even at a reduced level, remains harmful. Short-term use of e-cigarettes has been associated with mild adverse effects such as headaches, dry mouth or throat, and throat or mouth irritation. The health risks associated with the long-term use of e-cigarettes are unknown. It is only known that the risks of smoking are likely to be much greater. Some e-liquids contain nicotine. For smokers, the nicotine in e-cigarettes poses little danger, however, in excessive amounts it can be lethal, especially for children. Nicotine products should be kept out of reach of others, particularly children. Use of e-cigarettes for stopping smoking There is a good rationale for people to use e-cigarettes to help them stop smoking as e cigarettes can provide nicotine, which is what people desire from smoking. Research into the effectiveness of e-cigarettes in smoking cessation is growing, but the findings from these studies are somewhat mixed and the quality of the evidence is low overall. This is an active area of research and more findings will become available over the next few years. At this stage, the Ministry of Health does not have enough evidence to recommend e-cigarettes confidently as a smoking-cessation tool. Smokers should use approved smoking-cessation medicines, such as NRT, to support them to stop smoking and seek behavioural support from stop-smoking services. 24 March 2017. Cigarette consumption down again by 5% in 2016 In 2016 cigarette and tobacco consumption per capita decreased by a further five percent below the changes noted in 2015. The average smoker smoked 704 cigarettes per year (per adult in the population) in 2015 and 668 in 2016. Millions of cigarettes sold were 2358 in 2015 and 2304 in 2016. The greatest decrease was in roll-your-owns, from 547 tonnes in 2015 to 512 tonnes in 2016. These data were collected by Dr Murray Laugesen from the manufacturers returns to the Ministry of Health for calendar year 2016. As 14.2% of adults smoked in 2015-16, it means that the average smoker smoked over 4700 cigarettes per year or 13.2 cigarettes per day. Any increased use of e-cigarettes may have occurred in 2017 rather than last year. 28 February 2017 Daily users compared to less frequent users find vape as or more satisfying and less dangerous than cigarettes, and are likelier to use non-cig-alike vaping products This report by Prof Lynn Koslowski et al on 105 adults in Preventive Medicine Reports http://dx.doi.org/10.1016/j.pmedr.2017.02.026 highlights what many vapers already know: o Daily users of e-cigarettes found them at least as satisfying as cigarettes. o Satisfaction from e-cigarettes was more likely in more frequent users. o All daily users reported them as less dangerous than cigarettes. o Perceived danger from e-cigarettes was higher in less frequent users. o Daily users of e-cigarettes were more likely to be using non-cig-alikes. 17 February 2017 Heets illegal for Heat not Burn but does this apply to Nicotine Lactate? According to the NZ Herald on Feb 2, quoting the Ministry of Health ''In our view, Heets products are prohibited for sale in New Zealand under the Smoke-free Environments Act.'' The ministry has now clarified its position and says that while the battery-powered holder is legal, the tobacco sticks, called Heets, are not, because the tobacco in them is burnt rather than heated. Comment: 1) This is illogical, because on this definition, HEETS and HnB are both illegal because the device heats up the air in it, and HEETs are only the mechanism for extracting that vapour. 2) But the legality of Heat not Burn is a matter of major importance, as 1 million Japanese have switched off mainstream smoking, nearly 6% of smokers having now switched. This is of major public health importance. 3) HEETS in Nicotine Lactate cigarettes are legal, because HEETS are heated to 100 deg C, and no tobacco is burnt in that device. 15 February 2017 New Shadow Minister for Tobacco Control Hon Annette King Labour Spokesperson on Health has replied on this topic today and says Yes, I am in favour of legislation of e-cigarettes, and have been saying so since last year. 8 February 2017 New Minister for Tobacco Control Hon Nicky Wagner is the new appointment to this task. We send her our best wishes. 8 February 2017 Study of inhaled toxins finds E-cigarettes are much safer than smoking This challenges the we just don't know school with what we can know if we look: that the toxic exposures from inhaling e-cigarette aerosol are much lower than for cigarette smoke. We don't have to wait 20 years for a cohort study to know enough to be confident these products are very much less risky. The effects of shifting completely to e-cigarettes are marked but the effects of half switching (dual smoking) are not. Shahab L, Goniewicz ML, Blount BC, Brown J, McNeill A, Alwis KU, et al. Nicotine, Carcinogen, and Toxin Exposure in Long-Term E-Cigarette and Nicotine Replacement Therapy Users. Ann Intern Med. 2017 Feb 7;24:442-8. http://annals.org/aim/article/2599869/nicotine-carcinogen-toxin-exposure-long-term-e-cigarette-nicotine-replacement For New Zealand, this information is confirmed by Laugesen M. Nicotine and toxicant yield ratings of electronic cigarette brands in New Zealand. NZ Med J, 27 Mar 2015. 21 Jan 2017 Tobacco elimination: an economic and public health imperative - Murray Laugesen Among the comments in a recent editorial in the Lancet was this: A recent comment in Lancet Public Health on the New Zealand experience, points to the importance of political champions, a government committed to dramatically reducing tobacco use, and a tireless and fearless non-government sector. Only with these types of leadership can real progress be made. (1) These comments came from Profs Robert Beaglehole and Ruth Bonita, who pointed out that the most recent surveys show that 14% of adults smoke daily, but 36% of Maori and 23% of Pacific people also smoke daily, and this needs attention. Their solutions include this: Electronic nicotine-delivery devices and low nicotine cigarettes may have a role to play in achieving the 2025 goal by encouraging cessation. This is the first time that New Zealand experts of conservative and radical positions in tobacco control have voiced support for e-cigarettes, and is almost 10 years since I conducted the first research on them. All sides should take note. We hope that the government will soon agree to making such devices legal to be sold. Recent moves to ban heat not burn cigarettes were a local enforcement issue, and should not influence approval of the nicotine lactate cigarette in the next 12 months when it has passed its final tests in Christchurch and elsewhere. The price of combustible cigarettes has escalated at a steady 10% per year since 2011, and in addition to the 5% per annum decline since 2011, we will soon know from 2016 data whether the decline is continuing. Meantime, we need less harmful products such as e-cigarettes and nicotine lactate to ease smokers off combustible tobacco. (1). Beaglehole R and Bonita R. Eliminating the scourge of tobacco for a fairer and healthier world: New Zealand leads the way. Lancet www.com/public health v.2 January 2017.e-13.13. 13 Jan 2017 Heat not burn cigarettes banned by Section 29(2) of the SFE Environments Act : law fails to distinguish types of tobacco sold See WWW.MOH.GOVT.NZ and use Heat not Burn to find the topic, which was posted just before Christmas. Ministry of Health in response to the manufacturers, Philip Morris, has notified them that s.29(2) bans Heat not Burn cigarettes, as it contains tobacco. However the tobacco is not combusted. Thus Ministry of Health has failed to make a distinction between tobacco-ignited cigarettes and tobacco heat-not- burn cigarettes. The former cause 5000 deaths a year, and the latter do not cause cigarette deaths as far as is known. The only solution to put HnB cigarettes on the market here is to amend s.29(2). In Japan HnB cigarettes have replaced 4.9% of the combustibles sold in the past 6 months. 4 Jan 2017 Price changes 31 Dec 2016 to 1 Jan 2017 Since I last wrote about e-cigarettes one year ago, headlines about the dangers of these devices have continued to appear and show no sign of abating. The result is clear. More people believe today, compared with a year ago, that e-cigarettes are as harmful as smoking. In fact these incorrect perceptions have risen year on year, from fewer than one in ten adults in Great Britain in 2013 to one in four this past summer. Surveys of smokers show similar patterns, with an increasing proportion believing that e-cigarettes are more or equally harmful than tobacco. Why can't scientists agree on e-cigarettes? Yet we know that these harm perceptions are wrong. There is now very strong evidence, from a range of studies, that vaping - inhaling nicotine without the combustion involved in smoking - is far less risky than smoking cigarettes. Just a few months ago this body of evidence was brought together by the Royal College of Physicians who published an authoritative report analysing dozens of studies and concluded that the hazard to health arising from long term vapour inhalation from e-cigarettes is unlikely to exceed 5% of the harm from smoking tobacco. The RCP, and since then other UK doctor s organisations such as the Royal College of General Practitioners, have made clear that it is important to promote the use of e-cigarettes, along with other non-tobacco nicotine products (like Nicotine Replacement Therapy such as gum or inhalators) to smokers who are trying to quit. The work of these organisations is underpinned by a consensus statement endorsed by many of the main health charities and public health bodies in the UK. They agree that vaping is safer than smoking, and while these products are not risk free and should not be promoted to children or never smokers, they have a legitimate and positive role to play in tobacco control. But this consensus is not shared around the world. The regular stream of media scare stories driving harm perceptions often originates in other countries where there is no such view about relative risks. Some media headlines are driven by poor science but others originate from reports by credible organisations who focus on the absolute risk of any e-cigarette use without comparing it to smoking (which is uniquely deadly and kills one in two regular users). 2016 saw at least two major reports of this kind. In September the World Health Organisation published a report that set out a series of steps on e-cigarette regulation for countries signed up to the Framework Convention on Tobacco Control, a global public health treaty. These options were primarily about banning or severely restricting the sale, distribution and marketing of e-cigarettes. The WHO report was comprehensively critiqued by the UK Centre for Tobacco and Alcohol Studies, but its findings mean that e-cigarettes will continue to be unavailable to millions of smokers in many countries who have banned these devices or are considering doing so. Does a tobacco-free world need to be nicotine free? December 2016 saw the publication of a review authored by the US Surgeon General, which focused on e-cigarette use in young people. This described e-cigarette use as a public health concern, arguing that e-cigarettes are now the most commonly used tobacco product amongst US youth and that nicotine use in any form is unsafe for young people and also pregnant women. While some of the science in the report is accurate, the conclusions endorsing heavy regulation of e-cigarettes were not. The report did not compare the risks of smoking and vaping, failed to make clear that e-cigarettes are not tobacco products, and drew conclusions about nicotine that would also apply to Nicotine Replacement Therapy - which is safe and licensed for use in pregnancy and by young smokers. It also endorsed policies which could deter current smokers from switching to e-cigarettes. American scientists have critiqued data from the USA that provided the basis for the Surgeon General s report, but it is likely that this publication will contribute to public perceptions that e-cigarettes are dangerous. These two reports largely ignore the fact that there are already measures in place in many countries (including all of the EU) to protect the public from any risks from e-cigarettes. These include policies like age of sale, limits on advertising and child- and tamper-proof packaging - all important to protect children while still allowing sales to adult smokers and ex-smokers. Concerns about exploding batteries and nicotine poisoning can also be dealt with by following simple safety rules, such as those set out by the Royal Society for the Prevention of Accidents. I believe that e-cigarettes have huge potential to save lives by providing an alternative to smoking. Yet this can only be realised if we address negative harm perceptions and communicate honestly with the public. Ongoing research can help with this, and 2016 has seen the start of important studies, many commissioned by Cancer Research UK, which will tell us more in the future. We also need to keep our eye on new technology, such as heat not burn tobacco products, which are emerging and about which we know little. Only time will tell whether the UK s positive approach towards e-cigarettes strikes the right balance between risks and benefits. For now, however, we must do all we can to encourage smokers to try to stop at New Year or any other time. For those trying with e-cigarettes, this is a positive choice that should be supported. Linda Bauld is Professor of Health Policy at the University of Stirling, Deputy Director of the UK Centre for Tobacco and Alcohol Studies and holds the CRUK/BUPA Chair in Behavioural Research for Cancer Prevention at Cancer Research UK. She is a former scientific adviser on tobacco control to the UK government and chaired the NICE guidance group on tobacco harm reduction. NZ Health Survey July 2015- June 2016 Smoking Total population: current 16.3% daily 14.2%. (2% drop since 2011-12) Maori population current 38.6%, daily 35.5%. (2% drop since 2011-12) Pacific population current 25.5%, daily 22.8% (virtually no change). Tobacco prices as from 1 Jan 2017 Customs Dept reports that duty on cigarettes and tobacco will rise to $738.13 per 1000 cigarettes of 0.7g or roll-your-owns of 0.7g. This is a rise of 10.4% on the 2016 prices. Tobacco manufacturers and importers are expected to raise their prices by the same amount. The average 2016 price was $22.83 for 20 cigarettes. November 2016 Fixing Medical Prices - How Physicians are paid Miriam J Laugesen Associate Professor Dept of Health Policy and Management, Columbia Mailman School of Public Health, New York NY. Harvard University Press. In Dec 2016 issue of Scientific American. Sir David Hay 1927-2016 A pioneer of tobacco control in New Zealand, Sir David Hay, had been ill for some weeks and died 3 December. His funeral was held on Thursday 1pm at St Andrew's College chapel on Papanui Rd in Christchurch. As in the case of Helen Kelly, the well-known trade unionists, Sir David died of lung cancer, even though his last cigarette was in his teens. Qualified as a physician in the 1950s he was the first person to ensure tobacco advertising on television was banned in November 1962, and a member of the Advisory Committee on Smoking and Health which gave its advice to government in May 1985. In 1991 he told the incoming National government their law to ban tobacco sponsorship of sport was wrong. He was the first medical director of the Heart Foundation and held this post for nearly two decades. In 2005 he published his life story Heart Sounds through Steele Roberts, Wellington. 26 Oct 2016 COMMENTARY ON WHO REPORT ON ELECTRONIC NICOTINE DELIVERY SYSTEMS AND ELECTRONIC NON-NICOTINE DELIVERY SYSTEMS John Britton University of Nottingham, Ilze Bogdanovica University of Nottingham, Ann McNeill King s College London, Linda Bauld University of Stirling, from the UK Centre for Tobacco and Alcohol Studies Document available online at: http://ukctas.net/news/commentary-on-WHO-report-on-ENDS ENNDS.html Positioning ENDS as a threat rather than opportunity. Overall, the WHO report does not correctly position ENDS primarily as an alternative to smoking and instead focusses excessively on risks of ENDS use without adequately recognising the deep reductions in health risks when a smoker switches to ENDS. The FCTC itself recognises harm reduction as a key strategy in tobacco control. But with minor exceptions, the WHO report discusses ENDS as a threat, whereas in fact they represent a major opportunity for public health. Failure to quantify risk. The WHO paper provides a poor assessment of ENDS risks. In terms of toxicology, the discussion is na ve and places excessive emphasis on negligible risks arising from very low exposures. In toxicology, the presence of a potentially harmful agent does not necessarily establish a material risk. This is because the level of exposure matters and the dose makes the poison . Inadequate comparisons with smoking. The WHO paper does not systematically make meaningful comparisons with exposures arising from inhaling tobacco smoke or refer to other useful comparators such as occupational exposure limits. However, data from around the world shows that almost all ENDS users are smokers, ex-smokers or would-be smokers. The most relevant comparison for health policy purposes is with smoking. Misrepresenting second hand ENDS vapour risks. The section on risks of second-hand exposure to ENDS aerosol provides no evidence that such exposures pose any material risks to bystanders. The claim that ENDS have the potential to lead to adverse health effects in bystanders does not reflect the science behind the cited source unless potential is taken to mean any exposure, no matter how trivial. Again, the issue is not the presence of particular chemicals, but the magnitude of exposure. Discounting the evidence that ENDS do help smokers quit. The WHO paper does not properly assess the role that ENDS play in quitting smoking and uncritically repeats a number of methodological errors found in the literature. Taking the totality of evidence including controlled trials, observational studies, changes in population smoking and ENDS use, the experience of nicotine replacement therapy, and widely reported user experience, there is confidence that ENDS are helping many smokers to quit smoking and not having negative effects like renormalising smoking, reducing quit rates or creating gateway effects. ENDS marketing can be anti-smoking advertising. The vast majority of ENDS marketing is truthful promotion of a low-risk alternative to smoking and targeted at adult smokers. The evidence cited by WHO has been misrepresented and does not make the case for any systematic malpractice by ENDS vendors. However, the WHO paper overlooks that most fundamental point, which is that ENDS marketing is promoting an alternative to smoking and may therefore be promoting desirable changes in smoking behaviour. It may also reach people who do not engage with conventional stop-smoking interventions. Flavours are essential to the appeal of ENDS as alternative to smoking. The section on product characteristics attempts to demonstrate a problem with flavours appealing to teenagers. In fact, flavours are integral to the appeal of ENDS to adults as an alternative to smoking. The citations are selective and findings misinterpreted and do not support this claim. Several citations simply reflect opinions or speculation, while important studies have been overlooked. These do not show that any interest amongst teenagers in ENDS flavours is resulting in regular use of ENDS in this age group. Mischaracterisation of the ENDS market and role of tobacco transnationals. The WHO paper misinterprets the ENDS market, makes misleading and unreferenced statements about the role of transnational tobacco companies in the market and is not grounded in an understanding of how competitive markets function. WHO s report fails to acknowledge the threat of disruptive technology such as ENDS to the commercial viability of the traditional cigarette business. Ironically, the only references given to published papers point out how regulations, such as those favoured by WHO, actually help the cigarette trade. WHO should be aware of the danger that its policy proposals may provide the traditional tobacco industry with a twin advantage: (1) slowing down the disruption of the cigarette market by ENDS; (2) shaping the ENDS market to suit the ENDS business model favoured by the tobacco industry. Unjustified support for ENDS prohibition. In the discussion of policy options, the opening paragraph for each policy set implicitly endorses ENDS prohibition. It does this by stating that Parties that have not banned the importation, sale, and distribution of ENDS/ENNDS may consider the following options . Prohibition is one regulatory option among many that ought to be discussed on its own merits, not taken as a default. The merits of prohibition are exceedingly poor given the pervasive availability of cigarettes in all jurisdictions. WHO should not be endorsing prohibitions, explicitly or implicitly. It is unethical to deny smokers much lower risk options than cigarettes, and there is no scientific support for ENDS prohibition as a public health intervention. The WHO s framing suggests that a prohibition is something for Parties to progress towards and should not be undone once done. In fact, it is a policy that should be reversed. Policy proposals made with no supporting policy analysis. Numerous policies are proposed without any supporting evidence for their effectiveness or cost-effectiveness. Any policy proposal should be subject to evidence-based justification, options appraisal and analysis of trade-offs or distributional effects, and impact assessment. Policies should be tested for proportionality and possible unintended consequences. The WHO has not applied any policy-making disciplines to its menu of proposed policy options. No assessment of unintended consequences. There is no recognition of the likelihood of unintended consequences arising from the policies proposed in the WHO paper. However, it is very likely that some of the proposed policies would have the effect of increasing smoking. The Royal College of Physicians explains this in its 2016 Nicotine without Smoke2 report as follows: A risk-averse, precautionary approach to e-cigarette regulation can be proposed as a means of minimising the risk of avoidable harm, e.g. exposure to toxins in e-cigarette vapour, renormalisation, gateway progression to smoking, or other real or potential risks. However, if this approach also makes e-cigarettes less easily accessible, less palatable or acceptable, more expensive, less consumer friendly or pharmacologically less effective, or inhibits innovation and development of new and improved products, then it causes harm by perpetuating smoking. Getting this balance right is difficult. (Section 12.10 page 187) Almost every policy listed in the WHO s paper could easily have the effect of protecting the incumbent cigarette trade, promoting smoking rather than vaping, and lead to increases in non-communicable diseases. It is very likely that widespread uptake of WHO s policy proposal would reduce harm reduction and therefore increase harm. Transparency and quality. The WHO report has been made available without the four supporting papers upon which it is supposed to be based. These papers are still undergoing revision during peer review. This is poor scientific practice and does not provide a reliable basis for policy advice. COMMENTARY ON WHO REPORT ON ELECTRONIC NICOTINE DELIVERY SYSTEMS AND ELECTRONIC NON-NICOTINE DELIVERY SYSTEMS (ENDS) The Seventh Conference of the Parties (COP-7) of the Framework Convention on Tobacco Control (FCTC), to be held in Delhi between the 7th and 12th of November 2016, will discuss and formulate future policy on the role of Electronic Nicotine Delivery Systems (ENDS; also known as electronic cigarettes or e-cigarettes) and Electronic Non-Nicotine Delivery Systems (ENNDS) in tobacco control. In preparation for this discussion, and in response to a request made by the COP at its 6th session (COP-6) in Moscow in 2014, the World Health Organisation (WHO) has prepared a report providing updates on evidence of the health impacts of ENDS/ENNDS; on their potential role in smoking cessation and tobacco control; and on policy options to achieve objectives set at COP-6. In our view, the WHO report succeeds in identifying a range of areas of uncertainty over the potential benefits and risks of ENDS to effective tobacco control policy. However, by doing so from a position of emphasis on the risks and disadvantages of these products which disregards their potential to reduce consumption of smoked tobacco, the report fails to deliver the equipoise required for dispassionate formulation of public health policy. The report also contains factual errors and misinterpretations of evidence available in the public domain; and refers at its outset to four reports, including two systematic reviews, commissioned by the WHO but as yet unpublished and hence unavailable for scrutiny. Oct 6, 2016. Philip Morris calls for light regulation of e-cigarettes Rob Stock International cigarette giant Philip Morris has appealed to the Government to go light when regulating its heat not burn tobacco devices. The Ministry of Health is receiving submissions on how to regulate e-cigarettes, which deliver nicotine-laden vapour, providing a safer alternative to smoking. But Philip Morris is keen the Government does not overlook its heat-not-burn cigarettes, which heat tobacco plugs to deliver their nicotine hit without the smoke which causes about 95 per cent of smoking-related disease. The submissions have not been made public yet, but Philip Morris said: Electronic cigarettes do not burn tobacco and do not generate smoke. Cigarette companies are seeking viable new business models as their traditional products go into terminal decline. They have invested heavily in both e-cigarettes and heat not burn devices, and want countries like New Zealand not to regulate them in the same way as conventional cigarettes. Cigarette companies are trying to transform themselves into nicotine, not tobacco companies We envision a smoke-free world in where a broad range of safer alternatives to cigarettes fully satisfies the continuing demand for tobacco and nicotine products, Philip Morris said. We are keen that e-cigarettes should be at least as available as cigarettes are, but we suggest that they should be regulated differently from cigarettes in order to encourage smokers to switch to them. Regulating e-cigarettes like cigarettes would run contrary to the science and public health purpose of tobacco harm reduction . The company said e-cigarettes should not be covered by the ban on cigarette advertising and sale. Advertising and in-store displays were important in promoting e-cigarettes, it said. Planned plain packaging laws should also not be applied to e-cigarette supplies. Philip Morris also did not want graphic health warnings on e-cigarette supplies which would relegate these less harmful products to packaging that is effectively equivalent to cigarettes . This would make it difficult to differentiate the products to smokers. Philip Morris also called for little or no excise tax to be levied on e-liquids and heat not burn tobacco plugs claiming it would discourage smokers from switching from conventional cigarettes. It also said vaping, as the use of e-cigarettes is known, should be permitted in some areas where smoking is banned, though the company agreed their use should be banned from places like schools. New regulations should also be flexible as nicotine-delivery technology was developing fast, and innovation should not be stifled. Technological innovation is transforming the tobacco industry, it said. The ministry plans to report its recommendations to the Government in the next few weeks.f 26 September 2016 Christchurch group completes another study on nicotine lactate Christchurch Clinical Studies Trust Ltd today announces the completion of a clinical study on an innovative alternative to cigarettes.The product prototype, designated P3L (Platform 3, Lactate) by the technology owner Philip Morris International, mixes nicotine with lactic acid to produce an inhalable nicotine salt aerosol with faster absorption rates than traditional nicotine replacement therapies. The device is the product of technology developed by Professor Jed Rose, co-inventor of the nicotine patch, and his colleagues at Duke University. Previously tested in Christchurch by Dr Chris Wynne and Dr Murray Laugesen, New Zealand's leading public health specialist, the study validated the belief that P3L can provide smokers with a suitable alternative to smoking. The study investigated nicotine absorption after a single use of the product by 16 adult smokers in comparison to the Nicorette inhalator. Approximating the rapid nicotine absorption rates and levels of cigarettes is an important element of providing smokers with a satisfactory alternative to smoking. With P3L, nicotine absorption reached peak levels six times faster than with the inhalator, suggesting easier absorption and a significantly higher potential for acceptance by smokers. The study also assessed a range of subjective effects, as well as safety and tolerability. Compared with use of the inhalator,the study participants found the product a more satisfactory alternative and reported less intention to smoke cigarettes; no relevant side effects were reported. Principal study investigator Dr Chris Wynne, Medical Director at St Georges Cancer Care Centre, Christchurch, commented on the results: In addition to quitting, which remains the safest way to reduce the harm from smoking, a tobacco harm reduction strategy envisions the development of products with the potential to reduce individual risk compared to smoking. A critical element for acceptance by smokers is nicotine delivery similar to cigarettes as well as the rewarding of subjective effects, and this novel nicotine-containing product has proven to perform better than existing nicotine delivery systems in both areas. Given the promising results of this first clinical study, Christchurch Clinical Studies Trust Ltd will conduct further studies to assess in a larger population the potential for smokers to substitute cigarettes with the product. 4 August 2016 New Zealand to make nicotine e-cigarettes legal Scoop NZ release from End Smoking NZ End Smoking NZ applauds the Government (August 2) on its decision to make nicotine for vaping (using electronic cigarettes) legally available in New Zealand. The Government has agreed in principle that nicotine for e-cigarettes should be legally available for sale with appropriate controls. Currently it can only be imported for personal use creating often insurmountable barriers preventing smokers from switching to vaping. The Associate Minister of Health, Peseta Sam Lotu-Iiga has made the right decision. Said End Smoking s Chairperson Associate Professor Marewa Glover. He has listened with compassion to smokers and vapers. We are so relieved that our pragmatic nature as a country has triumphed over the negative misinformation and unfounded fears that have dominated the debate for too long. Long-time advocate of nicotine e-cigarettes and founding Board member, Dr Murray Laugesen started work on e-cigarettes in 2007. I m absolutely delighted, he said. This will be a turning point that will have a significant impact on reducing the death and disease caused by smoking. It also gives us a real shot at achieving Smokefree 2025. He said. This announcement by the Minister gives health professionals a clear message that smokers who choose to use vaping to help them quit can be supported to do so. Said Board member Dr George Laking. The Ministry of Health is calling for submissions on how to legislate electronic cigarette products and what regulations or controls need to be in place. Vaping nicotine has been estimated to be 95% safer than smoking tobacco, thus End Smoking doesn t believe we need overly restrictive or costly regulation and controls of e-cigarette products. However, some concerns such as restricting sales to minors will be wise to prevent retailers who currently sell tobacco to minors pushing e-cigarette products on to kids. Dr Glover said. Some public health researchers and advocates in New Zealand and around the world have concerns that vaping will re-normalise smoking, be a gateway to smoking, and establish nicotine addiction among new users. However, there is no evidence that this is occurring in countries where vaping is established. Whilst there is still some way to go before nicotine for vaping will be legally available in New Zealand, End Smoking says the first steps are positive. 8 July 2016 Cigarette smoking prevalence down 10% in USA Cigarette smokers declined from 16.8% to 15.1% in 2014-5, with the greatest decline among young people. For e-cigarette smokers, the greatest increase was among former (ex-) smokers, from 2.0 million to 2.5 million, and increase of 26%, with 66% using them daily. A survey of teenage smoking showed that from 2011 to 2014, regular cigarette smoking had fallen from 4.0% to 1.3%, and exclusive e-cigarette use had risen from 0.3% to 2.7%. The inescapable fact is that e-cigarettes, used by, among others, 2.5 million former smokers, are not impeding the dramatic, welcome decline in cigarette smoking. http://rodutobaccotruth.blogspot.co.nz/2016/07/how-many-americans-vape-cdc-data-show_7.html ____________________________ 1 July 2016 Tobacco consumption in NZ 5% down per year since 2010, and 5% down in 2015 According to 2015 statistics, tobacco consumption per adult (including factory-made and roll-your-own at 0.7 g tobacco per cigarette) declined 5% in 2015. Consumption declined from 749 cigarettes per adult in 2014 to an all time low of 712 cigarettes per adult in 2015. This amounts to a 65% decrease since 1990. The data, from Health NZ, will be found under www.moh.govt.nz/ourwork/ In addition, assuming cigarette smoking prevalence declined to 14.86% in 2015, this means that of 541,000 smokers, the average smoker in 2015 smoked 4791 cigarettes per year, or 13.13 cigarettes per day. 30% of tobacco smoked was sold as RYOs. _________________________________ 27 June 2016 New Study Finds Electronic Cigarettes Helped 5 Million Quit Smoking by Lindsey Stroud The journal Addiction published a study in late June, finding the use of electronic cigarettes and vaporized nicotine products (VNPs) have helped 15 million smokers quit smoking tobacco cigarettes and/or cut back, in the European Union (E.U.). Using data from the 2014 Eurobarometer survey, which recorded responses of 27,460 participants, the study concluded that 48.5 million E.U. citizens had tried e-cigarettes and 7.5 million were currently vapers. Of the group reporting regular e-cigarette usage, 35 percent reported that e-cigarettes helped them quit smoking, while 32 percent said they were smoking less thanks to e-cigarettes. (2.6 and 2.4 million respectively) This research comes on the heels of a study published by the British Medical Journal earlier in June, that measured the effectiveness and safety of electronic cigarettes at 24 months using data from respondents that used e-cigarettes and VNPs to quit smoking and those that remained on traditional tobacco cigarettes. The study concluded that 61 percent of respondents had remained abstinent from tobacco and that only 23.1 percent of tobacco users reported abstinence. The study by Addiction is only the latest bit of research concerning the health implications of electronic cigarettes and VNPs. After U.S. Food and Drug Administration (FDA) announced in May to regulate electronic cigarettes as tobacco products, more studies have been finding greater evidence that e-cigarettes and VNPs may actually save more lives than endanger, and help ease the health burdens that are associated with tobacco. Addiction. 2016 Jun 24. doi: 10.1111/add.13506. [Epub ahead of print] _______________________________________________________ 18 June 2016 Butting out The Ministry of Health's refusal to consider making the sale of e-cigarettes here legal borders on the indefensible. On the evidence so far banning vaping actually punishes those most likely to be well on track to giving up smoking altogether..... New Zealander Dr Murray Laugesen, supports e-cigarettes as a prime and remarkably low-risk weapon against the killer habit. It's time the ministry listened. Butting out. Editorial. The Listener www.listener.co.nz _________________________________________________ 2 May 2016 Australian Health Organisations wrong to go against e-cigarettes According to Dr Colin Mendelsohn an influential tobacco treatment specialist from Sydney, the precautionary position taken by Australian health organisations and governments is not supported by the available evidence and overseas experience. The growing evidence for safety and effectiveness of e-cigarettes significantly outweighs any potential risks to public health. A rational, evidence-based approach would be to make e-cigarettes available in Australia as consumer products and to encourage their use while minimising uptake by people who would not otherwise have used nicotine products. Ongoing monitoring and appropriate proportionate regulation would help minimise any risks. E-cigarettes represent a massive opportunity for Australian smokers and have the potential for large-scale improvements in individual and public health, and social inequality. We cannot afford not to embrace them. -HTTPS://theconversation.com/australias-prohibition-of-e-cigarettes-is-out-of-step-with-the-evidence-58725 2 May 28 April 2016 PROMOTE E-CIGARETTES WIDELY AS SUBSTITUTE FOR SMOKING SAYS NEW RCP REPORT A new report released today from the Royal College of Physicians, London, Nicotine without smoke: tobacco harm reduction concludes that e-cigarettes are likely to be beneficial to UK public health. Smokers can therefore be reassured and encouraged to use them, and the public can be reassured that e-cigarettes are much safer than smoking. Tobacco smoking is addictive and lethal. Half of all lifelong smokers die early, losing an average of about 3 months of life expectancy for every year smoked after the age of 35, some 10 years of life in total. Although smoking prevalence in the UK has reduced to 18%, 8.7 million people still smoke. Harm reduction provides an additional strategy to protect this group of smokers from disability and early death. Since e-cigarettes became available in the UK in 2007, their use has been surrounded by medical and public controversy. This new 200-page report examines the science, public policy, regulation and ethics surrounding e-cigarettes and other non-tobacco sources of nicotine, and addresses these controversies and misunderstandings with conclusions based on the latest available evidence: - E-cigarettes are not a gateway to smoking in the UK, use of e-cigarettes is limited almost entirely to those who are already using, or have used, tobacco - E-cigarettes do not result in normalisation of smoking there is no evidence that either nicotine replacement therapy (NRT) or e-cigarette use has resulted in renormalisation of smoking. None of these products has to date attracted significant use among adult never-smokers, or demonstrated evidence of significant gateway progression into smoking among young people - E-cigarettes and quitting smoking - among smokers, e-cigarette use is likely to lead to quit attempts that would not otherwise have happened, and in a proportion of these to successful cessation. In this way, e-cigarettes can act as a gateway from smoking - E-cigarettes and long-term harm - the possibility of some harm from long-term e-cigarette use cannot be dismissed due to inhalation of the ingredients other than nicotine, but is likely to be very small, and substantially smaller than that arising from tobacco smoking. With appropriate product standards to minimise exposure to the other ingredients, it should be possible to reduce risks of physical health still further. Although it is not possible to estimate the long-term health risks associated with e-cigarettes precisely, the available data suggest that they are unlikely to exceed 5% of those associated with smoked tobacco products, and may well be substantially lower than this figure. The report acknowledges the need for proportionate regulation, but suggests that regulation should not be allowed significantly to inhibit the development and use of harm-reduction products by smokers. A regulatory strategy should take a balanced approach in seeking to ensure product safety, enable and encourage smokers to use the product instead of tobacco, and detect and prevent effects that counter the overall goals of tobacco control policy. Professor John Britton, chair of the RCP s Tobacco Advisory Group, said: The growing use of electronic cigarettes as a substitute for tobacco smoking has been a topic of great controversy, with much speculation over their potential risks and benefits. This report lays to rest almost all of the concerns over these products, and concludes that, with sensible regulation, electronic cigarettes have the potential to make a major contribution towards preventing the premature death, disease and social inequalities in health that smoking currently causes in the UK. Smokers should be reassured that these products can help them quit all tobacco use forever. RCP president Professor Jane Dacre said: Since the RCP s first report on tobacco, Smoking and health, in 1962, we have argued consistently for more and better policies and services to prevent people from taking up smoking, and help existing smokers to quit. This new report builds on that work and concludes that, for all the potential risks involved, harm reduction has huge potential to prevent death and disability from tobacco use, and to hasten our progress to a tobacco-free society. With careful management and proportionate regulation, harm reduction provides an opportunity to improve the lives of millions of people. It is an opportunity that, with care, we should take. Report summary Smoking is the biggest avoidable cause of death and disability, and social inequality in health, in the UK. Most of the harm to society and to individuals caused by smoking in the near-term future will occur in people who are smoking today. Vigorous pursuit of conventional tobacco control policies encourages more smokers to quit smoking. Quitting smoking is very difficult and most adults who smoke today will continue to smoke for many years. People smoke because they are addicted to nicotine, but are harmed by other constituents of tobacco smoke. Provision of the nicotine that smokers are addicted to without the harmful components of tobacco smoke can prevent most of the harm from smoking. Until recently, nicotine products have been marketed as medicines to help people to quit. NRT is most effective in helping people to stop smoking when used together with health professional input and support, but much less so when used on its own. E-cigarettes are marketed as consumer products and are proving much more popular than NRT as a substitute and competitor for tobacco cigarettes. E-cigarettes appear to be effective when used by smokers as an aid to quitting smoking. E-cigarettes are not currently made to medicines standards and are probably more hazardous than NRT. However, the hazard to health arising from long-term vapour inhalation from the e-cigarettes available today is unlikely to exceed 5% of the harm from smoking tobacco. ...the hazard to health arising from long-term vapour inhalation from the e-cigarettes available today is unlikely to exceed 5% of the harm from smoking tobacco Technological developments and improved production standards could reduce the long-term hazard of e-cigarettes. There are concerns that e-cigarettes will increase tobacco smoking by renormalising the act of smoking, acting as a gateway to smoking in young people, and being used for temporary, not permanent, abstinence from smoking. To date, there is no evidence that any of these processes is occurring to any significant degree in the UK. Rather, the available evidence to date indicates that e-cigarettes are being used almost exclusively as safer alternatives to smoked tobacco, by confirmed smokers who are trying to reduce harm to themselves or others from smoking, or to quit smoking completely. There is a need for regulation to reduce direct and indirect adverse effects of e-cigarette use, but this regulation should not be allowed significantly to inhibit the development and use of harm-reduction products by smokers. A regulatory strategy should, therefore, take a balanced approach in seeking to ensure product safety, enable and encourage smokers to use the product instead of tobacco, and detect and prevent effects that counter the overall goals of tobacco control policy. The tobacco industry has become involved in the e-cigarette market and can be expected to try to exploit these products to market tobacco cigarettes, and to undermine wider tobacco control work. However, in the interests of public health it is important to promote the use of e-cigarettes, NRT and other non-tobacco nicotine products as widely as possible as a substitute for smoking in the UK. 21 April 2016 New study finds exhaled e-cigarette vapour particles disappear within seconds A new study being presented today at the 4th Workplace and Indoor Aerosols conference in Barcelona shows, for the first time, that exhaled e-cigarette particles are liquid droplets that evaporate within seconds. The research - a collaboration between Kaunas University of Technology in Lithuania, EMPA Swiss Federal Laboratories for Materials Science and Technology, ETH Zurich the Swiss Federal Institute of Technology and Fontem Ventures - is the first detailed study of its kind conducted to investigate particles in exhaled e-cigarette vapour. Speaking from the conference today, Professor Dainius Martuzevicius, Vice Dean for Research at the Faculty of Chemical Technology, Kaunas University of Technology and leading expert on indoor air quality, said: There is little data available on the properties of exhaled e-cigarette 'particles' in the scientific literature and as a result there is a growing discussion amongst the public health community as to whether the 'particles' exhaled following use of vaping products have potential implications for indoor air quality. 12 April 2006 Are E-Cigarettes a Healthy Way to Quit Smoking? Electronic cigarettes have an unparalleled potential to reduce the public-health impact of smoking, by allowing smokers to replace the habit and nicotine of smoking without the toxic effects of combustion. - Dr. Rose is a professor of psychiatry and behavioral sciences and director of the Duke Center for Smoking Cessation at Duke University. He can be reached at reports@wsj.com. 10 April 2016 Wellington City Council to discuss banning smoking and also e-cigarettes (Vaping) Question to the Committee: what is the harm of developing dependence on a low cost non-fatal device? A committee of the Wellington City Council is about to ban use of e-cigarettes on its properties. The debate is on 13 April. According to Dr Joe Nitzkin, former chair of tobacco control for the College of Public Health Medicine in the USA: The bottom lines are these: 1)Imposing restrictions and increasing taxes on cigarettes and smoking will reduce tobacco-related addiction, illness and death. 2)Imposing these same restrictions and taxes on e-cigs will have the opposite effect. It will discourage smokers who would otherwise switch to keepsmoking. 3) Vaping is not smoking and should not be defined as such. 1 January 2016 Prices exceed $1 per cigarette As from 1 January 2016 the following prices have been charged, representing a 10.3% in excise and inflation as well as similar increases in ex-factory price. Port Royal $78 for 50 g. ($1.09 per cigarette of 0.7 g). Pall Mall $21.60 for 20 cigarettes.($1.08 per cigarette). 7 December 2015 NHS to give out e-Voke E-voke has been licensed by Medicines and Healthcare Regulatory Agency for medicinal use. The aim is to have these gadgets available for prescription by GPs in 2016. E-vokes are not an e-cig. They rely on producing a powder, like an inhaler. Vype e-cigarettes have been licensed but will not be available for some time. Both products are produced by BAT. C. Wheeler. Express. 7 December and ASH UK 8 December. 1 December 2015 Excise expected to rise 10.3% on 1 Jan 2016 According to NZ Customs Service the new rates will be $668.51 per 1000 cigarettes as from 1 January. Smoking tobacco will cost $666.83 per kg of tobacco content. This amounts to an increase of 10.3% in tobacco price since 1 January 2015. This means a cigarette costing $20 in 2015 could cost $22.06 in 2016, assuming tobacco companies also raise their price by the same percentage. 30 November 2015 Viewpoints: Is the jury still out on e-cigarettes? Monday, November 30, 2015 http://www.drugfoundation.org.nz/matters-of-substance/november-2015/viewpoints/e-cigarettes Short of a pill that will magically take addiction away, are e-cigarettes the best smoking cessation device since the humble patch? Or are they just another dangerous addiction,?a gateway device for children or, worse, a sneaky attempt by Big Tobacco to renormalise smoking? In the May 2012 Viewpoints, Matters of Substance compared the arguments and decided the jury was still probably out on e-cigarettes. A recent report by Public Health England, however, has become the first authoritative declaration that e-cigarettes are safer than cigarettes and by a significant margin. In this edition, we take a look at the English report and at one of its detractors. Is the jury still out, and should we bother waiting? Public Health England In August 2015, Public Health England (PHE) published its commissioned report E-cigarettes: an evidence update, which summarised the findings from two extensive literature reviews. The report s conclusions were almost startling. It said the evidence suggests using e-cigarettes is 95 percent safer than smoking and that e-cigarettes have the potential to make a significant contribution to the endgame for tobacco. Its policy recommendations included making e-cigarettes much more prominent in smoking cessation initiatives and streamlining convoluted processes for them to be licensed as quit-smoking aids. Among the report s findings was that e-cigarette use by people who had never smoked was extremely low, at around 0.2 percent. Regular use (at least once weekly) by young people is also very rare at just 2 percent, and while there is some youthful experimentation, only 0.3 percent of young people who used e-cigarettes had never smoked tobacco before. It said the most important reason people use e-cigarettes is to reduce smoking- related harms and that, while curiosity plays a role in why some people experiment with them, most of these experiments did not lead to regular use. It concluded from this that e-cigarettes are not undermining, and may even be contributing to, the long-term decline in cigarette smoking . The report made much of a September 2014 Cochrane Review, Electronic cigarettes for smoking cessation and reduction, featuring New Zealanders Hayden McRobbie and Chris Bullen amongst its authors. The review s meta-analysis of 600 records found that e-cigarettes can help smokers unable to stop smoking ... to reduce their cigarette consumption when compared with placebo e-cigarettes and nicotine patches . The PHE report also found e-cigarettes do not replicate the problems of second-?hand smoke. They release negligible levels of nicotine into ambient air with no identified health risks to bystanders . No concerns were found around the labelling of nicotine cartridges or e-liquids , and when they were poorly labelled, they mostly contained less nicotine than declared. While acknowledging nicotine is a poison, the report found no evidence of nicotine poisoning to users. The risks of poisoning to others (such as children) or of evices causing fires were found to be on a par with other household electrical goods or substances. The report s authors discount recent news headlines reporting high levels of formaldehyde found in e-cigarettes as misinterpretations of research findings. They found no indication electronic cigarette users are exposed to dangerous levels of aldehydes and said this could only happen when e-liquid was heated to levels unpalatable to users . Instead, they assert that most of the chemicals causing smoking-related diseases are absent in e-cigarettes and that those that are present pose limited danger. PHE s findings have been supported by a number of high-profile medical experts, including UK s Chief Medical Officer Dame Sally Davies. A September 2015 British Journal of General Practice editorial concluded that, for every million smokers who switched from tobacco to e-cigarettes, more than 6,000 premature deaths would be prevented in the UK every year. If all 9 million smokers took up e-cigarettes instead, 54,000 lives could be saved. Critique of PHE The PHE research will probably be music to the ears of the millions of smokers around the world who have turned to e-cigarettes but who may still have niggling doubts that their new drug delivery device is really all that better for their health. But in one of the greatest parade-raining articles so far this century, Martin McKee and Simon Capewell, writing in the British Medical Journal, are scornful of the research and suggest its foundation is built on sand. First, they say a recent cohort study shows most smokers who switch to e-cigarettes (80 percent) are still also smoking cigarettes at 12 months (dual use) and that reduced smoking may not reduce overall risk of death. Next, they attack the Cochrane report, on which the PHE report relies heavily, by pointing out that it included only two randomised controlled trials and that, by its own admission, its evidence had limitations and was of low or very low quality. The claim that e-cigarettes are 95 percent safer gets a particular hiding. McKee and Capewell cite a recent systematic review in Preventative Medicine that found serious methodological problems in many of the studies it reviewed and so many conflicts of interest that no firm conclusions can be drawn about the safety of e-cigarettes but that they can hardly be considered harmless . They also point out the 95 percent figure does not come from a review of the evidence but from a single meeting of 12 people convened to synthesise their opinions on the harms associated with different products containing nicotine. They point out two of those present had received tobacco industry funding in the past and that some other attendees were known e-cigarette champions McKee and Capewell also dispute the report s finding that e-cigarettes are not helping to renormalise smoking. They say a July 2015 survey by the Health and Social Care Information Centre showed more than 20 percent of 11 15-year-olds had used e-cigarettes, and 73 percent of these were non-smokers. An American study, published after the PHE report, they say, concluded that those who had ever used e-cigarettes at baseline compared with non-users were more likely to report initiation of combustible tobacco use over the next year . The McKee and Capewell rebuttal, which points out a number of further perceived problems and inconsistencies, does not claim to prove e-cigarettes are as harmful as smoking tobacco. Rather,?its contention is that the PHE report isn t sufficiently evidence based to underpin changes in public health policy. And therein lies the rub. The precautionary principle: for Many of those opposing e-cigarettes rely pretty heavily on the precautionary principle. It s a bit like insisting that policy must be evidence based but goes a small step further. The precautionary principle states that, if an action or policy has a suspected risk of causing harm and there is no scientific consensus that the action or policy is not harmful, the burden of proof that it is not harmful falls on those taking an action. In other words, it doesn t matter that common sense suggests breathing in vapour containing a handful of chemicals is better than breathing in smoke containing hundreds. Until there is enough evidence to provide scientific consensus that e-cigarettes are safe, we cannot endorse them. This is the view taken by the World Health Organization and by our own Ministry of Health, which currently refuses to recommend any?use of e-cigarettes. That sort of scientific consensus is probably a long way off. There is little available research on the long-term effects of e-cigarettes because they just haven t been around long enough. The precautionary principle: against Massey University Associate Professor Marewa Glover, who also chairs End Smoking NZ, is less a fan of the precautionary principle when it comes to public health policy. She points out the precautionary principle was used first in the environmental risk arena and that there aren t any real grounds for transferring it to public health. Disease and illness are well established areas, and we have well established practices determining risks to health so we don t need to rely so heavily on such a guilty until proven innocent approach, she says. In a randomised controlled trial, where the particular new drug being investigated is clearly working and alleviating harm for the intervention group receiving it, a point is reached where it becomes unethical to continue withholding that drug from the control group. Glover thinks the situation is very similar with e-cigarettes. E-cigarettes are clearly working in terms of helping people stop smoking far more than anything we ve seen so far. We may not have had many randomised controlled trials yet, but the evidence is definitely mounting, so why make it difficult for people who want to use them? She also points out there s an uncanny exchange between falls in smoking rates and rising e-cigarette use in the US and the UK that strongly suggests e-cigarettes help people quit. And then there s the anecdotal stories from millions of people who say their health has improved or that e-cigarettes have saved their lives.?The precautionary principle is being used by people who fear another industry-driven epidemic. But an epidemic of what? What s the disease? Is the jury still out in terms of the safety of e-cigarettes? Not at all, Glover says. But the jury is absolutely in on how dangerous smoking is, and there s ample evidence of its harm. With e-cigarettes, there is no evidence of acute or longitudinal harm whatsoever, even though researchers are looking for it. You can buy e-cigarette devices in New Zealand, but nicotine must be ordered in from overseas because it is not licensed here for non-medicinal sale. The case is similar in most jurisdictions, and it s a major impediment, especially if you re not well off. Nevertheless, e-cigarette use is growing just about everywhere, suggesting a lot of smokers aren t bothering to wait for the jury. The day is probably coming when stances soften and e-cigarettes become more officially sanctioned perhaps not because there s been a rush of irrefutable evidence but because our government and Ministry of Health suddenly find themselves woefully behind the times. There s little doubt e-cigarettes are here to stay. 9 November 2015 How cigarette mortality applies to NZ smokers Knowing that smoking kills half of current smokers, but e-cigarettes do not, it can be calculated that if NZ has 0.6 million smokers as at present, a total switch of those smokers to e-cigarettes would have the eventual effect of saving half of those smokers (300,000) from predictable deaths due to smoking. If however, only half switch to E-cigarettes, smoking deaths would decrease by 150,000 over the next 15 years. 2 October 2015 Cigarette consumption, NZ 2014 For the years 2010-2014 the average drop in consumption was 6.3% across New Zealand, and the fall was 23%. For 2013-4 the fall was 3.8%. This was the sum of changes in factory-made and roll-your-own cigarettes. In March 2013 the Census showed that a total of 15.1% of adults smoked daily. In 2014 a total of 1% of smokers consumed e-cigarettes daily. 1 Oct 2015 Reduced nicotine cigarettes reduces nicotine exposure In this 6-week study 780 smokers (unwilling to quit smoking) of reduced nicotine cigarettes versus standard cigarettes, reduced their nicotine exposure, and dependence on nicotine, and number of cigarettes smoked, as well as craving during abstinence from smoking. Compensation was minimal. Donny E. et al. Randomised trial of reduced-nicotine standards for cigarettes. N. Engl J Med 2015 Oct 1;313: 340-349. http://www.nejm.org/doi/pdf/10.1056/NEJMsa1502403 NB: this study argues that reduced nicotine in the cigarette means reduced addiction, and increased effect from increased taxation. 19 August 2015 Give out e-cigarettes free in England, doctors told Doctors should be able to prescribe E-cigarettes says Public Health England, as it tried to debunk the myth that 'vaping' was as bad for health as inhaling tobacco smoke.. If all of England's eight million smokers switched to e-cigarettes overnight, over 75,000 lives a year would be saved, experts say. Not only are e-cigarettes 20 times less dangerous than tobacco, they are also among the most effective quitting aids, they added. Kim Lay, The Times London. http://www.thetimes.co.uk/tto/health/ news/article4531500.ece 17 July 2015 Ex-smokers know a thing or two about nicotine! In the USA, in 2014, 16.7% of adults smoked. In the USA, 6.3 million smokers used e-cigarettes, and 22% used them daily. Of nearly 2 million ex-smokers 63% use e-cigarettes daily, and obtained their nicotine only from e-cigarettes. (Vaping nicotine e-cigarettes is illegal in NZ, but smoking cigarettes which gives more nicotine is legal!) Rodu B. 30 million US adults have used e-cigarettes, unpublicised CDC data reveals. Tobacco Truth. 14 July 2015. (based on the 2014 National Health Interview Survey, released June 29). http://rodutobaccotruth.blogspot.co.nz/2015/07/30-million-have-used.e.html 1 Jan 2015 Excise and price up again in 2015 Excise up 10% and price of 20 cigarettes reaches $20, and for 30g RYOs, reaches $30.50. Excise will increase again on 1 Jan 2016. 2 Jan 2014 Murray Laugesen. Nicotine and Health American Council on Science and Health, New York. Of special interest to smoking cessation experts and policy makers. This world-first publication (71 pages, 137 references) details 1 How nicotine affects your health 2 How smokeless affects your health 3 Electronic cigarettes. To view the free copy see http://acsh.org/2014/01/effects-nicotine-human-health/ (and download.) For more details please see www.healthnz.co.nz/News2013  __________________________ ____ Disclaimer: Health NZ has no financial interest in any nicotine or tobacco product or business. Clinical trials and pharmacokinetic research Risk profile testing of alternatives to smoking products Cigarettetesting.htm  Alternatives.htm Policy analysis and advice; Consultancy, to reduce heart disease, cancer, and smoking. Aim:    To promote the health of New Zealanders  20 June 2015. Vaping in the USA 10% of US adults are now vaping, compared with a year ago. Almost all of these also smoke. www.trust.org/item/20150610110053-ye2me. and ASH UK London. For more info on e-cigarettes see www.endsmoking.org.nz 15 July 2015 E-cigs and air unaffected; but smoke kills respiratory cells within 6 hours E-cigarettes (NJoy brands) vapour has no adverse effect on respiratory epithelial cells in a respiratory model of cells in culture for 6 hours, whereas tobacco smoke from commercial brands in the same time killed such cells, preventing their viability. Authors from BAT in Toxicology in Vitro 15 July 2015. DOI: 10.1016/j.tiv.2015.05.018). 31 May 2015. Smoking in Iceland has diminished from 14.2% in 2012 to 11.3% in 2015. Use of tobacco in the lip (Snus) increased from 1.9% to 3.4% in this period. - Embaetti Landlaeknis Directorate of Health.http://www.landlaeknir.is/um-embaettid/frettir/frett/item27026/Dagur-an-tobaks-31--mai-2015 ------------------------------------------------   27 February 2010: New Nicotine cigarette gives fast delivery of nicotine to the lung. Now published. For the full text report in Experimental and Clinical Psychopharmacology, click here to see from this website provided  www.healthnz.co.nz  is acknowledged as source.   Dr Murray Laugesen QSO for public services WHO Tobacco or Health medallist MBChB NZ, FRCS Edin, MCCM NZ, FNZCPHM Dip Obst Managing director and public health physician Adjunct Professor, University of Canterbury (Dept of Pyschology). On leaving the Public Health Commission in 1995 Dr Laugesen founded Health New Zealand Ltd as his consultancy company. Dr Laugesen has been involved in the prevention of cancer, heart disease and smoking at national level since 1984 267 Memorial Av Burnside Christchurch Press Release: Frost And Sullivan A majority of healthcare professionals in New Zealand view Electronic Nicotine Delivery Systems (ENDS), such as e-cigarettes and heated tobacco products, as a viable alternative to cigarettes if they are legalised and regulated appropriately, according to new research conducted by Frost Sullivan. Over 500 adults in New Zealand (including current, former and non-smokers), as well as 60 healthcare professionals (including GPs, medical specialists (such as psychiatrists, surgeons and radiologists), nurses, pharmacists, and allied healthcare professionals) were interviewed as part of an opinion research study to gauge the level of understanding and attitudes towards alternatives to cigarettes . New Zealand has moved to reduce smoking rates in recent decades, and currently boasts one of the lowest smoking rates in the developed world. However, almost 600,000 New Zealanders continue to smoke, with particularly high smoking rates among population groups such as Maori and the most economically-disadvantaged New Zealanders. While the Government has set a target of achieving a Smokefree New Zealand by 2025, with a smoking rate of 5% or less nationwide, achieving this goal is likely to be challenging. Smoking is therefore likely to continue to be a significant health and economic challenge for New Zealanders. Managing Director of Frost Sullivan ANZ, Mark Dougan noted: Smoking is still a key area of concern amongst healthcare professionals, with 90% believing that the government still needs to do more to address smoking. Our research shows that there is broad acceptance that ENDS are significantly less harmful than cigarettes, and widespread agreement amongst healthcare professionals that ENDS should be legalised as long as they are appropriately regulated. Healthcare professionals are largely supportive of the use of ENDS, with 65% agreeing that they would prefer smokers who are unable or unwilling to quit to switch to these instead of smoking cigarettes, with 33% unsure and only 2% opposed. In general, healthcare professionals believe that tobacco harm reduction products such as ENDS can aid in reducing the harm from smoking, Mr Dougan said. Our survey indicates that 60% of smokers overall and 64% of Maori smokers would like to quit, but are facing challenges in doing so, with current smokers who have tried to quit reporting, on average, over six unsuccessful attempts to do so, he added. However, about 40% of smokers do not wish to quit or are not sure. In this case, switching to tobacco harm reduction products is a better option in the long term than continuing to smoke cigarettes, he said. The survey also showed that healthcare professionals believe that greater promotion and raising awareness of the role of ENDS to both healthcare professionals and smokers and their families is necessary. For more information or to download the report, please visit http://frost.ly/3ej This research was commissioned by Philip Morris International, however the analysis contained in this research reflects the views of Frost Sullivan analysts without any bias or influence from any third party. Contact us: Start the discussion. Scoop Media Researching safer, effective alternatives to smoking Home News Policy research Diagnostics Addiction R D plan E-cigarette Smokefree air Nutrition research Publisher: Dr Murray Laugesen Director, Health New Zealand Ltd and Adjunct Professor, Department of Psychology, University of Canterbury. ph 03 358 9329 For peer reviewed publications see www.healthnz.co.nz/Publicnsall.htm 7 March 2019 PM wants concession on price of Heat Not Burn PM is selling its combustibles and its non-combustibles for the same excise. (over 80 cents per cigarette). This may be fixed up during the select Committee process later this year, but meantime this serious anomaly persists. It is especially so because the Wellington court has ruled that Heat Not Burn is entitled to be sold, and does not contain tobacco, ie it is a non-combustible, and is therefore of no harm, unlike the Marlboro cigarette. 11 January 2019 PMI to stop selling cigarettes in the UK by 2030. With new research from Public Health England suggesting that parts of the UK could be smokefree by as early as 2024, PMI's director of corporate affairs in the UK Mark MacGregor has stated that 2030 seems a realistic time to pull cigarettes from sale. Source: the Daily Star. 11 Jan 2029. 23 November 2018 Vaping and smokeless tobacco products to be regulated Jenny Salesa Associate Minister of Health announced today that vaping and smokeless tobacco products are to be regulated. The Smoke-free Environments Act will be amendedin 2019 to give smokers more confidence in the quality of vaping and smokeless tobacco products, while also protecting children and young people from the risks associated with them. Use of these products will be limited in bars restaurants and workplaces. Advertising will also be restricted. Scoop 4 Sep 2018 Dr Fiona Bruce Vaping the methadone of smoking so let's support patients to use it. Blaming patients for smoking, making them feel like losers , is bullying within general practice. - Report of RNZCGP conference 2018- reported by Fiona Thomas. 12 June 2018 End Smoking NZ welcomes Snus to NZ Dr Penny Truman and Dr George Laking have both recommended snus as used in Sweden for use in NZ, as being much safer than smoking. Stuff NZ 6 June 2018 Ministry says E-cigarettes and Smokeless are legal to sell as a result of recent judicial decision. - www.moh.govt.nz 23 May 2018 End Smoking NZ appoints new chair Dr George Laking of Auckland DHB has now replaced Professor Marewa Glover as chair of ESNZ. 10 May 2018 Ministry to consider risk-proportionate regulation for vaping and heated tobacco products In the court case below, it was found that nearly all tobacco products could be sold lawfully under the Smoke-free Environments Act. This means that largely the same regulatory controls apply to smoked tobacco products, heated tobacco products and vaping products made from tobacco. The Ministry plans to consider how best to apply risk-proportionate regulation to all tobacco and vaping produccts. Ministry of Health 28 Marcch 2018 Heets not part of Section 29. Philip Morris win over Ministry of Health In the Wellington District Court on 12 March the Ministry's claim that S. 29 of the Smoke-free Environments Act included HEETS (the nicotine containing sticks in the Heat Not Burn device) was dismissed. This was not the original design of the 1990 Act, said Judge Patrick J Butler. http://www.districtcourts.govt.nz/assets/unsecure/2018-03-27/2018-NZDC-4478-MOH-v-Morris.pdf 15 March 2018 Cigarette plain packaging comes into force across NZ today Starting today tobacco companies will no longer be able to sell cigarettes in branded packaging. Instead they will sell them in olive green brown packets which retain the graphic health warnings already prominent on current branded packets. The brand is given in small letters on the front of the pack. Deadline for selling the old style is June 6. 8 February 2018 Vaping helps people quit smoking A recent survey of vapers found the majority started smoking e-cigarettes to help them quit smoking. More than 200 people from across New Zealand took part in the online survey in 2016, led by Dr Penny Truman from Massey University s School of Health Sciences. The results, published in the International Journal of Environmental Research and Public Healthyesterday, are of interest internationally because at the time of the survey vaping products containing nicotine were not able to be sold legally in New Zealand. Dr Truman says this study confirms accessing nicotine for vaping was the main problem people had with vaping. We found the main reason for trying vaping was to stop or reduce smoking. Most study participants said they had completely switched from smoking to vaping. Some newer vapers still smoked, but they were still cutting down on cigarettes and some only smoked occasionally, Dr Truman says. 7 February 2018 Public Health England publishes independent expert e-cigarettes evidence review ..... vaping poses only a small fraction of the risks of smoking and switching completely from smoking to vaping conveys substantial health benefits ......e-cigarettes could be contributing to at least 20,000 successful new quits per year and possibly many more .....e-cigarette use is associated with improved quit success rates over the last year and an accelerated drop in smoking rates across the country .....many thousands of smokers incorrectly believe that vaping is as harmful as smoking; around 40% of smokers have not even tried an e-cigarette .....there is much public misunderstanding about nicotine (less than 10% of adults understand that most of the harms to health from smoking are not caused by nicotine) .....the use of e-cigarettes in the UK has plateaued over the last few years at just under 3 million ....the evidence does not support the concern that e-cigarettes are a route into smoking among young people (youth smoking rates in the UK continue to decline, regular use is rare and is almost entirely confined to those who have smoked) Editor: Ann McNeill et al. 16 November 2017 Correction statements on tobacco required by law in the USA As from Nov 27, the media will be required to print on behalf of the tobacco companies, a series of corrective statements, as a result of a court case against US tobacco companies, chaired by Judge Gladys Kessler: : 1. More people die every year from smoking than from murder, AIDS, suicide, drugs, car crashes and alcohol combined. 2. Smoking also causes reduced fertility, low birth weight in newborns, and cancer of the cervix. 3. Smoking is highly addictive. Nicotine is the addictive drug in tobacco. 4. Various companies (US companies) intentionally designed cigarettes to make them more addictive. 5. When you smoke, the nicotine actually changes the brain - that's why quitting is so hard. 6. All cigarettes cause cancer, lung disease, heart attacks and premature death. .. There is no safe cigarrette. 7. Secondhand smoke causes lung cancer and coronary heart disease in adults who do not smoke 8. Children exposed to secondhand smoke are at an increased risk for sudden infant death syndrome (SIDS), acute respiratory infections, ear problems, severe asthma, and reduced lung function. 9. There is no safe level of exposure to secondhand smoke. - Harold Farber, American Thoracic Society. 19 October 2017 Change of Government in New Zealand The dominant parties are now Labour, Greens and NZ First, rather than National. The emphasis on harm reduction and legalisation of e-cigarettes in 2018 is not expected to change. 11 October 2017 NZ Ministry of Health position statement - E-cigarettes In 2011, the Government set a goal for Smokefree 2025. The goal aims to reduce smoking prevalence to minimal levels. The Ministry of Health believes e-cigarettes have the potential to make a contribution to the Smokefree 2025 goal and could disrupt the significant inequities that are present. The potential of e-cigarettes to help improve public health depends on the extent to which they can act as a route out of smoking for New Zealand's 550,000 daily smokers, without providing a route into smoking for children and non-smokers. Recent decisions taken by Government have increased the focus on harm reduction with an aim to support smokers to switch to significantly less harmful products like e-cigarettes. The Ministry of Health encourages smokers who want to use e-cigarettes to quit smoking to seek the support of local stop smoking services. Local stop smoking services provide smokers with the best chance of quitting successfully and should support smokers who want to quit with the help of e-cigarettes. Expert opinion is that e-cigarettes are significantly less harmful than smoking tobacco but not completely harmless. A range of toxicants have been found in e-cigarette vapour including some cancer causing agents but, in general, at levels much lower than found in cigarette smoke or at levels that are unlikely to cause harm. Smokers switching to e-cigarettes are highly likely to reduce their health risks and for those around them. When used as intended, e-cigarettes pose no risk of nicotine poisoning to users, but e-liquids should be in child resistant packaging. E-cigarettes release negligible levels of nicotine and other toxicants into ambient air with no identified health risks to bystanders. Currently there are no mandatory product safety requirements specifically for e-cigarettes in New Zealand, however generic product safety standards apply. The Ministry of Health will continue to monitor the uptake of e-cigarettes, their health impact at individual and population levels, including long term effects and their effectiveness for smoking cessation as products, evidence and technologies develop. The Ministry of Health will also continue to meet its obligations under Article 5.3 of the WHO Framework Convention on Tobacco Control to protect public health policy from commercial and other vested interests of the tobacco industry. August 2017 British Psychological Society Changing behaviour: Electronic cigarettes Lynne Dawkins and Hayden McRobbie. Data on smoking from Eurobarometer 2014 show that of 7.5 million surveyed, 35% of smokers quit.and 32% reduced their smoking. BPS recommends use of e-cigarettes. Drug and Alcohol Nurses of Australasia Electronic cigarettes for Tobacco Harm Reduction September 2017 Position Statement No 3. Darren Smyth President E-cigarettes are not risk free but evidence suggests they are around 95% safer than smoking. Clinical Use. All patients should be encouraged to stop smoking and offered bes practice treatments to assist quitting. Consider E-cigarettes for smokers who are unable to quit with conventional therapies. September 13, 2017 New York Yach heads up Foundation for a Smoke-free World President is Dr Derek Yach, a renowned anti-smoking crusader. . The Foundation has secured funding of approximately US$80 million annually over the next 12 years, beginning in 2018 from Philip Morris International. PMI does not interfere with the workings of Smoke-free World. (www.smoke-freeworld.org ) Initial activities are expected to be focused in four areas of need: 1) Support research into harm reduction and build research capacity through academic centers of excellence 2) Collaboratively build consensus around which interventions can best reduce harm and deaths from smoking and increase smoking cessation 3) Measure and report on global progress towards smoking harm reduction 4) Identify alternative crops and livelihoods for tobacco farmers as the global demand for tobacco declines Dr Derek Yach, studied under Dr Michael Russell, the father of addiction science, at the Institute of Psychiatry in London. At WHO he was a cabinet director and led the development of the Framework Convenrtion on Tobacco Control. He has since been a professor of global health at Yale University. He holds the degrees of MBChB and MPH. 29 September 2017 Comment from WHO When it comes to the Foundation for a Smoke-Free World, there are a number of clear conflicts of interest involved with a tobacco company funding a purported health foundation, particularly if it promotes sale of tobacco and other products found in that company s brand portfolio. WHO will not partner with the Foundation. Governments should not partner with the Foundation and the public health community should follow this lead. Answer to WHO The Foundation is a health foundation with by-laws in place to prevent the sale of tobacco such as Marlboro. 2 June 2017 NZ Med J;130 (1456) Tobacco consumption down 41%, cigarette prices up 230%: lessons from 1985-1988: Life expectancy rises 3.6 years for men. Murray Laugesen and Randolph C. Grace New Zealand men are living much longer due to giving up tobacco smoking in the 1985 1995 period. Diet had an improving effect. In 1988, men were living 3.6 years more than 10 years before, and women 2.8 years more. That is equal to three months gain in life per person over these 10 years. Most of the effect has benefited men. Tobacco consumption per adult fell by 41% in these 10 years. To do that, the price of cigarettes went up 230%, and we started eating more vegetables and fruit and a variety of polyunsaturated fats. Aim. We compared changes in tobacco consumption and diet in relation to changes in life expectancy in 1988 1998 in 22 OECD (Organisation for Economic Cooperation and Development) countries. Method. Between 1985 and 1995 using regression analysis we estimated differences in tobacco consumption per adult and the differences in the sum of atherogenic and thrombogenic indices against life expectancy. Each index was derived from the various fats per gram of food from standard texts, and from the annual measurements of fat in the food balance sheets of each country. Results. In 1985 1995, New Zealand showed the largest decrease in tobacco consumption per adult (41%) and the greatest decrease (except for Switzerland) in the sum of atherogenic and thrombogenic indices (17%) as a measure of diet. New Zealand ranked first for life expectancy increases from 1988 1998 for men (3.6 years), women (2.8 years) and for both sexes combined. Regression analyses revealed that increases in life expectancy across the OECD for males, but not females, were strongly associated with decreases in tobacco consumption, with a weaker effect of diet improvement. Conclusion. These results suggest that reduced tobacco consumption in 1985 1995 likely contributed to New Zealand s gains in life expectancy from 1988 1998. 2 June 2017 NZ Med J 130 (1456) Reduced tobacco consumption, improved diet and life expectancy for 1988-1998: analysis of New Zealand and OECD data. The 3.6 years will be included in an erratum submitted to the NZMJ.

TAGS:Health New Zealand 

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