tag:theconversation.com,2011:/ca-fr/topics/smoking-451/articlesSmoking – La Conversation2024-03-24T19:06:49Ztag:theconversation.com,2011:article/2261172024-03-24T19:06:49Z2024-03-24T19:06:49ZWe’ve taken smoking from ‘normal’ to ‘uncommon’ and we can do the same with vaping – here’s how<p>Vaping is a pressing public health issue. While adult smoking rates continue to fall, vaping rates are rising. Some 7% of adults now <a href="https://www.bmj.com/content/384/bmj.q559">vape daily</a>, up nearly three-fold since 2019. Most alarmingly, the rate of current vape use – on a daily, weekly or monthly basis – among 18-to-24-year-olds has climbed from 5% in 2019 to 21% in 2023. </p>
<p>Nicotine, especially in high doses, is known to be <a href="https://www.tobaccoinaustralia.org.au/chapter-18-e-cigarettes/18-6-the-health-effects-of-e-cigarette-use/18-6-2-health-effects-of-e-cigarette-use-during-adolescence#_ENREF_4">harmful to brain development</a>. Vaping products also contain more than 200 chemicals, some of them known carcinogens. </p>
<p>While the research on long-term health harms of non-therapeutic vaping is still emerging, there is an urgent need for governments to act in the interests of public health.</p>
<h2>Historical parallels</h2>
<p>We have confronted youth nicotine addiction before. Lessons can be learned from Australia’s decades-long, world-leading efforts to control tobacco.</p>
<p>Firstly, global tobacco organisations <a href="https://www.tobaccoinaustralia.org.au/chapter-18-e-cigarettes/18-1-the-ecigarettemarket">now control</a> the vaping industry. Like smoking historically, vapes are aggressively marketed to young people.</p>
<p>In 1969, in the early years of tobacco control, <a href="https://www.tobaccoinaustralia.org.au/chapter-1-prevalence/1-3-prevalence-of-smoking-adults">36% of adults smoked daily</a>, but prevalence was declining. Tobacco companies sought new young buyers for their products. They <a href="https://theconversation.com/how-the-push-to-end-tobacco-advertising-in-the-1970s-could-be-used-to-curb-gambling-ads-today-200915">flooded television and radio with advertising</a>, which rapidly drove up youth smoking. We are seeing the devastating effects today of tobacco-induced disease.</p>
<p>Anti-tobacco advocates in 1971 pressured a reluctant Commonwealth government to ban tobacco advertising. They used celebrity-studded, satirical television adverts showing smoking’s health harms, drumming up media attention, and lobbied politicians using international data showing the powerful effect cigarette advertising had on promoting youth smoking. </p>
<p>On the back of growing public outrage, politicians eventually <a href="https://theconversation.com/how-the-push-to-end-tobacco-advertising-in-the-1970s-could-be-used-to-curb-gambling-ads-today-200915">banned tobacco advertising on television and radio by 1977</a>.</p>
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Read more:
<a href="https://theconversation.com/how-the-push-to-end-tobacco-advertising-in-the-1970s-could-be-used-to-curb-gambling-ads-today-200915">How the push to end tobacco advertising in the 1970s could be used to curb gambling ads today</a>
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<h2>The rise of the Quit campaigns</h2>
<p>Despite this success, more was needed to drive down smoking. In 1978, the Commonwealth government and the NSW Department of Health funded a <a href="https://www.bmj.com/content/287/6399/1125">“Quit for Life” campaign</a> in northern NSW to discover how best to help smokers to quit.</p>
<p>It revealed that memorable ads – notably the famous <a href="https://www.youtube.com/watch?v=ZCkx610Gn6M&ab_channel=Freeman">“Sponge” ad</a> – combined with counselling and medical assistance were most effective. </p>
<p>“Quit”-branded campaigns were then rolled out in Western Australia (1982), Sydney and Melbourne (1983) and South Australia (1984). </p>
<p>The first Quitline providing guidance on accessing support was trialled in Sydney. In Victoria, a dedicated organisation, <a href="http://www.quit.org.au">Quit</a> Victoria, was established in 1985. From 1987, it received funding from the Victorian Health Promotion Foundation (VicHealth), using revenue from cigarette taxes.</p>
<p>Each campaign relied on the same tools: anti-smoking education complemented by a Quitline and other practical support for smokers to quit.</p>
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<h2>Banishing smoking from public space</h2>
<p>Tobacco companies pivoted to sport sponsorship in the 1980s to keep their brands in public view. In response, anti-smoking advocates pushed to close legislative loopholes allowing this “sports-washing”, and Quit Victoria began sponsoring sport.</p>
<p>But the problem of youth smoking <a href="https://link.springer.com/article/10.1007/s10552-008-9127-8">re-emerged due to a lack of co-ordinated national action</a>. By the mid-1990s, smoking prevalence among young people <a href="https://www.tobaccoinaustralia.org.au/chapter-1-prevalence/1-6-prevalence-of-smoking-teenagers">was back at 30%</a>. </p>
<p>Advocates pushed for a nationwide education campaign using a consistent message: “<a href="https://tobaccocontrol.bmj.com/content/12/suppl_2/ii9.short">Every cigarette is doing you damage</a>”. A nation-wide Quitline service was launched, as were new anti-smoking regulations, including smoke-free areas, stronger health harm warnings on cigarette packs, and increased taxation. <a href="https://www.tobaccoinaustralia.org.au/chapter-1-prevalence/1-6-prevalence-of-smoking-teenagers">Youth smoking rapidly decreased</a>.</p>
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<p>However, success was not guaranteed, and advocates continued pressing. Through the early 2000s, <a href="https://www.tobaccoinaustralia.org.au/chapter-11-advertising/11-9-retail-promotion-and-access">each state progressively banned</a> point-of-sale tobacco advertising, including the visual display of packs. </p>
<p>A Commonwealth-led agreement with the states to co-ordinate their laws led to a nationwide indoor smoking ban from July 1 2007. And, in a world first, the Gillard government <a href="https://www.smh.com.au/politics/federal/a-decade-on-from-plain-packaging-what-is-the-result-20210709-p588e7.html">legislated the plain packaging</a> of tobacco, finally removing all tobacco branding.</p>
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Read more:
<a href="https://theconversation.com/australias-restrictive-vaping-and-tobacco-policies-are-fuelling-a-lucrative-and-dangerous-black-market-225279">Australia's restrictive vaping and tobacco policies are fuelling a lucrative and dangerous black market</a>
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<h2>Three major lessons</h2>
<p>This history offers important lessons for the vaping crisis: </p>
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<li><p>the importance of a multi-pronged strategy, which includes stressing that vaping is addictive and unhealthy, and evidence-based advocacy to government </p></li>
<li><p>the need to provide appropriate supports to help people quit</p></li>
<li><p>a consistent, national approach targeting people of all ages, especially young people, before they become nicotine-dependent.</p></li>
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<p>Tobacco-control efforts were evidence-based, from the science of smoking’s health harms, to the power of cigarette advertising on youth, to the best response strategies.</p>
<p>Public education campaigns about the harms of vapes must also be evidence-based and sophisticated in their targeting of vaping’s appeal.</p>
<p>More than four decades of “Quit” campaigning show the value of complementary resources, including counselling and medical support. Practical supports to help people to stop vaping should be strengthened wherever needed. </p>
<p>Finally, the Commonwealth must continue to lead. The laws implemented by federal Health Minister Mark Butler on March 1 2024 enforce the existing ban on the import of all unregulated vapes, nicotine and non-nicotine alike. The <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/world-leading-vaping-legislation-introduced-to-parliament?language=en">second phase of laws</a> promised by the Commonwealth on March 21 enforces existing retail bans that have been widely flouted. It requires the states to assist.</p>
<p>This is a complicated issue of public policy because — despite what some opponents have suggested — <a href="https://simonchapman6.com/2024/03/17/vaping-theology-22-prohibition-has-never-worked-at-any-point-in-history-for-any-other-illicit-substance/">vapes are not prohibited, but regulated</a>. This means they are accessible by prescription for their original intended use: to quit smoking.</p>
<p>To make this work, the Commonwealth must encourage states to enforce bans. It must press for consistent laws across the country regarding the enforcement of vape-free areas. It must also seek a national approach to ensuring doctors and other healthcare providers have up-to-date evidence on prescribing therapeutic e-cigarettes for people seeking to quit smoking.</p>
<p>The health minister should be commended for the strong steps he has taken to tackle non-therapeutic vaping. The government should also take comfort in the knowledge it has the legacy of Australia’s considerable success in tobacco control on its side. </p>
<p>However, a challenge lies ahead with a politically motivated opposition and a Greens cross-bench. Both misrepresent current policy as “prohibition” when it is merely regulation to keep vapes away from young people. </p>
<p>We’ve taken smoking from “normal” to “uncommon”. We can do the same with vaping when these laws come into full effect, providing states and territories are equipped to enforce them.</p>
<p><em>Correction: This piece originally stated the rate of daily vaping among 18-to-24-year-olds has climbed from 5% in 2019 to 21% in 2023. In fact, 21% is current use – either daily, weekly or monthly.</em></p><img src="https://counter.theconversation.com/content/226117/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Carolyn Holbrook receives funding from the Australian Research Council. </span></em></p><p class="fine-print"><em><span>Thomas Kehoe receives funding from the Australian Research Council and is an employee of Cancer Council Victoria.</span></em></p>Australia’s anti-smoking public health campaign has been hugely successful, and it offers lessons on how to tackle the rise in vaping.Carolyn Holbrook, Associate Professor in History, Deakin UniversityThomas Kehoe, Historian, Cancer Council VictoriaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2230842024-02-25T19:05:37Z2024-02-25T19:05:37ZNicotine pouches are being marketed to young people on social media. But are they safe, or even legal?<figure><img src="https://images.theconversation.com/files/576964/original/file-20240221-30-zpsdc9.jpg?ixlib=rb-1.1.0&rect=7%2C0%2C5024%2C3357&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/male-hands-hold-hand-box-snus-2134161211">Piskova Photo/Shutterstock</a></span></figcaption></figure><p>Flavoured nicotine pouches are <a href="https://www.theguardian.com/australia-news/2024/feb/07/all-good-to-take-to-school-australian-influencers-spruik-flavoured-nicotine-pouches-to-vape-addicted-youths">being promoted to young people</a> on social media platforms such as TikTok and Instagram. </p>
<p>Although some viral videos have been taken down following a series of reports in <a href="https://www.theguardian.com/australia-news/2024/feb/08/albanese-government-condemns-widespread-marketing-of-nicotine-pouches-to-young-people">The Guardian</a>, clips featuring <a href="https://www.tiktok.com/@anabolicgabe/video/7300486987331472641">Australian influencers</a> have claimed nicotine pouches are a safe and effective way to quit vaping. A number of the videos have included links to websites selling these products.</p>
<p>With the rapid rise in youth vaping and the subsequent <a href="https://theconversation.com/from-today-new-regulations-make-it-harder-to-access-vapes-heres-whats-changing-218816">implementation of several reforms</a> to restrict access to vaping products, it’s not entirely surprising the tobacco industry is introducing more products to maintain its future revenue stream.</p>
<p>The major trans-national tobacco companies, including Philip Morris International and British American Tobacco, all manufacture nicotine pouches. British American Tobacco’s brand of nicotine pouches, Velo, is a leading sponsor of the <a href="https://www.formula1.com/en/latest/article.mclaren-new-livery-reveal-2024-f1-season.216OAbbqt6SWUjIio6GLqP.html">McLaren Formula 1 team</a>.</p>
<p>But what are nicotine pouches, and are they even legal in Australia?</p>
<h2>Like snus, but different</h2>
<p>Nicotine pouches are available in many countries around the world, and their sales are <a href="https://iris.who.int/bitstream/handle/10665/372463/9789240079410-eng.pdf?sequence=1">increasing rapidly</a>, especially among <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10203764/">young people</a>.</p>
<p>Nicotine pouches look a bit like small tea bags and are placed between the lip and gum. They’re typically sold in small, colourful tins of about 15 to 20 pouches. While the pouches <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9915420/">don’t contain tobacco</a>, they do contain nicotine that is either extracted from tobacco plants or made synthetically. The pouches come in a wide range of strengths. </p>
<p>As well as nicotine, the pouches commonly contain plant fibres (in place of tobacco, plant fibres serve as a filler and give the pouches shape), sweeteners and flavours. Just like for vaping products, there’s <a href="https://storage.googleapis.com/who-fctc-cop10-source/Supplementary%20information/nicotine_pouch_paper.pdf">a vast array</a> of pouch flavours available including different varieties of fruit, confectionery, spices and drinks.</p>
<p>The range of appealing flavours, as well as the fact they can be used discreetly, may make nicotine pouches particularity attractive to young people.</p>
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<img alt="Two teenage girls vaping on a blanket in a park." src="https://images.theconversation.com/files/576966/original/file-20240221-22-1haedq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/576966/original/file-20240221-22-1haedq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/576966/original/file-20240221-22-1haedq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/576966/original/file-20240221-22-1haedq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/576966/original/file-20240221-22-1haedq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/576966/original/file-20240221-22-1haedq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/576966/original/file-20240221-22-1haedq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Vaping has recently been subject to tighter regulation in Australia.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/vape-lgbt-teenagers-bisexual-lesbian-young-1535887709">Aleksandr Yu/Shutterstock</a></span>
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<p>Users absorb the nicotine in their mouths and simply replace the pouch when all the nicotine has been absorbed. Tobacco-free nicotine pouches are a relatively recent product, but similar style products that do contain tobacco, <a href="https://tobaccotactics.org/article/snus/">known as snus</a>, have been popular in Scandinavian countries, particularly Sweden, for decades.</p>
<p>Snus and nicotine pouches are however different products. And given snus contains tobacco and nicotine pouches don’t, the products are subject to quite different regulations in Australia.</p>
<h2>What does the law say?</h2>
<p>Pouches that contain tobacco, like snus, have been banned in Australia since 1991, as part of a <a href="https://www.productsafety.gov.au/products/health-lifestyle/personal/tobacco-related-products/smokeless-tobacco-products">consumer product ban</a> on all forms of smokeless tobacco products. This means other smokeless tobacco products such as chewing tobacco, snuff, and dissolvable tobacco sticks or tablets, are also banned from sale in Australia.</p>
<p>Tobacco-free nicotine pouches cannot legally be sold by general retailers, like tobacconists and convenience stores, in Australia either. But the reasons for this are more complex.</p>
<p>In Australia, under the <a href="https://www.legislation.gov.au/F2024L00095/latest/downloads">Poisons Standard</a>, nicotine is a prescription-only medicine, with two exceptions. Nicotine can be used in tobacco prepared and packed for smoking, such as cigarettes, roll-your-own tobacco, and cigars, as well as in preparations for therapeutic use as a smoking cessation aid, such as nicotine patches, gum, mouth spray and lozenges.</p>
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Read more:
<a href="https://theconversation.com/from-today-new-regulations-make-it-harder-to-access-vapes-heres-whats-changing-218816">From today, new regulations make it harder to access vapes. Here's what's changing</a>
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<p>If a nicotine-containing product does not meet either of these two exceptions, it cannot be legally sold by general retailers. No nicotine pouches have currently been approved by the <a href="https://www.tga.gov.au/products/unapproved-therapeutic-goods/vaping-hub/nicotine-pouches">Therapeutic Goods Administration</a> as a therapeutic aid in smoking cessation, so in short they’re not legal to sell in Australia.</p>
<p>However, nicotine pouches can be legally imported for personal use only if users have a prescription from a medical professional who can assess if the product is appropriate for individual use.</p>
<p>We only have anecdotal reports of nicotine pouch use, not hard data, as these products are very new in Australia. But we do know authorities are increasingly <a href="https://www.9news.com.au/national/more-than-1-million-in-vapes-nicotine-products-seized-in-raids-across-sydney/e86beb9b-437f-4904-b0cc-d1c46bfb2ef3">seizing these products</a> from retailers. It’s highly unlikely any young people using nicotine pouches are accessing them through legal channels.</p>
<h2>Health concerns</h2>
<p>Nicotine exposure <a href="https://adf.org.au/drug-facts/nicotine/">may induce effects including</a> dizziness, headache, nausea and abdominal cramps, especially among people who don’t normally smoke or vape.</p>
<p>Although we don’t yet have much evidence on the long term health effects of nicotine pouches, we know nicotine is addictive and <a href="https://iris.who.int/bitstream/handle/10665/372463/9789240079410-eng.pdf?sequence=1">harmful to health</a>. For example, it can cause problems in the cardiovascular system (such as heart arrhythmia), particularly at high doses. It may also have negative effects on <a href="https://www.tga.gov.au/products/unapproved-therapeutic-goods/vaping-hub/nicotine-pouches">adolescent brain development</a>.</p>
<p>The nicotine contents of some of the nicotine pouches on the market is alarmingly high. Certain brands offer pouches containing more than <a href="https://truthinitiative.org/research-resources/emerging-tobacco-products/what-zyn-and-what-are-oral-nicotine-pouches">10mg of nicotine</a>, which is similar to a cigarette. According to a World Health Organization (WHO) <a href="https://iris.who.int/bitstream/handle/10665/3724%20yes63/9789240079410-eng.pdf?sequence=1">report</a>, pouches deliver enough nicotine to induce and sustain nicotine addiction.</p>
<p>Pouches are also being marketed as a product to use when it’s not possible to vape or smoke, such as <a href="https://www.velo.com/gb/en/blog/post/flying-with-nicotine-products">on a plane</a>. So instead of helping a person quit they may be used in addition to smoking and vaping. And importantly, there’s <a href="https://factcheck.afp.com/doc.afp.com.34JC8Q2">no clear evidence</a> pouches are an effective smoking or vaping cessation aid.</p>
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<img alt="A Velo product display at Dubai airport in October 2022." src="https://images.theconversation.com/files/575503/original/file-20240214-30-khf94f.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/575503/original/file-20240214-30-khf94f.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/575503/original/file-20240214-30-khf94f.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/575503/original/file-20240214-30-khf94f.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/575503/original/file-20240214-30-khf94f.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/575503/original/file-20240214-30-khf94f.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/575503/original/file-20240214-30-khf94f.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">A Velo product display at Dubai airport in October 2022. Nicotine pouches are marketed as safe to use on planes.</span>
<span class="attribution"><span class="source">Becky Freeman</span></span>
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<p>Further, some nicotine pouches, despite being tobacco-free, still contain <a href="https://tobaccocontrol.bmj.com/content/early/2022/08/05/tc-2022-057280.abstract">tobacco-specific nitrosamines</a>. These compounds can damage DNA, and with long term exposure, can cause cancer. </p>
<p>Overall, there’s limited data on the harms of nicotine pouches because they’ve been on the market for only a short time. But the WHO <a href="https://iris.who.int/bitstream/handle/10665/372463/9789240079410-eng.pdf?sequence=1">recommends a cautious approach</a> given their similarities to smokeless tobacco products.</p>
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Read more:
<a href="https://theconversation.com/the-missing-ingredient-australia-needs-to-kick-its-smoking-addiction-for-good-167973">The missing ingredient Australia needs to kick its smoking addiction for good</a>
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<p>For anyone wanting advice and support to quit smoking or vaping, it’s best to talk to your doctor or pharmacist, or access trusted sources such as <a href="https://www.health.gov.au/contacts/quitline">Quitline</a> or the <a href="https://www.icanquit.com.au/">iCanQuit website</a>.</p><img src="https://counter.theconversation.com/content/223084/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Becky Freeman is an Expert Advisor to the Cancer Council Tobacco Issues Committee and a member of the Cancer Institute Vaping Communications Advisory Panel. These are unpaid roles. She has received relevant competitive grants that include a focus on e-cigarettes/vaping from the NHMRC, MRFF, NSW Health, the Ian Potter Foundation, VicHealth, and Healthway WA; relevant research contracts from the Cancer Institute NSW and the Cancer Council NSW; relevant personal/consulting fees from the World Health Organization, the Hong Kong Special Administrative Region Department of Health, BMJ Tobacco Control, the Heart Foundation NSW, the US FDA, the NHMRC e-cigarette working committee, NSW Health, and Cancer Council NSW; and relevant travel expenses from the Oceania Tobacco Control Conference and the Australia Public Health Association preventive health conference.</span></em></p>Nicotine pouches are placed between the lip and gum, and users absorb the nicotine in their mouths. Although these products don’t contain tobacco, this doesn’t mean they’re safe.Becky Freeman, Associate Professor, School of Public Health, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2119102024-02-13T02:09:32Z2024-02-13T02:09:32ZWhy has it been so difficult to create smoke-free areas in Indonesia? The answer lies in the way laws are made<figure><img src="https://images.theconversation.com/files/568384/original/file-20240109-23-38gv4r.jpg?ixlib=rb-1.1.0&rect=18%2C12%2C4180%2C2921&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Illustration of cigarette ban. </span> <span class="attribution"><a class="source" href="https://www.freepik.com/free-photo/front-view-cigarette-bad-habit-concept_8153684.htm#query=no%20smoking%20area&position=5&from_view=search&track=ais">Freepik</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Indonesia has one of the <a href="https://www.who.int/indonesia/news/detail/30-05-2020-statement-world-no-tobacco-day-2020">highest smoking rates globally</a>. In 2021, the Ministry of Health estimated there are <a href="https://www.badankebijakan.kemkes.go.id/perokok-dewasa-di-indonesia-meningkat-dalam-sepuluh-tahun-terakhir/">69.1 million smokers</a>, the third largest number in the world behind only China and India.</p>
<p>For the past decade, the Indonesian government has introduced policies to try and address this. In 2012, it issued <a href="https://peraturan.bpk.go.id/Details/5324/pp-no-109-tahun-2012">a regulation</a> to reduce smoking rates in the country. This included a mandatory to create smoke-free areas in all local districts. But to enact this, local authorities are required to make laws to set up smoke-free areas.</p>
<p>As of 2018 only <a href="https://pubmed.ncbi.nlm.nih.gov/32317061/">345 out of 514 districts in Indonesia</a> had issued laws on smoke-free areas in 2018. In June 2023, more than ten years after the regulation was issued nationally, <a href="https://sehatnegeriku.kemkes.go.id/baca/umum/20230608/3043211/tahun-2023-seluruh-daerah-ditargetkan-miliki-kawasan-tanpa-rokok/">13% of districts</a> were still yet to create local smoke-free area laws. </p>
<p><a href="https://journals.sagepub.com/doi/10.1177/18681034231185159">Our recent study</a> shows the challenges local governments face translating national laws into local laws as well as the role of local politics.</p>
<h2>Smoke-free area challenges in three provinces</h2>
<p><a href="https://www.who.int/europe/health-topics/tobacco/driving-the-creation-of-smoke-free-public-places#tab=tab_1">Smoke-free areas</a> are public places where smoking is forbidden. Breaking this rule can result in various punishments, including fines or imprisonment, depending on the local regulations.</p>
<p>We analysed smoke-free area regulations in three provinces: Aceh, Malang, East Java and Bandung, West Java, to understand how local contexts influence the trajectory of law-making.</p>
<p>Each site represents a different socio-cultural and political context in Indonesia. </p>
<p>Aceh has <a href="https://www.bps.go.id/indicator/30/1435/1/persentase-merokok-pada-penduduk-umur-15-tahun-menurut-provinsi.html">one of the highest smoking rates in Indonesia</a> and smoking plays an <a href="https://www.insideindonesia.org/forbidden-smoke">important social role</a>. Aceh also has a unique legal system based on Sharia law, requiring laws to have Islamic justifications. </p>
<p>Malang is considered one of the leading “<a href="https://www.researchgate.net/publication/327701629_The_Dynamics_of_Clove_Cigarette_Industrial_Clusters_In_Indonesia">industrial clusters</a>” of cigarette manufacturing in Indonesia. </p>
<p>Bandung is neither a manufacturing hub for the cigarette industry nor part of Indonesia’s tobacco heartland. Still, it did not have a mayor who was very <a href="https://news.detik.com/berita-jawa-barat/d-2877174/ridwan-kamil-bandung-menuju-bebas-reklame-rokok">committed to reducing smoking</a>. </p>
<h2>Local differences</h2>
<p>In all three cases, there was a large gap between when the central government issued the initial national regulation in 2012 and the issuance of local laws. </p>
<p>Malang took six years to enact local regulations for smoke-free areas. At the same time, Aceh and Bandung did not issue these laws until 2021, 11 years after the initial policy was enacted.</p>
<p>Each local government must go through the formal law-making process, which requires time, money and resources to research and draft the law. </p>
<p>We found the main reason for the delay was a lack of local legislative support. Local governments are also required to discuss the proposed laws with relevant stakeholders to ensure the local community’s needs are met.</p>
<p>While some local leaders ardently championed the cause, their ability to influence local parliaments* is limited.</p>
<p>For instance, Bandung’s mayor, Ridwan Kamil, fervently endorsed anti-smoking regulations. He introduced a mayoral decree in 2017 and established a smoke-free area task force. Still, the local parliament was not keen, delaying finalising the law until 2021.</p>
<p>In Aceh, before 2019, there was little discussion of the issue, unsurprising given a considerable proportion of the province’s politicians were smokers.</p>
<p>There were also differences in the way that the laws were justified.</p>
<p>In Aceh, with the legal system based on Sharia Law, legislators had to find religious justifications for the smoke-free areas. Even though they were required to implement the law in accordance with national regulations, politicians still had to provide a religious rationale.</p>
<p>In the end, they settled on the concept of <em>Hibunnas</em>, which states humans are obligated to take care of themselves and remain healthy and capable. Through this, the law was drafted with the underlying view to protect Aceh’s citizens. </p>
<p>Laws in Bandung and Malang did not require any religious justification.</p>
<p>The case studies also suggested industry interests were also at play. For example, the drafting process in Malang was opaque, pandering to tobacco company interests and excluding stakeholders representing tobacco control concerns.</p>
<h2>Political dynamics and patchwork laws</h2>
<p>Our study also showed how making local laws is intertwined with local political dynamics. The commitment of local government politicians is crucial for steering the trajectory of regulations, often shaping the pace and nature of their inception. </p>
<p>Elections often serve as a turning point, altering the course of legislative trajectories. The 2014 national elections shifted the narrative in Malang with the rise of political parties more supportive of smoke-free areas. </p>
<p>Similar patterns were observable in Bandung and Aceh following the 2019 national elections. The election result shifted the composition of the local government towards political parties that were more pro-tobacco control.</p>
<p>Activists and bureaucrats also played a crucial role in passing smoke-free area regulations by keeping the issue on the political agenda in regions. </p>
<p>Health authorities also kept nudging local politicians to do their jobs. For example, in Malang, the municipal health office formally appealed to the local parliament, advocating for the creation of laws. </p>
<p>In Bandung, a collaboration between regional health office personnel and academics led to drafting a comprehensive law proposal. </p>
<p>In Aceh, a medical doctor, the head of the smoke-free area task force, was pivotal in pushing for the required smoke-free area laws.</p>
<h2>What’s next?</h2>
<p>Local law-making is complex due to the legacy of political decisions made decades ago, perhaps without a complete understanding of the consequences of deregulation. </p>
<p>Our study highlights the cumbersome process of law creation. Giving local politicians responsibility for creating local laws based on pre-existing national regulations creates multiple issues, especially if they do not see it as a priority. </p>
<p>The system could be more efficient. Taking steps to delineate which laws require local consideration and which can simply be enacted nationally would save time and resources, creating more consistency across Indonesia.</p><img src="https://counter.theconversation.com/content/211910/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Elisabeth Kramer receives funding from Sydney Southeast Asia Centre (SSEAC) at University of Sydney for conducting this research.</span></em></p><p class="fine-print"><em><span>Anastasia Maria Sri Redjeki, Eni Maryani, Lestari Nurhajati, Masduki, dan Rizanna Rosemary tidak bekerja, menjadi konsultan, memiliki saham, atau menerima dana dari perusahaan atau organisasi mana pun yang akan mengambil untung dari artikel ini, dan telah mengungkapkan bahwa ia tidak memiliki afiliasi selain yang telah disebut di atas.</span></em></p>Our recent study shows that the creation of local smoke-free areas has faced numerous challenges due to the complexities involved in translating national laws into local laws.Elisabeth Kramer, Scientia Senior Lecturer in Politics and Public Policy, UNSW SydneyAnastasia Maria Sri Redjeki, Dosen, London School of Public Relation (LSPR) JakartaEni Maryani, Dr/Head of Centre for Study of Communication, Media and Culture, Universitas PadjadjaranLestari Nurhajati, Dosen dan Peneliti Kajian Media, London School of Public Relation (LSPR) JakartaMasduki, Pengajar dan Peneliti Kebijakan Media di Program Studi Ilmu Komunikasi, Universitas Islam Indonesia (UII) YogyakartaRizanna Rosemary, PhD Candidate, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2230042024-02-11T19:07:40Z2024-02-11T19:07:40ZHILDA survey at a glance: 7 charts reveal we’re smoking less, taking more drugs and still binge drinking<p>Australians’ vices, including drinking, smoking and illicit drugs, have been revealed in the latest <a href="https://melbourneinstitute.unimelb.edu.au/hilda/publications/hilda-statistical-reports">HILDA survey</a>.</p>
<p>The <a href="https://melbourneinstitute.unimelb.edu.au/hilda">Household, Income and Labour Dynamics in Australia survey tracks</a> the same 17,000 Australians each year, with participants followed over the course of their lifetime. The survey collects information on many facets of life and is the only study of its kind in Australia.</p>
<h2>Smoking is declining, but young people are more likely to vape</h2>
<p>There has been substantial progress in reducing smoking rates since 2001, when 25% of males and 20% of females aged 15 and over reported being smokers. In 2021, these rates had dropped to 16% for males and 12% for females. This likely reflects the effects of tobacco control measures, as well as increased public awareness of the harmful health effects of smoking.</p>
<p>Declines have been biggest for young people, which reflects the fact that it is easier to prevent the take-up of smoking than it is to get smokers to quit. Indeed, HILDA shows that over 60% of people who quit smoking take it up again within three years.</p>
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<p>The progress on reducing smoking appears to have been somewhat offset by the rise in vaping or using e-cigarettes. In 2021, 14.1% of people aged 15 and over reported having tried vaping, and 16% of these people vaped daily.</p>
<p>Vaping is very much a young person’s activity. It is most common among people aged 15 to 24, and also relatively common among people aged 25 to 29. Many people who report vaping also report being smokers.</p>
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<h2>Binge drinking remains common, especially for young men</h2>
<p>Risky drinking, here defined as usually consuming five or more standard drinks on each occasion, is relatively common, applying to over 20% of males and about 10% of females who ever drink alcohol. </p>
<p>After rising slightly between 2003 and 2009, there has since been a small decline in this measure of risky drinking for males. There has been little change in this measure for females. </p>
<p>Another measure of risky drinking, presented in the figure, is “excessive binge drinking”, defined as drinking at least five (if female) or seven (if male) drinks per occasion at least twice per month. This measure of risky drinking is more prevalent, but it has declined for both males and females since 2007.</p>
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<p>Risky drinking is most common among men aged 20 to 24, followed by men aged 25 to 29. However, for both males and females, <em>regular</em> (but not necessarily “risky”) consumption of alcohol (drinking on five or more days per week) is more common in older age groups, and highest among people aged 60 and over.</p>
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<hr>
<h2>30 to 34 year-olds had the largest increase in using drugs</h2>
<p>The HILDA survey shows use of illicit drugs, such as marijuana, methamphetamine and cocaine, increased between 2017 and 2021, with annual use increasing from 15.7% to 17.6% for males and from 8.6% to 11% for females.</p>
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<p>People aged 20 to 24 are the most likely to use illicit drugs, but the increase in use was greatest for people aged 30 to 34.</p>
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<p>The use of multiple types of illicit drugs, known as polydrug use, is common for users of methamphetamine, cocaine and ecstasy, but much less common for users of marijuana.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/hilda-data-show-womens-job-prospects-improving-relative-to-mens-and-the-covid-changes-might-have-helped-222897">HILDA data show women's job prospects improving relative to men's, and the COVID changes might have helped</a>
</strong>
</em>
</p>
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<img src="https://counter.theconversation.com/content/223004/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Roger Wilkins receives funding from the Australian Research Council.</span></em></p>Some 17,000 people told us exactly how much they drank, smoked and used illicit drugs. Here’s a unique snapshot of Australians’ vices.Roger Wilkins, Professorial Fellow and Deputy Director (Research), HILDA Survey, Melbourne Institute of Applied Economic and Social Research, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2218172024-02-06T12:29:36Z2024-02-06T12:29:36ZIs your pet exposed to secondhand smoke? Here are the (serious) health risks<figure><img src="https://images.theconversation.com/files/573211/original/file-20240203-21-iufaha.jpg?ixlib=rb-1.1.0&rect=24%2C32%2C5439%2C3604&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.gettyimages.co.uk/detail/news-photo/man-relaxes-at-home-with-his-dog-december-5-2022-in-news-photo/1447421907?adppopup=true">Andrew Lichtenstein/Corbis via Getty Images</a></span></figcaption></figure><p>Our pets share our homes, lifestyles, and sometimes even our food <a href="https://theconversation.com/there-are-benefits-to-sharing-a-bed-with-your-pet-as-long-as-youre-scrupulously-clean-221536">and beds</a>. For many pets, this close contact with humans can include exposure to secondhand smoke from cigarettes and other air pollutants. This may have <a href="https://www.bbc.co.uk/news/uk-scotland-glasgow-west-61865311">serious health consequences</a> for our animal companions.</p>
<p>So, how significant a risk is passive smoking for our pets and should we be concerned?</p>
<p>Smoking is well understood to come with negative health outcomes for people. Between <a href="https://www.nature.com/articles/nrc2190">80 and 90%</a> of lung cancer cases are associated with exposure to cancer-causing componds from first-or second-hand smoking.</p>
<p>Passive smoking is also linked increased risks of other forms of cancer including <a href="https://link.springer.com/article/10.1007/s10549-015-3628-4">breast</a> and <a href="https://doi.org/10.1177/1010539516650724">colorectal cancer</a>, <a href="https://pubs.acs.org/doi/10.1021/acs.est.2c00991">heart</a> and <a href="https://www.ingentaconnect.com/content/iuatld/ijtld/2004/00000008/00000005/art00002;jsessionid=1k6bnal73xupb.x-ic-live-03">respiratory disease</a>. </p>
<p>Children’s <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8060945/">oral health</a>, <a href="https://journals.lww.com/co-pediatrics/abstract/2017/04000/tobacco,_e_cigarettes,_and_child_health.16.aspx">development, and future health outcomes</a> are also negatively affected by exposure to secondhand smoke.</p>
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<p>More than 50% of bladder cancer cases in humans are <a href="https://www.mdpi.com/2076-3271/8/1/15">attributed to cigarette smoking</a>, making exposure a significant risk factor. The recent identification of passive smoking associated with <a href="https://www.sciencedirect.com/science/article/pii/S1090023323000953">dogs developing bladder cancer</a> highlights the potentially serious health consequences of secondhand smoke for our furry friends too.</p>
<h2>Canine cancer risk</h2>
<p>Cancer is commonly <a href="https://academic.oup.com/aje/article-abstract/135/3/234/97261?redirectedFrom=fulltext&login=false">diagnosed in dogs</a> and is a significant cause of death. While many factors may predispose a pet to <a href="https://www.frontiersin.org/articles/10.3389/fvets.2022.1004122/full#B26">developing cancer</a>, evidence suggests that passive smoking is a key risk.</p>
<p>Scottish terriers living in homes where they were exposed to cigarette smoke were <a href="https://www.sciencedirect.com/science/article/pii/S1090023323000953">six times more likely</a> to develop bladder cancer than those not routinely exposed.</p>
<p>Nasal cancer in dogs is also <a href="https://academic.oup.com/aje/article/147/5/488/158913?login=false">linked to passive smoking</a>, and is a particular problem for dogs with long muzzles, such as collies. This is compared to a <a href="https://academic.oup.com/aje/article/147/5/488/158913?login=false">lower incidence of nasal cancer</a>, but <a href="https://academic.oup.com/aje/article-abstract/135/3/234/97261?redirectedFrom=fulltext&login=false">higher risk of lung cancer</a> in brachycephalic, or short-nosed breeds such as pugs.</p>
<p>The difference in cancer type might be linked to how dogs are exposed to the many toxic compounds found in cigarette smoke. In dogs with longer noses, more of these compounds will potentially become <a href="https://vcahospitals.com/know-your-pet/the-effects-of-second-hand-smoke-on-pets">trapped in their nasal tissues</a>. Conversely, dogs with short snouts may be more likely to <a href="https://academic.oup.com/aje/article-abstract/135/3/234/97261?redirectedFrom=fulltext&login=false">inhale these compounds</a> into their lungs.</p>
<h2>Not just dogs</h2>
<p>All domestic pets living in the home are potentially at risk from exposure to secondhand smoke. This includes dogs, cats, birds, small pets such as rabbits and guinea pigs and even fish.</p>
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<p>Cats exposed to passive smoking have an increased incidence of <a href="https://academic.oup.com/aje/article/156/3/268/71617">malignant lymphoma</a>. Nicotine concentrations <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/jsap.12616">are higher</a> in the hair of cats living with smokers than non-smokers. Similar findings have been found for <a href="https://bvajournals.onlinelibrary.wiley.com/doi/epdf/10.1136/vr.f2468?saml_referrer">dogs living with smokers</a>, regardless of whether pet owners smoked inside or outside.</p>
<p>Because cats tend to self-groom by licking, they may be at particular risk of <a href="https://vcahospitals.com/know-your-pet/the-effects-of-second-hand-smoke-on-pets">ingesting even more toxic substances</a> from passive smoking than simply inhaling them.</p>
<p>Birds have <a href="https://www.smithsonianmag.com/smart-news/story-real-canary-coal-mine-180961570/">particularly sensitive</a> respiratory systems and exposure to smoke and air pollutants can be extremely distressing and harmful – think about canaries in mines. Indeed, our pets may well act as <a href="https://www.mdpi.com/2076-2615/13/18/2923#B99-animals-13-02923">useful sentinels</a> for air pollution more generally.</p>
<p>Toxic compounds found in cigarette smoke can also <a href="https://www.pdsa.org.uk/pet-help-and-advice/looking-after-your-pet/all-pets/passive-smoking-and-our-pets">dissolve into the water</a> in fish tanks, creating risks for the health and welfare of fish or amphibious pets, too.</p>
<h2>Minimising hazards for health</h2>
<p>Passive smoking alone is not responsible for health concerns in people and pets. <a href="https://onlinelibrary.wiley.com/doi/10.1111/vco.12186">Genetics</a>, <a href="https://avmajournals.avma.org/view/journals/javma/227/1/javma.2005.227.94.xml">diet</a> and <a href="https://avmajournals.avma.org/view/journals/javma/224/8/javma.2004.224.1290.xml">exposure to other potentially toxic substances</a> in the environment all combine to affect overall disease susceptibility.</p>
<p>But evidence repeatedly indicates more than just a casual link between <a href="https://www.bbc.co.uk/news/uk-41748090">secondhand smoke exposure</a> and serious health concerns in our pets such as <a href="https://academic.oup.com/aje/article-abstract/135/3/234/97261?redirectedFrom=fulltext&login=false">cancer</a> and <a href="https://vcahospitals.com/know-your-pet/the-effects-of-second-hand-smoke-on-pets">respiratory illnesses</a>.</p>
<p>Owners concerned about the wellbeing of their pet may be encouraged to be more <a href="https://www.asthmaandlung.org.uk/living-with/indoor-air-pollution/improving">aware of air quality</a> in their home generally and make appropriate lifestyle changes. </p>
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<p>Choosing to <a href="https://www.nhsinform.scot/healthy-living/stopping-smoking/reasons-to-stop/dangers-of-second-hand-smoke">smoke outdoors</a> can reduce some risk. Opening windows, improving ventilation and using air filters may help too, although it is important to note that even low level exposure <a href="https://vcahospitals.com/know-your-pet/the-effects-of-second-hand-smoke-on-pets">can be harmful</a> to our furry and feathered friends.</p>
<p>Indeed, awareness raising and education about the dangers of pet exposure to secondhand smoke could be an <a href="https://doi.org/10.1136/tc.2008.028282">important motivator for smoking cessation</a>. </p>
<p>Exposure to secondhand smoke is a common but avoidable risk factor for health concerns in pets and people alike. Reducing exposure to secondhand smoke, can enhance overall health, welfare and longevity for both pets and their people.</p><img src="https://counter.theconversation.com/content/221817/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jacqueline Boyd is affiliated with The Kennel Club (UK) through membership, as Chair of the Activities Health and Welfare Subgroup and member of the Dog Health Group. Jacqueline is a full member of the Association of Pet Dog Trainers (APDT #01583) and she also writes, consults and coaches on canine matters on an independent basis, in addition to her academic affiliation at Nottingham Trent University.</span></em></p>The dangers of passive smoking for humans may be well-known but second – and even third-hand – smoke is also hazardous to our pets. Here’s what you need to know.Jacqueline Boyd, Senior Lecturer in Animal Science, Nottingham Trent UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2222702024-01-31T19:07:29Z2024-01-31T19:07:29ZDon’t lower the price: 3 more effective ways to reduce the costs of smoking<p>Associate Health Minister <a href="https://www.dpmc.govt.nz/cabinet/portfolios/health">Casey Costello</a> recently said she was concerned about the <a href="https://www.nzherald.co.nz/nz/politics/official-documents-suggest-nz-first-minister-wants-to-freeze-excise-tax-on-cigarettes-but-she-denies-it/D5ZIEESDCFF65I7GS5L4H2FCRA/">financial burden on people who smoke</a>. She has requested advice on freezing the Consumers Price Index (CPI) adjustment applied annually to tobacco products, according to a leaked Ministry of Health document. </p>
<p>But is this really the best option to reduce the cost of smoking?</p>
<p>Costello’s proposal attracted considerable criticism, not least because the rising price of tobacco is well established as the <a href="https://www.who.int/activities/raising-taxes-on-tobacco">most effective tool</a> currently used to reduce tobacco use. </p>
<p>An <a href="https://www.health.govt.nz/system/files/documents/pages/evaluation-tobacco-excise-increases-final-27-nov2018.pdf">Ernst Young report</a> commissioned by the Ministry of Health found: </p>
<blockquote>
<p>There is strong evidence, both international and from within New Zealand, that demonstrates changes in consumer behaviour as a result of the tax increases –reducing uptake, cutting down consumption and increasing quit attempts, with spikes in quit attempts around January each year in New Zealand. </p>
</blockquote>
<p>The minister is right to be concerned about people who smoke and the enormous drain smoking imposes on their health, wellbeing and finances. But freezing the excise tax on tobacco products won’t ease those costs. </p>
<p>If the minister is serious about reducing the financial and other costs of smoking, here are three tips that will help her achieve her goal. </p>
<h2>Leave the CPI adjustment alone</h2>
<p>For people who smoke a pack a day, freezing the CPI adjustment means they will save around NZ$12 a week or $730 a year. </p>
<p>But if those people quit smoking, they would save $35-$50 a day, or around $13,000 to $15,000 each year. The most important thing that will ease the financial cost for people who smoke is to help them stop smoking – freezing the tobacco excise tax will actually make quitting less likely.</p>
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<h2>Examine what makes it so hard to quit</h2>
<p>We know most people who smoke regret having started and want to quit. <a href="https://aspireaotearoa.org.nz/sites/default/files/2023-12/ITC%20Adult%20NZ%20Report-Dec%2010%202023.pdf">Our study</a> of more than a thousand people who smoke found 74% regret having started, 84% would like to stop smoking, and 81% have tried to stop smoking. </p>
<p>Given this very strong desire not to smoke, what’s preventing people from realising their goal? The answer is simple: addiction. Nearly 90% of people who smoke said they are somewhat or very addicted to smoking.</p>
<p>Tobacco companies have manipulated cigarette nicotine content and the speed with which nicotine is delivered to <a href="https://truthinitiative.org/research-resources/harmful-effects-tobacco/how-big-tobacco-made-cigarettes-more-addictive#:%7E:text=Sugars%252C%2520flavors%2520and%2520menthol%2520were,importance%2520to%2520tobacco%2520company%2520executives.">make smoking highly addictive</a>. However, it’s now possible to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632983/">remove most of the nicotine</a> from tobacco.</p>
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Read more:
<a href="https://theconversation.com/forget-tobacco-industry-arguments-about-choice-heres-what-young-people-think-about-nzs-smokefree-generation-policy-193529">Forget tobacco industry arguments about choice. Here's what young people think about NZ's smokefree generation policy</a>
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<p><a href="https://www.nejm.org/doi/pdf/10.1056/NEJMsa1502403">Research</a> shows people who smoke very low-nicotine cigarettes cannot smoke enough to get a satisfying dose of nicotine, so they lose interest in smoking and smoke fewer cigarettes. </p>
<p>A <a href="https://www.sciencedirect.com/science/article/pii/S0955395921003418">recent review</a> found low-nicotine cigarettes increased the likelihood of smoking cessation among all population groups. This includes people with psychiatric comorbidities or low socioeconomic status – the group Minister Costello is particularly keen to assist. It will also minimise the likelihood of young people starting smoking.</p>
<p>Aotearoa New Zealand is ready to implement denicotinisation (reducing the levels of nicotine in tobacco products). A <a href="https://tobaccocontrol.bmj.com/content/tobaccocontrol/early/2023/01/10/tc-2022-057655.full.pdf">modelling study</a> predicted this move would bring profound, rapid and equitable reductions in smoking prevalence. However, the new government has announced plans to <a href="https://theconversation.com/reducing-nicotine-in-tobacco-would-help-people-quit-without-prohibiting-cigarettes-221383">repeal the smokefree law</a> that mandated denicotinisation.</p>
<h2>Use tax revenue for community support</h2>
<p>Because smoking is a <a href="https://www.tandfonline.com/doi/pdf/10.1080/09581596.2014.980396">social practice</a>, many people may find quitting support helpful, even when only low-nicotine cigarettes are available. </p>
<p>Minister Costello has an opportunity to use the tax revenue generated by tobacco sales to support smoking cessation. For example, allocating funds generated by tobacco sales would enable her to increase funding for services that support people who smoke to quit. </p>
<p>Additional targeted support could be particularly helpful to groups that bear a disproportionate portion of the harms caused by smoking.</p>
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Read more:
<a href="https://theconversation.com/no-doubt-about-it-smokefree-laws-cut-heart-attacks-in-big-way-73724">No doubt about it: smokefree laws cut heart attacks in big way</a>
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<p>Community support has a crucial role to play, as people with local knowledge understand the needs of fellow community members and can respond with tailored advice.</p>
<p>The minister doesn’t have to reinvent the wheel or replace the current evidence-based approach. Several measures that would minimise the enormous burden smoking imposes on thousands of people are ready for implementation – starting with the <a href="https://www.health.govt.nz/system/files/documents/publications/hp7801_-_smoke_free_action_plan_v15_web.pdf">Smokefree Aotearoa 2025 Action Plan</a>. </p>
<p>The government should also abandon its plans to repeal New Zealand’s smokefree legislation. The measures this law introduces could profoundly reduce the many costs smoking imposes on those who do it. Furthermore, it would benefit the very people whose plight troubles the minister.</p><img src="https://counter.theconversation.com/content/222270/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Janet Hoek currently receives research funding from the Health Research Council of New Zealand, the Cancer Society of New Zealand, the University of Queensland (Australia) and the National Health and Medical Research Council (Australia). Her affiliations include the Society for Nicotine and Tobacco Research, Health Coalition Aotearoa's Smokefree Expert Advisory Group, Aukati Tupeka Kore Group, Project Sunset (International and Oceania), the Australian Government Department of Health and Aged Care, the NZ Cancer Society Research Collaboration, and the Australasian Tobacco Issues Group.</span></em></p><p class="fine-print"><em><span>Andrew Waa receives funding from the Health Research Coincil of New Zealand. He is a member of the Health Coalition Aotearoa and a member of Te Ropu Tupeka Kore. </span></em></p><p class="fine-print"><em><span>Richard Edwards receives research funding from the Health Research Council of New Zealand, the Cancer Society of New Zealand, the University of Queensland (Australia) and the National Institute of Health (US). His affiliations include the Society for Nicotine and Tobacco Research, the Public Health Communication Centre Briefing, Smokefree Expert Advisory Group, Health Coalition Aotearoa and the National Tobacco Control Advocacy Service Advisory Group.</span></em></p>If the government is serious about reducing the cost of smoking, it should stick with Labour’s smokefree legislation rather than freezing the price of smoked tobacco products.Janet Hoek, Professor of Public Health, University of OtagoAndrew Waa, Lecturer in Public Health, University of OtagoRichard Edwards, Professor of Public Health, University of OtagoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2213832024-01-18T03:35:54Z2024-01-18T03:35:54ZReducing nicotine in tobacco would help people quit – without prohibiting cigarettes<p>Supporters of the <a href="https://www.nzherald.co.nz/nz/politics-changes-to-smoking-vaping-laws-planned-under-coalition-government/7RQTSDKY3VFJDKEA47ZEQ54RQU/">new government’s plan to repeal Aotearoa New Zealand’s smokefree legislation</a> have claimed <a href="https://www.nzinitiative.org.nz/reports-and-media/opinion/nipping-tobacco-prohibition-in-the-bud/">victory against “prohibition”</a>. </p>
<p>Introduced under Jacinda Ardern’s government, the <a href="https://legislation.govt.nz/bill/government/2022/0143/latest/whole.html">smokefree law</a> came into effect in January 2023 and included a commitment to introduce mandated “denicotinisation” (cutting the nicotine to levels that are no longer addictive) of smoked tobacco products. </p>
<p>Studies estimated this measure would have <a href="https://tobaccocontrol.bmj.com/content/tobaccocontrol/early/2023/01/10/tc-2022-057655.full.pdf?with-ds=yes">greatly reduced</a> smoking and helped prevent avoidable death and suffering. </p>
<p>However, opponents, notably the tobacco industry and its allies, criticised the measure as “prohibition”.</p>
<p>In a <a href="https://bills.parliament.nz/v/6/cad89158-461d-4392-aad3-e499142a0114?">submission to the select committee</a> on the smokefree legislation, Imperial Tobacco claimed</p>
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<p>Mandating very low nicotine levels is equivalent to prohibiting the regular cigarettes currently consumed by millions of adult smokers.</p>
</blockquote>
<p>In its submission, Japan Tobacco International wrote</p>
<blockquote>
<p>The nicotine reduction policy is a de facto prohibition on conventional cigarettes and will have dire consequences.</p>
</blockquote>
<p>But are the tobacco industry’s claims really true? And why has the current Health Minister gone from supporting denicotinisation to being set to repeal it?</p>
<h2>Misunderstanding prohibition</h2>
<p>When commentators label a public health measure as “prohibition”, they usually draw a comparison with <a href="https://www.pbs.org/kenburns/prohibition/unintended-consequences">alcohol prohibition in the United States</a> in the 1920s and 1930s. A statement that “prohibition never works” typically follows. </p>
<p>Yet, these arguments fail on at least three grounds. </p>
<p>First, they imply prohibition is never justified and fail to mention other highly successful “prohibitions”, such as the elimination of asbestos, leaded paint and petrol, or chlorofluorocarbons in aerosols. Or water quality standards prohibiting hazardous drinking water or car safety requirements prohibiting unsafe cars.</p>
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Read more:
<a href="https://theconversation.com/smoke-and-mirrors-why-claims-that-nzs-smokefree-policy-could-fuel-an-illicit-tobacco-trade-dont-stack-up-191753">Smoke and mirrors: why claims that NZ’s smokefree policy could fuel an illicit tobacco trade don’t stack up</a>
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<p>Second, they offer only a simplistic interpretation of the experience of the American prohibition era. Although not without its problems, it did <a href="https://theconversation.com/legalizing-once-illicit-substances-can-have-a-public-health-impact-108580">substantially reduce alcohol consumption</a> and have positive impacts on population health.</p>
<p>Third, denicotinisation of cigarettes and tobacco is very different from alcohol prohibition in the US in the 1920s. Claiming “prohibition never works” based on that single experience a century ago is vacuous and wrong. Denicotinisation applies to a different product, in a different setting, and in a different time.</p>
<p>More fundamentally, denicotinisation of cigarettes and tobacco is not a prohibition. </p>
<p>Prohibition requires that something is prohibited. So what is that something under the smokefree law? </p>
<p>Not cigarettes, as tobacco products would still be available to people who wish to buy and use them, but they would no longer contain sufficient nicotine to be addictive. Nor is it banning nicotine; anyone walking down a street in any town or city centre in Aotearoa will see numerous specialist vape stores and other retailers selling nicotine-containing vapes.</p>
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<h2>Harm reduction, not prohibition</h2>
<p>So if denicotinisation is not prohibition, what is it? And is it a good idea? </p>
<p>Denicotinisation is a form of harm reduction. Although denicotinised cigarettes would still create harmful toxins when smoked, they would cause less overall harm because they are no longer addictive and people would stop using them. </p>
<p><a href="https://www.phcc.org.nz/briefing/removing-nicotine-tobacco-key-component-current-smokefree-bill">Research</a> found participants given denicotinised cigarettes smoked less and were more likely to quit smoking, because they found the cigarettes unrewarding and less appealing to smoke. </p>
<p>People who cannot stop using nicotine products completely would be encouraged to switch to less harmful products, such as vaping, which would still deliver nicotine. </p>
<p><a href="https://aspireaotearoa.org.nz/sites/default/files/2023-12/ITC%20Adult%20NZ%20Report-Dec%2010%202023.pdf">Our own research</a> showed a strong majority of people who smoke in New Zealand regret starting, wanted to quit, and have tried to quit. However, almost nine out of ten felt addicted to smoking. </p>
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Read more:
<a href="https://theconversation.com/how-raising-tobacco-taxes-can-save-lives-and-cut-poverty-across-the-asia-pacific-197912">How raising tobacco taxes can save lives and cut poverty across the Asia-Pacific</a>
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<p>Removing the nicotine from cigarettes and tobacco would liberate people from that addiction. Almost half of our study respondents anticipated that if tobacco products were denicotinised they would reduce the number of cigarettes they smoked, would stop smoking, or switch to alternative products like e-cigarettes.</p>
<p>For ethical reasons, there are no trials giving young people denicotinised cigarettes. However, logic suggests adolescents and youth would be less inclined to try cigarettes with minimal nicotine content, and even if they did, they would be very unlikely to become addicted and continue to smoke long-term.</p>
<p>Denicotinisation is therefore not, as it is often portrayed, a constraint on freedom. It would enhance freedom. It would help liberate people who smoke from the grip of cigarettes and protect future generations from the risk of lifelong addiction and the terrible health effects that so often follow.</p>
<h2>A question of life and death</h2>
<p><a href="https://tobaccocontrol.bmj.com/content/tobaccocontrol/early/2023/01/10/tc-2022-057655.full.pdf?with-ds=yes">Modelling studies</a> suggest denicotinisation would rapidly and equitably reduce smoking and smoking related disease, preventing 7570 deaths from 2020–2040 in Aotearoa, including 4260 Māori deaths. </p>
<p>While he was still in opposition, the current Health Minister Shane Reti acknowledged denicotinisation as a powerful measure that would do most of the “heavy lifting” to reduce smoking. </p>
<p>During the debates on the smokefree law, Reti strongly <a href="https://www.parliament.nz/en/pb/hansard-debates/rhr/combined/HansDeb_20221213_20221213_24">supported denicotinisation</a> and submitted a Supplementary Order Paper to the <a href="https://legislation.govt.nz/bill/government/2022/0143/latest/whole.html">Smokefree Environments and Regulated Products (Smoked Tobacco) Amendment Act</a>, arguing it should be the first measure implemented. </p>
<p>Reti has since abandoned this position to support the <a href="https://www.phcc.org.nz/briefing/stubbing-out-democracy-no-government-mandate-smokefree-repeal">coalition government’s repeal</a>. </p>
<p>The government seems unaware of, or is ignoring, the research evidence and the very strong support for denicotinisation among the <a href="https://www.healthcoalition.org.nz/wp-content/uploads/2023/12/Smokefree-survey-results-Dec-23.pdf">general population</a> and among <a href="https://www.phcc.org.nz/briefing/young-new-zealanders-want-tobacco-free-future-new-research">youth and young adults</a>. </p>
<p>Numerous surveys <a href="https://tobaccocontrol.bmj.com/content/early/2023/12/07/tc-2023-058128">from around the world</a>, including <a href="https://aspireaotearoa.org.nz/sites/default/files/2023-12/ITC%2520Adult%2520NZ%2520Report-Dec%252010%25202023.pdf">our studies in Aotearoa</a>, have found most people who smoke (or who have recently quit) strongly support denicotinisation.</p>
<p>Almost the only groups that don’t support this measure are the tobacco industry and their apologists. Formerly secret internal tobacco company files reveal the reason for their opposition. A 1959 <a href="https://publichealthlawcenter.org/sites/default/files/resources/tclc-verdict-addiction.pdf">British American Tobacco document explained</a> </p>
<blockquote>
<p>To lower nicotine too much might end up destroying the nicotine habit in a large number of consumers and prevent it ever being acquired by new smokers.</p>
</blockquote>
<p>The New Zealand government should reverse its decision to repeal the smokefree legislation. Doing so will reassert themselves as ethical and principled leaders, whose evidence-based decisions will enhance individual New Zealanders’ freedom and health.</p><img src="https://counter.theconversation.com/content/221383/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Richard Edwards receives research funding from the Health Research Council of New Zealand, the Cancer Society of New Zealand, the University of Queensland (Australia) and the National Institute of Health (US). His affiliations include the Society for Nicotine and Tobacco Research, the Public Health Communication Centre Briefing, Smokefree Expert Advisory Group, Health Coalition Aotearoa and the National Tobacco Control Advocacy Service Advisory Group.</span></em></p><p class="fine-print"><em><span>Janet Hoek currently receives research funding from the Health Research Council of New Zealand, the Cancer Society of New Zealand, the University of Queensland (Australia) and the National Health and Medical Research Council (Australia). Her affiliations include the Society for Nicotine and Tobacco Research, Health Coalition Aotearoa's Smokefree Expert Advisory Group, Aukati Tupeka Kore Group, Project Sunset (International and Oceania), the Australian Government Department of Health and Aged Care, the NZ Cancer Society Research Collaboration, and the Australasian Tobacco Issues Group.</span></em></p>Research shows many smokers regret starting the habit. So why are we repealing the law that would have made smoked tobacco products less addictive?Richard Edwards, Professor of Public Health, University of OtagoJanet Hoek, Professor of Public Health, University of OtagoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2199222023-12-29T11:43:49Z2023-12-29T11:43:49ZYoung people took up smoking during the pandemic – how tobacco has been used for stress relief for more than a century<figure><img src="https://images.theconversation.com/files/567147/original/file-20231221-19-yqrw02.jpg?ixlib=rb-1.1.0&rect=125%2C62%2C5847%2C3844&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-people-smoking-outdoors-sitting-on-1571491495">Lomb/Shutterstock</a></span></figcaption></figure><p>In the UK and much of the west, smoking rates have consistently declined since <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/drugusealcoholandsmoking/bulletins/smokingprevalenceintheukandtheimpactofdatacollectionchanges/latest">the turn of the millennium</a>. But during some of the most anxiety-ridden months of the COVID pandemic in early 2020, that rate of decline slowed almost to a stop. </p>
<p>What’s more, despite a rise in the rate of people trying to quit, there was a curious increase in the number of young people (aged 18 to 24) <a href="https://www.bbc.co.uk/news/health-67703066">smoking for the first time</a>. </p>
<p>A recent study <a href="https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-023-03157-2">suggests</a> that the social disruption, boredom and stress brought about by the pandemic may have contributed to a rise in young people taking up smoking.</p>
<p>As a historian of wartime endurance and resilience in modern Britain, I’ve been studying tobacco use from the 1850s to the 1950s. I try to understand why smoking was so central to everyday life during particularly stressful times, like the armed conflicts of the period. Indeed, there has long been a link made between smoking and stress relief.</p>
<h2>Smoking as stress relief</h2>
<p>Many Victorian and Edwardian writers, including notable doctors and surgeons, showed a keen interest in tobacco. For some, it was the drug of modernity, as its soothing effects (caused by nicotine) were the ideal antidote to the <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(02)20279-2/fulltext">stress and tension</a> that came with the machine age. </p>
<p>The invention of new technology such as the telegraph and railways made life more fast-paced and stressful. As early as the late 1850s, some <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(02)20283-4/fulltext">doctors claimed</a> that people could fall prey to overexcited “nerves” (a common shorthand for the effects of stress that we still use today) if they did not find a calming intoxicant. </p>
<p>From the 1880s, cigarettes were mass produced, reaching more consumers than ever before. Many working-class men switched from the pipe to the cigarette, which was seen as a more practical accompaniment to modern life. It was also cheap: a pack could be picked up and smoked without any prior preparation, for no more than a few pence. </p>
<p>At the turn of the 20th century, even medical journal The Lancet <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(01)85017-0/fulltext">suggested</a> that smoking could ease the “restlessness and irritability” that accompanied urban life. Such an endorsement helped tobacco manufacturers and retailers sell their wares. </p>
<p>But crisis and war have always provided the biggest boost to tobacco use. The onset of the first world war in 1914 ensured the supremacy of the cigarette in Britain. By Christmas 1914, <a href="https://militaryhealth.bmj.com/content/160/Suppl_1/i57">more than 96% of British soldiers were smokers</a>, and both the government and civilians at home sent, literally, tonnes of tobacco to the front.</p>
<figure class="align-center ">
<img alt="Black and white photo of three soldiers in heavy sheepskin coats and helmets, smoking cigarettes" src="https://images.theconversation.com/files/566360/original/file-20231218-19-nbaryq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/566360/original/file-20231218-19-nbaryq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=428&fit=crop&dpr=1 600w, https://images.theconversation.com/files/566360/original/file-20231218-19-nbaryq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=428&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/566360/original/file-20231218-19-nbaryq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=428&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/566360/original/file-20231218-19-nbaryq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=537&fit=crop&dpr=1 754w, https://images.theconversation.com/files/566360/original/file-20231218-19-nbaryq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=537&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/566360/original/file-20231218-19-nbaryq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=537&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">British soldiers take a smoking break on the western front during the first world war.</span>
<span class="attribution"><a class="source" href="https://collection.nam.ac.uk/detail.php?acc=1995-03-88-7">National Army Museum</a></span>
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<p>Cigarettes didn’t just ease the boredom of life in the trenches, they were seen to improve the mental and physical wellbeing of servicemen. As The Lancet put it in October 1914: </p>
<blockquote>
<p>To the soldier and the sailor in the present war, with his nervous system in a ceaseless state of tension from the dangers and excitement, tobacco must be a real solace and joy when he can find time for this well-earned indulgence. </p>
</blockquote>
<p>Nurses even <a href="https://www.iwm.org.uk/collections/item/object/205253353">administered cigarettes</a> to injured men in hospitals. In earlier conflicts, including the Boer war (1899-1902) and the Crimean war (1853-56), many military and medical writers had said much the same thing. But the machine-made cigarette made smoking more accessible.</p>
<h2>Concerns about young smokers</h2>
<p>For the late Victorians and Edwardians, the ease with which the cigarette habit could be acquired was a source of worry, as more and more young people seemed to be falling under tobacco’s spell. </p>
<p>As I’ve found when reading journals from the early 1900s at the British Library, smoking was seen by some doctors and anti-tobacco activists to cause bad manners and antisocial behaviour in idle young boys. It was also purported to stunt their growth.</p>
<p>This was a period where fears of national decline and “degeneration” abounded, especially after the <a href="https://history.port.ac.uk/?p=2264">poor physical condition</a> of working-class army recruits was discovered during the Boer war. Such views are, therefore, understandable. Smoking was endangering the health of the next generation and, by extension, the health and longevity of the British empire. </p>
<p>In many ways, these fears never really went away, particularly about the effects of smoking on <a href="https://healthmedia.blog.gov.uk/2023/10/12/creating-a-smokefree-generation-and-tackling-youth-vaping-what-you-need-to-know/">future generations</a>. However, anti-tobacco public health messages and smoking cessation programmes would not become common until after the link between smoking and lung cancer was proved in the 1950s. </p>
<p>We can now add recent crises such as the COVID pandemic to the timeline of historical smoking boosters. Even if wars and pandemics are clearly different kinds of crisis, they both lead to widespread anxiety and stress, providing a perceived need for soothing, often psychoactive, remedies. </p>
<p>Much like the young soldiers who had to endure a mix of intense stress and numbing boredom in the major wars of the modern era, the new, youthful smokers of the pandemic perhaps lit their first ever cigarette to deal with life in lockdown.</p><img src="https://counter.theconversation.com/content/219922/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Reeve does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Since the Victorian age, tobacco has been a form of stress relief.Michael Reeve, Lecturer in Modern British History, The Open UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2145802023-12-26T20:30:36Z2023-12-26T20:30:36ZYou can’t reverse the ageing process but these 5 things can help you live longer<figure><img src="https://images.theconversation.com/files/565071/original/file-20231212-19-m904rz.jpg?ixlib=rb-1.1.0&rect=0%2C437%2C6500%2C3746&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/seniors-enjoying-breakfast-1105683980">Rawpixel.com/Shutterstock</a></span></figcaption></figure><p>At this time of year many of us resolve to prioritise our health. So it is no surprise there’s a <a href="https://digiday.com/marketing/health-food-brands-ramp-up-marketing-efforts-around-consumers-new-years-resolutions/">roaring trade</a> of products purporting to guarantee you live longer, be healthier and look more youthful. </p>
<p>While an <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4822264/">estimated</a> 25% of longevity is determined by our genes, the rest is determined by what we do, day to day. </p>
<p>There are no quick fixes or short cuts to living longer and healthier lives, but the science is clear on the key principles. Here are five things you can do to extend your lifespan and improve your health.</p>
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Read more:
<a href="https://theconversation.com/no-you-cant-reverse-ageing-by-injecting-young-blood-and-fasting-but-that-doesnt-stop-people-trying-207038">No, you can't reverse ageing by injecting 'young blood' and fasting. But that doesn't stop people trying</a>
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<h2>1. Eat a predominantly plant-based diet</h2>
<p>What you eat has a huge impact on your health. The evidence overwhelmingly <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8210981/#:%7E:text=According%20to%20an%20expansive%20review,13%20Given%20that%20so%20many">shows</a> eating a diet high in plant-based foods is associated with health and longevity. </p>
<p>If you eat more plant-based foods and less meat, processed foods, sugar and salt, you reduce your risk of a range of illnesses that shorten our lives, including heart disease and cancer. </p>
<figure class="align-center ">
<img alt="Delicious Mediterranean serving platter." src="https://images.theconversation.com/files/565062/original/file-20231212-19-nxaeys.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/565062/original/file-20231212-19-nxaeys.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=371&fit=crop&dpr=1 600w, https://images.theconversation.com/files/565062/original/file-20231212-19-nxaeys.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=371&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/565062/original/file-20231212-19-nxaeys.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=371&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/565062/original/file-20231212-19-nxaeys.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=466&fit=crop&dpr=1 754w, https://images.theconversation.com/files/565062/original/file-20231212-19-nxaeys.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=466&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/565062/original/file-20231212-19-nxaeys.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=466&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The Mediterranean diet is one of the healthiest and most studied eating patterns.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/tray-of-food-on-white-surface-K47107aP8UU">Louis Hansel/Unsplash</a></span>
</figcaption>
</figure>
<p>Plant-based foods <a href="https://www.nature.com/articles/s41398-019-0552-0">are rich</a> in nutrients, phytochemicals, antioxidants and fibre. They’re also anti-inflammatory. All of this protects against damage to our cells as we age, which helps prevent disease. </p>
<p>No particular diet is right for everyone but one of the most studied and <a href="https://www.hsph.harvard.edu/nutritionsource/healthy-weight/diet-reviews/mediterranean-diet/#:%7E:text=%5B6%5D%20Those%20who%20had%20the,who%20had%20the%20lowest%20adherence.">healthiest</a> is the <a href="https://www.eatingwell.com/article/291120/mediterranean-diet-for-beginners-everything-you-need-to-get-started/">Mediterranean diet</a>. It’s based on the eating patterns of people who live in countries around the Mediterranean Sea and emphases vegetables, fruits, wholegrains, legumes, nuts and seeds, fish and seafood, and olive oil.</p>
<h2>2. Aim for a healthy weight</h2>
<p>Another important way you can be healthier is to try and achieve a healthy weight, as obesity <a href="https://www.healthline.com/health/obesity/how-obesity-affects-body">increases the risk</a> of a number of health problems that shorten our lives.</p>
<p>Obesity puts strain on all of our body systems and has a whole myriad of physiological effects including causing inflammation and hormonal disturbances. These <a href="https://www.ncbi.nlm.nih.gov/books/NBK572076/">increase your chances</a> of a number of diseases, including heart disease, stroke, high blood pressure, diabetes and a number of cancers.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-body-mass-index-cant-tell-us-if-were-healthy-heres-what-we-should-use-instead-211190">The body mass index can't tell us if we're healthy. Here's what we should use instead</a>
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</em>
</p>
<hr>
<p>In addition to affecting us physically, obesity is also <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6052856/">associated with</a> poorer psychological health. It’s linked to depression, low self-esteem and stress.</p>
<p>One of the biggest challenges we face in the developed world is that we live in an <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6817492/">environment</a> that promotes obesity. The ubiquitous marketing and the easy availability of high-calorie foods our bodies are hard-wired to crave mean it’s easy to consume too many calories.</p>
<h2>3. Exercise regularly</h2>
<p>We all know that exercise is good for us – the <a href="https://www.insurancebusinessmag.com/au/news/breaking-news/hcf-reveals-australias-most-popular-new-years-resolutions-for-2023-431665.aspx">most common resolution</a> we make this time of year is to do more exercise and to get fitter. Regular exercise <a href="https://www.who.int/news-room/fact-sheets/detail/physical-activity">protects</a> against chronic illness, lowers your stress and improves your mental health. </p>
<p>While one of the ways exercising helps you is by supporting you to control your weight and lowering your body fat levels, the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1402378/#:%7E:text=For%20instance%2C%20routine%20physical%20activity,HDL%5D%20cholesterol%20levels%20and%20decreased">effects</a> are broader and include improving your glucose (blood sugar) use, lowering your blood pressure, reducing inflammation and improving blood flow and heart function.</p>
<figure class="align-center ">
<img alt="Woman with grey hair does yoga outside" src="https://images.theconversation.com/files/565049/original/file-20231212-27-u1vhzr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/565049/original/file-20231212-27-u1vhzr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/565049/original/file-20231212-27-u1vhzr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/565049/original/file-20231212-27-u1vhzr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/565049/original/file-20231212-27-u1vhzr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/565049/original/file-20231212-27-u1vhzr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/565049/original/file-20231212-27-u1vhzr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Do the types of exercise you enjoy.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/woman-in-black-tank-top-and-gray-denim-jeans-sitting-on-green-grass-field-during-daytime-FGQQho5XXn4">Kelly Newton/Unsplash</a></span>
</figcaption>
</figure>
<p>While it’s easy to get caught up in all of the hype about different exercise strategies, the evidence <a href="https://www.medicalnewstoday.com/articles/320760">suggests</a> that any way you can include physical activity in your day has health benefits. You don’t have to run marathons or go to the gym for hours every day. Build movement into your day in any way that you can and do things that you enjoy.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/cant-afford-a-gym-membership-or-fitness-class-3-things-to-include-in-a-diy-exercise-program-206204">Can't afford a gym membership or fitness class? 3 things to include in a DIY exercise program</a>
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</em>
</p>
<hr>
<h2>4. Don’t smoke</h2>
<p>If you want to be healthier and live longer then don’t smoke or vape. </p>
<p>Smoking cigarettes affects almost every organ in the body and is associated with both a shorter and lower quality of life. There is no safe level of smoking – every cigarette increases your <a href="https://theconthatkills.org.au/?utm_source=googlesearch&utm_medium=search&utm_campaign=theconthatkills23&utm_content=RSA&gclid=Cj0KCQjwqP2pBhDMARIsAJQ0Czrlep6EQHC-8_9xUhpz0h9v2ZglMF-6-k7_65awq8FxVaIL5HRoivwaAqJwEALw_wcB&gclsrc=aw.ds">chances of developing</a> a range of cancers, heart disease and diabetes. </p>
<p>Even if you have been smoking for years, by giving up smoking at any age you can experience <a href="https://www.cdc.gov/tobacco/quit_smoking/how_to_quit/benefits/index.htm">health benefits</a> almost immediately, and you can reverse many of the harmful effects of smoking.</p>
<p>If you’re thinking of switching to vapes as a healthy long term option, <a href="https://theconversation.com/can-vaping-help-people-quit-smoking-its-unlikely-204812">think again</a>. The long term health effects of vaping are not fully understood and they come with their own <a href="https://theconversation.com/no-vapes-arent-95-less-harmful-than-cigarettes-heres-how-this-decade-old-myth-took-off-203039">health risks</a>.</p>
<h2>5. Prioritise social connection</h2>
<figure class="align-center ">
<img alt="Older men play chess outdoors." src="https://images.theconversation.com/files/565064/original/file-20231212-21-u1vhzr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/565064/original/file-20231212-21-u1vhzr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/565064/original/file-20231212-21-u1vhzr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/565064/original/file-20231212-21-u1vhzr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/565064/original/file-20231212-21-u1vhzr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/565064/original/file-20231212-21-u1vhzr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/565064/original/file-20231212-21-u1vhzr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Don’t forget about friendship and socialising.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/two-men-playing-chess-ItphH2lGzuI">Vlad Sargu/Unsplash</a></span>
</figcaption>
</figure>
<p>When we talk about living healthier and longer, we tend to focus on what we do to our physical bodies. But one of the most important discoveries over the past decade has been the recognition of the importance of spiritual and psychological health. </p>
<p>People who are lonely and socially isolated have a much higher risk of dying early and are <a href="https://healthnews.com/longevity/healthspan/social-connection-and-longevity/#:%7E:text=One%20of%20the%20biggest%20benefits,the%20following%20factors%20and%20influences.">more likely</a> to suffer from heart disease, stroke, dementia as well as anxiety and depression. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/are-you-part-of-a-social-group-making-sure-you-are-will-improve-your-health-81996">Are you part of a social group? Making sure you are will improve your health</a>
</strong>
</em>
</p>
<hr>
<p>Although we don’t fully understand the mechanisms, it’s likely due to both behavioural and biological factors. While people who are more socially connected are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3150158/">more likely</a> to engage in healthy behaviours, there also seems to be a more direct physiological effect of loneliness on the body. </p>
<p>So if you want to be healthier and live longer, build and maintain your connections to others.</p><img src="https://counter.theconversation.com/content/214580/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hassan Vally does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Don’t believe the hype about products claiming they can help you live longer. Here are five lifestyle changes to prioritise instead.Hassan Vally, Associate Professor, Epidemiology, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2199272023-12-19T16:54:10Z2023-12-19T16:54:10ZVape deals are everywhere this Christmas – here’s how to deal with the horrific waste problem<p>Vape deals are all over the place in the run-up to Christmas. Vape kits, e-liquids and accessories are being widely promoted as stocking fillers, frequently with upwards of 50% off. </p>
<p>There’s certainly a big market, with <a href="https://ash.org.uk/uploads/Use-of-e-cigarettes-among-adults-in-Great-Britain-2023.pdf?v=1691058248#:%7E:text=The%20number%20of%20e%2Dcigarette,see%20Appendix%201%20for%20methodology).&text=There%20are%20differences%20in%20vaping,of%20those%20classified%20as%20ABC1.">nearly 5 million</a> vapers in the UK alone, growing at nearly 10% a year. Many are no doubt attracted by all the bright colours and funky shapes, not to mention a <a href="https://www.gov.uk/government/news/smokers-urged-to-swap-cigarettes-for-vapes-in-world-first-scheme#:%7E:text=As%20part%20of%20the%20world,smoking%20rates%20to%205%25%20or">UK government plan</a> to offer starter kits to one in five smokers to help make the nation “smoke-free” by 2030. </p>
<p>Quite aside from <a href="https://theconversation.com/uk-plan-to-encourage-smokers-to-take-up-vaping-means-swapping-one-health-risk-with-another-204152">the potential health issues</a>, this is causing an enormous waste problem – above all with disposable vapes. These now make up <a href="https://ash.org.uk/uploads/Use-of-e-cigarettes-among-adults-in-Great-Britain-2023.pdf?v=1691058248#:%7E:text=The%20number%20of%20e%2Dcigarette,see%20Appendix%201%20for%20methodology).&text=There%20are%20differences%20in%20vaping,of%20those%20classified%20as%20ABC1.">almost a third</a> of the whole market, a near-doubling in share in the past year alone. According to research by recycling campaigners Material Focus, some <a href="https://www.bbc.co.uk/news/business-66740556">5 million vapes</a> are now being disposed of weekly in the UK – that’s nearly 500 a minute. </p>
<p>So how bad are the consequences and what might a solution look like?</p>
<h2>Why it’s a problem</h2>
<p>Vapes traditionally consist of an e-liquid cartridge, heating element, wick, built-in battery and a mouthpiece. Disposable vapes are very similar, except that instead of a cartridge, there’s typically a small quantity of e-liquid absorbed into the wick; when the wick dries out, the device is spent. For both disposables and reusables, there’s usually also an electronic system to control power and functionality and ensure safe operation. </p>
<p>These devices consist of plastic, glass, rubber, various metals and cotton. The electronic parts use elements that are both valuable and potentially hazardous. These include lithium in the batteries, various heavy metals and rare earths in the battery, circuitry and wiring, and aluminium in the cartridge and battery casings. </p>
<p>To give just one example of what we’re throwing away, research <a href="https://www.materialfocus.org.uk/press-releases/one-million-single-use-vapes-thrown-away-every-week-contributing-to-the-growing-e-waste-challenge-in-the-uk/">published in 2022</a> indicated that annual UK vape waste included 10 tonnes of lithium, enough to power 1,200 electric vehicles. And with vape disposals having <a href="https://www.bbc.co.uk/news/business-66740556">already trebled</a> since then, the figure is now likely to be considerably higher. </p>
<p>When it comes to recycling, vapes are comparable to other small devices such as electric toothbrushes, smoke detectors and battery-operated toys. These are all complex to recycle, even if few product lines have been growing so quickly as vapes. Most concerning, however, is the environmental footprint of the disposables. </p>
<p><a href="https://www.materialfocus.org.uk/press-releases/one-million-single-use-vapes-thrown-away-every-week-contributing-to-the-growing-e-waste-challenge-in-the-uk/">Most are not</a> disposed of properly and end up in household trash or even littering pavements, public amenities and beaches. <a href="https://www.gov.uk/government/publications/electrical-and-electronic-equipment-eee-covered-by-the-weee-regulations/electrical-and-electronic-equipment-eee-covered-by-the-weee-regulations#:%7E:text=Category%207%3A%20toys%2C%20leisure%20and%20sports%20equipment&text=e%2Dcigarettes,details%20see%20European%20Commission%20guidance">By law</a> they are supposed to be disposed of in the same way as electrical toys and sports equipment, either via household waste-recycling centres or retailer take-back channels, where they are subsequently sent for dismantling and recycling or safe disposal. </p>
<p>If you look closely at the product or packaging, this requirement should be confirmed with a symbol of a crossed-out wheelie bin with a thick line underneath, which refers to WEEE (waste electrical and electronic equipment) recycling, though in my experience this is not always evident. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/565974/original/file-20231215-15-jc6k6c.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="The WEEE symbol." src="https://images.theconversation.com/files/565974/original/file-20231215-15-jc6k6c.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/565974/original/file-20231215-15-jc6k6c.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=861&fit=crop&dpr=1 600w, https://images.theconversation.com/files/565974/original/file-20231215-15-jc6k6c.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=861&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/565974/original/file-20231215-15-jc6k6c.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=861&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/565974/original/file-20231215-15-jc6k6c.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1082&fit=crop&dpr=1 754w, https://images.theconversation.com/files/565974/original/file-20231215-15-jc6k6c.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1082&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/565974/original/file-20231215-15-jc6k6c.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1082&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The WEEE symbol.</span>
<span class="attribution"><a class="source" href="https://upload.wikimedia.org/wikipedia/commons/thumb/7/7e/WEEE_symbol_vectors.svg/350px-WEEE_symbol_vectors.svg.png">Wikimedia</a></span>
</figcaption>
</figure>
<p>Improper disposal of vapes <a href="https://www.theguardian.com/society/2023/may/13/single-use-vapes-sparking-surge-in-fires-at-uk-waste-plants">can result</a> in harmful chemicals leaching into the environment. There’s a fire and explosion hazard when batteries become detached, damaged or submerged in water. Disposable vapes are also linked with <a href="https://lungfoundation.com.au/wp-content/uploads/2023/10/First_Nations_Vape-Animation_Fact-Sheet.pdf">generating microplastics</a>. </p>
<p>Unfortunately producers, importers and retailers are not fully acknowledging or even understanding the problem. This is exemplified by most UK producers failing to register with a UK environmental agency under WEEE regulations, which they are supposed to do. Instead most mistakenly <a href="https://www.mrw.co.uk/news/vape-firms-failing-to-comply-with-weee-regulations-07-03-2023/">register with</a> the Medicines and Healthcare Products Regulatory Agency. </p>
<p>Meanwhile, leading disposable-vapes manufacturer Elf Bar was <a href="https://www.theguardian.com/society/2023/nov/29/elf-bar-vape-ads-uk-over-recycling-asa">recently censured</a> by the Advertising Standards Authority for playing up the recycling service it offers customers, when in reality all manufacturers are supposed to offer this service, and also because it implied vapes could be disposed of at home. </p>
<h2>What can be done</h2>
<p>Clearly, users need a greater understanding of the environmental harm and potential dangers that improper disposal of single-use vapes can cause, as well as better awareness of and access to suitable recycling facilities. Local drop-off points and take-back schemes for small electrical items could be better promoted for single-use vapes by councils, while everyone from universities to festivals could incentivise vape-recycling or offer collection points. </p>
<p>Even then, the fire hazard during storage and transport is a concern. To this end, Veolia, the largest waste management company in the UK, <a href="https://www.letsrecycle.com/news/veolia-launches-nationwide-vape-recycling-scheme/">recently launched</a> a nationwide fire-safe vape-recycling scheme where retailers are supplied with containers of vermiculite, a mineral that minimises the risk of combustion. The vapes are then transported in these containers to specialist facilities for recycling.</p>
<p>Veolia and the UK Environment Agency are also calling for vapes to be put in their own unique WEEE category because of the quantities and hazards associated with them. Alternatively, it’s sometimes suggested that councils should be made to start including all WEEE electrical waste in their rubbish collection. </p>
<p>Other potential solutions include getting the manufacturers to bear more costs towards vape collection and recycling, making them put clearer instructions about safe disposal on the packaging, or even banning disposable vapes altogether. This latter option is currently being considered by the <a href="https://www.gov.scot/news/single-use-vapes-ban-considered/#:%7E:text=The%20Scottish%20Parliament%20has%20successfully,from%20the%20Internal%20Market%20Act.">Scottish government</a> and would be my preferred choice. </p>
<p>In the meantime, for individuals getting knockdown deals on vapes this Christmas, it is best to keep spent ones in good condition and with the battery intact until you can get to a suitable recycling facility. Your retailer should be able to point you towards the nearest one, or else the information is <a href="https://www.recycleyourelectricals.org.uk/how-to-recycle-electronics/what-electronics-can-be-recycled/recycle-vapes/">available online</a>. Whatever you do, please don’t make this waste problem any worse than it is already.</p><img src="https://counter.theconversation.com/content/219927/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew Turner does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>With 5 million vapers in the UK and rising fast, nearly 500 of these devices are being thrown away every minute.Andrew Turner, Associate Professor in Environmental Sciences, University of PlymouthLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2172032023-12-14T13:48:45Z2023-12-14T13:48:45ZHow much could the NHS save if people had healthier lifestyles? Hundreds of millions according to research<figure><img src="https://images.theconversation.com/files/565332/original/file-20231212-19-rf91na.jpg?ixlib=rb-1.1.0&rect=77%2C132%2C5106%2C3292&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-backpack-hiking-on-footpath-autumn-2377721871">encierro/Shutterstock</a></span></figcaption></figure><p>The NHS spends a lot of time and money looking after people who smoke, or drink too much or don’t do enough exercise. Hospital admissions and treatments are an expensive business. </p>
<p>So what would happen if these people were able to change their lifestyles, for example by switching to vaping, moderating alcohol intake and being more physically active? My research suggests that costs to the NHS could be significantly reduced. </p>
<p>One of <a href="https://www.magonlinelibrary.com/doi/abs/10.12968/bjhc.2023.0046">my studies</a> indicates that if half of England’s <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandlifeexpectancies/bulletins/adultsmokinghabitsingreatbritain/2022#smoking-prevalence-in-the-uk-by-sex-age-and-region">5 million smokers</a> switched to e-cigarettes or heated tobacco, the NHS would save more than £500 million a year. The shift away from cigarettes would lead to a decrease in cases of lung cancer, mouth cancer and heart disease. While the risks of vaping are still <a href="https://theconversation.com/how-bad-is-vaping-and-should-it-be-banned-197913">not entirely clear</a>, the damage caused by smoking has been firmly established.</p>
<p><a href="https://www.sciencedirect.com/science/article/abs/pii/S1090944323000613">Another study</a> I carried out in Italy reinforces this conclusion. It suggests that if half of Italy’s smoking population transitioned to alternative products, that country’s public health service could save over €700 million (£600 million) a year.</p>
<p>The larger figure comes from a slightly different cost structure for Italy’s health service, and the fact that more people smoke in Italy than in England. That study also delves into potential savings related to reducing excessive alcohol consumption and promoting increased physical activity.</p>
<p>My research <a href="http://dati.istat.it/Index.aspx?QueryId=16778&lang=en">used statistics</a> which suggest that just under 3% of Italians are currently considered heavy drinkers. Overindulging in alcohol can lead to many <a href="https://www.thelancet.com/pdfs/journals/lanrhe/PIIS2665-9913(23)00073-5.pdf">health problems</a>, including liver damage, heart defects, increased blood pressure, and a heightened risk of certain types of cancer.</p>
<p>I found that if a single heavy drinker (someone who consumes over four units of alcohol a day) out of every 1,000 Italians reduced their consumption to the recommended guidelines (two units a day for men, one a day for women), this would result in an annual saving to the health service of €60 million (£52 million). </p>
<p>Another finding was that if one physically inactive person out of every 100 Italians started to take the recommended level of at least 150 minutes of moderate physical activity, the gain would be €223 million (£193 million) per year. </p>
<p>Almost 40% of Italians do no exercise, which increases the risk of cardiovascular diseases, type 2 diabetes and obesity. It also <a href="https://www.who.int/news/item/04-04-2002-physical-inactivity-a-leading-cause-of-disease-and-disability-warns-who">elevates the risk</a> of colon cancer, high blood pressure, osteoporosis, depression and anxiety. </p>
<p>So overall, as the Italian government – in common with many wealthy countries – struggles with healthcare funding, close to €1 billion could be saved every year in direct costs if a relatively small number of people made fairly straightforward changes. </p>
<h2>Save lives, save money</h2>
<p>A similar impact could be had on the NHS (which has an annual budget of £182 billion) by targeting smokers, heavy drinkers and those who take no exercise. </p>
<p>The economic impact could in fact be far greater than my calculations suggest. For the savings predicted by my research do not account for the loss in productivity due to time off work connected to illness, treatment and recovery. </p>
<figure class="align-center ">
<img alt="Bottles of water held up in celebration." src="https://images.theconversation.com/files/565334/original/file-20231212-19-lbgug.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/565334/original/file-20231212-19-lbgug.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/565334/original/file-20231212-19-lbgug.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/565334/original/file-20231212-19-lbgug.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/565334/original/file-20231212-19-lbgug.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/565334/original/file-20231212-19-lbgug.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/565334/original/file-20231212-19-lbgug.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Contains no alcohol.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/cheers-healthy-couple-cheering-fresh-water-1134634340">AePatt Journey/Shutterstock</a></span>
</figcaption>
</figure>
<p>Some may argue that given the risky nature of cigarettes and alcohol, a more straightforward – and economically beneficial – approach would be to implement an outright ban. After all, if successful, it could potentially result in even greater savings of lives and resources. </p>
<p>But banning people from doing things they like, even if those things are harmful, <a href="https://theconversation.com/history-not-harm-dictates-why-some-drugs-are-legal-and-others-arent-110564">rarely works out well</a>. The idea of taking away the right to smoke or drink, or enforcing physical exercise would be a tough political sell. </p>
<p>Recognising that people are often inclined to engage in risky behaviour, the objective should be to reduce the excessive harm they cause themselves. A push towards encouraging and enabling people to smoke less, drink less and do more exercise would benefit them and significantly decrease the financial pressure on our healthcare systems.</p><img src="https://counter.theconversation.com/content/217203/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Francesco Moscone is affiliated with University of Ca' Foscari Venice </span></em></p>Small changes, big savings.Francesco Moscone, Professor of Business Economics, Ca' Foscari University of Venice, Brunel University LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2172212023-11-10T15:20:10Z2023-11-10T15:20:10ZProposed smoking ban would improve UK public health – but tobacco industry opposition could be a major roadblock<p>In his <a href="https://www.gov.uk/government/speeches/the-kings-speech-2023">speech on Tuesday</a>, King Charles III outlined what measures the government plans to introduce to cut smoking rates and create a smoke-free generation in England.</p>
<p>Among the measures the government hopes to introduce as part of its new tobacco and vapes bill are plans to restrict sales of e-cigarettes so they’re less accessible to children and young people, as well as exploring the possibility of a new duty on vapes.</p>
<p>But perhaps the most notable of these measures are plans to introduce a so-called “generational” smoking ban. Current legal smokers would be unaffected but, if the legislation came into force as planned, it would mean that from 2027 anyone aged 14 or under will never be able to <a href="https://www.independent.co.uk/news/uk/home-news/uk-smoking-ban-age-sunak-kings-speech-b2443057.html">legally buy a cigarette</a>.</p>
<p>Prime minister Rishi Sunak claims that not only would eradicating smoking save <a href="https://www.abc.net.au/news/2023-10-05/uk-government-set-to-ban-cigarettes-for-younger-generations/102936224">£17 billion</a> per year, it would also reduce pressure on the NHS. Over roughly the last decade, <a href="https://digital.nhs.uk/data-and-information/publications/statistical/statistics-on-smoking/statistics-on-smoking-england-2020/part-1-smoking-related-ill-health-and-mortality#:%7E:text=In%202019%2F20%20there%20were,an%20increase%20of%2010%25">25%-31% of all hospital admissions</a> were from conditions directly caused by smoking – such as respiratory and circulatory diseases, and cancers.</p>
<p>Smoking is also the <a href="https://www.rcplondon.ac.uk/news/rcp-welcomes-tobacco-and-vapes-bill-kings-speech">leading cause</a> of preventable death and illness in the UK – accounting for around <a href="https://www.rcplondon.ac.uk/news/rcp-responds-khan-review-making-smoking-obsolete">64,000 deaths</a> each year. Smoking even just <a href="https://www.bmj.com/content/360/bmj.j5855">one cigarette a day</a>, when compared to being a non-smoker, can increase the risk of suffering from heart disease by 48% in men and 57% in women. It can also increase the risk of stroke by 25% in men and 31% in women.</p>
<p>It’s clear a smoking ban could have many potential economic and public health benefits. But whether such a ban actually comes to fruition is uncertain – and the tobacco industry will probably do as much as it can to ensure this policy never comes to pass.</p>
<h2>Smoke-free generation</h2>
<p>The proposed smoking ban is being introduced as part of the government’s efforts to phase out smoking and make England <a href="https://commonslibrary.parliament.uk/research-briefings/cbp-9655/">smoke-free by 2030</a>. If this plan goes through, it would make England the second country in the world to introduce such a ban. <a href="https://www.bbc.co.uk/news/uk-scotland-67017093">Sunak reportedly</a> wants to work with the UK’s devolved governments to eventually introduce the ban across the rest of the country.</p>
<p>New Zealand was the <a href="https://www.bbc.co.uk/news/world-asia-63954862">first country</a> to successfully implement a generational smoking ban in January 2023. This means that no one born after January 1, 2009 will ever be legally allowed to purchase cigarettes in New Zealand.</p>
<p>It’s still too early to know exactly what benefits this policy will have on public health. But computer modelling suggests that a well-enforced effort would halve smoking rates <a href="https://www.health.govt.nz/system/files/documents/publications/proposals_for_a_smokefree_aotearoa_2025_action_plan-final.pdf">within 10-15 years</a> after the ban is implemented.</p>
<p>In the UK’s case, the government claims this policy would be the “<a href="https://www.gov.uk/government/news/prime-minister-to-create-smokefree-generation-by-ending-cigarette-sales-to-those-born-on-or-after-1-january-2009">most significant public health intervention</a> in a generation, saving tens of thousands of lives” – and that it has wide support from <a href="https://ash.org.uk/media-centre/news/press-releases/health-leaders-welcome-kings-speech-setting-out-governments-proposals-for-a-smokefree-generation">public health voices</a>.</p>
<p>But for years the tobacco industry has opposed virtually every tobacco control policy that has been proposed – including <a href="https://www.instituteforgovernment.org.uk/sites/default/files/smoking_in_public_places.pdf">smoke-free public places</a> and <a href="https://bmjopen.bmj.com/content/6/10/e012634">standardised tobacco packaging</a>. It should come as no surprise then that the industry could be a major roadblock in the government’s plans to implement a smoking ban.</p>
<p>Research by the <a href="https://www.bath.ac.uk/research-groups/tobacco-control-research-group/">Tobacco Control Research Group</a> at the University of Bath, of which we’re members, has <a href="https://stories.bath.ac.uk/investigating-big-tobacco-s-influence-on-public-health/index.html">highlighted the techniques</a> the tobacco industry uses to undermine such policies. One main strategy they have been accused of using is spreading a false narrative about the effect tobacco control policies will have on society and the economy. </p>
<p>This <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5029800/">narrative is spread</a> using a number of techniques – including producing skewed evidence, sometimes by third parties with undisclosed industry links, and bringing forward litigation. Tobacco industry actors have previously denied interfering in policy change.</p>
<figure class="align-center ">
<img alt="A no smoking sign hung on a post." src="https://images.theconversation.com/files/558637/original/file-20231109-15-rjpa5w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/558637/original/file-20231109-15-rjpa5w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/558637/original/file-20231109-15-rjpa5w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/558637/original/file-20231109-15-rjpa5w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/558637/original/file-20231109-15-rjpa5w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/558637/original/file-20231109-15-rjpa5w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/558637/original/file-20231109-15-rjpa5w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">New Zealand is the first country in the world to introduce a generational smoking ban.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/no-smoking-sign-shopping-place-background-180758084">totojang1977/ Shutterstock</a></span>
</figcaption>
</figure>
<p>Previous attempts to create tobacco-free generations have been blocked using such techniques.</p>
<p>For example, in 2019 the Philippine Tobacco Institute, which represents multiple tobacco companies, <a href="https://www.tobaccocontrollaws.org/litigation/decisions/philippine-tobacco-institute-v-city-of-balanga-et-al">filed two court cases</a> challenging the city government of Balanga in the Philippines. </p>
<p>The city was hoping to introduce regulations which would prevent the legal sale of tobacco products to residents born on or after January 1, 2000. However, the court case went in the industry’s favour – and so the regulation was never implemented.</p>
<p>In the US state of Massachusetts, the town of Brookline is also <a href="https://brookline.news/brooklines-tobacco-free-generation-law-facing-challenge-in-mas-highest-court/#:%7E:text=A%20legal%20challenge%20filed%20by,court%20in%20Massachusetts%20next%20month">facing a similar battle</a> in the state’s Supreme Judicial Court. </p>
<p>The town was hoping to introduce the same policy measure, which would prevent legal sale of tobacco or cigarettes to anyone born after January 1, 2000. This lawsuit was brought to court by local shops whose businesses benefit from selling tobacco.</p>
<p>Litigation was not brought against New Zealand for its generational ban. Only time will tell if this will be the case for the UK, too.</p>
<p>Either way, industry arguments have already appeared in UK media following coverage of the government’s plans. For example, <a href="https://tobaccotactics.org/article/forest">Forest</a> – a smoker’s rights group which <a href="https://www.forestonline.org/about-forest/frequently-asked-questions/">receives funding from tobacco companies</a> – has <a href="https://www.independent.co.uk/news/uk/home-news/uk-phased-smoking-ban-kings-speech-b2443557.html">been quoted</a> in one UK publication, referring to the proposal as “desperate” and stating that it “won’t work”. Their industry links weren’t mentioned in the article.</p>
<p>It’s crucial that any industry attempts to delay, weaken or scrap the policy are strongly resisted. One way to help achieve this is for the UK to adhere to the Framework Convention on Tobacco Control – an international treaty signed by the UK which requires <a href="https://fctc.who.int/publications/m/item/guidelines-for-implementation-of-article-5.3">health policy be protected</a> from the vested interest of the tobacco industry. </p>
<p>There’s also a role to be played by the media to ensure transparency and full disclosure in their coverage of the policy so that when industry-affiliated voices comment, they are clearly identified as such.</p>
<p>Beyond pressure from industry, another potential roadblock for the policy is resourcing to enforce the policy. The policy also stands to be most successful when not viewed in isolation. Other stop smoking measures will continue to have a role to play, given that many current smokers will not be affected by the legislation.</p>
<hr>
<p><em>A previous version of this article incorrectly stated that smoking even just one cigarette a day can double a person’s risk of dying from heart disease or stroke.</em></p><img src="https://counter.theconversation.com/content/217221/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Phil Chamberlain is a member of the Tobacco Control Research Group (TCRG) which is part of the global tobacco industry watchdog STOP, funded by Bloomberg Philanthropies. For a list of recent and current research funding within the TCRG, see: <a href="https://www.bath.ac.uk/corporate-information/tobacco-control-research-group-research-projects/">https://www.bath.ac.uk/corporate-information/tobacco-control-research-group-research-projects/</a></span></em></p><p class="fine-print"><em><span>Allen Gallagher is a member of the Tobacco Control Research Group (TCRG) which is part of the global tobacco industry watchdog STOP, funded by Bloomberg Philanthropies. For a list of recent and current research funding within the TCRG, see: <a href="https://www.bath.ac.uk/corporate-information/tobacco-control-research-group-research-projects/">https://www.bath.ac.uk/corporate-information/tobacco-control-research-group-research-projects/</a></span></em></p>A previous attempt to introduce such a ban in the Philippines was struck down by an industry-funded lawsuit.Phil Chamberlain, Deputy Director of the Tobacco Control Research Group, University of BathAllen Gallagher, Postdoctoral Research Associate, Department of Health, University of BathLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2122562023-09-07T12:23:32Z2023-09-07T12:23:32ZSecondhand smoke may be a substantial contributor to lead levels found in children and adolescents, new study finds<figure><img src="https://images.theconversation.com/files/545649/original/file-20230830-19-lkn4ka.jpg?ixlib=rb-1.1.0&rect=77%2C0%2C8660%2C5717&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Childhood exposure to lead can limit cognitive development and cause a drop in IQ.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/mother-smoking-near-children-royalty-free-image/1291760178?phrase=secondhand+smoke+children&adppopup=true">Yamasan/iStock via Getty Images Plus</a></span></figcaption></figure><p>Secondhand smoke may be an important but overlooked source of chronic lead exposure in kids and adolescents. That is the <a href="https://doi.org/10.1186/s12889-023-16005-y">key finding of our recent study</a>, published in the journal BMC Public Health.</p>
<p>We analyzed national data on blood lead levels and secondhand smoke exposure in 2,815 U.S. children and teenagers ages 6 to 19 from 2015 to 2018. We looked at levels of lead and a nicotine metabolite – a substance known as cotinine produced in the body’s chemical process that forms when tobacco smoke is inhaled. Levels of cotinine indicate exposure to tobacco smoke.</p>
<p>We found that the average blood lead levels in the intermediate and high tobacco smoke exposure groups were 18% and 29% higher, respectively, than those in the group with the lowest tobacco smoke exposure. The lowest lead exposure group was comparable to the U.S. average. A greater number of boys had detectable lead levels in their blood, as did a greater number of Black children and adolescents, compared with the other ethnic groups we studied. </p>
<p>Elevated blood levels were more common in children ages 6 to 10 than in older participants. Notably, children from low-income households showed 27% higher blood lead levels compared with those from high-income households. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/L-crRQLn_p0?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The damage lead does to the body is irreversible.</span></figcaption>
</figure>
<h2>Why it matters</h2>
<p>Lead, unlike many other toxins, does not get diluted when exposure decreases. Nor does the body excrete it naturally. Instead, it accumulates in the bones and leaches into blood. The only way to remove it is through an <a href="https://www.atsdr.cdc.gov/csem/leadtoxicity/patient_treatment.html">oral medical treatment</a>.</p>
<p>Exposure to lead can cause numerous and <a href="https://doi.org/10.1515/reveh.2009.24.1.15">severe neurological problems</a>, including nerve damage, cognitive problems, <a href="https://doi.org/10.1073/pnas.2118631119">loss of IQ points</a> and possibly even conditions such as <a href="https://doi.org/10.2174/156720512800617991">Alzheimer’s disease</a> and <a href="https://doi.org/10.1016/j.neuro.2011.11.008">schizophrenia</a>.</p>
<p>Lead exposure is more harmful to younger children than older children and adults because their bodies are still developing and they are growing so rapidly.</p>
<p><a href="https://www.cdc.gov/nceh/lead/prevention/populations.htm">Children at high-exposure risk</a> often come from low-income households in older homes built before 1978, when lead paint was still used. Young children’s frequent hand-to-mouth activity provides a pathway for lead exposure at home. Lead-containing water pipes in these older, low-income housing areas also contribute to the issue.</p>
<p>Children and others can also be exposed to lead through a variety of everyday household items, including <a href="https://www.fda.gov/food/environmental-contaminants-food/questions-and-answers-lead-glazed-traditional-pottery">some ceramic cookware and dishes</a>, some <a href="https://doi.org/10.1177/0009922806294068">vinyl lunchboxes</a> – especially those manufactured outside the United States – many common <a href="https://www.popularmechanics.com/home/food-drink/a38413337/heavy-metals-found-in-herbs-spices/">spices</a> and some <a href="https://www.reuters.com/article/uk-toys-lead/lead-found-in-toys-and-backpacks-in-u-s-stores-idUKN1023090320071010">toys</a>, <a href="https://www.fda.gov/cosmetics/potential-contaminants-cosmetics/lead-cosmetics">hair-coloring products and cosmetics</a>. Lead exposure has even been traced to <a href="https://doi.org/10.5334/aogh.2754">some candies</a> from Mexico.</p>
<p>Over the past four decades, U.S. regulators have banned <a href="https://www.cdc.gov/nceh/lead/prevention/sources/paint.htm#">lead-based paint for residential use</a> and <a href="https://www.eia.gov/energyexplained/gasoline/history-of-gasoline.php#">leaded gasoline</a>. This has led to a significant decrease in lead exposure from major traditional sources. </p>
<p>Despite continued efforts, lead exposure continues to pose a risk. Our findings help create awareness of the link between secondhand tobacco smoke and lead exposure, especially for young people. Approximately 35% of U.S. children, or over 23 million, were <a href="https://www.cdc.gov/nchs/products/databriefs/db348.htm">exposed to secondhand smoke between 2013 and 2016</a>, according to the Centers for Disease Control and Prevention. </p>
<h2>What’s next</h2>
<p>We are working within our local areas to educate parents and school administrators about the dangers of lead poisoning, including exposure from secondhand smoke. Our efforts include encouraging individuals and communities to test their drinking water for lead and to take actions to reduce children’s lead exposure from drinking water.</p>
<p>We plan to conduct further studies to quantify the contribution of various sources to lead exposure. We believe that this research will enhance our understanding of children’s exposure and contribute to the improvement of environmental health disparities.</p>
<p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take on interesting academic work.</em></p><img src="https://counter.theconversation.com/content/212256/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Researchers found that children exposed to secondhand smoke had higher than average levels of lead in their blood.Genny Carrillo, Associate Professor of Environmental and Occupational Health, Texas A&M UniversityTaehyun Roh, Assistant Professor of Epidemiology, Texas A&M UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2085862023-09-04T20:04:37Z2023-09-04T20:04:37ZMy teen is addicted to vaping. How can I help them quit and manage their withdrawal symptoms?<figure><img src="https://images.theconversation.com/files/540952/original/file-20230803-29-ilkf8h.jpg?ixlib=rb-1.1.0&rect=44%2C440%2C4913%2C3547&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/a-man-young-man-sitting-on-a-chair-with-a-vape-on-hand-10951435/">Pexels/Mushtaq Hussain</a></span></figcaption></figure><p>The Australian government is <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/taking-action-on-smoking-and-vaping">cracking down</a> on vaping. Recreational vapes of any type – whether they contain nicotine or not – will be banned from retail sale across Australia after <a href="https://www.theguardian.com/australia-news/2023/aug/16/australia-vaping-crackdown-new-laws">legislation</a> is introduced (though the date is yet to be set).</p>
<p>Rates of teen vaping have been <a href="https://www.aihw.gov.au/reports/children-youth/health-of-young-people">rising rapidly</a> in Australia, <a href="http://www.health.gov.au/sites/default/files/2023-06/current-vaping-and-smoking-in-the-australian-population-aged-14-years-or-older-february-2018-to-march-2023.pdf">from</a> 0.8% of 14- to 17-year-olds describing themselves as a current vaper over the past six months in 2018 <a href="https://www.health.gov.au/sites/default/files/2023-06/current-vaping-and-smoking-in-the-australian-population-aged-14-years-or-older-february-2018-to-march-2023.pdf">to</a> 14.5% in 2023. Among 18- to 24-year-olds, 19.8% have been a current vaper over the past six months. </p>
<p>Teens <a href="https://www.cancercouncil.com.au/news/new-research-finds-aussie-teens-find-illegal-vapes-easy-to-access/">mainly get</a> vaping products from their friends, retail vaping stores or the internet. Once the government restricts the distribution of vaping products, many will suddenly lose access to supplies. </p>
<p>In anticipation of this loss, people <a href="https://edition.cnn.com/2019/09/21/us/vape-stockpiling-legislation-trnd/index.html">may start stockpiling</a> vapes. But at some stage, they will have a drastic reduction in their use of vaping. </p>
<p>The majority of e-cigarettes <a href="https://www.uow.edu.au/the-stand/2022/whats-in-a-vape-.php">contain nicotine</a>, even when they’re not labelled as such. <a href="https://www.watoday.com.au/national/western-australia/largest-bust-of-vapes-nangs-in-australia-found-in-perth-s-north-east-20230812-p5dvyu.html">Some vapes tested in Australia</a> contained 900 milligrams of nicotine – the equivalent of the nicotine in almost 100 cigarettes. </p>
<p>So we can expect teenagers who vape will experience nicotine withdrawal symptoms. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-bad-is-vaping-and-should-it-be-banned-197913">How bad is vaping and should it be banned?</a>
</strong>
</em>
</p>
<hr>
<h2>What is nicotine dependence and withdrawal?</h2>
<p>Nicotine dependence means a person is physically and psychologically addicted to nicotine. This produces a strong desire for, and difficulty controlling, nicotine use. </p>
<p>Young people are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8287334/#:%7E:text=In%20adolescents%2C%20even%20infrequent%20smoking,smokers%20(7%E2%80%9310)">at greater risk of nicotine dependence</a> than adults and can develop dependence faster. </p>
<p>Once nicotine-dependent, a person will <a href="https://ctimaine.org/wp-content/uploads/2018/09/Tobacco-Diagnosis-Coding.pdf">experience withdrawal symptoms</a> if they reduce or cease their use. These symptoms can include irritability, frustration, or anger; anxiety; difficulty concentrating; increased appetite; restlessness; depressed mood; and insomnia. </p>
<p>The <a href="https://kidshealth.schn.health.nsw.gov.au/sites/default/files/honc_june_2022.pdf">Hooked on Nicotine Checklist</a> is helpful for teens and their parents. It’s a ten-item checklist to assess dependence on smoking cigarettes or vaping, specially designed for adolescents. The higher the score, the less control your teen will have over their nicotine addiction. </p>
<p>Feeling a loss of control can begin after using vapes for only a short time. Some adolescents <a href="https://tobaccocontrol.bmj.com/content/9/3/313">start showing signs</a> of becoming dependent on nicotine within days of occasionally using it – before they are smoking or vaping daily.</p>
<figure class="align-center ">
<img alt="Mother talks to teen" src="https://images.theconversation.com/files/541400/original/file-20230807-19-6usu56.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/541400/original/file-20230807-19-6usu56.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/541400/original/file-20230807-19-6usu56.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/541400/original/file-20230807-19-6usu56.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/541400/original/file-20230807-19-6usu56.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/541400/original/file-20230807-19-6usu56.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/541400/original/file-20230807-19-6usu56.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Teens who have a nicotine dependence are likely to experience withdrawal symptoms when they stop vaping.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/worried-parent-young-mom-comforting-depressed-1701862456">Shutterstock</a></span>
</figcaption>
</figure>
<h2>I don’t even know if my teen vapes …</h2>
<p>Nicotine exposure during adolescence can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8287334/#:%7E:text=In%20adolescents%2C%20even%20infrequent%20smoking,smokers%20(7%E2%80%9310)">disrupt</a> the brain’s normal development, <a href="https://www.cancercouncil.com.au/news/5-things-parents-should-know-about-vaping/">impacting</a> their mood, impulse control, memory and ability to focus and learn. </p>
<p>If your teen is <a href="https://www.health.nsw.gov.au/tobacco/Pages/vaping-factsheet-young.aspx">unusually irritable or has an unexplained low mood</a>, consider the possibility of nicotine withdrawal, particularly after vapes are no longer readily available. Many adolescents are vaping without the adults in the household being aware. Vapes can be hidden in plain sight, as they look like a highlighter pen or USB stick.</p>
<p>Initiating a conversation is <a href="https://adf.org.au/talking-about-drugs/vaping/vaping-youth/talking-about-vaping/">sometimes easier</a> when side-by-side, not face-to-face with a young person – for example, when walking together or if your teen is in the car with you. One way to bring the subject up is to ask whether any of their friends are vaping or if they’ve seen it at school. Then gradually move on to whether they have tried it themselves and their usage. </p>
<p>During the conversation listen out for hints that mean your teen could be a heavy user of vaping, <a href="https://research.avondale.edu.au/cgi/viewcontent.cgi?article=1000&context=oer_materials">such as</a>:</p>
<ul>
<li>vaping alone, instead of only socially</li>
<li>vaping within 30 minutes of waking up in the morning, or</li>
<li>vaping through the night (this might mean keeping an e-cigarette under the pillow for night-time use). </li>
</ul>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/tiktok-promotes-vaping-as-a-fun-safe-and-socially-accepted-pastime-and-omits-the-harms-203423">TikTok promotes vaping as a fun, safe and socially accepted pastime – and omits the harms</a>
</strong>
</em>
</p>
<hr>
<h2>So how do I help my teen quit?</h2>
<p>Once you know your teen is vaping, broach the subject of quitting with them in a non-judgemental way. Try questions like “have you ever tried having a break from them?” and “how did that feel?”</p>
<p>If they are willing to attempt quitting, or are already withdrawing due to reduced access to vaping products, let them know you are there to support them and help is available. </p>
<h2>First try counselling and cold turkey</h2>
<p>The Quitline or a GP can help with goal setting, such as setting a quit date, <a href="https://www.quit.org.au/make-a-plan/">making a quit plan</a> and identifying triggers for vaping and strategies to address them. </p>
<p>There are also online tools your teen may like, such as <a href="https://www.health.gov.au/resources/apps-and-tools/my-quitbuddy-app">My Quit Buddy</a>, an app that provides practical tips, progress charts and health information to help with quitting.</p>
<h2>Nicotine replacement therapy</h2>
<p>If counselling alone is not successful, <a href="https://www.aap.org/en/patient-care/tobacco-control-and-prevention/youth-tobacco-cessation/nicotine-replacement-therapy-and-adolescent-patients/#:%7E:text=Overall%20efficacy%20findings%20have%20been,US%20Preventive%20Services%20Task%20Force.">nicotine replacement therapy</a> <a href="https://www.cancer.org.au/cancer-information/causes-and-prevention/smoking/quit-smoking">may help</a>. </p>
<p>Nicotine-replacement therapy is <a href="https://www.quit.org.au/articles/nicotine-replacement-therapy-frequently-asked-questions/">available</a> in a fast-release form (used by mouth via a nicotine inhalator, spray, gum, or lozenges) or a slow-release patch. For someone quitting vaping, fast-release forms are likely to work best.</p>
<p>However, sometimes a teenager might need more than one nicotine-replacement product, called “<a href="https://www.quit.org.au/articles/combination-nicotine-replacement-therapy-nrt">combination therapy</a>”. Combination therapy is better when the teen is highly dependant on nicotine and has strong and frequent urges to vape. </p>
<p>Be sure to follow the instructions for each product and encourage regular doses so withdrawal symptoms are controlled. </p>
<figure class="align-center ">
<img alt="Teen talks to nurse in waiting room" src="https://images.theconversation.com/files/543890/original/file-20230822-29-bb1bls.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/543890/original/file-20230822-29-bb1bls.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/543890/original/file-20230822-29-bb1bls.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/543890/original/file-20230822-29-bb1bls.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/543890/original/file-20230822-29-bb1bls.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/543890/original/file-20230822-29-bb1bls.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/543890/original/file-20230822-29-bb1bls.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Teens should try counselling and going cold turkey first.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/nurse-talking-african-american-female-teenager-1979853032">Shutterstock</a></span>
</figcaption>
</figure>
<p>Eighteen year olds can buy nicotine-replacement products without a script at a supermarket or pharmacy. A pharmacist can advise on the correct use. </p>
<p>If your child is aged 12–17, it’s recommended they are first assessed by their GP, who <a href="https://healthinfo.healthengine.com.au/nicotine-replacement-therapy-nrt">can prescribe</a> nicotine-replacement therapy. A script from a GP may allow access to a subsidised course through the Pharmaceutical Benefits Scheme (PBS). </p>
<p>Aboriginal and Torres Strait Islander youth can get <a href="https://www.icanquit.com.au/quitting-methods/professional-support-and-advice/quitline/aboriginal-quitline">further help</a> from their local Aboriginal health service, which can offer culturally safe support and may also have supplies of nicotine-replacement therapy.</p>
<p>When using nicotine replacement therapy, adherence is critical to <a href="https://www.mdpi.com/1660-4601/18/22/12225">successfully quitting</a>. Use it for a <a href="https://www.cancercouncil.com.au/wp-content/uploads/2016/09/16138_CA_CAN5084_NRTFactsheet_WEB.pdf">minimum of eight weeks</a> and preferably 12 weeks to avoid relapse.</p>
<p>GPs can also <a href="https://www1.racgp.org.au/ajgp/2022/july/an-update-on-vaping-and-nicotine-prescribing">prescribe</a> nicotine liquid (non-flavoured) for a refillable e-cigarette. But clinical guidelines recommend discouraging vaping because of their ongoing addictive nature because <a href="http://www.mja.com.au/system/files/issues/218_06/mja251890.pdf">they’re a gateway</a> for smoking tobacco. </p>
<p>Teens who vape are <a href="http://www.mja.com.au/system/files/issues/218_06/mja251890.pdf">three times more likely to take up smoking</a>. So addressing your teen’s vaping is an important preventative step for <a href="https://pubmed.ncbi.nlm.nih.gov/36156328/">both smoking and vaping</a> in future. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-can-i-help-my-teen-quit-vaping-201558">How can I help my teen quit vaping?</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/208586/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gillian Sandra Gould receives funding from the National Health and Medical Research Council, Global Alliance for Chronic Disease, Cancer Australia, Cure Cancer Australia, NSW Health, RACGP Foundation, and the Dept. of Health and Aged Care.
</span></em></p><p class="fine-print"><em><span>Marilyn Clarke receives funding from Dept of Health and NHMRC for research projects involving smoking cessation and pregnant Aboriginal women.</span></em></p><p class="fine-print"><em><span>Karen McFadyen does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Teens who quit vaping or drastically cut back are likely to experience withdrawal symptoms. Here’s how to support young adults through withdrawal and quitting.Gillian Sandra Gould, Professor in Health Equity, Southern Cross UniversityKaren McFadyen, Research Fellow, Faculty of Health, Southern Cross UniversityMarilyn Clarke, Senior Research Fellow, Southern Cross UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2116012023-08-30T12:18:09Z2023-08-30T12:18:09ZMany people think cannabis smoke is harmless − a physician explains how that belief can put people at risk<figure><img src="https://images.theconversation.com/files/544788/original/file-20230825-11495-v7ifhx.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2121%2C1412&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Cannabis smoke shares many of the same toxins and carcinogens as tobacco smoke.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/joint-in-the-hand-royalty-free-image/1036594994">Tunatura/iStock via Getty Images Plus</a></span></figcaption></figure><p>Though <a href="http://dx.doi.org/10.15585/mmwr.mm6946a4">tobacco use is declining</a> among adults in the U.S., <a href="http://doi.org/10.1001/jamapsychiatry.2015.1858">cannabis use is increasing</a>. Laws and policies regulating the use of tobacco and cannabis are also <a href="https://law.siu.edu/_common/documents/law-journal/articles-2020/fall-2020/2-cork-final.pdf">moving in different directions</a>.</p>
<p>Tobacco policies are becoming more restrictive, with bans on smoking in public places and limits on sales, such as statewide bans on flavored products. In contrast, more states are legalizing cannabis for medical or recreational use, and there are efforts to allow exceptions for cannabis in smoke-free laws. </p>
<p>These changes mean an increasing number of people are likely to get exposed to cannabis smoke. But how safe is direct and secondhand cannabis smoke?</p>
<p>I am a <a href="https://profiles.ucsf.edu/beth.cohen">primary care doctor and researcher</a> in a state where cannabis is now legal for medical and recreational use. My colleagues and I were interested in how opinions about tobacco and cannabis smoke safety have been changing during this time of growing cannabis use and marketing.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/u6yxo2msHvo?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">An increasing number of states have legalized recreational use of marijuana.</span></figcaption>
</figure>
<p>In our survey of over 5,000 U.S. adults in 2017, 2020 and 2021, we found that people <a href="https://doi.org/10.1001/jamanetworkopen.2023.28691">increasingly felt that exposure to cannabis smoke</a> was safer than tobacco smoke. In 2017, 26% of people thought that it was safer to smoke a cannabis joint than a cigarette daily. In 2021, over 44% chose cannabis as the safer option. People were similarly more likely to rate secondhand cannabis smoke as being “completely safe” compared with tobacco smoke, even for vulnerable groups such as children and pregnant women. </p>
<p>Despite these views, emerging research raises concerns about the health effects of cannabis smoke exposure.</p>
<h2>Do opinions on cannabis match the science?</h2>
<p>Decades of research and hundreds of studies have linked tobacco smoke to <a href="https://doi.org/10.1002/ijc.23033">multiple types of cancer</a> and to <a href="https://doi.org/10.1136/bmj.j5855">cardiovascular disease</a>. However, far fewer studies have been done on the long-term effects of cannabis smoke. Since cannabis remains <a href="https://en.wikipedia.org/wiki/Legality_of_cannabis_by_U.S._jurisdiction">illegal at the federal level</a>, it is more challenging for scientists to study. </p>
<p>It has been particularly hard to study health outcomes that may take a long time and heavier exposure to develop. Recent reviews of research on cannabis and <a href="https://doi.org/10.1001/jamanetworkopen.2019.16318">cancer</a> or <a href="https://doi.org/10.7326/M17-1548">cardiovascular disease</a> found those studies inadequate because they contained relatively few people with heavy exposure, didn’t follow people for a long enough time or didn’t properly account for cigarette smoking. </p>
<p>Many advocates point to the lack of clear findings on negative health effects of cannabis smoke exposure as proof of its harmlessness. However, my colleagues and I feel that this is an example of the famous scientific quote that “absence of evidence is not evidence of absence.”</p>
<p>Scientists have identified hundreds of chemicals in both cannabis and tobacco smoke, and they share <a href="https://doi.org/10.1021/tx700275p">many of the same</a> <a href="https://doi.org/10.1038/s41598-020-63120-6">carcinogens and toxins</a>. Combustion of tobacco and cannabis, whether by smoking or vaping, also releases particles that can be <a href="https://doi.org/10.1289/EHP8689">inhaled deep into the lungs</a> and cause tissue damage. </p>
<p>Animal studies on the effects of secondhand tobacco and cannabis smoke show similar concerning effects on the cardiovascular system. These include impairments in <a href="https://doi.org/10.1161/JAHA.116.003858">blood vessel dilation</a>, <a href="https://doi.org/10.1016/j.hrthm.2022.09.021">increased blood pressure</a> and reduced heart function.</p>
<p>Though more research is needed to determine the risk of lung cancer, heart attacks and strokes posed by cannabis smoke, what is already known has <a href="https://www.epa.gov/indoor-air-quality-iaq/secondhand-marijuana-smoke-and-indoor-air-quality">raised concerns among</a> <a href="https://www.cdc.gov/marijuana/health-effects/index.html">public health agencies</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/544792/original/file-20230825-19-xmkxiz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Hands of two people passing a joint between each other" src="https://images.theconversation.com/files/544792/original/file-20230825-19-xmkxiz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/544792/original/file-20230825-19-xmkxiz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/544792/original/file-20230825-19-xmkxiz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/544792/original/file-20230825-19-xmkxiz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/544792/original/file-20230825-19-xmkxiz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/544792/original/file-20230825-19-xmkxiz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/544792/original/file-20230825-19-xmkxiz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Public perceptions of the safety of cannabis determine how it is used and regulated.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/hands-of-man-and-woman-passing-marijuana-joint-royalty-free-image/1087610046">Jamie Grill/Tetra images via Getty Images</a></span>
</figcaption>
</figure>
<h2>Why do opinions on cannabis matter?</h2>
<p>How people perceive the safety of cannabis has important implications for its use and public policy. Researchers know from <a href="https://doi.org/10.1016/j.drugalcdep.2018.03.012">studying cannabis</a> and <a href="https://doi.org/10.1111/j.1465-7295.2007.00079.x">other substances</a> that if people think something is less risky, they are more likely to use it. Opinions on cannabis safety will also shape medical and recreational cannabis use laws and other policies, such as whether cannabis smoke will be treated like tobacco smoke or whether exceptions will be made in smoke-free air laws.</p>
<p>Part of the complexity in decisions about cannabis use is that, unlike tobacco, clinical trials have demonstrated that cannabis can have <a href="https://doi.org/10.17226/24625">benefits in certain settings</a>. These include managing specific types of chronic pain, reducing nausea and vomiting associated with chemotherapy and increasing appetite and weight gain in those with HIV/AIDS. Notably, many of these studies were not based on smoked or vaped cannabis. </p>
<p>Unfortunately, though Googling cannabis will return thousands of hits about the health benefits of cannabis, many of these claims <a href="https://doi.org/10.1007/s11606-020-06421-w">aren’t supported by scientific research</a>.</p>
<p>I encourage people who want to learn more about the <a href="https://doi.org/10.2105%2FAJPH.2017.303818">potential benefits and risks of cannabis</a> to talk to health care providers or seek sources that present an unbiased view of the scientific evidence. The <a href="https://www.nccih.nih.gov/health/cannabis-marijuana-and-cannabinoids-what-you-need-to-know">National Center for Complementary and Integrative Health</a> has a good overview of studies on cannabis for treatment of a variety of medical conditions, as well as information about potential risks.</p><img src="https://counter.theconversation.com/content/211601/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Beth Cohen receives funding from the Tobacco Related Disease Research Program and National Institutes of Health. </span></em></p>Clinical trials have demonstrated the health benefits of cannabis for certain conditions, but many aren’t testing smoked or vaped forms. Research on cannabis smoke is raising concerns.Beth Cohen, Professor of Medicine, University of California, San FranciscoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2065952023-06-27T20:07:29Z2023-06-27T20:07:29Z‘The dirty disease’ – both smokers and non-smokers get lung cancer. They face stigma on top of illness<figure><img src="https://images.theconversation.com/files/532865/original/file-20230620-17-3stso2.jpg?ixlib=rb-1.1.0&rect=35%2C44%2C5955%2C3943&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/elderly-asian-woman-sitting-wheelchair-hospital-2148997691">Shutterstock</a></span></figcaption></figure><p>Earlier this year, federal health minister Mark Butler announced <a href="https://www.health.gov.au/our-work/national-lung-cancer-screening-program">a new national Lung Cancer Screening Program</a>. The first of its kind for lung cancer, the screening program will open initially to current and former smokers aged 50 to 70 years by July 2025. It aims to <a href="https://insightplus.mja.com.au/2023/20/world-leading-lung-cancer-screening-could-save-500-lives-each-year/">save lives</a> by detecting lung cancer earlier. </p>
<p>Since the 1980s, highly successful <a href="https://www.youtube.com/watch?v=QnTcb-DR4RU&ab_channel=QuitlineNewZealand">public health campaigns</a> have raised awareness about the dangers of smoking and, in economically wealthy countries like Australia, the rate of smoking has dropped considerably. </p>
<p>Unfortunately, the success of anti-smoking campaigns has been accompanied by growing stigma around lung cancer. In fact, <a href="https://www.lungcancercoalition.org/wp-content/uploads/2021/03/Australia-data-briefing-FINAL.pdf">28% of Australians</a> admit they have less sympathy for lung cancer sufferers than those with other forms of cancer. And when it comes to an array of health issues, stigma negatively affects <a href="https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-019-1256-2">diagnosis, treatment and outcomes</a>. </p>
<p><a href="https://lungfoundation.com.au/blog/dealing-with-feelings-of-stigma-and-shame/">Patient support groups</a>, <a href="https://www.cosa.org.au/media/dkblellu/9-lung-cancer-screening-media-release-final.pdf">professional associations</a> and <a href="https://www.cancercouncil.com.au/news/lung-cancer-stigma-harms-survivors/">peak bodies</a> are all in agreement that we need to rethink and modernise our understanding and approach to lung cancer, smoking and stigma. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/can-vaping-help-people-quit-smoking-its-unlikely-204812">Can vaping help people quit smoking? It's unlikely</a>
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</em>
</p>
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<h2>More never-smokers are getting diagnosed</h2>
<p>As well as the National Lung Cancer Screening Program, May saw the announcement of a <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/taking-action-on-smoking-and-vaping">nationwide ban</a> on the sale of nicotine vapes in response to alarming increases in both vaping and smoking <a href="https://twitter.com/Lungfoundation/status/1664494389857755138">among young people</a>. The vaping ban sparked a national conversation about the use of nicotine products, but little media attention has been paid to the lung cancer screening program. </p>
<p>Lung cancer is the <a href="https://www.aihw.gov.au/reports/cancer/lung-cancer-in-australia-overview/summary">fourth most</a> diagnosed cancer in Australia and the leading cause of cancer-related death in Australia, followed by breast cancer. </p>
<p>While there is no disputing the link between lung cancer and smoking, nor the value of public health measures like the <a href="https://theconversation.com/vaping-and-behaviour-in-schools-what-does-the-research-tell-us-204794">recent vaping ban</a>, the proportion of people diagnosed with lung cancer who have <a href="https://pubmed.ncbi.nlm.nih.gov/28783541/">never smoked</a> – especially <a href="https://pubmed.ncbi.nlm.nih.gov/28132018/">young women</a> – is increasing. There is also growing recognition of other lung cancer risks such as <a href="https://pubmed.ncbi.nlm.nih.gov/32848276/">environmental exposures</a> and <a href="https://www.nature.com/articles/s41586-023-05874-3">air pollution</a>.</p>
<p>Despite this, lung cancer receives <a href="https://www.canceraustralia.gov.au/sites/default/files/publications/cancer-research-australia-overview-funding-cancer-research-projects-and-programs-australia-2012-2020/pdf/cancer_of_funding_for_cancer_research_projects_and_programs_in_australia_2012_to_2020_final.pdf">less funding</a> (around 30% of what breast cancer receives) and is beset by poor screening, delayed diagnoses and low survival rates. The <a href="https://lungfoundation.com.au/wp-content/uploads/2018/09/Infographic-Lung-cancer-Oct2018.pdf">symptoms</a> of lung cancer – including new cough, hoarse voice, coughing up blood, breathlessness, weightloss – can be missed and lead to diagnosis when the disease is already advanced.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1650666415488221189"}"></div></p>
<p>Unfortunately, cancer as a disease is prone to various forms of moralising and many Australians think that ex-smokers “<a href="https://theconversation.com/its-your-fault-you-got-cancer-the-blame-game-that-doesnt-help-anyone-66995">deserve</a>” lung cancer as a consequence of their health behaviours. </p>
<p>But smoking and other so-called “lifestyle choices” are <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0135338">highly dependent</a> on social status, family environment, wealth, and educational exposure over a lifetime.</p>
<p>Lung cancer <a href="https://academic.oup.com/ije/article/50/3/942/6118443">disproportionately impacts</a> people of Aboriginal and Torres Strait Islander heritage, those in regional and rural areas and those with lower socioeconomic backgrounds.</p>
<p>Smoking is not simply an individual choice, but rather is heavily influenced by one’s social context. Likewise, developing lung cancer, much like heart disease or diabetes, is not a personal or moral failing, despite having clear lifestyle links.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/new-funds-will-tackle-indigenous-smoking-but-heres-what-else-we-know-works-for-quit-campaigns-205016">New funds will tackle Indigenous smoking. But here's what else we know works for quit campaigns</a>
</strong>
</em>
</p>
<hr>
<h2>‘It’s the dirty disease’</h2>
<p>In our recent study, we interviewed 14 women and 3 men aged 30–72 and recruited from social media. They spoke about undergoing treatment for lung cancer. In addition to dealing with their illness and treatment, they faced significant stigma:</p>
<blockquote>
<p>[…] it’s the first time I’ve really been aware of the sort of shame attached to an illness.</p>
</blockquote>
<p>Some participants spoke about the lack of funding for lung cancer: </p>
<blockquote>
<p>[…] people don’t donate to lung cancer because we’re not pretty. We’re stinky and tobacco-y.</p>
</blockquote>
<p>And of how public health campaigns had contributed to stigma and needed to be updated:</p>
<blockquote>
<p>They know young people are getting it out there and it’s just not hitting the press because it’s the ‘dirty disease’. There is so many young people. Who deserves to die, whether they’re smokers or not? I mean, it needs to be acknowledged.</p>
<p>There needs to be another campaign around: Why are so many people getting lung cancer when they’ve never smoked?</p>
</blockquote>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/passive-vaping-time-we-see-it-like-secondhand-smoke-and-stand-up-for-the-right-to-clean-air-198766">Passive vaping – time we see it like secondhand smoke and stand up for the right to clean air</a>
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<h2>Changing the conversation</h2>
<p>The national lung cancer screening program is a step in the right direction to improve survival rates of lung cancer in Australia. But it’s important we confront the idea of lung cancer as a “dirty” disease, “brought on one’s self”. </p>
<p>The nationwide conversation around vaping provides as a good opportunity to do away with simplistic – and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6319257/">stigmatising</a> – narratives about nicotine use that characterise it as weak or shameful. It’s time to disrupt assumptions about lung cancer being solely attributable to a person’s decisions to smoke. And we need to recognise the importance of supporting and caring for people experiencing ill-health regardless of lifestyle “choices”.</p><img src="https://counter.theconversation.com/content/206595/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alex Broom receives funding from the Australian Research Council </span></em></p><p class="fine-print"><em><span>Katherine Kenny receives funding from The University of Sydney and The Australian Research Council</span></em></p><p class="fine-print"><em><span>Malinda Itchins has received honoraria payments from Pfizer, AstraZeneca, Takeda, Roche, Novartis, BMS, MSD, Bayer, consultancy fees from Roche, Merck, has received funds to sit on an advisory board for Pfizer, Takeda, Bayer, MSD, Amgen, Merck, Roche, Beigene and research grant funding from Pfizer.
Malinda is a Board Member and Lung Cancer Chair on Council for the not-for-profit organisation, Clinical Oncology Society of Australia (COSA). </span></em></p><p class="fine-print"><em><span>Jianni Tien does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The success of anti-smoking campaigns has come with growing stigma around lung cancer. Over one quarter of Australians admit they have less sympathy for lung cancer sufferers.Jianni Tien, Postdoctoral Research Fellow, University of SydneyAlex Broom, Professor of Sociology & Director, Sydney Centre for Healthy Societies, University of SydneyKatherine Kenny, ARC DECRA Senior Research Fellow, University of SydneyMalinda Itchins, Researcher, Department of Medical Oncology, Royal North Shore Hospital,, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1979122023-06-01T02:22:15Z2023-06-01T02:22:15ZHow raising tobacco taxes can save lives and cut poverty across the Asia-Pacific<figure><img src="https://images.theconversation.com/files/528759/original/file-20230529-25-x9rrqe.png?ixlib=rb-1.1.0&rect=281%2C215%2C3712%2C1928&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>The human costs of tobacco and smoking worldwide are huge. 1.3 billion people use tobacco, mostly in low- and middle-income countries. More than 8 million people die prematurely because of tobacco, at an annual economic loss of at least US$1.4 trillion. And you don’t have to be a smoker to be harmed: secondhand smoke exposure kills nearly 400,000 women every year.</p>
<p>Asia is home to seven of the world’s top 10 countries with the highest number of smokers: Bangladesh, China, India, Indonesia, Japan, the Philippines, and Viet Nam. Yet, according to <a href="https://www.undp.org/publications/policy-brief-pro-poor-taxes-sustainable-development-financing">our recent research</a> for the United Nations Development Programme, not enough being done to reduce tobacco’s harms. </p>
<p>That’s why it’s worth pointing out a solution that really works, yet not enough Asian nations have acted on it: raising tobacco prices through higher taxes. </p>
<p>As the Philippines, Australia and Aotearoa New Zealand have shown, doing that – coupled with other policy changes – can make a real difference.</p>
<h2>The pay-off for higher taxes</h2>
<p>Increasing tobacco taxes costs relatively little, but yields a high impact. </p>
<p>In <a href="https://www.undp.org/publications/policy-brief-pro-poor-taxes-sustainable-development-financing">our study</a> of six Asia-Pacific countries, we found that for every unit of local currency invested in increasing tobacco taxes, the countries would gain between 20 and 1,057 units in return over 15 years. That’s a remarkable return on investment ratio of between 20:1 and 1,057:1.</p>
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<p>One direct benefit is a substantial increase in government revenue. <a href="https://www.undp.org/cambodia/publications/investment-case-tobacco-control-cambodia">In Cambodia</a> alone, the projected additional government revenue would be US$230 million over five years from the recommended levels of tobacco tax increases.</p>
<p>And it would be pro-poor, pro-development, and pro-women. </p>
<h2>Who would benefit most?</h2>
<p>Smoking is responsible for <a href="https://documents1.worldbank.org/curated/en/726831505802275018/pdf/119792-REVISED-v1-FINAL-WBG-TobaccoTaxReform-ExecutiveSummary-web-003-pdf-english.pdf">nearly half</a> of the difference in death rates between wealthy and poor people, meaning measures that reduce smoking disproportionately benefit poor people.</p>
<p>People with low incomes – both men and women – are more likely to use tobacco than their wealthier counterparts. In Myanmar, for example, 41% of men and 4% of women in the lowest income group smoke, compared with 25% of men and 0.4% of women in the highest group. </p>
<p>It is true that tax increases initially make the low earners who don’t cut back worse off, but over time the <a href="https://www.adb.org/sites/default/files/publication/42475/tobacco-taxes-fiscal-space-and-benefit-poor.pdf">health gains</a> to low earners become more important.</p>
<p>Although the reductions in smoking-related deaths from higher taxes are concentrated in men, the financial benefits appear to flow to women.</p>
<p>As smokers quit, household budgets become easier, facilitating what a study in the British Medical Journal describes as an <a href="https://www.bmj.com/content/361/bmj.k1162">income transfer</a> from male smokers to females and other family members.</p>
<p>Lower smoking rates also protect female non-smokers from exposure to second-hand smoke at home and work.</p>
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<h2>How the Philippines became an Asia-Pacific leader</h2>
<p>In the Philippines, half of the excise tax collected from tobacco products and sugar-sweetened beverages, and 80% of the excise tax collected from alcohol and vaping products is used to fund healthcare services. </p>
<p>The remaining 20% of alcohol and vaping excise revenue is allocated to social development, while 5% of tobacco excise tax revenue is earmarked to support tobacco farmers, including to help them switch crops.</p>
<p>Among its many reforms, the Philippines also instituted a whole-of-public sector code of conduct to prevent tobacco industry interference in its public policymaking.</p>
<p>Between 2012 and 2015, substantial tax increases in the Philippines cut cigarette sales by 28% and cut the number smokers by 3 million, with the largest reductions among the <a href="https://www.researchgate.net/publication/342854587_Raising_Tobacco_Taxes_The_Philippine_Experience">poorest parts of the population</a>.</p>
<p>Yet despite the Philippines’ example and the clear benefits of significant tobacco tax increases, tobacco tax rates in most low income countries remain low. On average, tax accounts for only <a href="https://tobacconomics.org/research/cigarette-tax-scorecard/">19%</a> of the retail price of cigarettes in low-income countries, compared to 51% in high-income countries.</p>
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<h2>Higher taxes, fewer smokers in Australia & NZ</h2>
<p>Among other Asia-Pacific nations, Australia’s rate of tobacco excise has climbed from <a href="https://data.gov.au/data/dataset/excise-data/resource/b9227cdf-4c04-492d-bd84-65031adc408e">19</a> cents per cigarette in 1999 to <a href="https://www.ato.gov.au/Business/Tobacco-and-excise/Excise-duty-rates-for-tobacco/">A$1.16</a>, and will climb again by <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/taking-action-on-smoking-and-vaping">5% per year</a> for each of the next three years in addition to normal indexation.</p>
<p>Over that time the proportion of Australians aged 14 and over who smoke daily has plummeted from 22% to <a href="https://www.aihw.gov.au/reports/alcohol/alcohol-tobacco-other-drugs-australia/contents/drug-types/tobacco">11%</a>. The Australian government says it wants to get it below 10% by 2025 and to <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/taking-action-on-smoking-and-vaping">5%</a> by 2030.</p>
<p>Aotearoa New Zealand has gone even further with its <a href="https://www.smokefree.org.nz/smokefree-in-action/smokefree-aotearoa-2025">“Smokefree 2025” policy</a>, with a goal that by 2025, fewer than 5% of New Zealanders will be smokers. This strategy includes banning the sale of tobacco products to anyone born after Jan 1, 2009.</p>
<p>The NZ government increased the tobacco excise tax by inflation plus 10% each year between 2010 and 2020. Decades of efforts in tobacco control, including tobacco taxation, have resulted in smoking rates declining from <a href="https://tobaccocontrol.bmj.com/content/9/2/155">36% in 1976</a> to <a href="https://www.health.govt.nz/publication/annual-update-key-results-2019-20-new-zealand-health-survey">13% in 2020</a>. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1603093224515584000"}"></div></p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/new-zealand-is-introducing-law-to-create-a-smokefree-generation-here-are-6-reasons-to-support-this-policy-186283">New Zealand is introducing law to create a smokefree generation. Here are 6 reasons to support this policy</a>
</strong>
</em>
</p>
<hr>
<h2>Even smokers back higher tax – if it goes to health</h2>
<p>Higher taxes on cigarettes are overwhelmingly supported by non-smokers. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/528767/original/file-20230529-27-azrpvf.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/528767/original/file-20230529-27-azrpvf.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/528767/original/file-20230529-27-azrpvf.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=967&fit=crop&dpr=1 600w, https://images.theconversation.com/files/528767/original/file-20230529-27-azrpvf.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=967&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/528767/original/file-20230529-27-azrpvf.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=967&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/528767/original/file-20230529-27-azrpvf.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1215&fit=crop&dpr=1 754w, https://images.theconversation.com/files/528767/original/file-20230529-27-azrpvf.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1215&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/528767/original/file-20230529-27-azrpvf.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1215&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">60% of smokers in a US survey backed higher tax if it’s used for healthcare.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>But a US study has found that when the extra tax revenue is directed to healthcare programs, they are also overwhelmingly supported by smokers: 60% of those surveyed, up from 25% if the extra revenue is unallocated.</p>
<p>The tax gap between rich and poorer countries might be partly due to myths such as that increasing tobacco taxes </p>
<ul>
<li><p>disproportionately hurts poor people, </p></li>
<li><p>leads to massive job losses, and </p></li>
<li><p>substantially diminishes government revenue. </p></li>
</ul>
<p>Our <a href="https://www.undp.org/publications/policy-brief-pro-poor-taxes-sustainable-development-financing">policy brief</a> debunks these myths with evidence. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/nzs-smokefree-law-will-reduce-the-number-of-tobacco-retailers-heres-what-people-who-smoke-think-of-that-200436">NZ's smokefree law will reduce the number of tobacco retailers – here's what people who smoke think of that</a>
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</em>
</p>
<hr>
<p>Economic stress is brewing in many Asia-Pacific countries, with many under unprecedented pressure from stagnating revenue and growing needs for spending on health, education and social protection. </p>
<p>The United Nations’ <a href="https://hdr.undp.org/content/human-development-report-2021-22">Human Development Index</a> has declined for two consecutive years for the first time since data became available. </p>
<p>These extraordinary circumstances offer an extraordinary opportunity to act decisively. Taxation on tobacco and other harmful products should be one of them.</p>
<p><em>* This article was co-authored with Kazuyuki Uji, Policy Specialist, Health and Inclusive Development, United Nations Development Programme Bangkok Regional Hub.</em></p><img src="https://counter.theconversation.com/content/197912/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>This article was co-authored with Kazuyuki Uji, Policy Specialist, Health and Inclusive Development, United Nations Development Programme (UNDP) Bangkok Regional Hub. He has a long experience working on non-communicable diseases, including tobacco control, universal health coverage, access to health technologies, and disability rights. Sudyumna Dahal and Kazuyuki Uji both work for the UNDP. </span></em></p>Our study of six Asia-Pacific countries found that there would be a remarkable return on investment from higher tobacco taxes. The Philippines, Australia and New Zealand have already shown it works.Sudyumna Dahal, PhD Student, Australian National UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2066212023-05-30T11:49:49Z2023-05-30T11:49:49ZTobacco use is costly, but so is quitting. Surveys of 8 African countries show who needs help<figure><img src="https://images.theconversation.com/files/528876/original/file-20230529-17-hxj4e5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Media Lens King/Getty Images</span></span></figcaption></figure><p>Tobacco use imposes a large health and economic burden worldwide. Research <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8223261/#bib10">estimates</a> that, in 2019, about 8 million deaths were attributable to tobacco smoking. Tobacco also reduces <a href="https://www.who.int/data/gho/indicator-metadata-registry/imr-details/158">years of healthy living</a>: about 200 million <a href="https://www.who.int/data/gho/indicator-metadata-registry/imr-details/158#:%7E:text=Definition%3A-,One%20DALY%20represents%20the%20loss%20of%20the%20equivalent%20of%20one,health%20condition%20in%20a%20population.">disability-adjusted life years</a> in 2019. </p>
<p>This health burden comes with high economic costs, directly through medical treatment for tobacco-related diseases, and indirectly through productivity losses. Globally, the total economic cost of smoking amounted to around <a href="https://tobaccocontrol.bmj.com/content/27/1/58">1.8%</a> of the world’s annual GDP in 2012. Global studies are rare because they are so data intensive. </p>
<p>Though overall tobacco use has been <a href="https://www.annualreviews.org/doi/10.1146/annurev-publhealth-032315-021850?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub++0pubmed">declining</a> in most high-income countries since the 1970s, it has been stable or rising in most low- and middle-income countries. Today, more than <a href="https://www.who.int/news-room/fact-sheets/detail/tobacco#:%7E:text=Over%2080%25%20of%20the%20world's,(WHO%20FCTC)%20in%202003.">80%</a> of the world’s smokers live in low- and middle-income countries, resulting in a skewed burden of disease. </p>
<p>This skewed burden of tobacco-related disease exists within countries too. In <a href="https://cancercontrol.cancer.gov/sites/default/files/2020-06/m21_2.pdf">most countries</a>, tobacco use is disproportionately prevalent among the poor - the very people who can least afford to finance the healthcare and financial costs associated with it.</p>
<p>Tobacco use is not only about who smokes but about who quits. In high-income <a href="https://doi.org/10.1136/jech-2014-205171">countries</a>, it’s mostly wealthier users who attempt to quit – and who succeed. But research on cessation in lower income countries has been scarce.</p>
<p>A <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0277702#sec018">study</a> I co-authored with <a href="https://www.iash.ed.ac.uk/profile/dr-laura-rossouw">Dr Laura Rossouw</a> set out to fill some gaps. We decided to measure inequalities in tobacco cessation in eight sub-Saharan African countries. Using the most recent <a href="https://www.who.int/teams/noncommunicable-diseases/surveillance/systems-tools/global-adult-tobacco-survey">Global Adult Tobacco Surveys</a> in Botswana, Cameroon, Ethiopia, Kenya, Nigeria, Senegal, Tanzania and Uganda, we found that the people most likely to try and succeed at quitting were wealthier and better-educated individuals. Inequalities in ability to stop using tobacco were associated with socio-economic status, urban or rural residence, and not knowing or believing that tobacco consumption leads to serious illness.</p>
<p>We suggest that governments in these countries can do more to support socio-economically disadvantaged smokers in their efforts to stop using tobacco. Their strategies should be aligned with the guidelines outlined in the <a href="https://fctc.who.int/who-fctc/overview">World Health Organization’s (WHO) Framework Convention on Tobacco Control</a>.</p>
<p>Providing subsidised medical support to smokers trying to quit could make these services more accessible to the poor. This would ease the <a href="https://cancercontrol.cancer.gov/sites/default/files/2020-06/m21_2.pdf">disproportionate</a> health and financial burden of the tobacco-related illnesses that they suffer.</p>
<h2>Who uses tobacco</h2>
<p>Our analysis used nationally representative surveys of individuals aged 15 and older from each of the eight countries included in our sample. The Global Adult Tobacco Survey captures information about who is using tobacco and in what form, as well as demographic and socio-economic variables. It’s a standard survey design which allows comparison of countries. </p>
<p>We chose the eight sub-Saharan countries based on availability of data. The earliest survey was conducted in 2012 in Nigeria; the most recent, in Tanzania in 2018. Each survey recorded information on thousands of individuals – tobacco users and non-users. It also showed who had attempted to quit.</p>
<p>Across the countries, tobacco users were more likely to be in the lowest income group. In Uganda, Tanzania, Kenya, and Botswana, more than 40% of current and past tobacco users were in the lowest fifth of the income spectrum. And in Cameroon, Ethiopia, Kenya, Senegal and Uganda, more than 50% of current and past tobacco users had not completed any formal education.</p>
<p>Smokers who had tried to stop in the past year made up as many as 53% of current smokers (in Botswana), and at least 29% (Cameroon).</p>
<p>Our analysis showed that differences in wealth status contributed to inequalities between former and current tobacco users. Education widened the wealth-related gap. Living in an urban area (versus rural) did so too in some of the countries but not in Ethiopia, Senegal and Uganda. Tobacco health knowledge also played a part in creating inequality between richer and poorer smokers. Being misinformed about tobacco’s health consequences was concentrated among individuals with lower levels of education.</p>
<p>Our results showed that attempts to stop using tobacco – and successful attempts – were concentrated among wealthier individuals and those with higher levels of education.</p>
<h2>What helps smokers quit?</h2>
<p>The WHO’s guidelines, ratified by <a href="https://fctc.who.int/who-fctc/overview/parties">182 countries</a>, show which policies work best to reduce tobacco use. The WHO also <a>monitors</a> which countries are using the policies. </p>
<p>Among the <a href="https://www.who.int/initiatives/mpower">key policies</a> are warning about the dangers of tobacco use, banning advertising, offering help to quit, and taxing tobacco products.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-ghana-is-using-graphic-pictures-to-cut-tobacco-use-116845">How Ghana is using graphic pictures to cut tobacco use</a>
</strong>
</em>
</p>
<hr>
<p>The most recent WHO <a href="https://www.who.int/publications/i/item/9789240032095">Report on the Global Tobacco Epidemic</a> (2021) covers all 195 of the world’s countries. It shows there has been progress in following policies to reduce tobacco demand. </p>
<p>But of all the recommended measures to reduce the demand for tobacco, the least progress has been made with:</p>
<ul>
<li><p>offering tobacco users help to quit </p></li>
<li><p>raising tobacco taxes.</p></li>
</ul>
<p>A large body of <a href="https://cancercontrol.cancer.gov/sites/default/files/2020-06/m21_complete.pdf">evidence</a> conclusively shows that tobacco taxation is the most effective and efficient way to reduce tobacco consumption. But right now, out of all the policies, best-practice tobacco tax <a href="https://fctc.who.int/docs/librariesprovider12/technical-documents/who-fctc-article-6-guidelines.pdf?sfvrsn=3bee36c8_50&download=true">policies</a> protect the least number of people in the world. </p>
<p>As for offering <a href="https://theconversation.com/tobacco-control-south-africa-must-do-more-to-help-people-quit-smoking-161628">services</a> to tobacco users trying to quit: 55% of all low-income countries offer no support at all. No low-income countries offer the best-practice services. </p>
<p>Counselling and medication can <a href="https://www.cdc.gov/tobacco/data_statistics/sgr/2020-smoking-cessation/fact-sheets/healthcare-professionals-health-systems/index.html">more than</a> double a tobacco user’s chance of successfully quitting. But paying for it is a <a href="https://linkinghub.elsevier.com/retrieve/pii/S0091743519301057">challenge</a>. </p>
<p>There’s an opportunity to use tobacco taxation not only to reduce the demand for tobacco, but also to <a href="https://www.who.int/publications/i/item/9789240019188">generate revenue</a> for efforts to help users quit. </p>
<h2>Action is required</h2>
<p>Governments have an opportunity to reap health benefits for their citizens, and financial benefits for their country, through implementation of evidence-based tobacco-control policies.</p>
<p><a href="https://link.springer.com/article/10.1007/s00181-022-02226-4">Research</a> shows that a healthy population is a more productive and prosperous one.</p><img src="https://counter.theconversation.com/content/206621/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sam Filby works for the Research Unit on the Economics of Excisable Products based at the University of Cape Town. Her research is funded by the African Capacity Building Foundation through the Bill & Melinda Gates Foundation, Tax Justice Network Africa (also through the Bill & Melinda Gates Foundation), the CDC Foundation, and Cancer Research UK. Sam is also CIO of byegwaai, an app-based smoking cessation program.</span></em></p>In low-income countries, tobacco use is often associated with lower income and less education. These users can’t afford to pay for counselling and medication.Sam Filby, Research Officer, Research Unit on the Economics of Excisable Products, University of Cape TownLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2049592023-05-12T12:11:33Z2023-05-12T12:11:33ZIs loneliness really as damaging to your health as smoking 15 cigarettes a day?<p>Vivek Murthy, the US surgeon general, recently warned that “being socially disconnected” has a similar effect on mortality as smoking <a href="https://www.hhs.gov/sites/default/files/surgeon-general-social-connection-advisory.pdf">up to 15 cigarettes a day</a>. This statement was widely reported in the media, including in the <a href="https://www.washingtonpost.com/business/2023/05/08/this-epidemic-of-isolation-is-as-harmful-as-smoking/3f2d683a-eda5-11ed-b67d-a219ec5dfd30_story.html">Washington Post</a>, <a href="https://www.thetimes.co.uk/article/loneliness-does-damage-of-15-cigarettes-a-day-5jrw7knc7">the Times</a> and the <a href="https://www.dailymail.co.uk/health/article-12037641/Americas-doctor-warns-LONELINESS-epidemic-deadly-smoking-15-cigarettes-day.html">Daily Mail</a>. But where does this “15 cigarettes a day” figure come from?</p>
<p>Dr Murthy is referring to <a href="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1000316#abstract1">a study published in 2010</a> that explored social relationships and mortality rates. The researchers combined the data from 148 studies on the topic, in what is known as a “meta-analysis”, to arrive at a more robust statistical answer to their questions. </p>
<p>The meta-analysis contained data on 300,000 participants who were studied for an average of seven and a half years. The researchers explored the extent to which social relationships can influence the risk of premature death, the aspects of social relationships that are most likely to predict an early death, and any factors that mitigate the risk. </p>
<p>They concluded that lonely people are 50% more likely to die prematurely than people with strong social relationships. They then used a statistical tool called “random effects models” to compute that the influence of social relationships on the risk of death is comparable to well-established risk factors for death, such as smoking cigarettes.</p>
<p>Although the methodology the researchers used was sound – and loneliness is certainly damaging for health – it could be argued that the “equivalent to 15 cigarettes a day” analogy is sensationalist. </p>
<p>The researchers also pointed out that the health risks of loneliness are similar to alcohol consumption (more than six drinks a day) and exceed other risk factors, such as physical inactivity and obesity. Yet these comparisons are rarely mentioned in the media or keynote speeches as they don’t have the same impact as smoking. </p>
<p>The smoking comparison also has the potential to add to the burden of people who feel lonely and exacerbate the stigma associated with loneliness. However, the effectiveness of the analogy cannot be underestimated. Thirteen years on, the paper continues to raise awareness about loneliness and the associated damaging health consequences.</p>
<h2>Studies that didn’t grab the headlines</h2>
<p>Other studies that are just as robust, but perhaps fail to grab the headlines in the same way, have likewise shown a range of health conditions associated with loneliness and social isolation, including <a href="https://pubmed.ncbi.nlm.nih.gov/27091846/">heart disease and stroke</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8511338/#R12">type 2 diabetes</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8511338/">rheumatoid arthritis</a> and <a href="https://digitalwellbeing.org/wp-content/uploads/2020/03/An-overview-of-systematic-reviews-on-the-public-health-consequences-of-social-isolation-and-loneliness.pdf">cancer</a>. Even recovery following <a href="https://www.researchgate.net/publication/336492953_Loneliness_social_isolation_and_cardiovascular_risk">heart surgery</a> can be compromised by isolation. </p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/16594799/">Mental health conditions</a> can also be triggered by loneliness, including loss of hope, depression, problems with sleep, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4225959/">alcohol abuse</a> and other psychiatric disorders. Lonely people also have heightened <a href="https://www.pnas.org/doi/epdf/10.1073/pnas.1514249112">sensitivity to social threat</a>. It is believed loneliness has an <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3855545/">evolutionary function</a> that is felt in a similar way to hunger or thirst and is a signal to people to change their lifestyle and social connections. However, when loneliness becomes chronic it can be different to break out of and for people to know how to overcome the negative feelings they are experiencing. </p>
<p>Loneliness is also associated with an increased risk of <a href="https://pubmed.ncbi.nlm.nih.gov/30914351/">developing dementia</a>.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/B8pa506BFk4?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Dr Vivek Murthy’s address on loneliness.</span></figcaption>
</figure>
<p>The number of people experiencing loneliness <a href="https://www.nature.com/articles/s41599-021-00710-3">increased sharply during the pandemic</a>, including among <a href="https://pdfs.semanticscholar.org/d4b8/7055101c6b3988c43eb3a53f59b8be68e986.pdf">young adults</a>. The pandemic also accelerated societal transformations, such as remote working and online shopping, that have exacerbated the loneliness epidemic.</p>
<p>The need to address loneliness is further heightened by its costs to health services, businesses and economies. The annual cost of loneliness to the UK economy and UK private sector employers could be <a href="http://allcatsrgrey.org.uk/wp/wpfb-file/rb_dec17_jocox_commission_finalreport-pdf-2/">as high as £32 billion</a> and <a href="https://www.campaigntoendloneliness.org/costs-of-loneliness/#:%7E:text=This%20report%2C%20launched%20jointly%20by,%C2%A32.5%20billion%20a%20year.">£2.5 billion</a> respectively.</p>
<p>So, while Dr Murthy is correct – loneliness can harm your health as much as smoking – there are also many other ways of measuring its harmful impacts.</p><img src="https://counter.theconversation.com/content/204959/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrea Wigfield has received funding from a range of organisations for her work on loneliness including National Lottery Community Fund, Leeds Older People's Forum, Leeds City Council, Unilever, British Red Cross, Co-operative Society, Age UK. </span></em></p><p class="fine-print"><em><span>Jan Gurung and Laura Makey do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A statistic from a 2010 study is doing the rounds again. But is it helpful?Andrea Wigfield, Professor Applied Social and Policy Research; Director, Centre for Loneliness Studies, Sheffield Hallam UniversityJan Gurung, Researcher in Centre for Loneliness Studies, Sheffield Hallam UniversityLaura Makey, PhD Candidate, Sheffield Hallam UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2017162023-05-07T08:28:51Z2023-05-07T08:28:51ZMental health: almost half of Johannesburg students in new study screened positive for probable depression<figure><img src="https://images.theconversation.com/files/522267/original/file-20230421-15-slnlgo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Wesley Lazarus/Shutterstock </span></span></figcaption></figure><p>Depression is a mental health disorder characterised by a persistently low mood or loss of interest in activities. It causes significant impairment in daily life. Possible causes include a combination of biological, psychological and social sources of distress. </p>
<p>It’s a major mental illness that largely goes undiagnosed. Survey <a href="https://doi.org/10.1192/bjp.187.6.495">estimates</a> put the lifetime risk of depression at 10%. This makes depression one of the <a href="https://www.who.int/news-room/fact-sheets/detail/depression#:%7E:text=Approximately%20280%20million%20people%20in%20the%20world%20have%20depression%20(1)">most common mental illnesses</a>. In 2019, the World Health Organization estimated that <a href="https://www.who.int/news-room/fact-sheets/detail/depression#:%7E:text=Approximately%20280%20million%20people%20in%20the%20world%20have%20depression%20(1)">280 million</a> people in the world – about 3.8% of the population – had depression. </p>
<p>Projections for South Africa are alarming, with research suggesting that <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4038770/">one in three people</a> will experience depression, anxiety or a substance use disorder in their lifetime. </p>
<p>University students are particularly at <a href="https://pubmed.ncbi.nlm.nih.gov/30211576/">high risk</a> of depression. One South African study estimated that <a href="https://www.tandfonline.com/doi/full/10.1080/07448481.2016.1178120">24.2%</a> of university students have mild depression, and <a href="https://www.tandfonline.com/doi/full/10.1080/07448481.2016.1178120">12.4%</a> have moderate to severe depression. Globally, an average of about <a href="https://psycnet.apa.org/manuscript/2018-44951-001.pdf#page=17">21%</a> of university students have major depressive disorder.</p>
<p>This is concerning because students with depression face very specific challenges. These include: </p>
<ul>
<li><p>worse <a href="https://pubmed.ncbi.nlm.nih.gov/7793438/">academic outcomes</a></p></li>
<li><p>low productivity</p></li>
<li><p>more likely to struggle with <a href="https://pubmed.ncbi.nlm.nih.gov/15060400/">alcohol abuse</a> in their adulthood </p></li>
<li><p>and high <a href="https://pubmed.ncbi.nlm.nih.gov/21823951/">rates of suicide</a>. </p></li>
</ul>
<p>It is clear that this population group needs targeted interventions. Up-to-date research on the prevalence and drivers of depression among students is crucial to inform potential interventions in this group.</p>
<p>The studies that have been done in South Africa do not cover the student population across the country. There’s a lack of data on the prevalence and drivers of depression among students in Johannesburg. Johannesburg is South Africa’s main commercial city and has the country’s highest population of students. To address this gap, we recently conducted an <a href="https://www.frontiersin.org/articles/10.3389/fpsyt.2023.1018197/full">online survey</a> among undergraduate students at the University of the Witwatersrand in South Africa.</p>
<p>Almost half of the study participants screened positive for probable depression. Probable depression was associated with socio-demographic factors such as economic status, and modifiable behavioural factors such as substance use. These two factors are commonly identified correlates of depression in this group. The prevalence of probable depression among undergraduate students in this study was high relative to the general population. Our findings are an important step towards helping universities tailor mental health programmes to students’ needs.</p>
<h2>Our study</h2>
<p>We used the <a href="https://aidsetc.org/sites/default/files/resources_files/PHQ-2_English.pdf">Patient Health Questionnaire (PHQ-2)</a> to assess the prevalence of probable depression. We also identified factors associated with probable depression. These factors included age, marital status and substance use (alcohol, cannabis, tobacco and other substances). </p>
<p>We had a response rate was 8.4% (1,046/12,404). Though low, such response rates are common in online surveys. While our survey should be interpreted with caution, the key findings are similar to other <a href="https://pubmed.ncbi.nlm.nih.gov/32664032/">studies elsewhere</a>.</p>
<p>Forty-eight per cent (439/910) screened positive for probable depression.</p>
<p>Certain socio-demographic factors were associated with lower odds of screening positive for probable depression. Students who identified as white were 36% less likely than black students to screen positive for depression. Those who could afford the most important things – but few luxury goods – were 50% less likely to screen positive for depression than those who had enough money for food and clothes, but were short of many other things.</p>
<p>Students with enough money for luxury goods and extra things were 56% less likely than those who had enough money for food and clothes, but were short of many other things, to screen positive for depression. These findings are similar to a recent <a href="https://sajp.co.za/index.php/SAJP/article/view/1795">study</a> among undergraduate physiotherapy clinical students. </p>
<p>Students who reported substance use had higher odds of screening positive for probable depression. But the probabilities varied based on the substance used. </p>
<p>Those reporting using cannabis were 29% more likely than students who didn’t use cannabis to screen positive for probable depression. It’s important to note that the global <a href="https://www.cambridge.org/core/journals/psychological-medicine/article/association-between-cannabis-use-and-depression-a-systematic-review-and-metaanalysis-of-longitudinal-studies/B144B7AE5A3D973289DBDD99ADE21E58">findings</a> on the <a href="https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2723657">association</a> between cannabis use and depression <a href="https://pubmed.ncbi.nlm.nih.gov/17662880/">vary</a>. But our finding is an important consideration given the legal use of cannabis in South Africa.</p>
<p>Reported alcohol use was common in our study. But it was not associated with screening positive for probable depression. This is contrary to <a href="https://onlinelibrary.wiley.com/doi/10.1111/add.14935">findings</a> from other <a href="https://pubmed.ncbi.nlm.nih.gov/31733662/">studies</a>. Our study did not find an association between tobacco use and screening positive for probable depression. But other <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-9-356">researchers</a> have reported a strong association between smoking and depression in adolescents and adults. While we did not find significant associations between alcohol and tobacco use and screening positive for depression, we believe these are important correlates. Alcohol and tobacco are often used as coping mechanisms for individuals with depression. </p>
<h2>Recommendations</h2>
<p>The odds of screening positive for depression were associated with specific sociodemographic and selected behavioural factors. </p>
<p>Mental health professionals working with undergraduate students at the University of Witwatersrand should strengthen mental health (including depression) and risk factors (substance use) screening and referral for treatment services. </p>
<p>In addition, these findings call for strengthening the awareness and use of existing counselling services among undergraduate students at the campus and other services out of the university campus, such as the South African Depression and Anxiety Group’s <a href="https://www.sadag.org/index.php?option=com_content&view=article&id=11&Itemid=114">help line</a>.</p><img src="https://counter.theconversation.com/content/201716/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Joel Msafiri Francis receives funding from the South Africa National Research Foundation (NRF) and the University of the Witwatersrand. </span></em></p>University students are particularly at high risk of depression. One global study suggests 21% of students have major depressive disorder.Joel Msafiri Francis, Senior Researcher, University of the WitwatersrandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2050162023-05-05T07:04:25Z2023-05-05T07:04:25ZNew funds will tackle Indigenous smoking. But here’s what else we know works for quit campaigns<figure><img src="https://images.theconversation.com/files/524535/original/file-20230504-29-jg5f4w.jpg?ixlib=rb-1.1.0&rect=0%2C88%2C1000%2C562&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/beautiful-african-american-girl-breaking-cigarette-2280036417">Studio Romantic/Shutterstock</a></span></figcaption></figure><p>Among all the talk this week about a <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/taking-action-on-smoking-and-vaping">crackdown on vaping</a> – the most significant <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/minister-for-health-and-aged-care-speech-national-press-club-2-may-2023?language=en">tobacco control reforms</a> in a decade – has been the roll-out of another major document.</p>
<p>The <a href="https://www.health.gov.au/resources/publications/national-tobacco-strategy-2023-2030">National Tobacco Strategy 2023–2030</a> was launched this week.</p>
<p>A key priority of the strategy is Aboriginal and Torres Strait Islander smoking and <a href="https://www.closingthegap.gov.au/">Closing the Gap</a>. We heard the Tackling Indigenous Smoking program would be extended and widened – <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/taking-action-on-smoking-and-vaping?language=en">with A$141 million funding</a> – to reduce both vaping and smoking among Aboriginal and Torres Strait Islander people.</p>
<p>Here’s why that’s urgently needed and what needs to happen next to reduce smoking rates among Aboriginal and Torres Strait Islander people.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/we-can-cut-indigenous-smoking-and-save-lives-heres-how-42119">We can cut Indigenous smoking and save lives – here's how</a>
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</em>
</p>
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<h2>Tobacco is still a killer</h2>
<p>Tobacco <a href="https://www.aihw.gov.au/news-media/media-releases/2019/october/tobacco-use-linked-to-more-than-1-in-8-deaths-but">legally kills</a> over 57 Australians a day. That’s equivalent to extinguishing an entire country town of 21,000 every year. </p>
<p>It’s still the single biggest <a href="https://www.aihw.gov.au/reports-data/health-conditions-disability-deaths/burden-of-disease/overview">preventable</a> risk factor for disease and premature death. For Aboriginal and Torres Strait Islander <a href="https://www.aihw.gov.au/reports/burden-of-disease/illness-death-indigenous-2018/summary">people</a>, <a href="https://academic.oup.com/ije/article/50/3/942/6118443">more than a third</a> of all deaths are caused by tobacco. Over the past decade we have lost more than <a href="https://academic.oup.com/ije/article/50/3/942/6118443">10,000</a> Aboriginal and Torres Strait Islander lives due to smoking.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1654018018169753600"}"></div></p>
<p><a href="https://healthbulletin.org.au/articles/review-of-tobacco-use-among-aboriginal-and-torres-strait-islander-peoples/">Multiple policy failures</a> beyond health – from poverty, education, employment, housing, family removals, dislocation and the systematic embedding of tobacco as rations <em>in lieu</em> of wages – mean Aboriginal and Torres Strait Islander people are disproportionately impacted by the harms of Big Tobacco. </p>
<p>So the <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/taking-action-on-smoking-and-vaping?language=en">funding</a> to expand the <a href="https://tacklingsmoking.org.au/">Tackling Indigenous Smoking program</a> is urgently needed to have no more than 27% of Aboriginal and Torres Strait Islander smoking by 2030 (5% of all Australians).</p>
<p>There have been huge achievements in reducing Aboriginal and Torres Strait Islander smoking. In <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/1753-6405.13049">2018–19</a>, 40% of Aboriginal and Torres Strait Islander adults smoked daily, down from 50% in 2004–05. A target of 27% is achievable. But to get there we need something “extra” to accelerate those reductions.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/heres-how-to-close-the-gap-on-indigenous-women-smoking-during-pregnancy-62347">Here's how to close the gap on Indigenous women smoking during pregnancy</a>
</strong>
</em>
</p>
<hr>
<h2>We know what works</h2>
<p>Tobacco campaigns are one of the most <a href="https://www.tobaccoinaustralia.org.au/chapter-14-social-marketing/14-1-social-marketing-and-public-education-campaig">cost-effective</a> <a href="https://tobaccocontrol.bmj.com/content/tobaccocontrol/21/2/127.full.pdf">interventions</a> when evidence-based, market-tested, sustained and with support services at the end of the call to action. When they are adequately funded, they can <a href="https://tobaccocontrol.bmj.com/content/31/2/284">impact inequities</a>.</p>
<p>Campaigns must be personally relevant and meaningful <a href="https://www.wiley.com/en-au/Health+Behavior%3A+Theory%2C+Research%2C+and+Practice%2C+5th+Edition-p-9781118629000">to be effective</a>. This makes the case for targeted approaches, including local level campaigns, reinforced by general, national activity. Audiences engage with the message when they can see themselves and their community members (sometimes actually) in the advertising.</p>
<p>We saw this nationally with <a href="https://www.youtube.com/watch?v=0yvjBU-E0aw">Break the Chain</a> starring Aboriginal actor and comedian Elaine Crombie. Originally this was a targeted campaign for Aboriginal and Torres Strait Islander people. But it then aired nationally targeting all Australians in 2014.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/0yvjBU-E0aw?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The ‘Break the Chain’ campaign featured Aboriginal actor and comedian Elaine Crombie.</span></figcaption>
</figure>
<p><a href="https://www.health.gov.au/resources/collections/campaign-resources-dont-make-smokes-your-story">Don’t Make Smokes Your Story</a> was launched in 2016, as part of the Tackling Indigenous Smoking program. This was created by Indigenous agency Carbon Media, starring musician <a href="https://www.youtube.com/watch?v=878H2fkw3L8">Fred Leone</a> alongside real stories <a href="https://www.youtube.com/watch?v=xCX-ZfopeSE">from community members</a>. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/1_dS1sYkLiQ?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">‘Don’t Make Smokes Your Story’ campaign.</span></figcaption>
</figure>
<p>One of the <a href="https://www.phrp.com.au/issues/september-2020-volume-30-issue-3/tackling-indigenous-smoking-a-good-news-story-in-australian-tobacco-control/">most successful</a> and innovative Aboriginal and Torres Strait Islander tobacco campaigns, it included a
<a href="https://www.health.gov.au/resources/publications/dont-make-smokes-your-story-toolkit?language=en">toolkit</a> for Aboriginal and Torres Strait Islander communities to use and adapt the national campaign to their <a href="https://tacklingsmoking.org.au/sharing-our-stories/">local contexts</a>.</p>
<p>An excellent example of this is from the <a href="https://www.apunipima.org.au/tackling-indigenous-smoking/#:%7E:text=The%20Apunipima%20Tackling%20Indigenous%20Smoking,to%20culturally%20appropriate%20quit%20support">Apunipima Tackling Indigenous Smoking team</a> with its local campaign <a href="https://www.youtube.com/watch?v=tohg0QEGVU0">Don’t Make Smokes Your Story Cape York</a>.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/tohg0QEGVU0?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Campaigns can be localised, like this one from Cape York.</span></figcaption>
</figure>
<p>When Aboriginal and Torres Strait Islander people lead and promote smoke-free behaviours, communities are <a href="https://www.mja.com.au/journal/2015/202/10/predictors-wanting-quit-national-sample-aboriginal-and-torres-strait-islander">more interested in quitting</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/telehealth-has-much-to-offer-first-nations-people-but-technical-glitches-and-a-lack-of-rapport-can-get-in-the-way-201872">Telehealth has much to offer First Nations people. But technical glitches and a lack of rapport can get in the way</a>
</strong>
</em>
</p>
<hr>
<h2>What works? Product, price, place and promotion</h2>
<p>Social marketing campaigns, like the ones we’ve mentioned, really work well when they take on the <a href="https://www.cdc.gov/nccdphp/dch/programs/healthycommunitiesprogram/tools/pdf/social_marketing.pdf">Four Ps</a> of product, price, place and promotion.</p>
<p>The beautifully produced ads, the “promotion”, can’t have impact on their own. This is where the rest of the National Tobacco Strategy comes in.</p>
<p><strong>1. Product</strong></p>
<p>We’ve reduced product appeal with <a href="https://theconversation.com/world-first-plain-packaging-for-tobacco-products-a-step-closer-to-becoming-law-3053">plain packaging</a> and graphic health warnings. This will be enhanced with new warnings, including on the sticks themselves, plus greater uniformity of standardised packaging and tightened rules around additives and flavours that make smoking palatable.</p>
<p><strong>2. Price</strong></p>
<p>Price increases <a href="https://www.sciencedirect.com/science/article/pii/S2468266719302038">reduce smoking</a> and we’ll see a tax increase of 5% each year for three years across all different tobacco product types. </p>
<p><strong>3. Place</strong></p>
<p>We have known about the harms of commercial tobacco since at least 1950. Yet we still expect individuals to give up nicotine instead of removing this lethal product from sale at pretty much every supermarket, service station and convenience store. </p>
<p>The National Tobacco Strategy is considering a national licensing scheme, removing online sales and delivery services, and potential for reducing the number, type and location of tobacco outlets.</p>
<p>There will also be more action on smoke-free areas and making sure all health professionals (particularly in remote places) are equipped to support quit attempts.</p>
<p>The strategy states it will explore raising the age you can buy cigarettes and monitor how this works overseas. </p>
<p><strong>4. Promotion</strong></p>
<p>The commitment to close any last promotional loopholes for tobacco and e-cigarettes, particularly online is also important, along with local and national anti-smoking campaigns. But we know these are not enough on their own.</p>
<h2>What we also need</h2>
<p>Addressing all four Ps is what comprehensive tobacco social marketing would look like. It’s what’s required to accelerate the declines to get to the 27% target for Aboriginal and Torres Strait Islander peoples, and 5% nationally.</p>
<p>Targeted approaches are critical and can be effective, but they need to be supported by bigger, whole of population structural changes. The community-led campaigns, supported by national activity, will reinforce and amplify the policy changes that will come through on the tobacco product, its cost and its availability. </p>
<p>That’s how we realise our goals and ultimately eliminate tobacco related disease and death.</p><img src="https://counter.theconversation.com/content/205016/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Christina Heris receives funding from the NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame (NHMRC GNT1198301), and the Australian Government Department of Health and Aged Care for the Tackling Indigenous Smoking – Regional Grants Impact and Outcomes Assessment.</span></em></p><p class="fine-print"><em><span>Lisa J Whop receives funding from the National Health and Medical Research Council and the Australian Research Council. She is also a member and incoming chair of Cancer Australia's Leadership Group on Aboriginal and Torres Strait Islander Cancer Control.</span></em></p><p class="fine-print"><em><span>Michelle Kennedy receives funding from the National Health and Medical Research Council, Medical Research Future Fund and the National Heart Foundation. </span></em></p><p class="fine-print"><em><span>Raglan Maddox receives funding from from the NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame (NHMRC GNT1198301), and the Australian Government Department of Health and Aged Care for the Tackling Indigenous Smoking – Regional Grants Impact and Outcomes Assessment.</span></em></p><p class="fine-print"><em><span>Raymond Lovett receives funding from the NHMRC. </span></em></p><p class="fine-print"><em><span>Tom Calma is the National Coordinator, Tackling Indigenous Smoking (TIS). This position is a consultancy to the Commonwealth Department of Health and Aged Care. </span></em></p>If we are to reduce the numbers of Aboriginal and Torres Strait Islander people smoking we need to consider a whole suite or approaches.Christina Heris, Research Fellow, Australian National UniversityLisa J Whop, Senior Fellow, Australian National UniversityMichelle Kennedy, Assistant Dean Indigenous Strategy & Leadership, University of NewcastleRaglan Maddox, Fellow, National Centre for Epidemiology and Public Health, Australian National UniversityRaymond Lovett, Director Mayi Kuwayu Study, Australian National UniversityTom Calma, Chancellor, University of CanberraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2048122023-05-03T05:13:19Z2023-05-03T05:13:19ZCan vaping help people quit smoking? It’s unlikely<figure><img src="https://images.theconversation.com/files/523954/original/file-20230503-14-m0t8hk.jpg?ixlib=rb-1.1.0&rect=81%2C63%2C5925%2C3944&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/many-different-disposable-ecigarettes-hand-delicious-2049512471">Shutterstock</a></span></figcaption></figure><p>Australian Health Minister Mark Butler has announced a <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/taking-action-on-smoking-and-vaping?language=en">major policy shift on vaping</a>. Its two primary objectives are to make it harder for children and non-smokers to access vapes and to allow people trying to quit smoking to access nicotine vapes with a prescription. </p>
<p>Vapes are unquestionably popular, with many who vape saying they are trying to quit or to cut down on cigarettes. “Recreational” vapers of any age with no interest in quitting will find themselves frozen out.</p>
<p>But can vapes actually help significant numbers of people quit smoking? The evidence suggests it’s unlikely. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/a-potted-history-of-smoking-and-how-were-making-the-same-mistakes-with-vaping-200708">A potted history of smoking, and how we're making the same mistakes with vaping</a>
</strong>
</em>
</p>
<hr>
<h2>Myth of the ‘hardened smokers’</h2>
<p>First, let’s bust a widely believed myth. With smoking at an <a href="https://www.health.gov.au/sites/default/files/2023-05/national-tobacco-strategy-2023-2030.pdf">all time low</a>, some experts argue today’s smokers are the die-hard addicts: frequently relapsing smokers who just can’t quit. </p>
<p>Whenever this hypothesis has been tested it has been found wanting. In nations where smoking prevalence has fallen most, we would expect (if the hypothesis was true) that indicators of hardened smokers (such as average number of cigarettes smoked per day) would be rising because the remaining smokers would be over-represented by heavy, addicted smokers.</p>
<p>But according to <a href="https://pubmed.ncbi.nlm.nih.gov/30868166/">a 2020 review of 26 studies</a>:</p>
<blockquote>
<p>Some have argued that a greater emphasis on harm reduction or intensive treatment approaches is needed because remaining smokers are those who are less likely to stop with current methods. This review finds no or little evidence for this assumption.</p>
</blockquote>
<p>In other words, there is no evidence long-term smokers are impervious to the suite of tobacco control policies and campaigns that have driven hundreds of millions of smokers around the world to quit. </p>
<figure class="align-center ">
<img alt="Ashtray close up" src="https://images.theconversation.com/files/523958/original/file-20230503-19-71ckwh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/523958/original/file-20230503-19-71ckwh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=385&fit=crop&dpr=1 600w, https://images.theconversation.com/files/523958/original/file-20230503-19-71ckwh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=385&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/523958/original/file-20230503-19-71ckwh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=385&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/523958/original/file-20230503-19-71ckwh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=484&fit=crop&dpr=1 754w, https://images.theconversation.com/files/523958/original/file-20230503-19-71ckwh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=484&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/523958/original/file-20230503-19-71ckwh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=484&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The idea that ‘hardened smokers’ can’t quit is a myth.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/ashtray-full-smoked-cigarettes-extreme-close-1579956118">Shutterstock</a></span>
</figcaption>
</figure>
<h2>Vapes don’t help smokers cut back</h2>
<p>The idea that vaping helps people smoke fewer cigarettes isn’t supported by the evidence. Studies of the number of cigarettes foregone by vapers who still smoke have shown that, compared with smokers who never vape, the average daily cigarette consumption is very similar. </p>
<p>Data from 2019 from the United Kingdom government’s annual <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandlifeexpectancies/methodologies/opinionsandlifestylesurveyqmi">Opinions and Lifestyle Survey</a> also <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/drugusealcoholandsmoking/datasets/ecigaretteuseingreatbritain">show</a> the average number of cigarettes smoked daily by smokers who vape (8 a day) is almost identical to that by smokers who have never vaped (8.1 a day).</p>
<p><a href="https://bmjopen.bmj.com/content/8/6/e016046">A 2018 paper</a> considered the surge in e-cigarette use in England and whether this was reducing the number of cigarettes being smoked at the population level across the country. The authors concluded:</p>
<blockquote>
<p>No statistically significant associations were found between changes in use of e-cigarettes […] while smoking and daily cigarette consumption. Neither did we find clear evidence for an association between e-cigarette use […] specifically for smoking reduction and temporary abstinence, respectively, and changes in daily cigarette consumption. </p>
<p>If use of e-cigarettes […] while smoking acted to reduce cigarette consumption in England between 2006 and 2016, the effect was likely very small at a population level. </p>
</blockquote>
<h2>How effective are vapes in quitting?</h2>
<p>The most recent <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010216.pub7/full">Cochrane review</a> of randomised controlled trials compared vaping with nicotine replacement therapy (such as drugs, gums and patches). It found <a href="https://profglantz.com/2022/11/21/cochrane-collaborative-concludes-e-cigs-as-medical-interventions-help-smokers-quit-again-while-continuing-to-ignoring-stronger-more-relevant-real-world-evidence-that-they-dont/">about 82%</a> of people who vape are still smoking when followed up six or more months later. </p>
<p>This was better than those using nicotine replacement therapy: 90% were still smoking.</p>
<p>Neither nicotine replacement therapy or vapes are hugely disruptive of smoking. You certainly wouldn’t be confident using a drug for any health issue that had a 82-90% failure rate. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/drugs-gums-or-patches-wont-increase-your-chances-of-quitting-89767">Drugs, gums or patches won't increase your chances of quitting</a>
</strong>
</em>
</p>
<hr>
<figure class="align-center ">
<img alt="GP listens to patient" src="https://images.theconversation.com/files/523955/original/file-20230503-26-oc0x2b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/523955/original/file-20230503-26-oc0x2b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/523955/original/file-20230503-26-oc0x2b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/523955/original/file-20230503-26-oc0x2b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/523955/original/file-20230503-26-oc0x2b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/523955/original/file-20230503-26-oc0x2b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/523955/original/file-20230503-26-oc0x2b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Nicotine replacement therapies aren’t very effective at helping people quit.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/female-consultant-meeting-teenage-patient-284516786">Shutterstock</a></span>
</figcaption>
</figure>
<p>Randomised controlled trials also poorly reflect the ways vapes and nicotine replacement therapy are used in the real world and aren’t representative of all smokers wanting to quit. </p>
<p>A <a href="https://pubmed.ncbi.nlm.nih.gov/21212379/">review</a> of 54 randomised controlled trials on quitting smoking, for example, found two-thirds of smokers with nicotine dependence would have been excluded from clinical trials by at least one criterion. This may result in participation biases, which reduce the applicability of the results to smokers at large, or even smokers at large who want to quit. </p>
<p>This, and <a href="https://ses.library.usyd.edu.au/bitstream/handle/2123/28576/Mass%20distraction%20with%20cover.pdf?sequence=3&isAllowed=y">other factors</a>, make randomised controlled trials likely to overestimate effectiveness, as I outline in <a href="https://ses.library.usyd.edu.au/bitstream/handle/2123/28576/Mass%20distraction%20with%20cover.pdf?sequence=3&isAllowed=y">chapter two of my book</a>. </p>
<h2>What does the real-world evidence show?</h2>
<p>The best evidence we have about how vapes perform comes from studies where large numbers of vapers are followed for several years. The <a href="https://tobaccocontrol.bmj.com/content/26/4/371">US Population Assessment of Tobacco and Health (PATH) project</a>, for example, has been collecting national cohort data on 46,000 Americans since 2013.</p>
<p>As the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6202279/pdf/nihms965122.pdf">PATH data</a> below show, when randomly selected groups of vapers are followed up at 12 months, the most common outcome is those who were smoking and vaping at the beginning of the study period will still be vaping and smoking at the end of the 12 months. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/523994/original/file-20230503-16-7qv313.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/523994/original/file-20230503-16-7qv313.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=578&fit=crop&dpr=1 600w, https://images.theconversation.com/files/523994/original/file-20230503-16-7qv313.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=578&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/523994/original/file-20230503-16-7qv313.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=578&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/523994/original/file-20230503-16-7qv313.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=726&fit=crop&dpr=1 754w, https://images.theconversation.com/files/523994/original/file-20230503-16-7qv313.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=726&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/523994/original/file-20230503-16-7qv313.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=726&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The most common outcome is those who were smoking and vaping at the start were still doing both 12 months later.</span>
<span class="attribution"><span class="source">Data from the US Population Assessment of Tobacco and Health (PATH) project</span></span>
</figcaption>
</figure>
<p>I’ve summarised 16 other <a href="https://simonchapman6.com/vaping-research-alerts/#smoking-cessation">reviews and expert group conclusions</a> of the evidence published since 2017. Words like “low quality”, “inconclusive”, “insufficient”, “weak”, “low level” and “limited” abound.</p>
<h2>The upshot?</h2>
<p>The prescription vapes access scheme’s most important population effect is likely to be that it will massively reduce access to vapes by children. State governments will start hitting retailers illegally selling with massive fines and Border Security will do the same with importing suppliers. </p>
<p>Taiwan fines sellers a maximum of <a href="https://en.rti.org.tw/news/view/id/2009188">US$1.65 million, with a minimum of US$330,000</a>. The current maximum fine in New South Wales is currently only A$1,600. Such a fine would barely raise dust in big retailers’ petty cash drawers.</p>
<p>Based on the research, we might expect 10-18% of vapers using the prescription scheme to quit within 12 months (with some relapse expected), but many more will <a href="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1000216">quit unassisted</a>.</p>
<p>Preventing new generations of kids from becoming addicted to nicotine and more likely to start smoking is a huge policy advance that is hugely welcome.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/vaping-and-behaviour-in-schools-what-does-the-research-tell-us-204794">Vaping and behaviour in schools: what does the research tell us?</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/204812/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Simon Chapman does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Many people who vape saying they are trying to quit or to cut down on cigarettes.Simon Chapman, Emeritus Professor in Public Health, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2042952023-04-25T16:55:04Z2023-04-25T16:55:04ZResearchers discover 18th-century clay tobacco pipes were used as weapons and surgical tools<figure><img src="https://images.theconversation.com/files/522769/original/file-20230425-3184-k614lx.jpeg?ixlib=rb-1.1.0&rect=2%2C11%2C995%2C802&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The ready availability of clay pipes meant that they were sometimes used for other activities other than smoking. </span> <span class="attribution"><a class="source" href="https://artuk.org/discover/artworks/still-life-with-a-clay-pipe-142872">Ashmolean Museum</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span></figcaption></figure><p>Tobacco pipes were one of the first mass-produced, <a href="https://academic.oup.com/histres/advance-article/doi/10.1093/hisres/htac032/7069223">disposable objects</a> in Britain. Through contact with indigenous peoples of the Americas, tobacco pipes and tobacco were introduced to Europe as early as the 16th century, but had been used in the Americas for centuries before this. </p>
<p>Pipes were adapted for European tastes using European materials, and in England the most popular material for pipes between 1600 and 1900 was clay. Shapes and styles varied over the years, but the basic design remained the same: a hand-held bowl to burn tobacco in and a stem to draw the smoke the mouth of the smoker. </p>
<p>Pipes were lightweight, rigid and made out of inexpensive materials. They were also rather breakable. This cheapness and breakability means they show up in <a href="https://academic.oup.com/histres/advance-article/doi/10.1093/hisres/htac032/7069223">large number</a> across post-medieval archaeological sites in Britain. </p>
<p>The usefulness of pipes as artefacts is <a href="https://orb.binghamton.edu/cgi/viewcontent.cgi?article=1473&context=neha">well established</a>. Tobacco pipes found in archaeological digs can help researchers identify the dates when a particular site may have been occupied (based on bowl or stem size) and even who may have occupied these spaces (bite marks in stems may indicate workers holding them in their mouths while working, for example). Pipes can also inform researchers about patterns of tobacco consumption over time.</p>
<p>However, <a href="https://academic.oup.com/histres/advance-article/doi/10.1093/hisres/htac032/7069223">our research</a> has uncovered fascinating new evidence about some of the other ways people used tobacco pipes in the past. Smoking might kill but what we found is that people routinely used tobacco pipes as weapons and as medical instruments from at least as early as the 17th century, although most of the evidence dates to the 18th century. </p>
<p>This new evidence brings to life the everyday experiences of those who encountered tobacco pipes. It also gives historians and archaeologists new ways of thinking about how we study historic artefacts because it encourages us to think beyond the intended functions of objects.</p>
<p>What these alternative uses tell us is that pipes were objects that occupied the everyday lives of men and women in the British past far beyond what we have assumed. The archaeological record has already told us that pipes were incredibly common. </p>
<p>By looking at evidence from archives, such as criminal records and medical texts, we understand that this commonality meant that pipes were not just used to smoke tobacco and likely played a more prominent role in everyday life than we have previously considered.</p>
<h2>Pipes as weapons</h2>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/522623/original/file-20230424-24-mlfe4o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="An illustration showing a smoking man being killed by another with a tobacco pipe." src="https://images.theconversation.com/files/522623/original/file-20230424-24-mlfe4o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/522623/original/file-20230424-24-mlfe4o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=870&fit=crop&dpr=1 600w, https://images.theconversation.com/files/522623/original/file-20230424-24-mlfe4o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=870&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/522623/original/file-20230424-24-mlfe4o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=870&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/522623/original/file-20230424-24-mlfe4o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1093&fit=crop&dpr=1 754w, https://images.theconversation.com/files/522623/original/file-20230424-24-mlfe4o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1093&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/522623/original/file-20230424-24-mlfe4o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1093&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">An illustration of how a pipe in a hand could kill someone from the book Tobacco Jokes for Smoking Folks (London, 1888).</span>
</figcaption>
</figure>
<p>Clay tobacco pipes were hand-held and breakable. This made them ideal for striking or stabbing with when tempers flared. In about three-quarters of the cases we looked at, attacks happened when someone holding a pipe lashed out at another person. A punch to the head, face or neck could result in a serious puncture wound, cause blindness or even death if a pipe was involved. </p>
<p>For example, in Caernarfonshire in Wales in 1788, a man named Sylvanus Owen was found guilty of manslaughter for striking another man with his right hand. The punch proved fatal because Owen had two pieces of a clay pipe in his had at the time, one of which entered the other man’s eye, causing a serious infection.</p>
<p>We also found pipes being used to intentionally burn others and as <a href="https://www.theatlantic.com/magazine/archive/1881/12/british-state-assassins-and-the-defense-of-insanity/632566/">shot in pistols</a>.</p>
<h2>Pipes as medical instruments</h2>
<p>Some of the same properties that made pipes excellent impromptu weapons also made them useful improvised medical instruments. The ready availability of pipes meant that one was likely always to hand and the long, narrow stems and wide bowls meant they had several uses beyond smoking.</p>
<p>Evidence from medical publications such as the Lancet and surgical guides suggest that pipe stems could be used as catheters to relieve both men and women of retained urine. </p>
<p>Pipes were also <a href="https://doi.org/10.1093/hisres/htac032">recommended</a> for emergency <a href="https://www.mountsinai.org/health-library/surgery/emergency-airway-puncture">tracheotomies</a>, as straws for those who could not eat and drink on their own, and as lactation aides for nursing mothers. In 1796, Erasmus Darwin (grandfather of Charles Darwin) even recommended using the stem of a tobacco pipe to remove a guinea worm (a waterborne parasite found in certain parts of Africa) from an infected patient.</p>
<p>As both weapons and medical instruments, it was the combination of clay tobacco pipes’ properties and availability that made them ideal improvised tools. There is an obvious and interesting contradiction that one alternative use was to harm or end life and the other was to improve or preserve it.</p><img src="https://counter.theconversation.com/content/204295/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sarah Inskip receives funding from the UKRI-AHRC. </span></em></p><p class="fine-print"><em><span>Angela Muir does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A pipe in the hand could end or save a life.Angela Muir, Lecturer in British Social and Cultural History and Director of the Centre of Regional and Local History, University of LeicesterSarah Inskip, Future Leaders Fellow in the School of Archaeology and Ancient History, University of LeicesterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2041522023-04-25T14:07:02Z2023-04-25T14:07:02ZUK plan to encourage smokers to take up vaping means swapping one health risk with another<figure><img src="https://images.theconversation.com/files/522587/original/file-20230424-28-vyodce.jpg?ixlib=rb-1.1.0&rect=15%2C0%2C3479%2C1938&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The scheme would offer smokers vape starter kits to help them quit.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/vaping-device-cigarettes-mans-hand-concept-1185129853">ducu59us/Shutterstock</a></span></figcaption></figure><p>The UK government set out ambitious plans in 2019 to make England smoke free by 2030. To achieve this, they <a href="https://www.gov.uk/government/news/smokers-urged-to-swap-cigarettes-for-vapes-in-world-first-scheme">recently announced</a> plans to offer free vape starter kits to one million smokers in a bid to help them quit. </p>
<p>While smoking cigarettes is associated with a <a href="https://www.nhs.uk/common-health-questions/lifestyle/what-are-the-health-risks-of-smoking/">range of serious health problems</a>, mounting evidence shows that vaping is also not without harms and risks. Given that there is still a lot we do not know about the health effects of vaping, we argue it is potentially irresponsible to recommend smokers switch to vaping to quit – especially when other <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5003586/">medically proven methods to quit</a> smoking already exist. </p>
<p>E-cigarettes and vapes have only been around since the early 2000s. As such, there is still a lot we do not know about the harms that may be associated with their long-term use. But a growing body of evidence indicates vaping is not as harmless as many believe. </p>
<p>For example, studies have shown that vaping can <a href="https://physoc.onlinelibrary.wiley.com/doi/10.1113/JP279754">induce bronchiolitis</a>, an infection which closes off the smaller airways in the lungs, making breathing more difficult. This can become irreversible with prolonged vaping, given how fragile our lungs are. </p>
<p>Research also shows vaping can cause similar cellular changes in the lungs as smoking does. <a href="https://www.atsjournals.org/doi/10.1164/rccm.201903-0615OC">One study</a> showed that people who vaped (including those who vaped nicotine) had similarly elevated levels of protease enzymes – harmful enzymes that may damage lung function – as smokers. Vaping may also increase mucus production in lung cells, <a href="https://link.springer.com/article/10.1007/s11882-017-0747-5">worsening asthma</a> and causing airways to become more sensitive and constrict more easily.</p>
<p>Long-term use of vaping products can affect the way blood vessels function as well, increasing the risk of cardiovascular disease. In <a href="https://journals.lww.com/jhypertension/Abstract/2018/06001/EFFECT_OF_ELECTRONIC_CIGARETTE_SMOKING_ON_BLOOD.12.aspx">one report</a> people who used nicotine e-cigarettes had increased blood pressure, heart rate and blood vessel constriction immediately after vaping nicotine. These effects were similar to those seen in people who smoke cigarettes, but are occurring at a much younger age. </p>
<p>Much of this harm is probably caused by the contents of the vaping liquids used. In addition to nicotine, vape liquids also contain a cocktail of <a href="https://www.sciencedirect.com/science/article/pii/S0731708520312504?via%3Dihub">flavour chemicals</a> and additives used in food products. </p>
<p>Most of these chemicals have not undergone testing to <a href="https://www.nature.com/articles/s41598-019-39550-2">check if they are safe</a> to be heated to high temperatures and inhaled into the lungs. To add to the already complex scenario, they can break down when heated in vaping devices, causing them to turn into more reactive chemicals. These reactive chemicals can <a href="https://www.nejm.org/doi/full/10.1056/NEJMc1913069">cause damage to cells and tissues</a> in the lung.</p>
<figure class="align-center ">
<img alt="A young woman breathes out vapour from her vape pen." src="https://images.theconversation.com/files/522588/original/file-20230424-1294-vj5jul.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/522588/original/file-20230424-1294-vj5jul.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=328&fit=crop&dpr=1 600w, https://images.theconversation.com/files/522588/original/file-20230424-1294-vj5jul.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=328&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/522588/original/file-20230424-1294-vj5jul.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=328&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/522588/original/file-20230424-1294-vj5jul.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=413&fit=crop&dpr=1 754w, https://images.theconversation.com/files/522588/original/file-20230424-1294-vj5jul.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=413&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/522588/original/file-20230424-1294-vj5jul.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=413&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Vaping liquids can contain many chemicals alongside nicotine.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/beautiful-women-smoke-electronic-cigarette-street-2054025671">ilkov_igor/ Shutterstock</a></span>
</figcaption>
</figure>
<p>In fact, in 2019 the <a href="https://theconversation.com/vaping-related-lung-disease-now-has-a-name-and-a-likely-cause-5-things-you-need-to-know-about-evali-125730">death of 68 people</a> was found to be caused by the thermal breakdown of a specific chemical (vitamin E acetate) that was being added to some vaping liquids. The condition was even given a name: Evali (e-cigarette or vaping use-associated lung injury). Although this additive is now banned in both the US and UK, it is an example of the damage that can happen when vape-heated chemicals are inhaled into the lungs. </p>
<p>While there are regulations on the <a href="https://www.gov.uk/guidance/e-cigarettes-regulations-for-consumer-products#:%7E:text=The%20requirements%3A,no%20more%20than%2020mg%2Fml">kinds of ingredients</a> vaping liquids can contain, research into how vaping causes them to convert into other chemicals is <a href="https://pubs.acs.org/doi/pdf/10.1021/acs.chemrestox.0c00412">only beginning</a>. As such, the health risks from these vape-generated chemicals could lead to similar health problems as vitamin E acetate did – though it’s likely to take years of accumulative damage before such problems emerge.</p>
<p>Alongside these health risks is the fact that vaping is not a guaranteed way to help smokers quit. In fact, vaping to quit may only lead to dual use – <a href="https://www.sciencedirect.com/science/article/abs/pii/S0749379719303915?via%3Dihub">which is riskier</a> than using either product alone. One review also found that smokers who switched to e-cigarettes may <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8078138/">relapse and use cigarettes</a> later on.</p>
<h2>Alternative solutions</h2>
<p>The <a href="https://www.fda.gov/tobacco-products/products-ingredients-components/e-cigarettes-vapes-and-other-electronic-nicotine-delivery-systems-ends#:%7E:text=Many%20studies%20suggest%20e%2Dcigarettes,effective%20tools%20for%20quitting%20smoking.">Food and Drug Administration</a> in the US, alongside <a href="https://www2.hse.ie/living-well/quit-smoking/vaping/">other agencies in Europe</a>, do not recommend vaping as a replacement for smoking. Most cite the lack of evidence supporting the use of vaping to help people quit smoking, alongside the lack of safety testing as reasons they do not recommend it. </p>
<p>It’s mystifying to us that there has been such little concern expressed about the UK’s proposal to encourage smokers to take up vaping since it was first put forward by an <a href="https://www.gov.uk/government/publications/the-khan-review-making-smoking-obsolete/making-smoking-obsolete-summary">independent review</a> for the government in 2022.</p>
<p>Instead of recommending people switch from one risky habit to another, the government should instead recommend the use of <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013308/full">medically proven nicotine replacement therapies</a> (such as skin patches, gums and nasal or oral sprays) and <a href="https://www.cochrane.org/CD001292/TOBACCO_does-individually-delivered-counselling-help-people-stop-smoking#:%7E:text=Combining%20the%20results%20of%20the,%25%2C%20compared%20to%20minimal%20support">personalised counselling</a> to help smokers quit. The government also needs to put more onus on vaping companies to prove their products are safe before they can be sold to the public, following similar protocols that <a href="https://www.ema.europa.eu/en/human-regulatory/overview/medical-devices">drug companies need to follow</a>. </p>
<p>Remember that it took much longer than it should have for the <a href="https://onlinelibrary.wiley.com/doi/pdf/10.1046/j.1440-1843.2003.00483.x">serious harm caused by tobacco</a> to be proven and accepted. The evidence that vaping can be harmful is mounting, and we cannot afford to take as long as it took with cigarettes to warn people about the potential risks it poses. Instead of encouraging people to vape in order to quit smoking, they should instead be encouraged to ask their GP or pharmacist for access to proven and safe nicotine replacement therapies.</p><img src="https://counter.theconversation.com/content/204152/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A growing body of evidence shows vaping is not without harms.Donal O'Shea, Professor of Chemistry, RCSI University of Medicine and Health SciencesGerry McElvaney, Professor of Medicine, RCSI University of Medicine and Health SciencesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2007082023-03-05T19:20:17Z2023-03-05T19:20:17ZA potted history of smoking, and how we’re making the same mistakes with vaping<figure><img src="https://images.theconversation.com/files/513309/original/file-20230303-18-tocrry.png?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption"></span> </figcaption></figure><p>When smoking first became popular we were told it was healthy, it was heavily marketed (including to young people) as being cool, and the time it took for us to learn otherwise was long, and came too late for many. Unfortunately, it seems history is repeating itself with vaping.</p>
<p>Before the invention of machines to make cigarettes, they were hand-rolled – with an experienced roller making around 240 cigarettes an hour. When mechanisation arrived in the late nineteenth century, early machines could make 12,000 per hour. Eventually, they could churn out <a href="https://www.pmi.com/investor-relations/overview/how-cigarettes-are-made">1.2 million an hour</a>. </p>
<p>This made smoking immensely affordable, accessible to those on even meagre incomes. These machines would go on to become perhaps the worst development in public health history.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/513320/original/file-20230303-14-mtvyn3.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Advertisement reading 'More doctors smoke camels than any other cigarette'" src="https://images.theconversation.com/files/513320/original/file-20230303-14-mtvyn3.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/513320/original/file-20230303-14-mtvyn3.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=755&fit=crop&dpr=1 600w, https://images.theconversation.com/files/513320/original/file-20230303-14-mtvyn3.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=755&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/513320/original/file-20230303-14-mtvyn3.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=755&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/513320/original/file-20230303-14-mtvyn3.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=949&fit=crop&dpr=1 754w, https://images.theconversation.com/files/513320/original/file-20230303-14-mtvyn3.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=949&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/513320/original/file-20230303-14-mtvyn3.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=949&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://tobacco.stanford.edu/cigarettes/doctors-smoking/more-doctors-smoke-camels/">Screenshot Stanford Research into the Impact of Tobacco Advertising</a></span>
</figcaption>
</figure>
<p>Combined with <a href="https://tobaccotactics.org/wiki/advertising-strategy/">mass cigarette advertising</a>, including the infamous 1940s “<a href="https://tobacco.stanford.edu/cigarettes/doctors-smoking/more-doctors-smoke-camels/">More doctors smoke Camel than any other cigarette</a>” which successfully distracted the population from early concerns about harm, cheap cigarettes saw smoking prevalence skyrocket globally. </p>
<p><a href="https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-015-0281-z">Two in three long-term smokers died from their addiction</a>.</p>
<p>Ever since, governments have been struggling to introduce potent controls on Big Tobacco. The World Health Organization’s 2003 <a href="https://fctc.who.int/who-fctc/overview">Framework Convention on Tobacco Control</a> has an entire section devoted to ways of <a href="https://escholarship.org/uc/item/98w687x5">minimising industry interference</a>.</p>
<h2>Lung cancer was rare</h2>
<p>Despite <a href="https://ehne.fr/en/encyclopedia/themes/ecology-and-environment-in-europe/environmental-risks/industrial-pollution-in-europe">heavy industrial air pollution</a> in cities dating from the early 1800s, lung cancer was a rare disease. <a href="https://journal.chestnet.org/article/S0012-3692(15)34009-5/fulltext">US surgeon Alton Ochsner</a>, recalling attendance at his first lung cancer autopsy in 1919, was told he and his fellow interns “might never see another such case as long as we lived”. </p>
<p>He saw no further cases until 1936, and then saw another nine cases in six months. Given the smoking boom that occurred in the US with World War I, Ochsner was quick to assume cigarettes were to blame. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/513303/original/file-20230302-18-j0i1mo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Highlighted spots on a chest x-ray" src="https://images.theconversation.com/files/513303/original/file-20230302-18-j0i1mo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/513303/original/file-20230302-18-j0i1mo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=525&fit=crop&dpr=1 600w, https://images.theconversation.com/files/513303/original/file-20230302-18-j0i1mo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=525&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/513303/original/file-20230302-18-j0i1mo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=525&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/513303/original/file-20230302-18-j0i1mo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=660&fit=crop&dpr=1 754w, https://images.theconversation.com/files/513303/original/file-20230302-18-j0i1mo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=660&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/513303/original/file-20230302-18-j0i1mo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=660&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Before smoking took off in the early 20th century, lung cancer was a rarity.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Since the 1960s, lung cancer has been (by far) the world’s <a href="https://acsjournals.onlinelibrary.wiley.com/doi/10.3322/caac.21660">leading cause of cancer death</a>. Lung cancer (<a href="https://www.cdc.gov/cancer/lung/basic_info/risk_factors.htm#:%7E:text=Cigarette%20smoking%20is%20the%20number,of%20more%20than%207%2C000%20chemicals.">almost all</a> of which can be attributed to smoking) was responsible for 18% of all cancer deaths in 2020, with the next most frequent killer, liver cancer, at 8.3%.</p>
<p>Most public health graduates in recent decades are familiar with a <a href="https://tobaccocontrol.bmj.com/content/tobaccocontrol/3/3/242.full.pdf">famous 1994 graph</a> illustrating the shape of the tobacco-caused disease epidemic across time. The graph shows four stages of the smoking and disease epidemics. </p>
<p>Nations in the first 20 year-long stage have accelerating smoking but negligible tobacco-caused disease. By the fourth stage, smoking is declining but disease is growing more rapidly than ever. These gaps are known as <a href="https://www.youtube.com/watch?v=bhTJaESyFOA">latency periods</a> in epidemiology.</p>
<p>Mesothelioma caused by breathing asbestos fibres also follows this pattern. The latency period between initial exposure and the onset of symptoms can be <a href="https://www.mesothelioma.com/mesothelioma/latency-period/#:%7E:text=Mesothelioma%20latency%20period%20is%20the,and%20the%20duration%20of%20exposure.">up to 50 years</a>.</p>
<hr>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/513311/original/file-20230303-20-de2cgx.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/513311/original/file-20230303-20-de2cgx.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/513311/original/file-20230303-20-de2cgx.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=576&fit=crop&dpr=1 600w, https://images.theconversation.com/files/513311/original/file-20230303-20-de2cgx.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=576&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/513311/original/file-20230303-20-de2cgx.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=576&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/513311/original/file-20230303-20-de2cgx.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=724&fit=crop&dpr=1 754w, https://images.theconversation.com/files/513311/original/file-20230303-20-de2cgx.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=724&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/513311/original/file-20230303-20-de2cgx.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=724&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://tobaccocontrol.bmj.com/content/tobaccocontrol/3/3/242.full.pdf">Source: Tobacco Control 1994</a></span>
</figcaption>
</figure>
<hr>
<h2>Enter nicotine vaping products</h2>
<p>Vaping has only been widespread for about ten years. So, if it causes serious diseases such as lung cancer, cardiovascular or respiratory disease, we would expect very few cases by now. This has not stopped <a href="https://ajph.aphapublications.org/doi/10.2105/AJPH.2019.305424">cavalier</a> declarations that vaping is “95% less dangerous than smoking”.</p>
<p>This statistic is still used by many, despite the paper that gave birth to this factoid <a href="https://www.karger.com/Article/FullText/360220">admitting</a> there is a lack of evidence for most of the criteria used to assess vaping’s harms. </p>
<p>There is a great deal of early evidence now available that vaping is likely to be anything but benign. For example, recent reviews on vapes have found they <a href="https://pubmed.ncbi.nlm.nih.gov/33429159/">contain carcinogens known to cause lung cancer</a>, <a href="https://www.tandfonline.com/doi/abs/10.1080/02770903.2021.1971703?journalCode=ijas20">are correlated with asthma</a>, and <a href="https://www.frontiersin.org/articles/10.3389/fphys.2020.00492/full">impair our vascular systems</a>.</p>
<p>Knowledge about the deadly toxicology of tobacco smoke emerged over decades. By contrast, the many thousands of flavouring chemicals in vapes present bewildering challenges for regulators.</p>
<p>In 2021, the US Flavour and Extracts Manufacturing Association <a href="https://web.archive.org/web/20211015203320/https://www.femaflavor.org/node/24344">declared</a> “E-cigarette manufacturers should not represent or suggest that the flavor ingredients used in their products are safe […] because such statements are false and misleading”. Regulators have never allowed asthma drug inhalers to contain flavourants.</p>
<p>All forms of tobacco advertising and promotion have long been <a href="https://tobaccocontrol.bmj.com/content/tobaccocontrol/31/2/216.full.pdf">banned or seriously restricted in many nations</a>. But vaping emerged in the internet era where regulation presents formidable barriers. Social media today are awash with vaping promotions, with illegal vapes flagrantly being sold as “fruit” on Facebook Marketplace.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/513300/original/file-20230302-20-4w08bk.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Screenshot of vaping ads." src="https://images.theconversation.com/files/513300/original/file-20230302-20-4w08bk.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/513300/original/file-20230302-20-4w08bk.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=548&fit=crop&dpr=1 600w, https://images.theconversation.com/files/513300/original/file-20230302-20-4w08bk.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=548&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/513300/original/file-20230302-20-4w08bk.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=548&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/513300/original/file-20230302-20-4w08bk.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=688&fit=crop&dpr=1 754w, https://images.theconversation.com/files/513300/original/file-20230302-20-4w08bk.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=688&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/513300/original/file-20230302-20-4w08bk.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=688&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Advertisements for ‘fruit’ on Facebook are really for vapes.</span>
<span class="attribution"><span class="source">Author Screenshot.</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Research has shown indoor areas with many vapers contain <a href="https://tobaccocontrol.bmj.com/content/tobaccocontrol/26/1/109.full.pdf">airborne particulate matter concentrations</a> higher than crowded bars in the days when smoking was permitted. <a href="https://www.misteliquid.co.uk/blog/travelling-with-an-ecig/#:%7E:text=All%20airlines%20have%20banned%20the,packed%20in%20your%20hand%20luggage">No airline in the world</a> permits in-flight vaping.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/passive-vaping-time-we-see-it-like-secondhand-smoke-and-stand-up-for-the-right-to-clean-air-198766">Passive vaping – time we see it like secondhand smoke and stand up for the right to clean air</a>
</strong>
</em>
</p>
<hr>
<h2>Repeating the same mistakes</h2>
<p>With children’s vaping accelerating dramatically in <a href="https://insightplus.mja.com.au/2023/1/vaping-and-e-cigarette-use-on-the-rise-among-young-people/">Australia</a>, <a href="https://www150.statcan.gc.ca/n1/daily-quotidien/220720/dq220720d-eng.htm">Canada</a>, the <a href="https://newsinhealth.nih.gov/2019/02/vaping-rises-among-teens">US</a>, <a href="https://www.theguardian.com/society/2022/jul/23/child-vaping-epidemic-risks-becoming-public-health-catastrophe-in-uk-experts-warn">United Kingdom</a> and <a href="https://theconversation.com/young-non-smokers-in-nz-are-taking-up-vaping-more-than-ever-before-here-are-5-reasons-why-185400">New Zealand</a>, governments are scrambling to find solutions to the problem they created by rash, rushed policies.</p>
<p>Vaping advocates argue laws and regulations for vapes should be no more harsh than those that apply to cigarettes. So with no restrictions on where cigarettes can be sold, we see <a href="https://www.theguardian.com/australia-news/2023/feb/26/facebook-ads-opposing-a-ban-on-vaping-in-australia-failed-to-disclose-tobacco-company-backing">tobacco industry-led efforts today</a> in Australia trying to allow vapes to be sold under the same conditions.</p>
<p>The first baby steps in Australian tobacco control were <a href="https://tobaccocontrol.bmj.com/content/tobaccocontrol/12/suppl_3/iii13.full.pdf">tiny health warnings</a> that appeared in 1973. It then took 40 years to fight for all the policies and quit campaign funding that have together taken smoking down to its <a href="https://www.abs.gov.au/statistics/health/health-conditions-and-risks/smoking/latest-release">lowest ever levels</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/513305/original/file-20230302-16-elpdil.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Cigarette packets showing an eyeball and the warning 'smoking causes blindness'" src="https://images.theconversation.com/files/513305/original/file-20230302-16-elpdil.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/513305/original/file-20230302-16-elpdil.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=367&fit=crop&dpr=1 600w, https://images.theconversation.com/files/513305/original/file-20230302-16-elpdil.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=367&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/513305/original/file-20230302-16-elpdil.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=367&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/513305/original/file-20230302-16-elpdil.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=461&fit=crop&dpr=1 754w, https://images.theconversation.com/files/513305/original/file-20230302-16-elpdil.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=461&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/513305/original/file-20230302-16-elpdil.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=461&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Graphic health warnings now dominate cigarette packets free of branding. But it took 40 years to get here.</span>
<span class="attribution"><a class="source" href="https://www.accc.gov.au/system/files/Tobacco%20graphic%20health%20warnings%20-%20fact%20card_0.pdf">ACCC Product Safety Supplier Guide</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>This 40 years was due to both early ignorance of the latent size of the emerging smoking disease epidemic, and sustained pressure from the tobacco industry to defeat, delay and dilute every policy that threatened to reduce smoking.</p>
<p>Just as the tobacco industry for decades denied targeting children, we are seeing <a href="https://www.nbcnews.com/health/kids-health/e-cigarette-ads-target-millions-kids-cdc-says-n490601">almost identical claims and strategies</a> being used by vaping industries today. And it’s important to note all major tobacco companies are now also manufacturing vapes, so it’s not just the same game, it’s the same players.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/marketers-are-targeting-teens-with-cheap-and-addictive-vapes-9-ways-to-stem-rising-rates-of-youth-vaping-198291">Marketers are targeting teens with cheap and addictive vapes: 9 ways to stem rising rates of youth vaping</a>
</strong>
</em>
</p>
<hr>
<p>It’s often said that if cigarettes were invented tomorrow, and we knew now what we didn’t know then, no government in the world would permit their sale (let alone allow them to be sold in every convenience store). But this is what is happening now with vapes.</p>
<p>With pharmaceutical products that save lives, treat illness and reduce severe pain, we allow only people with a four-year pharmacy degree to sell them, and only to those with a temporary licence (a dose- and time-limited prescription) issued by a doctor. With cigarettes, we foolishly allowed them to be sold everywhere.</p>
<p>All health departments in Australia, most major political parties, nearly every health and medical agency in Australia and <a href="https://simonchapman6.com/2019/05/20/global-regional-and-national-agencies-concerned-about-e-cigarettes-statements-you-are-unlikely-to-hear-from-vaping-advocates/">many internationally, including the WHO</a>, are saying vapes should be strongly regulated.</p>
<p>Vaping advocates argue we need vapes to help smokers quit, but the evidence they do that is <a href="https://simonchapman6.com/vaping-research-alerts/#smoking-cessation">weak</a>.</p>
<p>Currently vaping devices are widely available, but those including vaping liquids containing nicotine are only legally available with a prescription in Australia. This doesn’t stop people buying them easily online or from many convenience stores blatantly breaking the law. </p>
<p>The previous health minister tried to ban personal importation of nicotine vapes and liquid, and the current one expressed interest in doing the same before a period of public consultation <a href="https://www.tga.gov.au/resources/consultation/consultation-proposed-reforms-regulation-nicotine-vaping-products">via the Therapeutic Goods Administration</a>. </p>
<p>As with Australia pioneering plain packaging laws in 2012, if the import ban is implemented we will again quickly be emulated by other nations. And again detested by the tobacco giants.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/learning-about-the-health-risks-of-vaping-can-encourage-young-vapers-to-rethink-their-habit-199557">Learning about the health risks of vaping can encourage young vapers to rethink their habit</a>
</strong>
</em>
</p>
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<img src="https://counter.theconversation.com/content/200708/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Simon Chapman in the past has receive funding from the National Health and Medical Research Council and the US National Institutes of Health. </span></em></p>It’s often said if cigarettes were invented tomorrow, and we knew now what we didn’t know then, they would be banned outright. But vaping is showing us we’re repeating the same mistakes.Simon Chapman, Emeritus Professor in Public Health, University of SydneyLicensed as Creative Commons – attribution, no derivatives.