Tag: research

Survey Reveals Scale of Advocacy for Safer Nicotine

Knowledge-Action-Change (KAC) has released a global survey investigating the role and activities of consumer organizations advocating for access to safer nicotine products (SNPs) and tobacco harm reduction.
Carried out by KAC’s Global State of Tobacco Harm Reduction project, the research was published in Public Health Challenges.
It reveals that there are 54 active consumer advocacy groups working around the world to raise awareness about, and promote the availability of and access to, SNPs, which include nicotine vaping products (e-cigarettes), Swedish-style snus, nicotine pouches and heated-tobacco products.
The authors of the survey found that the vast majority of organizations (42) were operated entirely by volunteers, most of whom had successfully quit smoking with the help of SNPs.
Only seven of the groups had any contracted or paid staff (13 people globally), and for the last full year, the total funding for all organizations surveyed amounted to $309,810. This is in stark contrast to the millions of dollars spent on campaigns by actors, such as Bloomberg Philanthropies, seeking to limit access to SNPs, such as nicotine vaping products. The paper also notes that none of the consumer advocacy organizations reported receiving funding from tobacco or pharmaceutical companies.

This paper starkly demonstrates the major imbalance in resources available to consumer organizations advocating for access to safer nicotine products and those opposed to tobacco harm reduction, unfairly skewing the debate.
Gerry Stimson, director, KAC
Many of these organizations are members of four regional umbrella organizations covering Latin America (ARDT Iberoamerica), Africa (CASA), Europe (ETHRA) and Asia-Pacific (CAPHRA).
“This survey offered a unique opportunity to map these advocacy organizations for the first time and provide valuable insight into how they are operating all over the world,” said Tomasz Jerzynski, lead author and data scientist for the Global State of Tobacco Harm Reduction project. “The sustainability of these organizations is one of the main concerns that has come out of the data. All of these groups face challenges due to their small numbers of core workers and their dependence on volunteers.”
“This paper starkly demonstrates the major imbalance in resources available to consumer organizations advocating for access to safer nicotine products and those opposed to tobacco harm reduction, unfairly skewing the debate,” said Gerry Stimson, report author, director of KAC and emeritus professor at Imperial College London. “It also highlights why consumer groups must be recognized as legitimate stakeholders in the policy sphere.”
February 1, 2023
Study Finds Dual Users Likely to Keep Smoking

Photo: Teo
Most adults who both smoke and vape are likely to carry on smoking or continue dual use over the long term, according to new research published in Tobacco Control.
Researchers looked at 545 dual users in waves one through five (2013/2014 to 2018/2019) of the U.S. Population Assessment of Tobacco and Health Study.
Over the six years of data, quitting vaping early but continuing to smoke was the most common pattern for almost half of participants (42 percent). Only 10 percent of participants quit both vaping and smoking early, and 15 percent of dual users continued to use both products.
The frequency of vaping and smoking, nicotine dependence, use of cannabis and other tobacco products at wave one were all influential. Dual users who smoked less frequently at wave one were more likely to quit both products early or to gradually quit smoking.
This is an observational study, and product use was based on self-report and not biochemically verified. No information was available for product use between waves.
“Our findings suggest that smoking reduction could help dual users to quit using both products; additionally, for those smokers unable or unwilling to quit using nicotine, cutting down on smoking could help them switch to exclusive [vape] use,” wrote the authors.
Their results also suggest that “before 2019, [vaping] did not contribute to substantial smoking cessation at the population level.”
“Continued monitoring of trajectories and their predictors is warranted considering the rapid evolution of the [vaping] marketplace,” the authors wrote in a press release.
December 14, 2022
Canada Drops Findings From First Vape Legislation Review
The results of Canada’s first legislative review of the Tobacco and Vaping Products Act (TVPA) has been submitted to its Parliament. The review focuses primarily on the vaping-related provisions of the TVPA, which includes an obligation for a legislative review three years after coming into force, followed by subsequent reviews every two years, according to a government press release.
Brought forth by the Honorable Carolyn Bennett, Minister of Mental Health and Addictions and Associate Minister of Health, the review is informed by public consultations and available evidence, which included peer-reviewed scientific journal publications, population-level surveys, and public opinion research.
“Vaping products offer the 3.8 million Canadians who smoke a less harmful source of nicotine than tobacco products, and do help people to stop smoking. These products, however, are not without risk — particularly to youth and people who do not smoke cigarettes,” Bennett said. “This first legislative review of the Tobacco and Vaping Products Act is a valuable opportunity to take stock of the progress we’ve made to address youth vaping – but there is more to do. Our government will continue to work to put the right safeguards in place to protect young people from the harms of vaping and nicotine addiction.”
The review’s findings suggest that the TVPA is making progress towards meeting the objectives it set out in relation to vaping. Notably, youth vaping rates, which were rising at a rapid pace, have leveled off over the past two years yet remain relatively high with more work to be done to protect youth.
The TVPA was implemented in 2018 to respond to the increasing availability of vaping products in Canada and to help ensure that Canadians would be informed about and protected from the health hazards associated with vaping. It regulates the manufacture, sale, labelling and promotion of vaping products sold in Canada.
The TVPA includes a requirement for a legislative review three years after coming-into-force, and every two years thereafter. Periodic reviews provide a means to examine and respond to tobacco and/or vaping related issues that may emerge over time.
The review was informed by a public consultation that ran from March 16, 2022 to April 27, 2022. Canadians were encouraged to provide feedback on a TVPA Legislative Review Discussion Paper. Health Canada received 3,092 submissions as part of the public consultation.
Information to help Canadians to quit smoking is available at Canada.ca/quitsmoking.
Health Canada provided financial support to the Centre for Addiction and Mental Health to develop Lower-Risk Nicotine Use Guidelines. The Guidelines recommend that people who smoke cigarettes should try to quit using approved smoking cessation treatments first. If they are unable or unwilling to quit, vaping or e-cigarettes can be considered.
The review also identified areas for potential action, including examining access to vaping products by youth, communicating the potential benefits of vaping as a less harmful source of nicotine for people who smoke.
The report suggest smokers completely switch to vaping and addresses the health hazards, strengthening compliance and enforcement, and the scientific and product uncertainty in order to better understand the vaping product market and the health impacts of vaping.
December 12, 2022
Study: Evidence on Heat-not-Burn Products Lacking

Photo: librakv
The quality of evidence available about heated tobacco products (HTPs) is substandard and policymakers should be wary of claims made about their role in harm reduction, say the authors of a new study published in Tobacco Control.
HTPs have gained popularity in recent years, with proponents insisting they are less harmful to health than conventional cigarettes. However, researchers at the University of Bath argue that the evidence underpinning these claims is largely unrepresentative of real-world use and at high-risk of bias.
In their analyses of 40 publicly available clinical trials for HTPs—29 of which were tobacco industry affiliated or funded—the researchers judged most of the available clinical trials “at high risk of bias” given their methodology and choice of study design.
The most common reason for studies being at high risk of bias was performance bias, whereby the interventions allocated were known to participants and those conducting tests. There was also failure to report all results data for all trial measurements, a shortcoming known as selective reporting bias.
The authors argue that presence of these biases compromises the validity of trials and can lead to overestimation of the effects of HTPs. They also identified further limitations within trials, including short durations, restrictive conditions unreflective of real-world circumstances, and a lack of relevant comparators, like e-cigarettes.
Bath’s Tobacco Control Research Group says much more detailed, independent research is needed to assess the short- and long-term health effects of HTPs.
In the meantime, they argue that consumers should be wary of harm reduction claims and that policymakers and regulators should carefully consider the usefulness of these trials when making decisions surrounding HTPs.
“Over recent years we have seen great expansion in the heated tobacco market in the U.K. and around the world. This growth has been predicated on a marketing claim that these products are better for health, in comparison with traditional cigarettes,” said lead researcher Sophie Braznell from Bath’s Department for Health.
“Our analysis suggests that the picture is far less clear-cut. The clinical trials available, which are used by the tobacco industry to substantiate these claims, were often substandard in terms of how studies were conducted and reported, and most were industry-affiliated in some way.
“As more consumers move away from cigarettes towards these new generation products, we need much better evidence to assess their health impacts now and into the future. In the meantime, the jury is very much still out on their benefits.”
“These findings in relation to clinical trials for heated tobacco products are significant and we need to be wary of health claims made,” added study co-author Gemma Taylor from the Addiction & Mental Health Group and Deparmtent of Psychology at the University of Bath.
“At the same time though, it is important to note the clear distinction between ‘heated tobacco products’ and ‘e-cigarettes.’ Consumers and health policymakers must not equate the potential benefits of e-cigarettes in helping people to quit smoking with heated tobacco products.”

November 10, 2022
Mexico Invents Aerosol Test for Vapes ‘Since None Exist’

Credit: Niyazz
A health regulatory body for Mexico’s government says its scientists have developed a new methodology to analyze the aerosols in electronic nicotine-delivery systems (ENDS) because “no one else has come up with one.” The sale of ENDS products was banned in Mexico in June.
Final results of a new analysis of ENDS products using the new method will be published in scientific journals in the coming months, according to Cofepris chief Alejandro Svarch, who added that the “pioneering methodology” developed in Mexico will be of interest to health authorities in other countries.
Aerosol testing has been performed on vaping products since at least 2014 in other countries, such as the U.S. and the UK. Svarch offered no explanation on how Mexico’s new testing method is performed or why it is effective or why other methods were not effective, only that a testing method “did not exist.” There was no mention of what products were tested or at what temperatures.
He said an analysis using the exclusive method by health regulator Cofepris detected “30 undisclosed substances in aerosols inhaled” via ENDS products.
Linalool, which can be used as an insecticide, was one of the substances detected, Svarch said during Mexican President López Obrador’s press conference last week.
“This in itself is an enormous deception of consumers, who trust that the product is less harmful than a conventional cigarette, because it [supposedly] only has flavorings and nicotine, when in fact, it has other kinds of substances or ingredients that are highly dangerous for humans,” Svarch said.
Among the “hidden” ingredients that “producers of vaping devices don’t want us to know about,” he said, are dimethyl ether, benzyl alcohol, ethyl propionate, isoamyl acetate, butyl acetate and methyl cinnamate.
Svarch also presented a song commissioned by Cofepris (song starts at 1:40) that warns of the risks of vaping and advises ENDS users to “give up now.”
Among the cautionary tales offered via the song’s lyrics are the cases of a woman who lost three teeth due to vaping and a handsome man who became known as “burnt face” because his “beloved vape” exploded while he was using it, according to media reports.
October 25, 2022
BAT’s Glo Brand Doubles its Market Share in Korea

Credit: Radub85
Non-combustible products are rising in popularity in South Korea, especially the heated tobacco market. According to the latest government data, 210 million packs of heat-not-burn devices were sold in the first half of 2021, up 16.2 percent from the same period a year earlier.
The category’s share in Korea’s entire tobacco market has also increased to 12.4 percent in 2021 from 2.2 percent in 2017, according to Korea Biz Wire.
The country is a key market for the BAT’s glo device, with its market share growing twofold in the past two years. “Our local share has grown greatly since the launch of our heat-not-burn glo pro in 2019. Glo’s share in the non-combustible tobacco market has doubled from two years ago,” BAT’s Country Manager Kim Eun-ji said at the news conference.
BAT’s share in Korea’s non-combustible tobacco market has grown from 6.04 percent in 2017 to around 12 percent in June 2022, said Kim.
In line with such a trend, BAT, the maker of Dunhill and Lucky Strike cigarettes, has invested over $488 million in Korea, which includes a factory in Sacheon, 440 kilometers south of Seoul, which has served as a core export base of BAT since 2002.
“We are aware that the industry’s position is different from that of the health ministry. If we continue to push with more ‘data-driven’ (ways of) communication, we think it will create momentum (that can push) the government to take a step forward, but it will take time,” Kim said.
BAT is the third-largest player in the Korean market for non-combustible tobacco products. The front-runner is KT&G, which accounts for 47 percent of the local market as of June.
BAT Rothmans, the Korean arm of BAT, also reported Tuesday its tobacco heating device glo can reduce health risks of traditional cigarettes, according to a recent study published in the medical journal “Internal and Emergency Medicine.”
The study compared the health effects of glo against traditional cigarettes among 500 British adults aged between 23 and 55 over a one-year period. Researchers found that aerosol produced from glo had 90 to 95 percent less toxicant compared with smoke from traditional cigarettes.
Toxic compounds produced by burning tobacco were either not detected or significantly reduced through the glo device, the company added. “This real-world study allows us to assess the changes that adult smokers switching exclusively to glo experience. It reinforces glo’s potential as a reduced-risk product,” Sharon Goodall, BAT’s head of regulatory science, said at the news conference.
The study results come amid growing calls from the Korean government to increase regulations on e-cigarettes. In September, the health ministry pointed out that e-cigarette devices should go under tighter regulations, citing a growing number of teenage users of such products in the country.
E-cigarette heating devices, like glo, are categorized as ‘industrial products’ in Korea and are subject to looser regulations compared with cigarettes. “It’s hard to entirely trust a clinical study result unilaterally conducted by the tobacco industry. The World Health Organization has concluded that there’s insufficient evidence to support that e-cigarettes are less harmful than traditional cigarettes,” a health ministry official said. He asked not to be identified, citing the issue’s sensitivity.
October 11, 2022
Study: Cannabis Users More Likely to Use Nicotine

Credit: Wing-Wing
Medicinal cannabis users are more prone to consume nicotine products than the general population, according to a recent study.
The study, published in the American Journal on Addictions, is among the first to examine nicotine use among patients of a medical marijuana dispensary, according to a release from Rutgers University.
“Simultaneous use of cannabis and nicotine is a growing concern, but while the relationship between recreational cannabis and nicotine use is well-established, little is known about nicotine use among users of medical cannabis,” said Mary Bridgeman, a clinical professor at Rutgers Ernest Mario School of Pharmacy.
The researchers surveyed 697 patients between ages 18 and 89 at a medical marijuana dispensary on their nicotine and cannabis use, how they self-administered the cannabis (smoked, vaped) and the medical conditions that qualified them for using therapeutic cannabis.
They found that close to 40 percent of medical marijuana users also use nicotine – sharply higher than the 14 percent of U.S. adults who smoke.
Therapeutic cannabis users who also used e-cigarettes or didn’t use nicotine at all were about four times more likely to vape, rather than smoke, cannabis than those who exclusively smoked cigarettes.
The study also found that 75 percent of the respondents smoked cannabis rather than vaped and about 80 percent of the cigarette smokers reported planning to quit in the next six months.
“These findings reveal that while medical cannabis dispensaries may recommend vaping rather than smoking cannabis due to the health concerns associated with combustible products, this recommendation alone may not influence patients who also smoke cigarettes,” said co-author Marc Steinberg, author of the study and a professor in the department of psychiatry at Rutgers Robert Wood Johnson Medical School.
“Between the higher rates of nicotine use in those using medical cannabis, the fact that cigarette smokers opt to smoke cannabis as well and that those people also are seeking to quit using nicotine presents a strong argument that dispensaries provide tobacco control messaging at the point-of-sale to encourage cigarette smokers to quit,” Steinberg added. “The strategy also could increase the chances that a medical cannabis user would vape the product, which is a less harmful route than smoking.”
September 1, 2022
US Poll Shows Marijuana Use Tops Tobacco for First Time

Credit: Martijn Baudoin
A landmark poll in the U.S. has shown that marijuana use is greater than tobacco for the first time. The recently released Gallup poll showed that 16 percent of Americans said they smoked marijuana, compared to 11 percent who had smoked tobacco in the past week.
For comparison, a Gallup poll from the year 1969 showed that at that time, just four percent of Americans admitted they had even tried marijuana – compared to 48 percent today. But polling data from that same year revealed 40 percent of Americans had smoked tobacco cigarettes in the past week – and that number was the lowest recorded by Gallup on that issue between 1944 and 1972.
Marjiuana and tobacco usage trends have been going in opposite directions for a few decades now. By 1985, nearly as many Americans said they had tried marijuana (33 percent) as had smoked a cigarette in the past week (35 percent), according to News9.
Cigarette smoking has been declining ever since. By 2013, just 19 percent of Americans were smoking cigarettes at least once a week. The trend toward more marijuana smokers is driven by young people.
The National Institutes of Health reported last week that more young adults used marijuana in 2021 than in any year prior. Nearly a third (30 percent) of adult respondents under the age of 35 admitted to Gallup this year that they smoke marijuana. That’s significantly higher than those aged 35-54 (16 percent) or 55-plus (seven percent).
And just eight percent of adults under 35 are smoking cigarettes at least once a week. Slightly more adults aged 35-54 (10 percent) or 55-plus (14 percent) said they had.
The higher rates of marijuana smoking come with major political implications. A record high percentage of Americans (over two-thirds, per Gallup) say they favor legalization of recreational marijuana.
August 30, 2022
FDA Issues Guidance on Perception, Intention Studies
The U.S. Food and Drug Administration Today issued a final guidance on Guidance perception and intention studies.
This guidance, “Tobacco Products: Principles for Designing and Conducting Tobacco Product Perception and Intention Studies,” is intended to help applicants design and conduct tobacco product perception and intention (TPPI) studies that may be submitted as part of a modified risk tobacco product (MRTP) application, a premarket tobacco product application (PMTA), or a substantial equivalence report (SE Report).
TPPI studies can be used to assess, among other things, individuals’ perceptions of tobacco products, understanding of tobacco product information (e.g., labeling, modified risk information), and intentions to use tobacco products, according to the FDA.
These studies provide critical information during the review of product applications and this guidance provides recommendations on how to perform these studies.
This final guidance addresses the following scientific issues for applicants to consider when designing and conducting TPPI studies to support tobacco product applications:
- Developing study aims and hypotheses
- Designing quantitative and qualitative studies
- Selecting and adapting measures of study constructs
- Determining study outcomes
- Selecting and justifying study samples
- Analyzing study results
This guidance document is intended to provide clarity to applicants regarding existing requirements under the law. FDA guidance documents, including this guidance, should be viewed as recommendations for consideration, unless specific regulatory or statutory requirements are cited.
August 23, 2022
NIH, FDA Fund Study to Understand Effect of Flavors

Credit: Feng Yu
The National Institutes of Health and the U.S. Food and Drug Administration have given the University of Louisville a $3.6 million grant to study the effects of flavorings like mango and bubblegum used in vaping products.
Researchers at UofL’s Christina Lee Brown Envirome Institute hope to better understand the short-and long-term impacts of flavorings -specifically on the heart- and catalog which are potentially harmful, according to Kentucky Today.
“E-cigarettes are still relatively new, and we don’t yet fully understand what their health effects are,” said Alex Carll, an assistant professor in the Department of Physiology and co-lead on the project. “Understanding this could help us make better purchasing and regulatory decisions.”
The FDA banned flavors used in disposable e-cigarette and has not approved any flvors except tobacco through its premarket tobacco product application (PMTA) process. The agency contends that some flavors could appeal to kids and help fuel rising rates of youth vaping.
Matthew Nystoriak, an associate professor of medicine and co-lead on the project, said some flavors may seem harmless because they taste like or use the same ingredients as in food. But while those ingredients are safe to eat, they may not be safe to inhale.
“Our goal is to understand how individual flavoring chemicals impact the heart,” Nystoriak said. “There are many flavor chemicals used in e-cigarettes and if we know which are potentially more harmful than others, it’s possible for people to make more informed decisions about which products they use.”
Identifying their biological effects also is likely to help the FDA in regulating flavoring additives in e-cigarettes in the future.
June 16, 2022