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Recent eLetters

Displaying 1-10 letters out of 374 published

  1. Beyond tobacco to divesting from eco-destructive resource and industrial sectors

    NOT PEER REVIEWED To the Editor:

    Beyond the plea to divest from funding tobacco companies, shareholders need to consider the adverse impact of investing in industries and resource extraction that worsen eco-degradation.

    At a group level, the impetus for environmentally accountable investing by colleges and universities can be better maintained by teaching every student the practical ways to minimize their community's ecological footprint. Mandatory ecology courses delivered to young minds could incite a life-long pledge to heightened civic responsibility. It holds potential to cultivate future leaders that will cogitate for not just sustainable investment in centres of higher learning but become strong advocates for environmentally friendly policy and industry in the wider world. Students' concerted demands for sustainable investment on campus are a positive, but only a first step.

    The long-term commitment to lessening ecological degradation through informed protest, "maintaining the rage," policy debate and green innovation comprise better imprinted values that can be passed on to children and grandchildren. The latter is best achieved through formal education on humanity's impact on the natural world.

    Conflict of Interest:

    None declared

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  2. Assessing Google Trends Data for Electronic Nicotine Delivery System Interest

    NOT PEER REVIEWED Cavazos-Rehg et al. compared the results of Google Trends relative search volume (RSV) data for non-cigarette tobacco use with data from state- and national-level youth surveys.[1] Given the authors' findings of positive correlations with Google Trends and survey data, we agree with the conclusion that Google Trends may be a potential tool to provide real- time monitoring for non-cigarette tobacco use. The 2014 National Youth Tobacco Survey indicates that electronic nicotine delivery system (ENDS) use has tripled by middle and high school students from 2013-2014.[2] We have conducted a preliminary review of Google Trends RSV data for ENDS to detect if there were trends that may mirror acquisition patterns of ENDS within and outside of the US.

    The methods we used were similar to Ayers et al., who conducted a data analysis from Google search engines from January 2008 through September 2010.[3] We compiled a list of search terms in singular and plural forms that reflected the most commonly used search terms for ENDS including "e cig," "e cigarette," "electronic cigarette," and popular name brands. To continue building the list, we added popular "related terms" as indicated by Google Trends searches. When search terms exceeded the 30- word limit, we compared RSV for individual terms and removed those with the lowest RSV. Irrelevant (non-ENDS) results were excluded.[1] Results were limited to October 2011 to May 2015 and included all countries. Search queries range from 0-100 in volume, with the highest RSV assigned a 100.[4]

    Similar to prior work,[3] ENDS emerged in all markets and RSV trends have slowly increased since 2011, peaking in January each year. This suggests that interest in information on ENDS is growing, and that there has been a recent shift in interest by country compared to prior findings.[3] The greatest RSV of ENDS is in the United Kingdom (100), followed by the United States (84), Ireland (63), Cyprus (46), Malta (42), Canada (41), Trinidad and Tobago (35), Australia (33), Philippines (29), and New Zealand (29).

    Web search data can help fill gaps by providing a timely understanding of real-world activity and good temporal and spatial resolution.[5] It is unclear how these search patterns reflect use patterns in youth. Future investigations with comparisons to youth surveillance datasets and population-level efforts using real-time monitoring of youth interest,[6] and tracking of use patterns may help to inform timely prevention programs and policies for ENDS, other non- tobacco, and tobacco products.

    References

    1. Cavazos-Rehg PA, Krauss MJ, Spitznagel EL, et al. Monitoring of non-cigarette tobacco use using Google trends. Tob Control. 2015;24(3):249 -255.

    2. Centers for Disease Control and Prevention. E-cigarette use triples among middle and high school students in just one year. Centers for Disease Control and Prevention Newsroom. 2015. http://www.cdc.gov/media/releases/2015/p0416-e-cigarette-use.html (accessed 01 Jun 2015).

    3. Ayers JW, Ribisl KM, Brownstein JS. Tracking the rise in popularity of electronic nicotine delivery systems (electronic cigarettes) using search query surveillance. Am J Prev Med. 2011;40(4):448-453.

    4. Google Trends. About Google Trends. Google. 2015. https://support.google.com/trends/answer/4355164?hl=en&ref_topic=4365531 (accessed 05 Jun 2015).

    5. Mohebbi M, Dan Vanderkam JK, Kodysh J, et al. Google correlate whitepaper. Google. 2011:1-6. https://www.google.com/trends/correlate/whitepaper.pdf (accessed 01 Jun 2015).

    6. Goel S, Hofman JM, Lahaie S, et al. Predicting consumer behavior with web search. Proc Natl Acad Sci U S A. 2010;107(41):17486-17490.

    Conflict of Interest:

    None declared

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  3. RE: Estimates of the economic contributions of the bidi manufacturing industry in India

    NOT PEER REVIEWED I read the research paper (other authors Ashvin, Emmanuel, Frank and Prabhat) with interest.

    Quite a few new points have been brought out. One of the important political reasons for resistance is that hand made ones are done in rural areas where alternate means of employment are hard to come by. This results in the local political representative arguing against tax.

    Alternatives such as Agarbathi (insense stick) manufacturing, Coir weaving or other rural handicrafts - must be suggested to make the argument for higher taxation on Bidi. In all these cases the raw material supply and picking up the finished products remains the responsibility of the manufacturer (similar to the operation of making Bidi, but with no ill effects on society).

    Also, the higher probability of cancer in cigarette smoking must be countered with the argument that larger number of Bidis are smoked per person per day (since it is considerably cheaper).

    Without such specific suggestions - this will remain a research paper of analysis but not directive. Without a clear directive, no government (much less the local politician) can act to change the situation. Also, advertising of tobacco products is banned in India. So, that channel is not an option.

    How could the top manufacturer "Mangalore Ganesha Bidi" regain market share in a matter of 1-2 years? They continue to supply 3.5 million small packets every day (25 bidi in each packet). They have been the biggest manufacturer for over five decades now. Their industry was built on the fact that it is all hand made and provides employment in rural areas.

    Therefore, alternatives that provide credible means of livelihood in the rural area, are essential in order to make any progress.

    Conflict of Interest:

    None declared

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  4. Response to E-Letter from May 6, 2015

    NOT PEER REVIEWED We explicitly did not do a systematic review, which would have included things such as assessing articles for quality and assessing for presence of publication bias. Instead we opted for a narrative review. This decision was made given the limited time available for the authors to complete the supplement prior to the World Conference on Tobacco or Health and the small number of available articles after our literature search. Our exclusion and inclusion criteria were also stated (see Figure 1). Lastly, our search was up until September 9, 2014, therefore any articles published afterwards were not included in the publication. We believe that this paper represents a significant contribution concerning a newly emerging threat to the health of the public.

    Conflict of Interest:

    None declared

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  5. These are not real-world conditions.

    NOT PEER REVIEWED "The GC temperature programme for all analyses was: 35C hold for 5???min; 10C/min to 300C; then hold for 3.5???min at 300C." Water is not dangerous. Yet, if I submerge a human test subject in a container of water for 3.5 minutes, then this water becomes quite lethal. No vaping device is intended to run continuously for longer than a few seconds. Furthermore, 300C is far too high a temperature for any vaping device. If I force a human test subject to drink a large cup of coffee heated to 300C, they will suffer severe injuries, possibly fatal. This does not make coffee consumed at an appropriate temperature and at an appropriate pace dangerous.

    Conflict of Interest:

    None declared

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  6. Questions asked and answered

    NOT PEER REVIEWED

    This letter responds to misrepresentations in a recent article by Daniel Stevens and Stanton Glantz (1). In the article, Stevens and Glantz question my integrity based on some questions during a 4-day deposition which I gave in 2014 in a legal proceeding against my employer. These writers cite snippets from the 1,000+-page transcript of that deposition, relating the text of a facetious note that I had sent to my boss almost 20 years ago in 1996. The writers use a small portion of that note, together with my answers to other deposition questions, taken out of context, to infer that I gave questions from the open-book examination for recertification to my co-workers to answer for me.

    It is well-understood that recertification candidates must complete the self-assessment examination themselves (2), which is precisely what I did in both 1992 and 1996. Period. I stand by my sworn testimony that I did not provide questions from either my 1992 or 1996 recertification examinations to anyone to answer for me, and that my examination responses were my own work. This is made clear in the deposition transcript and I refute this attempt by Stevens and Glantz to suggest otherwise.

    I am taken aback by the willingness of Tobacco Control to accept the sort of "scholarship" pursued by Stevens and Glantz. These authors advise special scrutiny of my work, with specific mention of my lead authorship of the Industry Menthol Report that was written at the request of the FDA (3). I stand by the scientific integrity of and conclusions in that report, as well as by the comments provided to FDA on the recently-voided TPSAC menthol report (4), and on FDA's own Preliminary Scientific Evaluation of menthol (5).

    Jonathan Daniel Heck, Ph.D., DABT, ATS

    References

    1. Stevens D, Glantz S. Tob Control Published Online First: May 12, 2015, doi:10.1136/ tobaccocontrol-2015-052271.

    2.http://www.abtox.org/Candidates/ABOT_recertification/ABOT_recertification_policy.aspx (accessed May 19, 2015)

    3 http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/TobaccoProductsScientificAdvisoryCommittee/UCM249320.pdf (accessed May 19, 2015).

    4 http://www.lorillard.com/pdf/fda/Comments_to_FDA_on_TPSAC_Report.pdf (accessed May 19, 2015)

    5. http://www.lorillard.com/wp-content/uploads/2013/11/PSE- Response_Lorillard_Final.pdf (accessed May 19, 2015)

    Conflict of Interest:

    I am a full-time employee of the Lorillard Tobacco Company. I have been asked on occasion to provide testimony in litigation involving my employer. I have done so from time to time, and receive no payment for this beyond the normal salary and benefits of my employment

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  7. Re:No evidence that the tobacco industry evaded the FDA's ban on 'Light' cigarette descriptors

    NOT PEER REVIEWED This comment summarizes, but mischaracterizes the findings and conclusions of our study. Our analyses and interpretation are based strictly on the letter of the Family Smoking Prevention and Tobacco Control Act (FSPTCA) and its requirements, including Section 911(b)(2)(ii), which bans "the use of explicit or implicit descriptors that convey messages of reduced risk including 'light', 'mild' and 'low', or similar descriptions in a tobacco product, label, labeling or advertising". The findings demonstrated that manufacturers did not simply remove descriptors, to be in compliance with the law, but introduced new color- coded brand name descriptors which smokers were able to recognize and easily identify the formerly labeled "lights" brands. We did not examine the use of colors themselves, which may be protected by the First Amendment, but rather the use of color terms. The marketing materials examined make explicit the fact that the use of substituted color terms in brand names is similar to the dropped "descriptors, so that consumers will continue to recognize these brands as "lights". The National Cancer Institute previously found that filter ventilation has been used by manufacturers to delineate the misleading "lights" categories, which are now color-coded, and which conveyed messages of reduced risk resulting in increased initiation and reduced cessation. Our conclusions are stated in conservative terms that manufacturers appear to have evaded this critical element of the FSPTCA, which is intended to protect the public health.

    Conflict of Interest:

    None declared

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  8. Review of air quality, biological indicators and health effects of second-hand waterpipe smoke exposure - Letter

    NOT PEER REVIEWED Dear Editor,

    Research on waterpipe smoking, also called hookah, is still emerging, and research on second-hand hookah exposure is still in its nascent stages. However, after reading the review on the various effects of second -hand waterpipe smoke exposure by Kumar et al recently published in Tobacco Control1, we noted several major issues in its execution and have serious reservations about the potential of this review as a tool in the development of public health policy. First, the authors failed to synthesize all available research on the topic into their review, by utilizing only two electronic search databases. When a search was conducted in CINAHL, we found one more relevant article that could have been included in this review2. However, we are unable to judge as the authors don't present the inclusion criteria for the review. Furthermore, we found another systematic review on this topic and found that the amount of nicotine absorption resulting from daily hookah use was similar to that of daily cigarette use3. This is concerning because the authors did not include the older systematic review in the narrative nor did they derive information from it; consequently, calling into question the relevance of the current review. In addition, the authors were unclear regarding their methodology. They only provided a list of search terms and failed to specify any inclusion criteria, making it impossible for anyone to replicate their review. Second, the authors did not seem to have assessed the scientific quality of the included studies, negatively affecting the transparency of the review process. Thus, readers cannot properly assess its quality as a comprehensive review of the current body of literature or assess the validity of the findings that were included in the review. They also failed to assess publication bias, which would have been a relevant issue as they only included published studies. Given that a number of reporting guidelines for reviews have been produced, these issues are almost unjustifiable. Although the authors examined an important, often overlooked public health issue, their review suffered from major methodological flaws that could not be ignored. Unfortunately, the review's weaknesses prevent it from being a proper synthesis of the current body of research on the effects of second-hand exposure to hookah smoke and a useful tool for assisting decision-making in public health policy.

    REFERENCES 1 Kumar SR, Davies S, Weitzman M, Sherman S. A review of air quality, biological indicators and health effects of second-hand waterpipe smoke exposure. Tob Control. 2015; 24: i54-i59. doi: 10.1136/tobaccocontrol-2014 -052038 2 Aydin A, Kiter G, Durak H, Ucan ES, Kaya GC, Ceylan E. Water-pipe smoking effects on pulmonary permeability using technetium-99m DTPA inhalation scintigraphy. Ann Nucl Med. 2004; 18(4): 285-289. doi: 10.1007/BF02984465 3 Neergaard J, Singh P, Job J, Montgomery S. Waterpipe smoking and nicotine exposure: a review of the current evidence. Nicotine Tob Res. 2007; 9(10): 987-994. doi: 10.1080/14622200701591591

    Conflict of Interest:

    None declared

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  9. An update on smoking prevalence projections to 2025 and beyond in New Zealand

    NOT PEER REVIEWED

    Frederieke S. van der Deen and Nick Wilson (on behalf of the other authors; both from the University of Otago, Wellington, New Zealand)

    This electronic letter aims to give readers an update on the smoking prevalence projections to 2025 and beyond in New Zealand (NZ) that were provided in the paper by Ikeda et al. NZ is now one of four nations with an official smokefree goal (others are: Finland, Scotland, and Ireland). In NZ, this goal is generally interpreted as achieving a smoking prevalence under 5% by the year 2025.

    The modelling work by Ikeda et al aimed to explore the feasibility of achieving this goal under current annual trends in smoking uptake and cessation (ie, business-as-usual (BAU)). Smoking prevalence data from a regularly conducted NZ health-related survey between 2002 and 2011 were used to provide information on recent annual trends in smoking uptake and cessation as input for future BAU smoking prevalence projections. However, since this modelling work was first published (as an e-publication in 2013), smoking prevalence data from the 2013 Census has become available. A larger than expected fall in smoking rates in the general NZ adult population, but especially in Maori (indigenous population), was observed. It was therefore decided to update the future BAU smoking prevalence projections that were provided in the Ikeda et al paper by using smoking prevalence data from the 2013 Census.

    The updated future BAU projected smoking prevalence in 2025 was 8.3% and 6.4% for non-Maori (Ikeda et al: 10.7% and 8.8%), and 18.7% and 19.3% for Maori men and women, respectively (Ikeda et al: 30.0% and 37.3%). Although the updated projections are more favourable from a public health perspective (especially for Maori) than the previous modelling work, a smoking prevalence below 5% by 2025 is still not attained by any demographic group. Achieving the 2025 smokefree goal will most likely require implementation of more intense existing tobacco control strategies or potentially even entirely novel measures (eg, major changes in the tobacco retail environment as per the Tobacco Control themed supplement for March 2015 'The Pack and the Retail Environment').

    Updating the previously published smoking prevalence projections proved to be a feasible and relatively easy exercise. Projecting and regularly updating future BAU smoking prevalence projections with most up- to-date smoking prevalence data, in NZ and in other nations, may assist policy makers in planning how much more intense tobacco control measures may need to be to achieve smokefree goals. For more detail around the methods of updating the previous modelling work by Ikeda et al, we would refer readers to the recently published paper that describes this work [1].

    Reference

    1. van der Deen FS, Ikeda T, Cobiac L, Wilson N, Blakely T (2014) Projecting future smoking prevalence to 2025 and beyond in New Zealand using smoking prevalence data from the 2013 census. N Z Med J 127 (1406): 71-79. http://www.otago.ac.nz/wellington/otago083774.pdf

    Conflict of Interest:

    None declared

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  10. Tobacco industry peddling overestimates of illicit cigarettes to dampen tax increase

    NOT PEER REVIEWED

    We refer to the article, "Did the tobacco industry inflate estimates of illicit cigarette consumption in Asia? An empirical analysis" Chen J, et al. published in Tobacco Control on November 25, 2014 (Tob Control 2015;0:1-7) and concur with the important points raised in this article. While the article focuses on Hong Kong, other countries in South East Asia also faced a similar experience. The authors revealed that the tobacco industry-funded study on the illicit trade of cigarettes in Asia, "Asia-11 Illicit Tobacco Indicator 2012" by the International Tax and Investment Center (ITIC) and Oxford Economics (OE) inflated the extent of illicit consumption in Hong Kong by 133-337 percent. Similarly, other scholars have also questioned the methodology applied in this report. For example, Dr. Frank Chaloupka, Distinguished Professor of Economics at the University of Illinois at Chicago, criticized the reliability of the study's estimates in using an inconsistent approach and the lack of details about the empty pack surveys, the main source of data for the estimates. In June 2014, the South East Asia Tobacco Control Alliance (SEATCA) released a critique of the "Asia-11 Illicit Tobacco Indicator 2012" showing how its estimates are being used to rescind tobacco tax policies. As illustrated in Hong Kong's experience, the SEATCA critique revealed that the ITIC-OE report overestimated the total illegal consumption in other countries in South East Asia. In the case of Vietnam, it claimed that in 2012 about 103.3 billion cigarettes consumed in Vietnam were illegal, which amounted to 19.4% of total cigarette consumption. The estimate was based primarily on the data of a tobacco industry group, the Vietnam Tobacco Association (VTA), and the full details of the methodology were not disclosed. The report admitted that data were collected only in urban areas, but it failed to mention that 68.3% of the Vietnamese population live in rural areas. This means that the findings are not representative of the Vietnamese population and are very likely biased since illicit cigarettes consumption is concentrated in big cities and near borders.

    Unfortunately, as in Hong Kong, the glossy ITIC-OE study took its toll on tobacco tax policy in Vietnam. The Government of Vietnam considered the results of the study and opted for a less than ambitious tobacco tax rate increase. When the Ministry of Finance proposed a rather moderate tobacco tax roadmap in March 2014 (an increase from 65% to 75% in July 2015 and to 85% in January 2018), they noted that their decision was influenced by the illicit cigarette issue. The scope of illicit cigarettes consumption and the associated government revenue loss continued to be highlighted both in the press and during the policy debates until November 2014, when the National Assembly adopted an even weaker excise tax law: an increase to 70% in Jan 2016, and to 75% in 2019. Since these taxes are based on ex-factory price, and the tobacco industry is in full control of that price, the full impact on cigarette retail prices and tax revenue is likely to be minuscule. The average real retail cigarettes prices are expected to increase by less than 1% per year in the period from 2015 to 2020 (5.8% in 6 years), which, given the 5-6% annually per capita real income grows, is insufficient to prevent cigarette consumption from rising. In summary, the Asia-Illicit Tobacco Indicator 2012 report was as non- transparent in Hong Kong as it was in Vietnam and nine other countries covered by the report. It was used to undermine a pro-health tobacco tax policy supported both by public health advocates as well as the general public. We thank Tobacco Control for publishing the findings of Hong Kong colleagues, which successfully challenged the invalid evidence and arguments supported by the tobacco industry. We hope that other countries in Asia and elsewhere will follow Hong Kong's initiative and expose the tobacco industry's tactic to undermine pro-health tobacco tax policies that signatories to the WHO FCTC are committed to under Article 6 of the Convention.

    Thank you

    Sincerely, Son Dao , Hana Ross and Sophapan Ratanachena

    Conflict of Interest:

    None declared

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