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Recent eLetters

Displaying 1-10 letters out of 380 published

  1. Corroborating experimental study finds no effect of e-cigarette advertisements on interest in or susceptibility to tobacco smoking or e-cigarette use

    In a smaller sample of older teenagers, I recently extended and replicated some of Vasiljevic and colleagues' findings [1]. In line with their results, I found that e-cigarette advertisements did not increase interest in tobacco smoking, interest in using e-cigarettes or susceptibility to either behaviour.

    In this experimental study, 65 UK non-smokers aged 16-19 years were randomised to viewing either six e-cigarette advertisements cleared for television broadcast in the UK in 2014/15 or recent nicotine replacement therapy (NRT) adverts. The e-cigarette adverts featured five different brands and varied in content, setting, people portrayed, type of e- cigarette and whether flavours were a focus. Participant completed a baseline survey, watched the three-minute videos and completed a distractor task and a post-exposure survey in their own time on individual computers using headphones.

    The main outcome measures were interest in using e-cigarettes and interest in smoking tobacco cigarettes measured using visual analogue scales from 0 'no interest at all' to 100 'most interest ever' completed at baseline and post-exposure [2]. Additionally, at both time-points, four items measured susceptibility to use e-cigarettes/smoke cigarettes by asking participants if they would use an e-cigarette/smoke a cigarette if offered one by a friend and if they thought they would use/smoke in the next month [3]. Those ticking anything other than 'definitely not' on a 4- point scale were considered susceptible to e-cigarette use or smoking, respectively.

    Ethical approval was granted from a Research Ethics Subcommittee at King's College London (PNM 1415 61).

    The majority of participants were female (63%), British (83%), and of non-white ethnicities (65%). The NRT group was on average a few months older than the e-cigarette group (p=0.02) and the e-cigarette group indicated higher baseline interest in using e-cigarettes than the NRT group (p=0.04). Mixed two-way analyses of variance therefore adjusted for baseline differences between groups.

    There was no significant group by time interaction for interest in using e-cigarettes [F(1,62)=0.81, p=0.372, partial eta-squared=0.013] or smoking tobacco cigarettes [F(1, 61)=0.30, p=0.86, partial eta-squared <0.001], indicating that interest was not affected by exposure to the adverts. Non-parametric tests showed no significant change in the proportion susceptible to using e-cigarettes or smoking (all p>0.1), any small changes were towards a reduction in susceptibility.

    In conclusion, these results from an older age group of adolescents and using a different control condition corroborate Vasiljevic and colleagues' finding that there is no evidence of renormalisation of smoking due to e-cigarette advertising.

    References

    1. Vasiljevic M, Petrescu DC, Marteau TM. Impact of advertisements promoting candy-like flavoured e-cigarettes on appeal of tobacco smoking among children: an experimental study. Tobacco control 2016 doi: 10.1136/tobaccocontrol-2015-052593.

    2. King AC, Smith LJ, McNamara PJ, Matthews AK, Fridberg DJ. Passive exposure to electronic cigarette (e-cigarette) use increases desire for combustible and e-cigarettes in young adult smokers. Tobacco control 2015;24(5):501-4 doi: 10.1136/tobaccocontrol-2014-051563.

    3. Bogdanovica I, Szatkowski L, McNeill A, Spanopoulos D, Britton J. Exposure to point-of-sale displays and changes in susceptibility to smoking: findings from a cohort study of school students. Addiction (Abingdon, England) 2014 doi: 10.1111/add.12826.

    Conflict of Interest:

    None declared

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  2. Other Possible Supplements to Cigarette Warning Labels?

    It is enormously helpful when researchers consider new, not-yet-tried tobacco control interventions (such as this study's consideration of warning messages on cigarette sticks), especially when researchers figure out effective ways to evaluate the not-yet-tried interventions.

    Some additional possibilities related to new warnings or pack changes that might be considered:

    (1) Put instructions for use in all cigarette packs that instruct smokers (with explanations) about how they can minimize the harms and risks to themselves and to others from their consumption of the cigarettes, such as:

    -- Do not smoke the cigarettes

    -- Do not smoke near anyone else

    -- Do not smoke in enclosed spaces

    -- Do not smoke by inhaling

    -- If inhaled, inhale as shallowly as possible

    -- Do not smoke more than a few puffs of each cigarette (or do not smoke more than halfway)

    -- Do not smoke in bed or when tired

    -- Make sure all smoked cigarettes are fully extinguished before discarding

    -- Discard of all cigarettes carefully (do not litter, do not discard in waterways, do not leave where children or pets might consume).

    (2) Make one cigarette in each pack a rolled-up scroll of information or instructions for use for smokers (which would also reduce the number of cigarettes that could be smoked in each pack, perhaps reducing consumption).

    (3) Audio warnings that play each time a pack is opened or a cigarette is extracted (now possible with available technologies).

    Conflict of Interest:

    None declared

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  3. Reply to Does smuggling negate the impact of a tobacco tax increase?

    NOT PEER REVIEWED This article is manifestly wrong in material content. Hong Kong has in fact, two current large domestic manufacturers of tobacco products, Hong Kong Tobacco Co Ltd and Nanyang Brothers Tobacco Co Ltd. Moreover the HK Customs Dept are all over the local dial-up-delivery smuggling syndicates to the extent that the tobacco funded front groups ITIC and Oxford Economics had to produce wildly false and flawed Information on the supposed level of illicit product availability (suitably decimated by the following reports). The HK Government gauges smoking prevalence from its Thematic Household survey reports; what is lacking in Hong Kong is the absence of questions in these Thematic Household Surveys seeking information on how many interviewees had purchased and / or used illicit tobacco in the previous year, the price they paid for it and the frequency of such DNP usage and whether they were concerned that the ingredients / nicotine/tar levels would most likely be far more toxic than the excise DP cancer sticks. Only with the incorporation of this relevant data could the claimed 10.7% prevalence levels be accurately gauged. In Singapore which has a lower cost of living than Hong Kong, a DP packet of Marlboro retails at HK$ 76 whereas the same DP packet in Hong Kong costs only HK$ 50, meaning tobacco remains affordable and available to HKG youth and there is no tobacco retailer license system, no POS display legislation and no onus on liquor /mahjong / sauna licensees to enforce the anti smoking legislation in their premises. The Health Department Policy Bureau failed to seek an excise increase in the last Budget, according to the Financial Secretary in an RTHK radio interview in Feb 2015. The Tobacco Control Office has just over 100 'enforcement' officers to cover Hong Kong, Kowloon, the New Territories and the Islands area over two shifts meaning they have insufficient manpower to patrol. http://seatca.org/dmdocuments/Asia%2014%20Critique_Final_20May2015.pdf http://tobaccocontrol.bmj.com/content/early/2015/01/05/tobaccocontrol-2014-051937.full http://www.legco.gov.hk/yr11-12/english/counmtg/hansard/cm0322-translate-e.pdf page 7400 http://www.customs.gov.hk/en/publication_press/press/index_current.html Shows the multiple seizures and arrests. Hong Kong Tobacco Company Ltd Address : 3/F Paramount Building, Hong Kong Tel 25618111 Owner Charles HO Tsu Kwok https://webb-site.com/dbpub/positions.asp?p=4462 http://www.bloomberg.com/research/stocks/people/person.asp?personId=8075652&ticker=1105:HK https://webb-site.com/articles/bauhiniafound.asp Nanyang Brothers Tobacco Co Ltd http://www.nbt-hk.com/ Location: Tuen Mun Hong Kong http://www.zigsam.at/B_Peel.htm http://www.scmp.com/news/hong-kong/law-crime/article/1846318/tobacco-worker-43-dies-industrial-accident-hong-kong Nan Yang also manufacture flavored tobaccos (PEEL)which are sold in the local market http://english.caijing.com.cn/2004-03-20/110030213.html Smuggling arrests http://www.siic.com/en_service_4.html Nanyang owners Nanyang Brothers Tobacco Co., Ltd. Nanyang Brothers Tobacco (short for "NBT")is the largest cigarette manufacturer in Hong Kong, of which main brand is "Double Happiness " and has a history of more than 100 years. At present, "Double Happiness" has been one of the most valuable trademarks in the tobacco industry. The production base of NBT is located in Tuen Mun, Hong Kong. NBT owns advanced manufacturing techniques, and its process of production is completely under computer control and management in order to guarantee the quality of products. The product of NBT is not only sold to China Mainland, Taiwan, Hong Kong and Macao, but also sold to Singapore, Thailand and Korea and so on. In 2011, its sales revenue and net profit reached 2,473 million HK dollars and 610 million HK dollars respectively. Cigarettes manufactured by Nanyang Brothers Tobacco Nanyang Brothers Tobacco Co. Ltd., located at Tuen Mun, New Territories, Hong Kong, China Nanyang Brothers Tobacco Co. Ltd., located at 9 Tsing Yeung Circuit, Hong Kong, China Founded in 1906. NANYANG means SOUTH PACIFIC. Current PRODUCTS: Alain Delon, Centori, Chunghwa, DJ Mix, Just Above, Peel, Polar Bear, Shuang Xi, Texas 5, (The Globe), Wealth

    Conflict of Interest:

    None declared

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  4. Response to McDaniel re: Endgame Review and Wake-up Call to the Tobacco Control Community

    NOT PEER REVIEWED The recent endgame review by McDaniel et al1 demonstrates a major flaw in thinking within the tobacco control community. The industry is seen as dominated by the "big tobacco" cigarette companies. The real life industry is intensely competitive and highly fragmented. There are, within the industry, many who could effectively partner with the public health community, if given the opportunity to do so. Because of this flaw in thinking, the tobacco control community has been unwilling to consider any role for tobacco harm reduction or electronic cigarettes in any public health initiative. E-cigarettes have the potential to substantially reduce smoking-related illness and death and do so without recruiting significant numbers teens or other non-smokers to nicotine use. .2-5

    The McDaniel paper1 lists sixteen end-game proposals, fourteen of which consist of partial or total bans on aspects of the manufacture or sale of non-pharmaceutical nicotine delivery products. Only two, one referencing e-cigarettes and another "advantage cleaner nicotine products over combustibles" make any reference to tobacco industry participation in pursuit of tobacco control objectives. Both are discouraged as unproven and impractical despite substantial scientific evidence to the contrary.

    The time has come for the public health community to engage in dialogue with those stakeholders in tobacco-related industries who are ready, willing and able to partner with public health in pursuit of shared public health objectives. The purpose of this dialogue would be to help secure reductions in tobacco-related illness and death not likely achievable by other means.

    Experience to date with e-cigarettes gives us grounds for optimism that this could easily be done without recruitment of teens and other non- users to nicotine use. .2-4

    A world in which tobacco-related addiction, illness and death have been reduced to trivial public health problems could be achieved within our lifetimes. Achieving this goal will require re-orienting tobacco control from a crusade against all things "tobacco," to a public health initiative considering all options for the prevention of addiction, illness and death. This is a goal not likely achievable by any other means. A seemingly small change in the wording of our tobacco control goal from "a tobacco-free society" to "a smoke-free society" would get us most of the way there. References

    1. McDaniel PA, Smith EA, Malone RE. The tobacco endgame: A qualitative review and synthesis. Tob Control 2015 28 August; Special Communication Published On Line:1-11. 2. Nitzkin JL. The case in favor of e-cigarettes for tobacco harm reduction. International Journal of Environmental Research and Public Health 2014;11:6459-71. 3. Nitzkin JL. E-cigarettes: A life-saving technology or a way for tobacco companies to re-normalize smoking in American society? FDLI's Food and Drug Policy Forum 2014 30 June;4(6):1-17. 4. McNeill A, Brose L, Calder R, Hitchman S. E-cigarettes: An evidence update. A report commissioned by Public Health England [https://www.gov.uk/government/publications/e-cigarettes-an-evidence- update]. A an Evidence Update Plus Policy Implications. London, England, August, 2015. 19 August 2015. 5. Farsalinos K, Polosa R. Safety evaluation and risk assessment of electronic cigarettes as tobacco cigarette substitutes: A systematic review. Therapeutic Advances in Drug Safety 2014;5(20):67-86

    Conflict of Interest:

    I currently serve as Senior Fellow for Tobacco Policy for the R Street Insitute

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  5. Re: Raising the Minimum tobacco sales age to 21- worth a try?

    To the Editor,

    Despite the seemingly decline in tobacco use, the habit is picked up by youths on a daily basis. According to the CDC fact sheet, tobacco use is established primarily during adolescence where 9 out of 10 cigarette smokers first initiate smoking by age 18. In the United States, more than 3,800 youths aged 18 years or younger try their first cigarette every day [1]. If the trend continues, about 5.6 million Americans that are less than 18 years will die early from a smoking-related illness i.e. 1 of every 13 young Americans will lose their lives to tobacco use [1]. These figures are disturbing, and though tobacco control is at the forefront in trying to reduce these mortalities from tobacco use, the road ahead seems long and weary.

    In 2007, a study using modelling techniques showed that increasing the smoking age would lead to a drop in youth smoking prevalence from 22% to under 9% for the 15- 17 year old age [2]. Another study done in England, also found that increasing the age for legal purchase of tobacco was associated with reduction in smoking [3]. According to a study done in 1996, "adopting the tobacco policy of raising the legal age would delaying the initiation of smoking if it succeeds"[4]. And that it might also contribute to the reduction of smoking-related mortality and morbidity in the youth[4].

    In this current study, the authors showed that the Needham community in Massachusetts has achieved success with this policy by comparing the youth smoking trends in this community with surrounding nearby communities that have not raised the legal age for tobacco purchase [5]. Their results showed that there was a greater decline in youth smoking in Needham due to an increase in the legal smoking age relative to the other communities. Although this study shows promising results for the immediate effects of decline in tobacco use, it should be noted that present day youths now have the leisure of purchasing alternative tobacco products in the form of e-cigarettes, hookahs and smokeless tobacco. It is reported that nearly 4 of every 100 middle school students in 2014 use e-cigarettes, 3 in 100 had used hookah and more than 5 in 100 currently use smokeless tobacco [1].

    Enacting the policy on increasing the legal age to purchase tobacco should be thoroughly comprehensive to include alternative tobacco products as well. Though, the future of tobacco control seems daunting, it is still worth a try to raise the legal age of tobacco purchase in order to curb the sequelae of a lifelong addiction that has deleterious health effects.

    References

    1.http://www.cdc.gov/tobacco/data_statistics/fact_sheets/youth_data/tobacco_use/index.htm#background

    2. Ahmad. (2007). Limiting youth access to tobacco: Comparing the long-term health impacts of increasing cigarette excise taxes and raising the legal smoking age to 21 in the united states. Health Policy (Amsterdam), 80(3), 378; 378-391; 391.

    3. Millett, C., Lee, J. T., Gibbons, D. C., & Glantz, S. A. (2011). Increasing the age for the legal purchase of tobacco in England: Impacts on socio-economic disparities in youth smoking. Thorax, 66(10), 862-865.

    4. Breslau, N. (1996). Smoking cessation in young adults: Age at initiation of cigarette smoking and other suspected influences. American Journal of Public Health (1971), 86(2), 214.

    5. Schneider, S. K., Buka, S. L., Dash, K., Winickoff, J.P., O'Donell, L. (2015). Community reductions in youth smoking after raising the minimum tobacco sales age to 21. Tobacco Control doi:10.1136/tobaccocontrol-2014-052207

    Conflict of Interest:

    None declared

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  6. Letter to the Editor: Analytical concern regarding the measurement of weight control beliefs.

    NOT PEER REVIEWED To the Editors, In the article entitled, "Weight control belief and its impact on the effectiveness of tobacco control policies on quit attempts: findings from the ITC 4 Country Project" I noticed a problem regarding the measurement of weight control beliefs. This variable (weight control beliefs associated with tobacco use) is measured using only one question. The researchers indicate, "In order to identify weight concerns related to smoking, we exploit a question that measures smokers' level of agreement with the following statement using a 5-point scale (strongly agree, agree, neither agree nor disagree, disagree and strongly disagree): Smoking helps weight control" (Shang et. al, p.2, 2015). This statement illustrates the limited manner in which the aforementioned variable was measured. While the limitation of weight control beliefs being analyzed using self- reporting was addressed, the limitation of using only one question to measure this variable was not. In the study entitled, "Smoking Expectancies, Weight Concerns, and Dietary Behaviors in Adolescence" the authors noted that they used the appetite control factor of the Smoking Consequences Questionnaire (SCQ) to determine weight control beliefs. The author of "Smoking Expectancies, Weight Concerns, and Dietary Behaviors in Adolescence indicates, "Participants who endorsed smoking were given 5 possible consequences of smoking and were asked to rate the likelihood of each consequence on a 10-point scale from 'completely unlikely' to 'completely likely.' The statements included, 'Smoking controls my appetite,' 'Smoking keeps my weight down,' 'Cigarettes keep me from overeating,' 'Cigarettes keep me from eating more than I should,' and, 'Smoking helps me control my weight.' Scores were an average across all items" (Cavallo et. al., p. 68, 2010). This multifaceted approach to measuring a variable is a more thorough and a more accurate measure of the weight control variable. This more detailed measure, as indicted by the author, has been measured by three different criteria: internal consistence, degree of factor loading, and coefficient significance (.72 to .97). This measure starkly compares to the measure used in the article, "Weight control belief and its impact on the effectiveness of tobacco control policies on quit attempts: findings from the ITC 4 Country Project", which was only measured in its degree of sensitivity.

    References

    Cavallo, D. A., Smith, A. E., Schepis, T. S., Desai, R., Potenza, M. N., & Krishnan-Sarin, S. (2010). Smoking expectancies, weight concerns, and dietary behaviors in adolescence. Pediatrics, 126(1), e66-e72.

    Shang, C., Chaloupka, F. J., Fong, G. T., Thompson, M., Siahpush, M., & Ridgeway, W. (2015). Weight control belief and its impact on the effectiveness of tobacco control policies on quit attempts: findings from the ITC 4 Country Project. Tobacco control. doi:10.1136/tobaccocontrol- 2014-051886

    Conflict of Interest:

    None declared

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  7. 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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  8. 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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  9. 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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  10. 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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