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....
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.
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
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 iden...
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
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 th...
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.
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. T...
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.
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.
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.
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 ou...
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.
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 de...
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.
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 h...
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
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',
o...
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.
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 th...
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
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....
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 iden...
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 th...
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. T...
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...
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 ou...
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 h...
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', o...
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 th...
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