499 e-Letters

  • WHO "smoking-related deaths" indicator is misleading
    Konstantin Krasovsky
    NOT PEER REVIEWED The authors of the paper "Contribution of smoking-related and alcohol-related deaths to the gender gap in mortality: evidence from 30 European countries" use the WHO indicators of alcohol-related and smoking-related causes of deaths and state that this even underestimates the scope of influence of alcohol and tobacco use on mortality. In fact, however, it is an enormous overestimate. In case of Ukraine, to consid...
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  • Hate mail etc.
    Jonathan H Bagley

    NOT PEER REVIEWED Please can I make a few points in response.

    First, in the UK at least, the individual commenters and blog writers who criticise the anti tobacco movement do not, in general, receive money or favours from, or have any connection with the Tobacco Industry. FOREST does receive money from the tobacco industry and doesn't hide the fact. The anti tobacco movement receives money and favours (sponsored...

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  • Re: Hate mail, tobacco control and social change
    Stephen L Hamann

    NOT PEER REVIEWED Perhaps inflaming social confrontation has become so common that people no longer care what they say to each other any longer. Many feel it is all temporary posturing in order to stake out a claim in the impersonal electronic landscape. It is a reflection of unbridled identity rather than thought. In the electronic communications environment, opinionated commentators have started to believe they are...

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  • Sheer hypocrisy
    David C Atherton


    Tobacco control has instigated a level of prejudice against an identifiable group of people that if we were a minority or gay would be quite rightly simply unacceptable. We have to put up with outrageous language too and have a database where we keep the best examples.

    "Smoke in your own home. Get cancer. Die. Just keep it away from me, that's all I ask.

    "..let's have free l...

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  • Biological toxins
    Kevin M. Mulvina

    NOT PEER REVIEWED This paper, although the authors may well have found evidence in line with their intent, could also open our eyes to another distinct and obvious perspective. One which may well be glossed over, in our determination to find the target perspective many seek. What if a smoke free environment could substantially increase population mortality and morbidity health risks? Is it too late to rethink our positi...

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  • Many constituents of third hand smoke can be found in all homes and cars, regardless of smoking
    Simon Chapman

    Matt et al's demonstration that nicotine can be detected in house dust, on surfaces and on fingers in homes formerly occupied by smokers[1] is used as a springboard to promote concern about third hand smoke(THS)[2]. Given the rudimentary nature of most domestic cleaning and the common experience of the distinctive smell of stale tobacco smoke, few will find it surprising that traces of nicotine can be found in smokers'...

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  • Pig's blood in cigarette filters and the media
    Norbert Hirschhorn

    It would be useful to know if international brands contain pig hemoglobin -- could DNA analysis be helpful?

    Also, did Muslim and Jewish smokers quit after hearing the story?

    Conflict of Interest:

    None declared

  • Response to Noel et al re Electronic Cigarettes
    Joel L Nitzkin

    The commentary by Noel, Rees and Connolly on E-cigarettes is truly remarkable. They appear to draw the conclusion that E-cigarettes represent a potentially substantial hazard to the American public that requires "efforts . . . to counteract e-cigarette industry marketing and inform regulatory strategies," then urge research to justify the conclusions they have already reached. All this was done without considering the res...

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  • Critique of "Quantifying the effects of promoting smokeless tobacco as a harm reduction strategy in the USA" by Mejia AB, Ling PM, Glantz SA. Tobacco Control 2010
    Annette M Bachand

    NOT PEER REVIEWED Funding: While this assessment was funded by RJ Reynolds Tobacco Company, it is the product of independent scientific thought, and it expresses solely the opinions of the authors. When data are lacking, models that simulate population health events under different exposure scenarios may serve to inform policy by providing the basis for decision making. In order for models to be used in this manner,...

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  • Thirdhand smoke: is it something like making mountains out of a mole?
    Dr. Naseem A. Qureshi

    Smokers tend to leave their smoking prints permanently or semipermanently in buildings where they live and enjoy the taste of smoking regularly. The nonsmokers, newcomers moving into the said buildings, dislike smoking leftovers in terms of nicotine and other byproducts of tobacco use. The comparative analysis of relevant samples from firsthand, secondhand and thirdhand smokers would have shed some light on the levels o...

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  • Lee did not provide any quantitative estimates of the effects of smokeless promotion on population health
    Stanton A Glantz

    We are mildly flattered that Philip Morris found it worthwhile to have Peter Lee criticize our framework [1] for assessing the likely population effects of aggressive promotion of smokeless tobacco as a harm reduction strategy in the USA. Peter Lee is a longtime tobacco industry consultant who has a history spanning decades criticizing important studies demonstrating the harms of tobacco and secondhand smoke [2], inclu...

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  • Lifting the lid on Nicotine Replacement Therapy. Re: "Ending appreciable tobacco use in a nation: using a sinking lid on supply"
    Brent O Caldwell

    Thomson and colleagues present a novel radical approach for national tobacco elimination supported by cogent arguments and discussion of the various pros and cons for such a policy (Tobacco Control 2010;10:431-435). They discuss, albeit briefly, the importance of best practice cessation support. However current best practice is not especially effective, and just as they have argued for a radical policy approach, there sim...

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  • Quantifying the effects of promoting smokeless tobacco as a harm reduction strategy in the USA" A commentary on the paper by Mejia et al
    Peter N. Lee

    INTRODUCTION Mejia et al1 argue that a harm reduction strategy based on promoting snus, the form of smokeless tobacco widely used in Sweden, is unlikely to result in any substantial health benefit to the US population. They divide the population into five tobacco groups (never tobacco users, former tobacco users, current cigarette smokers, current snus users, and current dual users), attaching to each group an estimate of...

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  • Re:British American Tobacco on Facebook: undermining article 13 of the global World Health Organization Framework Convention on Tobacco Control
    Becky Freeman

    Ms Murphy,

    I am hoping that you may be able to answer a query for me? Does BAT sponsor or promote BAT cigarette brands at the MODERNITY festivals in Switzerland?

    It seems a BAT employee is promoting MODERNITY events through Facebook - I have provided the relevant links below for your information.

    Profile of Matthieu Kowalczyk - BAT employee National HoReCa Event Manager


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  • Snus and Quid Consumption not only Risking for Occurrence of Oral Cancer (O-SCC), also development of Metabolic Syndrome (MS).
    Chitta R CHOWDHURY

    Snus is threatening not only for Sweden also other parts of Europe. We have anecdotal information that UK tourists in Sweden(who are smokers) are trying Snus quite frequently. Therefore, there is a threat of cross-border transmission of Snus addiction. Some of the reports claim that Snus is less injurious to health comparing smoking, but, the evidence shows there is a higher risk for the occurrence of oral cancer (OSCC)...

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  • Tobacco waste - make the industry pay!
    Fenton O Howell

    ASH Ireland very much welcomes the comprehensive article on cigarette waste by Smith and McDaniel. This is an issue ASH Ireland has been actively engaged with. In November 2009 ASH Ireland met with the Minister for the Environment, Heritage and Local Government (Leader of the Green Party in Ireland) and outlined the scale of the problem to him and his department. Cigarette waste accounts for nearly half of all the litter...

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  • Risk assessment in the regulatory science process.
    Lars E. Rutqvist

    The approach by Ayo-Yusuf and Connolly (2010) to evaluate cancer risks of smokeless tobacco products (STP) addresses issues that could be relevant to modified risk claims for Swedish snus tobacco products. We disagree with the authors' conclusions, and in some cases they simply have the facts wrong. Nonetheless, the issues presented warrant consideration by the tobacco science community, including the FDA Center for Tobac...

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  • One grows weary at such profound inanity
    David C Atherton

    In economic terms anti tobacco have created a faux market. In economic terms there are significant barriers to entry to any new tobacco manufacturer and distributor with the ban on advertising.

    Good heavens you even admit it: "These problems have been exaggerated by unintended consequences of tobacco control policies."

    Your paper says "...market failure, excess profits..wherein a cap is placed on the ma...

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  • danger of low nicotine
    Jonathan H Bagley

    Smokers will smoke more cigarettes and inhale more deeply should the nicotine content of cigarettes be reduced. It is the burning tobacco which kills - not the nicotine. Each smoker has his own comfortable level of nicotine. Perhaps high nicotine cigarettes are safer?

    The speculation that dependence can result from smoking 1 - 2 cigarettes a day is at odds with the more extreme claims by anti tobacco campaigners...

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  • After 25 Years of Misinformation, What Would You Expect
    James R Rothenberger

    Joel L Nitzkin and Elaine Keller did an excellent job of identifying problems with this study so I shall not endeavor to duplicate their suggestions. Instead I wish to speak as a 43 year, at the end 2 to 3 pack, smoker who used Swedish snus 6 months ago to completely stop smoking.

    I attempted smoking cessation for over 30 years using just about every NRT product except Chantix. I tried hypnosis twice, group a...

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  • 2 remarks
    Philippe Boucher

    It is totally true that tobacco control is funded very little compared to the profits derived by the tobacco companies and the taxes collected by governments. At one point (in the 80s?), WHO had suggested that 1% of the tobacco taxes be allocated to fund tobacco control activities. Then this suggestion "disappeared": I wonder if you know why as it would be a simple request that remains valid.

    It is also true tha...

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  • Response to Mejia, Ling and Glantz
    Joel L Nitzkin

    In this paper, Mejia et al run a number of Monte Carlo simulations based on a set of totally unrealistic assumptions to reach the conclusion that promoting smokeless tobacco as a safer alternative to cigarettes is unlikely to result in substantial health benefits at a population level. In their analysis, Mejia et al do not consider the potential impact on the current adult smokers who will account for virtually all of the...

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  • What if we told smokers (and their doctors) the truth?
    Elaine D. Keller

    How might those estimates change if we all told smokers the truth?

    What if the government changed the warning labels to read "THIS PRODUCT IS NOT A 100% SAFE ALTERNATIVE TO SMOKING"? See what a difference one tiny change can make? This would lead folks to ask, "Well if it's not 100% safe, how much safer is it?"

    The way the message is worded now, 85% of the people who read it conclude it means that...

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  • Wither thee Glantz
    Dave C Atherton

    Glantz et al conclude that "Promoting smokeless tobacco as a safer alternative to cigarettes is unlikely to result in substantial health benefits at a population level."

    Obviously Glantz is not up to speed on Sweden. It has the lowest incidence of lung cancer in the developed world because so many smokers have switched to snus.

    "Results: There were 172,000 lung cancer deaths among men in the EU in 200...

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  • Help-seeking behaviour or 'Feel Good' factor? A Psychiatrist's perspective...
    Jonas S. Sundarakumar

    I read with interest your article affirming public support in England for dedicated cigarette price increases and especially highlighting the finding that almost 50% of smokers supported the measure.

    As proposed by the authors, the support for the price hike seems likely to be contingent on allocating funds to tobacco control activities (Surveys from United States, Australia, New Zealand and several European and...

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  • According to BAT, IDRC-funded tobacco control programs "are truly serious threats to the long-term success of our business"
    Neil E. Collishaw

    Re: Africa/Canada: BAT Director on Aid Board Spurs Boycott Tobacco Control. June 2010, Vol 19, No 3, pp. 175-176

    Reference is made in the above-noted article to a 15 October 1996 memo written by Shabanji Opukah (1) of British-American Tobacco(BAT)claiming that "one of the IMASCO Directors sits on the IDRC Board!" In fact, Mr. Opukah erred in this statement. A thorough review of the Annual Reports of both IMASCO...

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  • Use of Smokeless Tobacco (SL): a cause of oral sub-mucosal fibrosis (OSMF/OSF), an alarming health situation in India and regional countries- is rising rapidly.
    Chitta Ranjan CHOUDHURY

    I refer to the recently published paper- 'Scott L Tomar, Hillel R Alpert and Georgery N Connolly. Patterns of dual use of cigarettes and smokeless tobacco among US males: findings from national surveys. Tob Control 2010;19:104-109'.

    The rising trend of smokeless tobacco (ST) use, among adolescent and young adults is not only a problem in the USA, it is equally affecting the same age group population in India and...

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  • Re:British American Tobacco on Facebook: undermining article 13 of the global World Health Organization Framework Convention on Tobacco Control
    Simon Chapman

    We are grateful to learn of the deep concern in BAT about unauthorised use of Web 2.0 social media platforms to promote BAT tobacco products and its rules for its employees, agents and service providers that no company or product promotions should appear on these [1]. We are rather amused to learn though, that despite the vast resources of BAT, it seeks understanding from critics that the task of locating such sites is...

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  • Let's have more of a good thing!
    Stewart N Brock

    Dear Daniel

    A very interesting paper confirming the exceptional value of NSD to UK society. The obvious conclusion we should draw is that NSD is too valuable to only happen once a year. In Somerset last year we started a Somerset Stop Smoking Day on 1st October, aiming to encourage quit attempts before the onset of winter with the slogan "Don't be left out in the cold this winter", making a play on the smoking...

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  • British American Tobacco on Facebook: undermining article 13 of the global World Health Organization Framework Convention on Tobacco Control
    Marina Murphy

    With respect to the recent article by Freeman et al. (Tobacco Control doi:10.1136/tc.2009.032847), I would like to make clear it's absolutely not our policy to use social networking sites such as Facebook to promote our tobacco product brands. To do so could breach local advertising laws and our own International Marketing Standards, which apply to our companies everywhere.

    Social media and other types of user-...

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  • Research letter contradicts marketing materials
    Thomas Eissenberg

    To the editor:

    Ms. Keller asks a straightforward question: "Why was [I] so surprised to find very low levels of nicotine in the blood of subjects who had taken 10 puffs from an electronic cigarette?".

    The straightforward answer is that I, perhaps naively, was influenced by marketing materials such as this:


    This advertisement,...

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  • More junk science
    Dave C Atherton

    Any paper which has Professor Stanton Glantz's paw prints on it should be treated with caution. However let me critique it, he says:

    "Because there is a dose-response relation between the amount of on- screen exposure to smoking and the likelihood that adolescents will begin smoking..."

    So in plain English the more adolescents see adults smoking, the more likely they are to smoke. So Glantz et al must b...

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  • Earmarking part of cigarette tax revenues for tobacco control programs has public support, but will it lead to more spending for tobacco control?
    Anthony P. Polednak

    Correspondence Earmarking part of cigarette tax revenues for tobacco control programs has public support, but will it lead to more spending for tobacco control? Anthony P. Polednak Connecticut Department of Public Health, Hartford, Connecticut USA (Retired)

    Re: Smoker support for increased (if dedicated) tobacco tax by individual deprivation level: national survey data. Wilson et al., Tob Control 2009;18:512....

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  • Known Fact: Electronic Cigarettes Deliver Nicotine More Slowly
    Elaine D Keller

    Why was Dr. Eissenberg so surprised to find very low levels of nicotine in the blood of subjects who had taken 10 puffs from an electronic cigarette? He implies that he expected to find equal nicotine levels when compared to 10 puffs from a tobacco cigarette. However, he cited as one of his references M. Laugesen's Poster presented to the joint conference of the Society for Research on Nicotine and Tobacco, Europe; Apr...

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  • Re:Questionable PREP selection
    Richard M Freeman

    I find it intriguing that the eCigarette samples found no discernible nicotine content. I have personally conducted my own (albeit uncontrolled) blind-study using a lower nicotine brand (12mg) of "e-cigarette Juice" and a higher nicotine content brand (36mg).

    The two brands were largely identical in terms of content and taste but the differences in terms of their satisfaction in relieving the stress of not smoking...

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  • Tobacco-Free Hospital Campuses in Europe
    Esteve Fernandez

    We have read with interest the paper by Williams et al.(1) assessing the prevalence of smoke-free hospital campuses' policies in the United States. In addition to the data and wise comments in the paper, we want to share some reflections from Europe. There is general consensus that health organizations should be an example in developing and implementing tobacco control policies(2,3). Many hospitals have become tobacco free...

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  • The Single Most Preventable Cause of Disease, Disability, and Death
    Suzanne M. Marks

    According to the US Centers for Disease Control and Prevention (CDC), smoking is the single most preventable cause of disease, disability, and death in the United States (http://www.cdc.gov/nccdphp/publications/aag/osh.htm). Each year, an estimated 443,000 people die prematurely from smoking or exposure to secondhand smoke, and another 8.6 million have a serious illness caused by smoking. And as aptly demonstrated by Lee...

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  • "I should not hang around with classmates who smoke!"
    Reiner Hanewinkel

    We read the recent paper on the effects of the school-based smoking prevention program "Mission TNT.06" in Canada with interest [1]. The authors address an often neglected but nonetheless very important subject: The question of potential negative side effects of interventions that try to denormalize smoking in the classroom. To our knowledge, it is the first study outside Europe evaluating a school-based smoking prevention...

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  • Reply to Dr. Rose
    Elizabeth A. Smith

    Dr. Rose responds that the offer of confidentiality was made in accordance with standard institutional review board procedure for human subjects research. However, the email to which the editorial refers offered me $1000 to act as an “expert consultant,” not as a research subject. If its intention was to recruit me as a research subject, the email was even less transparent than I gave it credit for.

    Jed E. Rose

    Innovative opportunities and strategies should be considered for reducing the harm of tobacco in the 21st century. Since the mid 20th century, governmental approaches have evolved from a laissez-faire attitude to active NIH funding for tobacco research, aggressive promotion of nonsmoking environments and, now, congressionally mandated regulation of the tobacco industry. The tobacco industry itself has also evolved fro...

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  • Compare ST Switchers to Continuing Smokers
    Elaine D Keller

    In "Tobacco-related disease mortality among men who switched from cigarettes to spit tobacco" Tob Control 2007; 16: 22-28, Henley, et al compared mortality rates for smokers who switched to spit tobacco to the rates for those who quit all forms of tobacco. This is useful information. However, the fact that the number of smokers in the US has remained relatively unchanged for the past 20 years tells us that there are t...

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  • Re: Response to Ramstrom
    Lars M Ramstrom

    The authors’ response to my comments fails to disqualify my criticism. A large part of their response consists of a misinterpretation of some of my points. This appears to be due to confusion about terminology. Unfortunately, terminology practices are not as perfectly unequivocal as would be desirable. If the authors had been well enough familiar with the international scientific literature in this field, they should ha...

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  • Community perspective on reducing Australian Indigenous Smoking
    Alan R Clough

    In our study in remote Indigenous communities in Arnhem Land we have now interviewed 305 smokers. Of these, 181 had quit intentions and 37 were trying to quit at the time of interview. The effectiveness of more intensive support compared with brief advice has not been evaluated in these populations. However, the need for more intensive support is highlighted in smokers’ own words, for example:

    “I’m trying to...

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  • How best to quickly reduce the prevalence of Australian Indigenous smoking
    David P Thomas

    We agree with the authors of this letter that closing the gap between the smoking prevalence in Indigenous and other Australians is possible, but we do not agree how this is most likely to be achieved.

    Many health clinics in remote Indigenous communities in Australia are better at providing brief advice than is implied by the authors. An audit of records in 56 health clinics found that 43% of diabetics and 25% th...

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  • Response to Ramstrom
    Shu-Hong Zhu

    If we understand him correctly, Ramstrom considered our findings on what has happened in the U.S. too obvious to be interesting. It is obvious because, for over 50 years, Sweden has had a particular smokeless tobacco product, snus, that the US did not have [1]. He apparently considered the history of U.S smokeless tobacco use (which is over 100 years) of no significance and he was confident that the U.S. smokeless tobac...

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  • Questionable PREP selection
    Hank H Stocker

    The products mentioned in the study appear to be selected specifically selected for their low nicotine content. While the paper succeeds in adapting existing methodology for traditional tobacco products to these new classes of smokeless tobacco products, only testing PREPs containing a low amount of nicotine understates their potential as a smoking cessation aid.

    Star Scientific Inc. (manufacturers of Ariva) pro...

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  • Potential utility of switching to smokeless tobacco
    Lars M Ramstrom

    The study by Zhu et al. "Quitting Cigarettes Completely or Switching to Smokeless Tobacco:Do U.S. Data Replicate the Swedish Results?" has raised a number interesting questions. [1] However, the conclusions of the study need further scrutiny in addition to the previously published comments.

    The main conclusion “The Swedish results are not replicated in the U.S.” is certainly true, but not very interesting since...

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  • Overestimate of cost of smoking to the NHS
    Christine Callum

    This paper addresses a number of important issues around the costs of smoking to society, and in particular to the UK National Health Service (NHS). However there are methodological issues which result in the paper overestimating the costs of smoking to the NHS. While smoking does represent a significant cost to the NHS, the estimates provided in this paper, based as they are on a mixture of very old data and parameters...

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  • Response to Nitzkin March 24 eletter
    Shu-Hong Zhu

    We appreciate Dr. Nitzkin’s desire to improve the current FDA bill. Our paper clearly stated that smokers are generally uninformed about the relative risk of various tobacco products and that is an issue that the public health community still must address (1). However, it is important not to equate providing accurate risk information with promoting the use of specific tobacco products. Nitzkin does not seem to make this...

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  • Response to Zhu February 24 e-letter
    Joel L Nitzkin

    This note is in response to the latest communication from Zhu, relative to whether a harm reduction component to tobacco control programming in the United States would yield public health benefits. Zhu is very skeptical. Nitzkin and Rodu are certain such a benefit would accrue. In his latest posting, Zhu suggests that Rodu “only did half the math” -- and suggested that one can read anything one wants into the available...

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  • A Belated Reply to Foulds et al. and Bates
    Scott L. Tomar, DMD, DrPH

    First, an apology is in order for taking so long to respond to the online discussion surrounding the review by Foulds et al. [1] and the opinion piece by Bates et al. [2]. As we had promised in our earlier reply to Foulds et al. (19 December 2003) and have been reminded by Bates, we are belatedly responding to the specific points raised by Foulds et al. in their e-letter dated 5 December 2003:

    1. “Misrepresentation of...

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  • Boffetta et al
    Jeffrey R Johnstone

    The authors quote a study by Boffetta et al to support the idea that second-hand smoking causes disease. The Boffetta study does not support that claim. Boffetta et al found no significant association between lung cancer and passive smoking from spouse or workplace. They did find a significant association with childhood exposure: those so exposed were less likely to develop lung cancer. The results of Boffetta et al are...

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  • Response to Rodu’s and Bergen & Phillips’ Comments
    Shu-Hong Zhu

    Rodu is correct in stating that because the U.S. population is so large, even a small percentage of cigarette smokers switching to smokeless would mean many thousands of people [1]. However, he has done only half the math- the other half is that exclusive smokeless users also switch to cigarettes. In fact, it is easy to see from Table 2 in Zhu et al. that the number switching from smokeless to cigarettes is much greater th...

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  • Still no response - but there's still time
    Clive D Bates

    I thought I would revisit this debate some five years on, only to find that the promised response (19 December 2003) has not yet been done.

    None of the facts have changed much - those that wish to intervene to prevent smokers choosing tobacco products that are many times less hazardous still have the upper hand - not in argument or evidence, but in dominant public health approach and (in Europe) in the most...

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  • Response to Zhu et al. (1, 2)
    Paul Bergen

    The authors of this paper (1), the responders (3), and most everyone else agree that smoking is high risk, and that the use of smokeless tobacco is fairly low risk. In any other area, the obvious conclusion would be to encourage smokers to switch to the lower risk alternative.

    However, what follows instead is a strange and yet quite common argument that because many smokers might not switch, this alternative...

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  • Evidence From Zhu et al. That American Smokers Have Switched to Smokeless Tobacco
    Brad Rodu

    Zhu et al. reported that 0.3% of men who were exclusive current smokers in 2002 became smokeless tobacco users at follow-up in 2003 (1). Similarly, they reported that 1.7% of men who were former smokers of one year or less duration and 0.3% of men who were former smokers for a longer time were smokeless tobacco users in 2003.

    These percentages are quite small, prompting the first author to issue a statement in...

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  • Response to Nitskin and Rodu's Comments
    Shu-Hong Zhu

    Nitzkin and Rodu raise several interesting points about harm reduction and how they would like to see the current FDA bill (HR1108/S625) be improved [1]. However, the purpose of Zhu et al.’s paper is not to advocate for or against harm reduction. It is simply to examine whether current US data replicate the Swedish results [2].

    If large numbers of US smokers could be induced to switch to smokeless tobacco, tha...

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  • Promoting Snus Will Save Lives in the USA
    Joel L Nitzkin

    Zhu, et al., when comparing tobacco-related behaviors in the U.S. and Sweden concluded that “promoting smokeless tobacco for harm reduction in countries with ongoing tobacco control programs may not result in any positive population effect on smoking cessation.” [1]

    We believe that this conclusion is too pessimistic.

    Promotion of snus in the U.S., as a low-risk alternative for smokers unable or unwillin...

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  • Mental disorders and smoking: Correlation is not causality
    John Hughes

    A recent article in Tobacco Control 1 reported that 33% of cigarettes are consumed by smokers who had a current mental disorder. The title, abstract and discussion of that article stated that this 33% represented how much “mental disorders contribute to tobacco consumption in New Zealand.” This statement is misleading for at least two reasons. First, although 33% of smokers had a current mental disorder, 21% of nonsmok...

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  • This may be due to Low DHEA
    James M. Howard

    It is known that smoking increases DHEAS, the precursor of DHEA. The same should happen because of exposure to secondhand smoke.

    DHEA is the active molecule, so increases in DHEAS may indicate that smoking is reducing DHEA. DHEA is known to be important to normal pregnancy-associated outcomes.

    I suggest the findings of Peppone, et al., may be explained by reduced DHEA in these women.

  • Philip Morris International's view on "Existing technologies to reduce toxicants in cigarette smoke"
    Ruth Dempsey

    In their article, “Existing technologies to reduce specific toxicant emissions in cigarette smoke,” RJ O’Connor & PJ Hurley list technologies that, they propose, manufacturers could use to comply with ceilings on nine smoke constituents proposed by the WHO Study Group on Tobacco Product Regulation (TobReg).

    Initially, it is important to address any conjecture that these ceilings will reduce the harm cause...

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  • Response so far
    Simon Chapman

    Jim Sargent says I support business as usual for Hollywood. What I emphatically and unapologetically do support is business as usual for consistency. R-rating of any scene of smoking invites unavoidable questions about parallel controls on a wide range of activity that an equally wide range of interest groups would wish to see implemented in the name of health, religion or morality. Jonathan Klein implies that because ni...

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  • blunt instraments for a nuanced issue
    Becky Freeman

    I do support R ratings (actually M15, as this is roughly the Australian equivalent to an American R) for films that decidedly glamourise or blatantly promote smoking. I do however believe that smoking can be shown in films in ways that do not promote the product - without having to be a hit-you-over-the-head health message.

    While I agree the current system of ratings for films has to be considered in any realist...

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  • Missing the Point
    Michael Siegel

    The responses so far to Dr. Chapman's article have missed the fundamental point of his argument: that a policy requiring an R-rating for any movie which depicts smoking is a narrow-minded one that treats smoking differently than other dangerous health behaviors depicted in films and which fails to address the overall public health problem of the media portrayal of unhealthy behaviors.

    In order to defend the polic...

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  • Business as Usual
    James Sargent

    Simon Chapman's editorial supports business as usual for Hollywood. By considering only the commercial element of paid product placement, he ignores that making films in Hollywood is a business. Free artistic speech is a fundamental right that everyone in Western societies supports, but Hollywood uses it as a mantra to avoid changing how they do business. Movies are a combination of art and business, just like many othe...

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  • Smoking imagery in movies requires action now
    Jonathan D Klein

    Simon Chapman’s recent commentary on smoking in movies misses several important points with regard to the influence of media portrayal of tobacco on children’s health (1). Chapman fails to recognize the ease with which other socially questionable behavior is rated R in US films. Using the Motion Picture Association of America voluntary ratings system (2), use of the 'F' word as an exclamation twice, or once in a sexu...

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  • Late to the Party
    Stanton A Glantz

    I would have written Simon Chapman's editorial 15 years ago, when I first joined behind-the-scenes discussions in Hollywood to advocate the same "solutions" he is now. Serious and sustained efforts by many organizations (sometimes at substantial cost) to pursue the ideas Chapman is now proposing repeatedly failed. Indeed, the amount of smoking onscreen actually increased during this time. We only developed the Smoke...

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  • Australian government excludes tobacco industry from routine consultation
    Simon Chapman

    An important new marker of the denormalisation of the tobacco industry has occurred in Australia in 2008. It is traditional – indeed usually mandatory -- for industries which may be affected by proposed changes in government policy or legislation to be fully consulted through formal processes prior to any changes taking place. In 2008, the Australian government established a Preventative (sic) Health Task Force, with s...

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  • Identification of Jewish Ghetto in Rome
    Norbert Hirschhorn

    The authors's Figure 2 identifies the 'smokers' zone' overlaid on a map of modern Rome as resembling "the location of the Jewish ghetto during the Third Reich."

    In fact, a Jewish community has existed in Rome for over two thousand years. In 1555 Pope Paul IV created a walled-ghetto for Jews as one of a series of anti-semitic measures. The walls were torn down in 1870 when Italy was unified as a single nation, lea...

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  • Rate for New Zealand: typographical error
    Maria J Lopez

    The authors thank Holger Moeller for the previous e-letter. As he noticed, there is a typographical error in the number related to attributable deaths in New Zealand. The correct number is 8 per 100,000.

  • Passive smoking rate for New Zealand
    Holger Moeller

    I think the rate for New Zealand in the discussion was meant to be 8 per 100,000 and not 8 per 10,000 which would be rather high.

  • A Reply from R.M. Davis to JJ Boddwyn
    Ronald M. Davis

    Professor Boddewyn’s reply is interesting for what it admits and omits.

    He admits that the International Advertising Association (IAA) reports published in 1983 and 1986 were based on his editing of “the draft paper written by Paul Bingham [of British American Tobacco].” To my knowledge, there has been no such public admission previously by Professor Boddewyn, BAT, or IAA in the 20+ years since publication of tho...

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  • A Reply from JJ Boddwyn to R.M. Davis
    Jean J Boddewyn

    What a pleasure to be cited for something I published 25 years ago! It is, of course, less pleasant to be implicitly incriminated as being some sort of a “paid hack” for the tobacco industry. Besides, the intended harm has been done since the Editor did not have the academic courtesy of asking me to reply to this personal attack in the same issue where the article by R.M. Davis has appeared.

    In answering this ch...

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  • Regulation and precautions
    Jonathan D Liberman

    In response to our piece cautioning about the use of the ‘precautionary principle’ in debates about setting emissions limits, Nigel Gray writes that it has been around since the beginning of public health activity and offers as examples ‘[taking] the precaution of hunting for clean water on the grounds that doing nothing might allow epidemics of cholera, typhoid and hookworm to continue’ and the introduction of polio vac...

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  • Regulation and precautions
    Nigel J Gray

    Regulation and precautions Nigel Gray April 11, 2008

    Jonathon Lieberman worries about TobReg’s use of the precautionary principle as justification for recommending reduction of toxicants in cigarette emissions and suggests that the precautionary principle is a 1970’s development. I thought it had been around since the beginning of Public Health activity when we took the precaution of hunting for clean water on...

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  • Use of the precautionary principle in the debate about emissions limits
    Jonathan D Liberman


    The proposal by the World Health Organization Study Group on Tobacco Product Regulation (TobReg) for the setting of limits on emissions of certain toxicants in cigarette smoke (1) is certain to generate heated debate. Product regulation remains the most fraught policy area in tobacco control. In other areas, public health dictates are clear. Ongoing contests tend to be primarily either ones of competi...

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  • We all did not go quietly
    Jill McDonald

    Dear Simon and Becky, As a fellow advocate of non smoking I would like to congratulate you on the Article: Markers of the demormalisation of smoking and the tobacco industry. I note with interest your comments under the heading Smoking rooms at airports. You note "In early 2007, these uninviting rooms were quietly removed from Australian airports...." The Darwin International Airport still provides a room for the (many)...

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  • : Exploring the role of independent convenience stores in the cigarette black-market in Toronto, ON
    Russell C Callghan

    In a recently published article in Tobacco Control, Vander Beken and colleagues [1] concluded that the Belgian cigarette black-market manifested myriad links with the legitimate business world and, as a result, effective tobacco control policies will need to address the role of legitimate businesses in this market. Our letter confirms this conclusion within a Canadian context.

    Approximately 10-17% of cigarettes...

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  • Error in Abstract Layout
    Simon Chapman

    Readers of our paper Markers of the Denormalisation of Smoking and the Tobacco Industry may be perplexed about the way the Abstract is structured with the traditional Background, Methods, Results and Conclusion headings. These headings were inserted during the editing process after we as authors had approved the proofs of the paper. The paper we approved had an unstructured abstract as was appropriate to a paper of thi...

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  • Corrections
    Leland K. Ackerson

    We have found a series of slight typographical errors in the text of our paper(1) from the December 2007 issue. The results in the full sample should have read that, compared to those living in households where women reported no domestic violence, the odds of smoking were 1.25 (95% confidence interval 1.20 to 1.31) times higher for those living in households where women reported past abuse, and 1.38 (95% confidence inte...

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  • Alcohol abuse - a major cause of DV is missing.
    Dr. Urmila Jagadeesan Nair

    This study by Ackerson et al concludes that Domestic violence is associated with higher odds of smoking and chewing tobacco in India. The authors have taken into account a range of individual and household level demographic and socioeconomic covariates. Odds ratios obtained for the risk have been adjusted for location of residence, age, sex, religion, caste, marital status, education, employment, living standard, pregnanc...

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  • Correction to spelling of coauthor's name
    Nick Wilson

    The correct spelling of the second author's name is "Gombodorj Tsetsegdary" (first name and then surname name). This error arose due to the difficulties in translating from Mongolian Cyrillic script to English language script.

  • YouTube clip on buzz, viral and stealth marketing
    Simon Chapman

    This video will be of interest to readers of this paper. http://www.youtube.com/watch?v=VkA2Gvi-8tA

  • Thank you for posting this article.
    Phoebe A Oelheim

    Thank you for posting this article on-line. It is a public service. I have always wondered about the effects of my "light smoking" and have been advised by doctors that it was not dangerous. I am not a scientist and I appreciated the straight forward approach of the article and study. This information will be a huge help in my endeavor to quit smoking.

  • Free self-help behavioral resources to help inmates quit
    John R. Polito

    During July and August I presented ten nicotine cessation seminars in five South Carolina prisons, prisons that were not just banning smoking from the entire prison but all tobacco. Although in total agreement that prison administrators should be offering inmates high quality cessation programs, it is our job to teach them why doing so is in everyone's best interests and, frankly, until now we have not done a very good job....

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  • Apologies for insensitive placement
    Simon Chapman

    The cartoon that fills the remainder of the second page of this editorial is highly critical of the subject matter of the editorial. The placement of the cartoon was the result of a careless layout error and in no way intended to reflect the editors' views on the editorial.

    We apologise to the author, Matt Myers, for this error and have now reviewed the editorial process where cartoons are placed adjacent to a...

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  • Israel Defense Force Faces Similar Problem
    John D Borowski

    Dear Sirs,

    The USA Amed Forces are not alone in subsidising tobacco for their members. Here in Israel, the independent company (Shekel) which runs the canteens on Israeli Military bases also sells tobacco at prices significantly below those of civillian establishments.

    In terms of profit generation, tobacco is in fact the single most important item sold by the canteens. This fact along with the fact t...

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  • ERRATUM for “Old ways, new means: tobacco industry funding of academic and private sector scientist
    Suzaynn F Schick

    The published paper (p. 158) says "From 2002 to 2004, the IFSH granted US$3.9 million to academic scientists studying biomarkers of tobacco-smoke exposure and harm, tobacco harm reduction and toxicity of tobacco constituents”. The correct number for this time period is $2.9 million. As of August, 2007 the nonprofit Institute for Science and Health had spent US$3.83 million on tobacco industry funded research and US$12...

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  • Further comments on "Water-pipe smoking and dental stains – Adding fuel to the controversy?"

    Dear editor,

    In reference to the e-letter published on July, 24, 2007, entitled "Water-pipe smoking and dental stains – Adding fuel to the controversy?" and authored by Sebastian et al., I'd like to share with comments on the following:

    1- The generalizations that "Shisha (Water-pipe) smokers did not develop any stains while Cigarette smokers had grade 3 dental stains at the end of 100 days" and "Coal...

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  • BAT’s co-branding with BlackBerry –tested in Malaysia?
    Mary Assunta

    Lee and Mackenzie’s news analysis article on BAT’s Blackberry-picking endorsement (TC 2007;16:223) jolted to memory an advertisement from Malaysia a couple of years ago. In March 2005, the Clearing House on Tobacco Control (based at the National Poison Centre, Penang) alerted Malaysians to a similar endorsement advert for BlackBerry by BAT Malaysia in a national newspaper (see illustration at http://tobacco.health.usyd.ed...

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  • Waterpipe and not Shisha should be the unifying term
    Sebastian Thomas

    Dear editor,

    I beg to differ with the statement “Shisha –this word is used everywhere in the world” {e-letter- Shisha vs. “Water-pipe” : The Question of a Unifying Term(Kamal Chaouachi)}

    The word Shisha is not used everywhere in the world. If it is used, the meaning is different. In the Indian subcontinent, a region where hundreds of languages are spoken, the word connoting any type of waterpipe is ‘...

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  • The arrive of British AmericanTobacco (BAT) and the rise in tobacco sales in Italy
    Roberto Mazza

    While a recent editorial in Tobacco Control wonders “Falling prevalence of smoking: how low can we go?”1, in Italy something worrying is happening in tobacco control. After a constant decline in the past 3 years, in 2006 an excess of a 1000 tonnes of tobacco was sold in Italy2. This means “only” an increase of 1.1% of the total market, but represents also an excess of 50 million of cigarette packs, one for each Italian. This...

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  • Blasting away at POS displays
    Kathryn I Barnsley

    Dear Editors

    This is another interesting and useful contribution from Richard Pollay. It reinforces my arguments made in a 2000 article in Tobacco Control, that detailed legislation is required to specifically prohibit POS displays and any industry visual and aural trickery associated with tobacco product sales.

    Ten years ago when we eliminated advertising at POS in Tasmania (Australia), we were warn...

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  • Waterpipe Smoking and Dental Stains-Adding fuel to the controversy?”
    Sebastian Thomas

    A controversy has been raging regarding the relative safety of waterpipe smoking . To investigate the claims of few university students who smoked waterpipe that waterpipe smoke (WPS) does not cause dental stains, we compared cigarette and waterpipe smokers.

    Two groups each of 10 subjects were selected .One group comprising of only water pipe smokers (including 9 waterpipe cafe caretakers), the other made of on...

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  • EU healthcare arena boycotted BAT's CSR stunt
    Nick K Schneider

    The BAT lobbying event on "corporate social responsibility" was luckily not only critisized by Dr Jean King, but widely boycotted by major Brussels based organisations and stakeholders. The initiative was spearhheaded by the European Respiratory Society (ERS), following the invitation to the BAT event by, among others, the Chairperson of the Health and Environment Committee of the European Parliament. Signatories to the...

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  • Failure to declare competing interest
    Simon Chapman

    On March 15 2007, my attention was drawn to a patent for a tobacco smoking device, filed with the U.S. Patent and Trademark Office (USPTO) for a "Hookah with simplified lighting" on June 9 2005. One of the authors of the device being patented was Kamal Chaouachi, who on December 2 2004, had a rapid response published in Tobacco Control [1] which was critical of a paper by Masiak et al [2]. The submission process for rapid...

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  • The CDC must share the mortality data for all tobacco users
    Brad Rodu

    Foulds and Ramström raise important questions regarding a direct comparison of mortality rates among smokers, smokeless tobacco (ST) users, persons with mixed or former use, and non-users. They urge officials from the Centers for Disease Control and Prevention (CDC) and from the American Cancer Society (ACS) to make these comparisons and report the results, so that Americans are fully informed about the health risks relate...

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  • What are the health effects of switchers relative to continuing smokers?
    Jonathan Foulds

    Henley et al’s paper (1) showing worse health outcomes in men switching from cigarettes to smokeless tobacco, compared with men ceasing tobacco use completely, adds to our understanding of the potential risks from smokeless tobacco use. However, it also raises some additional questions:

    1. Like the authors’ earlier paper comparing health outcomes in exclusive smokers with those of exclusive smokeless users in C...

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  • Shame on the Military for Promoting Tobacco Use
    Bruce W. Adkins

    The longstanding tradition of the U.S. military and tobacco industry leaders 'smoking in the good ol' boys room' is well documented by the Smith, Blackmon, Malone "Death at a Discount" research paper!

    It is time that the military and other federal politicos become concerned about the health of our military, and drop the montra of tobacco use being a 'right'. Obviously, the lobby of the tobacco industry even infi...

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  • Time For Increase

    This death-at-a-discount study has excellent timing; it may be that the 110th Congress will approve an increase in commissary tobacco prices! I suggest the pricing of tobacco products available to our soldiers be added to the criteria for grading the federal government on tobacco control [1].

    [1] American Lung Association. State of Tobacco Control: 2006. [cited 2/13/07]; Available from: http://lungaction.org/...

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