The spread of heated tobacco product (HTP) use across various subgroups during 2015-16 and 2017-18 in Japan

BACKGROUND@#Heated tobacco product (HTP) use has increased substantially between 2016 and 2017 in Japan. This study aims to clarify how HTP use (IQOS, Ploom, and glo) spread across the different combustible cigarette smoking statuses during 2015-16 and 2017-18 in Japan.@*METHODS@#We compared the two periods of (i) 2015 to 2016 (N = 5,366) and (ii) 2017 to 2018 (N = 3,422) from a longitudinal study randomly sampling members from the Japan "Society and New Tobacco" Internet Survey (JASTIS). Multivariable logistic regression models for current HTP use in the previous 30 days by combustible cigarette smoking status in the previous year were used adjusting for socio-demographic factors.@*RESULTS@#HTP use increased by 10 times in the 2017-18 cohort compared with the 2015-16 cohort according to the adjusted odds ratio (95% confidence interval) for current HTP use as 10.2 (7.03-14.8). According to smoking status, significantly higher adjusted ORs (95% CIs) of current HTP use for the after period were observed: 2.60 (1.37-4.94) for never smokers, 7.82 (3.64-16.8) for former smokers, 21.1 (5.73-77.9) for current smokers with intention to quit, and 17.0 (9.58-30.3) for current smokers without intention to quit.@*CONCLUSION@#During 2015 to 2018 in Japan, HTP use dramatically increased in all subgroups except for never smokers.

Awareness about pictorial warnings on tobacco products and its impact on tobacco consumers in coastal Karnataka

Background: Tobacco use is a major risk factor for many chronic diseases, including cancer. India revised the pictorial warnings on all tobacco products in 2018, but its impact on tobacco consumers after the revision is less studied. Aim and Objective: To assess the awareness of the revised pictorial warnings on tobacco products and the impact of it on tobacco consumers in a coastal town. Methods: This cross-sectional study was conducted from 1st to 31st March 2021 among 185 adult tobacco consumers in a coastal town in Karnataka after obtaining ethical clearance and informed consent. The data was analysed using SPSS version 16.0 by descriptive statistics, Chi-square, Fisher’s exact test and binary logistic regression analysis. Results: Majority (95.7%) were males and 96.2% had seen the pictorial warning on the tobacco products. The commonly consumed tobacco products were panmasala (44.9%), gutka (38.9%), cigarette (31.4%) and bidi (15.1%). The mean age of initiation of consuming tobacco products was 24.8 years and mean duration of the habit was 17 years. Conclusions: A majority (96.2%) have seen the pictorial warnings on the tobacco products and significant predictors for reducing tobacco consumption were those who inferred the pictorial warnings as tobacco is injurious to health and cancerous

Analysis of furans and pyridines from new generation heated tobacco product in Japan

BACKGROUND@#In recent years, heated tobacco products (HTPs), which are widely used in Japan, have been sold by various brands using additives such as flavors. It has been reported that the components of mainstream smoke are different from those of conventional cigarettes. In this study, we established an analytical method for furans and pyridines in the mainstream smoke, which are characteristic of HTPs and particularly harmful among the generated components, and investigated the amount of component to which the smokers are exposed.@*METHODS@#We established a simple analytical method for simultaneous analysis of gaseous and particulate compounds in the mainstream smoke of HTPs (IQOS, glo, ploom S) in Japan by combining a sorbent cartridge and glass fiber filter (Cambridge filter pad (CFP)). Both the sorbent cartridge and CFP were extracted using 2-propanol and analyzed via GC-MS/MS to determine the concentration of furans and pyridines generated from each HTP.@*RESULTS@#The results showed that the levels of target furans such as furfural, 2-furanmethanol, 2(5H)-furanone, and 5-methylfurfural tended to be higher in the mainstream smoke of glo than in standard cigarettes (3R4F). Pyridine, which is generated at a high level in 3R4F as a combustion component, and 4-ethenylpyridine (EP), which is a known marker of environmental tobacco smoke, were detected. Among these components, 2-furanmethanol and pyridine are classified as Group 2B (possibly carcinogenic to humans) by the International Agency for Research on Cancer (IARC). Therefore, it is possible that they will contribute to the health effects caused by use of HTPs.@*CONCLUSIONS@#Using the new collection and analytical method for furans and pyridines in the mainstream smoke of HTPs, the level of each compound to which smokers are exposed could be clarified. By comprehensively combining information on the amount of ingredients and toxicity, it will be possible to perform a more detailed calculation of the health risks of using HTPs. In addition, the components detected in this study may be the causative substances of indoor pollution through exhaled smoke and sidestream smoke; therefore, environmental research on the chemicals generated from HTPs would be warranted in future studies.

The plain packaging of tobacco products and its recognition by the WTO as a legitimate policy measure for the protection of public health / A embalagem genérica de produtos fumígenosderivados do tabaco e seu reconhecimento pela OMC como uma medida de política pública legítima para a proteção da saúde / El empaquetado neutro de tabaco y su reconocimiento por parte de la OMC como una medida política legítima para la protección de la salud pública

Introduction: the adoption by the WTO DSB of the Panel Reports that resolved the disputes against the Australian tobacco plain packaging scheme unveil important aspects of international health law intertwined with international trade law. Objectives: this paper aims at understanding the concept of plain packaging and the scope of the WTO decision for countries envisaging the adoption ofsimilar measures in policymaking. The research questions are descriptive and encompass how the position expressed by the WTO DSB affects the WHO FCTC and what legal reasoning the referred decision used. Methodology:ahistorical method is employed to identify the origins of plain packaging and the main concerns and challenges surrounding it, whilst a discursive analysis of the Panel Reports allows an interpretation of its basic principles and possible implications for public health policies. Results and discussion: from a microeconomic policy analysis, the standardization of tobacco packets is a reasonable regulatory approach at a government's disposal for addressing welfare losses due to externalities and internalities. Although there is no consensus on the empirical evidence supporting plain packaging, its assessment by the WTO Panel played a vital role in the decision rendered, notably with respect to Article 2.2 of the TBT Agreement and Article 20 of the TRIPS Agreement. Conclusion:Honduras and Dominican Republic have appealed and consequently a final ruling is still pending. Nonetheless, the decision is so far a recognition under WTO law of a State's regulatory autonomy to implement the necessary measures on behalf of public health.

Introdução: adecisão da OMC sobre embalagens genéricas de produtos fumígenos revela aspectos relevantes da relação entre o direito internacional da saúde com o direito internacional do comércio. Objetivos:este artigo analisa o conceito da embalagem genérica e o alcance da decisão da OMC para países que pretendem debater a adoção de medidas semelhantes. As perguntas de pesquisa são descritivas e perquirem a forma como a decisão da OMC se relaciona com a CQCT/OMS e a fundamentação jurídica em que ela se baseou. Metodologia: um método histórico é empregado para identificar as origens da embalagem e seus principais embates, enquanto uma análise discursiva da decisão da OMC permite a interpretação de seus princípios básicos e suas implicações na formulação de políticas de saúde. Resultados e discussão: uma análise econômica indica que a embalagem genéricaé uma alternativa regulatória razoável à disposição dos Estados para tentarem lidar com as perdas de bem-estar resultantes de externalidades e internalidades. Embora existam discordâncias quanto à efetividade das embalagens genéricas, os dados levados à OMC tiveram um papel importante na tomada da decisão, em particular na aplicação do artigo 2.2 do Acordo TBT e do artigo 20 do Acordo TRIPS. Conclusão:Honduras e República Dominicana recorreram. Um julgamento final ainda é aguardado, mas a atual decisão representa, à luz do direito internacional do comércio, um reconhecimento pela OMC da soberania e autonomia dos Estados para adotarem as medidas regulatórias baseadas em evidências que entendam necessárias para a tutela da saúde pública.

Introducción:la adopción del OSD de la OMC de los informes del Panel que resolvió lasdisputas contra el esquema de empaquetado neutro de tabaco en Australia revela aspectos importantes del derecho internacional de la salud entrelazados con derecho comercial internacional. Objetivos:comprender el concepto de empaquetado genérico y el alcance de la decisión de la OMC para los países que pretenden debatir la adopción de medidas similares. Las preguntas de investigación son descriptivas y abarcan cómo la posición expresada por la OMC afecta el CMCT/OMS y la base legal de la decisión. Metodología:un método histórico sirve para identificar los orígenes de los paquetes estandarizados, mientras que un análisis discursivo de la decisión de la OMC permite la interpretación de sus principios básicos y sus implicaciones para la formulación de políticas de salud. Resultados y discusión:la estandarización de los paquetes de tabaco es un enfoque regulatorio a disposición del gobierno para abordar las afectaciones al bienestar social causadas por externalidades e internalidades. Aunque no hay consenso sobre la evidencia empírica que respalda el empaquetado neutro, su evaluación por el Panel de la OMC desempeñó un papel importante en la decisión emitida, en particular con respecto al Artículo 2.2 del Acuerdo OTC y el Artículo 20 de Acuerdo sobre los ADPIC.Conclusión:aunque Honduras y República Dominicana han apelado y, en consecuencia, aún está pendiente la resolución final; la decisión es hasta ahora es un reconocimiento bajo la ley de la OMC de la autonomía reguladora de un Estado.

Prevalence Of Tobacco Consumption Among Adolescents From Rural Area Of Wardha District

Background-Globally adolescent population is around 1200 million and out of six person, every one person is in ado-lescence (aged10 to 19 years) period. Yet most of them are healthy, but premature death, illness and injury among them can hinder ability to grow and develop to their full potential. It is estimated that 1.2 million adolescents died in 2015 and mostly from preventable or treatable causes. Tobacco consumption is world’s leading cause of preventable morbidity and mortality. National Family Health Survey conducted in year 2016-17 reported tobacco consumption prevalence 38.9% in urban area and 48% in rural area of India. Method-It was a community based cross-sectional study conducted in eight villages of Wardha district adopted under Community Health Care program run by depart-ment of community medicine. Data was collected by interview from 485 adolescent in the age group of 10-19 years by domiciliary visits using pre-designed pre-tested questionnaire. Results:Prevalence of tobacco use (all forms), smoke-less tobacco use and smoking in rural adolescents were 20.82%, 20.41%, and 2.68%, respectively. Prevalence of to-bacco use in boys (30.29%) was more than girls (4.49%). Higher Prevalence was found in late adolescent period. Bidi was commonly used form of smoke tobacco while Kharra was the preferred smokeless tobacco. Almost all smokers were male but few exceptions were there. Conclusion: The prevalence of tobacco use among rural adolescents was very high (20.82%) as compared to national prevalence of 14.6% according to the global youth tobacco survey India 2009. There is a need of early intervention for tobacco cessation as overall mean age of 1st experienced to tobacco consumption was 12.02 years and in male and female users it was 12.25 years and 10.88 years respectively. 42.10 % adolescents 1st time experienced any type of tobacco products when they were in the 12-14 years age and only 0.66% adolescents experienced at the age of 17 -19 years. Maximum male (42.19%) and female (41.67%) ever user experi-enced their 1st tobacco consumption when they were 12-14 years old.

Feedback from vendors on gutka ban in two States of India

Background & objectives: Beginning in 2012, all States in India eventually banned the sale of gutka. This study was conducted to investigate gutka vendors' knowledge on gutka ban, products covered under ban, penalties for non-compliance and action for enforcement by government agencies. Methods: Twenty vendors were interviewed, 10 each in Mumbai (Maharashtra) and Indore (Madhya Pradesh) during May - June, 2013, one year after ban was imposed. Interviewers used a standardized questionnaire to assess vendors' knowledge of gutka ban, their attitude towards it and compliance to it in practice. Results: All 20 vendors were aware that gutka sale was banned. However, despite ban, eight of the 10 vendors in Mumbai perceived sale of pan masala as legal. In Indore, all 10 vendors perceived sale of Indori Tambakoo, a local gutka variant, as legal. No vendor was sure about the quantum of fine applicable on being caught selling the banned product. Two vendors in Mumbai and nine in Indore admitted selling gutka. Five vendors in Mumbai and four in Indore supported an existing ban on gutka. Interpretation & conclusions: All vendors were aware of the ban on gutka and reason for it. Many vendors supported the ban. However, awareness of other products covered under ban and on fines in case of non-compliance was low. Law enforcement system needs to be intensified to implement ban. Notification of ban needs to be further strengthened and made unambiguous to explicitly include all smokeless tobacco products.

Tobacco product usage among the adolescent / Монголын Анагаах Ухаан

BackgroundTobacco use is responsible for a considerable number of morbidity and mortality in the World. It isconsidered to be one of the main preventable risk factors of non-communicable diseases. The tobaccosmoke contains more than 4000 substances that are harmful to health, and at least 43 of them arecarcinogenic. Globally, there are 1.3 billion smokers and nearly 5 million persons die every year fromtobacco-related illness. Based on current smoking trends, tobacco will soon become the leading causeof death worldwide. Most people begin using tobacco before the age of 18 years. Recent trends nowindicate earlier age of initiation and increasing prevalence of smoking among children and adolescents.In recent years the number of teenagers and women who smoke has grown significantly, with an averageage of initiation of 16 years.MethodsSurvey uses a global standardized methodology that includes a two-stage sample design with schoolsselected proportional to enrollment size. The classrooms within selected schools are chosen randomlyand all students in selected classes are invited to participate in the survey. The survey uses a standardglobal core questionnaire with a set of optional questions that permits adaptation to meet the needsof the country on tobacco use and key tobacco control indicators. A total of 7,298 eligible students ingrades 7-10 completed the survey, of which 6,178 were aged 13-15 years. The overall response rate ofall students surveyed was 92.3%.ResultsA total of 7298 students were covered in the survey. Amongst surveyed schoolchildren, 77.5% werestudents in grades 8-9 and 53.3% were females. 14.3% [95%CI: 4.7-6.7] of surveyed students (n=5775)currently used any tobacco product. Male students were as twice as more likely than female studentsto smoke daily [20.3%, 95%CI: 17.6-23.4 vs. 8.3%, 95%CI: 6.9-10.1]. 15.6% of students were havingever smoked cigarettes. Among those who have ever smoked, 8.6 percent reported to have first triedcigarette smoking before the age of 10-11 years. Male students were more likely to have earlier triedsmoking than female students (р>0.001). The percentage of students who currently use any tobaccoproduct is increased with the student’s age and it was the highest among students aged 15 years oldat 17.8% [95%CI: 15.2-20.8]. 28.6% of all surveyed students, 28.8% of male students and 31.8% offemale students smoked less than one cigarette per day. 37.4% of students smoked one cigarette perday, 25.5% smoked 2-5 cigarettes per day, 3.5% 6-10 cigarettes per day, 1.0% 11-20 cigarettes perday, and 3.9% smoked 20 or more cigarettes per day. 88.6% of those who tried to stop smoking did itbecause they wanted to be healthy. Of the current smokers, 84.3% think that they can stop smoking ifthey wanted to and most of the current smokers never received help or advice when trying to quit stopsmoking.Conclusion:The survey findings would serve as a baseline information database for undertaking a comparativeanalysis of tobacco smoking across the regions of the country; for evaluating of interventions and activitiesfor prevention and control of smoking related diseases; for establishing of surveillance system anddatabase on tobacco smoking; and for implementing of evidence based public health interventions anddecision making. Students had tried to stop smoking and wanted to quit smoking, however, programs,organizations and professionals who can help them to quit smoking are in shortage.

“Toxic Butts”: Key Performance Indicators from a California Statewide Social Media Campaign for Tobacco Control.

Background: The “Toxic Butts” campaign was funded by the California Tobacco Control Program as part of a tobacco product waste toolkit. The campaign was to function as a case study, helping to establish best practices for social media use by tobacco control while at the same time serving as a training tool for local lead agencies interested in better leveraging social media. Little information existed on monitoring and evaluation of social media so new metrics were devised and results reported with the intent of publication. Methods: Campaign staff published English-language content twice a day, seven days a week, for six months. The same content was posted on Facebook and Twitter, with occasional exceptions made for character limits on Twitter. Data were collected usin Twitter and Facebook as primary sources, as well as with a third-party social media monitoring program. Interactions of social media users with the campaign’s content in Facebook and Twitter were examined using six key performance indicators. Two indicators offered novel approaches to quantify engagement, representing any action performed by a social media user with campaign content. Results: The six key performance indicators used to measure campaign performance indicated 1.1 million impressions of “Toxic Butts” campaign content by 340,200 individuals on Facebook, over the six-month period of the study. The largest proportion (42.96 percent) of the campaign’s Twitter followers (n=650) was between the ages of 35 and 44 years, whereas Facebook fans (n=1057) were primarily between the ages of 13 to 17 years (59.1 percent). Twitter followers were nearly evenly split between women and men (51 percent and 49 percent, respectively), whereas Facebook followers were mostly male (60.5 percent compared to 39.50 percent female). Health organizations (34.3 percent) represented the largest share of Twitter followers; Facebook followers were mostly individuals (92.8 percent). Engagement ratios clarified social media users’ interactions with campaign content month-by-month and were considered a valuable point of reference for the overall performance of campaign content. Discussion: The reported key performance indicatorsprovide a starting point of measures of engagement by social media users with a campaign, and the reach of a campaign’s content. Recommendations for future research are provided.

A global health perspective on the future of tobacco control / Una perspectiva de salud global sobre el futuro del control del tabaco

In this age of globalization, the outcome of tobacco control in one country is connected to events on the global stage. Tobacco control has become an increasingly consolidated global movement, catalyzed by the global tobacco control treaty, the World Health Organization's Framework Convention on Tobacco Control (FCTC) as well as the Bloomberg Initiative. This global collective effort is necessary in the face of an increasingly aggressive tobacco industry that has consolidated into a small number of very large multinational corporations, operating globally to expand their markets. Looming issues for tobacco control include the success with which the FCTC is implemented within individual nations, finding the proper role of harm reduction approaches, and using "lessons learned" from experience in the United States with tobacco product regulation.

Con el desarrollo de la globalización, el resultado del control del tabaco en un país está conectado con eventos mundiales. El control del tabaco se ha convertido en un movimiento mundial cada vez más consolidado, catalizado por el Convenio Marco de la Organización Mundial de la Salud para el Control del Tabaco así como de la Iniciativa Bloomberg. Este esfuerzo colectivo global es necesario, ya que la industria del tabaco ha consolidado una serie de grandes corporaciones multinacionales que trabajan globalmente para hacer crecer sus mercados. Algunos problemas pendientes siguen limitando el éxito del control del tabaco. Los problemas incluyen el relativo éxito de cada país al implementar el Convenio Marco, encontrar el papel del enfoque de reducción de daños, y utilizar experiencias y éxitos de los Estados Unidos en la regulación de productos de tabaco.