Tobacco-specific nitrosamines (TSNAs) are a group of carcinogens, which originate from nicotine and other tobacco alkaloids during fermentation and burning of tobacco. Between 1990 and 2010, the tobacco industry-funded extensive academic research on TSNAs in Germany. The objective was to gain better knowledge of how industry aims and strategies correlate with contents of publications by German toxicologists accepting tobacco industry funding by focusing on one prominent such toxicologist.
The authors analysed previously secret tobacco industry documents that were disclosed following a series of litigation cases in the USA and compared them with peer-reviewed published results of tobacco industry-funded toxicologists. The tobacco industry, in particular Philip Morris, developed sophisticated strategies to downplay TSNA's carcinogenic potential. Over 2 decades, German toxicologist Elmar Richter, faculty member of the renowned Ludwig-Maximilians-University, Munich, received substantial financial support from the tobacco industry. Numerous publications show that his research findings supported the aims of the tobacco industry. In his commissioned work, he suggested that TSNA burden can be explained by misclassification of smokers or assay background levels caused by TSNA-like molecules from food. Other publications cast doubt on the relevance of animal testing for TSNAs to humans claiming a detoxifying effect of nicotine on the metabolism of TSNAs or suggesting that adducts of TSNAs are unsuitable as biomarkers of exposure to tobacco smoke.
Economic interests of the tobacco industry have strongly influenced the research activity of Richter and his group. The publications of his working group about carcinogenic effects of TSNAs published between 1992 and 2009 should therefore not be regarded as independent. Scientists and policy makers should consider the long-standing and intensive inter-relation between certain toxicologists and the tobacco industry when assessing the research results and consider ignoring them.
There are important inequities in smoker access to clinic-based smoking cessation services. Low barrier high-reach interventions are proposed as solutions to these inequities. Although effective, telephone quitlines, which provide multi-session counselling but no medication, have low utilization with high attrition. The objective of this study was to determine the effectiveness of free nicotine replacement therapy (NRT), brief advice and self-help materials on quit attempts and 6-month quit rates in motivated smokers.
In this open-label naturalistic study, 14 000 treatments of 5 weeks in duration of either nicotine patch (n=10 000) or nicotine gum (n=4000) were made available to all eligible adult smokers in Ontario, Canada, who called a toll-free number to register with the STOP (Smoking Treatment for Ontario Patients) Study and receive a single brief intervention. The primary outcome measure was self-reported abstinence rates at 6 months post-treatment among STOP participants. These data were compared with quit rates that were reported in a concurrent no-intervention cohort of Ontario smokers matched for eligibility.
16 405 callers were assessed and 13143 eligible participants were mailed a treatment package with 5 weeks of NRT (choice of patch or gum), self-help and community resource materials. Among the 6261 participants who consented to follow-up, 2601 (42%) had complete follow-up data. Of those with complete follow-up data, the percentage reporting abstinence after 6 months in the treatment cohort was 21.4%, relative to 11.6% in the no-intervention cohort (rate ratio of 1.84; 95% CI 1.79 to 1.89), with the 30-day point prevalence of 17.8% and 9.8% for the intervention and no-intervention cohorts, respectively (rate ratio 1.81; CI 1.75 to 1.87).
Provision of free NRT by mail following a brief telephone intervention is an effective strategy to reach and assist a large number of smokers making a quit attempt.
About a third of the world's population is exposed to secondhand smoke (SHS), despite reductions in smoking prevalence in many countries. Accurate, cost-effective measures of exposure are needed in investigations of the health risks associated with SHS, and in studies of interventions to extend smoke-free environments. There have been important developments in the use of questionnaires, air quality monitoring and biomarkers, but still, there is no single, gold standard assessment of exposure to SHS. Choice of measure depends on circumstances, including cost, scale and time window.
]]>This paper considers the evidence on whether outdoor secondhand smoke (SHS) is present in hospitality venues at high levels enough to potentially pose health risks, particularly among employees.
Searches in PubMed and Web of Science included combinations of environmental tobacco smoke, secondhand smoke, or passive smoke AND outdoor, yielding 217 and 5,199 results, respectively through June, 2012.
Sixteen studies were selected that reported measuring any outdoor SHS exposures (particulate matter (PM) or other SHS indicators).
The SHS measurement methods were assessed for inclusion of extraneous variables that may affect levels or the corroboration of measurements with known standards.
The magnitude of SHS exposure (PM2.5) depends on the number of smokers present, measurement proximity, outdoor enclosures, and wind. Annual excess PM2.5 exposure of full-time waitstaff at outdoor smoking environments could average 4.0 to 12.2 μg/m3 under variable smoking conditions.
Although highly transitory, outdoor SHS exposures could occasionally exceed annual ambient air quality exposure guidelines. Personal monitoring studies of waitstaff are warranted to corroborate these modeled estimates.
In October 2012, European Union (EU) commissioner for health and consumer policy John Dalli was forced to resign after an investigation by the European Anti Fraud Office (OLAF) connected him with a cash-for-influence scandal involving smokeless tobacco company Swedish Match. However, several questions have been left unanswered about the circumstances of his departure, and Mr Dalli himself has disputed the European Commission version of events. The report of the OLAF investigation has not been released.
In March, the European ombudsman launched an investigation into Dalli's resignation and has requested the European Commission to hand over all files related to the case. However, dissatisfied with the lack of information that has been made available, some European MEPs have pressed for an inquiry into the circumstances of the case, as well as the broader influence of tobacco lobbying on EU decision making.
...]]>To estimate the association between local clean indoor air ordinances and prenatal maternal smoking across 351 municipalities in Massachusetts before the 2004 statewide ban and to test the effect of time since ordinance adoption on the association.
The authors linked 2002 birth certificate data of women who gave birth in the state and reported a Massachusetts residence (n=67 584) to a database of indoor smoking ordinances in all municipalities. Multilevel regression models accounting for individual- and municipality-level variables estimate the associations between the presence of local smoking ordinances, strength of the ordinances, time since ordinance adoption and prenatal smoking.
Compared with those living in municipalities with no ordinances, women living in municipalities with a smoking ordinance had lower odds of prenatal smoking (OR=0.72, CI=0.53 to 0.98). No effect was found for 100% smoke-free ordinances. For the analyses testing the effect of time, pregnant women living in municipalities with ordinances enacted >2 years were less likely to smoke than those in municipalities with more recent (<1 year) ordinances.
Preventing smoking among women of reproductive age is a public health priority. This study suggests that indoor smoking ordinances were associated with lower prenatal smoking prevalence and the favourable effect increased over time. Findings highlight the public health benefit of tobacco control policies.
‘Neighbour smoke’ is transfer of secondhand smoke between apartments including shared areas, such as hallways, community rooms and stairwells in multiunit dwellings and is an emerging issue for public health and health equity.
To describe the prevalence of exposure to neighbour smoke in Denmark.
A population-based sample of 5049 respondents (2183 in multiunit dwellings) living in Denmark aged ≥15 years completed a questionnaire in 2010 on tobacco-related behaviour and exposure to secondhand smoke. The authors examined the relations between exposure to neighbour smoke, own smoking, smoking inside the home, type of residence and demographic factors with descriptive statistics and logistic regression analysis.
In this sample, 22% of those living in multiunit dwellings reported exposure to neighbour smoke. Of respondents living in apartments, 41% preferred to live in a building in which smoking is banned. Smoke-free buildings were preferred by 58% of persons exposed to neighbour smoke compared with 37% of persons not exposed. Of the smokers (daily and occasional), 14% preferred to live in a smoke-free building; 31% never smoked indoors in their own home.
The only way to avoid absorbing tobacco smoke from neighbours is to live in a smoke-free multiunit dwelling. There is great demand for such dwellings, especially by young people, people with children and people exposed to neighbour smoke, as well as by people who smoke.
To date, no research exists on the role that different sources of exposure to second-hand smoke (SHS) have on 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) and nicotine uptake, assessed via urinary 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) and cotinine concentrations of non-smoking pregnant women, nor the differences in NNAL concentrations among pregnant women who quit smoking in comparison to those who do not.
As part of the ‘Rhea’ mother childbirth cohort in Crete, Greece, 1317 mother–child pairs were followed-up until delivery, while among a subsample, maternal urine was assessed for its NNAL (n=117) and cotinine concentrations (n=377).
Pregnant women who continued to smoke during pregnancy were found to have geometric mean urinary NNAL concentrations of 0.612 pmol/ml, in comparison to the 0.100 pmol/ml of ex-smokers and 0.0795 pmol/ml of non-smokers exposed to SHS. Exposure to SHS in the home was associated with a 4.40 ng/ml increase in urinary cotinine levels, while reported exposure to SHS in cars was associated with an even higher (8.73 ng/ml) increase in cotinine concentrations and was strongly related to NNAL concentrations. Exposure to SHS in the workplace and in public places was also shown to increase cotinine and NNAL concentrations. The NNAL:cotinine ratio was found to be higher among pregnant women who were exposed to SHS but did not smoke (p<0.001).
Using cotinine levels as an indicator of NNK, exposure due to SHS during pregnancy leads to an underestimation of exposure to NNK uptake. Moreover, each source of exposure contributed to the increase in cotinine levels, indicating the importance of avoiding SHS exposure from any source.
Some car rental companies in California and other states in the USA have established non-smoking policies for their vehicles. This study examined the effectiveness of these policies in maintaining smoke-free rental cars.
A stratified random sample of 250 cars (non-smoker, smoker and unknown designation) was examined in San Diego County, California, USA. Dust, surfaces and the air of each vehicle cabin were sampled and analysed for residual tobacco smoke pollutants (also known as thirdhand smoke (THS)), and each car was inspected for visual and olfactory signs of tobacco use. Customer service representatives were informally interviewed about smoking policies.
A majority of putative non-smoker cars had nicotine in dust, on surfaces, in air and other signs of tobacco use. Independent of a car's smoking status, older and higher mileage cars had higher levels of THS pollution in dust and on surfaces (p<0.05), indicating that pollutants accumulated over time. Compared with smoker cars, non-smoker cars had lower levels of nicotine on surfaces (p<0.01) and in dust (p<0.05) and lower levels of nicotine (p<0.05) and 3-ethynylpyridine (p<0.05) in the air. Non-smoking signage in cars was associated with lower levels of THS pollutants in dust and air (p<0.05).
Existing policies and practices were successful in lowering THS pollution levels in non-smoker cars compared with smoker cars. However, policies failed in providing smoke-free rental cars; THS levels were not as low as those found in private cars of non-smokers with in-car smoking bans. Major obstacles include inconsistent communication with customers and the lack of routine monitoring and enforcement strategies. Strengthening policies and their implementation would allow car rental companies to reduce costs, better serve their customers and make a constructive contribution to tobacco control efforts.