We have World No Tobacco Day so let’s start with the highlights from our forensic blog on Tobacco last year.
FOR THE RECORD – Simple Living Global is not short of content but this snapshot gives us a laser update…
The tobacco epidemic is one of the biggest public health threats the world has ever faced. (1)
7 million people die from tobacco use every year
8 million predicted by 2030 (2)
Six trillion – 6,000,000,000,000 cigarettes are smoked every year (3)
Over 1 billion smokers in the world (1)
$1,000,000,000,000 – one trillion US dollars
Tobacco industry’s annual revenues (4)
Nicotine is a toxic poison and is highly addictive (5)
We could actually leave it at that because this one page of stats speaks volumes to all of us.
Anyway we choose to look at Tobacco and what it is doing to us tells us it is harmfull.
We cannot get away from that immutable fact.
WORLD No Tobacco Day 2018: Tobacco and Heart Disease
31 May 2018
WNTD focus for 2018 is Tobacco and Heart Disease.
Cardiovascular diseases (CVD), including stroke, are the world’s leading causes of death.
Tobacco use is the second leading cause of CVDs after High Blood Pressure.
12% all heart disease deaths are from Tobacco use and second hand smoke exposure.
50% all deaths in WHO European region is CVDs
28% – highest overall prevalence for smoking in 2017 estimated in the European region.
The campaign for World No Tobacco Day aims to increase awareness on feasible actions and measure that key audiences, including governments and the public, can take to reduce the risks to heart health posed by Tobacco. (6)
If we keep it Simple and just join the dots here, we know that Tobacco hurts our heart and causes damage.
What if we stopped coming up with the next campaign or Solution and instead put all our efforts and focus onto finding out the following –
What is hurting the hearts of our children and teenagers that leads them to taking up smoking?
Would this be the game changer for us in the world as these kids are our future adult population?
Do we need to put our attention on education so we can warn them up front at a very young age that any form of smoking is bad for us?
Kids like things simple and they want to learn so why not give them an understanding as to WHY smoking affects our heart?
Next – it’s been well over a century that we have known cigarettes kill us and we all have this awareness. Let’s stop pretending and let’s stop thinking we don’t know.
Ask a young child and they will tell us it is bad – they just know.
So, with due respect to all those who are in positions of power and can make changes at a country and global level, let’s Get Real – is reducing the risks to heart health posed by Tobacco the answer?
Is this a form of reductionism?
In other words, are we looking for ways to band-aid our biggest killer that comes from a lifestyle choice?
Are we with our yearly No Tobacco day actually getting on the front foot and can we be Absolutely Honest and say things are not great and things are not working and could there be Another Way?
Can we admit that our soft and nice approach is doing nothing?
Can we admit that banning smoking means most find another way to continue?
Can we admit that our policymakers have not really stopped those who want to smoke? Can we admit that we are so creative we will find alternatives like electronic cigarettes?
Can we admit we are nowhere near getting to the root cause of WHY anyone smokes?
Can we admit that we simply demand more and more research to tell us the same thing? Can we admit we are really into reading the same thing circulating over and over again? Can we admit that we need to stop judging those who smoke and find out why they do?
Can we admit that there are no articles out there on Smoking that give us what Simple Living Global is presenting to us?
In other words, all the facts and the possibility that there could be another way.
Electronic cigarettes have grown rapidly among youth and are the fastest growing part of the Tobacco market. (7)
What are Electronic Cigarettes?
Also known as –
- Electronic nicotine delivery systems
- Hookah pens
- Mods (customizable, more powerful vaporizers)
- Tank systems (8)
- Vape pens
Electronic cigarettes are battery operated devices that are used to inhale an aerosol which contains nicotine, flavourings and other chemicals.
They resemble traditional Tobacco cigarettes (cig-a-likes), cigars or pipes and items like pens or USB memory sticks.
Other devices with fillable tanks may look different.
Generally, they operate in a similar manner regardless of design and appearance. (8)
How E-Cigarettes Work
Most e-cigarettes consist of four different components –
- Cartridge or reservoir, which holds a liquid solution containing varying amounts of nicotine, flavourings and other chemicals.
- Heating element – atomiser
- Power source – battery
- Mouthpiece – used to inhale
Puffing activates the battery-powered heating device, which vaporises the liquid in the cartridge.
The smoker then inhales the resulting aerosol or vapour (called vaping). (8)
First Generation E-Cigarettes
2004 – development of first electronic cigarette generally attributed to a company in China.
Electronic cigarettes consist of battery, vaporising chamber and electronic cigarette liquid.
First generation were typically designed to look like a cigarette and use cartomisers that combine both the vaporising system and e-cigarette liquid in a single unit.
When the user takes a puff or presses a button, depending on the model, a heating coil is activated and subsequently vaporises the electronic cigarette liquid creating a mist or vapour that can be inhaled.
Many first generation models have LED on the end of the device that glows when puff is taken. (9)
Second Generation E-Cigarettes
Look less like a regular cigarette and contain a ‘tank’ which user fills with electronic cigarette liquid. They choose the flavours and strength (nicotine concentration ranging up to 24mg/ml).
There appears to be a trend towards more experienced electronic cigarette users (vapers) preferring newer generation electronic cigarettes (often called personal vaporisers).
They bear little resemblance to cigarettes and can be used with a range of atomisers, cartomisers and tank systems giving the user a greater range of choice.
These systems typically use larger batteries with adjustable power settings and replaceable coils and wicks.
Third Generation E-Cigarettes
These devices allow user to adjust the voltage applied to the atomiser using a control unit that can be set to different modes. The atomisers sit in the fluid and use different types of coils or wicks that can be replaced. Some come with ‘puff counters’ or downloadable software so the user can program their own voltage level and monitor their patterns of use. (9)
Electronic cigarettes have been developed as a ‘lifestyle’ or consumer product and not as a medicine.
Think about how creative we are and where we choose to put our so-called Intelligence?
While the world continues to Sit on the Fence, waiting for more and more research, there are people out there coming up with another way to use the lethal substance called Nicotine and because that is foul they add the fancy flavours that hook us in and bingo we buy it?
ADD to that they know there is an untapped market who are not keen on that puffing smoke business, we call cigarettes that is so last century. So, they create these devices that are so smart, slick and sophisticated that youngsters like to own one.
ADD to that the older generation, who want bespoke because they have the bling and money to do so, there are fancy places to hang out and buy and try these devices.
If not, there is always the Internet to search for the latest, unusual, must have top of the range so it will guarantee we get noticed.
We want it and it is there.
We call that demand and supply.
Let’s stop Blaming the inventors, producers, retailers, manufacturers, dodgy dealers, the government, the boredom at school, our mates and our parents with bad habits.
Let’s just take the RESPONSIBILITY that we make the choices and it is us who can change those choices.
E-Cigarette Use in Teenagers
E-cigarettes are popular among teens.
Now the most commonly used form of Tobacco among youth.
- Easy availability
- Alluring advertisements
- Various e-liquid flavours
- Belief they are safer than cigarettes
All the above make them appealing to this age group.
1 in 4 teenagers reported using e-cigarettes for dripping – practice where people produce and inhale vapours by placing e-liquid drops directly onto heated atomiser coils.
- 5% used dripping to create a thicker vapour
- 7% to improve flavours
- 7% to produce a stronger throat hit – a pleasurable feeling the vapour creates
More research is needed on the risks of this practice. (8)
E-liquids reach higher temperatures when dripped directly onto the coil. This also creates a bigger vapour cloud and provides a bigger throat hit.
A new study now raises special concerns for teenagers who drip.
Allowing the liquid to get superhot can transform harmless chemicals in the e-liquid into toxic ones.
One study showed the hotter the vaped liquid, the more likely it is to undergo toxic transformation. (10)
Vaping hobbyists that do smoke tricks may have popularised dripping.
Suchitra Krishnan-Sarin – Psychiatrist
Yale University, New Haven, Connecticut
1,080 high school students said they vaped
1 in 4 teenagers who vaped had tried dripping
This is the first study reporting on the popularity of dripping in teenagers.
Researchers do not yet know how common dripping is among adults. (11)
In addition to the unknown health effects, early evidence suggests that e-cigarettes may serve as an introductory product for preteens and teens who then go on to use other Tobacco products, including cigarettes, which are known to cause disease and premature death.
Study showed students who used e-cigarettes before 9th grade – more likely to start smoking cigarettes and other smokable Tobacco products within the next year.
Leventhal AM, Strong DR, Kirkpartrick MG et al.,
Association of Electronic Cigarette Use with Initiation of Combustible Tobacco Product Smoking in Early Adolescence. JAMA. 2015; 314(7): 700-707. doi:10.1001/jama.2015.8950 (8)
Another study showing high school students who used e-cigarettes, 7 times more likely to report that they smoked cigarettes 6 months later, compared to student that did not use e-cigarettes.
These results suggest teens using e-cigarettes are at greater risk for smoking cigarettes in the future.
Bold Kw, Kong G, Camenga DR et al.
Trajectories of E-Cigarette and Conventional Cigarette Use Among Youth. Pediatrics. December 2017: e20171832. doi: 10.542/peds.2017-1832 (8)
However, more research is still needed to understand if experimenting with e-cigarettes lead to regular use of smokable Tobacco.
WHY is it that we need more research to understand something that is a no brainer staring us in the face? In other words, we are all capable of joining the dots here and coming to our own conclusion.
If in any doubt, could this forensic article and part 1 Tobacco that Simple Living Global are presenting be enough evidence to bring us all a deeper understanding of the harm of Tobacco, whichever way we want to look at it?
2016 – FDA established a rule for e-cigarettes and their liquid solutions.
Because e-cigarettes contain nicotine derived from Tobacco, they are now subject to government regulation as Tobacco products, including the requirement that both in-store and online purchasers be at least 18 years of age.
Can we just stop here and re-read the whole section on e-cigarettes?
Can we join the dots and work this out without another study telling us?
Do we really need more research to suggest that any form of Tobacco is bad for us?
Is this the best way to fund our research knowing what we already know about Tobacco?
Do we really need to now find out more about dripping and if we do what is it that we are asking?
Do we need to wait any longer to find out the ‘unknown health effects’ when we all know Tobacco has nicotine in it and that means it is the same in cigarettes and e-cigarettes? The End.
What is it about science and all the evidence-based thinking, that we seem to demand above common sense?
What if good old fashion back to basics knowledge that some of us call innate wisdom is available on tap to all of us and we go with that?
Would that cut it?
Are we bonkers thinking the age thing is going to stop our kids finding a way to get what they want on or off line?
Let’s get real, our kids are up to stuff that we would not dare even think about, yet it is going on.
Burying our head in the sand and hoping it will pass is no longer going to help them or us.
Blaming the creators of this new device or the government or x y and z will not change anything.
Next – who on earth comes up with these creations?
What makes someone create something – be it a substance, device or practice that is going to pull in the masses and get them hooked and create ill health, not only to their body but to society as a whole?
What is behind the people who keep coming up with whatever they think will sell?
What is it about us that goes for it without any responsibility to the short and long-term consequences?
WHY are we all not uniting on the fact that education is the way forward if we are ever going to stop the rise of Tobacco products in all their forms?
WHY are we not asking serious Questions, so we get to find out why our children are even thinking about lighting up and before we know it are addicted to a lethal legal substance?
WHY are we going to wait for more research into e-cigarettes before they tell us it is just as harmfull as traditional cigarettes and we cannot get away from that immutable fact?
Have we ever stopped long enough to think that e-cigarettes may just be another version of the same stuff?
In other words, it is still ice-cream but a different flavour?
Is this making sense?
Does any of the blue commentary on this forensic blog make sense to us on the street?
Are we ready to look at this serious topic from all sides and open up conversations and discussions so more of us become aware of the killer that Tobacco really is?
How E-Cigarettes Affect the Brain
The nicotine in e-liquids absorbs in to the bloodstream.
When it enters the blood, nicotine stimulates the adrenal glands to release the hormone epinephrine (adrenaline).
Epinephrine stimulates the central nervous system and increases blood pressure, breathing and heart rate.
Like most addictive substances, nicotine increases levels of a chemical messenger in the brain called dopamine, which affects the part of the brain that controls reward (pleasure from natural behaviours). These feelings motivate smokers to use nicotine again and again, despite possible risks to their health and well-being. (8)
Would it be wise to learn more about our adrenal glands and the importance of the hormones that they naturally produce which are essential to life?
Do we need to find out more about Adrenal Fatigue and whether it is possible to suffer from Adrenal Exhaustion where it goes undetected for years?
Could it be possible that smokers are not aware that they may have depletion in the form of lack of vitality levels in their body?
Could it be possible that nicotine becomes a way to mask and hide the real drain of the body that goes on behind the stress of daily life?
Could it be possible that nicotine is messing with our internal body clock hence sleep is way off and whacky for many smokers, regardless of age?
Could it be possible that without a strong Sleep rhythm our adrenals suffer from fatigue?
Could it be possible that the disturbance from sleep is linked to our nervousness and anxiety?
Has anyone ever noticed that those who smoke are not settled or steady in their body?
Could it be possible that this is because nicotine can cause High Blood Pressure so the heart is pumping at an un-natural pace, leaving us edgy and shaky, not solid and stable?
Nicotine is an alkaloid – a chemical compound that is present in Tobacco.
0.6 to 3.0% of dry weight of Tobacco made up of nicotine.
Nicotine is found in Tobacco plants (Nicotiana tabacum) where it is synthesised in the roots and accumulates in the leaves. It is an oily liquid that is miscible with water in its base form.
Tobacco smoked – nicotine is absorbed through the wall lining of the small air sacs in the lungs. When it is sniffed or chewed, it is absorbed through the mucous membranes of the nose or mouth. Nicotine can be absorbed through the skin. (12)
Nicotine works by mimicking the actions of a naturally occurring brain chemical acetylcholine, by docking with its special receptor molecules. Some of these nicotine receptors in the brain activate part of the ‘pleasure centre’ which could be responsible for nicotine’s euphoric affects. (13)
Regardless of how nicotine is absorbed, it enters the blood stream where it circulates throughout the body and travels to the brain where it crosses the blood-brain barrier. Once in the brain, it binds to and activates receptors called the cholinergic receptors. (12)
Nicotine and the Blood Brain Barrier
The blood brain barrier is a physiological barrier between the circulatory system and the central nervous system that establishes a privileged blood supply, restricting the flow of substances into the central nervous system. (14)
However, some substances can get through the Blood Brain Barrier –
Fat-soluble substances dissolve in the cell membrane and cross the barrier –
Alcohol, Nicotine and Caffeine. (15)
In both pre-clinical and clinical studies, psycho-stimulants including
produce Blood Brain Barrier dysfunction through alterations in tight junction protein expression and conformation, increased glial activation, increased enzyme activation related to Blood Brain Barrier cytoskeleton remodelling and induction of neuroinflammatory pathways.
These detrimental changes lead to increased permeability of the Blood Brain Barrier and subsequent vulnerability of the brain to peripheral toxins. (16)
Nicotine is a toxic substance which because of its lipid solubility can cross the Blood Brain Barrier.
It has several different actions in the Central Nervous System, one of which is neuroexcitation where it can result in seizure activity. (17)
Nicotine is a soluble small molecule that rapidly diffuses through the Blood Brain Barrier and can interact directly with nicotinic acetylcholine receptors (nAChRs) on brain endothelial cells. (16)
Cholinergic receptors are present in the brain as well as in other areas such as the muscles, heart, adrenal glands and other vital organs. Normally these receptors are activated by the neurotransmitter acetylcholine, which is produced at nerve endings in the brain and in the nerves of the peripheral nervous system.
The actions of acetylcholine help to maintain healthy respiration, heart function, muscle movement and cognitive functions such as memory.
Since nicotine has a similar structure to acetylcholine, it can activate the cholinergic receptors.
Unlike acetylcholine, nicotine enters the brain and disrupts its normal functioning.
Regular smoking leads to a change in the number of cholinergic receptors and to changes in their sensitivity to nicotine. This can lead to the development of nicotine tolerance.
Once this happens, the person needs to use nicotine regularly to maintain normal brain function. If the level of nicotine falls, the smoker may experience withdrawal symptoms that lead them to ‘top up’ their nicotine levels by smoking again.
Smoking is considered by the American Heart Association to be one of the hardest addictions to break because of its highly addictive properties. (12)
WHY IS THIS NOT BASIC EDUCATION AT SCHOOL?
What if we all got a simple clear understanding of what the harmful chemical called nicotine is doing to us if we smoke?
Would we then be equipped to make different choices because we know the facts?
What if we made it super simple so our kids just get it, like this example –
Our body has a job to do and it just KNOWS everything so we do not have to worry.
It has chemicals that activate and do jobs like breathing and move our heart and muscles.
There are special ones designed just to do particular things in the brain like memory, so we never forget things when we need to recall them.
Cigarettes and e-cigarettes (this new stuff) is dangerous because it has nicotine inside it. That is the poison chemical that pretends to be the real natural thing when we smoke it and our brain is tricked so it cannot function like it normally would.
The worst thing is we want more of this dangerous stuff as it hooks us in and so we do even more damage inside our brain and body.
Most people cannot stop and give it up as they do not like the ugly feelings when they stop smoking.
So most smokers continue to smoke and fill up their lungs with a false breath, which they take in with smoking poison, but really deep down they want the real breath that came with us when we were born.
So, could it be possible all of us need to be reminded and learn how to breathe the true breath, so we never ever will end up smoking or harming our precious body?
Would it be wise to help all children and get this information into every single school in the world?
What if simply connecting to our own natural breath and having that as a basic teaching from first school is the answer, because the rest will take care of itself?
What if this is the missing ingredient on the school agenda that will support our young children to become steady responsible adults in the future?
Why is Nicotine Addictive?
Nicotine is addictive because the brain starts to rely on it to work properly, so that it becomes sensitive to its own chemical – acetylcholine.
90% smokers say they would like to stop but can’t.
Nicotine withdrawal symptoms include irritability, anxiety, sleeplessness and loss of concentration.
Cigarette smoke contains other harmful substances including carbon monoxide and tar.
25% of all cancer deaths are caused by smoking. (13)
Health Effects of E-Cigarettes – are they Safer than Tobacco Cigarettes?
Some research suggests e-cigarettes may be less harmful than traditional cigarettes when those who regularly smoke switch as a complete replacement.
Nicotine in any form is a highly addictive drug (8)
Research suggests e-cigarettes can even prime the brain’s reward system, putting vapers at risk for addiction to other drugs.
Levine A, Huang Y, Drisaldi, B, et al. Molecular Mechanism for a Gateway Drug: Epigenetic Changes Initiated by Nicotine Prime Gene Expression by Cocaine. Sci Transl Med. 2011; 3(107):107ra109. doi:10.1126/scitranslmed.3003062 (8)
E-cigarette use exposes the lungs to a variety of chemicals, including those added to e-liquids and other chemicals produced during the heating/vaporising process. (8)
University of California study where scientists looked at first generation e-cigarettes because they are inexpensive, which can make them attractive to teenagers.
Five different brands of e-cigarettes where the liquids came packaged from the manufacturer and were non-refillable. Traces of toxic metals included nickel, chromium and manganese were found and the amounts varied between brands.
Research suggests that nickel and certain forms of chromium may cause Cancer. Manganese can harm the nervous system. (11)
Additionally, another study found significantly toxicant exposure in adolescent e-cigarette users.
In most cases, these harmful chemicals were present whether the product contained nicotine or flavourings.
More research is needed on the health consequences of repeated exposure to these chemicals. (8)
Researchers found significant levels of lead, arsenic and other metals in the e-liquids inside the refill dispensers of vapers.
John Hopkins Bloomberg School of Public Health, Baltimore
It is important for the FDA, the e-cigarette companies and vapers themselves to know that these heating coils, as currently made, seem to be leaking toxic metals, which then get into the aerosols that vapers inhale.
Ana Maria Rule – Senior Study Author (18)
WHY do we need more research when we have enough already telling us, spelling it out to us that SOMETHING IS NOT RIGHT?
WHY are we all sitting around after a century of knowing that anything to do with smoking is bad for us and has no health benefits?
WHY are we all not united on the simple fact that no more research is needed as WE KNOW SMOKING OR VAPING IS NOT FOR HUMAN CONSUMPTION?
Could our researchers be put to better use with their time and skills as the old way is not working?
Could we get them on the street, talking and having conversations and finding out what gets our youth into taking up smoking for the very first time?
Could we then get them digging deeper and looking at their family life and lifestyle choices that go with that and see what they come up with?
Could we then join the dots and see what is missing that makes someone so young want to get hold of a poison that will seriously harm their body?
Could we then interview adult smokers and find out everything we can about them and use this anecdotal evidence to report real life findings and end the hypothesis of this and that?
Could we then get our researchers uniting, so on a global scale we leave no stone unturned?
Could we ensure that all research is funded and is Absolutely Independent and that means no back handers from those in the industry that could tamper with the findings to suit an agenda?
Could this type of research get us to the root cause of why anyone smokes in the first place?
Could this be the research of the future that will see the tides turning once and for ALL?
In other words, real change that benefits us ALL.
Health Effects for Teenagers
Teenage years are critical for brain development.
Nicotine affects the development of the brain’s reward system and continued e-cigarette use can not only lead to nicotine addiction but it can make other drugs such as Cocaine and Methamphetamine more pleasurable to a teenager’s developing brain.
Nicotine affects the development of brain circuits that control attention and learning.
Other risks include mood disorders and permanent problems with impulse control – failure to fight an urge or impulse that may harm oneself or others. (8)
Surgeon General Reports on Smoking
The Surgeon General report process is an enduring example of evidence-based public health in practice.
Cigarette smoking remains one of the most pressing global health issues of our time. (19)
The Surgeon General has published 34 reports on Tobacco since 1964
Smoking and Health: Report of the Advisory Committee to the Surgeon General of the Public Health Service
The Health Consequences of Smoking: A Public Health Service Review: 1967
The Health Consequences of Smoking: 1968 Supplement to the 1967 Public Health Service Review
The Health Consequences of Smoking: 1969 Supplement to the 1967 Public Health Service Review
The Health Consequences of Smoking: a Report of the Surgeon General: 1971
The Health Consequences of Smoking 1972
The Health Consequences of Smoking
The Health Consequences of Smoking 1974
The Health Consequences of Smoking 1975
The Health Consequences of Smoking: A Reference Edition
The Health Consequences of Smoking 1977-1978
Smoking and Health
The Health Consequences of Smoking for Women
The Health Consequences of Smoking: The Changing Cigarette
The Health Consequences of Smoking: Cancer
The Health Consequences of Smoking: Cardiovascular Disease
The Health Consequences of Smoking: Chronic Obstructive Lung Disease
The Health Consequences of Smoking: Cancer and Chronic Lung Disease in the Workplace
The Health Consequences of Involuntary Smoking
The Health Consequences of Using Smokeless Tobacco
The Health Consequences of Smoking: Nicotine Addiction
Reducing the Health Consequences of Smoking: 25 Years of Progress
The Health Benefits of Smoking Cessation
Smoking and Health in the Americas
Preventing Tobacco Use Among Young People
Tobacco use Among U.S. Racial/Ethnic Minority Groups –
African Americans, American Indians, Alaska Natives, Asian Americans, Pacific Islanders and Hispanics
Reducing Tobacco Use
Women and Smoking
The Health Consequences of Smoking
The Health Consequences of Involuntary Exposure to Tobacco Smoke
How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease
Preventing Tobacco Use Among Youth and Young Adults
The Health Consequences of Smoking: 50 Years of Progress (19)
1964 Surgeon General Report
This famous report from Luther Terry, the Surgeon General alerted Americans to the deadly dangers of cigarettes.
A 150,000 word report title – Smoking and Health (20)
Let’s not fall asleep reading this long list…
Let’s ALL wake up and smell the smoke…
54 years later – can we be Absolutely Honest and say that the biggest change is the statistics have gone up and things have got worse?
In 1964 a 150,000 word report about smoking and health was published.
That is around 7 times the size of this article from Simple Living Global.
Could it be possible that either we are not reading the stuff or those who do read it do not have the power to change things even at a country level?
How can we end this cycle of 54 years and bring about real change?
Is it time to at least consider Another Way?
What if those who can really help need to have a clear radar?
In other words, the quality that they live needs to be Absolutely free of Tobacco and their health needs to show us vitality levels so that means they are not living on stimulants or modern day alternatives to function in daily life.
What if we put these people into schools, colleges, universities, workplaces, hospitals and GP surgeries to give small presentations about the harm of smoking in any form?
What if this could be the game changer simply because these people hold a vibration in their body that others can feel and it gets them to at least stop and consider what is being presented?
What if this would be a cheap and cost-effective way to get down on the street and get on with it and humanity benefits as a whole and no one is left out?
Is this not what our world needs to be about?
In other words, those who can help and support others instead of leaving them to it and then complaining or blaming as we seem to have a habit of doing that.
The study identified cigarette smoking as the chief cause of lung cancer in men (and later as the gender gap between smokers narrowed, women too).
Smoking was also named as the most important cause of chronic bronchitis in men and women and laryngeal cancer.
Committee – 10 scientific experts, five smokers and five non-smokers.
14 month review
7,000 scientific and public health studies
“the most comprehensive analysis ever taken”
70% of smokers more likely die of fatal heart attack than non-smokers
Strong association between cigarette smoking and Cancer of the oesophagus and bladder, emphysema, peptic ulcers and premature babies.
42% of all adults were smokers in 1964 (20)
“It is the judgement of the Committee that cigarette smoking contributes substantially to mortality from specific diseases and to the overall death rate.”
The public’s health has long been stymied on this issue by the powerful Tobacco industry, a business so ingrained in the American fabric that Tobacco leaves are inscribed in stone on the façade of the U.S. Capitol building.
Introducing this seminal document, Dr Terry promised to ‘move promptly’ in taking bold steps to ‘advise anyone to discontinue smoking’ or at least recognise ‘the health hazard of cigarettes. Although roadblocks were in the way for him and his successor, he was responsible for one of the most famous warnings ever made in this history of medicine and public health:
“Caution: Cigarette smoking may be hazardous to your health”
The following year, Congress passed legislation requiring this warning to be prominently displayed on every package of cigarettes.
27 July 1965 – President Lyndon Johnson, a smoker himself signed the act into law.
It took another 6 years to fully implement.
1971 – cigarette manufacturers were finally banned from advertising on television.
In each of these years, up to the present, 500,000 Americans died from the results of smoking.
1980’s – cigarette smoking” banned from airplanes, hospitals, restaurants and other public spaces.
Cigarette manufacturers did their best to discredit the scientific findings of the 1964 study, which have only proved to be more ominous in the decades that followed.
The Tobacco industry also stepped up the marketing of their products not only to the millions of Americans who were already hooked on smoking but also to women and minorities who had not previously taken up the habit.
Millions of dollars were put into lobbying congressmen and senators to keep their products profitable and widely used.
A few decades later, cigarette manufacturers tried to discredit subsequent scientific research on the dangers of second hand smoke and the addictive nature of nicotine.
1967 – Dr Terry continued to warn the American public about the dangers of smoking as Chairman of the National Interagency Council on Smoking and Health.
“The period of uncertainty is over. There is no longer any doubt that cigarette smoking is a direct threat to the user’s health. There was a time when we spoke of the smoking and health ‘controversy’. To my mind the days of argument are over…”
1990s – coalition of state attorneys general sued the Tobacco industry for the harm caused to many addicted smokers.
Yet we are nowhere near ending the profitable sales of these toxic deadly products.
Cigarette smoking remains the leading cause of preventable disease and death according to the United States Centers for Disease Control. (20)
U.S. Tobacco Companies will run Anti-Smoking Ads everywhere – except Social Media (21)
A court in U.S. directed that 4 Tobacco companies publish the corrective statements on –
- The Health effects of Tobacco use
- Second hand smoke
- False sale and advertising of low tar and light cigarettes as less harmful than regular cigarettes
- That smoking and nicotine are highly addictive
- That they have designed cigarettes to enhance the delivery of nicotine
The statements, appearing in advertisements paid for by the Tobacco industry, were ordered to appear in more than 50 U.S. newspapers, as well as on American television stations.
The publication of the corrective statements, which started 26 November 2017, follows a lawsuit filed by the U.S. Justice Department in 1999 under the Federal Racketeer Influenced and Corrupt Organizations law. The Federal Court first ordered Tobacco companies to implement these corrective statement adverts in 2006, but years of Tobacco industry appeals blocked their publication. (22)
Following numerous appeals to the original lawsuit, the U.S. District Court for the District of Columbia ruled that these major tobacco companies have “lied, misrepresented and deceived the American public” and thus, must “clarify for the public the effects of Tobacco use” by financing the barefaced campaign, which underlines undeniable facts such as
“more people die every year from smoking than murder, AIDS, suicide, drugs, car crashes and alcohol combined.”
The digital print ads are slated to run for four months, while the commercials will air for a full year.
Note – these ads are not on social media, where Big Tobacco’s youngest audiences would see them. (21)
37.8 million adults currently smoke cigarettes
16 million live with a smoking-related disease
Men more likely to be current cigarette smokers
Higher among age 18 to 65 years
Higher among persons living below poverty level
Higher among persons with disability/limitation
Adults that experienced serious psychological distress more likely to be current smokers (23)
Can we all get honest here and admit we all like to blame when something is not right for us?
What if we stopped blaming the Tobacco industry and just looked at this from another angle?
What if the Tobacco industry exists as it does because it has the punters, the customers who demand ‘keep supplying, we want it’ and so they do and they make big fat profits and they are not interested in human health as they are a business, just like many in this world that put PROFITS BEFORE PEOPLE?
Could it be that simple?
We all like this finger pointing business but not once do we stop and truly consider that word RESPONSIBILITY and that means we have a hand in this and so it is time to stop all blame.
Blaming guarantees no evolution and if we are seeking to evolve it would be worth reading our blog on this website about Blame.
E-Cigarette Use Among Youth and Young Adults
The 2016 Surgeon General’s report comprehensively reviews the public health issue of e-cigarettes and their impact on U.S. youth and young adults.
Studies highlighted in the report cover
- Age 11 to 14 young adolescents
- Age 15 to 17 adolescents
- Age 18 to 25 young adults
Scientific evidence in the report supports the following facts:
E-cigarettes typically deliver nicotine, flavourings and other additives to users via an inhaled aerosol.
E-cigarettes are battery powered devices that heat a liquid into an aerosol that the user inhales.
The aerosol is also the vapour – the big cloud we see when smokers exhale e-cigarettes. This can be potentially harmful to the public’s health as it includes nicotine; ultrafine particles; flavourings such as diacetyl – a chemical linked to serious lung disease; volatile organic compounds such as benzene, which is found in car exhaust; heavy metals such as nickel, tin and lead.
The liquid has nicotine and can include solvents, flavourants and toxicants. (24)
E-cigarettes are now the most commonly used Tobacco product among Youth.
E-cigarette use among youth and young adults has become a public health concern.
The use of products containing nicotine in any form among youth, including e-cigarettes is unsafe.
E-cigarette use is strongly associated with the use of other Tobacco products among youth and young adults, including cigarettes and other burned Tobacco products.
25% youth in middle and high school have tried e-cigarettes
3 million youth used e-cigarettes in past month
6 out of 10 high school cigarette smokers also used e-cigarettes
Among young adults, e-cigarette use more than doubled from 2013 to 2014. (24)
So what would the real figures be today in 2018?
We all know the popularity among our youth for this new form of tobacco is on the rise.
Are we going to stop and ask Questions or shall we just accept it and carry on, which is how we have always dealt with our youth issues?
Do we point the finger and Blame our education systems and the policy makers for all this?
Do we think that parents could do more but they seem too stressed with other issues?
Do we think this is happening on our watch and in our world so we each have a hand in this?
Do we ever go deeper to ask why is there such a huge demand and what is going on for our young people of today that they need to consume a poison?
Can we come together and start conversations and keep asking questions until we get to the root cause of why this is happening?
Is there more that each one of us can do, talking in the community, writing and expressing or sharing something we have observed – in other words, good old fashion citizen journalism?
What would it be like if we had jobs for elders in the community to get them active and be a guardian for our youth?
What if a good old fashion daily talk would cut it, because most of us tend to respect the older generations as we know they are wise?
Research has found youth who use tobacco products, such as e-cigarettes are more likely to go on to use other tobacco products, like cigarettes.
The brain is the last organ in the human body to develop fully.
Brain development continues until the early to mid-20s.
Nicotine exposure during periods of significant brain development in adolescence can disrupt the growth of brain circuits that control attention, learning, and susceptibility to addiction.
The effects of nicotine exposure during youth and young adulthood can be long-lasting and include lower impulse control and mood disorders.
Nicotine in e-cigarettes and other Tobacco products can prime young brains for addiction to other drugs, such as Cocaine and Methamphetamine.
Nicotine can cross the placenta and affect foetal and postnatal development.
Nicotine exposure during pregnancy can result in multiple adverse consequences, including sudden infant death syndrome.
Ingestion of e-cigarette liquids containing nicotine can cause acute toxicity and possible death if the contents of refill cartridges or bottles containing nicotine are consumed.
E-cigarettes are marketed by promoting flavours and using a wide variety of media channels and approaches that have been used in the past for marketing conventional Tobacco products to youth and young adults. (24)
$3.5 billion – e-cigarettes business in United States
$125 million – manufacturers spent on advertising
70% middle and high school students had seen e-cigarette advertising
2012 Surgeon General’s Report on Tobacco use among youth and young adults found that Tobacco product advertising causes young people to start using Tobacco products. (24)
85% users aged 12 – 17 use flavoured e-cigarettes and flavours are the leading reason for youth use.
Action can be taken at the national, state, local, tribal and territorial levels to address e-cigarette use among youth and young adults.
Actions could include –
- Incorporating e-cigarettes into smoke free policies
- Preventing access to e-cigarettes by youth, price and tax policies, retail licensure
- Regulation of e-cigarette marketing likely to attract youth
- Educational initiatives targeting youth and young adults
The Food and Drug Administration (FDA) now regulates the manufacturing, importing, packaging, labelling, advertising, promotion, sale and distribution of e-cigarettes.
2016 – FDA began enforcing a ban on vending machines sales unless in adult-only facilities and a ban on free samples and sales to minors.
Parents, teachers, health care providers and others who influence youth and young adults can advise and inform them of the dangers of nicotine; discourage youth Tobacco use in any form, including e-cigarettes; and set a positive example by being Tobacco-free themselves. (24)
Is something missing or have we nailed it?
Are those who set the rules on the front foot?
Are our Solutions going to work when it comes to our Youth?
Are any of us ready to be a positive example to our kids?
Has anyone tried as an adult to give up Tobacco and remain Tobacco free?
Are we aware how difficult it is to give up a highly addictive drug?
Could it be possible that even our best efforts to set an example and be Tobacco-free is just not happening as it really is not that simple?
Could it be possible that our kids need real role models and when they look around there does not seem to be any?
Could it be possible that our children would truly benefit from good old fashion daily no nonsense talk and some discipline with a big dose of Responsibility?
In other words, talk to them like adults and get them to step up and realise that their choices have consequences and teach them about decency and respect.
Could it be possible that our youth are getting out of control because there is no one out there who is a constant in their life that they can go to in times of need?
Could it be possible that no adolescent will ever listen if we tell them to stop smoking while we are still doing the stuff, albeit behind their back?
900% increase in e-cigarette use among high school students (25)
Understanding e-cigarette use among young people is critical (24)
No kid should be using any tobacco product
Dr. Scott Gottlieb – FDA Commissioner (26)
9 in 10 adult smokers first try conventional cigarettes during adolescence (24)
Crack Down on E-Cigarettes
The Food and Drug Administration (FDA) is failing in its responsibility to regulate e-cigarettes. By inaction, the agency allows a wall of vapour to obscure the fact that Tobacco in any form poses a real danger and imperils children’s lives. (27)
Sleek, featherweight, metallic dark colours are now a brand of electronic cigarettes that have become a fashion – a contagion among high school students across America.
Easily mistaken for a flash drive, USB stick, the gadgets let kids do vaping without notice in hallways or school cafeterias and conveniently recharge on their laptops.
Is this where we need to just stop and ask who on earth comes up with these things and what drives them to do this when we all know it harms?
WHY are these inventors so creative in making sure they are on the front foot and coming up with this stuff that they know will be a hit and bring in the big bucks?
WHY are we back peddling and not getting ahead and knocking this stuff out with our innate wisdom and know how?
Are we able to admit that whilst we don’t like what it is doing to our youth, we are not hating it enough, so we just leave it, hoping others will take action or say something?
1,700,000 high-school students used e-cigarettes
500,000 middle-school students used e-cigarettes
Beguiled by unregulated advertisements and fruit flavourings.
Undeterred by the federal prohibition on sales to minors.
Children take in as much nicotine from these vaping devices as from combustible cigarettes.
Research suggests once addicted to vaping, they may be more easily drawn to old fashioned smoking.
Anyone vaping suffers the ill effects of Nicotine on blood pressure and heart rate and expose themselves to any number of other toxic chemicals that may inflame airways and otherwise poison teenage and adult lungs and other organs. (27)
FDA Commissioner hopes e-cigarettes might be useful in helping smokers quit.
But there is far too little evidence to support that idea.
On the contrary –
new research suggests that smokers who switch to e-cigarettes may be less likely to quit than those who don’t.
Even if e-cigarettes help a few people escape Tobacco, they attract so many teenagers that their net effect is decidedly harmful. (27)
The FDA is belatedly considering limiting or banning e-cigarette flavourings like ‘peanut butter cup’ and ‘bubble pop’ which obviously appeal to kids.
The FDA Commissioner has postponed any further regulations and requirements that e-cigarette makers disclose their ingredients.
The American Academy of Pediatrics and several other health groups, including Campaign for Tobacco-Free Kids have filed suit to challenge the FDAs delay.
Litigation should not have been necessary. The agency ought to move quickly to restrict e-cigarette advertising and online sales and to impose testing and labelling rules so consumers know what dangerous ingredients e-cigarettes contain.
Further delay will prolong the myth that e-cigarettes are benign, give a malignant habit time to spread and destroy the health of millions of American children.
Just because there is no smoke, it does not mean that cigarettes cannot kill us. (27)
1 in 3 students – 12th grade report using some kind of vaping device which contains nicotine, marijuana or ‘just flavouring’.
Survey suggests use of hookahs and regular cigarettes declining.
2017 Monitoring the Future (MTF) survey of 8th 10th 12th graders in schools nationwide.
Annual research conducted by scientists of University of Michigan and National Institute on Drug Abuse (NIDA)
2017 – MTF survey
360 public and private schools
1975 start of survey to measure how teenagers report their drug, alcohol and cigarette use and related attitudes in 12th graders nationwide.
1991 – 8th and 10th graders were added. (28)
Important to note that some research suggests many teenagers do not actually know what is in the device they are using. Not all labelling is consistent or accurate.
27.8% – high school seniors reported ‘vaping’
1 in 10 – 12th graders say they use nicotine
1 in 20 – report using Marijuana in the device
“We are especially concerned because the survey shows that some of the teens using these devices are first-time nicotine users.
Recent research suggests that some of them could move on to regular cigarette smoking, so it is critical that we intervene with evidence-based efforts to prevent youth from using these products”.
Nora D. Volkow M.D. – Director of National Institute on Drug Abuse (NIDA) (28)
79.8% – 8th graders said they disapprove of regularly vaping nicotine (28)
E-Cigarette Brand ‘In’ With Today’s Teenagers
How the FDA is Cracking Down –
The Food and Drug Administration will target 7-Eleven stores, Shell gas stations and other vape retailers in a nationwide crackdown on sales of vape pens to underage teenagers.
There is one particular brand of e-cigarette that has become wildly popular among high schoolers with flavours such as fruit medley, cool mint and crème.
As teen smokers did in past decades, kids vape in the boy’s and girl’s room.
The bathroom is the main source of it.
As students grow bolder, usage has moved to classrooms.
Maureen Byrne – Principal of Dublin High School, San Francisco
What is the FDA doing?
The agency issued warnings to 40 online and traditional retailers, including convenience stores and vape speciality shops. This is part of a “blitz” that FDA Commissioner Scott Gottlieb said will continue through with additional actions in coming weeks.
Immediately after the FDAs announcement, a particular e-cigarette company announced its own $30 million campaign to curb underage use of its products, funding both research and a panel of experts led by an Attorney General. (29)
Is this campaign the answer?
Is this a Solution in any way?
Will the experts be unbiased?
Can we guarantee that the research will be totally Independent if it is funded by those who are being exposed – in this case the makers of a popular device where sales are growing rapidly for the youth market?
The wallop of nicotine packed into these pods could backfire for kids seeking a cigarette alternative. The nicotine’s addictive nature amounts to a “very real possibility” users will move from vaping to smoking.
Dr. Steven Masters – Family Physician, Tennessee (29)
Is this family doctor telling us something that we need to pay attention to?
Is this man on the front foot and spelling it out for us that our kids could end up being the adult smoking population in the future?
Many e-cigarettes contain traces of formaldehyde and other chemicals but the health effects of those are not clear. (29)
Is this something we should be concerned about?
Can we trust the research is going to tell us the Truth?
Do we have reservations or are we going to wait and accept what research tells us?
Is this statement ok for now because it says ‘traces’ of this gas called formaldehyde?
Do we need to be worried as we do not know what the ‘other chemicals’ are right now?
WHY are we all not banging on about this to get the facts clear?
WHY are the media not reporting the dangers and serious harm of e-cigarettes?
WHY are we not being Absolutely Honest and being totally transparent about this topic?
WHY are we Sitting on the Fence when it comes to conversations that require our attention before things get even more out of control?
Ads for E-Cigarettes Today
Robert Jackler is an ear, nose and throat surgeon from Stanford University and has spent more than a decade researching the history of advertisements produced by Big Tobacco, who are the five largest global Tobacco industry companies.
His diverse collection contains more that 50,000 ads from magazines, newspapers, billboards, television and the Internet from 1900 to present day.
The collection is archived within the Smithsonian’s National Museum of American History and it highlights the Tobacco industry’s efforts to deceive the public about the health risks of their products.
Central themes of Jackler’s collection include faux medical imagery and exaggerated health claims, posh cultural icons and celebrity endorsements and the explicit targeting of youth populations with cartoon characters, sweet flavours and promises of elevated social status.
Now, decades after the U.S. government began regulating Tobacco advertising, these techniques are being diverted toward getting young people to try e-cigarettes.
Late 1900s – Federal government tightened regulations on the placement and content of traditional Tobacco advertisements, largely limiting their exposure to children. The first of these regulations came when Congress passed the Public Health Cigarette Smoking Act of 1970 to ban the advertising of cigarettes on television and radio, following the landmark 1964 Surgeon General report that causally linked lung cancer and chronic bronchitis to smoking.
In early 2000s – emerging companies promulgated a new way of getting hooked on nicotine:
Electronic cigarettes, commonly known as e-cigarettes.
Jackler has collected 13,000 items pertaining to this fad and his research has revealed troubling similarities between the campaigns of old and the practices used today.
“E-cigarette producers ignore absolutely everything that was ever agreed to around combustible cigarettes.
You have pictures of doctors saying ‘use this e-cigarette’. You have all sorts of claims in e-cigarettes that are the kinds of things that would have been forbidden. E-cigarettes show up on television and radio.”
His collection of e-cigarette ads has misleading and targeted messages from pseudoscientific health claims to kid-friendly bubble gum flavours and ‘back to school’ sales.
Jackler and others argue that e-cigarette companies’ marketing campaigns carry much more appeal to adolescents – most of whom never may have considered cigarettes and have not been subjected to heavy cigarette marketing thank to new regulations.
With bright colours, sleek design and fashionable millennial models, advertisements for a device that is a popular high nicotine product, could easily be promoting the newest smartphone line.
“Very clearly, they do the same thing today as they did then. The messaging is very subtle, very carefully crafted. They target, in the same way, adolescents” says Jackler. (30)
We could say this surgeon is on a mission to expose the Tobacco industry because he sees first hand what smoking does because he is a throat specialist.
Whatever our views and beliefs are, we cannot negate the fact that the marketing of a device, small enough to fit in a closed fist, with tech inspired design that resembles a USB flash drive, was manufactured for a certain age group.
ADD to that the flavours like mint, mango and crème brulee and bingo you have a ready-made market called adolescents. It is the ultimate appeal for young people and facilitates initiation of Tobacco use.
One cartridge has 200 cigarette puffs which is equal to a pack of cigarettes.
What is alarming and should be of great concern to us all is that many young people do not even realise they are inhaling nicotine when they vape or use e-cigarettes. The majority think they are vaping only flavouring, not nicotine according to the University of Michigan’s 2016 Monitoring the Future study. (31)
The Centers for Disease Control and Prevention reported that in 2015 –
99% of e-cigarettes sold in U.S. convenience stores, supermarkets and similar outlets contained nicotine. (32)
While e-cigarettes are advertised as a less-harmful alternative to their combustible counterparts, studies have linked e-cigarettes to a host of health issues, including Asthma and chronic bronchitis.
They can also act as a gateway to traditional smoking: studies find adolescents who use e-cigarettes are 20% more likely to take up traditional cigarettes in the future.
One fMRI brain imaging study supports Jackler’s claims that e-cigarette ads appeal particularly to kids. Research by Yvonnes Chen suggests that some e-cigarette advertisements may trigger high levels of activation in the reward centres of adolescent brains – even for those who have never smoked.
Themes of rebelliousness, sex appeal and kid-friendly flavours abounded in the e-cigarette ads, which explains the adolescents’ heightened neural and behavioural responses.
“If you take a look at these categories, these have been traditionally used by Tobacco companies when they were trying to market the combustible Tobacco products.
The appeals are very consistent throughout the decades…and clearly, these are the traits that are traditionally appealing to adolescents and even children.”
Yvonnes Chen – University of Kansas
Many studies have shown for adult smokers watching videos featuring Tobacco products, it activates the reward centre in the brain in the same way that physically smoking a cigarette would.
It is a very harmful effect that tends to result in more intense cravings for cigarettes, thus reinforcing the vicious circle of nicotine addiction.
Chen’s team in their study looked at the same reward centres in a group of 30 non-smoking participants aged 14 to 21.
In addition to the neural activity, the adolescents expressed a stronger desire to use e-cigarettes than the other products after exposure to the advertisements suggesting that youth appeal may be even stronger than researchers had expected.
“These ads are designed to appeal to users who are not of age…and we know based on animal models that adolescents’ brains are already so much more susceptible to nicotine…there definitely are a lot of consequences socially with that.
E-cigarette companies have a bigger role to play in terms of being more responsible citizens.”
Yvonnes Chen – University of Kansas (30)
According to Jackler, far from being a win for anti-tobacco groups, the e-cigarette industry’s youth appeal and outpacing of regulatory activity could be a win-win for Big Tobacco…he foresees a marketplace where the major Tobacco companies swallow up their more youthful competitors.
The e-cigarettes’ adolescent customer base might then be Big Tobacco’s next generation of combustible cigarette smokers.
Smoking initiation is an adolescent thing…they smoke, they get hooked on the nicotine and they become lifelong consumers.
Robert K. Jackler MD Otolaryngologist – Stanford University, California (30)
Alcohol Flavoured Tobacco Products
50 alcohol-flavoured Tobacco product lines are marketed by over 400 Tobacco brands and these products attract teenagers, luring them into Tobacco addiction, according to a new study.
Adolescent drinking and smoking go hand in hand and the combination of alcohol flavours in Tobacco products appeal to teen users.
So-called characterizing flavours in cigarettes are banned by the U. S. Food and Drug Administration (FDA) and these restrictions should be extended to the many flavoured Tobaccos for cigars, cigarillos and hookahs, as well as e-cigarette liquids the study authors add.
Jackler and colleagues analysed the top 20 U.S. brands of cigarillos and e-cigarettes using the Nielsen database, which includes unit sales in 25 major chains and 14,000 convenience stores.
The researchers also looked for the top hookah and shisha brands online.
Then they searched among the top brands for products with flavours related to alcoholic beverages such as beer, appletini and margarita.
The research team found –
455 e-cigarette brands
100 flavoured cigar, cigarillo and hookah brands
Most popular fruity flavours were pina colada, mojito and margarita
Most popular spirit flavours were rum, bourbon and whiskey
We found it disturbing that major International Tobacco companies, which claim to be socially responsible and who profess they would never target underage youth, produce a wide spectrum of flavoured mini-cigars and e-cigarettes, including quite a few with alcohol-themed names.
Robert Jackler MD
June 2017 – San Francisco Board of Supervisors unanimously banned flavoured Tobacco.
One Tobacco company is reported to have spent $700,000 on a campaign to collect 34,000 signatures and bring a referendum before city voters.
Ballot to be held in June 2018
If this company spent this much money on a local policy in one city they are sending a message that these bans could severely hurt their business and affect who smokes.
Dr. Pamela Ling – University of California at San Francisco School of Medicine
She was not involved with the study.
Jackler and colleagues are now studying how flavoured products are advertised to appeal to teens. They are comparing differences on Social Media channels, which predominantly appeals to adult smokers and another platform which appeals to younger smokers.
Dr. Pamela Ling of the University of California at San Francisco School of Medicine encourages parents to be informed and take a stand in their communities as well.
Parents should take action and say they do not want these products in their stores or neighbourhoods.
There is not a good scientific reason to leave these products on the market.
Dr. Pamela Ling (33)
Research study at University of North Carolina to know whether e-liquid flavours affected how safe people thought vaping was.
40 studies on flavoured Tobacco products reviewed, including flavoured e-cigarettes.
Most studies were conducted between 2010 and 2016
Both Tobacco users and non-users said Tobacco products more appealing when pleasing flavour.
Younger people were particularly interested in fruity and candy-flavoured products.
2009 – U.S. Food and Drug Administration banned flavoured cigarettes except menthol. It was to limit their appeal to kids.
“Interest in flavours is one of the main reasons youth try e-cigarettes.
It is important to note that just because something does not taste like Tobacco does not mean it is safe. Studies have shown that some flavour compounds in e-liquids such as cinnamon extract appear to become harmful when heated in an e-cigarette.
Research suggests that if you remove the flavours, far fewer youth around the country would use any Tobacco product and that would put fewer kids at risk for vaping-related damage to the mouth and lungs.”
Adam Goldstein, Researcher – University of North Carolina (11)
Loophole Allows Tobacco Products to be Sold on Social Media
Tobacco companies and vendors are making use of Social Media to market and sell their products, including to children under 18.
Research by Stanford University’s Medical School found Tobacco and E-Cigarette companies making extensive use of unpaid or ‘organic’ marketing to sell their products on a social network.
108 pages found by the researchers
50% contained links to buy Tobacco products
75% included coupons and discounts to entice potential buyers
99% pages contained images of E-Cigarettes, Cigars and Smokeless Tobacco
50% Tobacco brand-sponsored pages and
90% online Tobacco store pages did not have “age-gating” safeguards
The social media platform bans “buy now” links and images of Tobacco products under their Tobacco advertising rules.
Their terms require private sellers to restrict children’s access to pages promoting sales of regulated goods and services, which include items such as prescription drugs, Alcohol, firearms and Tobacco.
2 billion people worldwide use this social media platform and brands are increasingly using this medium to market their products and services to young people. (34)
WHY do we have a hole in social media that allows this to happen?
Have we forgotten that each of us has a Responsibility and each of us does make a difference as each of us make up this whole world?
What if we simply started up conversations and posted well-researched articles, like this one so more people become aware?
What if those of us who are ready, can express and use our skills to get the message out on social media and on the Internet?
What if we changed our way and instead of the next photo we choose to upload that has zero purpose for humanity, we made a difference by talking about stuff like this that needs to be out there?
Would that help and support our world that is currently in a real mess?
Recently Tobacco companies have come under fire for marketing cigarettes to children particularly in low and middle income countries.
The focus of this study was on younger people, as they are more likely to take up smoking and tend to be the most active on social media.
Very few adults decide ‘I am smoking today’
Smoking infiltration begins with teenagers
The industry understands that is where its customers come from.
Many of the tactics employed by marketers on this social media platform were deliberately designed to appeal to young people.
Dr. Robert Jackler – Lead Author of the Study and Principal Investigator of Stanford Research (34)
Could we all agree with what Dr Jackler is telling us?
Can we read between the lines and note that something happens in the teenage years and so we need to put our Focus and Priority into finding out what is missing that starts the smoking infiltration that this big wig surgeon is telling us?
How evil we could say it is that the industry knows this and it knows how to market and keep the customers happy BUT what if the real evil is the thoughts that we have entering our mind that makes us do what we do?
For the record – we are using the word evil as a force that separates us from who we truly are.
This may be too far-fetched, way off, whacky and weird right now for most of us, but what if there is something here that the scholars of our future will study?
What if those who will study this website one day, know beyond doubt that back in the early 21st century there were people on the front foot, delivering volumes of what is going to be needed in the years to come, so man will know there is another way?
Liquid Nicotine is a Poison
Why is it Being Packaged Like Junk Food?
1st May 2018
Food and Drug Administration (FDA) and the Federal Trade Commission sent 13 warning letters to manufacturers, distributors and retailers for selling e-liquids used in e-cigarettes with labelling and/or advertising that cause them to resemble kid-friendly food products, such as juice boxes, candy or cookies, some of them with cartoon-like imagery.
The FDA is an agency within the U.S. Department of Health and Human Services and protects the public health by assuring safety, effectiveness and security of human and veterinary drugs, vaccines and other biological products for human use and medical devices.
The agency is also responsible for the safety and security of the nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation and for regulating Tobacco products.
The Federal Trade Commission works to promote competition and protect and educate consumers. (35)
Nicotine is poisonous because it mimics one of the chemical messengers that nerves use to communicate. It can affect signals like how fast your heart beats, muscles move and can lead to vomiting, abdominal cramps, drooling, seizures, problems breathing, paralysis and even death.
The risk is real. This is not new, it is not hidden – it is common and it is well described.
This is by no stretch of the imagination a scare tactic.
Professor Edward Boyer, Toxicologist – Brigham and Women’s Hospital, Boston (36)
Our children can be exposed to dangerous doses of nicotine by eating Tobacco products like cigarettes, cigarette butts and e-cig liquids.
National Poison Control Center (36)
The packaging can make liquid nicotine refills for e-cigarettes look delicious.
The agency called out products which looks like a juice box and another that looks like candy and also is packaged with actual candy.
That kind of marketing strategy is dangerous because depending on the concentration, even less than a teaspoon could be fatal, according to the Federal Trade Commission. (36)
Feds Warn E-Cigarette Companies about Packaging
8,200 e-cigarette and liquid nicotine exposures among children age 6 or under
January 2012 to April 2017
Analysis of National Poison Data System
For children, exposure to the nicotine in e-liquid products, even in small amounts, could lead to death from cardiac arrest, seizure, coma and respiratory failure.
No child should be using any Tobacco product and no Tobacco products should be marketed in a way that endangers kids – especially by using imagery that misleads them into thinking the products are things they eat or drink.
Scott Gottlieb, Physician – FDA Commissioner (37)
The Food and Drug Administration has the authority to regulate e-cigarettes and e-liquids. (18)
Can E-Cigarettes Help a Person Quit Smoking?
People believe e-cigarettes may help lower nicotine cravings in those who are trying to quit smoking.
E-cigarettes are not an FDA-approved quit aid.
There is no conclusive scientific evidence on the effectiveness of e-cigarettes for long-term smoking cessation.
E-cigarettes have not been thoroughly evaluated in scientific studies.
For now, not enough data exists on the safety of e-cigarettes, how the health effects compare to traditional cigarettes and if they are helpful for people trying to quit smoking. (8)
On this point, Simple Living Global has just done some citizen journalism and that means talking to smokers on the street. What was clear is that they all said e-cigarettes are just as bad for health and may even be worse.
Note – Simple Living Global is very aware this is not valid data evaluation for a scientific study and it was not double blind tested or carried out in a laboratory, so it would be seen as not reliable.
Nevertheless, it was simple real life ‘get talking on the street’ and finding out what the people had to say – those who are doing the habit day in and day out as they would know from lived experience. They call this anecdotal evidence and may be one day man will rely on this type of information as the true facts to work out how to get out of all the ills we have created.
Concerns over New Health Risks of Vaping
Irfan Rahman, a Toxicologist from University of Rochester, New York – talked to young vapers and some complained of bleeding mouths and throats. These bloody sores seemed slow to heal.
He investigated what the vapours inhaled from electronic cigarettes might be doing to mouth cells.
October 2016 – his team showed those vapours inflame mouth cells in ways that could potentially promote gum disease. That gum damage can destroy the tissues that hold teeth in place and lead to teeth loss.
Vapers inhale those same gases and particles into their lungs
E-Cigarette vapours also make it hard for lung cells to repair damage
Students age 12 or 13 are now more likely to vape than to smoke
Many under the impression that e-cigs do not contain Tobacco so less risk to health
Research has evidence now that vaping can pose many brand new risks
The vapours affect Immunity
‘Smokers cough’ and bloody sores have begun showing up in teenage vapers
Hotter a vaped liquid gets, the harsher its effects on human cells
New vaping behaviour called dripping ups the heat, which threatens to intensify a teen’s risks from those vapours.
“There are a lot of potentially harmful substances in e-cigarettes
If you are a teenager with your whole life in front of you, why would you take that risk?”
Rob McConnell – Internal Medicine Specialist
University of Southern California in Los Angeles (11)
New emerging data suggest that adolescents ignore these risks
Impaired Wound Healing
Cells in the body face constant damage from foreign substances, infections and injury.
The body has a system in place to heal itself
Most organs have special cells – fibroblasts
These cells repair damaged or injured tissue
Fibroblasts make up the connective tissues that keep organs in place
When injured, these cells morph together into wound-healers
“If you cut your hand, fibroblasts are the guys that are going to come in and help heal it,” explains Irfan Rahman
In their wound-healing form, fibroblasts at the edges of a cut will shrink. This causes the wound to close up. This squeezing or contraction of the skin takes a lot of energy.
Fibroblasts are powered by cellular engines called mitochondria and these tiny powerhouses turn food into fuel.
A lab experiment was carried out where growing cells were exposed to e-cigarette vapours.
As expected, the fibroblasts morphed into wound-healing cells. But they did not close up the cut.
Rahman looked more closely at the cellular machinery, some mitochondria had been destroyed.
The fibroblasts simply had run out of the energy they needed before they could successfully squeeze the wound closed.
Smokers Cough – Vapers Cough
Inhaling pollution can irritate the lungs
When the assaulting particles are breathed in regularly, the lungs tend to respond by triggering a cough that will not go away.
There are a lot of these irritants in e-cigarette vapour
Rob McConnell – Internal Medicine Specialist
University of Southern California in Los Angeles (11)
2,000 students in last two years of high school in Los Angeles, California
Researchers asked about their vaping habits and any respiratory symptoms
Anyone who reported daily cough for 3 months was judged to have chronic bronchitis.
Persistent congestion or phlegm for three months or more, not accompanied by cold or flu was also suspected of having chronic bronchitis.
500 students had vaped at some point
200 vaped within past 30 days
Recent vapers twice as likely have chronic bronchitis to those who never vaped.
Researchers looked for other possible causes for students’ persistent coughs and phlegm.
Local air pollution, exposure to triggers for allergic asthma were looked at.
Accounting for above, it did not erase the link between vaping and chronic bronchitis.
Findings were first announced in November 2016
Vapers show some of the same lung symptoms as cigarette smokers.
More teenagers are taking up vaping.
Cigarette smokers with chronic bronchitis often develop permanent lung damage as they get older.
Researchers do not know yet whether long-term vapers will too.
People have not been using e-cigarettes long enough to answer that question.
E-cigarettes have been available in the United States only since 2007 (11)
Do we really need to wait another 50 years for research to tell us the long-term damage of vaping?
Can we use our common sense, as we already know with the evidence thus far?
Smoking Triggers DNA Mutations
Researchers for the first time examined the impact of smoking on human cells.
The study analysed DNA sequences of more than 5000 cancers, in tumours found from both smokers and non-smokers and found those who smoke 20 cigarettes a day for a year typically develop an extra –
150 mutations in every lung cell
97 more in the cells of the larynx
23 in the mouth
18 in the bladder
6 in the liver
Mutations are changes to a cell’s genetic programming that can occur when cells divide.
When they start to build up, cells are more likely to begin dividing uncontrollably – which is what leads to the growth of cancer tumours.
“If you smoke even a little bit, you will erode the genetic material of most of the cells in your body.
You can really think of it as playing Russian roulette”.
The Week – Issue 1100 Page 23 19 November 2016
Risk Factors for Lung Cancer
Cigarette, Cigar and Pipe Smoking
Tobacco smoking – most important risk factor for lung cancer
Cigarette, cigar and pipe smoking all increase the risk of lung cancer.
90% lung cancer in men caused by Tobacco smoking
80% lung cancer in women
Studies have confirmed that smoking low tar or low nicotine cigarettes does not lower risk of lung cancer.
Studies also show risk of lung cancer from smoking cigarettes increases with the number of cigarettes smoked per day and the number of years smoked.
20 times risk of lung cancer for people who smoke.
Second hand smoke also a risk factor for lung cancer
Smoke that comes from burning a cigarette or other tobacco product or that is exhaled by smokers is classed as second hand smoke.
People who inhale second hand smoke are exposed to the same cancer-causing agents as smokers.
Inhaling second hand smoke is called involuntary or passive smoking. (38)
So this involuntary business tells us we did not sign up for it but hey ho it is what it is.
Do we just sigh and give up and accept that is life or do we say NO this has to stop?
What about the tiny babies where adults smoke in a small space in the home?
What about our precious pets who let’s face it, are like family to most owners?
What about the vet bills that go with the smoke they inhale daily?
Family pets are equally, if not more at risk of being affected by passive smoking as humans, research suggests.
Animals inhale more smoke and because of their grooming routines they also digest nicotine when licking their fur – a study by Glasgow University.
Smoke exposure worsens bronchitis and asthma in animals that already have those conditions.
Source: Royal College of Nurses (39)
Has anyone noticed that banning smokers from trains, planes, eating places and hospitals has not stopped them going outside to puff and leave their ciggie butts by the entrance?
Are we getting any closer to nailing this for all of humanity with our campaigns, solutions and new research which are telling us the same thing – smoking is harmful?
People who have a relative who has had lung cancer, twice as likely to get lung cancer.
Cigarette smoking tends to run in families and Family members are exposed to second hand smoke, so it is hard to know whether the increased risk of lung cancer is from the family history of lung cancer or from being exposed to cigarette smoke. (14)
Why is it hard to know?
Can we work this out?
Can we use a dose of common sense?
Are we asking enough Questions?
What if the behaviour that leads to anyone smoking in the first place, is the thing that is passed down and this is the family history?
In other words, we have role models as young children growing up and if they happen to be smokers, then we may pick up the patterns of behaviour and do the same.
Could it be possible that if an environment growing up has people who smoke, there is a high chance we will pick up the same habits because it is the accepted normal?
Human immunodeficiency virus, the cause of acquired immunodeficiency syndrome (AIDS), is linked with a higher risk of lung cancer.
People infected with HIV – more than twice the risk of lung cancer.
Smoking rates higher in those infected with HIV.
It is not clear whether the increased risk of lung cancer is from HIV infection or from being exposed to cigarette smoke. (38)
There are many things we are not clear about, so let’s stick to what we know and the obvious in our face stuff, like this blog and this website full of content to bring more awareness so we are not left in the dark about topics like Tobacco.
Beta Carotene Supplements
Taking beta carotene pills increased the risk of lung cancer.
Higher risk – one or more alcoholic drink or smoking one or more packs of cigarettes a day. (38)
Difference Between Healthy Lungs and Smoker’s Lungs Revealed
This video showing the reality of what smoking does to our lungs was posted by a nurse from North Carolina on Facebook.
It compares one set of healthy lungs with those of a full-time smoker.
On one side of the footage, a pair of red-coloured healthy lungs – taken from someone who has never smoked before – are shown inflating and deflating as normal.
The much larger black and cancer ridden set belonged to a smoker who used a packet of cigarettes a day for 10 years. The lungs are failing to properly inflate.
“These lungs are COPD, cancerous lungs.
The elasticity has gone, so they stretch but the recoil of them just snaps right back because there is nothing to help them open. You can see how fast they deflate” the nurse states.
Chronic Obstructive Pulmonary Disease is constriction of the airways and difficulty breathing
Teenager Develops ‘Wet Lung’ After Vaping 3 Weeks
18 year old female vaping for three weeks developed symptoms and went to emergency room of the University of Pittsburgh Medical Center.
Doctors recorded cough, difficulty breathing that was worsening by the minute, stabbing pains in her chest with every inhalation and exhalation.
When coughing became more frequent, ER doctors admitted her to paediatric intensive-care unit and started antibiotics, but her condition rapidly worsened.
Soon the young woman experienced what is commonly known as respiratory failure.
She was unable to get enough oxygen into her blood from her lungs and required a mechanical ventilator (respirator) to breathe for her until her lungs recovered.
Dr. Daniel Weiner (40)
In addition to a breathing machine, tubes were inserted on both sides of the chest to drain fluid from the lungs.
Doctors diagnosed hypersensitivity pneumonitis, (wet lung) an inflammation of the lungs due to an allergic reaction to chemicals or dust.
“Chemicals in the e-cigarettes led to lung damage and inflammation, which triggered the body to mount an immune response.
This immune response can lead to increased inflammation and ‘leaky’ blood vessels, which can lead to fluid accumulation in the lungs.”
Dr. Casey Sommerfeld, Pediatrician – Lead author of the study (40)
This case was written up as a study in the Medical Journal Pediatrics – published May 2018
Most recent UK data show 15% smokers surveyed currently using electronic cigarettes
2.9 million adults vape
1.5 million ex-smokers use e-cigarettes (41)
Promoting E-Cigarettes to Stop Adults Smoking is Encouraging Young People to Vape
Researchers from the University of Stirling, Scotland studied 4,000 teenagers to examine whether there was a relationship between adolescents’ recollection of e-cigarette displays at point of sale and their past use and intended use of the products.
Promotion of e-cigarettes needs to be considered “carefully” experts have said, after finding that if teenagers notice the products in shops it may influence whether or not they use them.
Officials must consider the balance between promoting e-cigarettes to adult smokers to help them quit and minimising their uptake by teens. (42)
Warnings Over E-Cigarettes That Look Like Sweets
All of the products are available in the UK, either via the Internet or from vaping stores.
The Department of Health said it would be ‘closely monitoring’ the situation but has not issued warning letters to manufacturers.
E-cigarettes are being promoted by UK health officials as a safer alternative to Tobacco.
By law, the devices and fillers can only be bought by over-18s.
But many are purchased online and customers only have to tick a box saying they are 18 or over.
The availability of the confectionary-like brands in the UK was uncovered by the Pharmaceutical Journal.
Daily Mail – 5 May 2018
YES – we all know what the law is but there are holes because things are not rubber tight.
Can we be deeply honest and ask – have we got the resources to get on the front foot and monitor the industry closely and stop them from advertising to kids?
Would it be true to say that our kids are on the front foot as they seem to find ways of getting what they want and Getting away with it?
Who comes up with these new creations and do we stop to ever ask why would anyone buy this stuff in the first place?
Would it be true to say that as long as we keep the demand going, the suppliers will come up with new ways to keep us going with no value on human health?
WHY would any responsible adult, organisation or an industry even consider marketing e-cigarette products that look like sweets?
Would it be true to say that the marketing has a simple agenda and that is to get maximum sales from a group of people who are not yet hooked into this poisonous substance, which is replacing conventional cigarettes?
Have those who design and produce packaging to tempt our kids forgotten their moral compass?
Did we somewhere along the line, lose our way and make it all about how we can profit from people without any care about human health?
Are we innately configured to make it all about people before profit?
Have we dropped our real true standard about what is Truth and what is not?
Is it simple to say ‘companies have a responsibility’ but they do not dish out the same RESPONSIBILITY to each and every single one of us in this world?
So we seem to be on it when it comes to protecting our children’s health but what about adults?
Have we lost sight of the damage smoking in any form is doing and the real cost, not only to our body but to our family, community, country and society at large?
Where does this freedom to choose and free will come from if it is harming our human frame?
UK councils under pressure as funds managing the pension investments of local authority staff still own at least £1 billion of Tobacco stocks. (43)
One of the obstacles to council pension funds selling tobacco stocks is a legal argument that trustees are obliged to prioritise the need to maximise investment returns over anything else.
“Local governments should give serious thought to divesting, particularly given the cost to the public purse of smoking-related illness.
We call on all government–related pension funds and sovereign wealth funds to look again at their policy.
The health sector across the world is unified on Tobacco but that alone will not be enough.
If the finance sector continues to invest in Tobacco and strives to profit from it, we are working against each other.”
Dr. Bronwyn King – an Oncologist who was instrumental in persuading a large financial service organisation to drop its Tobacco investments (43)
So do we have a hand in this supply and demand chain?
Maybe not directly but on another level what if we are demanding higher investment returns so we get a bigger better pension pot and we are not really fussed or bothered how that money is made?
What if this supports our lifestyle?
What if we do care but only to a point?
In other words, we are willing to say no but only where it suits us and not across the board in all areas of life.
What if we hate smoking and what it is doing to others but at the same time we want the profits that the Tobacco industry makes, as it will let us live the life we want and demand because our work pension can give us that?
75% British smokers aged 16 to 24 began smoking before age 18
Children who start smoking younger – more like to smoke heavily (34)
“There is a real risk that easy access to cheap Tobacco through the Internet could undermine the Government’s vision, set out in the Tobacco Control Plan for England, of achieving a ‘smoke-free generation’.
The guidelines are clear – promoting the sale of use of Tobacco is forbidden, yet cigarettes are still readily available on this social media platform and complaints about it have been ignored.”
Deborah Arnott – CEO of Action on Smoking and Health (34)
Even One Cigarette a Day is a Risk
A meta-analysis of 141 studies looked at smoking and heart health.
50% raised risk of cardiovascular disease for one a day smokers.
The findings tally with earlier studies that found passive smokers have raised risk of arterial stiffness and inflammation.
Heart Disease is the biggest smoking related killer, linked to even more premature deaths than lung cancer.
“No safe level of smoking exists for cardiovascular disease”.
University College London Team – Report published in British Medical Journal
The Week – Issue 1161 Page 21 3 February 2018
New South Wales parliament has banned vaping in public spaces.
E-cigarette smokers could be fined up to $550 if caught vaping in public spaces or on public transport across NSW under new laws from July 2018.
This includes shopping centres, cinemas, libraries, trains, buses, public swimming pools, near children’s play equipment, sports grounds, public transport stops and outdoor dining areas.
Put simply, where you are not allowed to smoke cigarettes, you now cannot vape either.
Brad Hazzard – Health Minister
There is evidence of potential health risks from e-cigarette vapours – even if there is no illegal nicotine in the e-liquid.
Vapours can contain chemicals, toxins and metals and some of these substances like formaldehyde are known to cause cancer.
Dr, Kerry Chant – NSW Chief Health Officer (44)
Note – Formaldehyde is a colourless, strong smelling gas.
It is used to make building materials and household products. (45)
There is conclusive evidence that e-cigarette vapour increases particulate matter and nicotine in the air, which may be a risk to bystanders who are exposed to the vapour.
The new laws also force retailers to notify NSW Health they are selling e-cigarettes. (44)
Indigenous Women – Three Times More Likely to Die from Lung Cancer
There has been an overall surge in female lung cancer deaths as a result of women taking up smoking in the 1970s.
Latest figures show it is having a damaging impact on the indigenous population.
“Lung cancer has now overtaken breast cancer as the leading cause of cancer deaths in women and Indigenous women factored highly in the statistics.
Women who are Aboriginal and Torres Strait Islander living in Victoria are more than three times as likely to be diagnosed and die from lung cancer as non-Indigenous women.
Aboriginal Victorians tend to smoke more than non-aboriginal Victorians, so we are going to see that difference in mortality as a direct relationship to the difference in smoking rates.”
Dr. Sarah White – Director of Quit Victoria (46)
A small Himalayan nation and the only country in the world that completely bans sale and production of Tobacco and Tobacco products.
Any individual found selling Tobacco can face imprisonment for 3 to 5 years.
A woman who sells Tobacco illegally from her shop says –
“Look at everything in the store. Cigarettes bring more profit than anything else.
I have to pay rent for this place and if I stop selling cigarettes my profits will plummet”
700,000 population and long history of Tobacco control
1729 – first country in the world to have Tobacco regulation
1990s – many districts began autonomously declaring smoke-free zones
2004 – National Assembly banned sale of Tobacco throughout country.
Smoking also banned in public places, private offices and bars.
It was highly praised for being the first country in the world to go smoke-free.
Implementation of the ban remained weak.
2010 – Government passed the Tobacco Control Act under which smoking cigarettes or chewing Tobacco became non-bailable offence.
First person to be imprisoned was a Buddhist monk caught with 180g chewing Tobacco $2.25.
2012 – Under public pressure amended Act increased permissible amounts of Tobacco that can be imported for personal consumption.
Import now authorised on the following –
250g other Tobacco products
However, a receipt for import duties has to be produced or if caught, face hefty fines.
The strict laws have given rise to a thriving black market.
Most sellers get supplies of cigarettes and chewing Tobacco from a dealer, twice a week.
The dealer smuggles in the products across the border from India. (47)
World’s biggest consumer of cigarettes
Data from the World Health Organisation
- Belarus, Europe
- Lebanon, Middle East
- Macedonia, Europe
- Russia (48)
20,900 people killed by Tobacco caused disease
72,000 children aged 10-14 use Tobacco every day
4,138,000 adults continue to use Tobacco each day
3,416,058 million Colombian pesos Economic cost of smoking
this includes direct costs related to Healthcare and indirect costs related to loss productivity due to early mortality and morbidity.
28,600 metric tons of Tobacco produced in 2014
6.58 billion cigarettes produced in 2016
Current Policy in Colombia
30% product packaging is covered by a graphic warning label
All public places completely smoke-free (49)
2012 – one of the strictest smoking regulations in the world was passed.
Legislation prohibits lighting up in taxis, buses, trains, public buildings, bars, casinos and workplaces. Smoking is also banned from all enclosed public-access buildings and no separate “smoking areas” are allowed.
The country has seen high compliant rates since the ban came into effect. (50)
2017 – French Bank BNP Paribas announced it would stop its financing and investment activities related to Tobacco companies, including producers, wholesalers and traders.
BNP is the latest financial institution to declare it is ending its association with the Tobacco industry, including Axa SA and the Bank of New Zealand. (22)
1 in 5 children between grade 5 and 10 have smoked shisha Tobacco
Survey by health insurance company DAK-Gesundheit reveals use of water pipes known as hookahs, is widespread among children and adolescents.
The company believe this is to do with sweet and fruity flavours added to the Tobacco that give the impression that smoking shisha is harmless.
267 million Tobacco users (52)
Majority adults smoke bidis, which are small, thin hand rolled cigarettes.
Bidis comprise Tobacco wrapped in a tendu or temburni leaf (plants native to Asia) and may be secured with a colourful string at one or both ends. They can be flavoured e.g. – chocolate, mango. (53)
Second Hand Smoke Exposure
30.2% adults exposed in indoor workplaces
36.6% youth aged 13-15 exposed in public places
21.9% exposed at home
1 million killed each year from Tobacco use
926,000 people killed from second hand smoke
200,000 people killed from smokeless Tobacco
74% global burden of smokeless Tobacco
13% of all deaths by 2020 – Tobacco will account for, if current trends continue.
85 billion cigarettes sold in 2016
Bidi rolling is a cottage-based industry employing mainly women and children.
Bidis outsell cigarettes by a ratio of eight to one 8:1 (52)
Tobacco product packs will need to carry new pictorial warnings and for the first time a helpline number for those who wish to quit.
The health ministry notified a new set of two graphic pictorial warnings that doctors say display advanced stages of oral cancer in former tobacco users.
These images will replace the existing warnings that also display images of oral cancer and had come into effect in 2016 and cover 85% of the total surface area of packs of cigarettes, beedis and chewing Tobacco products.
One image will have a health warning TOBACCO CAUSES CANCER
Another image TOBACCO CAUSES PAINFUL DEATH
Both will have QUIT TODAY CALL 1800-11-2356
The idea of making available a helpline number on Tobacco packs is a great step forward by the government – it will offer free cessation advice to those wishing to quit or even thinking of quitting.
Pankaj Chaturvedi – Surgical Oncologist Tata Memorial Centre Hospital, Mumbai (54)
65% male age 15+ smoke Tobacco
2% women smoke Tobacco
19.8% tried first cigarette before age 10
88.6% tried first cigarette before age 13
88.4% of smokers use kreteks – clove flavour cigarettes
Second Hand Smoke Exposure
85% are exposed at restaurants
70% on public transportation
51% adults working inside exposed at workplace
60% youth age 13 – 15 exposed in public places
57% youth are exposed at home
214,000 people killed annually by smoking
Costs to Society
1,85 TRILLION IDR ($192 MILLION USD)
3.5 million disability-adjusted life years from loss of productivity due to premature mortality and disabilities from consumption of Tobacco, which corresponds to –
106 TRILLION IDR ($11 BILLION USD) ECONOMIC LOSS (55)
Vaping is under threat in Indonesia as chain-smoking is moving to stub out booming e-cigarette sector, sparking criticism that the government is siding with giant Tobacco firms at the expense of public health.
Cigarette advertising is everywhere across the vast archipelago, which once had the distinction of being home to the world’s youngest nicotine addicts. A chain-smoking toddler made global headlines in 2010.
Smoking cessation products are hard to find.
Indonesia stands out as a key growth market for global Tobacco firms who are increasingly shut out of countries with tough anti-smoking legislation.
Despite the countries Tobacco-haven status, e-cigarette cafes have been popping up in recent years amid debate over their safety.
57% tax on non-Tobacco alternatives to be imposed in summer 2018
We agree with a tax plan to control consumption but 57% duty is too high and will kill a growing industry.
Rhomedal Aquino, Spokesman – Association of Indonesian Personal Vaporisers (56)
The early scientific consensus was that e-cigarettes are likely safer than conventional cigarettes for adults.
The trade minister set off a backlash from anti-smoking groups when he suggested Tobacco farmers would be hurt by the fledging industry and that those turning to e-cigarettes should smoke regular cigarettes instead. We should turn vapers into conventional cigarette smokers he said.
The customs office said it hopes the big tax hike will make e-cigarettes unaffordable for children, while the health ministry said it is not sold on the argument that vaping is safe.
“E-cigarettes are just as dangerous and can be even more carcinogenic than regular cigarettes.
We reject both conventional and electronic cigarettes – it is better to quit smoking altogether.
There is no such thing as ‘less dangerous’ when it comes to smoking.”
Muhammad Subuh – Senior Ministry Official (56)
$10.5 BILLION USD TOBACCO TAX ANNUALLY
$7.5 MILLION VAPING INDUSTRY SALES TAX
State income from the vaping sector is not as big as Tobacco duty.
Cigarette duties vary with a top rate of 54%.
Deni Sirjantoro – Spokesperson for Indonesian Customs and Excise Office (56)
Activists say most popular brands are taxed at rates 35 – 40% and there are concerns that the ‘safe’ image will create a new generation of nicotine addicts and act as a gateway to traditional smoking.
E-cigarettes is still an addictive substance
Imposing higher duties is the most effective method to control consumption – people care more about losing money than losing their health. (56)
Regarding the trade minister’s comments, this is nothing new, say observers of politics and that because of the power of the Tobacco industry here, Indonesia lags far behind the rest of the world in controlling use and suffers from severe health problems as a result.
Indonesia only country in Asia-Pacific region that has not ratified the World Health Organization’s Framework Convention on Tobacco Control. (57)
5 million children smoke cigarettes
The Tobacco industry here is very strong.
Unlike in most other countries, they still perceived simply as normal business.
We lack many control measures that are needed and those rules we do have, like on advertising to children, often go unenforced.
Dr. Widyastuti Soerojo – Head of The Tobacco Control Unit
Indonesian Public Health Association (57)
The government periodically execute people by firing squad, usually foreigners for non-violent drug offences.
It is the world’s largest Muslim-majority country and the sale of Alcohol is prohibited in convenience stores and is heavily taxed where available.
Children see lengthy Tobacco ads before watching a Hollywood superhero movie
Cigarettes are cheap
Cigarette tax level far below what United Nations recommend
Smoking indoors is common
The big companies have convinced the government they are important for local Tobacco farmers and for tax revenues.
60% men smoke – Highest known rate of male Tobacco consumption in the world
In reality, the costs of treating diseases caused by Tobacco far outweigh any economic benefits.
Mark Hurley – Communications Director, Former Indonesia Country Director at
The Campaign for Tobacco-Free Kids in Washington (57)
The new legislation concerning vapour products will require vendors to seek a combination of special government licenses, which could take many years to acquire.
These are standards we will never be able to meet.
It will really hurt both small businesses and consumers in our sector.
Rhomedal Aquino, Spokesman – Association of Indonesian Personal Vaporisers (57)
44% Health Professionals smoke – twice the rate of the general population
Dr. Giuseppe La Torre describes seeing doctors and nurses smoking on hospital grounds and even in hospital bathrooms, sometimes while still wearing their medical uniforms.
50% Nurses are smoking
34% Physicians are smoking
22% General Population currently smoking
Many medical students pick up smoking while at university due to high stress levels in medical courses, students who may be away from home for the first time and the lack of formal anti-smoking education.
Research suggests that doctors and nurses who smoke are likely to be less proactive in advising their patients to kick the habit. There is a national problem of teen smoking, especially among young girls.
In the most recent report from the European School Survey Project on Alcohol and Other Drugs, Italy had the highest rates in Europe of 15 – 16 year olds who had smoked a cigarette within the past month – 35% for boys and 40% for girls.
2005 – Italy introduced a ban on smoking in public places and were one of the first European countries to do so and has since continually toughened legislation on smoking in advertising and graphic warning labels on packages and has stiffened penalties for those selling to minors. It is becoming socially less acceptable.
Professor Giuseppe La Torre, Tobacco Researcher based in Florence – Sapienza University of Rome (58)
Italy votes to Effectively Destroy the Independent Vaping Sector
2017 – legislation adopted introducing a “super-tax” of €5 for every 10ml e-liquid and even banned the sales of vaping products both online and in specialised shops without a Tobacco license.
The move is expected to put thousands of companies out of business and leave thousands of people unemployed. (59)
59,000,000 current population (60)
25% population smokes
1.5 million vapers (59)
93,300 people killed each year by Tobacco caused disease
64,000 children age 10-14 use Tobacco each day
11,062,000 adults age 15+ use Tobacco each day
€26,041 million – economic cost of smoking
This includes direct costs related to healthcare expenditures and indirect costs related to lost productivity due to early mortality and morbidity.
53,925 metric tons of Tobacco produced
5.91 billion cigarettes produced in 2016
65% product packaging covered by graphic warning label (61)
Do we need to look at this a bit deeper by reading between the lines?
Is it time to ask who benefits and is any of this truly going to help us?
Are we controlling the masses here and will it really work?
Are we ready to read this article and Tobacco Part 1 and come to our own conclusions?
21.7% adults smoke
Figure higher among men and older generations, according to the World Health Organization
2017 – Tokyo based organisation granted non-smoking employees 6 extra days paid holiday as staff complained they were working more than those who took time off for cigarette breaks. (62)
Smoking banned in hospitals, airports, public toilets, government premises, Internet cafes.
2010 – RM10,000 or 2 years imprisonment if smoking in private office space with air conditioning.
2017 – No smoking zones in public and national parks to protect from second hand smoke. (50)
2016 – smoking banned in most public places under royal decree and includes religious, educational, health, sport, cultural institutions, company workplaces, government offices, factories, banks and all public transport facilities.
Also banned in all food and drinks manufacturing and processing facilities
Petrol, gas and fuel distributions systems; warehouses, elevators and restroom and “several unspecified public places”.
Under 18 forbidden from designated smoking areas in public facilities.
The law issues 8 new regulations intended to curb selling of Tobacco and these include:
- Tobacco products may only be sold in closed containers
- Not to be discount
- Not to be given away as free samples
- Not to be purchased using self-serving cashiers
- Not be sold in vending machines
- Not to be sold to anyone under 18
Inventions related to Tobacco will not be patented in the kingdom.
SR20,000 ($5,331) fine for anyone who violates the law
SR200 ($133) fine if smoking in a prohibited area
Repeat violations incur higher fines (63)
2004 – first Latin American country to prohibit smoking in public places, including restaurants, bars and the workplace. (50)
Tobacco Farms: Child Labour, Abuse Rife
Zimbabwe is world’s 6th largest Tobacco producer.
$933 million generated in 2016 from Tobacco as country’s most valuable export commodity.
Malpractice in Zimbabwe Tobacco industry is rampant.
Human Rights Watch said cases of child labour, worker exploitation and low pay, rife on farms.
Farm workers face serious health risk, particularly younger labourers.
The report, titled A Bitter Harvest: Child Labour and Human Rights Abuses on Tobacco Farms in Zimbabwe documents how children work in hazardous conditions, performing tasks that threaten their health and safety or interfere with their education.
Research was conducted in four provinces responsible for nearly all Tobacco production.
Report based on interviews with 125 small scale Tobacco farmers, hired workers, children and former child workers – late 2016 to early 2017.
Zimbabwe government needs to take urgent steps to protect Tobacco workers.
Companies sourcing Tobacco from Zimbabwe should ensure that they are not buying a crop produced by child workers sacrificing their health and education.
Margaret Wurth – Children’s Rights Researcher, Human Rights Watch (64)
Child workers are exposed to nicotine and toxic pesticides
Many suffer symptoms consistent with nicotine poisoning from handling Tobacco leaves
Adults working on Tobacco farms also face serious health risks and labour abuses
At one of the biggest auction floors, teenage boys and girls accompany parents and sleep at the floor premises after travelling overnight to sell their Tobacco.
Because they cannot afford to outsource labour, many rural families depend on the produce of Tobacco, including underage children, who are forced to miss school or drop out altogether.
$900 million – Tobacco industry contribution to economic growth and improved livelihoods
So this is telling us that Tobacco contributes to the country’s economic growth but have we really improved the livelihoods and if so, AT WHAT COST to human life?
Is it time we all got deeply and Absolutely Honest about the real harm of Tobacco?
Making any country dependent on a substance that is killing the human being is well worth studying as it guarantees no evolution.
We cannot get away from this immutable fact.
The rights group discovered government and companies have generally not provided workers with enough information, training, and equipment to protect themselves from nicotine poisoning and pesticide exposure.
They also found similar conditions on Tobacco farms in research in other countries including United States.
Some of the world’s largest multinational Tobacco – purchase Tobacco grown in Zimbabwe
Under human rights norms, companies buying Tobacco from Zimbabwe have a responsibility to ensure that their business operations do not contribute to child labour and other human rights abuses.
Most of the multinational companies involved have policies prohibiting their suppliers from using child labour and engaging in other human rights abuses, but the findings in this report suggest there are serious gaps in carrying out and monitoring these policies in Zimbabwe.
“Tobacco companies should explicitly prohibit direct contact by children with Tobacco in any form, conduct regular and rigorous human rights monitoring in the supply chain and report transparently on their findings.”
Human Rights Watch (64)
One of the most serious health risks in Tobacco farming is acute nicotine poisoning or Green Tobacco Sickness caused by absorbing nicotine through the skin from Tobacco plants.
Child workers and most adults interviewed said they had experienced at least one symptom consistent with acute nicotine poisoning; nausea, vomiting, headaches or dizziness while handling Tobacco.
The law in Zimbabwe sets 16 as the minimum age for employment and prohibits children under 18 from performing hazardous work, but does not specifically ban children from handling tobacco.
The labour ministry told Human Rights Watch that it had not documented any cases of child labour in the Tobacco industry. (65)
Almost no one interviewed had ever heard of acute nicotine poisoning or received information about how to protect themselves.
Children and adults interviewed also handled toxic pesticides, often without proper protective equipment.
They also found some workers on large-scale farms worked excessive hours without overtime compensation or that wages were withheld for weeks or months in violation of labour law and regulations. Some workers were paid less than they were owed or promised, without explanation.
120 labour inspectors for the whole country.
Farmworker union organisers were concerned that the government lacked resources and personnel for effective labour inspections.
Every time they spray pesticide, people go home sick.
Rufaro – age 15 Tobacco worker
During grading, you are sneezing and having trouble breathing. It is the smell of Tobacco.
Once it hits you, it is like you have been burned.
Fungai – age 16 Tobacco worker
It causes a lot of absenteeism. You see right from the onset of the Tobacco growing season, these children start being absent. Out of 63 days of the term, a child is coming 15 to 24 days only.
Joseph – Grade 5 Teacher
The way I am growing up is not a good starting point.
Prosper – age 13 Tobacco worker
During Tobacco season, I always have chest pains and coughing.
We normally share our bedroom with cured Tobacco and the air is not good.
It is not safe and I also feel dizzy and have headaches.
Moses – age 18 Tobacco worker (65)
Is this blog a no brainer?
In other words do we get it, as it is so clear what smoking does to us.
This is not new stuff and this is not something that science is telling us today. Every single one of us knows that smoking has zero benefits.
What we do all know is that any form of smoking is harmfull and that means we are allowing and accepting Abuse.
What is it about us humans that keeps wanting more and more research?
Are we ready to admit that we may be going about it the wrong way?
Has the time come to say – enough we need to find out the root cause of WHY we take our first puff way back as a teenager?
Can we stop judging others and have an open mind about this serious topic that needs to be in every conversation?
What is going on in the life of someone who ends up being a smoker?
Can we be Absolutely Honest and say that the Tobacco industry exists because they have the customers – those who demand it?
Could it be possible that we all have a hand in this and we cannot just let this go on any longer as there is a Responsibility?
We will report more next year on World No Tobacco Day – 31 May 2019
(1) (March 9, 2018). Tobacco. World Health Organization. Retrieved May 27, 2018 from
(2) (2017). World No Tobacco Day, 31 May 2017. World Health Organization. Retrieved May 27, 2018 from
(3) Proctor, R.N. (2011). Golden Holocaust: Origins of the Cigarette Catastrophe and the Case for Abolition. California, CA: University of California Press. (p.3)
(4) Eriksen, M., Mackay, J., Islami Gomeshtapeh, F., & Drope, J. (2015). The Tobacco Atlas, 5th Edition (p.7). Retrieved May 25, 2018 from
(5) Martin, T. (2018, February 13). Important Facts About Nicotine. Very Well Mind. Retrieved May 27, 2018 from
(6) (2018). World No Tobacco Day 2018: Tobacco and Heart Disease. World Health Organization. Retrieved May 27, 2018 from
(7) Tressler, C. (2018, May 1). Nicotine is Not a Child’s Food. Federal Trade Commission. Retrieved May 27, 2018 from
(8) (2018, March). Electronic Cigarettes (E-cigarettes). National Institute on Drug Abuse; National Institutes of Health; U.S. Department of Health and Human Services. Retrieved May 27, 2018 from
(9) Mc Robbie, H. (2014). Electronic Cigarettes. National Centre for Smoking Cessation and Training (NCSCT). pp. 4 – 6. Retrieved May 27, 2018 from
(10) Raloff, J. (2016, July 28). E-Cigs Create Toxic Vapours from Harmless E-Liquids. Science News for Students. Retrieved May 27, 2018 from
(11) Konkel, L. (2017, April 25). Concerns Explode Over New Health Risks of Vaping. Science News for Students. Retrieved May 27, 2018 from
(12) Mandal, A. (2014, October 8). What is Nicotine? News Medical. Retrieved May 27, 2018 from
(13) (n.d). What is Nicotine? Science Museum. Retrieved May 27, 2018 from
(14) (n.d). Blood Brain Barrier. The Visual MD. Retrieved May 27, 2018 from
(15) Jain, K. (2012). Nanobiotechnology-Based Strategies for Crossing the Blood-Brain Barrier. Medscape. Retrieved May 27, 2018 from
(16) Kousik, S.M., Napier, T.C., & Carvey, P.M. (2012). The Effects of Psychostimulant Drugs on Blood Brain Barrier Function and Neuroinflammation. Front. Pharmacol. 3:121. doi:10.3389/fphar.2012.00121
(17) DIler, A.S., Üzüm, G., Lefauconnier, J.M., & Ziylan, Y.Z. The Effect of Nicotine Pretreatment on the Blood-Brain Barrier Permeability in Nicotine-Induced Seizures. Biology and Physiology of the Blood Brain Barrier. Retrieved May 27, 2018 from
(18) John Hopkins University Bloomberg School of Public Health. (2018, February 21). Lead and Other Toxic Metals Found in E-Cigarette ‘Vapors’: Potentially Dangerous Levels of Metals Leak from Some E-Cigarette Heating Coils. Science Daily. Retrieved May 26, 2018 from
(19) Alberg, A.J., Shopland, D.R., & Cummings, K.M. (2014, January 15). The 2014 Surgeon General’s Report: Commemorating the 50th Anniversary of the 1964 Report of the Advisory Committee to the US Surgeon General and Updating the Evidence on the Health Consequences of Cigarette Smoking. American Journal of Epidemiology, Volume 179(4) 403 – 412. Retrieved May 20, 2018 from
(20) Markel, H. (2018, January 11). This Surgeon General’s Famous Report Alerted Americans to the Deadly Dangers of Cigarettes. PBS. Retrieved May 27, 2018 from
(21) Valenti, L. (2017, December 1). U.S Tobacco Companies Will Run Anti-Smoking Ads Everywhere – Except Social Media. Vogue. Retrieved May 27, 2018 from
(22) (2017, November 29). Tobacco Industry Admissions Should Strengthen Global Resolve on Tobacco Control. World Health Organization. Retrieved May 27, 2018 from http://www.who.int/tobacco/communications/statements/tobacco-industry-corrective-statements/en/
(23) (2018, February 15). Current Cigarette Smoking Among Adults in the United States. Centers for Disease Control and Prevention (CDC). Retrieved May 20, 2018 from
(24) U.S. Department of Health and Human Services. E-Cigarette Use Among Youth and Young Adults: A Report of the Surgeon General—Executive Summary. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2016
(25) Vivek Murthy – U.S. Surgeon General – U.S. Department of Health and Human Services. E-Cigarette Use Among Youth and Young Adults: A Report of the Surgeon General—Executive Summary. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2016, p. vii
(26) (2018, April 8). Vaping Now an Epidemic Among US High Schoolers. CBS 46. Retrieved May 23, 2018 from
(27) The Editors. (2018, March 28). Crack Down on E-Cigarettes. Bloomberg. Retrieved May 20, 2018 from
(28) (2017, December 14). Vaping Popular Among Teens; Opioid Misuse at Historic Lows. National Institute on Drug Abuse (NIH). Retrieved May 20, 2018 from
(29) Hafner, J. (2018, April 25). Juul E-Cigarettes are ‘In’ with Today’s Teens. Here’s How the FDA is Cracking Down. USA Today. Retrieved May 27, 2018 from
(30) Keller, K. (2018, April 11). Ads for E-Cigarettes Today Hearken Back to the Banned Tricks of Big Tobacco. Smithsonian.com. Retrieved May 27, 2018 from
(31) Johnston L.D., O’Malley, P.M., Miech, R.A., Bachman, J.G., & Schulenberg, J.E. (2017). Monitoring the Future National Survey Results on Drug Use, 1975 – 2016: Overview, Key Findings on Adolescent Drug Use. Ann Arbor: Institute for Social Research, The University of Michigan, p.8. Retrieved May 27, 2018 from
(32) Marynak K.L., Gammon, D.G., Rogers, T., Coats, E.M., Singh, T., & King, B.A. (2017, May 1). Sales of Nicotine-Containing Electronic Cigarette Products: United States 2015, American Journal of Public Health 107, no 5, pp.705 – 705
(33) Crist, C. (2017, September 21). Dozens of Alcohol Flavoured Tobacco Products May Lure Teens. Reuters. Retrieved May 27, 2018 from
(34) Majid, A. (2018, April 8). Loophole Allows Cigarettes to be Sold on Facebook. The Telegraph. Retrieved May 20, 2018 from
(35) (2018, May 1). FDA, FTC Take Action Against Companies Misleading Kids with E-Liquids that Resemble Children’s Juice Boxes, Candies and Cookies. U.S. Food and Drug Administration (FDA). Retrieved May 26, 2018 from
(36) Becker R. (2018, May 1). Liquid Nicotine is a Poison, so Why is it Being Packaged Like Junk Food? The Verge. Retrieved May 27, 2018 from
(37) O’Donnell, J. (2018, May 1). Feds Warn E-Cig Companies about Packaging After Thousands of Kids Drink Toxic Liquid. USA Today. Retrieved May 27, 2018 from
(38) (2018, May 4). 6 Risk Factors for Lung Cancer Everyone Should Know. Health Minute. Retrieved May 27, 2018 from
(39) (2017, October 30) Second-hand Smoke Linked to Pet Deaths and Illnesses, Experts Say. BBC News. Retrieved May 27, 2018 from
(40) Scutti, S. (2018, May 17). Teen Develops ‘Wet Lungs’ After Vaping for Just 3 Weeks. CNN. Retrieved May 27, 2018 from
(41) Bradley, S. (2017, July 27). E-Cigarettes Help People Quit Smoking, Study Says. Wired. Retrieved May 27, 2018 from
(42) Pickover, E. (2016, April 14). Promoting E-Cigarettes to Stop Adults Smoking is Encouraging Young People to Vape, Researchers Claim. Independent. Retrieved May 26, 2018 from
(43) Davies, R. (2017, May 31). UK Councils Under Pressure Over £1bn of Tobacco Investments. The Guardian. Retrieved May 20, 2018 from
(44) (2018, April 12). NSW Bans Public Vaping with $550 Fine for Offenders. SBS News. Retrieved May 23, 2018 from
(45) (2016, February 10). Formaldehyde and Your Health. Agency for Toxic Substances and Disease Registry (ATSDR). Retrieved May 26, 2018 from
(46) Indigenous Women Three Times More Likely to Die from Lung Cancer in Victoria. SBS News. Retrieved May 27, 2018 from
(47) Parameswaran, G. (2012, September 28). Bhutan Smokers Huff and Puff Over Tobacco Ban. Alijazeera. Retrieved May 27, 2018 from https://www.aljazeera.com/indepth/features/2012/09/201292095920757761.html
(48) Pearson-Jones, B. (2017). The Average Number of Cigarettes Smoked Per Person, Per Year, Mapped. Indy 100. Retrieved May 27, 2018 from
(49) (n.d). Columbia. The Tobacco Atlas. Retrieved May 27, 2018 from
(50) Ogrodnik, I. 5 Countries with Strict Smoking Bans. Global News. Retrieved May 27, 2018 from
(51) (2017, December 12). One in Five German Schoolkids Have Smoked Shisha Tobacco: Survey. The Local de. Retrieved May 26, 2018 from
(52) (2018, January). The Toll of Tobacco in India. Campaign for Tobacco-Free Kids. Retrieved May 23, 2018 from
(53) (2018, January 17). Bidis and Kreteks. Centers for Disease Control and Prevention (CDC). Retrieved May 27, 2018 from
(54) (2018, April 5). Helpline and New Warning on Cigarettes. The Telegraph India. Retrieved May 23, 2018 from
(55) (2017, August). Tobacco Burden Facts: Indonesia. Tobacco-Free Kids. Retrieved May 26, 2018 from
(56) Vaping Under Threat in Tobacco-Loving Indonesia. The Straight Times. Retrieved May 26, 2018 from
(57) Bevins, V. (2017, November 27). Indonesia Where Smoking is Widespread, Just Placed Tough Restrictions on E-Cigarettes. The Washington Post. Retrieved May 26, 2018 from
(58) Watkins, J. (2018, April 30). Why Do Italian Doctors Smoke So Much? Ozy.com Retrieved May 26, 2018 from
(59) (2017, December 6). Italy Votes to Effectively Destroy the Independent Vaping Sector. Vape Ranks. Retrieved May 26, 2018 from
(60) Italy Population 2018. World Population Review. Retrieved May 26, 2018 from
(61) (n.d). Italy. The Tobacco Atlas. Retrieved May 26, 2018 from
(62) (2018, April 18). Japanese Workers Banned from Lifts for 45 Minute ‘Decontamination Period’ After Smoking. The Telegraph. Retrieved May 26, 2018 from
(63) Staff Writer. (2016, June 13). Saudi Arabia Bans Smoking in Public Areas. Arabian Business. Retrieved May 26, 2018 from
(64) Muchinjo, E. (2018, April 8). Zimbabwe Tobacco Farms: Child Labour, Abuse Rife, HRW says. Alijazeera. Retrieved May 23, 2018 from
(65) (2018, April 5). Zimbabwe: Tobacco Work Harming Children. Human Rights Watch. Retrieved May 23, 2018 from