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First comparison of effects of tobacco cigarettes, e-cigarettes and waterpipes
A study, published today in the European Heart Journal, has compared the effects of the three forms of smoking and vaping on human health and the function of cells that line blood vessels (the endothelium). It provides an overview of the available evidence about the chemicals produced and the mechanisms by which smoking and vaping affect the body. The researchers also looked at the effects of each on medical conditions ranging from stroke to heart attacks and lung cancer.
The researchers found there were multiple good studies showing that, overall, tobacco cigarettes were more harmful than e-cigarettes. However, there were few good, large studies about the adverse effects of waterpipes (often referred to as hookahs, shisha or narghile) and e-cigarettes on endothelial dysfunction and so the evidence was more variable. The researchers say the long-term effects of water pipes and e-cigarettes need to be investigated more thoroughly. In the meantime, they write, "waterpipe smoking is not less harmful than tobacco smoking and thus cannot be considered a healthy alternative".
The researchers reviewed a range of studies, which they graded as providing strong, good or medium levels of evidence on the harmfulness of the three types of smoking and vaping. Compared to non-smokers, tobacco cigarettes increased the risk of chronic obstructive pulmonary disease (COPD) by 704% (good level of evidence), waterpipes by 218% (strong) and e-cigarettes by 194% (good); tobacco cigarettes and waterpipes increased the risk of lung cancer by 1210% (strong) and 122% (strong) respectively, while the level of evidence for e-cigarettes was not sufficient to draw reliable conclusions.
They also looked at how much the three smoking techniques stiffened the arteries, an important prognostic indicator for the risk of heart problems and stroke. Compared to non-smokers, tobacco cigarettes increased arterial stiffness by 10%, waterpipes by 9% and e-cigarettes by 7% (medium level of evidence for all three).
The researchers looked at the effects of smoking and vaping on COVID-19 infections. In the EHJ paper, they write: "As outlined by the WHO, tobacco cigarette and waterpipe smoking may contribute to increased burden of symptoms due to COVID-19 compared to non-smoking, including being admitted to intensive care, requiring mechanical ventilation, and suffering severe health consequences."
Source: Medical Xpress, 26 June 2020
Editorial Note
Dr Nick Hopkinson, Chair of ASH and Reader in Respiratory Medicine at Imperial College London, provided comment on the paper as follows:
“In this review the search strategy used to identify papers is not defined so it is not clear if it is a systematic review of all the evidence. There are also a number of reasons to be cautious about measuring risk in this area and the figure in the paper runs the risk of misleading people.
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Most of the illnesses or disease events seen in people who vape e.g. myocardial infarction or COPD are likely to be due to their past smoking history, not their use of an e-cigarette.
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People who need to use a substitute source of nicotine (i.e. an e-cigarette) to quit may have smoked more intensely than those who were able to quit without using an aid which also makes comparisons difficult.
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The important comparison for individuals is between carrying on smoking or switching to vaping, as that is the choice that most people are making in relation to e-cigarette use, rather than between vaping and nothing.
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Cigarette smuggling booms in South Africa
South Africa and Zimbabwe have stepped up border patrols in a bid to stop cigarette smuggling, which has boomed since Pretoria banned the sale of tobacco in March. From Zimbabwe, there are more than 200 illegal entry points into South Africa where cigarettes are being sold from under the counter in shops or from people’s homes, with WhatsApp groups being used to market the business.
One tobacco operator told the Guardian: “People are making a lot of money through smuggling because they buy the cigarettes in the local currency which makes Zimbabwean cigarettes very cheap. During the second phase of the lockdown in Zimbabwe, cigarettes would disappear quickly off the shelves which shows that there is somewhere where they are being taken to.”
A recent study by the University of Cape Town researchers showed 90% of smokers had bought cigarettes during the lockdown, and that smokers who could not buy their usual brands had access to other new brands on the market, from Zimbabwe, Mozambique, Angola, the Democratic Republic of the Congo and China.
Police in Zimbabwe said they are investigating syndicates involved in the illegal trade and have arrested several smugglers in transit.
Source: The Guardian, 26 June 2020
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Australia: Prime Minister open-minded on vaping import ban
The Prime Minister of Australia, Scott Morrison, is open to reversing a ban on importing e-cigarettes containing nicotine. Dozens of coalition government backbenchers have penned an open letter condemning the tough restrictions.
Mr Morrison said he would let the health minister deal with the blowback, but was keeping an open mind. "I'm sure he'll be addressing that issue further with colleagues and take into account the various feedback that's coming back," Mr Morrison told 2GB radio on Friday.
Nicotine vaping products are currently banned under state and territory regulations. Earlier this month, Health Minister Greg Hunt extended the import ban, which can only be lifted for a doctor's prescription. The ban will remain in place for 12 months to allow for public consultation through the Therapeutic Goods Administration. A final decision is expected to be announced early in 2021.
Source: This Is Money, 26 June 2020
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Opinion: Why Australia should make it as easy as possible for smokers to switch to vaping
Alex Wodak, a retired physician, is an emeritus consultant at St Vincent’s Hospital, Sydney, and a director of the Australian Tobacco Harm Reduction Association (ATHRA).
“I have been involved in drug harm-reduction debates in Australia since the early 1980s. Every new harm-reduction intervention met fierce resistance, often lasting years. This happened with methadone treatment for problem heroin users, needle syringe programs to slow the spread of HIV, and drug consumption rooms to reduce drug overdose deaths.
“Successful harm reductions have taken a bottom-up approach. Early in my harm-reduction career I learnt that to be effective I had to work closely with the people who use drugs. When advocating for needle syringe programs, senior people told me that those who injected drugs would never use sterile needles. Yet I knew from talking to people who injected drugs that sharp, unused needles hurt much less than needles blunted from use many times, so-take up rates would be high.
“Vaping is similarly a bottom-up approach, and therefore likely to succeed. As digital cameras are to film cameras and smartphones are to landlines, vaping is a disruptive innovation that has significantly undermined the cigarette industry. In the past few years since vaping and other harm-reduction options began to eat into the lucrative cigarette market, the market capitalisation of tobacco companies has fallen steeply.
“The critics argue that vaping hasn’t been around long enough for all its negatives to be known. Yet cigarette smoke contains 7000 chemicals at high concentration, whereas vaping aerosol contains fewer than 300 chemicals, mostly at trace concentration. Surely this has to be a much lower risk. Even with unknown risks, the Royal College of Physicians estimates that the long-term risks of vaping are likely to be no more than 5 per cent of the risk of smoking.
“Australia should make it as easy as possible for our 2.7 million smokers to switch from high-risk cigarettes to much lower-risk vaping, while also minimising the uptake of all nicotine products by youth through regulation.”
Source: The Sydney Morning Herald, 26 June 2020
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National Smoking Cessation Audit Report 2019
On Wednesday, the British Thoracic Society published its second UK wide audit of the smoking cessation advice and services offered by hospitals to their patients, which found modest improvement in most areas since 2016, with slow progress in referrals, adopting and enforcing smoke free grounds and a decrease in hospitals-funded smoking cessation practitioners.
The press release and full audit report are both available to read online.
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Ian Willmore (5 November 1958 – 7 April 2020)
Ian Willmore, former Media and Campaigns Manager at ASH, sadly died following a heart attack on 7 April 2020. Information about his life and achievements in smokefree campaigning is now available here.
Ian's friend Kathy Jones has written an obituary published in The Guardian today.
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ASH Daily News is a digest of published news on smoking-related topics. ASH is not responsible for the content of external websites. ASH does not necessarily endorse the material contained in this bulletin.
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