PertGorr

26/01/2022

New evidence shows e-ci******es can help people quit smoking
Electronic ci******es, or e-ci******es, are a popular aid for quitting smoking, but it is taking time for scientific research to catch up and provide clear answers on how well they work, and whether they are safe to use for this purpose.

An updated review of the evidence, covering 50 studies and more than 12,000 participants, now provides greater confidence that e-ci******es with ni****ne can help more people to quit smoking than traditional ni****ne replacement therapy (such as gums or patches) or e-ci******es without ni****ne. However, the evidence is of moderate certainty – and more studies are needed to confirm the degree of effect, particularly testing newer e-cigarette devices.

The review found no evidence of serious harms of e-ci******es with ni****ne. But the data was limited – the longest follow-up was just two years – and considerable uncertainty remains regarding harms.

Smoking kills one in two regular users. Most people who smoke want to quit, but quitting smoking can be extremely difficult, and better treatments are needed.

For many, the arrival of e-ci******es signalled an exciting opportunity. E-ci******es represented a new treatment for cigarette addiction, mimicking some of the behavioural, social and pharmacological aspects of ci******es. But some policymakers remain cautious, despite the increase in research findings that support e-ci******es for quitting smoking.

Whereas e-ci******es are widely available in some countries, in other areas current policies include complete bans on e-ci******es and policies in which e-ci******es with ni****ne are available on prescription only.

The caution behind restrictive regulations is not to do with whether people who smoke should switch to e-ci******es. While there are still unknowns regarding possible longer-term harms of e-ci******es, experts generally agree that e-ci******es are considerably less harmful than smoking, even though they are not completely risk free.

Evali, the e-cigarette-related illness that made headlines last year, raised significant concerns around the safety of e-ci******es. But it was quickly discovered that this was linked to vitamin E acetate – an additive that has been found in unregulated e-cigarette liquids, typically containing THC (the active ingredient in cannabis). This additive is banned from e-ci******es in many parts of the world, including Europe.

Two v**e pens containing cannabis oil.
The illness Evali was related to va**ng cannabis oil containing vitamin E acetate. Shannon L Price/Shutterstock
Caution, instead, largely has to do with how the availability of e-ci******es affects young people. Young people who use e-ci******es are more likely to go on to smoke. Some interpret this data to mean that young people who would never smoke experiment with e-ci******es become addicted to ni****ne and then start smoking. In other words, some argue that e-ci******es act as a gateway to smoking to***co. Others argue that the link is instead due to commonalities between young people who would try e-ci******es and try smoking regardless – the idea that: “kids who try things, try things”. While research is ongoing on this, debates on policy divide into “help the adults quit” and “protect the kids”.

Not mutually exclusive
Helping adults quit and protecting kids are not mutually exclusive. Children whose parents smoke are around three times more likely to smoke in later life. Whereas secondhand smoke is known to cause many health problems in infants and children, including sudden infant death syndrome, the harm of e-cigarette vapour to bystanders appears far less than that from ci******es.

By acknowledging that helping adults quit smoking is also a way to protect kids, it may be possible to move the debate along. This is needed to craft regulations that both prevent young people from starting to use e-ci******es and from starting to smoke, and help the adults around them to stop smoking. One approach that has been tried is to reduce the amount of ni****ne in e-ci******es. But studies have shown that this may have unintended effects – people who smoke seem to puff harder on e-ci******es with a lower ni****ne content to get the ni****ne levels they seek.

Ni****ne is not the chemical that causes the many diseases linked to smoking. In fact, ni****ne replacement therapy, which provides ni****ne without the other harmful chemicals from ci******es, has been available to help people safely stop smoking for decades. Despite its wide availability, there is very little evidence that non-smokers use it. This is down to a combination of factors, but marketing and regulation have undoubtedly played important roles.

The regulation of e-cigarette sales and marketing varies substantially worldwide. Though this muddies the waters when communicating potential benefits and harms of e-ci******es, regional differences in e-cigarette use among young people may help guide effective regulation in the future. For example, researchers and policymakers can look to areas where e-cigarette use in young people is low and compare regulations to those in place in areas where e-cigarette use in young people is more widespread. Ideally, lessons could be learned about ways to ensure e-ci******es are readily available to people struggling to quit smoking, but are not appealing to people who don’t smoke.

The tension between “protecting the kids” and “helping adults who smoke” has been getting in the way of clear public health messaging for years. As new evidence emerges, the message remains the same: e-ci******es with ni****ne are not risk free but are considerably less harmful than smoking. Translated into actions: if you don’t smoke, don’t start to use e-ci******es. If you do smoke, consider switching.

26/01/2022

Most New Zealanders don’t know how deadly strokes are – claiming 2,300 lives a year and rising
Stroke is the third highest cause of death in New Zealand, after cancer and coronary heart disease. But our new research shows very few people are aware of the risk, particularly in Pasifika communities – despite being much more likely to have an early stroke.

Each year, about 9,000 New Zealanders have a stroke and according to the latest data, 2,322 died of stroke in 2016. Just over half of the people who survive a stroke live with ongoing health impacts.

Our study, based on a random national sample of 400 people, shows only 1.5% identified stroke as a common cause of death. In contrast, 37% identified heart disease and 33% identified cancer as common causes of death.

Our research is unique in that it recruited a group of participants who represent New Zealand’s ethnic groups. It shows people from Pasifika communities have the lowest stroke awareness, despite being at higher risk than the general population.

Recognising stroke symptoms and risk factors
The research also shows around 43% of people surveyed did not believe they could tell if a person was having a stroke.

The most common symptoms of stroke are:

the sudden onset of face drooping on one side

arm weakness, especially if one-sided

speech difficulty

complete or partial loss of vision on one side

swallowing difficulties

acute confusion or memory loss

unusually severe, abrupt headaches.

While the majority responded correctly to stroke symptoms, a large proportion (45-70%) also responded “yes” to unrelated symptoms, such as chest pain.

How to recognise that someone is having a stroke.
Read more: Coronavirus may be increasing risk of stroke – doctors on the frontline witness new pattern

Awareness of stroke risk factors was also low. There is clear evidence that stroke is highly preventable. Ten potentially modifiable risk factors are associated with around 90% of strokes.

Risk factors include high blood pressure, diabetes, smoking, low levels of physical activity, and a diet low in fresh fruits and vegetables. Without any prompting, only 30% of people identified two or more risk factors for stroke.

People identifying as Pasifika or Māori recognised fewer stroke symptoms compared to European New Zealanders, and Pasifika people were 58% less likely to correctly identify risk factors. This is an important finding because our earlier research highlights that age-standardised rates of stroke are 30-60% higher for Pasifika and Māori, with an onset 15 years earlier compared to European New Zealanders.

A Pasifika person in New Zealand is twice as likely to die of a stroke as a European New Zealander. That disproportionately high stroke risk, combined with lower awareness about strokes and their warning signs, means New Zealand needs to develop more language and culturally specific education material, as well as better methods of delivery.

Stroke rates in younger people on the rise
In our study, higher incomes and education were both associated with better stroke awareness, and this is similar to findings in other developed countries such as Spain. People in middle-income households were twice as likely to correctly identify stroke risk factors as those on low incomes.

People for whom English is a second language, or who don’t speak it at all, are further disadvantaged. If we want to improve stroke prevention, we need to develop better communication strategies to address language gaps in understanding that stroke is avoidable.

Globally and in New Zealand, the number of people having strokes and dying from them is increasing because people are living longer and are more exposed to risk factors, including more sedentary lifestyles.

For the first time, over the past decade we’ve started to see an increase in the rate of younger people having strokes. This is of concern. It means more people are living longer with disabilities caused by a stroke and experience growing health and financial stress themselves as well as in their families.

Given that stroke is highly preventable, we call for better access to population-wide strategies, available to people at all levels of risk of stroke. Existing strategies are mostly aimed at people at moderate to high risk of cardiovascular diseases, including stroke.

This so-called “high-risk” strategy leaves out most people at risk, while those in the high-risk categories often lack the knowledge and motivation to address their individual lifestyle risks.

Read more: New blood pressure guidelines may make millions anxious that they're at risk of heart disease

Preventing strokes will cut the risk of other deadly diseases
Population-wide strategies aimed at stroke prevention would also help prevent other major non-communicable diseases with similar risk factors, including coronary heart disease, many types of cancers and even some types of dementia.

The free Stroke Riskometer app can assess an individual’s risk of stroke, inform them about their personal risk factors and provide information about symptoms. Free blood pressure checks provided by the New Zealand Stroke Foundation throughout the country help raise awareness of the most important modifiable risk factors for stroke.

The economic cost of stroke is enormous, with an estimate of NZ$1.1 billion for 2020, increasing to NZ$1.7 billion by 2038.

The high health, social and economic burden of stroke on New Zealand – and its disproportionate impact on Māori and Pasifika communities – needs to be addressed urgently. The lower level of awareness in these groups highlights we need to deliver information that is tailored and delivered by culturally competent community workers.

We also need to complement these steps with improved access to affordable healthy foods, preventative primary healthcare, and support at individual and community levels to improve health and lifestyle.

26/01/2022

Making it harder to import e-ci******es is good news for our health, especially young people’s
From next year, access to e-ci******es and related products containing liquid ni****ne will require a doctor’s prescription. This is to ensure liquid ni****ne is handled like the poisonous, addictive substance it is and not promoted to young people. It’s good news for public health and bad news for the to***co and e-cigarette industries.

This restriction comes into effect from January 1 2021, six months later than originally proposed.

It’s not a ban on importing e-ci******es. But it will close loopholes between established prohibitions on the supply and sale of ni****ne at the federal level, and state and territory laws restricting access to ni****ne.

Here’s the evidence to show why closing the loophole between health regulations, customs regulations and state and territory laws is good news for the nation’s health.

Read more: Twelve myths about e-ci******es that failed to impress the TGA

The so-called benefits of e-cigs don’t stand up
There have only been a small number of quality reviews on the harms and benefits of e-ci******es for the whole population (rather than for individual people). They draw the same conclusions.

CSIRO and the US National Academies of Science, Engineering and Medicine reviews found the evidence for e-ci******es helping people quit smoking is inconclusive. The reviews also found e-ci******es are harmful in their own right and associated with increased smoking and ni****ne use in young people.

A 2017 review from Australia’s National Health and Medical Research Council drew similar conclusions.

Australian regulator, the Therapeutic Goods Administration or TGA, found no evidence to support the sale of e-ci******es as a “therapeutic good”; the evidence of therapeutic benefit was inconclusive. Nor has the TGA found evidence to relax existing poison safety controls that require liquid ni****ne access to be authorised by a doctor.

Despite the e-cigarette industry’s claims and further promotion that “e-ci******es are 95% less harmful” than smoking traditional ci******es, there is no scientific basis for this either.

Protecting young people
To***co companies and retailers claim e-ci******es are an effective quit aid and are targeted at adult smokers who need them.

However, the to***co industry and retail sector promote e-ci******es through youth-friendly events, such as music festivals, and through social media by using influencers and celebrities, including singer Lily Allen.

And the promotion of flavoured e-cigarette products — strawberry, doughnut or banana, for instance — could create a generation of ni****ne addicts.

Flavoured e-ci******es can be appealing to children.
So, Australia’s latest move will protect young people and avoid the fate of countries like the US, where e-cigarette use in secondary school children has increased 78% in just 12 months.

Parents and teachers are now seeing more e-cigarette use in Australian schools. It is telling that the largest growing segment in e-cigarette use in Australia is in 18 to 24-year-old non-smokers and use has also risen among 12 to 17-year-olds.

What about quitters?
There are individuals who feel e-ci******es help reduce the harms of smoked to***co, and doctors who agree with them.

Read more: Why the ban on ni****ne v**e fluid will do more harm than good

Given the toxicity and addictiveness of liquid ni****ne, it is entirely appropriate to close loopholes that until now have enabled it to be acquired with no medical authority.

This is no different from controls around other harmful substances, such as methadone for treating he**in addiction.

There are two key differences with e-ci******es. One, the case has not been made within an evidence-based framework that the products are safe and effective for widespread distribution; and two, they are being pushed through retailers operating outside the health system.

Is this the end of the line for e-ci******es in Australia?
The government’s proposal is not closing the door to evidence or to options that may work for some individuals with a legitimate need to access these products. It is closing a door that exploits a disconnect between the poison and import laws to protect young Australians.

The restrictions will also prevent profiteers from addicting young Australians to harmful, novel products. Evidence on the benefits of e-ci******es remains inconclusive but the risks to young Australians are increasingly clear.

26/01/2022

26/01/2022