A long-term view of harm reduction.

The concept of harm reduction is controversial, as it brings to mind the failures, public misconceptions, and undermining of prevention associated with the low-tar cigarette campaign. Modern cigarettes are, however, unnecessarily carcinogenic and toxic, a situation that could be improved by sensible and serious regulation of the contents of tobacco smoke. The risks potentially associated with reducing levels of known toxicants in cigarettes are tiny in comparison with the acceptance of the status quo, which is disastrous. Failure to act in these circumstances is negligence.     

Little cigars, big cigars: omissions and commissions of harm and harm reduction information on the Internet.

We conducted a comparative analysis of "harm," "harm reduction," and "little cigar" information about cigars on 10 major English-language health Web sites. The sites were from governmental and nongovernmental organizations based in seven different countries and included "harm" and "harm reduction" information, discussions of little cigars, quantitative estimates of health risks, and qualifying behavioral characteristics (inhalation, number per day). Of the 10 Web sites, 7 offered statements explicitly indicating that cigars may be safer than cigarettes. None of the Web sites reviewed described that little cigars are likely as dangerous as cigarettes. Some Web sites provided quantitative estimates of health risks and extensive discussions of qualifying factors. Reading grade levels were higher than desirable. Extensive and complex information on the reduced risks of cigars compared with cigarettes is available on Web sites affiliated with prominent health organizations. Yet these sites fail to warn consumers that popular cigarette-like little cigars and cigarillos are likely to be just as dangerous as cigarettes, even for those who have never smoked cigarettes. Improvement of these Web sites is urgently needed to provide the public with high-quality health information.     

Nutrition and physical activity interventions for low-income populations.

A systematic review was conducted of community-based nutrition and physical activity strategies for chronic disease prevention targeting low-income populations. A computer search of the relevant published literature from 1996 to 2004 was done using Medline, EMBASE, ERIC, CINAHL, PubMed, and HealthSTAR databases. The primary objective was to develop an inventory of intervention strategies. The interventions ranged in approach from traditional group sessions taught by allied health professionals, peer-led workshops, one-on-one counselling print material, and home-based telephone and mail interventions to multimedia strategies and experiential activities such as food demonstrations and group exercise. The results suggest that nutrition and physical activity interventions aimed at low-income audiences tend to be delivered in an interactive visual format, to be culturally appropriate, to be administered in accessible primary care settings, and to provide incentives.     

Reactivity-based VOC control for solvent products: more efficient ozone reduction strategies

It has been almost 40 years since scientists and regulators began to publicly recognize that volatile organic compounds (VOCs) differ in their potential to form ozone. Since 1977, our understanding of the mechanisms by which VOCs contribute to ozone formation has grown substantially. An assessment of the science indicates that we now have sufficient understanding to develop and implement a more efficient approach to VOC control policy that will promote smarter, more cost-effective VOC controls. Furthermore, the U.S. Environmental Protection Agency's recently published Interim Guidance on Control of Volatile Organic Compounds in Ozone State Implementation Plans "encourages States to consider recent scientific information on the photochemical reactivity of volatile organic compounds (VOC) in the development of State implementation plans (SIPs)." As has been demonstrated by the California Air Resources Board's Aerosol Coatings Rule and the recent experience in Houston addressing high-reactivity VOCs, reactivity-based regulations may be more effective and efficient than mass-based rules in many applications. It is time for regulators, industry, and other stakeholders to work togetherto accelerate efforts to bring about a new paradigm in VOC control, in which the focus is on the ozone-forming potential of VOC emissions, rather than the mass of VOCs emitted.     

Tobacco industry strategies to undermine the 8th World Conference on Tobacco or Health

Objective: To demonstrate that Philip Morris and British American Tobacco Company attempted to initiate a wide ranging campaign to undermine the success of the 8th World Conference on Tobacco or Health held in Buenos Aires, Argentina, in 1992.

Data sources: Publicly available tobacco industry documents housed in Minneapolis, Minnesota, USA; Guilford, UK; on-line document websites; and telephone interviews with informed parties.

Study selection: Those documents determined to be relevant to the companies' campaigns against the 8th World Conference on Tobacco or Health.

Data extraction: Revision of chapter VIII of the July 2000 WHO report by a committee of experts, entitled: Tobacco company strategies to undermine tobacco control activities at the World Health Organization: report of the committee of experts on tobacco industry documents.

Data synthesis: Internal documents describe proposed media and science orientated campaigns developed by BAT, Philip Morris, and their consultants to divert attention away from the conference.

Results and conclusion: This work shows that the tobacco industry has the resources and vested interest to combat perceived threats in its regional operating markets, in this case its Latin American market. It is important for the worldwide public heath community to become aware of the numerous ways in which the tobacco industry and its front groups can work against international tobacco control meetings, even including the manipulation of or working with other public health groups to oppose tobacco control efforts. Future world conference planners and participants should be aware that the tobacco industry is likely to continue to employ such methodology. There is no reason to think that the industry is paying less attention to such conferences in the present or future. Rather, it is likely the industry will adopt and expand strategies that were successful while abandoning those that were not effective. Required disclosure of financial support by all participants at all tobacco scientific conferences is recommended. For the tobacco control community, we also recommend careful coalition building and networking with other public health groups on the ways tobacco is implicated in other public health issues.

     

Perspectives on the role of the Society for Research on Nicotine and Tobacco in promoting global tobacco research and reducing tobacco harm.

The Society for Research on Nicotine and Tobacco (SRNT) has a critical role to play in advancing tobacco research globally. To date SRNT has sponsored a number of successful initiatives including meetings held by the society's European affiliate, establishment of the Global Network Committee in 1999, and the 2003 and 2005 global tobacco pre-conferences. The most recent SRNT conference was held for the first time outside of North America and attracted over 900 participants from 50 countries. SRNT also has sponsored workshops, provided member scholarships to researchers from low- and middle-income countries, and partnered with the World Health Organization to host www.treatobacco.net. Although these initiatives are impressive, SRNT can further support global tobacco research by (a) working with other organizations to support global tobacco science and policy (this is especially timely given the recent coming into force of the Framework Convention on Tobacco Control), (b) providing more resources including increased funding and access to online journals for those in low- and middle-income countries, (c) increasing the representation of science at world and national tobacco conferences, and (d) expanding the role of the Training Committee to place increased emphasis on mentoring tobacco scientists from low- and middle-income countries. Science will be crucial in addressing the global tobacco pandemic, and SRNT is uniquely positioned to further tobacco science and research capacity on a global basis.     

The US tobacco control community's view of the future of tobacco harm reduction

Objective: Tobacco harm reduction (THR) has garnered recent attention due to the introduction of novel nicotine delivery products ostensibly intended to reduce risk for inveterate cigarette smokers. This study evaluates the grassroots tobacco control community's knowledge, opinions, and beliefs about THR.

Design: A web/mail survey conducted in October and November 2002, with a telephone survey of a sample of non-respondents.

Subjects: The 2833 US based registrants for the 2001 National Conference on Tobacco or Health.

Main outcome measures: Respondents' awareness of THR, perception of its importance, support for regulation, and perception of which THR products should be recommended to inveterate cigarette smokers.

Results: 70% of respondents were aware of THR but respondents had low recognition of specific products at the forefront of the debate, such as Swedish snuff. Half believe THR will reduce smoking cessation and cause nicotine experimentation by children; 63% anticipate unintended adverse side effects. More expect THR to have a negative than a positive impact on health. Large majorities support government regulation of THR and conventional tobacco products, but fewer than 30% expect legislation regulating either. Most would recommend nicotine patches (76%) and gum (70%) to inveterate smokers, but no other product was supported by a majority. Scientists are more supportive of THR than activists, while respondents focusing on national/international issues are more supportive than those concentrating on local/state issues.

Conclusions: Many members of the US tobacco control community are unaware of the THR "movement", while others possess only rudimentary familiarity with it. If and as THR achieves an increasingly prominent role on the tobacco-or-health scene, this community will have to become educated about THR, and be prepared to advocate for regulatory policies that will maximise the potential for positive outcomes. The potential for negative outcomes remains significant.

     

A Premiere example of the illusion of harm reduction cigarettes in the 1990s

Objective: To use the product launch of Player's Premiere as a case study for understanding the new cigarette product development process during the 1990s. We determine the (in)validity of industry claims that: (1) development of the physical product preceded the promotional promise of "less irritation"; (2) "less irritation" was actually realised; (3) advertising informed consumers; and (4) advertising regulations caused the product's failure in the marketplace.

Setting: Court proceedings assessing the constitutionality of Canada's Tobacco Act, which substantially restricts cigarette advertising. The 2002 Quebec Superior Court trial yielded a new collection of internal documents from Imperial Tobacco Ltd (ITL), including several about the development and marketing of Player's Premiere.

Method: Trial testimony and corporate documents were reviewed to determine the validity of the industry representations about the new cigarette product development process, focusing on the case history of Player's Premiere.

Results: In direct contradiction to industry testimony, the documentary evidence demonstrates that (1) communications for Player's Premiere, which claimed less irritation, were developed long before finding a product that could deliver on the promise; (2) ITL did not sell a "less irritating" product that matched its promotional promise; (3) the advertising and other communications for Player's Premiere were extensive, relying on the hi-tech appearances ("tangible credibility") of a "unique" filter, yet were uninformative and vague; and (4) Player's Premiere failed in the marketplace, despite extensive advertising and retail support, because it was an inferior product that did not live up to its promotional promise, not because of regulation of commercial speech.

Conclusions: New product development entails extensive consumer research to craft all communications tools in fine detail. In the case of Player's Premiere, this crafting created a false and misleading impression of technological advances producing a "less irritating" cigarette. This product was solely a massive marketing ploy with neither consumer benefits, nor public health benefits. The industry attempted to deceive both consumers and the court.

     

Tea caffeine: Metabolism, functions, and reduction strategies

Tea is a product made up from topmost part of the plant Camellia sinensis. This part includes bud, first leaf (next to bud), second leaf, and stem (spanning from bud to second leaf). Tea is the second most consumed beverage in the world, well ahead of coffee, beer, wine, and carbonated soft drinks. Clinical studies have demonstrated that one of the harmful effects of tea over consumption, at least in sensitive peoples is due to its caffeine content. In view of this, major points discussed in this article are the following: i) a brief overview on tea and its biochemical composition, ii) health effects of tea drink, iii) caffeine metabolism and its functions, iv) possible strategies for caffeine reduction in tea, and v) feasibility of tea improvement through biotechnological approaches.     

Beer: benefit or harm. Looking hygienist

The presentation contemporary look of hygienist on consumption beer-low alcohol drink.     

Promoting physical activity in the Americas

Physical inactivity, obesity, and noncommunicable disease rates are rapidly climbing to epidemic proportions and are becoming the leading causes of death and disability in the Americas and globally. The causes are complex and will require a multifaceted, multisectoral approach. Recognizing this, the World Health Organization adopted a broad-ranging process to develop a Global Strategy for the Promotion of Diet, Physical Activity, and Health, as mandated by the World Health Assembly in May 2002. The results of the yearlong effort are to be presented at the World Health Assembly in May 2004.