Public attitudes towards e-cigarette regulations and policies in Taiwan

Background: There are various approaches to e-cigarette regulation globally. In Taiwan, the term “e-cigarette” is not found in existing regulations, but health authorities apply explanatory notes derived from standing laws to e-cigarette. Taiwan health authority is in the process of regulative reform to include “e-cigarette” in standing tobacco law. Our objective was to investigate the public’s attitudes towards potential policy options for e-cigarette regulations in Taiwan.Design and Methods: We conduct an anonymous online survey in the general public. A questionnaire in Mandarin was posted on the website Stop-tabac.ch between July and November 2017.Results: Participants (n=236) were mostly male, young, highly educated, employed, and smoked or had smoked cigarettes in the past. Half were e-cigarette users. Four measures banning e-cigarettes, labelling content and nicotine level and establishing a maximum-allowable nicotine level were supported by more than 70% of participants. Vaping status was strongly associated with support for most measures after controlling for other factors in multivariate models.Conclusion: We documented attitudes of a self-selected sample of the general public in Taiwan regarding e-cigarette regulations and policies. These results may be useful to design studies in more representative samples and to inform e-cigarette regulations, policies and education campaigns

Saliva Cotinine Levels in Smokers and Nonsmokers

The authors collected by mail self-reported data on smoking habits and saliva samples that were analyzed for cotinine concentration in 222 smokers and 97 nonsmokers. Participants were members of the University of Geneva (Switzerland) in 1995. The 207 cigarette-only smokers smoked on average 10.7 cigarettes/day and had a median concentration of cotinine of 113 ng/ml. The cotinine concentration was moderately associated with the number of cigarettes smoked per day (+14 ng/ml per additional cigarette, p > 0.001, FF = 0.45) and was 54 ng/ml higher in men than in women after adjustment for cigarettes per day and for the FagerstrSm Test for Nicotine Dependence. The cotinine level was not associated with the nicotine yield of cigarettes (r= 0.08). In nonsmokers, the median concentration of cotinine was 2.4 ng/ml. The cotinine concentration was 1.5 times higher in nonsmokers whose close friends/spouses were smokers than in nonsmokers whose close friends/spouses were nonsmokers (p = 0.05). A cutoff of 7 ng/ml of cotinine distinguished smokers from nonsmokers with a sensitivity of 92.3% and a specificity of 89.7%; a cutoff of 13 ng/ml provided equally satisfactory results (sensitivity, 86.5%; specificity, 95.9%). This study provides evidence for the construct validity of both questionnaires and saliva cotinine for the assessment of active and passive exposure to tobacco smoke. Am J Epidemiol 2000: 151: 251-

Erratum to: A mixed methods feasibility study of nicotine-assisted smoking reduction programmes delivered by community pharmacists - The RedPharm study

Following publication of this article [1], it has come to our attention that the author, Susan MacAskill, has had her name captured incorrectly. The correct spelling is the aforementioned

Comparing Tobacco and Alcohol Policies From a Health Systems Perspective: The Cases of the Philippines and Singapore

Objective: To provide a comparative analysis of current tobacco and alcohol control laws and policies in the Philippines and SingaporeMethods: We used a public health law framework that incorporates a systems approach using a scorecard to assess the progress of the Philippines and Singapore in tobacco and alcohol control according to SDG indicators, the WHO Framework Convention on Tobacco Control and the WHO Global Strategy to Reduce Harmful Use of Alcohol. We collected data from the scientific literature and government documents.Results: Despite health system differences, both the Philippines (73.5) and Singapore (86.5) scored high for tobacco control, but both countries received weak and moderate scores for alcohol control: the Philippines (34) and Singapore (52.5). Both countries have policy avenues to reinforce restrictions on marketing and corporate social responsibility programs, protect policies from the influence of the industry, and reinforce tobacco cessation and preventive measures against alcohol harms.Conclusion: Using a health system-based scorecard for policy surveillance in alcohol and tobacco control helped set policy benchmarks, showed the gaps and opportunities in these two countries, and identified avenues for strengthening current policies

A mixed methods feasibility study of nicotine-assisted smoking reduction programmes delivered by community pharmacists – The RedPharm study

BACKGROUND: Pivotal trials have established that, among people who have no immediate intention to quit smoking, nicotine replacement therapy (NRT) helps people reduce and eventually stop smoking. The prime aim of this trial was to investigate the feasibility of implementing such a programme in community pharmacies. In addition, we investigated the effectiveness of providing behavioural support compared with self-help methods and of shorter compared with standard length reduction programmes. METHODS: Pharmacists were trained to deliver a smoking reduction programme and opportunistically invite people to participate in the programme. In a 2 × 2 factorial design, eligible volunteers were randomised to either receive in-person behavioural support or a self-help booklet. In both cases, participants were supported to set targets to reduce their smoking and use behavioural techniques to assist reduction. In addition, participants were randomised to cut down and stop over 4 weeks or over 16 weeks, but in either case continue NRT for up to nine months. We assessed uptake and adherence to the programme and smoking cessation four weeks and six months after a quit day and reduction in the three months following programme end and incorporated a qualitative processes assessment. RESULTS: Only 68 of the planned 160 smokers could be recruited. Pharmacists were deterred by the bureaucracy of trial enrolment and that many smokers did not return for further support. Pharmacists sometimes subverted the randomisation or provided support to participants in the self-help arm. Smokers stayed in the programme for an average of 6 weeks rather than the 9 months envisaged. Rates of follow-up declined to around 20% of participants by 12 months. There was insufficient evidence to assess whether support or speed of reduction enhanced cessation or reduction but cessation and reduction were less common overall than in the pivotal trials for licensing NRT for this indication. CONCLUSIONS: This programme of smoking reduction and the trial design to assess its effectiveness proved unpopular to potential participants and pharmacists. As a result, the trial produced no evidence on the effectiveness of behavioural support or speed or smoking reduction. A trial of this programme in this context is unfeasible

An Online Survey of the Perceptions of Clinical and Non-Clinical Professionals on Healthcare for Non-Communicable Diseases and COVID-19 Measures During the Pandemic in Malaysia

Objectives: This study assesses the opinions of health professionals in Malaysia on the disruption of non-communicable disease (NCD) services during the COVID-19 pandemic from March 2020 to January 2022. Methods: We conducted a cross-sectional online survey with 191 non-clinical public health workers and clinical health service workers in Malaysia from November 2021 to January 2022. Participants were recruited by the Malaysian Ministry of Health using major networks including key experts and practitioners. Secondary respondents were subsequently enrolled through snowballing. Results: The most notable issues raised by the survey participants relate to NCD service disruption, the redirection of NCD care resources, and NCD care being overburdened post-pandemic. Respondents also reported accounts of resilience and prompt reaction from the healthcare system, as well as calls for innovation. Conclusion: Most respondents perceived that the challenges arising from COVID-19 were mostly managed well by the healthcare system, which was able to provide the necessary services to NCD patients during this health emergency. However, the study identifies gaps in the health system response and preparedness capacity, and highlights solutions for strengthening NCD services

Citations to trials of nicotine replacement therapy were biased toward positive results and high-impact-factor journals

OBJECTIVE: To study variations in the number of times trials of nicotine replacement therapy (NRT) were cited, and which characteristics of trials predicted the number of citations and the impact factors of journals in which articles were published. STUDY DESIGN AND SETTING: We used all 105 randomized controlled trials in the Cochrane review of NRT for smoking cessation. We obtained impact factors from the Journal Citation Reports and the number of citations from ISI Web of Knowledge and Google Scholar. RESULTS: Trials were cited from 0 to 632 times (median 23 times). Trials were cited more often when results were statistically significant than when they were not (median=41 vs. 17 times, P<0.001), and when impact factors were higher (10.2 more citations per impact factor point, P<0.001). Patch trials were cited more often than gum trials (median=29 vs. 17 times, P=0.001), and trials funded by the pharmaceutical industry were cited more often than other trials (median=28 vs. 16.5 times, P=0.001). Trials with statistically significant results were published in journals with higher impact factors than trials with nonsignificant results (median impact factor=2.80 vs. 1.81, P=0.011). CONCLUSION: Citations were biased toward trials with positive results and toward trials published in high-impact-factor journals