Smoking: Developing the evidence base
TL;DR: Professor Wilson's proposed advancements in oral health along with the Health Care 2035 vision are already taking place in a rural town in Japan, where a group of dentists has gradually developed a new social system to enhance oral care in a holistic manner with an emphasis on the patients’ values.
Abstract: not sufficient as the health system should be rebuilt in the future as a new ‘social system’ which is integrated to provide values to patients. In 2015, an advisory panel appointed by the health minister of young experts in their 30s and 40s, developed a vision of health care: Health Care 2035.4 Sakata City (100,000 population) is a unique rural community in Japan, having a model with this point of view. Since 1980, a group of dentists (re-educating themselves and other dentists nationally to become ‘oral physicians’ rather than dental surgeons), hygienists, specialists, community nurses, school teachers and government officials have collaborated with the private sector, academic institutions and civil society. The group has gradually developed a new social system to enhance oral care in a holistic manner with an emphasis on the patients’ values.5 Local industries have started to pay for preventive oral care, which benefits employees and their family members and enhances productivity. The group has developed a consortium with large companies to advocate and facilitate the continuum of quality care after patient transfers. The consortium has developed a cloud-based, people-centred health information system. This system integrates various personal data and facilitates a personalised approach to health promotion and disease prevention by empowering each individual to design their own life style, with an ambitious goal, namely ‘KEEP 28’ to keep all of your own teeth for your general and oral health even for a 100-year life span. In 2016, Sakata City legislated for a holistic approach to oral care,6 obviously being influenced by these activities of the group. Professor Wilson’s proposed advancements in oral health along with the Health Care 2035 vision are already taking place in a rural town in Japan. T. Kumagai, N. Kumagai, M. Nishi, K. Shibuya, by email
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01 Aug 2015
TL;DR: There is no evidence that EC are undermining the long-term decline in cigarette smoking among adults and youth, and may in fact be contributing to it, and new regulations currently planned should also maximise the public health opportunities of EC.
Abstract: E-cigarettes are 95% less harmful to your health than normal cigarettes. When supported by a smoking cessation service, they help most smokers to quit tobacco altogether.
Key messages:
1. Smokers who have tried other methods of quitting without success could be encouraged to try e-cigarettes (EC) to stop smoking and stop smoking services should support smokers using EC to quit by offering them behavioural support.
2. Encouraging smokers who cannot or do not want to stop smoking to switch to EC could help reduce smoking related disease, death and health inequalities.
3. There is no evidence that EC are undermining the long-term decline in cigarette smoking among adults and youth, and may in fact be contributing to it. Despite some experimentation with EC among never smokers, EC are attracting very few people who have never smoked into regular EC use.
4. Recent studies support the Cochrane Review findings that EC can help people to quit smoking and reduce their cigarette consumption. There is also evidence that EC can encourage quitting or cigarette consumption reduction even among those not intending to quit or rejecting other support. More research is needed in this area.
5. When used as intended, EC pose no risk of nicotine poisoning to users, but e-liquids should be in ‘childproof' packaging. The accuracy of nicotine content labelling currently raises no major concerns.
6. There has been an overall shift towards the inaccurate perception of EC being as harmful as cigarettes over the last year in contrast to the current expert estimate that using EC is around 95% safer than smoking.
7. Whilst protecting non-smoking children and ensuring the products on the market are as safe and effective as possible are clearly important goals, new regulations currently planned should also maximise the public health opportunities of EC.
8. Continued vigilance and research in this area are needed.
425 citations
TL;DR: While e-cigarette aerosol may contain fewer toxicants than cigarette smoke, studies evaluating whether e-cigarettes are less harmful than cigarettes are inconclusive and some evidence suggests that e- cigarette use may facilitate smoking cessation, but definitive data are lacking.
Abstract: Objective With the rapid increase in use of electronic nicotine delivery systems (ENDS), such as electronic cigarettes (e-cigarettes), users and non-users are exposed to the aerosol and product constituents. This is a review of published data on the human health effects of exposure to e-cigarettes and their components. Methods Literature searches were conducted through September 2013 using multiple electronic databases. Results Forty-four articles are included in this analysis. E-cigarette aerosols may contain propylene glycol, glycerol, flavourings, other chemicals and, usually, nicotine. Aerosolised propylene glycol and glycerol produce mouth and throat irritation and dry cough. No data on the effects of flavouring inhalation were identified. Data on short-term health effects are limited and there are no adequate data on long-term effects. Aerosol exposure may be associated with respiratory function impairment, and serum cotinine levels are similar to those in traditional cigarette smokers. The high nicotine concentrations of some products increase exposure risks for non-users, particularly children. The dangers of secondhand and thirdhand aerosol exposure have not been thoroughly evaluated. Conclusions Scientific evidence regarding the human health effects of e-cigarettes is limited. While e-cigarette aerosol may contain fewer toxicants than cigarette smoke, studies evaluating whether e-cigarettes are less harmful than cigarettes are inconclusive. Some evidence suggests that e-cigarette use may facilitate smoking cessation, but definitive data are lacking. No e-cigarette has been approved by FDA as a cessation aid. Environmental concerns and issues regarding non-user exposure exist. The health impact of e-cigarettes, for users and the public, cannot be determined with currently available data.
388 citations
01 Jan 2012
TL;DR: This systematic review outlines findings from 37 studies that provide evidence of the impacts of plain tobacco packaging in order to inform a public consultation on the issue.
Abstract: (From the Executive Summary): This systematic review outlines findings from 37 studies that provide evidence of the impacts of plain tobacco packaging. The review was conducted following the publication of the March 2011 White Paper Healthy Lives: Healthy People which set out a renewed Tobacco Control Plan for England. One of the key actions identified in the plan was to consult on possible options to reduce the promotional impact of tobacco packaging, including plain packaging. This systematic review was commissioned to provide a comprehensive overview of evidence on the impact of plain packaging in order to inform a public consultation on the issue.
126 citations
TL;DR: There was a statistically significant increase in gingival inflammation when tobacco smokers switched from smoking to vaping for two weeks, and this study should provide a stepping stone to encourage further investigation of the effects of vaping on periodontal health.
Abstract: Introduction Tobacco smoking is one of the most important risk factors for periodontitis as it alters the host response to plaque. Although the prevalence of tobacco smoking has declined in recent years, the use of electronic-cigarettes (vaping) has increased. The effect of vaping on the gingiva is unknown and an evidence-base needs to be established before providing dental advice about the use of these products.Objective To compare the gingival health of a group of established smokers before and after substituting vaping for smoking tobacco.Design Pilot.Setting Guy's Dental Hospital (England) from April-December 2015.Materials and methods Twenty established smokers (all staff members at Guy's Hospital) with mild periodontal disease replaced their regular smoking habits with the use of e-cigarettes for two weeks.Main outcome measure The primary outcome measure of gingival inflammation was bleeding on probing. Levels of selected pro-inflammatory cytokines in GCF, saliva and serum samples were also determined.Results and conclusions There was a statistically significant increase in gingival inflammation when tobacco smokers switched from smoking to vaping for two weeks. However, this result must be interpreted with extreme caution since this is only a pilot study. Nonetheless, this study should provide a stepping stone to encourage further investigation of the effects of vaping on periodontal health.
55 citations