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E-cigarettes need quality safeguards	Rapid Response letter published in British Medical Journal 22 January 2010
Murray Laugesen, public health physician Health New Zealand Ltd, Christchurch, New Zealand 8082
Flouris and Oikonomou lament the lack of data on e-cigarette risks.[1] Apart from our 2008 poster cited [1], our further reports [2, 3] and extensive emissions data we gathered in 2009 show complete absence of most priority cigarette toxicants in e-cigarette liquid and mist. However, we only tested one brand (Ruyan, Beijing). And, as Flouris and Oikonomou point out, quality safeguards in manufacture are essential. Even if testing showed all e-brands were less toxic than cigarettes, consumer safety requires quality control at site of manufacture, and monitoring to minimise the risk of adulteration. In 1990, propylene glycol, now used to create the mist in e-cigarettes, was adulterated by toxic diethylene glycol (DEG) with tragic results. As recently as 2007, US FDA found DEG in Chinese toothpaste at 3%,[4] and found DEG at 1% level in 2009 in one e-cigarette brand.[5] E-cigarettes need regulation imposed to safeguard their quality, so they can continue to provide an alternative to cigarette smoking. Murray Laugesen, Public health physician, Health New Zealand Ltd. www.healthnz.co.nz 1. Flouris AD, Dimitris N Oikonomou DN. Electronic cigarettes: miracle or menace? Letter. BMJ 2010;340:c311 2. Laugesen M. Safety report on Ruyan e-cigarette and cartridge. 30 October 2009. http://www.healthnz.co.nz/RuyanCartridgeReport30-Oct-08.pdf 3. Laugesen M. Ruyan e-cigarette bench-top tests. Poster. Society for Research on Nicotine and Tobacco. Dublin April 2009. laugesen@healthnz.co.nz/DublinEcigBenchtopHandout.pdf 4. Throw away Chinese toothpaste, FDA warns. Products may contain poisonous chemical used in antifreeze. Associated Press 1 June 2007. http://www.msnbc.msn.com/id/18985512/ 5. Westenberger BJ. Evaluation of e-cigarettes. Center for Drug Evaluation and Research, Division of Pharmaceutical Analysis, St Louis, MO. US Food and Drug Administration. 2009. Competing interests: Research contract with Ruyan during 2008, but no financial interest in Ruyan.

TV 3 Sunrise programme: 5 July Study suggests rollies worst for health. Dr Laugesen interviewed re RYOs.

Roll-your-own cigarettes dangerous money-savers: research

Friday Jun 26, 2009
By Martin Johnston

NZ Herald http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10580788

Roll-your-own smokes could be even more harmful than factory-made cigarettes because people suck them harder and more efficiently, Christchurch research indicates.

The researchers are calling for the Government to act on their findings by applying a higher tax and specific warnings on roll-your-own tobacco.

In the first comparison between the two types of smoking using people rather than smoking machines, the study suggests rollies are "apparently no less and possibly more dangerous" than factory-made cigarettes.

Public health specialist Dr Murray Laugesen and his co-researchers found roll-your-own smokers inhaled 28 per cent more smoke per filtered cigarette, even though the rollies contained less tobacco than the factory-mades.

And both types boosted the level of carbon monoxide, measured in exhaled breath, by the same amount.

"Whereas a smoker of factory-mades lets a lot of the smoke go up in the air, these roll-your-own smokers suck like crazy and don't let so much be wasted," Dr Laugesen said yesterday. "They're getting more value out of the tobacco - and more harm."

The study, using cigarette holders containing flow meters, compared 26 people who usually smoke rollies with 22 who usually smoke factory-mades.

In their paper, the researchers said rollies accounted for nearly a third of tobacco used in New Zealand.

The country's comparatively high tobacco excise tax - levied by tobacco content, not per cigarette - had encouraged smokers to hand-roll thin cigarettes and pay less tax.

"Thus excise increases have perversely encouraged cheaper smoking rather than quitting."

Overseas research has shown roll-your-own smokers are twice as likely as smokers of factory-mades to believe rollies are less risky. Norwegian research shows they also have twice the lung-cancer risk. Although rollies contain less tobacco, they contain no fewer additives and their smoke contains much more tar.

Associate Health Minister Tariana Turia wants more tax on roll-your-own tobacco, but a spokesman for the Finance Minister said the Government was not considering it.

ROLLIE DRAWBACKS

A study that compared smoking of roll-your-own and factory-made cigarettes showed rollie smokers:
* Inhaled 28 per cent more smoke per cigarette.
* Took 25 per cent more puffs.
* Puffed for six seconds longer per cigarette.
* Increased their carbon monoxide level by the same amount.

Roll-your-own cigarettes as dangerous as factory-made cigarettes 18 June 2008

In research published today, we show that smokers of RYO cigarettes inhale more smoke and absorb as much carbon monoxide as factory made cigarette smokers.

LAUGESEN, M., EPTON, M., FRAMPTON, C., GLOVER, M., LEA, R.A. Hand-rolled cigarette smoking patterns, compared with factory-made cigarette smoking in New Zealand men. BMC Public Health 2009, 9:194. http://www.biomedcentral.com/1471-2458/9/194

Health warning: Precautions with e-cigarettes 3 June 2009.

Health New Zealand wishes to warn users of certain dangers due to defects in the child safety design of some products and brands. See www.healthnz.co.nz/ecigarette.htm

Nicotine pouch to reduce cravings, (Nicotine snus) now selling in Sweden 19 May 2009

Thornley S, McRobbie H, Lin RB, Bullen C, Hajek P, Laugesen M, Senior H, Whittaker R. A single-blind,

randomized, crossover trial of the effects of a nicotine pouch on the relief of tobacco withdrawal symptoms

and user satisfaction. Nicotine Tob Res. 2009 Jun;11(6):715-21. Epub 2009 May 19. Researched at CTRU, Univ of Auckland.

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Health New Zealand research presented in Dublin at the 15^th Annual Conference, Society for Research on Nicotine and Tobacco, (SRNT) conference, April 2009:

1) E-cigarette Safety: Ruyan e-cigarette benchtop tests. Poster 5-11.

See. www.healthnz.co.nz/DublinEcigBenchtopHandout.pdf The poster itself is found in the following two powerpoint files: http://www.healthnz.co.nz/DublinEcigPoster1.ppt and http://www.healthnz.co.nz/DublinEcigPoster2.ppt

The mist of the e-cigarette has been rigorously tested. Of over 50 priority-listed cigarette smoke toxicants tested, none was detectable in the mist of the Ruyan® e-cigarette, except for a trace of mercury close to the limit of detection. Some toxicants remain to be tested before the results are submitted for publication. On the basis of findings to date, inhaling mist from the e-cigarette is rated several orders of magnitude (100 to 1000 times) less dangerous than smoking tobacco cigarettes. The nicotine dose per puff is comparable to that of a medicinal nicotine inhaler. E-cigarette nicotine is apparently not absorbed from the lung, but from the upper airways.

Comment: Given that continued smoking of cigarettes carries a cumulative 1 in 2 death risk, the findings, argue for

1) less stringent regulation for very low-risk non-medicinal nicotine cigarette substitute products

2) the sale of this brand as a non-medicinal cigarette substitute, as its emissions have been tested.

Status: June 2009: to be submitted for publication in a peer-reviewed journal.

2) E-cigarette efficacy: Effect of an E-cigarette on Cravings and Withdrawal, Acceptability and Nicotine Delivery: Randomised Cross-over Trial. Poster 5-50,

On behalf of Ruyan, manufacturer of the Ruyan V8 e-cigarette, Health New Zealand Ltd sponsored this research carried out in Auckland by researchers at the School of Population Health, University of Auckland. See http://www.healthnz.co.nz/ecig_effect-2.pdf

Status May 2009: The study has been submitted for publication in a peer-reviewed journal.

3) Potential toxicity of Hand-rolled and Factory-made cigarette smoking compared

Poster 3-41, http://www.healthnz.co.nz/LandscapeTemplRYO_w5graphs.ppt

Status: 5 June 2009 Accepted for publication in BMC Public Health. See above.

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E-cigarettes – a high tech way to kick the habit? New Scientist

14 February 2009

Helen Thomson interviews Dr Laugesen and WHO. www.NewScientist.com For a clear diagram see:

http://www.newscientist.com/data/images/archive/2695/26951701.jpg

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Safety report on the Ruyan® e-cigarette & cartridge

30 October 2008

This report (23 pp) amends and replaces the 21 October report and completes the tests on mist and

cartridges meantime. Further test results at pages 9 -11 confirm

previous findings, that nothing of note has been found so far.

http://www.healthnz.co.nz/RuyanCartridgeReport30-Oct-08.pdf

Safety report on the Ruyan® e-cigarette & cartridge

21 October 2008

Health New Zealand today released further safety data (22 pages) based on reports from

seven different laboratories examining various possible safety issues with respect to the

Ruyan® e-cigarette and nicotine cartridge.

http://healthnz.co.nz/RuyanCartridgeReport21-Oct-08.pdf

Tests are continuing. Nothing of note has been found so far. This work is funded by Ruyan.

Comparison of toxicity of RYO and factory-made cigarettes

21 October 2008

Data from 48 smokers have been analysed and will be presented at the Dublin SRNT conference April 2009. www.srnt.org A paper is being submitted for publication in a scientific journal. This study was funded by the Health Sponsorship Council.

Marlboro UltraSmooth withdrawn from sale

23 June 2008

After investing millions in its research, Philip Morris has withdrawn this state-of-the-art filter cigarette

from sale in its test markets in the United States. On a small Heart Foundation grant, Health New

Zealand researched the toxicity of Marlboro UltraSmooth in 2006 (see www.tobaccocontrol.com

and search under Laugesen or Fowles) and found it behaved like a low nicotine cigarette – fooling

the smoke machine ratings and registering very low harmful gas emissions. But after adjustment for its

low nicotine, this cigarette was potentially more toxic than regular Marlboro, more so than Holiday

regular, NZ’s most popular brand, and more so than 16 regular brands from British Columbia.

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Safety of the Ruyan® e-cigarette

1 March 2008, updated 9 April

See Health New Zealand’s poster How safe is the e-cigarette? presented to the 14^th annual meeting

of the Society for Research on Nicotine and Tobacco (SRNT) in Portland, Oregon, USA, 1 March

2008, which attracted considerable interest. http://www.healthnz.co.nz/Portland2008ECIG.pdf

Since April 2008 this website has attracted over 20 hits per hour.

Further tests are planned for the Ruyan® e-cigarette.

Fast acting nicotine pouch, mouth spray and lozenge – NEWS Study

1 March 2008

See the final report http://www.healthnz.co.nz/NicoNovumSRNT2008Poster.pdf presented at the

14^th SRNT meeting, Portland, Oregon, 2008. The study is to be published in Nicotine & Tobacco

Research (first author Dr Simon Thornley).

The pouch and mouth spray were clinically effective and may give faster and greater relief of cravings

than nicotine gum. In 2007, nearly 80 smokers completed a phase three trial of three fast acting

nicotine products in the NEWS study (Niconovum Evaluation of Withdrawal relief study) at

Clinical Trials Research Unit, School of Population Health, University of Auckland. Dr Hayden

McRobbie was the principal investigator, and Dr Laugesen of Health New Zealand, a co-investigator.

This was sponsored by Heart Foundation, and Niconovum AB, Sweden.

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First cigarettes can addict

13 December 2007

Scragg R, Wellman R, Laugesen M. DiFranza J. ‘Diminished Autonomy over Tobacco Can

Appear With the First Cigarettes’ Addictive Behaviours 2008. Doi:10.1016/j.addbeh.2007.12.002

Abstract at www.pubmed.org (search under author)

Full text at http://www.healthnz.co.nz/Addiction1stcigFeb08.pdf

This study, written up by two New Zealand and two US researchers, analyses results from the

ASH New Zealand surveys of smoking in year 10 students. The ASH survey included the

Hooked On Nicotine Checklist (HONC) of DiFranza et al, of symptoms of students’ loss of

autonomy (control) over their smoking. Dr Laugesen included this checklist in the ASH surveys

of 2002-2004, answered by nearly 100,000 students, and Dr Robert Scragg analysed the data.

Our data confirm previous reports that diminished autonomy appears soon after the onset of

intermittent tobacco use. We extend this literature by providing the first description of how

diminished autonomy develops in relation to the total number of cigarettes smoked.

Our data indicate that the first cigarette can prompt a loss of autonomy in one in four

adolescents.

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A2 Milk to be sold throughout NZ, including South Island

The Press, Christchurch NZ. 12 Dec 07 www.press.co.nz

Ridge Natural Foods has arranged to supply 150 Countdown supermarkets including

South Island supermarkets with A1 beta-casein -free milk for a retail price of $4.50 per 2L,

as opposed to $3.50 for A1-containing milk. www.healthnz.co.nz/milk.htm

This fulfils one of the aims of Health New Zealand’s research on A1 milk in 2003; to

ensure choice for consumers wishing to apply the precautionary principle to their own

milk purchases. Eventually A2 milk could fetch a premium at the farm gate, persuading

dairy farmers to use only bull semen of pure A2 beta-casein genotype.

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No smoke No fire Just nicotine. NZ Herald. 8 December 2007

(the Ruyan® e-cigarette) www.smokeless.org.nz/NosmokeNofire.htm

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Health New Zealand milk research in the news again 30 Oct 07

Health New Zealand research on A1 milk is being quoted at length in a recent book.

See www.healthnz.co.nz/milk.htm

Health New Zealand Ltd to test the Ruyan® (nicotine) e-cigarette

17 October 2007

SBT Holdings Ltd (Hong Kong and Beijing), recently renamed Ruyan® Holdings Ltd, a subsidiary of Golden Dragon Holdings Ltd, Hong Kong, has selected Health New Zealand Ltd to test the Ruyan® e-cigarette, a promising cigarette-substitute device that rapidly delivers nicotine to the lungs, without the tar and other harmful smoke gases, for its first full testing outside of China. Subject to the necessary approvals, Health New Zealand Ltd will be testing its effect in raising nicotine blood levels and in satisfying the smokers’ need for another cigarette. For more on the e-cigarette, see www.healthnz.co.nz/ecigarette.htm and for more still see www.healthnz.co.nz/Ruyan® _ecigarette.htm

R-rated film viewing and adolescent smoking – classification does matter

24 August, 2007

Murray Laugesen, Robert Scragg, Robert Wellman, Joseph DiFranza.

Preventive Medicine 2007 doi:10.1016/j.ypmed.2007.07.025

ASH surveyed nearly 100,000 Year 10 students in 2002-4, and found 94% of students watched

R-rated movies, nearly 80% watched them at least monthly, and 38.5% watched them weekly.

Weekly viewing of R-rated movies nearly tripled students’ susceptibility to future smoking, and

was linked to a doubling of past experimentation and of current smoking, compared to those not

watching R-rated films at all.

We conclude that classifying all smoky G and PG films as R-rated will usefully protect some though

not all young people from viewing on-screen smoking. The findings apply to all ethnic groups, and

remain after allowing for smoking by family and best friend.

www.healthnz.co.nz/corrProofPrevMedAug24.pdf

National Heart Foundation declines to fund research of snuff as alternative

to smoking

3 August 2007

Funding of the testing of the best available stop-smoking aids should be a shoe-in. Not so. Health New Zealand applied 31 March to the National Heart Foundation for research funds for SNEWS (Snuff and Nicotine Evaluation of Withdrawal relief Study) to compare nasal and oral snuff with a fast acting nicotine pouch and nicotine gum. The NHF grant round was sufficiently funded to cover one-third of applications. Health New Zealand was not successful. Because snuff is tobacco and addictive, many of those who believe in tobacco abstinence as the national goal, are not enthusiastic for researching it. Others such as Health New Zealand Ltd, believe smoking is the problem, and seek to test a range of scientifically-based cigarette substitute products. The research design was based on the successful NEWS study (see above).

This is the third of three applications for funding of trials of snuff in New Zealand to be rejected by health funding bodies. Industry funding is available, but whether they sell nicotine or tobacco, each company is usually only interested in researching its own product, providing no useful comparison. Apart from this, researchers know tobacco industry funding these days can damage their future careers.

Investigators included principal investigator Dr Murray Laugesen, biostatistician Dr Chris Frampton, addiction specialist, Professor Doug Sellman, respiratory physician Dr Mark Epton, and smoking cessation experts Dr Mark Wallace-Bell and Trish Fraser. This research was to investigate a short list of available nicotine-containing products most likely to quell smokers’ urges to smoke. This was an open-label cross-over trial, in which some 50 addicted smokers were to each try a different product each morning in random sequence to test the ability of each to relieve their urge to smoke. See http://www.healthnz.co.nz/VASurges.htm

Influence of smoking of family and best friend on adolescent smoking. July 2007.

Robert Scragg and Murray Laugesen.

Australian and New Zealand Journal of Public Health.2007; 31: 217-223.

Based on the ASH survey of year 10 students in 2002, we show family smoking is highly influential, even

when the influence of best friend is allowed for. www.healthnz.co.nz/ANZJPH 2007-3 pp 217-223 Scragg.pdf

Health Sponsorship Council funds hand-rolled cigarette toxicity study

31 May 2007

Health Sponsorship Council has granted funding for Health New Zealand to test the first stage of a study

to test the toxicity of hand-rolled cigarettes compared with factory-made cigarettes. Eighty volunteer male

European and Maori smokers, will help determine how intensively each type of cigarette is smoked, and

based on these measurements, the average levels of smoke toxicants from each type of cigarette.

Health New Zealand shifts to Lyttelton, Christchurch in 2006

From 1 September 2006, after nearly ten years in the Auckland region, Health New Zealand Ltd shifted to Christchurch. With the help of broadband, and Skype for low cost tolls, we plan to keep in contact as before.

Nicotine and Tobacco Research Conference in Europe and lecture at Harvard University

Dr Laugesen attended the Fourth conference of the Society for Research on Nicotine and Tobacco in Kusadasi Turkey 23-26 September 2006, and in early October lectured on Snuffing out cigarette sales in New Zealand to the Tobacco Working Group at the Harvard School of Public Health, Cambridge Massachusetts. USA.

Health New Zealand research published in Tobacco Control

The first independent report assessing the toxicity of the Marlboro UltraSmooth cigarette brand, which Philip Morris was test marketing in the USA during 2005, by Drs Laugesen (Health New Zealand Ltd) and Fowles (ESR) was published in Tobacco Control journal in December 2006. See www.healthnz.co.nz/MUS.htm

- Laugesen M and Fowles J. Marlboro UltraSmooth - a potentially reduced exposure cigarette? Tobacco Control December 2006. www.tobaccocontrol.com

The smoke of Marlboro UltraSmooth was tested against smoke from Marlboro Red Regular and Holiday regular brands, and compared with smoke results from 16 Canadian regular brands. A grant from the NZ Heart Foundation of $15,000 paid for the laboratory testing in Canada.

Current research 2006-9

Health New Zealand is working to provide smokers with better nicotine products to help them quit smoking. In 2005, Health Research Council of NZ awarded grants for three randomized controlled trials of smoking cessation methods to the Clinical Trials Research Unit (CTRU), School of Population Health, University of Auckland. Dr Laugesen is a co-investigator for these major research projects. The first (the PICNIC study, using NRT before quit date) completed recruitment of over 1000 volunteers by May 2007, and the second (the SONIQ study letting quitters choose from a selection of nicotine products) begins late 2007. The third, beginning 2008 tests usefulness of reduced nicotine cigarettes along with nicotine products during quitting.

Tobacco policy presentation

Dr Laugesen’s powerpoint presentation of 24 March 2006 at the University of Auckland symposium Towards a Smokeless New Zealand. www.healthnz.co.nz/StubbingOutCigaretteSales.htm called for an end to cigarette sales within ten years, making use of smokeless nicotine and/or tobacco alternatives for addicted smokers. (Repeat clicking will gain access to the file).

A new charitable trust, SmokeLess New Zealand Inc, www.smokeless.org.nz has since been formed to help end cigarette sales, and has been active in the media since that time.

Physicians alerted to harm reduction

May 2005 marked the release of the Royal Australasian College of Physicians report on Tobacco Policy – using evidence for better outcomes. Dr Laugesen was a member of the College’s working party.

Tenth anniversary

One of the aims of business is to stay in business. July 2005 marked the 10^th anniversary of the founding of the company. For Dr Laugesen, 2005 also marked 21 years of work in reducing smoking in New Zealand.

Street address See www.healthnz.co.nz/Lyttelton.htm < >