Modelling the global economic costs of tobacco product waste.

Tobacco smoking continues to cause considerable premature mortality and morbidity worldwide. Most of the approximately six trillion cigarettes sold globally each year are discarded improperly as toxic environmental waste. Tobacco product waste, including cigarette butts, is the most commonly collected waste item worldwide. Of particular concern is the cellulose acetate filter, a poorly degradable plastic additive attached to most commercially manufactured cigarettes. This filter was introduced by the tobacco industry to reduce smokers' perception of harm and risk but it has no health benefit. To inform health policy and practice and improve public health outcomes, governments and society can benefit from cost estimates of preventing, properly disposing of and/or cleaning up tobacco product waste. Estimating the costs of tobacco product waste to communities and responsible authorities could encourage the development of health, environmental and fiscal policy interventions and shift accountability for the costs of tobacco product waste onto the global tobacco industry. To support health and environmental policy-making, we therefore propose an empirical approach to estimate the economic costs of tobacco product waste based on its negative environmental externalities. We first present general estimates for six representative countries and then identify data gaps that need to be addressed to develop global estimates. Interventions against tobacco product waste may be new channels to regulate tobacco products across sectors - for example, health, environment and finance - and consequently reduce overall tobacco use.

Le tabagisme continue à entraîner un taux de morbidité et de mortalité précoce considérable à travers le monde. La plupart des quelque six billions de cigarettes vendues chaque année à l'échelle planétaire ne sont pas correctement éliminées et deviennent une source de pollution environnementale toxique. Les déchets liés aux produits du tabac, notamment les mégots, sont les résidus les plus fréquemment collectés dans le monde. C'est surtout le filtre qui pose problème car il est composé d'acétate de cellulose, un additif plastique difficilement biodégradable que l'on retrouve dans la majorité des cigarettes commercialisées. Ce filtre a été introduit par l'industrie du tabac afin de donner aux fumeurs l'impression qu'ils courent moins de risques, alors qu'il n'a aucun effet bénéfique sur la santé. Les gouvernements et la société pourraient récolter les fruits d'une estimation des coûts engendrés par la prévention, l'élimination correcte et/ou le nettoyage des déchets liés aux produits du tabac, qui leur permettrait de mieux orienter les politiques et pratiques en la matière, mais aussi d'améliorer les résultats de santé publique. Estimer l'impact de ces déchets sur les communautés et les autorités compétentes pourrait encourager à adopter des mesures sanitaires, environnementales et fiscales, et pousser à responsabiliser davantage l'industrie mondiale du tabac vis-à-vis des coûts qu'ils entraînent. En vue de soutenir l'élaboration de politiques sanitaires et environnementales, nous proposons donc une approche empirique visant à déterminer les conséquences économiques des déchets générés par les produits du tabac en nous fondant sur l'influence néfaste qu'ils exercent sur l'environnement. Nous commençons par présenter des estimations globales pour six pays représentatifs, puis nous identifions les lacunes à combler dans les données afin de produire des estimations mondiales. Prendre des mesures de lutte contre ce type de déchets pourrait constituer un nouveau moyen de réglementer les produits du tabac dans différents secteurs comme la santé, l'environnement et les finances par exemple ­ et, par conséquent, faire diminuer la consommation de tabac en général.

El tabaquismo sigue causando una considerable tasa de mortalidad y morbilidad prematura en todo el mundo. La mayor parte de los casi seis billones de cigarrillos que se venden cada año en el mundo se desechan de forma inadecuada como residuos tóxicos para el medio ambiente. Los residuos de los productos del tabaco, incluidas las colillas, son los que más se recogen en todo el mundo. Un aspecto especialmente preocupante es el filtro de acetato de celulosa, un aditivo plástico poco degradable que se adhiere a la mayoría de los cigarrillos fabricados en el mercado. La industria del tabaco introdujo este filtro para reducir la percepción de daño y riesgo de los fumadores, pero no tiene ningún beneficio para la salud. A fin de fundamentar las políticas y prácticas sanitarias y mejorar los resultados en materia de salud pública, los gobiernos y la sociedad se pueden beneficiar de las estimaciones de costes de la prevención, la eliminación adecuada o la limpieza de los residuos de productos del tabaco. La estimación de los costes de los residuos de productos del tabaco para las comunidades y las autoridades responsables podría fomentar el desarrollo de intervenciones de política sanitaria, medioambiental y fiscal y trasladar la responsabilidad de los costes de los residuos de productos del tabaco a la industria del tabaco mundial. Para apoyar la elaboración de políticas sanitarias y medioambientales, se propone un enfoque empírico para estimar los costes económicos de los residuos de los productos del tabaco en función de sus consecuencias negativas para el medio ambiente. En primer lugar, se presentan estimaciones generales para seis países representativos y, a continuación, se identifican las deficiencias de información que se deben abordar para desarrollar estimaciones globales. Las intervenciones contra los residuos de productos del tabaco pueden constituir canales nuevos para regular los productos del tabaco en todos los sectores, por ejemplo, la salud, el medio ambiente y las finanzas, y, en consecuencia, reducir el consumo general de tabaco.

Naturalistic Topography Assessment in a Randomized Clinical Trial of Smoking Unfiltered Cigarettes: Challenges, Opportunities, and Recommendations.

Smoking topography (ST) is a set of measures profiling the behavioral characteristics of smoking in various settings. The CReSS portable device can measure ST in the natural environment. No standard protocol exists for measuring ST longitudinally with the CReSS. This study examined the utilization of the CReSS to measure ST and highlights challenges and opportunities in a naturalistic setting. This study is part of a randomized cross-over clinical trial of smoking filtered or unfiltered cigarettes. Participants (n = 43) smoked in each study condition for two weeks using the CReSS device for five days in their naturalistic smoking setting. The devices were calibrated and cleaned during the washout period, and data were downloaded every visit. Five test puffs were administered to calibrate each device. Moderate compliance rates (74.1%) were found with device usage, and the issues encountered were overheating/clogging, incorrectly registered date/time-stamped data, and device repair/replacement. Routine inspection/cleaning and training in device usage were instrumental in mitigating device malfunctioning. The CReSS device proved to be a feasible tool to examine naturalistic smoking topography and the potential impact of changes in tobacco product design on smoking unfiltered cigarettes. This is the first study to examine ST variables longitudinally, measured at multiple time points, and using unfiltered cigarettes.

Remediating Thirdhand Smoke Pollution in Multiunit Housing: Temporary Reductions and the Challenges of Persistent Reservoirs.

INTRODUCTION: Toxic tobacco smoke residue, also known as thirdhand smoke (THS), can persist in indoor environments long after tobacco has been smoked. This study examined the effects of different cleaning methods on nicotine in dust and on surfaces. AIMS AND METHODS: Participants had strict indoor home smoking bans and were randomly assigned to: dry/damp cleaning followed by wet cleaning 1 month later (N = 10), wet cleaning followed by dry/damp cleaning (N = 10) 1 month later, and dry/damp and wet cleaning applied the same day (N = 28). Nicotine on surfaces and in dust served as markers of THS and were measured before, immediately after, and 3 months after the cleaning, using liquid chromatography with triple quadrupole mass spectrometry (LC-MS/MS). RESULTS: Over a 4-month period prior to cleaning, surface nicotine levels remained unchanged (GeoMean change: -11% to +8%; repeated measures r = .94; p < .001). Used separately, dry/damp and wet cleaning methods showed limited benefits. When applied in combination, however, we observed significantly reduced nicotine on surfaces and in dust. Compared with baseline, GeoMean surface nicotine was 43% lower immediately after (z = -3.73, p < .001) and 53% lower 3 months later (z = -3.96, p < .001). GeoMean dust nicotine loading declined by 60% immediately after (z = -3.55, p < .001) and then increased 3 months later to precleaning levels (z = -1.18, p = .237). CONCLUSIONS: Cleaning interventions reduced but did not permanently remove nicotine in dust and on surfaces. Cleaning efforts for THS need to address persistent pollutant reservoirs and replenishment of reservoirs from new tobacco smoke intrusion. THS contamination in low-income homes may contribute to health disparities, particularly in children. IMPLICATIONS: Administered sequentially or simultaneously, the tested cleaning protocols reduced nicotine on surfaces by ~50% immediately after and 3 months after the cleaning. Nicotine dust loading was reduced by ~60% immediately after cleaning, but it then rebounded to precleaning levels 3 months later. Cleaning protocols were unable to completely remove THS, and pollutants in dust were replenished from remaining pollutant reservoirs or new secondhand smoke intrusion. To achieve better outcomes, cleaning protocols should be systematically repeated to remove newly accumulated pollutants. New secondhand smoke intrusions need to be prevented, and remaining THS reservoirs should be identified, cleaned, or removed to prevent pollutants from these reservoirs to accumulate in dust and on surfaces.

Online Simulation Model to Estimate the Total Costs of Tobacco Product Waste in Large U.S. Cities.

Tobacco product waste (TPW) is one of the most ubiquitous forms of litter, accumulating in large amounts on streets, highways, sidewalks, beaches, parks, and other public places, and flowing into storm water drains, waste treatment plants, and solid waste collection facilities. In this paper, we evaluate the direct and indirect costs associated with TPW in the 30 largest U.S. cities. We first developed a conceptual framework for the analysis of direct and indirect costs of TPW abatement. Next, we applied a simulation model to estimate the total costs of TPW in major U.S. cities. This model includes data on city population, smoking prevalence rates, and per capita litter mitigation costs. Total annual TPW-attributable mean costs for large US cities range from US$4.7 million to US$90 million per year. Costs are generally proportional to population size, but there are exceptions in cities that have lower smoking prevalence rates. The annual mean per capita TPW cost for the 30 cities was US$6.46, and the total TPW cost for all 30 cities combined was US$264.5 million per year. These estimates for the TPW-attributable cost are an important data point in understanding the negative economic externalities created by cigarette smoking and resultant TPW cleanup costs. This model provides a useful tool for states, cities, and other jurisdictions with which to evaluate a new economic cost outcome of smoking and to develop new laws and regulations to reduce this burden.

How Should Physicians in Low- and Middle-Income Countries Regard Electronic Nicotine Delivery Systems to Facilitate Smoking Cessation?

Electronic nicotine delivery systems (ENDS) have been widely referred to as "safer," "healthier," and more "effective" smoking cessation aids, but little evidence supports such claims. New concerns about pulmonary injuries associated with ENDS suggest reasons for concern about these products' health risks and potential for nicotine addiction. Nevertheless, multinational tobacco companies heavily market ENDS to retain customers with nicotine addiction, and global progress against tobacco use might slow as a result. The tobacco industry has managed to divide the tobacco control community by offering hope of harm reduction without actual evidence of ENDS' effectiveness or long-term safety. Low- and middle-income countries need this evidence to assess ENDS' value in mitigating tobacco use.

Tobacco industry responsibility for butts: a Model Tobacco Waste Act.

Cigarette butts and other postconsumer products from tobacco use are the most common waste elements picked up worldwide each year during environmental cleanups. Under the environmental principle of Extended Producer Responsibility, tobacco product manufacturers may be held responsible for collection, transport, processing and safe disposal of tobacco product waste (TPW). Legislation has been applied to other toxic and hazardous postconsumer waste products such as paints, pesticide containers and unused pharmaceuticals, to reduce, prevent and mitigate their environmental impacts. Additional product stewardship (PS) requirements may be necessary for other stakeholders and beneficiaries of tobacco product sales and use, especially suppliers, retailers and consumers, in order to ensure effective TPW reduction. This report describes how a Model Tobacco Waste Act may be adopted by national and subnational jurisdictions to address the environmental impacts of TPW. Such a law will also reduce tobacco use and its health consequences by raising attention to the environmental hazards of TPW, increasing the price of tobacco products, and reducing the number of tobacco product retailers.

Increasing hookah use in California.

Hookah use is gaining popularity nationwide. We determined the correlates and trends for hookah use from the California Tobacco Survey. Between 2005 and 2008 hookah use increased more than 40%, and in 2008, 24.5% of young men reported ever using a hookah. Hookah use was more common among the young (18-24 years), the educated, the non-Hispanic Whites, and the cigarette smokers. Hookah use is increasing in California, especially among young adults, and in 2008 reached the highest prevalence ever reported for both genders.

Global health diplomacy.

A variety of shifts emergent with globalization, which are reflected in part by nascent programs in "Global Public Health," "Global Health Sciences," and "Global Health," are redefining international public health. We explore three of these shifts as a critical discourse and intervention in global health diplomacy: the expansion in non-governmental organization participation in international health programs, the globalization of science and pharmaceutical research, and the use of militarized languages of biosecurity to recast public health programs. Using contemporary anthropological and international health literature, we offer a critical yet hopeful exploration of the implications of these shifts for critical inquiry, health, and the health professions.

Mortalidad atribuible al tabaquismo, años de vida potencial perdidos y costos directos para la atención de salud en Puerto Rico, 1983 / Smoking-attributable mortality, years of potential life lost, and direct health care costs for Puerto Rico, 1983

Se describen los efectos del tabaquismo en la salud observados en Puerto Rico en 1983. Mediante un programa para microcomputador que calcula la morbilidad atribuible al hábito de fumar, se estimó que el número de defunciones atribuibles al tabaquismo fue 2 468. Esta cifra equivale a 11,5 por ciento del total de defunciones de la isla en 1983 y representa aproximadamente 19 445 años de vida potencial perdidos. El hábito de fumar originó en Puerto Rico gastos directos por atención de salud de 55,9 millones de dólares estadounidenses, cantidad equivalente a 10 por ciento del total de gastos anuales en salud en la isla. Las estimaciones de este tipo demuestran los notables efectos del tabaquismo en la morbilidad y pueden ayudar a los responsables de las políticas de salud a planificar actividades de prevención e intervención, tanto en Puerto Rico como en cualquier otro país de América Latina

Smoking-attributable mortality, years of potential life lost, and direct health care costs for Puerto Rico, 1983

The authors report the impact of smoking upon health in Puerto Rico for the year 1983. Using a microcomputer spread-sheet program that calculates smoking-attributable disease impact, they estimated that 2,468 deaths were attributable to smoking. This represented 11.5 percent of all deaths on the island in 1983 and resulted in approximately 19,445 years of potential life lost (YPLL). It appears that cigarette smoking caused US$55.9 million in direct health care expenditures for Puerto Rico in 1983, an amount equal to 10 percent of the island's yearly expenditures on health. Calculations such as these demonstrate the enormous disease impact of smoking and may assist policy-makers in planning prevention and intervention activities, both in Puerto Rico and elsewhere in Latin America

Mortalidad atribuible al tabaquismo, años de vida potencial perdidos y costos directos para la atención de salud en Puerto Rico, 1983 / Smoking-attributable mortality, years of potential life lost, and direct health care costs for Puerto Rico, 1983

Se describen los efectos del tabaquismo en la salud observados en Puerto Rico en 1983. Mediante un programa para microcomputador que calcula la morbilidad atribuible al hábito de fumar, se estimó que el número de defunciones atribuibles al tabaquismo fue 2 468. Esta cifra equivale a 11,5 por ciento del total de defunciones de la isla en 1983 y representa aproximadamente 19 445 años de vida potencial perdidos. El hábito de fumar originó en Puerto Rico gastos directos por atención de salud de 55,9 millones de dólares estadounidenses, cantidad equivalente a 10 por ciento del total de gastos anuales en salud en la isla. Las estimaciones de este tipo demuestran los notables efectos del tabaquismo en la morbilidad y pueden ayudar a los responsables de las políticas de salud a planificar actividades de prevención e intervención, tanto en Puerto Rico como en cualquier otro país de América Latina

Disponible en inglés en Bull. Pan Am. Health Organ 25(1) 1991