Characteristics of new tobacco products emerging on the tobacco market: implications
for tobacco control policies
Lars M. Ramström
Institute for Tobacco Studies
Stockholm, Sweden
Annual 8th Conference of ISPTID, Boston, USA, 29 Septemner to 1 October 2010
New tobacco/nicotine products
• ”Ultra-light” cigarettes• Electronic cigarettes• Water pipe• Nicotine water• Nicotine disolvables
- strips- sticks- pellets
• Swedish snus
Electronic cigarettes
Nicotine concentrations and craving relief by E-Cigarettes
Eissenberg et al 2010
Reasons for using E-Cigarette N=81 In total 225 comments.• To quit smoking 53• For health reasons 49 • E-cigarettes less expensive 26• E-cigs can be smoked everywhere 21• To avoid disturbing other people 20• For the pleasure of smoking 19• To reduce consumption of cigs 14• By curiosity 10
Does/did e-cigarette help you quit smoking
Yes a lot 79%
Somewhat 16%
Not at all 5%Etter 2010
Waterpipe (Hookah, Hubble-Bubble)
(Am J Prev Med 2009;37(6):518–523)
Eissenberg T, Shihadeh A
Khabour et al. Assessment of Genotoxicity of Waterpipeand Cigarette Smoking in Lymphocytes Using the Sister-Chromatid Exchange Assay: A Comparative Study. Environmental and molecular mutagenesis 2010
The results show that waterpipe smoking and cigarettesmoking significantly increase the frequenciesof SCEs (P < 0.01) compared with those of nonsmokers,indicating the genotoxic effect of tobacco smoking.
In addition, frequencies of SCEs were significantlyhigher among waterpipe smokers compared with CS (P < 0.01), indicating that waterpipe smoking is more genotoxic than cigarette smoking.
Moreover, the frequency of SCEs increased with theextent of waterpipe use.
Swedish snus
Fine ground tobacco leaves predominantly from air-cured dark tobacco
Manufactured by a pasteurizing-like heating process (without fermentation as in manufacturing of American snuff), which results in very low levels of tobacco-specific nitrosamines and benzo(a)pyrene
Mean nitrosamine content of moist snuff products from various sources based on dry weight
Country Brand (yr sampled)
NNK g/g
NNN g/g
Sweden Ettan snus (2000)
0.5
1.1
Sudan (Toombak) 3 samples (1993)
188 - 362 241 - 369
United States Skoal (2000) Copenhagen (2000)
4.3 3.4
20.8 14.3
EstoniaEstoniaEstoniaEstoniaEstoniaLithuaniaLithuaniaLithuaniaLithuaniaLithuania
LatviaLatviaLatviaLatviaLatviaFranceFranceFranceFranceFrance
Austria Austria Austria Austria Austria DenmarkDenmarkDenmarkDenmarkDenmarkGermanyGermanyGermanyGermanyGermany
IrelandIrelandIrelandIrelandIrelandBelgium Belgium Belgium Belgium Belgium
LuxembourgLuxembourgLuxembourgLuxembourgLuxembourgSwitzerlandSwitzerlandSwitzerlandSwitzerlandSwitzerland
IcelandIcelandIcelandIcelandIcelandNorwayNorwayNorwayNorwayNorway
United KingdomUnited KingdomUnited KingdomUnited KingdomUnited KingdomCanadaCanadaCanadaCanadaCanada
The NetherlandsThe NetherlandsThe NetherlandsThe NetherlandsThe NetherlandsUnited StatesUnited StatesUnited StatesUnited StatesUnited States
SwedenSwedenSwedenSwedenSweden
0 1 2 3 4 5 6
Cancer of the oral cavityAge adjusted mortality rates per 100 000Men in North America, Northern and Western Europe
Source: GLOBOCAN 2002 database: http://www.-dep.iarc.fr
Gartner et al. Lancet 2007
“Our argument is that nicotine products should all be regulated rationally in relation to each other, in proportion to their level of hazard, in a system designed to reduce the overall harm caused by nicotine dependence and use.”
John Britton, Richard Edwards. Tobacco smoking, harm reduction, and nicotine product Regulation. Lancet 2008; 371: 441–45.
HARM100% 10 0%
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THE CONTINUUM OF HARM FROM NICOTINE-DELIVERING PRODUCTS
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Recommendations for regulation of smokeless tobacco●The combined concentration of NNN plus NNK in smokeless tobacco should be limited to 2 μg/g dry weight of tobacco.●The concentration of benzo[a]pyrene in smokeless tobacco should be limited to 5 ng/g dry weight of tobacco.
”Although nearly half of the smokers surveyed were willing to purchase an LNSLT product, most were interested in using these products for cessation rather than as a long-term substitute or for dual use with cigarettes.”
Summary• Waterpipe smoking appears to be even more harmful than smoking
traditional cigarettes.• Toxicants in E-cigarette vapour are not well known. Nicotine delivery is
low, but smoking cessation might be faciltated to some extent.• Mortality risk in users of Swedish snus is modestly higher than in never
tobacco users.• The potential public health benefits of Swedish snus as a non-medical
aid for large scale smoking cessation have now been demonstrated also outside Sweden.
• Product regulation of all smokeless tobaccos so as recommended by the WHO Study Group on Tobacco Product Regulation is an important public health issue.
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