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.

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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.