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Dr. Lars M. Ramstom, Stockholm Sweden on Emerging Tobacco Products and the Impact on Tobacco Control Policy

Dr. Lars M. Ramstom, Stockholm Sweden on Emerging Tobacco Products and the Impact on Tobacco Control Policy



Dr. Ramstrom, from the Institute for Tobacco studies in Boston, 2010.

Dr. Ramstrom, from the Institute for Tobacco studies in Boston, 2010.



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  • Prevention of tobacco induced diseases is a very multifaceted issue. I am here going to focus on an aspect that, in recent years, has gained increasing attention, namely the need to help smokers who cannot quit so that they can find other means to minimise their risk for tobacco induced diseases. <br /> In order to put these matters in context, we need an overview of goals and objectives in the field of tobacco control. <br />

Dr. Lars M. Ramstom, Stockholm Sweden on Emerging Tobacco Products and the Impact on Tobacco Control Policy Dr. Lars M. Ramstom, Stockholm Sweden on Emerging Tobacco Products and the Impact on Tobacco Control Policy Presentation Transcript

  • 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 ECigarettes Eissenberg et al 2010
  • Reasons for using E-Cigarette N=81 In total 225 comments. • To quit smoking • For health reasons • E-cigarettes less expensive • E-cigs can be smoked everywhere • To avoid disturbing other people • For the pleasure of smoking • To reduce consumption of cigs • By curiosity 53 49 26 21 20 19 14 10 Does/did e-cigarette help you quit smoking Yes a lot 79% Somewhat 16% Etter 2010 Not at all 5%
  • Waterpipe (Hookah, Hubble-Bubble)
  • Eissenberg T, Shihadeh A (Am J Prev Med 2009;37(6):518–523)
  • Khabour et al. Assessment of Genotoxicity of Waterpipe and 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 cigarette smoking significantly increase the frequencies of SCEs (P < 0.01) compared with those of nonsmokers, indicating the genotoxic effect of tobacco smoking. In addition, frequencies of SCEs were significantly higher 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 the extent 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 µg/g NNN µg/g Sweden Ettan snus (2000) 0.5 1.1 188 - 362 241 - 369 4.3 3.4 20.8 14.3 Sudan (Toombak) 3 samples (1993) United States Skoal (2000) Copenhagen (2000)
  • Cancer of the oral cavity Age adjusted mortality rates per 100 000 Men in North America, Northern and Western Europe Estonia Lithuania Latvia France Austria Denmark Germany Ireland Belgium Luxembourg Switzerland Iceland Norway United Kingdom Canada The Netherlands United States Sweden 0 1 2 3 4 Source: GLOBOCAN 2002 database: http://www.-dep.iarc.fr 5 6
  • 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.
  • E-cig ? 100% 0% Snus Nicotine replacement products No tobacco use Snokless tobacco, e.g. India Modified cigarettes Traditional cigarettes, Waterpipes THE CONTINUUM OF HARM FROM NICOTINE-DELIVERING PRODUCTS HARM 10
  • 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.