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. In order to put these matters in context, we need an overview of goals and objectives in the field of tobacco control.
Dr. Lars M. Ramstom, Stockholm Sweden on Emerging Tobacco Products and the Impact on Tobacco Control Policy
Characteristics of new tobacco products
emerging on the tobacco market: implications
for tobacco control policies
Lars M. Ramström
Institute for Tobacco Studies
Annual 8th Conference of ISPTID, Boston, USA, 29 Septemner to 1 October 2010
New tobacco/nicotine products
• Swedish snus
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
Does/did e-cigarette help you quit smoking
Yes a lot
Not at all
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.
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
Brand (yr sampled)
Ettan snus (2000)
188 - 362
241 - 369
3 samples (1993)
Cancer of the oral cavity
Age adjusted mortality rates per 100 000
Men in North America, Northern and Western Europe
Source: GLOBOCAN 2002 database: http://www.-dep.iarc.fr
“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.
Nicotine replacement products
No tobacco use
Snokless tobacco, e.g. India
Traditional cigarettes, Waterpipes
THE CONTINUUM OF HARM FROM
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.”
• 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.