Characteristics of new tobacco products emerging on the tobacco market: implications for tobacco control policies

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TobaccoFindings

Oral presentation by Lars Ramström at the Annual 8th Conference of ISPTID, Boston, USA, 29 Septemner to 1 October 2010

Health & Medicine

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

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Nicotine concentrations and craving relief by E-Cigarettes Eissenberg et al 2010

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(Am J Prev Med 2009;37(6):518–523) Eissenberg T, Shihadeh A

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 v ery low levels of tobacco-specific nitrosamines and benzo(a)pyrene

Mean nitrosamine content of moist snuff products from various sources based on dry weight

“ 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.

HARM 100% 10 0% Nicotine replacement products Snus Traditional cigarettes, Waterpipes Modified cigarettes E-cig ? THE CONTINUUM OF HARM FROM NICOTINE-DELIVERING PRODUCTS Snokless tobacco, e.g. India No tobacco use

Recommendations for regulation of smokeless tobacco ● The combined concentration of NNN plus NNK in smokeless tobacco should be limited to 2 μ g/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.”

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The document discusses tobacco harm reduction through the use of low-toxicity smokeless tobacco products like Swedish snus. It summarizes evidence from Swedish population studies that finds little risk of snus leading to smoking, strengthening nicotine addiction, or weakening smokers' efforts to quit. The evidence suggests that snus use can substantially reduce tobacco-related disease risk and that some smokers who switch to snus do subsequently quit nicotine altogether. There is little scientific evidence to support arguments against tobacco harm reduction and good evidence to reject such arguments.

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New tobacco and nicotine products such as e-cigarettes, waterpipes, and smokeless tobacco are emerging on the market. Waterpipe smoking appears to be more harmful than traditional cigarettes due to higher levels of toxic compounds. E-cigarettes deliver lower levels of nicotine but may help with smoking cessation to some extent. Swedish snus has a modest mortality risk increase over non-users but its use in Sweden has demonstrated public health benefits as an aid for smoking cessation. Regulating all smokeless tobacco products according to WHO guidelines on toxicant limits could benefit public health.

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The document discusses strategies for reducing tobacco harm in New Zealand. It agrees that increasing options for smokers who find quitting difficult is urgent. However, it argues that more can be done with existing nicotine replacement therapies (NRT) before introducing new tobacco products like Swedish snus. Specifically, the document suggests exploring longer-term NRT treatment and faster-acting NRT products first to help more smokers reduce harm from tobacco use. Introducing snus raises concerns about evidence of effectiveness, impacts on indigenous Māori populations, ties to the tobacco industry, and potential health risks from tobacco-specific nitrosamines.

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1) Tobacco was introduced to Europe in the 16th century and there are now over 1 billion smokers worldwide. Smoking causes over 8 million deaths per year projected to rise to 12% of all deaths by 2020. 2) Tobacco smoke contains over 500 compounds including nicotine and tars. Cigarette smoke is acidic whereas cigar and pipe smoke is alkaline, affecting how nicotine is absorbed and the associated health risks. 3) Smoking causes diseases of the cardiovascular and respiratory systems as well as various cancers. It is estimated smoking will cause over 450 million deaths between 2000-2050, around half between ages 30-69.

Tobacco Harm Reduction by Somchai Bovornkitti* in Crimson Publishers: Telemedicine and e-Health open access journals Cigarette smoke contain approximately 250 different chemicals known to be harmful to human health. Thousands of harmful chemical substances produce by the combustion of tobacco. The health impacts such as cancer and chronic lung disease are not only associated with smokers but also people who are exposed to secondhand smoke. Tobacco Harm Reduction is a concept to minimize the impacts of tobacco on the individual and on society at large. A key component of this strategy is using alternative source of nicotine as a substitute to tobacco cigarettes. Electronic cigarette and heated tobacco are alternatives that might have potential in reduce harm from smokes. This paper elaborates on available research associated with electronic cigarette and heated tobacco with harm reduction and risk perspective. https://crimsonpublishers.com/tteh/fulltext/TTEH.000522.php For more Open access journals in Crimson Publishers Please click on: https://crimsonpublishers.com/ For more Articles on Telemedicine and e-Health open access journals please click on link: https://crimsonpublishers.com/tteh/index.php Please follow the below link for our LinkedIn page https://www.linkedin.com/company/crimsonpublishers

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“Chemistry,” includes a brief description of technologies used by cigarette manufacturers in a limited number of cigarette brands marketed as “reduced exposure” or “lower yield” products. These commercial products have not been met with widespread consumer acceptance. The following section, “Biomarkers,” focuses on the manufactured tobacco burning cigarette consumed by the majority of smokers in the United States and elsewhere. The review on “Chemistry” describes the chemical components of cigarette smoke and addresses aspects of product design that alter the components of cigarette smoke and factors affecting delivery of smoke to the smoker. In most cases, the data reported for chemical levels in mainstream smoke were derived under standard smoking conditions described by the U.S. Federal Trade Commission FTC and the International Organization for Standardization ISO . These standard conditions are puff volume of 35 milliliters mL , two second puff duration, one minute puff frequency, and butt length defined as either 23 millimeters mm for nonfilter cigarettes or the length of the filter overwrap paper plus 3 mm. When alternative smoking regimens are used, levels of potentially harmful substances in smoke emissions usually differ from those measured under standard conditions. For more details, see “Delivery of Chemical Constituents into Tobacco Smoke” later in this chapter. When people smoke, they do not use the puff volume and puff frequency programmed into smoking machines, and smoking habits vary significantly from person to person and cigarette to cigarette. Consequently, actual exposures to and doses of components of smoke cannot be derived from values obtained with machine smoking. Cigarette smoke is a complex mixture of chemical compounds that are bound to aerosol particles or are free in the gas phase. Chemical compounds in tobacco can be distilled into smoke or can react to form other constituents that are then distilled to smoke. Researchers have estimated that cigarette smoke has 7,357 chemical compounds from many different classes .In assessing the nature of tobacco smoke, scientists must consider chemical composition, concentrations of components, particle size, and particle charge. These characteristics vary with the cigarette design and the chemical nature of the product.Scientists suggested an approach to identify the chemical components in tobacco smoke with the greatest potential for toxic effects. They considered the risk for cancer, cardiovascular disease, and heart disease. Using this approach, these investigators found that 1,3 butadiene presented by far the most significant cancer risk acrolein and acetaldehyde had the greatest potential to be respiratory irritants and cyanide, arsenic, and the cresols were the primary sources of cardiovascular risk. Other chemical classes of concern include other metals, N nitrosamines, and polycyclic aromatic hydrocarbons PAHs . This evaluation, along with the Hoffmann list of biol

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Smoking involves burning a substance and inhaling the smoke, which is harmful. Cigarette smoke contains over 4,000 chemicals including 43 cancer-causing compounds and 400 toxins like tar and nicotine. Nicotine is highly addictive and acts as both a stimulant and depressant in the brain. Smoking causes nearly 500,000 deaths annually in the US from cancers, heart disease, and strokes. While e-cigarettes were created to potentially reduce harm, they still deliver addictive nicotine and many contain other toxins. Quitting smoking improves health by reducing cancer risks and repairing damage to the lungs and blood vessels over time.

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This document summarizes a study comparing self-reported health perceptions among different groups of tobacco users in Sweden. The study found that: 1) Current daily smokers reported poorer satisfaction with their health, life, and higher numbers of sick days than other groups. 2) Daily snus users, both with and without a history of smoking, reported health perceptions similar to non-users and better than current smokers. 3) Former smokers who now use snus daily reported better mental health and life satisfaction than current smokers. The results suggest that smoking impairs perceived health while switching from smoking to snus may improve it.

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Characteristics of new tobacco products emerging on the tobacco market: implications for tobacco control policies

1. 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

3. Electronic cigarettes

4. Nicotine concentrations and craving relief by E-Cigarettes Eissenberg et al 2010

6. Waterpipe (Hookah, Hubble-Bubble)

7. (Am J Prev Med 2009;37(6):518–523) Eissenberg T, Shihadeh A

8. 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.

9. 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 v ery low levels of tobacco-specific nitrosamines and benzo(a)pyrene

10. Mean nitrosamine content of moist snuff products from various sources based on dry weight

11.

12.

13. Gartner et al. Lancet 2007

14. “ 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.

15. HARM 100% 10 0% Nicotine replacement products Snus Traditional cigarettes, Waterpipes Modified cigarettes E-cig ? THE CONTINUUM OF HARM FROM NICOTINE-DELIVERING PRODUCTS Snokless tobacco, e.g. India No tobacco use

16.

17. Recommendations for regulation of smokeless tobacco ● The combined concentration of NNN plus NNK in smokeless tobacco should be limited to 2 μ g/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.

18.

19.

20. ” 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.”

21.

Editor's Notes

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.

Characteristics of new tobacco products emerging on the tobacco market: implications for tobacco control policies

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Editor's Notes