Emerging Tobacco Product Issues -- The New Kids in Town

MDCH Tobacco Program 11/09 Revised 11/10 AKA…

• So-called “harm reduced” products • Potentially reduced exposure products = PREPS • NonNon--tobaccotobacco nicotinenicotine productsproducts • Alternative tobacco products

The term ““HarmHarm ReductionReduction””

• Has been generally used in the fields of substance abuse, alcohol abuse, and sex health education

• And more recently to tobacco use – reducing the harm caused by tobacco by using products that are potentially less toxic…. Tobacco Harm Reduction Why?Why? • 70% of smokers want to quit • But only 4.7% of them quit for 3-12 months • This indicates difficulty in quitting… The Tobacco industry’s interest is to keep the addiction and protect their products… • The industry response: Provide a strategy to reduce tobacco harm (other thanthan quittingquitting); hence, the so-called “Harm Reduction” strategy. The term suggests a concern about the individual smoker’s health Yes, NicotineNicotine is highly addictive!

The Tobacco Industry always builds on its strength… Nicotine

There is ample evidence that the tobacco companies have long been expert in manipulating the amount of nicotine in their tobacco products… Increased Nicotine velsLe in Cigarettes Average Nicotine Yields Per Cigarette 1997-2005 Massachusetts Department of Health & Harvaard SchoolPublic of Health, 2007

1.95 1.91 1.9 1.9

1.85 1.84 1.82 1.82 1.8

1.75 1.73 1.7 1.7 1.68 1.68

Milligrams per cigarette 1.65

1.6

1.55 1997 1998 1999 200001 20 2002 2003 2004 2005 Year The mixed message about “harm reduction” and “reduced exposure”….

Reduced exposure ≠ reduced harm

ReducedReduced exposureexposure should result in reducedreduced riskrisk ofof diseasedisease if it is to be acceptable as a public health solution Tobacco Harm Reduction TheThe evidence?evidence? There is NO EVIDENCE to suggest that:

• there is enough reduction in tobacco toxinstoxins exposureexposure with any of the existing tobacco products to expect a corresponding reduction in diseasedisease riskrisk.

• Additionally, the extentextent of reduction of toxin exposure necessary to result in disease reduction is notnot yetyet knownknown. The following slides are pictures of so-called “reduced harm” or potentially “reduced exposure” products

Have you seen any of these in your community? Switching to Low-Tar Cigarettes

Light Cigarettes

Examples of looseloose--leafleaf Spit (chewing) Tobacco (Moist Snuff) Spit (chewing) Tobacco looseloose--leafleaf TuckedTucked betweenbetween thethe gumgum andand jawjaw Snuff-MoistMoist AA pinchpinch isis placedplaced betweenbetween thethe liplip oror cheekcheek andand gumgum andand heldheld forfor 3030 minutesminutes Snus AA finelyfinely groundground tobaccotobacco inin sachetssachets "tea"tea bagbag--likelike pouchespouches”” DryDry Snuff maymay bebe sniffedsniffed DryDry Snuff or used justjust thethe samesame asas moistmoist DryDry Snuff Examples of TwistTwist-Spit Tobacco Spit Tobacco - PlugPlug ChewedChewed oror heldheld inin thethe cheekcheek andand maymay bebe heldheld forfor hourshours Spit Tobacco - PlugPlug

Orbs Tobacco PlacedPlaced inin thethe mouth,mouth, onon thethe tonguetongue oror betweenbetween thethe cheekcheek andand gumgum wherewhere itit dissolvesdissolves toto releaserelease nicotinenicotine Orbs Tobacco ResemblesResembles candycandy andand breathbreath mintmint stripsstrips

Hookah (Water-pipe) Basic parts of the Hookah

1. Head: where tobacco is heated by charcoal.

2. Bowl: filled with liquid ( mostly water.)

1. Pipe (Body): that connect the head to the base of the bowl.

2. Hose: where the smokers inhale from. Flavored Tobacco UsedUsed forfor thethe HookahHookah E-cigarette ManufacturersManufacturers say:say: itit lookslooks likelike aa cigarette,cigarette, feelsfeels likelike aa cigarettecigarette andand tastestastes likelike aa cigarette,cigarette, yetyet itit isnisn’’tt aa cigarettecigarette E-cigarettes ManufacturersManufacturers considerconsider itit aa devicedevice –– notnot aa drugdrug E-Cigs: to confront the smoke free environmental law E-cigarettes ManufacturersManufacturers claimclaim thatthat theythey areare safersafer E-cigarettes ManufacturersManufacturers claimclaim thatthat theythey areare safersafer

•• TheThe FDA,FDA, onon JulyJuly 22,22, 20092009 announcedannounced thatthat thethe resultsresults ofof thethe analysisanalysis ofof thethe electronicelectronic cigarettecigarette samplessamples showedshowed thatthat thethe productproduct containedcontained detectabledetectable levelslevels ofof knownknown carcinogenscarcinogens andand toxictoxic chemicalschemicals toto whichwhich usersusers couldcould bebe exposed.exposed.

•• TheThe FDAFDA hashas notnot approvedapproved thethe importimport ofof ee-- cigarettescigarettes intointo thethe U.S.U.S. EE--cigarettescigarettes areare notnot anan approvedapproved FDAFDA product.product.

______

For more information, please contact your MDCH consultant