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SpotlightHigh School Students Smoking Less Overall But Amount of Occasional Smokers Increasing A recent study from the CDC's Youth Risk Behavior Survey reveals an increased rate of occasional smoking among teenagers. The study, which surveyed over 11,000 teens, showed that while the overall rate of smoking has lowered, the amount of teens who smoke less than 11 cigarettes per day has increased from 67.2 percent in 1991 to 79.4 percent in 2009. Using data from the Youth Risk Behavior Survey, the study sought to explore trends in tobacco use among teenage smokers. The results were published in the September issue of the American Journal of Preventive Medicine. Dr. Terry Pechacek, associate director for science at the Office on Smoking and Health at the CDC, and one of the study's co-authors, remarked on the decrease in teens who smoke heavily, saying that "There may be an emerging pattern." According to Pechacek, "We may be creating a new type of smoker that may be more durable, that are adapting to smoke-free environments and to changing social norms." One key finding of the study was that while 19.5 percent of teens may call themselves smokers, the majority of these kids do not smoke daily. While this may seem like positive news, there is still a great deal of health risks associated even with light smoking. The risk of medical conditions such as ischemic heart disease, heart attack, aneurysm, and lung cancer are increased for even light smokers over non-smokers. So teens who smoke even four cigarettes per day can be gambling with their future health. Another key finding of the study with negative future health implications is the fact that heavy smoking has actually increased in Hispanic students, where teen smoking rates rose from 3.1 percent to 6.4 percent. Also, there was no change found among African-American teens, which goes against the trend of a decrease in tobacco use by white non-Hispanic high school students. In an interview with Reuters, Pechacek said that "We want to get across to people that although this is a positive trend, it's very unacceptable to have so many children exposing themselves to something so addictive. The greatest danger is minimizing the risk." This study shows that while there seems to be some breakthroughs among teens regarding the dangers of regular smoking, the burden of prevention must remain an active agenda item with parents and educators in order to continue reinforcing the dangers of tobacco use. The smoking cessation discourse towards teens needs to focus on targeting these new occasional users, and to include ways to create a decrease in the amount of heavy smoking in minority populations.
Research HighlightsMenthol Thwarts Smoking CessationSmokers of menthol cigarettes had a significantly lower quit rate than those who smoked nonmenthol brands, according to data from a large population survey. Overall, menthol cigarettes were associated with about a 10 percent lower cessation rate among smokers who tried to quit, as reported online in the American Journal of Preventive Medicine. The relationship was stronger among blacks, although some Hispanic subgroups had quit rates that were more than 40 percent lower if they smoked menthol cigarettes. "Despite the small associations, the present results are nontrivial," Cristine D. Delnevo, PhD, of the University of Medicine and Dentistry of New Jersey and the Cancer Institute of New Jersey in New Brunswick, and coauthors wrote in their discussion of the findings. "On the contrary, small but robust findings for smoking cessation are clinically meaningful because of the public health gains that accrue from stopping smoking." One recent study suggested that a ban on menthol cigarettes would prevent 300,000 to 600,000 tobacco-caused deaths over the next 40 years (Am J Pub Health2011;101:1236-1240), they added. Studies of smoking cessation have yielded conflicting results with respect to the impact of menthol cigarettes on quit rates. Clinical/community studies and national population surveys have produced a mix of significant associations between menthol cigarettes and lower quit rates and no evidence of a relationship. Delnevo and colleagues undertook a study that differed from previous investigations in that former smokers who recently quit were not excluded. Data for the analysis came from the Tobacco Use Supplement to the Current Population Survey. The Census Bureau conducts the labor force survey monthly for the Bureau of Labor Statistics, and the Tobacco Use Supplement is compiled every three years. The analysis comprised pooled data from 2003 and 2006/2007. The authors tested five population restrictions:
The sample comprised 71,193 survey respondents: 54,662 current smokers and 16,531 former smokers. With regard to racial/ethnic mix, whites accounted for 60,525 respondents, blacks for 5,827, and Hispanics for 4,841. The Hispanic group was further sub-grouped into Mexicans (2,769) and Puerto Ricans (735). About a fourth of the respondents reported smoking menthol cigarettes, including 27.9 percent of current smokers and 24.5 percent of former smokers. A higher proportion of women smoked menthol cigarettes (32.0 percent versus 22.8 percent), which also were associated with lower education and income and younger respondents. Blacks overwhelmingly preferred menthol cigarettes (71.8 percent) as compared with whites (21.0 percent) and Hispanics (28.1 percent). Overall, menthol smokers had an adjusted odds ratio for quitting of 0.91 as compared with smokers of nonmenthol cigarettes. Of the four other population restrictions, three had odds ratios of 0.90 to 0.92 and were statistically significant. Only the odds ratio for past-12-month smokers did not achieve statistical significance but was in the same direction as the other analyses. The odds decreased to 0.81 among blacks and ranged as low as 0.68 across the population restrictions. Whites had an odds ratio of 0.93, which was statistically significant, and Hispanics an odds ratio of 0.94, which did not achieve significance. The association between menthol cigarettes and quit rate varied among Hispanics by country of origin. Overall, Mexicans who smoked menthol cigarettes had increased odds for quitting, ranging as high as 1.35. In contrast, Puerto Ricans who smoked menthol cigarettes had substantially lower quit rates, associated with odds ratios of 0.42 to 0.63. "The magnitude of the relationships between menthol smoking and poorer cessation differed considerably by race/ethnicity and would have been masked in models that adjust only for race/ethnicity," the authors wrote in the discussion of their findings. "Historically, smoking-cessation research generally has grouped Hispanics together and contrasted them with non-Hispanic whites," they continued. "This prevailing approach ignores the vast heterogeneity of the Hispanic population." For more information, see web link:
Withdrawal from Heavy Cigarette Smoking Associated With Brain Imaging Changes in Regions Related to Mood Regulation Findings from a brain imaging study may provide clues for why some individuals with heavy cigarette-smoking habits experience depressed mood upon withdrawal from smoking, according to a report in the Archives of General Psychiatry. Cigarette smoking is the second leading cause of preventable death and is an important risk factor for coronary artery disease, lung disease, suicide and cancer, according to background information in the article. "Although many people who smoke cigarettes would like to quit, the effects of withdrawal frequently lead to relapse," write the authors. "Relapse is particularly problematic in early withdrawal because 50 percent of people relapse within the first 3 days of quitting." Previous research into early cigarette withdrawal has focused on nicotine's modulation of dopamine-releasing neurons. "However, other neural targets that may be important in cigarette withdrawal are affected by cigarette smoke," write the authors. For instance, the enzyme monoamine oxidase A (MAO-A), which metabolizes mood-enhancing chemicals, has been shown to be affected by cigarette smoke. In regions of the brain that modulate affect (mood), such as the prefrontal cortex and anterior cingulate cortex, elevations in MAO-A binding are associated with depressive episodes. "The main hypothesis of this study," the authors explain, "is that MAO-A binding increases during acute cigarette withdrawal in regions implicated in affect regulation, such as the prefrontal cortex and the anterior cingulate cortex." Ingrid Bacher, Ph.D., and colleagues from the Centre for Addiction and Mental Health, Toronto, and the University of Toronto, conducted a study of 24 healthy, nonsmoking individuals and 24 otherwise healthy cigarette-smoking individuals. Among the latter group, 12 were moderate smokers (15 to 24 cigarettes per day) and 12 were heavy smokers (25 or more cigarettes per day). Positron emission tomography (PET) scans were performed once in nonsmokers and twice in smokers (once after active cigarette smoking and once after acute withdrawal). Before scans were conducted, participants also completed an assessment of their mood, energy level, anxiety level and urge to smoke. An elevation in MAO-A density during cigarette withdrawal was found in the heavy-smoking subgroup but not the moderate-smoking subgroup, with a magnitude of change of 23.7 percent and 33.3 percent in the prefrontal and anterior cingulate cortices, respectively. A highly significant interaction between smoking severity and condition (measurement of MAO-A density during active smoking and withdrawal) was noticed among participants who smoked heavily. The MAO-A density levels in the prefrontal and anterior cingulate cortex were also significantly greater during heavy smokers' withdrawal period compared with healthy nonsmoking controls. In heavy-smoking individuals, researchers also noticed a change in depressed mood self-report between the withdrawal day and the active smoking day. "These results have significant implications for quitting heavy smoking and for understanding what has previously appeared to be a paradoxical association of cigarette smoking with major depressive disorder and suicide," state the authors. "Understanding the neurobiology of heavy cigarette smoking is important because those who smoke heavily are much more likely to have major depressive disorder and to experience medical complications resulting from cigarette smoking." The researchers also call for clinical trials of MAO-A inhibiting drugs among individuals in the earliest stages of quitting heavy cigarette smoking.
Smoking Linked to Half of Bladder Cancer Cases In WomenWomen cigarette smokers have a higher risk of bladder cancer than previously reported. According to scientists from the National Cancer Institute, published in the Journal of the American Medical Association. Bladder cancer is a cancer that forms in the tissue of the bladder in the inner lining of the bladder. The cells that form squamous cell carcinoma and adenocarcinoma develop as a result of chronic irritation and inflammation. In 2011, an estimated 69,250 people will be diagnosed with bladder cancer and 14,990 will die from the disease in the United States. In a study using data from over half a million participants in the NIH AARP Diet and Health, researchers found that in comparison to previous studies that has shown that only 20-30 percent of bladder cancer cases in the women were caused by smoking, new study data shows that smoking is responsible for about half of female bladder cancer cases, similar to the proportion found in men. The increase in the proportion of cases among women may be the result of the increased amount of female smokers; overall both men and women are equally likely to smoke in the United States, according to the CDC. The majority of earlier studies were conducted at the time when smoking was less common amongst women. Researchers found that risk by smoking is higher in this study than previously reported. "Current smokers in our study had a fourfold excess risk of developing bladder cancer, compared to a threefold excess risk in previous studies. The stronger association between smoking and bladder cancer is possibly due to changes in cigarette composition or smoking habits over the years," said the study author Neal Freedman, Ph.D. in the Division of Cancer Epidemiology and Genetics (DCEG) in National Cancer Institute (NCI). Researchers found that although there have been reductions in concentration of tar and nicotine in cigarettes, the concentration of certain carcinogens associated with bladder cancer has been increased. In the current study, former smokers were twice as likely to develop bladder cancer compared to non smokers, smoking cessation was associated with reduced bladder cancer risk, and participants who have not smoked for over 10 years had a lower incidence of bladder cancer compared to those who quit earlier or are continually smoking. "Our findings provide additional evidence of the importance of preventing smoking initiation and promoting cessation for both men and women," said senior author Christian Abnet, Ph.D., also from DCEG. "Although the prevalence of cigarette smoking has declined, about 20 percent of the U.S. adult population continues to smoke." For more information, see web link: Medical Daily August 21, 2011
Early Morning Smokers Have Increased Risk of Lung and Head and Neck Cancers, Study FindsTwo new studies have found that smokers who tend to take their first cigarette soon after they wake up in the morning may have a higher risk of developing lung and head and neck cancers than smokers who refrain from lighting up right away. Published online in Cancer, a peer-reviewed journal of the American Cancer Society, the results may help identify smokers who have an especially high risk of developing cancer and would benefit from targeted smoking interventions to reduce their risk. Cigarette smoking increases one's likelihood of developing various types of cancers. But why do only some smokers get cancer? Joshua Muscat, PhD, of the Penn State College of Medicine in Hershey, and his colleagues investigated whether nicotine dependence as characterized by the time to first cigarette after waking affects smokers' risk of lung and head and neck cancers independent of cigarette smoking frequency and duration. The lung cancer analysis included 4,775 lung cancer cases and 2,835 controls, all of whom were regular cigarette smokers. Compared with individuals who smoked more than 60 minutes after waking, individuals who smoked 31 to 60 minutes after waking were 1.31 times as likely to develop lung cancer, and those who smoked within 30 minutes were 1.79 times as likely to develop lung cancer. The head and neck cancer analysis included 1,055 head and neck cancer cases and 795 controls, all with a history of cigarette smoking. Compared with individuals who smoked more than 60 minutes after waking, individuals who smoked 31 to 60 minutes after waking were 1.42 times as likely to develop head and neck cancer, and those who smoked within 30 minutes were 1.59 times as likely to develop head and neck cancer. These findings indicate that the need to smoke right after waking in the morning may increase smokers' likelihood of getting cancer. "These smokers have higher levels of nicotine and possibly other tobacco toxins in their body, and they may be more addicted than smokers who refrain from smoking for a half hour or more," said Dr. Muscat. "It may be a combination of genetic and personal factors that cause a higher dependence to nicotine." According to the authors, because smokers who light up first thing in the morning are a group that is at high risk of developing cancer, they would benefit from targeted smoking cessation programs. Such interventions could help reduce tobacco's negative health effects as well as the costs associated with its use.
Pumping Iron Helps Smokers Quit Without Weight Gain: StudyThose who lifted weights regularly were twice as likely to kick the habit, researchers found. Would-be ex-smokers may want to try weight lifting to help them kick the habit for good, a new study suggests. The researchers found that three months of pumping iron seemed to help curb cigarette cravings and withdrawal symptoms, while lessening the weight gain that sometimes accompanies quitting. Overall, men and women who completed the resistance training program were twice as likely to kick the habit as smokers who didn't lift weights. "Cigarette smoking kills more than a thousand Americans every day, and while the large majority of smokers want to quit, less than 5 percent are able to do it without help," the study's lead author, Joseph Ciccolo, an exercise psychologist with the Miriam Hospital's Centers for Behavioral and Preventive Medicine, in Providence, said in a news release from the Lifespan health system. "We need any new tools that can help smokers successfully quit and it appears resistance training could potentially be an effective strategy," he added. In the study, which was funded by the U.S. National Cancer Institute, Ciccolo's team recruited 25 male and female smokers between the ages of 18 and 65 who had smoked at least five cigarettes per day for the past year or more. All of the participants were counseled on quitting smoking for 15 to 20 minutes and given an eight-week supply of the nicotine patch, before being randomized into two groups, the authors noted. The first group of smokers was asked to complete two one-hour full-body resistance training sessions involving 10 exercises each week for 12 weeks. The intensity of the training program was also increased every three weeks. Meanwhile, the second group of smokers ("controls") simply watched a brief health and wellness video twice a week. After completing the 12-week regimen, 16 percent of smokers in the weight-lifting group had successfully quit smoking, according to the study published in the journal Nicotine & Tobacco Research. As an added bonus, they had also lost body weight and body fat. In contrast, only 8 percent of the smokers in the control group had quit, and they had also gained both weight and body fat, the results showed. Three months later, 15 percent of those in the weight-lifting group had still not started smoking again, compared to 8 percent of the control group. However, despite "promising" results, the study authors noted that more research is needed on resistance training before it can be considered a clinical treatment for smoking cessation.
Support From Doctors May Help Smokers With Comorbid Conditions To QuitSmokers who also have alcohol, drug, and mental disorders would benefit greatly from smoking cession counseling from their primary care physicians and would be five times more successful at kicking the habit, a study by researchers at UCLA's Jonsson Comprehensive Cancer Center has found. Smokers with these comorbid conditions make up about 40 percent of the smoking population, have a more difficult time quitting and represent a significant burden on the healthcare system. If their primary care physicians could help them to quit smoking, it would aid both in improving the health of patients and reducing tobacco-related healthcare costs, said Dr. Michael Ong, an assistant professor of general internal medicine and health services research and a researcher with UCLA's Jonsson Comprehensive Cancer Center. "We found it would be very effective for primary care physicians to provide help in quitting smoking to these patients," Ong said. "However, in the context of everything these physicians are trying to do in a day, smoking cessation may fall by the wayside. It's also been thought that with this patient population, doctors should only take on one thing at a time, for example treating an opiate addiction and opting to deal with the smoking cessation later. But at the end of the day, we showed that smoking cessation counseling is effective in this patient population and should definitely be pursued." The study appears in Nicotine & Tobacco Research, the peer-reviewed journal of the Society for Research on Nicotine and Tobacco. Primary care physicians play an important role in smoking cessation counseling. However, prior to this study, their effectiveness with this patient population was unclear, Ong said. And while the Ong's study found that smokers with and without alcohol, drug or mental disorders were equally likely to receive smoking cessation counseling - 72.9 percent and 79.9 percent respectively - those with these disorders also quit smoking at equal levels when they got a little help from their doctor. The study found that the probability of patients with the comorbid disorders quitting without smoking cessation counseling was 6 percent, while patients without the comorbid disorders had a 10.5 percent chance of successfully kicking the habit. With smoking cessation counseling, patients with the comorbid conditions had five-fold better chance of quitting at 31.3 percent, while smokers without the other disorders had a three-fold better chance at 34.9 percent. "This study shows that primary care physicians can help smokers with alcohol, drug or mental disorders to successfully quit," the study states. "These smokers should be targeted for smoking cessation counseling to reduce the health burden of tobacco." Ong said there are much higher rates of smoking among schizophrenics and those with depression and anxiety disorders. Among drinkers, those with alcohol disorders include people who are alcohol dependent as well as weekend binge drinkers. For more information, see web link:
Other Cessation NewsFTC Reports Show Tobacco Companies Still Spend Huge Sums on MarketingThe Federal Trade Commission reported that cigarette marketing expenditures in the United States declined from $12.5 billion in 2006 to $10.9 billion in 2007 and $9.9 billion in 2008. The FTC also reported that smokeless tobacco marketing increased from $354.1 million in 2006 to $411.3 million in 2007 and $547.9 million in 2008. When measured from 2005, smokeless tobacco marketing has more than doubled (from $250.8 million to $547.9 million). While it is a positive step that cigarette marketing has declined, the tobacco companies continue to spend huge sums to market their deadly and addictive products. Counting both cigarette and smokeless tobacco marketing, the tobacco companies spent $10.5 billion on marketing in 2008 – nearly $29 million each day and 52 percent more than they spent at the time of the 1998 settlement of state lawsuits against the industry, which was supposed to curtail tobacco marketing. Tobacco companies in 2008 spent 20 times more to market tobacco products than the states currently spend on programs to prevent kids from smoking and help smokers quit (the states spent $517.9 million on such programs in fiscal year 2011). This huge mismatch between how much tobacco companies spend to encourage tobacco use and how much states spend to discourage it is a major contributing factor to the slowing of smoking declines in recent years. It is especially troubling that smokeless tobacco marketing more than doubled from 2005 to 2008 and increased by 277 percent since 1998. This has contributed to a 36 percent increase in smokeless tobacco use among high school boys between 2003 and 2009 (from 11 to 15 percent reporting smokeless tobacco use in the past month, according to the Centers for Disease Control and Prevention). Much of smokeless tobacco marketing in recent years has been aimed at enticing kids to start and at discouraging smokers from quitting, undermining efforts to reduce tobacco use. Tobacco companies continue to aggressively market traditional smokeless tobacco products, often in kid-friendly candy and fruit flavors (such as vanilla, cherry and apple Skoal). They have also introduced an array of new smokeless tobacco products, many like R.J. Reynolds' Camel Sticks, Strips and Orbs that appeal to kids because they look, taste and are packaged like candy and are easy to conceal. Increasingly, manufacturers have marketed smokeless tobacco as a complement to cigarettes in the growing number of places where smoking is not allowed. Marketing for R.J. Reynolds' Camel Snus has used the slogan "Pleasure for wherever," specifically encouraging use of the product in offices, bars, airplanes and concerts. Similarly, advertising for Philip Morris' Marlboro Snus stated, "So next time smoking isn't an option, just reach for your Snus." These products and marketing campaigns clearly discourage smokers from quitting – and truly protecting their health. The continuing high level of tobacco marketing shows why we need aggressive action by all levels of government to stop the tobacco epidemic. The Food and Drug Administration must effectively exercise its new authority over tobacco products and marketing, while the Administration and Congress should fund and implement the federal government's new Tobacco Control Strategic Action Plan. The states must pick up the pace of their efforts to increase tobacco taxes, enact smoke-free laws and fund tobacco prevention and cessation programs. Tobacco use is the nation's number one cause of preventable death, killing more than 400,000 people and costing $96 billionin health care bills each year. These deaths and costs are entirely preventable if elected officials at all levels fight tobacco use as aggressively as the tobacco companies market their deadly products. Related materials: FTC cigarette report for 2007 and 2008 FTC smokeless tobacco report for 2007 and 2008 For more information, see web link: PR Newswire August 1, 2011
Tobacco Giants Suing FDA Over Warning Labels MandateFive tobacco companies, including some of the largest in the United States, filed a lawsuit against the federal government, alleging that government-mandated graphic warning labels on cigarette packages unconstitutionally infringe on the companies' rights. "The primary complaint is that we think it violates the First Amendment for the government to require people who produce a lawful product to essentially urge prospective purchasers not to buy it," says Floyd Abrams, a prominent First Amendment case expert who's representing the plaintiffs. The lawsuit, filed in the U.S. District Court for the District of Columbia, pits R.J. Reynolds, Lorillard, Commonwealth, Liggett, and Santa Fe Natural Tobacco against the Food and Drug Administration, its chief, Margaret Hamburg, and Health and Human Services Secretary Kathleen Sebelius. In June, the FDA unveiled nine new warning labels, complete with graphic photos and the phone number 1-800-QUIT-NOW. FDA regulations say that starting in September, 2012, half of each cigarette package will have to display one of those new labels. Abrams says the tobacco companies don't have a problem with the written wording required by the latest FDA ruling. "The government has lot of power to require warnings, but it doesn't require half of a cigarette pack to scream out, 'Don't buy this product!," the New York-based attorney says. "What is at issue is putting photographs of diseased people on every cigarette pack, include a phone number, and ask people to stop smoking. It's the direct advocacy to not buy the product, as opposed to a straightforward warning." Abrams says it's likely his clients will seek some sort of preliminary injunction against the warning labels before the statute goes into effect next year. "[We're] seeking resolution prior to that, in light of all the funds that would need to be expended changing current warnings to the level of screaming at prospective purchasers not to buy the product," Abrams says. An FDA spokeswoman said in a statement that the agency "does not comment on proposed, pending or ongoing litigation." Tobacco use is the leading cause of premature and preventable death in the United States, and it claims almost half a million lives each year, according to the FDA website. The more prominent cigarette health warnings are the first time those warnings have been revised in 25 years and "are a significant advancement in communicating the dangers of smoking... expected to have a significant public health impact by decreasing the number of smokers, resulting in lives saved, increased life expectancy, and lower medical costs," the FDA website says.
How Safe Is Tobacco That Melts In Your Mouth?Big name tobacco brands are ramping up their presence in the dissolvable tobacco game, and consumers in test markets, as well as regulators, are trying to figure out what make of the new products. In early 2011, in Colorado and North Carolina, R.J. Reynolds began test-marketing Camel-branded wares — tobacco compressed into toothpicks, mints and strips that dissolve in your mouth. Unlike cigarettes, they produce no smoke, and unlike smokeless tobacco, you don't have to spit when you use them. Aimed at adult smokers who want a nicotine kick in cigarette-free zones, Camel ads tout the products with the tag line, "What you want, when you want, where you want." The Colorado Department of Public Health held a hearing to discuss the problem of who might want them: namely, kids and teens. Stephanie Walton of the state's health department, who specializes in youth tobacco prevention, laid out the potential draws: youth are price- and brand-oriented, she said, and Camel Sticks, Orbs and Strips are selling in Colorado for about $2.50 for a 12-pack, compared to roughly $5 for a pack of cigarettes. (Dissolvables are cheaper because they aren't yet taxed like tobacco products.) Camel is also a recognizable brand, as are Marlboro and Skoal, which have been test-marketing their own dissolvable "tobacco sticks" in Kansas, and are therefore more likely to attract younger customers. Although other dissolvable tobacco products have been on the market for a decade, including Ariva and Stonewall, both manufactured by Star Scientific, they have not been advertised like Camel products and are likely unknown to the average teenager (or adult for that matter). The new dissolvables are all mint-flavored, like "a really weak Listerine breath strip, with a cigarette undertone," as a Colorado man sampling Camel Strips at recent beer festival described the experience for a local media station — another draw for youths, particularly young girls. They're also small and easy to conceal. However, R.J. Reynolds says the products are made for and marketed to adults and will be sold in convenience stores and smoke shops right alongside other tobacco products, with the same age restrictions and health warnings. In response to critics' suggestions that the products appear too much like little treats, R.J. Reynolds spokesman Richard Smith counters, "Those who keep referring to these tobacco products as 'candy' or 'mints' are irresponsibly perpetuating false and misleading information." During the hearing, R.J. Reynolds scientist Geoffrey Curtin emphasized that the health risks associated with dissolvable products are less dire than those linked with cigarettes; there's less concern about lung cancer, for example. But studies have shown that use of smokeless tobacco increases the risk of heart disease and gum disease, as well as the risk of oral, esophageal and pancreatic cancers. Some advocates for "harm reduction," like the Consumer Advocates for Smoke-Free Alternatives, typically view such products as a lesser evil — better, at least, than smoking. The American Cancer Society also describes smokeless products as "less lethal," but notes that users "set themselves up for new health problems" by using them as a crutch instead of quitting tobacco altogether. Curtin issued the industry argument that dissolvables "may serve as a gateway away from smoking," but rather than rely on them as vehicle for quitting, many consumers use similar smokeless products, including Camel's Snus, spitless tobacco pouches, in conjunction with cigarettes. In fact, dissolvables deliver about as much of the addictive drug nicotine as cigarettes do. Meanwhile, the U.S. Food and Drug Administration (FDA), which was for the first time in 2009 given the power to regulate cigarettes and other tobacco products, is reviewing whether and how it may control dissolvables. The agency is examining the health effects and marketing of the products, but will not produce a report on the matter — or even speculate about what the report will contain — until March 2012. The FDA has asked for all available research from the tobacco companies, but relatively few studies have been conducted. In March of this year, in response to an application submitted by Star Scientific for approval to market two new lower-potency dissolvables as "modified risk tobacco products," the FDA announced, much to the dismay of anti-smoking advocates, that the lozenges were not subject to the agency's regulation. However, 12 U.S. Senators asked the FDA to reconsider, and the agency is expected to close any loopholes that would prevent it from controlling dissolvables in the future. FDA spokesperson Stephanie Yao said in an email that the agency "believes" many, though not all, of these products will fall under the category of smokeless tobacco, which the FDA is fully able to regulate. So far, though, there isn't yet a statutory definition for the new products. R.J. Reynolds says it is operating under the assumption that all dissolvable tobacco products will be subject to regulation. But skeptics say they'll believe that when they see it. "Tobacco companies are always one step ahead of the sheriff," Sen. Sherrod Brown (D-Ohio) recently told the Los Angeles Times. "They have found ways to evade the rules and regulations and public health warnings." If the growing popularity of other smokeless tobacco products, including electronic cigarettes, chew and snuff, is any indication, the FDA's problem isn't going away. According to a 2010 report by the international company Research and Markets, the use of these products is increasing 7% per year. In some states the rate of smokeless tobacco use among men is nearly equal to the national smoking rate, at 20.8%. R.J. Reynolds' Smith says dissolvables were developed specifically to meet smokers' needs. In an era of proliferating smoking bans and less social acceptance of the habit, the industry has had to transform, he says. "They meet societal expectations," says Smith. "There's no second-hand smoke, there's no spitting, and with dissovables, there's no cigarette-butt litter."
Extra Benefits Of Smoke-Free Policies: A Saving In Cleaning CostsWhen apartment tenants light up a cigarette, it's not just their smoking-averse neighbors who suffer. Landlords are also sucking it up - in increased cleaning costs.
The researchers caution that the survey response rate - 22.4 percent - was low, though it was similar to other CAA survey respose rates. Also, the study was suspended for approximately six months due to the state budget crisis, which may have affected the response rate. In addition, responses to detailed financial questions may have been affected by recall bias, though potential respondents were notified in advance that they would be asked about these costs.
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