The Vast Majority of Smokers Inaccurately Believe that
Smokeless Tobacco Products are as Hazardous as Cigarettes
While ST products are far less hazardous alternatives to cigarettes, a recent survey of more than 13,000 cigarette smokers in the US, Canada, UK and Australia found that only 13% correctly believed that ST products are less hazardous than cigarettes.
Smokers' beliefs about the relative safety of other tobacco products: Findings from the ITC Collaboration, Richard J. O'Connor; Ann McNeill; Ron Borland; David Hammond; Bill King; Christian Boudreau; K. Michael Cummings, Nicotine & Tobacco Research, Volume 9, Issue 10 October 2007, pages 1033-1042.
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A 2000 survey of 36,012 young adults entering the U.S. Air Force found that 75% of males and 81% of females incorrectly believed that switching from cigarettes to ST products would not result in any risk reduction, while another 16% of males and 13% of females incorrectly believed that only a small risk reduction would occur. Only 2% of males and 1% of females correctly thought that a large risk reduction would occur by switching from cigarettes to ST.
Modified Tobacco Use and Lifestyle Change in Risk-Reducing Beliefs About Smoking, Haddock CK, Lando H, Klesges RC, et al, American Journal of Preventive Medicine, 2004 Vol. 27, No. 1, 35-41.
Another survey found that 89% of college freshmen incorrectly believe that ST is just as or more harmful than cigarettes.
Harm perception of nicotine products in college freshmen, Smith SY, Curbow B, Stillman FA, Nicotine Tob Res. 2007 Sep;9(9):977-82.
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A survey of more than 2,000 adult U.S. smokers found that only 10.7% correctly agreed that ST products are less hazardous than cigarettes, while 82.9% incorrectly disagreed.
Smoker Awareness of and Beliefs About Supposedly Less-Harmful Tobacco Products, O’Conner RJ, Hyland A, Giovino G, et al, American Journal of Preventive Medicine, 2005, Vol. 29, No. 2, 85-90.
In yet another survey, when asked if they believed that chewing tobacco is just as likely to cause cancer as smoking cigarettes, 82% of U.S. smokers incorrectly agreed.
Informing Consumers about the Relative Health Risks of Different Nicotine Delivery Products, presentation by K. Michael Cummings at the National Conference on Tobacco or Health, New Orleans, LA, November 2001.
A recently published study in 2011 at
http://www.harmreductionjournal.com/...-7517-8-21.pdf similarly found that 5 of 6 smokers in the US inaccurately believe that smokeless tobacco products are just as hazardous as cigarettes.
The reason for this lack of knowledge is largely due to the 1986 Comprehensive Smokeless Tobacco Education Act, which required three rotating warnings on all smokeless tobacco products (i.e. This product is not a safe alternative to cigarettes. This
product may can mouth cancer. This product may cause gum disease and tooth loss.)
Since the FSPTCA now requires even larger warnings on smokeless tobacco products and advertisements, it is critically important for the FDA propose a regulation to eliminate these misleading mandatory warnings on smokeless tobacco products.
Authors of a study that evaluated 316 English language websites (none of which were tobacco companies) that contained health risk information about cigarettes and smokeless tobacco use concluded: “The risk from ST is widely conflated with the risk from cigarettes on websites that provide health advice and information. Almost every website had statements that played up the health risks from ST without caveat, making it difficult for consumers to recognize the huge contrast with cigarettes. The quantitative claims of health risks from ST were very often beyond a worst-case-scenario interpretation of the scientific literature. A large portion of websites directly stated or implied that the risks from ST and cigarettes are similar.”
You might as well smoke; the misleading and harmful public message about smokeless tobacco, Carl V Phillips, Constance Wang, Brian Guenzel,
BMC Public Health 2005, 5:31doi:10.1186/1471-2458-5-31
BioMed Central | Full text | You might as well smoke; the misleading and harmful public message about smokeless tobacco
It is extremely important that FDA truthfully inform all tobacco consumers and the public about the vastly different health risks and benefits of different types of tobacco products. Unfortunately, the FDA, like many other government health agencies, is presently misrepresenting the health risks of different products by falsely claiming:
“To date, no tobacco products have been scientifically proven to reduce risk of tobacco-related disease, improve safety or cause less harm than other tobacco products.” at Health Fraud, the webpage entitled “Health Fraud”. The FDA needs to correct that webpage ASAP.
Smokers have a Human Right to be Truthfully Informed that Smokeless Tobacco Products are Far Less Hazardous Alternatives to Cigarettes
Just as sexually active individuals have a human right to be informed that condoms can reduce risks of pregnancy and STD transmission, and just as ...... addicts have a right to be informed that clean needles can reduce risks of HIV, hepatitis and other blood borne diseases, cigarette smokers have a human right to be truthfully informed that ST products are far less hazardous alternatives than cigarettes.
Harm reduction, public health, and human rights: Smokers have a right to be informed of significant harm reduction options, Kozlowski L, Nicotine & Tobacco Research, S55-S60, 2002.
http://ash.org.uk/html/regulation/pdfs/hr_kozlowski.pdf
First Tell The Truth, A Dialogue on Human Rights, Deception, and the Use of Smokeless Tobacco as a Substitute for Cigarettes, Kozlowski L, Tob Control,12:34-36, 2003. Search Results
Public Health Officials have an Ethical Duty to Truthfully Inform Smokers that Smokeless Tobacco Products are Far Less Hazardous Alternatives
Just as the US Public Health Service had an ethical duty to inform black syphilis sufferers in the notorious Tuskegee Study that there were effective treatments for syphilis, public health officials have an ethical duty to truthfully inform smokers that ST products are less hazardous alternatives to cigarettes. To intentionally deceive smokers and the public about health risks of smokeless tobacco products is public health malpractice.
No Evidence Smokeless Tobacco is a Gateway to Cigarette Smoking
Authors of a recently published analysis of NSDUH data concluded that: “Smokeless Tobacco (ST) use has played virtually no role in smoking initiation among White men and boys, the demographic groups among which ST use is most prevalent. There is evidence that, compared with cigarette initiators, ST initiators are significantly less likely to smoke.”
Evidence against a gateway from smokeless tobacco use to smoking, Brad Rodu and Philip Cole, Nicotine Tob Res (2010) 12 (5): 530-534. doi: 10.1093/ntr/ntq033
http://ntr.oxfordjournals.org/content/12/5/530.short
Using most of the same data, a 2009 SAMHSA report found that, among US residents who had used both cigarettes and smokeless tobacco products in their lifetime, 65.5% used cigarettes prior to smokeless tobacco use, and 31.8% used smokeless tobacco prior to cigarette usage.
Substance Abuse and Mental Health Services Administration, Office of Applied Studies. (February 19, 2009). The NSDUH Report: Smokeless Tobacco Use, Initiation, and Relationship to Cigarette Smoking: 2002 to 2007. Rockville, MD.
Smokeless Tobacco Use, Initiation, and Relationship to Cigarette Smoking: 2002 to 2007
Smokeless Tobacco Products Pose Very Little Risk of
Accidental Child Ingestion
A recently published article, which has been widely publicized by abstinence-only advocates who oppose tobacco harm reduction, alleged that dissolvable tobacco products (which the author’s repeatedly referred to as candy-like) are potentially toxic to children and that thousands of cases of ingestion of tobacco products has been reported.
Unintentional Child Poisonings Through Ingestion of Conventional and Novel Tobacco Products, Gregory N Connolly, Patricia Richter, Alfred Aleguas Jr, Terry Pechacek, Stephen Stanfill, Hilbert Albert, Pediatrics 2009-2835.
http://pediatrics.aappublications.or...-2835.abstract
In rebutting the alarmist claims made in the Connolly et al article, Brad Rodu revealed that, according to the 2008 report of the American Association of Poison Control Centers, all types of tobacco products only accounted for 1% of all reported exposures to non-pharmaceutical agents of all kinds in children less than 6 years of age, and that smokeless tobacco products accounted for just 15% of the reported tobacco exposures.
Poisoning Public Health Issues, Brad Rodu, Tobacco Truth, April 19, 2010
Tobacco Truth: Poisoning Public Health Issues
A recently published study at ScienceDirect - Regulatory Toxicology and Pharmacology : Frequency and outcomes of accidental ingestion of tobacco products in young children
evaluated twenty-seven years of annual reports by American Association of Poison Control Centers (AAPCC) for occurrence and outcomes associated with accidental ingestion events involving tobacco and pharmaceutical nicotine products among young children. In sharp contrast to the alarmist claims by Connolly et al (cited above), the author of this far more comprehensive review concluded: “The rate of major, non-fatal, outcomes was <0.1%. Data from AAPCC reports and other sources indicate the frequency of accidental poisoning events is relatively low for tobacco products compared with other products such as drugs, dietary supplements, cleaning products, and personal care products. These findings, along with those for pharmaceutical nicotine products, are consistent with published case reports and reviews, indicating that the frequency and severity of outcomes associated with accidental ingestion of tobacco products by young children appear to be relatively low. However, adults should keep tobacco products out of the reach of children.”
The Overwhelming Majority of NRT Users Switch Back to Cigarettes
A meta-analysis found that an average of just 7% of those using over-the-counter NRT products remained cigarette free after six months, a 93% relapse rate.
A meta-analysis of the efficacy of over-the-counter nicotine replacement, Hughes JR, Shiffman S, Callas P, Zhang Z, Tobacco Control, 2003, Vol. 12, 21-27. Sign In
Another recent meta-analysis also found that 7% of NRT remain cigarette free after six months, and that just 2% remain cigarette free after 20 months (a 98% relapse rate).
Effectiveness and safety of nicotine replacement therapy assisted reduction to stop smoking: systematic review and meta-analysis, David Moore, Paul Aveyard, Martin Connock, Dechao Wang, Anne Fry-Smith, Pelham Barton, BMJ 2009;338:b1024
Effectiveness and safety of nicotine replacement therapy assisted reduction to stop smoking: systematic review and meta-analysis -- Moore et al. 338 -- bmj.com
A meta analysis of seven placebo controlled randomised controlled trials involving different NRT products found that just 6.75% of those receiving NRT had quit smoking after six months. While this may have been twice the quit rate compared to placebo, it represents a 93.25% failure rate for smoking cessation, and clearly indicates that smokers need additional and alternative methods of reducing the health risk of cigarette smoking.
Effectiveness and safety of nicotine replacement therapy assisted reduction to stop smoking: systematic review and meta-analysis, David Moore, Paul Aveyard, Martin Connock, Dechao Wang, Ann Fry-Smith, Pelham Burton, BMJ 2009; 338:b1024
ScienceDirect - Addictive Behaviors : Adolescents' self-reported reasons for using nicotine replacement therapy products: A population-based study
While supposedly double-blind clinical trials have found that NRT products double the chances of quitting when compared to using a placebo, skepticism has been raised about the accuracy and reliability of these studies, since it is likely that many participants who were assigned to placebos realized they were not getting nicotine.
The blind spot in the nicotine replacement therapy literature: Assessment of the double-blind in clinical trials, Mooney M, White T, Hatsukami D, Addictive Behaviors, 2004 Vol. 29, 673-684.
http://whyquit.com/studies/NRT_Blinding_Failures.pdf
Precessation treatment with nicotine patch significantly increases abstinence rates relative to conventional treatment, Jed E. Rose, Joseph E. Herskovic, Frederique M. Behm and Eric C. Westman, Nicotine & Tobacco Research 2009 11(9):1067-1075; doi:10.1093/ntr/ntp103.
http://ntr.oxfordjournals.org/cgi/co...bstract/ntp103
Skin patches appear to be ineffective smoking cessation aids for those who fail to quit smoking during their first use of NRT, as two published studies on the use of NRT skin patches to quit smoking after an initial failure with NRT found six-month smoking cessation rates of 0% and 1.4%, respectively.
Recycling with nicotine patches in smoking cessation. Tonnesen P, Norregaard J, Sawe U, Simonsen K, Addiction. 1993 Apr;88(4):533-9.
Recycling with nicotine patches in smoking cessation. [Addiction. 1993] - PubMed - NCBI
Double blind trial of repeated treatment with transdermal nicotine for relapsed smokers. Gourlay SG, Forbes Q, Marriner T, et al. British Medical Journal, 1995, Vol. 311, No 7001 363-366.
A survey of 500 U.S. smokers found only 16% agreed that NRT helps people quit smoking.
Attitudes toward nicotine replacement therapy in smokers and ex-smokers in the general public. Etter JF, Perneger TV, Clinical Pharmocol Therapy 2001 Volume 69, 175-83.
An estimated 36.6% of current nicotine gum users have consumed the product for longer than six months, indicating that long-term nicotine maintenance can occur with NRT gum, just as can occur with smokefree tobacco products.
Persistent use of nicotine replacement therapy: analysis of actual purchase patterns in a population based sample, Shiffman S, Hughes JR, Pillitteri JL, Burton SL, Tobacco Control, Vol. 12, 310-316, 2003. Sign In
Dissolvable nicotine lozenges marketed by GlaxoSmithKline as smoking cessation aids (formerly called Commit and now called Nicorette) have been available in different flavorings, including cherry, mint and formerly cappuccino.
Nicorette Lozenge - Nicotine Lozenge | To Help You Quit
NEW! Nicorette mini Lozenge | Nicotine Lozenges To Help You Quit Smoking
Ironically (or not), critics of flavored tobacco products that receive funding from drug companies have remained silent about strikingly similar flavored NRT products.
This extensive research indicates that the more than 95% of smokers who have used NRT products (to quit smoking) relapse back to cigarettes, that subsequent attempts to quit by using NRT virtually always fail, and that smokers should be provided truthful information about, and legal and affordable access to, other types of smokefree tobacco/nicotine products.
Marketing of tobacco products to minors violates the 1998 Master Settlement Agreement, laws in all 50 states, and the FSPTCA
Although some anti-tobacco activists continue to publicly accuse tobacco companies of target marketing tobacco products to youth (including dissolvable tobacco products), it is critically important to note that marketing tobacco products to minors violates the 1998 Master Settlement Agreement, statutes in all 50 states, and the FSPTCA.
During the Senate HELP Committee markup of the FSPTCA in 2009, Senators Sherrod Brown and Jeff Merkley (when proposing the amendment to require the FDA to study dissolvable tobacco products) repeatedly accused RJ Reynolds of target marketing the company’s new dissolvable tobacco products (i.e. Camel Orbs, Strips and Sticks) to minors. But no evidence was provided indicating that Reynolds (or any other tobacco company) was marketing their tobacco products to minors.
Similar unsubstantiated allegations were made against Star back in 2001/2002 when Citizens Petitions urged the FDA to ban Star’s Ariva and Stonewall dissolvable tobacco products. In the past decade, no evidence has been provided indicating that youth use Ariva or Stonewall, or that Star markets its products to minors.
All three of the 2001/2002 Citizen Petitions urging the FDA to ban Star’s Ariva and Stonewall also repeatedly referred to the products as “candy like” in an attempt to deceive the agency and the public to believe that Star was marketing to youth. A decade later, and the same false “candy like” references to dissolvable tobacco products has been repeated by those who accuse tobacco companies of marketing the products to minors.
Instead of repeating unsubstantiated accusations to the media, anyone who has any evidence that any tobacco products are being illegally marketed to youth should notify the State AG, State Health Department and/or FDA for enforcement or other remedial action.
Referring to any tobacco product as “candy” or “candy-like” can only encourage youth to use these products, which raises serious concerns about the true motives of those who call tobacco products “candy” or “candy-like’. But that’s precisely what many anti tobacco activists have done, including Karla Sneegas from the Indiana Dept. of Health, as well as in an article recently coauthored by FDA’s Lawrence Deyton.
At the July TPSAC meeting, Neal Benowitz repeatedly cited the results of a 2010 junk science push-poll at
http://www.healthyyouthva.org/documents/Meltdown.pdf that showed prearranged photographs of similar looking candy and tobacco products/packages to youth (the latter of which most youth had never heard of or seen before), and then asked the youth if they believed the tobacco products looked like candy and if they might want to try using them. The grossly misleading VA Foundation for Healthy Youth's press release publicizing the manufactured results of this push-poll is at:
http://www.healthyyouthva.org/docume...el_May2010.pdf
and a subsequent newspaper article (that repeated the push-poll’s unscientific findings) entitled “Many teens mistook smokeless tobacco products for candy” is at:
Many teens mistook smokeless tobacco products for candy | Richmond Times-Dispatch
Since Section 906(d)(3)(A)(ii) of the FDA tobacco laws prohibits the FDA from banning tobacco sales to 18 year olds (the vast majority of whom are 12th grade high school students), it is doubtful that any amount or type of FDA tobacco regulation can substantially reduce tobacco use among 12th graders (or underclass peers/siblings who obtain tobacco from 18 year olds).
Although some surveys indicate that youth usage of smokeless tobacco products has increased slightly during the past several years, it is likely that many new youth smokeless users are also cigarette smokers who desire smokefree alternatives to cigarettes. While many anti tobacco extremists have falsely claimed that smokers who also use smokefree tobacco products increase their risks, dual usage of smokeless tobacco and cigarettes is a necessary prerequisite (that can last several weeks, months or years) for cigarette smokers to switch to less hazardous smokefree alternatives, which sharply reduces their tobacco attributable disease and death risks.
Interestingly, a newly published survey of 14-18 year old adolescents in Finland found that 10% had used NRT products, and that most users were daily smokers. The reasons for NRT use were just try (56%), to quit (33%) and smoking not possible (24%). Adolescents’ self-reported reasons for using nicotine replacement therapy products: A population-based study, Susanna Raisamo, David Doku, Arja Rimpela, Addictive Behaviors Volume 36, Issue 9, September 2011, 945-947.
ScienceDirect - Addictive Behaviors : Adolescents' self-reported reasons for using nicotine replacement therapy products: A population-based study
Electronic Cigarettes also are Far Less Hazardous Alternatives to Cigarettes, and Have Helped About a Million Smokers Quit Smoking
Although electronic cigarettes (e-cigarettes) are not currently subject to Section 911’s MRTP provisions, approximately one million smokers have quit smoking or sharply reduced their cigarette consumption by switching to or substituting smokefree e-cigarettes. To date, there is no evidence that e-cigarette usage has harmed anyone, which is logical since the products emit a tiny amount of vaporized nicotine (similar to nicotine inhalers that are marketed as smoking cessation aids) and water vapor. Of the dozen plus laboratory tests conducted on e-cigarettes, only one (conducted by the FDA in 2009) found a trace (and well below toxic) level of one so-called toxic chemical in just one of eighteen samples tested, and levels of nitrosamines in e-cigarettes are nearly identical to those in nicotine gums and patches. And despite marketing claims by many e-cigarette companies that the products are less hazardous than cigarettes, there is no evidence that e-cigarettes are used by youth or non-tobacco-users.
http://www.healthnz.co.nz/RuyanCartr...t30-Oct-08.pdf
http://www.starscientific.com/404/st...0tsna in.pdf
CASAA.org
http://www.hsph.harvard.edu/centers-...ticle.jphp.pdf
SEIKATSUEISEI : Vol. 55 (2011) , No. 1 p.59-64
Effect of a nicotine free inhalator as part of a smoking cessation program
http://ectoh.org/documents/3B.5 Et...20efficacy.pdf
http://ntr.oxfordjournals.org/conten...95WzUwnLNO6Er9
'It's Not the Addiction that Kills People, It's the Smoke' - The Takeaway
Electronic Cigarettes
Electronic cigarettes (e-cigs): views of af... [Int J Clin Pract. 2011] - PubMed - NCBI
http://www.scirp.org/journal/PaperIn...ublishStatus=2
ScienceDirect - Toxicology : Non-clinical safety and pharmacokinetic evaluations of propylene glycol aerosol in Sprague-Dawley rats and Beagle dogs
Taylor & Francis Online :: ANALYSIS OF ELECTRONIC CIGARETTE CARTRIDGES, REFILL SOLUTIONS, AND SMOKE FOR NICOTINE AND NICOTINE RELATED IMPURITIES - Journal of Liquid Chromatography & Related Technologies - Volume 34, Issue 14
CASAA.org
Behavioural Insight Team annual update | Cabinet Office
Former FDA Commissioner David Kessler has also acknowledged the benefits of smokeless tobacco, dissolvables and e-cigarettes as less hazardous alternatives for cigarette smokers at Q&A: Former FDA Commissioner talks about tobacco - Westport News by stating "there's no doubt that in terms of risk of death there are some advantages to that substitution."
E-cigarettes also have been found to contain/emit similar or lower levels of nicotine than nicotine gums and lozenges
http://www.healthnz.co.nz/2010 Bullen ECig.pdf
http://www.e-cigarette-forum.com/for...igarettes.html
This indicates that e-cigarettes emit enough nicotine to satisfy the cravings of smokers, but may not emit enough nicotine to addict nonsmokers. Several published surveys have confirmed that e-cigarettes satisfy the cravings of smokers, and provide many health benefits to users who switched from cigarettes.
Sign In
http://www.biomedcentral.com/content...458-10-231.pdf
THR2010. (tobaccoharmreduction.org) (see chapter 9)
Other public health organizations that have extensively studied e-cigarettes have also endorsed their use by smokers, including The American Association of Public Health Physicians at Regulations.gov and the American Council on Science and Health at NEJM editorial: e-cigarette users should resume smoking for their own good > Facts & Fears > ACSH.
Unfortunately, after stating it would comply with Judge Richard Leon's court ruling at Regulation of E-Cigarettes and Other Tobacco Products , FDA webpages continue to falsely claim that e-cigarettes are unapproved drug devices, continue to misrepresent the health risks and benefits, and continue to falsely claim that e-cigarettes are marketed to children via legally defective 2009/2010 agency documents, including former FDA Deputy Commissioner Josh Sharfstein’s July 22, 2009 press conference materials and the agency's gross misrepresentation of its own laboratory report findings on SE & NJOY e-cigarettes products Electronic Cigarettes.
The FDA should take corrective action to eliminate all of the agency’s inaccurate and misleading claims about e-cigarettes, and issue a correction/clarification to the public.