The relative risks of a low-nitrosamine smokeless tobacco product compared with smoking cigarettes: Stimates of a panel of experts

Department of Economics, University of Baltimore, 11710 Beltsville Drive, Suite 300, Calverton, MD 20878, USA.
Cancer Epidemiology Biomarkers & Prevention (Impact Factor: 4.32). 12/2004; 13(12):2035-42.
Source: PubMed

ABSTRACT A nine-membered panel of experts was asked to determine expert opinions of mortality risks associated with use of low-nitrosamine smokeless tobacco (LN-SLT) marketed for oral use. A modified Delphi approach was employed. For total mortality, the estimated median relative risks for individual users of LN-SLT were 9% and 5% of the risk associated with smoking for those ages 35 to 49 and > or =50 years, respectively. Median mortality risks relative to smoking were estimated to be 2% to 3% for lung cancer, 10% for heart disease, and 15% to 30% for oral cancer. Although individual estimates often varied between 0% and 50%, most panel members were confident or very confident of their estimates by the last round of consultation. In comparison with smoking, experts perceive at least a 90% reduction in the relative risk of LN-SLT use. The risks of using LN-SLT products therefore should not be portrayed as comparable with those of smoking cigarettes as has been the practice of some governmental and public health authorities in the past. Importantly, the overall public health impact of LN-SLT will reflect use patterns, its marketing, and governmental regulation of tobacco products.

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Available from: David Theodore Levy, Jul 18, 2015
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    • "In addition, use of snus in Sweden has been associated in some studies with the reduction in smoking and has been used for smoking cessation (Ramström & Foulds, 2006; Stegmayr, Eliasson, & Rodu, 2005; Stenbeck, Hagquist, & Rosen, 2009). Therefore, encouraging smokers to switch to these novel smokeless products is seen by some as a potential harm-reduction strategy (Bates et al., 2003; Levy et al., 2004; Savitz, Meyer, Tanzer, Mirvish, & Lewin, 2006). On the other hand, potential negative consequences include dual use of smokeless products and cigarettes, recruitment of new smokeless tobacco users, and maintenance of tobacco use in current smokers (Accortt, Waterbor, Beall, & Howard, 2002; Hatsukami, Lemmonds, & Tomar, 2004; Severson, Forrester, & Biglan, 2007; Teo et al., 2006; Tomar, 2003). "
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    ABSTRACT: Introduction: Analysis of novel smokeless tobacco products purchased in Round I of the New Product Watch (NPW)-a national tobacco monitoring network-demonstrated that some tobacco constituents vary not only across various brands but also regionally and over time within the same product. In this study, we analyzed snus and dissolvable tobacco products that were purchased in Round II of the NPW. Methods: We analyzed tobacco-specific N-nitrosamines (TSNA) and nicotine in snus and dissolvable tobacco products that were purchased in various regions of the country during the spring and summer of 2011. The results were compared against the Round I data, across different U. S. regions, and among products. Results: A total of 216 samples were received from different states representing 6 regions of the country. Compared with the previous analyses, TSNA levels increased significantly in Marlboro and Camel Snus and some dissolvable Camel products. The levels of unprotonated nicotine in Marlboro Snus and Camel Snus in this study were not different from Round I but varied significantly by regions; the differences between the highest and the lowest average regional levels were similar to 3.2-fold in Marlboro Snus similar to 1.7-fold in Camel Snus. Conclusions: Our results indicate that some novel smokeless tobacco products contain TSNA at the levels found in the conventional moist snuff. Observation of regional variations in unprotonated nicotine content in both Round I and Round II of NPW suggest that manufacturers may tailor the levels of this constituent consistently to different regions.
    Nicotine & Tobacco Research 08/2014; 16(8):1070–1078. DOI:10.1093/ntr/ntu026 · 2.81 Impact Factor
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    • "Existing epidemiologic studies indicate that the use of Swedish snus—a smokeless tobacco product low in TSNA— even though associated with an increased risk of pancreatic cancer when compared with never-users of any tobacco is not related to lung cancer and that the risk of oral cancer, if it exists, is very limited (Greer, 2011; Luo et al., 2007). Because of their potential for reducing exposure to TSNA and other carcinogens that are present in cigarette smoke, the use of low-TSNA smokeless products is seen by some as a potential harm-reduction strategy (Bates et al., 2003; Levy et al., 2004). Another critical chemical in smokeless tobacco is nicotine, the main known addictive constituent. "
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    ABSTRACT: Information on chemical composition of the new oral "spitless" smokeless tobacco products is scarce, and it is not clear whether there is some variability as a function of purchase place or time due to either unintended or intended manufacturing variations or other conditions. We analyzed tobacco-specific N-nitrosamines (TSNA) and nicotine in Marlboro Snus, Camel Snus, and dissolvable Camel products Orbs, Sticks, and Strips that were purchased in various regions of the country during the summer of 2010. A total of 117 samples were received from different states representing six regions of the country. Levels of unprotonated nicotine in Marlboro Snus and Camel Snus varied significantly by regions, with the differences between the highest and the lowest average regional levels being relatively small in Marlboro Snus (∼1.3-fold) and large in Camel Snus (∼3-fold). Some regional variations in TSNA levels were also observed. Overall, Camel Snus had significantly higher TSNA levels than Marlboro Snus, and Camel Strips had the lowest TSNA levels among all novel products analyzed here. The amount of unprotonated nicotine in the dissolvable Camel products was comparable to the levels found in Marlboro Snus. Our study demonstrates some regional variations in the levels of nicotine and TSNA in Marlboro and Camel novel smokeless tobacco products. Continued monitoring of this category of products is needed as the existing products are being test marketed and modified, and new products are being introduced. This information is particularly important given its relevance to Food and Drug Administration regulation of tobacco products.
    Nicotine & Tobacco Research 03/2012; 14(3):274-81. DOI:10.1093/ntr/ntr209 · 2.81 Impact Factor
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    • "Newer forms of smokeless products have been positioned by the tobacco industry as potentially less harmful alternatives to smoking, including the heat-pasteurized, teabag-like Swedishstyle snuff known as " snus. " Although all smokeless products present a serious risk to users, they are significantly less harmful than combustible products, which release dozens of toxins during combustion (Levy et al., 2004; Stratton, Shetty, Wallace, & Bondurant, 2001; Tobacco Advisory Group of the Royal College of Physicians, 2002). For example, newer smokeless products that have undergone heat pasteurization to reduce formation of carcinogenic nitrosamines are estimated to be more than 90% less hazardous than conventional cigarettes (Hatsukami et al., 2007). "
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    ABSTRACT: Although the health risks from smokeless tobacco (ST) are lower than cigarettes, it remains unclear how smokers might use ST products, including as a substitute, a cessation aid, or concurrently with cigarette use, if at all. Additionally, there is little evidence examining the impact of health warning labels (HWL) on ST use and perceptions. The current study investigated perceptions of ST products with and without HWL and a relative health risk (RHR) message. The study consisted of a full-factorial "between-subjects" experiment in which 3 HWL and a RHR message were systematically varied. Canadian smokers aged 18-30 years (N = 611) completed an online survey where they viewed four brands of ST packages altered according to the experimental conditions. Approximately half of the smokers indicated that they were willing to try ST as a substitute and to help quit smoking. More than one quarter (28%) of smokers were unaware that using ST is less harmful than smoking. Pictorial HWL increased false beliefs about the RHR of ST and decreased smokers' willingness to try ST, whereas text warnings did not. Adding a RHR message communicating the lower risk of ST compared with cigarettes increased willingness to try ST when added to text HWL but decreased willingness to try ST even further when added to pictorial HWL. The findings indicate relatively high levels of appeal for ST among young adult Canadian cigarette smokers. Pictorial HWL reduced the appeal of ST products and increased perceived risks, including the false belief that ST is equally harmful as cigarettes. Further research could consider evaluating designs of HWL on ST products that better balance absolute and RHR.
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