Article

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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    • "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.
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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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    • "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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