Smokeless Tobacco Truth

In his Huffington Post blog on April 18, Dr. Glenn Braunstein penned “Chew on This: The Real Dangers of Smokeless Tobacco.” (available here) Dr. Braunstein is professor and chairman of the Department of Medicine at Cedars-Sinai Medical Center in Los Angeles. The “dangers” he described are demonstrably fictitious. Compounding this offense, Dr. Braunstein subsequently violated HuffPo blog moderating rules by removing my April 19 reasoned and fact-driven comment, which read:
“It is regrettable that Dr. Braunstein used the Huffington Post to misinform Americans about smokeless tobacco.
“Dr. Braunstein: ‘Contrary to popular belief, ingesting [smokeless] tobacco carries risks just as serious and severe as smoking.’ This ignores numerous scientific studies documenting that smokeless tobacco use is 98% safer than smoking. Smokeless does not cause lung cancer, heart disease or emphysema, and the risk for mouth cancer is far lower than with cigarettes. Statistically, smokeless users have about the same risk of dying from mouth cancer as automobile users have of dying in a car wreck.
“Dr. Braunstein goes even further, suggesting that ‘…ingested tobacco may be even more dangerous than cigarettes…’ because of nicotine. This is grossly misleading. All tobacco products have roughly the same nicotine content and produce about the same blood levels. More importantly, nicotine does not cause any smoking-related disease.
“Dr. Braunstein’s comments are at odds with the viewpoint of prominent tobacco research and policy professionals. A group of leading tobacco experts in 2004 concluded: … ‘[smokeless] products pose a substantially lower risk to the user than do conventional cigarettes. This finding raises ethical questions concerning whether it is inappropriate and misleading for government officials or public health experts to characterize smokeless tobacco products as comparably dangerous with cigarette smoking.’
“The established scientific and medical literature on tobacco harm reduction clearly refutes the major objections raised by Dr. Braunstein concerning modern smoke-free tobacco products.”
My comment appeared just long enough on HuffPo to elicit a supporting comment from another reader: “I agree with Dr. Rodu. I’d like to see Dr. Braunstein’s reponse to Dr. Rodu’s points, though we probably won’t. As a dentist, I encourage those who use smokeless to quit, but not by giving them false information. The information in this article is very very misleading.”
According to Dr. Braunstein’s HuffPo biography, he is an endocrinologist with an interest in the treatment of thyroid cancer and in male and female reproductive endocrinology; he has no apparent expertise in tobacco issues. His blog entry on the subject closely aligns with smokeless tobacco misinformation issued in the past by the leading tobacco-prohibitionist organizations (Campaign for Tobacco Free Kids and others).
HuffPo says on its site that its mission is “to promote an open and transparent conversation.” But allowing Dr. Braunstein to erase a fair and factual rejoinder to his unfounded remarks violates that tenet, and disserves the public interest.

Upward trend in marijuana use, smokeless tobacco

BLOOMINGTON, Ind. — Alcohol use by Indiana sixth- through 12th-graders has declined, but findings from the 21st Annual Survey of Alcohol, Tobacco, and Other Drug Use also revealed a continuing increase in marijuana and smokeless tobacco use.
The survey, conducted by the Indiana Prevention Resource Center at Indiana University Bloomington and funded by the Indiana Family and Social Services Administration’s Division of Mental Health and Addiction, questioned 168,801 students in public and private schools. Researchers found that the reported use of marijuana is on the rise for grade seven as well as grades nine through 12. Marijuana use among youth in grade eight has decreased, which signals the end of an upward trend that occurred from 2008-2010 in monthly marijuana use.
Marijuana-use
“Unfortunately we are seeing a continuation of an upward trend in both monthly and lifetime use of marijuana since 2008 in grade seven and grades nine to 12. It should be noted the rate of past month marijuana use among Indiana’s eighth-grade youth is higher on average than the 2010 national prevalence rate reported in the Monitoring the Future survey,” said Ruth Gassman, director of the IPRC, which is part of IU’s School of Health, Physical Education and Recreation. “Among some grade levels, marijuana use did not increase significantly this year compared to last year, however, when the rates are examined over a four-year period (since 2008) the continuation of an upward trend is apparent.”

Tobacco: Lifetime use of smokeless tobacco increased for 12th-graders

The survey revealed an upward trend in smokeless tobacco for lifetime and past month use among 12th-graders since 2007, with the largest increase found in their lifetime use, which registered an increase of 4.2 percentage points from 2007-2011.
“This is a concern because although rates of cigarette use among high school students continue to decline, smokeless tobacco use still exposes youth to the harmful carcinogenic elements of tobacco,” Gassman said. “It is even worse for students who are using both cigarettes and smokeless tobacco concurrently because this increases an individual’s exposure to nicotine, which is the addictive agent in all tobacco products.”
smokless-use
Tobacco companies target younger consumers with a variety of new products that come out yearly. Items such as tobacco strips and orbs contain finely ground tobacco and are easy for youth to use without being detected. The packaging of smokeless tobacco products is often very appealing to young consumers. These products are also advertised as being lower in chemicals and as tools for quitting smoking. Gassman said it is important to remember that tobacco in any form is dangerous.
Alcohol: Lifetime use is on the decline for youth in grades 6-12
Another important finding from the survey shows that lifetime use of alcohol in grades six-12 is decreasing. In 1993, rates of lifetime alcohol use were 37.8 percent for sixth graders and 85 percent among 12th-graders. Those rates are now at 17.4 percent and 65.4 percent, respectively.
“We are pleased to see that lifetime alcohol use has gradually declined since 1993. Unfortunately, we have seen few reductions in binge drinking among youth in recent years,” Gassman said. “Binge drinking is defined as five or more alcoholic drinks for males and four or more for females in one sitting in the last two weeks. Binge drinking is very dangerous and among youth is associated with unintentional injuries such as car crashes, intentional injuries such as sexual assault, and with alcohol poisoning, sexually transmitted diseases and unintended pregnancy.”

Reasons for drinking

Among youth who were surveyed, the top reasons given for drinking alcohol were “to have a good time with friends,” “to experiment,” “because it tastes good,” and “to relax or relieve tension.” The majority of adolescents in sixth to ninth grades reported no consumption of alcoholic beverages.
Gassman said it is important to understand why adolescents are turning to alcohol so that risk and protective factors can be evaluated and used to implement programs aimed at continuing to reduce alcohol consumption among minors in Indiana. Risk factors refer to situations or conditions that increase chances for involvement in substance use among youth while protective factors are conditions in an adolescents life that protect against negative influences associated with risk factors. There are four areas of risk and protective factors in youth socialization: community, family, school and peer-individual.
The IPRC provides substance abuse prevention resources and services for those working with youth in schools and communities throughout Indiana.
Gassman can be reached at 812-855-1237 or rgassman@indiana.edu. Questions about the survey can also be addressed by Courtney Stewart, 812-855-5556 or cestewar@indiana.edu, and Mi Kyung Jun, 812-855-1237 and mkjun@indiana.edu. For additional assistance, contact Tracy James, 812-855-0084 and traljame@iu.edu.

Big Tobacco growing smokeless business

R.J. Reynolds Tobacco Company is ramping up marketing for dissolvable tobacco products in Colorado and North Carolina test smokeless tobacco usemarkets, meanwhile the FDA is still reviewing whether and how it can control the new substances.

In a February 2010 letter to the president of R.J. Reynolds, the FDA requested detailed information regarding research conducted that relates to the “risk of accidental nicotine toxicity through the use of dissolvable tobacco products, reports of accidental ingestion of dissolvable tobacco products, and the physiologic effects of swallowing or chewing the products, or otherwise not using the products as described in product labeling, advertising and promotional materials.”

The FDA has announced that its own report on the products will not be issued until March 2012.According to tobaccoproducts.org, “the dissolvable products — a pellet (Camel Orbs), a twisted stick the size of a toothpick (Camel Sticks), and a film strip for the tongue (Camel Strips), are made from finely ground flavored tobacco. The products melt in the mouth within three to 30 minutes.”
“I’ve heard about these products for a while now, and we expect to have them in stock this year,” said Jamie Shepard, manager at Tobacco Road Outlet, in Rockingham.

Colorado Department of Public Health has already begun meeting over concerns that these products might be too attractive to younger consumers due to taste, packaging and reduced costs.

Camel Sticks, Orbs and Strips sell for about $2.50 per 12 pack, compared with $5 for a pack of cigarettes, and are packaged in brightly colored tins.
“Those who keep referring to these products as ‘candy’ or ‘mints’ are irresponsibly perpetuating false and misleading information,” said Richard Smith, an R.J. Reynolds spokesman.

Until the FDA issues a report on the newest products, no one can be sure what kind of health risk they pose or how attractive they may be to younger consumers.

“No known existing tobacco product is safe, and a market order issued by the FDA for these products should never be interpreted as such,” said Lawrence R. Deyton, M.S.P.H., M.D., director of the FDA’s Center for Tobacco Products.
“These products will not be safer, but we are required by law to not allow even more dangerous products to cause further harm to those Americans who use tobacco products,” Deyton said.

Camel Snus, a smokeless spitless tobacco product, has found success in the market in the past few years.“The Snus sells well,” said Shepard. “It’s $2.89 per package.”
Shepard said many of her customers are smokers who rely on products like this when they’re in smoke-free environments.

While critics of such products argue that they still pose a health risk, studies show the risks are lower than with traditional cigarette usage.

Nicotine without the smoke

Anti-smoking groups worry that smokeless tobacco products will exacerbate a public health problem.
While standbys like chewing tobacco and snuff have long been around, newer alternatives, such as dissolvable pellets and tobacco-coated sticks, offer less messy, more socially acceptable ways for nicotine-addicted users to get what they need.
For tobacco companies pinched by declining smoking rates and increasingly strict indoor air laws, these smoke-free options may be a growing source of revenue. Cigarette consumption has been declining about 3 percent each year, while sales of smokeless tobacco have been growing by about twice that amount annually. Last month, after New York City implemented laws banning smoking in parks, public beaches and other crowded areas, Reynolds American Inc. launched an advertising campaign encouraging smokers to switch to Camel Snus, a pouch-type smokeless tobacco product.
Anti-smoking advocates worry that the growing popularity of smokeless products could reignite interest in tobacco consumption and keep people addicted who might have otherwise quit. In the past, anti-smoking laws like Delaware’s 2002 Clean Indoor Air Act offered the incentive needed for many smokers to finally kick the habit, helping drop the number of adult smokers in the state to 18.3 percent, according to 2009 statistics from the state’s behavioral risk factor survey. Among high school students, 19 percent smoke cigarettes.
As tobacco manufacturers look for ways to keep customers while enticing new ones, smokeless tobacco is being positioned as a bridge that allows consumers to manage their nicotine needs without stepping outside for a smoke break, said Danny McGoldrick, vice president for research at the Campaign for Tobacco-Free Kids. That’s particularly worrisome since teen boys are one of the faster-growing segments of the smokeless tobacco market, he added.
Dissolvable products, such as pellets, sticks and strips, that contain nicotine haven’t yet made it to Delaware, where 2 percent of the adult population uses smokeless tobacco, according to the 2009 survey data. But the state Division of Public Health is already trying to put out the message that these “other tobacco” options — which also include cigars and cigarillos — come with their own health risks.
Both adults and teens are the target audience; almost 7 percent of high school students said they use smokeless tobacco.
“In some cases, we’re seeing individuals become dual users,” said Deborah Brown, president and chief executive officer of the American Lung Association of the Mid-Atlantic. “We’ve seen people with the snus, sliding them in front of their cigarette pack. If they’re indoors, they’re using the snus, if they’re outside they’re smoking, so it may be harder for them to quit smoking.”
Transition product?
The health risks associated with smoking and secondhand exposure are well-known — lung cancer, heart disease and stroke. There are 40 or so carcinogens that go into making a cigarette.
Smoking costs the state of Delaware more than $1 billion a year, according to a Penn State study released last year by the American Lung Association. That includes $430 million in direct medical expenses and $417 million in premature death costs. In Delaware, one in five deaths is still caused by tobacco use.
Because cigarettes can be hard to quit, a few public health advocates have suggested smokeless tobacco products may help some smokers make the transition to being nonsmokers. A University of South Carolina researcher is conducting a yearlong study looking at whether the use of smokeless products like snus leads to attempts at quitting, smoking reduction or cessation among smokers. In Sweden, where snus is most popular, studies suggest that users of the moist snuff product face fewer health problems than those who smoke. Sweden has one of the lowest smoking rates in the world.
But Brown said that doesn’t mean smokeless tobacco is safe, especially since it keeps people addicted to nicotine while putting them at risk for other health problems later on, including oral cancer, tooth loss and gum disease. The amount of nicotine in smokeless products typically is about the same or slightly less than the level found in cigarettes, although one brand of tobacco sticks has about three times as much nicotine.
In addition to the oral health risks, smokeless tobacco can be dangerous if accidentally ingested by children, according to a study published last year in the medical journal Pediatrics.
Newer varieties like dissolvable lozenges have a higher amount of the nicotine that is most rapidly absorbed in the mouth, which could make them more toxic if accidentally swallowed by children.
Smokeless tobacco is different than nicotine-replacement medication products, which include gum, nasal spray, inhalers, lozenges and patches. Those are designed to wean the body off cigarettes by providing nicotine in controlled amounts without the chemicals found in other tobacco products. They require FDA approval as smoking cessation aids.
In 2009, Congress passed legislation to give the U.S. Food and Drug Administration authority to regulate tobacco products. Anti-tobacco advocates want the FDA to regulate dissolvable tobacco products, too, but in March the FDA ruled that one company’s brand of dissolvable tobacco didn’t fall under the jurisdiction of the new law. The company, Star Scientific, had hoped to market its dissolvable tobacco lozenges as a reduced-risk product (compared to cigarettes), which would have required FDA approval.
Some analysts suggest it may be difficult for tobacco companies to prove smokeless tobacco products pose different health risks than cigarettes.
“We have the position that there is no safe tobacco,” Brown said.
Marketing criticized
McGoldrick said the colorful marketing, portable packaging and candy-like appearance of smokeless tobacco products may give people, kids in particular, the idea that smokeless tobacco is a healthier alternative. He and other anti-tobacco advocates are concerned about statistics that found 15 percent of high school boys nationwide used smokeless tobacco in 2009, a 36 percent increase from 2003.
“These are efforts to make it easier to use, with the pouches and things, and also somewhat more amenable,” McGoldrick said. “They’ve just done a masterful job going after where the replacement users are.”
Tobacco companies contend that their products are marketed for adults and must be purchased with identification. Still, Brown and McGoldrick said these products represent something of a graduation strategy, with young people starting with mild, flavored tobacco products before moving on to other products once they’ve gotten addicted to the nicotine.
Vanessa Adams, a nurse practitioner and director of the Indian River High School wellness center, said some kids, mostly boys, tend to use chewing tobacco to get them through situations when they can’t smoke.
“I don’t think they’re saying, ‘Let’s do smokeless tobacco.’ Most of the time they hide it,” said Adams, who tries to talk with chew users about oral health and the effect it has on their teeth.
Mount Pleasant High School student Matt Coyle serves as the statewide chair for the Kick Butts Generation, a youth movement focused on decreasing tobacco use in Delaware. He said most of the questions he gets from young people are about smoking, but some kids want to know if the newer products are better for them.
“A lot of people think the toxins are only in the cigarette, when tobacco and nicotine are still bad for you,” said Coyle, who drives a car wrapped with anti-tobacco messages. “We’re still in an area where it’s still cool to smoke. But the smokeless tobacco is making an appearance with their color ads. I’ve heard from downstate people who say it’s common down there. It’s easy to consume and conceal.”
Role models
Nationally, there’s a growing effort by anti-tobacco advocates to educate people about smokeless tobacco. McGoldrick said Major League Baseball, whose players have long been seen spitting tobacco juice on the field and in the dugout, is trying to ban chewing tobacco from the clubhouse as part of its upcoming collective bargaining agreement. At the same time, several prominent players have announced they are trying to stop the habit, most notably Josh Hamilton and Stephen Strasburg.
“We know baseball players are a huge role model for our kids. We can have all these messages, but when their heroes are doing this, it’s hard to ignore,” McGoldrick said.
Delaware is starting its “Other Tobacco” campaign, which hopes to educate parents and kids about smokeless tobacco products, cigars and cigarillos, said Lisa Moore, tobacco prevention and control program manager with the Division of Public Health. The campaign is being funded with a grant of more than $1 million from the U.S. Centers for Disease Control and Prevention. It will include television and radio ads, social marketing messages and billboards aimed at exposing the risks of these tobacco alternatives.
Moore said pricing is one area of concern, because smokeless tobacco products, cigars and cigarillos cost less than a pack of cigarettes, which may add to their appeal. Such products aren’t taxed at the same levels as cigarettes. Almost 12 percent of high school students in Delaware smoke cigars, according to the 2009 risk survey.
Beth Mattey, school nurse at Mount Pleasant High School, said cigarettes remain the focus of prevention efforts among young people, but as more products appear on the market, anti-tobacco organizations are expanding their efforts. She said members of Kick Butts Generation recently approached a vendor at a mall who was selling electronic cigarettes, a battery-operated device that uses liquid nicotine to produce a vapor.
They had more information about the product, including its risks, than the vendor did, which was an empowering moment for the students, she said.
“We’re being proactive is what we’re doing,” she said.
By Kelly Bothum, 324-2962
kbothum@delawareonline.com
Delawareonline

Snus focus of yearlong study

A University of South Carolina researcher is preparing to answer two questions with widespread implications for the tobacco industry and public-health community.
Can a smokeless product, in this instance Camel Snus, contribute to a smoker quitting cigarettes — particularly one who doesn’t want to stop?
If it does, could an increase in use of smokeless-tobacco products over cigarettes cause a net harm to the population?
Trying to provide clarity is Matthew Carpenter, an associate professor in the Department of Psychiatry and Behavioral Sciences and the Department of Medicine at the Medical University of South Carolina. Carpenter’s research focus has been on tobacco use and control, with his studies primarily funded by the National Institutes of Health.
The yearlong study will consist of 1,250 smokers nationwide, half being given Camel Snus or another smokeless product, and the other half given nothing.
Carpenter’s research team wants to learn whether Snus leads to quit attempts, smoking reduction and cessation. They also want to measure the amount and pattern of Snus use.
“The study will provide strong, clear and objective evidence to guide clinical and regulatory decision-making for this controversial area of tobacco control,” Carpenter said.
Matt Myers, president of the Campaign for Tobacco-Free Kids, said research of smokeless products must evaluate what harm is caused by the product along with how the product is marketed.
“If a smokeless product reduces the risk of disease, but results in more people using tobacco, it could result in more deaths, not fewer,” Myers said.
Carpenter said researchers are not trying to encourage the use of smokeless tobacco with the study.
“We’re just trying to mimic the real-world scenario of a smoker being exposed to these products in their own environment, such as a grocery store,” Carpenter said.
“If they decide to use them, what is the effect? We believe no matter the determination of this study, it will have a public-health impact.”
The study follows up on a similar smoking-cessation study Carpenter released in February 2010 on Star Scientific Inc.’s Ariva and Stonewell tobacco lozenges.
The main determination of that study was smoking decreased by 40 percent during the two-week study period, but overall use of tobacco remained stable.
“This suggests that Ariva and Stonewall are effective products to curb withdrawal and craving,” Carpenter said in his report. “We found no changes in overall craving or withdrawal, as smokers substituted Ariva/Stonewall for cigarettes.
“We found no evidence that smokeless tobacco (Ariva or Stonewall) undermines quitting. To the contrary, readiness to quit — in the next month and within the next six months — significantly increased among smokers who used a smokeless-tobacco product relative to those who continued to smoke conventional cigarettes.”
Carpenter said it is “doubtful that a smokeless-tobacco product could ever serve as a total substitute for cigarettes among a majority of smokers.”
“However, the amount of substitution among those smokers who choose to use smokeless products is not insignificant,” he said.
* * * * *
The multimillion-dollar Camel Snus study is part of an initiative the National Cancer Institute began in October 2009.
The institute wants to determine whether smokeless products, such as snus and dissolvable Camel Orbs, Camel Sticks and Camel Strips from R.J. Reynolds Tobacco Co., provide “a truly less-harmful alternative to conventional tobacco products, both at the individual and population level.”
“We want to explore all aspects of tobacco products, including the sale, marketing and health risks,” said Michele Bloch, medical officer of the Tobacco Control Research Branch of the National Cancer Institute.
Carpenter said “a number of short-term lab studies of toxicant exposure suggest smokeless tobacco could offer reduced harm as compared to conventional cigarettes.”
Major U.S. tobacco manufacturers, led by Reynolds, are putting more emphasis on smokeless products to gain market share and sales as the smoking rate among adults is declining. Government figures show that fewer than 44 million Americans smoke, down from a peak of 53.5 million in 1983.
“We certainly support studies conducted objectively while using sound scientific principles and techniques on the use of tobacco products and tobacco-harm reduction,” said David Howard, a spokesman for Reynolds.
The evolution of some health-advocacy groups from anti-smoking to anti-tobacco is ratcheting up the moralistic aspect of buying and consuming a legal product.
Some advocates say that smokeless tobacco can serve as a gateway for youths to smoking.
Others are encouraging the Food and Drug Administration to allow the advertising of smokeless tobacco as less harmful than cigarettes if such claims can be proved through research.
A study of smokers ages 18 to 70 — released in November by the Tobacco Use Research Center of the University of Minnesota — found that “quit rates for Camel Snus were comparable to those obtained with nicotine-replacement therapy.”
The Minnesota center said a “properly powered study is needed to determine if use of smokeless-tobacco products with higher nicotine content can be an effective path to smoking cessation, perhaps especially among smokers who are not interested in or previously were not successful with using approved pharmacotherapies.”
Reynolds added fuel to the debate in December when it launched its first campaign aimed specifically at encouraging smokers to switch to Camel Snus.
* * * * *
Reynolds has marketed Camel Snus as an option for tobacco consumers who can’t smoke in a growing majority of public venues.
Carpenter acknowledges the intensity of debate in his abstract. “There is limited evidence to determine if potentially reduced exposure products ultimately undermine or promote public health,” he said.
John Spangler, a professor of family and community medicine at Wake Forest University School of Medicine, said he supports research that determines whether smokeless tobacco can help with quitting cigarettes.
Spangler is conducting a National Cancer Institute study, which began in September 2009, that’s aimed at developing strategies to encourage reduced use or even quitting smokeless-tobacco products. Wake Forest received a $2.9 million grant for its study.
Among the goals are: determining the health risk of smokeless-tobacco products; whether the products serve as a gateway for nontobacco users, particularly teenagers and young adults, into smoking; and whether they can be accurately marketed as a reduced-risk alternative to cigarettes.
“We have a substantial amount of data in our research showing that users of smokeless tobacco have a very high likelihood, not of quitting smoking, but of co-using smokeless and cigarettes,” Spangler said.
Bill Godshall, executive director of SmokeFree Pennsylvania, said, “I’d be shocked if Reynolds would apply to market it as a smoking-cessation drug device.”
Scott Ballin, past chairman of the Coalition on Smoking or Health, said the study could demonstrate that there is not enough evidence available about reduced risk, “therefore products like snus or Ariva or Stonewall should not be able to make any claims.”
“That would preserve the status quo and give the pharmaceutical companies the competitive protections they want,” Ballin said.
In October, the consumer health care division of GlaxoSmithKline (GSK), which sells nicotine-replacement therapy products Nicorette and NicoDerm, requested that the FDA take Reynolds’ dissolvable tobacco products out of test markets.
The FDA acknowledges Reynolds is marketing the products to adult consumers, but has concerns that the marketing and shape of the dissolvable products might appeal to children and adolescents.
GSK’s request strikes at the core of Reynolds’ attempt to create a reputation as an innovator of products that could be less harmful to consumers than cigarettes.
Elizabeth Whelan, president of the American Council on Science and Health, said “GSK is clearly trying to protect its own market for dissolvable tobacco.”
“From a business perspective, this is understandable,” Whelan said. “But from a purely public-health point of view, if products like the orbs can help more smokers quit more effectively than other cessation products, then let them stay on the market.”
rcraver@wsjournal.com
(336) 727-7376

Reynolds launches campaign to push smokeless product

R.J. Reynolds Tobacco Co. is attempting to make lemonade out of the outdoor smoking ban that begins Monday in New York City.
The company is launching a major advertising campaign for Camel Snus next week in hopes of getting smokers to try the smokeless product “and reclaim the world’s greatest city.”
Reynolds is the first large U.S. tobacco company to encourage smokers to quit smoking by urging them to switch to a smokeless product, said Bill Godshall, the executive director of SmokeFree Pennsylvania. The ads do not make any claims of reduced health risks with a potential switch.
The New York City law is considered one of the largest outdoor smoking bans in the country. There also are bans affecting Los Angeles city parks and Chicago parks with playgrounds. The goal in each instance is reducing second-hand smoke.
New York City violators could be subjected to a fine of up to $100 for each instance by the city’s parks department, but police will not enforce the ban.
Two ads will run in the New York Daily News, New York Post, Newsday and some New York weeklies, as well as nationally in USA Today and Wall Street Journal. The New York Times does not take tobacco ads, Reynolds spokesman David Howard said.
One ad features the image of a flame holder with the tagline “NYC Smokers: Enjoy freedom without the flame.” The other ad is in the shape of the Empire State Building with the tagline “NYC Smokers: Rise above the ban.” Both ads feature health warnings.
“We thought this was a good opportunity to communicate with adult smokers in New York City, and across the country, to inform them of a smoke-free, spit-free tobacco option they might want to consider switching to,” Howard said.
The campaign also includes point-of-sale advertising, interaction with age-verified and certified adult tobacco consumers, messages on packs and an age-restricted website.
“Camel is transforming to meet demand from adult tobacco consumers, as well as societal changes,” Howard said. “We wanted to raise awareness of another tobacco product that doesn’t produce second-hand smoke.”
Since Reynolds agreed to participate in the landmark 1998 Master Settlement Agreement that restricted its advertising options, the company has tried to walk a fine line in marketing to young adults.
As expected, the Camel Snus campaign drew criticism from anti-tobacco advocates.
“These ads continue Reynolds’ irresponsible marketing of snus as a way for smokers to get their nicotine fix in the growing number of smoke-free places,” said Vince Willmore, a spokesman for the Campaign for Tobacco-Free Kids.
“The goal is to discourage smokers from taking the one step that would truly protect their health, which is to quit entirely. Once again, Reynolds is putting its bottom line ahead of public health.
“It’s also deeply offensive Reynolds is using iconic New York City images to market a harmful and addictive products, especially in a city that is a global leader in fighting tobacco use,” Willmore said.
Reynolds has not run cigarette ads in newspapers and consumer magazine in 3½ years.
But it has been aggressive with its Camel Snus advertising, including in magazines such as Entertainment Weekly, People, Sports Illustrated, Time and US Weekly, as well as free and alternative publications.
The New York City campaign also is Reynolds’ latest attempt to connect its brands with specific geographic regions and landmarks.
For example, Reynolds conducted a 10-week “Break free adventure” marketing campaign from November through January that had participants guess which trendy destinations the Camel mascot was visiting before coming home to Winston-Salem. Destinations included Austin, Texas; Brooklyn, N.Y.; New Orleans; Las Vegas; San Francisco; Seattle; and Sturgis, S.D.
Anti-smoking groups and health and government officials protested the campaign for using well-known images of the destinations behind the Camel logo. Reynolds distributed packs bearing the images nationally in December and January.
“The Camel advertising is simultaneously both pragmatic — it is concerned with practical consequence — and yet an auger for the slow but steady change in tobacco-use habits,” said Stephen Pope, an industry analyst and the managing partner of Spotlight Ideas in England.
John Sweeney, the director of the sports-communication program at UNC Chapel Hill, said that the campaign may succeed in attracting new users among smokers.
“It will only get long-term success if it captures a loyal, enthusiastic following,” Sweeney said. “It will only do that if it provides a truly satisfying experience to the current smoker.”
By RICHARD CRAVER
rcraver@wsjournal.com
(336) 727-7376

Smokeless-tobacco ban for MLB teams

Televisions on Thursday will broadcast the usual iconic images of baseball’s opening day: fans cheering from the stands, umpires Major League Baseballmaking close calls at the plate, and players in the thick of the game, spitting tobacco juice.
With smokeless tobacco use spiking among high school boys – a reported 36% increase since 2003 – public health officials are targeting their role models to set a healthy example, and calling for a ban on tobacco at major league ballparks.
Tobacco use was banned in baseball’s minor leagues in 1993. But a ban in the major leagues would have to be negotiated with the players union during collective bargaining – something Commissioner Bud Selig said Wednesday he intends to pursue as talks get under way for a new contract, effective in 2012.
Brewers first baseman Prince Fielder, who occasionally chews tobacco during games, said he understands the reasoning behind a tobacco ban, but isn’t sure he wants to give up the right to chew.
“I get it,” Fielder said. “I understand what they’re saying. You don’t want kids watching you and doing it. So, I really do get it. But that’s a tough one. I’m sure we’ll talk about it, but (banning tobacco) is a big move. In the off-season, I don’t do it. Just during the season. My kids have never asked me about it. It’s not that it’s not important, but I just don’t know about (banning it).”
Use frowned upon
Major League Baseball discourages the use of tobacco. Clubs provide alternatives such as chewing gum and sunflower seeds, prohibit tobacco companies from providing free tobacco products to players in the clubhouse, and prohibit clubhouse employees from purchasing tobacco on behalf of players. The league also established the National Spit Tobacco Education Program in 1994 to try to curb player use.
Players say they take the health risks seriously. And the players union says it has worked to educate players about the risks of tobacco use, including oral cancer, esophageal cancer, pancreatic cancer, heart disease and gum disease.
But it appears unlikely the players union will agree to a ban.
“I think that would be difficult,” said veteran Milwaukee Brewer Craig Counsell, a member of the players union executive council who chews tobacco on occasion. “We’ve always championed the fact that we’re adults who can make their own choices.”
Top public health officials in 15 Major League Baseball cities – including Milwaukee – earlier this week joined the call to ban tobacco from baseball. In a letter to Selig and Michael Weiner, executive director of the Major League Baseball Players Association, the health officials wrote, “we know that baseball is important to civic life and that ballplayers are local heroes. They should provide positive role models and not associate themselves with a product that causes disease and death.”
The letter from city health officials followed a call in November by the chief executives of 10 major medical and public health groups, who wrote a letter to Selig and Weiner, seeking to ban use of all tobacco products, including smokeless tobacco, by players, coaches, managers and other team personnel at all major league ballparks.
“I am personally committed to the fight against smokeless tobacco in baseball,” Selig said Wednesday. “I am proud of our longtime ban on smokeless tobacco in the minor leagues.”
Kids are watching

The Campaign for Tobacco-Free Kids, a nonprofit advocacy group, contends that too many kids pick up the cancer-causing habit from watching their idols chew and spit. “Baseball players are heroes to kids,” said spokesman Dan Cronin. “I learned how to kick dirt from Billy Martin.”
A spokesman for the players union declined to comment on whether baseball players should be expected to serve as role models of good health.
“We most certainly take the issue seriously and agree there are serious health risks involved with tobacco,” said spokesman Greg Bouris. “That’s why we do what we can to educate players.”
Tobacco use among baseball players has declined significantly over the last 20 years, according to Dan Halem, senior vice president and general counsel for Major League Baseball.
The hope in prohibiting tobacco in the minor leagues “is that players won’t use it anymore,” he said. “The tobacco cessation programs we run definitely are utilized.”
The NCAA and National Hockey League prohibit tobacco use.
By Karen Herzog and Tom Haudricourt of the Journal Sentinel

Big Tobacco Test Smokeless Tobacco Products

RICHMOND, Va. — Philip Morris USA and R.J. Reynolds are gearing up to test smokeless tobacco products come March. This will mark smokeless-tobaccothe debut of PM USA’s cigarette-store.biz/online/marlboro and Skoal smokeless tobacco sticks and the second round of testing for R.J. Reynolds’s Camel Sticks, Camel Strips and Camel Orbs.
The Marlboro smokeless tobacco sticks are geared to adult smokers who are looking for a smokeless alternative to cigarettes. Similarly, Skoal is introducing a spit-free product aimed at adult users of moist tobacco products who are looking for a spitless alternative, according to a spokesman for Altria Client Services. Altria Group Inc. is the parent company of Philip Morris USA. “About a quarter of adult cigarette smokers say they are interested in smokeless tobacco,” he said, adding that a large percentage of adult users of moist tobacco products are also looking for an alternative.
Out of the gate the products will be available in limited distribution in select markets in Kansas. The company declined to release how long the test period will last.
The Marlboro products will be available in four varieties: rich tobacco sticks, original tobacco sticks, cool mint tobacco sticks and smooth mint tobacco sticks. The new Skoal products will also be available in four varieties: rich tobacco sticks, original tobacco sticks, mint tobacco sticks and smooth mint sticks.
All varieties of the Marlboro and Skoal smokeless tobacco sticks will come 10 per pack and will be merchandised like all other cigarette and smokeless tobacco products, the spokesman added.
R.J. Reynolds is also conducting tests on products. The company has tapped Denver and Charlotte, N.C. as markets for the second test phase of its Camel Dissolvable product line. This round comes two months after the tobacco manufacturer wrapped up the first test phase in Columbus, Ohio; Indianapolis; and Portland, Ore.
Based on testing of the Camel Sticks, Camel Strips and Camel Orbs with adult tobacco users the company made some changes to the packaging to bring it more in line with other tobacco products already on the market, according to David Howard, a spokesman for R.J. Reynolds. Specifically, he explained, the packaging is now larger which allows for more information to be displayed. Information includes the child resistant features, as well as wording explaining that the product contains nicotine and is for adult tobacco users only, and that there is no safe tobacco product.
All three styles are now mint and all three will have the same number of products per package, 12, Howard said. Previously, the Camel Strips came 20 to a pack, the Camel Orbs came 15 to a pack and the Camel Sticks came 10 to a pack.
Overall, R. J. Reynolds was happy with the first round of testing. “We were very pleased with the feedback we received from adult tobacco users in the lead markets over the past two years,” Howard added. “And we are looking forward to additional feedback and new perspectives.”
Howard explained that lead markets are chosen for their make-up of the adult tobacco audience and for the overall awareness of the Camel brand. He added that there is no timetable for the second test phase.
By Melissa Kress

Chewing Tobacco for Kids Spreads Oral Cancer in India

Safiq Shaikh was 13 when he began chewing a blend of tobacco and spices that jolted him awake when his job at a textile loom got too dreary. Five years later, doctors in Mumbai lopped off his tongue to halt the cancer that was spreading through his mouth.
Shaikh believed the fragrant, granular mixture he chewed, known in India as gutka, was a harmless stimulant and at first he ignored the milky Chewing Tobacco for Kidslump growing inside his mouth. Now Shaikh is one of about 200,000 Indians diagnosed with a tobacco-related malignancy this year, says his surgeon, Pankaj Chaturvedi.
India has the highest number of oral cancers in the world after a group of entrepreneurs known locally as “gutka barons” turned a 400-year-old tobacco product hand-rolled in betel leaves into a spicy blend sold for 2 cents on street corners from Bangalore to New Delhi. Sales of chewing tobacco, worth 210.3 billion rupees ($4.6 billion) in 2004, are on track to double by 2014, according to Datamonitor, a branch of the international research firm based in Hyderabad, India.
“Now you have an industrial version of a traditional thing” spurring demand, said Chaturvedi, who works at Tata Memorial Hospital in Mumbai, Asia’s largest cancer treatment center, and draws cartoons to warn of tobacco’s dangers in his spare time. “By the time you are experimenting with this product, you become the slave of the industry.”
India had almost 70,000 diagnosed cases of cancers of the mouth in 2008, the highest in the world ahead of the U.S. at 23,000 cases, according to statistics compiled by the World Health Organization’s International Agency for Research on Cancer.
Selling Near Schools
“I have seen many children who started chewing gutka when they were 8 or 10 years old and got cancer in their teens,” Chaturvedi said as Chewing Tobacco for Kidspatients with tubes protruding from their throats and swollen jaws awaited their turn outside his office.
Gutka is sold at street stalls across India in bright rectangular pouches. Once opened, the powder emits a spicy smell. Inside the mouth, it has the consistency of gravel and creates a tingling sensation on the tongue. It’s the abrasion of the mouth’s lining that can accelerate the effect of nicotine and cancer-causing chemicals, according to Dhirendra Sinha, a technical officer for tobacco control at the WHO’s New Delhi office.
Street vendors crowd around schools, breaking Indian law, which prohibits the sale of tobacco products within 100 yards of educational institutions, says Devika Chadha, a program director at the Salaam Bombay Foundation, a nonprofit organization that works with schools to educate children about tobacco’s dangers.
‘Can’t Quit’
In Khetwadi, a low-income neighborhood in Mumbai, on a recent morning, three street vendors had set up their stalls about 55 yards from Sant Gadge Maharaj College as students gathered near the school gates. Javeed Shaikh, 21, says he began chewing gutka three years ago and now consumes two or three packets a day.
“I’m trying to quit and it’s hard,” he said as he sat on a motorcycle chatting with friends. The habit is easy to sustain with “all these shops,” he said, pointing at the street stalls. He isn’t related to Safiq Shaikh.
The combination of tobacco and areca nut makes gutka and its hand-made ancestor, known as paan, addictive, scientists say. Areca nut is the fourth-most commonly used psychoactive substance in the world after tobacco, alcohol and caffeine, according to the Geneva-based WHO.
‘Mystery Ingredients’
Manufacturers like to keep gutka’s other ingredients a mystery. Rajendra Malu, who owns the brand called “Jhee,” says a pouch contains three-fourths areca nut, 12 percent tobacco flakes and proprietary fragrances he won’t disclose.
A chemical analysis of gutka highlighted in a 2008 report from the WHO found that it contains chromium, nickel, arsenic and lead as well as tobacco-related nitrosamines, all of which are known carcinogens.
Malu estimates he sold 250 million packets last year from his manufacturing plant in the western state of Gujarat. He shrugs at the mention of a link between gutka and cancer.
“I have been chewing tobacco for the last 37 years and I am not suffering from anything,” he said from the living room of his apartment in Mumbai’s Prabha Devi neighbourhood.
While gutka is mostly used in India, Pakistan, Bangladesh and Sri Lanka, its reach is worldwide because of migration, according to the International Agency for Research on Cancer.
“The practice of areca nut chewing and the presence of oral precancerous lesions are spreading from South Asia to the Western countries, with the potential of becoming a major public health issue,” researchers at the University of British Columbia in Vancouver wrote in a commentary published last year.
Tobacco Companies
More youngsters are picking up the habit. A survey of 1,500 teenagers in Mumbai aged 13 to 15 found that double the students identified themselves as tobacco chewers compared with a decade ago, according to Healis, a public health research institute.
That’s not just true in India. The number of U.S. teenage boys using smokeless tobacco went up to 4.4 percent from 3.4 percent between 2002 and 2007, according to a nationwide survey published by the Department of Health and Human Services.
Tobacco companies such as Philip Morris International Inc. and British American Tobacco Plc are selling more nicotine products that are sucked, not burned, in response to smoking bans. The situation in India could be a harbinger of the global risks posed by smokeless products, says Saman Warnakulasuriya, a professor of oral medicine at King’s College London.
Altria Group Inc., which sells Marlboro cigarettes in the U.S., last month said profit had exceeded analysts’ estimates, helped by rising shipments of smokeless tobacco.
“There’s movement of consumption,” Chief Executive Officer Michael Szymanczyk in an Oct. 20 conference call. “Some of that movement is people smoking fewer cigarettes and using smokeless tobacco as an alternative.”
Smokeless, Not Harmless
A spokesman for Altria, Bill Phelps, declined to comment and deferred to a statement found on Philip Morris USA’s website that says public health authorities found smokeless tobacco products are addictive and can cause cancer, heart problems and diseases of the mouth, gums and teeth.
A British American Tobacco spokeswoman, Kate Matrunola, said some smokeless tobacco products like Swedish snus are less damaging than cigarettes, though “smokeless does not mean harmless.”
Earlier this month, delegates from governments of 171 countries, including India, agreed at the latest session of the WHO Framework Convention on Tobacco Control to regulate flavouring ingredients that are used to lure youngsters and focus more on control and prevention of smokeless tobacco.
Breath Freshener
In India, billboards, television commercials and even public transport buses around Mumbai advertise a fragrant chewable product close to gutka in texture and taste called pan masala. The difference: it contains no tobacco and it’s promoted as a breath freshener. The price, packets and street sellers are almost identical, though, increasing the confusion about which product is which, says Prakash Gupta, who heads the non-profit research firm Healis.
Godfrey Philips India Ltd., which is 25.1 percent-owned by Philip Morris International, began selling its own version of pan masala this year.
Gutka, whose name is derived from a Punjabi word meaning “a miniature version of Sikhism’s holy book of scriptures,” has a health warning on the packet and the image of a scorpion to indicate its use has been linked to cancer.
That’s not effective enough, says Jagdish Kaur, chief medical officer at the tobacco control unit of India’s Ministry of Health and Family Welfare, and a new set of tobacco warning labels with graphic images of mouth cancer has been approved.
People “need to be very clearly told” about the risks, Kaur said in a telephone interview. “It cannot be just a scorpion or butterfly or whatever.”
Gutka’s Roots
Gutka first appeared in the 1970s, when a New Delhi paan seller began giving clients a ready-made version of paan, according to Malu. Unlike paan, gutka doesn’t stain the mouth pink or leave the hands sticky. It’s also easy to store and transport.
“Selling it in packets has revolutionized the sale of smokeless tobacco in India,” says Babu Mathew, a dental surgeon who headed the Trivandrum Oral Cancer Screening project, which followed 200,000 residents of the southern Indian state of Kerala for 15 years.
Mathew says he has seen multiple cases of patients developing cancers five or 10 years after starting on gutka.
Cancer Connection
A panel convened by the WHO’s International Agency for Research on Cancer found in 2004 that areca nut caused cancer in animal studies, and that in humans it triggers the development of precancerous lesions. Tobacco, meantime, brings on genetic mutations that can lead to cancer.
Doctors point to three reasons why gutka bring on cancer much faster than cigarettes or 400-year-old paan. Both tobacco and areca nut play a role, say Mathew and Tata Memorial’s Chaturvedi.
The tobacco in gutka releases cancer-causing chemicals called nitrosamines in the mouth. In paan, they are neutralized in part by the fresh betel leaf, a benefit that gutka lacks, according to Mathew.
The chemicals in areca nut, meantime, stimulate the production of collagen, a protein that causes the mouth’s muscles to thicken, says Warnakulasuriya of King’s College London. At the same time, the coarse chunks of areca nut rub against the gums and cause tiny injuries that expose the blood vessels in the mouth, a trauma that can take several hours to heal, according to Chaturvedi.
“This injury and healing process is going on for 24 hours,” and over time it makes the inner lining of the mouth very stiff, Chaturvedi says.
Tight Mouths
The muscles in the mouth eventually lose their ability to stretch, resulting in a pre-cancerous condition called oral submucous fibrosis.
“From an uncommon disease found mainly among old persons in India, oral submucous fibrosis is emerging as a new epidemic mainly among the youth,” according to a 2004 report by India’s Ministry for Health and Family Affairs and the World Health Organization.
Patients who previously could grab a sizable chunk of an apple in a single bite are able to open their mouth to just about the size of a grape.
“Before I could put four fingers inside, now I can only put two,” said Aqeel Shaikh, 32, Safiq’s older brother. Shaikh says he chewed six packets of gutka a day for six years before he gave up the habit.
By Adi Narayan
Bloomberg

New smokeless cigarettes on sale in Tokyo

Japan Tobacco, Inc., began selling a new kind of cigarette that doesn’t release smoke on Monday, but reactions from Japan’s major Zero Style Mintairline companies and Japan Railways on the new cigarette’s use in public transportation are mixed.
The new cigarette, being sold as zero-style-mint-japan-tobacco uses cartridges, each containing tobacco leaves, which are set inside the cigarette and smoked. A pack with two cartridges sells for 300 yen. Currently, the cigarettes are only being sold in Tokyo, but based on how well they sell, they may become available in the rest of the country.
“They’re selling well. Some people have bought several packs at once, and they look like they’ll sell out before the day is done. Since it was first announced they were on sale, there’s also been lots of customers asking about them,” said one employee at a Tokyo cigarette store.
Whether the new cigarettes are usable in public, however, is another question.
A spokesperson from Japan Airlines said, “We have no complaint with customers using smokeless cigarettes, including on international flights.”
All Nippon Airways, however, is taking the opposite stance. Its spokesperson said, “Smokeless cigarettes cannot be smoked onboard flights. Even if they’re smokeless, they’re still cigarettes.”
East Japan Railway Co.’s stance was expressed as, “At this time, we have no particular intention of forbidding smokeless cigarettes.”
Central Japan Railway Co. similarly expressed acceptance of the cigarettes, with its spokesperson saying, “We don’t consider them as subject to our no-smoking policy. However, our staff may interfere if necessary to prevent the discomfort of other passengers.”
Spokespeople from West Japan Railway Co., said that their policy is not yet decided, and there is a possibility that they will not allow use of the cigarettes on their trains.
Among prefectural and local governments, an inclination toward acceptance of the smokeless cigarettes is apparent.
In Tokyo’s Chiyoda Ward, a local ordinance forbids smoking on any public roads or sidewalks, but a ward official said, “Currently, the smokeless cigarettes are not subject to the no-smoking ordinance. There’s not even a danger of burning others with a flame.”
One man who bought some smokeless cigarettes in the ward was happy with the new cigarettes: “In the past, I’ve had to pay a fine for smoking in public, but with these I don’t have to worry.”
Even Kanagawa Prefecture, which in April began enforcing the country’s first local anti-secondary smoke ordinance for indoor facilities such as restaurants, says that the smokeless cigarettes will be allowed. While those smoking normal cigarettes in non-smoking areas will be fined 2,000 yen, people using smokeless cigarettes will be left alone.
However, the prefecture’s real goal is the reduction of tobacco use. “Even if the cigarettes are smokeless, they’re still bad for the health. I hope that people will stop smoking altogether,” said the head of the prefecture’s anti-smoking policy group.
Mainichi, May 18, 2010