E-cigarettes, as they are known to consumers, are battery-operated devices shaped like a traditional
cigarette that contain liquid nicotine. When a user presses a button, the tip illuminates, releasing a burst
of nicotine-infused vapor into the consumer‟s lungs. The nicotine can be flavored, and comes in varying
nicotine levels. A consumer can buy a starter kit for about $150 and nicotine refills for about $45. Popular
brands include NJoy, SmokingEverywhere.com, and Gamucci.
E-cigarettes are becoming more popular as they gain visibility in the marketplace, and as more celebrities
are seen using them. However, the health risks of e-cigarettes are still mostly unknown, just as those of
other new tobacco products. The FDA, in September 2010, wrote to five e-cigarette manufacturers
admonishing them for “violations of good manufacturing practices, making unsubstantiated drug claims,
and using the devices as delivery mechanisms for active pharmaceutical ingredients like rimonabant and
tadalafil,” according to a letter from Janet Woodcock, Director of the Center for Drug Evaluation and
Research, found o
E-cigarettes are potentially harmful to consumers for several reasons:
1. According to a July 22, 2009 FDA report e-cigarettes “contain carcinogens and toxic chemicals
such as diethylene glycol, an ingredient used in antifreeze,” which contradicts manufacturers‟ claims of being a safer cigarette replacement.
2. The liquid nicotine in e-cigarettes is highly concentrated and could be harmful to children if
3. There has not been widespread testing on these products, which leaves many health risks
An example of the reach e-cigarette companies are seeking to gain in the marketplace was found in a press release from Rapid Fire Marketing (RFMK) on June 22, 2011. This release announced that the e-cigarette brand “Bionic Cigs” would be a featured sponsor at the upcoming NASCAR Brickyard 400 race, one of NASCAR‟s most popular events. This deal would include 288 advertising spots for the brand over the course of the event, which is popular among families with children, and young adults. This may strengthen the appeal of a brand and a product that up until the event may have had little recognition among this population.
SNUS, a product originally produced in Sweden, is a type of moistened, finely ground tobacco. Each container of SNUS contains several individually packs of SNUS, which are single doses of tobacco in a porous, teabag-like pouch. Users then place a pouch between the lower lip and bottom teeth, where nicotine is then absorbed through the lip membrane. In a factsheet on smokeless tobacco products, Legacy wrote that part of the appeal of SNUS is that unlike other oral tobacco products, such as chewing tobacco, SNUS does not result in excess saliva production and thus does not require users to spit. This also makes it harder to detect whether someone is using SNUS.
Popular brands of SNUS include Camel, Marlboro and Triumph, with flavors ranging from peppermint, spearmint, „mellow‟, and „robust‟. Packaging is sleek and can resemble gum or mint boxes. This can be appealing for youth that may not enjoy the strong flavor of plain tobacco, but who may be enticed by something mint-flavored and sleek looking.
Health risks associated with SNUS are similar to those of chewing tobacco products:
1. NCI has reported over 28 carcinogens or cancer-causing agents in smokeless tobacco products,
2. Smokeless tobacco use carries an increased risk of oral cancer, and even though SNUS is less
destructive to oral tissue during product use compared with chewing tobacco, the affected areas are still at risk.
3. SNUS needs to be refrigerated to avoid a buildup of nitrosamines, which are carcinogenic.
Users typically find SNUS more appealing because it is a less harsh version of chewing tobacco—it does not burn the cheek and mouth as much as chewing tobacco does. Also favorable is the fact that users do not need to spit. Therefore, SNUS can be used anywhere, even in places where smoking is prohibited. There is a risk for people to use SNUS while also smoking cigarettes, which can make it more difficult to end a nicotine addiction.
Dissolvable Tobacco Products (DTPs) and Tobacco Sticks
DTPs strongly resemble candy in appearance, flavor, and packaging. They are sold in flavors such as mint, chocolate, and coffee, and may be difficult for people to distinguish between non-tobacco products, such as mints and gum. Several health organizations including The American Heart Association, the American Lung Association, The Cancer Action Network and The American Legacy Foundation, wrote a letter to the FDA expressing their concerns for DTPs. The letter outlines several reasons why DTPs are potentially harmful for consumers including:
1. The appeal of DTPs to children and youth because of their flavors and packaging, which
resembles „tic-tac‟ containers and cell phones.
2. The high nicotine content of DTPs may cause youth to become addicted to nitcotine, and
smokers that are trying to quit cigarettes may become addicted to DTPs instead.
3. DTPs are still new products and there has not yet been enough time for comprehensive research
DTPs and tobacco sticks and strips appeal to youth because there is no spitting or leftovers that could alert adults to their use; the products burn the mouth less than other products; and they are also highly flavored and resemble candy. Popular brands include Camel Orbs, Camel Strips and Sticks, Ariva, and Stonewall.
A number of health organizations and smoking cessation groups are speaking out against this new breed of tobacco products. These include those mentioned earlier in the FDA letter, and others such as the Campaign for Tobacco Free Kids, and the Truth campaign. In their letter to the FDA, these groups urge that the “FDA ensure that none of the dissolvable products be marketed with any explicit or implicit claims that they reduce the risk or are safer than any other tobacco product.” This is to prevent tobacco companies from misleading people into abusing a product that may substitute the vessel of their nicotine addiction from one product, cigarettes for example, to another such as e-cigarettes or DTPs.
Since according to a fact sheet by the Kansas Department of Health and Environment (KDHE), “dissolvable tobacco products may contain up to three times the amount of nicotine absorbed by a smoker from one cigarette,” these products can be extremely addictive and potentially toxic to consumers. This is especially
harmful to those who continue to smoke while using a smokeless tobacco product, and to children who may find an unguarded DTP and consume a lethal amount of nicotine, thinking it was candy.
The Next Generation of Products
In the near future there also appears to be a new generation of tobacco products under development, including a new technology that would deliver nicotine via an aerosol burst. In a May 26, 2011 AP article, Michael Felberbaum reported that Jed Rose, the Director of the Center for Nicotine and Smoking Cessation Research at Duke University, has sold this new aerosol technology to Phillip Morris International (PMI).
Developers of this technology are excited by this product because of its ability to avoid "the burning process altogether, finding a way of giving smokers nicotine to inhale but without those toxic substances," Rose said. He hopes that this technology will pave the way for future products that will potentially reduce the occurrence of smoking-related diseases, and death from cigarette fumes.
What this product does not directly address so far is the issue of nicotine addiction or abuse among users. It will be worth watching how the aerosol spray develops and to see how PMI markets the aerosol spray to the public.
In the marketplace today there is a proliferation of smokeless tobacco products, with new technologies being continuously developed. While the health benefits purported by manufacturers of smokeless tobacco are less impressive than the reported dangers to consumers, the appeal of these products to consumers is only increasing with marketing advances by producers.
Knapp, W.M., R.F.C. Naczi, W.D. Longbottom, C.A. Davis, W.A. McAvoy, C.T. Frye, J.W. Harrison, and P. Stango, III. 2011. Floristic discoveries in Delaware, Maryland, and Virginia. Phytoneuron 2011-64: 1–26. Published 15 December 2011. ISSN 2153 733X FLORISTIC DISCOVERIES IN DELAWARE, MARYLAND, AND VIRGINIA ESLEY M. KNAPP Maryland Department of Natural Resources ROBERT F. C. NACZI
Summary of Recommendations for Adult Immunization (Page 1 of 4) Vaccine name Contraindications and precautions For whom vaccination is recommended Schedule for vaccine administration and route (mild illness is not a contraindication) Seasonal • Beginning with the 2010–11 influenza season, vaccination is • Give 1 dose every year in the fall or winter. Contrain