Is using smokeless tobacco just as harmful as smoking, or is it potentially a safer option?
Getting a definitive answer to that question has proved elusive despite centuries of medical research.
Resolving the issue, and providing clarity amid the heated rhetoric, has prompted a new series of medical studies sponsored by the National Cancer Institute.
One set focuses on whether such smokeless products as snus and the dissolvable products from R.J. Reynolds Tobacco Co., provide “a truly less-harmful alternative to conventional tobacco products, both at the individual and population level,” according to the institute’s grant application.
Another set, including one that was started Sept. 1 at Wake Forest University School of Medicine, is aimed at developing strategy to encourage reduced use or even quitting smokeless-tobacco products. Wake Forest is receiving a $2.9 million grant for its study.
Maura Payne, a spokeswoman for Reynolds, said that the company supports “well-designed studies” that could help develop science-based, tobacco-harm-reduction strategies.” Payne said that Reynolds does not promote its new smokeless products as a way to quit smoking.
The institute said that the studies are necessary because “previous tobacco-use reduction efforts pursued by the public-health community were disadvantaged by incomplete knowledge and methods for evaluating the health impact of modified tobacco products.”
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.
The studies are being conducted while there’s more focus than ever on smokeless products.
Major U.S. tobacco manufacturers 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.
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. It also is pitting more health-care and anti-smoking officials on both sides of the smokeless debate.
Wake Forest researchers are following freshmen — both users and nonusers of smokeless tobacco — at 10 unidentified colleges in North Carolina.
“The harm-reduction thesis, as applied to smokeless-tobacco products, is that a significant number of smokers can and will switch to smokeless tobacco and quit smoking,” said Mark Wolfson, one of the two lead researchers for the Wake Forest study.
“One of the reasons we think this study is so important is that many new smokeless-tobacco products are being marketed as a substitute for smoking. We don’t know whether people toggle back and forth between different products.”
Wolfson said that researchers will study whether students’ response to smokeless tobacco differs by school, geography, socioeconomic status and race.
“It may have to do with the availability, price and level of advertising of various smokeless-tobacco products in the community,” he said. “The research field is very hungry for this kind of data on young people, and we think there will be a lot of interest in our results.”
For many people, smokeless tobacco carries images of rural America, of bulging jaws or just a pinch between the cheek and gum, and spit cups.
But in recent years, smokeless products have become more much subtle by use and by design, enabling tobacco users to consume without breaking the law or facing scornful looks.
In June, Congress granted the Food and Drug Administration the power to regulate tobacco products. That includes removing ingredients considered to be hazardous, restricting the marketing and distribution of cheap cigarettes and smokeless tobacco, and focusing on limiting the impact of advertising on youth. The law requires premarket approval for new products, designated as those introduced after Feb. 15, 2007.
“Just like there is no safe cigarette, there is no safe tobacco product,” said Melva Fager Okun, the senior manager for N.C. Prevention Partners. “Spit tobacco and other smokeless products are harmful to your health and can cause cancer in the mouth and jaw and other illnesses.”
Bill Godshall, the executive director of SmokeFree Pennsylvania, said that anti-tobacco groups “are trying to deny people the opportunity to use a legal product, a product with less risk than cheap cigarettes, a product in which there is no one else can be harmed by its use.”
“They want tobacco-free laws rather than no-smoking laws.”
In August, Reynolds was among three tobacco manufacturers that filed a lawsuit against the federal government and the FDA in an attempt to carve out a “free speech” marketing niche for its new generation of tobacco products.
Danny McGoldrick is the vice president of research for the Campaign for Tobacco-Free Kids, which is opposed to promoting smokeless tobacco as an alternative to smoking.
He said that the studies will be “critical to understanding the role these products play in enticing young people to the tobacco habit and/or discouraging smokers from quitting by marketing the products as a source of nicotine in places where smokers cannot smoke.”
“This type of research will inform FDA’s efforts to put in place the public health standard central to its new authority.”
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