Stealth tobacco

Spring 2009 ]
spr09tobaccohead

Products Designed to Evade Control

Can’t smoke on an airplane, but still crave tobacco? Tobacco companies have come up with a solution for you: a pill that is packaged like a Tic Tac.

With cigarette sales declining and the threat of regulation by the U.S. Food and Drug Administration (FDA) or another federal agency on the horizon, tobacco companies have recently introduced a raft of products, including some you don’t smoke. These companies are rushing to stay ahead of the FDA, which could halt certain product innovations if proposed legislation passes muster with Congress this year.

[Tobacco control researchers call for complete disclosure on now that FDA has power to regulate, Press Release, June 19, 2009]

In the past few years, a smokeless tobacco market once dominated by companies with no interest in selling cigarettes has been subsumed by cigarette manufacturers. In January, R.J. Reynolds began test-marketing a dissolvable tobacco pill called Camel Orbs in three U.S. cities. These aspirin-sized, flavored lozenges travel-on planes, trains, and anywhere else. Pop one in your mouth, and no one will know.

Big Tobacco is always looking to skirt public health initiatives designed to curb use of its lethal, addictive products, says Gregory N. Connolly, professor of the practice of public health at the Harvard School of Public Health (HSPH). Manufacturers manipulate nicotine levels, menthol content, and other additives to target specific consumer groups, retain current smokers, and lure young people. Current laws, which focus on cigarettes, restrict tobacco marketing, advertising, and distribution, but not the products themselves.

[Connolly: New Camel magazine ads tout Snus as "complementary" product, not replacement (New York Times, September 21, 2009)]

Because of this, Connolly says, passage by Congress of a proposal to have the FDA regulate future products is critical. The House of Representatives passed such a bill last year, and again this year. At press time, the Senate was expected to take it up. The legislation would set up a new FDA department to evaluate the safety of new products as well as changes to existing ones. Connolly testified at the Senate hearings last year, sharing with the Senate committee new findings by his research team.

Below is a roundup of the latest products, marketing tactics, and HSPH studies.

spr09tbcoorbs_thumbnailEASY TO HIDE “Dissolvables,” newest on the market, are tobacco pills, strips, or sticks that dissolve in the mouth. Made from milled tobacco and food-grade binders, they come in mint and other flavors. Manufacturers tout them as tobacco-anywhere products-at work, at the movies, in a bar. Brands include Ariva and Stonewall as well as Camel Orbs, Sticks, and Strips, which are packaged like candy. Dissolvables appeal to kids because they’re easy to hide. Although dissolvables eliminate dangers posed by smoking, nicotine is addictive, critics note; moreover, they may open the gate to cigarette smoking and deter smokers from quitting. Sparse data exist on their health effects.
spr09TBCOslimsTHE FEMININE TOUCH
Last year, Phillip Morris USA introduced Virginia Slims Superslims Lights. These ultra-thin cigarettes, packaged in lipstick-sized boxes, drew fire from health advocates, who say they target women and teenage girls. R.J. Reynolds’ Camel No. 9 cigarettes come in hot pink and minty green (for menthol) packages displaying the slogan, “light & luscious.” They entered the U.S. market in 2007.
spr09scolePLAYBOY PROMOTION
For the 25th anniversary issue of Playboy magazine, in January 2009, the makers of Skoal, a chewing and spitting tobacco, ran a 12-page promotional section—a practice that could be curtailed under FDA regulation–and embarked on a cross-promotional campaign with the magazine.
spr09TBCOsnusSNUS ON THE TRAIN
Snus, pronounced snoose, first hit the U.S. in 2006. Users place the teabag-like pouches of tobacco behind the upper lip, and throw them away after about 30 minutes. Like dissolvables, Snus can be used anywhere. Camel and Marlboro both offer Snus, which originated in Sweden decades ago.
NEW MENTHOL CRUSH R.J. Reynolds introduced Camel Crush in 2008. A squeezable filter on these cigarettes injects menthol into smoke at varying levels.
AND NOW, THE E-VERSION
A plastic ecigarette is tobacco-free. Still, it gives puffers a dose of nicotine while emitting a smoke-like trail of vapor. Developed through a cottage industry in China in 2004, ecigarettes bear no ties to big tobacco companies as yet. Small companies have begun offering several brands in selected U.S. areas while also promoting distributorships. In one state, Minnesota, public health officials have done nothing to prohibit these devices in public places. But some bar owners have balked, saying ecigarettes too closely resemble the real things. 
Cigars, smokeless tobacco sales rising
Although higher cigarette prices and expanding restrictions on where people can smoke have helped fuel a decline in smoking, sales of cigars and smokeless tobacco are on the rise. HSPH’s Gregory Connolly and Research Scientist Hillel Alpert reported on this trend last year in the Journal of the American Medical Association.
Smokeless tobacco “dual use” emphasized
In a study published in Tobacco Control in February, Connolly’s research team examined internal tobacco-industry documents and found that manufacturers were developing new smokeless tobacco products to promote their “dual use” with cigarettes. Such marketing strategies could bode ill for public health, the researchers warn.
Smokless product ads up
According to an HSPH-led study in the November-December issue of Health Affairs, spending on magazine ads for smokeless tobacco products in the U.S. rose from $18.7 million in 1998 to $26.6 million in 2006. The study, conducted by Alpert, Connolly, and Howard Koh, Harvey V. Fineberg Professor of the Practice of Public Health and associate dean for public health practice, also found that youths’ use of moist snuff-Skoal, Grizzly, and Copenhagen-increased 6 percent per year, on average, from 2002 to 2006.
Facebook sites promote products
In scouring the Internet, HSPH researchers found 60 Web sites on Facebook alone related to smokeless tobacco use. The largest, for Skoal, had 6,000 members, all self-reported high schoolers.
Menthol manipulation
After examining tobacco-company documents and testing various mentholated products, HSPH researchers, including Connolly, concluded last year that manufacturers boosted menthol levels to retain older smokers and lowered levels to make smoking less harsh for young, first-time smokers. In a victory for the tobacco lobby, pending FDA legislation excludes menthol from a clause concerning flavors. However, the legislation gives the FDA authority to look into the potential for any additive, including menthol, to cause harm.

Larry Hand is associate editor of the Review.
Photos, Kent Dayton, HSPH