Non-cigarette tobacco products: what have we learnt and where are we headed?

Abstract

A wide variety of non-cigarette forms of tobacco and nicotine exists and their use varies regionally and globally. Smoked forms of tobacco such as cigars, bidis, kreteks, and waterpipes have high popularity and are often perceived erroneously as less hazardous than cigarettes, when in fact their health burden is similar. Smokeless tobacco products vary widely around the world in both form and health hazards, with some clearly toxic forms (e.g. South Asia), and some forms with far fewer hazards (e.g., Sweden). There are also emerging nicotine delivery systems not directly reliant on tobacco (e.g. electronic nicotine delivery systems [ENDS]). The presence of such products presents both challenges and opportunities for public health. Future regulatory actions such as expansion of smokefree environments, product health warnings, and taxation may serve to increase or decrease the use of non-cigarette forms of tobacco. These regulations may also bring about changes in non-cigarette tobacco products themselves that could impact public health by affecting attractiveness and/or toxicity.

Opinions About Electronic Cigarette Use in Smoke-Free Areas Among U.S. Adults, 2012

“…E-cigarettes were originally designed to closely resemble regular cigarettes. 2 They now vary in design, shape, ingredients, 3,4 as well as the amounts of nicotine in a cartridge and that delivered per puff. 5 E-cigarettes are a class of products that come in three main models: cigarettelike e-cigarettes that mimic regular cigarettes in shape and size and can either have a disposable (e.g., NJOY) or a rechargeable power source (e.g., Blu, GreenSmoke); pen-like, medium-sized rechargeable e-cigarettes (e.g., Vapor King); and tank-style vaporizers, also known as "mods," which contain a large cartridge and an efficient battery (e.g., Volcano).…”

Cigarette Smokers’ Use of Unconventional Tobacco Products and Associations With Quitting Activity: Findings From the ITC-4 U.S. Cohort

“…On the other hand, the Institute of Medicine (IOM) warns that availability of other tobacco products may have a net negative impact on public health since smokers might delay or refrain from quitting, former smokers may be drawn back to tobacco use, and nonsmokers might be encouraged to start using tobacco (IOM, 2012). Therefore, evaluating the net impact of these other tobacco products (hereafter referred to as unconventional tobacco products) on public health is an important and complex question (Bombard, Rock, Pederson, & Asman, 2008;Hatsukami et al, 2002;Hatsukami, Ebbert, Feuer, Stepanov, & Hecht, 2007;O'Connor, 2012;Shiffman et al, 2002).…”

Tobacco packaging and labelling policies in countries of the Eastern Mediterranean and Western Pacific Regions: Post-deadline assessment of the time-bound measures of WHO FCTC Article 11

“…Smokeless tobacco products and other forms of smoked tobacco (hand-rolled cigarettes, bidis, kreteks, cigars, cigarillos, pipe tobacco) are used in both regions [37][38][39][40][41][42][43][44][45] . For example, waterpipe tobacco was traditionally used across countries of the EMR and in few countries in the WPR, but it has recently surpassed cigarette use in some countries [37][38][39][40][41][42][43][44][45] .…”

“…For example, waterpipe tobacco was traditionally used across countries of the EMR and in few countries in the WPR, but it has recently surpassed cigarette use in some countries [37][38][39][40][41][42][43][44][45] . In Malaysia, one in three female tobacco users consumed smokeless tobacco alone, but PHWs were required by law on cigarettes only 20 .…”

“…Furthermore, new forms of tobacco are constantly being invented, exploiting loopholes in existing tobacco control laws. This creates an additional challenge to countries already struggling to contain the growing tobacco epidemic [37][38][39][40][41][42][43] . Therefore, health warning provisions must cover all types of tobacco products equally, and should consider specific health effects related to each 1,[17][18][19] .…”