Your Thoughts on Smoking: Laws, Taxes, and Kids

In a country where health-and-safety regulations butt heads with civil rights and privacy laws, smoking is a hot topic only a few rungs below, say, abortion and gun control. What you do to your own body is your own business, cigarette supporters argue. But smoke travels, the other side answers, and innocent people are hurt and even killed. Smoking is, in a sense, a tax on the cost of health care for the whole country.

Our first Health survey asked six provocative questions at the heart of the argument. And here’s what we found.

47% say that smoking in a home or car around children should be illegal

41% want to see smoking banned in all public places

44% think that smokers should pay more for health insurance

28% believe that taxes should be raised to make cigarettes $10 or even $20 a pack

27% wish that all smoking scenes would be banned from movies

44% think that all smoking billboards and magazine ads should be outlawed

Background: The California Environmental Protection Agency estimates that secondhand smoke causes approximately 3,400 lung cancer deaths and up to 69,600 heart disease deaths annually among adult nonsmokers nationwide. In children, it causes sudden infant death syndrome (SIDS), respiratory infections, ear problems, and more frequent and severe asthma attacks, reports the Centers for Disease Control.

Still, about 25% of children aged 3 to 11 (and about 7% of nonsmoking adults) live with at least one smoker, and almost 60% of U.S. children are regularly exposed to secondhand smoke. Kids are exposed to the idea of smoking, as well, through advertisements, television, and film—a factor that Dartmouth University researchers say increases their risk of becoming smokers later in life.

Local, state, and even international laws about smoking seem to change every day, while science keeps finding new arguments against lighting up. Need more motivation? Here are 97 reasons to quit, and advice on how to break your addiction forever.

Take this month’s pollAre you more afraid of breast cancer or heart disease? Would you have your breasts removed if you had the breast cancer gene? Do you think breast cancer is caused by pollution? Is breast cancer research underfunded? Your opinions count. Take this month’s Health breast cancer poll.

Related Links:An Addiction Specialist Explains Nicotine’s Powerful Blog: Should Smoking Around Kids Be Illegal?16 Ways to Help a Loved One Quit SmokingHome Smoking Ban Keeps Teens From Lighting UpQuiz: What Kind of Smoker Are You?

Tobacco Control Program Saved Billions in Health Costs

TUESDAY, Aug. 26 (HealthDay News) — California’s state tobacco program resulted in a 50-to-1 return on investment over 15 years, say researchers from the University of California, San Francisco.

In a study published in the Aug. 25 issue of PLoS Medicine, researchers evaluated the health care savings that occurred as a result of the tobacco control program between 1989, when the program began, and 2004, when the study ended.

They found that the program saved $86 billion — in 2004 dollars — while only costing the state $1.8 billion to fund the program.

The savings were due to the fact that the program prevented 3.6 billion packs of cigarettes from being smoked over the 15-year period.

“The benefits of the program accrued very quickly and are very large,” senior author Stanton Glantz, director of the UCSF Center for Tobacco Control Research and Education, said in a university press release.

Glantz said that the reason the California program had such sizable and rapid benefits in health-care cost savings was the fact it was directed at adults, not youth.

“When adults stop smoking, you see immediate benefits in heart disease, with impacts on cancer and lung diseases starting to appear a year or two later,” he said.

These savings occurred despite the fact that there was a substantial diversion of funding during the mid-1990s. In fact, the researchers estimated, if the funding had been maintained at the same intensity as it had in the program’s early years, the total health-care cost savings would have increased from $86 billion to $156 billion over the 15 years.

Previous research has shown that large state tobacco control programs can reduce smoking, heart attacks and cancer. But this study is the first to quantify the health-care savings that result from these types of programs.

Glantz teamed up with James Lightwood, assistant adjunct professor in the UCSF School of Pharmacy, who specializes in mathematical modeling, health economics, and statistics.

For this study, Lightwood used methods that were developed to analyze financial markets. The researchers used these methods to model the relationship between per capita tobacco control expenditures, per capita cigarette consumption, and health-care expenditures across the study time frame. They compared the California results to those from 38 states that did not have comprehensive tobacco control programs before 2000.

The researchers hope that this study will help support the development of new tobacco control programs.

“The methods in this study can be used to forecast future costs and will provide important additional means for validating program evaluations that previously did not exist,” Lightwood in the university new release.

More information

The U.S. Centers for Disease Control and Prevention has more about smoking and tobacco use.

— Krisha McCoy

SOURCE: University of California, San Francisco, news release, Aug. 25, 2008

Last Updated: Aug. 26, 2008

Copyright © 2008 ScoutNews, LLC. All rights reserved.

Related Links:97 Reasons to Quit SmokingAn Addiction Specialist Explains Nicotine’s Powerful HoldHow Much Money Are You Spending on Cigarettes?Health Risks of Smoking Cigarettes

Nicotine Replacement May Help Smokers Quit Gradually

FRIDAY, April 3 (HealthDay News) — For smokers who want to cut down on the number of cigarettes they smoke, using nicotine replacement therapy not only helps them smoke less but makes it twice as likely that they will quit altogether, British researchers report.

Although using nicotine replacement therapy — such as gum, inhalers, patches and lozenges — as a way to reduce smoking is approved in Britain and other countries, it remains unapproved and controversial in the United States. Some think it sends the wrong message — that cutting down on smoking is OK. Others think that because tobacco companies make other nicotine delivery devices, this approach is merely a boon to the tobacco industry.

“We looked at papers that took people who said, ‘I don’t want to stop smoking, but I am prepared to reduce my smoking,’ ” said lead researcher Dr. Paul Aveyard, from the School of Health and Population Sciences at the University of Birmingham. They were given either a nicotine replacement product or a placebo, “and twice as many in the active treatment groups quit smoking compared with the placebo side,” he said.

The results are similar to studies on the use of nicotine replacement therapy among people who said they wanted to quit.

In addition, Aveyard said, there were no serious adverse effects from the use of nicotine replacement while people continued to smoke.

The findings were published online April 3 in BMJ.

For the study, Aveyard’s team reviewed seven studies that compared the use of nicotine gum or inhalators with placebos to see which was more effective in gradually getting smokers to quit. The studies included a total of 2,767 people.

Over six to 18 months, 6.75 percent of those using nicotine replacement stopped smoking for six months — double the proportion of those using placebos. The researchers said it meant that 3 percent of smokers quit who otherwise would not have.

Participants in the studies who used nicotine replacement also received regular behavioral support and monitoring, and the researchers said that this support may have been as important as the nicotine replacement itself.

Aveyard said that use of nicotine replacement would allow treatment of many more smokers than the small number who say they want to quit. “It potentially opens the door to treat almost all smokers with treatments that were formally reserved for people who are wanting to quit right now,” he said.

Because most nicotine replacement drugs are available over-the-counter but are not approved in the United States for smoking reduction, Aveyard suggests that people who want to try this approach should first consult with their doctor.

Dr. Norman H. Edelman, chief medical officer of the American Lung Association, predicted that the topic is going to be widely discussed in the United States.

“In Britain, they are a little bit ahead of us,” Edelman said. “Right now, the FDA approval for nicotine replacement therapy is as an aid to cessation. The next issue is whether we should use nicotine therapy to reduce smoking without worrying about whether people quit or not.”

The American Lung Association says that it should be used to help people quit smoking, but the group has “not adopted the idea of using nicotine replacement therapy for risk reduction,” Edelman said.

And whether the Food and Drug Administration will approve its use to cut down on smoking is unclear, he said.

“It’s a hot potato topic,” Edelman said. “Cigarette companies are manufacturing nicotine delivery devices of all kinds, and there is a tendency to be negative about that. Nobody feels kindly disposed to letting tobacco companies make nicotine delivery devices.”

And using nicotine replacement to reduce smoking sends the message that you can benefit by just smoking less, and “the American Lung Association is very opposed to that,” Edelman said. “We do not support risk reduction by just smoking fewer cigarettes.”

In a related article in the Journal of Thoracic Oncology, researchers reported that programs to help people quit smoking are cost-effective even for people with lung cancer.

A research team led by Dr. Christopher Slatore, from the University of Washington in Seattle, found that a smoking cessation program started before lung resection surgery was cost-effective both one and five years after surgery. They based their analysis on length of survival and improvement in the person’s quality of life.

Although the results of the study apply only to people eligible for resection, all lung cancer patients should take part in smoking cessation programs, the researchers concluded.

More information

The American Lung Association has more on quitting smoking.

SOURCES: Paul Aveyard, M.D., Ph.D., School of Health and Population Sciences, University of Birmingham, England; Norman H. Edelman, M.D., chief medical officer, American Lung Association; April 3, 2009, British Medical Journal, online; April 2009, Journal of Thoracic Oncology

By Steven ReinbergHealthDay Reporter

Last Updated: April 03, 2009

Copyright © 2009 ScoutNews, LLC. All rights reserved.

Growing Up With Smokers May Cause Lasting Lung Damage

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By Anne HardingTUESDAY, May 19, 2009 ( — Adults who were exposed to large amounts of secondhand smoke during childhood have lungs that look different on CT scans than people who grew up in a smoke-free environment, a new study suggests.

Specifically, their lungs have slightly more, and larger, emphysema-like “holes” than those with less smoke exposure, says Gina Lovasi, MPH, PhD, of Columbia University, and her colleagues. Although breathing tests showed that the smoke-exposed lungs were functioning just fine, Lovasi said the changes could signal an increased vulnerability to developing emphysema and other lung problems down the road.

Emphysema is a progressive lung disease characterized by shortness of breath, coughing, fatigue, and weight loss. About 24 million people in the United States have emphysema and/or chronic bronchitis, which together are known as chronic obstructive pulmonary disease (COPD); however about half of those people don’t realize they have COPD.

The lung condition is the fourth leading cause of death in the United States, and smoking is a major cause of COPD.

“The interesting part about this is that we don’t know a lot about how the lungs change over time and whether they heal completely after being exposed to tobacco,” says Lovasi, who is scheduled to present her findings on Tuesday at the American Thoracic Society’s 105th International Conference in San Diego. “We can still see a difference even decades later.”

The harmful short-term effects of breathing other people’s cigarette smoke are well known, but the long-term consequences aren’t as clear. To investigate, Lovasi and her team looked at CT scans of the lungs of 1,781 nonsmoking 45- to 84-year-olds taking part in the Multi-Ethnic Study of Atherosclerosis (MESA) trial.

About half of the study participants said that no one who they lived with during childhood smoked cigarettes at home, 31% lived with one person who smoked at home, and 17% lived with two or more smokers.

Lovasi and her team checked the lung CT scans for large areas where the density was similar to air (lung tissue is naturally denser than air), and also calculated what percentage of their lungs was made up of these “holes.”

“The lungs are supposed to have air in them, but it’s important that the air is interspersed with blood vessels so that we can get the oxygen out of the air,” she says. “Small holes can expand over time and merge to form larger holes.”

For people who hadn’t grown up with smokers, 17% of their lung tissue had this air-like density, while “holes” made up 20% of the lung area of people who had lived with at least two smokers during childhood. The more heavily smoke-exposed study participants also had more relatively large holes in their lungs. In comparison, “someone with emphysema would have typically have between 30% and 60% of the lungs classified as air-like (or emphysema-like) using the threshold we used for our study,” says Lovasi.

Lovasi says she and her colleagues will be following the MESA participants over time to see how their lungs change, and whether people with more early smoke exposure are indeed more vulnerable to lung problems later on.

Related Links:Should Smoking Around Kids Be Illegal?I’m a Nonsmoker, But I Have Emphysema Due to a Rare Genetic Condition5 Celebrities Who Had—or Are at Risk of—the Lung Disease COPDMy Smoker’s Cough Turned Out to Be Emphysema1 in 3 Smokers Would Kick Habit to Protect Pet

Women Get Prettier, Teen Overdoses on Nicotine Gum, and What Wine Has in Common With Toilet Cleaner

For smokers trying to quit, 10 to 15 pieces of nicotine gum a day usually does the trick. When a 14-year-old from England chewed 45 pieces in a day, however, he ended up in the hospital from an overdose! [BBC]

Here’s a fun tidbit for your next after-work happy hour: Most commercial wines contain sodium bisulfite—a compound that makes up 50% of certain toilet bowl cleaners! Here are some other weird food ingredients worth thinking twice about. [AOL Health]

Evolution seems to be favoring women these days: We’re getting prettier, says a new study. Women with traits generally considered attractive tend to have more children, and those children are more likely to be female. Those little girls inherit their good looks from Mom, and the generations just keep on getting cuter! As for guys, well, not so much. [Times Online]

Need a quick fix for the high price of prescriptions? Before shelling out big bucks, check a pharmacy’s website for printable coupons. If you’re lucky, your local pharmacy may even accept coupons from its competitors. Here are more helpful hints for lowering prescription costs. [MomLogic]

The lack of incentives—like being paid—for donating organs is at least partly to blame for the shortage of donations that’s currently causing many Americans to dabble in illegal trafficking. So why not pay for them? We’re perfectly fine with women selling their eggs, argues one women’s health blogger. [U.S. News and World Report]

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The Lung Cancer Breathalyzer, How Slugs Cure Insomnia, and the PMS Bill of Rights

After years of dealing with those crampy, bloat-y, teary days of the month, we’ve learned what to expect. The new man friend, on the other hand, may not be so accustomed to all the sweatpants and chocolate cravings. Make sure he’s prepared with this PMS Bill of Rights. [The Frisky]

Can’t sleep? Try a spoonful of sea slug entrails! OK, so maybe Ambien sounds like a safer bet, but back in the day, slugs and other strange insomnia cures worked better than counting sheep. [Mental Floss]

We’re hoping that with summer ending, it will be easier to kick our frozen yogurt addiction to the curb. But since we’re pretty sure we’ll be craving the delicious and healthy treat year-round, we figured we’d save some money by learning how to make our own fro-yo. With only two ingredients, it couldn’t get much easier! [Sunset]

While town-hall meetings and congressional debates rage on over health-care reform, one blogger who found relief in public health insurance considers moving to Canada. [Connecticut News]

The future of Breathalyzer tests may have little to do with drunk drivers: Scientists have created an ultra-sensitive breath sensor to be used with lung cancer patients. Recognizing certain compounds common in a lung cancer patient’s breath could help doctors detect the deadly disease in its earliest stages. [Technology Review]

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Study Shows Showerheads May Deliver Blast of Bacteria


By Denise MannMONDAY, Sept. 14, 2009 ( — If the shower scene in Alfred Hitchcock’s Psycho scared you, here’s another reason to scream: A new study says that potentially disease-causing germs can get trapped in showerheads and grow into biofilm, or coats of slime that deliver a bacteria blast along with your hot water.

Although the classic horror film gave legions of moviegoers a fear of showering, the new study shouldn’t do the same, experts say. The bacteria probably don’t pose a threat to most people, although they could be problematic for those with weakened immune systems.

Showerheads are dark, wet, and warm—the ideal environment for bacteria that cause lung diseases to thrive. As we turn on the faucet to get clean, the showerhead may spray our bodies and the air around us with such opportunistic bugs as Mycobacterium avium and other germs known as non-tuberculosis mycobacteria, according to the new research in the Proceedings of the National Academy of Sciences. In fact, levels of these bacteria are more than 100-fold higher than levels found in the pre-shower water, according to the researchers, who analyzed the germs in the biofilm of 45 showerheads from nine U.S cities, including New York and Denver.

“If you are immune compromised or are susceptible to pulmonary infections, take a bath instead of a shower,” says lead researcher Leah M. Feazel, of the University of Colorado, in Boulder. “If you are healthy and your immune system is functioning properly, you should not worry about the germs in your showerhead.”

Mycobacterium avium, found in 20% of study samples, can cause lung infections in both healthy people and those with weakened immune systems, particularly smokers, alcoholics, people with chronic lung disease, and others with conditions that make it difficult to fight off infection. Symptoms include fatigue, a chronic dry cough, and shortness of breath.

The good news is that L. pneumophila, the water-loving germ that causes Legionnaires’ disease, was rare in the study. Only 3 out of 6,000 genetic sequences tested were L. pneumophila. Legionnaires’ disease is a severe type of pneumonia, and outbreaks have been linked to L. pneumophila–contaminated water in large central-air-conditioning systems, whirlpool spas, and other sources of water droplets.

“[The study] is nothing to freak out about because most germs don’t hurt you,” says Philip M. Tierno Jr., PhD, the director of clinical microbiology and immunology at New York University Langone Medical Center. People come into contact with 60,000 types or groups of bacteria on a regular basis, says Tierno, who is also a clinical professor of microbiology and pathology at the New York University School of Medicine in New York City. “Only one or two percent are pathogenic,” he explains.

That said, cleanliness is next to godliness. “The new study emphasizes the need for us to periodically get rid of biofilm on our showerheads,” he says. Change the showerhead once a year or more frequently, like they do in hospitals, to prevent mineral deposits and biofilm, he suggests.

Metal showerheads appear to be less likely than plastic showerheads to grow biofilm, according to the researchers. Tierno recommends taking a steel brush and good cleaning solution to wash out metal showerheads.

Wearing Patch for 6 Months May Help Smokers Quit

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By Anne Harding

MONDAY, Feb. 1, 2010 ( — If you’re trying to quit smoking, wearing a nicotine patch for up to six months—far longer than is generally recommended—may increase your chances of staying smoke-free, a new study has found.

Even with the longer treatment, however, your chances of successfully quitting are only about 1 in 7, according to the study, which was funded by the National Cancer Institute and the National Institute on Drug Abuse.

“There’s an assumption that nicotine dependence is an acute disease that can be treated with short-term therapy,” says Caryn Lerman, PhD, one of the study’s authors and the director of the Tobacco Use Research Center at the University of Pennsylvania. “Smokers should talk to their health-care provider about whether it makes sense for them to continue on the nicotine patch for an extended period of time as an alternative to returning to smoking.”

The patch reduces cravings and withdrawal symptoms by releasing a slow and steady dose of nicotine through the skin. The latest guidelines from the U.S. Public Health Service recommend that smokers who are trying to quit use the patch for eight weeks or less, although some brands of patches are designed to be used for up to 10 weeks.

In the new study, published this week in the Annals of Internal Medicine, 568 adult smokers who were otherwise healthy wore a 21-milligram nicotine patch (Nicoderm CQ brand) for eight weeks. At that point, half of the smokers continued to wear the nicotine patch for an additional 16 weeks, while the others wore an identical placebo patch for the same amount of time.

After 24 weeks, 32% of the participants who received the nicotine patch for the duration hadn’t smoked in the previous week, compared to just 20% of those who received the placebo patch. (Whether the participants had smoked that week was verified by checking a breath sample for carbon monoxide.)

Related links:

Common Smoking Triggers—and How to Fight Them

97 Reasons to Quit Smoking

Gum vs. the Patch: Which Is Right for You?

The longer nicotine treatment also proved more effective when a stricter measure of quitting was used. At the 24-week mark, 19% of the people who wore the patch throughout hadn’t smoked even one cigarette since quitting, compared to 13% in the placebo group.

People who wore the patch for a full 24 weeks were also more inclined to try to quit again if they temporarily fell off the wagon, the researchers found. “If somebody has a slip and smokes a few puffs or even has a whole cigarette, they’ll be more likely to return to abstinence if they’re on the nicotine patch,” Lerman says.

After one year, however, there was no significant difference between the two groups in the percentage of study participants who remained smoke-free. Just 14% of the people in either group hadn’t smoked a cigarette in the previous week—underscoring just how hard it is to kick the nicotine habit.

Next page: Many experts now believe 8 to 10 weeks is insufficient

Many smoking-cessation experts have come to believe that wearing the patch for 8 to 10 weeks is insufficient for most smokers. In its 2008 guidelines, the U.S. Public Health Service called for more research into the effectiveness of longer-term nicotine replacement therapy. Lerman and her colleagues are now conducting another study in which quitting smokers will wear the patch for an entire year.

There’s no evidence that wearing the patch for an extended period is unsafe, says Robert A. Schnoll, PhD, the lead author of the current study. The two groups of participants in the study showed no significant differences in side effects, he points out. And, Scholl says, “Everyone would agree that it’s safer than smoking.”

Nicotine patches deliver a relatively pure dose of the drug, while cigarettes contain chemical additives that have been shown to cause cancer.

Jonathan Foulds, PhD, the director of the Tobacco Dependence Program at the University of Medicine and Dentistry of New Jersey, in New Brunswick, says the study’s findings should prompt experts to reconsider how they help people quit smoking.

“We should tailor the duration of pharmaceutical treatment for smoking cessation to the client’s needs, rather than what the box says,” says Foulds, who wasn’t involved in the study. “It’s clear that what the box says may not be long enough for some patients.”

Foulds has his patients stay on the patch until they go a full two weeks without any cigarette cravings or withdrawal symptoms. At that point, he weans them off the patch by using progressively smaller sizes.

“There’s nothing magical about 24 weeks,” he says. “The point is that staying on [nicotine replacement therapy] helps you stay off cigarettes—and, it seems, the longer the better.”

Every smoker is different, according to Lerman. Some can quit with brief treatment, she says, but others will need to stick with nicotine replacement therapy for a longer time. People who experience very severe withdrawal symptoms, for example, are likely to be better off with longer-term use, she says.

Cigars, Pipes Can Damage Lungs Too

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By Denise Mann

MONDAY, Feb. 15, 2010 ( — Cigar aficionados and pipe smokers often claim that their habit is safer than cigarette smoking because they don’t inhale. Even if they think they’re just harmlessly puffing away, they’re still damaging their lungs, a new study shows.

People who smoke cigars and pipes, but have never smoked cigarettes, are more than twice as likely as people who never smoked to have decreased lung function, according to the study. Cigar and pipe smokers who smoke cigarettes (or used to) are at even greater risk; those smokers were nearly 3.5 times more likely than nonsmokers to have decreased lung function.

The cigar and pipe smokers also had elevated levels of a nicotine by-product called cotinine in their urine, the researchers found.

“Some pipe and cigar smokers say they do not inhale, or inhale less, than cigarette smokers,” says the lead author of the study, Josanna Rodriguez, MD, a fellow in pulmonary medicine at Columbia University Medical Center, in New York City. “The elevated cotinine levels found in this study, however, prove that nicotine is being absorbed when you smoke pipes or cigars.”

Related links:

15 Ways Smoking Ruins Your Looks

97 Reasons to Quit Smoking

10 Crazy Ways Smokers Finally Kicked the Habit

Thanks to public-health campaigns, cigarette smoking has been on the decline, but as the study points out, pipe and cigar smoking has increased in recent years. Studies have shown that many cigarette smokers turn to pipes and cigars in the mistaken belief that they are safer than cigarettes. (Ex-cigarette smokers also cite cost as a factor in making the switch.)

Although cigar and pipe tobacco don’t contain many of the harmful, cancer-causing additives found in cigarettes, the study’s findings show that they still increase the risk of developing chronic obstructive pulmonary disease (COPD), a diagnosis that includes both emphysema and chronic bronchitis.

About 12 million people in the U.S. have been diagnosed with COPD and another 12 million have the disease without knowing it; COPD is the country’s fourth leading cause of death. People with COPD have an irreversible decline in lung function to the point that they may need oxygen just to perform daily activities.

Pipes and cigars also put smokers at increased risk for oral cancers, such as lip and mouth cancer.

Next page: No such thing as a safe tobacco product

“Tobacco people have let the rumor fly that cigars and pipes are somehow safer than cigarettes,” says Neil Schachter, MD, the director of the COPD program at Mount Sinai Medical Center, in New York City. “There is no safe cigarette or tobacco product. They all have complications associated with them, and you are not finding a safe harbor if you switch from cigarettes to cigars and pipes.”

In the study, published this week in the Annals of Internal Medicine and funded by the National Heart, Lung, and Blood Institute, some 3,500 people ages 48 to 90 answered questionnaires about their current and past smoking habits. Of the participants, 11% reported smoking cigars, 9% reported smoking a pipe, and 52% said they smoked cigarettes now or in the past. The vast majority of pipe and cigar smokers—nearly 9 out of 10—also smoked cigarettes currently or formerly.

The researchers tested the participants’ breathing function and measured the amount of cotinine in their urine. The people who smoked cigarettes had lower lung function than the people who smoked cigars or pipes alone, according to the study. Cotinine levels were also lower among cigar and pipe smokers than among cigarette smokers.

A number of studies have explored the link between cigarette smoking and COPD, says Dr. Rodriguez. This study is one of the few to look at the lung damage caused by pipes and cigars, and the first to do so in the United States.

The study does have some limitations. Although it included more than 3,500 people overall, just 56 of the participants smoked cigars or pipes but had never smoked cigarettes.

And as Dr. Schachter points out, because most people don’t smoke 20 cigars or pipes a day (the way a pack-a-day smoker does with cigarettes), the time elapsed between the study participants’ urine test and their last cigarette, cigar, or pipe is likely to vary considerably.

Still, the findings underscore that smoking in any form is bad for your lungs. “I would counsel someone who smokes a pipe or cigars to stop smoking,” says Dr. Rodriguez.


Harvard School of Public Health

By Denise Mann

MONDAY, April 19, 2010 ( — A new generation of smokeless, flavored tobacco products that look like breath mints or breath-freshening strips may be life-threatening for children who mistake them for candy, according to researchers from the Harvard School of Public Health and the Centers for Disease Control and Prevention (CDC).

“Nicotine is a poison, and now we’re seeing smokeless tobacco products that look like Tic Tacs or M&M’s, which parents can leave on the counter and children can be attracted to,” says Greg N. Connolly, DMD, the director of the Tobacco Control Research Group at the Harvard School of Public Health, in Boston.

Connolly led a research team that found that smokeless tobacco products are the second most common cause of nicotine poisoning in children, after cigarettes. The researchers reviewed data from 61 poison control centers and identified 13,705 cases of tobacco ingestion between 2006 and 2008, the vast majority of which were in infants. Smokeless tobacco was involved in 1,768 of the cases.

Related links:

How Smoking Ruins Your Looks

97 Reasons to Quit Smoking

Common Smoking Triggers—and How to Fight Them

The new products—currently being test-marketed in three cities—include Camel Orbs, which resemble breath mints; Camel Sticks, which are about the size of a toothpick and dissolve in the mouth; and Camel Strips, which are similar to breath-freshening strips. Small, teabag-like “snus”—pouches filled with tobacco that are placed between the upper lip and gum—are also a potential hazard, according to the study, which appears in the journal Pediatrics.

These products are not smoking cessation aids; rather, they are marketed as a nicotine alternative in places where smoking isn’t allowed.

Although children in the study were most often poisoned from eating cigarettes and smokeless tobacco products in general, the researchers single out the new, dissolvable products—especially Camel Orbs—as a “major concern.” Orbs are available in cinnamon and mint flavors and could easily be mistaken for candy, the researchers say.

“The candy form can only mean trouble, particularly for children and infants,” says Connolly. “And snus are attractive, flavorful, and easily ingested by an infant or child.”

R.J. Reynolds spokesman David Howard says that the packaging of Camel Orbs and the other dissolvable products is “100% child-resistant in accordance with Consumer Product Safety Commission standards” and bears a label that says “Keep Out of Reach of Children.” Adults, he adds, should ensure that “children do not have access to any tobacco products—including dissolvable tobacco products.”

Next page: Nicotine poisoning can cause vomiting—or worse

Still, the researchers say, the pellets could find their way into children’s mouths. Nicotine poisoning can cause nausea or vomiting, and severe cases can result in convulsions, respiratory failure, and even death. Just under 0.5 milligrams of nicotine per pound of body weight is the minimum lethal dose for children, according to Connolly.

A chemical analysis conducted by Connolly and his colleagues found that Camel Orbs contain an average of 0.83 milligrams of nicotine in each pellet. Some of the nicotine is “un-ionized,” which allows for more rapid absorption and may be more toxic than other forms of the drug, they write.

“A small pellet with a rapid release of nicotine and a young child with a low body weight can be a very serious problem,” Connolly says. “We have to look at high-risk groups who may ingest these thinking that they are candy, and be very cautious about dispensing them and not leaving them around.”

Regulators, he adds, “must ask tough questions about who is at risk from these products, and who we are trying to help with them.”

To focus on the poison risk of Camel Orbs and dissolvable nicotine products is “remarkably selective,” Howard says. He points out that Dr. Connolly and his colleagues make no mention of nicotine gums and lozenges used in smoking cessation, which are also available in a range of flavors and resemble candy and gum.

In a commentary accompanying the study, officials from the Center for Tobacco Products at the Food and Drug Administration (FDA) write that dissolvable tobacco products “pose unique concerns for public health authorities.” Marisa Cruz, MD, and Lawrence Deyton, MD, write that the FDA has requested research on the products from tobacco companies and will hold a series of public meetings to help develop a regulatory policy.

The FDA has broad authority to regulate tobacco products under the Family Smoking Prevention and Tobacco Control Act, which was signed into law last June. Later that fall, the agency banned the sale of candy- and fruit-flavored cigarettes.

“I would feel safer if the FDA…looked at the packaging [of these products] as well as their safety,” says Jonathan P. Winickoff, MD, an assistant professor of pediatrics at Massachusetts General Hospital, in Boston.

While accidental infant poisonings are certainly cause for concern, purposeful ingestion of smokeless tobacco products by kids and teens may be a larger problem, Dr. Winickoff points out. As the study notes, the use of smokeless tobacco products among adolescents increased 6% per year from 2002 to 2006.

“An adolescent thinks this is harmless because it looks harmless, but they’re exposing their brain to nicotine, and there’s a chance that they would be primed to develop a nicotine addiction,” says Dr. Winickoff, who was not involved in the study. “If teens ended up using smokeless product because they are attracted to candy flavors and they end up getting addicted to nicotine, the public health benefit of smokeless tobacco is neutralized.”

One of the study authors, Terry F. Pechacek, PhD, the associate director for science at the CDC’s Office on Smoking and Health, in Atlanta, notes that nearly half of first-time users of smokeless tobacco are under age 18.

Products such as Camel Orbs, he says, “look like candy, are more easily concealed, and can be used at school or in front of parents. That raises even greater concerns.”