1. Campaign for Tobacco-Free Kids www.tobaccofreekids.org New Products Old Tricks The Problem Victoria Almquist Director, Outreach Campaign for Tobacco-Free Kids valmquist@tobaccofreekids.org

2. Campaign for Tobacco-Free Kids www.tobaccofreekids.org What’s the Problem with New Products? New tobacco products are designed to: – Draw in new and youth users – Keep smokers smoking These goals are achieved by: – Skirting marketing restrictions that are imposed on cigarettes – Evading higher taxes

3. Campaign for Tobacco-Free Kids www.tobaccofreekids.org TOLL OF OTHER TOBACCO USE Increased youth smokeless tobacco use Harms from other tobacco use

4. Campaign for Tobacco-Free Kids www.tobaccofreekids.org National Youth Smoking and Smokeless Tobacco Use 1997 - 2011 Source: CDC, Youth Risk Behavior Surveillance Survey. 2003-2009: +32.8% 2003-2011: +14.9% 2003-2009: +32.8% 2003-2011: +14.9% 2003-2009: +36.4% 2003-2011: +16.4% 2003-2009: +36.4% 2003-2011: +16.4% 2003-2009: -11.0% 2003-2011: -17.4% 2003-2009: -11.0% 2003-2011: -17.4% 2003-2009: -9.2% 2003-2011: -8.7% 2003-2009: -9.2% 2003-2011: -8.7%

5. Campaign for Tobacco-Free Kids www.tobaccofreekids.org 5 2003-2009: -5.4% 2003-2011: -11.5% 2003-2009: -5.4% 2003-2011: -11.5% 2003-2009: -11.0% 2003-2011: -17.4% 2003-2009: -11.0% 2003-2011: -17.4% 2003-2009: -6.5% 2003-2011: -10.6% 2003-2009: -6.5% 2003-2011: -10.6% 2003-2009: -6.4% 2003-2011: -14.9% 2003-2009: -6.4% 2003-2011: -14.9% National Youth Cigar and Cigarette Smoking 2001-2011 Source: CDC, Youth Risk Behavior Surveillance Survey.

6. Campaign for Tobacco-Free Kids www.tobaccofreekids.org ATTRACTING NEW AND YOUTH USERS Use of flavors Circumventing cigarette regulations New smokeless, spit-less products

7. Campaign for Tobacco-Free Kids www.tobaccofreekids.org CAMEL AND MARLBORO FLAVOR CAPSULE CIGARETTES 7 CAMEL CRUSH MARLBORO NXT

8. Campaign for Tobacco-Free Kids www.tobaccofreekids.org So-Called “Little Cigars” (not to be confused with legitimate little cigars) Cigarettes Legitimate Little Cigars So-Called “Little Cigars”

9. Campaign for Tobacco-Free Kids www.tobaccofreekids.org $10.69 per carton = $1.07 per pack Cheap Flavored “Little or Filtered Cigars”

10. Campaign for Tobacco-Free Kids www.tobaccofreekids.org

11. Flavored Blunt Wraps But what they’re really used for…

12. Campaign for Tobacco-Free Kids www.tobaccofreekids.org KEEPING SMOKERS SMOKING New smokeless, spit-less products “…the use of smokeless tobacco products is not a safe alternative to smoking, nor is there evidence to suggest that it is effective in helping smokers quit.” -- U.S. Public Health Service Clinical Practice Guidelines, 2008

13. Campaign for Tobacco-Free Kids www.tobaccofreekids.org

14. High School Student describing using Camel Snus: “It’s easy, it’s super-discreet…and none of the teachers will ever know what I’m doing.” Kansas City Star, October 31, 2007

15. Campaign for Tobacco-Free Kids www.tobaccofreekids.org Camel recently introduced 2 new flavors of Snus: Winterchill and Robust

16. Campaign for Tobacco-Free Kids www.tobaccofreekids.org

17. Philip Morris USA’s Marlboro Snus Redesigned Pack in early 2009 to fit “perfectly alongside your smokes” – to prevent smokers from quitting.

18. Campaign for Tobacco-Free Kids www.tobaccofreekids.org R.J. Reynolds’ Camel Dissolvables Original packs test-marketed in Columbus, OH, Portland, OR, and Indianapolis, IN starting in January 2009. Redesigned the pack to be LESS child- resistant and re-released products in two new test markets, Denver and Charlotte, beginning March 2011.

19. Campaign for Tobacco-Free Kids www.tobaccofreekids.org 19

20. Campaign for Tobacco-Free Kids www.tobaccofreekids.org New Forms of Smokeless, Spitless Tobacco Put Users and Children At Risk

21. Campaign for Tobacco-Free Kids www.tobaccofreekids.org Philip Morris USA’s Marlboro & Skoal Sticks Resemblance to: Four flavors being test-marketed in select Kansas stores since March 2011. Marlboro Sticks are being placed with cigarettes and Skoal Sticks are being placed with smokeless tobacco products.

22. Campaign for Tobacco-Free Kids www.tobaccofreekids.org 22 “As the state’s health agency, KDHE is particularly concerned about the potential appeal of these new tobacco sticks to youth,” KDHE Secretary Dr. Robert Moser said. “The packages are so small that they could easily be concealed in a shirt or pants pocket and youth could use tobacco sticks in front of parents or teachers while appearing to have a simple toothpick in their mouth. We are also concerned about the risk of young children accidentally ingesting these products.”

23. Campaign for Tobacco-Free Kids www.tobaccofreekids.org 23 Altria’s Newest Smokeless Product: VERVE Announced in May 2012 and will be test-marketed in select Sheetz stores in Virginia.

24. Campaign for Tobacco-Free Kids www.tobaccofreekids.org Cigarette marketing expenditures declined between 2005 and 2008, but smokeless tobacco marketing expenditures more than doubled between 2005 and 2008. These data are based on the most recent official data available from the federal government. The most recent available marketing data for smokeless tobacco is for 2008 and comes from the FTC’s Smokeless Tobacco Report for 2007 and 2008. 118.5% increase since 2005

25. Campaign for Tobacco-Free Kids www.tobaccofreekids.org HOW INDUSTRY ACHIEVES THE GOAL Price Differences

26. Campaign for Tobacco-Free Kids www.tobaccofreekids.org Why Keep Prices Lower? Lower prices are more accessible, affordable, and appealing to youth – Draws them in to a lifetime of addiction – Can lead to smoking, the big money-maker for the tobacco industry Promotes dual use and hinders quit attempts – Smokers can buy fewer cigarettes by using other products sometimes – Why quit because cigarettes are more expensive when you can temporarily substitute with OTPs? 26

27. Campaign for Tobacco-Free Kids www.tobaccofreekids.org Pushing Weight-Based Taxes What they claim: Losing market share to competitors with cheaper products that pay less tax. It’s a fair tax for all smokeless products. What Weight-Based really means: New light-weight products (i.e., snus, dissolvables, and sticks) will pay pennies, if that, in tax. Premium products, which are most popular with youth, would get a tax break, while cheap products would get a tax increase (thus it’s unfair for cheaper products). Over time, states will lose revenue as the value of the tax erodes with inflation and product price increases.

28. Campaign for Tobacco-Free Kids www.tobaccofreekids.org What is a Hookah? Figure courtesy Dr. Alan Shihadeh, American University of Beirut A waterpipe

29. Campaign for Tobacco-Free Kids www.tobaccofreekids.org 2010 MTF survey found that 17% of 12 th graders had smoked a hookah in the past month. Studies of college students have found rates as high as 20% for past month and 48% for lifetime usage. Hookah pipes used in hookah bars and cafes may not be cleaned properly, risking the spread of infectious diseases. In 2008, Colorado State University reported an outbreak of Herpes among hookah users, and hookah use was suspected in the spread of TB in Egypt. There is a common misconception that smoking through a hookah and being exposed to secondhand hookah smoke is not as dangerous as smoking cigarettes or being exposed to SHS from cigarettes. According to researchers at the Mayo clinic, hookah smokers are exposed to more carbon monoxide and smoke than are cigarette smokers. Hookah smoking sessions typically last an hour. A study conducted by UCSF and published on 4-18-13 showed that while hookah users had half the amount of nicotine in their systems, they had 2.5 times the amount of carbon monoxide (breath test) and 2 times the amount of benzene (metabolite test). SOME INFO ABOUT HOOKAH USE

30. Campaign for Tobacco-Free Kids www.tobaccofreekids.org Policy changes that would help address hookah use Close loopholes that exempt hookah bars from clean indoor air laws. State laws should include hookahs in the definition of smoking. This would help eliminate exemptions in clean indoor air laws. FDA should assert authority over hookah tobacco. Federal, state and local laws can be used to prohibit the use of flavorings in hookah tobacco. Close loopholes in laws and enforce existing laws about sales of hookah tobacco and paraphernalia to minors. States and localities can use zoning and licensure rules to limit or eliminate hookah lounges.

31. Campaign for Tobacco-Free Kids www.tobaccofreekids.org Questions? Victoria Almquist Director, Outreach Campaign for Tobacco-Free Kids valmquist@tobaccofreekids.org