1. Emerging Tobacco Product Issues -- The New Kids in Town MDCH Tobacco Program September 2009

2. AKA… So-called “harm reduced” products Potentially reduced exposure products = PREPS Non-tobacco nicotine products Alternative tobacco products

3. The term “Harm Reduction” Has been generally used in the fields of substance abuse, alcohol abuse, and sex health education And more recently to tobacco use – reducing the harm caused by tobacco by using products that are potentially less toxic….

4. Why? Tobacco -Harm Reduction!? Why? 70% of smokers want to quit. But only 4.7% of them quit for 3-12 months This indicates difficulty in quitting, So Tobacco industries wanted to keep the addiction and protect their products…and came with: than quitting Strategies to reduce tobacco harm (other than quitting) and one of them is Tobacco Harm reduction products to appear that they care about smoker’s health

5. There is ample evidence that the tobacco companies have long been expert in manipulating the amount of nicotine in their tobacco products…

7. Some pictures of so-called reduced harm or potentially reduced exposure products

8. The mixed message about “harm reduction” and “reduced exposure”…. Reduced exposure ≠ reduced harm Reduced exposure reduced risk of disease Reduced exposure should result in reduced risk of disease to be significantly acceptable!

9. The evidence? Tobacco -Harm Reduction!? The evidence? There is NO EVIDENCE to suggest that: toxins exposure disease riskthere is enough of a reduction in tobacco toxins exposure with any of the existing tobacco products to expect a reduction in disease risk. extent not knownAlso the extent of toxin exposure reduction necessary to result in disease reduction is not known yet.

10. loose-leaf Example of loose-leaf chewing (spit) tobacco

12. Switching to Low-Tar Cigarettes

13. Twist Examples of Twist-Chewing tobacco

14. loose-leaf Chewing (spit) tobacco - loose-leaf

15. Moist Examples of Snuff-Moist

16. loose-leaf Chewing (spit) tobacco- loose-leaf Tucked between the gum and jaw

17. Plug Chewing tobacco - Plug Chewed or held in the cheek and may be held for hours

18. Moist Snuff Flavored…

19. Plug Chewing tobacco - Plug

20. Twist Chewed or held in the cheek and may be held for hours Chewing tobacco - Twist Chewed or held in the cheek and may be held for hours

21. Moist snuff Moist snuff A pinch is placed between the lip or cheek and gum and held for 30 minutes

22. Light Cigarettes

23. Dry Dry Snuff Same as moist, may also be sniffed

24. Dry Dry Snuff

25. Used for the Hookah Flavored Tobacco Used for the Hookah

26. Used for cigarettes Flavored Tobacco Used for cigarettes

27. Placed in the mouth, on the tongue or between the cheek and gum where it dissolves to release tobacco Orbs Tobacco Placed in the mouth, on the tongue or between the cheek and gum where it dissolves to release tobacco

28. Resembles candy and breath mint strips Orbs Tobacco Resembles candy and breath mint strips

29. A finely ground tobacco in sachets "tea bag-like pouches” Snus A finely ground tobacco in sachets "tea bag-like pouches”

30. More spit tobacco

32. The Marketers say: it looks like a cigarette, feels like a cigarette and tastes like a cigarette, yet it isn’t a cigarette E-cigarette The Marketers say: it looks like a cigarette, feels like a cigarette and tastes like a cigarette, yet it isn’t a cigarette

33. Manufacturers consider it a device – not a drug E-cigarette Manufacturers consider it a device – not a drug

34. Manufacturers claim that they are safer??? E-cigarette Manufacturers claim that they are safer???

35. But the FDA On July 22, 2009 announced that the results of the analysis of the electronic cigarette samples showed that the product contained detectable levels of known carcinogens and toxic chemicals to which users could potentially be exposed.But the FDA On July 22, 2009 announced that the results of the analysis of the electronic cigarette samples showed that the product contained detectable levels of known carcinogens and toxic chemicals to which users could potentially be exposed.

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