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Smokeless tobacco: problems and opportunities
Jonathan Foulds
Abstract
Despite being around 90% less harmful to health than smoked tobacco, most forms of smokeless tobacco are illegal in Europe and are presented by public health authorities around the world as being at least as harmful as cigarettes. The strongest evidence for smokeless tobacco potentially playing a useful role in reducing smoking comes from Sweden, where they (primarily men) use a form of smokeless tobacco (snus) that is low in many toxins (but not nicotine) and so appears not to cause cancer, or respiratory disease and to have a much lower cardiovascular risk than cigarettes. In Sweden more men now use snus than smoke cigarettes. Snus is commonly used by young people instead of smoking and in adults it is the most frequently used smoking cessation aid. However, there now may be a realistic possibility of snus playing a role in reducing tobacco-caused harm in other countries. Major cigarette manufacturers have started to take an apparently serious interest in smokeless tobacco, and have started to test market using their established brand names (e.g. Lucky Strike snus and Camel snus). This is a difficult issue for public health advocates for many reasons:
(a) we have a bad history of getting it wrong (e.g. Light Cigarettes)
(b) some forms of smokeless tobacco are clearly carcinogenic (e.g. Sudanese Toombak)
(c) all forms of smokeless likely cause some harms to health (e.g. in pregnancy), but the magnitude is likely much (>90%) lower than cigarettes.
(d) there are concerns that the tobacco industry would market these smokeless products to people who wouldn't otherwise use tobacco.
(e) some believe that every country can dramatically reduce smoking prevalence using effective policies (smoke-free legislation, high cigarette taxes, etc), without transferring millions of smokers to smokeless tobacco.
(f) we have effective medications and other treatments to help smokers quit tobacco, so why risk people switching to smokeless?
(g) We have a long experience of dishonesty on the part of the tobacco industry, with health receiving little or no weighting in that industry's actions.
However, the opportunity presented by snus is to repeat the Swedish experience in other countries and have a significant proportion of the population of smokers switch from cigarettes to a much less harmful tobacco product. Also there is an opportunity for tobacco companies to stay in business by selling a much less harmful product, and so become less dependent on cigarettes.
Biography
Dr Foulds obtained a first class honours degree in psychology at the University of Aberdeen in Scotland before being trained as a Clinical Psychologist at the University of Glasgow. At that time his main research interests were on the psychophysiology and treatment of blood-injury phobia and fainting.
In 1989 he moved to the world-renowned tobacco research group at the Institute of Psychiatry in London and focused his research and clinical work on tobacco addiction. While there he published the first placebo-controlled trials of nicotine patches in the UK, and also studied the psychological effects of nicotine in smokers and non-smokers.
In 1994 he moved to St George's Hospital Medical School in London where he became the UK's first "Lecturer in Tobacco Addiction". While at St George's, Dr Foulds was an investigator in the world's first randomized trial to directly compare nicotine patch, gum, inhaler and nasal spray, and also a large randomized trial of brief smoking cessation advice in pregnant women. He was also on the Management Group of the Hungarian Anti-Smoking Campaign (1995-6).
In 1997 he moved to the University of Surrey where he helped run a doctoral training course for Clinical Psychologists and was also a Principal Clinical Psychologist at Broadmoor Hospital, a large maximum security psychiatric hospital for mentally disordered offenders. However, he maintained a strong research interest in tobacco addiction, became technical leader of a World Health Organization project to improve the regulation of tobacco dependence treatment in Europe, and also became Director of Research
for the charity, Quit, which runs the largest telephone help line for smokers in the world.
Dr Foulds came to the School of Public Health at University of Medicine and Dentistry of New Jersey (UMDNJ) in the United States in 2000 to be the Director of the Tobacco Dependence Program. The program is funded by New Jersey Department of Health and Senior Services to train health professionals in New Jersey to treat tobacco dependence, and also runs its own Tobacco Dependence Clinic. In 2003 Dr Foulds was elected to be Vice President of the Association for the Treatment of Tobacco use and Dependence. Dr Foulds has therefore been conducting research on tobacco for over 16 years. While most of it has focused on treatment for addicted smokers, his work has also addressed such topics as the measurement of passive smoke exposure, the uptake of smoking in young people, the effects of nicotine on mental performance and the health effects of tobacco products. He has published over 50 articles in peer-reviewed journals.
Associate Professor & Director
Tobacco Dependence Program
317 George Street, Suite 210
New Brunswick
Middlesex
08901
USA
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