Potentially Reduced Exposure Products

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Potentially Reduced Exposure Products

What are Potentially Reduced Exposure Products (PREPs)?

  • PREPs are tobacco-based products that claim to reduce the exposure to and harm from the toxins found in tobacco.10
  • Some of these products are nicotine delivery devices that are lit the same way as a cigarette, but heat rather than burn (e.g. Eclipse, Accord). With these products, very little tobacco is burned. The lack of smoke reduces exposure to toxins by removing the combustion process.
  • Other researchers have worked to create cigarettes with reduced levels of toxins by using different tobacco curing or fermentation processes, or by adding chemicals (such as palladium) to the tobacco leaves (examples of cigarettes include OMNI and Advance cigarettes).
  • Other research has focused on creating genetically engineered tobacco leaves with reduced nicotine levels (e.g. Quest).
  • Lastly, there are several oral non-combustible tobacco products (e.g., Arriva and Stonewall, which are types of dissolvable tobacco products that dissolve in the mouth) being marketed as tobacco alternatives to smoking. They are not marketed as cessation products.

Types of PREPs

Electronic Cigarettes (E-Cigarettes or E-cigs) or Electronic Nicotine Delivery System (ENDS):

  • Are devices designed to look similar to cigarettes in shape, size, and general appearance.
  • Operate by vaporizing a solution containing nicotine, creating a mist that is then inhaled.12
  • Are available in various flavors, such as vanilla,13 menthol,13 pina colada,13.
  • Nicotine cartridges contain various levels of nicotine. It is important to note that a single cartridge contains anywhere from 6-48 mg of nicotine. This is significantly more nicotine compared to the typical range of 0.5-1.2 mg of nicotine in a single cigarette.12
  • Use is commonly referred to as “vaping.”12

Important Findings

Currently, the research concerning the safety of electronic cigarettes is ambiguous. On one hand, some research indicates electronic cigarettes could be a safe alternative to smoking and that it can be used as a possible cessation tool. On the other hand, as more and more research is being conducted, the possible danger of electronic cigarettes is surfacing in both the actual electronic mechanisms and the chemicals included in the cartridges. Research is still being conducted to better understand both positions in this debate.

Possible Benefits

As mentioned previously, there is some research indicating that the use of electronic cigarettes is a possible alternative to smoking cigarettes thereby reducing the exposure to toxins from inhaling the smoke of cigarettes.

  • In 2010, an online survey was conducted to determine possible electronic cigarette use patterns and the effectiveness of electronic cigarettes as a smoking-cessation tool.
  • What the researchers found was that the more an individual used electronic cigarettes, the less that person smoked cigarettes (66.8%), the more they stayed abstinent from cigarettes for a period of time (48.8%), and the more likely they were to quit if they used their electronic cigarettes more than 20 times a day (70.0%).

Disadvantages

The other half of the debate concerning the pragmatic and safe use of electronic cigarettes is focused on the danger of the chemicals included in the vapor exposure and the danger of the mechanism itself.

  • In one study, conducted by the FDA’s Division of Pharmaceutical Analysis, researchers examined ingredients of cartridges from two leading brands of electronic cigarettes.
    • In one sample, they found diethylene glycol (a chemical used in antifreeze that is toxic in humans). In additional samples they found known carcinogens, including nitrosamines, and several tobacco-specific impurities suspected of being harmful to humans (e.g. anabasine, myosmine, and β-nicotyrine).
  • Another study tested the difference between conventional and electronic cigarettes and the amount of suction needed for them to produce smoke (conventional) or aerosol (e-cigarettes) and their density over time.
  • The results of this study indicated that higher suction was needed to smoke e-cigarettes than conventional cigarettes.
    • In addition, the smoke/aerosol was constant for both conventional and electronic cigarettes over the first 10 puffs, but then dropped for e-cigarettes requiring more and more suction to produce the same effect as time progressed. While current research has not yet established the health effects of exposure to the chemicals in the vapor of electronic cigarettes, detrimental health effects could be compounded based on the increased suction required.

Conclusion

Currently, there is a dearth of much needed research on electronic cigarettes. As mentioned above, the field of tobacco research has begun to examine the utility and health effects of these products, but is only at the beginning. To date, research has not shown consistent findings that these products are safe and able to reduce cigarette consumption. Bearing that in mind, until there is more research on electronic cigarettes, health and safety claims are not yet refutable.

CLICK HERE for an interview with a leading authority, Dr. Dorothy Hatsukami, co-director of the Transdisciplinary Tobacco Use Research Center (TTURC) at the University of Minnesota.

CLICK HERE for Dr. Hatsukami's paper entitled "Hope or Hazard? What Research Tells Us about Potentially Reduced-Exposure Tobacco Products".

Last updated: February 08, 2013
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References

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http://www.apa.org/science/psa/sb-hatsukami.html, April 2007.
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12Kuschner, WG, Reddy, S, Mehrotra, N, Paintal, HS. Electronic cigarettes and thirdhand tobacco smoke: Two emerging health care challenges for the primary care provider. InInt J Gen Med. 2011;4:115-120. doi: 10.2147/IJGM.S16908.

13Flavored cartridges (2012). blu Cig Web site. Available at: http://www.blucigs.com/cartridges. Accessed June 29, 2012.

14Siegel, M. B., Tanwar, K. L., & Wood, K. S. (2011). Electronic cigarettes as a smoking-cessation tool: Results from an online survey. American Journal Of Preventive Medicine, 40(4), 472-475. doi:10.1016/j.amepre.2010.12.006

15Trtchounian, A., Williams, M., & Talbot, P. (2010). Conventional and electronic cigarettes (e-cigarettes) have different smoking characteristics. Nicotine & Tobacco Research, 12(9), 905-912. doi:10.1093/ntr/ntq114

16Williams, M., & Talbot, P. (2011). Variability among electronic cigarettes in the pressure drop, airflow rate, and aerosol production. Nicotine & Tobacco Research, 13(12), 1276-1283. doi:10.1093/ntr/ntr164