The Scientific Basis of Tobacco Product Regulation - World Health ...

deliberations of the TobReg and additional invited experts who met in July
2007 (http://www.who.int/tobacco/global_interaction/tobreg/en/).
1.3 Types of smokeless tobacco product
Products referred to as ‘smokeless tobacco’ differ widely in form, content
and manufacture, with substantial regional and national variation. For example,
in India, products are made and marketed by large national and multinational
companies as well as by street vendors and small unregistered family
businesses. In contrast, the Swedish smokeless tobacco market is dominated
by the multinational Swedish Match company and a small number of national
companies.
The report of the Scientific Committee on Emerging and Newly Identified
Health Risks (European Commission, 2008) provides a comprehensive
overview of product types, which is summarized briefly in Table 1.1. The
original table contains additional information on product contents and use
and the brand names of commonly marketed products. The reasons and patterns
of use vary, some products being taken mainly after meals, some being
used at least partly to clean the teeth, some being used almost continuously
and at least one product being used to calm teething infants. A common factor
is that all appear capable of inducing and sustaining nicotine addiction, primarily
by delivering nicotine to the oral cavity and nasal passages, although
some absorption undoubtedly occurs through the gastrointestinal tract from
swallowed nicotine-infused saliva. The nicotine concentrations in the products
used usually vary by more than 100-fold. The plasma levels of nicotine
and the speed of delivery depend on pH and buffering capacity: raising the
oral pH into the alkaline range results in more rapid nicotine absorption
through the buccal mucosa (Food and Drug Administration, 1995, 1996; Fant
et al., 1999; Stratton et al., 2001; IARC, 2007; European Commission, 2008).
The buffering agents include slaked lime, bicarbonate and ash. As discussed
elsewhere and in detail in reports published by IARC (2007) and the Scientific
Committee on Emerging and Newly Identified Health Risks (European Commission,
2008), the products also vary by several thousandfold in their
concentrations of carcinogens such as tobacco-specific nitrosamines
(TSNA), benzo[a]pyrene, arsenic, nickel, and formaldehyde, radioactive
polonium-210, and other toxicants.
The wide diversity of products makes it difficult to make generalizations
about the potential health hazards of products designated ‘smokeless
tobacco’.
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