FDA's new role in tobacco control: Guidance on helping kids to say no
Pediatric health care practitioners are on the frontlines of intervention with youth and young adults to dissuade them from starting to use tobacco or to help their patients quit using tobacco. Given the increase in diverse and novel tobacco products on the market targeting current tobacco users and potential new users, it is worth reviewing tobacco products and information regarding the responsibilities of the US Food and Drug Administration's (FDA's) new Center for Tobacco Products (CTP).
Tobacco use is the leading preventable cause of death in the United States, responsible for approximately 443,000 deaths—or 1 in every 5 deaths—each year.1 Smoking harms nearly every organ in the body, causing many diseases and impairing the health of smokers in general.2 Smokeless tobacco is not a safe substitute for smoking cigarettes because it can cause cancer and noncancerous oral conditions and diseases as well as promote nicotine addiction.3,4
Smoking and smokeless tobacco use almost always begin in adolescence. More than 80% of adult smokers began smoking before 18 years of age.5 Additionally, adolescent smokeless tobacco users are more likely than nonusers to become adult cigarette smokers. The Surgeon General encourages physicians to talk to their patients about tobacco use. Half of all long-term smokers, particularly those who began smoking in adolescence, eventually will die from their use of tobacco.1
Even small amounts of nicotine can be toxic to children. Unintentional ingestion of tobacco products is a major reason for infant and child toxic exposures reported to poison control centers. The large majority (90%) of such accidental poisonings in the population involve children younger than 6 years.6 The discreet form, candy-like appearance, and added flavorings of some new oral tobacco products may make them attractive and dangerous to young children.
Tobacco products overview
The basic components of a cigarette are the tobacco, filter, and paper wrapping. American cigarettes typically contain a blend of tobaccos (burley, flue-cured or bright, Maryland, and oriental or Turkish tobacco) and tobacco-derived materials (eg, expanded tobacco, tobacco stems, and reconstituted tobacco).1,7 The papers surrounding the filter and the tobacco control the air entering and mixing with the smoke. Every state in the United States currently mandates sale of cigarettes using cigarette paper with a reduced propensity to burn when left unattended.8
Tobaccos and tobacco-derived materials differ in their nicotine content and combustion products.7 Nicotine levels are highest in the smoke of flue-cured tobacco, followed by burley, Turkish, reconstituted tobacco sheet, and expanded tobacco blend.9 As a consequence of using tobacco products to satisfy a craving for nicotine, smokers and smokeless tobacco users repeatedly are exposed to toxic and cancer-causing chemicals.
The composition of the tobacco blend also can influence the composition of smoke. For example, use of tobaccos with higher nitrate concentrations (eg, burley) results in an increase in human bladder carcinogens in smoke. Although flue-cured tobacco has a lower nitrate content, it is associated with higher smoke levels of other toxic chemicals such as the cancer-causing polycyclic aromatic hydrocarbon compound benzo[a]pyrene.10
A 2009 nationally representative sample of students in grades 6 to 12 from all 50 states and the District of Columbia showed that 5.2% of middle school students and 17.2% of high school students reported being current (use on at least 1 of the past 30 days) cigarette smokers.11