Experts pipe up about hookahs and smokeless tobacco, but not cigarettes?

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Today is World No Tobacco Day, and the media have commemorated the occasion from a variety of perspectives. The New York Times today features an article focusing on new state laws that seek to ban or limit hookah use, which many teens and young adults wrongly believe is a safer alternative to cigarette smoking. Paul G. Billings, a vice president of the American Lung Association, tells The Times that such anti-hookah policies are “a top priority” for the group.

Meanwhile, the Kansas Department of Health and Environment (KDHE) has decided to mark the holiday by informing Kansans that Philip Morris/Altria, in partnership with the smokeless tobacco company Skoal USA, is using the state as a test market for their tobacco sticks — which reports as “a new product that comes with some of the same health risks as other tobacco products.” However, this is actually old news: ACSH covered this story on April 6, immediately after market testing in Kansas began for these smokeless tobacco products. The tobacco sticks, packaged in matchbox-sized cartons, look like toothpicks that are covered about two-thirds of the way with tobacco. KDHE’s Dr. Robert Moser, however, is concerned that the appearance and “candy-like” taste of the sticks will appeal to youth. “The packages are so small that they could easily be concealed in a shirt or pants pocket and youth could use tobacco sticks in front of parents or teachers while appearing to have a simple toothpick in their mouth. We are also concerned about the risk of young children accidentally ingesting these products.”

Another concern voiced by the KDHE is that the dose of nicotine from the sticks could be lethal if ingested by a small child. The estimated minimal pediatric dose of nicotine that would cause toxic side effects (like nausea and vomiting) is one milligram of nicotine per 2.2 pounds of body weight. (A similar tobacco product, Camel Sticks, contains approximately three milligrams.)

ACSH’s Dr. Josh Bloom points out that, while the amount of nicotine in one of these sticks could be quite toxic for a small child, an equally valid concern would be swallowing the stick.

ACSH's Dr. Gilbert Ross adds, “Anything that can be swallowed by a child can become toxic. Like any other product children could put in their mouths, it could be harmful but no more than, say, choking on a hot dog. As far as toxicity from the nicotine goes, that seems far-fetched. I seriously doubt that a child would suck on ten of these sticks at once. Those who highlight such ill-founded fears fail to appreciate the desperate need of addicted smokers for effective cessation products.”

ACSH’s Dr. Elizabeth Whelan, however, believes these stories illustrate the misguided priorities implied by World No Tobacco Day. “Clearly, the main focus of the occasion — that is, cigarettes — has been missed,” she says.

Dr. Ross elaborates: “We agree that the world would be a much healthier place if tobacco were not used. That being said, in our country alone there are 45 million addicted adult smokers. From their point of view, similar to that of smokers in the rest of the Western world, it should be ‘World No Cigarette Day,’ or ‘World No Smoking Day,’ because some forms of tobacco can actually be beneficial in helping the cessation efforts of those who expose themselves to the lethal effects of inhaling cigarette smoke.”