Send letter to journal:
Re: Questionable PREP selection

The products mentioned in the study appear to be selected specifically selected for their low nicotine content. While the paper succeeds in adapting existing methodology for traditional tobacco products to these new classes of smokeless tobacco products, only testing PREPs containing a low amount of nicotine understates their potential as a smoking cessation aid.

Star Scientific Inc. (manufacturers of Ariva) produces a similar product, another compressed milled tobacco lozenge, with additional nicotine. This PREP, Stonewall, is marketed towards "heavy smokers." The only appreciable difference is that Stonewall is advertised as containing more nicotine. Considering that the individual participants reported a mean daily consumption of over 20 cigarettes, one could reasonably categorize them as heavy smokers.

In addition, the selected pasteurized tobacco sachets (in particular, Phillip Morris' Marlboro Snus) have been characterized by Foulds and Furberg as a low-nicotine product (due to a number of factors, ranging from moisture content to acidity to starting free nicotine content), in contrast to Swedish snus, which delivers nicotine comparable to a cigarette. The graphs show that plasma nicotine levels for PREPs were all much less than own-brand cigarettes, and all PREPs were remarkably similar. All PREPs delivered half or less of the plasma nicotine levels the subjects were accustomed to with cigarettes.

Swedish Match AB, the largest player in the Swedish smokeless tobacco market, has started to export its most popular product line, General Snus, to American test markets. This product is identical in nicotine content to the one offered in Sweden. Another brand of snus, Triumph (manufactured by Swedish Match for Lorillard), essentially a reflavored version of Swedish Match's General, features the same nicotine content. Neither of the two products would be difficult to obtain or test. These represent only two brands of a quickly growing "reduced-harm" tobacco market in America; also note that many North European smokeless tobacco manufacturers offer a "sterk" or strong version of their regular product lines, with additional nicotine.

The authors might find, unsurprisingly, PREPs that deliver more nicotine will be perceived as more "satisfying" and more effective in suppressing abstinence symptoms than the selection tested in the study, perhaps even to the point of being a successful smoking cessation aid.

I am an undergraduate student at The Ohio State University, and I declare no conflict of interest.

References:

Foulds, J, & Furberg, H (2008). Is low-nicotine marlboro snus really snus?. Harm Reduction Journal, 5, 9.

Waters, L (2009, June 30). Triumph Snus. Retrieved July 14, 2009, from Snus Central Web site: http://snuscentral.org/snusnus/mr-unz- reports/248-triumph-snus-the-latest-on-nicotine-levels-.html