Tob Control 19:367-373 doi:10.1136/tc.2008.028993
  • Research paper

Evaluating the acute effects of oral, non-combustible potential reduced exposure products marketed to smokers

  1. T Eissenberg
  1. Virginia Commonwealth University, Richmond, Virginia, USA
  1. Correspondence to Dr Thomas Eissenberg, Virginia Commonwealth University, 1112 East Clay Street, Suite B-08, PO Box 980205, Richmond, VA 23298, USA; teissenb{at}
  • Received 5 December 2008
  • Accepted 25 March 2009
  • Published Online First 2 April 2009


Background Non-combustible potential reduced exposure products (PREPs; eg, Star Scientific's Ariva; a variety of other smokeless tobacco products) are marketed to reduce the harm associated with smoking. This marketing occurs despite an absence of objective data concerning the toxicant exposure and effects of these PREPs. Methods used to examine combustible PREPs were adapted to assess the acute effects of non-combustible PREPs for smokers.

Methods 28 overnight abstinent cigarette smokers (17 men, 14 non-white) each completed seven, Latin-squared ordered, approximately 2.5 h laboratory sessions that differed by product administered: Ariva, Marlboro Snus (Philip Morris, USA), Camel Snus (RJ Reynolds, Winston-Salem, North Carolina, USA), Commit nicotine lozenge (GlaxoSmithKline; 2 mg), own brand cigarettes, Quest cigarettes (Vector Tobacco; delivers very low levels of nicotine) and sham smoking (ie, puffing on an unlit cigarette). In each session, the product was administered twice (separated by 60 min), and plasma nicotine levels, expired air CO and subjective effects were assessed regularly.

Results Non-combustible products delivered less nicotine than own brand cigarettes, did not expose smokers to CO and failed to suppress tobacco abstinence symptoms as effectively as combustible products.

Conclusions While decreased toxicant exposure is a potential indicator of harm reduction potential, a failure to suppress abstinence symptoms suggests that currently marketed non-combustible PREPs may not be a viable harm reduction strategy for US smokers. This study demonstrates how clinical laboratory methods can be used to evaluate the short-term effects of non-combustible PREPs for smokers.


  • Funding Supported by US Public Health Service grants CA103827 and CA120142.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the institutional review board for research subjects protection at Virginia Commonwealth University.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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