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NEWS | May 27, 2014

Beware: The many faces of tobacco

By Claudia Dion Naval Health Clinic Charleston Registered Nurse and certified tobacco treatment specialist

On April 24, 2014, the U.S. Food and Drug Administration released a proposal to regulate more than just cigarettes, cigarette tobacco, roll-your-own tobacco, and smokeless tobacco. The new proposal would extend FDA regulation to cigarettes, e-cigarettes, cigars, pipe tobacco, nicotine gels, waterpipe or hookah tobacco and dissolvables.

Perhaps you had no idea there were so many forms of tobacco. According to an FDA Consumer Health Information sheet called Recognize Tobacco in its Many Forms, "tobacco companies regularly modify their products and introduce novel tobacco products to the market ... to attract users." Current products are appealing to young people. They are flavored like candy. Many smokeless products no longer require spitting. They have a "coolness" factor attached to them. Some of them are "forbidden" to those under 18. The FDA wants to make it all of them.

What do we know?
1. Tobacco use is the single largest preventable cause of disease and death in the U.S.
2. It is expensive to buy tobacco products and to treat tobacco-related illnesses.
3. The tobacco plant contains many chemicals even before the tobacco companies add any.
4. Both smoked and smokeless tobacco products contain added carcinogens (cancer-causing agents).
5. Nicotine comes from the tobacco plant.
6. Nicotine is highly addictive.
7. Nicotine is a stimulant that increases physical stress. It causes the release of epinephrine (adrenaline) which constricts blood vessels and raises your pulse and blood pressure.
8. Nicotine also causes the release of dopamine, a naturally-occurring brain chemical that helps you feel calm ... but not for long.
9. The smoke from a waterpipe is at least as toxic as, or more toxic than, cigarette smoke.
10. Little information is known about the safety of e-cigarettes.

What about e-cigarettes? Don't they reduce the harm from all those chemicals in commercial tobacco? In a statement published July 9, 2013, the World Health Organization reports that "the safety of electronic nicotine delivery devices has not been scientifically demonstrated." In addition, propylene glycol "is a known irritant when inhaled." Other potential dangers include inconsistent amounts of nicotine and chemicals being delivered, an increased risk of nicotine poisoning, and a higher rate of addiction to nicotine by people who don't smoke or chew.

But aren't e-cigarettes just another form of nicotine replacement? Can't I wean myself off of nicotine using an e-cigarette? Doses of nicotine delivered by e-cigarettes are difficult to determine, so tapering off of nicotine using an e-cigarette is difficult. Plus, the hand-to-mouth habit remains. The WHO further states, "Until such time as a given ENDS is deemed safe and effective and of acceptable quality ..., consumers should be strongly advised not to use any of these products."

The FDA proposal on expanding tobacco regulation is available for public comment until July 9, 2014. In honor of World No Tobacco Day, May 31, 2014, you can tell the FDA to strengthen the deeming regulation" (for example, ban youth-appealing flavors and certain types of advertising) when you visit

Or maybe you would like to observe World No Tobacco Day by starting a quit attempt yourself. There are many resources available to help you. Call the Naval Health Clinic at 794-6916. Cessation medications and counseling are available. Send a Relay Health message to your PCM or ask about help at your next appointment. Call the TRICARE South toll-free quitline at 1-877-414-9949 or the South Carolina state quitline at 1-800-QUITNOW. Or go online and type "help me quit tobacco" in the search box.

Need more motivation? See Jason's story at