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University study: Is there a less harmful way to smoke?

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Tobacco researchers at the University of Minnesota are thinking what they once thought unthinkable.

Maybe there is a hard-core group of smokers who simply can't quit, and maybe it's time for Plan B: satisfy their craving for nicotine using alternative products without eliminating their use of tobacco.

Faced with a smoking rate that hasn't budged for more than a decade, the university's tobacco research center is using a $9 million federal grant to find out whether there is a less harmful way to smoke.

"I have become discouraged that we can't improve our success rates beyond a certain point," said Harry Lando, a University of Minnesota epidemiologist who has long studied nicotine addiction. "It's critical to look for alternatives for people who simply are not quitting."

The idea is controversial among public health researchers because they fear that it might encourage some people to start smoking and might stop others from quitting. But pressure to find answers is building, researchers said.

The pressure is building because some tobacco companies already are offering nicotine alternatives for smokers.

"It's critically important that research be conducted to answer these questions because the tobacco companies are already moving there," said Scott Leischow, a tobacco control researcher with the National Cancer Institute (NCI).

The new, unregulated nicotine products include Omni and Eclipse cigarettes, which promise fewer carcinogens, and mint-flavored Ariva tobacco lozenges.

The U.S. Food and Drug Administration (FDA) last month warned three Internet pharmacies not to sell nicotine-laced lollipops and lip balm as ways to quit or reduce smoking. The FDA said the products were being sold without a prescription and contained a form of nicotine not tested for safety and effectiveness in smoking cessation.

Researchers don't know whether any of the products will be less harmful than cigarettes, or whether reducing tobacco use lowers health risks. But scientists at the university's Transdisciplinary Tobacco Use Research Center are conducting more than a dozen studies to address those and other questions.

Smoking less

That is why Candy Mahoney of Minneapolis drives to a bland office building near the university campus every two weeks to give blood and urine samples, and to report how much she has been smoking.

Mahoney sometimes wears a nicotine patch -- but not because she is quitting. She is trying to cut down on her smoking. Researchers gave her the patch for this research because it has FDA approval.

Lead researcher Dorothy Hatsukami, a university psychologist and nicotine addiction specialist, wants to know if the 150 people in the study can use the patch to reduce smoking by at least 75 percent and if that translates into less tobacco toxins in their bodies.

Mahoney's progress has been swift -- and painful. With the help of the patch she has cut down from 30 to seven cigarettes a day in six weeks, she said. She had promised her kids she would quit when she was 40. She is now 48, and her expectations are more realistic. "I am hoping I can quit, but I'm not saying I'm going to," she said.

The research won't be published for a year or two, and so far the results appear mixed, Hatsukami said. There has been a drop in cigarette toxins in some people who cut down, but not in others, she said.

University epidemiologist Deborah Hennrikus is leading another study to find out whether mothers who don't quit can learn to protect their young children by not smoking around them. If some can accomplish that, she said, it might give them the resolve to quit.

It worked for Judy Vavreck-Vollmers, 36, a waitress from Inver Grove Heights who joined the study last November. Her second baby, Eva, was born 10 months ago. Although she smoked through both pregnancies, at the time she agreed to participate in the study, she had already stopped smoking in the house.

A counselor gave her nicotine gum, suggested she set small goals for cutting down, and advised that she not smoke in the car with her kids.

On Feb. 27, early in the pregnancy of her third child, she stopped.

"I think about it every day," she said of her nicotine craving. But she reminds herself that she has been smoking for 20 years -- longer than some of her young co-workers have been alive.

Hard-core question

Underlying this research is a question that is the subject of an upcoming NCI report -- are hard-core smokers somehow different than people who have stopped?

About half of adults who ever smoked have quit, experts said. Dr. Richard Hurt, director of Mayo Clinic's Nicotine Dependence Center, is among those who believe that genes play a role, at least in susceptibility to nicotine.

"Some experimented with cigarettes and did not become smokers," he said. "They are genetically different compared to those who smoke a few cigarettes and are hooked right away."

Regardless of how many cigarettes it takes, he said, the process and the end result are the same for most people. Nicotine exposure changes the structure of the brain, building receptors that demand to be fed, he said.

Smokers tend to have lower incomes, less education and a range of other personal issues, experts say. People who are unemployed, depressed, schizophrenic, alcoholic or drug dependent smoke at higher rates than people who don't have such problems, said Dr. David Burns, a tobacco researcher at the University of California in San Diego.

That makes some experts believe it's harder for them to quit, yet there is no clear evidence one way or the other, Burns said. In any case, he said, "We will have a large population smoking for an extended period of time."

Low-cancer smokes?

Some companies are thinking along the same lines.

"Our business plan is formed around a mission to explore ways to reduce the harm associated with tobacco use," said Sara Troy Machir, director of communications for Star Scientific Inc., the Virginia-based maker of Ariva tobacco lozenges and other smokeless tobacco products.

These new products with their messages about being less harmful are perplexing to public health experts. Several anti-tobacco groups have challenged the claims that such products are less harmful. Even so, the products are forcing public health experts to consider what messages they should convey to the public.

Because such tobacco products are unregulated by the FDA, companies can make claims without putting their products through independent review by the FDA or other researchers, Hatsukami said.

Hatsukami and others at the university have launched a study that examines the level of toxins in Omni smokers' bloodstreams. Omni claims its smoke has fewer carcinogens compared to other cigarettes.

Public health experts are mindful of what happened with low-tar, low-nicotine cigarettes. They proved to be nothing of the kind, she said. Smokers simply adapted by smoking more often or more intensely, she said.

"It was in some ways a public health disaster because people were led to believe that they were safer when they were not," she said. "Hopefully, we won't be replicating that."



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