Emerging Issues

Monitoring emerging tobacco control issues is important because information is continually being acquired to explain the link between use and behavior, exposure, and multiple adverse health outcomes. Research on tobacco product toxicity and the subsequent health effects increases the understanding of individual and population risks of tobacco use as well as overall patterns of use of tobacco products.

Use of and risks from potentially reduced exposure products (PREPs) that purportedly deliver lower amounts of toxic, carcinogenic, or addictive agents to the user compared with conventional products is an emerging issue.⁴¹ PREPs are increasingly appearing on the market. Accordingly, there is a growing need to study them.⁴¹ Little is known about the impact of PREPS on individual or population risk. Of concern, these products may discourage smokers from quitting or encourage youth to start.⁴¹ Some PREPs are promoted with explicit or implicit claims that they are less harmful or less addictive.^{42, 43} However, the scientific evidence is insufficient to evaluate whether these products reduce exposure to toxins or risk for tobacco-related diseases.⁴¹ These products are not yet in wide use. Information on their toxicity is limited, and many questions remain about their potential appeal to current or former smokers and youth. Monitoring patterns of initiation, use, and quitting in response to PREPs will improve understanding of these products.

Smokeless tobacco is another emerging issue. Use of smokeless tobacco, a known human carcinogen, can lead to addiction and other serious health consequences, as can use of other products such as cigars and bidis.^{44, 45, 46, 47, 48} Hookah (water-pipe) smoking is a growing practice among smokers, particularly in urban areas and around college campuses.⁴⁹ Little research has been done on its health consequences, its toxicity compared with smoking conventional cigarettes, or its potential for addiction. Preliminary data indicate these products have high levels of nicotine and potential to cause significant exposure to toxins.^{50, 51}

Expanded research is also needed to link information on toxic or addictive chemicals in smoke and tobacco products with the presence of such chemicals in humans. Identifying these biomarkers will allow for improved documentation of the actual exposure that tobacco users experience. This information will be critical to understanding the biological effects of a variety of tobacco products.

Internet sale of tobacco products has emerged as an issue of increasing concern, especially as it applies to youth. Internet vendors have weak or nonexistent age verification mechanisms, potentially allowing underage youth to access cigarettes and other tobacco products.^{52, 53} Such access may mitigate successful efforts to reduce sales of tobacco products to youth in traditional retail outlets.

Finally, as youth access to retail sources of tobacco declines,^{54, 55, 56} access to tobacco products through other sources is emerging as an issue. Recent surveys^{57, 58} indicate that youth report most commonly obtaining tobacco from other sources, including friends and family.⁵⁶ Current knowledge on effective strategies to reduce access to tobacco through social sources is limited.

In conclusion, a majority of the objectives made progress toward their targets. Most of the objectives that are not currently measurable are expected to have data by the end of the decade. Focusing on youth smoking is a key aspect in achieving the Healthy People 2010 goal to reduce illness, disability, and death related to tobacco use and exposure to secondhand smoke. Analyses of CDC's national Youth Risk Behavior Surveys show that lifetime, current, and current frequent cigarette use among high school students was stable or increased during the late 1990s and then decreased significantly from the late 1990s to 2003. However, decreases in State funding and the increase in tobacco advertising and promotional expenditures will likely have a negative impact on many of the objectives, including a potential deceleration of the rate of decline in cigarette use among high school students over the past several years.^{11, 59, 60}

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