Smoke and mirrors

The choices for smokers used to be so simple. There were cigarettes. And there were cigars. Maybe an occasional pipe.

But as the tobacco industry attempts to adapt to smoking bans, it is developing dozens of new ways for the body to absorb nicotine - from hookahs to snus to lozenges to smokeless nicotine delivery systems. And, in a clear attempt to attract younger users, they come in more flavors than you can find at a Ben & Jerry's ice cream store.

Public health and anti-tobacco experts are perplexed about all those new products. Some might be a safer alternative to cigarettes and could help smokers quit. On the other hand, they know almost nothing about how many carcinogens they harbor, how they're marketed, who uses them and why.

That new terrain in the world of tobacco was sketched out by Dorothy Hatsukami, a tobacco researcher at the University of Minnesota, for some of the approximately 3,000 anti-tobacco experts from around the world who met in Minneapolis in late fall at the National Conference on Tobacco or Health.

``Is it a gateway drug to cigarette smoking?'' she said. ``Does it help them quit smoking? We don't know.''

For the first time, the National Cancer Institute has developed an experimental fast-track research process so scientists and public health officials can keep up with those new products and devise their own public programs to counter them. They said they do not want a repeat of the public health debacle that occurred with the introduction of low-tar cigarettes. They were marketed as a healthier alternative, but turned out to be just as dangerous as the full-strength variety.

Some of the new products are smokeless. There are snus - little pouches of tobacco that users put in their cheeks - and lozenges. There are also new variations on ancient ways to smoke. Hookahs, for example, are an ongoing trend with teenagers and young adults.

There are now hookah bars in some 33 states, said marketing expert Barry Matthews, and they are usually found around college campuses.

``But what's in the smoke?'' he said. And how does it compare to cigarette smoking?

Even though some users believe that flavored tobacco pulled through water is cleaner, the little analysis that has been done doesn't show that, he said. Hookah tobacco has more nicotine and vastly more tar than a cigarette, Matthews said. In addition to the diseases normally associated with tobacco, hookah smoking carries the added risk of infectious disease from sharing the mouthpiece, he said.

One of the most startling new trends in tobacco use has been the sharp increase in small cigars, such as Winchester and Swisher.

They're becoming more popular because cigars are taxed at much lower rates, making them much less expensive. Manufacturers are now making them - and marketing them - a lot like cigarettes, but in dozens of flavors. In 2006 there were 4.5 billion sold in the United States, the highest number ever, she said. And while that pales in comparison to the hundreds of billions of cigarettes that are sold, it's an alarming trend, she said.

Anti-tobacco organizers have asked the federal government to more precisely define cigarettes and cigars. If it agrees and clearly delineates the difference between them, then the small-cigar market could disappear, she said.

The newest tobacco products to arrive in the United States are snus, often described as spitless tobacco.

Snus alarm health advocates because the tobacco companies market them as a replacement for cigarettes in places where people can't smoke. Camel SNUS, which are now being test marketed in a few U.S. cities, come with the tag line ``pleasure for whenever.''

Research shows that they have fewer carcinogens than other sorts of tobacco products but just as much nicotine, Hatsukami said. They could help people quit smoking or it could just keep smokers addicted.

Anti-tobacco researchers are on it, however, with the new, fast-track grant-making system at the National Cancer Institute. Normally, it can take a year or more before the federal government approves a research grant and many more months before the studies are completed.

But now, even as the tobacco manufacturers are test-marketing snus in Indianapolis; Portland, Ore.; and on the Internet, their anti-tobacco counterparts are shadowing them.

They have even adopted an attitude about this program that sounds more like warfare than staid scientific research. They call it ``rapid mobilization.''