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Frequently Asked Questions
What is a PREP or potential reduction exposure product?
A PREP is a product used instead of typical cigarettes or smokeless tobacco to try to reduce exposure to tobacco toxins. Much about PREPS and their ability or inability to reduce exposure is unknown. But if a PREP actually results in reducing exposure to tobacco toxins, then it also may be a product that would offer less risk for tobacco-related disease. There is not necessarily a link between reduced exposure and reduced risk. Determining if there is one must be scientifically tested.
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Are PREPs safe?
No PREP is known to be safe. Inhaling or using any tobacco product is not healthy. The only known way to reduce the risk of smoking is to quit. For more information, see the American Lung Association Quit Smoking page at .
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Are PREPs safer than traditional tobacco products?
No PREP has been tested thoroughly enough to make the claim that using it is safer than smoking or using traditional smokeless tobacco products. Most PREP testing has been done by tobacco companies which have a financial interest in the success of their products. That's why the National Cancer Institute () has awarded a research and development grant to TobPRAC (Tobacco Product Assessment Consortium). TobPRAC scientists will perform unbiased tests and clinical trials to determine if PREPs are actually less harmful than traditional tobacco products.
TobPRAC and many scientists worldwide believe that if a PREP is found to meaningfully reduce exposure to tobacco toxins, it may play a part in a wide-ranging tobacco control plan. The plan would focus on encouraging people to quit smoking and never to start using tobacco products.
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Are there any known benefits to PREPs?
Right now, the answer is no. However, the Institute of Medicine has determined that reducing harm from tobacco products is possible (). If PREPs can meaningfully reduce exposure to toxins, a benefit could be the potential for less disease in smokers. However, more independent evidence is required before lower exposure can be linked to a lower risk of disease.
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What are some concerns about using PREPs to reduce harm?
Scientists must first understand what a "meaningful" reduction in exposure means, and who might benefit from this type of reduction. Scientists must know:
- If an individual has a history of smoking
- How long the smoking lasted
- What medical problems the individual has
- The individual's gender and racial or ethnic differences, which might result in different uses and effects of PREPs.
One of scientist's main concerns is that because of the many differences among individuals and how they might use PREPs, a claim about PREPs will not be relevant for everyone. Another major concern is that claims by tobacco companies that their products result in less exposure may confuse or mislead consumers. For instance, if a smoker believes that less exposure means fewer chances for disease, they might decide to continue smoking rather than quit. Or, former smokers may resume smoking. This might result in increased tobacco-related disease. Another concern is that while a PREP may reduce one toxin or class of toxins, other kinds of toxins might not be decreased - or might even increase. This means that all PREPs products must be thoroughly tested, and not just those that claim to have fewer toxins.
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Does reducing exposure mean the same thing as reducing risk?
Cigarette smoke contains numerous carcinogens, mutagens and other toxins that are inhaled into the lungs. Smokeless tobacco products deliver carcinogens, mutagens and other toxins into the mouth and throat. A PREP may reduce exposure to these toxins. However, the amount of reduction in exposure needs to be tested in people with biomarkers (a biochemical feature that can be used to measure the progress of disease or treatment) to determine if the reduced exposure is meaningful. Reduction in exposure may be small and so the risk of tobacco-related disease might not change. PREPs that change delivery of one or a few of their many toxins might not lower risk. This means that reducing exposure does not mean the same thing as reducing risk.
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I have read advertisements or newspaper articles that PREPs are less risky than regular tobacco products.
According to some advertisements from tobacco and other companies that manufacture PREPs, allegedly lower level yields of tobacco toxins may reduce the incidence of disease in smokers. Some companies make claims through press releases that look and read as truth. To date, no cigarette-like PREP has been sufficiently tested and proven to possibly reduce disease risk. Some scientists believe that if smokers switch to smokeless tobacco products, they would be better off. However, this has not been directly tested.
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What are examples of PREPs?
Some PREPs look similar to traditional tobacco products. Others look or behave differently. PREPs are generally classified as combustible (smoked) and smokeless.
Smokeless tobacco products include those that are cured so that they have lower contents of one type of carcinogen called tobacco-specific nitrosamines. In Sweden, these snuff products are called "snus". Snus is packaged in miniature pouches like a tiny tea bag, and placed between the lip and gum. Snus products are now being test marketed in the U.S. (e.g., Camel Snus, Taboka and Marlboro Snus). Another type of smokeless PREP is a nicotine mint that also contains tobacco, called a cigalett or Ariva. Combustible or cigarette-like PREPs use different types of filters that reduce some types of tobacco toxins. Some of these, such as Omni, are no longer on the market. Marlboro UltraSmooth is currently being test marketed. Another type of cigarette-like PREP is advertised to "heat" rather than "burn" the tobacco. This claim may or may not be accurate. Examples are Accord, which is no longer marketed in the U.S. Another type is Eclipse. Quest is a reduced nicotine cigarette. Some smokers may falsely believe that Quest is a PREP. They mistakenly believe that smoking a lower nicotine cigarette will be less addictive, or that nicotine is the carcinogen in tobacco smoke. Nicotine is not a known human carcinogen, but a highly addictive agent that causes chemical dependency on cigarettes. Smoking lower nicotine cigarettes, however, is not known to reduce addiction.
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How will TobPRAC test the PREPs?
TobPRAC is funded by the National Cancer Institute to conduct both laboratory and human studies with volunteer smokers (clinical trials) to determine if one tobacco product is less risky than another. ( See mission statement for more information.)
Over the five-year study, TobPRAC also will be investigating such important issues as:
- The ingredients and emissions of new and conventional tobacco products, and their toxic effects
- Chemical and physical characteristics of PREPs
- Behavioral and physiological changes that result after switching to PREPs
- Exposure changes and toxic effects in people who use PREPs
- Characteristics of individuals who switch to PREPs in comparison to those who quit smoking
- Addictive potential of PREPs
- How the availability of PREPS might discourage smokers from quitting, or encourage former smokers and those who have never smoked, to smoke.
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When will I know whether or not PREPs are less harmful to use than traditional tobacco products?
TobPRAC is committed to releasing results of its studies quickly. But first the public health community must agree on how to scientifically evaluate PREPs, which are new types of tobacco products. A testing framework will then be put in place in a regulatory agency before product labeling begins. Results of a variety of studies will be made public on this website and others continually.
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Are tobacco products regulated by a government agency such as the Food and Drug Administration?
Although the Federal Trade Commission is in charge of some aspects of tobacco products, no federal agency has regulatory authority over tobacco products. So tobacco companies are free to manufacture any type of product they choose, as long as it contains tobacco.
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Are advertisements and health claims by tobacco companies approved by a government agency such as the Food and Drug Administration?
No, tobacco companies can make unproven claims about the benefits of their products. However, if a company makes a claim that is false, the Federal Trade Commission may stop the advertising, and state attorneys general and others may have the right to sue the companies.
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