In the past decade, many Americans and Europeans have become more aware of the dangers of smoking. Large tobacco companies have seen their cigarette sales in these countries plummet as legislators have passed laws forbidding smoking in restaurants, bars and many other public places. But, as Rose Hoban reports, other tobacco sales are increasing.

New research from the Harvard School of Public Health has found that in the U.S. the drop in sales of cigarettes has been accompanied by increased sales of tobacco in other forms. This increase appears to offset at least a third of the drop in cigarette sales.
 

Sales of small cigars have increased in the United States, as cigarette sales declined

Harvard researcher Hillel Alpert says more people now buy snuff, smokeless and roll-your-own tobaccos, as well as small cigars. "Each of these products carry their own health hazards," he points out. "Combustion products are essentially as serious as cigarettes in terms of the toxins and the mode that it's ingested. Oral tobacco products are also known to be carcinogenic and, each of these products contain the extremely highly addictive ingredient, nicotine."
 
Albert says he doubts the boost in sales is a coincidence. He says tobacco manufacturers have lost income on cigarettes in western countries, so they've ramped up advertising and promotions on other forms of tobacco.
 
They've also been looking elsewhere to improve their revenues. Alpert says some of the large cigarette and tobacco manufacturers are increasingly marketing their products overseas, and acquiring tobacco interests in other countries as well. "Some countries have more substantial use of smokeless and moist snuff types of tobacco products," he explains. "Cigars actually are prominent in the U.S., compared to the other countries. And in some places roll-your-own tobacco is more popular."
 
Alpert says he and his colleagues were surprised at the magnitude of the growth in sales of other forms of tobacco, compared to cigarettes. But he notes that in the U.S. these other forms of tobacco are usually taxed at about one-tenth the rate of cigarettes, and research consistently shows that the higher the taxes on tobacco products, the lower the use.

"Each country would probably be best to consider the patterns of tobacco use in their country and implement policies that are designed to decrease tobacco use overall, regardless of the form of tobacco," he concludes.
 
Although Alpert and his colleagues did their best to account for all other forms of tobacco, he admits reductions in cigarette sales are probably being offset by other tobacco products even more than they estimated.
 
Alpert's research is published in JAMA - the Journal of the American Medical Association.