The association between cigarette rod length, slim design, and blood cadmium levels among U.S. smokers: NHANES 1999-2010

Smokers' support for the ban on sale of slim cigarettes in six European countries: findings from the EUREST-PLUS ITC Europe Surveys

Background: Efforts to regulate tobacco products and reduce consumption in the European Union (EU) include the European Tobacco Products Directive (TPD), which went into force in May 2016. Despite the initial discussion to include a ban on sale of slim cigarettes, it was excluded in the final TPD. The main goal of this study was to examine support for a ban on slim cigarettes among smokers in six European Countries. Methods: Data from the 2018 (Wave 2) International Tobacco Control Policy Evaluation Project 6 European Country (ITC 6E) EUREST-PLUS project survey, a cross sectional study of adult smokers (n=5592) from Germany, Greece, Hungary, Poland, Romania, and Spain, was analysed. Descriptive statistics were used to estimate support for a ban on slim cigarettes by sociodemographic characteristics and smoking behaviors. Logistic regression analysis was used to examine factors associated with support for a ban on slim cigarettes and perceptions of harm. Results: Support for a ban on slims varied across countries, with highest support in Romania (33.8%), and lowest in Greece (18.0%). Female smokers (OR=0.78; 95%CI=0.67-0.91, daily smokers (OR=0.68; 95%CI=0.47-0.97), menthol smokers (OR=0.55; 95%CI=0.36-0.86), and smokers who did not have plans to quit within next six months (OR=0.45; 95%CI=0.36-0.56) had significantly lower odds of supporting a ban on slim cigarettes. Overall, 21% of smokers perceived slim cigarettes as less harmful than regular cigarettes. Conclusions: Support for a ban of slim cigarettes was relatively low among smokers, while misperceptions that slim cigarettes are less harmful is high, particularly among countries where slim cigarette use is more prevalent. Findings support a ban on slim cigarettes to reduce misperceptions around slim cigarettes being less harmful.

From old pollutants to the regulation of bisphenol A: Lessons learned for health promotion and disease prevention

Citizens deserve regulatory changes and policies more sensitive to the current needs of humans, the climate, and nature. In this work we draw on prior experiences of preventable human suffering and economic losses caused by delayed regulation of legacy and emerging pollutants. Heightened awareness of environmental health problems is necessary among health professionals, the media, and citizens' organizations. Improved translation from research to the clinical world and to policy is critical to reduce the population burden of diseases caused by exposure to endocrine disruptors and other environmental chemicals. Numerous lessons can be learned from science-to-policy processes built for "old pollutants" (as persistent organic pollutants, heavy metals, tributyltin), as well as from current trends regarding the regulation of non-persistent chemicals, such as the prototypical endocrine disruptor bisphenol A. We end discussing relevant pieces of the puzzle to tackle the environmental and regulatory challenges faced by our societies.

Consumer Perceptions of Cigarette Design in France: A Comparison of Regular, Slim, Pink and Plain Cigarettes

INTRODUCTION

The cigarette, like the cigarette pack, is used by tobacco companies as a promotional tool. We explore how the cigarette could potentially be used as a dissuasive tool.

METHODS

An online survey was conducted with 15-30-year-old smokers and nonsmokers (N = 998) in France to explore their perceptions of a plain cigarette (gray with no brand name) and three branded cigarettes (regular, slim, pink). Participants were randomly assigned to view the plain cigarette and either the regular, slim, or pink cigarette. They were asked to rate the cigarettes by Appeal (tastiest, highest quality, and most expensive), Harm (most dangerous and most effective for motivating people to talk about tobacco dangers), and Perceived behavioral impact (most effective to convince teenagers not to start and to motivate smokers to reduce consumption and quit).

RESULTS

In comparison to the gray cigarette, each of the branded cigarettes were considered more appealing, less harmful, and more likely to motivate teenagers to start and less likely to motivate smokers to reduce consumption or quit.

CONCLUSIONS

The study suggests that altering the appearance of the cigarette may reduce cigarette appeal, increase harm perceptions, and deter both young people and smokers.

IMPLICATIONS

Very little research has focused on dissuasive cigarettes whereas the cigarette stick has become very important for tobacco companies for communication purposes. This is the first study to compare the effect of various branded cigarettes (regular, slim, and pink) with a plain gray cigarette on young adult smokers and nonsmokers. The findings suggest that a plain gray cigarette can reduce cigarette appeal, increase perceptions of harm, and may deter use among both smokers and nonsmokers.

Connecting gastrointestinal cancer risk to cadmium and lead exposure in the Chaoshan population of Southeast China

Cadmium (Cd) and lead (Pb) pose a serious threat to human health because of its carcinogenicity. China ranks first according to the Global Cancer Report for 2014 in newly diagnosed gastrointestinal cancers and cancer deaths. The aim of the present study was to evaluate the association of Cd and Pb burden with the risk of gastrointestinal cancers in a hospital-based case-control study from southern regions of China, Chaoshan area. A total of 279 hospitalized patients were recruited in this study, of which 167 were gastrointestinal cancer cases (70 esophageal cancer, 51 gastric cancer, and 46 colorectal cancer), and 112 controls were recruited from two hospitals in the Chaoshan area of southeast China. Basic clinical data and information on gender, age, and other demographic characteristics were collected from medical records. Blood Cd and Pb levels were detected by graphite furnace atomizer absorption spectrophotometry (GFAAS). Blood Cd/Pb levels and over-limit ratios between cases and controls were compared by Mann-Whitney U and Kruskal-Wallis H tests. We used logistic regression to estimate odds ratios (ORs) as measures of relative risk and explored the relationships between blood Cd/Pb levels and gastrointestinal cancer risk and clinicopathological characteristics. Median levels of blood Cd and Pb in cases (2.12 and 60.03 μg/L, respectively) were significantly higher than those of controls (1.47 and 53.84 μg/L, respectively). The over-limit ratios for Cd (≥ 5 μg/L) and Pb (≥ 100 μg/L) in the cases were both higher than that of controls. Blood Cd levels had a tendency to accumulate in the human body with gender, age, and tobacco smoking, while blood Pb levels only were associated with tobacco smoking. The logistic regression model illustrated that gastrointestinal cancers were significantly associated with blood Cd levels and blood Pb levels. The concentrations of Cd and Pb in patients with T3 + T4 stage were markedly higher than in patients with T1 + T2. On the other hand, blood Cd levels were dramatically increased in the distant -metastasis (M1). Blood Cd and Pb levels are significantly higher in gastrointestinal cancers compared to controls. Cd and Pb appear to be risk factors for gastrointestinal cancers in Chaoshan region, and higher levels of Cd and Pb may promote the occurrence and progression of gastrointestinal cancers.

A systematic review of smoker and non-smoker perceptions of visually unappealing cigarette sticks

INTRODUCTION

Cigarette stick appearance can significantly contribute to perceptions of cigarette taste, harm, and appeal, and may be modified to reduce positive perceptions of cigarettes and other tobacco products. A systematic review was conducted to investigate how smokers and non-smokers identify cigarettes as being attractive or unattractive, and the resulting perceptions of cigarette appeal, perceived harm, and impact on quit intentions.

METHODS

Eligible articles were identified using database searches conducted with a date range of January 1990 to May 2017 in PubMed, CINAHL, PsycINFO, Google Scholar and Web of Science. Articles were included if they evaluated participant (any smoking status) perceptions of visual cigarette stick attributes. We identified studies describing visual attributes of cigarette sticks and the resulting perceptions of participants. Changes or differences in quitting intentions, cigarette appeal, perceptions of taste, and cigarette harm, and the likelihood of smoking uptake were recorded. Data were grouped into two main categories: those of physical cigarette design, and those including health messages on cigarette sticks.

RESULTS

Of the 950 identified non-duplicated records, 9 matched the eligibility criteria. These studies were all conducted in developed countries, and largely enrolled adolescent and young adult smokers and non-smokers. Slim, lighter coloured and branded cigarettes were favoured over longer, broader, or darker coloured cigarettes, and those without any branding or embellishments. Health warnings including ‘Minutes of life lost’, ‘Smoking kills’, and the names of carcinogenic constituents in cigarettes, reduced cigarette attractiveness and increased participant quit intentions.

CONCLUSIONS

Cigarette appeal and resulting smoking behaviours can be influenced by several visual attributes of individual cigarettes. Unappealing visual attributes of cigarette sticks, including modifications to the size and colour of cigarettes, and the inclusion of health warnings on cigarette sticks may serve as an effective tobacco control method, potentially leading to a reduction in tobacco use.

Slim cigarette smoking prevalence among Canadian youth smokers: Implications for federal standardized packaging legislation

OBJECTIVES

Tobacco companies market to females and young people through slim cigarette design features and packaging. This study assessed the prevalence and perceptions of slim cigarette smoking in grades 9-12 student smokers across Canada using multiple data sources.

METHODS

Data from three cycles of the Youth Smoking Survey (2008/2009 to 2012/2013) and one cycle of the Cancer Risk Assessment in Youth Survey (2015) were used. The prevalence and perceptions of slim cigarette smoking among current smokers were compared by sex and grade.

RESULTS

In all surveys, the rate of slim cigarette use was higher among females than males; however, this difference was not statistically significant. In the two most recent surveys, grades 9-10 students had a significantly higher prevalence of use compared with grades 11-12 students. The majority of students (59.8% of females and 53.3% of males) responded, "I don't know" to the survey item seeking to determine perceptions of harm of slim cigarettes compared with regular cigarettes.

CONCLUSION

Slim cigarette use among Canadian grades 9-12 students represents a small but growing problem. Youths' uncertainty around the harms associated with slim cigarette use and the effect of slim cigarette packaging and design on harm perceptions indicate the need for product design regulations and further education in Canada.

Effect of surfactant in mitigating cadmium oxide nanoparticle toxicity: Implications for mitigating cadmium toxicity in environment

Cadmium (Cd), classified as human carcinogen, is an extremely toxic heavy metal pollutant, and there is an increasing environmental concern for cadmium exposure through anthropogenic sources including cigarette smoke. Though Cd based nanoparticles such as cadmium oxide (CdO) are being widely used in a variety of clinical and industrial applications, the toxicity of CdO nanoparticles has not been well characterized. Herein we report the toxicity of CdO nanoparticles employing zebrafish as a model. Two different CdO nanoparticles were prepared, calcination of Cd(OH)₂ without any organic molecule (CdO-1) and calcination of Cd-citrate coordination polymer (CdO-2), to evaluate and compare the toxicity of these two different CdO nanoparticles. Results show that zebrafish exposed to CdO-2 nanoparticles expressed reduced toxicity as judged by lower oxidative stress levels, rescue of liver carboxylesterases and reduction in metallothionein activity compared to CdO-1 nanoparticles. Histopathological observations also support our contention that CdO-1 nanoparticles showed higher toxicity relative to CdO-2 nanoparticles. The organic unit of Cd-citrate coordination polymer might have converted into carbon during calcination that might have covered the surface of CdO nanoparticles. This carbon surface coverage can control the release of Cd²⁺ ions in CdO-2 compared to non-covered CdO-1 nanoparticles and hence mitigate the toxicity in the case of CdO-2. This was supported by atomic absorption spectrophotometer analyses of Cd²⁺ ions release from CdO-1 and CdO-2 nanoparticles. Thus the present study clearly demonstrates the toxicity of CdO nanoparticles in an aquatic animal and also indicates that the toxicity could be substantially reduced by carbon coverage. This could have important implications in terms of anthropogenic release and environmental pollution caused by Cd and human exposure to Cd²⁺ from sources such as cigarette smoke.

Blood cadmium burden and the risk of nasopharyngeal carcinoma: a case-control study in Chinese Chaoshan population

Cadmium is a ubiquitous carcinogenic pollutant with multiple biological effects. Both observational and experimental studies have suggested associations between cadmium and the rates of many types of cancers. The aim of the present study was to evaluate whether cadmium exposure is associated with nasopharyngeal carcinoma (NPC) in a population with a relatively high prevalence in southeast China. Hospital-based 134 NPC cases and 132 cancer-free controls were recruited from a cancer hospital in Chaoshan area, southeast of China. Basic clinical data and information of lifetime styles, smoking, and drinking as well as other demographic characteristics were also collected from medical records. Blood cadmium levels (BCLs) were detected by graphite-furnace atomizer absorption spectrophotometer (GFAAS). BCLs and over-limit ratios between cases and controls were compared. The relationships between BCLs and NPC were explored by comparing BCLs differences between/among different characteristics of related factors and logistic regression analysis. In addition, BCLs within cases were also compared in relation to the disease clinical stages, pathological types, and metastasis. The median concentration of blood cadmium in cases (3.84, interquartile range 2.21-6.10) was significantly higher than that of controls (2.28, interquartile range 1.79-3.45). The over-limit ratio (≥5 μg/L) in cases was also higher than that in controls (35.1 vs. 13.6%, χ(2) = 16.55, p < 0.001). Smokers tended to have high levels of cadmium burden, and smokers with longer smoking pack-years in cases had relatively higher BCLs (p = 0.001). NPC patients with diseases history presented lower cadmium burden (p = 0.020). In the NPC cases, BCLs were positively associated with clinical stages and N classification (r = 0.193, 0.187, respectively, p < 0.05). Cadmium seems to be a risk factor of NPC, and high cadmium exposure may promote the occurrence and development of NPC.