Cigarette filter ventilation is a defective design because of misleading taste, bigger puffs, and blocked vents

Switching to cigarette brand variants with different filter ventilation levels: a descriptive analysis

BACKGROUND

Regulation of filter ventilation (FV) has been proposed to reduce misperceptions that ventilation reduces the health risks of smoking. We describe smoking behaviour and exposure after switching to a cigarette brand variant (CBV) with a different FV level.

METHODS

Wave 1 (2013-2014) of the Population Assessment of Tobacco Use and Health Study was merged with FV levels of participants' CBV and restricted to adults with a usual CBV, smoked daily and included in wave 4 (2016-2017; n=371). Generalised estimation equations method modelled changes in FV and cigarettes per day (CPD), quit interest, total nicotine equivalents (TNE) and total NNAL (biomarker of a tobacco-specific carcinogen). FV change was defined as a change in CBV resulting in a ≥20% increase or decrease in FV. Secondary analyses used FV change based on an increase from <5% to >10% or a decrease from >10% to <5%.

RESULTS

A non-significant pattern indicating an increase of 0.97 and 0.49 CPD was observed among those who switched to a CBV and increased FV by ≥20% and from <5% to >10%, respectively. A non-significant pattern indicating a decrease of 1.31 and 1.97 CPD was observed among those who decreased FV by ≥20% and from >10% to <5%, respectively. Changes in quit interest and biomarkers were also non-significant with one exception: greater reduction in TNE among those who decreased from >10% to <5% FV versus no change (-8.51 vs -0.25 nmol/mg creatinine; p=0.0447).

CONCLUSIONS

Switching to CBV with lower FV does not appear to increase exposure and may even reduce exposure for some. Additional investigations are recommended to confirm these descriptive findings.

Perceptions of the Addictiveness of Low-Nicotine Cigarettes Versus Typical Cigarettes and Exposure to Tobacco Industry-Sponsored Corrective Campaign

BACKGROUND

In 2017, the U.S. Food and Drug Administration (FDA) announced a regulatory plan to reduce the nicotine content of cigarettes. This study examines the association of exposure to industry-sponsored corrective statements on perceptions of the addictiveness of low-nicotine cigarettes relative to typical cigarettes within the general US population.

METHODS

The study comprised 4975 US adult respondents of the 2019 Health Information National Trends Survey (HINTS 5, Cycle 3). Multinomial logistic regression models were used to examine associations between exposure to tobacco industry corrective messages and perceptions of the addictiveness of low-nicotine cigarettes relative to typical cigarettes.

RESULTS

In the overall population, 4.1% reported that low-nicotine cigarettes were much more addictive than typical cigarettes, 67.5% said they were equally addictive, while 28.4% reported they were slightly/much less addictive. Adults exposed to industry-sponsored corrective messages had higher odds of perceiving low-nicotine cigarettes as equally addictive as typical cigarettes (aOR 1.57; 95% CI, 1.13-2.19) than those who saw no corrective messages. Those exposed to the corrective messages specifically about the addictiveness of smoking and nicotine had higher odds of perceiving low-nicotine cigarettes as equally addictive as typical cigarettes (aOR, 1.73; 95% CI, 1.07-2.81) compared to those who saw no corrective message.

CONCLUSIONS

Our findings suggest that exposure to court-ordered tobacco industry corrective statements may have reinforced perceptions on the addictive potential of nicotine. However, study findings indicate a need for campaigns specifically tailored to address misperceptions observed in this study.

Estimating human pharmacokinetic parameters forelectronic nicotine delivery system products from chemical analyses of their aerosols

The ability of Electronic Nicotine Delivery Systems (ENDS) to deliver nicotine is central to their function to substitute for cigarettes, allowing people who smoke to switch away from smoking, thus reducing their exposure to harmful chemicals in cigarette smoke. The nicotine concentration in ENDS e-liquid has proved to be a poor predictor of nicotine uptake in users. Using meta-analytic methods to analyze 12 pharmacokinetic studies of nicotine-salt closed-system ENDS, this paper examines whether the mass of nicotine/puff of aerosol can predict Cmax in pharmacokinetic studies. Cmax values were available for 38 products, in 58 use conditions (including both controlled [3 s] and ad libitum puffing), comprising 1769 participant observations. Nicotine/puff data reflected chemical analyses of aerosol obtained under nonintense (3 s) or intense (6 s) machine puffing. Meta-regression analyses (weighted by reliability of Cmax estimate) assessed the relationship of nicotine/puff to Cmax. In some models, empirical data were used to impute the variation in Cmax or the nicotine/puff value under intense puffing. In simple linear models, Cmax was significantly associated with nicotine/puff under all combinations of intense/nonintense and controlled/ad-libitum conditions, with R2 values of 0.71-0.77. More complex models based on quadratic effects or log[nicotine/puff] did not generally improve upon more parsimonious linear models. Application of the model illustrates the divergence between nicotine concentration in e-liquids and expected Cmax when other ENDS parameters vary. The meta-analytic model may have utility in settings where clinical pharmacokinetic data are not available, including product development.

Toxicological Aspects Associated with Consumption from Electronic Nicotine Delivery System (ENDS): Focus on Heavy Metals Exposure and Cancer Risk

Tobacco smoking remains one of the leading causes of premature death worldwide. Electronic Nicotine Delivery Systems (ENDSs) are proposed as a tool for smoking cessation. In the last few years, a growing number of different types of ENDSs were launched onto the market. Despite the manufacturing differences, ENDSs can be classified as "liquid e-cigarettes" (e-cigs) equipped with an atomizer that vaporizes a liquid composed of vegetable glycerin (VG), polypropylene glycol (PG), and nicotine, with the possible addition of flavorings; otherwise, the "heated tobacco products" (HTPs) heat tobacco sticks through contact with an electronic heating metal element. The presence of some metals in the heating systems, as well as in solder joints, involves the possibility that heavy metal ions can move from these components to the liquid, or they can be adsorbed into the tobacco stick from the heating blade in the case of HTPs. Recent evidence has indicated the presence of heavy metals in the refill liquids and in the mainstream such as arsenic (As), cadmium (Cd), chromium (Cr), nickel (Ni), copper (Cu), and lead (Pb). The present review discusses the toxicological aspects associated with the exposition of heavy metals by consumption from ENDSs, focusing on metal carcinogenesis risk.

Acute effects of charcoal filters and package color on cigarette perceptions and use behaviors: Results from a randomized pilot study examining Natural American Spirit "Sky"

INTRODUCTION

Charcoal-filtered cigarettes have been available for decades but have never held a major share of the U.S. cigarette market. This pilot study gathered initial behavioral data characterizing how "Sky"-a recently introduced charcoal-filtered cigarette variety that uses potentially misleading marketing features-is used and what impact its packaging color has on consumer perceptions.

METHODS

Forty adult daily non-menthol cigarettes users (52.5% male, 75.0% White, mean age = 46.1, 14.3 mean cigarettes/day) completed a single-session deception study utilizing a 2 ×2 mixed factorial design to manipulate cigarette filter condition (charcoal vs. non-charcoal) and pack color (light vs. dark). Participants smoked two cigarettes identical in appearance and packaging but differing in filter type (blinded and order counterbalanced) and completed pre- and post-cigarette CO samples and post-cigarette questionnaires.

RESULTS

Participants endorsed more favorable subjective ratings, puffed less of, held more correct beliefs about risks, and expressed greater intentions to use the charcoal (vs. non-charcoal)-filtered cigarette (p's <0.05). Pack color had few effects on outcomes; however, cigarettes in light vs. dark colored packs were rated as cleaner tasting (p <0.01). Neither filter condition nor pack color affected CO boost. There were no interaction effects on any outcomes.

CONCLUSIONS

Under blinded conditions, Sky charcoal-filtered cigarettes are initially appealing independent of their packaging color. Findings warrant further study of these effects on perceptions, behavior, and harm exposure after longer, open-label use periods. Findings may inform regulatory decisions regarding cigarette packaging and filter composition.

Nicotine dependence among undergraduates who use nicotine salt-based e-cigarettes

OBJECTIVE

This study examined the relationship between use patterns of a popular e-cigarette brand using nicotine salts, JUUL, and symptoms of nicotine dependence in a college cohort.

PARTICIPANTS

Data for this study came from a prospective cohort of undergraduate students at a large Midwestern university from 2018 to 2019.

METHODS

Among participants who had ever tried a JUUL (N = 411), univariate and multivariable logistic regression were used to test the associations between use frequency (past 30-day use) and quantity (time to finish a pod) and nicotine dependence at follow up.

RESULTS

In the multivariable models, both frequency of use and quantity of use were associated with subsequent nicotine dependence, based on most indicators of dependence.

CONCLUSIONS

As salt-based nicotine is now present in the most popular e-cigarette brands used by young people, such findings inform our contemporary understanding of e-cigarettes' addictive potential and can help inform campus-based interventions.

Quality variations of leachate resulting from cigarette filter recycling as a challenge for its management

Recycling is known as a solution for cigarette filter management, but this may cause the release of trapped pollutants in it. Cigarette smoke toxins and chemicals that trapped in the cigarette filter can accumulate in the recycling leachate. In this study, littered cigarette filters and freshly smoked cigarette filters were recycled and the resulting leachate was analyzed. The results showed that the minimum and maximum Chemical Oxygen Demand (COD) of the studied leachates were 2100 mg/L and 11,300 mg/L, respectively. The maximum temporal variation in the studied leachate quality was 74.28%, but the maximum spatial variation was 314.2%. COD in the freshly smoked sample was 2600-9200 mg/L more than the littered samples. The average concentration of chromium, lead, nickel, and cadmium in littered samples was 0.023, 0.024, 0.045, and 0.019 mg/L, respectively. Environmental conditions such as humidity, the efficiency of the urban cleaning system in reducing the resistance of littered filters, the difference in the quality of the filter and tobacco, and the difference in smoking behaviors were effective in this variation. Reducing the toxicity of cigarette smoke and improving the efficiency of the urban cleaning system can lead to the same quality, but leachate treatment is necessary to reduce the environmental risk.

Illegal product purchasing in the experimental tobacco marketplace: Effects of menthol cigarette and cigarette ventilation ban

BACKGROUND

Tobacco regulations may increase demand for illegal cigarettes. We use the Experimental Tobacco Marketplace to estimate the impact of banning menthol cigarettes (Experiment 1) and decreasing allowable cigarette filter ventilation levels (Experiment 2).

METHODS

Crowdsourced participants were randomized into one of four groups (2×2 factorial design). Experiment 1 included menthol availability (yes/no) by purchasing option (legal only vs illegal available). Experiment 2 included filter-vented cigarettes availability (yes/no) by purchasing option (legal only vs illegal available). Participants were given an individualized budget to purchase tobacco. Percent budget spent was the outcome measure.

RESULTS

Experiment 1, with a legal marketplace only, non-menthol cigarette purchasing was lower (p=0.010) and electronic-cigarette purchasing was higher (p=0.016), when cigarettes were banned compared to when they were available. With an illegal marketplace, switching to legal non-menthol cigarettes was less likely (p<0.001) and purchasing illegal menthol cigarettes was higher (p<0.001), when cigarettes were banned compared to when they were available. Experiment 2, with a legal marketplace only, cigarette purchasing was lower (p=0.010), when the participant's filtered vented cigarettes were banned compared to when they were available. With an illegal marketplace, purchasing the legal low-ventilated cigarette option was lower (p<0.001) and significant differences in illegal filter-vented cigarette purchasing were not observed, when their filter-vented cigarettes were banned compared to when they were available legally.

CONCLUSIONS

Without an illegal option, both restrictions decreased cigarette purchasing, but the menthol ban increased e-cigarette purchasing. With an illegal option, a menthol ban increased illegal cigarette purchasing, but decreasing filter ventilation did not.

Protecting public health and the environment: towards a general ban on cellulose acetate cigarette filters in the European Union

After the establishment of a causal relationship between tobacco use and cancer in the 1950s, cellulose acetate filters were introduced with the claim to reduce the adverse health impact of unfiltered cigarettes. Often perceived to be more pleasant and healthy, filters encouraged smoking. However, filtered cigarettes are more deeply inhaled to obtain the same nicotine demand while altered combustion releases more tobacco-specific nitrosamines. The increasing use of cigarette filter ventilation is associated with a sharp rise in lung adenocarcinomas in recent decades. While not preventing adverse health effects, a global environmental problem has been created due to the non-biodegradable filter litter, causing ecotoxicological effects and the spread of microplastics. Recently, the Belgian Superior Health Council advised policymakers to ban cigarette filters as single-use plastics at both national and European levels. This article outlines the arguments used to justify this plea (human health and environment), the expected effects of a filter ban, as well as the public reception and reactions of the tobacco industry. The specific context of the European Union is discussed including the revision of the Single-Use Plastics Directive, affording a new opportunity to ban plastic filters. This perspective article aims to fuel the momentum and cooperation among member states for this purpose.

Variations in cigarette brand characteristics: can consumers tell the difference?

OBJECTIVES

Sensory experience is an important determinant of smoking initiation, brand choice and harm perception, but little is known about how cigarette design shapes sensory experience. This study reports which variations in tobacco blend and design characteristics available on the market are likely to be perceived as different by consumers.

METHODS

Truth Tobacco Industry Documents was reviewed for studies showing noticeable sensory differences resulting from variations in tobacco blend and design characteristics. These differences were compared with tobacco product data as available in the Dutch section of the European Common Entry Gate (EU-CEG) system on 30 April 2020.

RESULTS

Industry documents identified discrimination thresholds for ventilation, pressure drop, tobacco weight, filter length, and tar and nicotine levels in smoke while evidence for other design characteristics was less conclusive. In the 103 different cigarette varieties in the EU-CEG database, five main types of cigarettes could be identified by principal component analysis, differing in (combinations of) design characteristics. The most significant differences between brand varieties were tar, nicotine and carbon monoxide emissions and associated parameters filter ventilation, filter length, cigarette length and tobacco weight.

CONCLUSIONS

While some clusters of brand varieties provided a noticeably different product for consumers, in many cases design differences within these clusters did not exceed the expected discrimination threshold. This indicates that many products on the market are not discernibly different for consumers, and that proliferation of brand varieties has a non-sensory purpose, such as marketing. Policy makers should consider limiting available brand varieties and regulating design characteristics to reduce product appeal.

Risk perceptions and continued smoking as a function of cigarette filter ventilation level among US youth and young adults who smoke

BACKGROUND

While evidence demonstrates that the industry's marketing of cigarettes with higher filter ventilation (FV) misleads adults about their health risks, there is no research on the relationships between FV, risk perceptions and smoking trajectories among youth (ages 12-17) and young adults (ages 18-24).

METHODS

Data on FV levels of major US cigarette brands/sub-brands were merged with the Population Assessment of Tobacco and Health Study to examine whether FV level in cigarettes used by wave 1 youth/young adults (n=1970) predicted continued smoking at waves 2-4, and whether those relationships were mediated by perceived risk of their cigarette brand. FV was modelled based on tertiles (0.2%-11.8%, low; 11.9%-23.2%, moderate; 23.3%-61.1%, high) to predict daily smoking, past 30-day smoking and change in number of days smoking at successive waves.

RESULTS

The odds of perceiving one's brand as less harmful than other cigarette brands was 2.21 times higher in the high versus low FV group (p=0.0146). Relationships between FV and smoking outcomes at successive waves were non-significant (all p>0.05).

CONCLUSION

Youth and young adults who use higher FV cigarettes perceived their brand as less harmful compared with other brands. However, level of FV was not associated with continued smoking.

Illusion of filtration: Evidence from tobacco industry documents

INTRODUCTION

We compared the design features of popular filtered and non-filtered cigarettes sold in the United States between 1960 and 1990, to assess the relationship between cigarette filter and tobacco weight.

METHODS

We analyzed data on the design features of six popular filtered and three non-filtered cigarette brands sold in the US including the weight of tobacco used provided in the Cigarette Information Reports produced by Philip Morris Tobacco Company between 1960 and 1990. We also collected information on other design features such as stick length and circumference, the percentage of reconstituted tobacco in the blend, among other product parameters. We used joinpoint regression to test for trends in outcome variables for each brand assessed between 1960 and 1990.

RESULTS

In all years, filtered cigarettes had less tobacco by weight compared to non-filtered cigarettes. The lower average weight of tobacco found in filtered cigarettes appears to be due to a combination of factors including stick and filter length, and the amount of reconstituted tobacco in the blend. The average percentages of total alkaloids and expanded tobacco increased over time but were similar between filtered and non-filtered brands.

CONCLUSIONS

While various design features of popular filtered and non-filtered brands changed between 1960 and 1990, the observed reduction in tobacco weight among filtered brands was perhaps the most salient in terms of disease risk. Less tobacco in a filtered cigarette calls into question the presumed exclusive role of cigarette filter tips in the reduced health risks of filtered versus non-filtered cigarette smoking.

Tobacco industry strategies for flavour capsule cigarettes: analysis of patents and internal industry documents

BACKGROUND

The global market for flavour capsule variants (FCVs), cigarettes with a crushable flavour capsule, has grown exponentially. To inform further regulatory efforts, it is important to understand tobacco industry strategies for FCVs.

METHODS

Analysis of data from 65 patents and 179 internal tobacco industry documents, retrieved via snowball searches in Patsnap and the Truth Tobacco Industry Documents Library, describing tobacco industry developments related to FCVs. We used an inductive coding method to identify themes relating to FCV features or developments.

RESULTS

Tobacco companies were developing FCVs since the 1960s, with little market success until the 2000s following the launch of Camel Crush, a brand which targeted millennials (in their teens or early 20s at the time). Tobacco companies have patented, but not yet marketed, FCVs with microcapsule surface coatings, adjustable or heat-triggered flavour release systems, airflow manipulation features, transparent filters to visualise flavour release, and various flavours and additives for capsules including nicotine/tobacco extracts for an on-demand nicotine hit. Tobacco companies developed FCVs purported to be reduced harm, although their own tests showed that FCVs have higher toxicant concentrations. They have also developed loose flavour capsule units designed to fit into cigarettes, packs, or recessed filters to enable users to customise cigarettes and circumvent tobacco flavour bans.

CONCLUSIONS

To prevent tobacco companies from targeting young people and exploiting regulatory loopholes, regulations on tobacco products should ban flavours and consider the broad variety of FCV designs, additives and loose products designed to impart flavour into tobacco products.

Is perception reality? Associations among "light" cigarettes and number of cigarettes smoked per day

INTRODUCTION

Cigarette filter ventilation and light descriptors are associated with lowered perceptions of risk and smoking more cigarettes per day (CPD). This study examined the relationship between usual cigarette ventilation, perception, and CPD.

METHODS

A crowdsourced sample (N = 995) of individuals who smoke higher-ventilated (=>20% ventilation) or lower-ventilated (=<10% ventilation) cigarettes identified their usual cigarette as "light" or "full flavor", and reported their average CPD.

RESULTS

We found: 1) no association between ventilation status and perception of light versus full flavor (AUC=0.58), with the inaccurate perception being more prevalent in younger individuals (p = 0.041) and those who smoke L&M (73%, p < 0.001) and Camel (61%, p = 0.006) brands; and 2) perception, but not ventilation of usual cigarette, was significantly associated with CPD (p = 0.006), with individuals who perceived their cigarettes as light reporting an average of 13% more cigarettes per day (2.6 CPD), compared to those who perceived their cigarette as full flavor.

CONCLUSIONS

Perceptions of light versus full-flavor, but not ventilation status, predicted CPD. These findings may inform anti-smoking health communication strategies and smoking cessation interventions.

IMPLICATIONS

Tobacco control policies should eradicate the perception of cigarettes as light or full-flavored. Future research investigating the associations between cigarette filter ventilation and smoking behavior should consider the confounding effects that may lie in an individual's perceptions of their cigarettes.

Mouth Level Intake of Nicotine from Three Brands of Little Filtered Cigars with Widely Differing Product Characteristics Among Adult Consumers

Little filtered cigars are tobacco products with many cigarette-like characteristics. However, despite cigars falling under the U.S. Food and Drug Administration regulatory authority, characterizing flavors, which are still allowed in little filtered cigars, and filter design may influence how people use the products and the resulting exposure to harmful and potentially harmful constituents. We estimated nicotine mouth level intake (MLI) from analyses of little cigar filter butt solanesol levels, brand characteristics, carbon monoxide boost, and puff volume in 48 dual cigarette/cigar users during two repeat bouts of ad lib smoking of three little filtered cigar brands. Mean nicotine MLI for the three brands was significantly different with Swisher Sweets (0.1% ventilation) Cherry at 1.20 mg nicotine, Cheyenne Menthol (1.5%) at 0.63 mg, and Santa Fe unflavored (49%) at 0.94 mg. The association between nicotine MLI and puff volume was the same between Cheyenne Menthol and Santa Fe unflavored. However, these were different from Swisher Sweets Cherry. At least five main factors─flavor, ventilation, filter design, nicotine delivery related to tar, and user puff volume─may directly or indirectly impact MLI and its association with other measures. We found that users of little filtered cigars that have different filter ventilation and flavor draw dissimilar amounts of nicotine from the product, which may be accompanied by differences in exposure to other harmful smoke constituents.

Effects of advertising features on smokers' and non-smokers' perceptions of a reduced nicotine cigarette modified risk tobacco product

INTRODUCTION

Research is needed to determine the impact of marketing on perceptions and use of reduced nicotine content (RNC) cigarettes, particularly as US regulators have permitted the sale of an RNC cigarette modified risk tobacco product (MRTP) that seeks further authorisation to advertise using modified risk claims. This study examined the effects of two advertising elements (product name and disclaimer content) on perceptions of an RNC cigarette MRTP.

METHODS

Adult participants (n=807, 28.7% smokers, 58.2% male, 74.2% non-Latinx white) completed an online MTurk survey. Participants were randomised to view one of six RNC cigarette advertisements, using a 2×3 between-subject factorial design to manipulate product name ('Moonlight' vs 'Moonrise') and disclaimer content (industry-proposed: 'Nicotine is addictive. Less nicotine does NOT mean a safer cigarette' vs focused: 'Less nicotine does NOT mean a safer cigarette' vs no content), then completed recall and product perception questionnaires.

RESULTS

All participants who viewed the industry-proposed disclaimer (vs no content) perceived greater addiction risk (p's<0.05). Non-smokers who viewed this disclaimer also perceived greater health risks and held fewer false beliefs (p's<0.05). Smokers who viewed Moonlight (vs Moonrise) ads perceived lower health risks (p<0.05).

CONCLUSIONS

Disclaimer content may effectively inform consumers about addiction risk of a new RNC cigarette MRTP, and further inform non-smokers about health risks. This element, however, had little effect on perceived health risks among smokers, among whom the Moonlight product name was associated with health risk misperceptions similar to the banned 'light' descriptor.

Tobacco industry marketing adaptations to Singapore plain packaging

BACKGROUND

Singapore has implemented plain packaging, a measure that strips all colours, logos and branding elements from tobacco packs. In other countries, tobacco companies responded to plain packaging with a variety of marketing tactics. Our goal was to describe the tobacco industry's marketing adaptations to Singapore plain packaging.

METHODS

Qualitative analysis of 378 cigarette packs sampled from Singapore retailers in March 2019, March 2020 and January 2021, 12 months prior to, 2 weeks prior to and 6 months after plain packaging phase-in, respectively. For each pack, we collected descriptive information on the brand and variant name, pack and stick dimensions, pack shape, differentiating features and distinctive scents, as well as photographic data of the pack, cigarette sticks and any distinct features. We used the March 2019 collection as our baseline dataset, and March 2020 and January 2021 collections as comparison datasets to examine changes in tobacco marketing strategies just before and after plain packaging phase-in.

RESULTS

Around Singapore's plain packaging phase-in, tobacco companies launched variants with flavour capsules, novelty filter features and new flavours and used more descriptive variant names reflecting the variant's colour coding or market positioning. Tobacco companies revamped some existing variants, often with Japanese marketing themes to convey a more premium product image. After plain packaging, tobacco companies used longer packs and variations in stick length, filter length and foil texture to further differentiate products.

CONCLUSIONS

Following plain packaging in Singapore, tobacco companies rely increasingly on nomenclature and the cigarette stick itself to market and differentiate products.

Intention to purchase alternative tobacco products as a function of smoking status and responses to advertising, packaging, and sensory experiences

INTRODUCTION

Tobacco manufacturers design and marketed products with appealing sensory characteristics to drive product uptake and continued use. We assessed smokers' and non-smokers' cognitive, affective, and sensory responses to Camel Snus (CS) and Nicotine gum (NG) to gauge future intentions to use.

METHOD

In a single laboratory session, 348 participants (including current smokers and nonsmokers in Buffalo, NY and Boston, MA) were exposed to CS and NG products in counterbalanced order. Exposure involved a cumulative set of 3 steps in which participants i) viewed an advertisement; ii) viewed the packaging, and iii) touched and smelled the product, without actual use. Current daily and non-daily smokers were invited to undertake a fourth exposure step by sampling the product. Following product exposure, participants completed perception measures and reported future intentions to use either product at the end of the survey. After each exposure, participants' reported feelings of valence and arousal.

RESULTS

Smokers reported greater preference to try NG (63.8%) compared with CS (17.4%) or neither (18.8%), whereas majority of nonsmokers preferred neither product (64.3%) (p < 0.01). Of those offered to sample the products, 78.3% daily smokers and 68.4% non-daily smokers opted to sample. When asked about intentions to try, a greater proportion of smokers stated a preference to try NG over CS, as did the small number of nonsmokers who expressed a preference.

CONCLUSION

Intentions to try CS were low despite different levels of exposure to product, and this low product appeal and interest in use may translate to limited potential of CS to serve as a reduced harm product for smokers.

Acute nicotine reinforcement requires ability to discriminate the stimulus effects of nicotine

This review of research on behavioral discrimination of nicotine and how it informs public health policy for reducing risk of tobacco dependence is adapted from Kenneth A. Perkins's American Psychological Association Division 28 (Psychopharmacology and Substance Abuse) 2020 Med Associates Brady/Schuster Award Lecture. The author's initial programmatic clinical research on nicotine is introduced, especially efforts to develop and validate a novel method of acute nicotine dosing. After the public health rationale for characterizing the discriminative stimulus effects of nicotine in humans are described, details from two separate programs of research on nicotine discrimination in humans are presented. The first, conducted with nicotine dosing by nasal spray, documented that humans could discriminate nicotine administered rapidly, examined nicotine's neuropharmacological specificity, identified discrimination threshold dose in smokers and nonsmokers, and explored other conditions that might alter ability to discriminate its effects. The second, more recent program focused on threshold doses for discrimination of nicotine by cigarette smoking, a program that was very difficult to do until the past decade, and how nicotine's self-reported "reward" and preference via choice behavior relate to its discriminability. Differences due to menthol and degree of tobacco dependence were also examined. For each of these two programs, the main findings of selected studies are noted, followed by very recent work on nicotine discrimination and choice that informs Food and Drug Administration's efforts to formulate public policy to improve health and reduce the nearly half million American deaths per year due to persistent tobacco use. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Where to next for countries with high tobacco taxes? The potential for greater control of tobacco pricing through licensing regulation

Optimising the taxation of tobacco products should be among the highest priorities for health and hence economic policy in every country. The WHO Technical Manual on Tobacco Tax Policy and Administration released in April 2021 provides invaluable advice, including 26 best practice recommendations on policy design, administrative efficiency and addressing industry tactics to circumvent tobacco tax increases. Introducing and increasing tobacco taxes is the most important tobacco control measure for any jurisdiction. The effects of simple tax structures, high tax levels, and frequent above-inflation increases in specific excise duties can be enhanced through strict controls on packaging (including pack size), product design, and discounting. However, even with such measures, tobacco companies can continue to undermine the effectiveness of tax policy by offering some products in their ranges at very low prices, as well as gradually and selectively increasing the prices of some but not all products after tax increases. This paper is aimed at policymakers in countries that have already adopted best practice tax policy. It explores the idea of wholesale price capping combined with retail licensing to address the problems of brand proliferation, dispersion of prices, cushioning and strategic under/overshifting of tax increases, thereby radically and sustainably increasing the effectiveness of tobacco tax policy while also raising additional tax revenue for governments by reducing industry profitability.

Shedding 'light' on cigarette pack design: colour differences in product perceptions, use and exposure following the US descriptor ban

INTRODUCTION

Many countries removed misleading descriptors (eg, 'light,' 'mild') from cigarette packaging because they falsely conveyed messages of reduced risk. It is unclear if relabelled products currently promote misperceptions or differences in product use and toxicant exposure. We compared product perceptions, use and exposure between a US sample of Marlboro Gold (formerly 'light') and Red smokers.

METHODS

240 non-treatment-seeking adult daily Marlboro smokers (70% male, 71% White, mean cigarettes/day=16.4 (SD=8.3)) completed two laboratory sessions over a 5-day period. During sessions, participants smoked two cigarettes through a topography device to capture their puffing behaviour, provided precigarette and postcigarette carbon monoxide (CO) assessments, and completed risk perception and subjective rating questionnaires. Self-reported cigarettes per day were verified via daily filter collection; urine collected at the end of the period was assayed for nicotine metabolites.

RESULTS

Gold (n=49) smokers were more likely than Red (n=191) to incorrectly believe their cigarettes had less nicotine and tar than regular cigarettes (ps<0.001), and rated them as weaker, less harsh, and mild tasting (ps<0.05). Differences between Red and Gold smokers in cigarettes per day and puffing behaviours trended towards significance (ps<0.1). Notably, there were no group differences on CO boost or total nicotine equivalents (ps>0.1).

CONCLUSIONS

Misperceptions about nicotine and tar exist years after rebranding Marlboro Lights as Marlboro Gold. Biological results support that Gold smokers do not have lower toxicant exposure. The US should consider comprehensive packaging or product design regulations to properly inform smokers of product risks.Trial registeration number NCT02301351.

A Low-Cost, High-Throughput Digital Image Analysis of Stain Patterns on Smoked Cigarette Filter Butts to Estimate Mainstream Smoke Exposure

Standard machine smoking protocols provide useful information for examining the impact of design parameters, such as filter ventilation, on mainstream smoke delivery. Unfortunately, their results do not accurately reflect human smoke exposure. Clinical research and topography devices in human studies yield insights into how products are used, but a clinical setting or smoking a cigarette attached to such a device may alter smoking behavior. To better understand smokers' use of filtered cigarette products in a more natural environment, we developed a low-cost, high-throughput approach to estimate mainstream cigarette smoke exposure on a per-cigarette basis. This approach uses an inexpensive flatbed scanner to scan smoked cigarette filter butts and custom software to analyze tar-staining patterns. Total luminosity, or optical staining density, of the scanned images provides quantitative information proportional to mainstream smoke-constituent deliveries on a cigarette-by-cigarette basis. Duplicate sample analysis using this new approach and our laboratory's gold-standard liquid chromatography/tandem mass spectrometry (LC/MS/MS) solanesol method yielded comparable results (+7% bias) from the analysis of 20 commercial cigarettes brands (menthol and nonmentholated). The brands varied in design parameters such as length, filter ventilation, and diameter. Plots correlating the luminosity to mainstream smoked-nicotine deliveries on a per-cigarette basis for these cigarette brands were linear (average R2 > 0.91 for nicotine and R2 > 0.83 for the tobacco-specific nitrosamine NNK), on a per-brand basis, with linearity ranging from 0.15 to 3.00 mg nicotine/cigarette. Analysis of spent cigarette filters allows exposures to be characterized on a per-cigarette basis or a "daily dose" via summing across results from all filter butts collected over a 24 h period. This scanner method has a 100-fold lower initial capital cost for equipment than the LC/MS/MS solanesol method and provides high-throughput results (~200 samples per day). Thus, this new method is useful for characterizing exposure related to filtered tobacco-product use.

Health without filters: the health and environmental impacts of cigarette filters

Tobacco-related diseases kill eight million people worldwide ever year and are responsible for thousands of cases of cancer, cardiovascular disease and other illnesses in Brazil. Cigarette filters are believed by many to reduce the health risks of smoking. This article outlines the history of the technology of filters and discusses the impacts of these cigarette design features and their regulation. We conducted a literature review to assess the impacts of this technology. The results show that filters were initially developed for aesthetic purposes and later improved and marketed as a harm reduction technology. The most widely-used filters are those made of cellulose acetate with or without activated carbon. Despite smokers' beliefs and advertising claims, filters have no health benefits and filter tip ventilation can increase the health risks of smoking. Filters can also make cigarettes more appealing and cause significant environmental impacts. Cigarette filters have no health benefits and lull smokers into a false sense of security and should therefore be banned.

Smokers' awareness of filter ventilation, and how they believe it affects them: findings from the ITC Four Country Survey

BACKGROUND

Filter ventilation creates sensations of 'lightness' or 'smoothness' and is also highly effective for controlling machine-tested yields of tar, nicotine and carbon monoxide. Nearly all factory-made cigarettes (FMC) now have filter ventilation in countries such as Australia, Canada, the UK and the USA. Research conducted before 'light' and 'mild' labelling was banned found low smoker awareness of filter ventilation and its effects. This study explores current levels of awareness of filter ventilation and current understanding of its effects in these four countries.

METHODS

We used data from the 2018 wave of the ITC Four Country Smoking and Vaping Survey with samples from USA, England, Canada and Australia. Analyses were conducted initially on a weighted sample of 11 844, and subsequently on 7541 daily FMC smokers.

FINDINGS

Only 40.3% of all respondents reported being aware of filter ventilation. Among daily FMC smokers, only 9.4% believed their cigarettes had filter ventilation. Believing that their usual cigarettes are smoother was positively associated with believing they are also less harmful. Both these beliefs independently predict believing their cigarettes are ventilated (smoother OR=1.97 (95% CI 1.50 to 2.59) and less harmful OR=2.41 (95% CI 1.66 to 3.49) in relation to those believing each characteristic is average.

INTERPRETATION

Awareness of filter ventilation is currently low, despite decades of public 'education efforts around the misleading nature of 'light' and 'mild" descriptors. Few smokers realise that their cigarettes almost certainly are vented. Smokers who believed their cigarettes have filter ventilation were more likely to believe they were both smoother and less harmful. Awareness of the technology appears to be insufficient to prevent smokers being deceived by it. Filter ventilation is inherently misleading to smokers and it is time to ban it.

Direct imaging evidences of metal inorganic contaminants traced into cigarettes

Today, environmental health research on toxicological adverse effects of metal-inorganic materials diffused by cigarettes represents a new challenge for assessing new health risks directly related to the critical chemical-size features of the particles. Therefore, morpho-chemical analyses of hazardous particles become critical in response to the distinctive assumptions about the origin, evolution, and coexisting phases. Here, we report a detailed investigation through direct microscopy imaging of metal-inorganic contaminants for one traditional and two heat-not-burn commercial cigarettes of three different brands. Chemical-size studies revealed the critical presence of heavy metal-inorganic nanostructured microparticles on both paper and filter components of the cigarette, before and after smoking. The direct experimental imaging evidenced on how hazardous particles evolved in mass-size forming coexisting multi-phases of large agglomerate because of the persistence and accumulative effect of the heating puffing. The estimated porosity of the unsuitable engineered filters validated the allowed migration of micrometric pollutants independently from their intrinsic size-shape property. Furthermore, the inappropriate design of the filters made it an adverse sponge reservoir capable of collecting all possible hazardous chemical agents potentially toxic. These substantial results strongly support experimentally the tremendous effect of the smoke capable of transporting and manipulating a high amount of elusive particles, as a particles heat carrier.

A Forced-Choice Procedure to Assess the Acute Relative Reinforcing Effects of Nicotine Dose per se in Humans

INTRODUCTION

A method to assess acute reinforcement due to nicotine may aid identification of doses needed to maintain dependence. After describing development of a forced-choice procedure, results are presented from two studies using it to determine the relative reinforcing effects of nicotine dose per se.

AIMS AND METHODS

Choice between a higher versus a very low or no nicotine option, via smoking (Study 1, n = 59) and via nasal spray (Study 2, n = 42), was assessed in nontreatment-seeking dependent smokers abstinent overnight. Using a within-subject design, different nicotine levels for each product were administered under blind conditions, initially to assess their discriminability (Study 1: 1.3-17 mg/g each vs. 0.4 mg/g nicotine Spectrum cigarettes; Study 2: 2.5 µg/kg vs. 0 µg/kg nicotine per spray). At the end of sessions for each study, participants engaged in forced-choice trials to assess preference, requiring a fixed number of puffs/sprays for one and/or the other.

RESULTS

Confirming the procedure's validity, the choice of the higher nicotine option was significantly greater than that for the very low or no nicotine option in both studies. In Study 1, choice relative to 0.4 mg/g was greater for cigarettes 5.3 mg/g or more but not 2.3 mg/g or less (p = .003 for the interaction of higher content vs. 0.4 mg/g comparison). In Study 2, choice was greater for the nicotine versus placebo spray (p < .005), as nicotine was preferred nearly twice as much as the placebo.

CONCLUSION

This forced-choice procedure may efficiently determine the relative reinforcing value of a nicotine dose per se.

IMPLICATIONS

The forced-choice procedure described here may identify nicotine doses that are acutely reinforcing in dependent smokers. A priori research of choice comparisons between small versus zero nicotine doses could inform clinical research in larger and more diverse samples to determine nicotine contents in cigarettes, and perhaps in other commercial products, that are not reinforcing and, thus, likely to reduce the risk of their addictiveness. This procedure may also be applicable to assessing changes in acute nicotine reinforcement due to different product formulations, novel drugs, or other manipulations, perhaps helping inform development of new interventions for cessation or harm reduction.

Relationships among smoking, oxidative stress, inflammation, macromolecular damage, and cancer

Smoking is a major risk factor for a variety of diseases, including cancer and immune-mediated inflammatory diseases. Tobacco smoke contains a mixture of chemicals, including a host of reactive oxygen- and nitrogen species (ROS and RNS), among others, that can damage cellular and sub-cellular targets, such as lipids, proteins, and nucleic acids. A growing body of evidence supports a key role for smoking-induced ROS and the resulting oxidative stress in inflammation and carcinogenesis. This comprehensive and up-to-date review covers four interrelated topics, including 'smoking', 'oxidative stress', 'inflammation', and 'cancer'. The review discusses each of the four topics, while exploring the intersections among the topics by highlighting the macromolecular damage attributable to ROS. Specifically, oxidative damage to macromolecular targets, such as lipid peroxidation, post-translational modification of proteins, and DNA adduction, as well as enzymatic and non-enzymatic antioxidant defense mechanisms, and the multi-faceted repair pathways of oxidized lesions are described. Also discussed are the biological consequences of oxidative damage to macromolecules if they evade the defense mechanisms and/or are not repaired properly or in time. Emphasis is placed on the genetic- and epigenetic alterations that may lead to transcriptional deregulation of functionally-important genes and disruption of regulatory elements. Smoking-associated oxidative stress also activates the inflammatory response pathway, which triggers a cascade of events of which ROS production is an initial yet indispensable step. The release of ROS at the site of damage and inflammation helps combat foreign pathogens and restores the injured tissue, while simultaneously increasing the burden of oxidative stress. This creates a vicious cycle in which smoking-related oxidative stress causes inflammation, which in turn, results in further generation of ROS, and potentially increased oxidative damage to macromolecular targets that may lead to cancer initiation and/or progression.

Impact of Filter on the Estimation of Quantitative Mixture Risk Caused by Some Chemical Constituents Generated from Popular Cigarette Brands in Iran

Background

This study was conducted to evaluate the impact of filter on the eventual carcinogenic and non-carcinogenic risks caused by the main toxic constituents of popular cigarette brands in Iran.

Methods

At this laboratory study, the concentration of benzene, formaldehyde, arsenic, and cadmium in the mainstream smoke of 11 popular cigarette brands in Iran, on the without and with-filter modes was determined based on an established method. The hazard quotient (HQ), incremental lifetime cancer risk (ILCR), and mixture quantitative risk assessments (QRAs) were performed based on the QRA method recommended by United States Environmental Protection Agency (USEPA).

Findings

The mean of HQ due to benzene, formaldehyde, arsenic, and cadmium in without-filter cigarette smoke was from 3.96 to 3505. The findings indicated that the HQs related to benzene, formaldehyde, arsenic, and cadmium in cigarette smoke were decreased with filter by 48.3%, 25.3%, 37.6%, and 49.1%, respectively. The filter of cigarette decreased ILCR of benzene, formaldehyde, arsenic, and cadmium in cigarette smoke by 53.02%, 25.31%, 37.70%, and 61.01%, respectively. The mixture of non-carcinogenic and carcinogenic estimated risks due to inhalation of studied cigarettes smoke was very high and unacceptable.

Conclusion

The cigarette filter plays an essential role in reducing inhalation exposure to hazardous compounds in mainstream cigarette smoke; nevertheless, the average of overall mixture HQs and ILCRs estimated caused by studied compounds was higher than the acceptable value. It is recommended that future empirical studies investigate the impact of the type of fiber used in cigarette filter on reducing carcinogenic and non-carcinogenic risks caused by cigarette smoke.

Smoking regular and low-nicotine cigarettes results in comparable levels of volatile organic compounds in blood and exhaled breath

Smokers are exposed to more than 6000 (toxic) smoke components including volatile organic compounds (VOCs). In this study VOCs levels in headspace of blood and exhaled breath, in the mainstream smoke of three types of cigarettes of one brand varying in declared tar, nicotine and carbon monoxide (TNCO) yields are investigated. The objective was to identify whether VOC levels correlate with TNCO yields of cigarettes smoked according to ISO 3308. Our data show that smoking regular and low-TNCO cigarettes result in comparable levels of VOCs in blood and exhaled breath. Hence, declared TNCO-yields as determined with the ISO 3308 machine smoking protocol are irrelevant for predicting VOC exposure upon human smoking. Venous blood and exhaled breath were sampled from 12 male volunteers directly before and 10 min after smoking cigarettes on 3 d (day 1 Marlboro Red (regular), day 2 Marlboro Prime (highly ventilated, low-TNCO), day 3 Marlboro Prime with blocked filter ventilation (taped)). Upon smoking, the levels of toluene, ethylbenzene, m/p-xylene, o-xylene, and 2,5-dimethylfuran in both headspace of venous blood and exhaled breath increase within the same range for all three cigarette types smoked. However, no strong correlation was found between VOC levels in exhaled breath and VOC levels in headspace of blood because of variations between the individual smoking volunteers. More research is required in order to use exhaled breath sampling as a non-invasive quantitative marker for volatile toxicants from cigarette smoke exposure of different brands.

Australian smokers’ experiences and perceptions of recessed and firm filter cigarettes

Background

While cigarette filter modifications have long been used to increase product appeal and assuage health concerns, tighter marketing restrictions, including plain packaging, have further spurred the growth of filter variants. We explored and assessed experiences and perceptions of smokers who had tried and/or currently use recessed filter cigarettes (RFCs) and firm filter cigarettes (FFCs).

Method

In November 2018, we undertook eight exploratory focus groups of Australian adult factory-made cigarette smokers (total n=56). In July 2019, we surveyed 999 smokers aged 18–69 years to quantify ever and current use of these products and associated beliefs and sensory experiences.

Results

Focus group and survey findings were consistent. Among 988 smokers who had at least tried factory-made cigarettes, 28.9% had tried FFCs and 11.1% currently smoked these, while 36.4% had tried RFCs and 7.5% currently smoked these. Smokers in both studies believed these filters may reduce harm and that FFCs increase appeal. In the survey, 58.9% of RFC triers agreed these hide the filter’s brown stain and 48.9% agreed that RFCs keep harmful substances away from the mouth. Similarly, 58.4% of FFC triers agreed these trap more harmful substances than standard filters. Relative to standard filter cigarettes, more smokers experienced FFCs and RFCs as feeling clean (p=0.03) and more current FFC users experienced these as feeling smooth (p=0.01).

Conclusion

RFCs and FFCs undermine plain packaging legislation, which aims to reduce appeal and minimise misperceptions about the relative harms of different tobacco products. Like other filter modifications, these filter variants should be disallowed.

Can Removing Tar Information From Cigarette Packages Reduce Smokers' Misconceptions About Low-Tar Cigarettes? An Experiment From One of the World's Lowest Tar Yield Markets, South Korea

INTRODUCTION

Despite regulations that forbid cigarette packages from displaying messages such as "mild," "low-tar," and "light," many smokers still have misperceptions about "light" or "low-tar" cigarettes. One reason may be that tar amount displays continue to be permitted. This study examines whether removing tar delivery information from packaging reduces consumer misperceptions about "low-tar" cigarettes.

METHODS

An online experiment was conducted in South Korea among 531 smokers who were randomly assigned to one of two conditions: with and without tar information on cigarette packages. Participants evaluated which type of cigarette was mildest, least harmful, easiest for nonsmokers to start smoking, and easiest for smokers to quit.

RESULTS

Ten out of 12 chi-square tests showed that people judged the lowest reported tar delivery cigarette to be the mildest (p < .01), least harmful (p < .05), easiest to start (p < .05), and easiest to quit (p < .05)-less so in the "no-tar" condition than the "tar" condition. A higher level of misbeliefs about supposed low-tar cigarettes were found in the "tar" condition compared to the "no-tar" condition for all three brands (t = 5.85, 4.07, 3.82, respectively, p < .001). Regression analyses showed that the "no-tar" condition negatively predicted the level of misbeliefs after controlling for demographic and smoking-related variables (B [SE] = -.72 (.12), -.50 (.12), -.48 (.13), respectively, p < .001).

CONCLUSIONS

Banning reported tar deliveries from cigarette packages is likely to reduce smokers' misconceptions about "low-tar" cigarettes. When reported tar deliveries are absent, smokers have inconsistent judgments about differently packaged cigarettes.

IMPLICATIONS

When cigarette packages depict lower reported tar number deliveries, participants erroneously perceive them to be less harmful than packages displaying higher tar numbers. These misperceptions of harm may prompt smokers who might otherwise attempt to quit smoking to instead consume cigarettes with lower tar deliveries due to the mistaken belief that they will reduce their risk.

Impact of Cigarette Filter Ventilation on U.S. Smokers' Perceptions and Biomarkers of Exposure and Potential Harm

BACKGROUND

Relationships between cigarette filter ventilation levels, biomarkers of exposure (BOE) and potential harm (BOPH), and harm perceptions were examined.

METHODS

Filter ventilation levels in cigarette brands were merged with Wave 1 (2013-2014) Population Assessment of Tobacco Use and Health study. Data were restricted to smokers who reported a usual brand and not regular users of other tobacco products. BOEs included nicotine, tobacco-specific nitrosamines, volatile organic compounds (VOC), and polycyclic aromatic hydrocarbons. BOPHs measured inflammation and oxidative stress. Perceived harm was assessed as self-reported risk of one's usual brand compared with other brands.

RESULTS

Filter ventilation ranged from 0.2% to 61.1% (n = 1,503). Adjusted relationships between filter ventilation and BOE or BOPH were nonsignificant except for VOC N-acetyl-S-(phenyl)-L-cysteine (PHMA) and high-sensitivity C-reactive protein (hsCRP). In pairwise comparisons, PHMA was higher in quartile (Q) 4 (4.23 vs. 3.36 pmol/mg; P = 0.0103) and Q3 (4.48 vs. 3.36 pmol/mg; P = 0.0038) versus Q1 of filter ventilation and hsCRP comparisons were nonsignificant. Adjusted odds of perceiving one's own brand as less harmful was 26.87 (95% confidence interval: 4.31-167.66), 12.55 (3.01-52.32), and 19.18 (3.87-95.02) times higher in the Q2, Q3, and Q4 of filter ventilation compared with Q1 (P = 0.0037).

CONCLUSIONS

Filter ventilation was not associated with BOE or BOPH, yet smokers of higher ventilated cigarettes perceived their brand as less harmful than other brands compared with smokers of lower ventilated cigarettes.

IMPACT

Research to understand the impact of this misperception is needed, and remedial strategies, potentially including a ban on filter ventilation, are recommended.

Tobacco industry targeting of health-conscious youth with 'lighter' cigarettes: the case of Singapore

BACKGROUND

Despite Singapore's strict tobacco control policies, smoking rates have not decreased since 2004. We examined the primary targets, motivations and strategies behind targeted marketing activities in Singapore from the tobacco industry's perspective to understand how tobacco companies continue to target people in their marketing.

METHODS

Snowball search in the Truth Tobacco Industry Documents Library for documents covering the industry's targeted marketing activities in Singapore. Information from the documents was subsequently triangulated with market data obtained from the Euromonitor Passport database, analysed for trends by tar segment and data from cigarette packs purchased from Singapore retailers, analysed in terms of product positioning.

RESULTS

In the 1970s and 1980s, as young people in Singapore became more health-conscious, tobacco companies positioned 'light' cigarettes for growth in the 1990s. Many of these 'lights' contained similar tar and nicotine levels as regular brands; they were only light in their branding. In the 1990's, 'lights' became more popular in Singapore and this demand was largely youth driven. Into the 2010s, while the low tar (<6 mg) segment comprised only a small portion of Singapore's cigarette market, most cigarette variants were marketed as 'lighter' or as having harm reductive benefits to appeal to more health-conscious people.

CONCLUSIONS

The differentiation of 'lighter' cigarettes remains an important marketing tool for tobacco companies amidst Singapore's strict regulations. Legislation to remove all remaining avenues for tobacco companies to make harm reduction claims on their products, explicit or implicit, coupled with improving health literacy and exposing industry deception, could help to further bring down smoking prevalence in Singapore.

Human Biomonitoring of Trace Elements in Scalp Hair from Healthy Population of Pakistan

The present study deals with the assessment of essential trace and toxic elements in biological samples (scalp hair) of healthy smoker and non-smoker residents of Lahore (the second most populous city), Pakistan. Human biomonitoring of various trace elements like zinc (Zn), iron (Fe), copper (Cu), chromium (Cr), cadmium (Cd), nickel (Ni), lead (Pb), and arsenic (As) was evaluated in human hair samples of smokers and non-smokers (males and females) as per IFCC criteria. For the purpose of comparison, scalp hair samples of age- and sex-equivalent healthy persons were also analyzed. The results of this study show that the concentrations (P95 values) of As (0.17, 0.81, and 0.91 μg/g), Cd (2.80, 3.81, and 3.16 μg/g), Cr (4.1, 4.2, and 5.3 μg/g), Cu (20.0, 21.0, and 21.9 μg/g), Ni (3.9, 4.6, and 4.3 μg/g), Pb (4.0, 4.8, and 5.0 μg/g), and Fe (49.0, 49.0, and 59.3 μg/g) were significantly higher in scalp hair samples of smokers than in referents, for various age groups (16-32 years, 33-50 years, and 51-62 years), respectively. The concentrations of Zn (165, 163, and 173 μg/g various age groups, respectively) in similar age group were found lower in the scalp hair samples of smokers than referents. Exposure of high toxic metal level through smoking and deficiency of Zn could be synergistic with the risk factors associated with the use of tobacco. Correlation studies for the elements in cigarette with the elements in scalp hair of male smokers show a highly positive correlation between Cr-Cd, Cr-Ni, Cu-Fe, and Ni-Zn.

Smokers Awareness and Risk Perceptions of Filter Ventilation

Objectives

The addition of tiny rows of holes in the tipping paper (filter ventilation) of cigarettes allows air to mix with the smoke, which can change risk perceptions. In this study, we examine smokers' knowledge and beliefs about filter ventilation.

Methods

Web-based panel surveys conducted in 2016 and 2017 of current adult cigarette smokers (N = 2355) provided data on awareness and understanding of filter vents in their cigarettes, whether they believed blocking the holes would change the taste of their cigarettes, and their perceptions about their future risk of being diagnosed with lung cancer. The most commonly used cigarette brands reported by participants also were characterized on the presence and level of ventilation holes.

Results

Approximately 40% of participants (mostly younger and male) reported awareness of the filter ventilation in their cigarettes. Only 30% of the participants were both aware of and understood the function of filter ventilation; they also were significantly more likely to worry about developing lung cancer.

Conclusion

Although misleading descriptors associated with filter ventilation are prohibited, most smokers still smoked cigarettes with filter vents, and many are unaware and misunderstand the potential risks of filter ventilation.

Menthol, Nicotine, and Flavoring Content of Capsule Cigarettes in the US

Objectives

Characterize physical design features of cigarette brands sold in the US according to the delivery method of menthol that may affect sensory perception among users.

Methods

Twelve cigarette brands, mentholated and non-mentholated, were purchased for analyses of the physical design characteristics, quantification of nicotine and menthol, and identification of flavor additives.

Results

Physical design characteristics did not differ significantly between the various cigarette brands. However, significant differences were seen in levels of menthol. Menthol levels were greatest in products that had dual delivery methods of menthol (6.7mg/cigarette; SE=0.27) followed by products mentholated in a filter capsule only (5.7mg/cigarette; SE=0.25), and those mentholated in the tobacco only (3.8mg/cigarette; SE=0.12); products that were not mentholated had the least (0.38mg/cigarette; SE=0.31). Finally, flavor additives with a mint flavor profile other than menthol were identified, such as pulegone and limonene, and differed between cigarette brands, which are likely contributing to the menthol flavor experience associated with use of these products.

Conclusions

The regulation of menthol delivery method, flavorings added to the capsule, and/or menthol concentration may be beneficial for the public health as these factors are likely creating unique sensory experiences.

The Impact of Exclusive Use of Very Low Nicotine Cigarettes on Compensatory Smoking: An Inpatient Crossover Clinical Trial

BACKGROUND

The FDA is considering a mandated reduction in the nicotine content of cigarettes. Clinical trials have been limited by non-study cigarette use (noncompliance), which could mask compensation. The goal of this study was to assess whether compensation occurs when smokers provided with very low nicotine cigarettes cannot access normal nicotine cigarettes.

METHODS

In a within-subjects, crossover design, current smokers (n = 16) were confined to a hotel for two 4-night hotel stays during which they were only able to access the research cigarettes provided. The hotel stays offered normal nicotine cigarettes or very low nicotine content (VLNC) cigarettes, in an unblinded design, available for "purchase" via a study bank.

RESULTS

In the context of complete compliance with the study cigarettes (n = 16), there was not a significant increase during the VLNC condition for cigarettes smoked per day, expired carbon monoxide, or N-acetyl-S-(cyanoethyl)-l-cysteine (cyanoethyl-MA, metabolite of acrylonitrile). There was a significant nicotine × time interaction on urine N-acetyl-S-(3-hydroxypropyl)-l-cysteine (hydroxypropyl-MA, metabolite of acrolein), driven by an increase in the VLNC condition during the first 24 hours. By the end of the VLNC condition, there was no evidence of compensation across any measure of smoking or smoke exposure.

CONCLUSIONS

Among current smokers who exclusively used VLNC cigarettes for 4 days, there was no significant compensatory smoking behavior.

IMPACT

These data, combined with the larger body of work, suggest that a mandated reduction in nicotine content is unlikely to result in an increase in smoking behavior to obtain more nicotine.

Preclinical and clinical research on the discriminative stimulus effects of nicotine

Across species, nicotine can produce robust discriminative stimulus (DS) effects, as with other drugs of abuse, a feature that has been harnessed to advance our understanding on the neuropharmacological mechanisms of nicotine's actions. With the crucial role played by nicotine in supporting tobacco dependence, nicotine DS effects have presented an ideal platform to develop novel generation of smoking cessation compounds. Findings from preclinical strands of research have invigorated the field of human discrimination research to objectively assess nicotine's interoceptive stimulus effects. As such, translation studies provide proof of concept for nicotine DS research as a method to assess the subjective effects of nicotine per se, separate from non-nicotine stimuli involved in smoking. Recent clinical studies with low doses have demonstrated that perceiving nicotine's DS effects is necessary, yet not sufficient, for that dose to be reinforcing. These measures have been instrumental in developing novel strategies with regards to establishing threshold doses of nicotine contained in tobacco products, to then determine subthreshold doses that cannot be discriminated and, therefore, fail to maintain reinforcement. Findings from preclinical and clinical nicotine DS research could substantially inform public health policies aimed at regulating nicotine content of consumer products so that they minimize risks of dependency. This article is part of the special issue on 'Contemporary Advances in Nicotine Neuropharmacology'.

Mouth-Level Nicotine Intake Estimates from Discarded Filter Butts to Examine Compensatory Smoking in Low Nicotine Cigarettes

BACKGROUND

A mandated reduction in the nicotine content of cigarettes could reduce smoking rate and prevalence. However, one concern is that smokers may compensate by increasing the intensity with which they smoke each cigarette to obtain more nicotine. This study assessed whether smokers engage in compensatory smoking by estimating the mouth-level nicotine intake of low nicotine cigarettes smoked during a clinical trial.

METHODS

Smokers were randomly assigned to receive cigarettes with one of five nicotine contents for 6 weeks. An additional group received a cigarette with the lowest nicotine content, but an increased tar yield. The obtained mouth-level nicotine intake from discarded cigarette butts for a subset of participants (51-70/group) was estimated using solanesol as described previously. A compensation index was calculated for each group to estimate the proportion of nicotine per cigarette recovered through changes in smoking intensity.

RESULTS

There was no significant increase in smoking intensity for any of the reduced nicotine cigarettes as measured by the compensation index (an estimated 0.4% of the nicotine lost was recovered in the lowest nicotine group; 95% confidence interval, -0.1 to 1.2). There was a significant decrease in smoking intensity for very low nicotine content cigarettes with increased tar yield.

CONCLUSIONS

Reductions in nicotine content did not result in compensatory changes in how intensively participants smoked research cigarettes.

IMPACT

Combined with data from clinical trials showing a reduction in cigarettes smoked per day, these data suggest that a reduction in nicotine content is unlikely to result in increased smoke exposure.

Strategies to Reduce Illicit Trade of Regular Nicotine Tobacco Products After Introduction of a Low-Nicotine Tobacco Product Standard

The US Food and Drug Administration is considering mandating a substantial reduction in the nicotine level of cigarettes and possibly other combusted tobacco products to render them minimially addictive. This would likely result in several public health benefits, including increased cessation, decreased progression to dependence, and reduced consumption of combusted tobacco products. However, findings from clinical trials of reduced-nicotine cigarettes suggest that many smokers consuming low nicotine-content cigarettes sought out regular nicotine-content cigarettes, even when they were asked to only smoke free low-nicotine cigarettes. If this policy were implemented without ensuring that cessation treatments and appealing alternative products (e.g., e-cigarettes) were readily available, some consumers would be likely to seek banned regular nicotine-content combusted tobacco products from illicit sources: retail, online, and individuals. Left unchecked, this illicit market could undermine the public health benefits of the policy. We describe supply and demand factors in an illicit market. Informed by the literature on controlling Internet tobacco sales and reducing illicit trade in low-cost cigarettes when there are price differentials, we recommend tracking and tracing products and greater surveillance and enforcement efforts to minimize illicit trade in normal nicotine products under a low-nicotine tobacco product standard.

Research on Behavioral Discrimination of Nicotine May Inform FDA Policy on Setting a Maximum Nicotine Content in Cigarettes

INTRODUCTION

The Food and Drug Administration may set a maximum nicotine content in cigarettes to minimize smoking's addictiveness. Our recent research may indirectly support setting levels applicable to the population of dependent smokers below 1 mg/g (mg nicotine/g of tobacco filler).

METHODS

Using a within-subjects design in laboratory-based studies totaling 61 nontreatment seeking adult dependent smokers, Spectrum research cigarettes with nicotine contents ranging from 1.3 to 17 mg/g (just one per session) were compared with the lowest content available, 0.4 mg/g. Identified for each participant was the smallest difference in nicotine content, or "threshold," between cigarettes that still supported behavioral discrimination (ie, ability to objectively distinguish their difference). The next lower nicotine content cigarette, not discriminated (by definition), was labeled their "subthreshold." Subjective perceptions and choice behavior were also assessed.

RESULTS

Thresholds varied widely among all 61 smokers but, importantly, fewer than 7% of smokers could discriminate the two lowest, 1.3 versus 0.4 mg/g nicotine, meaning more than 90% could not do so. Moreover, we found a consistent association between their nicotine discrimination threshold and their subjective perceptions and subsequent reinforcement behavior later in the session. Specifically, a participant's discrimination threshold cigarette was also more highly rated and preferred (ie, self-administered), whereas their subthreshold cigarette was rated similarly to the 0.4 mg/g and not preferred.

CONCLUSIONS

Cigarette nicotine content below the threshold for perceiving nicotine's effects (ie, its discriminability) in nearly all smokers from a no nicotine comparison is likely below 1.0 mg/g, or less than or equal to 10% of that in typical commercial cigarettes.

IMPLICATIONS

Cigarettes with nicotine contents able to be discriminated (threshold) are also reinforcing, and those unable to be discriminated are not reinforcing, as anticipated. Yet, research explicitly comparing cigarettes with contents below 1.0 mg/g versus no nicotine (ie, a "placebo") is needed with larger samples. Results may confirm what nicotine content lower than 1.0 mg/g is below the threshold for discrimination (and self-administration) in the vast majority (>95%) of adult dependent smokers as well as teens beginning to smoke. Identifying that content would strongly support the Food and Drug Administration policy to establish a maximum nicotine content in cigarettes that will not maintain dependence.

Estimating Demand and Cross-Price Elasticity for Very Low Nicotine Content (VLNC) Cigarettes Using a Simulated Demand Task

Introduction

Very Low Nicotine Content (VLNC) cigarettes might be useful as part of a tobacco control strategy, but relatively little is known about their acceptability as substitutes for regular cigarettes. We compared subjective effects and demand for regular cigarettes and VLNC cigarettes, and estimated cross-price elasticity for VLNC cigarettes, using simulated demand tasks.

Method

Forty New Zealand smokers sampled a VLNC cigarette and completed Cigarette Purchase Tasks to indicate their demand for regular cigarettes and VLNC cigarettes at a range of prices, and a cross-price task indicating how many regular cigarettes and VLNC cigarettes they would purchase at 0.5x, 1x, and 2x the current market price for regular cigarettes, assuming the price of VLNC cigarettes remained constant. They also rated the subjective effects of the VLNC cigarette and their usual-brand regular cigarettes.

Results

Cross-price elasticity for VLNC cigarettes was estimated as 0.32 and was significantly positive, indicating that VLNC cigarettes are partially substitutable for regular cigarettes. VLNC cigarettes were rated as less satisfying and psychologically rewarding than regular cigarettes, but this was unrelated to demand or substitutability.

Conclusion

VLNC cigarettes are potentially substitutable for regular cigarettes. Their availability may reduce tobacco consumption, nicotine intake and addiction; making it easier for smokers to quit.

Implications

VLNC cigarettes share the behavioral and sensory components of smoking while delivering negligible levels of nicotine. Although smokers rated VLNCs as less satisfying than regular cigarettes, smokers said they would increase their consumption of VLNCs as the price of regular cigarettes increased, if VLNCs were available at a lower price. This suggests that VLNCs are partially substitutable for regular cigarettes. VLNCs can be part of an effective tobacco control strategy, by reducing nicotine dependence and improving health and financial outcomes for smokers.

Answering questions about electronic cigarettes using a multidisciplinary model

Electronic cigarettes (ECIGs) are a relatively new class of tobacco products and a subject of much debate for scientists and policymakers worldwide. Objective data that address the ECIG risk-benefit ratio for individual and public health are needed, and addressing this need requires a multidisciplinary approach that spans several areas of psychology as well as chemistry, toxicant inhalation, and physiology. This multidisciplinary approach would benefit from methods that are reliable, valid, and swift. For this reason, we formed a multidisciplinary team to develop methods that could answer questions about ECIGs and other potential modified risk tobacco products. Our team includes scientists with expertise in psychology (clinical, community, and experimental) and other disciplines, including aerosol research, analytical chemistry, biostatistics, engineering, internal medicine, and public health. The psychologists on our team keep other members focused on factors that influence individual behavior, and other team members keep the psychologists aware of other issues, such as product design. Critically, all team members are willing to extend their interests beyond the boundaries of their discipline to collaborate effectively with the shared goal of producing the rigorous science needed to inform empirically based tobacco policy. In addition, our trainees gain valuable knowledge from these collaborations and learn that other disciplines are accessible, exciting, and can enhance their own research. Multidisciplinary work presents challenges: learning other scientists' languages and staying focused on our core mission. Overall, our multidisciplinary team has led to several major findings that inform the scientific, regulatory, and public health communities about ECIGs and their effects. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Whether to push or pull? Nicotine reduction and non-combusted alternatives - Two strategies for reducing smoking and improving public health

Combustible cigarettes remain the most harmful and addictive tobacco product, and reducing the prevalence of smoking continues to be a critical public health goal. While nicotine is the constituent primarily responsible for addiction to cigarettes, most of the harm associated with smoking comes from byproducts of tobacco combustion. Recently, two different approaches for reducing the harms of smoking have emerged, both of which focus on breaking the link between the addiction to nicotine and the harms caused by smoking. First, the addictive potential of cigarettes could be minimized by requiring a large reduction in the nicotine content of cigarettes. Evidence for a nicotine reduction policy thus far shows that the use of very low nicotine content cigarettes results in a reduction in the number of cigarettes people smoke per day and a reduction in cigarette dependence. Second, emerging alternative nicotine delivery systems (ANDS) like electronic cigarettes may provide sufficient nicotine to act as substitutes for cigarettes while delivering much lower levels of toxicants. Evidence suggests that the emergence of ANDS has increased the percentage of smokers who are able to quit. The present paper will briefly review the evidence for each of these approaches, and consider what contemporary reinforcement and addiction theories can tell us about their likely success. We argue that the most effective endgame approach is one that pursues both nicotine reduction and alternative nicotine delivery systems as complementary.

Smokers' risk perceptions and misperceptions of cigarettes, e-cigarettes and nicotine replacement therapies

INTRODUCTION AND AIMS

To identify the range and coherence of smokers and recent ex-smokers' general beliefs about the harms associated with smoking and the implications of these beliefs for their assessments of the relative harms and addictiveness of various nicotine containing products.

DESIGN AND METHODS

The study consisted of 18 single participant interviews with current smokers or vapers (13 M, 5 F) and three focus groups (15 M, 14 F) with current smokers/vapers and recent quitters. Both individual interviews and focus groups included semi-structured discussions of how nicotine and cigarette smoke cause disease and addiction, and a structured task involving rating the relative harmfulness and addictiveness of 17 nicotine products against a reference, popular, cigarette.

RESULTS

Most participants were able to give adequate accounts of what makes cigarette smoking harmful and addictive but this general knowledge was not consistently applied to making harmfulness and addictiveness judgements about specific products. Many participants applied simple affect-based heuristics to harmfulness and addictiveness judgments, even when they had apparently demonstrated more sophisticated knowledge earlier. Most used binary safe/dangerous thinking, with addictiveness and harmfulness strongly linked and a decoupling of satisfaction and addictiveness.

DISCUSSION AND CONCLUSIONS

Many smokers appear to have reasonable general knowledge of the risks of smoking but cannot reliably apply this knowledge to practical risk judgements. We need to rethink how we communicate with the public about the risks of smoking, and using other nicotine products, in ways that allow them to make more informed decisions about their smoking.

Cigarette Filter Ventilation and Smoking Protocol Influence Aldehyde Smoke Yields

The WHO study group on tobacco product regulation (TobReg) advised regulating and lowering toxicant levels in cigarette smoke. Aldehydes are one of the chemical classes on the TobReg smoke toxicants priority list. To provide insight in factors determining aldehyde yields, the levels of 12 aldehydes in mainstream cigarette smoke of 11 Dutch brands were quantified. Variations in smoking behavior and cigarette design affecting human exposure to aldehydes were studied by using four different machine testing protocols. Machine smoking was based on the International Standardization Organization (ISO) and Health Canada Intense (HCI) regime, both with and without taping the filter vents. The 11 cigarette brands differed in (i) design and blend characteristics; (ii) tar, nicotine, and carbon monoxide (TNCO) levels; (iii) popularity; and (iv) manufacturer. Cigarette smoke was trapped on a Cambridge filter pad and carboxen cartridge. After being dissolved in methanol/CS2 and derivatization with DNPH, the aldehyde yields were determined using HPLC-DAD. Using an intense smoking regime (increased puff volume, shorter puff interval) significantly increased aldehyde yields, following the pattern: ISO < ISO-taped < HCI-untaped < HCI. For all of the regimes, acetaldehyde and acrolein yields were strongly correlated ( r = 0.804). The difference in TNCO and aldehyde levels between regular and highly ventilated low-TNCO cigarettes (as measured using ISO) diminished when smoking intensely; this effect is stronger when combined with taping filter vents. The highly ventilated low-TNCO brands showed six times more aldehyde production per mg nicotine for the intense smoking regimes. In conclusion, acetaldehyde and acrolein can be used as representatives for the class of volatile aldehydes for the different brands and smoking regimes. The aldehyde-to-nicotine ratio increased when highly ventilated cigarettes were smoked intensely, similar to real smokers. Thus, a smoker of highly ventilated low-TNCO cigarettes has an increased potential for higher aldehyde exposures compared to a smoker of regular cigarettes.