The future of tobacco product regulation and labelling in Europe: implications for the forthcoming European Union directive

The influencing factors of health hazards of benzo[a]pyrene in cigarette mainstream smoke: The example of one brand in Beijing

INTRODUCTION

METHODS

RESULTS

CONCLUSIONS

Cigarette Filter Ventilation and its Relationship to Increasing Rates of Lung Adenocarcinoma

The 2014 Surgeon General's Report on smoking and health concluded that changing cigarette designs have caused an increase in lung adenocarcinomas, implicating cigarette filter ventilation that lowers smoking machine tar yields. The Food and Drug Administration (FDA) now has the authority to regulate cigarette design if doing so would improve public health. To support a potential regulatory action, two weight-of-evidence reviews were applied for causally relating filter ventilation to lung adenocarcinoma. Published scientific literature (3284 citations) and internal tobacco company documents contributed to causation analysis evidence blocks and the identification of research gaps. Filter ventilation was adopted in the mid-1960s and was initially equated with making a cigarette safer. Since then, lung adenocarcinoma rates paradoxically increased relative to other lung cancer subtypes. Filter ventilation 1) alters tobacco combustion, increasing smoke toxicants; 2) allows for elasticity of use so that smokers inhale more smoke to maintain their nicotine intake; and 3) causes a false perception of lower health risk from "lighter" smoke. Seemingly not supportive of a causal relationship is that human exposure biomarker studies indicate no reduction in exposure, but these do not measure exposure in the lung or utilize known biomarkers of harm. Altered puffing and inhalation may make smoke available to lung cells prone to adenocarcinomas. The analysis strongly suggests that filter ventilation has contributed to the rise in lung adenocarcinomas among smokers. Thus, the FDA should consider regulating its use, up to and including a ban. Herein, we propose a research agenda to support such an effort.

Self-administration of nicotine and cigarette smoke extract in adolescent and adult rats

Although smoking initiation typically occurs during adolescence, most preclinical studies of tobacco use involve adult animals. Furthermore, their focus is largely on nicotine alone, even though cigarette smoke contains thousands of constituents. The present study therefore aimed to determine whether aqueous constituents in cigarette smoke affect acquisition of nicotine self-administration during adolescence in rats. Adolescent and adult male rats, aged postnatal day (P) 25 and 85, respectively, were food trained on a fixed ratio 1 (FR1) schedule, then allowed to self-administer one of 5 doses of nicotine (0, 3.75, 7.5, 15, or 30 μg/kg) or aqueous cigarette smoke extract (CSE) with equivalent nicotine content. Three progressively more difficult schedules of reinforcement, FR1, FR2, and FR5, were used. Both adolescent and adult rats acquired self-administration of nicotine and CSE. Nicotine and CSE similarly increased non-reinforced responding in adolescents, leading to enhanced overall drug intake as compared to adults. When data were corrected for age-dependent alterations in non-reinforced responding, adolescents responded more for low doses of nicotine and CSE than adults at the FR1 reinforcement schedule. No differences in adolescent responding for the two drugs were seen at this schedule, whereas adults had fewer responses for CSE than for nicotine. However, when the reinforcement schedule was increased to FR5, animals dose-dependently self-administered both nicotine and CSE, but no drug or age differences were observed. These data suggest that non-nicotine tobacco smoke constituents do not influence the reinforcing effect of nicotine in adolescents.

An inventory of methods suitable to assess additive-induced characterising flavours of tobacco products

BACKGROUND

Products with strong non-tobacco flavours are popular among young people, and facilitate smoking initiation. Similar to the U.S. Food and Drug Administration Tobacco Control Act, the new European Tobacco Product Directive (TPD) prohibits cigarettes and roll-your-own tobacco with a characterising flavour other than tobacco. However, no methods are prescribed or operational to assess characterising flavours. This is the first study to identify, review and synthesize the existing peer-reviewed and tobacco industry literature in order to provide an inventory of methods suitable to assess characterising flavours.

METHODS

Authors gathered key empirical and theoretical papers examining methods suitable to assess characterising flavours. Scientific literature databases (PubMed and Scopus) and tobacco industry documents were searched, based on several keyword combinations. Inclusion criteria were relevance for smoked tobacco products, and quality of data.

RESULTS

The findings reveal that there is a wide variation in natural tobacco flavours. Flavour differences from natural tobacco can be described by both expert and consumer sensory panels. Most methods are based on smoking tests, but odour evaluation has also been reported. Chemical analysis can be used to identify and quantify levels of specific flavour additives in tobacco products.

CONCLUSIONS

As flavour perception is subjective, and requires human assessment, sensory analysis in consumer or expert panel studies is necessitated. We recommend developing validated tests for descriptive sensory analysis in combination with chemical-analytical measurements. Testing a broad range of brands, including those with quite subtle characterizing flavours, will provide the concentration above which an additive will impart a characterising flavour.

Comparison of the reinforcing properties of nicotine and cigarette smoke extract in rats

Tobacco dependence is difficult to treat, with the vast majority of those who try to quit relapsing within the first year. Improvements in smoking cessation therapies may be achieved by improving current preclinical research methods. However, most experimental tests in animals use nicotine alone, ignoring the 8000 other constituents found in tobacco smoke. To improve on this model, we have used self-administration to test the reinforcing properties of aqueous cigarette smoke extract (CSE) in rats, made by bubbling cigarette smoke through a saline solution. CSE is more potent than nicotine alone in both the acquisition and maintenance of self-administration, but did not exhibit higher progressive ratio responding. Mecamylamine and varenicline had similar potencies to block nicotine and CSE self-administration, indicating the involvement of nicotinic receptors in CSE reinforcement. Following extinction of responding, reinstatement was triggered by exposing animals to a pharmacological stressor, yohimbine (2.5 mg/kg, i.p.), alone and in combination with cues. Animals that self-administered CSE were significantly more sensitive to stress-induced reinstatement than those that self-administered nicotine. Ligand binding autoradiography studies showed nicotine and CSE to have similar affinities for different nicotinic receptor types. CSE significantly reduced MAO-A and MAO-B activities in vitro, whereas nicotine did not. Although CSE inhibition of MAO-A activity in vitro was found to be partially irreversible, irreversible inhibition was not observed in vivo. These experiments show that CSE is an effective reinforcer acting via nicotinic receptors. Furthermore, it better models MAO inhibition and is more sensitive to stress-induced reinstatement than nicotine alone, which is a potent trigger for relapse in smokers.

A comprehensive evaluation of selected components and processes used in the manufacture of cigarettes: approach and overview

CONTEXT

In addition to tobacco and cigarette ingredients, there are many non-tobacco components and processes used to manufacture commercial cigarettes. Proposed cigarette components and manufacturing process changes were evaluated using a tiered toxicological testing program.

OBJECTIVE

The toxicological testing and evaluation of proposed changes to selected non-tobacco cigarette components and manufacturing processes are described in this special report.

MATERIALS AND METHODS

Selected non-tobacco cigarette components and manufacturing processes were evaluated using experimental and control cigarettes. These experimental cigarettes were evaluated using mainstream smoke chemistry, bacterial mutagenicity and cytotoxicity assays. In some evaluations, 90-day nose-only mainstream smoke inhalation studies using rats were performed.

RESULTS

Some proposed design changes were not implemented, or limitations on their use were established. Most study results, however, were similar to those previously reported in the scientific literature for design changes in cigarette construction.

CONCLUSION

The studies reported in the series of publication demonstrate that our testing approach is feasible for evaluation of cigarette component and manufacturing process changes.

Mouth level smoke exposure using analysis of filters from smoked cigarettes: a study of eight countries

The analysis of spent cigarette filters enables the estimation of the nicotine and tar (nicotine-free dry particulate matter) yields obtained by smokers in their everyday environment and has been shown to correlate well with biomarkers of exposure. Leading products across the range of ISO tar yields were selected from Australia, Brazil, Canada, Germany, Japan, New Zealand, South Africa and Switzerland. At least fifty demographically representative smokers were recruited per product. Subjects, ≥ 21 years of age and smoking ≥ 5 cigarettes per day, were asked to collect ≥ 15 filters from cigarettes they had smoked. The collected filters were analysed for nicotine and UV absorbance to enable the smokers' mouth level exposure to nicotine and tar to be estimated and a comparison of countries and tobacco blend styles to be made. Smoking history data were also collected. More than 80,000 filters were collected from 5703 smokers of 106 products from eight countries. Mean ± SD estimated nicotine exposures per cigarette and per day ranged from 0.93 ± 0.34 mg/cigarette (Brazil) to 1.77 ± 0.69 mg/cigarette (South Africa) and from 16.4 ± 11.1mg/day (Germany) to 31.5 ± 14.8 mg/day (South Africa), respectively. Male smokers obtained higher mean estimated tar and nicotine exposures than female smokers. These gender differences were statistically significant for six countries. Significant correlations were found between estimated nicotine exposure and ISO nicotine yield, and between estimated tar exposure and ISO tar yield (p<0.001).

A survey of mouth level exposure to cigarette smoke in the United States

Smoke yields determined by a machine-based smoking method cannot adequately predict exposures experienced by human smokers. In this work, a filter analysis technique which addresses this fundamental limitation was used to measure mouth level exposures (MLE) to tar and nicotine in 1330 smokers of 26 brand-styles of US cigarettes covering a wide range of machine-generated yields. Despite the high degree of variability observed among individual smokers, MLEs were significantly correlated with machine-derived tar and nicotine yields (r=0.423 for nicotine MLE/cigarette; r=0.493 for tar MLE/cigarette; p<0.001 for both). Mean tar and nicotine MLE was higher for males than for females. Mean MLE across races was generally similar. Menthol cigarettes tended toward lower MLE than non-menthol cigarettes and King-Size cigarettes (≈ 83 mm) tended toward lower MLE than 100's cigarettes (≈ 100 mm), though those trends were not statistically significant. There were good agreements between MLEs measured in a group of 159 subjects smoking their usual cigarette brand-style on two separate occasions and between two independent groups of subjects smoking the same brand-styles. The results indicated that the filter analysis method used had sufficient precision to show similarity among groups.

Daring to dream: reactions to tobacco endgame ideas among policy-makers, media and public health practitioners

Background

Tobacco control strategies have mainly targeted reducing demand. Supply-side focused measures, though less familiar, deserve consideration, particularly to achieve 'endgame' tobacco control aims (e.g. achieving close to zero smoking prevalence). We explored attitudes towards supply-side focused 'endgame' tobacco control approaches and how they can be best communicated with senior policymakers, journalists, and public health practitioners.

Methods

We identified five supply-side focused approaches which could potentially lead to the tobacco endgame: two structural models and three discrete actions. The structural models were: (i) a Nicotine Authority to coordinate tobacco control activities and regulate the nicotine/tobacco market for public health aims; and (ii) a Tobacco Supply Agency acting as a monopoly purchaser of tobacco products and controlling the tobacco supply for public health aims. The actions were: (a) allocating progressively reducing tobacco product import quotas (the 'sinking lid') until importation and commercial sale of tobacco products ceased; (b) making tobacco companies responsible for reducing smoking prevalence with stringent financial penalties if targets were missed; and (c) new laws to facilitate litigation against tobacco companies. These approaches were presented as means to achieve a tobacco free New Zealand by 2020 to 19 senior policymakers, journalists, and public health physicians in two focus groups and eight interviews, and their reactions sought.

Results

The tobacco-free vision was widely supported. Participants engaged fully with the proposed tobacco control approaches, which were viewed as interesting or even intriguing. Most supported increasing the focus on supply-side measures. Views differed greatly about the desirability, feasibility and likely effectiveness of each approach. Participants identified a range of potential barriers to implementation and challenges to successfully advocating and communicating these approaches. The current framing of tobacco as a risky but legal commodity was noted as an important potential barrier to implementing endgame approaches.

Conclusions

Endgame tobacco control approaches were considered to be viable policy options. Further policy analysis, research and public discussion are needed to develop endgame approaches. A significant change in the public framing of tobacco may be a prerequisite for implementing endgame solutions.

An evaluation of the toxicity of 95 ingredients added individually to experimental cigarettes: approach and methods

CONTEXT

Ingredients have been used in modern cigarette manufacturing to facilitate tobacco processing, provide flavor, and preserve tobacco. Concern has been raised regarding the use of ingredients in cigarette manufacturing due to the possible generation of toxic chemicals resulting from their combustion when added to tobacco.

OBJECTIVE

Investigate the impact of individual ingredients on cigarette smoke toxicity.

MATERIALS AND METHODS

A total of 95 ingredients were tested individually through addition at different concentrations to the tobacco of experimental cigarettes. Mainstream cigarette smoke chemistry analysis, bacterial mutagenicity testing, and cytotoxicity testing were conducted. Additionally, 31 of the ingredients were tested in 90-day nose-only rat inhalation studies using mainstream cigarette smoke. Studies were designed following conventional toxicity testing methods employed for food additives and other consumer products.

RESULTS

The studies reported here demonstrate that high levels of some ingredients can change the quantity of some smoke constituents, altering the smoke chemistry profile. From the panel of biological endpoints monitored, these added ingredients produced minimal changes in the overall toxicity profile of mainstream cigarette smoke. In some cases, the addition of high levels of an ingredient caused a small reduction in toxicity findings, probably due to displacement of burning tobacco.

CONCLUSION

The battery of testing results presented here is a useful addition to the available scientific information for cigarette ingredients and extends the dataset which can be used for evaluating their appropriate use.

Marketing of menthol cigarettes and consumer perceptions: a review of tobacco industry documents

OBJECTIVE

To examine tobacco industry marketing of menthol cigarettes and to determine what the tobacco industry knew about consumer perceptions of menthol.

METHODS

A snowball sampling design was used to systematically search the Legacy Tobacco Documents Library (LTDL) (http://legacy.library.ucsf.edu) between 28 February and 27 April 2010. Of the approximately 11 million documents available in the LTDL, the iterative searches returned tens of thousands of results from the major US tobacco companies and affiliated organisations. A collection of 953 documents from the 1930s to the first decade of the 21st century relevant to 1 or more of the research questions were qualitatively analysed, as follows: (1) are/were menthol cigarettes marketed with health reassurance messages? (2) What other messages come from menthol cigarette advertising? (3) How do smokers view menthol cigarettes? (4) Were menthol cigarettes marketed to specific populations?

RESULTS

Menthol cigarettes were marketed as, and are perceived by consumers to be, healthier than non-menthol cigarettes. Menthol cigarettes are also marketed to specific social and demographic groups, including African-Americans, young people and women, and are perceived by consumers to signal social group belonging.

CONCLUSIONS

The tobacco industry knew consumers perceived menthol as healthier than non-menthol cigarettes, and this was the intent behind marketing. Marketing emphasising menthol attracts consumers who may not otherwise progress to regular smoking, including young, inexperienced users and those who find 'regular' cigarettes undesirable. Such marketing may also appeal to health-concerned smokers who might otherwise quit.

A study to estimate and correlate cigarette smoke exposure in smokers in Germany as determined by filter analysis and biomarkers of exposure

A clinical study, conducted in Germany, compared two methods of estimating exposure to cigarette smoke. Estimates of mouth level exposure (MLE) to nicotine, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), pyrene and acrolein were obtained by chemical analysis of spent cigarette filters for nicotine content. Estimates of smoke constituent uptake were achieved by analysis of corresponding urinary biomarkers: for nicotine; total nicotine equivalents (nicotine, cotinine, trans-3'-hydroxycotinine plus their glucuronide conjugates), for NNK; (4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) plus glucuronide, for pyrene; 1-hydroxy pyrene (1-OHP) plus glucuronide and for acrolein; 3-hydroxylpropyl-mercapturic acid (3-HPMA) plus the nicotine metabolite cotinine in plasma and saliva. Two hundred healthy volunteer subjects were recruited; 50 smokers of each of 1-2 mg, 4-6 mg and 9-10 mg ISO tar yield cigarettes and 50 non-smokers (NS). Smokers underwent two periods of home smoking, each followed by residence in a clinic. Smoking was permitted ad libitum, and spent cigarette filters, cigarette consumption data, 24h urine, as well as plasma and saliva samples were collected. Significant correlations (p<0.001) were found between MLE and the relevant biomarker for each smoke constituent. The Pearson correlation coefficients (r) were 0.83 (nicotine), 0.76 (NNK), 0.82 (acrolein) and 0.63 (pyrene). Mean MLE estimates for nicotine, NNK and pyrene showed a dose response in line with ISO tar yield smoked, with 10 mg > 4 mg >1 mg, and for acrolein 10 mg> 4 mg > *1mg (where * indicates not significant at 95% confidence level). The mean exposure estimates from biomarkers for nicotine, NNK and acrolein also showed a dose response in line with ISO tar yield with 10 mg > 4 mg > 1 mg > NS, and for pyrene 10 mg > *4 mg> 1 mg> NS. This study shows that estimates of exposure obtained by filter analysis and biomarkers of exposure correlate significantly over a wide range of smoke exposures and that filter analysis may provide a simple and effective alternative to biomarkers for estimating smokers' exposure.

Dependence of tar, nicotine and carbon monoxide yields on physical parameters: implications for exposure, emissions control and monitoring

OBJECTIVE

To estimate the extent to which tar, nicotine and carbon monoxide (TNCO) yields are dependent on cigarette design features such as burn rate, filter ventilation and paper porosity, and to consider the implications for human exposure and the regulation of TNCO emissions. A related aim is to determine whether accurate prediction of TNCO yields is possible using only simple physical parameters.

DESIGN AND METHODS

Datasets that include quantitative design parameters as well as measurements of TNCO yields collected under standard conditions with vents unblocked (International Organization for Standardization) and under intense conditions with vents fully blocked (Health Canada) were compiled from the literature (primarily US and UK brands). Forward stepwise multiple regression analysis is used to assess the relative importance of each design feature in explaining variability in the observed emissions. Using randomly split data subsets, multiple linear regression is used to model the dependence of TNCO yields on design features in the training subset and validated against the test subset. Tar and carbon monoxide correlate with many of the particulate- and volatile-phase toxins in smoke, and brand values normalised to nicotine yield are used as surrogate measures of exposure within the bounds defined by non-intense and intense smoking protocols.

RESULTS AND CONCLUSIONS

Filter ventilation is the dominant control on measured TNCO emissions, but other factors including burn rate, amount of tobacco and paper porosity also contribute. Yields are predictable with reasonable accuracy and precision using only measured physical parameters. Surrogate exposure indicators suggest that filter ventilation does not lead to any reduction in exposure and that highly ventilated (low-yield) brands may actually increase exposure to the more volatile toxins.

Revising the machine smoking regime for cigarette emissions: implications for tobacco control policy

BACKGROUND

The WHO Framework Convention on Tobacco Control includes provisions for testing and regulating cigarette emissions. However, the current international standard for generating cigarette emissions--the ISO machine smoking regime--is widely acknowledged to be inappropriate for purposes of setting regulatory restrictions.

OBJECTIVE

To review alternatives to the ISO machine smoking regime and the extent to which they: 1) Represent human smoking behaviour, 2) Reduce the potential for industry exploitation, particularly in the area of risk communication, and 3) Serve as suitable measures for product regulation.

METHODS

Emissions data from 238 Canadian cigarette brands tested under the ISO and "Canadian Intense" machine smoking regimes.

RESULTS

None of the alternative smoking regimes, including the Canadian Intense method, are more "representative" of human smoking behaviour and none provide better predictors of human exposure.

CONCLUSIONS

Given that alternatives such as the Canadian Intense regime are subject to the same fundamental limitations as the ISO regime, key questions need to be addressed before any smoking regime should be used to set regulatory limits on smoke emissions. In the meantime, regulators should remove quantitative emission values from cigarette packages and more work should be done on alternative machine smoking methods.

Cigarette yields and human exposure: a comparison of alternative testing regimens

OBJECTIVE

There is general agreement that the testing protocol for measuring cigarette smoke constituents-the International Organization for Standardization regimen-is an inappropriate mechanism for evaluating human exposure. Alternative smoking regimens have been introduced in Canada and Massachusetts; however, these regimens have not been evaluated against human smoking behavior and biomeasures of exposure. The objective of this study was to compare measures of smoke volume and nicotine uptake among human smokers against the puffing variables and nicotine yields generated by five different machine smoking regimens: (a) International Organization for Standardization, (b) Massachusetts, (c) Canadian, (d) a Compensatory regimen, and (e) a Human Mimic regimen.

METHODS

Measures of smoke volume and puffing behavior were recorded for 51 smokers who used a portable smoking topography device for three 1-week trials. Measures of salivary cotinine were taken at the completion of each week. The cigarette brands smoked by participants were then machine-smoked under five testing regimens, including a human mimic condition where brands were machine smoked using the puffing behavior recorded from human smokers. The total volume of smoke collected from each cigarette and the nicotine, tar, and carbon monoxide yields were recorded.

RESULTS

None of the four machine smoking regimens adequately reflected Human Mimic Yields of tar, nicotine, and carbon monoxide. In addition, none of the four smoking regimens generated nicotine yields that were associated with actual nicotine uptake in humans.

CONCLUSIONS

None of the existing smoking regimens adequately represents human smoking behavior nor do they generate yields associated with human measures of nicotine uptake.

Relationship between constituent labelling and reporting of tar yields among smokers in four countries

Countries have adopted different approaches to disseminating cigarette tar, nicotine, and carbon monoxide (CO) levels to consumers, with some (e.g. EU member states, Canada, Australia, but not the United States) requiring disclosure of results from the International Organization for Standardization (ISO) test method on packs. Cross-country comparisons can provide insight into how smokers use yields when information is presented differently. We examined whether smokers in four different countries could recall the tar yield of their brand of cigarettes, using data from the third wave of the International Tobacco Control Four Country Survey (ITC-4). Of current smokers in the United States, Canada, Australia and the United Kingdom, 33.6% gave a numeric response when asked to report the tar yield of their brand, whereas 66.4% responded 'I don't know.' American participants (9.2%) were less likely than Canadian (28.0%), UK (36.5%) or Australian (68.2%) smokers to give an answer, even after controlling for sociodemographic and smoking behaviour factors. Constituent labelling policies can affect whether smokers report a tar yield for their cigarette brand. Pack labelling appears to be useful for conveying information about cigarettes to smokers; however, there is an urgent need to develop more meaningful information on toxic constituents of cigarette smoke.

Sugars as tobacco ingredient: Effects on mainstream smoke composition

Sugars are natural tobacco components, and are also frequently added to tobacco during the manufacturing process. This review describes the fate of sugars during tobacco smoking, in particular the effect of tobacco sugars on mainstream smoke composition. In natural tobacco, sugars can be present in levels up to 20 wt%. In addition, various sugars are added in tobacco manufacturing in amounts up to 4 wt% per sugar. The added sugars are usually reported to serve as flavour/casing and humectant. However, sugars also promote tobacco smoking, because they generate acids that neutralize the harsh taste and throat impact of tobacco smoke. Moreover, the sweet taste and the agreeable smell of caramelized sugar flavors are appreciated in particular by starting adolescent smokers. Finally, sugars generate acetaldehyde, which has addictive properties and acts synergistically with nicotine in rodents. Apart from these consumption-enhancing pyrolysis products, many toxic (including carcinogenic) smoke compounds are generated from sugars. In particular, sugars increase the level of formaldehyde, acetaldehyde, acetone, acrolein, and 2-furfural in tobacco smoke. It is concluded that sugars in tobacco significantly contribute to the adverse health effects of tobacco smoking.

Monoamine oxidase inhibitors allow locomotor and rewarding responses to nicotine

Although nicotine is generally considered to be the main compound responsible for the addictive properties of tobacco, experimental data indicate that nicotine does not exhibit all the characteristics of other abused substances, such as psychostimulants and opiates. For example, nicotine is only a weak locomotor enhancer in rats and generally fails to induce a locomotor response in mice. This observation contradicts the general consensus that all drugs of abuse release dopamine in the nucleus accumbens, a subcortical structure, and thus increase locomotor activity in rodents. Because tobacco smoke contains monoamine oxidase inhibitors (MAOIs) and decreases MAO activity in smokers, we have combined MAOIs with nicotine to determine whether it is possible to obtain a locomotor response to nicotine in C57Bl6 mice. Among 15 individual or combined MAOIs, including harmane, norharmane, moclobemide, selegiline, pargyline, clorgyline, tranylcypromine and phenelzine, only irreversible inhibitors of both MAO-A and -B (tranylcypromine, phenelzine, and clorgyline+selegiline) allowed a locomotor response to nicotine. The locomotor stimulant interaction of tranylcypromine and nicotine was absent in beta2-nicotinic acetylcholine receptor subunit knockout mice. Finally, it was found that, whereas naïve rats did not readily self-administer nicotine (10 microg/kg/injection), a robust self-administration of nicotine occurred when animals were pretreated with tranylcypromine (3 mg/kg). Our data suggest that MAOIs contained in tobacco and tobacco smoke act in synergy with nicotine to enhance its rewarding effects.

Taking ad-Vantage of lax advertising regulation in the USA and Canada: reassuring and distracting health-concerned smokers

We explored the evolution from cigarette product attributes to psychosocial needs in advertising campaigns for low-tar cigarettes. Analysis of previously secret tobacco industry documents and print advertising images indicated that low-tar brands targeted smokers who were concerned about their health with advertising images intended to distract them from the health hazards of smoking. Advertising first emphasized product characteristics (filtration, low tar) that implied health benefits. Over time, advertising emphasis shifted to salient psychosocial needs of the target markets. A case study of Vantage cigarettes in the USA and Canada showed that advertising presented images of intelligent, upward-striving people who had achieved personal success and intentionally excluded the act of smoking from the imagery, while minimal product information was provided. This illustrates one strategy to appeal to concerned smokers by not describing the product itself (which may remind smokers of the problems associated with smoking), but instead using evocative imagery to distract smokers from these problems. Current advertising for potential reduced-exposure products (PREPs) emphasizes product characteristics, but these products have not delivered on the promise of a healthier alternative cigarette. Our results suggest that the tobacco control community should be on the alert for a shift in advertising focus for PREPs to the image of the user rather than the cigarette. Global Framework Convention on Tobacco Control-style advertising bans that prohibit all user imagery in tobacco advertising could preempt a psychosocial needs-based advertising strategy for PREPs and maintain public attention on the health hazards of smoking.

Implementation failures in the use of two New Zealand laws to control the tobacco industry: 1989-2005

BACKGROUND

We reviewed the implementation of New Zealand laws in relation to the activities of the tobacco industry and their allies. Material for two brief case studies was obtained from correspondence with official agencies, official information requests, internet searches (tobacco industry documents and official government sites), and interviews with 12 key informants.

RESULTS

The first case study identified four occasions over a period of 14 years where New Zealand Government agencies appeared to fail to enforce consumer protection law, although apparent breaches by the tobacco industry and their allies had occurred in relation to statements on the relative safety of secondhand smoke. The second case study examined responses to a legal requirement for the tobacco industry to provide information on tobacco additives. There was failure to enforce the law, and a failure of the political process for at least 13 years to clarify and strengthen the law. Relevant factors in both these cases of 'policy slippage' appear to have been financial and opportunity costs of taking legal action, political difficulties and the fragmented nature of government structures.

CONCLUSION

Considered together, these case studies suggest the need for governments to: (i) make better use of national consumer laws (with proper monitoring and enforcement) in relation to tobacco; and (ii) to strengthen international law and resources around tobacco-related consumer protection. A number of options for achieving these aims are available to governments.

Methods to assess potential reduced exposure products

The availability of tobacco products purported to reduce toxin exposure or potentially reduce health risks necessitates the development of methods and identification of biomarkers that can be used to assess these products. These assessments occur on multiple levels and stages, from identifying constituents in the tobacco products and smoke, to human exposure and health effects trials, to postmarketing surveillance. A conference of multidisciplinary experts was convened to present and discuss methods and biomarkers to assess these products and to consider the infrastructure necessary to facilitate the evaluation process. Although no currently available set of measures was thought to be sufficient for determining the relative health risk of potential reduced exposure products, this paper provides a blueprint for future research toward this end.

Stages of change and other factors in 'light' cigarette smokers

BACKGROUND

It has become well known that 'light' cigarettes are deceiving in fostering the attitude that they are 'safer' or less health damaging than regular cigarettes. The goal of this study is to analyse the smoking of 'light' cigarettes according to the progress over the stages of change to stop or reduce smoking.

METHODS

A sample representing the general population of a northern German region aged 18 to 64 was drawn (T1, N=4075). 1520 smokers of 'light' and regular cigarettes were identified by a face-to-face interview and reassessed longitudinally by questionnaire 30 months later (T2, n=913).

RESULTS

At baseline smokers of 'light' cigarettes, in particular males, were more likely to be contemplators or preparators in terms of smoking cessation. Those who smoked 'light' cigarettes were more likely to have made a quit attempt, were more likely to be female, at younger age, never married, higher educated and less nicotine dependent compared to smokers of regular cigarettes. The follow-up data shows that males who smoked 'light' before or changed to 'light' cigarettes were more likely to contemplate or to prepare quitting, had more often tried a quit attempt and stopped smoking more often.

CONCLUSION

The results suggest that 'light' cigarettes especially by males are used for reasons of reducing or quitting smoking. It is concluded that as such they deceive the smoker and potentially hinder the process of reducing or quitting.

Industry research on the use and effects of levulinic acid: A case study in cigarette additives

Public health officials and tobacco researchers have raised concerns about the possible contributions of additives to the toxicity of cigarettes. However, little attention has been given to the process whereby additives promote initiation and addiction. Levulinic acid is a known cigarette additive. Review of internal tobacco industry documents indicates that levulinic acid was used to increase nicotine yields while enhancing perceptions of smoothness and mildness. Levulinic acid reduces the pH of cigarette smoke and desensitizes the upper respiratory tract, increasing the potential for cigarette smoke to be inhaled deeper into the lungs. Levulinic acid also may enhance the binding of nicotine to neurons that ordinarily would be unresponsive to nicotine. These findings held particular interest in the internal development of ultralight and so-called reduced-exposure cigarette prototypes. Industry studies found significantly increased peak plasma nicotine levels in smokers of ultralight cigarettes following addition of levulinic acid. Further, internal studies observed changes in mainstream and sidestream smoke composition that may present increased health risks. The use of levulinic acid illustrates the need for regulatory authority over tobacco products as well as better understanding of the role of additives in cigarettes and other tobacco products.

Toward a comprehensive long term nicotine policy

Global tobacco deaths are high and rising. Tobacco use is primarily driven by nicotine addiction. Overall tobacco control policy is relatively well agreed upon but a long term nicotine policy has been less well considered and requires further debate. Reaching consensus is important because a nicotine policy is integral to the target of reducing tobacco caused disease, and the contentious issues need to be resolved before the necessary political changes can be sought. A long term and comprehensive nicotine policy is proposed here. It envisages both reducing the attractiveness and addictiveness of existing tobacco based nicotine delivery systems as well as providing alternative sources of acceptable clean nicotine as competition for tobacco. Clean nicotine is defined as nicotine free enough of tobacco toxicants to pass regulatory approval. A three phase policy is proposed. The initial phase requires regulatory capture of cigarette and smoke constituents liberalising the market for clean nicotine; regulating all nicotine sources from the same agency; and research into nicotine absorption and the role of tobacco additives in this process. The second phase anticipates clean nicotine overtaking tobacco as the primary source of the drug (facilitated by use of regulatory and taxation measures); simplification of tobacco products by limitation of additives which make tobacco attractive and easier to smoke (but tobacco would still be able to provide a satisfying dose of nicotine). The third phase includes a progressive reduction in the nicotine content of cigarettes, with clean nicotine freely available to take the place of tobacco as society's main nicotine source.

The unbearable lightness of "light" cigarettes: a comparison of smoke yields in six varieties of Canadian "light" cigarettes

BACKGROUND

Labelling cigarettes as "light" or "mild" is claimed to be one of the biggest marketing scams in Canadian history. Arguably, such labelling implies that these varieties of cigarettes are less harmful than "regular" cigarettes. In Canada, a food product can be labelled "light" if there is a 25% reduction from the "reference food" and if the constituent being reduced is clearly identified (e.g., light in fat). Cigarette labelling does not comply with these regulations, however. To examine whether or not some tobacco constituents meet the 25% reduction criterion, we compared yields of 41 toxic and/or carcinogenic smoke constituents in six varieties of "light" cigarettes to the yields of "regular" cigarettes. We selected cigarettes from the two most popular Canadian brands, Du Maurier and Players.

METHODS

Using a set of data provided by Imperial Tobacco Canada and made available to the public by the Government of British Columbia, we compared yields measured under a laboratory protocol (modified ISO) that was designed to provide a more rigorous evaluation of the differences between varieties of cigarettes and a more accurate assessment of smokers' potential smoke intake than the traditional protocol (standard ISO).

FINDINGS

For all six varieties of "light" cigarettes, the yields of nicotine were higher by an average of 5% (range: 1% to 13%). The 25% reduction criterion was not met for any variety of "light" cigarettes concerning yields of tar. For all cigarettes tested, yields of tar were reduced on average by only 16% (range: 5% to 22%). For carbon monoxide (CO), only Player's Smooth Light had an over 25% reduction (30%) compared with Player's Regular. Conversely, yield of CO was 24% higher for Du Maurier Lights compared with Du Maurier Regular. As for the other smoke constituents, the majority (75%) were not reduced by 25% or more in "light" cigarettes, and a sizeable proportion of yields (e.g., acrylonitrile, benzene, chromium, m+p cresol, mercury, nickel, toluene) were larger in these varieties of cigarettes. Only yields of formaldehyde, crotonaldehyde, 1-aminonaphtalene, and proprionaldehyde were systematically reduced in all varieties of "light" cigarettes.

CONCLUSION

The six varieties of "light" cigarettes examined in this study do not differ substantially from "regular" cigarettes in terms of smoke yields. We argue that the modified ISO protocol should be implemented for a more valid comparison of potential smoke yields in all varieties of cigarettes and that labelling based on this protocol should be promoted.

The unbearable lightness of "light" cigarettes: a comparison of smoke yields in six varieties of Canadian "light" cigarettes

BACKGROUND

Labelling cigarettes as "light" or "mild" is claimed to be one of the biggest marketing scams in Canadian history. Arguably, such labelling implies that these varieties of cigarettes are less harmful than "regular" cigarettes. In Canada, a food product can be labelled "light" if there is a 25% reduction from the "reference food" and if the constituent being reduced is clearly identified (e.g., light in fat). Cigarette labelling does not comply with these regulations, however. To examine whether or not some tobacco constituents meet the 25% reduction criterion, we compared yields of 41 toxic and/or carcinogenic smoke constituents in six varieties of "light" cigarettes to the yields of "regular" cigarettes. We selected cigarettes from the two most popular Canadian brands, Du Maurier and Players.

METHODS

Using a set of data provided by Imperial Tobacco Canada and made available to the public by the Government of British Columbia, we compared yields measured under a laboratory protocol (modified ISO) that was designed to provide a more rigorous evaluation of the differences between varieties of cigarettes and a more accurate assessment of smokers' potential smoke intake than the traditional protocol (standard ISO).

FINDINGS

For all six varieties of "light" cigarettes, the yields of nicotine were higher by an average of 5% (range: 1% to 13%). The 25% reduction criterion was not met for any variety of "light" cigarettes concerning yields of tar. For all cigarettes tested, yields of tar were reduced on average by only 16% (range: 5% to 22%). For carbon monoxide (CO), only Player's Smooth Light had an over 25% reduction (30%) compared with Player's Regular. Conversely, yield of CO was 24% higher for Du Maurier Lights compared with Du Maurier Regular. As for the other smoke constituents, the majority (75%) were not reduced by 25% or more in "light" cigarettes, and a sizeable proportion of yields (e.g., acrylonitrile, benzene, chromium, m+p cresol, mercury, nickel, toluene) were larger in these varieties of cigarettes. Only yields of formaldehyde, crotonaldehyde, 1-aminonaphtalene, and proprionaldehyde were systematically reduced in all varieties of "light" cigarettes.

CONCLUSION

The six varieties of "light" cigarettes examined in this study do not differ substantially from "regular" cigarettes in terms of smoke yields. We argue that the modified ISO protocol should be implemented for a more valid comparison of potential smoke yields in all varieties of cigarettes and that labelling based on this protocol should be promoted.

Acetaldehyde enhances acquisition of nicotine self-administration in adolescent rats

Tobacco use has one of the highest rates of addiction and relapse of any abused drug. Paradoxically, however, in animal models of reinforcement nicotine appears weak compared to other abused drugs. We report here that acetaldehyde, a major component of tobacco smoke, enhances nicotine self-administration. Juvenile and adult male rats were implanted with intravenous catheters and tested for self-administration 4 days later at postnatal day 27 or 90, respectively. Animals were tested, without prior response training, in five daily 3-h sessions where each nose-poke delivered an intravenous injection followed by a 60-s timeout. Animals (11-13/group) were offered one of the following solutions: nicotine (30 microg/kg/injection), acetaldehyde (16 microg/kg/inj), nicotine (30 microg/kg/inj)+acetaldehyde (16 microg/kg/inj), or saline. The youngest animals responded significantly more for nic+acet than for saline or for either drug alone. Responding at the reinforced hole was significantly higher than at the nonreinforced hole or at the reinforced hole during noncontingent injections of nic+acet. Tests with receptor antagonists indicated that these drug effects are mediated by central, but not peripheral, nicotinic receptors. There was an age-related decline in self-administration of nic+acet, but not for cocaine. Taken together, these results indicate that acetaldehyde, at the low concentrations found in tobacco smoke, interacts with nicotine to increase responding in a stringent self-administration acquisition test where nicotine alone is only weakly reinforcing, and that adolescent animals are more sensitive to these actions than adults. Animal models of tobacco addiction could be improved by combining acetaldehyde, and possibly other smoke components, with nicotine to more accurately reflect the pharmacological profile of tobacco smoke.

"If we can just 'stall' new unfriendly legislations, the scoreboard is already in our favour": transnational tobacco companies and ingredients disclosure in Thailand

OBJECTIVES

To review the strategies employed by overseas cigarette manufacturers operating in Thailand to obstruct the passage and subsequent enforcement of national public health legislation, specifically the ingredients disclosure provision of the 1992 Tobacco Products Control Act.

METHODS

Analysis of previously confidential tobacco industry documents relevant to non-compliance with the ingredients disclosure legislation.

RESULTS

Requirement for disclosure of ingredients contained in cigarettes contained in the Tobacco Products Control Act was identified by transnational tobacco companies (TTCs) not only as a significant threat to their operations in Thailand, but as a dangerous global precedent. Industry documents reveal a determined campaign to block, stall, or amend the proposed regulation during the legislative process. Industry representatives petitioned the Ministry of Health to revise the requirement from by brand disclosure to a more palatable by company submission. Strategies were adapted in the wake of the passage of the Act. Most significantly, the industry in concert with embassies in Bangkok threatened the Thai government with appeals to international trade bodies on the grounds of violation of international agreements. Industry documents also reveal that as submission of ingredient lists appeared unavoidable, leading companies operating in Thailand endeavoured to confound the disclosure requirement by disguising ingredients and reformulating brand recipes.

CONCLUSIONS

The evidence presented highlights the importance of ingredients regulation and demonstrates how health policy can be transformed during its implementation. A greater understanding of trade agreements emerges as a priority for global tobacco control.

Adolescent development of forebrain stimulant responsiveness: insights from animal studies

Although initiation of drug abuse occurs primarily during adolescence, little is known about the central effects of nicotine and other abused drugs during this developmental period. Here evidence, derived from studies in rodents, is presented that suggests that tobacco use initiation during early adolescence results from a higher reward value of nicotine. The developmental profiles of the rewarding effects of other abused drugs, such as cocaine, differ from that of nicotine. Using in situ hybridization to quantify mRNA levels of the immediate early gene, cfos, the neuronal activating effects of nicotine in limbic and sensory cortices at different developmental stages are evaluated. Significant age changes in basal levels of cfos mRNA expression in cortical regions are observed, with a peak of responding of limbic cortices during early adolescence. A changing pattern of nicotine-induced neuronal activation is seen across the developmental spectrum, with unique differences in both limbic and sensory cortex responding during adolescence. An attentional set-shifting task was also used to evaluate whether the observed differences during adolescence reflect early functional immaturity of prefrontal cortices that regulate motivated behavior and psychostimulant responding. The finding of significantly better responding during adolescence suggests apparent functional maturity of prefrontal circuits and greater cognitive flexibility at younger ages. These findings in rodent models suggest that adolescence is a period of altered sensitivity to environmental stimuli, including abused drugs. Further efforts are required to overcome technical challenges in order to evaluate drug effects systematically in this age group.

[What perception have smokers of nicotine and tar yields of cigarettes?]

INTRODUCTION

Advertising information on cigarette package participate to the reduction of health risks from smoking. Impact on smokers has been poorly studied. This study intended to determine the smoker perception of nicotine and tar yields of cigarettes.

METHODS

Consulting in an outpatient smoking cessation clinic, 171 smokers answered freely and spontaneously to a questionnaire evaluating their perception of nicotine and tar yields, cigarette consumption (number and brand), nicotine dependence. Simultaneously, biological tobacco markers were measured.

RESULTS

The number of cigarettes, nicotine dependence and specific tobacco markers were not significantly different according to the cigarette type: "full savour", "light" or "ultra light". Women smoked less than men and 54% preferred "light" cigarettes versus 37% of men. These smokers were entering a tobacco cessation program, it was assumed they had lead a prior reflection about their smoking habits. Only 8% of them gave the correct values of nicotine and tar yields and 14% gave approximate values. Tar levels were highly underestimated.

CONCLUSIONS

This study shows that smokers have actually no interest for nicotine and tar yields. As the new decree which modifies manufacture's obligation concerning the legal mentions, is applicable in January 2004 in France; our conclusion may change in the future.

The influence of changing nicotine to tar ratios on human puffing behaviour and perceived sensory response

RATIONALE

Smokers modify their smoking behaviour when switching from their usual product to higher or lower tar and nicotine-yield cigarettes.

OBJECTIVE

The aims of the current study were to assess the influence of varying nicotine yields at constant tar yield on human puffing measures, nicotine deliveries under human smoking conditions and the sensory response to mainstream cigarette smoke. These assessments would allow an evaluation of the degree of compensation and the various possible causes of changes, if any.

METHODS

The participants were 13 regular smokers of commercial or hand-rolled cigarettes. They were tested with four cigarettes, which exhibited a wide range of nicotine to "tar" ratios at a relatively constant "tar" yield. Their smoking behaviour was monitored by placing the test cigarettes into an orifice-type holder/flowmeter attached to a custom-built smoker behaviour analyser. In addition, a comprehensive sensory evaluation of the products was carried out.

RESULTS

The differences in the nicotine to tar ratios of the samples did not significantly influence the puffing behaviour patterns, i.e. puff number and interval, total and average puff volume, integrated pressure and puff duration. Additionally the pre- to post-exhaled CO boosts were not significantly influenced by the experimental samples used in the study. However, the nicotine yields obtained by the smokers were significantly influenced by the machine-smoked nicotine yields or the nicotine to tar ratios of the samples. The machine-smoked nicotine yields were highly correlated with the nicotine yields obtained under human smoking conditions. For the sensory evaluation, there was only a significant difference between the samples in the intensity of the impact.

CONCLUSION

These observations imply that these puffing variables are not controlled by the nicotine yield of the cigarette.

Sustaining dietary changes for preventing obesity and diabetes: lessons learned from the successes of other epidemic control programs

A degree of success has been achieved in controlling several epidemics of infectious and non-infectious causes of death in countries, such as, Australia and New Zealand. Using the epidemiological triad (host, vector, environment) as a model, the key components of the control of these epidemics have been identified and compared to the current status of interventions to prevent obesity and its main disease consequence, type 2 diabetes. Reductions in mortality from tobacco, cardiovascular diseases, road crashes, cervical cancer and sudden infant death syndrome have been achieved by addressing all corners of the triad. Similarly, prevention programs have minimized the mortality from HIV AIDS and melanoma mortality rates are no longer rising. The main lessons learned from these prevention programs that could be applied to the obesity/diabetes epidemic are: taking a more comprehensive approach by increasing the environmental (mainly policy-based) initiatives; increasing the 'dose' of interventions through greater investment in programs; exploring opportunities to further influence the energy density of manufactured foods (one of the main vectors for increased energy intake); developing and communicating specific, action messages; and developing a stronger advocacy voice so that there is greater professional, public and political support for action. Successes in the other epidemics have been achieved in the face of substantial barriers within individuals, society, the private sector and government. The barriers for preventing obesity/diabetes are no less formidable, but the strategies for surmounting them have been well tested in other epidemics.

Regulatory strategies to reduce tobacco addiction in youth

Preventing tobacco addiction and achieving cessation in established users are the cornerstones of efforts to reduce tobacco use and disease. It has been increasingly recognised that reducing tobacco toxin exposure has theoretical potential to reduce disease in continuing tobacco users. This has been controversial because such approaches also carry the potential to undermine prevention and cessation. As complicated as harm reduction issues are for adults, they are still more complicated for youth. Harm reduction is not a singular approach, but rather a concept that encompasses an extremely diverse array of potential approaches. These carry equally diverse potential risks and benefits. The regulatory framework (for example, whether or not the Food and Drug Administration regulates the approach) is also predicted to be a major factor in determining the consequences of harm reduction approaches. This paper examines the various issues and potential approaches concerning the application of harm reduction to youth. We conclude that although some carry great risk, others may actually support broader tobacco control efforts to prevent tobacco use and foster cessation in youth and adults.

Programs and policies to discourage the use of tobacco products

The past 50 years has witnessed a dramatic change in attitudes toward and use of tobacco by Americans that has resulted in recent declines in the incidence of lung cancer. Most public health scholars believe that this change has been accelerated by public policy interventions to reduce tobacco use. The research literature suggests that the most potent demand reducing influences on tobacco use have been efforts to increase the financial cost of using tobacco products primarily through taxation, smoke-free policies, comprehensive advertising bans, and paid counter-advertising campaigns. New therapies for treating nicotine dependence and measures to liberalize access to medicinal forms of nicotine have the potential to revolutionize the way societies address the problem of tobacco use in the future. Unfortunately, the economic reality of the tobacco business has hindered public health efforts to curb the use of tobacco products. While government regulation of tobacco products is a worthy goal, capitalism, and not government regulation, most likely holds the greatest potential to rapidly alter the worldwide epidemic of tobacco caused disease. It is up to the public health community to harness the powers of capitalism to speed the development of less dangerous alternatives to the conventional cigarette.

Trends in sales weighted tar, nicotine, and carbon monoxide yields of UK cigarettes

BACKGROUND

Reducing tar yields of manufactured cigarettes has been an important plank of government policy on tobacco, but sale weighted yields are not routinely published.

METHODS

Tar, nicotine, and carbon monoxide yields measured by the Laboratory of the Government Chemist were combined with cigarette brand market shares from national surveys of smoking behaviour to generate sales weighted yield estimates for the period 1972-99.

RESULTS

Sales weighted mean tar yields have declined steadily and in 1999 were 9.6 mg per cigarette, less than half their level in 1972. Over the same period nicotine yields have come down from 1.33 mg to 0.79 mg per cigarette. Carbon monoxide yields have shown smaller declines. At the same time as absolute yields have declined, there have also been changes in tar to nicotine ratios. Smokers in 1999 were exposed to 22% less tar per unit of nicotine than in 1973, and smokers of low tar brands have consistently been exposed to less tar per unit of nicotine than smokers of other brands.

CONCLUSIONS

The value of reducing cigarette tar and nicotine yields has been questioned, since the tendency of smokers to compensate for reductions in nicotine delivery undermines the policy. The favourable trends in tar to nicotine ratios suggest that, despite this, there may have been some modest public health benefit. It cannot be assumed that future reductions from present levels would necessarily result in further improvement in tar to nicotine ratios. An explicit focus on the ratio of tar to nicotine may provide a metric of greater relevance for public health than the present emphasis on absolute tar yields.

Is compulsory restriction of tar yield of cigarettes a worthwhile public health policy?

BACKGROUND

Although the notion of a "safe cigarette" has proved an illusion, while people continue to smoke, an issue remains of whether compulsory restriction of tar yield is a worthwhile public health policy.

METHODS

The study group was comprised of a random population sample of middle-aged Scottish men and women-3464 smokers of cigarettes with known tar yield at baseline. Tar yields were classified into low (< 10 mg), low/middle (10-14.99 mg), and middle or high (> or = 15 mg), according to standard groupings. Deaths within the study cohort were recorded over a period of 13 years.

RESULTS

Among low, low/middle, and middle or high tar smokers, 55 (10%), 178 (16%), and 276 (16%), respectively, died. In a comparison group of lifetime never-smokers, 178 (6%) died. After adjustment for daily cigarette dose, duration of smoking, age, gender, social class, type A personality, body mass index, urinary potassium, and antioxidant vitamin consumption, hazard ratios (95% confidence intervals) for all-cause mortality comparing low-tar smokers to low/middle-tar smokers and to middle- or high-tar smokers were 1.64 (1.04-2.58) and 1.46 (0.95-2.26), respectively. Corresponding results for cardiovascular disease were 1.48 (0.74-2.96) and 1.35 (0.79-2.60). For lung cancer, after adjusting for known confounding factors, corresponding hazard ratios were 2.82 (0.98-8.15) and 2.30 (0.81-6.49).

CONCLUSIONS

Smoking any type of cigarette is far more risky than abstaining altogether. Although the results obtained comparing tar levels are limited because of lack of repeat measures of smoking during follow-up, potential residual confounding factors, statistical imprecision, and failure to show a dose-response relationship, results do support the hypothesis that persistent smokers will reduce their tobacco-induced health risk if they smoke cigarettes with < 10 mg of tar. However, the data do not permit quantification of the benefits of switching to lower-tar cigarettes. Worldwide legislation to limit tar levels to 10 mg as an absolute maximum is recommended, while recognizing that this must be part of an integrated approach to tobacco control.

Whose standard is it, anyway? How the tobacco industry determines the International Organization for Standardization (ISO) standards for tobacco and tobacco products

OBJECTIVE

To describe the extent of the tobacco industry involvement in establishing international standards for tobacco and tobacco products and the industry influence on the International Organization for Standardization (ISO).

METHODS

Analysis of tobacco industry documents made public as part of the settlement of the Minnesota Tobacco Trial and the Master Settlement Agreement. Search words included "ISO", "CORESTA", "Barclay", "compensation and machine smoking", "tar and nicotine deliveries", and the name of key players, in different combinations.

RESULTS

It is clear that the tobacco industry, through the Cooperation Centre for Scientific Research Relative to Tobacco (CORESTA), play a major role in determining the scientific evidence and suggesting the standards that are eventually adopted as international standards for tobacco and tobacco products in several areas, including the measurement of cigarette tar and nicotine yield.

CONCLUSIONS

ISO's tobacco and tobacco products standards are not adequate to guide tobacco products regulatory policies, and no health claims can be made based on ISO's tobacco products standards. There is an urgent need for tobacco control advocates and groups worldwide to be more involved with the work of the ISO, both directly and through their national standardisation organisations.

Nicotine yield from machine-smoked cigarettes and nicotine intakes in smokers: evidence from a representative population survey

BACKGROUND

The relevance of nicotine yields from machine-smoked cigarettes for quantifying smokers' nicotine intakes and exposure to cigarette toxins has been called into question. However, most studies of the relationship between nicotine yield and nicotine intake have been on relatively small and unrepresentative samples and have included few smokers of "ultra-low" brands (i.e., those yielding around 1 mg of tar and 0.1 mg of nicotine).

METHODS

We examined the relationship between salivary cotinine (a major metabolite of nicotine) concentrations and nicotine yields of machine-smoked cigarettes in a nationally representative sample of 2031 adult smokers of manufactured cigarettes surveyed in the 1998 Health Survey for England. We used standard linear regression techniques to examine associations and two-sided tests of statistical significance.

RESULTS

Cotinine concentrations varied widely between smokers at any level of nominal brand nicotine yield. On average, cotinine levels were slightly lower in smokers of lower nicotine-yielding brands, but these smokers differed in terms of sex, socioeconomic profile, and cigarette consumption. After we controlled for potential confounders, nicotine yield from the brand smoked accounted for only 0.79% of the variation in saliva cotinine concentrations. Nicotine intake per cigarette smoked, as estimated from salivary cotinine level, did not correspond with machine-smoked yields at any level of nicotine yield. Nicotine intake per cigarette was about eight times greater than machine-smoked yields at the lowest deliveries (1.17 mg estimated nicotine intake per cigarette from brands averaging 0.14-mg delivery from machine smoking) and 1.4 times greater for the highest yield cigarettes (1.31-mg estimated nicotine intake per cigarette from brands averaging 0.91 mg from machine smoking).

CONCLUSIONS

Smokers' tendency to regulate nicotine intake vitiates potential health gains from lower tar and nicotine cigarettes. Current approaches to characterizing tar and nicotine yields of cigarettes provide a simplistic guide to smokers' exposure that is misleading to consumers and regulators alike and should be abandoned.