Lessons from the history of tobacco harm reduction: The National Cancer Institute's Smoking and Health Program and the "less hazardous cigarette".

Scientists and public health practitioners are sharply divided today over the risks and benefits of tobacco harm-reduction strategies. At the same time, a range of novel tobacco products is being marketed with claims of reduced exposure or risk. Current scientific efforts to study tobacco products and harm reduction should be informed by past experience. During the 1960s and 1970s, there was substantial support within government and academia, as well as among voluntary health organizations, for efforts to modify tobacco products to reduce harm. This paper analyzes the former National Cancer Institute (NCI) Smoking and Health Program, which, between 1968 and 1980, pursued the development of "less hazardous" cigarettes as its primary goal. During this period, the program spent over dollar 50 million on contract research, of which 74% went toward biological and chemical analysis of modified cigarettes, 9.6% to epidemiological studies of risk factors, and only 1.4% to studies evaluating smoking cessation or prevention programs. NCI officials predicted during the mid-1970s that new "low-tar" cigarette brands would substantially reduce smoking-related mortality, but by 1978 the research agenda began to change in response to a reorganization of NCI research activities, modification of government antismoking efforts, and an emerging understanding of nicotine addiction that challenged key scientific assumptions. In retrospect, the program suffered from significant weaknesses that severely limited the likelihood that it would generate knowledge beneficial to public health, including a research agenda that failed to include surveillance and behavioral research, tobacco industry influence of the research agenda, and a lack of access to information about the characteristics of products on the market. There exists today a need for a public health-oriented research agenda on tobacco products and harm reduction, but current efforts should include input from a diverse range of disciplines, collect data on users' behavior, and limit the involvement of industry scientists.     

"Not safe" is not enough: smokers have a right to know more than there is no safe tobacco product

The right to health relevant information derives from the principles of autonomy and self direction and has been recognised in international declarations. Providing accurate health information is part of the basis for obtaining "informed consent" and is a recognised component of business ethics, safety communications, and case and product liability law. Remarkably, anti-tobacco and pro-tobacco sources alike have come to emphasise the message that there is "no safe cigarette" or "no safe tobacco product". We propose that the "no safe" message is so limited in its value that it represents a violation of the right to health relevant information. There is a need to go beyond saying, "there is no safe tobacco product" to indicate information on degree of risks. The "no safe tobacco" message does not contradict, for example, the mistaken belief that so called light or low tar cigarettes are safer choices than higher tar cigarettes. We encourage a kind of "rule utilitarian" ethical position in which the principle of truth telling is observed while trying to produce the greatest good for the greatest number of people. Although harm reduction approaches to easing the burden of tobacco related diseases are founded on science based comparative risk information, the right to health information is independently related to the need to promote health literacy. This right should be respected whether or not harm reduction policies are judged advisable.     

A long-term view of harm reduction.

The concept of harm reduction is controversial, as it brings to mind the failures, public misconceptions, and undermining of prevention associated with the low-tar cigarette campaign. Modern cigarettes are, however, unnecessarily carcinogenic and toxic, a situation that could be improved by sensible and serious regulation of the contents of tobacco smoke. The risks potentially associated with reducing levels of known toxicants in cigarettes are tiny in comparison with the acceptance of the status quo, which is disastrous. Failure to act in these circumstances is negligence.     

Smokers' beliefs about the relative safety of other tobacco products: findings from the ITC collaboration.

Most tobacco control efforts in western countries focus on the factory-made, mass-produced (FM) cigarette, whereas other tobacco products receive relatively little attention. Noncombusted tobacco products (i.e., referred to as smokeless tobacco), particularly Swedish-style snus, carry lower disease risks, compared with combusted tobacco products such as cigarettes. In this context, it is important to know what tobacco users believe about the relative harmfulness of various types of tobacco products. Data for this study came from random-digit-dialed telephone surveys of current smokers aged 18 or older in Australia, Canada, the United Kingdom, and the United States. Three waves of data, totaling 13,322 individuals, were assessed. Items assessed use of and beliefs about the relative harms of cigars, pipes, smokeless tobacco, and FM and roll-your-own cigarettes, as well as sociodemographics and smoking behaviors. Cigars (2.8%-12.7%) were the other tobacco products most commonly used by current cigarette smokers, followed by pipes (0.3%-2.1%) and smokeless tobacco (0.0%-2.3%). A significant minority of smokers (12%-21%) used roll-your-own cigarettes at least some of the time. About one-quarter of smokers believed that pipes, cigars, or roll-your-own cigarettes were safer than FM cigarettes, whereas only about 13% responded correctly that smokeless tobacco was less hazardous than cigarettes. Multivariate analyses showed that use of other tobacco products was most strongly related to beliefs about the reduced harm of these other products. Use of other tobacco products was low but may be growing among smokers in the four countries studied. Smokers are confused about the relative harms of tobacco products. Health education efforts are needed to correct smoker misperceptions.     

Smoking behavior and risk perception among the parents of infants in the neonatal intensive care unit.

The goal of this study was to explore the prevalence of smoking and attitudes and behaviors relevant to smoking cessation among parents of babies treated in a neonatal intensive care unit (NICU). Participants were 235 mothers and 83 fathers of infants admitted to the NICU of a large, university-based hospital. The 38-item survey included questions that assessed smoking status (current, former, never-smoker), motivation to quit, perceived health risks from smoking, and whether or not they received smoking cessation advice or counseling from a health care provider. A total of 26% of all participants were current smokers. Compared with mothers, fathers were more likely to be current smokers (22% vs. 31%) and smoked more cigarettes per day (11.3% vs. 17.2%). Among participants, 57% reported that smoking affected their own health "a little" or "not at all," and 70% believed that others' smoking would affect the baby's health "a little" or "somewhat." Mothers were more likely than fathers to report health care provider intervention for smoking cessation. Indeed, none of the fathers in this study reported being offered assistance with quitting smoking. More than half of smokers were willing to receive counseling for smoking cessation, and health care provider intervention was positively associated with both motivation to quit and perceived health risk to their infant (p<.01). The NICU may provide a teachable moment in which parents can be assisted with quitting smoking, thus improving their own health and the health of their babies.     

Perceived risk of harm from cigarettes or smokeless tobacco among U.S. high school seniors.

This study examined perceived risk of harm from smoking or ST use in a U.S. nationally representative sample of high school seniors and examined its association with current smoking status. Data were derived from the Monitoring the Future project for 1999 through 2003 (n = 11,093). We used multiple logistic regression analysis to examine the association between comparative perceived risk of harm of smoking and ST use with current smoking status, while adjusting for sex, race, and perceived risk of harm from smoking. In 1999-2003, 74.0% of high school seniors perceived great risk of harm from smoking and 44.9% perceived great risk from using ST. Perceived risk varied by smoking intensity: 80.3% of non-smokers perceived great risk of harm from smoking, compared to 49.7% of students who smoked about one-half pack per day and 36.1% of pack-a-day smokers. Overall, 52.7% perceived equal risk of harm from using either product, 41.3% perceived greater risk from cigarettes, and 6.1% perceived a greater risk from using ST. Adjusting for sex and race, high school seniors who perceived that smoking conveyed a greater risk for harm than did using smokeless tobacco were significantly more likely to be smokers than were those who perceived equal risk from the products (odds ratio [OR] = 1.43; 95% confidence interval [CI] 1.29-1.60). Those who perceived that using smokeless tobacco was riskier than smoking were even more likely to be current smokers (OR = 2.43; 95% CI 1.96-3.01). Effective methods for communicating accurate health risks to young people are needed.     

国产雪茄分类探讨及其实际应用分析

为便于统计分析和研究雪茄产品的生产发展状况,依据制作方式和产品结构将国产雪茄分为手制雪茄、半手制雪茄、机制雪茄和卷烟型雪茄四种类型,并遵循术语一致性原则,突出雪茄特征描述用语的规范性和严谨性,首次探讨性地提出雪茄烟支属性采用茄衣原料种类、茄套原料种类、茄芯原料形态、茄衣卷制方式、茄胚成型方式和雪茄接嘴种类等6种特征进行表述,并通过对近15年国产雪茄生产发展数据进行统计分析的应用实例阐明了雪茄分类和属性特征描述的应用方法。文中还对国内在雪茄学术研究和实际应用中长期存在的术语认知问题进行了讨论辨析,并就国产雪茄发展中的短板以及技术研究、标准制订和术语规范化等有关方面提出了一些看法与建议。      

基于SHS-GC-MS和GC-IMS的对两种雪茄烟挥发性香味成分的分析与研究

【目的】为明确雪茄烟挥发性香味成分,比较不同雪茄烟挥发性香味成分的差异性。【方法】采用静态顶空-气质联用仪（SHS-GC-MS）和气相色谱离子迁移谱（GC-IMS）两种分析检测技术,对长城2号和蒙特4号两种雪茄烟的挥发性香味成分进行检测,并结合主成分分析（PCA）和偏最小二乘-判别分析（PLS-DA）方法分析了两种雪茄烟的香味主要差异成分。【结果】（1）从嗅香来看,两支雪茄烟的主体香韵均为较为明显的晾晒烟特征香气和蜂蜜样的甜香。蒙特4号的花香、木香和可可香气更加明显一些,长城2号的甜香和膏香则相对较强,并稍带果甜,香气比较厚实浓郁。（2）通过SHS-GC-MS分析检测技术从长城2号雪茄烟中鉴定出18种挥发性香味成分,从蒙特4号中鉴定出30种挥发性香味成分;蒙特4号中异龙脑、乙酸异龙脑酯、α-柏木烯、罗汉柏烯等成分的含量明显高于长城2号;而3,5-二甲基苯酚和6-甲基-5-庚烯-2-酮两种香味成分仅存在于长城2号中。（3）GC-IMS在两种雪茄烟中共鉴定出47种成分,包括了3种酸类、4种酯类、12种酮类、10种醛类、11种醇类、2种杂环类和5种烯烃类成分;运用PCA和PLS-DA的分析方...     

Literature review and summary of perceptions, attitudes, beliefs, and marketing of potentially reduced exposure products: communication implications.

Potentially reduced exposure products (PREPs) have continued to enter the market during the 1990s and first part of the 21st century. Attempts by the tobacco industry to develop and market products with implied reductions in adverse health effects (i.e., harm reduction) are not new. Over the last half of the 20th century, the tobacco industry developed and marketed several products that purported to reduce the health risks associated with smoking cigarettes. Among these were filtered cigarettes in the 1950s and light and ultra-light cigarettes in the 1970s and 1980s. This review summarizes published and unpublished research that is directly relevant to the marketing, advertising, and communication about PREPs. The marketing strategies for these new products do not appear to differ from those used by the tobacco industry for light and ultra-light cigarettes. Although smokers report not using the new products in large numbers because of dissatisfaction with taste, they are interested in using products with reduced risk. Despite the absence of explicit health claims by the industry for PREPs, many smokers believe that these products are safer based on the advertising claims of reduced exposure and a belief that claims are approved by the government. No data are available to indicate that PREPs are useful for prevention or cessation of smoking, nor does specific research exist to suggest what health communication messages will provide smokers with accurate information about these products.     

国内外雪茄烟专利技术研究热点及趋势分析

  背景和目的  为使我国烟草行业相关科技人员准确把握雪茄烟的专利申请现状、研判今后的发展趋势。  方法  依托国家知识产权局和德温特专利平台对2009—2018年度在全球申请的657件相关专利进行统计分析。  结果  1)雪茄烟专利的地域集中度相对较高,专利主要分布在美国和中国大陆等地,与当前雪茄烟的市场分布情况较为一致,其次是欧盟和法国。国外个人、国外其他单位以及国内烟草行业是该领域的创新主体,但具体专利权人的集中度并不高,以BLUNT WRAP,U.S.A.,INC的专利数量最多,其次是四川中烟、湖北中烟和重庆中烟等国内工业企业。2)雪茄烟专利申请主要集中在A24F(吸烟者用品,主要为配件)小类,其次是B65D(雪茄贮存或运输容器)、A24C(雪茄机械)、A24B(加工方法)和A24D(烟支结构设计)小类;而外观设计专利主要集中在27-06小类。在具体技术领域,专利申请主要分布在配件和外观设计两个方面。3)国内申请人(含国内烟草行业)在外观设计方面的专利申请略显不足。  结论  综合考虑专利保护的地域性以及国外申请主体在中国的专利布局率相对较低等情况,对于海外专利的跟踪、研究以及积极开展相关专利的海外布局战略等方面,国内烟草行业有待加强。      

Smoking too few cigarettes to be at risk? Smokers' perceptions of risk and risk denial,a French survey

Background

Past studies on smokers'' risk perception have produced mixed results. We endorsed a new approach to assess smokers'' perceptions of risk by asking them to estimate threshold values for the cancer risk associated with daily consumption of tobacco and number of smoking years. We expected that many smokers would endorse a “risk denial” attitude, with threshold estimates higher than their own smoking consumption and duration.

Methodology

A French national telephone survey (n = 3820; 979 current smokers) included several questions about smoking behaviours and related beliefs.

Results

Among current smokers, 44% considered that smoking can cause cancer only for a daily consumption higher than their own consumption, and an additional 20% considered that the cancer risk becomes high only for a smoking duration higher than their own. Most smokers also agreed with other “risk denial” statements (“smoking is not more dangerous than air pollution,” “some people smoke their whole life but never get sick”). Those who considered they smoked too few cigarettes to be at risk were less likely to report personal fear of smoking related cancer.

Conclusion

Risk denial is quite widespread among smokers and does not simply reflect a lack of information about health risks related to tobacco. Fully informing smokers about their risks may necessitate changing the way they process information to produce beliefs and limiting their capacity to generate self exempting beliefs.     

Relighting cigarettes: how common is it?

In a representative sample of 434 daily smokers, half reported that they relight cigarettes at least some of the time. Relighting cigarettes was positively associated with severity of smoking addiction, as well as with being female, with markers of lower socioeconomic status (income, employment status), and with having less education. Smokers contemplating change were less likely to relight cigarettes. Given that previous research has indicated that relighting cigarettes leads to increased harm, the public health implications of this smoking practice are discussed.     

Surveillance of tobacco industry retail marketing activities of reduced harm products.

With the introduction of potential reduced exposure products (PREPs) and the interest in studying tobacco harm reduction, sound research and surveillance are needed to examine and understand the distribution and availability of PREPs in communities, as well as the tobacco industry's marketing practices surrounding these products. We examined the availability and marketing of PREPs in a national sample of tobacco retail stores. We also compared the price of PREPs to those of premium brand cigarettes and examined the distribution of PREPs in comparison with premium brand cigarettes by store type, urbanization, region, and race/ethnicity. We found that PREPs are not widely available, are priced similarly to leading cigarette brands, and have few promotional offers. We also found some significant differences in the distribution of PREPs and cigarettes, as well as in the distribution of Ariva and Omni, by store type and community demographics. The fact that this study used data collected nationally emphasizes the importance of these findings and helps shed some light on the tobacco industry's PREP marketing strategies. This study's national sample provides a unique perspective that needs to be replicated if and when other PREPs are widely marketed.     

Harm perception of nicotine products in college freshmen.

This study examined the association of sociodemographic characteristics and smoking behaviors (i.e., cigarette, cigar, and waterpipe) with nicotine product harm perception in college freshmen. Students were asked to compare the perceived harmfulness of 11 nicotine-delivering products with that of a regular cigarette. Data were from a cross-sectional Internet survey conducted during the spring 2004 semester at a private university (N = 411). Binomial logistic regression was used to determine the association between sociodemographic and behavioral factors with nicotine product harm perception. A statistically significant association was found between nicotine product harm perception and sex, race, income, citizenship, and smoking behavior (p< or =.05). Regarding the three medicinal nicotine replacement therapies, 19.6% of respondents incorrectly perceived the nicotine patch to be as harmful as or more harmful than a regular cigarette; corresponding values were 24.1% for nicotine gum and 52.9% for nicotine inhaler. Respondents incorrectly perceived the following smoked tobacco products to be less harmful than regular cigarettes: ultra-light cigarettes (40.4%), waterpipe (37%), light cigarettes (35.2%), cigarillos (17.4%), and cigars (16.9%). Regarding smokeless nicotine products, 89.3% of respondents incorrectly perceived dip and chew to be as harmful as or more harmful than regular cigarettes; corresponding values were 36.2% for nicotine lollipops and 35.2% for nicotine water. Our findings reveal misperceptions about nicotine product harmfulness and underscore the importance of developing a science base to inform policies and educate consumers about these products.     

Tobacco harm reduction strategies: the case for physical activity.

Since the effects of tobacco smoke are so detrimental to health, growing consideration has been given to the development of harm reduction strategies for those smokers who are unable or unwilling to stop using tobacco. The term harm reduction refers to a policy, strategy, or particular intervention that assumes continued use of an undesired behavior and aspires to lower the risk of adverse consequences associated with the continuation of this addictive behavior. Up to this point, tobacco harm reduction interventions have focused on reducing tobacco-related harm through the utilization of innovative tobacco products, reduced tobacco consumption, and pharmaceutical medications. With the possible exception of medicinal nicotine products, these strategies remain unproven and thus far no scientific or medical literature exists to suggest these harm reduction strategies reduce tobacco-related exposure, morbidity, or mortality. Consequently, a need exists for broadening the range of potentially effective harm reduction strategies. This preliminary review suggests that physical activity has the potential to become one such strategy. Of the eight principles that characterize a harm reduction strategy, all are at least partially satisfied by physical activity. Further, emerging evidence indicates that physical activity may delay the occurrence of disease and premature death initiated by tobacco consumption. Significant concerns remain regarding the practicality of physical activity as a harm reduction strategy and the extent to which participation in physical activity may be used to justify continued smoking.     

Asian herbal‐tobacco cigarettes: “not medicine but less harmful”?

Objective

To describe the development and health claims of Asian herbal‐tobacco cigarettes.

Methods

Analysis of international news sources, company websites, and the transnational tobacco companies'' (TTC) documents. PubMed searches of herbs and brands.

Results

Twenty‐three brands were identified, mainly from China. Many products claimed to relieve respiratory symptoms and reduce toxins, with four herb‐only products advertised for smoking cessation. No literature was found to verify the health claims, except one Korean trial of an herb‐only product. Asian herbal‐tobacco cigarettes were initially produced by China by the 1970s and introduced to Japan in the 1980s. Despite initial news about research demonstrating a safer cigarette, the TTC analyses of these cigarettes suggest that these early products were not palatable and had potentially toxic cardiovascular effects. By the late 1990s, China began producing more herbal‐tobacco cigarettes in a renewed effort to reduce harmful constituents in cigarettes. After 2000, tobacco companies from Korea, Taiwan, and Thailand began producing similar products. Tobacco control groups in Japan, Taiwan, and Thailand voiced concern over the health claims of herbal‐tobacco products. In 2005, China designated two herbal‐tobacco brands as key for development.

Conclusion

Asian herbal‐tobacco cigarettes claim to reduce harm, but no published literature is available to verify these claims or investigate unidentified toxicities. The increase in Asian herbal‐tobacco cigarette production by 2000 coincides with the Asian tobacco companies'' regular scientific meetings with TTCs and their interest in harm reduction. Asia faces additional challenges in tobacco control with these culturally concordant products that may discourage smokers from quitting.