Reducing the addictiveness of cigarettes

OBJECTIVE—To assess the feasibility of reducing tobacco-caused disease by gradually removing nicotine from cigarettes until they would not be effective causes of nicotine addiction.
DATA SOURCES—Issues posed by such an approach, and potential solutions, were identified from analysis of literature published by the US Food and Drug Administration (FDA) in its 1996 Tobacco Rule, comments of the tobacco industry and other institutions and individuals on the rule, review of the reference lists of relevant journal articles, other government publications, and presentations made at scientific conferences.
DATA SYNTHESIS—The role of nicotine in causing and sustaining tobacco use was evaluated to project the impact of a nicotine reduction strategy on initiation and maintenance of, and relapse to, tobacco use. A range of potential concerns and barriers was addressed, including the technical feasibility of reducing cigarette nicotine content to non-addictive levels, the possibility that compensatory smoking would reduce potential health benefits, and whether such an approach would foster illicit ("black market") tobacco sales. Education, treatment, and research needs to enable a nicotine reduction strategy were also addressed. The Council on Scientific Affairs came to the following conclusions: (a) gradually eliminating nicotine from cigarettes is technically feasible; (b) a nicotine reduction strategy holds great promise in preventing adolescent tobacco addiction and assisting the millions of current cigarette smokers in their efforts to quit using tobacco products; (c) potential problems such as compensatory over-smoking of denicotinised cigarettes and black market sales could be minimised by providing alternate forms of nicotine delivery with less or little risk to health, as part of expanded access to treatment; and (d) such a strategy would need to be accompanied by relevant research and increased efforts to educate consumers and health professionals about tobacco and health.
CONCLUSIONS—The council recommends the following: (a) that cessation of tobacco use should be the goal for all tobacco users; (b) that the American Medical Association continue to support FDA authority over tobacco products, and FDA classification of nicotine as a drug and tobacco products as drug-delivery devices; (c) that research be encouraged on cigarette modifications that may result in less addicting cigarettes; (d) that the FDA require that the addictiveness of cigarettes be reduced within 5-10 years; (e) expanded surveillance to monitor trends in the use of tobacco products and other nicotine-containing products; (f) expanded access to smoking cessation treatment, and strengthening of the treatment infrastructure; and (g) more accurate labelling of tobacco products, including a more meaningful and understandable indication of nicotine content.


     

烟碱转化率与卷烟感官评吸品质和烟气TSNA含量的关系

用具有不同烟碱向降烟碱转化能力的白肋烟鄂烟一号上部叶(2003年)和中部叶(2004年)分别卷制试验卷烟,研究了烟碱转化率与卷烟感官评吸品质和烟丝及烟气中TSNA含量的关系。同一年份的卷烟样品间总生物碱含量无显著差异,烟碱含量和降烟碱含量呈相反趋势变化,从而形成样品间烟碱转化率的梯度差异。感官评吸由5-6名评吸专家组成的评吸小组进行。结果表明,随着烟碱转化率的增高,白肋烟风格程度直线下降,香气质逐渐下降,香气量减少,烟气浓度变淡,生理强度下降,杂气有增加的趋势,余味变劣,口腔残余加重,但刺激性有减小的趋势。两年卷烟样品基本表现相同的趋势,但2003年样品,由于生物碱水平高,不同样品间烟碱转化率的幅度较大,所以各项评吸指标的变化更为明显。随着烟碱转化水平的增高,烟丝和烟气亚硝基降烟碱(NNN)含量和总的烟草特有亚硝胺(TSNA)含量大幅增加,而其它3种烟草特有亚硝胺含量无较大变化。      

Determination of tar, nicotine, and carbon monoxide yields in the mainstream smoke of selected international cigarettes

Objective: Survey of nicotine, tar, and carbon monoxide (CO) smoke deliveries from 77 cigarette brands purchased in 35 countries was conducted using a standardised machine smoking method. The goal of this study was to determine regional variations and differences in the tar, nicotine, and CO smoke yields of a cigarette brand manufactured by a leading transnational corporation and of non-US locally popular cigarette brands.

Design: The majority of the cigarettes were purchased in each of the participating countries by delegate members of the World Health Organization and forwarded to the Centers for Disease Control and Prevention for analysis. Smoke deliveries were determined using a standardised smoking machine method and subsequent gravimetric and gas chromatography analysis.

Results: The smoke deliveries varied widely. Mainstream smoke deliveries varied from 6.8 to 21.6 mg tar/cigarette, 0.5 to 1.6 mg nicotine/cigarette, and 5.9 to 17.4 mg CO/cigarette. In addition to the smoke deliveries, the cigarettes were examined to determine physical parameters such as filter composition, length, and ventilation levels.

Conclusion: Analysis of the smoke deliveries suggested that cigarettes from the Eastern Mediterranean, Southeast Asia, and Western Pacific WHO regions tended to have higher tar, nicotine, and CO smoke deliveries than did brands from the European, American, or African WHO regions surveyed.

     

Nicotine delivery capabilities of smokeless tobacco products and implications for control of tobacco dependence in South Africa

Objectives: Smokeless tobacco (SLT) use is popular among black South African women and children. The study sought to determine the nicotine delivery capability of popular industrialised and traditional SLT brands in South Africa, and to provide information for policy action by regulatory authorities.

Design: Laboratory chemical analysis of four industrialised and one traditional SLT products commercially available, using previously published analytical methods. Potential for dependence was inferred from nicotine delivery capabilities determined by the percentage free base nicotine.

Measurements: Moisture, pH, total nicotine, and percentage free base nicotine.

Results: Total nicotine content was between 6–16 mg/g. The pH varied between 7–10 and this correlated with percentage free base nicotine, which ranged between 10–99%. The nicotine delivery capability of the traditional product was lower than that of the industrialised products except for the recently introduced portion bag snus, which had comparable total nicotine but the lowest pH and percentage free base nicotine. The most popular SLT brands showed the highest percentage free base nicotine ever reported for any industrialised SLT or cigarette brands. Small cans contained higher nicotine than the large cans of the same brand tested. Findings from the study support a potential for limited "product graduation" by users.

Conclusions: South African SLT users are mostly exposed to potentially very highly addictive levels of nicotine that may favour tobacco dependence and its consequent health risks. The increasing use of SLT by women of childbearing age support the need for intensified policy action to control its use.

     

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.     

Roll-your-own smoke yields: theoretical and practical aspects

OBJECTIVE—To identify the key parameters that influence smoke yields from roll-your-own (RYO) cigarettes and to compare smoke yields of cigarettes made under laboratory conditions with those made by habitual RYO consumers.
DESIGN AND SETTING—One-way parametric variations in the laboratory-based production of RYO cigarettes complemented by a consumer survey conducted in a busy street at Romford, Essex, United Kingdom.
SUBJECTS—26 habitual RYO consumers.
MAIN OUTCOME MEASURES—Cigarette weights, puff numbers, and yields (carbon monoxide, nicotine, and tar).
RESULTS—Smoke yields vary for specimen changes in weight of tobacco used, paper porosity, and the incorporation of a filter in the cigarette. Yields of cigarettes produced by 26 RYO smokers ranged from 9.9 to 21.0 mg tar per cigarette and from 0.9 to 1.8 mg nicotine per cigarette, and were generally lower than yields of laboratory-produced RYO cigarettes.
CONCLUSIONS—Laboratory studies can provide useful information concerning the parameters that affect smoke yields of RYO cigarettes such as the incorporation of a filter to reduce yields. However, such studies must be complemented by surveys of cigarettes made by actual current RYO smokers. In one such investigation, it was found that the mean tar yields from cigarettes produced by 57% of the smokers were above the current maximum of 15 mg per cigarette for manufactured cigarettes. Currently 8% of manufactured cigarettes in the UK have a declared nicotine yield of greater than 1.1 mg per cigarette whereas 77% of RYO smokers produced cigarettes with a nicotine yield greater than this value.


Keywords: roll-your-own cigarettes; smoke yield; carbon monoxide; tar; nicotine     

Determination of 14 polycyclic aromatic hydrocarbons in mainstream smoke from domestic cigarettes

Polycyclic aromatic hydrocarbons (PAHs) are a class of environmental pollutants created primarily from incomplete combustion of various organic materials including tobacco. Cigarette smoke is a complex mixture of various classes of compounds, including numerous PAHs, in both the mainstream and the sidestream smoke fractions. We measured the levels of 14 PAHs in mainstream smoke from unfiltered custom cigarettes made from individual tobacco types and 30 brands of domestic blended cigarettes using standardized smoking conditions, extraction from the Cambridge filter pads, and gas chromatography/mass spectrometry. Differences in smoke PAHs from cigarettes with selected tobacco blends were identified and illustrate how blend composition contributes to the overall mainstream smoke PAH profile. The PAH levels varied among the different commercial cigarette brands, with the amount of total mainstream smoke PAHs ranging from 1 to 1.6 microg per cigarette. Under machine smoking conditions, the mainstream smoke from domestic cigarettes had individual PAHs ranging from benzo[k]fluoranthene at levels below 10 ng/cigarette to naphthalene at levels of around 500 ng/cigarette. Low delivery cigarettes smoked with blocked filter vent holes dramatically increased the mainstream smoke PAH deliveries with respect to their unblocked counterparts. Inhalation of PAHs and other harmful chemicals from cigarette smoke are unique as they represent a routine voluntary exposure to common environmental pollutants.     

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.     

卷烟劲头与其烟丝、烟气主要化学成分的相关性

测定了33种成品卷烟及17种单料烤烟烟丝的pH值、总挥发碱、总烟碱、游离烟碱、总氮和还原糖及其烟气总粒相物、总粒相物pH值、焦油、烟碱、游离烟碱和含水率,评价了其劲头,并将其劲头与其常规化学指标进行了灰色关联分析。结果发现,烟丝及烟气中的总烟碱是影响卷烟劲头的主要因素,游离烟碱是次要因素。     

Emotions for sale: cigarette advertising and women's psychosocial needs

Objective: To explore messages of psychosocial needs satisfaction in cigarette advertising targeting women and implications for tobacco control policy.

Methods: Analysis of internal tobacco industry documents and public advertising collections.

Results: Tobacco industry market research attempted to identify the psychosocial needs of different groups of women, and cigarette advertising campaigns for brands that women smoke explicitly aimed to position cigarettes as capable of satisfying these needs. Such positioning can be accomplished with advertising that downplays or excludes smoking imagery. As women's needs change with age and over time, advertisements were developed to reflect the needs encountered at different stages in women's lives. Cigarette brands for younger women stressed female camaraderie, self confidence, freedom, and independence; cigarette brands for older women addressed needs for pleasure, relaxation, social acceptability, and escape from daily stresses.

Conclusions: Psychosocial needs satisfaction can be communicated without reference to cigarettes or smoking. This may explain why partial advertising bans are ineffective and comprehensive bans on all forms of tobacco marketing are effective. Counter-advertising should attempt to expose and undermine the needs satisfaction messages of cigarette advertising campaigns directed at women.

     

Effects of low nicotine content cigarettes on smoke intake.

Cigarettes with selective reductions in nicotine delivery have been considered as potential tools to prevent or treat nicotine dependence or to reduce harm by virtue of reduced nicotine and nitrosamine delivery. An important question is whether individuals smoke these products more intensively, as has been shown to occur with ventilated-filter cigarettes. To investigate this issue, we compared conventional highly ventilated filter cigarettes, having very low tar and nicotine yields when smoked by Federal Trade Commission method (1 mg tar, 2 mg carbon monoxide [CO],.2 mg nicotine), with low nicotine content cigarettes, manufactured from a genetically modified strain of tobacco, which had higher tar but lower nicotine yield (14 mg tar, 13 mg CO,.02 mg nicotine). A total of 16 cigarette smokers participated in two 8-hr sessions (order counterbalanced) during which they smoked each type of cigarette ad libitum. Expired-air CO, plasma nicotine, and smoking topography measures were collected. Subjects showed significant increases in smoking when using the highly ventilated filter cigarettes, and puff volume was significantly greater than with the low nicotine content cigarettes. Subjects achieved an expired-air CO level 74% as high as with the low nicotine content cigarettes; the latter produced CO levels similar to those measured at baseline when subjects smoked their habitual brands of cigarettes. Plasma nicotine levels obtained when subjects smoked the highly ventilated filter cigarettes also were significantly higher than when they smoked the low nicotine content cigarettes. These results indicate that the delivery of substantial amounts of smoke, with selective reductions in nicotine yield, appears to prevent compensatory smoking behavior. Further studies should determine whether similar results are obtained in naturalistic environments.     

Hand rolling cigarette papers as the reference point for regulating cigarette fire safety

Aim: To compare the burning characteristics of the tobacco and paper of manufactured and hand rolled cigarettes, and set a fire safety standard of manufacture to largely reduce the fire risk from discarded cigarettes.

Methods: (1) Cigarette extinction test of ignition strength: 40 cigarettes per brand, lit and placed on 15 layers of filter paper, in accordance with ASTM test standard E2187-02. (2) Citrate extracted by 0.1N hydrochloric acid from cigarette papers and from tobacco in manufactured cigarettes, the supernatant analysed by high performance liquid chromatography using ultraviolet visual light spectrophotometer. (3) Survey of 750 nationally representative adults age 18 years and over, by telephone, including 184 smokers.

Materials: (a) New Zealand made Holiday, and Horizon, and US made Marlboro manufactured cigarettes; (b) US manufactured Merit with banded paper; (c) Holiday, Horizon and Marlboro hand rolling tobaccos, hand rolled in Rizla cigarette papers; (d) manufactured cigarettes as in (a), reconstructed using Rizla hand rolling cigarette papers.

Results: 1. (a) For each brand of manufactured cigarettes, 40/40 burnt full length; (b) for Merit banded paper cigarettes 29/40 (73%) burnt full length; (c) for each brand of hand rolled cigarettes 0/40 burnt full length; (d) 0/40 manufactured cigarettes reconstructed with Rizla hand rolling paper burnt full length. 2. Citrate content: (a) In manufactured cigarette papers: 0.3–0.8 mg; in tobacco of manufactured cigarettes: Holiday 0, Horizon 0, Marlboro 8.8 mg; (b) Merit: in banded paper 0.418 mg; in tobacco 10.23 mg; (c) In hand rolled cigarettes: in the papers < 0.08 mg; in hand rolled tobacco 13.3–15.0 mg; (d) In hand rolling papers of reconstructed cigarettes: < 0.018 mg. 3. Requiring manufactured cigarettes to compulsorily self-extinguish when left unattended was supported by 67% of smokers, 61% of manufactured cigarette smokers, 82% of hand rolled smokers, and by 68% of non-smokers.

Conclusion: The wrapping paper is a key determinant of whether or not unpuffed cigarettes burn their full length. Using international test methods, popular brands of manufactured cigarettes all burnt full length, but none did so when re-wrapped in hand rolling cigarette paper. This provides a ready-to-hand smoker acceptable standard for reducing ignition potential from manufactured cigarettes, as a basis for regulation or litigation.

     

Paradoxical increase in cigarette smuggling after the market opening in Taiwan

Objectives

To assess the magnitude of cigarette smuggling after the market opened in Taiwan.

Methods

Review of tobacco industry documents for references to smuggling activities related to Taiwan and government statistics on seizure of smuggled cigarettes.

Results

The market opening in 1987 led to an increase in smuggling. Contraband cigarettes became as available as legal ones, with only a small fraction (8%) being seized. Being specifically excluded from the market‐opening, Japan entered the Taiwan market by setting up a Swiss plant as a legal cover for smuggling 10–20 times its legal quota of exports to Taiwan. Smuggling in Taiwan contributed to increased consumption of foreign brands, particularly by the young. Taiwan, not a member of the World Health Organization, was excluded from the East Asian 16‐member “Project Crocodile”, a regional anti‐smuggling collaborative effort to implement the Framework Convention on Tobacco Control.

Conclusions

Taiwan showed a sharp increase in smuggling after market liberalisation. Being excluded from the international community, Taiwan faces an uphill battle to fight smuggling alone. If Taiwan remained as its weakest link, global efforts to reduce tobacco use will be undermined, particularly for countries in the East Asian region.     

切丝宽度对中支卷烟烟丝结构、烟支理化指标及感官质量的影响

为了探究切丝宽度对中支卷烟烟丝结构、烟支物理指标、烟气指标、主流烟气粒相物致香成分含量及感官质量的影响,在切丝宽度分别为0.80、0.85、0.90、0.95、1.00 mm时,采用相同的烟丝加工和卷制条件卷制成烟支圆周为22 mm的中支卷烟,分析了烟丝结构和成品烟支物理指标、烟气指标、主流烟气粒相物致香成分含量和感官质量。结果表明:①切丝宽度由0.80 mm增加至1.00 mm,整丝率提高2.85百分点,碎丝率降低0.80百分点,烟支圆周呈现增加的趋势,烟支吸阻呈现逐渐降低的趋势,烟支吸阻降低164 Pa。切丝宽度为0.85 mm时,烟支单支质量标准偏差和吸阻标准偏差最小。②烟气CO量和切丝宽度之间呈现显著负相关;随着切丝宽度增加,烟气烟碱量增大,变化在0.04 mg/支范围内;烟气焦油量先增大后减小,在切丝宽度为0.95 mm时达到最大。③烟气粒相物致香成分中羰基类化合物、杂环类化合物、酚类化合物含量及致香成分总量,均呈现先增加后降低并趋于稳定的趋势,在切丝宽度为0.85 mm时达到最大。④烟支整体感官质量得分和单项指标得分随着切丝宽度的增加均呈现下降的趋势,切丝宽度为0.80~0.90 mm的样品感官质量明显好于切丝宽度为0.95 mm和1.00 mm的样品。     

Effect of the New York State cigarette fire safety standard on ignition propensity, smoke constituents, and the consumer market

Objectives: This study examines empirical evidence from the New York experience testing tobacco industry arguments made in opposition to fire safety standards for cigarettes. Design: Percentages of cigarettes exhibiting full length burns (FLBs), cigarette sales before and following the implementation of the New York standards, a sample of retail cigarette prices, brand availability, and selected smoke constituent yields were compared between cigarettes sold in New York and two other states. Cigarette paper analysis was conducted on cigarettes sold in New York. Results: New York cigarette brands averaged 10.0% FLBs as compared to 99.8% for California and Massachusetts brands. Reduced ignition propensity (RIP) appears to have been achieved by cigarette paper banding. Cigarette sales, prices, and brand availability do not appear to have been affected by the New York standards. Yields of the majority of smoke constituents tested did not differ substantially between RIP cigarettes sold in New York as compared to the same brands sold in Massachusetts. Average yields of tar, carbon monoxide, and two compounds were slightly higher, the yields of seven compounds were higher for one brand only, and nicotine was lower, among New York brands tested. Conclusions: RIP cigarette brands have been designed to meet the New York fire safety standards. Their introduction has not affected cigarette sales or prices in New York. There is no evidence that the small increases in smoke constituent yields affect the already highly toxic nature of cigarette smoke. Data on smoking caused fires, deaths, and injuries dating from after the change in law are not yet available. Such data will be able to address the question of whether the demonstrated reduced ignition standards are associated with reduced fires and injuries. Based on the New York experience, prior industry objections to producing RIP cigarettes are unfounded. Other states and nations should adopt similar standards.     

German tobacco industry's successful efforts to maintain scientific and political respectability to prevent regulation of secondhand smoke

Objective

To examine the tactics the tobacco industry in Germany used to avoid regulation of secondhand smoke exposure and to maintain the acceptance of public smoking.

Methods

Systematic search of tobacco industry documents available on the internet between June 2003 and August 2004.

Results

In West Germany, policymakers were, as early as the mid 1970s, well aware of the fact that secondhand smoke endangers non‐smokers. One might have assumed that Germany, an international leader in environmental protection, would have led in protecting her citizens against secondhand smoke pollution. The tobacco manufacturers in Germany, however, represented by the national manufacturing organisation “Verband” (Verband der Cigarettenindustrie), contained and neutralised the early debate about the danger of secondhand smoke. This success was achieved by carefully planned collaboration with selected scientists, health professionals and policymakers, along with a sophisticated public relations programme.

Conclusions

The strategies of the tobacco industry have been largely successful in inhibiting the regulation of secondhand smoke in Germany. Policymakers, health professionals, the media and the general public should be aware of this industry involvement and should take appropriate steps to close the gap between what is known and what is done about the health effects of secondhand smoke.     

Philip Morris's Project Sunrise: weakening tobacco control by working with it

Objective

To analyse the implications of Philip Morris USA''s (PM''s) overtures toward tobacco control and other public health organisations, 1995–2006.

Data sources

Internal PM documents made available through multi‐state US attorneys general lawsuits and other cases, and newspaper sources.

Methods

Documents were retrieved from several industry documents websites and analysed using a case study approach.

Results

PM''s Project Sunrise, initiated in 1995 and proposed to continue through 2006, was a long‐term plan to address tobacco industry delegitimisation and ensure the social acceptability of smoking and of the company itself. Project Sunrise laid out an explicit divide‐and‐conquer strategy against the tobacco control movement, proposing the establishment of relationships with PM‐identified “moderate” tobacco control individuals and organisations and the marginalisation of others. PM planned to use “carefully orchestrated efforts” to exploit existing differences of opinion within tobacco control, weakening its opponents by working with them. PM also planned to thwart tobacco industry delegitimisation by repositioning itself as “responsible”. We present evidence that these plans were implemented.

Conclusion

Sunrise exposes differences within the tobacco control movement that should be further discussed. The goal should not be consensus, but a better understanding of tensions within the movement. As the successes of the last 25 years embolden advocates to think beyond passage of the next clean indoor air policy or funding of the next cessation programme, movement philosophical differences may become more important. If tobacco control advocates are not ready to address them, Project Sunrise suggests that Philip Morris is ready to exploit them.