Secondhand smoke exposure and risk following the Irish smoking ban: an assessment of salivary cotinine concentrations in hotel workers and air nicotine levels in bars

Objective: To investigate whether the Irish smoking ban has had an impact on secondhand smoke (SHS) exposures for hospitality workers. Design, setting, and participants: Before and after the smoking ban a cohort of workers (n = 35) from a sample of city hotels (n = 15) were tested for saliva cotinine concentrations and completed questionnaires. Additionally, a random sample (n = 20) of city centre bars stratified by size (range 400–5000 square feet), were tested for air nicotine concentrations using passive samplers before and after the ban. Main outcome measures: Salivary cotinine concentrations (ng/ml), duration of self reported exposures to secondhand smoke, air nicotine (µg/cubic metre). Results: Cotinine concentrations reduced by 69%, from 1.6 ng/ml to 0.5 ng/ml median (SD 1.29; p < 0.005). Overall 74% of subjects experienced decreases (range 16–99%), with 60% showing a halving of exposure levels at follow up. Self reported exposure to SHS at work showed a significant reduction from a median 30 hours a week to zero (p < 0.001). There was an 83% reduction in air nicotine concentrations from median 35.5 µg/m³ to 5.95 µg/m³ (p < 0.001). At baseline, three bars (16%) were below the 6.8 µg/m³ air nicotine significant risk level for lung cancer alone; at follow up this increased to 10 (53%). Conclusions: Passive smoking and associated risks were significantly reduced but not totally eliminated. Exposure to SHS is still possible for those working where smoking is still allowed and those working where smoke may migrate from outdoor areas. Further research is required to assess the true extent and magnitude of these exposures.     

Particulate matter from tobacco versus diesel car exhaust: an educational perspective

Methods: A 60 m³ garage was chosen to assess PM emission from three smouldering cigarettes (lit sequentially for 30 minutes) and from a TDCi 2000cc, idling for 30 minutes.

Results: Particulate was measured with a portable analyser with readings every two minutes. Background PM₁₀, PM_2.5, and PM₁ levels (mean (SD)) were 15 (1), 13 (0.7), and 7 (0.6) µg/m³ in the car experiment and 36 (2), 28 (1), and 14 (0.8) µg/m³ in the ETS experiment, respectively. Mean (SD) PM recorded in the first hour after starting the engine were 44 (9), 31 (5), and 13 (1) µg/m³, while mean PM in the first hour after lighting cigarettes were 343 (192), 319 (178), and 168 (92) µg/m³ for PM₁₀, PM_2.5, and PM₁, respectively (p < 0.001, background corrected).

Conclusions: ETS is a major source of PM pollution, contributing to indoor PM concentrations up to 10-fold those emitted from an idling ecodiesel engine. Besides its educational usefulness, this knowledge should also be considered from an ecological perspective.

     

Secondhand smoke levels in Scottish pubs: the effect of smoke-free legislation

Objective

To compare levels of particulate matter, as a marker of secondhand smoke (SHS) levels, in pubs before and 2 months after the implementation of Scottish legislation to prohibit smoking in substantially enclosed public places.

Design

Comparison of SHS levels before and after the legislation in a random selection of 41 pubs in 2 Scottish cities.

Methods

Fine particulate matter <2.5 μm in diameter (PM_2.5) was measured discreetly for 30 min in each bar on 1 or 2 visits in the 8 weeks preceding the starting date of the Smoking, Health and Social Care (Scotland) Act 2005 and then again 2 months after the ban. Repeat visits were undertaken on the same day of the week and at approximately the same time of the day.

Results

PM_2.5 levels before the introduction of the legislation averaged 246 μg/m³ (range 8–902 μg/m³). The average level reduced to 20 μg/m³ (range 6–104 μg/m³) in the period after the ban. Levels of SHS were reduced in all 53 post‐ban visits, with the average reduction being 86% (range 12–99%). PM_2.5 concentrations in most pubs post‐ban were comparable to the outside ambient air PM_2.5 level.

Conclusions

This study has produced the largest dataset of pre‐ and post‐ban SHS levels in pubs of all worldwide smoke‐free legislations introduced to date. Our results show that compliance with the Smoking, Health and Social Care (Scotland) Act 2005 has been high and this has led to a marked reduction in SHS concentrations in Scottish pubs, thereby reducing both the occupational exposure of workers in the hospitality sector and that of non‐smoking patrons.Public health policy in a growing number of countries has moved to control non‐smokers'' exposure to secondhand smoke (SHS), with recent legislation introduced in Ireland, Italy, Spain and Norway. The Smoking, Health and Social Care (Scotland) Act 2005 to ban smoking in substantially enclosed public places was implemented on 26 March 2006 with the aim of protecting non‐smokers from the health effects of SHS.¹A recent review of occupational exposure to SHS suggested that workers in the hospitality sector have among the highest exposures to SHS of all occupational groups.² Data on exposure to SHS across a wide range of entertainment establishments indicated that airborne nicotine concentrations were up to 18.5 times higher than in offices or domestic residences.³ Studies have shown that non‐smoking bar workers have salivary cotinine levels four times those of non‐smokers who live with partners who smoke.⁴ Data from New Zealand indicate that non‐smoking hospitality workers in establishments that permit smoking have salivary cotinine levels between 3 and 4 times those of non‐smoking workers in smoke‐free premises.⁵ One estimate indicates that between 1500 and 2000 non‐smokers'' deaths per year in Scotland can be attributed to SHS exposure.⁶ It has been suggested that SHS exposure may lead to the deaths of over 50 hospitality sector workers in the UK each year.⁷The introduction of smoke‐free legislation in other countries has been shown to dramatically reduce SHS levels. A recent analysis of the effect of the Norwegian legislation⁸ showed that total dust levels in 13 bars and restaurants reduced from an average level of 262 to 77 μg/m³, a 70% reduction, whereas a study in the USA indicated that respirable dust levels in a selection of 8 hospitality venues reduced to approximately 9% of the pre‐ban level.⁹ Similar work in New York State in a mixture of bars and restaurants measured levels of particulate matter <2.5 μm in diameter (PM_2.5), and found that mean levels decreased from 412 to 27 μg/m³ (93.5%).¹⁰ Mulcahy et al¹¹ measured changes in airborne nicotine levels as a result of the Irish smoking ban. Their study of 20 pubs showed nicotine reductions of approximately 83%.Although there are currently no air quality standards for PM_2.5 in the UK, both the US Environmental Protection Agency (EPA) and the World Health Organization (WHO) have issued air quality guidance for outdoor air pollution levels measured in PM_2.5.^12,13 The US EPA air quality guidance is divided into bands, and for PM_2.5 these bands are arranged at cut points of <15.4 μg/m³ (good), 15.5–40.4 μg/m³ (moderate), 40.5–65.4 μg/m³ (unhealthy for sensitive groups), 65.5–150.4 μg/m³ (unhealthy), 150.5–250.4 μg/m³ (very unhealthy) and >250.5 μg/m³ (hazardous). The US EPA standard for PM_2.5 has a 24 h averaged target of 65 μg/m³, with an annualised average of 15 μg/m³. The WHO recently revised its outdoor air quality guidance and now recommends a 24 h average limit of 25 μg/m^3, with an annual average not exceeding 10 μg/m³ measured in PM_2.5.¹³This paper describes our methods of measurement of SHS concentrations in a selection of Scottish pubs and examines the changes in SHS levels that occurred as a result of the implementation of the ban on 26 March 2006. It forms part of a comprehensive evaluation strategy to measure the effects of the introduction of the Scottish smoke‐free legislation.¹⁴     

Second-hand tobacco smoke in public places in urban and rural China

Objective

To assess airborne nicotine concentrations as an indicator of second‐hand smoke (SHS) exposure in public places in both urban and rural areas of China.

Design

Measurement of vapour‐phase nicotine concentration using a common protocol in all locations. A total of 273 samplers were placed for 7 days in urban and rural areas of China, including Beijing and the capital city, and a county (rural) area of the following provinces: Sichuan (Chengdu/Mianzhu), Jiangxi (Nanchang/Anyi) and Henan (Zhengzhou/Xin''an).

Setting

Samplers were placed in hospitals, secondary schools, city government buildings, train stations, restaurants and entertainment establishments (internet cafes, mahjong parlours and karaoke bars) in each location.

Main outcome measure

The time‐weighted average airborne concentration of nicotine (μg/m³) was measured by gas chromatography.

Results

Airborne nicotine was detected in 91% of the locations sampled. Beijing had the highest nicotine concentrations in most indoor environments (median 3.01 μg/m³) and Chengdu had the lowest concentrations (median 0.11 μg/m³). Overall, restaurants and entertainment establishments had the highest nicotine concentrations (median 2.17 and 7.48 μg/m³, respectively). High nicotine concentrations were also found in government buildings and in train stations.

Conclusions

The data collected in this study provide evidence that SHS exposure is frequent in public places in China. Environmental nicotine concentrations in China provide evidence for implementation and enforcement of smoke‐free initiatives in public places in China and indicate the need for protecting the public from exposure to SHS.Tobacco use causes death and disease not only among those who actively smoke but also among those who are exposed to second‐hand smoke (SHS) in indoor environments.^1,2 Over the past two decades, evidence on the adverse health effects of SHS exposure has led to initiatives worldwide to reduce exposure in public places, workplaces, homes and transportation environments. Although cities and entire countries, including New York City and State, Italy, Ireland, Norway and Scotland, have passed legislation banning smoking in all public places, most countries and particularly the low‐income to middle‐income countries, such as China, do not have effective policies in place to reduce active and passive smoking. Making indoor environments smoke‐free has not been easy; in many countries, a majority of men smoke and the tobacco industry has vigorously attempted to counter the growing call for smoke‐free indoor environments. Industry efforts include attempts at discrediting scientific evidence on the health effects of SHS, subverting regulatory initiatives, and advancing ineffective alternatives to eliminate smoking indoors.³ In addition, many countries lack data documenting exposure of the population to SHS.China is a particularly critical nation in the global effort to control tobacco use. China has the largest population of smokers in the world: over 350 million of its 1.2 billion people.⁴ Governments, including the Chinese government, are increasingly becoming aware of the significant impact of the tobacco epidemic on their citizens.⁵In August 2006, the Chinese government ratified the World Health Organization''s Framework Convention on Tobacco Control, and some Chinese cities, government departments and organisations have now adopted rules and regulations banning smoking in public places and workplaces. Recently, a deputy to the China legislature called for a ban on smoking in all public places.⁶ However, progress has been hindered by the high prevalence of smoking and a general view that smoking is acceptable.⁴ There is also concern about the possible negative economic impact of tobacco control policies, especially in the rural and less‐developed areas of China.To develop the required evidence for advancing tobacco control, we measured airborne nicotine concentrations in various locations across China. In this study, we report the results of an assessment of nicotine concentrations in schools, hospitals, government offices, train stations, facilities, restaurants and entertainment establishments in urban and rural areas of China.     

Exposure to fine and ultrafine particles from secondhand smoke in public places before and after the smoking ban, Italy 2005

Background

A smoking ban in all indoor public places was enforced in Italy on 10 January 2005.

Methods

We compared indoor air quality before and after the smoking ban by monitoring the indoor concentrations of fine (<2.5 μm diameter, PM_2.5) and ultrafine particulate matter (<0.1 μm diameter, UFP). PM_2.5 and ultrafine particles were measured in 40 public places (14 bars, six fast food restaurants, eight restaurants, six game rooms, six pubs) in Rome, before and after the introduction of the law banning smoking (after 3 and 12 months). Measurements were taken using real time particle monitors (DustTRAK Mod. 8520 TSI; Ultra‐fine Particles Counter‐TRAK Model 8525 TSI). The PM_2.5 data were scaled using a correction equation derived from a comparison with the reference method (gravimetric measurement). The study was completed by measuring urinary cotinine, and pre‐law and post‐law enforcement among non‐smoking employees at these establishments

Results

In the post‐law period, PM_2.5 decreased significantly from a mean concentration of 119.3 μg/m³ to 38.2 μg/m³ after 3 months (p<0.005), and then to 43.3 μg/m³ a year later (p<0.01). The UFP concentrations also decreased significantly from 76 956 particles/cm³ to 38 079 particles/cm³ (p<0.0001) and then to 51 692 particles/cm³ (p<0.01). Similarly, the concentration of urinary cotinine among non‐smoking workers decreased from 17.8 ng/ml to 5.5 ng/ml (p<0.0001) and then to 3.7 ng/ml (p<0.0001).

Conclusion

The application of the smoking ban led to a considerable reduction in the exposure to indoor fine and ultrafine particles in hospitality venues, confirmed by a contemporaneous reduction of urinary cotinine.     

Residual tobacco smoke: measurement of its washout time in the lung and of its contribution to environmental tobacco smoke

Background

Tobacco smoking entails inhaling millions of fine particles with each puff, and it is intuitive that after smoking a cigarette it will take a certain time to washout residual tobacco smoke (RTS) from the lungs with subsequent breaths.

Objectives

To study the washout time of 0.3–1.0 µm particles after the last puff in 10 volunteer smokers by using equipment capable of measuring particle concentration in real time in the exhaled air.

Result

Mean (standard deviation (SD)) lung RTS washout time was 58.6 (23.6) s, range 18–90 s, and corresponded to 8.7 (4.6) subsequent breathings. The contribution of individual and overall RTS to indoor pollution was calculated by subtracting incremental background particle concentration from room concentration after 10 consecutive re‐entries of smokers after the last puff into a room of 33.2 m³, with an air exchange rate per hour in the range of 0.2–0.4. Mean (SD) individual RTS contribution consisted of 1402 (1490) million particles (range 51–3611 million), whereas RTS increased room 0.3–1.0 µm particle concentration from a baseline of 22 283 particles/l to a final room concentration of 341 956 particles/l, corresponding to a total increase in particulate matter (2.5) from a background of 0.56 up to 3.32 µg/m³.

Conclusion

These data reveal a definite although marginal, role of RTS as a source of hidden indoor pollution. Further studies are needed to understand the relevance of this contribution in smoke‐free premises in terms of risk exposure; however, waiting for about 2 min before re‐entry after the last puff would be enough to avoid an unwanted additional exposure for non‐smokers.Environmental tobacco smoke (ETS) is considered to be the most important source of indoor pollution and a recognised health risk factor.^1,2 Despite a putative lower exposure to toxic substances of tobacco, its effect on human tissues and organs seems to be almost as dangerous as active smoke.³ ETS monitoring carried out by means of particulate matter measurements showed that the smoke of a few cigarettes can contribute to indoor pollution up to levels exceeding outdoor limits,^1,4 and even higher than those produced by recent diesel engines.⁵ Research in this field conducted in the past 20 years led to the enactment of smoking policy rules in many countries, whose enforcement was linked to improvement in the health status of citizens.⁶ Where smoking is restricted, smokers are required to smoke outdoors, and often light up in the vicinity or in front of the buildings; they then re‐enter the buildings through common entrances immediately after finishing their cigarettes. To date, the retention time of mainstream smoke in the lung residual tobacco smoke (RTS) after the last puff has been investigated for volatile organic compounds,^7,8 but not yet for particulate matter, and its contribution to indoor ETS pollution has not been fully evaluated.⁹ New technologies in the field of aerosol analysers have recently made it possible to measure aerosol particles in the exhaled air in real time.¹⁰ We carried out this study to measure the retention time of tobacco smoke particulate matter after the last puff and to evaluate the contribution of RTS to ETS pollution.     

Nicotine replacement therapy, professional therapy, snuff use and tobacco smoking: a study of smoking cessation strategies in southern Sweden

Objectives

The strategies used to support smoking cessation among quitters were investigated according to year of smoking cessation and sociodemographic characteristics.

Methods

The 2004 public health survey in Skåne, Sweden, is a cross‐sectional study. A total of 27 757 people aged 18–80 answered a postal questionnaire. The participation rate was 59%. Different strategies to support smoking cessation—that is, no therapy, nicotine replacement (NRT), professional therapy and snus (snuff) use, were investigated among quitters according to year of smoking cessation, and demographic and socioeconomic characteristics.

Results

14.9% of the men and 18.1% of the women were daily smokers. The prevalence of daily snus use was 19.5% among men but only 2.3% among women. Stratifying the data according to year of smoking cessation (1938–2004) revealed a significant increase in active smoking cessation strategies such as NRT, professional therapy and snus use. NRT was more common among women (23.6%) than men (14.8%) among smokers who quit in 2000–4, but snus use was more common among men (30.4% versus 8.7%). No replacement or other therapy at all was significantly more common among women (63.6%) than men (52.1%). People aged 35–80 years used more nicotine replacement than people aged 18–34, while men aged 18–34 used snus to quit smoking significantly more than men aged 55–80.

Conclusions

Snus is used commonly among men as a support for smoking cessation in Sweden. Women use pharmacological NRT to a greater extent, but this can probably not compensate for the much higher extent of snuff use as a cessation strategy among men.     

An ethnographic study of tobacco control in hospital settings

Background

Tobacco control in hospital settings is characterised by a focus on protection strategies and an increasing expectation that health practitioners provide cessation support to patients. While practitioners claim to have positive attitudes toward supporting patient cessation efforts, missed opportunities are the practice norm.

Objective

To study hospital workplace culture relevant to tobacco use and control as part of a mixed‐methods research project that investigated hospital‐based registered nurses'' integration of cessation interventions.

Design

The study was conducted at two hospitals situated in British Columbia, Canada. Data collection included 135 hours of field work including observations of ward activities and designated smoking areas, 85 unstructured conversations with nurses, and the collection of patient‐care documents on 16 adult in‐patient wards.

Results

The findings demonstrate that protection strategies (for example, smoking restrictions) were relatively well integrated into organisational culture and practice activities but the same was not true for cessation strategies. An analysis of resources and documentation relevant to tobacco revealed an absence of support for addressing tobacco use and cessation. Nurses framed patients'' tobacco use as a relational issue, a risk to patient safety, and a burden. Furthermore, conversations revealed that nurses tended to possess only a vague awareness of nicotine dependence.

Conclusion

Overcoming challenges to extending tobacco control within hospitals could be enhanced by emphasising the value of addressing patients'' tobacco use, raising awareness of nicotine dependence, and improving the availability of resources to address addiction issues.     

"Accommodating" smoke-free policies: tobacco industry's Courtesy of Choice programme in Latin America

Objective

To understand the implementation and effects of the Courtesy of Choice programme designed to “accommodate” smokers as an alternative to smoke‐free polices developed by Philip Morris International (PMI) and supported by RJ Reynolds (RJR) and British American Tobacco (BAT) since the mid‐1990s in Latin America.

Methods

Analysis of internal tobacco industry documents, BAT “social reports”, news reports and tobacco control legislation.

Results

Since the mid‐1990s, PMI, BAT and RJR promoted Accommodation Programs to maintain the social acceptability of smoking. As in other parts of the world, multinational tobacco companies partnered with third party allies from the hospitality industry in Latin America. The campaign was extended from the hospitality industry (bars, restaurants and hotels) to other venues such as workplaces and airport lounges. A local public relations agency, as well as a network of engineers and other experts in ventilation systems, was hired to promote the tobacco industry''s programme. The most important outcome of these campaigns in several countries was the prevention of meaningful smoke‐free policies, both in public places and in workplaces.

Conclusions

Courtesy of Choice remains an effective public relations campaign to undermine smoke‐free policies in Latin America. The tobacco companies'' accommodation campaign undermines the implementation of measures to protect people from second‐hand smoke called for by the World Health Organization Framework Convention on Tobacco Control, perpetuating the exposure to tobacco smoke in indoor enclosed environments.Latin Americans are highly exposed to second‐hand tobacco smoke (SHS) both in public places and in workplaces.^1,2 In 2001, the Pan American Health Organization launched its “Smoke Free Americas” initiative³ to “raise awareness of the harm caused by secondhand tobacco smoke, and support efforts to achieve more smoke‐free environments in the Americas.” There is longstanding strong public concern over the effects of SHS in Latin America. In 1997, research conducted for Philip Morris International (PMI) showed that about 80% of respondents in four Latin American countries agreed that “Other people''s tobacco smoke poses a long term health risk to nonsmokers.”⁴ These results reflect a stronger consensus that SHS is hazardous than Philip Morris (PM) found in the US in 1989—62% of non‐smokers and 32% of smokers—as the movement for smoke‐free workplaces and public places was beginning to accelerate them.⁵ A 2001 survey conducted for the World Health Organization (WHO) in the main urban areas of Argentina showed strong public support (94%; 96% non‐smokers and 89% smokers) for the creation of smoke‐free places to avoid SHS.⁶ Public opinion polls conducted in 2006 in Argentina⁷ and Uruguay⁸ reported that 92% of respondents agreed that “SHS is dangerous for nonsmokers'' health”, showing an increase in public concern about SHS by 12% since 1997.The main barrier to progress in implementing smoke‐free policies in Latin America has been the efforts by two transnational tobacco companies, PMI and British American Tobacco (BAT), which control almost the entire cigarette market in the region through their subsidiaries (PMI 40%, BAT 60%). Similar to the voluntary self‐regulating advertising codes, which the tobacco companies use to fight restrictions on tobacco advertising,^9,10 the tobacco industry has orchestrated public relations campaigns in Latin America since the mid‐1990s to avoid legislated smoke‐free policies.^11,12 As in the US, beginning in the late 1980s,¹¹ this effort mobilised the hospitality industry to block meaningful tobacco control legislation to preserve the social acceptability of smoking and to protect industry profits. These programmes, known as Accommodation in the US and Courtesy of Choice in most parts of the rest of the world,^11,13,14,15 encourage the voluntary creation of smoking and non‐smoking sections in the hospitality industry as an alternative to legislation requiring 100% smoke‐free environments. Also, as in the US, the tobacco industry sought to present ventilation as the “solution” to SHS.¹⁶As of April 2007, 12 Latin American countries (Bolivia, Brazil, Chile, Ecuador, Guatemala, Honduras, Mexico, Panama, Paraguay, Peru, Uruguay and Venezuela) had ratified the WHO Framework Convention on Tobacco Control (FCTC). The FCTC, the first international public health treaty, calls for the implementation of “effective legislative, executive, administrative or other measures … at the appropriate governmental level to protect all persons from exposure to tobacco smoke” (Article 4.1) “in indoor workplaces, public transport, indoor public places and, as appropriate, other public places.” (Article 8).¹⁷ Given the fact that the only truly effective protection from SHS is the creation of 100% smoke‐free environments,¹⁸ in 2003, Venezuela approved a state law (in Monagas¹⁹) and between 2005 and 2006, Argentina passed and regulated two provincial laws (in Santa Fe and Tucumán) to establish 100% smoke‐free public places and workplaces. In March 2006, Uruguay became the first 100% smoke‐free country in the Americas. In response to this movement, one can expect the tobacco industry to accelerate its Accommodation efforts as a way of undermining such effective smoke‐free policies to implement FCTC.     

Use of nicotine replacement therapy to reduce or delay smoking but not to quit: prevalence and association with subsequent cessation efforts

Objective

To assess the prevalence of nicotine replacement therapy (NRT) use for purposes other than quitting smoking and examine the relation of this non‐standard NRT use (NSNRT) with subsequent smoking cessation efforts.

Design

A population based cohort study of adult smokers who were interviewed by telephone at baseline (2001–2) and at two year follow‐up. The association between NSNRT use to cut down on smoking or to delay smoking before baseline and cessation attempts and smoking outcomes at two year follow‐up was assessed using logistic regression to adjust for multiple potential confounding factors.

Setting

Massachusetts, USA.

Subjects

1712 adult smokers in Massachusetts who were selected using a random digit dial telephone survey.

Main outcome measures

Quit attempt in 12 months before follow‐up, NRT use at quit attempt in 12 months before follow‐up, smoking cessation by follow‐up, or 50% reduction in cigarettes smoked per day between baseline and follow‐up.

Results

18.7% of respondents reported ever having used NSNRT. In a multiple logistic regression analysis, there was no statistically significant association between past NSNRT use and quit attempts (OR_{cut down}  = 0.89, 95% CI 0.59 to 1.33; OR_delay  = 1.29, 95% CI 0.73 to 2.29), smoking cessation (OR_{cut down}  = 0.74, 95% CI 0.43 to 1.24; OR_delay  = 1.22, 95% CI 0.60 to 2.50) or 50% reduction in cigarettes smoked per day (OR_{cut down}  = 0.93, 95% CI 0.62 to 1.38; OR_delay  = 0.80, 95% CI 0.43 to 1.49) at follow‐up. Past use of NRT to cut down on cigarettes was associated with use of NRT at a follow‐up quit attempt (OR_{cut down}  = 2.28, 95% CI 1.50 to 3.47) but past use of NRT to delay smoking was not (OR_delay  = 1.25, 95% CI 0.67 to 2.34).

Conclusions

Use of NRT for reasons other than quitting smoking may be more common than was previously estimated. This population based survey finds no strong evidence that NRT use for purposes other than quitting smoking is either harmful or helpful.     

Controlled atmosphere storage of pomegranate

Pomegranates cv. Mollar were stored for up to 8 weeks at 5 °C and above 95% relative humidity (RH) in air and in controlled atmospheres of 10% O₂ and 5% CO₂, 5% O₂ and 5% CO₂, 5% O₂ and 0% CO₂ and 5% O₂ and 0% CO₂ ethylene-free. Storage was followed by a shelf-life period of 6 days at 20 °C in air. Respiratory activity slightly declined during storage at 20 °C, from 12 to 8 ml CO₂ · kg^–1 · h^–1 and was around 4 ml CO₂ · kg^–1 · h^–1 at 5 °C showing a non-climacteric pattern. When compared with color at harvest, an increase in thea ^* value in the juice from pomegranates stored in 10% O₂ and 5% CO₂ was observed. This supports that view that juice red colour can increase in intensity during storage. Controlled atmosphere storage reduced weight loss, the risk of decay and the severity of husk scald (except at 10% O₂ and 5% CO₂). The relatively low control of husk scald at 5% O₂ disagrees with the level proposed previously for Wonderful cv.; Mollar cv. seems to be more sensitive to scald than other varieties. No symptoms of black spots or membranose and no off-flavours were detected at any time. However after a period of shelf-life storage, the controlled atmosphere caused a slight reduction (lower than in air-stored fruit) in titratable acidity, reducing sugars and vitamin C and an increase of the soluble solids content/titratable acidity (maturity index) without differences among the various gas compositions studied. The maturity index must be considered to be a good criterion of pomegranate maturity for sweet varieties.     

Nicotine pharmacokinetics and subjective effects of three potential reduced exposure products, moist snuff and nicotine lozenge

Objective

To compare nicotine pharmacokinetics and subjective effects of three new smokeless tobacco potential reduced exposure products (PREPs; Ariva, Revel and Stonewall) with moist snuff (Copenhagen) and medicinal nicotine (Commit lozenge).

Methods

10 subjects completed a randomised, within‐subject, crossover study. Subjects used one product for 30 min at each of the five laboratory sessions. Maximal nicotine concentration (C_max) was determined and area under the concentration time curve (AUC) was calculated for a 90‐min period (during use and 60 min after use). Nicotine craving, withdrawal symptoms and ratings of product effects and liking were measured during product use.

Results

Nicotine AUC and C_max were higher for Copenhagen than for any other product (p<0.002) and higher for Commit than for either Ariva or Revel (p<0.001). C_max for Commit was also higher than for Stonewall (p = 0.03). Craving was lowest during use of Copenhagen (p<0.03). Craving during use of Stonewall, Ariva and Commit was lower than during use of Revel (p<0.05). Withdrawal symptom score during use of Copenhagen was lower than during use of Revel (p = 0.009). Copenhagen scores were higher (p<0.005) than all other products in several measures of drug effects and liking (feel good effects, satisfaction, liking and desire for product, and strength of product).

Conclusion

The new smokeless tobacco PREPs result in lower nicotine concentrations and equivalent or lower reductions in subjective measures compared with medicinal nicotine. Since health effects of PREPs are largely unknown, medicinal nicotine should be preferentially encouraged for smokers or smokeless tobacco users wishing to switch to lower‐risk products.Over the past several years, a number of new tobacco products have been introduced, some of which are being marketed, either implicitly or explicitly, as having reduced toxicant exposure or decreased health risks. To assist in evaluating these potential reduced exposure products (PREPs), the United States Food and Drug Administration in 1999 asked the Institute of Medicine to formulate methods and standards by which PREPs could be assessed.¹ More recently, an expert panel was convened to develop guidelines for the evaluation of PREPs on both individual and population levels. Among the topics addressed was human clinical testing, which included recommendations on methods and biomarkers to assess PREPs.^2,3 The recommended evaluation of PREPs included conducting studies on the pharmacokinetic properties of the products and assessing misuse liability by measuring subjective responses to the products and ability of the products to suppress withdrawal.³The use of smokeless tobacco products, in lieu of cigarettes, has been suggested as a promising method by which to reduce tobacco‐related health consequences.⁴ Currently, tobacco companies including major cigarette‐manufacturing companies are test marketing smokeless and spitless tobacco products (eg, Camel Snus by Reynolds American, Taboka by Philip Morris) as a substitute for smoking. Although overall morbidity and mortality associated with the use of moist snuff or chewing tobacco is lower than the risks associated with cigarette smoking, health consequences such as increased rates of oral and pancreatic cancers remain.^5,6 Furthermore, health effects of all forms of smokeless tobacco are not equivalent. For example, an evaluation of the content of tobacco‐specific nitrosamines found large differences between the various forms and brands of smokeless tobacco.⁷ In a human study, a significant decrease in the uptake of tobacco carcinogens has been observed when users of conventional brands of smokeless tobacco switch to Swedish snus.⁸ A comparison of several brands of moist snuff products found significant differences between brands in the amount of unionised (free) nicotine^9,10,11 and in exposure to nicotine and heart rate response after use of a single dose of each product.¹² To accurately assess the potential health effects of a product and the factors associated with consumer use, it is therefore necessary to test each smokeless tobacco product individually, including evaluating the nicotine pharmacokinetics.The purposes of this study were to assess the pharmacokinetics and subjective responses of smokeless tobacco users when using three new PREPs and to compare them with a commonly used brand of moist snuff (Copenhagen) and the medicinal nicotine lozenge (4 mg Commit). The new smokeless tobacco products studied were (1) Ariva, a compressed powdered tobacco lozenge manufactured to contain low tobacco‐specific nitrosamines by Star Scientific marketed for use by smokers when they cannot or choose not to smoke; (2) Stonewall, another compressed powdered low tobacco‐specific nitrosamine tobacco lozenge from Star Scientific marketed as a spit‐free alternative for users of traditional moist snuff smokeless tobacco products; and (3) Revel, a spit‐free smokeless tobacco packet marketed by US Smokeless Tobacco for smokers seeking a discrete alternative to smoking.     

Analysis of hydrogen peroxide in cigarette smoke from selected Chinese cigarette brands under conventional and intense machine smoking conditions

The purpose of the present work was to investigate the concentration ranges of H₂O₂ generated from cigarette smoke of selected Chinese brands and the effect of different smoking behaviors on the deliveries of H₂O₂. A simple, rapid and reliable fluorescence assay was developed for the measurement of H₂O₂ based on the catalytic activity of hemoglobin using 10-acetyl-3, 7-dihydroxyphenoxazine (Amplex Red) as the substrate. The proposed method was applied to determine the H₂O₂ deliveries from mainstream cigarette smoke of 30 Chinese (5 blended and 25 Virginia) and two reference cigarettes (3R4F and 1R5F) under two machine smoking regimes. Results showed that, under ISO smoking conditions, Chinese blended cigarettes had lower H₂O₂ yields than Chinese flue-cured cigarettes (mean value 2.41 vs. 4.69?μg?cig^?1, p?<?0.05). As expected, the deliveries of H₂O₂ for all cigarettes analyzed were higher under Canadian intense smoking conditions than those under ISO conditions (ISO mean 4.31?μg?cig^?1 vs. Canadian mean 5.96?μg?cig^?1, p?<?0.05). In addition, the ratios of H₂O₂ to nicotine yields were utilized to show the relative differences in yields among brands tested in this work and more than a twofold difference was found for most of selected Chinese blended and flue-cured cigarettes.     

New tobacco products: do smokers like them?

Background

There is little information about smokers who tried potentially reduced exposure products (PREPs) (Eclipse^®, Omni^®, Advance Lights^®, Accord^®, or Ariva^®), why they tried them, if they liked these products, and if they will continue to use them.

Objectives

The objectives of this qualitative study were to understand: (1) how smokers who tried PREPs learned about them, (2) reasons for first trying PREPs, (3) which PREP(s) they tried, (4) what they thought of the product at first trial, (5) reasons for continuing or discontinuing use, and (6) whether they would recommend PREPs to others.

Design

In October 2002, 16 focus group sessions were conducted with current cigarette smokers aged 30–50 years: eight groups in Chattanooga, Tennessee, and eight in Dallas, Texas. Specific focus groups were composed of white men, white women, African American men, African American women, Hispanic men, or Hispanic women.

Results

The majority of the participants learned about PREPs through advertising or promotion, family, friends, and co‐workers; major reasons given for first trying PREPs were that the products were free or inexpensive, they wanted to stop smoking, they believed the product claims of fewer health risks, or they were curious; most of them tried Eclipse^® probably because the focus groups were conducted in the same cities where Eclipse^® was introduced; most participants did not like PREPs; most discontinued the use of PREPS, some who continued to use them did so infrequently and also kept smoking their regular brands of cigarettes; and most would not recommend PREPs, although a few might recommend them to specific groups (for example, new smokers, the young, women, curious or health conscious people).

Conclusions

Although most established smokers did not like the PREPs they tried and will not recommend them to anyone, a minority of established smokers believe that there may be a market for these products.     

Assessment of Relationships between Sensory and Instrumental Quality of Controlled-atmosphere-stored 'Fuji' Apples by Multivariate Analysis

ABSTRACT: Physicochemical parameters, sensory attributes, and total aroma emission of ‘Fuji’ apples (Malus×domestica Borkh.) were studied in relation to storage conditions, storage duration, and shelf life period. Commercially ripe fruit were analyzed after 3, 5, and 7 mo of cold storage in normal atmosphere (AIR) (210 L/m³ O₂+ 0.3 L/m³ CO₂) or under 3 different controlled atmosphere (CA) treatments (10 L/m³ O₂+ 10 L/m³ CO₂, 20 L/m³ O₂+ 20 L/m³ CO₂, or 10 L/m³ O₂+ 30 L/m³ CO₂), after which apples were kept at 20 °C for 1, 5, and 10 d. Data were subjected to partial least square regression (PLSR) analysis. Physicochemical parameters were well preserved throughout storage, especially in CA‐stored apples; however, these apples showed lower total aroma emission. Sensory acceptability was also higher for CA‐stored fruit after 7 mo of storage, whereas no significant differences were found for shorter storage periods. Accordingly, greater scores in sensory firmness, sensory flavor, sensory acidity, and appearance were observed for fruit stored in 10 L/m³ O₂+ 10 L/m³ CO₂ after long storage. Two PLSR models were established, 1 for relating physicochemical parameters to overall acceptability, and another for assessing the correlation between sensory acidity and instrumentally measured titratable acidity. The 1st PLSR model indicated that soluble solids concentration, titratable acidity, flesh firmness, and background color of the shaded side have a positive influence on acceptability. The 2nd model indicated that sensory acidity also showed an excellent correlation to instrumentally measured titratable acidity.