Regulation of tobacco ingredients for largest possible reduction of health risks

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Oral presentation by Lars Ramström at Workshop on tobacco ingredients, National Institute for Public Health and the Environment, Bilthoven, The Netherlands, 30 and 31 October 2003

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Regulation of tobacco ingredients for largest possible reduction of health risks

  1. 2. Regulation of: - amounts of various constituents in cigarette smoke - information on packages regarding smoke constituents - smokefree tobacco products
  2. 3. To be meaningful from health point of view, regulation of smoke constituents should relate, not to machine yield , but to smokers’ intake, taking into account the interaction between the smoker and the product.
  3. 4. Jarvis MJ, Boreham R, Primatesta P, Feyerabend C, Bryant A.   N icotine yield from machine-smoked cigarettes and nicotine intakes in smokers: evidence from a representative population survey. J Natl Cancer Inst. 2001 Jan 17;93(2):134-8 .
  4. 8. In I 2001, the U.S. National Cancer Institute (NCI) published Monograph 13
  5. 9. Monograph 13 concluded: “Measurements of tar and nicotine yields using the FTC method do not offer smokers meaningful information on the amount of tar and nicotine they will receive from a cigarette.” <ul><li>and therefore asked for: “Measurement of constituent yields in a manner that more closely resembles the way smokers actually consume cigarettes .” </li></ul>
  6. 10. But, there is no such thing as ” the (one and only) way smokers actually consume cigarettes” because: <ul><li>Different smokers use different ways to smoke the same cigarette </li></ul><ul><li>Each individual smoker uses different ways to smoke different cigarettes </li></ul>
  7. 11. What is it that determines an individual smoker’s intake ? <ul><li>Nicotine: His personal need for nicotine (governing the way he smokes in order to get the amount he needs). </li></ul><ul><li>Any other substance: The (brand-specific) amount of the substance in question that accompanies his personal amount of nicotine (as expressed by the ratio between the yield of that substance and the yield of nicotine). </li></ul>
  8. 12. A smoker’s intake of substance A = machine yield of A (his nicotine intake) × machine yield of nicotine Amount of nicotine RATIO substance A / nicotine determined by determined by the smoker cigarette properties
  9. 14. Example of brand comparison
  10. 15. Example of rule in an ”intake-related” regulation of cigarette smoke constituents . T/N ratio <10 (and, optionally Machine yield of tar <12 mg Machine yield of nicotine <1.4 mg)
  11. 16. Example of brand comparison
  12. 17. Regulation of: - amounts of various constituents in cigarette smoke - information on packages regarding smoke constituents - smokefree tobacco products
  13. 18. Health-related purpose of consumer info on cigarette packages: To help the smoker minimize his intake of harmful smoke constituents. Therefore, info should be related to potential INTAKE. Consequently, machine yield figures are meaningless.
  14. 19. Machine yield figures on packages are even MISLEADING, since their appearence gives the false impression that: - nicotine intake were determined by cigarette properties and differing widely between different brands but independent of how you smoke. - low figures for a substance, e.g. tar, would indicate low intake of that substance i.e. ”This is a mild cigarette”.
  15. 20. Instead, smokers should be aware... - that they are themselves influencing their intake by the way they smoke - that the self-determined intake of nicotine is about the same from all cigarettes - that the intake of other substances is influenced also by cigarette properties (yield ratio to nicotine)
  16. 21. Possible model for a meaningful and truthful info box on packages : Nicotine delivery from one of these cigarettes - to a smoking machine (ISO standard): 0.6 mg - to a smoker: 0.1 – 2.0 mg depending on how it is smoked Every milligram of nicotine is accompanied by: Tar: 8 mg Carbon monoxide: 9 mg
  17. 22. Regulation of: - amounts of various constituents in cigarette smoke - information on packages regarding smoke constituents - smokefree tobacco products
  18. 23. Mean nitrosamine content of moist snuff products from various sources based on dry weight
  19. 28. Summary (1) Regulation of amounts of smoke constituents <ul><li>A smokers’ intake of nicotine is about the same from all cigarettes and can therefore not be effectively influenced by limits for machine yield of nicotine. </li></ul><ul><li>A smokers’ intake of other smoke constituents can be reduced by setting limits for the ratio between yield of a certain substances and the yield of nicotine. </li></ul>
  20. 29. Summary (2) Regulation of information on packages <ul><li>Machine yield figures are not only meaningless but even misleading. </li></ul><ul><li>Smokers should be informed that their - intake of nicotine can be varied in a wide range depending on the way they smoke, but not very much by the choice of cigarette brand - intake of other substances is influenced by cigarette properties (brand-specific amount of various substances per unit of nicotine) </li></ul>
  21. 30. Summary (3) Regulation of smokefree products <ul><li>Regulations must recognize the very large differences in toxicity between different smokefree products and aim at eliminating from the market those who carry serious health risks rahter than those who do not. </li></ul><ul><li>There are examples of standards that can serve as models for designing meaningful regulations. </li></ul>

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