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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Meaningful public education by labelling on tobacco packages: Some elements o...
Information provided on tobacco packages should clarify that:
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2. Intake of other harmful substances depends on the brand-specific ratio of each substance to nicotine.
3. Health risk information should make clear that nicotine itself poses little risk, while combustion products in smoked tobacco are highly dangerous, and nicotine replacement therapies and smokeless tobacco are much less risky than smoking.
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Meaningful public education by labelling on tobacco packages: Some elements o...
Information provided on tobacco packages should clarify that:
1. A smoker's nicotine intake from cigarettes varies widely based on how they smoke and depends on their personal nicotine needs, not machine-measured yields.
2. Intake of other harmful substances depends on the brand-specific ratio of each substance to nicotine.
3. Health risk information should make clear that nicotine itself poses little risk, while combustion products in smoked tobacco are highly dangerous, and nicotine replacement therapies and smokeless tobacco are much less risky than smoking.
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- Products like cigarettes, smokeless tobacco, e-cigarettes, and novel products will be regulated. Ingredients giving flavors or health impressions will be restricted. Misleading packaging and labeling will be prohibited.
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3) Regulating e-cigarettes as medications poses several problems and may stifle innovation, give the market to big tobacco, and result in fewer smokers quitting. Consumer product regulation with additional safety standards may better balance public health and individual freedom.
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ANTI TOBACCO LAW
India has a significant tobacco problem, with 16% of smokers globally living in India. Tobacco use causes over 2,500 deaths per day in India. Several laws and policies have been implemented to reduce tobacco use. The Cigarettes and Other Tobacco Products Act of 2003 expanded regulations to include all tobacco products and required larger health warnings. Executive orders have also targeted tobacco, such as banning scenes depicting tobacco use in films. Other measures include prohibiting indoor smoking in public places and imposing taxes on tobacco. However, myths still exist around the economic and health impacts of tobacco that require addressing to curb its widespread use in India.
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This document summarizes a study comparing self-reported health perceptions among different groups of tobacco users in Sweden. The study found that:
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- 2. Regulation of: - amounts of various constituents in cigarette smoke - information on packages regarding smoke constituents - smokefree tobacco products
- 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.
- 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 .
- 8. In I 2001, the U.S. National Cancer Institute (NCI) published Monograph 13
- 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
- 14. Example of brand comparison
- 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)
- 16. Example of brand comparison
- 17. Regulation of: - amounts of various constituents in cigarette smoke - information on packages regarding smoke constituents - smokefree tobacco products
- 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.
- 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”.
- 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)
- 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
- 22. Regulation of: - amounts of various constituents in cigarette smoke - information on packages regarding smoke constituents - smokefree tobacco products
- 23. Mean nitrosamine content of moist snuff products from various sources based on dry weight