Geoffrey Ferris Wayne

Developing smokeless tobacco products for smokers: an examination of tobacco industry documents

Objective: To investigate whether development of smokeless tobacco products (SLT) is intended to target current smokers. Methods: This study analysed internal tobacco industry documents to describe research related to the smokeless tobacco market. Relevant documents included those detailing the development and targeting of SLT products with a particular emphasis on moist snuff. Results: Cigarette and SLT manufacturers recognised that shifting demographics of SLT users, as well as indoor smoking restrictions, health concerns and reduced social acceptability of smoking could impact the growth of the SLT market. Manufacturers developed new SLT products to target cigarette smokers promoting dual cigarette and SLT use. Conclusions: Heavy marketing of new SLT products may encourage dual use and result in unknown public health effects. SLT products have been designed to augment cigarette use and offset regulatory strategies such as clean indoor air laws. In the United States, the SLT strategy may provide cigarette companies with a diversified range of products under the prospect of federal regulation. These products may pose significant challenges to efforts by federal agencies to reduce harm caused by tobacco use.

Tobacco industry control of menthol in cigarettes and targeting of adolescents and young adults.

OBJECTIVES We examined whether tobacco manufacturers manipulate the menthol content of cigarettes in an effort to target adolescents and young adults. METHODS We analyzed data from tobacco industry documents describing menthol product development, results of laboratory testing of US menthol brands, market research reports, and the 2006 National Survey on Drug Use and Health. RESULTS The tobacco industry attracted new smokers by promoting cigarettes with lower menthol content, which were popular with adolescents and young adults, and provided cigarettes with higher menthol content to long-term smokers. Menthol cigarette sales remained stable from 2000 to 2005 in the United States, despite a 22% decline in overall packs sold. CONCLUSIONS Tobacco companies manipulate the sensory characteristics of cigarettes, including menthol content, thereby facilitating smoking initiation and nicotine dependence. Menthol brands that have used this strategy have been the most successful in attracting youth and young adult smokers and have grown in popularity.

Application, function, and effects of menthol in cigarettes: A survey of tobacco industry documents

Menthol cigarettes are the only cigarette market category identified by use of a flavor additive and constitute more than a quarter of the overall market. Menthol also is used at reduced levels in many nonmenthol brands. Public health research has suggested patterns of use of mentholated brands as a potential explanation for the health disparities between Black (largely menthol) and White (largely nonmenthol) smokers and has explored the effects of menthol on smoker behavior, consumption patterns, and consequent delivery of smoke constituents. However, relatively few published studies have directly examined the physiological impact and function of menthol delivery in cigarettes. In this study, we review internal tobacco industry documents to assess industry research on function and effects of menthol in cigarettes. Industry documents describe a range of physiological effects of menthol, with important implications for use and consumption patterns. These effects include altered perception of tobacco smoke and its constituents via cooling, smoothing, and anesthetic effects; increased impact through stimulation of trigeminal receptors; interaction with nicotine controlling its perception, delivery, and uptake; and increased respiratory irritation and toxic effects. Further studies are needed to evaluate these findings. We conclude that the unique differences between menthol cigarettes and nonmenthol cigarettes must be considered in research, cessation treatment, and enactment of tobacco product regulations.

Revisiting the evidence on health and health care disparities among the Roma: a systematic review 2003-2012.

ObjectivesTo conduct a systematic review of the epidemiological and health service utilization literature related to the Roma population between 2003 and 2012.MethodsSystematic review of empirical research related to Roma health and health care utilization published between 2003 and 2012 identified through electronic databases (PsycInfo, Medline, Google Scholar). Methodological rigor was evaluated using a six-point set of design criteria.ResultsWe found evidence for lower self-reported health and significantly higher mortality risk for Roma compared to non-Roma, and greater prevalence of health risk factors for Roma children, including environmental risks, low birth weight, and lower vaccination coverage. Studies of non-communicable and infectious disease remain insufficient to make firm conclusions on disparities. Barriers to care include lack of documentation and affordability of care, though more studies on health care utilization are needed.ConclusionsRoma youth and adults are in need of programs that reduce health disparities and their increased mortality risk. Reducing exposure to risk factors such as smoking, obesity, and poor living conditions may be a target for interventions. More intervention studies and rigorous evaluations are needed.

Trends in nicotine yield in smoke and its relationship with design characteristics among popular US cigarette brands, 1997–2005

Objectives: To determine whether nicotine yields in the smoke of cigarettes would show an overall increase over time or an increasing trend limited to any particular market category (eg, full flavour vs light, medium (mild) or ultralight; mentholated vs non-mentholated), manufacturer, or brand family or brand style, and whether nicotine yields in smoke would be associated with measurable trends in cigarette design. Methods: Machine-based measures of nicotine yield in smoke and measures of cigarette design features related to nicotine delivery (ventilation, nicotine content in the tobacco rod and number of puffs), as well as market category descriptors, were obtained from annual reports filed with the Massachusetts Department of Public by tobacco manufacturers for 1997–2005. Trends in nicotine yield and its relationship with design features and market parameters were analysed with multilevel mixed-effects regression modelling procedures. Results: A statistically significant trend was confirmed in increased nicotine yield, of 0.019 (1.1%) mg/cig/year over the period 1997–2005 and 0.029 (1.6%) mg/cig/year over the period 1998–2005. The increasing trend was observed in all major market categories (mentholated vs non-mentholated, and full flavour vs light, medium (mild) or ultralight). Nicotine yield in smoke was positively associated with nicotine concentration in the tobacco and number of puffs per cigarette, both of which showed increasing trends during the study period. Conclusions: This study confirms increased machine-measured levels of nicotine, the addictive agent in cigarettes, in smoke, to be a result of increased nicotine in the tobacco rod and other design modifications.

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.

Assessing internal tobacco industry knowledge of the neurobiology of tobacco dependence

The recent availability of internal tobacco industry documents provides a significant resource for evaluating industry understanding of the pharmacological, psychosocial, and behavioral mechanisms underlying tobacco dependence. In this study, we catalog the range of efforts undertaken by tobacco manufacturers seeking knowledge of these mechanisms. Some areas of industry research, such as cellular and molecular studies of nicotine and its effects, are widely available in the open literature. Of greater interest are internal research projects that have demonstrated direct influence on product development. These include studies of smoker psychology and behavior, evoked-response studies of tobacco-delivered nicotine, the effects of sensory perception, dose-related effects, and the development of nicotine analogs and synergists. Our findings suggest extensive industry knowledge of mechanisms that determine smoker perception and behavior, and application of this knowledge in product development, including control of sensory response, uptake of nicotine, and product effects. Independent research recently has begun to consider the contributions of tobacco product ingredients and design factors to the determination of risk, severity, and prevalence of addiction. However, the application of these findings to cessation and treatment efforts is still quite limited. We conclude that clinical research would greatly benefit from further examination of the decades of knowledge accumulated by tobacco manufacturers.

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.

The impact of menthol cigarettes on smoking initiation among non-smoking young females in Japan.

Japan presents an excellent case-study of a nation with low female smoking rates and a negligible menthol market which changed after the cigarette market was opened to foreign competition. Internal tobacco industry documents demonstrate the intent of tobacco manufacturers to increase initiation among young females through development and marketing of menthol brands. Japanese menthol market share rose rapidly from less than 1% in 1980 to 20% in 2008. Menthol brand use was dominated by younger and female smokers, in contrast with non-menthol brands which were used primarily by male smokers. Nationally representative surveys confirm industry surveys of brand use and provide further evidence of the end results of the tobacco industry’s actions—increased female smoking in Japan. These findings suggest that female populations may be encouraged to initiate into smoking, particularly in developing nations or where female smoking rates remain low, if the tobacco industry can successfully tailor brands to them. The Japanese experience provides a warning to public health officials who wish to prevent smoking initiation among young females.

Tobacco Industry Manipulation of Nicotine Dosing

For more than a half century, tobacco manufacturers have conducted sophisticated internal research to evaluate nicotine delivery, and modified their products to ensure availability of nicotine to smokers and to optimize its effects. Tobacco has proven to be a particularly effective vehicle for nicotine, enabling manipulation of smoke chemistry and of mechanisms of delivery, and providing sensory cues that critically inform patterns of smoking behavior as well as reinforce the impact of nicotine. A range of physical and chemical product design changes provide precise control over the quantity, form, and perception of nicotine dose, and support compensatory behavior, which is driven by the smokers addiction to nicotine. Cigarette manufacturers also enhance the physiological effects of nicotine through the introduction and use of compounds that interact with nicotine but do not directly alter its form or delivery. A review of internal documents indicates important historical differences, as well as significant differences between commercial brands, underscoring the effectiveness of methods adopted by manufacturers to control nicotine dosing and target the needs of specific populations of smokers through commercial product development. Although the focus of the current review is on the manipulation of nicotine dosing characteristics, the evidence indicates that product design facilitates tobacco addiction through diverse addiction-potentiating mechanisms.