Tobacco Documents Online

• ,q* ~ # F~3M: tin. I. W. ~G , DR. R. A. REYNOI/MS/ MR. M. L. c. a. 4 rt / Toward Less Hazardous Cigarettes Current Advances Gio B. Gori, PhD, Cornelius J. Lynch. PhD • Criticat levels Of selected cigarette smoke constituent~ have bean llxpfessed In lerml; {)f maximum numbers of pre~1960 cig~telles that a ihloke~ may COnsume daily wllhout increasing his tour rarity risk substanlially above thai of a rtonsmoker. Thill could still imply ;~n ~mporlant risk, although It may be dif ficull to detect we relate these levels to the yields of 27 cut rent low tar and .Icoline commercial cigarettes, as measured at 1he Oak Ridge NationsI Labo~atorF. In eidditiort, the yields of II~ese selacle(I conetit~litnle ¢o.comitan| with the yield of 1 mg cf nicotine are provided as =l guide for the Ir~c)ker who tilrates Or IldJUSI$ his smoking pattern Io accommodate a fixed d|ily intake of nicotine, (JAMA 240:1255-1259, 197B) SINCE the Surgeon General's repert 011 smoking and heallh,' considerable attention has been f~used on alga- rette ~lnok~ ¢onstitu(l~ta implicated i. the cause of tobacco-related dis eases Many such comp0neIltS have b~en considered, the rnosl frequently For #dltoria! comment seep 1271. c~ted being total particulate mt~tter (tar). nicotlne, carbon mom~xide (COl. t~itroge, oxides (NO.). hydrogen cya- hide (HCNI. and aeroleln Several iftvest]gati0ns document the eontrihu- From t~e WltlC~ll Clncm InttJl~o. Bet~eldt Md (Dr GotiL al~a E.,aro Cc*~aot, k~c JRotkvilll lUlhorl a.d do not neo,ega.~ t efl=,c~ 1Ire view~ ot pohcies el IP, e Nit ,or,el C a.¢,t~ Inltltotl Pubh¢ , Rac~,~ I I aO;~• BetP~l~l MD 2t~ 14 (13. GCrll tlfln of base ¢ornponen S to cancer, chronic pulmonary disease, or eardle vascular lmpalrment~'' Many studie~ also indicale that there is a dose response between the number of ciga- rettes smoked and disease incidence and morbld~ty'"'" Since publication of the Surgeon General's report, aver- age tar values of commercial elga- rettes have deereased by 29r7'* and n~rotine yields have decreased by 21%, indicatlng a continuing prenecu- patlon t~ward reduced hazard " ]~valuatlon of health benefits re= su)t~ng from these reductions w~uJd be premature because of the Inng latent p eri~d~ invMved Available data suggest that, for the presetlt, smaki~g-ret~ed diseases have not abated substantially, with the possi- ble exceptloh of cardiovascular dis- eases Ilo~ever, factors contributing to the decline in these latter diseases are not yet clear. On the other hand, Sap1 15, IgTB~Vol 240, No. 12 mortality from tracheal bronchial and long cancer has continued to r~se; projections for t he imlnediate f~ture indicate that further increases may be expected¸ This probably is because smokers nov; n/ the age groups in which cancer ~s most likely to develop have spent a conslder~ble parL of their smoking hislory using h~gb tar and nlcotin~ cigarettes As younger 6nlokers who are exposed to lower tar and n~cotine cigarettes approach ¢ancer-suscei)tibIe ages. a reduction in morbidi~3¸ and mortality tales co~]dbeex~ctedHowever, conslder- ing tar and nicotine alone may give an incomplete and miMeading picture of hazard reduetinn: the [ail impact of low tar and n~cotine cigaretleg o~ health effecLs should be evaluated in Tattle L Ave[age Cr~licel Levels el pte-19~D CJ~att~I~ C~sum#Ji~" N=. of pie lg6n Dl~lln ctgarltltt Cancer ¢~ t~ ¢~p cramr a ph~,yng~al ca.cer ~ 5 E~hagea~ cancl¢ 7 3 pancreatic 0l.c*r ~ O Llt~gea~ c|.cer ~ 8 L~.= c~nc~t 5 7 Bl~d~r inO kid,~y ¢1~c1~ ~ 5 Ccro~arr a~l,y di*~lt~ 4 2 Coron~,y he*n din=lit 3 5 AO~,C I.*ut~*m • 5 Emph~ml. bt On¢~l~l. W born roe ~IE CIU~II ft~ cur.Ira |m~k~,B • O Less Hazardous Cigaretles--Geri & Lynch 1255 g ,;=

terma of aft the major toxic smoke ¢omp0.er*ts men(~nned prcvlausly Criticai levels of daily smoke inhal atlon have been discussed recq~tly in terms of the maximum nqmber of pre-l~J) cigarettes thai ma' be smoked daily without detectable in- crease to the average smoker's risk of mortality beyond that of a nonsmok- er," These are hy no means safe levels bul merely impl) that, for a smoker whose daily cnnsumptlon does not ex~tP~ the~e le¢~lg, any steendant tobacco-related mortalitl' risk may he epiderniologicalIy indiscernible from tkat of a i~onsmoker. ~¢ This cnu d sti]] imp y a s hs an a although less readily apparent rigk~ For instance, if the smoker's risk of developing lung cancer could he reduced from the present levc) of aopro~imateb l~l to some value less than 2:t th;s risk, while ransiderah e~ ¢ouJd be dJ~cull to esiah)Js~ ep)de- miologically, The inabilit.' to veri y this reduced risk might lead ~o its being considered socially tolerable Average critical levels relalix,e to diseases to which smokers are par tic- ularly susceptihie are listed in Table 1, expressed as daily numbers of pet' 1960 cigarettes The last entr3 in Table l. "All causes for current stunk- ors," is a ¢omprellenslve rategnr• representing the effect of eigarelle. consumption on mortaliqy in g~neral These xalues are based on t3piral~ yields per ei!zarOte of pro 1960 ci~a-- rettes: 43 mg of lar, 30 mg nf nice. tine. 23 mg of CO, 270 ug ~f NO., 410 ,uR of HCN, and 130 ~ e[ acrolein." CURRENT COMMEFICIAL CIGARETTES Mo~t commercia) brands toda, have yields that arc below the lyplt'al ore-1960 lex e[s, with partlcul~r inter- est in lowered tar and nicotine ylelds, h recent publicatlorl from the Oak Ridge Na anal Labora ory" its the yLelds of the six conslituents referred to previously for 32 brands of eom- merelal low far a~d nicotine riga reties, Twenty-se~en of these brands. have measured tar yiebls thai do I~ot exceed 100 mg hy more than two SEs. Results of testing for the~e 27 brand~ are sumr~arized in Table P The lowest measured tar yield is 12 rag, and the highest is 1o.3 mg ($E, 0.40 rag), Table 3 presents the percentage TDble 2 -- AnalyllC ~ DSlm [or Seleclqd Low Ta~ a~d Ni¢olme C,g~rettel ,, Cmr~O~ Ndnogmn Hyd,o~gn p~II M=II ~Ira M,Id S I n 47 5 ~ ~6 65 Real I0 ~ t 01 12 ~ 99 15~ Z6 Temp~ 69 es~ i0~ ise ~e Br~n~ m~'¢~" m9 ¢19 m~,clg s9 ¢i~ ~¢~ ~ ~;~ D~c~d~ B7 aS 81 ~ 1256 JAMA, Sept T5 1978--VO[ 240. NO. 12 Less ,~BZaFdOUS Clgaratfes--Gofl g Lynch Lq

~, . ~ ~1~ 4 --Grd;cal Lever~ .( $erec~.rf $mt)ke C,~r~st,t. NO olC~glrltt~sfleq,~,ed RellMe~ ~1, 5t 6 5~r,~ It~ 108" >8~ 2~ 10~ T~t~O ~" li~ 3~ 8 ~ Table 5--¥;e1~ ~f ~ele~edConsraue~ls Co~com;t~nl With yiel~ of 1 m0 N~C~I,~" ~6 ~7 r 13~ 130 ~a 85 Kenl~oF~e~Lr~htsM~m~l ~5 ~25 107 3~ 66~t H~ 4O 5~ 820f 40~ ~T5 13 a4 ~2 5~ 15 ~3 104 L|rk ~1 ll7 133 ra~ Luckyl~ 3~B g~ ~5 ~A iril Mer,thOl ~6 134 16 a ~75 10 T5 C} 103 Now 5a 63 Reil i 0 1O • i 0 12 9 99 q55 76 .E~¢~ ¢(,lu~ ~ ~1o ~;~e~ ¢~slil~en~/n~¢~l;n,* ~lio F~r ~x~mple~ ~s under col,Jm~ ~u~ed -TBt.~ ~i~e I~t ~ ~co~,~. ,~t;o~ ~Ex¢l*dl er;,~l yaks. JAMA. Sepl tS; 1978--Vol 24C, No 12 Less Hazardous Clgstettes--Gori & Lynch 1257

reductions in yieMs of these brands compared wRh yields of typical pre- 1960 cigarettes. Reductions range from a Mgh of more than 98% {Stride HCN yieM} to a low of 24% IKing 8Bno Menthol NO, yield ) On the aver- age, the brands under consideration have had the greatest percentage reduction in tar yield Ififi%) and the ]e~-st percentage reduction in CO and NO, yields (69%) compared with pre- 1960 cigarettes. The numbers of these cigarettes smoked daily wlthout exceeding criti- cal levels have been calculated from the data in Tables t and 2. as in the following example: since the critical level for all causes is two pre-19fi0 cigarettes, each yielding 48 mg of tar, the number of Bunsen & fledges Lights O0.1 mg of tar each) with the equivalent tar yield is fib Th~s, fi5 Bunsen & Hedges Lights bare a total tar yield equal to the critical level for the "AH causes for current smokers" category Similar values for all of the brands and constituents considered in this article are given in TaMe 4, rounded off to the nearest integer Critical levels were calculated under the assumption of a smoking pattern uniformly distributed over a ten hour period for any given day Deviations from such a smoking pattern emdd alter some critlea] values, such as those associated with CO effects " The lowest entry in each ro~ of Table 4 represents the maximum number of cigarettes of that brand that if smoked daily would not exceed the critical level for any of the smoke constituents considered• The highest row entry represents the maximum number of cigarettes of that beaod that if smoked daily would not exceed at least one of the smoke constituents considered. The range from highest Io lowest row erttries prm'ides the smok- er with intermediate goals for grad uaffy reducing his smoMng hahlt through progressively less hazardous smoking stages proceeding in this manner, be would gradually reach the lowest row entry as a daily maximum dgarette consumplion level At this point, the smoker is likely to be more receptive to taking the final step toward total eessatlnn " Similar con- siderations apply to brands not ex- plicitly addressed in this article It the majority of smokers proceeded along these lines, it would be reason- able to predict a substantial decrease in tobacco related morbidity and mortality It should be noted from Table 4 that the highest row entries for 14 brands are fok tar yields, whereas Ihe lowest row entries for 13 of the brands are for NO, y~elds In addlt~on, lowest row entries for nine brands occur for CO and acrolein These values suggest that the cigarette manufacturers should concentrate on ~be further reduction of NO, yields, while still altempting ta reduce further the y[eIds of other eonstitu- edits, particularly CO and acrolein. With the introduction of relatively I.o~x nieotine yields, it has been suggested that some smokers may compensate by increasin the total number of cigarettes smoked to main- tain a fixed dai/y level Df nicotine intake~ The daily intake of olher k6nstituents for such a person ~nuld depend on the nicotine enmpensatlen rate Table fi [isis the yMds of selected smoke eonstittlents coneomi rant with the yield of 1 mg of nicotine for the brands under consideration For example, for Bunsen & Hedges Lights about 12eigareltes yield 1 mg of nicotine This same number of cigarettes yields 12 I mg of tar, 145 mg of CO, 162 pg of NO.. 139 ,g of HCN. and 73 vg of aerolein. Thus, a sMloker eompensgt ins to 1 mg Of Men- fine would be exposed also to these ~ields of other smoke constituents Cunlpensatlng to o(her n~enilne ~al ues ,could affect assnclated yfelds proportionalely Tah/e 5 allows a smoker to estimate his smoke constit- uent intake, depending- on his own nicotine emnpensation vales The 1 mg of nicotine yield (one sixth or 17% el the critical valuel is accompanied by an NO. yield tha~ exceeds the ccitt cal level for two brands and by a CO yield 1hat exceeds it for one of these brands. Fur the remaining brands the nicoline intake can exceed 1 nlg before cnnconl[tant yields of other constituents exceed critical values COMMENT Pre-1960 eigaretles ha~e contrlh- uted most tn the current epidemic or tubaceo-relalod dlseases, and epide- mlologlc studles show a relationshlp belween number of clgaretles smoked daily and the risk of the development 12S8 JAMA, Sepl 15, 1978--VOl 240, NO 12 ) of dlsease From these studies, we can define the critical daily smoke intake that would nnl appreciably increase the risk of Ihe smoker over that of the nonsmoker. Because different cigare!te brands deliver different amounts of smoke of different eomlmsitions this critical smoke intake can be reel by smoking different numbers of cigarettes, de- pending on brand Today, cigarettes having toxic con stituent yields considerab]5 below pre-1960 cigarettes are feaslb/e, and forerunners of such clgaretles are commerciall) available T~enty-sev en Ilrands that fall loin tb~s category were tested at ~be Oak Ridge National Laboratory, and the numbers of these cigarettes smoked daill wilfioul ex- eeedln~ critical values ha~e been esti soled for six major toxic smoke constituents These critical values may serve as internmdlaln goals for a smoker whn is ~ntent On redudn~ his smoking habit through progressively less hazardous smoking slaves These calculations are hosed on the assump- tion tbat the smoker of the low tar and nlcotlnq cigaretles t~i]l not change his smnk[n~ habi!s in l.rms of depth of inharatlnn, fretluen% of puffing, and bull length Findings of recent studies support this assump- tion " Althml~h the linlds for 1he 27 brands are eons~derald! belm~ tile yields of the typical pre-lgfin else- reLies, addiqinnat reductions are war rnnled, partieularl3 t~ilh respect In NO.. (?O, and acroleln. Other~isc, smokers who compensate for fixed lexels of nicotine intake, even lhongh these levels do not exceed critical values for nicotine, may he sub)erring themsehes to dail5 ~ntakes of other toxic smoke ennstffnenls in exee~s of their esthnated crilleal ~ahw~ Metbeds for furlher reductions in 2. folds of Ioxic smoke censtlhwnts have been de~e/nped t hrlnJgh re~earch such as that eonduclod h3 he Na on- al Cancer Institnte's ,~nlokln~ and Health Program ~ fine nf the prlnri pal objectives of this prn~ram is In identify thtrse characteristics of riga- reties that lead ta toxlr and olher adverse effects and to delelnp meth- ods for reducing or elimlnating' such ~ factors. Progress has been made thus "%2 far in improvinl~ methods for reduc- ing tar yields through the use of Less Hazs#do*=~ Cigarsltes--Gori & Lynch

.4 ~recnnstituted tohacco sheet and in reducing ~rotlne ylelds throl~l~h In- bacqrl extrat'{;o~ i~t-o~-esseg ~n~ re. blending 01her smoke yields ha~e hean adjusted through selected enm. hinatinns of filters lnd smoke dilu- tion devices, the usr of h~hqmro~tx paper, the use of Iohaccn blends rich in nitrates, and the adjustmenl of the cigarette's burning r~e Ftlrther in- corporation of these and n~her slale- oLthe-art &d,ances coupled ~Gth fls vor geeeptabilit) characteristics can I ~e,~l.g ~m~ lh~llh liep~ qfthr Ad~.t~ly lh~dlb y~, ~.i~es rmhlieiIi~ 1103¸ public Heallh ~rviee. 19~4 2 A~der~n EW, Andttmar EJ. STraurh J~1 t,~ al Effe¢1 r+f la~ level ¢~rh~a mt,n~ide e~p~. Sur~ r~ nn~e~ and durarlnn or an~m~ l~Clnrix A stud~ in te~ p|~irnts ,~th isehem~ h~arl dis~ace ,4 ~it I ~#-rl; Mvd 7~ I~ 1973 3 AuerhachO, Stout~P. llKmm~ilEll, eIRl llis1~In¢~¢ ¢h~ges i~ es~p~=~ ir~ relatio~ to =m0kinf hahi~B Arrh E~.iro. H~hb t14.1S 19.5S t. Ar~n~ WS Smnkln~. rlrhon mnn+]~ide and ~,ro,xary heart disuse rtrr u/,~t,m, 4~ 11~9. II~ Iq73 S Aron~v¸ WS S~Ins,,~ A~: The effe¢l of Io~ nier*l~e rieare1{~s o~ anJ, J~z p¢ctnris A~ I~ter~; ~t~e,f 71 5~9 601 l~fi~ fi Dol~ P~ Hill AR Mortalily ~n ~1=lh1~ to imok~n;z Ten year~ ohser, a~;ons of R~t~sh dn~t nrs Br ~;~d J I I ~EO.I I~7 ]~4 ? Ft=umeni JF Jr C~;{arelle ~mokJ~ mnd ra~ers of Lhe u~Jnary ~ract Ger~zraphi¢ ,aria finn in the United $1~t~ J NaI~ f~,~rer I~ 41 I~5 1211, I~$ $ GrOBS P, d~ Tr~liLle RTP, Babyak M ~, ~t a! improve cor~mcreial]! ava~rahle c~a retle~ to the no;hi tthnr¢ Ihey rna3 prnper]y ~, {or nit(1 ]e~,s ha~rclt~Ls The ralinnalc ~r dove[opln~ less ~a~ardnu~ cigarettes rn~(s nn the fac~ Ihal despite 1he p~ddiei(y izivc n to Ihe heallh risks associated with smakin¢. nld~re th~n 5~ miTllon ~,meriean~ ~till smnkin~ shmdd continue, the~e ed~l ealional elf~rI~ shollh~ he eoulded wlth nthers direcled Inward rcdnein~ the ri~ks to persislent Smokers¸ Rlfere~ce$ E~i,erlme.lal rml,~sema Effr¢l~ ~f rhr~Mie ni~ rr,~en 4io~id e cxr~r e and papain ~n normal ~nd p~e.m~nni~tic hm~ A.'~ E. i,i~ r~,l Ih~tDh I~ Sl 5~, I r~ ~- ~ I[a.,mond E~" Smnkin~, in t,hl~r,~ I~ the deall¸ ralr~ ,,. I mill~,m mrn and ~omen. in ila, n~,I ~ 4vd~ Ep~d, mi~;~c.i tpp,r~rh,~ ~n National Ca~.~ Insllhlqe. I~C,~ ~p 127 .~11 In I(ahn IIA Th~ P, orn studI ~t s.lokin~ sn~I F.p,drm,~.~,cnl A/,~rr.,rhcs h, th, ~t,4~ ,~¢ rn.r~r n~d ~hr,¸ D~nses m~n~rap~ 19 ~¢lheMa. ~fd Puhli¢ Ileahh Service, Nati0T~l II I~ r ain T,S CT~,~S~nI~ of the rnnr t al~ cur,e~ for stoma, h and pacer e~t~r carc~nom ~ lrt~ S~,,'~ ST ~,O~ 31n 1972 ~2 Mnrr~'~ ~" Su=re~ G M~tc.sal rl~n~es |rid ¢~¢er in intra~ral ~mokJnl[ L~t~r~ol~" Er,ider, Lml~~ ,,~ cancvr nf the p~n~r,~s ,'~t~ 14 M,,~w~PI JC Jr The IP?~ Maxwell reprrl t~ersuadin,~ the smokPr tn wean h~mselI tn prc, l~l'e~si~ei! less hazard. mrs chzareHes may prodd~ an slier- nat[re to ~lllnk~n~ cessation thai i~ perhaps more effecfilo than the sell den~al apprn~ches of o=rrenl anti- snlokin~ nl~ssa~cs Altlmlt~h Ihis ~w~lld not eI~nlin;lt¢, Ihe rNks hi Ihe snicker, it is an ai)p~ ~ach [h~t has the pmenti~l in r~hlce the cl~rr~n~ elli. denlic of $1~lo~irl~ 3s=-(/ll;~t(~d ~i~e~sP~ In a ¢nn~idernhl1 le~ ~erlr,u~ puhlic health problem Oak RhlR,s Te~n Oak Ri,h.~ N~i~l r~=h,,.z t~r~ • Iq77 L~*~ I,~nr~ln, Mass. Che~,,I t'~hllrslion~ I~ ~lJ~serl MMI Wil~n F. p~rel / A ~ a~ ('nn,l,aHsnn nf elT~,q nn trh~rr~ r~ns~,n,pI,r,n ind ~aH~.~ m ¢mo ~irle ah.or;,ti,,n *if ch~n~in~ ~n high ~d low ~i¢~ilne ¢igareqt e~ /~, M,~I 1512. 1973 pr~thJclx and ~he~r ar,~pt~n~e h, ~he r*,ns~mcr I%~¢cctliny, ~f ~h¢ ~lh Inlernzli~al T~,arro ~,r I~;r B~qhe~ Mrl pI~, Health Fer, ire Nallon~l ( ~nerr Institute. 197~ C~ J&MA, Sep( 15. Ig/g--Vol :MO, No 12 Less Hezardous CigatellaS GOd & Lynch 1259