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Tungare S, Myers AL. Retail Availability and Characteristics of Addictive Areca Nut Products in a US Metropolis. J Psychoactive Drugs 2021; 53:256-271. [PMID: 33491557 DOI: 10.1080/02791072.2020.1860272] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Consumption of the areca (betel) nut is the world's fourth-most common addictive habit, only after caffeine, alcohol, and nicotine. Mastication of the nut releases psychoactive alkaloids that produce greater alertness, a tingling sensation in the body, and euphoria. Consumption is prevalent in many Asia-Pacific countries, but also within immigrant populations in Europe and North America. Regarding use/abuse in the US, data are limited to mostly case/anecdotal reports, and some published literature. Little is known about the retail availability and product characteristics of areca products in the US. In this field observational study, we found that areca products were relatively inexpensive, readily available, and easily purchased in grocery stores visited in Houston, TX. Almost entirely, no hindrances or warnings for purchasing occurred, which is concerning since it is well-established that consumption is associated with substance abuse and untoward oral/systemic health effects. Several products contained the sweetening agent sodium cyclamate, a substance currently banned by the FDA. Others products contain menthol, the role of which in areca addiction is unknown. Collectively, our findings support the need for future psychopharmacological and public health research, as well as closer investigation by US policy makers and statewide/federal regulatory agencies.
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Affiliation(s)
- Sayali Tungare
- Department of Epidemiology, School of Public Health, The University of Texas Health Science Center, Houston, TX, USA
| | - Alan L Myers
- Department of Diagnostic & Biomedical Sciences, School of Dentistry, The University of Texas Health Science Center, Houston, TX, USA
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High Particulate Matter Burden of Cigarettes from the United Arab Emirates and Germany: Are There Country-Specific Differences? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072415. [PMID: 32252343 PMCID: PMC7177534 DOI: 10.3390/ijerph17072415] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 03/31/2020] [Accepted: 04/01/2020] [Indexed: 01/08/2023]
Abstract
Although the big tobacco companies offer the same cigarette brands across countries, little is known about the potential regional differences of the particulate matter (PM) emissions of apparently equal brands. PM emissions of three cigarette brands (Marlboro Gold, Winston Red resp. Classic, Parliament Platinum resp. Night Blue) from the United Arab Emirates (UAE) and Germany were analysed. Second-hand smoke was produced in a 2.88 m3 measuring cabin by an automatic environmental tobacco smoke emitter. PM size fractions PM10, PM2.5, and PM1 were detected in real-time using laser aerosol spectrometry. Depending on the PM fraction Marlboro cigarettes from UAE showed 33%-35% higher PM amounts. Moreover, Winston cigarettes from UAE showed distinctly higher PM values (28-31%) than the German counterparts. The "lighter" Parliament from UAE emitted 3%-9% more PM than the German one. The measured mean PM10 values laid between 778 and 1163 µg/m3 (mean PM2.5: 777-1161 µg/m3; mean PM1: 724-1074 µg/m3). That means smoking in enclosed rooms causes massive PM burden. The PM emission of equal or similar tobacco products from different countries can differ distinctly. Hence, the declaration of PM emission values, besides nicotine, tar, and carbon monoxide amounts, should be obligatory worldwide. Furthermore, complete information about the ingredients and production processes of tobacco products should be provided to health officials and the public. This can help to minimise or ban substances or product designs that make smoking even more harmful, and to enhance the awareness of the risks of smoking.
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Paraje G, Araya D, Drope J. The association between flavor capsule cigarette use and sociodemographic variables: Evidence from Chile. PLoS One 2019; 14:e0224217. [PMID: 31644598 PMCID: PMC6808557 DOI: 10.1371/journal.pone.0224217] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 10/08/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose The objective of this article is to examine the factors associated with smoking of flavor capsule cigarettes in Chile, where the popularity of these products has increased dramatically, a trend increasingly observed across the world. Methods A representative poll of 851 smokers in Metropolitan Santiago de Chile, which comprises 40% of the country's total population, was implemented in mid-2017. Smokers were given a questionnaire that collected socio-demographic information and information on smoking patterns. Four discrete-choice models were estimated on the decision to smoke flavor capsule cigarettes to better understand the statistical relationships between traits of smokers and the consumption of flavor capsule cigarettes. Results The results of these models show that each year less in a smoker’s age increases the likelihood of preferring flavor capsule cigarettes by, on average, between 0.8 and 0.9 percentage points. If the smoker is a woman, the likelihood of preferring flavor capsule cigarettes increases between 13.4 and 13.5 percentage points. Results also reveal a positive relationship between the price paid and the consumption of flavor capsule cigarettes, indicating that these cigarettes tend to be more expensive. There is no statistical relationship between participation in the labor market and smoking these products. Conclusions Chile has the world’s highest prevalence of flavor capsule cigarette smoking, which is concentrated among young people (25 years and younger) and females. No relationship between socioeconomic status and use of these products is found, though there are indications that such relationship may exist, as they were at the time of study 14% more expensive, on average, than conventional non-flavored cigarettes. As in most countries, the tobacco industry appears to be deliberately promoting these products with the goal of halting or slowing the decline in cigarette consumption in Chile. Thus, to reduce cigarette consumption (especially among youth), restricting or forbidding cigarette flavorings of all types, including flavor capsules, would be an effective strategy.
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Affiliation(s)
- Guillermo Paraje
- Escuela de Negocios, Universidad Adolfo Ibáñez, Santiago de Chile, Chile
- Economic & Health Policy Research, American Cancer Society, Atlanta, Georgia, United States of America
- * E-mail:
| | - Daniel Araya
- Escuela de Negocios, Universidad Adolfo Ibáñez, Santiago de Chile, Chile
| | - Jeffrey Drope
- Economic & Health Policy Research, American Cancer Society, Atlanta, Georgia, United States of America
- Department of Political Science, Marquette University, Atlanta, Georgia, United States of America
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Oliveira da Silva AL, Bialous SA, Albertassi PGD, Arquete DADR, Fernandes AMMS, Moreira JC. The taste of smoke: tobacco industry strategies to prevent the prohibition of additives in tobacco products in Brazil. Tob Control 2019; 28:e92-e101. [PMID: 31152115 DOI: 10.1136/tobaccocontrol-2018-054892] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 04/10/2019] [Accepted: 04/23/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND The tobacco industry (TI) uses several strategies to attract new consumers, including using additives in tobacco products, which makes tobacco especially attractive to youth. Based on scientific evidence and the principles of the WHO Framework Convention on Tobacco Control, the Brazilian Health Regulatory Agency (ANVISA, for the name in Portuguese), published the Collegiate Board Resolution (RDC, for the name in Portuguese) 14/2012 in 2012, prohibiting the addition of substances that enhance the flavour and taste of tobacco products in order to make them more attractive. In response, the TI used various strategies to prevent RDC 14/2012 from entering into force. At the time, the Brazilian additive ban was the most comprehensive in the world as it included a ban on menthol. OBJECTIVES This paper analyses the arguments and strategies used by the TI to prevent the implementation of the additives ban. METHODS Review of published articles, reports, legislation and legislative activity, internal TI documents, media stories and other documents to describe TI's reaction to the ban. RESULTS The results show that the TI used some well-known strategies to delay or cancel the entering into force of the resolution. For example, the TI attempted political interference, used litigation and commissioned studies with findings that questioned the resolution's rationale. The TI strategies used in Brazil are similar to those used at the global level to oppose other tobacco control measures. CONCLUSIONS TI successfully delayed the most comprehensive additive ban in the world using its usual tactics, despite the fact that none of the arguments presented by the TI had an acceptable scientific basis or evidence.
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Affiliation(s)
- Andre Luiz Oliveira da Silva
- CESTEH, Escola Nacional de Saude Publica Sergio Arouca, Rio de Janeiro, RJ, Brazil .,Agencia Nacional de Vigilancia Sanitaria - ANVISA, Rio de Janeiro, RJ, Brazil
| | | | | | | | | | - Josino Costa Moreira
- CESTEH, Escola Nacional de Saude Publica Sergio Arouca, Rio de Janeiro, RJ, Brazil
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Affiliation(s)
- Stanton A Glantz
- Department of Medicine, Center for Tobacco Control Research and Education, Cardiovascular Research Institute, Philip R. Lee Institute for Health Policy Studies, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA 94143-1390, USA
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Braun M, Koger F, Klingelhöfer D, Müller R, Groneberg DA. Particulate Matter Emissions of Four Different Cigarette Types of One Popular Brand: Influence of Tobacco Strength and Additives. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E263. [PMID: 30658514 PMCID: PMC6352107 DOI: 10.3390/ijerph16020263] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 01/10/2019] [Accepted: 01/15/2019] [Indexed: 01/13/2023]
Abstract
The inhalation of particulate matter (PM) in second-hand smoke (SHS) is hazardous to health of smokers and non-smokers. Tobacco strength (amount of tar, nicotine, and carbon monoxide) and different additives might have an effect on the amount of PM. This study aimed to investigate the influence of tobacco strength or additives on PM. Four cigarette types of the brand Marlboro with different strengths and with or without additives were analyzed in comparison to the 3R4F reference cigarette. SHS was generated by an automatic environmental tobacco smoke emitter (AETSE) in an enclosed space with a volume of 2.88 m³. PM concentrations (PM10, PM2.5, PM₁) were measured with a laser aerosol spectrometer followed by statistical analysis. The two strongest Marlboro brands (Red and Red without additives) showed the highest PM concentrations of all tested cigarettes. The measured mean concentrations Cmean of PM10 increased up to 1458 µg/m³ for the Marlboro Red without additives (PM2.5: 1452 µg/m³, PM₁: 1263 µg/m³). The similarly strong Marlboro Red showed very similar PM values. The second strongest type Marlboro Gold showed 36% (PM10, PM2.5) and 32% (PM₁) lower values, respectively. The "lightest" type Marlboro Silver Blue showed 54% (PM10, PM2.5) or 50% (PM₁) lower PM values. The results indicate that the lower the tar, nicotine, and carbon monoxide amounts, as well as the longer the cigarette filter, the lower are the PM levels. An influence of additives could not be determined.
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Affiliation(s)
- Markus Braun
- Institute of Occupational, Social and Environmental Medicine, Goethe University Frankfurt, Theodor-Stern-Kai 7, D-60590 Frankfurt am Main, Germany.
| | - Friedemann Koger
- Institute of Occupational, Social and Environmental Medicine, Goethe University Frankfurt, Theodor-Stern-Kai 7, D-60590 Frankfurt am Main, Germany.
| | - Doris Klingelhöfer
- Institute of Occupational, Social and Environmental Medicine, Goethe University Frankfurt, Theodor-Stern-Kai 7, D-60590 Frankfurt am Main, Germany.
| | - Ruth Müller
- Institute of Occupational, Social and Environmental Medicine, Goethe University Frankfurt, Theodor-Stern-Kai 7, D-60590 Frankfurt am Main, Germany.
- Medical Entomology, Department of Biomedical Sciences, Institute of Tropical Medicine, Nationalestraat 155, B-2000 Antwerpen, Germany.
| | - David A Groneberg
- Institute of Occupational, Social and Environmental Medicine, Goethe University Frankfurt, Theodor-Stern-Kai 7, D-60590 Frankfurt am Main, Germany.
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Braun M, Fromm EL, Gerber A, Klingelhöfer D, Müller R, Groneberg DA. Particulate matter emissions of four types of one cigarette brand with and without additives: a laser spectrometric particulate matter analysis of secondhand smoke. BMJ Open 2019; 9:e024400. [PMID: 30782733 PMCID: PMC6340634 DOI: 10.1136/bmjopen-2018-024400] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 11/14/2018] [Accepted: 11/15/2018] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Inhaled particulate matter (PM) in secondhand smoke (SHS) is deleterious for smokers and non-smokers. Different additives in cigarettes might effect the amount of PM. This study aimed to assess the influence of additives on the PM emissions from different cigarette types in SHS. DESIGN An experimental study of PM measuring in SHS of cigarettes without exposition of any person. METHOD The concentrations of PM (PM10, PM2.5 and PM1) in SHS of four different types of cigarettes of the brand Lucky Strike, two types with additives (Original Red, Original Blue) and two types without additives (Straight Red, Straight Blue), in comparison to the reference cigarette 3R4F were analysed. An automatic environmental tobacco smoke emitter generated SHS in an enclosed space with a volume of 2.88 m3. PM was measured with a laser aerosol spectrometer (Grimm model 1.109). Afterwards, the measuring values of the four Lucky Strike brands and the reference cigarette were statistically evaluated and visualised. RESULTS Lucky Strike Straight Blue, a cigarette type without additives and lower tar amount, showed 10% to 25% lower PM mean values compared with the other tested Lucky Strike products, but 21% (PM1) respectively 27% (PM2.5,PM10) higher mean values than the reference cigarette. The PM mean of all measured smoke-free baseline values (clean air) was 1.6 µg/m³. It increased up to about 1800 µg/m³ for the reference cigarette and up to about 3070 µg/m³ for the Lucky Strike Original Blue. CONCLUSIONS The findings of this study show the massive increase of PM amount by smoking cigarettes in enclosed spaces and suggest that additives in tobacco products increase the PM amount in SHS. For validation, further comparative studies are necessary focusing on the comparison of the PM concentration of cigarettes with and without additives. IMPLICATIONS Due to the exposure to SHS, 890 000 people die each year worldwide. PM in SHS endangers the health of both non-smokers and smokers. This study considers the effect of additives like aromatics and humectant agents in cigarettes on PM in SHS. Do additives in tobacco products increase the amount of PM?
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Affiliation(s)
- Markus Braun
- Institute of Occupational, Social and Environmental Medicine, Goethe University Frankfurt, Frankfut am Main, Germany
| | - Elsa-Luise Fromm
- Institute of Occupational, Social and Environmental Medicine, Goethe University Frankfurt, Frankfut am Main, Germany
| | - Alexander Gerber
- Institute of Occupational, Social and Environmental Medicine, Goethe University Frankfurt, Frankfut am Main, Germany
| | - Doris Klingelhöfer
- Institute of Occupational, Social and Environmental Medicine, Goethe University Frankfurt, Frankfut am Main, Germany
| | - Ruth Müller
- Institute of Occupational, Social and Environmental Medicine, Goethe University Frankfurt, Frankfut am Main, Germany
| | - David A Groneberg
- Institute of Occupational, Social and Environmental Medicine, Goethe University Frankfurt, Frankfut am Main, Germany
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Glantz SA. PMI's own in vivo clinical data on biomarkers of potential harm in Americans show that IQOS is not detectably different from conventional cigarettes. Tob Control 2018; 27:s9-s12. [PMID: 30131374 PMCID: PMC6202159 DOI: 10.1136/tobaccocontrol-2018-054413] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 07/10/2018] [Accepted: 08/01/2018] [Indexed: 11/03/2022]
Abstract
INTRODUCTION New 'heated tobacco products' are being marketed in several countries with claims that they expose users to lower levels of toxins than conventional cigarettes which could be read as being less likely to cause health problems than conventional cigarettes. In the USA, Philip Morris International (PMI) has submitted an application to the Food and Drug Administration for permission to market its heated tobacco product, IQOS, with reduced exposure and reduced risk claims. METHODS Analysis of detailed results on 24 biomarkers of potential harm in PMI studies of humans using IQOS compared with humans using conventional cigarettes. RESULTS Among American adults, there is no statistically detectable difference between IQOS and conventional cigarette users for 23 of the 24 biomarkers of potential harm in PMI's studies. In Japan, there were no significant differences between people using IQOS and conventional cigarettes in 10 of 13 biomarkers of potential harm. It is likely that some of the significant differences are false positives. CONCLUSION Despite delivering lower levels of some toxins than conventional cigarettes, PMI's own data fail to show consistently lower risks of harm in humans using its heated tobacco product, IQOS, than conventional cigarettes.
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Affiliation(s)
- Stanton A Glantz
- Department of Medicine/Division of Cardiology, University of California San Francisco, San Francisco, CA 94143-1390, USA
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA 94143-1390, USA
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Gerharz J, Bendels MHK, Braun M, Klingelhöfer D, Groneberg DA, Mueller R. Particulate matter emissions of different brands of mentholated cigarettes. JOURNAL OF THE AIR & WASTE MANAGEMENT ASSOCIATION (1995) 2018; 68:608-615. [PMID: 29315025 DOI: 10.1080/10962247.2017.1417184] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 12/08/2017] [Indexed: 06/07/2023]
Abstract
UNLABELLED Inhaling particulate matter (PM) in environmental tobacco smoke (ETS) endangers the health of nonsmokers. Menthol, an additive in cigarettes, attenuates respiratory irritation of tobacco smoke. It reduces perceptibility of smoke and therefore passive smokers may inhale ETS unnoticed. To investigate a possible effect of menthol on PM concentrations (PM10, PM2.5, and PM1), ETS of four mentholated cigarette brands (Elixyr Menthol, Winston Menthol, Reyno Classic, and Pall Mall Menthol Blast) with varying menthol content was analyzed. ETS was generated in a standardized way using an automatic environmental tobacco smoke emitter (AETSE), followed by laser aerosol spectrometry. This analysis shows that the tested cigarette brands, despite having different menthol concentrations, do not show differences with regard to PM emissions, with the exception of Reyno Classic, which shows an increased emission, although the menthol level ranged in the midfield. More than 90% of the emitted particles had a size smaller than or equal to 1 µm. Regardless of the menthol level, the count median diameter (CMD) and the mass median diameter (MMD) were found to be 0.3 µm and 0.5 µm, respectively. These results point out that there is no effect of menthol on PM emission and that other additives might influence the increased PM emission of Reyno Classic. IMPLICATIONS Particulate matter (PM) in ETS endangers the health of nonsmokers and smokers. This study considers the effect of menthol, an additive in cigarettes, on PM emissions. Does menthol increase the amount of PM? Due to the exposure to secondhand smoke nearly 900,000 people die each year worldwide. The aim of the study is to measure the particle concentration (L-1), mass concentration (µg m-3), and dust mass fractions shown as PM10, PM2.5, and PM1 of five different cigarette brands, including four with different menthol concentrations and one menthol-free reference cigarette, in a well-established standardized system.
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Affiliation(s)
- Julia Gerharz
- a Institute of Occupational, Social and Environmental Medicine, Goethe University Frankfurt , am Main , Germany
| | - Michael H K Bendels
- a Institute of Occupational, Social and Environmental Medicine, Goethe University Frankfurt , am Main , Germany
| | - Markus Braun
- a Institute of Occupational, Social and Environmental Medicine, Goethe University Frankfurt , am Main , Germany
| | - Doris Klingelhöfer
- a Institute of Occupational, Social and Environmental Medicine, Goethe University Frankfurt , am Main , Germany
| | - David A Groneberg
- a Institute of Occupational, Social and Environmental Medicine, Goethe University Frankfurt , am Main , Germany
| | - Ruth Mueller
- a Institute of Occupational, Social and Environmental Medicine, Goethe University Frankfurt , am Main , Germany
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Velicer C, St Helen G, Glantz SA. Tobacco papers and tobacco industry ties in regulatory toxicology and pharmacology. J Public Health Policy 2018; 39:34-48. [PMID: 29116189 PMCID: PMC5775030 DOI: 10.1057/s41271-017-0096-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Indexed: 11/21/2022]
Abstract
We examined the relationship between the tobacco industry and the journal Regulatory Toxicology and Pharmacology (RTP) using the Truth Tobacco Industry Documents Library and internet sources. We determined the funding relationships, and categorised the conclusions of all 52 RTP papers on tobacco or nicotine between January 2013 and June 2015, as "positive", "negative" or "neutral" for the tobacco industry. RTP's editor, 57% (4/7) of associate editors and 37% (14/38) of editorial board members had worked or consulted for tobacco companies. Almost all (96%, 50/52) of the papers had authors with tobacco industry ties. Seventy-six percent (38/50) of these papers drew conclusions positive for industry; none drew negative conclusions. The two papers by authors not related to the tobacco industry reached conclusions negative to the industry (p < .001). These results call into question the confidence that members of the scientific community and tobacco product regulators worldwide can have in the conclusions of papers published in RTP.
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Affiliation(s)
- Clayton Velicer
- Center for Tobacco Control Research and Education, University of California San Francisco, 530 Parnassus, Suite 366, San Francisco, CA, 94143-1390, USA
| | - Gideon St Helen
- Center for Tobacco Control Research and Education, University of California San Francisco, 530 Parnassus, Suite 366, San Francisco, CA, 94143-1390, USA
- Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Stanton A Glantz
- Center for Tobacco Control Research and Education, University of California San Francisco, 530 Parnassus, Suite 366, San Francisco, CA, 94143-1390, USA.
- Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA, USA.
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA.
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
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Twardella D, Geiss K, Radespiel-Tröger M, Benner A, Ficker JH, Meyer M. [Trends in incidence of lung cancer according to histological subtype among men and women in Germany : Analysis of cancer registry data with the application of multiple imputation techniques]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 61:20-31. [PMID: 29181809 DOI: 10.1007/s00103-017-2659-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Lung cancer can be described by histological subtype, of which small cell, squamous cell and adenocarcinoma are the most common. International data show that adenocarcinoma is becoming the dominant histological subtype of lung cancer although the relative risk due to smoking has been found to be smaller than that for other histological subtypes. OBJECTIVE The aim of the analysis was to describe the time trends in incidence of lung cancer among women and men in Germany according to histological subtype. MATERIALS AND METHODS All lung cancer cases (ICD-10 C33-C34) newly diagnosed between 2003 and 2012 and collected by the epidemiologic cancer registries of the German federal states with average completeness of registration of at least 90% were considered and grouped into histologic subtypes. If data on tumor histology were not microscopically verified or unspecific, multiple imputation techniques were applied to estimate the histologic subtype. RESULTS Among women age-standardized lung cancer rates increased considerably between 2003 and 2012 (annual percent change APC = 2.7%), mostly driven by a rising adenocarcinoma incidence (APC = 4.7%). Among men overall lung cancer rates decreased during the same time (APC = -1.7%). Still, a slight increase in adenocarcinoma incidence was also observed in men (APC = 1.0%). CONCLUSION The rising incidence of adenocarcinoma of the lung is alarming. The cancer registry data do not allow risk factor analysis. In the international discussion, the introduction of filter cigarettes as well as the changing composition of cigarettes has been hypothesized as being responsible. Further epidemiologic studies are strongly needed.
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Affiliation(s)
- Dorothee Twardella
- Zentrum für Krebsfrüherkennung und Krebsregistrierung, Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Schweinauer Hauptstraße 80, 90441, Nürnberg, Deutschland.
| | - Karla Geiss
- Zentrum für Krebsfrüherkennung und Krebsregistrierung, Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Schweinauer Hauptstraße 80, 90441, Nürnberg, Deutschland
| | - Martin Radespiel-Tröger
- Zentrum für Krebsfrüherkennung und Krebsregistrierung, Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Schweinauer Hauptstraße 80, 90441, Nürnberg, Deutschland
| | - Axel Benner
- Abteilung Biostatistik, Deutsches Krebsforschungszentrum, Heidelberg, Deutschland
| | - Joachim H Ficker
- Universitätsklinik für Innere Medizin 3, Schwerpunkt Pneumologie, Allergologie, Schlafmedizin, Klinikum Nürnberg/Paracelsus Medizinische Privatuniversität Nürnberg, Nürnberg, Deutschland
| | - Martin Meyer
- Zentrum für Krebsfrüherkennung und Krebsregistrierung, Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Schweinauer Hauptstraße 80, 90441, Nürnberg, Deutschland
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Paumgartten FJR, Gomes-Carneiro MR, Oliveira ACAXD. The impact of tobacco additives on cigarette smoke toxicity: a critical appraisal of tobacco industry studies. CAD SAUDE PUBLICA 2017; 33Suppl 3:e00132415. [PMID: 28954055 DOI: 10.1590/0102-311x00132415] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 10/13/2016] [Indexed: 12/21/2022] Open
Abstract
Cigarette production involves a number of substances and materials other than just tobacco, paper and a filter. Tobacco additives include flavorings, enhancers, humectants, sugars, and ammonium compounds. Although companies maintain that tobacco additives do not enhance smoke toxicity and do not make cigarettes more attractive or addictive, these claims are questioned by independent researchers. This study reviewed the studies on the effects of tobacco additives on smoke chemistry and toxicity. Tobacco additives lead to higher levels of formaldehyde and minor changes in other smoke analytes. Toxicological studies (bacterial mutagenicity and mammalian cytoxicity tests, rat 90 days inhalation studies and bone-marrow cell micronucleus assays) found that tobacco additives did not enhance smoke toxicity. Rodent assays, however, poorly predicted carcinogenicity of tobacco smoke, and were clearly underpowered to disclose small albeit toxicologically relevant differences between test (with tobacco additives) and control (without tobacco additives) cigarettes. This literature review led to the conclusion that the impact of tobacco additives on tobacco smoke harmfulness remains unclear.
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Waqa G, Bell C, Snowdon W, Moodie M. Factors affecting evidence-use in food policy-making processes in health and agriculture in Fiji. BMC Public Health 2017; 17:51. [PMID: 28068981 PMCID: PMC5223561 DOI: 10.1186/s12889-016-3944-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 12/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is limited research on the use of evidence to inform policy-making in the Pacific. This study aims to identify and describe factors that facilitate or limit the use of evidence in food-related policy-making in the Health and Agriculture Ministries in Fiji. METHODS Semi-structured face-to-face interviews were conducted with selected policy-makers in two government ministries that were instrumental in the development of food-related policies in Fiji designed to prevent Non-Communicable Diseases (NCDs). Snowball sampling was used to recruit, as key informants, senior policy-makers in management positions such as national advisors and directors who were based at either the national headquarters or equivalent. Interviewees were asked about their experiences in developing food-related or other policies, barriers or facilitators encountered in the policy development and implementation process and the use of evidence. Each interview lasted approximately 45-60 minutes, and was conducted in English. Audio-recorded interviews were transcribed, thematically coded and analyzed using N-Vivo 8.0 software. RESULTS Thirty-one policy-makers from the Ministry of Health and Medical Services (MoHMS n = 18) and the Ministry of Agriculture (MoA n = 13) in Fiji participated in the study. Whilst evidence is sometimes used in food-related policy-making in both the Health and Agriculture Ministries (including formal evidence such as published research and informal evidence such as personal experiences and opinions), it is not yet embedded as an essential part of the process. Participants indicated that a lack of resources, poor technical support in terms of training, the absence of clear strategies for improving competent use of evidence, procedures regarding engagement with other stakeholders across sectors, varying support from senior managers and limited consultation across sectors were barriers to evidence use. The willingness of organizations to create a culture of using evidence was reported as a facilitator. CONCLUSION The use of evidence in policy-making will only become a reality in Fiji if it is a formalized part of the government's policy-making systems. A systems approach to food-related policy-making and implementation may achieve this by helping Ministries manage the complex and dynamic nature of food-related policy-making in Fiji.
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Affiliation(s)
- Gade Waqa
- C-POND, Fiji School of Medicine, College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji. .,Deakin Health Economics, Centre for Population Health Research, Faculty of Health, Deakin University, Melbourne, Australia.
| | - Colin Bell
- Global Obesity Centre, Centre for Population Health Research, Faculty of Health, Deakin University, Melbourne, Australia
| | - Wendy Snowdon
- Global Obesity Centre, Centre for Population Health Research, Faculty of Health, Deakin University, Melbourne, Australia
| | - Marj Moodie
- Deakin Health Economics, Centre for Population Health Research, Faculty of Health, Deakin University, Melbourne, Australia.,Global Obesity Centre, Centre for Population Health Research, Faculty of Health, Deakin University, Melbourne, Australia
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Kienhuis AS, Staal YCM, Soeteman-Hernández LG, van de Nobelen S, Talhout R. A test strategy for the assessment of additive attributed toxicity of tobacco products. Food Chem Toxicol 2016; 94:93-102. [PMID: 27155068 DOI: 10.1016/j.fct.2016.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 04/07/2016] [Accepted: 05/03/2016] [Indexed: 10/21/2022]
Abstract
The new EU Tobacco Product Directive (TPD) prohibits tobacco products containing additives that are toxic in unburnt form or that increase overall toxicity of the product. This paper proposes a strategy to assess additive attributed toxicity in the context of the TPD. Literature was searched on toxicity testing strategies for regulatory purposes from tobacco industry and governmental institutes. Although mainly traditional in vivo testing strategies have been applied to assess toxicity of unburnt additives and increases in overall toxicity of tobacco products due to additives, in vitro tests combined with toxicogenomics and validated using biomarkers of exposure and disease are most promising in this respect. As such, tests are needed that are sensitive enough to assess additive attributed toxicity above the overall toxicity of tobacco products, which can associate assay outcomes to human risk and exposure. In conclusion, new, sensitive in vitro assays are needed to conclude whether comparable testing allows for assessment of small changes in overall toxicity attributed to additives. A more pragmatic approach for implementation on a short-term is mandated lowering of toxic emission components. Combined with risk assessment, this approach allows assessment of effectiveness of harm reduction strategies, including banning or reducing of additives.
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Affiliation(s)
- Anne S Kienhuis
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA Bilthoven, The Netherlands.
| | - Yvonne C M Staal
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA Bilthoven, The Netherlands.
| | - Lya G Soeteman-Hernández
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA Bilthoven, The Netherlands
| | - Suzanne van de Nobelen
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA Bilthoven, The Netherlands
| | - Reinskje Talhout
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA Bilthoven, The Netherlands
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Velicer C, Lempert LK, Glantz S. Cigarette company trade secrets are not secret: an analysis of reverse engineering reports in internal tobacco industry documents released as a result of litigation. Tob Control 2015; 24:469-80. [PMID: 24920577 PMCID: PMC4263698 DOI: 10.1136/tobaccocontrol-2014-051571] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 05/14/2014] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Use previously secret tobacco industry documents to assess tobacco companies' routine claims of trade secret protection for information on cigarette ingredients, additives and construction made to regulatory agencies, as well as the companies' refusal to publicly disclose this information. METHODS We analysed previously secret tobacco industry documents available at (http://legacy.library.ucsf.edu) to identify 100 examples of seven major tobacco companies' reverse engineering of their competitors' brands between 1937 and 2001. RESULTS These reverse engineering reports contain detailed data for 142 different measurements for at least two companies, including physical parameters of the cigarettes, tobacco types, humectants, additives, flavourings, and smoke constituents of competitors' cigarettes. These 100 documents were distributed to 564 employees, including top managers in domestic and foreign offices across multiple departments, including executive leadership, research and design, product development, marketing and legal. These documents reported new competitors' products, measured ingredient changes over time, and informed companies' decisions regarding ingredients in their own products. CONCLUSIONS Because cigarette companies routinely analyse their competitors' cigarettes in great detail, this information is neither secret nor commercially valuable and, thus, does not meet the legal definition of a 'trade secret.' This information is only being kept 'secret' from the people consuming cigarettes and the scientific community. Public agencies should release this detailed information because it would provide valuable information about how ingredients affect addictiveness and toxicity, and would help the public health community and consumers better understand the impact of cigarette design on human health.
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Affiliation(s)
- Clayton Velicer
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, California, USA
| | - Lauren K Lempert
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, California, USA
| | - Stanton Glantz
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, California, USA Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California, USA Department of Medicine, University of California San Francisco, San Francisco, California, USA
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Velicer C, Aguinaga-Bialous S, Glantz S. Tobacco companies' efforts to undermine ingredient disclosure: the Massachusetts benchmark study. Tob Control 2015; 25:575-83. [PMID: 26292701 DOI: 10.1136/tobaccocontrol-2015-052392] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 08/05/2015] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To assess the 'Massachusetts Benchmark Study' (MBS) that the tobacco companies presented to the Massachusetts Department of Public Health (MDPH) in 1999 in response to ingredient disclosure regulations in the state. This case study can inform future ingredient disclosure regulations, including implementation of Articles 9 and 10 of the WHO Framework Convention on Tobacco Control (FCTC). METHODS We analysed documents available at http://legacy.library.ucsf.edu to identify internal communications regarding the design and execution of the MBS and internal studies on the relationship between tar, nicotine and carbon monoxide and smoke constituents and reviewed publications that further evaluated data published as part of the MBS. RESULTS The companies conducted extensive studies of cigarette design factors and ingredients that significantly impacted the levels of constituents. While this study asserted that by-brand emissions could be estimated reliably from published tar, nicotine, and carbon monoxide levels, the tobacco companies were well aware that factors beyond tar, nicotine and carbon monoxide influenced levels of constituents included in the study. This severely limited the potential usefulness of the MBS predictor equations. CONCLUSIONS Despite promises to provide data that would allow regulators to predict constituent data for all brands on the market, the final MBS results offered no useful predictive information to inform regulators, the scientific community or consumers. When implementing FCTC Articles 9 and 10, regulatory agencies should demand detailed by-brand information on tobacco product constituents and toxin deliveries to users.
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Affiliation(s)
- Clayton Velicer
- Center for Tobacco Control Research and Education, San Francisco, California, USA
| | - Stella Aguinaga-Bialous
- Center for Tobacco Control Research and Education, San Francisco, California, USA Department of Social and Behavioral Sciences, San Francisco, California, USA
| | - Stanton Glantz
- Center for Tobacco Control Research and Education, San Francisco, California, USA Philip R. Lee Institute for Health Policy Studies, San Francisco, California, USA Helen Diller Family Comprehensive Cancer Center, San Francisco, California, USA Department of Medicine, University of California San Francisco, San Francisco, California, USA
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Brand Cigarillos: Low Price but High Particulate Matter Levels-Is Their Favorable Taxation in the European Union Justified? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:9141-53. [PMID: 26258782 PMCID: PMC4555270 DOI: 10.3390/ijerph120809141] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 06/17/2015] [Accepted: 07/31/2015] [Indexed: 01/09/2023]
Abstract
BACKGROUND Second hand smoke (ETS)-associated particulate matter (PM) contributes considerably to indoor air contamination and constitutes a health risk for passive smokers. Easy to measure, PM is a useful parameter to estimate the dosage of ETS that passive smokers are exposed to. Apart from its suitability as a surrogate parameter for ETS-exposure, PM itself affects human morbidity and mortality in a dose-dependent manner. We think that ETS-associated PM should be considered an independent hazard factor, separately from the many other known harmful compounds of ETS. We believe that brand-specific and tobacco-product-specific differences in the release of PM matter and that these differences are of public interest. METHODS To generate ETS of cigarettes and cigarillos as standardized and reproducible as possible, an automatic second hand smoke emitter (AETSE) was developed and placed in a glass chamber. L&M cigarettes ("without additives", "red label", "blue label"), L&M filtered cigarillos ("red") and 3R4F standard research cigarettes (as reference) were smoked automatically according to a self-developed, standardized protocol until the tobacco product was smoked down to 8 mm distance from the tipping paper of the filter. RESULTS Mean concentration (Cmean) and area under the curve (AUC) in a plot of PM2.5 against time were measured, and compared. CmeanPM2.5 were found to be 518 μg/m(3) for 3R4F cigarettes, 576 μg/m(3) for L&M "without additives" ("red"), 448 μg/m(3) for L&M "blue label", 547 μg/m(3) for L&M "red label", and 755 μg/m(3) for L&M filtered cigarillos ("red"). AUCPM2.5-values were 208,214 μg/m(3)·s for 3R4F reference cigarettes, 204,629 μg/m(3)·s for L&M "without additives" ("red"), 152,718 μg/m(3)·s for L&M "blue label", 238,098 μg/m(3)·s for L&M "red label" and 796,909 μg/m(3)·s for L&M filtered cigarillos ("red"). CONCLUSION Considering the large and significant differences in particulate matter emissions between cigarettes and cigarillos, we think that a favorable taxation of cigarillos is not justifiable.
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Laccourreye O, Werner A, Laccourreye H, Bonfils P. Tobacco and otorhinolaryngology: epic and disaster. Eur Ann Otorhinolaryngol Head Neck Dis 2014; 131:183-8. [PMID: 24908635 DOI: 10.1016/j.anorl.2013.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Accepted: 11/17/2013] [Indexed: 11/16/2022]
Abstract
More than 500 papers are retrieved from the PubMed database by the keywords "Tobacco" and "Otorhinolaryngology", none of which, however, is devoted to the history of a plant that has a major impact on our specialty and practice. The present report describes and analyzes how tobacco conquered the world, the conflicts it triggered and the impact it has had in our field over the past centuries.
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Affiliation(s)
- O Laccourreye
- Service ORL et chirurgie cervico-faciale, hôpital européen Georges-Pompidou, AP-HP, université Paris Descartes Sorbonne Paris Cité, 20, rue Leblanc, 75015 Paris cedex 15, France.
| | - A Werner
- 18, rue de la Ferme, 92200 Neuilly-sur-Seine, France
| | - H Laccourreye
- Académie nationale de médecine, rue Bonaparte, 75006 Paris, France
| | - P Bonfils
- Service ORL et chirurgie cervico-faciale, hôpital européen Georges-Pompidou, AP-HP, université Paris Descartes Sorbonne Paris Cité, 20, rue Leblanc, 75015 Paris cedex 15, France
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Indirect effects of cigarette butt waste on the dengue vector Aedes aegypti (Diptera: Culicidae). Acta Trop 2014; 130:123-30. [PMID: 24239749 DOI: 10.1016/j.actatropica.2013.11.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 11/04/2013] [Accepted: 11/05/2013] [Indexed: 11/23/2022]
Abstract
Despite major insecticide-based vector control programs, dengue continues to be a major threat to public health in urban areas. The reasons for this failure include the emergence of insecticide resistance and the narrowing of the spectrum of efficient products. Cigarette butts (CBs), the most commonly discarded piece of waste, also represent a major health hazard to human and animal life. CBs are impregnated with thousands of chemical compounds, many of which are highly toxic and none of which has history of resistance in mosquitoes. This study was performed to examine whether exposure to CB alters various biological parameters of parents and their progeny. We examined whether the mosquito changes its ovipositional behaviors, egg hatching, reproductive capacity, longevity and fecundity in response to CB exposure at three different concentrations. Females tended to prefer microcosms containing CBs for egg deposition than those with water only. There were equivalent rates of eclosion success among larvae from eggs that matured in CB and water environments. We also observed decreased life span among adults that survived CB exposure. Extracts of CB waste have detrimental effects on the fecundity and longevity of its offspring, while being attractive to its gravid females. These results altogether indicate that CB waste indirectly affect key adult life traits of Aedes aegypti and could conceivably be developed as a novel dengue vector control strategy, referring to previously documented direct toxicity on the larval stage. But this will require further research on CB waste effects on non-target organisms including humans.
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Toxic metal concentrations in cigarettes obtained from U.S. smokers in 2009: results from the International Tobacco Control (ITC) United States survey cohort. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 11:202-17. [PMID: 24452255 PMCID: PMC3924441 DOI: 10.3390/ijerph110100202] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 11/28/2013] [Accepted: 12/02/2013] [Indexed: 11/18/2022]
Abstract
Smoking-related diseases can be attributed to the inhalation of many different toxins, including heavy metals, which have a host of detrimental health effects. The current study reports the levels of arsenic (As), cadmium (Cd), chromium (Cr), nickel (Ni), and lead (Pb) in cigarettes obtained from adult smokers participating in the 2009 wave of the ITC United States Survey (N = 320). The mean As, Cd, Cr, Ni, and Pb levels were 0.17, 0.86, 2.35, 2.21, and 0.44 µg/g, respectively. There were some differences in metal concentrations of cigarette brands produced by different manufacturers, suggesting differences in the source of tobaccos used by different companies. For Ni, there were significant pairwise differences between Philip Morris U.S. (PMUSA) and R.J. Reynolds (RJR) brands (PMUSA higher; p < 0.001), PMUSA and other manufacturer (OM) brands (PMUSA higher; p < 0.001), and RJR and OM brands (RJR higher; p = 0.006). For Cr, RJR brands had higher levels than did OM brands (p = 0.02). Levels of As, Cd, and Pb did not differ significantly across manufacturer groups (p > 0.10). Because of the variety of toxic heavy metals in cigarette tobacco, and their numerous negative health effects, metal content in cigarette tobacco should be reduced.
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Popova L, Ling PM. Perceptions of relative risk of snus and cigarettes among US smokers. Am J Public Health 2013; 103:e21-3. [PMID: 24028247 DOI: 10.2105/ajph.2013.301547] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
In a survey of 1836 adult US smokers, when using a direct comparison measure, 22.1% reported snus was less harmful than were cigarettes. When asked indirectly (estimating the health risk of snus and cigarettes in 2 separate questions and comparing the answers to each other), 51.6% rated snus as less risky. The Food and Drug Administration should consider both direct and indirect measures when perceived risk data are presented as evidence for tobacco regulation.
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Affiliation(s)
- Lucy Popova
- Lucy Popova and Pamela M. Ling are with the Center for Tobacco Control Research and Education, University of California, San Francisco. Pamela M. Ling is also with the Division of General Internal Medicine, Department of Medicine, University of California, San Francisco
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Sepetdjian E, Abdul Halim R, Salman R, Jaroudi E, Shihadeh A, Saliba NA. Phenolic compounds in particles of mainstream waterpipe smoke. Nicotine Tob Res 2013; 15:1107-12. [PMID: 23178319 PMCID: PMC3716329 DOI: 10.1093/ntr/nts255] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 10/16/2012] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Waterpipe tobacco smoking has in recent years become a popular international phenomenon, particularly among youth. While it has been shown to deliver significant quantities of several carcinogenic and toxic substances, phenols, an important class of chemical compounds thought to promote DNA mutation and cardiovascular diseases, however, has not been studied. Due to the relatively low temperature characteristic of waterpipe tobacco during smoking (i.e., <450 °C), it was hypothesized that phenolic compounds, which form at approximately 300 °C, will be found in abundance in waterpipe smoke. METHODS In this study, phenolic compounds in the particle phase of waterpipe mainstream smoke were quantified. Waterpipe and cigarette mainstream smoke generated using standard methods were collected on glass fiber pads and analyzed using gas chromatography/mass spectroscopy selected ion current profile chromatogram method for quantification. RESULTS We found that relative to a single cigarette, a waterpipe delivers at least 3 times greater quantities of the 7 analyzed phenols (phenol, o-cresol, m-cresol, p-cresol, catechol, resorcinol, and hydroquinone). Moreover, phenol derivatives such as methylcatechol, and flavorings such as vanillin, ethyl vanillin, and benzyl alcohol were found in quantities up to 1,000 times greater than the amount measured in the smoke of a single cigarette. CONCLUSION The large quantities of phenols and phenol derivatives in waterpipe smoke add to the growing evidence that habitual waterpipe use may increase the risk of cancer and cardiovascular diseases.
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Affiliation(s)
| | - Rasha Abdul Halim
- Chemistry Department, American University of Beirut, Beirut, Lebanon
| | - Roula Salman
- Mechanical Engineering Department, American University of Beirut, Beirut, Lebanon
| | - Ezzat Jaroudi
- Mechanical Engineering Department, American University of Beirut, Beirut, Lebanon
| | - Alan Shihadeh
- Mechanical Engineering Department, American University of Beirut, Beirut, Lebanon
| | - Najat A. Saliba
- Chemistry Department, American University of Beirut, Beirut, Lebanon
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Tan CE, Kyriss T, Glantz SA. Tobacco company efforts to influence the Food and Drug Administration-commissioned Institute of Medicine report clearing the smoke: an analysis of documents released through litigation. PLoS Med 2013; 10:e1001450. [PMID: 23723740 PMCID: PMC3665841 DOI: 10.1371/journal.pmed.1001450] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 04/08/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Spurred by the creation of potential modified risk tobacco products, the US Food and Drug Administration (FDA) commissioned the Institute of Medicine (IOM) to assess the science base for tobacco "harm reduction," leading to the 2001 IOM report Clearing the Smoke. The objective of this study was to determine how the tobacco industry organized to try to influence the IOM committee that prepared the report. METHODS AND FINDINGS We analyzed previously secret tobacco industry documents in the University of California, San Francisco Legacy Tobacco Documents Library, and IOM public access files. (A limitation of this method includes the fact that the tobacco companies have withheld some possibly relevant documents.) Tobacco companies considered the IOM report to have high-stakes regulatory implications. They developed and implemented strategies with consulting and legal firms to access the IOM proceedings. When the IOM study staff invited the companies to provide information on exposure and disease markers, clinical trial design for safety and efficacy, and implications for initiation and cessation, tobacco company lawyers, consultants, and in-house regulatory staff shaped presentations from company scientists. Although the available evidence does not permit drawing cause-and-effect conclusions, and the IOM may have come to the same conclusions without the influence of the tobacco industry, the companies were pleased with the final report, particularly the recommendations for a tiered claims system (with separate tiers for exposure and risk, which they believed would ease the process of qualifying for a claim) and license to sell products comparable to existing conventional cigarettes ("substantial equivalence") without prior regulatory approval. Some principles from the IOM report, including elements of the substantial equivalence recommendation, appear in the 2009 Family Smoking Prevention and Tobacco Control Act. CONCLUSIONS Tobacco companies strategically interacted with the IOM to win several favored scientific and regulatory recommendations.
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Affiliation(s)
- Crystal E. Tan
- Center for Tobacco Control Research and Education, Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Thomas Kyriss
- Schillerhoehe Hospital, Thoracic Surgery, Gerlingen, Germany
| | - Stanton A. Glantz
- Center for Tobacco Control Research and Education, Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America
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Gray N, Borland R. Research required for the effective implementation of the framework convention on tobacco control, articles 9 and 10. Nicotine Tob Res 2013; 15:777-88. [PMID: 23024247 PMCID: PMC3693498 DOI: 10.1093/ntr/nts175] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 06/24/2012] [Indexed: 01/13/2023]
Abstract
This paper is part of a series of articles intended to set out the research questions that are relevant to the successful implementation of the various provisions of the Framework Convention on Tobacco Control (FCTC). This paper focuses on issues affecting Articles 9 and 10 of the FCTC. This paper focuses on the research that is most important for most countries, rather than on what is desirable in countries with high levels of research capacity. Articles 9 and 10 of the FCTC address the regulation of contents and emissions of tobacco products and regulation of tobacco product disclosure. Such regulation will be essential if the long-term objective of reducing the danger of tobacco products is to be achieved. There are many components of tobacco and tobacco smoke that are excessively toxic and dangerous to the user. Many of these components are carcinogenic and addictive and can be removed or reduced substantially with current known technology. The fact that these components remain in tobacco and tobacco smoke at levels that are unnecessarily dangerous is precisely the reason why the successful implementation of Articles 9 and 10 of the FCTC is important to tobacco control. This paper discusses the scientific challenges involved in successfully implementing Articles 9 and 10 of the FCTC, which focuses on regulating carcinogens and toxins in tobacco and tobacco smoke, the abuse liability of tobacco products, and the additives and engineering features in tobacco products that make tobacco products appealing to future consumers. The research issues we focus on are those required to support the early stages of regulation. As regulation proceeds, new and more sophisticated research questions will undoubtedly emerge.
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Affiliation(s)
- Nigel Gray
- Cancer Council Victoria, Carlton, Victoria, Australia.
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Jones MR, Apelberg BJ, Tellez-Plaza M, Samet JM, Navas-Acien A. Menthol cigarettes, race/ethnicity, and biomarkers of tobacco use in U.S. adults: the 1999-2010 National Health and Nutrition Examination Survey (NHANES). Cancer Epidemiol Biomarkers Prev 2012; 22:224-32. [PMID: 23250935 DOI: 10.1158/1055-9965.epi-12-0912] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND In the United States, cigarette flavorings are banned, with the exception of menthol. The cooling effects of menthol could facilitate the absorption of tobacco toxicants. We examined levels of biomarkers of tobacco exposure among U.S. smokers of menthol and nonmenthol cigarettes. METHODS We studied 4,603 White, African-American, and Mexican-American current smokers 20 years of age or older who participated in the National Health and Nutrition Examination Survey (NHANES) from 1999 through 2010 and had data on cigarette type and serum cotinine, blood cadmium, and blood lead concentrations. Urinary total 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol) (NNAL) was studied in 1,607 participants with available measures. RESULTS A total of 3,210 (74.3%) participants smoked nonmenthol cigarettes compared with 1,393 (25.7%) participants who smoked menthol cigarettes. The geometric mean concentrations comparing smokers of nonmenthol with menthol cigarettes were 163.1 versus 175.9 ng/mL for serum cotinine; 0.95 versus 1.02 μg/L for blood cadmium; 1.87 versus 1.75 μg/dL for blood lead; and 0.27 versus 0.23 ng/mL for urine NNAL. After multivariable adjustment, the ratios [95% confidence interval (CI)] comparing smokers of menthol with nonmenthol cigarettes were 1.03 (0.95-1.11) for cotinine, 1.10 (1.04-1.16) for cadmium, 0.95 (0.90-1.01) for lead, and 0.81 (0.65-1.01) for NNAL. CONCLUSIONS In a representative sample of U.S. adult smokers, current menthol cigarette use was associated with increased concentration of blood cadmium, an established carcinogen and highly toxic metal, but not with other biomarkers. IMPACT These findings provide information regarding possible differences in exposure to toxic constituents among menthol cigarette smokers compared with nonmenthol cigarette smokers.
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Affiliation(s)
- Miranda R Jones
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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Affiliation(s)
- Martin McKee
- Department of Health Services Research and Policy, School of Hygiene and Tropical Medicine, London WC1H 9SH, UK.
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