Smoking Topography in Response to Denicotinized and High-Yield Nicotine Cigarettes in Adolescent Smokers

PurposeThe objective of this study was to explore the smoking topography of adolescent smokers. It is well established that the majority of adult nicotine-dependent smokers began smoking as adolescents. Whereas recent advances have been made with respect to identification of factors that predispose to nicotine dependence, very little is known about the actual smoking behavior (e.g., topography) of adolescent smokers, or its relationship to nicotine dependence. Correspondingly, the extent to which adolescent smokers smoke to obtain nicotine is also unknown.MethodsIn the present study, we assessed several topographical indices of smoking (e.g., puff volume, puff number) in a sample of 35 light, adolescent smokers. Moreover, we examined whether smoking behavior is different in response to smoking a denicotinized relative to a high-yield, nicotine cigarette.ResultsAll participants evidenced a significant increase in expired air carbon monoxide after the smoking of a cigarette. Results of independent-sample t-tests revealed that adolescents who smoked a low-yield nicotine cigarette took significantly more puffs per cigarette than did those who smoked a high-yield cigarette.ConclusionsThese findings suggest that adolescent smokers do titrate their nicotine intake in response to smoking denicotinized cigarettes, but do so not by taking larger puffs or smoking more quickly, but by simply taking more puffs per cigarette. Implications of the findings and future directions for this type of research with adolescents are discussed.     

Smoking topography and biomarkers of exposure among Japanese smokers: associations with cigarette emissions obtained using machine smoking protocols

Objectives

Although the relative risk of lung cancer due to smoking is reported to be lower in Japan than in other countries, few studies have examined the characteristics of Japanese cigarettes or potential differences in smoking patterns among Japanese smokers.

Methods

To examine tar, nicotine and carbon monoxide (TNCO) emissions from ten leading cigarettes in Japan, machine smoking tests were conducted using the International Organization for Standardization (ISO) protocol and the Health Canada Intense (HCI) protocol. Smoking topography and tobacco-related biomarkers were collected from 101 Japanese smokers to examine measures of exposure.

Results

The findings indicate considerable variability in the smoking behavior of Japanese smokers. On average, puffing behaviors observed among smokers were more similar to the parameters of the HCI protocol, and brands with greater ventilation that yielded lower machine values using the ISO protocol were smoked more intensely than brands with lower levels of ventilation. The smokers of “ultra-low/low” nicotine-yield cigarettes smoked 2.7-fold more intensively than those of “medium/high” nicotine-yield cigarette smokers to achieve the same level of salivary cotinine (p = 0.024). CO levels in expiratory breath samples were associated with puff volume and self-reported smoking intensity, but not with nominal values of nicotine-yield reported on cigarette packages.

Conclusions

Japanese smokers engaged in “compensatory smoking” to achieve their desired nicotine intake, and levels of exposure were greater than those suggested by the nominal value of nicotine and tar yields reported on cigarette packages.     

Evidence for compensation in smokers of low yield cigarettes

To determine the relation of smoking low yield cigarettes (tar yield less than 15.0 mg and nicotine yield less than 1.0 mg per cigarette) to the number of cigarettes smoked per day, we analysed information provided on self-administered questionnaires by 7706 current, regular cigarette smokers. The mean age at starting to smoke and the mean number of years of smoking were not consistently different in smokers of low yield compared with smokers of high yield cigarettes. In contrast, at all ages in both men and women, smokers of low yield cigarettes smoked significantly more cigarettes per day than smokers of high yield cigarettes. The differences in the number of cigarettes smoked per day between smokers of low and high yield cigarettes were small--about 3 cigarettes per day in men and about 1 1/2 cigarettes per day in women. However, these small differences might translate to the smoking of as many as one billion more packs of cigarettes per year in the United States alone. The potential beneficial effect of the smoking of cigarettes whose yield per cigarette is lower must be weighed against a possible adverse effect of the smoking of more cigarettes if the relation between smoking low yield cigarettes and smoking more cigarettes is causal.     

Nicotine yield and measures of cigarette smoke exposure in a large population: are lower-yield cigarettes safer?

We examined the relationship of machine-estimated nicotine yield by cigarette brand with the level of cigarette consumption and two biochemical measures of smoke exposure (expired-air carbon monoxide and plasma thiocyanate) in a large, population-based sample of smokers (N = 713). The lower the nicotine yield of the cigarette, the greater the number of cigarettes smoked per day. Prior to adjusting for number of cigarettes smoked per day, nicotine yield was not related to the actual measures of smoke exposure. Smokers of ultralow-yield cigarettes had laboratory tests of smoke exposure which were not significantly different from those of smokers of higher-yield brands. Only after adjustment for number of cigarettes smoked per day did nicotine yield become significantly related to expired-air carbon monoxide and to plasma thiocyanate. In multivariate analysis, the number of cigarettes smoked per day accounted for 28 per cent and 22 per cent of the variance in observed expired-air carbon monoxide and plasma thiocyanate levels, respectively, whereas nicotine yield accounted for only 1 per cent and 2 per cent of the variance, respectively. The relative lack of an effect of nicotine yield on the biochemical measure appears to be due to the fact that smokers of lower nicotine brands smoked more cigarettes per day, thereby compensating for reduced delivery of smoke products. Our data do not support the concept that ultralow-yield cigarettes are less hazardous than others. Machine estimates suggesting low nicotine yield underrepresent actual human consumption of harmful cigarette constituents.     

Determinants of salivary cotinine concentrations in Chinese male smokers

BACKGROUND: Identifying factors that affect cotinine levels in smokers may be useful for smoking cessation programs. Our aims were to characterize the distribution of salivary cotinine levels in Chinese smokers and to investigate factors that influence cotinine concentrations. METHODS: In a cross-sectional study, 600 Chinese adult smokers answered a questionnaire on smoking habits and provided a saliva sample for cotinine analysis. Modification of the relation between number of cigarettes smoked and cotinine concentration by individual characteristics, smoking behavior, and type of tobacco was evaluated. RESULTS: Quadratic model provided the best fit for the relation between number of cigarettes smoked in the previous 24 hours and salivary cotinine concentration. Among those smoking up to 20 cigarettes, the median cotinine concentration was higher among younger subjects, those smoking cigarettes without filter and regular rather than light cigarettes, and those inhaling frequently and deeply. Such trends were not observed among heavier smokers. The increase in cotinine per cigarette tended to be larger in those with lower median cotinine level. CONCLUSIONS: Our findings show that smoking behavior-related factors modify the relation between number of cigarettes smoked and salivary cotinine concentration. This suggests that smokers may regulate their smoking behavior to achieve a certain optimum nicotine level.     

Spontaneous cigarette brand switching: consequences for nicotine and carbon monoxide exposure.

A group of smokers who had participated in smoking-related studies three to six years earlier were re-studied to assess changes in their smoking practices. Individuals who smoked the same brands of cigarettes showed no change in plasma cotinine (reflecting exposure to nicotine) or expired carbon monoxide (CO) concentration. Those who switched to cigarettes of lower nicotine yield (average decrease 38 per cent) showed reduced plasma cotinine concentrations, due primarily to smoking fewer cigarettes per day. The intake of nicotine per cigarette was not different. Subjects who smoked cigarettes of higher yield (102 per cent increase) had higher cotinine and CO levels, due to greater intake per cigarette.     

Standardization of definitions concerning smoking behavior among Japanese adolescents--results from the Japan Adolescent Smoking Survey (JASS)]

The aim of the Japan Adolescent Smoking Survey (JASS) is to standardize the definitions of smoking behavior among Japanese adolescents together with measurement methods and questionnaires concerned. A study of 9921 school children aged 9 to 18 years in 17 elementary schools, 16 junior high schools and 18 senior high schools in 9 prefectures, was conducted between June and July of 1989, to determine the relationship between actual smoking behavior during the past month or year and the "self-referent label" concerning their smoking status. The main results were as follows: 1) The percentage of those who smoked at least one cigarette during the past month showed a high degree of similarity to the percentage of those who referred to themselves as "regular smokers" or "occasional smokers". 2) Less than 10% of students who identified themselves as "never smokers" or "ex-smokers" smoked at least one cigarette during the past month, while more than 80% of students who referred to themselves as "regular smokers" or "occasional smokers" smoked during the past month. 3) On the whole, those who smoked 20 or more cigarettes during the past month referred to themselves as "regular smokers"; those who smoked between 2 and 19 cigarettes as "occasional smokers"; those who smoked 1 cigarette as "ex-smokers"; those who did not smoke during the past month as "never smokers". 4) The definition where students who smoked one cigarette during the past month are classified as a category of smoker, displayed a high level of sensitivity and specificity for all school-level groups and for both sexes.(ABSTRACT TRUNCATED AT 250 WORDS)     

Cigarette advertising and black-white differences in brand preference

Anecdotal evidence indicates that the cigarette industry is targeting the sale of specific brands, notably menthol cigarettes, to black consumers. This paper presents data on the types of cigarettes smoked by white and black smokers. The cigarette brand preferences of two populations of smokers were examined. The first comprised 70 white and 365 black adult smokers seen at the Deaconness Family Medicine Center located in Buffalo, NY. The second population included 1,070 white and 92 black smokers who called a Stop Smoking Hotline in Buffalo. The results showed that, in both populations, blacks were twice as likely to smoke mentholated cigarettes compared with whites. In an attempt to evaluate the targeting of cigarette ads to black smokers as a possible explanation for black-white differences in brand preferences, cigarette ads appearing in magazines targeted to predominantly white or black readers were compared. Cigarette ads appearing in seven magazines were reviewed, four directed to predominantly white readers (Newsweek, Time, People, Mademoiselle) and three with wide circulation among black audiences (Jet, Ebony, Essence). The results showed that the magazines targeted to black readers contained significantly more cigarette ads and more ads for menthol brand cigarettes than magazines similar in content but targeted to white readers. The observation that a higher percentage of blacks smoke menthol cigarettes than do whites is consistent with the findings regarding differences in the type of cigarette ads appearing in magazines intended for black or white readers. However, it is not possible to determine from this study whether cigarette advertising is the cause of the differences in preference of cigarette brands between white and black smokers.(ABSTRACT TRUNCATED AT 250 WORDS)     

'Light' and 'mild' cigarettes: who smokes them? Are they being misled?

Using two population-based surveys of Ontarians, we examined the proportions of smokers who smoke 'light' and 'mild' cigarettes (L/M). We compared L/M smokers to regular cigarette smokers regarding demographic, health knowledge, and smoking characteristics and examined their health-related perceptions of L/M and reasons for smoking them. Use of these cigarettes increased from 71% in 1996 to 83% in 2000. Those who smoked L/M were more likely to be female, to be less addicted, and to be more advanced toward quitting. In 1996, one in five believed that smoking L/M lowers the risk of cancer and heart disease. In 1996 and 2000, respectively, 44% and 27% smoked L/M to reduce health risks, 41% and 40% smoked them as a step toward quitting, and 41% in both years said they would be more likely to quit if they learned L/M could provide the same tar and nicotine as regular cigarettes. These data provide empirical support for banning 'light' and 'mild' on cigarette packaging.     

Cigarette smoking and birthweight: type of cigarette smoked and a possible threshold effect

The effects on birthweight of the number of cigarettes smoked and their tar, nicotine and carbon monoxide yields were investigated prospectively in 1309 pregnant women of whom 414 were smokers. Several approaches to modelling the effect of smoking were tried. These suggested that while both yield and quantity smoked were important, yield had the greatest effect. This led to an empirical approach whereby consistent smokers were divided into four categories according to whether they smoked a low or high quantity of cigarettes per day and whether they smoked low or high yield cigarettes. Using these four groups it emerged that women smoking a low quantity of low yield cigarettes had babies of a similar mean birthweight to those of non-smokers whereas those smoking a low quantity of high yield cigarettes had babies whose birthweight was reduced to the same degree (6% or more) as those of mothers who smoked higher quantities. This apparent threshold was estimated as 13 cigarettes/day and 15 mg/cigarette carbon monoxide. We conclude that brand smoked is at least as important as quantity and that in this population there is evidence for a threshold for tobacco smoke intake below which no discernible effect on birthweight is seen.     

Characteristics of smokers who enroll and quit in self-help programs

Smokers who volunteer for self-help smoking cessation programsmay be poor candidates for such minimal treatments. Throughgeneral publicity, we recruited 2021 Health Maintenance Organizationenrollees for a self-help quit smoking intervention trial. Volunteerswere mostly heavy smokers (mean 26 cigarettes/day) with a long-establishedhabit (mean 27 years), strong nicotine dependency (77% smokedtheir first cigarette of the day within 30 min of awakening)and extensive quitting histories [median of three serious quitattempts and many who had already tried group or individualquitting programs (35%), nicotine gum (25%) or quitting guides(43%)]. Self-reported, cotinine-validated, 7-day abstinencerates at 16 months follow-up were significantly higher for smokerswith lower nicotine dependency, lower cigarette brand nicotinecontent, no previous use of nicotine gum, no smoking-relatedchronic medical conditions, longer duration of previous quit,a more health promotive lifestyle with respect to alcohol anddiet, and a supportive partner, and in subjects randomized toa minimal contact telephone counseling intervention. The telephonecounseling advantage was significantly greater for smokers whoat baseline were less nicotine dependent, had not used an intensivecessation treatment, smoked higher nicotine cigarettes and hadless social support. Diffusion strategies to reach smokers withlower readiness to volunteer and triage mechanisms to screenout smokers who are poor candidates for self-help treatmentsare needed if these treatments are to achieve their potential.     

What smokers believe about light and ultralight cigarettes

OBJECTIVES: To assess the knowledge of smokers and ex-smokers about light cigarettes and nicotine yields and their perception of the risk of lung cancer, and to identify the characteristics of smokers of light cigarettes. METHODS: Mail survey in a population sample of 494 smokers and exsmokers in Geneva, Switzerland, in 1999. RESULTS: Participants were on average 40 years old, and 49% were men. They estimated that one would have to smoke two light cigarettes or four ultralight cigarettes in order to inhale the same amount of nicotine as that in one regular cigarette. Most participants (60%) answered that the risk of lung cancer was the same, but 27% answered that this risk was lower in smokers of light cigarettes than in smokers of regular cigarettes. The most frequent answer (41% of answers) to an open-ended question on the meaning of the number of milligrams of nicotine printed on cigarette packs was that this number indicated the nicotine content in cigarettes, rather than a machine-determined yield in smoke. In a multivariate model, smoking mild, light, or ultralight (vs regular) cigarettes was associated with females, a lower Fagerstr?m dependence score, an intention to quit smoking, and an intention to decrease cigarette consumption. CONCLUSIONS: Many smokers choose light cigarettes because they think that such cigarettes are safer or less addictive. The public should be further informed of the meaning and purpose of cigarette labels.     

Heterogeneity in Smokers' Responses to Tobacco Control Policies

This paper uses unconditional quantile regression to estimate whether smokers' responses to tobacco control policies change across the distribution of smoking levels. I measure smoking behavior with the number of cigarettes smoked per day and also with serum cotinine levels, a continuous biomarker of nicotine exposure, using individual‐level repeated cross‐section data from the National Health and Nutrition Examination Surveys. I find that the cigarette taxes lead to reductions in both the number of cigarettes smoked per day and in smokers' cotinine levels. These reductions are most pronounced in the middle quantiles of both distributions in terms of marginal effects, but most pronounced in the lower quantiles in terms of tax elasticities. I do not find that higher cigarette taxes lead to statistically significant changes in the amount of nicotine smokers ingest from each cigarette. Copyright © 2015 John Wiley & Sons, Ltd.     

The effects of higher cigarette prices on tar and nicotine consumption in a cohort of adult smokers

The objective of this paper is to estimate the demand for tar and nicotine in cigarettes as a function of cigarette prices in a cohort of cigarette 11,966 smokers followed for 5 years. Data for the analysis come from a longitudinal telephone survey of 11,966 smokers who were interviewed in 1988 and 1993 as part of the Community Intervention Trial for Smoking Cessation (COMMIT). Separate models are estimated for three age groups to account for differences in levels of addiction and brand loyalty across age. We found that smokers respond to higher cigarette prices by reducing the number of cigarettes smoked per day but also by switching to cigarettes that are higher in tar and nicotine per cigarette.     

Smoking rates among Rhode Island physicians: achieving a smoke-free society.

Over a 25-year period, regular surveys of physicians licensed in Rhode Island have recorded their smoking behavior. The six surveys show a decrease in the rate of cigarette smoking from 33% in 1963 to 4.6% in 1988. In the most recent survey, 65% of respondents reported never having smoked, and 87% of those who had ever smoked reported having quit. However, the statistic for the maximum number of cigarettes smoked regularly was higher for current smokers than for former smokers. Among physicians in the 1988 survey, most former smokers (85%) reported using only unassisted personal effort in quitting, whereas nearly half (48%) of current smokers tried methods involving assistance, such as self-help programs, group programs, or nicotine gum. Among former smokers who quit after 1983, the percentage trying assisted methods (34%) was closer to the percentage among current smokers. Apparently, remaining smokers include many heavy smokers who require more potent interventions in order to quit. Physicians in Rhode Island have almost become a smoke-free group. Their experience, coupled with their involvement in smoking prevention and cessation for their patients, can lead the rest of society on its path to becoming smoke-free.     

The effect of Taiwan's tax-induced increases in cigarette prices on brand-switching and the consumption of cigarettes

The effect of raising cigarette taxes to reduce smoking has been the subject of several studies, which often treat the price of cigarettes as an exogenous factor given to smokers who respond to it by adjusting their smoking behavior. However, cigarette prices vary with brand and quality, and smokers can and do switch to lower-priced brands to reduce the impact of the tax on the cost of cigarettes as they try to consume the same number of cigarettes as they had before a tax hike. Using data from a two-year follow-up interview survey conducted before and after a new cigarette tax scheme was imposed in Taiwan in 2002, this study examines three behavioral changes smokers may make to respond to tax-induced cigarette price increase: brand-switching, amount consumed, and amount spent on smoking. These changes were studied in relation to smoker income, before-tax cigarette price, level of addiction, exposure to advertizing, and consumer loyalty.We found that smokers, depending upon exposure to advertizing, level of consumer loyalty and initial price of cigarettes, switched brands to maintain current smoking habits and control costs. We also found that the initial amount smoked and level of addiction, not price, at least not at the current levels in Taiwan, determined whether a smoker reduced the number of cigarettes he consumed.     

Consumption of 'low-yield' cigarettes: its frequency and relationship to serum thiocyanate.

To determine the use and possible health risks of low-yield cigarettes, we ascertained the cigarette brands and serum thiocyanate (SCN) levels of 2,561 adult smokers (age 25-74) in population-based samples of seven upper Midwestern communities during 1980-82. Brands were coded according to December 1981 Federal Trade Commission (FTC) ratings for "tar", nicotine, and carbon monoxide (CO). Compared to 1980 data from the National Center for Health Statistics for the United States as a whole, a greater proportion of smokers in these communities smoked low-yield brands. More people with higher education than lesser and more women than men smoked low-yield cigarettes. Greater proportions of older people (65-75 years) than younger people (less than 65 years) smoked cigarettes in the highest and lowest brand yield categories. SCN, adjusted for number of cigarettes smoked and for sex, was only weakly associated with brand ratings for "tar" (r = +.12), nicotine (R = +.11), and CO (r = +.15). Furthermore, the gradient in SCN between lowest and highest quintiles of brand strength was less than 16 per cent--much lower than the 300-500 per cent gradient in smoke components implied by FTC ratings. These data add to the evidence that smoking low-yield cigarettes may not be significantly less hazardous than smoking high-yield brands.     

Role of mentholated cigarettes in increased nicotine dependence and greater risk of tobacco-attributable disease

BACKGROUND: Cold air stimulates upper airway cold receptors causing a reflex depressive effect on respiratory activity. Menthol, in low concentrations can also stimulate these same cold receptors causing a depressive effect on respiratory activity. Menthol cigarettes when smoked, deliver enough menthol to stimulate cold receptors resulting in the smoker experiencing a "cool sensation." The "cool sensation" experienced by the menthol smoker can result in a reflex-depressive effect on respiratory activity. METHOD: Literature searches were done for the NLM databases (e.g., MEDLINE from 1966, TOXLINE, OLDMEDLINE (1985-1965), CANCERLIT, plus tobacco industry documents and hardcopy indices. The evidence was evaluated with application to mentholated cigarette smoking. RESULTS AND DISCUSSION: A logical progression is presented that develops the framework to prove that menthol found in mentholated cigarettes may cause respiratory depression resulting in greater exposure to the toxic substances found in tobacco smoke. CONCLUSION: As a result of breath holding that results from the stimulation of cold receptors there is a greater opportunity for exposure and transfer of the contents of the lungs to the pulmonary circulation. For the menthol smoker this results in a greater exposure to nicotine and the particulate matter (tar) of the smoked cigarette. This exposure can result in increased nicotine dependence and greater chance of tobacco-attributable disease.     

Cigarette smoking and cessation behaviors among urban blacks and whites

Smoking behaviors among blacks and whites were studied in a population-based sample of 2,626 residents of Minneapolis-St. Paul, MN. More blacks than whites were found to be smokers, before and after adjusting for age and education differences. More whites than blacks were former smokers, but the prevalence of those who had never smoked was comparable for whites and blacks. Among smokers, the mean number of cigarettes smoked per day was lower among blacks than whites, but more blacks were found to smoke cigarettes with high "tar" (dry particulate matter) and nicotine content. Men smokers were found to smoke more than women smokers, young people smoked more than older people, and those with a high school education or less smoked more than those with more than a high school education. Smoking cessation behavior consisted mostly of a variety of strategies that began with reducing cigarette consumption, followed by changing to lower tar brands, attempting to quit, and actually quitting. In general, a higher percentage of whites than blacks reported smoking cessation behaviors. A greater percentage of white than black women had tried cigarette brands lower in tar and nicotine within the previous year. Among men, a lower percentage of black than white smokers had tried quitting, and fewer black men planned to quit in the future. Blacks appeared to lag behind whites in their efforts to quit smoking. Smoking behavior continues to be problematic for both blacks and whites. Studies are needed to explain better the racial differences in smoking and smoking cessation behaviors, and to facilitate programs to encourage cessation.     

Active and passive exposure status to tobacco smoke of department store employees measured by cotinine ELISA

Quantitation of urinary cotinine, a major metabolite of nicotine, by an enzyme-linked immunosorbent assay (ELISA), was performed in parallel with questionnaires containing items on smoking status, such as active and/or passive smokers, the number of cigarettes smoked, and the presence or absence of active smokers in the surroundings in a department store (517 employees). The cotinine values corrected by creatinine (cotinine-creatinine ratios, CCRs) approximately conformed to the extent of self-recognition of their exposure status to tobacco-smoke, and were low in the order of active smokers, passive smokers and non-smokers who felt they were not exposed to tobacco-smoke. Occupational differences of the CCRs were not found in the employees. In the active smokers, the CCRs were increasing according to the number of cigarettes per day they smoked, and the values were nearly proportional to nicotine contents of cigarette in the moderate smokers who smoked 11-20 cigarettes per day. The CCRs of males were higher than those of females in the active smokers, which also agreed well with the numbers of cigarettes they smoked per day. In the passive smokers, the CCRs were remarkably and significantly higher in subjects who felt they were exposed to tobacco-smoke both in their workplaces and homes. Urinary CCRs measured by ELISA are thus found to be a reliable and excellent objective indicator of both active and passive exposure-status to tobacco-smoke.