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Study: China Struggles to Kick World-Leading Cigarette Habit

Most smokers in China, the world’s largest tobacco consumer, have no intention of kicking the habit and remain unaware of some of its most damaging health effects, Chinese health officials and outside researchers said Wednesday.

http://www.voanews.com/a/china-smoking/3879050.html

An estimated 316 million people smoke in China, almost a quarter of the population, and concerns are growing about the long-term effects on public health and the economy.

The vast majority of smokers are men, of whom 59 percent told surveyors that they have no plans to quit, according to a decade-long study by the Chinese Center for Disease Control and Prevention and Canadian researchers with the International Tobacco Control project.

Such numbers have prompted efforts to restrict the formerly ubiquitous practice. Major cities including Beijing and Shanghai having recently moved to ban public smoking, with Shanghai’s prohibition going into effect in March. In 2015, the central government approved a modest nationwide cigarette tax increase.

But Chinese and international health officials argue that more is needed, including a nationwide public smoking ban, higher cigarette taxes and more aggressive health warnings. Such actions are “critically important,” Yuan Jiang, director of tobacco control for the Chinese Center for Disease Control, said in a statement released with Wednesday’s study.

A public smoking ban appeared imminent last year. The government health ministry said in December that it would happen by the end of 2016, but that has yet to materialize.

“They have to figure out what’s important as a health policy,” said Geoffrey Fong of Canada’s University of Waterloo, one of the authors of Wednesday’s study. “Every third man that you pass on the street in China will die of cigarettes. …When you have cheap cigarettes, people will smoke them.”

In line with global trends, smoking rates among Chinese have fallen slowly over the past 25 years, by about 1 percent annually among men and 2.6 percent among women, according to a separate study published in April in the medical journal The Lancet.

Yet because of China’s population growth — 1.37 billion people at last count — the actual number of smokers has continued to increase. Rising prosperity means cigarettes have become more affordable, while low taxes keep the cost of some brands at less than $1 a pack.

Sixty percent of Chinese smokers were unaware that cigarettes can lead to strokes and almost 40 percent weren’t aware that smoking causes heart disease, according to the study, which was released on World No Tobacco Day, when the World Health Organization and others highlight health risks associated with tobacco use.

Judith Mackay, an anti-tobacco advocate based in Hong Kong, said China has made strides with the public smoking bans in some cities and a similar ban covering schools and universities, but that’s not enough.

“This is the first time there has been a report looking at the overall picture of where China stands,” said Mackay, senior adviser at Vital Strategies, a global health organization. “The reality is, it’s falling behind.”

Mackay blamed behind the scenes lobbying by China’s state-owned tobacco monopoly for impeding efforts to toughen tobacco policies. The State Tobacco Monopoly Administration did not immediately respond to a request for comment.

Government agencies and research institutes in China, Canada and the United States funded the study.

Study reveals high environmental cost of tobacco

Smoking kills 7 million people a year, and it scars the planet through deforestation, pollution and littering.

http://edition.cnn.com/2017/05/31/health/tobacco-environment-who-report/

Details of the environmental cost of tobacco are revealed in a study released Wednesday by the World Health Organization, adding to the well-known costs to global health, which translate to a yearly loss of $1.4 trillion in health-care expenses and lost productivity.

From crop to pack, tobacco commands an intensive use of resources and forces the release of harmful chemicals in the soil and waterways, as well as significant amounts of greenhouse gases. Its leftovers linger, as tobacco litter is the biggest component of litter worldwide.

“Tobacco not only produces lung cancer in people, but it is a cancer to the lungs of the Earth,” said Dr. Armando Peruga, who previously coordinated the WHO Tobacco Free Initiative and now works as a consultant. He reviewed the new report for the WHO.

world-of-tobacco

Commercial tobacco farming is a worldwide industry that involves 124 countries and occupies 4.3 million hectares of agricultural land. About 90% of it takes place in low-income countries, with China, Brazil and India as the largest producers.

Because tobacco is often a monocrop — grown without being rotated with other crops — the plants and the soil are weak in natural defenses and require larger amounts of chemicals for growth and protection from pests.

“Tobacco also takes away a lot of nutrients from the soil and requires massive amounts of fertilizer, a process that leads to degradation of the land and desertification, with negative consequences for biodiversity and wildlife,” Peruga said.

The use of chemicals directly impacts the health of farmers, 60% to 70% of whom are women. This is especially prominent in low- and middle-income countries, where some compounds that are banned in high-income countries are still used.

300 cigarettes = one tree

Farming also uses a surprisingly large amount of wood, rendering tobacco a driver of deforestation, one of the leading causes of climate change.

About 11.4 million metric tonnes of wood are utilized annually for curing: the drying of the tobacco leaf, which is achieved through various methods, including wood fires.

That’s the equivalent of one tree for every 300 cigarettes, or 1.5 cartons.

This adds to the impact of plantations on forest land, which the study describes as a significant cause for concern, citing “evidence of substantial, and largely irreversible, losses of trees and other plant species cause by tobacco farming.”

Deadly gases

In 2012, 967 million daily smokers consumed approximately 6.25 trillion cigarettes worldwide, the WHO estimates.

“That means about 6,000 metric tonnes of formaldehyde and 47,000 metric tonnes of nicotine are released into the environment,” Peruga said.

Tobacco smoke contains about 4,000 chemicals, at least 250 of which are known to be harmful. It also contains climate-warming carbon dioxide, methane and nitrous oxides. “The combination of greenhouse gases from combustion is equivalent to about 1.5 million vehicles driven annually,” Peruga said.

Secondhand smoke is particularly deadly: It contains twice as much nicotine and 147 times more ammonia than so-called mainstream smoke, leading to close to 1 million deaths annually, 28% of them children.

Some of these pollutants remain in the environment (and our homes) as “third-hand smoke,” accumulating in dust and surfaces indoors, and in landfills. Some, like nicotine, even resist treatment, polluting waterways and potentially contaminating water used for consumption, the study notes.

Non-biodegradable litter

Tobacco litter is the most common type of litter by count worldwide.

“We calculate that two-thirds of every cigarette ends up as litter,” Peruga said.

The litter is laced with chemicals including arsenic and heavy metals, which can end up in the water supply. Cigarette butts are not biodegradable, and tossing one on the ground is still considered a socially acceptable form of littering in many countries.

The WHO estimates that between 340 million and 680 million kilograms of tobacco waste are thrown away every year, and cigarette butts account for 30% to 40% of all items collected in coastal and urban clean-ups.

“In addition to that, there are 2 million tons of paper, foil, ink and glue used for the packaging,” Peruga said.

A way forward?

Even though smoking is declining globally, it is increasing in some regions, such as the eastern Mediterranean and Africa. China is a world leader both in production (44%) and consumption, with 10 times more cigarettes smoked than in any other nation.

Every stage of the production of a cigarette has negative effects on the environment and the people who are involved in manufacturing tobacco products, even before the health of smokers and non-smokers is affected.

Although governments worldwide already collect $270 billion in tobacco taxes a year, the WHO suggests that increasing tax and prices is an effective way of reducing consumption and help development priorities in each country, adding that by collecting 80 cents more per pack, the global tax revenue could be doubled.

“Tobacco threatens us all,” WHO Director-General Margaret Chan said in a note. “It exacerbates poverty, reduces economic productivity, contributes to poor household food choices, and pollutes indoor air.”

World No Tobacco Day 2017

World No Tobacco Day 2017: Beating tobacco for health, prosperity, the environment and national development

http://www.who.int/mediacentre/news/releases/2017/no-tobacco-day/en/

Action to stamp out tobacco use can help countries prevent millions of people falling ill and dying from tobacco-related disease, combat poverty and, according to a first-ever WHO report, reduce large-scale environmental degradation.

On World No Tobacco Day 2017, WHO is highlighting how tobacco threatens the development of nations worldwide, and is calling on governments to implement strong tobacco control measures. These include banning marketing and advertising of tobacco, promoting plain packaging of tobacco products, raising excise taxes, and making indoor public places and workplaces smoke-free.

Tobacco’s health and economic costs

Tobacco use kills more than 7 million people every year and costs households and governments over US$ 1.4 trillion through healthcare expenditure and lost productivity.

“Tobacco threatens us all,” says WHO Director-General Dr Margaret Chan. “Tobacco exacerbates poverty, reduces economic productivity, contributes to poor household food choices, and pollutes indoor air.”

Dr Chan adds: “But by taking robust tobacco control measures, governments can safeguard their countries’ futures by protecting tobacco users and non-users from these deadly products, generating revenues to fund health and other social services, and saving their environments from the ravages tobacco causes.”

All countries have committed to the 2030 Agenda for Sustainable Development, which aims to strengthen universal peace and eradicate poverty. Key elements of this agenda include implementing the WHO Framework Convention on Tobacco Control, and by 2030 reducing by one third premature death from noncommunicable diseases (NCDs), including heart and lung diseases, cancer, and diabetes, for which tobacco use is a key risk factor.

Tobacco scars the environment

The first-ever WHO report, Tobacco and its environmental impact: an overview, also shows the impact of this product on nature, including:

  • Tobacco waste contains over 7000 toxic chemicals that poison the environment, including human carcinogens.
  • Tobacco smoke emissions contribute thousands of tons of human carcinogens, toxicants, and greenhouse gases to the environment. And tobacco waste is the largest type of litter by count globally.
  • Up to 10 billion of the 15 billion cigarettes sold daily are disposed in the environment.
  • Cigarette butts account for 30–40% of all items collected in coastal and urban clean-ups.

Tobacco threatens women, children, and livelihoods

Tobacco threatens all people, and national and regional development, in many ways, including:

  • Poverty: Around 860 million adult smokers live in low- and middle-income countries. Many studies have shown that in the poorest households, spending on tobacco products often represents more than 10% of total household expenditure – meaning less money for food, education and healthcare.
  • Children and education: Tobacco farming stops children attending school. 10%–14% of children from tobacco-growing families miss class because of working in tobacco fields.
  • Women: 60%–70% of tobacco farm workers are women, putting them in close contact with often hazardous chemicals.
  • Health: Tobacco contributes to 16% of all noncommunicable diseases (NCDs) deaths.

Taxation: a powerful tobacco control tool

“Many governments are taking action against tobacco, from banning advertising and marketing, to introducing plain packaging for tobacco products, and smoke-free work and public places,” says Dr Oleg Chestnov, WHO’s Assistant Director-General for NCDs and Mental Health. “But one of the least used, but most effective, tobacco control measures to help countries address development needs is through increasing tobacco tax and prices.”

Governments collect nearly US$ 270 billion in tobacco excise tax revenues each year, but this could increase by over 50%, generating an additional US$ 141 billion, simply from raising taxes on cigarettes by just US$ 0.80 per pack (equivalent to one international dollar) in all countries. Increased tobacco taxation revenues will strengthen domestic resource mobilization, creating the fiscal space needed for countries to meet development priorities under the 2030 Agenda.

“Tobacco is a major barrier to development globally;” says Dr Douglas Bettcher, Director of WHO’s Department for the Prevention on NCDs. “Tobacco-related death and illness are drivers of poverty, leaving households without breadwinners, diverting limited household resources to purchase tobacco products rather than food and school materials, and forcing many people to pay for medical expenses.”

“But action to control it will provide countries with a powerful tool to protect their citizens and futures,” Dr Bettcher adds.

Editor’s note

Tobacco-related illness is one of the biggest public health threats the world faces, killing more than 7 million people a year. But tobacco use is one of the largest preventable causes of noncommunicable diseases.

Tobacco control represents a powerful tool in improving health in communities and in achieving the Sustainable Development Goals (SDGs). SDG target 3.4 is to reduce premature deaths from NCDs by one third by 2030, including cardiovascular and chronic respiratory diseases, cancers, and diabetes.

Another SDG target, 3.a, calls for implementation of the WHO Framework Convention for Tobacco Control (WHO FCTC). The WHO FCTC entered into force in 2005, and its Parties are obliged to take a number of steps to reduce demand and supply for tobacco products. Actions addressed in the Convention include protecting people from exposure to tobacco smoke; banning tobacco advertising, promotion and sponsorship; banning sales to minors; requiring health warnings on tobacco packaging; promoting tobacco cessation; increasing tobacco taxes; and creating a national coordinating mechanism for tobacco control. There are 180 Parties to the Convention.

For more information, please contact:

Paul Garwood
WHO Department of Communications
Telephone: +41 22 791 15 78
Mobile: +41 79 603 72 94
Email: garwoodp@who.int

Christian Lindmeier
WHO Department of Communications
Telephone: +41 22 791 1948
Mobile: +41 79 500 6552
Email: lindmeierch@who.int

Tobacco kills 7 million a year, wreaks environmental havoc: WHO

Smoking and other tobacco use kills more than seven million people each year, the World Health Organization said Tuesday, also warning of the dire environmental impact of tobacco production, distribution and waste.

http://www.timeslive.co.za/world/2017/05/30/Tobacco-kills-7-million-a-year-wreaks-environmental-havoc-WHO

The UN agency said tougher measures were needed to rein in tobacco use, urging countries to ban smoking in the workplace and indoor public spaces, outlaw marketing of tobacco products and hike cigarette prices.

“Tobacco threatens us all,” WHO chief Margaret Chan said in a statement.

“Tobacco exacerbates poverty, reduces economic productivity, contributes to poor household food choices, and pollutes indoor air,” she said.

In a report released ahead of World No Tobacco Day on Wednesday, WHO warned that the annual death toll of seven million people had jumped from four million at the turn of the century, making tobacco the world’s single biggest cause of preventable death.

And the death toll is expected to keep rising, with WHO bracing for more than one billion deaths this century.

“By 2030, more than 80 percent of the deaths will occur in developing countries, which have been increasingly targeted by tobacco companies seeking new markets to circumvent tightening regulation in developed nations.”

Tobacco use also brings an economic cost: WHO estimates that it drains more than $1.4 trillion (1.3 trillion euros) from households and governments each year in healthcare expenditures and lost productivity, or nearly two percent of the global gross domestic product.

In addition to the health and economic costs linked to smoking, the WHO report for the first time delved into the environmental impact of everything from tobacco production to the cigarette butts and other waste produced by smokers.

“From start to finish, the tobacco life cycle is an overwhelmingly polluting and damaging process,” WHO Assistant Director-General Oleg Chestnov said in the report.

The report detailed how growing tobacco often requires large quantities of fertilisers and pesticides, and it warned that tobacco farming had become the main cause of deforestation in several countries.

This is largely due to the amount of wood needed for curing tobacco, with WHO estimating that one tree is needed for every 300 cigarettes produced.

WHO also highlighted the pollution generated during the production, transport and distribution of tobacco products.

The report estimates that the industry emits nearly four million tonnes of carbon dioxide equivalent annually — the same as around three million transatlantic flights.

And waste from the process contains over 7,000 toxic chemicals that poison the environment, including human carcinogens, WHO said.

Once in the hands of the consumer, tobacco smoke emissions spewed thousands of tonnes of human carcinogens, toxic substances and greenhouse gases into the environment.

Cigarette butts and other tobacco waste make up the largest number of individual pieces of litter in the world, the agency said.

Two thirds of the 15 billion cigarettes sold each day are thrown on to the street or elsewhere in the environment, it said, adding that butts account for up to 40 percent of all items collected in coastal and urban clean-ups.

WHO urged governments to take strong measures to rein in tobacco use.

“One of the least used, but most effective tobacco control measures… is through increasing tobacco tax and prices,” Chestnov said.

Current Tobacco Smoking and Desire to Quit Smoking Among Students Aged 13–15 Years

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CIGARETTE FILTERS MAY INCREASE LUNG CANCER RISK

A study’s authors argue that tiny ventilation holes in virtually all cigarettes sold today are creating a new health risk.

http://ewn.co.za/2017/05/23/cigarette-filters-may-increase-lung-cancer-risk

Cigarette filters, introduced decades ago to reduce the amount of tar smokers inhale, also alter other properties of smoke and smoking in a way that raises the risk of lung cancer, researchers say.

In a review of research on changes in lung cancer rates, and changes in the types of lung cancer that are most common, the study authors argue that tiny ventilation holes in virtually all cigarettes sold today are creating a new health risk.

“The design of cigarette filters that have ventilation can make the cigarettes even more dangerous, because those holes can change how the tobacco burns, allow smokers to inhale more smoke and to think that the smoke is safer because it is smoother,” senior author Dr. Peter D. Shields from The Ohio State University’s Wexner Medical Center in Columbus told Reuters Health by email.

“This applies to all cigarettes, because almost all the cigarettes on the market have the holes, not just the ones that used to be called lights and ultra-lights,” he noted.

Although rates of lung cancer in the population have fallen with declines in smoking overall, rates of lung cancer among smokers have risen significantly, the researchers point out. And the type of lung cancer associated with smoking has also shifted since the 1950s.

Rates of adenocarcinoma of the lung, the lung cancer most associated with smoking, have more than quadrupled in men and increased eight-fold in women along with changes in the design and composition of cigarettes since the 1950s, the researchers write.

Shields and his team review the evidence linking cigarette filter ventilation to these increased rates of lung cancer in a report online 22 May in the Journal of the National Cancer Institute.

Filter ventilation reduces the amount of tar in the cigarette smoke when tested on smoking machines, but the increased ventilation and slower tobacco burn result in more puffs per cigarette and more toxic cancer-causing chemicals being inhaled by smokers, they write.

“The use of the ventilation holes yields lower tar only on a machine,” Shields said. “Machines have nothing to do with actual exposures in humans. The holes let them actually inhale more smoke with more cancer-causing agents.”

Because of the claims of lower tar content, though, smokers develop the false belief that a lower tar cigarette is a healthier cigarette, Shields’ team writes.

Increased filter ventilation also results in smaller particle size, allowing more smoke to reach vulnerable parts of the lung.

Moreover, even though machine-measured tar and nicotine levels have decreased over time, there has been no appreciable change in daily nicotine intake among smokers over the past 25 years, they write.

“The evidence shows that more modern cigarettes are more risky for lung cancer,” Shields said. “There are reasons in addition to the holes that also can contribute to the increasing risk, but one does not preclude the other.”

Cigarette designs could and should be regulated to address all the possible reasons, Shields said.

“The holes have no health benefits; they serve no health purpose,” he explained. “They do not lower tar delivery to people. So, if they have the potential harm, the FDA can act, even if the science is not perfect. The FDA can require cigarette manufacturers to make filters without the holes. This is easy and they are doing it for some brands already.”

Having filters may indeed be safer, Shields clarified. “This study is about the holes on the filters. We are not saying to remove filters, only to change their designs by removing the holes on the filters.”

“The FDA now has the authority to require the elimination of filter ventilation, as ventilation does not serve any public health purpose and instead provides a false promise of reduced risk,” the study team concludes.

“This single action for banning filter ventilation by the FDA is scientifically justified, and within its mandate to improve the public health,” they write.

There is some precedent for the ban Shields and colleagues propose, Jonathan M. Samet and Lilit Aladadyan, both from the Tobacco Center of Regulatory Science at the Keck School of Medicine of USC and the USC Institute for Global Health in Los Angeles, write in an accompanying editorial.

The evidence gathered by Shields’ team seems strong enough to support FDA action, and “given a lack of evidence for countervailing harms, ending filter ventilation could be a ‘no regrets’ action that would benefit public health,” they write.

Rise in Lung Adenocarcinoma Linked to ‘Light’ Cigarette Use

A new study shows that so-called “light” cigarettes have no health benefits to smokers and have likely contributed to the rise of a certain form of lung cancer that occurs deep in the lungs.

http://journals.lww.com/oncology-times/blog/onlinefirst/pages/post.aspx?PostID=1618

For this new study, researchers at The Ohio State University Comprehensive Cancer Center–Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC–James) and five other universities/cancer centers examined why the most common type of lung cancer, called adenocarcinoma, has increased over the past 50 years, rather than decreasing as smokers have been able to quit. Other types of lung cancer have been decreasing in relationship to fewer people smoking, but not lung adenocarcinoma. Because of this, lung adenocarcinoma is now the most common type of lung cancer.

Results confirm what tobacco-control researchers have suspected for years: There is no health benefit to high-ventilation (light) cigarettes–long marketed by the tobacco industry as a “healthier” option–and these cigarettes have actually caused more harm. Holes in cigarette filters were introduced 50 years ago and were critical to claims for low-tar cigarettes.

“This was done to fool smokers and the public health community into thinking that they actually were safer,” said Peter Shields, MD, Deputy Director of the OSUCCC–James and a lung medical oncologist. “Our data suggests a clear relationship between the addition of ventilation holes to cigarettes and increasing rates of lung adenocarcinoma seen over the past 20 years. What is especially concerning is that these holes are still added to virtually all cigarettes that are smoked today.”

The FDA was given the authority to regulate the manufacture, distribution, and marketing of tobacco products through the Family Smoking Prevention and Tobacco Control Act in 2009. Current regulations ban tobacco companies from labeling and marketing cigarettes as “low tar” or “light.” Study authors, however, say that given this new data, the FDA should take immediate action to regulate the use of the ventilation holes, up to and including a complete ban of the holes.

“The FDA has a public health obligation to take immediate regulatory action to eliminate the use of ventilation holes on cigarettes,” added Shields. “It is a somewhat complicated process to enact such regulations, but there is more than enough data to start the process. We believe that such an action would drive down the use and toxicity of conventional cigarettes, and drive smokers to either quit or use less harmful products. There are some open questions about unintended consequences for enacting a ban, which provides for an important research agenda.”

A team made up of lung oncology, public health, and tobacco regulation researchers conducted a comprehensive, multi-faceted analysis of existing literature that included chemistry and toxicology studies, human clinical trials and epidemiological studies of both smoking behavior and cancer risk. They studied scientific publications in the peer-reviewed literature and internal tobacco company documents.

Researchers hypothesized that the higher incidence rates of lung adenocarcinoma were attributable to the filter ventilation holes, which allow smokers to inhale more smoke that also has higher levels of carcinogens, mutagens and other toxins.

“The filter ventilation holes change how the tobacco is burned, producing more carcinogens, which then also allows the smoke to reach the deeper parts of the lung where adenocarcinomas more frequently occur,” explained Shields.

To date, all the scientific evidence involves the adverse impact of adding ventilation, but not removing it. Additional research is needed to confirm that the addictiveness of the cigarette or toxic exposures from cigarettes would not increase with elimination of the ventilation holes. The OSUCCC–James and researchers at the University of Minnesota, Roswell Park Cancer Institute, Virginia Tech, Harvard University and Medical University of South Carolina are conducting additional research to reconcile human biomarkers studies and smoke distribution/exposure in the lung.

Heat-Not-Burn Tobacco Cigarettes: Smoke by Any Other Name

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The Hole Story: Ventilated Filters Make Smoking More Deadly

The ventilation systems built into cigarette filters in the mid-1960s to reduce tar and make smoking ‘smoother’ and ‘safer’ were responsible for the paradoxical rise in rates of lung adenocarcinoma — even as rates of other lung cancer subtypes dropped along with the number of smokers. These conclusions were in the 2014 US Surgeon General’s report on the health consequences of smoking.

http://www.medscape.com/viewarticle/880383

Now, two new weight-of-evidence reviews have pinpointed 25 “causation analysis evidence blocks” that could support an outright ban of filter ventilation, according to lead author, Peter G. Shields, MD, deputy director of the Comprehensive Cancer Center, the Ohio State University Wexner Medical Center, in Columbus, and colleagues.

The review found that between the 1960s and the 1980s, the health risks associated with smoking jumped almost 2-fold in men and increased 10-fold in female smokers. At the same time, the relative risks for adenocarcinomas rocketed from 4.6 to 19.0 in men and from 1.5 to 8.1 in women — even though the risks for other lung cancer subtypes didn’t increase. “Thus, there was a paradoxical increase for lung adenocarcinomas while squamous cell cancers decreased with decreased smoking rates,” the review authors write.

“The analysis strongly suggests that filter ventilation has contributed to the rise in lung adenocarcinomas among smokers,” they say in a report published online May 22 in the Journal of the National Cancer Institute.

“Based on these weight-of-evidence reviews, the FDA [Food and Drug Administration] should embark on a regulatory process of data evaluation and consider regulation(s) for the use of ventilation in filters, up to and including a ban on their use,” the authors conclude.

“The prime point is to rally the troops to get the FDA to focus on this,” Dr Shields told Medscape Medical News. “To me, this is a policy paper. Physicians can’t be silent.”

This is a policy paper. Physicians can’t be silent. Peter D. Shields

Ventilation holes in filters are now found in nearly every brand of cigarettes, and they make smoking even more deadly, Dr Shields elaborated in an interview.

The tiny filter holes slow down tobacco combustion, giving smokers more puffs per cigarette but also allowing more toxic constituents to form, increasing the mutagenicity of the smoke, the review authors explain. To get the requisite nicotine hit from a cigarette with a ventilated filter, a smoker must also inhale more deeply, drawing smoke farther into the lungs and exposing cells vulnerable to adenocarcinoma.

Increasing amounts of tobacco-specific nitrosamines can also be found in new blended tobaccos that provide a “smoother” smoking experience, albeit with more carcinogens, Dr Shields commented. This makes smoking more dangerous than ever before, and patients need to know this, he emphasized.

“As part of your risk counseling, tell patients who smoke that the cigarettes today are more deadly than the cigarettes from 30 or 40 years ago. We need to take away smokers’ perception that any cigarette is safe. It’s like putting your head in a chimney,” Dr Shields said.

Increased Risk for Adenocarcinoma

In an accompanying editorial, Jonathan M. Samet, MD, and Lilit Aladadyan, MS, MPH, say that ending filter ventilation “could be a ‘no regrets’ action that would benefit public health.”

Dr Samet is professor and Flora L. Thornton Chair for the Department of Preventive Medicine at the Keck School of Medicine at the University of Southern California (USC) in Los Angeles, and Aladadyan is center director for the USC Tobacco Center of Regulatory Science.

The editorialists note the review looked at a “large and somewhat poorly circumscribed body of literature” and that the evidentiary threshold required for the FDA to take action is not supported by any record of precedents.

However, they also say that the review’s conclusion about the contribution of filter ventilation to rising rates of lung adenocarcinoma in smokers “is well justified” and supports “the indictment of filter ventilation as increasing risk for adenocarcinoma.”

Filter ventilation was originally designed to lower smoking machine tar yields in so-called light cigarettes marketed primarily to women as a “healthier” alternative to regular cigarettes. “This was done to fool smokers and the public health community into thinking that they actually were safer,” Dr Shields said in a statement.

In 2009, the Family Smoking Prevention and Tobacco Control Act gave the FDA authority to ban tobacco companies from labeling and marketing cigarettes as “low tar” or “light.”

Dr Shields has served as an expert in class action suits against tobacco companies marketing light cigarettes as a healthier alternative. He’s also heard lawyers for Big Tobacco say peer-reviewed evidence was needed. “From our perspective, there is more than enough data to start the process and it’s time for regulation,” he said. “We believe that such an action would drive down the use and toxicity of conventional cigarettes and drive smokers to either quit or use less harmful products. There are some open questions about unintended consequences for enacting a ban, which provides for an important research agenda.”

Future clinical trials could assess smokers switching to filtered cigarettes without ventilation, using a panel of biomarkers to measure exposure to carcinogens and lung toxicants, markers of oxidative damage and inflammation in lung, blood, or/and urine, the review authors suggest. At present, human exposure biomarker studies do not appear to support a causal relationship, they didn’t measure exposure in the lung or “utilize known biomarkers of harm,” they note.

Smokers’ perceptions, and transition to alternate products, should also be assessed, looking at differences by race and ethnicity, sex, age, and vulnerable populations. The effect of filter ventilation on the risk for other diseases, such as chronic obstructive pulmonary disease, could also be studied, they say.

This study was supported by the National Cancer Institute of the National Institutes of Health and the FDA Center for Tobacco Products. Dr Shields and coauthors Neal L. Benowitz, MD, and Theodore M. Brasky, PhD, disclose they have served as consultants and expert witnesses in litigation against tobacco companies. Coauthor K. Michael Cummings, PhD, MPH, declares a relationship with Pfizer Inc. The study authors and editorialists have disclosed no relevant financial relationships.

Cigarette Filter Ventilation and its Relationship to Increasing Rates of Lung Adenocarcinoma

https://academic.oup.com/jnci/article-abstract/109/12/djx075/3836090/Cigarette-Filter-Ventilation-and-its-Relationship?redirectedFrom=fulltext

The 2014 Surgeon General’s Report on smoking and health concluded that changing cigarette designs have caused an increase in lung adenocarcinomas, implicating cigarette filter ventilation that lowers smoking machine tar yields. The Food and Drug Administration (FDA) now has the authority to regulate cigarette design if doing so would improve public health. To support a potential regulatory action, two weight-of-evidence reviews were applied for causally relating filter ventilation to lung adenocarcinoma. Published scientific literature (3284 citations) and internal tobacco company documents contributed to causation analysis evidence blocks and the identification of research gaps. Filter ventilation was adopted in the mid-1960s and was initially equated with making a cigarette safer. Since then, lung adenocarcinoma rates paradoxically increased relative to other lung cancer subtypes. Filter ventilation 1) alters tobacco combustion, increasing smoke toxicants; 2) allows for elasticity of use so that smokers inhale more smoke to maintain their nicotine intake; and 3) causes a false perception of lower health risk from “lighter” smoke. Seemingly not supportive of a causal relationship is that human exposure biomarker studies indicate no reduction in exposure, but these do not measure exposure in the lung or utilize known biomarkers of harm. Altered puffing and inhalation may make smoke available to lung cells prone to adenocarcinomas. The analysis strongly suggests that filter ventilation has contributed to the rise in lung adenocarcinomas among smokers. Thus, the FDA should consider regulating its use, up to and including a ban. Herein, we propose a research agenda to support such an effort.