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November, 2006:

Protect Children From Secondhand Smoke In Cars

Measuring Air Quality To Protect Children From Secondhand Smoke In Cars 

Rees VW, Connolly GN.

Harvard School of Public Health, Division of Public Health Practice, Boston, Massachusetts 02115, USA.

BACKGROUND: Secondhand tobacco smoke (SHS) is a major, preventable contributor to acute and chronic adverse health outcomes that affect children disproportionately. The predominant source of SHS among children is domestic exposure, and while up to two thirds of U.S. households have car smoking bans, an unacceptable number of children remain vulnerable. To help promote more effective protection through legislation, health communication strategies, or behavioral interventions, data demonstrating the adverse effect of SHS on air quality in cars are needed.

METHODS: Secondhand tobacco smoke in a motor vehicle under actual driving conditions was monitored by measuring respirable suspended particles (RSPs) of less than 2.5 microns in diameter, and carbon monoxide. Forty-five driving trials were conducted, using teams of volunteer drivers and smokers recruited from the general community. Three smoking conditions (nonsmoking baseline, active smoking, and immediate post-smoking period, each 5 minutes) were crossed with two ventilation conditions (windows open, closed) in a 3 x 2 within-sessions factorial design.

RESULTS: The highest mean observed RSP level was 271 mug/m(3), which is unsafe, particularly for children. Peak RSP levels were considerably higher. RSPs and carbon monoxide increased significantly from baseline after smoking, and these increases were greatest during the closed ventilation condition, compared with open ventilation.

CONCLUSIONS: Private passenger cars are a domestic environment with the potential to yield unsafe levels of SHS contaminants. These data may assist policymakers and health advocates to promote protective strategies to ensure smoke-free domestic environments for children.

PMID: 17046406 [PubMed – indexed for MEDLINE]

Light and Low Tar Product Descriptors Mislead Consumers


Framework Convention on Tobacco Control – Article 11

Packaging and labeling of tobacco products

1. Each Party shall, within a period of three years after entry into force of this Convention for that Party, adopt and implement, in accordance with its national law, effective measures to ensure that:

(a) tobacco product packaging and labeling do not promote a tobacco product by any means that are false, misleading, deceptive or likely to create an erroneous impression about its characteristics, health effects, hazards or emissions, including any term, descriptor, trademark, figurative or any other sign that directly or indirectly creates the false impression that a particular tobacco product is less harmful than other tobacco products. These may include terms such as “low tar”, “light”, “ultra-light”, or “mild.”


The evidence is clear that terms such as “low-tar,” “light,” “ultra-light” and “mild” mislead consumers into believing that some cigarettes are less hazardous than others. However, years of research shows cigarettes labeled as “light” and “low tar” have not resulted in a meaningful reduction in the disease burden or health risks caused by cigarette use either for smokers as a group or for the population as a whole. A landmark November 2001 report by the National Cancer Institute (U.S.) concluded that the marketing of these products as delivering less tar and reducing smokers’ health risks is “deceptive” and smokers’ choice of these products as an alternative to quitting makes this deception an “urgent public health issue.” In the interest of public health, countries should prohibit these misleading terms, along with other descriptors, numbers or symbols giving the false impression that some cigarettes are less hazardous than others.

The Rise of “Light” and “Low-tar” Cigarettes:

As the public began to understand the link between smoking and disease, cigarette companies, fearing a massive loss in sales, scrambled to develop products that would ease consumers’ fears about the health effects of smoking. This quote from the internal files of British American Tobacco’s American subsidiary in 1977 illustrates the industry’s approach:

“All work in this area should be directed towards providing consumer reassurance about cigarettes and the smoking habit. This can be provided in different ways, e.g. by claimed low deliveries, by the perception of low deliveries and by the perception of ‘mildness’. Furthermore, advertising for low delivery or traditional brands should be constructed in ways so as not to provoke anxiety about health, but to alleviate it, and enable the smoker to feel assured about the habit and confident in maintaining it over time.”

To reassure consumers, the companies introduced “low-tar” and “light” cigarettes, which took their name from the fact that when measured by smoking machines, these cigarettes delivered less tar and nicotine. Internal tobacco industry documents show the industry deliberately designed these cigarettes to produce low yields of tar when tested by machines, knowing full well that they would be smoked differently by actual smokers seeking to maintain nicotine levels. Despite knowing this, the cigarette companies marketed them as safer products. On August 17, 2006, U.S. District Judge Gladys Kessler issued a final opinion in the U.S. government’s landmark lawsuit against the major tobacco companies. In addition to finding that the companies violated civil racketeering laws and lied for decades about the health risks of smoking, Judge Kessler also found that the companies “falsely marketed and promoted low tar/light cigarettes as less harmful than full-flavor cigarettes in order to keep people smoking and sustain corporate revenues.” For health-conscious adults who wanted to quit smoking but were unable to do so because they were addicted, switching to cigarettes with lower tar and nicotine yields seemed to be an attractive alternative.

Smoker Impressions of “Light” and “Low-tar” Cigarettes:

A number of scientific surveys have examined how smokers perceive “light,” “ultra light” and “low tar” cigarettes and their motivations for smoking these brands. The studies conclude that many smokers of “light” and “ultra light” cigarettes mistakenly believe that these cigarettes have lower tar. Many consumers also assume that these products present less of a health risk than other cigarettes.

The desire to reduce health risks is a key motivation for smoking “light” cigarettes. Despite the fact that many smokers choose “light” or “ultra light” cigarettes to reduce their exposure to tar and nicotine, and smoking risks in general, 9 out of 10 smokers did not know that one “ultra light” cigarette could deliver the same amount of tar as one regular cigarette. And more than one quarter of the “light” and “ultra light” smokers said they would be likely to quit if they knew this information.

Smoking “light” cigarettes can be a barrier to quitting. Formerly confidential tobacco industry documents, made public in legal proceedings against the industry, reveal that tobacco companies introduced and marketed “light” and “ultra light” brands to provide an alternative to quitting to smokers who were increasingly concerned about their health. The documents reveal that the tobacco companies knew that “low tar” cigarettes may keep smokers from quitting. A 1978 Imperial Tobacco document says “We have evidence of virtually no quitting among smokers of these brands, and there are indications that the advent of ultra low tar cigarettes has actually retained some potential smokers in the cigarette market by offering them a viable alternative.”

The Evidence Is Clear That “Light” and “Low-tar” Cigarettes Are Not Less Harmful:

The scientific evidence has shown that, in practice, “light” cigarettes have not produced a public health benefit and have not lowered disease risk among smokers. In November 2001, the U.S. National Cancer Institute (NCI) released a landmark study on the subject. The report found that while changes in cigarette design have reduced the amount of tar and nicotine measured by smoking machines, these machine measurements do not accurately show how much tar and nicotine is actually received by the smoker. There is in fact no meaningful difference in exposure from smoking low-tar and regular brands, and therefore no difference in disease risk. That is because smokers smoke low-tar brands differently to obtain the same amount of nicotine. Smokers block ventilation holes; inhale more deeply; take larger, more rapid, or more frequent puffs; or increase the number of cigarettes smoked per day.

The NCI report concluded that “Epidemiological and other scientific evidence, including patterns of mortality from smoking-caused diseases, does not indicate a benefit to public health from changes in cigarette design and manufacturing over the last fifty years.” The report noted that while “many smokers switch to lower yield cigarettes out of concerns for their health believing these cigarettes to be less risky or to be a step towards quitting…current evidence does not support either claims of reduced harm or policy recommendations to switch to these products.”

A more recent study published in the British Medical Journal found that smoking cigarettes labeled as “low-tar” and “ultra-low-tar” does not reduce a smoker’s risk of developing lung cancer compared to smoking regular brands.

Policy Interventions:

The Framework Convention on Tobacco Control (FCTC) prohibits misleading or deceptive terms on tobacco product packages. Although the treaty does not specify the terms that Parties must ban, the scientific evidence supports banning the use of terms such as “light”, “mild”, “low tar”, etc. However, descriptive words are just one of the methods employed by the tobacco industry to convey the “lightness” of products. Cigarette companies are devising ways of getting around bans on misleading descriptors. Alternative marketing is already being practiced in some countries; for example, particular colors are used in cigarette packaging and advertising to denote “light” from regular brands. Therefore, the Scientific Advisory Committee on Tobacco Product Regulation recommended that any such ban should “include not only misleading terms and claims but also names, trademarks, imagery and other means to conveying the impression that the product provides a health benefit.”

Several government entities have already taken steps towards banning deceptive labeling on tobacco products:

Australia. After a lengthy investigation, the Australian Competition and Consumer Commission (ACCC) found that the country’s three major tobacco companies represented that low yield cigarettes had certain health benefits in relation to those marketed as regular or higher yield. The ACCC found these claims to be misleading and in 2005 required the tobacco companies to remove “light,” “mild” and similar descriptors (including numbers) from their products. In addition, the companies cannot make claims about the health benefits of low yield cigarettes when compared to higher yield brands.

Brazil. On March 28, 2001, the Agencia Nacional de Vigilancia Sanitaria (the national health
agency of Brazil), issued a resolution prohibiting the use of “any type of descriptor” on
tobacco products “produced, transported, marketed and/or stored on national territory or
imported” in Brazil. The exact language from the Brazilian resolution (effective November 28, 2001) states, “It is prohibited to use any type of descriptor, on the packaging or in advertising material, such as: classes (s), ultra low tar, low tar, smooth, light, soft, leve, moderate tar, high or any others that could induce consumers to an erroneous interpretation as to the tar contained in cigarettes.”

Canada. On May 31, 2001 the Canadian Government called on the tobacco industry to voluntarily stop the use of misleading descriptors such as “light” and “low tar.” In November 2001, the Canadian Health Minister announced he would proceed to ban these terms from cigarettes sold in Canada. Five years later, in November 2006, the Competition Bureau reached an agreement with the country’s three major cigarette manufacturers to stop using the terms “light” and “mild” on cigarette packages. The Commissioner of Competition said that the companies “agreed to voluntarily discontinue use of these descriptors in advance of anticipated regulations requiring their removal.” The companies will start phasing out use of the terms at the end of 2006, and they will be completely gone from packaging by August 2007.

Public health groups are urging the government to continue with the regulation process and take additional action to protect consumers, including prohibiting the use of misleading colors or numbers, and prohibiting the “marketing and display of cigarettes in ways that falsely conveys distinctions between types of cigarettes.”

European Union. In response to concerns that the terms “light”, “low tar”, and “mild” “mislead the consumer into the belief that such products are less harmful,” on June 5, 2001, the European Union (EU) issued a directive that bans all misleading descriptors on tobacco
products. The exact language of the EU directive states, “With effect from 30 September 2003, and without prejudice to Article 5(1), texts, names, trademarks and figurative or other signs suggesting that a particular tobacco product is less harmful than others shall not be used on the packaging of tobacco products.”

Campaign for Tobacco-Free Kids, November 29, 2006

1 Short, P. “Smoking & Health Item 7: The Effect on Marketing” (1977), Brown and Williamson Bates 170041126
2 Risks Associated with Smoking Cigarettes with Low Machine-Yields of Tar and Nicotine; Report of the NCI Expert Committee. National Institutes of Health. National Cancer Institute. Smoking and Tobacco Control Monograph 13.
3 Kessler Final Opinion at 740.
4 Risks Associated with Smoking Cigarettes with Low Machine-Yields of Tar and Nicotine; Report of the NCI Expert Committee. National Institutes of Health. National Cancer Institute. Smoking and Tobacco Control Monograph 13.
5 Joossens, L. Regulation of tobacco products: an update on European developments 1999-2001. World Health Organization Regional Office for Europe (October 2001).
6 Joossens, L. Regulation of tobacco products: an update on European developments 1999-2001. World Health Organization Regional Office for Europe (October 2001).
7 Kozlowski, L.T., et al., “Smokers’ Misperceptions of Light and Ultra-Light Cigarettes May Keep Them Smoking,” American Journal of Preventive Medicine 15(1): 9-16 (July 1998).
8 SACTob Conclusions on Health Claims Derived from ISO/FTC Method to Measure Cigarette Yield. Scientific Advisory Committee on Tobacco Product Regulation (2003).
9 Hurt RD, Robertson CR. Prying open the door to the tobacco industry’s secrets about nicotine. The Minnesota Tobacco Trial. JAMA 1998;280:1173-81.
10 Response of the Market and of Imperial Tobacco to the smoking and health environment. Imperial Tobacco Ltd., p.2 (15102). Montreal Court of Appeal, Case Numbers 500-09-001296-912 and 500-090001297-910. 1991. Joint Record, Exhibit Number AG-4. Volume 76, pp.15101-15110, in Collishaw, N. From Montreal to Minnesota: Following the Trail of Imperial Tobacco’s Document, September 1999.
11 Risks Associated with Smoking Cigarettes with Low Machine-Yields of Tar and Nicotine; Report of the NCI Expert Committee. National Institutes of Health. National Cancer Institute. Smoking and Tobacco Control Monograph 13.
12 Harris, J.E., et al., “Cigarette tar yields in relation to mortality from lung cancer in the cancer prevention study II prospective cohort, 1982-8,” British Medical Journal 328 (January 10, 2004).
13 SACTob Conclusions on Health Claims Derived from ISO/FTC Method to Measure Cigarette Yield. Scientific Advisory Committee on Tobacco Product Regulation (2003).
14 Australian Competition and Consumer Commission News Release, “ACCC resolves ‘light’ and ‘mild’ cigarette issue with B.A.T. and Philip Morris,” May 2, 2005.
15 Australian Competition and Consumer Commission News Release, “ACCC resolves ‘light’ and ‘mild’ cigarette investigation with Imperial Tobacco,” November 7, 2005.
16 Competition Bureau News Release, “Competition Bureau Reaches Agreement with the Three Major Cigarette Manufacturers to Stop Using “light” and “mild” on Cigarette Packages,” November 9, 2006.
17 Physicians for a Smoke-Free Canada News Release, “Anti-smoking group slams voluntary agreement reached with tobacco companies,” November 9, 2006.

ETS Causes Respiratory Symptoms In Healthy Adults

Exposure To Environmental Tobacco Smoke Causes Respiratory Symptoms In Healthy Adults

ScienceDaily (Nov. 22, 2006) — Over time, inhaling environmental tobacco smoke (ETS)–a process often called “passive smoking”–can cause otherwise healthy adults to develop chronic respiratory symptoms.

The findings appear in the second issue for November 2006 of the American Journal of Respiratory and Critical Care Medicine, published by the American Thoracic Society.

Margaret W. Gerbase, Ph.D., of the Division of Pulmonary Medicine at the University Hospitals of Geneva in Switzerland, and 11 associates assessed the respiratory symptoms in 1,661 never-smokers over an 11-year period. All individuals in the study cohort participated in the Swiss Study on Air Pollution and Lung Diseases in Adults in 1991 and again in 2002. The two-part study was the first large-scale investigation of the long-term health effects of moderate ambient air pollution in Switzerland.

“The results of our longitudinal assessment of ETS effects in asymptomatic never-smokers showed that exposure to ETS was associated with the development of respiratory symptoms,” said Dr. Gerbase. “A particularly strong effect of continued exposure to ETS was observed among previously asymptomatic individuals with bronchial hyper-reactivity.”

The researchers found ETS exposure to be strongly associated with the development of cough. In subjects with bronchial hyper-reactivity, they observed a link between ETS and symptoms like wheeze, cough, dyspnea (shortness of breath) and chronic bronchitis. However, only the association between dyspnea and ETS reached statistical significance.

According to the authors, individuals with bronchial hyper-reactivity who are persistently exposed to ETS are at particular risk of developing early-onset chronic respiratory disease. “Symptom development in our subjects was accompanied by decrements in spirometric indices reflecting peripheral airway narrowing, notably in subjects with bronchial hyper-responsiveness,” said Dr. Gerbase.

Of the 1,661 participants, 1,202 individuals (72.4 percent) reported never being exposed to ETS, 309 persons (18.6 percent) reported exposure only during the 1991 survey, and 150 subjects (9 percent) reported exposure both in 1991 and 2002.

“Indirect evidence derived from smokers shows that airway responsiveness increases the risk to develop cough, phlegm, dyspnea and chronic bronchitis,” said Dr. Gerbase. “Cessation of smoking leads to remission of symptoms and improvement in airway hyper-reactivity.”

Excluded from participation in the study at baseline (1991) were all potential participants who reported such symptoms as wheeze, cough, phlegm, dyspnea and chronic bronchitis, or who were taking a medication for asthma at the time.

The researchers concluded that their findings support the need for policies protecting all nonsmokers from the “detrimental effects” of ETS.

Smoking (Public Health) (Amendment) Bill 2005

James Middleton (a member of Clear The Air) has put in a big effort to inform the Bills Committe of relevant information regarding the Smoking Bill which was passed on 19th of October 2006:

November 10, 2006 11:02 AM Subject: Smoking (Public Health) (Amendment) Bill 2005

Dear Mr Middleton,

I am the legal adviser of the Bills Committee of the Smoking (Public Health) (Amendment) Bill 2005. I am pleased to inform you that the Bill was passed on 19 October 2006. I wish to express my gratitude for the materials you have sent to us. I read most of them and used the relevant parts in my research. After discussion for 6 months, finally the Government decided to abandon the grandfathering of Mild Seven and other trade marks.

Thanks very much.
Regards, Monna Lai ALA7

Feasibility Study On Installing Smoking Rooms

Following is a question by the Dr Hon Kwok Ka-ki and a written reply by the Secretary for Health, Welfare and Food, Dr York Chow, in the Legislative Council today (November 1):


At the resumption of the Second Reading debate on the Smoking (Public Health) (Amendment) Bill 2005 in this Council on 19 October this year, the Secretary for Health, Welfare and Food said that the Government would study the feasibility of installing smoking rooms. In this connection, will the Government inform this Council:

(a) whether it has any evidence to prove the effectiveness of smoking rooms in preventing second-hand smoke from affecting the neighbouring environment;

(b) whether the above study will be conducted solely by the government departments concerned or undertaken by commissioned consultants;

(c) of the estimated expenditure on the above study; whether such expenditure would be borne wholly by the Health, Welfare and Food Bureau and whether other services of the departments concerned will be affected by the additional expenditure;

(d) whether it will invite health care practitioners, anti-smoking groups, academics in building services and other relevant groups to participate in the entire study; and

(e) whether it will report to this Council on the progress of the study regularly?


Madam President,

First of all, I wish to reiterate that what we propose to study is a room which is solely meant for smokers to smoke therein. There should not be any other activities going on in the room (including the serving of food and beverages and provision of any other type of services). Non-smokers and employees should not be allowed to enter into the room. I also wish to emphasize that with the passage of the Smoking (Public Health) (Amendment) Bill 2005 (the Bill), the top priority of the Administration at the moment is to ensure its effective implementation. We will pool our resources together to mount an intensive publicity campaign on the many amendments made to the Ordinance, in particular the smoking ban that will come into force starting January 1, 2007, with the aim to ensure that the public is well informed of the stipulations for compliance. At the same time, we will continue to actively promote smoking cessation services and anti-smoking education in the hope that the number of smokers, in particular teenage smokers, could be reduced as many as possible. The proposal of setting up “smoking rooms” is not part of the Bill, neither is the proposed feasibility study our working priority at this stage.

My replies to the various parts of the question are as follows:

(a) As pointed out by my colleagues from the Bureau during the deliberations of the Bills Committee over the past year or so, no sufficient evidence from any scientific research or internationally accepted ventilation standards are available at the moment to support the feasibility of setting up the type of “smoking room” mentioned above, on which we propose to conduct a study. This is precisely why I raised the idea of carrying out a feasibility study in my speech at the Second Reading of the Bill. One of the focuses of the study will be to find out whether it is technically feasible to effectively avoid the air outside the room from contamination by the secondhand smoke produced from within the room. The overriding principle is to protect the health of those who are outside the room.

With the new Ordinance coming into effect, it is envisaged that many of the smokers may have to resort to pursue their habit in outdoor areas. Road users in some busy districts may probably be left without a choice but to tolerate the intake of a lot of secondhand smoke. The primary consideration of setting up a “smoking room” is to afford protection to non-smokers by imposing a more effective separation between smokers and non-smokers.

(b) to (e) The Bill was just passed on October 19. To date, we have not yet commenced the study on the “smoking room” and have not reached any conclusion on its feasibility, neither have we worked out the details for the study, including the expenditure, the collaborative parties to take it forward or the details of its implementation.

Nevertheless, as I said at the Second Reading of the Bill, we must have collected sufficient scientific data and experimental evidence to prove its technical feasibility before we can be convinced of the feasibility of the “smoking room” or formulate any specific standards. Hence, it is anticipated that we shall need the prior assistance of experts from the engineering sector to carry out a technical study. We will also seek advice from other experts, as required, if and when we encounter any technical or professional problem.

Only after the completion of the proposed feasibility study will we be able to give further thought to this proposal and discuss whether it should be put into practice. At this stage, it is premature to jump to any conclusion. The study, together with the discussion in the process, will be open and transparent and the public and this Council will also be consulted at appropriate times.

Ends/Wednesday, November 1, 2006
Issued at HKT 13:21