Last updated: February 2020
Suggested citation: Bellew, B, Greenhalgh, EM & Winstanley, MH. 3.26 Health effects of brands of tobacco products which claim or imply, delivery of lower levels of tar, nicotine and carbon monoxide. In Greenhalgh, EM, Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2020. Available from http://www.tobaccoinaustralia.org.au/3-26-health-effects-of-smoking-brands-that-claim-t
With reports published during the 1950s linking cigarette smoking with disease, tobacco companies experimented with various modifications to their products. Firstly, filters were added, and later ventilation holes in the form of tiny perforations were added around the mouthpiece, with the apparent intention of diluting the delivery of tar, nicotine, carbon monoxide (CO) and other compounds to the smoker. Tobacco leaf itself has also undergone various treatments to alter toxic delivery. While it was initially hoped by health interests that lower delivery cigarettes would prove to be a less harmful form of tobacco use, bringing about reductions in death and disease, this has proved not to be the case.1, 2
Low delivery cigarettes do not offer a health advantage. Two major reports have reviewed the evidence regarding the impact on health of smoking cigarettes with lower levels of toxicity. The US Surgeon General’s report for 2010 concluded that “changing cigarette designs over the last five decades, including filtered, low-tar, and “light” variations, have not reduced overall disease risk among smokers and may have hindered prevention and cessation efforts.” p. 213 The National Cancer Institute, part of the US National Institutes of Health, stated in its 2001 report 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,” and that “widespread adoption of lower yield cigarettes in the United States has not prevented the sustained increase in lung cancer among older smokers.” p. 101
The reasons why ‘lower delivery’ cigarettes have not benefited health lie in the way a smoker typically smokes a cigarette, as opposed to how a machine designed to measure smoke output ‘smokes’ a cigarette under laboratory conditions. Because addicted smokers need to maintain their level of intake of nicotine, they tend to compensate for the delivery of lower levels of nicotine by adjusting puff frequency, rapidity or depth of inhalation, by increasing the numbers of cigarettes smoked daily, or by blocking with their fingers the ventilation holes around the filter intended to dilute the smoke. Because exposure to tar compared to nicotine appears to be similar among smokers of conventional cigarettes, this results in very little change in the actual intake of tar and other compounds. In contrast, of course, a machine simply “puffs” according to its calibration.1, 4, 5 Wider public health interests were first alerted2 to the discrepancy between laboratory-measured and smokers’ actual exposure by the release of the US Surgeon General’s Report of 1981,4 but for the following decade it was generally held that smokers choosing low delivery brands were reducing their intake to at least some degree.2 The tobacco industry operated under no such illusions. It is now known that the industry had long been aware of compensatory smoking and the limitations of machine measurements, and from the 1970s onwards, was using this knowledge to manipulate consumers and subvert the official laboratory testing systems.1 Tobacco companies engineered their products so that smokers could obtain as much nicotine as they needed by altering their smoking behaviour, but also ensured that when tested by standard smoking machine protocols, the same brand of cigarettes would return acceptably low yields.1, 2 The tobacco industry also experimented with the composition of cigarettes and filters in order to minimise machine-measured noxious outputs, but took no steps to create a cigarette which truly delivered lower toxins to the smoker under normal conditions.1
Beyond the phenomenon of compensation, the 2014 US Surgeon General’s report explored whether the changes in the design and composition of cigarettes since the 1950s that paralleled the reduction in machine-measured tar yields may have changed smokers’ risk of lung cancer. The report concluded that the increased risk of adenocarcinoma of the lung has been caused by these changes in the design and composition of cigarettes. It found insufficient evidence to identify which changes have caused this increase, but suggested that ventilated filters and increased levels of tobacco-specific nitrosamines may be partially responsible.6 A more recent review concluded that there is a high likelihood that filter ventilation has contributed to a rise in lung cancers among smokers since its introduction in the mid-1960s.7
The production and vigorous marketing of ‘light’ and ‘mild’ brands allowed the tobacco industry, over several decades, to reassure smokers that there were less harmful ways of smoking.1, 2 Two major tobacco companies in Australia have agreed to discontinue the use of misleading descriptors and information on tar, nicotine and CO levels on tobacco packages since they have been judged by the Australian Competition Consumer Commission to be misleading.i Based on the evidence that filter ventilation appears to have contributed to the rise in lung cancer,7 in addition to creating perceptions of reduced harm,8 Cancer Council Australia has recommended a ban on the sale or importation of filter ventilated cigarettes.9 For detailed discussion about the changes made to manufactured cigarettes in Australia, along with regulatory aspects, refer to Chapter 12, Section 12.4.
The regulation of the level of nicotine in tobacco products has been suggested as a potential strategy for avoiding the transition from experimental smoking to addiction. Unlike ‘low tar and light’ cigarettes promoted by tobacco companies, reduced nicotine cigarettes could be manufactured the same as regular cigarettes except with tobacco that has a lower nicotine content. If the nicotine content was low enough, it would be virtually impossible to absorb significant levels of nicotine by using these products.10 See Section 18.4 for a discussion of the evidence and support for this strategy.
For a broader discussion of the potential for harm reduction in tobacco control, including attempts to make cigarettes less harmful and addictive, and the use of alternative products that may carry fewer risks than traditional cigarettes, see Chapter 18.
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See the ACCC website: http://www.accc.gov.au/content/index.phtml/itemId/683533
References for Section 3.26
1. Burns D and Benowitz NL. Public health implications of changes in cigarette design and marketing, in Tobacco control research. Smoking and tobacco control monographs. Monograph 13: Risks associated with smoking cigarettes with low tar machine-measured yields of tar and nicotine. Bethesda, MD: National Cancer Institute, US National Institutes of Health; 2001. Available from: http://www.cancercontrol.cancer.gov/tcrb/monographs/13/m13_1.pdf
2. King W, Carter SM, Borland R, Chapman S, and Gray N. The Australian tar derby: The origins and fate of a low tar harm reduction programme. Tobacco Control, 2003; 12 Suppl 3(suppl. 3):iii61-70. Available from: https://www.ncbi.nlm.nih.gov/pubmed/14645950
3. US Department of Health and Human Services. How tobacco smoke causes disease: The biology and behavioral basis for smoking-attributable disease. A report of the US Surgeon General, Atlanta, Georgia: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2010. Available from: http://www.surgeongeneral.gov/library/tobaccosmoke/report/index.html.
4. US Department of Health and Human Services. The health consequences of smoking. The changing cigarette. A report of the Surgeon General. Washington DC: US Department of Health and Human Services, Public Health Service, Office of Smoking and Health, 1981. Available from: http://profiles.nlm.nih.gov/NN/B/B/S/N/segments.html.
5. McNeill A. Harm reduction. BMJ (Clinical Research Ed.), 2004; 328(7444):885-7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/15073074
6. US Department of Health and Human Services. The health consequences of smoking - 50 years of progress. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014. Available from: http://www.surgeongeneral.gov/library/reports/50-years-of-progress/.
7. Song MA, Benowitz NL, Berman M, Brasky TM, Cummings KM, et al. Cigarette filter ventilation and its relationship to increasing rates of lung adenocarcinoma. Journal of the National Cancer Institute, 2017; 109(12):djx075. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28525914
8. Kozlowski LT and O'Connor RJ. Cigarette filter ventilation is a defective design because of misleading taste, bigger puffs, and blocked vents. Tobacco Control, 2002; 11 Suppl 1(Suppl 1):I40-50. Available from: https://www.ncbi.nlm.nih.gov/pubmed/11893814
9. Cancer Council Australia. Position statement - reducing the palatability of tobacco products: Banning the use of filter design features and flavourings. 2018. Available from: https://wiki.cancer.org.au/policy/Position_statement_-_Reducing_palatability.
10. Benowitz NL and Henningfield JE. Reducing the nicotine content to make cigarettes less addictive. Tobacco Control, 2013; 22 Suppl 1(suppl 1):i14-7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/23591498