Recent research by Ontario Tobacco Research Unit investigators provides data showing that a substantial proportion of Ontario smokers smoke 'light' and 'mild' cigarettes. (1,2) Using analysis from two population based surveys, Ashley and colleagues have found that the use of these cigarettes increased from 71% in 1996 to 83% in 2000. According to the 2000 survey, over a quarter of 'light' and 'mild' smokers reported smoking these brands to reduce their risks of smoking, and 40% reported smoking 'light' and 'mild' brands as a step toward quitting. Forty-one percent of this group indicated that they would likely quit if they learned that light and mild cigarettes provided the same amount of tar and nicotine as regular cigarettes. The authors conclude that many of these smokers are being misled by the terms 'light' and 'mild' on cigarettes and that smokers of 'ultra-light' brands are the most deceived.
Tar and nicotine yields reported on cigarette packages are determined by smoking machines under a standard set of conditions. Assays of Canadian cigarettes smoked under standard conditions have found that some 'light" or 'mild' brands actually yield tar and nicotine levels that are equal or higher than those of regular brands. (3)
Even when reported tar and nicotine yields are lower, the level of exposure to toxic and carcinogenic compounds from cigarettes is related more to the smoking behaviour of the individual smoker than the machine-measured yields printed on the cigarette package. Smokers often compensate for lower yields of nicotine by altering their puffing patterns to take deeper, or more frequent puffs (4,5) or by blocking ventilation holes on the filters. (6,7) Using a sample of over 2,000 smokers, researchers from the United Kingdom compared salivary cotinine, as a measure of nicotine intake, to the reported nicotine yield of various cigarette brands smoked. Their research found that compared to machine-smoked readings, actual nicotine intake per cigarette was about 8 times greater for 'low' yield cigarettes and about 1.4 times greater for 'high' yield cigarettes. (8) When Canadian brands are machine-tested under 'intense' conditions, which more closely mimic smoking by humans, 'light' and 'mild' cigarettes are essentially indistinguishable from regular cigarettes. (9)
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III National Cancer Institute Report
In November 2001, the National Cancer Institute in the United States released an extensive report on the risk associated with smoking cigarettes with low machine-measured yields of tar and nicotine. (10) In particular, it stated the following:
* Epidemiologic and other scientific evidence do not indicate a benefit to public health from changes in cigarette design and manufacturing over the last fifty years.
* Spontaneous brand switchers compensate completely for nicotine delivery, reflecting more intensive smoking of lower-yield cigarettes.
* Many smokers switch to lower yield cigarettes out of concern for their health, believing these cigarettes to be less risky or to be a step toward quitting.
This monograph documents the same conclusions about health risk and deception that were reported to the Canadian Minister of Health.
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IV Ministerial Advisory Council on Tobacco Control Report
In Canada, the Ministerial Advisory Council on Tobacco Control (11) convened an international expert panel to review and advise on labeling such as 'light' and 'mild'. Based on the report of the expert panel (9), the Ministerial Advisory Council advised the Minister that
* cigarette descriptions such as 'light' and 'mild' are a major public health problem and have already contributed to the deaths of thousands of Canadians. To reduce tobacco-caused illness and death, this problem must be corrected as quickly and as effectively as possible; and
* an end to the 'light' and 'mild' deception can only be achieved through a complete ban on misleading descriptors, accompanied by appropriate public education efforts.
Further to the Minister's stated intent to ban the use of the terms 'light' and 'mild' in Canada, (12) a Notice of Intent was published on December 1, 2001 in the Canada Gazette, Part I. The notice indicates that Health Canada is considering regulations under the Tobacco Act to prohibit manufacturers and importers from selling a tobacco product in a package displaying the terms 'light' or 'mild'. Interested parties were invited to comment in January 2002.
The Ministerial Advisory Council also advised the Minister that the government must ensure that other terms and devices that have a similarly misleading effect, or could have a misleading effect, are eliminated rapidly or not allowed onto the market at all. For example, the use of colours to reinforce perceptions of relative risk is a major concern. Cigarette manufacturers in other countries such as Brazil have already colour-coded their brands to denote 'strength' within brand families; (13) when descriptors are removed, this colour coding is likely to play an even bigger role in shaping customers' perceptions. The Council advised that the obvious solution for eliminating these difficulties is to introduce plain packaging. The Council also advised the Minister that the government needs to put the onus on manufacturers to demonstrate that elements of their packaging and marketing do not mislead smokers about issues that are vital to their health.
1. Ashley MJ, Cohen JE, Ferrence RG. 'Light' and 'mild' cigarettes: Who smokes them? Are they being misled? Canadian Journal of Public Health 2001; 92:407-411.
2. Cohen J. Public perceptions of the meaning of 'light' and 'mild' labelling on cigarette packs. In: Putting an End to Deception: Proceedings of the International Expert Panel on Cigarette Descriptors. A Report to the Canadian Minister of Health from the Ministerial Advisory Council on Tobacco Control. January 2002.
3. Selin, H. Face Value? Descriptive Cigarette Brand Labelling and Reported Toxin Levels. Ottawa: Smoking and Health Action Foundation, March 1997. Accessed at http://www.nsra-adnf.ca/slitemild.html
4. Djordjevic, MV, Fan J, Ferguson S, Hoffman D. Self-regulation of smoking intensity. Smoke yields of the low-nicotine, low-'tar' cigarettes. Carcinogenesis 1995;16:2015-2021.
5. Djordjevic, MV, Stellman SD, Zang E. Doses of nicotine and lung carcinogens delivered to cigarette smokers. J Natl Cancer Institute 2000; 92;106-111.
6. Kozlowski LT, Frecker RC, Khouw V, Pope MA. The misuse of 'less-hazardous' cigarettes and its detection: hole blocking of ventilated filters. Am J Public Health 1980; 70:1202-1203.
7. Kozlowski LT, Pillitteri JL, Sweeney CT. Misuse of 'light' cigarettes by means of vent blocking. J Subst Abuse 1994; 6:333-336.
8. Jarvis MJ, Boreham R, Primatesta P, et al. Nicotine yields from machine-smoked cigarettes and nicotine intakes in smokers: evidence from a representative population survey. J Natl Cancer Inst 2001; 93:134-138.
9. Ministerial Council on Tobacco Control. Putting an End to Deception. A Report to the Canadian Minister of Health. September 2001.
10. National Cancer Institute. Smoking and Tobacco Control Monograph 13. Risks Associated with Smoking Cigarettes with Low Machine-Measured Yields of Tar and Nicotine. Bethesda, Maryland: 2001. http://cancercontrol.cancer.gov/tcrb/monographs/13/index.html
11. Health Canada. Ministerial Advisory Council on Tobacco Control. Terms of Reference. http://www.hc-sc.gc.ca/english/media/releases/2001/2001_62ebk2.htm
12. Rock A. Letter from the Minister of Health for Canada to the Canadian tobacco industry, Ottawa, May 2001.
13. Vianna, C. Brazilian legislation on tobacco control: The ban of descriptors on tobacco products, packages and advertising. In: Putting an End to Deception: Proceedings of the International Expert Panel on Cigarette Descriptors. A Report to the Canadian Minister of Health from the Ministerial Advisory Council on Tobacco Control. January 2002.