Comparison of Serum Cotinine Concentration within and across Smokers of Menthol and Nonmenthol Cigarette Brands among Non-Hispanic Black and Non-Hispanic White U.S. Adult Smokers, 2001–2006

Background: The Food and Drug Administration (FDA) is examining options for regulating menthol content in cigarettes. There are many pharmacologic properties of menthol that may facilitate exposure to tobacco smoke, and it has been suggested that the preference for menthol cigarettes in black smokers accounts for their higher cotinine levels. Objective: To assess cigarettes smoked per day–adjusted cotinine levels in relation to smoking a menthol or nonmenthol cigarette brand among non-Hispanic black and white U.S. adult smokers under natural smoking conditions. Method: Serum cotinine concentrations were measured in 1,943 smokers participating in the 2001 to 2006 National Health and Nutrition Examination Surveys (NHANES). The effect of smoking a menthol brand on cigarettes smoked per day–adjusted serum cotinine levels in these two populations was modeled by adjusting for sex, age, number of smokers living in the home, body weight, time since last smoked, and FTC (Federal Trade Commission)-measured nicotine levels. The 8- or 12-digit Universal Product Code (UPC) on the cigarette label was used to determine the cigarette brand and whether it was menthol. Results: Smoking a menthol cigarette brand versus smoking a nonmenthol cigarette brand was not associated (P≥ 0.05) with mean serum cotinine concentration in either black or white smokers. Conclusions: The higher levels of cotinine observed in black smokers compared with white smokers are not explained by their higher preference for menthol cigarette brands. Impact: Further studies like ours are needed to improve our ability to understand health consequences of future changes in tobacco product design

Origins in the USA in the 1980s of the warning that smokeless tobacco is not a safe alternative to cigarettes: a historical, documents-based assessment with implications for comparative warnings on less harmful tobacco/nicotine products

Abstract Background Before the 1980s in the USA, smokeless tobacco carried no health warnings, was not judged to cause disease, and was a declining practice. In 1986, the federal government passed legislation requiring rotating warnings on “mouth cancer,” “gum disease and tooth loss,” and “This product is not a safe alternative to cigarettes.” This paper explores the history of the establishment of these warnings with emphasis on the ‘not a safe alternative’ warning and the bases for claiming that smokeless was ‘not safe’ (absolute harm) versus ‘not safer than cigarettes’ (relative harm). Methods Results of searches of Truth Tobacco Industry Document archives and transcripts of legislative hearings were analyzed. Critical assessments were made of the evidence-base. Results New evidence of oral cancer causation emerged along with a much-publicized case of a teenager dying of oral cancer. Public health concerns also arose over a widespread, successful marketing campaign implying smokeless was a safe alternative to cigarettes. Industry wanted pre-emptive federal warnings, to prevent a diversity of pending state warnings. To avoid an addiction warning, the industry accepted a compromise ‘not a safe alternative’ warning, which had not been initially proposed and which the cigarette industry may have sought in order to constrain the smokeless tobacco industry. The evidence presented supported smokeless only as ‘not safe’ and not ‘as harmful as cigarette smoking.’ Conclusions The comparative warning was a compromise to prevent an addiction warning and consistent with the preferences of cigarette companies. Prior surveys indicated that the public generally did not view smokeless tobacco as harmless, but they did generally report smokeless as less harmful than cigarettes despite expert interpretations to the contrary. As would not have been appreciated by public health supporters at the outset, subsequent research has shown that the ‘not a safe alternative’ message is misinterpreted by consumers to indicate that smokeless is ‘not safer’ than cigarettes—which was not established and has been disconfirmed by subsequent assessments of that question. Though many countries have banned smokeless tobacco (but not cigarettes), where smokeless is legally available accurate information on the nature of harms and differential harms needs to be developed

The diverging trajectories of cannabis and tobacco policies in the United States: Reasons and possible implications

To examine briefly the (i) rationales for two policy proposals in the United States to make it mandatory for cigarettes to contain very low levels of nicotine and to legalize cannabis for recreational use by adults; and (ii) possible lessons that participants in each policy debate may learn from each other.We briefly describe the diverging policies towards cannabis and tobacco in the United States, explain and critically analyse their rationales and discuss possible policy lessons.Advocates of cannabis legalization have argued that prohibition has been an ineffective and expensive policy that penalizes ethnic minority users unjustly of a drug that is far less harmful than alcohol. The prohibition of traditional tobacco cigarettes has been advocated as a way to eliminate cigarette smoking. These proposals embody very different attitudes towards the harms of recreational adult drug use. Advocates of nicotine prohibition demand that alternative methods of nicotine delivery must be shown to be completely safe before adults are allowed to use them. Advocates of tobacco prohibition ignore evidence that smokers may not use these products and the likelihood of expanding the illicit tobacco market. Advocates of legalizing and regulating recreational cannabis ignore the need to tax and regulate sales in order to minimize the harms of heavy use.It is not clear that the prohibition of adult use has a useful role to play in the regulation of either cannabis or tobacco. If both products remain legal, the goals of regulating tobacco and cannabis products should be to restrict youth access, promote the use of the least harmful products, provide users with evidence-based information on both absolute and differential product risks of use and use differential taxes and marketing controls to promote ways of using these products that cause the least harm to their users

Softening of monthly cigarette use in youth and the need to harden measures in surveillance

Objective: To assess changes in monthly smoking in its relationship to daily smoking and heavier smoking in high school seniors. Public health agencies often report only “current use” of cigarettes among youth as any use in the past 30 days, even though additional measures are collected. Monthly use is a crude and changing indicator. Methods: Results from 1975 to 2013 from Monitoring The Future Project were plotted and analyzed by linear regression. Results: From 1975 to 2013, the percentage of monthly smokers who smoked daily decreased by 29% (21.2 percentage points) and monthly smokers who smoked 10+ cigarettes/day dropped by 57% (28 percentage points); the percentage of daily smokers who smoked 10+ cigarettes/day decreased by 40% (26.5 percentage points). Conclusion: Additional measures of frequency and intensity of use of cigarettes and other tobacco/nicotine products need to be more regularly reported. These results indicate softening rather than hardening of “current smoking” and have important implications for tobacco surveillance and for tobacco research because of a) increased likelihood of quitting smoking, b) health effects of cigarette smoking, and c) similar and interacting issues related to measuring the use of all tobacco/nicotine products