Transforming the tobacco market: why the supply of cigarettes should be transferred from for-profit corporations to non-profit enterprises with a public health mandate.

Current tobacco control strategies seek primarily to decrease the demand for cigarettes through measures that encourage individuals to adopt healthier behaviours. These measures are impeded and undermined by tobacco corporations, whose profit drive compels them to seek to maintain and expand cigarette sales. Tobacco corporations seek to expand cigarette sales because they are for-profit business corporations and are obliged under law to maximise profits, even when this results in harm to others. It is not legally possible for a for-profit corporation to relinquish its responsibility to make profits or for it to temper this obligation with responsibilities to support health. Tobacco could be supplied through other non-profit enterprises. The elimination of profit driven behaviour from the supply of tobacco would enhance the ability of public health authorities to reduce tobacco use. Future tobacco control strategies can seek to transform the tobacco market from one occupied by for-profit corporations to one where tobacco is supplied by institutions that share a health mandate and will help to reduce smoking and smoking related disease and death.

Deaths in Canada from lung cancer due to involuntary smoking.

Recently published evidence indicates that involuntary smoking causes an increased risk of lung cancer among nonsmokers. Information was compiled on the proportion of people who had never smoked among victims of lung cancer, the risk of lung cancer for nonsmokers married to smokers and the prevalence of such exposure. On the basis of these data we estimate that 50 to 60 of the deaths from lung cancer in Canada in 1985 among people who had never smoked were caused by spousal smoking; about 90% occurred in women. The total number of deaths from lung cancer attributable to exposure to tobacco smoke from spouses and other sources (mainly the workplace) was derived by applying estimated age- and sex-specific rates of death from lung cancer attributable to such exposure to the population of Canadians who have never smoked; about 330 deaths from lung cancer annually are attributable to such exposure.

Estimates of maximum or average cigarette tar, nicotine, and carbon monoxide yields can be obtained from yields under standard conditions.

Average yields of tar, nicotine, and carbon monoxide per liter of smoke and per cigarette were determined for 10 brands of cigarettes smoked under 27 different conditions (one standard and 26 nonstandard). Per cigarette yields were highly variable across smoking conditions due to differences in the total volume of smoke taken for analysis. The results of a simple linear regression analysis indicated that up to 95% of the variation in tar yield per cigarette could be explained by variations in the total volume of smoke produced per cigarette. Per liter yields for tar, nicotine, and carbon monoxide were almost constant over the conditions investigated. Since most smokers inhale less than this amount, yields per liter provide a rough estimate of the maximum amount to which a smoker might be exposed. Yields per liter, taken over all 26 conditions, are highly correlated with per cigarette yields under standard conditions. Consequently, values on one scale can be converted to the other, at least for the 10 brands investigated. The average conversion factor for tar, nicotine, and carbon monoxide is 2.5 when proceeding from milligrams per king-size cigarette under standard conditions to milligrams per liter. This relationship is true for both vented and nonvented cigarettes when ventilation holes are not blocked.

Characterization of tobacco products: a comparative study of the tar, nicotine, and carbon monoxide yields of cigars, manufactured cigarettes, and cigarettes made from fine-cut tobacco.

Yields of tar, nicotine, and carbon monoxide were compared in selected Canadian brands of manufactured and hand-rolled cigarettes, and small and large cigars. To control for varying volumes of smoke delivery per cigarette or cigar, standardized comparisons in milligrams of toxic substance per liter of smoke were made. The mean deliveries per liter of smoke and tar, nicotine, and carbon monoxide were highest for small cigars, followed by hand-rolled and manufactured cigarettes; large cigars had the lowest deliveries. Five out of six brands of cigarettes handmade from fine-cut tobacco delivered significantly more tar, nicotine, and carbon monoxide per cigarette or per liter than did the identically named manufactured brand.

Tobacco smoke in the workplace: an occupational health hazard.

Tobacco smoke, which contains over 50 known carcinogens and many other toxic agents, is a health hazard for nonsmokers who are regularly exposed to it while at work. Involuntary exposure to tobacco smoke annoys and irritates many healthy nonsmokers. Serious acute health effects are probably limited to the one fifth of the population with pre-existing health conditions that are aggravated by exposure to tobacco smoke. The consequences of long-term exposure include decreased lung function and lung cancer. Existing air quality standards for workplaces do not directly specify an acceptable level for tobacco smoke. The evidence on the composition of tobacco smoke and on the health hazards of involuntary exposure suggests that there may not be a "safe" level for such exposure.

Yields of tar, nicotine, and carbon monoxide in the sidestream smoke from 15 brands of Canadian cigarettes.

Sidestream smoke yields for 15 brands of cigarettes were determined under conditions where mainstream yields were approximately equal to those used for determining the values which appear on packages of Canadian cigarettes. Sidestream yields of tar, nicotine, and carbon monoxide were much higher than mainstream yields for all brands tested. The average sidestream-to-mainstream ratios for the 15 brands were 3.5, 6.6, and 6.8 for tar, nicotine, and carbon monoxide, respectively. The highest yields of sidestream were obtained from the brands with the lowest mainstream yields.

A comparison of the yields of tar, nicotine, and carbon monoxide of 36 brands of Canadian cigarettes tested under three conditions.

A number of countries, including Canada, sponsor routine monitoring of cigarette tar, nicotine, and carbon monoxide yields which are evaluated by cigarette-smoking machines according to a standard protocol. These standardized yields continue to decline as tobacco companies modify their brands to meet consumers' demand for "light" products. This trend toward cigarettes with low average deliveries of toxic substances may reduce health risks for some people. However, switching to low-yield cigarettes may not result in reduced risks for smokers who smoke these cigarettes intensively. Thirty-six brands of Canadian cigarettes, including 28 with ventilated filters, were tested under standard conditions and 2 others in order to determine how yields of tar, nicotine, and carbon monoxide change when cigarettes are manipulated by smokers in order to increase their smoke intake. While the rank order yields of tar, nicotine, and carbon monoxide was preserved, the average yields of all three substances more than doubled when cigarettes were intensively smoked in comparison with standard smoking.

Estimating the hazards of "less hazardous" cigarettes. III. A study of the effect of various smoking conditions on yields of hydrogen cyanide and cigarette tar.

A brand of cigarette with nominal tar and nicotine yields of 4.0 mg and 0.4 mg, respectively, was examined under various machine-smoked conditions that reflect the wide range of human smoking behavior. Three levels of each of five smoking parameters--butt length, puff duration, puff interval, puff volume, and ventilation occlusion--were examined, and the effects on puff number and total particulate matter (TPM) as well as gas phase, particulate phase, and total HCN yields were estimated. Yields of hydrogen cyanide (a ciliatoxic agent) and TPM varied significantly under different smoking conditions. Ventilation occlusion had the most pronounced effect, accounting for 34% of the response variation of TPM yields and 42% of the response variation for total hydrogen cyanide yields. In the survey of available brands, total hydrogen cyanide yields varied from 2 to 233 micrograms/cigarette for the 115 brands tested, a range less than that observed for a single brand smoked under various nonstandard conditions, providing a possible explanation for the previously noted lack of correspondence between HCN yields under standard conditions and levels of thiocyanate in samples of smokers' plasma and saliva. In addition, hydrogen cyanide yields and efficiency of filters in removing HCN were examined under standard smoking conditions. Acetate filters, the most common variety, were found to remove an average of about 14% of the hydrogen cyanide from the mainstream smoke.