27 November 2007

 


 

 

 

Current New Zealand situation   

 The Smoke-free Environments Act 1990 by default permits the use of terms and descriptors such as light, extra-mild, low tar, and permits various colour codes to denote some of these characteristics.

The international situation

The Framework Convention on Tobacco Control requires packaging and labeling that inform the public about the harmfulness of tobacco products.[1] By implication, labeling should not mislead.

 

What is known from the United States

In 1983 Benowitz noted that smokers of very low-tar, low-nicotine cigarettes nevertheless obtained ample nicotine – from excess nicotine content.[2] Although very few ultra low yield cigarettes are sold in New Zealand, this paper was important proof of the concept of compensatory smoking. The potential addictive burden was not lessened.

In 2001 the National Cancer Institute (NCI) in a major review of the topic, concluded that low yield cigarettes were designed to induce compensatory smoking, thus resulting in inhaling more smoke, and more toxicants. Widespread switching to low yield cigarettes in the USA had not prevented increases in lung cancer in older smokers. Health conscious smokers sought out low yield brands because they equated these brands with reduced risk; but low yield brands did not assist them to quit.  There was no evidence found that changes in cigarette design had lowered the disease burden for smokers or the general population in any important way.[3] In short, low yield labels falsely allayed smokers’ health concerns. 


What is known from Canada.

Are labels misleading and if so should government take action?

 In 2001 Canadian Health Minister Alan Rock set up a ministerial advisory council (MAC) on tobacco control which he then asked for advice on this topic. His MAC then called an international panel together, which in turn made recommendations which achieved ministerial support. The issue lapsed with a change of minister.

The international expert panel convened in Quebec in 2001 led to a comprehensive, concise and clear report which explained how tar levels underreport actual yields, how cigarettes are engineered to attain low machine ratings, and canvassed possible remedies. It recommended that regulations be enacted: to totally ban light and mild descriptors; and also ban possible replacement terms; to remove tar numbers from packs; and that the public be (re-) educated, on the nature and causes of the deception.[4]

Toxicological evidence Laboratory surveys of cigarette smoke show that tar did not correlate significantly with the overall brands’ toxic emission scores for the 16 regular brands sold in British Columbia in 2001, (r =0.25).[5]

Is intervention beneficial? Telephone surveys show that in Canada 43%,  in the US 51%, in Australia 55%, in UK 70% believed that light cigarettes offered some health benefit[6]; publicity of this issue in Canada may or may not have been influential, but further action at government level seems possible.

 

Light and mild labels banned in Australia 

Peter Jackson brand is now being issued without colours as full flavour (9 mg tar or less), smooth (6 mg tar or less) and fine (3 mg or less), instead of regular, light and ultra-mild. The Australian Competition and Consumer Commission (ACCC) investigated whether "light" and "mild" descriptors breach the Commonwealth Trade Practices Act. It  told Parliament it believed the industry was involved in misleading and deceptive conduct, and that it was negotiating a settlement with the three manufacturers.[7] This industry move if permitted would largely take the sting out of any moves to ban the current light, mild, extra-mild and ultra-mild descriptors, and the deception would continue. Obviously any regulation undertaken needs to anticipate defensive moves by cigarette makers.

In November 2005, the Australian Competition and Consumer Commission (ACCC) announced it has obtained court-enforceable undertakings from Imperial to remove descriptors such as 'light' and 'mild' from its products.
This follows a similar deal with British American Tobacco Australia and Philip Morris earlier this year, meaning that no Australian cigarette manufacturers or importers can use these descriptions. Imperial must remove the light and mild descriptors from all cigarettes produced for Australian consumers after October 24, 2005.[8]

 

What is known from New Zealand

Market share of milds In New Zealand the proportion of manufactured cigarettes sold as mild or low yield (<0.9 mg nicotine) was 22% in 2002. In 2004, mild or similar brands comprised 22% of the top ten brand sales volumes. The mean sales-weighted tar was 12.4 mg, the mean nicotine 1.1 mg, up from the year before, suggesting no trend at present towards low yield cigarettes in New Zealand.[9] Ultra milds account for a tiny proportion of the total market.[10] 

Of daily smokers, 27% said they smoked mild cigarettes, and smoked milds because they tasted better and were “not so strong.” [11] (A typical response for a ventilated cigarette, which dilutes the smoke with air, but results in more smoke inhaled).

Are labels misleading?  Toxicological evidence.

Addiction keeps smokers smoking, despite the risks. The dissonance created in the smoker’s mind is presumably relieved by clutching at the notion that low tar numbers on the packet means a lower risk of cancer. However:

         Less than one fifth of a cigarette’s toxic emissions are due to toxicants in the tar.[12]

  • Analyses on published toxicant data for some 37 brands shows no reduced toxicity correlation with tar levels across many brands. Tar is not correlated with other toxicantsHowever, the low nicotine yield accompanying the low tar ensures smokers inhale more smoke to compensate.
  • Testing by the NZ Ministry of Health found that Holiday Extra-mild, the top-selling mild brand, had a higher toxicity emission score than 35 other brands studied,12 notably higher than Holiday regular.
  • With respect to packet labels for Mild Seven brand, a Japanese brand sold mainly to Japanese tourists, neither tar yield (mg) nor the descriptors ‘mild, ‘light’, or ‘extramild’, or ‘charcoal filter’ for these three brands was associated with any reduction of the combined respiratory—and cardiovascular toxicity of mainstream smoke, as measured by leading toxicants tested by the intensive method.[13]

On the other hand, four popular brands of mild labeled cigarettes on average yielded less tar than regular brands (13.1 v. 11.7 mg per cigarette).[14]  If tar was the best measure of overall toxicity, which it is clearly not, these mild New Zealand cigarette brands could arguably be correctly labeled mild.

Other markings. Discordance in the packet display.  Often there is discordance between the government warning and the rest of the pack under manufacturer’s controlAlthough the sombre warnings “Smoking kills” are now in clear black on white bold font, the smoker’s attention from that warning is distracted by packet imagery of beaches and sunshine with respect to the top-selling Holiday brand.  In this respect, a case remains for regulation for tombstone packet labeling, and colouring in harmony with government warning fonts.   

 

 

What is known from cigarette manufacturers

Scientific communications Philip Morris researchers, apparently to underline the toxicity to tar link, have promoted tar (under ISO conditions) as a correlate of toxicantsThe correlation did not hold, however, for the major and dominant (volatile) toxicants, when these were tested by Philip Morris under Health Canada smoking conditions. (r=0.30, 48 brands) by Philip Morris scientists.[15] The correlations found mainly refer to the smaller proportion of toxicants found in tar. Tar numbers on the pack, therefore, do not rank cigarette brands correctly when smoked intensively under Health Canada conditions. Without a scientific basis, tar numbers will mislead.

Communications to regulators Philip Morris International in its submission to the NZ Government, in promoting a secure business environment for continued sale of cigarettes, appears to support the continued use of ISO measurements, based on a machine taking one shallow puff per minute. The tar numbers printed on the packet apparently help to sell cigarettes. Philip Morris discusses

            descriptors, which adult smokers use to identify and select brand variants with the taste they prefer. Regulations can help ensure that consumers do not assume that cigarettes that are “light” or “mild” in taste are safe or safer than other products. Removing descriptors could inadvertently confuse consumers. Therefore, we recommend regulations require manufacturers to provide additional information to clarify what descriptors mean, rather than prohibiting them.” [16] 

This in effect is more or less a defence of the status quo.

Communications to smokers At consumer level, Philip Morris is careful to protect itself from making misleading statements. On a recent packet, the on-sert stated:

             “There is no such thing as a safe cigarette, including this one. The terms “Ultra Light” “Light” “Medium” and “Mild” are used as descriptors of the strength of taste and flavor. The terms also serve as a relative indication of the average tar and nicotine yield per cigarette, as measured by a standard government test method.”  “The tar and nicotine yield numbers are not meant to communicate the amount of tar or nicotine actually inhaled by the smoker, as individuals do not smoke like the machine used in the government test method. The amount of tar and nicotine you inhale will be higher than the stated tar and nicotine yield numbers if, for example, you block ventilation holes, inhale more deeply, take more puffs or smoke more cigarettes.” [17]

This onsert, while acknowledging the dangers of all cigarettes, says “light” etc indicates the amount of harmful tar in the smoke (using a smoking machine). This will be read by many smokers as “low tar is less harmful’. Having reassured or confused the reader, the onsert then tells smokers, if the cigarette is low on taste, exactly how to obtain more flavour (nicotine) as desired. Thus whatever their concerns, the smokers are told how to get the nicotine they crave, at the dose they want.


Some policy options.

Ban the present descriptors. This would not be sufficient. See under Australia above.

Ban all descriptors. This would cut across the smoker’s consumer rights (as long as the product remains legal) to some indication of difference if in fact they taste differently - as they will. 

Ban the tar and nicotine yield numbers.  Manufacturers rely on the tar numbers to indicate to smokers which are the supposedly lower risk products. and the low nicotine which accompanies the low tar ensures compensatory smoking. A ban on numbers is desirable, as it is based on the ISO method of testing, and is not a true description of how smokers smoke, or of cigarette brand rankings. A statement of nicotine content of the cigarette would not mislead. 

Support a firm health counter-statement After a brand name such as “Brand x menthol,”  require a statement such as  “All types of cigarette, including this brand, have a high risk of killing the smoker.” This could be placed on the packet as a health warning, in which case ample precedent and powers exist to act. This could be with or without a ban on descriptors. The graphic warnings to be introduced without regard to whether a cigarette is ‘light’ or ‘mild’ on all cigarette packets from 2008 may be regarded as providing a strong health counter-argument.

Making amends. In Australia firms have been ordered to pay for media campaigns to set the record straight.

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Conclusions

      Packet descriptors may or may not fairly describe the cigarettes within, because, if tar is not the main measure of toxicity, a lower packet tar rating may raise false hopes that a mild brand is safer than a regular brand, because its packet tar rating is lower.

  • Due to the dominance of regular (full-flavour) brands in the New Zealand cigarette market, the case against descriptors may not be as strong overall as in Canada or the United States, or even Australia, where the reverse is the case.
  • Descriptors trade in false hopes because of smokers’ false belief in smoke machine tar ratings, and that lower tar and nicotine yields on packet labels means less harm. If this be the case, smokers need re-education, and tar number ratings on the packet should not be required by regulation any longer.
  • Misleading descriptors may be best countered by a health warning and better health information on the packet or via mass media. Government has ample powers to regulate and use the packet for a strong countering if not a corrective statement. Graphic health warnings on packets may achieve this well.
  • Whole-of-packet impact should be considered, to avoid packet design distracting smokers from the sombre warning messages.

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References


[1] The Framework Convention on Tobacco Control, Article 11. World Health Organization. www.who.int

[2] Benowitz N, Hall SM, Herning RI, Jacob P,. Jones RT, Osman AL. Smokers of low-yield cigarettes do not consume less nicotine. N Engl J Med 1983; 309: 139-42.

[3] National Cancer Institute. Risks associated with smoking cigarettes with low machine-yields of tar and nicotine. Smoking and Tobacco Control monograph no. 13. Bethesda MD: US Department of Health and Human Services, National Institutes of Health, NCI. NIH Pub. No. 02-5074,  October 2001.

[4] Putting an end to deception. Proceedings of the International Expert Panel on cigarette descriptors, Quebec 2001. A report to the Canadian Minister of Health from the Ministerial Advisory Council on Tobacco Control. Ottawa: Canadian Council for Tobacco Control. January 2002.

[5] Laugesen M. Fowles J. Marlboro Ultrasmooth – a potentially reduced exposure cigarette?  Tobacco Control 2006; 15:430-435

[6] Borland R, Yong HH, King B, Cummings MK, Fong GT, Elton-Marshall T, Hammond D, McNeill A. Use of and beliefs about light cigarettes in four countries: findings from the International Tobacco Control Policy Evaluation Survey. Nic Tob Res 2004; 6: S 4, S311-S321.

[7] King B, Borland R. What was ‘light’ and ‘mild’ is now ‘smooth’ and ‘fine’: new labeling of Australian cigarettes. Letter. Tobacco Control 2005; 14: 214-5.

[8] Clark T. Mild, light cigarette labels banned. The Courier Mail (Australia) 7 Nov. 2005.

[9] Laugesen M. Analysis of tobacco returns for 2004. Ministry of Health 2005. http://www.ndp.govt.nz/tobacco/tobaccoreturns/2004/analysis/analysis-2004.pdf  

[10] Laugesen M. Analysis of tobacco returns for 2004. Ministry of Health 2005. http://www.ndp.govt.nz/tobacco/tobaccoreturns/2004/analysis/analysis-2004-tableg-i.pdf   At Table G.

[11] Waa A, Gillespie, J, Afzal R. Influence on smoking behaviour and perceptions of cigarette packing in New Zealand. Report to Ministry of Health, May 2004. www.ndp.govt.nz

[12] Laugesen M, Fowles J. Scope for regulation of cigarette smoke toxicity according to brand differences in toxicant emissions. NZMJ 15 April 2005, Vol 118 No 1213 Page 1 of 14 URL: http://www.nzma.org.nz/journal/118-1213/1401/

[13] Laugesen M, Fowles J. Scope for regulation of cigarette smoke toxicity: the case for including charcoal filters. NZMJ 15 April 2005, Vol 118 No 1213 1—7. URL: http://www.nzma.org.nz/journal/118-1213/1402/

[14] Blakely T, Laugesen M, Symons R. Fellows K. New Zealand cigarettes have a high nicotine content. NZ Public Hlth Rep 1997; 4: 33-4, 85.

[15] Counts ME. Morton MJ, Laffoon SW, Cox RH, Lipowicz PJ. Smoke composition and predicting relationships for international commercial cigarettes smoked with three machine-smoking conditions. Regulatory Toxicology and Pharmacology 2005; 41: 185-227.

[16] Regulating to reduce harm. Philip Morris (New Zealand) Ltd and Philip Morris International Management SA’s joint comments on Smokefree Environments Regulations Consultation Document. 8 Oct 2004. http://www.philipmorrisinternational.com/global/downloads/OBE/NZ_Comments_on_SFE_Regulations.pdf 

[17] Information for smokers. Philip Morris USA. Onsert on Marlboro UltraSmooth cigarettes test marketed in Tampa Florida, 2005.

 

Copyright Health New Zealand 2007. All rights reserved.