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CIGARETTE NICOTINE
REDUCTION PLAN
Abstract
The nicotine
content of cigarettes and smoking tobaccos can be reduced to near zero in
as few as seven reduction steps, and completed within as short a time as
28 months, with a reduction of just under 2 mg nicotine content per
cigarette with 90% of smokers not expected to notice the transitions,
provided regular nicotine cigarettes and tobacco are excluded from import
and from sale.
Such legislation,
if well notified in advance, is unlikely to cause a major backlash from
smokers if
1)
alternative
products are on hand at lower price, to supply nicotine in the customary
satisfying amount, without the risks of tobacco cigarette smoking. See http://www.endsmoking.org.nz/ecigarette.htm
2)
the Ministry
of Health publicises the relative risks of
smoking tobacco versus inhaling nicotine.
3)
The
prices of tobacco smoking are raised while the price of alternative nicotine
products is kept low.
The reduction
process assumes that the start point is the nicotine content of a regular
New
Zealand cigarette; by the third reduction step nicotine content
approximates to that of supermild cigarette,
(nicotine smoke yield 0.6 mg ).
Smoking prevalence,
at 23% initially, would be largely unaffected until the sixth step at
20-23 months, when it would fade rapidly to a new low plateau of
approximately 5% still smoking. Demand for nicotine patches and gum (and
personal mail orders for smokeless tobaccos perhaps) would increase
greatly for say 3 months, and then decrease to a new steady level.
Provided suitable alternative nicotine or smokeless products are already
accessible to smokers,
this method is justified as a support policy for
ending cigarette sales. It can be done without inducing compensatory
over-smoking; and safely, without any increase in exposure to carbon
monoxide or carcinogenic nitrosamines.
Method
Calculation of a
rate of nicotine reduction to suit smokers
As nicotine is the
main reason why addicted smokers smoke, and most smokers say they are
addicted, any
reduction of nicotine interferes with the smoker’s enjoyment of the
product, if a reduction is perceived.
Ten percent of
smokers can, based on perceived reductions in throat harshness or
strength, detect a reduction in nicotine percentage concentration in the
tobacco of 0.27% (regular, full flavour) 0.41% (low tar) and
0.77% (ultra low tar) cigarettes.2 3 If 90% of
smokers cannot detect the change, we take that as acceptable. To achieve
this, any reduction should be of no more than 0.27% in the concentration
of nicotine in the tobacco of the cigarette. This concentration applies to all
smokers, as smokers of low tar and ultra low tar (mild, light, supermild) cigarettes were less sensitive than
regular brand smokers to changes in nicotine.
Assumptions
- Five percent of smokers will continue to
smoke due to black market supply, or home growing for personal use.
- Start values are based on tests of New Zealand cigarettes in 1996-7, and smoking
prevalence (any cigarette) in New Zealand in 2004.
- Nicotine concentration is reduced by
0.25% per 4 months, such that 90% of smokers do not perceive a
difference.
- As tobacco weight is held constant,
nicotine content falls in proportion to concentration
- Maximum nicotine availability to the
smoker is limited to 40% of actual nicotine content.
- Nicotine on the pack label (machine
tested yield) would also reduce in proportion, assuming no change in
cigarette design.
- The percentage still smoking is
estimated to not reduce appreciably until the available nicotine
falls below 1 mg, or 0.2 mg yield, when the number expected to quit
is increases greatly. The average intake to maintain addiction is 5
mg per day, and at 30 cigarettes per day, the threshold is 0.17 mg
absorbed per cigarette. Therefore addiction can be maintained until
the end of step 6.
Table 1.
Nicotine content reduction plan to attain to non-addictive levels,
for regular cigarettes and hand rolled tobacco
|
Nicotine reduction plan
|
|
|
|
|
|
|
|
|
|
|
Programme months elapsed on
fast track plan
|
Pre-
reduction
|
0-3
|
4-7
|
8-11
|
12-15
|
16-19
|
20-23
|
24-27
|
Average
|
|
Reduction step
|
Units, sales weighted
|
0
|
1
|
2
|
3
|
4
|
5
|
6
|
7
|
1-6
|
|
Nicotine concentration (moist
weight) %
|
% of moist weight
|
1.70%
|
1.45%
|
1.20%
|
0.95%
|
0.70%
|
0.45%
|
0.20%
|
0.00%
|
1%
|
|
Tobacco moist weight
|
Mg/cigarette
|
762
|
760
|
760
|
760
|
760
|
760
|
760
|
760
|
760
|
|
Nicotine content
|
mg /cigarette
|
13.0
|
11.0
|
9.1
|
7.2
|
5.3
|
3.4
|
1.5
|
0.0
|
5
|
|
Maximum nicotine availability
|
Mg of
content/cigarette
|
5.2
|
4.4
|
3.7
|
2.9
|
2.1
|
1.4
|
0.6
|
0.0
|
2
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Nicotine on pack label
|
Machine test, mg/cig
|
1.3
|
1.1
|
0.9
|
0.7
|
0.5
|
0.3
|
0.1
|
0.0
|
1
|
|
Nicotine trend
|
as % of start value
|
100%
|
85%
|
70%
|
56%
|
41%
|
27%
|
12%
|
0%
|
42%
|
|
% still smoking
|
|
23%
|
23%
|
23%
|
23%
|
23%
|
22%
|
10%
|
5%
|
5%
|
Assumptions
for Table 1.
·
Starting
levels were 1996-7 values for cigarette content: 4-6
·
Target
non-addictive levels were as estimated by Benowitz7.
·
Nicotine
concentration is assumed to reduce at values proportionately reduced by
0.245% per step. Or 1.9
mg/cigarette per step.
** Maximum possible
absorption assumed to be 40% of the nicotine content, assuming 40% bioavailability to the smoker.
# Nicotine yield is less than the
bio-available content by the amount presumed lost in sidestream
smoke, and some trapped in filter. Values are proportionately reduced by
0.15mg per step.
## Adjusted for the
number of cigarettes smoked.8 at p.164.
Compensatory smoking while reducing nicotine
can be entirely prevented
Compensatory smoking is
increased puffing that occurs when smoking many low yield cigarettes.
However compensatory smoking will not occur while reducing nicotine content, all that is required is that regulations to
reduce nicotine require that tar not be reduced below say 9 mg yield per
cigarette.
Commercial
low-nicotine cigarettes are almost always also low-tar cigarettes, or low
yield cigarettes for short. When both nicotine and tar are low, the
smoker inhales more smoke to get sufficient nicotine. Manufacturers can,
however, make cigarettes that do not cause over-smoking, by only lowering
the nicotine or the tar but not both. Changing the nicotine yield while
keeping tar yield constant, does not change puffing volumes. 8 9 This
type of cigarette is available commercially.(Quest brand, www.vectortobacco.com)
Benowitz, for example, found no compensation, when
smokers were switched to progressively lower nicotine-containing
cigarettes each week, from their usual brand, to 12 mg content, to 8 mg,
to 4mg, to 2mg, and then to 1mg content per cigarette. Carbon monoxide
and NNAL a lung carcinogen were assessed at each dose, but did not
increase, showing that nicotine reduction is a safe procedure. Cigarette
consumption in fact fell, by 70% during the trial. In the weeks after the
smokers had the option of reverting to their own brand, a quarter of them
quit smoking. Cigarette consumption and cotinine
were lower than at baseline.9
Speed of reduction
In New Zealand the stock of cigarettes in the supply chain
is completely changed every few months. Thus the nicotine concentration
of tobacco used could be reduced every 4 months, by say 0.245%. Over 90%
of smokers would not notice any change in the strength or flavour or throat harshness of their cigarette.
Would young people learn to smoke more
easily if these cigarettes contained less nicotine?
Possibly yes, but
without nicotine, there would be little incentive to keep smoking.
Conclusion
To reduce the
average 2.03% nicotine concentration of moist tobacco, and the 13.0 mg
nicotine content of regular filter brand cigarettes,4 5 to a
non-addictive nicotine concentration of 0.067% and nicotine content of
0.4 mg per cigarette without 90 percent of smokers noticing the
difference in switching to the next step (until the final steps), would
need seven reductions at four monthly intervals, of no more than 0.245%
nicotine concentration or a reduction of 1.45 mg nicotine content per
cigarette per reduction step. Table 1 shows how this can be done, with
seven equal reductions, and 28 months elapsing from the commencement of
the reductions. Nicotine concentration and nicotine yield on smoke test
are correlated. (Fig 2, p.968 ) The same method would apply to
hand rolled tobacco.
__________________
1. Laugesen M, Clements M. Cigarette smoking mortality among
Maori 1954-2028. Wellington: Te Puni Kokiri (Ministry of Maori Development), 1998.
2. Gordin
H, Perfetti T, Hawley R. Nicotine just
noticeable difference study of full flavor low "tar" and ultra
low "tar" non-menthol 85mm products. Tobacco Science 1988;32:61-65.
3. Janjigian
K, Perfetti T, Green C, Jnr
FC, Rivers J, Smith L, et al. Nicotine just noticeable difference studies
of full flavour non-menthol 85mm products. Tobacco Science 1986;30:146-151.
4. Blakely T, Laugesen M,
Symons R, Fellows K. New Zealand cigarettes have a high
nicotine content. NZ Public Health
Rep 1997;4:33-34.
5. Blakely T, Symons R.
Update on nicotine concentration in New Zealand-manufactured cigarettes. NZ Public Health Rep 1997;4(11/12):85.
6. Cigarette Manufacturers.
Returns to the Ministry of Health for 1990-1996. Wellington: Ministry of
Health, 1991-1997.
7. Benowitz
NL, Henningfield JE. Establishing a nicotine
threshold for addiction. New
England Journal of Medicine 1994;331:123-125.
8. NCI Expert Committee. The FTC Cigarette Test Method for
determining tar, nicotine, and carbon monoxide yields of US cigarettes.
Bethesda Maryland: National Institutes of Health, National Cancer
Institute, 1996.
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