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Historically, cigarettes and other tobacco products have been exempt from health and safety standards for ingredients and emissions that are typically applied to other consumed products including foods, beverages and drugs (1, 2, 3). Although some countries have begun to develop and apply standards for allowable ingredients, there are no globally accepted standards or guidelines (2). Presently limits on emissions from tobacco products have not been implemented with the exception of estimates of tar, nicotine and carbon monoxide (2). An important consideration in the regulation of ingredients is that when the cigarette is used as intended, the ingredients can be modified and emission profiles altered during the processes of combustion (“burning”) and pyrolysis (“modification by heat”). Therefore, the focus of this document is on the importance of evaluating tobacco product emissions as well as their ingredients under the conditions in which these products are actually used. The purpose of the document is to provide recommendations to support the development of protocols for assessing tobacco product ingredients and associated emissions with the intent to reduce tobacco caused disease.The central premise is that tobacco product ingredients and emissions thereof, including nicotine, should be regulated. Ingredients include all product components, materials used to manufacture those components, residual substances from agricultural practices, storage and processing, and substances that can migrate from packaging into the product. [The term ingredients is preferred to terms such as “additives” and “processing aids”]. Emissions comprise what is actually delivered to the user and are the product responsible for most tobacco-attributable death and disease. Emissions are substances that are produced when the product is used and this is distinguished from "exposure", a term that in this context refers to the fraction of emissions that is actually absorbed by the user.

It has been suggested that the common practice of adding ingredients to cigarette tobacco might affect patterns of smoking initiation, consumption or cessation. These suggestions have themselves prompted claims that regulation of such ingredients may contribute to reducing the prevalence of tobacco use and dependence among new and continuing smokers. In order to investigate the evidential basis for such claims, we performed a cross-sectional statistical analysis of smoking quit ratios across a sample of 80 countries, comparing those with high market shares of traditional blended cigarettes and those with high market shares of Virginia-style cigarettes, utilizing the fact that traditional blended cigarettes contain added ingredients whereas Virginia-style cigarettes contain no or very few added ingredients. Our results support the findings of our previous study performed in 2012 (across a sample of 46 countries), showing no evidence that the hypothesised effects exist with regard to quit ratios, and find that the use of ingredients can account for virtually none of the crosscountry variation in quit behaviour. This conclusion is robust to alternative specifications of variables, and to controlling for a variety of socio-economic indicators in a multivariate regression setting. We find socio-economic variables - notably income, education and internet access - exert a significant effect on the quit ratio, inducing higher cessation rates as standards in medical care and information improve as societies develop. We also find various tobacco control measures induce high quit ratios across countries. Both of these findings are in line with existing international evidence on smoking patterns. [ABSTRACT FROM AUTHOR]

Objective: The US government requires the public display of information about toxic chemicals in cigarettes and smoke by brand in a way that is understandable and not misleading. We sought to identify risk communication formats that meet these goals. Methods: We conducted 3 online experiments with US adult convenience samples (total N = 1866). Participants viewed a webpage displaying information about chemicals in the smoke of a cigarette brand. Experiment 1 varied the chemicals listed and format for their health effects. Experiments 2 and 3 varied the format of chemical quantities and presence/absence of a visual risk indicator. Outcomes were understandable (increasing knowledge) and not misleading (not reinforcing misperceptions). Results: Information about chemicals and health effects increased knowledge of these topics by ~30% (p < .001) compared to no information. Quantity format and use of a risk indicator generally did not affect knowledge. The proportion of participants misled ranged from 0% to 92%, depending on measure. Findings indicated 52% would use a website to search for safer cigarettes. Risk communication formats did little to reduce being misled. Conclusions: Some risk communication formats successfully increased knowledge of chemicals and health effects. However, the formats did little to reduce the proportion of people misled. [ABSTRACT FROM AUTHOR]

The optimal way to display constituent levels (e.g. tar) on tobacco packaging has not received adequate attention but has important policy implications. Adult smokers and non-smokers (n = 836) were surveyed in France using Computer Assisted Personal Interviewing to assess perceptions of constituent levels displayed numerically (brand-specific tar and nicotine numbers from smoking machines and the current format in European Union), descriptively (a short sentence describing chemicals and their health effects but without any brand-specific numbers) or as a pack insert (a card placed on the inside of the pack describing the presence of chemicals and their health effects in more detail, as well as information on cessation). We also assessed perceptions of identically packaged cigarettes differing only on nicotine levels. Displaying information regarding ingredients either descriptively or on pack inserts was perceived as more comprehensible and informative than displaying them numerically. Numeric yields were associated with false beliefs: almost half the sample perceived packs with lower nicotine levels (0.8 mg vs. 0.9 mg) to be safer. [ABSTRACT FROM AUTHOR]