This section outlines the future directions that research on lower
“tar” and nicotine cigarettes should take. These are: (1) to perform
additional laboratory studies under controlled experimental conditions,
(2) to conduct additional research on compensatory smoking; and (3) to
investigate both the biological and psychological factors involved in
smoking.

Research Priorities

Controlled Studies To Determine the Role of Nicotine as a
Primary Reinforcer in Cigarette Smoking

Many important questions on the pharmacological importance of
nicotine in maintaining cigarette smoking remain unanswered, despite
a large number of studies on the topic (1, 2, 19, 25, 36, 44, 46, 49, 65, 69,
73).

Nicotine is probably the primary source of the pharmacodynamic
appeal of tobacco, but not enough is known about its exact role in
smoking to determine whether it is the only source. (For reviews on
nicotine and smoking, see 18, 21, 31, 57, 61.)

Tobacco without nicotine appears not to be sufficiently reinforcing
to support sustained use (18). There has never been an appropriately
designed study with a large number of subjects randomly assigned to
smoke flavor-balanced cigarettes of varying nicotine content over a
substantial (months) time period. The behavioral aspects of cigarette
smoking are of paramount importance in the evaluation of less
hazardous cigarettes. Behavior is the interface between cigarette
smoking, its pharmacological and physiological effects, and the
generation of disease. Compensation for nominally reduced machine-
measured “tar” and nicotine yields of cigarettes by increased depth
and volume of inhalation as well as proportion of the burning cigarette
consumed has been demonstrated. Such a study would be necessary to
conclusively support this hypothesis of cigarette habituation.

Instead, we can only look at the distribution of smoking by nicotine
yield and the experimental literature. In 1979, the percentage of
current regular smokers in the United States who smoked cigarettes
low in nicotine content (less than 0.5 mg nicotine and less than 5 mg
“tar”) was very small, about 4 percent. Research studies using tobacco
cigarettes virtually free of nicotine show these to be rated as aversive
by smokers (86, 64). At the same time, it has been difficult to
demonstrate that smokers will use nicotine in a nontobacco medium. In
one study, lettuce leaf cigarettes injected with nicotine were smoked
for 1-week periods at intake levels only approximately 50 percent the
rate of the subject’s own brand, and with protest of much reduced
satisfaction (18). Considered a more direct route of administration,
injections of nicotine became a satisfying replacement for cigarettes

7
after repeated trials, but this early study was not conducted in a
“blind” fashion (38).

More recent studies of intravenously administered nicotine have
contained subjective reports of perceived pleasure (89), but also have
included reports of an inability to suppress subsequent smoking to a
major extent (39, 46, 49). Although the results were perceived as only
mildly pleasurable, nicotine administered in oral tablet form ($5) or
embedded in chewing gum (44, 64) has decreased various measures of
smoking in individuals not trying to quit.

The major problem with giving nicotine in other than inhaled form is
that it lacks some of the biological as well as many of the behavioral
similarities to smoking. The nicotine bolus, when inhaled, reaches the
central nervous system in less than 8 seconds (58).

More information is needed to understand the pharmacological,
psychological, and situational cofactors that may contribute to the
reinforcing effects of nicotine. By analyzing the mechanisms whereby
nicotine reinforces smoking behavior, it may be possible to design more
efficacious treatments for cigarette dependence or to devise techniques
for maximizing the rewards of smoking while minimizing the risks to
health.

Animal Models of Nicotine Use

Animal models have several advantages over human models in
studying the effects of nicotine. In the animal laboratory, environmen-
tal variables can be controlled to a much greater extent than they can
in the human laboratory. History of exposure to the drug can be
manipulated in a true experimental fashion. One of the greatest
limitations of much epidemiological and behavioral research on human
smoking behavior is that the subjects are self-selected. Consequently,
the research is inherently correlational rather than experimental.
Correlational research can describe associations between variables, but
it is often confounded by unmeasured variables (30).

Animal models have been used to study the dependence liability and
toxicity of many drugs (17, 75). The techniques used in analyzing
responses to other drugs should be developed further and applied to the
study of nicotine—and perhaps other substances in tobacco.

Methods of administration can have a large effect on the pharmaco-
kinetics of nicotine. Oral, intravenous, and inhalation modes of
administration should be employed, but since smokers receive nicotine
from inhaled smoke, the inhalation route is particularly important.
Unfortunately, animals do not inhale nebulized nicotine or cigarette
smoke in ways that are comparable to human inhalation patterns (53).
Until reliable inhalation methods for animals are perfected, intrave-
nous administration will have to be used in much of this research.

178
The Self-Administration of Nicotine by Animals

Since people take nicotine on their own, an ideal animal model would
be one in which animals take nicotine on their own. Attempts to get
animals to administer nicotine to themselves have not been uniformly
successful (17, 21). Maintained self-administration has been found in
the monkey and the rat in some studies (6, 22, 47, 50), but not in others
(82). Recent work has shown that under some schedules of reinforce-
ment, monkeys will self-administer injections of nicotine (12). In order
to discover precisely what variables are critical to the reinforcing
properties of nicotine, further studies are needed.

In addition to studying the parameters of self-administration,
toxicity should also be measured. For example, it is important to look
at the variables of physical dependence, food and water intake, and
morbidity, as well as necropsy findings.

The Study of Tolerance and Physical Dependence

Both tolerance and physical dependence can develop to nicotine or
other ingredients in tobacco ($8, 48, 71, 78). Animal models have been
used successfully in research on opioids and alcohol (70) and could
prove effective in future research on nicotine and smoking.

Appropriate animal models would facilitate the study of the
pharmacokinetics of nicotine and would help in the evaluation of
pharmacological treatments for dependence. Since tolerance and
physical dependence can influence the reinforcing properties of drugs
of abuse, animal studies should investigate the extent to which
withdrawal phenomena may contribute to the reinforcing properties of
cigarette smoke. Methods developed for evaluation of opioid drugs
could be adopted for these purposes.

Nicotine Research With Humans

The scientific issues in human and animal research are similar,
although not all studies conducted on animals are practically and
ethically suitable for research on humans. A great amount of
preliminary data already exists on the role of nicotine in human
smoking behavior (see the reviews cited above), but the influence of
tolerance and dependence on nicotine on the initiation, maintenance,
and cessation of smoking behavior are still not resolved (27, 46, 59, 61,
68). Clearly, both biological and psychosocial factors influence human
cigarette intake (41), and it is in the human model of cigarette smoking
that the interplay of these factors can best be studied. There is no
known analog in animal behavior for future orientation and cognitive
factors, such as worrying about the risks of cancer or about weight
gain upon giving up smoking.

Progress to date in laboratory studies of smoking dependence has
been slowed by the lack of standardized test materials, such as

179
cigarettes made to research specifications, and of standardized, easily
accessible laboratory analyses, such as for plasma levels of nicotine.

Compensatory Behavior in Smoking

If, in the course of a standard assay for the “tar” and nicotine yields
of a cigarette (54), a smoking-machine derives relatively small amounts
of “tar” and nicotine, the cigarette can be called lower “tar” and
nicotine. Unfortunately the smoking-machine model is limited in
accurately reproducing human smoking behavior. The machines take a
2 second, 35 cc puff each minute until a predetermined butt length is
reached. Smokers, however, are able to take larger, more frequent, and
higher velocity puffs than the machines do. It appears that such
compensatory adjustments often turn nominally lower “tar” and
nicotine cigarettes into higher “tar” and nicotine cigarettes (1, 4, 9, 25,
36, 46, 60, 62). Even if the compensations made in smoking a single
cigarette are small or nonexistent, smokers can increase their intake of
“tar” and nicotine by smoking more cigarettes (66).

Cigarettes of less than about 6 mg “tar” and 0.5 mg nicotine are also
subject to the influences of compensatory smoking. Most of these
cigarettes achieve their lower yields as a result of ventilation holes
placed in the filters, which cause each puff of smoke to be diluted with
air. These air-diluted puffs deliver relatively small amounts of “tar,”
nicotine, and carbon monoxide to the smoking-machines (29). Some
smokers have learned to block the ventilation holes with their lips or
fingers—or sometimes with tape—and thereby, often unwittingly,
defeat the purpose of the holes. If the ventilation holes are blocked,
yields of nicotine, “tar,” and carbon monoxide can increase by about
two, three, and four times, respectively (42). In 1979, ventilated-filter
cigarettes accounted for about 25 percent of total cigarette sales (29).

Many studies have used estimates of nicotine and smoke intake
based on direct observations (44), measurements of smoking topogra-
phy by means of special cigarette holders (24, 36), or analyses of
residual nicotine in cigarette filters (1, 9, 55). Only a few studies have
measured the levels of nicotine in plasma as a function of the nominal
smoking-machine yields (1, 63), but research indicates that some
smokers do compensate for reduced yields of nicotine.

By smoking more to compensate for lower nicotine intake, lower
“tar” and nicotine cigarette smokers can inadvertently increase their
exposure to “tar” and carbon monoxide beyond what might be
expected from a less intensively smoked higher “tar” and nicotine
cigarette (57, 67). Because less hazardous cigarettes may require the
delivery of moderate levels of nicotine while delivering lower levels of
“tar” and carbon monoxide, Russell (5 7) has proposed that lower “tar”
to nicotine ratios should be used to indicate less hazardous cigarettes.
These ratios may direct smokers to potentially less hazardous ciga-
rettes, but the way in which a cigarette is smoked can affect the ratio

180
examination of the advisability of encouraging people to switch to
milder cigarettes should be undertaken. (See Russell (60) for a brief
discussion of the possible role of self-selection biases in the epidemio-
logical finding that filter-tipped cigarettes are less hazardous (8, 81).
See Harris (23) for a summary discussion of behavioral and economic
factors affecting the promotion of lower “tar” and nicotine cigarettes.)

Controlled Switching

Very few studies on controlled switching have employed measures of
plasma nicotine (1, 28, 60). No large-scale studies have been conducted
that make use of plasma nicotine, carbon monoxide, and physiological
measures of smoke exposure.

The relationship between smoker satisfaction and compensatory
smoking appears to be complex. One forced switching study (74) has
shown that, even though the compensation was incomplete and did not
change for the few days of the study, satisfaction did improve during
the course of the experiment. We do not know if satisfaction with
lower “tar” and nicotine cigarettes increases with duration of their use,
if it decreases with time if compensation occurs initially, or if nicotine
yield alone determines cigarette acceptability.

Additional Comments

As noted earlier, progress in compensatory smoking research has
been hindered by the lack of research cigarettes varying systematically
in nicotine, “tar,” and carbon monoxide, and by the shortage of
laboratory facilities in which to do needed analyses.

One byproduct of the proposed research on switching to lower “tar”
and nicotine cigarettes might be the development of practical diagnos-
tic techniques. Smokers and physicians have not determined whether
lower “tar” and nicotine cigarettes have produced “low-yield” smok-
ing, but simple measures such as expired air carbon monoxide (11, 26)
might help supply needed information concerning smoke exposure.

Natural History of Smoking Along Both Biological and
Psychosocial Dimensions

Since almost nothing is known about the role of lower “tar” and
nicotine cigarettes at crucial transition points in a smoker’s history,
this issue cannot be considered in detail (7, 20, 40, 52, 56). One key
unanswered question is whether lower “tar” and nicotine cigarettes
tend to facilitate taking up the smoking habit. Presumably, initiation
of smoking is easier for those who first try lower “tar” and nicotine
cigarettes than for those who first try regular cigarettes. Thus, lower
“tar” and nicotine cigarettes can reduce aversive physical responses to
early smoking episodes that might otherwise deter taking up the habit
(43, 56).

182
Teenagers generally prefer moderately high-yield cigarettes (77),
but 2.5 percent of the boys and 12.3 percent of the girls who smoke use
lower “tar” and nicotine brands (here defined as < 10 mg “tar”).
Research has not addressed the question of what percentage of these
smokers may have been helped either in their initiation to smoking or
in their shift from casual to habitual smoking by the use of lower “tar”
and nicotine cigarettes. The incidence of smoking among teenage girls
has increased during the past 10 years (76, 77). Silverstein et al. (72)
present data supporting the hypothesis that the increasing availability
of lower “tar” and nicotine cigarettes has encouraged this increase in
smoking. Analysis of a survey of high school students suggests that
girls experience greater social pressure to smoke than do boys, and that
they also face greater physiological pressure not to smoke because of
their higher sensitivity to nicotine. Girls appear to resolve these
pressures by becoming lighter smokers than boys and by switching to
lower “tar” and nicotine cigarettes. Perhaps if lower “tar” and nicotine
cigarettes were less available, some girls would choose not to smoke
rather than to experience unpleasant nicotine reactions.

Most research on the initiation of smoking and casual smoking has
been psychosocial. No doubt there are practical, if not ethical,
constraints on studying biological influences on smoking among
teenagers. Whatever the reason, very little is known, for example,
about the role of nicotine in early smoking experiences. No one knows
how much exposure (days, months, years) to smoking is needed before
withdrawal symptoms appear. More balance is needed in research on
teenage smoking. Whenever possible, biological factors—both physio-
logical and pharmacological—should be studied along with psychoso-
cial factors (27, 41).

There has been little research on the effects of lower “tar” and
nicotine cigarettes on maintenance or cessation of smoking. There are
studies on the effects of using decreasing amounts of “tar” and
nicotine as a cessation or reduction aid (10), but these studies do not
include biochemical or physiological measures of change in smoke
exposure. It seems plausible that the alternative of a supposedly less-
hazardous cigarette might make some smokers less likely to try to
abstain completely. By the same token, the example of a satisfied,
though perhaps fully compensating, smoker of lower “tar” and nicotine
cigarettes might make a former smoker more likely to relapse. The
former smoker might view the lower “tar” and nicotine cigarettes as
both acceptable and safe (14, 15). Answers to these questions can have
immediate implications for smoking treatment. Research in this area
should include such crucial variables as gender (72). Both experimental
and epidemiological data are needed in these studies. Perhaps large-
scale smoking surveys can be expanded to include more questions that
would help characterize the natural histories of smokers.

183
Recommendations
Clinical Testing Facilities and Standardized Research Cigarettes

There has been an active research effort in this country on the
behavioral aspects of smoking. To further its productivity and to refine
the scientific questions that this research can address, especially with
regard to lower “tar” and nicotine cigarettes, the facilities and
research cigarettes described here are needed.

Clinical Testing Facilities

These facilities should be able to provide biochemical and pharmaco-
logical analyses of assays for plasma nicotine, cotinine, carboxyhemo-
globin, and salivary thiocyanate. (Jarvik (34) reviews the use of these
assays.) Each of these assays can be used to measure a smoker's
exposure to some of the toxic and/or reinforcing ingredients in tobacco
smoke. Plasma assays for nicotine (8) are available in a few laborato-
ries; these assays can require special facilities to avoid problems of
contamination. For example, a laboratory that is used part of the time
by a worker who smokes may be unacceptable for the evaluation of
plasma nicotine levels. Few behavioral researchers have access to or
sufficient control over the needed laboratory facilities. Laboratories of
this nature would be a great boon to behavioral research and would
help to standardize assays in this area.

Research Cigarettes

A supply of clinically acceptable cigarettes that vary in nicotine,
“tar,” and carbon monoxide yield should be made available to
behavioral researchers. Although some standardized cigarettes have
been available for years from the Tobacco and Health Research
Institute of the University of Kentucky, these cigarettes have no
filters, and their lack of palatability and acceptability almost complete-
ly precludes their use in behavioral research. Cigarette technology has
several ways of altering “tar,” nicotine, and carbon monoxide yields.
Ideally, different strategies would be employed to produce cigarettes
with identical machine-smoked yields. Consider two examples. A fast-
burning, strong-tobacco cigarette might have the same yields as a
slow-burning, mild-tobacco cigarette, but it is not clear how human
smoking behavior might change as a function of these modes of yield
reduction. A cigarette low in carbon monoxide could be made with
either vented cigarette paper or a vented filter. The vented filter can
be closed by smokers accidentally or intentionally, thereby increasing
the actual yield to the smoker (42), but the effect of porous cigarette
papers cannot readily be circumvented by the smoker.

Variations in “tar” to nicotine ratios should be of special concern
(57). It is important to determine the lowest ratios that still produce a
satisfying cigarette. Obviously, identical “tar” and nicotine ratios can

184
occur in cigarettes that have very different standard nicotine yields.
Research could show if there is an optimum combination of standard
yield and ratio that leads to maximum satisfaction and minimal
exposure to toxic products. Cigarettes that vary systematically in “tar”
to nicotine ratios are needed for this research.

Machine-Smoked Yields of Lower “Tar” and Nicotine Cigarettes

The standard smoking-machine assay of “tar” and nicotine yields
provides inadequate information to the tobacco consumer as well as to
the researcher (16, 45, 74). The published yields do not indicate how
many puffs were taken on a particular brand (45); assays at the Oak
Ridge National Laboratory (37) reveal that from 6.9 to 11.5 puffs are
taken on different brands of king-size filter cigarettes during standard
assays.

The current smoking-machine standards are meant to represent an
average smoker, but it is probable that the standard puff volume (35
ec) is too small (5, 51) and that the puff interval (one puff per minute)
is too long (4, 74). Since compensatory smoking occurs with lower “tar”
and nicotine cigarettes, larger and more frequent puffs tend to be
taken. Smokers sometimes interfere with ventilation holes on lower
“tar” and nicotine cigarettes (45); smoking-machines do not.

In addition to the standard assays, there should be maximum-yield
assays of “tar,” nicotine, and carbon monoxide. These assays would be
based on puffing parameters of volume, rate, and duration for the
95th—or even the 75th—percentile of heavy smokers smoking lower
“tar” and nicotine ventilated cigarettes up to the tip overwrap. These
parameters would be used in smoking-machines, with these same
ventilated brands, to derive yields with ventilation holes in both
blocked and unblocked conditions. This procedure would produce much
higher yields than does the standard assay, and these values would
better represent the possible maximum risks of the lower “tar” and
nicotine cigarettes to smokers who engage in compensatory smoking.
Without access to information about how much the standard yields can
change with intensive smoking, there can be only a limited understand-
ing of possible reductions in actual smoking exposure. Using research
in the British-American Tobacco Company Laboratories in the United
Kingdom, Green (16) has argued that intensive smoking can make
middle “tar” cigarettes (11 to 16 mg) deliver as much as high “tar”
cigarettes (31 to 35 mg). Green could not demonstrate that low “tar”
cigarettes (0.4 to 9 mg) can be made to deliver high “tar” levels, but
this study did not consider the effect of blocking the ventilation holes
on these cigarettes.

Toxicology of Nicotine

A probable outcome of behavioral research will be that nicotine is
the primary pharmacological reinforcer for cigarette smoking. If this

185
prediction is correct, a lower “tar” and nicotine cigarette that will be
used by smokers and that will minimize the exposure to other toxic
components of smoke may require substantial yields of nicotine (57,
62). Consideration of the toxicity of nicotine, then, may become crucial
in determining whether the benefits of lower “tar” and nicotine
cigarette smoking outweigh the costs.

Summary

1. Nicotine appears to be the primary pharmacological reinforcer in
tobacco, but other pharmacological and psychosocial factors may
also contribute a reinforcing effect.

2. It appears that some smokers make compensatory adjustments in
their smoking behavior with cigarettes of different yields that
might increase the amounts of harmful substances entering the
body. The frequency and amount of Spontaneous compensatory
changes in smoking style with different cigarettes require further
investigation.

3. Additional information is needed on the role of lower “tar” and
nicotine cigarettes in the initiation, maintenance, and cessation of
smoking.

4. Rigorous comparative behavioral studies involving animals are
needed to provide comprehensive, experimentally valid results on
behavioral aspects of smoking.

5. Laboratory techniques developed for study of opioids and alcohol
should be adapted for studies of tolerance and dependence on
nicotine.

6. Improved laboratory facilities are necessary for more tightly
controlled behavioral research. A particular need exists for
clinically acceptable cigarettes with standardized ingredients.

7. Smoking-machine measurements that more closely simulate the
practices of human smokers must be developed.

186
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Section 8. LOWER “TAR” AND
NICOTINE CIGARETTES:
PRODUCT CHOICE AND
USE
CONTENTS

Introduction

 

 

The Growth in the Use of Lower “Tar” and Nicotine
Cigarettes
An Increasing Public Awareness of the Health
Hazards of Cigarette Smoking
Public Attitudes
The Cigarette Profile

 

Cigarette Choice and Smoking Behavior
Overview
Relationship of “Tar” and Nicotine Yields to Smoking
Behavior
Consumption Patterns
Cessation

 

Summary

 

Addendum: Comparison of “Tar” and Nicotine Yields of
Cigarettes in 1978 and 1979
Yields of “Tar” and Nicotine
Correlation of Varieties Reported in 1978 and 1979
“Tay” and Nicotine Yields of New Brands in 1979
Applications to the Discussion

 

References

LIST OF FIGURES

Figure 1.—Market share of dollars expended in the U.S.
on advertising and promotion of cigarettes yielding <15
mg “tar” compared with total domestic cigarette
advertising and promotional expenditures for years 1970,
1975, 1976, 1977, and 1978

 

195
 

 

 

Figure 2.—Domestie market share of cigarettes yielding
<15 mg “tar,” 1967-1978

 

 

 

 

 

Figure 3.—Sales-weighted averages of “tar” and nicotine
per cigarette consumed in the US., 1954-1975

 

 

 

Figure 4.—Sales-weighted averages of “tar” and nicotine
per cigarette consumed in the U.S., 1968-1978

 

 

 

Figure 5.—Ratio of “tar” to nicotine based on sales-
weighted averages of cigarettes consumed in the US.,
1968-1978

 

 

 

 

 

Figure 6.—Delivery of nicotine as a function of “tar” of
commercial cigarettes, U.S.

 

Figure 7.—Delivery of carbon monoxide as a function of
“tar” of selected U.S. commercial cigarettes

 

 

 

Figure 8.—Index of average “tar” and tobacco per
cigarette, annually, 1967-1979

 

 

Figure 9.—Annual per capita consumption of total
cigarettes and filter-tipped cigarettes in the U.S., for
persons aged 18 and older, 1900-1979

 

 

Figure 10.—Annual per capita consumption of tobacco
products in the U.S, (including overseas forces) for
persons aged 18 and older, 1925-1979

 

 

 

 

 

Figure 11.—Annual per capita consumption of cigarettes in
the U.S. (including overseas forces) for persons aged 18
and older, 1963-1978

LIST OF TABLES

Table 1.—Estimated percentage distribution of current
regular smokers by “tar” yield of primary brand of
cigarette, by Sex, race, age, and education, adults, U.S.,
1979

 

196
 

Table 2.—Mean daily dose of “tar” or nicotine for current
regular smokers by race, sex, and age, U.S., 1979

 

Table 3.—Estimated percentage distribution of current
regular smokers by “tar” and nicotine yield of primary
cigarette used, U.S., 1978 and 1979

 

Table 4._Estimated percentage distribution of regular
smokers by “tar” yield, adolescents aged 12-18, US.,
1974 and 1979

 

Table 5.—Percent distribution of adolescent regular
smokers by “tar” yield of primary brand, by sex and
age, U.S., 1979 |

 

Table 6.—Mean age at onset of regular smoking by “tar”
or nicotine yield of primary brand, by age at interview,
current regular smokers, U.S., 1979

 

Table 7.—Estimated percentage distribution of current
regular smokers by number of cigarettes smoked daily
by approximate quintiles of “tar” or nicotine yield,
adults, U.S., 1979

 

Table 8.—Mean number of cigarettes smoked daily by
“tar” or nicotine yield, by age groups, current regular
smokers, adults, U.S., 1979

 

Table 9.—Estimated percent of current regular smokers
who have tried seriously at least once to quit, by “tar”
or nicotine level and age, U.S., 1979

 

Table 10.—Estimated percentage distribution of recent
smokers by status of recent attempt to quit, by “tar” or
nicotine yield of primary brand, July 1978 through

December 1979

 

Table 11.—Estimated percentage distribution of current
regular smokers by number of serious attempts to quit
smoking, by “tar” or nicotine level, U.S., 1979

 

Table 12.—Mean duration of most recent attempt to quit,
by “tar” or nicotine yield of current primary brand,
current regular smokers, 1979

197
 

Table 13.—Mean yield of “tar” and nicotine of cigarettes,
by type of modifier, all and filtertip varieties, U.S., 1978
and 1979

 

Table 14.—Mean yield of “tar” and nicotine of the
varieties of cigarette marketed in both 1978 and 1979,
by type of modifier, all and filtertip varieties, U.S.

 

Table 15.—Comparison of “tar” and nicotine yield on the
varieties of cigarette marketed in both 1978 and 1979,
US.

 

Table 16.—Mean yield of “tar” and nicotine of the new
varieties of cigarette marketed in 1979, by type of
modifier, U.S.

 

Table 17.—Distribution of “tar” and nicotine yield of the
new varieties of cigarette marketed in 1979, U.S.

198
Introduction

This section discusses changes in cigarette smoking over recent years
in the United States. Currently available evidence indicates that, while
the prevalence of cigarette smoking is at its lowest point in several
decades among both adults and adolescents, there are significant
differences in the cigarettes being used by those persons who do
smoke.

The discussion does not attempt to describe comprehensively the
patterns of cigarette smoking; such reviews have been published
previously (25, 26). Rather, it focuses on the information that describes
the cigarette products currently being used by smokers and the role
that such modified products may play in the smoking habit. It includes
examination of (1) the growth of the lower “tar” and nicotine
cigarette, including social and marketplace activity in recent years,
and (2) cigarette product choice and use by the smoking population.

This consideration of changes in the cigarette is restricted to that of
“tar” and nicotine yields of various cigarette brands, because of the
availability of systematic measures of these constituents through the
annual reports of the Federal Trade Commission (FTC). Note should be
taken, however, that the extensive discussion of “tar” yields in this
Report ought not to be construed as implying a primary or singular
role of “tar” in causation of all the adverse health effects associated
with cigarette smoking. Rather, “tar” yields are used because they are
readily available and correlate closely to nicotine levels. No comparable
measurements are available for carbon monoxide or other constituents
of cigarette smoke, such as acrolein, hydrogen cyanide, or the nitrogen
oxides, which are identified as probable contributors to smoking-
related disease. Further, there are no systematic data available
regarding the effects of commercially used cigarette additives on the
yields of any of these constituents.

Although the data cited here are derived from multiple sources,
much of it represents the first analysis of a large, ongoing national
survey. At the request of the Office on Smoking and Health, a smoking
supplement was added to the continuing National Health Interview
Survey (NHIS) by the National Center for Health Statistics. Begun in
July 1978 and continued through 1979, the smoking supplement was
designed to provide data on the prevalence of smoking, amount
smoked, and attempts to quit smoking. Representing a random one-
third subsample of the NHIS interviews of noninstitutionalized
persons aged 17 or older, the 18-month data included approximately
36,000 individuals interviewed. Unless otherwise indicated, the data
cited represent analysis of the approximately 24,000 interviews on
smoking conducted during calendar year 1979. Lifetime smoking status
(i.e, never, regular, occasional, and former smoker), age at onset,
brand choice, amount smoked, and data on the attempt(s) to quit were
collected for recent and current smokers. The “tar” and nicotine yields

199
for the 1978 and 1979 NHIS data sets are based on the FTC listing of
cigarette varieties, sampled in 1977 and published in May 1978, and
updated to include cigarettes identified by the FTC as marketed in
July 1978.

Three major conclusions can be elicited. First, Government and other
agency activities in recent decades have led to widespread public
recognition of the health hazards of smoking cigarettes, Second, the
marked increase in the use of filter-tipped cigarettes in the late 1950s
has been followed by a reduction in the “tar” and nicotine content of
the cigarette products actually being selected and used by the smoking
population. Third, the role of cigarettes of varying levels of “tar” and
nicotine in the initiation, maintenance, or cessation of smoking js
unknown. The data from the National Center for Health Statistics
presented here neither prove nor disprove a role of lower “tar” and
nicotine cigarettes in easing initiation, increasing daily consumption
among regular smokers, or decreasing the probability of attempting to
quit or of succeeding in the attempt. Much further work remains to be
done to clarify and define the effects of lower “tar” and nicotine
cigarettes on these behaviors, and thus their effect on total lifetime
patterns of cigarette smoke exposure.

The Growth in the Use of Lower “Tar” and Nicotine Cigarettes

An Increasing Public Awareness of the Health Hazards of
Cigarette Smoking

The decades since the first medical reports of a link between lung
cancer and smoking in the 1950s have seen multiple changes in the
cigarette products being used by the smoking population (7, 14, 15, 16,
25). A number of factors may have encouraged these changes.

The U.S. Public Health Service (PHS) has been active in assessing
and attempting to reduce the excess burden of preventable illness
related to cigarette smoking. Its first comprehensive review of the
evidence linking cigarette smoking and adverse health effects by the
Advisory Committee to the Surgeon General of the Public Health
Service in 1964 was followed by regularly issued reports from 1966
through 1980, each of which continued and extended the PHS concern.
In 1966, the PHS submitted to Congress (42) the Technical Report on
“Tar” and Nicotine. On the basis of the clear demonstration of
cigarette dose-dependent risks of several diseases, the PHS concluded:

The preponderance of scientific evidence strongly suggests that the
lower the “tar” and nicotine content of cigarette smoke, the less
harmful would be the effect.

We recommend . . . the progressive reduction of the “tar” and
nicotine content of cigarette smoke.

200