Changes in tobacco blends and curing of tobacco has caused US cigarettes to have higher levels of tobacco specific nitrosamines , a group of carcinogens found in tobacco and nicotine products. The 2014 Surgeon General Report observed that “[f]or Kentucky reference cigarettes, mutagenicity per mg of total particulate matter was 30–40% lower for unfiltered cigarettes than for the same cigarette with a filter added.” These design changes have not only made cigarettes become more dangerous in terms of rising lung cancer rates, but also contributed to an increase in overall mortality, chronic obstructive pulmonary disease and heart disease. The rising risks correspond to changes in cigarette design – unfiltered to filtered, higher tar to lower tar, introduction of filter vents, among other changes to cigarette design. Deeper inhalation of more dilute smoke increases exposure of the lung parenchyma. These and other design changes in cigarettes mayalso have contributed to the shift, beginning in the 1970s, in the histologic and topographic features of lung cancers in male smokers, with an increase in the incidence of peripheral adenocarcinomas that largely offset the decrease in squamous-cell and small cell cancers of the central airways. Filters are part of modern cigarette design, weed trimming tray including the presence of microscopic “ventilation” holes designed to dilute smoke when it is being tested in a smoking machine to trick tests into rating the cigarettes as having lower tar and nicotine deliveries than they actually do.
Filters represent the kind of technology that a corporatized marijuana industry could develop to mislead the public into thinking that products were less dangerous than they are and to engineer products to increase use. The resulting lower tar and nicotine readings were used to mislead smokers into thinking that the cigarettes were safer to keep health-concerned smokers smoking. Filter technology is also an important element of the design of a modern cigarette to lower particle size and make the smoke go deeper into the lung to increase nicotine absorption, with the effect that it causes more disease. In addition, the filters themselves break down and deposit tiny pieces of the filter material in smokers’ lungs, which may contribute to the diseases smoking causes. Filter material found in smokers’ lungs includes toxin-containing charcoal granules and plant and plastic fibers. Cigarette filter fibers have been observed in lung Thissue from patients with lung cancer and who were known to be habitual smokers. In short, a cigarette filter functions much as the way Volkswagen manipulated the pollution controls on its diesel engines: They create the illusion of being less polluting while making the disease burden worse. Internal industry documents demonstrate that the cigarette companies designed cigarettes with filters knowing from the beginning that filters did not actually reduce risk. Filters were part of an overall public relations strategy and marketing tool to manipulate smokers into continuing to use hazardous tobacco products. The tobacco companies use menthol and other flavour additives including fruit and candy flavouring as marketing tools to attract young smokers. National survey findings from the United States and Japan confirm that menthol cigarette use is disproportionately common among younger and newer adolescent smokers. Tobacco products that disguise the taste of tobacco through flavouring agents and palatability enhancers create products that largely appeal to youth and young adults.
Menthol is the most popular characterizing flavour of cigarettes in the US, with more than 90% of all cigarettes containing menthol. Such harsh effects, if experienced by the smoker, could encourage quit attempts and cessation among menthol users. Women perceive the minty aroma of menthol cigarettes to be more socially acceptable than nonmenthol cigarettes, which complicates public health efforts to denormalize tobacco use. In the US, the tobacco companies intensely market menthol cigarettes in predominately black communities through price discounts, signage, and through associations of menthol use with hip hop lifestyle and culture. Family and social factors that prevented smoking among African American teens do not seem to carry over into young adulthood likely due to tobacco company targeted marketing. In 2012, teenage smoking prevalence among whites was twice as high as black smoking prevalence . While use rates among young adults remains higher for whites than blacks , compared to white smokers, menthol cigarettes are disproportionately used among black smokers. National data from the United States show that around 80% of African American smokers use menthol cigarettes compared to around 30% of whites. Tobacco-caused morbidity and mortality rates are disproportionately higher among African Americans compared to whites, and menthol cigarette smoking is disproportionately high among African Americans, which may help to partly explain the disproportionate tobacco-related disease burdens. These rapid changes in medical costs are due to the fact that risks of cardiac events, non-cancer lung disease, complications of pregnancy, and effects on children begin to appear almost immediately when people stop smoking or being exposed to secondhand smoke. Cancer is also affected, albeit more slowly over time. Hospitalizations for heart attacks, other cardiovascular conditions, stroke, and pulmonary conditions drop immediately following implementation of smoke free laws, as do need for treatment of respiratory conditions, and complications of pregnancy and hospitalizations for childhood illnesses. The fact that marijuana smoke exposure has similar – indeed larger – effects on vascular function73 suggests that there may be similar adverse consequences and medical costs if marijuana use increases following legalization and expansion of the market.
Tobacco control policy change in Australia between 2001 and 2011 played a substantial role in reducing smoking prevalence among Australian adults between 2001 and 2011. During that time, the Australian government increased tobacco taxes, adopted more comprehensive smoke free laws, and increased investment in mass media campaigns, which can explain 76% of the decrease in smoking prevalence from 23.6% to 17.3% . Comprehensive tobacco control policies may have an even greater impact on cigarette consumption and demand reduction in low and middle income countries compared to high income countries.306 For example, there has been a 50% reduction in male and female smoking prevalence in Brazil between 1989 and 2010, which represents a 46% relative reduction compared to the 2010 prevalence under the counterfactual scenario of policies held to 1989 levels. Combined these policies had averted 420,000 deaths by 2010, with estimates of an almost 7 million deaths averted projected by 2050. Uruguay, an international leader in tobacco control, became one of the first countries to fully implement the Framework Convention on Tobacco Control. In 2006, Uruguay implemented its national smokefree law, and in 2009 the government implemented the largest graphic warning label, covering 80% of the package. In that same year Uruguay prohibited use of false or misleading statements on tobacco packages . There were three tobacco tax increases in June 2007, June 2009, and February 2010, which made tobacco products in Uruguay the highest in the region. In 2012, the Ministry of Health launched an aggressive mass media campaign308 and in 2014 the government prohibited all forms of tobacco marketing including advertising, promotion and sponsorship, product promotion, and point-of sale displays. Since implementation of its comprehensive tobacco control program, tobacco consumption, risk perceptions, and social acceptability of use and the tobacco industry have shifted dramatically. From 2003 to 2011, adult smoking dropped by 3.3 percent each year while youth smoking dropped by 8 percent, from 39% to 31% for males and from 28% to 20% for females. In 2012, 75% of Uruguayans favored a total ban on all tobacco products within 10 years and 60% of the population believed the tobacco companies were unethical. Support for comprehensive smoke free laws among smokers increased from 54% in 2006 to 90% in 2012. After Uruguay implemented its smoke free law, hospital admissions for heart attacks dropped 20% and non-hospital emergency visits for bronchospasm dropped by 15%. A 2000 study on marketing restrictions in OECD countries found that the effects of marketing bans are cumulative and that partial bans were not associated with reductions in tobacco use. Overall, cannabis grow setup comprehensive bans on advertising and promotions were associated with a significant reduction in tobacco consumption since implementation, with larger effects for more comprehensive bans. Market segmentation is an important aspect of tobacco industry marketing.
Tobacco companies use market research to understand smoking behaviour among different segments of the population, and, in turn, use such research in future marketing campaign messages. This information can be used to design advertising campaigns that circumvent partial advertising restrictions by shifting expenditures toward other media outlets .For example, after the 1998 Master Settlement Agreement in the United States, in which the tobacco companies agreed to some limitations on their advertising and promotional activities, the tobacco industry shifted marketing expenditures to direct mailings and online marketing. Partial advertising restrictions permit cigarette companies to target young adults through lifestyle magazines created by the industry, event sponsorships, and low income and less educated women through distribution of coupons with food stamps, direct mail, and bundle offers at the point-of-sale. Following implementation of a 2012 law that prohibited point-of-sale tobacco displays in New Zealand the odds dropped significantly for experimentation with smoking , smoking initiation , and smoking prevalence , among adolescents, consistent with similar studies from Ireland, Norway, and Australia. There was a marginal decrease in perceived peer smoking among New Zealand smokers, which may have been greater if all forms of tobacco marketing had been prohibited simultaneously. Because the tobacco industry continuously seeks to evade any advertising restrictions, the World Health Organization recommends that governments license tobacco manufacturers and retailers, with penalties and sanctions for noncompliance, including license suspension and revocation for repeat violations commensurate on the nature and seriousness of the offence, to magazines created by the industry, event sponsorships, and low income and less educated women through distribution of coupons with food stamps, direct mail, and bundle offers at the point-of-sale. Following implementation of a 2012 law that prohibited point-of-sale tobacco displays in New Zealand the odds dropped significantly for experimentation with smoking , smoking initiation , and smoking prevalence , among adolescents, consistent with similar studies from Ireland, Norway, and Australia. There was a marginal decrease in perceived peer smoking among New Zealand smokers, which may have been greater if all forms of tobacco marketing had been prohibited simultaneously. Because the tobacco industry continuously seeks to evade any advertising restrictions, the World Health Organization recommends that governments license tobacco manufacturers and retailers, with penalties and sanctions for noncompliance, including license suspension and revocation for repeat violations commensurate on the nature and seriousness of the offence, to assist with enforcement efforts to control tobacco advertising. It is also recommended by the World Health Organization that governments dedicate funding for comprehensive enforcement programs provides legal protection and an ongoing revenue stream for government efforts to monitor and enforce regulatory compliance with marketing bans.In 2006 the U.S. Surgeon General affirmed that there is no risk-free level of exposure to tobacco smoke. Secondhand smoke causes cardiovascular disease, lung cancer, stroke, respiratory disease, and premature death in adults. Infants and children exposed to secondhand smoke are at risk for sudden infant death , asthma attacks, ear infections, and respiratory infections. Smoke free laws are designed to protect the health and safety of the public from secondhand smoke. They also have the beneficial side effect of denormalizing tobacco use, and supporting smoking cessation. In addition, comprehensive smokefree laws stimulate adoption of voluntary smokefree home policies, which also help to denormalize smoking, discourage initiation , and supports quit attempts and smoking cessation among current smokers. Comprehensive smokefree laws are associated with larger drops in hospitalizations for heart attacks, other cardiovascular conditions, stroke, and pulmonary conditions, as well as complications of pregnancy, hospitalizations for childhood illnesses, and perinatal complications. Exemptions in smokefree laws negatively impact lower socioeconomic groups and contribute to health disparities. Lower socioeconomic status individuals are more likely to work in establishments that do not have 100% smokefree coverage or circumvent the law through exemptions . In addition, women are disproportionately impacted by exemptions in smokefree laws because women are over represented in the hospitality industry. In California, for example, exemptions in the statewide smokefree law had disproportionately exposed low income workers, Latinos, and young adults to secondhand tobacco smoke in the workplace, thereby contributing to health disparities. In 2016 California passed a law that eliminated these exemptions.