777 



440 



AMERICAN REVIEW OF RESPIRATORY DISEASE VOL 148 1993 



posure. and for which there are few data, include Individual differ- 

 ences in the metabolism and excretion of tobacco combustion 

 products (34). 



Our results provide additional information on assessment of 

 exposure to tobacco combustion products; the findings has-e prac- 

 tical implications for epidemiologic research on smoking and 

 health and for counseling smokers atx>ut yields of tar and nico- 

 tine. Because FTC yields are not strongly predictive of exposure 

 to tobacco combustion products, subjects reports of cigarette 

 brand should not be used as a primary marker of exposure in 

 epidemiologic investigations. The potential for misclassification 

 of exposure based on brand, and thus on FTC yields, is great and 

 may largely explain inconsistent results among studies compar- 

 ing health effects in smokers of high-yield cigarettes with those 

 in smokers of lower yield cigarettes (1. 35). 



Although many smokers perceive cigarettes labeled low in tar 

 and in nicotine as less hazardous, our results suggest that FTC 

 cigarette yields provide the smoker with inaccurate information 

 on actual exposures to tobacco combustion products. Smokers 

 need to be advised about the limitations of cigarette yield infor- 

 mation. Switching to lower yield cigarettes may not reduce a 

 smoker's exposure to hazardous tobacco combustion products, 

 and switching is unlikely to produce substantial health benefits 

 compared with those that follow complete cessation. 



Acknowfedgmenr The wntera thank the interviewers and partiopanta >n the 

 study and Jennitor Chavez. Carotyn Ian, and Rita EllkXt for their help in prepar- 

 ing the manuftcnpt. 



References 



1 u S. Oepartment of Hearth and Human Sefvtcas. The heatth consequencas 

 ot smoking: the changing cigarette. A report of the surgeon general. 

 Washington. DC: U.S. Government Printing Office. DHHS (PHS) Put>- 

 licatlon No. 81-50156. 1981. 



2. Participants of the Fourth Scarborough Conference Is there a future tor 



tower-tar-yield ctgarenes? Lancet 1985; 2:1111-4. 



3. U.S. Department of Health and Human Services. Reducing iha health 



consequences ot smoking: 25 years of progress. A report of the sur- 

 geon general Washington. DC: Government Printing Office, DHHS 

 (CDC) Publication No. 89-6411. 1989. 



4. flickert WS, Robinson JC. Lawless E. Limitations to potential uses for 



data based on ihe machine smoking of cigarettes: ctgarette smoke con- 

 tents In V^atd N. Frogan P, eds, Nicoiino. smoking and the Kns tar 

 programme. New York" Oxford University Press. 1989; 8S-9. 



5. Samet JM. Coultas OB, Howard CA. Skipper 8J. Resptratory diseases 



and cigarette smokirtg in a HispanK: population in New Mexico. Am Rev 

 Respir Oi$ 1988; 137:815-9. 



6. Jones RH. Etiicott MF. Cadtgan JB. Gaensler EA The relationship be- 



tween alveolar and blood carbon monoxide coocemratiorts during brealh- 

 holding J Lab Clin Med 1958; 51 553-64. 

 7 Langone JJ. Gjika HB, Van Vunakis H. Nicotine and its metabolites. Ra- 

 dioimmunoassays for nicotine and cotmine. Biochemistry 1973; 12: 

 5025-30 



8. Ccultas OB, Howard CA, Peake QT, Skipper BJ. Same) JM. Salivary cott- 



ntne levels artd involuntary tobacco smoke exposure in children arrd 

 adults in New Mexico. Am Rev Respir Ois 1987; 136 305-9 



9. Federal Trade Commission. Repon of tar.' nicotine artd carbon mornix- 



ide of the snx>ke of 207 varieties of domestic cigarettes Federal Trade 

 Commission Repon. 1984, 



10. Federal Trade Commission Reponoftar.' nicotir>earKlcart>on monox- 

 ide of the smoke of 207 varieties of domestic cigarettes. Fe<}eraJ Trade 

 Commission Repon. 198S. 



1 1 SAS Institute Inc. SAS users' guide: stalislics, S(h ed. Cary. NO: SAS In- 

 stitute, inc.. 1985. 



12. PaachH.ShahD.Morr^aRW.Vetklilyofsmokers'lnformadonaboutpresent 



and past cigarette bnvxls - implicaDons for studies at the sftects of falling 

 tar yietda of cigarettes on health Thorax 1066; 4i 203-"' 



13. Markldes kS. Coreil J, Ray LA Smoking among Mexican Amencana: a 



Ihree-generaiion study. Am J Public Health 1987, 77708-11. 

 14 Escobedo LQ. Remington PL Birth cohonanaiysis of prevalence of cig- 

 arette smoking among Hispantcs in Iha United Stales, JAMA 1989: 

 261:66-9 



15. Mann G. Perez-Stabia EJ. Marin BV Cigarette smoking among San Fran- 



cisco Hispanics: the role of acculturation and gender. Am J Public Haafth 

 1989. 79:196-9. 



16. Haynes SO. Harvey C. Montes H, Nickons H. Cohen BH. Vllt. Patterns 



of cigarette smokiftg among Hispanic* m the United Stales: results from 

 HHanes 1982-84 Am J Public Health (Suppi) 1990: 80:47-54. 

 17 Jarvia MJ, Russell MAH. Tar and nicotine yiekla of U.K. cigarettes 

 1972-1963: salea-weighted estimates from non-industry sources. Br 

 J Addict 1985; 80:429-34 



18. WyT>derEL.GoodmanMT.HortmannO.Oemographtcaspect»ofthekMv- 



yield cigarette: considerations m the evaluation of health risk. J Natl 

 Cancer Inst 1984; 72:817-22. 



19. Folsom AR, Pechacek TF. Gaudemaris R. Luepker RV, Jacobs DR. Gl>- 



lum RF. Consumption of low-yrekT cigarenes: its frequency and rela- 

 tionship to serum th^xyanote. Am J Public Health 1984; 74'564-8. 



20. Stollmen SO, Garfinkai L. Smoking habits arn] tar levels in a new Ameri- 



can Cancer Society prospective study of 1 .2 miltion rrwn and women. 

 J Natl Cancer (nst 1966; 76:1067-63. 



21. MaronOkJ. FoftmannSP. Nicotine yteM and measures Ot Ctgarette smoke 



exposure in a large oopulalton: are lower-yield cigarettes safer? Am 

 J Public Hearth 1937: 77 548-9. 

 22- Centers tor Disease Ccnrot Comparison of the cigarette brand prefer- 

 er>ces ot adult and teenaged smokers— United Stales. 1989. and 10 

 U S. communil>9S. 1988 and 1990. JAMA 1992: 267:1893-6. 



23. Benowiu NL. Hall SM. Homing Rl. Jacob P ill. Jones RT. Osman AL. 



Smokers of lowyiek] cigarettes do not consume less nicotine. N Engl 

 J Med 1983; 309:139-42. 



24. Russeli MAH, Jar/is MJ. Feyerabend C, Sakx>iee Y. Reduction of tar. 



nicotine and cartX}r monoxide intake in low tar smokers. J Epidemiol 

 Community Healttt 1966; 40:80-5. 



25. Abrams DB. Follick MJ, Biener L. Carey KB. Hitti J. Saitva cotlnine as 



a measure of smoking stattis in Retd settings. Am J PubUc Healtn 1987; 

 77:848-6. 



26. Pierce JP. Dwyer T, Dtgluslo E, Carpenter T. Hannam C, Amin A. Yong 



C. Sarfaty Q. Burke N, ar^ Quit for Life Steering Committee. Cotlnine 

 valklatKxi of setl-reported smoking In commercialty run community sur- 

 veys. J Chron Ois 1987; 40:689-95. 



27. Woodward M, Tunsial^Pedow H. Smith WCS. Tavendaie R. Smoking char- 



actensttcs and inhalation biochemistry in the Scottish populalton. J Clin 

 Epklemiol 1991; ^4 1405-10 



28. U S. Department o< Health and Human Services. Tne heatt^ consequencee 



of smoking: nicotine addiction. A repon of the sijroeon general. Washmg- 

 lon. DC: U.S. Government Printing Office. 1988. DHHS (CDC) PuWl- 

 catlon No 88-8406 



29. Woodman Q. Newman SP. Pavia D. Clarfta SW. Inhaled smoke volume 



and puff Indices with ctgarottes of different tar and nicottne tevels. Eur 

 J Respir Dis 1987, 70:187-92. 



30. Kozlowski IT. Frecker RC, Khouw V. Pope tAA. The misuse of tese- 



hazanJous* cigarettes artd its detection: hole bkxrMrtg of ventilaMd fUters. 

 Am J Public Hearth 1990; 70:1202-3. 



31 . Benowitz NL. Jacob P 111. Kozlowski LT. Yu L. Influence ot smoking fewer 



cigarettes on exposure to tar, nicotine, and carbon monoxide. N Engl 

 J Med 1988; 315:1310-3, 



32. Benowitz NL. Jacob P III. Yu L. Talcon R. Hall S. Jones RT. Reduced 



tar, nicotine, and cart>on monostde exposure while smoking ultralow— 

 but not iow-yield cigarettes JAMA 198«; 256 241-6. 



33. Russell MAH. Nicotine and the sstf-reguiation cf smoke intake. In: Wakl 



N. Frogan P. eds Nicotine, smoking and the low tar programme. New 

 York: Oxford University Presa. 1989; 151-69. 



34. Idle JR. Titrating exposora to tobacco smoke using cotlnine— a minetiekj 



of misunderstandings. J Clin Epidemtot 1990: 43:313-7. 



35. Samet JM Leu i^&zaroous cigarenes ana dia e asee of Ihe lung. Chest 



1989; 88:602-3. 



