Oral presentation by Lars Ramström at Workshop on tobacco ingredients, National Institute for Public Health and the Environment, Bilthoven, The Netherlands, 30 and 31 October 2003

2. Regulation of: - amounts of various constituents in cigarette smoke - information on packages regarding smoke constituents - smokefree tobacco products

3. To be meaningful from health point of view, regulation of smoke constituents should relate, not to machine yield , but to smokers’ intake, taking into account the interaction between the smoker and the product.

4. Jarvis MJ, Boreham R, Primatesta P, Feyerabend C, Bryant A. N icotine yield from machine-smoked cigarettes and nicotine intakes in smokers: evidence from a representative population survey. J Natl Cancer Inst. 2001 Jan 17;93(2):134-8 .

8. In I 2001, the U.S. National Cancer Institute (NCI) published Monograph 13

12. A smoker’s intake of substance A = machine yield of A (his nicotine intake) × machine yield of nicotine Amount of nicotine RATIO substance A / nicotine determined by determined by the smoker cigarette properties

14. Example of brand comparison

15. Example of rule in an ”intake-related” regulation of cigarette smoke constituents . T/N ratio <10 (and, optionally Machine yield of tar <12 mg Machine yield of nicotine <1.4 mg)

16. Example of brand comparison

17. Regulation of: - amounts of various constituents in cigarette smoke - information on packages regarding smoke constituents - smokefree tobacco products

18. Health-related purpose of consumer info on cigarette packages: To help the smoker minimize his intake of harmful smoke constituents. Therefore, info should be related to potential INTAKE. Consequently, machine yield figures are meaningless.

19. Machine yield figures on packages are even MISLEADING, since their appearence gives the false impression that: - nicotine intake were determined by cigarette properties and differing widely between different brands but independent of how you smoke. - low figures for a substance, e.g. tar, would indicate low intake of that substance i.e. ”This is a mild cigarette”.

20. Instead, smokers should be aware... - that they are themselves influencing their intake by the way they smoke - that the self-determined intake of nicotine is about the same from all cigarettes - that the intake of other substances is influenced also by cigarette properties (yield ratio to nicotine)

21. Possible model for a meaningful and truthful info box on packages : Nicotine delivery from one of these cigarettes - to a smoking machine (ISO standard): 0.6 mg - to a smoker: 0.1 – 2.0 mg depending on how it is smoked Every milligram of nicotine is accompanied by: Tar: 8 mg Carbon monoxide: 9 mg

22. Regulation of: - amounts of various constituents in cigarette smoke - information on packages regarding smoke constituents - smokefree tobacco products

23. Mean nitrosamine content of moist snuff products from various sources based on dry weight