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Mandated lowering of toxicants in cigarette smoke: a description of the World Health Organization TobReg proposal
  1. D M Burns1,
  2. E Dybing2,
  3. N Gray3,
  4. S Hecht4,
  5. C Anderson1,
  6. T Sanner5,
  7. R O’Connor6,
  8. M Djordjevic7,
  9. C Dresler8,
  10. P Hainaut9,
  11. M Jarvis10,
  12. A Opperhuizen11,
  13. K Straif9
  1. 1
    UCSD School of Medicine, San Diego, California, USA
  2. 2
    Division of Environmental Medicine, Norwegian Institute of Public Health, Oslo, Norway
  3. 3
    Cancer Council of Victoria, Melbourne, Victoria, Australia
  4. 4
    University of Minnesota Cancer Center, Minneapolis, Minnesota, USA
  5. 5
    Department of Environmental and Occupational Cancer, Institute of Cancer Research, The Norwegian Radium Hospital, Oslo, Norway
  6. 6
    Roswell Park Research Institute, Buffalo, New York, USA
  7. 7
    Tobacco Control Research Branch, National Cancer Institute, Bethesda, Maryland, USA
  8. 8
    Arkansas Department of Health, Little Rock, Arkansas, USA
  9. 9
    International Agency for Research on Cancer, Lyon, France
  10. 10
    Royal Free and University College London Medical School, London, UK
  11. 11
    National Institute of Public Health and the Environment (RIVM), The Netherlands
  1. D Burns, 1120 Solana Drive, Del Mar, California 92014, USA; dburns{at}

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Preventing initiation of tobacco product use, promoting cessation of tobacco use, and protecting the public from exposure to second hand smoke are recognised by the World Health organization (WHO) Framework Convention on Tobacco Control (FCTC) and by the WHO Study Group on Tobacco Product Regulation (TobReg) as the most effective approaches to reducing tobacco related morbidity and mortality. However, the FCTC also recognises the need for tobacco product regulation in articles 9 and 10 of the treaty. In order to inform that process TobReg has developed a series of reports that begin to provide a scientific foundation for tobacco product regulation.16 This paper summarises a proposal, and the considerations that led to it, developed by a joint International Agency for Research on Cancer (IARC) and WHO working group, and approved by TobReg, which presents performance standards for cigarettes and a strategy to use them to mandate a reduction in the toxicant yields for cigarette smoke.


The most common measurements used historically to categorise cigarette smoke have been machine measured tar, nicotine and carbon monoxide (TNCO) yields per cigarette based on the US Federal Trade Commission (FTC)/International Standards Organization (ISO) testing regimen. There is a current scientific consensus that these per cigarette yields do not provide valid estimates of human exposure or of relative human exposure when smoking different brands of cigarettes.1 79 Communication of these measures to smokers as estimates of their exposure or risk creates harm by misleading smokers to believe that differences in exposures and risk are likely to occur with switching to cigarette brands with different machine-measured yields. This ongoing harm precludes continued acceptance of current regulatory strategies based on per cigarette machine measured TNCO levels and necessitates development of new regulatory approaches.

Machine smoking regimens other than the FTC/ISO regimen …

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  • The views expressed here are those of the authors only and do not represent any official position of the National Cancer Institute or the National Institutes of Health.

  • Funding: The funding for this work was provided by the World Heath Organization (WHO) and International Agency for Research on Cancer (IARC).

  • Competing interests: DB has testified in multiple court cases against the tobacco industry. The views expressed here are those of the authors only and do not represent any official position of the National Cancer Institute or National Institutes of Health.

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