• Carcinogens
• Packaging and Labelling
• Harm Reduction
• Tobacco industry

In this issue of Tobacco Control, Agaku, Omaduvie, Fillipidis and Vardavas (see page e233) make an important contribution to the case for stronger tobacco product regulation. Using data from the 2012 Eurobarometer survey, the authors analyse the influences of cigarette design and marketing elements on European smokers’ current brand choices, initiation to smoking and beliefs in less harmful cigarettes. The study is timely, because the International Tobacco Control Community needs to reinvigorate the conversation about which directions we should take in advocating for new tobacco control measures. There are good reasons for taking much stronger action to regulate the contents and construction of cigarettes, as there are limits to what can be achieved with a continuing focus on the packaging and labelling of cigarettes, and public education as the twin means for countering smokers’ misperceptions.1–4 Regulation of contents and construction could provide important additional means for discouraging initiation and facilitating cessation. It would do so in two ways: first, by making cigarettes less palatable and second, by constraining the ability of the industry to produce cigarettes with characteristics that some smokers believe make them less harmful.

During the past decade, efforts to implement Articles 9 and 11 of the Framework Convention on Tobacco Control (FCTC) (respectively concerning regulation of the contents of tobacco products and regulation of the packaging and labelling of tobacco products) have focused strongly on those cigarettes formerly marketed as ‘low tar’, ‘light’ or ‘mild.’ Within most jurisdictions, implementation of Articles 9 and 11 has been confined to banning those product descriptors and the removal of on-pack tar, nicotine and carbon monoxide yield figures.1–4 However, the tobacco industry has mostly remained free to produce the same variety of cigarettes.1 The measures introduced within most jurisdictions have restricted how the tobacco industry may depict cigarettes in order to promote use but not restricted how it may engineer cigarettes to promote use. Further, the industry has been left with considerable freedom to use code words for ‘light’ and ‘mild’ (such as ‘smooth’ and ‘fine’), as well as the colour coding of packs in order to draw the attention of health-concerned smokers and experimenting adolescent smokers to weaker tasting, lower impact and less irritating cigarettes, which are characterised by high-efficiency filters and high levels of filter ventilation.1 ,2 For some smokers, such cigarettes may simply be more palatable; for others, they may provide compelling (albeit misleading) sensory evidence of reduced harm.3 ,4 However, so-called ‘light’ cigarettes are not the only ones significant numbers of smokers continue to believe are less harmful. As Agaku and colleagues demonstrate, diverse factors contribute significantly to belief in less harmful cigarettes including factors we might not readily anticipate, such as size and shape, and ‘organic’ and ‘natural’ labelling.

Some countries have already taken action on regulating the contents and construction of cigarettes. In Canada, a law which banned the use of flavour additives in cigarettes, little cigars and blunts came into force in July 2010. Brazil's National Health Surveillance Agency (Anvisa) also announced a ban on most additives in March 2012, giving cigarette manufacturers 18 months’ notice to comply. Other countries have been paving the way for future action. For instance, the USA Food and Drug Administration now has authority to regulate cigarettes and the Australian Government has produced a discussion paper for options on the regulation of additives and other contents and construction factors, such as filter ventilation, which are likely to affect the palatability of cigarettes.

The case is strengthening that filter ventilation should be a priority for action among possible regulatory measures and I will conclude by touching on it briefly. Filter ventilation is arguably the most important means for optimising the sensory characteristics of cigarettes to the preferences of target consumer groups and for producing cigarettes that many smokers will believe are less harmful, even without tar, nicotine and carbon monoxide yield labelling and ‘lights’ branding.3 It may even increase harm, at the same time as it creates a powerful illusion of reduced harm. The most recent Report of the US Surgeon General5 makes a strong case that cigarettes have become more harmful over the past three to four decades, at least within the USA and the UK. The report finds two plausible explanations, which may be complementary. The first possible explanation concerns the likely increased exposures to tobacco-specific nitrosamines in cigarette smoke since the 1970s. The second possible explanation concerns the effects of filter ventilation on smoke retention and smoke particle deposition within the respiratory tract, as well as its role in increasing smokers’ exposures to a broad range of harmful smoke constituents under actual smoking conditions. Accordingly, banning filter ventilation may not only reduce the consumer attractiveness of cigarettes, it may have the added benefit of making cigarettes at least marginally less harmful.