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Little and filtered cigars meet the legal definition of cigarettes and should be included in nicotine reduction regulation
  1. M Justin Byron1,2,
  2. Andrew A Strasser3,
  3. Cristine D Delnevo4
  1. 1 Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  2. 2 Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  3. 3 Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  4. 4 Center for Tobacco Studies, Rutgers School of Public Health, Piscataway, New Jersey, USA
  1. Correspondence to Dr M Justin Byron, Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; jbyron{at}unc.edu

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The US Food and Drug Administration (FDA) has invested tens of millions of dollars in clinical trials examining the effectiveness of very low nicotine cigarettes for smoking cessation among smokers, including vulnerable populations, with promising results.1 Trials indicate that very low nicotine cigarettes reduce dependence and increase quit attempts in comparison with standard nicotine cigarettes.2–8 Subsequently, in 2017, the FDA announced a new, nicotine-centred framework for tobacco regulation that includes greatly reducing the nicotine in combustible cigarettes and encouraging innovation in safer forms of nicotine.9 Then, in 2018, the FDA released an advanced notice of proposed rulemaking on cigarette nicotine reduction.10 The aim is to reduce nicotine to minimally addictive or non-addictive levels in order to reduce smoking initiation and aid smoking cessation.11 The tobacco control community is cautiously optimistic that a nicotine reduction policy may be the big step needed to make substantial progress in reducing tobacco-caused death and disease in the USA.12–14 Other countries are considering similar measures.15 16

While the current proposal includes only cigarettes, the FDA acknowledges that ‘some number of addicted smokers could migrate to other similar combusted tobacco products to maintain their nicotine dose (or engage in dual use with other combusted tobacco products), potentially reducing the positive public health impact of such a rule’.10 Obvious tobacco products for cigarette substitution are little and filtered cigars. Often made on the same rolling machines as cigarettes, these cigars have features common to cigarettes, such as shape, size (length 70–100 mm), and cigarette-like tipping paper and filters, including ventilation in filters similar to ‘light’ cigarettes. The industry packaging and marketing of these products often mimic those of cigarettes (eg, packaged in the traditional 20-cigarette pack). A pack of little or filtered cigars costs roughly half of that of a pack of cigarettes, and little and filtered cigars are likely smoked by consumers as inexpensive substitutes for cigarettes.17 18 Recent data from the Population Assessment of Tobacco and Health survey reveal that filtered cigar smokers are especially likely to be dual cigarette smokers, and they endorse affordability as a primary reason for smoking filtered cigars.19

As a tobacco product class, little and filtered cigars have historically had a number of policy and regulatory advantages compared with cigarettes.18 In the context of these differences, the tobacco industry has exploited legislative and policy loopholes to market their products as cigarette substitutes. Indeed, in the 1970s, RJ Reynolds created little cigars, explicitly for cigarette smokers, to circumvent the broadcast ban for cigarette on television; in the early 2000s, filtered cigar companies explicitly marketed their products as cigarette substitutes and leveraged price differentials given the Master Settlement Agreement escrow payments and high taxes on cigarettes; then, to avoid cigarette tax parity after the national legislation in 2009, some little cigar companies added weight to their products and marketed them as filtered cigars; and a clove cigarette company circumvented the FDA ban on flavoured cigarettes by creating a filtered clove cigar.17 18 20 The tobacco industry has historically shown resourcefulness and skills in minimising the effects of regulations. Moreover, the little and filtered cigar industry has repeatedly shown that any loophole or exemption will be exploited. As such it is highly probable that in the context of a low nicotine standard for cigarettes, little and filtered cigar companies will leverage the opportunity to widely promote their more addictive and less regulated products.

We have previously outlined a detailed case for regulating little and filtered cigars as cigarettes.18 In brief, the US Federal Cigarette Labeling and Advertising Act includes in its definition of cigarette any roll of tobacco wrapped in any substance containing tobacco which because of its appearance, the type of tobacco used in the filler, or its packaging and labelling is likely to be offered to or purchased by consumers as a cigarette. The FDA has already applied this definition in taking action against four tobacco manufacturers for selling flavoured cigarettes labelled as cigars.21 At a minimum, we recommend that the FDA consider extending any low nicotine standard for cigarettes to little and filtered cigars given that these products meet the legal definition of cigarettes under the Tobacco Control Act. Doing so would also extend numerous other regulatory requirements (eg, flavour ban, minimum package size) to little and filtered cigars.22 The low price, minimal regulation and design mimicry of little and filtered cigars make them a ready substitute for cigarettes. To prevent them from undermining the public health benefits of a nicotine reduction policy, they should be included within it.

References

Footnotes

  • Contributors MJB and CDD conceived of this commentary and drafted the initial text, and all authors contributed to the research, writing and final editing.

  • Competing interests The authors have received grant funding from the National Cancer Institute and the Food and Drug Administration Center for Tobacco Products.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement This commentary does not involve data analysis.

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