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Switching to cigarette brand variants with different filter ventilation levels: a descriptive analysis
  1. Dana Mowls Carroll1,2,
  2. Katelyn Tessier2,
  3. Xianghua Luo3,
  4. Irina S Stepanov1,2,
  5. Peter G Shields4,
  6. Richard O'Connor5,
  7. Vaughan W Rees6,
  8. Michael Cummings7,
  9. Warren Bickel8,
  10. Dorothy Hatsukami9
  1. 1 Division of Environmental Health Sciences, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
  2. 2 Masonic Cancer Center, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
  3. 3 Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota, USA
  4. 4 James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
  5. 5 Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York, USA
  6. 6 Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
  7. 7 Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
  8. 8 Department of Psychiatry, Virginia Tech Carilion Medical School, Roanoke, Virginia, USA
  9. 9 Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota, USA
  1. Correspondence to Dr Dana Mowls Carroll, University of Minnesota Twin Cities, Minneapolis, MN 55414, USA; dcarroll{at}


Background Regulation of filter ventilation (FV) has been proposed to reduce misperceptions that ventilation reduces the health risks of smoking. We describe smoking behaviour and exposure after switching to a cigarette brand variant (CBV) with a different FV level.

Methods Wave 1 (2013–2014) of the Population Assessment of Tobacco Use and Health Study was merged with FV levels of participants’ CBV and restricted to adults with a usual CBV, smoked daily and included in wave 4 (2016–2017; n=371). Generalised estimation equations method modelled changes in FV and cigarettes per day (CPD), quit interest, total nicotine equivalents (TNE) and total NNAL (biomarker of a tobacco-specific carcinogen). FV change was defined as a change in CBV resulting in a ≥20% increase or decrease in FV. Secondary analyses used FV change based on an increase from <5% to >10% or a decrease from >10% to <5%.

Results A non-significant pattern indicating an increase of 0.97 and 0.49 CPD was observed among those who switched to a CBV and increased FV by ≥20% and from <5% to >10%, respectively. A non-significant pattern indicating a decrease of 1.31 and 1.97 CPD was observed among those who decreased FV by ≥20% and from >10% to <5%, respectively. Changes in quit interest and biomarkers were also non-significant with one exception: greater reduction in TNE among those who decreased from >10% to <5% FV versus no change (−8.51 vs −0.25 nmol/mg creatinine; p=0.0447).

Conclusions Switching to CBV with lower FV does not appear to increase exposure and may even reduce exposure for some. Additional investigations are recommended to confirm these descriptive findings.

  • carcinogens
  • addiction
  • tobacco industry

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  • Contributors DMC, KT and DH led the study design. DMC drafted the manuscript and serves as the guarantor. DMC and KT conducted the statistical analysis. All authors provided critical revision of the manuscript for important intellectual content and approved the final version for publication.

  • Funding This work was supported by NCI of the NIH under award numbers P01 CA217806 (to DH and PGS) and R01 CA179246 (to ISS). Research reported in this article was also supported by NIMHD of the NIH under award number K01MD014795 (to DMC) and NIH grant P30 CA77598 using the Biostatistics and Bioinformatics Core shared resource of the Masonic Cancer Center, University of Minnesota and by the National Center for Advancing Translational Sciences of the National Institutes of Health award number UL1TR002494.

  • Competing interests RO’C reports personal fees and non-financial support from WHO and FDA outside the submitted work. MC, PGS and VWR each report payment as an expert witness on behalf of plaintiffs in litigation against cigarette companies outside the submitted work.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.