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Stop Smoking

   New approach to the problem of smoking?

Smoking is the principal avoidable cause of premature death in the UK. The government has assembled a number of strategies to help smokers quit and non-smokers not to start smoking, which it sets out on websites and in a range of publicity materials. But these measures have been, by any standards, a miserable failure.

Since 1990, the numbers of smokers in the UK have remained stubbornly high (1); some 12 million Britons still smoke, amounting to a quarter of the entire adult population. The quit rates for smoking cessation techniques are pitifully low, and smoking-related disease and death are still prevalent.

Could our political masters have done more to wean us off this pernicious weed? Have they been using the wrong strategies? Or perhaps they have not been trying hard enough.

It is hard, when presented with the economic case for smoking, not to feel that the government is in two minds about smoking cessation. Tobacco duty provides enormous sums of money to the exchequer, a significant proportion of which goes into funding the NHS. And from the Treasury’s point of view, the last thing they want is for large numbers of people to start living longer, and drawing pensions for longer.

Nonetheless, and in line with current EU policy, the UK government has started to make it progressively harder for smokers to smoke by extending no-smoking zones from offices, trains and planes to an increasing number of public places.

The truth is that it’s hard for smokers to give up their habit, and it has been hard too for the government and health authorities to admit that they have been hopelessly out-played by the tobacco industry.

Attempts to frighten consumers with ever more graphic on-pack warnings have worn off, and in some circles have perversely succeeded in glamourising the product.

Attempts to persuade the tobacco companies to switch to cigarettes with lower tar and nicotine have stimulated the development of sophisticated products specially designed to recruit children (Wayne & Connolly ’02) – the exact equivalent of the pernicious alco-pops which make it easier for young folk to learn to love alcohol.

‘Youth’ brands are routinely spiked with levulinic acid, an additive which not only makes smoke less irritating – so kiddies can inhale more easily – but also increases nicotine yield, so that the little ones get hooked more quickly (Keithly et al ’05). This is so scandalous that I believe it is worth quoting the conclusions of a key study here.

Industry research on the use and effects of levulinic acid: 
a case study in cigarette additives
Keithly L, Ferris Wayne G, Cullen DM, Connolly GN

Nicotine Tob Res. 2005 Oct;7(5):761-71. Massachusetts Department of Public Health Tobacco Control Program.

Public health officials and tobacco researchers have raised concerns about the possible contributions of additives to the toxicity of cigarettes. However, little attention has been given to the process whereby additives promote initiation and addiction.

Levulinic acid is a known cigarette additive. Review of internal tobacco industry documents indicates that levulinic acid was used to increase nicotine yields while enhancing perceptions of smoothness and mildness.

Levulinic acid reduces the pH of cigarette smoke and desensitizes the upper respiratory tract, increasing the potential for cigarette smoke to be inhaled deeper into the lungs. Levulinic acid also may enhance the binding of nicotine to neurons that ordinarily would be unresponsive to nicotine.

These findings held particular interest in the internal development of ultralight and so-called reduced-exposure cigarette prototypes. Industry studies found significantly increased peak plasma nicotine levels in smokers of ultralight cigarettes following addition of levulinic acid. Further, internal studies observed changes in mainstream and sidestream smoke composition that may present increased health risks.

The use of levulinic acid illustrates the need for regulatory authority over tobacco products as well as better understanding of the role of additives in cigarettes and other tobacco products.

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