1. Maciej Lukasz Goniewicz1,2,3,
  2. Jakub Knysak3,
  3. Michal Gawron3,
  4. Leon Kosmider3,4,
  5. Andrzej Sobczak3,4,
  6. Jolanta Kurek4,
  7. Adam Prokopowicz4,
  8. Magdalena Jablonska Czapla5,
  9. Czeslawa Rosik Dulewska5,
  10. Christopher Havel6,
  11. Peyton Jacob III6,
  12. Neal Benowitz6
  1. 1Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Cancer Institute, Buffalo, New York, USA
  2. 2Tobacco Dependence Research Unit, Queen Mary University of London, London, UK
  3. 3Department of General and Analytical Chemistry, Medical University of Silesia, Sosnowiec, Poland
  4. 4Department of Chemical Hazards, Institute of Occupational and Environmental Health, Sosnowiec, Poland
  5. 5Polish Academy of Science, Institute of Environmental Engineering, Zabrze, Poland
  6. 6Division of Clinical Pharmacology and Experimental Therapeutics, Departments of Medicine and Bioengineering & Therapeutic Sciences, University of California, San Francisco, California, USA
  1. Correspondence to Dr Maciej L Goniewicz, Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Cancer Institute, Elm & Carlton Streets / Carlton House A320, Buffalo, NY 14263, USA at
  • Received 24 October 2012
  • Accepted 31 January 2013
  • Published Online First 6 March 2013

Abstract

Significance Electronic cigarettes, also known as e cigarettes, are devices designed to imitate regular cigarettes and deliver nicotine via inhalation without combusting tobacco. They are purported to deliver nicotine without other toxicants and to be a safer alternative to regular cigarettes. However, little toxicity testing has been performed to evaluate the chemical nature of vapour generated from e cigarettes. The aim of this study was to screen e cigarette vapours for content of four groups of potentially toxic and carcinogenic compounds carbonyls, volatile organic compounds, nitrosamines and heavy metals.

Materials and methods Vapours were generated from 12 brands of e cigarettes and the reference product, the medicinal nicotine inhaler, in controlled conditions using a modified smoking machine. The selected toxic compounds were extracted from vapours into a solid or liquid phase and analysed with chromatographic and spectroscopy methods.

Results We found that the e cigarette vapours contained some toxic substances. The levels of the toxicants were 9 450 times lower than in cigarette smoke and were, in many cases, comparable with trace amounts found in the reference product.

Conclusions Our findings are consistent with the idea that substituting tobacco cigarettes with e cigarettes may substantially reduce exposure to selected tobacco specific toxicants. E cigarettes as a harm reduction strategy among smokers unwilling to quit, warrants further study. (To view this abstract in Polish and German, please see the supplementary files online.)

  • Electronic nicotine delivery devices
  • Toxicology
  • Carcinogens
  • Harm Reduction

“i always thought they were all pure tobacco”: american smokers’ perceptions of “natural” cigarettes and tobacco industry advertising strategies

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For nearly 100&#x02005 years, American cigarette companies have used the terms &#x0201c natural&#x0201d or &#x0201c nature&#x0201d to communicate various, mostly positive messages about cigarettes and smoking. Before the 1950s, these messages included normalising smoking or brand choice and describing the physiological effects of particular cigarettes. In the 1950s, use of the word natural by tobacco companies in print advertising began to shift focus, perhaps in reaction to questions about cigarette safety being raised by the media for the first time. Increasingly, advertisements using the term &#x0201c natural&#x0201d used it to emphasise aspects of product quality, such as &#x0201c natural&#x0201d taste or &#x0201c natural&#x0201d mildness, which could have reassured worried smokers. In much the same way that the mild taste of &#x0201c light&#x0201d cigarettes convinces some smokers that they are safer than regular cigarettes,121 a cigarette advertised as tasting both &#x0201c natural&#x0201d and &#x0201c mild&#x0201d could have been interpreted by smokers as less risky.

Given that alarms continued to sound about cigarettes’ health risks, it is perhaps unsurprising that cigarette advertisements continued to use &#x0201c natural&#x0201d primarily to describe aspects of taste and mildness in the 1960s. With the rise of consumer interest in natural foods in the 1970s, the use of &#x0201c natural&#x0201d in cigarette advertisements took on a narrower, ingredient&#x02010 specific meaning. The term &#x0201c natural&#x0201d in relation to cigarettes is now largely indicative of an absence of particular ingredients, or the presence of natural flavourings. But, for many smokers, this manner of using the term &#x0201c natural&#x0201d to describe cigarettes is not particularly meaningful. The tobacco industry&#x02010 sponsored market research that we reviewed indicates that American smokers place cigarettes in one of two categories inherently natural or inherently unnatural. Despite the fact that these categories are mutually exclusive, they each lead smokers to the conclusion that explicitly labelling cigarettes as &#x0201c natural&#x0201d is somewhat unnatural, being either superfluous or inaccurate. Given the limitations of the documents we reviewed, we do not know whether particular characteristics (ie, education, gender) lead smokers to choose one category over another. One might speculate that smokers who are most health concerned would be more likely to regard cigarettes as inherently unnatural, but this potential relationship was not explored by tobacco companies.

Despite this initial reaction, however, when smokers were informed of tobacco companies’ definition of &#x0201c natural&#x0201d cigarettes, they frequently concluded that &#x0201c natural&#x0201d cigarettes must be healthier or safer than cigarettes containing chemicals, regardless of how they initially categorised cigarettes. This conclusion runs counter to research demonstrating that additive&#x02010 free cigarettes are no less toxic than conventional cigarettes.122,123,124,125 This &#x0201c naturalness bias&#x0201d has been noted in relation to food, with Western consumers regarding natural foods (ie, those unaltered by added chemicals or genetic modification) as healthier.126,127,128,129 But, due to smokers’ lack of knowledge about cigarette ingredients, their naturalness bias did not arise spontaneously, as it typically does in relation to food.

The failure of &#x0201c natural&#x0201d to elicit an immediate positive reaction from smokers posed a problem for tobacco companies. It suggested that successfully marketing a natural cigarette depended upon educating smokers about cigarette ingredients, a step the tobacco industry had traditionally avoided. Any education process might ultimately backfire, by creating doubt about the act of smoking itself and undermining the implicit message of all cigarette advertising, that cigarettes and smoking are a normal, natural part of life. It might also generate ill will towards the tobacco industry for failing to educate earlier generations of smokers.

This background threat may help to explain why major American tobacco manufacturers have not embraced the marketing recommendation offered by smokers in focus groups using the &#x0201c scare tactic&#x0201d of highlighting the chemicals added to most cigarettes. RJR was the only major tobacco company to venture into this territory with one Winston advertisement. However, most of the chemicals named in the advertisement sounded like familiar foods, rather than the unfamiliar chemicals that are more likely to inspire concern and possibly lead smokers to question whether it was still worth it to smoke. The Winston advertisement aimed to create a manageable problem (cigarettes containing a few, mostly familiar additives), one that the reformulated Winston could easily solve, restoring &#x0201c faith and confidence in the smoking habit&#x0201d .130 RJR also hedged its bets through a series of advertisements in which &#x0201c the problem&#x0201d Winston solved had nothing to do with ingredients and everything to do with finding a cigarette to match one’s no&#x02010 nonsense personality in these advertisements, viewers might miss the &#x0201c no additives&#x0201d message entirely.

Tobacco control advocates could take the step that tobacco companies are unwilling to take, and, in an attempt to inspire quitting or deter initiation, educate smokers about the chemicals routinely added to or contained in cigarettes.9 Indeed, a recent Legacy truth advertisement ( ) takes precisely this approach. It uses a group of shirtless men to demonstrate visually the ease and speed with which a caustic chemical added to cigarettes, sodium hydroxide, removes the hair on their backs, and concludes by noting &#x0201c That can’t be good for you&#x0201d .

Although the market research we reviewed lends ample support to the idea that informing smokers of the chemical contents of most cigarettes results in shock and alarm, it also suggests that, for many smokers, this alarm can be allayed by a &#x0201c natural&#x0201d cigarette. Given that PM and RJR tied their introduction of additive&#x02010 free brands in the 1980s to an additives controversy generated by a third party, it is probable that successfully raising smokers’ awareness of chemicals in cigarettes will lead tobacco companies to introduce numerous additive&#x02010 free alternatives. Even if the major US tobacco companies are ultimately barred from describing these cigarettes as &#x0201c natural&#x0201d , the recent court ruling does not explicitly address the term &#x0201c additive&#x02010 free&#x0201d . &#x0201c Denaturalising&#x0201d cigarettes may, then, be of limited value as a cessation tool unless it is combined with a broader focus on denaturalising smoking.

Even without an additives controversy, as &#x0201c natural&#x0201d cigarettes are associated in some smokers’ minds with responsible corporate behaviour, tobacco companies may be inclined to introduce natural brands as part of their burgeoning corporate social responsibility efforts.131 Such efforts may involve expanding the current concept of natural cigarettes, with their emphasis on no additives, into &#x0201c green&#x0201d cigarettes&#x02014 organic (pesticide&#x02010 free), completely biodegradable, or manufactured using renewable energy. Indeed, SFNTC is already heading in this direction several years ago, it introduced organic versions of its Natural American Spirit cigarettes, and a recent advertisement refers to the company’s earth friendly growing practices and commitment to wind power and reforestation.132 As a corporate social responsibility project, a natural or green cigarette would not necessarily have to be popular among smokers to benefit its manufacturer it could simply provide tangible evidence of &#x0201c reasonableness&#x0201d and &#x0201c responsibility&#x0201d that would allow the company to resist regulation or establish good will with
lawmakers and the public.133