“Light” Cigarettes Carry Heavy Risk

Taken from the July/August 2006 issue of the Women's Health Activist Newsletter.

Nicotine, of course, is highly addictive; I’ve had patients tell me it was harder to quit smoking than to quit heroin. In Gus Van Sant’s movie Drugstore Cowboy, a character who is addicted to prescription drugs says something like: “Most people don’t know how they’re going to feel in the next five minutes. A junkie has a pretty good idea just by looking at the label on a bottle.” Controlling sensation is a powerful temptation, and part of the reason that smoking is so addictive is that it can have either stimulant or sedative effects: different neurotransmitters are activated depending on how a smoker draws on a cigarette.

“Light” (or “low tar”) cigarettes, each containing 7-14 mg tar, were introduced in the late 1960s, at a time when regular cigarettes averaged 22 mg tar. “Ultralight” (or “very-low-tar”) cigarettes, containing less than 7 mg tar, soon followed.1 Nowadays, almost all (85%) of cigarettes sold in the U.S. have less than 14 mg tar.2 Sure, the filtered cigarettes available today are less carcinogenic than the unfiltered high-tar cigarettes of the 1960s, but there is no health distinction to be made between regular, light, and ultralight cigarettes today. Why?

“Lights” deliver less tar, nicotine, and carbon monoxide – but only when smoked by a machine. No kidding, the test method used by the Federal Trade Commission (FTC) uses a smoking robot. But, human smokers get just as much nicotine and carcinogens from “lights” as they do from regular cigarettes. It’s not a conscious act, but apparently smokers change their mode of smoking by taking deeper or more frequent drags, by covering the perforations meant to dilute smoke with air, and adapting in other ways.

Most people know that smoking is associated with cancers, cardiovascular disease, and (for those for whom appearance trumps health) wrinkles. But the public appears to believe that these risks – and the urgency to quit smoking -- can be reduced by switching to “light” cigarettes. In the most recent National Health Interview Survey, more than a third (37%) of 12,285 people who had ever smoked said “yes” to the question, “Did you ever use or switch to a lower tar and nicotine cigarette to reduce your health risk?” An analysis of these data by Hilary Tindle and colleagues, published in the American Journal of Public Health found that those who reported use of “light” cigarettes were half as likely to have quit smoking at the time of the survey than those who had only smoked regular cigarettes.2

We have to be cautious about drawing conclusions from these data because there may be differences between people who choose to smoke “light” cigarettes compared to those who choose to smoke regular cigarettes. Nevertheless, it seems likely, as the authors point out, that the former feel less urgency to stop smoking because they believe they’ve lessened their risks by switching to “lights”.

The belief that “lights” have fewer health risks is widespread among adults and starts early. 2 A survey of high school students found that many teens believe that “light” cigarettes are less addictive, cause fewer health risks, and would be easier to quit. Studies have shown that all of these beliefs are false.

It benefits tobacco companies that young people have misguided impressions about the health risks of “light” cigarettes, as this population is the primary market for their sales. Tobacco companies target young people because younger smokers have more time to be loyal addicts and consumers of the product. Tobacco companies have been prohibited from promoting smoking to minors since 1998, so marketing now focuses on college-age students. Bars and nightclubs are favored locations for promotional events where free cigarettes are distributed; some promotional events take place on college campuses as well.

The outreach seems to be working. A survey of more than 10,000 college students found that, among those who had not smoked regularly before age 19, being exposed to a promotional event doubled a student’s chance of being a current smoker, when compared to students who were not exposed to such events (27.3% vs. 11.8%).3 During the 1990s, smoking rates declined for most age groups, but rose for the 18--24 age group. By 2002, 28.5% of young U.S. adults aged 18--24 were smokers.4

The bottom line is that quitting definitely reduces smoking-related health risks, but switching to light cigarettes doesn’t reduce risk at all. Light cigarettes are just as addictive, and just as bad for health, as regular cigarettes. Quitting smoking is the single best thing smokers can do for their health. It’s a political act as well; tobacco companies have a long history of fostering addiction while minimizing the risks of tobacco. Let’s boycott their products!

Adriane Fugh-Berman, MD, is a former NWHN Board Chair whose research presents a critical analysis of the marketing of prescription drugs. Adriane educates prescribers on pharmaceutical marketing practices as Director of the PharmedOUT program, and created the Health in the Public Interest program at Georgetown University School of Medicine where she trains a new generation of consumer advocates.

Read more from Adriane Fugh-Berman.

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1Rigotti N.A, Tindle HA. “The fallacy of ‘light’ cigarettes.” BMJ USA 2004;4:E278-E279.
2Tindle M, Rigotti NA, Davis RB et al. “Cessation among smokers who used light cigarettes: results from the 2000 National Health Interview Survey.” Am J Public Health 2006;96(8):1498-1504.
3Rigotti NA, Moron SE, Wechsler H. “U.S. College Students exposure to tobacco promotions: prevalence and association with tobacco use.” Am J Public Health 2005;95(1): 138-144.
4Richter PA, Pederson LL, O’Hegarty MM. “Young adult smoker risk perceptions of traditional cigarettes and nontraditional tobacco products.” Am J Health Behav 2006;30(3):302-312.