All about SMOKING!

Ciggerette vacine

Cigarette engineering and nicotine addiction

Fact Sheet

What's in Your Cigarette?

Tips for Quitting Smoking 2

Tips for Quitting Smoking

NICOTINE ANONYMOUS

2005-05-23T06:21:00.000-07:00

ORLANDO, Fla., and SCHLIEREN, Switzerland, May 14 /PRNewswire/ -- Cytos
Biotechnology AG (SWX :CYTN) announced today that its vaccine candidate
CYT002-NicQb to treat nicotine addiction has achieved proof of efficacy. The
phase II clinical trial results were presented by Prof. Dr. Jacques Cornuz
(CHUV Lausanne), principal investigator, at the Annual Meeting of the American
Society of Clinical Oncology (ASCO) in Orlando, USA, on behalf of the three
Swiss study centres. The study included 341 smokers and assessed safety,
tolerability and efficacy of the vaccine candidate. Efficacy of the vaccine
was determined by continuous abstinence from smoking between week 8 and 24
after treatment start and was measured by self-reporting of the participating
smokers and by independent biochemical validation.
Two thirds of the smokers received the vaccine, whereas one third received
placebo. All smokers who received the vaccine mounted an anti-nicotine
antibody response, which corresponds to an immunological response rate of
100%. Based on the measured levels of antibodies, the vaccine-treated
smokers were grouped into a high, a medium, and a low responder group. All
smokers who received placebo had no measurable anti-nicotine antibodies in
their blood. The following table provides the continuous abstinence values of
the analysis of all smokers from whom complete antibody measurements were
available and who refrained from using nicotine replacement products
(NRT) (NRT use was considered a major protocol violation):

Continuous Abstinence

CYT002-NicQb high antibody response 57% (30 / 53)(1)
medium antibody response 32% (17 / 53)(1) 40% (64/159)
low antibody response 32% (17 / 53)(1)

Placebo no antibody response 31% (25 / 80)(1)

(1) (Number of continuously abstinent subjects/ total number of subjects
in group)

The above data show with a high statistical significance (p=0.014) a
strong relationship between the induced antibody levels against nicotine
(mechanism of action of the vaccine) and the desired clinical effect
(continuous abstinence from smoking); and this was irrespective of the
unexpected high placebo response observed. The difference of continuous
abstinence between the high responder group and the placebo group was highly
significant (p=0.004). Overall cigarette consumption in the high responder
group was less than half of that seen in the placebo group (p=0.004).
Moreover, the average cigarette consumption by those people who did not
achieve continuous abstinence was also lower in the high responder group than
in the placebo group (p=0.16). The vaccine was safe and generally well
tolerated with common side effects being local injection site reactions and
flu-like symptoms, which usually resolved within 24 hours.
Prof. Dr. Jacques Cornuz commented: "I am very excited about the outcome
of this study, as the data clearly suggest that antibodies against nicotine
are effective in helping people quit smoking. There is certainly no doubt that
new approaches such as vaccination are urgently needed. Despite the fact
that smoking causes 30% of all cancer deaths, including 87% of deaths from
lung cancer, there are 1.3 billion smokers worldwide. And each smoker looses
on average more than 10 years of lifetime as a result from this serious
addiction. I believe that the vaccine approach has the potential to
dramatically alter the way how we will treat smoking addiction in the future."
Dr. Wolfgang Renner, Chief Executive Officer of Cytos Biotechnology,
added: "We are extremely pleased about the results as the data in the high
responder group are better than anything we have seen so far. The clear
correlation between antibody levels and clinical effect greatly supports us in
the further development of this vaccine. It is now our goal to get everybody
into this high antibody response range; and to achieve this we have several
measures at hand: A) We will increase the dose of the vaccine, as we have
already done with other clinical candidates in different indications, B) we
can add more injections as even after the fourth injection there appeared to
be no antibody plateau, and C) we will certainly use these findings in our
ongoing formulation development. But most importantly, the data show elegantly
that we can use the body's own defence, the immune system,
to modulate even such complex conditions like addiction. This finding is
extremely important with respect to our pipeline of 27 vaccine candidates in
other major disease areas like high blood pressure, obesity or Alzheimer's
disease where we use the same basic Immunodrug(TM) principle."
More information about the phase II study, the vaccine candidate
CYT002-NicQb and general information about smoking and nicotine addiction can
be found on http://www.smokersvaccine.com.

About nicotine addiction
According to the World Health Organization, 1.3 billion people smoke. With
5 million tobacco-related deaths per year, tobacco use is the leading cause of
preventable death in the world today. Smoking harms nearly every organ of the
body and 30% of all cancer deaths, including 87% of deaths from
lung cancer, are attributable to smoking (American Cancer Society, 2005).
Nicotine, an alkaloid derived from tobacco leaves, has been shown to be the
principal addictive component of tobacco. Upon inhalation of cigarette smoke,
nicotine passes into the bloodstream and within seconds penetrates through the
blood-brain barrier, where it stimulates specific neurons in the brain.
Stimulation of these neurons leads to the release of messenger molecules,
which give rise to an almost immediate reward and a feeling of pleasure. This
sensory stimulus is critical to the addictive properties of nicotine and
causes a high relapse rate after quitting attempts. Although nearly 75% of
smokers in the U.S. report that they want to quit smoking, less than 5% of
those who try quitting are able to stay tobacco-free for 3 to 12 months
(Surgeon's General Report, USA, 2004).

About CYT002-NicQb
CYT002-NicQb is a therapeutic vaccine in development for the treatment of
nicotine addiction. Vaccination with CYT002-NicQb has been shown to induce
high levels of nicotine-specific antibodies that bind nicotine in the blood.
As the complex of nicotine attached to an antibody is too large to
pass the blood-brain-barrier, nicotine uptake into the brain and the
subsequent stimulation of nicotine-perceptive neurons in the brain is believed
to be significantly reduced or even prevented. In this way the addiction-
driving and satisfaction-inducing stimulus of nicotine is minimized.

About the phase II study
The study, the largest ever performed with a vaccine to treat nicotine
addiction, was a randomized, double blind, placebo-controlled, multicenter
phase II clinical trial to assess safety, tolerability and efficacy of the
vaccine candidate. It was carried out at the Kantonsspital St. Gallen, the
Centre Hospitalier Universitaire Vaudois (CHUV) Lausanne, and the Lung Center
Hirslanden Zurich, all in Switzerland. The study was conducted in 341 healthy
male and female smokers, aged 18-70 who have been smoking between 10 and 40
cigarettes per day for at least 3 years and who were motivated to
quit smoking. 5 injections of the vaccine or placebo were given at monthly
intervals at month 0, 1, 2, 3, and 4. All participants received smoking
cessation counselling by the study collaborators at each visit during three
months. One month after the first injection, the participants were asked to
make a serious attempt to quit smoking. Smoking behaviour was recorded by the
participants in personal diaries, and independent biochemical validation was
performed by measuring carbon monoxide in exhaled air (a by-product of
cigarette burn that remains in the blood for up to 24 hours).

About the analysis
Out of 341 smokers enrolled in the study, all participants were included
in the efficacy analysis from whom complete antibody measurements were
available and who refrained from using nicotine replacement therapy (NRT)
(n=239). NRT is believed to have a different effect on the two treatment
groups (CYT002-NicQb and placebo). Based on the proposed mechanism of action,
NRT products and the vaccine are expected to neutralize each other, whereas in
smokers on placebo NRT has a documented positive effect. An intent-to-treat
analysis of the entire study population has not achieved statistical
significance; therefore, the sub-group analysis based on antibody levels was
performed. In this analysis, NRT users were excluded, then, the vaccinated
smokers with complete antibody measurements were divided into three groups of
increasing antibody levels (low, medium, and high responder group), and
efficacy analysis was performed on each group. The placebo group was treated
identically: NRT users were excluded and all participants with complete
antibody measurements were included. Study participants were counted as
continuously abstinent only when at all visits between week 8 and 24 the
carbon monoxide concentration in their exhaled air was below 10 ppm and when
throughout the entire period between week 8 and 24 they declared
themselves as being non-smokers.

Media and Analyst Conferences for CYT002-NicQb phase II study results
Cytos Biotechnology will hold the following media and analyst conferences
related to the CYT002-NicQb phase II study results:

- 2 Media Conferences on Tuesday, May 17, 2005, 10.30am (CET) at Cytos
Biotechnology, Wagistrasse 25, CH-8952 Schlieren, and at the CHUV, Rue du
Bugnon 46, CH-1011 Lausanne, room "Andros" at level 8, room No 1205.
At Cytos Biotechnology in Schlieren: Dr. Wolfgang Renner, CEO, and Dr.
Philipp Muller, Executive Vice President Clinical Development of Cytos
Biotechnology, and the study investigators Dr. Felix Jungi and Dr. Karl
Klingler will be available for interviews. The presentation will be in German
(or on demand in English).
At the CHUV in Lausanne: Jakob Schlapbach, CFO of Cytos Biotechnology, and
Prof. Dr. Jacques Cornuz, principal investigator of the study will be
available for interviews. The presentation will be in French.
- Conference for analysts and investors on Tuesday, May 17, 2005, 2pm
(CET) at Cytos Biotechnology, Wagistrasse 25, CH-8952 Schlieren.
Dr. Wolfgang Renner, CEO, and Dr. Philipp Muller, Executive Vice President
Clinical Development of Cytos Biotechnology, and the study investigators Dr.
Felix Jungi and Dr. Karl Klingler will be available for interviews. The
presentation will be in English and will also be accessible by live
webcast via the internet site http://www.cytos.com.

About Cytos Biotechnology AG
Cytos Biotechnology AG is a public Swiss biotechnology company that
specializes in the discovery, development and commercialization of a new class
of biopharmaceutical products - the Immunodrugs(TM). Immunodrugs(TM) are
intended for use in the treatment and prevention of common chronic diseases,
which afflict millions of people worldwide. Immunodrugs(TM) are designed to
instruct the patient's immune system to produce desired therapeutic
antibody or cytotoxic T-cell responses that modulate chronic disease
processes. Taking advantage of the high flexibility of its Immunodrug(TM)
platform, Cytos Biotechnology has built a pipeline of 27 different
Immunodrug(TM) candidates in various disease areas, of which six are currently
in clinical development. The Immunodrug(TM) candidates are developed both
in-house (24) and together with Novartis (1) and Pfizer Animal Health (2).
Founded in 1995 as a spin-off from the Swiss Federal Institute of Technology
(ETH) in Zurich, the company is located in Schlieren (Zurich). Currently, the
company has 110 employees. Cytos Biotechnology AG has been listed
on the SWX Swiss Exchange (SWX:CYTN) since October 2002.

This foregoing press release may contain forward-looking statements that
include words or phrases such as "believe," "has the potential," "it is the
goal," "will," "can," "is believed," designed to," "intend," or other similar
expressions. These forward-looking statements are subject to a variety of
significant uncertainties, including scientific, business, economic
and financial factors, and therefore actual results may differ significantly
from those presented. There can be no assurance that any other therapeutic
entities will enter clinical trials, that clinical trial results will be
predictive for future results, that therapeutic entities will be the subject
of filings for regulatory approval, that any drug candidates will receive
marketing approval from the U.S. Food and Drug Administration or equivalent
regulatory authorities, or that drugs will be marketed successfully. Against
the background of these uncertainties readers should not rely on forward-
looking statements. The company assumes no responsibility to update forward-
looking statements or adapt them to future events or developments. This
document does not constitute an offer or invitation to subscribe or purchase
any securities of Cytos Biotechnology AG.

2005-05-23T06:11:00.000-07:00

Additives in tobacco products

ASH/ Product regulation/ Tobacco additives

Tobacco additives

Cigarette engineering and nicotine
addiction

Clive Bates

Action on Smoking and Health

London

Dr. Martin Jarvis

Imperial Cancer Research Fund

London

Dr. Gregory Connolly

Massachusetts Tobacco Control Program

Boston

14 July 1999

Summary

Introduction. In the European Union over 600 additives may be used in the
manufacture of tobacco products under an extremely loose and de-centralised regulatory
framework. Although tobacco additives are generally screened for their direct toxicity,
there is virtually no assessment of the impact additives have on smoking behaviour or
other undesirable external consequences. If a small quantity of a relatively benign
substance added to a tobacco product can make the product more addictive, make it easier
to start smoking or facilitate continued smoking then it may be causing great harm by
'leveraging' additional smoking. The additional smoking brings increased exposure to over
4,000 chemicals, including many that are highly toxic and carcinogenic. Given that over
500,000 people die prematurely in the European Union each year as a result of
smoking-related disease, even a one per cent change in smoking attributable to the use of
additives would have large absolute health consequences - tens of thousands of lives
annually. For this reason, tobacco additives should be seen as major public health issue
in their own right.

Evidence. This report draws on evidence from tobacco industry internal documents
released during recent litigation in the United States and held on the Internet or in
British American Tobacco's document depository in Guildford, UK. The views of the UK
Government's scientific advisory committees since 1971 are also discussed - showing that
the issue has been recognised and debated for more than twenty years.

Which brands use which additives? Though 600 additives are authorised for use in
tobacco products, only the tobacco manufacturers can say which additives are used and in
which brands. Not even the Government or the European Commission, which are responsible
for the regulation of tobacco products have this information or the power to demand it.

Findings. Most additives are not necessary and few were used before 1970. The
purpose of this report is to raise concerns about the impact of additives on smoking
behaviour. The findings suggest that there is a case to answer and that there is need for
increased regulatory scrutiny. There is cause for concern in the following areas.

Additives are used to make cigarettes that provide high levels of 'free' nicotine which
increases the addictive 'kick' of the nicotine. Ammonium compounds can fulfil this role by
raising the alkalinity of smoke

Additives are used to enhance the taste of tobacco smoke, to make the product more
desirable to consumers. Although seemingly innocuous the addition of flavourings making
the cigarette 'attractive' and 'palatable' is in itself cause for concern.

Sweeteners and chocolate may help to make cigarettes more palatable to children and
first time users; eugenol and menthol numb the throat so the smoker cannot feel the
smoke's aggravating effects.

Additives such as cocoa may be used to dilate the airways allowing the smoke an easier
and deeper passage into the lungs exposing the body to more nicotine and higher levels of
tar.

Some additives are toxic or addictive in their own right or in combination. When
additives are burned, new products of combustion are formed and these may be toxic or
pharmacologically active.

Additives are used to mask the smell and visibility of side-stream smoke, making it
harder for people to protect themselves and undermining claims that smoking is anti-social
without at the same time reducing the health risks of passive smoking.

Regulation. The existing regulatory framework is based on the assumption that
additives are useful to facilitate consumer acceptance of lower tar yield cigarettes. By
facilitating the switch to lower tar products, it was hoped that tobacco additives would
lead to 'health gains'. No data is available to show that additives are in fact used
only or predominantly in lower yielding brands. However, there is now good evidence that
questions the value of low tar cigarettes. Low tar cigarettes have generally used
perforated filters to dilute the smoke with air. Smokers learn to block the holes, often
subconsciously, thus adjusting the dilution of nicotine in the smoke. The smoker may also
compensate by smoking more intensely. With the primary rationale for a relaxed regime
discredited, it is necessary to adopt a new approach.

New regulatory framework needed. A new regulatory framework is required in which
the manufacturer is obliged to demonstrate that no additional harm arises from tobacco
product design decisions such as the use of an additive. This should include the impact of
additives on smoking behaviour, passive smoking and fire risks. While it is impossible to
make safe cigarettes, it is perfectly reasonable to prevent the manufacturers doing things
that lead to an increase in the harm caused by tobacco. Such a framework may have
the following elements:

Disclosure. As a first step, manufacturers should be required to disclose all
additives used in tobacco products, by brand, to a regulator - in the UK this is the
Department of Health. This approach has already been adopted in Massachusetts and British
Columbia.

Public information. Such information should not be confidential, but made available
to the public through publications, the Internet or on request from the regulator.

Packaging. There may be some additives that should be listed as ingredients on
tobacco product packaging. This is a separate decision to a requirement for disclosure and
making the information public in other ways -- the right approach will depend on
assessment of the direct value of such information to consumers.

Disclosure of purpose. Tobacco companies should be required to disclose the purpose
of an additive and any secondary consequences -- whether intentional or unintended.

Conduct and disclosure of research. Tobacco companies should be required to
undertake extensive toxicology and pharmacological testing of all additives

Regulatory challenges. Regulators should have the power to challenge any of the
existing 600 additives currently allowed and to have them removed until the manufacturer
is able show that no extra harm to the public arises as a direct or indirect result of the
additive. If it is impossible to supply evidence, for example because of restrictions on
animal testing, then under a precautionary approach the additive should be banned.

Focus on pharmacologically active additives. There should be an automatic challenge to any
additive thought to have a direct or indirect pharmacological influence. New additives
should be permitted only if the manufacturer can show that no extra harm or other net
negative consequences arise from use of the additive.

Permit essential additives. Any regulatory framework should permit additives
necessary for the manufacture and storage of tobacco products providing these are safe,
but should challenge all additives that may influence smoking behaviour.

Contents

1    Introduction: tobacco products and
additives

2    Scientific advisory committee reports on
tobacco additives

2.1    First Report of the ISCSH (1975)

2.2    Second Report of the ISCSH (1979)

2.3    Third (1983) and Fourth (1988) Report of
ISCSH

2.4    SCOTH (1998)

2.5    The 1997 UK Voluntary Agreement

3 Enhancing impact -- additives with a pharmacological effect

3.1    Free basing nicotine

3.2    Ammonia Technology and The Marlboro Story

3.3    Concealing the nicotine by increasing the
vapour phase

3.4    Other additives that may enhance the effect
of nicotine

3.4.1    Acetaldehyde

3.4.2    Levulinic acid

3.4.3    Cocoa and theobromine

3.4.4    Glycyrrhizin

3.4.5    Pyridine

4 Masking the taste and immediate effects of tobacco

4.1 Additives and 'low tar' cigarettes.

4.2 Front end 'lift'

5    Additive Toxicity

6    Changing the Perception of side-stream
smoke

7    Notes

1. Introduction:
tobacco products and additives

Cigarettes as nicotine delivery systems	To understand the role of additives, it is important first to have a grasp of how cigarettes work. The long-term success of the tobacco industry is the direct result of the addictive nature of nicotine and tobacco use. As those in the industry were first to recognise, the cigarette - marketed as a lifestyle accessory - is in fact a delivery device for an addictive drug. There are many tobacco industry documents that show tobacco products acting in this role, essentially as sophisticated, highly engineered nicotine delivery systems. For a more detailed survey see ASH's report Tobacco Explained (Chapter Two).¹ Two examples are given below:
Philip Morris explains...	"The cigarette should be conceived not as a product but as a package. The product is nicotine. Think of the cigarette pack as a storage container for a day's supply of nicotine.... Think of the cigarette as the dispenser for a dose unit of nicotine..... Smoke is beyond question the most optimised vehicle of nicotine and the cigarette the most optimised dispenser of smoke."² (Philip Morris 1972)
RJR recognises it is in the drug business	"In a sense, the tobacco industry may be thought of as being a specialised, highly ritualised, and stylised segment of the pharmaceutical industry."³ (RJR 1972)
Impact of additives on smoking behaviour	Additive technology is a major tool used by the tobacco industry in the production of this nicotine 'package'. While some cigarettes have been marketed as additive free, according to the verbal testimony of JL Pauly of the Santa Fe Natural Tobacco Co., the modern U.S cigarette contains about 10 percent additives by weight, mostly in the form of sugars, flavourings, and humectants⁴. But there are others - present in smaller quantities -- which may have a more profound influence on the product. Evidence suggests that additives are actually used by manufacturers to influence the pharmacological effects of nicotine, make individual brands taste more appealing to young and 'aspirational' smokers and mask the taste and immediate discomfort of smoke.
How nicotine addiction works -- additives play a subtle role	At the simplest level, a cigarette delivers a dose of the main active ingredient, nicotine, into the smokers' lungs in a mixture of smoke particles and gases. The nicotine is rapidly absorbed into the blood through the large surface of the lungs (and mouth and throat) and reaches the brain within ten seconds. Receptors in the brain respond to nicotine stimulation by producing chemicals (dopamines and other neurotransmitters) that give the user what is variously described as a 'hit', 'kick' or 'impact' - the drug effect of nicotine. Over time the receptors become conditioned to expect nicotine (tolerance), and when deprived, the smoker experiences nicotine withdrawal - a very unpleasant sensation for many. This pharmacological impact and withdrawal, enhanced by psychological and social factors related to smoking, create dependency on tobacco products. Nicotine is the main reason why tobacco products are addictive. As this report shows there are a number of subtle ways in which the delivery of nicotine to the brain's receptors can be influenced by additives.
Harm caused by smoking	The smoke particles and gases in which the nicotine is transported contain thousand of chemicals, many of which are toxic or carcinogenic. Though nicotine itself is the reason people smoke, the other chemicals do the bulk of the damage to health. The other chemicals are often collectively referred to as 'tar' and provide flavour and other taste sensations. This tar and the gases produced by combustion such as carbon monoxide, cause cancer, heart disease and respiratory illnesses as well as many other conditions. Regulators aimed to reduce tar exposure by insisting that tar yields should be decreased.
Low tar cigarettes in theory	The rise of additives in tobacco products is intimately linked with the strategy to reduce tar yields. The amount of tar and nicotine in smoke is measured by a standard smoking machine in which the cigarette is smoked with a fixed puff volume and frequency with tar and nicotine residues collected on a filter and weighed. Governments have insisted on reducing tar levels as measured by this approach, hoping that this would reduce tar exposure to smokers -- and therefore lead to reduced harm.
Low tar cigarettes in practice	In practice, low tar cigarettes have been produced by the addition of filters and most importantly, by the use of filter ventilation (Kozlowski et al, 1998).⁵ Holes in the filter allow air to be drawn in to dilute the smoke and this reduces the amount of tar and nicotine residues collected by the machine. In the lowest tar cigarettes 80% of the 'smoke' is air drawn in through ventilation holes. Ventilation also means that the smoke might taste 'weaker' because the agents that give rise to flavour are diluted with air. However, smokers do not smoke like machines. Faced with diluted smoke, smokers will tend to 'compensate' by smoking the lower-tar cigarette more intensively, in order to obtain a satisfactory dose of nicotine. Compensation may take the form of deeper or more frequent puffs, or blocking of ventilation holes -- often sub-consciously. The result is that smokers of low-tar cigarettes do not consume less nicotine (Benowitz et al, 1983,⁶ Bates and Jarvis, 1999⁷). A survey of tobacco company documents by ASH and Imperial Cancer Research Fund ( HREF="./big-one.html">Low Tar: why low tar cigarettes don't work and how the tobacco industry fools the smoking public⁸) gives greater detail on why low tar cigarettes do not work and what the tobacco companies knew privately and said publicly.
Low tar cigarettes and additives	One of the prime justifications for the addition of artificial flavourings is to replace the lost flavour of the diluted smoke. This has in theory been done to facilitate the switch to low-tar. However, any hoped-for health benefits from low-tar cigarettes have largely failed to materialise. At the same time an extremely lax regulatory regime for additives has emerged. Although smokers of lower tar cigarettes may be consuming as much tar and nicotine in total, they will be consuming greater volumes of diluted smoke to do it. This is perhaps analogous to drinking watered down wine - it is possible to become intoxicated, but drinkers will have to consume more and the flavour will be weaker.

2. Scientific advisory committee reports on tobacco additives

Scientific
advice to government

The Government takes
advice on smoking and health from a long-running scientific standing committee. Guidelines
for the monitoring of tobacco additives were initially published in the First Report of
the Independent Scientific Committee on Smoking and Health (ISCSH) in 1975.⁹ The
ISCSH was established in 1973, primarily to prepare guidelines for the testing of tobacco
substitutes which were being developed at the time. This section gives an overview of the
conclusions regarding tobacco additives.

Arrangements
before 1970

Prior to 1970, the
use of additives in tobacco products was prohibited without special permission from the
Commissioners of Customs and Excise, under Section 176 of the Customs and Excise Act,
1952. This permission was given only within very strict limits and mainly in respect of
flavourings in tobacco products other than cigarettes. The prohibition extended to the
importation of tobacco products containing additives as well as a ban on the production of
cigarettes with additives for export.

2.1 First Report of
the ISCSH (1975)

The Finance Act of 1970 changed
the rules and allowed for tobacco duty to be charged on additives and tobacco substitutes,
thus paving the way for the restrictions on additives to be removed. Statutory control
over the materials used in the manufacture of cigarettes finally ceased with a revision of
the tax system in 1978. The First Report of the ISCSH stated that the Committee was
concerned that these changes in the law should not increase the health hazards of smoking
and concluded that:

"Other
means have to be found to guard against the possible risk to health."

The "other means" resulted in a
voluntary agreement between the tobacco manufacturers and the Government whereby the
companies would supply details of proposed additives. Only those approved by the ISCSH
would be permitted. Guidelines for the testing and use of tobacco products containing
additives were included an appendix to the First Report of the ISCSH, published in 1975.
In the Second Report, the guidelines were amended to include the general requirement for
an acute inhalation toxicity study and data on transference to smoke for any new additive.

2.2 Second Report
of the ISCSH (1979)

The Second Report of the ISCSH
expresses concern that no additional "dependence-inducing" compounds should be
incorporated into tobacco. Paragraph 13 states: size="2">

"The concept of adding flavouring ingredients to cigarettes might not
lessen the incentives to smoke and could indeed have the opposite effect."¹⁰

The tobacco industry argues that one of
the key purposes of additives is to make lower tar cigarettes more palatable. The ISCSH
accepts this and notes:

"Some smokers find existing
low and low to middle tar brands unsatisfying, but if those who smoked middle or middle to
high tar cigarettes could switch to low tar brands whose acceptability was improved by
additives, the dangers of smoking could be reduced. The Committee recognises the potential
value of using flavouring additives in this way."¹¹

The Second Report of the ISCSH expresses
satisfaction with the use of other additives not covered by the guidelines. These include
additives in filters, cigarette papers, filter wrappers, tips and overwrappers. Thus, such
additives could be used without reference to the Committee. Between 1979 and 1983, the
Committee revised the guidelines to include an assessment of "all substances added to
those parts of tobacco products intended to be burnt". Thus any substances added to
cigarette papers were included in the revised guidelines as appended to the Third Report.

2.3 Third (1983)
and Fourth (1988) Report of ISCSH

The Third Report of the ISCSH concluded that
the system of providing information on additives had been working well and recommended
that the system should continue.¹² The Fourth Report, published in 1988, made a
similar recommendation for the continuation of the voluntary system.¹³

2.4 SCOTH (1998)

Official acceptance
of the tobacco industry's arguments regarding the need for additives appears to have
continued until the publication of the report of the Scientific Committee on Tobacco and
Health (SCOTH) in 1998. SCOTH states:

"One
of the effects [of additives] has been the maintenance of "taste" as tar yields
have fallen with an ensuing reduction in natural flavour. The negative side of this has
been the maintenance of the appeal of a product, which might otherwise have been rendered
unacceptable through the adulteration of intrinsic flavour."¹⁴

SCOTH, which replaced the ISCSH,
reviewed the tobacco additive guidelines and made recommendations for their revision in
the light of scientific and technical advances. While the Committee expressed the clear
reservation about the possibility that additives may prolong use of cigarettes by making
them more palatable, SCOTH only recommends that the use of additives in tobacco products
be closely monitored. Specifically, it recommends that the Technical Advisory Group, which
reports to SCOTH, should regularly review the changing patterns and types of additives
used.

At no stage in the 25
year period has the Department of Health or its advisory committees been provided with
information regarding which additives have been used in which tobacco product brands. There
has therefore, never been evidence of whether the approved additives have actually been
used in low-yield brands, or more widely. There has also been no validation of the
anticipated health benefits that the liberal regulatory regime for additives was supposed
to offer.

2.5 The 1997 UK Voluntary Agreement

Existing additives escape detailed scrutiny	The 1997 Voluntary Agreement requires tobacco manufacturers to provide toxicological and other data for any new additives manufacturers wish to add to the approved list, but such information is not required for the 600 existing approved additives.
Limited scope of evaluation	Furthermore, even for new additives there is no requirement for companies to state the purpose of the additives, merely that it is "desirable that the purpose of use should be detailed". While it is possible that some additives may be harmless or even beneficial, under the present voluntary agreement system there is no way of ascertaining the relative advantages and disadvantages of these substances. No broad criteria for acceptance or rejection are stated in the agreement. The criteria applied are only "the results of toxicity testing are unsatisfactory; or acceptability cannot be judged on the basis of the information provided." The impact on smoking behaviour is not assessed.
European loophole	The final and fatal weakness of the Voluntary Agreement is that it can be side-stepped in its entirety. Directive 83/189/EEC requires the Department of Health to 'raise no objection' to the use of an additive permitted in any other EU member state provided that certain specified information is provided.
Conclusion	The regime established in the 1997 UK Voluntary Agreement is not retrospective, too narrowly focussed, can be avoided entirely. It therefore offers minimal safeguards and may be lending spurious legitimacy to practices that cause harm to health.

3. Enhancing impact -- additives with
a pharmacological effect

"The main technical challenge was to decrease the yield of tar in a cigarette
while maintaining a level of nicotine acceptable to the smoker."¹⁵

(Farone, W.A. 1996 former Philip Morris scientist.)

3.1 Free basing
nicotine

Free-basing nicotine	At least as far as its rivals are concerned, the success of Philip Morris's Marlboro brand stems from greater 'free' nicotine resulting from higher alkalinity (pH) induced by the addition of ammonia technology (see section 3.2). Ammonia can speed the delivery of 'free' or unbound nicotine to smokers by raising the pH (alkalinity) of tobacco smoke using additives. This causes the smoker to 'freebase' the drug -- much as a crack-user takes cocaine. Dr. Jack E Henningfield of the John Hopkins University School of Medicine explains the action of ammonia thus: "A third thing that ammonia-like compounds can do is increase the pH, increase the amount of free base nicotine, or what Dr Rickert earlier referred to as unprotonated nicotine.... The free-based form of cocaine or the free based form of nicotine is more rapidly absorbed, has a more explosive effect on the nervous system. Ammonia is one of the ways that you can provide free-based cocaine or free-based nicotine." (1997)¹⁶
Nicotine in different forms	Many documents explain the tobacco companies' recognition that nicotine is available in different forms. face="Times New Roman, Times" size="2"> "Nicotine may be presented to the smoker in at least three forms: (I) salt form in the particulate phase, (ii) free base form in the particulate phase, (iii) free base form in the vapour phase. It has long been believed that nicotine presented as in (ii)/(iii) is considerably more 'active'."(BAT 1984)¹⁷
	"Nicotine is in the smoke in two forms as free nicotine base (think of ammonia) and as a nicotine salt (think of ammonium chloride) and it is almost certain that the free nicotine base is absorbed faster into the blood-stream."(BAT 1964)¹⁸
More free nicotine means higher 'impact'	Once the relationship between pH, free nicotine and nicotine 'impact' was established, it became a research objective. "The purpose of this project is to develop a method for increasing the smoke pH of a cigarette. A low smoke solids, low nicotine cigarette with an increased smoke pH would then have relatively more free nicotine in its smoke, and consequently, a higher nicotine impact." (Liggett 1974)¹⁹
Changing the chemical form of nicotine increases the 'kick'	In a paper entitled, 'Cigarette concept to assure RJR a larger segment of the youth market' RJR talk about the 'kick' of nicotine:"Still with an old style filter, any desired additional nicotine 'kick' could be easily obtained through pH regulation."²⁰ (RJR 1973) The pH also relates to the immediacy of the nicotine impact. As the pH increases, the nicotine changes its chemical form so that it is more rapidly absorbed by the body and more quickly gives a 'kick' to the smoker."²¹ (RJR 1976) "When a cigarette is smoked, nicotine is released momentarily in the free-form. In this form, nicotine is more readily absorbed through the body tissue. Hence it is the free nicotine which is associated with IMPACT, i.e. The higher the free nicotine, the higher the IMPACT." (BAT 1988)²²
Making nicotine more potent	"Increasing the pH of a medium in which nicotine is delivered increases the physiological effect of the nicotine by increasing the ratio of free base to acid salt form, the free base form being more readily transported across physiological membranes. We are pursuing this project with the eventual goal of lowering the total nicotine present in smoke while increasing the physiological effect of the nicotine which is present, so that no physiological effect is lost on nicotine reduction."²³(Liggett 1971)
Free nicotine fraction increases 'physiological strength'	"Since the unbound nicotine is very much more active physiologically and much faster acting than the bound nicotine, the smoke at a high pH seems to be strong nicotine. Therefore, the amount of free nicotine in the smoke may be used for at least a partial measure of the physiological strength of the cigarette."²⁴(RJR 1973)
Nicotine transfer increased as a result of ammonia treatment	According to BAT, the addition of ammonia was a technical option to enhance nicotine transfer: face="Times New Roman, Times" size="2"> "The results show that ammonia treatment caused a general increase in the delivery of bases including a 29% increase in nicotine. This result, despite the decrease in nicotine content and a 10% drop in the weight of tobacco burnt in puffing, is only partly due to a small decrease in nicotine filtration. In other words, the nicotine transfer has increased as a result of ammonia treatment..."²⁵ (BAT 1965)
'Judicious' use of additives to increase the free base nicotine	The US tobacco company Lorillard accepts that additives can change the qualitative delivery of nicotine: face="Times New Roman, Times" size="2"> "It should be obvious that if the preceding goals of high physiological impact are to be realised, flavour profiles and their effect on physiological impact must be understood, even though measures of such perceived quantities are highly subjective... Hence judicious use of additives may increase the pH of the delivered smoke, thereby the apparent free base nicotine." (Lorillard, 1976)²⁶
Additives to increase nicotine 'kick'	Ammonia can be used to increase the alkalinity of smoke and increase the amount of nicotine in the 'free' form rather than in the 'bound' form of nicotine salts. R J R explains: face="Times New Roman, Times" size="2"> "In essence, a cigarette is a system for delivery of nicotine to the smoker in attractive, useful form. At "normal' smoke pH, at or below about 6.0, essentially all of the smoke nicotine is chemically combined with acidic substance hence is non-volatile and relatively slowly absorbed by the smoker. As the smoke pH increases above about 6.0, an increasing proportion of the total smoke nicotine occurs in 'free' form, which is volatile, rapidly absorbed by the smoker, and believed to be instantly perceived as nicotine 'kick'."²⁷ (RJR 1973)

3.2 Ammonia
Technology and The Marlboro Story

The Rise of Marlboro - the world's best selling cigarette	The myth is that Marlboro man made the Marlboro cigarette: The square jawed icon of American individualism lassoed a gullible public and herded them into the Marlboro corral. On the face of it Marlboro's success appears to be a tribute to the power of advertising and iconography. However, the chemical history of the brand sheds interesting light on the subject. In the early sixties Philip Morris was the smallest of America's six leading cigarette companies and RJR's brand Winston had annual sales nearly three times the size of Marlboro's. By 1978 there had been a seismic shift, Marlboro was the world's best selling cigarette accounting for one in five of all cigarettes sold and over fifty percent of smokers aged 17 and below.²⁸
The search begins for the 'soul of Marlboro'	Not surprisingly this dramatic growth in Marlboro cigarettes instigated frenzied research by other tobacco manufacturers. Through analysis and reverse engineering of Marlboro cigarettes, industry competitors came to the conclusion that 'ammonia technology' was essentially the 'soul' of Marlboro. "Philip Morris began using an ammoniated sheet material in 1965 and increased use of the sheet periodically from 1965 to 1974. This time period corresponds to the dramatic sales increase Philip Morris made from 1965 to 1974."²⁹(RJR)
Ammonia technology is the key to Marlboro	"What product technology, then, makes Marlboro a Marlboro? Looking at all of the technology employed in Marlboro on a world-wide basis, ammonia technology remains the key factor."³⁰ (B&W 1992)
Brands that are selling well have high levels of free nicotine	The higher pH of Marlboro cigarettes helped to maintain the same level of free nicotine as high-tar cigarettes despite a two third reduction in overall tar and nicotine - and helped develop a 'US standard taste', enhancing the iconography associated with the quintessentially American 'Marlboro Man'. "If our data, correlations and conclusions are valid, then what has emerged is a rather new type of cigarette, represented by Marlboro and Kool, with high nicotine 'kick', burley flavour, mildness to the mouth, and increased sensation to the throat, all largely the result of higher smoke pH. There is evidence that other brands, which are selling well also, have some of these attributes, particularly increased 'free' nicotine impact.³¹ (RJR, 1973)

Marlboro's growth follows introduction of ammonia technology	The graph shows how Marlboro's steady rise in sales follows increases in cigarette pH -- which also has led to an increase in free nicotine content. RJR, 1973³²
Brown and Williamson seeks to catch up	"It appears that we have sufficient expertise available to 'build' a lowered mg tar cigarette which will deliver as much 'free nicotine' as a Marlboro, Winston or Kent without increasing the total nicotine delivery above that of a 'light' product. There are products already being marketed which deliver high percentage 'free nicotine' levels in smoke, i.e. Merit, Now."³³ (B&W 1980)
	"It would appear that the increased smoker response is associated with nicotine reaching the brain more quickly... On this basis, it appears reasonable to assume that the increased response of a smoker to the smoke with a higher amount of extractable nicotine (not synonymous with but similar to free base nicotine) may be either because this nicotine reaches the brain in a different chemical form or because it reaches the brain more quickly."³⁴ (BAT 1966)
align="right">High smoke pH linked to high sales	Competitors understood the link between Marlboro's sales and its alkalinity. face="Times New Roman, Times" size="2"> "The smoke pH for Kool and Marlboro are 7.12 and 6.98 respectively confirming the relationship between high smoke pH and cigarette sales increase."³⁵ (Lorillard 1973) "As a result of its higher smoke pH, the current Marlboro, despite a two thirds reduction in smoke 'tar' and nicotine over the years, calculates to have essentially the same amount of 'free' nicotine in its smoke as did the early Winston."³⁶ (RJR 1973) "Our data show that smoke from our brands, and all other significant competitive brands, in recent years has been consistently and significantly lower in pH (less alkaline) than in smoke from Marlboro and to a lesser degree Kool... All evidence indicates that the relatively high smoke pH (high alkalinity) shown by Marlboro (and other Philip Morris brands) and Kool is deliberate and controlled. This has raised questions as to: (1) the effect of higher pH on nicotine impact and smoke quality, hence market performance, and (2) how the higher smoke pH might be accomplished."³⁷ (RJR 1973)

3.3 Concealing
the nicotine by increasing the vapour phase

Ammonia helps cheat the federal test for levels of nicotine and tar	The exploitation of 'free' nicotine and its enhanced effects helped cigarette companies cheat the US Federal Trade Commission (FTC) machine measurements of tar and nicotine levels. Using additive technology they were able to build cigarettes which registered low tar readings on the machine but delivered high levels of nicotine to the smoker. "If the desired goal is defined to be increased nicotine yield in the delivered smoke there appear to be only two alternatives: either increase the absolute yield of delivered nicotine, or increase the pH, which increases the 'apparent' nicotine content without changing the absolute amount."³⁸ (Lorillard, 1976)
Concealing nicotine in the gas phase	The FTC machine measures overall levels of liquid and solid nicotine, but not its concentration in the vapour phase where 'free' nicotine is found. Additives allowed reduced tar and nicotine without compromising the pharmacological effects -- legally required disclosure of tar and nicotine levels on billboards and cigarette packets showed a significant reduction while smokers were still being exposed to high levels of an addictive drug. Changes in the state of nicotine from liquid or solid to gas would have the effect of evading the standard measuring process which records the residues left on the filter in the standard smoking machine. "The perfect example of that is that if you don't take into account the gas phase, if I do something like increase the pH and the smoke drops so that I can put more of the nicotine from the liquid into the gas and I am not measuring the gas, then in fact, you don't measure that nicotine which gets in the gas phase. This has been known since the late 1960's and early 1970's."³⁹ (Farone, W.A. 6/12/97)
Business as usual while appearing to reduce nicotine	The increase in the free nicotine fraction - a qualitative change in the chemical form of nicotine -- means that the same 'hit' can be obtained from less nicotine. Put another way, there can be the appearance of a reduction in pharmacological impact without there being a real reduction. "The amount of nicotine in the vapour phase can be modified by changing the acidity (pH) of the smoke. Hence it is readily feasible to have two cigarettes which deliver the same amount of nicotine (as measured on a Cambridge pad - the FTC method) but which are easily differentiated on the sensory basis of impact since the acidity of the smoke (and hence amount of nicotine in the vapour phase) is different."⁴⁰ (B&W 1984)

3.4 Other additives that may enhance the
effect of nicotine

Evidence
of other substances with pharmacological effects

Although in the
documents surveyed, ammonia emerges as the primary chemical tool used to enhance nicotine
effects, other additives with similar functions are currently in use and more are being
researched. Of particular note are Acetaldehyde, Levulinic Acid, Theobromine and
Glycyrrhizin -- Although described by the tobacco industry as 'smoothers' and 'flavour
enhancers', all appear to have some pharmacological effect in controlling nicotine
absorption levels and/or delivery.

Synergistic
interactions...

In his testimony
during recent litigation, W.A. Farone noted that, face="Times New Roman, Times" size="2">

"the interactions (between additives and
nicotine) may be the basis for the difference between the difficulty in giving up
pipe or cigars compared to giving up cigarettes."⁴¹ (Farone WA 1997)

3.4.1 Acetaldehyde

Acetaldehyde is produced
by the burning of sugars (the most common tobacco additives⁴²). Industry scientists
suspected that acetaldehyde could enhance the addictive effects of nicotine. Senior Philip
Morris scientist Victor J. DeNoble began research in the early eighties, into the
behavioural effects of nicotine and acetaldehyde in rats. He discovered that the two drugs
worked synergistically to enhance the addictive nature of nicotine. DeNoble's research
papers for Philip Morris reveal the potential for acetaldehyde to act in this way: face="Times New Roman, Times" size="2">

"The results can be summarized as
follows: 1 acetaldehyde does function as a positive reinforcer for rats. 2 acetaldehyde at
equal doses (mg) to(-) nicotine is more effective at maintaining self-administration
behaviour, 3 the endogenous opioid system is not involved in the maintenance of
acetaldehyde self administration, and 4) combinations of nicotine and acetaldehyde produce
supra-additive effects when self administered."⁴³ (PM)

"Acetaldehyde alone maintained
lever pressing at a greater rate than nicotine at equal mg/kg doses. This is consistent
with other findings at this laboratory." (Philip Morris, 1983)⁴⁴

"Overall, the effects of acetaldehyde on EEGs were similar to those of
nicotine."⁴⁵ (PM 1983)

"DeNoble detected a synergistic or "additive" effect with
acetaldehyde-nicotine combinations. This experiment was extended, with a slightly
different but acceptable protocol, with one rat again using doses less than one cigarette
(8 ug/kg / dose) and again DeNoble detected a synergistic effect between acetaldehyde -
nicotine."⁴⁶ (PM 1982)

Following this discovery DeNoble and his team were ordered to find the optimal ratio of
the two compounds. According to DeNoble's testimony, once the company had discovered the
optimal ratio for addiction they increased the levels of sugar in Marlboro cigarettes to
achieve the required increase in levels of acetaldehyde.

"How did they do it?
Simple, they added sugar, because if you burn sugar you form acetaldehyde. Now I ask you
this. If tobacco companies are reducing acetaldehyde as Philip Morris says why has
Marlboro increased acetaldehyde by 40% in ten years and has maintained that increase
today?"⁴⁷ (DeNoble, Verbal Testimony 1997)

3.4.2 Levulinic acid

Adding straight
nicotine to tobacco has two unwanted effects. Firstly it makes the smoke harsh and
difficult to smoke, and secondly it increases the FTC reading of nicotine. RJR patented a
way round this by using a nicotine salt of an organic acid, (e.g., nicotine levulinate)
which increases the impact of nicotine whilst keeping a low tar to nicotine ratio on the
FTC reading:

The use of organic acid salts to mask the
harshness of nicotine.

It would be desirable to provide a
cigarette such as an 'ultra low tar' cigarette, which is capable of delivering a good
tobacco taste, strength and smoking satisfaction characteristic of a 'full flavour low
tar' cigarette while not being perceived as being overly harsh or irritating. In addition,
it would be desirable to provide a cigarette such as a ' full flavour low tar' cigarette,
which is capable of delivering a good tobacco taste, strength and smoking satisfaction
characteristic of a 'full flavour' cigarette while not being perceived as being overly
harsh or irritating. Cigarettes having incorporated therein a salt such as nicotine
levulinate exhibit low FTC 'tar' to nicotine ratios while (i) having a smooth palatable,
flavourful taste, and (ii) providing smoking satisfaction to the user. The cigarettes do
not exhibit a harsh or irritating character; and do not exhibit a non-tobacco or off
taste.

Patent No 4,830,028. Salts provided from nicotine and
organic acids as cigarette additives, RJR, May 16 1989.

RJR
researches techniques for enhanced binding

Titled 'Enhancement
of nicotine binding to nicotinic receptors by nicotine levulinate and levulinic acid', the
following document shows how levulinic acid enhances the effects of nicotine. face="Times New Roman, Times" size="2">

"Nicotine levulinate and levulinic acid
significantly increased the amount of L (3H) nicotine bound to nicotinic receptors in rat
brain tissue. The observed increase ranged from 20 - 50 %, with a mean value of around 30
%. The total amount of radiolabeled nicotine bound to receptors was more than could be
accounted for by binding to high affinity receptors alone. The maximal effect which was
observed at concentrations of nicotine levulinate and levulinic acid in the low nanomolar
range, was reversed at higher concentrations. A computer model consistent with the results
was developed and tested. According to the model, levulinic acid binds to an allosteric
site on a class of low-affinity receptors and increases the affinity of these receptors
for nicotine. At higher concentrations, this effect is reversed by the levulinic acid
itself, assuming that it also has a reasonable affinity for the nicotine binding
sites."⁴⁸ (RJR 1989)

"Levulinic acid (4-oxopentanoic acid) is primarily a breakdown product of
starch, cane sugar and other cellulosic materials."⁴⁹ (RJR 1989)

Are
there other compounds which help nicotine bind to receptors?

The same document
possibly describing other research.

"Similarly,
it has been shown that there are some compounds which enhance the binding of nicotine to
its receptors in brain tissue"⁵⁰ (RJR 1989)

The above quotes illustrate the extent to which cigarette manufacturers can manipulate
the chemistry of smoke and nicotine addiction. Levulinate and levulinic acid change the
chemistry of the brain itself so it becomes more receptive to nicotine.

3.4.3 Cocoa and theobromine

Widely used as an
additive, cocoa contains alkaloids, which may modify the effects of nicotine and have a
pharmacological effect in themselves. Cocoa also contains about 1% theobromine, a
'bronchodilator' - encouraging expansion of the airways and facilitating increased smoke
and nicotine intake.

The following quotes are from scientific and medical papers held
by Philip Morris:

"Theobromine: The principal
alkaloid of the cocoa bean which contains 1.5-3% of the base... bronchodilation effect in
asthma."⁵¹

"The bronchodilator effect of a 10mg dose of theobromine was compared with that
of 5mg of theophylline in young patients with asthma.... In this single dose study the
bronchodilatory effect produced by theobromine was clinically and statistically
significant.... improvement in all pulmonary function tests was noted after the ingestion
of theobromine or theophylline."⁵²

It should be noted that 'improvement' refers to
a significant expansion of the airways within the smoker's lungs.

3.4.4 Glycyrrhizin

An ingredient of
liquorice - another commonly used additive, glycyrrhizin also acts as a bronchodilator. face="Times New Roman, Times" size="2">

"What does a bronchodilator do? The
bronchodilator makes it easier for you to inhale, so obviously if you are having
difficulty putting smoke in your lungs, it's good to have a bronchodilator in there. Now I
was asked recently whether I knew whether the glycerizon being delivered is delivered in
adequate concentration to cause that to happen. I do not know the answer to that question.
It would be interesting to know whether that has been studied by the industry. If they
have studied it, it would seem that that is the kind of information that should be shared
with regard to ingredients. The point is, however, that we know it can happen, it is a
bronchodilator. The probability that it happens is very high, but that would be related to
studies that should be done."⁵³ (Farone WA 1997)

3.4.5 Pyridine

A testimony from WA
Farone, a former Philip Morris employee, speculates on the impact of adding alkaloids
other than nicotine to cigarettes:

"We
normally think only of nicotine, but we have to remember there are other alkaloids in
tobacco. As an example of that I have here a very old book on pharmacy and therapeutics.
It was written in 1894, published in 1895, and I'd like to just read you one little thing.
This is on the section under tobacco and it says, 'It contains a very powerful and
poisonous food alkaloid named nicotine'. It goes on to say, "It's combustion gives
rise to several products of which pyridine and its compounds of the sheath having the same
action as nicotine but of less severity." So here we are back in 1894 knowing full
well that pyridine acts like nicotine at least in some regard, and if you go to a modern
book.... you are going to find out that it is a central nervous system depressant, much
the same as nicotine. So if I now add pyridine, either in the form of pyridine itself or
in the form of some chemical, which when I combust it or pyrolyse it , it converts to
pyridine, then I have increased the pyridine that the smoker gets if I put pyridine in
with nicotine I increase the total central nervous system effect, and it becomes very,
very important for us to understand the interactions between the additives the
ingredients, and what is happening with the pharmacological effects of nicotine."⁵⁴
(Farone WA 1997)

The following BAT report explores the
absorption of pyridine and its synergy with nicotine. While the report says that the
levels of pyridine found in tobacco smoke are 'unlikely' to be high enough to cause any
effect, due to lack of disclosure it is difficult to ascertain weather current level of
pyridine are high enough to be pharmacologically active.

"Peripherally, i.e. the
tissue of the body excluding the brain, whether acting similarly, by nicotine receptor
stimulation, or by different mechanisms pyridine and nicotine act synergistically."⁵⁵
(BAT)

"Centrally, pyridine and nicotine produce opposite antagonistic effects,
nicotine being stimulant, pyridine depressant."⁵⁶ (BAT)

"...This is indicative that pyridine is producing this effect by stimulating a
nicotinic receptor at this site."⁵⁷ (BAT)

"Discussion of the Interaction of Pyridine with Nicotine.

It would appear that in the majority of cases there is a degree of addition between
the effects of nicotine and pyridine. It does not really matter if the two agents are
producing their effects by different mechanisms, as with their effects on heart rate.

This conclusion seems to be true for the peripheral effects, but as can be seen from
the results of the section concerned with the CNS effects of pyridine, and from the
results of the mouse and rat toxicities in: the absorption section of the report, pyridine
and nicotine have directly opposite effects on the brain, and thus will antagonise each
others effects."⁵⁸ (BAT)

4 Masking the taste and immediate effects of tobacco

Is an 'improved' cigarette desirable?	Tobacco products enjoy widespread exemptions from consumer safety and product liability legislation through historical accident. Tobacco products are also the only consumer products that cause disease and death when used as intended by the manufacturer. Because of this unique anomalous status, additives to tobacco products present an unusual philosophical problem. For most products, the use of additives for 'improvement' does not lead to any harmful consequences arising from modest extra consumption. However, if the cigarette smoke is made to taste 'better' more people may start to smoke, continue to smoke or decide not to quit. This concern was reflected in the 1998 SCOTH report: face="Times New Roman, Times" size="2"> "One of the effects [of additives] has been the maintenance of "taste" as tar yields have fallen with an ensuing reduction in natural flavour. The negative side of this has been the maintenance of the appeal of a product, which might otherwise have been rendered unacceptable through the adulteration of intrinsic flavour."⁵⁹
Additives are needed to modify the taste of nicotine	An ex Philip Morris employee explains in testimony one of the main functions of tobacco flavouring additives. face="Times New Roman, Times" size="2"> "It is widely known that harshness and bitterness of nicotine is not acceptable alone in a cigarette. There is strong scientific evidence to support both the need for nicotine in the products and the need to modify its flavour to make its delivery acceptable to the smoker."⁶⁰ (Farone, W.A. Ex-Philip Morris employee. 1996)
	The largest single additive used is sugar - around three percent of the total weight - masking the unpalatable taste of nicotine. Choosing a sweetened or flavoured cigarette brand allows smokers to inhale increased volumes of smoke, more easily absorbing the desired dose of nicotine. Over 80% of new smokers start below eighteen years of age - this is recognised by the industry and targeted in production and marketing strategies.⁶¹ The use of sugars, honey, liquorice, cocoa, chocolate and other flavourings make cigarettes more palatable and 'aspirational' - particularly to children and the young.
"Flavouring do effect smoking behaviour"	"Is it not the flavour that distinguishes the brands and cause some cigarettes to be more successful in the marketplace than others? The marketplace is probably one of the greatest proofs that flavourings do affect smoking behaviour."⁶² (Farone, W.A. 1996, Ex employee of Philip Morris.)
Use additives to replace lost flavours	Reducing tar levels, in an attempt to neutralise serious health concerns, caused manufacturers major problems - tar provides a strong flavour and mouth sensation, masking the harsher, bitter taste of nicotine - unpalatable to new smokers and uncomfortable to established smokers. The response was the use of additives to play the role of the missing tar. face="Times New Roman, Times" size="2"> "The Merit concept of utilising flavour technology to circumvent the tar problem by using flavour from additives instead of flavour from tar may represent the best compromise between the demand for a product with high flavour and/or physiological impact and/or degree of nicotine satisfaction, and at the same time low tar and nicotine." (Lorillard, 1976)⁶³
Additives have multiple purposes	A BAT document gives some indication of the role of tobacco additives. Four of the seven reasons for additives involve masking the taste of tobacco. face="Times New Roman, Times" size="2">"The Role of Tobacco Flavour Additives. Tobacco flavour additives of all types are gaining importance in manufacturing practice for a number of reasons. Additives may be required: 1. To introduce a u.s.p [unique selling point] to a product. 2. To modify the smoke sensory characteristics of poorer quality grades particularly where government or economic compulsion dictates that the better quality material is not available for manufacturing. 3. To achieve a satisfactory smoking quality in situations where league tables influence the design of the product. 4. To counter the effect on smoke quality of including synthetic smoking materials in the blend. 5. To maintain brand character. 6. To improve the smoking quality of an existing brand. 7. To improve side-stream smoke character."⁶⁴ (BAT)
Added ammonia reacts with sugar to create 'milder' smoke	Competing companies were obsessed with the success of Marlboro, and ran countless experiments to unravel its secrets. These are discussed in greater detail in the previous section. What they found was a cigarette packed full of additives. size="2"> "There is more to PM's [Philip Morris'] ammonia processing than simple addition of ammonia, which leads to different results. They somehow force much of it to react with tobacco constituents in a manner such that pectin is released, while also forming sugar-ammonia reaction products that contribute to a mild and natural tasting smoke."⁶⁵ (BAT 1985)
Additives enable PM to use cheaper tobaccos in there cigarettes	"PM people often state in public that additives are important to them with regard to controlling smoke chemistry and taste. Indeed, their leaf people have been known to say that the additives are one reason that they can buy some cheaper tobaccos. Casings are an obvious choice of a vehicle for use of such additives."⁶⁶ (BAT 1985)
	"The wide scale use of sugars in casing formulas (adopted originally on the basis of smoker acceptance) and the general observation that most blends which have received wide scale consumer acceptance have significant sugar levels would certainly suggest that sugar level is important to quality."⁶⁷ (BAT 1963)
Liquorice boosts the sweetness of tobacco	According to BAT, face="Times New Roman, Times" size="2"> "Although each tobacco manufacturer carefully guards the secrets of his casing (and flavour) formulas, it is well known that casings for smoking products often contain sugar, liquorice, cocoa, or chocolate liquor and sometimes natural extracts. Of these, liquorice deserves special mention. Just as sugar is used in 'casing' the tobacco to mellow and smooth the smoke, liquorice is used as an adjunct to boost the sweetness of tobacco products. The taste of liquorice to the smoker is that of a mellow sweet woody note which, at proper use levels, greatly enhances the quality of the final product."⁶⁸ (BAT)
Additives may be flavour enhancers or flavour suppressers	"The greater use of reconstituted tobaccos presents two major problems to the flavour industry. Stems have higher nicotine content. You run into a second problem with them that you don't run into with the blend tobaccos. Reconstituted tobaccos will start off with a bad character. You've got a twofold problem. You've got to suppress a bad flavour and neutralise harshness, and you've go to put a good flavour back in. So, in some cases, we make suppressants ----- flavourings that, in effect, neutralise and diminish a bad flavour. On top of that, we have to add a flavour to bring it to a point where it's acceptable. One is an eraser and one is a writer."⁶⁹ (Tobacco Reporter 1979)
Chocolate gives better mouth feel	"The tobacco leaf of and by itself does not have sufficient impact. So, what you do is try to round off some of the harsher edges; try to add nuances of chocolate, for instance, which give you a better mouth feel when the smoke comes in and that's why these additives go in."⁷⁰ (Tobacco Reporter 1979)
	"As far as liquorice is concerned, the smoothing effect of this is probably due to the Glycyrrhizin present which is renowned for its demulcent therapeutic property."⁷¹ (BAT 1963) Glycyrrhizin is an effective demulcent; it is also a bronchodilater and carcinogenic when burnt.⁷²
Cocoa butter reduces harshness of smoke	"Although by no means conclusive, the results now presented lend some support to the claim that treatment of tobacco with cocoa butter reduces the harshness of the smoke."⁷³ (BAT 1967)
	BAT adds around 1250 tonnes of cocoa to its cigarettes per year. size="2"> "I have circulated all Companies in the Division, and from their replies, estimate that the Company uses about one and a quarter million kilos of Cocoa in its tobacco products each year."⁷⁴ BAT 1978

4.1 Additives and 'low tar'
cigarettes.

Low tar cigarettes have low desirability without additives	"Low delivery cigarettes are commonly judged to lack acceptable levels of flavour. Attention is increasingly being focussed upon novel methods of incorporating flavours in cigarettes so that the desirable flavour level can be re-established."⁷⁵ (BAT 1982)
	"As attempts are made to go lower in both tars and nicotine, flavour additives are needed to bring taste levels up to par."⁷⁶ (Tobacco Reporter 1979)
	"Tobacco companies are concerned with putting something into a low yield cigarette to compensate for the loss of flavour and bring the taste partially back to the level of a higher delivery product."⁷⁷ (Tobacco Reporter 1979)
Ethics questioned...	Although there were concerns about lost taste, the priority was to ensure that smokers could continue to receive enough nicotine. "Compensatable Filters. Strategic Objective: To make it easier for smokers to take what they require from a cigarette. This means in effect that the filter will be compensatable and implies a high taste to tar rates." Constraints: Is this the ethical thing to do?"⁷⁸ (BAT 1985) In effect this means that the cigarette is designed to allow smokers to take a much higher level of tar and nicotine from the cigarette than is registered on official machines.

4.2 Front end 'lift'

The
cigarette is designed around smoker's vulnerabilities

BAT uses additives
and design to play to the smokers largely unconscious smoking desires. The very first puff
on a cigarette can be engineered to have the greatest impact -- both relieving the pent up
nicotine withdrawal symptoms and providing the best taste. face="Times New Roman, Times" size="2">"Front-end lift.

Strategic objectives:

To improve the taste and flavour of the first few puffs on cigarettes.

It is assumed that smokers are most likely to make judgements about the cigarette
quality in the first few puffs.

It is assumed that 'need' for smoking is highest when a cigarette is lit."
⁷⁹ (BAT 1985)

5 Additive Toxicity

	The limited regulation of tobacco additives has tended to concentrate on the toxicity of the additive itself. This has tended to draw upon food regulation -- however, it is quite likely that the toxicity of an additive when ingested as food may differ from its effect when inhaled in smoke. There should, therefore, be caution in accepting the effectiveness of even these limited safeguards: " Because the delicate respiratory system lacks the powerful enzymes and detoxifying metabolic pathways of the digestive system, these compounds may be significantly more toxic when inhaled than when ingested. Pyrolysis of additives may also produce novel toxic constituents, thereby creating additional health risks to the smoker."⁸⁰ (Connolly, Lymperis, 1998)
Coumarin	Health concerns surrounding the use of a highly toxic flavouring compound called coumarin (which causes severe liver damage) began to emerge in the late fifties. Cigarette manufacturers voluntarily removed coumarin from the permitted list in September 1997. Although the controversy is almost four decades old, it serves as a reminder of the bias towards sales over health concerns within the tobacco industry as a whole. face="Times New Roman, Times" size="2"> "In the meantime we think you would be interested to know that in America the manufacturers of all food products intended for human consumption abandoned the use of coumarin during 1953/54 'until such time that adequate tests and investigations were completed wherein the use of coumarin may be considered to be deleterious and injurious to health.'⁸¹ (BAT, 1959) Cigarette manufacturers have been subject to a relatively liberal legislative framework, partly on the grounds that the industry should regulate themselves - evidence shows they are unlikely to do so:
BAT test additives for carcinogens	"Mutagenic Activity of Flavour Compounds: Some 270 compounds have been assayed for mutagenic activity in Ames test ........ In these experiments a number of flavour compounds have been shown to be positive mutagens...... Acetaldehyde: Is a positive mutagen, it is embryotoxic, teratogenic and induces respiratory tract tumours in hamsters when inhaled. Furfural: This is confirmed by complementary work as a clear mutagen and, in conjunction with other respiratory tract carcinogens, e.g. benzo(a)pyrene, it may act in a concerted way to increase the yield of tumours. Furfural Acetate: The work of Mortelmans et al. is the only mutagenic study on this compound. However, the experiments on fufural and furfuryl alcohol would seem to indicate a general mutagenic reactivity of this family of compounds. Maltol: The positive mutagenic activity is confirmed by other studies in vitro; however, the compound does not seem to have been tested in vivo. O-Methoxycinnamaldehyde: Does have the potential to be a positive carcinogen. Recommendations: Acetaldehyde, furfural and furfural acetate....... If these agents are to be added to tobacco, it would appear prudent to review the levels of addition in the light of the above evidence. For maltol and o-methoxycinnamaldehyde, the evidence indicates a possible carcinogenic potential of these agents. This would again suggest reviewing the use of such agents for human use."⁸² (BAT 1986)
A dilemma: reduced toxicity or reduced sales?	There is evidence to suggest that the tobacco companies do not have adequate internal controls over potentially harmful additives:"We were quite well aware that Eugenol is a phenol ...We also agree with you that phenol is a dirty word at present." "Really this comes down to a point of asking ourselves this question: Would we be willing to accept a possibly slightly undesirable means to accomplish a desirable end?" "It has occurred to us that whereas there would be no reason to fear any health danger from the use of Eugenol if the question of phenols had never been raised, yet now that it has been so raised we have got to take it into account since Eugenol is itself a phenol." "Is the chemical evidence adequate to justify immediate sale of the cigarettes to the public subject to further chemical and/or biological tests being carried out with reasonable despatch.?"⁸³ (BAT 1982)

6 Changing the Perception of side-stream smoke

Additives to reduce the appearance of passive smoking	Additives are also used to mask the effects of environmental tobacco smoke (ETS), primarily to undermine the negative image of smoking and remove some of the social pressures that make smokers more likely to quit. Environmental tobacco smoke is a big problem for the industry. Since the 1970s scientific evidence has accumulated proving that exposure to ETS is a serious health hazard (in the UK alone several hundred deaths are attributable to ETS each year)^{href="#_Toc5014">84}. This discovery had a profound effect on the politics of smoking - moving from an issue of individual choice to one of social responsibility - and encouraging even more smokers to reassess their habit. The tobacco industry response was twofold; firstly research was conducted specifically to find evidence countering claims that exposure to ETS was a health hazard, and secondly chemical additives were identified to reduce its anti-social and irritating effects - making it harder for non-smokers to avoid or criticise. There were also some attempts to reduce overall ETS, however the primary concern was modifying perception of the smoke rather than its properties.
Choose the result then find the proof	"Strategic objectives (of sidestream smoke research) remain as follows: 1. Develop cigarettes with reduced sidestream yields and/or reduced odour and irritation. 2. Conduct research to anticipate and refute claims about the health effects of passive smoking."⁸⁵ (BAT 1984)
Reducing the visibility of ETS may increase its toxicity	"It was thought prudent to ensure that the Company could show no adverse effects on sidestream toxicity for a product designed to have a lower visibility sidestream."⁸⁶ (BAT 1984) face="Arial, sans-serif" size="2"> Worryingly this opens up the possibility that work on lowering the visibility of side-stream smoke was increasing its overall toxicity.
Additives used to stop quitting because of social pressure	" To pre-empt potential volume decline from smokers under pressure in social and work environments by providing them with an offer which combines re-assurance in social smoking with taste and satisfaction."⁸⁷ (BAT 1984)
	"Studies into alternative burn additives that reduce visible sidestream: As a result of these studies sodium acetate has been used to replace tri-potassium citrate in low visibility sidestream papers...Potassium salts give greater reductions in sidestream visibility."⁸⁸ (BAT 1987)
	"It has been found that a 'Ca (OH)2 filled cigarette paper gives a reduced visible sidestream smoke...It was noticed that the cigarettes made with treated papers gave a more pleasant and less irritating sidestream aroma than the cigarettes made with untreated papers. Also the taste of the mainstream smoke had changed and seemed to be milder than for the cigarettes made with the treated papers"⁸⁹ (BAT 1983)
BAT reduce visibility but are not interested in toxicity	"Smoke control: sidestream reduction: Visibility. RD&E is interested in work dealing with sidestream smoke reduction, but is not interested in the biological testing of products produced. David will explain this to Allen Herd and ask whether projects could be run without biological testing."⁹⁰ (BAT 1986) size="2"> It appears that while reducing the visibility of side-stream smoke is considered important, the toxicity of the resultant vapour is not.

7. Notes

Action on Smoking and Health, Tobacco Explained: the truth about the tobacco industry in
its own words, June 1998. See www.ash.org.uk/papers/tobexpld2.html

Philip Morris, 1972, Dunn W.L, Motives and incentives in cigarette smoking. Minn Trial
Exhibit 18089.

RJR, 1972, C Teague, Research planning memorandum on the nature of the tobacco business
and the crucial role of nicotine. Minn Trial Exhibit 12408

Santa Fe Natural Tobacco Co. An analysis of the ingredients added to tobacco in the
manufacture of cigarettes: Health and Legal Implications. FDA GRAS&FDA approved food
additives. Santa Fe Natural Tobacco Company; October 12, 1994 p3

Kozlowski LT, Mehta NY, Sweeney CT, et al. Filter ventilation and nicotine content of
tobacco in cigarettes from Canada, the United Kingdom, and the United States. Tobacco
Control 1998; 7:369-375.

Benowitz NL, Hall SM, Herning, RI et al. Smokers of low-yield cigarettes do not consume
less nicotine. New England Journal of Medicine, 1983; 309: 139-42.

Bates C., Jarvis M., Letter Tobacco Control 1999;8:106-112

Bates C., Jarvis M. Low Tar: why low tar cigarettes don't work and how the tobacco
industry fooled the smoking public. 1999 Edition. March 1999. HREF="./big-one.html">www.ash.org.uk/papers/big-one.html

First Report of the Independent Scientific Committee on Smoking and Health, HMSO, 1975

Second Report of the Independent Scientific Committee on Smoking and Health, HMSO, 1979

Second Report of ISCSH, 1979

Third Report of the Independent Scientific Committee on Smoking and Health, HMSO, 1983

Fourth Report of the Independent Scientific Committee on Smoking and Health, HMSO, 1988

Report of the Scientific Committee on Tobacco and Health, The Stationery Office, 1998

Farone WA, The manipulation and Control of Nicotine and Tar in the Design and
Manufacture of Cigarettes: A Scientific perspective. Statement March 19, 1996

Henningfield, Jack E. Verbal Testimony. Jan 30 1997.

Riehl T, McMurtrie D, Heemann V, et al Project SHIP review of progress November 5-6 1984
BAT, November 12^th , 1984, Minn Trial Exhibit 10752.

Anderson HD. Potassium carbonate Memo to RP Dobson, BAT, August 7^th 1964,
Minn Trial Exhibit 10356.

Liggett, January 29^th 1974, Development of a Cigarette with an Increased
Smoke pH

Colby FG. Cigarette concept to assure RJR a larger segment of the youth market. December
4^th 1973, Minn Trial Exhibit 12464.

RJR 1976, McKenzie JL. Product characterisation definitions and implications. Minn Trail
Exhibit 12270.

BAT June 1988, The significance of pH in Tobacco and Tobacco Smoke." Minn Trial
Exhibit No 12 223 p5.

Williams RL, Development of a cigarette with increased smoke pH. Liggett, December 16^th
1971, Minn Trial Exhibit 11903.

Woods JD Harlee GC. Historical review of smoke pH data and sales trends for competitive
brand filter cigarettes. RJR, May 10th 1973, Minn Trial Exhibit 12337.

BAT 17^th May 1965, FN B2107 BN105454359-4346 The Effect of Additives on Smoke
Chemistry.

Chen Leighton, pH of smoke, a review, Lorillard Research Centre, 1976, Minn Trial
Exhibit 10110.

RJR , August 14^th, 1973, Minn Trial Exhibit 13155

Richard Kluger, Ashes to Ashes , 1998 page 292

RJR, Minn Trial exhibit 13141.

B&W, October 26, 1992, Minn Trial exhibit 10001, p51.

RJR, 14^th August, 1973, Teague CE, Implications and Activities Arising from
Correlation of Smoke pH with nicotine Impact, Other Smoke Qualities, and Cigarette Sales.
Minn Trial Exhibit 13155.

RJR, 14^th August, 1973. Implications And Activities Arising From Correlation
Of Smoke pH With Nicotine Impact, Other Smoke Qualities And Cigarette Sales. Minn Trial
Exhibit 13155.

Gregory CF, Observation of free nicotine changes in tobacco smoke, B&W, January 4^th,
1980 Minn Trial Exhibit 13182

Blackhurst JD. Further work on "extractable" nicotine. Report issued by I w
Hughes, BAT September 30^th, 1966, Minn Trial Exhibit 17825.

Lorillard, 8^th February 1973, Minn trial exhibit 10095.

RJR, 14^th August 1973, Implications and activities arising from correlation
of smoke pH with nicotine impact, other smoke qualities, and cigarette sales. Minn trial
exhibit 13155.

Lorillard, July 12^th, 1976, Chen L. pH of smoke: a review Minn Trail Exhibit
10110.

Farone, William A, Verbal Testimony, June 12 1997.

Proceedings of the smoking behaviour- marketing conference, July 9-12^th, 1984
session to Dr L C F Blackman and Mr AM Heath B&W, July 30th 1984, Minn Trial Exhibit
13430.

, Farone W A, Department of public health. Proposed hearing on proposed regulations:
Reports of added constituents and nicotine ratings. June 12 1997.

Santa Fe natural tobacco Co, 1994

Philip Morris, Termination of chronic acetaldehyde administration does not result in a
physical dependence syndrome. Tobacco Resolution, Bates Number 1000060695-60704

Philip Morris, 1983 Victor J DeNoble 'Behavioral Pharmacology annual report'. Tobacco
Resolution, Bates Number 206056611-

Philip Morris 1983, "Behavioural Pharmacology Annual Report" V. J. DeNoble.
Tobacco Resolution, BN 206056611-6612

Philip Morris 1982, Evaluation of the DeNoble nicotine acetaldehyde Data, Tobacco
Resolution, BN 2056144727-4728.

DeNoble V.J. Verbal Testimony 1/3/97 p77

RJR 1989, Lippiello PM, Fernandes KG. "Enhancement of nicotine binding to nicotinic
receptors by nicotine levulinate and levulinic acid." September 25 1989.BN508295794

RJR 1989, Lippiello PM, Fernandes KG. "Enhancement of nicotine binding to nicotinic
receptors by nicotine levulinate and levulinic acid." September 25 1989. BN508295794

Philip Morris, Bates number 2060535086

Philip Morris, Bates number 2060535081-85

Farone WA, Verbal testimony, Public hearing on proposed regulation: Reports on added
constituents and nicotine ratings, Massachusetts tobacco control program, June 12^th
1997.

BAT, The absorption and mechanism of action of pyridine and its interaction with
nicotine, FN AW2730, BN 402419398-9486.

Report of the Scientific Committee on Tobacco and Health, The Stationery Office, 1998

Farone, W A, March 27 1996 "thoughts on Philip Morris response on manipulation and
control. The use of casings and flavourings." p4

Action on Smoking and Health, Tobacco Explained: the truth about the tobacco industry in
its own words, June 1998. Chapter 3 - see HREF="../../conduct/html/tobexpld2.html">www.ash.org.uk/papers/tobexpld3.html

Farone, W A. "thoughts on Philip Morris response on manipulation and control. The
use of casings and flavourings. Instalment 2" draft document, March 27 1999 p4.

Chen Leighton, pH of smoke, a review, Lorillard Research Centre 1976, Minn Trial Exhibit
10110.

BAT, Casings and Flavourings,BN401375070, FN EQ 2295.

BAT February 1985, The Unique Differences Of Philip Morris Cigarette Brands, BN
109359953,FN K762

Ibid., BN 109359981

BAT September 18^th 1963 Minn Trial Exhibit 10,856.

BAT, Tobacco Flavouring For Smoking Products, BN104805407, FN F1500

Tobacco Reporter, September 1979.

Tobacco Reporter, September 1979

BAT January 15^th, 1963, Additives Australia, FN G443, BN 102630086-102630092

Connolly, G. and Lympers, D. 1998 summary of evidence, findings and conclusions
concerning the nicotine yield ratings of and added constituents of cigarettes and
smokeless tobacco products. The Massachusetts department of public health tobacco control
programme, p 281.

BAT October 1967, Cocoa Butter As A Tobacco Additive. BN 105534584, FN B4263

BAT 20^th April 1978, BN 110034159 FN M453

BAT, June 1982, Methods Of Flavouring Cigarettes. BN105525477, FN B3650.

Tobacco Reporter, September 1979.

Ibid. Frank Mild, Manager of flavour research, Fritzsche Dodge & Olcott.

BAT 1985 FN J81, BN 100501670

BAT, 1985,New Brand development post lights, BN 100501668, FN J81

BAT April 21^st 1959 FNM463, BN 10067349

BAT December 12^th, 1986, Mutagenic Activity of Flavour Compounds. FN AQ2222,
BN 400916808-400916815

BAT December 12^th 1962, Letter regarding Eugenol, FN M456, BN
110090779-110090785

SCOTH report March 1998

BAT 1984, Summary of research activities. See the Cigarette Papers by Stanton Glantz p
391.

BAT 1984, R&D conference report. See the Cigarette Papers by Stanton Glantz, p409.

Ibid.

BAT 1987, June 15^th. Studies into alternative burn additives that reduce
visible sidestream. FN AW 1428, BN 402385586-402385589.

BAT September 9^th, 1983, The addition of sugar solutions of Ca(oh)2 in sugar
to cigarette paper. BN 100480228-0229 FN J562

BAT February 17^th, 1986, See the Cigarette Papers by Stanton Glantz et al
p245.

2005-05-23T06:09:00.000-07:00

factsheet no:12

What’s in a cigarette

Action on Smoking and Health – August 2001

Cigarette composition

Cigarettes look deceptively simple, consisting of paper tubes containing chopped up tobacco leaf, usually with a filter at the mouth end. In fact, they are highly engineered products, designed to deliver a steady dose of nicotine. Cigarette tobacco is blended from two main leaf varieties: yellowish ‘bright’, also known as Virginia where it was originally grown, contains 2.5-3% nicotine; and ‘burley’ tobacco which has a higher nicotine content (3.5-4%). US blends also contain up to 10% of imported ‘oriental’ tobacco which is aromatic but relatively low (less than 2%) in nicotine. [1]

In addition to the leaf blend, cigarettes contain ‘fillers’ which are made from the stems and other bits of tobacco which would otherwise be waste products. These are mixed with water and various flavourings and additives. The ratio of filler varies among brands. For example, a high filler content makes a less dense cigarette with a slightly lower tar delivery. Additives are used to make tobacco products more acceptable to the consumer. They include humectants (moisturisers) to prolong shelf life; sugars to make the smoke seem milder and easier to inhale; and flavourings such as chocolate and vanilla. While some of these may appear to be quite harmless in their natural form they may be toxic in combination with other substances. Also when additives are burned, new products of combustion are formed and these may be toxic. The full list of 600 permitted additives can be viewed on the Department of Health’s website [2] For further information on tobacco additives, see also the ASH/ICRF report, Tobacco Additives. [3]

The nicotine and tar delivery can also be modified by the type of paper used in the cigarette. Using more porous paper will let more air into the cigarette, diluting the smoke and (in theory) reducing the amount of tar and nicotine reaching the smoker’s lungs. Filters are made of cellulose acetate and trap some of the tar and smoke particles from the inhaled smoke. Filters also cool the smoke slightly, making it easier to inhale. They were added to cigarettes in the 1950s, in response to the first reports that smoking was hazardous to health. Tobacco companies claimed that their filtered brands had lower tar than others and encouraged consumers to believe that they were safer.

Tobacco Smoke

Tobacco smoke is made up of “sidestream smoke” from the burning tip of the cigarette and “mainstream smoke” from the filter or mouth end. Tobacco smoke contains thousands of different chemicals which are released into the air as particles and gases. Many toxins are present in higher concentrations in sidestream smoke than in mainstream smoke and, typically, nearly 85% of the smoke in a room results from sidestream smoke. [4] The particulate phase includes nicotine, "tar" (itself composed of many chemicals), benzene and benzo(a)pyrene. The gas phase includes carbon monoxide, ammonia, dimethylnitrosamine, formaldehyde, hydrogen cyanide and acrolein. Some of these have marked irritant properties and some 60, including benzo(a)pyrene and dimethylnitrosamine, have been shown to cause cancer. One study has established the link between smoking and lung cancer at the cellular level. It found that a substance in the tar of cigarettes, benzo(a)pyrene diol epoxide (BPDE), damages DNA in a key tumour suppresser gene. [5]

What is tar?

“Tar”, also known as total particulate matter, is inhaled when the smoker draws on a lighted cigarette. In its condensate form, tar is the sticky brown substance which can stain smokers’ fingers and teeth yellow-brown. All cigarettes produce tar but the brands differ in amounts. The average tar yield of British cigarettes (as measured by a standard machine method by the Government Chemist) has declined from about 30mg per cigarette in the period 1955‑61 to 11mg today. There have also been reductions in nicotine (from an average of about 2mg in 1955‑61 to about 0.9mg by 1996). [6] [7]

Until January 1992, information about tar yields of cigarettes was given in a general fashion on cigarette packets and advertisements as a result of a voluntary agreement between the tobacco industry and the Government. Under the terms of The Tobacco Products Labelling (Safety) Regulations 1991, which implement EU requirements for health warnings on tobacco, cigarette packets must include a statement of both the tar and the nicotine yield per cigarette on the packet itself. The same figures are printed on cigarette advertising, along with the health warning, as part of a voluntary agreement between the industry and the Department of Health.

Under the current EU tar yield directive, cigarettes with a tar yield of 15mg or more were phased out by the end of 1992. From the 1st January 1998, an upper limit of 12mg per cigarette was applied to all cigarettes sold in the EU with the exception of Greece which was granted an extension until 2006. Both the labelling and tar yield directives will be replaced by a new directive, [8] effective from September 2000, which will place an upper limit of 10mg of tar, 10mg of carbon monoxide and 1mg of nicotine on all cigarettes sold in the EU. For further information on tobacco regulation, see Fact Sheet 20, Tobacco Policy in the European Union.

Why low tar cigarettes are no safer than higher tar cigarettes

Following the discovery in the 1950s that it was the tar in tobacco smoke which was associated with the increased risk of lung cancer, tobacco companies, with the approval of successive governments, embarked on a programme to gradually reduce the tar levels in cigarettes. Although there is a moderate reduction in lung cancer risk associated with lower tar cigarettes, research suggests that the assumed health advantages of switching to lower tar may be largely offset by the tendency of smokers to compensate for the reduction in nicotine (cigarettes lower in tar also tend to be lower in nicotine) by smoking more or inhaling more deeply. [9] Also, a study by the American Cancer Society found that the use of filtered, lower tar cigarettes may be the cause of adenocarcinoma, a particular kind of lung cancer. [10] There is no evidence that switching to lower tar cigarettes reduces coronary heart disease risk.

Nicotine

Nicotine, an alkaloid, is an extremely powerful drug. The Royal College of Physicians has affirmed that the way in which nicotine causes addiction is similar to drugs such as heroin and cocaine. [11] Only 60mg of pure nicotine placed on a person's tongue would kill within minutes. Nicotine is contained in the moisture of the tobacco leaf: when the cigarette is lit, it evaporates, attaching itself to minute droplets in the tobacco smoke inhaled by the smoker. It is absorbed by the body very quickly, reaching the brain within 10-19 seconds. It stimulates the central nervous system, increasing the heart beat rate and blood pressure, leading to the heart needing more oxygen.

Carbon Monoxide

Carbon monoxide, the main poisonous gas in car exhausts, is present in all cigarette smoke. It binds to haemoglobin much more readily than oxygen, thus allowing the blood to carry less oxygen. Heavy smokers may have the oxygen carrying power of their blood cut by as much as 15%. [12]

2005-01-08T13:25:00.003-08:00

Cigarette smoke contains more than 4,000 chemical compounds, including 60 that can cause cancer. Many toxic agents are also in cigarettes, some of which are manufactured during the smoking process itself. A lighted cigarette generates more than 150 billion tar particles per cubic inch, making up the visible portion of cigarette smoke. According to chemists at R.J. Reynolds Tobacco Company, cigarette smoke is 10,000 times more concentrated than the automobile pollution at rush hour on a freeway. Visible smoke, however, contributes only 5 percent to 8 percent to the total output of a cigarette. What you can't see are the so-called vapors or gases in the cigarette smoke. Besides nitrogen and oxygen, the vapor contains toxic gases such as carbon monoxide, formaldehyde, acrolein, hydrogen cyanide, and nitrogen oxides. There are countless more.
The carcinogens in cigarette smoke include:
Acrolein, 4-Aminobiphenyl, Aromatic Amines, Aromatic Nitrohydrocarbons, Arsenic, Benzene, Benz{a}anthracene, Benzo{a}pyrene, Benzo {b}fluoranthene, Benzo {c}phenanthrene, Benzo{e}pyrene, Benzo{j}fluoranthene, Cadmium, Chromium, Chrysene, Dibenz{a,j}acridine, Dibenz{a,c}anthracene, Dibenz{a,h}acridine, Dibenzo{a,h}pyrene, Dibenzo{a,i}pyrene, Dibenzo{c,g}carbazole, Dichlorostilbene, 4-Ethycatechol, Formaldehyde, Hydrazine, Indeno{1,2,3-cd}pyrene, Methylchrysene, Mehtylfluoranthene, Mehtylnaphtalenes, 1-Methylindoles, 3-Methycatechol, 4-Methycatechol, 4-Methycatechol, 4(methylnitrosamino)-1-(3-pyridyl)-butanone, 2-Naphthylamine, Nickel, Nitropropane, Nitrosodimethylamine, Nitrosoethymethylamine, Nitrosodiethylamine, Nitrosodi-n-propylamine, Nitrosodi-n-butylamine, Nitrosopyrrolidine, Nitrosopiperidine, Nitrosomorpholine, N'-Nitrosonornicotine, N'-Nitrosoanabasine, N'-Nitrosoanatabine, Polonium-210 (Radon), Urethane, Vinyl Chloride.

2005-01-08T13:25:00.002-08:00

19) Look at quitting as an investment.Once you quit for an hour, you have invested this hour in becoming a healthier person. Now, invest one more hour. Continue to add to your investment hour by hour. It will grow and become more valuable as the hours go by. You will begin to see and feel the rewards from this investment more and more. Protect and guard it just as you would your life's savings.
20) Quit nicotine one day at time and think only about the part of the day you are in. "I am not going to smoke (chew) before noon." "I am not going to smoke (chew) before three o'clock." Sometimes just do it an hour at a time or a craving at a time. This is a lot easier than thinking about trying to quit forever.
21) Any discomforts you experience in the beginning will ease with time and abstinence. You will never have to go through it again if you stay nicotine free. Remember your discomforts! They are valuable! These memories may prevent you from the common risk of trying to have "just one."
22) If you could have just one, you wouldn't have had the thousands of cigarettes you have smoked.A pack a day for ten years is 73,000 cigarettes! None of them solved a single problem.
23) Think about letting go of nicotine as a "choice" rather than something you are doing to deprive yourself.You can tell yourself that you can smoke a carton tomorrow, but "just for today" you are choosing to be abstinent.
24) Pray instead of puff.The intimacy of personal prayer improves our relationship with ourselves and others. Within the privacy of our own mind and heart, we can pray anywhere. Nicotine arrives by paper, pipe, or pinch; recovery arrives by spiritual delivery.
25) When you quit you may experience a sense of loss.Don't dwell on these thoughts. The sense of loss is temporary, but the gains you receive will be enjoyed the rest of your life. It will become a pleasure to remove nicotine from your life.
26) If you feel an urge to use nicotine think H.A.L.T. Four basic triggers for using nicotine are when we are Hungry, Angry, Lonely and Tired.
27) Feed your body with nutrition instead of nicotine. We have used nicotine to suppress our feelings, even hunger. Recovery is about learning to take care of ourselves in life affirming ways. Pay attention to when you get "edgy", you may need to feed yourself. Or it could simply be time to stretch and take in some fresh air.
28) Drink lots of liquids to help flush the poison out of your system. Water can be a wonderful washer. Orange juice is good because smoking depletes the vitamin C content in our bodies.
29) What and how much you eat is important when you quit nicotine. Your metabolism changes. Your organs function differently. You may experience weight gain. There are things you can do to modify gaining weight. There is no cure for emphysema!
30) When you first stop, don't be surprised if you find yourself feeling cranky, grumpy, crabby or downright angry. Withdrawal from nicotine will be physically uncomfortable and you may feel deprived and generally annoyed. It is important to talk with someone about these feelings rather than venting at someone. Anger can hurt. You may end up feeling guilty which could lead you to feeling justified to use nicotine again.
31) Take a second look before you react. Withdrawal can distort one's perception of a situation. However, nicotine may have masked issues that are genuinely upsetting and anger may be a valid feeling that requires being addressed in a healthy manner.
32) There are better companions than cigarettes. As we end our relationship with nicotine there may be feelings of grief or loneliness. It is good to share what you are experiencing with others who are going through the same thing. Use your meeting's phone list to keep connected and clean with feelings of fellowship.
33) Avoid becoming too tired. When we are tired, situations can get misunderstood, our patience thins, and our overall resistance becomes weak. This is dangerous. "Everything" doesn't need to get done today.
34) Take breaks. Develop new ways to "take a moment" without using nicotine. We are learning to take care of ourselves in healthier ways. Enjoying a few moments of rest or pausing to reflect on how we might undertake our next task can be done without a cigarette. Really.
35) Sometimes all we need is a distraction to shift our focus from a craving. In the beginning it is better to keep yourself busy than to allow yourself the time to obsess about what you are not doing. It is important to keep putting more time between you and your last dose of nicotine.
36) Surround yourself with supportive positive people. This will help you keep a positive attitude. Avoid negative people, places and things as best you can, especially in the first weeks of stopping your tobacco use. Don't try to test yourself or try to prove a point by taking chances. Act as if your life is at stake.
37) Ask for help from family, friends, and co-workers. Whether it's to ask for some tolerance as you go through withdrawal or asking them not to use tobacco around you for a while. They may not be as understanding as your group or Higher Power, but you can ask. After all, when you look at the statistics, you could say it is matter of life or death.
38) Plan activities that do not permit tobacco use. Go to the movies or museums or any public place where tobacco use is not allowed. Relax in a warm bath. Go swimming, hiking, visit non-smoking friends, or do something else you enjoy.
39) Keep something handy for your hands. We are accustomed to holding a cigarette; being without one might leave our hands at a loss. Squeeze a small ball, playdough or fiddle with any object. You may also have a personal item that offers spiritual strength when held.
40) Boredom is a signal to get busy. It is hard to just sit and not smoke. Offering service to your group will enhance your recovery. You can also keep busy with things you enjoy or explore new activities. Pace yourself, but stay active. Take a walk to see beauty. Enroll in an evening class just for fun. This is a good time to indulge yourself with a sense of newness and enjoyment.
41) Suck, bite, or chew. You may miss putting something in your mouth. Avoid fattening foods. Some people substitute sucking lollipops or candy. Carrot or celery sticks are good to bite and good for you. Chewing gum is also a good substitute. Others enjoy cinnamon sticks or licorice roots from health food stores.
42) Caffeine is a stimulant like nicotine. Once you stop smoking, your body's chemistry changes and caffeine stays in your body longer. You may crave cigarettes more to smooth out a caffeine high. To help make these initial stages of nicotine abstinence easier consider gradually reducing your coffee intake if you drink a lot of coffee or eliminating it if you are a moderate drinker.
43) Avoid drinking alcohol while you are quitting. Once alcohol is in your system your defenses will diminish greatly.
44) Change your routine. Drive to work using another route to avoid familiar triggers along the way. Watch TV in another chair to break the association. Changing your patterns helps change your responses.
45) Give yourself rewards, frequently. What you are doing isn't easy by any means. It takes a lot of guts to change and break the cycle of addiction.
46) Avoid the self-pity trap. If we begin to feel sorry for ourselves, our minds will tell us that we deserve a cigarette to make us feel better.

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Tips for Gaining Freedom From NicotinePrior to quitting
1) It's not as hard as you think.This is not to suggest that it is easy, but many of us had developed the view that stopping our tobacco use was impossible. Nicotine is a powerful substance that can alter your sense of the truth.
2) Inform yourself about nicotine.Nicotine is a poisonous alkaloid substance. It has been officially declared an addictive chemical.
3) Understand that you do not need nicotine (it is not nutritional).Nicotine use creates a physical craving. The only way to stop your craving is to keep nicotine out of your body.
4) Understand that addiction is a chemically compelled behavior.Nicotine is a poisonous alkaloid whose commands can be more insistent than rational thought. You respond to these chemical commands, often unconsciously. Ever find a smoking cigarette (or two) in your hand and you can't recall ever having lit them?
5) Make an honest appraisal of your nicotine use.Ask yourself exactly what it is doing for you; then ask yourself what it is not doing for you. If you think using nicotine offers you something, consider if there are healthier ways for you to get any of these perceived benefits. Keep in mind that it is a medical fact that tobacco use affects every organ in your body in a harmful way. Ask yourself whether using nicotine is relaxing you or is it just relieving the tension caused by the chemical craving for nicotine.
6) Don't delay action toward stopping your use of nicotine because you think there are too many pressures in your life. Nicotine and the 4,000 chemicals in processed tobacco (over 40 can cause cancer) are a real pressure on your physical and spiritual life. These substances steadily erode your state of health.
7) Open your life up to new approaches and new possibilities.If you keep going about things in the same old way, how can you realistically expect different results? "If nothing changes, nothing changes."
8) Treat yourself with love and respect rather then by placating yourself with rationalizations.Meetings will help change the way you talk to and treat yourself. Just by reading this you are taking action. Reward yourself in some positive way for each action you take.
9) Write down reasons why you want to be nicotine free rather than thinking about reasons why you "can't quit yet."Don't focus on what you feel you cannot do, but take an action on something that you can do. Move forward toward your goal, no matter how small a step it may be.
10) Quit for yourself.You may have family and loved ones who are urging you to quit using tobacco. This may be helpful, but can sometimes leave a nicotine user annoyed and defensive. Even though your family and loved ones will benefit tremendously from your quitting, it is you who will benefit most. There is a better chance of quitting and staying stopped when we quit for ourselves. Attending meetings helps to raise your hopes and to strengthen your desire to quit.
11) Look at quitting the use of nicotine as giving yourself a precious gift.You are giving yourself a better quality of life, possibly a longer life. You are giving yourself a healthier body. You are giving yourself more self-esteem. You are also giving yourself a clearer sense of your feelings. Recovery is a gift that keeps on giving.
12) Make things easier for yourself. Before quitting, plan your activities for the first few days of abstinence. This way you will not have to make too many decisions during withdrawal.
13) Consider quitting as a challenging adventure.Become willing to go to any length to remove nicotine from your life. We have found that willingness can change a length into a strength. If you are not willing, try praying for the willingness. Even if you still feel hesitant, practice saying aloud, "I am willing to go to any length to be free." Affirm your desire with your voice. If this feels awkward, be willing to feel awkward. Keep moving your willingness forward. The gift is ahead.
14) Imagine letting go of nicotine.Some people use visualizations as an aid in changing. Imagine your pack lifting or drifting away. You may reach out to grab it, okay, but then imagine letting it go again. Sense the release, imagine the relief. Strengthen your willingness with practice. Rehearse for an opening.
15) There is no perfect time to start preparing to quit.
Today is a good day to start. Today you are reading this pamphlet. You may not stop using nicotine today but stay in the process of preparing for the possibility. Seek your own pace to prepare rather than seeking excuses to delay.
16) If you are not going to quit right away, try cutting down.
If you smoke one less cigarette each day that will be seven less per day in a week. However, if this is difficult, remember it is each dose of nicotine that is creating the next craving.
17) Don't minimize the truth or deny the risks even if you are not quitting today.
If this feels uncomfortable, talk about it with a fellow member. Kept in the dark, denial grows like a mold. The truth may be awkward at first, but in time can set you free.
18) Set a quit date.
Give it a try. Remember, it is all right if you don't succeed at first. Just keep trying. The only way you can lose is by ceasing to try.

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2005-01-08T13:25:00.000-08:00

Nicotine User's View of the Twelve StepsBy practicing the Twelve Steps in our daily lives, many of our attitudes change. We begin to appreciate the miracles that are happening within us and around us. We begin to realize that God will help us if we let Him.The following is just one person's views on how the Steps can help anyone attain freedom from nicotine.
Step OneWe admitted we were powerless over nicotine--that our lives had become unmanageable.By first admitting that we are powerless over nicotine, we immediately open the door to receive help. This admission of powerlessness enables us to become more open-minded and willing to accept a strength far greater than our own.For some people this is hard to do, but if we were not powerless over nicotine, then we should be able to smoke any number of cigarettes in any given day--some days two or three, some days a pack or more, some days none at all. Most of us simply cannot do this.The second part of Step One "that our lives had become unmanageable," is easy to prove. If we stop smoking for a few hours, going it alone on pure willpower we soon realize how unmanageable our lives really are. The craving for a cigarette begins to take control of us and we are helpless until we have one.
Step TwoCame to believe that a Power greater than ourselves could restore us to sanity
The first part of this step is coming to believe that there is a "Power greater than ourselves." Many of us already have a belief in a Higher Power that we call God. If we don't have a belief in a Power greater than ourselves, it's important that we at least remain open-minded.Perhaps we have asked God for help in a time of need and have received it. Maybe we were gazing over an ocean at sunset and suddenly had the feeling that there was definitely a Higher Power. Maybe it was when we gave birth to a child and prayed to God that it would be all right. If we find it hard to believe now maybe we can recall some of these times.Coming to believe that God could actually do something for us is the second part of this step. If we can believe that He gave us life, then surely we can believe that He will help us live it as healthy human beings. If we have even a slight amount of faith that God can and will help us, it will open the door.The third part of this step is "restore us to sanity." From what insanity do we have to be restored? We purposely inhale into our lungs a poisonous alkaloid called nicotine. The effects on our bodies from inhaling this substance have been proven over and over to be hazardous to our health, yet we continue to smoke. This is insanity
Step Three Made a decision to turn our will and our lives over to the care of God as we understood Him.
In Step One we admitted that we were powerless over nicotine, and that our lives had become unmanageable. In Step Two we came to believe that a Power greater than ourselves could restore us to sanity.
Step Three is simply making the decision to let God care for us. If we can let Him care for our lives, and we are trying to quit something as harmful to our lives as nicotine, then surely we can believe that He will help us.
By taking these first three steps we open the door to let in the help and strength of a Power greater than ourselves. God is always with us and will help us if we are willing to let Him.
Step FourMade a searching and fearless moral inventory of ourselves.The importance of doing an inventory is to enable us to know ourselves better. By being fearless and searching, we discover our assets and our character defects. Writing out the inventory helps us better to see and understand what we have to deal with.
In this step we begin to clean house. As we discover our reasons for smoking, it becomes easier to eliminate them from our lives. By doing this we strengthen tremendously our chances of staying off cigarettes.
Step FiveAdmitted to God, to ourselves, and to another human being the exact nature of our wrongs.In this step our "house cleaning" continues. We no longer have to hold the burden of our wrongs inside us. When taking this step we might also discover things that could cause us concern in the future.
Getting some of the weight off our shoulders makes it a lot easier to eliminate anxieties and tensions from our lives. Many of the reasons we might use for returning to nicotine are brought out in this step.
By sharing our past with another human being, many things may suddenly seem different. Things that used to stay inside us and cause us to worry and smoke will no longer be our secrets alone.
Step SixWere entirely ready to have God remove all these defects of character.
In Step One we admitted we were powerless over nicotine and in Step Two we came to believe that God could help us. In Step Three we made the decision to let Him care for our lives. Steps Four and Five uncovered our defects of character.
After doing these first five steps, we now have to become willing to let go of our character defects. The willingness to have them removed is the key to Step Six.
It's important to remember that many of our character defects relate directly to our nicotine addiction. By being willing to let go of these character defects, we are greatly increasing our chances of staying off nicotine.
Step SevenHumbly asked Him to remove our shortcomings.
By now we should be somewhat humble. We've admitted we were powerless over nicotine, uncovered our character defects and shared the exact nature of wrongs with someone else.
Now we can ask God to remove our shortcomings. This is trusting God to a high degree. We are asking Him to change us. We are asking Him to remove our fears, our anger, our dishonesty, our jealousy, and everything that might be a shortcoming.
This change that we will undergo will strengthen our character and give us a stronger defense against any harmful addiction that might tempt us.
Step EightMade a list of all persons we had harmed, and became willing to make amends to them all.
In this step even more strength is added to our program. If there is anybody we have harmed in our past, it is important that we get the guilt off our conscience. By making a list we become clear as to exactly who these people are.
In Step Five we may have mentioned some wrongs we've done to specific people in our past. If we have a family, it's likely our nicotine addiction has caused them some worry. There may be people at work who have suffered with our second-hand smoke. Our list should include all persons we have harmed regardless of how much or under what circumstances.
We may want to put ourselves at the top of the list. We are the ones who have probably suffered the most. On a constant basis we have inhaled into our lungs something defined by the dictionary as poisonous. In the truest sense of the word we have done ourselves harm.
Step NineMade direct amends to such people wherever possible, except when to do so would injure them or others.By giving ourselves the gift of being a nonsmoker, we are making amends. This is truly one of the finest gifts we can give ourselves. Our bodies will begin to recover immediately and much of the damage will be completely reversed.
We begin to make amends to our loved ones by showing them that we are caring for ourselves. No longer do they have to fear that we are practicing a deadly habit. Many of our amends will be made by the simple act of quitting.
Making amends in other areas of our life will strengthen our chances of staying off cigarettes for good. This will also give us more self-esteem and more freedom. Self-esteem is what we've been lacking. We should always remember, "We're just too good to be addicted to nicotine."Step TenContinued to take personal inventory and when we were wrong promptly admitted it.
In order to maintain a comfortable state of mind, we have to stay in tune with ourselves and others. By continuing to take a personal inventory we can accomplish this.When defects like anger, fear and jealousy come up we can immediately go back and do a "Seventh Step" on them, asking God to remove these shortcomings.The second part of this step, "when we were wrong promptly admitted it," is essential if we want to stay calm. By doing this we don't let anything build up inside of us that might cause us to smoke.
Step ElevenSought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
When dealing with an addiction as strong as nicotine we need all the help we can get. The help of a power greater than ourselves is available to us through prayer and meditation. By practicing this in our daily lives, we can keep a channel open to our higher power. We can rely on God's strength to help us at any time.The second part of this step, "praying only for knowledge of His will for us," is easy to do. The hard part is understanding what He tells us. We receive knowledge of His will for us in many different ways, though sometimes we overlook the obvious.When we have a cough, or a sore throat from using nicotine, this might be God's way of telling us we're doing something wrong. In whatever form the message comes, we can rest assured that nicotine addiction isn't God's will for us. He wants us to be healthy and He wants us to be free. He doesn't want us to be tied to a substance as dangerous and deadly as nicotine. God's will for us is to stop using nicotine.Once we believe that we are trying to do God's will, we can ask Him for the power to carry it out. When we have a compulsion to use nicotine we can ask Him to take it away. God is always with us and willing to help us.It is important to remember that we have to do the footwork, though, by going to meetings and listening to others with the same problem, we learn about the different methods of quitting, what has worked for some and what hasn't worked for others. We learn about the pitfalls and what to expect. We get group support. There are many things we can do if we are willing.Step TwelveHaving had a spiritual awakening as the result of these steps, we tried to carry this message to nicotine users and to practice these principles in all our affairs.
By the time we have reached Step Twelve a change has taken place. The compulsion to use nicotine has been lifted, not by our own power, but by a power greater than ourselves. This in itself is a spiritual awakening. It's an awakening to a new life, a better and healthier life.