2. Information on tobacco packages could encourage and help tobacco users to stop using tobacco or find least possible harmful ways of use for those unable to stop.

3. Information on cigarette packs regarding toxic substances Laboratory measurements tell us what the cigarette delivers to a smoking machine. But, how do we know what it delivers to a smoker?

4. Intake of Nicotine The major pieces of scientific background are found in: Jarvis MJ, Boreham R, Primatesta P, Feyerabend C, Bryant A. Nicotine yield from machine-smoked cigarettes and nicotine intakes in smokers: Evidence from a representative population survey. J Natl Cancer Inst. 2001 Jan 17;93(2):134-8.

7. Intake of Nicotine (summary) An individual smoker’s intake of nicotine is NOT determined by the cigarette (as expressed by the machine yield of nicotine). Intake of nicotine is determined by the smoker´s personal need for nicotine (governing the way he smokes in order to get the amount he needs).

8. Intake of other substances Examples of tar intake by a smoker who takes in 1.3 mg nicotine Machine yield Tar intake by Tar Nicotine this smoker Brand 1 (high tar) 9 mg 1.0 mg 11.7 mg

9. Intake of other substances Examples of tar intake by a smoker who takes in 1.3 mg nicotine Machine yield Tar intake by Tar Nicotine this smoker Brand 1 (high tar) 9 mg1.0 mg 11.7 mg Brand 2 (low tar) 6 mg 0.5 mg 15.6 mg 6 / 0.5 = 12 mg tar per mg nicotine (tar/nicotine ratio) 12 (t/n ratio)  1.3 (indiv. nic. dose) = 15.6 mg (indiv. tar dose)

10. Intake of other substances Examples of tar intake by a smoker who takes in 1.3 mg nicotine Machine yield Tar intake by Tar Nicotine this smoker Brand 1 (high tar) 9 mg 1.0 mg 11.7 mg Brand 2 (low tar) 6 mg 0.5 mg 15.6 mg Brand 3 (high tar) 10 mg 0.6 mg 21.7 mg Brand 4 (low tar) 3 mg 0.7 mg 5.6 mg

11. Intake of other substances (summary) The intake of each other substance than nicotine can be described as the amount of that substance that accompanies the smoker-determined amount of nicotine The ”accompanying amount” of a substance is determined by: - the size of the personal nicotine intake - the brand-specific ratio to nicotine for the substance in …question

12. Comparing brands for toxicity Nicotine - No major differences according to brands (since intake is mainly regulated by the smoker) Other substances - Intake can differ between brands according to the brand-specific ratio to nicotine for the substance - The ratios to nicotine are about the same irrespective of the way the cigarette is smoked and can therefore serve as comparative indicators of brand-specific toxicity

13. Possible model for meaningful and truthful ”consumer information” on cigarette packages: Smokers´ intake of nicotine from one cigarette: 0.5 – 2.5 mg, depending (mainly) on HOW it is smoked One mg of nicotine from this cigarette is accompanied by: Tar: 7 mg Carbon monoxide: 8 mg Formaldehyde: 0.05 mg Hydrogen Cyanide: 0.08 mg Benzene: 0.04 mg

14. Data presented to the UK National Smoking Cessation Conference, London, 9-10 June 2005. Bobak A. Perceived safety of nicotine replacement products among general practitioners and current smokers in the UK: impact on utilisation Large proportions (37 %) of the smokers agreed that "Stop smoking products with nicotine are just as harmful as cigarettes". These smokers were slightly less likely to have used NRT in the past and reported being less likely to use it during future quit attempts.

15. “For total mortality, the estimated median relative risks for individual users of LN-SLT were 9% and 5% of the risk associated with smoking for those ages 35 to 49 and ≥50 years, respectively.” “The risks of using LN-SLT products therefore should not be portrayed as comparable with those of smoking cigarettes as has been the practice of some governmental and public health authorities in the past.”

16. 10203040 20 40 60 80 100 Range of health risk levels for smokers of different kinds of cigarettes Range of health risk levels for users of low nitrosamine smokeless tobacco Health risk level for non-tobacco users Schematic comparison of risk levels (arbritrary scale)

17. Summary (1) Product description labelling should make clear that: Intake of nicotine from a cigarette can be anything in a wide range and is determined (mainly) by the way the smoker smokes to adjust to his need for nicotine (while machine yield figures are irrelevant) Intake of other substances (and subsequent health risks) do to some extent depend on the cigarette also (the brand-specific yield ratio to nicotine for the substance in question)

18. Summary (2) Health information messages on tobacco packages should, in addition to traditional ”health warnings”, make clear that: The major disease causing substances are the combustion products in tobacco smoke, not the nicotine Nicotine cessation aids and low nitrosamine smokeless tobacco products are much less harmful to health than any cigarette