摘要：Objectives. We compared multiple measures of surveillance of “light” cigarette use, including population use, sales, and design features. Measures were obtained before the 2010 descriptors ban to establish a baseline for future evaluation of the effect of the ban. Methods. We examined light cigarette use, sales, and design using 3 data sets from 2009. We assessed population use using National Survey on Drug Use and Health data. Sales data were drawn from AC Nielsen. We gathered design features, including nicotine concentration, filter ventilation, and weight, from tobacco industry disclosures mandated by the Massachusetts Department of Public Health. Results. In 2009, 52.7% of smokers self-reported light cigarette use, which accounted for 56.0% of cigarettes sold in the United States. Self-reported light smokers were more likely to be female, White, older, and nondaily smokers. Of design features analyzed, only average filter ventilation differed significantly between light and “full-flavored” cigarettes. Conclusions. Assessment of the impact of the descriptors ban and any future policies surrounding light cigarettes should use multiple surveillance strategies, including measures of population use, sales, and cigarette design. Cigarette smoking is the primary cause of preventable morbidity and mortality in the United States, causing more than 400 000 deaths each year. 1 A causal link between smoking and disease was established with the first Surgeon General’s report on smoking in 1964. 2 The ensuing public concerns about smoking and health prompted the tobacco industry to develop so-called “light” and “low-tar” cigarettes, which were promoted as being less harmful than “full-flavor” cigarettes. 3 Consumers were influenced by marketing of light cigarettes, which led smokers to switch to light cigarettes rather than quitting altogether. 4–6 However, manufacturers’ claims were shown to be profoundly misleading, with evidence that light cigarettes offer no health benefits. 3 In 2006, several leading tobacco companies were found by a US federal court to have violated the Racketeer Influenced and Corrupt Organizations Act, citing that, among other actions, the companies knew that light and low-tar cigarettes were no less harmful than full-flavor cigarettes but marketed them as such despite this knowledge. 7 More recent studies performed after the Racketeer Influenced and Corrupt Organizations decision have reported that a substantial proportion of US smokers continue to believe that light cigarettes are less harmful (27.5%), ease quitting (15.2%), and deliver less tar (42.7%). 8 The continued marketing of light cigarettes in the United States is a major public health concern. 3 In a 2006–2007 nationally representative sample of adult smokers, almost half (47%) reported smoking a brand with the text descriptor light or mild. 9 The Federal Trade Commission (FTC) has classified cigarettes using machine-measured tar yields. Cigarettes with tar yields of less than 15 milligrams per cigarette have been classified as lights or ultra lights, and those with yields of 15 milligrams per cigarette or more have been classified as full flavor. 3 Machine smoke-yield methods, including the FTC method, have been criticized as flawed and misleading measures because they have no relationship with actual human exposure to tobacco smoke toxicants. 10 Nevertheless, manufacturers have exploited the flawed machine yield measures to perpetuate the misperception among smokers that certain brands may deliver lower levels of toxicants and thus produce less risk, communicated through the use of text-based light-style descriptors on cigarette packs. Under the classification based on the FTC’s former machine yield method, the domestic market share of light cigarettes increased from 54.2% in 1988 to 81.9% in 1998 and 82.6% in 2008, the most recent year for which data are available. 11 In response to public health concerns, in 2008 the FTC rescinded its support of its machine yield tar measure, explaining that it was confusing and misleading for consumers. 12 In 2009, the Family Smoking Prevention and Tobacco Control Act granted the US Food and Drug Administration (FDA) broad regulatory authority over tobacco products. Public health concerns about deceptive marketing of light cigarettes were addressed in Section 911 of the act, which prohibited manufacturers, as of June 22, 2010, from labeling or advertising cigarettes with misleading text descriptors such as light, low tar, and mild. 13,14 Such terms explicitly communicate the relative risk of a given cigarette compared with its full-flavored counterpart. Evidence from international markets has suggested that similar bans on descriptors that communicate risk have been circumvented by manufacturers who substitute explicit strength descriptors with color schemes or sensory descriptors, such as smooth or mellow, that may also imply reduced risk. 15,16 Thus, when implemented without supporting educational measures, the removal of explicit strength descriptors has been ineffective in changing risk perceptions in the long term. 17 Physical design features inherent to light cigarettes, including high filter ventilation or mentholation, may affect the sensory experience of smoking. 18,19 For example, filter ventilation allows an influx of outside air to mix with smoke as it passes through the filter, thus reducing the temperature and harshness of inhaled smoke. 18 Such features, which can be highly brand specific, may provide the smoker with chemosensory information that implies reduced risk. 20 Research has shown that even when text descriptors are removed from cigarette packaging, certain physical design features may perpetuate smokers’ perceptions of lower risk. 21 Reduced harshness may also make it easier for youths to initiate smoking with light cigarettes 22 and discourage cessation. 23 This evidence has suggested that cigarette manufacturers have used strategies other than light-type pack descriptors to imply lowered risk, including descriptors and colors that instead communicate cigarette design or formulation differences that alter taste, strength, and harshness. 8,9,15,16,17 The effect of removal of US cigarette pack descriptors on smokers’ use of light cigarettes can be empirically assessed. 24 Research needs that have been identified to inform the implementation of the Family Smoking Prevention and Tobacco Control Act include surveillance and evaluation of reported use, persistence of perceptions surrounding light cigarettes (particularly in specific populations, including gender, race/ethnicity, age, etc.), tracking of marketing practices, and expanded characterization of tobacco constituents. 21,25 To address the challenge of surveillance needs surrounding light cigarettes, we sought to simultaneously compare multiple measures, including population use, sales, and design features of light cigarettes. Measures were obtained before the 2010 descriptors ban to provide an assessment of light cigarette use epidemiology before the ban and to establish a baseline for future postban surveillance.
