A reanalysis of nicotine yield from major brand name cigarettes sold in Massachusetts from 1997 to 2005 has confirmed that manufacturers have steadily increased the levels of this agent in cigarettes. This independent analysis, based on data submitted to the Massachusetts Department of Public Health (MDPH) by the manufacturers, found that increases in smoke nicotine yield per cigarette averaged 1.6 percent each year, or about 11 percent over a seven-year period (1998-2005). Nicotine is the primary addictive agent in cigarettes. In addition to confirming the magnitude of the increase, first reported in August, 2006 by MDPH, researchers from the Harvard School of Public Health (HSPH) extended the analysis to: 1. ascertain how manufacturers accomplished the increase -- not only by intensifying the concentration of nicotine in the tobacco but also by modifying several design features of cigarettes to increase the number of puffs per cigarette. The end result is a product that is potentially more addictive. 2. examine all market categories -- finding that smoke nicotine yields were increased in the cigarettes of each of the four major manufacturers and across all the major cigarette market categories (e.g. mentholated, non-mentholated, full-flavor, light, ultralight). Findings from the report "Trends in Smoke Nicotine Yield and Relationship to Design Characteristics Among Popular U.S. Cigarette Brands" were presented at Harvard School of Public Health, Bldg 3/Rm 203, on Thurs., Jan. 18, 2007. The analysis was performed by a research team from the Tobacco Control Research Program at HSPH led by program director Gregory Connolly, professor of the practice of public health, and Howard Koh, associate dean for public health practice at HSPH and a former commissioner of public health for the Commonwealth of Massachusetts (1997-2003). The other co-investigators were HSPH researchers Hillel R. Alpert and Geoffrey Ferris Wayne. "Cigarettes are finely-tuned drug delivery devices, designed to perpetuate a tobacco pandemic," said former Commissioner Koh. "Yet precise information about these products remains shrouded in secrecy, hidden from the public. Policy actions today requiring the tobacco industry to disclose critical information about nicotine and product design could protect the next generation from the tragedy of addiction." Said Connolly: "Our findings call into serious question whether the tobacco industry has changed at all in its pursuit of addicting smokers since signing the Master Settlement Agreement of 1998 with the State Attorneys General. Our analysis shows that the companies have been subtly increasing the drug nicotine year by year in their cigarettes, without any warning to consumers, since the settlement. Scrutiny by the Attorneys General is imperative. Proposed federal legislation has been filed by Senator Edward Kennedy (D-Ma.) that would address this abuse and bring the tobacco industry under the rules that regulate other manufacturers of drugs." Beginning in 1997, Massachusetts regulations have required an annual report to be filed with the MDPH by all manufacturers of cigarettes sold in Massachusetts. The reported data include machine-based measures of nicotine yield as well as measures of cigarette design related to nicotine delivery. The Tobacco Research Program at HSPH obtained from the MDPH a complete set of brand-specific data from 1997 to 2005 and analyzed trends in smoke nicotine yield. The discovery of an 11 percent increase in nicotine content, said Connolly, confirms recent statements by the US District Court for the District of Columbia that manufacturers have the ability to manipulate addictive additives, and, he said, "it underscores the need for continued surveillance of nicotine delivery in products created by an unregulated industry." In an opinion in US vs. Philip Morris USA et. al. Judge Gladys Kessler wrote that tobacco companies "can and do control the level of nicotine delivered in order to create and sustain addiction" and further, that the "goal to ensure that their products deliver sufficient nicotine to create and sustain addiction influences their selection and combination of design parameters." Cigarette smoking causes an estimated 438,000 premature deaths (or about 1 of every 5 deaths) annually in the U.S., and approximately 900,000 persons become addicted to smoking each year. In conclusion, according to the HSPH researchers, the extended analysis of MDPH data has demonstrated its potential to reveal undisclosed hazards to human health. They suggest that MDPH amend its unique reporting requirements to include more information about cigarette and smokeless tobacco product design features that affect nicotine delivery - as well as testing of a sample of brands for the actual delivery of nicotine to the body. ### Work on the report was supported by funds from The American Legacy Foundation and the National Cancer Institute. Harvard School of Public Health is dedicated to advancing the public's health through learning, discovery, and communication. More than 300 faculty members are engaged in teaching and training the 900-plus student body in a broad spectrum of disciplines crucial to the health and well being of individuals and populations around the world. Programs and projects range from the molecular biology of AIDS vaccines to the epidemiology of cancer; from risk analysis to violence prevention; from maternal and children's health to quality of care measurement; from health care management to international health and human rights. Contact: Robin Herman

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