Nitrosamine and nicotine exposure after switching from filtered to unfiltered cigarette smoking: a cross-over clinical trial

Clinical Snapshot

Key Findings

• P Value: Not significant (exact values not provided)

• Effect Size: No significant differences between filtered and unfiltered cigarettes

• Primary Outcome: Urinary cotinine and NNAL biomarker levels

• Nnt Or Sensitivity: Not applicable - no significant treatment effect demonstrated

• Confidence Interval: Not reported in abstract

Clinical Application

Limited by very small sample size and lack of behavioural outcome data Relevant to Australian tobacco control policy discussions, though TGA and ACCC would require larger studies before considering filter ban policies Current cigarette smokers, particularly relevant for policy discussions about filter bans

Abstract

BACKGROUND: The cellulose acetate filter is a plastic attachment on nearly all commercial cigarettes sold worldwide. It is the main component of discarded cigarette butts, and the most prevalent waste item collected during urban and beach cleanups. This waste leaches toxic chemicals, including nicotine, metals and tobacco-specific nitrosamines and contributes to environmental microplastic pollution. There is growing international interest in reducing plastic waste from single-use, non-essential products such as cellulose acetate cigarette filters. Public health and environmental advocates recommend a ban on the sale of filtered cigarettes to reduce environmental pollution caused by discarded cigarette butts and to discourage cigarette smoking. RESEARCH QUESTION: What potential health and behavioural implications might arise among people who smoke if filtered cigarettes are removed from the market. METHODS: We conducted a cross-over, randomised clinical trial of 29 people who smoke to evaluate changes in biomarkers for nicotine and tobacco-specific nitrosamine exposure when switching between filtered and unfiltered cigarette smoking. RESULTS: Although unfiltered smoking showed a higher trend in the geometric means of 4-[(methylnitrosamino])-1-[3-pyridyl]-1-butanol (NNAL) compared with filtered cigarettes, regression models for urinary cotinine and NNAL showed no significant differences when switching between filtered and unfiltered cigarettes. CONCLUSION: This proof-of-principle study suggests there is no increased risk to people who smoke when switching to unfiltered cigarette smoking. Although larger studies might provide more evidence regarding unfiltered cigarette smoking, banning the sale of filtered cigarettes may be an important policy intervention to both reduce hazardous tobacco waste and discourage smoking.

References

1. 1.Appolon, G., Oren, E., Pulvers, K., Romero, D., Hoh, E., Dodder, N. G., Wong, J., Nynas, K., Tracey, L., Lemus, H., & Novotny, T. E. (2024). Nitrosamine and nicotine exposure after switching from filtered to unfiltered cigarette smoking: a cross-over clinical trial. Tobacco Control. https://doi.org/10.1136/tc-2024-058765