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Year : 2014  |  Volume : 139  |  Issue : 2  |  Page : 328-329

WHO Study Group on Tobacco Product Regulation

7, Yugprabhat Society Siteladevi Temple Road Mahim, Mumbai 400 016, India

Date of Web Publication9-Apr-2014

Correspondence Address:
Rajani Bhisey
7, Yugprabhat Society Siteladevi Temple Road Mahim, Mumbai 400 016
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Source of Support: None, Conflict of Interest: None

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How to cite this article:
Bhisey R. WHO Study Group on Tobacco Product Regulation. Indian J Med Res 2014;139:328-9

How to cite this URL:
Bhisey R. WHO Study Group on Tobacco Product Regulation. Indian J Med Res [serial online] 2014 [cited 2021 May 6];139:328-9. Available from:

- Report on the Scientific Basis of Tobacco Product Regulation: Fourth Report of a WHO Study Group, WHO Technical Report Series, No. 967 (World Health Organization, Geneva, Switzerland) 2012. 88 pages. Price: CHF 30.00 / US$ 36.00; in developing countries: CHF 21.00 / US$ 25.40

ISBN 978-92-4-120967-0

Tobacco use and its ensuing dependence is a major cause of human mortality and morbidity all over the world. Earlier meetings on tobacco product regulation had addressed topics such as prevention and control of tobacco use, tobacco industry legislation, tobacco control campaigns, tobacco chemistry, and adverse effects of heavy metal exposure. The book under review is the outcome of discussions of the international group of experts that met in Buenos Aires, Argentina during November 22-24, 2012, at the sixth meeting of the WHO Study Group to formulate policy for regulating tobacco products and control dependence on tobacco.

Voluminous information is available on addictive, toxic and carcinogenic components present in smokeless tobacco products and tobacco smoke. In addition to chemical moieties, tobacco contains a large number of toxic metals. In the sixth meeting, the WHO Work Group members assessed data on heavy metals in tobacco (smokeless tobacco used orally or as cigarette filler) and in cigarette smoke and pathologies induced by exposure to heavy metals in tobacco, tobacco smoke and smoke particulates. Another topic discussed was the need and ways to be adopted for reducing dependence potential of tobacco products.

The book comprises two advisories. "Recommendations on toxic elements in tobacco and in cigarette smoke" and "Recommendations on the basis for a regulatory framework to reduce the dependence potential of tobacco products". The advisory on "Toxic elements in tobacco and cigarette smoke" addresses health risks caused by heavy metals in tobacco products and provides a platform for formulating regulatory framework. Heavy metals in tobacco include Aluminium (Al), Arsenic (As), Barium (Ba), Beryllium (Be), Cadmium (Cd), Chromium (Cr), Copper (Cu), Iron (Fe), Lead (Pb), Manganese (Mn), Mercury (Hb), Nickel (Ni), and Cobalt (Co). Radioactive Polonium-210 present in trace amounts in tobacco filler may also pose a threat due to exposure to α radiation. Metals like Al, As, Be, Cd, Cr and Ni are designated by the International Agency for Research on Cancer (IARC) as Group 1 carcinogens.

Metalloids in tobacco are known to exert adverse health effects. Occupational exposure to Al has been shown to result in chronic bronchitis, pneumoconiosis, and pulmonary fibrosis in workers. Arsenic is absorbed by oral or inhalation routes causing cancer of the lung and skin and drinking of well water containing high amounts of As is known to cause skin lesions. An important finding is that the level and the risk of developing skin lesions were higher in tobacco users than in non-users, presumably due to additional exposure from As present in tobacco products. Although low levels of beryllium were found in tobacco and tobacco smoke, it is believed to cause lung inflammation among smokers and oral or GI tract inflammation among oral users of tobacco. Concentration of Cd is the highest of all metalloids in tobacco and it is known to remain in the body for a long time. It is highly toxic to kidney, bone and neural tissues and blood circulatory system. Cd concentration was reportedly higher in blood and scalp hair of chewers of tobacco and areca nut or betel quid than non tobacco users. High levels of intra- or extracellular Fe were found in alveolar lavage samples from healthy smokers and those with chronic bronchitis as compared to samples from non-smokers. Tissue concentrations of Pb, a highly neurotoxic metal, were found to be higher in lung tissues of smokers and in breath condensate of smokers with chronic obstructive pulmonary disease (COPD) than that of non-smoking controls. Ni, a Group 1 IARC human carcinogen, and Co may cause epidermal and oral allergies, contact dermatitis, pulmonary inflammation, pneumoconiosis and asthma. Metals such as Ba, Cr, Co, Hg, Ni were found to cause oral allergic contact stomatitis in smokeless tobacco users, and Co levels were higher in scalp hair of oral cancer patients, users of chewing tobacco with areca nut or betel quid than in those who did not use tobacco. Metals and other irritants in tobacco are absorbed easily in the oral cavity. Metals from tobacco have also been shown to be extrac[Table 1]n artificial saliva. Therefore, it is reasonable to attribute chronic oral inflammation caused by consumption of smokeless tobacco products to metals alone or in combination with other tobacco constituents.

The Work Group assessed data on influence of metals in tobacco smoke on human health. The analysis revealed that metals in tobacco smoke particulates can cause airway sensitization and inflammation as a result of uptake by epithelial cells. Exposure to smoke particulates has been shown to result in generation of oxidative stress and tissue inflammation due to activity of neutrophils, macrophages, dendritic cells, eosinophils and basophils.

Data screened by the Work Group also showed that smoking-induced COPD was associated with exposure to heavy metals. High concentration of Al, Cd, Pb in breath condensate of patients with COPD established a link between exposure to metals by tobacco smoking and induction of pulmonary pathology. These findings led the Work group to conclude that besides inducing cancer of the oral cavity and lung cancer, exposure to smokeless tobacco and tobacco smoke cause pathological changes in the oral cavity and airways tract. The Work Group also debated on factors that contribute to tobacco dependence. The committee members opined that regulation of product design and reduced attractiveness of the packages made for their sale is likely to improve public health by reducing initiation to tobacco use among youth. Another conclusion was that "the dependence producing effect of nicotine can be manipulated by designs that increase or decrease the amount and speed of nicotine delivery and absorption."

The committee members, however, have refrained from stating how this objective can be achieved, or what measures are necessary to compel manufacturers of tobacco products to reduce nicotine content. However, the proposal on ban of low nicotine products that attract non-users to tobacco smoking together with making product packages less attractive seems feasible.

An important point that should have been debated by the Work Group members while considering tobacco dependence refers to feasibility of reducing free nicotine content and alkaline substances in tobacco products. This needs to be investigated as free or unionized form of nicotine is most rapidly and easily absorbed in the oral mucosa particularly in the presence of alkaline agents.

This Report projects new ideas on toxic effects of metals present in smokeless tobacco including cigarette fillers and cigarettes smoke. The Report is recommended to those interested in all aspects of tobacco research including tobacco control. Scientists interested in various aspects of tobacco research will find new directions in this Report. Accurate estimation of metalloids in various smokeless tobacco products, bidis and cigarettes manufactured in India and their effect on health parameters will help understand their role in the Indian context. Additionally, experimental studies are required to understand the contribution of metals individually and together with other irritants and carcinogens in smokeless tobacco and tobacco smoke in cancer development.


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