About smoking

At British American Tobacco, we have long accepted that smoking is risky. Our business is not about persuading people to smoke; it is about offering quality brands to adults who have already taken the decision to smoke. e strongly believe that smoking should only be for adults who are aware of the risks. !n a nutshell, our view on smoking is this" British American Tobacco companies produce fine quality products that provide pleasure to many millions of adult smokers around the world. Along with the pleasures of cigarette smoking come real risks of serious diseases. We also recognise that, for many people, smoking is difficult to quit. Smoking is a cause of various serious and fatal diseases such as lung cancer, respiratory disease and heart disease. The risks associated with smoking are primarily defined by epidemiological population statistical! studies that show that groups of lifetime smokers have far higher incidence of certain diseases than comparable groups of non"smokers. These risks tend to be greater in groups that start smoking younger, smoke for longer, and smoke more cigarettes per day. The statistics, however, do not tell us whether a particular individual smoker will avoid an associated disease by smoking less. and all smoking behaviours are associated with significantly increased health risks. Studies also show that the only way to avoid smoking"related risks is not to smoke in the first place, and the best way to reduce the risks is to quit. There is more about the health risks in #ealth risks of smoking. #lick on the drop"down navigation bar.

$an people quit smoking%

&moking can be hard to quit. #owever, we believe it is important that smokers who decide to quit realise they can, provided they have the motivation to quit and the belief that they can. $any smokers are said to be dependent on cigarettes because they know the real risks of disease involved but still smoke frequently and find it very difficult to quit. %t has been known for centuries that smoking is difficult to quit. &nder international definitions for determining whether people are dependent on smoking, including those from the World 'ealth (rganisation, many smokers would be classified as

being dependent. 'owever, millions of smokers have quit without any medical help, and millions have modified how often, where and when they smoke in the light of differing social norms. %n some countries, such as the &), there are now as many e*"smokers as smokers. While smoking is commonly understood to be addictive, we believe it is important that smokers who decide to quit realise they can, provided they have the motivation to quit and the belief that they can. We believe that if you want to quit, you should. +arious ways have been suggested to help people quit, including using ,nicotine replacement therapy- patches and gums!. While all these forms of assistance may be beneficial, the most important factors in successfully quitting are having the motivation to quit and the self"belief that you can do so.

#ealth risks of smoking

Along with the pleasures of smoking there are real risks of serious diseases such as lung cancer, respiratory disease and heart disease, and for many people, smoking is difficult to quit. Smoking is a cause of various serious and fatal diseases, including lung cancer, emphysema, chronic bronchitis and heart diseases. &tudies The health risks of smoking are derived from epidemiology. .pidemiology is a statistically based science, dealing with risks among large groups of people, rather than with individuals. Through questionnaires and observations of people, epidemiological studies can identify the incidence of disease in a given group, such as smokers, and compare it with the incidence in another group, such as non" smokers. (ver many years, epidemiological studies have consistently reported a much higher incidence of certain diseases among smokers compared with non"smokers. The studies also report that the risks are reduced after quitting and that quitting earlier has by far the best effect on reducing risks. Traditionally, epidemiology has been used to identify associations that point to possible causes of a disease, providing direction for thorough laboratory investigations. With smoking, the many laboratory investigations over the years have proved more problematic, and science has not to date been able to identify

biological mechanisms which can e*plain with certainty the statistical findings linking smoking and certain diseases, nor has science been able to clarify the role of particular smoke constituents in these disease processes. This means that science is still to determine which smokers will get a smoking related disease and which will not. /or can science tell whether any individual became ill solely because they smoked. This is, in part, because all the diseases that have been associated with smoking also occur in life"long non"smokers. We do not point out these scientific limitations to cast doubt that smoking is a cause of serious disease. An important point is that the lack of complete understanding about the biological aspects of the disease mechanisms, and the role of particular smoke constituents, creates uncertainty for efforts to design less harmful cigarettes. (ur own work for many years has included, and still includes, research into less harmful cigarettes. We remain committed to this work, although the scientific uncertainties make it a ma0or challenge.

'nvironmental tobacco smoke

The orld #ealth Organisation and various other public health bodies have reported that e(posure to environmental tobacco smoke )'T&*, sometimes called +passive smoking+, is a cause of various diseases. The risks they report are far lower than those associated with active smoking, but are said to be large enough to make public smoking an important public health issue. Our view of the science is that 'T& e(posure is associated with various short term health impacts, such as e(acerbating symptoms in asthmatics and respiratory illnesses in children. The science on 'T& and chronic diseases, such as lung cancer and heart disease, is in our view not definitive and at most suggests that if there is a risk from 'T& e(posure, it is too small to measure with any certainty. &o while we understand and support measures to reduce involuntary e(posure to 'T&, we do not believe that blanket bans on public and workplace smoking are fair or necessary, as there are more practical solutions based on air quality standards. hat is 'T&% Technically, it is an 1aged1, diluted mi*ture of sidestream smoke from smouldering cigarettes! and e*haled mainstream smoke from smokers puffing!. ,a-or studies .ung cancer" $ost studies looking at whether .TS increases the risk of lung cancer have compared non"smoking women married to smokers with non"smoking women married to non"smokers. The ma0ority of such studies have reported small increases in risk, though most have not been statistically significant. (ne of the

largest studies on .TS and lung cancer, undertaken by the World 'ealth (rganisation W'(!, found small increases in lung cancer risk that were typically not statistically significant for growing up, living, working, travelling or socialising with a smoker. #eart disease" The most substantial sources of data on .TS and heart disease are two huge databases of the American #ancer Society1s #ancer 2revention Study, and the database of the &S /ational $ortality 3ollowback Survey. Although other studies have reported small increases in risk, analyses of the ma0or &S research databases have reported no overall association between .TS and heart disease. /espiratory disease" .pidemiological studies on .TS and respiratory disease in adults, taken overall, do not show an increase in risk. #linical studies with adults suffering, for e*ample, from asthma have had difficulty in prompting a measurable response, though clearly some asthmatics do have adverse reactions to smoky environments. 4uite a large number of studies report a statistically significant increase in respiratory symptoms in pre"school children e*posed to .TS at home. (ther studies have suggested a relationship between parental smoking and sudden infant death syndrome. Whether or not passive smoking plays a causal role in this, we believe it makes sense not to smoke around infants and young children. We also believe smokers should be considerate towards people who suffer from respiratory problems such as asthma, and who may regard themselves as particularly sensitive to .TS. There is more about associations between actual smoking and diseases mentioned here in The primary health issues. There is more about the practical solutions that we believe show the way forward in /egulation" 0ublic place smoking restrictions.

About smokeless snus and health

e are trialling smokeless &wedish1style snus in two test markets in &outh Africa and &weden because some research has indicated that it is much less harmful than cigarettes. The move is in line with our continuing efforts in harm reduction and a response to those public health stakeholders who told us they believe that snus, properly regulated, can contribute to reducing the health impact of tobacco use. hat is snus% Snus is not smoked. %t is finely"ground moist tobacco that comes either loose or in tiny sachets 5 a bit like miniscule tea"bags 5 that are placed under the upper lip and typically held in the mouth for about 67 minutes before being discarded. The snus we are trialling is the sachet"type. Snus has a long history in Sweden and amongst Swedish men is now more popular than smoking.

Smokeless does not mean harmless and the best way to avoid the risks associated with consuming tobacco is not to consume it at all. 'owever, there are indications that the use of snus in Sweden has had a positive effect on lessening the impact of smoking on public health. Sweden has the highest consumption of smokeless tobacco per capita in the world and it has been found there that as snus use has increased, cigarette consumption has fallen. $ore than 89 per cent of men in Sweden use snus regularly, while fewer than :9 per cent smoke. ;ong"term studies have shown that Swedish men now have among the lowest lung cancer rates in the world. %n manufacturing snus, it is heated in a process similar to pasteurisation. This reduces the formation of nitrosamines, which are chemicals that are potentially carcinogenic and have historically been found at relatively high levels in other forms of oral tobacco, such as some types of chewing tobacco. %n 877<, the Swedish /ational 3ood Administration Service reported research showing that nitrosamines in Swedish snus had fallen by around =9> over 87 years. hat health studies show Some independent researchers say that low"nitrosamine Swedish snus is much safer than smoking. Studies of snus use in Sweden suggest it leads to no increase in risk for lung cancer and chronic obstructive pulmonary disease, two diseases strongly associated with cigarette smoking. This is not surprising, as consuming snus does not involve inhaling smoke. While research on various other forms of smokeless tobacco has found associations with oral cancer, research to date on snus in Sweden suggests no increase in risk overall. ?esearch on snus and heart disease is less clear, though any risks associated with snus use again seem lower than the risks associated with cigarette smoking. Snus releases about the same amount of nicotine a smoker would get from a cigarette, so it is assumed that some snus users would be defined as being dependent. 'owever, it-s the smoke generated from burning tobacco that presents the serious risk to health for smokers. /icotine is a stimulant, like caffeine, that can cause dependency and has effects on blood pressure. /ot enough science e*ists to compare difficulty in quitting for cigarette smokers and people who use snus.