Abstract

Tobacco-related diseases kill eight million people worldwide ever year and are responsible for thousands of cases of cancer, cardiovascular disease and other illnesses in Brazil. Cigarette filters are believed by many to reduce the health risks of smoking. This article outlines the history of the technology of filters and discusses the impacts of these cigarette design features and their regulation. We conducted a literature review to assess the impacts of this technology. The results show that filters were initially developed for aesthetic purposes and later improved and marketed as a harm reduction technology. The most widely-used filters are those made of cellulose acetate with or without activated carbon. Despite smokers’ beliefs and advertising claims, filters have no health benefits and filter tip ventilation can increase the health risks of smoking. Filters can also make cigarettes more appealing and cause significant environmental impacts. Cigarette filters have no health benefits and lull smokers into a false sense of security and should therefore be banned.

Key words
The tobacco industry; Control and supervision of tobacco derived products

Introduction

Tobacco-related diseases kill eight million people every year. In other words, the consumption of tobacco and its derivatives kills more people than AIDS, cocaine, heroin, alcohol, suicide and road traffic accidents put together1.

Every year in Brazil smoking is responsible for around 156,000 deaths, 1,103,421 medical procedures, 157,000 acute myocardial infarctions, 75,000 strokes and 63,000 cases of cancer²2 Pinto MT, Pichon-Riviere A, Bardach A. Estimativa da carga do tabagismo no Brasil: mortalidade, morbidade e custos. Cad Saude Publica 2015; 31(6):1283-1297..

It is therefore natural that smokers seek ways of reducing tobacco impacts, and cigarette filters are believed by many to reduce the risks of inhaling cigarette smoke³3 Hastrup J, Cummings K, Swedrock T, Hyland A, Pauly J. Consumers' knowledge and beliefs about the safety of cigarette filters. Tob Control 2001; 10(1):84.^–55 Czoli CD, Hammond D. Cigarette packaging: Youth perceptions of "natural" cigarettes, filter references, and contraband tobacco. J Adolesc Health Off Publ Soc Adolesc Med 2014; 54(1):33-39.. In addition, some cigarette manufacturers claim that filters are capable of reducing the emission of certain tobacco smoke toxins, without however linking this decrease to reduced health risks⁶6 BAT Science. Filters [Internet]. [cited 2019 Apr 2]. Available from: https://www.bat-science.com/groupms/sites/BAT_9GVJXS.nsf/vwPagesWebLive/DO7AXGBN
https://www.bat-science.com/groupms/site... . Some authors point out that the tobacco industry markets filters as a technology that makes cigarettes safer and less toxic. Filters are the main technology used by companies in so-called “light” or low-tar cigarettes⁷7 Pollay RW, Dewhirst T. The dark side of marketing seemingly "Light" cigarettes: successful images and failed fact. Tob Control 2002 Mar 1; 11(supl. 1):i18-31..

However, independent studies have shown that filters do not reduce the health risks of smoking (and in some cases may even increase the risks), but rather are used to boost cigarette consumption and attract new smokers and have a significant environmental impact⁸8 Hoffmann I. The changing cigarette, 1950-1995. J Toxicol Environ Health A 1997; 50(4):307-364.^–1212 Novotny TE, Slaughter E. tobacco product waste: an environmental approach to reduce tobacco consumption. Curr Environ Health Rep 2014;1(3):208-216..

In light of the above, this article outlines the history of the technology of filters and discusses the impacts of these cigarette design features and their regulation.

Methods

Data sources

Between April and May 2019, we conducted a literature review using the PubMed database search engine as our main source. We included relevant articles cited in publications retrieved by the search. We also searched cigarette manufacturers’ websites, news websites and blogs.

Non-peer reviewed publications were also included because they can often provide information that is not available in peer-reviewed literature, such as how filters are used in marketing and the current technologies on the Brazilian market.

Data selection, extraction and synthesis

We searched for publications and documents in English and Portuguese related to cigarette design and marketing, filter technology and new types of filter. The search focused on toxic emissions, perceptions and use, health and environmental impacts, and relevant legislation.

The search was performed using the snowball method with a combination of initial keywords (cigarette and filter), keywords related to filter design features (capsules, filter ventilation, additives, design), and terms relevant to the initial keywords (emissions, marketing, flavor, among others). The search was not restricted to a specific period or geographical region.

Results

The final sample consisted of 93 articles (93 with the terms “cigarette filter”, 14 with the term “cigarette filter ventilation”, eight with the terms “cigarette filter capsules”, 14 with the terms “cigarette filter additives” and 18 with the term “cigarette filter design”) and 15 documents.

History

Cigarette filters were introduced in 1860 to prevent pieces of tobacco from entering the smoker’s mouth and keep the lips moist, being mainly targeted at women¹³13 Gene Borio. Tobacco History Timeline [Internet]. 2001 [cited 2019 Feb 27]. Available from: http://archive.tobacco.org/History/Tobacco_History.html
http://archive.tobacco.org/History/Tobac...

14 Kennedy P. who made that cigarette filter? The New York Times [Internet]. 2012 [cited 2018 Mar 12]. Available from: https://www.nytimes.com/2012/07/08/ magazine/who-made-that-cigarette-filter.html
https://www.nytimes.com/2012/07/08/ maga... ^-1515 Pauly JL, Mepani AB, Lesses JD, Cummings KM, Streck RJ. Cigarettes with defective filters marketed for 40 years: what Philip Morris never told smokers. Tob Control 2002; 11(Supl. 1):I51-61.. In 1936, filters were called “beauty tips”, making it clear who the target audience was. They were originally made of cork and, even to this day, many filters simulate this material to preserve this appearance¹⁴14 Kennedy P. who made that cigarette filter? The New York Times [Internet]. 2012 [cited 2018 Mar 12]. Available from: https://www.nytimes.com/2012/07/08/ magazine/who-made-that-cigarette-filter.html
https://www.nytimes.com/2012/07/08/ maga... .

By this time, a process for making filters from crepe paper had already been patented and, in 1935, a machine that produced filtered cigarettes was developed¹⁶16 Tobacco Asia. The History of Filters [Internet]. Web Archive (recovered). 2003 [cited 2019 Apr 2]. Available from: https://web.archive.org/web/20030824115139/ http://www.tobaccoasia.com/news.asp?id=534
https://web.archive.org/web/200308241151... , increasing the scale of production.

However, the filtered cigarette only became popular in the 1960s in response to scientific evidence showing the damage caused by smoking. Tobacco company advertising contained claims that filtered cigarettes were safer, even using doctors in their ad campaigns. Various types of cigarette filters were developed at this time, capitalizing on public concern about the harmful effects of tobacco, with some filters containing asbestos. By 1980, filtered cigarettes accounted for more than 90% of cigarette sales⁸8 Hoffmann I. The changing cigarette, 1950-1995. J Toxicol Environ Health A 1997; 50(4):307-364.^,1313 Gene Borio. Tobacco History Timeline [Internet]. 2001 [cited 2019 Feb 27]. Available from: http://archive.tobacco.org/History/Tobacco_History.html
http://archive.tobacco.org/History/Tobac... .

In response to public health concerns, the tobacco industry prioritized successful marketing campaigns focused on filtered cigarettes. For example, at the beginning of the 1920s, Marlboro was a women’s cigarette and was taken off the market during World War II. In the middle of the 1950s, the brand was reintroduced as a men’s cigarette with a filter, symbolized by the famous Marlboro man and later becoming one of the world’s best-selling brands¹⁷17 Stevenson T, Proctor RN. The SECRET and SOUL of Marlboro. Am J Public Health 2008; 98(7):1184-1194..

At the beginning of the 1970s, the tobacco industry introduced filter tips with perforations designed to dilute mainstream tobacco smoke. On the basis of machine smoking conditions, perforated cigarettes showed lower nicotine, tar and carbon monoxide yields⁸8 Hoffmann I. The changing cigarette, 1950-1995. J Toxicol Environ Health A 1997; 50(4):307-364.^,1818 Talhout R, Richter PA, Stepanov I, Watson CV, Watson CH. cigarette design features: effects on emission levels, user perception, and behavior. Tob Regul Sci 2018; 4(1):592-604.^,1919 Song M-A, Benowitz NL, Berman M, Brasky TM, Cummings KM, Hatsukami DK, Marian, C, O'Connor R, Rees VW, Woroszylo C, Shields,PG. Cigarette filter ventilation and its relationship to increasing rates of lung adenocarcinoma. J Natl Cancer Inst [Internet]. 2017; 109(12). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6059254/
https://www.ncbi.nlm.nih.gov/pmc/article... . However, machine-based measures of chemicals from cigarettes with ventilation holes do not accurately reflect actual smoking because smokers block the holes with their fingers and lips, being used by the industry to support spurious health claims in “light” or “mild” cigarette advertising⁸8 Hoffmann I. The changing cigarette, 1950-1995. J Toxicol Environ Health A 1997; 50(4):307-364.^,2020 Russell MA, Jarvis MJ, Feyerabend C, Saloojee Y. Reduction of tar, nicotine and carbon monoxide intake in low tar smokers. J Epidemiol Community Health 1986; 40(1):80-85.

21 Benowitz NL, Hall SM, Herning RI, Jacob P, Jones RT, Osman AL. Smokers of low-yield cigarettes do not consume less nicotine. N Engl J Med 1983; 309(3):139-42.

22 Herning RI, Jones RT, Bachman J, Mines AH. Puff volume increases when low-nicotine cigarettes are smoked. Br Med J Clin Res Ed 1981; 283(6285):187-189.^-2323 Kozlowski LT, Rickert WS, Pope MA, Robinson JC, Frecker RC. estimating the yield to smokers of tar, nicotine, and carbon monoxide from the 'lowest yield'ventilated filter-cigarettes. Br J Addict 1982; 77(2):159-165..

These days, filters come in a range of colors and have various design features, including additives, adjustable filters and flavor capsules⁴4 Ford A, Moodie C, MacKintosh AM, Hastings G. Adolescent perceptions of cigarette appearance. Eur J Public Health 2014; 24(3):464-468.^,88 Hoffmann I. The changing cigarette, 1950-1995. J Toxicol Environ Health A 1997; 50(4):307-364.^,2424 Moodie C, Angus K, Mitchell D, Critchlow N. How tobacco companies in the United Kingdom prepared for, and responded to, standardised packaging of cigarettes and rolling tobacco. Tob Control 2018; 27(e1):e85-92..

Type of filters and associated technologies

Various materials have been used or suggested for use as cigarette filters besides cork and crepe paper, including natural and synthetic foams and sponges, resins, special papers, cotton, silk, flax, corn silk and other natural fibers, synthetic fibers, absorbent granules and powders, aluminum oxides and salicylate, and fine-cut tobacco⁸8 Hoffmann I. The changing cigarette, 1950-1995. J Toxicol Environ Health A 1997; 50(4):307-364..

The materials that most grabbed our attention were commercially produced filters with asbestos, due to its high toxicity²⁵25 Longo WE, Rigler MW, Slade J. Crocidolite asbestos fibers in smoke from original Kent cigarettes. Cancer Res 1995; 55(11):2232-2235., and a patent for a cheese-filter with or without activated carbon, which appears not to have been commercially produced²⁶26 Stebbings SM. Cheese-filter cigaret [Internet]. US3234948A, 1966 [cited 2019 Apr 2]. Available from: https://patents.google.com/patent/US3234948A/en
https://patents.google.com/patent/US3234... .

The most widely-used filters these days are those made of cellulose acetate treated with triacetin or combined with activated carbon⁶6 BAT Science. Filters [Internet]. [cited 2019 Apr 2]. Available from: https://www.bat-science.com/groupms/sites/BAT_9GVJXS.nsf/vwPagesWebLive/DO7AXGBN
https://www.bat-science.com/groupms/site... ^,88 Hoffmann I. The changing cigarette, 1950-1995. J Toxicol Environ Health A 1997; 50(4):307-364..

The efficiency of filters made of cellulose acetate fiber in reducing particulate matter is influenced by a range of factors, including size, circumference, number of fiber filaments, and use of additives in the fibers. Cellulose acetate filters with active carbon are designed to selectively remove tobacco smoke toxins⁸8 Hoffmann I. The changing cigarette, 1950-1995. J Toxicol Environ Health A 1997; 50(4):307-364.^,2727 Hoffmann D, Hoffmann I, Wynder EL. Lung cancer and the changing cigarette. IARC Sci Publ 1991; (105):449-459..

The articles and documents reveal that the tobacco industry uses cigarette filters to produce “elastic” cigarettes, which deliver higher toxin yields for smokers than would be expected from standard machine smoked tests. The underestimation of actual smoke exposure gives the impression that “light” cigarettes emit less toxins than conventional cigarettes²⁸28 Kozlowski L, O'Connor R. Cigarette filter ventilation is a defective design because of misleading taste, bigger puffs, and blocked vents. Tob Control 2002; 11(Supl. 1):i40-50.

29 Kozlowski LT, O'Connor RJ. Official cigarette tar tests are misleading: use a two-stage, compensating test. Lancet Lond Engl 2000;355(9221):2159-2161.

30 Hurt RD, Robertson CR. Prying open the door to the tobacco industry's secrets about nicotine: the Minnesota Tobacco Trial. JAMA 1998; 280(13):1173-1181.^-3131 Martin Jarvis, Clive Bates. Why Low Tar Cigarettes Don't Work and How the Tobacco Industry Has Fooled the Smoking Public. [Internet]. London: Action on Smoking and Health - ASH; 1999[cited 2017 Dec 28] p. 13. Available from: http://ash.org.uk/information-and-resources/tobacco-industry-information-and-resources/low-tar-cigarettes/
http://ash.org.uk/information-and-resour... .

Filters and smokers’ health

Smokers believe that the risks of smoking are lower with filtered cigarettes⁹9 Harris B. The intractable cigarette "filter problem." Tob Control 2011; 20 Supl. 1:i10-16.^,1515 Pauly JL, Mepani AB, Lesses JD, Cummings KM, Streck RJ. Cigarettes with defective filters marketed for 40 years: what Philip Morris never told smokers. Tob Control 2002; 11(Supl. 1):I51-61.^,3232 O'Connor RJ, Caruso RV, Borland R, Cummings KM, Bansal-Travers M, Fix BV, King B, Hammond D, Fong GT. Relationship of Cigarette-Related Perceptions to Cigarette Design Features: Findings From the 2009 ITC U.S. Survey. Nicotine Tob Res 2013;15(11):1943-1947., despite evidence to the contrary (especially in relation to cigarettes with filter tip ventilation)¹⁹19 Song M-A, Benowitz NL, Berman M, Brasky TM, Cummings KM, Hatsukami DK, Marian, C, O'Connor R, Rees VW, Woroszylo C, Shields,PG. Cigarette filter ventilation and its relationship to increasing rates of lung adenocarcinoma. J Natl Cancer Inst [Internet]. 2017; 109(12). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6059254/
https://www.ncbi.nlm.nih.gov/pmc/article... ^,3333 Stellman SD, Muscat JE, Hoffmann D, Wynder EL. Impact of filter cigarette smoking on lung cancer histology. Prev Med 1997; 26(4):451-456..

Filters and perforated filter tips led to the emergence of the so-called low-tar or “light” and “ultra-light” cigarettes¹⁹19 Song M-A, Benowitz NL, Berman M, Brasky TM, Cummings KM, Hatsukami DK, Marian, C, O'Connor R, Rees VW, Woroszylo C, Shields,PG. Cigarette filter ventilation and its relationship to increasing rates of lung adenocarcinoma. J Natl Cancer Inst [Internet]. 2017; 109(12). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6059254/
https://www.ncbi.nlm.nih.gov/pmc/article... . The health claims in advertising and health professionals’ beliefs that filtered cigarettes were “healthier” than unfiltered cigarettes, meant that that the former have come to be preferred by smokers, especially those concerned about their health³⁴34 Centers for Disease Control and Prevention. The health consequences of smoking: a report of the surgeon general [Internet]. Washington, D.C: Dept. of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2004 [cited 2019 Apr 2]. Report No.: ISBN 0-16-051576-2. Available from: http://www.cdc.gov/tobacco/data_statistics/sgr/2004/
http://www.cdc.gov/tobacco/data_statisti...

35 Jarvis MJ, Boreham R, Primatesta P, Feyerabend C, Bryant A. Nicotine yield from machine-smoked cigarettes and nicotine intakes in smokers: evidence from a representative population survey. J Natl Cancer Inst 2001; 93(2):134-138.

36 Institute of Medicine, Stratton K, Shetty P, Wallace R, Bondurant S, editors. Clearing the Smoke: assessing the science base for tobacco harm reduction. 1 edition. Washington, D.C: National Academies Press; 2001. 656 p.^-3737 World Health Organization (WHO). Scientific Advisory Committee on Tobacco Product Regulation, WHO Tobacco Free Initiative. SACTob recommendation on health claims derived from ISO/FTC method to measure cigarette yield [Internet]. Geneva: WHO; 2003 [cited 2019 Apr 2]. Available from: https://apps.who.int/iris/handle/10665/42779
https://apps.who.int/iris/handle/10665/4... . These technologies also reduce the irritation caused by cigarette smoke, resulting in lower perceived risk¹⁹19 Song M-A, Benowitz NL, Berman M, Brasky TM, Cummings KM, Hatsukami DK, Marian, C, O'Connor R, Rees VW, Woroszylo C, Shields,PG. Cigarette filter ventilation and its relationship to increasing rates of lung adenocarcinoma. J Natl Cancer Inst [Internet]. 2017; 109(12). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6059254/
https://www.ncbi.nlm.nih.gov/pmc/article... ^,2828 Kozlowski L, O'Connor R. Cigarette filter ventilation is a defective design because of misleading taste, bigger puffs, and blocked vents. Tob Control 2002; 11(Supl. 1):i40-50..

Studies show that the use of filters and perforations increases health impacts as smokers change their puffing patterns to increase the volume of smoke to obtain adequate levels of nicotine. This increase in puff volume leads to higher toxin intake, resulting in a greater impact on smokers’ health²⁸28 Kozlowski L, O'Connor R. Cigarette filter ventilation is a defective design because of misleading taste, bigger puffs, and blocked vents. Tob Control 2002; 11(Supl. 1):i40-50.

29 Kozlowski LT, O'Connor RJ. Official cigarette tar tests are misleading: use a two-stage, compensating test. Lancet Lond Engl 2000;355(9221):2159-2161.

30 Hurt RD, Robertson CR. Prying open the door to the tobacco industry's secrets about nicotine: the Minnesota Tobacco Trial. JAMA 1998; 280(13):1173-1181.^-3131 Martin Jarvis, Clive Bates. Why Low Tar Cigarettes Don't Work and How the Tobacco Industry Has Fooled the Smoking Public. [Internet]. London: Action on Smoking and Health - ASH; 1999[cited 2017 Dec 28] p. 13. Available from: http://ash.org.uk/information-and-resources/tobacco-industry-information-and-resources/low-tar-cigarettes/
http://ash.org.uk/information-and-resour... . This phenomenon is known as compensatory smoking or compensation²⁸28 Kozlowski L, O'Connor R. Cigarette filter ventilation is a defective design because of misleading taste, bigger puffs, and blocked vents. Tob Control 2002; 11(Supl. 1):i40-50..

Other studies also showed that when filter vents were blocked, measured tar yields increased by more than 10-fold in comparison to unblocked cigarettes of the same brand, revealing that low-tar or “light” cigarettes do not differ from conventional cigarettes¹⁸18 Talhout R, Richter PA, Stepanov I, Watson CV, Watson CH. cigarette design features: effects on emission levels, user perception, and behavior. Tob Regul Sci 2018; 4(1):592-604.^,3131 Martin Jarvis, Clive Bates. Why Low Tar Cigarettes Don't Work and How the Tobacco Industry Has Fooled the Smoking Public. [Internet]. London: Action on Smoking and Health - ASH; 1999[cited 2017 Dec 28] p. 13. Available from: http://ash.org.uk/information-and-resources/tobacco-industry-information-and-resources/low-tar-cigarettes/
http://ash.org.uk/information-and-resour... .

Studies reported that filtered cigarettes are not less harmful than unfiltered cigarettes⁹9 Harris B. The intractable cigarette "filter problem." Tob Control 2011; 20 Supl. 1:i10-16.^,3838 Schulz M, Gerber A, Groneberg DA. Are filter-tipped cigarettes still less harmful than non-filter cigarettes? -a laser spectrometric particulate matter analysis from the non-smokers point of view. Int J Environ Res Public Health 2016 2016; 13(4):429.. Another study also suggests that cigarettes with filter ventilation may lead to an increased rate of lung adenocarcinoma when compared with cigarettes without ventilation¹⁹19 Song M-A, Benowitz NL, Berman M, Brasky TM, Cummings KM, Hatsukami DK, Marian, C, O'Connor R, Rees VW, Woroszylo C, Shields,PG. Cigarette filter ventilation and its relationship to increasing rates of lung adenocarcinoma. J Natl Cancer Inst [Internet]. 2017; 109(12). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6059254/
https://www.ncbi.nlm.nih.gov/pmc/article... . Moreover, a preliminary study published in 2018 suggests that removing filter ventilation reduces cigarette abuse liability³⁹39 Stein JS, Koffarnus MN, O'Connor RJ, Hatsukami DK, Bickel WK. effects of filter ventilation on behavioral economic demand for cigarettes: a preliminary investigation. Nicotine Tob Res Off J Soc Res Nicotine Tob 2017; 20(10):1278-1282..

Filters and cigarette attractiveness

Filter ventilation also reduces the irritation caused by cigarette smoke, making the product more palatable and appealing, and giving smokers the impression that filtered cigarettes are less toxic²⁸28 Kozlowski L, O'Connor R. Cigarette filter ventilation is a defective design because of misleading taste, bigger puffs, and blocked vents. Tob Control 2002; 11(Supl. 1):i40-50.^,3131 Martin Jarvis, Clive Bates. Why Low Tar Cigarettes Don't Work and How the Tobacco Industry Has Fooled the Smoking Public. [Internet]. London: Action on Smoking and Health - ASH; 1999[cited 2017 Dec 28] p. 13. Available from: http://ash.org.uk/information-and-resources/tobacco-industry-information-and-resources/low-tar-cigarettes/
http://ash.org.uk/information-and-resour... .

Some filters also contain flavor capsules that allow users to choose characterizing or non-characterizing flavors. According to the literature, these capsules can potentially increase the attractiveness of cigarettes and reduce perceived risk¹⁰10 Thrasher JF, Abad-Vivero EN, Moodie C, O'Connor RJ, Hammond D, Cummings KM, Yong H-H, Salloum RG, Czoli C, Reynales-Shigematsu LM. Cigarette brands with flavour capsules in the filter: trends in use and brand perceptions among smokers in the USA, Mexico and Australia, 2012-2014. Tob Control 2016; 25(3):275-283.^,4040 Brown J, Cohen J, Smith K. Flavor capsule cigarettes in six countries: availability by brand, variant and flavor. Tob Induc Dis 2018; 16(Supl. 1):A506. [cited 2018 Oct 9]. Available from: http://www.tobaccoinduceddiseases.org/Flavor-capsule-cigarettes-in-six-countries-availability-by-brand-variant-and-flavor,83926,0,2.html
http://www.tobaccoinduceddiseases.org/Fl... .

Brands in Brazil containing capsules inside the filters have different design features, including flavor-changing filters (allowing the smoker to regulate flavor intensity) and two capsules that can be pressed to release individual flavors, theoretically giving the smoker a choice of four flavors (non-flavored, flavor 1 or 2, and a mixture of the two).

Environmental impacts

Improperly discarded cigarette filters (or butts) are the most ubiquitous form of litter worldwide and most common pollutant found in the earth’s oceans¹²12 Novotny TE, Slaughter E. tobacco product waste: an environmental approach to reduce tobacco consumption. Curr Environ Health Rep 2014;1(3):208-216.. An estimated 4.5 trillion cigarette butts are thrown away every year worldwide⁴¹41 Slaughter E, Gersberg RM, Watanabe K, Rudolph J, Stransky C, Novotny TE. Toxicity of cigarette butts, and their chemical components, to marine and freshwater fish. Tob Control 2011; 20 (Supl. 1):i25-29., representing approximately 845,000 tons of waste⁴²42 Novotny TE, Lum K, Smith E, Wang V, Barnes R. cigarettes butts and the case for an environmental policy on hazardous cigarette waste. Int J Environ Res Public Health 2009; 6(5):1691-1705..

Data from the UNEP’s International Coastal Cleanup program⁴³43 United Nations Environment Programme (UNEP). Marine litter: a global challenge [Internet]. Nairobi: UNEP; 2009. 232 p. [cited 2018 Oct 9]. Available from: http://wedocs.unep.org/bitstream/handle/20.500.11822/7787/-Marine%20Litter_%20A%20Global%20Challenge%20%282009%29-2009845.pdf?sequence=3&isAllowed=y
http://wedocs.unep.org/bitstream/handle/... for the period 1989 to 2007 show that cigarette filters were the most common marine litter item, accounting for 24,6% of the total number of debris items⁴³43 United Nations Environment Programme (UNEP). Marine litter: a global challenge [Internet]. Nairobi: UNEP; 2009. 232 p. [cited 2018 Oct 9]. Available from: http://wedocs.unep.org/bitstream/handle/20.500.11822/7787/-Marine%20Litter_%20A%20Global%20Challenge%20%282009%29-2009845.pdf?sequence=3&isAllowed=y
http://wedocs.unep.org/bitstream/handle/... , followed by paper and plastic bags (9,4%), clearly illustrating the environmental impact of cigarette butts⁴³43 United Nations Environment Programme (UNEP). Marine litter: a global challenge [Internet]. Nairobi: UNEP; 2009. 232 p. [cited 2018 Oct 9]. Available from: http://wedocs.unep.org/bitstream/handle/20.500.11822/7787/-Marine%20Litter_%20A%20Global%20Challenge%20%282009%29-2009845.pdf?sequence=3&isAllowed=y
http://wedocs.unep.org/bitstream/handle/... .

The cigarette butt litter issue raised concerns among the tobacco industry, which understood that, just as evidence on the harmful effects of passive smoking had prompted smoke-free laws, cigarette waste could potentially lead to more restrictive environmental legislation⁴⁴44 Smith EA, McDaniel PA. covering their butts: responses to the cigarette litter problem. Tob Control 2011; 20(2):100-106..

Tobacco industry internal documents show that companies monitored and developed strategies for addressing this issue because of its effects on the social acceptability of smoking and potential alliances between tobacco control advocates and environmentalists⁴⁴44 Smith EA, McDaniel PA. covering their butts: responses to the cigarette litter problem. Tob Control 2011; 20(2):100-106..

It is also important to highlight that cigarette butts are not classified as toxic waste, despite the various toxins contained in tobacco smoke, such as nicotine, tobacco-specific nitrosamines, phenol and formaldehyde⁴⁵45 U.S. Department of Health and Human Services. The health consequences of smoking: 50 years of progress. a report of the surgeon general [Internet]. Atlanta (GA): U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion; 2014 Jan [cited 2016 May 16] p. 944. Available from: www.cdc.gov/tobacco
www.cdc.gov/tobacco... , meaning that cigarette litter is not properly treated even when disposed of “correctly”.

Some studies revealed that filters are toxic to aquatic organisms⁴¹41 Slaughter E, Gersberg RM, Watanabe K, Rudolph J, Stransky C, Novotny TE. Toxicity of cigarette butts, and their chemical components, to marine and freshwater fish. Tob Control 2011; 20 (Supl. 1):i25-29.^,4444 Smith EA, McDaniel PA. covering their butts: responses to the cigarette litter problem. Tob Control 2011; 20(2):100-106. as they release arsenic, nicotine, cadmium, lead and other chemical components to the environment.

In addition to these factors, cigarette butts are photodegradable, but are not biodegradable, meaning that they are broken down into small pieces that remain in the environment, essentially becoming diluted in water or soil⁴²42 Novotny TE, Lum K, Smith E, Wang V, Barnes R. cigarettes butts and the case for an environmental policy on hazardous cigarette waste. Int J Environ Res Public Health 2009; 6(5):1691-1705.. The non-biodegradability of filters also increases landfill demands, increasing waste management costs and blighting public places⁴²42 Novotny TE, Lum K, Smith E, Wang V, Barnes R. cigarettes butts and the case for an environmental policy on hazardous cigarette waste. Int J Environ Res Public Health 2009; 6(5):1691-1705..

Regulation of cigarette filters in Brazil and around the world

As far as we are aware, as yet, no place has prohibited the use of cigarette filters. Three attempts to ban filters in California based on their negative health and environmental impacts have failed⁴⁶46 California Legislature. Bill Text - AB-2308 Cigarettes: single-use filters. [Internet]. Feb 13, 2018. [cited 2018 Oct 9]. Available from: https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180AB2308
https://leginfo.legislature.ca.gov/faces... . However, Germany has banned cigarettes containing menthol capsules⁴⁷47 World Health Organization (WHO). Germany - Cigarettes containing menthol capsules banned [Internet]. Geneva: WHO; 2012 [cited 2018 Nov 7]. Available from: http://www.who.int/fctc/implementation/news/news_germ/en/
http://www.who.int/fctc/implementation/n... .

The European Union also introduced legislation on single-use plastic products that provides that the packaging of tobacco products with filters should state that they contain single-use plastic and outline responsibility provisions and proper means of disposal and recycling⁴⁸48 European Union. Directive of the European Parliament and of the Council on the Reduction of the Impact of Certain Plastic Products on the Environment [Internet]. PE-CONS 11/1/19 REV 1 Jun 5, 2019. Available from: https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=consil:PE_11_2019_REV_1
https://eur-lex.europa.eu/legal-content/... .

No legislation banning the perforation of filters was identified; however, various authors claim that filter vents are a misleading and dangerous design feature that can actually increase health risks, and should therefore be banned⁸8 Hoffmann I. The changing cigarette, 1950-1995. J Toxicol Environ Health A 1997; 50(4):307-364.^,1515 Pauly JL, Mepani AB, Lesses JD, Cummings KM, Streck RJ. Cigarettes with defective filters marketed for 40 years: what Philip Morris never told smokers. Tob Control 2002; 11(Supl. 1):I51-61.^,2020 Russell MA, Jarvis MJ, Feyerabend C, Saloojee Y. Reduction of tar, nicotine and carbon monoxide intake in low tar smokers. J Epidemiol Community Health 1986; 40(1):80-85.

21 Benowitz NL, Hall SM, Herning RI, Jacob P, Jones RT, Osman AL. Smokers of low-yield cigarettes do not consume less nicotine. N Engl J Med 1983; 309(3):139-42.

22 Herning RI, Jones RT, Bachman J, Mines AH. Puff volume increases when low-nicotine cigarettes are smoked. Br Med J Clin Res Ed 1981; 283(6285):187-189.^-2323 Kozlowski LT, Rickert WS, Pope MA, Robinson JC, Frecker RC. estimating the yield to smokers of tar, nicotine, and carbon monoxide from the 'lowest yield'ventilated filter-cigarettes. Br J Addict 1982; 77(2):159-165.^,2828 Kozlowski L, O'Connor R. Cigarette filter ventilation is a defective design because of misleading taste, bigger puffs, and blocked vents. Tob Control 2002; 11(Supl. 1):i40-50.^,4949 Sweeney CT, Kozlowski LT. Blocking filter vents increases carbon monoxide levels from ultralight, but not light cigarettes. Pharmacol Biochem Behav 1998; 59(3):767-773..

Final considerations

Considering that cigarette filters have no health benefits¹⁵15 Pauly JL, Mepani AB, Lesses JD, Cummings KM, Streck RJ. Cigarettes with defective filters marketed for 40 years: what Philip Morris never told smokers. Tob Control 2002; 11(Supl. 1):I51-61.^,1919 Song M-A, Benowitz NL, Berman M, Brasky TM, Cummings KM, Hatsukami DK, Marian, C, O'Connor R, Rees VW, Woroszylo C, Shields,PG. Cigarette filter ventilation and its relationship to increasing rates of lung adenocarcinoma. J Natl Cancer Inst [Internet]. 2017; 109(12). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6059254/
https://www.ncbi.nlm.nih.gov/pmc/article... ^,5050 O'Connor RJ, Bansal-Travers M, Cummings KM, Hammond D, Thrasher JF, Tworek C. Filter presence and tipping paper color influence consumer perceptions of cigarettes. BMC Public Health 2015; 15:1279.^,5151 Strasser AA, Ashare RL, Kozlowski LT, Pickworth WB. The effect of filter vent blocking and smoking topography on carbon monoxide levels in smokers. Pharmacol Biochem Behav 2005 Oct; 82(2):320-329., are used by the tobacco industry to attract new smokers, prompt an increase in puff volume, lull smokers into a false sense of security, and have a significant environmental impact¹⁰10 Thrasher JF, Abad-Vivero EN, Moodie C, O'Connor RJ, Hammond D, Cummings KM, Yong H-H, Salloum RG, Czoli C, Reynales-Shigematsu LM. Cigarette brands with flavour capsules in the filter: trends in use and brand perceptions among smokers in the USA, Mexico and Australia, 2012-2014. Tob Control 2016; 25(3):275-283.^,1212 Novotny TE, Slaughter E. tobacco product waste: an environmental approach to reduce tobacco consumption. Curr Environ Health Rep 2014;1(3):208-216.^,1515 Pauly JL, Mepani AB, Lesses JD, Cummings KM, Streck RJ. Cigarettes with defective filters marketed for 40 years: what Philip Morris never told smokers. Tob Control 2002; 11(Supl. 1):I51-61.^,2828 Kozlowski L, O'Connor R. Cigarette filter ventilation is a defective design because of misleading taste, bigger puffs, and blocked vents. Tob Control 2002; 11(Supl. 1):i40-50.^,4141 Slaughter E, Gersberg RM, Watanabe K, Rudolph J, Stransky C, Novotny TE. Toxicity of cigarette butts, and their chemical components, to marine and freshwater fish. Tob Control 2011; 20 (Supl. 1):i25-29.^,5252 Novotny, TE, Bialous, SA, Burt, L, Curtis, C, Silva, VL da C e, Iqtidar, SU, Liu, Y, Pujari, S, d'Espaignet, ET. The environmental and health impacts of tobacco agriculture, cigarette manufacture and consumption. Bull World Health Organ 2015; 93(12):877-880.

53 B'chir F, Laouani A, Ksibi S, Arnaud MJ, Saguem S. Cigarette filter and the incidence of lung adenocarcinoma among Tunisian population. Lung Cancer Amst Neth 2007; 57(1):26-33.

54 Zacny JP, Stitzer ML, Yingling JE. Cigarette filter vent blocking: effects on smoking topography and carbon monoxide exposure. Pharmacol Biochem Behav 1986; 25(6):1245-1252.^-5555 Pauly JL, Allaart HA, Rodriguez MI, Streck RJ. Fibers released from cigarette filters: an additional health risk to the smoker? Cancer Res 1995; 55(2):253-258., there is no justification from a health and environmental point of view for the continued use of these items and they should therefore be banned.

Acknowledgements

The authors are grateful to Brazil’s National Health Surveillance Agency (ANVISA), the Oswaldo Cruz Foundation (Fiocruz), Coordination of Improvement of Higher Education Personnel (CAPES) and National Council for Scientific and Technological Development (CNPq, all acronyms in Portuguese). The statements and opinions expressed in the article are those of the authors and based on current scientific evidence. They do not in any way reflect the opinions or views of ANVISA, Fiocruz, the National Cancer Institute, Ministry of Health or Brazilian government.

References

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