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Less is known about the potential of cigarette composition to affect smoking risks.
Lung cancer mortality patterns throughout Europe are very heterogeneous and largely reflect past smoking habits (Kubik et al, 1995), although changes in cigarette composition are also likely to be important.
Limitations of our exposure measure include that it does not reflect secondhand smoke exposure, does not include postnatal exposure, and does not capture differences in cigarette composition, inhalation, or metabolism.
Temporal changes which affect all members of the population (e.g. air pollution, a change in cigarette composition or a new treatment) are examples of period effects which could affect cancer mortality rates.
These findings could be due to the decrease in the number of cigarettes smoked per day (O'Connor et al. 2006; Pierce et al. 2011) and to changes in cigarette composition over time (Hoffmann et al. 2001; Scherer and Barkemeyer 1983).
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The complexity of cigarette smoke composition reflects the fact that tobacco is a plant material [ 4].
Our findings argue against the hypothesis that increases in the ratio arise from changes in cigarette design and composition.
These concerns are of particular importance as US style blended cigarettes gain market share in many countries where the WHO Framework Convention on Tobacco Control may create an opportunity to regulate these changes in cigarette design and composition.
We hypothesize that the increase in adenocarcinoma of the lung over time and differences between US adenocarcinoma rates and those of other countries may be due to differences in cigarette design and composition over time and across countries, and that the increase in the risk of adenocarcinoma contributes to an increase in overall lung cancer rates.
Despite the widely diverse designs and deliveries of the selected kretek cigarettes, their smoke composition and in vitro toxicity data present a consistent pattern when data were normalized to total particulate matter (TPM) deliveries.
For fifty years, the judge found, they deceived "the American public about the health effects of smoking and environmental tobacco smoke, the addictiveness of nicotine, the health benefits from low tar, 'light' cigarettes, and their manipulation of the design and composition of cigarettes in order to sustain nicotine addiction".
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