Clove cigarette smoking: biochemical, physiological, and subjective effects

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Abstract

Alternative tobacco products such as clove (kreteks) and bidi cigarettes have become increasingly popular among US smokers. The nicotine content of a popular clove cigarette (Djarum Special) filler averaged 7.4 mg; conventional cigarettes contained 13.0 mg. However, smoke yields from standardized machine-smoking analysis indicated it delivered more nicotine, carbon monoxide (CO), and tar than conventional cigarettes. In a clinical study, nicotine delivery, physiologic, and subjective effects of the clove cigarette were compared to their own brand of cigarette in 10 adult smokers (7 males). Average time to smoke the clove cigarette (549 s) and number of puffs (15.1) were significantly greater than own brand (314 s and 9.4 puffs). Increases in venous plasma nicotine and exhaled CO after smoking the clove cigarette (17.4 ng/ml; 6 ppm) were similar to those after own brand (17.6 ng/ml; 4.5 ppm). Maximal changes in heart rate (HR), systolic, and diastolic blood pressures (BP) did not differ significantly between the clove and own brand of cigarette. Compared to their own brand of cigarette, the clove cigarette was rated as better tasting and being distinctly different. Our findings indicate that clove cigarettes deliver significant quantities of nicotine, CO, and presumably other toxic components of tobacco smoke. Taste satisfaction, aromatic odor, and novelty may contribute to their appeal to young smokers.

Introduction

The Federal Trade Commission (FTC) periodically publishes nicotine, carbon monoxide (CO), and tar delivery yields from machine smoking of domestic cigarettes (Federal Trade Commission, 2000); however, no such data are readily available for foreign cigarettes that penetrate the US market. Bidis and clove cigarettes are imported tobacco products popular among US smokers. In previous reports, the physical composition and clinical effects of bidi cigarettes have been described Malson and Pickworth, 2002, Malson et al., 2001, Malson et al., 2002. However, no clinical reports on the effects of clove cigarette smoking have been published.

Clove cigarettes are produced in Indonesia and exported throughout the world. They are composed of a mixture of tobacco (60–80%) and ground clove buds (20–40%), available with or without filters, and are usually machine rolled in white, brown, or black paper (California State Department of Health Services, 1988). The cigarettes are usually marketed in brightly colored packaging and have a distinctly different aroma than traditional cigarettes because of the cloves. Eugenol, an analgesic, is naturally occurring in cloves and is present in milligram quantities in the clove cigarette filler (Claus and Tyler, 1965). Like menthol, eugenol may diminish the harshness of the tobacco smoke American Academy of Pediatrics Committee on Substance Abuse, 1991, Centers for Disease Control and Prevention (CDCP), 1985. In fact, clove cigarettes are referred to as “trainer cigarettes,” implying that the use of clove cigarettes may prove to be a gateway product to conventional cigarettes American Academy of Pediatrics Committee on Substance Abuse, 1991, Guidotti and Laing, 1992.

A significant proportion of young smokers in the United States use clove cigarettes. A 1999 national survey found that 1.9% of middle school students and 5.8% of high school students currently smoked clove cigarettes (CDCP, 2000). However, there have been no prevalence rates published for clove smoking among adults.

Although clove smoking has been documented in epidemiological studies and in survey data, there are no clinical studies of their acute physiological and subjective effects. In the present report, the nicotine content of the filler rod and smoking machine estimates of nicotine and tar delivery from a popular brand of clove cigarette were determined. The clove cigarette was then used in a clinical study to compare changes in plasma nicotine levels, exhaled CO, cardiovascular, and subjective effects with a conventional cigarette.

Section snippets

Physical composition

The clove cigarette used in the present study was Djarum Special, manufactured for Kretek International (Moorpark, CA) by PT Djarum (Kudos, Indonesia) and was obtained from a local tobacco outlet. The nicotine content of the clove cigarettes was determined by methods described in Malson et al. (2001). Briefly, rod filler and cigarette weight were determined from an average of 10 cigarettes. The rod filler (“tobacco”) was removed, weighed and pooled for chemical analysis. Nicotine concentration

In vitro studies

Table 1 provides physical characteristics of the clove cigarette and the average of four popular US cigarettes (Malson et al., 2001). The total nicotine content of filler in the rod of the clove cigarette averaged 7.39 mg. The manufacturer acknowledges that 60% of the rod is composed of tobacco and 40% is ground clove buds.

Table 2 provides standardized machine-smoking yields for the Djarum Special clove cigarette and the average FTC yields of four popular US cigarettes. Compared to the

Discussion

Although the cigarettes most often consumed by teenagers are the heavily advertised brands, such as Marlboro, Camel, and Newport (Cummings et al., 1997), cigarettes sold by importers and small manufacturers retain a small but significant market share. Niche products such as bidis, cloves, and additive-free cigarettes are often sold in health food stores, ethnic groceries, head shops, and on the internet (Fisher, 2000). Although clove cigarettes are widely used, very little is known of their

Acknowledgements

The authors gratefully acknowledge Lillie Morgan, RN who provided nursing support for the study. The authors are especially appreciative of the contributions of Drs. Cliff Watson and Greg Polzin of the CDCP, for their FTC analysis and comments to this manuscript. Kristi Sims, Murty Pharmaceuticals provided analyses of the clove cigarettes. Ms. Sharifeh Farasat assisted with the preparation of the manuscript. Salary support of Ms. Malson and Ms. Lee were provided by Transdisciplinary Tobacco Use

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