Tobacco and Public Health - TCSC Indonesia

American Caucasians and Hispanics (Perez-Stable et al. 1998; Benowitz et al. 2002).
As mentioned previously the slower metabolism of nicotine and cotinine by Asians can
be explained by the high frequency of CYP2A6 gene alleles that are associated with
diminished or absent enzyme activity (Oscarson 2001). Slower metabolism of nicotine
among Asians may explain, at least in part, lower cigarette consumption among
Asians compared to Caucasians (Benowitz et al. 2002). African Americans also metabolize
nicotine and cotinine via the glucuronidation pathway more slowly than do
Caucasians (Benowitz et al. 1999). The genetic basis and biological consequences of
slower glucuronidation among African Americans have not yet been determined.
Pregnancy is associated with a marked acceleration of nicotine and cotinine metabolism
(Dempsey et al. 2002). Thus the pregnant woman may require higher dose of
nicotine medication to aid smoking cessation compared to the non-pregnant woman.
Ageing has been reported to be associated with slower metabolism of nicotine, as has
the presence of kidney disease (Molander et al. 2000, 2001). The importance of individual
differences in nicotine metabolism in determining cigarette consumption
and/or addiction risk is a subject of ongoing investigation.
Tobacco-delivered nicotine
JACK E. HENNINGFIELD AND NEAL L. BENOWITZ 135
Tobacco products are a means of storing nicotine and serve as vehicles for its delivery.
Tobacco companies use a variety of techniques to control the nicotine dosing
characteristics of cigarettes. The modern cigarette is elaborately designed, involving
numerous patents for wrappers, manufacturing, filter systems, and processes for
making ‘tobacco’ filler out of tobacco materials and other substances (Browne 1990;
FDA 1995, 1996). The function of the cigarette has been described eloquently by senior
Philip Morris researcher William Dunn, as reprinted in Hurt and Robertson (1998):
The cigarette should be conceived not as a product but as a package. The product is nicotine.
Think of the cigarette pack as a storage container for a day’s supply of nicotine… Think of the
cigarette as dispenser for dose unit of nicotine… Think of a puff of smoke as the vehicle of
nicotine. Smoke is beyond question the most optimized vehicle of nicotine and the cigarette the
most optimized dispenser of smoke.
Although both the tobacco industry and non-industry scientists and agencies
have described cigarettes as nicotine delivery systems, not all of their effects are
explained by nicotine delivery (e.g. FDA 1995, 1996; Slade et al. 1995; Hurt and
Robertson 1998; WHO 2001). Most of the toxicity of the products is due to
substances other than nicotine. Substances in tobacco smoke, in addition to nicotine,
may also contribute to the development and maintenance of tobacco use (FDA 1995,
1996; Slade et al. 1995; Hurt and Robertson 1998; WHO 2001).
Because the speed and nature of the absorption process is a strong determinant
of the effects of nicotine, it is not surprising that the tobacco industry has focused
much attention on tobacco product development and the control of nicotine dosing