Int. J. Environ. Res. Public Health 2007, 4(3), 233-242 International Journal of Environmental Research and Public Health ISSN 1661-7827 www.ijerph.org © 2007 by MDPI Mapping Cigarettes Similarities using Cluster Analysis Methods Sorana D. Bolboacă1*, and Lorentz Jäntschi2 1 “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, 6 Louis Pasteur, 400349 Cluj-Napoca, Romania 2Technical University of Cluj-Napoca, 103-104 Muncii Bdv, 400641 Cluj-Napoca, Romania *Correspondence to Dr. Sorana D. Bolboacă; E-mail: [email protected] Received: 18 June 2007/ Accepted: 28 August 2007/ Published: 30 September 2007 Abstract: The aim of the research was to investigate the relationship and/or occurrences in and between chemical composition information (tar, nicotine, carbon monoxide), market information (brand, manufacturer, price), and public health information (class, health warning) as well as clustering of a sample of cigarette data. A number of thirty cigarette brands have been analyzed. Six categorical (cigarette brand, manufacturer, health warnings, class) and four continuous (tar, nicotine, carbon monoxide concentrations and package price) variables were collected for investigation of chemical composition, market information and public health information. Multiple linear regression and two clusterization techniques have been applied. The study revealed interesting remarks. The carbon monoxide concentration proved to be linked with tar and nicotine concentration. The applied clusterization methods identified groups of cigarette brands that shown similar characteristics. The tar and carbon monoxide concentrations were the main criteria used in clusterization. An analysis of a largest sample could reveal more relevant and useful information regarding the similarities between cigarette brands. Keywords: Tobacco tar, nicotine and carbon monoxide; heath warnings; explanatory health messages; multidimensional analysis; cluster analysis. List of Abbreviations BAT - British American Tobacco JT - Japan Tobacco PM - Philip Morris CT - Continental Tobacco HW - Health Warning EHM - Explanatory Health Message Introduction (33.2% for male and 10.3% for female) between 2002 and 2005 [2]. In 2004, Romania was on the top three Global consumption of cigarettes has been rising worldwide cigarette consumptions [3]. from the beginning of the 20th century. China, United The compounds of the cigarette smoke and the effect States of America, Japan, Russia, and Indonesia are the of smoking are well known today. The cigarette smoke top five countries on cigarette consumption [1]. The contains a number of four thousand compounds with smoking prevalence in Romanian adults was of 21.4% different actions on human body [4, 5]. Today it was © 2007 MDPI. All rights reserved. 234 Int. J. Environ. Res. Public Health 2007, 4(3) recognized that tobacco smoking is the major etiologic • "Smoking slow down blood circulation and induce factor associated with cancer (lung cancer [6, 7], impotence" – EHM11 pancreatic cancer [8], gastric cancer [9], oral cancer [10], • "Smoking induce skin aging" – EHM12 renal cancer [11], and breast cancer [12]). It is also known • "Smoking can decrease sperm quality and fertility" – that the main addictive component, nicotine, is not a EHM13 carcinogenic by itself [13]. • "Cigarette smoke contains benzene, nitrosamines, Some counties introduced regulations on cigarette tar, formaldehyde and cyanides" – EHM14 nicotine and carbon monoxide in order to reduce the The aim of the study was to investigate the effect of these substances on human body. In the United relationship between chemical composition information States of America for example, the Federal Trade (tar, nicotine, carbon monoxide), market information Commission has published standardized tar and nicotine (brand, manufacturer, price), and public health ratings since 1967. The carbon monoxide rating has been information (class, health warning) by using multivariate introduced since 1980 for all cigarettes sell on American and clustering techniques. marked [14, 15]. In Romania, the cigarette market suffered some st Material and Method changes since 1 January 2007, when Romania becomes a European Union state, and some regulations entered into The material of the present research was represented force. The tar, nicotine and carbon monoxide by a sample of cigarette. The inclusion of the cigarette in concentrations are printed on cigarettes packs as the World the sample was performed based of the following Health Organization Framework Convention on Tobacco inclusion criteria: filtered cigarettes; tar concentration Control recommended [16] and the Romanian laws and printed on the packet; nicotine concentration printed on regulations [17-19] imposed. The maximum concentration the packet; health warnings and explanatory health of tar (10 mg/cig), nicotine (1 mg/cig) and carbon messages printed on the front and the back of the cigarette monoxide (10 mg/cig) of the cigarettes sell or fabricated in packet. A supermarket from Cluj-Napoca was chosen Romania are also regulated through a number of laws [17- randomly from the total number of supermarkets and all 19]. The health warnings and explanatory health messages cigarettes which accomplished the inclusion criteria were could be found on the front and back sides of cigarette bought. The following quantitative and qualitative packs according with Romanian regulations [17, 20]. The variables were collected: cigarette brand, manufacturer, advertising of tobacco products in cinema halls and of price, (as market information); tar, nicotine concentration, selling tobacco products to minors [21-23] is under and carbon monoxide concentration (as cigarette chemical interdiction in Romania. Smoking in closed public places, composition); class, health warning, and explanatory educational and medical establishments [17, 18, 22, 23] is health messages (as public health information). prohibiting in Romania. The cigarettes were classified by applying the order Regarding the public information of smoking effects, no. 919/1997 specification. Based on the sugars, two types of warning messages are imposed: general polyphones, tar (mg/cigarette) concentrations, free ("Smoking kills" with two variants: "Smoking can kill" – burning speed (mm/minute), cigarette length (mm), and abbreviated as HW1 and "Smoking harms yourself and filter length (mm) three classes of cigarettes were defined: people around you" – abbreviated as HW2) and additional superior, medium, and inferior [24]. or explanatory health messages. The additional Thirty cigarette packs manufactured by four explanatory health message could be one of the following: manufacturers, British American Tobacco (BAT) - on • "Smokers died younger" – abbreviated as EHM01 Romanian market since 1997 [25], Philip Morris (PM) - • "Smoking blocks blood circulation in arteries, induce on Romanian market since 2001 [26], Japan Tobacco (JT) heart and stroke attacks" – EHM02 - on Romanian market since 1995 [27], and Continental • "Smoking cause fatal lung cancer" – EHM03 Tobacco [28], were included into analysis. The • "Smoking when pregnant harms your baby" – EHM04 characteristics of the studied cigarette are presented in • "Protect children: don't let them breathe your smoke" Table 1. – EHM05 The relationship between chemical composition • "Your physician or pharmacist can help you to quit information (tar, nicotine, carbon monoxide) has been smoking" – EHM06 investigated by using multiple linear regression technique. • "Cigarettes are addictive. Do not start to smoke!" – Two-steps clustering and hierarchical cluster analysis EHM07 techniques were used in characterization of market and • "Quitting smoking decrease the risk of cardiac and public health information, as well as in clusterization of the entire collected data. The data were analyzed and lung fatal diseases" – EHM08 • "Smoking can cause a painful and fatal dead" – summarized using SPSS 12.0 software. The confidence intervals at a significance level of 5% associated with the EHM09 • "For smoking cessation consult your physician or binomial distributed frequencies were calculated using dedicated software [29]. pharmacist" – EHM10 Int. J. Environ. Res. Public Health 2007, 4(3) 235 Table 1: Sample of investigated cigarettes Tar Nicotine Carbon monoxide Price No Brand - Class Brand Serial No. TM Class (mg) (mg) (mg) (RON) 1 Dunhill - Dark Blue YA 00112466 BAT 7 0.8 8 5.56 superior 2 Dunhill - Light Blue YA 00460907 BAT 4 0.4 5 5.72 superior 3 Dunhill - Red BG 40180115 BAT 10 0.8 10 5.72 superior 4 Dunhill - Silver BG 31416538 BAT 4 0.4 5 5.72 superior 5 Kent - Blue BG 30536922 BAT 8 0.7 10 5.50 superior 6 Kent - Silver BH 36040416 BAT 4 0.4 5 5.56 superior 7 Kent - White BH 05954810 BAT 10 0.7 10 5.56 superior 8 Lucky Strike - Silver BG 53145741 BAT 7 0.6 8 4.69 superior 9 Pall Mall - Menthol BG 60887308 BAT 7 0.6 8 5.60 superior 10 Pall Mall - Orange BG 79156614 BAT 4 0.4 5 4.48 superior 11 Pall Mall - Red BG 44202018 BAT 10 0.8 10 4.48 superior 12 Pall Mall - Superslim BH 59927073 BAT 7 0.7 6 4.48 superior 13 Rothmans - King Size BG 64837127 BAT 10 0.9 10 5.64 superior 14 Viceroy - Blue-Red-Gold BG 14241889 BAT 10 0.8 10 4.84 medium 15 Viceroy - Charcoal BG 54416312 BAT 4 0.4 5 4.84 medium 16 Viceroy - Ultra Light BG 28844119 BAT 6 0.5 n.a. 4.84 medium 17 Vogue - Superslim l'adoration BH 71897282 BAT 7 0.7 6 5.69 superior 18 Pannonia - Blue GA 02862705 CT 12 0.8 12 2.25 medium 19 Camel - Filters CD 85473545 JT 10 0.9 10 5.00 superior 20 Camel