What can be learnt from tobacco butts? An observational study in a realistic hospital setting.

OBJECTIVE: Examination of tobacco butts and its possible use in tobacco control. DESIGN: Macroscopic examination of cigarette butts collected outside or in dedicated smoking rooms of a smoke-free hospital. RESULTS: Of 925 butts, 3.8% were cigarillos, 11.1% cigarettes without filter, 57.7% ventilated filter cigarettes, 22.5% filter cigarettes without macroscopic ventilation and 4.9% undetermined. Thirty-six different cigarette brands were identified. A wide distribution of butt lengths (mean 32.1 mm, variation coefficient 28%), peripheral ovalisation of the filter in 83.9%, and extended browning of the mouth end of the filter in 48.6% were observed. Vent holes were macroscopically detectable in 70.5% and a sharp decrease in browning in 53.4% of the filter cigarettes. Most (94.7%) ventilation holes were located at > or =10 mm from the mouth end. CONCLUSIONS: In a smoke-free hospital, the use of tobacco products (mainly ventilated filter cigarettes) remains sizeable. Given the wide distribution of butt lengths, the number of cigarettes per day is a poor marker of toxin intake. Vent-hole localisation and signs of vent-blocking confirm the inadequacy of machine-measured smoke yields and the presence of compensatory smoking. More intensive individual cessation advice with pharmacological support is necessary. Examination of a smoker's own cigarette butts can be used as a tool for individual cessation advice.