Make your own cigarettes: toxicant exposure, smoking topography, and subjective effects

Nicotine Delivery of a Menthol-Flavored Heat-not-Burn Tobacco Product During Directed Use

INTRODUCTION

IQOS was authorized by the U.S. Food and Drug Administration (FDA) as a modified-risk tobacco product. We conducted a pharmacokinetic study evaluating the nicotine delivery and subjective effects of IQOS use among current menthol cigarette smokers to better understand if IQOS is an acceptable cigarette alternative in light of the proposed menthol cigarette ban.

AIMS AND METHODS

Participants were adult smokers of >4 menthol cigarettes per day. After 14-hour nicotine abstinence, participants were provided an IQOS device and menthol heatstick to puff every 20 seconds for a total of 14 puffs. Blood samples were collected at baseline and during active use to calculate nicotine boost from baseline to peak concentration. Nicotine withdrawal symptoms were collected before and after IQOS use. In addition, a modified Product Evaluation Scale for IQOS was collected after use.

RESULTS

Participants (n = 8) were a mean age of 43.9 years, 63% were female, 88% identified as White, and they smoked a mean of 17.1 menthol cigarettes per day. After IQOS use, the mean nicotine boost obtained was 15.96 ng/mL (SD = 6.91) (range 9.31 to 30.55 ng/mL). Most (75%) participants reported enjoying use of the product "a lot" or greater and more than half (62.5%) reported reduced cigarette cravings. Most participants reported no side effects after use; however, two experienced dry mouth, three experienced dizziness, one experienced throat irritation, and one experienced headache.

CONCLUSION

We found that directed use (14 puffs) of menthol IQOS delivered a mean nicotine boost of 15.96 ng/mL which reduced craving for a cigarette. The majority of participants enjoyed use of IQOS and reported mild side effects.

IMPLICATIONS

Menthol IQOS delivered a sufficient dose of nicotine perceived as satisfying by menthol cigarette smokers and it reduced craving with mild side effects. Menthol IQOS has potential to serve as a less harmful alternative for menthol cigarette smokers. The availability of modified risk products like IQOS should be considered by FDA's Comprehensive Plan for Tobacco and Nicotine Regulation.

Cigarette filter ventilation, smoking topography, and subjective effects: A mediational analysis

BACKGROUND

Filter ventilation in cigarettes has been associated with alterations in smoking topography in order to compensate for the lower nicotine yields. Subjective effects of cigarettes include sensations, which can be affected by how a person smokes a cigarette. We look at smoking topography as a mediator in the relationship between filter ventilation levels and subjective effects.

METHODS

Smoking topography and subjective effects data come from the baseline usual cigarette brand laboratory visits of participants (N = 607) in a randomized clinical trial on reduced nicotine cigarettes. Conditional process analysis was done using PROCESS macro version 3.5 in SPSS.

RESULTS

There was a positive indirect effect of ventilation on satisfaction through total puff volume (0.004, 95% CI: 0.002, 0.007]) as well as ventilation on satisfaction through puff count then total puff volume, sequentially (0.001, 95% CI: [0.000, 0.003]). There was a positive indirect effect of ventilation on enjoyment through puff count for individuals less than 43 years of age (0.01, 95% CI: [0.002, 0.013]). There was a positive indirect effect of ventilation on enjoyment through total puff volume for individuals who smoke less than 14.33 cigarettes per day (0.009, 95% CI: [0.004, 0.015]).

CONCLUSIONS

We found preliminary evidence that topography measures (puff count and total puff volume), mediate the relationship between filter ventilation and specific subjective effects of smoking (satisfaction and enjoyment). Age and cigarettes smoked per day moderated these relationships. These results could have implications regarding filter ventilation restrictions and smokers' perceptions of using such cigarettes.

Effect of exogenous progesterone administration on smoking topography

INTRODUCTION

Progesterone has been implicated as protective against drug taking behaviors, including combustible cigarettes. While prior research indicates higher endogenous progesterone levels are associated with a reduction in smoking intensity (as measured by smoking topography), it is unknown if exogenous delivery of progesterone may have the same effect.

METHODS

This double-blind, counterbalanced, cross-over randomized trial enrolled women between the ages of 18 and 40 who smoked at least five cigarettes per day and were currently using oral contraceptives. After overnight abstinence participants attended two topography lab sessions. One lab session was conducted during progesterone (200 mg twice per day) treatment and the other was during placebo treatment. Analyses included linear mixed effect models to examine the effect of exogenous progesterone administration and endogenous progesterone values on topography outcomes.

RESULTS

Participants (n = 43) were 23.8 (standard deviation [SD] ± 4.5) years old, smoked 10.5 (SD ± 3.7) cigarettes per day. Compared to placebo administration, progesterone administration reduced cumulative puff volume by 300 mL (95% confidence interval [CI]: -536, -65; p-value = 0.01) with additional trends indicating possible reductions in the number of puffs, average puff volume, and average flow. There were no significant effects of endogenous progesterone on smoking topography outcomes.

CONCLUSIONS

Progesterone administration has the potential to reduce smoking intensity after overnight abstinence in women of reproductive age. Additional research is needed to explore how this may relate to smoking cessation outcomes in women of reproductive age.

Impact of tobacco tax increases and industry pricing on smoking behaviours and inequalities: a mixed-methods study

Background

Increasing tobacco prices through taxation is very effective for reducing smoking prevalence and inequalities. For optimum effect, understanding how the tobacco industry and smokers respond is essential. Tobacco taxation changes occurred in the UK over the study period, including annual increases, a shift in structure from ad valorem to specific taxation and relatively higher increases on roll-your-own tobacco than on factory-made cigarettes.

Objectives

Understanding tobacco industry pricing strategies in response to tax changes and the impact of tax on smokers’ behaviour, including tax evasion and avoidance, as well as the effect on smoking inequalities. Synthesising findings to inform how taxation can be improved as a public health intervention.

Design

Qualitative analysis and evidence synthesis (commercial and Nielsen data) and longitudinal and aggregate cross-sectional analyses (International Tobacco Control Policy Evaluation Project data).

Setting

The UK, from 2002 to 2016.

Data sources and participants

Data were from the tobacco industry commercial literature and retail tobacco sales data (Nielsen, New York, NY, USA). Participants were a longitudinal cohort (with replenishment) of smokers and ex-smokers from 10 surveys of the International Tobacco Control Policy Evaluation Project (around 1500 participants per survey).

Main outcome measures

(1) Tobacco industry pricing strategies, (2) sales volumes and prices by segments over time and (3) smokers’ behaviours, including products purchased, sources, brands, consumption, quit attempts, success and sociodemographic differences.

Review methods

Tobacco industry commercial literature was searched for mentions of tobacco products and price segments, with 517 articles extracted.

Results

The tobacco industry increased prices on top of tax increases (overshifting), particularly on premium products, and, recently, the tobacco industry overshifted more on cheap roll-your-own tobacco than on factory-made cigarettes. Increasingly, price rises were from industry revenue generation rather than tax. The tobacco industry raised prices gradually to soften impact; this was less possible with larger tax increases. Budget measures to reduce cheap product availability failed due to new cheap factory-made products, price marking and small packs. In 2014, smokers could buy factory-made (roll-your-own tobacco) cigarettes at real prices similar to 2002. Exclusive roll-your-own tobacco and mixed factory-made cigarettes and roll-your-own tobacco use increased, whereas exclusive factory-made cigarette use decreased, alongside increased cheap product use, rather than quitting. Quitting behaviours were associated with higher taxes. Smokers consumed fewer factory-made cigarettes and reduced roll-your-own tobacco weight over time. Apparent illicit purchasing did not increase. Disadvantaged and dependent smokers struggled with tobacco affordability and were more likely to smoke cheaper products, but disadvantage did not affect quit success.

Limitations

Different for each data set; triangulation increased confidence.

Conclusions

The tobacco industry overshifted taxes and increased revenues, even when tax increases were high. Therefore, tobacco taxes can be further increased to reduce price differentials and recoup public health costs. Government strategies on illicit tobacco appear effective. Large, sudden tax increases would reduce the industry’s ability to manipulate prices, decrease affordability and increase quitting behaviours. More disadvantaged, and dependent, smokers need more help with quitting.

Future work

Assessing the impact of tax changes made since 2014; changing how tax changes are introduced (e.g. sudden intermittent or smaller continuous); and tax changes on tobacco initiation.

Funding

This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 6. See the NIHR Journals Library website for further project information.

Roll-your-own cigarette use in Italy: sales and consumer profile-data from PASSI surveillance, 2015-2016

OBJECTIVES

The use of roll-your-own (RYO) cigarette has substantially increased in most high-income countries recently. This work aims to update Italian trends on loose tobacco sales and to describe the consumer profile of predominant RYO users.

METHODS

Data from the Italian Agency of Customs and State Monopolies and from PASSI (Italian behavioral risk factor surveillance system) were used. Information on 16,858 interviews to current smokers aged 18-69 was analyzed.

RESULTS

Sales of loose tobacco increased more than sevenfold between 2004 and 2017. In 2015-2016, 11.6% of smokers reported smoking predominantly RYO cigarettes, with higher percentages among the youngest where a significant association between use of RYO and education was observed, unlike what happened in older adults. The association between economic difficulties and use of RYO was observed only in older adults.

CONCLUSIONS

A growing trend in RYO cigarette sales was registered between 2004 and 2017. In young smokers, the greater use of RYO was observed among the most educated regardless of financial strain, while in older ones among those with economic difficulties.

Effects of Charcoal on Carbonyl Delivery from Commercial, Research, and Make-Your-Own Cigarettes

Previous literature has shown that adding charcoal to cigarette filters can have varying effects on the delivery of toxic carbonyls depending on filter design, amount of charcoal, and puffing profiles. However, these studies have relied on either comparisons between commercially available charcoal and noncharcoal filtered cigarettes or experimental modification of filters to insert a charcoal plug into existing cellulose acetate filters. Make-your-own (MYO) cigarettes can help obviate many of the potential pitfalls of previous studies; thus, we conducted studies using commercial charcoal cigarettes and MYO cigarettes to determine the effects of charcoal on carbonyl delivery. To do this, we analyzed carbonyls in mainstream smoke by HPLC-UV after derivatization with 2,4-dinitrophenylhydrazine (DNPH). Charcoal was added in-line after the cigarettes or through the use of MYO charcoal cigarette tubes. MYO cigarettes had carbonyl deliveries similar to that of 3R4F research cigarette, regardless of tobacco type. The greatest effect on carbonyl delivery was observed with 200 mg of charcoal, significantly reducing all carbonyls under both methods tested. However, "on-tow" design charcoal filters, available on many commercially available charcoal brands, appeared to have a minimal effect on carbonyl delivery under intense smoking methods. Overall, we found that charcoal, when added in sufficient quantity (200 mg) as a plug, can substantially reduce carbonyl delivery for both MYO and conventional cigarettes. As carbonyls are related to negative health outcomes, such reductions may be associated with reductions in carbonyl-related harm in smokers.

Keeping smoking affordable in higher tax environments via smoking thinner roll-your-own cigarettes: Findings from the International Tobacco Control Four Country Survey 2006-15

BACKGROUND

Roll-Your-Own tobacco (RYO) use is increasingly popular in many countries: it is generally cheaper than factory-made cigarettes (FM), and smokers can further reduce costs by adjusting the amount of tobacco in each cigarette. However, the level of risk of RYO compared with FM cigarettes is similar and does not meaningfully change with cigarette weight. We assessed the weight of tobacco in RYO cigarettes across jurisdictions with differing tobacco taxes/prices and over time.

METHOD

Six waves of the International Tobacco Control 4 Country longitudinal study of smokers and recent ex-smokers, providing 3176 observations from exclusive RYO users covering 2006-15, are used to calculate the weight of tobacco used in RYO cigarettes in the US, Canada, Australia, and the UK. Multilevel regression analyses were used to compare weights across countries, socio-demographic factors, and over time.

RESULTS

Smokers in the UK and Australia, where tobacco is relatively expensive, show higher levels of exclusive RYO use (25.8% and 13.8% respectively) and lower mean weights of tobacco per RYO cigarette (0.51 g(sd 0.32 g) and 0.53 g(0.28 g)), compared with both Canada and especially the US (6.0% and 3.5%, and 0.76 g(0.45 g) and 1.07 g(0.51 g)). Smokers in the UK and Australia also exhibited a statistically significant year-on-year decrease in the mean weight of each RYO cigarette.

CONCLUSIONS

Taxation of RYO should increase considerably in the UK and Australia so that RYO and FM cigarettes are taxed equivalently to reduce RYO attractiveness and inequalities. Other measures to reduce the price differentials, including taxing RYO solely on weight, are also discussed.

Differences in nicotine dependence, smoke exposure and consumer characteristics between smokers of machine-injected roll-your-own cigarettes and factory-made cigarettes

BACKGROUND

Consumption of machine-injected roll-your-own (RYO) filtered cigarettes made from pipe tobacco increased almost 7-fold from 2008 to 2011 in the United States.

METHODS

We used data from the Pennsylvania Adult Smoking Study to compare the differences in sociodemographic, smoking topography, nicotine dependence, and cotinine levels between 280 smokers using factory made (FM) cigarettes and 68 smokers using RYO cigarettes.

RESULTS

RYO smokers were older (41 vs. 37, P = 0.053), had significantly lower levels of income (P < 0.001) and education (P = 0.007), and were less likely to be fully employed (P = 0.009). RYO smokers consumed more cigarettes per day [CPD] (21 vs. 15, P < 0.001), and had a higher mean score on the Fagerström Test for Cigarette/Nicotine Dependence (5.2 vs. 4.1, P < 0.001). The main reasons for choosing RYO cigarettes were the lower cost (68%) and believed they are less harmful (12%). The average cost per pack of FM cigarettes was $5.74 vs. $1.13 for RYO. In multiple regression analyses, RYO smokers had significantly lower cotinine levels across all levels of CPD. Among smokers of king-size cigarettes, mean interpuff interval (P < 0.05) and total smoke duration (P < 0.01) per cigarette was significantly greater in RYO smokers. In laboratory measurements, RYO cigarettes contained more tobacco by weight than FM cigarettes, but weight varied by both tobacco and cigarette tube brands.

CONCLUSIONS

Machine-injected RYO cigarettes made from pipe tobacco are cheaper than FM cigarettes but may have higher abuse liability. Smokers who might otherwise reduce their cigarette consumption or quit altogether may continue to smoke RYO cigarettes due to their affordability.

[Old and new tobacco products]

Tobacco use is not just about manufactured cigarettes. Rolling tobacco, highly prized in the wake of price increases, is estimated to carry more toxic agents than its counterpart. This study shows that the use of cigar, pipe, cigarillos and narghile also leads to a cohort of pathologies similar to or more than what is known for smoking single cigarettes. Exotic, liquid or heated forms do just as much. The non-smoked tobacco, often fallen into disuse in France is very used in the United States and especially in Scandinavia. Denuded of inhaled products, it is often pointed as a form of reduction of smoking risks. Its use by athletes in all countries as a doping attitude, especially in ski disciplines, required a campaign of prevention within the federations concerned.

Large Cigars: Smoking Topography and Toxicant Exposure

Background

Cigar smoking in the United States continues despite decreases in cigarette smoking and increased tobacco control efforts. We compared large cigar and cigarette smoking for use patterns, smoking topography, and toxicant exposure.

Methods

Dual users (n = 17, 94% men, 77% African American) smoked ad libitum either their usual cigarette brand or a study large cigar (Phillies Blunt) in two laboratory sessions. Plasma nicotine and exhaled carbon monoxide were collected before and after smoking. Smoking topography measures of puff volume, puff duration, puff velocity, and interpuff interval were also collected.

Results

Both cigarettes and large cigars significantly increased plasma nicotine and carbon monoxide and significantly decreased the urge to smoke. Cigarettes delivered more nicotine per gram of tobacco smoked and per 1000 mL of puff volume. Number of puffs, time to smoke, puff volume, and puff velocity were significantly larger and interpuff interval was significantly shorter in large cigar smoking. The temporal pattern of puffing more intensely at the beginning of smoking was similar for both large cigars and cigarettes.

Conclusions

People who regularly use both large cigars and cigarettes adapt their smoking pattern such that they are exposed to similar levels of nicotine from each product. The immediate increase in plasma nicotine and carbon monoxide suggest significant inhalation of large cigar smoke. These data call to question the assumption that cigar smoking is less toxic than cigarette smoking. By smoking large cigars, dual users expose themselves to toxic components that have been linked with the addiction risk, morbidity, and mortality of cigarette smoking.

Implications

This study found that dual users of large cigars and cigarettes inhale significant quantities of carbon monoxide, nicotine, and presumably other components of mainstream smoke. Large cigar smoke exposure may lead to or sustain nicotine addiction as wells as subject large cigar consumers to similar risks associated with cigarette smoking such as lung cancer and cardiovascular disease.

Media exposure and tobacco product addiction beliefs: Findings from the 2015 Health Information National Trends Survey (HINTS-FDA 2015)

BACKGROUND

Addiction beliefs about tobacco use are associated with intentions to use and use of tobacco products. Exposure to information about tobacco products in media sources may affect addiction beliefs.

PURPOSE

To examine the relationship between media exposure and tobacco product addiction beliefs.

METHODS

A nationally representative sample of US adults (n=3738) from the 2015 National Cancer Institute's Health Information National Trends Survey was used to examine addiction beliefs about cigarettes, cigars, smokeless tobacco, electronic cigarettes, hookah/waterpipe tobacco, and roll-your-own cigarettes. We used logistic regression to examine the relationship between media exposure and addiction beliefs. We defined media exposure by hours exposed, as well as exposure to tobacco use health effects information through media sources including social media. We categorized media sources by whether respondents actively or passively engaged with the source.

FINDINGS

A majority (60.6% to 87.3%) of respondents believed that cigarettes, cigars, roll-your-own cigarettes and smokeless tobacco are addictive. Less than half of respondents believed that electronic cigarettes or hookah/waterpipes are addictive (45.2% and 49.8%, respectively). Respondents exposed to messages about tobacco use health effects on active media channels (e.g., social media) had greater odds of believing that smokeless tobacco (adjusted odds ratio [AOR]=1.48), hookah/waterpipe (AOR=1.69), and roll-your-own cigarettes (AOR=1.61) are addictive. Respondents exposed to tobacco use health effects messages on passive media channels (e.g., television), had greater odds of believing that cigarettes (AOR=2.76) and electronic cigarettes (AOR=2.12) are addictive.

CONCLUSIONS

US adult exposure to information about the health effects of tobacco use was associated with addiction beliefs about tobacco products.

Effects of Topography-Related Puff Parameters on Carbonyl Delivery in Mainstream Cigarette Smoke

Smoking topography parameters differ substantially between individual smokers and may lead to significant variation in tobacco smoke exposure and risk for tobacco-caused diseases. However, to date, little is known regarding the impact of individual puff parameters on the delivery of many harmful smoke constituents including carbonyls. To examine this, we determined the effect of altering individual puff parameters on mainstream smoke carbonyl levels in machine-smoked reference cigarettes. Carbonyls including formaldehyde, acetaldehyde, crotonaldehyde, propionaldehyde, methyl ethyl ketone (MEK), acrolein, and acetone were determined in cigarette smoke by HPLC after derivatization with 2,4-dinitrophenylhydrazine (DNPH). Deliveries of all carbonyls were nearly two-fold greater when cigarettes were smoked according to the more intense Health Canada Intense (HCI) protocol compared to the International Organization of Standardization (ISO) method, consistent with the two-fold difference in total puff volume between methods (ISO: 280-315 mL; CI: 495-605 mL). When individual topography parameters were assessed, changes in puff volume alone had the greatest effect on carbonyl delivery as predicted with total carbonyls being strongly correlated with overall puff volume (r2: 0.52-0.99) regardless of how the differences in volume were achieved. All seven of the carbonyls examined showed a similar relationship with puff volume. Minor effects on carbonyl levels were observed from vent blocking and changing the interpuff interval, while effects of changing puff duration and peak flow rate were minimal. Overall, these results highlight the importance of considering topography, especially puff volume, when the toxicant delivery and potential exposure smokers receive are assessed. The lack of an impact of other behaviors, including puff intensity and duration independent of volume, indicate that factors such as temperature and peak flow rate may have minimal overall effects on carbonyl production and delivery.

Subjective experiences at first use of cigarette, e-cigarettes, hookah, and cigar products among Texas adolescents

INTRODUCTION

Subjective experiences ("SEs") at first cigarette use have been thoroughly examined; however, limited research has examined SEs at first use of non-cigarette products. This study addresses this gap in the literature.

METHODS

Cross-sectional data from 6th, 8th and 10th grade students in four metropolitan areas of Texas (n=3907/N=461,069). Nausea, coughing, relaxation, rush/buzz, and dizziness at first use were assessed for cigarettes, e-cigarettes, hookah, and cigar products. Chi-square analyses examined differences in the prevalence of first use SEs by product. Weighted multiple logistic regression analyses examined the association of SEs and current product use. Covariates were grade, gender, race/ethnicity, and current other tobacco product use.

RESULTS

Exploratory factor analysis of SEs determined differing factor structures across tobacco products. For example, the following items loaded onto the positive SE factor: 1) relaxation, rush, and dizziness for cigarettes, and 2) relaxation and rush for e-cigarettes, hookah, and cigar products. Prevalence of negative SEs (coughing and nausea) were higher for cigarette and cigar products compared to e-cigarettes and hookah. Positive SEs for cigarettes were associated with increased odds of current cigarette use (AOR=1.51); similarly positive SEs for cigars were associated with increased odds of current cigar use (AOR=2.11). Feeling nauseous at first use of cigars was associated with decreased odds of current cigar use (AOR=0.18). No SEs were associated with current e-cigarette or hookah use.

CONCLUSIONS

Subjective experiences at first use differ by tobacco product. Longitudinal studies are needed to examine temporal relationships between SEs at first use and sustained tobacco use.

Smoking Behavior and Smoke Constituents from Cigarillos and Little Cigars

OBJECTIVE

Although most cigarillos and little cigars smokers also smoke cigarettes (dual use), there are few studies comparing toxicant exposure and smoking behavior in cigars and cigarettes.

METHODS

Two groups of dual users smoked their usual brand of cigarette and either a Winchester unflavored little cigar (N = 21) or a Black & Mild cigarillo (N = 23). Acute exposure of nicotine and exhaled carbon monoxide (CO) and puffing topography parameters were collected. Individual cigar puffing data were used to machine-replicate smoking for analysis of volatile organic compounds (VOC) and semi-volatile organic compounds (SVOC) in mainstream smoke.

RESULTS

There were significant differences in puff topography, plasma nicotine and exhaled CO after cigarettes, little cigars, and cigarillos. Puff topography differences between cigarillos and cigarettes were due to the difference in the size of the article. Mainstream cigar and cigarette smoke was qualitatively similar; the yield was dependent on the smoking behavior. When smoke yield was adjusted for weight of tobacco burned or puff volume, exposure differences decreased.

CONCLUSIONS

There is a wide range of delivery of both SVOC and VOC components of cigar and cigarillo smoke. The difference in exposure is largely dependent on the article size and the amount consumed.

Nicotine and carbon monoxide exposure from inhalation of cigarillo smoke

BACKGROUND

There has been an increase in the use of cigarillos in the US. People who smoke cigarillos typically also regularly smoke cigarettes (dual users).

METHODS

We compared puffing topography, biomarkers of acute exposure [exhaled carbon monoxide (COex) and plasma nicotine] and physiologic effects from usual brand cigarette and Black & Mild cigarillo smoking in dual users (N=23) in two laboratory sessions.

RESULTS

Participants (21 men) smoked an average of 17.5cigarettes/day. Cigarillo consumption varied widely from as few as 1/week to daily. Participants were highly nicotine dependent (average FTND score: 6.3). There were statistically significant differences in smoking behavior between cigarette and cigarillo smoking in time to smoke, number of puffs, and total puff volume (all P<0.001). Average puff duration, interpuff interval average puff volume, and puff velocity did not differ between cigarettes and cigarillos. Nicotine boost was similar after both cigarettes and cigarillos. COex boost was significantly greater after cigarillo smoking compared to cigarette smoking (P<0.001).

CONCLUSIONS

The smoking pattern and exposure profile indicate that dual users inhale cigarillo smoke just as they inhale cigarette smoke thereby exposing themselves to considerable amounts of nicotine and other components of tobacco smoke. COex exposure results imply that cigarillo smoking may be associated with higher exposure to smoke-delivered volatile components of mainstream cigarillo smoke including carcinogens when compared to cigarettes.

IMPACT

The findings that cigarillos and cigarettes are smoked similarly in dual users are relevant to health and regulatory considerations on cigar products.