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Yang Y, Lindblom EN, Ward KD, Salloum RG. Would banning menthol cigarettes, flavored cigars, and flavored e-cigarettes prompt users to seek illicit channels for obtaining them in the United States? Prev Med 2024; 183:107954. [PMID: 38621422 PMCID: PMC11088487 DOI: 10.1016/j.ypmed.2024.107954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 04/10/2024] [Accepted: 04/11/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Banning flavors in tobacco and nicotine products may reduce youth initiation and prompt quit attempts but such bans may lead to illicit markets. We examined how likely current users would be to seek flavored products from illicit channels under various ban scenarios. METHODS Cross-sectional surveys of 2552 current users of menthol cigarettes or flavored cigars and 2347 users of flavored e-cigarettes were conducted between 2021 and 2022 in the United States. For each ban scenario, respondents reported if they would have intentions to seek the banned flavored products from any illicit channels and identified the specific illicit channel they would consider. Logistic regressions were used to estimate how the likelihood of having intentions to seek illicit channels was associated with demographics, ban scenarios, and status of tobacco use. RESULTS Under various ban scenarios, 24-30% of people who smoked said they would seek illicit channels to obtain the banned products compared with 21-41% of dual users and 35-39% of users of flavored e-cigarettes. Online retailers were favored by people who smoked while users of flavored e-cigarettes favored local retailers. Heavy users were more likely to say they would try illicit channels. Under bans restricting more types of flavored tobacco products, users would be less likely to try illegal channels. CONCLUSIONS A significant proportion of users of flavored tobacco and nicotine products would not reject using illicit banned products. Tailored programs are needed to apply to the groups with a higher risk of seeking illicit channels for banned products.
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Affiliation(s)
- Yong Yang
- School of Public Health, University of Memphis, Memphis, TN 38152, United States of America.
| | - Eric N Lindblom
- O'Neill Institute for National & Global Health Law, Georgetown University Law Center, Washington, DC 20001, United States of America
| | - Kenneth D Ward
- College of Population Health, University of New Mexico, Albuquerque, NM 87131, United States of America
| | - Ramzi G Salloum
- Department of Health Outcomes and Policy, University of Florida, Gainesville, FL 32608, United States of America
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Freitas-Lemos R, Tegge AN, Shevorykin A, Tomlinson DC, Athamneh LN, Stein JS, Sheffer CE, Shields PG, Hatsukami DK, Bickel WK. Selective Reduction of Socioeconomic Disparities in the Experimental Tobacco Marketplace: Effects of Cigarette and E-cigarette Flavor Restrictions. Nicotine Tob Res 2024; 26:S103-S111. [PMID: 38817033 PMCID: PMC11140227 DOI: 10.1093/ntr/ntad070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/30/2023] [Accepted: 05/05/2023] [Indexed: 06/01/2024]
Abstract
INTRODUCTION Cigarette smoking accounts for >30% of the socioeconomic gap in life expectancy. Flavored restrictions claim to promote equity; however, no previous studies have compared the effect of cigarette and e-cigarette flavor restrictions among individuals who smoke with lower and higher socioeconomic status (SES). AIMS AND METHODS In a between-group within-subject design, individuals with lower (n = 155) and higher (n = 125) SES completed hypothetical purchasing trials in the experimental tobacco marketplace (ETM). Conditions were presented in a 2 × 2 factorial design (cigarette flavors restricted or unrestricted and e-cigarette flavors restricted or unrestricted) with increasing cigarette prices across trials. RESULTS Results show (1) SES differences in cigarette, e-cigarette, and NRT purchases under unrestricted policies, with lower SES showing higher cigarette demand and lower e-cigarette and NRT substitution than higher SES, (2) cigarette restrictions decreased cigarette and increased NRT purchases among lower SES, but no significant changes among higher SES, (3) decreased SES differences in cigarette demand under cigarette restrictions, but persistence under e-cigarette restrictions or their combination, (4) persistence of SES differences in e-cigarette purchases when all restrictions were enforced, and (5) waning of SES differences in NRT purchasing under all restrictions. CONCLUSIONS Flavor restrictions differentially affected individuals based on SES. Within-group comparisons demonstrated restrictions significantly impacted lower SES, but not higher SES. Between-group comparisons showed SES differences in cigarette purchasing decreased under cigarette restrictions, but persisted under e-cigarette-restrictions or their combination. Additionally, SES differences in NRT substitution decreased under flavor restrictions. These findings highlight the utility of the ETM to investigate SES disparities. IMPLICATIONS With increasing trends of socioeconomic differences in smoking prevalence and cessation rates, smoking-related health disparities are expected to continue to widen. Restricting menthol flavor in cigarettes while enhancing the availability and affordability of NRT have the potential to alleviate SES disparities in tobacco use, therefore, positively impacting health equity. However, this effect may depend on flavor availability in other tobacco products.
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Affiliation(s)
| | - Allison N Tegge
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA
- Department of Statistics, Virginia Tech, Blacksburg, VA, USA
| | - Alina Shevorykin
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Devin C Tomlinson
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA
- Graduate Program in Translational Biology, Medicine, and Health, Virginia Tech, Blacksburg, VA, USA
| | - Liqa N Athamneh
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA
| | - Jeffrey S Stein
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA
| | - Christine E Sheffer
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Peter G Shields
- Comprehensive Cancer Center, Ohio State University and James Cancer Hospital, Columbus, OH, USA
| | - Dorothy K Hatsukami
- Masonic Cancer Center and Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Warren K Bickel
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA
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Marshall LL, Norman L, Rose SW, Tseng TS. Preventing Chronic Disease Collection: From Data to Action: National, State, and Local Efforts to End Menthol and Other Flavored Commercial Tobacco Product Use. Prev Chronic Dis 2024; 21:E39. [PMID: 38815047 PMCID: PMC11155687 DOI: 10.5888/pcd21.240143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024] Open
Affiliation(s)
- LaTisha L Marshall
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
- Centers for Disease Control and Prevention, Office on Smoking and Health, 4770 Buford Hwy NE, Mail Stop S107-7, Atlanta, GA 30341
| | - Leslie Norman
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shyanika W Rose
- University of Kentucky, College of Medicine, Behavioral Science and Center for Health Equity Transformation, Lexington, Kentucky
| | - Tung-Sung Tseng
- Louisiana State University Health Sciences Center, Behavioral and Community Health Sciences, School of Public Health, New Orleans, Louisiana
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Oliveira da Silva AL, Lempert LK, Glantz SA. More than a "characterizing flavor": Menthol at subliminal levels in tobacco products. Drug Alcohol Depend 2024; 261:111346. [PMID: 38870568 DOI: 10.1016/j.drugalcdep.2024.111346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 05/16/2024] [Accepted: 05/19/2024] [Indexed: 06/15/2024]
Abstract
INTRODUCTION In addition to imparting flavor, menthol in menthol-flavored cigarettes enhances nicotine addiction and increases experimentation, initiation, and progression to regular smoking. Menthol can be added to cigarettes at perceptible levels (so-called flavored cigarettes or characterized flavored cigarettes) or non-perceptible levels (subliminal). Our objective was to understand the reasons that tobacco companies use subliminal menthol. METHODS We identified previously secret internal tobacco company documents dated 1955-2012 in the Truth Tobacco Industry Documents archive on menthol at subliminal levels. RESULTS Beginning in at least the 1950s, tobacco companies used subliminal menthol to compensate the flavor loss caused by filters, reduce smoke harshness, reduce dryness, and increase smoke coolness. Varying menthol concentrations were considered to help convert people who smoke non-menthol to menthol brands, possibly because people who use menthol cigarettes have more harship quitting than people who use non-menthol cigarettes. CONCLUSIONS Menthol is an important additive beyond its function as a "characterizing flavor." Tobacco companies use menthol in "non-menthol" cigarettes at subliminal (non-perceptible by the people who smoke cigarettes) levels to improve taste, make them easier to smoke and facilitate initiation, and possibly convert people who smoke non-menthol cigarettes to menthol cigarettes.
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Affiliation(s)
- Andre Luiz Oliveira da Silva
- Tobacco Control Office, Brazilian Health Regulatory Agency, Rio de Janeiro - Brazil; Center for Tobacco Control Research & Education, University of California, San Francisco - USA.
| | - Lauren K Lempert
- Center for Tobacco Control Research & Education, University of California, San Francisco - USA
| | - Stanton A Glantz
- Center for Tobacco Control Research & Education, University of California, San Francisco - USA
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Janssen I, Powell LH, Dugan SA, Derby CA, Kravitz HM. Cardiovascular Health, Race, and Decline in Cognitive Function in Midlife Women: The Study of Women's Health Across the Nation. J Am Heart Assoc 2024; 13:e031619. [PMID: 38656121 PMCID: PMC11179880 DOI: 10.1161/jaha.123.031619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 03/08/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Cognitive decline may progress for decades before dementia onset. Better cardiovascular health (CVH) has been related to less cognitive decline, but it is unclear whether this begins early, for all racial subgroups, and all domains of cognitive function. The purpose of this study was to determine the impact of CVH on decline in the 2 domains of cognition that decline first in White and Black women at midlife. METHODS AND RESULTS Subjects were 363 Black and 402 White women, similar in baseline age (mean±SD, 46.6±3.0 years) and education (15.7±2.0 years), from the Chicago site of the Study of Women's Health Across the Nation. Cognition, measured as processing speed and working memory, was assessed annually or biennially over a maximum of 20 years (mean±SD, 9.8±6.7 years). CVH was measured as Life's Essential 8 (blood pressure, body mass index, glucose, non-high-density lipoprotein cholesterol, smoking, physical activity, diet, sleep). Hierarchical linear mixed models identified predictors of cognitive decline with progressive levels of adjustment. There was a decline in processing speed that was explained by race, age, and the 3-way interaction of race, CVH, and time (F1,4308=8.8, P=0.003). CVH was unrelated to decline in White women but in Black women poorer CVH was associated with greater decline. Working memory did not decline in the total cohort, by race, or by CVH. CONCLUSIONS In midlife Black women, CVH promotion may be a target for preventing the beginnings of cognitive decline, thereby enhancing independent living with aging.
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Affiliation(s)
- Imke Janssen
- Department of Family and Preventive MedicineRush University Medical CenterChicagoILUSA
| | - Lynda H. Powell
- Department of Family and Preventive MedicineRush University Medical CenterChicagoILUSA
- Department of Psychiatry and Behavioral SciencesRush University Medical CenterChicagoILUSA
- Department of PharmacologyRush University Medical CenterChicagoILUSA
| | - Sheila A. Dugan
- Department of Family and Preventive MedicineRush University Medical CenterChicagoILUSA
- Department of Physical Medicine and RehabilitationRush University Medical CenterChicagoILUSA
| | - Carol A. Derby
- Department of Neurology and of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNYUSA
| | - Howard M. Kravitz
- Department of Family and Preventive MedicineRush University Medical CenterChicagoILUSA
- Department of Psychiatry and Behavioral SciencesRush University Medical CenterChicagoILUSA
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Bigwanto M, Pénzes M, Urbán R. Does sensation-seeking behavior influence the patterns of flavored e-cigarette use? A cross-sectional study among Indonesian adolescents and young adults. BMC Public Health 2024; 24:1140. [PMID: 38658887 PMCID: PMC11040837 DOI: 10.1186/s12889-024-18626-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 04/16/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND The variety of available flavors in e-cigarettes may be a driver for young people to start using these products. The objectives of our study were to examine the relationship between sensation-seeking behavior and e-cigarette use, and to identify the predictors of flavor use patterns among adolescents in Indonesia. METHODS Students aged 15 to 24 years participated from randomly selected high schools and universities in Indonesia. Participants answered questions about their demographic data, e-cigarette use, conventional cigarette use, and sensation-seeking. Flavor preferences were identified from eight different flavor categories. Multivariate multinomial regression analysis was employed to predict conventional cigarette and e-cigarette use among students. A latent class analysis was conducted to determine the number of latent classes of flavor use. RESULTS One thousand six hundred high school and university students, with a mean age of 18.2 years (SD 2.19), were recruited between March and August, 2023. Conventional cigarette use in the past 30 days was higher (16.3%) compared to e-cigarette use (13.3%, p = 0.017), with approximately 8.5% of students were being dual users. Higher levels of sensation-seeking significantly increased the odds of being a current e-cigarette user (OR = 2.54, 95%CI 1.99-3.25) and a current conventional cigarette smoker (OR = 2.38, 95%CI 1.85-3.07). Three groups of flavor classes were identified: 1) primarily menthol flavor users (14%), who had a strong association with current conventional cigarette use; 2) experimenters, who mostly preferred fruit-flavored e-cigarettes (76%); and 3) the multi-flavor user group (10%), who had a higher sensation-seeking tendency. CONCLUSIONS Flavors, especially menthol and fruit flavors, attract youth, broaden the e-cigarette audience and are particularly appealing to high sensation-seekers. Banning these flavors could significantly deter e-cigarette initiation among youth.
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Affiliation(s)
- Mouhamad Bigwanto
- Doctoral School of Psychology, Eötvös Loránd University, Izabella U. 46, Budapest, 1064, Hungary.
- Institute of Psychology, Eötvös Loránd University, Izabella U. 46, Budapest, 1064, Hungary.
- Faculty of Health Sciences, Universitas Muhammadiyah Prof. Dr. HAMKA, Jl Limau II, Jakarta, 12210, Indonesia.
| | - Melinda Pénzes
- Data-Driven Health Division of the National Laboratory for Health Security, Health Services Management Training Centre, Semmelweis University, Kútvölgyi út 2, Budapest, H-1125, Hungary
| | - Róbert Urbán
- Doctoral School of Psychology, Eötvös Loránd University, Izabella U. 46, Budapest, 1064, Hungary
- Institute of Psychology, Eötvös Loránd University, Izabella U. 46, Budapest, 1064, Hungary
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7
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Mus S, Barrientos I, Vidaña-Pérez D, Monzon J, Barnoya J, Page MK, Block AC, Goniewicz ML, O’Connor RJ, Thrasher JF. Chemicals in Cigarette Flavor Capsules From Guatemala and Mexico. Nicotine Tob Res 2024; 26:545-551. [PMID: 37930843 PMCID: PMC11033577 DOI: 10.1093/ntr/ntad216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 09/06/2023] [Accepted: 10/22/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND The global market share for cigarettes with flavor capsules has grown exponentially over the last decade, particularly in Latin America. When smoking, consumers crush a liquid capsule in the filter that flavors the smoke. Little is known about the chemical constituents of the liquids in capsules or their potential health risks. METHODS Based on consumer data and availability in Mexico and Guatemala, 31 flavor capsule brands were purchased (19 and 12, respectively) in 2020. Since some cigarettes included multiple capsules in a stick (up to 2) or pack (up to 4), the final analytic sample included 50 capsules. We conducted qualitative and quantitative analyses using gas chromatography with mass spectrometry (GC-MS, Agilent Technologies, Inc). RESULTS The qualitative analysis detected 296 compounds (range = 9-67 per capsule), and all capsules contained menthol. Among the compounds detected in more than half the sample were limonene, menthone, benzaldehyde, eucalyptol, and triacetin. Traces of nicotine were found in 22% of the capsules. In the quantitative analysis, menthol concentrations were 33 times greater than the next most common compound (limonene). Benzyl alcohol and vanillin were also found in high concentrations. Comparing same-brand varieties across countries showed substantial variability in the concentration of menthol and other compounds. CONCLUSIONS Menthol is an omnipresent constituent in capsule cigarettes, perhaps because of its anesthetizing and reinforcing addictive properties. Other compounds found are toxic, potentially carcinogenic, and may enhance addictiveness. Variance in the presence and concentrations of such compounds highlights the importance of product standards to regulate capsule content. IMPLICATIONS This study evaluated the chemical content of capsule cigarettes from two Latin American countries that have two of the highest market shares for capsule cigarettes worldwide. Compared to other studies, our assessment included brand varieties from two countries to compare the differences in chemical content by country. Our results yield that menthol is found in all capsules, and that other chemicals found may prolong nicotine exposure and therefore reinforce the addictive properties of cigarettes.
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Affiliation(s)
- Sophia Mus
- Unidad de Cirugía Cardiovascular de Guatemala, UNICAR, Guatemala City, Guatemala
| | - Inti Barrientos
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública. Cuernavaca, Morelos, Mexico
| | - Desirée Vidaña-Pérez
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - José Monzon
- Unidad de Cirugía Cardiovascular de Guatemala, UNICAR, Guatemala City, Guatemala
| | - Joaquin Barnoya
- Unidad de Cirugía Cardiovascular de Guatemala, UNICAR, Guatemala City, Guatemala
| | - Michelle K Page
- Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Ashleigh C Block
- Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Maciej L Goniewicz
- Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Richard J O’Connor
- Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - James F Thrasher
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública. Cuernavaca, Morelos, Mexico
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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Yang Y, Lindblom EN, Ward KD, Salloum RG. Should menthol e-cigarettes be banned? Reaction of adult smokers and users of e-cigarettes to hypothetical bans. Tob Control 2024; 33:e125-e127. [PMID: 36446577 PMCID: PMC10225471 DOI: 10.1136/tc-2022-057439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 11/16/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION This study examines how current smokers using menthol cigarettes or flavoured cigars, and current users of flavoured e-cigarettes may respond to three hypothetical flavour-ban scenarios: (1) banning only menthol cigarettes and flavoured cigars; (2) also banning e-cigarettes with any non-tobacco flavours except menthol; and (3) also banning e-cigarettes with any non-tobacco flavours, including menthol. METHODS Recruited from mTurk, respondents were asked if they would quit all tobacco-nicotine use or continue or start using products that were still legally available. The patterns of responding to each ban scenario, for both flavoured smokers and users of non-tobacco flavoured e-cigarettes, were summarised. Multinomial logistic regressions were used to estimate associations between demographics, smoking or e-cigarette use status and reactions to a ban. RESULTS A ban on menthol cigarettes and flavoured cigars would lead to 12%-20% of flavoured smokers trying to quit all tobacco use and 32%-52% switching to non-flavoured smoking, with the remaining switching to e-cigarettes or other products. Compared with a ban on only menthol cigarettes and flavoured cigars, also banning flavoured e-cigarettes would increase the likelihood of quitting all tobacco-nicotine use (OR=2.58) but also increase the likelihood of switching to non-flavoured smoking (OR=1.74). CONCLUSIONS Our results indicate that a ban on menthol cigarettes and flavoured cigars would decrease smoking. However, it is unclear if adding a ban of menthol e-cigarettes would lead to additional benefits because without menthol e-cigarettes as an alternative, some smokers and e-cigarette users may switch to non-flavoured tobacco smoking, rather than quit all tobacco use.
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Affiliation(s)
- Yong Yang
- School of Public Health, University of Memphis, Memphis, Tennessee, USA
| | - Eric N Lindblom
- O'Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC, USA
| | - Kenneth D Ward
- School of Public Health, University of Memphis, Memphis, Tennessee, USA
| | - Ramzi G Salloum
- Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
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Wagener TL, Mehta T, Hinton A, Schulz JA, Erath TG, Tidey J, Brinkman MC, Wilson C, Villanti AC. Addiction potential of combustible menthol cigarette alternatives: a randomised cross-over trial. Tob Control 2024; 33:e97-e105. [PMID: 36424139 PMCID: PMC10227719 DOI: 10.1136/tc-2022-057421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 11/02/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The Food and Drug Administration (FDA) has issued proposed product standards banning menthol as a characterising flavour in cigarettes and cigars. The public health benefits of these product standards may be attenuated by the role of plausible substitutes in the marketplace. Therefore, the present study examined the addiction potential of plausible combustible menthol alternatives compared with usual brand menthol cigarettes (UBMC). METHODS Ninety-eight adult menthol cigarette smokers completed four visits, smoking their UBMC at the first session and three menthol cigarette alternatives in random order at the subsequent visits: (1) a preassembled menthol roll-your-own (mRYO) cigarette using menthol pipe tobacco and mentholated cigarette tube, (2) a menthol filtered little cigar (mFLC) and (3) a non-menthol cigarette (NMC). Measures of smoking topography, exhaled carbon monoxide (CO), craving and withdrawal, subjective effects and behavioural economic demand indices were assessed. RESULTS Compared with UBMC, menthol cigarette alternatives resulted in different puffing topography and CO exposure (except mRYO), and lower levels of positive subjective experience and behavioural economic demand indices. Among the alternative products, participants reported the highest level of positive subjective experience and higher demand for mRYO, compared with mFLC and NMC. Similarly, participants were significantly more likely to want to try again, purchase and use the mRYO product regularly compared with mFLC and NMC. CONCLUSIONS AND RELEVANCE mRYO cigarettes were the most highly rated cigarette alternative among study products, suggesting their potential appeal as a menthol cigarette substitute and needed inclusion of menthol pipe tobacco and cigarette tubes in FDA's proposed ban.
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Affiliation(s)
- Theodore L Wagener
- Center for Tobacco Research, The Ohio State University James Comprehensive Cancer Center, Columbus, Ohio, USA
- Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Toral Mehta
- Center for Tobacco Research, The Ohio State University James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Alice Hinton
- Center for Tobacco Research, The Ohio State University James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Jonathan A Schulz
- Vermont Center on Behavior and Health, University of Vermont, Burlington, Vermont, USA
| | - Tyler G Erath
- Vermont Center on Behavior and Health, University of Vermont, Burlington, Vermont, USA
| | - Jennifer Tidey
- Behavioral and Social Sciences, Brown University, Providence, Rhode Island, USA
| | - Marielle C Brinkman
- Center for Tobacco Research, The Ohio State University James Comprehensive Cancer Center, Columbus, Ohio, USA
- College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Clark Wilson
- Center for Tobacco Research, The Ohio State University James Comprehensive Cancer Center, Columbus, Ohio, USA
- College of Public Health, The Ohio State University, Columbus, Ohio, USA
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Bello MS, Schulte AR, Ring CR, Cho J, Barrington-Trimis JL, Pang RD, Jao NC, Colby SM, Cassidy RN, Leventhal AM. Effects of mint, menthol, and tobacco-flavored e-cigarettes on tobacco withdrawal symptoms in adults who smoke menthol cigarettes: A laboratory pilot study. Drug Alcohol Depend 2024; 256:111110. [PMID: 38359606 PMCID: PMC10906679 DOI: 10.1016/j.drugalcdep.2024.111110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Menthol cigarette smoking has remained stable or increased in certain groups, despite an overall decline in cigarette smoking rates in the U.S. Understanding whether e-cigarettes alter patterns of menthol cigarette use is critical to informing efforts for reducing the public health burden of menthol cigarette smoking. This 2019-2020 laboratory pilot study evaluated whether self-administration of mint-, menthol-, or tobacco-flavored e-cigarettes would differentially impact tobacco withdrawal symptoms in e-cigarette-naïve adults who smoke menthol cigarettes daily. METHODS Participants (N=17; 35.3% Female; mean age=51.8) attended three laboratory sessions after 16-hours of tobacco abstinence. Participants self-administered a study-provided JUUL e-cigarette (0.7mL with 5% nicotine by weight) at each session in which flavor was manipulated (mint vs. menthol vs. tobacco; order randomized). Participants completed pre- and post-e-cigarette administration self-report assessments on smoking urges, nicotine withdrawal, and positive and negative affect states. Multilevel linear regression models tested differences between the three flavor conditions for individual study outcomes. RESULTS Following overnight tobacco abstinence, vaping either a mint or menthol (vs. tobacco) flavored e-cigarette led to significantly greater reductions in smoking urges over time; menthol (vs. tobacco) flavored e-cigarettes also suppressed urges to smoke for pleasure. Notably, no differences in nicotine withdrawal, positive affect, or negative affect were observed. CONCLUSIONS In this laboratory pilot study, mint and menthol (vs. tobacco) flavored e-cigarettes provided some negative reinforcement effects via acute reductions in smoking urges during tobacco abstinence, yet only menthol flavored e-cigarettes demonstrated suppressive effects on smoking urges for pleasure in adults who smoke menthol cigarettes daily.
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Affiliation(s)
- Mariel S Bello
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA.
| | - Alison R Schulte
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Colin R Ring
- Department of Psychology, Loma Linda University School of Behavioral Health, Loma Linda, CA, USA
| | - Junhan Cho
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Institute for Addiction Science, University of Southern California, Los Angeles, CA, USA
| | - Jessica L Barrington-Trimis
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Institute for Addiction Science, University of Southern California, Los Angeles, CA, USA
| | - Raina D Pang
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Institute for Addiction Science, University of Southern California, Los Angeles, CA, USA
| | - Nancy C Jao
- Department of Psychology, Rosalind Franklin University of Medicine and Science, Chicago, IL, USA
| | - Suzanne M Colby
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA; Department of Psychiatry & Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Rachel N Cassidy
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
| | - Adam M Leventhal
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Institute for Addiction Science, University of Southern California, Los Angeles, CA, USA
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Kazemi A, Iraji A, Esmaealzadeh N, Salehi M, Hashempur MH. Peppermint and menthol: a review on their biochemistry, pharmacological activities, clinical applications, and safety considerations. Crit Rev Food Sci Nutr 2024:1-26. [PMID: 38168664 DOI: 10.1080/10408398.2023.2296991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
In this manuscript, we conducted a comprehensive review of the diverse effects of peppermint on human health and explored the potential underlying mechanisms. Peppermint contains three main groups of phytochemical constituents, including essential oils (mainly menthol), flavonoids (such as hesperidin, eriodictyol, naringenin, quercetin, myricetin, and kaempferol), and nonflavonoid phenolcarboxylic acids. Peppermint exhibits antimicrobial, antioxidant, anti-inflammatory, immunomodulatory, anti-cancer, anti-aging, and analgesic properties and may be effective in treating various disorders, including gastrointestinal disorders (e.g., irritable bowel syndrome, dyspepsia, constipation, functional gastrointestinal disorders, nausea/vomiting, and gallbladder stones). In addition, peppermint has therapeutic benefits for psychological and cognitive health, dental health, urinary retention, skin and wound healing, as well as anti-depressant and anti-anxiety effects, and it may improve memory. However, peppermint has paradoxical effects on sleep quality and alertness, as it has been shown to improve sleep quality in patients with fatigue and anxiety, while also increasing alertness under conditions of monotonous work and relaxation. We also discuss its protective effects against toxic agents at recommended doses, as well as its safety and potential toxicity. Overall, this review provides the latest findings and insights into the properties and clinical effects of peppermint/menthol and highlights its potential as a natural therapeutic agent for various health conditions.
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Affiliation(s)
- Asma Kazemi
- Nutrition Research Center, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Aida Iraji
- Research Center for Traditional Medicine and History of Medicine, Department of Persian Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- Stem Cells Technology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Niusha Esmaealzadeh
- Department of Traditional Pharmacy, School of Persian Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Traditional Persian Medicine and Complementary Medicine (PerCoMed) Student Association, Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Salehi
- Traditional and Complementary Medicine Research Center (TCMRC), Department of Traditional Medicine, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Mohammad Hashem Hashempur
- Research Center for Traditional Medicine and History of Medicine, Department of Persian Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Issabakhsh M, Meza R, Li Y, Yuan Z, Sanchez-Romero LM, Levy DT. Public health impact of a US menthol cigarette ban on the non-Hispanic black population: a simulation study. Tob Control 2023; 33:126-130. [PMID: 35700999 PMCID: PMC10803953 DOI: 10.1136/tobaccocontrol-2022-057298] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/31/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION With the US Food and Drug Administration recently proposing to implement a ban on menthol cigarettes, it is critical to estimate the potential public health effects of such a ban. With high rates of menthol cigarette use and important smoking-related health disparity implications, the impact of the ban on the non-Hispanic black (NHB) population merits strong consideration. METHODS We apply the previously developed Menthol Smoking and Vaping Model to the NHB population. A status quo scenario is developed using NHB-specific population, smoking and vaping initiation, cessation and death rates. Estimates from a recent expert elicitation on behavioural impacts of a menthol cigarette ban on the NHB population are used to develop a menthol ban scenario implemented in 2021. The public health impacts of the menthol ban are estimated as the difference between smoking and vaping attributable deaths (SVADs) and life years lost (LYLs) in the status quo and the menthol ban scenarios from 2021 to 2060. RESULTS Under the menthol ban scenario, overall smoking is projected to decline by 35.7% in 2026 and by 25.3% in 2060 relative to the status quo scenario. With these reductions, SVADs are estimated to fall by about 18.5% and LYLs by 22.1%, translating to 255 895 premature deaths averted, and 4.0 million life years gained over a 40-year period. CONCLUSIONS A menthol cigarette ban will substantially reduce the smoking-associated health impact on the NHB population, thereby reducing health disparities.
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Affiliation(s)
- Mona Issabakhsh
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Rafael Meza
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Yameng Li
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Zhe Yuan
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | | | - David T Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
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13
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Jones JT, Xu K, Deng L, Sawdey MD, Reyes-Guzman CM, Chang CM, Chang JT. Smoking cessation prevalence by menthol cigarette use and select demographics among adults in the United States, TUS-CPS, 2003-2019. Prev Med Rep 2023; 36:102440. [PMID: 37810267 PMCID: PMC10556806 DOI: 10.1016/j.pmedr.2023.102440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 10/10/2023] Open
Abstract
People who smoke menthol cigarettes, particularly those who are non-Hispanic Black/African American, are less likely to achieve successful smoking cessation compared with people who smoke non-menthol cigarettes. This study examined the 2003-2019 Tobacco Use Supplement to the Current Population Survey (TUS-CPS) harmonized data to estimate cross-sectional trends in cigarette smoking cessation among U.S. adults, stratified by menthol cigarette use, race/ethnicity, sex, and age. The analytic sample included respondents who smoked for ≥ 2 years (current users and former users who reported quitting during the past year). We tested cessation trends using orthogonal polynomial contrasts for overall, menthol, and non-menthol smoking cessation prevalence and stratified by race/ethnicity, sex, and age in logistic regression models. We also analyzed the 2018-2019 non-harmonized TUS-CPS data among recent quitters to examine differences in characteristics (e.g., demographic characteristics, smoking frequency, use of smoking cessation aids, switching to other tobacco products) by menthol cigarette use. We observed significant linear changes in prevalence trends for overall cigarette smoking cessation, menthol smoking cessation, and non-menthol smoking cessation (p < 0.0001 for all linear trends), and changes in menthol cessation among non-Hispanic White and non-Hispanic Other race/ethnicity categories during 2003-2019. In the 2018-2019 wave, we observed differences in menthol status for sex, race/ethnicity, age, and educational attainment. We did not observe differences for other characteristics. We observed changes in overall cigarette smoking cessation, menthol, and non-menthol smoking cessation prevalence during the study period; however, gains in cigarette smoking cessation were not experienced among non-Hispanic Black/African American adults who smoke.
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Affiliation(s)
- Jamal T. Jones
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, United States
| | - Kerui Xu
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, United States
| | - Li Deng
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, United States
| | - Michael D. Sawdey
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, United States
| | - Carolyn M. Reyes-Guzman
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Cindy M. Chang
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, United States
| | - Joanne T. Chang
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, United States
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14
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Barsha RAA, Assari S, Hossain MB, Apata J, Sheikhattari P. Black Americans' Diminished Return of Educational Attainment on Tobacco Use in Baltimore City. J Racial Ethn Health Disparities 2023; 10:3178-3187. [PMID: 37755685 PMCID: PMC10645619 DOI: 10.1007/s40615-023-01805-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 09/10/2023] [Accepted: 09/14/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND Socioeconomic status (SES) indicators such as educational attainment are fundamental factors affecting health. One mechanism through which education affects health is by reducing the likelihood of engaging in high-risk behaviors such as smoking. However, according to the marginalization-related diminished returns (MDRs) theory, the association between education and health may be weaker for marginalized populations such as Black than White, primarily due to racism and discrimination. However, little is known about the racial variations in the differential associations between educational attainment and tobacco use in a local setting. AIM This study aimed to investigate the differential association between educational attainment and tobacco use among racial groups in a community sample in Baltimore City. METHODS This cross-sectional study used data from a community survey conducted in 2012-2013 in Baltimore City among adults aged 18 years or older. The participants were 3501 adults. Univariate, bivariate, and logistic regression analyses were performed using Stata to investigate the racial difference in the association between education and two outcomes: current smoking status and menthol tobacco product use. RESULTS The study found that adults with a graduate degree were less likely to be current smokers (adjusted odds ratio [AOR]: 0.10, 95% confidence interval [CI]: 0.08-0.13) and menthol tobacco users (AOR: 0.10, 95% CI: 0.07-0.14) compared to those with less than high school diploma. The inverse associations between educational attainment and current smoking (AOR: 1.83, 95% CI: 1.05-3.21) and menthol tobacco product use (AOR: 4.73, 95% CI: 2.07-10.80) were weaker for Back individuals than those who were White. CONCLUSION Due to MDRs of educational attainment, while highly educated White adults show a low risk of tobacco use, educated Black adults remain at a disproportionately increased risk. The study emphasizes the need for better policies and programs that address minorities' diminished return of education for tobacco use.
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Affiliation(s)
- Rifath Ara Alam Barsha
- Center for Urban Health Disparities Research and Innovation, Morgan State University, Baltimore, MD, USA
| | - Shervin Assari
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA, USA.
- Department of Urban Public Health, Charles R Drew University of Medicine and Science, Los Angeles, CA, USA.
| | - Mian B Hossain
- Center for Urban Health Disparities Research and Innovation, Morgan State University, Baltimore, MD, USA
- School of Community Health and Policy, Morgan State University, Baltimore, MD, USA
| | - Jummai Apata
- Center for Urban Health Disparities Research and Innovation, Morgan State University, Baltimore, MD, USA
| | - Payam Sheikhattari
- Center for Urban Health Disparities Research and Innovation, Morgan State University, Baltimore, MD, USA
- The Prevention Sciences Research Center, School of Community Health and Policy, Morgan State University, Baltimore, MD, USA
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15
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Moodie C, Thrasher JF, Barnoya J, Mejia R, Barrientos-Gutierrez I, Zavaleta A, Chaloupka F. Tobacco Industry Claims About Transformation are Inconsistent With Combustible Cigarette Innovations: The Case of Flavor Capsule Cigarettes. Nicotine Tob Res 2023; 25:1891-1895. [PMID: 36149828 DOI: 10.1093/ntr/ntac224] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 08/03/2022] [Accepted: 10/17/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Crawford Moodie
- Faculty of Health Sciences and Sport, Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - James F Thrasher
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Joaquin Barnoya
- Departamento de Ciencias de la Salud, Vicerrectoría de Investigación y Proyección, Rafael Landívar University, Guatemala City, Guatemala
- Unidad de Cirugía Cardiovascular de Guatemala, Guatemala City, Guatemala
| | - Raul Mejia
- Centro de Estudios de Estado y Sociedad (CEDES), Buenos Aires, Argentina
| | | | - Alfonso Zavaleta
- Information and Education Center for the Prevention of Drug Abuse (CEDRO), Lima, Peru
- Faculty of Sciences and Philosophy, Peruvian Cayetano Heredia University, Lima, Peru
| | - Frank Chaloupka
- School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA
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Moze JM, O’Gara EK, Fritz Fogel K, D’Silva J, Matter CM, Nichols EM. Youth Perspectives on Menthol Sales Restrictions in Minneapolis and Duluth, Minnesota. Health Promot Pract 2023; 24:1163-1173. [PMID: 36263446 PMCID: PMC10601345 DOI: 10.1177/15248399221127046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although menthol cigarettes are a starter product for youth, menthol was exempted from the 2009 Tobacco Control Act, which banned all other characterizing flavors. Minneapolis and Duluth, Minnesota, implemented menthol tobacco sales restrictions in 2018 to advance health equity for youth, African American, lesbian, gay, bisexual, trans, and queer (LGBTQ), and other communities adversely affected by menthol. This evaluation assesses the policy impact on youth access to menthol tobacco, exposure to menthol advertising, and tobacco use. A core group of youth aged 14 to 17 years (n = 30) was recruited from Minneapolis and Duluth to gather data through photo voice and peer interviews 2 months before and after policy implementation. This evaluation shares the results of focus groups with these core youth where they reflected on what they observed in the community and heard from peers. The core youth identified and categorized emergent themes using the evaluation questions. Following the focus groups, the evaluation staff used these preliminary themes and coded remaining transcripts. The core youth had mixed reactions to the impact of policies on access and use because many tobacco users in their age group obtain tobacco informally through peers, family members, and online. They observed decreases in retail advertising of menthol cigarettes, although many felt e-cigarettes and online advertising were more significant issues for their age group. Findings show a need for increased education and more comprehensive policy approaches, including addressing use of flavored e-cigarettes, online tobacco sales, and informal access, making youth access to tobacco more difficult.
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Affiliation(s)
- Joanne M. Moze
- Blue Cross and Blue Shield of Minnesota, Saint Paul, MN, USA
| | | | | | | | - Chris M. Matter
- Blue Cross and Blue Shield of Minnesota, Saint Paul, MN, USA
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17
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Kaai SC, Fong GT, Ong'ang'o JR, Goma F, Meng G, Craig LV, Ikamari L, Quah ACK, Elton-Marshall T. Prevalence, perceptions and factors associated with menthol cigarette smoking: findings from the ITC Kenya and Zambia Surveys. Tob Control 2023; 32:709-714. [PMID: 35459749 PMCID: PMC10646928 DOI: 10.1136/tobaccocontrol-2021-057100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 04/01/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Menthol masks the harshness of cigarette smoke, promotes youth smoking and encourages health-concerned smokers who incorrectly believe that menthols are less harmful to smoke menthols. This study of smokers in Kenya and Zambia is the first study in Africa to examine menthol use, smokers' beliefs about its harmfulness and the factors associated with menthols. METHODS Data were from the International Tobacco Control (ITC) Kenya Wave 2 (2018) and Zambia Wave 2 Survey (2014), involving nationally representative samples of smokers. This study focuses on 1246 adult smokers (644 in Kenya, 602 in Zambia) who reported smoking a usual brand of cigarettes (menthol or non-menthol). RESULTS Overall, menthol use was significantly higher among smokers in Zambia than in Kenya (48.0% vs 19.0%), females (45.6% vs 31.2% males), non-daily smokers (43.8% vs 30.0% daily) and those who exclusively smoked factory-made (FM) cigarettes (43.0% vs 15.2%). The erroneous belief that menthols are less harmful was more likely among smokers in Zambia than in Kenya (53.4% vs 29.3%) and among female smokers (38.5% vs 28.2%). In Kenya, menthol smoking was associated with being female (adjusted odds ratios (AOR)=3.07; p=0.03), worrying about future health (AOR=2.28; p=0.02) and disagreeing with the statement that smoking was calming (AOR=2.05; p=0.04). In Zambia, menthol use was associated with being female (AOR=3.91; p=0.002), completing primary school (AOR=2.14; p=0.03), being a non-daily smoker (AOR=2.29; p=0.03), exclusively using FM cigarettes (AOR=14.7; p<0.001), having a past quit attempt (AOR=1.54; p=0.02), believing that menthols are less harmful (AOR=3.80; p<0.001) and choosing menthols because they believed it was less harmful (AOR=3.52; p<0.001). CONCLUSIONS Menthols are highly prevalent among females in both countries. There is a need in African countries to combat the myth that menthols are less harmful and to ban menthol and other flavourings.
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Affiliation(s)
- Susan Cherop Kaai
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | | | - Fastone Goma
- University of Zambia School of Medicine, Lusaka, Zambia
| | - Gang Meng
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Lorraine V Craig
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | | | - Anne C K Quah
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Tara Elton-Marshall
- School of Epidemiology and Public Health, University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, London, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
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Klupinski TP, Strozier ED, Koebel DD, Lucas EA. Detection of the Synthetic Coolant Menthone 1,2-Glycerol Ketal in an e-Liquid and in Electronic Waterpipe Aerosols Therefrom. Chem Res Toxicol 2023; 36:1355-1360. [PMID: 37439580 PMCID: PMC10529952 DOI: 10.1021/acs.chemrestox.3c00089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
The presence and toxicological risks of synthetic coolants in electronic nicotine delivery systems (ENDS) have not been thoroughly studied. We identified the synthetic coolant menthone 1,2-glycerol ketal (MGK) in a menthol-flavored e-liquid at a concentration of ∼170 μg/mL. We also detected MGK in aerosols resulting from heating the e-liquid with an electronic waterpipe. MGK was initially detected in the e-liquid by two-dimensional gas chromatography-time-of-flight mass spectrometry. To avoid potential analytical artifacts that could result from heating samples in the injection port of the gas chromatograph, quantitation of MGK in the e-liquid was accomplished using a liquid chromatography-tandem mass spectrometry method. Following recent reports identifying other synthetic coolants in e-liquids, these results add knowledge about inhalation exposures from ENDS use and suggest the importance of future research to study the potential inhalation toxicity related to the use of MGK-containing e-liquids in ENDS devices. Furthermore, the results demonstrate the ability to quantify ketals in e-liquids using liquid chromatography methods.
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Affiliation(s)
| | | | - David D Koebel
- Battelle, 505 King Ave., Columbus, Ohio 43201, United States
| | - Eric A Lucas
- Battelle, 505 King Ave., Columbus, Ohio 43201, United States
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19
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Yang Y, Lindblom EN, Ward KD, Salloum RG. Reactions to hypothetical flavor bans among current users of flavored e-cigarettes. Transl Behav Med 2023; 13:533-538. [PMID: 36694931 PMCID: PMC10415732 DOI: 10.1093/tbm/ibac109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Banning flavors in e-cigarettes and other tobacco products may decrease their use. To examine how current users of flavored e-cigarettes might react to a ban on flavored e-cigarettes when: (i) menthol flavor is banned together with other flavors, or (ii) this ban on e-cigarettes is combined with a ban on menthol cigarettes and flavored cigars. A national cross-sectional survey of 2,347 current users of flavored e-cigarettes was conducted in May 2022. For each hypothetical ban scenario, respondents reported if they would quit all tobacco product use, continue to use e-cigarettes with no flavor or flavors that were not banned, or switch to alternative tobacco products. Multinomial logistic regressions were used to estimate the associations between responses and ban scenarios, adjusting for tobacco use and demographic variables. If e-cigarettes with any flavors except menthol and tobacco were banned, the majority of current e-cigarette users would keep using e-cigarettes with no flavor or tobacco and menthol flavor. When menthol flavor was added to a ban, a greater proportion of respondents would quit all tobacco use; however, more would also switch to cigarettes or cigars. When menthol cigarettes and flavored cigars were added to a ban, those who used menthol flavor only would be less likely to switch to cigarettes and cigars. Among current e-cigarette users, the harm reduction (i.e., from quitting all use) from a ban on flavored e-cigarettes, particularly if menthol is also banned, may be outweighed by the harm increases (i.e., switching to cigarettes or cigars, or other products that are more harmful than using e-cigarettes). A concurrent ban on menthol cigarettes and flavored cigars would secure more certain net reductions to public health harms from e-cigarette use and smoking.
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Affiliation(s)
- Yong Yang
- School of Public Health, University of Memphis, Memphis, TN, 38152, USA
| | - Eric N Lindblom
- O’Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC, 20001, USA
| | - Kenneth D Ward
- School of Public Health, University of Memphis, Memphis, TN, 38152, USA
| | - Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, 32610, USA
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20
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White AM, Barnes AJ, Garner W. Racial/ethnic differences in the association between menthol cigarette use and mental illness among adults who smoke in the United States. J Ethn Subst Abuse 2023:1-21. [PMID: 37052141 PMCID: PMC10570396 DOI: 10.1080/15332640.2023.2196645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Data from the National Survey on Drug Use and Health (2012-2018) were used to characterize the association between menthol cigarette use and indicators of Any (AMI) and Serious (SMI) Mental Illness among adults who smoke in the United States. In general, people who smoke menthol cigarettes were more likely to have AMI (aOR = 1.123 [1.063-1.194]) than people who smoke non-menthol cigarettes, but not SMI (aOR = 1.065 [0.966-1.175]). However, among non-Hispanic African American/Black people who smoke, those that used menthol cigarettes had lower adjusted odds of both AMI (aOR = 0.740 [0.572-0.958]) and SMI (aOR = 0.592 [0.390-0.899]) than their counterparts who used non-menthol cigarettes. Results suggest there may be race/ethnicity-specific drivers of the association between menthol cigarette use and mental illness.
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Affiliation(s)
- Augustus M. White
- Department of Health Behavior and Policy, Virginia
Commonwealth University, 830 E. Main St., 9 Floor, Richmond, VA, 23219
USA
- Center for the Study of Tobacco Products, Virginia
Commonwealth University, 100 W. Franklin St., Suite 200, Richmond, VA, 23220
USA
| | - Andrew J. Barnes
- Department of Health Behavior and Policy, Virginia
Commonwealth University, 830 E. Main St., 9 Floor, Richmond, VA, 23219
USA
- Center for the Study of Tobacco Products, Virginia
Commonwealth University, 100 W. Franklin St., Suite 200, Richmond, VA, 23220
USA
| | - William Garner
- Department of Public Health, University of North Texas at
Dallas, 7300 University Hills Boulevard, Dallas, TX 75241, USA
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21
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Shi Z, Wang AL, Fairchild VP, Aronowitz CA, Lynch KG, Loughead J, Langleben DD. Addicted to green: priming effect of menthol cigarette packaging on brain response to smoking cues. Tob Control 2023; 32:e45-e52. [PMID: 34599084 PMCID: PMC8971144 DOI: 10.1136/tobaccocontrol-2021-056639] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 08/11/2021] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Mentholated tobacco cigarettes are believed to be more addictive than non-menthol ones. Packaging of most menthol cigarette brands includes distinctive green hues, which may act as conditioned stimuli (ie, cues) and promote menthol smoking. To examine the cue properties of menthol cigarette packaging, we used a priming paradigm to assess the effect of packaging on the neural substrates of smoking cue reactivity. We hypothesised that menthol packaging will exert a specific priming effect potentiating smoking cue reactivity in menthol compared with non-menthol smokers. METHODS Forty-two menthol and 33 non-menthol smokers underwent functional MRI while viewing smoking and neutral cues. The cues were preceded (ie, primed) by briefly presented images of menthol or non-menthol cigarette packages. Participants reported craving for cigarettes in response to each cue. RESULTS Menthol packaging induced greater frontostriatal and occipital smoking cue reactivity in menthol smokers than in non-menthol smokers. Menthol packaging also enhanced the mediation by neural activity of the relationship between cue exposure and cigarette craving in menthol but not non-menthol smokers. Dynamic causal modelling showed stronger frontostriatal-occipital connectivity in response to menthol packaging in menthol compared with non-menthol smokers. The effects of non-menthol packaging did not differ between categories of smokers. CONCLUSIONS Our findings demonstrate heightened motivational and perceptual salience of the green-hued menthol cigarette packaging that may exacerbate menthol smokers' susceptibility to smoking cues. These effects could contribute to the greater addiction severity among menthol smokers and could be considered in the development of science-based regulation and legal review of tobacco product marketing practices.
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Affiliation(s)
- Zhenhao Shi
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - An-Li Wang
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Catherine A Aronowitz
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Kevin G Lynch
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - James Loughead
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Daniel D Langleben
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Annenberg Public Policy Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Levy DT, Meza R, Yuan Z, Li Y, Cadham C, Sanchez-Romero LM, Travis N, Knoll M, Liber AC, Mistry R, Hirschtick JL, Fleischer NL, Skolnick S, Brouwer AF, Douglas C, Jeon J, Cook S, Warner KE. Public health impact of a US ban on menthol in cigarettes and cigars: a simulation study. Tob Control 2023; 32:e37-e44. [PMID: 34475258 PMCID: PMC9210349 DOI: 10.1136/tobaccocontrol-2021-056604] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 07/26/2021] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The US Food and Drug Administration most recently announced its intention to ban menthol cigarettes and cigars nationwide in April 2021. Implementation of the ban will require evidence that it would improve public health. This paper simulates the potential public health impact of a ban on menthol in cigarettes and cigars through its impacts on smoking initiation, smoking cessation and switching to nicotine vaping products (NVPs). METHODS After calibrating an established US simulation model to reflect recent use trends in cigarette and NVP use, we extended the model to incorporate menthol and non-menthol cigarette use under a status quo scenario. Applying estimates from a recent expert elicitation on the behavioural impacts of a menthol ban, we developed a menthol ban scenario with the ban starting in 2021. We estimated the public health impact as the difference between smoking and vaping-attributable deaths and life-years lost in the status quo scenario and the menthol ban scenario from 2021 to 2060. RESULTS As a result of the ban, overall smoking was estimated to decline by 15% as early as 2026 due to menthol smokers quitting both NVP and combustible use or switching to NVPs. These transitions are projected to reduce cumulative smoking and vaping-attributable deaths from 2021 to 2060 by 5% (650 000 in total) and reduce life-years lost by 8.8% (11.3 million). Sensitivity analyses showed appreciable public health benefits across different parameter specifications. CONCLUSIONS AND RELEVANCE Our findings strongly support the implementation of a ban on menthol in cigarettes and cigars.
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Affiliation(s)
- David T Levy
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Rafael Meza
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Zhe Yuan
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Yameng Li
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Christopher Cadham
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Luz Maria Sanchez-Romero
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Nargiz Travis
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Marie Knoll
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Alex C Liber
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Ritesh Mistry
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Jana L Hirschtick
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Nancy L Fleischer
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Sarah Skolnick
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Andrew F Brouwer
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Cliff Douglas
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Jihyoun Jeon
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Steven Cook
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Kenneth E Warner
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
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23
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Leas EC, Benmarhnia T, Strong DR, Pierce JP. Effects of menthol use and transitions in use on short-term and long-term cessation from cigarettes among US smokers. Tob Control 2023; 32:e31-e36. [PMID: 34230056 PMCID: PMC8733048 DOI: 10.1136/tobaccocontrol-2021-056596] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 06/11/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To estimate the effect of menthol use and transitions in use (switching to or from menthol) on short-term and long-term cessation from cigarette smoking and whether this differed across demographic groups (age, sex, race). METHODS We compared the probability of 30+ day and 12-month abstinence from cigarette smoking by menthol use status using two cohorts of US adult cigarette smokers who attempted to quit smoking in the Population Assessment of Tobacco and Health (wave 1 to wave 3 and wave 2 to wave 4; n=5759), inverse probability of treatment weighting and adjusted risk ratios (aRRs). RESULTS Using menthol (vs non-menthol) prior to a quit attempt decreased the probability of 30+ day abstinence by 28% (aRR=0.78; 95% CI 0.67 to 0.91) and the probability of 12-month abstinence by 53% (aRR=0.65; 95% CI 0.47 to 0.88). Additionally, switching from menthol (vs maintaining menthol use) increased the probability of 30+ day abstinence by 58% (aRR=1.58; 95% CI 1.00 to 2.50) and the probability of 12-month abstinence by 97% (aRR=1.86; 95% CI 0.92 to 3.74). Switching to menthol (vs maintaining non-menthol use) was associated with a lower probability of 30+ day (aRR=0.70; 95% CI 0.42 to 1.16) and 12-month abstinence (aRR=0.64; 95% CI 0.30 to 1.36), but these associations were imprecise. The effects of menthol use on impaired quitting were slightly larger for non-Hispanic Black smokers, but not different for other demographic groups. CONCLUSION These results demonstrate that menthol impaired menthol smokers' attempts to quit smoking but switching from menthol improved success. This suggests that removing menthol may improve menthol smokers' success during quit attempts.
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Affiliation(s)
- Eric C Leas
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Tarik Benmarhnia
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
- Scripps Institution of Oceanography, University of California San Diego, La Jolla, CA, USA
| | - David R Strong
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
| | - John P Pierce
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
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24
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Byron MJ, Enyioha C, Goldstein AO. The Role of Communication Research to Support Policy Change: The US Menthol Ban. Nicotine Tob Res 2023; 25:841-843. [PMID: 36321785 PMCID: PMC10032179 DOI: 10.1093/ntr/ntac249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/30/2022] [Accepted: 11/01/2022] [Indexed: 11/18/2022]
Affiliation(s)
- M Justin Byron
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Chineme Enyioha
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Adam O Goldstein
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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25
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Oncken C, Litt MD, Thurlow S, Mead-Morse EL, Wang L, Hatsukami DK. Manipulation of Menthol and Nicotine Content in Cigarettes: Effects on Smoking Behavior and Toxicant Exposure in Women Menthol Smokers. Nicotine Tob Res 2023; 25:665-673. [PMID: 36156108 PMCID: PMC10032200 DOI: 10.1093/ntr/ntac225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/26/2022] [Accepted: 09/23/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND The purpose of this study was to determine the effects of smoking and other outcomes of assigning cigarettes with reduced nicotine and/or no menthol to female menthol smokers. AIMS AND METHODS Nontreatment-seeking female menthol smokers (N = 263) participated in a randomized controlled trial in which levels of menthol and nicotine in cigarettes were manipulated using experimental cigarettes. After a baseline period, participants were assigned to the following conditions for 6 weeks: (1) their own brand of cigarette (conventional nicotine with menthol), (2) a conventional nicotine cigarette with no menthol, (3) a cigarette with reduced nicotine (RNC) with menthol, or (4) a RNC cigarette and no menthol. Participants then returned to using their own brand and were followed for another 6 weeks. Outcomes included cigarettes smoked, biomarkers of exposure, and dependence measures. RESULTS Results indicated that, after an initial increase, rates of smoking of all three experimental cigarettes were at or below baseline rates of smoking of one's own brand. Levels of biomarkers also decreased during the experimental phase but rebounded somewhat after participants resumed smoking their own brand. There was evidence that the overall amount of smoking decreased similarly among women who switched to non-menthol and/or RNC cigarettes. CONCLUSIONS These results suggest that no detrimental effect will occur in nicotine or toxicant exposure levels with a ban on characterizing menthol and/or a product standard on nicotine content in cigarettes. IMPLICATIONS The implication of this work is that there would be no risk to women menthol smokers associated with regulations restricting nicotine and eliminating menthol in cigarettes.
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Affiliation(s)
- Cheryl Oncken
- University of Connecticut School of Medicine, Farmington, CT 06030, USA
| | - Mark D Litt
- University of Connecticut School of Medicine, Farmington, CT 06030, USA
- University of Connecticut School of Dental Medicine, Farmington, CT 06030, USA
| | - Sheila Thurlow
- University of Connecticut School of Medicine, Farmington, CT 06030, USA
| | - Erin L Mead-Morse
- University of Connecticut School of Medicine, Farmington, CT 06030, USA
| | - Lanqing Wang
- Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
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26
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Sawyer AN, Combs M, Clark V, Soule EK, Lee JGL, Breland AB. Reactions to a Hypothetical Menthol Cigarette Ban among Sexual- and Gender-Minoritized Communities: A Concept Mapping Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3891. [PMID: 36900905 PMCID: PMC10001923 DOI: 10.3390/ijerph20053891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 02/15/2023] [Accepted: 02/19/2023] [Indexed: 06/18/2023]
Abstract
Menthol cigarette use is disproportionately higher among sexual- and gender-minoritized (SGM; 36%) individuals compared to cisgender, heterosexual (29%), individuals. The FDA has announced intentions to ban menthol in cigarettes, citing these use and health disparities as partial motivation. This study identified potential outcomes of a menthol cigarette ban among SGM individuals who smoke menthol cigarettes (N = 72). Potential outcomes were identified via concept mapping using the prompt: "If menthol in cigarettes was banned, a specific action I would take related to my tobacco use is…" Participants generated 82 response statements, sorted them, and rated them on personal relevance. Eight thematic clusters were identified: (1) Thoughtful Consideration of the Ban, (2) Negative Reactions to the Ban, (3) Positive Aspects of the Ban, (4) Strategies to Reduce Cravings, (5) Intent to Quit and Cessation Strategies, (6) Support-Seeking and Engagement in Positive Behaviors, (7) Strategies to Maintain Menthol-Flavored Product Use, and (8) Substance Use Alternatives to Menthol Cigarettes. Cluster differences based on sociodemographic factors, smoking behavior, and quitting interest were identified. Results provide insight into potential responses to a menthol cigarette ban and can contribute to public health prevention and intervention efforts, messaging campaigns, and support services for SGM people who smoke menthol cigarettes, specifically.
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Affiliation(s)
- Ashlee N. Sawyer
- Center for the Study of Tobacco Products, Department of Psychology, Virginia Commonwealth University, Richmond, VA 23220, USA
| | - Madison Combs
- Center for the Study of Tobacco Products, Department of Psychology, Virginia Commonwealth University, Richmond, VA 23220, USA
| | - Viktor Clark
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA 23220, USA
| | - Eric K. Soule
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, NC 27858, USA
| | - Joseph G. L. Lee
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, NC 27858, USA
| | - Alison B. Breland
- Center for the Study of Tobacco Products, Department of Psychology, Virginia Commonwealth University, Richmond, VA 23220, USA
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA 23220, USA
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27
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Mavragani A, Tang Q, Xie Z, Li D. Public Perceptions of the Food and Drug Administration's Proposed Rules Prohibiting Menthol Cigarettes on Twitter: Observational Study. JMIR Form Res 2023; 7:e42706. [PMID: 36763414 PMCID: PMC9960014 DOI: 10.2196/42706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 01/09/2023] [Accepted: 02/02/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND On April 28, 2022, the Food and Drug Administration (FDA) proposed rules that prohibited all menthol-flavored cigarettes and other flavored cigars to prevent the initiation of tobacco use in youth and reduce tobacco-related diseases and death. OBJECTIVE The objective of this study was to investigate public perceptions of the FDA's proposed menthol cigarette rules on Twitter. METHODS Through the Twitter streaming application programming interface, tobacco-related tweets were collected between April 28, 2022, and May 27, 2022, using a set of keywords, such as smoking, cigarette, and nicotine. Furthermore, 1941 tweets related to the FDA's proposed menthol cigarette rules were extracted. Based on 300 randomly selected example tweets, the codebook for the attitudes toward the FDA's proposed rules and related topics was developed by 2 researchers and was used to label the rest of the tweets. RESULTS Among tweets related to the FDA's proposed menthol cigarette rules, 536 (27.61%) showed a positive attitude, 443 (22.82%) had a negative attitude, and 962 (49.56%) had a neutral attitude toward the proposed rules. Social justice (210/536, 39%) and health issues (117/536, 22%) were two major topics in tweets with a positive attitude. For tweets with a negative attitude, alternative tobacco or nicotine products (127/443, 29%) and racial discrimination (84/536, 16%) were two of the most popular topics. CONCLUSIONS In general, the public had a positive attitude toward the FDA's proposed menthol cigarette rules. Our study provides important information to the FDA on the public perceptions of the proposed menthol cigarette rules, which will be helpful for future FDA regulations on menthol cigarettes.
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Affiliation(s)
| | - Qihang Tang
- Goergen Institute for Data Science, University of Rochester, Rochester, NY, United States
| | - Zidian Xie
- Department of Clinical and Translational Research, University of Rochester Medical Center, Rochester, NY, United States
| | - Dongmei Li
- Department of Clinical and Translational Research, University of Rochester Medical Center, Rochester, NY, United States
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28
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Kreslake JM, O'Connor KM, Stephens D, Vallone DM, Hair EC. Perceived Sensory Characteristics of Blended and Ambiguous "Concept" Flavors Among Adolescent and Young Adult E-cigarette Users. Nicotine Tob Res 2023; 25:524-532. [PMID: 36703225 DOI: 10.1093/ntr/ntac236] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 08/14/2022] [Accepted: 10/13/2022] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Flavors with names describing blended tastes/sensations or with ambiguous terminology ("concept flavors") are available on the e-cigarette market. AIMS AND METHODS This study investigates adolescent and young adult use and sensory perceptions of blended and concept flavors. Current e-cigarette users aged 15-24 years (N = 2281) completed an online convenience sample survey (October 20-November 23, 2020) and rated the sensory attributes (fruity, cooling, sweet, and minty) of their current flavor(s) using nine-point scales. T-tests compared mean sensory perception scores within and between flavors. To compare concept flavors to blends, reference categories used the average of blends with relevant descriptors: fruit (Banana Ice, Iced Mango, Melon Ice, Cool Cucumber); cooling (Banana Ice, Iced Mango, Melon Ice, Blue B Ice, Cool Cucumber, Lush Ice, and Menthol Purple); sweet (Vivid Vanilla) and mint (Mint-sation). RESULTS Most respondents had used at least one product with blended descriptors (74.8%) or concept flavor (57.9%) in the past 30 days. All flavors had high perceived strength for at least two sensory attributes. Mint taste was not perceived to be a strong sensory characteristic for all but two flavors (Mint-sation and Winter) in the study. The most commonly used flavors used blended descriptors (Iced Mango was used by 30.2% of the sample; Banana Ice: 26.2%; Lush Ice: 23.8%; Melon Ice: 22.9%). Some concept flavors did not significantly differ from flavor blend reference categories for strength of: fruit taste (Bahama Mama and Tropic); cooling sensation (Marigold, Island Breeze, Winter); sweet taste (Bahama Mama, Honeymoon, Island Breeze, Island Cream, Meteor Milk, OMG, Royal Dagger and Tropic); and mint taste (Winter). CONCLUSIONS Blended and concept flavors are used by most young e-cigarette users, who describe these products as fruity, sweet, and cooling. A variety of flavored products with high youth appeal are available in the U.S. market. IMPLICATIONS This study of adolescent and young adult e-cigarette users finds evidence of the popularity of e-cigarette flavors combining a cooling sensation with fruity and sweet flavorings. Some products with this flavor profile do not use characterizing descriptors. Findings inform public health interventions intended to reduce e-cigarette use in young people.
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Affiliation(s)
- Jennifer M Kreslake
- Schroeder Institute at Truth Initiative, Washington, DC, USA.,Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Daniel Stephens
- Schroeder Institute at Truth Initiative, Washington, DC, USA
| | - Donna M Vallone
- Schroeder Institute at Truth Initiative, Washington, DC, USA.,Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,School of Global Public Health, New York University, New York, NY, USA
| | - Elizabeth C Hair
- Schroeder Institute at Truth Initiative, Washington, DC, USA.,Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,School of Global Public Health, New York University, New York, NY, USA
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29
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Brown JL, Neptune E. Role of Menthol and Other Flavors on Tobacco and Nicotine Product Use. Respir Med 2023. [DOI: 10.1007/978-3-031-24914-3_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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30
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Kotlyar M, Shanley R, Dufresne SR, Corcoran GA, Hatsukami DK. Effect of restricting menthol flavored cigarettes or E-cigarettes on smoking behavior in menthol smokers. Prev Med 2022; 165:107243. [PMID: 36087624 DOI: 10.1016/j.ypmed.2022.107243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/08/2022] [Accepted: 09/02/2022] [Indexed: 11/26/2022]
Abstract
Bans of menthol characterizing flavor in tobacco products have been enacted in some localities and proposed in the United States for cigarettes. To gather data regarding how restrictions for menthol in cigarettes and e-cigarettes may affect current menthol cigarette smokers, 37 African American menthol smokers participated in a pilot study in which they were asked to abstain (n = 18) or not abstain from menthol cigarettes (n = 19) for 8-weeks. All participants received menthol flavored e-cigarettes for 4 weeks and tobacco flavored e-cigarettes for 4 weeks in random order. Number of cigarettes smoked per day (estimated mean ratio [EMR] = 0.31; 95% CI: 0.13, 0.72) and exhaled CO concentrations (EMR = 0.61; 95% CI: 0.43, 0.88) were lower in the menthol cigarette abstainer group compared to the menthol cigarette non-abstainer group. Those in the menthol cigarette abstainer group reported higher scores on motivation to quit (p = 0.03) and perceived effectiveness of quitting skills (p = 0.02). There were no substantial effects seen in amount smoked or exhaled CO based on flavor of e-cigarettes provided. Higher e-cigarette use (based on reported puffs per day) was reported in the menthol cigarette abstainer (vs. non-abstainer) group (p < 0.01) and also during the 4-week period when provided with menthol (vs. tobacco) e-cigarettes (p < 0.01). These data suggest that the potential of e-cigarettes to reduce tobacco related harm may be enhanced if combined with a ban on menthol flavor in combustible cigarettes. Larger studies are needed to determine the effect of limiting menthol in e-cigarettes on smoking behavior among current menthol smokers.
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Affiliation(s)
- Michael Kotlyar
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, USA; Masonic Cancer Center, University of Minnesota, Minneapolis, USA; Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, USA.
| | - Ryan Shanley
- Biostatistics Core, Masonic Cancer Center, University of Minnesota, Minneapolis, USA
| | - Sheena R Dufresne
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, USA
| | - Gretchen A Corcoran
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, USA
| | - Dorothy K Hatsukami
- Masonic Cancer Center, University of Minnesota, Minneapolis, USA; Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, USA
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31
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Morean ME, Bold KW. The Modified Cigarette Evaluation Questionnaire: Psychometric properties of the originally-proposed five-factor structure and a novel four-factor structure for use with adults who currently smoke cigarettes. Drug Alcohol Depend 2022; 241:109684. [PMID: 36371995 PMCID: PMC9772171 DOI: 10.1016/j.drugalcdep.2022.109684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/25/2022] [Accepted: 10/30/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The Modified Cigarette Evaluation Questionnaire (MCEQ) measures self-reported, subjective reinforcing and aversive effects of smoking. The MCEQ is proposed as comprising five factors. However, its latent factor structure has been confirmed in only one published study, and key psychometric properties like measurement invariance and test-criterion validity have not been formally examined. METHODS We examined the latent structure of the MCEQ using confirmatory and exploratory factor analysis and evaluated internal consistency, measurement invariance, between-group differences, and relationships with smoking-related characteristics in a sample of 764 adults who smoke cigarettes. As a secondary test of construct validity, we fit identified latent factor structures to a sample of 131 adults from a prior trial who were biochemically-confirmed to currently smoke. RESULTS A four-factor structure that recently was validated for an e-cigarette-adapted version of the MCEQ outperformed the originally-proposed five-factor structure in several ways: it uniquely evidenced good model fit both within the primary and replication samples, reached scalar invariance for all participant subgroups tested, was sensitive to detecting numerous between-groups differences in subsamples of interest, and each of its subscales was associated with at least one smoking characteristic assessed. CONCLUSIONS The four-factor MCEQ structure evidenced stronger psychometric properties in our sample than did the original five-factor MCEQ. However, until additional research is conducted on the utility of the five- and four-factor solutions in other samples, neither the five- nor the four-factor MCEQ structure should be assumed. In the meantime, researchers should examine the MECQ's latent structure in their data prior to conducting subsequent analyses.
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Affiliation(s)
- Meghan E Morean
- Yale School of Medicine, Department of Psychiatry, 34 Park Street, New Haven, CT 06519, USA.
| | - Krysten W Bold
- Yale School of Medicine, Department of Psychiatry, 34 Park Street, New Haven, CT 06519, USA.
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32
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Cohn AM, Cassidy R, Denlinger-Apte R, Donny E, Villanti AC, Hatsukami D, Dunn D, Wyatt R, Niznik T, Cohen-Davidyan T, Smith M, Ehlke SJ. Impact of a reduced nicotine standard on young adult appeal for menthol and non-menthol cigarettes. BMJ Open 2022; 12:e067694. [PMID: 36410805 PMCID: PMC9680144 DOI: 10.1136/bmjopen-2022-067694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The Food and Drug Administration (FDA) announced its intention to reduce the nicotine content in cigarettes as a strategy to promote cessation and reduce smoking-related harm. A low nicotine product standard will apply to all cigarettes on the market, including menthol cigarettes. In December 2021, the FDA approved a modified risk tobacco product application for menthol and non-menthol flavoured very low nicotine cigarettes (VLNC) from the 22nd Century Group. Notably, experimentation with menthol cigarettes is linked to smoking progression, as well as greater nicotine dependence relative to non-menthol cigarette use. If menthol VLNCs are perceived as more appealing than non-menthol VLNCs, this would indicate that some aspect of menthol may maintain smoking even in the absence of nicotine and FDA's regulatory authority to ban or restrict the sale of menthol cigarettes should apply to reduced nicotine content of cigarettes. In April 2022, the FDA announced proposed rulemaking to prohibit menthol cigarettes, however it is unclear if a menthol prohibition would apply to VLNCs. METHODS AND ANALYSIS This study will recruit 172 young adult menthol smokers (with a specific subsample of n=40 sexual and gender minority young adults) and measure appeal for smoking experimental menthol and non-menthol VLNCs, and the impact of proposed product standards on tobacco product purchasing behaviour using an Experimental Tobacco Marketplace. Appeal across product standards will be assessed in a controlled laboratory and using ecological momentary assessment. ETHICS AND DISSEMINATION The protocol was approved by the University of Oklahoma Health Sciences Center Institutional Review Board (#11865). Findings will examine the effects of a reduced nicotine standard and a menthol ban on young adult smoking and will be disseminated through peer-reviewed journal articles and presentations at scientific conferences. TRIAL REGISTRATION NUMBER NCT04340947.
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Affiliation(s)
- Amy M Cohn
- Department of Pediatrics, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- TSET Health Promotion Research Center, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Rachel Cassidy
- Center for Alcohol & Addiction Studies, Brown University, Providence, Rhode Island, USA
| | - Rachel Denlinger-Apte
- Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Eric Donny
- Department of Physiology and Pharmacology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Andrea C Villanti
- Health Behavior, Society & Policy, Deparment of Health Behavior, Rutgers Center for Tobacco Studies, School of Public Health, Rutgers University, New Brunswick, New Jersey, USA
| | - Dorothy Hatsukami
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota, USA
| | - Delaney Dunn
- TSET Health Promotion Research Center, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Riley Wyatt
- TSET Health Promotion Research Center, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Taylor Niznik
- TSET Health Promotion Research Center, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Tamar Cohen-Davidyan
- TSET Health Promotion Research Center, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Michael Smith
- TSET Health Promotion Research Center, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Sarah J Ehlke
- Department of Psychology, Old Dominion University, Norfolk, Virginia, USA
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Ellison-Barnes A, Galiatsatos P. Initiating Pharmacologic Treatment in Tobacco-Dependent Adults. Med Clin North Am 2022; 106:1067-1080. [PMID: 36280333 DOI: 10.1016/j.mcna.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
There is a strong evidence base for the use of existing pharmacotherapies to support tobacco cessation, alone or in combination, ideally with concurrent behavioral interventions. Future pharmacotherapies under development may assist in the most refractory cases. Incorporating current and future therapies into a longitudinal chronic care model for tobacco dependence will help a diverse range of patients achieve independence from nicotine addiction.
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Affiliation(s)
- Alejandra Ellison-Barnes
- The Tobacco Treatment and Cancer Screening Clinic, The Johns Hopkins Health System, Baltimore, MD, USA; Division of General Internal Medicine, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Panagis Galiatsatos
- The Tobacco Treatment and Cancer Screening Clinic, The Johns Hopkins Health System, Baltimore, MD, USA; Division of Pulmonary and Critical Care Medicine, The Johns Hopkins School of Medicine, Baltimore, MD, USA.
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Yang Y, Lindblom EN, Ward KD, Salloum RG. How Smokers of Menthol Cigarettes and Flavored Cigars Might Respond to FDA's Proposed Bans. Nicotine Tob Res 2022; 24:1645-1653. [PMID: 35353183 PMCID: PMC9575974 DOI: 10.1093/ntr/ntac078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/16/2022] [Accepted: 03/26/2022] [Indexed: 11/14/2022]
Abstract
INTRODUCTION A ban on menthol cigarettes and flavored cigars may reduce smoking and tobacco-related disparities. AIMS AND METHODS We aimed to examine the response of current smokers to a hypothetical ban on menthol cigarettes and flavored cigars. Current smokers were recruited online and reported the alternative products that they may switch to under a hypothetical ban, if they would try to obtain the banned products from illicit channels, and their support to the ban. RESULTS 51% of current smokers would use nonflavored cigarettes and cigars as alternatives, 45% would switch to flavored heated tobacco products or e-cigarettes or quit smoking. 17% would try to obtain the banned flavored products from illicit markets. A majority of menthol only smokers opposed the ban. Daily smokers would be more likely to switch to nonflavored smoking, to try illicit market products, and were less supportive of the ban. Black smokers would be less likely to switch to nonflavored smoking and were more supportive of the ban. Smokers who used menthol cigarettes only would be more likely to switch to nonflavored smoking, less likely to try illicit market sellers, and were the least supportive of the ban. CONCLUSIONS In response to a ban of all added flavors for cigarettes or cigars, nearly half of the current smokers would quit smoking, largely by switching to nonsmoking products. However, smokers with more chronic use and those who used only menthol cigarettes would be more likely to switch to nonflavored smoking, diminishing the harm reduction potential. The ban may decrease the relatively higher prevalence of menthol cigarette smoking among Blacks compared with other groups. IMPLICATIONS A ban on the sale of menthol cigarettes and flavored cigars may decrease the prevalence of smoking because some current smokers may quit smoking and switch to nonsmoking products. However, smokers with more chronic use and those who used menthol cigarettes only were more likely to switch to nonflavored cigarettes or cigars, diminishing the harm reduction potential of the ban. Black smokers would be more likely to switch to products other than cigarettes and cigars thus decreasing their relatively higher prevalence of smoking compared with other groups.
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Affiliation(s)
- Yong Yang
- School of Public Health, University of Memphis, Memphis, TN, USA
| | - Eric N Lindblom
- O’Neill Institute for National & Global Health Law, Georgetown University Law Center, Washington, DC, USA
| | - Kenneth D Ward
- School of Public Health, University of Memphis, Memphis, TN, USA
| | - Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, USA
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Ali FRM, King BA, Seaman EL, Vallone D, Schillo B. Impact of Massachusetts law prohibiting flavored tobacco products sales on cross-border cigarette sales. PLoS One 2022; 17:e0274022. [PMID: 36099316 PMCID: PMC9469949 DOI: 10.1371/journal.pone.0274022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/19/2022] [Indexed: 11/25/2022] Open
Abstract
Background In June 2020, Massachusetts implemented a law prohibiting the sale of all flavored tobacco products, including menthol cigarettes. This law was associated with significant declines in overall cigarette and menthol cigarette sales in Massachusetts, however it is unknown whether the law has increased cross-border sales in neighboring states where menthol cigarettes are still sold. Methods U.S. cigarette retail scanner data were licensed from the IRi Company. Cigarette pack sales were summed in 4-week periods during January 2020-December 2021 (n = 832). Outcomes were state-level pack sales per 1000 population, overall and by flavor status (menthol and non-flavored). A difference-in-differences analysis was used to examine adjusted sales for Massachusetts border states (New Hampshire, Connecticut, Vermont, and Rhode Island) before (January 2020-May 2020) and after (June 2020-December 2021) the Massachusetts’s law, compared to 28 non-border states. Control variables included state and time fixed effects; real price per pack; tobacco control policies; COVID-19 cases and deaths, and related statewide closure; and state sociodemographic characteristics. Results Following the law, unadjusted sales of menthol, non-flavored, and overall cigarettes trended upward in border states; however, these increases were not statistically significant or different from sales patterns in non-border states. This finding persisted after accounting for product prices, tobacco control policies, the COVID-19 pandemic, sociodemographic factors, and fixed effects. Conclusion Laws prohibiting the sale of flavored tobacco products, including menthol products, reduce access to these products, while having no significant impact on cross-border sales in neighboring states where menthol cigarettes are sold.
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Affiliation(s)
- Fatma Romeh M. Ali
- Non-Infectious Disease Programs, CDC Foundation, Atlanta, Georgia, United States of America
- * E-mail:
| | | | - Elizabeth L. Seaman
- Non-Infectious Disease Programs, CDC Foundation, Atlanta, Georgia, United States of America
| | - Donna Vallone
- Truth Initiative, Washington, DC, United States of America
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Kim MM, Curtin GM. Assessing the Evidence on the Differential Impact of Menthol versus Non-menthol Cigarette Use on Smoking Dependence in the US Population: A Systematic Review and Meta-analysis. Am J Health Behav 2022; 46:376-422. [PMID: 36109861 DOI: 10.5993/ajhb.46.4.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Menthol's effect on cigarette smoking behaviors is an intensely scrutinized US public health issue. This systematic review and meta-analysis examined the question: Does menthol cigarette use have a differential impact on smoking dependence compared with non-menthol cigarette use? Methods: We consulted 6 databases from inception to October 15, 2021. We included articles comparing menthol versus non-menthol cigarette smokers against predefined smoking dependence outcomes. Risk of bias was assessed using the AHRQ Evidence-Based Practice Center approach. We applied a random-effects model to pool adjusted odds ratios. Results: We synthesized 37 demographically adjusted studies. Meta-analytic results suggested non-menthol smokers were equally/more likely to report daily versus non-daily smoking; menthol use was associated with needing a cigarette within one hour; cigarettes per day was not associated with menthol use; menthol use was associated with a low (vs high) Heaviness of Smoking Index score; and results were either non-significant or associated menthol use with lower TTFC. Conclusions: Despite consistently good or fair quality adjusted studies across several measures, results were discordant depending on measures used and means of measurement. Overall, the evidence is insufficient to draw clear conclusions on a differential association between menthol (vs non-menthol) cigarette use and smoking dependence.
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Affiliation(s)
- Mimi M Kim
- Mimi M. Kim, Senior Director, Scientific & Regulatory Affairs, RAI Services Company, Winston-Salem NC, United States;,
| | - Geoffrey M Curtin
- Geoffrey M. Curtin, retired employee, RAI Services Company, Winston-Salem, NC, United States
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Watson CV, Alexander DS, Oliver BE, Trivers KF. Substance use among adult marijuana and nicotine e-cigarette or vaping product users, 2020. Addict Behav 2022; 132:107349. [PMID: 35580371 PMCID: PMC11056937 DOI: 10.1016/j.addbeh.2022.107349] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 04/28/2022] [Accepted: 04/30/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Co-use of marijuana and tobacco/nicotine have unknown impacts on addiction and health. There are limited data on the extent to which adults are co-using tetrahydrocannabinol (THC)- and nicotine-containing products, in any of their various modes. This study describes adult use of THC- and nicotine-containing products among electronic vaping product (EVP) users. METHODS Data on marijuana and tobacco use were collected from February 25-29, 2020 through an online survey of adults aged ≥18 years who reported using THC- and nicotine-containing electronic vaping products (EVPs) in the past 3 months (n = 3,980). Survey respondents from 18 states participated in the U.S. YouGov panel, a proprietary opt-in internet panel survey of 1.8 million U.S. residents. RESULTS Among those who reported using nicotine and THC-containing EVPs in the past 3 months, 90.1% of respondents reported smoking marijuana in the past 3 months; 82.7% reported smoking as the most frequent mode of marijuana use. Almost 63% of EVP users reported smoking cigarettes; 55.6% reported smoking for over 8 years, while 7.7% had been smoking cigarettes for under a year. CONCLUSIONS In this study, respondents reported cigarette smoking and marijuana smoking in addition to using marijuana- and nicotine- containing EVPs. Considering the unknown health effects of co-use of tobacco and THC-containing products, the finding that adults are vaping THC and nicotine alongside traditional modes of marijuana and tobacco use of these substances warrants further investigation. IMPLICATIONS Findings from this study provide evidence that adults who use nicotine and THC EVPs are also using a variety of other THC-containing and tobacco-containing products. This indicates the importance of continued surveillance to assess trends of polysubstance EVP and multi-modal marijuana and tobacco use. Monitoring various modes of marijuana and tobacco use may inform policies, prevention education, communication, and cessation tools.
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Affiliation(s)
- Christina V Watson
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, United States.
| | - Dayna S Alexander
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, United States
| | - Briana E Oliver
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, United States
| | - Katrina F Trivers
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, United States
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Lin W, Zhu J, Hayes JE, Richie JP, Muscat JE. Comparison of Carcinogen Biomarkers in Smokers of Menthol and Nonmenthol Cigarettes: The 2015-2016 National Health and Nutrition Examination Survey Special Sample. Cancer Epidemiol Biomarkers Prev 2022; 31:1539-1545. [PMID: 35654409 PMCID: PMC9357114 DOI: 10.1158/1055-9965.epi-22-0239] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/13/2022] [Accepted: 05/26/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The US FDA announced its commitment to prohibiting menthol as a characterizing flavor in tobacco. The relationship between cigarette menthol and exposure to toxic substances in mainstream tobacco smoke is not well characterized. METHODS Data from the National Health and Nutrition Examination Survey (NHANES) 2015 to 2016 special sample were used to study markers of 26 harmful and potentially harmful constituents (HPHC) in tobacco smoke. These include urine metabolites of polycyclic aromatic hydrocarbons (PAH), volatile organic compounds (VOC), and heavy metals in exclusive menthol (n = 162) and nonmenthol (n = 189) cigarette smokers. Urine metabolites of 7 PAHs, 15 VOCs, and 4 heavy metal biomarkers were compared by menthol status. Multivariable analyses were conducted on creatinine-adjusted concentrations. RESULTS There were no significant differences in cotinine levels or in 22 of 26 HPHCs. Among the urine metabolites of PAHs, the levels of 1-hydroxyphenanthrene were about 16% lower in menthol smokers. Among the urine metabolites of VOCs, menthol cigarette smokers presented significantly lower concentrations of acrylamide, N,N-dimethylformamide, and acrylonitrile. Menthol and nonmenthol smokers presented similar levels of heavy metals. Menthol did not affect the levels of cotinine and the nicotine metabolite ratio in urine. CONCLUSIONS Menthol and nonmenthol cigarettes deliver similar levels of most HPHCs. IMPACT Findings on toxicity are similar for menthol and nonmenthol cigarettes.
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Affiliation(s)
- Wenxue Lin
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA 17033, United States
| | - Junjia Zhu
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA 17033, United States
| | - John E. Hayes
- Sensory Evaluation Center, The Pennsylvania State University, 220 Erickson Food Science Building, University Park, PA 16802, United States
- Department of Food Science, College of Agricultural Sciences, The Pennsylvania State University, 220 Erickson Food Science Building, University Park, PA 16802, United States
| | - John P. Richie
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA 17033, United States
| | - Joshua E. Muscat
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA 17033, United States
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Steeger CM, Harlow AF, Barrington-Trimis JL, Simon P, Hill KG, Leventhal AM. Longitudinal associations between flavored tobacco use and tobacco product cessation in a national sample of adults. Prev Med 2022; 161:107143. [PMID: 35803351 PMCID: PMC9994601 DOI: 10.1016/j.ypmed.2022.107143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 05/05/2022] [Accepted: 07/02/2022] [Indexed: 11/28/2022]
Abstract
Use of flavored tobacco has been associated with lower likelihood of short-term abstinence from tobacco. It is unknown whether longer-term associations exist, particularly for a variety of products and specific flavor categories. This study used adult survey data from the Population Assessment of Tobacco and Health (PATH) Study (2013-2018). We tested associations of past 30-day tobacco product use at wave 2 using both a 2-category any flavor versus unflavored variable and 4-category specific flavor (menthol/mint, sweet, and both menthol/mint and sweet) versus unflavored variable with past 12-month cessation from the same product two years later at wave 4. Separate models were run for each product (combustible cigarettes, cigars, hookah, e-cigarettes, and smokeless), adjusting for wave 1 sociodemographic characteristics. For all five products, past 30-day use of any flavored (versus unflavored) product at wave 2 was associated with reduced likelihood of same-product cessation at wave 4. Most specific flavor categories were associated with reduced odds of same-product cessation across all products. Any flavor use was also associated with reduced likelihood of longer-term cessation (i.e., past 24-months at both waves 3 and 4) and cessation from all five tobacco products in several analyses. Exploratory moderation results indicated that the association between e-cigarette flavor use and lower likelihood of cessation was stronger for young adults (18-24) versus older adults (25+). Current use of flavored tobacco products is associated with lower likelihood of product cessation. Flavored tobacco products warrant consideration in regulatory policy to reduce the adverse public health impact of tobacco use.
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Affiliation(s)
- Christine M Steeger
- Institute of Behavioral Science, University of Colorado Boulder, 1440 15(th) St., Boulder, CO 80309, USA.
| | - Alyssa F Harlow
- School of Medicine, University of Southern California, 2250 Alcazar St., CSC 271, Los Angeles, CA 90033, USA; Institute for Addiction Science, University of Southern California, 2001 N. Soto Street, Los Angeles, CA 90032, USA.
| | - Jessica L Barrington-Trimis
- School of Medicine, University of Southern California, 2250 Alcazar St., CSC 271, Los Angeles, CA 90033, USA; Institute for Addiction Science, University of Southern California, 2001 N. Soto Street, Los Angeles, CA 90032, USA.
| | - Patricia Simon
- Department of Psychiatry, Yale School of Medicine, 389 Whitney Avenue, New Haven, CT 06511, USA.
| | - Karl G Hill
- Institute of Behavioral Science, University of Colorado Boulder, 1440 15(th) St., Boulder, CO 80309, USA.
| | - Adam M Leventhal
- School of Medicine, University of Southern California, 2250 Alcazar St., CSC 271, Los Angeles, CA 90033, USA; Institute for Addiction Science, University of Southern California, 2001 N. Soto Street, Los Angeles, CA 90032, USA.
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Dearfield CT, Horn K, Crandell I, Bernat DH. Behavioural intentions in response to a potential menthol cigarette sales ban: a survey examining smokers in Washington, DC public housing. BMJ Open 2022; 12:e059821. [PMID: 35831050 PMCID: PMC9280868 DOI: 10.1136/bmjopen-2021-059821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Local, national and international policies are being proposed to ban the sale of menthol-flavoured tobacco products. With more bans being implemented, it is increasingly important to understand reactions to these bans among smokers of low socioeconomic status. This study examined public housing residents' behavioural intentions if menthol-flavoured cigarettes were no longer sold. SETTING 15 District of Columbia Housing Authority properties between March 2019 and March 2021. PARTICIPANTS 221 District of Columbia Housing Authority residents ages 18-80 years who reported smoking menthol cigarettes (83.3% African-American/black). PRIMARY AND SECONDARY OUTCOMES Cigarette quitting and switching intentions due to a hypothetical menthol-flavoured cigarette sales ban. RESULTS Nearly one-half (48.0%) of residents said they intended to quit cigarette use if menthol-flavoured products were no longer sold, while 27.2% were unsure if they would quit, and 24.9% reported they would not quit. Older residents (OR 0.94 per year, 95% CI 0.91 to 0.97), senior/disabled building versus family building residents (OR 0.50, 95% CI 0.25 to 0.97), those who smoked within 30 min of waking (OR 0.48, 95% CI 0.23 to 0.98) and daily smokers (OR 0.42, 95% CI 0.21 to 0.84) had lower odds of reporting quit intentions associated with a menthol ban. Of those not intending to quit, 40.7% reported they would switch to non-menthol cigarettes, 20.4% to another non-menthol product, 13.0% to menthol e-cigarettes and 20.4% to another menthol product. CONCLUSIONS Results suggest banning the sale of menthol-flavoured products has the potential to impact cigarette smoking cessation. Nearly three-quarters of smokers in public housing indicated a possibility of quitting smoking because of a menthol cigarette ban. Bans that include all flavours in all tobacco products may be most effective for facilitating overall tobacco cessation.
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Affiliation(s)
- Craig T Dearfield
- Epidemiology, The George Washington University Milken Institute of Public Health, Washington, District of Columbia, USA
| | - Kimberly Horn
- Department of Population Health Sciences, Virginia Tech-Carilion Fralin Biomedical Research Institute, Roanoke, Virginia, USA
| | - Ian Crandell
- Department of Statistics, Center for Biostatistics and Health Data Science, Virginia Polytechnic Institute and State University, Roanoke, Virginia, USA
| | - Debra H Bernat
- Epidemiology, The George Washington University Milken Institute of Public Health, Washington, District of Columbia, USA
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Moodie C, Page N, Moore G. Prevalence of Menthol and Menthol Capsule Cigarette Use Among 11-16 Year Olds in Wales Prior to a Ban on Characterizing Flavors in Cigarettes: Findings From the 2019 Student Health and Wellbeing Survey. Nicotine Tob Res 2022; 24:1257-1263. [PMID: 35272351 PMCID: PMC9278836 DOI: 10.1093/ntr/ntac040] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/07/2022] [Accepted: 02/25/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The use of flavored cigarettes has increased in many countries because of the inclusion of one or more frangible flavor-changing capsules in the filter. Research suggests that these "capsule" cigarettes appeal most to youth, but little is known about how prevalent their use is among children. METHODS A cross-sectional school survey was conducted between September and December 2019 with 11-16 year-olds (N = 119 388) from 198 secondary schools across Wales; the sample represented approximately two-thirds of all 11-16 year-olds in the country. The sample was asked about smoking behavior, with a quarter (N = 26 950) also asked about awareness of menthol cigarettes, and use of menthol and menthol capsule cigarettes if a current smoker (N = 1447). RESULTS Current smoking prevalence was 5.7% among the entire sample and 5.9% among the analytical sample (those also asked about menthol and menthol capsule cigarettes). For the analytical sample, almost all current smokers (93.2%) were aware of menthol cigarettes, with three-fifths (60.5%) reporting having used menthol cigarettes in the past 30 days (42.3% capsule cigarettes, 18.2% noncapsule cigarettes). In comparison to nonmenthol smokers, those using menthol cigarettes (capsule and noncapsule) were more likely to be frequent smokers, with those using menthol capsule cigarettes more likely to have smoked for longer. CONCLUSIONS While past research suggests that flavored cigarettes appeal to youth, this study shows just how popular these products, and capsule cigarettes, in particular, were among young smokers in Wales. It also raises questions about why capsule cigarettes have received such limited public health attention. IMPLICATIONS That three in five 11-16 year-old smokers reported using menthol cigarettes in the past 30 days highlights how appealing these products are to young people, particularly capsule cigarettes, used by seventy percent of menthol smokers. Capsule cigarettes are one of the most successful tobacco product innovations in decades, even in countries with comprehensive bans on tobacco marketing and standardized packaging. The dearth of research on capsule cigarettes is a failure of global public health. Evaluation of the ban on characterizing flavors in the United Kingdom and across the European Union is critical.
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Affiliation(s)
- Crawford Moodie
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, Scotland
| | - Nicholas Page
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), Cardiff University, Cardiff, Wales
| | - Graham Moore
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), Cardiff University, Cardiff, Wales
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Hiatt RA, Kobetz EN, Paskett ED. Catchment Areas, Community Outreach and Engagement Revisited: The 2021 Guidelines for Cancer Center Support Grants from the National Cancer Institute. Cancer Prev Res (Phila) 2022; 15:349-354. [PMID: 35652232 DOI: 10.1158/1940-6207.capr-22-0034] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/18/2022] [Accepted: 03/23/2022] [Indexed: 11/16/2022]
Abstract
New guidelines for Cancer Center Support Grants have recently been issued by the NCI that require increased attention to cancer center catchment areas and their community outreach and engagement activities [PAR-21-321]. Past experience with these requirements has engendered some confusion and frustration on the part of both researchers and reviewers that these new guidelines aim to dispel. In this commentary we, as experienced cancer center leaders in population sciences, offer our views on the most important aspects of the new guidelines and provide three examples of the kinds of programs that can apply cancer prevention and control research to improve cancer population health. With 71 NCI-Designated Cancer Centers in 36 states, the potential for broad impact on the reduction of the nation's cancer burden is enormous if the intended application of cancer center research to individuals and populations is fulfilled.
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Affiliation(s)
- Robert A Hiatt
- Associate Director for Population Sciences, Helen Diller Family Comprehensive Cancer Center, Professor, Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Erin N Kobetz
- Associate Director of Population Science and Cancer Disparities, Sylvester Comprehensive Cancer Center, Vice Provost for Research, Professor, Departments of Medicine, Public Health Sciences, and Obstetrics and Gynecology, University of Miami, Florida
| | - Electra D Paskett
- Associate Director for Population Sciences, Program Leader, Cancer Control Program, The Ohio State University Comprehensive Cancer Center, Marion N. Rowley Professor of Cancer Research, Director, Center for Cancer Health Equity, James Cancer Hospital, Professor, Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio
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Ehlke SJ, Ganz O, Kendzor DE, Cohn AM. Differences between adult sexual minority females and heterosexual females on menthol smoking and other smoking behaviors: Findings from Wave 4 (2016-2018) of the population assessment of tobacco and health study. Addict Behav 2022; 129:107265. [PMID: 35139462 PMCID: PMC9673077 DOI: 10.1016/j.addbeh.2022.107265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 01/14/2022] [Accepted: 01/29/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Sexual minority females have higher rates of cigarette smoking than heterosexual females. Additionally, menthol cigarette use disproportionately impacts minority smokers, including sexual minority individuals. This study examined differences between sexual minority and heterosexual females on several smoking variables, including initiation with a menthol cigarette, and past 30-day cigarette and menthol cigarette use. METHODS Participants were female ever smokers (N = 11,576; n = 1,474, 12.7% sexual minority) who completed Wave 4 of the Population Assessment of Tobacco and Health Survey. Participants reported on the age they began smoking regularly (≤18 years old, 18-24, >25), whether they initiated with a menthol cigarette, past 30-day cigarette smoking and menthol cigarette use, cigarettes smoked per day (≤10, 11-20, >20), cigarette dependence (smoke ≤ 5 min of waking or > 5 min of waking), and whether they were a current (someday/every day) or former (no past year/current use) established smoker (≥100 lifetime cigarettes), or an experimental smoker (<100 lifetime cigarettes). Chi-square and multivariable logistic regression analyses examined differences between sexual minority females and heterosexual females on smoking variables. RESULTS Sexual minority female smokers began smoking regularly at an earlier age and smoked fewer cigarettes per day than heterosexual females. Sexual minority females were more likely to initiate smoking with a menthol cigarette (aOR = 1.27), report past 30-day smoking (aOR = 1.36) and menthol cigarette use (aOR = 1.24) compared to heterosexual females. There were no differences on cigarette dependence. CONCLUSIONS Given the high rates of initiation and current menthol smoking, policies to regulate menthol may decrease smoking disparities for sexual minority females.
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Affiliation(s)
- Sarah J Ehlke
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States.
| | - Ollie Ganz
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, NJ, United States; Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, United States
| | - Darla E Kendzor
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States; Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Amy M Cohn
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States; Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
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Leas EC, Benmarhnia T, Strong DR, Pierce JP. Use of Menthol Cigarettes, Smoking Frequency, and Nicotine Dependence Among US Youth. JAMA Netw Open 2022; 5:e2217144. [PMID: 35666498 PMCID: PMC9171563 DOI: 10.1001/jamanetworkopen.2022.17144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Menthol may make cigarette smoke less aversive and could lead youth to smoke more frequently and become more dependent on nicotine. OBJECTIVE To assess the association of menthol use with cigarette smoking frequency and nicotine dependence (ND) among youth cigarettes users. DESIGN, SETTING, AND PARTICIPANTS This cohort study used a pooled sample of cohorts of US youth (aged 12-17 years at their baseline and follow-up interviews) in the Population Assessment of Tobacco and Health Study (September 2013 to November 2019). Household interviews were conducted using audio computer-assisted self-interviews. US youth who were past-30-day cigarette smokers at any of wave 2 through wave 5, completed the preceding survey (eg, wave 2 past-30-day cigarette smokers completed wave 1), and indicated whether they used menthol cigarettes were eligible. The association of menthol use with smoking frequency and ND was estimated using inverse probability of treatment weighting adjusted mean differences (aMDs), adjusted risk ratios (aRRs), and corresponding 95% CIs. Data were analyzed from December 2021 to March 2022. EXPOSURES Menthol use and transitions in use (switching to or from menthol cigarettes). MAIN OUTCOMES AND MEASURES Main outcomes were the number of days smoked in the past 30 days, the risk of frequent smoking (smoking ≥20 days in the past 30 days), and symptoms of ND. RESULTS There were a total of 1492 observations among 1096 US youth cigarette smokers, of whom 49.4% were female, 67.2% were non-Hispanic White, and 28.7% were aged 12 to 14 years at their baseline survey (all percentages are weighted). Among those who switched from not smoking to smoking (61% of the sample), menthol use was associated with smoking on 3.1 additional days (aMD; 95% CI, 1.9 to 4.2 days), 59% higher risk of being a frequent smoker (aRR, 1.59; 95% CI, 1.23 to 2.06), and 10% higher ND scores (aMD, 1.09; 95% CI, 1.02 to 1.17). Switching from smoking menthol to smoking nonmenthol (vs maintaining menthol use) was associated with smoking on 3.6 fewer days (aMD; 95% CI, -6.3 to -0.9 days) and 47% lower risk of being a frequent smoker (aRR, 0.68; 95% CI, 0.50 to 0.92). CONCLUSIONS AND RELEVANCE These findings suggest that the addition of menthol to cigarettes is associated with increased smoking frequency and ND among US youth.
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Affiliation(s)
- Eric C. Leas
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
| | - Tarik Benmarhnia
- Scripps Institution of Oceanography, University of California, San Diego, La Jolla
| | - David R. Strong
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
| | - John P. Pierce
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
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Feld AL, Rogers T, Gaber J, Pikowski J, Farrelly MC, Henriksen L, Johnson TO, Halpern-Felsher B, Andersen-Rodgers E, Zhang X. Impact of Local Flavored Tobacco Sales Restrictions on Policy-Related Attitudes and Tobacco Product Access. HEALTH EDUCATION & BEHAVIOR 2022; 49:468-477. [PMID: 34399591 DOI: 10.1177/10901981211027520] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND As of September 2020, more than 300 state and local jurisdictions restrict the sales of flavored tobacco, with some including menthol. AIMS To evaluate the impact of local ordinances restricting the sale of flavored tobacco, we surveyed Californians regarding policy support and perceived access to flavored tobacco. METHODS In 2019, we conducted an online survey of 3,075 California youth and young adults recruited via social media, about half of whom lived in a policy jurisdiction. Logistic regressions assessed differences on propensity score-weighted outcomes, policy support, and perceived access. RESULTS Most respondents indicated agreement with almost all policy support statements. Although policy respondents were less likely than rest-of-California respondents to report perceived difficulty in buying flavored cigars, flavored vape users in policy jurisdictions were more likely than those in the rest of California to report perceived difficulty in buying flavored e-liquid. Regardless of jurisdiction, certain priority subgroups were significantly more likely to report perceived difficulty in accessing flavored cigars, flavored vaping products, flavored e-liquid, and menthol cigarettes. DISCUSSION With some exceptions, these findings demonstrate that among vape users in policy jurisdictions and priority subgroups, there is a higher likelihood of reporting perceived difficulty to access flavored tobacco products. CONCLUSIONS Findings might be an early indication of shifts in social norms about flavored tobacco products in California, which could gain traction as local sales restriction ordinances proliferate throughout the state and a statewide flavored-tobacco sales restriction goes into effect.
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Affiliation(s)
| | - Todd Rogers
- RTI International, Research Triangle Park, NC, USA
| | | | | | | | - Lisa Henriksen
- Stanford University School of Medicine, Palo Alto, CA, USA
| | | | | | | | - Xueying Zhang
- California Department of Public Health, Sacramento, CA, USA
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Glasser AM, Nemeth JM, Quisenberry AJ, Shoben AB, Trapl ES, Klein EG. Cigarillo Flavor and Motivation to Quit among Co-Users of Cigarillos and Cannabis: A Structural Equation Modeling Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5727. [PMID: 35565122 PMCID: PMC9101063 DOI: 10.3390/ijerph19095727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/04/2022] [Accepted: 05/06/2022] [Indexed: 11/16/2022]
Abstract
Flavored cigar restrictions have the potential to benefit public health. Flavor availability facilitates cigarillo use, but it is unknown if flavor impacts patterns of co-use of cigarillos and cannabis, an increasingly prevalent behavior among young adults. Data were collected (2020-2021) in a cross-sectional online survey administered to a convenience sample of young adults who smoked cigarillos from 15 areas with high cigar use prevalence. We assessed the relationship between flavored cigarillo use and motivation to quit cannabis and cigarillo use among past 30-day co-users (N = 218), as well as several covariates (e.g., cigarillo price and flavor/cannabis policy). Flavored cigarillo perceived appeal and harm were hypothesized parallel mediators. Most co-users reported usually using flavored cigarillos (79.5%), which was not significantly associated with motivation to quit cigarillos or cannabis. Perceived cigarillo harm (β = 0.17, 95% CI = 0.00, 0.33), advertising exposure (β = 0.12, 95% CI = 0.00, 0.24), and income (among racial/ethnic minorities; β = -0.13, 95% CI = -0.25, -0.02) were significant predictors of motivation to quit cigarillos. There were no significant predictors of motivation to quit cannabis. Cigarillo flavor was not associated with motivation to quit, so findings could suggest that banning flavors in cigars may have a neutral impact on co-use with cannabis among young adults.
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Affiliation(s)
- Allison M. Glasser
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, OH 43210, USA; (J.M.N.); (E.G.K.)
| | - Julianna M. Nemeth
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, OH 43210, USA; (J.M.N.); (E.G.K.)
| | - Amanda J. Quisenberry
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA;
| | - Abigail B. Shoben
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH 43210, USA;
| | - Erika S. Trapl
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA;
| | - Elizabeth G. Klein
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, OH 43210, USA; (J.M.N.); (E.G.K.)
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East KA, Reid JL, Burkhalter R, Kock L, Hyland A, Fong GT, Hammond D. Evaluating the Outcomes of the Menthol Cigarette Ban in England by Comparing Menthol Cigarette Smoking Among Youth in England, Canada, and the US, 2018-2020. JAMA Netw Open 2022; 5:e2210029. [PMID: 35503218 PMCID: PMC9066289 DOI: 10.1001/jamanetworkopen.2022.10029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 03/09/2022] [Indexed: 11/14/2022] Open
Abstract
Importance Menthol cigarettes were prohibited in England in May 2020 and nationally in Canada in October 2017 but remain permitted in the US. Evidence on the outcomes of menthol cigarette bans among youth outside of Canada, and the characteristics of youth smokers, is lacking. Objectives To evaluate the outcomes of menthol cigarette bans on youth menthol cigarette smoking and to characterize youth menthol cigarette smokers in terms of demographics and cigarette consumption and dependence. Design, Setting, and Participants This survey study uses data from online repeat cross-sectional International Tobacco Control Youth Tobacco and Vaping Surveys conducted in 2018, 2019, February 2020, and August 2020. Participants included past 30-day smokers aged 16 to 19 years. Data analysis was performed from March 2021 to January 2022. Main Outcomes and Measures Usually smoke a brand of cigarettes that was menthol, including capsule. Exposures Menthol cigarette ban, comparing 3 countries over time: Canada, where a ban already existed, England, where a ban was implemented during the study, and the US, where no national ban was present. Age, sex, race, and consumption and dependence were also examined by menthol smoking in each country, and in England before vs after the ban. Results The analytical sample comprised 7067 participants aged 16 to 19 years, of whom 4129 were female and 5019 were White. In England, the weighted percentage of youth smokers who reported smoking a menthol or capsule cigarette brand was stable in the 3 survey waves before the menthol ban (2018 to February 2020, 9.4% vs 12.1%; adjusted odds ratio [AOR], 1.03; 95% CI, 0.99-1.06; P = .15) but decreased to 3.0% after the ban (February 2020 vs August 2020, AOR, 1.07; 95% CI, 1.04-1.10; P < .001). The decrease between February and August 2020 in England was similar across all demographic groups but was greater among youth who perceived themselves as addicted to cigarettes (AOR, 0.37; 95% CI, 0.41-0.97; P = .04). In the 2 comparison countries, menthol or capsule smoking was stable across all waves (2018 to August 2020: US, 33.6%-36.9%; Canada, 3.1%-2.3%) and was more prevalent in the US than in England (AOR, 5.58; 95% CI, 4.63-6.72; P < .001). Menthol or capsule smoking was also more prevalent among smokers in England who were female vs male (10.9% vs 7.2%; AOR, 1.04; 95% CI, 1.01-1.06; P = .002); among smokers in the US who identified as Black vs White (60.6% vs 31.9%; AOR, 1.33; 95% CI, 1.23-1.44; P < .001) or who were frequent smokers (AOR, 1.07; 95% CI, 1.01-1.13; P = .03), smoked more cigarettes per day (2-5 vs 1, AOR, 1.09; 95% CI, 1.02-1.15; P = .006; >5 vs 1, AOR, 1.10; 95% CI, 1.03-1.18; P = .007), or had urges to smoke every or most days (AOR, 1.08; 95% CI, 1.02-1.14; P = .006); and among smokers in Canada who perceived themselves as addicted to cigarettes (AOR, 1.02; 95% CI, 1.00-1.03; P = .01). Conclusions and Relevance In this survey study, the proportion of youth smokers who smoke menthol (including capsule) cigarettes decreased substantially after the menthol ban in England. This association was consistent across all demographic groups. Perceived addiction among menthol smokers was also lower where menthol cigarettes were banned.
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Affiliation(s)
- Katherine A. East
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Jessica L. Reid
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
| | - Robin Burkhalter
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
| | - Loren Kock
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Andrew Hyland
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Geoffrey T. Fong
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - David Hammond
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
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Moodie C, O'Donnell R. 'I'm killing myself, but I'm saving the planet': rolling tobacco smokers' perceptions of rolling papers. Tob Control 2022; 31:479-482. [PMID: 33229464 DOI: 10.1136/tobaccocontrol-2020-056103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 09/28/2020] [Accepted: 10/12/2020] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Despite the global growth of rolling tobacco, we are unaware of any research that has explored smokers' perceptions of the types of rolling papers available, or plain rolling papers, which are now required in Canada and Israel. METHODS Eight focus groups were conducted with rolling tobacco smokers (n=50) in Greater Glasgow (Scotland) between February and March 2020. Participants were shown a number of packs of promotional rolling papers (natural, transparent, prerolled cones, flavoured) and plain rolling papers. RESULTS Rolling papers were often viewed as functional, a necessity for making roll-ups. The appeal of papers was based on the packaging, with a booklet-style pack of natural papers viewed very positively, as well as novelty, usability and taste/smell. Participants often associated papers with particular users, with prerolled cones and some flavoured papers thought to be used by cannabis smokers or younger people and those just starting to smoke. In terms of harm perceptions, natural papers were viewed as a healthier choice than standard papers and more environmentally friendly, whereas transparent papers raised concerns about safety to both the user and the environment. Participants were generally ambivalent towards plain papers, which they did not feel would alter their purchasing or smoking behaviour, although some felt they may be less appealing to youth as the branding would be diminished. CONCLUSIONS The panoply of rolling papers available offers consumers considerable choice. As some promotional papers can increase appeal or create misperceptions of harm then standardising papers would help to counter this.
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Affiliation(s)
- Crawford Moodie
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Rachel O'Donnell
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
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Welwean RA, Andersen-Rodgers E, Akintunde A, Zhang X. Evaluating the Impact of Strong and Weak California Flavored Tobacco Sales Restriction Policies on the Tobacco Retail Environment. Am J Health Promot 2022; 36:687-696. [PMID: 35105227 DOI: 10.1177/08901171211068469] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Evaluate success of local flavored tobacco (FT) policies in reducing availability of FT products in California. DESIGN Matched-jurisdiction cross-sectional design compared availability of FT at licensed tobacco retailers (LTR) in jurisdictions with and without such policies in 2013 and 2019. Flavor policy jurisdictions were split into strong and weak groups using Flavored Tobacco Policy Rating Rubric. SETTING 32 local California jurisdictions. SUBJECTS Final sample included 306 LTR in 2013 and 1441 LTR in 2019. LTR were classified as convenience store, liquor store, pharmacy, small market, supermarket, gas station booth, tobacco/vape product store, or other. MEASURES Retail availability of menthol cigarettes and flavored non-cigarette tobacco. ANALYSIS Logistic regression analysis including covariate (store type) determined whether differences existed in availability of FT in jurisdictions with and without FT policies. Percentage change assessed difference in proportion of retailers that sold FT in 2013 (i.e. before-policies-passed) and in 2019 (i.e. after-policies-became-effective). RESULTS Strong flavor-policy jurisdictions significantly differed from matched no-policy jurisdictions in availability of menthol cigarettes (OR = .04, 95% CI: .02-.08) and flavored non-cigarette tobacco (OR = .07, 95% CI: .05-.11). From 2013 to 2019, these jurisdictions experienced significant declines in menthol cigarettes (87.9% to 35.4%) and flavored non-cigarette tobacco sales (63.8% to 37.0%). CONCLUSION Strong FT sales restriction policies appear to be effective in reducing availability of FT, thereby creating a healthier retail environment in California.
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Affiliation(s)
- Ralph Amuanyu Welwean
- Department of Epidemiology, 174610Brown University School of Public Health, Providence, RI, USA
| | | | - Adebayo Akintunde
- California Tobacco Control Program, 117025California Department of Public Health, Sacramento, CA, USA
| | - Xueying Zhang
- California Tobacco Control Program, 117025California Department of Public Health, Sacramento, CA, USA
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50
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Glasser AM, Hinton A, Wermert A, Macisco J, Nemeth JM. Characterizing tobacco and marijuana use among youth combustible tobacco users experiencing homelessness - considering product type, brand, flavor, frequency, and higher-risk use patterns and predictors. BMC Public Health 2022; 22:820. [PMID: 35468777 PMCID: PMC9036780 DOI: 10.1186/s12889-022-13244-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 04/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cigarette smoking is three times more prevalent among youth experiencing homelessness compared with the general population. Co-use of tobacco and marijuana is also common. The aim of this study is to characterize tobacco and marijuana use among youth experiencing homelessness who use combustible tobacco in a Midwestern city to inform smoking cessation intervention. METHODS This study included 96 youth (ages 14-24 years; 52% male, 39% female, 5% transgender/non-binary) attending a homeless drop-in center who had used at least one combustible tobacco product in the past week. We assessed past-month use of tobacco products and marijuana, other product use characteristics (e.g., frequency, brand and flavor), and psychosocial predictors of more frequent (i.e., daily) use of combustible tobacco and marijuana. RESULTS Most youth experiencing homelessness with past-week combustible tobacco use had used cigarettes (n = 85, 88.5%), cigars (n = 89, 92.7%), and marijuana (n = 82, 85.4%) in the past month. One-third (n = 34) used electronic vapor products (EVPs), 19.8% (n = 19) smoked hookah, and 11.5% (n = 11) used smokeless tobacco (ST). Most marijuana users co-administered with tobacco (n = 67, 69.8%). Daily combustible tobacco smoking was associated with having a child and smoking out of boredom/habit. Daily marijuana use was associated with using substances to cope with one's housing situation. Newport (n = 66, 72.5%) and Black & Mild (n = 48, 51.1%) were the most popular brands of cigarettes and cigars among ever users. Most non-combustible tobacco ever users reported not having a usual brand (EVPs: n = 51, 73.9%; ST: n = 16, 57.1%). Cigar smokers reported the most varied selection of flavors. CONCLUSIONS Young combustible tobacco users experiencing homelessness engage in high-risk use patterns, including poly-tobacco use, co-use of tobacco with marijuana, and frequent combustible product use. Interventions that consider the full context of tobacco and marijuana use are needed to support smoking cessation in this population.
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Affiliation(s)
- Allison M. Glasser
- Division of Health Behavior and Health Promotion, The Ohio State University College of Public Health, 1841 Neil Avenue, Columbus, OH 43210 USA
| | - Alice Hinton
- Division of Biostatistics, The Ohio State University College of Public Health, 1841 Neil Avenue, Columbus, OH 43210 USA
| | - Amy Wermert
- Division of Health Behavior and Health Promotion, The Ohio State University College of Public Health, 1841 Neil Avenue, Columbus, OH 43210 USA
| | - Joseph Macisco
- Division of Health Behavior and Health Promotion, The Ohio State University College of Public Health, 1841 Neil Avenue, Columbus, OH 43210 USA
| | - Julianna M. Nemeth
- Division of Health Behavior and Health Promotion, The Ohio State University College of Public Health, 1841 Neil Avenue, Columbus, OH 43210 USA
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