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El-Hellani A, Watson CH, Huang M, Wilson CW, Fleshman CC, Petitti R, Pancake M, Bennett C, Keller-Hamilton BL, Jones J, Tran H, Bravo Cardenas R, Mays D, Ye W, Borthwick RP, Schaff J, Williamson RL, Wagener TL, Brinkman MC. Universal smoking machine adaptor for tobacco product testing. Tob Control 2024:tc-2023-058428. [PMID: 39009450 DOI: 10.1136/tc-2023-058428] [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] [Received: 10/05/2023] [Accepted: 06/29/2024] [Indexed: 07/17/2024]
Abstract
SIGNIFICANCE Historically, tobacco product emissions testing using smoking machines has largely focused on combustible products, such as cigarettes and cigars. However, the popularity of newer products, such as electronic cigarettes (e-cigarettes), has complicated emissions testing because the products' mouth-end geometries do not readily seal with existing smoking and vaping machines. The demand for emissions data on popularly used products has led to inefficient and non-standardised solutions, such as laboratories making their geometry-specific custom adaptors and/or employing flexible tubing, for each unique mouth-end geometry tested. A user-friendly, validated, universal smoking machine adaptor (USMA) is needed for testing the variety of tobacco products reflecting consumer use, including e-cigarettes, heated tobacco products, cigarettes, plastic-tipped cigarillos and cigars. METHODS A prototype USMA that is compatible with existing smoking/vaping machines was designed and fabricated. The quality of the seal between the USMA and different tobacco products, including e-cigarettes, cigars and cigarillos, was evaluated by examining the leak rate. RESULTS Unlike commercial, product-specific adaptors, the USMA seals well with a wide range of tobacco product mouth-end geometries and masses. This includes e-cigarettes with non-cylindrical mouth ends and cigarillos with cuboid-like plastic tips. USMA leak rates were lower than or equivalent to commercial, product-specific adaptors. CONCLUSION This report provides initial evidence that the USMA seals reliably with a variety of tobacco product mouth-end geometries and can be used with existing linear smoking/vaping machines to potentially improve the precision, repeatability and reproducibility of machine smoke yield data. Accurate and reproducible emissions testing is critical for regulating tobacco products.
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Affiliation(s)
- Ahmad El-Hellani
- Division of Environmental Health Sciences, The Ohio State University College of Public Health, Columbus, Ohio, USA
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Clifford H Watson
- Tobacco and Volatiles Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Michelle Huang
- Tobacco and Volatiles Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Clark W Wilson
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
- Division of Epidemiology, The Ohio State University College of Public Health, Columbus, Ohio, USA
| | - Clint C Fleshman
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
- Division of Epidemiology, The Ohio State University College of Public Health, Columbus, Ohio, USA
| | - Ryan Petitti
- Center for Design and Manufacturing Excellence, The Ohio State University, Columbus, Ohio, USA
| | - Mary Pancake
- Center for Design and Manufacturing Excellence, The Ohio State University, Columbus, Ohio, USA
| | - Chad Bennett
- Medicinal Chemistry Shared Resource, Drug Development Institute, The Ohio State University, Columbus, Ohio, USA
| | - Brittney L Keller-Hamilton
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
- Division of Medical Oncology, The Ohio State University Wexner Medical Center Department of Internal Medicine, Columbus, Ohio, USA
| | | | - Hang Tran
- Tobacco and Volatiles Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Roberto Bravo Cardenas
- Tobacco and Volatiles Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Darren Mays
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
- Division of Medical Oncology, The Ohio State University Wexner Medical Center Department of Internal Medicine, Columbus, Ohio, USA
| | - Wei Ye
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Robert P Borthwick
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Jason Schaff
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Raymond L Williamson
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Theodore L Wagener
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
- Division of Medical Oncology, The Ohio State University Wexner Medical Center Department of Internal Medicine, Columbus, Ohio, USA
| | - Marielle C Brinkman
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
- Division of Epidemiology, The Ohio State University College of Public Health, Columbus, Ohio, USA
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Powers JM, Zale EL, Deyo AG, Rubenstein D, Terry EL, Heckman BW, Ditre JW. Pain and Menthol Use Are Related to Greater Nicotine Dependence Among Black Adults Who Smoke Cigarettes at Wave 5 (2018-2019) of the Population Assessment of Tobacco and Health (PATH) Study. J Racial Ethn Health Disparities 2023; 10:2407-2416. [PMID: 36171497 PMCID: PMC10651305 DOI: 10.1007/s40615-022-01419-y] [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: 07/29/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 12/01/2022]
Abstract
Burdens related to pain, smoking/nicotine dependence, and pain-smoking comorbidity disproportionately impact Black Americans, and menthol cigarette use is overrepresented among Black adults who smoke cigarettes. Menthol may increase nicotine exposure, potentially conferring enhanced acute analgesia and driving greater dependence. Therefore, the goal of the current study was to examine associations between pain, menthol cigarette use, and nicotine dependence. Data was drawn from Black adults who were current cigarette smokers (n = 1370) at Wave 5 (2018-2019) of the Population Assessment of Tobacco and Health Study. Nicotine dependence was assessed using the Wisconsin Inventory of Smoking Dependence Motives. ANCOVA revealed that moderate/severe pain (vs. no/low pain) was associated with greater overall nicotine dependence (p < .001) and greater negative reinforcement, cognitive enhancement, and affiliative attachment smoking motives (ps < .001). Menthol smokers with moderate/severe pain also endorsed greater cigarette craving and tolerance, compared to non-menthol smokers with no/low pain (ps < .05). Findings support the notion that among Black individuals who smoke cigarettes, the presence of moderate/severe pain (vs. no/low pain) and menthol use may engender greater physical indices of nicotine dependence relative to non-menthol use. Compared to no/low pain, moderate/severe pain was associated with greater emotional attachment to smoking and greater proclivity to smoke for reducing negative affect and enhancing cognitive function. Clinical implications include the need to address the role of pain and menthol cigarette use in the assessment and treatment of nicotine dependence, particularly among Black adults. These data may help to inform evolving tobacco control policies aimed at regulating or banning menthol tobacco additives.
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Affiliation(s)
- Jessica M Powers
- Department of Psychology, Syracuse University, Syracuse, NY, 13244, USA.
| | - Emily L Zale
- Department of Psychology, Binghamton University, Binghamton, NY, 13902, USA
| | - Alexa G Deyo
- Department of Psychology, Syracuse University, Syracuse, NY, 13244, USA
| | - Dana Rubenstein
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, 27705, USA
| | - Ellen L Terry
- Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, 32610, USA
| | - Bryan W Heckman
- The Center for the Study of Social Determinants of Health, Meharry Medical College, Nashville, TN, USA
- Psychiatry and Behavioral Sciences, School of Medicine, Meharry Medical College, Nashville, TN, USA
- Division of Public Health, School of Graduate Studies and Research, Meharry Medical College, Nashville, TN, USA
| | - Joseph W Ditre
- Department of Psychology, Syracuse University, Syracuse, NY, 13244, USA
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Schroth KRJ, Villanti AC, Kurti M, Delnevo CD. Why an FDA Ban on Menthol Is Likely to Survive a Tobacco Industry Lawsuit. Public Health Rep 2019; 134:300-306. [PMID: 30970219 DOI: 10.1177/0033354919841011] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Kevin R J Schroth
- 1 Center for Tobacco Studies, Rutgers School of Public Health, New Brunswick, NJ, USA
| | - Andrea C Villanti
- 2 Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA
| | - Marin Kurti
- 1 Center for Tobacco Studies, Rutgers School of Public Health, New Brunswick, NJ, USA
| | - Cristine D Delnevo
- 1 Center for Tobacco Studies, Rutgers School of Public Health, New Brunswick, NJ, USA
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Abrams DB, Glasser AM, Villanti AC, Pearson JL, Rose S, Niaura RS. Managing nicotine without smoke to save lives now: Evidence for harm minimization. Prev Med 2018; 117:88-97. [PMID: 29944902 PMCID: PMC6934253 DOI: 10.1016/j.ypmed.2018.06.010] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 06/18/2018] [Accepted: 06/21/2018] [Indexed: 01/05/2023]
Abstract
Tobacco control has made strides in prevention and cessation, but deaths will not decline rapidly without massive behavior change. Currently, inhaled smoke from combusting tobacco is chiefly responsible for prematurely killing 7.2 million people worldwide and 530,000 in the United States annually. An array of noncombustible nicotine products (NNPs) has emerged and has disrupted the marketplace. Saving lives more speedily will require societal acceptance of locating a "sweet spot" within a three-dimensional framework where NNPs are simultaneously: 1. Less toxic, 2. Appealing (can reach smokers at scale), and 3. Satisfying (adequate nicotine delivery) to displace smoking. For this harm minimization framework to eliminate smoking, a laser focus on "smoking control" (not general tobacco control) is needed. By adopting these economically viable NNPs as part of the solution, NNPs can be smoking control's valued ally. Synthesis of the science indicates that policy and regulation can sufficiently protect youth while speeding the switch away from smoking. Despite some risks of nicotine dependence that can be mitigated but not eliminated, no credible evidence counters the assertion that NNPs will save lives if they displace smoking. But scientific evidence and advocacy has selectively exaggerated NNP harms over benefits. Accurate communication is crucial to dispel the misperception of NNPs harms and reassure smokers they can successfully replace smoking cigarettes with NNPs. Saving more lives now is an attainable and pragmatic way to call for alignment of all stakeholders and factions within traditional tobacco control rather than perpetuate the unrealized and unrealizable perfection of nicotine prohibition.
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Affiliation(s)
- David B Abrams
- Department of Social and Behavioral Sciences, NYU College of Global Public Health, New York University, New York, NY, USA.
| | - Allison M Glasser
- Department of Social and Behavioral Sciences, NYU College of Global Public Health, New York University, New York, NY, USA
| | - Andrea C Villanti
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | - Jennifer L Pearson
- School of Community Health Sciences, University of Nevada, Reno, NV, USA
| | - Shyanika Rose
- Truth Initiative Schroeder Institute, Washington, DC, USA
| | - Raymond S Niaura
- Department of Social and Behavioral Sciences, NYU College of Global Public Health, New York University, New York, NY, USA
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Abrams DB, Glasser AM, Pearson JL, Villanti AC, Collins LK, Niaura RS. Harm Minimization and Tobacco Control: Reframing Societal Views of Nicotine Use to Rapidly Save Lives. Annu Rev Public Health 2018; 39:193-213. [PMID: 29323611 PMCID: PMC6942997 DOI: 10.1146/annurev-publhealth-040617-013849] [Citation(s) in RCA: 191] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Inhalation of the toxic smoke produced by combusting tobacco products, primarily cigarettes, is the overwhelming cause of tobacco-related disease and death in the United States and globally. A diverse class of alternative nicotine delivery systems (ANDS) has recently been developed that do not combust tobacco and are substantially less harmful than cigarettes. ANDS have the potential to disrupt the 120-year dominance of the cigarette and challenge the field on how the tobacco pandemic could be reversed if nicotine is decoupled from lethal inhaled smoke. ANDS may provide a means to compete with, and even replace, combusted cigarette use, saving more lives more rapidly than previously possible. On the basis of the scientific evidence on ANDS, we explore benefits and harms to public health to guide practice, policy, and regulation. A reframing of societal nicotine use through the lens of harm minimization is an extraordinary opportunity to enhance the impact of tobacco control efforts.
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Affiliation(s)
- David B Abrams
- College of Global Public Health, New York University, New York, NY 10012, USA; ,
| | - Allison M Glasser
- Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC 20001, USA; ,
| | - Jennifer L Pearson
- School of Community Health Sciences, University of Nevada, Reno, Nevada 89557, USA;
| | - Andrea C Villanti
- Vermont Center on Behavior and Health, University of Vermont, Burlington, Vermont 05401, USA;
| | - Lauren K Collins
- Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC 20001, USA; ,
| | - Raymond S Niaura
- College of Global Public Health, New York University, New York, NY 10012, USA; ,
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Kasza KA, Hyland AJ, Bansal-Travers M, Vogl LM, Chen J, Evans SE, Fong GT, Cummings KM, O'Connor RJ. Switching between menthol and nonmenthol cigarettes: findings from the U.S. Cohort of the International Tobacco Control Four Country Survey. Nicotine Tob Res 2014; 16:1255-65. [PMID: 24984878 DOI: 10.1093/ntr/ntu098] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION This article examines trends in switching between menthol and nonmenthol cigarettes, smoker characteristics associated with switching, and associations among switching, indicators of nicotine dependence, and quitting activity. METHODS Participants were 5,932 U.S. adult smokers who were interviewed annually as part of the International Tobacco Control Four Country Survey between 2002 and 2011. Generalized estimating equations (GEEs) were used to examine the prevalence of menthol cigarette use and switching between menthol and nonmenthol cigarettes (among 3,118 smokers who participated in at least 2 consecutive surveys). We also evaluated characteristics associated with menthol cigarette use and associations among switching, indicators of nicotine dependence, and quitting activity using GEEs. RESULTS Across the entire study period, 27% of smokers smoked menthol cigarettes; prevalence was highest among Blacks (79%), young adults (36%), and females (30%). Prevalence of switching between menthol and nonmenthol cigarettes was low (3% switched to menthol and 8% switched to nonmenthol), and switchers tended to revert back to their previous type. Switching types was not associated with indicators of nicotine dependence or quit attempts. However, those who switched cigarette brands within cigarette types were more likely to attempt to quit smoking. CONCLUSIONS While overall switching rates were low, the percentage who switched from menthol to nonmenthol was significantly higher than the percentage who switched from nonmenthol to menthol. An asymmetry was seen in patterns of switching such that reverting back to menthol was more common than reverting back to nonmenthol, particularly among Black smokers.
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Affiliation(s)
- Karin A Kasza
- Division of Cancer Prevention and Population Sciences, Roswell Park Cancer Institute, Buffalo, NY;
| | - Andrew J Hyland
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY
| | | | - Lisa M Vogl
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY
| | - Jiping Chen
- Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD
| | - Sarah E Evans
- Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada; Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Kenneth Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Richard J O'Connor
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY
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Smoking, menthol cigarettes and all-cause, cancer and cardiovascular mortality: evidence from the National Health and Nutrition Examination Survey (NHANES) and a meta-analysis. PLoS One 2013; 8:e77941. [PMID: 24205038 PMCID: PMC3808303 DOI: 10.1371/journal.pone.0077941] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 09/06/2013] [Indexed: 12/04/2022] Open
Abstract
Background The U.S. Food and Drug Administration has the authority to regulate tobacco product constituents, including menthol, if the scientific evidence indicates harm. Few studies, however, have evaluated the health effects of menthol cigarette use. Objective To investigate associations of cigarette smoking and menthol cigarette use with all-cause, cancer and cardiovascular risk in U.S. adults. Methods We studied 10,289 adults ≥ 20 years of age who participated in the National Health and Nutrition Examination Survey from 1999-2004 and were followed through December 2006. We also identified studies comparing risk of all-cause mortality, cardiovascular disease and cancer for menthol and nonmenthol cigarette smokers and estimates were pooled using random-effects models. Results Fifty-five percent of participants were never smokers compared to 23%, 17% and 5% of former, current nonmenthol and current menthol cigarette smokers, respectively. The adjusted hazard ratios (95% CI) for former, current nonmenthol and current menthol cigarette smokers compared to never smokers were 1.24 (0.96, 1.62), 2.40 (1.56, 3.71) and 2.07 (1.20, 3.58), respectively, for all-cause mortality; 0.92 (0.62, 1.37), 2.10 (1.02, 4.31) and 3.48 (1.52, 7.99) for cardiovascular mortality; and 1.91 (1.21, 3.00), 3.82 (2.19, 6.68) and 2.03 (1.00, 4.13) for cancer mortality. Using data from 3 studies of all-cause mortality, 5 of cardiovascular disease and 13 of cancer, the pooled relative risks (95% CI) comparing menthol cigarette smokers to nonmenthol cigarette smokers was 0.94 (0.85, 1.05) for all-cause mortality, 1.28 (0.91, 1.80) for cardiovascular disease and 0.84 (0.76, 0.92) for any cancer. Conclusions In a representative sample of U.S. adults, menthol cigarette smoking was associated with increased all-cause, cardiovascular and cancer mortality with no differences compared to nonmenthol cigarettes. In the systematic review, menthol cigarette use was associated with inverse risk of cancer compared to nonmenthol cigarette use with some evidence of an increased risk for cardiovascular disease.
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