The role of sensory perception in the development and targeting of tobacco products

The Relative Reinforcing Value of Menthol Among Young Adult Cigarette Smokers: Results From a Behavioral Choice Task

INTRODUCTION

Menthol cigarettes are associated with experimentation and progression to regular use. Although reinforcement processes likely underlie menthol's appeal, the reinforcing value of menthol cigarettes remains unknown.

AIMS AND METHODS

This study examined the relative reinforcing value (RRV) of menthol versus nonmenthol cigarettes in young adult menthol (n = 54) and nonmenthol (n = 53) smokers, and differences in menthol's RRV by race, ethnicity, and sexual orientation. Overnight abstinent participants completed a choice task assessing willingness to "work" to click targets on a computer screen to earn menthol or nonmenthol cigarette puffs. A progressive ratio schedule was used where the menthol target had to be clicked progressively more times, over 10 trials, to earn a menthol cigarette puff, while clicks for the nonmenthol target were fixed across trials. RRV for menthol was defined by the breakpoint, or the highest trial (out of to 10) completed for a menthol cigarette puff. Number of clicks for menthol and nonmenthol puffs were also examined.

RESULTS

Menthol smokers worked harder for menthol versus nonmenthol cigarette puffs (breakpoint = 9.17; ~1236 clicks vs. 24 clicks). Breakpoint was higher among Hispanic (6.49) versus NH White (4.83) and NH non-White smokers (4.43). In exploratory analyses of interactions of menthol preference with race and ethnicity, nonmenthol Hispanic smokers worked harder for menthol cigarette puffs versus NH non-White and NH White nonmenthol smokers.

CONCLUSIONS

Menthol cigarettes are highly reinforcing for young adult menthol and Hispanic smokers. A menthol ban may reduce addiction risk among younger individuals and some minoritized groups of smokers.

IMPLICATIONS

This study provides evidence of the greater relative reinforcing value of menthol compared to nonmenthol cigarettes among young adults who had a cigarette flavor preference, suggesting increased addiction risk of menthol cigarettes. Young adult menthol smokers and Hispanic (vs. non-Hispanic) smokers worked harder to earn menthol (vs. nonmenthol) cigarette puffs. Findings add to the evidence base supporting the U.S. Food and Drug Administration's (FDA) intent to ban menthol in cigarettes. Further, prevention messaging campaigns and cessation programs should take into account the reinforcing value of menthol in cigarettes, especially in vulnerable and at-risk populations.

Awareness and perceived behaviour changes following the New York state vaping flavour ban, 2021-2022

SIGNIFICANCE

Despite an electronic cigarette (e-cigarette) flavour ban in New York (NY) since May 2020, most youth who vape continue to report vaping restricted flavours. This study aims to examine youth awareness and perceived behaviour change associated with the NY vaping flavour ban.

METHODS

NY cross-sectional data from 2021 and 2022 ITC Youth Survey were combined and analysed (N=1014). Weighted analyses were used to describe awareness and understanding of the e-cigarette flavour ban, as well as changes in tobacco use behaviour.

RESULTS

Only 0.9% (n=8) of NY youth understood the flavour ban, in that they were both aware of the flavour ban in all stores and accurately reported that all non-tobacco flavours were banned. Awareness and understanding of the flavour ban differed by vaping status (p<0.01): respondents who had vaped in the past 12 months or 30 days were more likely (adjusted OR (aOR)=2.15, 95% CI 1.34, 3.45; aOR=2.07, 95% CI 1.17, 3.64, respectively) to be aware of the flavour ban but misunderstand the stores or flavours included. Of the majority of youth who reported awareness of a flavour ban and vaped (n=122) or smoked (n=78) in the past 12 months reported no changes in behaviour (64.0% and 69.7%, respectively).

CONCLUSIONS

Less than one-third of NY youth, regardless of vaping status, reported that an e-cigarette flavour ban was present where they live. Further, most youth who were aware of the ban misunderstood which flavours were restricted and/or that the ban applied to all stores that sold e-cigarettes. Increased enforcement and educational efforts could improve awareness and understanding of the NY e-cigarette flavour ban.

Youth and Young Adult Awareness of and Perceptions About Tobacco Marketing as a Social Justice Issue

INTRODUCTION

Systemic racism and tobacco-industry targeting contribute to disparities in communities of color. However, understanding tobacco as a social justice issue and the industry's role in perpetuating inequities remains limited. This study explored youth and young adult awareness of tobacco marketing and perceptions of tobacco marketing as a social justice issue.

AIMS AND METHODS

Focus groups were conducted with youth and young adults in 2020 and 2021, including individuals who used tobacco and e-cigarettes and those who did not use either. Online surveys were conducted in 2021 with youth (n = 1227) and young adults (n = 2643) using AmeriSpeak's nationally representative panel, oversampling for black and Hispanic Americans and people who smoke. Perceptions of flavor bans, social justice, and industry marketing were assessed.

RESULTS

Most (>80%) survey respondents agreed that tobacco companies target youth. However, only 20% saw tobacco as a social justice issue. Focus group participants regardless of their tobacco or e-cigarette use, reported higher prevalence of tobacco advertising in their communities relative to survey respondents but did not view it as targeting communities of color. Black non-Hispanic (20.9%) and Hispanic (21.4%) survey respondents perceived tobacco as a social justice issue more than white non-Hispanic (16.1%) respondents. The majority (>60%) of survey respondents supported bans on menthol and flavored tobacco, regardless of race or ethnicity.

CONCLUSIONS

Respondents broadly supported menthol and flavored tobacco bans and recognized tobacco-industry influence on youth. Low awareness of tobacco as a social justice issue highlights the need to raise awareness of the underlying factors driving tobacco-related disparities.

IMPLICATIONS

The majority of young people see the tobacco industry as targeting them. Most young people support bans on menthol and flavored tobacco bans, with support across racial and ethnic groups. While few young respondents perceived tobacco as a social justice issue, some perceived tobacco companies as targeting low-income and communities of color. Black non-Hispanic and Hispanic respondents were more likely to perceive tobacco as a social justice issue than white non-Hispanic respondents. Efforts to raise awareness among young people of tobacco as a social justice issue may be key in addressing tobacco disparities and advancing support for flavor tobacco bans.

Metabolomics-based study of chemical compositions in cellulase additives derived from a tobacco-origin Bacillus subtilis and their impact on tobacco sensory attributes

To enhance the quality of tobacco leaves and optimize the smoking experience, diverse strains of functional bacteria and their associated metabolites have been used in tobacco aging. Exogenous cellulase additives are frequently employed to facilitate the degradation of cellulose and other macromolecular matrices and enhance the quality of the tobacco product. However, little is known about how microbial metabolites present in exogenous enzyme additives affect tobacco quality. In this study, crude cellulase solutions, produced by a tobacco-originating bacterium Bacillus subtilis FX-1 were employed on flue-cured tobacco. The incorporation of cellulase solutions resulted in the reduction of cellulose crystallinity in tobacco and the enhancement of the overall sensory quality of tobacco. Notably, tobacco treated with cellulase obtained from laboratory flask fermentation demonstrated superior scent and flavor attributes in comparison to tobacco treated with enzymes derived from industrial bioreactor fermentation. The targeted and untargeted metabolomic analysis revealed the presence of diverse flavor-related precursors and components in the cellulase additives, encompassing sugars, alcohols, amino acids, organic acids, and others. The majority of these metabolites exhibited significantly higher levels in the flask group compared to the bioreactor group, probably contributing to a pronounced enhancement in the sensory quality of tobacco. Our findings suggest that the utilization of metabolic products derived from B. subtilis FX-1 as additives in flue-cured tobacco holds promise as a viable approach for enhancing sensory attributes, establishing a solid theoretical foundation for the potential development of innovative tobacco aging additives.

Risk perceptions and continued smoking as a function of cigarette filter ventilation level among US youth and young adults who smoke

BACKGROUND

While evidence demonstrates that the industry's marketing of cigarettes with higher filter ventilation (FV) misleads adults about their health risks, there is no research on the relationships between FV, risk perceptions and smoking trajectories among youth (ages 12-17) and young adults (ages 18-24).

METHODS

Data on FV levels of major US cigarette brands/sub-brands were merged with the Population Assessment of Tobacco and Health Study to examine whether FV level in cigarettes used by wave 1 youth/young adults (n=1970) predicted continued smoking at waves 2-4, and whether those relationships were mediated by perceived risk of their cigarette brand. FV was modelled based on tertiles (0.2%-11.8%, low; 11.9%-23.2%, moderate; 23.3%-61.1%, high) to predict daily smoking, past 30-day smoking and change in number of days smoking at successive waves.

RESULTS

The odds of perceiving one's brand as less harmful than other cigarette brands was 2.21 times higher in the high versus low FV group (p=0.0146). Relationships between FV and smoking outcomes at successive waves were non-significant (all p>0.05).

CONCLUSION

Youth and young adults who use higher FV cigarettes perceived their brand as less harmful compared with other brands. However, level of FV was not associated with continued smoking.

Smokers' support for the ban on sale of slim cigarettes in six European countries: findings from the EUREST-PLUS ITC Europe Surveys

Background: Efforts to regulate tobacco products and reduce consumption in the European Union (EU) include the European Tobacco Products Directive (TPD), which went into force in May 2016. Despite the initial discussion to include a ban on sale of slim cigarettes, it was excluded in the final TPD. The main goal of this study was to examine support for a ban on slim cigarettes among smokers in six European Countries. Methods: Data from the 2018 (Wave 2) International Tobacco Control Policy Evaluation Project 6 European Country (ITC 6E) EUREST-PLUS project survey, a cross sectional study of adult smokers (n=5592) from Germany, Greece, Hungary, Poland, Romania, and Spain, was analysed. Descriptive statistics were used to estimate support for a ban on slim cigarettes by sociodemographic characteristics and smoking behaviors. Logistic regression analysis was used to examine factors associated with support for a ban on slim cigarettes and perceptions of harm. Results: Support for a ban on slims varied across countries, with highest support in Romania (33.8%), and lowest in Greece (18.0%). Female smokers (OR=0.78; 95%CI=0.67-0.91, daily smokers (OR=0.68; 95%CI=0.47-0.97), menthol smokers (OR=0.55; 95%CI=0.36-0.86), and smokers who did not have plans to quit within next six months (OR=0.45; 95%CI=0.36-0.56) had significantly lower odds of supporting a ban on slim cigarettes. Overall, 21% of smokers perceived slim cigarettes as less harmful than regular cigarettes. Conclusions: Support for a ban of slim cigarettes was relatively low among smokers, while misperceptions that slim cigarettes are less harmful is high, particularly among countries where slim cigarette use is more prevalent. Findings support a ban on slim cigarettes to reduce misperceptions around slim cigarettes being less harmful.

Sensory methods to evaluate perception of flavours in tobacco and other nicotine-containing products: a review

OBJECTIVES

Sensory methods use human senses to evaluate product attributes. This review provides an overview of the types of sensory methods used to evaluate the perception of flavour in tobacco and other nicotine-containing (ToNic) products and to discuss how sensory data could inform flavoured ToNic product policy.

DATA SOURCES

PubMed, Embase and Web of Science.

STUDY SELECTION

All peer-reviewed studies evaluating ToNic products using a sensory method published before 23 May 2020.

DATA EXTRACTION

Two independent coders completed title/abstract and full-text screening to choose articles for inclusion (Cohen's kappa=0.85, strong agreement). Each coder completed data extraction on half the articles, recording relevant information (eg, sensory methods used, results). The coders categorised sensory methods and generated overarching themes.

DATA SYNTHESIS

Of 110 articles identified, we included 29 articles containing 35 studies that used sensory methods to investigate ToNic products. The sensory methods included analytic methods such as discrimination and descriptive tests and hedonic methods such as liking tests. Six themes emerged regarding how sensory methods can be used to understand consumer perception and liking of ToNic products and to inform ToNic product policy.

CONCLUSIONS

The identified studies highlight that sensory data can inform ToNic product policy. Analytic and sensory hedonic ratings can be used to assess a ToNic product's ability to promote addiction in the user (ie, abuse liability). Lastly, hedonic ratings can provide information to assess potential use behaviours.

Integrative analysis of sensory evaluation and non-targeted metabolomics to unravel tobacco leaf metabolites associated with sensory quality of heated tobacco

INTRODUCTION

Heated tobacco (Nicotiana tabacum L.) products are heating tobacco plug at a temperature of 350°C and produce different emissions in aerosol and sensory perceptions of tobacco leaf compared with combustible tobacco. Previous study assessed different tobacco varieties in heated tobacco for sensory quality and analyzed the links between sensory scores of the final products and certain chemical classes in tobacco leaf. However, contribution of individual metabolites to sensory quality of heated tobacco remains largely open for investigation.

METHODS

In present study, five tobacco varieties were evaluated as heated tobacco for sensory quality by an expert panel and the volatile and non-volatile metabolites were analyzed by non-targeted metabolomics profiling.

RESULTS

The five tobacco varieties had distinct sensory qualities and can be classified into higher and lower sensory rating classes. Principle component analysis and hierarchical cluster analysis showed that leaf volatile and non-volatile metabolome annotated were grouped and clustered by sensory ratings of heated tobacco. Orthogonal projections to latent structures discriminant analysis followed by variable importance in projection and fold-change analysis revealed 13 volatiles and 345 non-volatiles able to discriminate the tobacco varieties with higher and lower sensory ratings. Some compounds such as β-damascenone, scopoletin, chlorogenic acids, neochlorogenic acids, and flavonol glycosyl derivatives had strong contribution to the prediction of sensory quality of heated tobacco. Several lyso-phosphatidylcholine and lyso-phosphatidylethanolamine lipid species, and reducing and non-reducing sugar molecules were also positively related to sensory quality.

DISCUSSION

Taken together, these discriminating volatile and non-volatile metabolites support the role of leaf metabolites in affecting the sensory quality of heated tobacco and provide new information on the types of leaf metabolites that can be used to predict applicability of tobacco varieties for heated tobacco products.

Chemosensory Contributions of E-Cigarette Additives on Nicotine Use

While rates of smoking combustible cigarettes in the United States have trended down in recent years, use of electronic cigarettes (e-cigarettes) has dramatically increased, especially among adolescents. The vast majority of e-cigarette users consume "flavored" products that contain a variety of chemosensory-rich additives, and recent literature suggests that these additives have led to the current "teen vaping epidemic." This review, covering research from both human and rodent models, provides a comprehensive overview of the sensory implications of e-cigarette additives and what is currently known about their impact on nicotine use. In doing so, we specifically address the oronasal sensory contributions of e-cigarette additives. Finally, we summarize the existing gaps in the field and highlight future directions needed to better understand the powerful influence of these additives on nicotine use.

Smoking Outcome Expectancies in Chinese Young Adults

The aims of this study were to: 1) validate the factor structure of the short-form smoking consequences questionnaire (S-SCQ) in Chinese young adults; 2) assess measurement invariance of the S-SCQ across smokers and never-smokers; 3) examine factors of the S-SCQ in relation to smoking-related variables. Data from 1,540 respondents (757 smokers, 783 never-smokers) were collected anonymously via an online survey in June, 2021. All respondents completed the S-SCQ and other smoking-related items. Confirmatory factor analysis (CFA) was conducted to validate the factor structure of S-SCQ. Measurement invariance of the S-SCQ was examined across smoking status. Relations between outcome expectancies and other smoking-related variables were further examined. CFA results supported the four-factor structure of the S-SCQ. Measurement invariance tests supported configural, metric, partial scalar, and strict invariance of the S-SCQ across smoking status. Never-smokers exposed to household SHS or intending to smoke had weight control and reinforcement expectancies. Smokers exposed to moderate household SHS or scored higher on the FTND had greater positive reinforcement expectancies. For never-smokers, household SHS exposure and future smoking intentions may be key constructs to target in smoking prevention efforts. For smokers, smoking-induced sensory satisfaction may be a key construct to transform in expectancy-based interventions.

Measuring young adult appeal for menthol and non-menthol cigarettes: protocol of a clinical trial using both laboratory and intensive longitudinal methods (PRISM)

INTRODUCTION

Although the Food and Drug Administration banned other characterising flavours in cigarettes, menthol cigarettes are still available to consumers. Young adult new smokers are initiating with menthol cigarettes, such that the prevalence of young adults menthol versus non-menthol smokers is increasing. Experimentation with menthol cigarettes is associated with progression to regular smoking and nicotine dependence. This ongoing clinical trial in young adult smokers measures appeal and the reinforcing value of smoking menthol versus non-menthol cigarettes and the impact of these variables on changes in smoking behaviour at a 6-month follow-up.

METHODS AND ANALYSIS

Reinforcement for menthol smoking is assessed in the laboratory using a validated behavioural economic choice task, and appeal is measured in the natural environment using ecological momentary assessment (EMA). Analyses will examine differences between menthol and non-menthol cigarette smoking on measures of subjective response in the laboratory and via EMA, and how subjective response mediates the association between menthol preference at baseline and smoking outcomes at follow-up.

ETHICS AND DISSEMINATION

This protocol was approved by the University of Oklahoma Health Sciences Center Institutional Review Board (#10581). The findings will isolate the unique effects of menthol in smoking and will help inform regulatory decisions about the abuse liability of menthol cigarettes. Findings will be disseminated through peer-reviewed journal articles and presentations at national and international conferences.

TRIAL REGISTRATION NUMBER

NCT03953508.

Affirming the Abuse Liability and Addiction Potential of Menthol: Differences in Subjective Appeal to Smoking Menthol Versus Non-Menthol Cigarettes Across African American and White Young Adult Smokers

INTRODUCTION

Menthol cigarettes are popular among young adults and are disproportionately used by African American smokers. Menthol's minty and cooling sensations have been hypothesized to enhance the appeal and reinforcement of smoking; however, differences in menthol's subjective appeal across races have been inconsistent. This secondary data analysis examined differences in subjective appeal for smoking menthol versus non-menthol cigarettes between African American and White young adult smokers.

METHODS

Young adults (ages 18-24) recruited from Amazon Mechanical Turk (December 2018-January 2019) completed an online survey of tobacco use behavior. Past year smokers (n = 1726) answered questions about subjective responses to smoking (reward, satisfaction, throat hit, craving reduction, and aversion).

RESULTS

Significantly more African American (73.2%) compared to White (52.4%) smokers preferred menthol cigarettes (p < .001). Menthol smokers reported greater positive and negative subjective responses to smoking than non-menthol smokers. Positive and negative subjective response were both associated with greater smoking intensity and lower cigarette harm perceptions. Interactions of menthol preference and race on indices of subjective appeal also emerged. African American non-menthol smokers reported lower levels of satisfaction, reward, and craving reduction compared to White non-menthol smokers.

CONCLUSIONS

The relationship between menthol preference and subjective response to smoking differs by race. Menthol is rated as more appealing than non-menthol smoking, and appeal indices were linked to smoking intensity and lower harm perceptions, indicating greater abuse liability of menthol cigarettes. Policies that ban menthol cigarettes may have a particularly positive impact on the cigarette smoking of African American young adult smokers.

IMPLICATIONS

The FDA issued an Advanced Notice of Proposed Rule Making to examine the role menthol in tobacco products to inform regulations to restrict or ban flavors. This study showed that menthol smokers reported greater appeal to smoking than non-menthol smokers; and an interaction of race x menthol preference showed African American non-menthol smokers reported the lowest levels of appeal to smoking. Multiple indices of cigarette appeal were positively correlated with smoking intensity and lower cigarette harm perceptions, highlighting the addiction potential of menthol cigarettes. Findings suggest a menthol cigarette ban could help reduce tobacco use among young adults.

The potential cytotoxic effects of urban particle matter on olfaction

BACKGROUND

Urban particulate matter (UPM) in ambient air is implicated in a variety of human health issues worldwide, however, few studies exist on the effect of UPM on the olfactory system. This study aimed to identify the factors affecting the destruction of the olfactory system in a mouse model following UPM exposure.

METHODS

Mice were divided into: control and four UPM-exposed groups (200 µg UPM at 1 and 2 weeks, and 400 µg UPM at 1 and 2 weeks [standard reference material 1649b; average particle diameter 10.5 μm]). The olfactory neuroepithelium was harvested for histologic examination, gene ontology, quantitative real-time polymerase chain reaction, and western blotting.

RESULTS

Compared to the control group, olfactory marker protein, Olfr1507, ADCY3, and GNAL mRNA levels were lower, and S-100, CNPase, NGFRAP1, BDNF, and TACR3 mRNA levels were higher in the olfactory neuroepithelium of the UPM groups. Moderately positive correlation was present between the 1- and 2-week groups. After analyzing the 200 and 400 UPM groups separately, the strength of the association between the 200 UPM 1- and 2-week groups was moderately positive. No differences was present in the neuroepithelial inflammatory marker levels between the UPM and control groups.

CONCLUSIONS

UPM could have cytotoxic effects on the olfactory epithelium. The exposure time and particular concentration of UPM exposure could affect the degree of destruction of the olfactory neuroepithelium. The olfactory regeneration mechanism could be related to the neurotrophic factors, olfactory ensheathing cell stimulation, and trigeminal nerve support.

Reporting of Differences in Taste Between Branded and Unbranded Cigarettes by Smokers Blinded to Cigarette Branding: Within-Person, Randomized Crossover Study

BACKGROUND

Saudi Arabia implemented a plain tobacco packaging regulation, one of the World Health Organization's recommended initiatives to help reduce smoking rates, in August 2019. A few weeks after implementation, a large number of smokers complained via various media channels, especially social media (eg, Twitter), that an extreme change in cigarette taste had occurred, frequency of coughing had increased, and for some, shortness of breath had led to hospitalization.

OBJECTIVE

The main objective is to determine whether smokers blinded to cigarette branding report differences in taste between branded and unbranded cigarettes. The secondary objective is to observe the frequency of immediate cough or shortness of breath.

METHODS

This study employed a within-person, randomized crossover design that recruited current smokers 18 years and older who were cleared upon physical assessment before the experiment. Participants received 6 sequences of different random exposures (3 puffs) to 3 plain-packaged cigarettes (2 from their favorite brand and 1 from another brand as a control) and 3 branded cigarettes (2 from the favorite brand and 1 from another brand as a control). Participants wore virtual reality goggles accompanied by special software to alter visual reality and gloves to alter the touch sensation.

RESULTS

This study recruited 18 participants, measured at 6 time points, to produce 108 experiments. Participants were not able to identify the correct type of cigarettes (plain or branded, estimate of fixed effect=-0.01, P=.79). Moreover, there were no differences in the ability of the participants to identify their favorite brand (t107=-0.63, mean 0.47, P=.53). In terms of immediate coughing, out of the 108 experiments, 1 episode of short coughing was observed, which was attributed to the branded cigarette, not the plain-packaged cigarette.

CONCLUSIONS

After controlling the visual and touch sensations, participants were not able to differentiate between branded and plain-packaged cigarettes in terms of taste or inducing immediate shortness of breath or cough. Interestingly, participants were not able to identify their favorite brand.

Toxicological assessment of electronic cigarette vaping: an emerging threat to force health, readiness and resilience in the U.S. Army

The U.S. Army and U. S. Army Public Health Center are dedicated to protecting the health, and readiness of Department of the Army Service Members, civilians, and contractors. Despite implementation of health programs, policies and tobacco control interventions, the advent of electronic nicotine delivery systems (ENDS), including electronic cigarettes (e-cigs), represent unregulated and poorly defined systems to supplant or substitute use of conventional nicotine products (e.g., cigarettes and pipe tobacco). E-cigs present unique challenges to healthcare officials vested in preventive medicine. The health impact of an e-cig and vaping on an individual's acute or chronic disease susceptibility, performance and wellness, is fraught with uncertainty. Given the relatively recent emergence of e-cigs, high-quality epidemiological studies, and applied biological research studies are severely lacking. In sparsely available epidemiological studies of short-term cardiovascular and respiratory health outcomes, any attempt at addressing the etiology of acute and chronic health conditions from e-cig use faces incredible challenges. Until relatively recently, this was complicated by an absent national regulatory framework and health agency guidance on the manufacture, distribution, selling and use of e-cigs or similar ENDS devices and their chemical constituents. Two key issues underpin public health concern from e-cig use: 1) continued or emergent nicotine addiction and potential use of these devices for vaping controlled substances; and 2) inadvertent sudden-onset or chronic health effects from inhalational exposure to low levels of complex chemical toxicants from e-cig use and vaping the liquid. Herein, the health impacts from e-cig vaping and research supporting such effects are discussed.

Fresher with flavour: young women smokers' constructions and experiences of menthol capsule cigarettes and regular cigarettes

Background

Flavour capsule cigarettes are one of the fastest growing segments of the tobacco market, and there is evidence that Australian young people are increasingly using menthol flavoured capsule cigarettes. This qualitative research examines how young women construct and experience menthol flavour capsule cigarettes as part of their smoking practices, and explores the perceived differences between menthol capsule cigarettes and regular cigarettes. Semi-structured face-to-face in-depth interviews were conducted with 41 Australian young women smokers, using a constructivist grounded theory approach.

Results

Findings reveal that the perceived fresh and improved taste of menthol and the ability to customise the smoking process positively contributed to young women’s experiences of smoking menthol capsule cigarettes. In particular, menthol capsule flavour cigarettes were constructed by the young women as “fresh”, “light” and “minty”, and “popping” the menthol capsule allowed the young women to personalise their smoking experience.

Conclusion

These results indicate that specific public health campaigns and legislation should be developed to counter the powerfully alluring effects and the innovative appeal of menthol capsule cigarettes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-021-01297-2.

Profiling of volatile substances by direct thermal desorption gas chromatography high-resolution mass spectrometry for flagging a characterising flavour in cigarette tobacco

This paper describes an analytical method that supports the implementation of articles 9 and 10 of the WHO Framework Convention on Tobacco Control (FCTC) regarding the provisions on the reduction of the palatability and attractiveness of tobacco products regarding flavour ingredients. This study aimed to develop a screening method to identify cigarettes that may have a characterising flavour to support the implementation of the ban of characterising flavours of tobacco products, as laid down in the US and EU law. An analytical method combining direct thermal desorption and GC-QTOF MS was developed for acquiring the profile of volatile and semi-volatile substances in tobacco. A database of flavour additives was created comprising 133 compounds. A group of cigarettes without a declared characterising flavour was used to establish a reference profile of flavouring chemicals commonly present in tobacco products. A reference profile was modelled both by the means of principal component analysis (PCA) and based on the calculation of threshold values specified as 95th percentile of measured compounds' relative responses. Cigarettes and roll-your-own tobacco labelled as flavoured were analysed to evaluate the discrimination power of the method. A constructed model of the reference cigarettes allowed the differentiation of the flavoured tobacco products from the reference group. The method allows drawing conclusions on the chemical profiles of flavour constituents of tobacco products at even sensorial subliminal concentration levels and is suitable for both the initial screening of products on the market for characterising flavours and for confirmatory purposes after sensory analysis.

Sensory experiences and cues among E-cigarette users

BACKGROUND AND AIMS

We characterized the extent and quality of respiratory sensations and sensory-related smoking cues associated with e-cigarette use among those who failed to quit combustible tobacco cigarette (CTC) use with traditional FDA approved medications but succeeded in doing so with e-cigarettes. Further, we sought to understand former smokers' perceptions about the influence of sensory experience with e-cigarette use on CTC cessation outcomes.

METHODS

A nonrandom purposive sample of 156 participants recruited in the USA through the Consumer Advocates for Smoke Free Alternatives Association Facebook page completed an online cross-sectional survey to assess sensory experiences and smoking cues associated with e-cigarette use. Descriptive statistics were calculated, and the ANOVA/Kruskal-Wallis test with post hoc testing and the two-sample t test/Wilcoxon rank-sum test, as appropriate based on distribution, were used to assess the association between sample characteristics and sensory experiences and cues using investigator constructed questions, the Modified Cigarette Evaluation Questionnaire (mCEQ) and the Smoking Cue Appeal Survey (SCAS).

RESULTS

With e-cigarette use, participants reported feeling the vapor in their throats, windpipes, noses, lungs, and on their tongues; reductions in nicotine craving; and enjoyment of their e-cigarette, including tasting, smelling, and seeing the vapor and touching the device. Women had greater craving reduction than men (p = 0.023). Those who began smoking at 13 years of age or younger had more satisfaction and had greater sensory enjoyment than those who began smoking at 16-17 years of age (p = 0.015 and p = 0.026, respectively), as well as greater sensory enjoyment than those who began smoking at 14-15 years of age (p = 0.047). There was a significant overall association between the number of years a respondent smoked and e-cigarette sensory enjoyment (p = 0.038). Participants 18-34 years old rated e-cigarettes as being more pleasant compared to 45 + years olds, (p = 0.012). Eighty-four percent of participants reported the sensation of the vapor as important in quitting CTCs, and 91% believed the sensations accompanying e-cigarette use contributed to their smoking cessation success.

CONCLUSIONS

For those who failed to quit previously using approved cessation medications to stop smoking cigarettes, sensory experiences associated with e-cigarette use may help smokers quit smoking.

A qualitative study of the views about smoking, licensed cessation aids and e-cigarettes in people with schizophrenia spectrum disorders

Smoking prevalence remains high among people with a mental health condition compared to those without. Understanding people's motivation to quit and their views of smoking cessation support may help to develop future interventions. We conducted a qualitative study to explore the perceptions of 30 people with schizophrenia spectrum disorders who were current smokers, about smoking traditional cigarettes, the appeal of licensed medicines and e-cigarettes for smoking cessation or smoking reduction. The experiences of participants who were motivated to quit were compared with those who were not motivated to quit. Findings suggest traditional cigarettes were pleasurable and licensed cessation aids and e-cigarettes unappealing to participants who were unmotivated to quit. Whereas nicotine replacement products and e-cigarettes may be an appealing smoking cessation or reduction strategy for those motivated to quit. There is a need to find ways of making traditional cigarettes less appealing and alternative less harmful nicotine products (licensed and unlicensed) more appealing and accessible to this group of high risk smokers.

Trends and Associations of Menthol Cigarette Smoking Among US Middle and High School Students-National Youth Tobacco Survey, 2011-2018

INTRODUCTION

Youth cigarette smoking decreased significantly over the last two decades in the United States. This study provides estimates and trends from 2011 to 2018 and factors associated with youth menthol and non-menthol smoking from 2016 to 2018.

METHODS

Using data from the 2011-2018 National Youth Tobacco Surveys, past 30-day (current) menthol and non-menthol cigarette smoking were estimated for all youth (prevalence) and youth smokers (proportions). Trends were examined using Joinpoint regression, calculating the annual percent change (APC). Multivariate logistic regression analyses identified factors associated with menthol smoking.

RESULTS

From 2011 to 2018, menthol cigarette smoking among current youth cigarette smokers significantly decreased from 57.3% to 45.7% (APC: -3.0%), while non-menthol (38.2% to 47.3% [APC: 2.9%]) and unknown menthol status (not sure\missing) (4.5% to 7.0% [APC: 7.1%]) significantly increased. Menthol cigarette smoking among high school, male, female, and non-Hispanic white current cigarette smokers decreased, but remained unchanged among middle school, non-Hispanic black, and Hispanic smokers. Significantly higher proportions of menthol cigarette smokers smoked on ≥20 days, ≥2 cigarettes per day, and ≥100 cigarettes in their lifetime compared to non-menthol smokers. Among current cigarette smokers, non-Hispanic blacks, Hispanics, flavored non-cigarette tobacco users, frequent smokers (≥20 days), those smoking 2-5 cigarettes per day, and those living with someone who uses tobacco had higher odds of menthol cigarette smoking.

CONCLUSIONS

In 2018, nearly half of current youth cigarette smokers smoked menthol cigarettes. While menthol cigarette smoking declined from 2011 to 2018 among all youth and among youth smokers, there was no change in menthol cigarette smoking among non-Hispanic black, Hispanic, and middle school cigarette smokers.

IMPLICATIONS

This study finds that overall cigarette and menthol cigarette smoking declined in youth from 2011 to 2018. However, menthol cigarette smoking among non-Hispanic black, Hispanic, and middle school youth cigarette smokers did not change. Information from this study can help inform efforts to reduce menthol cigarette smoking among US youth, particularly racial/ethnic minority populations.

Tobacco smoking, related harm and motivation to quit smoking in people with schizophrenia spectrum disorders

This narrative review focuses on the topic of tobacco smoking amongst people with schizophrenia spectrum disorders. We searched PubMed, PsycInfo and Scopus databases for schizophrenia spectrum disorders and smoking and included articles about the epidemiology of tobacco smoking in people with schizophrenia spectrum disorders, examining the relationship between smoking and mental health. This narrative review describes that a higher prevalence, frequency and impact of both high nicotine dependence and its harmful effects in patients with schizophrenia spectrum disorders compared with those in the general population. Despite several existent theories, the reasons for high smoking rates, the high dependence on nicotine and severity of nicotine withdrawal symptoms are not fully understood. The main aim of this paper is to inform mental health personnel and particularly clinical and health psychologists about the impact and role of tobacco smoking for smokers with schizophrenia spectrum disorders.

Menthol cigarette smoking is associated with greater subjective reward, satisfaction, and "throat hit", but not greater behavioral economic demand

AIMS

The cooling and minty flavor of menthol in cigarettes has been hypothesized to mask the harshness of inhaled cigarette smoke, contributing to menthol's appeal and subjective reinforcement and linking menthol use to smoking initiation, progression, nicotine dependence, and difficulty quitting. This study examined differences between menthol and non-menthol smokers on behavioral economic indices of reinforcing efficacy (i.e., demand) and subjective response to smoking (i.e., satisfaction, reward, "throat hit," aversion) and the association between measurements of reinforcement and subjective response.

DESIGN

600 current adult smokers were recruited from an online smoking cessation program. Following website enrollment, individuals completed a self-report measurement of subjective response to smoking (reward, satisfaction, aversion, "throat hit"), and a modified cigarette purchase task (CPT) to assess behavioral economic cigarette demand.

FINDINGS

In bivariate and adjusted ANOVA models, menthol smokers reported greater subjective reward, satisfaction, and positive sensations in the throat ("throat hit") from smoking compared to non-menthol smokers; and those outcomes were also correlated with greater nicotine dependence and lower likelihood of a past-year quit attempt. Although cigarette demand was associated with smoking level, subjective smoking reward, and nicotine dependence, there were no differences in smoking demand between menthol vs. non-menthol smokers.

CONCLUSIONS

The pleasurable aspects of menthol vs non-menthol smoking may be a mechanism linking it to greater nicotine dependence and difficulty quitting. A menthol ban could decrease population-level cigarette consumption by restricting smokers' access to a highly rewarding cigarette flavoring.

Knowledge and Awareness of Added Sugar in Cigarettes

INTRODUCTION

Sugars naturally occur in tobacco leaf but are also commonly added to cigarettes by tobacco companies. Added sugar increases levels of toxic chemicals in cigarette smoke. Little is known about smokers' knowledge of added sugar in cigarettes and awareness of its effects.

METHODS

Adult cigarette smokers were recruited through Amazon Mechanical Turk to participate in an online experiment on electronic cigarette advertising. After completing the experiment, participants (N = 4351) answered two items assessing knowledge and awareness of added sugar in cigarettes. Participants had the option of providing open-ended comments about the overall study, and two reviewers read and independently coded comments pertaining to the sugar items.

RESULTS

Only 5.5% of participants responded "yes" to the question: "Is sugar added to cigarettes?", and only 3.8% of participants indicated being aware that added sugar increases toxins in cigarette smoke. Forty-eight participants mentioned the sugar items when asked to comment about the overall questionnaire. Fifty-two percent of these comments expressed an interest in obtaining more information about added sugar, and 23% described the sugar items as interesting or informative. Three participants commented that learning about added sugar motivated them to quit or cut down on smoking.

CONCLUSIONS

Among a large sample of smokers, few reported knowledge of added sugar in cigarettes and awareness of its effects. Further, several smokers expressed an interest in learning more about added sugar. Messages about added sugar in cigarettes may be a promising new angle for campaigns to discourage smoking.

IMPLICATIONS

Few American smokers are aware that sugar is added to cigarettes, and some participants expressed a desire to learn more about this additive. Given such low awareness, the interest among smokers, and increased popular concerns about added sugar in foods and beverages, messaging about added sugar in cigarettes should be developed and tested for inclusion in public health media campaigns.

Early Subjective Sensory Experiences with "Cigalike" E-cigarettes Among African American Menthol Smokers: A Qualitative Study

Introduction

Despite smoker interest in e-cigarettes as a harm reduction or cessation aid, many smokers prematurely discontinue vaping after trying a product. This study explored the role of early subjective sensory experiences in vaping persistence and desistance.

Methods

African American menthol cigarette smokers aged ≥18 years (N = 15; M = 54.1 years; SD = 8.2), motivated to quit smoking, and interested in trying e-cigarettes were recruited in Washington, DC. Participants were followed for 3 weeks and provided menthol cigalike e-cigarettes after Week 1. Participants completed three interviews about their vaping experiences. Thematic analysis of responses was designed to understand the sensory aspects of vaping.

Results

During the first 2 weeks of vaping, four participants reported a positive vaping experience while 11 reported decreased satisfaction. Salient sensory attributes of dissatisfaction included poor taste, insufficient throat hit, difficulty pulling, and a lack of "whole body" satisfaction compared to their preferred cigarette brand.

Conclusions

The sensory experiences with a specific cigalike e-cigarette were related to vaping persistence and desistence. Although this was a small volunteer sample of African American menthol smokers motivated to quit smoking, 27% (N = 4) of participants with a positive vaping experience continued using the product, while 73% (N = 11) of participants' vaping experience was unsatisfactory across several experiential categories. In future research of e-cigarettes' efficacy as a smoking cessation or reduction aid, both device characteristics and smokers' expectations for these devices should be considered, so vapers do not expect the same taste sensations, throat sensations, and "whole body" satisfaction as they experienced with their menthol cigarettes.

Implications

The subjective sensory experiences associated with initial e-cigarette product use are associated with use patterns. Subjective sensory experiences may also help understand the differences in the appeal, satisfaction, and harm-reduction potential of the rapidly evolving diverse types of products emerging in the marketplace. How products meet the sensory needs of smokers wanting to switch or quit smoking may influence adherence and success rates.

A Review of the Use and Appeal of Flavored Electronic Cigarettes

PURPOSE OF REVIEW

E-cigarettes are available in a variety of flavors not found in traditional tobacco products (i.e., "nontraditional flavors"), which is a commonly-cited reason for e-cigarette use. This review examines the prevalence of nontraditional-flavored e-cigarette use, mechanisms through which flavorings enhance product appeal, use of nontraditional-flavored e-cigarettes for smoking cessation, and differences in these findings between youth and adults.

RECENT FINDINGS

Nontraditional-flavored e-cigarettes are used at e-cigarette initiation by the majority of youth. These flavors enhance the appeal of e-cigarettes by creating sensory perceptions of sweetness and coolness and masking the aversive taste of nicotine. Use of nontraditional-flavored e-cigarettes is higher among youth and young adults (vs. older adults) and among nonsmokers (vs. combustible cigarette smokers).

SUMMARY

Nontraditional-flavored e-cigarettes are popular among youth, but may be less common among older adults and combustible cigarette smokers. Further research is needed to determine whether use of e-cigarettes in nontraditional flavors affects smoking cessation.

Exposure to and Content of Marijuana Product Reviews

Many individuals now seek out product reviews in order to make an informed decision prior to making a purchase. In this study, we investigate consumers' exposure to and content within product reviews about marijuana because of their potential to shape marijuana purchasing decisions. The terms "weed review," "marijuana review," and "cannabis review" were searched on YouTube on June 10-11, 2015; the team viewed and coded the content of 83 product review videos about marijuana. In addition, we surveyed young adult (18-34 years old) current (past month) marijuana users (n = 742) from across the USA online to assess exposure to product reviews about marijuana and associations with socio-demographic characteristics and marijuana use behaviors. In our content analysis of videos, we observed that the reviewers tended to consume marijuana during the video and often shared personal, favorable experiences towards the marijuana they ingested (e.g., became as high as possible or experienced positive effects on physical and mental health). Most videos normalized marijuana use and could be easily accessed by underage youth. About one third (34%) of the survey participants viewed/sought a product review about marijuana in the past 30 days. In a multivariable logistic regression model, living in a state where recreational use is legal or using multiple forms of marijuana was associated with increased odds of viewing/seeking marijuana reviews. Prevention messages should counter product reviews about marijuana that tend to normalize and promote marijuana use given that they are more readily viewed by individuals who are increasingly susceptible to marijuana's potential harms.

Menthol Smoking Patterns and Smoking Perceptions Among Youth: Findings From the Population Assessment of Tobacco and Health Study

INTRODUCTION

Youth may be attracted to menthol cigarettes because they are perceived as less harmful and harsh to smoke relative to non-menthol cigarettes. This study examined demographic factors and menthol cigarette smoking patterns as correlates of youth harm perceptions of cigarette smoking and ease of smoking menthol versus non-menthol cigarettes.

METHODS

Data were from the Wave 1 (2013-2014) youth sample of the Population Assessment of Tobacco and Health Study. Weighted multivariable logistic regression models were used to examine correlations between demographic factors and menthol cigarette smoking patterns (menthol initiation, past 30-day menthol cigarette smoking, and menthol cigarette brand preference), with harm perceptions of cigarette smoking and ease of smoking a menthol cigarette.

RESULTS

Nearly half of ever cigarette smoking youth (43%) first used a menthol cigarette; 21% reported past 30-day menthol cigarette smoking; and 42% of past 30-day smokers providing brand information used a menthol cigarette as their preferred brand. In bivariate analyses, initiation with a menthol cigarette and menthol brand preference (versus non-menthol) were correlated with black race, older age at initiation, and past 30-day menthol cigarette smoking. In adjusted models, past 30-day menthol cigarette smoking and menthol cigarette brand preference, but not menthol initiation, were correlated with the perception that menthol cigarettes are easier to smoke.

CONCLUSIONS

Youth who smoke menthol cigarettes perceive them as easier to smoke, even after adjusting for other factors. Age of initiation and black race emerged as correlates of menthol cigarette initiation, brand preference, and cigarette harm perceptions, and may inform future prevention campaigns.

Toxic exposures and the senses of taste and smell

This review addresses the adverse influences of neurotoxic exposures on the ability to smell and taste. These chemical senses largely determine the flavor of foods and beverages, impact food intake, and ultimately nutrition, and provide a warning for spoiled or poisonous food, leaking natural gas, smoke, airborne pollutants, and other hazards. Hence, toxicants that damage these senses have a significant impact on everyday function. As noted in detail, a large number of toxicants encountered in urban and industrial air pollution, including smoke, solvents, metals, and particulate matter can alter the ability to smell. Their influence on taste, i.e., sweet, sour, bitter, salty, and savory (umami) sensations, is not well documented. Given the rather direct exposure of olfactory receptors to the outside environment, olfaction is particularly vulnerable to damage from toxicants. Some toxicants, such as nanoparticles, have the potential to damage not only the olfactory receptor cells, but also the central nervous system structures by their entrance into the brain through the olfactory mucosa.

Knowledge of Alternative Tobacco Products in Unaccompanied Homeless Youth

Objectives

This study examined perceptions of factors that influence use and non-use of Alternative Tobacco Products (ATPs) among unaccompanied youth experiencing homelessness.

Methods

Focus groups were conducted with 30 homeless 18-24 year olds (80% men, 50% Hispanic, 30% Black, 17% White, 20% multi-racial/other) recruited from drop-in centers in Los Angeles. Discussion focused on several ATPs (hookah, electronic cigarettes/vaping devices, cigarillos/little cigars, smokeless tobacco, snus, natural cigarettes, clove cigarettes), soliciting participants' experiences using each ATP and motivations for using or not using each ATP.

Results

Focus group transcripts were subjected to a rigorous coding procedure and 8 themes relating to the reasons that participants may or may not use ATPs emerged. Each ATP was associated with distinctive characteristics that motivated use and non-use. For example, hookah use was viewed positively with positive sensory and social features dominating the discussion, whereas electronic cigarettes were viewed largely negatively (i.e., that they were expensive and harmful to health). Homelessness characterized participants' responses to the extent that cost was a factor in their choice of ATP.

Conclusions

These data provide important, first look insights into factors that may influence the use and non-use of ATPs among unaccompanied youth experiencing homelessness.

The effects of oral smokeless tobacco administration on endurance performance

BACKGROUND

Smokeless tobacco is widely used by athletes to enhance performance. Nicotine is a central nervous system stimulant and acts on cardiocirculatory and metabolic systems, involving tissue blood flow and circulatory vasoreactivity. The aim of this study was to investigate the effects of the oral smokeless tobacco (Swedish snus (SS)) on the perception of fatigue and time to exhaustion (TTE) during moderate-intensity aerobic exercise.

METHODS

Fourteen healthy non-tobacco male users were recruited for a double-blind, controlled crossover design (SS vs. snus placebo (SP)). Subjects were tested for 3 sessions: experimental session 1 (Exp1) consisted of an incremental test to determine the maximal aerobic power output (W_max), whereas Exp2 and Exp3 consisted of exercising at 65%W_max until exhaustion in SS or SP conditions. During Exp2 and Exp3, muscle and cerebral oxygenation was assessed by means of near-infrared spectroscopy, and the rating of perceived exertion (RPE) was recorded.

RESULTS

Comparing SS with SP tests, significant differences (p < 0.05) were found in the values of cerebral (~3%) and muscular tissues oxygenation (~4%) in the first 30 min of exercise. The RPE values were not significantly different between the 2 conditions (SS vs. SP). No significant difference was found in TTE (SS: 54.25 ± 21.84 min; SP: 50.01 ± 17.03 min).

CONCLUSION

This study showed that muscular and cerebral oxygenation increased significantly with snus administration during an endurance exercise until exhaustion, but this did not affect fatigue perception and TTE. The results showed that snus could not be considered an ergogenic substance in non-tobacco users.

Differences in Subjective Experiences to First Use of Menthol and Nonmenthol Cigarettes in a National Sample of Young Adult Cigarette Smokers

Purpose

Menthol has been hypothesized to ease the harshness of cigarette smoke. Thus, sensory experiences at first cigarette use may be one mechanism by which menthol facilitates progression to regular smoking. This study examined differences in subjective experiences to the first use of a menthol versus nonmenthol cigarette among new young adult smokers.

Methods

Data were drawn from waves 5-8 of the Truth Initiative Young Adult Cohort Study, a national sample of 18-34 year olds assessed every 6 months. Analyses included a subset of young adult current smokers (n = 251) who initiated smoking in the past 6 months. Subjective responses to first cigarette use were assessed across menthol and nonmenthol initiators in bivariate analyses and adjusted models controlling for smoking correlates.

Results

Fifty-two percent of new young adult smokers used a menthol cigarette at first use. First use of a menthol cigarette was higher in those aged 18-24 (vs. 25-34). Most black smokers (93.1%) were menthol initiators compared to 43.9% of white smokers. More than half of menthol and nonmenthol initiates felt relaxed or calm, dizzy, lightheaded, liking the taste and a rush or buzz at first use. Menthol initiators were less likely in bivariate and multivariable analyses to experience feeling nauseated at first use (adjusted odds ratio = 0.45; p = .020) compared to nonmenthol initiators.

Conclusions

While few differences were found between menthol and nonmenthol initiators in their subjective experiences, fewer menthol initiates felt nauseated at first cigarette use. Future research needs to identify additional mechanisms linking menthol initiation to smoking progression.

Implications

Menthol initiators were more likely to be younger (18-24 vs. 25-34), and black (vs. white) compared to nonmenthol initiators. Our finding that menthol initiators were less likely to feel nauseated at first cigarette use compared to nonmenthol initiators suggests that menthol may reduce aversion to early cigarette use among young smokers and thus has the potential to facilitate continued experimentation. Interventions and policy approaches to reduce tobacco use initiation and progression are urgently needed in young people.

Acute perceptions of preferred cigarettes when blinded to brand

Background

Marketing claims often have promoted specific perceptions that users should expect from acutely smoking that cigarette brand. Yet, little controlled study has determined the degree to which actual perceptions are based on the cigarette’s tobacco constituents in the absence of knowledge about the brand’s identity.

Methods

194 adult dependent smokers rated their perceptions on ‘liking’, ‘satisfying’, ‘strong’ and perceived amount of ‘nicotine’ after smoking ad lib one of their preferred brands of cigarettes. All did so either when blinded (n=118) or unblinded (n=76) to the brand they were given, with the blinding conditions from separate studies. These between-groups secondary analyses determined differences in perceptions based on blinding to brand, controlling for age and cigarettes/day.

Results

All perceptions were lower for those smoking own brand under blinded versus unblinded conditions, as hypothesised. Consistent with lowered perceptions for smoking one’s own brand obtained from the 118 blinded to brand, their ‘somewhat’ ratings for a ‘how similar to own brand’ item indicated uncertainty, just mid-way between ‘not at all’ and ‘very much’ on the 0–100 visual analogue scale. (The 76 unblinded were already informed it was their own brand.)

Conclusions

Acute perceptions of one’s own cigarette are substantially lower when smokers are simply unaware of brand, relative to those aware it is their preferred brand. Results support the notion that perceptions of smoking own brand are enhanced by marketing efforts to associate brands with expectations of pleasurable subjective effects, beyond the impact due solely to the cigarette’s manufactured product constituents.

The effect of cigarillo packaging elements on young adult perceptions of product flavor, taste, smell, and appeal

Introduction

Product packaging has long been used by the tobacco industry to target consumers and manipulate product perceptions. This study examines the extent to which cigarillo packaging influences perceptions of product flavor, taste, smell, and appeal.

Methods

A web-based experiment was conducted among young adults. Participants viewed three randomly selected cigarillo packs, varying on pack flavor descriptor, color, type, branding, and warning—totaling 180 pack images. Mixed-effects models were used to estimate the effect of pack elements on product perceptions.

Results

A total of 2,664 current, ever, and never little cigar and cigarillo users participated. Cigarillo packs with a flavor descriptor were perceived as having a more favorable taste (β = 0.21, p < .001) and smell (β = 0.14, p < .001) compared to packs with no flavor descriptor. Compared to packs with no color, pink and purple packs were more likely to be perceived as containing a flavor (β = 0.11, p < .001), and were rated more favorably on taste (β = 0.17, p < .001), smell (β = 0.15, p < .001), and appeal (β = 0.16, p < .001). While warnings on packs decreased favorable perceptions of product taste (pictorial: β = -0.07, p = .03) and smell (text-only: β = -0.08, p = .01; pictorial: β = -0.09, p = .007), warnings did not moderate the effects of flavor descriptor or color.

Conclusions

To our knowledge, this study provides the first quantitative evidence that cigarillo packaging alters consumers’ cognitive responses, and warnings on packs do not suffice to overcome the effects of product packaging. The findings support efforts at federal, state, and local levels to prohibit flavor descriptors and their associated product flavoring in non-cigarette products such as cigarillos, along with new data that supports restrictions on flavor cues and colors.

A systematic review of smoker and non-smoker perceptions of visually unappealing cigarette sticks

INTRODUCTION

Cigarette stick appearance can significantly contribute to perceptions of cigarette taste, harm, and appeal, and may be modified to reduce positive perceptions of cigarettes and other tobacco products. A systematic review was conducted to investigate how smokers and non-smokers identify cigarettes as being attractive or unattractive, and the resulting perceptions of cigarette appeal, perceived harm, and impact on quit intentions.

METHODS

Eligible articles were identified using database searches conducted with a date range of January 1990 to May 2017 in PubMed, CINAHL, PsycINFO, Google Scholar and Web of Science. Articles were included if they evaluated participant (any smoking status) perceptions of visual cigarette stick attributes. We identified studies describing visual attributes of cigarette sticks and the resulting perceptions of participants. Changes or differences in quitting intentions, cigarette appeal, perceptions of taste, and cigarette harm, and the likelihood of smoking uptake were recorded. Data were grouped into two main categories: those of physical cigarette design, and those including health messages on cigarette sticks.

RESULTS

Of the 950 identified non-duplicated records, 9 matched the eligibility criteria. These studies were all conducted in developed countries, and largely enrolled adolescent and young adult smokers and non-smokers. Slim, lighter coloured and branded cigarettes were favoured over longer, broader, or darker coloured cigarettes, and those without any branding or embellishments. Health warnings including ‘Minutes of life lost’, ‘Smoking kills’, and the names of carcinogenic constituents in cigarettes, reduced cigarette attractiveness and increased participant quit intentions.

CONCLUSIONS

Cigarette appeal and resulting smoking behaviours can be influenced by several visual attributes of individual cigarettes. Unappealing visual attributes of cigarette sticks, including modifications to the size and colour of cigarettes, and the inclusion of health warnings on cigarette sticks may serve as an effective tobacco control method, potentially leading to a reduction in tobacco use.

Cigarette Design Features: Effects on Emission Levels, User Perception, and Behavior

Objectives

This paper describes the effects of non-tobacco, physical cigarette design features on smoke emissions, product appeal, and smoking behaviors - 3 factors that determine smoker's exposure and related health risks.

Methods

We reviewed available evidence for the impact of filter ventilation, new filter types, and cigarettes dimensions on toxic emissions, smoker's perceptions, and behavior. For evidence sources we used scientific literature and websites providing product characteristics and marketing information.

Results

Whereas filter ventilation results in lower machine-generated emissions, it also leads to perceptions of lighter taste and relative safety in smokers who can unwittingly employ more intense smoking behavior to obtain the desired amount of nicotine and sensory appeal. Filter additives that modify smoke emissions can also modify sensory cues, resulting in changes in smoking behavior. Flavor capsules increase the cigarette's appeal and novelty, and lead to misperceptions of reduced harm. Slim cigarettes have lower yields of some smoke emissions, but smoking behavior can be more intense than with standard cigarettes.

Conclusions

Physical design features significantly impact machine-measured emission yields in cigarette smoke, product appeal, smoking behaviors, and exposures in smokers. The influence of current and emerging design features is important in understanding the effectiveness of regulatory actions to reduce smoking-related harm.

Nicotine Acutely Enhances Reinforcement from Non-Drug Rewards in Humans

Preclinical research documents that, aside from the primary and secondary reinforcing effects of nicotine intake itself, nicotine also acutely enhances the reinforcing efficacy of non-drug reinforcers ("rewards"). Study of these effects in humans has largely been overlooked, but very recent findings suggest they may have clinical implications for more fully understanding the persistence of tobacco dependence. This overview first outlines the topic and notes some recent human studies indirectly addressing nicotine effects on related responses (e.g., subjective ratings), explaining why those findings do not directly confirm enhancement of behavioral reinforcement per se due to nicotine. Then, the methodology used in the subsequently presented studies is described, demonstrating how those studies specifically did demonstrate enhancement of reinforced responding for non-drug rewards. The main section focuses on the limited controlled research to date directly assessing nicotine's acute reinforcement-enhancing effects in humans, particularly as it relates to reinforced behavioral responding for non-drug rewards in non-human animal models. After detailing those few existing human studies, we address potential consequences of these effects for dependence and tobacco cessation efforts and then suggest directions for future research. This research indicates that nicotine per se increases responding in humans that is reinforced by some rewards (auditory stimuli via music, visual stimuli via video), but perhaps not by others (e.g., money). These reinforcement-enhancing effects in smokers are not due to dependence or withdrawal relief and can be restored by a small amount of nicotine (similar to a smoking lapse), including from e-cigarettes, a non-tobacco nicotine product. Future clinical research should examine factors determining which types of rewards are (or are not) enhanced by nicotine, consequences of the loss of these nicotine effects after quitting smoking, potential individual differences in these effects, and the possibility that nicotine via nicotine replacement therapy and non-nicotine quit medications may attenuate loss of these effects upon quitting. Further study with humans of nicotine's reinforcement-enhancing effects may provide a more complete understanding of smoking persistence and added mechanisms of cessation medication efficacy.

Perceptions of Menthol Cigarettes Among Twitter Users: Content and Sentiment Analysis

Background

Menthol cigarettes are used disproportionately by African American, female, and adolescent smokers. Twitter is also used disproportionately by minority and younger populations, providing a unique window into conversations reflecting social norms, behavioral intentions, and sentiment toward menthol cigarettes.

Objective

Our purpose was to identify the content and frequency of conversations about menthol cigarettes, including themes, populations, user smoking status, other tobacco or substances, tweet characteristics, and sentiment. We also examined differences in menthol cigarette sentiment by prevalent categories, which allowed us to assess potential perceptions, misperceptions, and social norms about menthol cigarettes on Twitter. This approach can inform communication about these products, particularly to subgroups who are at risk for menthol cigarette use.

Methods

Through a combination of human and machine classification, we identified 94,627 menthol cigarette-relevant tweets from February 1, 2012 to January 31, 2013 (1 year) from over 47 million tobacco-related messages gathered prospectively from the Twitter Firehose of all public tweets and metadata. Then, 4 human coders evaluated a random sample of 7000 tweets for categories, including sentiment toward menthol cigarettes.

Results

We found that 47.98% (3194/6657) of tweets expressed positive sentiment, while 40.26% (2680/6657) were negative toward menthol cigarettes. The majority of tweets by likely smokers (2653/4038, 65.70%) expressed positive sentiment, while 91.2% (320/351) of nonsmokers and 71.7% (91/127) of former smokers indicated negative views. Positive views toward menthol cigarettes were predominant in tweets that discussed addiction or craving, marijuana, smoking, taste or sensation, song lyrics, and tobacco industry or marketing or tweets that were commercial in nature. Negative views toward menthol were more common in tweets about smoking cessation, health, African Americans, women, and children and adolescents—largely due to expression of negative stereotypes associated with these groups’ use of menthol cigarettes.

Conclusions

Examinations of public opinions toward menthol cigarettes through social media can help to inform the framing of public communication about menthol cigarettes, particularly in light of potential regulation by the European Union, US Food and Drug Administration, other jurisdictions, and localities.

Role of sweet and other flavours in liking and disliking of electronic cigarettes

OBJECTIVE

To examine the extent to which the perception of sweet and other flavours is associated with liking and disliking of flavoured electronic cigarettes (e-cigarettes).

METHODS

31 participants (13 females/18 males; 12 sole/19 dual users) vaped 6 commercially available flavours of blu Tanks: Classic Tobacco (CT), Magnificent Menthol (MM), Cherry Crush (CC), Vivid Vanilla (VV), Piña Colada (PC) and Peach Schnapps (PS); all 'medium' strength, 12 mg/mL nicotine concentration. For each flavoured e-cigarette, participants first rated liking/disliking on the Labeled Hedonic Scale, followed by perceived intensities of sweetness, coolness, bitterness, harshness and specific flavour on the generalised version of the Labeled Magnitude Scale. The psychophysical testing was conducted individually in an environmental chamber.

RESULTS

PC was perceived as sweetest and liked the most; CT was perceived as least sweet and liked the least. Across all flavours, liking was correlated with sweetness (r=0.31), coolness (r=0.25), bitterness (r=-0.25) and harshness (r=-0.29, all p<0.001). Specifically, liking was positively correlated with sweetness of PS (r=0.56, p=0.001) and PC (r=0.36, p=0.048); and with coolness of MM, CT and VV (r=0.41-0.52, p<0.05). In contrast, harshness was negatively correlated with liking for CC, PC and PS (r=0.37-0.40, p<0.05). In a multivariate model, sweetness had the greatest positive impact on liking followed by coolness; harshness had the greatest negative impact on liking.

CONCLUSIONS

Our findings indicate that bitterness and harshness, most likely from nicotine, have negative impacts on the liking of e-cigarettes, but the addition of flavourants that elicit sweetness or coolness generally improves liking. The results suggest that flavours play an important role in e-cigarette preference and most likely use.

A study of pyrazines in cigarettes and how additives might be used to enhance tobacco addiction

BACKGROUND

Nicotine is known as the drug that is responsible for the addicted behaviour of tobacco users, but it has poor reinforcing effects when administered alone. Tobacco product design features enhance abuse liability by (A) optimising the dynamic delivery of nicotine to central nervous system receptors, and affecting smokers' withdrawal symptoms, mood and behaviour; and (B) effecting conditioned learning, through sensory cues, including aroma, touch and visual stimulation, to create perceptions of pending nicotine reward. This study examines the use of additives called 'pyrazines', which may enhance abuse potential, their introduction in 'lights' and subsequently in the highly market successful Marlboro Lights (Gold) cigarettes and eventually many major brands.

METHODS

We conducted internal tobacco industry research using online databases in conjunction with published scientific literature research, based on an iterative feedback process.

RESULTS

Tobacco manufacturers developed the use of a range of compounds, including pyrazines, in order to enhance 'light' cigarette products' acceptance and sales. Pyrazines with chemosensory and pharmacological effects were incorporated in the first 'full-flavour, low-tar' product achieving high market success. Such additives may enhance dependence by helping to optimise nicotine delivery and dosing and through cueing and learned behaviour.

CONCLUSIONS

Cigarette additives and ingredients with chemosensory effects that promote addiction by acting synergistically with nicotine, increasing product appeal, easing smoking initiation, discouraging cessation or promoting relapse should be regulated by the US Food and Drug Administration. Current models of tobacco abuse liability could be revised to include more explicit roles with regard to non-nicotine constituents that enhance abuse potential.

An inventory of methods suitable to assess additive-induced characterising flavours of tobacco products

BACKGROUND

Products with strong non-tobacco flavours are popular among young people, and facilitate smoking initiation. Similar to the U.S. Food and Drug Administration Tobacco Control Act, the new European Tobacco Product Directive (TPD) prohibits cigarettes and roll-your-own tobacco with a characterising flavour other than tobacco. However, no methods are prescribed or operational to assess characterising flavours. This is the first study to identify, review and synthesize the existing peer-reviewed and tobacco industry literature in order to provide an inventory of methods suitable to assess characterising flavours.

METHODS

Authors gathered key empirical and theoretical papers examining methods suitable to assess characterising flavours. Scientific literature databases (PubMed and Scopus) and tobacco industry documents were searched, based on several keyword combinations. Inclusion criteria were relevance for smoked tobacco products, and quality of data.

RESULTS

The findings reveal that there is a wide variation in natural tobacco flavours. Flavour differences from natural tobacco can be described by both expert and consumer sensory panels. Most methods are based on smoking tests, but odour evaluation has also been reported. Chemical analysis can be used to identify and quantify levels of specific flavour additives in tobacco products.

CONCLUSIONS

As flavour perception is subjective, and requires human assessment, sensory analysis in consumer or expert panel studies is necessitated. We recommend developing validated tests for descriptive sensory analysis in combination with chemical-analytical measurements. Testing a broad range of brands, including those with quite subtle characterizing flavours, will provide the concentration above which an additive will impart a characterising flavour.

Intraindividual covariation between e-cigarette and combustible cigarette use in Korean American emerging adults

Critical gaps exist in understanding the patterns and correlates of dual use of electronic cigarettes (ECs) and combustible cigarettes (CCs), particularly in ethnic minority populations. In this study, we assessed CC and EC use in the naturalistic environment using ecological momentary assessment (EMA). We hypothesized that within-subject variation in EC use (yes/no each day) would be inversely associated with within-subject variation in number of CCs consumed and craving during that same day. We also examined gender and nicotine dependence as moderators of the EC-CC and EC-craving covariations. Korean American emerging adult (KAEA; 18-25 years old) smokers (N = 78) completed 7 days of EMA. Participants completed EMA surveys throughout the day, which assessed CC craving, and end-of-day surveys, which assessed EC use and the number of CCs smoked that day. Generalized linear mixed models were used to predict day-level EC use, with number of CCs smoked and craving during that same day, gender, and nicotine dependence as predictors (n = 501). We found that within-subject variation in CC use was not associated with same-day EC use; neither was within-subject variation in craving (ps > .27). Gender moderated the relationship between craving and EC use on a given day (p = .03); only for females, on the days with higher craving, the likelihood of their EC use that day was significantly heightened. This study does not suggest that EC use is linked with lower CC smoking quantity, at least at the day level and among KAEA smokers. CC craving may play a role in dual EC-CC use for KAEA female smokers.

The importance of the belief that "light" cigarettes are smoother in misperceptions of the harmfulness of "light" cigarettes in the Republic of Korea: a nationally representative cohort study

BACKGROUND

A number of countries have banned misleading cigarette descriptors such as "light" and "low-tar" as called for by the WHO Framework Convention on Tobacco Control. These laws, however, do not address the underlying cigarette design elements that contribute to misperceptions about harm. This is the first study to examine beliefs about "light" cigarettes among Korean smokers, and the first to identify factors related to cigarette design that are associated with the belief that "light" cigarettes are less harmful.

METHODS

We analysed data from Wave 3 of the ITC Korea Survey, a telephone survey of a nationally representative sample of 1,753 adult smokers, conducted October - December 2010. A multinomial logistic regression was used to examine which factors were associated with the belief that "light" cigarettes are less harmful than regular cigarettes.

RESULTS

One quarter (25.0 %) of smokers believed that "light" cigarettes are less harmful than regular cigarettes, 25.8 % believed that smokers of "light" brands take in less tar, and 15.5 % held both of these beliefs. By far the strongest predictor of the erroneous belief that "light" cigarettes are less harmful was the belief that "light" cigarettes are smoother on the throat and chest (p < 0.001, OR = 44.8, 95 % CI 23.6-84.9).

CONCLUSIONS

The strong association between the belief that "light" cigarettes are smoother on the throat and chest and the belief that "light" cigarettes are less harmful, which is consistent with previous research, provides further evidence of the need to not only ban "light" descriptors, but also prohibit cigarette design and packaging features that contribute to the perception of smoothness.

Electronic cigarettes for smoking cessation

Electronic cigarettes (e-cigarettes) are novel vaporising devices that, similar to nicotine replacement treatments, deliver nicotine but in lower amounts and less swiftly than tobacco smoking. However, they enjoy far greater popularity than these medications due in part to their behaviour replacement characteristics. Evidence for their efficacy as cessation aids, based on several randomised trials of now obsolete e-cigarettes, suggests a modest effect equivalent to nicotine patch. E-cigarettes are almost certainly far less harmful than tobacco smoking, but the health effects of long-term use are as yet unknown. Dual use is common and almost as harmful as usual smoking unless it leads to quitting. Population effects, such as re-normalising smoking behaviour, are a concern. Clinicians should be knowledgeable about these products. If patients who smoke are unwilling to quit or cannot succeed using evidence-based approaches, e-cigarettes may be an option to be considered after discussing the limitations of current knowledge.

Sex differences in acute relief of abstinence-induced withdrawal and negative affect due to nicotine content in cigarettes

INTRODUCTION

Acute cigarette smoking may relieve withdrawal and negative affect due to tobacco abstinence to a greater extent in women versus men. Yet, the relative contribution of the cigarette's nicotine content to this sex difference is not clear.

METHODS

Non-quitting dependent adult smokers (N = 44; 21 males, 23 females) participated in 2 virtually identical sessions, each after abstaining overnight (CO < 10 ppm) and differing only in the nicotine content of the designated cigarette. While blind to brand markings, they consumed a total of 24 puffs in controlled fashion for 2 hr in each session, either from a nicotine (Quest 1, 0.6 mg) or denicotinized (Quest 3, 0.05 mg) cigarette. Withdrawal symptoms were obtained before and after smoking, and negative affect was assessed after each period of cigarette exposure consisting of 6 puffs every 25 min.

RESULTS

Men and women did not differ in baseline withdrawal and negative affect due to overnight abstinence, but reductions in each symptom were significantly influenced by the interaction of sex × nicotine/denicotinized cigarette (both p < .05). In men, but not in women, each symptom was generally decreased more by the nicotine versus denicotinized cigarette, and the nicotine cigarette reduced each to a greater degree in men versus women.

CONCLUSIONS

Sex differences in relief of abstinence-induced withdrawal and negative affect due to the nicotine content in cigarettes are consistent with prior research indicating that nicotine per se, compared to non-nicotine smoke stimuli, is less rewarding in women versus men.

Genetic variants and early cigarette smoking and nicotine dependence phenotypes in adolescents

Background

While the heritability of cigarette smoking and nicotine dependence (ND) is well-documented, the contribution of specific genetic variants to specific phenotypes has not been closely examined. The objectives of this study were to test the associations between 321 tagging single-nucleotide polymorphisms (SNPs) that capture common genetic variation in 24 genes, and early smoking and ND phenotypes in novice adolescent smokers, and to assess if genetic predictors differ across these phenotypes.

Methods

In a prospective study of 1294 adolescents aged 12–13 years recruited from ten Montreal-area secondary schools, 544 participants who had smoked at least once during the 7–8 year follow-up provided DNA. 321 single-nucleotide polymorphisms (SNPs) in 24 candidate genes were tested for an association with number of cigarettes smoked in the past 3 months, and with five ND phenotypes (a modified version of the Fagerstrom Tolerance Questionnaire, the ICD-10 and three clusters of ND symptoms representing withdrawal symptoms, use of nicotine for self-medication, and a general ND/craving symptom indicator).

Results

The pattern of SNP-gene associations differed across phenotypes. Sixteen SNPs in seven genes (ANKK1, CHRNA7, DDC, DRD2, COMT, OPRM1, SLC6A3 (also known as DAT1)) were associated with at least one phenotype with a p-value <0.01 using linear mixed models. After permutation and FDR adjustment, none of the associations remained statistically significant, although the p-values for the association between rs557748 in OPRM1 and the ND/craving and self-medication phenotypes were both 0.076.

Conclusions

Because the genetic predictors differ, specific cigarette smoking and ND phenotypes should be distinguished in genetic studies in adolescents. Fifteen of the 16 top-ranked SNPs identified in this study were from loci involved in dopaminergic pathways (ANKK1/DRD2, DDC, COMT, OPRM1, and SLC6A3).

Impact

Dopaminergic pathways may be salient during early smoking and the development of ND.

NIH electronic cigarette workshop: developing a research agenda

BACKGROUND

Electronic cigarettes (e-cigarettes) represent an emerging public health issue. These devices deliver nicotine along with other constituents, including flavorants, via an inhalable aerosol. Their uptake is rapidly increasing in both adults and youths, primarily among current smokers. Public debate is increasing on how these devices should be regulated and used, yet only limited peer-reviewed research exists. To develop a informed policy for e-cigarettes, their effects on human behavior, physiology, and health need to be understood.

PURPOSE

This paper describes proceedings from a National Institutes of Health-sponsored workshop, which was held in November 2013, to identify research needs related to the effects of e-cigarettes. Discussion topics included e-cigarette risks and abuse potential; the potential role for e-cigarettes in harm reduction and smoking cessation; unintended consequences of e-cigarette use, such as becoming a gateway to conventional cigarettes; and dual use of both e-cigarettes and conventional cigarettes.

RESULTS AND CONCLUSIONS

The research needs identified by the workshop participants included the following: standards to measure the contents and emissions of e-cigarettes; biomarkers of exposure; physiological effects of e-cigarettes on tissues and organ systems, including pulmonary and cardiovascular; information on e-cigarette users, how the devices are used, and identification of the best tools to assess these measures; factors that drive use and influence patterns of use; and appropriate methods for evaluating a potential role for e-cigarettes in smoking or nicotine cessation. To understand fully the challenges and the opportunities that e-cigarettes represent, expertise will be needed in basic, behavioral, translational, and clinical sciences.

Initial puffing behaviors and subjective responses differ between an electronic nicotine delivery system and traditional cigarettes

Background

Electronic nicotine delivery systems (ENDS) present an emerging issue for tobacco control and data on product use behaviors are limited.

Methods

Participants (N = 38 enrolled; N = 16 compliant) completed three lab visits over 5 days and were asked to abstain from regular cigarettes for 72 hours in favor of ENDS (Smoke 51 TRIO – 3 piece, First Generation with 11 mg/ml filters). Lab visits included measurement of exhaled carbon monoxide (CO) and salivary cotinine concentration, questionnaire measures of regular cigarette craving after the 72 hour abstinence, and subjective product effects. Participants used a topography device to record puff volume, duration, flow rate, and inter-puff interval.

Results

Analyses revealed significant differences across products in puff count, average volume, total volume and inter-puff interval, with ENDS broadly showing a more intensive smoking pattern. Cigarette craving scores dropped significantly after smoking regular cigarettes, but not ENDS (p = .001), and subjective measures showed ENDS rated less favorably. CO boost, after ENDS use, decreased significantly (p < .001), and saliva cotinine significantly dropped between visits 1 and 3 (p < 0.001) after ENDS use relative to after cigarette smoking. For compliant and non-compliant participants, there was an average 82.0% [V1 - 16.1 cpd; V3 - 2.9 cpd] and average 73.9% [V1 - 20.3 cpd; V3 - 5.3 cpd] reduction in regular cigarette use per day during the ENDS trial period, respectively.

Conclusions

The ENDS were smoked more intensively than own brand cigarettes, but delivered significantly less nicotineand were less satisfying. These findings have implications for the viability of certain ENDS as alternatives to cigarettes.

The association between smokers' perceived importance of the appearance of cigarettes/cigarette packs and smoking sensory experience: a structural equation model

OBJECTIVE

We assessed the reliability of a measure of the latent construct "smoking sensory experience." We further measured the relationship between "smoking sensory experience" and smokers' rating of the importance of the appearance of cigarettes/cigarette packs in brand choice and smoking dependence.

METHODS

Analyses involved a national sample of smokers (n = 633) who participated in the 2010 South African Social Attitudes Survey (N = 3,112). Smokers ranked on a scale of 1-5, the importance of the following attributes in choosing their cigarette brand: health concerns, cost, packaging, taste, satisfaction, and flavor/strength. Using structural equation modeling, an a priori model was specified based on the hypothesis that taste, satisfaction, and flavor/strength are measures of a construct of "smoking sensory experience" and that cigarette packaging would be positively related to "smoking sensory experience." Furthermore, "smoking sensory experience" would be positively related to cigarettes smoked per day.

RESULTS

The latent construct--"smoking sensory experience" was considered reliable (Cronbach's α = 0.75). The structural equation model confirmed that the specified model fitted the data well (goodness of fit index = 0.993; normed fit index = 0.978; root mean square error of approximation = 0.031). Higher "smoking sensory experience" was positively associated with increasing cigarettes smoked per day (β = 0.12). Higher rating of the cigarette package in brand choice positively covaried with both "smoking sensory experience" (β = 0.29), and higher rating of health considerations (β = 0.42).

CONCLUSIONS

These findings support the regulation of the appearance of cigarettes/cigarette packs to reduce cigarettes' appeal and abuse liability in line with Article 11 of WHO's Framework Convention on Tobacco Control.