The Effects of Changes in Cigarette Menthol Content on Acute Nicotine Pharmacology and Smoking Topography

INTRODUCTION

Menthol influences the appeal and addictiveness of cigarette smoking, however the data regarding menthol's effects on nicotine pharmacokinetics (PK) and smoking topography are inconsistent. This study investigated the impact of different cigarette menthol levels on nicotine pharmacology and smoking topography in current menthol smokers.

AIMS AND METHODS

The study was a double-blind, randomized, four-period, crossover study to investigate the effects of smoking cigarettes with varying menthol content (0, 3, 6, and 12 mg menthol) on nicotine PK, smoking topography, and subjective effects in current menthol smokers. Each experimental session consisted of a prescribed use session, followed by 145 min of no smoking and a 1-h ad libitum smoking session. Serial blood samples were collected; smoking topography was recorded using CReSS Lab topography device.

RESULTS

There was no significant effect of menthol on nicotine PK after prescribed smoking of cigarettes with varying menthol contents. During ad libitum smoking, there was significantly smaller total puff volume and puff duration in the 12 mg menthol condition compared to other menthol conditions. Subjective and sensory measures indicated significantly higher overall positive ratings for the 3 mg and 6 mg menthol cigarettes compared to the 0 mg menthol cigarette; the 12 mg menthol cigarette was less liked and harsher than the 3 mg condition.

CONCLUSIONS

These findings suggest that menthol, at concentrations reflecting the marketplace (3-6 mg), contributes to positive subjective smoking experiences among menthol smokers, but does not have a significant effect on nicotine PK or smoking topography in an acute laboratory setting.

IMPLICATIONS

While our data indicate that varying menthol content does not have a significant impact on nicotine's pharmacological effects under acute exposure conditions, these data highlight the contribution of menthol's flavor and sensory effects to product preference and positive smoking experiences, which facilitate repeated experimentation, progression to regular use, and subsequent dependence.

Effect of sweet flavouring on the rewarding and reinforcing value of cigarillo use among young adults

INTRODUCTION

Cigarillos dominate the US cigar market, and young adults largely drive use. While young adults prefer flavoured to non-flavoured cigarillos, especially those flavoured to taste like fruit or other sweets, the factors that underlie this preference have received little attention. We sought to determine if key indicators of abuse liability, the rewarding and reinforcing effects, are greater for sweet versus non-flavoured cigarillos.

METHODS

Young adults (18-24 years old) completed three laboratory visits assessing the subjective rewarding value (exposure paradigm), relative reinforcing value (computerised choice task) and absolute reinforcing value (ad libitum cigarillo smoking session) of sweet-flavoured versus non-flavoured cigarillos. General linear regression models were fit with the appropriate family link for each outcome measure.

RESULTS

Young adults rated sweet-flavoured cigarillos as more rewarding (estimated marginal mean (EMM) =4.52, 95% CI 4.00 to 5.03) than the non-flavoured cigarillo (EMM=3.31, 95% CI 2.80 to 3.83; B=1.20, 95% CI 0.80 to 1.60, p<0.001). The reinforcing value of sweet-flavoured cigarillos, measured by break point, was higher relative to non-flavoured cigarillos (6.34 out of 10), especially among young adults with a preference for flavoured cigarillos (B=1.94, 95% CI 0.71 to 3.18, p=0.003). Young adults took 1.9 times the number of puffs (35.75 vs 19.95) from sweet-flavoured cigarillos compared with non-flavoured cigarillos (Rate Ratio =1.94, 95% CI 1.30 to 2.90, p<0.001).

CONCLUSIONS

Sweet flavouring increases the abuse liability of cigarillos among young adults as reflected in greater liking, motivation to use and actual use. Banning sweet flavouring in cigarillos may diminish their use in young adults.Trial registration number CT.gov (NCT05092919).

Survey of Premium Versus Large Manufactured Cigars Use in U.S. Consumers

INTRODUCTION

An Internet questionnaire was used to determine smoking behavior, purchasing behavior, and risk perceptions among exclusive or nearly exclusive current users of either large manufactured (LMC) or premium cigars (PC).

AIMS AND METHODS

Respondents (n = 250) were recruited from a nationally representative market research panel. An a priori designation of PC users was adapted from criteria in published literature and the recent National Academy of Science report.

RESULTS

Examination of responses revealed a (n = 19) disagreement between cigar users' self-classifications and the a priori classification. After eliminating ineligible respondents 188 participants were classified as PC (n = 92; 55 male) or LMC (n = 96; 49 male) users. There were no significant differences in age or gender between groups. Respondents were all over 21 years old. The largest age groups were 30-39 years and 60-69 years. PC users were significantly more likely to have higher annual incomes and to buy cigars online or through tobacco specialty shops, whereas LMC users purchased from convenience stores. Most participants had used other combustible tobacco products (88%) but few had used ENDS (24%) or oral tobacco (7.5%). There was no significant difference in the frequency of smoke inhalation or perceptions of risk for health. There was marked uncertainty in self-characterization of cigar type; our sample had higher female representation than expected (n = 84, 45%), and inhalation was frequently endorsed in both groups (52%, overall).

CONCLUSIONS

The results support the need for standardized classifications and suggest current trends may indicate shifts in gender and use behavior but provide no evidence supporting less restrictive regulation of PC.

IMPLICATIONS

An Internet questionnaire was used to determine smoking behavior, purchasing behavior, and risk perceptions among current users of LMC or PC. There was uncertainty about cigar classification even in this sample of regular users. Our results demonstrated more than expected inhalation of cigar smoke, considerable use by females, and under appreciation of health risks. No results supported less restrictive regulations for premium cigars.

A Comparison of Use Topography and Nicotine Pharmacokinetics Among Loose and Portioned Smokeless Tobacco Users

INTRODUCTION

Moist snuff smokeless tobacco (ST) products are available in the United States in both "loose" and "portioned" (ie, pouched) formats, but no published study to date has clinically evaluated the associations between ST format, use behavior, and nicotine exposure.

AIMS AND METHODS

Participants used their usual brand of ST (loose ST [n = 30] or portioned ST [n = 20]) during an experimental visit wherein use behavior and plasma nicotine pharmacokinetic parameters were measured following single use (first hour of the session) and ad libitum use (remaining 7 h of the session). Participants' ST products were chemically characterized prior to use for pH and nicotine content.

RESULTS

The average amount per use (2.99 vs. 1.52 g; p = .005) and total amount used (11.45 vs. 5.4 g; p = .002) were significantly higher among the loose ST group. Maximum plasma nicotine concentration (Cmax; 33.4 vs. 19.1 ng/ml) and area under the nicotine concentration versus time curve (AUC) were significantly higher for the loose ST group for the first hour (1474.8 vs. 807.2 min* ng/ml; p = .003) and throughout the 8-hour session (15827.9 vs. 8155.3 min* ng/ml; p < .001). Significant associations were observed between free nicotine content and first use Cmax (rs = .488, loose ST group) and AUC0-1 h (rs = 0.448, loose ST group; rs = .441, portioned ST group).

CONCLUSIONS

The loose ST group used more product and had a greater average deposition time per use than the portioned ST group. Nicotine exposure was more strongly associated with free nicotine content than total nicotine content.

IMPLICATIONS

To our knowledge, the current investigation was the first study to date to clinically evaluate the associations between usual-brand smokeless format, use behavior, and nicotine exposure. We observed meaningful differences in use behavior and subsequent nicotine exposure between loose and portioned ST users. Further, we observed that nicotine exposure was more strongly associated with free nicotine content than total nicotine content.

A Method to Amend Cigarettes with Menthol for use in Research

INTRODUCTION

Studies have evaluated the role of menthol cigarettes on various addiction-related outcomes; however, the effect of varying menthol content on these outcomes has not been evaluated. We developed a method to amend non-menthol SPECTRUM Research Cigarettes to contain menthol at 4 different levels.

METHODS

SPECTRUM Research Cigarettes, NRC 600 (0.8 mg nicotine; 10 mg tar), were modified to contain target menthol amounts at 3, 6, and 12 mg/cigarette by injecting 25 µL ethanol/triacetin/menthol solutions of varying concentrations (120 mg menthol/mL, 240 mg/mL, and 480 mg/mL) into 4 distinct locations in the filter and tobacco rod. Menthol content was tested in triplicate in the whole cigarette and in the tobacco rod and filter at 1, 24, 48, and 72 hr for each target menthol level using an extraction solution of quinoline in methyl-tert-butyl ether and measured using gas chromatography with flame ionization detection.

RESULTS

Injections into the filter and tobacco rod (12.5 µL each) yielded equal menthol distribution up to 72 hr. However, total menthol content decreased from an average of 90.3% of the target menthol concentration at 1 hr to 80.7% at 72 hr in cigarettes stored individually in glass tubes at room temperature. Analysis of urinary menthol glucuronide confirmed that amended cigarettes used within 24 hr of injection delivered dose-related menthol levels to participants in a clinical laboratory setting.

CONCLUSION

This method can be used to modify cigarettes with a range of reliable menthol levels in both filter and tobacco rod for use in laboratory and clinical research.

IMPLICATIONS

This study presents a technique for modifying cigarettes with different levels of menthol that can reliably deliver dose-related menthol levels to participants when smoked in a clinical study. The technique can be used to quickly amend cigarettes to examine the independent effects of varying flavor and additive levels on smoking behavior, nicotine pharmacokinetics, mainstream smoke emissions, and other laboratory or clinical research outcomes.

Mouth Level Intake of Nicotine from Three Brands of Little Filtered Cigars with Widely Differing Product Characteristics Among Adult Consumers

Little filtered cigars are tobacco products with many cigarette-like characteristics. However, despite cigars falling under the U.S. Food and Drug Administration regulatory authority, characterizing flavors, which are still allowed in little filtered cigars, and filter design may influence how people use the products and the resulting exposure to harmful and potentially harmful constituents. We estimated nicotine mouth level intake (MLI) from analyses of little cigar filter butt solanesol levels, brand characteristics, carbon monoxide boost, and puff volume in 48 dual cigarette/cigar users during two repeat bouts of ad lib smoking of three little filtered cigar brands. Mean nicotine MLI for the three brands was significantly different with Swisher Sweets (0.1% ventilation) Cherry at 1.20 mg nicotine, Cheyenne Menthol (1.5%) at 0.63 mg, and Santa Fe unflavored (49%) at 0.94 mg. The association between nicotine MLI and puff volume was the same between Cheyenne Menthol and Santa Fe unflavored. However, these were different from Swisher Sweets Cherry. At least five main factors─flavor, ventilation, filter design, nicotine delivery related to tar, and user puff volume─may directly or indirectly impact MLI and its association with other measures. We found that users of little filtered cigars that have different filter ventilation and flavor draw dissimilar amounts of nicotine from the product, which may be accompanied by differences in exposure to other harmful smoke constituents.

Effect of very low nicotine content cigarettes on alcohol drinking and smoking among adult smokers who are at-risk alcohol drinkers

Alcohol and tobacco use are interrelated. This study examined response to very low nicotine content (VLNC) and moderate nicotine content (MNC) cigarettes by problematic drinking. We utilized a double-blind, randomized, within-subjects crossover design of VLNC and MNC cigarettes in two groups of adult cigarette smokers: with at-risk drinking (ARD; n = 23) and without ARD (n = 24). Participants smoked only their assigned experimental cigarette in their home environment for 7 days, and completed laboratory visits, including ad libitum smoking of the assigned experimental cigarette, at the beginning and end of each experimental week. Participants smoked their usual cigarettes for 7 days between conditions. Participants provided daily reports of alcohol and cigarette consumption. Current Diagnostic and Statistical Manual of Mental Disorders-5th edition (DSM-5) alcohol use disorder (AUD) was assessed at baseline and the end of each experimental week. Compliance with smoking of experimental cigarettes was good. Adjusting for baseline drinking, there was no significant effect of experimental cigarette or ARD group on drinks per day or alcohol urges. There was no effect of experimental cigarette or ARD group on cigarettes per day, or on any puff topography outcome or postsmoking exhaled carbon monoxide during laboratory smoking. No participant had a change in AUD status or AUD severity. After 7 days of exposure to VLNC cigarettes, adult cigarette smokers with ARD did not show compensatory drinking or compensatory smoking behavior. A future policy change in the United States to reduce nicotine content in cigarettes may not produce unintended compensatory drinking or smoking among this vulnerable and prevalent population of smokers. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Formulation of Smokeless Tobacco Products with a Wide Range of pH to Study Nicotine Pharmacokinetics and Pharmacodynamics

The rate of nicotine absorption from tobacco products is a determinant of addiction potential and other detrimental health effects. Oral nicotine bioavailability from moist snuff smokeless tobacco (ST) is influenced by nicotine content, pH, flavors, and tobacco cut. For use in a clinical study testing the effect of pH on nicotine pharmacokinetics, four investigational ST products that differed only in pH were produced. A commercial ST product (Copenhagen Long Cut Original, pH 7.7) was modified with citric acid monohydrate (23 mg/g tobacco) or sodium carbonate (4.6 and 11 mg/g) to create products with pH 5.0, 8.2, and 8.6, respectively. All products - including the original product with pH 7.7 - were individually packaged (approximately 2g) in aluminum foil pouches and stored frozen (-20 °C); pH, nicotine, tobacco-specific nitrosamines, moisture content, and mold and yeast counts were tested for up to 19 months to verify stability. Remarkable stability was demonstrated in this packaging/storage combination. For example, pH from all products were within 0.1 pH units and never exceeded 0.2 units. Nicotine concentration averaged 9.07 mg/g at baseline, maximal deviations from baseline in the four products averaged 0.30 mg/g. Similarly, TSNA, moisture content, yeast, and mold did not materially change. This study illustrates a method of investigational tobacco products formulation by manipulating a single design feature (or component) with the purpose of independently and systematically assessing its influence on nicotine bioavailability in a clinical study.

The pH of Smokeless Tobacco Determines Nicotine Buccal Absorption: Results of a Randomized Crossover Trial

Nicotine absorption rate influences tobacco products' addictiveness. For smokeless tobacco, nicotine buccal absorption is associated with its free-base form; the pH of smokeless tobacco defines the proportion of free-base (i.e., unprotonated) vs. protonated nicotine. This was the first study to compare nicotine pharmacokinetics (PK) and pharmacodynamics (PD) after the use of commercial smokeless tobacco products that were experimentally manipulated to differ only in pH and percent free-base nicotine. Moist snuff users (N = 40) completed four crossover visits and used a single 2 g portion of Copenhagen Original Long Cut amended to 4 pH levels: 5.0, 7.7, 8.2, and 8.6 (free-base nicotine 0.1, 32, 60, and 79%) for 30 minutes. Nicotine PK and PD were assessed for 4 hours post-use. Nicotine PK substantially depends on its free-base proportion, with more than 4-fold increases in mean plasma nicotine maximum concentration and area under the curve over 240 minutes (3.9 to 16.7 ng/mL; 385 to 1810 ng min/mL, respectively, both P < 0.001) from pH 5.0 to 8.6. The autonomic cardiovascular effects of smokeless tobacco use reflected percent free-base nicotine, with small (albeit significant) systematic increases in heart rate and blood pressure associated with free-base nicotine. Smokeless tobacco product pH and percent free-base nicotine play a major role in the rate and extent of nicotine absorption, determining product PD effects and abuse potential. Research and regulation of smokeless tobacco products should consider both total nicotine content and product pH. Further research may address the impact of modifying pH on the addictiveness of smokeless tobacco and associated use behaviors.

Impact of smoked cannabis on tobacco cigarette smoking intensity and subjective effects: A placebo-controlled, double-blind, within-subjects human laboratory study

Co-users of cannabis and tobacco frequently use cannabis, then tobacco cigarettes, in a sequential pattern within an occasion, that is, they "chase" smoked cannabis with a tobacco cigarette. The objective of this placebo-controlled, double-blind, within-subjects human laboratory study was to gather preliminary data on how smoking active versus placebo cannabis impacts tobacco cigarette smoking behavior, craving, and subjective effects. Adult daily cannabis and tobacco co-users (N = 9) were randomly assigned to two experimental visit orders (i.e., active cannabis (5.2% THC) first visit and placebo cannabis second visit, or vice versa). Participants smoked one cannabis cigarette, and approximately 30 min later were given a 5-min ad libitum period to smoke one of their own brand of tobacco cigarette. As expected, boost in plasma THC levels and cannabis-related subjective effects differed between active and placebo cannabis conditions. Tobacco cigarette puff topography measures and tobacco craving did not differ between cannabis conditions, but there appeared to be between-participants heterogeneity in cumulative total puff volume. After smoking active versus placebo cannabis, the changes in subjective effects of tobacco smoking after adjusting for pretobacco smoking levels were not significant. Results do not support the notion that immediate effects of smoked cannabis change the behavior of tobacco smoking. The strong overlap between cannabis and tobacco smoking may not be explained by primarily pharmacological factors, but may be driven by more nuanced and complex mechanisms involving pharmacological processes as well as learning factors. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Cigar and Marijuana Blunt Use Among Pregnant and Nonpregnant Women of Reproductive Age in the United States, 2006-2016

OBJECTIVES

To assess trends in prevalence of cigar and blunt use in relation to cigarette use among pregnant and nonpregnant women of reproductive age.

METHODS

We used 2006 to 2016 data from the US National Survey on Drug Use and Health to assess past-month use of cigarettes, cigars, and blunts among a total of 8695 pregnant women and 162 451 nonpregnant women aged 18 to 44 years.

RESULTS

Cigarette use was more prevalent than cigar or blunt use in pregnant and nonpregnant women, with higher prevalence in nonpregnant women for each product. Among all women, cigarette use decreased and blunt use increased over time, whereas cigar use remained stable. Smoking prevalence was highest in the first trimester.

CONCLUSIONS

The health implications of the increase in blunt use are not well known in the scientific literature or by the general public. Given the rapid changes in state marijuana laws, this issue should be a public health priority.

Sweet flowers are slow, and weeds make haste: leveraging methodology from research on tobacco, alcohol, and opioid analgesics to make rapid and policy-relevant advances in cannabis science

The legalization of medical and recreational cannabis use has occurred ahead of science. The current evidence base has poor utility for determining if cannabis products can meet the standards of safety, efficacy, and quality intrinsic to modern medicine, and for informing regulation of cannabis as a legal intoxicant. Individual jurisdictions that pass cannabis reforms may not have adequate resources to support the level of new scientific research needed to inform regulatory actions; this could make it difficult to keep a rapidly growing multi-billion-dollar cannabis industry in check. Further, the present lack of evidence-based regulatory oversight for cannabis parallels the climates that gave rise to the tobacco and prescription opioid epidemics, suggesting that continued omission may result in negative public health consequences. However, translating a methodological framework developed through research on these compounds may promote rapid advances in cannabis science germane to regulatory knowledge gaps. The present review highlights specific advancements in these areas, as well as in alcohol regulation, that are prime for informing policy-relevant cannabis science, and also offers some recommendations for evidence-based regulatory policy. Resulting progress may directly inform both regulation of cannabis in both medical and licit recreational drug frameworks, and new cannabis-related public health initiatives.

Cigarillo and Little Cigar Mainstream Smoke Constituents from Replicated Human Smoking

Little cigar and cigarillo smoking is increasing in popularity in the U.S., but little is known about the topography and mainstream smoke (MSS) constituents of these types of cigar products. This report describes the quantity of selected MSS toxicants generated from puff-by-puff replication of human laboratory smoking. Participants were dual users of cigarettes and either little cigars ( n = 21) or cigarillos ( n = 23). In the laboratory smoking session, participants of the little cigar group smoked a filtered unflavored Winchester Little Cigar; those in the cigarillo group smoked an unfiltered, unflavored Black & Mild cigarillo. MSS components included both volatiles and semivolatile compounds. The MSS of five representative U.S. domestic cigarettes was generated using smoking topography profiles of the participants smoking their own brand of cigarettes. Machine smoking accurately replicated individual puff profiles as indicated by a high correlation between lab and machine smoked: time to smoke, number of puffs, and total puff volume. There was wide variability in smoking patterns across subjects of both little cigars and cigarillos. For example, total puff volume ranged from 84 to 732 mL after the little cigar and from 270 to 2089 mL after the cigarillo. Qualitatively, cigar smoke from little cigars and cigarillos were similar and resembles cigarette smoke. All analytes (VOC and SVOCs) were greater in cigarillo smoke compared to that of little cigars and cigarettes. However, when the toxicants were adjusted for grams of tobacco burned, little cigar smoke contained more nicotine, tobacco-specific nitrosamines, acetonitrile, and acrylonitrile compared with cigarillo smoke. When the constituents were adjusted for nicotine content, cigarillo MSS contained more of all toxicants compared with little cigar. Cigarillos and little cigars, like cigarettes, deliver nicotine and other toxicants known to be harmful to health; their regulation by the FDA is appropriate for their public health risk.

Nicotine Content and Physical Properties of Large Cigars and Cigarillos in the United States

Introduction

Cigars are combusted tobacco products consisting of filler, binder, and wrapper, which are derived from tobacco. Despite the abundance of literature on the composition of traditional combusted cigarettes, research is limited on the physical and chemical properties of cigars. Therefore, research on cigar properties may be useful to better understand their health impact.

Methods

In this study, twenty large cigar and cigarillo products were characterized for physical properties (ie, weight, length, and diameter), filler nicotine content, and tobacco pH. Tobacco pH was used to calculate free nicotine content, free nicotine concentration, and percent free nicotine for all cigars using the Henderson-Hasselbach equation. An additional analysis was performed on a second batch of two large cigar and two cigarillo brands to determine within-brand consistency. All analyses were performed in triplicate.

Results

The initial analysis of the twenty cigars showed that cigars exhibited wide variation in product size and nicotine content, although tobacco pH was similar across cigars. Furthermore, in the two large cigar and cigarillo brands analyzed a second time, there was considerable within-brand variance in nicotine content and concentration between the first and second analyses.

Conclusions

While only a small sample of commercially-available cigars was analyzed, our data suggest there is wide variability in nicotine content and some physical properties in the domestic cigar market. The data may help to inform potential future regulatory decisions related to these products.

Implications

This study reveals some of the challenges to experimental cigar research and illustrates the need to characterize cigar products (eg, nicotine and tobacco content) before use in clinical studies. Additional studies and characterization of the physical and chemical properties of cigars may be useful to further understand these products' toxicity, abuse potential, and public health impact.

Large Cigars: Smoking Topography and Toxicant Exposure

Background

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

Methods

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

Results

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

Conclusions

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

Implications

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

Does marijuana "blunt" smoking contribute to nicotine exposure?: Preliminary product testing of nicotine content in wrappers of cigars commonly used for blunt smoking

INTRODUCTION

An increasingly popular method of consuming marijuana is through the smoking of "blunts," cigar products in which some or all of the tobacco filler is removed and repacked with marijuana. Even if all tobacco filler is removed from the cigar product in the process of making blunts, nicotine may be present in the wrapper of the cigar product. This preliminary analysis quantified the nicotine content in wrappers of cigar products commonly used for blunt smoking.

METHODS

Five cigar products (3 large cigars, 2 cigarillos) were tested, yielding physical characteristics of cigar length, diameter, weight, and wrapper weight. Nicotine concentration in the wrapper of each cigar product was analyzed via gas chromatography/mass spectrometry. Total nicotine content in the wrapper of each cigar product was computed as the product of cigar wrapper weight and nicotine concentration in wrapper.

RESULTS

Depending on the product, the cigar wrapper contributed between 8 and 18% of the weight of the entire cigar article. Total nicotine content in the cigar wrapper ranged from 1.2 to 6.0mg per cigar.

DISCUSSION

All 5 tested cigar products had wrappers that contain quantifiable levels of nicotine, indicating that users of blunts may expose themselves to some degree of nicotine, the addictive component of tobacco. Future experimental studies that examine the efficiency of nicotine delivery from typical blunt smoking, as well as surveillance studies that quantify the number of blunts smoked by an individual per day, are needed to evaluate the contribution of blunt smoking to nicotine dependence.

Menthol Smokers: Metabolomic Profiling and Smoking Behavior

BACKGROUND

The use of menthol in cigarettes and marketing is under consideration for regulation by the FDA. However, the effects of menthol on smoking behavior and carcinogen exposure have been inconclusive. We previously reported metabolomic profiling for cigarette smokers, and novelly identified a menthol-glucuronide (MG) as the most significant metabolite directly related to smoking. Here, MG is studied in relation to smoking behavior and metabolomic profiles.

METHODS

This is a cross-sectional study of 105 smokers who smoked two cigarettes in the laboratory one hour apart. Blood nicotine, MG, and exhaled carbon monoxide (CO) boosts were determined (the difference before and after smoking). Spearman correlation, χ², and ANCOVA adjusted for gender, race, and cotinine levels for menthol smokers assessed the relationship of MG boost, smoking behavior, and metabolic profiles. Multivariate metabolite characterization using supervised partial least squares-discriminant analysis (PLS-DA) was carried out for the classification of metabolomics profiles.

RESULTS

MG boost was positively correlated with CO boost, nicotine boost, average puff volume, puff duration, and total smoke exposure. Classification using PLS-DA, MG was the top metabolite discriminating metabolome of menthol versus nonmenthol smokers. Among menthol smokers, 42 metabolites were significantly correlated with MG boost, which linked to cellular functions, such as of cell death, survival, and movement.

CONCLUSIONS

Plasma MG boost is a new smoking behavior biomarker that may provide novel information over self-reported use of menthol cigarettes by integrating different smoking measures for understanding smoking behavior and harm of menthol cigarettes.

IMPACT

These results provide insight into the biological effect of menthol smoking. Cancer Epidemiol Biomarkers Prev; 26(1); 51-60. ©2016 AACR.

Metabolomic profiles of current cigarette smokers

Smoking-related biomarkers for lung cancer and other diseases are needed to enhance early detection strategies and to provide a science base for tobacco product regulation. An untargeted metabolomics approach by ultra-performance liquid chromatography-quadrupole-time of flight mass spectrometry (UHPLC-Q-TOF MS) totaling 957 assays was used in a novel experimental design where 105 current smokers smoked two cigarettes 1 h apart. Blood was collected immediately before and after each cigarette allowing for within-subject replication. Dynamic changes of the metabolomic profiles from smokers' four blood samples were observed and biomarkers affected by cigarette smoking were identified. Thirty-one metabolites were definitively shown to be affected by acute effect of cigarette smoking, uniquely including menthol-glucuronide, the reduction of glutamate, oleamide, and 13 glycerophospholipids. This first time identification of a menthol metabolite in smokers' blood serves as proof-of-principle for using metabolomics to identify new tobacco-exposure biomarkers, and also provides new opportunities in studying menthol-containing tobacco products in humans. Gender and race differences also were observed. Network analysis revealed 12 molecules involved in cancer, notably inhibition of cAMP. These novel tobacco-related biomarkers provide new insights to the effects of smoking which may be important in carcinogenesis but not previously linked with tobacco-related diseases. © 2016 Wiley Periodicals, Inc.

Nicotine and carbon monoxide exposure from inhalation of cigarillo smoke

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

IMPACT

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

Black Cigarette Smokers Report More Attention to Smoking Cues Than White Smokers: Implications for Smoking Cessation

INTRODUCTION

Black cigarette smokers have lower rates of smoking cessation compared with Whites. However, the mechanisms underlying these differences are not clear. Many Blacks live in communities saturated by tobacco advertisements. These cue-rich environments may undermine cessation attempts by provoking smoking. Moreover, attentional bias to smoking cues (attention capture by smoking cues) has been linked to lower cessation outcomes. Cessation attempts among Blacks may be compromised by attentional bias to smoking cues and a cue-rich environment.

METHOD

Attention to smoking cues in Black and White smokers was examined in 2 studies. In both studies, assessments were completed during 2 laboratory visits: a nonabstinent session and an abstinent session. In study 1, nontreatment-seeking smokers (99 Whites, 104 Blacks) completed the Subjective Attentional Bias Questionnaire (SABQ; a self-report measure of attention to cues) and the Smoking Stroop task (a reaction time measure of attentional bias to smoking cues). In study 2, 110 White and 74 Black treatment-seeking smokers completed these assessments and attempted to quit.

RESULTS

In study 1, Blacks reported higher ratings than Whites on the SABQ (p = .005). In study 2, Blacks also reported higher ratings than Whites on the SABQ (p = .003). In study 2, Blacks had lower biochemical-verified point prevalence abstinence than Whites, and the between-race difference in outcome was partially mediated by SABQ ratings.

CONCLUSION

Blacks reported greater attention to smoking cues than Whites, possibly due to between-race differences in environments. Greater attention to smoking cues may undermine cessation attempts.

Nicotine delivery and pharmacologic response from Verve, an oral nicotine delivery product

Verve, an oral nicotine delivery product (ONDP), was introduced by Nu Mark (Altria Client Group, Richmond VA) for smokers to use in places where smoking is prohibited. This study assessed the effect of this ONDP on plasma nicotine levels, heart rate, product satisfaction, and ability to suppress smoking urge and cigarette cravings. Thirteen daily cigarette smokers [8 men and 5 women; average age 33.4years] attended two laboratory sessions, one occurred after overnight tobacco abstinence. Plasma samples were collected before and after ONDP use and measured for nicotine. In non-abstinent smokers, mean plasma nicotine levels increased from 18.3 to 21.0ng/mL. In abstinent smokers, average nicotine levels increased from 3.1 to 4.5ng/mL. After overnight tobacco abstinence, ONDP use significantly (p<0.01) increased heart rate from 69beats per minute (bpm) to 75bpm; while urge to smoke decreased significantly (p<0.01) from a score of 8.6 to 4.9. Participants indicated moderate product satisfaction that was not changed by tobacco abstinence. Analysis of unused ONDP revealed total nicotine levels of 1.68±0.09mg/disc. Spent ONDP discs were also analyzed to determine % nicotine liberated during chewing; results were 80% in the non-abstinent and 82% in the abstinent conditions (ns). Our study results indicate that ONDP use can increase plasma nicotine levels and heart rate and reduce cigarette cravings in abstinent smokers.

Electronic cigarettes in adults in outpatient substance use treatment: Awareness, perceptions, use, and reasons for use

BACKGROUND AND OBJECTIVES

Most studies on e-cigarettes have come from population-based surveys. The current research aimed to provide initial data on e-cigarette awareness, perceptions, use, and reasons for use among adults seeking substance use treatment.

METHODS

A survey was conducted among 198 participants ≥18 years old in a community-based outpatient substance use treatment program.

RESULTS

Of the 198 participants, 69% currently smoked cigarettes, 92% were aware of e-cigarettes, and 58% had ever used e-cigarettes. The proportion of the number of participants who had ever used e-cigarettes to the number who currently smoked (89.7%) appeared higher than the corresponding proportion in the 2012-13 National Adult Tobacco Survey (78.3%). Almost half of the sample who reported ever using e-cigarettes endorsed quitting or reducing smoking as a reason for use, and 32% endorsed reasons for use relating to curiosity/experimentation. A greater likelihood of e-cigarette ever-use was significantly associated with younger age (adjusted odds ratio [AOR] = 0.94, 95%confidence interval [CI] = 0.90, 0.98) and perceptions related to using e-cigarettes in public places where smoking cigarettes is not allowed (AOR = 2.96, 95%CI = 1.18, 7.42) but was not associated with primary drug of choice.

DISCUSSION AND CONCLUSIONS

E-cigarette use in adults seeking substance use treatment appears higher than it is in the US general population of smokers. The high frequency of use may be due to curiosity/experimentation or attempts to quit or reduce smoking.

SCIENTIFIC SIGNIFICANCE

Future research may consider how e-cigarettes interact with other substance use and affect high rates of nicotine and tobacco use in this population.

Experimentally Switching from Factory Made to Self-Made Cigarettes: A Preliminary Study of Perceptions, Toxicant Exposure and Smoking Behavior

INTRODUCTION

There is currently the potential for a great deal of transition and product switching among cigarette smokers. Studies on the transition when cigarette smokers switch from one type of nicotine delivery product to another are needed to understand subsequent toxicant exposure.

METHODS

A preliminary study was performed to determine the feasibility of experimentally replicating the transition from factory made (FM) to personal machine made (PMM) cigarette smoking. The adaptability and perceptions of the consumer and the consequent exposure to cigarette-delivered toxins were assessed. Six adults (4 men) were recruited for four laboratory visits (V1-V4) on study days 1, 5, 10 and 15, respectively. All of the participants agreed to switch from exclusive FM smoking to exclusive PMM cigarette smoking for the duration of the study.

RESULTS

Compliance was very high among these participants. Participants progressively accepted the PMM cigarettes and became efficient producers of PMMs as evidenced in the reduced time to make 5 PMMs in the laboratory. Participants reported a preference for FM at visit 2 (V2), but had stated no preference by the fourth visit. Compared to the FMs, the PMMs at V3 (p<0.05) and V4 (p<0.10) had lower CO boost (7.3 vs. 4.1 ppm; p<0.05). Over all conditions, nicotine plasma levels averaged 18.0±2.4 ng/ml before smoking (for both FM and PMM) and 34.0±5.3 ng/mL after smoking; there were no significant differences in the plasma nicotine boost (average 17.7 and 15.4ng/ml after FM and PMM smoking, respectively). Although there were differences between individual subjects' filter butt levels of deposited solanesol the within-subject levels were remarkably similar. Puff topography measures did not vary across visits or cigarette type.

CONCLUSIONS

Although interpretation of study results must be conservative because of the small sample size, this study demonstrates that experimentally-induced transition from FM to PMM smoking is feasible for laboratory study and the subsequent toxicant exposure is comparable for FM and PMM cigarettes.

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

BACKGROUND

Despite considerable use of make your own (MYO) cigarettes worldwide and increasing use in the United States, relatively little is known about how these cigarettes are smoked and the resultant toxicant exposure.

METHODS

In a laboratory study, we compared two types of MYO cigarettes-roll your own (RYO) and personal machine made (PMM)-with factory-made (FM) cigarettes in three groups of smokers who exclusively used RYO (n = 34), PMM (n = 23), or FM (n = 20). Within each group, cigarettes were smoked in three conditions: (i) after confirmed overnight tobacco abstinence; (ii) in an intense smoking paradigm; and (iii) without restrictions. All cigarettes were smoked ad lib through a smoking topography unit.

RESULTS

Plasma nicotine significantly increased after cigarettes in all conditions except PMM in the intense smoking paradigm. Puff volume, puff duration, total puff volume, and puff velocity did not differ between cigarette types but the puffs per cigarette and time to smoke were significantly smaller for RYO compared with PMM and FM. Regardless of the cigarette, participants consumed the first three puffs more vigorously than the last three puffs.

CONCLUSIONS

Despite the belief of many of their consumers, smoking MYO cigarettes is not a safe alternative to FM cigarettes. Like FM, MYO cigarettes expose their users to harmful constituents of tobacco smoke. Despite differences in size and design their puffing profiles are remarkably similar.

IMPACT

These data are relevant to health and regulatory considerations on the MYO cigarettes.

Cortisol levels decrease after acute tobacco abstinence in regular smokers

OBJECTIVE

The aim of this study was to examine the effect of acute tobacco abstinence on cortisol levels in regular smokers, and whether abstinence-induced changes in cortisol levels are correlated with various signs and symptoms of the tobacco withdrawal syndrome.

METHODS

Smokers (N = 77, ≥15 cigarettes/day) attended two counterbalanced sessions (avg = 1 h), one following 12-20 h of abstinence and the other following ad lib smoking. At both sessions, salivary cortisol levels were measured at three time points. Additionally, a battery of self-report questionnaires, physiological assessments, and cognitive performance tasks were administered to measure signs and symptoms of tobacco withdrawal.

RESULTS

Salivary cortisol levels were significantly lower during the abstinent session versus the non-abstinent session. No significant associations were found between abstinence-induced changes in cortisol and other tobacco withdrawal measures, although there was suggestive evidence that abstinence-induced changes in cortisol levels and hunger were inversely associated to a modest degree.

CONCLUSION

Acute tobacco abstinence was associated with decreased cortisol levels. Cortisol dampening during acute tobacco abstinence may reflect nicotine-mediated modulation of hypothalamic-pituitary-adrenal axis activity, which may be relevant to the maintenance of tobacco dependence. Tobacco-withdrawal cortisol changes do not appear to be a cause or consequence of many manifestations of acute tobacco withdrawal with the possible exception of hunger.

Nicotine Absorption from Smokeless Tobacco Modified to Adjust pH

INTRODUCTION

Nicotine delivery from smokeless tobacco (ST) products leads to addiction and the use of ST causes pathology that is associated with increased initiation of cigarette smoking. The rapid delivery of nicotine from ST seems to be associated with the pH of the aqueous suspension of the products - high pH is associated with high nicotine absorption. However, early studies compared nicotine absorption from different commercial products that not only differed in pH but in flavoring, nicotine content, and in format-pouches and loose tobacco.

METHODS

The present study compared nicotine absorption from a single unflavored referent ST product (pH 7.7) that was flavored with a low level of wintergreen (2 mg/g) and the pH was amended to either high (8.3) or low (5.4) pH with sodium carbonate or citric acid, respectively.

RESULTS

In a within-subject clinical study, the higher pH products delivered more nicotine. No significant differences were seen between perceived product strengths and product experience in all conditions. Heart rate increased by 4 to 6 beats per minute after the high pH flavored and the un-amended product but did not change after the low pH flavored product.

CONCLUSIONS

These results indicate that pH is a primary determinant of buccal nicotine absorption. The role of flavoring and other components of ST products in nicotine absorption remain to be determined.

The acute tobacco withdrawal syndrome among black smokers

Black smokers have greater difficulty quitting tobacco than White smokers, but the mechanisms underlying between-race differences in smoking cessation are not clear. One possibility is that Black smokers experience greater acute withdrawal than Whites. We investigated whether Black (n = 104) and White smokers (n = 99) differed in abstinence-induced changes in self-report, physiological, and cognitive performance measures. Smokers not wishing to quit completed two counterbalanced experimental sessions. Before one session, they abstained from smoking for at least 12 hr. They smoked normally before the other session. Black smokers reported smaller abstinence-induced changes on a number of subjective measures including the total score of the 10-item Questionnaire for Smoking Urges (QSU) and the total score of the Wisconsin Smoking Withdrawal Scale (WSWS). However, on most subjective measures, and on all objective measures, there were no between-race differences in abstinence-induced change scores. Moreover, Black participants did not report lower QSU and WSWS ratings at the abstinent session, but they did experience significantly higher QSU and WSWS ratings at the nonabstinent session. Abstinence-induced changes in subjective, physiological, and cognitive measures in White smokers were similar for smokers of nonflavored and menthol-flavored cigarettes. There was no evidence that Black smokers experienced greater acute tobacco withdrawal than Whites. To the contrary, Black participants experienced smaller abstinence-induced changes in self-reported craving and withdrawal on some measures. Racial differences in smoking cessation are unlikely to be explained by acute withdrawal.

Make your own cigarettes: characteristics of the product and the consumer

INTRODUCTION

Despite a worldwide increase in the use of Make Your Own (MYO) cigarettes, there is little research characterizing MYO smokers in the United States and the cigarettes they make.

METHODS

In a single laboratory visit, exclusive MYO smokers brought 5 MYO cigarettes they prepared at home, completed demographic and smoking history questionnaires, and prepared 25 cigarettes using their own tobacco and materials.

RESULTS

Participants were mostly male (86.7%), average age of 41.3 years, and smoked an average of 19.5 (SD = 7.9) MYO cigarettes per day. They produced two types of cigarettes-by rolling tobacco in a paper leaf (Roll Your Own [RYO, n = 56]) and by injecting tobacco into a tube (Personal Machine Made [PMM, n = 42]). The PMM cigarettes were significantly larger than RYO cigarettes (p < .001). Home- (0.97 g) and laboratory-produced (0.95 g) PMM cigarettes did not differ by weight; however, the RYO cigarettes made at home (0.45 g) were slightly, but significantly, larger than those produced in the laboratory [0.43 g (p < .05)]. There was significant internal consistency in the weight of RYO and PMM cigarettes (intraclass correlation coefficient = 0.82, 0.84, respectively). Time to produce RYO cigarettes (53 s/cigarette) was significantly longer than that of PMM cigarettes (42 s/cigarette) (p < .01).

CONCLUSIONS

By using commercially available tobacco, tubes, and paper, experienced MYO smokers can quickly and consistently prepare cigarettes that may be useful in laboratory smoking topography and exposure experiments. Increasing the regulation of Factory Made (FM) cigarettes may lead to increased use of MYO cigarettes with unknown toxicant exposure and health risks to their consumers.

Cigarette smoking among college students: longitudinal trajectories and health outcomes

INTRODUCTION

Light and intermittent patterns of cigarette smoking are prevalent among U.S. college-aged individuals. It is unclear whether intermittent smokers maintain their use over time or are transitioning to daily use or nonuse, and whether they experience more adverse health outcomes than nonsmokers.

METHODS

This study examined the trajectories of tobacco cigarette smoking, their predictors, and health outcomes among students (N = 1,253) assessed during their first year of college (Y(1)) and annually thereafter (Y(2), Y(3), and Y(4)).

RESULTS

In Y(1), 3.4% smoked daily and 4.1% exhibited signs of dependence (first cigarette within 30 min of waking). Growth curve modeling identified five distinct smoking trajectories. After stable nonsmokers (71.5%(wt)), the low-stable smoking trajectory was the most common (13.3%(wt)), outnumbering both low-increasing (6.5%(wt)) and high-stable smokers (5.5%(wt)) by 2:1 and high-decreasing smokers (3.2%(wt)) by 4:1. The likelihood of maintaining a low level of smoking over time was inversely related to Y(1) smoking frequency. Few demographic, smoking, and alcohol use characteristics measured in Y(1) distinguished low-increasers from low-stable smokers or high-decreasers from high-stable smokers. By Y(4), high-stable smokers rated their health significantly worse than all others except low-increasers. High-stable smokers had the most Y(4) health problems (i.e., provider visits for health problems and days of illness-related impairment), but only among nonWhites.

CONCLUSIONS

Many college students smoke, but few smoke daily or are nicotine dependent. Intermittent smoking patterns are often stable throughout college and are associated with adverse health outcomes. Prevention strategies should be designed to mitigate the possible long-term health consequences of light and intermittent smoking.

Ad lib smoking of Black & Mild cigarillos and cigarettes

INTRODUCTION

Over the past 20 years, there has been a tripling in the consumption of small cigars and cigarillos, with further increases expected because cigar products are not subject to Food and Drug Administration regulations. Acute toxin exposure from cigar smoking is difficult to assess because unlike cigarettes, cigars vary widely in size, design, composition, and in the smoking behavior of their consumers. For example, a recent practice among urban youth is to remove the paper liner (i.e., "freaking") of a small cigar in the belief that it is this paper liner that leads to addiction and cancer.

METHODS

We examined acute exposure (CO and nicotine boosts) and puffing behavior in 12 participants (10 men) who smoked (ad lib) their usual conventional cigarette, a Black & Mild cigar (B&M) and a B&M without the paper liner (i.e., "freaked" [B&Mf]).

RESULTS

All products (cigarettes, B&M, and B&Mf) significantly increased heart rate and CO with a trend for plasma nicotine. Nicotine boost was significantly higher after cigarette smoking than both B&M and B&Mf, while CO boost was significantly greater after B&M and B&Mf than cigarettes. The CO boost after B&M was larger than after B&Mf.

CONCLUSIONS

These findings suggest that small cigar smoking is associated with smoke inhalation that leads to significant exposure to nicotine, CO, and presumably other components of tobacco smoke and that removing the inner liner does not substantially reduce toxin exposure.

Levels of mint and wintergreen flavorants: smokeless tobacco products vs. confectionery products

Nicotine and flavorant compound levels were measured in 10 "mint"-related sub-brands and 8 "wintergreen" sub-brands of smokeless tobacco (SLT). Also analyzed were "mint"-related and "wintergreen" confectionery products. Of the "mint" SLT, "Timberwolf Packs Mint Pouches" contained the highest menthol level (5.3 mg/g); the average for the five most-highly mentholated SLT products was 4.3 mg/g. The average for the most five most-highly mentholated confectionery products was 3.5 mg/g. For hard candy, a reported average of maximum use levels is 2.1 mg/g (Burdock, 2009). Of the "wintergreen" SLT, "Hawken Wintergreen" was found to contain the highest methyl salicylate (MS) level (29.7 mg/g). The average of the five highest SLT MS levels was 23.8 mg/g, i.e., 5x higher than the level found in the confectionery product with the highest MS level (LifeSavers Wint O Green Sugar Free, 4.6 mg/g). For hard candy, a reported average of maximum use levels is 2.0 mg/g (Burdock, 2009). Assuming 23.8 mg/g MS in SLT, SLT use at 15 g/day, 100% bodily absorption of the MS, and 60 kg body weight, the average daily intake would be 6.0 mg/kg-day, i.e., 12x the acceptable daily intake (ADI) of 0.5 mg/kg-day established for this compound by a joint FAO/WHO committee.

Reliability and validity of a Short Form of the Tobacco Craving Questionnaire

The Tobacco Craving Questionnaire (TCQ) is a valid and reliable 47-item self-report instrument that assesses tobacco craving in four dimensions: emotionality, expectancy, compulsivity, and purposefulness. For use in research and clinical settings, we constructed a 12-item version of the TCQ by selecting three items from each of the four factors that exhibited optimal within-factor reliability (Cronbach's alpha coefficient) and inter-item correlation. Smokers (N = 196) completed the TCQ-Short Form (TCQ-SF) after overnight tobacco deprivation and on a separate day during ad libitum smoking. Confirmatory factor analyses indicated acceptable model fit for a 4-factor model, with congruence coefficients suggesting high to very high similarity in factor patterns and magnitude of factor loadings between the TCQ and TCQ-SF in both conditions. Scores on each factor were significantly greater after tobacco deprivation than ad libitum smoking, were associated with measures of tobacco withdrawal, and varied with degree of nicotine dependence. Cronbach's alpha coefficients and average inter-item correlations were similar in both conditions and were consistent with reliability values obtained in the initial validation of the TCQ. Test-retest correlation coefficients were also similar to those found in a previous study. These findings suggest that the TCQ-SF is as valid and reliable as the 47-item TCQ in measuring tobacco craving.

Associations between Cloninger's temperament dimensions and acute tobacco withdrawal

This study examined associations between three temperament dimensions measured by the Temperament and Character Inventory-125 [Cloninger, C.R. (1992). The Temperament and Character Inventory-125 (TCI-125; Version 1.)] and tobacco abstinence effects. Smokers (N=203, >/= 15 cigarettes/day) attended two laboratory sessions, one following 12 h of abstinence and the other following ad libitum smoking (order counterbalanced). Participants completed measures of withdrawal symptoms, cigarette urges, and affect. Smokers high in Novelty Seeking reported greater abstinence-induced increases in several nicotine withdrawal symptoms, negative affect, and cigarette craving. Smokers high in Harm Avoidance reported greater abstinence-induced increases in negative affect and urges to smoke to relieve distress. Reward Dependence was not associated with abstinence effects. Novelty Seeking and Harm Avoidance showed independent predictive associations with negative affect and urges, and their associations with abstinence effects persisted when controlling for FTND scores. Smokers with different temperaments display different patterns of acute tobacco withdrawal, and may benefit from treatments matched to their particular abstinence profile.

Gender differences in acute tobacco withdrawal: effects on subjective, cognitive, and physiological measures

Gender differences in tobacco withdrawal are of considerable clinical importance, but research findings on this topic have been mixed. Methodological variation in samples sizes, experimental design, and measures across studies may explain the inconsistent results. The current study examined whether male (n = 101) and female (n = 102) smokers (> or =15 cigarettes/day) differed in abstinence-induced changes on a battery of self-report measures (withdrawal, affect, craving), cognitive performance tasks (attention, psychomotor performance), and physiological responses (heart rate, blood pressure, brain electroencephalogram). Participants attended 2 counterbalanced laboratory sessions, 1 following 12 hr of abstinence and the other following ad libitum smoking. Results showed that women reported greater abstinence-induced increases in negative affect, withdrawal-related distress, and urge to smoke to relieve withdrawal distress. In contrast, both genders reported similar abstinence-induced changes in positive affect and urge to smoke for pleasure. Men and women exhibited generally similar abstinence-induced changes in physiological and cognitive performance measures. In addition, gender did not moderate the association between withdrawal symptoms and baseline measures of smoking behavior and dependence. Abstinence-induced changes in withdrawal distress mediated the effect of gender on latency until the 1st cigarette of the day at trend levels ( p < .10). These findings suggest that there are qualitative gender differences in the acute tobacco withdrawal syndrome that may underlie gender-specific smoking patterns.

New lower nicotine cigarettes can produce compensatory smoking and increased carbon monoxide exposure

Potential reduced exposure products (PREPs) are marketed as a means to reduce exposure to tobacco toxicants. Quest cigarettes, a new type of PREP, use genetically modified tobacco to provide a nicotine step-down approach, and are available as 0.6, 0.3 and 0.05 mg nicotine cigarettes. However, these cigarettes deliver equivalent levels of tar (10 mg). Prior research on low nicotine cigarettes suggests smokers will compensate for lower nicotine delivery by increasing their puffing behavior to extract more nicotine. This study tested the hypothesis that compensatory smoking will occur with this PREP as nicotine levels decrease, increasing exposure to tobacco toxins. Fifty smokers completed a within-subject human laboratory study investigating the effect of cigarette nicotine level on smoking behavior. Cigarette nicotine level was double-blinded and order of presentation counter-balanced. Breath carbon monoxide (CO) boost was used as a biomarker of smoke exposure; total puff volume to assess smoking behavior. Total puff volume was greatest for the 0.05 mg nicotine cigarette and CO boost was moderately greater after smoking the 0.3 and 0.05 mg cigarettes compared to the 0.6 mg nicotine cigarette. These data provide novel behavioral and biochemical evidence of compensatory smoking when smoking lower nicotine cigarettes. Although marketed as a PREP, increases in CO boost suggest this product can potentially be a harm-increasing product.

Smoking rates and topography predict adolescent smoking cessation following treatment with nicotine replacement therapy

Establishing measurement invariance of tobacco addiction among adolescents remains challenging. In adult smoking cessation trials, poor outcome is predicted by high cigarette consumption and large puff volume at baseline. We examined the predictive value of pretreatment smoking rates and topography variables for abstinence outcomes among 66 adolescents enrolled in a 3-month smoking cessation trial using nicotine replacement and cognitive behavioral therapy. Pretreatment variables included cigarettes per day (CPD), puff volume, puff duration, and several youth-adapted Fagerström-derived questionnaire scores. Outcome measures included prolonged abstinence at end of treatment and point-prevalent abstinence 3 months after the end of the trial. Logistic regression controlling for treatment group showed that increases in baseline CPD (odds ratio, 1.438; 95% confidence interval, 1.051-1.967) and average puff volume (odds ratio, 1.168; 95% confidence interval, 1.030-1.326) predicted continued smoking at the end of treatment. Puff volume (P=0.013), but not CPD, predicted abstinence at the 3-month follow-up. None of the youth-adapted Fagerström questionnaires predicted outcome on either abstinence measure. If confirmed in a larger sample, our findings suggest that puff topography, and possibly CPD, might predict cessation outcome better than Fagerström scores in adolescent smokers.

The effect of filter vent blocking and smoking topography on carbon monoxide levels in smokers

Two studies were conducted to examine the effect of filter vent blocking and smoking topography on carbon monoxide (CO) levels in smokers. In Study 1, 12 participants smoked two types of cigarettes (Marlboro Light and Carlton 100) under two types of blocking conditions (unblocked and half-blocked) while using a smoking topography device. Participants were restricted to 8 puffs, separated by 45 s. Significant main effects of CO boost for cigarette type and blocking condition replicated previous findings. A significant increase in CO boost for the Marlboro Light blocked condition is a novel finding for this best-selling brand. That result and the finding that topography measures did not predict CO boost made us question the reliability of CO boost. In Study 2, we examined the reliability of CO boost by recruiting 12 participants to smoke three unblocked Carlton 100 cigarettes in one session and three half-blocked in another. CO boost was significantly greater for the blocked sessions compared to the unblocked and CO boost did not differ within session, thus supporting the reliability of the measure. When participants do not switch brands within a session, smoking topography measures are predictive of CO boost.

Placebo cigarettes in a spaced smoking paradigm

Existing evidence supports the notion that nicotine delivery and recentness of smoking mediate the effects of smoking, including decreases in tobacco craving. However, smoking placebo (denicotinized) cigarettes decreases tobacco craving after overnight abstinence. The present study tested whether the recentness of smoking was an important determinant in the ability of a placebo cigarette to reduce tobacco craving. Placebo (0.07 mg nicotine) and conventional (1.1 mg nicotine) cigarettes were used in a spaced smoking paradigm. In six experimental sessions lasting 240 min, subjects smoked either a placebo or conventional nicotine cigarette in intervals of either 30, 60, or 240 min. Heart rate (HR), exhaled carbon monoxide (CO) levels, and subjective (Schuh-Stitzer, QSU) measures of tobacco craving were obtained throughout the spaced smoking paradigm. HR and CO levels increased after smoking both types of cigarettes. Increasing the interval since the last cigarette significantly (p<0.001) increased the baseline values of tobacco craving. Smoking either the placebo or the conventional cigarette caused a significant (p<0.01) reduction in the craving score after smoking. However, the nicotine yield of the cigarette did not influence these patterns. It is concluded that acute tobacco cravings can be repeatedly diminished with cigarettes that do not deliver nicotine.

Safety and efficacy of the nicotine patch and gum for the treatment of adolescent tobacco addiction

OBJECTIVES

To determine the safety and efficacy of the nicotine patch and gum for adolescents who want to quit smoking.

DESIGN

Double-blind, double-dummy, randomized, 3-arm trial with a nicotine patch (21 mg), nicotine gum (2 and 4 mg), or a placebo patch and gum; all participants received cognitive-behavioral group therapy.

SETTING

Inner-city, outpatient clinic on the East Coast. Subjects. Thirteen- to 17-year-old adolescents who smoked > or =10 cigarettes per day (CPD), scored > or =5 on the Fagerstrom Test of Nicotine Dependence, and were motivated to quit smoking. Intervention. Twelve weeks of nicotine patch or gum therapy with cognitive-behavioral therapy, with a follow-up visit at 6 months (3 months after the end of treatment).

MAIN OUTCOME MEASURES

Safety assessed on the basis of adverse event reports for all 3 groups, prolonged abstinence, assessed through self-report and verified with exhaled carbon monoxide (CO) levels of < or =6 ppm, in intent-to-treat analyses, and smoking reduction (CPD and thiocyanate concentrations) among trial completers.

RESULTS

A total of 120 participants were randomized (72% white, 70% female; age: 15.2 +/- 1.33 years; smoking: 18.8 +/- 8.56 CPD; Fagerstrom Test of Nicotine Dependence score: 7.04 +/- 1.29) from 1999 to 2003. Participants started smoking at 11.2 +/- 1.98 years of age and had been smoking daily for 2.66 +/- 1.56 years; 75% had at least 1 current psychiatric diagnosis. Mean compliance across groups was higher for the patch (mean: 78.4-82.8%) than for the gum (mean: 38.5-50.7%). Both the patch and gum were well tolerated, and adverse events were similar to those reported in adult trials. Changes in mean saliva cotinine concentrations throughout treatment were not statistically significant. Intent-to-treat analyses of all randomized participants showed CO-confirmed prolonged abstinence rates of 18% for the active-patch group, 6.5% for the active-gum group, and 2.5% for the placebo group; the difference between the active-patch and placebo arms was statistically significant. There was no significant effect of patch versus gum or gum versus placebo on cessation outcomes. Abstinence rates at the 3-month follow-up assessment were sustained but were not significantly associated with treatment group. Mean smoking rates, but not CO or thiocyanate concentrations, decreased significantly in all 3 arms but not as a function of treatment group.

CONCLUSIONS

Nicotine patch therapy combined with cognitive-behavioral intervention was effective, compared with placebo, for treatment of tobacco dependence among adolescent smokers. Decreases in the numbers of cigarettes smoked appeared to be offset by compensatory smoking. Additional study of nicotine gum, with enhanced instructional support, is needed to assess its efficacy among adolescent smokers.

Risk Factors Predicting Changes in Marijuana Involvement in Teenagers

BACKGROUND

Marijuana use during adolescence has various adverse psychological and health outcomes. It is poorly understood whether the same risk factors influence different stages in the development of marijuana involvement.

OBJECTIVE

To establish which risk factors best explain different stages of marijuana involvement.

DESIGN

Data were collected at 2 points using computer-assisted personal interview (wave 1 and wave 2 were separated by 1 year). Twenty-one well-established risk factors of adolescent substance use/abuse were used to predict 5 stages of marijuana involvement: (1) initiation of experimental use, (2) initiation of regular use, (3) progression to regular use, (4) failure to discontinue experimental use, and (5) failure to discontinue regular use. Data were analyzed using logistic regression analysis.

PARTICIPANTS

Middle school and high school students (N = 13 718, aged 11-21 years) participating in the National Longitudinal Study of Adolescent Health (Add Health).

RESULTS

Three risk factors (own and peer involvement with substances, delinquency, and school problems) were the strongest predictors of all stages. Their combined presence greatly increased risk of initiation of experimental (odds ratio, 20) and regular (odds ratio, 87) marijuana use over the next year. Personality, family, religious, and pastime factors exerted stage-specific, sex-specific, and age-specific influences.

CONCLUSIONS

Assessment of substance, school, and delinquency factors is important in identifying individuals at high risk for continued involvement with marijuana. Prevention and/or intervention efforts should focus on these areas of risk.

Effects of different nicotine replacement therapies on postcessation psychological responses

Transdermal nicotine patch (TN) and nicotine nasal spray (NS) are both efficacious forms of smoking cessation treatment, but have different pharmacokinetic properties and modes of action. To understand better psychological responses to treatment, we investigated the effects of TN versus NS on positive affect, negative affect, and withdrawal symptoms during treatment. Participants were randomly assigned to receive TN (n=172) or NS (n=163) plus seven sessions of behavioral counseling, and completed self-report questionnaires at pretreatment and during treatment. TN participants, but not NS participants, reported significant increases in positive affect during treatment. Increases in negative affect and withdrawal were observed, independent of treatment. Only changes in negative affect predicted relapse by the end of the treatment phase. These findings indicate that, although TN may enhance positive affect for smokers in treatment compared with NS, only changes in negative affect predict treatment outcome.

Smoking topography and trajectory of asthmatic adolescents requesting cessation treatment

BACKGROUND

Teenage smokers cite health concerns as their primary motivators for tobacco smoking cessation. Smoke exposure aggravates the clinical course of asthma, yet few reports have examined the association between asthma and smoking topography and trajectory.

METHODS

Before their enrollment in a smoking cessation trial, we assessed the smoking topography (i.e., puff volume, maximum puff velocity, puff duration, and interpuff interval) and smoking trajectory (i.e., age of first cigarette, age of daily smoking, time to treatment request, and prior quit attempts) in 30 self-reported asthmatic and 92 nonasthmatic tobacco-dependent teenagers (mean age, 15.2 +/- 1.3 years, 28.7% African-American). Approximately one-half of asthmatics used prescribed medications for their asthma.

RESULTS

There was no significant difference in smoking topography or smoking trajectory variables between asthmatic and nonasthmatic adolescents, nor between medicated and nonmedicated asthma subgroups.

CONCLUSIONS

Although tobacco smoking exacerbates asthmatic symptoms, these data suggest that age of smoking initiation, as well as smoking topography characteristics in asthmatic adolescents, does not differ from those of adolescents without asthma. These findings highlight the need for more effective health counseling of asthmatic youth regarding the physical and behavioral effects of smoking.

Smoking Topography Predicts Abstinence following Treatment with Nicotine Replacement Therapy

Objective: Smoking topography refers to how a person smokes a cigarette and includes measures of the number of puffs and puff volume, duration, and velocity. This study examined the relationship between smoking topography and abstinence from cigarettes following nicotine replacement therapy. A secondary objective was to determine the relationship of smoking topography to carbon monoxide (CO) exposure.

Method: Participants (n = 113) smoked one of their preferred brands of cigarette through a smoking topography device prior to participating in an open-label trial of transdermal nicotine versus nicotine nasal spray. A subset of participants (n = 50) provided breath CO samples prior to and following smoking the cigarette.

Results: Mean Vmax [odds ratio (OR), 1.12; 95% confidence interval (95% CI), 1.02-1.24; P = 0.02], mean puff volume (OR, 0.95; 95% CI, 0.91-0.98; P = 0.01), mean interpuff interval (OR, 1.06; 95% CI, 1.00-1.11; P = 0.03), and cigarette type (full flavor versus light/ultralight; OR, 0.35; 95% CI, 0.14-0.89; P = 0.03) were significant predictors of abstinence in a model controlling for treatment group and nicotine dependence. Controlling for time since last cigarette and initial CO level, mean puff velocity (β = 0.171; P = 0.01) was the only significant predictor of CO boost.

Conclusion: These results suggest that smoking topography may be useful to predict abstinence after using nicotine replacement therapy and to assess harm from smoking.

Smoking topography predicts abstinence following treatment with nicotine replacement therapy

OBJECTIVE

Smoking topography refers to how a person smokes a cigarette and includes measures of the number of puffs and puff volume, duration, and velocity. This study examined the relationship between smoking topography and abstinence from cigarettes following nicotine replacement therapy. A secondary objective was to determine the relationship of smoking topography to carbon monoxide (CO) exposure.

METHOD

Participants (n = 113) smoked one of their preferred brands of cigarette through a smoking topography device prior to participating in an open-label trial of transdermal nicotine versus nicotine nasal spray. A subset of participants (n = 50) provided breath CO samples prior to and following smoking the cigarette.

RESULTS

Mean V(max) [odds ratio (OR), 1.12; 95% confidence interval (95% CI), 1.02-1.24; P = 0.02], mean puff volume (OR, 0.95; 95% CI, 0.91-0.98; P = 0.01), mean interpuff interval (OR, 1.06; 95% CI, 1.00-1.11; P = 0.03), and cigarette type (full flavor versus light/ultralight; OR, 0.35; 95% CI, 0.14-0.89; P = 0.03) were significant predictors of abstinence in a model controlling for treatment group and nicotine dependence. Controlling for time since last cigarette and initial CO level, mean puff velocity (beta = 0.171; P = 0.01) was the only significant predictor of CO boost.

CONCLUSION

These results suggest that smoking topography may be useful to predict abstinence after using nicotine replacement therapy and to assess harm from smoking.

Olanzapine attenuates cue-elicited craving for tobacco

RATIONALE

Recent biological conceptualizations of craving and addiction have implicated mesolimbic dopamine activity as a central feature of the process of addiction. Imaging, and pharmacological studies have supported a role for dopaminergic structures in cue-elicited craving for tobacco.

OBJECTIVE

If mesolimbic dopamine activity is associated with cue-elicited craving for tobacco, a dopamine antagonist should attenuate cue-elicited craving for tobacco. Thus, the aim of the present study was to determine whether an atypical antipsychotic (olanzapine, 5 mg) decreased cue-elicited craving for tobacco.

METHOD

Participants were randomly assigned to 5 days of pretreatment with olanzapine (5 mg; n=31) or were randomly assigned to 5 days of a matching placebo (n=28). Approximately 8 h after the last dose, participants were exposed to a control cue (pencil) followed by exposure to smoking cues. Participants subsequently smoked either nicotine cigarettes or de-nicotinized cigarettes.

RESULTS

Olanzapine attenuated cue-elicited craving for tobacco but did not moderate the subjective effects of smoking.

DISCUSSION

This study represents one of the first investigations of the effect of atypical antipsychotics on cue-elicited craving for tobacco. The results suggest that medications with similar profiles may reduce cue-elicited craving, which in turn, may partially explain recent observations that atypical antipsychotics may reduce substance use.

Predictors of smoking development in a population-based sample of adolescents: a prospective study

PURPOSE

To study the development of smoking behavior in adolescents using a longitudinal, multivariate design.

METHODS

Adolescents (n = 14,133, age range 12 to 18 years) took part in the longitudinal Add Health study (two waves, separated by 1 year, 56% smokers and 44% nonsmokers at Wave 1). Eight risk factor domains were established at Wave 1 (daily activities, psychological health, personality, school situation, family functioning, rough living, religion, and neighborhood status), which were further separated into subdomains by factor analysis. Subdomains were used to predict risk at Wave 2 of smoking initiation, progression, or failure to discontinue, using logistic regression analysis. Analyses were performed for boys and girls separately and results corrected for age, race, urbanicity, and socioeconomic status.

RESULTS

Use/abuse of other substances by self and peers influenced most stages of smoking, whereas trouble in school was associated with initiation and progression of smoking. Poor family relations predicted initiation of experimental smoking for girls, whereas low involvement in active pastimes predicted failure to discontinue experimental smoking. For boys, low religiosity predicted progression to regular smoking and failure to quit regular smoking, whereas delinquency also reduced success of regular smoking discontinuation.

CONCLUSIONS

These findings may direct efforts for prevention and intervention of adolescent smoking behavior and may also provide guidance for future studies.

History of marijuana use and tobacco smoking topography in tobacco-dependent adolescents

Adolescent tobacco smokers have higher rates of marijuana (MJ) use than nonsmokers. Because MJ smoking typically involves deeper inhalation and longer breathholding than tobacco smoking, we hypothesized greater puff volume, longer puff duration and puff interval, and higher puff velocity during tobacco smoking among (1) MJ-using teens; (2) teens whose onset of MJ smoking occurred before tobacco (MBT). One hundred and three tobacco-dependent adolescents presented for smoking cessation treatment (66.0% female, 71.0% European American, mean age 15.3+/-1.25 years) smoked one cigarette of their own brand in the laboratory prior to study entry. Topography and associated physiological measures among current recreational (<5 days in a 14-day period) MJ users (n=25), current heavy (>/=5 days in a 14-day period) MJ users (n=22) and current non-MJ-smoking teens (n=56) were compared. There were no differences in tobacco smoking topography or physiological measures by recent MJ-smoking history or by order of substance initiation. Significantly more African American than European American adolescent smokers reported MJ use before tobacco. Our findings in adolescent smokers are consistent with results from adult studies in which history of MJ smoking was not associated with changes in tobacco smoking topography.