Elsevier

Drug and Alcohol Dependence

Volume 238, 1 September 2022, 109580
Drug and Alcohol Dependence

Short communication
Menthol preference moderates the relationship between cigarette nicotine content choice and reactions in young adults who smoke infrequently

https://doi.org/10.1016/j.drugalcdep.2022.109580Get rights and content

Highlights

  • Young adults who smoke infrequently smoked from varied nicotine content cigarettes.

  • Menthol group did not have increased negative reactions to greater nicotine content.

  • Cigarette choice and positive reactions were only related in non-menthol group.

  • Menthol ban and nicotine reduction standard must be coupled for this population.

Abstract

Background

Half of young adults who smoke use menthol cigarettes, which is associated with continued smoking and greater nicotine dependence. Additionally, early subjective reactions to cigarettes predict future use. Menthol may blunt the sensory effects of nicotine. We investigated the moderating role of menthol on subjective reactions to, and choice of varied nicotine content cigarettes in young adults who smoke infrequently.

Methods

In three counterbalanced, double-blinded sessions, young adults who smoke ≤ 15 days/month smoked fixed doses from very low (VLNC), intermediate (INC), and normal (NNC) nicotine content cigarettes, which were menthol or non-menthol depending on preference. Participants chose their preferred cigarette in a final session. Positive and negative subjective reactions were measured in each session. ANOVA tests investigated the relationship between menthol preference, nicotine content, and subjective reactions.

Results

Participants (N = 87) were 18–25 years old and reported smoking 15.2 cigarettes per month over 8 days (35 % menthol). Non-menthol preferring participants had increased negative reactions with greater nicotine content (F(1, 55)= 10.76, p < .001); menthol preferring participants did not. Choice of higher nicotine cigarettes was associated with having reported a greater difference in positive reactions to NNC and VLNC for non-menthol preferring participants (F(1, 55)= 12.72, p < .001) but not for menthol preferring participants.

Conclusions

Young adults who smoke infrequently are a priority tobacco control population given their high risk of transitioning to daily smoking. Results from this study in the form of subjective reactions indicate that a menthol ban is required for a nicotine reduction standard to be maximally effective in this vulnerable group.

Introduction

Cigarette consumption in the U.S. between 2000 and 2018 decreased by 46 %, yet menthol smoking notably decreased at half the rate of non-menthol smoking (Delnevo et al., 2020). Menthol flavoring provides a cooling sensation, reducing the throat irritation caused by smoking cigarettes (Klausner, 2011, Kreslake et al., 2008). This desirable sensory experience contributes to positive ratings on qualities like taste and mildness (Strasser et al., 2013), as well as a decreased harm perception by young adults (Brennan et al., 2015, Klausner, 2011, van der Eijk et al., 2021). Consequently, 50 % of U.S. 18–25 year-olds who smoke report using menthol cigarettes (Villanti et al., 2016), and menthol cigarette smoking in youth and young adults is associated with increased nicotine dependence and progression to regular smoking (Collins and Moolchan, 2006, Mantey et al., 2021, Villanti et al., 2021). Menthol plays an important role in subjective reactions to cigarettes, which are essential to consider in this population, as positive early smoking experiences are associated with nicotine dependence and future smoking (Hu et al., 2006, Urbán, 2010). Evidence suggests that negative early experiences mitigate the risk of future smoking (Urbán, 2010, Zabor et al., 2013), although one study found no association (Pomerleau et al., 1998).

The U.S. Food and Drug Administration (FDA) has the authority to reduce nicotine content in cigarettes (Congress, 2009). Reduced nicotine cigarettes decrease smoking and nicotine dependence and increase quit attempts among adults who smoke (Donny et al., 2015, Hatsukami et al., 2018). However, preliminary data suggest that the effects of a reduced nicotine standard may have differential effects among people who smoke menthol versus non-menthol cigarettes. In a clinical trial randomizing adults who smoke to either very low (VLNC) or normal (NNC) nicotine content cigarettes, the treatment effect of nicotine content on cigarettes per day was smaller for the menthol group than for the non-menthol group (−6.4 vs −9.3; Denlinger-Apte et al., 2019b). This effect may be due to decreased sensitivity to nicotine content among people who smoke menthol cigarettes. Karelitz and Perkins (2021), for instance, administered cigarettes of varied nicotine contents to adults who smoke and found a significant effect of nicotine content on subjective sensory perceptions for people using non-menthol cigarettes but not for those using menthol, indicating a blunting effect of menthol on subjective reactions.

In a prior study of young adults who smoke daily, menthol preference did not interact with cigarette nicotine content on subjective effects measured on the Cigarette Evaluation Scale (Denlinger-Apte et al., 2019a). However, the interactive effects of menthol preference and nicotine content remain unknown among young adults who smoke non-daily. It is important to study this group given they are at high risk of transitioning to daily smoking (Barrington-Trimis et al., 2020, Ganz and Delnevo, 2020), especially if they have positive early smoking experiences (Hu et al., 2006, Urbán, 2010). In a 2021 study, we evaluated subjective reactions to cigarettes of varied nicotine content among young adults who smoke infrequently, including trial sessions of cigarettes with three different nicotine doses followed by a choice session (Sweitzer et al., 2021). The current analysis evaluates (a) the interactive effects of menthol preference and nicotine content on subjective reactions, and (b) the interactive effects of menthol preference and cigarette choice on subjective reactions.

Section snippets

Participants

All participants provided written informed consent for the study. Eligible participants were between the ages of 18–25; generally healthy; used tobacco products between 1 and 15 days/month for at least 6 months; smoked at least 5 cigarettes/month; had a breath alcohol value = 0.000 at all study visits; and had their smoking status corroborated by two individuals familiar with their smoking habits. Participants were excluded if they reported any unstable medical or psychiatric condition; had a

Results

Participants (N = 87) were 18–25 years old and 49 % female. They reported smoking M= 15.2 cigarettes per month (SD=11.9) on M= 8 days (SD=3.6); 35 % smoked menthol cigarettes. There were no significant demographic differences between menthol versus non-menthol smoking participants (Supplemental Table 1).

Discussion

The primary finding of the study is that menthol moderates the relationship between choice behavior and positive reactions to nicotine content in young adults who smoke infrequently. Choice and positive reactions to nicotine content are only related among people who prefer non-menthol cigarettes. There was no discernible pattern in the menthol preference group suggesting they were less sensitive to the differential positive effects of nicotine content. Therefore, under a nicotine reduction

Funding

This research was supported by NIH, US grants R01 DA042532 (FJM), R03 CA252767 (RLD), and K23 DA039294 (MMS).

CRediT authorship contribution statement

Dana Rubenstein: Conceptualization, Formal analysis, Writing – original draft. Maggie Sweitzer: Conceptualization, Writing – review & editing. Lauren Scroggs: Writing – review & editing. Rachel Denlinger-Apte: Writing – review & editing. Rachel Kozink: Funding acquisition, Project administration, Writing – review & editing. Joseph McClernon: Conceptualization, Funding acquisition, Writing – review & editing, Supervision. All authors have approved the final article.

Acknowledgements

The authors would like to thank Lauren Pacek and Erin Locey for their contributions.

Declarations of interest

None.

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