Assessing Smoking Behavior and Exposure in Smokers Switching Between Menthol and Nonmenthol Cigarette Brands: Results of a Crossover Study

Authors:

Christina Watson (Presenter)
Centers for Disease Control and Prevention

Patricia Richter, Centers for Disease Control and Prevention
B. Rey de Castro, Centers for Disease Control and Prevention
Connie Sosnoff, Centers for Disease Control and Prevention
Jennifer Potts, Battelle Memorial Institute
Pamela Clark, University of Maryland
Joan McCraw, Centers for Disease Control and Prevention
Xizheng Yan, Centers for Disease Control and Prevention
David Chambers, Centers for Disease Control and Prevention
Clifford Watson, Centers for Disease Control and Prevention

Public Health Statement: Smoking menthol cigarettes can cause smokers to take larger, more frequent puffs, possibly increasing exposure to carcinogens found in tobacco smoke.

Purpose: How does menthol affect smoking behaviors and exposure to nicotine and lung carcinogens?

Methods/Approach

Study Design: Adult daily smokers were randomly assigned to alternate between 2 weeks of exclusively smoking a menthol test cigarette or a nonmenthol test cigarette. Urine and saliva were collected for biomarker measurements, carbon monoxide (CO) was measured, and participants smoked test cigarettes through a CreSS^® smoking topography device during 3 clinic visits. Participants turned in their cigarette butts from the test periods for determination of mouth-level nicotine and completed subjective questionnaires related to the test cigarettes.

Inclusion criteria: Self-identification as African American or Caucasian; 21 years of age or older; established smokers, defined as smoking daily, at least 6 cigarettes per day, and smoking for at least 3 years; flexibility in smoking unfamiliar brands and willingness to smoke both menthol and nonmenthol cigarettes; and, ability to attend 3 visits, each lasting approximately 2 hours.

Results

Summary of results: Statistical analysis was conducted using the PROC MIXED subroutine of the SAS/STAT software. Regardless of cigarette preference, participants had higher salivary cotinine when smoking the nonmenthol test cigarette. Conversely, mouth-level nicotine, puff volume, and puff duration were significantly higher when smoking the menthol brand. There were no significant differences detected in urine NNAL between the test cigarettes.

Conclusions/Implications

Summary of conclusions and public health impact:Mouth-level intake is a useful, non-invasive analytical tool for estimating exposure to carcinogens and other chemicals of public health concern. It can be applied to clinical or population-level studies and, unlike with some biomarkers, interpretation of mouth-level intake data is not confounded by non-tobacco sources of exposure to the chemicals of interest. Our results suggest that smoking menthol cigarettes can cause smokers to take larger, more frequent puffs, possibly increasing exposure to carcinogens found in tobacco smoke.