Community-Led Action to Reduce Menthol Cigarette Use in the African American Community.

Background. African Americans suffer a disproportionate burden of tobacco harm and researchers have posited that menthol cigarettes are a key contributor to this disparity. In 2015, a county health department and African American community-based organization (CBO) in Minnesota partnered to educate and engage the African American community on menthol and its role in tobacco-related health disparities. The following case study describes successes, challenges, and recommendations from this work. We focus on the role of a public health and community partnership in menthol policy adoption so others can more effectively implement a community-driven approach in their own communities. Methods. Interviews were conducted with local and state public health staff, leadership from the CBO, youth coordinators, and change agents-that is, leaders in the African American community recruited to educate and engage the community on menthol. Interviews were transcribed verbatim and analyzed in Atlas.ti using thematic analysis. Results. Participants identified several successes: (1) assessment data from community members helped inform policy decision making, (2) collaboration between local public health and CBO was powerful and a key to success, and (3) change agents were trusted communicators and effectively engaged and provided education to the community. Participants faced challenges related to stylistic and cultural differences in communication. Participants recommended engaging youth and incorporating cessation into the broader context of issues systemically affecting African American communities (e.g., economic inequity, police violence, incarceration). Implications. Menthol tobacco restrictions have the potential to reduce tobacco-related health inequities for African Americans. Findings highlight the role that public health and community partnerships can play in supporting this critical work to effect policy change.

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

AIMS: The cooling and minty flavor of menthol in cigarettes has been hypothesized to mask the harshness of inhaled cigarette smoke, contributing to menthol's appeal and subjective reinforcement and linking menthol use to smoking initiation, progression, nicotine dependence, and difficulty quitting. This study examined differences between menthol and non-menthol smokers on behavioral economic indices of reinforcing efficacy (i.e., demand) and subjective response to smoking (i.e., satisfaction, reward, "throat hit," aversion) and the association between measurements of reinforcement and subjective response. DESIGN: 600 current adult smokers were recruited from an online smoking cessation program. Following website enrollment, individuals completed a self-report measurement of subjective response to smoking (reward, satisfaction, aversion, "throat hit"), and a modified cigarette purchase task (CPT) to assess behavioral economic cigarette demand. FINDINGS: In bivariate and adjusted ANOVA models, menthol smokers reported greater subjective reward, satisfaction, and positive sensations in the throat ("throat hit") from smoking compared to non-menthol smokers; and those outcomes were also correlated with greater nicotine dependence and lower likelihood of a past-year quit attempt. Although cigarette demand was associated with smoking level, subjective smoking reward, and nicotine dependence, there were no differences in smoking demand between menthol vs. non-menthol smokers. CONCLUSIONS: The pleasurable aspects of menthol vs non-menthol smoking may be a mechanism linking it to greater nicotine dependence and difficulty quitting. A menthol ban could decrease population-level cigarette consumption by restricting smokers' access to a highly rewarding cigarette flavoring.

Passive Upper Airway Thermoregulation and High-Speed Assessment for Conventional versus Menthol Cigarette: Implications for Laryngeal Physiology.

PURPOSE: This investigation combined measures of upper airway temperature (UAT) with high-speed laryngeal imaging in an individual who smoked a filtered conventional and menthol cigarette to identify laryngeal vibratory differences with upper airway temperature change. It was hypothesized that (1) average UAT differences between trials would be similar with UAT change ≤2°C and (2) high-speed parameters would not differ between trials. METHOD: In a repeated measures design, UAT was measured continuously during smoking. High-speed laryngeal imaging was conducted immediately after each smoking trial and 10 minutes post. RESULTS: Average UAT and end-inspiratory temperature during the menthol trial was unexpectedly low. Immediately following both trials, there was an increase in phase asymmetry, vibratory amplitude (greater magnitude of change for the nonmenthol trial), and the opening phase of the glottal cycle and a decrease in fundamental frequency compared to the baseline. During recovery, parameters returned to the baseline for the nonmenthol trial, however, fundamental frequency continued to be lower and vibratory amplitude continued to be larger at recovery for the menthol trial. The measure of oscillatory onset time did not change across the trials immediately post cigarette trial and during recovery suggesting that smoking resulted in changes in sustained vibratory function rather than the onset behavior. CONCLUSIONS: Preliminary findings suggest that continuous thermal mapping and high-speed laryngeal function assessment may provide new information about the manner in which laryngeal tissue responds to passive thermal perturbations with direct implications for laryngeal epithelial and skeletal muscle function. Future large-scale studies are needed to investigate this in detail.

Peppermint and its respective active component in diets of broiler chickens: growth performance, viability, economics, meat physicochemical properties, and carcass characteristics.

This study was conducted to investigate effects of dietary peppermint leaves and menthol supplementations on performance, survivability rate, cost economics, meat physicochemical properties, and carcass characteristics of broiler chicks. A total of 384 1-day-old, unsexed Ross 308 broiler chicks, were divided into 2 experiments. Each experiment included 192 birds that were assigned to 4 dietary treatments that included peppermint leaves at concentrations of 0, 5, 10, or 15 g/kg in the first experiment or menthol at concentrations of 0, 26, 52, or 78 mg/kg in the second experiment. Each treatment had 6 replicate pens with 8 birds. The experiments lasted for 35 D. The peppermint leaves contained 1.48% essential oil that contained 35.1% menthol, and the levels of menthol were selected based on the concentrations in peppermint leaf levels. Body weight and body-weight gain increased with the increase in dietary peppermint leaves (linear, P < 0.01) and menthol concentrations (linear, quadratic, P < 0.01) during the trial periods. In addition, the feed intake linearly increased (P < 0.01) with increasing peppermint leaves or menthol levels and, in turn, caused linear improvements (P < 0.01) in feed conversion values. Interestingly, a lower mortality rate was recorded in the supplementation groups and, therefore, a higher net return was observed. However, pH values and drip loss percentage of breast and leg muscles were not affected by either dietary peppermint levels or menthol levels. Increasing peppermint or menthol levels decreased (P < 0.001) cook-loss percentage of breast and leg muscles. On the other hand, dietary supplementation of peppermint leaves or menthol had no effect (P ≥ 0.05) on the relative weights of dressing, breast, leg, liver, heart, gizzard, spleen, or pancreas. Interestingly, abdominal fat percentage was decreased by either supplemental peppermint or menthol. Hence, the present investigation demonstrates that peppermint leaves can be used as an effective novel nutritional bio-agent up to 15 g/kg to improve the performance of broiler chicks, mainly due to its active component.

Young adult dual combusted cigarette and e-cigarette users' anticipated responses to a nicotine reduction policy and menthol ban in combusted cigarettes.

BACKGROUND: The aim of the study was to assess young adult dual e-cigarette (EC) and combusted cigarette (CC) users' anticipated responses to a hypothetical very low nicotine content product standard and menthol ban in CC. METHODS: Data came from 240 young adult (18-29 years) dual CC and EC users recruited via Amazon Mechanical Turk between June 20-22, 2017. Descriptive statistics were used to report sample characteristics. McNemar's tests were used to assess differences between product categories in terms of anticipated responses to hypothetical regulations. RESULTS: A hypothetical very low nicotine content product standard in CC resulted in reported intentions to quit or reduce CC use and increase use of EC (p's<0.001). Hypothetical restrictions regarding the availability of menthol CC resulted in marginally significant reported intentions to increase EC use (p = 0.080). Anticipated responses to regulation were associated with baseline EC and CC use characteristics. CONCLUSIONS: This work provides preliminary evidence of the impact that regulations regarding nicotine content and menthol in CC may have on the use of EC among young adult dual users.

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

Introduction: Despite smoker interest in e-cigarettes as a harm reduction or cessation aid, many smokers prematurely discontinue vaping after trying a product. This study explored the role of early subjective sensory experiences in vaping persistence and desistance. Methods: African American menthol cigarette smokers aged ≥18 years (N = 15; M = 54.1 years; SD = 8.2), motivated to quit smoking, and interested in trying e-cigarettes were recruited in Washington, DC. Participants were followed for 3 weeks and provided menthol cigalike e-cigarettes after Week 1. Participants completed three interviews about their vaping experiences. Thematic analysis of responses was designed to understand the sensory aspects of vaping. Results: During the first 2 weeks of vaping, four participants reported a positive vaping experience while 11 reported decreased satisfaction. Salient sensory attributes of dissatisfaction included poor taste, insufficient throat hit, difficulty pulling, and a lack of "whole body" satisfaction compared to their preferred cigarette brand. Conclusions: The sensory experiences with a specific cigalike e-cigarette were related to vaping persistence and desistence. Although this was a small volunteer sample of African American menthol smokers motivated to quit smoking, 27% (N = 4) of participants with a positive vaping experience continued using the product, while 73% (N = 11) of participants' vaping experience was unsatisfactory across several experiential categories. In future research of e-cigarettes' efficacy as a smoking cessation or reduction aid, both device characteristics and smokers' expectations for these devices should be considered, so vapers do not expect the same taste sensations, throat sensations, and "whole body" satisfaction as they experienced with their menthol cigarettes. Implications: The subjective sensory experiences associated with initial e-cigarette product use are associated with use patterns. Subjective sensory experiences may also help understand the differences in the appeal, satisfaction, and harm-reduction potential of the rapidly evolving diverse types of products emerging in the marketplace. How products meet the sensory needs of smokers wanting to switch or quit smoking may influence adherence and success rates.

The tobacco endgame: it's all about behavior.

One of the ten great public health achievements in the 20th century was turning the tide on one of the greatest public health disasters of that century: the tobacco use and related disease epidemic. The premature death and disease caused by tobacco can be considered largely as a side-effect of tobacco use behavior and the disease of addiction. The spread of that disease was fostered by an industry that researched the behavioral and biological basis of tobacco use and addiction and applied its findings and knowledge to develop products and marketing approaches to increase the likelihood that people, especially young people, would try tobacco products and develop persistent use and addiction. Researchers outside of the tobacco industry also investigated the behavioral biology of tobacco use and their research has been critical in turning the tide of the tobacco and disease epidemic. The behavioral factors are considered vital to understand and address by United States Food and Drug Administration and Surgeon General, as well as the World Health Organization in their tobacco control efforts. This commentary discusses key behavioral factors in the rise and fall of the epidemic, as well as some of those increasingly discussed as potential contributors to the endgame.

Flavored tobacco use among Canadian students in grades 9 through 12: prevalence and patterns from the 2010-2011 youth smoking survey.

INTRODUCTION: This study examined patterns of use of flavored tobacco products in a nationally generalizable sample of Canadian students in grades 9 through 12 after the implementation of a national ban on certain flavored tobacco products. METHODS: Data from the 2010-2011 Youth Smoking Survey, a nationally generalizable sample of Canadian students in grades 9 through 12 (n = 31,396), were used to examine tobacco product use. Logistic regression models were used to examine differences in use of flavored tobacco products (cigarettes, pipes, little cigars or cigarillos, cigars, roll-your-own cigarettes, bidis, smokeless tobacco, water pipes, and blunt wraps) by sociodemographic and regional characteristics. RESULTS: Approximately 52% of young tobacco users used flavored products in the previous 30 days. Flavored tobacco use varied by product type and ranged from 32% of cigarette smokers reporting menthol smoking to 70% of smokeless tobacco users reporting using flavored product in the previous 30 days. The percentage of last-30-day users who used flavored tobacco was significantly higher in Quebec than in Ontario and significantly higher among youths who received weekly spending money than among those who received no money. CONCLUSION: More than half of tobacco users in grades 9 through 12 in Canada use flavored tobacco, despite a national ban on certain flavored tobacco products.

An assessment of the quality of care provided to orthognathic surgery patients through a multidisciplinary clinic.

The quality of care delivered to 74 patients undergoing orthognathic surgery was assessed using a patient satisfaction questionnaire and data collected from hospital case records. Surgical complications, hospital services, patient satisfaction, and impact on quality of life, were the main aspects considered. The majority of patients reported that their treatment objectives had been achieved and that they were satisfied with the quality of care provided. The main concern of the patients regarding the clinic was the waiting time before an appointment could be offered. Eating and breathing difficulties and low mood after surgery were the main reported complications. Sixty-three patients experienced post-operative weight loss. The importance of a nutritious, high calorie soft diet should be emphasised and the use of menthol inhalations following maxillary osteotomies should be considered more frequently. Clinicians should be aware of post-operative low mood, which may require psychological support. We developed a sensitive assessment battery with comprehensive parameters to audit quality of orthognathic surgery service, and recommend that a similar approach should be considered by teams which undertake management of orthognathic patients.

A cross-sectional study of menthol cigarette preference by 14- to 15-year-old smokers in New Zealand.

INTRODUCTION: This study investigates the epidemiology of menthol cigarette preference, its association with smoking initiation, and nicotine addiction measured by loss of autonomy among New Zealand adolescent smokers. METHODS: Data from the 2006-2009 national surveys among New Zealand Year 10 students (14-15 years old) were analyzed using multiple logistic regression. Menthol preference was an outcome variable; demographic factors and smoking status were covariates. Loss of autonomy and menthol preference were examined using multiple linear regression analysis. The Hooked on Nicotine Checklist measured loss of autonomy as an outcome variable. Menthol status, smoking status, and demographic factors were covariates. All analyses were controlled for clustering of data by school. RESULTS: Overall, 17.7% of New Zealand 14- to 15-year-old smokers in this study indicated a preference for menthol cigarette, with greater odds of menthol cigarette preference among girls (odds ratio [OR] = 2.43; 95% CI = 2.15-2.75), ethnic minorities (Maori OR = 1.21; 95% CI = 1.07-1.36, Asians OR = 2.24; 95% CI = 1.79-2.82, Pacific Islanders OR = 1.83; 95% CI = 1.52-2.19), smokers from high socioeconomic status schools (OR = 1.24; 95% CI = 1.03-1.49), when parents smoked (OR = 1.16; 95% CI = 1.03-1.31), and newer smokers (smoked 11-100 cigarettes OR = 1.16; 95% CI = 1.03-1.31, smoking on a monthly OR = 1.17; 95% CI = 1.00-1.37, and a weekly basis OR = 1.29; 95% CI = 1.15-1.44). No significant correlation was found among those who smoked 1-10 cigarettes in total (OR = 1.02; 95% CI = 0.86-1.20) nor was any correlation found between menthol preference and nicotine addiction measured by loss of autonomy (coef. = -.21, p value = .165). CONCLUSION: This study found inequalities in menthol cigarette preference among New Zealand adolescent smokers, consistent with patterns found in the United States but did not find any significant correlation between menthol preference and loss of autonomy.

Smoking-cessation prevalence among U.S. smokers of menthol versus non-menthol cigarettes.

BACKGROUND: The Food and Drug Administration currently is assessing the public health impact of menthol cigarettes. Whether menthol cigarettes pose increased barriers to quitting is a critical issue because previous declines in smoking prevalence have stalled. PURPOSE: To explore whether menthol cigarette smokers are less likely to quit than non-menthol smokers at the population level and whether this relationship differs by race/ethnicity. METHODS: Cross-sectional analyses of the 2003 and 2006/2007 Tobacco Use Supplement to the Current Population Survey were conducted in 2010. Multiple logistic regressions were used to calculate the adjusted odds of cessation for menthol smoking relative to non-menthol smoking. Five different sample restrictions were used to assess the robustness of the findings. RESULTS: In the broadest sample restriction, menthol smokers were less likely to have quit smoking (AOR=0.91, 95% CI=0.87, 0.96). This relationship holds among whites (AOR=0.93, 95% CI=0.88, 0.98) and blacks (AOR=0.81, 95% CI=0.67, 0.98). The magnitude of the relationship among Hispanics was similar to that among whites, but differed by Hispanic origin. Among those of Mexican origin, the AOR for menthol smokers was protective but not significant (AOR=1.29, 95% CI=0.99, 1.61), whereas among those of Puerto Rican origin, menthol smokers were less likely to have quit (AOR=0.57, 95% CI=0.37, 0.87). These findings were robust and significant in four of five sample restrictions. CONCLUSIONS: Smoking menthol cigarettes is associated with decreased cessation at the population level, and this association is more pronounced among black and Puerto Rican smokers. These findings support the recent calls to ban menthol flavoring in cigarettes.

A low-cost repellent for malaria vectors in the Americas: results of two field trials in Guatemala and Peru.

BACKGROUND: The cost of mosquito repellents in Latin America has discouraged their wider use among the poor. To address this problem, a low-cost repellent was developed that reduces the level of expensive repellent actives by combining them with inexpensive fixatives that appear to slow repellent evaporation. The chosen actives were a mixture of para-menthane-diol (PMD) and lemongrass oil (LG). METHODS: To test the efficacy of the repellent, field trials were staged in Guatemala and Peru. Repellent efficacy was determined by human-landing catches on volunteers who wore the experimental repellents, control, or 15% DEET. The studies were conducted using a balanced Latin Square design with volunteers, treatments, and locations rotated each night. RESULTS: In Guatemala, collections were performed for two hours, commencing three hours after repellent application. The repellent provided >98% protection for five hours after application, with a biting pressure of >100 landings per person/hour. The 15% DEET control provided lower protection at 92% (p < 0.0001). In Peru, collections were performed for four hours, commencing two hours after repellent application. The PMD/LG repellent provided 95% protection for six hours after application with a biting pressure of >46 landings per person/hour. The 20% DEET control provided significantly lower protection at 64% (p < 0.0001). CONCLUSION: In both locations, the PMD/LG repellent provided excellent protection up to six hours after application against a wide range of disease vectors including Anopheles darlingi. The addition of fixatives to the repellent extended its longevity while enhancing efficacy and significantly reducing its cost to malaria-endemic communities.

Menthol and nonmenthol cigarettes and smoke exposure in black and white women.

Purposes of this investigation were to compare smoke constituent exposure (CO and nicotine boosts) and smoking topography parameters between black and white women, and between women regularly using menthol or nonmenthol cigarettes. A two-factor factorial design with a sample of 37 women stratified by race and menthol or nonmenthol cigarette use was implemented. There were significant main and interaction effects of race and menthol/nonmenthol use on CO boost. Black women had a mean CO boost of 10.1 ppm vs. 7.2 ppm for white women, while women using nonmenthol cigarettes had a higher CO boost (mean = 10.6 ppm) compared to those regularly using menthol cigarettes mean = 6.5 ppm). White menthol smokers had the lowest CO boost of all subgroups. There was a trend for black women to have higher nicotine boost than white women (21.4 ng/ml vs. 15.9 ng/ml). Black women had nonsignificantly higher puff volumes compared to white women (mean = 48.4 vs. 43.5 ml), while nonmenthol smokers had nonsignificantly higher puff volumes than menthol smokers (mean = 48.5 vs. 42.7 ml). Lower CO boost with mentholated cigarettes suggests factors beyond mentholation may affect elevated smoke constituent exposure among black women.