Higher nicotine and carbon monoxide levels in menthol cigarette smokers with and without schizophrenia

ArticleinNicotine & Tobacco Research 9(8):873-81 · August 2007with12 Reads
DOI: 10.1080/14622200701484995 · Source: PubMed
This study examined whether smoking menthol cigarettes was associated with increased biochemical measures of smoke intake. Expired carbon monoxide (CO) and serum nicotine and cotinine were measured in 89 smokers with schizophrenia and 53 control smokers immediately after smoking an afternoon cigarette. Serum nicotine levels (27 vs. 22 ng/ml, p = .010), serum cotinine levels (294 vs. 240 ng/ml, p = .041), and expired CO (25 vs. 21 ppm, p = .029) were higher in smokers of menthol compared with nonmenthol cigarettes, with no differences in 3-hydroxycotinine/cotinine ratios between groups when controlling for race. Backward stepwise linear regression models showed that, in addition to having a diagnosis of schizophrenia, smoking menthol cigarettes was a significant predictor of nicotine and cotinine levels. Individuals with schizophrenia or schizoaffective disorder smoked more generic or discount value brands (Basic, Doral, Monarch, USA, Wave, others) compared with control smokers (28% vs. 6%, p = .002) but did not smoke more brands with high nicotine delivery as estimated by the U.S. Federal Trade Commission method. Although rates of mentholated cigarette smoking were not higher in smokers with schizophrenia overall, they were significantly higher in non-Hispanic White people with schizophrenia compared with controls of the same ethnic/racial subgroup (51% vs. 28%, p<.0001). The higher exhaled CO in menthol smokers suggests that the higher nicotine levels are at least partly related to increased intake of smoke from menthol cigarettes, although menthol-mediated inhibition of nicotine metabolism also may be a factor. Menthol is an important cigarette additive that may help explain why some groups have lower quit rates and more smoking-caused disease.
    • "A paucity of published research , however, has focused on the link between mental health factors and menthol cigarette and other tobacco product use in young adult populations, despite the exceedingly high rates of menthol tobacco use in this age group. Of the few studies published linking menthol use to mental health, findings show that the prevalence of menthol cigarette smoking is high among those with severe psychological distress compared to those without [11, 27, 28] and that menthol smokers report worse general mental health than non-menthol smokers [29, 30]. One recent population-based study of young adults found that menthol cigarette smoking was correlated with marijuana use and binge drinking [31] , two healthrisk behaviors that are also robustly linked to psychiatric distress323334353637 . "
    [Show abstract] [Hide abstract] ABSTRACT: Background: Depression and anxiety are correlated with greater nicotine dependence, smoking persistence, and relapse back to smoking after a quit attempt. Menthol cigarette smoking, which is prevalent in young adults, is associated with nicotine dependence, progression to regular smoking, and worse cessation outcomes than non-menthol smoking. Few have established a link between menthol tobacco use, beyond just smoking, with mental health in this high-risk age group. This study examined the association of menthol tobacco use to anxiety and depression in a national sample of young adults. Methods: Data were from Waves 1 through 7 (n = 9720, weighted) of the Truth Initiative Young Adult Cohort, a national sample of men and women aged 18 to 34 assessed every 6-months. Demographics, past 30-day use of non-menthol and menthol tobacco products, and current alcohol, marijuana, and other drug use were assessed among those with depression and anxiety. Results: Thirty nine percent of current tobacco users used menthol as their preferred brand. Using a cross-sectional analysis (collapsed across waves), past 30-day menthol tobacco was uniquely associated with greater odds of both depression and anxiety, beyond the effects of demographic and substance correlates and non-menthol tobacco product use. Conclusions: Menthol is disproportionately used among young adults tobacco users with mental health problems, above and beyond the impact of a variety of other mental health and tobacco use risk factors. Findings suggest a strong link between menthol tobacco use and poor health outcomes. Policies should be developed to deter menthol tobacco use in vulnerable groups.
    Full-text · Article · Dec 2016
    • "In cigarettes, menthol has been shown to affect a smoker's exposure to nicotine [1], [2] and smokers who use mentholated cigarettes have lower cessation rates in standardized treatment programs than smokers who use non-menthol cigarettes [3], [4], [5] . Although many factors have been implicated in the initiation and dependence of menthol cigarettes, earlier studies showed that menthol itself inhibits nicotine metabolism [1] and that menthol cigarette smoking leads to elevated serum nicotine and cotinine levels and greater exhaled carbon monoxide (CO) levels [2]. These elevated levels of nicotine may influence smoking dependence and intake since nicotine mediates most of the pharmacological and addictive properties of tobacco. "
    [Show abstract] [Hide abstract] ABSTRACT: Although menthol, a common flavoring additive to cigarettes, has been found to impact the addictive properties of nicotine cigarettes in smokers little is known about its pharmacological and molecular actions in the brain. Studies were undertaken to examine whether the systemic administration of menthol would modulate nicotine pharmacokinetics, acute pharmacological effects (antinociception and hypothermia) and withdrawal in male ICR mice. In addition, we examined changes in the brain levels of nicotinic receptors of rodents exposed to nicotine and menthol. Administration of i.p. menthol significantly decreased nicotine's clearance (2-fold decrease) and increased its AUC compared to i.p. vehicle treatment. In addition, menthol pretreatment prolonged the duration of nicotine-induced antinociception and hypothermia (2.5 mg/kg, s.c.) for periods up to 180 min post-nicotine administration. Repeated administration of menthol with nicotine increased the intensity of mecamylamine-precipitated withdrawal signs in mice exposed chronically to nicotine. The potentiation of withdrawal intensity by menthol was accompanied by a significant increase in nicotine plasma levels in these mice. Western blot analyses of α4 and β2 nAChR subunit expression suggests that chronic menthol impacts the levels and distribution of these nicotinic subunits in various brain regions. In particular, co-administration of menthol and nicotine appears to promote significant increase in β2 and α4 nAChR subunit expression in the hippocampus, prefrontal cortex and striatum of mice. Surprisingly, chronic injections of menthol alone to mice caused an upregulation of β2 and α4 nAChR subunit levels in these brain regions. Because the addition of menthol to tobacco products has been suggested to augment their addictive potential, the current findings reveal several new pharmacological molecular adaptations that may contribute to its unique addictive profile.
    Full-text · Article · Sep 2015
    • "Laboratory-based studies have also yielded mixed results because of compliance issues that require established menthol or nonmenthol cigarette smokers to use the opposite cigarette style for the extended periods necessary to compare classic measures of toxicity [7]. For example, when comparing biomarkers of exposure between menthol and nonmenthol smokers (e.g., cotinine, carbon monox- ide [CO]), some studies showed decreased levels, some increased, and some no difference [4,17181920212223. The reason for this may be that commercial cigarettes are so highly engineered that there are many significant differences between menthol and nonmenthol cigarettes other than menthol levels. "
    [Show abstract] [Hide abstract] ABSTRACT: In the U.S. menthol remains the sole permitted characterizing cigarette flavor additive in part because efforts to link menthol cigarette use to increased tobacco-related disease risk have been inconclusive. To perform definitive studies, cigarettes that differ only in menthol content are required, yet these are not commercially available. We prepared research cigarettes differing only in menthol content by deposition of L-menthol vapor directly onto commercial nonmenthol cigarettes, and developed a method to measure a cigarette's menthol and nicotine content. With our custom-mentholation technique we achieved the desired moderately high menthol content (as compared to commercial brands) of 6.7 ± 1.0 mg/g (n = 25) without perturbing the cigarettes’ nicotine content (17.7 ± 0.9 mg/g [n = 25]). We also characterized other pertinent attributes of our custom-mentholated cigarettes, including percent transmission of menthol and nicotine to mainstream smoke and the rate of loss of menthol over time during storage at room temperature. We are currently using this simple mentholation technique to investigate the differences in human exposure to selected chemicals in cigarette smoke due only to the presence of the added menthol. Our cigarettes will also aid in the elucidation of the effects of menthol on the toxicity of tobacco smoke.
    Full-text · Article · Dec 2014
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