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Addicted to green: priming effect of menthol cigarette packaging on brain response to smoking cues
  1. Zhenhao Shi1,
  2. An-Li Wang2,
  3. Victoria P Fairchild3,
  4. Catherine A Aronowitz1,
  5. Kevin G Lynch1,
  6. James Loughead1,
  7. Daniel D Langleben1,4
  1. 1Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
  2. 2Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
  3. 3Department of Psychology, City University of New York, New York, New York, USA
  4. 4Annenberg Public Policy Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Zhenhao Shi, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA; zhshi{at}pennmedicine.upenn.edu

Abstract

Introduction Mentholated tobacco cigarettes are believed to be more addictive than non-menthol ones. Packaging of most menthol cigarette brands includes distinctive green hues, which may act as conditioned stimuli (ie, cues) and promote menthol smoking. To examine the cue properties of menthol cigarette packaging, we used a priming paradigm to assess the effect of packaging on the neural substrates of smoking cue reactivity. We hypothesised that menthol packaging will exert a specific priming effect potentiating smoking cue reactivity in menthol compared with non-menthol smokers.

Methods Forty-two menthol and 33 non-menthol smokers underwent functional MRI while viewing smoking and neutral cues. The cues were preceded (ie, primed) by briefly presented images of menthol or non-menthol cigarette packages. Participants reported craving for cigarettes in response to each cue.

Results Menthol packaging induced greater frontostriatal and occipital smoking cue reactivity in menthol smokers than in non-menthol smokers. Menthol packaging also enhanced the mediation by neural activity of the relationship between cue exposure and cigarette craving in menthol but not non-menthol smokers. Dynamic causal modelling showed stronger frontostriatal-occipital connectivity in response to menthol packaging in menthol compared with non-menthol smokers. The effects of non-menthol packaging did not differ between categories of smokers.

Conclusions Our findings demonstrate heightened motivational and perceptual salience of the green-hued menthol cigarette packaging that may exacerbate menthol smokers’ susceptibility to smoking cues. These effects could contribute to the greater addiction severity among menthol smokers and could be considered in the development of science-based regulation and legal review of tobacco product marketing practices.

  • addiction
  • nicotine
  • packaging and labelling
  • public policy

Data availability statement

Data are available upon reasonable request. Open access individual human participant data deposition poses privacy and legal concerns, therefore data will be made available to researchers upon reasonable request from and approval of the University of Pennsylvania Office of Research Services, Franklin Building Annex, P-221 FB/6205, 3451 Walnut Street, Philadelphia, PA 19104-6205, phone 215-573-6707, fax 215-898-9708, http://www.upenn.edu/researchservices.

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Data availability statement

Data are available upon reasonable request. Open access individual human participant data deposition poses privacy and legal concerns, therefore data will be made available to researchers upon reasonable request from and approval of the University of Pennsylvania Office of Research Services, Franklin Building Annex, P-221 FB/6205, 3451 Walnut Street, Philadelphia, PA 19104-6205, phone 215-573-6707, fax 215-898-9708, http://www.upenn.edu/researchservices.

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Footnotes

  • ZS and A-LW contributed equally.

  • Contributors ZS, A-LW and DDL designed the study. ZS, A-LW, VPF, CAA and DDL collected the data. ZS, VPF and CAA organised the data. ZS and KGL analysed the data. ZS, KGL, JL and DDL interpreted the results. ZS and DDL wrote the manuscript. All authors contributed to the revision of the manuscript for critical intellectual content and approved the final version.

  • Funding Research reported in this publication was supported by the National Institute on Drug Abuse (NIDA) of the National Institutes of Health (NIH) and the Center for Tobacco Products (CTP) of the Food and Drug Administration (FDA) under award number R01DA036028 (PI: DDL).

  • Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the FDA.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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