TY - JOUR T1 - Addicted to green: priming effect of menthol cigarette packaging on brain response to smoking cues JF - Tobacco Control JO - Tob Control SP - e45 LP - e52 DO - 10.1136/tobaccocontrol-2021-056639 VL - 32 IS - e1 AU - Zhenhao Shi AU - An-Li Wang AU - Victoria P Fairchild AU - Catherine A Aronowitz AU - Kevin G Lynch AU - James Loughead AU - Daniel D Langleben Y1 - 2023/04/01 UR - http://tobaccocontrol.bmj.com/content/32/e1/e45.abstract N2 - 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.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. ER -