Short communicationShorter time to first cigarette of the day in menthol adolescent cigarette smokers
Introduction
Menthol smoking is thought to contribute to the addictiveness of smoking by several mechanisms. Menthol cigarettes contain on average more nicotine than non-menthol cigarettes. Of the preferred brands smoked by the current youth sample, the average nicotine content for menthol cigarettes was 1.2 mg vs. 1.1 mg for non-menthol cigarettes (FTC File No. 992 3169). Menthol has also been shown to decrease the metabolism of nicotine, which results in greater nicotine exposure (Benowitz, Herrera, & Jacob, 2004). Additionally, both cooling and anesthetizing effects of menthol (resulting in decreased peripheral burn by inhaled smoke) and tobacco industry promotional messages contribute to the perception of less harm from smoking menthol compared to non-menthol cigarettes (Ahijevych and Parsley, 1999, Eccles, 1994).
Recent studies have documented the high prevalence of menthol smoking in youth (Giovino et al., 2004, Moolchan, 2004), a time when lifelong behaviors are being established. Given this and the concern of increased addictiveness of smoking associated with smoking mentholated cigarettes, the aim of the current analysis was to examine differences in consumption, commonly used markers of dependence, and morning smoking urgency between menthol and non-menthol adolescent smokers. Thus, we compared the number of cigarettes per day (CPD) and Fagerstrom Test for Nicotine Dependence (FTND) (Heatherton, Kozlowski, Frecker, & Fagerstrom, 1991) scores among menthol and non-menthol smokers requesting participation in a cessation trial. Various scoring systems have been applied to measures of consumption (such as CPD) in assessing dependence among adolescent smokers (e.g. Prokhorov et al., 1996, Rojas et al., 1998), with arguable validity (Colby, Tiffany, Shiffman, & Niaura, 2000). In a previous study, the Heavy Smoking Index (HSI) was the most valid measure of nicotine dependence self-report (Heatherton, Kozlowski, Frecker, Rickert, & Robinson, 1989). Smoking rates have also been shown to vary substantially according to ethnic and genetically determined differences in nicotine metabolism, thus impacting scores of all Fagerstrom-derived instruments. Hence, we also compared the two groups for time to first cigarette of the day (TTF), an item of both the FTND and the HSI (Heatherton et al., 1989), as a marker of smoking urgency after overnight abstinence.
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Methods
All data for the current analysis were collected from a telephone interviewing process by trained staff to recruit volunteer adolescent smokers for a cessation treatment study. Items included, (1) “How soon after you get up in the morning do you smoke your first cigarette?”, (2) “Number of cigarettes smoked per day?”, (3) “Do you still smoke if you are sick and in bed for most of the day?”, (4) “Do you find it difficult to refrain from smoking in forbidden places?”, (5) “Would it bother you to
Results
Of 1347 interviews, 572 adolescent smokers had complete data on variables needed for this analysis. Demographic characteristics of the sample are shown in Table 1.
Of this sample, 531 reported smoking menthol cigarettes and 41 reported smoking non-menthol as their usual brand (Fig. 1). Independent t tests showed no statistically significant difference in FTND score or CPD between the two groups. We then proceeded to compare groups on the various time categories of the FTND.
A one-tailed Fisher's
Discussion
The main finding of this study is that adolescent menthol cigarette smokers had shorter TTF cigarette of the day when compared to non-menthol adolescent cigarette smokers, despite a lack of group differences in FTND scores or smoking rates (CPD). Greater smoking urgency among adolescent menthol smokers may provide a clinical indication of dependence not captured by overall consumption or FTND because of metabolic differences. While the FTND was shown to be an effective tool in measuring tobacco
Acknowledgements
The authors wish to thank the dedicated staff of the Teen Tobacco Addiction Treatment Research Clinic for valiant efforts to assist teen smokers. We also thank Jennifer Schroeder, Ph.D. for statistical support. Supported by funds from the National Institute on Drug Abuse, Intramural Research Program.
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