Addiction and Behavior Related to Menthol Cigarette Substitutes

NCT04844762 | Completed Results DMC

• 2 other identifiers: OSU-191451R21DA046333-01A1
• Study Type: interventional
• Target: 120
• Locations: 1 country
• Sites: 1

Brief Summary

The goal of the proposed study is to examine the abuse liability and substitutability of plausible menthol cigarette alternatives currently on the market, including menthol filtered little cigars (mFLC), menthol roll-your-own (mRYO) pipe tobacco and cigarette tubes, and non-menthol cigarettes (nmC). In addition, the study will elucidate real-time mechanisms including product characteristics and perceived effects associated with greater substitution.

Conditions

Smoking (Tobacco) Addiction

Keywords

Menthol cigarettes

Outcome Measures

Primary Outcomes (16)

• Puffing Topography: Puff Duration

  Average puff duration for each participant, in seconds.

  Phase 1, Four visits; 20 minute puffing session in total.

• Puffing Topography: Inter-puff-interval

  Inter-puff-interval, the average time between each puff for each participant, in seconds.

  Phase 1, Four visits; 20 minute puffing session in total.

• Puffing Topography: Puff Flow Rate

  Puff flow rate, the average rate of air flow during each puff for each participant, in ml/second.

  Phase 1, Four visits; 20 minute puffing session in total.

• Puffing Topography: Total Puff Volume

  The total volume of all puffs taken for each participant, in ml.

  Phase 1, Four visits; 20 minute puffing session in total.

• Drug Effects/Liking Questionnaire

  An adapted version of the Drug Effects/Liking Questionnaire will assess the desire and liking of UBMC and all three study products, positive and negative effects (i.e., side effects), and perceived strength and effectiveness. Five visual analog scale items ranging from 0 ('not at all') to 100 ('extremely') assessed wanting to smoke the product again, liking the product, enjoying the product, finding the product pleasurable and satisfying.

  Phases 1 and 3 - Up to 3 weeks

• Modified Cigarette Evaluation Questionnaire (mCEQ)

  The modified Cigarette Evaluation Questionnaire (mCEQ) will assess subjective responses to cigarettes (e.g., reward, satisfaction). The 11-item mCEQ includes five subscales: Smoking Satisfaction, Psychological Reward, Aversion, Enjoyment of Respiratory Tract Sensations, and Craving Reduction, with items rated from 1 (not at all) to 7 (extremely likely). Items are averaged to create each of the subscales also ranging from 1 to 7 with higher values indicating greater levels of smoking satisfaction, psychological reward, aversion, enjoyment of respiratory tract sensations, an craving reduction.

  Phase 1 - Up to 2 weeks

• Modified Cigarette Evaluation Questionnaire (mCEQ)

  The modified Cigarette Evaluation Questionnaire (mCEQ) will assess subjective responses to cigarettes (e.g., reward, satisfaction). The 11-item mCEQ includes five subscales: Smoking Satisfaction, Psychological Reward, Aversion, Enjoyment of Respiratory Tract Sensations, and Craving Reduction, with items rated from 1 (not at all) to 7 (extremely likely). Items are averaged to create each of the subscales also ranging from 1 to 7 with higher values indicating greater levels of smoking satisfaction, psychological reward, aversion, enjoyment of respiratory tract sensations, an craving reduction.

  Phase 3 - Approximately 3 hours

• Cigarette Purchase Task

  The Cigarette Purchase Task will ask participants how much they would be willing to pay (ranging from 0 cents to $1) to smoke each product. Given that the study products will look similar to cigarettes, we will retain the original language (e.g., 1 cigarette) in the purchase task. Willingness to spend more will indicate greater abuse liability. Pmax (the price associated with the maximal expenditure, i.e., the highest price before the curve changes from inelastic to elastic), and breakpoint (the last price in which consumption is greater than 0) are reported.

  Phase 1 - Up to 2 weeks

• Cigarette Purchase Task

  The Cigarette Purchase Task will ask participants how much they would be willing to pay (ranging from 0 cents to $1) to smoke each product. Given that the study products will look similar to cigarettes, we will retain the original language (e.g., 1 cigarette) in the purchase task. Willingness to spend more will indicate greater abuse liability. Pmax (the price associated with the maximal expenditure, i.e., the highest price before the curve changes from inelastic to elastic), and breakpoint (the last price in which consumption is greater than 0) are reported.

  Phase 3 - Approximately 3 hours

• Tiffany-Drobes Questionnaire of Smoking Urges: Brief Form (Modified)

  Smoking urges/craving will be measured using the Tiffany-Drobes Questionnaire of Smoking Urges: Brief Form. This is a 10-item measure where participants rate smoking-related items (All I want right now is a cigarette) on a 7-point Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree). Similar to previous studies, we will collapse the items into two previously identified factors (Factor 1: strong desire and intention to smoke; Factor 2: anticipation of relief from withdrawal symptoms). Scores are calculated by summing the items and range from 5 to 35 with higher scores indicating greater craving to smoke.

  Phase 1-3 - Up to 3 weeks

• Minnesota Nicotine Withdrawal Scale

  Nicotine withdrawal will be assessed using the empirically validated 15-item version of the Minnesota Nicotine Withdrawal Scale (MNWS). Items were rated on a 5-point scale from 0 (none) to 4 (severe). This measure assesses smoking craving, anger/irritability, anxiety, depressed mood, restlessness/difficulty concentrating, increased appetite, sleep problems, and somatic symptoms (nausea, constipation, sore throat, dizziness, coughing). MNWS is the sum of 7 items with scores ranging from 0 to 28 and MNWS Craving is a single item with scores ranging from 0 to 4, higher scores indicate a greater craving.

  Phase 1-3 - Up to 3 weeks

• Subjective Effects (EMA)

  Subjective effects (EMA) of the Phase 2 substitute product will be derived from daily diary EMAs assessing product satisfaction and pleasure. Self-report measure with items rated from 1 (not at all) to 7 (extremely).

  Phase 2 - 1 week

• Cross Price Elasticity Task

  A Cross-Price Task in Phases 1 and 3 will estimate substitutability of the study product for the UBMC. Participants will be asked how many study products and UBMCs they would consume when the price of the study product is fixed at $1 and the UBMC prices escalate. The data are then fit to an exponential equation that indicates whether the fixed-price product substitutes for the primary product, and the degree of substitution. Cross price elasticity (CPE) for each study product compared to UBMC \> 0.2 indicates substitution, CPE \< -0.2 indicates complementarity, and CPE between -0.2 and 0.2 indicate independence of the two products.

  Phases 1 - Up to 2 weeks

• Cross Price Elasticity Task

  A Cross-Price Task in Phases 1 and 3 will estimate substitutability of the study product for the UBMC. Participants will be asked how many study products and UBMCs they would consume when the price of the study product is fixed at $1 and the UBMC prices escalate. The data are then fit to an exponential equation that indicates whether the fixed-price product substitutes for the primary product, and the degree of substitution. Cross price elasticity (CPE) for each study product compared to UBMC \> 0.2 indicates substitution, CPE \< -0.2 indicates complementarity, and CPE between -0.2 and 0.2 indicate independence of the two products.

  Phase 3 - Approximately 3 hours

• Progressive Ratio Task (UBMC vs. Study Product)

  The PR task will simulate the effect that restricting menthol in cigarettes would have on increasing (or not) preference for other alternative menthol substitutes. Participants will complete a 90-minute concurrent choice task with different cost (effort) required to earn the reinforcement (2 puffs) from their UBMC and the study product (mFLC or mRYO). Puffs from the study product can be earned by clicking a computer mouse 10 times on a picture of the study product, but to earn two puffs of the UBMC, they will required to make escalating response requirements (computer mouse clicks) according to the following schedule: 10, 160, 320, 640, 1280, 2400, 3600, 4800, 6000, 7200, and 8400. A maximum of 10 reinforcers (20 puffs) per session will be allowed. Participants will be informed of the different sequence between products and instructed that the session are 3 hours in length no matter how much or how little they respond.

  Phase 3 - Approximately 3 hours

• Use Behavior (EMA)

  Participants will receive on EMA delivered randomly during the day and an evening daily diary (around 30mins before bedtime). Random EMAs will assess: mood, affect, nicotine craving and withdrawal symptoms, stress, recency of smoking, alcohol use, current setting, and switching self-efficacy; daily diary EMAs will assess UBMC/study product smoked per day, product satisfaction and pleasure. Substitution assessed via use behavior during Phase 2 will be operationalized as the ratio of study product to UBMC used, with a ratio \> 0 indicating any substitution and a ratio \> 1 indicating substitution of study product for the UBMC at least 50% of the time.

  Phase 2 - 1 week

Study Arms (4)

usual brand menthol cigarette (UBMC)

ACTIVE COMPARATOR

Study participant's usual brand menthol cigarette

Behavioral: Menthol cigarettes substitutes; Behavioral: Menthol cigarettes substitutes and menthol cigarettes

menthol roll-your-own cigarette (mRYO)

ACTIVE COMPARATOR

Mentholated pipe tobacco in a roll-your-own cigarette tube

Behavioral: Menthol cigarettes substitutes; Behavioral: Usual brand menthol cigarettes and substitutes; Behavioral: Menthol cigarettes substitutes and menthol cigarettes

menthol filtered little cigar (mFLC)

ACTIVE COMPARATOR

The menthol filtered cigar will be Cheyenne (Cheyennecigars.com) Seneca (senecacigars.com)

Behavioral: Menthol cigarettes substitutes; Behavioral: Usual brand menthol cigarettes and substitutes; Behavioral: Menthol cigarettes substitutes and menthol cigarettes

non-menthol cigarette (nmC)

ACTIVE COMPARATOR

The non-menthol cigarette will be Newport non-menthol cigarettes.

Behavioral: Menthol cigarettes substitutes; Behavioral: Usual brand menthol cigarettes and substitutes; Behavioral: Menthol cigarettes substitutes and menthol cigarettes

Interventions

Menthol cigarettes substitutes BEHAVIORAL

In Phase 1, participants will complete 4 smoking sessions using a different product each session to examine each product's abuse liability.

menthol filtered little cigar (mFLC); menthol roll-your-own cigarette (mRYO); non-menthol cigarette (nmC); usual brand menthol cigarette (UBMC)

Usual brand menthol cigarettes and substitutes BEHAVIORAL

In Phase 2, to assess uptake, changes in subjective effects, and use over time, participants will select their preferred study product from Phase 1 and be instructed to completely substitute the product for their usual brand menthol cigarette for one week.

menthol filtered little cigar (mFLC); menthol roll-your-own cigarette (mRYO); non-menthol cigarette (nmC)

Menthol cigarettes substitutes and menthol cigarettes BEHAVIORAL

In Phase 3, participants will complete a final in-lab visit to assess the substitutability of their preferred product from Phases 1 and 2, under simulated ban conditions using a progressive ratio task.

menthol filtered little cigar (mFLC); menthol roll-your-own cigarette (mRYO); non-menthol cigarette (nmC); usual brand menthol cigarette (UBMC)

Eligibility Criteria

• Age: 18 Years - 50 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64)

You may qualify if:

• current menthol cigarette smoker (\>90% menthol cigarette use; ≥5 cigarettes per day) for at least the past 6 months.
• between 18-24 (young adult) or 25-50 years old (aged 25+)
• willing to provide informed consent and abstain from all tobacco and nicotine use for at least 12 hours prior to the five lab sessions
• willing to complete one week of EMA
• read and speak English.

You may not qualify if:

• self-reported diagnosis of lung disease including asthma, cystic fibrosis, or chronic obstructive pulmonary disease
• unstable or significant psychiatric conditions (past and stable conditions will be allowed)
• history of cardiac event or distress within the past 3 months
• currently pregnant, planning to become pregnant, or breastfeeding (will be verified with urine pregnancy test)
• use of other tobacco products (e.g., e-cig, cigar, etc.) \>5 days in the past month
• current marijuana use \>5 times per month
• any use of other illicit drugs during the last 30 days (verified by urinalysis at initial visit)
• currently engaging in a smoking cessation attempt
• currently using one of the alternative menthol study products

Sponsors & Collaborators

• Ohio State University Comprehensive Cancer Center: lead
• University of Vermont: collaborator
• Brown University: collaborator
• National Institutes of Health (NIH): collaborator
• National Institute on Drug Abuse (NIDA): collaborator

Study Sites (1)

The Ohio State University Comprehensive Cancer Center

Columbus, Ohio, 43214, United States

Location

Related Publications (1)

• Villanti AC, Hinton A, Schulz JA, Erath TG, Mehta T, Reed D, Tidey J, Businelle M, Wagener TL. Substitutability of menthol cigarette alternatives: a clinical trial. Tob Control. 2025 Apr 1;34(2):154-161. doi: 10.1136/tc-2023-058272.

  PMID: 37963771 DERIVED

Related Links

• Jamesline

MeSH Terms

Conditions

Smoking; Behavior, Addictive

Condition Hierarchy (Ancestors)

Behavior; Compulsive Behavior; Impulsive Behavior

Results Point of Contact

• Title: Dr. Theodore L. Wagener
• Organization: OhioSUCCC

Theodore.Wagener@osumc.edu

614-366-4265

Study Officials

• Theodore Wagener, PhD

  Ohio State University Comprehensive Cancer Center

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: No
• Restrictive Agreement: No

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: CROSSOVER
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator

Study Record Dates

• First Submitted: July 2, 2020
• First Posted: April 14, 2021
• Study Start: December 16, 2019
• Primary Completion: August 9, 2021
• Study Completion: August 9, 2021
• Last Updated: February 9, 2024
• Results First Posted: February 9, 2024

Record last verified: 2024-02

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)