Zachary R. Rosenberry

Nicotine and carbon monoxide exposure from inhalation of cigarillo smoke.

BACKGROUND There has been an increase in the use of cigarillos in the US. People who smoke cigarillos typically also regularly smoke cigarettes (dual users). METHODS We compared puffing topography, biomarkers of acute exposure [exhaled carbon monoxide (COex) and plasma nicotine] and physiologic effects from usual brand cigarette and Black & Mild cigarillo smoking in dual users (N=23) in two laboratory sessions. RESULTS Participants (21 men) smoked an average of 17.5cigarettes/day. Cigarillo consumption varied widely from as few as 1/week to daily. Participants were highly nicotine dependent (average FTND score: 6.3). There were statistically significant differences in smoking behavior between cigarette and cigarillo smoking in time to smoke, number of puffs, and total puff volume (all P<0.001). Average puff duration, interpuff interval average puff volume, and puff velocity did not differ between cigarettes and cigarillos. Nicotine boost was similar after both cigarettes and cigarillos. COex boost was significantly greater after cigarillo smoking compared to cigarette smoking (P<0.001). CONCLUSIONS The smoking pattern and exposure profile indicate that dual users inhale cigarillo smoke just as they inhale cigarette smoke thereby exposing themselves to considerable amounts of nicotine and other components of tobacco smoke. COex exposure results imply that cigarillo smoking may be associated with higher exposure to smoke-delivered volatile components of mainstream cigarillo smoke including carcinogens when compared to cigarettes. IMPACT The findings that cigarillos and cigarettes are smoked similarly in dual users are relevant to health and regulatory considerations on cigar products.

Make Your Own Cigarettes: Characteristics of the Product and the Consumer

INTRODUCTION Despite a worldwide increase in the use of Make Your Own (MYO) cigarettes, there is little research characterizing MYO smokers in the United States and the cigarettes they make. METHODS In a single laboratory visit, exclusive MYO smokers brought 5 MYO cigarettes they prepared at home, completed demographic and smoking history questionnaires, and prepared 25 cigarettes using their own tobacco and materials. RESULTS Participants were mostly male (86.7%), average age of 41.3 years, and smoked an average of 19.5 (SD = 7.9) MYO cigarettes per day. They produced two types of cigarettes-by rolling tobacco in a paper leaf (Roll Your Own [RYO, n = 56]) and by injecting tobacco into a tube (Personal Machine Made [PMM, n = 42]). The PMM cigarettes were significantly larger than RYO cigarettes (p < .001). Home- (0.97 g) and laboratory-produced (0.95 g) PMM cigarettes did not differ by weight; however, the RYO cigarettes made at home (0.45 g) were slightly, but significantly, larger than those produced in the laboratory [0.43 g (p < .05)]. There was significant internal consistency in the weight of RYO and PMM cigarettes (intraclass correlation coefficient = 0.82, 0.84, respectively). Time to produce RYO cigarettes (53 s/cigarette) was significantly longer than that of PMM cigarettes (42 s/cigarette) (p < .01). CONCLUSIONS By using commercially available tobacco, tubes, and paper, experienced MYO smokers can quickly and consistently prepare cigarettes that may be useful in laboratory smoking topography and exposure experiments. Increasing the regulation of Factory Made (FM) cigarettes may lead to increased use of MYO cigarettes with unknown toxicant exposure and health risks to their consumers.

Toxicant exposure from smoking a little cigar: further support for product regulation

Background Although numerous studies have documented the prevalence and increasing use of little cigars and other cigar products, the present study is the first direct, head-to-head laboratory comparison of little cigar and cigarette smoking. The study addressed a fundamental objective to compare exposure and use characteristics of little cigar and cigarette smoking. Methods Smoking patterns, toxicant exposure and subjective measures were collected and analysed in 21 adults after smoking a little cigar (Winchester) and a cigarette (own brand). Participants were dual users of little cigars and cigarettes. Results Similar to cigarettes, little cigars delivered substantial nicotine and relatively more carbon monoxide. Puff volume, puff duration and time to smoke were significantly greater after cigarettes, but the temporal pattern of smoking more intensively at the beginning was similar in little cigars and cigarettes. Both little cigars and cigarettes reduced urge to smoke. Participants consistently mentioned that the lower cost of little cigars was a reason for initiation and continuation of their use. Conclusions The results support the notion that regulation of little cigars is appropriate in light of public health considerations.

Make Your Own Cigarettes: Toxicant Exposure, Smoking Topography, and Subjective Effects

Background: Despite considerable use of make your own (MYO) cigarettes worldwide and increasing use in the United States, relatively little is known about how these cigarettes are smoked and the resultant toxicant exposure. Methods: In a laboratory study, we compared two types of MYO cigarettes—roll your own (RYO) and personal machine made (PMM)—with factory-made (FM) cigarettes in three groups of smokers who exclusively used RYO (n = 34), PMM (n = 23), or FM (n = 20). Within each group, cigarettes were smoked in three conditions: (i) after confirmed overnight tobacco abstinence; (ii) in an intense smoking paradigm; and (iii) without restrictions. All cigarettes were smoked ad lib through a smoking topography unit. Results: Plasma nicotine significantly increased after cigarettes in all conditions except PMM in the intense smoking paradigm. Puff volume, puff duration, total puff volume, and puff velocity did not differ between cigarette types but the puffs per cigarette and time to smoke were significantly smaller for RYO compared with PMM and FM. Regardless of the cigarette, participants consumed the first three puffs more vigorously than the last three puffs. Conclusions: Despite the belief of many of their consumers, smoking MYO cigarettes is not a safe alternative to FM cigarettes. Like FM, MYO cigarettes expose their users to harmful constituents of tobacco smoke. Despite differences in size and design their puffing profiles are remarkably similar. Impact: These data are relevant to health and regulatory considerations on the MYO cigarettes. Cancer Epidemiol Biomarkers Prev; 23(9); 1793–803. ©2014 AACR.

Large Cigars: Smoking Topography and Toxicant Exposure.

Background Cigar smoking in the United States continues despite decreases in cigarette smoking and increased tobacco control efforts. We compared large cigar and cigarette smoking for use patterns, smoking topography, and toxicant exposure. Methods Dual users (n = 17, 94% men, 77% African American) smoked ad libitum either their usual cigarette brand or a study large cigar (Phillies Blunt) in two laboratory sessions. Plasma nicotine and exhaled carbon monoxide were collected before and after smoking. Smoking topography measures of puff volume, puff duration, puff velocity, and interpuff interval were also collected. Results Both cigarettes and large cigars significantly increased plasma nicotine and carbon monoxide and significantly decreased the urge to smoke. Cigarettes delivered more nicotine per gram of tobacco smoked and per 1000 mL of puff volume. Number of puffs, time to smoke, puff volume, and puff velocity were significantly larger and interpuff interval was significantly shorter in large cigar smoking. The temporal pattern of puffing more intensely at the beginning of smoking was similar for both large cigars and cigarettes. Conclusions People who regularly use both large cigars and cigarettes adapt their smoking pattern such that they are exposed to similar levels of nicotine from each product. The immediate increase in plasma nicotine and carbon monoxide suggest significant inhalation of large cigar smoke. These data call to question the assumption that cigar smoking is less toxic than cigarette smoking. By smoking large cigars, dual users expose themselves to toxic components that have been linked with the addiction risk, morbidity, and mortality of cigarette smoking. Implications This study found that dual users of large cigars and cigarettes inhale significant quantities of carbon monoxide, nicotine, and presumably other components of mainstream smoke. Large cigar smoke exposure may lead to or sustain nicotine addiction as wells as subject large cigar consumers to similar risks associated with cigarette smoking such as lung cancer and cardiovascular disease.

Nicotine Absorption from Smokeless Tobacco Modified to Adjust pH

INTRODUCTION Nicotine delivery from smokeless tobacco (ST) products leads to addiction and the use of ST causes pathology that is associated with increased initiation of cigarette smoking. The rapid delivery of nicotine from ST seems to be associated with the pH of the aqueous suspension of the products - high pH is associated with high nicotine absorption. However, early studies compared nicotine absorption from different commercial products that not only differed in pH but in flavoring, nicotine content, and in format-pouches and loose tobacco. METHODS The present study compared nicotine absorption from a single unflavored referent ST product (pH 7.7) that was flavored with a low level of wintergreen (2 mg/g) and the pH was amended to either high (8.3) or low (5.4) pH with sodium carbonate or citric acid, respectively. RESULTS In a within-subject clinical study, the higher pH products delivered more nicotine. No significant differences were seen between perceived product strengths and product experience in all conditions. Heart rate increased by 4 to 6 beats per minute after the high pH flavored and the un-amended product but did not change after the low pH flavored product. CONCLUSIONS These results indicate that pH is a primary determinant of buccal nicotine absorption. The role of flavoring and other components of ST products in nicotine absorption remain to be determined.

Trends in and characteristics of marijuana and menthol cigarette use among current cigarette smokers, 2005-2014

Background Given increasing co-marijuana and tobacco use in the United States, this study aimed to explore the overlap between menthol cigarette use (MCU) and marijuana. Methods Data came from past month US cigarette smokers 12 years and older responding to the National Survey on Drug Use and Health between 2005 and 2014 (N = 51 500). Prevalence, demographics and substance use characteristics from 2013 to 2014 were assessed across four groups, based on past month marijuana and tobacco use: cigarette smokers with marijuana and MCU, with marijuana but no MCU, with no marijuana but MCU, and with use of neither. Multivariable logistic regression explored the relationship between MCU, marijuana, and dependence. Linear and quadratic trends were assessed using logistic regression with orthogonal polynomials. Results Past month marijuana/MCU among cigarette smokers was 8.3% in 2013-2014. Overall, marijuana/MCU was significantly higher among blacks versus whites (20.8% vs. 5.8%, p < .0001), though among 12-25 year olds, prevalence was significantly higher among whites versus blacks (6.3% vs. 0.9% for 12-17-year-olds; 39.2% vs. 26.8% for 18-25-year-olds). Marijuana/MCU increased significantly between 2005 and 2014 overall, and among whites and blacks. No adjusted associations were found between marijuana, MCU and nicotine or marijuana dependence. Conclusions Past month marijuana/MCU among cigarette smokers is increasing in the United States, with specific racial and age-based disparities. Research about the implications of consuming both marijuana and menthol, and the potential overlap in consumption of flavors across the products is warranted to better inform future preventive and treatment approaches. Implications This is the first study to assess the overlap between MCU and marijuana use among a nationally representative sample of US current smokers ages 12 and older. Findings from this study suggest that past month marijuana and menthol use among cigarette smokers is increasing in the United States, with specific racial/ethnic and age-based disparities. More research about the implications of consuming both marijuana and menthol, and the potential overlap in consumption of flavors in marijuana and tobacco products is warranted to better understand what preventive and treatment approaches may be needed.Background Given increasing co-marijuana and tobacco use in the United States, this study aimed to explore the overlap between menthol cigarette use (MCU) and marijuana. Methods Data came from past month US cigarette smokers 12 years and older responding to the National Survey on Drug Use and Health between 2005 and 2014 (N = 51 500). Prevalence, demographics and substance use characteristics from 2013 to 2014 were assessed across four groups, based on past month marijuana and tobacco use: cigarette smokers with marijuana and MCU, with marijuana but no MCU, with no marijuana but MCU, and with use of neither. Multivariable logistic regression explored the relationship between MCU, marijuana, and dependence. Linear and quadratic trends were assessed using logistic regression with orthogonal polynomials. Results Past month marijuana/MCU among cigarette smokers was 8.3% in 2013-2014. Overall, marijuana/MCU was significantly higher among blacks versus whites (20.8% vs. 5.8%, p < .0001), though among 12-25 year olds, prevalence was significantly higher among whites versus blacks (6.3% vs. 0.9% for 12-17-year-olds; 39.2% vs. 26.8% for 18-25-year-olds). Marijuana/MCU increased significantly between 2005 and 2014 overall, and among whites and blacks. No adjusted associations were found between marijuana, MCU and nicotine or marijuana dependence. Conclusions Past month marijuana/MCU among cigarette smokers is increasing in the United States, with specific racial and age-based disparities. Research about the implications of consuming both marijuana and menthol, and the potential overlap in consumption of flavors across the products is warranted to better inform future preventive and treatment approaches. Implications This is the first study to assess the overlap between MCU and marijuana use among a nationally representative sample of US current smokers ages 12 and older. Findings from this study suggest that past month marijuana and menthol use among cigarette smokers is increasing in the United States, with specific racial/ethnic and age-based disparities. More research about the implications of consuming both marijuana and menthol, and the potential overlap in consumption of flavors in marijuana and tobacco products is warranted to better understand what preventive and treatment approaches may be needed.

Marijuana and tobacco cigarettes: Estimating their behavioral economic relationship using purchasing tasks.

Although marijuana and tobacco are commonly coused, the nature of their relationship has not been fully elucidated. Behavioral economics has characterized the relationship between concurrently available commodities but has not been applied to marijuana and tobacco couse. U.S. adults ≥18 years who coused marijuana and tobacco cigarettes were recruited via Mechanical Turk, a crowdsourcing service by Amazon. Participants (N = 82) completed online purchasing tasks assessing hypothetical marijuana or tobacco cigarette puff consumption across a range of per-puff prices; 2 single-commodity tasks assessed these when only 1 commodity was available, and 2 cross-commodity tasks assessed these in the presence of a concurrently available fixed-price commodity. Purchasing tasks generated measures of demand elasticity, that is, sensitivity of consumption to prices. In single-commodity tasks, consumption of tobacco cigarette puffs (elasticity of demand: &agr; = 0.0075; 95% confidence interval [0.0066, 0.0085], R2 = 0.72) and of marijuana puffs (&agr; = .0044; 95% confidence interval [0.0038, 0.0049], R2 = 0.71) declined significantly with increases in price per puff. In cross-commodity tasks when both tobacco cigarette puffs and marijuana puffs were available, demand for 1 commodity was independent of price increases in the other commodity (ps > .05). Results revealed that, in this small sample, marijuana and tobacco cigarettes did not substitute for each other and did not complement each other; instead, they were independent of each other. These preliminary results can inform future studies assessing the economic relationship between tobacco and marijuana in the quickly changing policy climate in the United States.

Cigarillo and Little Cigar Mainstream Smoke Constituents from Replicated Human Smoking

Little cigar and cigarillo smoking is increasing in popularity in the U.S., but little is known about the topography and mainstream smoke (MSS) constituents of these types of cigar products. This report describes the quantity of selected MSS toxicants generated from puff-by-puff replication of human laboratory smoking. Participants were dual users of cigarettes and either little cigars ( n = 21) or cigarillos ( n = 23). In the laboratory smoking session, participants of the little cigar group smoked a filtered unflavored Winchester Little Cigar; those in the cigarillo group smoked an unfiltered, unflavored Black & Mild cigarillo. MSS components included both volatiles and semivolatile compounds. The MSS of five representative U.S. domestic cigarettes was generated using smoking topography profiles of the participants smoking their own brand of cigarettes. Machine smoking accurately replicated individual puff profiles as indicated by a high correlation between lab and machine smoked: time to smoke, number of puffs, and total puff volume. There was wide variability in smoking patterns across subjects of both little cigars and cigarillos. For example, total puff volume ranged from 84 to 732 mL after the little cigar and from 270 to 2089 mL after the cigarillo. Qualitatively, cigar smoke from little cigars and cigarillos were similar and resembles cigarette smoke. All analytes (VOC and SVOCs) were greater in cigarillo smoke compared to that of little cigars and cigarettes. However, when the toxicants were adjusted for grams of tobacco burned, little cigar smoke contained more nicotine, tobacco-specific nitrosamines, acetonitrile, and acrylonitrile compared with cigarillo smoke. When the constituents were adjusted for nicotine content, cigarillo MSS contained more of all toxicants compared with little cigar. Cigarillos and little cigars, like cigarettes, deliver nicotine and other toxicants known to be harmful to health; their regulation by the FDA is appropriate for their public health risk.

Sweet flowers are slow, and weeds make haste: leveraging methodology from research on tobacco, alcohol, and opioid analgesics to make rapid and policy-relevant advances in cannabis science

Abstract The legalization of medical and recreational cannabis use has occurred ahead of science. The current evidence base has poor utility for determining if cannabis products can meet the standards of safety, efficacy, and quality intrinsic to modern medicine, and for informing regulation of cannabis as a legal intoxicant. Individual jurisdictions that pass cannabis reforms may not have adequate resources to support the level of new scientific research needed to inform regulatory actions; this could make it difficult to keep a rapidly growing multi-billion-dollar cannabis industry in check. Further, the present lack of evidence-based regulatory oversight for cannabis parallels the climates that gave rise to the tobacco and prescription opioid epidemics, suggesting that continued omission may result in negative public health consequences. However, translating a methodological framework developed through research on these compounds may promote rapid advances in cannabis science germane to regulatory knowledge gaps. The present review highlights specific advancements in these areas, as well as in alcohol regulation, that are prime for informing policy-relevant cannabis science, and also offers some recommendations for evidence-based regulatory policy. Resulting progress may directly inform both regulation of cannabis in both medical and licit recreational drug frameworks, and new cannabis-related public health initiatives.