Studying the interactive effects of menthol and nicotine among youth: An examination using e-cigarettes

Introduction:
This article presents the results of a study examining the interactive effects of menthol and nicotine among youth using e-cigarettes. The study used a randomized controlled design to assess changes in e-cigarette liking/wanting, taste, coolness, stimulant effects, nicotine withdrawal, and ad-lib use in response to different combinations of menthol and nicotine concentrations. The study also measured urinary menthol glucuronide and salivary nicotine levels to validate menthol and nicotine exposure.

Key Points:

* The study found that menthol, even at very low doses, alters the appeal of e-cigarettes among youth.
* Both 0.5% and 3.5% menthol concentrations significantly improved taste and increased coolness.
* There was marginal evidence of nicotine*menthol interactions, with an increase in liking/wanting when 3.5% menthol was combined with 12 mg/ml nicotine, but not 6 mg/ml nicotine.
* The study did not observe nicotine or menthol-related changes in stimulant effects, nicotine withdrawal symptoms, or ad-lib use.
* The study used e-cigarettes with varying concentrations of menthol (0%, 0.5%, and 3.5%) and nicotine (0 mg/ml, 6 mg/ml, and 12 mg/ml) in a randomized order across three sessions.
* Participants were 60 e-cigarette users aged 16-20 years who had used e-cigarettes with nicotine for the past year and reported having tried menthol-flavored tobacco products.
* The study used a fixed-dose period followed by an ad-lib period, with saliva and urine samples collected at multiple time points.
* Participants rated e-cigarette liking/wanting, taste, coolness, stimulant effects, and nicotine withdrawal using validated questionnaires.

Main Message:
The study provides important evidence on the interactive effects of menthol and nicotine among youth using e-cigarettes. The findings suggest that menthol, even at low doses, enhances the positive rewarding effects of high nicotine-containing e-cigarettes among youth. The study highlights the need for regulatory measures to reduce the appeal of tobacco products, particularly those that contain flavors such as menthol, which may facilitate progression from initiation to nicotine dependence. The study also underscores the importance of further research to understand the influence of flavors on the appeal of tobacco products and their role in nicotine addiction.

Krishnan-Sarin, Suchitra, Barry G. Green, Grace Kong, Dana A. Cavallo, Peter Jatlow, Ralitza Gueorguieva, Eugenia Buta, and Stephanie S. O’Malley. “Studying the Interactive Effects of Menthol and Nicotine among Youth: An Examination Using e-Cigarettes.” Drug and Alcohol Dependence 180 (November 2017): 193–99. https://doi.org/10.1016/j.drugalcdep.2017.07.044.