Chukwudi Keke

Background: Synthetic cooling additives (eg, Wilkinson Sword (WS)-3) in tobacco products may provide menthol-like sensory effects without characterising flavour. This randomised, double-blind crossover pilot study evaluated sensory attributes, appeal and puffing topography of three market-available cigarettes that differ in menthol and WS-3 content among young adults (YAs) who smoke regularly (≥100 cigarettes lifetime and either ≥5 cigarettes daily or weekly use in the past 3 months). Methods: YAs aged 21–29 years (n=30) were randomly assigned to conditions (WS-3, menthol and non-menthol control cigarettes) across three visits. Products were chemically analysed using gas chromatography mass spectrometry. Between-product measures, including sensory and appeal post ad-libitum smoking, were assessed and puffing topography was recorded. Inferential analyses accounted for the within-participant crossover design using mixed-effects regression models with random participant effects. Results: Participants (M _age =25.5, SD=2.1) on average smoked 15.8 cigarettes per day (SD=25.0), for 7.8 years (SD=4.4), and used non-menthol cigarettes (63%). Between-product appeal ratings did not significantly differ (p values >0.05), and WS-3 cigarettes were rated as significantly cooler (p<0.001), sweeter (p=0.005) and less harsh (p=0.003) compared with the control. Participants smoked menthol (p=0.035) and WS-3 (p=0.004) significantly faster than the control cigarettes. Fewer puffs were taken from WS-3 compared with control (p=0.038) and menthol cigarettes (p=0.011). Conclusions: The present study showed that WS-3 cigarettes may offer similar sensory effects as menthol cigarettes, providing further evidence to support regulatory agencies’ consideration of synthetic cooling additives in flavour regulations. Trial registration number: ClinicalTrials.gov ID: NCT06230159 .

The nicotine metabolite ratio (NMR) has been informative in selecting treatment choices for nicotine dependence and increasing treatment efficacy in Western settings; however, the clinical utility of the NMR among smokers in low-resource settings remains unclear. Prospective analysis was conducted using data from a randomized controlled trial of smoking cessation among adults living with HIV, to examine the association between the NMR and response to smoking cessation treatment. NMR was assessed using bio-banked urine samples collected at baseline. Self-reported smoking at 6 months was verified using a urine cotinine test and exhaled breath carbon monoxide (CO). We found no associations between the NMR and smoking abstinence (adjusted risk ratio (aRR) = 0.82; 95% CI: 0.45, 1.49; p = 0.53). No evidence of effect modification by treatment conditions was observed on the multiplicative scale (aRR = 1.17; 95% CI: 0.32, 4.30; p = 0.81) or additive scale (adjusted relative excess risk due to interaction (aRERI) = 0.10; 95% CI: −1.16, 1.36; p = 0.44). Our results suggest that the NMR may not be a viable approach for selecting smoking cessation treatment in this setting, given the minimal variability in our sample and racial/ethnic makeup of this population.

The nicotine metabolite ratio (NMR) is associated with race/ethnicity but has not been evaluated among smokers in the African region. We conducted a cross-sectional analysis of baseline data from a large randomized, controlled trial for smoking cessation among people with HIV (PWH) in South Africa. Urine samples were analyzed for the NMR and evaluated as a binary variable using a cutoff value of the fourth quartile to determine the fastest metabolizers. The median NMR was 0.31 (IQR: 0.31, 0.32; range: 0.29, 0.57); the cut-point for fast metabolizers was ≥0.3174 ng/mL. A high NMR was not associated with the number of cigarettes per day (OR = 1.10, 95% CI: 0.71, 1.70, p = 0.66) but was associated with 40% lower odds of a quit attempt in the past year (OR = 0.69; 95% CI: 0.44, 1.07, p = 0.09) and alcohol use (OR = 0.59, 95% CI: 0.32, 1.06, p = 0.07). No association was seen with marijuana or HIV clinical characteristics. As we found only minimal variability in the NMR and minimal associations with intensity of smoking, NMR may be of limited clinical value in this population, although it may inform which individuals are less likely to make a quit attempt.