Two recent studies look at menthol cigarettes — whether they are more addicting and more hazardous; also the rise in numbers of part-time smokers. Dr Inaba shares his thoughts.
Transcript (edited):
Welcome to the CNS Podcast featuring Dr. Darryl Inaba, research director for CNS Productions.
CNS: Smoking is in the news – one story is on menthol and smoking and the other on the rise of the part-time smoker.
Darryl: Well, they are two very separate things, and so we should probably look at each one separately. There are a couple of controversial studies that looked at thousands of smokers and the role menthol played in their smoking – nicotine addiction. For the most part, I kind of agree with those who believe that it’s a contributing factor because menthol is a coolant to the throat. It’s a counter irritant in a way, soothing the irritation of smoke. It makes the smoke feel cooler and therefore I believe that people who smoke mentholated cigarettes smoke deeper thereby increasing the frequency of smoking. If you are a Marlboro, Camel or Lucky Strike smoker, as your tolerance to the nicotine continues to go up you increase your dosage by smoking more and more cigarettes. The nicotine is harsh, nasty tasting and becomes almost unbearable as you get into 2 or 3 packs a day, but addiction is powerful so those who are addicted put up with the harshness and the coughing and the hacking and emphysema and continue to smoke 3 or 4 packs a day. The menthol smoker seems to have less of that irritation so their perception of the damage they are doing to themselves is lessened. As they escalate their dosage by smoking more and more some studies show that they inhale deeper taking more nicotine into their system.
CNS: And carbon monoxide as well.
Darryl: It is important to know that cigarettes contain about 420 different substances. Some of them are carcinogenic, many are irritable. The tars and the resins created by the ignition or the burning process are very nasty. Smokers get a lot more of that deep into their lungs. Menthol sort of offsets some of that negative feeling.
CNS: And there’s probably a psychological aspect too. Menthol is compared to mentholatum, perceived as a relief for a cold.
Darryl: Sort of a medical treatment – The other thing these studies show is the demographic breakdown (racial, ethnic, socioeconomic) of menthol versus non-menthol cigarette smokers. Mentholated cigarette users are much poorer, much less educated and much more likely to be a person of color, Hispanic or African American or even Asian, than smokers of non-mentholated cigarettes.
CNS: I don’t understand the contradiction there or the disparity. It would seem that it would be pretty easy to put numbers together based on targeted studies.
Darryl: Well, that’s the problem. The two major studies mentioned in the report looks at one study of 1300 smokers and finds a disparity in the difficulty in quitting cigarette smoking being much harder amongst the menthol smokers who are more likely to be ethic minorities, less educated and poorer. The other study looked at 13,000 smokers or so and followed them for 5 years and though it did mention that it seemed harder to kick nicotine when it’s combined with menthol, it also indicated that they found no differences in the ability of ethnic, education or socioeconomic groups to quit. So, there is not a lot of agreement on those factors. There is agreement on the disparity on people who smoke mentholated cigarettes. These studies have found that 75% of Anglo or white smokers smoke non-mentholated cigarettes. I’m sorry that’s wrong. 25%….let me say that again. These studies have found that 25% of whites who smoke…. smoke mentholated cigarettes and 75% of African American and Hispanics who smoke ….smoke mentholated cigarettes.
CNS: Well, I’m sure that we each have our individual impressions based on people we have known and our histories, but it’s interesting. Let’s move on to the (January 12, 2010) Wall Street Journal article on the rise of the part-time smoker. We all know, especially those of us that are smokers or have been smokers, that it’s becoming increasingly more difficult to maintain that habit. Up to 70% of Americans don’t allow smoking in their home and about ½ of those are smokers themselves. There is also the pressure by friends to quit and the constant stream of news stories about the really serious health hazards of smoking tobacco. But on to the part-time smoker. The article identifies 5 different categories – social smoking; secret smokers – those that sneak off, so their kids or parents don’t see them, smokers that do so mainly when they are under stress or having emotional issues; and smoking without thinking, which probably covers most people that smoke; and a couple of other categories – those worried about weight loss. Does any of this resonate for you?
Darryl: Well it does and it doesn’t. I think this does describe the different reasons that people smoke but it misses the major point which is that nicotine is the purest form of addiction that any substance offers. Although smokers say it relieves stress, it relieves boredom, it helps deal with diet, and you don’t find a lot of smokers describing that hit on a cigarette as being “ecstatic or euphoric” or asking “just give me this wonderful buzz and high”. When people remember their first cigarette – they remember the negative effects they experienced
CNS: It was bad! It was really bad.
Darryl: They experienced an uncomfortable ness in their brain. They felt nauseous, they didn’t feel good at all and then they hacked and they hewed and that begs the question, “well why continue smoking?” Why did you develop a 2 or 3 pack a day habit? The answer is nicotine – it is pure addiction from the first cigarette. Studies now show that the nicotine level for a cigarette and its effect on dopamine in the compulsive centers of the brain and in the control centers of the brain, which we call the “go switch” and the “stop switch” slowly damage the connective tissues that connects those switches. So beginning with the first cigarette, the ability to control its use diminishes. It’s not the smoker is feeling great or relieving boredom or managing their weight – it’s because the brain can not stop – it now has this compulsion to keep exposing itself to nicotine, that it e needs it and can’t live without it. The part of the brain that says “No, that’s not right…this stuff is killing you…it’s bad for you” cannot communicate to that part of the brain that says keep doing it so people keep using.
I had an experience recently that exposed me to those changes in society you mentioned. I was at a wedding in New Orleans the weekend the Saints won the playoff that would take them to the Super Bowl. Bourbon Street was just jammed like Mardi Gras every night. I was there…ate at restaurants, the bars, everything was just full of the Saints fans wearing all the Saints garments and doing all the Saint chants, but the most amazing thing to me – coming from, California and the West Coast was: …My God, they’re smoking in restaurants! They’re smoking in the bars! They’re out in the streets where you can’t even see each other because there is so much smoke in the air and they’re drinking too. It was a shock today when it used to be common place – you could drink and smoke in the bars and on the streets and now you can’t. It was just strange for me to witness that. So it does validate the fact that society has changed its view on smoking and has created the part-time smoker. You can’t…you don’t want to…you’re embarrassed to smoke in public. You want to be a secret smoker, sometimes hiding it from your own family, your own children. You can’t smoke at home. You can’t smoke in the office. And because of that …people have cut down. I think the article mentioned that in 1980, the average smoker lit 21 cigarettes a day. Over a pack a day was the average and today it is down to 13. But they should know…and all smokers should know that evidence shows that even as few as 3 cigarettes a day will create tremendous health problems including an increased risk of heart attack, stroke, and lung problems, so no level of smoking is good healthy. Although there has been a cut back on smoking, the addiction has not stopped. Even with lower doses, the addiction remains intact. One interesting thing about “part-time smokers” is their association of time and place or environment that triggers the urge to smoke or continue to smoke and when they are away from that environment they are able to stay smoke-free for 3 or 4 days or even a week, but when they return to those environments, they find themselves sliding up and trying to control it, but they light up nonetheless.
There are a lot of experiments done by researchers and reported on by the National Institute on Drug Abuse, using mice and rats and showing that environments were so powerful that when they addicted a rat or mouse to a certain drug addiction – it could be nicotine – but in these cases I think they were using methamphetamine or cocaine, if they took that rat out of the environment to a place with a different floor, different color walls, different furniture, different things around them, the rat didn’t press the lever that would to administer the drug they were testing, like methamphetamine. But as soon as the researches put the rat back in the environment where the rat became addicted, the rodent went straight for the lever and started self-injecting again. So maybe there’s this environmental queuing or triggering that takes place with drugs of addiction and especially nicotine and maybe a change of environment is in order if someone is having problems.
CNS: There’s no question that it’s a complex mix of physical addiction, behavioral conditioning and psychological factors. We’ll talk more about this and about the stop and go switch in later podcasts. One interesting note as we wrap this – I found it interesting that the web versions of these articles contained ads for electronic cigarettes – embedded in the article.
Darryl: That is fascinating! The problem with electronic cigarettes is they contain other chemicals and additives that are damaging and harmful. If they came in a form that was healthier they could be an alternative or way to stop in the future.
CNS: But, as you say, … it is the nicotine.
Darryl: That’s right. Nicotine is the addiction.
CNS: Okay, thank you for listening – if you have any comments or questions, we would very much like to hear them. Your experiences with smoking or with not smoking or with anything else, stop by our website, which is cnsproductions.com and drop us a note. Darryl, thank you. Talk soon. That wraps our pod for today. Thanks for visiting the CNS podcast. Please check back soon for the next in the series and visit our website, www.cnsproductions.com.
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