Menthol and Mint Experimental Tobacco Marketplace (ETM) Study
Study Details
Study Description
Brief Summary
Menthol cigarettes comprise almost one-third of the United States (US) market share and are disproportionately smoked by racial minorities. Tobacco control policies targeting menthol flavoring in tobacco could have significant public health outcomes, especially among black smokers. One key challenge of tobacco regulation is weighing the risks and benefits of potential policies across different populations (i.e., users and non-users). Tension arises between policies intended to prevent adolescent and young adult (AYA) tobacco initiation and those intended to reduce harm among current tobacco users. The availability of menthol e-liquids may be important for encouraging menthol cigarette smokers to switch to e- cigarettes, but mint e-liquids, which are appealing to AYA, may be unnecessary to facilitate switching. Including mint e-liquids in flavor bans but allowing menthol e-liquids to remain on the market as potential substitution products for menthol smokers may be an optimal policy approach. The study team is proposing a lab study and field assessment to determine how including menthol and mint e-liquids in e-liquid flavor bans or sales restrictions affects tobacco product purchasing and use among menthol cigarette smokers. At lab sessions, participants will complete the Experimental Tobacco Marketplace (ETM) task, a behavioral economics task in which they receive account balances to an online store and can buy menthol cigarettes at escalating costs or buy e-liquids, non-menthol cigarettes, or nicotine replacement gum at fixed costs. They will complete the task under four marketplace conditions: (1) only tobacco e-liquids available, (2) menthol and tobacco e-liquids available, (3) menthol, mint, and tobacco e-liquids available, and (4) tobacco, menthol, mint, fruit, dessert. During a field assessment, product choice is validated by assessing use of products purchased during the ETM task. This proposal will inform policy-makers about the impact banning menthol and mint e-liquids will have on facilitating menthol cigarette smokers switching to e-cigarettes.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
N/A |
Detailed Description
The study team proposes to conduct a within-subjects, multi-session virtual lab study and validation field assessment to determine how the availability of menthol and mint e-liquids affects product purchasing among menthol cigarette smokers. Adult daily menthol cigarette smokers will be recruited for this study. After initial eligibility is assessed, participants will complete six virtual sessions and one field assessment to evaluate their tobacco use.
Participants will be recruited from Winston-Salem, North Carolina (NC) and the surrounding area using advertisements on public transit, community flyers, and social media. Curbside visits to drop off biosamples and pickup study products will be conducted outside the Wake Forest Tobacco Control Center of Excellence located in Biotech Place in the Innovation Quarter.
The study team anticipates recruiting up to 100 participants to achieve 80 completers. Equal numbers of black and white participants will be enrolled.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: E-liquid Availability Flavor availability is manipulated |
Behavioral: Tobacco e-liquids
Marketplace includes tobacco flavored e-liquids
Behavioral: Menthol and Tobacco e-liquids
Marketplace includes menthol and tobacco flavored e-liquids
Behavioral: Mint, Menthol and Tobacco e-liquids
Marketplace includes mint, menthol and tobacco flavored e-liquids
Behavioral: All e-liquid flavors
Marketplace includes fruit, dessert, mint, menthol and tobacco flavored e-liquids
|
Outcome Measures
Primary Outcome Measures
- Total amount of combusted tobacco purchased [Day 3]
Total amount of non-menthol cigarettes purchased when menthol cigarettes are not available.
- Total amount of combusted tobacco purchased [Day 4]
Total amount of non-menthol cigarettes purchased when menthol cigarettes are not available.
- Total amount of combusted tobacco purchased [Day 5]
Total amount of non-menthol cigarettes purchased when menthol cigarettes are not available.
- Total amount of combusted tobacco purchased [Day 6]
Total amount of non-menthol cigarettes purchased when menthol cigarettes are not available.
Secondary Outcome Measures
- Total amount of tobacco e-liquid purchased [Day 3, Day 4, Day 5, Day 6]
Total amount of tobacco e-liquid purchased when menthol cigarettes are not available.
- Total amount of menthol e-liquid purchased [Day 3, Day 4, Day 5, Day 6]
Total amount of menthol e-liquid purchased when menthol cigarettes are not available.
- Total amount of mint e-liquid purchased [Day 3, Day 4, Day 5, Day 6]
Total amount of mint e-liquid purchased when menthol cigarettes are not available
- Total amount of dessert and fruit e-liquid purchased [Day 3, Day 4, Day 5, Day 6]
Total amount of dessert and fruit e-liquid purchased with menthol cigarettes are not available
Other Outcome Measures
- Total amount of non-menthol cigarettes [Day 3, Day 4, Day 5, Day 6]
Total amount purchased when menthol cigarettes are not available according to race
- Total Amount of Tobacco e-liquid Purchased [Day 3, Day 4, Day 5, Day 6]
Total amount of tobacco e-liquid purchased when menthol cigarettes are not available according to race.
- Total Amount of Menthol e-liquid Purchased [Day 3, Day 4, Day 5, Day 6]
Total amount of menthol e-liquid purchased when menthol cigarettes are not available according to race.
- Total Amount of Mint e-liquid Purchased [Day 3, Day 4, Day 5, Day 6]
Total amount of mint e-liquid purchased when menthol cigarettes are not available according to race.
- Total amount of dessert/fruit e-liquid purchased. [Day 3, Day 4, Day 5, Day 6]
Total amount of dessert/fruit e-liquid purchased when menthol cigarettes are not available according to race.
- Themes emerging from the qualitative interviews [Day 14]
Qualitative interviews will be conducted and then analyzed in an effort to learn common themes or trends among the participants specific to various tobacco and nicotine products.
- Mean Perceived Health Risk Scale Score [Baseline, Day 14]
This is a measure of the perceived addictive potential and other health risks associated with cigarettes, e-cigarettes and nicotine gum. Scale 1-10 (1=very low risk of disease and 10=very high risk of disease). Each item/question has a score of 1-10. There are 14 different items in this questionnaire and each item will be evaluated independently.
- Mean Product Evaluation Scale Score [Baseline, Day 14]
This scale measures the participant's experience while using cigarettes, nicotine gum, or vaping devices. Each of the three products will include 13 items with a total score range of 13-91 for each of the three products. A higher score denotes more enjoyment from the product.
- Mean Minnesota Nicotine Withdrawal Scale Score [Baseline, Day 3, Day 4, Day 5, Day 6, Day 14]
This is a 15-item self-reported scale to evaluate the effects of smoking cessation and withdrawal symptoms. This scale is important because it allows the researchers to understand the experience of the participant throughout the study while using various tobacco products. The study team will use 7/15 items from this scale each ranging in score from 1-5. Total score range for the questionnaire would be 7-35 with higher score denoting more severe symptoms.
- Mean Questionnaire on Smoking Urges Score [Baseline, Day 3, Day 4, Day 5, Day 6, Day 14]
This scale measures the person's urge to smoke throughout the study while potentially using various tobacco and nicotine products. This questionnaire consists of 10 items each ranging from 1-7. Total score range for the entire questionnaire is 10-70. A higher score denotes greater urge.
- Mean Tobacco Product Interest Scores [Baseline, Day 14]
A visual analog scale assessing interest in use of various tobacco and nicotine products. Each item has a score from 0-100. This scale ranges from no interest (0) to very interested (100). The total questionnaire has 9 items that will be evaluated independently. The study team is looking at the following: Preferred cigarette brand Any other cigarette brand A cigarette brand with 95% less nicotine I Quit Ordinary Smoking (IQOS) Heat-Not-Burn Device Juice Universal Serial Bus Lighting (JUUL) Vaping Device Zyn Nicotine Pouches NicoDerm Nicotine Patch Nicorette Nicotine Lozenge Nicorette Nicotine Gum
- Tobacco Policy Questionnaire Score [Baseline, Day 14]
A visual analog scale assessing interest in use of various tobacco and nicotine products. This questionnaire will assess support for various tobacco control policies, including banning menthol flavoring in cigarettes and e-cigarettes. Each of the 14 items has a score of 1-3. 1 means the subject is supportive of the policy, 2 means subject is opposed. 3 indicates that the subject does not know. Each of the 14 items will be evaluated independently from one another.
Eligibility Criteria
Criteria
Inclusion Criteria:
-
21+ years of age
-
Self-report smoking at least 5 cigarettes per day for the past year
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Self-report smoking menthol cigarette brands > 80% of the time
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Breathe carbon monoxide (CO) level > 8 ppm Willingness to use other tobacco products during the study
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Speak, comprehend, and read English sufficiently to complete study procedures
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Have home access to a computer or tablet with a web camera and internet access
Exclusion Criteria:
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Currently seeking treatment to quit smoking
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Self-reported serious medical or psychiatric condition(s) including cardiovascular and chronic respiratory diseases
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Body temperature > 100.4 F
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Cold, flu or Novel Coronavirus (COVID-19) symptoms including fever, cough, and runny nose in the past 30 days
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Currently pregnant, breastfeeding or intending to become pregnant for the duration of the study or unwilling to agree to use adequate protection to avoid pregnancy
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CO reading > 80 ppm
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Enrollment stratum (Non-Hispanic, white or Black/African American)
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Wake Forest Health Sciences | Winston-Salem | North Carolina | United States | 27157 |
Sponsors and Collaborators
- Wake Forest University Health Sciences
Investigators
- Principal Investigator: Rachel Denlinger, PhD, MPH, Wake Forest Health Sciences
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- IRB00065077