Menthol's potential effects on nicotine dependence: a tobacco industry perspective.

ObjectiveTo examine what the tobacco industry knows about the potential effects menthol may have on nicotine dependence.MethodsA snowball strategy was used to systematically search the Legacy Tobacco Documents Library (http://legacy.library.ucsf.edu/) between 22 February and 29 April, 2010. Of the approximately 11 million documents available in the Legacy Tobacco Documents Library, the iterative searches returned tens of thousands of results. We qualitatively analysed a final collection of 309 documents relevant the effects of menthol on nicotine dependence.ResultsThe tobacco industry knows that menthol overrides the harsh taste of tobacco and alleviates nicotine's irritating effects, synergistically interacts with nicotine, stimulates the trigeminal nerve to elicit a 'liking' response for a tobacco product, and makes low tar, low nicotine tobacco products more acceptable to smokers than non-mentholated low delivery products.ConclusionMenthol is not only used in cigarettes as a flavour additive; tobacco companies know that menthol also has sensory effects and interacts with nicotine to produce tobacco products that are easier to smoke, thereby making it easier to expose smokers, especially those who are new and uninitiated, to the addictive power of nicotine

Menthol sensory qualities and smoking topography: a review of tobacco industry documents.

ObjectiveTo determine what the tobacco industry knew about the potential effects of menthol on smoking topography-how a person smokes a cigarette.MethodsA snowball strategy was used to systematically search the Legacy Tobacco Documents Library (http://legacy.library.ucsf.edu) between 1 June 2010 and 9 August 2010. We qualitatively analysed a final collection of 252 documents related to menthol and smoking topography.ResultsThe tobacco industry knew that menthol has cooling, anaesthetic and analgesic properties that moderate the harshness and irritation of tobacco. Owing to its physiological effects, menthol contributes to the sensory qualities of the smoke and affects smoking topography and cigarette preference.ConclusionOur review of industry studies suggests that the amount of menthol in a cigarette is associated with how the cigarette is smoked and how satisfying it is to the smoker. If menthol in cigarettes was banned, as the US Food and Drug Administration (FDA) is currently considering, new/experimental smokers might choose not to smoke rather than experience the harshness of tobacco smoke and the irritating qualities of nicotine. Similarly, established menthol smokers might choose to quit if faced with an unpleasant smoking alternative

Menthol Sensory Qualities and Possible Effects on Topography: A White Paper

Publicly available internal tobacco industry documents were analyzed to answer the following questions regarding the sensory qualities of menthol and its possible effects on topography: 1) What properties does menthol contribute to the smoking experience? 2) Does menthol contribute to the sensory qualities of the smoke and affect smoking topography? 3) Do changes in smoking topography lead to greater exposure to toxic substances, increased nicotine dependence, or greater chance of tobacco-related disease? 4) What are the various ways menthol is measured and how are menthol yields determined? 5) Does the menthol content and/or yield have an effect on how the cigarette is smoked or cigarette preference? 6) What is the relationship between menthol and intensity in use of cigarettes (i.e., does menthol lead to a higher delivery of smoke per cigarette)? A final collection of 252 documents was analyzed for this report, of which 67 were deemed relevant to one or more of the research questions and cited in this paper. Our analyses of the documents indicate the following: 1) Menthol has cooling and anesthetic properties that moderate the harshness and irritation of tobacco; 2) Menthol contributes to the sensory qualities of the smoke and affects smoking behavior and cigarette preference depending on the level of menthol and nicotine in the cigarette; 3) It is unclear whether menthol’s effect on smoking behavior leads to greater exposure to toxic substances; 4) Menthol is measured in milligrams or micrograms that are distilled from a cigarette before and after smoking; 5) It is unclear whether the menthol content and/or yield have an effect on how a cigarette is smoked because most testing that we were able to locate in the documents was done on new mentholated products by in-house smoker panels; and 6) It is unclear what the tobacco industry knew about the relationship between menthol and intensity in use of cigarettes. The documents provide evidence that cigarette manufacturers not only use menthol as a flavorant, but also as an ingredient that has physiological effects, and synergistically interacts with nicotine

Estimating Core Unemployable And Workforce Non-Participants: A Study Of Rural Pennsylvania's Labor Force

Rural unemployment rates persistently have run higher than the national average for many years.  In addition, multiple studies have established that rural underemployment also remains a long-running problem. Unfortunately, it is not yet fully understood how the various factors contributing to rural unemployment and underemployment interact to adversely affect rural labor markets.  The contribution of this paper is to gain insight as to the amount of slack labor force at the county level, focusing on the application to the labor force of rural Pennsylvania. By comparing the actual number of working-age adults presently not in a county’s labor force (using data from the Bureau of Labor Statistics and the US Census) against an estimated number of core unemployable and workforce non-participants (Core NPW) individuals in the county we can generate estimates of the potential up-swing in employment for the regional labor market if participation rates were to become among the best in their national peer group. The study’s methodology and findings provide guidance to policy makers in identifying regions most likely in need of greater assistance as to how to best spend scarce public dollars across various programs aimed at improving local labor markets.

Rural Pennsylvania Underemployment And Its Determinants

This paper investigates the impact of age distribution and educational attainment on the level of underemployment in Appalachian regions of the United States.  Furthermore, this study shows the similarities and differences at the state and county levels for Pennsylvania.  Following the methodology of Price and Wail (2005) linear regression models are used to estimate the marginal impacts of general economic conditions measured by the unemployment rate, as well as age and educational attainment, on the level of underemployment in the state.  In rural Appalachia, younger workers and those with some post-baccalaureate education are more likely to find themselves underemployed.  Keywords: rural economics, Appalachian studies, unemployment, underemployment, measurement issues

Recommendations to advance equity in tobacco control

Reducing racial and socioeconomic inequities in smoking has been declared a priority for tobacco control in the USA for several decades. Yet despite the rhetoric, these inequities persist and some have actually worsened over time. Although tobacco companies have targeted racially and ethnically diverse and lower-income tobacco users, which substantially contributes to these disparities, less attention has been given to the role of individuals and organisations within the tobacco control movement who have allowed progress in eliminating disparities to stagnate. We examine the failure of tobacco control professionals to ensure the widespread adoption of equity-focused tobacco control strategies. Review of major US tobacco control reports found that the focus on equity often stops after describing inequities in tobacco use. We suggest ways to advance equity in tobacco control in the USA. These recommendations fall across five categories: surveillance, interventions, funding, accountability and addressing root causes. Policy interventions that will have a pro-equity impact on smoking and related disease should be prioritised. Funding should be designated to tobacco control activities focused on eliminating racial and socioeconomic inequities in smoking, and tobacco control programmes should be held accountable for meeting equity-related goals

Common extensor origin release in recalcitrant lateral epicondylitis - role justified?

The aim of our study was to analyse the efficacy of operative management in recalcitrant lateral epicondylitis of elbow. Forty patients included in this study were referred by general practitioners with a diagnosis of tennis elbow to the orthopaedic department at a district general hospital over a five year period. All had two or more steroid injections at the tender spot, without permanent relief of pain. All subsequently underwent simple fasciotomy of the extensor origin. Of forty patients thirty five had improvement in pain and function, two had persistent symptoms and three did not perceive any improvement. Twenty five had excellent, ten had well, two had fair and three had poor outcomes (recurrent problem; pain at rest and night). Two patients underwent revision surgery. Majority of the patients had improvement in pain and function following operative treatment. In this study, an extensor fasciotomy was demonstrated to be an effective treatment for refractory chronic lateral epicondylitis; however, further studies are warranted

Paradigms in multiple sclerosis: time for a change, time for a unifying concept

It has recently been suggested that, rather than being an autoimmune disease, multiple sclerosis (MS) is an example of a neurocristopathy, a pathological process resulting from a faulty development of the neural crest. Whilst several characteristics of the disease suggest a neurocristopathy, other aetiological factors require consideration, including hygiene-related factors that alter the immune responses to common pathogens resulting in an eclipse of immune reactivity that could protect against MS, the possible role of human endogenous retroviruses (HERVs) in pathogenesis and autoimmune phenomena, HLA polymorphism, vitamin D levels before and after birth and immune repair mechanisms. A postulated aetiological factor in MS, associated with altered vitamin D metabolism and abnormal HERV expression, is a long-lasting disturbed redox regulation in the biosynthesis of a melanoma-like melanin pigment. Although intensive further studies on melanin pigments in nerve tissue in MS are required, the known properties of a pathological form of such pigments in melanoma could explain a number of observations in MS, including the impact of light, UV-light, and vitamin D, and could explain the clinical manifestations of MS on the basis of an oscillating process of oxidative charge and discharge of the pigments and a threshold phenomenon with a change of the quasi-catalytic function of the pigment from destroying reactive oxygen radicals or species to transforming them to more harmful long-persisting highly reactive species. Taken together with the consequences of an adaptive process in partly demyelinated neurons, resulting in an increase in number of mitochondria, and the impact of stressful life events, these conditions are necessary and sufficient to explain the disease process of MS with its spatial (plaques) and temporal (attacks and remissions) characteristics. This suggested unifying concept of the pathogenesis of MS may open perspectives for prevention, diagnosis and therapy. In particular, prevention may be achieved by vaccinating against Epstein-Barr virus in early childhood