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Bold KW, Sharma A, Haeny A, Gueorguieva R, Buta E, Baldassarri S, Lempert L, Krishnan-Sarin S, O'Malley S. A randomized controlled trial of potential tobacco policies prohibiting menthol flavor in cigarettes and e-cigarettes: a study protocol. BMC Psychiatry 2024; 24:201. [PMID: 38475757 DOI: 10.1186/s12888-024-05619-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/15/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Menthol cigarette use remains a large public health problem and disproportionately affects Black adults in the United States. The Food and Drug Administration has proposed prohibiting menthol flavor in cigarettes to protect public health. However, e-cigarettes are available in menthol flavor and are a popular alternative product adults might switch to if menthol is prohibited in cigarettes. Research is needed to understand how availability of menthol (vs. tobacco) flavored e-cigarettes could impact cigarette use among adults who smoke menthol cigarettes. METHODS We will recruit 150 adults who currently smoke menthol cigarettes and will randomize them to 1 of 3 conditions modeling different regulatory scenarios. We will recruit equal numbers of participants identifying as Black vs. non-Black and will stratify randomization by race. To promote standardization and adherence, cigarette and e-cigarette products will be provided for 8 weeks based on the assigned condition: (A) no menthol restriction (menthol cigarette and menthol flavored e-cigarette), (B) menthol prohibited in cigarettes only (non-menthol cigarette and menthol flavored e-cigarette), (C) menthol prohibited in both cigarettes and e-cigarettes (non-menthol cigarette and tobacco flavored e-cigarette). A follow-up visit will occur at week 12 to assess tobacco use status. The study aims are to (1) examine the impact of prohibiting menthol flavor in cigarettes and e-cigarettes on smoking behavior and (2) investigate whether outcomes differ by race to understand the impact of menthol policies on Black (vs. non-Black) individuals given high rates of menthol cigarette use in this population. The primary outcome will evaluate changes in the number of cigarettes smoked per day during the 8-week study period and will examine differences by regulatory scenario. Secondary outcomes will compare percent days smoke-free, changes in nicotine dependence, and motivation, confidence, and intentions to quit smoking by the regulatory scenarios. We will examine whether changes in the outcomes differ by Black vs. non-Black participants to compare the magnitude of the effect of the various menthol policy scenarios by race. DISCUSSION Results will contribute critical information regarding menthol in cigarettes and e-cigarettes to inform regulatory policies that maximize reductions in cigarette smoking and reduce tobacco-related health disparities. TRIAL REGISTRATION NCT05259566. Yale IRB protocol #2000032211, last approved 12/8/2023.
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Affiliation(s)
- Krysten W Bold
- Yale School of Medicine, Department of Psychiatry, New Haven, CT, USA.
- Yale Cancer Center, New Haven, CT, USA.
| | - Akshika Sharma
- Yale School of Medicine, Department of Psychiatry, New Haven, CT, USA
| | - Angela Haeny
- Yale School of Medicine, Department of Psychiatry, New Haven, CT, USA
| | - Ralitza Gueorguieva
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Eugenia Buta
- Yale Center for Analytical Sciences, Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Stephen Baldassarri
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT, USA
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Lauren Lempert
- Department of Pediatrics, Division of Adolescent Medicine, Stanford University, Palo Alto, CT, USA
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA, USA
| | | | - Stephanie O'Malley
- Yale School of Medicine, Department of Psychiatry, New Haven, CT, USA
- Yale Cancer Center, New Haven, CT, USA
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Suttiratana SC, Morean ME, Krishnan-Sarin S, Bold KW. Qualitative exploration of longer versus shorter quit attempts among adults using E-Cigarettes for combustible cigarette cessation. Addict Behav 2023; 143:107710. [PMID: 37015170 PMCID: PMC10165882 DOI: 10.1016/j.addbeh.2023.107710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 03/24/2023] [Accepted: 03/25/2023] [Indexed: 04/03/2023]
Abstract
Empirical evidence about the effectiveness of using e-cigarettes to quit smoking cigarettes remains inconclusive, yet e-cigarettes are commonly used for smoking cessation. Moreover, people who have longer duration quit attempts are likely to have even longer quit attempts in the future. Researchers analyzed 40 qualitative interviews to assess adults' experiences using e-cigarettes during their longest duration quit attempt. Interviewees quit smoking for ≥ one month (n = 20) or for shorter durations (n = 20). Thematic and comparative content analyses were used to analyze interview transcripts for factors facilitating or impeding the duration of quit attempts when using e-cigarettes. Participant narratives were mostly similar irrespective of their quit attempt duration. Six themes common across groups as well as themes more often discussed by people with shorter quit attempts are described. Most participants discussed using e-cigarette devices and flavors to either replace sensations similar to smoking combustible cigarettes (e.g., inhaling from a cylindrical object) or to distract themselves from cravings to smoke. E-cigarettes also were described by the majority of participants as useful for smoking cessation because they approximate combustible cigarette use, potentially reduce health-related harms, save money, and lead to reduced social stigma compared to smoking cigarettes. Those who reported shorter duration quit attempts shared e-cigarette product challenges, health concerns, needs for support. Study findings demonstrate the need for additional research on the factors that may increase the likelihood that using e-cigarettes will result in longer and sustained e-cigarette-based quit attempts among adults.
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Affiliation(s)
- Sakinah C Suttiratana
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale School of Medicine, 60 College Street, New Haven, CT 06510, USA.
| | - Meghan E Morean
- Department of Psychiatry, Yale School of Medicine, CMHC, 34 Park Street, New Haven, CT 06519, USA.
| | - Suchitra Krishnan-Sarin
- Department of Psychiatry, Yale School of Medicine, CMHC, 34 Park Street, New Haven, CT 06519, USA.
| | - Krysten W Bold
- Department of Psychiatry, Yale School of Medicine, CMHC, 34 Park Street, New Haven, CT 06519, USA.
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Bold K, O’Malley S, Krishnan-Sarin S, Morean M. E-cigarette Use Patterns, Flavors, and Device Characteristics Associated With Quitting Smoking Among a U.S. sample of Adults Using E-cigarettes in a Smoking Cessation Attempt. Nicotine Tob Res 2023; 25:954-961. [PMID: 36462196 PMCID: PMC10077943 DOI: 10.1093/ntr/ntac276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 11/03/2022] [Accepted: 11/30/2022] [Indexed: 12/05/2022]
Abstract
INTRODUCTION Many adults who smoke cigarettes use e-cigarettes to try to quit smoking; however, some are not successful. Identifying factors that are associated with successfully quitting smoking using e-cigarettes is important for maximizing cigarette cessation. AIMS AND METHODS Online survey data were collected in 2021 from 857 adults in the United States who reported using e-cigarettes in a recent attempt to quit smoking. Survey items assessed patterns of e-cigarette use and device characteristics (flavors, device, and nicotine) used when trying to quit smoking. Multivariable linear regression models examined characteristics associated with the longest duration of smoking abstinence when using e-cigarettes to try to quit. RESULTS The average duration of smoking abstinence when using e-cigarettes during a quit attempt was 65 days (SD = 104). In the multivariable model, greater frequency of e-cigarette use when quitting and abruptly switching to e-cigarettes from cigarettes (vs. gradually reducing) were significantly associated with longer durations of abstinence (p < .001). Preference for non-tobacco (relative to tobacco) flavors and nicotine concentration were not associated with duration of abstinence, although preference for rechargeable pod and mod device types (vs. cig-a-likes) was associated with longer durations of abstinence. CONCLUSIONS Patterns of e-cigarette use were related to abstinence duration, which may provide guidance for adults who are using e-cigarettes to quit smoking to encourage complete substitution and maximize smoking cessation. Findings indicate that non-tobacco e-cigarette flavors and nicotine strength are not related to longer durations of cessation success for adults, which may inform tobacco regulatory policies limiting these constituents to protect public health. IMPLICATIONS This study provides important new information about the characteristics of e-cigarettes used during an attempt to quit smoking among adults across the United States and identifies factors associated with quitting success. Patterns of e-cigarette use were associated with longer durations of abstinence. In contrast, few e-cigarette characteristics were associated with abstinence. Although preference for some pod and mod device types was associated with longer abstinence duration compared to earlier cig-a-like devices, preference for non-tobacco (vs. tobacco) flavor and nicotine concentration were not associated with abstinence. Findings may help inform guidance for adults using e-cigarettes to quit smoking and support tobacco regulatory policies.
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Affiliation(s)
- Krysten Bold
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Yale Cancer Center, New Haven, CT, USA
| | | | | | - Meghan Morean
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
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Liber AC, Knoll M, Cadham CJ, Issabakhsh M, Oh H, Cook S, Warner KE, Mistry R, Levy DT. The Role of Flavored Electronic Nicotine Delivery Systems in Smoking Cessation: A Systematic Review. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 7:100143. [PMID: 37012981 PMCID: PMC10066538 DOI: 10.1016/j.dadr.2023.100143] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/27/2023] [Accepted: 03/09/2023] [Indexed: 03/18/2023]
Abstract
Background Electronic nicotine delivery systems (ENDS) come in numerous flavors and may aid smoking cessation. This systematic review examines evidence on the role of ENDS flavors in smoking cessation. Methods We searched EMBASE OVID, PsychInfo, and Medline databases for studies that: 1) examined cigarette cessation outcomes for persons using ENDS (intent, attempts, and success) and 2) reported results separated by respondent's ENDS flavor used. We extracted crude and adjusted odds ratios for associations between cessation outcomes and types of ENDS flavors used (nontobacco vs. tobacco/unflavored; nontobacco and nonmenthol vs. tobacco/unflavored and menthol). We did not consider cessation outcomes among people not using ENDS. We evaluated the evidence using the GRADE approach, focusing on consistency and reliability of findings across studies. Results 29 studies met inclusion criteria, producing 36 odds ratios (ORs) comparing cessation outcomes across ENDS flavor groups. Three ORs examined quit intent, five examined quit attempts, and 28 examined quit success. Using GRADE, we reached Low levels of certainty that there was not an association between ENDS flavor use and intention to quit smoking or making a quit attempt. There were Very Low levels of certainty that nontobacco flavored versus tobacco/unflavored ENDS use was not associated with smoking cessation success, with similar findings for nonmenthol and nontobacco compared to tobacco and menthol flavored ENDS. Conclusion The evidence about the role of different flavored ENDS use and smoking cessation outcomes is inconclusive, reflecting highly heterogeneous study definitions and methodological limitations. More high-quality evidence, ideally from randomized controlled trials, is required.
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Affiliation(s)
- Alex C. Liber
- Lombardi Comprehensive Cancer Center, Georgetown Medical University, 3800 Reservoir Rd. NW, Washington, DC 20057, United States
- Corresponding author.
| | - Marie Knoll
- Lombardi Comprehensive Cancer Center, Georgetown Medical University, 3800 Reservoir Rd. NW, Washington, DC 20057, United States
| | - Christopher J. Cadham
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Mona Issabakhsh
- Lombardi Comprehensive Cancer Center, Georgetown Medical University, 3800 Reservoir Rd. NW, Washington, DC 20057, United States
| | - Hayoung Oh
- Lombardi Comprehensive Cancer Center, Georgetown Medical University, 3800 Reservoir Rd. NW, Washington, DC 20057, United States
| | - Steve Cook
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Kenneth E. Warner
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Ritesh Mistry
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - David T. Levy
- Lombardi Comprehensive Cancer Center, Georgetown Medical University, 3800 Reservoir Rd. NW, Washington, DC 20057, United States
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Coleman SRM, Piper ME, Byron MJ, Bold KW. Dual Use of Combustible Cigarettes and E-cigarettes: a Narrative Review of Current Evidence. CURRENT ADDICTION REPORTS 2022; 9:353-362. [PMID: 36467719 PMCID: PMC9718538 DOI: 10.1007/s40429-022-00448-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2022] [Indexed: 11/28/2022]
Abstract
Purpose of Review E-cigarette use (vaping) among adults has increased, and various patterns of concurrent smoking and vaping (i.e., "dual use") have emerged. Understanding dual use is important for mitigating tobacco-related harm. This narrative review summarizes recent research on dual use, including prevalence and types of dual use, sociodemographic and psychiatric characteristics, nicotine dependence, reasons for dual use, harm perceptions, toxicant exposure, trajectories of dual use, and emerging treatments for dual use. Recent Findings Nearly half of e-cigarette users concurrently use cigarettes, and many smoke more frequently than they use e-cigarettes. This is concerning because dual users are exposed to both cigarette and potential e-cigarette toxicants and the data are mixed regarding the ability of e-cigarettes to promote smoking cessation. Summary Further work is needed to identify ways to increase complete smoking abstinence and optimize harm reduction among dual users, including strategies to encourage e-cigarette cessation after stopping smoking.
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Affiliation(s)
- Sulamunn R. M. Coleman
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, 1 South Prospect Street, Burlington, VT 05401-1419, USA
| | - Megan E. Piper
- Center for Tobacco Research and Intervention, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - M. Justin Byron
- Department of Family Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Krysten W. Bold
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
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