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Hendlin YH, Han EL, Ling PM. Pharmaceuticalisation as the tobacco industry's endgame. BMJ Glob Health 2024; 9:e013866. [PMID: 38316465 PMCID: PMC10859997 DOI: 10.1136/bmjgh-2023-013866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 11/27/2023] [Indexed: 02/07/2024] Open
Abstract
CONTEXT Declining smoking prevalence and denormalisation of tobacco in developed countries reduced transnational tobacco company (TTC) profit during 1990s and 2000s. As these companies faced increasingly restrictive policies and lawsuits, they planned to shift their business to socially acceptable reduced-harm products. We describe the internal motivations and strategies to achieve this goal. METHODS We analysed previously secret tobacco industry documents available through the Truth Tobacco Documents Library. These documents were triangulated with TTCs' investor and other professional reports, websites and public statements. FINDINGS Mimicking pharmaceutical business models, tobacco companies sought to refurbish their image and ensure long-term profitability by creating and selling pharmaceutical-like products as smoking declined. These products included snus, heated tobacco products, e-cigarettes, nicotine gums and inhalers. Tobacco companies created separate divisions to develop and roll out these products, and the majority developed medical research programmes to steer these products through regulatory agencies, seeking certification as reduced-harm or pharmaceutical products. These products were regarded as key to the survival of the tobacco industry in an unfriendly political and social climate. CONCLUSIONS Pharmaceuticalisation was pursued to perpetuate the profitability of tobacco and nicotine for tobacco companies, not as a sincere search to mitigate the harms of smoking in society. Promotion of new pharmaceuticalised products has split the tobacco control community, with some public health professionals and institutions advocating for the use of 'clean' reduced-harm nicotine and tobacco products, essentially carrying out tobacco industry objectives.
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Affiliation(s)
- Yogi Hale Hendlin
- Erasmus University Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
- Center for Tobacco Control Research and Education, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Elieen Le Han
- Center for Tobacco Control Research and Education, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Pamela M Ling
- Center for Tobacco Control Research and Education, University of California San Francisco School of Medicine, San Francisco, California, USA
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Peters EN, Pickworth WB, Monahan E, Smith CE, Triplett CA, Coleman-Cowger VH. Effect of very low nicotine content cigarettes on alcohol drinking and smoking among adult smokers who are at-risk alcohol drinkers. Exp Clin Psychopharmacol 2023; 31:733-744. [PMID: 36174143 PMCID: PMC10118745 DOI: 10.1037/pha0000603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Alcohol and tobacco use are interrelated. This study examined response to very low nicotine content (VLNC) and moderate nicotine content (MNC) cigarettes by problematic drinking. We utilized a double-blind, randomized, within-subjects crossover design of VLNC and MNC cigarettes in two groups of adult cigarette smokers: with at-risk drinking (ARD; n = 23) and without ARD (n = 24). Participants smoked only their assigned experimental cigarette in their home environment for 7 days, and completed laboratory visits, including ad libitum smoking of the assigned experimental cigarette, at the beginning and end of each experimental week. Participants smoked their usual cigarettes for 7 days between conditions. Participants provided daily reports of alcohol and cigarette consumption. Current Diagnostic and Statistical Manual of Mental Disorders-5th edition (DSM-5) alcohol use disorder (AUD) was assessed at baseline and the end of each experimental week. Compliance with smoking of experimental cigarettes was good. Adjusting for baseline drinking, there was no significant effect of experimental cigarette or ARD group on drinks per day or alcohol urges. There was no effect of experimental cigarette or ARD group on cigarettes per day, or on any puff topography outcome or postsmoking exhaled carbon monoxide during laboratory smoking. No participant had a change in AUD status or AUD severity. After 7 days of exposure to VLNC cigarettes, adult cigarette smokers with ARD did not show compensatory drinking or compensatory smoking behavior. A future policy change in the United States to reduce nicotine content in cigarettes may not produce unintended compensatory drinking or smoking among this vulnerable and prevalent population of smokers. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
| | | | - Erin Monahan
- Battelle Public Health Research Center, Baltimore, MD, USA
| | | | - Cheryl A. Triplett
- Health Analytics, Health Outcomes and Biotechnology Solutions, Battelle, Columbus, OH, USA
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DeAtley T, Harrison A, Cassidy R, Kuo C, Higgins ST, Tidey JW. Subjective experiences, contexts, and risk perceptions of very low nicotine content cigarettes and electronic cigarettes among people with depression and anxiety disorders who smoke. Drug Alcohol Depend 2023; 244:109767. [PMID: 36638679 PMCID: PMC9974802 DOI: 10.1016/j.drugalcdep.2023.109767] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 12/06/2022] [Accepted: 01/06/2023] [Indexed: 01/11/2023]
Abstract
BACKGROUND A low-nicotine product standard is currently under consideration by the U.S. Food and Drug Administration (FDA). This standard may be more effective if alternative, non-combusted sources of nicotine are concurrently available. This qualitative study explored the lived experiences of people with depression and anxiety disorders who used very low nicotine content (VLNC) cigarettes with or without e-cigarettes during a randomized controlled trial. METHODS We conducted semi-structured qualitative interviews with participants (n = 20) as they completed a 16-week blinded trial of VLNC cigarettes with or without electronic cigarettes. Interviews explored 1) experiences with these products, 2) social and environmental contexts for use and 3) relative risk perceptions. Interviews were transcribed and analyzed using a hybrid inductive and deductive thematic analysis. RESULTS Concurrent access to e-cigarettes helped to ease the transition from usual-brand cigarettes to VLNC cigarettes. Some participants held misperceptions that VLNC cigarettes could reduce cancer risk whereas others did not. Participants expressed skepticism about the safety of e-cigarettes and the authenticity of the VLNC cigarettes. Smoking restrictions influenced e-cigarette use in some instances, but product preference was the overriding factor that influenced use. Participants did not note effects on psychiatric symptoms. CONCLUSIONS Should a nicotine reduction policy be implemented with e-cigarettes concurrently available on the market, tailored messaging for people with anxiety and depression disorders may be necessary to educate people about and the availability of alternative sources of nicotine, such as e-cigarettes, as well as the relative risk of VLNC cigarettes and e-cigarettes.
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Affiliation(s)
- Teresa DeAtley
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02912, USA.
| | - Abigail Harrison
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02912, USA
| | - Rachel Cassidy
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02912, USA
| | - Caroline Kuo
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02912, USA
| | - Stephen T Higgins
- Department of Psychological Science, University of Vermont, VT 05405, USA
| | - Jennifer W Tidey
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02912, USA
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White CM, Tessier KM, Koopmeiners JS, Denlinger-Apte RL, Cobb CO, Lane T, Campos CL, Spangler JG, Hatsukami DK, Strasser AA, Donny EC. Preliminary evidence on cigarette nicotine reduction with concurrent access to an e-cigarette: Manipulating cigarette nicotine content, e-liquid nicotine content, and e-liquid flavor availability. Prev Med 2022; 165:107213. [PMID: 35995103 PMCID: PMC10080461 DOI: 10.1016/j.ypmed.2022.107213] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 07/28/2022] [Accepted: 08/17/2022] [Indexed: 10/15/2022]
Abstract
The reinforcing characteristics of e-cigarettes could moderate the impact of reducing cigarette nicotine content. In this study, people who smoke daily were recruited from North Carolina and Pennsylvania (US) in 2018 and 2019. Within a randomized 2 × 2 × 2 factorial design, participants received investigational cigarettes and an e-cigarette for 12 weeks. Cigarette nicotine content was very low (0.4 mg/g of tobacco; VLNC) or normal (15.8 mg/g; NNC). E-liquids were 0.3% ("low") or 1.8% ("moderate") freebase nicotine, and available in tobacco flavors or tobacco, fruit, dessert and mint flavors. Study recruitment concluded before reaching the planned sample size (N = 480). Fifty participants were randomized and 32 completed the study. We found that randomization to VLNC, relative to NNC cigarettes, reduced self-reported cigarettes per day (CPD; mean difference: -12.96; 95% CI: -21.51, -4.41; p = 0.005); whereas e-liquid nicotine content and flavor availability did not have significant effects. The effect of cigarette nicotine content was larger in the moderate vs. low nicotine e-liquid groups and in the all flavors versus tobacco flavors e-liquid groups; tests of the interaction between e-liquid characteristics and cigarette nicotine content were not significant. Biomarkers of smoke exposure at Week 12 did not differ across conditions, which may reflect variability in adherence to only using VLNC cigarettes. In conclusion this study offers preliminary evidence that the extent to which cigarette nicotine reduction decreases smoking may depend on the reinforcing characteristics of alternative products, including the available nicotine contents and flavors of e-cigarettes.
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Affiliation(s)
- Cassidy M White
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - Katelyn M Tessier
- Masonic Cancer Center, Biostatistics Core, University of Minnesota, Minneapolis, MN, USA
| | - Joseph S Koopmeiners
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Rachel L Denlinger-Apte
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Caroline O Cobb
- Department of Psychology and Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA
| | - Tonya Lane
- Department of Psychiatry and Behavioral Sciences and Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Claudia L Campos
- Department of General Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - John G Spangler
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Dorothy K Hatsukami
- Department of Psychiatry and Behavioral Sciences and Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Andrew A Strasser
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Eric C Donny
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC, USA
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5
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Tidey JW, Snell LM, Colby SM, Cassidy RN, Denlinger-Apte RL. Effects of very low nicotine content cigarettes on smoking across vulnerable populations. Prev Med 2022; 165:107099. [PMID: 35642796 PMCID: PMC9699899 DOI: 10.1016/j.ypmed.2022.107099] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/19/2022] [Accepted: 05/22/2022] [Indexed: 10/18/2022]
Abstract
There has been long-standing interest in a reduced-nicotine product standard for combusted tobacco, which is within the regulatory purview of the Food and Drug Administration (FDA). In weighing whether to establish this standard, it is important to consider potential responses among people who are at elevated risk for tobacco-related health harms. In this narrative review, we summarize studies of very low nicotine content (VLNC) cigarettes conducted between 2010 and 2021 in groups that the FDA has identified as vulnerable populations. Studies conducted to date in adults with mental health conditions, adults with opioid use disorder, socioeconomically-disadvantaged adults, and youth or young adults indicate that immediate switching to VLNC cigarettes decreases smoking, with minimal or no unintended negative consequences. Few studies have investigated the effects of VLNC cigarettes in racial or ethnic minorities, people who smoke menthol cigarettes, and pregnant women, but initial findings suggest that responses of these individuals are similar to responses observed in other vulnerable populations. We are not aware of studies that have investigated VLNC cigarettes in military/veteran populations, sexual or gender minority individuals, or people living in underserved rural environments. Future research directions include understanding how to promote cessation in the context of a reduced-nicotine standard, and how to correct VLNC misperceptions in vulnerable populations. Nevertheless, the evidence to date indicates that a reduced-nicotine standard is likely to have the same beneficial effects on smoking reductions as it does in less vulnerable populations, which should provide some confidence in pursuing this regulatory approach.
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Affiliation(s)
- Jennifer W Tidey
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, USA.
| | - L Morgan Snell
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, USA
| | - Suzanne M Colby
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, USA
| | - Rachel N Cassidy
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, USA
| | - Rachel L Denlinger-Apte
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, USA
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Morgan SL, Reed GL, Tidey J, Bunn JY, Harfmann RF, Heil SH, Sigmon SC, Gaalema D, Higgins ST. Predictors of Adherence Among Vulnerable Populations of Adults Assigned to Smoke Very Low Nicotine Content Cigarettes. Nicotine Tob Res 2022; 24:1959-1967. [PMID: 35704338 PMCID: PMC9653083 DOI: 10.1093/ntr/ntac145] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 05/19/2022] [Accepted: 06/13/2022] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Regulators are considering reducing the nicotine content in cigarettes to a minimally addictive level. This could particularly benefit smokers from populations vulnerable to heavy smoking and difficulties quitting. We assessed predictors of adherence among adults from vulnerable populations assigned to use very low nicotine content cigarettes (VLNCs) in randomized clinical trials, to identify characteristics of those who require additional assistance if a nicotine reduction policy were implemented. AIMS AND METHODS Data came from three populations of vulnerable adult smokers assigned to use VLNC cigarettes (0.4 mg/g nicotine) during 12-week randomized controlled trials (n = 286): Socioeconomically disadvantaged women of reproductive age, opioid-maintained adults, and adults with affective disorders. Logistic and linear regressions modeled predictors of adherence based on changes in cotinine at week-6 and week-12 assessments relative to baseline, and as a 90% reduction in cotinine relative to baseline (full adherence: yes/no). Predictors included satisfaction with study cigarettes, craving, nicotine dependence severity, withdrawal, population membership, baseline affective-disorder symptoms, and sociodemographic characteristics. RESULTS Dependence severity was negatively associated with both adherence measures at week 6 (p < .01), whereas increased satisfaction with study cigarettes and age were positively associated with both measures at weeks 6 and 12 (p < .01). Opioid-maintained adults exhibited reduced adherence and were less likely to reach full adherence at week 12 compared to disadvantaged women (p = .02). CONCLUSIONS Factors associated with VLNC adherence in vulnerable populations are similar to those in the general population of smokers. Furthermore, studies are indicated investigating nicotine supplements (e.g., e-cigarettes, NRT) to support highly dependent adults faced with using VLNCs. IMPLICATIONS This study identified factors predicting difficulty maintaining adherence to a regimen of very low nicotine content cigarettes (VLNC) among adults from vulnerable populations. Findings suggested that factors predicting difficulty maintaining adherence (greater nicotine dependence and low satisfaction with study-provided VLNC) were common across vulnerable smokers and the general population of adults who smoke. Furthermore, research should investigate alternatives to support highly dependent adults, such as pairing VLNC with supplemental, noncombusted nicotine. Some vulnerable populations (e.g., opioid-maintained adults) may be especially in need of supplemental, noncombusted nicotine.
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Affiliation(s)
- Snell L Morgan
- Corresponding Author: L Morgan Snell, Center for Alcohol and Addiction Studies, Brown University, Box G-S121-5, Providence, RI 02912, USA. Telephone: 401-863-2402; Fax: 401-863-6697; E-mail:
| | - G L Reed
- Brown University, Providence, RI, USA
| | - J Tidey
- Brown University, Providence, RI, USA
| | - J Y Bunn
- University of Vermont, Burlington, VT, USA
| | | | - S H Heil
- University of Vermont, Burlington, VT, USA
| | - S C Sigmon
- University of Vermont, Burlington, VT, USA
| | - D Gaalema
- University of Vermont, Burlington, VT, USA
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Puljević C, Morphett K, Hefler M, Edwards R, Walker N, Thomas DP, Khan MA, Perusco A, Le Grande M, Cullerton K, Ait Ouakrim D, Carstensen G, Sellars D, Hoek J, Borland R, Bonevski B, Blakely T, Brolan C, Gartner CE. Closing the gaps in tobacco endgame evidence: a scoping review. Tob Control 2022; 31:365-375. [PMID: 35241614 DOI: 10.1136/tobaccocontrol-2021-056579] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 01/12/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Tobacco endgame policies aim to rapidly and permanently reduce smoking to minimal levels. We reviewed evidence syntheses for: (1) endgame policies, (2) evidence gaps, and (3) future research priorities. DATA SOURCES Guided by JBI scoping review methodology, we searched five databases (PubMed, CINAHL, Scopus, Embase and Web of Science) for evidence syntheses published in English since 1990 on 12 policies, and Google for publications from key national and international organisations. Reference lists of included publications were hand searched. STUDY SELECTION Two reviewers independently screened titles and abstracts. Inclusion criteria were broad to capture policy impacts (including unintended), feasibility, public and stakeholder acceptability and other aspects of policy implementation. DATA EXTRACTION We report the results according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. DATA SYNTHESIS Eight policies have progressed to evidence synthesis stage (49 publications): mandatory very low nicotine content (VLNC) standard (n=26); product standards to substantially reduce consumer appeal or remove the most toxic products from the market (n=1); moving consumers to reduced risk products (n=8); tobacco-free generation (n=4); ending sales (n=2); sinking lid (n=2); tax increases (n=7); and restrictions on tobacco retailers (n=10). Based on published evidence syntheses, the evidence base was most developed for a VLNC standard, with a wide range of evidence synthesised. CONCLUSIONS VLNC cigarettes have attracted the most attention, in terms of synthesised evidence. Additional focus on policies that reduce the availability of tobacco is warranted given these measures are being implemented in some jurisdictions.
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Affiliation(s)
- Cheneal Puljević
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Kylie Morphett
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Marita Hefler
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Richard Edwards
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Natalie Walker
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Addiction Research, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - David P Thomas
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Md Arifuzzaman Khan
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Andrew Perusco
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Michael Le Grande
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Katherine Cullerton
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Driss Ait Ouakrim
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Georgia Carstensen
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - David Sellars
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Queensland, Australia
| | - Janet Hoek
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Ron Borland
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Billie Bonevski
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- College for Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Tony Blakely
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Claire Brolan
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Coral E Gartner
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
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8
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Affiliation(s)
- Sanjay Agrawal
- University Hospitals of Leicester NHS Trust, Leicester, UK
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9
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Barbalich I, Gartner C, Edwards R, Hoek J. New Zealand Smokers' Perceptions of Tobacco Endgame Measures: A Qualitative Analysis. Nicotine Tob Res 2022; 24:93-99. [PMID: 34498088 DOI: 10.1093/ntr/ntab161] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 08/06/2021] [Indexed: 11/12/2022]
Abstract
INTRODUCTION New Zealand's equity-focused endgame goal (Smokefree 2025) aims to reduce smoking prevalence to minimal levels (ie, <5%) in all population groups by 2025. Inadequate progress has stimulated discussion of innovative measures to reduce prevalence; because few studies have explored how marginalized groups perceive these measures, we addressed this knowledge gap. AIMS AND METHODS In November and December 2020, we conducted 20 in-depth interviews with people who smoked daily, were aged between 21 and 53, earned less than the median income (NZD33 900), and had marginal or inadequate income sufficiency. We explored participants' smoking history and used an elicitation exercise to probe their views on smokefree policies, including potential endgame measures. We used qualitative descriptive analysis and reflexive thematic analysis to interpret the data. RESULTS Participants favored increasing personal support to quit and reducing nicotine levels in cigarettes, but generally opposed tobacco excise tax increases and paying people to quit. While many privileged their right to "choose," some recognized that stronger policies could restore the loss of agency addiction caused. Participants felt smoking's powerful addictiveness remained poorly understood, and called for smoking to be recognized and treated as an addiction. CONCLUSIONS Several participants supported intensifying existing measures or introducing new measures. However, their use of tobacco industry rhetoric to frame smoking as a choice they had made could inadvertently reinforce the stigma they experienced. Reframing cigarettes as an addictive product engineered by a deceptive industry, may make it easier for participants to access the expanded support and compassion they sought. IMPLICATIONS Policy measures, such as reducing the nicotine level in cigarettes, could support endgame goals; however, greater public understanding of addiction is needed to reduce stigma, support self-efficacy, and foster smoking cessation. Industry denormalization campaigns could challenge views of smoking as a personal choice, decrease self-blame among people who smoke, and present endgame goals as likely to enhance agency.
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Affiliation(s)
- Ivana Barbalich
- Otago School of Medicine, University of Otago, Dunedin, New Zealand
| | - Coral Gartner
- School of Public Health, University of Queensland, St Lucia, QLD, Australia
| | - Richard Edwards
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Janet Hoek
- Department of Public Health, University of Otago, Wellington, New Zealand
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10
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Li Q, Chen X, Li X, Gorowska M, Li Z, Li Y. The Effects of Immediate vs Gradual Reduction in Nicotine Content of Cigarettes on Smoking Behavior: An Ecological Momentary Assessment Study. Front Psychiatry 2022; 13:884605. [PMID: 35633808 PMCID: PMC9130591 DOI: 10.3389/fpsyt.2022.884605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 04/20/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In recent years, much research has examined the effects of various interventions and treatments for smoking cessation. The results suggest that interventions targeting changes of nicotine content can help smokers reduce tobacco use or quit smoking. A number of clinical studies show that smokers who received an immediate reduction in nicotine content to very low levels have significantly greater reductions in the number of cigarettes smoked and toxic substance exposure compared to those with gradual reductions. However, from the perspective of smoking craving, whether the immediate and gradual reduction in nicotine content reduce smoking by reducing cravings needs further investigation. METHODS 74 eligible Participants were randomly allocated to one of the two experimental conditions: (1) immediate reduction to 0.1 mg of nicotine per cigarette (n = 40); (2) gradual reduction from 1.0 (0.8 g ~ 1.2 mg) to 0.1 mg of nicotine per cigarette (n = 34). All participants completed 1-week baseline period during which they smoked their usual cigarette, followed by 16-week of interventions. The primary outcomes included cigarette cravings and number of cigarettes smoked per day (CPD); secondary outcomes included the number of cigarette-free day and emotional states. RESULTS Among the 52 participants [51 (98.1%) men; mean (SD) age, 33.44 (6.71) years; mean (SD) CPD, 16.83 (9.94)] who completed the trial, significantly lower cravings for cigarettes were observed in the immediate (n = 25) vs. gradual nicotine reduction group (n = 27) in the morning (t = -2.072, p = 0.039) and after dinner (t = -2.056, p = 0.041). Compared with the baseline daily smoking, the number of cigarettes smoked per day was significantly reduced at the beginning of week 12 in the immediate nicotine reduction group (p = 0.001) and at week 16 in the gradual nicotine reduction group (p < 0.001). The number of participants with any cigarette-free day was not significantly different between the groups (p = 0.198). The number of cigarette-free days was significantly more in the immediate vs. gradual nicotine reduction group (p = 0.027). CONCLUSIONS The significantly lower cravings were observed in the immediate vs. gradual nicotine reduction group, and led to faster reduction in the number of CPD, and a significant increase in the number of cigarette-free days. These findings add to the evidence base for reduced nicotine content in cigarettes. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, identifier: ChiCTR2100048216.
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Affiliation(s)
- Qianling Li
- Chinese Academy of Sciences (CAS) Key Laboratory of Mental Health, Institute of Psychology, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Xijing Chen
- Chinese Academy of Sciences (CAS) Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
| | - Xiuli Li
- YiDu Central Hospital of Weifang, Weifang, China
| | - Monika Gorowska
- Chinese Academy of Sciences (CAS) Key Laboratory of Mental Health, Institute of Psychology, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Zimin Li
- Chinese Academy of Sciences (CAS) Key Laboratory of Mental Health, Institute of Psychology, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yonghui Li
- Chinese Academy of Sciences (CAS) Key Laboratory of Mental Health, Institute of Psychology, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
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11
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Reed GL, Colby SM, Sokolovsky AW, Snell LM, DeAtley T, Tidey JW. Predicting Non-Adherence With Very Low Nicotine Content Cigarettes Among Adults With Serious Mental Illness Who Smoke. Nicotine Tob Res 2021; 24:914-918. [PMID: 34958368 PMCID: PMC9048920 DOI: 10.1093/ntr/ntab271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 12/17/2021] [Accepted: 12/22/2021] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Reducing the nicotine content of cigarettes is a promising policy intervention to decrease cigarette dependence among people who smoke. Randomized trials support the potential efficacy of a reduced nicotine product standard for cigarettes. However, interpretation of such trials is challenged by incomplete adherence to the randomized treatment assignment, as some participants may continue to use commercial cigarettes not provided by the trial. The current study examined prevalence and predictors of non-adherence among trial participants with serious mental illness (SMI). AIMS AND METHODS Adults with SMI who smoke daily and were not trying to quit (N = 58) were randomized to receive very low nicotine content (VLNC) or normal nicotine content cigarettes over 6 weeks. We investigated predictors of biologically assessed non-adherence in participants assigned to VLNC cigarettes (n = 30). Predictors included subjective responses to VLNC cigarettes, baseline nicotine dependence and dependence motives, and psychiatric symptom severity. We fit a series of linear models regressing non-adherence metrics onto covariates (gender; menthol preference) and focal predictors. RESULTS Nearly all participants (96%) were estimated to be less than completely adherent to VLNC cigarettes. Lower enjoyment ratings of respiratory tract sensations of VLNC cigarettes predicted a greater degree of non-adherence (b = -.40, SE = .14, 95% CI: -0.71, -0.10). CONCLUSIONS Less positive subjective response to smoking VLNC cigarettes was the only significant predictor of incomplete adherence among individuals with SMI, consistent with prior research in a general population sample. This suggests the potential for shared strategies to help different smoking populations adjust to a reduced nicotine product standard. IMPLICATIONS Results offer preliminary insight into potential barriers to adherence in SMI populations. Adherence might be enhanced by supplementing VLNC cigarettes with alternative sources of non-combusted nicotine, paired with educational campaigns to encourage quitting or switching to less harmful products. Future studies should replicate these analyses in a larger sample of individuals with SMI who smoke.
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Affiliation(s)
- Grace L Reed
- Corresponding Author: Grace L. Reed, Center for Alcohol and Addiction Studies, Brown University School of Public Health, 69 Brown St, #4867, Providence, RI 02912, USA. Telephone: 401-595-2666; E-mail:
| | - Suzanne M Colby
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
| | - Alexander W Sokolovsky
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
| | - L Morgan Snell
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
| | - Teresa DeAtley
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
| | - Jennifer W Tidey
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
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12
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Hung F, Wallach JD, O’Malley SS, Bold KW. Characteristics of Registered Clinical Trials Evaluating the Role of e-Cigarettes in Cessation or Reduction of Cigarette Smoking. JAMA Psychiatry 2021; 78:1280-1283. [PMID: 34468716 PMCID: PMC8411353 DOI: 10.1001/jamapsychiatry.2021.2468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This observational study examines the characteristics of completed and ongoing domestic and international clinical trials registered in the World Health Organization Registry Network.
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Affiliation(s)
- Felicia Hung
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, Connecticut
| | - Joshua D. Wallach
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, Connecticut
| | | | - Krysten W. Bold
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
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13
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Johnson AC, Mercincavage M, Souprountchouk V, Rogelberg S, Sidhu AK, Delnevo CD, Strasser AA. Responses to reduced nicotine cigarette marketing features: a systematic review. Tob Control 2021; 32:tobaccocontrol-2021-056826. [PMID: 34620718 PMCID: PMC8986886 DOI: 10.1136/tobaccocontrol-2021-056826] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/20/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To systematically review the literature regarding responses to commercial and public health marketing features for reduced nicotine cigarettes (RNCs) to anticipate potential industry and regulatory actions should an RNC product standard be issued. DATA SOURCES We searched PubMed for English-language articles using several keywords for reduced nicotine products, cigarettes and marketing features published through 2020. STUDY SELECTION Of 4092 records, 26 studies were retained for review that met criteria focusing on responses to RNC marketing features. DATA EXTRACTION Search terms created by the research team were used for review and included independent extraction and coding by two reviewers. Coding was categorised using study design terminology, commercial and public health features in tobacco regulatory science, and their association with individual responses outlined by several message processing outcomes. DATA SYNTHESIS Most studies focused on current cigarette smokers and were cross-sectional. Reactions to RNCs and attitudes and beliefs were the most common outcomes measured. For commercial features, articles generally studied RNC advertisements, products and/or descriptors. For public health features, articles studied counter-messaging (eg, warning labels) or general descriptors about nicotine or a reduced nicotine product standard. Commercial features were generally associated with favourable responses. Public health features offset favourable responses across most outcomes, though their efficacy was mixed. Contrasts in results by smoking status are discussed. CONCLUSIONS Commercial marketing of RNCs is appealing and may need stronger regulations or communication campaigns to accurately convey risks. Opportunities exist for future research within tobacco regulatory science.
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Affiliation(s)
- Andrea C Johnson
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, Pennsylvania, USA
| | - Melissa Mercincavage
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, Pennsylvania, USA
| | - Valentina Souprountchouk
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, Pennsylvania, USA
| | - Sasha Rogelberg
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Anupreet K Sidhu
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, Pennsylvania, USA
| | - Cristine D Delnevo
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, Pennsylvania, USA
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey, USA
| | - Andrew A Strasser
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, Pennsylvania, USA
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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14
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Smith TT, Nahhas GJ, Borland R, Cho YJ, Chung-Hall J, Fairman RT, Fong GT, McNeill A, Popova L, Thrasher JF, Cummings KM. Which tobacco control policies do smokers support? Findings from the International Tobacco Control Four Country Smoking and Vaping Survey. Prev Med 2021; 149:106600. [PMID: 33957152 PMCID: PMC8580201 DOI: 10.1016/j.ypmed.2021.106600] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 04/27/2021] [Accepted: 05/01/2021] [Indexed: 11/22/2022]
Abstract
As governments consider policy action to reduce smoking, a key factor in creating political will is the level of public support, particularly among smokers who are most affected by the policies. The goal of this paper is to assess and compare the level of support in Canada, the United States, England, and Australia for five smoking control policies: 1) banning menthol in cigarettes, 2) banning cigarette additives, 3) reducing nicotine in cigarettes to make them less addictive, 4) raising the minimum age to purchase cigarettes to 21 years and older, and 5) requiring pictorial warning labels on cigarette packs (examined in the US only). Data for these analyses come from 8165 daily cigarette smokers who responded to the 2016 International Tobacco Control Four Country Smoking and Vaping Survey. In all countries, the highest level of support was for raising the legal age for purchase to 21 years and older (62-70%) and reducing the nicotine content of cigarettes to make them less addictive (57-70%). Smokers who were less dependent on cigarettes and those expressing interest in quitting were more likely to support all policies. When asked how they would respond to a nicotine reduction policy, the most common response given was to try the non-nicotine cigarettes to see how they liked them (42-48%), with the next most common response being to quit smoking entirely (16-24%). The high level of support for these proposed policies among daily smokers provides important evidence for policymakers to counteract claims that such policies would be unpopular.
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Affiliation(s)
- Tracy T Smith
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, United States; Cancer Control and Prevention, Hollings Cancer Center, Charleston, SC 29425, United States.
| | - Georges J Nahhas
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, United States; Cancer Control and Prevention, Hollings Cancer Center, Charleston, SC 29425, United States
| | - Ron Borland
- School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Yoo Jin Cho
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, 29208, United States
| | - Janet Chung-Hall
- Department of Psychology, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Robert T Fairman
- School of Public Health, Georgia State University, Atlanta, GA, 30302, United States
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, ON N2L 3G1, Canada; Ontario Institute for Cancer Research, Toronto, ON M5G 0A3, Canada; School of Public Health and Health Systems, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Ann McNeill
- Addictions Department, King's College London, London, United Kingdom
| | - Lucy Popova
- School of Public Health, Georgia State University, Atlanta, GA, 30302, United States
| | - James F Thrasher
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, 29208, United States
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, United States; Cancer Control and Prevention, Hollings Cancer Center, Charleston, SC 29425, United States
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15
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Freitas-Lemos R, Keith DR, Tegge AN, Stein JS, Cummings KM, Bickel WK. Estimating the Impact of Tobacco Parity and Harm Reduction Tax Proposals Using the Experimental Tobacco Marketplace. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7835. [PMID: 34360124 PMCID: PMC8345477 DOI: 10.3390/ijerph18157835] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 11/17/2022]
Abstract
Taxes are a demonstrably effective method to suppress tobacco use. This study examined the effects of the tobacco parity (i.e., imposing taxes equally on all tobacco products) and the harm reduction (i.e., applying taxes in proportion to the products' levels of harm) tax proposals on demand and substitution across products. A crowdsourced sample of cigarette smokers (n = 35) completed purchasing trials with increasing tax magnitudes across different tax tiers in the Experimental Tobacco Marketplace in a repeated-measures design. Products were placed in three tax tiers (high, medium, and no tax) according to each proposal's goal. The results indicated that total nicotine (mg) purchased was not significantly different between the proposals, with higher taxes yielding lower demand. However, as taxes increased, the tobacco parity proposal decreased the purchasing of all tobacco products and increased the purchasing of medicinal nicotine (i.e., the no tax tier). Conversely, the harm reduction proposal resulted in greater purchases of electronic nicotine delivery systems and smokeless tobacco (i.e., the medium tax tier). These findings support tobacco taxation as a robust tool for suppressing purchasing and suggest that differential taxation in proportion to product risk would be an effective way to incentivize smokers to switch from smoked to unsmoked products. Further studies should investigate the unintended consequences of their implementation.
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Affiliation(s)
- Roberta Freitas-Lemos
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA 24016, USA; (R.F.-L.); (D.R.K.); (A.N.T.); (J.S.S.)
| | - Diana R. Keith
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA 24016, USA; (R.F.-L.); (D.R.K.); (A.N.T.); (J.S.S.)
| | - Allison N. Tegge
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA 24016, USA; (R.F.-L.); (D.R.K.); (A.N.T.); (J.S.S.)
- Department of Statistics, Virginia Tech, Blacksburg, VA 24060, USA
| | - Jeffrey S. Stein
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA 24016, USA; (R.F.-L.); (D.R.K.); (A.N.T.); (J.S.S.)
| | - K. Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA;
| | - Warren K. Bickel
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA 24016, USA; (R.F.-L.); (D.R.K.); (A.N.T.); (J.S.S.)
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16
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Dermody SS, Tessier KM, Meier E, al'Absi M, Denlinger-Apte RL, Drobes DJ, Jensen J, Koopmeiners JS, Pacek LR, Tidey JW, Vandrey R, Donny E, Hatsukami D. An Evaluation of Potential Unintended Consequences of a Nicotine Product Standard: A Focus on Drinking History and Outcomes. Nicotine Tob Res 2020; 23:1168-1175. [PMID: 33220047 DOI: 10.1093/ntr/ntaa236] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 11/16/2020] [Indexed: 01/02/2023]
Abstract
INTRODUCTION A nicotine product standard reducing the nicotine content in cigarettes could improve public health by reducing smoking. This study evaluated the potential unintended consequences of a reduced nicotine product standard by examining its effects on (1) smoking behaviors based on drinking history; (2) drinking behavior; and (3) daily associations between smoking and drinking. METHODS Adults who smoke daily (n = 752) in the United States were randomly assigned to smoke very low nicotine content (VLNC) cigarettes versus normal nicotine content (NNC; control) cigarettes for 20 weeks. Linear mixed models determined if baseline drinking moderated the effects of VLNC versus NNC cigarettes on Week 20 smoking outcomes. Time-varying effect models estimated the daily association between smoking VLNC cigarettes and drinking outcomes. RESULTS Higher baseline alcohol use (vs no use or lower use) was associated with a smaller effect of VLNC on Week 20 urinary total nicotine equivalents (ps < .05). No additional moderation was supported (ps > .05). In the subsample who drank (n = 415), in the VLNC versus NNC condition, daily alcohol use was significantly reduced from Weeks 17 to 20 and odds of binge drinking were significantly reduced from Weeks 9 to 17. By Week 7, in the VLNC cigarette condition (n = 272), smoking no longer predicted alcohol use but remained associated with binge drinking. CONCLUSIONS We did not support negative unintended consequences of a nicotine product standard. Nicotine reduction in cigarettes generally affected smoking behavior for individuals who do not drink or drink light-to-moderate amounts in similar ways. Extended VLNC cigarette use may improve public health by reducing drinking behavior. IMPLICATIONS There was no evidence that a VLNC product standard would result in unintended consequences based on drinking history or when considering alcohol outcomes. Specifically, we found that a very low nicotine standard in cigarettes generally reduces smoking outcomes for those who do not drink and those who drink light-to-moderate amounts. Furthermore, an added public health benefit of a very low nicotine standard for cigarettes could be a reduction in alcohol use and binge drinking over time. Finally, smoking VLNC cigarettes may result in a decoupling of the daily associations between smoking and drinking.
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Affiliation(s)
- Sarah S Dermody
- Department of Psychology, Ryerson University, Toronto, ON, Canada
| | | | - Ellen Meier
- Department of Psychology, University of Wisconsin-Stevens Point, USA
| | - Mustafa al'Absi
- Masonic Cancer Center, University of Minnesota, Duluth, MN, USA
| | - Rachel L Denlinger-Apte
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - David J Drobes
- Tobacco Research and Intervention Program, Moffitt Cancer Center, Tampa, FL, USA
| | - Joni Jensen
- Masonic Cancer Center, University of Minnesota, Duluth, MN, USA
| | | | - Lauren R Pacek
- Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Jennifer W Tidey
- Department of Behavioral and Social Sciences, Brown University, Providence, RI, USA.,Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
| | - Ryan Vandrey
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Eric Donny
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
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17
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Oliveri D, Liang Q, Sarkar M. Real-World Evidence of Differences in Biomarkers of Exposure to Select Harmful and Potentially Harmful Constituents and Biomarkers of Potential Harm Between Adult E-Vapor Users and Adult Cigarette Smokers. Nicotine Tob Res 2020; 22:1114-1122. [PMID: 31563966 PMCID: PMC7291803 DOI: 10.1093/ntr/ntz185] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 09/26/2019] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Real-world evidence regarding likely long-term health effects of e-vapor products (EVP) under actual use conditions relative to cigarette smoking is not well studied. METHODS In this cross-sectional, observational study, biomarkers of exposure (BOE) to select harmful and potentially harmful constituents and biomarkers of potential harm (BOPH) relevant to smoking-related diseases were measured in exclusive adult EVP users (AEVP, n = 144) and exclusive adult cigarette smokers (AS, n = 73). AEVP used their own brand of EVP for 6+ months following 10+ years of cigarette smoking and AS smoked own brand of cigarettes for 10+ years. Subject recruitment and informed consent were obtained online and urine/blood samples were collected at local clinical laboratories, representing a new paradigm for collecting real-world evidence. RESULTS The levels of total NNAL (NNK metabolite), 3-hydroxypropyl mercapturic acid (acrolein metabolite), and carboxyhemoglobin (carbon monoxide measure) were 46% to 86% lower in AEVP compared with AS (p ≤ .0001) as was nicotine equivalents (nicotine and its five metabolites; 36%, p < .01). The levels of some BOPH were significantly lower in AEVP compared with AS for 11-dehydrothromboxane-B2 (29%, p = .04; platelet activation), 8-epi-prostaglandin F2α (23%, p = .02; oxidative stress) and soluble intercellular adhesion molecule-1 (16%, p = .02; endothelial function). CONCLUSIONS This study demonstrates the feasibility of a new approach for collecting real-world evidence. Substantially lower levels of BOEs (NNK, nicotine, acrolein, carbon monoxide) and favorable differences in BOPHs (platelet activation, oxidative stress, endothelial function) suggest EVP users may have lower health risks than cigarette smokers. IMPLICATIONS Cigarette smoking causes serious diseases. Switching from a combustible tobacco product to a noncombustible product is a potential harm reduction pathway for adult smokers unable or unwilling to quit. Real-world evidence regarding the relative risk of EVP use compared with cigarettes is not well established. This study provides data specific to BOE to tobacco smoke constituents and biomarkers of potential harm collected under actual use conditions in a real-world setting. The totality of evidence suggests that exclusive EVP use may present lower health risk compared with smoking cigarettes.
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18
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Alashoor T, Han S. The smoking paradox: exploring why attitudes toward cigarette smoking are a weak predictor of cigarette smoking. Psychol Health 2020; 36:847-861. [PMID: 32862721 DOI: 10.1080/08870446.2020.1798958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE An attitude change perspective represents a central line of research in the smoking literature. This line of research focuses on influencing individuals' attitudes toward smoking in order to alleviate the negative outcomes of smoking and to achieve positive smoking behaviours. This line of research, however, does not explain why attitudes toward cigarette smoking are a weak predictor of cigarette smoking, an indication of a smoking paradox. The current study introduces two domain-general factors to explore this smoking paradox. DESIGN We used an online survey and collected data from American subjects (n = 328) via a crowdsourcing platform, Amazon Mechanical Turk, in 2018. RESULTS We found that the association between attitude toward smoking and the likelihood of smoking is significantly weaker when individuals perceive a low probability of risk and/or believe that this probable risk will only occur in the distant future, after many years. These results suggest that smoking may not be consistent with attitude because individuals perceive low probability of risk and/or they temporally discount the occurrence of this probable risk. CONCLUSION The results suggest that novel strategies that incorporate the concepts of perceived risk probability and temporal discounting of the probable risk are needed for smoking cessation.
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Affiliation(s)
- Tawfiq Alashoor
- Information Technology, Analytics, and Operations, Mendoza College of Business, University of Notre Dame, Notre Dame, IN, USA.,Information Systems & Operations Management, KFUPM Business School, King Fahd University of Petroleum and Minerals, Dhahran, Saudi Arabia
| | - Sehee Han
- Institute of Social Sciences, Kookmin University, Seongbok-gu, South Korea
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19
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Johnson AC, Mays D, Villanti AC, Niaura RS, Rehberg K, Phan L, Mercincavage M, Luta G, Strasser AA. Marketing Influences on Perceptions of Reduced Nicotine Content Cigarettes. Nicotine Tob Res 2020; 21:S117-S124. [PMID: 31867656 PMCID: PMC6939778 DOI: 10.1093/ntr/ntz167] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 08/29/2019] [Indexed: 11/25/2022]
Abstract
Introduction The Food and Drug Administration announced intent to reduce the nicotine content in cigarettes. There is limited evidence on how reduced nicotine content cigarette (RNC) marketing affects product beliefs and use, and research on this is needed to inform regulations. Methods In an online experiment, 426 young adult cigarette smokers (aged 18–30 years) were randomized in a 2 (implicit: red package vs. blue package) × 2 (explicit: corrective message vs. no corrective message) design to view an advertisement for previously commercially available RNCs. Outcomes were advertisement content recall, product beliefs, and use intentions. Participants’ responses to open-ended assessment of their beliefs about the stimuli were coded to identify prevailing themes. Results Red packaging and corrective messaging were independently associated with greater advertisement content recall (p = .01 and p = .04, respectively). There were no significant main or interaction effects on product beliefs or use intentions. Controlling for condition, advertisement content recall was significantly associated with less favorable product beliefs (p < .001) and favorable product beliefs were associated with intent to use the product (p < .001). Open-ended responses converged on the finding that respondents were interested in RNCs, but expressed skepticism about effectiveness and value. Conclusions Brief exposure to an RNC advertisement with red packaging and corrective messaging were each independently associated with greater advertisement content recall. The results indicate: (1) interest and confusion among young adult smokers regarding RNCs, (2) beliefs about RNCs are influenced by marketing, and (3) beliefs are associated with intention to use RNCs. Implications Findings from this study demonstrate the importance of advertising effects on beliefs about RNC products and support the need to regulate advertising and labeling alongside product regulation. More detailed study of advertisement features that affect consumers’ beliefs about RNCs and how they impact their processing of explicit messaging about product risks will be important to guide regulatory decision-making.
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Affiliation(s)
- Andrea C Johnson
- Milken Institute School of Public Health, George Washington University, Washington, DC.,Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Darren Mays
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Andrea C Villanti
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont Larner College of Medicine, Burlington, VT
| | - Raymond S Niaura
- New York University College of Global Public Health, New York, NY
| | - Kathryn Rehberg
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Lilianna Phan
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC.,University of Maryland School of Public Health, College Park, MD
| | - Melissa Mercincavage
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - George Luta
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC.,Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University Medical Center, Washington, DC
| | - Andrew A Strasser
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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20
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Burrows C, Dallery J, Kim SJ, Raiff BR. Validity of a Functional Assessment for Smoking Treatment Recommendations Questionnaire. PSYCHOLOGICAL RECORD 2020. [DOI: 10.1007/s40732-020-00375-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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21
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Abstract
Human behavior can be controlled by physical or psychological dependencies associated with addiction. One of the most insidious addictions in our society is the use of tobacco products which contain nicotine. This addiction can be associated with specific receptors in the brain that respond to the natural neurotransmitter acetylcholine. These nicotinic acetylcholine receptors (nAChR) are ligand-gated ion channels formed by the assembly of one or multiple types of nAChR receptor subunits. In this paper, we review the structure and diversity of nAChR subunits and our understanding for how different nAChR subtypes play specific roles in the phenomenon of nicotine addiction. We focus on receptors containing β2 and/or α6 subunits and the special significance of α5-containing receptors. These subtypes all have roles in regulating dopamine-mediated neurotransmission in the mesolimbic reward pathways of the brain. We also discuss the unique roles of homomeric α7 nAChR in behavioral responses to nicotine and how our knowledge of nAChR functional diversity may help guide pharmacotherapeutic approaches for treating nicotine addiction. While nicotine addiction is a truly global problem, the use of areca nut (betel) products is also a serious addiction associated with public health issues across most of South Asia, impacting as many as 600 million people. We discuss how cholinergic receptors of the brain are also involved with areca addiction and the unique challenges for dealing with addiction to this substance.
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22
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Smith TT, Donny EC, Luo X, Allen AM, Carroll DM, Denlinger-Apte RL, Dermody SS, Koopmeiners JS, McClernon FJ, Pacek LR, Vandrey R, Hatsukami DK. The Impact of Gradual and Immediate Nicotine Reduction on Subjective Cigarette Ratings. Nicotine Tob Res 2019; 21:S73-S80. [PMID: 31867651 PMCID: PMC6939762 DOI: 10.1093/ntr/ntz158] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 08/24/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND A recent clinical trial showed that an immediate transition to very low nicotine content (VLNC) cigarettes, compared with a gradual transition, produced greater reductions in smoking behavior, smoke exposure, and dependence. However, there was less compliance with the instruction to smoke only VLNC cigarettes in the immediate versus gradual reduction condition. The goal of this study was to test whether nicotine reduction method alters subjective ratings of VLNC cigarettes, and whether subjective ratings mediate effects of nicotine reduction method on smoking behavior, smoke exposure, dependence, and compliance. METHODS This is a secondary analysis of a randomized trial conducted across 10 sites in the United States. Smokers (n = 1250) were randomized to either a control condition, or to have the nicotine content of their cigarettes reduced immediately or gradually to 0.04 mg nicotine/g of tobacco during a 20-week study period. Participants completed the modified Cigarette Evaluation Questionnaire (mCEQ). RESULTS After Week 20, the immediate reduction group scored significantly lower than the gradual reduction group on multiple subscales of the mCEQ (ps < .001). The Satisfaction subscale of the mCEQ mediated the impact of nicotine reduction method on smoke exposure, smoking behavior, dependence, compliance, and abstinence. Other subscales also mediated a subset of these outcomes. CONCLUSIONS An immediate reduction in nicotine content resulted in lower product satisfaction than a gradual reduction, suggesting that immediate reduction further reduces cigarette reward value. This study will provide the Food and Drug Administration with information about the impact of nicotine reduction method on cigarette reward value. IMPLICATIONS These data suggest that an immediate reduction in nicotine content will result in greater reductions in cigarette satisfaction than a gradual reduction, and this reduction in satisfaction is related to changes in smoking behavior and dependence.
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Affiliation(s)
- Tracy T Smith
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
- Baptist Comprehensive Cancer Center and Department of Physiology and Pharmacology, Wake Forest University, Winston-Salem, NC
| | - Eric C Donny
- Baptist Comprehensive Cancer Center, Wake Forest University, Winston-Salem, NC
- Department of Physiology and Pharmacology, Wake Forest University, Winston-Salem, NC
| | - Xianghua Luo
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | - Alicia M Allen
- Department of Family and Community Medicine, University of Arizona, Tucson, AZ
| | - Dana M Carroll
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | - Rachel L Denlinger-Apte
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI
| | - Sarah S Dermody
- School of Psychological Science, Oregon State University, Corvallis, OR
| | - Joseph S Koopmeiners
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN
| | - F Joseph McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Ryan Vandrey
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD
| | - Dorothy K Hatsukami
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN
- Department of Psychiatry, University of Minnesota, Minneapolis, MN
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23
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White CM, Pickworth WB, Sved AF, Donny EC. Using Product Standards to Render the Most Harmful Tobacco Products Minimally Addictive: Maximum Nicotine Level, Non-Nicotine Constituents, and Scope. Nicotine Tob Res 2019; 21:S13-S15. [PMID: 31867639 PMCID: PMC6939768 DOI: 10.1093/ntr/ntz121] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 07/17/2019] [Indexed: 01/12/2023]
Affiliation(s)
- Cassidy M White
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Wallace B Pickworth
- Center for Analytics and Public Health, Battelle Memorial Institute, Baltimore, MD
| | - Alan F Sved
- Department of Neuroscience, University of Pittsburgh, Pittsburgh, PA
| | - Eric C Donny
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC
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Randomized Trial of Low-Nicotine Cigarettes and Transdermal Nicotine. Am J Prev Med 2019; 57:515-524. [PMID: 31542129 PMCID: PMC6756174 DOI: 10.1016/j.amepre.2019.05.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 05/19/2019] [Accepted: 05/20/2019] [Indexed: 12/30/2022]
Abstract
INTRODUCTION A mandated reduction in the nicotine content of cigarettes may decrease smoking, but also increase demand for other nicotine products. The present study tested the impact of smoking cigarettes with very low nicotine content and concurrent use of a transdermal nicotine patch. STUDY DESIGN A balanced 2 × 2 factorial randomized clinical trial investigating the impact of cigarette nicotine content (double-blind, very low nicotine content versus normal nicotine content) and use of a transdermal nicotine patch (open label, patch versus no patch). SETTING/PARTICIPANTS Adult daily smokers (n=240) in the Pittsburgh, PA area. INTERVENTION Participants were provided with research cigarettes and transdermal nicotine patches (if assigned to patch condition) for 7 weeks. Cigarettes were Spectrum brand (National Institute on Drug Abuse) and either 15.8 mg nicotine/g tobacco (normal nicotine content) or 0.4 mg nicotine/g tobacco (very low nicotine content). In the 7th week, participants were monetarily incentivized to abstain from smoking. MAIN OUTCOME MEASURES Participants reported daily cigarette use throughout the trial and the primary outcome was average number of cigarettes smoked per day (study + nonstudy) during Week 6. Participants were recruited from 2015 to 2017 and data were analyzed between 2017 and 2018. RESULTS Assignment to very low nicotine content cigarettes and assignment to wear a nicotine patch both reduced the number of cigarettes smoked per day during Week 6 (p=0.001 and 0.04, respectively). However, assignment to the patch along with very low nicotine content cigarettes did not significantly reduce cigarette smoking compared with assignment to very low nicotine content cigarettes alone. CONCLUSIONS A mandated reduction in the nicotine content of cigarettes is likely to reduce the number of cigarettes smoked per day, but the added benefit of concurrent transdermal nicotine is unclear. Future studies should investigate whether alternative sources of noncombusted tobacco, such as e-cigarettes, enhance the effects of very low nicotine content cigarettes on smoking. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT02301325.
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Smith EA, Malone RE. An argument for phasing out sales of cigarettes. Tob Control 2019; 29:703-708. [PMID: 31542777 PMCID: PMC7591796 DOI: 10.1136/tobaccocontrol-2019-055079] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 08/21/2019] [Accepted: 08/26/2019] [Indexed: 11/04/2022]
Abstract
The successes of tobacco control in some countries and locales have led to discussions of ending the tobacco epidemic, often called the 'endgame'. In this paper, we recommend articulating the endgame goal as phasing out sales of cigarettes, a goal once called 'unthinkable'. We develop a logic and argumentation for ending cigarette sales intended to move the discussion beyond the shadow of 'prohibition', proposing an approach that appeals to consumer protection standards and suggesting that the effort be led by low-prevalence communities. While phasing out cigarettes will not happen everywhere all at once, and may unfold differently along several lines, we argue that the gradual phase-out approach we propose will reduce the likelihood of the negative consequences often predicted to come with such a policy. To continue permitting widespread sales of the single most deadly consumer product in history is a public health failure that must be addressed.
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Affiliation(s)
- Elizabeth A Smith
- Social and Behavioral Sciences, University of California San Francisco, San Francisco, California, USA
| | - Ruth E Malone
- Social and Behavioral Sciences, University of California San Francisco, San Francisco, California, USA
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26
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Flavored electronic cigarette use, preferences, and perceptions in pregnant mothers: A correspondence analysis approach. Addict Behav 2019; 91:21-29. [PMID: 30446262 DOI: 10.1016/j.addbeh.2018.10.043] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 09/12/2018] [Accepted: 10/28/2018] [Indexed: 11/23/2022]
Abstract
Use, preferences, and perceptions of flavored electronic cigarettes (e-cigarettes) were investigated in an ethnically diverse sample of pregnant mothers (N = 100; 50% smokers, Mage = 26; 66% low income; 65% minorities) via detailed interviews. Fruit and mint were the most commonly used flavors. Pregnant women endorsed increased use of fruit flavored e-cigarettes in preconception and pregnancy, greater preferences and intentions to use sweet flavors (fruit and candy), and lowest preferences for tobacco flavors. No differences in perceptions of general, pregnancy, or fetal-related health risks emerged across flavors. Latent factor mapping (biplots) based on correspondence analyses of contingency tables revealed clustering of more-preferred fruit and candy flavors versus least-preferred tobacco flavored e-cigarettes, with other sweet flavors-mint and alcohol-clustering more closely with fruit and candy flavors, and more pungent flavors-spice, coffee, chocolate-clustering near tobacco. Correspondence analysis also revealed uncorrelated clustering of preferences and harm perceptions, with intentions showing associations with both preferences and harm perceptions. Preference for fruit and mint flavored e-cigarettes and decreased harm perceptions significantly differentiated lifetime e-cigarette users from non-users. Results highlight preferences for fruit and mint flavored e-cigarettes during preconception and pregnancy, and links between preferences for fruit and mint flavors and lifetime use of e-cigarettes. These findings also highlight the utility of correspondence analysis for elucidating clustering of flavor perceptions and preferences for novel tobacco products.
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Abstract
This Special Issue of Preventive Medicine (PM) is the 5th in a series on behavior change, health, and health disparities. Unhealthy behavior patterns (i.e., lifestyle choices) including cigarette smoking and other substance abuse, physical inactivity, unhealthy food choices, and non-adherence with recommended medical regimens, undermine U.S. population health by increasing risk for chronic disease and premature death. This Special Issue brings together scholarly contributions from the emerging area of tobacco regulatory science to examine current topics of critical importance to reducing the burden of cigarette smoking on U.S. population health. More specifically, three related topics are examined including (a) the potential for reducing smoking by adopting a national policy that would cap the nicotine content of cigarettes at minimally-addictive levels; (b) increasing scientific understanding of cigarette smoking and other tobacco use among populations that are especially vulnerable to initiating smoking, tobacco addiction, and its adverse health consequences; and (c) the potential of a harm-reduction strategy for reducing the burden of smoking by advocating that those who are unwilling or unable to quit nicotine use substitute electronic cigarettes or other non-combusted sources of nicotine for cigarettes in order to avoid exposure to the other toxins in tobacco smoke that are most responsible for smoking morbidity and mortality. While tremendous progress has been made in reducing overall U.S. smoking prevalence and its adverse health impacts, more needs to be done. This Special Issue offers some ideas that have the potential to make a substantive contribution towards that goal.
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Affiliation(s)
- Stephen T Higgins
- Vermont Center on Behavior and Health, Departments of Psychiatry and Psychological Science, University of Vermont.
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28
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Denlinger-Apte RL, Tidey JW, Koopmeiners JS, Hatsukami DK, Smith TT, Pacek LR, McClernon FJ, Donny EC. Correlates of support for a nicotine-reduction policy in smokers with 6-week exposure to very low nicotine cigarettes. Tob Control 2018; 28:352-355. [PMID: 30385649 PMCID: PMC6482068 DOI: 10.1136/tobaccocontrol-2018-054622] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 09/19/2018] [Accepted: 10/10/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND The US Food and Drug Administration recently issued an advanced notice of proposed rule-making for reducing the nicotine content in cigarettes to a minimally addictive level. Very little is known about whether use of very low nicotine content (VLNC) cigarettes affects support for a nicotine reduction policy. OBJECTIVE This study examined the effects of using VLNC versus usual brand (UB) cigarettes on support for a nicotine reduction policy and determined whether participant characteristics and responses to VLNC cigarettes were associated with policy support. METHODS Participants from a cigarette trial who were assigned to either 0.4 mg nicotine/g tobacco research cigarettes or their UB for 6 weeks were asked about their support for the policy. χ2 tests were used to compare support for the policy between cigarette conditions and logistic regression analyses were conducted to assess covariates associated with policy support. FINDINGS Policy support did not differ by condition. After 6 weeks of using VLNC cigarettes, 50% of participants supported the policy, 26% opposed and 24% responded 'Don't Know'. Support was higher among those adherent to smoking only VLNC cigarettes (65%) compared with those who were non-adherent (44%). Older participants and those interested in quitting had increased odds of support. Cigarette satisfaction, perceived harm and perceived nicotine content were not significantly associated with support. CONCLUSIONS Smoking VLNC cigarettes did not affect support for a nicotine reduction policy. Understanding predictors of policy support and opposition will help public health officials to maximise the public health acceptance and impact of this policy (ClinicalTrials.gov Identifier: NCT01681875 Post-Results).
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Affiliation(s)
- Rachel L Denlinger-Apte
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Jennifer W Tidey
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Brown University, Providence, Rhode Island, USA.,Department of Psychiatry and Human Behavior, Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island, USA
| | - Joseph S Koopmeiners
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Dorothy K Hatsukami
- Masonic Cancer Center and Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota, USA
| | - Tracy T Smith
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - F Joseph McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Eric C Donny
- Baptist Comprehensive Cancer Center and Department of Physiology and Pharmacology, Wake Forest University, Winston-Salem, North Carolina, USA
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29
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Affiliation(s)
- John Britton
- UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Clinical Sciences Building, City Hospital, Nottingham NG5 1PB, UK.
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