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Pakdaman S, Broun A, Duart DA, Ajith A, Jewett B, Wong N, Mead-Morse EL, Choi K, Chen-Sankey J. Exploring the hypothetical impact of flavored cigar sales restrictions among black young adult cigar smokers: a semi-structured in-depth interview investigation. J Ethn Subst Abuse 2022:1-19. [PMID: 35943488 PMCID: PMC9908770 DOI: 10.1080/15332640.2022.2109089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
This study assessed the hypothetical impact of flavored cigar sales restrictions on cigar smoking among Black young adult cigar smokers (ages 21-29). Forty in-depth interviews were conducted in 2020. Interviews were independently coded and analyzed using thematic analysis. When asked how they would smoke cigars given a flavor sales restriction, half of participants reported they would smoke in the same way, a third would stop or reduce smoking, and a few were unsure of what they would do. Cigar smoking outcome expectancies, preference for flavors, and perceived addictiveness of cigar products may predict cigar smoking change given flavor sales restrictions.
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Affiliation(s)
- Sheila Pakdaman
- Department of Preventive Medicine, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Aaron Broun
- National Institute on Minority Health and Health Disparities, Division of Intramural Research, Bethesda, MD USA
- George Washington University, Milken Institute School of Public Health, Washington, D.C., USA
| | - Danielle A. Duart
- National Institute on Minority Health and Health Disparities, Division of Intramural Research, Bethesda, MD USA
- National Cancer Institute. Division of Cancer Epidemiology & Genetics, Rockville, MD, USA
| | - Aniruddh Ajith
- National Institute on Minority Health and Health Disparities, Division of Intramural Research, Bethesda, MD USA
- University of Pittsburgh, School of Medicine
| | - Bambi Jewett
- National Institute on Minority Health and Health Disparities, Division of Intramural Research, Bethesda, MD USA
| | - Nicholas Wong
- Health, Emotion, and Addiction Laboratory, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | | | - Kelvin Choi
- National Institute on Minority Health and Health Disparities, Division of Intramural Research, Bethesda, MD USA
| | - Julia Chen-Sankey
- Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, USA
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2
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Elhabashy M, Phan L, Hamilton-Moseley KR, Broun A, Duarte DA, Ajith A, Jewett B, Mead-Morse EL, Choi K, Chen-Sankey J. Exploring the Experiences and Perceptions of Cigar Craving and Addiction among Young Adult Black Cigar Smokers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:6680. [PMID: 35682264 PMCID: PMC9180285 DOI: 10.3390/ijerph19116680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 05/27/2022] [Accepted: 05/28/2022] [Indexed: 01/25/2023]
Abstract
Black young adults have the highest prevalence of cigar smoking in the U.S. Little is known about how this population perceives addiction to cigar smoking, which may influence long-term smoking and cessation outcomes. This study used semi-structured in-depth interviews to understand cravings, triggers, and perceived addiction from cigar smoking among a purposive sample of Black young adult cigar smokers (N = 40; 21-29 years). An iterative process was used to develop the codebook, and thematic analysis was used to capture findings based on the products predominantly used: cigarillos, large cigars, or blunts. Results suggest that while participants may share similar types of cravings and triggers (e.g., stress) across the use of these products, predominant blunt smokers reported more unique triggers related to relieving physical discomforts. While most participants reported cigars could be addictive to people in general, only a few perceived that they themselves were addicted. Participants who predominantly smoked cigarillos reported high perceived addiction to cigars, while those who predominantly smoked blunts reported low addiction. Education messages are needed to inform young Black adult cigar smokers about the risks and health symptoms of cigar addiction. These efforts may help increase cigar cessation seeking and reduce cigar addiction-related health consequences and disparities among Black populations.
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Affiliation(s)
- Maryam Elhabashy
- Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ 08901, USA;
| | - Lilianna Phan
- National Institute on Minority Health and Health Disparities, Division of Intramural Research, Bethesda, MD 20814, USA; (L.P.); (K.R.H.-M.); (B.J.); (K.C.)
| | - Kristen R. Hamilton-Moseley
- National Institute on Minority Health and Health Disparities, Division of Intramural Research, Bethesda, MD 20814, USA; (L.P.); (K.R.H.-M.); (B.J.); (K.C.)
| | - Aaron Broun
- Milken Institute School of Public Health, George Washington University, Washington, DC 20052, USA; (A.B.); (D.A.D.)
| | - Danielle A. Duarte
- Milken Institute School of Public Health, George Washington University, Washington, DC 20052, USA; (A.B.); (D.A.D.)
| | - Aniruddh Ajith
- School of Medicine, University of Pittsburgh, Pittsburgh, PA 15201, USA;
| | - Bambi Jewett
- National Institute on Minority Health and Health Disparities, Division of Intramural Research, Bethesda, MD 20814, USA; (L.P.); (K.R.H.-M.); (B.J.); (K.C.)
| | - Erin L. Mead-Morse
- School of Medicine, University of Connecticut, Farmington, CT 06032, USA;
| | - Kelvin Choi
- National Institute on Minority Health and Health Disparities, Division of Intramural Research, Bethesda, MD 20814, USA; (L.P.); (K.R.H.-M.); (B.J.); (K.C.)
| | - Julia Chen-Sankey
- Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ 08901, USA;
- School of Public Health, Rutgers University, Piscataway, NJ 08854, USA
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3
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Bono RS, Cobb CO, Wall CS, Lester RC, Hoetger C, Lipato T, Guy MC, Eissenberg T, Bickel WK, Barnes AJ. Behavioral economic assessment of abuse liability for Black & Mild cigar flavors among young adults. Exp Clin Psychopharmacol 2022; 30:113-119. [PMID: 33001692 PMCID: PMC8513892 DOI: 10.1037/pha0000400] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Cigars are available in a variety of flavors that may impact uptake and use, but little is known about how different flavors affect abuse liability. This study used 3 behavioral economic tasks to examine abuse liability of Black & Mild cigars differing in flavor among young adult cigarette smokers. Participants were 25 cigar-naïve young adults (aged 18-25 years) who smoked ≥ 5 cigarettes/day. In 5 Latin square-ordered laboratory visits, participants completed 3 abuse liability tasks (drug purchase task, cross-price purchase task, and multiple-choice procedure) for each of 4 cigar flavors (original, cream, wine, or apple) and own-brand cigarettes. In the drug purchase task, relative to own-brand cigarettes, all cigar flavors were associated with lower abuse liability using most measures (intensity, breakpoint, maximum total tobacco expenditure for 1 day [ps < .05]), although only wine-flavored cigars scored significantly lower using 1 measure (price at maximum total tobacco expenditure for 1 day). When cigars and cigarettes were available concurrently in the cross-price purchase task, all cigar flavors functioned as substitutes for cigarettes. Using the multiple-choice procedure, crossover points for wine- (mean = $0.61) and apple-flavored cigars (mean = $0.71) were significantly lower than own-brand cigarettes (mean = $0.86) and original-flavored cigars (mean = $1.00); no significant differences existed between own-brand cigarettes and original-flavored cigars. Thus, whereas abuse liability may be highest for participants' own-brand cigarette, young adult smokers may be willing to use flavored cigars. Furthermore, abuse liability varies by cigar flavor, with original- and cream-flavored cigars appearing to have the highest abuse liability. Characterizing flavors and flavor additives in cigars represent an important tobacco regulatory target. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Rose S. Bono
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA, USA,Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA
| | - Caroline O. Cobb
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA,Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Catherine S. Wall
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Rebecca C. Lester
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA,Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Cosima Hoetger
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA,Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Thokozeni Lipato
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Mignonne C. Guy
- Department of African American Studies, Virginia Commonwealth University, Richmond, VA, USA
| | - Thomas Eissenberg
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA,Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Warren K. Bickel
- Addiction Recovery Research Center, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA
| | - Andrew J. Barnes
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA, USA,Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA
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Ajith A, Broun A, Duarte DA, Jewett B, Phan L, Mead-Morse EL, Guy MC, Choi K, Chen-Sankey J. Cigar-Smoking-Cessation Interest and Experience among Black Young Adults: A Semi-Structured In-Depth Interview Investigation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147309. [PMID: 34299759 PMCID: PMC8307651 DOI: 10.3390/ijerph18147309] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/02/2021] [Accepted: 07/06/2021] [Indexed: 12/21/2022]
Abstract
Although Black/African American populations have high cigar-smoking prevalence, little is known about cigar-smoking cessation among this group. This study explored the perceptions and experiences of cigar-smoking cessation and assistance received from healthcare providers among forty Black young-adult cigar smokers (ages 21-29). Semi-structured in-depth phone interviews were transcribed and coded. Qualitative data were analyzed by using thematic analysis. Participants mostly smoked cigarillos, large cigars, and blunts. Overall, many regular cigarillo smokers reported interest in quitting eventually, while large-cigar and blunt smokers shared less interest in quitting because they perceived low harm from smoking these products. The reasons for cigar-smoking cessation were health concerns and financial constraints. Most of the participants who attempted to quit cigars did not use any cessation aids. The reasons for relapse included nicotine withdrawal, stress, and easy access. Additionally, most participants reported their healthcare providers did not ask whether they smoked cigars, and even when they knew, little assistance for cigar-smoking cessation was provided. Informing Black cigar smokers of the harm of cigar smoking and encouraging healthcare providers to screen for and assist with cigar-smoking cessation may alleviate the health burden of cigar smoking in this population.
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Affiliation(s)
- Aniruddh Ajith
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD 20814, USA; (A.A.); (A.B.); (D.A.D.); (B.J.); (L.P.); (K.C.)
| | - Aaron Broun
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD 20814, USA; (A.A.); (A.B.); (D.A.D.); (B.J.); (L.P.); (K.C.)
| | - Danielle A. Duarte
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD 20814, USA; (A.A.); (A.B.); (D.A.D.); (B.J.); (L.P.); (K.C.)
| | - Bambi Jewett
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD 20814, USA; (A.A.); (A.B.); (D.A.D.); (B.J.); (L.P.); (K.C.)
| | - Lilianna Phan
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD 20814, USA; (A.A.); (A.B.); (D.A.D.); (B.J.); (L.P.); (K.C.)
| | - Erin L. Mead-Morse
- School of Medicine, University of Connecticut, Farmington, CT 06032, USA;
| | - Mignonne C. Guy
- Department of African American Studies, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, VA 23220, USA;
| | - Kelvin Choi
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD 20814, USA; (A.A.); (A.B.); (D.A.D.); (B.J.); (L.P.); (K.C.)
| | - Julia Chen-Sankey
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD 20814, USA; (A.A.); (A.B.); (D.A.D.); (B.J.); (L.P.); (K.C.)
- Correspondence: ; Tel.:+1-301-827-0343
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5
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Crosby L, Yucesoy B, Leggett C, Tu Z, Belinsky SA, McDonald J, Leng S, Wu G, Irshad H, Valerio LG, Rosenfeldt H. Smoke Chemistry, In Vitro Cytotoxicity, and Genotoxicity Demonstrates Enhanced Toxicity of Cigarillos Compared With Cigarettes. Toxicol Sci 2021; 180:122-135. [PMID: 33021639 DOI: 10.1093/toxsci/kfaa155] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023] Open
Abstract
There has been limited toxicity testing of cigarillos, including comparison to cigarettes. This study compared the smoke chemistry and the cytotoxic and genotoxic potential of 10 conventional cigarettes and 10 cigarillos based on the greatest market share. Whole smoke and total particulate matter (TPM) were generated using the Canadian Intense and International Organization for Standardization puffing protocols. Tobacco-specific nitrosamines, carbonyls, and polycyclic aromatic hydrocarbons were measured using gas chromatography-mass spectrometry. TPM smoke extracts were used for the in vitro assays. Cytotoxicity was assessed in human bronchial epithelial continuously cultured cell line cells using the neutral red uptake assay. Genotoxic potential was assessed using the micronucleus (human lung adenocarcinoma continuously cultured cell line cells), Ames, and thymidine kinase assays. TPM from all cigarillos tested was more cytotoxic than cigarettes. Micronucleus formation was significantly greater for cigarillos compared with cigarettes at the highest dose of TPM, with or without rat liver S9 fraction. In the Ames test +S9, both tobacco products exhibited significant dose-dependent increases in mutation frequency, indicating metabolic activation is required for genotoxicity. In the thymidine kinase assay +S9, cigarillos showed a significantly enhanced mutation frequency although both tobacco products were positive. The levels of all measured polycyclic aromatic hydrocarbons, tobacco-specific nitrosamines, and carbonyls (except acrolein) were significantly greater in cigarillos than cigarettes. The Canadian Intense puffing protocol demonstrated increased smoke constituent levels compared with International Organization for Standardization. Even though the gas vapor phase was not tested, the results of this study showed that under the tested conditions the investigated cigarillos showed greater toxicity than comparator cigarettes. This study found that there is significantly greater toxicity in the tested U.S. marketed cigarillos than cigarettes for tobacco constituent levels, cytotoxicity, and genotoxicity. These findings are important for understanding the human health toxicity from the use of cigarillos relative to cigarettes and for building upon knowledge regarding harm from cigarillos to inform risk mitigation strategies.
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Affiliation(s)
- Lynn Crosby
- Center for Tobacco Products, Office of Science, U.S. Food and Drug Administration, Silver Spring, Maryland 20993
| | - Berran Yucesoy
- Center for Tobacco Products, Office of Science, U.S. Food and Drug Administration, Silver Spring, Maryland 20993
| | - Carmine Leggett
- Center for Tobacco Products, Office of Science, U.S. Food and Drug Administration, Silver Spring, Maryland 20993
| | - Zheng Tu
- Center for Tobacco Products, Office of Science, U.S. Food and Drug Administration, Silver Spring, Maryland 20993
| | - Steven A Belinsky
- Lovelace Respiratory Research Institute, Albuquerque, New Mexico, 87108
| | - Jake McDonald
- Lovelace Respiratory Research Institute, Albuquerque, New Mexico, 87108
| | - Shuguang Leng
- Lovelace Respiratory Research Institute, Albuquerque, New Mexico, 87108
| | - Guodong Wu
- Lovelace Respiratory Research Institute, Albuquerque, New Mexico, 87108
| | - Hammad Irshad
- Lovelace Respiratory Research Institute, Albuquerque, New Mexico, 87108
| | - Luis G Valerio
- Center for Tobacco Products, Office of Science, U.S. Food and Drug Administration, Silver Spring, Maryland 20993
| | - Hans Rosenfeldt
- Center for Tobacco Products, Office of Science, U.S. Food and Drug Administration, Silver Spring, Maryland 20993
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Abdelwahab SH, Reidel B, Martin JR, Ghosh A, Keating JE, Haridass P, Carpenter J, Glish GL, Tarran R, Doerschuk CM, Kesimer M. Cigarillos Compromise the Mucosal Barrier and Protein Expression in Airway Epithelia. Am J Respir Cell Mol Biol 2020; 63:767-779. [PMID: 32877614 PMCID: PMC7790145 DOI: 10.1165/rcmb.2019-0085oc] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 09/02/2020] [Indexed: 12/22/2022] Open
Abstract
Smoking remains a leading cause of preventable morbidity and mortality worldwide. Despite a downward trend in cigarette use, less-regulated tobacco products, such as cigarillos, which are often flavored to appeal to specific demographics, such as younger people, are becoming increasingly popular. Cigar/cigarillo smoking has been considered a safer alternative to cigarettes; however, the health risks associated with cigar in comparison with cigarette smoking are not well understood. To address this knowledge gap, we characterized the effects of multiple brands of cigarillos on the airway epithelium using ex vivo and in vivo models. To analyze these effects, we assessed the cellular viability and integrity of smoke-exposed primary airway cell cultures. We also investigated the protein compositions of apical secretions from cigarillo-exposed airway epithelial cultures and BAL fluid of cigarillo-exposed mice through label-free quantitative proteomics and determined the chemical composition of smoke collected from the investigated cigarillo products. We found that cigarillo smoke exerts similar or greater effects than cigarette smoke in terms of reduced cell viability; altered protein levels, including those of innate immune proteins; induced oxidative-stress markers; and greater nicotine delivery to cells. The analysis of the chemical composition of the investigated cigarillo products revealed differences that might be linked to the differential effects of these products on cell viability and protein abundance profiles, which have been associated with a range of health risks in the context of airway biology. These findings contradict the assumption that cigarillos might be safer and less harmful than cigarettes. Instead, our results indicate that cigarillo smoke is associated with equal or greater health risks and the same or increased airway toxicity compared with cigarette smoke.
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Affiliation(s)
| | - Boris Reidel
- Department of Pathology and Laboratory Medicine
- Marsico Lung Institute
| | | | | | | | | | - Jerome Carpenter
- Department of Pathology and Laboratory Medicine
- Marsico Lung Institute
| | | | - Robert Tarran
- Marsico Lung Institute
- Department of Cell Biology and Physiology, and
| | - Claire M. Doerschuk
- Department of Pathology and Laboratory Medicine
- Marsico Lung Institute
- Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Mehmet Kesimer
- Department of Pathology and Laboratory Medicine
- Marsico Lung Institute
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7
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Filippidis FT, Mechili EA, Girvalaki C, Vardavas C. Cost, prevalence and correlates of cigarillo use in 28 European countries in 2017. Cent Eur J Public Health 2019; 27:182-187. [PMID: 31580551 DOI: 10.21101/cejph.a5583] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 07/27/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Although manufactured cigarettes remain the most popular tobacco product worldwide, the use of other products, including little cigar and cigarillo, has been rising in recent years; however, there is a paucity of data on the correlates of current and ever use of cigarillos in Europe. The aim of this study was to explore the extent and determinants of cigarillo use, as well as to describe the cost and affordability of cigarillos across the EU, in light of the current regulatory framework at a European level. METHODS We performed a secondary analysis of data collected across 28 European Union (EU) Member States through wave 87.1 of the Eurobarometer survey, conducted in March 2017 (N = 27,901). A multilevel logistic regression model was fitted to assess the association of current and ever cigarillo use with the above socio-demographic factors. We also analysed Euromonitor International data on cigarillo prices in 2017 from 24 EU Member States. RESULTS Across the EU, 0.46% (95% CI: 0.33-0.63) of those aged ≥ 15 years reported at least weekly current use of cigarillos in 2017, which corresponds to 1,966,516 (95% CI: 1,426,554-2,709,563) people. Finland recorded the highest prevalence (20.51%) of ever cigarillo use in Europe while Ireland had the lowest (1.15%). Male sex, living in urban area and being over 55 years old compared to 15-24 year olds were associated with greater odds of ever cigarillo use. Median cigarillo prices varied widely, ranging from 3.60 Euros in Portugal to 20.40 Euros in Bulgaria per 20 sticks. CONCLUSIONS The use of cigarillos in Europe is associated with several socio-demographic factors such as gender, age and living area. Policy makers of EU countries, especially now under the regulatory framework of the EU Tobacco Products Directive, should work together to enforce more restrictive rules for cigarillos.
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Affiliation(s)
- Filippos T Filippidis
- Department of Primary Care and Public Health, School of Public Health, Imperial College, London, United Kingdom.,Centre for Health Services Research, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Enkeleint A Mechili
- Department of Health Care, Faculty of Public Health, University of Vlora, Vlora, Albania
| | - Charis Girvalaki
- Laboratory of Toxicology, Medical School, University of Crete, Rethymnon, Greece
| | - Constantine Vardavas
- Centre for Health Services Research, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Laboratory of Toxicology, Medical School, University of Crete, Rethymnon, Greece.,European Network for Smoking and Tobacco Prevention, Brussels, Belgium
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8
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Chen-Sankey JC, Choi K, Kirchner TR, Feldman R, Butler J, Mead EL. Flavored cigar smoking among African American young adult dual users: An ecological momentary assessment. Drug Alcohol Depend 2019; 196:79-85. [PMID: 30754022 PMCID: PMC6377319 DOI: 10.1016/j.drugalcdep.2018.12.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 12/19/2018] [Accepted: 12/26/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Flavored cigar sales have increased in recent years in the U.S. African American young adults (AAYAs) have high prevalence of smoking flavored cigars and dual use with cigarettes, but the predictors of use are unclear. We examined the predictors of flavored cigar smoking among AAYA dual users. METHODS We analyzed data from an Ecological Momentary Assessment (EMA) study that captured near real-time affect, smoking cues, and tobacco smoking from eight text-messaging surveys per day over two weeks. Sixty-three AAYA (ages 18-29) dual users of cigarettes and cigars recorded 1205 cigar smoking moments. Multivariable Generalized Estimating Equations were used to assess the predictors of smoking cigars with flavors and specific flavor types. RESULTS Half of the participants were women (49.2%) and aged between 18-24 (46.7%). Over the two-weeks, almost all (98.4%) participants smoked flavored cigars, and 64.2% of the cigars smoked were flavored. Alcohol (34.4%) was the most frequently smoked flavor type followed by sweet (23.4%) and mint (5.7%). Feeling stressed (AOR = 1.07) and bored (AOR = 1.10) predicted smoking alcohol flavors. Blunt smoking positively predicted smoking sweet flavors (AOR = 4.79), but negatively predicted smoking alcohol flavors (AOR = 0.40). CONCLUSIONS Smoking flavored cigars, especially alcohol-flavored cigars, was prevalent among AAYA dual users in this study. This group might use specific flavors for different purposes including smoking blunts and boosting mood. Efforts to reduce cigar use need to tackle these risk factors and the increased marketing and low-cost pricing of cigars. A federal ban of cigar flavors might reduce the appeal of cigar products.
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Affiliation(s)
- Julia Cen Chen-Sankey
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD, USA
| | - Kelvin Choi
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD, USA
| | | | - Robert Feldman
- University of Maryland, School of Public Health, MD, USA
| | - James Butler
- University of Maryland, School of Public Health, MD, USA
| | - Erin L. Mead
- University of Connecticut, School of Medicine, CT, USA
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9
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Chang CM, Rostron BL, Chang JT, Corey CG, Kimmel HL, Sosnoff CS, Goniewicz ML, Edwards KC, Hatsukami DK, Wang Y, Del Valle-Pinero AY, Yang M, Travers MJ, Arnstein S, Taylor K, Conway K, Ambrose BK, Borek N, Hyland A, Wang L, Blount BC, van Bemmel DM. Biomarkers of Exposure among U.S. Adult Cigar Smokers: Population Assessment of Tobacco and Health (PATH) Study Wave 1 (2013-2014). Cancer Epidemiol Biomarkers Prev 2019; 28:943-953. [PMID: 30733305 DOI: 10.1158/1055-9965.epi-18-0539] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 08/09/2018] [Accepted: 01/30/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Given the diverse cigar market and limited data on biomarker patterns by cigar type, we compared biomarkers of nicotine and tobacco toxicants among cigar smokers and other groups. METHODS Using Wave 1 urinary biomarker data from 5,604 adults in the Population Assessment of Tobacco and Health (PATH) Study, we compared geometric mean concentrations among cigar-only smokers (all cigars and separately for traditional, cigarillo, and filtered cigars), cigarette-only smokers, dual cigar/cigarette smokers, and never users of tobacco. We calculated geometric mean ratios comparing groups with never users adjusting for sex, age, race/ethnicity, education and creatinine. RESULTS Some day cigar-only smokers had lower biomarker concentrations than every day cigar-only smokers, but higher than never users. Every day cigar-only smokers (n = 61) had lower TNE-2 (cotinine+trans-3'-hydroxycotinine) compared to every day cigarette-only (n = 2217; P < 0.0001) and dual cigar/cigarette smokers (n = 601; P < 0.0001). Several biomarkers, including NNAL (NNK metabolite) and CYMA (metabolite of acrylonitrile), were comparable in these groups. In exploratory analyses, every day filtered cigar-only (n = 7) smokers had higher biomarker concentrations compared with every day traditional cigar-only smokers (n = 12) and cigarillo-only smokers (n = 24). Every day smokers of each cigar type were similar to exclusive cigarette smokers. For some biomarkers, particularly for every day filtered cigar-only smokers, concentrations were higher. CONCLUSIONS For some biomarkers, every day cigar-only smokers were comparable with every day cigarette-only smokers. Exploratory analyses suggest that biomarkers vary by cigar type with every day filtered cigar-only smokers having the highest concentrations. IMPACT High exposure to harmful constituents among cigar smokers is a continuing health issue.
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Affiliation(s)
- Cindy M Chang
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland.
| | - Brian L Rostron
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland
| | - Joanne T Chang
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland
| | - Catherine G Corey
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland
| | - Heather L Kimmel
- National Institute on Drug Abuse, National Institutes of Health, Bethedsa, Maryland
| | - Connie S Sosnoff
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | - Yuesong Wang
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Maocheng Yang
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland
| | - Mark J Travers
- Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Stephen Arnstein
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Kevin Conway
- National Institute on Drug Abuse, National Institutes of Health, Bethedsa, Maryland
| | - Bridget K Ambrose
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland
| | - Nicolette Borek
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland
| | - Andrew Hyland
- Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Lanqing Wang
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Dana M van Bemmel
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland
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Wall CS, Bono RS, Lester RC, Hoetger C, Lipato T, Guy MC, Eissenberg TE, Bickel WK, Barnes AJ, Cobb CO. Triangulating abuse liability assessment for flavoured cigar products using physiological, behavioural economic and subjective assessments: a within-subjects clinical laboratory protocol. BMJ Open 2018; 8:e023850. [PMID: 30309993 PMCID: PMC6252773 DOI: 10.1136/bmjopen-2018-023850] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION In the USA, Food and Drug Administration regulations prohibit the sale of flavoured cigarettes, with menthol being the exception. However, the manufacture, advertisement and sale of flavoured cigar products are permitted. Such flavourings influence positive perceptions of tobacco products and are linked to increased use. Flavourings may mask the taste of tobacco and enhance smoke inhalation, influencing toxicant exposure and abuse liability among novice tobacco users. Using clinical laboratory methods, this study investigates how flavour availability affects measures of abuse liability in young adult cigarette smokers. The specific aims are to evaluate the effect of cigar flavours on nicotine exposure, and behavioural and subjective measures of abuse liability. METHODS AND ANALYSES Participants (projected n=25) are healthy smokers of five or more cigarettes per day over the past 3 months, 18-25 years old, naive to cigar use (lifetime use of 50 or fewer cigar products and no more than 10 cigars smoked in the past 30 days) and without a desire to quit cigarette smoking in the next 30 days. Participants complete five laboratory sessions in a Latin square design with either their own brand cigarette or a session-specific Black & Mild cigar differing in flavour (apple, cream, original and wine). Participants are single-blinded to cigar flavours. Each session consists of two 10-puff smoking bouts (30 s interpuff interval) separated by 1 hour. Primary outcomes include saliva nicotine concentration, behavioural economic task performance and response to various questionnaire items assessing subjective effects predictive of abuse liability. Differences in outcomes across own brand cigarette and flavoured cigar conditions will be tested using linear mixed models. ETHICS AND DISSEMINATION The Virginia Commonwealth University Institutional Review Board approved the study (VCU IRB: HM20007848). Dissemination channels for study findings include scientific journals, scientific meetings, and policy briefs. TRIAL REGISTRATION NUMBER NCT02937051.
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Affiliation(s)
- Catherine S Wall
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Rose S Bono
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Rebecca C Lester
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Cosima Hoetger
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Thokozeni Lipato
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Mignonne C Guy
- Department of African American Studies, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Thomas E Eissenberg
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Warren K Bickel
- Department of Psychology, Virginia Tech Carilion Research Institute, Roanoke, Virginia, USA
| | - Andrew J Barnes
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, Virginia, USA
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Caroline O Cobb
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA
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11
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Szyfter K, Napierala M, Florek E, Braakhuis BJM, Takes RP, Rodrigo JP, Rinaldo A, Silver CE, Ferlito A. Molecular and health effects in the upper respiratory tract associated with tobacco smoking other than cigarettes. Int J Cancer 2018; 144:2635-2643. [DOI: 10.1002/ijc.31846] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 06/14/2018] [Accepted: 07/26/2018] [Indexed: 12/12/2022]
Affiliation(s)
| | - Marta Napierala
- Laboratory of Environmental Research, Department of ToxicologyPoznan University of Medical Sciences Poznan Poland
| | - Ewa Florek
- Laboratory of Environmental Research, Department of ToxicologyPoznan University of Medical Sciences Poznan Poland
| | | | - Robert P. Takes
- International Head & Neck Scientific Group Padua Italy
- Department of Otolaryngology‐Head and Neck Surgery, Radboud University Medical CentreRadboud Institute for Health Sciences Nijmegen the Netherlands
| | - Juan P. Rodrigo
- International Head & Neck Scientific Group Padua Italy
- Department of Otolaryngology, Hospital Universitario Central de Asturias, IUOPAUniversity of Oviedo, CIBERONC Oviedo Spain
| | - Alessandra Rinaldo
- International Head & Neck Scientific Group Padua Italy
- Department of OtolaryngologyUniversity of Udine School of Medicine Udine Italy
| | - Carl E. Silver
- International Head & Neck Scientific Group Padua Italy
- Department of SurgeryUniversity of Arizona College of Medicine Phoenix AZ
| | - Alfio Ferlito
- Coordinator of the International Head & Neck Scientific Group Padua Italy
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12
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Majeed BA, Nyman A, Sterling KL, Slovic P. Little cigars and cigarillos: Affect and perceived relative harm among U.S. adults, 2015. Addict Behav 2018; 85:107-112. [PMID: 29886248 DOI: 10.1016/j.addbeh.2018.05.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 05/22/2018] [Accepted: 05/24/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Similar to cigarette smoking, consumption of cigars delivers nicotine and byproducts of tobacco combustion and elevates the risk of addiction, illness, and premature death. This study examined the relationship of affect, perceived relative harm, and LCC smoking behavior among U.S. adults. METHODS Data were from Tobacco Products and Risk Perceptions Survey conducted in 2015. The study included a probability based sample of 6051 adults (18+) drawn from an online research panel. A current LCC smoker was defined as having ever smoked LCCs and was currently smoking LCCs every day, somedays, or rarely. Participants were asked whether smoking LCCs was less harmful, had about the same level of harm, or was more harmful than smoking regular cigarettes. Feelings about LCCs were collected using word association technique. Descriptive and multinomial logistic regression analyses were conducted. RESULTS About 7% of the study participants were current LCC smokers. Adults with positive feelings had four-fold the adjusted odds to be current LCC smokers. Perceiving LCCs to be less harmful had 2.7 higher adjusted odds of being current LCC smokers. CONCLUSIONS Compared to cigarettes, LCCs evoked more positive feelings among adults and these positive feelings were strongly associated with both perceiving LCCs as less harmful than cigarettes and with current LCC smoking. Cessation and prevention interventions would benefit from applying the principles of social marketing in which information is provided not only to inform consumers but also to evoke negative feelings and associations with LCC smoking.
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Affiliation(s)
- Ban A Majeed
- Division of Epidemiology, Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA, USA.
| | - Amy Nyman
- Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA, USA
| | | | - Paul Slovic
- Decision Research, Eugene, OR, USA; Department of Psychology, University of Oregon, Eugene, OR, USA
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13
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Spindle TR, Talih S, Hiler MM, Karaoghlanian N, Halquist MS, Breland AB, Shihadeh A, Eissenberg T. Effects of electronic cigarette liquid solvents propylene glycol and vegetable glycerin on user nicotine delivery, heart rate, subjective effects, and puff topography. Drug Alcohol Depend 2018; 188:193-199. [PMID: 29778773 PMCID: PMC7193252 DOI: 10.1016/j.drugalcdep.2018.03.042] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 03/18/2018] [Accepted: 03/23/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Electronic cigarettes (ECIGs) are a class of tobacco products that produce different effects (e.g., nicotine delivery), depending on the device, liquid, and behavioral factors. However, the influence of the two primary ECIG liquid solvents, propylene glycol (PG) and vegetable glycerin (VG), on ECIG acute effects is unknown. METHODS Thirty ECIG-experienced, ≥12-h nicotine- abstinent participants completed four conditions consisting of two ECIG-use bouts (10 puffs, 30 s interpuff-interval) differing only by liquid PG:VG ratio (2PG:98VG, 20PG:80VG, 55PG:45VG, 100PG). Device power (7.3 W) and liquid nicotine concentration (18 mg/ml) remained constant. Nicotine delivery, subjective effects, heart rate (HR), and puff topography were assessed. RESULTS In the 100PG condition, participants took shorter and smaller puffs but obtained significantly more nicotine relative to the two VG-based conditions. Total nicotine exposure (i.e., area under the curve) was also significantly higher during use of the two PG-based liquids. However, participants reported that the 100 PG liquid was significantly less "pleasant" and "satisfying" relative to the other liquids (all ps < .05). Increases in HR and decreases in abstinence symptoms (e.g., "craving") did not differ across conditions. CONCLUSIONS PG:VG ratio influenced nicotine delivery, some subjective effects, and puff topography. Lower overall product satisfaction associated with the 100PG liquid suggests factors other than nicotine delivery (e.g., aerosol visibility) may play a role in maintaining ECIG use. Regulating ECIG acute effects such as nicotine delivery and subjective effects may require simultaneous attention to liquid PG:VG ratio as well as device, liquid, and behavioral factors known to influence these outcomes.
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Affiliation(s)
- Tory R Spindle
- Department of Psychology, Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, United States
| | - Soha Talih
- Department of Psychology, Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, United States; Department of Mechanical Engineering, American University of Beirut, Beirut, Lebanon
| | - Marzena M Hiler
- Department of Psychology, Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, United States
| | - Nareg Karaoghlanian
- Department of Psychology, Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, United States; Department of Mechanical Engineering, American University of Beirut, Beirut, Lebanon
| | - Matthew S Halquist
- Department of Pharmaceutics, Virginia Commonwealth University, Richmond, VA, United States
| | - Alison B Breland
- Department of Psychology, Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, United States
| | - Alan Shihadeh
- Department of Psychology, Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, United States; Department of Mechanical Engineering, American University of Beirut, Beirut, Lebanon
| | - Thomas Eissenberg
- Department of Psychology, Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, United States.
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Pickworth WB, Rosenberry ZR, Yi D, Pitts EN, Lord-Adem W, Koszowski B. Cigarillo and Little Cigar Mainstream Smoke Constituents from Replicated Human Smoking. Chem Res Toxicol 2018; 31:251-258. [PMID: 29582659 DOI: 10.1021/acs.chemrestox.7b00312] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Little cigar and cigarillo smoking is increasing in popularity in the U.S., but little is known about the topography and mainstream smoke (MSS) constituents of these types of cigar products. This report describes the quantity of selected MSS toxicants generated from puff-by-puff replication of human laboratory smoking. Participants were dual users of cigarettes and either little cigars ( n = 21) or cigarillos ( n = 23). In the laboratory smoking session, participants of the little cigar group smoked a filtered unflavored Winchester Little Cigar; those in the cigarillo group smoked an unfiltered, unflavored Black & Mild cigarillo. MSS components included both volatiles and semivolatile compounds. The MSS of five representative U.S. domestic cigarettes was generated using smoking topography profiles of the participants smoking their own brand of cigarettes. Machine smoking accurately replicated individual puff profiles as indicated by a high correlation between lab and machine smoked: time to smoke, number of puffs, and total puff volume. There was wide variability in smoking patterns across subjects of both little cigars and cigarillos. For example, total puff volume ranged from 84 to 732 mL after the little cigar and from 270 to 2089 mL after the cigarillo. Qualitatively, cigar smoke from little cigars and cigarillos were similar and resembles cigarette smoke. All analytes (VOC and SVOCs) were greater in cigarillo smoke compared to that of little cigars and cigarettes. However, when the toxicants were adjusted for grams of tobacco burned, little cigar smoke contained more nicotine, tobacco-specific nitrosamines, acetonitrile, and acrylonitrile compared with cigarillo smoke. When the constituents were adjusted for nicotine content, cigarillo MSS contained more of all toxicants compared with little cigar. Cigarillos and little cigars, like cigarettes, deliver nicotine and other toxicants known to be harmful to health; their regulation by the FDA is appropriate for their public health risk.
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Affiliation(s)
- Wallace B Pickworth
- Battelle Memorial Institute, Public Health Center for Tobacco Research, 6115 Falls Road Suite 200 , Baltimore , Maryland 21209 , United States
| | - Zachary R Rosenberry
- Battelle Memorial Institute, Public Health Center for Tobacco Research, 6115 Falls Road Suite 200 , Baltimore , Maryland 21209 , United States
| | - Daniel Yi
- University of Maryland School of Pharmacy , 20 North Pine Street , Baltimore , Maryland 21201 , United States
| | - Emily N Pitts
- Notre Dame of Maryland University School of Pharmacy , 4701 North Charles Street , Baltimore , Maryland 21210 , United States
| | - Wilhelmina Lord-Adem
- University of Maryland School of Pharmacy , 20 North Pine Street , Baltimore , Maryland 21201 , United States
| | - Bartosz Koszowski
- Battelle Memorial Institute, Public Health Center for Tobacco Research, 6115 Falls Road Suite 200 , Baltimore , Maryland 21209 , United States
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15
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Antognoli E, Koopman Gonzalez S, Trapl E, Cavallo D, Lim R, Lavanty B, Flocke S. The Social Context of Adolescent Co-Use of Cigarillos and Marijuana Blunts. Subst Use Misuse 2018; 53:654-661. [PMID: 28933976 PMCID: PMC5820125 DOI: 10.1080/10826084.2017.1355388] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The use of cigarillos for smoking as a tobacco product and for making marijuana blunts is increasing among adolescents. Previous research has documented the co-use of these products, however little is known about the contextual features that generate and sustain this practice. OBJECTIVE This study aims for a deeper understanding of why and how co-use of cigarillos and marijuana blunts occurs. METHODS Between December 2015 and April 2016, we conducted in-depth interviews with 30 adolescents aged 14-18 who reported smoking ≥1 cigarillo per week. Semi-structured interviews were designed to capture participants' smoking products, practices, and preferences, as well as their beliefs and experiences about smoking. Interviews were audio-recorded and transcribed. Analysis was guided by a phenomenological approach designed to identify emergent themes. RESULTS All participants reported smoking cigarillos for use as a tobacco product, averaging 13 per week. Twenty-five (83%) also reported using cigarillos to smoke marijuana blunts. A preference for group smoking and product sharing, and the belief that cigarillos extend the high of marijuana were found to promote the co-use of these products. Cigarillos were also found to be used as a substitute for blunts when marijuana was unavailable or when its use was being restricted or monitored. Conclusions/Importance: This analysis of adolescent cigarillo and marijuana co-use demonstrates how marijuana use can initiate, increase, and reinforce tobacco use. These findings can be used to inform public health education campaigns and other programs and policies aimed at reducing cigarillo and marijuana use by youth.
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Affiliation(s)
- Elizabeth Antognoli
- Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, OH, USA
| | - Sarah Koopman Gonzalez
- Prevention Research Center for Healthy Neighborhoods, Case Western Reserve University, Cleveland, OH, USA
| | - Erika Trapl
- Prevention Research Center for Healthy Neighborhoods, Case Western Reserve University, Cleveland, OH, USA
| | - David Cavallo
- Department of Nutrition, Case Western Reserve University, Cleveland, OH, USA
| | - Rock Lim
- Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, OH, USA
| | - Brittany Lavanty
- Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, OH, USA
| | - Susan Flocke
- Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, OH, USA
- Prevention Research Center for Healthy Neighborhoods, Case Western Reserve University, Cleveland, OH, USA
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16
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Rosenberry ZR, Pickworth WB, Koszowski B. Large Cigars: Smoking Topography and Toxicant Exposure. Nicotine Tob Res 2018; 20:183-191. [PMID: 27798089 PMCID: PMC5896453 DOI: 10.1093/ntr/ntw289] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 10/19/2016] [Indexed: 01/19/2023]
Abstract
Background Cigar smoking in the United States continues despite decreases in cigarette smoking and increased tobacco control efforts. We compared large cigar and cigarette smoking for use patterns, smoking topography, and toxicant exposure. Methods Dual users (n = 17, 94% men, 77% African American) smoked ad libitum either their usual cigarette brand or a study large cigar (Phillies Blunt) in two laboratory sessions. Plasma nicotine and exhaled carbon monoxide were collected before and after smoking. Smoking topography measures of puff volume, puff duration, puff velocity, and interpuff interval were also collected. Results Both cigarettes and large cigars significantly increased plasma nicotine and carbon monoxide and significantly decreased the urge to smoke. Cigarettes delivered more nicotine per gram of tobacco smoked and per 1000 mL of puff volume. Number of puffs, time to smoke, puff volume, and puff velocity were significantly larger and interpuff interval was significantly shorter in large cigar smoking. The temporal pattern of puffing more intensely at the beginning of smoking was similar for both large cigars and cigarettes. Conclusions People who regularly use both large cigars and cigarettes adapt their smoking pattern such that they are exposed to similar levels of nicotine from each product. The immediate increase in plasma nicotine and carbon monoxide suggest significant inhalation of large cigar smoke. These data call to question the assumption that cigar smoking is less toxic than cigarette smoking. By smoking large cigars, dual users expose themselves to toxic components that have been linked with the addiction risk, morbidity, and mortality of cigarette smoking. Implications This study found that dual users of large cigars and cigarettes inhale significant quantities of carbon monoxide, nicotine, and presumably other components of mainstream smoke. Large cigar smoke exposure may lead to or sustain nicotine addiction as wells as subject large cigar consumers to similar risks associated with cigarette smoking such as lung cancer and cardiovascular disease.
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Abstract
Objectives To examine factors important to cigar smoking and subsequent nicotine exposure, we evaluated the impact of cigar type, cigarette smoking history, and inhalation behaviors on nicotine dependence, smoking topography, and biomarkers of exposure in current exclusive cigar smokers. Methods Adult, exclusive cigar smokers (N = 77) were recruited based on cigar type, cigarette smoking history, and self-reported inhalation behaviors. Participants smoked their own brand product ad libitum for up to one hour; dependence symptoms, smoking topography, and biomarkers of exposure were assessed. Results Cigar smokers showed low levels of dependence. Cigar smoking alleviated withdrawal and craving symptoms, increased plasma nicotine concentration, and increased exhaled CO. Multiple regression analyses indicate that inhalation behaviors were associated with increased dependence and greater reductions in withdrawal symptoms upon cigar smoking. Large cigar smokers smoked longer and smoked more tobacco than small cigar and cigarillo smokers. Furthermore, large cigar smokers and self-reported inhalers were exposed to more nicotine than small cigar smokers and non-inhalers. Conclusions Our study suggests that cigar type and smoking behaviors affect dependence and nicotine exposure upon cigar smoking. These findings provide additional insight into the substantial risks associated with cigar smoking.
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18
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Kong G, Bold KW, Simon P, Camenga DR, Cavallo DA, Krishnan-Sarin S. Reasons for Cigarillo Initiation and Cigarillo Manipulation Methods among Adolescents. TOB REGUL SCI 2017; 3:S48-S58. [PMID: 29085867 PMCID: PMC5658780 DOI: 10.18001/trs.3.2(suppl1).6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To understand reasons for cigarillo initiation and cigarillo manipulation methods among adolescents. METHODS We conducted surveys in 8 Connecticut high schools to assess reasons for trying a cigarillo and cigarillo manipulation methods. We used multivariable logistic regressions to assess associations with demographics and tobacco use status. RESULTS Among ever cigarillo users (N = 697, 33.6% girls, 16.7 years old [SD = 1.14], 62.1% White), top reasons for trying a cigarillo were curiosity (41.9%), appealing flavors (32.9%), because "friends use it" (25.3%), and low cost (22.4%). Overall, 40.3% of ever cigarillo users added marijuana (to create blunts) and 39.2% did not manipulate the product. Endorsement of these reasons for initiation and manipulation methods differed significantly across sex, age, SES and other tobacco use. CONCLUSIONS Cigarillo regulations should include restricting all appealing flavors, increasing the cost, monitoring the restriction of sales of cigarillos to minors, and decreasing the appeal of cigarillo manipulation.
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Abstract
OBJECTIVE Although most cigarillos and little cigars smokers also smoke cigarettes (dual use), there are few studies comparing toxicant exposure and smoking behavior in cigars and cigarettes. METHODS Two groups of dual users smoked their usual brand of cigarette and either a Winchester unflavored little cigar (N = 21) or a Black & Mild cigarillo (N = 23). Acute exposure of nicotine and exhaled carbon monoxide (CO) and puffing topography parameters were collected. Individual cigar puffing data were used to machine-replicate smoking for analysis of volatile organic compounds (VOC) and semi-volatile organic compounds (SVOC) in mainstream smoke. RESULTS There were significant differences in puff topography, plasma nicotine and exhaled CO after cigarettes, little cigars, and cigarillos. Puff topography differences between cigarillos and cigarettes were due to the difference in the size of the article. Mainstream cigar and cigarette smoke was qualitatively similar; the yield was dependent on the smoking behavior. When smoke yield was adjusted for weight of tobacco burned or puff volume, exposure differences decreased. CONCLUSIONS There is a wide range of delivery of both SVOC and VOC components of cigar and cigarillo smoke. The difference in exposure is largely dependent on the article size and the amount consumed.
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20
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Blank MD, Breland AB, Cobb CO, Spindle T, Ramôa C, Eissenberg T. Clinical Laboratory Evaluation of Electronic Cigarettes/Electronic Nicotine Delivery Systems: Methodological Challenges. TOB REGUL SCI 2016; 2:426-439. [PMID: 28819633 PMCID: PMC5555604 DOI: 10.18001/trs.2.4.12] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Evaluating electronic cigarettes (ECIGs) in the clinical laboratory is critical to understanding their effects. However, laboratory evaluation of ECIGs can be challenging, as they are a novel, varied, and evolving class of products. The objective of this paper is to describe some methodological challenges to the clinical laboratory evaluation of ECIGs. METHODS The authors gathered information about challenges involved in the laboratory evaluation of ECIGs. Challenges were categorized and solutions provided when possible. RESULTS Methods used to study combustible cigarettes may need to be adapted to account for ECIG novelty and differences within the class. Challenges to ECIG evaluation can include issues related to 1) identification of ECIG devices and liquids, 2) determination of short -term ECIG abstinence, 3) measurement of use behavior, and 4) assessment of dependence. These challenges are discussed, and some suggestions to inform ECIG evaluation using clinical laboratory methods are provided. CONCLUSIONS Awareness of challenges and developing, validating, and reporting methods used to address them aids interpretation of results and replication efforts, thus enhancing the rigor of science used to protect public health through appropriate, empirically-based, ECIG regulation.
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Affiliation(s)
- Melissa D Blank
- Assistant Professor, West Virginia University, Morgantown, WV
| | - Alison B Breland
- Assistant Professor, Virginia Commonwealth University, Center for the Study of Tobacco Products, Richmond, VA
| | - Caroline O Cobb
- Assistant Professor, Virginia Commonwealth University, Center for the Study of Tobacco Products, Richmond, VA
| | - Tory Spindle
- Virginia Commonwealth University, Center for the Study of Tobacco Products, Richmond, VA
| | - Carolina Ramôa
- Post-Doctoral Fellow, Virginia Commonwealth University, Center for the Study of Tobacco Products, Richmond, VA
| | - Thomas Eissenberg
- Thomas Eissenberg, Professor, Virginia Commonwealth University, Center for the Study of Tobacco Products, Richmond, VA
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21
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Pickworth WB, Rosenberry ZR, Koszowski B. Toxicant exposure from smoking a little cigar: further support for product regulation. Tob Control 2016; 26:269-276. [DOI: 10.1136/tobaccocontrol-2015-052633] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 03/31/2016] [Indexed: 01/17/2023]
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22
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Messer K, Vijayaraghavan M, White MM, Shi Y, Chang C, Conway KP, Hartman A, Schroeder MJ, Compton WM, Pierce JP. Cigarette smoking cessation attempts among current US smokers who also use smokeless tobacco. Addict Behav 2015; 51:113-9. [PMID: 26253939 DOI: 10.1016/j.addbeh.2015.06.045] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 05/12/2015] [Accepted: 06/30/2015] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Concurrent use of cigarettes and smokeless tobacco is common, but little is known regarding the association of smokeless tobacco use with cigarette smoking cessation. Dual users may have lower cigarette consumption levels, which may also play a role in smoking cessation. METHODS The 2010-2011 Tobacco Use Supplement to the Current Population Survey included 26,760 current cigarette smokers, of which 675 concurrently used smokeless tobacco. We compared characteristics of the most recent cigarette smoking quit attempt of the past year between dual users and exclusive smokers, using multivariate regression. RESULTS Dual users (45%) were more likely than exclusive smokers (37%) to have made a cigarette smoking quit attempt during the previous year (p<0.01), even after adjusting for demographic differences and cigarette dependence levels (ORadj 1.33, 95% CI 1.15-1.53). Half (48%) of dual users who made a quit attempt tried to quit "by switching to smokeless tobacco". However, once in a quit attempt, dual users relapsed more quickly than exclusive smokers (Cox regression HRadj 1.13, 95% CI 1.02-1.26). There was no difference in 30-day abstinence rates on the most recent quit attempt (ORadj 1.09, 95% CI 0.88-1.37). For both groups, the best predictor of past 30-day abstinence was cigarette consumption level. CONCLUSIONS Current cigarette smokers who also use smokeless tobacco are more likely to have tried to quit, but relapse more quickly than exclusive smokers, and are not more likely to have attained 30day smoking cessation. Prospective studies at the population level are needed.
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Affiliation(s)
- Karen Messer
- Cancer Prevention and Control Division, Moores UCSD Cancer Center, University of California, 3855 Health Sciences Dr. MC 0901, La Jolla, CA 92093-0901, United States; Division of Biostatistics and Bioinformatics, UCSD, La Jolla, CA 92093, United States; Department of Family Medicine and Public Health, UCSD, La Jolla CA 92093, United States.
| | - Maya Vijayaraghavan
- Cancer Prevention and Control Division, Moores UCSD Cancer Center, University of California, 3855 Health Sciences Dr. MC 0901, La Jolla, CA 92093-0901, United States; Department of Family Medicine and Public Health, UCSD, La Jolla CA 92093, United States
| | - Martha M White
- Cancer Prevention and Control Division, Moores UCSD Cancer Center, University of California, 3855 Health Sciences Dr. MC 0901, La Jolla, CA 92093-0901, United States
| | - Yuyan Shi
- Cancer Prevention and Control Division, Moores UCSD Cancer Center, University of California, 3855 Health Sciences Dr. MC 0901, La Jolla, CA 92093-0901, United States; Department of Family Medicine and Public Health, UCSD, La Jolla CA 92093, United States
| | - Cindy Chang
- Center for Tobacco Products, U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993, United States
| | - Kevin P Conway
- National Institute on Drug Abuse, National Institutes of Health, 6001 Executive Boulevard, Room 5213, Bethesda, MD 20892-9561, United States
| | - Anne Hartman
- National Institutes of Health, National Cancer Institute, Division of Cancer Control and Population Sciences, 9609 Medical Center Drive, Rockville, MD 20850, United States
| | - Megan J Schroeder
- Center for Tobacco Products, U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993, United States
| | - Wilson M Compton
- National Institute on Drug Abuse, National Institutes of Health, 6001 Executive Boulevard, Room 5213, Bethesda, MD 20892-9561, United States
| | - John P Pierce
- Cancer Prevention and Control Division, Moores UCSD Cancer Center, University of California, 3855 Health Sciences Dr. MC 0901, La Jolla, CA 92093-0901, United States; Department of Family Medicine and Public Health, UCSD, La Jolla CA 92093, United States
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Nasim A, Guy MC, Soule EK, Cobb CO, Blank MD, Eissenberg T. Characteristics and Patterns of Black & Mild Use Among African American Smokers. Nicotine Tob Res 2015; 18:842-9. [PMID: 26615202 DOI: 10.1093/ntr/ntv260] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 11/12/2015] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Increased consumption of little cigars and cigarillos (LCCs) among late adolescent and young adult African American smokers is an emerging public health concern. Despite a growing body of epidemiological evidence, there is scant research on systematic variations in LCC use among young adult African Americans. This study aimed to disaggregate African American Black & Mild (B&M) smokers and to identify subgroups of cigarillo smokers' behaviors and associated characteristics. METHODS Using telephone screening data for a NIH-funded clinical laboratory study of toxicant exposure associated with B&M use, latent class analysis (LCA) was used to classify 331 African American B&M smokers' based on daily use, average daily consumption, preference for flavors, preference for product design tips, and product modification behaviors. RESULTS Results showed five classes, three of which (Daily-Hypers, Daily-Flavored, and Heavy-Daily-Hypers) reflected daily use and average daily consumption rate ranging between 2.7 and 8.9 B&M cigarillos per day. Non-Daily-Hypers and Non-Daily-Flavored classes represented non-daily use patterns and averaged less than 1.0 B&M cigarillo per day. Both sets of classes defined by daily users and non-daily users included smokers who preferred flavored tobacco and who practiced product modification techniques involving hyping and blunting. CONCLUSIONS Latent class analysis is a useful method to detect subtle differences in B&M product preferences and smoking behaviors among African Americans. Study findings highlight the importance of developing tailored interventions that consider within group differences in order to reduce the prevalence of cigarillo smoking among those with the greatest burden. IMPLICATIONS The current study is the first to identify unique subgroups of African American B&M smokers based on cigarillo use behaviors and associated characteristics. Latent class analyses may prove useful for understanding other subgroups of tobacco users. Current findings concerning patterns of LCC use illustrate how future tobacco cessation and prevention interventions may be tailored for African American smokers.
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Affiliation(s)
- Aashir Nasim
- Institute for Inclusion, Inquiry, and Innovation, Virginia Commonwealth University, Richmond, VA; Office of the Provost and Vice President for Academic Affairs, Virginia Commonwealth University, Richmond, VA;
| | - Mignonne C Guy
- Department of African American Studies and Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA
| | - Eric K Soule
- Department of Psychology and Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA
| | - Caroline O Cobb
- Department of Psychology and Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA
| | - Melissa D Blank
- Department of Psychology, West Virginia University, Morgantown, VA
| | - Thomas Eissenberg
- Department of Psychology and Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA
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Koszowski B, Rosenberry ZR, Kanu A, Viray LC, Potts JL, Pickworth WB. Nicotine and carbon monoxide exposure from inhalation of cigarillo smoke. Pharmacol Biochem Behav 2015; 139:7-14. [PMID: 26459155 DOI: 10.1016/j.pbb.2015.10.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 09/24/2015] [Accepted: 10/08/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND There has been an increase in the use of cigarillos in the US. People who smoke cigarillos typically also regularly smoke cigarettes (dual users). METHODS We compared puffing topography, biomarkers of acute exposure [exhaled carbon monoxide (COex) and plasma nicotine] and physiologic effects from usual brand cigarette and Black & Mild cigarillo smoking in dual users (N=23) in two laboratory sessions. RESULTS Participants (21 men) smoked an average of 17.5cigarettes/day. Cigarillo consumption varied widely from as few as 1/week to daily. Participants were highly nicotine dependent (average FTND score: 6.3). There were statistically significant differences in smoking behavior between cigarette and cigarillo smoking in time to smoke, number of puffs, and total puff volume (all P<0.001). Average puff duration, interpuff interval average puff volume, and puff velocity did not differ between cigarettes and cigarillos. Nicotine boost was similar after both cigarettes and cigarillos. COex boost was significantly greater after cigarillo smoking compared to cigarette smoking (P<0.001). CONCLUSIONS The smoking pattern and exposure profile indicate that dual users inhale cigarillo smoke just as they inhale cigarette smoke thereby exposing themselves to considerable amounts of nicotine and other components of tobacco smoke. COex exposure results imply that cigarillo smoking may be associated with higher exposure to smoke-delivered volatile components of mainstream cigarillo smoke including carcinogens when compared to cigarettes. IMPACT The findings that cigarillos and cigarettes are smoked similarly in dual users are relevant to health and regulatory considerations on cigar products.
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Affiliation(s)
- Bartosz Koszowski
- Battelle Memorial Institute, Battelle Public Health Center for Tobacco Research, Baltimore, MD, United States.
| | - Zachary R Rosenberry
- Battelle Memorial Institute, Battelle Public Health Center for Tobacco Research, Baltimore, MD, United States
| | - Alieu Kanu
- Battelle Memorial Institute, Battelle Public Health Center for Tobacco Research, Baltimore, MD, United States
| | - Lauren C Viray
- Battelle Memorial Institute, Battelle Public Health Center for Tobacco Research, Baltimore, MD, United States
| | - Jennifer L Potts
- Battelle Memorial Institute, Battelle Public Health Center for Tobacco Research, Baltimore, MD, United States
| | - Wallace B Pickworth
- Battelle Memorial Institute, Battelle Public Health Center for Tobacco Research, Baltimore, MD, United States
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25
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Feirman SP, Lock D, Cohen JE, Holtgrave DR, Li T. Flavored Tobacco Products in the United States: A Systematic Review Assessing Use and Attitudes. Nicotine Tob Res 2015; 18:739-49. [PMID: 26315475 DOI: 10.1093/ntr/ntv176] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 08/07/2015] [Indexed: 12/30/2022]
Abstract
OBJECTIVES We systematically reviewed research examining use of and attitudes toward nonmenthol-flavored tobacco products to provide information relevant to a decision to regulate these products in the future. METHODS To identify eligible studies, we searched PubMed, CINHAL, Embase, LILACS, and PsycINFO on September 19, 2013, without date restrictions. We obtained additional studies via gray literature searches, expert contacts, and hand-searching citations of included articles. We included participants of all ages. We conducted a qualitative synthesis for included studies. RESULTS The 32 studies included in this review exhibited substantial heterogeneity and were of varied methodological quality. Findings from observational, experimental, and quasiexperimental studies suggest that flavored tobacco use is associated with young age and that consumers may perceive flavored products more favorably than nonflavored products. Evidence from qualitative studies indicates that flavoring in tobacco is viewed favorably by users and nonusers of these products. CONCLUSIONS The Food and Drug Administration has expressed interest in regulating flavored tobacco products. This systematic review strengthens the evidence base relating to this issue by synthesizing the literature from the United States on the use of and attitudes toward flavored tobacco. To address gaps in the literature, more research is needed to understand how flavoring impacts tobacco use over time. The evidence base would further be strengthened with the collection of brand-, flavor-, and product-specific data.
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Affiliation(s)
- Shari P Feirman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC;
| | - Diana Lock
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Joanna E Cohen
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - David R Holtgrave
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Tianjing Li
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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26
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Blank MD, Cobb CO, Eissenberg T, Nasim A. Acute Effects of "Hyping" a Black&Mild Cigarillo. Nicotine Tob Res 2015; 18:460-9. [PMID: 25782456 DOI: 10.1093/ntr/ntv063] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 03/05/2015] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Cigars remain a widely used tobacco product among adolescent and adult populations. The appeal of a certain type of cigar, the cigarillo, may be enhanced by users' beliefs that their harm potential can be reduced by removing the inner tobacco liner before use (a.k.a. "hyping"). The purpose of this within-subject study was to compare the acute effects of smoking an original cigarillo, a modified ("hyped") cigarillo, and an unlit cigarillo. METHODS Twenty smokers (19 males, 1 female; 19 non-Hispanic blacks, 1 Hispanic "other") of at least 7 Black&Mild (B&M) cigarillos/week and at most 5 cigarettes/day completed the study. All participants reported hyping their cigarillos at least occasionally. Primary outcomes, assessed over two, 30-minute smoking bouts, included plasma nicotine, expired air carbon monoxide (CO) concentration, subjective ratings (product effects, nicotine abstinence symptoms), and puff topography. RESULTS Mean plasma nicotine concentration increased significantly within (pre- to post-bouts), but not between, original and modified B&M conditions. Mean CO concentration was significantly lower for modified, relative to original, B&M smoking at all post-administration timepoints. Both smoked conditions significantly increased ratings of positive product effects (satisfaction, pleasant) and decreased abstinence symptom magnitude; however, ratings generally did not differ between these conditions. Overall, topography outcomes did not differ between modified and original B&M smoking. CONCLUSIONS Results are consistent with a previous report in that "hyping" may decrease users' CO, but not nicotine, exposure. While these data collectively suggest reduced exposure to CO acutely with engagement in "hyping," longer-term assessments are needed to determine the impact on individual and public health.
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Affiliation(s)
- Melissa D Blank
- Department of Psychology, West Virginia University, Morgantown, WV;
| | - Caroline O Cobb
- Department of Psychology and Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA
| | - Thomas Eissenberg
- Department of Psychology and Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA
| | - Aashir Nasim
- Department of African American Studies, Department of Psychology, and Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA
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Vupputuri S, Hajat C, Al-Houqani M, Osman O, Sreedharan J, Ali R, Crookes AE, Zhou S, Sherman SE, Weitzman M. Midwakh/dokha tobacco use in the Middle East: much to learn. Tob Control 2014; 25:236-41. [PMID: 25342581 PMCID: PMC4789808 DOI: 10.1136/tobaccocontrol-2013-051530] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 08/27/2014] [Indexed: 01/30/2023]
Abstract
Many alternative tobacco products (ATPs), such as hookahs, have grown in popularity and use beyond their locale of origin and are therefore becoming a significant global public health concern. This article provides an overview of an under-reported and understudied ATP, dokha, which is smoked in a midwakh pipe. It describes the state of tobacco control in the Arabian Gulf region where midwakh smoking appears to be most common, the history of midwakh and dokha use, and what is known about midwakh smoking from the published literature. On the basis of the stark lack of data on midwakh use, we suggest priority areas to focus future research. Preliminary data and observations from health providers and the public health sector suggest that midwakh smoking may pose challenges to the tobacco control efforts in the Arabian Gulf region. If it is emerging as a new ATP outside this region, there could be a significant impact on tobacco control strategies globally.
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Affiliation(s)
- S Vupputuri
- Kaiser Permanente Georgia, The Center for Health Research, Atlanta, Georgia, USA
| | - C Hajat
- United Arab Emirates University, College of Medicine and Health Sciences, Institute of Public Health, Al Ain, UAE
| | - M Al-Houqani
- United Arab Emirates University, College of Medicine and Health Sciences, Institute of Public Health, Al Ain, UAE
| | - O Osman
- United Arab Emirates University, College of Medicine and Health Sciences, Institute of Public Health, Al Ain, UAE
| | - J Sreedharan
- Gulf Medical University, Research Division, Ajman, UAE
| | - R Ali
- United Arab Emirates University, College of Medicine and Health Sciences, Institute of Public Health, Al Ain, UAE Cancer Epidemiology Unit, University of Oxford, Oxford, UK
| | - A E Crookes
- Heriot-Watt University, School of Life Sciences, Dubai, UAE
| | - S Zhou
- Department of Pediatrics and Environmental Medicine, New York University School of Medicine, New York, New York, USA
| | - S E Sherman
- New York University/Abu Dhabi Public Health Research Center, Abu Dhabi, UAE Department of Population Health, Medicine and Psychiatry, New York University School of Medicine, New York, New York, USA
| | - M Weitzman
- Department of Pediatrics and Environmental Medicine, New York University School of Medicine, New York, New York, USA
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Nasim A, Blank MD, Cobb CO, Berry BM, Kennedy MG, Eissenberg T. How to freak a Black & Mild: a multi-study analysis of YouTube videos illustrating cigar product modification. HEALTH EDUCATION RESEARCH 2014; 29:41-57. [PMID: 24162926 PMCID: PMC6080838 DOI: 10.1093/her/cyt102] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 09/25/2013] [Indexed: 06/02/2023]
Abstract
Cigar smoking is increasingly common among adolescents who perceive cigars as less harmful than cigarettes. This perception of reduced harm is especially true for cigars that are user-modified by removing the tobacco binder through a process called 'freaking'. Little is known about 'freaking' and this multi-study, mixed-methods analysis sought to understand better the rationale and prevailing beliefs about this smoking practice using YouTube videos. In Study 1, we conducted a descriptive content analysis on the characteristics of 26 randomly sampled cigar product modification (CPM) videos posted during 2006-10. In Study 2, a thematic analysis was performed on the transcripts of commentary associated with each video to characterize viewers' comments about video content. Study 1 results revealed that 90% of videos illustrated a four-step CPM technique: 'Loosening the tobacco'; 'Dumping the tobacco'; 'Removing the cigar binder' and 'Repacking the tobacco'. Four themes related to the purpose of CPM were also derived from video content: 'Easier to smoke' (54%), 'Beliefs in reduction of health risks' (31%), 'Changing the burn rate' (15%) and 'Taste enhancement' (12%). Study 2 results concerning the content characteristics of video comments were categorized into three themes: 'Disseminating information/answering questions' (81%), 'Seeking advice/asking questions' (69%) and 'Learning cigar modification techniques' (35%). Favorable comments were more common (81%) compared to unfavorable (58%) and comment content suggested low-risk perceptions and poor understanding of smoking harms. These findings highlight a novel means for youth to access information concerning CPM that may have important implications for tobacco control policy and prevention.
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Affiliation(s)
- Aashir Nasim
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, USA, Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA 23298, USA, Department of Psychology, West Virginia University, Morgantown, WV, 26506, USA and Department of Social and Behavioral Health, Virginia Commonwealth University, Richmond, VA, 23219, USA
| | - Melissa D. Blank
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, USA, Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA 23298, USA, Department of Psychology, West Virginia University, Morgantown, WV, 26506, USA and Department of Social and Behavioral Health, Virginia Commonwealth University, Richmond, VA, 23219, USA
| | - Caroline O. Cobb
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, USA, Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA 23298, USA, Department of Psychology, West Virginia University, Morgantown, WV, 26506, USA and Department of Social and Behavioral Health, Virginia Commonwealth University, Richmond, VA, 23219, USA
| | - Brittany M. Berry
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, USA, Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA 23298, USA, Department of Psychology, West Virginia University, Morgantown, WV, 26506, USA and Department of Social and Behavioral Health, Virginia Commonwealth University, Richmond, VA, 23219, USA
| | - May G. Kennedy
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, USA, Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA 23298, USA, Department of Psychology, West Virginia University, Morgantown, WV, 26506, USA and Department of Social and Behavioral Health, Virginia Commonwealth University, Richmond, VA, 23219, USA
| | - Thomas Eissenberg
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, USA, Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA 23298, USA, Department of Psychology, West Virginia University, Morgantown, WV, 26506, USA and Department of Social and Behavioral Health, Virginia Commonwealth University, Richmond, VA, 23219, USA
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Yates EA, Dubray J, Schwartz R, Kirst M, Lacombe-Duncan A, Suwal J, Hatcher J. Patterns of cigarillo use among Canadian young adults in two urban settings. Canadian Journal of Public Health 2014; 105:e11-4. [PMID: 24735690 DOI: 10.17269/cjph.105.3879] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 02/10/2014] [Accepted: 11/28/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Current estimates indicate that cigarillo use has become commonplace among young adults in Canada despite the established risks to health. However, little else is known about patterns of cigarillo use in this subpopulation. The intent of this research was to examine the patterns, attitudes, and beliefs regarding cigarillo use and co-use of cigarillos and cigarettes among Canadian young adults. METHODS Canadians aged 19-29 years from the Greater Toronto Area, Ontario and Edmonton, Alberta were recruited from September 2009 to February 2010 and in June 2010, respectively (n=133). Eligible participants completed questionnaires assessing cigarillo, cigarette, and cannabis use; social influence of usage; and beliefs about cigarillo use. RESULTS Cigarillo use was common in social settings, with friends, and during leisure time. The majority of participants were co-users of cigarillos and cigarettes (82%), and currently used cannabis (72%). Respondents reported "replacing cigarette smoking" and "flavour" as main reasons for smoking cigarillos; and half (52%) believed they were not at all addicted to cigarillos. Disconcertingly, participants perceived the risk of cancer attributed to smoking cigarillos as significantly less than the risk of cancer attributed to smoking cigarettes (p<0.0001). CONCLUSION These findings highlight the social nature of cigarillo use, and suggest a lack of awareness of the health risks associated with cigarillo and polytobacco use in this small convenience sample of Canadian young adults. Population-level analyses are needed to further investigate cigarillo, polytobacco and concurrent cannabis use patterns and beliefs among Canadian young adults.
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Lauterstein D, Hoshino R, Gordon T, Watkins BX, Weitzman M, Zelikoff J. The changing face of tobacco use among United States youth. CURRENT DRUG ABUSE REVIEWS 2014; 7:29-43. [PMID: 25323124 PMCID: PMC4469045 DOI: 10.2174/1874473707666141015220110] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 10/01/2014] [Accepted: 10/01/2014] [Indexed: 11/22/2022]
Abstract
Tobacco use, primarily in the form of cigarettes, is the leading cause of preventable morbidity and mortality in the United States (U.S.). The adverse effects of tobacco use began to be recognized in the 1940's and new hazards of active smoking and secondhand smoke (SHS) exposure from cigarettes continue to be identified to this day. This has led to a sustained and wide-ranging array of highly effective regulatory, public health, and clinical efforts that have been informed by extensive scientific data, resulting in marked decreases in the use of cigarettes. Unfortunately, the dramatic recent decline in cigarette use in the U.S., has been accompanied by an upsurge in adolescent and young adult use of new, non-cigarette tobacco and nicotine-delivery products, commonly referred to as alternative tobacco products (ATPs). Commonly used ATPs include hookah, cigars, smokeless tobacco, and electronic cigarettes. While there have been a number of review articles that focus on adult ATP use, the purpose of this review is to provide an overview of what is, and is not known about emerging ATP use among U.S. adolescents on a national scale; as well as to identify research gaps in knowledge, and discuss future health and policy needs for this growing public health concern. This paper is not meant to systemically review all published survey data, but to present clear depiction of selected ATP usage in youth populations using national survey data.
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Affiliation(s)
- Dana Lauterstein
- Department of Environmental Medicine, New York University School of Medicine
| | - Risa Hoshino
- Department of Pediatrics, New York University School of Medicine
- Department of Pediatrics, Mount Sinai Hospital
| | - Terry Gordon
- Department of Environmental Medicine, New York University School of Medicine
| | | | - Michael Weitzman
- Department of Environmental Medicine, New York University School of Medicine
- Department of Pediatrics, New York University School of Medicine
- Global Institute for Public Health, New York University
| | - Judith Zelikoff
- Department of Environmental Medicine, New York University School of Medicine
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Exposure to celebrity-endorsed small cigar promotions and susceptibility to use among young adult cigarette smokers. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2013; 2013:520286. [PMID: 24371444 PMCID: PMC3859200 DOI: 10.1155/2013/520286] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 09/25/2013] [Accepted: 10/08/2013] [Indexed: 11/17/2022]
Abstract
Small cigar smoking among young adult cigarette smokers may be attributed to their exposure to its advertisements and promotions. We examined the association between exposure to a celebrity music artist's endorsement of a specific brand of small cigars and young adult cigarette smokers' susceptibility to smoking that brand. Venue-based sampling procedures were used to select and survey a random sample of 121 young adult cigarette smokers, aged 18-35. Fourteen percent reported exposure to the artist's endorsement of the small cigar and 45.4% reported an intention to smoke the product in the future. The odds of small cigar smoking susceptibility increased threefold for those who reported exposure to the endorsement compared to those not exposed (OR = 3.64, 95% CI 1.06 to 12.54). Past 30-day small cigar use (OR = 3.30, 95% CI 1.24 to 8.74) and past 30-day cigar use (OR = 5.08, 95% CI 1.23, 21.08) were also associated with susceptibility to smoke a small cigar. An association between young adult cigarette smokers' exposure to the music artist's small cigar endorsement and their susceptibility to smoke small cigars was found. This association underscores the importance of monitoring small cigar promotions geared toward young people and their impact on small cigar product smoking.
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Fabian LA, Canlas LL, Potts J, Pickworth WB. Ad lib smoking of Black & Mild cigarillos and cigarettes. Nicotine Tob Res 2011; 14:368-71. [PMID: 22025543 DOI: 10.1093/ntr/ntr131] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Over the past 20 years, there has been a tripling in the consumption of small cigars and cigarillos, with further increases expected because cigar products are not subject to Food and Drug Administration regulations. Acute toxin exposure from cigar smoking is difficult to assess because unlike cigarettes, cigars vary widely in size, design, composition, and in the smoking behavior of their consumers. For example, a recent practice among urban youth is to remove the paper liner (i.e., "freaking") of a small cigar in the belief that it is this paper liner that leads to addiction and cancer. METHODS We examined acute exposure (CO and nicotine boosts) and puffing behavior in 12 participants (10 men) who smoked (ad lib) their usual conventional cigarette, a Black & Mild cigar (B&M) and a B&M without the paper liner (i.e., "freaked" [B&Mf]). RESULTS All products (cigarettes, B&M, and B&Mf) significantly increased heart rate and CO with a trend for plasma nicotine. Nicotine boost was significantly higher after cigarette smoking than both B&M and B&Mf, while CO boost was significantly greater after B&M and B&Mf than cigarettes. The CO boost after B&M was larger than after B&Mf. CONCLUSIONS These findings suggest that small cigar smoking is associated with smoke inhalation that leads to significant exposure to nicotine, CO, and presumably other components of tobacco smoke and that removing the inner liner does not substantially reduce toxin exposure.
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Affiliation(s)
- Lacy A Fabian
- Centers for Public Health Research and Evaluation, Battelle, Baltimore, MD 21209, USA.
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