Transitions in smoking status over time in a population-based panel study of smokers

Prevalence of social anxiety disorder and its associated factors among foreign-born undergraduate students in Türkiye: A cross-sectional study

Social anxiety disorder (SAD) is prevalent among university students, yet data on its severity among foreign-born international undergraduate students in Türkiye remains limited. This study aims to determine the prevalence of SAD and its associated factors within this population. A cross-sectional study was conducted using a Google Form survey distributed across various universities from September 17, 2023, to February 1, 2024. The survey comprised two sections: sociodemographic information and 17 items of the Social Phobia Inventory (SPIN), which measures the frequency and intensity of social anxiety symptoms. Data analysis included descriptive statistics and inferential analysis, multiple regression, and binomial logistic regression. Out of 506 participants, 455 were included in the study. Results revealed that 39.1% exhibited no or very mild symptoms of SAD, while 23.7% experienced mild symptoms, 21.3% faced moderate symptoms, and 11.6% and 4.2% presented with severe to very severe symptoms, respectively. Factors such as gender (p < 0.0001), previous academic failures (p = 0.013), family history of mental health issues (p = 0.009), exercise frequency (p < 0.0001), and perceptions of relationships with classmates (p < 0.0001) were significantly associated with SAD. Females showed a higher probability of SAD compared to males (OR = 1.976). Individuals engaging in over 90 minutes of exercise per week were less likely to have SAD (OR = 0.383), and occasional smokers had a lower risk of SAD compared to non-smokers (OR = 0.422). Our study uncovered a notably elevated prevalence of Social Anxiety Disorder (SAD) among foreign-born undergraduate students in Türkiye. Factors such as being female, having a family history of mental illnesses, studying in a stressful environment, experiencing academic failure, and engaging in less frequent exercise were associated with noticeable symptoms of SAD. These findings emphasize the urgent need for heightened efforts in recognizing and addressing SAD within this population.

Socializing with Smoker and Social Smoking Behavior among Chinese Male Smokers with Low Nicotine Dependence: The Mediating Roles of Belief of Smoking Rationalization and Smoker Identity

BACKGROUND

Previous studies have shown that socializing with other smokers is an essential trigger for social smoking among smokers with a low nicotine dependence. This study further explored the mediating effects of the belief of smoking rationalization and smoker identity on the relationship between socializing with smokers and social smoking behavior.

METHODS

A cross-sectional design was conducted. A total of 696 low-nicotine-dependent smokers in China completed questionnaires that assessed socializing with smokers, social smoking behavior, smoker identity, and the belief of smoking rationalization. The mediating roles of the belief of smoking rationalization and smoker identity on the relationship between socializing with smokers and social smoking behavior were assessed by using SPSS 23 and AMOS 23.

RESULTS

The belief of smoking rationalization, smoker identity, socializing with smokers, and social smoking behavior were significantly and positively correlated with each other. In addition, this study found an independently mediated role for smoker identity in the relationship with smoker socialization and social smoking behavior, and a sequentially mediated role for smoking rationalization and smoker identity in this relationship.

CONCLUSION

Reducing the belief of smoking rationalization and smoker identity may be conducive to reducing social smoking behavior for low-nicotine-dependent smokers when socializing with other smokers.

Short interpregnancy interval and pregnancy outcomes: How important is the timing of confounding variable ascertainment?

BACKGROUND

Estimation of causal effects of short interpregnancy interval on pregnancy outcomes may be confounded by time-varying factors. These confounders should be ascertained at or before delivery of the first ("index") pregnancy, but are often only measured at the subsequent pregnancy.

OBJECTIVES

To quantify bias induced by adjusting for time-varying confounders ascertained at the subsequent (rather than the index) pregnancy in estimated effects of short interpregnancy interval on pregnancy outcomes.

METHODS

We analysed linked records for births in British Columbia, Canada, 2004-2014, to women with ≥2 singleton pregnancies (n = 121 151). We used log binomial regression to compare short (<6, 6-11, 12-17 months) to 18-23-month reference intervals for 5 outcomes: perinatal mortality (stillbirth and neonatal death); small for gestational age (SGA) birth and preterm delivery (all, early, spontaneous). We calculated per cent differences between adjusted risk ratios (aRR) from two models with maternal age, low socio-economic status, body mass index, and smoking ascertained in the index pregnancy and the subsequent pregnancy. We considered relative per cent differences <5% minimal, 5%-9% modest, and ≥10% substantial.

RESULTS

Adjustment for confounders measured at the subsequent pregnancy introduced modest bias towards the null for perinatal mortality aRRs for <6-month interpregnancy intervals [-9.7%, 95% confidence interval [CI] -15.3, -6.2). SGA aRRs were minimally biased towards the null (-1.1%, 95% CI -2.6, 0.8) for <6-month intervals. While early preterm delivery aRRs were substantially biased towards the null (-10.4%, 95% CI -14.0, -6.6) for <6-month interpregnancy intervals, bias was minimal for <6-month intervals for all preterm deliveries (-0.6%, 95% CI -2.0, 0.8) and spontaneous preterm deliveries (-1.3%, 95% CI -3.1, 0.1). For all outcomes, bias was attenuated and minimal for 6-11-month and 12-17-month interpregnancy intervals.

CONCLUSION

These findings suggest that maternally linked pregnancy data may not be needed for appropriate confounder adjustment when studying the effects of short interpregnancy interval on pregnancy outcomes.

The Associations of Aspirin, Statins, and Metformin With Lung Cancer Risk and Related Mortality: A Time-Dependent Analysis of Population-Based Nationally Representative Data

INTRODUCTION

The aim of this study was to investigate the associations of aspirin, metformin, and statins with lung cancer risk and mortality using population-based nationwide cohort data.

METHODS

This study included a total of 732,199 participants who underwent a national health check-up from 2002 to 2003. Lung cancer incidence and mortality were identified using a registered lung cancer diagnosis code (International Classification of Diseases, 10th revision, code C34) and the Korean National Death Registry. The study participants were followed up from January 1, 2004 to December 31, 2013. Medication exposure was defined by the cumulative duration of use and cumulative defined daily dose per 2-year interval. To avoid immortal-time bias, drug exposure was inserted as a time-dependent variable in Cox analysis, which evaluated the associations of these medications with lung cancer.

RESULTS

Metformin use had a protective association with lung cancer incidence (p's for trend 0.008) and mortality (p's for trend < 0.001) in a dose-response fashion, and these associations were prominent among participants with a metformin cumulative defined daily dose of 547.5 and above compared with patients without diabetes. Lung cancer mortality was dose-dependently reduced with the use of aspirin (p's for trends 0.046) and statin (p's for trends < 0.001). The combined use of aspirin, statins, and metformin exhibited more prominent protective associations with lung cancer risk and mortality.

CONCLUSIONS

The use of aspirin, metformin, and statins had independent protective associations with lung cancer mortality, and metformin had an inverse association with lung cancer risk. Further studies are necessary to develop clinically applicable anticancer strategies using these drugs for the reduction of lung cancer and related mortality.

The Value of a Statistical Life for Risk-Averse and Risk-Seeking Individuals

This article estimates the value of a statistical life (VSL) for Chile under the hedonic wage method while accounting for individual risk preferences. Two alternative measures of risk aversion are used. First, risk aversion is directly measured using survey measures of preferences over hypothetical gambles, and second, over observed individual behaviors that may proxy for risk preferences, such as smoking status, are used. I reconcile the results with a theoretical model of economic behavior that predicts how the wage-risk tradeoff changes as risk aversion differs across individuals. The VSL estimates range between 0.61 and 8.68 million dollars. The results using smoking behavior as a proxy for risk attitudes are consistent with previous findings. However, directly measuring risk aversion corrects the wage-risk tradeoff estimation bias in the opposite direction. The results are robust to other observed measures of risk aversion such as drinking behavior and stock investments. Results suggest that, consistent with the literature that connects smoking behavior with labor market outcomes, smoking status could be capturing poor health productivity effect in addition to purely risk preferences.

Correlates of Transitions in Tobacco Product Use by U.S. Adult Tobacco Users between 2013⁻2014 and 2014⁻2015: Findings from the PATH Study Wave 1 and Wave 2

More than half of adult tobacco users in the United States (U.S.) transitioned in tobacco product use between 2013⁻2014 and 2014⁻2015. We examine how characteristics of adult tobacco users in the U.S. relate to transitions in tobacco product use. Population Assessment of Tobacco and Health (PATH) Study data were analyzed from 12,862 adult current tobacco users who participated in Wave 1 (W1, 2013⁻2014) and Wave 2 (W2, 2014⁻2015). Three types of transitions were examined-(1) adding tobacco product(s); (2) switching to non-cigarette tobacco product(s); and (3) discontinuing all tobacco use-among those currently using: (1) any tobacco product; (2) cigarettes only (i.e., exclusive cigarette); and (3) cigarettes plus another tobacco product(s) (i.e., poly-cigarette). Multinomial logistic regression analyses determined relative risk of type of transition versus no transition as a function of demographic and tobacco use characteristics. Transitions in tobacco product use among adult tobacco users were common overall, but varied among different demographic groups, including by age, sex, sexual orientation, race/ethnicity, educational attainment, and poverty level. Further, cigarette smokers with higher dependence scores were more likely to add product(s) and less likely to discontinue tobacco use compared to those with low dependence scores. That high nicotine dependence is a barrier to discontinuing tobacco use adds evidence to support policy to lower nicotine content of cigarettes and to evaluate new products for their potential to reduce cigarette use.

Factors associated with changing cigarette consumption patterns among low-intensity smokers: Longitudinal findings across four waves (2008-2012) of ITC Mexico Survey

Background

Light and intermittent smoking has become increasingly prevalent as smokers shift to lower consumption in response to tobacco control policies. We examined changes in cigarette consumption patterns over a four-year period and determined which factors were associated with smoking transitions.

Methods

We used data from a cohort of smokers from the 2008–2012 ITC Mexico Survey administrations to investigate transitions from non-daily (ND; n = 669), daily light (DL; ≤5 cigarettes per day (cpd); n = 643), and daily heavy (DH; >5 cpd; n = 761) smoking patterns. To identify which factors (i.e., sociodemographic measures, perceived addiction, quit behavior, social norms) were associated with smoking transitions, we stratified on smoking status at time t (ND, DL, DH) and used multinomial (ND, DL) and binomial (DH) logistic regression to examine transitions (quitting/reducing or increasing versus same level for ND and DL, quitting/reducing versus same level for DH).

Results

ND smokers were more likely to quit at follow-up than DL or DH smokers. DH smokers who reduced their consumption to ND were more likely to quit eventually compared to those who continued as DH. Smokers who perceived themselves as addicted had lower odds of quitting/reducing smoking consumption at follow-up compared to smokers who did not, regardless of smoking status at the prior survey. Quit attempts and quit intentions were also associated with quitting/reducing consumption.

Conclusions

Reducing consumption may eventually lead to cessation, even for heavier smokers. The findings that perceived addiction and quit behavior were important predictors of changing consumption for all groups may offer insights into potential interventions.

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Smoking transitions were evaluated in a cohort of Mexican smokers.

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The cohort consisted mostly of understudied light and intermittent smokers (LITS).

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Reductions in smoking intensity were found to facilitate smoking cessation.

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Greater perceived addiction inhibited cessation for smokers at all levels of intensity.

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LITS patterns warrant attention as number of low-intensity smokers worldwide grows.

Effect of a Mobile Phone Intervention on Quitting Smoking in a Young Adult Population of Smokers: Randomized Controlled Trial

Background

Digital mobile technology presents a promising medium for reaching young adults with smoking cessation interventions because they are the heaviest users of this technology.

Objective

The aim of this study was to determine the efficacy of an evidence-informed smartphone app for smoking cessation, Crush the Crave (CTC), on reducing smoking prevalence among young adult smokers in comparison with an evidence-informed self-help guide, On the Road to Quitting (OnRQ).

Methods

A parallel, double-blind, randomized controlled trial with 2 arms was conducted in Canada to evaluate CTC. In total, 1599 young adult smokers (aged 19 to 29 years) intending to quit smoking in the next 30 days were recruited online and randomized to receive CTC or the control condition OnRQ for a period of 6 months. The primary outcome measure was self-reported continuous abstinence at the 6-month follow-up.

Results

Overall follow-up rates were 57.41% (918/1599) and 60.48% (967/1599) at 3 and 6 months, respectively. Moreover, 45.34% (725/1599) of participants completed baseline, 3-, and 6-month follow-up. Intention-to-treat analysis (last observation carried forward) showed that continuous abstinence (N=1599) at 6 months was not significantly different at 7.8% (64/820) for CTC versus 9.2% (72/779) for OnRQ (odds ratio; OR 0.83, 95% CI 0.59-1.18). Similarly, 30-day point prevalence abstinence at 6 months was not significantly different at 14.4% (118/820) and 16.9% (132/779) for CTC and OnRQ, respectively (OR 0.82, 95% CI 0.63-1.08). However, these rates of abstinence were favorable compared with unassisted 30-day quit rates of 11.5% among young adults. Secondary measures of quit attempts and the number of cigarettes smoked per day at 6-month follow-up did not reveal any significant differences between groups. For those who completed the 6-month follow-up, 85.1% (359/422) of young adult smokers downloaded CTC as compared with 81.8% (346/423) of OnRQ, χ²_1(N=845)=1.6, P=.23. Furthermore, OnRQ participants reported significantly higher levels of overall satisfaction (mean 3.3 [SD 1.1] vs mean 2.6 [SD 1.3]; t₆₄₄=6.87, P<.001), perceived helpfulness (mean 5.8 [SD 2.4] vs mean 4.3 [SD 2.6], t₆₅₇=8.0, P<.001), and frequency of use (mean 3.6 [SD 1.2] vs mean 3.2 [SD 1.1], t₆₈₃=5.7, P<.001) compared with CTC participants.

Conclusions

CTC was feasible for delivering cessation support but was not superior to a self-help guide in helping motivated young adults to quit smoking. CTC will benefit from further formative research to address satisfaction and usage. As smartphone apps may not serve as useful alternatives to printed self-help guides, there is a need to conduct further research to understand how digital mobile technology smoking cessation interventions for smoking cessation can be improved.

Trial Registration

ClinicalTrials.gov NCT01983150; http://clinicaltrials.gov/ct2/show/NCT01983150 (Archived by WebCite at http://www.webcitation.org/6VGyc0W0i)

Nondaily Cigarette Smoking Is Increasing Among People With Common Mental Health and Substance Use Problems in the United States: Data From Representative Samples of US Adults, 2005-2014

OBJECTIVE

The current study estimated trends in the prevalence of daily and nondaily cigarette smoking among United States adults with any common mental health or substance use problem (MHSUP), compared to US adults without MHSUP, from 2005 to 2014.

METHODS

Data were drawn from the years 2005 to 2014 from the public use data files for the annually conducted National Survey on Drug Use and Health. Linear time trends of current, daily, and nondaily cigarette smoking among adults (age 18 years and older) with and without MHSUP were assessed using logistic regression models with continuous year as the predictor.

RESULTS

In 2014, the prevalence of current cigarette smoking among those with MHSUP was more than twice that of those without MHSUP. Nondaily cigarette smoking increased significantly from 2005 to 2014 among those with MHSUP (P = .001) in contrast to a decline in nondaily cigarette smoking among those without MHSUP (P < .01). The rate of change differed significantly (P < .001). Daily cigarette smoking declined significantly from 2005 to 2014 among those with and without MHSUP (P values < .001).

CONCLUSIONS

The prevalence of nondaily cigarette smoking is increasing among US adults with common mental health and substance use problems, while it continues to decline among those without these vulnerabilities. The disparity in prevalence of daily cigarette smoking between those with and without MHSUP remains substantial. Conclusions about how to reach the tobacco endgame may need to be reconsidered to develop targeted tobacco control public health approaches that address common MHSUP.

Association Between Socioeconomic Status and Access to Care and Quitting Smoking With and Without Assistance

Introduction

Socio-economic disparities in smoking rates persist, in Ontario, despite public health care and universal tobacco control policies. Mechanisms for continuing disparities are not fully understood. Unequal access or utilization of assistance for cessation may contribute. The objective of this research was to use longitudinal data on smokers to examine the associations between socioeconomic status (SES) and access to care measures and assisted and unassisted quit attempts.

Methods

Data were taken from 3578 smokers with at least one follow-up interview participating in the Ontario Tobacco Survey (OTS). Multinomial regression models with imputed missing values were run for each measure of SES and access to care to assess the association with quitting behavior and use of assistance, unadjusted and while adjusting for smoking history and demographic covariates.

Results

Adjusted analyses found smokers living in areas with the lowest ethnic concentration were more likely to make an assisted quit attempt compared to unassisted quitting (RR = 1.64; 95% CI = 1.08-2.50) or making no quit attempt (RR = 1.65; 95% CI = 1.15-2.37). Smokers who reported visiting a doctor in the previous 6 months were more likely to quit with assistance versus unassisted compared to those not visiting a doctor, whether they were advised (RR = 1.89, 95% CI = 1.43-2.48) or not advised to quit (OR = 1.32, 95% CI = 1.01-1.74). Similar results were seen when comparing assisted quit attempts with no quit attempts.

Conclusions

Adjusted analyses showed that quitting with assistance was unrelated to measures of SES except ethnic concentration. Physician intervention with patients who smoke is important for increasing assisted quit attempts.

Implications

For most measures of SES there were no significant associations with either assisted or unassisted quitting adjusting for demographic and smoking history. Smokers who live in areas with the lowest ethnic concentration were most likely to use assistance as were smokers who visited their doctor and were advised to quit smoking. Interventions to increase the delivery of effective quitting methods in smokers living in areas with high ethnic concentrations and to increase physician compliance with asking and advising patients to quit may increase assisted quit attempts.

Association of Ontario's Ban on Menthol Cigarettes With Smoking Behavior 1 Month After Implementation

This study compares respondents’ planned behavior before the 2017 menthol cigarette ban in Ontario with actual behavior 1 month after the ban.

Quantifying population-level health benefits and harms of e-cigarette use in the United States

BACKGROUND

Electronic cigarettes (e-cigarettes) may help cigarette smokers quit smoking, yet they may also facilitate cigarette smoking for never-smokers. We quantify the balance of health benefits and harms associated with e-cigarette use at the population level.

METHODS AND FINDINGS

Monte Carlo stochastic simulation model. Model parameters were drawn from census counts, national health and tobacco use surveys, and published literature. We calculate the expected years of life gained or lost from the impact of e-cigarette use on smoking cessation among current smokers and transition to long-term cigarette smoking among never smokers for the 2014 US population cohort.

RESULTS

The model estimated that 2,070 additional current cigarette smoking adults aged 25-69 (95% CI: -42,900 to 46,200) would quit smoking in 2015 and remain continually abstinent from smoking for ≥7 years through the use of e-cigarettes in 2014. The model also estimated 168,000 additional never-cigarette smoking adolescents aged 12-17 and young adults aged 18-29 (95% CI: 114,000 to 229,000), would initiate cigarette smoking in 2015 and eventually become daily cigarette smokers at age 35-39 through the use of e-cigarettes in 2014. Overall, the model estimated that e-cigarette use in 2014 would lead to 1,510,000 years of life lost (95% CI: 920,000 to 2,160,000), assuming an optimistic 95% relative harm reduction of e-cigarette use compared to cigarette smoking. As the relative harm reduction decreased, the model estimated a greater number of years of life lost. For example, the model estimated-1,550,000 years of life lost (95% CI: -2,200,000 to -980,000) assuming an approximately 75% relative harm reduction and -1,600,000 years of life lost (95% CI: -2,290,000 to -1,030,000) assuming an approximately 50% relative harm reduction.

CONCLUSIONS

Based on the existing scientific evidence related to e-cigarettes and optimistic assumptions about the relative harm of e-cigarette use compared to cigarette smoking, e-cigarette use currently represents more population-level harm than benefit. Effective national, state, and local efforts are needed to reduce e-cigarette use among youth and young adults if e-cigarettes are to confer a net population-level benefit in the future.

Evaluation of menthol per se on acute perceptions and behavioral choice of cigarettes differing in nicotine content

Subjective perceptions and self-administration of cigarettes are each influenced by nicotine. Yet, differences specifically due to menthol in perceptions and choice of cigarettes varying in nicotine, and the association between these responses, have not been directly tested. Using a mixed between- and within-subjects design, acute responses to each of two menthol or non-menthol Spectrum research cigarettes, moderate (16-17 mg/g) versus very low (0.4 mg/g) in nicotine contents, were compared following brief abstinence in adult smokers preferring menthol ( n=44) or non-menthol ( n=29) brands. To ensure reliable perceptions, they experienced five exposures to each cigarette, then chose between them. All perceptions and choices were greater for moderate vs very low nicotine, as expected, and the magnitude of difference in four of six perceptions was associated with subsequently greater choice of the moderate nicotine cigarette. Importantly, virtually no differences were found between menthol and non-menthol, as nearly all perceptions, cigarette choices, and the association between perceptions and choice were not moderated by menthol or the interaction of nicotine by menthol. Our results indicate perceptions and reinforcement from cigarettes do not differ due to menthol when nicotine content and smoking topography are carefully controlled. Thus, regardless of menthol, smoking perceptions directly predict self-administration behavior.

Atopy Is Associated with Age at Asthma Onset in Elderly Patients

BACKGROUND

Asthma in the elderly population (60 years of age and older) is frequently underdiagnosed, as well as atopy. Atopy, although more prevalent in younger patients, can be a major cause of asthma in the elderly. Chronic obstructive pulmonary disease (COPD) and cardiovascular disease are common differential diagnoses, especially in elderly smokers.

OBJECTIVE

The objective of this study was to assess atopy and comorbidities in elderly patients with asthma.

METHODS

This was an observational and retrospective study involving elderly asthmatic patients followed up at a tertiary center. Patients were assessed for severity of asthma, frequency of atopy, and frequency of comorbidities concomitant with asthma. Then, they were classified according to their age at asthma onset and the groups compared with each other for atopy, spirometric parameters, and comorbidities.

RESULTS

This study included 243 elderly asthmatic patients, 71.8% of them presenting severe disease and 82.3% forced expiratory volume in 1 second (FEV₁) < 80%. Gastroesophageal reflux disease, obesity, and asthma-COPD overlap syndrome were observed, respectively, in 64%, 37%, and 13% of these patients. Atopy was observed in 63%, mainly in those with early onset disease, and its frequency decreased as the age of asthma onset increased (P < .05). Total serum IgE was higher for allergic patients and FEV₁ values were lower for patients with long-term asthma. Aspirin-exacerbated respiratory disease was more frequent in patients with nonallergic asthma.

CONCLUSIONS

Most elderly asthmatic patients followed up in our tertiary center were atopic and higher values of total serum IgE suggest atopy. Atopy was inversely correlated with age of asthma onset. The diagnosis of allergic asthma in the elderly population is essential to treat patients more properly, improving their quality of life and decreasing asthma morbidity and mortality.

Changes in smoking status among a longitudinal cohort of gay, bisexual, and other men who have sex with men in Vancouver, Canada

BACKGROUND

Cigarette smoking is common among gay, bisexual, and other men who have sex with men (GBMSM) and most of the mortality gap between HIV-positive and HIV-negative individuals is attributable to smoking.

METHODS

We recruited sexually active HIV-positive and HIV-negative GBMSM age ≥16 years using respondent-driven sampling. Study visits occurred every six months for up to four years and included a computer-assisted self-interview and clinical assessment. We conducted bivariate analyses to compare factors associated with "never", "former", "daily", or "non-daily" smoking at baseline and longitudinal mixed effects models to examine factors associated with cessation and (re)initiation.

RESULTS

774 participants completed a baseline visit and 525 enrolled in the cohort and completed at least one follow-up visit. At baseline, the median age was 34 years and 31.5% were daily smokers. In follow-up (median=2.5years), 116 daily or non-daily smokers (41%) quit at least once and of these, 101 (87%) remained former smokers at their last visit. Smoking cessation was positively associated with incomes ≥$60,000 and self-reported excellent health. Alcohol use, ecstasy use, and having a partner who smokes were associated with decreased odds of cessation. Substance use (cannabis, GHB, and crystal methamphetamine) and having a partner who smokes were positively associated with increasing to/resuming daily smoking. HIV-positive GBMSM were more likely to smoke but not more likely to quit.

CONCLUSIONS

Targeted, culturally relevant smoking cessation resources are needed, especially for HIV-positive GBMSM. Engaging couples in cessation interventions may be useful.

Depression Among Non-Daily Smokers Compared to Daily Smokers and Never-Smokers in the United States: An Emerging Problem

INTRODUCTION

Depression is strongly associated with daily smoking. Yet, little is known about the association between depression and non-daily smoking. The aim of this study was to investigate the prevalence of past-year depression and changes in past-year depression over time among non-daily smokers, compared to daily smokers and never-smokers, overall and stratified by age, gender, income, nicotine dependence, and cigarettes per day.

METHODS

Data were drawn from the National Household Survey on Drug Use (NSDUH), an annual cross-sectional study of persons aged 12 and over (total study population N = 496 805). The prevalence of past-year depression was examined annually among non-daily smokers, daily smokers, and never-smokers from 2005 to 2013 using linear trend analyses.

RESULTS

Past-year depression was common among 10.10% of non-daily smokers, common among 10.78% of daily smokers, and 5.51% of never-smokers in 2013. The prevalence of depression increased from 2005 to 2013 among non-daily smokers (9.06% vs. 10.10%; p = .034) while there was no significant change in depression over time among daily smokers. Increases in depression among non-daily smokers occurred for both men and women and appear most pronounced youth, those smoking fewer cigarettes, and those without nicotine dependence.

CONCLUSIONS

The prevalence of depression among non-daily smokers was equivalent to daily smokers and nearly twice that among nonsmokers. Depression appears to be increasing over time in non-daily smokers especially among youth, those who smoke less, and those without nicotine dependence. More work on the mental health of non-daily smokers is needed as this is an increasing and understudied group.

IMPLICATIONS

This is the first study to investigate changes in the prevalence of depression among non-daily smokers compared to daily smokers and never-smokers over the past decade in a nationally representative sample of the United States. The results suggest an increase in depression among non-daily smokers over time that did not similarly occur for daily smokers. Further, there were several subgroups of non-daily smokers among whom depression has increased more rapidly. This study suggests the need for more information about the relationship between depression and non-daily smoking including the impact of depression on quit attempts and outcomes.

Changes in cigarette smoking initiation, cessation, and relapse among U.S. adults: a comparison of two longitudinal samples

BACKGROUND

The tobacco epidemic in the U.S. has matured in the past decade. However, due to rapidly changing social policy and commercial environments, tailored prevention and interventions are needed to support further reduction in smoking.

METHODS

Using Tobacco Use Supplement to the Current Population Survey (TUS-CPS) 2002-2003 and 2010-2011 longitudinal cohorts, five smoking states are defined including daily-heavy, daily-light, non-daily, former and non-smoker. We quantified the changes between smoking states for the two longitudinal cohorts, and used a series of multivariable logistic regression models to examine the association of socio-demographic attributes and initial smoking states on smoking initiation, cessation, and relapse between waves within each cohort.

RESULTS

The prevalence of adult heavy smoking decreased from 9.9% (95% CI: 9.6%, 10.2%) in 2002 to 7.1% (95% CI: 6.9%, 7.4%) in 2010. Non-daily smokers were less likely to quit in the 2010-2011 cohort than the 2002-2003 cohort (37.0% vs. 44.9%). Gender, age group, smoker type, race and marital status exhibit similar patterns in terms of their association to the odds of initiation, cessation and relapse between the two cohorts, while education groups showed some inconsistent results between the two cohorts regarding the odds of cessation.

CONCLUSIONS

Transitions between smoking states are complex and increasingly unstable, requiring a holistic, population-based perspective to understand the stocks and flows that ultimately dictate the public health impact of cigarette smoking behavior. This knowledge helps to identify groups in need of increased tobacco control prevention and intervention efforts.

Smoking transitions in a sample of Hispanic daily light and intermittent smokers

Few studies have documented the differences between daily light (DLS; ≤10 cigarettes per day) and intermittent (ITS; nondaily) smokers. The primary aim of this study was to assess the potential transitions (i.e., increased/stayed at same level) between baseline and a 3month follow-up of Hispanic DLS and ITS who were randomly assigned to a control group of a brief cessation intervention. Additionally, potential nicotine addiction differences between groups of smokers (e.g., ITS who became DLS vs. those who did not change) were assessed. Participants were 190 Hispanic DLS/ITS (who represent a subsample from a larger dataset, n=370) with complete data (53.7% female; Mage=38.6years, SD=15.1; range=18-74years) randomized to the control arm of a brief cessation intervention. Participants completed sociodemographics, tobacco use history, and the Fagerström Test for Nicotine Dependence (FTND; Heatherton, Kozlowski, Frecker and Fagerström, 1991). The majority of participants remained DLS (41.1%) or ITS (21.6%). ANCOVA findings indicated significant group differences regarding FTND scores (F [5114]=6.93, p<0.001). Those who remained DLS had significantly higher FTND scores than those who remained ITS and those who converted from ITS to DLS. Within these DLS/ITS who were randomized to a control group, smoking transitions primarily remained stable over time, particularly among DLS (who demonstrated higher nicotine dependence), suggesting the need for low level cessation interventions to continue and include a focus on dependence symptoms.

Changes in Social Capital and Cigarette Smoking Behavior Over Time: A Population-Based Panel Study of Temporal Relationships

INTRODUCTION

Identifying factors that influence individuals' smoking behavior remains a huge public health concern. This study aimed to investigate changes in individuals' cigarette smoking while considering well-known smoking determinants, including social capital, its presence being postulated to reduce smoking.

METHODS

From British Household Panel Survey data, two baseline smoking cohorts were created ("smoking" and "not smoking"). The same individuals from this nationally representative sample (N_T = 8114, aged 16-91 years) were interviewed on four occasions between years 2000 and 2007 to investigate changes in cigarette smoking behavior. Logistic regression models with random effects compensated for within-individual behavior over time. Temporal pathways were investigated by lagging independent variables (t - 1) in relation to our cigarette-use outcome at time (t).

RESULTS

Active social participation at (t - 1) was positively associated with smoking cessation at (t) (odds ratio [OR] = 1.39; 95% confidence interval [CI] [1.07-1.82]). Separating from one's spouse at (t - 1) increased risk for smoking relapse/initiation at (t) (OR = 6.63; 95% CI [1.70-28.89]). Conversely, being married protected against smoking cigarettes (OR = 1.87; 95% CI [1.15-3.04]). These associations held in our robustness checks.

CONCLUSIONS

Initial marital breakdown predicted a high risk of smoking relapse/initiation. The timing of this life event provides a critical window where adverse smoking behavior might occur. Conversely, the positive effects of active social participation on cigarette cessation remained consistent, its absence further predicting smoking relapse/initiation. Robustness of results confirms the important role that active participation has on cigarette smoking behavior. Group smoking cessation interventions could harness participatory elements to better achieve their goals.

IMPLICATIONS

By investigating temporal relationships between well-known smoking determinants and cigarette smoking outcomes, we identified that being "separated" (not "divorced") at time (t) predicted a higher risk of smoking relapse/initiation at (t). Tailored health messages could be employed to highlight the increased risk of cigarette smoking relapse/initiation during this stressful life event. Conversely, active social participation (a common social capital proxy) consistently predicted smoking cessation over time. Future group smoking cessation interventions could be designed explicitly to harness participatory elements to better achieve their goals.

Correlates of Converted and Native Nondaily Smoking

OBJECTIVES

Nondaily smokers represent a growing proportion of current smokers in the United States. However, little is known about which characteristics are important in distinguishing between nondaily smokers who are former daily smokers (converted nondaily) and nondaily smokers who never smoked daily (native nondaily). This study contrasts converted and native nondaily smokers on demographic, psychosocial, tobacco-related characteristics and quit intentions and behaviors in a tri-ethnic sample (Blacks, Whites, and Latinos) of smokers.

METHODS

Smokers were recruited for a web-based survey using an online panel survey company. Participants were 1,201 nondaily smokers (904 converted nondaily smokers and 297 native nondaily smokers). A multivariable logistic regression was conducted to assess the associations between demographic, smoking-related, and psychosocial variables with converted versus native nondaily smoking.

RESULTS

Logistic regression indicated that number of years smoking, years as a nondaily smoker, number of days smoked in a month, smoking dependence, identity as a smoker, and number of smoking cessation methods used were correlates of being converted nondaily smokers versus native nondaily smokers.

CONCLUSIONS

Clinicians and researchers should consider characteristic variations in nondaily smokers when designing and implementing intervention efforts targeting this smoking population.

Experimentally Switching from Factory Made to Self-Made Cigarettes: A Preliminary Study of Perceptions, Toxicant Exposure and Smoking Behavior

INTRODUCTION

There is currently the potential for a great deal of transition and product switching among cigarette smokers. Studies on the transition when cigarette smokers switch from one type of nicotine delivery product to another are needed to understand subsequent toxicant exposure.

METHODS

A preliminary study was performed to determine the feasibility of experimentally replicating the transition from factory made (FM) to personal machine made (PMM) cigarette smoking. The adaptability and perceptions of the consumer and the consequent exposure to cigarette-delivered toxins were assessed. Six adults (4 men) were recruited for four laboratory visits (V1-V4) on study days 1, 5, 10 and 15, respectively. All of the participants agreed to switch from exclusive FM smoking to exclusive PMM cigarette smoking for the duration of the study.

RESULTS

Compliance was very high among these participants. Participants progressively accepted the PMM cigarettes and became efficient producers of PMMs as evidenced in the reduced time to make 5 PMMs in the laboratory. Participants reported a preference for FM at visit 2 (V2), but had stated no preference by the fourth visit. Compared to the FMs, the PMMs at V3 (p<0.05) and V4 (p<0.10) had lower CO boost (7.3 vs. 4.1 ppm; p<0.05). Over all conditions, nicotine plasma levels averaged 18.0±2.4 ng/ml before smoking (for both FM and PMM) and 34.0±5.3 ng/mL after smoking; there were no significant differences in the plasma nicotine boost (average 17.7 and 15.4ng/ml after FM and PMM smoking, respectively). Although there were differences between individual subjects' filter butt levels of deposited solanesol the within-subject levels were remarkably similar. Puff topography measures did not vary across visits or cigarette type.

CONCLUSIONS

Although interpretation of study results must be conservative because of the small sample size, this study demonstrates that experimentally-induced transition from FM to PMM smoking is feasible for laboratory study and the subsequent toxicant exposure is comparable for FM and PMM cigarettes.

Softening of monthly cigarette use in youth and the need to harden measures in surveillance

Objective

To assess changes in monthly smoking in its relationship to daily smoking and heavier smoking in high school seniors. Public health agencies often report only “current use” of cigarettes among youth as any use in the past 30 days, even though additional measures are collected. Monthly use is a crude and changing indicator.

Methods

Results from 1975 to 2013 from Monitoring The Future Project were plotted and analyzed by linear regression.

Results

From 1975 to 2013, the percentage of monthly smokers who smoked daily decreased by 29% (21.2 percentage points) and monthly smokers who smoked 10 + cigarettes/day dropped by 57% (28 percentage points); the percentage of daily smokers who smoked 10 + cigarettes/day decreased by 40% (26.5 percentage points).

Conclusion

Additional measures of frequency and intensity of use of cigarettes and other tobacco/nicotine products need to be more regularly reported. These results indicate softening rather than hardening of “current smoking” and have important implications for tobacco surveillance and for tobacco research because of a) increased likelihood of quitting smoking, b) health effects of cigarette smoking, and c) similar and interacting issues related to measuring the use of all tobacco/nicotine products.

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From 1975 to 2013, monthly 12th grade smokers were 29% less likely to smoke daily.

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Monthly smokers in 2013 were 57% less likely to smoke ≥ 10 cigarettes/day.

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Daily smokers in 2013 were 40% less likely to smoke ≥ 10 cigarettes/day.

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Reliance solely on monthly product use in tobacco surveillance is problematic.

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Reports on e-cigarette/tobacco products should include data on heavier levels of use.

One cigarette is one too many: evaluating a light smoker-targeted media campaign

BACKGROUND

Light smokers represent an increasing share of adult smokers in various parts of the world including New York City (NYC). Since 2007, the NYC Department of Health and Mental Hygiene has aired hard-hitting antitobacco media campaigns paired with time-limited nicotine replacement therapy (NRT) giveaways. We evaluated an original antitobacco media campaign, developed to increase awareness of smoking risks and encourage cessation service use among light smokers in NYC.

METHODS

We compared cessation service request volume during the campaign to historical periods without ads targeting light smokers. We used a cross-sectional online panel survey to assess the ad's perceived effectiveness and its impact on learning something new, quit intentions and concern for smoking-related health risks among non-daily, light daily and heavy daily smokers.

RESULTS

The proportion of light smokers among smokers requesting cessation services increased 50% (from 13% to 20%) relative to previous time-limited NRT giveaways. Compared to heavy daily smokers, non-daily (aOR: 1.95, p<0.05) and light daily (aOR: 2.27, p<0.05) smokers were more likely to express increased concern about smoking-related health risks after viewing the ad. Perceived effectiveness of the ad did not differ by smoker type.

CONCLUSIONS

This study provides evidence that light smokers were receptive to a targeted antitobacco message encouraging use of cessation services. The campaign appears to have been particularly effective in increasing smoking-related health concerns in this group. The lack of difference in perceived ad effectiveness by smoker type suggests the potential to develop such ads without sacrificing broad impact.