Nondaily, Low-Rate Daily, and High-Rate Daily Smoking in Young Adults: A 17-Year Follow-Up

Switching away from smoking at 12 months among adult JUUL users varying in recent history of quit attempts made with and without smoking cessation medication

Some smokers switch away from smoking using e-cigarettes, but guidelines recommend trying approved medications first. We analyzed switching in adult smokers using JUUL by their recent history of quit attempts and use of smoking cessation medications. Participants were 8511 adult (21+) established smokers (at baseline), in which 50.3% are daily smokers, in a longitudinal observational study who completed a survey 12 months after first purchasing a JUUL Starter Kit. At baseline, participants reported attempts to quit smoking in the prior year and use of pharmacotherapy (nicotine replacement therapy [NRT] or prescription medication) in their most recent attempt. The outcomes were switching (self-reported no past-30-day smoking) and 50%+ reductions in cigarette consumption. Multivariable analyses were adjusted for baseline covariates. Two thirds of the participants had made a quit attempt in the year before purchasing JUUL. Overall, 59% [58%, 60%] had switched at 12 months. Switching was more likely in those who had used NRT and who attempted quitting without medication versus those who used prescription medications or made no quit attempt. In adjusted multivariable analyses, only making a past-year quit attempt (vs. not) was associated with higher odds of switching (OR = 1.15 [1.04, 1.28]). Over 60% of dual users reduced cigarette consumption by ≥50%. These associations were largely similar in daily smokers. Twelve months after purchasing JUUL, almost all smokers reported either switching or reducing their smoking by 50%+, including those who had recently failed to quit smoking with approved pharmacotherapies. E-cigarettes provide an alternative route to abstinence from smoking for smokers with a history of cessation and cessation treatment failure.

Smoking is associated with lower brain volume and cognitive differences: A large population analysis based on the UK Biobank

The evidence about the association of smoking with both brain structure and cognitive functions remains inconsistent. Using structural magnetic resonance imaging from the UK Biobank (n = 33,293), we examined the relationships between smoking status, dosage, and abstinence with total and 166 regional brain gray matter volumes (GMV). The relationships between the smoking parameters with cognitive function, and whether this relationship was mediated by brain structure, were then investigated. Smoking was associated with lower total and regional GMV, with the extent depending on the frequency of smoking and on whether smoking had ceased: active regular smokers had the lowest GMV (Cohen's d = -0.362), and former light smokers had a slightly smaller GMV (Cohen's d = -0.060). The smaller GMV in smokers was most evident in the thalamus. Higher lifetime exposure (i.e., pack-years) was associated with lower total GMV (β = -311.84, p = 8.35 × 10-36). In those who ceased smoking, the duration of abstinence was associated with a larger total GMV (β = 139.57, p = 2.36 × 10-08). It was further found that reduced cognitive function was associated with smoker parameters and that the associations were partially mediated by brain structure. This is the largest scale investigation we know of smoking and brain structure, and these results are likely to be robust. The findings are of associations between brain structure and smoking, and in the future, it will be important to assess whether brain structure influences smoking status, or whether smoking influences brain structure, or both.

Momentary associations between affect and craving as a function of perceived smoking opportunity in young adults smoking 1-5 cigarettes per day: An ecological momentary assessment study

BACKGROUND

Very light daily smoking (1-5 cigarettes/day) is associated with adverse consequences and is prevalent among young adults. Evidence suggests that perceived smoking opportunity modulates links between affect and craving in adults with heavier smoking patterns (e.g., > 10 cigarettes per day), but there is a lack of similar data in young adults with very light daily smoking patterns. This study addresses this gap by investigating the associations between affect and craving as a function of perceived smoking opportunity under naturalistic conditions.

METHODS

Forty-one young adults aged 18-25 (M=21.03, SD=1.75) who reported smoking 1-5 cigarettes per day (M=3.2, SD=1.2) completed intermittent ratings of momentary affective valence and arousal, smoking craving, and perceived smoking opportunity on smartphones five times per day for seven days.

RESULTS

Multilevel analyses suggested that when participants felt more pleasant or unpleasant, they were likely to report more intense craving. When smoking opportunity was perceived as high, affective arousal was positively associated with craving; this association was not observed when opportunity to smoke was perceived as low.

CONCLUSIONS

These findings indicate that higher momentary intensity of affective valence (both negative and positive) is linked to stronger momentary craving in young adults who report very light daily smoking. Anticipating an opportunity to satisfy craving by smoking may strengthen the association between reported affective arousal and craving in this population. These results highlight the potential benefits of coping with craving (e.g., by regulating affect) for those who engage in light tobacco use, especially in environments with high cigarette availability.

Alternative Tobacco Use and Cigarette Smoking Transitions among College Students in Texas

Background: High prevalence of very light cigarette smoking and use of alternative tobacco products (ATPs; i.e. electronic nicotine delivery systems [ENDS], cigars, and hookah) among young adult college students are causes for concern. The purpose of this study is to examine transitions in cigarette smoking (never vs. non-current vs. very light vs. heavier) among college students across 2.5 years and determine if the use of ATPs is related to these transitions. Methods: This study used six waves of data across 2.5 years from Project M-PACT. Participants who were 18-25 years of age at baseline were included in this study (n = 4,806). Cigarette smoking state was categorized as never smoking, non-current smoking [0 cigarettes smoked per day (cpd) in past month], very light smoking (< =5 cpd in past month), and heavier smoking (>5 in past month). Multi-state Markov models were used to examine temporal transitions in the four smoking states and examine the association of time-varying current ATP use with transitions in smoking states. Results: The probabilities of remaining in a smoking state decreased over time. The time-varying current ATP use was significantly related to increased odds of transitioning from never smoking to non-current smoking, from never smoking to very light smoking, and from non-current to very light smoking. Conclusions: Findings highlight the need to prevent ATP use among college students and in turn inhibit initiation and escalation of cigarette smoking.

Could We See the End of Tobacco Being Sold in Bars and Pubs in New Zealand?

BACKGROUND

Disallowing the sale of tobacco wherever alcohol is consumed is one policy option to help achieve Smokefree 2025. This study aimed to investigate the prevalence of selling tobacco in New Zealand (NZ) on-license premises and explore attitudes toward the sale of tobacco.

METHODS

A sample of managers of on-license premises were asked by telephone about the importance of tobacco to their business, advantages and disadvantages of selling tobacco, and the impact of not being able to sell tobacco in the future. Logistic and linear regression analyses were used to investigate associations between on-license characteristics and selling status and importance scores, respectively.

RESULTS

Of on-license premises, 6.5% (95% CI: 5.3, 8.0) sold tobacco; 17.4% (95% CI: 14.0, 21.4) of hotels, 17.5% (95% CI: 13.8, 21.9) of taverns, and 1.3% (95% CI: 0.6, 3.2) of restaurants. Both retailer type and population density were associated with selling status. On-licenses were more likely to rate tobacco as "unimportant" (51.7%) to their business than "important" (30.0%), although premises where the closest tobacco retailer was at least 1 km away were associated with a higher score. Similar proportions of businesses were opposed to (45.7%) and supported (47.2%) the policy of removing all tobacco sales from on-license premises.

CONCLUSION

Few on-license premises in NZ sell tobacco. Most retailers would support transitioning out of selling tobacco before the 2025 Smokefree goal, and they believed ending sales of tobacco would not negatively affect their business. However, businesses and customers in rural areas may be more affected than others.

IMPLICATIONS

Many countries have tobacco-free goals, with several still developing their endgame strategies to achieve these goals. This study provides NZ and other jurisdictions with evidence useful in the development of such strategies. Having on-license alcohol retailers transition out of sales of tobacco would contribute to a reduction in tobacco availability. Moreover, the results of this study suggest that, in part due to declining tobacco sales and increased thefts, such a policy is likely to have the support of retailers. Policy developers should note, however, the potential for different impacts where the distance to the closest tobacco retailer is over 1 km or in rural areas.

Associations Between Covid-19-Related Threat, Stress, and Smoking in UK Adults Aged Under- and Over-30

It has been suggested that smoking and age are associated with higher vulnerability to Covid-19. While threat of Covid-19 may reduce or stop smoking, increased stress due to lockdown could increase smoking behaviour. This study aimed to investigate changes in smoking behaviour in relation to age, Covid-19-related threat and subjective perceived stress during the UK lockdown. A cross-sectional study was performed. Online adverts were used to recruit UK residents who smoked combustible tobacco any time from January 2020. A questionnaire measured demographic information, smoking behaviour pre- and during-lockdown, perceived subjective stress (PSS), and Covid-19 related threat. Data were collected from a total of 145 participants (58% women, 39% men, 3% non-binary; mean age: 26 years, SD = 7.7), during UK lockdown between 22nd May and 22nd June 2020. Independent of stress and Covid-19-related threat, smoking was reduced in those aged less than 30 years. In participants aged 30 and above, increases in smoking behaviour were associated with higher PSS. The results highlight the relevance of the different stages of life on the relationship between stress, threat, and smoking behaviour. Greater emphasis should be placed on stress reduction for adult smokers aged 30 and above to enable smoking cessation.

Non-daily Cigarette Smoking: Stability and Transition to Abstinence in Young Adults

INTRODUCTION

There is increasing recognition that non-daily cigarette smoking is common in early adulthood but less is known about its stability over time, or what influences transitions to heavier or nonsmoking. We examined the stability of non-daily smoking in a sample of young adults, and tested whether social and cognitive factors predicted transitions to other smoking patterns over time.

AIMS AND METHODS

Participants were 579 young adults (18-24 years old at enrollment, 52% male) who were non-daily and never-daily cigarette smokers and California residents. Participants completed 13 waves of assessment over 3 years. We used descriptive statistics to evaluate the frequency of consistent abstinence, defined as no cigarette use at two consecutive waves and no cigarette use at any subsequent waves. Cox and logistic regression were used to test predictors of consistent abstinence.

RESULTS

We found that 55% of participants smoked intermittently throughout the study, while 43% were consistently abstinent by the end of the study; few transitioned to daily smoking. Stopping smoking was associated with having fewer smoking friends, smoking less in social situations, having lower positive reinforcement expectancies for smoking, and having stronger intent to quit. Post hoc analyses indicated those who stopped smoking tended to report reductions in positive reinforcement expectancies and increased intent to quit in the 6 months before stopping.

CONCLUSIONS

Findings suggest a substantial minority of young adult non-daily smokers may stop on their own, but that the majority continue smoking and may require intervention. Interventions for this population should address social motives and reinforcement expectancies.

IMPLICATIONS

The majority of young adults who are non-daily cigarette smokers appear to maintain this habit over an extended period and may require intervention. Interventions that focus on reducing expectancies for positive effects of and social motives for cigarette use and on increasing intent to quit smoking may be most effective.

Substance Use among Belgian Higher Education Students before and during the First Wave of the COVID-19 Pandemic

The COVID-19 pandemic prompted many countries to issue far-reaching policy measures that may have led to increased substance use. Higher education students may have been disproportionally affected due to the rearrangement of educational life and their susceptibility to psychosocial distress and substance use. The current study examined associations between pandemic-related stressors, psychosocial distress, and self-reported alcohol, tobacco, and cannabis use before and during the first wave of the pandemic. Data were collected in Belgium as part of the COVID-19 International Student Well-being Study (C19 ISWS) and analyzed using multinomial logistic regression analyses. The sample contained 18,346 higher education students aged 17 to 24 (75% women). Overall use of alcohol, tobacco, and cannabis as well as binge drinking decreased during the pandemic, perhaps due to limited social gatherings. Moving back to the parental home was associated with decreased substance use, while depressive symptoms were associated with increased substance use. Perceived threat and academic stress were associated with increased binge drinking among heavy bingers and increased tobacco use. Decreases among students who moved back to their parental home may be explained by increased informal social control. Increased substance use was associated with a number of stressors and psychosocial distress, which suggests that some students may have been self-medicating to manage their mental health amidst the pandemic. Public health policy concerning substance use may prove to be less effective if not tailored to particular subgroups within the student population.

Tobacco and Nicotine Use Among US Adult "Never Smokers" in Wave 4 (2016-2018) of the Population Assessment of Tobacco and Health Study

INTRODUCTION

A common criterion for being labeled a "never smoker" is having smoked <100 lifetime cigarettes. This category is often used as an unexposed reference group to estimate the relative harm from cigarettes. We examined the amount of current and past cigarette and non-cigarette tobacco/nicotine use among adults who met this "never smoker" criterion.

METHODS

We analyzed cross-sectional data from 17 179 adult "never smokers" (ie, reported <100 lifetime cigarettes) in Wave 4 (2016-2018) of the Population Assessment of Tobacco and Health (PATH) Study, a United States nationally representative sample. We used PATH-derived variables to describe "never smokers'" demographics as well as cigarette and non-cigarette tobacco/nicotine use.

RESULTS

Approximately half of "never smokers" were young adults (49.3%). Most were white (68.6%) with some college or more (64.4%). Most "never smokers" had tried any cigarette or non-cigarette tobacco/nicotine in their lifetime (66.7%), 8.5% smoked cigarettes in the past 30 days, and 5.3% were current experimental (ie, some days or every day) cigarette smokers. By definition, "never smokers" reported smoking <100 lifetime cigarettes. One fifth (22.8%) had a lifetime history of established regular non-cigarette tobacco/nicotine use and 8.6% were current established regular non-cigarette tobacco/nicotine users. In total, 9.4% of "never smokers" were current experimental or established regular users of combustible tobacco.

CONCLUSIONS

The 100-cigarette lifetime threshold includes substantial amounts of current and past tobacco use and thus does not represent lack of exposure to cigarette or non-cigarette tobacco. "Never smoker" reference groups may produce underestimates of the relative harms from cigarettes.

IMPLICATIONS

The <100 lifetime cigarettes criterion may not capture what many would consider true "never smokers." Relying on the current definition of "never smokers" as a reference group will include a substantial number of those currently and recently using combustible tobacco and thus produce data that may underestimate the relative harm from cigarettes. Prospective longitudinal research is needed to compare how the 100-cigarette lifetime threshold versus other definitions of regular cigarette smoking differ in predictive validity of clinically meaningful outcomes and health harms to determine the optimal criteria to define established cigarette smoking.

Very Light Daily Smoking in Young Adults: Relationships Between Nicotine Dependence and Lapse

INTRODUCTION

Very light daily smoking is increasingly common among young adults. Evidence suggests that levels of nicotine dependence vary significantly among young adults who engage in very light daily smoking. However, the links between dependence and clinically relevant outcomes (eg, lapse) in this population remain unclear. The goal of this study was to address this gap by evaluating how well different nicotine dependence scales predict lapse behavior among very light daily smoking young adults.

AIMS AND METHODS

Very light daily smokers (1-5 cigarettes/day) aged 18-25 participated in an initial laboratory session, during which nicotine dependence was assessed using four commonly used measures: the Fagerstrӧm Test for Cigarette Dependence (FTCD), the Hooked On Nicotine Checklist (HONC), the Transdisciplinary Tobacco Use Research Centers (TTURC) Nicotine Dependence Inventory, and the Wisconsin Inventory of Smoking Dependence Motives (WISDM). After a baseline period, eligible participants (n = 40) completed a 10-day abstinence incentive period in which they attempted to refrain from smoking to earn monetary rewards. Cox proportional hazards models were used to test whether dependence predicted days to first lapse.

RESULTS

FTCD scores significantly predicted days to lapse, as did scores on the FTCD item assessing time to first cigarette of the day (TTFC). No other dependence measures predicted time to lapse. Both the FTCD and TTFC continued to independently predict time to lapse after controlling for smoking frequency and duration.

CONCLUSIONS

The FTCD may be a particularly useful tool for capturing clinically meaningful variability in nicotine dependence among young adults who engage in very light daily smoking.

IMPLICATIONS

This is the first study to directly link self-reported nicotine dependence with the ability to achieve and maintain abstinence among very light daily smoking young adults. The results may aid clinicians in selecting among variable measures of nicotine dependence when assessing and treating this population.

Not really a smoker? A study on the prevalence of and attitudes to occasional social smoking in a third level institution in Ireland

BACKGROUND

Occasional smoking is defined as any smoking occurring on a less than daily basis. Social smoking, i.e. smoking primarily in social contexts, is a sub-group of occasional smoking. Data on occasional cigarette smoking and the subset of social smoking among third level students are limited.

OBJECTIVES

(1) To determine prevalence of occasional/social smoking among third level students in an Irish university; (2) to evaluate students' attitudes to occasional/social smoking, including perceived benefits and harm; (3) to explore when students commenced occasional/social smoking, their reasons and continued smoking habits; and (4) to determine any influence of other factors, e.g. alcohol consumption, on occasional/social smoking.

METHODS

An anonymous online survey was distributed to undergraduates and postgraduates, using SurveyMonkey. Data were analysed in Microsoft Excel.

RESULTS

Of 18,407 students surveyed, 1310 (7.1%) responded;1267 (96.7%) provided adequate data for analysis. Of the 1267 students, 423 (33.4%) self-reported as current smokers of whom 106/1267 (8.4%) self-classified as daily smokers and 317/1267 (25%) as occasional smokers. The 25% of occasional smokers comprised 266/1267 (21%) social smokers and 51/1267 (4%) non-social smokers. Occasional smokers tended to start smoking earlier and think less about quitting than daily smokers. Of 423 current smokers, 386 (97.2%) reported that alcohol increased their smoking habits.

CONCLUSION

Prevalence of self-reported occasional smoking among university students was higher than daily smoking. Most occasional smokers primarily smoked in social contexts. All current smokers reported that alcohol increased cigarette intake. Effective intervention campaigns tailored to determinants of occasional/social smoking are needed as part of induction to third level.

A latent class analysis of heavy substance use in Young adulthood and impacts on physical, cognitive, and mental health outcomes in middle age

BACKGROUND

This study examines whether longitudinal patterns of persistent or experimental heavy substance use across young adulthood were associated with physical and mental health in midlife.

METHODS

Data (N = 21,347) from Monitoring the Future from adolescence (age 18) to midlife (age 40) were used. Repeated measures latent class analysis modeled patterns of patterns of cigarettes, alcohol, marijuana, and other illicit drugs across young adulthood (ages 18-30). Latent classes were then used as predictors of physical health problems, cognitive problems, self-rated health, and psychological problems in midlife (age 40), while controlling for sociodemographic variables (i.e., gender, race/ethnicity, parental education).

RESULTS

Identified classes were "Extreme Heavy Users" (3.9%), "Early Young Adult Users" (8.9%), "Cigarette Smokers" (9.2%), "All But Cigarette Smokers" (5.0%), "Frequent Alcohol Bingers" (10.4%), and "Not-Heavy Users" (62.6%). Extreme Heavy Users, Early Young Adult Users, and Cigarette Smokers had significantly poorer overall health based on a number of physical conditions and self-rated health. Extreme Heavy Users, Early Young Adult Users, Cigarette Smokers, and All But Cigarette Smokers had more cognitive problems than other classes. Extreme Heavy Users, Early Young Adult Users, Cigarette Smokers, and All But Cigarette Smokers were more likely to see a health professional for a psychological problem.

CONCLUSIONS

Patterns of heavy substance use were associated with health across decades. Regular cigarette smokers and heavy users across substances and ages had the worst health in midlife, although even those with time-limited use during young adulthood were at risk for later physical and cognitive health problems.

A longitudinal analysis of nondaily smokers: the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

PURPOSE

Nondaily smoking is increasing in the United States and common among Hispanic/Latino smokers. We characterized factors related to longitudinal smoking transitions in Hispanic/Latino nondaily smokers.

METHODS

The Hispanic Community Health Study/Study of Latinos is a population-based cohort study of Hispanics/Latinos aged 18-74 years. Multinomial logistic regression assessed the baseline factors (2008-2011) associated with follow-up smoking status (2014-2017) in nondaily smokers (n = 573), accounting for complex survey design.

RESULTS

After ∼6 years, 41% of nondaily smokers became former smokers, 22% became daily smokers, and 37% remained nondaily smokers. Factors related to follow-up smoking status were number of days smoked in the previous month, household smokers, education, income, and insurance. Those smoking 16 or more of the last 30 days had increased risk of becoming a daily smoker [vs. < 4 days; relative risk ratio (RRR) = 5.65, 95% confidence interval (95% CI) = 1.96-16.33]. Greater education was inversely associated with transitioning to daily smoking [>high school vs. <ninth grade: RRR (95% CI) = 0.30 (0.09-0.95)]. Living with smokers was associated with decreased likelihood of quitting [RRR (95% CI) = 0.45 (0.24-0.86)]. Having insurance was associated with quitting [RRR (95% CI) = 2.11 (1.18-3.76)] and becoming a daily smoker [RRR (95% CI) = 3.00 (1.39-6.48)].

CONCLUSIONS

Many Hispanic/Latino nondaily smokers became daily smokers, which may increase their risk of adverse health outcomes. Addressing different smoking patterns in primary care may be useful to prevent smoking-related diseases.

Trend in the Prevalence of Non-Daily Smoking and Their Relationship with Mental Health Using the Korea Health and Nutrition Examination Survey

Introduction: Non-Daily Smoking (NDS), which is increasingly prevalent worldwide, has not yet attracted as much attention as has daily smoking in Asia. The aims of this study were to identify trends in the prevalence of NDS and to compare characteristics by age, gender, and mental health indicators such as depression, suicidality, and alcohol consumption in South Korea. Methods: We included 33,806 adults (aged ≥ 19 years) who participated in the Korean National Health and Nutrition Examination Survey (KNHNES) from 2010 to 2015. The dataset includes self-reported medical history and questionnaires that explore depression, suicidality, and alcohol use, which are known to be highly related to smoking. We divided the respondents into four groups according to smoking status: Never Smoking (NS, N = 20,270); Past Smoking (PS = 6835); Daily Smoking (DS = 5927), who reported smoking every day; and Non-Daily Smoking (NDS = 774), who reported that they sometimes smoke. Results: Increased NDS prevalence is observed in most age groups in both male and female adults despite the prevalence of total smoking and daily smoking gradually decreasing. Depression and suicidality were significantly more prevalent in the NDS than the NS group (Depression Odds ratio, OR = 1.72, 95% Confidence interval, CI = 1.31–2.26; Suicidality OR = 3.14, 95% CI = 1.40–7.02). NDS is also associated with a higher frequency of binge drinking and alcohol use disorder than NS (OR = 4.17, 95% CI = 3.49–4.99). Conclusions: This study suggests that more concern is warranted for NDS given the increasing prevalence and characteristics of poor mental health in NDS respondents.

Patterns of Tobacco Use and Related Protective Factors Among Somali Youth in the United States

Anti-smoking norms and educational aspirations are established tobacco prevention targets for general United States (U.S.) adolescent populations but protective factors remain poorly characterized for Somali-American youth. Here we describe patterns of past 30-day tobacco use and associated protective factors among eighth, ninth, and eleventh grade Somali adolescent respondents (n = 2009) to the 2016 Minnesota Student Survey using multivariate logistic regressions. E-cigarette (5.7%) and hookah (5.0%) use were most prevalent. Male youth reported higher levels of tobacco use across products. Adjusted odds ratios showed that internal developmental assets (e.g., e-cigarettes aOR 0.37, 95% CI 0.37, 0.79) and parental anti-smoking norms (e.g., e-cigarettes aOR 0.19, 95% CI 0.09, 0.38) protected against use of all tobacco products. E-cigarettes and hookah are prevalent among U.S. Somali youth, highlighting the need for prevention efforts that address emerging tobacco products and leverage protective factors such as internal assets and parental anti-smoking norms.

Heterogeneity of intermittent smokers in a Hispanic college student sample

Hispanics are more likely to be daily light smokers (DLS) and intermittent smokers (ITS) than non-Hispanic whites. Although daily light (≤10 cigarettes per day [CPD]) and intermittent (nondaily) smoking have increased in recent years, few studies have compared DLS and ITS, especially within a Hispanic sample. The primary aims of this study were to investigate differences between DLS and ITS, and within ITS, differences between converted ITS (CITS; previously smoked daily for ≥6 months) and native ITS (NITS; never smoked daily) in a Hispanic college student sample (M_age = 23.74, SD = 5.17; 58.1% male). Analyses were conducted using baseline data from a larger study that evaluated attitudes toward tobacco free campus policies in a U.S. university on the border with México. This study included data from 45 DLS and 216 ITS (CITS: n = 77, NITS: n = 139; N = 261). Compared to DLS, ITS were younger (on average), less likely to identify as smokers, smoked on fewer days in the past month, smoked fewer cigarettes on smoking days, and reported less nicotine dependence. Compared to CITS, NITS were younger, less likely to self-identify as smokers, smoked on fewer days in the past month, smoked fewer CPD on smoking days, and were less dependent on nicotine. Given the similarities between current and past findings (suggesting that CITS are in between DLS and NITS-regarding smoking behavior), these data suggest a similar pattern likely exists also among Hispanic smokers. Additionally, the absence of some previously observed differences is relevant in characterizing this particular Hispanic college sample. These findings provide further insight for the tailoring of interventions that target Hispanic DLS, CITS and NITS).

Trends in cannabis use disorder by cigarette smoking status in the United States, 2002-2016

BACKGROUND

Cannabis use is on the rise in the United States (US) and is disproportionately common among cigarette smokers. Cannabis use disorder (CUD) occurs among a small subset of cannabis users and may impact cigarette use. The objective of this study was to estimate trends in the prevalence of CUD among daily, non-daily, former, and never cigarette smokers from 2002 to 2016.

METHODS

Data were drawn from cross-sectional, nationally representative samples of individuals ages 12 and older in the US that were collected annually. The prevalence of past 12-month CUD was estimated each year from 2002 to 2016 among daily, non-daily, former, and never cigarette smokers (total analytic N = 837,326).

RESULTS

Overall, the prevalence of CUD decreased from 2002 to 2016. Yet, trends differed by cigarette smoking status. Adjusting for demographics, the prevalence of CUD increased significantly among non-daily smokers (aOR = 1.02; 95% CI = 1.01-1.03) from 2002 to 2016 and did not change among daily, former, or never smokers. CUD was significantly more common among non-daily (4.32%) and daily cigarette smokers (2.92%) compared with former (0.99%) and never smokers (1.11%) in 2016. Approximately one in five (18.11%-22.87%) youth ages 12-17 who smoke cigarettes met criteria for CUD in 2016, compared with approximately 2% of non-smoking youth.

CONCLUSIONS

Despite downward trends in CUD observed at the general population level, the prevalence of CUD significantly increased among non-daily cigarette smokers from 2002 to 2016. In the US, CUD remains significantly higher among cigarette smokers relative to non-cigarette smokers.

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.

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.

Trends in characteristics and multi-product use among adolescents who use electronic cigarettes, United States 2011-2015

Objectives

Evaluate trends from 2011–2015 in electronic cigarette (e-cigarette) use among U.S. adolescents, grades 6–12, including prevalence and associations with past month use of cigarettes and other tobacco products, cigarette smoking intensity, quit attempts, and quit contemplation.

Methods

Five consecutive waves from the National Youth Tobacco Survey (N = 101,011) were used to estimate the grade- and race/ethnicity-standardized prevalence of past month use of e-cigarettes and nine non e-cigarette tobacco products. We assessed linear trends by year and compared outcomes (e.g., tobacco use, smoking intensity) by e-cigarette past month use.

Results

Past month e-cigarette use rose sharply from 2011–2015. In all years and both sexes, e-cigarette past month use and ever use were positively associated with use of cigarettes and other tobacco products, with past month e-cigarette use reaching 52% in 2015 among individuals who used ≥1 non e-cigarette tobacco product in the past month. Meanwhile, from 2011–2015, the population of adolescent past month e-cigarette users increasingly encompassed adolescents who were not past month users of other products (females: 19.0% to 41.7%; males: 11.1% to 36.7%) or had never used other products (females: 7.1% to 13.5%; males: 6.7% to 15.0%). Among male (but not female) past month cigarette users, there was a statistically significant positive association between past month e-cigarette use and daily cigarette smoking but not in all individual years. Past month e-cigarette use among past month cigarette smokers was not associated with cigarette quit attempts or quit contemplation, with no temporal trend.

Conclusion

Adolescent past month e-cigarette use is associated with past month use of other tobacco but not with cigarette quit attempts or quit contemplation among cigarette users. Over five years, the average characteristics of U.S. adolescents who use e-cigarettes have shifted, increasingly including more adolescents who do not use non e-cigarette tobacco products.

Factors associated with short-term transitions of non-daily smokers: socio-demographic characteristics and other tobacco product use

AIMS

To examine the transitions in smoking status among non-daily smokers who transitioned to daily or former smokers or remained as non-daily smokers during a 12-month period. We analyzed factors associated with these transitions, including the use of cigars and smokeless tobacco (SLT).

DESIGN

Secondary data analyses using pooled data from the 2003, 2006/07 and 2010/11 Tobacco Use Supplements to the Current Population Survey (TUS-CPS).

SETTING

United States.

PARTICIPANTS

Self-respondents aged 18+ who have smoked for more than 5 years and were non-daily smokers 12 months before the interview (n = 13 673, or 14.5% of current smokers).

MEASUREMENTS

Multinomial logistic regression model to determine the correlates of non-daily to daily, stable non-daily and non-daily to former smoking transitions among non-daily smokers at baseline. The model controlled for socio-demographic factors and the use of cigars and SLT.

FINDINGS

Of the adults in our sample, 2.6% were non-daily smokers at baseline. Among these, 69.7% remained non-daily smokers (stable non-daily smokers), 18.4% became daily smokers (non-daily to daily smokers) and 11.9% quit smoking (non-daily to former smokers) after 12 months. The non-daily to daily versus stable non-daily smoking transition was less likely among those who were aged 65+ (P = 0.018), male (P < 0.001), Hispanic (P < 0.001), with an income of $25 000-49 999 or ≥$75 000 and current users of SLT (P = 0.003), but more likely among those without a college degree compared with the appropriate reference group. The non-daily to former versus stable non-daily smoking transition was less likely among those aged 25+, male (P = 0.013), non-Hispanic Asian (P = 0.032), without a college degree, widowed/divorced/separated (P = 0.013) or never married (P = 0.011) and current users of cigars (P = 0.003) compared with the appropriate reference group.

CONCLUSIONS

While more than two-thirds of non-daily smokers in the United States remain as such after 12 months, others become daily smokers or quit. The likelihood of remaining stable non-daily smokers and of transition from non-daily to daily and non-daily to former smokers is associated with socio-demographic factors and current use of cigars and smokeless tobacco.

Trends in smoking initiation in Canada: Does non-inclusion of young adults in tobacco control strategies represent a missed opportunity?

OBJECTIVES

Young adults face high prevalence rates for smoking. Recent evidence suggests that many people initiate smoking during young adulthood, but little is currently known about trends in initiation rates for this age group.

METHODS

We examined rates of initiation to first cigarette (FC) and daily smoking (DS) during youth (5-17 years) and young adulthood (18-25 years) using nationally representative data from the 2001, 2003, 2005, 2007, 2009, 2011 and 2013 cycles of the Canadian Community Health Survey. We included all participants aged 25-26 to obtain seven mutually exclusive retrospective cohorts (n = 16 216). We used logistic regression to examine four correlates of smoking - sex, education, poverty status, and immigration status - and whether these factors modify time trends in smoking.

RESULTS

We found that initiation rates decreased during youth (p &lt; 0.001 for FC, p = 0.02 for DS) but not during young adulthood (p = 0.94 for FC, p = 0.28 for DS). We found that men and respondents with fewer educational credentials had relatively higher odds of initiating during young adulthood. Trends in young adulthood stayed constant across subgroups. Trends in youth were modified by education: participants who did not complete high school had no decrease in initiation to FC and DS while those with post-secondary education experienced a decrease in both outcomes.

CONCLUSION

Tobacco control has failed to address smoking initiation during young adulthood. Given the considerable amount of initiation that occurs during this period, practitioners and policy-makers should direct more of their planning toward young adults.

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.

Assessing 30-day quantity-frequency of U.S. adolescent cigarette smoking as a predictor of adult smoking 14 years later

BACKGROUND

To improve measures of monthly tobacco cigarette smoking among non-daily smokers, predictive of future non-daily monthly and daily smoking.

METHODS

Data from United States National Longitudinal Study of Adolescent to Adult Health, tracking adolescents, ages 12-21, over 14 years were analyzed. At baseline, 6501 adolescents were assessed; 5114 individuals provided data at waves 1 and 4. Baseline past 30-day non-daily smokers were classified using quantity-frequency measures: cigarettes smoked/day by number of days smoked in the past 30 days.

RESULTS

Three categories of past 30-day non-daily smokers emerged using cigarettes/month (low:1-5, moderate: 6-60, high: 61+) and predicted past 30-day smoking at follow-up (low: 44.5%, moderate: 60.0%, high: 77.0%, versus 74.2% daily smokers; rτ=-0.2319, p<0.001). Two categories of non-smokers plus low, moderate and high categories of non-daily smokers made up a five-category non-daily smoking index (NDSI). High NDSI (61+ cigs/mo.) and daily smokers were equally likely to be smoking 14 years later (High NDSI OR=0.97, 95% CI=0.53-1.80 [daily as reference]). Low (1-5 cigs/mo.) and moderate (6-60 cigs/mo.) NDSI were distinctly different from high NDSI, but similar to one another (OR=0.21, 95% CI=0.15-0.29 and OR=0.22, 95% CI=0.14-0.34, respectively) when estimating future monthly smoking. Among those smoking at both waves, wave 1 non-daily smokers, overall, were less likely than wave 1 daily smokers to be smoking daily 14 years later.

CONCLUSIONS

Non-daily smokers smoking over three packs/month were as likely as daily smokers to be smoking 14-years later. Lower levels of non-daily smoking (at ages 12-21) predicted lower likelihood of future monthly smoking. In terms of surveillance and cessation interventions, high NDSI smokers might be treated similar to daily smokers.

When Free Is Not for Me: Confronting the Barriers to Use of Free Quitline Telephone Counseling for Tobacco Dependence

Remarkable disparities in smoking rates in the United States contribute significantly to socioeconomic and minority health disparities. Access to treatment for tobacco use can help address these disparities, but quitlines, our most ubiquitous treatment resource, reach just 1%-2% of smokers. We used community-based participatory methods to develop a survey instrument to assess barriers to use of the quitline in the Arkansas Mississippi delta. Barriers were quitline specific and barriers to cessation more broadly. Over one-third (34.9%) of respondents (n = 799) did not have access to a telephone that they could use for the quitline. Respondents reported low levels of knowledge about the quitline, quitting, and trust in tobacco treatment programs as well as considerable ambivalence about quitting including significant concerns about getting sick if they quit and strong faith-based beliefs about quitting. These findings suggest quitlines are not accessible to all lower socioeconomic groups and that significant barriers to use include barriers to cessation. These findings suggest targets for providing accessible tobacco use treatment services and addressing concerns about cessation among lower income, ethnic minority, and rural groups.