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Cruz-Jiménez L, Barrientos-Gutiérrez I, Vidaña-Pérez D, Gallegos-Carrillo K, Arillo-Santillán E, Rodríguez-Bolaños R, Hardin JW, Kim M, Thrasher JF. Heated tobacco product use frequency, smoking quit attempts, and smoking reduction among Mexican adult smokers. Tob Induc Dis 2024; 22:TID-22-90. [PMID: 38813582 PMCID: PMC11135162 DOI: 10.18332/tid/187576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 04/18/2024] [Accepted: 04/21/2024] [Indexed: 05/31/2024] Open
Abstract
INTRODUCTION Heated tobacco products (HTPs) are promoted as less harmful than cigarettes; nonetheless, whether HTPs help smokers quit is uncertain. METHODS Data from 4067 Mexican adult smokers surveyed longitudinally every four months (November 2019-March 2021) were analyzed. Mixed-effects multinomial models regressed HTP use frequency (no use=reference; monthly; weekly; and daily use) on sociodemographics and tobacco/nicotine-related variables. Among participants who completed at least two surveys (n=2900) over four months, the duration of their longest smoking quit attempt (SQA) between surveys (SQAs: <30 days; ≥30 days; no SQA=reference) was regressed on HTP use frequency, and changes in the number of cigarettes smoked per day were regressed on HTP initiation between surveys, adjusting for covariates. RESULTS Consistent predictors of all HTP use frequencies (monthly, weekly, or daily vs no use) were daily smoking >5 cigarettes (ARRR=1.69 [95% CI: 1.12-2.55], 1.88 [95% CI: 1.26-2.81] and 6.46 [95% CI: 3.33-12.52], respectively); e-cigarette use (ARRR =5.68 [95% CI: 3.38-9.53], 6.54 [95% CI: 4.06-10.55] and 2.59 [95% CI: 1.26-5.30]); lower HTP risk perceptions (ARRR=2.12 [95% CI: 1.50-30.00], 2.25 [95% CI: 1.63-3.10] and 2.00 [95% CI: 1.25-3.22]); exposure to HTP information inside (ARRR=2.13 [95% CI: 1.44-3.15], 2.13 [95% CI: 1.49-3.05] and 3.72 [95% CI: 2.28-6.09]) and outside stores (ARRR=2.36 [95% CI: 1.56-3.57], 2.32 [95% CI: 1.65-3.25] and 2.44 [95% CI: 1.41-4.24]) where tobacco is sold; having family (ARRR=2.46 [95% CI: 1.54-3.91], 2.90 [95% CI: 1.93-4.37] and 2.96 [95% CI: 1.52-5.77]) and friends (ARRR=5.78 [95% CI: 3.60-9.30], 4.98 [95% CI: 3.22-7.72] and 6.61 [95% CI: 2.91-15.01]) who use HTPs. HTP use frequency was not associated with quit attempts, except for monthly HTP use predicting SQAs lasting ≥30 days (ARRR=2.12 [95% CI: 1.17-3.85]). Initiation of HTP use was not associated with changes in smoking frequency. Limiting analysis to those who intend to quit smoking also yielded null results. CONCLUSIONS Among Mexican adult smokers, frequency of HTP use was mostly not associated with either cessation behaviors or changes in cigarette consumption, suggesting that HTPs have limited to no effectiveness for smoking cessation.
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Affiliation(s)
- Lizeth Cruz-Jiménez
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, United States
| | | | - Dèsirée Vidaña-Pérez
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, United States
| | - Katia Gallegos-Carrillo
- Evaluation and Survey Research Center, National Institute of Public Health, Cuernavaca, Mexico
- Epidemiology and Health Services Research Unit, Mexican Institute of Social Security, Cuernavaca, Mexico
| | - Edna Arillo-Santillán
- Tobacco Research Department, National Institute of Public Health, Cuernavaca, Mexico
| | | | - James W. Hardin
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, United States
| | - Minji Kim
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, United States
| | - James F. Thrasher
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, United States
- Tobacco Research Department, National Institute of Public Health, Cuernavaca, Mexico
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Odani S, Tsuno K, Agaku IT, Tabuchi T. Heated tobacco products do not help smokers quit or prevent relapse: a longitudinal study in Japan. Tob Control 2023:tc-2022-057613. [PMID: 36849258 DOI: 10.1136/tc-2022-057613] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 01/27/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Heated tobacco products (HTPs) are often marketed as a safer alternative to help cigarette smokers quit. We investigated the link between HTP use and smoking cessation and relapse. METHODS 7044 adults (≥20 years old) with at least two observations over three waves (2019-2021) of a longitudinal, nationwide, internet-based survey were classified into current (past 30-day), former and never cigarette smokers. ≥1 month and ≥6 months smoking cessation and smoking relapse at 1-year follow-up were assessed in relation to current HTP use at baseline. Generalised estimating equation models were weighted to account for population differences between HTP users and non-users. Adjusted prevalence ratios (APRs) were computed within population subgroups. RESULTS At baseline, 17.2%, 9.1% and 6.1% of the respondents were current cigarette smokers, HTP users and dual users, respectively. Among current established smokers (having smoked regularly, n=1910), HTP use was significantly associated with a decreased likelihood of ≥1 month cessation within those who reported having used evidence-based cessation measures (APR=0.61), smoking 20+ cigarettes per day (APR=0.62), high school education or less (APR=0.73) and fair/poor health (APR=0.59). Negative associations were also seen for ≥6 months cessation among those aged 20-29 years (APR=0.56) and full-time workers (APR=0.56). Among former smokers (n=2906), HTP use was associated with smoking relapse within those who last smoked >1 year ago (APR=1.54), among women (APR=1.61), those aged 20-29 years (APR=2.09), those reporting high school education or less (APR=2.36), those who were unemployed/retired (AOR=3.31) and never/non-current alcohol users (APR=2.10). CONCLUSION HTP use did not help smokers quit or prevent former smokers from relapsing. HTPs should not be recommended as a cessation aid.
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Affiliation(s)
- Satomi Odani
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Kanami Tsuno
- School of Health Innovation, Kanagawa University of Human Services, Kawasaki, Japan
| | - Israel T Agaku
- Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
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Zhang X, Sun Y, Cheung YTD, Wang MP, Wu YS, Chak KY, Chen J, Leung LT, Lam TH, Ho SY. Cigarettes, heated tobacco products and dual use: exhaled carbon monoxide, saliva cotinine and total tobacco consumed by Hong Kong tobacco users. Tob Control 2023:tc-2022-057598. [PMID: 36693724 DOI: 10.1136/tc-2022-057598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 01/11/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND Independent studies on exhaled carbon monoxide (CO) and saliva cotinine levels in regular heated tobacco product (HTP) users, and how they compare with conventional cigarette (CC) smokers, are lacking. METHODS A total of 3294 current users of CCs, HTPs or electronic cigarettes (ECs) from a household survey and a smoking hotspot survey were classified into seven groups: exclusive users of CCs, HTPs, ECs; dual users of CCs and HTPs, CCs and ECs, HTPs and ECs; and triple users. We measured exhaled CO level using the piCo Smokerlyzer (n=780) and saliva cotinine using NicAlert cotinine test strips (n=620). Among the seven groups, the differences in (1) CO and cotinine levels were examined using Kruskal-Wallis test, and (2) the average daily tobacco consumption in the past 30 days was examined using multivariable linear regression. RESULTS Both exclusive and dual users of CCs had a higher CO level than exclusive HTP or EC users (p<0.05). Exhaled CO levels were similar between HTP and EC users, as were saliva cotinine levels among the seven groups. Compared with exclusive CC users, those who also used HTPs or ECs smoked fewer CCs (CCs+HTPs: adjusted coefficient -2.79, 95% CI -3.90 to -1.69; CCs+ECs: -1.34, 95% CI -2.34 to -0.34), but consumed more tobacco sticks equivalent in total (2.79 (95% CI 1.61 to 3.96); 1.95 (95% CI 0.79 to 3.12)). CONCLUSIONS HTP or EC use showed lower exhaled CO but similar saliva cotinine levels compared with CC use. Dual users of CCs and HTPs/ECs smoked fewer CCs than exclusive CC users, but consumed more tobacco in total.
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Affiliation(s)
- Xiaoyu Zhang
- School of Public Health, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Yuying Sun
- School of Public Health, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Yee Tak Derek Cheung
- School of Nursing, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Yongda Socrates Wu
- School of Nursing, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Kin Yeung Chak
- School of Public Health, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Jianjiu Chen
- School of Public Health, The University of Hong Kong, Hong Kong SAR, People's Republic of China
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Lok Tung Leung
- School of Public Health, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Sai Yin Ho
- School of Public Health, The University of Hong Kong, Hong Kong SAR, People's Republic of China
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Levy DT, Cadham CJ, Li Y, Yuan Z, Liber AC, Oh H, Travis N, Issabakhsh M, Sweanor DT, Sánchez-Romero LM, Meza R, Cummings KM. A Decision-Theoretic Public Health Framework for Heated Tobacco and Nicotine Vaping Products. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13431. [PMID: 36294011 PMCID: PMC9602493 DOI: 10.3390/ijerph192013431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/22/2022] [Accepted: 09/30/2022] [Indexed: 06/16/2023]
Abstract
Markets for nicotine vaping products (NVPs) and heated tobacco products (HTPs) have grown as these products became positioned as harm-reduction alternatives to combusted tobacco products. Herein, we present a public health decision-theoretic framework incorporating different patterns of HTP, NVP, and cigarette use to examine their impacts on population health. Our framework demonstrates that, for individuals who would have otherwise smoked, HTP use may provide public health benefits by enabling cessation or by discouraging smoking initiation and relapse. However, the benefits are reduced if more harmful HTP use replaces less harmful NVP use. HTP use may also negatively impact public health by encouraging smoking by otherwise non-smokers or by encouraging initiation or relapse into smoking. These patterns are directly influenced by industry behavior as well as public policy towards HTPs, NVPs, and cigarettes. While substantial research has been devoted to NVPs, much less is known about HTPs. Better information is needed to more precisely define the health risks of HTPs compared to cigarettes and NVPs, the relative appeal of HTPs to consumers, and the likelihood of later transitioning to smoking or quitting all products. While our analysis provides a framework for gaining that information, it also illustrates the complexities in distinguishing key factors.
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Affiliation(s)
- David T. Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Christopher J. Cadham
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Yameng Li
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Zhe Yuan
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Alex C. Liber
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Hayoung Oh
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Nargiz Travis
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Mona Issabakhsh
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - David T. Sweanor
- Centre for Health Law, Policy & Ethics, University of Ottawa, Ottawa, ON K1N 6N5, Canada
- Faculty of Law, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | | | - Rafael Meza
- Department of Integrative Oncology, BC Cancer Institute, Vancouver, BC V5Z1L3, Canada
| | - K. Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of Charleston, Charleston, SC 29425, USA
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Stone MD, DeAtley T, Pianin S, Strasser AA, Audrain-McGovern J. Switching from cigarettes to IQOS: A pilot examination of IQOS-associated reward, reinforcement, and abstinence relief. Drug Alcohol Depend 2022; 238:109569. [PMID: 35841732 DOI: 10.1016/j.drugalcdep.2022.109569] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/06/2022] [Accepted: 07/08/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND It is unknown whether IQOS-associated decreases in cigarette craving, nicotine withdrawal, greater subjective reward, and relative reinforcing value predict subsequent switching from cigarettes to IQOS products. METHODS Nontreatment-seeking adult daily smokers (n = 33; 18-65 years old) completed a within-subject pilot study consisting of a baseline ad-lib smoking period (days 1-5), two laboratory visits (days 6-7), and a two-week period where participants switch from using cigarettes to using IQOS (days 8-21). Mixed-effect modelling estimated the percentage of baseline cigarette consumption replaced by daily IQOS HeatSticks used. Predictors of use included IQOS-associated reinforcement, subjective reward, and craving and withdrawal relief. RESULTS IQOS use alleviated cigarette abstinence-associated craving (change=-14.22, p < .001) but did not alleviate withdrawal symptoms. Smokers initially substituted IQOS for 59% of their average daily cigarette consumption, increasing to 87% by switch period end (B=0.02 [95%CI=0.01, 0.03], p = .002). Neither subjective reward of IQOS nor relief of cigarette craving and withdrawal symptoms were predictive of this change. By study end, IQOS consumption was 124% of regular cigarette consumption among participants with a low reinforcing value of cigarettes relative to IQOS (β = 0.03 [95%CI=0.00, 0.06], p = .049). In contrast, participants with a higher reinforcing value of smoking replaced 76% of their cigarettes with IQOS. CONCLUSIONS IQOS shows potential as an alternative to combustible cigarettes. However, IQOS use may result in dual-use for most smokers and increase tobacco consumption among a subgroup of smokers. These preliminary findings highlight the need for a larger investigation of the relationship between IQOS use and cigarette smoking.
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Affiliation(s)
- Matthew D Stone
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Teresa DeAtley
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Stephen Pianin
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Andrew A Strasser
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Janet Audrain-McGovern
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Zhang X, Sun Y, Cheung DYT, Wang MP, Wu Y, Chak KY, Chen J, Leung LT, Li WHC, Lam TH, Ho SY. Changes in Tobacco Use in the Early Phase of Coronavirus Disease 2019 Pandemic in Hong Kong: A Qualitative Study. Nicotine Tob Res 2022; 25:309-317. [PMID: 35716072 PMCID: PMC9384294 DOI: 10.1093/ntr/ntac147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 05/02/2022] [Accepted: 06/15/2022] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Changes in tobacco use and related personal and environmental factors amid the coronavirus disease 2019 (COVID-19) pandemic can be captured by qualitative studies, but they are few in non-Western populations. AIMS AND METHODS We assessed the perceived links between tobacco use and COVID-19, and changes in the use of cigarettes, electronic cigarettes (ECs), and heated tobacco products (HTPs) in the early phase of the pandemic in Hong Kong, where lockdown was not implemented. Semi-structured telephone interviews were conducted from January to June 2021 in 95 participants (36 EC users, 28 HTP users, and 32 exclusive cigarette users). Transcriptions were coded using deductive and inductive approaches, and factors for changes were nested in the social-ecological model. RESULTS Two-thirds of participants perceived their infection susceptibility was the same as never tobacco users, and 44.2% perceived more severe COVID-19 disease if infected. Amid the pandemic, tobacco use decreased overall but increased indoors for all three products. Increased tobacco use was mostly attributed to increased emotional distress, while decreases were attributed to various personal (health concerns) and environmental factors (e.g., COVID-19 regulations). Perceived convenience and lower costs were reasons for increased EC use. Limited access to HTPs was compensated by cigarette use. CONCLUSIONS Many participants were unaware of the potential harm of tobacco use on COVID-19. Overall tobacco use decreased due to COVID-19 regulations, which may not be sustainable post-pandemic. Indoor consumption increased, supporting a comprehensive smoke-free policy that covers private indoor areas. Better cessation services targeting EC, HTP, and cigarette use are needed. IMPLICATIONS Smokers need better awareness of the risk of tobacco use on COVID-19. Smoking cessation services can be improved by offering brief advice, strengthening advocacy against secondhand smoke, and covering EC and HTP use, highlighting their potential harms to users and others, and their risk of addiction and relapse to cigarette use.
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Affiliation(s)
| | | | | | - Man Ping Wang
- School of Nursing, University of Hong Kong, Hong Kong SAR, China
| | - Yongda Wu
- School of Nursing, University of Hong Kong, Hong Kong SAR, China
| | - Kin Yeung Chak
- School of Public Health, University of Hong Kong, Hong Kong SAR, China
| | - Jianjiu Chen
- School of Public Health, University of Hong Kong, Hong Kong SAR, China,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Lok Tung Leung
- School of Public Health, University of Hong Kong, Hong Kong SAR, China
| | | | - Tai Hing Lam
- School of Public Health, University of Hong Kong, Hong Kong SAR, China
| | - Sai Yin Ho
- Corresponding Author: Sai Yin Ho, PhD, School of Public Health, The University of Hong Kong, Patrick Manson Building (North Wing), 7 Sassoon Road, Pokfulam, 999077 Hong Kong SAR, China. Telephone: 852-3917-9883; Fax: 852-2855-9528; E-mail:
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Sun Y, Wang MP, Cheung YTD, Ho SY, Luk TT, Zhao S, Wu YS, Wong BYM, Weng X, Chen J, Zhang X, Leung LT, Chak KY, Lam TH. Changes in tobacco use at the early stage of the COVID-19
pandemic: Results of four cross-sectional surveys in Hong Kong. Tob Induc Dis 2022; 20:26. [PMID: 35342385 PMCID: PMC8895477 DOI: 10.18332/tid/145935] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/15/2021] [Accepted: 01/18/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Changes in tobacco use since the COVID-19 outbreak differed by countries and little is known about changes in the use of specific tobacco products. METHODS We analyzed data from four cross-sectional telephone/online surveys from April to June 2020 to investigate such changes since the 1st and 2nd wave outbreaks (February to April 2020) in Hong Kong. The respondents were 1595 adults (83.2% male) who used tobacco before the COVID-19 outbreak from our previous intervention study and surveys. We investigated the changes in tobacco use, intention to quit and quit attempts during the outbreak. RESULTS About two-thirds (65.3%) of respondents reported no change in overall tobacco use, while 23.1% used less (including cessation) and 11.6% used more, resulting in a net decrease of 11.5 percentage points. A greater net decrease was observed for cigarettes (14.3% points) than heated tobacco products (HTPs, 3.3% points) and electronic cigarettes (e-cigarettes, 2.5% points). Decreased use was mainly due to the more extended stay at home (63.2%), health considerations (52.6%) and mask-wearing (47.4%), while increased use was for passing time (75.0%) and releasing stress (46.4%). Eight percent of cigarette, HTP and e-cigarette users reported a higher intention to quit since the pandemic outbreak. Nineteen percent of tobacco users (176/948) attempted to quit during the pandemic. Only 2.9% (46/1569) were abstinent at the time of the survey. CONCLUSIONS Overall tobacco use decreased after the first two waves of the COVID-19 outbreak in Hong Kong. A greater proportion of cigarette users decreased use than HTP and e-cigarette users. Given the different methods used in the four surveys, future studies should aim for a large and representative sample.
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Affiliation(s)
- Yuying Sun
- School of Public Health, The University of Hong Kong, Hong Kong SAR, China
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong SAR, China
| | | | - Sai Yin Ho
- School of Public Health, The University of Hong Kong, Hong Kong SAR, China
| | - Tzu Tsun Luk
- School of Nursing, The University of Hong Kong, Hong Kong SAR, China
| | - Shengzhi Zhao
- School of Nursing, The University of Hong Kong, Hong Kong SAR, China
| | | | - Bonny Yee-Man Wong
- School of Public Health, The University of Hong Kong, Hong Kong SAR, China
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong SAR, China
| | - Xue Weng
- School of Nursing, The University of Hong Kong, Hong Kong SAR, China
- Institute of Advanced Studies in Humanities and Social Sciences, Beijing Normal University at Zhuhai, Zhuhai, China
| | - Jianjiu Chen
- School of Public Health, The University of Hong Kong, Hong Kong SAR, China
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, United States
| | - Xiaoyu Zhang
- School of Public Health, The University of Hong Kong, Hong Kong SAR, China
| | - Lok Tung Leung
- School of Public Health, The University of Hong Kong, Hong Kong SAR, China
| | - Kin Yeung Chak
- School of Public Health, The University of Hong Kong, Hong Kong SAR, China
| | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong SAR, China
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Luk TT, Cheung YTD, Chan HCH, Fok PWY, Ho KS, Sze CD, Lam TH, Wang MP. Mobile Chat Messaging for Preventing Smoking Relapse Amid the COVID-19 Pandemic: A Pilot Randomized Controlled Trial. Nicotine Tob Res 2022; 25:291-297. [PMID: 35166327 PMCID: PMC9383464 DOI: 10.1093/ntr/ntac045] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 02/03/2022] [Accepted: 02/10/2022] [Indexed: 01/11/2023]
Abstract
INTRODUCTION The ongoing COVID-19 pandemic had reduced access to traditional, in-person smoking cessation treatment. We examined the feasibility, acceptability, and potential effectiveness of mobile chat messaging in preventing smoking relapse in smokers who have recently quit smoking. METHODS In this assessor-blinded, pilot randomized controlled trial in five cessation clinics, we recruited adult daily smokers who had been receiving cessation treatments and abstained for 3 to 30 days. The intervention group received real-time, personalized chat messaging on relapse prevention via WhatsApp for 3 months. The control group received generic text messaging on the harms of smoking and benefits of quitting for 3 months. The primary outcome was carbon monoxide-validated abstinence at 6 months post-treatment initiation. The trial was registered with ClinicalTrials.gov (NCT04409496). RESULTS From June to July 2020, 108 of 130 (83%) eligible subjects were randomized to the intervention (N = 54) or control (N = 54) groups. The retention rate was 93% at 3 months (end of treatment) and 85% at 6 months. In the intervention group, 80% of participants responded to the chat messages at least once; 43% continuously engaged with the intervention over the 3-month intervention period. By intention-to-treat, validated abstinence at 6 months was higher in the intervention than control group (31% vs. 22%), with a relative risk of 1.72 (95% CI = 0.91% to 3.23%; p = .09) after adjusting for pre-quit nicotine dependence, duration of abstinence, and cessation treatment at baseline. CONCLUSIONS This pilot trial showed the feasibility and acceptability of mobile chat messaging for relapse prevention with preliminary evidence on its effectiveness in increasing validated abstinence. IMPLICATIONS Smoking relapse is the most likely outcome of smoking cessation attempts and an undertreated problem. This pilot trial showed the feasibility and acceptability of personalized chat messaging via WhatsApp for relapse prevention in recent abstainers amid the COVID-19 pandemic. The higher carbon monoxide-validated abstinence rate in participants who received chat messaging than controls showed preliminary evidence on the effectiveness of the intervention. Fully powered trials are warranted to test the intervention.
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Affiliation(s)
- Tzu Tsun Luk
- School of Nursing, The University of Hong Kong, Hong Kong SAR,Corresponding Author: Tzu Tsun Luk, PhD, School of Nursing, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong. Telephone: +852-3917-7574; E-mail:
| | | | - Helen Ching-han Chan
- Integrated Centre on Smoking Cessation, Tung Wah Group of Hospitals, Hong Kong SAR
| | - Patrick Wai-yin Fok
- Integrated Centre on Smoking Cessation, Tung Wah Group of Hospitals, Hong Kong SAR
| | - Kin Sang Ho
- Integrated Centre on Smoking Cessation, Tung Wah Group of Hospitals, Hong Kong SAR
| | - Chu Dik Sze
- School of Nursing, The University of Hong Kong, Hong Kong SAR
| | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong SAR
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong SAR
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Smoking Cessation and Mental Health According to Use of E-cigarettes and Heated Tobacco Products by Korean Adults. Int J Ment Health Addict 2021. [DOI: 10.1007/s11469-021-00698-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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10
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Laverty AA, Vardavas CI, Filippidis FT. Prevalence and reasons for use of Heated Tobacco Products (HTP) in Europe: an analysis of Eurobarometer data in 28 countries. THE LANCET REGIONAL HEALTH. EUROPE 2021; 8:100159. [PMID: 34557853 PMCID: PMC8454644 DOI: 10.1016/j.lanepe.2021.100159] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Heated Tobacco Products (HTP) are a relatively new class of tobacco products, with limited data on usage patterns. We assessed the prevalence and reasons for use among persons aged ≥15 years in 27 European Union member states and the United Kingdom·. METHODS The 2020 Eurobarometer (93·2) survey was analysed (n=28,300, aged ≥15). Multi-level regression analyses assessed socio-demographic differences in use while separate analyses investigated reasons for starting to use HTP. Results are presented as adjusted Odds Ratios (aOR) and weighted percentages with 95% Confidence Intervals (95%CI). FINDINGS Overall, 6·5% (95% CI 6·1;7·0) of participants had ever used a HTP. 1·3% (1·1%;1·5%) of participants were current users of HTP, and 0·7% (0·6% to 0·9%) daily users. Current and former tobacco smokers were more likely than never tobacco smokers to use HTP (aOR 36·3 (22·9;57·5), and 7·3 (4·3;12·3) respectively. Youth aged 15-24 years of age were substantially more likely to report use, e.g. aOR for ever use=7·77 (6·56;9·21) compared to those aged ≥55 years. 51·3% of ever HTP users reported at least weekly concurrent use of combustible tobacco. Among those who reported ever use of HTP, but not e-cigarettes, the most popular reason for use was the perception that HTP are less harmful than smoking tobacco (39·5%), followed by use by friends (28·4%) and stopping or reducing smoking (28·2%). INTERPRETATION Considerable numbers of people in the EU have ever used HTP, although current and daily use remains low. Current use is more common among younger people, and current and former smokers. FUNDING None.
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Affiliation(s)
- Anthony A. Laverty
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, United Kingdom
| | - Constantine I. Vardavas
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, MA, USA
- School of Medicine, University of Crete, Greece
| | - Filippos T. Filippidis
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, United Kingdom
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Xia W, Li WHC, Luo YH, Liang TN, Ho LLK, Cheung AT, Song P. The association between heated tobacco product use and cigarette cessation outcomes among youth smokers: A prospective cohort study. J Subst Abuse Treat 2021; 132:108599. [PMID: 34419325 DOI: 10.1016/j.jsat.2021.108599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 07/29/2021] [Accepted: 08/11/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The U.S. Food and Drug Administration authorized the marketing of heated tobacco products (HTPs) with modified-risk information for adults on July 7, 2020. However, the effects of HTP use on cigarette cessation among youth smokers remain unclear. This study aimed to explore the association of HTP use with cigarette abstinence and cessation outcomes among youth smokers in Hong Kong who were willing to receive telephone counseling for smoking cessation. METHODS This prospective cohort study included youth smokers aged ≤25 years who were enrolled in the Hong Kong Youth Quitline service. From December 1, 2016, to September 30, 2019, this study identified as HTP users 106 youth cigarette smokers who reported using HTPs on at least 1 of the past 30 days at enrollment, and identified as non-HTP users 473 smokers who reported smoking at least one conventional cigarette in the past 30 days and never using HTPs. The participants received follow-ups at 1 week and 1-, 3-, and 6-months postenrollment. The primary outcome was self-reported 7-day point prevalence of cigarette abstinence (PPA) at the 6-month follow-up. Secondary outcomes included reduction in cigarette smoking (excluding quitters), the number of cessation attempts, and the level of readiness to quit. RESULTS The self-reported 7-day PPA was statistically significantly lower among HTP users than among non-HTP users after 6 months (19.0% vs. 34.2%; p = 0.009), with an adjusted relative risk of 0.47 (95% confidence interval: 0.24-0.91; p = 0.03). The study identified no significant differences in secondary outcomes between the two groups. CONCLUSIONS Youth HTP users were less likely to abstain from tobacco use than their non-HTP-using counterparts. These results suggest that HTPs should not be promoted as smoking cessation or reduction aids among the youth population.
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Affiliation(s)
- Wei Xia
- School of Nursing, Sun Yat-Sen University, RM 613, 4/F, Block of School of Nursing, Sun Yat-Sen University North Campus, No. 74, 2nd Yat-Sen Rd, Yuexiu District, Guangzhou City, Guangdong Province, China; School of Nursing, The University of Hong Kong, 4/F, William M. W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China.
| | - William Ho Cheung Li
- School of Nursing, The University of Hong Kong, 4/F, William M. W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China.
| | - Yuan Hui Luo
- School of Nursing, The University of Hong Kong, 4/F, William M. W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China.
| | - Ting Na Liang
- School of Nursing, The University of Hong Kong, 4/F, William M. W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China.
| | - Laurie Long Kwan Ho
- School of Nursing, The University of Hong Kong, 4/F, William M. W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China.
| | - Ankie Tan Cheung
- School of Nursing, The University of Hong Kong, 4/F, William M. W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China.
| | - Peige Song
- School of Public Health, Zhejiang University School of Medicine, 866 Yuhangtang Rd, Hangzhou 310058, China; Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, Scotland, United Kingdom.
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Luk TT, Lam TH, Leung WC, Leung KY, Cheung KW, Kwa C, Siong KH, Tang KK, Lee KW, Hsieh CJ, Wu YS, Li WHC, Wang MP. Brief Advice, Nicotine Replacement Therapy Sampling, and Active Referral for Expectant Fathers Who Smoke Cigarettes: A Randomized Clinical Trial. JAMA Intern Med 2021; 181:1081-1089. [PMID: 34125135 PMCID: PMC8204256 DOI: 10.1001/jamainternmed.2021.2757] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Pregnancy presents an opportunity to engage expectant fathers in smoking cessation, but evidence from randomized clinical trials is scarce. OBJECTIVE To evaluate the effectiveness of a proactive, combined intervention for smoking cessation in expectant fathers. DESIGN, SETTING, AND PARTICIPANTS This pragmatic randomized clinical trial in prenatal clinics in 7 public hospitals in Hong Kong proactively recruited and enrolled 1053 participants from October 10, 2018, to February 8, 2020. Included male adults were 18 years or older, smoked cigarettes daily in the past 3 months, had partners who were pregnant and nonsmoking in the past 30 days, and had a landline or mobile telephone number for follow-up. These participants were randomized to either the intervention group or the control group. The primary analyses used an intention-to-treat approach. INTERVENTIONS The intervention group received brief cessation advice, a 1-week free sample of nicotine replacement therapy (NRT), and active referral to a community-based smoking cessation service. The control group received only brief cessation advice with a leaflet on the hazards of perinatal exposure to tobacco smoke and the toll-free quitline telephone number. MAIN OUTCOMES AND MEASURES The primary outcome was biochemically validated tobacco abstinence at 6 months after intervention initiation defined by an exhaled carbon monoxide level of 3 parts per million or lower. The secondary outcomes included self-reported 24-week continuous abstinence at 6 months after intervention initiation as well as 7-day point prevalence abstinence, use of any NRT, and use of a smoking cessation service at 3 and 6 months after intervention initiation. RESULTS All 1053 randomized participants were male adults with a mean (SD) age of 33.8 (6.9) years. The retention rate at 6-month follow-up was 80.7%. The primary outcome of biochemically validated tobacco abstinence at 6 months after intervention initiation was significantly higher in the intervention group than in the control group (6.8% [36 of 527 participants] vs 3.6% [19 of 526]; odds ratio [OR], 1.96; 95% CI, 1.11-3.46; P = .02). The main secondary outcomes of self-reported 24-week continuous abstinence at 6 months (OR, 1.87; 95% CI, 1.08-3.23; P = .03) and 7-day point prevalence abstinence at 3 months (OR, 1.48; 95% CI, 1.05-2.09; P = .03) and 6 months (OR, 1.74; 95% CI, 1.29-2.34; P < .001) were also significantly higher in the intervention group. The intervention group had a significantly higher increase in perceived family harmony (score range, 0-10, with a higher score indicating a higher level of harmony) from baseline to 6 months (B = 0.28; 95% CI, 0.063-0.50; P = .01). CONCLUSIONS AND RELEVANCE This trial found that combining brief advice with a 1-week sample of NRT and referral to smoking cessation programs nearly doubled the odds that expectant fathers who smoked would achieve validated abstinence compared with providing brief advice alone. The intervention was also effective in promoting family harmony. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03671707.
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Affiliation(s)
- Tzu Tsun Luk
- School of Nursing, The University of Hong Kong, Hong Kong Special Administrative Region (SAR), China
| | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong SAR, China
| | - Wing Cheong Leung
- Department of Obstetrics and Gynecology, Kwong Wah Hospital, Hong Kong SAR, China
| | - Kwok-Yin Leung
- Department of Obstetrics and Gynecology, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - Ka Wang Cheung
- Department of Obstetrics and Gynecology, Queen Mary Hospital, Hong Kong SAR, China
| | - Carina Kwa
- Department of Obstetrics and Gynecology, United Christian Hospital, Hong Kong SAR, China
| | - Kar-Hung Siong
- Department of Obstetrics and Gynecology, Tuen Mun Hospital, Hong Kong SAR, China
| | - Kwok-Keung Tang
- Department of Obstetrics and Gynecology, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China
| | - Kai-Wan Lee
- Department of Obstetrics and Gynecology, Princess Margaret Hospital, Hong Kong SAR, China
| | - Chi Ju Hsieh
- School of Nursing, The University of Hong Kong, Hong Kong Special Administrative Region (SAR), China
| | - Yongda Socrates Wu
- School of Nursing, The University of Hong Kong, Hong Kong Special Administrative Region (SAR), China
| | - William Ho-Cheung Li
- School of Nursing, The University of Hong Kong, Hong Kong Special Administrative Region (SAR), China
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong Special Administrative Region (SAR), China
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Petrache I, de Boer E. Cooling off the heated controversy of a safer cigarette: heat-not-burn no better than traditional combustion cigarettes. Thorax 2021; 76:536. [PMID: 34161919 PMCID: PMC10777482 DOI: 10.1136/thoraxjnl-2020-216743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/01/2021] [Accepted: 03/06/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Irina Petrache
- Department of Medicine, National Jewish Health, Denver, Colorado, USA
- Department of Medicine, University of Colorado Denver, School of Medicine, Aurora, Colorado, USA
| | - Esther de Boer
- Department of Medicine, University of Colorado Denver, School of Medicine, Aurora, Colorado, USA
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