1
|
Jao NC, Papandonatos GD, Stanfield J, Borba K, Stroud LR. Characterizing the use, preferences, and perceptions of flavors in cigars in pregnant women. J Addict Dis 2024; 42:194-204. [PMID: 36734291 PMCID: PMC10397361 DOI: 10.1080/10550887.2023.2170703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Flavors contribute to the appeal of tobacco products, but less is known about flavors in cigar products. The current study is the first to focus on characterizing the use and perceptions of flavors in cigar products among pregnant women. METHODS Pregnant women (N = 124) reported their use, preferences (liking, attractiveness, smoothness, interest), perceptions of harm (general, pregnancy-specific, fetal), and postpartum intention to use eight flavor categories (menthol/mint, spices, fruit, chocolate, alcohol, other beverages, candy/sweet, tobacco). We utilized correspondence analysis of contingency tables to investigate clustering of preferences and perceptions of flavors across the sample, and examined how preferences and perceptions of flavors may differ based on history of cigar use (none vs. lifetime vs. prenatal). RESULTS Overall, 37% reported never trying cigars, 51% reported lifetime use, and 12% reported prenatal use. Fruit (37%), tobacco (36%), and alcohol (14%) were the most common cigar flavors participants reported ever trying. Correspondence analysis revealed clustering in preferences for alcohol, fruit, and candy flavors compared to other flavors, and revealed lower intentions to use menthol/mint and tobacco flavors compared to other flavors. Participants who reported prenatal cigar use also reported more positive perceptions and greater intentions to use (1) spice and alcohol flavors compared to those who reported lifetime use (ps < .05); and (2) spice, alcohol, fruit, and tobacco cigar flavors compared to participants reporting never using cigars (ps < .04). CONCLUSIONS Regulations to restrict the availability of flavors, especially fruit, spice, and alcohol, may reduce the appeal and use of cigar products in pregnant women.
Collapse
Affiliation(s)
- Nancy C. Jao
- Department of Psychology, College of Health Professionals, Rosalind Franklin University of Medicine and Science, North Chicago, IL
| | | | | | - Katelyn Borba
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI
| | - Laura R. Stroud
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI
| |
Collapse
|
2
|
Buszkiewicz JH, Mok Y, Mukerjee R, Fleischer NL, Meza R, Jeon J. Cross-sectional patterns and longitudinal transitions of unflavored and flavored cigar use without and with cigarettes among United States adults. Prev Med 2024; 185:108027. [PMID: 38844050 DOI: 10.1016/j.ypmed.2024.108027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 05/25/2024] [Accepted: 06/01/2024] [Indexed: 06/10/2024]
Abstract
INTRODUCTION Over half of US adults who smoke cigars use flavored cigars, illustrating their broad appeal; however, their long-term impact on cigar and cigarette use is unknown. METHODS Using restricted data from Waves 1-5 (2013-2019) of the Population Assessment of Tobacco and Health Study, we investigated cross-sectional patterns and longitudinal transition rates of unflavored and flavored cigar use with and without cigarettes among a nationally representative sample of US adults. RESULTS Proportionally, more adults who used flavored cigars without or with cigarettes were younger and female. More adults with exclusive cigar use were non-Hispanic Black. More adults with dual use had lower educational attainment. The median number of cigars smoked daily and tobacco dependence was highest among adults who used flavored cigars with cigarettes. Only 14.6% of adults with exclusive flavored cigar use at Wave 1 continued their use to Wave 5, with most transitioning to non-current (46.4%) or exclusive cigarette use (22.9%). Likewise, 13.8% of adults with dual flavored cigar and cigarette use at Wave 1 continued their use to Wave 5, with 57.6% transitioning to exclusive cigarette use and 19.7% transitioning to non-current use. Comparatively, 72.9% of adults with exclusive cigarette use continued their use to Wave 5, while 23.6% transitioned to non-current use. CONCLUSION Adult cigar use was less stable than cigarette use, particularly among those who use flavored cigars. Future research should investigate whether these transition patterns between flavored and unflavored cigar and cigarette use vary across sociodemographic groups and their potential long-term health implications.
Collapse
Affiliation(s)
- James H Buszkiewicz
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA.
| | - Yoonseo Mok
- Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, BC, Canada
| | - Richa Mukerjee
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Nancy L Fleischer
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Rafael Meza
- Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Jihyoun Jeon
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| |
Collapse
|
3
|
Yang Y, Lindblom EN, Ward KD, Salloum RG. Would banning menthol cigarettes, flavored cigars, and flavored e-cigarettes prompt users to seek illicit channels for obtaining them in the United States? Prev Med 2024; 183:107954. [PMID: 38621422 PMCID: PMC11088487 DOI: 10.1016/j.ypmed.2024.107954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 04/10/2024] [Accepted: 04/11/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Banning flavors in tobacco and nicotine products may reduce youth initiation and prompt quit attempts but such bans may lead to illicit markets. We examined how likely current users would be to seek flavored products from illicit channels under various ban scenarios. METHODS Cross-sectional surveys of 2552 current users of menthol cigarettes or flavored cigars and 2347 users of flavored e-cigarettes were conducted between 2021 and 2022 in the United States. For each ban scenario, respondents reported if they would have intentions to seek the banned flavored products from any illicit channels and identified the specific illicit channel they would consider. Logistic regressions were used to estimate how the likelihood of having intentions to seek illicit channels was associated with demographics, ban scenarios, and status of tobacco use. RESULTS Under various ban scenarios, 24-30% of people who smoked said they would seek illicit channels to obtain the banned products compared with 21-41% of dual users and 35-39% of users of flavored e-cigarettes. Online retailers were favored by people who smoked while users of flavored e-cigarettes favored local retailers. Heavy users were more likely to say they would try illicit channels. Under bans restricting more types of flavored tobacco products, users would be less likely to try illegal channels. CONCLUSIONS A significant proportion of users of flavored tobacco and nicotine products would not reject using illicit banned products. Tailored programs are needed to apply to the groups with a higher risk of seeking illicit channels for banned products.
Collapse
Affiliation(s)
- Yong Yang
- School of Public Health, University of Memphis, Memphis, TN 38152, United States of America.
| | - Eric N Lindblom
- O'Neill Institute for National & Global Health Law, Georgetown University Law Center, Washington, DC 20001, United States of America
| | - Kenneth D Ward
- College of Population Health, University of New Mexico, Albuquerque, NM 87131, United States of America
| | - Ramzi G Salloum
- Department of Health Outcomes and Policy, University of Florida, Gainesville, FL 32608, United States of America
| |
Collapse
|
4
|
Audrain-McGovern J, Klapec O, Koita F, Manikandan D, Stone MD. The interacting effects of depression symptoms and sweet flavoring on the rewarding and reinforcing value of cigarillo use among young adults. DRUG AND ALCOHOL DEPENDENCE REPORTS 2024; 11:100234. [PMID: 38646014 PMCID: PMC11033167 DOI: 10.1016/j.dadr.2024.100234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 04/04/2024] [Accepted: 04/08/2024] [Indexed: 04/23/2024]
Abstract
Background Young adults 18-24 years old have the highest prevalence of cigarillo use, exposing young adults to comparable or higher nicotine levels and many of the same toxicants as combustible cigarettes. Identifying individual and product characteristics that increase the potential for persistent use is warranted. We sought to examine the interacting effects of depression symptoms and sweet flavoring on the rewarding and reinforcing value of cigarillo use. Methods 86 young adults (18-24 years old, 73.3 % male, 38.4 % White, 33.7 % Black, and 27.9 % Other) completed three laboratory visits assessing the subjective rewarding value (exposure paradigm), relative reinforcing value (computerized choice task), and absolute reinforcing value (ad libitum cigarillo smoking session) of sweet-flavored versus non-flavored cigarillos. Depression symptoms were measured with the 20-item Center for Epidemiologic Studies of Depression Scale and treated as a continuous variable. Results General linear models with the appropriate family link tested differences in depressive symptomology for each outcome. Irrespective of flavor, greater cigarillo subjective reward was reported across increasing depressive symptomology (B=.0.03 [95%CI=0.00, 0.05], p=.017). Across symptom levels, no significant differences were observed in the subjective reward and relative and absolute reinforcing values of sweet-flavored versus non-flavored cigarillos (p's >.05). Conclusions Young adults with elevated depression find cigarillos more rewarding but not more reinforcing. They are not more vulnerable than young adults with lower symptom levels to sweet cigarillo flavoring. Public health prevention campaigns and tobacco product regulations aimed at preventing the initiation and escalation of young adult cigarillo use may impact young adults broadly.
Collapse
Affiliation(s)
- Janet Audrain-McGovern
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Olivia Klapec
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Fodie Koita
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Divya Manikandan
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Matthew D. Stone
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, CA, USA
| |
Collapse
|
5
|
Sun Y, Prabhu P, Rahman R, Li D, McIntosh S, Rahman I. e-Cigarette Tobacco Flavors, Public Health, and Toxicity: Narrative Review. Online J Public Health Inform 2024; 16:e51991. [PMID: 38801769 PMCID: PMC11165290 DOI: 10.2196/51991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 11/08/2023] [Accepted: 05/09/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Recently, the US Food and Drug Administration implemented enforcement priorities against all flavored, cartridge-based e-cigarettes other than menthol and tobacco flavors. This ban undermined the products' appeal to vapers, so e-cigarette manufacturers added flavorants of other attractive flavors into tobacco-flavored e-cigarettes and reestablished appeal. OBJECTIVE This review aims to analyze the impact of the addition of other flavorants in tobacco-flavored e-cigarettes on both human and public health issues and to propose further research as well as potential interventions. METHODS Searches for relevant literature published between 2018 and 2023 were performed. Cited articles about the toxicity of e-cigarette chemicals included those published before 2018, and governmental websites and documents were also included for crucial information. RESULTS Both the sales of e-cigarettes and posts on social media suggested that the manufacturers' strategy was successful. The reestablished appeal causes not only a public health issue but also threats to the health of individual vapers. Research has shown an increase in toxicity associated with the flavorants commonly used in flavored e-cigarettes, which are likely added to tobacco-flavored e-cigarettes based on tobacco-derived and synthetic tobacco-free nicotine, and these other flavors are associated with higher clinical symptoms not often induced solely by natural, traditional tobacco flavors. CONCLUSIONS The additional health risks posed by the flavorants are pronounced even without considering the toxicological interactions of the different tobacco flavorants, and more research should be done to understand the health risks thoroughly and to take proper actions accordingly for the regulation of these emerging products.
Collapse
Affiliation(s)
- Yehao Sun
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, United States
| | - Prital Prabhu
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, United States
| | - Ryan Rahman
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, United States
| | - Dongmei Li
- Department of Clinical & Translational Research, University of Rochester Medical Center, Rochester, NY, United States
| | - Scott McIntosh
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
| | - Irfan Rahman
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, United States
| |
Collapse
|
6
|
Yang Y. An Estimation of the Prevalence of Smoking and e-Cigarette Use among U.S. Adults If Menthol Cigarettes and Flavored Cigars Are Banned. Subst Use Misuse 2024; 59:1394-1404. [PMID: 38725334 DOI: 10.1080/10826084.2024.2352616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
INTRODUCTION People's reaction to the FDA's ban on flavored cigarettes and cigars may be modified by a concurrent ban on flavored e-cigarettes. We aim to estimate the prevalence of smoking and e-cigarette use among U.S. adults under various ban scenarios. METHODS We collected the reactions of people who used cigarettes, cigars, and e-cigarettes reactions to three hypothetical ban scenarios, (1) restricting menthol cigarettes and flavored cigars only, or (2) further restricting e-cigarettes with any flavors except menthol or tobacco, or (3) further restricting e-cigarettes with all flavors. The above data were analyzed to identify determinants of reactions and to estimate and calibrate the probabilities of quitting and switching to non-flavored cigarettes and cigars. Afterward, the probabilities were applied to 2018-2019 TUS-CPS respondents to estimate the prevalence of smoking and e-cigarette use. RESULTS Compared with the baseline, the prevalence of smoking decreased from 12.6% to 10.5%, and e-cigarette use increased from 2.6% to 3.8% in Scenario No.1. In Scenario No.2 and No.3, the prevalence of smoking was 10.5% and 10.7%, and the prevalence of e-cigarette use were 3.1% and 2.4%, respectively. For black people, the prevalence of smoking decreased from 14.2% in baseline to 8.1%-8.8% in three scenarios. CONCLUSIONS The result indicated that for a ban on menthol cigarettes and flavored cigars, a concurrent ban on flavored e-cigarettes with an exemption of menthol flavor could be more effective in encouraging people to quit smoking. Black people may see a disproportionate benefit from all ban scenarios compared with other race/ethics groups.
Collapse
Affiliation(s)
- Yong Yang
- School of Public Health, University of Memphis, Memphis, Tennessee, USA
| |
Collapse
|
7
|
Havermans A, Pauwels CGGM, Bakker-'t Hart IME, Fayokun R, van Nierop LE, Hellmich IM, Talhout R. Across the world availability of flavour accessories for tobacco products. Tob Control 2024:tc-2023-058255. [PMID: 38580443 DOI: 10.1136/tc-2023-058255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 01/22/2024] [Indexed: 04/07/2024]
Abstract
OBJECTIVE This study aimed to provide an inventory of different types of flavour accessories for combustible tobacco products in eight countries varying in their approaches to flavour legislation and cultural aspects, including tobacco use. METHODS A standardised search protocol was developed and shared with local informants to acquire information on the availability and marketing of flavour accessories in web shops accessible from Brazil, India, Italy, Singapore, South Africa, Switzerland, the UK and the USA. Characteristics of the products and web shops were reported, and flavours were categorised in a flavour wheel. RESULTS Flavour accessories were available in all participating countries. Reported types are flavour capsules, cards, filter tips and tubes for make-your-own cigarettes, drops, sprays, rolling paper, aroma markers, a flavour stone and a flavour powder. In total, 118 unique flavours were reported, which were mostly fruity and sweet. Marketing of these products was often associated with (menthol) flavour bans. CONCLUSIONS The wide availability and variety of flavour accessories raise significant public health concerns, as they have attractive flavours, and thus hinder the regulatory aim of flavour bans. Flavour accessories are not tobacco products and thus not regulated as such. Therefore, it is recommended that policymakers include these products in comprehensive flavour bans, to close this loophole in existing tobacco control measures.
Collapse
Affiliation(s)
- Anne Havermans
- Centre for Health Protection, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Charlotte G G M Pauwels
- Centre for Health Protection, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Ingrid M E Bakker-'t Hart
- Centre for Health Protection, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Ranti Fayokun
- No Tobacco Unit, World Health Organization, Geneva, Switzerland
| | - Lotte E van Nierop
- Centre for Health Protection, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Ina M Hellmich
- Centre for Health Protection, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Reinskje Talhout
- Centre for Health Protection, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| |
Collapse
|
8
|
Meshnick AB, Faricy LE, Lushniak BD. Analysis of FDA's Vuse market authorisation: limitations and opportunities. Tob Control 2024; 33:e116-e121. [PMID: 36764685 DOI: 10.1136/tc-2022-057540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 11/04/2022] [Indexed: 02/12/2023]
Abstract
This special communication provides a physicians' critique of the US Food and Drug Administration (FDA)'s decision to authorise the Vuse Solo (Vuse) Premarket Tobacco Application (PMTA). The PMTA authorisation represents the first time that FDA has authorised an Electronic Nicotine Delivery System (ENDS) for marketing in the USA. Using the FDA Decision Summary, the special communication identifies significant unanswered public health and scientific questions that prevent the authors from reaching FDA's conclusion that Vuse meets the Appropriate for the Protection of the Public Health (APPH) standard. The authors recommend FDA suspend the market authorisation and use these questions to re-evaluate the PMTA, and to prospectively monitor whether Vuse meets APPH standard. The special communication advances the ENDS harm reduction conversation because it calls for national tobacco regulators to develop an epidemiological prediction of ENDS impact on the population and to expand the scope of their analysis to evaluate the impacts of ENDS on congenital birth defects, abuse liability and non-flavour drivers of youth usage. Through learning from the American experience regulating Vuse, national tobacco regulators around the globe will be better equipped to evaluate the impact of ENDS on the public health.
Collapse
Affiliation(s)
- Andrew B Meshnick
- Pediatrics, University of Vermont Children's Hospital, Burlington, Vermont, USA
| | | | - Boris D Lushniak
- Office of the Dean, University of Maryland School of Public Health, College Park, Maryland, USA
| |
Collapse
|
9
|
Xu K, Lee T, Reyes-Guzman CM, Davis Lynn BC, Kofie JN, Rostron BL, Chang CM, Chang JT. Use patterns of flavored non-cigarette tobacco products among US adults, 2010-2019. Prev Med 2024; 180:107870. [PMID: 38272271 PMCID: PMC10923177 DOI: 10.1016/j.ypmed.2024.107870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/03/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024]
Abstract
OBJECTIVE Flavored non-cigarette tobacco product (NCTP) use is common among US adult tobacco users. To update the estimates of use patterns of flavored NCTPs, this study assessed current NCTP use among adults by flavor use and flavor categories from 2010 to 2019. METHODS We analyzed data from the 2010-2019 Tobacco Use Supplement to the Current Population Survey to estimate the weighted proportion of adult NCTP users by flavor use across survey waves. Flavor use was defined as past 30-day use of any menthol/mint or fruit/other flavors. We used the 2018-2019 data to examine the differences in demographic characteristics and tobacco use patterns among users of menthol/mint or fruit/other flavors compared to exclusive users of tobacco flavor, by product type. RESULTS Compared to 2014-2015, electronic nicotine delivery system (ENDS) users were more likely (79.0% vs. 66.6%, p < 0.001) to report flavor use in 2018-2019, whereas cigar (26.9% vs. 31.2%, p = 0.030) and pipe (56.3% vs. 65.5%, p = 0.015) smokers were less likely to report flavor use in 2018-2019. In 2018-2019, the most prevalent flavor categories were exclusive use of tobacco flavor among cigar (73.1%) and smokeless tobacco (48.3%) users, and use of fruit/other flavors among ENDS (64.9%) and pipe (48.4%) users. Flavored users were more likely to be young adults aged 18-24 years (cigars, ENDS, smokeless tobacco) and Non-Hispanic Black or Hispanic persons (cigars, ENDS, pipes) compared to tobacco-flavored users. CONCLUSIONS Flavored product use increased among adult ENDS users but decreased among cigar and pipe smokers. These findings could inform tobacco regulatory efforts concerning flavored NCTPs.
Collapse
Affiliation(s)
- Kerui Xu
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA.
| | - Terrence Lee
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - Carolyn M Reyes-Guzman
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Brittny C Davis Lynn
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - Justina N Kofie
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - Brian L Rostron
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - Cindy M Chang
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - Joanne T Chang
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| |
Collapse
|
10
|
Vargees C, Stroup AM, Niznik T, Dunn D, Wyatt R, Hoetger C, Taleb ZB, Cohn AM, Cobb CO, Fetterman JL. Patterns of use, perceptions, and cardiopulmonary health risks of cigar products: a systematic review. BMC Public Health 2023; 23:2357. [PMID: 38017396 PMCID: PMC10685631 DOI: 10.1186/s12889-023-17216-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 11/13/2023] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVE A systematic review was conducted to evaluate the use patterns, health perceptions, and cardiopulmonary health effects of cigars. DATA SOURCES PubMed and Google Scholar were searched for peer-reviewed articles published between June 2014 and February 2021. Search keywords included cigars, cigarillos, little cigars, and cardiopulmonary health outcomes. STUDY SELECTION Of 782 papers identified, we excluded non-English articles, review articles, commentaries, and those without empirical data on cigars. Three coders independently reviewed all articles and compared codes to resolve discrepancies. 93 articles met the inclusion criteria and were included. DATA SYNTHESIS Cigars have evolved from premium cigars to encompass little cigars and cigarillos (LCCs). LCCs are available in an array of flavors and at a price advantage, and as a result, are used by different groups compared to premium cigars. LCCs are more frequently used by youth, young adults, and those who identify as Black/African American. LCCs are often used in combination with other tobacco products, alcohol, and cannabis. Despite limited regulation, cigars generate smoke of a similar composition as cigarettes. Among the studies identified, evidence suggests that cigar use is associated with cardiovascular and pulmonary toxicity. Higher all-cause and cancer-related mortalities are associated with cigar use, particularly with more frequent and deeper inhalation, compared to non-tobacco users. CONCLUSIONS LCCs are used more frequently by at-risk groups compared to premium cigars. Recent studies evaluating cigar cardiopulmonary health effects are limited but suggest cigars have similar health risks as conferred by cigarette smoking. With the use of LCCs and targeted marketing on the rise among high-risk groups, there is a critical need for continued research in this area.
Collapse
Affiliation(s)
- Comreen Vargees
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, 600 Albany Street, Boston, MA, USA
| | | | - Taylor Niznik
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Delaney Dunn
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Riley Wyatt
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Cosima Hoetger
- Department of Psychology, Virginia Commonwealth University, 806 W Franklin St, Richmond, VA, 23284, USA
- Center for the Study of Tobacco Products, Virginia Commonwealth University, 100 W Franklin St, Richmond, VA, 23220, USA
- Institute for Integrative Health Care and Health Promotion (IGVF), Witten/Herdecke University, Alfred-Herrhausen-Straße 50, Witten, 58455, Germany
| | - Ziyad Ben Taleb
- Department of Kinesiology, College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, USA
| | - Amy M Cohn
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, USA
- Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Caroline O Cobb
- Department of Psychology, Virginia Commonwealth University, 806 W Franklin St, Richmond, VA, 23284, USA
- Center for the Study of Tobacco Products, Virginia Commonwealth University, 100 W Franklin St, Richmond, VA, 23220, USA
| | - Jessica L Fetterman
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, 600 Albany Street, Boston, MA, USA.
| |
Collapse
|
11
|
Audrain-McGovern J, Manikandan D, Koita F, Klapec O, Pickworth WB, Stone MD. Effect of sweet flavouring on the rewarding and reinforcing value of cigarillo use among young adults. Tob Control 2023:tc-2023-058307. [PMID: 38050181 PMCID: PMC11116272 DOI: 10.1136/tc-2023-058307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/08/2023] [Indexed: 12/06/2023]
Abstract
INTRODUCTION Cigarillos dominate the US cigar market, and young adults largely drive use. While young adults prefer flavoured to non-flavoured cigarillos, especially those flavoured to taste like fruit or other sweets, the factors that underlie this preference have received little attention. We sought to determine if key indicators of abuse liability, the rewarding and reinforcing effects, are greater for sweet versus non-flavoured cigarillos. METHODS Young adults (18-24 years old) completed three laboratory visits assessing the subjective rewarding value (exposure paradigm), relative reinforcing value (computerised choice task) and absolute reinforcing value (ad libitum cigarillo smoking session) of sweet-flavoured versus non-flavoured cigarillos. General linear regression models were fit with the appropriate family link for each outcome measure. RESULTS Young adults rated sweet-flavoured cigarillos as more rewarding (estimated marginal mean (EMM) =4.52, 95% CI 4.00 to 5.03) than the non-flavoured cigarillo (EMM=3.31, 95% CI 2.80 to 3.83; B=1.20, 95% CI 0.80 to 1.60, p<0.001). The reinforcing value of sweet-flavoured cigarillos, measured by break point, was higher relative to non-flavoured cigarillos (6.34 out of 10), especially among young adults with a preference for flavoured cigarillos (B=1.94, 95% CI 0.71 to 3.18, p=0.003). Young adults took 1.9 times the number of puffs (35.75 vs 19.95) from sweet-flavoured cigarillos compared with non-flavoured cigarillos (Rate Ratio =1.94, 95% CI 1.30 to 2.90, p<0.001). CONCLUSIONS Sweet flavouring increases the abuse liability of cigarillos among young adults as reflected in greater liking, motivation to use and actual use. Banning sweet flavouring in cigarillos may diminish their use in young adults.Trial registration number CT.gov (NCT05092919).
Collapse
Affiliation(s)
| | - Divya Manikandan
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Fodie Koita
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Olivia Klapec
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Matthew D Stone
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
| |
Collapse
|
12
|
Do EK, O'Connor K, Diaz MC, Schillo BA, Kreslake JM, Hair EC. Relative increases in direct-to-consumer menthol ads following 2020 FDA guidance on flavoured e-cigarettes. Tob Control 2023; 32:779-781. [PMID: 35184047 DOI: 10.1136/tobaccocontrol-2021-057069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 02/07/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To examine potential changes in email and direct mail advertisements for flavoured e-cigarettes following the 2020 Food and Drug Administration (FDA) flavour guidance. METHODS Digital copies of e-cigarette advertisements were obtained from Mintel Comperemedia (November 2019-May 2020) and coded for the presence of flavours. Χ2 tests were used to determine changes in the prevalence of email and direct mail advertisements for e-cigarettes with menthol, non-menthol and no flavours. RESULTS Following FDA guidance, the relative proportion of menthol-flavoured e-cigarette advertisements sent via email significantly increased from 22.5% to 52.2%. No changes were found for e-cigarette advertisements mentioning no flavours, nor non-menthol-flavoured e-cigarettes, sent via email or direct mail. CONCLUSIONS The 2020 FDA flavour guidance was followed by an increased proportion of direct-to-consumer email advertisements of menthol-flavoured e-cigarette products.
Collapse
Affiliation(s)
- Elizabeth K Do
- Schroeder Institute, Truth Initiative, Washington, DC, USA
- Epidemiology, The George Washington University Milken Institute of Public Health, Washington, DC, USA
| | - Katie O'Connor
- Schroeder Institute, Truth Initiative, Washington, DC, USA
| | - Megan C Diaz
- Schroeder Institute, Truth Initiative, Washington, DC, USA
| | | | - Jennifer M Kreslake
- Schroeder Institute, Truth Initiative, Washington, DC, USA
- Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Elizabeth C Hair
- Schroeder Institute, Truth Initiative, Washington, DC, USA
- Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
13
|
Pravosud V, Holmes LM, Lempert LK, Ling PM. Impacts of Tax and Flavor Tobacco Policies on San Francisco Bay Area Tobacco Prices. EVALUATION REVIEW 2023; 47:763-785. [PMID: 36943027 PMCID: PMC10542911 DOI: 10.1177/0193841x231164908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
California Proposition 56 increased the state tobacco tax by $2 per cigarette pack effective April 1, 2017. Between 2015-2020 San Francisco (SF) and some cities in Alameda County enacted local flavored tobacco sales restrictions. SF also increased its Cigarette Litter Abatement Fee, from $0.20/pack in 2015 to $1.00 in 2020. Compare the change in tobacco prices before (2015) and after (2019/20) the implementation of a $2 increase in tobacco excise tax and local flavored tobacco policies in SF and Alameda Counties. Descriptive study of the pre-to-post policy analysis design. We drew a proportional random sample of retailers (N=463) in SF and Alameda Counties, by city. Using multivariable, single- and multiple-level linear regressions, we compared inflation-adjusted average tobacco prices in 2015 vs. 2019/20 by county and by flavor policy, accounting for socio-demographics. Change in inflation-adjusted average tobacco prices in 2015 vs. 2019/20 by county and flavor policy, accounting for socio-demographics. Between 2015-2019/20, the increase in cigarette prices was higher than the $2 tax increase, and higher in SF than Alameda County (+$4.6 vs +$2.5). SF retailers stopped selling Newport menthol cigarettes and Blu brand menthol e-cigarettes in 2019/20. Adjusted average cigarette prices increased significantly more in SF and Alameda County cities with comprehensive or partial flavor policies versus cities without flavor policies (by $3.23 and $2.11). Local flavor policies affected menthol product availability and may have had positive spillover effects and indirectly increased pack prices.
Collapse
Affiliation(s)
- Vira Pravosud
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA, USA
| | - Louisa M. Holmes
- The Pennsylvania State University, Departments of Geography and Demography, University Park, PA, USA
| | - Lauren K. Lempert
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA, USA
| | - Pamela M. Ling
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA, USA
- Division of General Internal Medicine, Department of Medicine, School of Medicine, University of California San Francisco, San Francisco, CA, USA
| |
Collapse
|
14
|
D'Mello K, Chan GCK, Hall W, Rychert M, Wilkins C, Hammond D. Use of flavored cannabis vaping products in the US, Canada, Australia, and New Zealand: findings from the international cannabis policy study wave 4 (2021). THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2023; 49:640-651. [PMID: 37624645 DOI: 10.1080/00952990.2023.2238116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 08/27/2023]
Abstract
Background: Vaping is an increasingly popular mode of cannabis use. Few studies have characterized the role of flavors in cannabis e-liquids.Objectives: To explore the prevalence of flavored vaping liquids, including differences between countries and correlates of use.Methods: Data were from Wave 4 (2021) of the International Cannabis Policy Study with national samples aged 16-65 in Canada, the United States (US), Australia, and New Zealand. The sample comprised 52,938 respondents, including 6,265 who vaped cannabis e-liquids in the past 12-months (2,858 females, 3,407 males). Logistic regression models examined differences in the use of flavored e-liquids between countries and sociodemographic characteristics.Results: The prevalence of vaping cannabis e-liquids was highest in the US (15.3%) and Canada (10.7%) compared to Australia (4.0%) and New Zealand (3.7%). Among past 12-month cannabis consumers, 57.5% reported using flavored vaping liquids, 34.2% used unflavored vaping products and 8.3% did not know. People who vape in Australia were most likely to report using flavored liquids compared to New Zealand (OR = 2.29), Canada (OR = 3.14), and the US (OR = 3.14) (p < .05 for all). Fruit was the most reported vaping flavor (40.8%), followed by candy/dessert (20.4%) and vanilla (15.2%). Use of flavored vapes was greater among younger, ethnic minorities, female, higher education and income adequacy, and more frequent consumers (p < .05).Conclusion: Many cannabis consumers reported using flavored e-liquids, with highest levels among young people aged 16-35. Given the high prevalence of vaping in legal markets, regulators should consider the role of flavored vaping products in promoting cannabis use among this group.
Collapse
Affiliation(s)
- Kimberly D'Mello
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
| | - Gary C K Chan
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
| | - Wayne Hall
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
| | - Marta Rychert
- SHORE & Whariki Research Centre, College of Health, Massey University, Auckland, New Zealand
| | - Chris Wilkins
- SHORE & Whariki Research Centre, College of Health, Massey University, Auckland, New Zealand
| | - David Hammond
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
| |
Collapse
|
15
|
Yang Y, Lindblom EN, Ward KD, Salloum RG. Reactions to hypothetical flavor bans among current users of flavored e-cigarettes. Transl Behav Med 2023; 13:533-538. [PMID: 36694931 PMCID: PMC10415732 DOI: 10.1093/tbm/ibac109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Banning flavors in e-cigarettes and other tobacco products may decrease their use. To examine how current users of flavored e-cigarettes might react to a ban on flavored e-cigarettes when: (i) menthol flavor is banned together with other flavors, or (ii) this ban on e-cigarettes is combined with a ban on menthol cigarettes and flavored cigars. A national cross-sectional survey of 2,347 current users of flavored e-cigarettes was conducted in May 2022. For each hypothetical ban scenario, respondents reported if they would quit all tobacco product use, continue to use e-cigarettes with no flavor or flavors that were not banned, or switch to alternative tobacco products. Multinomial logistic regressions were used to estimate the associations between responses and ban scenarios, adjusting for tobacco use and demographic variables. If e-cigarettes with any flavors except menthol and tobacco were banned, the majority of current e-cigarette users would keep using e-cigarettes with no flavor or tobacco and menthol flavor. When menthol flavor was added to a ban, a greater proportion of respondents would quit all tobacco use; however, more would also switch to cigarettes or cigars. When menthol cigarettes and flavored cigars were added to a ban, those who used menthol flavor only would be less likely to switch to cigarettes and cigars. Among current e-cigarette users, the harm reduction (i.e., from quitting all use) from a ban on flavored e-cigarettes, particularly if menthol is also banned, may be outweighed by the harm increases (i.e., switching to cigarettes or cigars, or other products that are more harmful than using e-cigarettes). A concurrent ban on menthol cigarettes and flavored cigars would secure more certain net reductions to public health harms from e-cigarette use and smoking.
Collapse
Affiliation(s)
- Yong Yang
- School of Public Health, University of Memphis, Memphis, TN, 38152, USA
| | - Eric N Lindblom
- O’Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC, 20001, USA
| | - Kenneth D Ward
- School of Public Health, University of Memphis, Memphis, TN, 38152, USA
| | - Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, 32610, USA
| |
Collapse
|
16
|
Fu CW, Huang CH, Tong SK, Chu CY, Chou MY. Nicotine reduces social dominance and neutralizes experience-dependent effects during social conflicts in zebrafish (Danio rerio). THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 894:164876. [PMID: 37343866 DOI: 10.1016/j.scitotenv.2023.164876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/22/2023] [Accepted: 06/12/2023] [Indexed: 06/23/2023]
Abstract
Nicotine, a psychoactive pollutant, binds to nicotinic acetylcholine receptors and disrupts the cholinergic modulation and reward systems of the brain, leading to attention deficit, memory loss, and addiction. However, whether nicotine affects social behaviors remains unknown. We assessed the effects of nicotine on the fighting behavior of zebrafish. Adult zebrafish treated with 5 μM nicotine were used in dyadic fighting tests with size-matched control siblings. The results indicate that nicotine treatment not only significantly reduced the likelihood of winning but also impaired the winner-loser effects (winner and loser fish did not show higher winning and losing tendencies in the second fight, respectively, after treatment.) Nicotine led to a considerable increase in c-fos-positive signals in the interpeduncular nucleus (IPN) of the brain, indicating that nicotine induces neural activity in the habenula (Hb)-IPN circuit. We used transgenic fish in which the Hb-IPN circuit was silenced to verify whether nicotine impaired the winner-loser effect through the Hb-IPN pathway. Nicotine-treated fish in which the medial part of the dorsal Hb was silenced did not have a higher winning rate, and nicotine-treated fish in which the lateral part of the dorsal Hb was silenced did not have a higher loss rate. This finding suggests that nicotine impairs the winner-loser effect by modulating the Hb-IPN circuit. Therefore, in these zebrafish, nicotine exposure impaired social dominance and neutralized experience-dependent effects in social conflicts, and it may thereby disturb the social hierarchy and population stability of such fish.
Collapse
Affiliation(s)
- Chih-Wei Fu
- Department of Life Science, National Taiwan University, Taiwan
| | | | - Sok-Keng Tong
- Department of Life Science, National Taiwan University, Taiwan
| | - Chia-Ying Chu
- Department of Life Science, National Taiwan University, Taiwan
| | - Ming-Yi Chou
- Department of Life Science, National Taiwan University, Taiwan.
| |
Collapse
|
17
|
Jeong M, Wackowski OA, Schroth KRJ, Strasser AA, Delnevo CD. Influence of cigarillo packaging characteristics on young adults' perceptions and intentions: findings from three online experiments. Tob Control 2023; 32:344-351. [PMID: 34711667 PMCID: PMC9046465 DOI: 10.1136/tobaccocontrol-2021-056785] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 09/27/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Packaging is an important component of tobacco marketing that influences product perceptions and use intentions. However, little research exists on cigar packaging. We leveraged variability in existing Swisher Sweets cigarillo packaging to extend the evidence base. METHODS Between 2017 and 2019, we conducted three online experiments with 774 young adult past-year cigar smokers recruited via Amazon Mechanical Turk. After viewing Swisher package images that differed by flavour descriptor and/or colour, participants rated them on perceptions and purchase intentions. In study 1, participants viewed one of four cigarillos ('Wild Rush Encore', 'Wild Rush Limited', 'Twisted Berry' and 'Strawberry'). In study 2, participants viewed two different watermelon rum-flavoured cigarillos ('Boozy Watermelon' and 'Island Madness'). In study 3, participants viewed two of three 'Wild Rush' cigarillo versions ('Encore' with or without an explicit flavour descriptor or 'Limited'). RESULTS In study 1, more participants perceived 'Twisted Berry' and 'Wild Rush Limited' as tasting good and less harsh tasting compared with 'Wild Rush Encore'. In study 2, compared with 'Island Madness', more participants perceived 'Boozy Watermelon' as tasting good, less harsh tasting and used by younger users but less by masculine users; female participants were more likely to purchase 'Boozy Watermelon'. In study 3, participants perceived 'Wild Rush Encore' with the explicit flavour descriptor as tasting better than packages without and being used by younger users but less by masculine users. CONCLUSIONS Variations in cigarillo packaging, even among cigarillos with the same flavour, may have differential consumer appeal, suggesting packaging features should be considered in cigar product regulation.
Collapse
Affiliation(s)
- Michelle Jeong
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey, USA
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Olivia A Wackowski
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey, USA
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Kevin R J Schroth
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey, USA
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Andrew A Strasser
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Cristine D Delnevo
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey, USA
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, New Jersey, USA
| |
Collapse
|
18
|
Blank MD, Romm KF, Childers MG, Douglas AE, Dino G, Bray BC. Longitudinal transitions in adolescent polytobacco use across waves 1-4 of the Population Assessment of Tobacco and Health study. Addiction 2023; 118:727-738. [PMID: 36401561 PMCID: PMC9992106 DOI: 10.1111/add.16095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 10/31/2022] [Indexed: 11/21/2022]
Abstract
AIMS This study aims to identify adolescent patterns of polytobacco use and measure transitions between patterns over time. DESIGN Longitudinal analysis using data derived from waves 1-4 (2013-18) of the Population Assessment of Tobacco and Health (PATH) study. Transitions in tobacco use patterns were examined via latent transition analysis, and then, socio-demographic characteristics were used to predict transitions via logistic regression. SETTING United States. PARTICIPANTS Participants included 975 adolescents who used at least one tobacco product at any wave (W1 mean age = 13.29, standard deviation = 0.86; W4 54.2% male; 54.5% white, 25.9% Hispanic). MEASUREMENTS Measurements included past 30-day use of cigarettes, electronic cigarettes (e-cigs), traditional cigars, cigarillos, filtered cigars, snus, smokeless tobacco (SLT) or hookah. FINDINGS Six latent classes were identified. Cigarette users (43.5-58.8%) and SLT users (50.8-79.6%) tended to persist in their use over time. E-cig users began to probably transition to non-users (80.0%), but became more likely to persist in this use over time (31.1%). Non-users at a given wave were most likely to transition to e-cig users (8.5-43.7%) or cigarette users (6.7-28.6%). Cigarillo/poly-users and hookah/poly-users displayed more variable transition patterns. Adolescents were more likely to transition to non-use (versus become/remain e-cig users) if they were older (cigarette users, SLT users), younger (e-cig users), other race (SLT users), male (SLT users) or had less-educated parents (SLT users) compared with their counterparts. Hispanic (versus white) cigarette users were more likely to transition to non-users than to persist in this use. CONCLUSIONS Among adolescents in the United States, patterns of tobacco use characterized by the use, mainly, of single, specific products appear to be stable, particularly by late adolescence. In contrast, patterns characterized by polytobacco use appear to be more variable and may represent experimentation without specialization.
Collapse
Affiliation(s)
- Melissa D Blank
- Department of Psychology, West Virginia University, Morgantown, WV, USA
- West Virginia Prevention Research Center, Department of Social and Behavioral Sciences, School of Public Health, West Virginia University, Morgantown, WV, USA
| | - Katelyn F Romm
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | | | - Ashley E Douglas
- Department of Psychology, West Virginia University, Morgantown, WV, USA
| | - Geri Dino
- West Virginia Prevention Research Center, Department of Social and Behavioral Sciences, School of Public Health, West Virginia University, Morgantown, WV, USA
| | - Bethany C Bray
- Institute for Health Research and Policy, The University of Illinois at Chicago, Chicago, IL, USA
| |
Collapse
|
19
|
Glasser AM, Nemeth JM, Quisenberry AJ, Shoben AB, Trapl ES, Klein EG. The Role of Cigarillo Flavor in the Co-Use of Cigarillos and Cannabis among Young Adults. Subst Use Misuse 2023; 58:717-727. [PMID: 36861952 PMCID: PMC10081100 DOI: 10.1080/10826084.2023.2184206] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Background: Research suggests flavor facilitates cigarillo use, but it is unknown if flavor impacts patterns of co-use of cigarillos and cannabis ("co-use"), which is common among young adult smokers. This study's aim was to determine the role of the cigarillo flavor in co-use among young adults. Methods: Data were collected (2020-2021) in a cross-sectional online survey administered to young adults who smoked ≥2 cigarillos/week (N = 361), recruited from 15 urban areas in the United States. A structural equation model was used to assess the relationship between flavored cigarillo use and past 30-day cannabis use (flavored cigarillo perceived appeal and harm as parallel mediators), including several social-contextual covariates (e.g., flavor and cannabis policies). Results: Most participants reported usually using flavored cigarillos (81.8%) and cannabis use in the past 30 days ("co-use") (64.1%). Flavored cigarillo use was not directly associated with co-use (p = 0.90). Perceived cigarillo harm (β = 0.18, 95% CI = 0.06, 0.29), number of tobacco users in the household (β = 0.22, 95% CI = 0.10, 0.33), and past 30-day use of other tobacco products (β = 0.23, 95% CI = 0.15, 0.32) were significantly positively associated with co-use. Living in an area with a ban on flavored cigarillos was significantly negatively associated with co-use (β = -0.12, 95% CI = -0.21, -0.02). Conclusions: Use of flavored cigarillos was not associated with co-use; however, exposure to a flavored cigarillo ban was negatively associated with co-use. Cigar product flavor bans may reduce co-use among young adults or have a neutral impact. Further research is needed to explore the interaction between tobacco and cannabis policy and use of these products.
Collapse
Affiliation(s)
- Allison M. Glasser
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, Ohio, 43210, USA
| | - Julianna M. Nemeth
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, Ohio, 43210, USA
| | - Amanda J. Quisenberry
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, 14263, USA
| | - Abigail B. Shoben
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, Ohio, 43210, USA
| | - Erika S. Trapl
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio, 44106, USA
| | - Elizabeth G. Klein
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, Ohio, 43210, USA
| |
Collapse
|
20
|
Leventhal AM, Dai H, Barrington-Trimis JL, Sussman S. 'Ice' flavoured e-cigarette use among young adults. Tob Control 2023; 32:114-117. [PMID: 34127549 PMCID: PMC8669039 DOI: 10.1136/tobaccocontrol-2020-056416] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 04/19/2021] [Accepted: 04/27/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND 'Ice' e-cigarette flavours-marketed as a combination of fruity/sweet and cooling flavours (eg, 'blueberry ice' or 'melon ice')-recently entered the US market. The prevalence and correlates of ice flavoured e-cigarette use in young adults are unknown. METHODS This cross-sectional study of a Los Angeles, California, USA, cohort analysed data from the past 30-day e-cigarette (current) users (n=344; M (SD)=21.2 (0.4) years old) who completed web-based surveys from May-August 2020. The exposure variable was self-reported e-cigarette flavour used most often in the past month (menthol/mint, fruit/sweet or ice). Outcomes included self-reported combustible tobacco use, vaping dependence symptoms, frequency of use and device type used. RESULTS Among current e-cigarette users, 48.8% reported using ice flavours most often, 33.7% predominately used fruit/sweet and 17.4% used menthol/mint. Using primarily ice-flavour was associated with reporting more past-30-day vaping days (vs menthol/mint: b=4.4, 95% CI (1 to 7.7); vs fruit/sweet: b=3.6, 95% CI (0.8 to 6.4)) and more episodes per vaping day versus fruit/sweet users (b=2.4, 95% CI (0.5 to 4.3)). Ice-flavour users were less likely than menthol/mint users to use JUUL/cartridge-based rechargeable (OR=0.1, 95% CI (0.03 to 0.45)) and more likely than sweet/fruit users to use disposable non-cartridge (OR=3.9, 95% CI (2.1 to 7.4)) devices than refillable/rechargeable tank/pen or other devices. Ice users had greater odds of past 30-day combustible tobacco use versus menthol/mint users (OR=2.7, 95% CI (1.3 to 5.7)) and vaping dependence symptoms than versus sweet/fruit users (OR=2.6, 95% CI (1.5 to 4.4)). CONCLUSION Young adult use of ice flavoured e-cigarettes may be common and positively associated with combustible tobacco use, nicotine vaping frequency and dependence and use of disposable e-cigarette devices. Further study of the prevalence, determinants and health effects of ice flavoured e-cigarette use is warranted.
Collapse
Affiliation(s)
- Adam M. Leventhal
- department of Preventive Medicine, University of Southern California Keck School of Medicine, 2001 N Soto Street, 302-C, Los Angeles, CA 90089
| | - Hongying Dai
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE, 68198-4355
| | - Jessica L. Barrington-Trimis
- department of Preventive Medicine, University of Southern California Keck School of Medicine, 2001 N Soto Street, 302-C, Los Angeles, CA 90089
| | - Steve Sussman
- department of Preventive Medicine, University of Southern California Keck School of Medicine, 2001 N Soto Street, 302-C, Los Angeles, CA 90089
| |
Collapse
|
21
|
Herbst RS, Hatsukami D, Acton D, Giuliani M, Moushey A, Phillips J, Sherwood S, Toll BA, Viswanath K, Warren NJH, Warren GW, Alberg AJ. Electronic Nicotine Delivery Systems: An Updated Policy Statement From the American Association for Cancer Research and the American Society of Clinical Oncology. J Clin Oncol 2022; 40:4144-4155. [PMID: 36287017 DOI: 10.1200/jco.22.01749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Combustible tobacco use has reached historic lows, demonstrating the importance of proven strategies to reduce smoking since publication of the 1964 Surgeon General's report. In contrast, the use of electronic nicotine delivery systems (ENDS), specifically e-cigarettes, has grown to alarming rates and threatens to hinder progress against tobacco use. A major concern is ENDS use by youth and adults who never previously used tobacco. While ENDS emit fewer carcinogens than combustible tobacco, preliminary evidence links ENDS use to DNA damage and inflammation, key steps in cancer development. Furthermore, high levels of nicotine can also increase addiction, raise blood pressure, interfere with brain development, and suppress the immune system. The magnitude of long-term health risks will remain unknown until longitudinal studies are completed. ENDS have been billed as a promising tool for combustible tobacco cessation, but further evidence is needed to assess their potential efficacy for adults who smoke. Of concern, epidemiological studies estimate that approximately 15%-42% of adults who use ENDS have never used another tobacco product, and another 36%-54% dual use both ENDS and combustible tobacco. This policy statement details advances in science related to ENDS and calls for urgent action to end predatory practices of the tobacco industry and protect public health. Importantly, we call for an immediate ban on all non-tobacco-flavored ENDS products that contain natural or synthetic nicotine to reduce ENDS use by youth and adults who never previously used tobacco. Concurrently, evidence-based treatments to promote smoking cessation and prevent smoking relapse to reduce cancer incidence and improve public health remain top priorities for our organizations. We also recognize there is an urgent need for research to understand the relationship between ENDS and tobacco-related disparities.
Collapse
Affiliation(s)
- Roy S Herbst
- Yale Comprehensive Cancer Center, Yale School of Medicine, New Haven, CT
| | | | - Dana Acton
- American Association for Cancer Research, Washington, DC
| | | | - Allyn Moushey
- American Society of Clinical Oncology, Alexandria, VA
| | | | | | | | | | | | | | - Anthony J Alberg
- Arnold School of Public Health, University of South Carolina, Columbia, SC
| |
Collapse
|
22
|
Akinola LS, Rahman Y, Ondo O, Cobb CO, Holt AK, Peace MR, Damaj MI. Impact of tobacco flavoring on oral nicotine consumption in C57BL/6J mice. Drug Alcohol Depend 2022; 241:109685. [PMID: 36370533 DOI: 10.1016/j.drugalcdep.2022.109685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The continued use of flavors in tobacco products has been a prominent factor in their popularity, yet little is known regarding their role in nicotine dependence. This study aimed to investigate the impact of tobacco flavoring on oral nicotine consumption in mice using the two-bottle choice (2BC) test and assessed the potential impact of age and sex in their interactions. METHODS Adolescent and adult male and female C57BL/6J mice were used. First, voluntary consumption of tobacco flavor concentrate from a commercial electronic cigarette liquid vendor (Avail Vapor LLC) was measured; then, the effects of tobacco flavoring in combination with nicotine were examined. In one approach, tobacco flavor concentration was kept constant while nicotine concentration varied, and in the second, nicotine was kept constant while the tobacco flavor concentration varied. RESULTS Overall, tobacco flavoring decreased oral nicotine consumption in mice, and its effects were sex- and age-dependent. Although females consumed the tobacco-flavored solution at a slightly higher rate than males, male mice were more sensitive to the effects of the combination (nicotine + tobacco). Furthermore, adolescent mice showed a starker reduction in nicotine consumption in the presence of tobacco flavoring compared to adult mice. This attenuation was most likely due to a basal aversion to the tobacco flavoring itself, thus, creating a negative synergistic effect with nicotine. CONCLUSIONS Tobacco flavoring increases aversion to nicotine in the 2BC test in C57BL6J mice, suggesting that some flavors may diminish rather than enhance oral nicotine consumption in rodents.
Collapse
Affiliation(s)
- Lois S Akinola
- Department of Pharmacology and Toxicology, Medical College of Virginia, Virginia Commonwealth University, Richmond, VA, USA.
| | - Yumna Rahman
- Department of Pharmacology and Toxicology, Medical College of Virginia, Virginia Commonwealth University, Richmond, VA, USA
| | - Olivia Ondo
- Department of Pharmacology and Toxicology, Medical College of Virginia, Virginia Commonwealth University, Richmond, VA, USA
| | - Caroline O Cobb
- Department of Psychology and Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA
| | - Alaina K Holt
- Department of Forensic Science, Virginia Commonwealth University, Richmond, VA, USA
| | - Michelle R Peace
- Department of Forensic Science, Virginia Commonwealth University, Richmond, VA, USA
| | - M Imad Damaj
- Department of Pharmacology and Toxicology, Medical College of Virginia, Virginia Commonwealth University, Richmond, VA, USA
| |
Collapse
|
23
|
Herbst RS, Hatsukami D, Acton D, Giuliani M, Moushey A, Phillips J, Sherwood S, Toll BA, Viswanath K, Warren NJH, Warren GW, Alberg AJ. Electronic Nicotine Delivery Systems: An Updated Policy Statement from the American Association for Cancer Research and the American Society of Clinical Oncology. Clin Cancer Res 2022; 28:4861-4870. [PMID: 36287033 DOI: 10.1158/1078-0432.ccr-22-2429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 09/01/2022] [Indexed: 01/24/2023]
Abstract
Combustible tobacco use has reached historic lows, demonstrating the importance of proven strategies to reduce smoking since publication of the 1964 Surgeon General's report. In contrast, the use of electronic nicotine delivery systems (ENDS), specifically e-cigarettes, has grown to alarming rates and threatens to hinder progress against tobacco use. A major concern is ENDS use by youth and adults who never previously used tobacco. While ENDS emit fewer carcinogens than combustible tobacco, preliminary evidence links ENDS use to DNA damage and inflammation, key steps in cancer development. Furthermore, high levels of nicotine can also increase addiction, raise blood pressure, interfere with brain development, and suppress the immune system. The magnitude of long-term health risks will remain unknown until longitudinal studies are completed. ENDS have been billed as a promising tool for combustible tobacco cessation, but further evidence is needed to assess their potential efficacy for adults who smoke. Of concern, epidemiological studies estimate that approximately 15% to 42% of adults who use ENDS have never used another tobacco product, and another 36% to 54% "dual use" both ENDS and combustible tobacco. This policy statement details advances in science related to ENDS and calls for urgent action to end predatory practices of the tobacco industry and protect public health. Importantly, we call for an immediate ban on all non-tobacco-flavored ENDS products that contain natural or synthetic nicotine to reduce ENDS use by youth and adults who never previously used tobacco. Concurrently, evidence-based treatments to promote smoking cessation and prevent smoking relapse to reduce cancer incidence and improve public health remain top priorities for our organizations. We also recognize there is an urgent need for research to understand the relationship between ENDS and tobacco-related disparities.
Collapse
Affiliation(s)
- Roy S Herbst
- Yale Comprehensive Cancer Center, Yale School of Medicine, New Haven, Connecticut
| | | | - Dana Acton
- American Association for Cancer Research, Washington, D.C
| | | | - Allyn Moushey
- American Society of Clinical Oncology, Alexandria, Virginia
| | | | | | - Benjamin A Toll
- Medical University of South Carolina, Charleston, South Carolina
| | | | | | - Graham W Warren
- Medical University of South Carolina, Charleston, South Carolina
| | - Anthony J Alberg
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| |
Collapse
|
24
|
Pike Moore S, Osborn C, Koopman Gonzalez S, Quisenberry A, Klein EG, Kaur M, Suratkal J, Trapl E. Flavour loyalty may predict cessation or substitution following a cigarillo flavour ban among young adults in the USA. Tob Control 2022; 31:s206-s213. [PMID: 36328462 PMCID: PMC9641532 DOI: 10.1136/tc-2022-057487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/24/2022] [Indexed: 11/22/2022]
Abstract
Significance The purpose of this research was to measure flavour loyalty and identify how current cigarillo users may respond to a hypothetical flavour ban in the USA. Methods Cigarillo users aged 21–28 (n=531) were recruited between October 2020 and April 2021 to participate in an online survey. Respondents categorised their preferred, usual and current cigarillo flavours. Individuals who preferred tobacco flavours were compared with individuals who preferred any other flavours. Strength of preferences, or flavour loyalty, was defined when an individual’s preferred flavour matched what they use both usually and currently creating a spectrum of individuals with a strong tobacco preference (n=34), weak tobacco preference (n=20), weak flavour preference (n=162) and strong flavour preference (n=315). Those preferring tobacco were aggregated into any tobacco preference (n=54). Results Individuals who preferred any flavour scored higher on a scale of nicotine dependence. There was a dose–response relationship in those who said they would discontinue cigarillos if flavoured options were not available: 11.4% of individuals with any tobacco flavour preference, 27.8% of those with a weak flavour preference and 38.1% of those with a strong flavour preference. A similar trend was noted among those who would switch to another product: 19.2% of those with tobacco flavour preference, 34.3% of those with a weak flavour preference and 43.2% of those with a strong flavour preference. Conclusion Individuals who display strong flavour preferences were more likely to say they would discontinue use or seek out alternative flavoured products following a ban on flavoured cigarillos.
Collapse
Affiliation(s)
- Stephanie Pike Moore
- Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Catherine Osborn
- Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Sarah Koopman Gonzalez
- Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | | | - Elizabeth G Klein
- College of Public Health, Ohio State University, Columbus, Ohio, USA
| | - Manpreet Kaur
- Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Jessica Suratkal
- Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Erika Trapl
- Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| |
Collapse
|
25
|
Yang Y, Lindblom EN, Ward KD, Salloum RG. How Smokers of Menthol Cigarettes and Flavored Cigars Might Respond to FDA's Proposed Bans. Nicotine Tob Res 2022; 24:1645-1653. [PMID: 35353183 PMCID: PMC9575974 DOI: 10.1093/ntr/ntac078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/16/2022] [Accepted: 03/26/2022] [Indexed: 11/14/2022]
Abstract
INTRODUCTION A ban on menthol cigarettes and flavored cigars may reduce smoking and tobacco-related disparities. AIMS AND METHODS We aimed to examine the response of current smokers to a hypothetical ban on menthol cigarettes and flavored cigars. Current smokers were recruited online and reported the alternative products that they may switch to under a hypothetical ban, if they would try to obtain the banned products from illicit channels, and their support to the ban. RESULTS 51% of current smokers would use nonflavored cigarettes and cigars as alternatives, 45% would switch to flavored heated tobacco products or e-cigarettes or quit smoking. 17% would try to obtain the banned flavored products from illicit markets. A majority of menthol only smokers opposed the ban. Daily smokers would be more likely to switch to nonflavored smoking, to try illicit market products, and were less supportive of the ban. Black smokers would be less likely to switch to nonflavored smoking and were more supportive of the ban. Smokers who used menthol cigarettes only would be more likely to switch to nonflavored smoking, less likely to try illicit market sellers, and were the least supportive of the ban. CONCLUSIONS In response to a ban of all added flavors for cigarettes or cigars, nearly half of the current smokers would quit smoking, largely by switching to nonsmoking products. However, smokers with more chronic use and those who used only menthol cigarettes would be more likely to switch to nonflavored smoking, diminishing the harm reduction potential. The ban may decrease the relatively higher prevalence of menthol cigarette smoking among Blacks compared with other groups. IMPLICATIONS A ban on the sale of menthol cigarettes and flavored cigars may decrease the prevalence of smoking because some current smokers may quit smoking and switch to nonsmoking products. However, smokers with more chronic use and those who used menthol cigarettes only were more likely to switch to nonflavored cigarettes or cigars, diminishing the harm reduction potential of the ban. Black smokers would be more likely to switch to products other than cigarettes and cigars thus decreasing their relatively higher prevalence of smoking compared with other groups.
Collapse
Affiliation(s)
- Yong Yang
- School of Public Health, University of Memphis, Memphis, TN, USA
| | - Eric N Lindblom
- O’Neill Institute for National & Global Health Law, Georgetown University Law Center, Washington, DC, USA
| | - Kenneth D Ward
- School of Public Health, University of Memphis, Memphis, TN, USA
| | - Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, USA
| |
Collapse
|
26
|
Abeyesundere N, Osborn CC, Pike Moore S, Suratkal JP, Kaur M, Otieno C, Quisenberry AJ, Klein EG, Trapl ES. Substitution of flavored cigarillos with menthol cigarettes among young adults in the U.S. Drug Alcohol Depend 2022; 239:109603. [PMID: 35987085 PMCID: PMC10983117 DOI: 10.1016/j.drugalcdep.2022.109603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/08/2022] [Accepted: 08/11/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Young adult cigarillo users often cite flavor as a primary reason for initiating and sustaining product use and are more likely to concurrently use other tobacco products such as menthol cigarettes. This study examines substitution with menthol cigarettes among cigarillo users facing a hypothetical ban on flavored cigarillos. METHODS Current young adult (21-28 years) cigarillo users were recruited from October 2020 to April 2021 for an online survey about cigarillo and other tobacco use behaviors. Participants (n = 500) self-reported past or current menthol cigarette experience, and if they would switch to menthol cigarettes if they could not get flavored cigarillos. Logistic regression was used to test differences in switching behaviors by level of experience with menthol cigarettes. RESULTS Most young adult cigarillo users (76.8 %) had ever used a menthol cigarette and 46.6 % reported current use of menthol cigarettes. No participant who had never used menthol cigarettes reported they would switch to menthol cigarettes. Current users were 4.2 times as likely to say they would switch after controlling for demographic characteristics and nicotine dependence. CONCLUSION Most young adult cigarillo users reported they would not switch to menthol cigarettes if flavored cigarillos became unavailable. However, participants who currently use or have used menthol cigarettes were more likely to report their intention to switch products than those who had never used menthol cigarettes. There may be a subsequent increase in menthol cigarette use among past menthol cigarette users if policies restricting flavored tobacco products exclude menthol cigarettes, diluting these policies' intended population health impact.
Collapse
Affiliation(s)
- Nichele Abeyesundere
- Department of Population and Quantitative Health Sciences, Prevention Research Center for Healthy Neighborhoods at Case Western Reserve University, Cleveland, OH, the United States of America
| | - Catherine C Osborn
- Department of Population and Quantitative Health Sciences, Prevention Research Center for Healthy Neighborhoods at Case Western Reserve University, Cleveland, OH, the United States of America
| | - Stephanie Pike Moore
- Department of Population and Quantitative Health Sciences, Prevention Research Center for Healthy Neighborhoods at Case Western Reserve University, Cleveland, OH, the United States of America
| | - Jessica P Suratkal
- Department of Population and Quantitative Health Sciences, Prevention Research Center for Healthy Neighborhoods at Case Western Reserve University, Cleveland, OH, the United States of America
| | - Manpreet Kaur
- Department of Population and Quantitative Health Sciences, Prevention Research Center for Healthy Neighborhoods at Case Western Reserve University, Cleveland, OH, the United States of America
| | - Christopher Otieno
- Department of Population and Quantitative Health Sciences, Prevention Research Center for Healthy Neighborhoods at Case Western Reserve University, Cleveland, OH, the United States of America
| | - Amanda J Quisenberry
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, the United States of America
| | - Elizabeth G Klein
- Division of Health Behavior & Health Promotion, The Ohio State University College of Public Health, Columbus, OH, the United States of America
| | - Erika S Trapl
- Department of Population and Quantitative Health Sciences, Prevention Research Center for Healthy Neighborhoods at Case Western Reserve University, Cleveland, OH, the United States of America.
| |
Collapse
|
27
|
Satchell T, Diaz MC, Stephens D, Bertrand A, Schillo BA, Whitsel LP. The impact of two state-level approaches to restricting the sale of flavored tobacco products. BMC Public Health 2022; 22:1799. [PMID: 36138373 PMCID: PMC9493160 DOI: 10.1186/s12889-022-14172-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 09/08/2022] [Indexed: 12/05/2022] Open
Abstract
Background Flavored tobacco products are highly appealing to youth. The Federal government lacks a comprehensive flavored tobacco products policy and states have adopted different approaches restricting these products. This study analyzes the impact of Massachusetts’ comprehensive prohibition and New Jersey’s partial restriction on the sale of flavored tobacco products. Methods NielsenIQ Retail Scanner data were used to construct four log per capita dependent variables: e-liquid milliliters, cigarette packs, cigars, and smokeless tobacco ounces for products flavored as fruit, menthol, mint, tobacco and other. All models used difference-in-differences regressions, with Virginia and Pennsylvania serving as controls. The models controlled for state level product prices, population percentages by race/ethnicity, proportion male, median household income, unemployment rate, minimum legal sales age, tobacco 21 policies, and cumulative cases and deaths of COVID-19; the models accounted for time-specific factors by using 4-week period fixed-effects. Results There was a significant decrease in sales across all flavored tobacco products in Massachusetts, including fruit [-99.83%, p < 0.01], menthol [-98.33%, p < 0.01], and all other flavored [-99.28%, p < 0.01] e-cigarettes. The cigar group “all other-flavors" [-99.92%, p < 0.01] and menthol flavored cigarettes [-95.36%, p < 0.01] also significantly decreased. In New Jersey, there was a significant decrease in per capita sales of menthol-flavored e-cigarettes [-83.80%, p < 0.05] and cigar group “all other-flavors" experienced a significant increase in per capita sales [380.66%, p < 0.01]. Conclusions This study contributes to the growing body of evidence demonstrating the impact of sales prohibitions on reducing sales of flavored tobacco products. Statewide comprehensive approaches appear more effective than partial restrictions and should be prioritized. Implications Results from this study support emerging research that demonstrates the promising effects of comprehensive flavoring sales prohibitions. This study can be used to inform future flavored tobacco product policy solutions developed by advocates and policy makers to curb overall tobacco initiation and use by youth and adults.
Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14172-y.
Collapse
|
28
|
Galimov A, Vassey J, Galstyan E, Unger JB, Kirkpatrick MG, Allem JP. 'Ice' flavor-related discussions on Twitter: a content analysis (Preprint). J Med Internet Res 2022; 24:e41785. [DOI: 10.2196/41785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/26/2022] [Accepted: 11/09/2022] [Indexed: 11/10/2022] Open
|
29
|
Gades MS, Alcheva A, Riegelman AL, Hatsukami DK. The Role of Nicotine and Flavor in the Abuse Potential and Appeal of Electronic Cigarettes for Adult Current and Former Cigarette and Electronic Cigarette Users: A Systematic Review. Nicotine Tob Res 2022; 24:1332-1343. [PMID: 35305014 PMCID: PMC9356694 DOI: 10.1093/ntr/ntac073] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 01/31/2022] [Accepted: 03/16/2022] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Many adult cigarette smokers use electronic cigarettes (e-cigarettes) to cut down on or quit smoking cigarettes. E-cigarettes with higher abuse potential and appeal might facilitate complete switching. E-liquid nicotine concentration and flavor are two of the characteristics that may affect the abuse potential and appeal of e-cigarettes. The objective of this systematic review was to compile results from survey, animal, human laboratory, and clinical studies to understand the possible effects of nicotine concentration and flavor on abuse potential and appeal of e-cigarettes in adult current and former cigarette and e-cigarette users. AIMS AND METHODS A comprehensive literature search was conducted in Ovid Medline and PsycINFO followed by citation tracking in Web of Science Core Collection. Peer-reviewed studies published in English between 2007 and August 2020 were selected that analyzed differences between e-liquid nicotine concentration and/or flavors, had outcome measures related to abuse potential and/or appeal, and included adult humans (18+) or animals. A total of 1624 studies were identified and screened. A qualitative synthesis of results was performed. RESULTS Results from 104 studies included in this review suggest that higher nicotine concentration and access to a variety of flavors are likely to be associated with higher abuse potential and appeal of e-cigarettes for adult current and former cigarette and e-cigarette users. CONCLUSIONS Higher nicotine concentrations and the availability of a variety of flavors in e-cigarettes might facilitate complete substitution for cigarettes. Future e-cigarette regulations should take into account their impact on smokers, for whom e-cigarettes may be a cessation tool or reduced-harm alternative. IMPLICATIONS E-cigarettes may provide a reduced-harm alternative to cigarettes for smokers unwilling/unable to quit or serve as a path for quitting all nicotine products. Higher nicotine concentrations and flavor variety are associated with higher abuse potential and appeal of e-cigarettes. Higher abuse potential and appeal products may help facilitate complete switching from cigarettes to e-cigarettes. Regulation of nicotine concentration and flavors aimed at decreasing naïve uptake may inadvertently decrease uptake and complete switching among smokers, reducing the harm reduction potential of e-cigarettes. Evidence-based effects of regulating nicotine concentration and flavors must be considered for the population as a whole, including smokers.
Collapse
Affiliation(s)
- Mari S Gades
- Department of Psychology, University of Minnesota, 75 E. River Road, Minneapolis, MN, 55454, USA
| | - Aleksandra Alcheva
- Division of Environmental Health Sciences, School of Public Health and Masonic Cancer Center, University of Minnesota, 2231 6th Street SE, Minneapolis, MN 55455, USA
| | - Amy L Riegelman
- Social Sciences Department, University of Minnesota Libraries, 309 19 Avenue S., Minneapolis, MN, 55455, USA
| | - Dorothy K Hatsukami
- Masonic Cancer Center and Department of Psychiatry and Behavioral Sciences, University of Minnesota, 717 Delaware St. SE, Minneapolis, MN, 55414, USA
| |
Collapse
|
30
|
Bansal-Travers M, Rivard C, Silveira ML, Kimmel H, Poonai K, Bernat JK, Jackson K, Rudy S, Johnson A, Cullen KA, Goniewicz M, Travers M, Hyland A, Villanti A, Hrywna M, Abrams D, Fong G, Elton-Marshall T, Stanton C, Sharma E. Factors associated with changes in flavored tobacco products used: Findings from wave 2 and wave 3 (2014-2016) of the population assessment of tobacco and health (PATH) study. Addict Behav 2022; 130:107290. [PMID: 35220150 PMCID: PMC9316535 DOI: 10.1016/j.addbeh.2022.107290] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 12/07/2021] [Accepted: 02/18/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Flavored non-cigarette tobacco product use is widespread in the U.S. The availability of flavor options could be playing a role in recent increases in use, especially for non-cigarette tobacco products, among youth and young adults. Little is known about specific flavor preferences of youth and adult flavored tobacco product users, as well as how preferences may change over time. METHODS This study analyzes PATH Study data from completed Wave 2 (2014-2015) and Wave 3 (2015-2016) youth (12-17 years), and adult (18 + years) interviews to estimate the prevalence of flavored non-cigarette tobacco product use. We assess flavor switching by examining changes between flavors and characteristics of those who changed flavors between waves. RESULTS Across age groups, and at both waves, fruit-flavored products were the most frequently used flavor by past 30-day electronic nicotine delivery systems (ENDS), cigar, cigarillo, and hookah users. In the past 30 days, a higher proportion of youth and young adults used candy/sweets-flavored ENDS than adults. Among adult ENDS users, the odds of changing flavors were highest among younger users and decreased with increasing age. CONCLUSIONS Flavored tobacco product use is prevalent across non-cigarette tobacco products. Stability in the number of flavors used, as well as specific flavors, is higher among adult tobacco users, while the use of multiple flavors, and change in specific flavor, is more prevalent among youth tobacco users. Additional longitudinal research can further examine the role flavors play in appeal, product trial, and switching.
Collapse
Affiliation(s)
- Maansi Bansal-Travers
- Department of Health Behavior, Division of Cancer Prevention & Population Sciences, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.
| | - Cheryl Rivard
- Department of Health Behavior, Division of Cancer Prevention & Population Sciences, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Marushka L Silveira
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA; Kelly Government Solutions, Rockville, MD, USA
| | - Heather Kimmel
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA
| | - Karl Poonai
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - Jennifer K Bernat
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - Kia Jackson
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - Susan Rudy
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - Amanda Johnson
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - Karen A Cullen
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - Maciej Goniewicz
- Department of Health Behavior, Division of Cancer Prevention & Population Sciences, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Mark Travers
- Department of Health Behavior, Division of Cancer Prevention & Population Sciences, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Andrew Hyland
- Department of Health Behavior, Division of Cancer Prevention & Population Sciences, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Andrea Villanti
- University of Vermont, College of Arts and Sciences, Department of Psychological Science, Burlington, VT, USA
| | - Mary Hrywna
- Rutgers School of Public Health, Department of Health Behavior, Society and Policy, Newark, NJ, USA
| | - David Abrams
- New York University, College of Global Public Health, New York, NY, USA
| | - Geoffrey Fong
- University of Waterloo, Department of Psychology, Waterloo, ON, Canada
| | | | | | | |
Collapse
|
31
|
Dissonance in Young Adult Cigarillo Users' Categorization of Concept Flavored and Unflavored Products. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127219. [PMID: 35742467 PMCID: PMC9223595 DOI: 10.3390/ijerph19127219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/01/2022] [Accepted: 06/08/2022] [Indexed: 01/27/2023]
Abstract
This study asks young adult cigarillo users to categorize their preferred flavor in order to examine user consensus and potential methodological and regulatory implications of flavor name-based categorization systems. Young adult (21–28 years) cigarillo users (n = 426) named and categorized their favorite cigarillo flavor into one of seven categories: Fruit, Sweet and Candy, Mint, Alcohol, Menthol, Tobacco, and Other. Flavor responses were coded as characterizing (ex: Grape, Wine) or concept (ex: Jazz, Diamond) flavors. Variation within and between categories was assessed, including the presence of concept flavors and the placement of flavors in multiple categories. Of the 66 unique flavor names provided, participants placed 20 (30.1%) in more than one flavor category. Most of the Tobacco (76.9%) and Other (69.2%) flavor names appeared in multiple categories. The majority of flavor names in the Tobacco (69.2%) and Other (61.5%) categories were concept flavors. Concept flavors were placed in multiple categories (45.0%) twice as often as characterizing flavors (23.9%). This study has identified dissonance among cigarillo users’ flavor categorizations, particularly for concept flavored and unflavored products. Flavor names may obscure how and whether a product is flavored. Research on and regulation of flavored tobacco products should classify products by flavor additives rather than by name alone.
Collapse
|
32
|
Olson LT, Coats EM, Rogers T, Brown EM, Nonnemaker J, Ross AM, Delahanty J, Xu X. Youth Tobacco Use Before and After Local Sales Restrictions on Flavored and Menthol Tobacco Products in Minnesota. J Adolesc Health 2022; 70:978-984. [PMID: 35272928 PMCID: PMC9133141 DOI: 10.1016/j.jadohealth.2022.01.129] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 01/04/2022] [Accepted: 01/09/2022] [Indexed: 11/15/2022]
Abstract
PURPOSE Minneapolis and St. Paul, Minnesota, implemented sales restrictions on all flavored tobacco products in 2016 ("flavor policy") and expanded the restrictions to menthol tobacco products in 2018 ("menthol policy"). We examined data from surveys of Minnesota youth collected before and after the flavor and menthol policies. METHODS We measured changes in youth tobacco use prevalence using data from the Minnesota Youth Tobacco Survey and the Minnesota Student Survey. We analyzed tobacco use overall and, where possible, by product category and flavor category among survey respondents in the Twin Cities area (including Minneapolis and St. Paul) and the rest of the state of Minnesota (ROS). RESULTS In the Minnesota Youth Tobacco Survey, overall youth use of any tobacco product significantly increased in ROS (by 26.6%) but did not change in the Twin Cities after the flavor policies. Similarly, the Minnesota Student Survey showed the youth use of any tobacco product increased to a greater extent in ROS (by 44.6%) than that in the Twin Cities (by 34.6%) after implementation of the menthol policies. In both surveys, increases in youth use of particular tobacco products were less pronounced in the Twin Cities relative to the rest of the state. DISCUSSION Policies restricting sales of all flavored and menthol tobacco products may be associated with attenuated increases in youth use of tobacco product categories. Policy exemptions and proximity to nonpolicy jurisdictions may have diluted the effect of policies on overall tobacco product use among youth tobacco users.
Collapse
Affiliation(s)
| | - Ellen M Coats
- RTI International, Research Triangle Park, North Carolina
| | - Todd Rogers
- RTI International, Research Triangle Park, North Carolina
| | | | | | - Ashley M Ross
- Food and Drug Administration, Center for Tobacco Products, FDA White Oak Campus, Silver Spring, Maryland
| | - Janine Delahanty
- Food and Drug Administration, Center for Tobacco Products, FDA White Oak Campus, Silver Spring, Maryland
| | - Xin Xu
- Food and Drug Administration, Center for Tobacco Products, FDA White Oak Campus, Silver Spring, Maryland
| |
Collapse
|
33
|
Hammond D, Reid JL, Burkhalter R, Bansal Travers M, Gravelly S, Hyland A, Kasza K, McNeill A. E-Cigarette Flavors, Devices, and Brands Used by Youths Before and After Partial Flavor Restrictions in the United States: Canada, England, and the United States, 2017-2020. Am J Public Health 2022; 112:1014-1024. [PMID: 35622007 DOI: 10.2105/ajph.2022.306780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To examine the impact of US restrictions implemented in February 2020 prohibiting flavors other than menthol and tobacco in cartridge-based e-cigarettes. Methods. We analyzed 5 cross-sectional waves of the International Tobacco Control Policy Evaluation Project Youth Tobacco and Vaping Surveys, conducted online with youths aged 16 to 19 years in the United States, Canada, and England, for differences in usual e-cigarette flavor, device, and brand reported by past-30-day vapers (n = 9512) before (2017, 2018, 2019), during (February 2020), and after (August 2020) implementation of US flavor restrictions. Results. In August 2020, 78.7% of vapers in the United States reported using a flavor prohibited in cartridges or pods, versus 86.3% in Canada (adjusted odds ratio [AOR] = 1.73; 95% CI = 1.25, 1.40) and 79.8% in England (AOR = 1.10; 95% CI = 0.78, 1.55). Disposable e-cigarettes (exempt from flavor restrictions) increased to a greater extent among vapers in the United States (13.2% to 36.8%) versus Canada (7.7% to 14.2%; AOR = 2.01; 95% CI = 1.33, 3.04) and England (10.8% to 16.4%; AOR = 2.33; 95% CI = 1.52, 3.57). Puff Bar (disposable) emerged as the most popular brand in the United States. Conclusions. Usual flavors used by youth vapers in the United States were unchanged after 2020 restrictions on cartridge-based e-cigarettes. Youths used brands and devices exempt from the restrictions. (Am J Public Health. Published online ahead of print May 26, 2022: e1-e11. https://doi.org/10.2105/AJPH.2022.306780).
Collapse
Affiliation(s)
- David Hammond
- David Hammond, Jessica L. Reid, and Robin Burkhalter are with the School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada. Maansi Bansal Travers, Andy Hyland, and Karin Kasza are with the Roswell Park Comprehensive Cancer Center, Buffalo, NY. Shannon Gravely is with the Department of Psychology, University of Waterloo. Ann McNeill is with the Department of Addictions, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Jessica L Reid
- David Hammond, Jessica L. Reid, and Robin Burkhalter are with the School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada. Maansi Bansal Travers, Andy Hyland, and Karin Kasza are with the Roswell Park Comprehensive Cancer Center, Buffalo, NY. Shannon Gravely is with the Department of Psychology, University of Waterloo. Ann McNeill is with the Department of Addictions, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Robin Burkhalter
- David Hammond, Jessica L. Reid, and Robin Burkhalter are with the School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada. Maansi Bansal Travers, Andy Hyland, and Karin Kasza are with the Roswell Park Comprehensive Cancer Center, Buffalo, NY. Shannon Gravely is with the Department of Psychology, University of Waterloo. Ann McNeill is with the Department of Addictions, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Maansi Bansal Travers
- David Hammond, Jessica L. Reid, and Robin Burkhalter are with the School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada. Maansi Bansal Travers, Andy Hyland, and Karin Kasza are with the Roswell Park Comprehensive Cancer Center, Buffalo, NY. Shannon Gravely is with the Department of Psychology, University of Waterloo. Ann McNeill is with the Department of Addictions, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Shannon Gravelly
- David Hammond, Jessica L. Reid, and Robin Burkhalter are with the School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada. Maansi Bansal Travers, Andy Hyland, and Karin Kasza are with the Roswell Park Comprehensive Cancer Center, Buffalo, NY. Shannon Gravely is with the Department of Psychology, University of Waterloo. Ann McNeill is with the Department of Addictions, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Andy Hyland
- David Hammond, Jessica L. Reid, and Robin Burkhalter are with the School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada. Maansi Bansal Travers, Andy Hyland, and Karin Kasza are with the Roswell Park Comprehensive Cancer Center, Buffalo, NY. Shannon Gravely is with the Department of Psychology, University of Waterloo. Ann McNeill is with the Department of Addictions, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Karin Kasza
- David Hammond, Jessica L. Reid, and Robin Burkhalter are with the School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada. Maansi Bansal Travers, Andy Hyland, and Karin Kasza are with the Roswell Park Comprehensive Cancer Center, Buffalo, NY. Shannon Gravely is with the Department of Psychology, University of Waterloo. Ann McNeill is with the Department of Addictions, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Ann McNeill
- David Hammond, Jessica L. Reid, and Robin Burkhalter are with the School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada. Maansi Bansal Travers, Andy Hyland, and Karin Kasza are with the Roswell Park Comprehensive Cancer Center, Buffalo, NY. Shannon Gravely is with the Department of Psychology, University of Waterloo. Ann McNeill is with the Department of Addictions, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| |
Collapse
|
34
|
Gaber J, Gammon DG, Lee YO, Nonnemaker J, Young B, Kim A, Porter L. JUUL's 2019 Removal of Mint-Flavored Pods and Changes to the Retail Environment of Electronic Nicotine Delivery Systems in Florida and the United States. Nicotine Tob Res 2022; 24:1748-1755. [PMID: 35569072 DOI: 10.1093/ntr/ntac128] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 01/17/2022] [Accepted: 05/11/2022] [Indexed: 11/14/2022]
Abstract
INTRODUCTION The increase in youth electronic nicotine delivery system (ENDS) use coincided with JUUL's rapid rise, which prompted investigations and lawsuits aimed at this leading brand. In response, JUUL discontinued sweet flavors in late 2018, followed by mint flavors in November 2019. We assessed ENDS sales and prices at both the state and national level before and after JUUL's removal of mint flavors. METHODS Nielsen retail sales data on ENDS products from convenience and food stores in 4-week aggregates were analyzed between January 2019 and January 2020 in Florida and the United States. Standardized units were created. Unit market share and growth rates were calculated for top brands and flavors in the periods before and after JUUL's mint removal. Average prices within brand and product type were calculated. RESULTS Following JUUL's removal of mint in November 2019, JUUL's market share dropped from over 66% in Florida and the United States to 37.1% (Florida) and 55.1% (United States). In January 2020, the second leading brands were Puff Bar (15.0%) in Florida and Vuse (18.1%) in the United States. Mint market share decreased and share of all other flavor categories increased, particularly menthol and concept. Total ENDS sales increased in Florida but decreased in the United States. Average prices of ENDS devices decreased. CONCLUSIONS While JUUL's actions led to a decline in its sales, Puff Bar emerged and menthol and concept flavors experienced growth. Findings also demonstrate how changes by influential brands differentially affect purchase patterns at the national and state level. IMPLICATIONS These findings support the growing body of evidence that tobacco industry self-regulation, with selective flavor removal by the leading ENDS brand in this case, is insufficient to reduce total ENDS sales, including sales of flavored products which are preferred by youth. Results suggest that brand and flavor substitution compensated for the removal of mint JUUL pods. Understanding changes to the ENDS market in response to industry actions, at both the state and national level, can inform future regulation and interventions. These findings can also inform efforts to prevent and reduce youth ENDS use.
Collapse
Affiliation(s)
- Jennifer Gaber
- RTI International, Center for Health Analytics, Media, and Policy
| | - Doris G Gammon
- RTI International, Center for Health Analytics, Media, and Policy
| | - Youn Ok Lee
- RTI International, Center for Health Analytics, Media, and Policy
| | - James Nonnemaker
- RTI International, Center for Health Analytics, Media, and Policy
| | - Brittany Young
- RTI International, Center for Health Analytics, Media, and Policy
| | - Annice Kim
- RTI International, Center for Health Analytics, Media, and Policy
| | | |
Collapse
|
35
|
Flocke SA, Ishler K, Albert E, Cavallo D, Lim R, Trapl E. Measuring nicotine dependence among adolescent and young adult cigarillo users. Nicotine Tob Res 2022; 24:1789-1797. [PMID: 35512368 PMCID: PMC9596997 DOI: 10.1093/ntr/ntac117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 03/11/2022] [Accepted: 05/02/2022] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Current measures of nicotine dependence (ND) were developed and validated for cigarette smokers only, limiting their utility for other combustible tobacco users. This study evaluates the psychometric properties of a pool of new and adapted items to measure ND among cigarillo and multiple tobacco product users. METHODS Items were drawn from the PROMIS Nicotine Dependence Item Bank which were adapted to be product neutral and new items were developed from a qualitative study of 60 adolescent and young adult cigarillo smokers. A total of 42 ND items were included in a web-based survey. Eligible participants were 14 to 28 year olds who smoked a minimum of 2 cigarillos per week. Analyses included confirmatory factor analysis, item response theory analysis, analysis of differential item functioning (DIF) and reliability. Ordinary least square regression was used to test the association of ND score with deciles of nicotine consumption. RESULTS Among the 1089 participants, the median number of cigarillos smoked per week was 20; 54% of participants also smoked cigarettes. All PROMIS items and 8 of 10 new items met the IRT fit criteria. Two PROMIS items had non-ignorable DIF. The pool of 40 items had good score reliability for a range of 2 standard deviations. Twenty-, eight-, and four-item short forms showed similarly good measurement properties; each was positively associated with decile of nicotine consumption, p<.001; R 2 = 0.33. CONCLUSIONS This adapted bank of ND items is psychometrically sound and includes items that are product neutral, making it suitable for assessing ND among cigarillo and polytobacco users. IMPLICATIONS This study rigorously evaluates adapted items to measure ND among cigarillo and polytobacco users and reports the reliability initial evidence of validity of short form scores.
Collapse
Affiliation(s)
- Susan A Flocke
- Department of Family Medicine, Oregon Health & Science University, Portland OR, USA
| | - Karen Ishler
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland OH, USA
| | - Elizabeth Albert
- Center for Community Health Integration, Case Western Reserve University, Cleveland OH,USA
| | - David Cavallo
- Department of Nutrition, Case Western Reserve University, Cleveland OH, USA
| | - Rock Lim
- Case Western Reserve University, Center for Community Health Integration, Cleveland OH, USA
| | - Erika Trapl
- Department of Population and Quantitative Health Sciences and the Prevention Research Center for Healthy Neighborhoods, Case Western Reserve University, Cleveland OH, USA
| |
Collapse
|
36
|
Notley C, Gentry S, Cox S, Dockrell M, Havill M, Attwood AS, Smith M, Munafò MR. Youth use of e-liquid flavours-a systematic review exploring patterns of use of e-liquid flavours and associations with continued vaping, tobacco smoking uptake or cessation. Addiction 2022; 117:1258-1272. [PMID: 34784651 PMCID: PMC9299186 DOI: 10.1111/add.15723] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 10/01/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS There is concern that young people may be attracted to e-liquid flavours, prompting long-term vaping in naive users and potentially subsequent tobacco smoking. We aimed to review the use of e-liquid flavours by young people and describe associations with uptake or cessation of both regular vaping and tobacco smoking, adverse effects and subjective experiences. DESIGN Systematic review, including interventional, observational and qualitative studies reporting on the use of e-cigarette flavours by young people (aged < 18 years). SETTING Studies published in English language from any country or cultural setting. PARTICIPANTS Young people and their carers (aged < 18 years). MEASUREMENTS A meta-analysis was not possible due to substantial heterogeneity, inconsistency in reporting of flavour categorizations and non-interventional study designs; thus, we narratively report findings. FINDINGS In total, 58 studies were included. The quality of the evidence was extremely low. Most (n = 39) studies were cross-sectional survey designs. In total, 11 longitudinal cohort studies assessed trajectories; eight qualitative studies reported on user experiences. Studies reported views and experiences of a total of 512 874 young people. Both cross-sectional and longitudinal studies suggested that flavours are important for initiation and continuation of vaping. Qualitative evidence shows interest and enjoyment in flavours. There was judged to be insufficient evidence that use of e-liquid flavours specifically is associated with uptake of smoking. No studies found clear associations between flavours and cessation in this population. We found no included reports of adverse effects of flavours. CONCLUSIONS Flavours may be an important motivator for e-cigarette uptake, but the role of flavours in tobacco smoking uptake or cessation is unclear. The quality of the evidence on use of e-cigarette flavours by young people is low overall.
Collapse
Affiliation(s)
- Caitlin Notley
- Norwich Medical SchoolUniversity of East AngliaNorwichUK
| | - Sarah Gentry
- Norwich Medical SchoolUniversity of East AngliaNorwichUK
| | - Sharon Cox
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | | | | | - Angela S. Attwood
- School of Psychological ScienceUniversity of BristolBristolUK,MRC Integrative Epidemiology Unit at University of BristolBristolUK
| | - Matthew Smith
- Norwich Medical SchoolUniversity of East AngliaNorwichUK
| | - Marcus R. Munafò
- School of Psychological ScienceUniversity of BristolBristolUK,MRC Integrative Epidemiology Unit at University of BristolBristolUK,NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and School of Psychological ScienceUniversity of BristolBristolUK
| |
Collapse
|
37
|
Holmes LM, Lempert LK, Ling PM. Flavored Tobacco Sales Restrictions Reduce Tobacco Product Availability and Retailer Advertising. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3455. [PMID: 35329145 PMCID: PMC8953832 DOI: 10.3390/ijerph19063455] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/10/2022] [Accepted: 03/12/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE This study examined differences in the availability and advertising of flavored tobacco products before and after flavored tobacco sales restrictions were enacted in Alameda and San Francisco Counties in California. MAIN OUTCOME MEASURES Data were collected from a sample of tobacco retailers in Alameda and San Francisco Counties at two time points: 2015, before flavored tobacco policies were enacted, and in 2019-2020, after some cities had enacted policies. Retailers were separated by city into Category 1 (n = 442)-retailers in cities that enacted a flavored tobacco policy between the two data collection periods, and Category 2 (n = 89), those that had not. Means comparison tests were conducted to evaluate significant differences over time and by category. RESULTS There was significantly reduced availability of menthol cigarettes, flavored little cigars, smokeless tobacco, vape pens, and Blu brand menthol e-cigarettes between 2015 and 2020 in Category 1 retailers. Category 2 retailers had reduced availability only for Blu menthol e-cigarettes and demonstrated an increase in smokeless tobacco availability. Exterior store advertising for cigarettes, little cigars, cigars, and e-cigarettes also decreased significantly in Category 1 cities relative to Category 2 cities; 8.1% of Category 1 stores were advertising flavored tobacco products in 2019-2020 compared to 36.2% of Category 2 stores. There was also a 78% reduction in flavored ads between 2015-2019 in Category 1 cities compared to a 38% decrease in Category 2 cities. Tobacco advertising inside Category 2 stores increased. Finally, Category 2 cities had significantly greater availability of cigalikes, mod or tank vapes, flavored e-cigarettes, and e-liquids compared to Category 1 cities. CONCLUSIONS Comprehensive flavored sales restriction policies reduce flavored tobacco availability and tobacco advertising, which may help prevent youth tobacco initiation and exposure.
Collapse
Affiliation(s)
- Louisa M. Holmes
- Departments of Geography and Demography, The Pennsylvania State University, University Park, PA 16802, USA
| | - Lauren Kass Lempert
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA 94117, USA; (L.K.L.); (P.M.L.)
| | - Pamela M. Ling
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA 94117, USA; (L.K.L.); (P.M.L.)
| |
Collapse
|
38
|
Chew R, Wenger M, Guillory J, Nonnemaker J, Kim A. Identifying Electronic Nicotine Delivery System Brands and Flavors on Instagram: Natural Language Processing Analysis. J Med Internet Res 2022; 24:e30257. [PMID: 35040793 PMCID: PMC8808345 DOI: 10.2196/30257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 11/01/2021] [Accepted: 11/21/2021] [Indexed: 01/30/2023] Open
Abstract
Background Electronic nicotine delivery system (ENDS) brands, such as JUUL, used social media as a key component of their marketing strategy, which led to massive sales growth from 2015 to 2018. During this time, ENDS use rapidly increased among youths and young adults, with flavored products being particularly popular among these groups. Objective The aim of our study is to develop a named entity recognition (NER) model to identify potential emerging vaping brands and flavors from Instagram post text. NER is a natural language processing task for identifying specific types of words (entities) in text based on the characteristics of the entity and surrounding words. Methods NER models were trained on a labeled data set of 2272 Instagram posts coded for ENDS brands and flavors. We compared three types of NER models—conditional random fields, a residual convolutional neural network, and a fine-tuned distilled bidirectional encoder representations from transformers (FTDB) network—to identify brands and flavors in Instagram posts with key model outcomes of precision, recall, and F1 scores. We used data from Nielsen scanner sales and Wikipedia to create benchmark dictionaries to determine whether brands from established ENDS brand and flavor lists were mentioned in the Instagram posts in our sample. To prevent overfitting, we performed 5-fold cross-validation and reported the mean and SD of the model validation metrics across the folds. Results For brands, the residual convolutional neural network exhibited the highest mean precision (0.797, SD 0.084), and the FTDB exhibited the highest mean recall (0.869, SD 0.103). For flavors, the FTDB exhibited both the highest mean precision (0.860, SD 0.055) and recall (0.801, SD 0.091). All NER models outperformed the benchmark brand and flavor dictionary look-ups on mean precision, recall, and F1. Comparing between the benchmark brand lists, the larger Wikipedia list outperformed the Nielsen list in both precision and recall. Conclusions Our findings suggest that NER models correctly identified ENDS brands and flavors in Instagram posts at rates competitive with, or better than, others in the published literature. Brands identified during manual annotation showed little overlap with those in Nielsen scanner data, suggesting that NER models may capture emerging brands with limited sales and distribution. NER models address the challenges of manual brand identification and can be used to support future infodemiology and infoveillance studies. Brands identified on social media should be cross-validated with Nielsen and other data sources to differentiate emerging brands that have become established from those with limited sales and distribution.
Collapse
Affiliation(s)
- Rob Chew
- Center for Data Science, RTI International, Research Triangle Park, NC, United States
| | - Michael Wenger
- Center for Data Science, RTI International, Research Triangle Park, NC, United States
| | - Jamie Guillory
- Center for Health Analytics, Media, and Policy, RTI International, Research Triangle Park, NC, United States
| | - James Nonnemaker
- Center for Health Analytics, Media, and Policy, RTI International, Research Triangle Park, NC, United States
| | - Annice Kim
- Center for Health Analytics, Media, and Policy, RTI International, Research Triangle Park, NC, United States
| |
Collapse
|
39
|
Parms TA, Head SK, Sawdey MD, Rostron BL, Cullen KA. Characteristics of Past 30-Day Cigar Smoking, U.S. Adolescents, 2020. Am J Prev Med 2022; 62:e39-e44. [PMID: 34497029 DOI: 10.1016/j.amepre.2021.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/13/2021] [Accepted: 06/10/2021] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Data from the 2019 National Youth Tobacco Survey indicated that cigars were the most commonly used combustible tobacco product in the past 30 days among youth. This study uses 2020 National Youth Tobacco Survey data to report the prevalence estimates and characteristics of current cigar use, overall and by cigar type, among middle- and high-school students in the U.S. METHODS Weighted prevalence estimates and 95% CIs were calculated in 2020 for overall cigar use and by cigar type. RESULTS In 2020, current cigar smoking was reported by 3.5% of students (1.5% middle school and 5.0% high school). Cigarillos (44.1%) were the most reported cigar type smoked, followed by regular (33.1%) and little (22.6%) cigars; 21.8% did not know the cigar type. Most cigar smokers were in high school (81.2%) and were male (52.4%), and 42.3% were non-Hispanic White. More than half of cigar smokers reported smoking flavored cigars (58.3%), with fruit (61.5%), candy/desserts/other sweets (34.0%), and mint (30.4%) as the most frequently reported flavor categories. Approximately 1 in 5 current cigar smokers (18.4%) smoked on ≥20 days in the past 30 days, and 78.8% reported multiple tobacco product use. CONCLUSIONS Cigar smoking was highest among non-Hispanic Black and Hispanic youth. More than half of youth cigar smokers reported using flavored cigars, and most were also currently using other tobacco products. Cigarillos were the most reported cigar type used by youth, followed by regular cigars. These findings highlight the continued importance of youth tobacco use reduction strategies and can inform policy development.
Collapse
Affiliation(s)
- Tiffany A Parms
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, Maryland.
| | - Sara K Head
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Michael D Sawdey
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Brian L Rostron
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Karen A Cullen
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, Maryland
| |
Collapse
|
40
|
Awareness, use and perceptions of cigarillos, heated tobacco products and nicotine pouches: A survey among Dutch adolescents and adults. Drug Alcohol Depend 2021; 229:109136. [PMID: 34763136 DOI: 10.1016/j.drugalcdep.2021.109136] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/29/2021] [Accepted: 10/04/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Many tobacco and related products (TRPs) are less strictly regulated and marketed as less harmful than cigarettes. Little is known about their awareness, use, user profile, use behavior, reasons for use and risk perception, especially for the newest products. In an exploratory survey study among Dutch adolescents and adults, we have investigated three examples of non-cigarette TRPs available on the worldwide market. METHODS In a two-step web-based design, data on cigarillos, heated tobacco products (HTPs) and nicotine pouches were collected. In the first step (N = 5805), a representative sample (≥13 years) was studied to quantify their awareness, ever and current use in the Dutch population. In the second step (N = 526), in-depth data regarding use behavior, reasons for use and risk perception were collected among users and non-users. RESULTS Awareness (<50%) and use (<15% ever use and <2% current use) is relatively low for all three products, but overall higher among men, (e-)cigarette users and respondents with higher education and social economic status. Most participants became aware of the products through people they knew. Reasons for use were mainly curiosity, pleasant taste, flavour variety, and lower harmfulness. All products were perceived as (slightly) less harmful and addictive than cigarettes. CONCLUSIONS This study is one of the first to investigate awareness and use of cigarillos, HTPs and nicotine pouches. To prevent increased use, we recommend regulators to extend flavour and smoking bans to these products. In addition, public information may discourage use by increasing awareness of health risks.
Collapse
|
41
|
Impact of Little Cigars and Cigarillos Packaging Features on Product Preference. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111443. [PMID: 34769959 PMCID: PMC8583443 DOI: 10.3390/ijerph182111443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/24/2021] [Accepted: 10/26/2021] [Indexed: 11/22/2022]
Abstract
Background: We conducted a discrete choice experiment (DCE) among young adult cigarette smokers in the period July–August 2018 to examine their preference for cigarillos in response to various packaging-related attributes, including flavor, flavor description, quality descriptors, pack size, and prices. Methods: A convenience sample of 566 US young adult cigarette smokers aged 18–34, among whom 296 were current little cigar and cigarillo (LCC) smokers, were recruited using Facebook ads and invited to participate in an online (Qualtrics) tobacco survey containing DCE and tobacco use questions. In the experiment, participants chose among two cigarillo products or “neither” (opt-out). Results: We analyzed preferences for LCCs using multinomial, nested, random parameter logit models. Results showed that young adult cigarette smokers preferred grape over menthol, tobacco/regular, and wine flavors; “color only” and “color and text” flavor depictions over text only; “smooth” and “sweet” quality descriptors over “satisfying”; and larger pack sizes and lower prices. Conclusions: Regulating packaging-related features will impact LCC choices among US young adult smokers. FDA regulation over these packaging-related features may impact LCC use among young adult smokers.
Collapse
|
42
|
Leventhal AM, Dai H. Prevalence of Flavored e-Cigarette Use Among Subpopulations of Adults in the United States. J Natl Cancer Inst 2021; 113:418-424. [PMID: 32785659 DOI: 10.1093/jnci/djaa118] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 07/29/2020] [Accepted: 08/05/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Evidence of US adult flavored e-cigarette use prevalence stratified by age, smoking status, and purpose for vaping (ie, quitting smoking, to use when or where smoking is not allowed) can inform policies that reduce the tobacco-related cancer burden. METHODS Current flavored e-cigarette use (use 1 or more nontobacco flavors) prevalence estimates were compared across subpopulation groups using 2-sided statistical significance tests in the July 2018 Current Population Survey Tobacco Use Supplement, a nationally representative cross-sectional adult survey (n = 46 759). RESULTS Current flavored e-cigarette use was reported by 1.6% (95% confidence interval [CI] = 1.47% to 1.69%) of all respondents. Among current vapers, the percentage of those who used flavored e-cigarettes was higher for adults aged 18-24 years (89.6%), 25-34 years (86.7%), and 35-44 years (76.0%) than for adults aged 45 years and older (60.4%, Ps < .001); was higher in never smokers (89.8%) than current (72.9%), long-term former (73.9%), and recent former (80.4%) smokers (Ps ≤ .009); was higher in smokers who reportedly did (78.9%) vs did not (71.1%) use e-cigarettes to vape where or when smoking is not allowed (P = .005); and did not differ between smokers who reportedly did (75.0%) vs did not (73.9%) vape to quit smoking (P = .71). Individuals who vaped to quit smoking and currently used flavored e-cigarettes constituted 0.9% (95% CI = 0.82% to 0.99%) of all adults (weighted N = 2 251 000, 95% CI = 2 046 000 to 2 476 000) and 57.2% of current flavored e-cigarette users. CONCLUSIONS Flavored e-cigarette use prevalence was low among US adults overall but common for current vapers. Flavored e-cigarette use was disproportionately prevalent among never smokers and other subpopulations that might experience harm from vaping.
Collapse
Affiliation(s)
- Adam M Leventhal
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA.,Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Hongying Dai
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| |
Collapse
|
43
|
Sterling K, Vishwakarma M, Ababseh K, Henriksen L. Flavors And Implied Reduced-Risk Descriptors In Cigar Ads At Stores Near Schools. Nicotine Tob Res 2021; 23:1895-1901. [PMID: 34214176 DOI: 10.1093/ntr/ntab136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 07/01/2021] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Although the FDA prohibits using inaccurate, reduced-risk descriptors on tobacco product advertising, descriptors that imply reduced-risk or an enhanced user experience may be present on cigar product advertising in retail outlets near schools. Therefore, to inform the development of federal labeling and advertising requirements that reduce youth appeal of cigars, we conducted a content analysis of cigar ads in retailers near schools to document the presence of implied health claims and other selling propositions that may convey enhanced smoking experience. METHODS Up to four interior and exterior LCC advertisements were photographed in a random sample of licensed tobacco retailers (n=530) near California middle and high schools. Unique ads (n= 234) were coded for brand, flavor, and presence of implicit health claims, premium branding descriptors, and sensory descriptors. Logistic regressions assessed the association among flavored ads and presence of implicit health claims, premium branding, or sensory descriptors. RESULTS Seventeen cigar brands were advertised near schools; Black & Mild (20.1%) and Swisher Sweets (20.1%) were most common. Flavor was featured in 64.5% of ads, with explicit flavor names (e.g., grape) being more prevalent than ambiguous names (e.g., Jazz) (49.6% vs. 34.2%). Compared to ads without flavors, ads with ambiguous flavors were more likely to feature implicit health claims (OR=1.83, 95%CI=1.06, 3.19) and sensory descriptors (OR=2.64, 95%CI=1.39, 5.04); ads with explicit flavors were more likely to feature premium branding (OR=2.84, 95%CI=1.53, 5.41). CONCLUSIONS Cigar ads that featured implicit health claims and premium branding, and sensory selling propositions are present at retailer stores near schools.
Collapse
Affiliation(s)
- Kymberle Sterling
- Department of Health Promotion & Behavioral Sciences, School of Public Health, The University of Texas Health Science Center, Dallas Campus, 6011 Harry Hines Blvd., V8.112, Dallas, Texas
| | - Monika Vishwakarma
- Stanford Prevention Research Center, Stanford University School of Medicine, 3300 Hillview Ave, Palo Alto, CA
| | - Kimberly Ababseh
- Stanford Prevention Research Center, Stanford University School of Medicine, 3300 Hillview Ave, Palo Alto, CA
| | - Lisa Henriksen
- Stanford Prevention Research Center, Stanford University School of Medicine, 3300 Hillview Ave, Palo Alto, CA
| |
Collapse
|
44
|
Toxicology of flavoring- and cannabis-containing e-liquids used in electronic delivery systems. Pharmacol Ther 2021; 224:107838. [PMID: 33746051 DOI: 10.1016/j.pharmthera.2021.107838] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/11/2021] [Indexed: 12/15/2022]
Abstract
Electronic cigarettes (e-cigarettes) were introduced in the United States in 2007 and by 2014 they were the most popular tobacco product amongst youth and had overtaken use of regular tobacco cigarettes. E-cigarettes are used to aerosolize a liquid (e-liquid) that the user inhales. Flavorings in e-liquids is a primary reason for youth to initiate use of e-cigarettes. Evidence is growing in the scientific literature that inhalation of some flavorings is not without risk of harm. In this review, 67 original articles (primarily cellular in vitro) on the toxicity of flavored e-liquids were identified in the PubMed and Scopus databases and evaluated critically. At least 65 individual flavoring ingredients in e-liquids or aerosols from e-cigarettes induced toxicity in the respiratory tract, cardiovascular and circulatory systems, skeletal system, and skin. Cinnamaldehyde was most frequently reported to be cytotoxic, followed by vanillin, menthol, ethyl maltol, ethyl vanillin, benzaldehyde and linalool. Additionally, modern e-cigarettes can be modified to aerosolize cannabis as dried plant material or a concentrated extract. The U.S. experienced an outbreak of lung injuries, termed e-cigarette, or vaping, product use-associated lung injury (EVALI) that began in 2019; among 2,022 hospitalized patients who had data on substance use (as of January 14, 2020), 82% reported using a delta-9-tetrahydrocannabinol (main psychoactive component in cannabis) containing e-cigarette, or vaping, product. Our literature search identified 33 articles related to EVALI. Vitamin E acetate, a diluent and thickening agent in cannabis-based products, was strongly linked to the EVALI outbreak in epidemiologic and laboratory studies; however, e-liquid chemistry is highly complex, and more than one mechanism of lung injury, ingredient, or thermal breakdown product may be responsible for toxicity. More research is needed, particularly with regard to e-cigarettes (generation, power settings, etc.), e-liquids (composition, bulk or vaped form), modeled systems (cell type, culture type, and dosimetry metrics), biological monitoring, secondhand exposures and contact with residues that contain nicotine and flavorings, and causative agents and mechanisms of EVALI toxicity.
Collapse
|
45
|
Crosby L, Yucesoy B, Leggett C, Tu Z, Belinsky SA, McDonald J, Leng S, Wu G, Irshad H, Valerio LG, Rosenfeldt H. Smoke Chemistry, In Vitro Cytotoxicity, and Genotoxicity Demonstrates Enhanced Toxicity of Cigarillos Compared With Cigarettes. Toxicol Sci 2021; 180:122-135. [PMID: 33021639 DOI: 10.1093/toxsci/kfaa155] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023] Open
Abstract
There has been limited toxicity testing of cigarillos, including comparison to cigarettes. This study compared the smoke chemistry and the cytotoxic and genotoxic potential of 10 conventional cigarettes and 10 cigarillos based on the greatest market share. Whole smoke and total particulate matter (TPM) were generated using the Canadian Intense and International Organization for Standardization puffing protocols. Tobacco-specific nitrosamines, carbonyls, and polycyclic aromatic hydrocarbons were measured using gas chromatography-mass spectrometry. TPM smoke extracts were used for the in vitro assays. Cytotoxicity was assessed in human bronchial epithelial continuously cultured cell line cells using the neutral red uptake assay. Genotoxic potential was assessed using the micronucleus (human lung adenocarcinoma continuously cultured cell line cells), Ames, and thymidine kinase assays. TPM from all cigarillos tested was more cytotoxic than cigarettes. Micronucleus formation was significantly greater for cigarillos compared with cigarettes at the highest dose of TPM, with or without rat liver S9 fraction. In the Ames test +S9, both tobacco products exhibited significant dose-dependent increases in mutation frequency, indicating metabolic activation is required for genotoxicity. In the thymidine kinase assay +S9, cigarillos showed a significantly enhanced mutation frequency although both tobacco products were positive. The levels of all measured polycyclic aromatic hydrocarbons, tobacco-specific nitrosamines, and carbonyls (except acrolein) were significantly greater in cigarillos than cigarettes. The Canadian Intense puffing protocol demonstrated increased smoke constituent levels compared with International Organization for Standardization. Even though the gas vapor phase was not tested, the results of this study showed that under the tested conditions the investigated cigarillos showed greater toxicity than comparator cigarettes. This study found that there is significantly greater toxicity in the tested U.S. marketed cigarillos than cigarettes for tobacco constituent levels, cytotoxicity, and genotoxicity. These findings are important for understanding the human health toxicity from the use of cigarillos relative to cigarettes and for building upon knowledge regarding harm from cigarillos to inform risk mitigation strategies.
Collapse
Affiliation(s)
- Lynn Crosby
- Center for Tobacco Products, Office of Science, U.S. Food and Drug Administration, Silver Spring, Maryland 20993
| | - Berran Yucesoy
- Center for Tobacco Products, Office of Science, U.S. Food and Drug Administration, Silver Spring, Maryland 20993
| | - Carmine Leggett
- Center for Tobacco Products, Office of Science, U.S. Food and Drug Administration, Silver Spring, Maryland 20993
| | - Zheng Tu
- Center for Tobacco Products, Office of Science, U.S. Food and Drug Administration, Silver Spring, Maryland 20993
| | - Steven A Belinsky
- Lovelace Respiratory Research Institute, Albuquerque, New Mexico, 87108
| | - Jake McDonald
- Lovelace Respiratory Research Institute, Albuquerque, New Mexico, 87108
| | - Shuguang Leng
- Lovelace Respiratory Research Institute, Albuquerque, New Mexico, 87108
| | - Guodong Wu
- Lovelace Respiratory Research Institute, Albuquerque, New Mexico, 87108
| | - Hammad Irshad
- Lovelace Respiratory Research Institute, Albuquerque, New Mexico, 87108
| | - Luis G Valerio
- Center for Tobacco Products, Office of Science, U.S. Food and Drug Administration, Silver Spring, Maryland 20993
| | - Hans Rosenfeldt
- Center for Tobacco Products, Office of Science, U.S. Food and Drug Administration, Silver Spring, Maryland 20993
| |
Collapse
|
46
|
Dai H, Khan AS. A Longitudinal Study of Exposure to Tobacco-Related Toxicants and Subsequent Respiratory Symptoms Among U.S. Adults with Varying E-cigarette Use Status. Nicotine Tob Res 2020; 22:S61-S69. [PMID: 33320254 PMCID: PMC8628872 DOI: 10.1093/ntr/ntaa180] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/19/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND The link between e-cigarette use and subsequent development of respiratory diseases remains an open question. AIMS AND METHODS A subset of a probability sample of U.S. adults from the Population Assessment of Tobacco and Health Study Waves 1 and 2 were selected for biospecimen analysis (n = 4614). Subjects were divided into three mutually exclusive groups at baseline: nonusers (n = 2849), exclusive e-cigarette users (n = 222), and poly e-cigarette/tobacco users (n = 1,543). Geometric mean concentrations of baseline biomarkers from five classes of harmful and potentially harmful constituents were reported. Multivariable linear regressions were conducted to examine the relationship between baseline biomarkers and subsequent respiratory symptoms among user groups. RESULTS Baseline exclusive e-cigarette users (33.6%[confidence interval, CI: 26.7% to 41.4%]) and poly e-cigarette/tobacco users (50.8%[CI: 47.4% to 54.2%]) had higher prevalence of subsequent respiratory symptoms than nonusers (21.7%[19.2% to 24.4%]). As compared with nonusers, poly e-cigarette/tobacco users had higher concentrations in clinically relevant biomarkers at baseline than exclusive e-cigarette users. Among poly e-cigarette/tobacco users, baseline nicotine metabolites (TNE2, cotinine), tobacco-specific nitrosamine (NNAL), PAH (1-NAP, 3-FLU), and volatile organic compound (N-Acetyl-S-(2-carboxyethyl)-l-cysteine, N-acetyl-S-(2-cyanoethyl)-l-cysteine) were significantly higher among those reporting subsequent respiratory symptoms than those who did not. Among exclusive e-cigarette users, baseline NNAL was significantly higher among those reporting subsequent respiratory symptoms than those who did not. Within subjects with subsequent respiratory symptoms, NNAL was 2.5 times higher in exclusive e-cigarette users (10.7[6.5 to 17.5]) and 63.4 times higher in poly e-cigarette/tobacco users (199.6[176.7 to 225.4]) than nonusers (3.1[2.4 to 3.9]). CONCLUSIONS E-cigarette use is associated with higher concentrations of known tobacco-related toxicants and risks of subsequent respiratory symptoms than nonusers. Poly e-cigarette/tobacco users exhibit higher risk than exclusive e-cigarette users. IMPLICATIONS This longitudinal study identified positive associations between baseline urinary biomarkers of exposure to tobacco-related toxicants and increased risks of subsequent respiratory symptoms across varying e-cigarette use groups. E-cigarette use is associated with increased exposure to known tobacco-related toxicants, and certain toxicant exposure increases the risk of respiratory symptoms.
Collapse
Affiliation(s)
- Hongying Dai
- College of Public Health, University of Nebraska Medical
Center, Omaha, NE, USA
| | - Ali S Khan
- College of Public Health, University of Nebraska Medical
Center, Omaha, NE, USA
| |
Collapse
|
47
|
Maier LJ, Ramo DE, Kaur M, Meacham MC, Satre DD. Factors associated with readiness to quit smoking among young adults enrolled in a Facebook-based tobacco and alcohol intervention study. Addict Behav 2020; 111:106524. [PMID: 32791434 PMCID: PMC8262102 DOI: 10.1016/j.addbeh.2020.106524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 06/15/2020] [Accepted: 06/23/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Young adults who smoke cigarettes often report heavy episodic drinking (HED) and co-use of other psychoactive substances which may complicate efforts to quit cigarette smoking. The current study examined factors associated with readiness to quit cigarette smoking among young adults who smoke and engage in HED. METHODS One hundred seventy-nine young adults aged 18 to 25 who reported regular cigarette smoking and past month HED enrolled in the 90-day Facebook-based Smoking Tobacco and Drinking (STAND) intervention study. Analyses compared baseline differences in patterns of cigarette smoking and alcohol and cannabis use, thoughts about abstinence, use of nicotine replacement therapy (NRT), sociodemographic characteristics, and other health behaviors between participants who were ready to quit cigarette smoking in the next 30 days and those who were not. RESULTS Participants were 40.2% female, 49.7% male, 10.1% non-binary, and 80.4% Non-Hispanic White. They reported on average moderate nicotine dependence (FTCD), moderate risk for alcohol use disorder (AUDIT), and occasional or regular cannabis use. Readiness to quit cigarette smoking in the next 30 days (33.5%) was positively associated with age (p = .021), NRT use in the past 30 days (p = .037) and perceived importance to also reduce alcohol use (p = .033). CONCLUSIONS Findings indicate that readiness to quit cigarette smoking among young adults who drink is positively associated with importance to reduce alcohol use, but not with use patterns or levels of dependence. Interventions addressing polysubstance use may be better suited to help young adults reduce or quit cigarette smoking once they signal readiness for behavior change.
Collapse
Affiliation(s)
- Larissa J Maier
- Department of Psychiatry and Weill Institute for Neurosciences, University of California, San Francisco, CA, United States; Early Postdoc. Mobility Grantee (P2ZHP1_174812), Swiss National Science Foundation, Bern, Switzerland.
| | - Danielle E Ramo
- Department of Psychiatry and Weill Institute for Neurosciences, University of California, San Francisco, CA, United States.
| | - Manpreet Kaur
- Department of Psychiatry and Weill Institute for Neurosciences, University of California, San Francisco, CA, United States.
| | - Meredith C Meacham
- Department of Psychiatry and Weill Institute for Neurosciences, University of California, San Francisco, CA, United States.
| | - Derek D Satre
- Department of Psychiatry and Weill Institute for Neurosciences, University of California, San Francisco, CA, United States; Kaiser Permanente Northern California, Division of Research, Oakland, CA, United States.
| |
Collapse
|
48
|
Schneller LM, Li D, Tavárez ZQ, Goniewicz ML, Quisenberry AJ, Xie Z, Rahman I, McIntosh S, O'Connor RJ, Ossip DJ. Flavor Inconsistencies between Flavored Tobacco Products among US Adults. Am J Health Behav 2020; 44:617-630. [PMID: 33121580 DOI: 10.5993/ajhb.44.5.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective: Banning flavors in some tobacco products, while allowing them in others, may shift consumer preferences towards products in which flavors are still allowed. In this study, we examine flavor popularity and inconsistencies in flavor preference across non-cigarette tobacco products among US adults. Methods: We used data from the Population Assessment of Tobacco and Health Study Wave 3 to assess the prevalence of flavor preference for users of non-cigarette tobacco products (N = 9037), as well as flavor inconsistencies between products among polyusers (N = 3183). Results: Most users of flavored tobacco products reported using one flavor category per product. Fruit and tobacco were among the most commonly used flavor categories of ENDS, hookah, traditional cigars, and cigarillo/filtered cigars. Menthol/mint was the most common flavor among snus/smokeless users. Polyusers of ENDS and traditional cigars had the largest inconsistency, where about 68%-76% used different flavors across products. Conversely, polyusers of traditional cigars and cigarillos/filtered cigars had the lowest inconsistency (25%-28%). Conclusions: Flavor preferences differed according to product, suggesting that consumers are not likely to switch across products to maintain a flavor preference. Future research should assess flavor preferences prospectively to improve understanding of the potential benefits of flavor bans.
Collapse
Affiliation(s)
- Liane M. Schneller
- Postdoctoral Fellow, the Clinical and Translational Science Institute, University of Rochester Medical Center, Rochester, NY;,
| | - Dongmei Li
- Associate Professor, the Clinical and Translational Science Institute, University of Rochester Medical Center, Rochester, NY
| | - Zahíra Quiñones Tavárez
- Doctorate Student, Translational Biomedical Science, University of Rochester Medical Center, Rochester, NY
| | - Maciej L. Goniewicz
- Associate Professor of Oncology, Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Amanda J. Quisenberry
- Assistant Professor of Oncology, Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Zidian Xie
- Senior Analyst and Programmer, the Clinical and Translational Science Institute, University of Rochester Medical Center, Rochester, NY
| | - Irfan Rahman
- Professor, Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY
| | - Scott McIntosh
- Associate Professor, Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY
| | - Richard J. O'Connor
- Professor of Oncology, Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Deborah J. Ossip
- Professor, Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY
| |
Collapse
|
49
|
Little MA, Pebley K, Porter K, Talcott GW, Krukowski RA. 'I Think Smoking's the Same, but the Toys Have Changed.' Understanding Facilitators of E-Cigarette Use among Air Force Personnel. JOURNAL OF ADDICTION & PREVENTION 2020; 8:7. [PMID: 33204766 PMCID: PMC7668561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The military has stringent anti-tobacco regulations for new recruits. While most tobacco products have declined in recent years, e-cigarette use has tripled among this population. However, little is known about the factors facilitating this inverse relationship. OBJECTIVES Examine the facilitators of e-cigarette use during a high risk period following initial enlistment among young adults. METHODS Focus groups were conducted with Airmen, Military Training Leaders (MTLs) and Technical Training Instructors (TTIs) to qualitatively explore unique characteristics of e-cigarettes leading to use in Technical Training. RESULTS The most commonly used tobacco product across participants was cigarettes (42.7%), followed by e-cigarettes (28.0%) and smokeless tobacco (22.6%). Almost a third (28.7%) of participants reported using more than one tobacco product. E-cigarette use was much more common among Airmen (76.1%), compared to MTLs (10.9%) and TTIs (13.0%).Four main facilitators around e-cigarette use were identified including: 1) There is no reason not to use e-cigarettes; 2) Using e-cigarettes helps with emotion management; 3) Vaping is a way of fitting in; and 4) Existing tobacco control policies don't work for vaping. E-cigarettes were not perceived as harmful to self and others, which could explain why Airmen were much less likely to adhere to existing tobacco control regulations. Subversion was viewed as the healthy option compared to utilizing designated tobacco use areas due to the potential exposure to traditional tobacco smoke. This coupled with a lack of understanding about e-cigarette regulations and difficulties with enforcement, promoted use among this young adult population. CONCLUSION Findings suggest that e-cigarettes are used for similar reasons as traditional tobacco products, but their unique ability to be concealed promotes their widespread use and circumvents existing tobacco control policies. In order to see reductions in use, environmental policies may need to be paired with behavioral interventions at the personal and interpersonal level.
Collapse
Affiliation(s)
- MA Little
- University of Virginia, School of Medicine, Department of
Public Health Sciences, 560 Ray C. Hunt Drive, Charlottesville, VA, USA,Address for Correspondence Little MA,
University of Virginia, School of Medicine, Department of Public Health
Sciences, 560 Ray C. Hunt Drive, Rm 2119 Charlottesville, VA, USA, 22903;
| | - K Pebley
- University of Memphis, Department of Psychology, 400
Innovation Drive, Memphis, TN, USA, 38152
| | - K Porter
- University of Virginia, School of Medicine, Department of
Public Health Sciences, 560 Ray C. Hunt Drive, Charlottesville, VA, USA
| | - GW Talcott
- University of Virginia, School of Medicine, Department of
Public Health Sciences, 560 Ray C. Hunt Drive, Charlottesville, VA, USA,Wilford Hall Ambulatory Surgical Center, 59 MDW/ 59 SGOWMP,
1100 Wilford Hall Loop, Bldg 4554, Joint Base Lackland AFB, TX, USA 78236
| | - RA Krukowski
- Department of Preventive Medicine, University of Tennessee
Health Science Center, 66 North Pauline Street, Memphis, TN, USA 38163
| |
Collapse
|