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Gratale SK, Chen-Sankey J, Ganz O, Teotia A, Strasser AA, Schroth K, Delnevo CD, Wackowski OA. Does noticing cigar warnings associate with cigar harm perceptions and smoking behaviors? Analysis from Wave 5 of the population assessment of tobacco and health study. Addict Behav 2024; 152:107958. [PMID: 38290323 DOI: 10.1016/j.addbeh.2024.107958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/17/2023] [Accepted: 01/17/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND In the US, cigar warning label standards are less stringent than cigarette warning requirements and are not uniformly required; research is needed about warning efficacy in promoting cigar risk beliefs, discouraging use and supporting public health. METHODS Using data from the PATH Study (Wave 5), we analyzed associations between noticing cigar warnings and perceived harm from cigar use, frequency of thinking about harms, and effects of warnings labels. RESULTS Among adults who smoke cigars, respondents noticing warnings at least sometimes (vs. never/rarely) had higher odds of thinking about harms of their tobacco use often/very often (cigarillos 30% vs. 19%, p <.001, aOR 1.80 [1.27, 2.56]); filtered cigars: 43% vs. 16%, p <.001, aOR 3.81 [2.50, 5.82]) and of reporting that smoking cigars is very/extremely harmful (cigarillos: 59% vs. 46%, p =.001, aOR 1.45 [1.05, 1.99]). A substantial majority found cigar warnings to be very/extremely believable (cigarillos: 63%, filtered cigars: 59%, traditional cigars: 65%), with 16%, 24% and 12% respectively reporting past-30-day warning avoidance. Those noticing warnings at least sometimes (vs. rarely) had higher rates of reporting that warnings sometimes/often/very often stopped them from having a cigar in the past 30 days (cigarillos: 36% vs. 10%; filtered cigars: 50% versus 6%; traditional cigars: 30% versus 9%; p's < 0.001) and that warnings made them somewhat/a lot more likely to quit smoking (cigarillos: 55% versus 37%, p <.01; filtered cigars: 55% versus 26%, p <.001; traditional cigars: 39% vs. 24%, p <.05). CONCLUSIONS Results support potential public health benefits of mandating the presence and increasing salience of cigar warning labels.
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Affiliation(s)
- Stefanie K Gratale
- Rutgers Institute for Nicotine & Tobacco Studies, Rutgers Biomedical and Health Sciences, Rutgers University, New Brunswick, NJ 08901, USA; Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Rutgers University, Piscataway, NJ 08854, USA.
| | - Julia Chen-Sankey
- Rutgers Institute for Nicotine & Tobacco Studies, Rutgers Biomedical and Health Sciences, Rutgers University, New Brunswick, NJ 08901, USA; Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Rutgers University, Piscataway, NJ 08854, USA.
| | - Ollie Ganz
- Rutgers Institute for Nicotine & Tobacco Studies, Rutgers Biomedical and Health Sciences, Rutgers University, New Brunswick, NJ 08901, USA; Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Rutgers University, Piscataway, NJ 08854, USA.
| | - Arjun Teotia
- The Nicholas C. Petris Center on Health Care Markets and Consumer Welfare, University of California - Berkeley, Berkeley, CA 94720, USA.
| | - Andrew A Strasser
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
| | - Kevin Schroth
- Rutgers Institute for Nicotine & Tobacco Studies, Rutgers Biomedical and Health Sciences, Rutgers University, New Brunswick, NJ 08901, USA; Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Rutgers University, Piscataway, NJ 08854, USA.
| | - Cristine D Delnevo
- Rutgers Institute for Nicotine & Tobacco Studies, Rutgers Biomedical and Health Sciences, Rutgers University, New Brunswick, NJ 08901, USA; Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Rutgers University, Piscataway, NJ 08854, USA.
| | - Olivia A Wackowski
- Rutgers Institute for Nicotine & Tobacco Studies, Rutgers Biomedical and Health Sciences, Rutgers University, New Brunswick, NJ 08901, USA; Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Rutgers University, Piscataway, NJ 08854, USA.
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Mays D, Johnson AC, Jeong M, Ganz O, Audrain-McGovern J, Strasser AA, Delnevo CD. Tobacco minimum packaging policy to reduce cigarillo use among young people: results of an experimental study. Tob Control 2024; 33:164-170. [PMID: 35840318 PMCID: PMC9840711 DOI: 10.1136/tc-2022-057304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 07/06/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVE The Food and Drug Administration has the authority to set a minimum for cigar pack size, a product feature linked to price. This study examined the effects of cigarillo package size and price on young adults' smoking and purchase intentions. DESIGN Young adults (n=1032) 18-30 years old who smoked cigarillos in the past 12 months completed an online 3×2 within-subjects experiment testing the effects of cigarillo pack size (1, 2, 5) and price (actual price, standardised price per stick) on intentions to purchase and smoke cigarillos. We modelled the main effects and interactions of pack size and price on intentions to buy and smoke cigarillos overall and by cigarillo use frequency. RESULTS Intentions to buy and smoke were strongest for lower priced singles and two packs compared with higher priced five packs. Under standardised price conditions, participants preferred larger packs, but under actual pricing conditions smaller packs, especially two packs, were preferred. Participants who smoked cigarillos less than monthly were more likely to buy and smoke the least expensive products (buy: singles actual price adjusted OR (aOR)=4.51, 95% CI 3.76 to 5.42; two packs actual price aOR=9.76, 95% CI 8.11 to 11.75; five packs standardised price aOR=3.17, 95% CI 2.89 to 3.48) with the strongest preference for two packs and singles. CONCLUSIONS Young adult cigarillo smokers prefer smaller packs in conditions where pricing incentivises smaller packs. Minimum pack size policies may reduce the appeal of cigarillos among young adults, especially less frequent cigarillo smokers. Pack size policy should take into consideration price, and ideally these two factors should be addressed together.
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Affiliation(s)
- Darren Mays
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Deparment of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Andrea C Johnson
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine and Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michelle Jeong
- Rutgers Center for Tobacco studies, Rutgers Biomedical Health Sciences, Rutgers University and Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Ollie Ganz
- Rutgers Center for Tobacco studies, Rutgers Biomedical Health Sciences, Rutgers University and Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Janet Audrain-McGovern
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine and Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrew A Strasser
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine and Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Cristine D Delnevo
- Rutgers Center for Tobacco studies, Rutgers Biomedical Health Sciences, Rutgers University and Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
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DeAtley T, Stone MD, Strasser AA, Audrain-McGovern J. The role of IQOS risk perceptions on cigarette smoking behaviours: results from a prospective pilot study. Tob Control 2024; 33:263-266. [PMID: 36002165 PMCID: PMC10394684 DOI: 10.1136/tc-2022-057461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/09/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND IQOS is a heated tobacco product marketed as an alternative to combustible cigarette smoking. Little is known about cigarette smokers' IQOS health risk perceptions and if these risk perceptions impact IQOS use and cigarette smoking behaviour. METHODS Adult, daily, non-treatment-seeking cigarette smokers (n=27), naïve to IQOS, were recruited from Philadelphia, Pennsylvania, USA. Participants were introduced to IQOS and then completed measures of risk perceptions. Participants were given an IQOS 2.4 holder, charger and HeatSticks, and asked to switch completely from cigarettes to IQOS for 14 days. The effects of risk perceptions on changes in IQOS use, cigarettes per day (CPD), the substitution of IQOS for cigarettes and motivation to quit smoking were evaluated. RESULTS Over the 14-day switch period, CPD significantly decreased (B=-0.18, 95% CI=-0.26 to -0.09, p<0.0001), IQOS use significantly increased (B=0.02, 95% CI=0.00 to 0.03, p=0.042), as did the percentage IQOS HeatSticks that replaced CPD (B=0.02, 95% CI=0.01 to 0.03, p=0.005). Participants who perceived IQOS as less risky than cigarettes used fewer IQOS HeatSticks per day. A lower percentage of IQOS HeatStick substitution for cigarettes was observed for participants with higher versus lower risk perceptions (B=-0.14, 95% CI=-0.28 to -0.01, p=0.042). Motivation to quit increased from a mean of 5.53 to 6.79 on the contemplation ladder from baseline to day 14 (B=1.26, 95% CI=0.54 to 1.97, p<0.001). CONCLUSIONS Smokers reduced their smoking rate and increased motivation to quit smoking while using IQOS. IQOS risk perceptions did not directly account for reductions in smoking, although they may contribute indirectly through increased IQOS use.
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Affiliation(s)
- Teresa DeAtley
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Matthew D Stone
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrew A Strasser
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Janet Audrain-McGovern
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Mercincavage M, Waugh LK, Gratale S, Wackowski O, Pearson JL, House K, O'Connor R, Strasser AA. Acute effects of charcoal filters and package color on cigarette perceptions and use behaviors: Results from a randomized pilot study examining Natural American Spirit "Sky". Drug Alcohol Depend 2024; 255:111080. [PMID: 38198898 PMCID: PMC10843540 DOI: 10.1016/j.drugalcdep.2024.111080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/01/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024]
Abstract
INTRODUCTION Charcoal-filtered cigarettes have been available for decades but have never held a major share of the U.S. cigarette market. This pilot study gathered initial behavioral data characterizing how "Sky"-a recently introduced charcoal-filtered cigarette variety that uses potentially misleading marketing features-is used and what impact its packaging color has on consumer perceptions. METHODS Forty adult daily non-menthol cigarettes users (52.5% male, 75.0% White, mean age = 46.1, 14.3 mean cigarettes/day) completed a single-session deception study utilizing a 2 ×2 mixed factorial design to manipulate cigarette filter condition (charcoal vs. non-charcoal) and pack color (light vs. dark). Participants smoked two cigarettes identical in appearance and packaging but differing in filter type (blinded and order counterbalanced) and completed pre- and post-cigarette CO samples and post-cigarette questionnaires. RESULTS Participants endorsed more favorable subjective ratings, puffed less of, held more correct beliefs about risks, and expressed greater intentions to use the charcoal (vs. non-charcoal)-filtered cigarette (p's <0.05). Pack color had few effects on outcomes; however, cigarettes in light vs. dark colored packs were rated as cleaner tasting (p <0.01). Neither filter condition nor pack color affected CO boost. There were no interaction effects on any outcomes. CONCLUSIONS Under blinded conditions, Sky charcoal-filtered cigarettes are initially appealing independent of their packaging color. Findings warrant further study of these effects on perceptions, behavior, and harm exposure after longer, open-label use periods. Findings may inform regulatory decisions regarding cigarette packaging and filter composition.
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Affiliation(s)
- Melissa Mercincavage
- Rutgers Institute for Nicotine and Tobacco Studies, New Brunswick, NJ, United States; University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, United States; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States.
| | - Lizza K Waugh
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Stefanie Gratale
- Rutgers Institute for Nicotine and Tobacco Studies, New Brunswick, NJ, United States; University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, United States
| | - Olivia Wackowski
- Rutgers Institute for Nicotine and Tobacco Studies, New Brunswick, NJ, United States; University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, United States
| | - Jennifer L Pearson
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, United States; University of Nevada-Reno, Reno, NV, United States
| | - Kendra House
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Richard O'Connor
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Andrew A Strasser
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, United States; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
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Strickland JC, Gelino BW, Naudé GP, Harbaugh JC, Schlitzer RD, Mercincavage M, Strasser AA, Johnson MW. Effect of nicotine expectancy and nicotine dose reduction on cigarette demand, withdrawal alleviation, and puff topography. Drug Alcohol Depend 2024; 254:111042. [PMID: 38086213 PMCID: PMC10872246 DOI: 10.1016/j.drugalcdep.2023.111042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/10/2023] [Accepted: 11/22/2023] [Indexed: 12/22/2023]
Abstract
BACKGROUND Current FDA plans include proposed nicotine reduction mandates by the end of 2023. Most research on reduced nicotine cigarettes has been dose-blinded, while a mandate would be known to the public. Few laboratory studies have examined specifically how low nicotine content labeling impacts behavioral response. The purpose of this within-subject, balanced-placebo, human laboratory study was to evaluate the main and interactive effects of nicotine dose expectancy and dose reduction on cigarette reinforcement, withdrawal alleviation, and puff topography. METHODS Participants who smoke daily (N=21; 9 female) completed one practice and four experimental sessions in which expectancy (labeled "average" versus "very low" nicotine) and nicotine dose (0.80mg versus 0.03mg yield) were manipulated. Participants in acute withdrawal sampled experimental cigarettes followed by withdrawal alleviation and puff topography measures. Cigarette demand was measured using an incentivized purchase task. Analyses evaluated main and interactive effects of expectancy and nicotine dose. RESULTS Nicotine dose manipulation produced expected physiological effects (e.g., heart rate increases) and both reduced nicotine dose and expectation manipulations reduced perceived nicotine content. Expectation of reduced nicotine alone or in combination with reduced nicotine dose did not alter demand, withdrawal alleviation, or topography. Effective withdrawal alleviation was observed in all conditions. CONCLUSIONS These data inform nicotine regulation policy by suggesting limited compensatory harms caused by reduced nicotine expectations. The minimal acute effects of reduced nicotine expectancy or exposure on demand suggests that reduced nicotine standards are likely to generate their greatest public health benefit through the slowing of newly initiating cigarette smoking.
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Affiliation(s)
- Justin C Strickland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Brett W Gelino
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gideon P Naudé
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jessica C Harbaugh
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rebekah D Schlitzer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Melissa Mercincavage
- Institute for Nicotine & Tobacco Studies, Rutgers University, New Brunswick, NJ, USA
| | - Andrew A Strasser
- Department of Psychiatry, University of Pennsylvania, Pennsylvania, PA, USA
| | - Matthew W Johnson
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Ganz O, Wackowski OA, Strasser AA, Jeong M, Villanti AC, Miller Lo E, Talbot EM, Delnevo CD. Emergence and growth of 'natural' cigars in the USA. Tob Control 2023; 33:137-140. [PMID: 36282630 PMCID: PMC9718888 DOI: 10.1136/tobaccocontrol-2022-057396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/24/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Ollie Ganz
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, USA
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Olivia A Wackowski
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, USA
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Andrew A Strasser
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michelle Jeong
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, USA
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Andrea C Villanti
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, USA
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Erin Miller Lo
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, USA
| | - Eugene M Talbot
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, USA
| | - Cristine D Delnevo
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, USA
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, NJ, USA
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Johnson AC, Mercincavage M, Tan ASL, Villanti AC, Delnevo CD, Strasser AA. Effects of reduced nicotine content cigarette advertising with warning labels and social media features on product perceptions among young adults. J Behav Med 2023; 46:948-959. [PMID: 37605036 PMCID: PMC10591832 DOI: 10.1007/s10865-023-00441-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 07/24/2023] [Indexed: 08/23/2023]
Abstract
This study sought to understand reactions to very low nicotine (VLN) cigarette advertising compared with conventional cigarette advertising with consideration of warning labels and social media context. The online experimental study recruited young adult cigarette smokers and nonsmokers (N = 1,608). Participants completed a discrete choice task with a 2 × 2 × 3 mixed design: brand, (VLN, Marlboro), context (Ad only, Ad on social media), and warning (Text-only, Well-known risk pictorial, or Lesser-known risk pictorial). Participants made choices about attention, appeal, harm, buying, and quitting intentions. Social media context increased attention and appeal. A well-known risk pictorial warning outperformed a text-only warning. Smokers had increased odds of quit intentions for VLN ads, yet nonsmokers had increased intentions to buy cigarettes on social media with a text-only warning. Results indicate differences in how young adults react to cigarette ads on social media, especially with the warnings they portray.
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Affiliation(s)
- Andrea C Johnson
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA, 19104-3309, USA.
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, PA, USA.
| | - Melissa Mercincavage
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA, 19104-3309, USA
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, PA, USA
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Andy S L Tan
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA, 19104-3309, USA
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, PA, USA
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Andrea C Villanti
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, PA, USA
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, NJ, USA
| | - Cristine D Delnevo
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, PA, USA
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, NJ, USA
| | - Andrew A Strasser
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA, 19104-3309, USA
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, PA, USA
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA
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Giovenco DP, Ganz O, Spillane TE, Easter AG, Wackowski OA, Villanti AC, Strasser AA, Delnevo CD. Changes in Pack Features Among Top-Selling Cigarettes in the U.S., 2018 and 2021. Am J Prev Med 2023; 65:1124-1128. [PMID: 37295659 PMCID: PMC10700656 DOI: 10.1016/j.amepre.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Cigarette packaging is designed to increase consumer appeal and remains a primary promotional tool in many countries, including the U.S. This study documented changes in the prevalence of pack characteristics among the top-selling cigarette products in the U.S. in 2018 and 2021. METHODS The 50 cigarette packs with the highest national unit sales in U.S. convenience stores in 2018 and 2021 were identified using Nielsen's Scantrack data and subsequently purchased. Packs were coded for features such as dominant color(s), descriptive text, and promotional language. Descriptive analyses conducted in 2022 weighted by total annual unit sales compared the prevalence of pack characteristics between years. RESULTS Three brands-Marlboro, Newport, and Camel-constituted over 80% of pack sales among the top-selling products. Packs with red as a dominant color grew less popular between years (33.3% vs 29.5%), whereas those with green became more prevalent (25.2% vs 28.9%), consistent with a rise in the proportion of menthol sales. The prevalence of descriptors such as flavor and fresh decreased from 46.0% to 39.4% and 9.7% to 5.2%, respectively. Meanwhile, the prevalence of promotional language (e.g., rewards programs) increased from 60.9% to 69.0%. CONCLUSIONS The use of visual and named colors remains common, which can implicitly communicate sensory or health-related attributes. Moreover, promotions may help recruit and retain consumers in the context of more restrictive tobacco control policies and price increases. Given the strong influence that cigarette packaging exerts on consumers, packaging-focused policies, such as plain packaging laws, may reduce appeal and accelerate declines in cigarette use.
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Affiliation(s)
- Daniel P Giovenco
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York.
| | - Ollie Ganz
- Rutgers Biomedical and Health Sciences, Rutgers Center for Tobacco Studies, New Brunswick, New Jersey; Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, New Jersey
| | - Torra E Spillane
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - Alexa G Easter
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - Olivia A Wackowski
- Rutgers Biomedical and Health Sciences, Rutgers Center for Tobacco Studies, New Brunswick, New Jersey; Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, New Jersey
| | - Andrea C Villanti
- Rutgers Biomedical and Health Sciences, Rutgers Center for Tobacco Studies, New Brunswick, New Jersey; Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, New Jersey
| | - Andrew A Strasser
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Cristine D Delnevo
- Rutgers Biomedical and Health Sciences, Rutgers Center for Tobacco Studies, New Brunswick, New Jersey; Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, New Jersey
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9
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Villanti AC, Peasley-Miklus C, Mercincavage M, Mays D, Donny EC, Cappella JN, Strasser AA. Effect of nicotine corrective messaging on nicotine-related beliefs in US adults: a randomised controlled trial. Tob Control 2023:tc-2023-058252. [PMID: 37989586 DOI: 10.1136/tc-2023-058252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 11/01/2023] [Indexed: 11/23/2023]
Abstract
INTRODUCTION Widespread misperceptions of the health risks of nicotine could undermine the public health benefits of the Food and Drug Administration's actions, including modified risk tobacco product authorisations and a reduced nicotine product standard for cigarettes. METHODS 794 US adults (aged 18+) in NORC's AmeriSpeak panel participated in a randomised controlled trial in Spring 2021 to test the effect of three exposures to eight nicotine corrective messages (NCM) on beliefs about nicotine, nicotine replacement therapy (NRT), e-cigarettes and reduced nicotine content (RNC) cigarettes at 3-month follow-up. Analyses conducted in 2022 examined the effect of study condition (NCM (n=393) vs no message control (n=401)) on nicotine beliefs, use intentions and use of nicotine and tobacco products. RESULTS Exposure to three NCM doses reduced nicotine (b=-0.33; 95% CI -0.60, -0.07), NRT (b=-0.49; 95% CI -0.85, -0.14), e-cigarette (b=-0.32; 95% CI -0.59, -0.05) and RNC cigarette false beliefs (b=-0.64; 95% CI -1.26, -0.02) compared with the control, controlling for baseline beliefs. Baseline tobacco use and concern about nicotine addiction attenuated intervention effects on false beliefs about RNC cigarettes. There were few intervention effects on intention or use of nicotine and tobacco products. CONCLUSIONS Repeated exposure to NCM was necessary to reduce false beliefs about nicotine and tobacco products. Future studies will improve understanding of the dose and duration of nicotine education needed to shift intentions and behaviour, as well as tailored content for tobacco product users to achieve similar reductions in false beliefs as non-users. TRIAL REGISTRATION NUMBER NCT04805515.
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Affiliation(s)
- Andrea C Villanti
- Rutgers Institute for Nicotine and 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
| | - Catherine Peasley-Miklus
- Vermont Center on Behavior and Health, University of Vermont Larner College of Medicine, Burlington, Vermont, USA
| | - Melissa Mercincavage
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Darren Mays
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Eric C Donny
- Baptist Comprehensive Cancer Center and Department of Physiology and Pharmacology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Joseph N Cappella
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrew A Strasser
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Andrews M, Cooper N, Mattan BD, Carreras-Tartak J, Paul AM, Strasser AA, Henriksen L, Falk EB. Causal effects of point-of-sale cigarette promotions and subjective social status on cigarette craving: a randomised within-person experiment. Tob Control 2023:tc-2023-058069. [PMID: 37949653 DOI: 10.1136/tc-2023-058069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 10/17/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Cigarette smoking continues to be a leading cause of preventable deaths in the USA, in part because the USA has not adopted the WHO Framework Convention on Tobacco Control. One way the tobacco industry counteracts tobacco control policies is by heavily advertising cigarettes at the point of sale in retailers (eg, at the cash register) and by offering discounts on cigarettes. DESIGN A within-subject experimental design with adults who smoke cigarettes daily (n=281) investigated whether: (1) exposure to images of cigarette promotions in an online experiment is associated with greater cigarette craving relative to viewing images of non-smoking cues, and (2) if exposure to images of point-of-sale cigarette promotions with a discount (vs without) increases cigarette craving. The study also examined how participants' subjective social status (compared with others in the USA) relates to cigarette craving after exposure to images of cigarette promotions with and without a discount. RESULTS In an online experiment, exposure to images of smoking cues, including point-of-sale cigarette promotions, elicited greater craving relative to non-smoking cues (all p<0.001). In addition, images of promotions with a discount elicited higher levels of craving compared with those without a discount (b=0.09, p=0.001). Although participants with a higher (vs lower) subjective social status craved cigarettes less overall (b=-0.12, p=0.012), there was no difference in their craving between images of promotions with and without a discount, while craving was higher for images of promotions with a discount than without for participants with higher subjective social status (b=0.06, p=0.021). CONCLUSION Viewing images of point-of-sale cigarette promotions can causally increase cravings to smoke, which may also apply to real-world retail settings that display cigarette promotions. Restricting point-of-sale promotions generally, and discounts specifically, could help reduce cigarette smoking and address tobacco use disparities in the USA.
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Affiliation(s)
- Mary Andrews
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nicole Cooper
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Bradley D Mattan
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - José Carreras-Tartak
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alexandra M Paul
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrew A Strasser
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lisa Henriksen
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California, USA
| | - Emily B Falk
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Wharton Marketing Department, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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11
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Johnson AC, Mercincavage M, Souprountchouk V, Deatley T, Mays D, Strasser AA. Assessing Attention to Tobacco Warnings With a Heatmapping Task. Am J Prev Med 2023; 65:809-817. [PMID: 37257762 PMCID: PMC10592484 DOI: 10.1016/j.amepre.2023.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 05/24/2023] [Accepted: 05/24/2023] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Attention is a critical outcome to understanding the impacts of tobacco warning labels and is commonly measured using eye tracking. Self-report, online methods may be efficient, scalable alternatives to capture attention. This study assesses warning label attention on cigarette marketing using a heatmapping task. METHODS Young adults (n=1,608) aged 18-30 years and registered on Mechanical Turk with a WorkerID verified in the U.S. were included. Data were collected in 2021-2022 and analyzed in 2022. Tobacco advertisement exposure included a 2 × 3 between-subjects factorial design for varying contexts and warnings. Attention was operationalized with self-reported frequency and timing of warning selection. Outcomes include credibility, willingness to use the advertised cigarettes, and intentions to use cigarettes and low-nicotine cigarettes. RESULTS Early and more frequent attention to the warning was associated with higher credibility (frequent: β=0.28, 95% CI=0.11, 0.44; early: β=0.14, 95% CI=0.02, 0.25), lower willingness to use the advertised cigarettes (frequent: β= -1.78, 95% CI= -2.24, -1.32; early: β= -1.16, 95% CI= -1.49, -0.84), lower cigarette use intentions in the next week (frequent: β= -0.44, 95% CI= -0.64, -0.25; early: β= -0.21, 95% CI= -0.35, -0.08), and lower low-nicotine cigarette use intentions in the next week (frequent: β= -0.47, 95% CI= -0.66, -0.28; early: β= -0.25, 95% CI= -0.38, -0.12) than no attention at all. CONCLUSIONS Greater attention as measured by a heatmapping task was observed for pictorial warnings and associated with lower intentions to use tobacco. Heatmapping selection patterns were a suitable proxy for attention in this online sample.
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Affiliation(s)
- Andrea C Johnson
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Tobacco Center of Regulatory Science (TCORS), Annenberg School of Communication, University of Pennsylvania-Rutgers University, Philadelphia, Pennsylvania.
| | - Melissa Mercincavage
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Tobacco Center of Regulatory Science (TCORS), Annenberg School of Communication, University of Pennsylvania-Rutgers University, Philadelphia, Pennsylvania; Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Valentina Souprountchouk
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Tobacco Center of Regulatory Science (TCORS), Annenberg School of Communication, University of Pennsylvania-Rutgers University, Philadelphia, Pennsylvania
| | - Teresa Deatley
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Tobacco Center of Regulatory Science (TCORS), Annenberg School of Communication, University of Pennsylvania-Rutgers University, Philadelphia, Pennsylvania
| | - Darren Mays
- Center for Tobacco Research, Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio; Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio
| | - Andrew A Strasser
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Tobacco Center of Regulatory Science (TCORS), Annenberg School of Communication, University of Pennsylvania-Rutgers University, Philadelphia, Pennsylvania; Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania; Annenberg School for Communication, University of Pennsylvania, Philadelphia, Pennsylvania
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12
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DeAtley T, Stone MD, Johnson AC, Mercincavage M, Audrain-McGovern J, Strasser AA. Differences in biobehavioral measures of cigarette smoking by depression symptomology. Addict Behav 2023; 146:107800. [PMID: 37437421 DOI: 10.1016/j.addbeh.2023.107800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 06/02/2023] [Accepted: 07/02/2023] [Indexed: 07/14/2023]
Abstract
INTRODUCTION Research that explores the clinical relevance of subclinical depressive symptoms and smoking is primarily focused on smoking cessation. We examine whether depression symptoms vary across an array of biological (carbon monoxide boost), behavioral (FagerströmTest of Nicotine Dependence, cigarettes per day, smoking topography), and psychological smoking-related outcomes (Questionnaire on Smoking Urges, Withdrawal Symptoms Checklist) in non-treatment-seeking smokers. METHODS Baseline data were pooled from three research trials with identical procedures designed to assess individual smoking behavior using smokers preferred cigarette brands. Depression symptom level (asymptomatic, subsyndromal, syndromal) was defined using established Center for Epidemiological Depression Scale (CES-D) cutpoint criteria. Smokers were instructed to smoke as usual for one-week. At the beginning and end of the baseline period, nicotine dependence, smoking topography, CO boost, desire to smoke, anticipation of positive reinforcement, negative affect, and withdrawal were measured. RESULTS Ordinary least squares linear regression models were used to test the association between depression symptom level and outcome measures adjusting for sex and education (N = 355). The results revealed no differences in topography measures, cigarettes per day and FTND. Smoking withdrawal and smoking urges were higher among both individuals with subsyndromal symptoms and syndromal depression symptoms compared to those who were asymptomatic. Individuals with subsyndromal depressive symptoms experienced higher smoke exposure and higher relief from negative affect. CONCLUSION Increased smoke exposure, greater withdrawal symptoms and urges to smoke, and anticipation of negative affect relief among smokers with subsyndromal depression symptoms suggest that depression symptoms need not reach syndromal levels to alter smoking-related outcomes.
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Affiliation(s)
- Teresa DeAtley
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Edicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Matthew D Stone
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Edicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Andrea C Johnson
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Edicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Melissa Mercincavage
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Edicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Janet Audrain-McGovern
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Edicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Andrew A Strasser
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Edicine, University of Pennsylvania, Philadelphia, PA, USA
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13
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Stone MD, Mercincavage M, Wileyto EP, Tan ASL, Audrain-McGovern J, Villanti AC, Strasser AA. Effects of cigarette package colors and warning labels on marlboro smokers' risk beliefs, product appraisals, and smoking behavior: a randomized trial. BMC Public Health 2023; 23:2111. [PMID: 37891513 PMCID: PMC10605973 DOI: 10.1186/s12889-023-17024-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 10/19/2023] [Indexed: 10/29/2023] Open
Abstract
OBJECTIVE Plain packaging and graphic warning labels are two regulatory strategies that may impact cigarette risk beliefs and reduce consumption, but data are needed to better understand how smokers respond to such regulations. METHODS Adult, daily, Marlboro non-menthol smokers (Red [n = 141] or Gold [n = 43]) completed a mixed factorial randomized trial. Participants smoked their usual cigarettes during baseline (5-days) and were randomized to receive cigarette packs with a warning label manipulation (graphic vs. text-only). Within each warning label condition, participants completed three within-subjects pack color manipulations (red, gold, plain), each lasting 15 days. Participants were blinded to the fact that all packs contained their usual cigarettes. Mixed-effects models examined between- and within-subject differences on risk beliefs, product perceptions, and smoking behavior. RESULTS Warning type and package color did not impact cigarette consumption or subjective ratings. However, use increased in all conditions (2.59-3.59 cigarettes per day) relative to baseline. While smokers largely held correct risk beliefs at baseline (Mean = 6.02, SE = 0.17, Range:0-8), the cumulative number of incorrect or uncertain cigarette risk beliefs increased from baseline in all pack color manipulations in the text (IRR range = 1.70-2.16) and graphic (IRR range = 1.31-1.70) warning conditions. Across all pack color periods, those in the graphic (vs. text) warning condition had reduced odds of reporting their study cigarettes as 'safer' than regular cigarettes (OR range = 0.22-0.32). CONCLUSIONS Pack color modification may increase uncertainty about several key cigarette risk beliefs, though graphic warnings may attenuate these effects. Regulatory agencies could consider supporting policy changes with information campaigns to maximize public knowledge. TRIAL REGISTRATION November 25, 2014; Registration number: NCT02301351.
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Affiliation(s)
- Matthew D Stone
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA, USA
| | - Melissa Mercincavage
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - E Paul Wileyto
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Andy S L Tan
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA
| | - Janet Audrain-McGovern
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Andrea C Villanti
- Rutgers, School of Public Health, The State University of New Jersey, New Brunswick, NJ, USA
| | - Andrew A Strasser
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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14
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Mercincavage M, Sidhu AK, Waugh L, Kreider C, Souprountchouk V, Delnevo CD, Villanti AC, Strasser AA. Effects of pictorial warning labels depicting lesser-known and well-known risks of smoking on viewing patterns, recall, and knowledge of smoking harms. Drug Alcohol Depend 2023; 251:110939. [PMID: 37660524 PMCID: PMC10538381 DOI: 10.1016/j.drugalcdep.2023.110939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/20/2023] [Accepted: 08/14/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND In 2019, the Food and Drug Administration introduced 11 pictorial warning labels (PWLs) for inclusion on cigarette packages, created in compliance with court recommendations and tailored to increase knowledge of smoking harms. Several highlighted lesser-known risks of smoking. No behavioral studies have yet evaluated how risk content in PWLs impacts viewing patterns, recall, and knowledge of smoking harms. METHODS Seventy adults who reported smoking cigarettes daily (62.9% male, 57.1% African American, mean age = 50.3, mean cigarettes per day = 14.4) completed a single-session laboratory study. They were randomized to view a set of four PWLs depicting either lesser-known or well-known risks of smoking while having eye movements recorded, then completed post-exposure recall and knowledge measures. RESULTS Participants exposed to PWLs depicting lesser-known smoking risks viewed the text of the warning sooner and for longer than the image (p's <0.05); those exposed to PWLs depicting well-known risks viewed the image longer than text (p <0.001). PWL condition did not affect recall of text or image (p's >0.1). Those viewing lesser-known (vs. well-known) risks had greater knowledge of smoking causing lesser-known risks of bladder cancer, blindness, bloody urine, cataracts, diabetes, and head and neck cancer (p's <0.001). CONCLUSIONS Individuals viewing PWLs depicting lesser-known (vs. well-known) smoking risks visually engaged with the PWL text more than image, had similarly high recall of PWL content, and had greater knowledge of lesser-known risks of smoking. Findings suggest including lesser-known risk information on PWLs improves overall knowledge of smoking health risks.
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Affiliation(s)
- Melissa Mercincavage
- Center for Interdisciplinary Research on Nicotine Addiction, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States; University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, PA, United States.
| | - Anupreet K Sidhu
- Center for Interdisciplinary Research on Nicotine Addiction, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States; University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, PA, United States
| | - Lizza Waugh
- Center for Interdisciplinary Research on Nicotine Addiction, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Catherine Kreider
- Center for Interdisciplinary Research on Nicotine Addiction, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Valentina Souprountchouk
- Center for Interdisciplinary Research on Nicotine Addiction, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Cristine D Delnevo
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, PA, United States; Rutgers Institute for Nicotine & Tobacco Studies, New Brunswick, NJ, United States
| | - Andrea C Villanti
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, PA, United States; Rutgers Institute for Nicotine & Tobacco Studies, New Brunswick, NJ, United States
| | - Andrew A Strasser
- Center for Interdisciplinary Research on Nicotine Addiction, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States; University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, PA, United States; Annenberg School of Communication, University of Pennsylvania, Philadelphia, PA, United States
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15
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DeAtley T, Johnson AC, Stone MD, Audrain-McGovern J, Mercincavage M, Strasser AA. Effects of Modified Tobacco Risk Products with Claims and Nicotine Features on Perceptions among Racial and Ethnic Groups. Int J Environ Res Public Health 2023; 20:6454. [PMID: 37568996 PMCID: PMC10418819 DOI: 10.3390/ijerph20156454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 08/13/2023]
Abstract
Research suggests consumers may misunderstand modified risk tobacco product (MRTP) claims. We examined the effects of nicotine content across four tobacco products with and without MRTP claims among a racially and ethnically diverse sample of adults who do and do not smoke. Adults (n = 1484) aged 21-65 completed an online experiment using a 2 × 2 × 4 mixed factorial design to examine the effects of tobacco product (Classic White Snus, IQOS, JUUL e-cigarette, and VLN cigarette) and nicotine content (high vs. low) stratified by MRTP claim (present vs. absent) across four outcomes: (1) likely to try (2) serious disease if used regularly, (3) least addictive, and (4) ease of quitting smoking. Not including an MRTP claim resulted in an increased likelihood of trying a product, decreased concern of serious disease, lower perceived addictiveness, and increased ease of quitting smoking. Participants selected low nicotine IQOS without a claim as the least likely to cause serious disease. Low nicotine JUUL, without a claim, was selected as least addictive and most likely to facilitate quitting. Intentions to try were highest for low nicotine JUUL. Participants selected low-nicotine products as less addictive than high nicotine products. Regulatory efforts should consider how MRTP claims interact with different product characteristics. Subtle differences exist across outcomes between racial and ethnic groups, which indicates that further research is warranted.
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Affiliation(s)
- Teresa DeAtley
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (A.C.J.); (J.A.-M.); (M.M.); (A.A.S.)
| | - Andrea C. Johnson
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (A.C.J.); (J.A.-M.); (M.M.); (A.A.S.)
| | - Matthew D. Stone
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, CA 92093, USA;
| | - Janet Audrain-McGovern
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (A.C.J.); (J.A.-M.); (M.M.); (A.A.S.)
| | - Melissa Mercincavage
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (A.C.J.); (J.A.-M.); (M.M.); (A.A.S.)
| | - Andrew A. Strasser
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (A.C.J.); (J.A.-M.); (M.M.); (A.A.S.)
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Musicus AA, Gibson LA, Bellamy SL, Orr JA, Hammond D, Glanz K, Volpp KG, Schwartz MB, Bleakley A, Strasser AA, Roberto CA. Effects of Sugary Beverage Text and Pictorial Warnings: A Randomized Trial. Am J Prev Med 2023; 64:716-727. [PMID: 36764835 PMCID: PMC10121881 DOI: 10.1016/j.amepre.2023.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 01/12/2023] [Accepted: 01/12/2023] [Indexed: 02/10/2023]
Abstract
INTRODUCTION Multiple U.S. localities have introduced legislation requiring sugar-sweetened beverage (SSB) warnings. This study effects of different warning designs on beverage selections and perceptions. STUDY DESIGN The study was an RCT. SETTING/PARTICIPANTS An online virtual convenience store and survey were used with a nationally representative sample of primary caregivers of 6-11-year-olds (n=961). Data were collected in January 2020 and analyzed in May-July 2020. INTERVENTION Participants were randomized to view SSBs with 1 of 4 front-of-package label designs: (1) no-warning control, (2) health-related text warning, (3) sugar pictorial warning (image of beverage sugar content in cubes/teaspoons/packets with health-related warning text), or (4) health pictorial warning (image of possible health consequences of overconsuming SSBs with health-related warning text). MAIN OUTCOME MEASURES Outcomes included participants' beverage choice for their child and perceptions of beverages, their assigned labels, and warning policies. RESULTS Proportionally fewer participants chose a SSB in the sugar pictorial warning condition (-13.4 percentage points; 95% CI= -21.6 to -0.1 percentage points; p=0.007) and in the health pictorial warning condition (-14.7 percentage points; 95% CI= -22.8 to -0.1 percentage points; p=0.004) compared to the control. Sugar pictorial warnings led to more accurate added-sugar content estimates than all conditions and greater label trust and support for sugar-sweetened beverage warning policies than health pictorial warnings. CONCLUSIONS SSB warning policies may be most effective if they mandate images of beverages' added sugar content accompanied by warning text. TRIAL REGISTRATION This study is registered at www. CLINICALTRIALS gov NCT03648138.
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Affiliation(s)
- Aviva A Musicus
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
| | - Laura A Gibson
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Scarlett L Bellamy
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jennifer A Orr
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Karen Glanz
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kevin G Volpp
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Marlene B Schwartz
- Rudd Center for Food Policy and Health, University of Connecticut, Storrs, Connecticut
| | - Amy Bleakley
- Department of Communication, College of Arts and Sciences, University of Delaware, Newark, Delaware
| | - Andrew A Strasser
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Christina A Roberto
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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18
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Ganz O, Strasser AA, Giovenco DP, Audrain-McGovern J, Cappella JN, Safi Z, Tan ASL, Talbot EM, Delnevo CD. IQOS print magazine advertising characteristics and reach before and after FDA authorisation as a modified risk tobacco product. Tob Control 2023:tc-2022-057741. [PMID: 36958825 PMCID: PMC10517063 DOI: 10.1136/tc-2022-057741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 03/07/2023] [Indexed: 03/25/2023]
Abstract
INTRODUCTION IQOS is a heated tobacco product that was authorised as a modified risk tobacco product (MRTP) in July 2020. While it was removed from the US market in 2021 for legal reasons, as the first tobacco product to receive an 'exposure modification' MRTP order, surveillance of IQOS marketing is needed to inform regulation and policy for future MRTPs. The purpose of this study is to expand the current research on IQOS advertising in the USA by examining content and readership characteristics of IQOS ads in print magazines before and after US Food and Drug Administration MRTP authorisation. METHODS We merged content analysis data with Kantar Media data on magazine placement and expenditures. Magazine readership data were obtained from MRI-Simmons. We compared data from pre-MRTP authorisation with data post-MRTP authorisation. This study was conducted in 2021. RESULTS There was one unique ad and there were 13 observations pre-MRTP, and eight unique ads and 132 observations post-MRTP. Compared with pre-MRTP ads, more post-MRTP ads featured Marlboro HeatSticks, including Amber HeatSticks, and featured people. All ads contained a warning label-most warning labels were cigarette specific. IQOS ads were featured in magazines that are especially popular among women. CONCLUSIONS After receiving MRTP authorisation, IQOS increased ad expenditures in print magazines with a readership comprised of primarily women. If IQOS returns to the US market, it will be important for tobacco control to monitor their advertisement content, placement, and expenditures.
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Affiliation(s)
- Ollie Ganz
- Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, New Jersey, USA
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Andrew A Strasser
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daniel P Giovenco
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Janet Audrain-McGovern
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joseph N Cappella
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Zeinab Safi
- Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, New Jersey, USA
| | - Andy S L Tan
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Eugene M Talbot
- Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, New Jersey, USA
| | - Cristine D Delnevo
- Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, New Jersey, USA
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, New Jersey, USA
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19
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Mercincavage M, Pacek LR, Thrasher J, Cappella JN, Delnevo C, Donny EC, Strasser AA. Effects of advertising features on smokers' and non-smokers' perceptions of a reduced nicotine cigarette modified risk tobacco product. Tob Control 2023; 32:6-12. [PMID: 33858965 PMCID: PMC8517036 DOI: 10.1136/tobaccocontrol-2020-056441] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/17/2021] [Accepted: 03/19/2021] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Research is needed to determine the impact of marketing on perceptions and use of reduced nicotine content (RNC) cigarettes, particularly as US regulators have permitted the sale of an RNC cigarette modified risk tobacco product (MRTP) that seeks further authorisation to advertise using modified risk claims. This study examined the effects of two advertising elements (product name and disclaimer content) on perceptions of an RNC cigarette MRTP. METHODS Adult participants (n=807, 28.7% smokers, 58.2% male, 74.2% non-Latinx white) completed an online MTurk survey. Participants were randomised to view one of six RNC cigarette advertisements, using a 2×3 between-subject factorial design to manipulate product name ('Moonlight' vs 'Moonrise') and disclaimer content (industry-proposed: 'Nicotine is addictive. Less nicotine does NOT mean a safer cigarette' vs focused: 'Less nicotine does NOT mean a safer cigarette' vs no content), then completed recall and product perception questionnaires. RESULTS All participants who viewed the industry-proposed disclaimer (vs no content) perceived greater addiction risk (p's<0.05). Non-smokers who viewed this disclaimer also perceived greater health risks and held fewer false beliefs (p's<0.05). Smokers who viewed Moonlight (vs Moonrise) ads perceived lower health risks (p<0.05). CONCLUSIONS Disclaimer content may effectively inform consumers about addiction risk of a new RNC cigarette MRTP, and further inform non-smokers about health risks. This element, however, had little effect on perceived health risks among smokers, among whom the Moonlight product name was associated with health risk misperceptions similar to the banned 'light' descriptor.
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Affiliation(s)
- Melissa Mercincavage
- Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, PA, USA
| | - Lauren R Pacek
- Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - James Thrasher
- Health Promotion, Education, and Behavior, School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Joseph N Cappella
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, PA, USA
- Annenberg School of Communication, University of Pennsylvania, Philadelphia, PA, USA
| | - Cristine Delnevo
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, PA, USA
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey, USA
| | - Eric C Donny
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, PA, USA
- Baptist Comprehensive Cancer Center and Department of Physiology and Pharmacology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Andrew A Strasser
- Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, PA, USA
- Annenberg School of Communication, University of Pennsylvania, Philadelphia, PA, USA
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20
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White CM, Tessier KM, Koopmeiners JS, Denlinger-Apte RL, Cobb CO, Lane T, Campos CL, Spangler JG, Hatsukami DK, Strasser AA, Donny EC. Preliminary evidence on cigarette nicotine reduction with concurrent access to an e-cigarette: Manipulating cigarette nicotine content, e-liquid nicotine content, and e-liquid flavor availability. Prev Med 2022; 165:107213. [PMID: 35995103 PMCID: PMC10080461 DOI: 10.1016/j.ypmed.2022.107213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 07/28/2022] [Accepted: 08/17/2022] [Indexed: 10/15/2022]
Abstract
The reinforcing characteristics of e-cigarettes could moderate the impact of reducing cigarette nicotine content. In this study, people who smoke daily were recruited from North Carolina and Pennsylvania (US) in 2018 and 2019. Within a randomized 2 × 2 × 2 factorial design, participants received investigational cigarettes and an e-cigarette for 12 weeks. Cigarette nicotine content was very low (0.4 mg/g of tobacco; VLNC) or normal (15.8 mg/g; NNC). E-liquids were 0.3% ("low") or 1.8% ("moderate") freebase nicotine, and available in tobacco flavors or tobacco, fruit, dessert and mint flavors. Study recruitment concluded before reaching the planned sample size (N = 480). Fifty participants were randomized and 32 completed the study. We found that randomization to VLNC, relative to NNC cigarettes, reduced self-reported cigarettes per day (CPD; mean difference: -12.96; 95% CI: -21.51, -4.41; p = 0.005); whereas e-liquid nicotine content and flavor availability did not have significant effects. The effect of cigarette nicotine content was larger in the moderate vs. low nicotine e-liquid groups and in the all flavors versus tobacco flavors e-liquid groups; tests of the interaction between e-liquid characteristics and cigarette nicotine content were not significant. Biomarkers of smoke exposure at Week 12 did not differ across conditions, which may reflect variability in adherence to only using VLNC cigarettes. In conclusion this study offers preliminary evidence that the extent to which cigarette nicotine reduction decreases smoking may depend on the reinforcing characteristics of alternative products, including the available nicotine contents and flavors of e-cigarettes.
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Affiliation(s)
- Cassidy M White
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - Katelyn M Tessier
- Masonic Cancer Center, Biostatistics Core, University of Minnesota, Minneapolis, MN, USA
| | - Joseph S Koopmeiners
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Rachel L Denlinger-Apte
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Caroline O Cobb
- Department of Psychology and Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA
| | - Tonya Lane
- Department of Psychiatry and Behavioral Sciences and Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Claudia L Campos
- Department of General Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - John G Spangler
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Dorothy K Hatsukami
- Department of Psychiatry and Behavioral Sciences and Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Andrew A Strasser
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Eric C Donny
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC, USA
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21
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Klemperer EM, Luo X, Jensen J, al'Absi M, Cinciripini PM, Robinson JD, Drobes DJ, McClernon J, Strasser AA, Strayer LG, Vandrey R, Benowitz NL, Donny EC, Hatsukami DK. Smoking abstinence and cessation-related outcomes one month after an immediate versus gradual reduction in nicotine content of cigarettes. Prev Med 2022; 165:107175. [PMID: 35870575 PMCID: PMC10676511 DOI: 10.1016/j.ypmed.2022.107175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/21/2022] [Accepted: 07/17/2022] [Indexed: 11/17/2022]
Abstract
The United States Food and Drug Administration has the authority to reduce the nicotine content in cigarettes to minimal or non-addictive levels and could do so immediately or gradually over time. A large clinical trial compared the two approaches. This secondary analysis assesses abstinence and cessation-related outcomes one month after the trial concluded, when participants no longer had access to very low nicotine content (VLNC) research cigarettes. Smokers not interested in quitting (N = 1250) were recruited for the parent trial from 2014 to 2016 across 10 sites throughout the US and randomized to a 20-week study period during which they immediately switched to VLNC cigarettes, gradually transitioned to VLNC cigarettes with five monthly dose reductions, or smoked normal nicotine research cigarettes (control). At the one-month follow-up, both immediate and gradual reduction resulted in greater mean cigarette-free days (4.7 and 4.6 respectively) than the control group (3.2, both p < .05). Immediate reduction resulted in fewer mean cigarettes per day (CPD = 10.3) and lower Fagerström Test for Cigarette Dependence (FTCD = 3.7) than the gradual (CPD = 11.7, p = .001; FTCD = 3.8, p = .039) and control (CPD = 13.5, p < .001; FTCD = 4.0, p < .001) groups. Compared to controls, gradual reduction resulted in reduced CPD (p = .012) but not FTCD (p = .13). Differences in CO-verified 7-day point-prevalence abstinence were not significant. Findings demonstrate that switching to VLNC cigarettes resulted in reduced smoking and nicotine dependence severity that was sustained for at least a month after the VLNC trial period in smokers who were not interested in cessation. The greatest harm reduction endpoints were observed in those who immediately transitioned to VLNC cigarettes.
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Affiliation(s)
- Elias M Klemperer
- Vermont Center on Behavior & Health, Department of Psychiatry, University of Vermont, United States of America.
| | - Xianghua Luo
- Masonic Cancer Center, University of Minnesota, United States of America; Division of Biostatistics, School of Public Health, University of Minnesota, United States of America
| | - Joni Jensen
- Masonic Cancer Center, University of Minnesota, United States of America
| | - Mustafa al'Absi
- Department of Family Medicine and BioBehavioral Health, University of Minnesota, United States of America
| | - Paul M Cinciripini
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, United States of America
| | - Jason D Robinson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, United States of America
| | - David J Drobes
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, United States of America
| | - Joseph McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University, United States of America
| | - Andrew A Strasser
- Department of Psychiatry, University of Pennsylvania, United States of America
| | - Lori G Strayer
- Masonic Cancer Center, University of Minnesota, United States of America
| | - Ryan Vandrey
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, United States of America
| | - Neal L Benowitz
- Department of Medicine, University of California, San Francisco, United States of America
| | - Eric C Donny
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, United States of America
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22
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Novick AM, Duffy KA, Johnson RL, Sammel MD, Cao W, Strasser AA, Sofuoglu M, Kuzma A, Loughead J, Epperson CN. Progesterone Increases Nicotine Withdrawal and Anxiety in Male but Not Female Smokers During Brief Abstinence. Nicotine Tob Res 2022; 24:1898-1905. [PMID: 35713950 PMCID: PMC9653080 DOI: 10.1093/ntr/ntac146] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 05/08/2022] [Accepted: 06/14/2022] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Although exogenous progesterone may hold promise as a treatment for nicotine use disorders, it is unclear whether it is similarly effective in males and females. This study examined the effects of progesterone on nicotine use disorder comprehensively using behavioral, psychological, and neural measures in male and female smokers exposed to brief abstinence. AIMS AND METHODS Thirty-three male and 33 female non-treatment-seeking smokers participated in a double-blind, randomized, placebo-controlled crossover study of 200 mg of progesterone or placebo daily over a four-day abstinence period. Smoking behavior and subjective effects of nicotine were assessed at baseline and after final drug administration. Nicotine withdrawal, smoking urges, mood states, and neural response to smoking cues were measured at baseline, after the first drug administration, and after the final drug administration. RESULTS No main effect of drug (progesterone vs. placebo) emerged for any outcome. Significant sex by drug interactions emerged for nicotine withdrawal (p = .020), perceived strength of nicotine (p = .040), and perceived bad effects of nicotine (p = .029). Males receiving progesterone reported worse nicotine withdrawal (p = .046) and a trend towards decreased bad effects of nicotine (p = .070). Males on progesterone also reported greater tension and anxiety relative to placebo (p = .021). Females on progesterone perceived nicotine's effects as being stronger relative to placebo (p = .046). CONCLUSIONS Progesterone causes sex-dependent effects on smoking-related outcomes during brief abstinence. Specifically, progesterone in males may increase rather than decrease nicotine withdrawal and negative affect during abstinence, potentially hindering efforts to quit smoking. IMPLICATIONS In male and female smokers undergoing a brief period of abstinence, we examined the effects of progesterone on smoking outcomes. While progesterone had limited effects in female smokers, in males, it worsened nicotine withdrawal and negative affect. Our findings emphasize the importance of analyzing sex differences in future studies examining progesterone as a potential treatment and suggest that progesterone in males could potentially exacerbate aspects of nicotine dependence. CLINICALTRIALS.GOV REGISTRATION NCT01954966. https://clinicaltrials.gov/ct2/show/NCT01954966.
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Affiliation(s)
- Andrew M Novick
- Corresponding Author: Andrew M. Novick, MD, PhD, Department of Psychiatry, University of Colorado-Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO 80045, USA. Telephone: 303-724-5656; Fax: 844-886-1892; E-mail:
| | - Korrina A Duffy
- Department of Psychiatry, School of Medicine, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - Rachel L Johnson
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - Mary D Sammel
- Department of Psychiatry, School of Medicine, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - Wen Cao
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Andrew A Strasser
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mehmet Sofuoglu
- Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Alexandra Kuzma
- Larner College of Medicine, University of Vermont, Burlington, VM, USA
| | - James Loughead
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - C Neill Epperson
- Department of Psychiatry, School of Medicine, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
- Department of Family Medicine, School of Medicine, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
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23
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Novick AM, Duffy KA, Johnson RL, Sammel MD, Cao W, Strasser AA, Sofuoglu M, Kuzma A, Loughead J, Morrow AL, Epperson CN. Effect of progesterone administration in male and female smokers on nicotine withdrawal and neural response to smoking cues: role of progesterone conversion to allopregnanolone. Biol Sex Differ 2022; 13:60. [PMID: 36274158 PMCID: PMC9590190 DOI: 10.1186/s13293-022-00472-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 10/15/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Progesterone administration has therapeutic effects in tobacco use disorder (TUD), with females benefiting more than males. Conversion of progesterone to the neurosteroid allopregnanolone is hypothesized to partly underlie the therapeutic effects of progesterone; however, this has not been investigated clinically. METHODS Smokers (n = 18 males, n = 21 females) participated in a randomized, double-blind, placebo-controlled crossover study of 200 mg progesterone daily across 4 days of abstinence. The ratio of allopregnanolone:progesterone was analyzed in relationship to nicotine withdrawal, smoking urges, mood states, subjective nicotine effects, and neural response to smoking cues. RESULTS Allopregnanolone:progesterone ratio interacted with sex to predict withdrawal symptoms (p = 0.047), such that females with higher allopregnanolone:progesterone ratios reported lower withdrawal severity (b = - 0.98 [- 1.95, - 0.01]; p = 0.048). In addition, allopregnanolone:progesterone ratio interacted with sex to predict confusion (p = 0.014) and fatigue (p = 0.034), such that females with higher allopregnanolone:progesterone ratios reported less confusion (b = - 0.45 [- 0.78, - 0.12]; p = 0.008) and marginally lower fatigue (b = - 0.50 [- 1.03, 0.02]; p = 0.062. Irrespective of sex, higher ratios of allopregnanolone:progesterone were associated with stronger "good effects" of nicotine (b = 8.39 [2.58, 14.20]); p = 0.005) and weaker "bad effects" of nicotine (b = - 7.13 [- 13.53, - 0.73]; p = 0.029). CONCLUSIONS Conversion of progesterone to allopregnanolone correlated with smoking-related outcomes in both sex-dependent and sex-independent ways. Sex-dependent effects suggest that conversion of progesterone to allopregnanolone may contribute to greater therapeutic benefits in females but not males with TUD. Trial registration Clinicaltrials.gov registration, retrospectively registered: NCT01954966; https://clinicaltrials.gov/ct2/show/NCT01954966 \.
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Affiliation(s)
- Andrew M Novick
- Department of Psychiatry, School of Medicine, University of CO-Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO, 80045, USA.
| | - Korrina A Duffy
- Department of Psychiatry, School of Medicine, University of CO-Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO, 80045, USA
| | - Rachel L Johnson
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of CO-Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Mary D Sammel
- Department of Psychiatry, School of Medicine, University of CO-Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO, 80045, USA
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of CO-Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Wen Cao
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Andrew A Strasser
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Mehmet Sofuoglu
- Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT, 06511, USA
| | - Alexandra Kuzma
- Larner College of Medicine, University of Vermont, Burlington, VM, 05405, USA
| | - James Loughead
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - A Leslie Morrow
- Departments of Psychiatry and Pharmacology and the Bowles Center for Alcohol Studies, University of North Carolina School of Medicine, Chapel Hill, NC, 27514, USA
| | - C Neill Epperson
- Department of Psychiatry, School of Medicine, University of CO-Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO, 80045, USA
- Department of Family Medicine, School of Medicine, University of CO-Anschutz Medical Campus, Aurora, CO, 80045, USA
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24
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Chen-Sankey J, Elhabashy M, Gratale S, Geller J, Mercincavage M, Strasser AA, Delnevo CD, Jeong M, Wackowski OA. Examining Visual Attention to Tobacco Marketing Materials among Young Adult Smokers: A Protocol for a Remote Webcam-based Eye-Tracking Experiment (Preprint). JMIR Res Protoc 2022; 12:e43512. [PMID: 37052989 PMCID: PMC10141307 DOI: 10.2196/43512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/03/2023] [Accepted: 01/10/2023] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Eye tracking provides an objective way to measure attention, which can advance researchers' and policy makers' understanding of tobacco marketing influences. The development of remote webcam-based eye-tracking technology, integrated with web-based crowdsourcing studies, may be a cost-effective and time-efficient alternative to laboratory-based eye-tracking methods. However, research is needed to evaluate the utility of remote eye-tracking methods. OBJECTIVE This study aimed to detail the process of designing a remote webcam-based eye-tracking experiment and provide data on associations between participant characteristics and the outcomes of experiment completion. METHODS A total of 2023 young adult (aged 18-34 years) cigarette smokers in the United States were recruited to complete a web-based survey that included a 90-second remote eye-tracking experiment that examined attention to e-cigarette marketing materials. Primary outcome measures assessed the completion of the remote eye-tracking experiment-specifically, experiment initiated versus not initiated, experiment completed versus not completed, and usable versus nonusable eye-tracking data generated. Multivariable logistic regressions examined the associations between outcome measures and participants' sociodemographic backgrounds, tobacco use history, and electronic devices (mobile vs desktop) used during the experiment. RESULTS Study recruitment began on April 14, 2022, and ended on May 3, 2022. Of the 2023 survey participants, 1887 (93.28%) initiated the experiment, and 777 (38.41%) completed the experiment. Of the 777 participants who completed the experiment, 381 (49%) generated usable data. Results from the full regression models show that non-Hispanic Black participants (adjusted odds ratio [AOR] 0.64, 95% CI 0.45-0.91) were less likely to complete the eye-tracking experiment than non-Hispanic White participants. In addition, female (vs male) participants (AOR 1.46, 95% CI 1.01-2.11), those currently using (vs not using) e-cigarettes (AOR 2.08, 95% CI 1.13-3.82), and those who used mobile (vs desktop) devices (AOR 5.10, 95% CI 3.05-8.52) were more likely to generate usable eye-tracking data. CONCLUSIONS Young adult participants were willing to try remote eye-tracking technology, and nearly half of those who completed the experiment generated usable eye-tracking data (381/777, 49%). Thus, we believe that the use of remote eye-tracking tools, integrated with crowdsourcing recruitment, can be a useful approach for the tobacco regulatory science research community to collect high-quality, large-scale eye-tracking data in a timely fashion and thereby address research questions related to the ever-evolving tobacco marketing landscape. It would be useful to investigate techniques to enhance completion rates and data usability. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/43512.
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Affiliation(s)
- Julia Chen-Sankey
- Center for Tobacco Studies, School of Public Health, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, United States
| | - Maryam Elhabashy
- Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, United States
| | - Stefanie Gratale
- Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, United States
| | - Jason Geller
- Department of Psychology, Princeton University, Princeton, NJ, United States
| | | | - Andrew A Strasser
- School of Medicine, University of Pennsylvania, Philadelphia, NJ, United States
| | - Cristine D Delnevo
- Center for Tobacco Studies, School of Public Health, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, United States
| | - Michelle Jeong
- Center for Tobacco Studies, School of Public Health, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, United States
| | - Olivia A Wackowski
- Center for Tobacco Studies, School of Public Health, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, United States
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25
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Stone MD, DeAtley T, Pianin S, Strasser AA, Audrain-McGovern J. Switching from cigarettes to IQOS: A pilot examination of IQOS-associated reward, reinforcement, and abstinence relief. Drug Alcohol Depend 2022; 238:109569. [PMID: 35841732 DOI: 10.1016/j.drugalcdep.2022.109569] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/06/2022] [Accepted: 07/08/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND It is unknown whether IQOS-associated decreases in cigarette craving, nicotine withdrawal, greater subjective reward, and relative reinforcing value predict subsequent switching from cigarettes to IQOS products. METHODS Nontreatment-seeking adult daily smokers (n = 33; 18-65 years old) completed a within-subject pilot study consisting of a baseline ad-lib smoking period (days 1-5), two laboratory visits (days 6-7), and a two-week period where participants switch from using cigarettes to using IQOS (days 8-21). Mixed-effect modelling estimated the percentage of baseline cigarette consumption replaced by daily IQOS HeatSticks used. Predictors of use included IQOS-associated reinforcement, subjective reward, and craving and withdrawal relief. RESULTS IQOS use alleviated cigarette abstinence-associated craving (change=-14.22, p < .001) but did not alleviate withdrawal symptoms. Smokers initially substituted IQOS for 59% of their average daily cigarette consumption, increasing to 87% by switch period end (B=0.02 [95%CI=0.01, 0.03], p = .002). Neither subjective reward of IQOS nor relief of cigarette craving and withdrawal symptoms were predictive of this change. By study end, IQOS consumption was 124% of regular cigarette consumption among participants with a low reinforcing value of cigarettes relative to IQOS (β = 0.03 [95%CI=0.00, 0.06], p = .049). In contrast, participants with a higher reinforcing value of smoking replaced 76% of their cigarettes with IQOS. CONCLUSIONS IQOS shows potential as an alternative to combustible cigarettes. However, IQOS use may result in dual-use for most smokers and increase tobacco consumption among a subgroup of smokers. These preliminary findings highlight the need for a larger investigation of the relationship between IQOS use and cigarette smoking.
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Affiliation(s)
- Matthew D Stone
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Teresa DeAtley
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Stephen Pianin
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Andrew A Strasser
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Janet Audrain-McGovern
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Gratale SK, Jeong M, Sidhu A, Safi Z, Strasser AA, Delnevo CD, Wackowski OA. Young adults' cigarillo risk perceptions, attention to warning labels and perceptions of proposed pictorial warnings: a focus group study. BMJ Open 2022; 12:e061064. [PMID: 35768091 PMCID: PMC9240892 DOI: 10.1136/bmjopen-2022-061064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Although cigars pose similar health risks to cigarettes, they are not uniformly required to carry a warning label on their packaging in the USA. The US Food and Drug Administration's 2016 deeming rule established a cigar warning requirement, but it was challenged in federal court for failing to document warning effects on prevention/cessation, thus necessitating an evidentiary base for such requirements. We sought to explore young adult users' understanding of cigarillo risks and addictiveness, as well as their perceptions of current (voluntary) and proposed cigar warning labels. DESIGN In December 2020-January 2021, we conducted eight focus groups with young adult cigarillo smokers. We asked participants their first associations of cigarillos and beliefs about product harms/addictiveness, and then discussed existing warning labels and examples of potential pictorial warnings. SETTING Focus groups were conducted remotely via the Adobe Connect platform, with participants from 20 US states. PARTICIPANTS Participants included 42 young adults (ages 18-29; 50% male), who were recent cigarillo users (ie, past 30 days) or less frequent users (ie, past 12 months). RESULTS Participants frequently used cigarillos as blunts and often conveyed uncertainty about cigarillo risks and addictiveness, in general and relative to cigarettes. Participants typically paid little attention to current text warnings, but many expressed that pictorial warnings would more effectively promote knowledge of product risks and discourage use among prospective users. CONCLUSIONS US young adult cigarillo users may lack knowledge about product risks and addictiveness. Standardised warning requirements, particularly pictorial labels, may help address this knowledge gap and deter use.
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Affiliation(s)
- Stefanie K Gratale
- Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey, USA
| | - Michelle Jeong
- Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey, USA
| | - Anupreet Sidhu
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Zeinab Safi
- Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey, USA
| | - Andrew A Strasser
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Cristine D Delnevo
- Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey, USA
| | - Olivia A Wackowski
- Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey, USA
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Johnson AC, Mercincavage M, Souprountchouk V, Sidhu AK, Villanti AC, Delnevo CD, Strasser AA. Construct validity of the Cigarette Ratings Scale and associations with tobacco use and product feature outcomes. Drug Alcohol Depend 2022; 234:109397. [PMID: 35287035 PMCID: PMC9018530 DOI: 10.1016/j.drugalcdep.2022.109397] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/02/2022] [Accepted: 03/04/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Subjective ratings are inconsistently associated with behavioral outcomes such as tobacco use and there is no current standard. The Cigarette Ratings Scale is an ideal measure for further evaluation because it has been widely used in tobacco regulatory science and tobacco industry research. PURPOSE This study investigated the construct validity of the Cigarette Ratings Scale and associations with tobacco use and product feature outcomes. METHODS Using secondary analysis of baseline data from five research trials, we conducted an exploratory factor analysis in one sample and validated the factor solution in a second sample. We then examined the relationship of the averaged subscales with tobacco outcomes and cigarette product features among current adult cigarette smokers (N = 752) who smoked ≥ 5 cigarettes daily for ≥ 5 years. RESULTS The results supported a three-factor solution: 1. Product harshness evaluation, 2. Smoking satisfaction, and 3. Positive sensory experience. Multivariable general linear models indicated that cigarettes per day was associated with a lower harshness rating b = -0.29 (95% CI: -0.51, -0.07) and higher positive sensory experience b = 0.32 (95% CI: 0.08, 0.56). FTND average dependence scores were associated with a more positive sensory experience b = 1.08 (95% CI: 0.28, 1.89). CO boost was associated with smoking satisfaction b = 0.77 (95% CI: 0.30, 1.26). CONCLUSIONS The Cigarette Ratings Scale subscales were primarily associated with behavioral outcomes, biological exposure, and nicotine dependence. This can help addiction efforts to determine how subjective evaluations of tobacco products relate to use behaviors.
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Affiliation(s)
- Andrea C Johnson
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, PA, USA.
| | - Melissa Mercincavage
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, PA, USA
| | - Valentina Souprountchouk
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, PA, USA
| | - Anupreet K Sidhu
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, PA, USA
| | - Andrea C Villanti
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, PA, USA; Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, NJ, USA
| | - Cristine D Delnevo
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, PA, USA; Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, NJ, USA
| | - Andrew A Strasser
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, PA, USA; Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA
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Gratale SK, Teotia A, Chen-Sankey J, Ganz O, Delnevo CD, Strasser AA, Wackowski OA. Cigar Warning Noticing and Demographic and Usage Correlates: Analysis from the United States Population Assessment of Tobacco and Health Study, Wave 5. Int J Environ Res Public Health 2022; 19:3221. [PMID: 35328908 PMCID: PMC8952384 DOI: 10.3390/ijerph19063221] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/03/2022] [Accepted: 03/05/2022] [Indexed: 12/10/2022]
Abstract
Although cigars pose health risks similar to cigarettes, their packaging/marketing is not subject to commensurate regulation in the US. In a 2000 agreement with the Federal Trade Commission, seven major manufacturers agreed to use some form of cigar warning. In 2016, the Food and Drug Administration passed a rule requiring larger standardized warnings, but the requirement was successfully challenged in court. Here, we examined U.S. population-level trends in noticing existing cigarillo, traditional and filtered cigar warnings. We analyzed Wave 5 Population Assessment of Tobacco and Health adult data to assess prevalence of past-30 day warning noticing and associations with socio-demographic and tobacco use variables. Noticing was higher among current users of cigarillos (27%), filtered (34%) and traditional cigars (21%), than non-users (8% for each product, p < 0.0001), and among every-day vs. some-day users, established vs. experimental users, and past-30 day users vs. those without past-30 day use. Results varied by product, but generally indicated lower noticing among non-Hispanic Whites and dual cigarette users, but higher noticing among those purchasing cigars by the box/pack (vs. not purchasing for themselves). Low overall noticing but higher prevalence among frequent users underscores a need for a stronger, uniform cigar warning label policy in the US.
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Affiliation(s)
- Stefanie K. Gratale
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, Rutgers University, New Brunswick, NJ 08901, USA; (A.T.); (J.C.-S.); (O.G.); (C.D.D.); (O.A.W.)
| | - Arjun Teotia
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, Rutgers University, New Brunswick, NJ 08901, USA; (A.T.); (J.C.-S.); (O.G.); (C.D.D.); (O.A.W.)
| | - Julia Chen-Sankey
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, Rutgers University, New Brunswick, NJ 08901, USA; (A.T.); (J.C.-S.); (O.G.); (C.D.D.); (O.A.W.)
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Rutgers University, Piscataway, NJ 08854, USA
| | - Ollie Ganz
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, Rutgers University, New Brunswick, NJ 08901, USA; (A.T.); (J.C.-S.); (O.G.); (C.D.D.); (O.A.W.)
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Rutgers University, Piscataway, NJ 08854, USA
| | - Cristine D. Delnevo
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, Rutgers University, New Brunswick, NJ 08901, USA; (A.T.); (J.C.-S.); (O.G.); (C.D.D.); (O.A.W.)
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Rutgers University, Piscataway, NJ 08854, USA
| | - Andrew A. Strasser
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Olivia A. Wackowski
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, Rutgers University, New Brunswick, NJ 08901, USA; (A.T.); (J.C.-S.); (O.G.); (C.D.D.); (O.A.W.)
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Rutgers University, Piscataway, NJ 08854, USA
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Johnson AC, Simmens SJ, Turner MM, Evans WD, Strasser AA, Mays D. Longitudinal effects of cigarette pictorial warning labels among young adults. J Behav Med 2022; 45:124-132. [PMID: 34554369 PMCID: PMC8821134 DOI: 10.1007/s10865-021-00258-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 09/08/2021] [Indexed: 02/03/2023]
Abstract
Young adults are influenced by cigarette package marketing. Pictorial warning labels are a recommended intervention. Evidence demonstrates pictorial warnings impact negative emotion, risk perceptions, and motivation to quit smoking, but there is limited research on their effects over time. This study analyzes data from a randomized trial of young adult smokers (N = 229) exposed to a pictorial or text-only cigarette warning. We assessed changes in fear, anger, risk perceptions, and motivation to quit smoking after 4 weeks using latent change score modeling and over 3 months using latent growth modeling. Latent change results showed exposure was associated with increases in fear, anger, and motivation to quit after 4 weeks. Latent growth showed exposure was associated with increases in motivation to quit smoking over 3 months, but not other outcomes. Findings suggest pictorial warning labels produce an emotional response and increase motivation to quit among young adult smokers.
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Affiliation(s)
- Andrea C. Johnson
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Samuel J. Simmens
- Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Monique M. Turner
- Department of Communication, Michigan State University, East Lansing, Michigan
| | - W. Douglas Evans
- Prevention and Community Health Department, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Andrew A. Strasser
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Darren Mays
- Department of Internal Medicine, Wexner Medical Center, Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH
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Differding M, Katz SJ, Strayer LG, White C, Strasser AA, Donny EC, Hatsukami DK, Carroll DM. Educating the Public on the Health Risks of Very Low Nicotine Content Cigarettes: Results From a US-Based Convenience Sample. Nicotine Tob Res 2022; 24:871-880. [PMID: 35023564 PMCID: PMC9048884 DOI: 10.1093/ntr/ntac010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/23/2021] [Accepted: 01/10/2022] [Indexed: 01/14/2023]
Abstract
INTRODUCTION US FDA issued an advance notice of proposed rulemaking to reduce nicotine in cigarettes. To maximize the benefits of this potential standard, very low nicotine content (VLNC) cigarettes must be communicated in a way that does not result in misperceptions. AIMS AND METHODS Adults (n = 567 who smoke; n = 610 non-smokers) from an online platform were randomized to a control message previously associated with accurate addictiveness perceptions of VLNC cigarettes but health misperceptions or to one of five messages that also included messaging on nicotine morbidity effects or VLNC cigarettes morbidity or mortality effects. p value <.01 was significant. RESULTS In participants who smoke, perceived lung cancer risk (responses: 1, very little risk to 10, very high risk) if smoked VLNC cigarettes regularly was higher in conditions that communicated mortality effects of VLNC cigarettes compared to the control (7.12-7.18 vs. 5.97, p values < .01). In non-smokers, perceived lung cancer risk was higher in all five message conditions when compared with the control (7.58-8.22 vs. 6.35, p values < .01). Proportion who responded accurately (ie, False) to the statement Cigarettes with 95% less nicotine are safer than cigarettes with normal nicotine levels was higher in conditions describing VLNC morbidity or mortality effects when compared with the control in both participants who smoke (52.04-67.37% vs. 30.85%, p values < .01) and do not smoke (62.50-72.38% vs. 32.00%, p values < .01). CONCLUSIONS Messaging on mortality effects of VLNC cigarettes (ie, cigarettes with 95% less nicotine are as deadly as current cigarettes) was associated with more accurate perceptions of the health risks of VLNC cigarettes than the control; however, misperceptions remained in one-third of participants. IMPLICATIONS One approach to communicating a VLNC cigarette standard to the public is to include messaging on the mortality effects of VLNC cigarettes. However, further study and possible refinement of this message condition are recommended since approximately one-third of participants exposed to this message still perceived VLNC cigarettes to be safer than normal nicotine content cigarettes.
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Affiliation(s)
| | - Sherri Jean Katz
- Hubbard School of Journalism and Mass Communication, University of Minnesota, Minneapolis, MN, USA
| | - Lori G Strayer
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Cassidy White
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Andrew A Strasser
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Eric C Donny
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Dorothy K Hatsukami
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
- Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Dana Mowls Carroll
- Corresponding Author: Dana Mowls Carroll, MPH, PhD, Division of Environmental Health Sciences, School of Public Health, Masonic Cancer Center, University of Minnesota, 717 Delaware St SE, Room 254, Minneapolis, MN 55414, USA. Telephone: 612-624-0132; E-mail:
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Sidhu AK, Johnson AC, Souprountchouk V, Wackowski O, Strasser AA, Mercincavage M. Cognitive and emotional responses to pictorial warning labels and their association with quitting measures after continued exposure. Addict Behav 2022; 124:107121. [PMID: 34583271 PMCID: PMC8603253 DOI: 10.1016/j.addbeh.2021.107121] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Previous research has highlighted the role of cognitive and affective mediators in facilitating the effectiveness of pictorial warning labels (PWLs). This study examines smokers' responses towards PWLs after 10 days of use and their associations with changes in quitting attitudes, beliefs, and intentions during this period. METHODS Non-treatment-seeking, daily smokers completed a randomized, parallel design trial. Participants were randomized to either a PWL or control (i.e., text only or no warning label) group and received their preferred brand cigarettes affixed with their assigned label for 10 days. We assessed quitting attitudes, intentions, and beliefs at the onset and end of the study. At study end, smokers rated their PWL on a 5-point scale for 8 cognitive and emotional attributes: memorable, understandable, shocking, informative, offensive, boring, relevant, and interesting. RESULTS Mean ratings of the PWLs were high for memorable, understandable, informative, relevant, and interesting (range = 3.4 to 4.0), moderate for shocking (2.9), and low for offensive (1.7), and boring (1.5). Among the PWLs, quitting-related attitudes, positive beliefs, and intentions increased over the study period (p < .001) and these changes were positively associated with most attributes except offensive and boring (p < .05). For the text-only label group, attitudes and intentions increased significantly but these changes were not associated with any attributes. CONCLUSION Smokers generally have favorable evaluations of PWLs following repeated exposures. Further, these evaluations are associated with increased quitting attitudes and intentions, which may facilitate cessation attempts over longer periods of exposure.
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Affiliation(s)
- Anupreet K Sidhu
- University of Pennsylvania Tobacco Center of Regulatory Science (UPenn TCORS) and Center for Interdisciplinary Research on Nicotine Addiction (CIRNA), Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States.
| | - Andrea C Johnson
- University of Pennsylvania Tobacco Center of Regulatory Science (UPenn TCORS) and Center for Interdisciplinary Research on Nicotine Addiction (CIRNA), Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Valentina Souprountchouk
- University of Pennsylvania Tobacco Center of Regulatory Science (UPenn TCORS) and Center for Interdisciplinary Research on Nicotine Addiction (CIRNA), Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Olivia Wackowski
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, and Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, NJ, United States
| | - Andrew A Strasser
- University of Pennsylvania Tobacco Center of Regulatory Science (UPenn TCORS) and Center for Interdisciplinary Research on Nicotine Addiction (CIRNA), Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Melissa Mercincavage
- University of Pennsylvania Tobacco Center of Regulatory Science (UPenn TCORS) and Center for Interdisciplinary Research on Nicotine Addiction (CIRNA), Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
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Mercincavage M, Albelda B, Mays D, Souprountchouk V, Giovenco DP, Audrain-McGovern J, Strasser AA. Shedding 'light' on cigarette pack design: colour differences in product perceptions, use and exposure following the US descriptor ban. Tob Control 2022; 31:19-24. [PMID: 32994296 PMCID: PMC8261712 DOI: 10.1136/tobaccocontrol-2020-055886] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/15/2020] [Accepted: 08/26/2020] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Many countries removed misleading descriptors (eg, 'light,' 'mild') from cigarette packaging because they falsely conveyed messages of reduced risk. It is unclear if relabelled products currently promote misperceptions or differences in product use and toxicant exposure. We compared product perceptions, use and exposure between a US sample of Marlboro Gold (formerly 'light') and Red smokers. METHODS 240 non-treatment-seeking adult daily Marlboro smokers (70% male, 71% White, mean cigarettes/day=16.4 (SD=8.3)) completed two laboratory sessions over a 5-day period. During sessions, participants smoked two cigarettes through a topography device to capture their puffing behaviour, provided precigarette and postcigarette carbon monoxide (CO) assessments, and completed risk perception and subjective rating questionnaires. Self-reported cigarettes per day were verified via daily filter collection; urine collected at the end of the period was assayed for nicotine metabolites. RESULTS Gold (n=49) smokers were more likely than Red (n=191) to incorrectly believe their cigarettes had less nicotine and tar than regular cigarettes (ps<0.001), and rated them as weaker, less harsh, and mild tasting (ps<0.05). Differences between Red and Gold smokers in cigarettes per day and puffing behaviours trended towards significance (ps<0.1). Notably, there were no group differences on CO boost or total nicotine equivalents (ps>0.1). CONCLUSIONS Misperceptions about nicotine and tar exist years after rebranding Marlboro Lights as Marlboro Gold. Biological results support that Gold smokers do not have lower toxicant exposure. The US should consider comprehensive packaging or product design regulations to properly inform smokers of product risks.Trial registeration number NCT02301351.
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Affiliation(s)
- Melissa Mercincavage
- Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Benjamin Albelda
- Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Darren Mays
- Department of Oncology, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Valentina Souprountchouk
- Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Daniel P Giovenco
- Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Janet Audrain-McGovern
- Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Andrew A Strasser
- Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Abstract
This study uses Nielsen Company data for cigar sales to describe trends and patterns in sales of flavored cigars and cigars sold in small pack sizes in US convenience stores from 2009 to 2020.
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Affiliation(s)
| | - Erin Miller Lo
- Rutgers Center for Tobacco Studies, New Brunswick, New Jersey
| | - Daniel P. Giovenco
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York
| | - Jennifer Cornacchione Ross
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Mary Hrywna
- Rutgers Center for Tobacco Studies, New Brunswick, New Jersey
| | - Andrew A. Strasser
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia
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Steinberg MB, Bover Manderski MT, Wackowski OA, Singh B, Strasser AA, Delnevo CD. Nicotine Risk Misperception Among US Physicians. J Gen Intern Med 2021; 36:3888-3890. [PMID: 32875504 PMCID: PMC8642586 DOI: 10.1007/s11606-020-06172-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/17/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Michael B Steinberg
- Department of Medicine, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA.
| | | | - Olivia A Wackowski
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, NJ, USA
| | - Binu Singh
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, NJ, USA
| | - Andrew A Strasser
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Cristine D Delnevo
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, NJ, USA
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Mays D, Johnson AC, Glasser A, Mercincavage M, Strasser AA. Effects of IQOS health warnings and modified risk claims among young adult cigarette smokers and non-smokers. Tob Control 2021:tobaccocontrol-2021-056810. [PMID: 34716283 PMCID: PMC9050959 DOI: 10.1136/tobaccocontrol-2021-056810] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 10/18/2021] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Heated tobacco products, including Marlboro IQOS, are available globally. In the USA, IQOS was authorised to be advertised with claims about reduced toxicant exposure relative to cigarettes. The effects of such modified risk claims and health warnings have not been studied among young adult cigarette smokers and non-smokers. METHODS In 2020, US young adult (18-30 years, n=1328) cigarette smokers and non-smokers viewed an IQOS ad in a 4 (modified risk claim variations or none) by 3 (warning variations or none) between-subjects experiment. Outcome measures assessed perceived credibility and effectiveness of the health or risk message for discouraging IQOS use, perceived harms, efficacy beliefs, and IQOS use intentions. RESULTS Smokers reported significantly higher (p<0.05) perceived credibility, lower perceived effectiveness, higher efficacy beliefs about switching to IQOS and higher intentions to use IQOS than non-smokers. Among smokers, health warnings increased perceived credibility (p<0.001) and effectiveness (p<0.05), but claims did not affect outcomes examined. Among non-smokers, warnings and claims increased perceived credibility, and warnings increased perceived effectiveness (p<0.003). The reduced exposure claim increased non-smokers' intentions to use IQOS (b=0.40, 95% CI 0.07 to 0.73). CONCLUSIONS Among young adult smokers, health warnings increased perceived effectiveness at discouraging IQOS use and perceived credibility. Among non-smokers, warnings and claims increased perceived credibility and warnings increased perceived effectiveness, but the Food and Drug Administration-authorised reduced exposure claim increased intentions to use IQOS. Research is warranted to understand how the content of modified risk claims and health warnings for IQOS affects IQOS use in this population.
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Affiliation(s)
- Darren Mays
- Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Andrea C Johnson
- Department of Psychiatry and Tobacco Center of Regulatory Science, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Allison Glasser
- College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Melissa Mercincavage
- Department of Psychiatry and Tobacco Center of Regulatory Science, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Andrew A Strasser
- Department of Psychiatry and Tobacco Center of Regulatory Science, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Johnson AC, Mercincavage M, Souprountchouk V, Rogelberg S, Sidhu AK, Delnevo CD, Strasser AA. Responses to reduced nicotine cigarette marketing features: a systematic review. Tob Control 2021; 32:tobaccocontrol-2021-056826. [PMID: 34620718 PMCID: PMC8986886 DOI: 10.1136/tobaccocontrol-2021-056826] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/20/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To systematically review the literature regarding responses to commercial and public health marketing features for reduced nicotine cigarettes (RNCs) to anticipate potential industry and regulatory actions should an RNC product standard be issued. DATA SOURCES We searched PubMed for English-language articles using several keywords for reduced nicotine products, cigarettes and marketing features published through 2020. STUDY SELECTION Of 4092 records, 26 studies were retained for review that met criteria focusing on responses to RNC marketing features. DATA EXTRACTION Search terms created by the research team were used for review and included independent extraction and coding by two reviewers. Coding was categorised using study design terminology, commercial and public health features in tobacco regulatory science, and their association with individual responses outlined by several message processing outcomes. DATA SYNTHESIS Most studies focused on current cigarette smokers and were cross-sectional. Reactions to RNCs and attitudes and beliefs were the most common outcomes measured. For commercial features, articles generally studied RNC advertisements, products and/or descriptors. For public health features, articles studied counter-messaging (eg, warning labels) or general descriptors about nicotine or a reduced nicotine product standard. Commercial features were generally associated with favourable responses. Public health features offset favourable responses across most outcomes, though their efficacy was mixed. Contrasts in results by smoking status are discussed. CONCLUSIONS Commercial marketing of RNCs is appealing and may need stronger regulations or communication campaigns to accurately convey risks. Opportunities exist for future research within tobacco regulatory science.
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Affiliation(s)
- Andrea C Johnson
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, Pennsylvania, USA
| | - Melissa Mercincavage
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, Pennsylvania, USA
| | - Valentina Souprountchouk
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, Pennsylvania, USA
| | - Sasha Rogelberg
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Anupreet K Sidhu
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, Pennsylvania, USA
| | - Cristine D Delnevo
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, Pennsylvania, USA
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey, USA
| | - Andrew A Strasser
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, Pennsylvania, USA
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Johnson AC, Turner MM, Simmens SJ, Evans WD, Strasser AA, Mays D. Mediational Effects on Motivation to Quit Smoking After Exposure to a Cigarette Pictorial Warning Label Among Young Adults. Ann Behav Med 2021; 56:737-748. [PMID: 34415010 DOI: 10.1093/abm/kaab073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Young adults are vulnerable to cigarette package marketing. Pictorial warning labels are recommended for tobacco control. Research should address questions raised in legal challenges including causal mechanisms. Evidence is mixed and understudied among young adults (e.g., discrete emotions and risk perceptions). PURPOSE This study investigated mediators of pictorial warning label effects on motivation to quit smoking among young adult smokers. METHODS This study analyzed data from a randomized trial with a 4 week exposure to a cigarette pictorial warning among young adult smokers (N = 229) aged 18-30 with assessments at baseline, immediately post-intervention, and 3 months. Mediation analyses used latent change scores to test the effects post-intervention on fear, anger, and risk perceptions. We also examined whether post-intervention measures predicted change in motivation to quit smoking at 3 months. The first model assessed aggregate risk perceptions and the second model assessed discrete risk perceptions (deliberative, affective). RESULTS Pictorial warning label exposure led to increases in fear which led to increased motivation to quit smoking for the first (B = 0.12, 95% CI = 0.04, 0.26) and second (B = 0.12, 95% CI = 0.03, 0.25) model. Exposure modestly increased motivation to quit by way of fear and affective risk perceptions (B = 0.01, 95% CI = 0.00, 0.04). Exposure had a direct relationship on increased motivation to quit as well. CONCLUSIONS Findings demonstrate factors contributing to change in motivation to quit smoking among young adult smokers after pictorial warning label exposure. Affective processes are mediators of pictorial warning label effects.
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Affiliation(s)
- Andrea C Johnson
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Monique M Turner
- Department of Communication, Michigan State University, East Lansing, MI, USA
| | - Samuel J Simmens
- Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - W Douglas Evans
- Prevention and Community Health Department, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Andrew A Strasser
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Darren Mays
- Department of Internal Medicine, Wexner Medical Center, Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
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Liu J, Benowitz NL, Hatsukami DK, Havel CM, Lazcano-Ponce E, Strasser AA, Jacob P. 3-Ethenylpyridine Measured in Urine of Active and Passive Smokers: A Promising Biomarker and Toxicological Implications. Chem Res Toxicol 2021; 34:1630-1639. [PMID: 33998799 DOI: 10.1021/acs.chemrestox.1c00064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In studies of tobacco toxicology, including comparisons of different tobacco products and exposure to secondhand or thirdhand smoke, exposure assessment using biomarkers is often useful. Some studies have indicated that most of the toxicity of tobacco smoke is due to gas-phase compounds. 3-Ethenylpyridine (3-EP) is a major nicotine pyrolysis product occurring in the gas phase of tobacco smoke. It has been used extensively as an environmental tracer for tobacco smoke. 3-EP would be expected to be a useful tobacco smoke biomarker as well, but nothing has been published about its metabolism and excretion in humans. In this Article we describe a solid-phase microextraction (SPME) GC-MS/MS method for determination of 3-EP in human urine and its application to the determination of 3-EP in the urine of smokers and people exposed to secondhand smoke. We conclude that 3-EP is a promising biomarker that could be useful in studies of tobacco smoke exposure and toxicology. We also point out the paucity of data on 3-EP toxicity and suggest that additional studies are needed.
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Affiliation(s)
- Jia Liu
- Clinical Pharmacology Program, Division of Cardiology, Department of Medicine, University of California, San Francisco, California 94143, United States
| | - Neal L Benowitz
- Clinical Pharmacology Program, Division of Cardiology, Department of Medicine, University of California, San Francisco, California 94143, United States
| | - Dorothy K Hatsukami
- Department of Psychiatry and Behavioral Sciences and Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota 55455, United States
| | - Christopher M Havel
- Clinical Pharmacology Program, Division of Cardiology, Department of Medicine, University of California, San Francisco, California 94143, United States
| | - Eduardo Lazcano-Ponce
- School of Public Health of Mexico, National Institute of Public Health, 62100 Cuernavaca, Morelos, Mexico
| | - Andrew A Strasser
- Tobacco Center of Regulatory Science, Department of Psychiatry and Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
| | - Peyton Jacob
- Clinical Pharmacology Program, Division of Cardiology, Department of Medicine, University of California, San Francisco, California 94143, United States
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Mercincavage M, Karelitz JL, Kreider CL, Souprountchouk V, Albelda B, Strasser AA. Comparing video observation to electronic topography device as a method for measuring cigarette puffing behavior. Drug Alcohol Depend 2021; 221:108623. [PMID: 33618196 PMCID: PMC8026715 DOI: 10.1016/j.drugalcdep.2021.108623] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/26/2021] [Accepted: 02/05/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Smoking topography, or puffing behavior, is an important measure of how consumers may use tobacco products. However, numerous issues may prevent collection of this data via in-person, electronic topography device (e.g., CReSS). This study compared cigarette topography measures collected by video observation and electronic device. METHODS Laboratory smoking sessions were video recorded and scored for 96 cigarettes collected from 34 daily, adult non-treatment-seeking smokers (73.5 % male, 82.4 % White). Participants smoked three of their preferred brand cigarettes using an electronic topography device, providing carbon monoxide (CO) samples before and after each cigarette. Analyses compared measures from both assessment methods and examined associations with device-obtained total puff volume and CO boost. RESULTS Agreement analyses indicated robust similarity between methods for measures of puff count and total interpuff interval (Intraclass Correlation Coefficient [ICC]'s > 0.96,p's < 0.001; Bland-Altman [B-A] plotted differences within a priori limit of clinical significance) but diverged on total duration (ICC's > .93, p's < .001, yet B-A plots outside a priori limits). Regardless of assessment method, total duration and puff count (but not total interpuff interval) predicted total puff volume (p's < .001). None predicted CO boost (p's = .07-.90)." CONCLUSIONS Although some topography outcomes (e.g., total puff volume) cannot be assessed via video observation, video-observed measures of puff count, total duration, and total interpuff interval are generally interchangeable with their topography device-obtained counterparts. Thus, video observation is likely a sufficient substitute method for assessing cigarette topography when using an electronic device is not possible.
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Affiliation(s)
- Melissa Mercincavage
- Center for Interdisciplinary Research on Nicotine Addiction, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States; University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, PA, United States.
| | - Joshua L. Karelitz
- Division of Cancer Control and Population Sciences, UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh PA,Department of Epidemiology, Graduate School of Publich Health, University of Pittsburgh, Pittsburgh, PA
| | - Catherine L. Kreider
- Center for Interdisciplinary Research on Nicotine Addiction, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Valentina Souprountchouk
- Center for Interdisciplinary Research on Nicotine Addiction, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Benjamin Albelda
- Center for Interdisciplinary Research on Nicotine Addiction, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Andrew A. Strasser
- Center for Interdisciplinary Research on Nicotine Addiction, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA,University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, PA
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Chatterjee S, Caporale A, Tao JQ, Guo W, Johncola A, Strasser AA, Leone FT, Langham MC, Wehrli FW. Acute e-cig inhalation impacts vascular health: a study in smoking naïve subjects. Am J Physiol Heart Circ Physiol 2020; 320:H144-H158. [PMID: 33216614 DOI: 10.1152/ajpheart.00628.2020] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
This study was designed to investigate the acute effects of nonnicotinized e-cigarette (e-cig) aerosol inhalation in nonsmokers both in terms of blood-based markers of inflammation and oxidative stress and evaluate their association with hemodynamic-metabolic MRI parameters quantifying peripheral vascular reactivity, cerebrovascular reactivity, and aortic stiffness. Thirty-one healthy nonsmokers were subjected to two blood draws and two identical MRI protocols, each one before and after a standardized e-cig vaping session. After vaping, the serum levels of C-reactive protein, soluble intercellular adhesion molecule, and the danger signal machinery high-mobility group box 1 (HMGB1) and its downstream effector and the NLR family pyrin domain containing 3 (NLRP3) inflammasome (as monitored by its adaptor protein ASC) increased significantly relative to the respective baseline (prevaping) values. Moreover, nitric oxide metabolites and reactive oxygen species production decreased and increased, respectively. These observations were paralleled by impaired peripheral vascular reactivity (with reduced flow-mediated dilation and attenuated hyperemic response after a cuff-occlusion test) and metabolic alterations expressed by decreased venous oxygen saturation, postvaping. The current results suggest propagation of inflammation signaling via activation of the danger signaling axis (HMGB1-NLRP3). The findings indicate that a single episode of vaping has adverse impacts on vascular inflammation and function.NEW & NOTWORTHY Endothelial cell signaling and blood biomarkers were found to correlate with functional vascular changes in a single episode e-cigarettes inhalation in healthy adults. This is indicative of the potential of e-cigarettes (even when inhaled acutely) to lead of vascular dysfunction.
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Affiliation(s)
- Shampa Chatterjee
- Institute for Environmental Medicine and Department of Physiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Alessandra Caporale
- Laboratory for Structural, Physiologic and Functional Imaging, Department of Radiology
| | - Jian Qin Tao
- Institute for Environmental Medicine and Department of Physiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Wensheng Guo
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Alyssa Johncola
- Laboratory for Structural, Physiologic and Functional Imaging, Department of Radiology
| | - Andrew A Strasser
- Department of Psychiatry and Center for Interdisciplinary Research on Nicotine Addiction, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Frank T Leone
- Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Michael C Langham
- Laboratory for Structural, Physiologic and Functional Imaging, Department of Radiology
| | - Felix W Wehrli
- Laboratory for Structural, Physiologic and Functional Imaging, Department of Radiology
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Johnson AC, Mays D, Villanti AC, Niaura RS, Rehberg K, Phan L, Mercincavage M, Luta G, Strasser AA. Marketing Influences on Perceptions of Reduced Nicotine Content Cigarettes. Nicotine Tob Res 2020; 21:S117-S124. [PMID: 31867656 PMCID: PMC6939778 DOI: 10.1093/ntr/ntz167] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 08/29/2019] [Indexed: 11/25/2022]
Abstract
Introduction The Food and Drug Administration announced intent to reduce the nicotine content in cigarettes. There is limited evidence on how reduced nicotine content cigarette (RNC) marketing affects product beliefs and use, and research on this is needed to inform regulations. Methods In an online experiment, 426 young adult cigarette smokers (aged 18–30 years) were randomized in a 2 (implicit: red package vs. blue package) × 2 (explicit: corrective message vs. no corrective message) design to view an advertisement for previously commercially available RNCs. Outcomes were advertisement content recall, product beliefs, and use intentions. Participants’ responses to open-ended assessment of their beliefs about the stimuli were coded to identify prevailing themes. Results Red packaging and corrective messaging were independently associated with greater advertisement content recall (p = .01 and p = .04, respectively). There were no significant main or interaction effects on product beliefs or use intentions. Controlling for condition, advertisement content recall was significantly associated with less favorable product beliefs (p < .001) and favorable product beliefs were associated with intent to use the product (p < .001). Open-ended responses converged on the finding that respondents were interested in RNCs, but expressed skepticism about effectiveness and value. Conclusions Brief exposure to an RNC advertisement with red packaging and corrective messaging were each independently associated with greater advertisement content recall. The results indicate: (1) interest and confusion among young adult smokers regarding RNCs, (2) beliefs about RNCs are influenced by marketing, and (3) beliefs are associated with intention to use RNCs. Implications Findings from this study demonstrate the importance of advertising effects on beliefs about RNC products and support the need to regulate advertising and labeling alongside product regulation. More detailed study of advertisement features that affect consumers’ beliefs about RNCs and how they impact their processing of explicit messaging about product risks will be important to guide regulatory decision-making.
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Affiliation(s)
- Andrea C Johnson
- Milken Institute School of Public Health, George Washington University, Washington, DC.,Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Darren Mays
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Andrea C Villanti
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont Larner College of Medicine, Burlington, VT
| | - Raymond S Niaura
- New York University College of Global Public Health, New York, NY
| | - Kathryn Rehberg
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Lilianna Phan
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC.,University of Maryland School of Public Health, College Park, MD
| | - Melissa Mercincavage
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - George Luta
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC.,Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University Medical Center, Washington, DC
| | - Andrew A Strasser
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Mercincavage M, Lochbuehler K, Villanti AC, Wileyto EP, Audrain-McGovern J, Strasser AA. Examining Risk Perceptions Among Daily Smokers Naïve to Reduced Nicotine Content Cigarettes. Nicotine Tob Res 2020; 21:985-990. [PMID: 29718357 DOI: 10.1093/ntr/nty082] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 04/27/2018] [Indexed: 11/14/2022]
Abstract
INTRODUCTION The U.S. Food and Drug Administration (FDA) has stated its interest in reducing the addictiveness of combustible cigarettes by lowering their nicotine content. Delineating risk perceptions of reduced nicotine content (RNC) cigarettes prior to federal regulation may inform the content of future educational campaigns accompanying this policy. METHODS Five hundred non-treatment-seeking, daily smokers naïve to RNC cigarettes (63.0% male, 51.6% nonWhite, mean [SD] cigarettes per day = 15.69 [7.58], age = 43.44 [11.46]) completed a 10-item RNC cigarette risk perception questionnaire at baseline in two, unrelated experimental studies. We used multinomial logistic regression models to identify demographic (eg, gender) and smoking-related (eg, nicotine dependence) correlates of RNC cigarette risk perceptions. RESULTS Although the majority of participants did not misperceive RNC cigarettes as less harmful than regular or high nicotine cigarettes, a large portion of the sample held misperceptions about RNC cigarettes' addictiveness (56.4%) and cessation aid potential (63.4%). More than 20% of the sample reported being unsure about RNC-related risks, especially tar content (51.8%). NonWhite smokers were 2.5 to 3 times more likely to be incorrect about multiple RNC cigarette risks (p = .002-.006). CONCLUSIONS If the FDA mandates a reduced nicotine content standard for cigarettes, educational campaigns will be needed to correct misperceptions about RNC cigarettes' addictiveness and potential to aid cessation as well as inform consumers about their safety risks. Campaigns tailored toward nonWhite smokers may also be needed to correct misperceptions of RNC cigarette risks held by this subgroup. IMPLICATIONS The FDA has stated its interest in reducing cigarettes' addictiveness by lowering their nicotine content, enabling smokers to quit. Our findings suggest that most smokers who have not used RNC cigarettes do not perceive these products as less addictive or as cessation tools, stressing a need for future educational campaigns to correct these misperceptions. Campaigns are also needed to educate uninformed smokers about RNC cigarettes and should consider targeting messages toward subgroups likely to hold misperceptions about the risks and benefits of using these products (eg, nonWhite smokers).
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Affiliation(s)
- Melissa Mercincavage
- Center for Interdisciplinary Research on Nicotine Addiction, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Kirsten Lochbuehler
- Center for Interdisciplinary Research on Nicotine Addiction, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Andrea C Villanti
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, Burlington, VT
| | - E Paul Wileyto
- Center for Interdisciplinary Research on Nicotine Addiction, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Janet Audrain-McGovern
- Center for Interdisciplinary Research on Nicotine Addiction, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Andrew A Strasser
- Center for Interdisciplinary Research on Nicotine Addiction, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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Smith TT, Koopmeiners JS, Hatsukami DK, Tessier KM, Benowitz NL, Murphy SE, Strasser AA, Tidey JW, Blount BC, Valentin L, Bravo Cardenas R, Watson C, Pirkle JL, Donny EC. Mouth-Level Nicotine Intake Estimates from Discarded Filter Butts to Examine Compensatory Smoking in Low Nicotine Cigarettes. Cancer Epidemiol Biomarkers Prev 2020; 29:643-649. [PMID: 32102909 PMCID: PMC7100998 DOI: 10.1158/1055-9965.epi-19-0905] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/15/2019] [Accepted: 12/09/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A mandated reduction in the nicotine content of cigarettes could reduce smoking rate and prevalence. However, one concern is that smokers may compensate by increasing the intensity with which they smoke each cigarette to obtain more nicotine. This study assessed whether smokers engage in compensatory smoking by estimating the mouth-level nicotine intake of low nicotine cigarettes smoked during a clinical trial. METHODS Smokers were randomly assigned to receive cigarettes with one of five nicotine contents for 6 weeks. An additional group received a cigarette with the lowest nicotine content, but an increased tar yield. The obtained mouth-level nicotine intake from discarded cigarette butts for a subset of participants (51-70/group) was estimated using solanesol as described previously. A compensation index was calculated for each group to estimate the proportion of nicotine per cigarette recovered through changes in smoking intensity. RESULTS There was no significant increase in smoking intensity for any of the reduced nicotine cigarettes as measured by the compensation index (an estimated 0.4% of the nicotine lost was recovered in the lowest nicotine group; 95% confidence interval, -0.1 to 1.2). There was a significant decrease in smoking intensity for very low nicotine content cigarettes with increased tar yield. CONCLUSIONS Reductions in nicotine content did not result in compensatory changes in how intensively participants smoked research cigarettes. IMPACT Combined with data from clinical trials showing a reduction in cigarettes smoked per day, these data suggest that a reduction in nicotine content is unlikely to result in increased smoke exposure.
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Affiliation(s)
- Tracy T Smith
- Department of Psychiatry and Behavioral Sciences, and Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina.
| | - Joseph S Koopmeiners
- Division of Biostatistics, School of Public Health, and Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Dorothy K Hatsukami
- Department of Psychiatry and Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Katelyn M Tessier
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Neal L Benowitz
- Departments of Medicine and Bioengineering & Therapeutic Sciences, University of California, San Francisco, San Francisco, California
| | - Sharon E Murphy
- Department of Biochemistry Molecular Biology and BioPhysics and Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Andrew A Strasser
- Department of Psychiatry, Perelman School of Medicine, and Abraham Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jennifer W Tidey
- Department of Behavioral and Social Sciences, Brown University, Providence, Rhode Island
| | - Benjamin C Blount
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Liza Valentin
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Roberto Bravo Cardenas
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Clifford Watson
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - James L Pirkle
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Eric C Donny
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Lawman HG, Henry KA, Scheeres A, Hillengas A, Coffman R, Strasser AA. Tobacco Retail Licensing and Density 3 Years After License Regulations in Philadelphia, Pennsylvania (2012-2019). Am J Public Health 2020; 110:547-553. [PMID: 32078358 DOI: 10.2105/ajph.2019.305512] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To evaluate changes in licensed tobacco retailers and retailer density 5 years before and 3 years after novel tobacco retailer licensing regulations were implemented in a large, urban area.Methods. We used administrative tobacco license data (n = 23 806 licenses, 2012-2019) to calculate (1) annual retailer density by district (n = 18), (2) density by district and school income status, and (3) retailers within 500 feet of schools (n = 673) before and after regulations.Results. Observed tobacco retailer density declined by 20.3% (from 1.97 to 1.57 per 1000 daytime residents) 3 years after regulation implementation. Regression results showed a decline in the trend of retailers per 1000 daytime population (b = -0.19; 95% confidence interval[CI] = -0.23, -0.14) that was modestly but significantly greater in low-income districts (interaction b = -0.18; 95% CI = -0.25, -0.11) and a 12% decline in the rates of retailers near schools (rate ratio = 0.88; 95% CI = 0.85, 0.92) following implementation of the regulations. We did not observe similar density changes in comparable cities.Conclusions. Tobacco retailer licensing strategies can be an effective policy approach to reduce the availability of tobacco and tobacco marketing, lessen socioeconomic disparities in tobacco retailer density, and decrease the number of tobacco outlets near schools.
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Affiliation(s)
- Hannah G Lawman
- Hannah G. Lawman, Annaka Scheeres, Amory Hillengas, and Ryan Coffman are with the Division of Chronic Disease and Injury Prevention, Philadelphia Department of Public Health, Philadelphia, PA. Kevin A. Henry is with the Department of Geography and Urban Studies, Temple University, Philadelphia. Andrew A. Strasser is with the Tobacco Center of Regulatory Science and Department of Psychiatry, University of Pennsylvania, Philadelphia
| | - Kevin A Henry
- Hannah G. Lawman, Annaka Scheeres, Amory Hillengas, and Ryan Coffman are with the Division of Chronic Disease and Injury Prevention, Philadelphia Department of Public Health, Philadelphia, PA. Kevin A. Henry is with the Department of Geography and Urban Studies, Temple University, Philadelphia. Andrew A. Strasser is with the Tobacco Center of Regulatory Science and Department of Psychiatry, University of Pennsylvania, Philadelphia
| | - Annaka Scheeres
- Hannah G. Lawman, Annaka Scheeres, Amory Hillengas, and Ryan Coffman are with the Division of Chronic Disease and Injury Prevention, Philadelphia Department of Public Health, Philadelphia, PA. Kevin A. Henry is with the Department of Geography and Urban Studies, Temple University, Philadelphia. Andrew A. Strasser is with the Tobacco Center of Regulatory Science and Department of Psychiatry, University of Pennsylvania, Philadelphia
| | - Amory Hillengas
- Hannah G. Lawman, Annaka Scheeres, Amory Hillengas, and Ryan Coffman are with the Division of Chronic Disease and Injury Prevention, Philadelphia Department of Public Health, Philadelphia, PA. Kevin A. Henry is with the Department of Geography and Urban Studies, Temple University, Philadelphia. Andrew A. Strasser is with the Tobacco Center of Regulatory Science and Department of Psychiatry, University of Pennsylvania, Philadelphia
| | - Ryan Coffman
- Hannah G. Lawman, Annaka Scheeres, Amory Hillengas, and Ryan Coffman are with the Division of Chronic Disease and Injury Prevention, Philadelphia Department of Public Health, Philadelphia, PA. Kevin A. Henry is with the Department of Geography and Urban Studies, Temple University, Philadelphia. Andrew A. Strasser is with the Tobacco Center of Regulatory Science and Department of Psychiatry, University of Pennsylvania, Philadelphia
| | - Andrew A Strasser
- Hannah G. Lawman, Annaka Scheeres, Amory Hillengas, and Ryan Coffman are with the Division of Chronic Disease and Injury Prevention, Philadelphia Department of Public Health, Philadelphia, PA. Kevin A. Henry is with the Department of Geography and Urban Studies, Temple University, Philadelphia. Andrew A. Strasser is with the Tobacco Center of Regulatory Science and Department of Psychiatry, University of Pennsylvania, Philadelphia
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Carroll DM, Murphy SE, Benowitz NL, Strasser AA, Kotlyar M, Hecht SS, Carmella SG, McClernon FJ, Pacek LR, Dermody SS, Vandrey RG, Donny EC, Hatsukami DK. Relationships between the Nicotine Metabolite Ratio and a Panel of Exposure and Effect Biomarkers: Findings from Two Studies of U.S. Commercial Cigarette Smokers. Cancer Epidemiol Biomarkers Prev 2020; 29:871-879. [PMID: 32051195 DOI: 10.1158/1055-9965.epi-19-0644] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/23/2019] [Accepted: 01/24/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND We examined the nicotine metabolite ratio's (NMR) relationship with smoking intensity, nicotine dependence, and a broad array of biomarkers of exposure and biological effect in commercial cigarette smokers. METHODS Secondary analysis was conducted on two cross-sectional samples of adult, daily smokers from Wave 1 (2013-2014) of the Population Assessment of Tobacco Use and Health (PATH) Study and baseline data from a 2014-2017 randomized clinical trial. Data were restricted to participants of non-Hispanic, white race. The lowest quartile of NMR (<0.26) in the nationally representative PATH Study was used to distinguish slow from normal/fast nicotine metabolizers. NMR was modeled continuously in secondary analysis. RESULTS Compared with slow metabolizers, normal/fast metabolizers had greater cigarettes per day and higher levels of total nicotine equivalents, tobacco-specific nitrosamines, volatile organic componds, and polycyclic aromatic hydrocarbons. A novel finding was higher levels of inflammatory biomarkers among normal/fast metabolizers versus slow metabolizers. With NMR modeled as a continuous measure, the associations between NMR and biomarkers of inflammation were not significant. CONCLUSIONS The results are suggestive that normal/fast nicotine metabolizers may be at increased risk for tobacco-related disease due to being heavier smokers, having higher exposure to numerous toxicants and carcinogens, and having higher levels of inflammation when compared with slow metabolizers. IMPACT This is the first documentation that NMR is not only associated with smoking exposure but also biomarkers of biological effects that are integral in the development of tobacco-related disease. Results provide support for NMR as a biomarker for understanding a smoker's exposure and potential risk for tobacco-related disease.
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Affiliation(s)
- Dana M Carroll
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota. .,Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Sharon E Murphy
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Neal L Benowitz
- Clinical Pharmacology Program, Division of Cardiology, Department of Medicine, University of California, San Francisco, California
| | - Andrew A Strasser
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael Kotlyar
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota.,Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota
| | - Stephen S Hecht
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Steve G Carmella
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Francis J McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Sarah S Dermody
- School of Psychological Science, Oregon State University, Corvallis, Oregon
| | - Ryan G Vandrey
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Eric C Donny
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Bleakley A, Jordan AB, Strasser AA, Lazovich D, Glanz K. Testing General Versus Specific Behavioral Focus in Messaging for the Promotion of Sun Protection Behaviors. Ann Behav Med 2020; 54:108-118. [PMID: 31586204 DOI: 10.1093/abm/kaz032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Recommendations for skin cancer prevention include behaviors such as using sunscreen, seeking shade, and wearing a shirt with sleeves, but the best way to persuasively communicate this information to the public is not clear. PURPOSE To test whether a messaging strategy using videos that focus on one specific behavior at a time versus a more general or multibehavior sun protection message is effective at changing attitudinal beliefs and intention with regard to sun protection behaviors. METHODS Online experiment among non-Hispanic white 18-49 year old adults in the USA. Participants were randomly assigned to one of four conditions, each one with health messages on a different sun protection prevention behavior: "using sunscreen" (Condition 1, n = 259), "seeking shade" (Condition 2, n = 245), or "covering up" (Condition 3, n = 289). Condition 4 (the control, n = 251) is a multibehavior message that equally promotes sunscreen, seeking shade, and covering up and features a general message on sun safety. RESULTS ANOVA and path analysis results suggest that messages which emphasize a single sun protection behavior compared with general sun safety messaging could potentially be a promising approach. The effectiveness of the videos in influencing attitudinal beliefs varied by behavior, with some gender and age moderation. There was an indirect effect on intention to use sunscreen. CONCLUSIONS This study advances our understanding of strategies for skin cancer prevention campaigns. Specifically, it suggests that focusing on a single sun protection behavior with targeted beliefs may be valuable as a first step in encouraging sun safety.
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Affiliation(s)
- Amy Bleakley
- Department of Communication, University of Delaware, Newark, DE
| | - Amy B Jordan
- School of Communication and Information, Rutgers the State University of New Jersey, New Brunswick, NJ
| | - Andrew A Strasser
- Perelman School of Medicine University of Pennsylvania, Philadelphia, PA
| | - Deann Lazovich
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
| | - Karen Glanz
- Perelman School of Medicine University of Pennsylvania, Philadelphia, PA.,School of Nursing, University of Pennsylvania, Philadelphia, PA
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Nardone N, Shahid M, Strasser AA, Dempsey DA, Benowitz NL. The influence of nicotine metabolic rate on working memory over 6 hours of abstinence from nicotine. Pharmacol Biochem Behav 2020; 188:172836. [PMID: 31812759 PMCID: PMC7009742 DOI: 10.1016/j.pbb.2019.172836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 10/11/2019] [Accepted: 12/04/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND A faster rate of nicotine metabolism has been associated with smoking more cigarettes, greater nicotine withdrawal symptoms, and lower smoking quit rates. However, the association between nicotine metabolic rate (NMR) and cognitive functioning during withdrawal has not been determined. METHODS We compared cognitive function in 121 fast or slow nicotine metabolizers after smoking, and at 3 and 6 h of nicotine abstinence. Cognitive functioning was assessed using N-back working memory tests with outcomes of accuracy and processing speed. Participants smoked two cigarettes and then abstained from smoking for 6 h. N-back tests were administered after smoking (0 h) and at 3 and 6 h of nicotine abstinence. RESULTS An effect of processing speed was found over time on the 2-back, in that participants had significantly longer average reaction times when the stimuli presented did not match the target letter. NMR was not significantly associated with the processing speed change over time. Within-race differences in working memory were evident in that Caucasian fast metabolizers had significantly poorer accuracy and processing speed. CONCLUSIONS Minimal change in working memory over 6 h of nicotine abstinence was observed. Overall, NMR was not significantly associated with the change in processing speed, however Caucasian fast metabolizers displayed poorer accuracy and processing speed at discrete time points.
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Affiliation(s)
- Natalie Nardone
- Clinical Pharmacology Research Program, Division of Cardiology, Department of Medicine, University of California, San Francisco, 3130 20(th) Street Suite 308, San Francisco, CA 94110, USA.
| | - Marian Shahid
- Department of Neurology, Stanford University, 300 Pasteur Dr. Room H3144, MC 5235, Stanford, CA 94305, USA.
| | - Andrew A Strasser
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street Suite 4100, Philadelphia, PA 19104, USA.
| | - Delia A Dempsey
- Clinical Pharmacology Research Program, Division of Cardiology, Department of Medicine, University of California, San Francisco, 3130 20(th) Street Suite 308, San Francisco, CA 94110, USA; Department of Pediatrics, University of California, San Francisco, 550 16(th) Street, Box 0110, San Francisco, CA 94143, USA.
| | - Neal L Benowitz
- Center for Tobacco Control Research and Education, University of California, San Francisco, 530 Parnassus Avenue, San Francisco, CA 94143, USA; Division of Clinical Pharmacology and Experiment Therapeutics, Departments of Medicine and Biopharmaceutical Sciences, University of California, San Francisco, 1001 Potrero Avenue, San Francisco, CA 94110, USA.
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Hatsukami DK, Luo X, Heskin AK, Tang MK, Carmella SG, Jensen J, Robinson JD, Vandrey R, Drobes DJ, Strasser AA, al’Absi M, Leischow S, Cinciripini PM, Koopmeiners J, Ikuemonisan J, Benowitz NL, Donny EC, Hecht SS. Effects of immediate versus gradual nicotine reduction in cigarettes on biomarkers of biological effects. Addiction 2019; 114:1824-1833. [PMID: 31140663 PMCID: PMC6732016 DOI: 10.1111/add.14695] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 12/19/2018] [Accepted: 05/21/2019] [Indexed: 12/27/2022]
Abstract
AIM A previous study showed significantly greater reductions in number of cigarettes smoked and biomarkers of toxicant and carcinogen exposure in smokers assigned to immediate reduction of nicotine in cigarettes to very low levels versus gradually over time or continued smoking of normal nicotine content cigarettes. This study examines the effects of these approaches on selected biomarkers associated with harmful biological effects. DESIGN Three-arm, randomized controlled trial. SETTING Ten United States academic institutional sites. PARTICIPANTS Daily smokers uninterested in quitting smoking with a mean age of 45.1 [standard deviation (SD) = 13.4)] years and smoking 17.1 (SD = 8.5) cigarettes/day; 43.9% (549 of 1250) female; 60.6% (758 of 1250) white ethnicity. INTERVENTIONS (1) Smoking cigarettes where nicotine content was immediately reduced to very low levels (n = 503); (2) smoking cigarettes where nicotine content was gradually reduced, with dose changes occurring monthly (n = 498); and (3) continued smoking with normal nicotine content cigarettes (n = 249). MEASUREMENTS Smokers were assessed at baseline while smoking their usual brand cigarettes, and again at 4, 8, 12, 16 and 20 weeks. Outcomes were areas under the concentration time curve (AUC) for the period of study of biomarkers of inflammation, oxidative stress and hematological parameters. FINDINGS No consistent significant differences were observed across groups (Bayes factors showing data to be insensitive), with the only exception being red blood cell size variability, which was observed to be lower in the immediate versus gradual nicotine reduction [mean difference = -0.11; 95% confidence interval (CI) = -0.18, -0.04, P = 0.004] and normal nicotine control groups (mean difference = - 0.15, 95% CI = -0.23, -0.06, P = 0.001). CONCLUSION It remains unclear whether switching to very low nicotine cigarettes leads to a short-term reduction in biomarkers of tobacco-related harm.
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Affiliation(s)
- Dorothy K. Hatsukami
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA,Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - Xianghua Luo
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA,Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Alisa K. Heskin
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Mei Kuen Tang
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | | | - Joni Jensen
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Jason D. Robinson
- University of Texas MD Anderson Cancer Center, Department of Behavioral Science, Houston, Texas, USA
| | - Ryan Vandrey
- Johns Hopkins University, Department of Psychiatry and Behavioral Sciences, Baltimore, Maryland, USA
| | - David j. Drobes
- Moffitt Cancer Center, Department of Health Outcomes and Behavior, Tampa, Florida, USA
| | - Andrew A. Strasser
- University of Pennsylvania, Department of Psychiatry, Philadelphia, Philadelphia, USA
| | - Mustafa al’Absi
- University of Minnesota Medical School, Behavioral Medicine Laboratories, Duluth, Minnesota
| | - Scott Leischow
- Mayo Clinic, Health Sciences Research, Scottsdale, Arizona, USA
| | - Paul M. Cinciripini
- University of Texas MD Anderson Cancer Center, Department of Behavioral Science, Houston, Texas, USA
| | - Joseph Koopmeiners
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | | | - Neal L. Benowitz
- University of California, Department of Medicine, San Francisco, California, USA
| | - Eric C. Donny
- Wake Forest School of Medicine, Department of Physiology and Pharmacology, Winston-Salem, North Carolina, USA
| | - Stephen S. Hecht
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
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Villanti AC, West JC, Mays D, Donny EC, Cappella JN, Strasser AA. Impact of Brief Nicotine Messaging on Nicotine-Related Beliefs in a U.S. Sample. Am J Prev Med 2019; 57:e135-e142. [PMID: 31542145 PMCID: PMC6756180 DOI: 10.1016/j.amepre.2019.05.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 05/23/2019] [Accepted: 05/24/2019] [Indexed: 12/29/2022]
Abstract
INTRODUCTION The current study pilot tested the effect of a single, brief exposure to nicotine education messages on beliefs about nicotine, nicotine-replacement therapy (NRT), E-cigarettes, and cigarettes with reduced nicotine content (RNC). METHODS Five hundred and twenty-one U.S. adults (aged ≥18 years) completed a 15-minute survey on Amazon Mechanical Turk in 2018. After completing items on sociodemographics, literacy, and cancer risk behaviors, participants were randomized in a 2:1:1 ratio to 1 of 3 conditions: nicotine education (n=263), sun safety education (attention control, n=128), or no message control (n=130). All participants completed items regarding nicotine, NRT, E-cigarette, and RNC cigarette beliefs, as well as norms about nicotine use, behavioral control regarding cigarette/tobacco use, and intention to use cigarettes, NRT, E-cigarettes, and RNC cigarettes in the next 12 months. Analyses were conducted in 2019. RESULTS Following exposure, nicotine education participants reported fewer false beliefs about nicotine (p<0.001), NRT (p<0.001), E-cigarettes (p<0.05), and RNC cigarettes (p<0.05) compared with the control conditions. Nicotine messaging doubled the probability of a correct response (false, 78.3% vs 36.8%) to nicotine is a cause of cancer and dramatically reduced the probability of responding don't know to this item (5.3% vs 26.0%). There was no impact of the intervention on beliefs about other substances within cigarette, norms, or behavioral intentions. CONCLUSIONS Findings from the current study support the hypothesis that a brief nicotine messaging intervention-similar to the messages likely to be seen on warning labels or in media campaigns-is likely to correct misperceptions of nicotine, NRT, E-cigarettes, and RNC cigarettes.
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Affiliation(s)
- Andrea C Villanti
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont Larner College of Medicine, Burlington, Vermont.
| | - Julia C West
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont Larner College of Medicine, Burlington, Vermont
| | - Darren Mays
- Department of Oncology, Georgetown University Medical Center, Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, District of Columbia
| | - Eric C Donny
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Joseph N Cappella
- Annenberg School for Communication at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andrew A Strasser
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Lochbuehler K, Wileyto EP, Mercincavage M, Souprountchouk V, Burdge JZ, Tang KZ, Cappella JN, Strasser AA. Temporal Effects of Message Congruency on Attention to and Recall of Pictorial Health Warning Labels on Cigarette Packages. Nicotine Tob Res 2019; 21:879-886. [PMID: 29917125 DOI: 10.1093/ntr/nty124] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 06/14/2018] [Indexed: 11/14/2022]
Abstract
OBJECTIVES Recent research has shown that message congruency is beneficial to recall of pictorial health warning label (PWL) content after initial exposure. Despite less attention to the text warning, smokers exposed to congruent PWLs were more likely to recall the text and the message. This study aimed to replicate these findings and to examine whether congruency also affects recall after multiple exposures over time. METHODS A total of 320 daily smokers (39.7% female; cigarettes/day: M = 15.31, SD = 7.15) were randomized to one congruent or incongruent PWL and attended 4 laboratory sessions over 10 days. During each session, eye movements were recorded while viewing the PWL and open-ended recall of label content was assessed after exposure. RESULTS Smokers who were exposed to a congruent PWL were more likely to recall the text (p = .01) and the message (p = .02) and less likely to recall the image (p = .003) of the PWL after initial exposure. By day 4, incongruent PWLs were recalled equally well as congruent PWLs. Independent of condition, image recall was initially high and remained high whereas text and message recall was relatively low initially but increased over time. It was not until day 7 that about 80% of text and message recall was observed. CONCLUSIONS Even when exposed to the same PWL over time, smokers require multiple exposures to recall the text and the message of a PWL. More research on the effects of congruency in the natural environment, where smokers are exposed to multiple PWLs, is needed. IMPLICATIONS The findings of this study, and of previous work showing that message congruency in PWLs is beneficial to initial recall of PWL content, could potentially help to address legal challenges regarding the implementation of PWLs in the United States. Factually correct text warnings have been uncontested on US cigarettes packages since 1966. Congruent PWLs simply provide a means to visually support the same information as the existing text using a medium that better garners attention to the health information. Investigating and understanding longer-term effects of congruency are important and can empirically inform future warning label development, both in the United States via the Family Smoking Prevention and Tobacco Control Act, and via other governing bodies.
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Affiliation(s)
- Kirsten Lochbuehler
- Tobacco Center of Regulatory Science (TCORS), University of Pennsylvania, Philadelphia, PA.,Department of Psychiatry, Center for Interdisciplinary Research on Nicotine Addiction, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - E Paul Wileyto
- Department of Psychiatry, Center for Interdisciplinary Research on Nicotine Addiction, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Melissa Mercincavage
- Tobacco Center of Regulatory Science (TCORS), University of Pennsylvania, Philadelphia, PA.,Department of Psychiatry, Center for Interdisciplinary Research on Nicotine Addiction, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Valentina Souprountchouk
- Department of Psychiatry, Center for Interdisciplinary Research on Nicotine Addiction, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jordan Z Burdge
- Department of Psychiatry, Center for Interdisciplinary Research on Nicotine Addiction, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Kathy Z Tang
- Department of Psychiatry, Center for Interdisciplinary Research on Nicotine Addiction, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Joseph N Cappella
- Tobacco Center of Regulatory Science (TCORS), University of Pennsylvania, Philadelphia, PA.,Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA
| | - Andrew A Strasser
- Tobacco Center of Regulatory Science (TCORS), University of Pennsylvania, Philadelphia, PA.,Department of Psychiatry, Center for Interdisciplinary Research on Nicotine Addiction, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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