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Crespi E, Hardesty JJ, Nian Q, Cohen JE. Decisions of the FDA on premarket tobacco product applications: Changes in the number of unique devices and liquids used by US adults who frequently use electronic nicotine delivery systems, 2020-2023. Tob Induc Dis 2024; 22:TID-22-52. [PMID: 38482508 PMCID: PMC10936557 DOI: 10.18332/tid/184240] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 02/17/2024] [Accepted: 02/20/2024] [Indexed: 03/17/2024] Open
Abstract
INTRODUCTION The majority of decisions on electronic nicotine delivery system (ENDS) premarket tobacco product applications (PMTAs) were made from October 2020 to February 2023; 99% (>25 million) had determinations by March 2023 and just twenty-three received marketing granted orders. We examined the unique devices and liquids used among US adults frequently using ENDS before, during, and after a majority of PMTA decisions were made. METHODS Data are from waves 1-5 (W1: May-Oct 2020, n=1179; W5: Feb-Apr 2023, n=1290) of a longitudinal survey of US adults (≥21 years) using ENDS ≥5 days/week. User-submitted photos of participants' most used devices and liquids were coded. Descriptive analyses and Wilcoxon signed-rank tests were used to understand the number and types of unique devices and liquids used in W1-W5, and the top brands in each wave. RESULTS From W1-W5, the number of unique ENDS device models and liquid products used by participants increased from 279 to 357 (p<0.001) and 546 to 695 (p<0.001), respectively. More unique devices in W5 versus W1 were disposable (W1: 16.5%; W5: 36.1%); fewer were disposable pod (W1: 6.5%; W5: 3.1%) or tank (W1: 53.8%; W5: 30.8%) devices. Liquids were primarily sweet-flavored (W1: 81.1%; W5: 82.0%). The median liquid nicotine concentration increased from 12 to 50 mg/mL. In W5, few participants used FDA-approved devices (n=17; 1.3%) or liquids (n=6; 0.5%), and Elf Bar was the most commonly used device and liquid brand. Results for all waves are reported. CONCLUSIONS Despite PMTA decisions, an increase in the number of unique device models and liquid products used among adults who frequently use ENDS was observed from 2020 to 2023. Few participants in 2023 were using FDA-approved devices or liquids. Further research and monitoring are needed to inform how FDA prioritizes enforcement actions and what types of enforcement actions are effective.
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Affiliation(s)
- Elizabeth Crespi
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States
| | - Jeffrey J. Hardesty
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States
| | - Qinghua Nian
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States
| | - Joanna E. Cohen
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States
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Nian Q, Cohen JE, Sinamo J, Crespi E, Zaman R, Hardesty JJ. Heterogeneity in sociodemographic characteristics of people who use different ENDS devices. Prev Med Rep 2024; 37:102561. [PMID: 38192298 PMCID: PMC10772807 DOI: 10.1016/j.pmedr.2023.102561] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/12/2023] [Accepted: 12/13/2023] [Indexed: 01/10/2024] Open
Abstract
Background The electronic nicotine delivery systems (ENDS) market is heterogeneous with a wide variety of devices and liquids available to consumers. People with distinct sociodemographic characteristics may have different ENDS device and liquid preferences. Methods 1290 U.S. adults (21 + ) using ENDS 5 + days/week completed the Wave 5 (February-April 2023) VAPER study survey and submitted photos of their most used ENDS device and liquid. Latent class analysis (LCA) was performed based on sociodemographic characteristics and cigarette smoking status to identify groups among respondents. We examined the association between identified groups and the device (disposable device/disposable pod/refillable pod/tank, power/airflow/coil modifiability)/liquid (nicotine salt/freebase) groupings found by exploratory factor analysis. Results Among our sample, there were three groups of adults frequently using ENDS: (1) group of women who are older, heterosexual, and have smoked cigarettes (62 % of the sample); (2) group of men who are higher-income and heterosexual (23 % of the sample); and (3) group of women who are younger and LGBTQ+ (16 % of the sample). The third group was more likely to use non-adjustable disposable devices with a nicotine salt liquid and less likely to use adjustable tanks with a freebase liquid than the other two groups (p < 0.001). Conclusions We found three distinct groups of adults frequently using ENDS. The group of younger LGBTQ + women was different from the other two groups in use of device and liquid characteristics. Our findings can enhance understanding of people using ENDS and inform the expected impacts of ENDS regulatory efforts to protect public health.
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Affiliation(s)
| | - Joanna E. Cohen
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 2213 McElderry St, 4 Floor, Baltimore, MD, USA 21205
| | - Joshua Sinamo
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 2213 McElderry St, 4 Floor, Baltimore, MD, USA 21205
| | - Elizabeth Crespi
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 2213 McElderry St, 4 Floor, Baltimore, MD, USA 21205
| | - Raniyan Zaman
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 2213 McElderry St, 4 Floor, Baltimore, MD, USA 21205
| | - Jeffrey J. Hardesty
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 2213 McElderry St, 4 Floor, Baltimore, MD, USA 21205
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Crespi E, Heller J, Hardesty JJ, Nian Q, Sinamo JK, Welding K, Kennedy RD, Cohen JE. Exploring Different Incentive Structures Among US Adults Who Use e-Cigarettes to Optimize Retention in Longitudinal Web-Based Surveys: Case Study. J Med Internet Res 2023; 25:e49354. [PMID: 38090793 PMCID: PMC10753419 DOI: 10.2196/49354] [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: 05/30/2023] [Revised: 09/07/2023] [Accepted: 10/11/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Longitudinal cohort studies are critical for understanding the evolution of health-influencing behaviors, such as e-cigarette use, over time. Optimizing follow-up rates in longitudinal studies is necessary for ensuring high-quality data with sufficient power for analyses. However, achieving high rates of follow-up in web-based longitudinal studies can be challenging, even when monetary incentives are provided. OBJECTIVE This study compares participant progress through a survey and demographics for 2 incentive structures (conditional and hybrid unconditional-conditional) among US adults using e-cigarettes to understand the optimal incentive structure. METHODS The data used in this study are from a web-based longitudinal cohort study (wave 4; July to September 2022) of US adults (aged 21 years or older) who use e-cigarettes ≥5 days per week. Participants (N=1804) invited to the follow-up survey (median completion time=16 minutes) were randomly assigned into 1 of 2 incentive structure groups (n=902 each): (1) conditional (US $30 gift code upon survey completion) and (2) hybrid unconditional-conditional (US $15 gift code prior to survey completion and US $15 gift code upon survey completion). Chi-square tests assessed group differences in participant progress through 5 sequential stages of the survey (started survey, completed screener, deemed eligible, completed survey, and deemed valid) and demographics. RESULTS Of the 902 participants invited to the follow-up survey in each group, a higher proportion of those in the conditional (662/902, 73.4%) than the hybrid (565/902, 62.6%) group started the survey (P<.001). Of those who started the survey, 643 (97.1%) participants in the conditional group and 548 (97%) participants in the hybrid group completed the screener (P=.89), which was used each wave to ensure participants remained eligible. Of those who completed the screener, 555 (86.3%) participants in the conditional group and 446 (81.4%) participants in the hybrid group were deemed eligible for the survey (P=.02). Of those eligible, 514 (92.6%) participants from the conditional group and 401 (89.9%) participants from the hybrid group completed the survey and were deemed valid after data review (P=.14). Overall, more valid completions were yielded from the conditional (514/902, 57%) than the hybrid group (401/902, 44.5%; P<.001). Among those who validly completed the survey, no significant differences were found by group for gender, income, race, ethnicity, region, e-cigarette use frequency, past 30-day cigarette use, or number of waves previously completed. CONCLUSIONS Providing a US $30 gift code upon survey completion yielded higher rates of survey starts and completions than providing a US $15 gift code both before and after survey completion. These 2 methods yielded participants with similar demographics, suggesting that one approach is not superior in obtaining a balanced sample. Based on this case study, future web-based surveys examining US adults using e-cigarettes could consider providing the full incentive upon completion of the survey. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/38732.
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Affiliation(s)
- Elizabeth Crespi
- Institute for Global Tobacco Control, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Johanna Heller
- Institute for Global Tobacco Control, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Jeffrey J Hardesty
- Institute for Global Tobacco Control, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Qinghua Nian
- Institute for Global Tobacco Control, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Joshua K Sinamo
- Institute for Global Tobacco Control, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Kevin Welding
- Institute for Global Tobacco Control, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Ryan David Kennedy
- Institute for Global Tobacco Control, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Joanna E Cohen
- Institute for Global Tobacco Control, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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Nian Q, Hardesty JJ, Crespi E, Sinamo JK, Kennedy RD, Welding K, Cohen JE. Transitions in device and liquid characteristic groupings among US adults frequently using electronic nicotine delivery systems (ENDS) over three timepoints, 2020-2021. Tob Induc Dis 2023; 21:134. [PMID: 37842545 PMCID: PMC10571097 DOI: 10.18332/tid/171354] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/14/2023] [Accepted: 08/17/2023] [Indexed: 10/17/2023] Open
Abstract
INTRODUCTION Electronic nicotine delivery system (ENDS) and liquid characteristics affect nicotine and toxicant exposure and use behaviors. Little is known about how adults who frequently use ENDS transition between ENDS device/liquid groupings. METHODS A total of 379 US adults (≥21 years) using ENDS frequently (≥5 days/week) self-reported and uploaded photos of their most used ENDS device and liquid in three waves of online surveys (May 2020 - November 2021). Device/liquid grouping was defined by device (i.e. disposable/refillable tank/refillable pod or cartridge/disposable pod or cartridge, adjustable/no adjustable settings) and liquid (i.e. salt/freebase) characteristics. Participants using the same grouping across waves were considered stable users. RESULTS The most prevalent wave (W) 1 grouping was tank (freebase, adjustable settings; 36.8%). From W1 to W3, the number of disposable device (salt, no adjustable settings) users increased 156.4% and the number of disposable pod/cartridge (salt, no adjustable settings) users decreased 15.2%. In W2 and W3, compared to stable users, participants using tank (freebase, adjustable settings) in W1 and another grouping in W2 and/or W3 reported significantly higher nicotine concentrations (mg/mL) (W2: 15.1 vs 5.5, p<0.001; W3: 22.9 vs 5.6, p<0.001) and lower device power (watt) (W2: 46.8 vs 58.7, p=0.02; W3: 34.0 vs 57.2, p<0.001). CONCLUSIONS Over a 1.5-year period, a rapid growth in disposable device (salt, no adjustable settings) use and a decrease in disposable pod/cartridge (salt, no adjustable settings) use were observed. Participants who transitioned from tank (freebase, adjustable settings) to other groupings were more likely to increase liquid nicotine concentration and reduce device power compared to stable users.
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Affiliation(s)
- Qinghua Nian
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States
| | - Jeffrey J. Hardesty
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States
| | - Elizabeth Crespi
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States
| | - Joshua K. Sinamo
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States
| | - Ryan D. Kennedy
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States
| | - Kevin Welding
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States
| | - Joanna E. Cohen
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States
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Crespi E, Hardesty JJ, Nian Q, Sinamo J, Welding K, Cohen JE, David Kennedy R. Device and liquid characteristics used with sweet, menthol/mint, and tobacco ENDS liquid flavors: The population-based VAPER study. Addict Behav 2023; 144:107727. [PMID: 37119714 PMCID: PMC10330428 DOI: 10.1016/j.addbeh.2023.107727] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 10/21/2022] [Revised: 03/09/2023] [Accepted: 04/12/2023] [Indexed: 05/01/2023]
Abstract
INTRODUCTION Electronic nicotine delivery system (ENDS) device and liquid characteristics (e.g., wattage, nicotine concentration) are diverse and important in determining product appeal, aerosol volume/nicotine levels, and toxicity. Little is known about how device and liquid characteristics vary by flavor; we address this gap to identify potential regulatory implications. METHODS Data are from a longitudinal cohort study (Waves 2 and 3; December 2020-December 2021) of adult (≥21 years) U.S. ENDS users (≥5 days of use/week). Participants (n = 1809) reported on and submitted photos of their most used device and liquid. Participants were categorized into flavor groups of high prevalence in our sample and in prior literature: sweet, menthol/mint, or tobacco. Participants using liquids without nicotine or flavors other than sweet, menthol/mint, or tobacco were excluded (n = 320). Data were analyzed cross-sectionally. Chi-square and linear regression (n = 1489) were used to examine device and liquid characteristics by flavor. RESULTS Sweet flavors were most common (n = 1135; 76.2%), followed by menthol/mint (n = 214, 14.4%) and tobacco (n = 140, 9.4%). Sweet flavors were less common among participants using reusable devices with disposable pods/cartridges (nicotine salt) than those using other device-liquid groupings (5.2% vs 86.5-93.9%; p < 0.001). Sweet flavors were less common among those using ENDS for non-flavor reasons vs the flavor (73.5% vs 90.4%; p < 0.001). Sweet flavors correlated with lower nicotine concentrations, higher wattages, and lower ages of ENDS first use (p < 0.001). CONCLUSIONS Regulatory agencies must consider how regulations on device and liquid characteristics may affect ENDS users' behaviors (e.g., limiting availability of sweet flavors may encourage use of non-sweet flavors and lower wattages).
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Affiliation(s)
- Elizabeth Crespi
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior, and Society, Institute for Global Tobacco Control, Baltimore, MD, USA.
| | - Jeffrey J Hardesty
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior, and Society, Institute for Global Tobacco Control, Baltimore, MD, USA.
| | - Qinghua Nian
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior, and Society, Institute for Global Tobacco Control, Baltimore, MD, USA.
| | - Joshua Sinamo
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior, and Society, Institute for Global Tobacco Control, Baltimore, MD, USA.
| | - Kevin Welding
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior, and Society, Institute for Global Tobacco Control, Baltimore, MD, USA.
| | - Joanna E Cohen
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior, and Society, Institute for Global Tobacco Control, Baltimore, MD, USA.
| | - Ryan David Kennedy
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior, and Society, Institute for Global Tobacco Control, Baltimore, MD, USA.
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Kaplan B, Crespi E, Hardesty JJ, Cohen JE. Assessing Electronic Nicotine Delivery Systems Device Type Accurately in Surveys. Nicotine Tob Res 2023; 25:1687-1690. [PMID: 37279173 PMCID: PMC10445248 DOI: 10.1093/ntr/ntad086] [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] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 04/17/2023] [Accepted: 06/05/2023] [Indexed: 06/08/2023]
Abstract
INTRODUCTION The electronic nicotine delivery systems (ENDS) market is highly heterogeneous and changing rapidly in the United States, making classification of devices complicated, especially for surveys. We assessed the percentage of concordant responses between self-reported device type and device type reported by manufacturer/retailer sites for three ENDS brands. AIMS AND METHODS Population Assessment of Tobacco and Health Study wave 5 (2018-2019) asked adult ENDS users about their ENDS device type with the following multiple-choice question: "What kind of electronic nicotine product [is/was] it?" with response options: (1) A disposable device, (2) A device that uses replaceable prefilled cartridges, (3) A device with a tank that you refill with liquids (4) A mod system, and (5) Something else. Participants using only one ENDS device and reporting brands of JUUL (n = 579), Markten (n = 30), or Vuse (n = 47) were included. Responses were dichotomized as "concordant=1" (prefilled cartridge for these three brands) and "discordant = 0" (other responses) to assess the concordance. RESULTS The overall concordance between self-reports and manufacturer/retail sites was 81.8% (n = 537). This percentage was 82.7% (n = 37) among Vuse users, 82.6% (n = 479) among JUUL users, and 69.1% (n = 21) among Markten users. Almost one in three people who use Markten did not indicate that their device uses replaceable prefilled cartridges. CONCLUSIONS While at least 70% concordance could be acceptable, collecting more information about device type (eg, liquid container (pod/cartridge/tank), refillability; and submitting pictures) may improve the accuracy of the information. IMPLICATIONS This study is particularly relevant for researchers analyzing smaller samples for example when examining disparities. Monitoring the characteristics of ENDS accurately in population-based studies is critical for regulatory authorities to understand ENDS toxicity, addiction, health effects, and use behaviors at the population level. There is evidence that higher concordance can be achieved with other questions- and methods. Adjusting survey questions about ENDS device type (eg, more descriptive response options, inclusion of separate questions asking about tank, pod, cartridge) and potentially including photos of participants' devices may help to classify ENDS device types more accurately.
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Affiliation(s)
- Bekir Kaplan
- Department of Health, Behavior, and Society, Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Elizabeth Crespi
- Department of Health, Behavior, and Society, Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jeffrey J Hardesty
- Department of Health, Behavior, and Society, Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Joanna E Cohen
- Department of Health, Behavior, and Society, Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Kaplan B, Hardesty JJ, Welding K, Breland AB, Eissenberg T, Cohen JE. Electronic Nicotine Delivery System flavor use over time by age group in the US: A longitudinal analysis. Tob Induc Dis 2023; 21:67. [PMID: 37215195 PMCID: PMC10198257 DOI: 10.18332/tid/162365] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/17/2023] [Accepted: 03/18/2023] [Indexed: 05/24/2023] Open
Abstract
INTRODUCTION The prevalence of flavor use in Electronic Nicotine Delivery Systems (ENDS) has been assessed in numerous studies, but limited research has focused on flavor use trends and maintenance of flavor preference over time. This study investigated the general trends and maintenance of ENDS flavor use for youth (aged 12-17 years), young adults (aged 18-24 years), and older adults (aged ≥25 years) between 2014 and 2019. METHODS Population Assessment of Tobacco and Health (PATH) Study Wave 2 (2014-2015), Wave 3 (2015-2016), Wave 4 (2016-2017), and Wave 5 (2018-2019) youth and adult data were used. Cross-sectional flavor use prevalence (trends) and flavor maintenance (using the same flavor category in at least three consecutive waves) were assessed. RESULTS The most reported primary flavor category was fruit among all age groups in all waves. Candy/desserts in waves two, three, four, and menthol/mint in wave five were the second most reported flavor in all age groups. The highest increase was observed for menthol/mint use among youth between wave two (21.9%) and five (58.1%) (OR=5.33; 95% CI: 3.58-7.96). Overall, 37.6% of fruit flavor users, 25.3% of candy/desserts users, 32.0% of menthol/mint users, and 33.4% of tobacco flavor users, maintained use of the same flavor in at least three consecutive waves. CONCLUSIONS Fruit flavor had the highest percentages of use and maintenance between 2014 and 2019. While the maintenance of fruit and candy/desserts flavors were higher among youth, adults had substantially higher maintenance percentages for menthol/mint and tobacco flavor. There was a substantial increase in menthol/mint use in wave five among youth, which may affect ENDS flavor maintenance patterns in the future. Understanding maintenance of flavors over time can inform regulation of ENDS flavors.
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Affiliation(s)
- Bekir Kaplan
- Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
| | - Jeffrey J. Hardesty
- Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
| | - Kevin Welding
- Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
| | - Alison B. Breland
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, United States
| | - Thomas Eissenberg
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, United States
| | - Joanna E. Cohen
- Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
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Nian Q, Hardesty JJ, Cohen JE, Kennedy RD. The association between viewing cigarette health warning labels and intention to quit smoking among Chinese adult smokers: support for including health outcome content and culturally specific messages. BMC Public Health 2023; 23:866. [PMID: 37170086 PMCID: PMC10176816 DOI: 10.1186/s12889-023-15718-4] [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: 09/13/2022] [Accepted: 04/20/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Tailored themes of pictorial health warning labels (HWLs) that considers specific cultural dimensions and within a specific policy/historical context can motivate behavior change, such as provoking smokers to think about quitting. Currently in China, the HWLs on cigarettes are text-only. This study designed pictorial HWLs using different themes to explore and examine the association between viewing pictorial HWLs and participants' intention to quit smoking. The themes included: (1) Self-harm from using cigarettes, (2) Harming family or children with secondhand smoke, (3) Complying with existing smoke-free policies, and (4) Cigarette gift giving practices. METHODS A cross-sectional randomized experimental survey was conducted among 1,625 smokers in Beijing (n = 545), Shanghai (n = 541), and Shenzhen (n = 539) during 2017. Before and after viewing eight pictorial HWLs of one theme, participants were asked if they had plans to quit smoking within the next month, within the next 6 months, beyond the next 6 months, or not at all. Ordinal logistic regression, Wilcoxon and Chi-square tests were used to analyze the data. RESULTS After viewing the HWLs, 434 participants (26.9%) reported an intention to quit smoking sooner, 987 (61.2%) reported the same intention to quit, and 191 (11.8%) reported an intention to quit later. The pre-post change in intention to quit was statistically significant among all participants and participants under each theme (p > 0.05). Participants who rated the effectiveness of the HWL communicating how secondhand smoke harms children had 1.13 (95% CI 1.01-1.27) greater odds of reporting an intention to quit sooner compared to those viewing labels from the other themes, adjusting for covariates. Female participants and participants with annual household income more than 100,000RMB had 1.39 (95% CI 1.14-1.69) and 1.29 (95% CI 1.04-1.60) greater odds of reporting an intention to quit sooner compared to their counterparts across the entire sample. CONCLUSIONS Findings of this study provide evidence of an association between all four pictorial HWL themes and smokers' intention to quit smoking. These findings can help inform what HWL themes might be appropriate when China implements pictorial health warning labels.
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Affiliation(s)
- Qinghua Nian
- Institute for Global Tobacco Control, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 2213 McElderry St, 4th Floor, Baltimore, MD, 21205, USA.
| | - Jeffrey J Hardesty
- Institute for Global Tobacco Control, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 2213 McElderry St, 4th Floor, Baltimore, MD, 21205, USA
| | - Joanna E Cohen
- Institute for Global Tobacco Control, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 2213 McElderry St, 4th Floor, Baltimore, MD, 21205, USA
| | - Ryan D Kennedy
- Institute for Global Tobacco Control, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 2213 McElderry St, 4th Floor, Baltimore, MD, 21205, USA
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Hardesty JJ, Crespi E, Nian Q, Sinamo JK, Breland AB, Eissenberg T, Welding K, Kennedy RD, Cohen JE. The Vaping and Patterns of e-Cigarette Use Research Study: Protocol for a Web-Based Cohort Study. JMIR Res Protoc 2023; 12:e38732. [PMID: 36862467 PMCID: PMC10020901 DOI: 10.2196/38732] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 12/13/2022] [Accepted: 01/18/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND In total, 3.2% of American adults report using e-cigarettes every day or some days. The Vaping and Patterns of E-cigarette Use Research (VAPER) Study is a web-based longitudinal survey designed to observe patterns in device and liquid use that suggest the benefits and unintended consequences of potential e-cigarette regulations. The heterogeneity of the e-cigarette devices and liquids on the market, the customizability of the devices and liquids, and the lack of standardized reporting requirements result in unique measurement challenges. Furthermore, bots and survey takers who submit falsified responses are threats to data integrity that require mitigation strategies. OBJECTIVE This paper aims to describe the protocols for 3 waves of the VAPER Study and discuss recruitment and data processing experiences and lessons learned, including the benefits and limitations of bot- and fraudulent survey taker-related strategies. METHODS American adults (aged ≥21 years) who use e-cigarettes ≥5 days per week are recruited from up to 404 Craigslist catchment areas covering all 50 states. The questionnaire measures and skip logic are designed to accommodate marketplace heterogeneity and user customization (eg, different skip logic pathways for different device types and customizations). To reduce reliance on self-report data, we also require participants to submit a photo of their device. All data are collected using REDCap (Research Electronic Data Capture; Vanderbilt University). Incentives are US $10 Amazon gift codes delivered by mail to new participants and electronically to returning participants. Those lost to follow-up are replaced. Several strategies are applied to maximize the odds that participants who receive incentives are not bots and are likely to possess an e-cigarette (eg, required identity check and photo of a device). RESULTS In total, 3 waves of data were collected between 2020 and 2021 (wave 1: n=1209; wave 2: n=1218; wave 3: n=1254). Retention from waves 1 to 2 was 51.94% (628/1209), and 37.55% (454/1209) of the wave 1 sample completed all 3 waves. These data were mostly generalizable to daily e-cigarette users in the United States, and poststratification weights were generated for future analyses. Our data offer a detailed examination of users' device features and specifications, liquid characteristics, and key behaviors, which can provide more insights into the benefits and unintended consequences of potential regulations. CONCLUSIONS Relative to existing e-cigarette cohort studies, this study methodology has some advantages, including efficient recruitment of a lower-prevalence population and collection of detailed data relevant to tobacco regulatory science (eg, device wattage). The web-based nature of the study requires several bot- and fraudulent survey taker-related risk-mitigation strategies, which can be time-intensive. When these risks are addressed, web-based cohort studies can be successful. We will continue to explore methods for maximizing recruitment efficiency, data quality, and participant retention in subsequent waves. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/38732.
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Affiliation(s)
- Jeffrey J Hardesty
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Elizabeth Crespi
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Qinghua Nian
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Joshua K Sinamo
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Alison B Breland
- Center for the Study of Tobacco Products, Department of Psychology, Virginia Commonwealth University, Richmond, VA, United States
| | - Thomas Eissenberg
- Center for the Study of Tobacco Products, Department of Psychology, Virginia Commonwealth University, Richmond, VA, United States
| | - Kevin Welding
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Ryan David Kennedy
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Joanna E Cohen
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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Nian Q, Hardesty JJ, Cohen JE, Xie X, Kennedy RD. Perceived effectiveness of four different cigarette health warning label themes among a sample of urban smokers and non-smokers in China. Tob Control 2023; 32:205-210. [PMID: 34400570 PMCID: PMC9985749 DOI: 10.1136/tobaccocontrol-2021-056703] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 04/07/2021] [Accepted: 06/22/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE This study, conducted in China, evaluated the effectiveness of four different themes of health warning labels (HWLs) that used both text and pictures: (1) self-harm from using cigarettes, (2) harming family or children with secondhand smoke, (3) reinforcing compliance with existing smoke-free policies and (4) anticigarette gift giving practices. METHODS A cross-sectional randomised experimental survey was conducted among 3247 adult (aged 18+ years) participants in Beijing, Shanghai and Shenzhen in 2017, using quotas for age group, gender and smoking status. Participants were randomly assigned to one of the four HWL themes. Each participant viewed eight HWLs and rated how effective these themed-labels were in terms of credibility, raising awareness of health harms of smoking on family and children, improving compliance with public smoking bans, stopping the practice of gifting cigarettes, thinking about quitting and preventing smoking using a 10-point scale, with 10 being most effective. Analysis of variance and independent t-tests were used to analyse these data. FINDINGS All four HWL themes performed well for each outcome with average ratings >6.5. Harming family or children with secondhand smoke was the theme that received the highest ratings for each outcome, with credibility (8.0, 95% CI 7.86 to 8.09) and prevention of smoking (8.8, 95% CI 8.63 to 8.91) outcomes being significantly higher (p<0.05). Overall, analysis of ratings by gender, income and education did not impact outcomes. CONCLUSION All four HWL themes tested could be effective in China; the theme of secondhand smoke harming family or children may be a particularly credible/effective theme.
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Affiliation(s)
- Qinghua Nian
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jeffrey J Hardesty
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Joanna E Cohen
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Ryan David Kennedy
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Cohen JE, Hardesty JJ, Nian Q, Crespi E, Sinamo JK, Kennedy RD, Welding K, Kaplan B, Soule E, Eissenberg T, Breland AB. Combinations of Electronic Nicotine Delivery System Device and Liquid Characteristics among U.S. adults. Addict Behav 2022; 135:107441. [DOI: 10.1016/j.addbeh.2022.107441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/22/2022] [Accepted: 07/22/2022] [Indexed: 11/01/2022]
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Crespi E, Hardesty JJ, Nian Q, Sinamo J, Welding K, Kennedy RD, Cohen JE. Agreement Between Self-reports and Photos to Assess e-Cigarette Device and Liquid Characteristics in Wave 1 of the Vaping and Patterns of e-Cigarette Use Research Study: Web-Based Longitudinal Cohort Study. J Med Internet Res 2022; 24:e33656. [PMID: 35475727 PMCID: PMC9096652 DOI: 10.2196/33656] [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: 09/21/2021] [Revised: 12/08/2021] [Accepted: 02/11/2022] [Indexed: 11/17/2022] Open
Abstract
Background e-Cigarette device and liquid characteristics are highly customizable; these characteristics impact nicotine delivery and exposure to toxic constituents. It is critical to understand optimal methods for measuring these characteristics to accurately assess their impacts on user behavior and health. Objective To inform future survey development, we assessed the agreement between responses from survey participants (self-reports) and photos uploaded by participants and the quantity of usable data derived from each approach. Methods Adult regular e-cigarette users (≥5 days per week) aged ≥21 years (N=1209) were asked questions about and submitted photos of their most used e-cigarette device (1209/1209, 100%) and liquid (1132/1209, 93.63%). Device variables assessed included brand, model, reusability, refillability, display, and adjustable power. Liquid variables included brand, flavor, nicotine concentration, nicotine formulation, and bottle size. For each variable, percentage agreement was calculated where self-report and photo data were available. Krippendorff α and intraclass correlation coefficient (ICC) were calculated for categorical and continuous variables, respectively. Results were stratified by device (disposable, reusable with disposable pods or cartridges, and reusable with refillable pods, cartridges, or tanks) and liquid (customized and noncustomized) type. The sample size for each calculation ranged from 3.89% (47/1209; model of disposable devices) to 95.12% (1150/1209; device reusability). Results Percentage agreement between photos and self-reports was substantial to very high across device and liquid types for all variables except nicotine concentration. These results are consistent with Krippendorff α calculations, except where prevalence bias was suspected. ICC results for nicotine concentration and bottle size were lower than percentage agreement, likely because ICC accounts for the level of disagreement between values. Agreement varied by device and liquid type. For example, percentage agreement for device brand was higher among users of reusable devices (94%) than among users of disposable devices (75%). Low percentage agreement may result from poor participant knowledge of characteristics, user modifications of devices inconsistent with manufacturer-intended use, inaccurate or incomplete information on websites, or photo submissions that are not a participant’s most used device or liquid. The number of excluded values (eg, self-report was “don’t know” or no photo submitted) differed between self-reports and photos; for questions asked to participants, self-reports had more usable data than photos for all variables except device model and nicotine formulation. Conclusions Photos and self-reports yield data of similar accuracy for most variables assessed in this study: device brand, device model, reusability, adjustable power, display, refillability, liquid brand, flavor, and bottle size. Self-reports provided more data for all variables except device model and nicotine formulation. Using these approaches simultaneously may optimize data quantity and quality. Future research should examine how to assess nicotine concentration and variables not included in this study (eg, wattage and resistance) and the resource requirements of these approaches.
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Affiliation(s)
- Elizabeth Crespi
- Institute for Global Tobacco Control, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Jeffrey J Hardesty
- Institute for Global Tobacco Control, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Qinghua Nian
- Institute for Global Tobacco Control, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Joshua Sinamo
- Institute for Global Tobacco Control, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Kevin Welding
- Institute for Global Tobacco Control, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Ryan David Kennedy
- Institute for Global Tobacco Control, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Joanna E Cohen
- Institute for Global Tobacco Control, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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Hardesty JJ, Li KA, Cohen JE, Kennedy RD, Breland AB, Rudy AK, Eissenberg T. A Deceptive Marketing Strategy: An Early Warning of Industry Behavior After the Premarket Tobacco Application Deadline? Nicotine Tob Res 2020; 22:2283-2284. [PMID: 32671385 DOI: 10.1093/ntr/ntaa129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 07/02/2020] [Indexed: 11/14/2022]
Affiliation(s)
- Jeffrey J Hardesty
- Department of Health, Behavior and Society, Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Kathleen A Li
- Department of Health, Behavior and Society, Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Joanna E Cohen
- Department of Health, Behavior and Society, Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Ryan D Kennedy
- Department of Health, Behavior and Society, Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Alison B Breland
- Department of Psychology, Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA
| | - Alyssa K Rudy
- Department of Psychology, Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA
| | - Thomas Eissenberg
- Department of Psychology, Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA
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Kaplan B, Hardesty JJ, Martini S, Megatsari H, Kennedy RD, Cohen JE. The Effectiveness of Cigarette Pack Health Warning Labels with Religious Messages in an Urban Setting in Indonesia: A Cross-Sectional Study. Int J Environ Res Public Health 2019; 16:ijerph16214287. [PMID: 31694236 PMCID: PMC6862042 DOI: 10.3390/ijerph16214287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/02/2019] [Accepted: 11/03/2019] [Indexed: 12/02/2022]
Abstract
This study sought to assess the effectiveness of religious cigarette health warning labels (HWLs) in Indonesia, a country with a high public health burden from tobacco use. The study tested different religious and nonreligious messages related to suicide, secondhand smoke (SHS) and gangrene. Participants were smokers and non-smokers from Surabaya, Indonesia (n = 817). Participants rated each HWL for its effectiveness on a scale of 1 to 10 (1 = “not at all”, 10 = “extremely”) with respect to 10 items. Nonreligious HWLs were marginally superior for SHS and suicide while religious HWLs were marginally superior for gangrene. Given the close rating scores between religious and nonreligious HWLs, they were functionally equal in effectiveness. With proper assessment of potential unintended consequences, the implementation of religious HWLs could be considered for a proportion of HWLs.
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Affiliation(s)
- Bekir Kaplan
- Department of Health, Behavior and Society, Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, USA
- Correspondence: ; Tel.: +1-410-614-5378
| | - Jeffrey J. Hardesty
- Department of Health, Behavior and Society, Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, USA
| | - Santi Martini
- Faculty of Public Health, University of Airlangga, Jl. Mulyorejo, Surabaya 60115, Indonesia
| | - Hario Megatsari
- Faculty of Public Health, University of Airlangga, Jl. Mulyorejo, Surabaya 60115, Indonesia
| | - Ryan D. Kennedy
- Department of Health, Behavior and Society, Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, USA
| | - Joanna E. Cohen
- Department of Health, Behavior and Society, Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, USA
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Hardesty JJ, Kaplan B, Martini S, Megatsari H, Kennedy RD, Cohen JE. Smoking among female daily smokers in Surabaya, Indonesia. Public Health 2019; 172:40-42. [PMID: 31158567 DOI: 10.1016/j.puhe.2019.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 01/03/2019] [Revised: 03/14/2019] [Accepted: 03/14/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Nationally representative studies suggest 1-2% of Indonesian women (2.3 million) smoke various tobacco products daily; however, in recent years, there has been concern that the tobacco industry has successfully increased female smoking. Our objective was to describe current cigarette smoking behaviors, past quit attempts, and intention to quit of female daily smokers in Surabaya, Indonesia. STUDY DESIGN Survey. METHODS Female daily smokers (n = 112) in Surabaya, Indonesia, the country's second largest city, were recruited to participate in a survey during 2018. Convenience sampling was utilized in two malls. Potential participants were intercepted in or near designated smoking areas and invited to the nearby data collection site. Survey items from Global Adult Tobacco Survey and the International Tobacco Control Policy Evaluation Project were utilized. RESULTS Participants self-reported smoking 13.8 cigarettes per day (7.3 white machine-rolled cigarettes per day, 4.2 kreteks per day, and 2.4 roll-your-own cigarettes per day). Over 75% smoked their first cigarette within 30 min of waking. Over 53% had a heaviness of smoking index score suggesting moderate or high addiction. Approximately half (51%) did not attempt to quit smoking in the previous 12 months, and 55% planned to quit beyond 6 months or not at all. CONCLUSIONS Our sample smoked five to six more cigarettes per day than female daily smokers in previous national surveys. Relative to previous studies, our data suggest an unexpected preference for white machine-rolled cigarettes and that there could be, at a minimum, pockets of increased smoking and addiction among female daily smokers in Indonesia.
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Affiliation(s)
- J J Hardesty
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior & Society, Baltimore, MD, USA.
| | - B Kaplan
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior & Society, Baltimore, MD, USA
| | - S Martini
- Airlangga University, Faculty of Public Health, Surabaya, Indonesia
| | - H Megatsari
- Airlangga University, Faculty of Public Health, Surabaya, Indonesia
| | - R D Kennedy
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior & Society, Baltimore, MD, USA
| | - J E Cohen
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior & Society, Baltimore, MD, USA
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Hardesty JJ, Kanarek NF. Barriers to non-small cell lung cancer trial eligibility. Contemp Clin Trials Commun 2018; 9:45-49. [PMID: 29696224 PMCID: PMC5898521 DOI: 10.1016/j.conctc.2017.11.010] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 11/19/2017] [Accepted: 11/22/2017] [Indexed: 11/16/2022] Open
Abstract
Introduction Cancer clinical trial (CCT) enrollment is low potentially threatening the generalizability of trial results and expedited regulatory approvals. We assessed whether type of initial patient appointment for non-small cell lung cancer (NSCLC) is associated with CCT eligibility. Methods Using a patient-to-accrual framework, we conducted a quasi-retrospective cohort pilot study at Sidney Kimmel Comprehensive Cancer Center (SKCCC), Baltimore, Maryland. 153 NSCLC patients new to SKCCC were categorized based on type of initial appointment: patients diagnosed or treated and patients seen for a consultation. CCT eligibility was determined by comparing eligibility criteria for each open trial to the electronic medical record (EMR) of each patient at every office visit occurring within 6-months of initial visit. Results We found no association between type of initial appointment and CCT eligibility (OR, 1.15; 95% CI, 0.49-2.73). Analyses did suggest current smokers were less likely to be eligible for trials compared to never smokers (OR, 0.15; 95% CI, 0.03-0.64), and stage 4 patients with second line therapy or greater were more likely to be eligible than stage 1 or 2 patients (OR, 5.18; 95% CI, 1.08-24.75). Additional analyses suggested most current smokers and stage 1 or 2 patients had trials available but were still ineligible. Conclusions SKCCC has a diverse portfolio of trials available for NSCLC patients and should consider research strategies to re-examine eligibility criteria for future trials to ensure increased enrollment of current smokers and stage 1 or 2 patients. We could not confirm whether type of initial visit was related to eligibility.
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Affiliation(s)
- Jeffrey J Hardesty
- Johns Hopkins University Bloomberg School of Public Health, USA.,Johns Hopkins University School of Medicine, Geriatrics Department, USA
| | - Norma F Kanarek
- Johns Hopkins University Bloomberg School of Public Health, USA.,Johns Hopkins University School of Medicine, Sidney Kimmel Comprehensive Cancer Center, USA
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Benoit JB, Patrick KR, Desai K, Hardesty JJ, Krause TB, Denlinger DL. Repeated bouts of dehydration deplete nutrient reserves and reduce egg production in the mosquito Culex pipiens. ACTA ACUST UNITED AC 2010; 213:2763-9. [PMID: 20675546 DOI: 10.1242/jeb.044883] [Citation(s) in RCA: 46] [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] [Indexed: 11/20/2022]
Abstract
In this study of the mosquito, Culex pipiens, we examined the impact of multiple bouts of dehydration and rehydration on survival, depletion of metabolic reserves and egg production in both non-diapausing and diapausing females. Mosquitoes provided with access to sugar during rehydration survived longer than those allowed to rehydrate without sugar, and their survival was similar to that of mosquitoes of the same age that were not dehydrated. Among mosquitoes not provided with sugar, each dehydration bout reduced the mosquito's dry mass - an effect likely to be due to the utilization of carbohydrates and lipid reserves. The toll on glycogen and lipid reserves is likely to be especially costly for diapausing mosquitoes that are dependent on these stored reserves for winter survival. Egg production in both non-diapausing and post-diapausing C. pipiens was also reduced in response to multiple bouts of dehydration. Although egg quality was not compromised, the number of eggs produced was reduced. Both non-diapausing and diapausing females can compensate for the nutrient loss due to dehydration by sugar feeding but the opportunity to feed on sugar is likely to be rarely available in the overwintering habitat of diapausing females, thus the impact of dehydration may be especially pronounced in overwintering populations of C. pipiens.
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Affiliation(s)
- Joshua B Benoit
- Department of Entomology, The Ohio State University, Columbus, OH 43210, USA.
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