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Kochvar A, Hao G, Dai HD. Biomarkers of metal exposure in adolescent e-cigarette users: correlations with vaping frequency and flavouring. Tob Control 2024:tc-2023-058554. [PMID: 38684372 DOI: 10.1136/tc-2023-058554] [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: 12/13/2023] [Accepted: 03/28/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Youth vaping poses a significant public health concern as metals have been detected in e-cigarette aerosols and liquids. This study investigated factors associated with biomarkers of metal exposure. METHODS Data were drawn from Wave 5 of the Population Assessment of Tobacco and Health (PATH) Study Youth Panel, a nationally representative sample of US adolescents aged 13-17 years. Urinary biomarkers of exposure to cadmium, lead, and uranium were assessed by vaping frequency (occasional (1-5 days), intermittent (6-19 days), and frequent (20+ days)) in the past 30 days and flavour type (menthol/mint, fruit, and sweet). RESULTS Among 200 exclusive e-cigarette users (median age 15.9 years, 62.9% female), 65 reported occasional use, 45 reported intermittent use, and 81 reported frequent use. The average number of recent puffs per day increased exponentially by vaping frequency (occasional: 0.9 puffs, intermittent: 7.9 puffs, frequent: 27.0 puffs; p=0.001). Both intermittent (0.21 ng/mg creatinine) and frequent users (0.20 ng/mg creatinine) had higher urine lead levels than occasional users (0.16 ng/mg creatinine). Frequent users also had higher urine uranium levels compared with occasional users (0.009 vs 0.005 ng/mg creatinine, p=0.0004). Overall, 33.0% of users preferred using menthol/mint flavours, 49.8% fruit flavours, and 15.3% sweet flavours. Sweet flavour users had higher uranium levels compared with menthol/mint users (0.009 vs 0.005 ng/mg creatinine, p=0.02). CONCLUSIONS Vaping in early life could increase the risk of exposure to metals, potentially harming brain and organ development. Regulations on vaping should safeguard the youth population against addiction and exposure to metals.
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Affiliation(s)
- Andrew Kochvar
- University of Nebraska Medical Center, Omaha, Nebraska, USA
- Kansas City University, Kansas City, Missouri, USA
| | - Gary Hao
- Millard West High School, Omaha, Nebraska, USA
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2
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Hawkins SS, Carey N, Levine Coley R, Baum CF. Associations between tobacco 21 and state flavour restrictions with young adult tobacco use. Tob Control 2024:tc-2023-058448. [PMID: 38527790 DOI: 10.1136/tc-2023-058448] [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: 10/17/2023] [Accepted: 03/13/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND States have recently enacted tobacco-related age and flavour restrictions in addition to federal T21 laws. Little is known about the independent effects of these policies on young adult tobacco use. METHODS Linking 2011-2022 Behavioural Risk Factor Surveillance System data on 2 696 870, 18-59 years from 50 states and DC with policy data, we conducted probit regression models to evaluate the associations between state and federal T21 laws and state flavour restrictions with cigarettes, electronic nicotine delivery system (ENDS) and smokeless tobacco use. Models were adjusted for sociodemographics, additional tobacco policies, COVID-19-related factors, year and state. We tested two-way and three-way interactions between age, state T21 and federal T21 laws. RESULTS Although we did not find evidence that state T21 laws were associated with cigarette, smokeless tobacco or ENDS use overall, the federal T21 law was associated with lower use of all three tobacco products by 0.39-0.92 percentage points. State flavour restrictions were associated with lower use of cigarettes by 0.68 (-1.27 to -0.09) and ENDS by 0.56 (-1.11 to -0.00) percentage points, but not with smokeless tobacco. A three-way interaction revealed that state and federal T21 laws together were associated with a lower prevalence of ENDS use among 18-20 years, but there were no differences in cigarette use from both policies combined versus either alone. CONCLUSION State and federal T21 laws are broadly effective at reducing adult tobacco use, while state flavour restrictions specifically lower use of cigarettes and ENDS.
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Affiliation(s)
| | - Naoka Carey
- Lynch School of Education & Human Development, Boston College, Chestnut Hill, Massachusetts, USA
| | - Rebekah Levine Coley
- Department of Counseling, Developmental, and Educational Psychology, Boston College Lynch School of Education, Chestnut Hill, Massachusetts, USA
| | - Christopher F Baum
- School of Social Work, Boston College, Chestnut Hill, Massachusetts, USA
- Department of Economics, Boston College, Chestnut Hill, Massachusetts, USA
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3
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Ng L, Ng XY, van der Eijk Y. Vaping in a heavily regulated setting: cross-sectional survey of e-cigarette use, perceptions and social media exposure. Tob Control 2024; 33:e11-e17. [PMID: 36813571 DOI: 10.1136/tc-2022-057805] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 02/11/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Singapore has completely banned e-cigarettes and the government's cautious stance against vaping has been consistent. Despite this, vaping appears to have gained popularity in Singapore, especially among younger people. With the heavy marketing of vaping products on social media, it is possible that such marketing, due to its cross-border nature, is reaching younger Singaporeans and driving changes in vaping-related perceptions or behaviours. This study examines their exposure to vaping-related content on social media, and whether such exposure is associated with more positive perceptions of vaping or e-cigarette ever use. METHODS Analysis of cross-sectional survey data of 550 adult (age 21-40 years) Singaporeans recruited via convenience methods in May 2022, using descriptive statistics, bivariate analyses, and multiple linear and logistic regression models. RESULTS 16.9% of participants reported they had ever used e-cigarettes. 18.5% of those who used social media recalled seeing vaping-related content on a social media platform in the past 6 months, mostly from influencers or friends, and on Instagram, Facebook, TikTok and/or YouTube. Reporting exposure to such content was not associated with e-cigarette ever use. It was associated with having a more positive overall perception of vaping (β=1.47; 95% CI: 0.17 to 2.78), although no significant difference was observed when examining only health-related perceptions. CONCLUSION Even in a heavily regulated environment such as Singapore's, people appear to be exposed to vaping-related content on social media platforms and this exposure is, in turn, associated with more positive perceptions of vaping, but not e-cigarette ever use.
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Affiliation(s)
- Lionel Ng
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Xian Yi Ng
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Yvette van der Eijk
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Issabakhsh M, Meza R, Li Y, Yuan Z, Sanchez-Romero LM, Levy DT. Public health impact of a US menthol cigarette ban on the non-Hispanic black population: a simulation study. Tob Control 2023; 33:126-130. [PMID: 35700999 PMCID: PMC10803953 DOI: 10.1136/tobaccocontrol-2022-057298] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 01/25/2022] [Accepted: 05/31/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION With the US Food and Drug Administration recently proposing to implement a ban on menthol cigarettes, it is critical to estimate the potential public health effects of such a ban. With high rates of menthol cigarette use and important smoking-related health disparity implications, the impact of the ban on the non-Hispanic black (NHB) population merits strong consideration. METHODS We apply the previously developed Menthol Smoking and Vaping Model to the NHB population. A status quo scenario is developed using NHB-specific population, smoking and vaping initiation, cessation and death rates. Estimates from a recent expert elicitation on behavioural impacts of a menthol cigarette ban on the NHB population are used to develop a menthol ban scenario implemented in 2021. The public health impacts of the menthol ban are estimated as the difference between smoking and vaping attributable deaths (SVADs) and life years lost (LYLs) in the status quo and the menthol ban scenarios from 2021 to 2060. RESULTS Under the menthol ban scenario, overall smoking is projected to decline by 35.7% in 2026 and by 25.3% in 2060 relative to the status quo scenario. With these reductions, SVADs are estimated to fall by about 18.5% and LYLs by 22.1%, translating to 255 895 premature deaths averted, and 4.0 million life years gained over a 40-year period. CONCLUSIONS A menthol cigarette ban will substantially reduce the smoking-associated health impact on the NHB population, thereby reducing health disparities.
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Affiliation(s)
- Mona Issabakhsh
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Rafael Meza
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Yameng Li
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Zhe Yuan
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | | | - David T Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
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Hammond D, Reid JL. Trends in vaping and nicotine product use among youth in Canada, England and the USA between 2017 and 2022: evidence to inform policy. Tob Control 2023:tc-2023-058241. [PMID: 37940402 DOI: 10.1136/tc-2023-058241] [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: 06/28/2023] [Accepted: 10/25/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Preventing uptake of nicotine products among youth remains a central objective of tobacco control policy. Comparing trends in the use of nicotine across countries provides an opportunity to identify emergent product trends and to evaluate 'natural experiments' in policies. METHODS Repeat cross-sectional data were analysed from eight waves of the International Tobacco Control Youth Tobacco and Vaping Survey, conducted between 2017 and 2022. Non-probability samples of youth aged 16-19 years in Canada, England and the USA (N=104 473) completed online surveys including measures on vaping, smoking and use of other nicotine products. This paper summarises findings across the 5-year period of the study, as part of a comprehensive report on key indicators of youth vaping in the three countries. RESULTS The youth nicotine market has rapidly evolved across the three countries, with different patterns of combustible and non-combustible product use in Canada, the USA and England. These changes are primarily attributable to trends in youth vaping: following declines during the initial COVID-19 pandemic period, by 2022, vaping prevalence neared pre-pandemic levels in the USA and Canada, and reached record highs in England. Notable shifts also occurred in the types of vaping products used by youth, including increased use of disposable, nicotine salt-based products. Additional findings are reported on a range of policy-relevant indicators, including for vaping products, promotions and purchasing. CONCLUSIONS Patterns of nicotine use among youth have rapidly evolved in recent years due to the proliferation of nicotine products, the COVID-19 pandemic and the emerging impact of policy measures.
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Affiliation(s)
- David Hammond
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Jessica L Reid
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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6
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Delnevo CD, Giovenco DP, Villanti AC. Impact of menthol capsule cigarettes on menthol and non-menthol cigarette consumption in the USA, 2008-2020. Tob Control 2023; 32:799-800. [PMID: 35537814 PMCID: PMC9646922 DOI: 10.1136/tobaccocontrol-2022-057422] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 03/24/2022] [Accepted: 05/02/2022] [Indexed: 01/12/2023]
Affiliation(s)
- Cristine D Delnevo
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey, USA
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, Pennsylvania, USA
| | - Daniel P Giovenco
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, Pennsylvania, USA
- Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Andrea C Villanti
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey, USA
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, Pennsylvania, USA
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7
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Hoek J, Rowse B. Point-of-sale displays: a comparison of tobacco and vaping product retail strategies. Tob Control 2023:tc-2023-058211. [PMID: 37827843 DOI: 10.1136/tc-2023-058211] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 09/06/2023] [Indexed: 10/14/2023]
Affiliation(s)
- Janet Hoek
- Department of Public Health, University of Otago, Wellington, New Zealand
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8
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Trigg J, Rich J, Williams E, Gartner CE, Guillaumier A, Bonevski B. Perspectives on limiting tobacco access and supporting access to nicotine vaping products among clients of residential drug and alcohol treatment services in Australia. Tob Control 2023:tc-2023-058094. [PMID: 37821220 DOI: 10.1136/tc-2023-058094] [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: 04/04/2023] [Accepted: 09/25/2023] [Indexed: 10/13/2023]
Abstract
INTRODUCTION Tobacco endgame strategies aim to drive down population smoking rates, the success of which can be improved with public buy-in, including from populations with high smoking rates such as alcohol and other drug (AOD) service clients. This study aimed to explore acceptability of tobacco retail and nicotine reduction, and subsidised nicotine vaping to support AOD service clients following a smoking cessation attempt. METHODS We interviewed 31 Australian AOD service clients who currently or previously smoked, following a 12-week randomised trial comparing nicotine replacement therapy with nicotine vaping product (NVP) for smoking cessation. Participants were asked how effectively three scenarios would support tobacco cessation: tobacco retailer reduction, very low-nicotine cigarette standard and subsidised NVP access. We thematically analysed participant views on how each approach would support tobacco abstinence. RESULTS Tobacco retailer reduction raised concerns about increasing travel and accessing cigarettes from alternate sources, with generally lower acceptability, though a range of perspectives were provided. Reducing nicotine in tobacco products was described as reducing appeal of smoking and potentially increasing illicit purchases of non-reduced nicotine products. Clients of AOD services were highly accepting of subsidised NVP access for tobacco cessation, as this would partly address financial and socioeconomic barriers. CONCLUSIONS Australian tobacco control policy should consider how these approaches impact ease and likelihood of tobacco access by AOD service clients in relation to the general population. Understanding clients' acceptability of tobacco control and endgame measures can inform how to avoid potential unintended consequences for these clients.
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Affiliation(s)
- Joshua Trigg
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Jane Rich
- School of Medicine and Public Health, College of Medicine, Health and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Edwina Williams
- School of Medicine and Public Health, College of Medicine, Health and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Coral E Gartner
- School of Public Health, Faculty of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Ashleigh Guillaumier
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Billie Bonevski
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
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Affiliation(s)
- Juliet P Lee
- Prevention Research Center, Pacific Institute for Research and Evaluation California, Berkeley, California, USA
| | - Raglan Maddox
- Bagumani (Modewa) Clan, Milne Bay, Papua New Guinea
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Michelle Kennedy
- Wiradjuri, Condobolin, New South Wales, Australia
- Equity in Health and Wellbeing Research Program, Hunter Medical Research Institute, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Shadi Nahvi
- Departments of Medicine, and Psychiatry & Behavioral Sciences, Albert Einstein College of Medicine - Montefiore Medical Center, Bronx, New York, USA
| | - Mignonne C Guy
- African American Studies, Virginia Commonwealth University, Richmond, Virginia, USA
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Gutiérrez-Torres DS, Brochier M, Stern D, Cortés-Valencia A, Hernández-Ávila JE, Morales-Carmona E, Barrientos-Gutierrez T, Inoue-Choi M, Lajous M, Freedman ND. Low-intensity daily smoking and mortality risk among Mexican women. Tob Control 2023:tc-2022-057839. [PMID: 37414526 PMCID: PMC10770292 DOI: 10.1136/tc-2022-057839] [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: 11/03/2022] [Accepted: 06/19/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE To examine the association between low-intensity smoking (10 or less cigarettes per day) and all-cause and cause-specific mortality risk among women who smoke and by age at cessation among women who previously smoked. METHODS In this study, 104 717 female participants of the Mexican Teachers' Cohort Study were categorised according to self-reported smoking status at baseline (2006/2008) and were followed for mortality through 2019. We estimated HRs and 95% CIs for all-cause and cause-specific mortality using multivariable Cox proportional hazards regression models with age as the underlying time metric. RESULTS Smoking as few as one to two cigarettes per day was associated with higher mortality risk for all causes (HR: 1.36; 95% CI 1.10 to 1.67) and all cancers (HR: 1.46; 95% CI 1.05 to 2.02), compared with never smoking. Similarly, slightly higher HRs were observed among participants smoking ≥3 cigarettes per day (all causes HR: 1.43; 95% CI 1.19 to 1.70; all cancers HR: 1.48; 95% CI 1.10 to 1.97; cardiovascular disease HR: 1.58; 95% CI 1.09 to 2.28). CONCLUSIONS In this large study of Mexican women, low-intensity smoking was associated with higher mortality risk for all causes and all cancers. Interventions are needed to promote cessation among women who smoke at low-intensity in Mexico, regardless of how few cigarettes they smoke per day.
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Affiliation(s)
| | - Marion Brochier
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Ciudad de México, Mexico
| | - Dalia Stern
- CONAHCyT - Center for Research on Population Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Adrian Cortés-Valencia
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Ciudad de México, Mexico
| | | | - Evangelina Morales-Carmona
- Centro de Investigación en Evaluación y Encuestas, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | | | - Maki Inoue-Choi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Martin Lajous
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Ciudad de México, Mexico
- Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Neal D Freedman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
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Rubenstein D, Denlinger-Apte RL, Cornacchione Ross J, Carroll DM, McClernon FJ. Older age is associated with greater misperception of the relative health risk of e-cigarettes and cigarettes among US adults who smoke. Tob Control 2023:tc-2023-057943. [PMID: 37137702 PMCID: PMC10622327 DOI: 10.1136/tc-2023-057943] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/25/2023] [Indexed: 05/05/2023]
Abstract
INTRODUCTION The prevalence of cigarette smoking among adults aged ≥55 has remained stagnant over the past decade. National data modelling suggests no reduction in cigarette smoking prevalence attributable to e-cigarette use in the USA among people aged ≥45. Misperceptions about the absolute risks (ie, cigarettes are not harmful) and relative risks (ie, e-cigarettes are more harmful than cigarettes) of tobacco products may contribute to sustained smoking prevalence and hesitancy to switch from cigarettes to e-cigarettes among older adults. METHODS Participants reported cigarette use (n=8072) at Wave 5 (2018-2019) of the Population Assessment of Tobacco and Health Study. Weighted multivariable logistic regressions included six age categories (independent variable) and cigarette and e-cigarette risk perceptions (outcomes). Additional models assessed the associations between dichotomous age (≥55 vs 18-54), risk perceptions and an interaction term (independent variables) with past 12-month quit attempts and past-month e-cigarette use (outcomes). RESULTS Adults aged ≥65 were less likely than adults aged 18-24 to rate cigarettes as very/extremely harmful (p<0.05). Odds of rating e-cigarettes as more harmful than cigarettes among adults aged 55-64 and ≥65 were 1.71 (p<0.001) and 1.43 (p=0.024) greater than for adults aged 18-24. This misperception was negatively associated with past-month e-cigarette use and was stronger among adults aged ≥55 (p<0.001) than adults aged <55 (p<0.001). DISCUSSION Adults aged ≥55 are more likely to have misperceptions about the absolute and relative risks of tobacco products, which may contribute to continued smoking. Health communications targeting this age group could modify beliefs about the perceived harms of tobacco products.
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Affiliation(s)
- Dana Rubenstein
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Clinical and Translational Science Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Rachel L Denlinger-Apte
- Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Jennifer Cornacchione Ross
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Dana Mowls Carroll
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - F Joseph McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Clinical and Translational Science Institute, Duke University School of Medicine, Durham, North Carolina, USA
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12
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Parnham JC, Vrinten C, Radó MK, Bottle A, Filippidis FT, Laverty AA. Multistate transition modelling of e-cigarette use and cigarette smoking among youth in the UK. Tob Control 2023:tc-2022-057777. [PMID: 36898842 DOI: 10.1136/tc-2022-057777] [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: 09/27/2022] [Accepted: 02/26/2023] [Indexed: 03/12/2023]
Abstract
INTRODUCTION E-cigarette use remains a controversial topic, with questions over how people transition between e-cigarette use and cigarette smoking. This paper examined transitions into and out of nicotine product use in a representative sample of UK youth. METHODS We used Markov multistate transition probability models on data from 10 229 participants (10-25 years old) in the UK Household Longitudinal Study (2015-2021). We used four product use states ('never', 'non-current use', 'e-cigarette only' and 'smoking and dual use') and estimated likelihood of transitions according to sociodemographic characteristics. RESULTS Among participants who had never used nicotine products, most were still non-users a year later (92.9% probability; 95% CI 92.6%, 93.2%); a small proportion transitioned to using e-cigarettes only (4.0%; 95% CI 3.7%, 4.2%) and cigarettes (2.2%; 95% CI 2.0%, 2.4%). Those aged 14-17 years were the most likely to start using a nicotine product. E-cigarette use was less persistent overtime than cigarette smoking, with a 59.1% probability (95% CI 56.9%, 61.0%) of e-cigarette users still using after 1 year compared with 73.8% (95% CI 72.1%, 75.4%) for cigarette smoking. However, there was a 14% probability (95% CI 12.8%, 16.2%) that e-cigarette users went onto smoke cigarettes after 1 year, rising to 25% (95% CI 23%, 27%) after 3 years. CONCLUSION This study found that although overall nicotine product use was relatively rare, participants were more likely to experiment with e-cigarette use than cigarette smoking. This was mostly not persistent over time; however, approximately one in seven transitioned to cigarette smoking. Regulators should aim to deter all nicotine product use among children.
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Affiliation(s)
- Jennie C Parnham
- Primary Care and Public Health, Imperial College London, London, UK
| | - Charlotte Vrinten
- Primary Care and Public Health, Imperial College London, London, UK.,Department of Management and Engineering, Institute for Analytical Sociology, Linköping University, Linköping, Sweden
| | - Márta K Radó
- Department of Management and Engineering, Institute for Analytical Sociology, Linköping University, Linköping, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Alex Bottle
- Dr Foster Unit, School of Public Health, Imperial College London, London, UK
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Puljević C, Feulner L, Hobbs M, Erku D, Bonevski B, Segan C, Baker A, Hefler M, Cho A, Gartner C. Tobacco endgame and priority populations: a scoping review. Tob Control 2023:tc-2022-057715. [PMID: 36720648 DOI: 10.1136/tc-2022-057715] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 01/11/2023] [Indexed: 02/02/2023]
Abstract
AIM To summarise the research literature on the impacts or perceptions of policies to end tobacco use at a population level (ie, tobacco endgame policies) among people from eight priority population groups (experiencing mental illness, substance use disorders, HIV, homelessness, unemployment or low incomes, who identify as lesbian, gay, bisexual, transgender, queer or intersex (LGBTQI+) or who have experienced incarceration). METHODS Guided by JBI Scoping Review Methodology, we searched six databases for original research examining the impacts or perceptions of 12 tobacco endgame policies among eight priority populations published since 2000. We report the results according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. RESULTS Of the 18 included studies, one described perceptions of five endgame policies among people on low incomes in Aotearoa (New Zealand), and 17 focused on the effectiveness or impacts of a very low nicotine content (VLNC) cigarette standard among people experiencing mental illness (n=14), substance use disorders (n=8), low incomes (n=6), unemployment (n=1) or who identify as LGBTQI+ (n=1) in the USA. These studies provide evidence that VLNC cigarettes can reduce tobacco smoking, cigarette cravings, nicotine withdrawal and nicotine dependence among these populations. CONCLUSIONS Most of the tobacco endgame literature related to these priority populations focuses on VLNC cigarettes. Identified research gaps include the effectiveness of endgame policies for reducing smoking, impacts (both expected and unexpected) and policy perceptions among these priority populations.
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Affiliation(s)
- Cheneal Puljević
- The NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Leah Feulner
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Maria Hobbs
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
| | - Daniel Erku
- Menzies Health Institute, Centre for Applied Health Economics, Griffith University, Brisbane, Queensland, Australia
| | - Billie Bonevski
- The NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | | | - Amanda Baker
- Hunter Medical Research Institute, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Marita Hefler
- The NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Ara Cho
- The NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Coral Gartner
- The NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
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14
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Mills SD, Rosario C, Yerger VB, Kalb MD, Ribisl KM. Recommendations to advance equity in tobacco control. Tob Control 2022:tc-2022-057670. [PMID: 36535756 PMCID: PMC10277310 DOI: 10.1136/tc-2022-057670] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 11/23/2022] [Indexed: 12/24/2022]
Abstract
Reducing racial and socioeconomic inequities in smoking has been declared a priority for tobacco control in the USA for several decades. Yet despite the rhetoric, these inequities persist and some have actually worsened over time. Although tobacco companies have targeted racially and ethnically diverse and lower-income tobacco users, which substantially contributes to these disparities, less attention has been given to the role of individuals and organisations within the tobacco control movement who have allowed progress in eliminating disparities to stagnate. We examine the failure of tobacco control professionals to ensure the widespread adoption of equity-focused tobacco control strategies. Review of major US tobacco control reports found that the focus on equity often stops after describing inequities in tobacco use. We suggest ways to advance equity in tobacco control in the USA. These recommendations fall across five categories: surveillance, interventions, funding, accountability and addressing root causes. Policy interventions that will have a pro-equity impact on smoking and related disease should be prioritised. Funding should be designated to tobacco control activities focused on eliminating racial and socioeconomic inequities in smoking, and tobacco control programmes should be held accountable for meeting equity-related goals.
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Affiliation(s)
- Sarah D Mills
- Department of Health Behavior, University of North Carolina, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Carrie Rosario
- Department of Public Health Education, The University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Valerie B Yerger
- Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Marlene Donato Kalb
- Department of Health Behavior, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Kurt M Ribisl
- Department of Health Behavior, University of North Carolina, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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15
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Budenz A, Gaber J, Crankshaw E, Malterud A, Peterson EB, Wagner DE, Sanders EC. Discrimination, identity connectedness and tobacco use in a sample of sexual and gender minority young adults. Tob Control 2022:tc-2022-057451. [PMID: 36601779 DOI: 10.1136/tc-2022-057451] [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: 04/11/2022] [Accepted: 11/19/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Studies show that tobacco use among sexual and gender minority (SGM) populations is disproportionately higher than heterosexual or cisgender populations. However, few studies have examined tobacco use among SGM subgroups by race/ethnicity or associations between SGM-specific discrimination and connection to SGM identity and tobacco use. METHODS This study analysed survey data from 11 313 SGM (gay, lesbian, bisexual, other sexual minority or gender minority) young adults in the USA and reported current cigarette, e-cigarette, other tobacco (cigar, smokeless tobacco, hookah) and polytobacco use. We used multinomial logistic regression to estimate associations between (a) SGM subgroup, race/ethnicity, SGM-specific discrimination and SGM identity connection and (b) each tobacco use outcome (vs never use of tobacco). We conducted postestimation testing to assess predicted probabilities of tobacco use against the sample average. RESULTS Lesbian females (particularly black lesbian females) had higher-than-average probability of polytobacco use. White bisexual and lesbian participants had higher-than-average probability of cigarette and e-cigarette use, respectively. Higher levels of discrimination were associated with polytobacco use. Higher levels of identity connectedness were protective against certain tobacco use behaviours among gender minority participants and participants with high levels of discrimination experience. CONCLUSIONS We found variations in tobacco use by SGM subgroups overall and by race/ethnicity. Discrimination may be a risk factor for certain tobacco use behaviours. However, SGM identity connectedness may be protective against tobacco use among gender minority individuals and individuals experiencing SGM-specific discrimination. These findings can inform targeted approaches to reach SGM subgroups at greater risk of tobacco use.
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Affiliation(s)
- Alex Budenz
- Center for Tobacco Products, Office of Health Communication and Education, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Jennifer Gaber
- Center for Health Analytics, Media and Policy, RTI International, Durham, NC, USA
| | - Erik Crankshaw
- Center for Health Analytics, Media and Policy, RTI International, Durham, NC, USA
| | - Andie Malterud
- Center for Tobacco Products, Office of Health Communication and Education, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Emily B Peterson
- Center for Tobacco Products, Office of Health Communication and Education, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Dana E Wagner
- Research Department, Rescue Agency, San Diego, CA, USA
| | - Emily C Sanders
- Center for Tobacco Products, Office of Health Communication and Education, U.S. Food and Drug Administration, Silver Spring, MD, USA
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16
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Chen-Sankey J, Cruz-Cano R, Pakdaman S, Wong N, Unger JB, Barrington-Trimis J, Pentz MA. Associations between living in localities with e-cigarette sales restrictions and e-cigarette use change among young adults in Los Angeles County. Tob Control 2022; 31:s187-s196. [PMID: 36328463 PMCID: PMC9639823 DOI: 10.1136/tc-2022-057478] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/28/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Local e-cigarette sales restrictions (ESRs) may impact e-cigarette use. This study examined the associations between living in localities with various ESR policies and changes in e-cigarette use among young adults in Los Angeles (LA) County, California, USA. METHODS Data were from a cohort of LA County young adults (18-21 years; n=2100) who completed two waves of surveys (Fall 2018-Summer 2019 and Summer-Fall 2020). Local flavoured (n=9) and comprehensive (n=2) ESRs in LA County implemented between June 2019 and May 2020 were identified, coded and merged with the baseline data. Multivariable logistic regressions were used to examine the associations between living in ESR localities and e-cigarette use at follow-up, controlling for covariates and stratified by cigarette smoking at baseline. RESULTS Overall, 20.9% and 14.3% of participants lived in localities with flavoured and comprehensive ESRs, respectively. Participants who were non-Hispanic, had higher socioeconomic statuses and were currently using e-cigarettes were generally more likely to live in ESR localities than their counterparts. The associations between living in ESR localities and e-cigarette use at follow-up were not found among baseline non-e-cigarette users regardless of their cigarette smoking status; a positive relationship was found among baseline e-cigarette users who also smoked cigarettes but not among non-smokers. DISCUSSION Participants who lived in localities with various ESR policies were different in their baseline e-cigarette use and socioeconomic backgrounds. Future research examining the potential impact of ESRs on e-cigarette use change should consider the localities' overall sociodemographic and tobacco-using characteristics and individuals' cigarette smoking histories.
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Affiliation(s)
- Julia Chen-Sankey
- Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, New Jersey, USA,School of Public Health, Rutgers University, Piscataway, New Jersey, USA
| | - Raul Cruz-Cano
- School of Public Health, University of Maryland at College Park, College Park, Maryland, USA
| | - Sheila Pakdaman
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Nicholas Wong
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Jennifer B Unger
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | | | - Mary Ann Pentz
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA,Institute for Health Promotion and Disease Prevention Research, University of Southern California, Los Angeles, California, USA
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17
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Primack BA, Shensa A, Sidani JE, Hoffman BL, Soneji S, Sargent JD, Hoffman RM, Fine MJ. Initiation of Traditional Cigarette Smoking after Electronic Cigarette Use Among Tobacco-Naïve US Young Adults. Am J Med 2018; 131:443.e1-443.e9. [PMID: 29242110 PMCID: PMC7054856 DOI: 10.1016/j.amjmed.2017.11.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [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: 06/01/2016] [Revised: 04/25/2017] [Accepted: 11/03/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Although electronic cigarettes (e-cigarettes) may help some smokers quit, some young adult never-smokers are now using e-cigarettes recreationally, potentially increasing their risk for initiation of smoking. We aimed to determine the association between baseline e-cigarette use and subsequent initiation of cigarette smoking among initially never-smoking young adults. METHODS We conducted a prospective cohort study with assessments at baseline (March 2013) and follow-up (October 2014). We used sampling frames representing 97% of the US population to recruit a nationally representative sample of never-smoking young adults aged 18 to 30 years. The independent variable was baseline ever use of e-cigarettes. The main outcome measure was initiation of traditional cigarette smoking between baseline and 18-month follow-up. RESULTS Baseline surveys were completed by 1506 never-smoking young adults, of whom 915 (60.8%) completed follow-up. There were no demographic differences between responders and nonresponders. After applying survey weights-which accounted for both nonresponse and overcoverage or undercoverage-2.5% of the represented population of never-smokers (801,010 of 32,040,393) used e-cigarettes at baseline. Cigarette smoking was initiated by 47.7% of e-cigarette users and 10.2% of nonusers (P = .001). In fully adjusted multivariable models, e-cigarette use at baseline was independently associated with initiation of smoking at 18 months (adjusted odds ratio, 6.8; 95% confidence interval, 1.7-28.3). Results remained similar in magnitude and statistically significant in all sensitivity analyses. CONCLUSIONS Baseline e-cigarette use was independently associated with initiation of traditional cigarette smoking at 18 months. This finding supports policy and educational interventions designed to decrease use of e-cigarettes among nonsmokers.
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Affiliation(s)
- Brian A Primack
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pa; Center for Research on Media, Technology, and Health, University of Pittsburgh School of Medicine, Pittsburgh, Pa; Division of Adolescent Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pa; University of Pittsburgh Honors College, University of Pittsburgh, Pittsburgh, Pa.
| | - Ariel Shensa
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pa; Center for Research on Media, Technology, and Health, University of Pittsburgh School of Medicine, Pittsburgh, Pa
| | - Jaime E Sidani
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pa; Center for Research on Media, Technology, and Health, University of Pittsburgh School of Medicine, Pittsburgh, Pa
| | - Beth L Hoffman
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pa; Center for Research on Media, Technology, and Health, University of Pittsburgh School of Medicine, Pittsburgh, Pa
| | - Samir Soneji
- C. Everett Koop Institute at Dartmouth, Geisel School of Medicine, Hanover, NH; Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - James D Sargent
- C. Everett Koop Institute at Dartmouth, Geisel School of Medicine, Hanover, NH; Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH; Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, NH
| | | | - Michael J Fine
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pa; Center for Research on Media, Technology, and Health, University of Pittsburgh School of Medicine, Pittsburgh, Pa; VA Pittsburgh Healthcare System, Pittsburgh, Pa
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18
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Abstract
In May 2016, the Australian Government announced that it would implement annual increases in tobacco excise of 12.5% up to and including 2020, raising the cost of a pack of cigarettes to $A40. This increase will lead to Australia having one of the highest prices of cigarettes in the world. Increasing the cost of tobacco is considered by public health experts to be one of the most effective strategies to reduce tobacco use, and is generally well supported by the public. However, tobacco tax increases differentially impact various subgroups of the population. Based on a review of existing literature, this paper examines some of the potential (unintended) consequences of the tax to individual and family income; illicit trade; social stigma and opportunities for lobbying by the tobacco industry. In light of these considerations, we offer strategies that might be used by policymakers to mitigate potential harms. While this paper focuses on the impacts primarily on populations in Australia, the consequences and strategies offered may be useful to other countries implementing tobacco excise increases.
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Affiliation(s)
- Katherine T Hirono
- Centre for Health Equity Training, Research and Evaluation, University of New South Wales, Liverpool, New South Wales, Australia
- Ingham Institute, Liverpool, New South Wales, Australia
| | - Katherine E Smith
- Global Public Health Unit, Social Policy, School of Social & Political Science, University of Edinburgh, Edinburgh, UK
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19
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Abstract
BACKGROUND In California, young adult tobacco prevention is of prime importance; 63% of smokers start by the age of 18 years, and 97% start by the age of 26 years. We examined social affiliation with 'peer crowd' (eg, Hipsters) as an innovative way to identify high-risk tobacco users. METHODS Cross-sectional surveys were conducted in 2014 (N=3368) among young adult bar patrons in 3 California cities. We examined use rates of five products (cigarettes, e-cigarettes, hookah, cigars and smokeless tobacco) by five race/ethnicity categories. Peer crowd affiliation was scored based on respondents' selecting pictures of young adults representing those most and least likely to be in their friend group. Respondents were classified into categories based on the highest score; the peer crowd score was also examined as a continuous predictor. Logistic regression models with each tobacco product as the outcome tested the unique contribution of peer crowd affiliation, controlling for race/ethnicity, age, sex, sexual orientation and city. RESULTS Respondents affiliating with Hip Hop and Hipster peer crowds reported significantly higher rates of tobacco use. As a categorical predictor, peer crowd was related to tobacco use, independent of associations with race/ethnicity. As a continuous predictor, Hip Hop peer crowd affiliation was also associated with tobacco use, and Young Professional affiliation was negatively associated, independent of demographic factors. CONCLUSIONS Tobacco product use is not the same across racial/ethnic groups or peer crowds, and peer crowd predicts tobacco use independent of race/ethnicity. Antitobacco interventions targeting peer crowds may be an effective way to reach young adult tobacco users. TRIAL REGISTRATION NUMBER NCT01686178, Pre-results.
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Affiliation(s)
- Nadra E Lisha
- Division of General Internal Medicine, Department of Medicine, Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, California, USA
| | | | - Pamela M Ling
- Division of General Internal Medicine, Department of Medicine, Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, California, USA
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20
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Hartwell G, Thomas S, Egan M, Gilmore A, Petticrew M. E-cigarettes and equity: a systematic review of differences in awareness and use between sociodemographic groups. Tob Control 2017; 26:e85-e91. [PMID: 28003324 PMCID: PMC5739861 DOI: 10.1136/tobaccocontrol-2016-053222] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [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] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 10/10/2016] [Accepted: 10/26/2016] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To assess whether electronic cigarette (e-cigarette) awareness, 'ever use' and current use vary significantly between different sociodemographic groups. DESIGN Systematic review. DATA SOURCES Published and unpublished reports identified by searching seven electronic databases (PubMed, MEDLINE, Web of Science, EMBASE, Global Health, PsycINFO, CINAHL Plus) and grey literature sources. STUDY SELECTION Systematic search for and appraisal of cross-sectional or longitudinal studies that assessed e-cigarette awareness, 'ever use' or current use, and included subgroup analysis of 1 or more PROGRESS Plus sociodemographic groups. No geographical or time restrictions imposed. Assessment by multiple reviewers, with 17% of full articles screened meeting the selection criteria. DATA EXTRACTION Data extracted and checked by multiple reviewers, with quality assessed using an adapted tool developed by the Joanna Briggs Institute. DATA SYNTHESIS Results of narrative synthesis suggest broadly that awareness, 'ever use' and current use of e-cigarettes may be particularly prevalent among older adolescents and younger adults, males, people of white ethnicity and-particularly in the case of awareness and 'ever use'-those of intermediate or high levels of education. In some cases, results also varied within and between countries. CONCLUSIONS E-cigarette awareness, 'ever use' and current use appear to be patterned by a number of sociodemographic factors which vary between different countries and subnational localities. Care will therefore be required to ensure neither the potential benefits nor the potential risks of e-cigarettes exacerbate existing health inequalities.
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Affiliation(s)
- Greg Hartwell
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, NIHR School for Public Health Research, London, UK
| | - Sian Thomas
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, NIHR School for Public Health Research, London, UK
| | - Matt Egan
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, NIHR School for Public Health Research, London, UK
| | - Anna Gilmore
- Department for Health, University of Bath, UK Centre for Tobacco and Alcohol Studies (UKCTAS), Bath, UK
| | - Mark Petticrew
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, NIHR School for Public Health Research, London, UK
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21
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Yang S, Xu L, He Y, Jiang C, Jin Y, Cheng KK, Zhang W, Lam TH. Childhood secondhand smoke exposure and pregnancy loss in never smokers: the Guangzhou Biobank Cohort Study. Tob Control 2017; 26:697-702. [PMID: 28011924 PMCID: PMC5661265 DOI: 10.1136/tobaccocontrol-2016-053239] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 10/01/2016] [Accepted: 11/01/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Studies of secondhand smoke (SHS) exposure especially childhood SHS exposure and pregnancy loss are limited. We used baseline data of the Guangzhou Biobank Cohort Study (GBCS) to examine the association of childhood SHS exposure with a history of pregnancy loss. METHODS Never smoking women aged 50 years or above in GBCS from 2003 to 2008 were included. Propensity score matching (PSM) was used to control for confounding. Negative binomial regression and logistic regression were used to examine the association of childhood SHS, assessed by number of smokers in childhood household and frequency of exposure, with past pregnancy loss. RESULTS Of 19 562 women, 56.7% (11 096) had SHS exposure during childhood. In negative binomial regression, after adjusting for age, education, past occupational dust exposure, past home fuel exposure, oral contraceptive, adulthood SHS exposure, age at first pregnancy and age at first menarche, compared to non-exposure, the incidence rate ratio of one more pregnancy loss was 1.20 (95% CI1.05 to 1.37) in those who lived with ≥2 smokers in the same household, and 1.14 (95% CI 1.04 to 1.25) in those exposed ≥5 times/week. After similar adjustment, logistic regression showed that the OR of pregnancy loss ≥2 times (versus 0 to 1 time) was 1.25 (95% CI 1.00 to 1.57) and 1.20 (95% CI 1.03 to 1.40) for high density (≥2 smokers in the same household) and frequency (≥5 times/week) of childhood exposure, respectively. CONCLUSIONS Childhood SHS exposure was associated with higher risks of pregnancy loss in middle-aged and older Chinese women.
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Affiliation(s)
- Shanshan Yang
- Institute of Geriatrics, Chinese PLA General Hospital, Beijing, China
- Jinan Military Area CDC, Jinan, Shandong, China
| | - Lin Xu
- School of Public Health, the University of Hong Kong, Hong Kong, China
| | - Yao He
- Institute of Geriatrics, Chinese PLA General Hospital, Beijing, China
- Beijing Key Laboratory of Aging and Geriatrics, Chinese PLA General Hospital, Beijing, China
- State Key Laboratory of Kidney Disease, Chinese PLA General Hospital, Beijing, China
| | | | - Yali Jin
- Guangzhou Number 12 People's Hospital, Guangzhou, China
| | - Kar Keung Cheng
- Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK
| | - Weisen Zhang
- Guangzhou Number 12 People's Hospital, Guangzhou, China
| | - Tai Hing Lam
- Institute of Geriatrics, Chinese PLA General Hospital, Beijing, China
- School of Public Health, the University of Hong Kong, Hong Kong, China
- Guangzhou Number 12 People's Hospital, Guangzhou, China
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22
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Cantrell J, Hair EC, Smith A, Bennett M, Rath JM, Thomas RK, Fahimi M, Dennis JM, Vallone D. Recruiting and retaining youth and young adults: challenges and opportunities in survey research for tobacco control. Tob Control 2017; 27:147-154. [PMID: 28432211 DOI: 10.1136/tobaccocontrol-2016-053504] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [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: 10/28/2016] [Revised: 02/28/2017] [Accepted: 03/10/2017] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Evaluation studies of population-based tobacco control interventions often rely on large-scale survey data from numerous respondents across many geographic areas to provide evidence of their effectiveness. Significant challenges for survey research have emerged with the evolving communications landscape, particularly for surveying hard-to-reach populations such as youth and young adults. This study combines the comprehensive coverage of an address-based sampling (ABS) frame with the timeliness of online data collection to develop a nationally representative longitudinal cohort of young people aged 15-21. METHODS We constructed an ABS frame, partially supplemented with auxiliary data, to recruit this hard-to-reach sample. Branded and tested mail-based recruitment materials were designed to bring respondents online for screening, consent and surveying. Once enrolled, respondents completed online surveys every 6 months via computer, tablet or smartphone. Numerous strategies were utilized to enhance retention and representativeness RESULTS: Results detail sample performance, representativeness and retention rates as well as device utilization trends for survey completion among youth and young adult respondents. Panel development efforts resulted in a large, nationally representative sample with high retention rates. CONCLUSIONS This study is among the first to employ this hybrid ABS-to-online methodology to recruit and retain youth and young adults in a probability-based online cohort panel. The approach is particularly valuable for conducting research among younger populations as it capitalizes on their increasing access to and comfort with digital communication. We discuss challenges and opportunities of panel recruitment and retention methods in an effort to provide valuable information for tobacco control researchers seeking to obtain representative, population-based samples of youth and young adults in the U.S. as well as across the globe.
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Affiliation(s)
- Jennifer Cantrell
- Evaluation and Science Research, Truth Initiative, Washington DC, USA.,Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Elizabeth C Hair
- Evaluation and Science Research, Truth Initiative, Washington DC, USA.,Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alexandria Smith
- Evaluation and Science Research, Truth Initiative, Washington DC, USA
| | - Morgane Bennett
- Evaluation and Science Research, Truth Initiative, Washington DC, USA
| | - Jessica Miller Rath
- Evaluation and Science Research, Truth Initiative, Washington DC, USA.,Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | - Donna Vallone
- Evaluation and Science Research, Truth Initiative, Washington DC, USA.,Global Institute of Public Health, New York University, New York, NY, USA
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23
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Miech R, Patrick ME, O'Malley PM, Johnston LD. E-cigarette use as a predictor of cigarette smoking: results from a 1-year follow-up of a national sample of 12th grade students. Tob Control 2017; 26:e106-e111. [PMID: 28167683 DOI: 10.1136/tobaccocontrol-2016-053291] [Citation(s) in RCA: 147] [Impact Index Per Article: 21.0] [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: 06/30/2016] [Revised: 11/22/2016] [Accepted: 11/27/2016] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To prospectively examine vaping as a predictor of future cigarette smoking among youth with and without previous cigarette smoking experience. A secondary aim is to investigate whether vaping may desensitise youth to the dangers of smoking. METHODS Analysis of prospective longitudinal panel data from the nationally representative Monitoring the Future study. The analysis is based on 347 12th grade students who were part of a randomly selected subsample that completed in-school surveys in 2014 and were resurveyed 1-year later. RESULTS Among youth who had never smoked a cigarette by 12th grade, baseline, recent vapers were more than 4 times (relative risk (RR)=4.78) more likely to report past-year cigarette smoking at follow-up, even among youth who reported the highest possible level of perceived risk for cigarette smoking at baseline. Among 12th grade students who had smoked in the past but had not recently smoked at baseline, recent vapers were twice (RR=2.15) as likely to report smoking in the past 12 months at the follow-up. Vaping did not predict cessation of smoking among recent smokers at baseline. Among never-smokers at baseline, recent vapers were more than 4 times (RR=4.73) more likely to move away from the perception of cigarettes as posing a 'great risk' of harm, a finding consistent with a desensitisation process. CONCLUSIONS These results contribute to the growing body of evidence supporting vaping as a one-way bridge to cigarette smoking among youth. Vaping as a risk factor for future smoking is a strong, scientifically-based rationale for restricting youth access to e-cigarettes.
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Affiliation(s)
- Richard Miech
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Megan E Patrick
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Patrick M O'Malley
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Lloyd D Johnston
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
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24
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England LJ, Aagaard K, Bloch M, Conway K, Cosgrove K, Grana R, Gould TJ, Hatsukami D, Jensen F, Kandel D, Lanphear B, Leslie F, Pauly JR, Neiderhiser J, Rubinstein M, Slotkin TA, Spindel E, Stroud L, Wakschlag L. Developmental toxicity of nicotine: A transdisciplinary synthesis and implications for emerging tobacco products. Neurosci Biobehav Rev 2017; 72:176-189. [PMID: 27890689 PMCID: PMC5965681 DOI: 10.1016/j.neubiorev.2016.11.013] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [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: 09/28/2016] [Revised: 11/18/2016] [Accepted: 11/19/2016] [Indexed: 12/24/2022]
Abstract
While the health risks associated with adult cigarette smoking have been well described, effects of nicotine exposure during periods of developmental vulnerability are often overlooked. Using MEDLINE and PubMed literature searches, books, reports and expert opinion, a transdisciplinary group of scientists reviewed human and animal research on the health effects of exposure to nicotine during pregnancy and adolescence. A synthesis of this research supports that nicotine contributes critically to adverse effects of gestational tobacco exposure, including reduced pulmonary function, auditory processing defects, impaired infant cardiorespiratory function, and may contribute to cognitive and behavioral deficits in later life. Nicotine exposure during adolescence is associated with deficits in working memory, attention, and auditory processing, as well as increased impulsivity and anxiety. Finally, recent animal studies suggest that nicotine has a priming effect that increases addiction liability for other drugs. The evidence that nicotine adversely affects fetal and adolescent development is sufficient to warrant public health measures to protect pregnant women, children, and adolescents from nicotine exposure.
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Affiliation(s)
- Lucinda J England
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Kjersti Aagaard
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - Michele Bloch
- Division of Cancer Control and Population Science, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Kevin Conway
- Division of Epidemiology, Services and Prevention Research, National Institute on Drug Abuse, National Institutes of Health, Rockville, MD, USA
| | - Kelly Cosgrove
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Rachel Grana
- Division of Cancer Control and Population Science, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Thomas J Gould
- Department of Biobehavioral Health, Pennsylvania State University, PA, USA
| | | | - Frances Jensen
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Denise Kandel
- Department of Psychiatry and Mailman School of Public Health, Columbia University, New York State Psychiatric Institute, New York, NY, USA
| | | | - Frances Leslie
- Department of Pharmacology, School of Medicine, University of California, Irvine, CA, USA
| | - James R Pauly
- College of Pharmacy, University of Kentucky, Lexington, KY, USA
| | - Jenae Neiderhiser
- Department of Psychology, Pennsylvania State University, University Park, PA, USA
| | - Mark Rubinstein
- Department of Pediatrics, School of Medicine, University of California, San Francisco, CA, USA
| | - Theodore A Slotkin
- Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC, USA
| | - Eliot Spindel
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, OR, USA
| | - Laura Stroud
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI, USA
| | - Lauren Wakschlag
- Department of Medical Social Sciences Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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25
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Hoffman AC, Salgado RV, Dresler C, Faller RW, Bartlett C. Flavour preferences in youth versus adults: a review. Tob Control 2016; 25:ii32-ii39. [PMID: 27633764 PMCID: PMC5127592 DOI: 10.1136/tobaccocontrol-2016-053192] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [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: 05/24/2016] [Revised: 08/02/2016] [Accepted: 08/04/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To understand the available evidence of how children and adults differ in their preferences for flavours that may be used in tobacco products. DATA SOURCES A total of 474 articles published between 1931 and August 2015 were retrieved through searches conducted in PubMed, EMBASE, Web of Science and PsycINFO. STUDY SELECTION AND EXTRACTION A 2-phase relevancy review process resulted in the identification of 59 articles and information was extracted by 2 independent reviewers. DATA SYNTHESIS Findings were grouped by taste and smell preferences, which are important components of overall flavour. For taste, evidence is summarised in the following categories: sweet, salty, sour, bitter, umami and fat; within each of them, findings are organised by age categories. For smell, evidence is summarised as follows: fruit/herbal/spices, tobacco and coffee and other odours. Major findings from this search indicated that sweet preference in children and adolescents was higher than in adults. Examples of preferred food-related tastes and odours for young people included cherry, candy, strawberry, orange, apple and cinnamon. Currently, all these are used to flavour cigars, cartridges for electronic cigarettes, hookah (waterpipe) and smokeless tobacco products. CONCLUSIONS Infants and children exhibited elevated sweet and salty preference relative to adults. Age-related changes in bitter, sour, umami and fat taste were not clear and more research would be useful. 'Sweet' food odours were highly preferred by children. Tobacco products in flavours preferred by young people may impact tobacco use and initiation, while flavours preferred by adults may impact product switching or dual use.
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Affiliation(s)
| | - Raydel Valdes Salgado
- Division of Population Health Sciences, SciMetrika, LLC, Silver Spring, Maryland, USA
| | | | | | - Christopher Bartlett
- Division of Population Health Sciences, SciMetrika, LLC, Silver Spring, Maryland, USA
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26
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Bonhomme MG, Holder-Hayes E, Ambrose BK, Tworek C, Feirman SP, King BA, Apelberg BJ. Flavoured non-cigarette tobacco product use among US adults: 2013-2014. Tob Control 2016; 25:ii4-ii13. [PMID: 27794065 PMCID: PMC5515238 DOI: 10.1136/tobaccocontrol-2016-053373] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [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: 08/10/2016] [Revised: 10/03/2016] [Accepted: 10/04/2016] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Limited data exist on flavoured non-cigarette tobacco product (NCTP) use among US adults. METHODS Data from the 2013 to 2014 National Adult Tobacco Survey (N=75 233), a landline and cellular telephone survey of US adults aged ≥18, were assessed to estimate past 30-day NCTP use, flavoured NCTP use and flavour types using bivariate analyses. RESULTS During 2013-2014, 14.4% of US adults were past 30-day NCTP users. Nationally, an estimated 10.2 million e-cigarette users (68.2%), 6.1 million hookah users (82.3%), 4.1 million cigar smokers (36.2%) and 4.0 million smokeless tobacco users (50.6%) used flavoured products in the past 30 days. The most prevalent flavours reported were menthol/mint (76.9%) for smokeless tobacco; fruit (74.0%) for hookah; fruit (52.4%), candy/chocolate/other sweet flavours (22.0%) and alcohol (14.5%) for cigars/cigarillos/filtered little cigars; fruit (44.9%), menthol/mint (43.9%) and candy/chocolate/other sweet flavours (25.7%) for e-cigarettes and fruit (56.6%), candy/chocolate/other sweet flavours (26.5%) and menthol/mint (24.8%) for pipes. Except for hookah and pipes, past 30-day flavoured product use was highest among 18-24-year olds. By cigarette smoking, never smoking e-cigarette users (84.8%) were more likely to report flavoured e-cigarette use, followed by recent former smokers (78.1%), long-term former smokers (70.4%) and current smokers (63.2%). CONCLUSIONS Flavoured NCTP use is prominent among US adult tobacco users, particularly among e-cigarette, hookah and cigar users. Flavoured product use, especially fruit and sweet-flavoured products, was higher among younger adults. It is important for tobacco prevention and control strategies to address all forms of tobacco use, including flavoured tobacco products.
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Affiliation(s)
- Michèle G Bonhomme
- Food and Drug Administration, Center for Tobacco Products, Office of Science, Silver Spring, Maryland, USA
| | - Enver Holder-Hayes
- Food and Drug Administration, Center for Tobacco Products, Office of Science, Silver Spring, Maryland, USA
| | - Bridget K Ambrose
- Food and Drug Administration, Center for Tobacco Products, Office of Science, Silver Spring, Maryland, USA
| | - Cindy Tworek
- Food and Drug Administration, Center for Tobacco Products, Office of Science, Silver Spring, Maryland, USA
| | - Shari P Feirman
- Food and Drug Administration, Center for Tobacco Products, Office of Science, Silver Spring, Maryland, USA
| | - Brian A King
- Centers for Disease Control and Prevention, Office on Smoking and Health, Atlanta, Georgia, USA
| | - Benjamin J Apelberg
- Food and Drug Administration, Center for Tobacco Products, Office of Science, Silver Spring, Maryland, USA
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de Andrade D, Kinner SA. Systematic review of health and behavioural outcomes of smoking cessation interventions in prisons. Tob Control 2016; 26:495-501. [PMID: 27798322 PMCID: PMC5574402 DOI: 10.1136/tobaccocontrol-2016-053297] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 09/13/2016] [Accepted: 09/26/2016] [Indexed: 01/06/2023]
Abstract
Objective We conducted a systematic review to examine the impact of smoking cessation interventions, including smoking bans, on prisoners and prison staff. Data sources We systematically searched health and criminal justice databases for relevant studies. Search strings were used to combine terms related to smoking cessation interventions with terms related to incarceration. We used forward and backward snowballing to capture additional studies. Study selection Studies were included if: they were published between 1 January 1994 and 23 May 2016; the population was incarcerated adults and/or prison staff; they had a quantitative component; they were published in English; and they reported outcomes of a smoking cessation programme/ban with regard to reported change in smoking behaviour and/or behavioural outcomes. Data extraction Studies were reviewed for methodological rigour using the Effective Public Health Practice Project's Quality Assessment Tool for Quantitative Studies. Data were independently reviewed for methodological quality by 1 author and a research assistant. Data synthesis Cessation programmes, including free nicotine replacement therapy and/or behavioural counselling can significantly increase the likelihood of quitting in prison and increase abstinence postrelease. Indoor bans have little impact on prisoner smoking behaviour. Prisoners who experience a complete smoking ban typically resume smoking shortly after release from prison. Bans may result in adverse behavioural outcomes, but these are generally minimal and short-lived. Conclusions While there is limited evidence to inform tobacco control policies in custodial settings, outcomes of this review suggest that cessation programmes/bans can be an effective mechanism to interrupt prisoner smoking behaviour when properly enforced.
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Affiliation(s)
- Dominique de Andrade
- Griffith Criminology Institute and Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Stuart A Kinner
- Griffith Criminology Institute and Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.,Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Centre for Adolescent Health, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
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28
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Villanti AC, Mowery PD, Delnevo CD, Niaura RS, Abrams DB, Giovino GA. Changes in the prevalence and correlates of menthol cigarette use in the USA, 2004-2014. Tob Control 2016; 25:ii14-ii20. [PMID: 27729565 DOI: 10.1136/tobaccocontrol-2016-053329] [Citation(s) in RCA: 141] [Impact Index Per Article: 17.6] [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: 07/20/2016] [Accepted: 09/09/2016] [Indexed: 11/03/2022]
Abstract
INTRODUCTION National data from 2004 to 2010 showed that despite decreases in non-menthol cigarette use prevalence, menthol cigarette use prevalence remained constant in adolescents and adults and increased in young adults. The purpose of the current study was to extend these analyses through 2014. METHODS We estimated the prevalence of menthol cigarette smoking in the USA during 2004-2014 using annual cross-sectional data on persons aged ≥12 years from the National Survey on Drug Use and Health. Self-reported menthol status for selected brands that were either exclusively menthol or non-menthol were adjusted based on retail sales data. Data were weighted to provide national estimates. RESULTS Although overall smoking prevalence has decreased, the proportion of past 30-day cigarette smokers using menthol cigarettes was higher (39%) in 2012-2014 compared to 2008-2010 (35%). Youth smokers remain the most likely group to use menthol cigarettes compared to all other age groups. Menthol cigarette prevalence has increased in white, Asian and Hispanic smokers since 2010. Menthol cigarette prevalence exceeded non-menthol cigarette prevalence in youth and young adult smokers in 2014. Among smokers, menthol cigarette use was positively correlated with co-use of cigars. Menthol cigarette and smokeless tobacco co-use also increased from 2004 to 2014. CONCLUSIONS The youngest smokers are most likely to use menthol cigarettes. Among smokers, increases in overall menthol cigarette use and menthol cigarette use in whites, Asians and Hispanics since 2010 are of concern. There is tremendous urgency to limit the impact of menthol cigarettes on public health, particularly the health of youth and young adults.
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Affiliation(s)
- Andrea C Villanti
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC, USA.,Department of Health, Behavior and Society, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Cristine D Delnevo
- Center for Tobacco Studies, School of Public Health, Rutgers, the State University, New Brunswick, New Jersey, USA.,Cancer Institute of New Jersey, Rutgers, the State University, New Brunswick, New Jersey, USA
| | - Raymond S Niaura
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC, USA.,Department of Health, Behavior and Society, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Oncology, Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - David B Abrams
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC, USA.,Department of Health, Behavior and Society, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Oncology, Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Gary A Giovino
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, New York, USA
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Sterling K, Fryer C, Pagano I, Jones D, Fagan P. Association between menthol-flavoured cigarette smoking and flavoured little cigar and cigarillo use among African-American, Hispanic, and white young and middle-aged adult smokers. Tob Control 2016; 25:ii21-ii31. [PMID: 27856997 DOI: 10.1136/tobaccocontrol-2016-053203] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [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: 05/26/2016] [Accepted: 09/07/2016] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Flavour additives in cigarettes and little cigars and cigarillos (LCCs), which influence smokers' risk perceptions, may reinforce dual flavoured tobacco use. We examined the association among mentholated cigarette use, risk perceptions for flavour additives in LCCs and flavoured LCC smoking behaviour. METHODS Data from a national probability sample of 964 young and middle-aged adult current cigarette smokers were analysed. Multinomial logistic regression models examined the relationship among mentholated cigarette smoking, risk perceptions and current flavoured LCC use for the analytic sample and gender and race/ethnicity. RESULTS Daily menthol cigarette smokers, compared to occasional, non-menthol smokers, had increased odds of flavoured LCC smoking (OR=1.75, 95% CI 1.02 to 2.98). This relationship was found for males, blacks/African-Americans and Hispanics/Latinos (p<0.05). Positive perceptions of menthol-flavoured additives in LCCs was associated with increased odds of flavoured LCC use among the analytic sample, males and blacks/African-Americans (p<0.05). Positive perceptions for clove-flavoured, spice-flavoured and alcohol-flavoured additives were also associated with flavoured LCC use among the analytic sample (p<0.05). CONCLUSIONS Use of menthol-flavoured cigarettes and positive perceptions about menthol-flavoured and other flavour additives in LCCs may contribute to dual use with flavoured LCCs among adult cigarette smokers, specifically those from vulnerable populations.
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Affiliation(s)
- K Sterling
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - C Fryer
- University of Maryland, College Park, Maryland, USA
| | - I Pagano
- University of Hawaii at Manoa, Honolulu, Hawaii, USA
| | - D Jones
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - P Fagan
- Univeristy of Arkansas for Medical Sciences, Fay W. Boozman College of Public Health, USA
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30
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Nez Henderson P, Roeseler A, Moor G, Clark HW, Yazzie A, Nez P, Nez C, Sabo S, Leischow SJ. Advancing smoke-free policy adoption on the Navajo Nation. Tob Control 2016; 25:i26-i31. [PMID: 27697945 PMCID: PMC5099220 DOI: 10.1136/tobaccocontrol-2016-053109] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 06/14/2016] [Indexed: 12/02/2022]
Abstract
Background Comprehensive smoke-free laws are effective at protecting non-smokers and reducing tobacco use, yet they are not widely adopted by tribal governments. Methods A series of smoke-free policy initiatives on the Navajo Nation, beginning in 2008, were reviewed to identify key issues, successes and setbacks. Results It has been essential that proposed policies acknowledge the Navajo people's spiritual use of nát'oh, a sacred plant used for gift-giving, medicinal purposes and traditional ceremonies, while simultaneously discouraging a secular use of commercial tobacco. Concern that smoke-free policies economically harm tribal casinos has been a major barrier to broad implementation of comprehensive smoke-free laws in Navajo Nation. Conclusions It is necessary for tobacco control researchers and advocates to build relationships with tribal leaders and casino management in order to develop the business case that will take comprehensive smoke-free policies to scale throughout tribal lands.
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Affiliation(s)
| | - April Roeseler
- California Tobacco Control Program, California Department of Public Health, Sacramento, California, USA
| | - Gregg Moor
- InSource, Coquitlam, British Columbia, Canada
| | - Hershel W Clark
- Black Hills Center for American Indian Health, Rapid City, South Dakota, USA
| | - Alfred Yazzie
- Black Hills Center for American Indian Health, Rapid City, South Dakota, USA
| | - Priscilla Nez
- Black Hills Center for American Indian Health, Rapid City, South Dakota, USA
| | - Chantal Nez
- Black Hills Center for American Indian Health, Rapid City, South Dakota, USA
| | - Samantha Sabo
- Department of Health Promotions Sciences, University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, USA
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31
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Aherrera A, Çarkoğlu A, Hayran M, Ergör G, Eirüder T, Kaplan B, Susan J, Zheng L, Cohen JE, Navas-Acien A. Factors that influence attitude and enforcement of the smoke-free law in Turkey: a survey of hospitality venue owners and employees. Tob Control 2016; 26:540-547. [PMID: 27645254 DOI: 10.1136/tobaccocontrol-2016-053088] [Citation(s) in RCA: 10] [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: 03/30/2016] [Accepted: 08/23/2016] [Indexed: 11/04/2022]
Abstract
INTRODUCTION In 2009, Turkey extended the smoke-free legislation to hospitality venues. Compliance, however, remains low in some hospitality venues. We identified characteristics associated with knowledge of health effects that can be prevented by the smoke-free law, the attitude towards and enforcement of the law. METHODS In 2014, we conducted 400 interviews with hospitality venue owners and employees in 7 cities in Turkey. The venues were identified based on a random sampling strategy in a previous phase of the study. RESULTS Over one-third (37.3%) of hospitality owners and employees had adequate knowledge of the health effects from secondhand smoke (SHS), 71.3% had a positive attitude towards the law and 19.5% had personally enforced the law. Participants who worked 70 hours or more per week were more likely to have a positive attitude towards the law. Older individuals, women, participants working in bars/nightclubs, venue owners receiving fines for non-compliance and current smokers were less likely to have a positive attitude towards the law. Participants working in traditional coffee houses, former smokers, and participants with a high school education or greater were more likely to enforce the law. Smokers who quit or reduced smoking because of the law were more likely to enforce the law compared with those who were not influenced by the law. CONCLUSIONS Although the attitude towards the law was positive, interventions are needed to increase knowledge on the health effects of SHS and facilitate enforcement of the law, particularly among subgroups less likely to have a positive attitude and enforce the law.
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Affiliation(s)
- Angela Aherrera
- Department of Environmental Health Sciences, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Asli Çarkoğlu
- Department of Psychology, Kadir Has University, Istanbul, Turkey
| | - Mutlu Hayran
- Department of Preventive Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Gül Ergör
- Izmir Dokuz Eylül School of Medicine, Izmir, Turkey
| | - Toker Eirüder
- World Health Organization Country Office, Ankara, Turkey
| | - Bekir Kaplan
- Ministry of Health, General Directorate of Health Research, Ankara, Turkey
| | - Jolie Susan
- Department of Environmental Health Sciences, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.,Institute for Global Tobacco Control, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Laura Zheng
- Department of Environmental Health Sciences, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Joanna E Cohen
- Institute for Global Tobacco Control, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ana Navas-Acien
- Department of Environmental Health Sciences, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.,Institute for Global Tobacco Control, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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32
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Pepper JK, Ribisl KM, Brewer NT. Adolescents' interest in trying flavoured e-cigarettes. Tob Control 2016; 25:ii62-ii66. [PMID: 27633762 DOI: 10.1136/tobaccocontrol-2016-053174] [Citation(s) in RCA: 165] [Impact Index Per Article: 20.6] [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: 05/17/2016] [Revised: 06/30/2016] [Accepted: 07/07/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND More US adolescents use e-cigarettes than smoke cigarettes. Research suggests flavoured e-cigarettes appeal to youth, but little is known about perceptions of and reasons for attraction to specific flavours. METHODS A national sample of adolescents (n=1125) ages 13-17 participated in a phone survey from November 2014 to June 2015. We randomly assigned adolescents to respond to survey items about 1 of 5 e-cigarette flavours (tobacco, alcohol, menthol, candy or fruit) and used regression analysis to examine the impact of flavour on interest in trying e-cigarettes and harm beliefs. RESULTS Adolescents were more likely to report interest in trying an e-cigarette offered by a friend if it were flavoured like menthol (OR=4.00, 95% CI 1.46 to 10.97), candy (OR=4.53, 95% CI 1.67 to 12.31) or fruit (OR=6.49, 95% CI 2.48 to 17.01) compared with tobacco. Adolescents believed that fruit-flavoured e-cigarettes were less harmful to health than tobacco-flavoured e-cigarettes (p<0.05). Perceived harm mediated the relationship between some flavours and interest in trying e-cigarettes. A minority of adolescents believed that e-cigarettes did not have nicotine (14.6%) or did not know whether they had nicotine (3.6%); these beliefs did not vary by flavour. DISCUSSION Candy-flavoured, fruit-flavoured and menthol-flavoured e-cigarettes appeal to adolescents more than tobacco-flavoured or alcohol-flavoured e-cigarettes. This appeal is only partially explained by beliefs about reduced harm. Given adolescents' interest in trying e-cigarettes with certain flavours, policymakers should consider restricting advertisements promoting flavoured products in media that reach large numbers of young people. Future research should examine other reasons for the appeal of individual flavours, such as novelty and perceived luxury.
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Affiliation(s)
- J K Pepper
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA.,RTI International, Research Triangle Park, North Carolina, USA
| | - K M Ribisl
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - N T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
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Petrescu DC, Vasiljevic M, Pepper JK, Ribisl KM, Marteau TM. What is the impact of e-cigarette adverts on children's perceptions of tobacco smoking? An experimental study. Tob Control 2016; 26:421-427. [PMID: 27601455 PMCID: PMC5520264 DOI: 10.1136/tobaccocontrol-2016-052940] [Citation(s) in RCA: 30] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 06/19/2016] [Accepted: 07/08/2016] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Exposure to e-cigarette adverts increases children's positive attitudes towards using them. Given the similarity in appearance between e-cigarettes and tobacco cigarettes, we examined whether exposure to e-cigarette adverts has a cross-product impact on perceptions and attitudes towards smoking tobacco cigarettes. METHODS Children aged 11-16 (n=564) were interviewed in their homes and randomised to one of three groups: two groups saw different sets of 10 images of e-cigarette adverts and one group saw no adverts. Of the 20 e-cigarette adverts, 10 depicted the product as glamorous and 10 depicted it as healthy. The children then self-completed a questionnaire assessing perceived appeal, harms and benefits of smoking tobacco cigarettes. RESULTS The analyses were conducted on 411 children who reported never having smoked tobacco cigarettes or used e-cigarettes. Exposure to the adverts had no impact on the appeal or perceived benefits of smoking tobacco cigarettes. While the perceived harm of smoking more than 10 cigarettes per day was similar across groups, those exposed to either set of adverts perceived the harms of smoking one or two tobacco cigarettes occasionally to be lower than those in the control group. CONCLUSIONS This study provides the first evidence that exposure to e-cigarette adverts might influence children's perceptions of smoking tobacco cigarettes, reducing their perceived harm of occasional smoking. These results suggest the potential for e-cigarette adverts to undermine tobacco control efforts by reducing a potential barrier (ie, beliefs about harm) to occasional smoking.
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Affiliation(s)
- D C Petrescu
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - M Vasiljevic
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - J K Pepper
- Department of Health Behaviour, UNC Gillings School of Global Public Health, Cambridge, UK.,RTI International, Research Triangle Park, North Carolina, USA
| | - K M Ribisl
- Department of Health Behaviour, UNC Gillings School of Global Public Health, Cambridge, UK.,Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, North Carolina, USA
| | - T M Marteau
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
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Abstract
BACKGROUND Although roll-your-own (RYO) tobacco often elicits negative connotations of a lower class product, uptake and use by young adult smokers has grown because RYO is more cost-effective than tailor-made (TM) cigarettes. We explored the practices and beliefs young adults develop to distance themselves from unattractive stereotypes of RYO smokers. METHODS We conducted 20 in-depth interviews with New Zealand young adult RYO users aged between 18 and 30 years, and used thematic analysis to interpret the transcripts. RESULTS We identified three themes: establishing the superiority of RYO tobacco; creating and enacting usage rituals, and ritual disruption. Participants regarded RYO tobacco as more natural and better-tasting; they used it to control their tobacco use and facilitate interactions with others. Many described rolling rituals where they used specific artefacts and microbehaviours to construct cigarettes they saw as personal and artisanal. Several, though not all, disliked unattractively coloured papers as these disrupted the value their rituals created. CONCLUSIONS Young adults imbue RYO tobacco with positive attributes, many of which centre on rolling rituals or draw on widely held misperceptions of RYO tobacco as less harmful. Excise tax increases could counter perceptions of RYO as more cost-effective while mandating that dissuasively coloured paper could disrupt reduced-harm connotations. However, evidence that erroneous harm beliefs are widespread and entrenched may justify restricting or eliminating the key artefact-the product itself.
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Affiliation(s)
- Janet Hoek
- Department of Marketing, University of Otago, Dunedin, New Zealand
| | - Shelagh Ferguson
- Department of Marketing, University of Otago, Dunedin, New Zealand
| | - Erin Court
- Department of Marketing, University of Otago, Dunedin, New Zealand
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Affiliation(s)
- Naphtali Offen
- Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Elizabeth A Smith
- Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Bob Gordon
- California LGBT Tobacco Education Partnership, San Francisco, California, USA
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Kushnir V, Sproule BA, Zawertailo L, Selby P, Tyndale RF, Leatherdale ST, Cunningham JA. Impact of self-reported lifetime depression or anxiety on effectiveness of mass distribution of nicotine patches. Tob Control 2016; 26:526-533. [PMID: 27543563 DOI: 10.1136/tobaccocontrol-2016-052994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 02/18/2016] [Accepted: 08/02/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND Large-scale public health initiatives providing free nicotine replacement therapy have been shown to increase smoking cessation rates; however, their effectiveness among the highly prevalent population of smokers with depression and anxiety disorders has not been explored. The aim of this study was to investigate the influence of lifetime history of depression or anxiety on smoking cessation success following the free distribution of nicotine patches. METHOD In the context of a randomised controlled trial, a secondary analysis was conducted on 1000 adult regular smokers randomised to be mailed a 5-week supply of nicotine patches or to a no intervention control group. Participants were divided into subgroups based on the presence of self-reported lifetime diagnosis of depression and anxiety. RESULTS Irrespective of self-reported lifetime history of depression or anxiety, odds of self-reported cessation at 6 months were significantly greater among groups receiving nicotine patches compared to no intervention control (no history of depression or anxiety: OR 2.20; 95% CI 1.05 to 4.63; history of depression or anxiety present: OR 3.90; 95% CI 1.28 to 11.88). Among nicotine patch recipients only, quit outcomes did not differ between those with and without self-reported lifetime depression or anxiety in models unadjusted and adjusted for differences in demographic and smoking characteristics. CONCLUSIONS The mass distribution of free nicotine patches (without behavioural support) is effective among smokers with or without lifetime history of depression or anxiety alike, providing further support for the adoption of similar initiatives as a means of promoting tobacco cessation on a population level. TRIAL REGISTRATION NUMBER NCT01429129, Post-results.
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Affiliation(s)
- Vladyslav Kushnir
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Pharmaceutical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Beth A Sproule
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Pharmaceutical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Laurie Zawertailo
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Peter Selby
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rachel F Tyndale
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Scott T Leatherdale
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - John A Cunningham
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,National Institute for Mental Health Research, Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
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Wills TA, Sargent JD, Gibbons FX, Pagano I, Schweitzer R. E-cigarette use is differentially related to smoking onset among lower risk adolescents. Tob Control 2016; 26:534-539. [PMID: 27543564 DOI: 10.1136/tobaccocontrol-2016-053116] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [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: 04/11/2016] [Revised: 07/18/2016] [Accepted: 08/02/2016] [Indexed: 12/24/2022]
Abstract
OBJECTIVE E-cigarette use has been linked to onset of cigarette smoking among adolescents, but some commentators have suggested that this simply reflects high-risk adolescents being more likely to use e-cigarettes and to smoke. We tested whether the effect of e-cigarette use for smoking onset differs for youth who are lower versus higher on propensity to smoke. METHODS School-based survey with a longitudinal sample of 1136 students (9th-11th graders, mean age 14.7 years) in Hawaii, initially surveyed in 2013 (T1) and followed up 1 year later (T2). We assessed e-cigarette use, propensity to smoke based on 3 psychosocial factors known to predict smoking (rebelliousness, parental support and willingness to smoke), and cigarette smoking status. Analyses based on T1 never-smokers tested the relation of T1 e-cigarette use to T2 smoking status for participants lower versus higher on T1 propensity to smoke. RESULTS The relation between T1 e-cigarette use and T2 smoking onset was stronger among participants with lower levels of rebelliousness and willingness and higher levels of parental support. A multiple logistic regression analysis with T2 smoking as the criterion tested the cross-product of T1 e-cigarette use and T1 smoking propensity score; the interaction (OR=0.88, p=0.01) indicated a significantly larger effect for smoking onset among lower risk youth. CONCLUSIONS The results indicate e-cigarette use is a risk factor for smoking onset, not just a marker of high risk for smoking. This study provides evidence that e-cigarettes are recruiting lower risk adolescents to smoking, which has public health implications.
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Affiliation(s)
- Thomas A Wills
- University of Hawaii, Cancer Center, Honolulu, Hawaii, USA
| | - James D Sargent
- Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Frederick X Gibbons
- Center for Health, Intervention & Prevention, University of Connecticut, Storrs, Connecticut, USA
| | - Ian Pagano
- University of Hawaii, Cancer Center, Honolulu, Hawaii, USA
| | - Rebecca Schweitzer
- Office of Public Health Studies, University of Hawaii at Manoa, Honolulu, Hawaii, USA
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Wang L, Lu B, Wewers ME, Foraker RE, Xie M, Ferketich AK. Are retailers compliant with zoning regulations that ban tobacco sales near schools in Changsha, China? Tob Control 2016; 26:446-451. [PMID: 27457789 DOI: 10.1136/tobaccocontrol-2015-052787] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 10/24/2015] [Revised: 05/16/2016] [Accepted: 06/06/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND Tobacco retail sales are prohibited within 100 m of schools in many large cities in China. However, little is known about the enforcement of this zoning regulation. The objectives of this study were to estimate tobacco retailers' compliance with the regulation, examine the density of tobacco retail stores, describe the types of tobacco products sold in stores and how they are marketed, and determine if there are displays of warning messages in retail stores around schools and in neighbourhoods in Changsha, China. METHODS Tobacco retail stores located within 200 m of 36 schools and 36 residential neighbourhoods were audited by trained students with a validated audit form. RESULTS On average, there were about 3 tobacco retail stores within 100 m of the front entrance of schools. The density of the stores and the types of tobacco products sold in the stores were similar near schools and in neighbourhoods. Over one-fourth of the stores had exterior tobacco advertisements. Interior advertising was slightly less prevalent, and it was most prevalent among tobacco shops (62.5%). Tobacco displays that target children were pervasive, with about 83% of tobacco retail stores displaying cigarettes within 1 m of the floor and 59% displaying cigarettes within 0.3 m of toys and candy. About 40% of stores within 100 m of a school had a visible retail licence. Only 19.6% of the stores had a 'smoke-free' sign and 22.2% had a 'no sales to minors' sign. CONCLUSIONS We observed low enforcement of the regulation that bans tobacco retail sales near schools and high prevalence of tobacco displays that target children in Changsha, China. Chinese officials should act to effectively enforce the regulation bans of tobacco sales near schools. In addition, regulations are urgently needed to limit tobacco marketing practices at the point of sale, especially those targeting youth.
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Affiliation(s)
- Ling Wang
- Nationwide Children's Hospital, Data Resource Center, Columbus, Ohio, USA
| | - Bo Lu
- Division of Biostatistics, The Ohio State University College of Public Health, Columbus, Ohio, USA
| | - Mary Ellen Wewers
- Division of Health Behavior and Health Promotion, The Ohio State University College of Public Health, Columbus, Ohio, USA.,Division of Epidemiology, The Ohio State University College of Public Health, Columbus, Ohio, USA
| | - Randi E Foraker
- Division of Epidemiology, The Ohio State University College of Public Health, Columbus, Ohio, USA
| | - Mengyao Xie
- Hunan University School of Economics and Trade, Changsha, Hunan, China
| | - Amy K Ferketich
- Division of Epidemiology, The Ohio State University College of Public Health, Columbus, Ohio, USA
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Williams RS, Derrick J, Phillips KJ. Cigarette sales to minors via the internet: how the story has changed in the wake of federal regulation. Tob Control 2016; 26:415-420. [PMID: 27413060 DOI: 10.1136/tobaccocontrol-2015-052844] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [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: 11/23/2015] [Accepted: 06/22/2016] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To assess how easily minors can purchase cigarettes online and online cigarette vendors' compliance with federal age/ID verification and shipping regulations, North Carolina's 2013 tobacco age verification law, and federal prohibitions on the sale of non-menthol flavoured cigarettes or those labelled or advertised as 'light'. METHODS In early 2014, 10 minors aged 14-17 attempted to purchase cigarettes by credit card and electronic check from 68 popular internet vendors. RESULTS Minors received cigarettes from 32.4% of purchase attempts, all delivered by the US Postal Service (USPS) from overseas sellers. None failed due to age/ID verification. All failures were due to payment processing problems. USPS left 63.6% of delivered orders at the door with the remainder handed to minors with no age verification. 70.6% of vendors advertised light cigarettes and 60.3% flavoured, with 23.5% and 11.8%, respectively, delivered to the teens. Study credit cards were exposed to an estimated $7000 of fraudulent charges. CONCLUSIONS Despite years of regulations restricting internet cigarette sales, poor vendor compliance and lack of shipper and federal enforcement leaves minors still able to obtain cigarettes (including 'light' and flavoured) online. The internet cigarette marketplace has shifted overseas, exposing buyers to widespread credit card fraud. Federal agencies should rigorously enforce existing internet cigarette sales laws to prevent illegal shipments from reaching US consumers, shut down non-compliant and fraudulent websites, and stop the theft and fraudulent use of credit card information provided online. Future studies should assess whether these agencies begin adequately enforcing the existing laws.
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Affiliation(s)
- Rebecca S Williams
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jason Derrick
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - K Jean Phillips
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Edwards R, Ajmal A, Healey B, Hoek J. Impact of removing point-of-sale tobacco displays: data from a New Zealand youth survey. Tob Control 2016; 26:392-398. [PMID: 27377342 DOI: 10.1136/tobaccocontrol-2015-052764] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [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: 10/13/2015] [Accepted: 06/06/2016] [Indexed: 11/03/2022]
Abstract
INTRODUCTION The tobacco industry increasingly invests in point-of-sale (POS) marketing. In July 2012, New Zealand required the removal of POS tobacco displays concurrently with increased enforcement and penalties for selling tobacco to minors, and additional restrictions on tobacco sponsorship. We evaluated the impact of these measures using a before-after study. METHODS We analysed data from annual surveys of more than 25 000 year 10 (14-15 years) students from 2007 and 2011 to 2014. Measures included prevalence of smoking-related behaviours and strength of association between visiting tobacco-retailing stores and smoking behaviours. RESULTS Between 2011 and 2014, smoking experimentation (had smoked ever but smoked less than monthly currently) decreased from 23% in 2011 to 17% in 2014 (adjusted odds ratio (aOR) 0.73, 95% CI 0.69 to 0.78); current smoking (at least monthly) prevalence from 9% to 7% (aOR 0.71, 0.64 to 0.79) and initiation in the last year from 13% to 11% (aOR 0.91, 0.84 to 0.98). Attempted purchase of cigarettes in the past 30 days among smokers decreased from 30% in 2012 to 26% in 2013 (aOR 0.77, 0.63 to 0.91). Positive associations between frequency of visiting tobacco-retailing stores and smoking-related behaviours weakened post-implementation. CONCLUSIONS The introduction of a POS display ban and concurrent measures was followed by significant reductions in initiation, experimental and regular smoking, attempted purchase of cigarettes, and reduced association between visiting tobacco-retailing stores and smoking behaviours. The findings suggest that POS display bans are important components of strategies to reduce smoking initiation among youth and young people.
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Affiliation(s)
- Richard Edwards
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Ali Ajmal
- Action on Smoking and Health (ASH), Auckland, New Zealand
| | - Benjamin Healey
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Janet Hoek
- Department of Marketing, University of Otago, Dunedin, New Zealand
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DeLong H, Chriqui J, Leider J, Chaloupka FJ. Common state mechanisms regulating tribal tobacco taxation and sales, the USA, 2015. Tob Control 2016; 25:i32-i37. [PMID: 27354677 PMCID: PMC5099202 DOI: 10.1136/tobaccocontrol-2016-053079] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 03/29/2016] [Accepted: 05/26/2016] [Indexed: 11/12/2022]
Abstract
Background Native American tribes, as sovereign nations, are exempt from state tobacco excise taxation, and self-govern on-reservation activity in the USA. Under Federal law, state excise taxes are owed by non-members purchasing tobacco on tribal land, but states are limited in how they enforce or collect these taxes. This study highlights the various policy approaches that states have taken to regulate tobacco sales on tribal lands given jurisdictional challenges. Methods State laws (statutes, regulations and case law), Attorney General opinions, and revenue notices and rulings effective as of 1 January 2015 for all 50 states and the District of Columbia were compiled using Boolean searches in Lexis-Nexis and Westlaw. Laws were limited to those addressing taxation compacts or tobacco sales involving tribal entities. Master Settlement Agreement laws and non-codified tribal codes/compacts were excluded. Results Twenty of the 34 states with tribal lands address tribal tobacco sales. Fourteen states address intergovernmental compacts: 11 are tobacco specific, and suggest or require specific provisions. Fifteen states address tribal tax stamps: 2 explicitly prohibit stamping tribally sold products, 9 stamp all products, and 4 stamp some. Prepayment of excise tax is required in 12 states: 6 on all products, 4 on products in excess of quota, and 2 on products sold by non-tribal retailers. 6 states use quotas to limit tax-free tobacco available to tribes. Conclusions Many states with a tribal presence have no formal strategies for non-members purchasing tobacco on tribal lands. Formalising policies and harmonising tax rates may assist states in collecting tax revenue from non-tribal consumers.
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Affiliation(s)
- Hillary DeLong
- Health Policy Center, Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Jamie Chriqui
- Health Policy Center, Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois, USA Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Julien Leider
- Health Policy Center, Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Frank J Chaloupka
- Health Policy Center, Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois, USA Department of Economics, University of Illinois at Chicago, Chicago, Illinois, USA
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Mullen KA, Manuel DG, Hawken SJ, Pipe AL, Coyle D, Hobler LA, Younger J, Wells GA, Reid RD. Effectiveness of a hospital-initiated smoking cessation programme: 2-year health and healthcare outcomes. Tob Control 2016; 26:293-299. [PMID: 27225016 PMCID: PMC5543264 DOI: 10.1136/tobaccocontrol-2015-052728] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 04/20/2016] [Indexed: 11/23/2022]
Abstract
Background Tobacco-related illnesses are leading causes of death and healthcare use. Our objective was to determine whether implementation of a hospital-initiated smoking cessation intervention would reduce mortality and downstream healthcare usage. Methods A 2-group effectiveness study was completed comparing patients who received the ‘Ottawa Model’ for Smoking Cessation intervention (n=726) to usual care controls (n=641). Participants were current smokers, >17 years old, and recruited during admission to 1 of 14 participating hospitals in Ontario, Canada. Baseline data were linked to healthcare administrative data. Competing-risks regression analysis was used to compare outcomes between groups. Results The intervention group experienced significantly lower rates of all-cause readmissions, smoking-related readmissions, and all-cause emergency department (ED) visits at all time points. The largest absolute risk reductions (ARR) were observed for all-cause readmissions at 30 days (13.3% vs 7.1%; ARR, 6.1% (2.9% to 9.3%); p<0.001), 1 year (38.4% vs 26.7%; ARR, 11.7% (6.7% to 16.6%); p<0.001), and 2 years (45.2% vs 33.6%; ARR, 11.6% (6.5% to 16.8%); p<0.001). The greatest reduction in risk of all-cause ED visits was at 30 days (20.9% vs 16.4%; ARR, 4.5% (0.4% to 8.7%); p=0.03). Reduction in mortality was not evident at 30 days, but significant reductions were observed by year 1 (11.4% vs 5.4%; ARR 6.0% (3.1% to 9.0%); p<0.001) and year 2 (15.1% vs 7.9%; ARR, 7.3% (3.9% to 10.7%); p<0.001). Conclusions Considering the relatively low cost, greater adoption of hospital-initiated tobacco cessation interventions should be considered to improve patient outcomes and decrease subsequent healthcare usage.
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Affiliation(s)
- Kerri A Mullen
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | | | - Andrew L Pipe
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | - Laura A Hobler
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Jaime Younger
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - George A Wells
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Robert D Reid
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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Campbell KA, Cooper S, Fahy SJ, Bowker K, Leonardi-Bee J, McEwen A, Whitemore R, Coleman T. 'Opt-out' referrals after identifying pregnant smokers using exhaled air carbon monoxide: impact on engagement with smoking cessation support. Tob Control 2016; 26:300-306. [PMID: 27225017 PMCID: PMC5520259 DOI: 10.1136/tobaccocontrol-2015-052662] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [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: 08/18/2015] [Accepted: 04/20/2016] [Indexed: 11/22/2022]
Abstract
Background In the UK, free smoking cessation support is available to pregnant women; only a minority accesses this. ‘Opt-out’ referrals to stop smoking services (SSS) are recommended by UK guidelines. These involve identifying pregnant smokers using exhaled carbon monoxide (CO) and referring them for support unless they object. Methods To assess the impact of ‘opt-out’ referrals for pregnant smokers on SSS uptake and effectiveness, we conducted a ‘before–after’ service development evaluation. In the 6-month ‘before’ period, there was a routine ‘opt-in’ referral system for self-reported smokers at antenatal ‘booking’ appointments. In the 6-month ‘after’ period, additional ‘opt-out’ referrals were introduced at the 12-week ultrasound appointments; women with CO≥4 ppm were referred to, and outcome data were collected from, local SSS. Results Approximately 2300 women attended antenatal care in each period. Before the implementation, 536 (23.4%) women reported smoking at ‘booking’ and 290 (12.7%) were referred to SSS. After the implementation, 524 (22.9%) women reported smoking at ‘booking’, an additional 156 smokers (6.8%) were identified via the ‘opt-out’ referrals and, in total, 421 (18.4%) were referred to SSS. Over twice as many women set a quit date with the SSS after ‘opt-out’ referrals were implemented (121 (5.3%, 95% CI 4.4% to 6.3%) compared to 57 (2.5%, 95% CI 1.9% to 3.2%) before implementation) and reported being abstinent 4 weeks later (93 (4.1%, 95% CI 3.3% to 4.9%) compared to 46 (2.0%, 1.5% to 2.7%) before implementation). Conclusions In a hospital with an ‘opt-in’ referral system, adding CO screening with ‘opt-out’ referrals as women attended ultrasound examinations doubled the numbers of pregnant smokers setting quit dates and reporting smoking cessation.
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Affiliation(s)
- Katarzyna A Campbell
- Division of Primary Care, School of Medicine, UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Nottingham, UK
| | - Sue Cooper
- Division of Primary Care, School of Medicine, UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Nottingham, UK
| | - Samantha J Fahy
- Division of Primary Care, School of Medicine, UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Nottingham, UK
| | - Katharine Bowker
- Division of Primary Care, School of Medicine, UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Nottingham, UK
| | - Jo Leonardi-Bee
- Division of Epidemiology and Public Health, School of Medicine, UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Nottingham, UK
| | - Andy McEwen
- National Centre for Smoking Cessation and Training (NCSCT), London, UK
| | - Rachel Whitemore
- Division of Primary Care, School of Medicine, UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Nottingham, UK
| | - Tim Coleman
- Division of Primary Care, School of Medicine, UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Nottingham, UK
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Basaza R, Otieno E, Musinguzi A, Mugyenyi P, Haddock CK. Factors influencing cigarette smoking among soldiers and costs of soldier smoking in the work place at Kakiri Barracks, Uganda. Tob Control 2016; 26:330-333. [PMID: 27165996 DOI: 10.1136/tobaccocontrol-2015-052878] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 12/09/2015] [Accepted: 04/20/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND Although Uganda has a relatively low prevalence of smoking, no data exists on cigarette use among military personnel. Studies in other countries suggests military service is a risk factor for tobacco use. OBJECTIVES To assess prevalence and risk factors for and costs of smoking among military personnel assigned to a large military facility in Uganda. DESIGN A mixed methods study including focus groups, interviews and a cross-sectional survey of military personnel. SETTING Kakiri Barracks, Uganda. SUBJECTS Key informants and focus group participants were purposively selected based on the objectives of the study, military rank and job categories. A multistage sample design was used to survey individuals serving in Uganda People's Defense Forces (UPDF) from June to November 2014 for the survey (n=310). RESULTS Participants in the qualitative portion of the study reported that smoking was harmful to health and the national economy and that its use was increasing among UPDF personnel. Survey results suggested that smoking rates in the military were substantially higher than in the general public (ie, 34.8% vs 5.3%). Significant predictors of smoking included lower education, younger age, having close friends who smoked and a history of military deployment. Estimated costs of smoking due to lost productivity was US$576 229 and US$212 400 for excess healthcare costs. CONCLUSIONS Smoking rates are substantially higher in the UPDF compared to the general public and results in significant productivity costs. Interventions designed to reduce smoking among UPDF personnel should be included in the country's national tobacco control plan.
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Affiliation(s)
- Robert Basaza
- International Health Sciences University Kampala, Kampala, Uganda.,School of Medicine Makerere University Kampala, Kampala, Uganda
| | - Emmanuel Otieno
- International Health Sciences University Kampala, Kampala, Uganda.,Uganda Peoples Defense Forces, Kampala, Uganda
| | | | - Possy Mugyenyi
- Centre for Tobacco Control in Africa Makerere University School of Public Health Kampala, Kampala, Uganda
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Poston WSC, Haddock CK, Jahnke SA, Jitnarin N, Malone RE, Smith EA. Perspectives of US military commanders on tobacco use and tobacco control policy. Tob Control 2016; 26:254-259. [PMID: 27084960 DOI: 10.1136/tobaccocontrol-2015-052829] [Citation(s) in RCA: 6] [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] [Received: 11/16/2015] [Accepted: 03/28/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND Tobacco use among members of the US military service is unacceptably high, resulting in substantial healthcare and personnel costs. Support of military command is critical to the success of tobacco control policies because line commanders are responsible for implementation and enforcement. This study is the first to examine US military line commanders' perspectives about current tobacco control policies and the impact of tobacco on readiness. METHODS We conducted key-informant interviews with 20 officers at the US Army's Command and General Staff College about military tobacco use and tobacco control policy. RESULTS Participants identified the long-term impact of tobacco use on military members, but were unaware of proximal effects on health and readiness other than lost productivity due to smoke breaks. Officers also discussed nicotine addiction and the logistics of ensuring that an addicted population had access to tobacco. Regarding policy, most knew about regulations governing smoke-free areas and were open to stronger restrictions, but were unaware of current policies governing prevention, intervention and product sales. CONCLUSIONS Findings suggest that strong policy that takes advantage of the hierarchical and disciplined nature of the military, supported by senior line and civilian leadership up to and including the secretaries of the services and the Secretary of Defense, will be critical to substantially diminishing tobacco use by military personnel.
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Affiliation(s)
- Walker S C Poston
- NDRI: National Development and Research Institutes, Inc., Institute for Biobehavioral Health Research, Leawood, Kansas, USA
| | - Christopher K Haddock
- NDRI: National Development and Research Institutes, Inc., Institute for Biobehavioral Health Research, Leawood, Kansas, USA
| | - Sara A Jahnke
- NDRI: National Development and Research Institutes, Inc., Institute for Biobehavioral Health Research, Leawood, Kansas, USA
| | - Nattinee Jitnarin
- NDRI: National Development and Research Institutes, Inc., Institute for Biobehavioral Health Research, Leawood, Kansas, USA
| | - Ruth E Malone
- Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Elizabeth A Smith
- Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
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Abstract
OBJECTIVE To explore the prevalence and sociodemographic makeup of smokers who do not self-identify as smokers (ie, phantom smokers) compared with self-identifying smokers in a sample of bar-going young adults aged 18-30 years to more accurately assess young adult prevalence of smoking and inform cessation message targeting. METHODS Cross-sectional surveys of smokers (n=3089) were conducted in randomly selected bars/nightclubs in seven US cities. Logistic regression models assessed associations between phantom smoking (past 30-day smoking and denial of being a smoker), tobacco and alcohol use behaviours (eg, social smoking, nicotine dependence, smoking while drinking, past 30-day alcohol use) and demographics. RESULTS Compared with smokers, phantom smokers were more likely to be college graduates (OR=1.43, 95% CI 1.03 to 1.98) and to identify themselves as social smokers (OR=1.60, 95% CI 1.27 to 2.12). Phantom smokers had lower odds of smoking while drinking (OR=0.28, 95% CI 0.25 to 0.32), being nicotine dependent (OR=0.36, 95% CI 0.22 to 0.76) and having quit for at least 1 day in the last year (OR=0.46, 95% CI 0.36 to 0.69) compared with smokers. CONCLUSIONS This research extends phantom smoking literature on college students to provide a broader picture of phantom smoking among young adults in high-risk contexts and of varying levels of educational attainment. Phantom smokers may be particularly sensitive to social pressures against smoking, suggesting the importance of identifying smoking as a behaviour (rather than identity) in cessation messaging to ensure that phantom smokers are reached.
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Affiliation(s)
- Jamie Guillory
- RTI International, Research Triangle Park, North Carolina, USA
| | - Nadra Lisha
- Cardiovascular Research Institute, University of California, San Francisco, San Francisco, California, USA
| | - Youn Ok Lee
- RTI International, Research Triangle Park, North Carolina, USA
| | - Pamela M Ling
- Cardiovascular Research Institute, University of California, San Francisco, San Francisco, California, USA
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Abstract
INTRODUCTION The availability of flavoured tobacco products is associated with increased initiation and youth smoking. New York City prohibited all sales of flavoured cigars, cigarillos, little cigars, chew, snuff, snus, tobacco, pipe tobacco, roll-your-own tobacco, and dissolvables, excluding menthol, in October 2009; enforcement began in November 2010. This paper describes the sales ban evaluation. METHODS Data on retail tobacco sales of cigars, smokeless and other tobacco products such as pipe tobacco and roll-your-own, were analysed using interrupted time series methods, estimating changes in flavoured and non-flavoured tobacco product inflation-adjusted dollar sales overall, and by product type. Changes in ever use of flavoured tobacco products, any tobacco product use, and smoking prevalence among adolescents were estimated using multivariable logistic regression. RESULTS Sales of flavoured tobacco products declined overall (87%; p<0.001), and for flavoured cigars (86%; p<0.001) and flavoured pipe and roll-your-own (91%; p<0.001) following ban enforcement, while non-flavoured sales increased for cigars (5%; p=0.003) and pipe and roll-your-own (4%, p=0.030). In adjusted models, teens in 2013 had 37% lower odds of ever trying flavoured tobacco products (p<0.001), 28% lower odds of using any type of tobacco product (p=0.025), and a non-significant change in current smoking prevalence (p=0.114) compared with teens in 2010. CONCLUSIONS Flavoured tobacco product sales and odds of ever using flavoured tobacco products or using any tobacco products among teens declined significantly after ban enforcement began. Collectively these findings demonstrate significant evidence that the flavoured tobacco products sales ban was successful in New York City, and could succeed elsewhere.
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Affiliation(s)
- Shannon M Farley
- New York City Department of Health and Mental Hygiene, Bureau of Chronic Disease Prevention and Tobacco Control, Long Island City, New York, USA
| | - Michael Johns
- New York City Department of Health and Mental Hygiene, Bureau of Chronic Disease Prevention and Tobacco Control, Long Island City, New York, USA
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48
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Abstract
OBJECTIVE While flavoured cigarettes were prohibited in the USA in 2009, flavoured little cigars and cigarillos (LCCs) remain on the market. We describe the evolving strategies used by tobacco companies to encourage uptake of flavoured LCCs and industry research findings on consumer perceptions of flavoured LCC products. METHODS Analysis of internal tobacco industry documents was triangulated with data from tobacco advertisement archives, national newspapers, trade press and the internet. RESULTS Flavoured LCC products were associated with young and inexperienced tobacco users, women and African-Americans. Internal industry studies confirmed that menthol and candy-like flavours (eg, vanilla and cherry) increased LCC appeal to starters by masking the heavy cigar taste, reducing throat irritation and making LCC smoke easier to inhale. To appeal to new users, manufacturers also reduced the size of cigars to make them more cigarette-like, introduced filters and flavoured filter tips, emphasised mildness and ease of draw in advertising, and featured actors using little cigars in television commercials. RJ Reynolds tried to capitalise on the popularity of menthol cigarettes among African-Americans and marketed a menthol little cigar to African-Americans. CONCLUSIONS Tobacco companies engaged in a calculated effort to blur the line between LCCs to increase the appeal to cigarette smokers, and the use of flavours facilitated these efforts. Bans on flavoured cigarettes should be expanded to include flavoured LCCs, and tobacco use prevention initiatives should include LCCs.
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Affiliation(s)
- Ganna Kostygina
- Center for Tobacco Control Research and Education, UCSF, San Francisco, California, USA
| | - Stanton A Glantz
- Center for Tobacco Control Research and Education, UCSF, San Francisco, California, USA Department of Medicine, Division of Cardiology, UCSF, San Francisco, California, USA
| | - Pamela M Ling
- Center for Tobacco Control Research and Education, UCSF, San Francisco, California, USA Department of Medicine, Division of General Internal Medicine, UCSF, San Francisco, California, USA
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Northrup TF, Khan AM, Jacob P, Benowitz NL, Hoh E, Hovell MF, Matt GE, Stotts AL. Thirdhand smoke contamination in hospital settings: assessing exposure risk for vulnerable paediatric patients. Tob Control 2015; 25:619-623. [PMID: 26635031 DOI: 10.1136/tobaccocontrol-2015-052506] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [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: 06/03/2015] [Accepted: 10/07/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND Tobacco has regained the status of the world's number two killer behind heart/vascular disease. Thirdhand smoke (THS) residue and particles from secondhand smoke (SHS) are suspected health hazards (eg, DNA damage) that are likely to contribute to morbidity and mortality, especially in vulnerable children. THS is easily transported and deposited indoors, where it persists and exposes individuals for months, creating potential health consequences in seemingly nicotine-free environments, particularly for vulnerable patients. We collected THS data to estimate infant exposure in the neonatal ICU (NICU) after visits from household smokers. Infant exposure to nicotine, potentially from THS, was assessed via assays of infant urine. METHODS Participants were mothers who smoked and had an infant in the NICU (N=5). Participants provided surface nicotine samples from their fingers, infants' crib/incubator and hospital-provided furniture. Infant urine was analysed for cotinine, cotinine's major metabolite: trans-3'-hydroxycotinine (3HC) and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), a metabolite of the nicotine-derived and tobacco-specific carcinogen 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK). RESULTS Incubators/cribs and other furniture had detectable surface nicotine. Detectable levels of cotinine, 3HC and NNAL were found in the infants' urine. DISCUSSION THS appears to be ubiquitous, even in closely guarded healthcare settings. Future research will address potential health consequences and THS-reduction policies. Ultimately, hospital policies and interventions to reduce THS transport and exposure may prove necessary, especially for immunocompromised children.
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Affiliation(s)
- Thomas F Northrup
- Department of Family and Community Medicine, The University of Texas Health Science Center at Houston (UTHealth) Medical School, Houston, Texas, USA
| | - Amir M Khan
- Department of Pediatrics, UTHealth Medical School; Medical Director Level III NICU, Children's Memorial Hermann Hospital, Houston, Texas, USA
| | - Peyton Jacob
- Departments of Medicine and Psychiatry, University of California San Francisco; Division of Clinical Pharmacology, San Francisco General Hospital Medical Center, San Francisco, California, USA
| | - Neal L Benowitz
- Departments of Medicine and Bioengineering & Therapeutic Sciences, University of California San Francisco, San Francisco, California, USA
| | - Eunha Hoh
- Division of Environmental Health, Graduate School of Public Health, San Diego State University, San Diego, California, USA
| | - Melbourne F Hovell
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego, California, USA
| | - Georg E Matt
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Angela L Stotts
- Department of Family and Community Medicine, Department of Psychiatry and Behavioral Sciences, UTHealth Medical School, Houston, Texas, USA
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50
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Popova L, Linde BD, Bursac Z, Talcott GW, Modayil MV, Little MA, Ling PM, Glantz SA, Klesges RC. Testing antismoking messages for Air Force trainees. Tob Control 2015; 25:656-663. [PMID: 26482786 DOI: 10.1136/tobaccocontrol-2015-052477] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Revised: 09/25/2015] [Accepted: 09/28/2015] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Young adults in the military are aggressively targeted by tobacco companies and are at high risk of tobacco use. Existing antismoking advertisements developed for the general population might be effective in educating young adults in the military. This study evaluated the effects of different themes of existing antismoking advertisements on perceived harm and intentions to use cigarettes and other tobacco products among Air Force trainees. METHODS In a pretest-post-test experiment, 782 Airmen were randomised to view antismoking advertisements in 1 of 6 conditions: anti-industry, health effects+anti-industry, sexual health, secondhand smoke, environment+anti-industry or control. We assessed the effect of different conditions on changes in perceived harm and intentions to use cigarettes, electronic cigarettes, smokeless tobacco, hookah and cigarillos from pretest to post-test with multivariable linear regression models (perceived harm) and zero-inflated Poisson regression model (intentions). RESULTS Antismoking advertisements increased perceived harm of various tobacco products and reduced intentions to use. Advertisements featuring negative effects of tobacco on health and sexual performance coupled with revealing tobacco industry manipulations had the most consistent pattern of effects on perceived harm and intentions. CONCLUSIONS Antismoking advertisements produced for the general public might also be effective with a young adult military population and could have spillover effects on perceptions of harm and intentions to use other tobacco products besides cigarettes. Existing antismoking advertising may be a cost-effective tool to educate young adults in the military.
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Affiliation(s)
- Lucy Popova
- Center for Tobacco Control Research and Education, University of California, San Francisco, California, USA
| | - Brittany D Linde
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Zoran Bursac
- Division of Biostatistics, Department of Preventive Medicine, Center for Population Sciences, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - G Wayne Talcott
- Department of Preventive Medicine, Center for Population Sciences, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Mary V Modayil
- Institute for Population Health Improvement, University of California, Davis Medical Center, Sacramento, California, USA
| | - Melissa A Little
- Department of Preventive Medicine, Center for Population Sciences, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Pamela M Ling
- Division of General Internal Medicine, Department of Medicine, Center for Tobacco Control Research and Education, University of California, San Francisco, California, USA
| | - Stanton A Glantz
- Division of Cardiology, Department of Medicine, Center for Tobacco Control Research and Education, Cardiovascular Research Institute, University of California, San Francisco, California, USA
| | - Robert C Klesges
- Department of Preventive Medicine, Center for Population Sciences, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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