Determinants of smoking intensity in South Africa: Evidence from township communities

In order to analyze the smoking patterns in economically disadvantaged communities in South Africa, this paper examines the determinants of smoking intensity, using pooled data on price and non-price determinants of smoking from two cross-sectional surveys conducted in 2017 and 2018 to investigate the drivers of conditional cigarette demand among daily smokers. The analysis was done using a negative binomial regression. The results show that smokers reduce the number of cigarettes smoked daily when cigarette prices increase. The conditional price elasticity of cigarette demand of −0.295 for the overall sample shows that a 10% increase in cigarette price leads to a 2.95% decline in cigarette consumption among smokers. For young smokers, a 10% increase in cigarette price causes their smoking intensity to fall by 5%. Similar to other studies, the response of female smokers to cigarette price changes is statistically insignificant. Other factors affecting the conditional demand for cigarettes are education, race, single stick sales, gender, wealth, and age. We conclude that cigarette prices play a significant role in reducing smoking intensity among the South African poor. Since the magnitude of the price effect varies across age groups, races, and genders, the policy of higher tobacco excise taxes should be accompanied by interventions targeted at those less responsive to price-related measures.

Tobacco use and harm perceptions among Appalachian youth

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Over one-third had tried tobacco and over one-fifth had tried two or more products.

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Most participants recognized harms associated with conventional tobacco use.

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E-cigarettes were perceived as less harmful than conventional tobacco products.

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Smokers and polytobacco users had lower odds of indicating tobacco health risks.

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E-cigarette users were less likely to perceive e-cigarettes as harmful or addictive.

Appalachian youth tobacco use rates exceed the national average. Additional inquiry is needed to better understand youth product perceptions and use patterns. This study examined tobacco harm perceptions and their relationship with tobacco use among Appalachian youth. From 2014 to 2016, a survey of Appalachian middle and high school students (N = 1,136) was conducted. Tobacco harm perceptions were assessed by tobacco use status, categorized as never user, cigarette only user, smokeless only user, e-cigarette only user, or polytobacco user. Descriptive characteristics were compared by tobacco use status and harm perceptions. Adjusted multivariable logistic regression models assessed the relationship between tobacco use status and harm perceptions. Over one-third of participants were tobacco users (34.6%; 4.7% cigarette only users, 3.3% smokeless only users, 5.6% e-cigarette only users, and 21.0% polytobacco users). Approximately half agreed that e-cigarettes cause health problems (54.4%), and 64.7% agreed that e-cigarettes are addictive. Most participants (83.4–92.3%) agreed that smoking and smokeless tobacco cause health problems and are addictive. Tobacco users more often disagreed that tobacco products cause health problems than did never users. Compared to never users, e-cigarette only users were more likely to disagree that smoking (AOR: 2.99, 95% CI: 1.30–6.90) and e-cigarettes cause health problems (AOR: 2.79, 95% CI: 1.64–4.75) and that e-cigarettes cause addiction (AOR: 2.48, 95% CI: 1.48–4.16). Most youth were aware of health dangers associated with smoking, but perceptions were split on whether e-cigarettes were associated with health problems or addiction.

The findings indicate the need for additional youth tobacco use prevention efforts.

Determinants of Youth-Reported Past 30-Day Tobacco Use

The objective of this study was to utilize cross-sectional surveys to identify factors associated with past 30-day tobacco use among a sample youth and to determine whether regional differences exist. Data were obtained from the Virginia Youth Survey (2015 and 2017). Multinomial logistic regression models were used to examine associations between measures of past 30-day tobacco use and region, sex, grade, race/ethnicity, tobacco advertisement exposure, and presence of tobacco-free policies in the home and personal vehicles. These correlates were selected based upon existing literature on youth tobacco use. Past 30-day cigarette use, combustible tobacco use, non-combustible tobacco use, and dual product use were associated with region, sex, grade, and race/ethnicity. Specifically, youth residing in the Southwestern region of the state, males, and non-Hispanic White students and youth of other race/ethnicity were more likely to report past 30-day tobacco use. Additionally, higher levels of exposure to tobacco advertisements was also associated with past 30-day tobacco use. Future research needs to investigate the mechanisms by which youth tobacco use may differ by region, to help guide and target future policy and programming related to tobacco prevention and control at the local level.

Naturalistic measurement of dual cue attentional bias in moderate to heavy-drinking smokers: A preliminary investigation

INTRODUCTION

Although cigarettes and alcohol are frequently used together, few studies have evaluated evidence of attentional bias to both smoking and alcohol cues. Attentional bias (AB) is defined as preferential attention to drug-specific cues and is most often studied in a laboratory with one cue type. AB may be an important mechanism associated with cigarette and alcohol co-use. In this study, we evaluated AB to both smoking and alcohol cues in daily life using ambulatory assessment.

METHODS

Daily smokers (N = 21) who consume moderate to heavy amounts of alcohol completed surveys and a dot probe task four times per day using a personal digital assistant over a period of 1 week.

RESULTS

Aggregated over subjects, there was evidence of AB to smoking and AB to alcohol cues. When smoking AB was higher than the person-specific average, alcohol AB was elevated, and when alcohol AB was higher than the person-specific average, smoking AB was elevated. AB was not significantly associated with craving for cigarettes or alcohol.

CONCLUSIONS

It is feasible to assess AB for cigarette and alcohol cues using ambulatory assessment. To the best of our knowledge, this is the first study to report a within-subject association between AB for two drug cues. The relationship between cigarette and alcohol use is likely dynamic and depends on context and exposure to substance-specific cues. Additionally, a larger sample may be needed to evaluate relationships between AB and craving. Further research on possible cognitive mechanisms that increase the likelihood of co-use can inform targeted interventions.

Motivation to quit cigarettes and alternative tobacco products: prevalence and correlates among youth experiencing homelessness

Use of alternative tobacco products, as well as regular cigarettes, is widespread among unaccompanied youth experiencing homelessness. However, little is known about their level of motivation for quitting use of these products, factors associated with motivation to quit, or how these might vary by type of tobacco product. Unaccompanied homeless youth were sampled from 25 street and service sites in Los Angeles County (N = 469). All participants were past month tobacco users who completed a survey on their tobacco-related behaviors and cognitions, including motivation to quit, as well as background characteristics. Among self-reported users of each product, motivation to quit in the next 30 days was highest for regular cigarettes (33%), followed by e-cigarettes/vaporizers (30%), little cigars/cigarillos (25%), cigars (20%), and natural cigarettes (20%). Between 33 and 49% of youth, depending on product, were not thinking about quitting at all. Correlates of lower motivation to quit differed somewhat by product type, with the most consistent being race, more frequent use, lower perceived riskiness of the product, and using the product because of its good taste or smell. Results from this study identify a set of psychosocial and behavioral factors, some that are common across tobacco products and others that are product-specific, that may be particularly important to address in efforts to reduce tobacco use among youth experiencing homelessness. Future regulations on the sale of flavored tobacco products may also serve to increase motivation to quit in this population.

Understanding the Prevalence of Smoking Among People Living with HIV (PLHIV) in Australia and Factors Associated with Smoking and Quitting

Understanding contributors to smoking and quitting cigarettes is important to developing effective cessation programs and addressing smoking related morbidity and mortality among people living with HIV (PLHIV). Using data from a large cross-sectional study of Australian PLHIV we provide a smoking prevalence estimate and explore the relationship between socio-demographic variables and smoking status. We also explore the relationship between HIV diagnosis and antiretroviral therapy (ART) initiation and quitting smoking. Of the 1011 respondents included in the analysis, 30.6% were current smokers. The strongest predictor of smoking was regular cannabis use (AOR 6.2, 95% CI 3.6-10.8) while the strongest predictor of being a past smoker was receiving ART (AOR 2.4, 95% CI 1.2-4.7). Quitting also increased around the time of diagnosis and ART initiation, highlighting the potential for these events to be optimal times to address smoking among PLHIV.

Public and private religious involvement and initiation of alcohol, cigarette, and marijuana use in Black and White adolescent girls

PURPOSE

This longitudinal study aimed to identify variation by race in the associations between religious involvement and initiation of alcohol, cigarette, and marijuana use, including distinctions by substance or type of religious involvement, in Black and White adolescent girls.

METHODS

Data were drawn from interviews conducted at ages 11 through 17 with 2172 Pittsburgh Girls Study participants (56.8% Black; 43.2% White). Two indicators of public religious involvement, religious service attendance and participation in other religious activities, and two indicators of private religious involvement, prayer, and importance of religion were queried. A series of Cox proportional hazards regression analyses were conducted to identify independent effects of religious involvement indicators on initiation of each substance.

RESULTS

Prior to adjusting for socioenvironmental and psychosocial factors (e.g., parental monitoring), importance of religion predicted initiation of alcohol use across race and cigarette and marijuana use in White but not Black girls. Participation in other religious activities also predicted marijuana use initiation only in White girls. In adjusted models, importance of religion remained significant for cigarette use initiation in White girls (hazard ratio [HR] = 0.68, 95% confidence intervals [CI]: 0.53-0.88) and participation in other religious activities remained significant for marijuana use initiation in White girls (HR = 0.63, CI: 0.47-0.83).

CONCLUSIONS

The protective effects of religious involvement against cigarette and marijuana use initiation are more robust for White than Black adolescent girls and overall relatively weak for alcohol use initiation. Furthermore, importance placed on religion may be a better indicator than religious service attendance of risk for adolescent substance use initiation.

Do tobacco industry websites target content to specific demographic groups?

BACKGROUND

Prior research has not examined whether tobacco brand websites vary content based on audience demographics. This study explored whether marketing content on tobacco brand websites varied by user ethnicity, gender or age group.

METHODS

Participants (n = 32) were adult smokers, representing equal numbers of eight demographic groups: user ethnicity (Non-Hispanic White, Hispanic, African American, Asian), gender (women, men) and age (age 21-35, age 36+). This study examined 12 tobacco brand websites representing four tobacco product categories (cigarettes, cigar/cigarillos, smokeless tobacco, and e-cigarettes). From January 2016 to January 2017, participants coded websites for themes, interactive activities, and links to social media sites (n = 874 website visits). Logistic regression was used to analyze observed content by participant ethnicity, age and gender.

RESULTS

All themes, all interactive activities and all links to social media were observed at least once for each demographic category. Male participants were more likely to observe Harm reduction themes, while female participants were more likely to observe Promotion themes. Older participants were more likely to observe website features allowing them to select music, and request coupons. Compared to Non-Hispanic White participants, African American participants were more likely to observe links to social media sites.

CONCLUSION

Tobacco brand website content varied across ethnic, age and gender groups. These findings suggest that other factors, such as tobacco use behaviors, may influence marketing strategies participants recall or find appealing. The findings from this study can inform future regulatory activities and communication strategies aimed at countering pro-tobacco content online.

A text message intervention for quitting cigarette smoking among young adults experiencing homelessness: study protocol for a pilot randomized controlled trial

BACKGROUND

Cigarette smoking is much more prevalent among young people experiencing homelessness than in the general population of adolescents and young adults. Although many young homeless smokers are motivated to quit, there are no empirically-evaluated smoking cessation programs for this population. It is important that any such program address the factors known to be associated with quitting-related outcomes among homeless young people, to provide ongoing support in a way that accommodates the mobility of this population, and does not rely on scarce service provider resources for its delivery. The objective of this project is to develop and pilot test a text messaging-based intervention (TMI), as an adjunct to brief cessation counseling and provision of nicotine patches, to help homeless young people who want to quit smoking.

METHODS/DESIGN

This pilot study will utilize a cluster cross-over randomized controlled design with up to 80 current smokers who desire to quit and are recruited from three drop-in centers serving young people experiencing homelessness in the Los Angeles area. All participants will be provided with a minimum standard of care: a 30-min group-based smoking cessation counseling session and free nicotine replacement. Half of these smokers will then also receive the TMI, as an adjunct to this standard care, which will provide 6 weeks of ongoing support for quitting. This support includes continued and more intensive education regarding nicotine dependence, quitting smoking, and relapse; does not require additional agency resources; can be available "on demand" to users; and includes features to personalize the quitting experience. This study will investigate whether receiving the TMI adjunct to standard smoking cessation care results in greater reductions in cigarette smoking compared to standard care alone over a 3-month period.

DISCUSSION

This study has the potential to address an important gap in the clinical research literature on cigarette smoking cessation and provide empirical support for using a TMI to provide ongoing assistance and support for quitting among young smokers experiencing homelessness. Trial registration ClinicalTrials.gov Identifier NCT03874585. Registered March 14, 2019, https://clinicaltrials.gov/ct2/show/record/NCT03874585.

Trends in the sequence of first alcohol, cannabis and cigarette use in Australia, 2001-2016

BACKGROUND

Recent analyses of data from the US found that young people were increasingly engaging in cannabis use before alcohol and cigarettes. These shifts are important for public health, but it is not clear whether such trends extend beyond the US. The aim of this study is to examine whether and how the age and sequencing of initiation into alcohol, cannabis and cigarette use has changed in Australia since the early 2000s.

METHODS

Data came from six waves of the Australian National Drug Strategy Household Survey, spanning 2001-2016. We used data from 18 to 21 year-olds (n = 6849) and examined trends in the age at first use for each of the three substances plus any changes in the order of initiation.

RESULTS

The mean age of initiation increased steadily for all three substances (e.g. from 14.9 in 2001 to 16.4 in 2016 for alcohol), while the prevalence of any use declined. There were some changes in ordering of use. For example, in 2001, 62 % of respondents who used both cigarettes and cannabis had first used cigarettes at an earlier age than cannabis, compared with 41 % in 2016. Young people who used both alcohol and cannabis remained more likely to try alcohol before cannabis across the study period.

CONCLUSIONS

Our results partly replicated US findings, with differences potentially reflecting the substantially different environment around these substances in the US compared to Australia. The age of initiation for alcohol, cigarette and cannabis use in Australia has increased sharply over the past 15 years.

Risk factors associated with subsequent initiation of cigarettes and e-cigarettes in adolescence: A structural equation modeling approach

BACKGROUND

Previous youth tobacco research has identified multiple correlated risk factors for initiation of cigarette and e-cigarette use; whether these factors are independently associated with initiation is not known, due to challenges with disentangling the independent effects of these correlated risk factors.

METHODS

Students in 11th/12th grade enrolled in the Southern California Children's Health Study were surveyed in 2014 (baseline) and again in 2015 (N = 1553). Structural equation models (SEM) were developed to investigate associations of susceptibility, marketing, and the social environment (as latent factors), and other tobacco use at baseline with cigarette or e-cigarette initiation between baseline and follow-up. Analyses were restricted to baseline never cigarette users (N = 1293) for models evaluating cigarette initiation, and to never e-cigarette users (N = 1197) for models evaluating e-cigarette initiation.

RESULTS

In fully-adjusted prospective SEM models, latent factors for cigarette susceptibility, marketing, and the social environment, along with ever e-cigarette use and ever hookah use at baseline were independently associated with cigarette initiation between baseline and follow-up (P < 0.05). Similarly, latent factors for e-cigarette susceptibility, marketing, and the social environment, along with ever hookah use at baseline were associated with e-cigarette initiation between baseline and follow-up (P < 0.05); however, cigarette use at baseline was not associated with e-cigarette initiation in SEM models (P = 0.16).

CONCLUSIONS

We identified independent effects of multiple risk factors in SEM models on initiation of cigarettes and e-cigarettes. E-cigarette use was associated with cigarette initiation, but cigarette use was not associated with e-cigarette initiation in fully adjusted models. Research to identify underlying causal mechanisms is warranted.

Effects of smoking cessation treatment attendance on abstinence: The moderating role of psychologically based behavioral health conditions

Available smoking cessation treatments have shown only modest quit success. Presence of a psychologically based behavioral health condition (PBHC), such as depression, anxiety, or addiction, can impact smoking cessation treatment engagement and quit success; however, the differential effect of treatment engagement on smoking cessation outcomes across smokers with and without a PBHC is unknown. The current study examined the moderating effect presence (versus absence) of a PBHC on the relation between treatment attendance and early smoking abstinence following a 4-session smoking cessation treatment. Participants included 529 (45.9% male; Mage = 38.23 years, SD = 13.56; 75.4% White) smokers enrolled in a large randomized controlled trial evaluating the efficacy of a transdiagnostic smoking cessation treatment. A repeated-measures latent class analysis (RMLCA) was conducted to examine treatment attendance. The effects of treatment attendance, PBHC (present/absent), and their interaction were modeled on biochemically-verified point prevalence abstinence using a latent growth curve from 1-week to 1-month post-quit. The RMLCA provided evidence for three classes: Drop-outs (n = 197), Titrators (n = 89), and Completers (n = 243). A significant interaction emerged such that Completers without a PBHC were significantly more likely to be abstinent relative to Completers with a PBHC (b = 2.69, SE = 0.67, p < .001) and Titrators without a PBHC (b = 3.36, SE = 0.80, p < .001). These results provide novel data that implicate the clinical importance of treatment attendance and PBHC status on smoking abstinence.

Menthol cigarette smoking is associated with greater subjective reward, satisfaction, and "throat hit", but not greater behavioral economic demand

AIMS

The cooling and minty flavor of menthol in cigarettes has been hypothesized to mask the harshness of inhaled cigarette smoke, contributing to menthol's appeal and subjective reinforcement and linking menthol use to smoking initiation, progression, nicotine dependence, and difficulty quitting. This study examined differences between menthol and non-menthol smokers on behavioral economic indices of reinforcing efficacy (i.e., demand) and subjective response to smoking (i.e., satisfaction, reward, "throat hit," aversion) and the association between measurements of reinforcement and subjective response.

DESIGN

600 current adult smokers were recruited from an online smoking cessation program. Following website enrollment, individuals completed a self-report measurement of subjective response to smoking (reward, satisfaction, aversion, "throat hit"), and a modified cigarette purchase task (CPT) to assess behavioral economic cigarette demand.

FINDINGS

In bivariate and adjusted ANOVA models, menthol smokers reported greater subjective reward, satisfaction, and positive sensations in the throat ("throat hit") from smoking compared to non-menthol smokers; and those outcomes were also correlated with greater nicotine dependence and lower likelihood of a past-year quit attempt. Although cigarette demand was associated with smoking level, subjective smoking reward, and nicotine dependence, there were no differences in smoking demand between menthol vs. non-menthol smokers.

CONCLUSIONS

The pleasurable aspects of menthol vs non-menthol smoking may be a mechanism linking it to greater nicotine dependence and difficulty quitting. A menthol ban could decrease population-level cigarette consumption by restricting smokers' access to a highly rewarding cigarette flavoring.

Adolescent menthol cigarette use and risk of nicotine dependence: Findings from the national Population Assessment on Tobacco and Health (PATH) study

BACKGROUND

Menthol cigarettes appeal to adolescents because they mask the harsh taste and sensation of tobacco smoke thereby making it easier to inhale the smoke. As a result, menthol cigarette users expose themselves to higher levels of nicotine relative to non-menthol cigarettes and increase their risk for developing nicotine dependence. We examined whether adolescent menthol smokers (vs. non-menthol smokers) reported higher nicotine dependence.

METHODS

Data were from adolescent past 30-day cigarette smokers participating in Wave 2 of the Population Assessment of Tobacco and Health survey (n = 434). Nicotine dependence was assessed using eight items from the Wisconsin Inventory of Smoking Dependence Motives corresponding to individual subscale constructs. Linear regression models evaluated the association of past 30-day menthol (vs. non-menthol) cigarette use with each dependence outcome in separate models, adjusting for age, gender, race, and other tobacco product use.

RESULTS

49.5% of past 30-day youth cigarette smokers reported smoking menthol cigarettes. In adjusted models, menthol smokers (vs. non-menthol smokers) reported significantly higher nicotine dependence for three constructs: craving (p = 0.005), affiliative attachment (p = 0.005), and tolerance (p = 0.003). No differences for menthol vs. non-menthol smokers were observed for loss of control, negative reinforcement, cognitive enhancement, automaticity, or social environment after correction for multiple comparisons.

CONCLUSIONS

Findings suggest that menthol cigarette smokers are not just more physically dependent on nicotine but also experience increased emotional attachments to cigarettes compared to their non-menthol smoking peers. Because adolescents are vulnerable to developing nicotine dependence, tobacco control policies that restrict youth access to menthol cigarettes are urgently needed.

The influence of smoking habits on cadmium and lead blood levels in the Serbian adult people

According to the World Health Organization, in 2015, the Serbian population ranked among the highest ones in Europe in terms of smoking habit: 44.3% males and 36.2% females aged 18-64 smoked tobacco. In the last 7 years, 25% of total mortality in men and 9% in women from Serbia were associated with smoking. Tobacco smoking is one of the most important sources of exposure to many toxic substances in general population. Our study confirmed higher blood levels of two toxic metals, cadmium and lead, in the blood of smokers (3.5 and 1.5 times higher than in non-smokers, respectively). Furthermore, smoking habits, such as number of smoked cigarettes per day, smoking period and cigarette type, along with age, were shown to influence these metals' blood concentration. Higher blood levels of Cd and Pb were found in smokers consuming more than 10 cigarettes per day for more than 10 years. The present study also highlighted the importance of the controlled tobacco production, since it was shown that consumption of illicit tobacco could manifold the exposure to toxic metals that can subsequently increase the frequency of related diseases as well.

Initiation Patterns and Trends of E-Cigarette and Cigarette Use Among U.S. Adolescents

PURPOSE

The primary objectives were to (1) examine the initiation patterns of e-cigarette and cigarette smoking, (2) compare recent trends in initiation patterns for 2015, 2016, and 2017, (3) examine sociodemographic differences in initiation patterns over time and, (4) examine how initiation patterns are associated with cigarette-related perceptions, behaviors, and intentions.

METHODS

Data were collected via self-administered questionnaires from 2015 to 2017 nationally representative samples of eighth-grade (modal ages 13-14 years) and 10th-grade (modal ages 15-16 years) students (N = 36,506) attending U.S. secondary public and private schools.

RESULTS

Among lifetime e-cigarette or cigarette users (n = 9,858), initiating e-cigarettes only was the most common (47.45%). This was followed by cigarette before e-cigarette initiation (18.50%), which decreased in prevalence from 2015 to 2017. E-cigarette before cigarette initiation was the smallest group (6.89%) but increased from 2015 to 2017. E-cigarette before cigarette users were more likely to perceive cigarette use as risky (adjusted odds ratios [aOR]: 1.40; 95% CI: 1.11-1.77) but also more likely to currently smoke cigarettes (aOR:1.30; 95% CI: 1.03-1.63) compared with those who initiated cigarettes before e-cigarettes. Both cigarette only initiators (aOR: .52; 95% CI: .33-.80) and e-cigarette only initiators (aOR: .22; 95% CI: .07-.16) were less likely to report future intentions to smoke compared with those who initiated cigarettes before e-cigarettes.

CONCLUSIONS

Initiation patterns related to e-cigarette and cigarette use among U.S. youth appears to be changing rapidly. Furthermore, patterns of initiation should be considered in future research as cigarette-related risk among different e-cigarette and cigarette use initiation patterns is heterogeneous.

The Utility of Social Learning Theory in Explaining Cigarette Use in a Military Setting

Background: A large body of empirical studies has shown that cigarette use has detrimental consequences. Along with its adverse health effects, it is also associated with negative outcomes for social institutions, including the military. Objectives: Utilizing a Social Learning Theory (SLT) framework, this study attempts to explore the associations among cigarette use and elements of social learning in a military setting, including differential association, differential reinforcement, and definitions favorable to smoking. Methods: We draw upon unique data from the Cadet Smoking Survey (CSS) conducted in 2015 at the Turkish Military Academy (n = 378), and utilize binary logistic regression as the analytic strategy. Results: The findings reveal that the smoking habits of fathers and peers, as well as cadets' own definitions that make smoking justifiable, were strong positive predictors of Turkish cadets being cigarette smokers. The links between smoking and parental reaction or peer reinforcement, however, were not robust. Conclusion/Importance: The results of this study partially support the assumptions in SLT and suggest that military units might serve as venues for facilitating learning regarding cigarette use. The implications, limitations, and directions for future research are discussed below.

High Prevalence of Tobacco Product and E-Cigarette Use among Electronic Dance Music Party Attendees

Background: Electronic dance music (EDM) party attendees are at high risk for use of various illegal drugs; however, little is known about their tobacco use. Understanding tobacco use patterns in this population at high risk for illegal drug use can inform multi-product interventions. Objectives: 954 EDM party attendees (ages 18-40) were surveyed in New York City in 2017. We estimated prevalence of use of cigarettes, hookah, cigars, other tobacco, and e-cigarettes and delineated correlates of current (past-month) use using bivariable and multivariable models. Results: Past-month use of cigarettes (36.2%), e-cigarettes (15.6%), cigars (12.5%), and hookah (11.7%) in particular was prevalent. In multivariable models, females were less likely to use e-cigarettes than males (adjusted prevalence ratio [aPR] = 0.63, p = .030), and those who attended graduate school were less likely to use cigarettes (aPR = 0.55, p = .003) and/or e-cigarettes (aPR = 0.33, p = .026). Past-year ecstasy/MDMA/Molly use was a risk factor for past-month use of cigarettes (aPR = 1.38, p = .013) and/or cigars (aPR = 1.61, p = .032), and past-year cocaine use was a risk factor for past-month use of cigarettes (aPR = 1.80, p < .001), cigars (aPR = 1.80, p = .013), other tobacco products (aPR = 3.05, p = .003), and/or e-cigarettes (aPR = 2.39, p = .003). 55.4% of ecstasy users and 60.3% of cocaine users were current cigarette smokers, but use of other products among users of these drugs was less prevalent (9.8-27.9%). Conclusions: Results suggest that current tobacco use is prevalent in this population who is also at high risk for use of drugs such as ecstasy and cocaine. Prevention and cessation efforts need to target tobacco users in this scene while incorporating components addressing illegal drug use.

Anhedonia, screen time, and substance use in early adolescents: A longitudinal mediation analysis

INTRODUCTION

Screen time is associated with substance use risk among adolescents; however, less is known about the underlying factors that explain this association.

METHODS

This research examined anhedonia, a facet of depression noted by the reduced capacity to experience pleasure, as a mediating factor in the relationship between screen time (hours spent watching television, using internet, and/or playing video games outside of school) and substance use (alcohol and/or cigarettes). We used a longitudinal survey design among a sample of students aged 9-11 years in the 4th to 6th grades in Southern California, United States of America [N = 709 (354 males)].

RESULTS

Structural equation modeling (SEM) findings revealed longitudinal mediation effects of anhedonia on the association between screen time and substance use, while controlling for baseline screen time, baseline individual and peer substance use, race/ethnicity, and gender. Moderation analysis based on a multiple-group approach revealed that gender was not a significant moderator of this mediation pathway.

CONCLUSIONS

Adolescents may become desensitized and exhibit a blunted response to hedonic effects from increased screen time. This may result in increased anhedonia and greater risk for substance use through the need to compensate for the reduced experience of rewards. These findings have implications for future school-based substance use prevention and intervention programs.

Tobacco smoking and the risk of pancreatitis: A systematic review and meta-analysis of prospective studies

BACKGROUND

Tobacco smoking has been associated with increased risk of pancreatitis in several studies, however, not all studies have found an association and it is unclear whether there is a dose-response relationship between increasing amount of tobacco smoked and pancreatitis risk. We conducted a systematic review and meta-analysis of prospective studies on tobacco smoking and pancreatitis to clarify the association.

METHODS

PubMed and Embase databases were searched for relevant studies up to April 13th^, 2019. Prospective studies that reported adjusted relative risk (RR) estimates and 95% confidence intervals (CIs) for the association between tobacco smoking and pancreatitis were included and summary RRs were calculated using a random effects model.

RESULTS

Ten prospective studies were included. The summary RR for acute pancreatitis was 1.49 (95% CI: 1.29-1.72, I² = 68%, n = 7) for current smokers, 1.24 (95% CI: 1.15-1.34, I² = 0%, n = 7) for former smokers, and 1.39 (95% CI: 1.25-1.54, I² = 69%, n = 7) for ever smokers compared to never smokers. Similar results were observed for chronic pancreatitis and acute/chronic pancreatitis combined. The summary RR per 10 cigarettes per day was 1.30 (95% CI: 1.18-1.42, I² = 42%, n = 3) and per 10 pack-years in current smokers was 1.13 (95% CI: 1.08-1.17, I² = 14%, n = 4) for acute pancreatitis and results were similar for chronic pancreatitis and acute/chronic pancreatitis combined.

CONCLUSIONS

These results suggest that tobacco smoking increases the risk of acute and chronic pancreatitis and acute and chronic pancreatitis combined and that there is a dose-response relationship between increasing number of cigarettes and pack-years and pancreatitis risk.

Roll-your-own cigarette smoking among youth experiencing homelessness

INTRODUCTION

Roll-your-own (RYO) cigarette smoking is uncommon among young smokers in the U.S. but may be more widespread among those experiencing homelessness as it is a less expensive source of cigarettes. This study examines the prevalence and correlates of RYO use among young cigarette smokers experiencing homelessness.

METHODS

The analytic sample consisted of 433 unaccompanied homeless youth who reported past month use of factory-manufactured cigarettes. Participants were sampled from 25 street and service sites in Los Angeles County, and completed a survey on their tobacco-related behaviors and cognitions.

RESULTS

RYO use was reported by 43% of cigarette smokers. Among those who filled RYOs with tobacco, 87% rolled them with used tobacco (typically mixed with new tobacco). Most RYO smokers reported engaging in high-risk smoking practices, such as smoking discarded cigarettes. Although RYO smokers were more likely than other smokers to perceive RYOs as less risky in general, these groups did not differ in the perceived relative harm, expense, and ease of access of RYOs compared to regular cigarettes. Multivariable analyses indicated that RYO use was associated with older age, less perceived riskiness of RYOs, greater exposure to RYO smokers, and stronger future intentions to smoke.

CONCLUSION

RYOs may encourage continued tobacco use among youth experiencing homelessness and pose additional health risks despite users' beliefs to the contrary. Future research is needed to obtain more detailed information on RYO practices and motivations for use, as well as how to address RYOs in efforts to reduce tobacco use in this population.

Higher smoking prevalence among United States adults with co-occurring affective and drug use diagnoses

INTRODUCTION

Individuals with drug use disorders or affective disorders have higher cigarette smoking prevalence and smoking intensity and are less likely to quit than the general population. We sought to estimate the prevalence of cigarette smoking by drug use and psychiatric diagnoses and to explore to what extent a co-occurring diagnosis was associated with current smoking.

METHODS

Data were derived from the most recent National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III, 2012-2013; n = 36,309). Cigarette smoking status was examined among those with any past-year or lifetime drug use disorders (i.e., alcohol, cannabis, opioid, cocaine) or affective disorders (i.e., mood, anxiety). Diagnoses were assessed using the Diagnostic and Statistical Manual of Mental Disorders criteria (DSM-5).

RESULTS

Adjusting for sociodemographic characteristics, those with drug use disorders (past-year AOR = 3.3, 95% CI: 3.0, 3.6; lifetime AOR = 3.2, 95% CI: 3.0, 3.5) and those with affective disorders (past-year AOR = 1.7; 95%CI: 1.5, 1.8, lifetime AOR = 1.3, 95% CI: 1.2; 1.4), had higher odds of current cigarette smoking compared to individuals with no diagnosis. The odds of current cigarette smoking was significantly higher in individuals with both drug use disorders and affective disorders compared to those with either a drug use or affective disorder or no disorder (past-year AOR = 5.1; 95% CI: 4.3, 5.9, lifetime AOR = 4.3; 95% CI: 3.8, 4.7).

CONCLUSIONS

Approximately 30% of the population had a past-year drug use or affective disorder, 17% of whom report both. The combination of both diagnoses produced a 1.5 to 3-fold higher correlation with smoking than either alone.

Effects of Fetal Substance Exposure on Offspring Substance Use

Prenatal exposure to alcohol and drugs is associated with physical, cognitive, and behavioral problems across the offspring's lifespan and an increased risk of alcohol and drug use in adolescent and young adult offspring. These prenatal effects continue to be evident after control for demographic background and parental alcohol and drug use. Behavior problems in childhood and adolescence associated with prenatal exposures may serve as a mediator of the prenatal exposure effects on offspring substance use.

Change in smoking cessation stage over 1 year in patients with schizophrenia: a follow up study in Japan

BACKGROUND

We performed a follow up study about willingness and behaviors to quit smoking among smokers with schizophrenia in Japan.

METHODS

Participants were outpatients with schizophrenia aged 20-69 years who had been visiting the hospital for ≥1 year as of April 1, 2016, and had visited the hospital more than once in the previous 6 months. A baseline survey on smoking behaviors including current smoking status and smoking cessation stage, was administered in 420 participants that were randomly extracted from a patient pool (n = 680) in 2016, and a follow-up survey was administered in 2017. We calculated the distribution and change in smoking cessation stage, number of smokers and nonsmokers after 1 year, and quitting rate from a naturalistic 1-year smoking-cessation follow up.

RESULTS

The number of baseline respondents was 350; 113 current smokers and 68 former smokers. Among the 113 current smokers, 104 (92.0%) were followed for 1 year, 79 (70.0%) were interested in smoking cessation, and only 7 had received smoking cessation treatments at baseline. Among the tracked 104 participants, only 6 (5.8%) stopped smoking after 1 year. Among the 25 participants who had intentions to quit smoking within 6 months at baseline, 6 (24.0%) maintained their intention to quit smoking for 1 year, and 16 (64.0%) did not maintain their intention to quit smoking.

CONCLUSIONS

Our findings showed that many smokers with schizophrenia were interested in quitting smoking, but few patients received treatment and actually quit smoking. Timely intervention, including the option to receive smoking cessation treatment, is necessary for those patients with schizophrenia who smoke.

TRIAL REGISTRATION

UMIN Clinical Trials Registry (UMIN000023874, registered on August 31, 2016).

Factors associated with past 30-day abstinence from cigarette smoking in adult established smokers who used a JUUL vaporizer for 6 months

BACKGROUND

JUUL is the fastest growing and highest selling brand of e-cigarette/vapor products in the USA. Assessing the effect of JUUL vapor products on adult smokers' use of conventional tobacco cigarettes can help inform the potential population health impact of these products.

METHODS

Participants were 15,456 US adult established current smokers aged 21 years who had purchased their first JUUL Starter Kit from a retail store or online within the past 7 days. Online surveys assessed past 30-day use of conventional cigarettes, JUUL vapor products, and other e-cigarettes/vapor products at 3 and 6 months after their first JUUL purchase. Logistic regression models examined factors associated with smokers' odds of self-reporting past 30-day abstinence from cigarette smoking at 6 months.

RESULTS

Past 30-day point prevalence abstinence from smoking at 6 months was 31.6% in the intent-to-treat (ITT) sample and 54.0% among those who responded at 6 months (n = 9040; 58.5% of ITT). Consecutive past 30-day smoking abstinence outcomes at 3 and 6 months were reported by 20.3% of the ITT sample and 40.6% of responders to both assessments (n = 7726). Covariate-adjusted odds for reporting past 30-day smoking abstinence at 6 months were significantly higher among primary users of mint- or mango-flavored JUULpods (compared to primary users of Virginia tobacco-flavored JUULpods), exclusive users of JUULpods in characterizing flavors (compared to exclusive users of tobacco-flavored JUULpods), daily users of the JUUL vaporizer (compared to less-than-daily), initial retail purchasers (compared to initial e-commerce purchasers), and those who first purchased a JUUL to help to quit smoking completely. Odds for reporting past 30-day smoking abstinence were significantly lower among those who, at study enrolment, had smoked regularly for ≥ 20 years, smoked ≥ 10 cigarettes per day, and smoked on all 30 of the previous 30 days.

CONCLUSIONS

Around one third of enrolled smokers and one half of smokers who responded to a 6-month follow-up reported being past 30-day abstinent from cigarette smoking after using a JUUL vaporizer for 6 months. More frequent use of a JUUL vaporizer and primary use of JUULpods in characterizing flavors, particularly mint and mango, appeared to be important to smokers' chances of quitting. The impact of suspending retail sales of flavored JUULpods on adult smokers' likelihood of quitting should be closely assessed.