What would menthol smokers do if menthol in cigarettes were banned? Behavioral intentions and simulated demand

Development of measures assessing attitudes toward contraband tobacco among a web-based sample of smokers

BACKGROUND

As regulation of tobacco products tightens, there are concerns that illicit markets may develop to supply restricted products. However, there are few validated measures to assess attitudes or purchase intentions toward contraband tobacco (CT). As such, it is important to investigate individual level characteristics that are associated with the purchase and use of contraband tobacco.

METHODS

In May 2013, a pilot survey assessed attitudes, behaviors, and purchase intentions for contraband tobacco based on previous research regarding non-tobacco contraband. The survey was administered via Amazon Mechanical Turk, a crowdsourcing resource, among current smoking respondents in the United States and Canada. Structural equation modeling was used to evaluate the validity of the proposed model for understanding attitudes toward contraband tobacco.

RESULTS

CT purchasers were more likely to report norms supportive of counterfeit products, more intentions toward purchasing counterfeit products, a lowered risk associated with these products, and to have more favorable attitudes toward CT than those who had not purchased CT. Attitudes toward CT mediated the relationship between subjective norms and prior purchase with behavior intentions. Perceived risk had a significant direct effect on intentions and an indirect effect through attitudes toward CT. The structural model fit the data well and accounted for over half (53%) of the variance in attitudes toward tobacco.

CONCLUSIONS

Understanding the mechanisms associated with CT attitudes and purchase behaviors may provide insight for how to mitigate possible iatrogenic consequences of newly implemented regulations. The measures developed here elucidate some elements that influence attitudes and purchase intentions for CT and may inform policy efforts to curtail the development of illicit markets.

The impact of pre-cessation varenicline on behavioral economic indices of smoking reinforcement

BACKGROUND

Varenicline was developed to aid smoking cessation by reducing smoking reinforcement. The present study tests this reinforcement-reduction hypothesis among smokers preparing to quit.

METHOD

After a one-week baseline, treatment-seeking smokers were randomized to receive three weeks of varenicline or placebo (Weeks 2-4). During each of the four weeks of the study, smokers completed a hypothetical cigarette purchase task (CPT) via handheld devices in their natural environment. Behavioral economic measures of simulated smoking if cigarettes were free (demand intensity), sensitivity of consumption to increasing price (elasticity), and price at which purchases would drop to 0 (breakpoint) were estimated.

RESULTS

The exponential demand equation fit the purchase task data well across subjects and time. As predicted, demand intensity decreased and sensitivity to price (elasticity) increased over time. However, changes in demand intensity did not differ by treatment group. Contrary to our hypothesis that varenicline would increase sensitivity to price, the placebo group tended to become more elastic in their purchases during Weeks 2 and 3; the groups did not differ in elasticity at Week 4. Breakpoint did not vary by group, time, or their interaction.

CONCLUSION

Simulated smoking demand can be validly assessed in the natural environment of treatment-seeking smokers. Simulated demand indices of smoking reinforcement diminished as smokers approached their target quit date. However, there was no evidence that varenicline facilitated these changes over a three-week period, leaving open the mechanisms by which varenicline reduces smoking rate prior to cessation and improves long-term abstinence.

Switching between menthol and nonmenthol cigarettes: findings from the U.S. Cohort of the International Tobacco Control Four Country Survey

INTRODUCTION

This article examines trends in switching between menthol and nonmenthol cigarettes, smoker characteristics associated with switching, and associations among switching, indicators of nicotine dependence, and quitting activity.

METHODS

Participants were 5,932 U.S. adult smokers who were interviewed annually as part of the International Tobacco Control Four Country Survey between 2002 and 2011. Generalized estimating equations (GEEs) were used to examine the prevalence of menthol cigarette use and switching between menthol and nonmenthol cigarettes (among 3,118 smokers who participated in at least 2 consecutive surveys). We also evaluated characteristics associated with menthol cigarette use and associations among switching, indicators of nicotine dependence, and quitting activity using GEEs.

RESULTS

Across the entire study period, 27% of smokers smoked menthol cigarettes; prevalence was highest among Blacks (79%), young adults (36%), and females (30%). Prevalence of switching between menthol and nonmenthol cigarettes was low (3% switched to menthol and 8% switched to nonmenthol), and switchers tended to revert back to their previous type. Switching types was not associated with indicators of nicotine dependence or quit attempts. However, those who switched cigarette brands within cigarette types were more likely to attempt to quit smoking.

CONCLUSIONS

While overall switching rates were low, the percentage who switched from menthol to nonmenthol was significantly higher than the percentage who switched from nonmenthol to menthol. An asymmetry was seen in patterns of switching such that reverting back to menthol was more common than reverting back to nonmenthol, particularly among Black smokers.

Young adults' behavioral intentions surrounding a potential menthol cigarette ban

INTRODUCTION

Menthol cigarette smoking is more prevalent among young adults, who are a known target of tobacco industry marketing. This study explores young adults' menthol use and behavioral intentions in the event of a ban on menthol cigarettes.

METHODS

Data from 2,871 respondents of the 2011 National Young Adult Health Survey were examined to estimate young adults' current smoking, current menthol smoking, and behavioral intentions in the event of a menthol cigarette ban.

RESULTS

Of all respondents, 23.8% were current smokers, and 40.3% of the current smokers were menthol smokers. Menthol use was significantly higher among 18- to 24-year-olds versus 25- to 34-year-olds (51% vs. 34.3%, p = .02) and was significantly associated with race/ethnicity (p < .0001), with prevalence highest among Black smokers (82.0%). Among menthol smokers, 65.7% indicated they would quit tobacco use altogether if menthol cigarettes were no longer sold, while 18.4% said they would switch to nonmenthol cigarettes, and 16.0% said they would switch to some other tobacco product (OTP). Behavioral intention was significantly associated with race/ethnicity (p = .02), where intention to quit tobacco was most prevalent among Black menthol smokers (79.3%), and concurrent use of OTPs (p = .03), where intention to switch to an OTP was more prevalent among menthol smokers who indicated concurrent OTP use (35.3% vs. 5.5%).

CONCLUSIONS

A majority of young adult menthol smokers stated they would quit smoking if menthol cigarettes were no longer sold, which builds on research finding public support for such a policy and on work modeling the public health impact such a ban could have.

Use of flavoured cigarettes in Poland: data from the global adult tobacco survey (2009-2010)

Background

Nowadays the European Union faces a debate on the ban of sale of flavoured cigarettes. There is growing evidence that certain subgroups of smokers are more vulnerable to the use of flavoured cigarettes. However in some European countries, figures on the use of these cigarettes are still scarce. The aim of the study was to assess the prevalence of flavoured cigarettes use in Poland, and examine whether its use among adults varies by socio-demographic characteristics.

Methods

Data on tobacco use including flavoured cigarettes and other characteristics were derived from the Global Adult Tobacco Survey (GATS). GATS is a cross-sectional, household survey implemented in Poland between 2009 and 2010. GATS provided data on a representative sample of 7,840 individuals covering 2,254 current smokers. Logistic regression model was used to obtain odds ratios (ORs) and 95% confidence interval (CI) of the selected socio-economic variables on the use of flavoured cigarettes.

Results

Among females the aromatized cigarettes use was 26.1% compared to 10.5% in males (OR = 2.3; 95% CI: 1.62–3.2; p ≤ 0.001). Respondents aged 20–29 years had an increased likelihood of using flavoured cigarettes compared to subjects aged 60 years or older (OR = 2.7; 95% CI: 1.1–6.5; p ≤ 0.001). Respondents aware of negative health consequences of smoking had OR = 1.4 95% CI: 1.1–2.1 (p ≤ 0.05) of smoking aromatized cigarettes compared to those who were unaware. Participants who perceived some kinds of cigarettes less harmful than others were also more likely to use flavoured cigarettes compared to subjects who were convinced that all cigarettes are equally harmful (OR = 1.4; 95% CI: 1.1–1.8; p ≤ 0.01). High educational attainment, living in large cities, being non-economically active was also associated with use of flavoured cigarettes.

Conclusion

Our results are consistent with majority of epidemiology studies on this topic to date and should be considered in the enactment of tobacco control legislation at the national as well as European levels. For combating tobacco epidemic, further efforts need to be made to prevent smoking uptake. Ban of flavoured cigarettes could considerably support achieving this goal.

Interrelationships among individual differences in alcohol demand, impulsivity, and alcohol misuse

An Alcohol Purchase Task (APT) is a novel behavioral economic measure for characterizing the incentive value of alcohol to an individual (i.e., alcohol demand). Individual differences in alcohol demand have been associated with a number of alcohol-related outcomes and the current investigation sought to extend these previous findings in a number of ways. The goals of the study were: (a) to examine the relationship between alcohol demand and alcohol misuse in a large sample of community adults; (b) to examine sex differences in alcohol demand; and, (c) to examine the relationship between alcohol demand and impulsive personality traits, both in general and as moderating variables. Participants (N = 720; 39% female) were adult smokers who reported drinking in the last year and were recruited from the community at large. All four behavioral economic indices of demand from the APT were significantly associated with alcohol misuse, with Omax and intensity uniquely associated in combined analyses. Males exhibited significantly higher demand, but these differences were largely eliminated after adjusting for drinks per week and other covariates. Trait levels of urgency, sensation-seeking and lack of premeditation were significantly associated with intensity and urgency was associated with Omax, but no moderating relationships were present. The significant relationships between aspects of impulsivity and the demand indices may signify a common process underlying disinhibition and demand for alcohol. These findings further support the relationship between indices of alcohol demand and alcohol misuse and a link between demand and impulsivity. Methodological considerations and future directions are discussed.

A Threat- and Efficacy-Based Framework to Understand Confidence in Vaccines among the Public Health Workforce

The Extended Parallel Process Model (EPPM) is an established threat- and efficacy-based behavioral framework for understanding health behaviors in the face of uncertain risk. A growing body of research has applied this model to understand these behaviors among the public health workforce. In this manuscript, we aim to explore the application of this framework to the public health workforce, with a novel focus on their confidence in vaccines and perceptions of vaccine injury compensation mechanisms. We characterize specific connections between EPPM’s threat and efficacy dimensions and relevant vaccine policy frameworks and highlight how these connections can usefully inform training interventions for public health workers to enhance their confidence in these vaccine policy measures.

The effect of menthol on cigarette smoking behaviors, biomarkers and subjective responses

BACKGROUND

As part of the Family Smoking Prevention and Tobacco Control Act, the U.S. Food and Drug Administration charged the Tobacco Products Scientific Advisory Committee with developing a report and recommendations about the effect of menthol in cigarettes on the public health. The purpose of this study was to examine smoking behaviors, biomarkers of exposure, and subjective responses when switching from a novel menthol cigarette to a non-menthol cigarette to isolate the effect of menthol and to approximate the effect a menthol ban might have on smokers.

METHODS

Thirty-two adult smokers completed this 35-day randomized, open-label, laboratory study. After a 5-day baseline period, participants were randomized to the experimental group (n = 22) where they would smoke menthol Camel crush for 15 days followed by 15 days of non-menthol Camel crush, or the control group (n = 10) where they smoked their own brand cigarette across all periods. Participants attended study visits every 5 days and completed measures of smoking rate, smoking topography, biomarkers of exposure, and subjective responses.

RESULTS

Although total puff volume tended to increase when the experimental group switched from menthol to non-menthol (P = 0.06), there were no corresponding increases in cigarette consumption or biomarkers of exposure (P > 0.1). Subjective ratings related to taste and smell decreased during the non-menthol period (P < 0.01), compared with the menthol.

CONCLUSIONS

Results suggest menthol has minimal impact on smoking behaviors, biomarkers of exposure, and subjective ratings.

IMPACT

When controlling for all other cigarette design features, menthol in cigarettes had minimal effect on outcome measures.