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Romm KF, Berg CJ. Patterns of Adverse Childhood Experiences and Problematic Health Outcomes Among US Young Adults: A Latent Class Analysis. SUBSTANCE USE & ADDICTION JOURNAL 2024; 45:191-200. [PMID: 38258814 DOI: 10.1177/29767342231218081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
INTRODUCTION Adverse childhood experiences (ACEs) predict problematic health outcomes (eg, substance use, mental health) among young adults; whether specific ACEs are differentially associated with specific substance use and mental health symptoms is understudied. METHODS Latent class analysis (LCA) identified classes of ACEs among 2209 US young adults (Mage = 24.69, range: 18-34; 57.4% female; 30.9% sexual minority; 35.8% racial/ethnic minority) in a 2-year study (2018-2020). Multivariable logistic regressions examined ACEs (reported in 2019) in relation to 2020 reports of current (past 30-day) substance use (ie, tobacco use; cannabis use and hazardous use; alcohol use and binge drinking) and mental health (ie, ≥moderate depression and anxiety symptoms), controlling for sociodemographics (ie, age, gender, race, ethnicity, sexual orientation, education). RESULTS Overall, 65.4% reported ≥1 ACE (M = 2.09, SD = 2.30); 34.8%, 39.1%, and 71.1% current tobacco, cannabis, and alcohol use; 39.1% and 15.3% hazardous cannabis use and binge drinking; and 24.2% and 34.5% ≥moderate depression and anxiety symptoms, respectively. LCA yielded 4 classes: Low ACEs (referent; 55.6%), Poor family health and divorce (16.3%), Parental abuse (16.0%), and High ACEs (12.1%). High ACEs (vs Low ACEs) was associated with each adverse substance use and mental health outcome except alcohol use. Poor family health and divorce was associated with tobacco use, cannabis use, and both mental health outcomes. Parental abuse was associated with tobacco use, cannabis use, hazardous cannabis use, and both mental health outcomes. CONCLUSIONS Health promotion interventions for young adults must assess ACEs, given that certain types of ACEs may be associated with distinct substance use and mental health outcomes.
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Affiliation(s)
- Katelyn F Romm
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Carla J Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
- George Washington Cancer Center, George Washington University, Washington, DC, USA
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Ahuja NA, Kedia SK, Regmi S, Dillon PJ. Disparities in E-Cigarette Harm and Addiction Perceptions Among Adolescents in the United States: a Systematic Review of the Literature. J Racial Ethn Health Disparities 2024; 11:696-709. [PMID: 36877379 DOI: 10.1007/s40615-023-01553-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Health disparities associated with e-cigarette use are increasingly apparent among US adolescents. Perceptions of e-cigarette harm and addiction play an important role in understanding adolescents' e-cigarette use behavior. The objective of this systematic review is to examine racial/ethnic and socio-economic disparities in e-cigarette harm and addiction perceptions among US adolescents. METHODS We searched five databases to identify cross-sectional or longitudinal studies that focused on adolescents (≤ 18 years of age) who were ever, current, or never e-cigarettes users; we then examined how race/ethnicity and/or socio-economic status (SES) impacted e-cigarette harm and/or addiction perceptions. Two co-authors independently identified relevant studies, extracted data, and assessed the risk of bias. RESULTS Adhering to PRISMA guidelines, eight of 226 identified studies met the inclusion criteria. These eight studies examined either perceptions regarding absolute e-cigarette harm and/or addiction (i.e., assessing perception of only e-cigarette) or relative e-cigarette harm and/or addiction (i.e., comparative perceptions to traditional cigarettes) by race and ethnicity. Two of the eight studies assessed absolute harm and/or addiction perceptions of e-cigarettes by SES. Our results indicate that, compared to all other racial/ethnic groups, relative e-cigarette harm and addiction perceptions were lower among Non-Hispanic White adolescents; however, absolute e-cigarette harm perception was higher among these groups. No clear patterns of racial/ethnic differences in absolute e-cigarette addiction perceptions and SES differences in absolute e-cigarette harm perceptions were reported. CONCLUSION More research is needed to explicitly assess perceptions of e-cigarette harm and addiction among US adolescents by race/ethnicity and SES to develop subgroup appropriate public health messaging.
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Affiliation(s)
- Nikhil A Ahuja
- Department of Public Health, College of Health Professions, Slippery Rock University of Pennsylvania, Slippery Rock, PA, USA.
| | - Satish K Kedia
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN, USA
| | - Sanjaya Regmi
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN, USA
| | - Patrick J Dillon
- School of Communication Studies, Kent State University at Stark, North Canton, OH, USA
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Hoetger C, White A, Bono RS, Hall CJ, Hood KB, Everhart RS, Nana-Sinkam P, Barnes AJ, Cobb CO. Perceptions of African American Youth and Adults Regarding Tobacco Use-Related Factors in Their Community: A Mixed-Methods Approach in Richmond, Virginia. FAMILY & COMMUNITY HEALTH 2024; 47:176-190. [PMID: 38372334 PMCID: PMC10878718 DOI: 10.1097/fch.0000000000000398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
INTRODUCTION The US Food and Drug Administration is poised to restrict the availability of menthol cigarettes and flavored cigars, products disproportionately used by Black/African American (B/AA) individuals. We examined B/AA youth and adult perceptions regarding factors contributing to tobacco use, as well as prevention/cessation resources. METHODS In 2 mixed-methods studies in Richmond, Virginia, we conducted cross-sectional surveys among youth (n = 201) and adult (n = 212) individuals who were primarily B/AA and reported past 30-day cigar smoking or nontobacco use, followed by focus groups with a subset (youth: n = 30; adults: n = 24). Focus groups were analyzed using a thematic analysis framework, and descriptive survey data provided context to themes. RESULTS Among focus group participants, 20% of youth and 75% of adults reported current cigar smoking. Six themes emerged across the groups: advertising/brands, sensory experiences, costs, social factors, youth-related factors, and dependence/cessation. Youth and adults perceived cigars as popular; cigar use was attributed to targeted advertising, flavors, affordability, and accessibility. While adults expressed concern regarding youth tobacco use, youth did not perceive tobacco prevention programs as helpful. Adults and youth reported limited access to community tobacco prevention/cessation programs. DISCUSSION Expanded tobacco prevention and cessation resources for B/AA people who smoke could leverage federal regulatory actions to ban tobacco products targeted toward this group and decrease disparities in tobacco-related morbidity and mortality.
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Affiliation(s)
- Cosima Hoetger
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA
- Universitat of Witten/Herdecke, Institute for Integrative Health Care and Health Promotion, Witten, Germany
| | - Augustus White
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA
- Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA, USA
| | - Rose S. Bono
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA
- Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA, USA
| | - Calvin J. Hall
- Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | | | | | | | - Andrew J. Barnes
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA
- Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA, USA
| | - Caroline O. Cobb
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA
- Psychology, Virginia Commonwealth University, Richmond, VA, USA
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El-Hellani A, Adeniji A, Erythropel HC, Wang Q, Lamb T, Mikheev VB, Rahman I, Stepanov I, Strongin RM, Wagener TL, Brinkman MC. Comparison of emissions across tobacco products: A slippery slope in tobacco control. Tob Induc Dis 2024; 22:TID-22-57. [PMID: 38560551 PMCID: PMC10980913 DOI: 10.18332/tid/183797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 02/07/2024] [Accepted: 02/10/2024] [Indexed: 04/04/2024] Open
Abstract
In this narrative review, we highlight the challenges of comparing emissions from different tobacco products under controlled laboratory settings (using smoking/vaping machines). We focus on tobacco products that generate inhalable smoke or aerosol, such as cigarettes, cigars, hookah, electronic cigarettes, and heated tobacco products. We discuss challenges associated with sample generation including variability of smoking/vaping machines, lack of standardized adaptors that connect smoking/vaping machines to different tobacco products, puffing protocols that are not representative of actual use, and sample generation session length (minutes or number of puffs) that depends on product characteristics. We also discuss the challenges of physically characterizing and trapping emissions from products with different aerosol characteristics. Challenges to analytical method development are also covered, highlighting matrix effects, order of magnitude differences in analyte levels, and the necessity of tailored quality control/quality assurance measures. The review highlights two approaches in selecting emissions to monitor across products, one focusing on toxicants that were detected and quantified with optimized methods for combustible cigarettes, and the other looking for product-specific toxicants using non-targeted analysis. The challenges of data reporting and statistical analysis that allow meaningful comparison across products are also discussed. We end the review by highlighting that even if the technical challenges are overcome, emission comparison may obscure the absolute exposure from novel products if we only focus on relative exposure compared to combustible products.
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Affiliation(s)
- Ahmad El-Hellani
- Division of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus, United States
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, United States
| | - Ayomipo Adeniji
- Division of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus, United States
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, United States
| | - Hanno C. Erythropel
- Department of Chemical and Environmental Engineering, School of Engineering & Applied Science, Yale University, New Haven, United States
- Yale Center for the Study of Tobacco Product Use and Addiction (YCSTP), Department of Psychiatry, Yale School of Medicine, New Haven, United States
| | - Qixin Wang
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, United States
| | - Thomas Lamb
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, United States
| | - Vladimir B. Mikheev
- Battelle Public Health Center for Tobacco Research, Battelle Memorial Institute, Columbus, United States
| | - Irfan Rahman
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, United States
| | - Irina Stepanov
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota Twin Cities, Minneapolis, United States
- Masonic Cancer Center, University of Minnesota Twin Cities, Minneapolis, United States
| | - Robert M. Strongin
- Department of Chemistry, Portland State University, Portland, United States
| | - Theodore L. Wagener
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, United States
- Department of Internal Medicine, The Ohio State University, Columbus, United States
| | - Marielle C. Brinkman
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, United States
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, United States
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Arakeri G, Rao Us V, Dhananjay KV, Chaturvedi P, Brennan PA. Unsuccessful ban on gutkha in India needs authentication - Authors' reply. Lancet 2024; 403:1238-1239. [PMID: 38555131 DOI: 10.1016/s0140-6736(23)01893-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/06/2023] [Indexed: 04/02/2024]
Affiliation(s)
- Gururaj Arakeri
- Department of Head and Neck Oncology, HCG Cancer Center, Bengaluru 560027, India; Department of Oral and Maxillofacial Surgery, HKDET Dental College and Hospital, Humnabad, India.
| | - Vishal Rao Us
- Department of Head and Neck Oncology, HCG Cancer Center, Bengaluru 560027, India
| | | | - Pankaj Chaturvedi
- Department of Head and Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Peter A Brennan
- Department of Oral and Maxillofacial Surgery, Queen Alexandra Hospital, Portsmouth, UK
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Barker HE, Czaplicki L, Cui Y, Shen R, Nian Q, Xie M, Cohen JE. Exposure to and Appeal of Tobacco Ads and Displays in China: A Qualitative Exploration of Chinese Youth Perceptions. Nicotine Tob Res 2024; 26:427-434. [PMID: 37788378 PMCID: PMC10959156 DOI: 10.1093/ntr/ntad192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 09/15/2023] [Accepted: 09/29/2023] [Indexed: 10/05/2023]
Abstract
INTRODUCTION Adolescents are uniquely vulnerable to nicotine addiction, and smoking is common among male adolescents in China. Although China implemented a ban on cigarette and e-cigarette advertising in public places, Chinese youth remain exposed to this marketing, which may contribute to future use. AIMS AND METHODS From December 2021 to January 2022, we conducted 20 online focus group discussions with 119 adolescents in 10 Chinese cities to explore sources of tobacco marketing exposure, defined as exposure to cigarette and e-cigarette ads and product displays, and what features made marketing attractive. RESULTS All groups discussed exposure to tobacco ads/displays in public places, including locations near their home or school. Nearly all groups discussed that exposure to online tobacco ads was common, particularly exposure to e-cigarette commercial ads and posts made by classmates or friends selling e-cigarettes. Most groups identified how eye-catching colors, imagery, product packaging, and price promotions featured in e-cigarette ads/displays attracted their attention. CONCLUSIONS Results suggest Chinese adolescents are exposed to cigarette and e-cigarette ads and displays, many of which are placed in youth-friendly locations and contain youth-appealing features. IMPLICATIONS Only a handful of studies have examined the influence of cigarette and e-cigarette advertising on youth in the context of China. Prior research has established the relationship between youth exposure to tobacco marketing and increased susceptibility to future use. Our findings emphasize the importance of effectively enforcing and expanding restrictions on cigarette and e-cigarette marketing in order to protect youth from exposure and future smoking/vaping initiation.
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Affiliation(s)
- Hannah E Barker
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg Schools of Public Health, Baltimore, MD, USA
| | - Lauren Czaplicki
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg Schools of Public Health, Baltimore, MD, USA
| | - Yuxian Cui
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg Schools of Public Health, Baltimore, MD, USA
| | - Rachel Shen
- Rising Sun Marketing Research and Consulting, Shanghai, People’s Republic of China
| | - Qinghua Nian
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg Schools of Public Health, Baltimore, MD, USA
| | - Marn Xie
- Rising Sun Marketing Research and Consulting, Shanghai, People’s Republic of China
| | - Joanna E Cohen
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg Schools of Public Health, Baltimore, MD, USA
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157
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Kowitt SD, Goldstein AO, Cornacchione Ross J, Clark SA, Jarman KL, Sheeran P, Thrasher JF, Ranney LM. Perceived Effectiveness of Cigar Warnings in Discouraging Blunt Use. Nicotine Tob Res 2024; 26:512-516. [PMID: 37819722 PMCID: PMC10959065 DOI: 10.1093/ntr/ntad199] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 10/13/2023]
Abstract
INTRODUCTION Many people remove the tobacco leaf from cigars and replace it with cannabis (ie, blunts), but few studies have examined whether messages about the risks of cigars, like warnings on cigar packages, can affect blunt use. METHODS Participants were 438 U.S. adults who reported past 30-day cigar use and ever blunt use, recruited from a probability-based national panel to take an online survey. In a 2 × 2 experiment with a between-subjects design, we manipulated two cigar warning characteristics: (1) warning type: text-only versus pictorial (ie, text + image) and (2) warning size: 30% (smaller) versus 50% (larger) of the product package. Participants then viewed six different warnings on a fictious cigarillo package, within their randomly assigned condition. After evaluating all stimuli, participants were asked the extent to which the warnings discouraged them from wanting to use cigars to smoke cannabis (ie, blunt perceived warning effectiveness). Response options ranged from "not at all" (1) to "a great deal" (5). RESULTS We observed no main effects of warning type or size on blunt perceived warning effectiveness. However, a significant interaction existed between the two experimental manipulations (p = .009). Whereas adding images made no difference to blunt perceived warning effectiveness when warnings were smaller (simple effect: -0.22, p = .28), images mattered for larger warnings. Specifically, adding images increased blunt perceived warning effectiveness when warnings were 50% of the product package (simple effect: 0.52, p = .008). CONCLUSIONS This experiment provides preliminary evidence that larger pictorial cigar warnings may discourage blunt use relative to larger but text-only warnings. IMPLICATIONS Blunts, which are hollowed out cigars with tobacco leaf wrappers that are filled with cannabis leaf, are one of the most common ways in which tobacco and cannabis are used simultaneously, yet few studies have examined whether messages about the risks of cigars can affect blunt use. We conducted an online experiment concerning the perceived effectiveness of cigar warnings among people who use blunts recruited from a probability-based panel. Results provide novel, preliminary evidence that larger pictorial cigar warnings may discourage blunt use, relative to larger but text-only warnings. More research evaluating cigar warnings on blunt use is needed.
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Affiliation(s)
- Sarah D Kowitt
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Adam O Goldstein
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jennifer Cornacchione Ross
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, USA
| | - Sonia A Clark
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kristen L Jarman
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Paschal Sheeran
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - James F Thrasher
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Leah M Ranney
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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158
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Yang Y, Lindblom EN, Ward KD, Salloum RG. Should menthol e-cigarettes be banned? Reaction of adult smokers and users of e-cigarettes to hypothetical bans. Tob Control 2024; 33:e125-e127. [PMID: 36446577 PMCID: PMC10225471 DOI: 10.1136/tc-2022-057439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 11/16/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION This study examines how current smokers using menthol cigarettes or flavoured cigars, and current users of flavoured e-cigarettes may respond to three hypothetical flavour-ban scenarios: (1) banning only menthol cigarettes and flavoured cigars; (2) also banning e-cigarettes with any non-tobacco flavours except menthol; and (3) also banning e-cigarettes with any non-tobacco flavours, including menthol. METHODS Recruited from mTurk, respondents were asked if they would quit all tobacco-nicotine use or continue or start using products that were still legally available. The patterns of responding to each ban scenario, for both flavoured smokers and users of non-tobacco flavoured e-cigarettes, were summarised. Multinomial logistic regressions were used to estimate associations between demographics, smoking or e-cigarette use status and reactions to a ban. RESULTS A ban on menthol cigarettes and flavoured cigars would lead to 12%-20% of flavoured smokers trying to quit all tobacco use and 32%-52% switching to non-flavoured smoking, with the remaining switching to e-cigarettes or other products. Compared with a ban on only menthol cigarettes and flavoured cigars, also banning flavoured e-cigarettes would increase the likelihood of quitting all tobacco-nicotine use (OR=2.58) but also increase the likelihood of switching to non-flavoured smoking (OR=1.74). CONCLUSIONS Our results indicate that a ban on menthol cigarettes and flavoured cigars would decrease smoking. However, it is unclear if adding a ban of menthol e-cigarettes would lead to additional benefits because without menthol e-cigarettes as an alternative, some smokers and e-cigarette users may switch to non-flavoured tobacco smoking, rather than quit all tobacco use.
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Affiliation(s)
- Yong Yang
- School of Public Health, University of Memphis, Memphis, Tennessee, USA
| | - Eric N Lindblom
- O'Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC, USA
| | - Kenneth D Ward
- School of Public Health, University of Memphis, Memphis, Tennessee, USA
| | - Ramzi G Salloum
- Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
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Khayat A, Levine H, Berg CJ, Shauly-Aharonov M, Manor O, Abroms L, Romm KF, Wysota CN, Bar-Zeev Y. IQOS and cigarette advertising across regulatory periods and population groups in Israel: a longitudinal analysis. Tob Control 2024; 33:e3-e10. [PMID: 36368887 PMCID: PMC10172385 DOI: 10.1136/tc-2022-057585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 10/12/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Tobacco regulation recently changed in Israel, including a partial advertisement ban. We assessed the impact of regulatory changes on Philip Morris International's (PMI) IQOS and cigarette advertisements. METHODS Weekly number of ads and weekly adspend of PMI's IQOS and cigarettes were analysed descriptively and using Quasi-Poisson regressions over time, across regulatory periods and in relation to subpopulations (general public, Arab, Russian and Ultra-Orthodox), from 25 December 2016 to 4 August 2020. Exponentiated coefficients (a value >1 indicates an increase) and 95% CIs are reported. RESULTS The average weekly number of ads and the average weekly adspend of IQOS were higher than cigarettes (42.22 vs 26.76 ads/week and 59 409 vs 45 613 new Israeli shekels/week; p<0.001 for both) during the study period, with exclusive IQOS advertisements during market penetration (December 2016 to May 2017). Variation in both outcomes was observed with regard to regulatory decisions. After the advertisement ban, there was a significant decrease in the weekly number of ads (IQOS: ß=0.04, 95% CI 0.002 to 0.20; cigarettes: ß=0.05, 95% CI 0.01 to 0.15) and weekly adspend (IQOS: ß=0.15, 95% CI 0.07 to 0.29; cigarettes: ß=0.31, 95% CI 0.17 to 0.53) for both products. The Ultra-Orthodox had significantly higher average weekly ads compared with the Arab population (IQOS: 0.67 vs 0.07; cigarettes: 2.74 vs 0.13; p=0.02 for both) but lower adspend. CONCLUSIONS IQOS and cigarette advertisements varied over time and appeared to have been impacted by regulatory changes. PMI invested more in IQOS advertisements than in cigarettes, with a partial advertisement ban decreasing both products' advertisements. PMI might be targeting the Ultra-Orthodox Jewish population which has a low smoking rate. Further research and surveillance are needed to better understand targeting strategies in order to inform tobacco control policy.
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Affiliation(s)
- Amal Khayat
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hagai Levine
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Carla J Berg
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Michal Shauly-Aharonov
- Department of Industrial Engineering, Jerusalem College of Technology, Jerusalem, Israel
| | - Orly Manor
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Lorien Abroms
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Katelyn F Romm
- Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Christina N Wysota
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Yael Bar-Zeev
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Wubshet H, Agegnehu AF, Workie MM, Addisu Y. Perception of the operation theater learning environment and related factors among anesthesia students in Ethiopian higher education teaching hospitals: a multicenter cross-sectional study. BMC MEDICAL EDUCATION 2024; 24:303. [PMID: 38504241 PMCID: PMC10949678 DOI: 10.1186/s12909-024-05320-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 03/15/2024] [Indexed: 03/21/2024]
Abstract
INTRODUCTION Operation theater learning involves three key elements: clinical work, learning, and the environment. There is little evidence regarding the operating theatre learning environment for anesthesia trainees. Identifying the overall perception of the operation theater learning environment helps to establish an efficient operation theater learning environment and produce competent anesthesia professionals. OBJECTIVE The aim of this study was to assess the perceptions of the operating theater learning environment and associated factors among undergraduate anesthesia students in Ethiopian higher education teaching hospitals from April to May 2023. METHODS A multicenter cross-sectional study was conducted on 313 undergraduate anesthesia students who began operation room clinical practice at 13 higher education teaching hospitals. The data were entered into EpiData version 4.6. A generalized ordered logistic regression model was used to analyze and identify factors associated with the operating theater learning environment using STATA software version MP17. RESULTS The findings of this study revealed that 45.05%,26.52%), 23% and 5.43% of the participants reported having desirable, moderately desirable, very desirable and undesirable perceptions of the operating theater learning environment, respectively, from highest to lowest. Preoperative discussion (AOR = 4.98 CI = 1.3-18.8), lack of teaching facilities (AOR = 0.16 CI = 0.03-0.75), noise from played music (AOR = 0.22 CI = 0.07-0.63), absence of tutors (AOR = 0.03 CI = 0.01-0.22), respect for students (AOR = 3.44 CI = 1.6-7.2), roll modeling for students (AOR = 3.23 CI = 1.5-6.8) and strict supervision of students (AOR = 0.24 CI = 0.07-0.88) were significantly associated with perceptions of the operation theater learning environment, with 95% CIs. CONCLUSION No study participant agreed that the operation theater learning environment in operation theatres was very undesirable. A lack of teaching facilities at the OR, a lack of tutors from the OR, noise from played music in the OR, a tutor respecting their student, a tutor role model for their student, a preoperative discussion with a tutor and strict supervision of the student are strongly associated with the operation theatre learning environment.
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Affiliation(s)
- Habtemariam Wubshet
- Department of Anesthesia, College of Medicine and Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
| | - Abatneh Feleke Agegnehu
- Department of Anesthesia, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Misganaw Mengie Workie
- Department of Anesthesia, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Yonas Addisu
- Department of Anesthesia, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Wagener TL, Mehta T, Hinton A, Schulz JA, Erath TG, Tidey J, Brinkman MC, Wilson C, Villanti AC. Addiction potential of combustible menthol cigarette alternatives: a randomised cross-over trial. Tob Control 2024; 33:e97-e105. [PMID: 36424139 PMCID: PMC10227719 DOI: 10.1136/tc-2022-057421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 11/02/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The Food and Drug Administration (FDA) has issued proposed product standards banning menthol as a characterising flavour in cigarettes and cigars. The public health benefits of these product standards may be attenuated by the role of plausible substitutes in the marketplace. Therefore, the present study examined the addiction potential of plausible combustible menthol alternatives compared with usual brand menthol cigarettes (UBMC). METHODS Ninety-eight adult menthol cigarette smokers completed four visits, smoking their UBMC at the first session and three menthol cigarette alternatives in random order at the subsequent visits: (1) a preassembled menthol roll-your-own (mRYO) cigarette using menthol pipe tobacco and mentholated cigarette tube, (2) a menthol filtered little cigar (mFLC) and (3) a non-menthol cigarette (NMC). Measures of smoking topography, exhaled carbon monoxide (CO), craving and withdrawal, subjective effects and behavioural economic demand indices were assessed. RESULTS Compared with UBMC, menthol cigarette alternatives resulted in different puffing topography and CO exposure (except mRYO), and lower levels of positive subjective experience and behavioural economic demand indices. Among the alternative products, participants reported the highest level of positive subjective experience and higher demand for mRYO, compared with mFLC and NMC. Similarly, participants were significantly more likely to want to try again, purchase and use the mRYO product regularly compared with mFLC and NMC. CONCLUSIONS AND RELEVANCE mRYO cigarettes were the most highly rated cigarette alternative among study products, suggesting their potential appeal as a menthol cigarette substitute and needed inclusion of menthol pipe tobacco and cigarette tubes in FDA's proposed ban.
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Affiliation(s)
- Theodore L Wagener
- Center for Tobacco Research, The Ohio State University James Comprehensive Cancer Center, Columbus, Ohio, USA
- Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Toral Mehta
- Center for Tobacco Research, The Ohio State University James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Alice Hinton
- Center for Tobacco Research, The Ohio State University James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Jonathan A Schulz
- Vermont Center on Behavior and Health, University of Vermont, Burlington, Vermont, USA
| | - Tyler G Erath
- Vermont Center on Behavior and Health, University of Vermont, Burlington, Vermont, USA
| | - Jennifer Tidey
- Behavioral and Social Sciences, Brown University, Providence, Rhode Island, USA
| | - Marielle C Brinkman
- Center for Tobacco Research, The Ohio State University James Comprehensive Cancer Center, Columbus, Ohio, USA
- College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Clark Wilson
- Center for Tobacco Research, The Ohio State University James Comprehensive Cancer Center, Columbus, Ohio, USA
- College of Public Health, The Ohio State University, Columbus, Ohio, USA
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162
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Khayat A, Berg CJ, Levine H, Rodnay M, Abroms L, Romm KF, Duan Z, Bar-Zeev Y. PMI's IQOS and cigarette ads in Israeli media: a content analysis across regulatory periods and target population subgroups. Tob Control 2024; 33:e54-e61. [PMID: 36418166 PMCID: PMC10203057 DOI: 10.1136/tc-2022-057671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 11/11/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND IQOS, manufactured by Philip Morris International (PMI), is the highest selling heated tobacco product globally. IQOS went through several regulatory changes in Israel: from no oversight to minimal tobacco legislation, to progressive legislation that included a partial advertisement ban (exempting print media) and plain packaging. We examined how PMI's advertising messages changed during these regulatory periods for both IQOS and cigarettes. METHODS Content analysis of PMI's IQOS and cigarette ads was performed using a predefined framework. Ad characteristics included regulatory period, target population, setting, product presentation, age and use restrictions, retail accessibility, additional detail cues (eg, QR code) and promotions. Ad themes included product features, legislation-related elements, social norms and comparative claims. Comparisons between IQOS and cigarette ads, and across regulatory periods, were examined using χ2 test or Fisher's exact test. RESULTS The dataset included 125 IQOS ads and 71 cigarette ads. IQOS ads featured more age restrictions, retail accessibility and additional detail cues, compared with cigarette ads (93.6% vs 16.9%; 56.0% vs 0.0%; and 95.2% vs 33.8%, p<0.001 for all). Cigarette ads featured mostly price promotions (52.1% vs 10.1% of IQOS ads, p<0.001). The main ad themes were technology for IQOS (85.6%) and quality for cigarettes (50.7%). In later (vs earlier) restrictive regulatory periods, IQOS ads featured more direct comparisons to cigarettes, QR codes and indoor settings, and did not feature product packaging. CONCLUSIONS IQOS advertisement content shifted as more restrictions went into effect, with several elements used to circumvent legislation. Findings from this study point to the necessity of a complete advertisement ban and ongoing marketing surveillance.
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Affiliation(s)
- Amal Khayat
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Carla J Berg
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, Washington, DC, Washington, USA
| | - Hagai Levine
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Maya Rodnay
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Lorien Abroms
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, Washington, DC, Washington, USA
| | - Katelyn F Romm
- Department of Pediatrics, College of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma, Oklahoma, USA
- TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma, Oklahoma, USA
| | - Zongshuan Duan
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, Washington, DC, Washington, USA
| | - Yael Bar-Zeev
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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163
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Berg CJ, Duan Z, Wang Y, Thrasher JF, Bar-Zeev Y, Abroms LC, Romm KF, Khayat A, Levine H. Impact of FDA endorsement and modified risk versus exposure messaging in IQOS ads: a randomised factorial experiment among US and Israeli adults. Tob Control 2024; 33:e69-e77. [PMID: 36428095 PMCID: PMC11347710 DOI: 10.1136/tc-2022-057639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 11/15/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND IQOS was the first heated tobacco product to receive Food and Drug Administration (FDA) authorisation for 'reduced exposure' marketing claims, which has been exploited globally. METHODS In November-December 2021, we conducted a survey-based 3×3 factorial experiment among US (n=1128) and Israeli adults (n=1094). We presented: (1) reduced exposure, reduced risk and control messaging and (2) 2 variations of FDA endorsement and control messaging. Each participant was randomly assigned to evaluate 2 ads (displayed on different ad imagery), then completed assessments of perceived relative harm, exposure and disease risk and likelihood of personally trying or suggesting IQOS to smokers. Ordinal logistic regression examined messaging conditions and their interactions, on the 5 outcomes, respectively, adjusting for covariates. RESULTS Control (vs reduced exposure) messaging resulted in higher perceived relative harm (adjusted OR (aOR)=1.29, 95% CI=1.12 to 1.48), exposure (aOR=1.34, 95% CI=1.17 to 1.54) and disease risk (aOR=1.23; 95% CI=1.08 to 1.40), and lower likelihood of suggesting IQOS to smokers (aOR=0.85; 95% CI=0.74 to 0.97). Reduced risk (vs exposure) messaging resulted in lower perceived relative harm (aOR=0.86; 95% CI=0.75 to 0.99). One FDA endorsement message ('IQOS (completed) the US FDA examination of tobacco products. FDA concluded that IQOS is a better choice for adult smokers') was associated with greater likelihood of suggesting IQOS to smokers, relative to control (aOR=1.19; 95% CI=1.04 to 1.37). No interactions between risk/exposure messaging and FDA endorsement messaging were found. Additionally, Israeli participants, cigarette users and men perceived lower relative harm and exposure and greater likelihood of trying or suggesting IQOS to smokers. CONCLUSIONS Regulators must monitor direct and indirect advertising content of modified risk tobacco product-authorised products and prevent potentially harmful misinterpretations.
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Affiliation(s)
- Carla J Berg
- Department of Prevention and Community Health, The George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA
| | - Zongshuan Duan
- Department of Prevention and Community Health, The George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA
| | - Yan Wang
- Department of Prevention and Community Health, The George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA
| | - James F Thrasher
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina, USA
| | - Yael Bar-Zeev
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah, Jerusalem, Israel
| | - Lorien C Abroms
- Department of Prevention and Community Health, The George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA
| | - Katelyn F Romm
- Department of Pediatrics, College of Medicine; TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Amal Khayat
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah, Jerusalem, Israel
| | - Hagai Levine
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah, Jerusalem, Israel
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164
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Kong G, Morean ME, Davis DR, Bold KW, Krishnan-Sarin S. Tobacco-free blunt wraps: a regulatory conundrum. Tob Control 2024; 33:e136-e137. [PMID: 37604696 PMCID: PMC10879446 DOI: 10.1136/tc-2023-058100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 08/07/2023] [Indexed: 08/23/2023]
Affiliation(s)
- Grace Kong
- Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Danielle R Davis
- Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Krysten W Bold
- Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
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165
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Yingst J, Midya V, White A, Foulds J, Cobb CO, Veldheer S, Yen MS, Eissenberg T. Effects of liquid nicotine concentration and flavour on the acceptability of electronic nicotine delivery systems (ENDS) among people who smoke participating in a randomised controlled trial to reduce cigarette consumption. Tob Control 2024:tc-2023-058282. [PMID: 38471776 DOI: 10.1136/tc-2023-058282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 02/27/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Research is needed to understand the acceptability of electronic nicotine delivery systems (ENDS) as a smoking reduction aid. This study examines the acceptability of ENDS by liquid nicotine concentration and flavour among people who smoke using ENDS to reduce their smoking. METHODS People who smoke cigarettes but were naïve to ENDS participated in a double-blind randomised controlled trial to reduce conventional cigarette smoking. Participants were randomised to either a control cigarette substitute (CS) or one of three ENDS groups; 0 mg/mL, 8 mg/mL or 36 mg/mL nicotine concentration. ENDS flavour was chosen by the participant (tobacco or menthol). Participants reported their CS, ENDS and cigarettes per day (CPD) from the past 7 days at 1-month, 3-month and 6-month follow-up visits. Participants also reported side effects and measures of satisfaction, psychological reward, aversion and craving relief. Outcome variables were modelled using linear mixed effects by the following groups: liquid nicotine concentration, flavour and a flavour-nicotine concentration interaction. RESULTS Participants (n=520) were 41.2% male, 67.3% white, had a mean age of 46.2 years and smoked a mean of 18.6 CPD (SD=7.74) at baseline. All flavour and concentration groups decreased CPD from baseline to all follow-up visits with the 36 mg/mL experiencing the greatest reduction, compared with the 0 mg/mL and 8 mg/mL groups. All groups except the 36 mg/mL group decreased their product use over time. The use of menthol flavour was associated with fewer side effects at 3 months (p=0.02) and lesser aversion at 1 month (p=0.03) compared with tobacco-flavoured ENDS. The 36 mg/mL group experienced the greatest craving relief and greatest aversion compared with other groups. CONCLUSIONS Both nicotine concentration and flavour appear to have independent, as well as interactive, effects that influence ENDS acceptability among people who use cigarettes.
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Affiliation(s)
- Jessica Yingst
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Vishal Midya
- Department of Environmental Medicine and Public Health, Icahn School of Medicine, New York, New York, USA
| | - Augustus White
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jonathan Foulds
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Caroline O Cobb
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Susan Veldheer
- Departmanrt of Family and Community Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Miao-Shan Yen
- Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Thomas Eissenberg
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
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166
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Snyder K, Liu ST, Donaldson EA, Wang T, Gentzke A. Exposure Among Middle and High School Students to Warning Labels on E-Cigarette Packages Before and After an FDA Requirement, 2018-2019. Prev Chronic Dis 2024; 21:E16. [PMID: 38483809 PMCID: PMC10944637 DOI: 10.5888/pcd21.220411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024] Open
Abstract
Introduction Beginning August 10, 2018, a US Food and Drug Administration (FDA) rule required all e-cigarette packages to have a health warning. We examined exposure among middle and high school students to e-cigarette warnings before and after the compliance date of the FDA's deeming rule, a rule allowing the FDA to regulate e-cigarettes, cigars, and other products. Methods We analyzed data from middle and high school students participating in the 2018 and 2019 National Youth Tobacco Survey. We generated weighted prevalence estimates for any exposure ("rarely," "sometimes," "most of the time," or "always") and high exposure ("most of the time" or "always") to warnings. We used independent 2-sided t tests to examine differences in exposure between 2018 and 2019 and χ2 tests to examine differences in any exposure and high exposure by demographic characteristics and tobacco use behaviors in 2019. Analyses excluded respondents who reported they had not seen an e-cigarette package. Results In 2019, 68.0% (vs 67.7% in 2018) of students reported any past 30-day exposure to e-cigarette warning labels and 35.0% (vs 28.7% in 2018) reported high exposure; we observed differences in the proportion of students reporting any and high exposure to warning labels across demographic characteristics and tobacco use behaviors. From 2018 to 2019, report of any and high exposure to e-cigarette warning labels increased among students who currently used any tobacco product and e-cigarettes. We observed increases in high exposure to e-cigarette warning labels overall, and among male students, female students, non-Hispanic White students, and middle and high school students. Conclusion After implementation of the health warnings per the FDA's deeming rule, the percentage of current tobacco users and e-cigarette users among middle and high school students who reported any and high exposure to e-cigarette warning labels increased. Continued monitoring of reactions can inform if warnings are achieving their regulatory goal.
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Affiliation(s)
- Kimberly Snyder
- Office of Science, Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland
- Office of Science, Center for Tobacco Products, Food and Drug Administration, 10903 New Hampshire Ave, Silver Spring, MD 20993
| | - Sherry T Liu
- Office of Science, Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland
| | - Elisabeth A Donaldson
- Office of Science, Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland
| | - Teresa Wang
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Andrea Gentzke
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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167
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Bono RS, White AM, Hoetger C, Lipato T, Bickel WK, Cobb CO, Barnes AJ. Expanding on cross-price elasticity: Understanding tobacco product demand and substitution from the cross-price purchase task. J Exp Anal Behav 2024; 121:175-188. [PMID: 37988256 PMCID: PMC10947944 DOI: 10.1002/jeab.890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 10/25/2023] [Indexed: 11/23/2023]
Abstract
We examine whether cigarettes serve as substitutes for electronic nicotine delivery systems (ENDS) among ENDS users and demonstrate methodological extensions of data from a cross-price purchase task to inform policies and interventions. During a clinical laboratory study, n = 19 exclusive ENDS users and n = 17 dual cigarette/ENDS users completed a cross-price purchase task with cigarettes available at a fixed price while prices of own-brand ENDS increased. We estimated cross-price elasticity using linear models to examine substitutability. We defined five additional outcomes: nonzero cross-price intensity (purchasing cigarettes if ENDS were free), constant null demand (not purchasing cigarettes at any ENDS price), cross-product crossover point (first price where participants purchased more cigarettes than ENDS), dual-demand score (percentage of prices where both products were purchased), and dual-use break point (minimum relative price to force complete substitution). The cross-price elasticity results indicated that cigarettes could serve as substitutes for ENDS among ENDS users on average, but this average effect masked substantial heterogeneity in profiles of demand (here, a measure of the drug's reinforcement potential). Policies and regulations that increase ENDS prices appear unlikely to steer most exclusive ENDS users toward cigarette use, as most would not purchase cigarettes at any ENDS price, but they could prompt some dual users to substitute cigarettes completely while others remain dual users. This heterogeneity in consumer responses suggests additional indices of cross-product demand are useful to characterize the anticipated and unanticipated effects of tobacco price policies more fully.
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Affiliation(s)
- Rose S. Bono
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond VA, USA
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Population Health, Richmond VA, USA
| | - Augustus M. White
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond VA, USA
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Population Health, Richmond VA, USA
| | - Cosima Hoetger
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond VA, USA
- Department of Psychology, Virginia Commonwealth University, Richmond VA, USA
- Institute for Integrative Health Care and Health Promotion, Faculty of Health/School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Thokozeni Lipato
- Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond VA, USA
| | - Warren K. Bickel
- Addiction Recovery Research Center, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke VA, USA
| | - Caroline O. Cobb
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond VA, USA
- Department of Psychology, Virginia Commonwealth University, Richmond VA, USA
| | - Andrew J. Barnes
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond VA, USA
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Population Health, Richmond VA, USA
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168
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Xu K, Lee T, Reyes-Guzman CM, Davis Lynn BC, Kofie JN, Rostron BL, Chang CM, Chang JT. Use patterns of flavored non-cigarette tobacco products among US adults, 2010-2019. Prev Med 2024; 180:107870. [PMID: 38272271 PMCID: PMC10923177 DOI: 10.1016/j.ypmed.2024.107870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/03/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024]
Abstract
OBJECTIVE Flavored non-cigarette tobacco product (NCTP) use is common among US adult tobacco users. To update the estimates of use patterns of flavored NCTPs, this study assessed current NCTP use among adults by flavor use and flavor categories from 2010 to 2019. METHODS We analyzed data from the 2010-2019 Tobacco Use Supplement to the Current Population Survey to estimate the weighted proportion of adult NCTP users by flavor use across survey waves. Flavor use was defined as past 30-day use of any menthol/mint or fruit/other flavors. We used the 2018-2019 data to examine the differences in demographic characteristics and tobacco use patterns among users of menthol/mint or fruit/other flavors compared to exclusive users of tobacco flavor, by product type. RESULTS Compared to 2014-2015, electronic nicotine delivery system (ENDS) users were more likely (79.0% vs. 66.6%, p < 0.001) to report flavor use in 2018-2019, whereas cigar (26.9% vs. 31.2%, p = 0.030) and pipe (56.3% vs. 65.5%, p = 0.015) smokers were less likely to report flavor use in 2018-2019. In 2018-2019, the most prevalent flavor categories were exclusive use of tobacco flavor among cigar (73.1%) and smokeless tobacco (48.3%) users, and use of fruit/other flavors among ENDS (64.9%) and pipe (48.4%) users. Flavored users were more likely to be young adults aged 18-24 years (cigars, ENDS, smokeless tobacco) and Non-Hispanic Black or Hispanic persons (cigars, ENDS, pipes) compared to tobacco-flavored users. CONCLUSIONS Flavored product use increased among adult ENDS users but decreased among cigar and pipe smokers. These findings could inform tobacco regulatory efforts concerning flavored NCTPs.
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Affiliation(s)
- Kerui Xu
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA.
| | - Terrence Lee
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - Carolyn M Reyes-Guzman
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Brittny C Davis Lynn
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - Justina N Kofie
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - Brian L Rostron
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - Cindy M Chang
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - Joanne T Chang
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
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Pradhyumnan H, Patel SH, Furones-Alonso O, Zhao W, Bramlett HM, Raval AP. Electronic Cigarette Vape Exposure Exacerbates Post-Ischemic Outcomes in Female but Not in Male Rats. Stroke 2024; 55:735-746. [PMID: 38323450 PMCID: PMC10940219 DOI: 10.1161/strokeaha.123.046101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/11/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND Nicotine-containing electronic cigarette (EC) vaping has become popular worldwide, and our understanding of the effects of vaping on stroke outcomes is elusive. Using a rat model of transient middle cerebral artery occlusion, the current exploratory study aims to evaluate the sex-dependent effects of EC exposure on brain energy metabolism and stroke outcomes. METHODS Adult Sprague-Dawley rats of both sexes were randomly assigned to air/EC vapor (5% nicotine Juul pods) exposure for 16 nights, followed by randomization into 3 cohorts. The first cohort underwent exposure to air/EC preceding randomization to transient middle cerebral artery occlusion (90 minutes) or sham surgery, followed by survival for 21 days. During the survival period, rats underwent sensorimotor and Morris water maze testing. Subsequently, brains were collected for histopathology. A second cohort was exposed to air/EC after which brains were collected for unbiased metabolomics analysis. The third cohort of animals was exposed to air/EC and received transient middle cerebral artery occlusion/sham surgery, and brain tissue was collected 24 hours later for biochemical analysis. RESULTS In females, EC significantly increased (P<0.05) infarct volumes by 94% as compared with air-exposed rats, 165±50 mm3 in EC-exposed rats, and 85±29 mm3 in air-exposed rats, respectively, while in males such a difference was not apparent. Morris water maze data showed significant deficits in spatial learning and working memory in the EC sham or transient middle cerebral artery occlusion groups compared with the respective air groups in rats of both sexes (P<0.05). Thirty-two metabolites of carbohydrate, glycolysis, tricarboxylic acid cycle, and lipid metabolism were significantly altered (P≤0.05) due to EC, 23 of which were specific for females. Steady-state protein levels of hexokinase significantly decreased (P<0.05) in EC-exposed females; however, these changes were not seen in males. CONCLUSIONS Even brief EC exposure over 2 weeks impacts brain energy metabolism, exacerbates infarction, and worsens poststroke cognitive deficits in working memory more in female than male rats.
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Affiliation(s)
- Hari Pradhyumnan
- Peritz Scheinberg Cerebral Vascular Disease Research Laboratories, Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Shahil H. Patel
- Peritz Scheinberg Cerebral Vascular Disease Research Laboratories, Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Ofelia Furones-Alonso
- Department of Neurological Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Weizhao Zhao
- Department of Biomedical Engineering, University of Miami, Coral Gables, FL 33146, USA
| | - Helen M. Bramlett
- Department of Neurological Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL 33136, USA
- Neuroscience Program, Leonard M. Miller School of Medicine, University of Miami, Miami, FL 33136, USA
- Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, FL 33136, USA
| | - Ami P. Raval
- Peritz Scheinberg Cerebral Vascular Disease Research Laboratories, Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Miami, FL 33136, USA
- Neuroscience Program, Leonard M. Miller School of Medicine, University of Miami, Miami, FL 33136, USA
- Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, FL 33136, USA
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170
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Stickler A, Hawkey AB, Gondal A, Natarajan S, Mead M, Levin ED. Embryonic exposures to cadmium and PAHs cause long-term and interacting neurobehavioral effects in zebrafish. Neurotoxicol Teratol 2024; 102:107339. [PMID: 38452988 PMCID: PMC10990771 DOI: 10.1016/j.ntt.2024.107339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/15/2024] [Accepted: 03/03/2024] [Indexed: 03/09/2024]
Abstract
Developmental exposure to either polycyclic aromatic hydrocarbons (PAHs) or heavy metals has been shown to cause persisting and overlapping neurobehavioral effects in animal models. However, interactions between these compounds have not been well characterized, despite their co-occurrence in a variety of environmental media. In two companion studies, we examined the effects of developmental exposure to cadmium (Cd) with or without co-exposure to prototypic PAHs benzo[a]pyrene (BaP, Exp. 1) or fluoranthene (FA, Exp. 2) using a developing zebrafish model. Zebrafish embryos were exposed to Cd (0-0.3 μM), BaP (0-3 μM), FA (0-1.0 μM), or binary Cd-PAH mixtures from 5 to 122 h post fertilization (hpf). In Exp. 1, Cd and BaP produced independent effects on an array of outcomes and interacting effects on specific outcomes. Notably, Cd-induced deficits in dark-induced locomotor stimulation were attenuated by BaP co-exposure in the larval motility test and BaP-induced hyperactivity was attenuated by Cd co-exposure in the adolescent novel tank test. Likewise, in Exp. 2, Cd and FA produced both independent and interacting effects. FA-induced increases on adult post-tap activity in the tap startle test were attenuated by co-exposure with Cd. On the predator avoidance test, FA- and 0.3 μM Cd-induced hyperactivity effects were attenuated by their co-exposure. Taken together, these data indicate that while the effects of Cd and these representative PAHs on zebrafish behavior were largely independent of one another, binary mixtures can produce sub-additive effects for some neurobehavioral outcomes and at certain ages. This research emphasizes the need for detailed risk assessments of mixtures containing contaminants of differing classes, and for clarity on the mechanisms which allow cross-class toxicant interactions to occur.
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Affiliation(s)
- Alexandra Stickler
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA
| | - Andrew B Hawkey
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA; Department of Biomedical Sciences, Midwestern University, Downers Grove, IL 60515, USA
| | - Anas Gondal
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA
| | - Sarabesh Natarajan
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA
| | - Mikayla Mead
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA
| | - Edward D Levin
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA.
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171
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Martino SC, Setodji CM, Dunbar MS, Jenson D, Wong JCS, Torbatian A, Shadel WG. Does Reducing the Size of the Tobacco Power Wall Affect Young People's Risk of Future Use of Tobacco Products? An Experimental Investigation. J Stud Alcohol Drugs 2024; 85:234-243. [PMID: 38206655 PMCID: PMC10941820 DOI: 10.15288/jsad.23-00174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 12/12/2023] [Indexed: 01/12/2024] Open
Abstract
OBJECTIVE A ban on tobacco power walls (in-store package displays) is unlikely in the United States because of concerns that such bans violate commercial free speech rights. This experiment evaluated the effectiveness of a more measured strategy for mitigating the influence of the power wall on young people's susceptibility to tobacco use: limiting its size. METHOD The experiment took place in the RAND StoreLab, a life-sized replica of a convenience store. Participants (N = 275) ages 11-20 years were randomly assigned to shop in a variant of the StoreLab that had either a large (status quo), medium, or small power wall situated behind the checkout counter. Before and after shopping, participants completed measures of risk of future use of unflavored and flavored cigarettes and vaping products. RESULTS Study condition was unrelated to future risk of smoking unflavored cigarettes, using menthol vaping products, and using sweet-flavored vaping products. Study condition was related to future risk of smoking menthol cigarettes and using unflavored vaping products; compared with exposure to a large power wall, exposure to a small power wall increased the odds of a participant's being at risk for future smoking of menthol cigarettes (odds ratio [OR] = 3.29, 95% CI [1.10, 9.83]) and the odds of a participant's being at risk for using unflavored vaping products (OR = 4.09, 95% CI [1.41, 11.85]). CONCLUSIONS These findings call into question the viability of reducing the size of the power wall as a singular strategy for dampening its effect on young people's susceptibility to tobacco use.
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Affiliation(s)
| | | | | | - Desmond Jenson
- Public Health Law Center, Mitchell Hamline School of Law, Saint Paul, Minnesota
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172
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Schiestl ET, Gearhardt AN, Wolfson J. The qualitative evaluation of food addiction across the lifespan. Appetite 2024; 194:107170. [PMID: 38147964 DOI: 10.1016/j.appet.2023.107170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 11/14/2023] [Accepted: 12/13/2023] [Indexed: 12/28/2023]
Abstract
Although it remains controversial, food addiction (FA) research has expanded substantially and empirical evidence for FA is growing. While quantitative studies have explored the prevalence and correlates of FA during childhood and adolescence, little is known about the perceived lived experience of FA across the lifespan, nor how experiences and perceptions of FA may change over time. For this study, 16 participants who met symptom threshold criteria for FA on the Yale Food Addiction Scale 2.0 completed in-depth, semi-structured qualitative interviews focused on their perceptions of the development of FA overtime, and perceived risk and protective factors. Thematic analysis was used to develop themes about the lived experience of FA in childhood, adolescence, and adulthood. Overall, highly palatable foods were viewed as the most problematic, while minimally processed foods were less associated with impairment and distress. Themes in childhood included a strong desire for highly processed foods and the perception that parental control over food choices could be either protective or risky for the later development of FA depending on which foods were available at home. In adolescence and young adulthood, increasing autonomy over food choices and the high availability of highly processed foods in the college environment were viewed as risk factors. Additionally, weight gain was a prominent theme. Finally, adulthood was characterized by more severe manifestations of FA, and the stress of adult responsibilities (e.g., work, parenting) contributed to this perception. This research sets the stage for future quantitative studies to explore these novel findings at the population level.
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173
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Sumbe A, Suchting R, Chen B, Wilkinson AV, Bataineh B, Clendennen SL, Harrell MB. Examining psychometric properties of the Metacognitions about Smoking Questionnaire among young e-cigarette users. Addict Behav 2024; 150:107913. [PMID: 37992452 DOI: 10.1016/j.addbeh.2023.107913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 11/06/2023] [Accepted: 11/18/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVE Metacognition can be understood as 'cognition of cognition' or 'thinking about thinking'. Metacognition research has primarily focused on cigarette smoking, while e-cigarette use has been relatively unexplored. The study sought to examine the properties of the Metacognitions about Smoking Questionnaire (MSQ), as it was adapted for use among adolescent and young adult e-cigarette users. Further, the study sought to examine the ability of the Metacognitions about Smoking Questionnaire (MSQ) to predict past 30-day e-cigarette use among adolescent and young adult e-cigarette users. METHODS The study analyzed data collected by the Texas Adolescent Tobacco and Marketing Surveillance System (TATAMS) in Spring 2020. The instrument consisted of 20 items found to have sound psychometric properties when validated among self-defined cigarette smokers in the UK. The instrument was adapted for e-cigarette use by providing a brief description before the items. Participants were asked "Which of the following products you use most often?", and those who selected "e-cigarettes" were included in the study. Participants were then presented with 20 statements about beliefs people hold about using e-cigarette and were instructed to determine their agreement with the statements on a four-point Likert scale with respect to e-cigarette use. Factors were extracted using Exploratory Factor Analysis (EFA) and factor structure was verified using Confirmatory Factor Analysis (CFA). Further, each of the extracted factors were used to predict past 30-day e-cigarette use frequency in the most frequent group, using conditional effects, holding the most frequent category of categorical covariates, mean of continuous covariates and the other two metacognitive factors as reference levels. Past 30-day e-cigarette use was measured as the number of days of use in the past 30-days. RESULTS Participants who reported e-cigarette use in the past 30-days were included in this analysis (n = 244). Participants were in 10th grade (n = 46), 12th grade (n = 92) and two years beyond high school (n = 106). EFA was conducted and items were assessed with varimax rotation. CFA was conducted with multiple models (one factor, two factor and three factor solutions) and the 3-factor solution showed the best fit. Factors were named as 'positive metacognitions about cognitive regulation'(PMCR) (e.g. '…helps me think more clearly'), 'positive metacognitions about emotional regulation'(PMER) (e.g. '…helps me to relax when I am agitated'), and 'negative metacognitions'(NM) (e.g. 'It is hard to control my desire for e-cigarettes'). Cronbach's alpha showed high internal consistency (0.92, 0.90 and 0.91, respectively). The median score (range) was 7 (5-20), 10 (5-20), and 11 (10-40) on PMCR, PMER, and NM factors. Higher scores denote higher levels of outcome expectancies of that factor. Lowest and highest score on PMCR was associated with 15 and 20.4 days of e-cigarette use in the past 30-days, respectively. Similarly, lowest and highest score on PMER and NM were associated with 13.2 and 21 days, and 14.7 and 24.6 days, respectively. The results indicate that participants who reported highest outcome expectancies for cognitive regulation, emotional regulation, and negative outcomes, used e-cigarettes on average 5, 8 and 10 days more than those who reported lowest outcome expectancies for these factors. CONCLUSION The MSQ showed good psychometric soundness for measuring metacognitive factors associated with e-cigarette use. For cigarette smoking, the original questionnaire distinguished negative cognitions of 'uncontrollability' and 'cognitive interference', which was not seen in e-cigarette users. This indicates a difference in cognitions of cigarette and e-cigarette users. The instrument can help understand the similar role of cognition in e-cigarette use behavior and further assess association with e-cigarette use.
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Affiliation(s)
- Aslesha Sumbe
- University of Texas Health Science Center, School of Public Health, Austin, TX, USA
| | - Robert Suchting
- McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - Baojiang Chen
- University of Texas Health Science Center, School of Public Health, Austin, TX, USA
| | - Anna V Wilkinson
- University of Texas Health Science Center, School of Public Health, Austin, TX, USA
| | - Bara Bataineh
- University of Texas Health Science Center, School of Public Health, Dallas, TX, USA
| | | | - Melissa B Harrell
- University of Texas Health Science Center, School of Public Health, Austin, TX, USA.
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174
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Pokhrel P, Kawamoto CT, Lipperman-Kreda S, Amin S, Charles P, Danko A, Valente T, Sussman S. Young adult peer crowds, e-cigarette advertising exposure, and e-cigarette use: Test of a mediation model. Drug Alcohol Depend 2024; 256:111064. [PMID: 38295509 PMCID: PMC11034631 DOI: 10.1016/j.drugalcdep.2023.111064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 12/02/2023] [Accepted: 12/09/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND Young people often make lifestyle choices or engage in behaviors, including tobacco product use, based on the norms of peer crowds they affiliate with. Peer crowds are defined as reputation-based peer groups centered around lifestyle norms (e.g., Hipster, Surfer, Hip Hop). This study examined the effects of peer crowd affiliation on e-cigarette use via increased exposure to e-cigarette advertising and increased social network e-cigarette use. METHOD Data were collected from 1398 ethnically diverse young adults (Mean age = 22.3; SD = 3.2; 62% women) in six-month intervals over one year. Path analyses were used to test a mediation model in which advertising exposure and social network e-cigarette use at six-month follow-up were specified to mediate the effects of baseline peer crowd affiliation on current e-cigarette use at one-year follow-up. RESULTS Affiliations with Popular-Social and Alternative peer crowds at baseline were associated with higher e-cigarette advertising exposure at six-month follow-up. Affiliation with Popular-Social peer crowd at baseline was associated with increased social network e-cigarette use at six-month follow-up. Affiliation with Popular-Social peer crowds at baseline was found to have a statistically significant indirect effect on increased e-cigarette use at one-year follow-up via increased e-cigarette advertising exposure at six-month follow-up. CONCLUSIONS Better understanding Popular-Social peer crowds may be highly relevant for development of tailored media and other interventions for e-cigarette use prevention among young adults.
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Affiliation(s)
- Pallav Pokhrel
- Population Sciences in the Pacific, University of Hawaii Cancer Center, University of Hawaii at Mānoa, 701 Ilalo St, Honolulu, HI 96813, United States.
| | - Crissy T Kawamoto
- Population Sciences in the Pacific, University of Hawaii Cancer Center, University of Hawaii at Mānoa, 701 Ilalo St, Honolulu, HI 96813, United States
| | - Sharon Lipperman-Kreda
- Prevention Research Center, Pacific Institute for Research and Evaluation, 2030 Addison St, Berkeley, CA 94704, United States
| | - Samia Amin
- Population Sciences in the Pacific, University of Hawaii Cancer Center, University of Hawaii at Mānoa, 701 Ilalo St, Honolulu, HI 96813, United States
| | - Paxton Charles
- Population Sciences in the Pacific, University of Hawaii Cancer Center, University of Hawaii at Mānoa, 701 Ilalo St, Honolulu, HI 96813, United States
| | - Ana Danko
- John A. Burns School of Medicine, University of Hawaii at Manoa, 651 Ilalo St, Honolulu, HI 96813, United States
| | - Thomas Valente
- Population and Public Health Sciences, Keck School of Medicine, University of Southern California, SSB 302W 2001 N. Soto Street, Los Angeles, CA 90031, United States
| | - Steve Sussman
- Population and Public Health Sciences, Keck School of Medicine, University of Southern California, SSB 302W 2001 N. Soto Street, Los Angeles, CA 90031, United States
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175
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Setodji CM, Martino SC, Dunbar M, Kim KJ, Jenson D, Wong JCS, Shadel WG. Measuring susceptibility to use tobacco in an increasingly complex consumer marketplace: How many questions do we really need? PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2024:2024-59384-001. [PMID: 38421778 PMCID: PMC11358647 DOI: 10.1037/adb0000997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
OBJECTIVE Predicting which young people are likely to use tobacco in the future is critical for prevention and intervention. Although measures for assessing susceptibility to using tobacco have fulfilled this goal for decades, there is almost no standard for the number of items that should be administered, or which items should be administered for which products. This study explored whether brief but psychometrically sound versions of commonly used susceptibility measures can adequately capture the construct relative to longer measures. METHOD A sample of young people (N = 451; Mage = 16.5 years; 64% females; 65% White) completed 33 susceptibility items, which are designed to assess susceptibility to use different types of tobacco products (cigarette, smokeless tobacco, vaping products, and little cigars/cigarillos) of various flavors (tobacco, menthol, and sweet). RESULTS Analysis of these 33 items indicated that asking about the likelihood of using each tobacco product class when a best friend offers it (four items in all) captures 98.5% of information that is captured using the longer set of items; asking the best friend question for each product by each flavor category (11 items in all) captures 99.7% of the information. CONCLUSIONS Depending on research needs, tobacco use susceptibility can be measured with little loss of information by administering a limited set of items assessing the likelihood that a young person will use a tobacco product if a friend offers it for any product-flavor combination. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | - Desmond Jenson
- Public Health Law Center, Mitchell Hamline School of Law,
Saint Paul, MN 55105
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176
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Ma S, Kaareen A, Park H, He Y, Jiang S, Qiu Z, Xie Z, Li D, Chen J, O'Connor RJ, Fong GT, Shang C. How to Identify e-Cigarette Brands Available in the United States During 2020-2022: Development and Usability Study. JMIR Form Res 2024; 8:e47570. [PMID: 38416562 PMCID: PMC10938231 DOI: 10.2196/47570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 10/31/2023] [Accepted: 01/30/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Prior studies have demonstrated that the e-cigarette market contains a large number of brands. Identifying these existing e-cigarette brands is a key element of market surveillance, which will further assist in policy making and compliance checks. OBJECTIVE To facilitate the surveillance of the diverse product landscape in the e-cigarette market, we constructed a semantic database of e-cigarette brands that have appeared in the US market as of 2020-2022. METHODS In order to build the brand database, we searched and compiled e-cigarette brands from a comprehensive list of retail channels and sources, including (1) e-liquid and disposable brands sold in web-based stores, (2) e-cigarette brands sold in brick-and-mortar stores and collected by the Nielsen Retail Scanner Data, (3) e-cigarette brands compiled by Wikipedia, (4) self-reported e-cigarette brands from the 2020 International Tobacco Control Four-Country Smoking and Vaping (ITC 4CV) US survey, and (5) e-cigarette brands on Twitter. We also estimated the top 5 e-cigarette brands by sales volume in brick-and-mortar stores, by the frequency and variety of offerings in web-based shops, and by the frequency of self-reported brands from the 2020 ITC 4CV US survey. RESULTS As of 2020-2022, a total of 912 e-cigarette brands have been sold by various retail channels. During 2020-2022, the top 5 brands are JUUL, vuse, njoy, blu, and logic in brick-and-mortar stores; blu, king, monster, twist, and air factory for e-liquids in web-based stores; hyde, pod mesh, suorin, vaporlax, and xtra for disposables sold in web-based stores; and smok, aspire, vaporesso, innokin, and eleaf based on self-reported survey data. CONCLUSIONS As the US Food and Drug Administration enforces the premarket tobacco market authorization, many e-cigarette brands may become illegal in the US market. In this context, how e-cigarette brands evolve and consolidate in different retail channels will be critical for understanding the regulatory impacts on product availability. Our semantic database of e-cigarette brands can serve as a useful tool to monitor product and marketplace development, conduct compliance checks, assess manufacturers' marketing behaviors, and identify regulatory impacts.
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Affiliation(s)
- Shaoying Ma
- Center for Tobacco Research, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Aadeeba Kaareen
- Center for Tobacco Research, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Hojin Park
- Center for Tobacco Research, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Yanyun He
- Center for Tobacco Research, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Shuning Jiang
- Department of Computer Science and Engineering, The Ohio State University, Columbus, OH, United States
| | - Zefeng Qiu
- Department of Computer Science and Engineering, The Ohio State University, Columbus, OH, United States
| | - Zidian Xie
- Department of Clinical and Translational Research, University of Rochester Medical Center, Rochester, NY, United States
| | - Dongmei Li
- Department of Clinical and Translational Research, University of Rochester Medical Center, Rochester, NY, United States
| | - Jian Chen
- Department of Computer Science and Engineering, The Ohio State University, Columbus, OH, United States
| | - Richard J O'Connor
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Ce Shang
- Center for Tobacco Research, The Ohio State University Wexner Medical Center, Columbus, OH, United States
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
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177
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Leigh NJ, Page MK, Robinson DL, Heldwein SD, O’Connor RJ, Goniewicz ML. Nicotine, Humectants, and Tobacco-Specific Nitrosamines (TSNAs) in IQOS Heated Tobacco Products (HTPs): A Cross-Country Study. TOXICS 2024; 12:180. [PMID: 38535913 PMCID: PMC10974984 DOI: 10.3390/toxics12030180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 04/01/2024]
Abstract
Heated Tobacco Products (HTPs) purport to reduce exposure to tobacco-related toxicants compared to combustible cigarettes. This cross-sectional study examined the content of nicotine, two humectants (propylene glycol (PG) and vegetable glycerin (VG)), and four tobacco-specific nitrosamines (TSNAs: NNN, NNK, NAT, and NAB) in the tobacco filler of a popular HTP brand (IQOS). Non-menthol and menthol IQOS sticks were purchased from nine countries between 2017 and 2020 and were classified into two versions ("Bold" and "Light") using Philip Morris's flavor descriptors. The average nicotine concentration was 4.7 ± 0.5 mg/stick, and the highest nicotine concentration was found in products from Japan (5.1 ± 0.2 mg/stick). VG was the dominant humectant found in all sticks, with an average concentration of (31.5 ± 2.3 mg/stick). NNN, NNK, and NAT were substantially higher in the "Bold" sticks than the "Light" sticks. Significant differences between countries for TSNAs were also observed: the NAT and NAB contents were the highest in the "Light" products from Canada (192.5 ± 24.1 and 22.9 ± 1.0 ng/stick, respectively); the NNK concentration was the highest in the "Bold" products from Poland (64.8 ± 7.9 ng/stick); and the highest NNN concentrations were observed in the "Bold" products from South Africa (488.9 ± 26.7 ng/stick). As NNN and NNK are known human carcinogens, and as humectants like PG and VG can degrade into toxic carbonyl compounds upon heating, monitoring the concentration of these chemicals in HTPs is important for protecting users' health and ensuring compliance with regulations.
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Affiliation(s)
- Noel J. Leigh
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (N.J.L.); (R.J.O.)
| | - Michelle K. Page
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (N.J.L.); (R.J.O.)
| | - Denisha L. Robinson
- Department of Cell Stress Biology, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA;
| | - Scott D. Heldwein
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (N.J.L.); (R.J.O.)
| | - Richard J. O’Connor
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (N.J.L.); (R.J.O.)
| | - Maciej L. Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (N.J.L.); (R.J.O.)
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178
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Silver N, Kucherlapaty P, Kierstead E, Schillo B. Objective Characteristics and Subjective Responses of 18-24-Year-Olds to U.S. nationally Televised Tobacco Advertisements. Subst Use Misuse 2024; 59:1115-1125. [PMID: 38409656 DOI: 10.1080/10826084.2024.2320394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
Background: Restrictions on televised tobacco ads do not apply to vaping and oral nicotine products. Several campaigns are currently active on U.S. national television. This research examines the extent to which objective ad features are associated with ad, brand, and product appeal and use intentions among 18-24-year-olds. Methods: We identified seven unique campaigns for Vuse, Velo, and JUUL from the Mintel Comperemedia database, coded for youth-appealing content, and then randomly assigned among N = 1450 18-24-year-olds. Following exposure to one 15-second ad, participants completed a survey assessing their subjective responses. Results: Youth-appealing content was prevalent across these ads to varying degrees. Mixed effects regression analyses showed a positive association between features from the Content Appealing to Youth (CAY) index and pro-social brand perceptions, positive attitudes, reactions, and perceived effectiveness of the ad, and positive use perceptions. Moreover, themes related to customization of the device and environmental sustainability were associated with similar positive perceptions, including that using the product would be cool, as well as behavioral intentions to try, use occasionally, and use daily. Conclusions: Regulators need to update tobacco advertising restrictions to accurately reflect the current tobacco product landscape. This study contributes to the research on tobacco promotion strategies by examining the current marketing landscape for newer tobacco products and their appeal to youth. Findings from this study inform comprehensive tobacco marketing regulations, recommending the FDA update its guidelines and apply current marketing restrictions to e-cigarettes and oral nicotine products.
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Affiliation(s)
- Nathan Silver
- Truth Initiative Schroeder Institute, Washington, DC, USA
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179
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Soule EK, Mayne S, Snipes W, Guy MC, Breland A, Fagan P. Reactions to a Hypothetical Ban of Open-System Electronic Cigarettes Among People Who Currently Use Electronic Cigarettes. Nicotine Tob Res 2024:ntae020. [PMID: 38408200 DOI: 10.1093/ntr/ntae020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/13/2023] [Accepted: 01/19/2024] [Indexed: 02/28/2024]
Abstract
INTRODUCTION Policies limiting electronic cigarette (ECIG) device and liquid characteristics have been considered to prevent dependence potential and youth product appeal. "Open-system" ECIGs allow people to adjust device and liquid characteristics, which may undermine these policies. This study examined anticipated reactions to a policy prohibiting the sale of open-system ECIG devices in the United States using concept mapping. METHODS In 2020, adults who reported ECIG use in the past 30 days (n = 70; 45.1% women; mean age = 33.0, SD = 10.6) recruited from a research registry of individuals from across the United States provided statements into a shared list that completed a prompt: "If open-system vaping devices were no longer sold in the US and only closed-system vaping devices were available, what is a specific reaction or response you would have?" at a study website. Participants rated statements (1-7) on how true the statements were for them. Multidimensional scaling and hierarchical cluster analyses were used to identify thematic clusters. Mean ratings of statements were calculated and compared based on the type of ECIG used and current cigarette smoking status. RESULTS Participants generated 85 unique statements. The analysis identified eight themes that were organized into two broad groups. The first group of five clusters described behavioral responses to the hypothetical policy (Loopholes, Switch to Closed-System ECIGs, Legal Approaches to Use Open-System ECIGs, ECIG Use Cessation, Switch to non-ECIG Products). The second group of three clusters described psychological responses to the hypothetical policy (Closed-System ECIG Cons, Psychological Responses, Policy Outcome Concerns). CONCLUSIONS While a ban on open-system ECIG devices may have positive impacts on public health, policy loopholes, and consumer behaviors may undermine the policy. Efforts to support policy enforcement could increase policy effectiveness. IMPLICATIONS Open-system electronic cigarettes (ECIGs) that allow people who use ECIGs to modify ECIG device and liquid characteristics may limit the effectiveness of policies that establish product standards which attempt to limit nicotine delivery and flavor content in ECIG liquids. This study identified predicted reactions to a hypothetical policy prohibiting the sale of open-system ECIGs in the United States. Results suggest that people who use ECIGs may view a policy prohibiting open-system ECIGs unfavorably, but would be willing to use closed-system ECIGs. However, many ECIG users may attempt to find loopholes in the policy or alternative sources to purchase open-system ECIGs if open-systems were banned. Future research should identify strategies for tobacco regulatory policy enforcement to increase effectiveness.
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Affiliation(s)
- Eric K Soule
- Department of Health Education and Promotion, East Carolina University, Greenville, NC, USA
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA
| | - Shannon Mayne
- Department of Health Education and Promotion, East Carolina University, Greenville, NC, USA
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA
| | - William Snipes
- Department of Health Education and Promotion, East Carolina University, Greenville, NC, USA
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA
| | - Mignonne C Guy
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA
- Department of African American Studies, College of Humanities and Sciences, Virginia Commonwealth University, Richmond, VA, USA
| | - Alison Breland
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA
- Department of Psychology, College of Humanities and Sciences, Virginia Commonwealth University, Richmond, VA, USA
| | - Pebbles Fagan
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA
- Department of Health Behavior and Health Education, Fay W. Boozman College of Public Health, Center for the Study of Tobacco, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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180
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Haynes A, Winnall WR, Brennan E, Dunstone K, Benowitz NL, Ashley DL, Samet JM, Hatsukami DK, Wakefield MA. Tobacco Constituents, Flavorants, and Paper Permeability of Factory-Made and Roll-Your-Own Cigarettes on the Australian Market. Nicotine Tob Res 2024; 26:289-297. [PMID: 37462724 DOI: 10.1093/ntr/ntad122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 05/24/2023] [Indexed: 02/23/2024]
Abstract
INTRODUCTION Roll-your-own (RYO) tobacco is a popular choice in Australia, with some people who smoke finding these products more attractive than factory-made cigarettes (FMC). Differences in visual and tactile properties and in the feel and taste of the smoke may contribute to this attractiveness. These differences may be driven by variation in tobacco constituents and wrapping paper permeability. However, to date, there has been no comparison of RYO and FMC products on the Australian market. AIMS AND METHODS Chemical constituents, pH, flavorants, and paper permeability were compared in unburned RYO tobacco and tobacco from FMC. RYO and FMC products from matched brands were compared, as were products from the most popular FMC and RYO brands on the Australian market in 2018. RESULTS RYO tobacco had higher moisture and humectant content (glycerol and propylene glycol) than FMC tobacco. RYO tobacco also had higher amounts of total and reducing sugars and lower nicotine when comparing the most popular brands. RYO papers were less permeable than FMC papers. Both RYO and FMC tobacco contained many chemicals identified as flavorants, including fourteen with known potential health risks. For most measured constituents and flavorants, RYO tobaccos had more in common with other RYO than FMC, with the commonalities remaining even when matched brands were compared. CONCLUSIONS Higher levels of moisture, humectants, and sugars in Australian RYO tobacco compared to FMC may be increasing attractiveness of RYO by reducing the harsh taste of the smoke and increasing the moist feel of the tobacco. IMPLICATIONS While price is the main factor driving the use of RYO tobacco, some people who smoke find these products more attractive. This study has shown that Australian RYO tobacco contains higher amounts of glycerol, propylene glycol, and sugars than FMC. These chemicals may be improving the taste of the tobacco, as well as creating a moist feel that is falsely perceived as indicating that the tobacco is "fresh" and "less chemically." Ironically, it may be that higher amounts of some added chemicals in RYO contribute to false perceptions of a more natural and less harmful product.
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Affiliation(s)
- Ashleigh Haynes
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, VIC, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Wendy R Winnall
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, VIC, Australia
| | - Emily Brennan
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, VIC, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Kimberley Dunstone
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, VIC, Australia
| | - Neal L Benowitz
- School of Medicine, University of California, San Francisco, CA, USA
| | - David L Ashley
- School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Jonathan M Samet
- Colorado School of Public Health, University of Colorado Anschutz, Aurora, CO, USA
| | - Dorothy K Hatsukami
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Melanie A Wakefield
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, VIC, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
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Taylor E, Simonavičius E, McNeill A, Brose LS, East K, Marczylo T, Robson D. Exposure to Tobacco-Specific Nitrosamines Among People Who Vape, Smoke, or do Neither: A Systematic Review and Meta-Analysis. Nicotine Tob Res 2024; 26:257-269. [PMID: 37619211 PMCID: PMC10882431 DOI: 10.1093/ntr/ntad156] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 08/02/2023] [Accepted: 08/21/2023] [Indexed: 08/26/2023]
Abstract
INTRODUCTION Smoking exposes people to high levels of Tobacco-Specific Nitrosamines (TSNAs), which include potent carcinogens. We systematically reviewed TSNA exposure between people smoking, vaping, and doing neither. AIMS AND METHODS Databases were searched between August 2017-March 2022, using vaping-related terms. Peer-reviewed articles reporting TSNA metabolites (NNAL, NNN, NAB, and NAT) levels in bio-samples among adults exclusively vaping, exclusively smoking, or doing neither were included. Where possible, meta-analyses were conducted. RESULTS Of 12 781 identified studies, 22 were included. TSNA levels fell substantially when people who smoke switched to vaping in longitudinal studies and were lower among people who vaped compared to smoked in cross-sectional studies. Levels of TSNAs were similar when comparing people who switched from smoking to vaping, to those who switched to no use of nicotine products, in longitudinal studies. Levels were higher among people who vaped compared to people who neither vaped nor smoked in cross-sectional studies.When comparing people who vaped to smoked: pooled urinary NNAL was 79% lower across three randomized controlled trials and 96% lower across three cross-sectional studies; pooled NAB was 87% lower and NAT 94% lower in two cross-sectional studies. When comparing people who neither vaped nor smoked to people who vaped, pooled urinary NNAL was 80%, NAB 26%, and NAT 27% lower in two cross-sectional studies. Other longitudinal data, and NNN levels could not be pooled. CONCLUSIONS Exposure to all TSNAs was lower among people who vaped compared to people who smoked. Levels were higher among people who vaped compared to people who neither vaped nor smoked. IMPLICATIONS As well as TSNAs, there are many other toxicant exposures from smoking and vaping that can increase the risk of disease. However, it is likely that the reduced exposure to TSNAs from vaping relative to smoking reduces the risk to health of those who use vaping products to quit smoking. Future high-quality research, with robust definitions of exclusive vaping and smoking, and accounting for TSNAs half-lives, is needed to fully assess exposure to TSNAs among people who vape.
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Affiliation(s)
- Eve Taylor
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College, London, UK
- NIHR HPRU Environmental Exposures and Health, London, UK
| | - Erikas Simonavičius
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College, London, UK
| | - Ann McNeill
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College, London, UK
- NIHR HPRU Environmental Exposures and Health, London, UK
- SPECTRUM Consortium, London, UK
- NIHR ARC SouthLondon, Oxford, UK
| | - Leonie S Brose
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College, London, UK
- SPECTRUM Consortium, London, UK
| | - Katherine East
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College, London, UK
| | - Tim Marczylo
- NIHR HPRU Environmental Exposures and Health, London, UK
- Radiation, Chemical and Environmental Hazards, UK Health Security Agency (UKHSA)
| | - Debbie Robson
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College, London, UK
- NIHR HPRU Environmental Exposures and Health, London, UK
- SPECTRUM Consortium, London, UK
- NIHR ARC SouthLondon, Oxford, UK
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Franchitto N, Bloch J, Solal C, Pélissier F. Self-poisoning by E-cigarette and E-liquids: National Reports to French Poison Control Centers from July 2019 to December 2020: VIGIlance and VAPE: The VIGIVAPE Study. Nicotine Tob Res 2024; 26:281-288. [PMID: 37422917 DOI: 10.1093/ntr/ntad116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 06/25/2023] [Accepted: 07/08/2023] [Indexed: 07/11/2023]
Abstract
INTRODUCTION Exposure to e-cigarette liquids, whether intentional or accidental, might lead to adverse events. This study aimed to describe the prevalence and characteristics of exposures to e-liquids reported to French Poison Control Centers. METHODS All e-liquids exposure cases reported to French Poison Control Centers from July 1, 2019, to December 31, 2020, were reviewed. Information was collected about the patient's characteristics, exposure circumstances, management and outcome. RESULTS About 919 cases of exposure to e-liquids were reported. Ages ranged from one month to 89 years, with a mean age of 16.6 ± 18.6 years and a median age of 4 years. The highest number of exposures-50.7%-concerned infants (0-4 years), 3.1% children (5-11 years), 5.9% adolescents (12-17 years), and 40.1% of cases concerned adults. The majority of cases were accidental (95.0%). Intentional exposures (4.9%) were mainly observed in patients older than 12 years of age (P < 0.001). The route of exposure was ingestion in 73.7% of the cases. A total of 455 exposures showed no symptoms or signs related to poisoning. High nicotine concentration in e-liquids was associated with an increase in hospital management (Odds-ratio from 1.77 to 2.60). CONCLUSION Involuntary exposures to e-liquids occurred more often in children under the age of five, mainly by ingestion. Unlike intentional ingestions, unintentional ingestions rarely resulted in severe adverse events. These findings highlight the importance of ongoing surveillance to prevent such exposures and associated injuries, emphasizing the need for effective regulation of these products.
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Affiliation(s)
- Nicolas Franchitto
- Service d'Addictologie Universitaire, Centre Hospitalier de Toulouse-Purpan, Toulouse, France
- CERPOP, Université de Toulouse, Inserm, UPS, Toulouse, France
| | | | | | - Fanny Pélissier
- Centre Antipoison et Toxicovigilance Occitanie, Centre Hospitalier et Universitaire de Toulouse-Purpan, Toulouse, France
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183
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Mills SD, Peddireddy S, Kurtzman R, Hill F, Catalan V, Bissram JS, Ribisl KM. The Impact of Menthol Cigarette Bans: A Systematic Review and Meta-Analysis. Nicotine Tob Res 2024:ntae011. [PMID: 38379278 DOI: 10.1093/ntr/ntae011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 12/29/2023] [Accepted: 01/04/2024] [Indexed: 02/22/2024]
Abstract
INTRODUCTION This review investigates the impacts of banning the sale of menthol cigarettes at stores. METHODS A systematic search of studies published in English up to November 2022 was conducted. The following databases were searched: PubMed/Medline, CINAHL, PsycINFO, Web of Science, and Embase, as well as a non-indexed journal. Studies evaluating either the impact of real-world or hypothesized menthol cigarette bans were included. Primary outcomes include tobacco use behaviors. Secondary outcomes include cigarette sales, retailer compliance, and the tobacco industry's response to a menthol ban. Data on tobacco use behavior after a menthol ban were pooled using random-effects models. Two pairs of reviewers independently extracted data and assessed study quality. RESULTS Of the 964 articles that were identified during the initial search, 78 were included in the review and 16 were included in the meta-analysis. Cessation rates among menthol cigarette smokers were high after a menthol ban. Pooled results show that 24% (95% confidence interval [95% CI]: 20%, 28%) of menthol cigarette smokers quit smoking after a menthol ban, 50% (95% CI: 31%, 68%) switched to non-menthol cigarettes, 12% (95% CI: 3%, 20%) switched to other flavored tobacco products, and 24% (95% CI: 17%, 31%) continued smoking menthol cigarettes. Hypothesized quitting and switching rates were fairly close to real-world rates. Studies found the tobacco industry attempts to undermine menthol bans. National menthol bans appear more effective than local or state menthol bans. CONCLUSIONS Menthol cigarette bans promote smoking cessation suggesting their potential to improve public health. IMPLICATIONS Findings from this review suggest that menthol cigarette bans promote smoking cessation among menthol cigarette smokers and have the potential to improve public health.
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Affiliation(s)
- Sarah D Mills
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Snigdha Peddireddy
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Rachel Kurtzman
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- National Opinion Research Center (NORC) at the University of Chicago, Chicago, IL, USA
| | - Frantasia Hill
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Victor Catalan
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jennifer S Bissram
- Health Sciences Library, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kurt M Ribisl
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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184
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DeAtley T, Stone MD, Strasser AA, Audrain-McGovern J. The role of IQOS risk perceptions on cigarette smoking behaviours: results from a prospective pilot study. Tob Control 2024; 33:263-266. [PMID: 36002165 PMCID: PMC10394684 DOI: 10.1136/tc-2022-057461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/09/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND IQOS is a heated tobacco product marketed as an alternative to combustible cigarette smoking. Little is known about cigarette smokers' IQOS health risk perceptions and if these risk perceptions impact IQOS use and cigarette smoking behaviour. METHODS Adult, daily, non-treatment-seeking cigarette smokers (n=27), naïve to IQOS, were recruited from Philadelphia, Pennsylvania, USA. Participants were introduced to IQOS and then completed measures of risk perceptions. Participants were given an IQOS 2.4 holder, charger and HeatSticks, and asked to switch completely from cigarettes to IQOS for 14 days. The effects of risk perceptions on changes in IQOS use, cigarettes per day (CPD), the substitution of IQOS for cigarettes and motivation to quit smoking were evaluated. RESULTS Over the 14-day switch period, CPD significantly decreased (B=-0.18, 95% CI=-0.26 to -0.09, p<0.0001), IQOS use significantly increased (B=0.02, 95% CI=0.00 to 0.03, p=0.042), as did the percentage IQOS HeatSticks that replaced CPD (B=0.02, 95% CI=0.01 to 0.03, p=0.005). Participants who perceived IQOS as less risky than cigarettes used fewer IQOS HeatSticks per day. A lower percentage of IQOS HeatStick substitution for cigarettes was observed for participants with higher versus lower risk perceptions (B=-0.14, 95% CI=-0.28 to -0.01, p=0.042). Motivation to quit increased from a mean of 5.53 to 6.79 on the contemplation ladder from baseline to day 14 (B=1.26, 95% CI=0.54 to 1.97, p<0.001). CONCLUSIONS Smokers reduced their smoking rate and increased motivation to quit smoking while using IQOS. IQOS risk perceptions did not directly account for reductions in smoking, although they may contribute indirectly through increased IQOS use.
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Affiliation(s)
- Teresa DeAtley
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Matthew D Stone
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrew A Strasser
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Janet Audrain-McGovern
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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185
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Mays D, Johnson AC, Jeong M, Ganz O, Audrain-McGovern J, Strasser AA, Delnevo CD. Tobacco minimum packaging policy to reduce cigarillo use among young people: results of an experimental study. Tob Control 2024; 33:164-170. [PMID: 35840318 PMCID: PMC9840711 DOI: 10.1136/tc-2022-057304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 07/06/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVE The Food and Drug Administration has the authority to set a minimum for cigar pack size, a product feature linked to price. This study examined the effects of cigarillo package size and price on young adults' smoking and purchase intentions. DESIGN Young adults (n=1032) 18-30 years old who smoked cigarillos in the past 12 months completed an online 3×2 within-subjects experiment testing the effects of cigarillo pack size (1, 2, 5) and price (actual price, standardised price per stick) on intentions to purchase and smoke cigarillos. We modelled the main effects and interactions of pack size and price on intentions to buy and smoke cigarillos overall and by cigarillo use frequency. RESULTS Intentions to buy and smoke were strongest for lower priced singles and two packs compared with higher priced five packs. Under standardised price conditions, participants preferred larger packs, but under actual pricing conditions smaller packs, especially two packs, were preferred. Participants who smoked cigarillos less than monthly were more likely to buy and smoke the least expensive products (buy: singles actual price adjusted OR (aOR)=4.51, 95% CI 3.76 to 5.42; two packs actual price aOR=9.76, 95% CI 8.11 to 11.75; five packs standardised price aOR=3.17, 95% CI 2.89 to 3.48) with the strongest preference for two packs and singles. CONCLUSIONS Young adult cigarillo smokers prefer smaller packs in conditions where pricing incentivises smaller packs. Minimum pack size policies may reduce the appeal of cigarillos among young adults, especially less frequent cigarillo smokers. Pack size policy should take into consideration price, and ideally these two factors should be addressed together.
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Affiliation(s)
- Darren Mays
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Deparment of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Andrea C Johnson
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine and Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michelle Jeong
- Rutgers Center for Tobacco studies, Rutgers Biomedical Health Sciences, Rutgers University and Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Ollie Ganz
- Rutgers Center for Tobacco studies, Rutgers Biomedical Health Sciences, Rutgers University and Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Janet Audrain-McGovern
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine and Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrew A Strasser
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine and Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Cristine D Delnevo
- Rutgers Center for Tobacco studies, Rutgers Biomedical Health Sciences, Rutgers University and Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
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186
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Kasza KA, Tang Z, Xiao H, Marshall D, Stanton CA, Gross AL, Jackson KM, Kelley D, Schroeder MJ, Vivar JC, Hyland A. National longitudinal tobacco product cessation rates among US adults from the PATH Study: 2013-2019 (waves 1-5). Tob Control 2024; 33:186-192. [PMID: 35879095 PMCID: PMC10249338 DOI: 10.1136/tc-2022-057323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 07/12/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To report on longitudinal tobacco product cessation rates, by product type, among adults (ages 18+ years) in the USA between 2013 and 2019. METHODS The Population Assessment of Tobacco and Health Study, a nationally representative, longitudinal cohort study was used to report on annual and biennial rates of the following three cessation behaviours across 2013-2019: (1) discontinuing tobacco product use (ie, transition from past 30-day use to no past 30-day use), (2) attempting to quit tobacco product use and (3) quitting tobacco product use among those who attempted to quit. Each cessation behaviour was evaluated separately for cigarettes, electronic nicotine delivery systems (ENDS), cigars, hookah and smokeless tobacco. Generalised estimating equations were used to evaluate linear and nonlinear trends in cessation rates across the study period. RESULTS Between 2013 and 2019, rates of discontinuing cigarette smoking among adults in the USA statistically increased from 16% to 18%, though these were consistently lower than rates of discontinuing use of other tobacco products. Similarly, quit attempt rates and rates of quitting among attempters increased for cigarette smokers. However, rates of discontinuing ENDS use sharply declined across the study period, from 62% to 44%. CONCLUSIONS Findings show that tobacco product cessation rates have been changing in recent years in the USA alongside the changing tobacco product marketplace and regulatory environment, though rates of discontinuing cigarette smoking remain relatively low. Findings can serve as a benchmark against which future cessation rates can be compared to evaluate the impacts of future tobacco regulatory policies.
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Affiliation(s)
- Karin A Kasza
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Zhiqun Tang
- Behavioral Health and Health Policy Practice, Westat Inc, Rockville, Maryland, USA
| | - Haijun Xiao
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Daniela Marshall
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland, USA
- Axle Informatics, Rockville, MD, USA
| | - Cassandra A Stanton
- Behavioral Health and Health Policy Practice, Westat Inc, Rockville, Maryland, USA
| | - Amy L Gross
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Kathy M Jackson
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Dannielle Kelley
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Megan J Schroeder
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Juan C Vivar
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Andrew Hyland
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
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187
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Cui Y, Dai Z, Cohen JE, Rosas S, Clegg Smith K, Welding K, Czaplicki L. Culturally specific health-related features on cigarette packs sold in China. Tob Control 2024; 33:232-239. [PMID: 36008126 DOI: 10.1136/tc-2022-057527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/08/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND China is the country with the highest burden of tobacco-caused disease. We characterised the extent to which cigarette pack marketing features (eg, imagery, text, pack color) could potentially mislead consumers by suggesting products are healthy. METHODS We used two methods: group concept mapping and content analysis. First, we used a group concept mapping approach to generate and sort Chinese consumer responses to an open-ended prompt asking what marketing features suggest a product is 'healthy' or 'good for you'. Second, based on the concept mapping results, we developed a codebook of health-related features on cigarette packs that were relevant to the unique cultural context of product marketing in China. Two trained coders who were native Chinese speakers double-coded a sample of 1023 cigarette packs purchased in 2013 (wave 1) and 2017 (wave 2). We examined differences in the presence of features overall and over time. RESULTS Overall, 83.5% (n=854) of Chinese cigarette packs in our sample contained at least one 'healthy' or 'good for you' feature, and the presence of health-related features on packs remained constant between wave 1 (83.5%, n=354) and wave 2 (83.5%, n=500; p=1.00). Across both waves, the most common categories of culturally specific health features present related to recycling symbols, rare animal imagery, bright colours (eg, bright yellow) and botanical imagery (eg, bamboo, mint). CONCLUSION Health-related features on cigarette packs sold in China are common. Enhanced policies to address tobacco packaging, labelling and branding could support and facilitate a reduction in the high tobacco burden in China.
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Affiliation(s)
- Yuxian Cui
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Zheng Dai
- Department of Applied Economics, Johns Hopkins University Zanvyl Krieger School of Arts and Sciences, Baltimore, Maryland, USA
| | - Joanna E Cohen
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Scott Rosas
- Concept Systems Incorporated, Ithaca, New York, USA
| | - Katherine Clegg Smith
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kevin Welding
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lauren Czaplicki
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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188
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Duan Z, Henriksen L, Vallone D, Rath JM, Evans WD, Romm KF, Wysota C, Berg CJ. Nicotine pouch marketing strategies in the USA: an analysis of Zyn, On! and Velo. Tob Control 2024; 33:154-163. [PMID: 35817549 DOI: 10.1136/tc-2022-057360] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/27/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Nicotine pouches are gaining popularity, yet their marketing is understudied. METHODS Using Numerator advertising data from January 2019 to September 2021 regarding three popular brands of nicotine pouch in the USA-Zyn (by Swedish Match, introduced in the USA in July 2016), On! (Altria, August 2016) and Velo (RJ Reynolds, July 2019)-we examined (1) general advertising characteristics (eg, media type, year); (2) ad content (ie, headlines and imagery themes); (3) prominent media channels (ie, specific websites, magazines, etc); and (4) ad expenditures. RESULTS There were 286 unique ads (Zyn: 44.4%; On!: 2.8%; Velo: 52.8%), 119 143 occurrences (Zyn: 3.5%; On!: 0.5%; Velo: 96.0%) and $24 774 650 total expenditures (Zyn: 4.7%; On!: 0.6%; Velo: 94.7%). The greatest proportion of ad occurrences and expenditures were accounted for by radio (75.9% and 28.2%, respectively) and television (16.2% and 56.5%), followed by mobile (0.5% and 7.2%) and online display (6.7% and 3.6%). Across ad occurrences and expenditures, prominent headline themes included 'freedom' (26.0% and 17.1%, respectively), 'brand' (9.6% and 18.6%) and 'flavour' (16.4% and 7.6%); images mainly featured the product alone (61.4% and 56.1%), text (16.2% and 24.6%) or men (8.7% and 8.6%); and prominent channel themes were entertainment (34.7% and 37.3%), news/weather (14.3% and 21.7%), business/finance (12.9% and 9.0%) and sports (9.5% and 1.0%). Zyn and On! prioritised online display and print; Velo prioritised radio and television. Zyn's and Velo's headlines focused on 'freedom', with Zyn also emphasising 'brand' and Velo 'innovation'; On!'s headlines emphasised 'flavour'. CONCLUSIONS Regulatory efforts must be informed by surveillance of nicotine pouch marketing and impacts on consumer subgroups (eg, young people).
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Affiliation(s)
- Zongshuan Duan
- Department of Prevention and Community Health, The George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA
| | - Lisa Henriksen
- Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, California, USA
| | - Donna Vallone
- Truth Initiative Schroeder Institute, Washington, District of Columbia, USA
- School of Global Public Health, New York University, New York, New York, USA
| | - Jessica M Rath
- Truth Initiative Schroeder Institute, Washington, District of Columbia, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - W Douglas Evans
- Department of Prevention and Community Health, The George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA
- Department of Global Health, The George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA
| | - Katelyn F Romm
- Department of Prevention and Community Health, The George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA
| | - Christina Wysota
- Department of Prevention and Community Health, The George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA
| | - Carla J Berg
- Department of Prevention and Community Health, The George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA
- Department of Global Health, The George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA
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189
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Ai J, Hassink M, Taylor KM, Kuklenyik P, Valentín-Blasini L, Watson C. Tobacco-Specific Nitrosamines in Current Commercial Large Cigars, Cigarillos, and Little Cigars. Chem Res Toxicol 2024; 37:220-226. [PMID: 38235526 PMCID: PMC10922615 DOI: 10.1021/acs.chemrestox.3c00211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
We measured levels of nitrosonornicotine (NNN) and 4-[methyl(nitroso)amino]-1-(3-pyridinyl)-1-butanone (NNK), the two most carcinogenic tobacco-specific nitrosamines, in the filler, binder, and wrapper of 50 cigars: 19 large cigars, 23 cigarillos, and 8 little cigars. The average NNN and NNK levels were 10.6 and 3.70 μg/g, respectively. These levels are 5- and 7-fold higher, respectively, than those of commercial cigarettes. The differences in NNN and NNK levels between cigars and cigarettes reflect differences in tobacco blends and tobacco treatments, such as fermentation. The average tobacco NNN and NNK levels of large cigars were 3- and 5-fold higher than those of cigarillos and little cigars, respectively. Large cigars also exhibited a significantly broader range of NNN and NNK than cigarillos and little cigars. The NNN and NNK levels in cigarillos are comparable to those of little cigars. These results are consistent with earlier studies finding that cigarillos and little cigars have similar tobacco blends with lower NNN and NNK content than large cigar tobacco blends.
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Affiliation(s)
- Jiu Ai
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Document Control Center, Building 71, Room G335, Silver Spring, Maryland 20993, United States
| | - Matthew Hassink
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Document Control Center, Building 71, Room G335, Silver Spring, Maryland 20993, United States
| | - Kenneth M Taylor
- U.S. Food and Drug Administration, Center for Veterinary Medicine, Office of Applied Science, Division of Residue Chemistry, 8401 Muirkirk Road, Laurel, Maryland 20708, United States
| | - Peter Kuklenyik
- Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, Georgia 30341, United States
| | - Liza Valentín-Blasini
- Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, Georgia 30341, United States
| | - Clifford Watson
- Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, Georgia 30341, United States
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190
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Lee DN, Bluestein MA, Stevens EM, Tackett AP, Mathews AJ, Hébert ET. Impact of Financial Disclosures and Health Warnings on Youth and Young Adult Perceptions of Pro-E-cigarette Instagram Posts. Nicotine Tob Res 2024; 26:S13-S18. [PMID: 38366339 PMCID: PMC10873497 DOI: 10.1093/ntr/ntad219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 10/05/2023] [Accepted: 10/31/2023] [Indexed: 02/18/2024]
Abstract
INTRODUCTION We examined the impact of financial disclosures and warning labels on pro-e-cigarette Instagram posts and their association with attitudes toward the ad and product among youth and young adults. METHODS During March to May 2021, we conducted a factorial experiment using an online convenience sample of youth and young adults (N = 1687, Mage = 21.54). Participants were randomized to one of four conditions: pro-e-cigarette Instagram posts with only a financial disclosure, only a warning label, both a financial disclosure + warning label, or no financial disclosure or warning label. After viewing the posts, participants answered questions regarding their attitude toward the ad and the product. We used one-way ANOVA to estimate the association of condition on outcomes controlling for demographics. RESULTS Young adults who viewed Instagram posts with only a financial disclosure reported more positive attitudes toward the ad than those who viewed posts with both a financial disclosure + warning label (p < .05). Young adults who viewed posts with only a financial disclosure reported more positive attitudes toward the product than those who viewed posts with only a warning label, both a financial disclosure + warning label, and without either (ps < .05). Differences were not statistically significant for youth. E-cigarette use status was associated with increased positive attitudes toward the ad (p < .001) and product (p < .001) for all participants. CONCLUSIONS Our results can inform policy interventions to mitigate the effects of e-cigarette social media marketing among youth and young adults. Including financial disclosures may not decrease appeal of e-cigarettes compared to posts without either. IMPLICATIONS Findings from the study suggest that a warning label may be more effective in reducing the effects of pro-e-cigarette social media posts than a financial disclosure among young adults. Public health officials should examine additional strategies beyond financial disclosures and warning labels (eg, social media peer mentoring program) to offset the persuasive effects of pro-e-cigarette social media marketing posts on young people. Additional policy interventional efforts are needed to limit the impact of e-cigarette social media marketing.
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Affiliation(s)
- Donghee N Lee
- Department of Population and Quantitative Health Sciences, Division of Preventive and Behavioral Medicine, UMass Chan Medical School, Worcester, MA, USA
| | - Meagan A Bluestein
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston School of Public Health, Austin, TX, USA
| | - Elise M Stevens
- Department of Population and Quantitative Health Sciences, Division of Preventive and Behavioral Medicine, UMass Chan Medical School, Worcester, MA, USA
| | - Alayna P Tackett
- Center for Tobacco Research, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ashley J Mathews
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Emily T Hébert
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston School of Public Health, Austin, TX, USA
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, Austin, TX, USA
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191
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Vogel EA, Barrington-Trimis JL, Vassey J, Soto D, Unger JB. Young Adults' Exposure to and Engagement With Tobacco-Related Social Media Content and Subsequent Tobacco Use. Nicotine Tob Res 2024; 26:S3-S12. [PMID: 38366337 PMCID: PMC10873498 DOI: 10.1093/ntr/ntad108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 04/18/2023] [Accepted: 06/28/2023] [Indexed: 02/18/2024]
Abstract
INTRODUCTION Nicotine/tobacco social media content may increase young people's risk for use. This study examined prospective associations between exposure to and engagement with nicotine/tobacco-related social media content and nicotine/tobacco use among young adults. AIMS AND METHODS Young adults (N = 2080) originally recruited from Southern California high schools for a prospective cohort study reported frequency of viewing and posting nicotine/tobacco content on four social media platforms (Facebook, Instagram, Twitter, and YouTube). Participants also reported frequency of seeing nicotine/tobacco posts from friends, seeing nicotine/tobacco posts from influencers or celebrities, and liking nicotine/tobacco posts. Within subsamples of nicotine/tobacco never users (n = 794), past users (n = 897) and current users (n = 389), analyses examined associations of baseline (May-October 2020) social media content exposure and engagement with follow-up (January-June 2021) tobacco use initiation (among never users), resumption (among past users), and continuation (among current users), adjusting for sociodemographic and socioenvironmental characteristics. RESULTS Never users who saw nicotine/tobacco posts from friends (Adjusted Odds Ratio [AOR] = 2.91 [95% Confidence Interval [CI]: 1.46, 5.82], p = .002) or from celebrities or influencers (AOR = 2.77 [1.32, 5.84], p = .007) were significantly more likely to initiate nicotine/tobacco use than their peers. Among past users, posting nicotine/tobacco content at baseline was associated with use resumption (AOR = 1.77 [1.12, 2.80], p = .014). Content exposure and engagement were not associated with nicotine/tobacco use continuation among current users (p-values > .05). CONCLUSIONS Seeing nicotine/tobacco posts from friends, influencers, or celebrities was associated with greater odds of tobacco use initiation, but not resumption or continuation, 6 months later. Young adults with past nicotine/tobacco use who post about nicotine/tobacco may be at elevated risk for resuming use. IMPLICATIONS Young adults with exposure to nicotine/tobacco social media content were more likely than their peers to initiate nicotine/tobacco use 6 months later. Past nicotine/tobacco users who reported posting about nicotine/tobacco on social media at baseline were more likely than their peers to resume nicotine/tobacco use. Among young adults with current nicotine/tobacco use at baseline, social media activity did not predict odds of nicotine/tobacco use continuation at follow-up. Nicotine/tobacco content on social media should be restricted to reduce young people's chances of nicotine/tobacco use initiation or resumption.
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Affiliation(s)
- Erin A Vogel
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, San Francisco, Los Angeles, CA, USA
- Institute for Addiction Science, University of Southern California, Los Angeles, CA, USA
| | - Jessica L Barrington-Trimis
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, San Francisco, Los Angeles, CA, USA
- Institute for Addiction Science, University of Southern California, Los Angeles, CA, USA
| | - Julia Vassey
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, San Francisco, Los Angeles, CA, USA
| | - Daniel Soto
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, San Francisco, Los Angeles, CA, USA
- Institute for Addiction Science, University of Southern California, Los Angeles, CA, USA
| | - Jennifer B Unger
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, San Francisco, Los Angeles, CA, USA
- Institute for Addiction Science, University of Southern California, Los Angeles, CA, USA
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192
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MacMonegle A, Bennett M, Speer JL, O'Brien EK, Pitzer L, Jaarsma A, Nguyen Zarndt A, Duke J. Evaluating The Real Cost Digital and Social Media Campaign: Longitudinal Effects of Campaign Exposure on E-cigarette Beliefs. Nicotine Tob Res 2024; 26:S19-S26. [PMID: 38366338 DOI: 10.1093/ntr/ntad185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 09/15/2023] [Accepted: 09/27/2023] [Indexed: 02/18/2024]
Abstract
INTRODUCTION Over the past decade, youth e-cigarette use has risen exponentially. At the same time, digital media use increased markedly while the use of traditional broadcast TV declined. In response, the U.S. Food and Drug Administration's The Real Cost public education campaign shifted to communicating the harms of e-cigarette via primarily digital and social platforms. This study evaluated longitudinal associations between exposure to campaign advertisements and changes in campaign-specific beliefs among US youth. METHODS A nationally representative longitudinal cohort of youth (aged 11-16 years at baseline) was surveyed five times. Building on earlier work, we analyzed data from the last three waves (April-July 2020; January-April 2021; and August-October 2021; N = 2625). We assessed self-reported exposure to six ads and agreement with 11 beliefs that were each targeted by one or more ads. Eleven weighted panel regression models assessed whether ad exposure predicted changes in campaign-specific beliefs over time. RESULTS We observed significant associations between ad exposure and increases in at least one campaign-specific belief for five of the six ads. Across the 11 beliefs, we observed associations between increased exposure and increases in 6 beliefs related to e-cigarettes and toxic metals, lung damage, dangerous ingredients, anxiety, cigarette use, and disappointing important people. CONCLUSIONS We found evidence that self-reported exposure to this digital and social media campaign was successful at influencing youth, providing support for the effectiveness of the campaign's adaption to address youth's changes in tobacco and media use habits. IMPLICATIONS The Food and Drug Administration's The Real Cost public education campaign educates youth about the dangers of e-cigarette use. This study evaluates longitudinal associations between exposure to The Real Cost's advertisements and changes in campaign-specific beliefs among youth. Considering evolving trends in youth media consumption, the campaign adapted its media approach to increase delivery across digital and social media platforms. Our findings indicate that the campaign reached its intended audience and increased youth beliefs around the harm of e-cigarettes and the consequences of e-cigarette use, offering evidence for the effectiveness of digital and social media youth prevention efforts within a fragmented digital environment.
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Affiliation(s)
- Anna MacMonegle
- RTI International, Research Triangle Park, North Carolina, USA
| | - Morgane Bennett
- Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Jessica L Speer
- RTI International, Research Triangle Park, North Carolina, USA
| | - Erin Keely O'Brien
- Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Lindsay Pitzer
- Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Allie Jaarsma
- RTI International, Research Triangle Park, North Carolina, USA
| | - Anh Nguyen Zarndt
- Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Jennifer Duke
- RTI International, Research Triangle Park, North Carolina, USA
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193
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Ju H, Lee H, Choi J, Kim S, Kang E. The online promotion strategies of e-cigarette and heated tobacco product retailers in South Korea following the COVID-19 pandemic: Implications for regulation. Tob Induc Dis 2024; 22:TID-22-37. [PMID: 38356660 PMCID: PMC10865470 DOI: 10.18332/tid/178380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 12/21/2023] [Accepted: 01/07/2024] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION The surge in popularity of e-cigarettes and heated tobacco products (HTPs) in South Korea, driven by perceived health benefits and COVID-19-related concerns, has led to increased advertising claims about their safety despite ongoing debates about their health effects. This study explores the marketing strategies of online e-cigarette and HTP retailers in South Korea pre- and post-COVID-19, examining potential misleading claims and providing a foundation for future regulatory measures. METHODS We conducted a comprehensive study of eight major e-commerce platforms and three dominant search engines in South Korea to analyze the marketing and advertising strategies of e-cigarettes and heated tobacco products (HTPs) (n=774). Using specific keywords, promotional strategies were identified and categorized, after which statistical analysis was conducted to understand the frequency and proportion of these strategies, highlighting differences between HTP and e-cigarette sellers. RESULTS Our analysis reveals a significant rise in the number of online retailers selling e-cigarettes and HTPs following the COVID-19 pandemic, with the promotional strategies 'Stay home and vape' and 'Trendy' being the most prevalent. Trends also indicate a shift in promotional strategies over the years, with a marked increase in health reassurance themes and appeals to trendiness, particularly targeting female consumers, which were used significantly more at HTPs stores. CONCLUSIONS The study highlights the need for stricter regulation due to the potential health risks posed by the aggressive marketing strategies of e-cigarette and HTP online retailers in South Korea, amplified by the COVID-19 pandemic.
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Affiliation(s)
- HyoRim Ju
- Department of Family Medicine, Dankook University Hospital, Cheonan, South Korea
- Department of Family Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - HyeWon Lee
- National Cancer Control Institute, National Cancer Center, Goyang, South Korea
| | - Juyoung Choi
- National Cancer Control Institute, National Cancer Center, Goyang, South Korea
| | - Soojeong Kim
- Department of Biomedical Sciences, Seoul National University, Seoul, South Korea
| | - EunKyo Kang
- National Cancer Control Institute, National Cancer Center, Goyang, South Korea
- Department of Family Medicine, National Cancer Center, Goyang, South Korea
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Zhang M, Wang J, Edmiston J. Underreporting of non-study cigarette use by study participants confounds the interpretation of results from ambulatory clinical trial of reduced nicotine cigarettes. Harm Reduct J 2024; 21:35. [PMID: 38331789 PMCID: PMC10854148 DOI: 10.1186/s12954-024-00953-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/30/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND As part of its comprehensive plan to significantly reduce the harm from tobacco products, the US Food and Drug Administration is establishing a product standard to lower nicotine in conventional cigarettes to make them "minimally addictive or non-addictive". Many clinical studies have investigated the potential impact of such a standard on smoking behavior and exposure to cigarette constituents. These ambulatory studies required participants who smoke to switch to reduced nicotine study cigarettes. In contrast to clinical trials on pharmaceuticals or medical devices, participants had ready access to non-study conventional nicotine cigarettes and high rates of non-study cigarette use were consistently reported. The magnitude of non-compliance, which could impact the interpretation of the study results, was not adequately assessed in these trials. METHODS We conducted a secondary analysis of data from a large, randomized trial of reduced nicotine cigarettes with 840 participants to estimate the magnitude of non-compliance, i.e., the average number of non-study cigarettes smoked per day by study participants assigned to reduced nicotine cigarettes. Individual participants' non-study cigarette use was estimated based on his/her urinary total nicotine equivalent level, the nicotine content of the study cigarette assigned and the self-reported number of cigarettes smoked, using a previously published method. RESULTS Our analysis showed that (1) there is a large variation in the number of non-study cigarettes smoked by participants within each group (coefficient of variation 90-232%); (2) participants in reduced nicotine cigarette groups underreported their mean number of non-study cigarettes smoked per day by 85-91%; and (3) the biochemical-based estimates indicate no reduction in the mean number of total cigarettes smoked per day for any group assigned to reduced nicotine cigarettes after accounting for non-study cigarettes. CONCLUSIONS High levels of non-compliance, in both the rate and magnitude of non-study cigarette use, are common in ambulatory reduced nicotine cigarette trials where participants have access to conventional nicotine non-study cigarettes. The potential impact of high non-compliance on study outcomes should be considered when interpreting the results from such ambulatory studies.
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Affiliation(s)
- Mingda Zhang
- Altria Client Services LLC, 601 E. Jackson Street, Richmond, VA, 23219, USA.
| | - Jingzhu Wang
- Altria Client Services LLC, 601 E. Jackson Street, Richmond, VA, 23219, USA
| | - Jeffery Edmiston
- Altria Client Services LLC, 601 E. Jackson Street, Richmond, VA, 23219, USA
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Mercier C, Pourchez J, Leclerc L, Forest V. In vitro toxicological evaluation of aerosols generated by a 4th generation vaping device using nicotine salts in an air-liquid interface system. Respir Res 2024; 25:75. [PMID: 38317149 PMCID: PMC10845662 DOI: 10.1186/s12931-024-02697-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/22/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Electronic cigarettes (EC) have gained popularity, especially among young people, with the introduction of fourth-generation devices based on e-liquids containing nicotine salts that promise a smoother vaping experience than freebase nicotine. However, the toxicological effects of nicotine salts are still largely unknown, and the chemical diversity of e-liquids limits the comparison between different studies to determine the contribution of each compound to the cytotoxicity of EC aerosols. Therefore, the aim of this study was to evaluate the toxicological profile of controlled composition e-liquid aerosols to accurately determine the effects of each ingredient based on exposure at the air-liquid interface. METHODS Human lung epithelial cells (A549) were exposed to undiluted aerosols of controlled composition e-liquids containing various ratios of propylene glycol (PG)/vegetable glycerin (VG) solvents, freebase nicotine, organic acids, nicotine salts, and flavoured commercial e-liquids. Exposure of 20 puffs was performed at the air-liquid interface following a standard vaping regimen. Toxicological outcomes, including cytotoxicity, inflammation, and oxidative stress, were assessed 24 h after exposure. RESULTS PG/VG aerosols elicited a strong cytotoxic response characterised by a 50% decrease in cell viability and a 200% increase in lactate dehydrogenase (LDH) production, but had no effects on inflammation and oxidative stress. These effects occurred only at a ratio of 70/30 PG/VG, suggesting that PG is the major contributor to aerosol cytotoxicity. Both freebase nicotine and organic acids had no greater effect on cell viability and LDH release than at a 70/30 PG/VG ratio, but significantly increased inflammation and oxidative stress. Interestingly, the protonated form of nicotine in salt showed a stronger proinflammatory effect than the freebase nicotine form, while benzoic acid-based nicotine salts also induced significant oxidative stress. Flavoured commercial e-liquids was found to be cytotoxic at a threshold dose of ≈ 330 µg/cm². CONCLUSION Our results showed that aerosols of e-liquids consisting only of PG/VG solvents can cause severe cytotoxicity depending on the concentration of PG, while nicotine salts elicit a stronger pro-inflammatory response than freebase nicotine. Overall, aerosols from fourth-generation devices can cause different toxicological effects, the nature of which depends on the chemical composition of the e-liquid.
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Affiliation(s)
- Clément Mercier
- Mines Saint-Etienne, Université Jean Monnet, INSERM, U1059 Sainbiose, Centre CIS, Saint-Etienne, 42023, France.
| | - Jérémie Pourchez
- Mines Saint-Etienne, Université Jean Monnet, INSERM, U1059 Sainbiose, Centre CIS, Saint-Etienne, 42023, France
| | - Lara Leclerc
- Mines Saint-Etienne, Université Jean Monnet, INSERM, U1059 Sainbiose, Centre CIS, Saint-Etienne, 42023, France
| | - Valérie Forest
- Mines Saint-Etienne, Université Jean Monnet, INSERM, U1059 Sainbiose, Centre CIS, Saint-Etienne, 42023, France
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Chen-Sankey J, La Cparia K, Glasser A, Padon AA, Moran MB, Wagoner KG, Jackson KM, Berg CJ. Associations between e-cigarette marketing exposure and vaping nicotine and cannabis among U.S. adults, 2021. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.02.03.24302079. [PMID: 38352380 PMCID: PMC10863020 DOI: 10.1101/2024.02.03.24302079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/19/2024]
Abstract
Importance Vaping has become an increasingly common method for consuming nicotine and cannabis, a trend potentially influenced by e-cigarette marketing. However, little is known about the influence of e-cigarette marketing on cannabis vaping behaviors. Objective To examine the associations between e-cigarette marketing exposure and nicotine and cannabis vaping behaviors among adults. Design Setting and Participants This cross-sectional study included a U.S. nationally representative sample of adults (≥18 years) from the Wave 6 survey of the Population Assessment of Tobacco and Health (PATH) Study, conducted from March to November 2021. Exposure Past 30-day e-cigarette marketing exposure (overall and by ten marketing channels). Main Outcomes and Measures Past 30-day vaping behavior (sole- and dual-vaping of nicotine and cannabis) overall and stratified by age. Results The study included 30,516 respondents (48.0% male and 63.9% non-Hispanic White). Overall, 52.0% of respondents reported past 30-day e-cigarette marketing exposure, and 89.8%, 5.6%, 3.2%, and 1.4% reported no vaping, sole-nicotine vaping, sole-cannabis vaping, and dual-vaping, respectively. Multinominal logistic regression results show exposure to e-cigarette marketing was associated with increased odds of reporting sole-cannabis vaping versus no vaping (adjusted risk ratio [aRR], 1.31; 95% confidence interval [CI], 1.09-1.57) and dual-vaping versus no vaping (aRR, 1.26; 95% CI, 1.01-1.57). Stratification analysis found these associations among those aged 18-24 and 25-34 years but not older adults (≥35 years). Those exposed to e-cigarette marketing also had increased odds of reporting sole-cannabis vaping versus sole-nicotine vaping (aRR, 1.28; 95% CI, 1.04-1.58). Stratification analysis found this association only among those aged 18-24 years. E-cigarette marketing exposure via several channels (retail stores, billboards, events, newspapers/magazines) was associated with increased odds of reporting sole-cannabis vaping. Conclusions and Relevance E-cigarette marketing exposure was only associated with sole-cannabis vaping and dual-vaping, not sole-nicotine vaping among U.S. adults. Such associations were mainly driven by young adults aged 18-24 and 25-35 years and were found for multiple marketing channels. Greater restrictions on tobacco marketing may have reduced the influence of e-cigarette marketing on nicotine vaping, while gaps in such marketing restrictions for cannabis may contribute to continued influence of e-cigarette marketing on cannabis vaping.
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Affiliation(s)
- Julia Chen-Sankey
- Rutgers Institute for Nicotine and Tobacco Studies, New Brunswick, NJ
- Rutgers School of Public Health, Piscataway, NJ
| | - Kathryn La Cparia
- Rutgers Institute for Nicotine and Tobacco Studies, New Brunswick, NJ
| | - Allison Glasser
- Rutgers Institute for Nicotine and Tobacco Studies, New Brunswick, NJ
| | | | - Meghan B. Moran
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD
| | | | - Kristina M. Jackson
- Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
- Rutgers Addiction Research Center, Piscataway, NJ
| | - Carla J. Berg
- George Washington University, Milken Institute School of Public Health, Washington, DC
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197
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Clark SA, Baler G, Jarman KL, Byron MJ, Goldstein AO, Ranney LM. Qualitative perspective on nicotine pouches from adults who smoke cigarettes in North Carolina. Tob Control 2024:tc-2023-058334. [PMID: 38307719 DOI: 10.1136/tc-2023-058334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 01/02/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND Little is known about how nicotine pouch products are perceived by people who smoke, including if they are perceived as a cessation aid or a substitute for when they cannot smoke. We qualitatively investigated the reactions and perceptions about On!, a leading brand of nicotine pouches. METHODS We conducted online semistructured interviews with 30 adults who smoke cigarettes. Participants viewed an On! brochure and an image of an opened nicotine pouch and were asked about their initial impression, who the intended user is, and how they thought of the product's safety compared with other tobacco and cessation products. Transcripts were independently coded and the data were analysed using thematic content analysis. RESULTS Among the participants, half identified as female and slightly more than half were white (n=16). The mean age was 43 years old. The following are the central themes that emerged: (1) participants perceived the concealability, flavours and packaging of On! as appealing to youth and young adults; (2) participants perceived nicotine pouches as a product that would supplement rather than replace tobacco use; and (3) the product raised health concerns, which decreased interest in trying nicotine pouches. CONCLUSIONS Participants believed that the On! nicotine pouch promotional material may promote youth and young adult nicotine product initiation and dual product use for people who smoke. Most viewed On! as a product to use with cigarettes, rather than a way to quit cigarettes. Increased surveillance of nicotine pouches is warranted to monitor the trajectory of this emerging tobacco product and prevent youth initiation.
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Affiliation(s)
- Sonia A Clark
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Guido Baler
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kristen L Jarman
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - M Justin Byron
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Adam O Goldstein
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Leah M Ranney
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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198
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Liu Y, Filippidis FT. Tobacco market trends in 97 countries between 2007 and 2021. Tob Induc Dis 2024; 22:TID-22-31. [PMID: 38314375 PMCID: PMC10835573 DOI: 10.18332/tid/177441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/01/2023] [Accepted: 12/14/2023] [Indexed: 02/06/2024] Open
Abstract
INTRODUCTION Analysis of the tobacco market can provide valuable insights for developing tobacco control strategies. This study examines the market trends of cigarettes, cigars/cigarillos, smoking tobacco, smokeless tobacco, e-cigarettes, heated tobacco products (HTPs), and tobacco-free oral nicotine, across 97 countries between 2007 and 2021. METHODS We obtained annual tobacco retail value data from Euromonitor Passport and calculated the market share for each type of tobacco product. The research examined trends in retail value and market share globally, stratified by national income level, as well as in individual countries. RESULTS From 2007 to 2015, the growth of the global tobacco market was primarily driven by cigarette sales. However, starting in 2016, emerging products, including e-cigarettes, HTPs, and tobacco-free oral nicotine, as well as non-cigarette combustible products, including cigars/cigarillos and smoking tobacco, have been mostly responsible for the increases in the global tobacco retail value. High-income countries experienced the greatest increase in the retail value of emerging products, while middle- and low-income countries still observed rises in cigarette sales. CONCLUSIONS Trends in the retail value of different tobacco products varied widely during the study period, with distinct trends observed in different income levels and within individual countries. These trends can supplement prevalence data and be used to inform local tobacco control policies.
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Affiliation(s)
- Yifei Liu
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, United Kingdom
| | - Filippos T. Filippidis
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, United Kingdom
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199
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Cristol BA, Clendennen SL, Hébert ET, Harrell MB. Nicotine dependence among young adults: Comparing exclusive ENDS users to exclusive cigarette smokers. Addict Behav 2024; 149:107897. [PMID: 37924585 PMCID: PMC11318270 DOI: 10.1016/j.addbeh.2023.107897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/25/2023] [Accepted: 10/26/2023] [Indexed: 11/06/2023]
Abstract
PURPOSE No studies of young adults have compared symptoms of nicotine dependence among exclusive past 30-day (P30D) ENDS users versus exclusive P30D cigarette smokers. METHODS Participants at Wave 14 (Fall 2021) of The Texas Adolescent and Tobacco Marketing Surveillance System (TATAMS) (n = 2,341; mean age = 20.95 years old) who reported P30D exclusive ENDS use (n = 212) and P30D exclusive cigarette smoking (n = 46). Symptoms of nicotine dependence were measured with the Hooked On Nicotine Checklist (the 10-item HONC scale). An independent samples t-test compared average HONC scores between groups, and a Pearson (or Fisher's Exact) Chi-Square (X2) test compared the prevalence of symptom(s) between groups. RESULTS The average HONC score was significantly higher for exclusive P30D ENDS users than exclusive P30D cigarette smokers (3.51 vs. 1.91, p ≤ 0.001). Compared to exclusive P30D cigarette smokers, a significantly higher proportion of exclusive P30D ENDS users reported having felt addicted (45.28% vs. 15.22%, p ≤ 0.001), having strong cravings (50.00% vs. 28.26%, p = 0.007), difficulty not using in prohibited places (i.e., school or work) (24.06% vs. 4.35%, p = 0.002), difficulty concentrating (21.23% vs. 6.52%, p = 0.021), and feeling nervous, restless, or anxious (28.77% vs. 10.87%, p = 0.012). CONCLUSIONS Symptoms of nicotine dependence were elevated among young adults who were exclusive P30D users of ENDS relative to exclusive P30D cigarette smokers.
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Affiliation(s)
- Benjamin A Cristol
- The University of Texas Health Science Center at Houston, School of Public Health, Austin, USA.
| | - Stephanie L Clendennen
- The University of Texas Health Science Center at Houston, School of Public Health, Austin, USA
| | - Emily T Hébert
- The University of Texas Health Science Center at Houston, School of Public Health, Austin, USA
| | - Melissa B Harrell
- The University of Texas Health Science Center at Houston, School of Public Health, Austin, USA
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200
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Mercincavage M, Waugh LK, Gratale S, Wackowski O, Pearson JL, House K, O'Connor R, Strasser AA. Acute effects of charcoal filters and package color on cigarette perceptions and use behaviors: Results from a randomized pilot study examining Natural American Spirit "Sky". Drug Alcohol Depend 2024; 255:111080. [PMID: 38198898 PMCID: PMC10843540 DOI: 10.1016/j.drugalcdep.2024.111080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/01/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024]
Abstract
INTRODUCTION Charcoal-filtered cigarettes have been available for decades but have never held a major share of the U.S. cigarette market. This pilot study gathered initial behavioral data characterizing how "Sky"-a recently introduced charcoal-filtered cigarette variety that uses potentially misleading marketing features-is used and what impact its packaging color has on consumer perceptions. METHODS Forty adult daily non-menthol cigarettes users (52.5% male, 75.0% White, mean age = 46.1, 14.3 mean cigarettes/day) completed a single-session deception study utilizing a 2 ×2 mixed factorial design to manipulate cigarette filter condition (charcoal vs. non-charcoal) and pack color (light vs. dark). Participants smoked two cigarettes identical in appearance and packaging but differing in filter type (blinded and order counterbalanced) and completed pre- and post-cigarette CO samples and post-cigarette questionnaires. RESULTS Participants endorsed more favorable subjective ratings, puffed less of, held more correct beliefs about risks, and expressed greater intentions to use the charcoal (vs. non-charcoal)-filtered cigarette (p's <0.05). Pack color had few effects on outcomes; however, cigarettes in light vs. dark colored packs were rated as cleaner tasting (p <0.01). Neither filter condition nor pack color affected CO boost. There were no interaction effects on any outcomes. CONCLUSIONS Under blinded conditions, Sky charcoal-filtered cigarettes are initially appealing independent of their packaging color. Findings warrant further study of these effects on perceptions, behavior, and harm exposure after longer, open-label use periods. Findings may inform regulatory decisions regarding cigarette packaging and filter composition.
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Affiliation(s)
- Melissa Mercincavage
- Rutgers Institute for Nicotine and Tobacco Studies, New Brunswick, NJ, United States; University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, United States; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States.
| | - Lizza K Waugh
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Stefanie Gratale
- Rutgers Institute for Nicotine and Tobacco Studies, New Brunswick, NJ, United States; University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, United States
| | - Olivia Wackowski
- Rutgers Institute for Nicotine and Tobacco Studies, New Brunswick, NJ, United States; University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, United States
| | - Jennifer L Pearson
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, United States; University of Nevada-Reno, Reno, NV, United States
| | - Kendra House
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Richard O'Connor
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Andrew A Strasser
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, United States; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
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