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Rubenstein D, Pacek LR, McClernon FJ. Multiple Tobacco Product Use Conceptual Framework: A 2021 Update on Evidence. Nicotine Tob Res 2022; 24:1208-1217. [PMID: 35137194 PMCID: PMC9278823 DOI: 10.1093/ntr/ntac032] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 01/04/2022] [Accepted: 01/31/2022] [Indexed: 02/07/2023]
Abstract
INTRODUCTION One-third of adults in the United States who use tobacco regularly use two or more types of tobacco products. As the use of e-cigarettes and other noncombusted tobacco products increases-making multiple tobacco product (MTP) use increasingly common-it is essential to evaluate the complex factors that affect product use. AIMS AND METHODS In this update to our 2019 conceptual framework, we review and evaluate recent literature and expand the model to include ways in which MTP use may be affected by market factors such as the introduction of new products and socioenvironmental factors like marketing and advertising. RESULTS AND CONCLUSIONS MTP use patterns are complex, dynamic, and multiply determined by factors at the level of individuals, products, situations or contexts, and marketplace. Substitution, or using one product with the intent of decreasing use of another, and complementarity, or using multiple products for different reasons or purposes, explain patterns in MTP use. Moreover, substitution and complementarity may inform our understanding of how market changes targeted at one product, for instance, new product standards, bans, product pricing, and taxation, affect consumption of other tobacco products. New data from natural experiments and novel laboratory-based techniques add additional data and expand the framework. IMPLICATIONS A substantial proportion of people who use tobacco use more than one product. This review synthesizes and evaluates recent evidence on the diverse factors that affect MTP use in addition to expanding our framework. Our review is accompanied by suggested research questions that can guide future study.
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Affiliation(s)
- Dana Rubenstein
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - F Joseph McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
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Hu Y, Zhao J, Wang Q, Chao H, Tang B, Cheng D, Tan I, Butlin M, Avolio A, Wang W, Zuo J. Disparate Associations of 24-h Central Aortic and Brachial Cuff Blood Pressure With Hypertension-Mediated Organ Damage and Cardiovascular Risk. Front Cardiovasc Med 2022; 9:795509. [PMID: 35274011 PMCID: PMC8902413 DOI: 10.3389/fcvm.2022.795509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 01/04/2022] [Indexed: 11/27/2022] Open
Abstract
Objective Aim of this study was to evaluate the associations of non-invasive central aortic and peripheral (brachial) blood pressure (BP) for Hypertension-mediated organ damage (HMOD) and atherosclerotic cardiovascular disease (ASCVD) risk. Methods We evaluated associations of HMOD with 24-h ambulatory blood pressure monitoring (ABPM) of central aortic and peripheral BP indices in patients with primary hypertension and presence of several cardiovascular risk factors. BP measurements were performed by means of a non-invasive automated oscillometric device (Mobil-O-Graph). HMOD was defined as the presence of carotid intima-media thickness (IMT) above normal values and/or carotid plaque, left ventricular hypertrophy (LVH), and/or renal abnormalities as assessed by urine albumin/creatinine ratio above normal values and/or estimated glomerular filtration rate (eGFR) <60 ml/min per 1.73 m2. Results In the study cohort of 273 (age 55.2 ± 13.4 years, 71.8% male) patients with primary hypertension, documented HMOD was present in 180 (65.9%), LVH in 70 (25.6%), increased IMT in 129 (47.3%). Fifty-six patients (20.5%) had kidney organ damage (20.5% albuminuria and 2.6% impaired eGFR). When accounting for confounding factors (age, sex, body-mass-index, antihypertensive treatment, smoking, triacylglycerol, statin treatment, glucose, hypoglycemic therapy, or heart rate) only peripheral 24-h pulse pressure (PP) maintained statistical significance with HMOD indices (OR: 1.126, 95% CI: 1.012~1.253; p = 0.029). Using ASCVD risk score as the independent continuous variable in multiple linear regression, 24-h central systolic pressure (SBP) (β = 0.179; 95% CI:0.019~0.387; p = 0.031), daytime central PP (β = 0.114; 95% CI:0.070~0.375; p = 0.005, night-time central SBP (β = 0.411; 95% CI:0.112~0.691; p = 0.007) and night-time PP (β = 0.257; 95% CI:0.165~0.780; p = 0.003) were all positively associated with ASCVD risk. Conclusions Blood pressure obtained by 24-h ABPM was better correlated with HMOD than office BP. Whilst 24-h peripheral BP showed a stronger association with HMOD than 24-h central BP, the prognostic value of 24-h central BP for the 10-year ASCVD risk was superior to 24-h peripheral BP.
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Affiliation(s)
- Yueliang Hu
- Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiehui Zhao
- Daning Community Health Service Center, Shanghai, China
| | - Qian Wang
- Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huijuan Chao
- Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Biwen Tang
- Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Di Cheng
- Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Isabella Tan
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Mark Butlin
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Alberto Avolio
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | | | - Junli Zuo
- Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
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Lin J, Zhu K, Soliván-Ortiz AM, Larsen SL, Irwin SP, Schneid TR, Shriver CD, Lee S. Dual use of cigarettes and smokeless tobacco among active duty service members in the US military. MILITARY PSYCHOLOGY 2021. [DOI: 10.1080/08995605.2021.2004046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Jie Lin
- Department of Surgery, John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Kangmin Zhu
- Department of Surgery, John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Aida M. Soliván-Ortiz
- Postgraduate Dental College, Uniformed Services University of the Health Sciences, San Antonio, Texas, USA
| | - Stacy L. Larsen
- Postgraduate Dental College, Uniformed Services University of the Health Sciences, Fort Bragg, North Carolina, USA
| | - Scott P. Irwin
- Postgraduate Dental College, Uniformed Services University of the Health Sciences, San Antonio, Texas, USA
| | - Thomas R. Schneid
- Postgraduate Dental College, Uniformed Services University of the Health Sciences, Fort Sam Houston, Texas, USA
| | - Craig D. Shriver
- Department of Surgery, John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Sukhyung Lee
- Department of Surgery, John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Budenz A, Klein A, Prutzman Y. The Relationship Between Trauma Exposure and Adult Tobacco Use: Analysis of the National Epidemiologic Survey on Alcohol and Related Conditions (III). Nicotine Tob Res 2021; 23:1716-1726. [PMID: 33848342 PMCID: PMC8562326 DOI: 10.1093/ntr/ntab057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 04/12/2021] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Previous research has examined cigarette smoking in trauma exposed populations. However, the relationships between trauma exposure and use of other tobacco products (eg, cigars, e-cigarettes) and specific trauma exposure characteristics that may be associated with tobacco use are understudied. AIMS AND METHODS Using the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (N = 36 151 adults), we conducted weighted bivariate analyses of tobacco use among participants with no trauma exposure, trauma exposure, and trauma exposure with post-traumatic stress disorder (trauma + PTSD), stratified by tobacco product use. We also performed weighted logistic regressions testing relationships between trauma exposure and tobacco use, controlling for behavioral health (BH) conditions (mood, anxiety, substance use, personality disorders) and sociodemographics. RESULTS Approximately 44% of participants had experienced trauma; 6% experienced trauma + PTSD. Trauma exposed participants had a higher prevalence of tobacco use (30%--46% vs. 22%) and poly-tobacco use (34%--35% vs. 28%) than unexposed participants. Cigarettes were the most used tobacco product; trauma + PTSD (19%), and trauma (15%) participants had a higher prevalence of e-cigarette use than unexposed participants (11%). Trauma exposure was associated with current tobacco use (AOR = 1.36 trauma + PTSD; 1.23 trauma) (but not former use), particularly among participants exposed to violence/abuse (AOR = 1.23). Personality and substance use disorders were strongly associated with current and former tobacco use. CONCLUSIONS Trauma exposure, PTSD, and experiences of violence/abuse are associated with current tobacco use. BH conditions may also play a role in current and former tobacco use. Recognizing and addressing trauma exposure and BH conditions among tobacco users may improve cessation rates in these populations. IMPLICATIONS This study contributes to research on tobacco use disparities in behavioral health populations by providing a comprehensive examination of tobacco use in trauma exposed individuals. Prior research has examined cigarette smoking, but not other tobacco product use in these populations. This study presents findings on multiple tobacco use behaviors (tobacco product, poly-tobacco use, cessation attempts) in trauma exposed populations and characteristics of trauma exposure (severity, type of traumatic event) associated with tobacco use. These findings underscore the importance of further examining the implications of trauma exposure for tobacco use and of screening and addressing trauma in cessation treatment.
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Affiliation(s)
- Alexandra Budenz
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Amanda Klein
- Center for Chronic Disease Prevention and Control Prevention and Health Promotion Administration, Maryland Department of Health, Timonium, MD, USA
| | - Yvonne Prutzman
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
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Rhee JU, Abugazia JY, Cruz YMED, Timberlake DS. Use of internal documents to investigate a tobacco company's strategies to market snus in the United States. Tob Prev Cessat 2021; 7:11. [PMID: 33598590 PMCID: PMC7879987 DOI: 10.18332/tpc/131809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/18/2020] [Accepted: 12/18/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Prior studies indicate that cigarette manufacturers have been interested for decades in developing a smokeless tobacco (SLT) product for smokers and non-users of SLT. The current study aims to assess a tobacco company’s use of novel marketing strategies and intent to promote snus in the US as either a replacement or situational substitute for the cigarette. METHODS A Boolean search string was used to search R. J. Reynolds’ (RJR) Records in UCSF’s Truth Tobacco Industry Documents Library. A total of 358 documents, from 2005–2009, met our initial search criteria and were selected for their relevance to the marketing of Camel Snus. A content analysis was subsequently conducted using the Framework Method to identify themes and strategies for promoting Camel Snus. RESULTS Four major themes about Camel Snus emerged from the documents: 1) promotion by third parties including retailers, snus ambassadors and secret shoppers, 2) expansion of the target population of SLT users to include female smokers and dual users of cigarettes and SLT, 3) emphasis on the difference between Camel Snus and other SLT, and 4) a shift from promoting the practical uses of Camel Snus to using emotional messages conveying freedom. CONCLUSIONS The findings align with other studies suggesting that RJR intended to market snus to non-users of SLT. The findings also reveal that RJR employed creative marketing strategies (e.g. snus ambassadors) and may have intended to promote snus as a situational substitute for the cigarette, as evidenced by the company’s recruitment of dual tobacco users.
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Affiliation(s)
- Joshua U Rhee
- Department of Population Health and Disease Prevention, College of Health Sciences, University of California, Irvine, United States
| | - Jamilla Y Abugazia
- Department of Population Health and Disease Prevention, College of Health Sciences, University of California, Irvine, United States
| | - Yan Marco E Dela Cruz
- Department of Population Health and Disease Prevention, College of Health Sciences, University of California, Irvine, United States
| | - David S Timberlake
- Department of Population Health and Disease Prevention, College of Health Sciences, University of California, Irvine, United States
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McQuoid J, Keamy-Minor E, Ling P. A Practice Theory Approach to Understanding Poly-Tobacco Use in the United States. CRITICAL PUBLIC HEALTH 2020; 30:204-219. [PMID: 32982073 DOI: 10.1080/09581596.2018.1541226] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
This paper uses practice theory to explore a poorly understood phenomenon with important health implications: How and why an increasing number of young Americans regularly use multiple tobacco products. Practice theory is a promising alternative to traditional public health frameworks for understanding everyday activities related to health. It broadens the analytic focus from characteristics of individuals to viewing practices as having lives of their own in competing for, winning, and losing practitioners. We drew from in-depth interviews with 21 young adults (ages 18-29; California) who regularly use cigarettes, electronic nicotine delivery systems (ENDS), and/or smokeless tobacco. Participants described their everyday routines. We examined the characterizing elements of each tobacco product use practice and the roles of each within participants' routines. We found that each product comprises a distinct substance use practice with different roles to play in different situations and contexts. Notably, many participants rotated between or modulated use of different products as a strategy for reducing perceived tobacco-related harms. Cigarettes are uniquely capable of aiding in the space-time organization of everyday activities and coping with crisis, while ENDS and smokeless tobacco open up times and spaces for nicotine consumption. This kind of approach aids our understanding and anticipation of the evolution of tobacco use practices as new products and regulations are introduced.
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Affiliation(s)
- Julia McQuoid
- Center for Tobacco Control Research and Education, University of California, San Francisco, 530 Parnassus Ave, Suite 366, San Francisco, California 94143
| | - Emily Keamy-Minor
- Center for Tobacco Control Research and Education, University of California, San Francisco, 530 Parnassus Ave, Suite 366, San Francisco, California 94143
| | - Pamela Ling
- Center for Tobacco Control Research and Education, University of California, San Francisco, 530 Parnassus Ave, Suite 366, San Francisco, California 94143
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Pacek LR, Wiley JL, McClernon FJ. A Conceptual Framework for Understanding Multiple Tobacco Product Use and the Impact of Regulatory Action. Nicotine Tob Res 2019; 21:268-277. [PMID: 29931176 DOI: 10.1093/ntr/nty129] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 06/18/2018] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Over 35% of the adult tobacco-using population regularly use more than one tobacco product. Although rates of tobacco use in the United States have declined over the last decade, rates of multiple tobacco product (MTP) have either remained stable (among adults) or increased (among youth). METHODS In this paper, we review the literature and propose a framework for understanding both MTP use and how regulatory actions on any single tobacco product (STP) may influence the use of other tobacco products. RESULTS AND CONCLUSIONS Within the framework, Product, Person, and Context/Situational factors (and their interactions) influence product cross-substitution and thus patterns of use of MTPs. In addition, we propose that Context/Situation effects specifically increase the complexity of MTP-use patterns resulting in "dynamic complementarity" in addition to substitution-like relationships between tobacco products. Experimentation with, and use of, various tobacco products results in reinforcement histories that affect which products are used, in what contexts, and by whom, which in turn has downstream impacts on toxicant exposure and health. We conclude our analysis with an examination of how regulation of STPs can have impacts on the use of other STP and MTP use and provide research questions for further examining MTP use. IMPLICATIONS Though rates of tobacco use have declined in the United States, over 35% of the adult tobacco-using population regularly uses more than one tobacco product. This paper provides a framework for understanding MTP use and how regulatory actions on any STP may influence the use of other tobacco products. We conclude our analysis by providing research questions for further examining MTP use.
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Affiliation(s)
- Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | | | - F Joseph McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
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Ganz O, Rimal RN, Johnson AL, Cohn AM, Horn K, Delnevo CD, Villanti AC. Tobacco use and the interplay of internalizing, externalizing and substance use problems: A latent class analysis of data from the Population Assessment of Tobacco and Health Study. Drug Alcohol Depend 2019; 205:107686. [PMID: 31706253 DOI: 10.1016/j.drugalcdep.2019.107686] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 10/04/2019] [Accepted: 10/14/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Cigarette smoking is disproportionately high among adults with two or more psychiatric disorders (psychiatric comorbidities), yet research on non-cigarette tobacco use among this population is scant. Additionally, most studies on tobacco use this among this population rely on psychiatric diagnoses rather than individual symptoms, potentially excluding individuals with symptom-specific issues that increase their risk for tobacco use but do not meet the criteria for diagnosis. The objectives of this study were to identify unique classes of individuals based on symptoms of psychiatric disorders and to assess differences in demographic characteristics and tobacco use behaviors between classes. METHODS This study used data from Wave 2 of the Population Assessment of Tobacco and Health Study adult dataset. Latent class analysis was used to classify individuals based on internalizing, externalizing and substance use problems. Bivariate and multivariable models examined the association between latent class membership and current use of cigarettes, cigar products, electronic nicotine delivery systems, pipe, hookah and smokeless tobacco products. Poly tobacco use was also examined. RESULTS Three latent classes were identified. The "normative" class reported low prevalence of all symptoms, the "severe internalizing and non-violent externalizing" class reported severe internalizing problems and non-violent externalizing problems and the "severe" class reported high prevalence of all symptoms. Tobacco use was highest for the "severe" class and lowest for the "normative" class across products. CONCLUSIONS Individuals in the "severe" class may be at elevated risk of tobacco-related morbidity and mortality and would likely benefit from targeted tobacco control interventions.
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Affiliation(s)
- Ollie Ganz
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, 950 New Hampshire Avenue NW, Washington, DC 20052, United States.
| | - Rajiv N Rimal
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, 950 New Hampshire Avenue NW, Washington, DC 20052, United States; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, United States
| | - Amanda L Johnson
- Oklahoma Tobacco Research Center, University of Oklahoma Health Sciences Center, 655 Research Parkway, Oklahoma City, Oklahoma 73104, United States
| | - Amy M Cohn
- Oklahoma Tobacco Research Center, University of Oklahoma Health Sciences Center, 655 Research Parkway, Oklahoma City, Oklahoma 73104, United States; Department of Oncology, Georgetown University Medical Center, 3800 Reservoir Rd. NW, Washington D.C. 20057, United States
| | - Kimberly Horn
- Department of Population Health Sciences, Virginia Tech Carilion Research Institute, 2 Riverside Circle, Roanoke, VA 24016, United States
| | - Cristine D Delnevo
- Center for Tobacco Studies, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ 08854, United States
| | - Andrea C Villanti
- Vermont Center on Behavior and Health, University of Vermont, 1 South Prospect Street, Burlington, VT 05401, United States; Department of Psychiatry, University of Vermont, 1 South Prospect Street, Burlington, VT 05401, United States
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Risk factors for multiple tobacco product use among high school youth. Addict Behav 2019; 99:106068. [PMID: 31470239 DOI: 10.1016/j.addbeh.2019.106068] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 07/29/2019] [Accepted: 07/29/2019] [Indexed: 11/21/2022]
Abstract
PURPOSE To examine how youth multiple tobacco product (MTP) users differ relative to non-users and to single-product users on risk factors at multiple levels of influence. METHODS We analyzed data on high school students from the North Carolina Youth Tobacco Survey, 2015 (n = 2922). Single- and MTP use were defined as use of one, or two or more tobacco products in the past month, respectively. Multinomial regressions estimated the association between risk factors and MTP use compared to single-product use and non-use of tobacco. Risk factors included intra-personal (e.g., harm perceptions), and interpersonal (e.g., household, peer tobacco use, secondhand smoke or vapor, and advertising) factors. RESULTS Of students, 12% and 13% were single product and MTP users, respectively. Many differences emerged between MTP users and non-tobacco users, with MTP users showing lower harm perceptions, higher perceived social benefits of smoking, significantly higher relative risk of having friends who use tobacco (RRR = 4.79, 95% CI 3.42, 6.70), of exposure to secondhand e-cigarette vapor (RRR = 1.35, 95% CI 1.23, 1.48), and of being receptive to tobacco marketing (RRR = 4.01, 95% CI 2.87, 5.61). Fewer differences emerged between MTP and single product users with MTP users having significantly higher relative risk of having friends who use tobacco (RRR = 2.31 95% CI 1.73, 3.07), of exposure to secondhand vapor (RRR = 1.10, 95% CI 1.02, 1.18), and of being receptive to tobacco marketing (RRR = 1.71, 95% CI 1.17, 2.50). CONCLUSIONS Efforts that target multiple tobacco product use should increase youth tobacco-related harm perceptions, and protect youth from social, peer, and industry influences.
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Clarke E, Thompson K, Weaver S, Thompson J, O’Connell G. Snus: a compelling harm reduction alternative to cigarettes. Harm Reduct J 2019; 16:62. [PMID: 31775744 PMCID: PMC6882181 DOI: 10.1186/s12954-019-0335-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 11/06/2019] [Indexed: 12/31/2022] Open
Abstract
Snus is an oral smokeless tobacco product which is usually placed behind the upper lip, either in a loose form or in portioned sachets, and is primarily used in Sweden and Norway. The purpose of this review is to examine the reported effects of snus use in relation to specified health effects, namely lung cancer, cardiovascular disease, pancreatic cancer, diabetes, oral cancer and non-neoplastic oral disease. The review also examines the harm reduction potential of snus as an alternative to cigarettes by comparing the prevalence of snus use and cigarette smoking, and the reported incidence of tobacco-related diseases across European Union countries. The scientific literature generally indicates that the use of snus is not a significant risk factor for developing lung cancer, cardiovascular disease, pancreatic cancer or oral cancer. Studies investigating snus use and diabetes have reported that high consumption of snus (estimated as being four or more cans per week) may be associated with a higher risk of developing diabetes or components of metabolic syndrome; however, overall results are not conclusive. Snus use is associated with the presence of non-neoplastic oral mucosal lesions which are reported to heal rapidly once use has stopped. The most recent Eurobarometer data from 2017 reported that Sweden had the lowest prevalence of daily cigarette use in the European Union at 5% whilst daily "oral tobacco" use was reported to be 20%. European data published by the World Health Organisation in 2018 indicated that Sweden had the lowest rate of tobacco-related mortality and the lowest incidence of male lung cancer. Overall, prevalence statistics and epidemiological data indicate that the use of snus confers a significant harm reduction benefit which is reflected in the comparatively low levels of tobacco-related disease in Sweden when compared with the rest of Europe. The available scientific data, including long-term population studies conducted by independent bodies, demonstrates that the health risks associated with snus are considerably lower than those associated with cigarette smoking.
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Affiliation(s)
| | - Keith Thompson
- Elucid8 Holdings Ltd, Ballymena Business Centre, 62 Fenaghy Road, Ballymena, BT42 1FL UK
| | - Sarah Weaver
- Imperial Brands Plc, 121 Winterstoke Road, Bristol, BS3 2LL UK
| | - Joseph Thompson
- Imperial Brands Plc, 121 Winterstoke Road, Bristol, BS3 2LL UK
| | - Grant O’Connell
- Imperial Brands Plc, 121 Winterstoke Road, Bristol, BS3 2LL UK
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Sung HY, Wang Y, Yao T, Lightwood J, Max W. Polytobacco Use and Nicotine Dependence Symptoms Among US Adults, 2012-2014. Nicotine Tob Res 2019; 20:S88-S98. [PMID: 30125019 PMCID: PMC6093419 DOI: 10.1093/ntr/nty050] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 03/09/2018] [Indexed: 12/22/2022]
Abstract
Introduction The tobacco product landscape has changed substantially. Little is known about the recent pattern of polytobacco use (at least two tobacco products) among US adults and its relationship to nicotine dependence. Methods Using the 2012–2013 and 2013–2014 National Adult Tobacco Survey (NATS) data (N = 135 425 adults), we analyzed the prevalence and correlates of polytobacco use among each of the six categories of current tobacco user (cigarettes, cigars, pipes, hookah, e-cigarettes, and smokeless tobacco). Based on five nicotine dependence symptom measures from the NATS, difference in the prevalence of dependence symptoms between polytobacco and sole-product users for each category of tobacco user was assessed using multivariable regression analyses. Results During 2012–2014, 25.1% of adults were current users of any tobacco product. Among them, 32.5% were poly users with the largest poly use category being dual use of cigarettes and e-cigarettes (30.2%). Poly use prevalence was the lowest among current cigarette smokers (38.7%), followed by current users of smokeless tobacco (52.4%), hookah (59.2%), cigars (69.3%), e-cigarettes (80.9%), and pipes (86.2%). Among each category of current tobacco user, the prevalence of dependence symptom was consistently greater in polytobacco users than sole users for every symptom measure. After controlling for frequency of use and demographic covariates, the difference in nicotine dependence between poly users and sole users was statistically significant and consistent across all symptom measures for each category of tobacco user. Conclusions Between 52% and 86% of noncigarette tobacco users and nearly 40% of cigarette smokers engaged in polytobacco use. Poly users showed greater nicotine dependence than sole-product tobacco users. Implications This study examines recent patterns of polytobacco use separately for US adult current cigarette smokers, cigar smokers, pipe smokers, hookah users, e-cigarette users, and smokeless tobacco users. By including more tobacco products, particularly e-cigarettes and hookah, this study provides more comprehensive insight into polytobacco use. This study is also unique in comparing nicotine dependence between polytobacco and sole-product users among each category of tobacco users. Our results indicate that polytobacco use is very common and is associated with greater likelihood of reporting nicotine dependence symptoms. Tobacco cessation policies and programs should be tailored to address polytobacco use.
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Affiliation(s)
- Hai-Yen Sung
- Institute for Health & Aging, School of Nursing, University of California, San Francisco, CA
| | - Yingning Wang
- Institute for Health & Aging, School of Nursing, University of California, San Francisco, CA
| | - Tingting Yao
- Institute for Health & Aging, School of Nursing, University of California, San Francisco, CA
| | - James Lightwood
- Department of Clinical Pharmacy, School of Pharmacy, University of California, San Francisco, CA
| | - Wendy Max
- Institute for Health & Aging, School of Nursing, University of California, San Francisco, CA
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12
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Kypriotakis G, Robinson JD, Green CE, Cinciripini PM. Patterns of Tobacco Product Use and Correlates Among Adults in the Population Assessment of Tobacco and Health (PATH) Study: A Latent Class Analysis. Nicotine Tob Res 2019; 20:S81-S87. [PMID: 30125013 PMCID: PMC6093445 DOI: 10.1093/ntr/nty025] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 02/01/2018] [Indexed: 11/22/2022]
Abstract
Introduction As the tobacco industry and market evolves, there is a growing need to understand the patterns of use of tobacco products and how they relate to demographics, dependency, withdrawal, and quit behavior. Methods We analyzed data from wave 1 of the PATH Study consisting of 14856 individuals. Current users were defined as consuming at least 1 of 10 tobacco products. We performed a latent class analysis (LCA) to identify patterns of tobacco use. We used multinomial regression analysis to explore the association between these patterns with covariates representing socioeconomic status dependence/addiction, past quit attempts, and withdrawal severity. Results We identified four groups of current tobacco users with distinct profiles: (1) 61% of the sample were identified as cigarette-only users; (2) 9% were smokeless tobacco users; (3) 17% of the sample were characterized by being current users of all types of combustible tobacco including cigars, cigarillos, filtered cigars, and smoking a pipe (4) finally, 13% were e-cig and hookah users. All classes also shared a varying frequency of cigarette use. Exclusive cigarette users were more likely to be older and female, and experienced higher dependency and withdrawal. Users of e-cigs and hookah were the younger, most educated of all four subgroups, and presented the lowest dependency and withdrawal among the four groups. Conclusions FDA policy makers may want to discourage the use of tobacco products associated with higher tobacco dependency, and products that may contribute to experiencing higher levels of withdrawal symptoms by the user when trying to quit. Implications We identified four patterns of tobacco product use that are significantly related to demographic characteristics, dependency, and withdrawal. Policies should target users more likely to use tobacco products that increase dependency and withdrawal, making quitting more difficult.
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Affiliation(s)
- George Kypriotakis
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jason D Robinson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Charles E Green
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX.,Center for Clinical Research and Evidence-Based Medicine, Department of Pediatrics, UTHealth, Houston, TX
| | - Paul M Cinciripini
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX
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13
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Delahanty J, Ganz O, Hoffman L, Guillory J, Crankshaw E, Farrelly M. Tobacco use among lesbian, gay, bisexual and transgender young adults varies by sexual and gender identity. Drug Alcohol Depend 2019; 201:161-170. [PMID: 31229704 DOI: 10.1016/j.drugalcdep.2019.04.013] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 04/01/2019] [Accepted: 04/01/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Research shows that tobacco products are disproportionately used by sexual and gender minorities, known collectively as those who are lesbian, gay, bisexual, and transgender (LGBT). While usage varies within this population by identity, differences in tobacco use patterns are not well understood. The present study uses evaluation data for This Free Life, a tobacco public education campaign from the FDA, to examine differences in tobacco use among LGBT young adults by subgroups based on sex at birth, gender and sexual identity. METHODS Data are from 4,057 18-24 LGBT young adults who completed the baseline This Free Life evaluation survey in 2016. Multivariable logistic regression models examined differences in tobacco use (cigarettes, cigars, hookah and electronic nicotine products) and poly use (2+ of any product, 2+ combustibles, at least one combustible and one noncombustible) between LGBT subgroups (cisgender gay males, cisgender bisexual males, cisgender lesbian/gay females, cisgender bisexual females and gender minorities). RESULTS Sexual minority females were more likely than gay males to use any tobacco product, electronic nicotine products and hookah. Cisgender bisexuals were more likely than gay males and gender minorities to use electronic nicotine products. Cisgender bisexual males were less likely than all other groups to use cigarettes. Cisgender sexual minority females were more likely than gender minorities to engage in poly use. CONCLUSIONS Findings suggest that sexual minority females are more likely to use tobacco than other subgroups. More research can help campaign developers better understand reasons for intragroup differences in tobacco use among LGBT subgroups.
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Affiliation(s)
- Janine Delahanty
- The Center for Tobacco Products at the Food and Drug Administration, White Oak, MD, USA.
| | - Ollie Ganz
- The Center for Tobacco Products at the Food and Drug Administration, White Oak, MD, USA.
| | - Leah Hoffman
- The Center for Tobacco Products at the Food and Drug Administration, White Oak, MD, USA.
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14
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Helme DW, Oser C, Knudsen HK, Morris E, de la Serna A, Zelaya C. Smokeless Tobacco and the Rural Teen: How Culture and Masculinity Contribute to Adolescent Use. JOURNAL OF HEALTH COMMUNICATION 2019; 24:311-318. [PMID: 30963816 DOI: 10.1080/10810730.2019.1601302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Tobacco use is the leading preventable cause of disease, disability, and death in the United States. Smokeless tobacco (SLT) is primarily used by younger, rural males and often in the presence of other males. This formative study examined how hegemonic masculinity and male norms can lead to initiation and continued use of SLT by rural adolescent males and females. Survey data collected from high school sophomores in 4 rural high schools (n = 293) explores perceptions of masculinity and male norms' contribution to SLT uptake and use. About 22.5% of total sample reported lifetime use (34.4% male, 13.7% female), 10.9% reported past-month use (20.0% male, 4.2% female). Logistic regressions show a one-unit increase in adherence to traditional perceptions of masculinity more than doubled the odds of ever using SLT and significantly increased odds of 30-day use. Having male household family members who uses SLT significantly increased the odds of lifetime and 30-day SLT use for both genders, while having male family members who smoke cigarettes was not a significant correlate. Recognition of health warnings on SLT packaging was negatively associated with SLT use for both genders. Implications for inclusion of masculinity and male role models in SLT prevention intervention strategies are discussed.
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Affiliation(s)
- Donald W Helme
- a Department of Communication , University of Kentucky , Lexington , USA
| | - Carrie Oser
- b Department of Sociology , University of Kentucky , Lexington , USA
| | - Hannah K Knudsen
- c Department of Behavioral Science , University of Kentucky , Lexington , USA
| | - Edward Morris
- b Department of Sociology , University of Kentucky , Lexington , USA
| | - Ana de la Serna
- d Communications Department , California State University , Dominguez Hills , USA
| | - Carina Zelaya
- a Department of Communication , University of Kentucky , Lexington , USA
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15
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A Computational Model for Assessing the Population Health Impact of Introducing a Modified Risk Claim on an Existing Smokeless Tobacco Product. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16071264. [PMID: 30970571 PMCID: PMC6479389 DOI: 10.3390/ijerph16071264] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 03/29/2019] [Accepted: 04/01/2019] [Indexed: 12/23/2022]
Abstract
Computational models are valuable tools for predicting the population effects prior to Food and Drug Administration (FDA) authorization of a modified risk claim on a tobacco product. We have developed and validated a population model using best modeling practices. Our model consists of a Markov compartmental model based on cohorts starting at a defined age and followed up to a specific age accounting for 29 tobacco-use states based on a cohort members transition pathway. The Markov model is coupled with statistical mortality models and excess relative risk ratio estimates to determine survival probabilities from use of smokeless tobacco. Our model estimates the difference in premature deaths prevented by comparing Base Case ("world-as-is") and Modified Case (the most likely outcome given that a modified risk claim is authorized) scenarios. Nationally representative transition probabilities were used for the Base Case. Probabilities of key transitions for the Modified Case were estimated based on a behavioral intentions study in users and nonusers. Our model predicts an estimated 93,000 premature deaths would be avoided over a 60-year period upon authorization of a modified risk claim. Our sensitivity analyses using various reasonable ranges of input parameters do not indicate any scenario under which the net benefit could be offset entirely.
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16
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Pacek LR, Rass O, Sweitzer MM, Oliver JA, McClernon FJ. Young adult dual combusted cigarette and e-cigarette users' anticipated responses to hypothetical e-cigarette market restrictions. Subst Use Misuse 2019; 54:2033-2042. [PMID: 31305213 PMCID: PMC6764889 DOI: 10.1080/10826084.2019.1626435] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Introduction: The aim of this exploratory study was to assess young adult dual e-cigarette (EC) and combusted cigarette (CC) users' anticipated responses to hypothetical market restrictions regarding key EC characteristics. Methods: Data came from 240 young adult dual EC and CC users recruited via Amazon Mechanical Turk in June 2017. Descriptive statistics were used to report sociodemographic, CC smoking, and EC use characteristics. McNemar's chi-square tests and chi-square tests were used to assess differences between groups in terms of anticipated responses to hypothetical EC market restrictions. Results: Hypothetical regulations resulted in reported intentions to reduce EC use and increase CC use; the greatest impact was found for restrictions regarding e-liquid nicotine content, followed by flavor and ability to modify EC devices. Moreover, individuals reporting use of flavored e-liquid, high nicotine content e-liquid, and customizable EC were most likely to report intentions to reduce EC use and increase CC use. Conclusions: This work provides preliminary evidence that restrictive regulations regarding key EC characteristics may increase intentions to increase CC use among young adult dual EC and CC users.
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Affiliation(s)
- Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine , Durham , North Carolina , USA
| | - Olga Rass
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration , Silver Spring , Maryland , USA
| | - Maggie M Sweitzer
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine , Durham , North Carolina , USA
| | - Jason A Oliver
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine , Durham , North Carolina , USA
| | - F Joseph McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine , Durham , North Carolina , USA
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17
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Zuo J, Chang G, Tan I, Butlin M, Chu SL, Avolio A. Central aortic pressure improves prediction of cardiovascular events compared to peripheral blood pressure in short-term follow-up of a hypertensive cohort. Clin Exp Hypertens 2018; 42:16-23. [PMID: 30554536 DOI: 10.1080/10641963.2018.1557682] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: The aim of this study was to assess indices of a comprehensive panel of central aortic pressure and arterial stiffness for prediction of cardiovascular events in a hypertensive cohort.Methods: Noninvasive measurements of central aortic blood pressure, brachial pressure, wave reflection augmentation index, pressure amplification, pulse wave velocity (PWV) and carotid intima-media thickness (IMT) were obtained in 675 hypertensive patients (age 61 ± 9 years, 425 males) for a mean follow-up period 25 ± 4 months. The primary endpoints were defined as cardiovascular disease (CVD) events or death from CVD.Results: After adjusting for confounding factors, central systolic (cSBP) and pulse pressure (cPP) showed higher hazard ratios (HR/10 mmHg) for cardiovascular events (CV) compared to peripheral pressure indices (pSBP, pPP) at age >60 years (cSBP: HR = 1.18, pSBP: HR = 1.17, p = 0.034; cPP: HR = 1.28, pPP: HR = 1.2, p = 0.019). Each SD increase in IMT and in central augmented pressure (cAP) entailed a 1.4 times higher risk of increased total events in elderly patients (age >60 years). For males, each SD increase in cAP was associated with 1.36 times higher risk of increased total events. For females, each SD increase in cAIx and cAP was associated with 0.4 and 0.5 times lower risk of increased total and major CV, respectively. This sex difference is most likely due to lack of age-related increase of cAIx in females after age >60 years compared to males.Conclusions: Central pressure improved prediction of CVD compared to peripheral pressure during a relatively short-term follow up of approximately 2 years at age >60 years.
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Affiliation(s)
- Junli Zuo
- Department of Hypertension, Ruijin Hospital North, Shanghai Jiaotong School of Medicine, Shanghai, China.,Department of Geriatrics, Ruijin Hospital North, Shanghai Jiaotong School of Medicine, Shanghai, China
| | - Guili Chang
- Department of Hypertension, Ruijin Hospital North, Shanghai Jiaotong School of Medicine, Shanghai, China
| | - Isabella Tan
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Mark Butlin
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Shao-Li Chu
- Department of Hypertension, Ruijin Hospital North, Shanghai Jiaotong School of Medicine, Shanghai, China
| | - Alberto Avolio
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
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18
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Hinton A, Nagaraja HN, Cooper S, Wewers ME. Tobacco product transition patterns in rural and urban cohorts: Where do dual users go? Prev Med Rep 2018; 12:241-244. [PMID: 30377574 PMCID: PMC6205333 DOI: 10.1016/j.pmedr.2018.10.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 10/16/2018] [Accepted: 10/21/2018] [Indexed: 12/22/2022] Open
Abstract
Introduction Understanding diverse tobacco product consumption represents a crucial area for tobacco regulatory science. With the increase in dual/poly use of tobacco products, transition patterns among exclusive and dual users are of considerable interest. We describe transition patterns of dual users over 18 months. Methods A cohort of 145 adults in urban and rural Ohio who reported dual tobacco product use at least some days/week was enrolled during 2014–17. Participants completed follow-up interviews every six months where they were classified into one of five categories: 1) exclusive combustible, 2) exclusive smokeless, 3) exclusive e-cigarette, 4) dual (at least 2 of the previous 3 categories), and 5) less than some days/week. Participants categorized as exclusive and dual (1–4) used their products at least some days per week. Separately within the rural and urban cohorts, 6, 12, and 18 month transition probabilities between the categories were estimated. Results The probability of remaining a dual user after 6 months is 43% in the rural and 37% in the urban cohort. The decline continues through 18 months with 24% of rural and 22% of urban dual users remaining in the category. The probability of a dual user consuming combustibles and e-cigarettes transitioning to exclusive combustible use in 6 months is over 50% in both the rural and urban cohorts. Conclusions Dual use is an unstable state with users being more likely to transition to exclusive combustible use than to remain in the dual use category. Transitions are similar in the rural and urban cohorts. Exclusive tobacco users remain loyal to their product category over time. Dual tobacco users often transition to the use of an exclusive category. Tobacco product transition patterns are similar between rural and urban cohorts.
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Affiliation(s)
- Alice Hinton
- The Ohio State University College of Public Health, Division of Biostatistics, Columbus, OH, USA.,The Ohio State University Center of Excellence in Regulatory Tobacco Science, Columbus, OH, USA
| | - Haikady N Nagaraja
- The Ohio State University College of Public Health, Division of Biostatistics, Columbus, OH, USA.,The Ohio State University Center of Excellence in Regulatory Tobacco Science, Columbus, OH, USA
| | - Sarah Cooper
- The Ohio State University College of Public Health, Division of Health Behavior & Health Promotion, Columbus, OH, USA.,The Ohio State University Center of Excellence in Regulatory Tobacco Science, Columbus, OH, USA
| | - Mary Ellen Wewers
- The Ohio State University College of Public Health, Division of Health Behavior & Health Promotion, Columbus, OH, USA.,The Ohio State University Center of Excellence in Regulatory Tobacco Science, Columbus, OH, USA
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19
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Savin MJ, Frank-Pearce SG, Pulvers K, Vidrine DJ. The association between lifetime polytobacco use and intention to quit among HIV-positive cigarette smokers. Drug Alcohol Depend 2018; 191:152-158. [PMID: 30107321 PMCID: PMC6709522 DOI: 10.1016/j.drugalcdep.2018.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 04/20/2018] [Accepted: 05/08/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND This secondary analysis aims to describe, over time, the relationship between HIV disease progression and intention to quit cigarette smoking among current monocigarette users with and without a lifetime history of polytobacco use. METHODS Participants completed a baseline assessment at the time of HIV care initiation and four follow-up assessments (3, 6, 9, and 12-months). Assessments included biochemically verified smoking status and audio computer-assisted self-interviews assessing psychosocial, substance use, and clinical variables known to influence smoking behaviors. Using linear and generalized linear fixed-effects models, we modeled the covariance structure for the repeated outcome measures (intention to quit and 7-day point prevalence smoking abstinence) across the study time points and included a three-way interaction term to examine the effects of disease stage and tobacco product use. RESULTS Participants (N = 357) were 73.1% male, 67.3% black/African American, and had a mean (SD) age of 38.7 (10.6) years. At baseline, lifetime polytobacco users reported significantly worse HIV-related symptoms and burdens, illness perception, social support, and nicotine dependence. Intention to quit, but not smoking abstinence, was predicted by a three-way interaction between time from HIV care initiation, disease progression, and tobacco product use (p = .04). Overall, progressive HIV was associated with greater intention to quit smoking cigarettes. However, the relationship differed over time between the two tobacco product groups. CONCLUSION Future studies should consider tailoring the timing of cessation interventions upon disease stage and lifetime history of polytobacco use.
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Affiliation(s)
| | | | - Kim Pulvers
- HIV Neurobehavioral Research Center, Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., San Diego, CA 92093, USA.
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20
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Jones DM, Popova L, Weaver SR, Pechacek TF, Eriksen MP. A National Comparison of Dual Users of Smokeless Tobacco and Cigarettes and Exclusive Cigarette Smokers, 2015-2016. Nicotine Tob Res 2018; 20:S62-S70. [PMID: 30125015 PMCID: PMC6093383 DOI: 10.1093/ntr/nty010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Accepted: 01/19/2018] [Indexed: 12/13/2022]
Abstract
Introduction While smoking rates have declined, use of smokeless tobacco (ST) has remained constant. ST is heavily marketed to cigarette smokers, and many ST users smoke cigarettes. This study provides updated comparisons of the characteristics, smoking behaviors, and perceptions of US adult dual ST and cigarette users and exclusive cigarette smokers in 2015-2016. Methods Data were from nationally representative, cross-sectional surveys from 2015 and 2016. Adult smokers reported past 30-day use of ST, current cigarette smoking, risk perceptions, smoking, and quitting behaviors. We estimated Rao-Scott χ2 and adjusted odds ratios (AORs) to compare dual users and exclusive smokers. Results Dual users were more likely to be younger, reside in nonmetropolitan statistical areas (MSA) and outside the Northeast United States. Adjusting for covariates, dual users did not differ significantly from exclusive smokers on most smoker characteristics, including number of past year quit attempts. Dual users were more likely to report past 30-day use of novel tobacco products (AORs 2.90 [little cigars and cigarillos] to 11.02 [hookah]). Dual users who reported at least 1 past year cigarette quit attempt were more likely than exclusive smokers to report using ST, traditional cigars, hookah, or heat-not-burn as a past year quit method (AOR: 9.54 [95% CI: 3.22 to 28.23]). Conclusions Smokers who use ST are more likely than exclusive smokers to attempt to quit smoking cigarettes using other tobacco products. These findings may be attributed to increasing use prevalence of novel products. We recommend further monitoring to assess polytobacco use and differences among these populations. Implications Many current ST users smoke cigarettes and ST promotions often target cigarette smokers. As the FDA considers ST regulations and implements a nicotine centered regulatory framework, it is imperative to evaluate how these policies and promotion of ST as potentially reduced risk products impact dual and polytobacco use. Our study found that many dual users engage in novel tobacco use in general and as a cessation method. Consideration of ST and polytobacco use among smokers may be helpful in the development of forthcoming FDA regulations, messaging, and interventions.
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Affiliation(s)
- Dina M Jones
- Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA
| | - Lucy Popova
- Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA
- Division of Health Promotion and Behavior, School of Public Health, Georgia State University, Atlanta, GA
| | - Scott R Weaver
- Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA
- Division of Epidemiology and Biostatistics, School of Public Health, Georgia State University, Atlanta, GA
| | - Terry F Pechacek
- Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA
- Division of Health Management and Policy, School of Public Health, Georgia State University, Atlanta, GA
| | - Michael P Eriksen
- Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA
- Division of Health Management and Policy, School of Public Health, Georgia State University, Atlanta, GA
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21
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Osman A, Kowitt SD, Ranney LM, Heck C, Goldstein AO. Trends and Racial Disparities in Mono, Dual, and Poly Use of Tobacco Products Among Youth. Nicotine Tob Res 2018; 20:S22-S30. [PMID: 30125016 PMCID: PMC6093353 DOI: 10.1093/ntr/nty051] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 03/12/2018] [Indexed: 11/18/2022]
Abstract
Introduction We examined racial disparities in mono, dual, and poly use of tobacco products including whether racial disparities changed over time. Methods We analyzed data on high school students from the North Carolina Youth Tobacco Survey collected in 2011, 2013, and 2015. Dual and poly use included use of two and three or more tobacco products, respectively, in the past month. Multinomial regression models assessed racial differences and changes over time in mono, dual, and poly use. Data include product combinations most commonly used by youth from different racial groups. Results In total, 24% (in 2011) and 26% (in 2013 and 2015) of students used tobacco products. No significant changes over time were observed in mono (12%) or dual use (6%). Poly use was 6%, 8%, and 7% in 2011, 2013, and 2015, respectively. Relative to nonuse of tobacco, White students had a higher relative risk than Blacks for mono use. Whites and Hispanics had a higher relative risk than Blacks for dual and poly use. Observed racial differences in tobacco use did not change over time. Types of tobacco products used varied by year and race. In 2015, e-cigarette was the most commonly used product among mono users from all racial groups. Conclusions Substantial racial variation persists over time in mono and multiple tobacco product use among North Carolina youth, including racial variation in the types of tobacco products used. Research and policy efforts should examine and eliminate factors that drive multiple tobacco use and racial disparities in use among youth. Implications This study reports on racial disparities in mono and multiple tobacco product use among youth. White and Hispanic youth have higher relative risk for dual and poly use of tobacco products than Black youth. In addition, significant racial variation exists in the types of tobacco products used among youth mono, dual, and poly users, with cigarettes, cigars, smokeless tobacco, and e-cigarettes being the most commonly used products. Patterns of multiple tobacco product use vary by race and may warrant tailored prevention efforts. Strengthening tobacco control regulations for other tobacco products than cigarettes is critical to reduce multiple tobacco product use among youth.
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Affiliation(s)
- Amira Osman
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Sarah D Kowitt
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Leah M Ranney
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Courtney Heck
- North Carolina Department of Health and Human Services, Division of Public Health, Tobacco Prevention and Control Branch Raleigh, NC
| | - Adam O Goldstein
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
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22
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Osibogun O, Ben Taleb Z, Bahelah R, Salloum RG, Maziak W. Correlates of poly-tobacco use among youth and young adults: Findings from the Population Assessment of Tobacco and Health study, 2013-2014. Drug Alcohol Depend 2018; 187:160-164. [PMID: 29674249 PMCID: PMC5959787 DOI: 10.1016/j.drugalcdep.2018.02.024] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 02/24/2018] [Accepted: 02/26/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Poly-tobacco use is common among youth and young adults. This study examined sociodemographic, tobacco-related, and substance use characteristics of poly-tobacco use compared to mono-tobacco use among youth and young adults (12-34 years) in the United States. METHODS We conducted a descriptive analysis by age-group of 12898 youth (12-17 years), 8843 younger young adults (18-24 years), and 6081 older young adults (24-34 years) from the 2013-2014 Population Assessment of Tobacco and Health study. Multiple logistic regression modeling was conducted to assess the sociodemographic, tobacco-related, and substance use associations with current (past 30 days) tobacco use on a binary scale (poly- versus mono-tobacco use) among tobacco users. RESULTS Between 2013 and 2014, 3.6% of youth, 21.7% of younger young adults, and 15.8% of older young adults were current poly-tobacco users in the general population. In the regression analyses, among youth tobacco users, heavy drinking was the only factor associated with higher odds of poly-tobacco use. Factors associated with higher odds of poly-tobacco use among younger young adults included being male, having less than high school diploma or GED, residing in the South, having 2 and ≥3 quit attempts, heavy drinking, and marijuana use. Residing in the South, older ages of exposure to tobacco use, and marijuana use were associated with higher odds of poly-tobacco use among older young adults. CONCLUSIONS Regardless of tobacco product type, poly-tobacco use was common among youth and young adults. Interventions designed to address factors associated with poly-tobacco use among youth and young adults are warranted.
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Affiliation(s)
- Olatokunbo Osibogun
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, AHC5, Miami, FL 33199, USA.
| | - Ziyad Ben Taleb
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, AHC5, Miami, FL 33199, USA
| | - Raed Bahelah
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, AHC5, Miami, FL 33199, USA
| | - Ramzi G. Salloum
- Department of Health Outcomes and Policy, University of Florida, PO Box 100177, Gainesville, FL 32610-0177, USA
| | - Wasim Maziak
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, AHC5, Miami, FL 33199, USA
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23
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Lee YO, Pepper JK, MacMonegle AJ, Nonnemaker JM, Duke JC, Porter L. Examining Youth Dual and Polytobacco Use with E-Cigarettes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15040699. [PMID: 29642480 PMCID: PMC5923741 DOI: 10.3390/ijerph15040699] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 03/27/2018] [Accepted: 03/27/2018] [Indexed: 11/19/2022]
Abstract
E-cigarettes and other non-cigarette tobacco products are increasingly popular among youth. Little is known to inform public health efforts to reduce youth use. We examined psychosocial correlates of single and multiple tobacco product use among youth e-cigarette users. Data were from the 2014 Florida Youth Tobacco Survey (N = 69,923), a representative sample of Florida middle and high school students. Associations between combinations of e-cigarette, cigarette and other tobacco product (OTP) use and psychosocial variables were examined using multinomial logistic regression with an analytic sample of N = 2756. Most e-cigarette-using youth used at least one other product (81%). Perceiving cigarettes as easy to quit was significantly associated with greater likelihood of combined e-cigarette/OTP use (relative risk ratio (RRR) = 2.51, p < 0.001) and combined e-cigarette/cigarette/OTP use (RRR = 3.20, p < 0.0001). Thinking you will be smoking cigarettes in 5 years was associated with product combinations that include cigarettes. Tobacco company marketing receptivity was associated with multiple product user types. Given that specific psychosocial factors put youth at risk for concurrent use of e-cigarettes with tobacco products, public health efforts should address polytobacco use specifically, instead of individual product use. Youth perceptions about the ease of quitting cigarettes, intentions to continue smoking cigarettes and receptivity to tobacco company marketing are promising areas for messaging aimed at reducing e-cigarette polytobacco product use.
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Affiliation(s)
- Youn Ok Lee
- RTI International, Public Health Research Division, Research Triangle Park, NC 27709, USA.
| | - Jessica K Pepper
- RTI International, Public Health Research Division, Research Triangle Park, NC 27709, USA.
| | - Anna J MacMonegle
- RTI International, Public Health Research Division, Research Triangle Park, NC 27709, USA.
| | - James M Nonnemaker
- RTI International, Public Health Research Division, Research Triangle Park, NC 27709, USA.
| | - Jennifer C Duke
- RTI International, Public Health Research Division, Research Triangle Park, NC 27709, USA.
| | - Lauren Porter
- Florida Department of Health, 4052 Bald Cypress Way, Tallahassee, FL 32399, USA.
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Cigarettes, Smokeless Tobacco, and Poly-Tobacco Among Workers in Three Dusty Industries. J Occup Environ Med 2018; 58:477-84. [PMID: 27158955 DOI: 10.1097/jom.0000000000000699] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Tobacco use remains high among blue-collar workers, the health consequences of which may be compounded by occupational dust exposure. Detailed data on tobacco use among workers in dusty industries are lacking. METHODS The 2006 to 2012 National Survey on Drug Use and Health was used to compare current tobacco use prevalence [including cigarettes, smokeless tobacco (SLT), and both (dual use)] among male workers in three dusty industries to all other employed men using bivariate and multivariate analysis. RESULTS Smoking rates were high among extraction (39.9%) and construction (38.5%) workers. Increased odds of SLT (odds ratio = 3.3) and dual use (odds ratio = 2.6) were observed among dusty-industry workers compared with other employed men. The prevalence of any tobacco use was unexpectedly high among extraction workers (60.4%). CONCLUSIONS Disparities in tobacco use behaviors by industry may point to opportunities for targeted workplace tobacco cessation programs.
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Matilla-Santander N, Fu M, Ballbè M, Bunch K, Lidón-Moyano C, Martín-Sánchez JC, Fernández E, Martínez-Sánchez JM. Use of electronic cigarettes in public and private settings in Barcelona (Spain). ENVIRONMENTAL RESEARCH 2017; 158:685-690. [PMID: 28734255 DOI: 10.1016/j.envres.2017.07.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/29/2017] [Accepted: 07/09/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To describe the prevalence of e-cigarette users who use them in selected indoor public and workplaces, and private venues in Barcelona (Spain) in 2015. METHODS This is a cross-sectional study of a sample of e-cigarette users (≥ 18 years) from Barcelona (n = 600). We calculated the proportion of e-cigarette users who used the device in public and private settings (in the last 30 days). We fit multivariate logistic regression models adjusted for sex and age to calculate the odds ratios (OR) with their 95% confidence intervals (CI) of e-cigarette use by socio-demographic factors, dual use and nicotine-containing e-cigarettes. RESULTS The highest proportion of e-cigarette users who used them in public places was found at restaurants or bars (69.4%) and nightclubs or pubs (55.4%). Also being current conventional tobacco smokers (dual users) was significantly associated with lower use of e-cigarettes in workplaces (OR = 0.61, 95%CI:0.41-0.91), restaurants (OR = 0.66, 95%CI:0.45-0.97) and nightclubs (OR = 0.56, 95%CI:0.37-0.86). Moreover, being a nicotine-containing e-cigarette user was associated with higher odds of using the device in workplaces (OR = 2.01, 95%CI:1.34-3.01), and lower odds of using it in nightclubs (OR = 0.56, 95%CI:0.39-0.82). 96.8% of the included e-cigarette users declared to use the device at home. Being a current tobacco smoker was associated with increased odds of using e-cigarettes at home (OR = 3.17, 95%CI:1.22-8.22). CONCLUSIONS E-cigarette use in private settings and in public settings where their use is not regulated by law is high. Therefore, the public health administration in Spain should consider expanding the prohibition of e-cigarette use to indoor public places and should take into account the possibility of exposure to aerosol from e-cigarettes.
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Affiliation(s)
- Nuria Matilla-Santander
- Group of Evaluation of Health Determinants and Health Policies, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain
| | - Marcela Fu
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Montse Ballbè
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Addictions Unit, Institute of Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Kailey Bunch
- Group of Evaluation of Health Determinants and Health Policies, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain
| | - Cristina Lidón-Moyano
- Group of Evaluation of Health Determinants and Health Policies, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain
| | - Juan Carlos Martín-Sánchez
- Group of Evaluation of Health Determinants and Health Policies, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain
| | - Esteve Fernández
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Addictions Unit, Institute of Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Jose M Martínez-Sánchez
- Group of Evaluation of Health Determinants and Health Policies, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain; Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.
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Cooper M, Loukas A, Harrell MB, Perry CL. College students' perceptions of risk and addictiveness of e-cigarettes and cigarettes. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2017; 65:103-111. [PMID: 27805472 PMCID: PMC5278646 DOI: 10.1080/07448481.2016.1254638] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND As conventional cigarette use is declining, electronic cigarette ("e-cigarette") use is rising and is especially high among college students. Few studies examine dual use of e-cigarettes and cigarettes among this population. This study explores the relationship between dual and exclusive e-cigarette / cigarette use and perceptions of harm and addictiveness of both products. METHODS This is a cross-sectional analysis of data from students attending 24 colleges in Texas (n=5,482). Multinomial logistic regression was employed to test the association between current e-cigarette / cigarette use and perceived harm and addictiveness of both products. Three tobacco groups were included: cigarette only users, e-cigarette only users, and dual users. RESULTS Dual users reported lower perceived harm of e-cigarettes most consistently (p<0.001, all comparisons). Perceived harm of cigarettes was significantly lower among cigarette only and dual users only, compared to non-users (p<0.001, all comparisons). Compared to non-users, all three groups reported significantly lower perceived addictiveness of e-cigarettes (p<0.001, all comparisons). The same finding was observed for perceived addictiveness of cigarettes, though findings were less consistent for the e-cigarette only group (p<0.02, all comparisons except one). CONCLUSION Findings demonstrate that among college students, perceptions of harm and addictiveness of e-cigarettes are lower than those for conventional cigarettes. For both products, perceptions of harm and addictiveness were lower among exclusive and dual users, compared to non-users.
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Affiliation(s)
- Maria Cooper
- University of Texas Health Science Center at Houston, School of Public Health, Austin Regional Campus, Austin, Texas, USA
| | - Alexandra Loukas
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, Texas, USA
| | - Melissa B. Harrell
- University of Texas Health Science Center at Houston, School of Public Health, Austin Regional Campus, Austin, Texas, USA
| | - Cheryl L. Perry
- University of Texas Health Science Center at Houston, School of Public Health, Austin Regional Campus, Austin, Texas, USA
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High Cigarette and Poly-Tobacco Use Among Workers in a Dusty Industry: New Jersey Quarry Workers. J Occup Environ Med 2017; 58:e133-9. [PMID: 27058491 DOI: 10.1097/jom.0000000000000686] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Tobacco use is high among US extraction and construction workers, who can also incur occupational dust exposure. Information on different types of tobacco use among quarry/mine workers is sparse. METHODS During mandated training sessions, New Jersey quarry workers were surveyed about their tobacco use. Prevalence was calculated for single and multiple tobacco use by demographic and workplace characteristics; logistic regression was used to assess associations with smoking. RESULTS Two hundred forty (97.1%) workers completed surveys. Among respondents, 41.7% [95% confidence interval (95% CI) 35.4 to 48.3] currently used any tobacco product of whom 28.1% smoked cigarettes. In multivariate analysis, positive associations with smoking included working as a contractor versus mine employee (odds ratio 2.32, 95% CI 1.01 to 5.36) and a usual job title of maintenance (odds ratio 2.02, 95% CI 0.87 to 4.94). CONCLUSION Industry-specific information may be helpful in developing targeted tobacco-cessation programs.
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Linde BD, Ebbert JO, Schroeder DR, Hanson AC, Talcott GW, Klesges RC. Smokeless tobacco use among United States Air Force trainees. Subst Abus 2016; 38:278-284. [PMID: 28027011 DOI: 10.1080/08897077.2016.1275924] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The prevalence of smokeless tobacco use in the United States Air Force (USAF) exceeds civilian use rates. The prevalence and correlates of smokeless tobacco use were assessed and evaluated in a sample of USAF trainees. METHODS We conducted a cross-sectional survey of USAF technical training school personnel at Joint Base San Antonio-Lackland and Fort Sam Houston (N = 14,810). Survey completion rate was 78%. Logistic regression was used to analyze the associations between demographic variables, tobacco use, and social factors for both regular and infrequent smokeless tobacco (e.g., chewing tobacco, snuff) users. RESULTS Overall, 16% of Airmen had ever used smokeless tobacco and 10% regularly used smokeless tobacco. In multivariate analyses, men had greater odds than women of regular smokeless tobacco use (adjusted odds ratio [OR] = 15.2; 95% confidence interval [CI]: 10.8-21.5) and infrequent smokeless tobacco use (adjusted OR = 4.2; 95% CI: 3.1-5.7). Smokeless tobacco use was associated with participation in high school sports (adjusted OR = 1.9; 95% CI: 1.6-2.3 for regular users; adjusted OR = 1.4; 95% CI: 1.1-1.7 for infrequent users), smoking cigarettes (adjusted OR = 4.3; 95% CI: 3.6-5.1 for regular users; adjusted OR = 4.0; 95% CI: 3.2-5.0 for infrequent users), or living with someone who used smokeless tobacco (adjusted OR = 2.2; 95% CI: 1.9-2.6 for regular users; adjusted OR = 1.4; 95% CI: 1.1-1.7 for infrequent users). Black or African Americans were less likely than whites to be regular (adjusted OR = 0.3; 95% CI: 0.1-0.4) or infrequent (adjusted OR = 0.3; 95% CI: 0.2-0.4) users of smokeless tobacco. CONCLUSIONS Smokeless tobacco use among incoming Air Force recruits is common and negatively impacts the Air Force's goal to be tobacco-free. Understanding sociodemographic characteristics perpetuating smokeless tobacco use in the Air Force population can inform the development of health promotion interventions.
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Affiliation(s)
- Brittany D Linde
- a Organizational Wellness and Learning Systems , Fort Worth , Texas , USA
| | - Jon O Ebbert
- b Division of Primary Care Internal Medicine , Department of Medicine , Mayo Clinic , Rochester , Minnesota , USA
| | - Darrell R Schroeder
- c Division of Biomedical Statistics and Informatics. Department of Health Sciences Research , Mayo Clinic , Rochester , Minnesota , USA
| | - Andrew C Hanson
- c Division of Biomedical Statistics and Informatics. Department of Health Sciences Research , Mayo Clinic , Rochester , Minnesota , USA
| | - G Wayne Talcott
- d Department of Preventive Medicine, Center for Population Sciences , University of Tennessee Health Science Center , Memphis , Tennessee , USA
| | - Robert C Klesges
- d Department of Preventive Medicine, Center for Population Sciences , University of Tennessee Health Science Center , Memphis , Tennessee , USA
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Ramström L, Borland R, Wikmans T. Patterns of Smoking and Snus Use in Sweden: Implications for Public Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13111110. [PMID: 27834883 PMCID: PMC5129320 DOI: 10.3390/ijerph13111110] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 10/22/2016] [Accepted: 11/02/2016] [Indexed: 02/07/2023]
Abstract
There has been concern that the availability of alternative less harmful forms of nicotine might inhibit smoking cessation and/or encourage those who would not otherwise have smoked to do so. The plausibility of such effects can be best assessed by looking at population trends in use of smoking in relation to alternatives. This paper looks at the relationships between snus use and smoking in Sweden. Analyses are based on a data set for the period January 2003 to February 2011 from a long-term study covering nationally representative samples of the Swedish population aged 18–79, with a total study population of 60,675 individuals. Questionnaires made it possible to identify detailed tobacco use categories and use trajectories. The results showed that uptake of snus use is much more common in males than females. Those who began daily tobacco use using snus were much less likely to subsequently take up smoking than those who had not, both among males (17.6% vs. 45.9%), and females (8.2% vs. 40.2%). Further, among those who started using snus after starting as smokers, 76.3% of men and 71.6% of women had stopped smoking completely, including 31.5% of the men and 28.6% of the women who had quit all forms of tobacco. Indeed, those who were primary snus users were also more likely to have quit altogether than those who only ever smoked. Snus was also reported as the most common smoking cessation aid among men and yielded higher success rates than nicotine replacement therapy and other alternatives. As conclusions, snus has both contributed to decreasing initiation of smoking and, when used subsequent to smoking, appears to facilitate smoking cessation. All these effects suggest that the availability and use of snus has been a major factor behind Sweden’s record-low prevalence of smoking and the lowest level of tobacco-related mortality among men in Europe.
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Affiliation(s)
- Lars Ramström
- Institute for Tobacco Studies, Kanalvägen 17, SE-18338 Täby, Sweden.
| | - Ron Borland
- Melbourne School of Population and Global Health, University of Melbourne, 235 Bouverie St, Carlton Victoria 3053, Australia.
- Nigel Gray Fellowship Group, Cancer Council Victoria, 615 St. Kilda Road, Melbourne, Victoria 3004, Australia.
| | - Tom Wikmans
- LiQuSa-Research, Industrial Business Residence, Örsätter, SE-597 94 Åtvidaberg, Sweden.
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Dunbar MS, Shadel WG, Tucker JS, Edelen MO. Use of and reasons for using multiple other tobacco products in daily and nondaily smokers: Associations with cigarette consumption and nicotine dependence. Drug Alcohol Depend 2016; 168:156-163. [PMID: 27664553 PMCID: PMC5086264 DOI: 10.1016/j.drugalcdep.2016.09.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 08/05/2016] [Accepted: 09/06/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Use of other tobacco products (OTPs) among smokers is increasing. Little is known about types of OTP used and the reasons for use, and how OTP use and reasons for use correlate with smoking patterns and nicotine dependence in daily and nondaily smokers. This paper addresses these gaps in the literature. METHODS 656 daily smokers and 203 nondaily smokers provided information on their use of different OTPs (hookah, e-cigarettes, chew/snuff, snus, cigars, dissolvables), and reasons for using OTPs (e.g., "to cut down on smoking"), as well as their cigarette consumption and nicotine dependence. Logistic regression models assessed the association of smoking status with OTP use (ever and current) and reasons for use. Within each smoking group, separate logistic regression models examined the associations of OTP use and reasons for use with cigarette consumption and nicotine dependence. RESULTS Compared to daily smokers, nondaily smokers were more likely to use hookah and cigars, less likely to use dissolvables, and less likely to endorse using OTPs to reduce their smoking. Among non-daily smokers, nicotine dependence was associated with a higher likelihood of current OTP use (OR=1.04 [95% CI 1.01-1.07]; p<0.05), whereas cigarette consumption was not. CONCLUSIONS Results suggest OTP use in nondaily smokers does not correlate with less frequent smoking, but may correlate with higher nicotine dependence. Use of combustible OTPs among nondaily smokers may offset any potential benefits achieved through less frequent cigarette consumption. Providers should explicitly address OTP use when discussing cigarette cessation and reduction.
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Affiliation(s)
- Michael S Dunbar
- RAND Corporation, 4750 Fifth Avenue, Suite 600, Pittsburgh, PA 15213, USA.
| | - William G Shadel
- RAND Corporation, 4750 Fifth Avenue, Suite 600, Pittsburgh, PA 15213, USA
| | - Joan S Tucker
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, USA
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Doran N, Brikmanis K. Expectancies for and use of e-cigarettes and hookah among young adult non-daily smokers. Addict Behav 2016; 60:154-9. [PMID: 27155241 PMCID: PMC4884616 DOI: 10.1016/j.addbeh.2016.04.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 04/12/2016] [Accepted: 04/18/2016] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Understanding predictors of e-cigarette and hookah use among young adults is important in light of their increasing prevalence, particularly in younger populations. The purpose of this study was to test the hypothesis that young adult non-daily cigarette smokers' use of e-cigarettes and hookah would be positively associated with their expectancies about these products. METHODS Young adults (n=377, 58.0% male) aged 18-24years (M=20.5, SD=1.8) who had been non-daily smokers for at least six months but had never been daily smokers completed a baseline assessment online or via mobile phone as part of a larger, longitudinal study. RESULTS Approximately one in three participants reported any e-cigarette (34.0%) and/or hookah (33.4%) use in the past 14days; 37% of those who used either product reported using both. More positive e-cigarette expectancies were associated with higher odds of any e-cigarette use and with heavier use in the past two weeks. Similarly, more positive expectancies for hookah use predicted greater odds of any use as well as more frequent use of hookah (all ps<0.001). Cigarette expectancies were correlated with ANTP expectancies, but did not account for the latter's association with ANTP use. CONCLUSIONS Findings suggest that expectancies play a role in determining whether young adult cigarette smokers also use these nicotine products. These data also suggest use of e-cigarettes and/or hookah may be as common as not among young adult nondaily smokers.
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Affiliation(s)
- Neal Doran
- University of California, San Diego, United States; VA San Diego Healthcare System, United States.
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Vijayaraghavan M, Tieu L, Ponath C, Guzman D, Kushel M. Tobacco Cessation Behaviors Among Older Homeless Adults: Results From the HOPE HOME Study. Nicotine Tob Res 2016; 18:1733-9. [PMID: 26920648 PMCID: PMC4941600 DOI: 10.1093/ntr/ntw040] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 02/14/2016] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Tobacco-attributable deaths contribute significantly to the increased mortality observed among homeless adults aged 50 years or more. Little is known about the epidemiology of tobacco use among older homeless individuals. This longitudinal cohort study examines smoking behaviors and factors associated with smoking cessation among homeless individuals aged 50 years or more. METHODS We recruited a prospective cohort of 350 homeless individuals sampled from the community in Oakland, California. At 6 months follow-up, participants reported their cigarette quit attempts and 30-day abstinence. We used multivariable logistic regression to examine factors associated with making a quit attempt at follow-up, hypothesizing that heavier smokers would be less likely to make a quit attempt. RESULTS Of the 272 ever-smokers, 229 (84.2%) were current smokers (quit ratio 15.8). Among current smokers at enrollment who had a follow-up interview at 6 months, 43.6% (n = 71) reported making a quit attempt during the follow-up. Of those who reported making a quit attempt, 14.3% (n = 10) reported 30-day abstinence at follow-up. Among those who had reported making a quit attempt at follow-up, 22.5% had used nicotine replacement therapy (NRT). Staying in shelters (adjusted odds ratio [AOR] = 2.5, 95% confidence interval [CI] = 1.0-5.8) was associated with higher odds of making a quit attempt at follow-up. Higher cigarette consumption was associated with lower odds of making a quit attempt (AOR = 0.9, 95% CI = 0.8-0.9). CONCLUSIONS In this study of tobacco use in older homeless adults, rates of quit attempts were similar to that observed in the general population, but successful quitting was lower. IMPLICATIONS The current study is among the first studies to focus specifically on tobacco use and cessation behaviors among older homeless adults. The high prevalence of smoking and the low rates of successful quitting highlight numerous opportunities to intervene to increase quitting rates among this population. Among these, increasing access to smoke-free living environments and identifying effective cessation therapies will be critical to reducing tobacco-related disease burden among older homeless adults.
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Affiliation(s)
- Maya Vijayaraghavan
- Division of General Internal Medicine, University of California, San Francisco, San Francisco General Hospital, San Francisco, CA
| | - Lina Tieu
- Division of General Internal Medicine, University of California, San Francisco, San Francisco General Hospital, San Francisco, CA
| | - Claudia Ponath
- Division of General Internal Medicine, University of California, San Francisco, San Francisco General Hospital, San Francisco, CA
| | - David Guzman
- Division of General Internal Medicine, University of California, San Francisco, San Francisco General Hospital, San Francisco, CA
| | - Margot Kushel
- Division of General Internal Medicine, University of California, San Francisco, San Francisco General Hospital, San Francisco, CA
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Pacek LR, Sweitzer MM, McClernon FJ. Non-cigarette tobacco and poly-tobacco use among persons living with HIV drawn from a nationally representative sample. Drug Alcohol Depend 2016; 162:251-5. [PMID: 27049581 PMCID: PMC4834032 DOI: 10.1016/j.drugalcdep.2016.03.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 03/22/2016] [Accepted: 03/24/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Smoking is more prevalent among persons living with HIV (PLWH) than the general population. Little is known about the prevalence of non-cigarette tobacco and poly-tobacco use (PTU; using multiple tobacco products) among this population, which, in the general population is associated with poor health and cessation outcomes. We aimed to characterize the prevalence of cigarette and non-cigarette tobacco use, PTU, and correlates of tobacco use status among a nationally-representative sample of PLWH. METHODS Data came from 472 HIV-positive adults from the 2005-2013 National Survey on Drug Use and Health (NSDUH). RESULTS The prevalence of PTU overall was 8.7% (95% CI=5.6-13.2), and 16.6% (95% CI=10.2-25.7) among past-year tobacco users. In multinomial logistic regression analyses, participants with a high school education or greater (aRRR=2.03, 95% CI=1.03-4.00) were more likely to be non-tobacco users than single product users. Past year drug users (aRRR=0.35, 95% CI=0.19-0.66) and past month binge drinkers (aRRR=0.24, 95% CI=0.12-0.50) were less likely to be non-tobacco users than single product users. Compared to 18-25 year olds, individuals age 26-34 (aRRR=0.13, 95% CI=0.03-0.65) and 35+ (aRRR=0.24, 95% CI=0.09-0.63), and with lifetime anxiety disorder(s) (aRRR=0.18, 95% CI=0.06-0.57) were less likely to be PTUs as compared to single product users. Individuals who reported liking to test themselves by doing risky things were more likely to be PTUs than single product users (aRRR=2.95, 95% CI=1.27-6.84). CONCLUSIONS PTU was slightly higher than in the general population, and should be taken into account when developing cessation interventions tailored to tobacco users living with HIV.
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Affiliation(s)
- Lauren R. Pacek
- Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC,Corresponding author: 2608 Erwin Road, Suite 3038, Durham, NC 27705; telephone: 919-684-5437; fax: 919-681-1600;
| | - Maggie M. Sweitzer
- Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - F. Joseph McClernon
- Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
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El-Toukhy S, Choi K. A Risk-Continuum Categorization of Product Use Among US Youth Tobacco Users. Nicotine Tob Res 2016; 18:1596-605. [PMID: 26764258 DOI: 10.1093/ntr/ntw008] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 01/05/2016] [Indexed: 12/16/2022]
Abstract
INTRODUCTION To examine prevalence and correlates of five mutually exclusive tobacco-use patterns among US youth tobacco users. METHODS A nationally representative sample of tobacco users (N = 3202, 9-17 years) was classified into five product-use patterns. Weighted multinominal and multivariate logistic regression models were used to examine prevalence of product-use patterns by gender, race and ethnicity, and grade level; and associations between product-use patterns and perceived accessibility of tobacco products, exposure and receptivity to pro-tobacco marketing, social benefits of smoking, and tobacco-associated risks. RESULTS Dual use (ie, use of two product categories) was the most prevalent pattern (30.5%), followed by non-cigarette combustible only (26.7%), polytobacco (ie, use of three product categories; 17.5%), cigarette only (14.9%), and noncombustible only (10.4%) use. Product-use patterns differed by gender, race, and ethnicity. Compared to cigarette only users, dual and polytobacco users were more likely to be exposed to and be receptive to pro-tobacco marketing, and were less likely to acknowledge tobacco-use related risks (Ps < .05). CONCLUSIONS Curbing tobacco use warrants research on users of more than one tobacco-product categories according to the risk-continuum categorization. IMPLICATIONS We present a risk-continuum categorization of product-use patterns among tobacco users not older than 17 years. We classify tobacco users into five mutually exclusive product-use patterns: cigarette only users, non-cigarette combustible only users, noncombustible only users, dual use, and polytobacco use. This categorization overcomes limitations in current literature on tobacco-use patterns, which include exclusion of certain products (eg, e-cigarettes) and product-use patterns (eg, exclusive users of non-cigarette products), and inconsistent classification of tobacco users. It is parsimonious yet complex enough to retain differential characteristics of sub-tobacco users based on number (single, dual, polytobacco) and categories (cigarettes, non-cigarette combustibles, noncombustibles) of tobacco products consumed.
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Affiliation(s)
- Sherine El-Toukhy
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD
| | - Kelvin Choi
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD
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Kaufman AR, Land S, Parascandola M, Augustson E, Backinger CL. Tobacco use transitions in the United States: The National Longitudinal Study of Adolescent Health. Prev Med 2015; 81:251-7. [PMID: 26361752 PMCID: PMC4679648 DOI: 10.1016/j.ypmed.2015.08.026] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 08/21/2015] [Accepted: 08/31/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The purpose of this study is to evaluate and describe transitions in cigarette and smokeless tobacco (ST) use, including dual use, prospectively from adolescence into young adulthood. METHODS The current study utilizes four waves of the National Longitudinal Study of Adolescent Health (Add Health) to examine patterns of cigarette and ST use (within 30 days of survey) over time among a cohort in the United States beginning in 7th-12th grade (1995) into young adulthood (2008-2009). Transition probabilities were estimated using Markov modeling. RESULTS Among the cohort (N=20,774), 48.7% reported using cigarettes, 12.8% reported using ST, and 7.2% reported dual use (cigarettes and ST in the same wave) in at least one wave. In general, the risk for transitioning between cigarettes and ST was higher for males and those who were older. Dual users exhibited a high probability (81%) of continuing dual use over time. CONCLUSIONS Findings suggest that adolescents who use multiple tobacco products are likely to continue such use as they move into young adulthood. When addressing tobacco use among adolescents and young adults, multiple forms of tobacco use should be considered.
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Affiliation(s)
- Annette R Kaufman
- Tobacco Control Research Branch, National Cancer Institute, Rockville, MD, United States.
| | - Stephanie Land
- Tobacco Control Research Branch, National Cancer Institute, Rockville, MD, United States
| | - Mark Parascandola
- Tobacco Control Research Branch, National Cancer Institute, Rockville, MD, United States
| | - Erik Augustson
- Tobacco Control Research Branch, National Cancer Institute, Rockville, MD, United States
| | - Cathy L Backinger
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, United States
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Messer K, Vijayaraghavan M, White MM, Shi Y, Chang C, Conway KP, Hartman A, Schroeder MJ, Compton WM, Pierce JP. Cigarette smoking cessation attempts among current US smokers who also use smokeless tobacco. Addict Behav 2015; 51:113-9. [PMID: 26253939 DOI: 10.1016/j.addbeh.2015.06.045] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 05/12/2015] [Accepted: 06/30/2015] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Concurrent use of cigarettes and smokeless tobacco is common, but little is known regarding the association of smokeless tobacco use with cigarette smoking cessation. Dual users may have lower cigarette consumption levels, which may also play a role in smoking cessation. METHODS The 2010-2011 Tobacco Use Supplement to the Current Population Survey included 26,760 current cigarette smokers, of which 675 concurrently used smokeless tobacco. We compared characteristics of the most recent cigarette smoking quit attempt of the past year between dual users and exclusive smokers, using multivariate regression. RESULTS Dual users (45%) were more likely than exclusive smokers (37%) to have made a cigarette smoking quit attempt during the previous year (p<0.01), even after adjusting for demographic differences and cigarette dependence levels (ORadj 1.33, 95% CI 1.15-1.53). Half (48%) of dual users who made a quit attempt tried to quit "by switching to smokeless tobacco". However, once in a quit attempt, dual users relapsed more quickly than exclusive smokers (Cox regression HRadj 1.13, 95% CI 1.02-1.26). There was no difference in 30-day abstinence rates on the most recent quit attempt (ORadj 1.09, 95% CI 0.88-1.37). For both groups, the best predictor of past 30-day abstinence was cigarette consumption level. CONCLUSIONS Current cigarette smokers who also use smokeless tobacco are more likely to have tried to quit, but relapse more quickly than exclusive smokers, and are not more likely to have attained 30day smoking cessation. Prospective studies at the population level are needed.
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Affiliation(s)
- Karen Messer
- Cancer Prevention and Control Division, Moores UCSD Cancer Center, University of California, 3855 Health Sciences Dr. MC 0901, La Jolla, CA 92093-0901, United States; Division of Biostatistics and Bioinformatics, UCSD, La Jolla, CA 92093, United States; Department of Family Medicine and Public Health, UCSD, La Jolla CA 92093, United States.
| | - Maya Vijayaraghavan
- Cancer Prevention and Control Division, Moores UCSD Cancer Center, University of California, 3855 Health Sciences Dr. MC 0901, La Jolla, CA 92093-0901, United States; Department of Family Medicine and Public Health, UCSD, La Jolla CA 92093, United States
| | - Martha M White
- Cancer Prevention and Control Division, Moores UCSD Cancer Center, University of California, 3855 Health Sciences Dr. MC 0901, La Jolla, CA 92093-0901, United States
| | - Yuyan Shi
- Cancer Prevention and Control Division, Moores UCSD Cancer Center, University of California, 3855 Health Sciences Dr. MC 0901, La Jolla, CA 92093-0901, United States; Department of Family Medicine and Public Health, UCSD, La Jolla CA 92093, United States
| | - Cindy Chang
- Center for Tobacco Products, U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993, United States
| | - Kevin P Conway
- National Institute on Drug Abuse, National Institutes of Health, 6001 Executive Boulevard, Room 5213, Bethesda, MD 20892-9561, United States
| | - Anne Hartman
- National Institutes of Health, National Cancer Institute, Division of Cancer Control and Population Sciences, 9609 Medical Center Drive, Rockville, MD 20850, United States
| | - Megan J Schroeder
- Center for Tobacco Products, U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993, United States
| | - Wilson M Compton
- National Institute on Drug Abuse, National Institutes of Health, 6001 Executive Boulevard, Room 5213, Bethesda, MD 20892-9561, United States
| | - John P Pierce
- Cancer Prevention and Control Division, Moores UCSD Cancer Center, University of California, 3855 Health Sciences Dr. MC 0901, La Jolla, CA 92093-0901, United States; Department of Family Medicine and Public Health, UCSD, La Jolla CA 92093, United States
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Cooper M, Case KR, Loukas A. E-cigarette use among Texas youth: Results from the 2014 Texas Youth Tobacco Survey. Addict Behav 2015; 50:173-7. [PMID: 26151581 PMCID: PMC4533923 DOI: 10.1016/j.addbeh.2015.06.034] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 06/02/2015] [Accepted: 06/16/2015] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Several characteristics of electronic cigarettes (e-cigarettes), such as candy flavorings, are worrisome for attracting youth. The current cross-sectional study uses data on e-cigarette use from the 2014 Texas Youth Tobacco Survey (TYTS), a representative statewide sample of Texas middle school and high school students. This study's aims are to determine the prevalence of e-cigarette use, including rates of concurrent use with other tobacco products among Texas youth and to describe the demographic and tobacco use differences between e-cigarette users and non-users. METHODS Participants were 13,602 6th through 12th grade students in Texas. Descriptive statistics were generated to determine the prevalence of current and lifetime e-cigarette use and to determine the prevalence of demographic characteristics across e-cigarette usage groups. Logistic regression analyses were conducted to examine differences in demographic characteristics, cigarette use in the home, and tobacco use behaviors for e-cigarette users versus non-users. RESULTS Almost one quarter of all middle and high school students reported lifetime e-cigarette use and 14.0% were past 30-day users of these products. Current e-cigarette users were more likely to be high school students, white and male than non-current users. Both current and lifetime e-cigarette users were also more likely than their peers to use other tobacco products, although 24.2% of current e-cigarette users had never smoked conventional cigarettes, and 7.3% had never used any other type of tobacco product besides an e-cigarette. CONCLUSIONS Findings highlight the urgency to regulate e-cigarettes as well as to include these products in tobacco prevention programs.
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Affiliation(s)
- Maria Cooper
- University of Texas, School of Public Health, Austin Regional Campus, 1616 Guadalupe, Suite 6.300, Austin, TX 78701, USA.
| | - Kathleen R Case
- University of Texas, School of Public Health, Austin Regional Campus, 1616 Guadalupe, Suite 6.300, Austin, TX 78701, USA.
| | - Alexandra Loukas
- University of Texas at Austin, Department of Kinesiology and Health Education, 2109 San Jacinto Blvd., Austin, TX 78712-1415, USA.
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Loukas A, Batanova M, Fernandez A, Agarwal D. Changes in use of cigarettes and non-cigarette alternative products among college students. Addict Behav 2015; 49:46-51. [PMID: 26046401 DOI: 10.1016/j.addbeh.2015.05.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 04/26/2015] [Accepted: 05/08/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The present study examined change in use of various smoked and smokeless non-cigarette alternative products in a sample of college students, stratified by current, or past 30-day, cigarette smoking status. METHODS Participants were 698 students from seven four-year colleges in Texas. Participants completed two waves of online surveys regarding tobacco use, knowledge, and attitudes, with 14 months between each wave. RESULTS The most prevalent products used by the entire sample at Wave 1 were cigarettes, followed by hookah, cigars/cigarillos/little cigars, and electronic cigarettes (e-cigarettes). At Wave 2, prevalence of e-cigarette use surpassed use of cigars/cigarillos/little cigars. Snus and chew/snuff/dip were relatively uncommon at both waves. Examination of change in use indicated that e-cigarette use increased across time among both current cigarette smokers and non-cigarette smokers. Prevalence of current e-cigarette use doubled across the 14-month period to 25% among current smokers and tripled to 3% among non-cigarette smokers. Hookah use also increased across time, but only among non-cigarette smokers, whereas it decreased among current cigarette smokers. Use of all other non-cigarette alternatives remained unchanged across time. Logistic regression analysis was used to examine the socio-demographic predictors of Wave 2 e-cigarette use, the only product that increased in use among both current cigarette smokers and non-cigarette smokers. Results indicated that Wave 1 current cigarette use and Wave 1 current e-cigarette use, but not gender, age, or race/ethnicity, were significantly associated with Wave 2 e-cigarette use. CONCLUSIONS Findings underscore the need to track changes in the use of non-cigarette alternatives and call for additional research examining the factors contributing to change in use.
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Affiliation(s)
- Alexandra Loukas
- Department of Kinesiology & Health Education, The University of Texas at Austin, Austin, TX 78712, United States.
| | - Milena Batanova
- Institute for Applied Research in Youth Development, Eliot-Pearson Department of Child Study and Human Development, United States
| | - Alejandra Fernandez
- Department of Kinesiology & Health Education, The University of Texas at Austin, Austin, TX 78712, United States
| | - Deepti Agarwal
- Department of Kinesiology & Health Education, The University of Texas at Austin, Austin, TX 78712, United States
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Sung HY, Wang Y, Yao T, Lightwood J, Max W. Polytobacco Use of Cigarettes, Cigars, Chewing Tobacco, and Snuff Among US Adults. Nicotine Tob Res 2015; 18:817-26. [PMID: 26136525 DOI: 10.1093/ntr/ntv147] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 06/26/2015] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Tobacco use prevalence has been commonly estimated on a product by product basis and the extent of polytobacco use among current users of each tobacco product is not well understood. This study aimed to examine the prevalence, trends, and correlates of polytobacco use among current users of cigarettes, cigars, chewing tobacco, and snuff in US adults aged ≥18. METHODS We used pooled data from the 1998, 2000, 2005, and 2010 Cancer Control Supplements of the National Health Interview Survey (N = 123 399 adults). Multivariate logistic regression models were estimated to determine significant factors associated with polytobacco use. RESULTS In 2010, the prevalence of polytobacco use was 8.6% among current cigarette smokers, 50.3% among current cigar users, 54.8% among current chewing tobacco users, and 42.5% among current snuff users. After controlling for other covariates, gender and race/ethnicity did not show consistent associations with poly-use across these four groups of current tobacco users; however, a positive association of young adulthood, less than high school education, and binge drinking with poly-use was consistently found among all these groups. CONCLUSIONS Polytobacco use is extremely popular among current users of non-cigarette tobacco products. Polytobacco use patterns differ across sociodemographic subpopulations, and the gender and racial/ethnic profiles in poly-users vary across different groups of current tobacco users. Tobacco control strategies need to consider the interrelationships in the use of different tobacco products and the diverse profiles of poly-users in order to develop tailored tobacco prevention and intervention policies to further reduce the burden of tobacco use.
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Affiliation(s)
- Hai-Yen Sung
- Institute for Health & Aging, School of Nursing, University of California, San Francisco, CA;
| | - Yingning Wang
- Institute for Health & Aging, School of Nursing, University of California, San Francisco, CA
| | - Tingting Yao
- Institute for Health & Aging, School of Nursing, University of California, San Francisco, CA
| | - James Lightwood
- Department of Clinical Pharmacy, School of Pharmacy, University of California, San Francisco, CA
| | - Wendy Max
- Institute for Health & Aging, School of Nursing, University of California, San Francisco, CA
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Elfassy T, Yi SS, Kansagra SM. Trends in cigarette, cigar, and smokeless tobacco use among New York City public high school youth smokers, 2001-2013. Prev Med Rep 2015; 2:488-91. [PMID: 26844107 PMCID: PMC4721468 DOI: 10.1016/j.pmedr.2015.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE This study aimed to describe the recent trends in youth smoking behaviors, and examine cigar and smokeless tobacco use patterns among youth smokers in New York City. METHODS Data, analyzed in 2014, were from the New York City Youth Risk Behavior Survey, a cross-sectional survey conducted bi-annually since 1997 in a representative sample of New York City public high school students (2001-2013), n = 59,122. RESULTS Cigarette smoking declined 53%, from 17.6% in 2001 to 8.2% in 2013 (p < 0.001). The proportion of cigar use among smokers doubled, from 22.2% in 2001 to 45.9% in 2013 (p < 0.001), while the proportion of smokeless tobacco use among smokers increased by 400% between 2001 and 2013 (4.2% vs. 21.2%, p < 0.001). CONCLUSIONS Youth cigarette smoking rates in New York City decreased, while cigar smoking and smokeless tobacco use among smokers increased considerably. These data highlight trends in youth smoking behaviors within the context of New York City's comprehensive tobacco control program and stress the need for additional activity to spur further declines in cigarette smoking and reverse the trends in cigar and smokeless tobacco use among New York City youth. Results demonstrate the need for continuous surveillance and action by the public health community to counteract tobacco industry promotion of other products.
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Affiliation(s)
- Tali Elfassy
- Bureau of Chronic Disease Prevention and Tobacco Control, Division of Health Promotion and Disease Prevention, New York City, USA
| | - Stella S Yi
- Bureau of Chronic Disease Prevention and Tobacco Control, Division of Health Promotion and Disease Prevention, New York City, USA
| | - Susan M Kansagra
- Bureau of Chronic Disease Prevention and Tobacco Control, Division of Health Promotion and Disease Prevention, New York City, USA
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Macy JT, Li J, Xun P, Presson CC, Chassin L. Dual Trajectories of Cigarette Smoking and Smokeless Tobacco Use From Adolescence to Midlife Among Males in a Midwestern US Community Sample. Nicotine Tob Res 2015; 18:186-95. [PMID: 25847287 DOI: 10.1093/ntr/ntv070] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 03/11/2015] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Identifying trajectories of tobacco use is critical for understanding its natural history and targeting interventions, but research on trajectories of smokeless tobacco and dual use of smokeless tobacco and cigarettes is very limited. This study identified tobacco use trajectories from adolescence to midlife and tested correlates of trajectory group membership. METHODS This study included all male participants in a longitudinal study who reported cigarette smoking or smokeless tobacco use in 1987, 1993, 1999, 2005, or 2011 (N = 2230). Group-based trajectory analyses were conducted with zero-inflated Poisson models. Analysis of covariance was used to test adolescent health beliefs associated with trajectory group membership. RESULTS Five smoking trajectory groups were identified: (1) consistent abstinence from cigarettes; (2) late onset intermittent, then cessation; (3) early onset regular, then cessation; (4) delayed onset regular, then cessation; and (5) consistent regular. Four smokeless tobacco trajectory groups were identified: (1) early onset, then cessation; (2) consistent abstinence from smokeless tobacco; (3) late onset, escalating; and (4) consistent regular. The proportion of participants in trajectory groups representing dual use was low. Adolescent beliefs favorable to smoking and smokeless tobacco were associated with membership in consistent regular use groups. CONCLUSIONS The prevalence of dual use of cigarettes and smokeless tobacco was low, and there was little evidence to suggest switching between tobacco products. Participants who held more positive beliefs about smoking and smokeless tobacco as adolescents were more likely to be consistent regular users of cigarettes and smokeless tobacco into adulthood.
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Affiliation(s)
- Jonathan T Macy
- Department of Applied Health Science, Indiana University School of Public Health, Bloomington, IN;
| | - Jing Li
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington, IN
| | - Pengcheng Xun
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington, IN
| | - Clark C Presson
- Department of Psychology, Arizona State University, Tempe, AZ
| | - Laurie Chassin
- Department of Psychology, Arizona State University, Tempe, AZ
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Tam J, Day HR, Rostron BL, Apelberg BJ. A systematic review of transitions between cigarette and smokeless tobacco product use in the United States. BMC Public Health 2015; 15:258. [PMID: 25849604 PMCID: PMC4377056 DOI: 10.1186/s12889-015-1594-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 02/27/2015] [Indexed: 01/31/2023] Open
Abstract
Background Smokeless tobacco use is becoming an increasingly important public health issue in the US and may influence cigarette smoking behavior. Systematic information on transitions between smokeless tobacco and cigarette use in the US is limited. Methods We conducted a systematic review of published literature on transitions between smokeless tobacco and cigarette use in the US. We searched PubMed, Web of Science and EbscoHost databases for all published articles from January 2000 to March 2014 that presented estimates of transitions in US youth and adult study populations over time between at least one of the following tobacco use states: exclusive cigarette smoking, exclusive smokeless tobacco use, dual use of both products, and use of neither product. We excluded non-English language studies, studies published before 2000, clinical trials, controlled cessation programs, and clinical studies or evaluations of smokeless tobacco cessation programs. Results The review identified six studies on US populations published since 2000 with longitudinal data on some or all of the transitions that users can undergo between smokeless tobacco and cigarette use. There was considerable heterogeneity across studies in design and tobacco use definitions. Despite these differences, the existing data indicate that switching behaviors from exclusive smoking to exclusive smokeless tobacco use are limited (adults: 0%-1.4%, adolescents: 0.8%-3.8%) but may be more common from exclusive smokeless tobacco use to exclusive smoking (adults: 0.9%-26.6%, adolescents: 16.6%-25.5%). Among adults, exclusive cigarette smoking was generally stable and consistent (79.7% to 87.6%) over follow-up across studies but less stable in adolescents (46.8%-78.7%). Exclusive smokeless tobacco use was less stable than exclusive cigarette smoking over time (adults: 59.4%-76.6%, adolescents: 26.2%-44.8%). Conclusion This review provides published estimates of the proportions of adults and adolescents transitioning between tobacco use categories from the most recently available studies on longitudinal transitions between smokeless tobacco and cigarettes in the US. These data can be used to track tobacco use behaviors and evaluate their effect on public health; however, the data for these studies were generally collected more than a decade ago. Additional research including nationally representative longitudinal estimates using consistent definitions and designs, would improve understanding of current tobacco transition behaviors.
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Kalkhoran S, Grana RA, Neilands TB, Ling PM. Dual use of smokeless tobacco or e-cigarettes with cigarettes and cessation. Am J Health Behav 2015; 39:277-84. [PMID: 25564840 DOI: 10.5993/ajhb.39.2.14] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To evaluate predictors of dual use of cigarettes with smokeless tobacco or e-cigarettes. METHODS Adult smokers (N = 1324) completed online cross-sectional surveys. Logistic regression evaluated predictors of dual use and cigarette quit attempts. RESULTS Smokeless tobacco dual use was associated with past attempts to quit smoking by switching to smokeless products. E-cigarette dual use was associated with using stop-smoking medication and strong anti-tobacco industry attitudes. Ever use of stop-smoking medication was associated with quit attempts among dual e-cigarette users and cigarette-only users. CONCLUSIONS Dual users are more likely than cigarette-only users to endorse certain cessation-related attitudes and behaviors. This may provide an opportunity for clinicians or others to discuss evidence-based strategies for smoking cessation.
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Affiliation(s)
- Sara Kalkhoran
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Rachel A Grana
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA, USA
| | - Torsten B Neilands
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Pamela M Ling
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
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Cohn A, Cobb CO, Niaura RS, Richardson A. The Other Combustible Products: Prevalence and Correlates of Little Cigar/Cigarillo Use Among Cigarette Smokers. Nicotine Tob Res 2015; 17:1473-81. [PMID: 25634932 DOI: 10.1093/ntr/ntv022] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 01/18/2015] [Indexed: 11/13/2022]
Abstract
BACKGROUND Despite the increasing consumption of little cigars and cigarillos (LCCs), few studies have examined unique predictors and correlates of LCC use among adult cigarette smokers. This study explored differences between cigarette smokers with and without a history of LCC use on harm perceptions, use of other tobacco products (chewing tobacco, snus, e-cigarettes, and dissolvables), cigarette smoking/cessation-related behaviors/cognitions, and mental health and substance use disorder symptoms. METHODS A geographically diverse sample of current cigarette smokers were included in analyses (n = 1270). Frequencies of LCC use, awareness, purchase, and harm perceptions were examined and logistic regression models investigated differences between LCC ever and never users on a variety of factors, controlling for demographics. RESULTS Bivariate analyses showed that LCC users were more likely to be male, younger, have lower income, have tried other tobacco products, perceive LCCs as less harmful than cigarettes, and endorse lifetime substance disorder symptoms. Menthol and other tobacco product use were the only significant correlates of LCC use in logistic regression models. Post-hoc analyses showed that other tobacco product use partially mediated an association between substance use disorder symptoms and LCC use. CONCLUSIONS A third of the sample had tried LCCs, and LCC users were more likely to have experimented with other tobacco products and used menthol. The high degree of co-use of cigarette smoking and LCCs with other tobacco products and the association of LCC use to substance use suggests that these users have unique risk factors and deserve specific targeting in public health campaigns.
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Affiliation(s)
- Amy Cohn
- Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC;
| | - Caroline O Cobb
- Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC
| | - Raymond S Niaura
- Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC; Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Oncology, Georgetown University Medical Center/Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC
| | - Amanda Richardson
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Health Behavior, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC
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Doran N, Godfrey KM, Myers MG. Hookah Use Predicts Cigarette Smoking Progression Among College Smokers. Nicotine Tob Res 2015; 17:1347-53. [PMID: 25586774 DOI: 10.1093/ntr/ntu343] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 12/22/2014] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Hookah use is increasingly common among U.S. college students, but little is known regarding the relationship between hookah and cigarette use. The purpose of this study was to test the hypothesis that the added nicotine exposure from hookah use may accelerate the uptake of cigarettes. METHODS An ethnically diverse sample of college students (n = 256; 43% female) who had smoked cigarettes in the past month completed 2 in-person interviews over 6 months. This study was a secondary analysis of data collected for a longitudinal study of young adult cigarette smoking patterns. Analyses examined 6-month changes in past 30 day cigarettes smoked and number of days smoking, controlling for age, nicotine dependence, marijuana use, and the respective baseline variable for each outcome. RESULTS Current hookah use (any use in past 30 days) was endorsed by 34% of participants at baseline, while 94% reported lifetime use. Change in past 30 day number of cigarettes (p = .043) and number of smoking days (p = .040) differed significantly between those who did or did not report recent hookah use at baseline. Hookah users reported a greater number of cigarettes smoked at the 6-month follow-up, while nonusers decreased their smoking quantity. For number of smoking days in the past 30, hookah users reported a smaller decrease than nonusers. CONCLUSIONS Recent hookah use predicted increased cigarette smoking over 6 months in a college sample. These are the first prospective data demonstrating this relationship, indicating the value of developing strategies to prevent hookah use among college students.
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Affiliation(s)
- Neal Doran
- Department of Psychiatry, University of California, San Diego, CA; Mental Health Care Line, VA San Diego Healthcare System, San Diego, CA;
| | - Kathryn M Godfrey
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA; VA Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA
| | - Mark G Myers
- Department of Psychiatry, University of California, San Diego, CA; Mental Health Care Line, VA San Diego Healthcare System, San Diego, CA
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Panda R, Persai D, Mathur M, Sarkar BK. Perception and practices of physicians in addressing the smokeless tobacco epidemic: findings from two States in India. Asian Pac J Cancer Prev 2015; 14:7237-41. [PMID: 24460281 DOI: 10.7314/apjcp.2013.14.12.7237] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Smokeless tobacco use in South Asia is believed to be a significant contributor to morbidity and mortality. In India, only a few studies involving health educational intervention by health care providers have demonstrated reduction in smokeless tobacco usage. In the present study we assessed the cessation efforts towards smokeless tobacco by physicians in two high tobacco prevalence states of India. The study also identified opportunities and barriers for integration of tobacco cessation services in routine practices of physicians. MATERIALS AND METHODS This mixed method study involved qualitative (phase I) and quantitative research study (phase II). In phase I, 59 in-depth interviews with physicians were conducted. In phase II, a quantitative study conducted among 238 physicians. An inductive approach was followed to analyze qualitative data using ATLAS. Ti software. The Chi-square test was employed to test the association between different variables of interest using SPSS version 17. RESULTS The majority of physicians related only respiratory problems and cancer with smokeless tobacco. Other major health effects like cardio-vascular problems, oral diseases, and effects on reproductive and neonatal health were recognized only by a few physicians. The age-group of 10-19 years was identified as most vulnerable to smokeless tobacco use. Less than one-third of physicians reported recording smokeless tobacco history of all patients. Findings indicated that less than half of physicians provided information on harmful health effects of smokeless tobacco with regard to specific diseases. CONCLUSIONS The study revealed a low level of knowledge of physicians about harmful effects of tobacco and their suboptimal engagement in tobacco control practices. The study indicates the need of capacity building initiatives to equip physicians with skills in tobacco cessation.
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Affiliation(s)
- Rajmohan Panda
- Public Health Foundation of India, New Delhi, India E-mail : raj.
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Jitnarin N, Poston WSC, Haddock CK, Jahnke SA, Day RS. Tobacco use pattern among a national firefighter cohort. Nicotine Tob Res 2015; 17:66-73. [PMID: 25145378 PMCID: PMC4832966 DOI: 10.1093/ntr/ntu131] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 06/28/2014] [Indexed: 02/06/2023]
Abstract
INTRODUCTION To date, there have been no large-scale, national epidemiological studies of tobacco use patterns among firefighters, particularly with a focus on smokeless tobacco (SLT) and dual use with cigarettes. While rates of firefighters' smoking are relatively low compared to the general population, SLT use typically is substantially higher than the populations they protect. In the current study, we systemically examine tobacco use, including SLT and dual use, and the health-related profiles of various tobacco use groups in a national sample of career firefighters. METHODS Data are from a national cohort study of career departments (N = 20) comprised of 947 male firefighters. RESULTS Among 947 participants, 197 (21%) were tobacco users, of which, 34.5% used cigarettes, 53.2% used SLT, and 12.2% used both cigarettes and SLT. Adjusted rates of smoking, SLT use, and dual use were 13.2%, 10.5%, and 12.2%, respectively. Tobacco users of all types were significantly younger and had served fewer years in fire service and were significantly more likely to engage in heavy and binge drinking, as well as more likely to show signs of depressive symptoms compared to nontobacco users. CONCLUSIONS Detailed information on tobacco use pattern will aid in better understanding what factors are contributing to the high rates of SLT and dual use among firefighters in order to guide and develop an appropriate treatment program for the fire service.
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Affiliation(s)
- Nattinee Jitnarin
- Center for Fire Rescue and EMS Health Research, Institute for Biobehavioral Health Research, National Development and Research Institutes, Leawood, KS;
| | - Walker S C Poston
- Center for Fire Rescue and EMS Health Research, Institute for Biobehavioral Health Research, National Development and Research Institutes, Leawood, KS
| | - Christopher K Haddock
- Center for Fire Rescue and EMS Health Research, Institute for Biobehavioral Health Research, National Development and Research Institutes, Leawood, KS
| | - Sara A Jahnke
- Center for Fire Rescue and EMS Health Research, Institute for Biobehavioral Health Research, National Development and Research Institutes, Leawood, KS
| | - Rena S Day
- Division of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX
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Meier EM, Tackett AP, Miller MB, Grant DM, Wagener TL. Which nicotine products are gateways to regular use? First-tried tobacco and current use in college students. Am J Prev Med 2015; 48:S86-93. [PMID: 25528714 DOI: 10.1016/j.amepre.2014.09.018] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 09/17/2014] [Accepted: 09/24/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND The potential for emerging tobacco products (ETPs) to be gateway products for further tobacco use among youth is of significant concern. PURPOSE To examine use of various nicotine-containing products on a tobacco-free college campus and whether the first product tried predicts subsequent tobacco use. METHODS Undergraduate students (N=1,304) at a large university completed an online survey of past/current use of cigarettes; smokeless tobacco (SLT); hookah; ETPs (dissolvables, snus, and electronic cigarettes); and nicotine replacement therapy (NRT). Data were collected from September 2012 to May 2013 and analyses were conducted from June to September 2013. Students were classified as single, dual, or poly tobacco users. RESULTS The sample consisted of 79.5% non-users, 13.8% single, 4.4% dual, and 1.5% poly users. Overall, 49.4% of participants reported trying a tobacco product. Hookah was the most tried product (38%), but cigarettes were most often the first product ever tried (51%). First product tried did not predict current tobacco use and non-use, but individuals who first tried SLT or cigarettes (rather than hookah or ETPs) were more likely to be poly tobacco users. Current tobacco users who first tried ETPs or hookah were largely non-daily users of hookah; current tobacco users who first tried cigarettes or SLT were largely non-daily or daily users of cigarettes/SLT. CONCLUSIONS Hookah and ETPs are increasingly becoming the first tobacco product ever tried by youth; however, uptake of ETPs is poor, unlike cigarettes and SLT, and does not appear to lead to significant daily/non-daily use of cigarettes and SLT.
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Affiliation(s)
- Ellen M Meier
- Oklahoma State University, Department of Psychology, Stillwater; Oklahoma Tobacco Research Center, Oklahoma City, Oklahoma.
| | - Alayna P Tackett
- Oklahoma State University, Department of Psychology, Stillwater; Oklahoma Tobacco Research Center, Oklahoma City, Oklahoma
| | - Mary B Miller
- Oklahoma State University, Department of Psychology, Stillwater
| | - DeMond M Grant
- Oklahoma State University, Department of Psychology, Stillwater; Oklahoma Tobacco Research Center, Oklahoma City, Oklahoma
| | - Theodore L Wagener
- University of Oklahoma Health Sciences Center, Section of General & Community Pediatrics; Oklahoma Tobacco Research Center, Oklahoma City, Oklahoma
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Gottlieb JC, Cohen LM, Haslam AK. Comparing college smokers' and dual users' expectancies towards cigarette smoking. Addict Behav 2014; 39:1784-8. [PMID: 25123347 DOI: 10.1016/j.addbeh.2014.07.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 06/25/2014] [Accepted: 07/10/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND As no agreed upon definition exists for dual use (i.e., individuals who concurrently use more than one form of tobacco), this population remains largely unstudied in the substance use literature, despite increases in smokeless tobacco use among young adults. Individuals 18-25years of age report the highest rates of smokeless tobacco use, dual use, and cigarette use. The current study compared the smoking outcome expectancies of college student dual users to those who reported only smoking cigarettes. METHODS The Short Form of the Smoking Consequences Questionnaire was used to examine potential differences in positive or negative expectations regarding cigarette use. RESULTS Data from this study suggest that smokers believe that smoking will lead to greater positive consequences ("cigarettes taste good"), negative reinforcement ("cigarettes help me deal with anger"), and weight/appetite reduction ("smoking controls my appetite") when compared to dual users. Conversely, dual users believed that smoking would lead to greater negative consequences (e.g., "smoking is taking years off of my life"). DISCUSSION These results may help to explain why some smokers choose not to use smokeless tobacco products for harm reduction or smoking cessation purposes, as well as why increases are being observed in smokeless tobacco rates among young adults.
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Pulvers K, Hayes RB, Scheuermann TS, Romero DR, Emami AS, Resnicow K, Olendzki E, Person SD, Ahluwalia JS. Tobacco Use, Quitting Behavior, and Health Characteristics Among Current Electronic Cigarette Users in a National Tri-Ethnic Adult Stable Smoker Sample. Nicotine Tob Res 2014; 17:1085-95. [PMID: 25385875 DOI: 10.1093/ntr/ntu241] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 11/03/2014] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The present study characterizes the tobacco use, quitting behaviors, and health characteristics of cigarette smokers who did not change their smoking pattern over the past 6 months and have used electronic cigarettes (ECs) in the past 30 days. This is an important subpopulation to characterize if EC dual use with cigarettes continues to grow. METHODS Participants (N = 2,376) from a research survey panel completed an online cross-sectional survey between June and August 2012. Sampling was stratified to recruit equal numbers of cigarette smoking participants by race/ethnicity (Black, Hispanic, and Caucasian) and smoking frequency (nondaily and daily). All displayed a stable rate of smoking for the past 6 months and were not currently in treatment. Bivariate and multivariate analyses were used to examine correlates of current EC use (any use within the past 30 days). RESULTS Current EC use was reported by 9.2% (n = 219) of the total sample. Of current EC users, 44% reported having used ECs as a quit method. Bivariate and multivariate analyses showed that current EC use was significantly associated with greater nicotine dependence, concurrent poly-tobacco use, more past-year quit attempts, past use of multiple cessation methods, and more depressive symptoms. No demographic variables were significantly associated with current EC use. CONCLUSIONS This study suggests that stable smokers who currently use ECs possess characteristics that are associated with difficulty in achieving smoking cessation. These characteristics should be considered when examining the effectiveness of ECs on cessation and in designing future cessation trials using ECs.
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Affiliation(s)
- Kim Pulvers
- Department of Psychology, California State University San Marcos, San Marcos, CA;
| | - Rashelle B Hayes
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Taneisha S Scheuermann
- Department of Preventive Medicine and Public Health, University of Kansas School of Medicine, Kansas City, KS
| | - Devan R Romero
- Department of Kinesiology, California State University San Marcos, San Marcos, CA
| | - Ashley S Emami
- Department of Psychology, California State University San Marcos, San Marcos, CA
| | - Ken Resnicow
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Effie Olendzki
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Sharina D Person
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Jasjit S Ahluwalia
- Center for Health Equity, University of Minnesota Medical School, Minneapolis, MN
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