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Mantey DS, Hebert ET, Clendennen SL, Kelder SH, Harrell MB. Commentary Regarding "Adult Smokers' Complete Switching Away from Cigarettes at 6, 9, and 12 Months After Initially Purchasing a JUUL e-Cigarette. Subst Use Misuse 2024:1-3. [PMID: 38898556 DOI: 10.1080/10826084.2024.2360662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Affiliation(s)
- Dale S Mantey
- Department of Health Promotion and Behavioral Science, University of Texas School of Public Health, Austin, Texas, USA
- Department of Epidemiology, University of Texas School of Public Health, Houston, Texas, USA
| | - Emily T Hebert
- Department of Health Promotion and Behavioral Science, University of Texas School of Public Health, Austin, Texas, USA
| | - Stephanie L Clendennen
- Department of Health Promotion and Behavioral Science, University of Texas School of Public Health, Austin, Texas, USA
| | - Steven H Kelder
- Department of Epidemiology, University of Texas School of Public Health, Houston, Texas, USA
| | - Melissa B Harrell
- Department of Epidemiology, University of Texas School of Public Health, Houston, Texas, USA
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2
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Sharma E, Zebrak K, Lauten K, Gravely S, Cooper M, Gardner LD, Zaganjor I, Edwards KC, Kasza K, Marshall D, Kimmel HL, Stanton C, Hyland A, Fong G. Cigarette and ENDS dual use longitudinal transitions among adults in the Population Assessment of Tobacco and Health (PATH) Study, Waves 4-5 (2016-2019). Addict Behav Rep 2024; 19:100528. [PMID: 38384864 PMCID: PMC10879705 DOI: 10.1016/j.abrep.2024.100528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 12/26/2023] [Accepted: 01/02/2024] [Indexed: 02/23/2024] Open
Abstract
Introduction The study assessed longitudinal transitions among adult (18 and older) past 30-day daily and non-daily dual users of cigarettes and electronic nicotine delivery systems (ENDS). Methods Using data from Wave 4 (W4; 2016/17) and Wave 5 (W5; 2018/19) of the Population Assessment of Tobacco and Health (PATH) Study, a nationally representative, longitudinal cohort study of US adults, multivariable regressions were conducted among W4 dual users of cigarettes and ENDS to examine past 30-day cigarette smoking at W5. The study also analyzed changes in frequency of past 30-day smoking and cigarettes smoked per day between W4 and W5, stratified by W4/W5 daily/non-daily ENDS use among W4 daily and non-daily cigarette smokers. Results Among W4 dual users, those smoking daily and using ENDS non-daily had higher odds of daily cigarette smoking at W5 than daily users of both products (AOR: 2.32, 95 % CI: 1.38-3.90). W4 daily smokers who used ENDS daily at Wave 5 smoked cigarettes on fewer days at Wave 5 than W4 daily smokers who were either daily ENDS users at Wave 4 (B = -4.59; SE = 1.43, p < 0.01) or non-daily ENDS users at Wave 4 (B = -4.55; SE = 1.24, p < 0.001). Among W4 non-daily cigarette smokers, W4 non-daily ENDS users who used daily at W5 smoked cigarettes on fewer days (B = -4.04, SE = 1.82) at W5 than those who were non-daily ENDS users at W4 and W5. Conclusions Findings highlight the importance of frequency of ENDS use in reducing cigarette smoking and could inform smoking cessation interventions among daily cigarette smokers.
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Affiliation(s)
| | | | | | | | - Maria Cooper
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - Lisa D. Gardner
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - Ibrahim Zaganjor
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | | | - Karin Kasza
- Department of Health Behavior, Division of Cancer Prevention & Population Sciences, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Daniela Marshall
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA
- Axle Informatics, Rockville, MD, USA
| | - Heather L. Kimmel
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA
| | | | - Andrew Hyland
- Department of Health Behavior, Division of Cancer Prevention & Population Sciences, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Geoff Fong
- University of Waterloo, Canada
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
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3
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Jebai R, Asfar T, Cano MÁ, Nakkash R, Schmidt M, Wu W, Bursac Z, Maziak W. Effects of Pictorial Health Warning Labels on Intention to Quit Waterpipe in Lebanon: A Mediation Analysis. Nicotine Tob Res 2024; 26:764-770. [PMID: 37952202 DOI: 10.1093/ntr/ntad223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 10/31/2023] [Accepted: 11/03/2023] [Indexed: 11/14/2023]
Abstract
INTRODUCTION Pictorial health warning labels (HWLs) on waterpipe (WP) tobacco packages represent a better strategy for communicating the health risks associated with WP use and promoting quit intention than text-only. However, the mechanism by which these warnings lead to higher intentions to quit remains unknown. AIMS AND METHODS This study explores how pictorial warnings versus text-only induces higher quit intention among a sample of young adult WP smokers in Lebanon. An online randomized cross-over experimental study was conducted in August 2021 among 276 young adult WP smokers who were exposed to two conditions: pictorial HWLs and text-only warnings on WP tobacco packages in random order. After each image, participants completed post-exposure assessments of health communication outcomes (eg, attention and negative affect). Using serial and parallel mediation analysis, we examined the role of attention, negative affect, cognitive elaboration, and perceived harm in mediating the relationship between exposure to HWLs and intention to quit. RESULTS Using serial mediation, exposure to pictorial warnings versus text-only was found to affect intention to quit through the following pathways: attention and negative affect, which accounted for 17.28% of the total effect, and through negative affect and cognitive elaboration, which accounted for 21.53% of the total effect. Results of parallel mediation showed that the indirect effect pathways via negative affect (β = 0.063; [95% bootstrap CI = 0.004 to 0.149]) and cognitive elaboration (0.047; [0.001 to 0.114]) were statistically significant. CONCLUSIONS The findings call on designing and implementing attention-grabbing, emotionally evocative, and cognitively persuasive pictorial warnings in Lebanon and other countries to curb WP tobacco smoking. IMPLICATIONS This is among the first experimental studies looking at multiple mediators underlying the effect of exposure to pictorial HWLs on intention to quit in a sample of current WP smokers in Lebanon. The findings showed that using attention-grabbing, emotionally evocative, and persuasive pictures with a clear textual warning is crucial to maximizing the impact of implementing WP-HWLs regulations in Lebanon and other countries to curb WP tobacco smoking.
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Affiliation(s)
- Rime Jebai
- Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL, USA
- Department of Health Law, Policy, and Management, School of Public Health, Boston University, Boston, MA, USA
| | - Taghrid Asfar
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
- Syrian Center for Tobacco Studies, Aleppo, Syria
| | - Miguel Ángel Cano
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rima Nakkash
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Department of Global and Community Health, College of Public Health, George Mason University, Fairfax, Virginia, USA
| | - Michael Schmidt
- School of Public Health and Department of Art, University of Memphis, Memphis, TN, USA
| | - Wensong Wu
- Department of Mathematics and Statistics, Florida International University, Miami, FL, USA
| | - Zoran Bursac
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Wasim Maziak
- Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL, USA
- Syrian Center for Tobacco Studies, Aleppo, Syria
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4
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Krishnan N, Berg CJ, Elmi AF, Klemperer EM, Sherman SE, Abroms LC. Trajectories of ENDS and cigarette use among dual users: analysis of waves 1 to 5 of the PATH Study. Tob Control 2024; 33:e62-e68. [PMID: 36601793 DOI: 10.1136/tc-2022-057405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 11/15/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Concurrent electronic nicotine delivery system (ENDS) and cigarette (dual) use is harmful. Identifying longitudinal trajectories of ENDS and cigarette use among dual users can help to determine the public health impact of ENDS and inform tobacco control policies and interventions. OBJECTIVES (1) To identify independent and joint trajectories of ENDS and cigarette use among wave (W) 1 adult dual users across W1 to W5 of the Population Assessment of Tobacco and Health (PATH) Study; and (2) identify W1 predictors of ENDS and cigarette joint trajectory group membership. METHODS We used group-based trajectory modelling to estimate independent and joint trajectories of ENDS and cigarette use from wave 1 (W1; 2013-2014) to wave 5 (W5; 2018-2019) among W1 adult established dual users of ENDS and cigarettes (n=545) from the PATH Study. We used multinomial logistic regression to identify W1 predictors of joint trajectories. RESULTS Two ENDS (early quitters=66.0%, stable users=34.0%) and three cigarette (stable users=55.2%, gradual quitters=27.3%, early quitters=17.5%) trajectories of W1 were identified. In joint trajectory analysis, 41.6% of participants were early ENDS quitters and stable cigarette users; 14.8% early ENDS quitters and gradual cigarette quitters; 14.6% stable ENDS users and stable cigarette users; 11.2% stable ENDS users and gradual cigarette quitters; 10.3% early ENDS quitters and early cigarette quitters; and 7.4% stable ENDS users and early cigarette quitters. Cigarette and ENDS use frequency, nicotine dependence, cannabis use and other non-combusted tobacco product use predicted trajectory group membership (p values <0.05). CONCLUSIONS Most dual users maintained long-term cigarette smoking or dual use, highlighting the need to address cessation of both products. Continued monitoring of trajectories and their predictors is needed, given ongoing changes to the ENDS marketplace.
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Affiliation(s)
- Nandita Krishnan
- Department of Prevention and Community Health, The George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA
| | - Carla J Berg
- Department of Prevention and Community Health, The George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA
| | - Angelo F Elmi
- Department of Biostatistics and Bioinformatics, The George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA
| | - Elias M Klemperer
- Department of Psychiatry, University of Vermont, Burlington, Vermont, USA
- Vermont Center on Behavior and Health, Burlington, Vermont, USA
| | - Scott E Sherman
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Lorien C Abroms
- Department of Prevention and Community Health, The George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA
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5
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Kishinchand R, Boyce M, Vyas H, Sewell L, Mohi A, Brengartner L, Miller R, Gorr MW, Wold LE, Cray J. In Utero Exposure to Maternal Electronic Nicotine Delivery System use Demonstrate Alterations to Craniofacial Development. Cleft Palate Craniofac J 2023:10556656231163400. [PMID: 36916055 DOI: 10.1177/10556656231163400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
OBJECTIVE Develop a model for the study of Electronic Nicotine Device (ENDS) exposure on craniofacial development. DESIGN Experimental preclinical design followed as pregnant murine dams were randomized and exposed to filtered air exposure, carrier exposure consisting of 50% volume of propylene glycol and vegetable glycine (ENDS Carrier) respectively, or carrier exposure with 20 mg/ml of nicotine added to the liquid vaporizer (ENDS carrier with nicotine). SETTING Preclinical murine model exposure using the SciReq exposure system. PARTICIPANTS C57BL6 adult 8 week old female pregnant mice and exposed in utero litters. INTERVENTIONS Exposure to control filtered air, ENDS carrier or ENDS carrier with nicotine added throughout gestation at 1 puff/minute, 4 h/day, five days a week. MAIN OUTCOME MEASURES Cephalometric measures of post-natal day 15 pups born as exposed litters. RESULTS Data suggests alterations to several facial morphology parameters in the developing offspring, suggesting electronic nicotine device systems may alter facial growth if used during pregnancy. CONCLUSIONS Future research should concentrate on varied formulations and exposure regimens of ENDS to determine timing windows of exposures and ENDS formulations that may be harmful to craniofacial development.
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Affiliation(s)
- Rajiv Kishinchand
- Department of Biomedical Education and Anatomy, 12305The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Mark Boyce
- Department of Biomedical Education and Anatomy, 12305The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Heema Vyas
- Department of Biomedical Education and Anatomy, 12305The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Leslie Sewell
- Department of Biomedical Education and Anatomy, 12305The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Amr Mohi
- Department of Biomedical Education and Anatomy, 12305The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Lexie Brengartner
- Department of Biomedical Education and Anatomy, 12305The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Roy Miller
- School of Nursing, 2647The Ohio State University, Columbus, OH 43210, USA
| | - Matthew W Gorr
- School of Nursing, 2647The Ohio State University, Columbus, OH 43210, USA.,Department of Physiology and Cell Biology, 12305The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Loren E Wold
- School of Nursing, 2647The Ohio State University, Columbus, OH 43210, USA.,Department of Physiology and Cell Biology, 12305The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - James Cray
- Department of Biomedical Education and Anatomy, 12305The Ohio State University College of Medicine, Columbus, OH 43210, USA.,Division of Biosciences, College of Dentistry, 2647The Ohio State University, Columbus, OH 43210, USA
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6
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Jongenelis MI. Challenges and opportunities associated with e-cigarettes in Australia: A qualitative study. Aust N Z J Public Health 2023; 47:100006. [PMID: 36693288 DOI: 10.1016/j.anzjph.2022.100006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/14/2022] [Accepted: 10/30/2022] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE The use of e-cigarettes in Australia has increased significantly in recent years. To assist with identifying policy and practice priorities, this study sought to provide a greater understanding of the population-level challenges and opportunities associated with these products. METHODS Semi-structured interviews were conducted with 34 public health experts working in tobacco- and/or nicotine-related policy, practice and research. Interview transcripts were subject to reflexive thematic analysis. RESULTS Several challenges associated with e-cigarettes were identified, with uptake of use among youth, the potential for use to lead to smoking and industry interference the most frequently mentioned. Recommended means of addressing these challenges included improved regulation and increased enforcement of existing laws. Most interviewees acknowledged some potential for e-cigarettes to assist with smoking cessation. CONCLUSIONS Despite strong restrictions on e-cigarettes in Australia, experts working in this field reported that these products, and the companies behind them, present several challenges to public health. IMPLICATIONS FOR PUBLIC HEALTH Tighter regulation and increased enforcement are needed to address the challenges posed by e-cigarettes. Controlled access to liquid nicotine under a pharmaceutical model offers an opportunity for smokers to access the behavioural support that may help them to quit while also restricting e-cigarette availability.
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Affiliation(s)
- Michelle I Jongenelis
- Melbourne Centre for Behaviour Change, Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Victoria, 3010, Australia.
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7
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Shiffman S, Goldenson NI. Changes in Dependence Over One Year among US Adults Who Smoke Cigarettes and Switched Completely or Partially to Use of the JUUL-Brand Electronic Nicotine Delivery System. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 6:100137. [PMID: 36994368 PMCID: PMC10040328 DOI: 10.1016/j.dadr.2023.100137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/24/2023] [Accepted: 01/25/2023] [Indexed: 01/27/2023]
Abstract
Background Electronic nicotine delivery systems (ENDS) are substitute sources of nicotine for adults who smoke cigarettes. Understanding changes in dependence as people switch from cigarettes to ENDS is relevant to public health. This study assessed changes in dependence among adults who switched completely or partially (dual users) from cigarettes to JUUL-brand ENDS over 12 months. Methods US adults who smoke and purchased a JUUL Starter Kit (n = 17,619) completed a baseline assessment and were invited to 1-, 2-, 3-, 6-, 9- and 12-month follow-ups. Dependence on cigarettes at baseline and on JUUL at follow-ups was assessed with the Tobacco Dependence Index (TDI; Range 1-5). Analyses estimated the minimal important difference (MID) for the scale, compared JUUL dependence to baseline cigarette dependence and assessed changes in JUUL dependence over 1-year, including among those using JUUL at all follow-ups. Results Participants who switched at month 2 had month 1 JUUL TDI scores 0.24 points greater than those who continued smoking (p<0.001); thus MID=0.24. Among both switchers and dual users overall, dependence on JUUL 1 and 12 months later was lower than baseline dependence on cigarettes (ps<0.001); participants who smoked every day showed more consistent and larger reductions. Among participants who persistently used JUUL without smoking, dependence increased 0.01 points per month (p<0.001), but was leveling off over time. Conclusions Dependence on JUUL was lower than baseline cigarette dependence. Increases in JUUL dependence were small over 12 months of continual JUUL use. These data indicate that ENDS, including JUUL, have lower dependence potential than cigarettes.
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Affiliation(s)
- Saul Shiffman
- Pinney Associates, Inc
- Corresponding author at: Pinney Associates, Inc., 201 North Craig Street, Suite 320, Pittsburgh, PA 15213, United States.
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8
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Krishnan N, Berg CJ, Elmi A, Klemperer EM, Sherman SE, Abroms LC. Predictors of electronic nicotine product quit attempts and cessation: Analysis of waves 3 and 4 of the PATH study. Addict Behav 2022; 134:107419. [PMID: 35810644 DOI: 10.1016/j.addbeh.2022.107419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 06/17/2022] [Accepted: 06/28/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Identifying theory-based predictors of electronic nicotine product (ENP) quit attempts and cessation can guide the development of effective vaping cessation interventions, which are currently limited. This study examined predictors of ENP quit attempts and cessation among adult ENP users. METHODS Using data from wave 3 (W3; 2015-2016) current established ENP users in the Population Assessment of Tobacco and Health study, we used multivariable logistic regression to identify predictors of (i) wave 4 (W4; 2016-2018) quit attempts (unweighted n = 1,135); and (ii) W4 cessation among those who made a quit attempt (unweighted n = 610). Predictors included Social Cognitive Theory (SCT)-based cognitive (interest in quitting, self-efficacy to quit, outcome expectancies, risk perception), behavioral (smoking status, and use of combustibles, non-combustibles, cannabis, and alcohol), and socio-environmental (perceived disapproval, household rules, exposure to advertising) factors. RESULTS Between W3 and W4, 51.7% of W3 ENP users made a quit attempt. Among those who tried quitting, 68.4% stopped using ENPs. SCT-based predictors of ENP quit attempts included higher interest in quitting ENPs (aOR = 1.18), greater self-efficacy to quit ENPs (aOR = 1.31), and currently using cigarettes (vs non-smoker; aOR = 1.71), non-combustibles (aOR = 2.25), and cannabis (aOR = 1.80). Predictors of ENP cessation included greater self-efficacy to quit ENPs (aOR = 1.33), greater perceived risk of ENPs (aOR = 1.35), and being a current smoker (vs non-smoker; aOR = 3.28). CONCLUSIONS ENP cessation interventions should address cognitive factors, particularly self-efficacy, as it predicted quit attempts and cessation. Cigarette smoking among dual users should be monitored and addressed to ensure that those who quit using ENPs do not maintain cigarette use.
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Affiliation(s)
- Nandita Krishnan
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
| | - Carla J Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Angelo Elmi
- Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Elias M Klemperer
- Vermont Center on Behavior & Health, Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | - Scott E Sherman
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Lorien C Abroms
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
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9
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Pisinger C, Rasmussen SKB. The Health Effects of Real-World Dual Use of Electronic and Conventional Cigarettes versus the Health Effects of Exclusive Smoking of Conventional Cigarettes: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192013687. [PMID: 36294263 PMCID: PMC9603628 DOI: 10.3390/ijerph192013687] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/13/2022] [Accepted: 10/14/2022] [Indexed: 05/31/2023]
Abstract
BACKGROUND A high prevalence of dual use of e-cigarettes and conventional cigarettes has been reported across the world. METHODS A systematic search was carried out. We included original articles on any topic relevant to health, excluding mental health, in all languages. The PRISMA guidelines were followed. Both reviewers independently screened and read all publications. We compared dual use with exclusive smoking of conventional cigarettes (ESCC). RESULTS Fifty-two publications (49 studies) were included. Thirteen papers/10 studies were prospective. There was great heterogeneity across studies. Many methodological weaknesses, such as inaccurate exposure measurement, lack of adjustment for former tobacco consumption, and lack of significance testing were identified. Most prospective studies found dual use to be at least as harmful as ESCC. The longest follow-up was six years. Most of the best available cross-sectional studies found dual use associated with the same and, in several studies, significantly higher risk of self-reported symptoms/disease than in ESCC. The intensity of cigarette smoking seems associated with worse health. CONCLUSION Existing studies indicate that dual use is at least as, or probably even more, harmful than ESCC. Due to the predominance of cross-sectional studies and the methodological weaknesses we judged the overall certainty of the evidence as "low certainty".
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Affiliation(s)
- Charlotta Pisinger
- Center for Clinical Research and Prevention, Bispebjerg-Frederiksberg University Hospital, Capital Region of Denmark, 2400 Copenhagen, Denmark
- Danish Heart Foundation, 1120 Copenhagen, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, 1165 Copenhagen, Denmark
| | - Sofie K. Bergman Rasmussen
- Center for Clinical Research and Prevention, Bispebjerg-Frederiksberg University Hospital, Capital Region of Denmark, 2400 Copenhagen, Denmark
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10
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Palmer AM, Price SN, Foster MG, Sanford BT, Fucito LM, Toll BA. Urgent Need for Novel Investigations of Treatments to Quit E-cigarettes: Findings from a Systematic Review. Cancer Prev Res (Phila) 2022; 15:569-580. [PMID: 35816038 PMCID: PMC9444997 DOI: 10.1158/1940-6207.capr-22-0172] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/01/2022] [Accepted: 07/05/2022] [Indexed: 11/16/2022]
Abstract
E-cigarette use has been increasing globally over the past decade. Many use e-cigarettes as an alternative or method to quit cigarette smoking, whereas others use these products recreationally. As technology has advanced, many individuals have reported symptoms of dependence on these products and continue to use them beyond achieving abstinence from smoking. Despite individuals reporting interest in quitting, little is known about e-cigarette cessation. This systematic review sought to identify and evaluate all human subjects literature published on the outcome of e-cigarette cessation through September 2021. Of the 79 articles identified, 56 were cross-sectional, 6 were qualitative, 5 were cohort studies, 3 were experimental, 2 were mixed methods, and 7 reported intervention or case studies of e-cigarette cessation. Results showed youth generally had high intent to quit e-cigarettes, whereas results were mixed with adult samples. Youth were motivated to quit e-cigarettes by health concerns, whereas adults were motivated to quit e-cigarettes by cost, lack of satisfaction, and psychologic factors. Adults were more likely to report past e-cigarette quit attempts, most commonly "cold turkey." Few interventions tested strategies for e-cigarette cessation, with a majority targeted for youth. Given the lack of information on e-cigarette cessation, recommendations for future studies are outlined.
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Affiliation(s)
- Amanda M. Palmer
- Department of Public Health Sciences, Medical University of South Carolina, Charleston SC USA,Department of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Sarah N. Price
- Department of Psychology, University of Arizona, Tucson, AZ, USA,Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Madeline G. Foster
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Brandon T. Sanford
- Department of Public Health Sciences, Medical University of South Carolina, Charleston SC USA,Department of Family Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Lisa M. Fucito
- Department of Psychiatry, Yale School of Medicine, New Haven, CT USA,Yale Cancer Center, New Haven, CT USA
| | - Benjamin A. Toll
- Department of Public Health Sciences, Medical University of South Carolina, Charleston SC USA,Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA,Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA,Department of Psychiatry, Yale School of Medicine, New Haven, CT USA
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11
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Yun HW, Jung KJ, Jee SH, Kimm H. Overall quit in triple users of conventional cigarette, e-cigarette and heated tobacco product among healthy adults: a Korea Medical Institute health check-up study. BMJ Open 2022; 12:e051865. [PMID: 35851018 PMCID: PMC9297207 DOI: 10.1136/bmjopen-2021-051865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE While multiuse patterns of e-cigarettes (EC) or heated tobacco products (HTP) with conventional cigarettes (CC) have been reported, smoking cessation of multiusers is not well known. We aimed to analyse overall quit in triple users of CC, EC and HTP among healthy adults. METHODS A questionnaire was conducted on 89 360 adults who visited the Korea Medical Institute health check-ups in Seoul, Korea, from May 2018 to September 2019. Among 38 812 ever smokers, 9252 were ever triple users of CC, EC and HTP. Frequency and related factors of overall quit were analysed in the cross-sectional study. RESULTS The average age was 38.8±9.0 years, and 8458 (91.4%) were men. There were 5329 (57.6%) current triple users, 3547 (38.3%) single or dual product quitters and 376 (4.1%) overall quitters. Among the former triple users, the most common tobacco product use pattern was 'dual quit of EC and HTP (eg, current CC use)' both in men (21.3%) and women (26.3%). Age 60s or older (OR 8.5, 95% CI 5.2 to 13.8), women (OR 1.7, 95% CI 1.1 to 2.5), no hyperlipidaemia and married status were significantly related to overall quit. CONCLUSION The most common pathway for 'ever triple users' of the three tobacco products was 'current triple users', and the second was 'CC users'. Single or dual product quitters could continue to smoke by EC or HTP instead of quit. Further research on overall quit will be needed to develop effective regulations.
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Affiliation(s)
- Hye Won Yun
- National Cancer Control Institute, National Cancer Center, Goyang, South Korea
- Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, South Korea
| | - Keum Ji Jung
- Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, South Korea
| | - Sun Ha Jee
- Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, South Korea
| | - Heejin Kimm
- Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, South Korea
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12
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Krishnan N, Abroms LC, Berg CJ. Electronic Nicotine Product Cessation and Cigarette Smoking: Analysis of Waves 3 and 4 From the PATH Study. Nicotine Tob Res 2022; 24:324-332. [PMID: 34313780 PMCID: PMC8842438 DOI: 10.1093/ntr/ntab155] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 07/26/2021] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Identifying predictors of electronic nicotine product (ENP) cessation can inform ENP cessation interventions. High rates of cooccurring ENP and cigarette (dual) use and transitions between these products underscore the importance of considering cigarette smoking status when assessing and addressing ENP cessation. AIMS AND METHODS We analyzed waves 3 (W3) and 4 (W4) of the Population Assessment of Tobacco and Health (PATH) study to identify (1) W3 socio-demographics, tobacco and ENP use characteristics, and psychosocial correlates of W3 cigarette smoking status (non-smoker, former, and current) among W3 adult ENP users, and (2) W3 predictors of W4 combined ENP and cigarette smoking abstinence relative to use of one or both products. RESULTS At W3, 65.6% of ENP users concurrently smoked cigarettes. Adjusted multinomial regression results indicated that different W3 socio-demographics, tobacco and ENP use characteristics, and psychosocial correlates were significantly associated with distinct W3 cigarette use profiles. At W4, 9.9% of individuals were abstinent from both products. These individuals were less likely to: (1) be current smokers (vs. non-smokers) or be advised to quit using tobacco, compared with cigarette only or dual users, and (2) use ENPs daily or live in a household allowing ENP use, compared with ENP only or dual users (p < .05). CONCLUSIONS ENP cessation approaches need to be tailored to the distinct cigarette use profiles of ENP users. Dual users and daily ENP users may require more intensive interventions to achieve the cessation of both products. Supportive physical environments, such as home vape-free policies, may facilitate ENP cessation. IMPLICATIONS This analysis contributes to advancing the nascent literature on predictors of electronic nicotine product (ENP) cessation, which can guide the development of ENP cessation interventions by indicating which populations, psychosocial and environmental constructs, and cooccurring behaviors interventions should target. This research also highlights the importance of considering cigarette smoking status when designing ENP cessation interventions and defining intervention outcomes.
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Affiliation(s)
- Nandita Krishnan
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Lorien C Abroms
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
- George Washington Cancer Center, George Washington University, Washington, DC, USA
| | - Carla J Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
- George Washington Cancer Center, George Washington University, Washington, DC, USA
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Goldenson NI, Augustson EM, Shiffman S. Differences in switching away from cigarettes and JUUL use characteristics among adult menthol and nonmenthol smokers who purchased the JUUL System. Drug Alcohol Depend 2022; 231:109238. [PMID: 34974269 DOI: 10.1016/j.drugalcdep.2021.109238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 11/18/2021] [Accepted: 11/30/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Studies have assessed switching away from cigarettes among adult smokers who use electronic nicotine delivery systems (ENDS), but there is little data assessing differences in likelihood of switching or ENDS use characteristics by menthol smoking. METHODS Adult (age ≥ 21) established smokers who purchased a JUUL Starter Kit (N = 15,036) completed baseline and 1-, 2-, 3-, 6-, 9- and 12-month assessments. Switching (no past-30-day cigarette smoking) and flavor use were assessed at each follow-up. Repeated-measure logistic regression models evaluated association of menthol smoking and switching across 1 year. RESULTS Across the 6 follow-ups, more menthol smokers primarily used Menthol/Mint-flavored JUULpods (53.8%) than nonmenthol smokers (22.9%). Only 6.4% of menthol smokers primarily used Tobacco flavors (vs. 25.9% of nonmenthol smokers). Across all follow-ups menthol smokers (41.2% of sample) were more likely to switch than nonmenthol smokers (42.6% vs. 38.8%: OR [95% CI] = 1.17 [1.11, 1.23]); this association remained significant after adjustment for sociodemographic, smoking and JUUL use covariates (aOR [95% CI] = 1.13 [1.05, 1.21]). Nonmenthol smokers, but not menthol smokers, were significantly more likely to switch when primarily using Menthol/Mint-flavored (vs. Tobacco-flavored) JUULpods (aOR [95% CI] = 1.14 [1.04, 1.25]). Differences in baseline smoking characteristics between menthol and nonmenthol smokers were small in magnitude. CONCLUSIONS Adult menthol (vs. nonmenthol) smokers using JUUL were more likely to switch. More than twice as many menthol (vs. nonmenthol) smokers primarily used Menthol/Mint-flavor JUULpods; few menthol smokers used tobacco flavors. Given these pronounced differences in flavor preferences, availability of ENDS in menthol flavors may be particularly important for menthol smokers, but may also benefit some nonmenthol smokers.
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14
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Boozary LK, Frank-Pearce SG, Alexander AC, Waring JJC, Ehlke SJ, Businelle MS, Cohn AM, Kendzor DE. Correlates of e-cigarette use among adults initiating smoking cessation treatment. Drug Alcohol Depend 2021; 224:108724. [PMID: 33940324 PMCID: PMC8552999 DOI: 10.1016/j.drugalcdep.2021.108724] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 03/08/2021] [Accepted: 03/21/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Little is known about the correlates of e-cigarette (EC) use among adults seeking smoking cessation treatment, and it is unclear how EC use affects smoking treatment outcomes. METHODS Participants were 649 adult smokers enrolled in smoking cessation treatment. Participants completed a baseline (pre-quit) assessment with follow-up at 4-, 12-, and 26-weeks after a scheduled combustible cigarette (CC) cessation date. EC use was described before and after the CC cessation date, and the impact of baseline EC use on CC cessation at follow-up was evaluated. RESULTS At baseline, 66.6 % of participants had ever-used ECs and 23.1 % reported past 30-day EC use. Past 30-day EC users were younger, more socioeconomically disadvantaged, more CC dependent, and less likely to report Black race compared to non-users. At the 4-, 12-, and 26-week follow-ups, 6.4 %, 7.4 %, and 8.1 % reported dual EC/CC use; and 2.7 %, 3.4 %, and 2.7 % had switched to exclusive EC use. Past 30-day EC use at baseline was not associated with CC cessation at any follow-up. However, among baseline past 30-day EC users (n = 150), using ECs ≥ once per week was associated with a lower likelihood of CC cessation at 26-week follow-up (adjusted OR 0.346, 95 % CI: 0.120, 0.997). CONCLUSION Findings indicated that dual users of CCs and ECs at baseline differed from CC-only users on sociodemographic and smoking characteristics. Baseline EC use did not impact smoking cessation overall. However, among past 30-day users, more frequent EC use at baseline adversely impacted longer-term cessation outcomes, perhaps due to greater baseline CC/nicotine dependence.
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Affiliation(s)
- Laili Kharazi Boozary
- Department of Psychology, Cellular and Behavioral Neurobiology, The University of Oklahoma, Norman, OK, United States; TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Summer G Frank-Pearce
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States; TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Adam C Alexander
- Department of Family and Preventive Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States; TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Joseph J C Waring
- TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Sarah J Ehlke
- TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Michael S Businelle
- Department of Family and Preventive Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States; TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Amy M Cohn
- TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States; Department of Pediatrics, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Darla E Kendzor
- Department of Family and Preventive Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States; TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States.
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Conner TS, Zeng J, Blank ML, He V, Hoek J. A Descriptive Analysis of Transitions from Smoking to Electronic Nicotine Delivery System (ENDS) Use: A Daily Diary Investigation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126301. [PMID: 34200773 PMCID: PMC8296109 DOI: 10.3390/ijerph18126301] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/06/2021] [Accepted: 06/08/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVES We aimed to examine patterns in smoking and electronic nicotine delivery system (ENDS) use over an extended period of time (up to 20 weeks) in people who smoked and who had never previously made a successful quit attempt using an ENDS. DESIGN AND SETTING We conducted a longitudinal mixed-methods study in Dunedin, New Zealand, during 2018 and 2019. PARTICIPANTS Purposively selected participants (N = 45; age (≥18 years), gender, ethnicities, cigarettes/day) who wished to quit smoking. INTERVENTIONS Participants were provided with a second-generation ENDS device (vape pen or starter "tank" device) at the start of their quit attempt, and asked to complete smartphone-based daily diary surveys assessing smoking and ENDS use. OUTCOME MEASURES Sunburst plots and a sequence plot were used to describe weekly and daily patterns of smoking and ENDS use (smoking only, ENDS use only, dual use, abstinent). RESULTS The most frequently reported movements among participants, classified according to their study week behaviour, occurred between dual use and exclusive ENDS use (and vice versa). A smaller group reported moving from dual use to exclusive smoking (and often back to dual use), and a small number reported moving between abstinence and different ENDS and smoked tobacco usage behaviours. Data visualisations focussing on those participants who had provided data during each of weeks 9-12 indicate that only a minority reported sustained dual use; instead, most participants indicated varied smoked tobacco and ENDS use, which included periods of dual use. CONCLUSIONS The considerable variety observed within and between study participants suggests that high variability is typical rather than exceptional. Transitions from smoking to ENDS use may involve considerable periods of dual use, which is likely to be dynamic and potentially sustained over several months.
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Affiliation(s)
- Tamlin S. Conner
- Department of Psychology, University of Otago, Dunedin 9054, New Zealand
- Correspondence:
| | - Jiaxu Zeng
- Department of Preventive and Social Medicine, University of Otago, Dunedin 9054, New Zealand; (J.Z.); (M.-L.B.); (V.H.)
| | - Mei-Ling Blank
- Department of Preventive and Social Medicine, University of Otago, Dunedin 9054, New Zealand; (J.Z.); (M.-L.B.); (V.H.)
| | - Vicky He
- Department of Preventive and Social Medicine, University of Otago, Dunedin 9054, New Zealand; (J.Z.); (M.-L.B.); (V.H.)
| | - Janet Hoek
- Department of Public Health, University of Otago, Wellington 6242, New Zealand;
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Goldenson NI, Ding Y, Prakash S, Hatcher C, Augustson EM, Shiffman S. Differences in Switching Away From Smoking Among Adult Smokers Using JUUL Products in Regions With Different Maximum Nicotine Concentrations: North America and the United Kingdom. Nicotine Tob Res 2021; 23:1821-1830. [PMID: 34002223 PMCID: PMC8653762 DOI: 10.1093/ntr/ntab062] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 04/01/2021] [Indexed: 12/20/2022]
Abstract
Introduction Electronic nicotine delivery systems (ENDS) may improve public health if they
facilitate smokers switching away from cigarettes. Conceptually, switching
is facilitated when ENDS provide adequate nicotine delivery. Switching rates
among smokers who purchased the JUUL System (“JUUL”) were
compared in the United Kingdom (UK), where regulations limit nicotine
concentration to 20 mg/mL versus North America (N.Am.; United States and
Canada), where higher concentrations are available. Aims and Methods Adult established smokers (age ≥21, smoked ≥100 cigarettes,
smoking some days or every day at baseline) who newly purchased JUUL were
recruited into a longitudinal study (UK: N = 1247; N.Am.:
N = 8835). Complete switching (no smoking for
≥30 days) was assessed 1, 3, and 6 months after purchase; propensity
score matching (PSM) and logistic regression compared switching after
adjusting for baseline characteristics. Results In both N.Am. and UK, ≥82% of participants reported using the highest
JUUL nicotine concentration available (UK: 18 mg/mL; N.Am.: 59 mg/mL).
Unadjusted switching rates did not differ at 1 month (17%–18%);
unadjusted and adjusted rates were significantly higher in N.Am. (vs. UK) at
3 and 6 months. In the PSM sample, after additional covariate adjustment,
rates were significantly higher in N.Am. (vs. UK) at 3 months (31.5% vs.
22.7%; odds ratio [95% confidence interval, CI] = 1.59 [1.25, 2.02]) and 6
months (38.0% vs. 26.0%; odds ratio [95% CI] = 1.79 [1.37, 2.35]). Conclusions These results suggest availability of ENDS in nicotine concentrations greater
than 20 mg/mL may be associated with increased switching among adult
smokers. Differences in smoking and ENDS use characteristics did not explain
associations of location and switching; however, between-country differences
may be affected by unmeasured factors. Implications Switching rates were lower among smokers who purchased the JUUL System
(“JUUL”) in the UK, where regulations limit nicotine
concentration to 20 mg/mL versus N.Am. (United States and Canada), where
higher concentrations are available—before and after controlling for
differences in smoking and ENDS use characteristics. These results suggest
availability of ENDS in nicotine concentrations greater than 20 mg/mL may be
associated with increased switching among adult smokers. Between-country
differences may be affected by unmeasured factors; future research should
consider these factors and the extent to which regulatory policy
environments may explain differences in switching among adult smokers.
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Affiliation(s)
| | - Yu Ding
- Juul Labs, Inc., Washington, DC, USA
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