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Pan Y, Ballard A, Cho B. Sex and Racial/Ethnic Patterns of Tobacco Product Use Among Students at a U.S. University in 2021-2023. Subst Use Misuse 2024; 59:1249-1255. [PMID: 38532555 DOI: 10.1080/10826084.2024.2330919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
Background: Although the prevalence of conventional tobacco product use among U.S. college students has declined, an increasing number of students use various novel tobacco products. Objectives: This study aims to examine up-to-date sex and racial/ethnic patterns of tobacco use among students at a U.S. university in 2021-2023. Methods: Data of 2,732 students at an urban university in the Southeast of the U.S. were collected in 2021-2023 as part of the National College Health Assessment of the American College Health Association. Self-reported past 3-month use of five tobacco products (cigarette, electronic vapor products, water pipe/hookah, smokeless tobacco, and cigars) was dichotomized. We conducted multinomial logistic regression analysis to examine sex (male or female) and racial/ethnic (non-Hispanic White, non-Hispanic Black, Hispanic, or non-Hispanic Other) differences in single and dual/poly (con-current use of two or more tobacco products) tobacco use compared to nonuse, adjusting for age, student status, parent education level, obese status, psychological distress level, and survey year. Results: Male students had higher odds of being dual/poly tobacco user than female students, adjusting for covariates (adjusted odds ratio [AOR] = 2.00, 95% confidence interval [CI] = 1.42, 2.82). Non-Hispanic Black students had lower odds of being single (AOR = 0.43, 95% CI = 0.26, 0.69) and dual/poly (AOR = 0.09, 95% CI = 0.02, 0.37) tobacco user compared to non-Hispanic White students, adjusting for covariates. Conclusions: Considering higher health risk of con-current use of multiple tobacco products, dual/poly tobacco use prevention strategies targeting male and non-Hispanic White students may be considered.
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Affiliation(s)
- Yining Pan
- Department of Public Health, University of North Florida, Jacksonville, FL, USA
| | - Ashley Ballard
- Department of Recreation and Wellness, University of North Florida, Jacksonville, FL, USA
| | - Beomyoung Cho
- Department of Public Health, University of North Florida, Jacksonville, FL, USA
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Chugh A, Arora M, Jain N, Vidyasagaran A, Readshaw A, Sheikh A, Eckhardt J, Siddiqi K, Chopra M, Mishu MP, Kanaan M, Rahman MA, Mehrotra R, Huque R, Forberger S, Dahanayake S, Khan Z, Boeckmann M, Dogar O. The global impact of tobacco control policies on smokeless tobacco use: a systematic review. Lancet Glob Health 2023; 11:e953-e968. [PMID: 37202029 DOI: 10.1016/s2214-109x(23)00205-x] [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: 09/12/2022] [Revised: 03/22/2023] [Accepted: 04/18/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Smokeless tobacco, used by more than 300 million people globally, results in substantial morbidity and mortality. For smokeless tobacco control, many countries have adopted policies beyond the WHO Framework Convention on Tobacco Control, which has been instrumental in reducing smoking prevalence. The impact of these policies (within and outside the Framework Convention on Tobacco Control) on smokeless tobacco use remains unclear. We aimed to systematically review policies that are relevant to smokeless tobacco and its context and investigate their impact on smokeless tobacco use. METHODS In this systematic review, we searched 11 electronic databases and grey literature between Jan 1, 2005, and Sept 20, 2021, in English and key south Asian languages, to summarise smokeless tobacco policies and their impact. Inclusion criteria were all types of studies on smokeless tobacco users that mentioned any smokeless tobacco relevant policies since 2005, except systematic reviews. Policies issued by organisations or private institutions were excluded as well as studies on e-cigarettes and Electronic Nicotine Delivery System except where harm reduction or switching were evaluated as a tobacco cessation strategy. Two reviewers independently screened articles, and data were extracted after standardisation. Quality of studies was appraised using the Effective Public Health Practice Project's Quality Assessment Tool. Outcomes for impact assessment included smokeless tobacco prevalence, uptake, cessation, and health effects. Due to substantial heterogeneity in the descriptions of policies and outcomes, data were descriptively and narratively synthesised. This systematic review was registered in PROSPERO (CRD42020191946). FINDINGS 14 317 records were identified, of which 252 eligible studies were included as describing smokeless tobacco policies. 57 countries had policies targeting smokeless tobacco, of which 17 had policies outside the Framework Convention on Tobacco Control for smokeless tobacco (eg, spitting bans). 18 studies evaluated the impact, which were of variable quality (six strong, seven moderate, and five weak) and reported mainly on prevalence of smokeless tobacco use. The body of work evaluating policy initiatives based on the Framework Convention on Tobacco Control found that these initiatives were associated with reductions in smokeless tobacco prevalence of between 4·4% and 30·3% for taxation and 22·2% and 70·9% for multifaceted policies. Two studies evaluating the non-Framework policy of sales bans reported significant reductions in smokeless tobacco sale (6·4%) and use (combined sex 17·6%); one study, however, reported an increased trend in smokeless tobacco use in the youth after a total sales ban, likely due to cross-border smuggling. The one study reporting on cessation found a 13·3% increase in quit attempts in individuals exposed (47·5%) to Framework Convention on Tobacco Control policy: education, communication, training, and public awareness, compared with non-exposed (34·2%). INTERPRETATION Many countries have implemented smokeless tobacco control policies, including those that extend beyond the Framework Convention on Tobacco Control. The available evidence suggests that taxation and multifaceted policy initiatives are associated with meaningful reductions in smokeless tobacco use. FUNDING UK National Institute for Health Research.
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Affiliation(s)
| | - Monika Arora
- HRIDAY, New Delhi, India; Health Promotion Division, Public Health Foundation of India, Gurugram, India.
| | - Neha Jain
- Health Promotion Division, Public Health Foundation of India, Gurugram, India
| | | | - Anne Readshaw
- Department of Health Sciences, University of York, York, UK
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | - Kamran Siddiqi
- Department of Health Sciences, University of York, York, UK
| | | | | | - Mona Kanaan
- Department of Health Sciences, University of York, York, UK
| | - Muhammad Aziz Rahman
- Institute of Health and Wellbeing, Federation University Australia, Berwick, VIC, Australia
| | - Ravi Mehrotra
- Indian Council of Medical Research, India Cancer Research Consortium, New Delhi, India
| | | | - Sarah Forberger
- Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany
| | - Suranji Dahanayake
- Department of Health Sciences, University of York, York, UK; Ministry of Health, Nutrition and Indigenous Medicine, Colombo, Sri Lanka
| | - Zohaib Khan
- Khyber Medical University, Peshawar, Pakistan
| | - Melanie Boeckmann
- Faculty of Human and Health Sciences, University of Bremen, Breman, Germany
| | - Omara Dogar
- Department of Health Sciences, University of York, York, UK; Usher Institute, University of Edinburgh, Edinburgh, UK
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Wackowski OA, O'Connor RJ, Diaz D, Rashid M, Lewis MJ, Greene K. '95% less harmful'? Exploring reactions to quantitative modified risk claims for snus and e-cigarettes. Tob Control 2022; 31:730-736. [PMID: 33753549 PMCID: PMC8455704 DOI: 10.1136/tobaccocontrol-2020-056303] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 02/03/2021] [Accepted: 02/11/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Studies examining perceptions of 'modified risk tobacco product' (MRTP) messages for e-cigarettes and smokeless tobacco have indicated consumers want statistics and quantification of harm reduction. However, limited research exists on reactions to quantitative MRTP messages. DESIGN We conducted 12 focus groups in the USA in 2019-6 focused on e-cigarette messages and 6 on snus messages. Eight groups were with current smokers (ages 21-66) and four with young adult (ages 18-25) non-smokers (n=57). Participants discussed messages stating that use of snus and vaping products have been estimated by scientists to be about 90% and 95% less harmful than smoking cigarettes, respectively. RESULTS Several participants agreed the messages strongly communicated that the products are less harmful than cigarettes, were attention getting and could be 'convincing'. However, participants expressed scepticism about the source and accuracy of the stated figures, and some noted the claims could be misleading and attractive to young people. Comments also reflected some claim misunderstandings (eg, that e-cigarettes only pose a 5% chance of harm). Participants also agreed that stating e-cigarette risks 'are unlikely to exceed 5% of cigarette smoking harms' was confusing and less impactful than the '95% less harmful' wording. CONCLUSIONS Quantitative claims suggesting high levels of reduced risk when comparing e-cigarettes or smokeless tobacco/snus relative to cigarettes may be successful in gaining attention and being persuasive for some audiences, particularly, if from more credible sources. However, message developers, users and evaluators should be mindful of message limitations and aim to mitigate unintended consequences.
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Affiliation(s)
- Olivia A Wackowski
- Center for Tobacco Studies, Rutgers The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Richard J O'Connor
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Destiny Diaz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Mariam Rashid
- Center for Tobacco Studies, Rutgers The State University of New Jersey, New Brunswick, New Jersey, USA
| | - M Jane Lewis
- Center for Tobacco Studies, Rutgers The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Kathryn Greene
- Department of Communication, Rutgers University, New Brunswick, New Jersey, USA
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Levy DT, Cadham CJ, Li Y, Yuan Z, Liber AC, Oh H, Travis N, Issabakhsh M, Sweanor DT, Sánchez-Romero LM, Meza R, Cummings KM. A Decision-Theoretic Public Health Framework for Heated Tobacco and Nicotine Vaping Products. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13431. [PMID: 36294011 PMCID: PMC9602493 DOI: 10.3390/ijerph192013431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/22/2022] [Accepted: 09/30/2022] [Indexed: 06/16/2023]
Abstract
Markets for nicotine vaping products (NVPs) and heated tobacco products (HTPs) have grown as these products became positioned as harm-reduction alternatives to combusted tobacco products. Herein, we present a public health decision-theoretic framework incorporating different patterns of HTP, NVP, and cigarette use to examine their impacts on population health. Our framework demonstrates that, for individuals who would have otherwise smoked, HTP use may provide public health benefits by enabling cessation or by discouraging smoking initiation and relapse. However, the benefits are reduced if more harmful HTP use replaces less harmful NVP use. HTP use may also negatively impact public health by encouraging smoking by otherwise non-smokers or by encouraging initiation or relapse into smoking. These patterns are directly influenced by industry behavior as well as public policy towards HTPs, NVPs, and cigarettes. While substantial research has been devoted to NVPs, much less is known about HTPs. Better information is needed to more precisely define the health risks of HTPs compared to cigarettes and NVPs, the relative appeal of HTPs to consumers, and the likelihood of later transitioning to smoking or quitting all products. While our analysis provides a framework for gaining that information, it also illustrates the complexities in distinguishing key factors.
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Affiliation(s)
- David T. Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Christopher J. Cadham
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Yameng Li
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Zhe Yuan
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Alex C. Liber
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Hayoung Oh
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Nargiz Travis
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Mona Issabakhsh
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - David T. Sweanor
- Centre for Health Law, Policy & Ethics, University of Ottawa, Ottawa, ON K1N 6N5, Canada
- Faculty of Law, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | | | - Rafael Meza
- Department of Integrative Oncology, BC Cancer Institute, Vancouver, BC V5Z1L3, Canada
| | - K. Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of Charleston, Charleston, SC 29425, USA
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5
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Svirsky L, Howard D, Berman ML. E-Cigarettes and the Multiple Responsibilities of the FDA. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2022; 22:5-14. [PMID: 33871325 DOI: 10.1080/15265161.2021.1907478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This paper considers the responsibilities of the FDA with regard to disseminating information about the benefits and harms of e-cigarettes. Tobacco harm reduction advocates claim that the FDA has been overcautious and has violated ethical obligations by failing to clearly communicate to the public that e-cigarettes are far less harmful than cigarettes. We argue, by contrast, that the FDA's obligations in this arena are more complex than they may appear at first blush. Though the FDA is accountable for informing the public about the health risks and benefits of products it regulates, it also has other roles (and attendant responsibilities) that inform when and how it should disseminate information. In addition to being a knowledge purveyor, it is also a knowledge producer, an advisor to the public, and a practical agent shaping the material conditions in which people make health-related choices. In our view, those other roles call for caution in the way the FDA interprets and communicates the available evidence.
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Affiliation(s)
- Larisa Svirsky
- College of Public Health and Center for Bioethics, The Ohio State University
| | - Dana Howard
- Center for Bioethics, The Ohio State University
| | - Micah L Berman
- College of Public Health and Moritz College of Law, The Ohio State University
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Wagoner KG, Reboussin BA, Ross JC, Denlinger-Apte R, Spangler J, Sutfin EL. Exposure to e-cigarette health claims and association with e-cigarette use and risk perceptions: A cohort study of young adults. Addict Behav 2022; 132:107359. [PMID: 35576816 PMCID: PMC9434727 DOI: 10.1016/j.addbeh.2022.107359] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 05/02/2022] [Accepted: 05/04/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION E-cigarettes have been marketed illicitly as smoking cessation aids and reduced risk tobacco products in the United States. Our study assessed consumers' exposure to such claims and evaluated their impact on relative risk perceptions and e-cigarette use. METHODS Data are from the Assessment of the post-College Experience study, which followed a cohort of young adults since 2010 when they were college freshmen. We used data from survey waves 10 (fall 2017) through 14 (fall 2019) to assess past 6 month exposure to e-cigarette marketing that made smoking cessation or modified risk tobacco product (MRTP) claims. Logistic regression models examined if exposure to claims at waves 11 through 14 were predictors of e-cigarette use and relative risk perceptions at wave 14. RESULTS Exposure to MRTP (28.4% to 40.1%) and cessation claims (29.1% to 46.6%) increased, with participants reporting more exposure to cessation than MRTP claims at each wave. Multiple exposures were associated with perceptions that e-cigarettes are less harmful compared to cigarettes (Cessation: AOR = 1.12, CI: 1.01-1.23; p = 0.025; MRTP: AOR = 1.16; CI: 1.05-1.29; p = 0.003). Neither claim type was associated with past 30-day e-cigarette use. Claim exposure did not increase e-cigarette initiation among never e-cigarette users. However, current cigarette smokers who had never used e-cigarettes at wave 10 had 2.5 higher odds of initiating e-cigarette use by wave 14 for each exposure to a cessation claim (AOR = 2.53; CI: 1.43-4.45; p = 0.001). CONCLUSIONS Young adults reported increasing exposure to unauthorized e-cigarette health claims. Exposure was associated with reduced relative risk perceptions, but was not associated with past 30-day e-cigarette use. Cessation claims may motivate current cigarette smokers to try e-cigarettes.
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Affiliation(s)
- Kimberly G Wagoner
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Beth A Reboussin
- Department of Biostatistics and Data Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Jennifer Cornacchione Ross
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Rachel Denlinger-Apte
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - John Spangler
- Department of Family and Community Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Erin L Sutfin
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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7
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AlMoosawi S, Bajec M, Mainy N, Kallischnigg G, Zwisele B, Fischer K, Magnani P, Roulet S. Risk perception of IQOS™ and cigarettes: Temporal and cross-country comparisons. SSM Popul Health 2022; 18:101123. [PMID: 35669892 PMCID: PMC9162949 DOI: 10.1016/j.ssmph.2022.101123] [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: 02/21/2022] [Revised: 04/28/2022] [Accepted: 05/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background Risk perception (RP) is central to smokers’ decision to switch to smoke-free tobacco and nicotine products (TNP). This study assessed temporal trends in the health RP of a novel heated tobacco product, IQOSTM, relative to cigarettes, among current IQOSTM users. Methods The analyses included repeated cross-sectional data from online surveys in Germany (2018–19), Italy (2018–19), and Japan (2016–17, 2017–18, and 2018–19) among a random sample of current adult IQOSTM users from local registers of IQOSTM users. The health RPs of cigarettes and IQOSTM were assessed using the ABOUT™–Perceived Risk instrument, and their difference was described as the relative RP of IQOSTM to cigarettes (RPCig:IQOSTM). Results After adjustment for covariates, the relative RPCig:IQOSTM was higher in 2018 than in 2019 (0.93; standard error, 0.33; P = 0.005). This was driven by an increase in the RP of IQOSTM over time in Italy (2018: 42.6 [95% CI, 41.6–43.5]; 2019: 44.4 [43.4–45.4]) and Japan (2017: 44.0 [43.1–44.9); 2018: 45.9 [45.2–46.7]; 2019: 48.6 [47.9–49.4]), while the RP of cigarettes remained stable. Conclusions The relative RP of IQOSTM decreased over time, driven by an increase in the RP of IQOSTM, in agreement with epidemiological studies indicating a temporal reduction in the relative RP of smoke-free TNPs. Continued surveillance of the RP of novel TNPs is warranted to inform effective TNP risk communication and ensure that adults smokers who would otherwise continue to smoke understand the relative risks of novel TNPs. Risk perception is central to smokers' decision to switch from cigarettes. Little is known of temporal changes in risk perception of novel tobacco products. Risk perception of heated tobacco increased in Italy and Japan. Difference in risk perception of heated tobacco relative to cigarettes declined.
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Affiliation(s)
- Suzana AlMoosawi
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000, Neuchâtel, Switzerland
- Corresponding author.
| | - Martha Bajec
- Bajec Senseworks consulting, Hamilton, L9A 1L5, Ontario, Canada
| | - Nelly Mainy
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000, Neuchâtel, Switzerland
| | - Gerd Kallischnigg
- ARGUS – Statistics and Information Systems in Environment and Public Health GmbH, Karl-Heinrich-Ulrichs-Straße 20a, DE-10785, Berlin, Germany
| | - Bertram Zwisele
- ARGUS – Statistics and Information Systems in Environment and Public Health GmbH, Karl-Heinrich-Ulrichs-Straße 20a, DE-10785, Berlin, Germany
| | - Karina Fischer
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000, Neuchâtel, Switzerland
| | - Pierpaolo Magnani
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000, Neuchâtel, Switzerland
| | - Steve Roulet
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000, Neuchâtel, Switzerland
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Nativity Status and Poly Tobacco Use among Young Adults in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031230. [PMID: 35162251 PMCID: PMC8835020 DOI: 10.3390/ijerph19031230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 02/01/2023]
Abstract
Young adults are the second largest segment of the immigrant population in the United States (US). Given recent trends in later age of initiation of tobacco use, we examined variation in use of tobacco products by nativity status for this population group. Methods: Our study included young adults 18–30 years of age sampled in the National Health Interview Survey (2015–2019), a nationally representative sample of the US population. We calculated prevalence of use of any and two or more tobacco products (cigarettes, cigars, pipes, e-cigarettes, and smokeless tobacco) for foreign-born (n = 3096) and US-born (n = 6811) young adults. Logistic regression models were adjusted for age, sex, race-ethnicity, education, and poverty, while accounting for the complex survey design. Results: Foreign-born young adults were significantly less likely to use any tobacco product (Cigarette = 7.3% vs. 10.7%; Cigar = 1.8% vs. 4.8%; E-cigarette = 2.3% vs. 4.5%, respectively; p < 0.01) or poly tobacco use (1.9% vs. 4.2%; p < 0.01) than US-born young adults. Adjusted regression models showed lower odds of poly tobacco use among the foreign-born than their US-born counterparts (Odds Ratio = 0.41, (95% Confidence Interval: 0.26–0.63)). Conclusions: The findings highlight the importance of targeted interventions by nativity status and further tobacco prevention efforts needed for the US-born.
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Prokhorov AV, Calabro KS, Arya A, Russell S, Czerniak KW, Botello GC, Chen M, Yuan Y, Perez A, Vidrine DJ, Perry CL, Khalil GE. Mobile Text Messaging for Tobacco Risk Communication Among Young Adult Community College Students: Randomized Trial of Project Debunk. JMIR Mhealth Uhealth 2021; 9:e25618. [PMID: 34822339 PMCID: PMC8663493 DOI: 10.2196/25618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 04/19/2021] [Accepted: 10/08/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The use of new and emerging tobacco products (NETPs) and conventional tobacco products (CTPs) has been linked to several alarming medical conditions among young adults (YAs). Considering that 96% of YAs own mobile phones, SMS text messaging may be an effective strategy for tobacco risk communication. OBJECTIVE Project Debunk is a community-based randomized trial aiming to identify specific types of messages that effectively improve perceived NETP and CTP risk among YAs in community colleges. METHODS With YAs recruited offline from 3 campuses at the Houston Community College (September 2016 to July 2017), we conducted a 6-month randomized trial with 8 arms based on the combination of 3 message categories: framing (gain-framed vs loss-framed), depth (simple vs complex), and appeal (emotional vs rational). Participants received fully automated web-based SMS text messages in two 30-day campaigns (2 messages per day). We conducted repeated-measures mixed-effect models stratified by message type received, predicting perceived CTP and NETP risks. Owing to multiple testing with 7 models, an association was deemed significant for P<.007 (.05 divided by 7). RESULTS A total of 636 participants completed the baseline survey, were randomized to 1 of 8 conditions (between 73 and 86 participants per condition), and received messages from both campaigns. By the 2-month post campaign 2 assessment point, 70.1% (446/636) completed all outcome measures. By the end of both campaigns, participants had a significant increase in perceived NETP risk over time (P<.001); however, participants had a marginal increase in perceived CTP risk (P=.008). Separately for each group, there was a significant increase in perceived NETP risk among participants who received rational messages (P=.005), those who received emotional messages (P=.006), those who received simple messages (P=.003), and those who received gain-framed messages (P=.003). CONCLUSIONS In this trial, YAs had an increase in perceived NETP risk. However, with stratification, we observed a significant increase in perceived NETP risk upon exposure to rational, emotional, simple, and gain-framed messages. In addition, YAs generally had an increase in perceived CTP risk and presented nonsignificant but observable improvement upon exposure to emotional, complex, and loss-framed messages. With the results of this study, researchers and practitioners implementing mobile health programs may take advantage of our tailored messages through larger technology-based programs such as smartphone apps and social media campaigns. TRIAL REGISTRATION ClinicalTrials.gov NCT03457480; https://clinicaltrials.gov/ct2/show/NCT03457480. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/10977.
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Affiliation(s)
- Alexander V Prokhorov
- Department of Behavioral Science, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Karen Sue Calabro
- Department of Behavioral Science, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Ashish Arya
- Department of Behavioral Science, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Sophia Russell
- Department of Health Disparities, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Katarzyna W Czerniak
- Department of Behavioral Science, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Gabrielle C Botello
- Department of Health Services Research, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Minxing Chen
- Department of Biostatistics, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Ying Yuan
- Department of Biostatistics, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Adriana Perez
- Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center, Austin, TX, United States
| | - Damon J Vidrine
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States
| | - Cheryl L Perry
- School of Public Health, Health Science Center, University of Texas, Austin, TX, United States
| | - Georges Elias Khalil
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States
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Antin TMJ, Hunt G, Annechino R. Tobacco Harm Reduction as a Path to Restore Trust in Tobacco Control. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5560. [PMID: 34067476 PMCID: PMC8196958 DOI: 10.3390/ijerph18115560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/27/2021] [Accepted: 05/19/2021] [Indexed: 11/17/2022]
Abstract
The controversy of tobacco harm reduction in the United States persists despite evidence that an important audience of tobacco prevention and control, i.e., the people who use or are likely to use nicotine and tobacco products, are engaging in practices that may be considered harm reduction. Despite this, a significant proportion of the US tobacco control and prevention field continues to be guided by a precept that there is "no safe tobacco," therefore failing to acknowledge practices that may be used to reduce the harms associated with consuming combustible forms of nicotine and tobacco. In this commentary, we argue that ignoring the potential benefits of harm reduction strategies may unintentionally lead to an erosion of trust in tobacco control among some members of the public. Trust in tobacco control as an institution is crucial for the success of tobacco control efforts. To ensure trust, we must return to our basic principles of doing no harm, developing programs that are responsive to people's experiences, and providing resources in assisting people to reduce the harms that may be associated with practices, such as smoking, which adversely affect health. Only by respecting an individual's priorities can we cultivate trust and develop tobacco prevention efforts that are grounded in the realities of people's lives and responsive to their needs.
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Affiliation(s)
- Tamar M. J. Antin
- Center for Critical Public Health, the Institute for Scientific Analysis, Alameda, CA 94501, USA; (G.H.); (R.A.)
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11
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Wackowski OA, O'Connor RJ, Pearson JL. Smokers' Exposure to Perceived Modified Risk Claims for E-Cigarettes, Snus, and Smokeless Tobacco in the United States. Nicotine Tob Res 2021; 23:605-608. [PMID: 32812028 DOI: 10.1093/ntr/ntaa159] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/13/2020] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Based on arguments for harm reduction and health benefits, tobacco companies in the United States can apply for regulatory authorization to make "modified risk tobacco product" (MRTP) marketing claims. The impact of future MRTP claims may depend on whether they are noticed, believed, and lead to smokers switching products. This study provides baseline data about smokers' exposure to perceived MRTP claims ahead of any MRTP authorizations. AIMS AND METHODS We analyzed measures from Wave 3 of the US-based Population Assessment of Tobacco and Health (PATH) study which asked smokers to indicate if they had seen any e-cigarettes, snus, or other smokeless tobacco (SLT) products that claim to be "less harmful" in the past 12 months, and their likelihood of using products with these claims in the next 30 days. RESULTS Significantly fewer smokers noted having seen snus (5.1%) or other SLT (5.6%) with "less harmful" claims compared with e-cigarettes (29.1%). For each product, the prevalence of MRTP claim exposure was higher among smokers who perceived the product to be less harmful than smoking, who currently used the product, and who had higher rates of tobacco advertising exposure at the point of sale. Among smokers who noticed products with "less harmful" claims, about one-quarter said they would use them in the future (24%-27%). CONCLUSIONS Ahead of any Food & Drug Administration (FDA) authorization for MRTP claims, some smokers already perceive exposure to "less harmful" claims for e-cigarettes, but few do for SLT. MRTP claims may motivate some smokers to use these products. IMPLICATIONS This study provides new baseline data about smokers' perceived exposure to MRTP claims in the United States ahead of any regulatory claim authorization. Using data from Wave 3 of the US PATH study, we found that some smokers already perceive exposure to "less harmful" claims for e-cigarettes (29%), but few do for SLT (5%-6%). Among smokers who noticed products with "less harmful" claims, about one-quarter said they would use them in the future (24%-27%), suggesting MRTP claims may motivate some smokers to use products described as "less harmful."
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Affiliation(s)
- Olivia A Wackowski
- Rutgers Center for Tobacco Studies, Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Rutgers University, New Brunswick, NJ
| | - Richard J O'Connor
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY
| | - Jennifer L Pearson
- Department of Health Administration and Policy, School of Community Health Sciences, University of Nevada, Reno, NV
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Harm Perceptions and Beliefs about Potential Modified Risk Tobacco Products. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020576. [PMID: 33445525 PMCID: PMC7827331 DOI: 10.3390/ijerph18020576] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/31/2020] [Accepted: 01/05/2021] [Indexed: 01/17/2023]
Abstract
Under US law, tobacco products may be authorized to claim lower exposure to chemicals, or lower risk of health harms. We sought to examine the harm perceptions and beliefs about potential modified risk tobacco products (MRTPs). We recruited 864 adult current and former smokers in August 2019. Participants read a paragraph describing the potential for the FDA to authorize MRTPs and a brief description of MRTPs. The most endorsed beliefs for each product were that they contained nicotine and that they were risky. Believing that e-cigarettes can help smokers quit smoking, that they tasted good, and looked cool were associated with greater odds of intending to try e-cigarettes after controlling for demographic and use factors. For snus, the beliefs that the product was not addictive and tasted good were associated with increased odds of intending to try snus. The beliefs that heated tobacco would taste good and would be a good quit aid was associated with increased odds of intentions to try heated tobacco products. Understanding what the public believes about products currently or potentially authorized to be marketed as modified risk tobacco products can inform communication efforts.
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Dissolution Testing of Nicotine Release from OTDN Pouches: Product Characterization and Product-to-Product Comparison. SEPARATIONS 2021. [DOI: 10.3390/separations8010007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In recent years, oral tobacco-derived nicotine (OTDN) pouches have emerged as a new oral tobacco product category. They are available in a variety of flavors and do not contain cut or ground tobacco leaf. The on!® nicotine pouches fall within this category of OTDN products and are currently marketed in seven (7) flavors with five (5) different nicotine levels. Evaluation of the nicotine release from these products is valuable for product assessment and product-to-product comparisons. In this work, we characterized the in vitro release profiles of nicotine from the 35 varieties of on!® nicotine pouches using a fit-for-purpose dissolution method, employing the U.S. Pharmacopeia flow-through cell dissolution apparatus 4 (USP-4). The nicotine release profiles were compared using the FDA’s Guidance for Industry: Dissolution Testing of Immediate Release Solid Oral Dosage Forms. The cumulative release profiles of nicotine show a dose dependent response for all nicotine levels. The on!® nicotine pouches exhibit equivalent percent nicotine release rates for each flavor variant across all nicotine levels. Furthermore, the nicotine release profiles from on!® nicotine pouches were compared to a variety of other commercially available OTDN pouches and traditional pouched smokeless tobacco products. The percent nicotine release rates were found to be dependent on the product characteristics, showing similarities and differences in the nicotine release profiles between the on!® nicotine pouches and other compared products.
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Algiers O, Wang Y, Laestadius L. Content Analysis of U.S. Newspaper Coverage of Causes and Solutions to Vaping-Associated Lung Injury. Subst Use Misuse 2021; 56:522-528. [PMID: 33627031 DOI: 10.1080/10826084.2021.1883663] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In 2019, an outbreak of vaping-associated lung injury (also known as "EVALI") spread throughout the U.S., linked to use of illicit THC cartridges. This paper examines U.S. newspaper coverage on the causes and solutions to EVALI. Methods: A content analysis of 417 articles from April to December 2019 from two national newspapers, one regional newspaper, and the Associated Press was conducted. Articles were coded for information about EVALI causes, mentions of the brand Dank Vapes, calls for individuals take a specific action to prevent harm, and mentions of policy actions to address vaping. Mentions of increasing youth vaping and JUUL were also coded. Results: Most articles (77%) provided an update on the number of EVALI cases and/or deaths. Fewer described EVALI symptoms (20%) or mentioned vaping cessation resources available to the public (2%). Almost half of articles also mentioned youth vaping as a concern (49%). Dank Vapes was mentioned rarely (4%) compared to JUUL (39%). After CDC recommendations changed to no longer recommend avoiding all vaping products, news articles became significantly less likely to mention nicotine products as a cause of EVALI or suggest that individuals cease all vaping. While policy was generally not articulated as a solution to EVALI, banning or limiting flavored nicotine vaping products were the most common policy actions mentioned. Conclusions/Importance: The discussions of causes of and solutions to EVALI were often intertwined with coverage of youth vaping, potentially failing to convey a clear sense of how the public should respond to the EVALI outbreak.
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Affiliation(s)
- Olivia Algiers
- Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Yang Wang
- Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Linnea Laestadius
- Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
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Hatsukami DK, Carroll DM. Tobacco harm reduction: Past history, current controversies and a proposed approach for the future. Prev Med 2020; 140:106099. [PMID: 32335031 PMCID: PMC7581601 DOI: 10.1016/j.ypmed.2020.106099] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 04/15/2020] [Accepted: 04/18/2020] [Indexed: 01/29/2023]
Abstract
Tobacco harm reduction remains a controversial topic in tobacco control. Tobacco harm reduction involves providing tobacco users who are unwilling or unable to quit using nicotine products with less harmful nicotine-containing products for continued use. The skepticism towards harm reduction is based in part on the experience with low-yield tar/nicotine cigarettes, which were presumed to be associated with lower health risks than higher yield cigarettes and marketed as such by cigarette manufacturers. Only later did the field learn that these cigarettes were a deceptive way for cigarette manufacturers to allay the health concerns over cigarette smoking. Since this experience, there has been a proliferation of tobacco products that might potentially serve as a means to reduce tobacco harm. Some members of the tobacco control community believe that these products have great potential to reduce mortality and morbidity among smokers who completely switch to them. Others believe that we will be addicting another generation to tobacco products. This paper reviews the past history, the current tobacco landscape and controversies, and an approach that might rapidly reduce the yearly half-million deaths associated with cigarette smoking in the U.S.
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Affiliation(s)
- Dorothy K Hatsukami
- Masonic Cancer Center and Department of Psychiatry, University of Minnesota, Minneapolis, MN, United States.
| | - Dana M Carroll
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN, United States
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Smokers' and Young Adult Non-Smokers' Perceptions and Perceived Impact of Snus and E-Cigarette Modified Risk Messages. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186807. [PMID: 32961924 PMCID: PMC7558440 DOI: 10.3390/ijerph17186807] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 12/02/2022]
Abstract
Although no tobacco products are safe, tobacco companies in the United States may request regulatory authorization to make certain “modified risk tobacco product” (MRTP) claims in their marketing. However, few qualitative studies have explored consumer perceptions and understanding of comparative risk messages and wordings. We examined consumer perceptions of statements indicating reduced risks and exposure to chemicals from snus and e-cigarettes relative to smoking. We conducted 12 focus groups with adult smokers (ages 21–66) and young adult (YA) non-smokers (ages 18–25) (n = 57) in the USA in 2019. Participants shared reactions to modified risk and exposure messages and message variations. Participants largely understood claims, including language about “switching completely.” However, participants expressed desire for more message specificity, evidence, risk reduction reasons, and statistics/quantitative information. Claim believability and acceptance was also limited by existing negative product beliefs and experiences, negative media reports, and skepticism about message source. YAs did not express product interest based on message exposure. Some YAs suggested the included “smoker” language made the messages less interesting/relevant. Given existing proposals for and use of MRTP messages, additional research on their wording, framing, delivery, and effects may help inform regulatory or organizational decisions about such messages, optimize potential benefits, and mitigate unintended consequences.
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Lazard AJ. Design cues for tobacco communication: Heuristic interpretations and usability of online health information about harmful chemicals. Int J Med Inform 2020; 141:104177. [PMID: 32521448 PMCID: PMC7606338 DOI: 10.1016/j.ijmedinf.2020.104177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 05/08/2020] [Accepted: 05/11/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Many people have a poor understanding of the numerous chemicals in tobacco products that cause severe health harms. The US government must display a list of these harmful chemicals for the public. Online disclosures are one promising solution, but evidence is needed for effective design strategies to encourage interpretation and use of information as intended. METHOD To examine the impact of website designs for the activation of heuristics and usability perceptions, a national probability sample of US adolescents and adults (n = 1441) was randomized in a 3 (chemical format) × 2 (webpage layout) between-subjects online experiment. Chemicals were displayed as names only, with a visual risk indicator, or with numerical ranges. Layouts displayed health harms at the top of the webpage separate from chemicals or the chemicals grouped by associated health harms. Participants viewed a webpage and reported activated heuristics, usability (perceived ease of use and usefulness), and intentions to use the website. RESULTS Displaying risk indicators increased website usability by encouraging users to rely on colors to interpret the risk of the chemicals (all p < .01). Website designs that grouped chemicals with harms allowed users to link the chemicals to harms they cause and increased perceived usability and intentions to use the website (all p < .001). CONCLUSION Assessing heuristics gives insights for how US adolescents and adults interpret chemical information and the impact of design strategies on usability. Public disclosures of chemicals in tobacco products could be optimized with color-coded risk indicators and layouts placing chemicals near the harms they cause.
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Affiliation(s)
- Allison J Lazard
- School of Media and Journalism, University of North Carolina at Chapel Hill, NC 27599-3365, United States; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, NC 27599-3365, United States.
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Elton-Marshall T, Driezen P, Fong GT, Cummings KM, Persoskie A, Wackowski O, Choi K, Kaufman A, Strong D, Gravely S, Taylor K, Kwan J, Bansal-Travers M, Travers M, Hyland A. Adult perceptions of the relative harm of tobacco products and subsequent tobacco product use: Longitudinal findings from waves 1 and 2 of the population assessment of tobacco and health (PATH) study. Addict Behav 2020; 106:106337. [PMID: 32145496 PMCID: PMC7441471 DOI: 10.1016/j.addbeh.2020.106337] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 01/07/2020] [Accepted: 02/03/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To examine: (1) How perceptions of harm for seven non-cigarette tobacco products predict subsequent use; (2) How change in use is associated with changes in perceptions of product harm; (3) Whether sociodemographic variables moderate the association between perceptions and use. METHODS Data are from the adult sample (18+) of the Population Assessment of Tobacco and Health (PATH) Study, a nationally representative longitudinal cohort survey conducted September 2013-December 2014 (Wave 1 (W1) n = 32,320) and October 2014-October 2015 (Wave 2 (W2) n = 28,362). RESULTS Wave 1 users and non-users of e-cigarettes, filtered cigars, cigarillos, and pipes, who perceived these products as less harmful had greater odds of using the product at W2. For the other products, there was an interaction between W1 perceived harm and W1 use status in predicting W2 product use. At W2, a smaller percentage of U.S. adults rated e-cigarettes as less harmful than cigarettes compared to W1 (41.2% W1, 29.0% W2). Believing non-cigarette products to be less harmful than cigarettes was more strongly associated with subsequent product use in the oldest age group (55+ years) while weaker effects were observed in the youngest age group (18-24 years). This moderating effect of age was significant for e-cigarettes, hookah, traditional cigars, and cigarillos. CONCLUSIONS Strategies to prevent initiation and promote cessation of these products may benefit from understanding and addressing perceptions of these products.
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Affiliation(s)
- Tara Elton-Marshall
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, London, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Ontario Tobacco Research Unit, Toronto, Ontario, Canada.
| | - Pete Driezen
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada; School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada; Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Alexander Persoskie
- United States Food and Drug Administration, Center for Tobacco Products, Silver Spring, MD, USA
| | - Olivia Wackowski
- Rutgers School of Public Health, Center for Tobacco Studies, Piscataway, NJ, USA
| | - Kelvin Choi
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD, USA
| | - Annette Kaufman
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - David Strong
- Cancer Prevention Program, Moores Cancer Center, University of California, San Diego, La Jolla, San Diego, CA, USA; Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, San Diego, CA, USA
| | - Shannon Gravely
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | | | - Jonathan Kwan
- United States Food and Drug Administration, Center for Tobacco Products, Silver Spring, MD, USA
| | - Maansi Bansal-Travers
- Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Mark Travers
- Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Andrew Hyland
- Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Cancer Institute, Buffalo, NY, USA
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Laestadius LI, Penndorf K, Seidl M, Pokhrel P, Patrick R, Cho YI. Young Adult Identification and Perception of Hashtag-Based Vaping Claims on Instagram. HEALTH EDUCATION & BEHAVIOR 2020; 47:611-618. [PMID: 32506949 DOI: 10.1177/1090198120928992] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Social media platforms are home to large volumes of ambiguous hashtag-based claims about the health, modified-risk, and cessation benefits of electronic cigarette products (e.g., #Vapingsavedmylife). The objective of this study was to qualitatively explore how young adults interpret these hashtags on the popular platform Instagram. Specifically, we sought to identify if they view these hashtags as making health-related claims, and if they find these claims to be credible and valid. We conducted 12 focus groups in 2018 with non-tobacco users, smokers, dual users, and vapers between the ages of 18 and 24 (n = 69). Using real Instagram posts to guide discussion, participants reflected on the meaning of potentially claims-making hashtags. Participants interpreted the majority of the hashtags as making health-related claims. However, many participants felt that the claims were too exaggerated to be entirely valid. Some participants, including dual users and vapers, argued that smoking and vaping were largely equivalent. Smokers were particularly skeptical of claims. Findings suggest that the U. S. Food and Drug Administration should consider hashtag-based claims in their regulatory efforts. However, further research is needed on how to pragmatically address claims taking the form of hashtags given legal and practical constraints.
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Affiliation(s)
| | | | - Melissa Seidl
- University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | | | - Ryan Patrick
- The MayaTech Corporation, Silver Spring, MD, USA
| | - Young Ik Cho
- University of Wisconsin-Milwaukee, Milwaukee, WI, USA
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Felicione NJ, Ozga-Hess JE, Ferguson SG, Dino G, Kuhn S, Haliwa I, Blank MD. Cigarette smokers' concurrent use of smokeless tobacco: dual use patterns and nicotine exposure. Tob Control 2020; 30:24-29. [PMID: 32051253 DOI: 10.1136/tobaccocontrol-2019-055345] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/25/2019] [Accepted: 12/10/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND The concurrent use of cigarettes with other tobacco products, such as smokeless tobacco (SLT), is increasingly common. Extant work with cigarette smokers who also use SLT is based heavily on retrospective reports and between-group comparisons. The purpose of this study was to assess prospectively the patterns of dual users' product use and nicotine exposure on days when cigarettes were smoked exclusively (single use) versus concurrently with SLT (dual use). DESIGN Forty-six dual cigarette-SLT users recorded their product use in real time via ecological momentary assessment for a 2-week longitudinal design. They responded to questions about situational factors (eg, location, mood) using this same diary, and collected saliva samples each night for later cotinine measurement. At the end of this 2-week period, users reported on their reasons for and beliefs about SLT use. RESULTS Cotinine levels were significantly higher on dual versus single use days (mean±SEM=374.48±41.08 ng/mL vs 300.17±28.13 ng/mL, respectively; p<0.01), and the number of cigarettes logged was higher on dual versus single use days (11.13±0.98 vs 9.13±1.11, respectively; p<0.01). Product use was distinguished by situational factors, with the strongest predictor being location of use. Moreover, the most common reason for initiating (56.52%) and continuing (67.39%) SLT use was to circumvent indoor smoking restrictions. CONCLUSIONS Results support the idea of product supplementation rather than replacement among this convenience sample of dual users. For smokers whose primary motivation for SLT use involves situations where they would otherwise be tobacco free, the potential benefits of clean indoor air laws may be diminished.
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Affiliation(s)
| | - Jenny E Ozga-Hess
- Psychology, West Virginia University, Morgantown, West Virginia, USA
| | - Stuart G Ferguson
- School of Medicine, University of Tasmania Faculty of Health, Hobart, Tasmania, Australia
| | - Geri Dino
- Social and Behavioral Sciences, West Virginia University School of Public Health, Morgantown, West Virginia, USA.,WV Prevention Research Center, West Virginia University School of Public Health, Morgantown, West Virginia, USA
| | - Summer Kuhn
- Health Sciences and Technology Academy, West Virginia University, Morgantown, West Virginia, USA
| | - Ilana Haliwa
- Psychology, West Virginia University, Morgantown, West Virginia, USA
| | - Melissa D Blank
- Psychology, West Virginia University, Morgantown, West Virginia, USA .,WV Prevention Research Center, West Virginia University School of Public Health, Morgantown, West Virginia, USA
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Persoskie A, O'Brien EK, Poonai K. Perceived relative harm of using e-cigarettes predicts future product switching among US adult cigarette and e-cigarette dual users. Addiction 2019; 114:2197-2205. [PMID: 31278802 DOI: 10.1111/add.14730] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/29/2019] [Accepted: 06/28/2019] [Indexed: 01/30/2023]
Abstract
BACKGROUND AND AIMS People's perceptions of the harmfulness of e-cigarettes, compared with cigarettes, may influence their product use decisions. We tested if perceiving e-cigarettes as less harmful than cigarettes predicted whether cigarette and e-cigarette dual users switched their product use status 1 year later, becoming exclusive e-cigarette users, exclusive cigarette smokers, or non-users of both product types. DESIGN Longitudinal analyses of waves 2 (2014-15) and 3 (2015-16) of the prospective, national Population Assessment of Tobacco and Health (PATH) Study. SETTING United States. PARTICIPANTS Adults who reported using both cigarettes and e-cigarettes within the past 30 days at wave 2 reported their perceptions of e-cigarette harm at wave 2, and reported whether they used cigarettes and e-cigarettes within the past 30 days at wave 3 (n = 2211). MEASUREMENTS The key predictor was wave 2 perceptions of e-cigarette harm compared with cigarettes ('less harmful,' 'about the same', 'more harmful' or 'don't know'). The key outcome was wave 3 past 30-day use of e-cigarettes and cigarettes, classified into four categories: exclusive e-cigarette use (i.e. use of e-cigarettes but not cigarettes), exclusive cigarette smoking (i.e. use of cigarettes but not e-cigarettes), dual use of both product types and non-use of both product types. FINDINGS At wave 2, 59.4% of dual users perceived e-cigarettes as less harmful than cigarettes [95% confidence interval (CI) = 56.9, 61.9]. Compared with those with other perceptions of e-cigarette harm, dual users who perceived e-cigarettes as less harmful than cigarettes were more likely to become exclusive e-cigarette users 1 year later [7.5 versus 2.7%; adjusted odds ratio (aOR) = 2.9, 95% CI = 1.7-4.8], more likely to remain dual users (39.6 versus 29.9%; aOR = 1.5, 95% CI = 1.2-1.8), less likely to become exclusive cigarette smokers (44.8 versus 59.4%; aOR = 0.6, 95% CI = 0.5-0.7) and similarly likely to become non-users of both product types (8.2 versus 8.0%; aOR = 1.1, 95% CI = 0.7-1.7). CONCLUSIONS US adult dual users of e-cigarettes and cigarettes who perceive e-cigarettes as less harmful than cigarettes appear to be more likely to switch to exclusive e-cigarette use, more likely to remain dual users and less likely to switch to exclusive cigarette use 1 year later than dual users with other perceptions of e-cigarette harm.
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Affiliation(s)
| | | | - Karl Poonai
- Office of Science, FDA Center for Tobacco Products, Calverton, MD, USA
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Prochaska JJ, Benowitz NL. Current advances in research in treatment and recovery: Nicotine addiction. SCIENCE ADVANCES 2019; 5:eaay9763. [PMID: 31663029 PMCID: PMC6795520 DOI: 10.1126/sciadv.aay9763] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 09/26/2019] [Indexed: 05/05/2023]
Abstract
The health harms of combusted tobacco use are undeniable. With market and regulatory pressures to reduce the harms of nicotine delivery by combustion, the tobacco product landscape has diversified to include smokeless, heated, and electronic nicotine vaping products. Products of tobacco combustion are the main cause of smoking-induced disease, and nicotine addiction sustains tobacco use. An understanding of the biology and clinical features of nicotine addiction and the conditioning of behavior that occurs via stimuli paired with frequent nicotine dosing, as with a smoked cigarette, is important for informing pharmacologic and behavioral treatment targets. We review current advances in research on nicotine addiction treatment and recovery, with a focus on conventional combustible cigarette use. Our review covers evidence-based methods to treat smoking in adults and policy approaches to prevent nicotine product initiation in youth. In closing, we discuss emerging areas of evidence and consider new directions for advancing the field.
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Affiliation(s)
- Judith J. Prochaska
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Neal L. Benowitz
- Program in Clinical Pharmacology, Division of Cardiology, and the Center for Tobacco Control Research and Education, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
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Yang B, Owusu D, Popova L. Testing messages about comparative risk of electronic cigarettes and combusted cigarettes. Tob Control 2019; 28:440-448. [PMID: 30104408 PMCID: PMC6374208 DOI: 10.1136/tobaccocontrol-2018-054404] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 07/16/2018] [Accepted: 07/26/2018] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Health agencies are grappling with communicating risks of electronic cigarettes (e-cigarettes) compared with combusted cigarettes. This study examined smokers' responses to two types of comparative risk messages with one type incorporating more negative antismoking elements in the design. METHODS In an online experiment, 1400 US adult (18+ years) current smokers and recent quitters were randomised to view one of three comparative risk messages about e-cigarettes (CR messages), one of three comparative risk messages that included more negative antismoking elements in the design (CR- messages) or a control message. Selection of outcomes was guided by the antismoking message impact framework. Multivariate analyses of covariance and logistic regression models analysed effects of messages on message evaluations, e-cigarette-related and cigarette-related beliefs and behavioural intentions. RESULTS Both CR and CR- messages decreased smokers' intentions to smoke cigarettes, increased intentions to switch to e-cigarettes completely and increased perceptions that e-cigarettes are less harmful than combusted cigarettes. Neither message type increased dual use intentions relative to exclusive e-cigarettes use or smoking cessation. CR messages decreased perceived absolute risks of e-cigarettes and self-exempting beliefs about smoking, whereas CR- versus CR messages produced higher self-efficacy to quit smoking. CONCLUSION Comparative risk communication might encourage smokers to switch to lower-harm tobacco products. Comparative risk messages with more negative antismoking elements in the design might be particularly effective, because they led to higher self-efficacy to quit smoking. Regulatory agencies may consider using comparative risk messages with more negative antismoking elements to educate the public about lower risk of e-cigarettes.
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Affiliation(s)
- Bo Yang
- Tobacco Center of Regulatory Science, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Daniel Owusu
- Tobacco Center of Regulatory Science, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Lucy Popova
- Tobacco Center of Regulatory Science, School of Public Health, Georgia State University, Atlanta, GA, USA
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Suliankatchi Abdulkader R, Sinha DN, Jeyashree K, Rath R, Gupta PC, Kannan S, Agarwal N, Venugopal D. Trends in tobacco consumption in India 1987–2016: impact of the World Health Organization Framework Convention on Tobacco Control. Int J Public Health 2019; 64:841-851. [DOI: 10.1007/s00038-019-01252-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 05/02/2019] [Accepted: 05/14/2019] [Indexed: 11/28/2022] Open
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Kozlowski LT. Younger Individuals and Their Human Right to Harm Reduction Information Should Be Considered in Determining Ethically Appropriate Public Health Actions. Nicotine Tob Res 2019; 22:1051-1053. [PMID: 30943281 DOI: 10.1093/ntr/ntz049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 03/23/2019] [Indexed: 11/13/2022]
Affiliation(s)
- Lynn T Kozlowski
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, NY
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Wackowski OA, Ray AE, Stapleton JL. Smokers' perceptions of risks and harm from snus relative to cigarettes: A latent profile analysis study. Addict Behav 2019; 91:171-174. [PMID: 30501991 PMCID: PMC6358499 DOI: 10.1016/j.addbeh.2018.11.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 11/07/2018] [Accepted: 11/13/2018] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Certain types of smokeless tobacco (SLT) products, particularly snus, carry fewer health risks than cigarette smoking and might be able to serve as harm-reduction products for smokers. However, studies frequently find that smokers misperceive SLT and snus to be as or more harmful than smoking. This perception is often measured with a single general harm question, and research on underlying risk perceptions is limited. METHODS Using a sample of 256 current smokers, we utilized Latent Profile Analysis to examine response profiles to items that assessed perceived risk of specific health outcomes (lung cancer, heart disease, oral cancer) from snus relative to cigarettes, along with the typical single item measure of overall harm from snus compared to cigarettes. RESULTS Three smoker response profiles emerged. Almost half (44.9%) of smokers perceived snus to be as or more risky than cigarettes for all three specific health outcomes (group 1), while over one third (38.3%) had an elevated perceived risk for oral cancer only (group 2). About 17% of smokers perceived snus to have lower risks for lung cancer only (group 3). Across each profile, perceived risk was highest for oral cancer. CONCLUSIONS If smokers are to consider snus for harm-reduction, efforts may be needed to better inform smokers about their lower relative risks, including for particular health outcomes of interest. This study also suggests that smokers may vary in their level of need for information to correct their relative risk misperceptions.
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Affiliation(s)
- Olivia A Wackowski
- Center for Tobacco Studies, Department of Social and Behavioral Health Sciences, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ 08854, USA.
| | - Anne E Ray
- Center for Tobacco Studies, Department of Social and Behavioral Health Sciences, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ 08854, USA
| | - Jerod L Stapleton
- Rutgers Cancer Institute of New Jersey, Department of Medicine, Rutgers University, 195 Little Albany Street, New Brunswick, NJ 08901, USA
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Yang B, Spears CA, Popova L. Psychological distress and responses to comparative risk messages about electronic and combusted cigarettes. Addict Behav 2019; 91:141-148. [PMID: 30477820 DOI: 10.1016/j.addbeh.2018.11.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 11/16/2018] [Accepted: 11/16/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND People with mental illness suffer disproportionately high health burdens of smoking. Communicating to these smokers that electronic cigarettes (e-cigarettes) are a less harmful alternative to combusted cigarettes might help them reduce their health risks by encouraging complete switching to e-cigarettes. However, such messages might also cause unintended consequences (e.g., dual use of both combusted and e-cigarettes). Our study examined how smokers with vs. without serious psychological distress (SPD) responded to messages communicating reduced harm of e-cigarettes in relation to cigarettes. METHOD In an online experiment, 1400 U.S. adult smokers with and without SPD viewed 1 of 6 messages about reduced harm of e-cigarettes compared to cigarettes or a control message. Then participants reported e-cigarette- and cigarette-related beliefs, and behavioral intentions. RESULTS Message type (comparative risk messages vs. control) did not interact with SPD status to produce differential impacts on smokers with and without SPD. Regardless of being exposed to a comparative risk message or a control message, smokers with SPD reported greater perceived absolute risk of e-cigarettes and cigarettes, greater support for tobacco control, greater intentions to switch to e-cigarettes completely and seek help with quitting, and were less likely to report e-cigarettes were less harmful than cigarettes compared to smokers without SPD. DISCUSSION Smokers with SPD had greater intentions to switch to e-cigarettes completely and seek help quitting compared to smokers without SPD, which indicates that smokers with SPD may be optimistic about e-cigarettes to help them quit smoking.
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Affiliation(s)
- Bo Yang
- Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Claire Adams Spears
- Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA, USA; Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Lucy Popova
- Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA, USA; Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA.
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Prokhorov AV, Khalil GE, Calabro KS, Machado TC, Russell S, Czerniak KW, Botello GC, Chen M, Perez A, Vidrine DJ, Perry CL. Mobile Phone Text Messaging for Tobacco Risk Communication Among Young Adult Community College Students: Protocol and Baseline Overview for a Randomized Controlled Trial. JMIR Res Protoc 2018; 7:e10977. [PMID: 30322833 PMCID: PMC6231779 DOI: 10.2196/10977] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 07/17/2018] [Accepted: 07/19/2018] [Indexed: 12/18/2022] Open
Abstract
Background Community-college students are at high risk for tobacco use. Because the use of mobile phone text messaging is nearly ubiquitous today, short message service (SMS) may be an effective strategy for tobacco risk communication in this population. Little is known, however, concerning the message structure significantly influencing perceived tobacco risk. Objective We aim to outline the rationale and design of Project Debunk, a randomized trial comparing the effects of different SMS text message structures. Methods We conducted a 6-month randomized trial comparing 8 arms, based on the combination of the 3 message structures delivered to young adults in a 2×2×2 study design: framing (gain-framed or loss-framed), depth (simple or complex), and appeal (emotional or rational). Participants were invited to participate from 3 community colleges in Houston from September 2016 to July 2017. Participants were randomized to 1 arm and received text messages in 2 separate campaigns. Each campaign consisted of 2 text messages per day for 30 days. Perceived tobacco risk was assessed at baseline, 2 months after the first campaign, and 2 months after the second campaign. We assessed the perceived risk of using conventional products (eg, combustible cigarettes) and new and emerging products (eg, electronic cigarettes). The validity of message structures was assessed weekly for each campaign. A 1-week follow-up assessment was also conducted to understand immediate reactions from participants. Results We completed data collection for the baseline survey on a rolling basis during this time and assessed the validity of the message structure after 1 week of SMS text messages. For the entire sample (N=636), the average age was 20.92 years (SD 2.52), about two-thirds were male (430/636, 67.6%), and most were black or African American (259/636, 40.7%) or white (236/636, 37.1%). After 1 week of receiving text messages, the following was noted: (a) loss-framed messages were more likely to be perceived as presenting a loss than gain-framed messages (F7,522=13.13, P<.001), (b) complex messages were perceived to be more complex than simple messages (F7,520=2.04, P=.05), and (c) emotional messages were perceived to be more emotionally involving than rational messages (F7,520=6.46, P<.001). Conclusions This study confirms that the recruitment, randomization, and message composition have been successfully implemented. Further analyses will identify specific types of messages that are more effective than others in increasing the perceived risk of tobacco use. If our results suggest that any of the 8 specific message structures are more effective for helping young adults understand tobacco risk, this would provide evidence to include such messages as part of a larger technology-based campaign such as mobile phone apps, entertainment-based campaigns, and social media. Trial Registration ClinicalTrials.gov NCT03457480; https://clinicaltrials.gov/ct2/show/NCT03457480 (Archived by WebCite at http://www.webcitation.org/6ykd4IIap) Registered Report Identifier RR1-10.2196/10977
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Affiliation(s)
- Alexander V Prokhorov
- Department of Behavioral Science, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Georges Elias Khalil
- Department of Behavioral Science, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Karen Sue Calabro
- Department of Behavioral Science, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Tamara Costello Machado
- Department of Behavioral Science, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Sophia Russell
- Department of Behavioral Science, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Katarzyna W Czerniak
- Department of Behavioral Science, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Gabrielle C Botello
- Department of Behavioral Science, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Minxing Chen
- Department of Biostatistics, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Adriana Perez
- Department of Biostatistics and Data Science, School of Public Health in Austin, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX, United States
| | - Damon J Vidrine
- Department of Family and Preventive Medicine, The University of Oklahoma Health Sciences Center, The University of Oklahoma, Oklahoma City, OK, United States
| | - Cheryl L Perry
- School of Public Health in Austin, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX, United States
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Adolescents' perceptions of flavored tobacco products, including E-cigarettes: A qualitative study to inform FDA tobacco education efforts through videogames. Addict Behav 2018; 82:189-194. [PMID: 29573891 DOI: 10.1016/j.addbeh.2018.03.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 03/08/2018] [Accepted: 03/12/2018] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Flavored tobacco products have been shown to appeal to youth, however tobacco control strategies have traditionally not focused on these products. To inform the adaptation of an existing videogame to focus on the prevention of flavored tobacco product use, this study explored adolescents' perceptions, beliefs, and social norms surrounding these products, including flavored e-cigarettes. METHODS We conducted and analyzed transcripts from seven focus groups with 11-17-year-old adolescents (n = 33) from after-school programs in CT and CA in 2016. Participants discussed flavored tobacco product beliefs and experiences, and how these compared to traditional cigarettes. RESULTS Thematic analysis of transcripts revealed that participants could name flavors in tobacco products, even though few discussed first-hand experience with the products. Most groups perceived that flavored tobacco product and flavored e-cigarette use facilitated peer approval and acceptance. All groups discussed how youth could easily access flavored tobacco products, including e-cigarettes. Flavoring was a salient aspect of e-cigarette advertisements; however the groups did not recall exposure to other types of flavored tobacco product counter-marketing. CONCLUSIONS These data can help inform the development of tobacco control strategies, novel interventions (such as videogames), and future FDA efforts to prevent adolescent tobacco product use through education and risk communication.
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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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Kozlowski LT. Origins in the USA in the 1980s of the warning that smokeless tobacco is not a safe alternative to cigarettes: a historical, documents-based assessment with implications for comparative warnings on less harmful tobacco/nicotine products. Harm Reduct J 2018; 15:21. [PMID: 29661189 PMCID: PMC5902931 DOI: 10.1186/s12954-018-0228-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 03/28/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Before the 1980s in the USA, smokeless tobacco carried no health warnings, was not judged to cause disease, and was a declining practice. In 1986, the federal government passed legislation requiring rotating warnings on "mouth cancer," "gum disease and tooth loss," and "This product is not a safe alternative to cigarettes." This paper explores the history of the establishment of these warnings with emphasis on the 'not a safe alternative' warning and the bases for claiming that smokeless was 'not safe' (absolute harm) versus 'not safer than cigarettes' (relative harm). METHODS Results of searches of Truth Tobacco Industry Document archives and transcripts of legislative hearings were analyzed. Critical assessments were made of the evidence-base. RESULTS New evidence of oral cancer causation emerged along with a much-publicized case of a teenager dying of oral cancer. Public health concerns also arose over a widespread, successful marketing campaign implying smokeless was a safe alternative to cigarettes. Industry wanted pre-emptive federal warnings, to prevent a diversity of pending state warnings. To avoid an addiction warning, the industry accepted a compromise 'not a safe alternative' warning, which had not been initially proposed and which the cigarette industry may have sought in order to constrain the smokeless tobacco industry. The evidence presented supported smokeless only as 'not safe' and not 'as harmful as cigarette smoking.' CONCLUSIONS The comparative warning was a compromise to prevent an addiction warning and consistent with the preferences of cigarette companies. Prior surveys indicated that the public generally did not view smokeless tobacco as harmless, but they did generally report smokeless as less harmful than cigarettes despite expert interpretations to the contrary. As would not have been appreciated by public health supporters at the outset, subsequent research has shown that the 'not a safe alternative' message is misinterpreted by consumers to indicate that smokeless is 'not safer' than cigarettes-which was not established and has been disconfirmed by subsequent assessments of that question. Though many countries have banned smokeless tobacco (but not cigarettes), where smokeless is legally available accurate information on the nature of harms and differential harms needs to be developed.
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Affiliation(s)
- Lynn T Kozlowski
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, State University of New York, 323 Kimball Tower, 3435 Main Street, Buffalo, NY, 14214-8028, USA.
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Bergsvik D, Rogeberg O. Assessing the effect of public health information by incentivised risk estimation: An example on Swedish snus. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 54:51-57. [PMID: 29414485 DOI: 10.1016/j.drugpo.2018.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 12/08/2017] [Accepted: 01/09/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND The provision of accurate information on health damaging behaviours and products is a widely accepted and widespread governmental task. It is easily mismanaged. This study demonstrates a simple method which can help to evaluate whether such information corrects recipient risk beliefs. METHODS Participants assess risks numerically, before and after being exposed to a relevant risk communication. Accuracy is incentivised by awarding financial prizes to answers closest to a pursued risk belief. To illustrate this method, 228 students from the University of Oslo, Norway, were asked to estimate the mortality risk of Swedish snus and cigarettes twice, before and after being exposed to one of three risk communications with information on the health dangers of snus. RESULTS The data allow us to measure how participants updated their risk beliefs after being exposed to different risk communications. Risk information from the government strongly distorted risk perceptions for snus. A newspaper article discussing the relative risks of cigarettes and snus reduced belief errors regarding snus risks, but increased belief errors regarding smoking. The perceived quality of the risk communication was not associated with decreased belief errors. CONCLUSION Public health information can potentially make the public less informed on risks about harmful products or behaviours. This risk can be reduced by targeting identified, measurable belief errors and empirically assessing how alternative communications affect these. The proposed method of incentivised risk estimation might be helpful in future assessments of risk communications.
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Affiliation(s)
- Daniel Bergsvik
- Norwegian Institute of Public Health, Department of Drug Policy, PO Box 4404, Nydalen, 0403 Oslo, Norway; Ragnar Frisch Centre for Economic Research, Gaustadalléen 21, 0349 Oslo, Norway.
| | - Ole Rogeberg
- Ragnar Frisch Centre for Economic Research, Gaustadalléen 21, 0349 Oslo, Norway.
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Elias J, Hendlin Y, Chaffee BW, Ling PM. Don't throw smokeless tobacco users under the bus. Addict Behav 2018; 77:289-290. [PMID: 28410775 PMCID: PMC5634941 DOI: 10.1016/j.addbeh.2017.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 04/03/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Jesse Elias
- Center for Tobacco Control Research & Education, Suite 366 Library, 530 Parnassus Avenue, University of California San Francisco, San Francisco, CA 94143-1390, USA.
| | - Yogi Hendlin
- Center for Tobacco Control Research & Education, Suite 366 Library, 530 Parnassus Avenue, University of California San Francisco, San Francisco, CA 94143-1390, USA.
| | - Benjamin W Chaffee
- Center for Tobacco Control Research & Education, Suite 366 Library, 530 Parnassus Avenue, University of California San Francisco, San Francisco, CA 94143-1390, USA.
| | - Pamela M Ling
- Center for Tobacco Control Research & Education, Suite 366 Library, 530 Parnassus Avenue, University of California San Francisco, San Francisco, CA 94143-1390, USA.
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An Online Survey of New Zealand Vapers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15020222. [PMID: 29382129 PMCID: PMC5858291 DOI: 10.3390/ijerph15020222] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 01/22/2018] [Accepted: 01/24/2018] [Indexed: 12/15/2022]
Abstract
Using electronic cigarettes (vaping) is controversial, but is increasingly widespread. This paper reports the results of an electronic survey of vapers in New Zealand, a country where the sale and supply of e-liquids containing nicotine is illegal, although vapers can legally access e-liquids from overseas. An on-line survey was conducted, using vaper and smoking cessation networks for recruitment, with follow up surveys conducted 1 and 2 months after the initial survey. 218 participants were recruited. Almost all had been smokers, but three quarters no longer smoked, with the remainder having significantly reduced their tobacco use. Three participants were non-smokers before starting to vape, but none had gone on to become smokers. The overriding motivation to begin and continue vaping was to stop or to reduce smoking. The results were consistent with a progression from initially both vaping and smoking using less effective electronic cigarette types, then moving to more powerful devices, experimentation with flavors and nicotine strengths—all resulting in reducing or stopping tobacco use. Lack of access to nicotine and lack of support for their chosen cessation method were the main problems reported. Vaping had resulted in effective smoking cessation for the majority of participants.
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Borland R. People are not mushrooms: Challenges in communicating risk. Addict Behav 2018; 76:382-383. [PMID: 28190651 DOI: 10.1016/j.addbeh.2017.01.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 01/23/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Ron Borland
- Nigel Gray Distinguished Fellow in Cancer Prevention, Cancer Council Victoria, Australia.
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Kozlowski LT, Sweanor DT. 'Not harmless' messages without comparisons disserve consumers, potential consumers, and public health approaches to tobacco/nicotine products. Addict Behav 2018; 76:390-391. [PMID: 28153393 DOI: 10.1016/j.addbeh.2017.01.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 01/23/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Lynn T Kozlowski
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, NY, USA.
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Ramström L. Insufficient knowledge about use of multiple tobacco/nicotine products. Addict Behav 2018; 76:384-385. [PMID: 28161154 DOI: 10.1016/j.addbeh.2017.01.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 01/23/2017] [Indexed: 11/26/2022]
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Kozlowski LT, Warner KE. Adolescents and e-cigarettes: Objects of concern may appear larger than they are. Drug Alcohol Depend 2017; 174:209-214. [PMID: 29350617 DOI: 10.1016/j.drugalcdep.2017.01.001] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Lynn T Kozlowski
- University at Buffalo, State University of New York, School of Public Health and Health Professions, Department of Community Health and Health Behavior, 323 Kimball Tower, 3435 Main St., Buffalo, NY 14214-028, United States.
| | - Kenneth E Warner
- University of Michigan, School of Public Health, Department of Health Management & Policy, Room M3517 SPH II, 1415 Washington Heights, Ann Arbor, MI 48109-2029, United States
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