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Bold KW, Kong G, O'Malley SS. The Scientific Basis for the Regulation of Flavors in Tobacco Products. Annu Rev Clin Psychol 2024; 20:381-406. [PMID: 38346292 DOI: 10.1146/annurev-clinpsy-080921-075624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Effective tobacco policies are important for reducing the harm of tobacco use and can have a broad impact at the population level. This review provides an overview of how clinical science can inform tobacco policies with a focus on policies related to flavored tobacco products, using menthol cigarettes as an illustrative example. Specifically, this review summarizes the role of flavors in tobacco use and the history of regulation of flavored tobacco products by the US Food and Drug Administration (FDA), provides an overview of clinical research methods used to contribute to the scientific evidence to inform FDA tobacco policies, discusses key findings related to menthol tobacco products using these methods, and proposes future directions for clinical research. As the tobacco marketplace continues to evolve with new products and flavor chemicals, ongoing clinical science will be essential for establishing evidence-based policies to protect public health and reduce tobacco-related health disparities.
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Affiliation(s)
- Krysten W Bold
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA;
- Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - Grace Kong
- Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA;
| | - Stephanie S O'Malley
- Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA;
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Tam J, Jimenez-Mendoza E, Buckell J, Sindelar J, Meza R. Responses to Real-World and Hypothetical Menthol Flavor Bans Among US Young Adults Who Smoke Menthol Cigarettes. Nicotine Tob Res 2024; 26:785-789. [PMID: 38147008 PMCID: PMC11109486 DOI: 10.1093/ntr/ntad259] [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: 07/21/2023] [Revised: 12/11/2023] [Accepted: 12/15/2023] [Indexed: 12/27/2023]
Abstract
INTRODUCTION Menthol cigarette bans have been implemented in some US states and localities, and a federal ban is being proposed by the FDA. This study asks how young adults who use menthol cigarettes respond to changes in menthol cigarette availability. AIMS AND METHODS An online survey of young adults ages 18-34 who reported smoking menthol cigarettes on ≥7 of 30 days around Thanksgiving 2019 (n = 734), oversampling Massachusetts-the first state with a menthol ban. Participants reported their tobacco use behavior following real-world menthol cigarette bans or predicted their behavior under a hypothetical federal ban. RESULTS Most respondents who exclusively smoked versus dual used with e-cigarettes continued smoking/using combustible tobacco following real-world bans (95.3% vs. 86.9%), accessing menthol cigarettes from other jurisdictions. Fewer who smoked exclusively responded by using e-cigarettes compared to those who dual used (3.9% vs. 43.7%). Quitting all tobacco use (ie, no smoking, vaping, or any tobacco use) was uncommon for both groups (3.6% vs. 9.0%). Under a hypothetical ban, majorities of those who exclusively smoke and who dual use predicted they would continue smoking (72.2% vs. 71.8%); fewer who smoke exclusively would use e-cigarettes compared to those who dual use (14.7% vs. 41.4%). Those who smoke exclusively were more likely to report quitting all tobacco compared to those who dual use (29.6% vs. 12.4%). CONCLUSIONS Under real-world and hypothetical menthol cigarette bans, most respondents continued smoking. However, more young adults continued smoking following real-world bans, reflecting the limitations of local/state restrictions when menthol cigarettes are available in other jurisdictions. IMPLICATIONS This survey asked young adults who use menthol cigarettes how they responded to real-world changes in the availability of menthol cigarettes; 89% reported continuing to smoke. Those who smoked exclusively were far less likely to respond by switching to e-cigarettes compared to people who dual used both products. Under a hypothetical federal menthol cigarette ban, 72% of young adults predicted that they would continue smoking. Quitting all tobacco was less common in the real-world scenario compared to the hypothetical ban. Access to menthol cigarettes in other jurisdictions and flavored cigars likely dampen the public health benefit of menthol cigarette bans.
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Affiliation(s)
- Jamie Tam
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
| | - Evelyn Jimenez-Mendoza
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - John Buckell
- Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK
| | - Jody Sindelar
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
| | - Rafael Meza
- Department of Integrative Oncology, BC Cancer Research Institute, BC Cancer Research Institute, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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Boyd DT, Quinn CR, Jones KV, Waller B, Coker EJ, Duprey EB, Cerulli C, McCoy H. Building stronger bonds: The impact of family support and communication on suicidal behaviors among Black men who have sex with men. Suicide Life Threat Behav 2024. [PMID: 38488644 DOI: 10.1111/sltb.13072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 02/10/2024] [Accepted: 03/01/2024] [Indexed: 03/28/2024]
Abstract
INTRODUCTION It has been well documented that men who identify with a sexual orientation other than heterosexual are at a greater risk for suicide-related outcomes. What is less known are the protective factors that can reduce such negative outcomes and contribute to their resilience. METHODS This study used data collected between December 1, 2021, and January 2022 to understand how family factors contribute to or prevent depression symptoms and suicide outcomes among young Black men who have sex with men (BMSM) ages 18 to 29 (N = 400). A path analysis was conducted to explore the direct and indirect effects of suicide attempts. RESULTS Surprisingly, there were nuanced findings that showed having a family member or friend die by suicide was indirectly associated with suicide planning and suicide attempts. It was also unexpectedly noted that there was a positive relationship between higher rates of depressive symptoms and higher levels of support from family members. CONCLUSIONS The population focused on in this study is understudied and has unique needs. Identifying familial support may not automatically reduce the thoughts and plans of young BMSM, which is an example of why their intersecting marginalized identities must be considered when conducting further research, creating interventions, and providing therapeutic services.
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Affiliation(s)
- Donte T Boyd
- College of Social Work, The Ohio State University, Columbus, Ohio, USA
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Camille R Quinn
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
- Center for Equitable Family and Community Well-being, School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
| | - Kristian V Jones
- School of Social Work, University of Washington, Seattle, Washington, USA
| | - Bernadine Waller
- Department of Psychiatry, Columbia University Irving Medical Center/New York State Psychiatric Institute, New York City, New York, USA
| | - Evelyn Joy Coker
- Sandra Rosenbaum School of Social Work, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Erinn B Duprey
- Mt. Hope Family Center, Rochester, New York, USA
- Children's Institute, Rochester, New York, USA
| | - Catherine Cerulli
- Department of Psychiatry, University of Rochester, Rochester, New York, USA
- Community Engagement Core TRANSFORM Center, Mt. Hope Family Center, Rochester, New York, USA
| | - Henrika McCoy
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, Texas, USA
- Texas Center for Equity Promotion, College of Education, The University of Texas at Austin, Austin, Texas, USA
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Mills SD, Peddireddy S, Kurtzman R, Hill F, Catalan V, Bissram JS, Ribisl KM. The Impact of Menthol Cigarette Bans: A Systematic Review and Meta-Analysis. Nicotine Tob Res 2024:ntae011. [PMID: 38379278 DOI: 10.1093/ntr/ntae011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 12/29/2023] [Accepted: 01/04/2024] [Indexed: 02/22/2024]
Abstract
INTRODUCTION This review investigates the impacts of banning the sale of menthol cigarettes at stores. METHODS A systematic search of studies published in English up to November 2022 was conducted. The following databases were searched: PubMed/Medline, CINAHL, PsycINFO, Web of Science, and Embase, as well as a non-indexed journal. Studies evaluating either the impact of real-world or hypothesized menthol cigarette bans were included. Primary outcomes include tobacco use behaviors. Secondary outcomes include cigarette sales, retailer compliance, and the tobacco industry's response to a menthol ban. Data on tobacco use behavior after a menthol ban were pooled using random-effects models. Two pairs of reviewers independently extracted data and assessed study quality. RESULTS Of the 964 articles that were identified during the initial search, 78 were included in the review and 16 were included in the meta-analysis. Cessation rates among menthol cigarette smokers were high after a menthol ban. Pooled results show that 24% (95% confidence interval [95% CI]: 20%, 28%) of menthol cigarette smokers quit smoking after a menthol ban, 50% (95% CI: 31%, 68%) switched to non-menthol cigarettes, 12% (95% CI: 3%, 20%) switched to other flavored tobacco products, and 24% (95% CI: 17%, 31%) continued smoking menthol cigarettes. Hypothesized quitting and switching rates were fairly close to real-world rates. Studies found the tobacco industry attempts to undermine menthol bans. National menthol bans appear more effective than local or state menthol bans. CONCLUSIONS Menthol cigarette bans promote smoking cessation suggesting their potential to improve public health. IMPLICATIONS Findings from this review suggest that menthol cigarette bans promote smoking cessation among menthol cigarette smokers and have the potential to improve public health.
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Affiliation(s)
- Sarah D Mills
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Snigdha Peddireddy
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Rachel Kurtzman
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- National Opinion Research Center (NORC) at the University of Chicago, Chicago, IL, USA
| | - Frantasia Hill
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Victor Catalan
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jennifer S Bissram
- Health Sciences Library, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kurt M Ribisl
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Rubenstein D, Pacek LR, McClernon FJ. Multiple Tobacco Product Use Conceptual Framework: A 2021 Update on Evidence. Nicotine Tob Res 2022; 24:1208-1217. [PMID: 35137194 PMCID: PMC9278823 DOI: 10.1093/ntr/ntac032] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 01/04/2022] [Accepted: 01/31/2022] [Indexed: 02/07/2023]
Abstract
INTRODUCTION One-third of adults in the United States who use tobacco regularly use two or more types of tobacco products. As the use of e-cigarettes and other noncombusted tobacco products increases-making multiple tobacco product (MTP) use increasingly common-it is essential to evaluate the complex factors that affect product use. AIMS AND METHODS In this update to our 2019 conceptual framework, we review and evaluate recent literature and expand the model to include ways in which MTP use may be affected by market factors such as the introduction of new products and socioenvironmental factors like marketing and advertising. RESULTS AND CONCLUSIONS MTP use patterns are complex, dynamic, and multiply determined by factors at the level of individuals, products, situations or contexts, and marketplace. Substitution, or using one product with the intent of decreasing use of another, and complementarity, or using multiple products for different reasons or purposes, explain patterns in MTP use. Moreover, substitution and complementarity may inform our understanding of how market changes targeted at one product, for instance, new product standards, bans, product pricing, and taxation, affect consumption of other tobacco products. New data from natural experiments and novel laboratory-based techniques add additional data and expand the framework. IMPLICATIONS A substantial proportion of people who use tobacco use more than one product. This review synthesizes and evaluates recent evidence on the diverse factors that affect MTP use in addition to expanding our framework. Our review is accompanied by suggested research questions that can guide future study.
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Affiliation(s)
- Dana Rubenstein
- Corresponding Author: Dana Rubenstein, BA, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2608 Erwin Road, Suite 300, Durham, NC 27705, USA. Telephone: 919-668-3987; Fax: 919-681-1600; E-mail:
| | - Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - F Joseph McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
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Menthol Smoking and Nicotine Dependence among Black/African American Women Smokers Living in Low-Resource, Rural Communities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010877. [PMID: 34682623 PMCID: PMC8535496 DOI: 10.3390/ijerph182010877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/07/2021] [Accepted: 10/13/2021] [Indexed: 12/23/2022]
Abstract
Black/African American women from low-resource, rural communities bear a disproportionate burden of tobacco-related morbidity and mortality. This study examined associations between menthol smoking and socioeconomic deprivation with nicotine dependence and quitting behaviors among Black/African American women cigarette and/or little cigar/cigarillo smokers, aged 18–50 living in low-resource, rural communities. Baseline survey data from a randomized controlled behavioral/intervention trial (#NCT03476837) were analyzed (n = 146). Outcomes included time to first tobacco product (cigarette/little cigar/cigarillo) use within 5 min of waking, Fagerstrom Test for Nicotine Dependence (FTND) score, and ever attempting to quit cigarettes. Socioeconomic deprivation measures included education, income, and receiving supplemental nutritional assistance (SNAP) program benefits. In adjusted regression analyses, menthol smoking was associated with both greater FTND scores and time to first tobacco product use within 5 min of waking, but not ever attempting to quit cigarettes. Regardless of menthol status, only 25.0% of smokers reported that they would quit smoking if menthol cigarettes were banned. The proportion of smokers who smoked their first tobacco product within 5 min of waking increased slightly with greater socioeconomic deprivation. Additional research and targeted efforts are needed to reduce nicotine dependence among Black/African American women smokers living in rural, low-resource communities where access to cessation services is limited.
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Popova L, Henderson K, Kute N, Singh-Looney M, Ashley DL, Reynolds RM, Nayak P, Spears CA. "I'm Bored and I'm Stressed": A Qualitative Study of Exclusive Smokers, ENDS Users, and Transitioning Smokers or ENDS Users in the Time of COVID-19. Nicotine Tob Res 2021; 25:185-192. [PMID: 34610133 PMCID: PMC8522380 DOI: 10.1093/ntr/ntab199] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 09/28/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND To better understand the various influences of COVID-19 on tobacco use, we examined three different tobacco user groups using qualitative methods. METHODS Ten online focus groups with 61 adults from the Atlanta, GA area were held in October-November 2020: four with exclusive smokers (n = 16), three with Electronic Nicotine Delivery System (ENDS) users (dual and exclusive, n = 22), and three with transitioning (recently quit or currently quitting) smokers and/or ENDS users (n = 23). RESULTS Exclusive smokers reported smoking more frequently, driven by COVID-19-related stress, time at home, and boredom. They were not motivated to quit during the pandemic, and some considered smoking to be protective against COVID-19. ENDS users reported vaping less, with dual users often increasing their smoking; many were concerned about health effects of smoking and ENDS use during the pandemic. Transitioning smokers/ENDS users worried about their health and wanted to quit, but many found the stress of COVID-19 unbearable without tobacco use. CONCLUSIONS There were some similarities among the groups, but also pronounced differences. Educational campaigns should capitalize on the teachable moment of COVID-19 to increase perceived risk of smoking. Smokers need access to more adaptive ways to deal with stress (such as mindfulness training) in lieu of smoking and systems-level approaches should address structural determinants of health that cause high levels of stress. The proposed policy to lower nicotine in combusted tobacco products might help smokers choose other means of coping instead of cigarettes by reducing the stress-relieving properties of smoking particularly salient during the pandemic. IMPLICATIONS Smokers believe that cigarettes help them deal with the stresses and challenges of the COVID-19 pandemic. This needs to be counteracted by educational campaigns to increase perceived harm of smoking, alternative stress-relief strategies, and mandated changes to the combusted tobacco products to make them less appealing.
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Affiliation(s)
- Lucy Popova
- Corresponding Author: Lucy Popova, PhD, School of Public Health, Georgia State University, Atlanta, GA 30302, USA. Telephone: 404-413-9338; Fax: 404-413-1140; E-mail:
| | | | - Nikita Kute
- School of Public Health, Georgia State University, Atlanta, GA, USA
| | | | - David L Ashley
- School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Reed M Reynolds
- School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Pratibha Nayak
- Individual and Population Health, Battelle Memorial Institute, Atlanta, GA, USA
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Smith TT, Nahhas GJ, Borland R, Cho YJ, Chung-Hall J, Fairman RT, Fong GT, McNeill A, Popova L, Thrasher JF, Cummings KM. Which tobacco control policies do smokers support? Findings from the International Tobacco Control Four Country Smoking and Vaping Survey. Prev Med 2021; 149:106600. [PMID: 33957152 PMCID: PMC8580201 DOI: 10.1016/j.ypmed.2021.106600] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 04/27/2021] [Accepted: 05/01/2021] [Indexed: 11/22/2022]
Abstract
As governments consider policy action to reduce smoking, a key factor in creating political will is the level of public support, particularly among smokers who are most affected by the policies. The goal of this paper is to assess and compare the level of support in Canada, the United States, England, and Australia for five smoking control policies: 1) banning menthol in cigarettes, 2) banning cigarette additives, 3) reducing nicotine in cigarettes to make them less addictive, 4) raising the minimum age to purchase cigarettes to 21 years and older, and 5) requiring pictorial warning labels on cigarette packs (examined in the US only). Data for these analyses come from 8165 daily cigarette smokers who responded to the 2016 International Tobacco Control Four Country Smoking and Vaping Survey. In all countries, the highest level of support was for raising the legal age for purchase to 21 years and older (62-70%) and reducing the nicotine content of cigarettes to make them less addictive (57-70%). Smokers who were less dependent on cigarettes and those expressing interest in quitting were more likely to support all policies. When asked how they would respond to a nicotine reduction policy, the most common response given was to try the non-nicotine cigarettes to see how they liked them (42-48%), with the next most common response being to quit smoking entirely (16-24%). The high level of support for these proposed policies among daily smokers provides important evidence for policymakers to counteract claims that such policies would be unpopular.
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Affiliation(s)
- Tracy T Smith
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, United States; Cancer Control and Prevention, Hollings Cancer Center, Charleston, SC 29425, United States.
| | - Georges J Nahhas
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, United States; Cancer Control and Prevention, Hollings Cancer Center, Charleston, SC 29425, United States
| | - Ron Borland
- School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Yoo Jin Cho
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, 29208, United States
| | - Janet Chung-Hall
- Department of Psychology, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Robert T Fairman
- School of Public Health, Georgia State University, Atlanta, GA, 30302, United States
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, ON N2L 3G1, Canada; Ontario Institute for Cancer Research, Toronto, ON M5G 0A3, Canada; School of Public Health and Health Systems, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Ann McNeill
- Addictions Department, King's College London, London, United Kingdom
| | - Lucy Popova
- School of Public Health, Georgia State University, Atlanta, GA, 30302, United States
| | - James F Thrasher
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, 29208, United States
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, United States; Cancer Control and Prevention, Hollings Cancer Center, Charleston, SC 29425, United States
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Cwalina SN, Pacek LR, Barrington-Trimis JL, Tackett AP, Pentz MA. Cross-Sectional Associations of Multiple Tobacco Product Use with Depressive and Anxiety Symptoms among Young Adult E-Cigarette Users. Subst Use Misuse 2021; 56:1807-1814. [PMID: 34320919 PMCID: PMC9153521 DOI: 10.1080/10826084.2021.1954026] [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: 10/20/2022]
Abstract
BACKGROUND Tobacco users with mental health conditions are a vulnerable population in tobacco research, yet few studies have evaluated the association of depressive and anxiety symptoms with multiple tobacco product (MTP) use among young adult electronic cigarette (ENDS) users. METHODS Cross-sectional survey data on U.S. young adult past 30-day ENDS users (N = 2348) were collected via Amazon MTurk from May-July 2019. Binary logistic regressions evaluated the association of tobacco use pattern (exclusive ENDS use, ENDS + one other tobacco product [OTP; dual use], ENDS + two or more OTPs [poly-use]) with depressive (PHQ-9) and anxiety (GAD-7) symptoms. Among MTP users (n = 1736), we evaluated the association of ENDS use relative to OTP use and same-day MTP use with depressive and anxiety symptoms. RESULTS The sample included 26% exclusive ENDS, 27% dual, and 47% poly-users. We observed a gradient-relationship for depressive and anxiety symptoms: poly-users had greater odds of depressive and anxiety symptoms compared to dual users (aOR = 1.86 [95%CI:1.50-2.30] and aOR = 1.61 [95%CI:1.30-2.01], respectively), and dual users had greater odds of depressive and anxiety symptoms compared to exclusive ENDS users (aOR = 1.42 [95%CI:1.11-1.81] and aOR = 1.56 [95%CI:1.20-2.02], respectively). MTP users who used ENDS more often than OTPs (vs. less often than OTPs) had greater odds of depressive (aOR = 1.38 [95%CI:1.06-1.80]) and anxiety (aOR = 1.37 [95%CI:1.04-1.79]) symptoms. CONCLUSIONS The majority of young adult past 30-day ENDS users in this sample reported OTP use. Future research on MTP use should distinguish between dual and poly-use. Tobacco prevention efforts for young adults with mental health symptoms are needed.
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Affiliation(s)
- Sam N Cwalina
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jessica L Barrington-Trimis
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Alayna P Tackett
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Mary Ann Pentz
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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TACKETT ALAYNAP, HÉBERT EMILYT, STEVENS ELISEM, WAGENER THEODOREL. E-cigarette regulation: a delicate balance for public health. Addiction 2020; 115:2197-2199. [PMID: 32307739 PMCID: PMC7572541 DOI: 10.1111/add.15092] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 04/10/2020] [Accepted: 04/15/2020] [Indexed: 11/28/2022]
Abstract
To address youth vaping, a regulatory strategy is required that includes removal of flavors from all tobacco products, closing the cartridge loophole, and an e-cigarette liquid product standard that decreases palatability to naïve users. Lawmakers, public health officials, and scientists need to collaborate, utilizing evidence-based approaches, to rigorously evaluate tobacco regulation policy.
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Affiliation(s)
- ALAYNA P. TACKETT
- Stephenson Cancer Center, Oklahoma Tobacco Research
Center, Oklahoma City, OK, USA,Department of Pediatrics, The University of Oklahoma
Health Sciences Center, Oklahoma City, OK, USA
| | - EMILY T. HÉBERT
- Department of Family and Preventive Medicine, The
University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA,Stephenson Cancer Center, Oklahoma Tobacco Research
Center, Oklahoma City, OK, USA
| | - ELISE M. STEVENS
- Harvard T. H. Chan School of Public Health, Dana-Farber
Cancer Institute, Harvard University, Cambridge, MA, USA
| | - THEODORE L. WAGENER
- Division of Medical Oncology, Department of Internal
Medicine, The Ohio State University Wexner Medical Center, Columbus, OH,
USA,Center for Tobacco Research, The Ohio State University
Comprehensive Cancer Center, Columbus, OH, USA
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11
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Cadham CJ, Sanchez-Romero LM, Fleischer NL, Mistry R, Hirschtick JL, Meza R, Levy DT. The actual and anticipated effects of a menthol cigarette ban: a scoping review. BMC Public Health 2020; 20:1055. [PMID: 32641026 PMCID: PMC7346606 DOI: 10.1186/s12889-020-09055-z] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 06/04/2020] [Indexed: 11/29/2022] Open
Abstract
Background The United States (US) Food and Drug Administration (FDA), under the 2009 Family Smoking Prevention and Tobacco Control Act, banned characterizing flavors in cigarettes; however, mentholated tobacco products were exempt. Since 2009, over 20 US jurisdictions and numerous countries around the world have extended this restriction to menthol. Currently, the FDA is reconsidering its position on a nation-wide menthol cigarette ban. However, the effects of such a ban remain unclear. We conducted a scoping review to explore the impact of a menthol cigarette ban on individual behaviors (initiation, cessation, and product switching), sales, and compliance. Methods We conducted a search of the international literature using PubMed, EBSCO, and Web of Science (to November 25, 2019). We retrieved articles relevant to the impacts of an implemented or hypothetical menthol ban. We also included studies of flavored tobacco product bans due to their potential relevance in gauging compliance and product substitutability. Results The search identified 493 articles, of which 24 were included. Studies examined the effects of implemented menthol bans (n = 6), hypothetical menthol bans (n = 12) and implemented flavor bans that exclude menthol (n = 6). Menthol bans were found to reduce sales and increase smoking cessation with only partial substitution for non-menthol cigarettes. US smokers’ reactions to a hypothetical ban indicate that about 25–64% would attempt to quit smoking and 11–46% would consider switching to other tobacco products, including 15–30% to e-cigarettes. Flavor ban studies indicate reductions in initiation of 6%. Ban compliance was high, but studies indicate that the tobacco industry and retailers have attempted to circumvent their impact via packaging changes and online sales. Conclusion Our review finds that extending the US cigarette flavor ban to menthol products would promote smoking cessation and reduce initiation. This evidence supports further action by the FDA towards mentholated tobacco products. However, few studies have been conducted in the vaping era.
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Affiliation(s)
- Christopher J Cadham
- Georgetown University-Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, 3300 Whitehaven St. NW, Washington, DC, USA
| | - Luz Maria Sanchez-Romero
- Georgetown University-Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, 3300 Whitehaven St. NW, Washington, DC, USA
| | - Nancy L Fleischer
- Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, USA
| | - Ritesh Mistry
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, USA
| | - Jana L Hirschtick
- Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, USA
| | - Rafael Meza
- Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, USA
| | - David T Levy
- Georgetown University-Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, 3300 Whitehaven St. NW, Washington, DC, USA.
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12
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Colby SM, Cassidy RN, Denlinger-Apte R, Smith TT, Pacek LR, McClernon FJ, Tidey JW. Anticipated Effects of Nicotine Reduction on Youth Smoking Initiation and Maintenance. Nicotine Tob Res 2019; 21:S46-S48. [PMID: 31867638 PMCID: PMC6939777 DOI: 10.1093/ntr/ntz101] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 06/14/2019] [Indexed: 12/31/2022]
Abstract
This commentary summarizes emerging findings on the potential impact of a nicotine reduction policy on youth and young adults. We conclude that: (1) adolescent smokers and nonsmokers alike are likely to be less sensitive to reinforcement from very low nicotine content (VLNC) cigarettes compared with adults; (2) reducing nicotine in cigarettes to 0.4 mg/g would reduce the abuse potential of cigarettes in adolescents and young adults; (3) findings to date do not support concerns that nicotine reduction leads to compensatory smoking in young smokers; and (4) if the scope of a reduced nicotine product standard were applied to all combusted tobacco products, that would likely maximize public health benefit of this policy.
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Affiliation(s)
- Suzanne M Colby
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI
| | - Rachel N Cassidy
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI
| | - Rachel Denlinger-Apte
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI
| | - Tracy T Smith
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - F Joseph McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Jennifer W Tidey
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI
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13
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Smith TT, Heckman BW, Tidey JW, Colby SM, Cummings KM. Behavioral Outcomes of Nicotine Reduction in Current Adult Smokers. Nicotine Tob Res 2019; 21:S125-S127. [PMID: 31867649 PMCID: PMC6939766 DOI: 10.1093/ntr/ntz102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 06/14/2019] [Indexed: 12/24/2022]
Affiliation(s)
- Tracy T Smith
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Bryan W Heckman
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Jennifer W Tidey
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI
| | - Suzanne M Colby
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
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14
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Patel M, Cuccia AF, Czaplicki L, Donovan EM, Simard B, Pitzer L, Hair EC, Schillo BA, Vallone DM. Smokers' behavioral intentions in response to a low-nicotine cigarette policy. Drug Alcohol Depend 2019; 205:107645. [PMID: 31704376 DOI: 10.1016/j.drugalcdep.2019.107645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/28/2019] [Accepted: 09/19/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Evidence suggests that reducing the nicotine concentration in cigarettes to sub-addictive levels would reduce use. Until a low-nicotine cigarette policy is enacted, population-level effects are unknown. This study examines the behavioral intentions of current U.S. cigarette smokers if a low-nicotine policy were implemented. METHODS Data were drawn from a nationally representative probability-based panel and opt-in panel. Weighted logistic regressions examined likelihood to (1) smoke lower nicotine cigarettes, (2) quit using tobacco, (3) use e-cigarettes, (4) illegally buy high-nicotine cigarettes, and (5) smoke cigars, cigarillos, or little cigars (CLCCs) among smokers, controlling for demographics, tobacco products used, dependence, and intentions to quit cigarettes. Latent class analyses (LCA) characterized patterns of behavioral intentions. RESULTS If a low-nicotine policy were implemented, most participants indicated a likelihood to smoke low-nicotine cigarettes (78.4%) or quit tobacco (61.9%), followed by use e-cigarettes (46.5%). Individuals with greater dependence had greater odds of intending to smoke low-nicotine cigarettes, use e-cigarettes, and illegally buy high-nicotine cigarettes. Current e-cigarette or CLCCs users had higher odds of intending to use these products. LCA revealed that individuals would 1) use low-nicotine cigarettes with low intentions to use other tobacco products or 2) use multiple tobacco products, including low-nicotine cigarettes. CONCLUSIONS A reduced nicotine standard for all combustible tobacco products is needed given that many tobacco users would likely intend to continue to use tobacco products. Differences in intentions by tobacco use and demographic characteristics indicate a need for additional cessation support and education around the harms of continued use of combustible tobacco.
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Affiliation(s)
- Minal Patel
- Truth Initiative Schroeder Institute, 900 G Street NW, Washington, D.C., 20001, USA.
| | - Alison F Cuccia
- Truth Initiative Schroeder Institute, 900 G Street NW, Washington, D.C., 20001, USA.
| | - Lauren Czaplicki
- Truth Initiative Schroeder Institute, 900 G Street NW, Washington, D.C., 20001, USA.
| | - Emily M Donovan
- Truth Initiative Schroeder Institute, 900 G Street NW, Washington, D.C., 20001, USA.
| | - Bethany Simard
- Truth Initiative Schroeder Institute, 900 G Street NW, Washington, D.C., 20001, USA.
| | - Lindsay Pitzer
- Truth Initiative Schroeder Institute, 900 G Street NW, Washington, D.C., 20001, USA.
| | - Elizabeth C Hair
- Truth Initiative Schroeder Institute, 900 G Street NW, Washington, D.C., 20001, USA; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | - Barbara A Schillo
- Truth Initiative Schroeder Institute, 900 G Street NW, Washington, D.C., 20001, USA.
| | - Donna M Vallone
- Truth Initiative Schroeder Institute, 900 G Street NW, Washington, D.C., 20001, USA; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; Global Institute of Public Health, New York University, New York, NY 10012, USA.
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15
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Jalili C, Arji Rodsari B, Roshankhah S, Salahshoor MR. Effect of curcumin on hippocampus dentate gyrus injury induced by nicotine in rats. JOURNAL OF HERBMED PHARMACOLOGY 2019. [DOI: 10.15171/jhp.2019.47] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Introduction: Nicotine is the most important alkaloid compound in tobacco and is a major risk factor in the development of functional disorder of several organ systems. Some plants produce Curcumin, which has antioxidant and neuroprotective properties. This study was designed to evaluate the therapeutic effects of curcumin against nicotine injury on the hippocampus CA1 region of rats. Methods: In this study, 48 male Wistar rats were randomly assigned to eight groups: Normal control (saline) group, Nicotine control group (0.5 mg/kg); Curcumin groups (10, 30, and 60 mg/kg) and Nicotine + Curcumin groups (10, 30, and 60 mg/kg). Treatments were administered intraperitoneally daily for 28 days. Golgi staining technique investigated the number of dendritic spines. Cresyl violet staining method was used to determine the number of neurons in hippocampal region CA1. Griess technique was assessed to determine serum nitrite oxide level. Also, the Ferric reducing/antioxidant power (FRAP) method was applied to determine the total antioxidant capacity. Results: Nicotine administration significantly increased nitrite oxide level and decreased total antioxidant capacity as well as the number of neuronal dendritic spines and neurons compared to the normal control group (P < 0.01). In all Curcumin and Nicotine + Curcumin groups, the number of neurons, neuronal dendritic spines, and total antioxidant capacity increased significantly compared to the nicotine control group, while nitrite oxide level decreased significantly compared to the nicotine control group (P < 0.01). Conclusion: Curcumin administration can improve hippocampal CA1 region injury induced by nicotine.
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Affiliation(s)
- Cyrus Jalili
- Medical Biology Research Center, Department of Anatomical Sciences, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Babak Arji Rodsari
- Department of Anatomical Sciences, Medical School, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shiva Roshankhah
- Department of Anatomical Sciences, Medical School, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammad Reza Salahshoor
- Department of Anatomical Sciences, Medical School, Kermanshah University of Medical Sciences, Kermanshah, Iran
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16
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Pacek LR, Rass O, Sweitzer MM, Oliver JA, McClernon FJ. Young adult dual combusted cigarette and e-cigarette users' anticipated responses to hypothetical e-cigarette market restrictions. Subst Use Misuse 2019; 54:2033-2042. [PMID: 31305213 PMCID: PMC6764889 DOI: 10.1080/10826084.2019.1626435] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Introduction: The aim of this exploratory study was to assess young adult dual e-cigarette (EC) and combusted cigarette (CC) users' anticipated responses to hypothetical market restrictions regarding key EC characteristics. Methods: Data came from 240 young adult dual EC and CC users recruited via Amazon Mechanical Turk in June 2017. Descriptive statistics were used to report sociodemographic, CC smoking, and EC use characteristics. McNemar's chi-square tests and chi-square tests were used to assess differences between groups in terms of anticipated responses to hypothetical EC market restrictions. Results: Hypothetical regulations resulted in reported intentions to reduce EC use and increase CC use; the greatest impact was found for restrictions regarding e-liquid nicotine content, followed by flavor and ability to modify EC devices. Moreover, individuals reporting use of flavored e-liquid, high nicotine content e-liquid, and customizable EC were most likely to report intentions to reduce EC use and increase CC use. Conclusions: This work provides preliminary evidence that restrictive regulations regarding key EC characteristics may increase intentions to increase CC use among young adult dual EC and CC users.
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Affiliation(s)
- Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine , Durham , North Carolina , USA
| | - Olga Rass
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration , Silver Spring , Maryland , USA
| | - Maggie M Sweitzer
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine , Durham , North Carolina , USA
| | - Jason A Oliver
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine , Durham , North Carolina , USA
| | - F Joseph McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine , Durham , North Carolina , USA
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