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Osibogun O, Li W, Jebai R, Kalan ME. Cigarettes and e-cigarettes use among US adults with multimorbidity. DRUG AND ALCOHOL DEPENDENCE REPORTS 2024; 11:100231. [PMID: 38665253 PMCID: PMC11043839 DOI: 10.1016/j.dadr.2024.100231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024]
Abstract
Background Tobacco use leads to multiple illnesses. Yet, the effects of different categories of tobacco use on multimorbidity remain understudied. We investigated the associations between tobacco use categories and multimorbidity and the potential moderating effects of age, sex, or race/ethnicity among adults in the United States. Methods We conducted a cross-sectional analysis using pooled data from the Behavioral Risk Factor Surveillance System for the years 2020-2022. Multimorbidity was ascertained through self-reported ≥2 chronic health conditions. We categorized tobacco use into nine derived from nonuse (did not use e-cigarettes or cigarettes), former cigarette or e-cigarette use, current (used on some days/everyday) cigarette use or e-cigarette use, or both (dual use). We used multinomial logistic regression to investigate the associations while accounting for potential confounding factors. Results Within the sample (N=1,080,257), 28.2% reported multimorbidity. For the categories examined (former exclusive e-cigarette, exclusive e-cigarette, former exclusive cigarette, former dual, former cigarette/current e-cigarette, exclusive cigarette, current cigarette/former e-cigarette and dual use), all reported higher odds of having multimorbidity compared to those who reported nonuse of both e-cigarettes and cigarettes. We found significant interactions for age, sex and race/ethnicity with the tobacco use categories for multimorbidity (p<0.01), where stronger associations were observed among younger adults, females and non-Hispanic Multiracial for current dual use (p<0.05). Conclusions The use of cigarettes, e-cigarettes, or both was associated with multimorbidity among adults, which was more pronounced among younger adults, females and non-Hispanic Multiracial. These findings underscore the importance of implementing targeted public health interventions to mitigate the health risks associated with using both products, particularly among specific demographics, to reduce the prevalence of multimorbidity.
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Affiliation(s)
- Olatokunbo Osibogun
- Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL, USA
| | - Wei Li
- Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Rime Jebai
- Department of Health Law, Policy, and Management, School of Public Health, Boston University, Boston, MA, USA
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Steinberg ML, Rosen RL, Ganz O, Wackowski OA, Jeong M, Delnevo CD. Communicating the benefits of quitting smoking on mental health increases motivation to quit in people with anxiety and/or depression. Addict Behav 2024; 149:107903. [PMID: 37924583 DOI: 10.1016/j.addbeh.2023.107903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 09/22/2023] [Accepted: 10/30/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND Although smoking rates have declined over time, this decline has not been observed among those with mental health concerns. It is therefore important to develop effective messaging to support quitting in this population. METHODS We conducted an online experiment with 419 adults who smoke cigarettes daily. Participants with, or without a lifetime history of anxiety and/or depression were randomized to view a message focused on the benefits of quitting smoking on mental or physical health. Participants then reported motivation to quit smoking, mental health concerns about quitting, and perceived effectiveness of the message. RESULTS Participants with a lifetime history of anxiety and/or depression who saw the message focused on the benefits of quitting smoking on mental health reported greater motivation to quit than when they saw a message focused on the benefits to physical health. This was not replicated when examining current symptoms instead of lifetime history. Pre-existing beliefs that smoking improves one's mood were greater in those experiencing current symptoms and in those with a lifetime history of anxiety and/or depression. There was no main or interaction (message type X mental health status) effect of message type received on mental health related concerns about quitting. CONCLUSIONS This study is one of the first to evaluate a smoking cessation message with content specifically targeted to those with mental health concerns about quitting smoking. Additional work is needed to determine how to best target those with mental health concerns with messages focused on the benefits of quitting on mental health.
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Affiliation(s)
- Marc L Steinberg
- Rutgers Robert Wood Johnson Medical School, USA; Rutgers Institute for Nicotine & Tobacco Studies, USA.
| | - Rachel L Rosen
- Rutgers, The State University of New Jersey, USA; Rutgers Institute for Nicotine & Tobacco Studies, USA
| | - Ollie Ganz
- Rutgers School of Public Health, USA; Rutgers Institute for Nicotine & Tobacco Studies, USA
| | - Olivia A Wackowski
- Rutgers School of Public Health, USA; Rutgers Institute for Nicotine & Tobacco Studies, USA
| | - Michelle Jeong
- Rutgers School of Public Health, USA; Rutgers Institute for Nicotine & Tobacco Studies, USA
| | - Cristine D Delnevo
- Rutgers School of Public Health, USA; Rutgers Institute for Nicotine & Tobacco Studies, USA
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Ma S, Jiang S, Yang O, Zhang X, Fu Y, Zhang Y, Kaareen A, Ling M, Chen J, Shang C. Use of Machine Learning Tools in Evidence Synthesis of Tobacco Use Among Sexual and Gender Diverse Populations: Algorithm Development and Validation. JMIR Form Res 2024; 8:e49031. [PMID: 38265858 PMCID: PMC10851114 DOI: 10.2196/49031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 12/06/2023] [Accepted: 12/29/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND From 2016 to 2021, the volume of peer-reviewed publications related to tobacco has experienced a significant increase. This presents a considerable challenge in efficiently summarizing, synthesizing, and disseminating research findings, especially when it comes to addressing specific target populations, such as the LGBTQ+ (lesbian, gay, bisexual, transgender, queer, intersex, asexual, Two Spirit, and other persons who identify as part of this community) populations. OBJECTIVE In order to expedite evidence synthesis and research gap discoveries, this pilot study has the following three aims: (1) to compile a specialized semantic database for tobacco policy research to extract information from journal article abstracts, (2) to develop natural language processing (NLP) algorithms that comprehend the literature on nicotine and tobacco product use among sexual and gender diverse populations, and (3) to compare the discoveries of the NLP algorithms with an ongoing systematic review of tobacco policy research among LGBTQ+ populations. METHODS We built a tobacco research domain-specific semantic database using data from 2993 paper abstracts from 4 leading tobacco-specific journals, with enrichment from other publicly available sources. We then trained an NLP model to extract named entities after learning patterns and relationships between words and their context in text, which further enriched the semantic database. Using this iterative process, we extracted and assessed studies relevant to LGBTQ+ tobacco control issues, further comparing our findings with an ongoing systematic review that also focuses on evidence synthesis for this demographic group. RESULTS In total, 33 studies were identified as relevant to sexual and gender diverse individuals' nicotine and tobacco product use. Consistent with the ongoing systematic review, the NLP results showed that there is a scarcity of studies assessing policy impact on this demographic using causal inference methods. In addition, the literature is dominated by US data. We found that the product drawing the most attention in the body of existing research is cigarettes or cigarette smoking and that the number of studies of various age groups is almost evenly distributed between youth or young adults and adults, consistent with the research needs identified by the US health agencies. CONCLUSIONS Our pilot study serves as a compelling demonstration of the capabilities of NLP tools in expediting the processes of evidence synthesis and the identification of research gaps. While future research is needed to statistically test the NLP tool's performance, there is potential for NLP tools to fundamentally transform the approach to evidence synthesis.
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Affiliation(s)
- Shaoying Ma
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States
| | - Shuning Jiang
- Department of Computer Science and Engineering, The Ohio State University, Columbus, OH, United States
| | - Olivia Yang
- Department of Computer Science and Engineering, The Ohio State University, Columbus, OH, United States
| | - Xuanzhi Zhang
- Department of Computer Science and Engineering, The Ohio State University, Columbus, OH, United States
| | - Yu Fu
- Department of Computer Science and Engineering, The Ohio State University, Columbus, OH, United States
| | - Yusen Zhang
- Department of Computer Science and Engineering, The Ohio State University, Columbus, OH, United States
| | - Aadeeba Kaareen
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States
| | - Meng Ling
- Department of Computer Science and Engineering, The Ohio State University, Columbus, OH, United States
| | - Jian Chen
- Department of Computer Science and Engineering, The Ohio State University, Columbus, OH, United States
| | - Ce Shang
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States
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4
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Steinberg ML, Rosen RL, Ganz O, Wackowski OA, Jeong M, Delnevo CD. Communicating the benefits of quitting smoking on mental health increases motivation to quit in people with anxiety and/or depression: A randomized trial of two health messages. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.02.17.23286103. [PMID: 36865337 PMCID: PMC9980264 DOI: 10.1101/2023.02.17.23286103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Background Although smoking rates have declined over time, this decline has not been observed among those with mental health concerns. It is therefore important to develop effective messaging to support quitting in this population. Methods We conducted an online experiment with 419 adults who smoke cigarettes daily. Participants with, or without a lifetime history of anxiety and/or depression were randomized to view a message focused on the benefits of quitting smoking on mental or physical health. Participants then reported motivation to quit smoking, mental health concerns about quitting, and perceived effectiveness of the message. Results Participants with a lifetime history of anxiety and/or depression who saw the message focused on the benefits of quitting smoking on mental health reported greater motivation to quit than when they saw a message focused on the benefits to physical health. This was not replicated when examining current symptoms instead of lifetime history. Pre-existing beliefs that smoking improves one's mood were greater in those experiencing current symptoms and in those with a lifetime history of anxiety and/or depression. There was no main or interaction (message type X mental health status) effect of message type received on mental health related concerns about quitting. Conclusions This study is one of the first to evaluate a smoking cessation message with content specifically targeted to those with mental health concerns about quitting smoking. Additional work is needed to determine how to best target those with mental health concerns with messages focused on the benefits of quitting on mental health. Implications These data can begin to inform regulatory efforts to address tobacco use in those with comorbid anxiety and/or depression by providing information on how to effectively communicate the benefits of quitting smoking on mental health.
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Affiliation(s)
- Marc L. Steinberg
- Rutgers Robert Wood Johnson Medical School
- Rutgers Center for Tobacco Studies
| | - Rachel L. Rosen
- Rutgers, The State University of New Jersey
- Rutgers Center for Tobacco Studies
| | - Ollie Ganz
- Rutgers School of Public Health
- Rutgers Center for Tobacco Studies
| | | | - Michelle Jeong
- Rutgers School of Public Health
- Rutgers Center for Tobacco Studies
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Higgins ST. Behavior change, health, and health disparities 2022: Innovations in tobacco control and regulatory science to decrease cigarette smoking. Prev Med 2022; 165:107309. [PMID: 36252828 DOI: 10.1016/j.ypmed.2022.107309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This Special Issue of Preventive Medicine (PM) is the 9th in a series on behavior change, health, and health disparities. This topic is critically important to improving population health. Unhealthy lifestyles including substance misuse, unhealthy food choices, physical inactivity, and non-adherence with medical regimens are important preventable causes of chronic disease and premature death. This year we focus on cigarette smoking, which continues to have devastating health impacts including more than 8 million annual premature deaths globally and 480,000 in the U.S. where most of the research reported in this Special Issue was conducted. While the introduction of new tobacco products into the marketplace like electronic nicotine delivery systems (ENDS) demands attention, it is essential that we remain focused on the enormous challenges involved in eliminating cigarette smoking. This Special Issue examines innovations in tobacco control and regulatory science aimed towards reducing cigarette smoking. Discussion of new tobacco products is largely limited to their role in this overarching aim of reducing combusted cigarette use. We discuss important innovations in tobacco control (e.g., digital text-based interventions, ENDS-assisted cessation, financial incentives) and regulatory science (e.g., nicotine reduction in cigarettes, flavor bans). Throughout, attention is given to the important topic of disparities in terms of understanding the uneven adverse impacts of cigarette smoking and efforts to eliminate it, and the critical importance of researching vulnerable populations. Across these topics we have recruited contributions from accomplished investigators, clinicians, and policymakers to acquaint readers with recent advances while also noting knowledge gaps and unresolved challenges.
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Affiliation(s)
- Stephen T Higgins
- Vermont Center on Behavior and Health, Departments of Psychiatry and Psychological Science, University of Vermont, United States.
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Nighbor TD, Browning KO, Reed EN, Oliver AC, DeSarno MJ, Kurti AN, Bickel WK, Higgins ST. Using an experimental tobacco marketplace to pilot test the substitutability of JUUL e-cigarettes and other alternative nicotine and tobacco products for conventional cigarettes among vulnerable populations. Prev Med 2022; 165:107122. [PMID: 35787842 PMCID: PMC9724801 DOI: 10.1016/j.ypmed.2022.107122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/21/2022] [Accepted: 06/27/2022] [Indexed: 11/15/2022]
Abstract
The Experimental Tobacco Marketplace (ETM) is an online research marketplace where increasing the cost of cigarettes is used to investigate the substitutability of other fixed-price tobacco products such as electronic nicotine delivery systems (ENDS). The ETM is useful for modeling effects of potential policy changes on use of various concurrently available products. To our knowledge, the ETM has not been used to investigate substitutability of newer generation e-cigarettes or populations at increased risk for smoking, heavy smoking, nicotine dependence, and smoking-attributable adverse effects. In the current pilot study, participants were 30 adult daily smokers with socioeconomic disadvantage or comorbid psychiatric conditions (substance-use disorder or mental illness). In each session, cigarette prices increased ($0.12, $0.25, $0.50, $1.00. and $2.00 per cigarette) while prices for alternative products remained fixed. Across three ETM sessions, either all products, all products except little cigars and cigarillos (LCCs), or all products except ENDS (JUUL e-cigarettes) were available. Linear regression was performed on individual participant data using log-transformed cigarette price to determine demand and substitution. Cigarette demand decreased as price increased across sessions (significantly non-zero slopes, ps ≤ 0.0001). When all products were available, ENDS substitution increased as cigarette price increased (significantly non-zero slope, p = .016). When LCCs were unavailable, ENDS again were a significant substitute (p = .008). When ENDS were unavailable, LCCs did not substitute (ps ≥ 0.48). In all sessions, participants rarely purchased other products (e.g., snus). Overall, ENDS were the most robust substitute for cigarettes, further underscoring the potential importance of ENDS availability on the impact of tobacco regulatory policies.
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Affiliation(s)
- Tyler D Nighbor
- Vermont Center on Behavior and Health, United States of America
| | - Kaitlyn O Browning
- Vermont Center on Behavior and Health, United States of America; Department of Psychiatry, University of Vermont, United States of America
| | - Ellaina N Reed
- Vermont Center on Behavior and Health, United States of America
| | | | - Michael J DeSarno
- Vermont Center on Behavior and Health, United States of America; Department of Medical Biostatistics, University of Vermont, United States of America
| | - Allison N Kurti
- Vermont Center on Behavior and Health, United States of America
| | - Warren K Bickel
- Addiction Recovery Research Center, Virginia Tech Carillion Research Institute, United States of America
| | - Stephen T Higgins
- Vermont Center on Behavior and Health, United States of America; Department of Psychiatry, University of Vermont, United States of America; Department of Psychological Science, University of Vermont, United States of America.
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Browning KO, DeSarno MJ, Davis DR, Streck JM, Bergeria CL, Harfmann RF, Parker MA, Heil SH, Sigmon SC, Gaalema DE, Tidey JW, Lee DC, Tetreault HJ, Higgins ST. Relating individual differences in the reinforcing value of smoking and dependence severity to nicotine exposure levels in vulnerable populations. Prev Med 2022; 165:107312. [PMID: 36272516 PMCID: PMC9986960 DOI: 10.1016/j.ypmed.2022.107312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 10/02/2022] [Accepted: 10/15/2022] [Indexed: 11/06/2022]
Abstract
Cigarette smoking is overrepresented in populations with psychiatric conditions and socioeconomic disadvantage. Greater understanding of the role of reinforcement and nicotine dependence in smoking among vulnerable populations may facilitate development of better targeted interventions to reduce smoking. Prior research demonstrated that individual differences in the reinforcing value of smoking and nicotine-dependence severity predicted total nicotine-exposure in vulnerable populations. The present study uses multivariate regression to address two aims: (1) Quantify the degree to which the reinforcing value of smoking, assessed using the Cigarette Purchase Task (CPT), and dependence severity assessed using the Fagerström Test of Nicotine Dependence and Brief Wisconsin Inventory of Smoking Dependence Motives (B-WISDM) each account for individual differences in cotinine-plus-3'-hydroxycotinine (COT+3HC) levels. (2) Explore whether there is overlap in the variance accounted for by the CTP, FTND, and B-WISDM. Participants were 628 adults with co-morbid psychiatric conditions or socioeconomic disadvantage who smoked daily. The CPT, FTND, and B-WISDM models accounted for 23.76%, 32.45%, and 29.61% of the variance in COT+3HC levels, respectively. Adding CPT to the FTND model failed to increase the variance accounted for and adding it to the B-WISDM model did so by only 1.2% demonstrating considerable overlap in the variance in nicotine exposure levels accounted for by these three instruments. These results provide new knowledge on the relationship between individual differences in the reinforcing value of smoking and nicotine-exposure levels and suggest differences in reinforcing value may underpin a considerable portion of the variance in nicotine exposure accounted for by dependence severity.
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Affiliation(s)
- Kaitlyn O Browning
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, United States of America
| | - Michael J DeSarno
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, United States of America
| | - Danielle R Davis
- Yale University Tobacco Center of Regulatory Science, Yale University School of Medicine, New Haven, CT, United States of America
| | - Joanna M Streck
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Cecilia L Bergeria
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Roxanne F Harfmann
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, United States of America
| | - Maria A Parker
- School of Public Health, Indiana University, Bloomington, IN, United States of America
| | - Sarah H Heil
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, United States of America
| | - Stacey C Sigmon
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, United States of America
| | - Diann E Gaalema
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, United States of America
| | - Jennifer W Tidey
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, United States of America
| | - Dustin C Lee
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Haley J Tetreault
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, United States of America
| | - Stephen T Higgins
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, United States of America.
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Gudi N, Swain A, Kulkarni MM, Pattanshetty S, Zodpey S. Tobacco prevention and control interventions in humanitarian settings: a scoping review protocol. BMJ Open 2022; 12:e058225. [PMID: 35906062 PMCID: PMC9345044 DOI: 10.1136/bmjopen-2021-058225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Tobacco has been a complex global problem that has adversely affected almost all the sectors of society. However, the ill-effects are often most reflected in humanitarian settings, which inadvertently are surmounted by fragile systems. We aim to map tobacco prevention and control intervention in humanitarian settings. METHODS AND ANALYSIS This scoping review will follow the guidelines of the Joanna Briggs Institute. A comprehensive search strategy was designed using Medical Subject Heading terms, subject experts and pertinent reviews. The search was conducted on Medline (through PubMed and Ovid), EMBASE (through OVID), ProQuest Health and Medical Complete, EBSCO (through CINAHL Complete), Scopus and Web of Science databases. Two reviewers will independently screen the identified studies on removing duplicates, which shall be followed by data extraction using a pretested data extraction form. A narrative synthesis approach will be employed to collate the findings from the studies and tabular formats would be used to aid the representation. ETHICS AND DISSEMINATION This review will identify, map and synthesise the interventions for tobacco prevention and control in the humanitarian settings. An ethics committee approval was not sought for this body of work as it does not include human subjects. Results from the study will be disseminated through conference presentations and peer-reviewed publications.
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Affiliation(s)
- Nachiket Gudi
- Public Health Evidence South Asia, Department of Health Information, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | | | - Muralidhar M Kulkarni
- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sanjay Pattanshetty
- Department of Global Health, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Murphy SP. Building Culturally Competent Practice with Sexual and Gender Minorities Using Nonviolent Communication. Issues Ment Health Nurs 2022; 43:395-400. [PMID: 34731073 DOI: 10.1080/01612840.2021.1990445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Psychiatric-Mental Health nurses can build cultural competence when caring for clients who are Sexual and Gender Minorities (LGBTQIA+) in the following ways: by learning how health care pathologized core aspects of Sexual and Gender Minorities' (SGM) identities; by understanding historical and current SGM minority stressors and consequent health disparities and inequities; and by framing health disparities and inequities as forms of cultural violence. To begin building trust among SGMs and health care providers, trust damaged by cultural violence and stigma, nurses can implement the Nonviolent Communication Process in clinical settings.
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Affiliation(s)
- Sean P Murphy
- Department of Population Health Nursing Science, University of Illinois at Chicago College of Nursing, Chicago, Illinois, USA
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10
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Blank MD, Ozga JE, Romm KF, Douglas A, Alexander L, Doogan NJ, Wilson M, Dino G. Geographic isolation predicts tobacco product use among youth: A latent class analysis. J Rural Health 2022; 38:373-381. [PMID: 33978979 PMCID: PMC8586053 DOI: 10.1111/jrh.12583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of the current study was to evaluate associations between geographic rurality and tobacco use patterns among adolescents. METHODS High school students (N = 566) from north-central Appalachia reported on their lifetime and/or current use of cigarettes, electronic cigarettes (ECIGs), cigars, and smokeless tobacco. Geographic rurality was measured via the Isolation scale, whereby residential ZIP Codes determined the degree to which respondents have access to health-related resources. Latent class analysis (LCA) was used to identify discrete classes of adolescent tobacco users based on their use of tobacco products. Then, associations between participants' geographic rurality and class membership were evaluated using a series of multinomial logistic regressions. FINDINGS LCA classified participants as Nonusers, Current ECIG Users, Cigarette/ECIG Experimenters, and Polytobacco Users. Individuals with higher Isolation scores were more likely to be Polytobacco Users and Cigarette/ECIG Experimenters than Nonusers, and were more likely to be Polytobacco Users than Current ECIG Users. CONCLUSIONS The continuous Isolation scale used in the present study predicted polytobacco use patterns among adolescents in a manner that is consistent with, while simultaneously expanding upon, prior work. Tobacco control practices and policies should be viewed through a lens that considers the unique needs of geographically isolated areas.
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Affiliation(s)
- Melissa D. Blank
- Department of Psychology, West Virginia University, Morgantown, West Virginia, USA
- WV Prevention Research Center, West Virginia University, Morgantown, West Virginia, USA
| | - Jenny E. Ozga
- Department of Behavioral Medicine & Psychiatry, West Virginia University, Morgantown, West Virginia, USA
| | - Katelyn F. Romm
- Department of Prevention and Community Health, George Washington University, Milken Institute School of Public Health, Washington, DC, USA
| | - Ashley Douglas
- Department of Psychology, West Virginia University, Morgantown, West Virginia, USA
| | - Linda Alexander
- Department of Social & Behavioral Sciences, West Virginia University, Morgantown, West Virginia, USA
| | - Nathan J. Doogan
- Government Resources Center, Ohio State University, Columbus, Ohio, USA
| | - Michael Wilson
- Department of Psychology, West Virginia University, Morgantown, West Virginia, USA
| | - Geri Dino
- WV Prevention Research Center, West Virginia University, Morgantown, West Virginia, USA
- Department of Social & Behavioral Sciences, West Virginia University, Morgantown, West Virginia, USA
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Krueger EA, Bello MS, Unger J, Boley Cruz T, Barrington-Trimis JL, Braymiller JL, Lanza HI, Chen-Sankey JC, Cho J, McConnell R, Leventhal AM. Sociodemographic differences in young adults' recall of tobacco and cannabis marketing online and in television/film. Prev Med Rep 2021; 24:101592. [PMID: 34976651 PMCID: PMC8683941 DOI: 10.1016/j.pmedr.2021.101592] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 09/27/2021] [Accepted: 10/03/2021] [Indexed: 11/21/2022] Open
Abstract
Young adults (YA) who report viewing pro-tobacco and cannabis marketing are at increased risk for using tobacco and cannabis. However, there is a growing diversity of tobacco and cannabis products on the market, as well as methods for marketing them. Prevalence of, and sociodemographic differences in, YA's recall of various types of tobacco and cannabis marketing is not well-characterized. Data were from a cohort of YA (mean age: 19.8) from Southern California in 2019. Respondents were asked whether they recalled having seen two types of marketing (online advertisements and portrayals of product use in TV/movies) for 5 tobacco and 3 cannabis products among never-users of tobacco (N = 954) and cannabis (N = 1,046), respectively. Sociodemographic differences in marketing recall were subsequently assessed. Among tobacco-naïve respondents, 31.3% and 49.3% recalled seeing online advertisements and tobacco use in TV/movies, respectively. Among cannabis-naïve respondents, 18.7% and 31.0% recalled seeing online advertisements and cannabis use in TV/movies, respectively. Overall, respondents recalled seeing tobacco and cannabis products on TV/movies at higher rates than seeing online advertisements, with the exception of electronic cigarettes, for which online advertisements were seen at higher rates. Women (vs. men) had higher odds of seeing tobacco (aOR = 1.9) and cannabis use in TV/movies (aOR = 1.4) and cannabis marketing online (aOR = 1.4). LGB (vs. straight) respondents had higher odds of seeing cannabis marketing online (aOR = 1.7). Efforts to regulate exposure to tobacco and cannabis marketing among young women and LGB people merit further consideration.
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Affiliation(s)
- Evan A. Krueger
- School of Social Work, Tulane University, New Orleans, LA 70112, United States
| | - Mariel S. Bello
- Department of Psychology, University of Southern California, Los Angeles, CA 90032, United States
| | - Jennifer Unger
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90032, United States
| | - Tess Boley Cruz
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90032, United States
| | - Jessica L. Barrington-Trimis
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90032, United States
| | - Jessica L. Braymiller
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY 14214, United States
| | - H. Isabella Lanza
- Department of Human Development, California State University Long Beach, CA 90840, United States
| | - Julia Cen Chen-Sankey
- Department of Health Behavior, Society and Policy, Rutgers University School of Public Health, New Brunswick, NJ 08901, United States
| | - Junhan Cho
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90032, United States
| | - Rob McConnell
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90032, United States
| | - Adam M. Leventhal
- Department of Psychology, University of Southern California, Los Angeles, CA 90032, United States
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90032, United States
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12
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Ozga JE, Romm KF, Turiano NA, Douglas A, Dino G, Alexander L, Blank MD. Cumulative disadvantage as a framework for understanding rural tobacco use disparities. Exp Clin Psychopharmacol 2021; 29:429-439. [PMID: 34014742 PMCID: PMC9752977 DOI: 10.1037/pha0000476] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Traditional tobacco product (cigarettes and smokeless tobacco) and polytobacco use rates are significantly higher among rural adolescents and adults compared to their nonrural counterparts. Such disparities are due to several factors that promote tobacco use initiation and continuation, including individual-level psychopharmacological factors and structural-level factors such as fewer tobacco control efforts (e.g., fewer smoke-free policies and lower tobacco excise taxes), targeted tobacco marketing, less access to health-relevant resources, and more positive cultural norms surrounding tobacco use in rural communities. In this review, we use cumulative disadvantage theory as a framework for understanding how psychopharmacological and structural-level factors serve as drivers of tobacco use in rural areas. We start by describing how structural-level differences between rural-nonrural communities impact psychopharmacological influences and, when available, how these factors influence tobacco use. We conclude by discussing the interplay between factors, providing suggestions for ways to assess our application of cumulative disadvantage theory empirically and making recommendations for research and policy implementation in rural areas. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Jenny E. Ozga
- Department of Behavioral Medicine and Psychiatry, West Virginia University
| | - Katelyn F. Romm
- Milken Institute School of Public Health, George Washington University
| | - Nicholas A. Turiano
- Department of Psychology, West Virginia University
- West Virginia Prevention Research Center, West Virginia University
| | | | - Geri Dino
- Department of Social and Behavioral Sciences, Clinical and Translational Sciences Institute, West Virginia University
- West Virginia Prevention Research Center, West Virginia University
| | - Linda Alexander
- Department of Social and Behavioral Sciences, Clinical and Translational Sciences Institute, West Virginia University
| | - Melissa D. Blank
- Department of Psychology, West Virginia University
- West Virginia Prevention Research Center, West Virginia University
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13
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Reed DD, Naudé GP, Salzer AR, Peper M, Monroe-Gulick AL, Gelino BW, Harsin JD, Foster RNS, Nighbor TD, Kaplan BA, Koffarnus MN, Higgins ST. Behavioral economic measurement of cigarette demand: A descriptive review of published approaches to the cigarette purchase task. Exp Clin Psychopharmacol 2020; 28:688-705. [PMID: 31961164 PMCID: PMC8428680 DOI: 10.1037/pha0000347] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The cigarette purchase task (CPT) is a behavioral economic method for assessing demand for cigarettes. Growing interest in behavioral correlates of tobacco use in clinical and general populations as well as empirical efforts to inform policy has seen an increase in published articles employing the CPT. Accordingly, an examination of the published methods and procedures for obtaining these behavioral economic metrics is timely. The purpose of this investigation was to provide a review of published approaches to using the CPT. We searched specific Boolean operators (["behavioral economic" AND "purchase task"] OR ["demand" AND "cigarette"]) and identified 49 empirical articles published through the year 2018 that reported administering a CPT. Articles were coded for participant characteristics (e.g., sample size, population type, age), CPT task structure (e.g., price framing, number and sequence of prices; vignettes, contextual factors), and data analytic approach (e.g., method of generating indices of cigarette demand). Results of this review indicate no standard approach to administering the CPT and underscore the need for replicability of these behavioral economic measures for the purpose of guiding clinical and policy decisions. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Derek D. Reed
- University of Kansas and Cofrin Logan Center for Addiction Research and Treatment, Lawrence, Kansas
| | - Gideon P. Naudé
- University of Kansas and Cofrin Logan Center for Addiction Research and Treatment, Lawrence, Kansas
| | - Allyson R. Salzer
- University of Kansas and Cofrin Logan Center for Addiction Research and Treatment, Lawrence, Kansas
| | | | | | - Brett W. Gelino
- University of Kansas and Cofrin Logan Center for Addiction Research and Treatment, Lawrence, Kansas
| | - Joshua D. Harsin
- University of Kansas and Cofrin Logan Center for Addiction Research and Treatment, Lawrence, Kansas
| | - Rachel N. S. Foster
- University of Kansas and Cofrin Logan Center for Addiction Research and Treatment, Lawrence, Kansas
| | - Tyler D. Nighbor
- Vermont Center on Behavior and Health, Burlington, Vermont, and University of Vermont
| | | | | | - Stephen T. Higgins
- Vermont Center on Behavior and Health, Burlington, Vermont, and University of Vermont
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14
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Higgins ST. Behavior change, health, and health disparities 2020: Some current challenges in tobacco control and regulatory science. Prev Med 2020; 140:106287. [PMID: 33068603 PMCID: PMC8364292 DOI: 10.1016/j.ypmed.2020.106287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 10/12/2020] [Indexed: 12/30/2022]
Abstract
This Special Issue of Preventive Medicine (PM) is the 7th in a series on behavior change, health, and health disparities. This series focuses on personal behavior patterns, including substance use disorders, physical inactivity/obesity, and non-adherence with medical regimens, which are among the most important modifiable causes of chronic disease and premature death. This 7th issue includes 17 commentaries, reviews, and original empirical studies, 16 of which are devoted to current tobacco control and regulatory science research and policy, topics critically important to protecting the public health from the longstanding and devastating harms of tobacco use. The challenge of balancing efforts to protect youth from e-cigarettes while allowing for evidence-based evaluation of their potential to reduce the harms of cigarette smoking among adults features prominently in many of these contributions, complemented by original studies on rural-urban disparities, tobacco harm perceptions, use patterns and toxin exposure, modeling of tobacco-related mortality, novel tobacco research methods, and reducing cigarette smoking through regulatory policies, including nicotine reduction in cigarettes, and novel clinical interventions. Continuing to give space in this series to the U.S. opioid epidemic, we also include an original empirical report on longitudinal trends of non-medical use of opioids from 2008 to 2020 in rural Appalachia, an epicenter in this epidemic. Across each of these topics we have recruited contributions from well-regarded investigators, clinicians, and policymakers to acquaint readers with recent advances and accomplishments while also noting knowledge gaps and unresolved challenges.
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Affiliation(s)
- Stephen T Higgins
- Vermont Center on Behavior and Health, Departments of Psychiatry and Psychological Science, University of Vermont, 1 S. Prospect St., UHC, MS482, Burlington, VT 05401, USA.
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15
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Relating individual differences in nicotine dependence severity to underpinning motivational and pharmacological processes among smokers from vulnerable populations. Prev Med 2020; 140:106189. [PMID: 32628945 PMCID: PMC7680415 DOI: 10.1016/j.ypmed.2020.106189] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/08/2020] [Accepted: 06/28/2020] [Indexed: 02/07/2023]
Abstract
We examined whether elucidating underpinning smoking motivation and related pharmacological processes enhances understanding of nicotine dependence among smokers from vulnerable populations. Data were obtained between Oct, 2016 and Sept, 2019 from 745 adult smokers with co-morbid psychiatric conditions or socioeconomic disadvantage at University of Vermont, Brown University, Johns Hopkins University. Smoking motivation was assessed using the Cigarette Purchase Task (CPT), a behavioral-economic task that models the relative reinforcing value of smoking under varying monetary constraint. Dependence severity was measured using the Heaviness of Smoking Index (HSI), Fagerström Test for Nicotine Dependence total scores (FTND), and FTND total scores minus items 1 and 4 (FTND2,3,5,6). We also assessed associations between dependence severity and smoking motivation with nicotine levels and metabolism rate. Principal Component Analysis was used to examine the latent structure of the conventional five CPT indices; bivariate and multivariable modeling was used to test associations. Factor analysis resulted in a two-factor solution, Amplitude (demand unconstrained by price) and Persistence (price sensitivity). CPT latent factors were associated with each dependence-severity measure (ps ≤ 0.0001), with associations stronger for Amplitude than Persistence across each, especially HSI which was exclusively associated with Amplitude. Amplitude and each dependence measure were associated with nicotine intake (ps ≤ 0.0002); Persistence was not (p = .19). Demand Amplitude more than Persistence appears key to understanding individual differences in dependence severity. Regarding potential application, the results suggest a need for interventions that more effectively target demand Amplitude to make greater headway in reducing smoking in vulnerable populations. Trial Registration:clinicaltrials.gov identifiers: NCT02232737, NCT02250664, NCT02250534.
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16
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Nighbor TD, Barrows AJ, Bunn JY, DeSarno MJ, Oliver AC, Coleman SRM, Davis DR, Streck JM, Reed EN, Reed DD, Higgins ST. Comparing participant estimated demand intensity on the cigarette Purchase Task to consumption when usual-brand cigarettes were provided free. Prev Med 2020; 140:106221. [PMID: 32717262 PMCID: PMC7680356 DOI: 10.1016/j.ypmed.2020.106221] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 07/16/2020] [Accepted: 07/20/2020] [Indexed: 12/25/2022]
Abstract
Accumulating evidence suggests that the hypothetical Cigarette Purchase Task (CPT), especially its demand Intensity index (i.e., estimated cigarettes participants would smoke if free), is associated with individual differences in smoking risk. Nevertheless, few studies have examined the extent to which hypothetical CPT demand Intensity may differ from consumption when participants are provided with free cigarettes. That topic is the overarching focus of the present study. Participants were 745 adult smokers with co-morbid psychiatric conditions or socioeconomic disadvantage. CPT was administered for usual-brand cigarettes prior to providing participants with seven days of their usual-brand cigarettes free of cost and consumption was recorded daily via an Interactive Voice Response (IVR) System. Demand Intensity was correlated with IVR smoking rate (rs 0.670-0.696, ps < 0.001) but estimates consistently exceeded IVR smoking rates by an average of 4.4 cigarettes per day (ps < 0.001). Importantly, both measures were comparably sensitive to discerning well-established differences in smoking risk, including greater cigarettes per day among men versus women (F(1,732) = 18.74, p < 0.001), those with versus without opioid-dependence (F(1,732) = 168.37, p < 0.001), younger versus older adults (F(2,730) = 32.93, p < 0.001), and those with lower versus greater educational attainment (F(1,732) = 38.26, p < 0.001). Overall, CPT demand Intensity appears to overestimate consumption rates relative to those observed when participants are provided with free cigarettes, but those deviations are systematic (i.e., consistent in magnitude and direction, Fs all <1.63; ps > 0.19 for all interactions with subgroups). This suggests that demand Intensity was sensitive to established group differences in smoking rate, supporting its utility as an important measure of addiction potential.
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Affiliation(s)
- Tyler D Nighbor
- Vermont Center on Behavior and Health, University of Vermont, United States of America; Department of Psychiatry, University of Vermont, United States of America
| | - Anthony J Barrows
- Vermont Center on Behavior and Health, University of Vermont, United States of America
| | - Janice Y Bunn
- Department of Medical Biostatistics, University of Vermont, United States of America
| | - Michael J DeSarno
- Department of Medical Biostatistics, University of Vermont, United States of America
| | - Anthony C Oliver
- Vermont Center on Behavior and Health, University of Vermont, United States of America; Department of Psychiatry, University of Vermont, United States of America
| | - Sulamunn R M Coleman
- Vermont Center on Behavior and Health, University of Vermont, United States of America; Department of Psychiatry, University of Vermont, United States of America
| | - Danielle R Davis
- Vermont Center on Behavior and Health, University of Vermont, United States of America
| | - Joanna M Streck
- Vermont Center on Behavior and Health, University of Vermont, United States of America
| | - Ellaina N Reed
- Vermont Center on Behavior and Health, University of Vermont, United States of America
| | - Derek D Reed
- Department of Applied Behavioral Science, University of Kansas, United States of America
| | - Stephen T Higgins
- Vermont Center on Behavior and Health, University of Vermont, United States of America; Department of Psychiatry, University of Vermont, United States of America; Department of Psychology, University of Vermont, United States of America.
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17
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Kurti AN. Reducing tobacco use among women of childbearing age: Contributions of tobacco regulatory science and tobacco control. Exp Clin Psychopharmacol 2020; 28:501-516. [PMID: 31855002 PMCID: PMC8168442 DOI: 10.1037/pha0000342] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Tobacco use has unique, adverse health consequences for reproductive-aged women, particularly should these women become pregnant. Thus, successful efforts to reduce tobacco use among this population have strong potential to improve public health and reduce health disparities. The present review examines contributions to reducing tobacco use among women of childbearing age spanning the domains of tobacco regulatory science and tobacco control from the passage of the Family Smoking Prevention and Tobacco Control Act in 2009 through September 2019. In the domain of tobacco regulatory science, such efforts include research conducted by various National Institutes of Health/Food and Drug Administration (FDA)-supported Tobacco Centers of Regulatory Science, epidemiological surveillance studies, as well as studies examining the potential impact of tobacco regulatory policies currently under consideration by the FDA (e.g., reduced nicotine content cigarettes, health warning labels). Tobacco control efforts within this same 10-year timeframe include developments in pharmacological and psychosocial approaches to promoting tobacco cessation, mHealth interventions, and tobacco control policy. Emerging issues pertinent to ongoing efforts to reduce tobacco use within the domains of both tobacco regulatory science and tobacco control are also reviewed, including e-cigarettes, comorbid health conditions, course of tobacco and other drugs of abuse, and obstacles to the dissemination and implementation of evidence-based treatment and policy. Although the past decade has seen numerous important contributions to reducing tobacco use among reproductive-aged women within both domains, existing obstacles must be surmounted to continue reducing tobacco use and protecting health among this population. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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18
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Higgins ST, Tidey JW, Sigmon SC, Heil SH, Gaalema DE, Lee D, Hughes JR, Villanti AC, Bunn JY, Davis DR, Bergeria CL, Streck JM, Parker MA, Miller ME, DeSarno M, Priest JS, Cioe P, MacLeod D, Barrows A, Markesich C, Harfmann RF. Changes in Cigarette Consumption With Reduced Nicotine Content Cigarettes Among Smokers With Psychiatric Conditions or Socioeconomic Disadvantage: 3 Randomized Clinical Trials. JAMA Netw Open 2020; 3:e2019311. [PMID: 33079196 PMCID: PMC7576411 DOI: 10.1001/jamanetworkopen.2020.19311] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
IMPORTANCE This study is part of a programmatic effort evaluating the effects of reducing nicotine content of cigarettes to minimally addictive levels. OBJECTIVE To examine whether very low-nicotine-content (VLNC) cigarettes decrease smoking rates and dependence severity among smokers with psychiatric disorders or socioeconomic disadvantage. DESIGN, SETTING, AND PARTICIPANTS These 3 randomized clinical trials were performed at the University of Vermont, Brown University, and Johns Hopkins University between October 2016 and September 2019. Participants received 12 weeks of exposure to study cigarettes with nicotine content ranging from levels representative of commercial cigarettes (15.8 mg nicotine/g tobacco) to less than a hypothesized addiction threshold (2.4 mg/g and 0.4 mg/g). Daily smokers from 3 at-risk populations participated: individuals with affective disorders, exemplifying smokers with mental illness; individuals with opioid use disorder, exemplifying smokers with substance use disorders; and women with high school educations or less, exemplifying smokers with socioeconomic disadvantage. Data were analyzed from September 2019 to July 2020. INTERVENTIONS Random assignment to 1 of 3 study cigarettes provided weekly at no cost for 12 weeks. MAIN OUTCOMES AND MEASURES The primary outcome was between-group differences in mean total cigarettes smoked daily (CPD) during week 12; secondary outcomes included CPD for study and nonstudy cigarettes and dependence severity across weeks analyzed using analysis of covariance, random coefficients growth modeling, or repeated measures analysis of variance. RESULTS A total of 775 participants were included (mean [SD] age, 35.59 [11.05] years; 551 [71.10%] women [owing to 1 population being exclusively women]); participants smoked a mean (SD) of 17.79 (9.18) CPD at study intake. A total of 286 participants were randomized to 0.4 mg/g, 235 participants were randomized to 2.4 mg/g, and 254 participants were randomized to 15.8 mg/g. Participants randomized to VLNC cigarettes had decreased mean [SEM] total CPD during week 12 across populations (Cohen d = 0.61; P < .001). At week 12, mean (SEM) CPD decreased to 17.96 (0.98) CPD in the 0.4 mg/g group and to 19.53 (1.07) CPD in the 2.4 mg/g group, both of which were significantly different from the 15.8 mg/g group (25.08 [1.08] CPD at week 12) but not each other (0.4 mg/g adjusted mean difference: -7.54 [95%CI, -9.51 to -5.57]; 2.4 mg/g adjusted mean difference: -5.34 [95% CI, 7.41 to -3.26]). Several secondary outcomes differed across populations randomized to VLNCs, including mean total CPD across weeks, with linear trends lower in participants receiving 0.4 mg/g (-0.28 [95%CI, -0.39 to -0.18]; P < .001) and 2.4 mg/g (-0.13 [95%CI, -0.25 to -0.01]; P < .001) doses compared with those receiving the 15.8 mg/g dose (0.30 [95% CI, 0.19 to 0.41]). Fagerström Test of Nicotine Dependence mean total scores were significantly lower in participants who received VLNCs (Cohen d = 0.12; P < .001), with those who received the 0.4 mg/g dose (mean [SD] score, 3.99 [0.06]; P < .001 vs 15.8 mg/g) or 2.4 mg/g dose (mean [SD] score, 4.07 [0.06]; P = .01 vs 15.8 mg/g) differing from those who received the 15.8 mg/g dose (mean [SD] score, 4.31 [0.06]) but not from each other. CONCLUSIONS AND RELEVANCE These findings demonstrate that decreasing the nicotine content of cigarettes to very low levels reduced smoking rate and nicotine-dependence severity in these high-risk populations, effects that may facilitate successful cessation. TRIAL REGISTRATION ClinicalTrials.gov Identifiers: NCT02232737, NCT02250664, NCT02250534.
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Affiliation(s)
- Stephen T. Higgins
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington
| | - Jennifer W. Tidey
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island
| | - Stacey C. Sigmon
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington
| | - Sarah H. Heil
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington
| | - Diann E. Gaalema
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington
| | - Dustin Lee
- Yale University Tobacco Center of Regulatory Science, Yale University School of Medicine, New Haven, Connecticut
| | - John R. Hughes
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington
| | - Andrea C. Villanti
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington
| | - Janice Y. Bunn
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington
| | - Danielle R. Davis
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington
- Yale University Tobacco Center of Regulatory Science, Yale University School of Medicine, New Haven, Connecticut
| | - Cecilia L. Bergeria
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joanna M. Streck
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Maria A. Parker
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington
- School of Public Health, Indiana University, Bloomington
| | - Mollie E. Miller
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island
| | - Michael DeSarno
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington
| | - Jeff S. Priest
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington
| | - Patricia Cioe
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island
| | - Douglas MacLeod
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington
| | - Anthony Barrows
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington
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Abstract
This Special Issue of Preventive Medicine (PM) is the 6th in a series on behavior change, health, and health disparities. This is a topic of critical importance to improving U.S. population health. There is broad consensus that personal behavior patterns or lifestyle such as substance abuse, physical inactivity/obesity, and non-adherence with medical regimens are among the most important modifiable causes of chronic disease, premature death and population health. Hence, effectively promoting health-related behavior change needs to be a key component of health care research and policy. In this issue we devote the majority of space (14 of 20 reports) to the U.S. opioid epidemic, especially the ongoing but still woefully inadequate efforts to build the necessary clinical infrastructure in rural communities to effectively address the epidemic. The remaining six reports focus on addressing the substantive challenges that tobacco use and non-adherence with medical regimens represent in these same communities. While giving the opioid epidemic the attention that it well deserves, we cannot afford to do so at the expense of these other longstanding and also devastating public health problems. Across each of these topics we include contributions from well-regarded investigators, clinicians, and policymakers to acquaint readers with recent accomplishments while also noting knowledge gaps and unmet challenges.
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Affiliation(s)
- Stephen T Higgins
- Vermont Center on Behavior and Health, Departments of Psychiatry and Psychological Science, University of Vermont, United States of America.
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20
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Davis DR, DeSarno MJ, Bergeria CL, Streck JM, Tidey JW, Sigmon SC, Heil SH, Gaalema DE, Stitzer ML, Higgins ST. Examining effects of unit price on preference for reduced nicotine content cigarettes and smoking rate. Prev Med 2019; 128:105823. [PMID: 31470023 PMCID: PMC6879848 DOI: 10.1016/j.ypmed.2019.105823] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 08/04/2019] [Accepted: 08/26/2019] [Indexed: 01/16/2023]
Abstract
Cigarette preference increases as a function of greater nicotine content, but manipulating cost can shift preference. The aims of the present study are to model whether (1) the behavioral-economic metric unit price (cost/reinforcer magnitude) accounts for preference shifts and (2) whether preference shifts toward reduced nicotine content are associated with smoking reductions. In a multisite study between 2015 and 2016, 169 daily smokers from vulnerable populations completed two concurrent-choice conditions examining preference for smoking normal (15.8 mg/g) and reduced (0.4 mg/g) nicotine content cigarettes. In Condition 1, both products were available at 10 responses/choice. In Condition 2, availability of the 0.4 mg/g dose remained at 10 responses/choice while the 15.8 mg/g dose was available on a progressive-ratio (PR) schedule wherein response cost increased following each choice. Unit prices were calculated by dividing dose by response requirement. Results were analyzed using ANOVA and binomial tests (p < .05). Participants preferred the 15.8 over 0.4 mg/g dose in Condition 1, but shifted preference to the 0.4 mg/g dose in Condition 2 (p < .001) immediately before the point in the PR progression where unit price for 15.8 dose exceeded unit price for the 0.4 dose (p < .001). This shift was associated with a reduction in smoking (p < .001). The unit price of nicotine appears to underpin cigarette product preference and may provide a metric for predicting preference and potentially impacting it through tobacco regulations. These results also demonstrate that reduced compared to normal nicotine content cigarettes sustain lower smoking rates discernible even under acute laboratory conditions and in vulnerable populations.
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Affiliation(s)
| | - Michael J DeSarno
- Department of Psychiatry, Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Department Psychological Science, Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA
| | - Cecilia L Bergeria
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Jennifer W Tidey
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA
| | - Stacey C Sigmon
- Department of Psychiatry, Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Department Psychological Science, Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA
| | - Sarah H Heil
- Department of Psychiatry, Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Department Psychological Science, Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA
| | - Diann E Gaalema
- Department of Psychiatry, Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Department Psychological Science, Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA
| | - Maxine L Stitzer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Stephen T Higgins
- Department of Psychiatry, Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Department Psychological Science, Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA
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21
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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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