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O'Neal RA, Carpenter MJ, Wahlquist AE, Leavens ELS, Smith TT, Fahey MC. The prospective relationship between a-priori intentions for and patterns of e-cigarette use among adults who smoke cigarettes. Addict Behav 2024; 156:108067. [PMID: 38823347 DOI: 10.1016/j.addbeh.2024.108067] [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] [Received: 01/12/2024] [Revised: 04/30/2024] [Accepted: 05/15/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND Electronic (e-)cigarettes may help adult cigarette smokers achieve cigarette cessation, depending on patterns of e-cigarette use. Among cigarette smokers who do not use e-cigarettes, it is unclear if and how a-priori intentions for use are related to uptake patterns. Longitudinal studies have focused on established e-cigarette users or adolescent and young adult populations exclusively. METHODS Within a nationwide randomized clinical trial (N = 638), adult cigarette smokers not currently using e-cigarettes were randomized (2:1) to receive (or not) one-month sampling of e-cigarettes. An exploratory factor analysis (EFA) was performed on an established 15-item measure assessing a-priori intentions for e-cigarette use to identify latent variables. Among those receiving e-cigarette products, regression models examined relationships between intentions and: 1) uptake (yes/no), 2) frequency (number of days per week), and 3) amount (puffing episodes per day) of e-cigarette use at one-month follow-up. RESULTS Two factors emerged from the EFA: 1) cigarette-related intentions (e.g., cigarette cessation, no smell) and 2) novel appeal of e-cigarettes (e.g., flavors). Three items remained and were treated as separate intentions: "feels like cigarette smoking", "curiosity", and "affordability". In the final multivariable models, "feel like cigarette smoking" predicted more frequent e-cigarette use (β = 0.187, SE = 0.086, p = 0.03); however, none of the five factors/intentions were significantly associated with uptake or amount of use. CONCLUSIONS For adult cigarette smokers not currently using e-cigarettes, a-priori intentions for using e-cigarettes might not be predictive of if or how these products will be used in the future, suggesting that motives may not drive use behavior.
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Affiliation(s)
- Riley A O'Neal
- Arnold School of Public Health, University of South Carolina, United States
| | - Matthew J Carpenter
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina (MUSC), United States; Department of Public Health Sciences, MUSC, United States; Hollings Cancer Center, MUSC, United States
| | - Amy E Wahlquist
- Center for Rural Health Research, East Tennessee State University, United States
| | - Eleanor L S Leavens
- Department of Population Health, The University of Kansas School of Medicine, United States; The University of Kansas Comprehensive Cancer Center, United States
| | - Tracy T Smith
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina (MUSC), United States; Hollings Cancer Center, MUSC, United States
| | - Margaret C Fahey
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina (MUSC), United States.
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Pearson J, Nides MA, Cataldo A, Martinez M, Morales J, Seltzer R, Kurka J, Broussard M, Leischow SJ. Varenicline OTC Trial on Efficacy and Safety. Nicotine Tob Res 2024:ntae172. [PMID: 39012011 DOI: 10.1093/ntr/ntae172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Indexed: 07/17/2024]
Abstract
INTRODUCTION Varenicline helps people who smoke quit at rates 2-3 times greater than placebo. Currently in the U.S., varenicline is not available over the counter (OTC). In this study, we assessed the safety and efficacy of 1mg and 0.5mg varenicline as an OTC medication for smoking cessation in comparison to placebo. METHODS This randomized, double-blind, placebo-controlled study was performed at two clinical sites in the United States of n=313 people. The treatment period was 12 weeks. During the COVID pandemic, the protocol was modified to allow remote participation; verification of smoking status was via breath carbon monoxide levels for in-person visits and mailed urine cotinine kits for the remote participants. RESULTS There was no difference in biologically confirmed continuous abstinence by condition between Weeks 8-12; however, the odds of biologically confirmed point prevalence abstinence were higher for those in the 1mg b.i.d. condition than for those in the placebo condition at Week 12 (OR 3.39; 95% CI 1.49, 7.71), and were higher for those assigned to the 1.0mg b.i.d. condition than the 0.5mg b.i.d. condition at Week 12 (OR 2.37; 95% CI 1.11, 5.05). Adverse events were modest, and as expected (vivid dreams and nausea in the medication conditions). CONCLUSIONS The results are suggestive that varenicline is safe and effective as an OTC medication.
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Affiliation(s)
- Jennifer Pearson
- Department of Health Behavior, Policy, and Administration Sciences, University of Nevada -- Reno, Reno, United States
| | | | - Alana Cataldo
- College of Health Solutions, Arizona State University, Tempe, United States
| | | | | | - Ryan Seltzer
- College of Health Solutions, Arizona State University, Tempe, United States
| | - Jonathan Kurka
- College of Health Solutions, Arizona State University, Tempe, United States
| | - Matthew Broussard
- College of Health Solutions, Arizona State University, Tempe, United States
| | - Scott J Leischow
- College of Health Solutions, Arizona State University, Tempe, United States
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Sisson ML, Gajos JM, Wolford-Clevenger C, Chichester KR, Hawes ES, Hill SV, Shelton RC, Hendricks PS, Businelle MS, Carpenter MJ, Cropsey KL. Impact of Nicotine Replacement Therapy Sampling on Cessation-Related Processes. J Addict Med 2024; 18:397-403. [PMID: 38446860 PMCID: PMC11290993 DOI: 10.1097/adm.0000000000001298] [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: 03/08/2024]
Abstract
OBJECTIVES Smoking prevalence remains high among low-income smokers. Understanding processes (eg, withdrawal, craving, motivation) in early smoking cessation is crucially important for designing effective interventions for this population. METHODS This is a secondary analysis of a novel, in-session sampling intervention (ie, In Vivo) as compared with standard care behavioral smoking cessation counseling (SC) among community-dwelling low-income smokers (n = 83). This analysis examined the effect of 5 in-session sampling interventions on cessation-related processes and perceived advantages or disadvantages of nicotine replacement therapy (NRT) products over time using daily diaries. RESULTS The In Vivo treatment had an early positive impact in terms of decreasing withdrawal symptoms and cravings, and increasing perceived advantages to NRT, with moderate to large effect sizes. Results also showed that the treatment effectively reduced withdrawal symptoms and cravings in-session, with small-to-medium and medium-to-large effect sizes, respectively. In-session reduction of withdrawal symptoms and cravings did not occur for the SC group, with the exception of decreased withdrawal symptoms occurring during week 4. The In Vivo treatment did not impact quit goal, desire to quit, abstinence self-efficacy, perceived difficulty in quitting, motivational engagement, or perceived disadvantages to NRT. The In Vivo group reported less daily cigarette use relative to the SC group, in addition to reporting less cigarette use on days they reported greater combination NRT use. CONCLUSIONS There is preliminary support for this In Vivo treatment over SC in reducing withdrawal, craving, and the number of cigarettes smoked per day, as well as promoting perceived advantages of NRT among low-income smokers.
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Affiliation(s)
- Michelle L Sisson
- From the Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL (MLS, CW-C, KRC, ESH, RCS, KLC); Department of Family and Community Medicine, University of Alabama at Birmingham, Birmingham, AL (JMG); Department of Pediatrics, School of Medicine, University of Alabama at Birmingham, Birmingham, AL (SVH); Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL (PSH); Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK (MSB); and Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC (MJC)
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Clohessy S, Arvanitis TN, Rashid U, Craddock C, Evans M, Toro CT, Elliott MT. Using digital tools in clinical, health and social care research: a mixed-methods study of UK stakeholders. BMJ Open 2024; 14:e076613. [PMID: 38569710 PMCID: PMC11146398 DOI: 10.1136/bmjopen-2023-076613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 02/08/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE The COVID-19 pandemic accelerated changes to clinical research methodology, with clinical studies being carried out via online/remote means. This mixed-methods study aimed to identify which digital tools are currently used across all stages of clinical research by stakeholders in clinical, health and social care research and investigate their experience using digital tools. DESIGN Two online surveys followed by semistructured interviews were conducted. Interviews were audiorecorded, transcribed and analysed thematically. SETTING, PARTICIPANTS To explore the digital tools used since the pandemic, survey participants (researchers and related staff (n=41), research and development staff (n=25)), needed to have worked on clinical, health or social care research studies over the past 2 years (2020-2022) in an employing organisation based in the West Midlands region of England (due to funding from a regional clinical research network (CRN)). Survey participants had the opportunity to participate in an online qualitative interview to explore their experiences of digital tools in greater depth (n=8). RESULTS Six themes were identified in the qualitative interviews: 'definition of a digital tool in clinical research'; 'impact of the COVID-19 pandemic'; 'perceived benefits/drawbacks of digital tools'; 'selection of a digital tool'; 'barriers and overcoming barriers' and 'future digital tool use'. The context of each theme is discussed, based on the interview results. CONCLUSIONS Findings demonstrate how digital tools are becoming embedded in clinical research, as well as the breadth of tools used across different research stages. The majority of participants viewed the tools positively, noting their ability to enhance research efficiency. Several considerations were highlighted; concerns about digital exclusion; need for collaboration with digital expertise/clinical staff, research on tool effectiveness and recommendations to aid future tool selection. There is a need for the development of resources to help optimise the selection and use of appropriate digital tools for clinical research staff and participants.
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Affiliation(s)
| | | | | | - Carly Craddock
- National Institute for Health Research Clinical Research Network West Midlands, Birmingham, UK
- The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Mark Evans
- National Institute for Health Research Clinical Research Network West Midlands, Birmingham, UK
- The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Carla T Toro
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Mark T Elliott
- WMG, University of Warwick, Coventry, UK
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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Klemperer EM, Streck JM, Lindson N, West JC, Su A, Hughes JR, Carpenter MJ. A systematic review and meta-analysis of interventions to induce attempts to quit tobacco among adults not ready to quit. Exp Clin Psychopharmacol 2023; 31:541-559. [PMID: 35771496 PMCID: PMC10106992 DOI: 10.1037/pha0000583] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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
The prevalence of past-year smoking cessation remains below 10% in the U.S. Most who smoke are not ready to quit in the near future. Cessation requires both (a) initiating a quit attempt (QA) and (b) maintaining abstinence. Most research has focused on abstinence among people already motivated to quit. We systematically reviewed interventions to promote QAs among people not motivated to quit tobacco. We searched PubMed, CENTRAL, PsycINFO, Embase, and our personal libraries for randomized trials of tobacco interventions that reported QAs as an outcome among adults not ready to quit. We screened studies and extracted data in duplicate. We pooled findings of the 25 included studies using Mantel-Haenszel random effects meta-analyses when ≥ 2 studies tested the same intervention. Most (24) trials addressed cigarettes and one addressed smokeless tobacco. Substantial heterogeneity among trials resulted in a series of small meta-analyses. Findings indicate varenicline may increase QAs more than no varenicline, n = 320; RR = 1.4, 95% CI [1.1, 1.7]; I² = 0%, and nicotine replacement therapy (NRT) may increase QAs more than no NRT, n = 2,568; RR = 1.1, 95% CI [1.02, 1.3]; I² = 0%. Pooled effects for motivational counseling, reduction counseling, and very low nicotine content cigarettes showed no clear evidence of benefit or harm. The evidence was judged to be of medium to very low certainty due to imprecision, inconsistency, and risk of bias, suggesting that further research is likely to change interpretation of our results. Findings demonstrate the need for more high-quality research on interventions to induce QAs among adults not ready to quit tobacco. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Elias M. Klemperer
- Vermont Center on Behavior & Health, Department of Psychiatry, University of Vermont
- Department of Psychological Science, University of Vermont
| | - Joanna M. Streck
- Tobacco Research & Treatment Center, Division of General Internal Medicine and Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School
| | - Nicola Lindson
- Nuffield Department of Primary Care Health Sciences, University of Oxford
| | - Julia C. West
- Vermont Center on Behavior & Health, Department of Psychiatry, University of Vermont
- Department of Psychological Science, University of Vermont
| | - Alan Su
- University of Vermont Medical Center
| | - John R. Hughes
- Vermont Center on Behavior & Health, Department of Psychiatry, University of Vermont
- Department of Psychological Science, University of Vermont
| | - Matthew J. Carpenter
- Department of Psychiatry and Behavioral Sciences & Hollings Cancer Center, Medical University of South Carolina
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Yang J, Lin JL, Liu J, Jiang XW, Zhang H, Peng L. Estimates of prevalence, time-trend, and association of smoking in adults living with HIV, HBV, and HCV (NHANES 1999-2018). Sci Rep 2022; 12:19925. [PMID: 36402865 PMCID: PMC9675830 DOI: 10.1038/s41598-022-24291-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 11/14/2022] [Indexed: 11/21/2022] Open
Abstract
Although the smoking rate of human immunodeficiency virus (HIV), hepatitis B virus (HBV) or hepatitis C virus (HCV) infected people was much higher than that of the general population, smoking cessation interventions have long been ineffective. We aimed to examine the estimates of prevalence, time-trend, and association of smoking among people living with HIV, HBV, or HCV. This cohort was composed of 32,115 individuals from the NHANES database (1999-2018) and they were collected in the US. The time trend analysis of smoking and quitting rates was conducted using different years of survey follow-up and different infected groups. Multivariable logistic regression analysis was used to identify the risk factors related to smoking behavior of these infected people. Compared to non-infected smokers, infected smokers were more likely to be older (aged 30-39, OR = 9.92, CI 6.07-16.21; aged 40-49,OR = 3.51, CI 2.49-4.94), males (1.99, 1.54-2.55), lower education and economic level (1.78, 1.39-2.29; 2.05, 1.59-2.65), unemployed (1.63, 1.21-2.20), suffering depression (1.35, 1.05-1.72), and drug users (7.65, 5.04-11.59). Taken together, our study showed that these complex psychosocial characteristics and unhealthy behavioral factors might be major independent risk factors for increasing smoking rate and decreasing smoking cessation rate among these infected people.
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Affiliation(s)
- Jie Yang
- grid.508318.7Major Infectious Diseases Management Department, Public Health Clinical Center of Chengdu, Chengdu, 610066 China
| | - Jin-Long Lin
- grid.12527.330000 0001 0662 3178School of Marxism, Tsinghua University, Beijing, 100084 China ,grid.11135.370000 0001 2256 9319Institute of Population Research, Peking University, Beijing, 100871 China
| | - Jing Liu
- People Liberation Army Haidian District 17th Retired Cadres Rest Home, Beijing, 100143 China
| | - Xiao-Wen Jiang
- grid.11135.370000 0001 2256 9319Department of Epidemiology, School of Clinical Oncology, Peking University, Beijing, 100142 China
| | - Hao Zhang
- grid.11135.370000 0001 2256 9319Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, 100191 China
| | - Lei Peng
- grid.11135.370000 0001 2256 9319Department of Epidemiology, School of Clinical Oncology, Peking University, Beijing, 100142 China
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Chen B, Silvestri GA, Dahne J, Lee K, Carpenter MJ. The Cost-Effectiveness of Nicotine Replacement Therapy Sampling in Primary Care: a Markov Cohort Simulation Model. J Gen Intern Med 2022; 37:3684-3691. [PMID: 35091913 PMCID: PMC9585132 DOI: 10.1007/s11606-021-07335-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 12/14/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Pharmacotherapies remain a central focus of successful tobacco control, but uptake remains very low. OBJECTIVE To estimate the cost effectiveness of a primary care nicotine replacement therapy (NRT) sampling intervention. DESIGN A Markov cohort simulation model was constructed to conduct cost-effectiveness analyses. Clinical trial results were used to initialize the Markov model. All other model parameters were derived from the literature. The study was conducted over a lifetime horizon, from the payers' budgetary perspective. PARTICIPANTS Smokers with a primary care visit. INTERVENTION Medication sampling, which provided short, starter packets of NRT (nicotine patch and lozenge) to smokers in the primary care setting. MAIN MEASURES Lifetime healthcare expenditures, quality-adjusted life years, and life years. KEY RESULTS Medication sampling was the dominant strategy compared to standard care. Our intervention cost $75, yielding a discounted lifetime savings of $1065 in healthcare expenditures, and increased both discounted quality-adjusted life years and discounted life years by 0.01. One-way sensitivity analyses showed that medication sampling remained dominant in plausible ranges except when it failed to increase cessation relative to standard care. Probabilistic sensitivity analyses confirmed that medication sampling was dominant in 94.1% of the simulated cases, with an implementation cost of $74 (95% CI $73-$76) and discounted lifetime savings in health expenditures of $1061 (- $1106 to - $1,017), increasing quality-adjusted life years by 0.008 (0.0085-0.0093) and life years by 0.008 (0.0081-0.0089). CONCLUSION Medication sampling, an easily implementable, scalable and low-cost intervention to encourage smoking cessation, is cost saving and improves quality of life.
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Affiliation(s)
- Brian Chen
- Arnold School of Public Health, University of South Carolina, 915 Greene St. #354, Columbia, SC, 29208, USA.
| | - Gerard A Silvestri
- Department of Medicine, Medical University of South Carolina (MUSC), Charleston, USA
- Hollings Cancer Center, MUSC, Charleston, USA
| | - Jennifer Dahne
- Hollings Cancer Center, MUSC, Charleston, USA
- Department of Psychiatry & Behavioral Sciences, MUSC, Charleston, USA
| | - Kyueun Lee
- University of Pittsburgh, Pittsburgh, USA
| | - Matthew J Carpenter
- Hollings Cancer Center, MUSC, Charleston, USA
- Department of Psychiatry & Behavioral Sciences, MUSC, Charleston, USA
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Kasza KA, Edwards KC, Anesetti-Rothermel A, Creamer MR, Cummings KM, Niaura RS, Sharma A, Pitts SR, Head SK, Everard CD, Hatsukami DK, Hyland A. E-cigarette use and change in plans to quit cigarette smoking among adult smokers in the United States: Longitudinal findings from the PATH Study 2014-2019. Addict Behav 2022; 124:107124. [PMID: 34598012 PMCID: PMC8511329 DOI: 10.1016/j.addbeh.2021.107124] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/17/2021] [Accepted: 09/20/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Much of the population-based e-cigarette use and cigarette cessation literature is restricted to smokers who have expressed intention to quit smoking, though experimental studies suggest e-cigarette use might motivate some smokers to change their quit intentions. We used U.S. nationally representative data to evaluate whether e-cigarette use by smokers initially not planning to ever quit is associated with change in plans to quit. METHODS Longitudinal Population Assessment of Tobacco and Health (PATH) Study data collected between 2014 and 2019 were analyzed. Main analyses were conducted among adult daily cigarette smokers not currently using e-cigarettes with no plans to ever quit smoking (n = 2366 observations from n = 1532 individuals). Generalized estimating equations were used to evaluate the association between change in e-cigarette use and change in plans to quit smoking within the next six months, over three assessment pairs. RESULTS Daily cigarette smokers with no plans to quit had a higher rate of change to plan to quit if at follow-up they used e-cigarettes daily (41.4%, 95% CI: 27.1-57.3%) versus not at all (12.4%, 95% CI: 10.6-14.5%; aOR = 5.7, 95% CI: 2.9-11.2). Rate of change to plan to quit did not statistically differ between those who at follow-up used e-cigarettes some days versus not at all. CONCLUSIONS Among adult daily cigarette smokers initially not planning to ever quit, subsequent daily e-cigarette use is associated with subsequent plans to quit smoking. Population-level research on e-cigarette use that is focused on smokers already motivated to quit may limit a complete evaluation of the smoker population.
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Affiliation(s)
- Karin A Kasza
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States.
| | | | | | - MeLisa R Creamer
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, United States.
| | | | | | - Akshika Sharma
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States.
| | - Stephanie R Pitts
- Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD, United States.
| | - Sara K Head
- Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD, United States.
| | - Colm D Everard
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, United States; Kelly Government Solutions, Rockville, MD, United States.
| | | | - Andrew Hyland
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States.
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