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Schlienz NJ, Felicione NJ, Lee DC, O'Connor RJ, Smith DM. The Cannabis Gray Market: A Case for Cannabis Regulatory Science Research. Cannabis Cannabinoid Res 2024. [PMID: 38946638 DOI: 10.1089/can.2023.0278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024] Open
Abstract
The cannabis gray market poses significant public health concerns and remains a major threat to consumer and/or potential consumer uptake of regulated cannabis markets in jurisdictions with legal state-sponsored cannabis programs. In this perspective, we provide an overview of the cannabis gray market, and describe an integrated epidemiological and regulatory science framework to study the gray market. Using tobacco regulatory science as a guide, we introduce example cannabis regulatory science research activities as a means to improve the field's understanding of the cannabis gray market. Cannabis regulatory science is a developing field that can improve our understanding of the cannabis regulatory ecosystem and provide regulatory officials and policymakers alike with much needed data to inform regulatory decision-making and improve the success and uptake of state-sponsored cannabis programs.
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Affiliation(s)
- Nicolas J Schlienz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Nicholas J Felicione
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, State University of New York at Buffalo, Buffalo, New York, USA
| | - Dustin C Lee
- Department of Psychiatry and Behavioral Sciences, Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Richard J O'Connor
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, State University of New York at Buffalo, Buffalo, New York, USA
| | - Danielle M Smith
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, State University of New York at Buffalo, Buffalo, New York, USA
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Noar SM, Jang Y, Nguyen Zarndt A, Zhao X, Ross JC, Cappella JN. Achieving Public Health Impact: Health Communication Research to Inform Tobacco Regulatory Science. HEALTH COMMUNICATION 2024:1-8. [PMID: 38478963 PMCID: PMC11393175 DOI: 10.1080/10410236.2024.2326250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/15/2024]
Abstract
Health communication research applies communication science to develop generalizable knowledge capable of improving the health and well-being of individuals and communities. But to what extent does the knowledge generated by the health communication field actually achieve public health impact? To answer this question, we discuss the application of health communication science and research within a tobacco regulatory science framework. We describe three areas in which health communication research funded by the Food and Drug Administration (FDA) Center for Tobacco Products (CTP) contributed to 1) youth tobacco prevention campaigns, 2) cigarette health warnings, and 3) regulation of labeling, advertising, and marketing claims. These examples demonstrate how communication regulatory science achieves public health impact in the real world by informing national policies, regulatory actions, and public health practice.
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Affiliation(s)
- Seth M Noar
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Youjin Jang
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Anh Nguyen Zarndt
- Office of Health Communication and Education, FDA Center for Tobacco Products
| | - Xiaoquan Zhao
- Office of Health Communication and Education, FDA Center for Tobacco Products
- Department of Communication, George Mason University
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Venrick SJ, Margolis KA, Bernat JK, Donaldson E, Pepper JK, Eggers ME, Nonnemaker JM. Believability of messaging concerning a hypothetical product standard to lower a constituent in cigarettes or smokeless tobacco among U.S. Adults who use tobacco. Prev Med Rep 2024; 37:102544. [PMID: 38169982 PMCID: PMC10758972 DOI: 10.1016/j.pmedr.2023.102544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 12/04/2023] [Accepted: 12/06/2023] [Indexed: 01/05/2024] Open
Abstract
The U.S. Food and Drug Administration (FDA) has regulatory authority to implement tobacco product standards to reduce harmful and potentially harmful constituents (HPHCs). This study examines people who use tobacco products' awareness of FDA's tobacco regulatory authority, knowledge of HPHCs, and belief in hypothetical tobacco product standard statements. We recruited adults who reported currently using tobacco (N = 1,592) from the National Panel of Tobacco Consumer Studies and randomized them to one of four conditions. Participants viewed a stimulus which consisted of a statement about a hypothetical product standard that would reduce the level of a chemical in cigarettes or smokeless tobacco (ST) and reduce cases of cancer or heart attack and stroke. A small majority of participants correctly believed that FDA regulates tobacco; however, the percentage of participants who recognized HPHCs varied widely depending upon the chemical. People who currently use ST found chemical and health statements more believable than people who did not currently use ST. Participants found it more believable that cigarettes, not ST, could be made with fewer harm-causing chemicals, and their belief in the chemical and health statements did not differ based on the health outcome specified in the hypothetical product standard statement.
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Affiliation(s)
- Samantha J. Venrick
- Center for Tobacco Products, U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD, USA
| | - Katherine A. Margolis
- Center for Tobacco Products, U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD, USA
| | - Jennifer K. Bernat
- Center for Tobacco Products, U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD, USA
| | - Elisabeth Donaldson
- Center for Tobacco Products, U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD, USA
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Stroup AM, Villanti AC, Pfund C, Benjamin EJ, Denlinger-Apte RL, Garcia-Cazarin ML, Kwan J, Stanton CA. Guidance for Addressing Conflicts, Bias, and Growth in Early Career Tobacco Regulatory Science Training Through Mentorship. Nicotine Tob Res 2024; 26:111-114. [PMID: 37632690 PMCID: PMC10734379 DOI: 10.1093/ntr/ntad162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 08/18/2023] [Accepted: 08/24/2023] [Indexed: 08/28/2023]
Affiliation(s)
- Andrea M Stroup
- Behavioral Health and Health Policy Practice, Westat, Rockville, MD, USA
| | - Andrea C Villanti
- Rutgers Center for Tobacco Studies, New Brunswick, NJ, USA
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Christine Pfund
- Institute for Clinical and Translational Research, University of Wisconsin-Madison, Madison, WI, USA
- Wisconsin Center for Education Research, University of Wisconsin-Madison, Madison, WI, USA
| | - Emelia J Benjamin
- Department of Medicine, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Rachel L Denlinger-Apte
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | | | - Jonathan Kwan
- Center for Tobacco Products, United States Food and Drug Administration, Silver Spring, MD, USA
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Smith TT, McClure EA, Halpern-Felsher B. Introduction to special issue of addictive behaviors: Tobacco regulatory science. Addict Behav 2023; 142:107671. [PMID: 36905899 DOI: 10.1016/j.addbeh.2023.107671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Affiliation(s)
- Tracy T Smith
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina and Hollings Cancer Center, Medical University of South Carolina, United States; Hollings Cancer Center, Medical University of South Carolina, United States
| | - Erin A McClure
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina and Hollings Cancer Center, Medical University of South Carolina, United States; Hollings Cancer Center, Medical University of South Carolina, United States
| | - Bonnie Halpern-Felsher
- REACH Lab, Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Palo Alto, CA, United States.
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Sharma K, Moyer J, Liggins C, Garcia-Cazarin M, Mandal RJ, Wanke KL, Meissner HI. Impact of National Institutes of Health and Food and Drug Administration Tobacco Research Funding: A Bibliometrics Analyses. Nicotine Tob Res 2023; 25:1082-1089. [PMID: 36789895 PMCID: PMC10202643 DOI: 10.1093/ntr/ntad024] [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: 08/10/2022] [Revised: 02/07/2023] [Accepted: 02/10/2023] [Indexed: 02/16/2023]
Abstract
INTRODUCTION Conduct bibliometric analyses documenting the output of National Institutes of Health (NIH) tobacco-related and Food and Drug Administration (FDA) tobacco regulatory science (FDA-TRS) research portfolios. AIMS AND METHODS PubMed identifiers for publications between 2015 and 2020 citing tobacco funding by NIH and/or FDA were imported into NIH iCite generating measures of productivity and influence, including number of citations, journal, relative citation ratios (RCR), and comparison of research influence across Web of Science (WoS) disciplines. Coauthorship and measures of centrality among and between NIH and FDA-supported investigators gauged collaboration. RESULTS Between FY 2015 and 2020, 8160 publications cited funding from NIH tobacco-related grants, 1776 cited FDA-TRS grants and 496 cited Common funding (ie, both NIH and FDA-TRS funding). The proportion of publications citing NIH grants declined while those citing FDA-TRS or Common funding rose significantly. Publications citing Common funding showed the highest influence (mean RCR = 2.52). Publications citing FDA-TRS funding displayed higher median RCRs than publications citing NIH funding in most WoS categories. Higher translational progress was estimated over time for FDA-TRS and Common publications compared to NIH publications. Authors citing Common funding scored highest across all collaboration measures. CONCLUSIONS This study demonstrates the high bibliometric output of tobacco research overall. The rise in publications citing FDA-TRS and Common likely reflects increased funding for TRS research. Higher RCRs across WoS subject categories and trends towards human translation among FDA-TRS and Common publications indicate focus on research to inform regulation. This analysis suggests that FDA support for TRS has expanded the field of tobacco control resulting in sustained productivity, influence, and collaboration. IMPLICATIONS This paper is the first effort to better describe the impact of tobacco research resulting from the addition of FDA funding for TRS in the past decade. The analysis provides impetus for further investigation into the publication topics and their focus which would offer insight into the specific evidence generated on tobacco control and regulation.
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Affiliation(s)
- Kriti Sharma
- Office of Disease Prevention, National Institutes of Health, Bethesda, MD, USA
| | - Jonathan Moyer
- Office of Disease Prevention, National Institutes of Health, Bethesda, MD, USA
| | - Charlene Liggins
- Office of Disease Prevention, National Institutes of Health, Bethesda, MD, USA
| | - Mary Garcia-Cazarin
- Office of Disease Prevention, National Institutes of Health, Bethesda, MD, USA
| | - Rachel J Mandal
- Office of Disease Prevention, National Institutes of Health, Bethesda, MD, USA
| | - Kay L Wanke
- Office of Disease Prevention, National Institutes of Health, Bethesda, MD, USA
| | - Helen I Meissner
- Office of Disease Prevention, National Institutes of Health, Bethesda, MD, USA
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Mays D, Long L, Alalwan MA, Wagener TL, Shang C, Roberts ME, Patterson JG, Keller-Hamilton B. The Effects of Oral Nicotine Pouch Packaging Features on Adult Tobacco Users' and Non-Users' Product Perceptions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3383. [PMID: 36834078 PMCID: PMC9965054 DOI: 10.3390/ijerph20043383] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/08/2023] [Accepted: 02/14/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Oral nicotine pouches (ONPs) are novel products that are marketed as "tobacco-free" alternatives to cigarettes and smokeless tobacco (ST). This study examined the effects of ONP packaging features on adult tobacco users' and non-users' product perceptions. MATERIALS AND METHODS Adult tobacco users (cigarettes, ST, and dual cigarette/ST) and non-users (total N = 301) viewed ONP pack images in a 4 × 3 × 2 between-subject experiment testing the effects of the displayed flavor (cool mint, coffee, dark frost, and smooth), nicotine concentration (none displayed on the package, 3 mg, and 6 mg), and addiction warning label (yes or no). The outcomes were perceived substitutability of ONPs for cigarettes and ST and perceived risks. We modeled the effects of tobacco user status and the experimental factors on these outcomes. RESULTS All tobacco user groups perceived ONPs to be significantly less harmful and less addictive than non-users. There were significant effects of nicotine concentration on perceived risks. Compared to packages that did not display nicotine concentration, packages displaying 6 mg nicotine concentration produced significantly lower perceived harm (β = -0.23, 95% CI -0.44, -0.02), perceived addictiveness (β = -0.28, 95% CI -0.51, -0.05), risk appraisals of harm (β = -0.50, 95% CI -0.88, -0.12) and risk appraisals of addictiveness (β = -0.53, 95% CI -0.95, -0.11). CONCLUSIONS The study findings demonstrate that the nicotine concentration displayed on ONP packaging can affect adults' perceptions of ONPs. Further research on the effects of ONP packaging features emphasizing nicotine (e.g., "tobacco free" nicotine claims) on tobacco users and non-users is needed to assess their potential public health impact.
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Affiliation(s)
- Darren Mays
- Department of Internal Medicine, The Ohio State University College of Medicine, Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43214, USA
| | - Lauren Long
- Department of Internal Medicine, The Ohio State University College of Medicine, Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43214, USA
| | - Mahmood A. Alalwan
- Department of Internal Medicine, The Ohio State University College of Medicine, Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43214, USA
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH 43210, USA
| | - Theodore L. Wagener
- Department of Internal Medicine, The Ohio State University College of Medicine, Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43214, USA
| | - Ce Shang
- Department of Internal Medicine, The Ohio State University College of Medicine, Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43214, USA
| | - Megan E. Roberts
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, OH 43210, USA
| | - Joanne G. Patterson
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, OH 43210, USA
| | - Brittney Keller-Hamilton
- Department of Internal Medicine, The Ohio State University College of Medicine, Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43214, USA
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DeVito NJ, Drysdale H, McKee M, Goldacre B. E-cigarette manufacturers' compliance with clinical trial reporting expectations: a case series of registered trials by Juul Labs. Tob Control 2023; 32:60-66. [PMID: 34127550 DOI: 10.1136/tobaccocontrol-2020-056221] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 04/07/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Electronic cigarettes (e-cigarettes) are a frequently debated topic in public health. It is essential that clinical trials examining e-cigarettes are fully and accurately reported, especially given long-standing concerns about tobacco industry research. We assess the reporting of clinical trials sponsored by Juul Labs, the largest e-cigarette company in the USA, against accepted reporting standards. METHODS We searched ClinicalTrials.gov for all trials sponsored by Juul Labs and determined those with registry data consistent with coverage by the Food and Drug Administration (FDA) Amendments Act 2007 (FDAAA). For trials with a primary completion date more than 1 year earlier, we searched ClinicalTrials.gov, the academic literature and a Juul-funded research database (JLI Science) for results. For located results, we compared reported outcomes with registered outcomes in line with Consolidated Standards of Reporting Trials (CONSORT) reporting guidelines. RESULTS We located five registered trials sponsored by Juul Labs that appeared covered by the FDAAA 2007 in the public data. All five trials did not have results available on ClinicalTrials.gov. We found one publication and four poster presentations reporting results for four of the five covered trials outside of ClinicalTrials.gov. Of 61 specified outcomes, 28 were CONSORT compliant. Specific outcome reporting issues are detailed. DISCUSSION Our findings raise substantial concerns regarding these trials. Clinicians, public health professionals, and the public cannot make informed choices about the benefits or hazards of e-cigarettes if the results of clinical trials are not completely and transparently reported. Clarification and potential enforcement of reporting laws may be required.
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Affiliation(s)
- Nicholas J DeVito
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Henry Drysdale
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Ben Goldacre
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Erath TG, Browning KO, Evemy C, Feinstein MJP, Wiley RC, Kemperer EM, DeSarno M, Higgins ST. A review of research on cigarette smoking in Preventive Medicine in recognition of the journal's 50th anniversary. Prev Med 2022; 164:107335. [PMID: 36334681 PMCID: PMC9742989 DOI: 10.1016/j.ypmed.2022.107335] [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: 08/25/2022] [Revised: 10/26/2022] [Accepted: 10/30/2022] [Indexed: 11/11/2022]
Abstract
This report reviews the literature on cigarette smoking published in Preventive Medicine over the past 50 years. The goal is twofold. First, to acknowledge the 50th anniversary of Preventive Medicine and its role in disseminating research on cigarette smoking by providing an abridged summary of smoking research published in the journal from inception through June 23, 2022. Second, to review experimental reports to identify contributions to innovations in tobacco control and regulatory efforts to reduce cigarette smoking. We searched PubMed using the search terms cigarette/cigarettes, tobacco products, smoking, smoking cessation, Preventive Medicine. Titles and abstracts were reviewed in duplicate, excluding reports not addressing cigarette smoking. Included reports were categorized by study type (original study, commentary, review). Experimental articles were assessed for impact using iCite, a National Institutes of Health web application that provides bibliometric information for articles in defined topic areas. The review identified 1181 articles on cigarette smoking: 1018 original studies (86.2%), 107 literature reviews (9.1%), and 56 commentaries (4.7%); 166 of the 1018 original studies (16%) were experimental reports. In the iCite analysis these 166 experimental articles received 6366 total citations, a mean (standard error) citation rate/article of 38.35 (±3.21) and mean relative citation ratio of 1.85 (±0.17) which is at the 73rd percentile for NIH-funded field- and time-normalized reports. Overall, this review demonstrates an ongoing and impactful contribution of Preventive Medicine to efforts to reduce cigarette smoking, the most preventable cause of premature death.
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Affiliation(s)
- Tyler G Erath
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, United States of America; Department of Psychiatry, University of Vermont, Burlington, VT, United States of America.
| | - Kaitlyn O Browning
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, United States of America; Department of Psychiatry, University of Vermont, Burlington, VT, United States of America
| | - Carolyn Evemy
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, United States of America; Department of Psychiatry, University of Vermont, Burlington, VT, United States of America; Department of Psychological Science, University of Vermont, Burlington, VT, United States of America
| | - Marc Jerome P Feinstein
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, United States of America; Department of Psychiatry, University of Vermont, Burlington, VT, United States of America; Department of Psychological Science, University of Vermont, Burlington, VT, United States of America
| | - Rhiannon C Wiley
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, United States of America; Department of Psychiatry, University of Vermont, Burlington, VT, United States of America; Department of Psychological Science, University of Vermont, Burlington, VT, United States of America
| | - Elias M Kemperer
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, United States of America; Department of Psychiatry, University of Vermont, Burlington, VT, United States of America; Department of Psychological Science, University of Vermont, Burlington, VT, United States of America
| | - Michael DeSarno
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, United States of America; Medical Biostatistics, 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; Department of Psychiatry, University of Vermont, Burlington, VT, United States of America; Department of Psychological Science, University of Vermont, Burlington, VT, United States of America
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Meissner HI, Sharma K, Mandal RJ, Garcia-Cazarin M, Wanke KL, Moyer J, Liggins C. NIH Tobacco Research and the Emergence of Tobacco Regulatory Science. Nicotine Tob Res 2022; 24:463-468. [PMID: 34624889 PMCID: PMC8887588 DOI: 10.1093/ntr/ntab205] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/06/2021] [Indexed: 11/13/2022]
Abstract
INTRODUCTION This study explores how the emergence of FDA-funded Tobacco Regulatory Science (TRS) research complements and perhaps influenced the direction of tobacco research supported by NIH. AIMS AND METHODS New NIH- and FDA-funded tobacco projects awarded in fiscal years (FY) 2011-2020 were identified using internal NIH databases of awarded grants. Project abstracts and research aims were coded by the authors to characterize research domains and tobacco products studied. RESULTS Between FY 2011 and 2020, NIH funded 1032 and FDA funded 322 new tobacco projects. For the years and grant activity codes studied, the number of new NIH tobacco projects declined while FDA's increased; combined the number of new projects held steady. Much of NIH research included smoking combustibles (43.7%). The most common products in FDA research were cigarettes (74.8%) and e-cigarettes/ENDS (48.1%). Most NIH (58.6%) and FDA (67.7%) projects included research on the determinants of tobacco use. Another area of apparent overlap was health effects (29.5% NIH and 30.1% FDA). Projects unique to NIH included treatment interventions (33.3%), disease pathology/progression (17.8%) and neurobiology (18.9%). A minority of both NIH and FDA projects included populations particularly vulnerable to tobacco product use. CONCLUSIONS In total, support for new tobacco research supported by NIH and FDA combined remained steady for the time period covered, though there was a concomitant decline in NIH tobacco projects with the increase in FDA-funded TRS projects for the activity codes studied. Despite the apparent overlap in some areas, both NIH and FDA support research that is unique to their respective missions. IMPLICATIONS NIH continues to support tobacco research that falls within and outside of FDA's regulatory authorities. This research still is needed not only to bolster the evidence base for regulatory decisions at the national and state levels, but also to advance a comprehensive scientific agenda that can inform multiple levels of influence on tobacco control, use and addiction. It will be important to continue monitoring FDA-funded TRS and NIH-funded tobacco research portfolios to ensure that the level of support for and focus of the research is sufficient to address the burden of tobacco-related morbidity and mortality.
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Affiliation(s)
- Helen I Meissner
- Office of Disease Prevention, National Institutes of Health, Bethesda MD, USA
| | - Kriti Sharma
- Office of Disease Prevention, National Institutes of Health, Bethesda MD, USA
| | - Rachel J Mandal
- Office of Disease Prevention, National Institutes of Health, Bethesda MD, USA
| | - Mary Garcia-Cazarin
- Office of Disease Prevention, National Institutes of Health, Bethesda MD, USA
| | - Kay L Wanke
- Office of Disease Prevention, National Institutes of Health, Bethesda MD, USA
| | - Jonathan Moyer
- Office of Disease Prevention, National Institutes of Health, Bethesda MD, USA
| | - Charlene Liggins
- Office of Disease Prevention, National Institutes of Health, Bethesda MD, USA
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Russell AM, Yang M, Barry AE, Merianos AL, Lin HC. Stealth Vaping Among College Students on Four Geographically Distinct Tobacco-Free College Campuses: Prevalence and Practices. Nicotine Tob Res 2022; 24:342-348. [PMID: 34297130 DOI: 10.1093/ntr/ntab153] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/21/2021] [Indexed: 12/25/2022]
Abstract
INTRODUCTION To offset tobacco use among college students, many universities have implemented tobacco-free campus policies. Given how easily e-cigarette users can discreetly vape in places where it is prohibited without being detected (ie, stealth vape), it is important to assess whether students are subverting these policies. This study examined the prevalence of stealth vaping on-campus among students at multiple universities, including frequency and methods for stealth vaping. AIMS AND METHODS A convenience sample of college students was obtained from four geographically distinct, large, public universities with established policies prohibiting all forms of tobacco use on campus. Participants (N = 863 current e-cigarette users) reported on demographics and e-cigarette use. Those who previously stealth vaped on-campus (n = 422) completed additional questions, including common locations, techniques, and devices/e-liquids used for stealth vaping. RESULTS Nearly half (48.9%) of past 30-day e-cigarette users reported previously stealth vaping on-campus. Among stealth vapers, 48.1% owned a smaller device for stealth vaping and 38.9% used e-liquids with low visibility vapors. Common on-campus stealth vaping locations included bathrooms, libraries, parking garages, and classrooms. Techniques used for stealth vaping included deep inhale, blowing a hit into one's clothes, and swallowing a hit. CONCLUSIONS A large percentage of respondents commonly violated campus tobacco-free policies by stealth vaping. For such policies to be effective at reducing on-campus e-cigarette use, there is a need for enhanced monitoring and enforcement. More research is needed to better understand factors influencing stealth vaping behaviors and public health implications. IMPLICATIONS This sample of college student e-cigarette users commonly violated campus smoke- and tobacco-free policies by stealth vaping on campus. Respondents used a range of methods (eg, smaller device and low visibility e-liquids) and locations (eg, bathrooms, libraries, and parking garages) for stealth vaping. If campus policies are to be effective at reducing on-campus e-cigarette use, there is a need for enhanced monitoring and enforcement. E-cigarette devices specifically designed and marketed to facilitate stealth vaping (eg, resembling USB flash drives and pens) may require regulatory action. More research is needed to better understand factors influencing stealth vaping behaviors and public health implications.
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Affiliation(s)
- Alex M Russell
- Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville, AR 72701, USA
| | - Meng Yang
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN 47405, USA
| | - Adam E Barry
- Department of Health & Kinesiology, Texas A&M University, College Station, TX 77843, USA
| | - Ashley L Merianos
- School of Human Services, University of Cincinnati, Cincinnati, OH 45221, USA
| | - Hsien-Chang Lin
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN 47405, USA
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Ajayi TB, Childs E, Di Frances Remein C, Forbush LR, Ragasa JB, Fetterman JL, Hirsch GA, Benjamin EJ. Fostering Tobacco Regulatory Team Science through a multisite, virtual fellowship program for early-career researchers. J Clin Transl Sci 2022; 6:e14. [PMID: 35211340 PMCID: PMC8826010 DOI: 10.1017/cts.2021.887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/26/2021] [Accepted: 12/23/2021] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION In an era of complex, multi-institutional, team-based science, there is little guidance for the successful creation of effective, collaborative, multisite training programs. OBJECTIVE We designed, implemented, and evaluated a multi-institutional Tobacco Regulatory Science (TRS) fellowship representing a scalable program that may be customized for other research areas. METHODS Using a mixed-methods approach, we analyzed program evaluations from trainees enrolled in the first 7 years of the American Heart Association (AHA) Tobacco Regulation and Addiction Center (A-TRAC) fellowship (2014-2021). We also reported the program outcomes, including published TRS manuscripts, independent grant funding, Food and Drug Administration (FDA) Docket comments submitted on TRS topics, TRS oral and poster presentations, research awards, and promotions in the TRS field. RESULTS Thirty-five unique trainees (49% [n = 17] female, 29% [n = 10] Black) from eight institutions within the A-TRAC network participated in the fellowship since its inception. The trainees reported 74 TRS publications, 78 TRS oral or poster presentations, 25 FDA Docket comment submissions, and 13 funded grant awards. Participant evaluations indicated six areas of programmatic strength: 1) blended instruction medium with webinars and in-person meetings, 2) curricular emphasis on theories of experiential learning, 3) focus on career and professional development, 4) integrated mentorship model, 5) culture of feedback and feedforward to foster successful learning, and 6) focus on recruiting diverse participants. The A-TRAC model stresses experiential education, feedback and feedforward, and peer learning. CONCLUSIONS Our resource-effective, needs-driven program is a reproducible model for institutions interested in developing multisite, virtual research education programs in the era of team science.
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Affiliation(s)
- Tinuola B. Ajayi
- Boston University School of Medicine, Boston, MA, USA
- Boston Medical Center, Boston, MA, USA
| | | | | | | | | | | | | | - Emelia J. Benjamin
- Boston University School of Medicine, Boston, MA, USA
- Boston Medical Center, Boston, MA, USA
- Boston University School of Public Health, Boston, MA, USA
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Prokhorov AV, Calabro KS, Arya A, Russell S, Czerniak KW, Botello GC, Chen M, Yuan Y, Perez A, Vidrine DJ, Perry CL, Khalil GE. Mobile Text Messaging for Tobacco Risk Communication Among Young Adult Community College Students: Randomized Trial of Project Debunk. JMIR Mhealth Uhealth 2021; 9:e25618. [PMID: 34822339 PMCID: PMC8663493 DOI: 10.2196/25618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 04/19/2021] [Accepted: 10/08/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The use of new and emerging tobacco products (NETPs) and conventional tobacco products (CTPs) has been linked to several alarming medical conditions among young adults (YAs). Considering that 96% of YAs own mobile phones, SMS text messaging may be an effective strategy for tobacco risk communication. OBJECTIVE Project Debunk is a community-based randomized trial aiming to identify specific types of messages that effectively improve perceived NETP and CTP risk among YAs in community colleges. METHODS With YAs recruited offline from 3 campuses at the Houston Community College (September 2016 to July 2017), we conducted a 6-month randomized trial with 8 arms based on the combination of 3 message categories: framing (gain-framed vs loss-framed), depth (simple vs complex), and appeal (emotional vs rational). Participants received fully automated web-based SMS text messages in two 30-day campaigns (2 messages per day). We conducted repeated-measures mixed-effect models stratified by message type received, predicting perceived CTP and NETP risks. Owing to multiple testing with 7 models, an association was deemed significant for P<.007 (.05 divided by 7). RESULTS A total of 636 participants completed the baseline survey, were randomized to 1 of 8 conditions (between 73 and 86 participants per condition), and received messages from both campaigns. By the 2-month post campaign 2 assessment point, 70.1% (446/636) completed all outcome measures. By the end of both campaigns, participants had a significant increase in perceived NETP risk over time (P<.001); however, participants had a marginal increase in perceived CTP risk (P=.008). Separately for each group, there was a significant increase in perceived NETP risk among participants who received rational messages (P=.005), those who received emotional messages (P=.006), those who received simple messages (P=.003), and those who received gain-framed messages (P=.003). CONCLUSIONS In this trial, YAs had an increase in perceived NETP risk. However, with stratification, we observed a significant increase in perceived NETP risk upon exposure to rational, emotional, simple, and gain-framed messages. In addition, YAs generally had an increase in perceived CTP risk and presented nonsignificant but observable improvement upon exposure to emotional, complex, and loss-framed messages. With the results of this study, researchers and practitioners implementing mobile health programs may take advantage of our tailored messages through larger technology-based programs such as smartphone apps and social media campaigns. TRIAL REGISTRATION ClinicalTrials.gov NCT03457480; https://clinicaltrials.gov/ct2/show/NCT03457480. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/10977.
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Affiliation(s)
- Alexander V Prokhorov
- Department of Behavioral Science, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Karen Sue Calabro
- Department of Behavioral Science, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Ashish Arya
- Department of Behavioral Science, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Sophia Russell
- Department of Health Disparities, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Katarzyna W Czerniak
- Department of Behavioral Science, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Gabrielle C Botello
- Department of Health Services Research, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Minxing Chen
- Department of Biostatistics, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Ying Yuan
- Department of Biostatistics, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Adriana Perez
- Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center, Austin, TX, United States
| | - Damon J Vidrine
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States
| | - Cheryl L Perry
- School of Public Health, Health Science Center, University of Texas, Austin, TX, United States
| | - Georges Elias Khalil
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States
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Mantey DS, Harrell MB, Chen B, Kelder SH, Perry CL, Loukas A. A Longitudinal Examination of Behavioral Transitions among Young Adult Menthol and Non-Menthol Cigarette Smokers Using a Three-State Markov Model. Nicotine Tob Res 2021; 23:1047-1054. [PMID: 33245357 DOI: 10.1093/ntr/ntaa240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 11/20/2020] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Young adult cigarette smoking behaviors are complex and dynamic. Emerging research suggests a growing rate of switching from non-menthol to menthol cigarettes. Transitions across cigarette smoking states are not well understood. This research longitudinally explores transitions in cigarette smoking behaviors among 18-29 year olds. METHODS We applied a Markov model to data collected biannually for 1542 initially 18-29 year old young adults (mean age: 20.9 years; SD = 2.6) in Texas, who provided 7021 total observations from Fall 2014 to Spring 2017. All participants were past 30 day menthol or non-menthol cigarette smokers at first observation. We examined transitions across three states of cigarette smoking (menthol, non-menthol, and nonsmoking) and compared predictors of each transition, during young adulthood. RESULTS Descriptively, 22.2% of menthol and 14.3% of non-menthol smokers switched products while 25.6% of menthol and 26.0% of non-menthol smokers quit smoking. Among quitters, 20.0% relapsed via menthol and 28.2% relapsed via non-menthol cigarettes. Results from Markov model indicated that Hispanic/Latinos (Hazard Ratio [HR]: 3.69) and Asians (HR: 2.85) were significantly more likely to switch from non-menthol to menthol cigarettes, relative to non-Hispanic whites. Among recent quitters, the use of non-cigarette products was associated with increased risk of relapse via menthol (HR: 1.54) and non-menthol (HR: 1.85) cigarettes. CONCLUSION A substantial proportion of young adult cigarette smokers transitioned across cigarette smoking states over the course of 2.5 years. Other tobacco use and nicotine dependence were impediments to becoming and remaining a non-smoker. Hispanic/Latinos and Asians, relative to non-Hispanic whites, had greater odds of transitioning from non-menthol smoking to both non-smoking and to menthol smoking. Findings suggest racial/ethnic differences in cigarette smoking transitions during young adulthood. IMPLICATIONS This paper examined multidirectional transitions across cigarette smoking, including switching between menthol and non-menthol cigarettes, among young adults. Results indicate that Hispanic/Latino and Asian young adults are at increased risk of transition to menthol cigarette smoking compared with non-Hispanic white young adults. Findings highlight need for further study of Hispanic/Latino and Asian young adult smoking behaviors.
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Affiliation(s)
- Dale S Mantey
- UT Health Science Center at Houston, UT Health, School of Public Health in Austin, Austin, TX
| | - Melissa B Harrell
- UT Health Science Center at Houston, UT Health, School of Public Health in Austin, Austin, TX
| | - Baojiang Chen
- UT Health Science Center at Houston, UT Health, School of Public Health in Austin, Austin, TX
| | - Steven H Kelder
- UT Health Science Center at Houston, UT Health, School of Public Health in Austin, Austin, TX
| | - Cheryl L Perry
- UT Health Science Center at Houston, UT Health, School of Public Health in Austin, Austin, TX
| | - Alexandra Loukas
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, TX
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Johnson AC, Mercincavage M, Souprountchouk V, Rogelberg S, Sidhu AK, Delnevo CD, Strasser AA. Responses to reduced nicotine cigarette marketing features: a systematic review. Tob Control 2021; 32:tobaccocontrol-2021-056826. [PMID: 34620718 PMCID: PMC8986886 DOI: 10.1136/tobaccocontrol-2021-056826] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/20/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To systematically review the literature regarding responses to commercial and public health marketing features for reduced nicotine cigarettes (RNCs) to anticipate potential industry and regulatory actions should an RNC product standard be issued. DATA SOURCES We searched PubMed for English-language articles using several keywords for reduced nicotine products, cigarettes and marketing features published through 2020. STUDY SELECTION Of 4092 records, 26 studies were retained for review that met criteria focusing on responses to RNC marketing features. DATA EXTRACTION Search terms created by the research team were used for review and included independent extraction and coding by two reviewers. Coding was categorised using study design terminology, commercial and public health features in tobacco regulatory science, and their association with individual responses outlined by several message processing outcomes. DATA SYNTHESIS Most studies focused on current cigarette smokers and were cross-sectional. Reactions to RNCs and attitudes and beliefs were the most common outcomes measured. For commercial features, articles generally studied RNC advertisements, products and/or descriptors. For public health features, articles studied counter-messaging (eg, warning labels) or general descriptors about nicotine or a reduced nicotine product standard. Commercial features were generally associated with favourable responses. Public health features offset favourable responses across most outcomes, though their efficacy was mixed. Contrasts in results by smoking status are discussed. CONCLUSIONS Commercial marketing of RNCs is appealing and may need stronger regulations or communication campaigns to accurately convey risks. Opportunities exist for future research within tobacco regulatory science.
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Affiliation(s)
- Andrea C Johnson
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, Pennsylvania, USA
| | - Melissa Mercincavage
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, Pennsylvania, USA
| | - Valentina Souprountchouk
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, Pennsylvania, USA
| | - Sasha Rogelberg
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Anupreet K Sidhu
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, Pennsylvania, USA
| | - Cristine D Delnevo
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, Pennsylvania, USA
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey, USA
| | - Andrew A Strasser
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, Pennsylvania, USA
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Lee JGL, O'Brien KF, Blanchflower TM, Swanson G, Averett PE, Gregory KR. Changes to cigarette packaging influence US consumers' choices: Results of two discrete-choice experiments to inform regulation. Tob Induc Dis 2021; 19:70. [PMID: 34602934 PMCID: PMC8445337 DOI: 10.18332/tid/140137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/10/2021] [Accepted: 07/11/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION While plain packaging of tobacco products has emerged as a policy intervention to reduce smoking, regulators in the US have limited ability to implement plain packaging. We sought to identify the impact of subtle changes to cigarette packaging (Study 1) and how packaging design influenced participant choices based on appeal, harm, and style (Study 2). METHODS We conducted two discrete-choice experiments with US adult smokers online in 2018. In Study 1 (n=285), we assessed participants’ selections based on subtle changes to pack design features (dimensions, color saturation, logo size). In Study 2 (n=284), we assessed three choices in which participants selected packs based on appeal, harmfulness, and best match to their personal style. Study 2 packs varied by color hue, design with different levels of organic labeling and natural imagery, and color saturation. RESULTS Pack designs influenced smokers’ choices. In Study 1, pack dimensions and color saturation emerged as the most important features, and, in Study 2, design and color hue were the most influential characteristics. CONCLUSIONS Regulators should consider how the design of cigarette packages may influence consumers’ perceptions and choices.
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Affiliation(s)
- Joseph G L Lee
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, United States.,Cancer Prevention and Control Program, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, United States
| | - Kevin F O'Brien
- Department of Biostatistics, College of Allied Health Sciences, East Carolina University, Greenville, United States
| | - Tiffany M Blanchflower
- Department of Interior Design and Merchandising, College of Health and Human Performance, East Carolina University, Greenville, United States
| | - Gunnar Swanson
- College of Fine Arts and Communication, East Carolina University, Greenville, United States
| | - Paige E Averett
- School of Social Work, College of Humanities and Social Sciences, North Carolina State University, Raleigh, United States
| | - Kyle R Gregory
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, United States
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Pope DA, Poe L, Stein JS, Kaplan BA, DeHart WB, Mellis AM, Heckman BW, Epstein LH, Chaloupka FJ, Bickel WK. The Experimental Tobacco Marketplace: Demand and Substitutability as a Function of Cigarette Taxes and e-Liquid Subsidies. Nicotine Tob Res 2020; 22:782-790. [PMID: 31350894 PMCID: PMC7171289 DOI: 10.1093/ntr/ntz116] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 07/23/2019] [Indexed: 11/14/2022]
Abstract
INTRODUCTION The experimental tobacco marketplace (ETM) approximates real-world situations by estimating the effects of several, concurrently available products and policies on budgeted purchasing. Although the effects of increasing cigarette price on potentially less harmful substitutability are well documented, the effects of other, nuanced pricing policies remain speculative. This study used the ETM as a tool to assess the effects of two pricing policies, conventional cigarette taxation and e-liquid subsidization, on demand and substitutability. METHODS During sampling periods, participants were provided 2-day samples of 24 mg/mL e-liquid, after which ETM purchase sessions occurred. Across two ETM sessions, conventional cigarettes were taxed or e-liquid was subsidized in combination with increasing cigarette price. The other four available products were always price constant and not taxed or subsidized. RESULTS E-liquid functioned as a substitute for conventional cigarettes across all conditions. Increasing cigarette taxation and e-liquid subsidization increased the number of participants for which e-liquid functioned as a substitute. Cigarette taxation decreased cigarette demand, by decreasing demand intensity, and marginally increased the initial intensity of e-liquid substitution, but did not affect the functions' slopes (substitutability). E-liquid subsidization resulted in large increases in the initial intensity of e-liquid substitution, but did not affect e-liquid substitutability nor cigarette demand. IMPLICATIONS 24 mg/mL e-cigarette e-liquid was the only product to significantly substitute for cigarettes in at least one condition throughout the experiment; it functioned as a significant substitute throughout all four tax and all four subsidy conditions. Increasing cigarette taxes decreased cigarette demand through decreases in demand intensity but did not affect e-cigarette substitution. Increasing e-liquid subsidies increased e-liquid initial intensity of substitution but did not affect cigarette demand. CONCLUSIONS This study extended research on the behavioral economics of conventional cigarette demand and e-liquid substitutability in a complex marketplace. The results suggest that the most efficacious method to decrease conventional cigarette purchasing and increase e-liquid purchasing may involve greatly increasing cigarette taxes while also increasing the value of e-liquid through potentially less harmful product subsidization or differential taxation.
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Affiliation(s)
- Derek A Pope
- Addiction Recovery Research Center, Fralin Biomedical Research Institute at VTC, Roanoke, VA
| | - Lindsey Poe
- Addiction Recovery Research Center, Fralin Biomedical Research Institute at VTC, Roanoke, VA
| | - Jeffrey S Stein
- Addiction Recovery Research Center, Fralin Biomedical Research Institute at VTC, Roanoke, VA
| | - Brent A Kaplan
- Addiction Recovery Research Center, Fralin Biomedical Research Institute at VTC, Roanoke, VA
| | - William B DeHart
- Addiction Recovery Research Center, Fralin Biomedical Research Institute at VTC, Roanoke, VA
| | - Alexandra M Mellis
- Addiction Recovery Research Center, Fralin Biomedical Research Institute at VTC, Roanoke, VA
| | - Bryan W Heckman
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Leonard H Epstein
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY
| | - Frank J Chaloupka
- Department of Economics, University of Illinois at Chicago, Chicago, IL
| | - Warren K Bickel
- Addiction Recovery Research Center, Fralin Biomedical Research Institute at VTC, Roanoke, VA
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Calabro KS, Khalil GE, Chen M, Perry CL, Prokhorov AV. Pilot study to inform young adults about the risks of electronic cigarettes through text messaging. Addict Behav Rep 2019; 10:100224. [PMID: 31828203 PMCID: PMC6889374 DOI: 10.1016/j.abrep.2019.100224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 09/10/2019] [Accepted: 09/22/2019] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Young adults are rapidly adopting electronic cigarette (e-cigarette) use. The popularity of e-cigarettes among young people can be attributed to heavy industry advertising and misleading health claims. Data indicate that young e-cigarette users who have never used conventional cigarettes may transition toward smoking combustible cigarettes. Communicating e-cigarette risks via text messaging is limited. This pilot study assessed the impact of exposure to 16 text messages on e-cigarette knowledge and risk perception. The short text messages delivered to participants conveyed e-cigarette use may lead to addiction to nicotine and explained the latest health-related findings. METHODS A two-group randomized pretest and posttest study was conducted among 95 racially, ethnically diverse young adults recruited from vocational training programs. Fifty percent of participants were randomized to receive either gain- or loss-framed messages. Knowledge and risk perceptions about e-cigarettes and tobacco use were assessed pre- and post-message exposure. RESULTS Participants had a mean age of 20.8 years, SD = 1.7. Current use of e-cigarettes was reported by 10.5% (10/95) and 27.4% (26/95) used a variety of other tobacco products. Findings revealed significant increases in knowledge about e-cigarettes after exposure to the messages (range for ps: p < 04 to p < 0.0001). A statistically significant increase in perceived e-cigarette risk was found post-exposure (p = 0.002). Participants randomized to gain-framed messages reported a significantly higher perceived risk of using e-cigarettes post-exposure than did those who received loss-framed messages (p = 0.02). CONCLUSIONS This was a small-scale pilot requiring additional evidence to support the effectiveness of text messaging for increasing e-cigarette knowledge and risk perception. Future research may apply text messages to test new ways to educate young populations about tobacco use and consider addressing these messages to specific subgroups at high risk of use such as non-college bound young adults.
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Affiliation(s)
- Karen S. Calabro
- Department of Behavioral Science, The University of Texas (UT) MD Anderson Cancer Center, Houston, TX, United States
| | - Georges E. Khalil
- Department of Behavioral Science, UT MD Anderson Cancer Center, Houston, TX, United States
| | - Minxing Chen
- Department of Biostatistics, UT MD Anderson Cancer Center, Houston, TX, United States
| | - Cheryl L. Perry
- School of Public Health at Austin, The University of Texas Health Science Center at Houston, Austin, TX, United States
| | - Alexander V. Prokhorov
- Department of Behavioral Science, UT MD Anderson Cancer Center, Houston, TX, United States
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Nonanimal toxicology testing approaches for traditional and deemed tobacco products in a complex regulatory environment: Limitations, possibilities, and future directions. Toxicol In Vitro 2019; 62:104684. [PMID: 31618670 DOI: 10.1016/j.tiv.2019.104684] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 10/09/2019] [Accepted: 10/10/2019] [Indexed: 11/20/2022]
Abstract
The evaluation of tobacco products is complex due to a multitude of factors including product diversity, limited testing standards, and variability in user behavior. Alternative approaches in current testing paradigms have limitations that generally truncate their applicability beyond screening for hazard identification; this is also true for toxicological evaluations of tobacco products. In a regulatory context, results from tobacco product toxicity assessments are extrapolated to the in vivo condition to assess human health relevance at the individual and population level. A key limitation of alternative approaches is the difficulty and uncertainty in extrapolating results to adverse outcomes relevant to chronic tobacco exposures in humans. This difficulty and uncertainty are increased when comparing toxicological outcomes between tobacco products. Given that the interpretation and quantification of differences in assay results (e.g., mutagenicity) for tobacco product comparison may be inconclusive, the predictive value of these approaches for human risk of relevant downstream pathologies (e.g., carcinogenesis) can be limited. Development and validation of fit-for-purpose alternative approaches that are predictive of human toxicity and dose response assays with adequate sensitivity and specificity for product comparisons would help advance the field of predictive toxicology.
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Hrabovsky SM, Midya V, Lester C, Veldheer S, Yingst JM, Allen SI, Krebs NM, Liao J, Reinhart L, Modesto J, Evins AE, Richie JP, Muscat JE, Horn K, Foulds J. Effect of Cigarette Rod Length on Smokers Switching to SPECTRUM Cigarettes. Am J Health Behav 2019; 43:380-392. [PMID: 30808477 DOI: 10.5993/ajhb.43.2.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives: Cigarettes vary in rod length but are generally thought of as a constant unit. In this study, we evaluated whether the rod length of participants' usual brand cigarettes affected their perceptions and smoking habits when switching to SPECTRUMs. Methods: Data were analyzed for 341 participants smoking their own brand cigarettes for one week and after switching to normal nicotine content (11.6 mg) SPECTRUMs for 2 weeks. Changes in perceptions of cigarette attributes and biomarkers of smoke exposure were evaluated using linear mixed models among 3 groups: usual length short (ULS, 72 mm); medium/king (ULM, ~84 mm); and long (ULL ≥ 100 mm). Results: Among the 3 cigarette length groups, only ULL smokers' rated SPECTRUMs significantly less strong, harder to draw, lower in taste, and lower in enjoyment (p < .03) compared to usual brand. Among all groups, satisfaction was significantly lower for SPECTRUMs (p < .02). Cigarettes per day (CPD) increased significantly more for ULL (+4.75 CPD) as compared to ULM (+1.38 CPD) (p < .001). When switching to SPECTRUMs, cotinine-per-cigarette decreased among all groups, and exhaled carbon monoxide increased significantly in ULL and ULM smokers (p < .001). Conclusion: People who smoked long cigarettes had the largest changes in perceptions and use when switching to SPECTRUM research cigarettes.
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Affiliation(s)
- Shari M. Hrabovsky
- Assistant Research Professor, Penn State College of Nursing, Hershey, PA;,
| | - Vishal Midya
- Pre-Doctoral Scholar, Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Courtney Lester
- Research Coordinator, Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Susan Veldheer
- Assistant Professor, Department of Community and Family Medicine, Penn State College of Medicine, Hershey, PA
| | - Jessica M. Yingst
- Pre-doctoral Scholar, Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Sophia I. Allen
- Postdoctoral Scholar, De- partment of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Nicolle M. Krebs
- Project Manager, Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Jason Liao
- Professor of Public Health Sciences and Biostatistics Core Director, Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Lisa Reinhart
- Research Technologist, Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Jennifer Modesto
- Laboratory Manager, Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - A. Eden Evins
- Director of the Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - John P. Richie
- Professor of Public Health Sciences and Pharmacology, Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Joshua E. Muscat
- Professor of Public Health Sciences, Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Kimberly Horn
- Associate Dean, Prevention and Community Health, Milken Institute School of Public Health at George Washington University, Washington, DC
| | - Jonathan Foulds
- Professor of Public Health Sciences and Psychiatry, Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
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Abstract
Communication regulatory science is an emerging field that uses validated techniques, tools, and models to inform regulatory actions that promote optimal communication outcomes and benefit the public. In the opening article to this special issue on communication and tobacco regulatory science, we 1) describe Food and Drug Administration (FDA) regulation of tobacco products in the US; 2) introduce communication regulatory science and provide examples in the tobacco regulatory science realm; and 3) describe the special issue process and final set of articles. Communication research on tobacco regulatory science is a burgeoning area of inquiry, and this work advances communication science, informs and potentially guides the FDA, and may help to withstand legal challenges brought by the tobacco industry. This research has the potential to have a major impact on the tobacco epidemic and population health by helping implement the most effective communications to prevent tobacco initiation and increase cessation. This special issue provides an example of 10 studies that exemplify tobacco regulatory science and demonstrate how the health communication field can affect regulation and benefit public health.
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Affiliation(s)
- Seth M. Noar
- School of Media and Journalism, University of North Carolina at Chapel Hill
- Center for Regulatory Research on Tobacco Communication, University of North Carolina at Chapel Hill
| | - Joseph N. Cappella
- Annenberg School for Communication, University of Pennsylvania
- Penn Tobacco Center of Regulatory Science, University of Pennsylvania
| | - Simani Price
- Coordinating Center for Tobacco Centers of Regulatory Science, Rockville, Maryland
- Westat, Rockville, Maryland
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Epperson AE, Averett PE, Blanchflower T, Gregory KR, Lee JGL. "The Packaging Is Very Inviting and Makes Smokers Feel Like They're More Safe": The Meanings of Natural American Spirit Cigarette Pack Design to Adult Smokers. HEALTH EDUCATION & BEHAVIOR 2019; 46:260-266. [PMID: 30606071 DOI: 10.1177/1090198118820099] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND/AIMS The aim of this investigation was to identify which design elements on Natural American Spirit packs are salient to (i.e., noticed by) U.S. adult smokers and what meanings smokers derive from these elements. METHOD We conducted a secondary analysis of qualitative data from a study of cigarette packaging design. U.S. adult smokers ( n = 33) from all nine census regions participated in six telephone-based focus groups in March 2017. We used constant comparison analysis to identify key themes. RESULTS Four themes were identified, two focused on salient design elements and two focused on design element meanings. The themes of "bright and flashy color" and "the American Indian logo" were identified as key design elements, while the themes of "healthy and safer" and "targeting at-risk smokers" were identified as meanings smokers derived from design elements. CONCLUSIONS Pack design elements influence smokers' perceptions about reduced health risk of Natural American Spirit cigarettes and may be especially dangerous to vulnerable populations, including young adults and American Indians. Findings from this study suggest that the banning of text descriptors may not be enough to address misconceptions about "healthier" cigarettes.
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Abrams DB, Glasser AM, Villanti AC, Pearson JL, Rose S, Niaura RS. Managing nicotine without smoke to save lives now: Evidence for harm minimization. Prev Med 2018; 117:88-97. [PMID: 29944902 PMCID: PMC6934253 DOI: 10.1016/j.ypmed.2018.06.010] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 06/18/2018] [Accepted: 06/21/2018] [Indexed: 01/05/2023]
Abstract
Tobacco control has made strides in prevention and cessation, but deaths will not decline rapidly without massive behavior change. Currently, inhaled smoke from combusting tobacco is chiefly responsible for prematurely killing 7.2 million people worldwide and 530,000 in the United States annually. An array of noncombustible nicotine products (NNPs) has emerged and has disrupted the marketplace. Saving lives more speedily will require societal acceptance of locating a "sweet spot" within a three-dimensional framework where NNPs are simultaneously: 1. Less toxic, 2. Appealing (can reach smokers at scale), and 3. Satisfying (adequate nicotine delivery) to displace smoking. For this harm minimization framework to eliminate smoking, a laser focus on "smoking control" (not general tobacco control) is needed. By adopting these economically viable NNPs as part of the solution, NNPs can be smoking control's valued ally. Synthesis of the science indicates that policy and regulation can sufficiently protect youth while speeding the switch away from smoking. Despite some risks of nicotine dependence that can be mitigated but not eliminated, no credible evidence counters the assertion that NNPs will save lives if they displace smoking. But scientific evidence and advocacy has selectively exaggerated NNP harms over benefits. Accurate communication is crucial to dispel the misperception of NNPs harms and reassure smokers they can successfully replace smoking cigarettes with NNPs. Saving more lives now is an attainable and pragmatic way to call for alignment of all stakeholders and factions within traditional tobacco control rather than perpetuate the unrealized and unrealizable perfection of nicotine prohibition.
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Affiliation(s)
- David B Abrams
- Department of Social and Behavioral Sciences, NYU College of Global Public Health, New York University, New York, NY, USA.
| | - Allison M Glasser
- Department of Social and Behavioral Sciences, NYU College of Global Public Health, New York University, New York, NY, USA
| | - Andrea C Villanti
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | - Jennifer L Pearson
- School of Community Health Sciences, University of Nevada, Reno, NV, USA
| | - Shyanika Rose
- Truth Initiative Schroeder Institute, Washington, DC, USA
| | - Raymond S Niaura
- Department of Social and Behavioral Sciences, NYU College of Global Public Health, New York University, New York, NY, USA
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Harris AC, Muelken P, Haave Z, Swain Y, Smethells JR, LeSage MG. Propylene glycol, a major electronic cigarette constituent, attenuates the adverse effects of high-dose nicotine as measured by intracranial self-stimulation in rats. Drug Alcohol Depend 2018; 193:162-168. [PMID: 30384324 PMCID: PMC6278948 DOI: 10.1016/j.drugalcdep.2018.08.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 07/25/2018] [Accepted: 08/26/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Non-nicotine tobacco constituents may contribute to the abuse liability of tobacco products. We previously reported that electronic cigarette (EC) refill liquids containing nicotine and a range of non-nicotine constituents attenuated the anhedonic/aversive effects of nicotine in an intracranial self-stimulation (ICSS) model. The alcohol propylene glycol (PG) is a primary ingredient in these and other EC liquids, yet its abuse potential has not been established. The goal of this study was to evaluate the effects of parenteral administration of PG alone and PG combined with nicotine on ICSS in rats. METHODS AND RESULTS PG alone did not affect ICSS at concentrations up to 100%. PG (25% or 60%) did not affect nicotine's reinforcement-enhancing (ICSS threshold-decreasing) effects at low to moderate nicotine doses, but attenuated nicotine's reinforcement-attenuating/aversive (ICSS threshold-increasing) effects at a high nicotine dose. PG concentrations similar to those in EC liquid doses used in our previous studies (1% or 3%) modestly attenuated the ICSS threshold-elevating effects of a high nicotine dose. CONCLUSIONS PG attenuated elevations in ICSS thresholds induced by high-dose nicotine, which may reflect an attenuation of nicotine's acute aversive/anhedonic and/or toxic effects. PG may have contributed to the attenuated ICSS threshold-elevating effects of EC liquids reported previously. Further examination of PG in models of addiction and toxicity is needed to understand the consequences of EC use and to inform the development of EC product standards by the FDA.
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Affiliation(s)
- Andrew C Harris
- Hennepin Healthcare Research Institute, 701 Park Avenue, Minneapolis, MN USA; Departments of Medicine, University of Minnesota Medical School, Variety Club Research Center (VCRC), 401 East River Parkway, 1(st) Floor - Suite 131, Minneapolis, MN 55455, USA; Departments of Psychology, University of Minnesota Medical School, N218 Elliott Hall, 75 E River Rd, Minneapolis, MN 55455, USA.
| | - Peter Muelken
- Hennepin Healthcare Research Institute, 701 Park Avenue, Minneapolis, MN USA
| | - Zach Haave
- Hennepin Healthcare Research Institute, 701 Park Avenue, Minneapolis, MN USA; Departments of Neuroscience, University of Minnesota Medical School, 6-145 Jackson Hall, 321 Church Street SE, Minneapolis, MN 55455, USA
| | - Yayi Swain
- Hennepin Healthcare Research Institute, 701 Park Avenue, Minneapolis, MN USA; Departments of Psychology, University of Minnesota Medical School, N218 Elliott Hall, 75 E River Rd, Minneapolis, MN 55455, USA
| | - John R Smethells
- Hennepin Healthcare Research Institute, 701 Park Avenue, Minneapolis, MN USA; Departments of Psychiatry, University of Minnesota Medical School, Fairview Riverside West Building, 2312 S. 6th St., Floor 2, Suite F-275, Minneapolis, MN 55454, USA
| | - Mark G LeSage
- Hennepin Healthcare Research Institute, 701 Park Avenue, Minneapolis, MN USA; Departments of Medicine, University of Minnesota Medical School, Variety Club Research Center (VCRC), 401 East River Parkway, 1(st) Floor - Suite 131, Minneapolis, MN 55455, USA; Departments of Psychology, University of Minnesota Medical School, N218 Elliott Hall, 75 E River Rd, Minneapolis, MN 55455, USA
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25
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Prokhorov AV, Khalil GE, Calabro KS, Machado TC, Russell S, Czerniak KW, Botello GC, Chen M, Perez A, Vidrine DJ, Perry CL. Mobile Phone Text Messaging for Tobacco Risk Communication Among Young Adult Community College Students: Protocol and Baseline Overview for a Randomized Controlled Trial. JMIR Res Protoc 2018; 7:e10977. [PMID: 30322833 PMCID: PMC6231779 DOI: 10.2196/10977] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 07/17/2018] [Accepted: 07/19/2018] [Indexed: 12/18/2022] Open
Abstract
Background Community-college students are at high risk for tobacco use. Because the use of mobile phone text messaging is nearly ubiquitous today, short message service (SMS) may be an effective strategy for tobacco risk communication in this population. Little is known, however, concerning the message structure significantly influencing perceived tobacco risk. Objective We aim to outline the rationale and design of Project Debunk, a randomized trial comparing the effects of different SMS text message structures. Methods We conducted a 6-month randomized trial comparing 8 arms, based on the combination of the 3 message structures delivered to young adults in a 2×2×2 study design: framing (gain-framed or loss-framed), depth (simple or complex), and appeal (emotional or rational). Participants were invited to participate from 3 community colleges in Houston from September 2016 to July 2017. Participants were randomized to 1 arm and received text messages in 2 separate campaigns. Each campaign consisted of 2 text messages per day for 30 days. Perceived tobacco risk was assessed at baseline, 2 months after the first campaign, and 2 months after the second campaign. We assessed the perceived risk of using conventional products (eg, combustible cigarettes) and new and emerging products (eg, electronic cigarettes). The validity of message structures was assessed weekly for each campaign. A 1-week follow-up assessment was also conducted to understand immediate reactions from participants. Results We completed data collection for the baseline survey on a rolling basis during this time and assessed the validity of the message structure after 1 week of SMS text messages. For the entire sample (N=636), the average age was 20.92 years (SD 2.52), about two-thirds were male (430/636, 67.6%), and most were black or African American (259/636, 40.7%) or white (236/636, 37.1%). After 1 week of receiving text messages, the following was noted: (a) loss-framed messages were more likely to be perceived as presenting a loss than gain-framed messages (F7,522=13.13, P<.001), (b) complex messages were perceived to be more complex than simple messages (F7,520=2.04, P=.05), and (c) emotional messages were perceived to be more emotionally involving than rational messages (F7,520=6.46, P<.001). Conclusions This study confirms that the recruitment, randomization, and message composition have been successfully implemented. Further analyses will identify specific types of messages that are more effective than others in increasing the perceived risk of tobacco use. If our results suggest that any of the 8 specific message structures are more effective for helping young adults understand tobacco risk, this would provide evidence to include such messages as part of a larger technology-based campaign such as mobile phone apps, entertainment-based campaigns, and social media. Trial Registration ClinicalTrials.gov NCT03457480; https://clinicaltrials.gov/ct2/show/NCT03457480 (Archived by WebCite at http://www.webcitation.org/6ykd4IIap) Registered Report Identifier RR1-10.2196/10977
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Affiliation(s)
- Alexander V Prokhorov
- Department of Behavioral Science, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Georges Elias Khalil
- Department of Behavioral Science, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Karen Sue Calabro
- Department of Behavioral Science, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Tamara Costello Machado
- Department of Behavioral Science, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Sophia Russell
- Department of Behavioral Science, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Katarzyna W Czerniak
- Department of Behavioral Science, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Gabrielle C Botello
- Department of Behavioral Science, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Minxing Chen
- Department of Biostatistics, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Adriana Perez
- Department of Biostatistics and Data Science, School of Public Health in Austin, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX, United States
| | - Damon J Vidrine
- Department of Family and Preventive Medicine, The University of Oklahoma Health Sciences Center, The University of Oklahoma, Oklahoma City, OK, United States
| | - Cheryl L Perry
- School of Public Health in Austin, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX, United States
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Pechacek TF, Nayak P, Slovic P, Weaver SR, Huang J, Eriksen MP. Reassessing the importance of 'lost pleasure' associated with smoking cessation: implications for social welfare and policy. Tob Control 2018; 27:e143-e151. [PMID: 29183920 PMCID: PMC6176518 DOI: 10.1136/tobaccocontrol-2017-053734] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 10/23/2017] [Accepted: 10/24/2017] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Benefit-cost analyses of tobacco regulations include estimates of the informed choice of smokers to continue smoking. Few studies have focused on subjective feelings associated with continued smoking. This study estimates how smoker discontent and regret relate to risk perceptions and health concerns. METHODS We analysed data from a 2015 nationally representative, online survey of 1284 US adult current smokers. Information was collected on regret, intention to quit, perceived addiction, risk perceptions and health concerns. Multivariate logistic regression adjusting for sociodemographics and health status was used to examine factors associated with smoker discontent. RESULTS More than 80% of current smokers report high (22.5%) or very high (59.8%) discontent due to inability to quit, perceived addiction and regret about having started to smoke. Higher levels of discontent did not vary significantly by sex, age, race/ethnicity, education or income (adjusted odds ratios (AORs) 0.5-1.2). Compared with the smokers expressing low (5.9%) or very low (3.6%) discontent, those expressing higher levels of discontent perceived their health status as fair/poor (AOR=2.3), worried most of the time about lung cancer (AOR=4.6) and felt they were more likely to develop lung cancer in the future (AOR=5.1). CONCLUSION The proportion of smokers who might be characterised as having a preference to continue smoking are greatly outnumbered by addicted, discontent and concerned smokers who want to quit and regret ever having started to smoke. These discontent smokers could have a substantial net welfare gain if new regulations helped them escape their concerns about the health effects from continuing smoking.
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Affiliation(s)
- Terry Frank Pechacek
- Georgia State University's Tobacco Center of Regulatory Science, Atlanta, Georgia, USA
- Division of Health Management & Policy, Georgia State University, Atlanta, Georgia, USA
| | - Pratibha Nayak
- Public Health Research & Translational Science, Battelle Memorial Institute, Atlanta, Georgia, USA
| | | | - Scott R Weaver
- Georgia State University's Tobacco Center of Regulatory Science, Atlanta, Georgia, USA
- Division of Epidemiology and Biostatistics, Georgia State University, Atlanta, Georgia, USA
| | - Jidong Huang
- Georgia State University's Tobacco Center of Regulatory Science, Atlanta, Georgia, USA
- Division of Health Management & Policy, Georgia State University, Atlanta, Georgia, USA
| | - Michael P Eriksen
- Georgia State University's Tobacco Center of Regulatory Science, Atlanta, Georgia, USA
- Division of Health Management & Policy, Georgia State University, Atlanta, Georgia, USA
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27
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Perkins KA, Karelitz JL. Acute perceptions of preferred cigarettes when blinded to brand. Tob Control 2018; 28:311-316. [DOI: 10.1136/tobaccocontrol-2018-054388] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 05/22/2018] [Accepted: 06/14/2018] [Indexed: 11/04/2022]
Abstract
BackgroundMarketing claims often have promoted specific perceptions that users should expect from acutely smoking that cigarette brand. Yet, little controlled study has determined the degree to which actual perceptions are based on the cigarette’s tobacco constituents in the absence of knowledge about the brand’s identity.Methods194 adult dependent smokers rated their perceptions on ‘liking’, ‘satisfying’, ‘strong’ and perceived amount of ‘nicotine’ after smoking ad lib one of their preferred brands of cigarettes. All did so either when blinded (n=118) or unblinded (n=76) to the brand they were given, with the blinding conditions from separate studies. These between-groups secondary analyses determined differences in perceptions based on blinding to brand, controlling for age and cigarettes/day.ResultsAll perceptions were lower for those smoking own brand under blinded versus unblinded conditions, as hypothesised. Consistent with lowered perceptions for smoking one’s own brand obtained from the 118 blinded to brand, their ‘somewhat’ ratings for a ‘how similar to own brand’ item indicated uncertainty, just mid-way between ‘not at all’ and ‘very much’ on the 0–100 visual analogue scale. (The 76 unblinded were already informed it was their own brand.)ConclusionsAcute perceptions of one’s own cigarette are substantially lower when smokers are simply unaware of brand, relative to those aware it is their preferred brand. Results support the notion that perceptions of smoking own brand are enhanced by marketing efforts to associate brands with expectations of pleasurable subjective effects, beyond the impact due solely to the cigarette’s manufactured product constituents.
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Abstract
The evolving legal cannabis landscape in the US continues to present novel regulatory challenges that necessitate the development of a Cannabis Regulatory Science. Two specific issues of concern within Cannabis Regulatory Science are (1) the impact that cannabis use has on the incidence, prevalence, and severity of mental disorders, and (2) how cannabis laws and regulations modify this impact. This paper first provides several conceptual points that are useful for evaluating the relationship between cannabis use and mental disorders. Second, it selectively reviews and comments on data relevant to the relationship between cannabis use and depression, several forms of anxiety, post-traumatic stress disorder, schizophrenia, and bipolar disorder. Next, regulatory and public health parallels between the nascent cannabis industry and the pharmaceutical, tobacco, and alcohol industries are discussed. The focus is on specific types of industry practices that may harm those with or at risk for mental disorders. Recommendations are then offered for legal cannabis regulations that could mitigate this harm. Last, future research goals are discussed for building the field of Cannabis Regulatory Science and addressing the potential negative impact of cannabis on those with mental disorders.
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Affiliation(s)
- Jacob T. Borodovsky
- Dartmouth Geisel School of Medicine, Center for Technology and Behavioral Health, 46 Centerra Parkway, Lebanon, NH 03766, United States,The Dartmouth Institute for Health Policy and Clinical Practice, 74 College St. Hanover, NH 03755, United States
| | - Alan J. Budney
- Dartmouth Geisel School of Medicine, Center for Technology and Behavioral Health, 46 Centerra Parkway, Lebanon, NH 03766, United States
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29
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Higgins ST, Redner R, Priest JS, Bunn JY. Socioeconomic Disadvantage and Other Risk Factors for Using Higher-Nicotine/Tar-Yield (Regular Full-Flavor) Cigarettes. Nicotine Tob Res 2018; 19:1425-1433. [PMID: 27613929 DOI: 10.1093/ntr/ntw201] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 07/23/2016] [Indexed: 12/27/2022]
Abstract
Introduction Use of machine-estimated higher nicotine/tar yield (regular full-flavor) cigarettes is associated with increased risk of nicotine dependence. The present study examined risk factors for using full-flavor versus other cigarette types, including socioeconomic disadvantage and other risk factors for tobacco use or tobacco-related adverse health impacts. Associations between use of full-flavor cigarettes and risk of nicotine dependence were also examined. Methods Data were obtained from nationally representative samples of adult cigarette smokers from the US National Survey on Drug Use and Health. Logistic regression and classification and regression tree modeling were used to examine associations between use of full-flavor cigarettes and educational attainment, poverty, race/ethnicity, age, sex, mental illness, alcohol abuse/dependence, and illicit drug abuse/dependence. Logistic regression was used to examine risk for nicotine dependence. Results Each of these risk factors except alcohol abuse/dependence independently predicted increased odds of using full-flavor cigarettes (p < .001), with lower educational attainment the strongest predictor, followed by poverty, male sex, younger age, minority race/ethnicity, mental illness, and drug abuse/dependence, respectively. Use of full-flavor cigarettes was associated with increased odds of nicotine dependence within each of these risk factor groupings (p < .01). Cart modeling identified how prevalence of full-flavor cigarette use can vary from a low of 25% to a high of 66% corresponding to differing combinations of these independent risk factors. Conclusions Use of full-flavor cigarettes is overrepresented in socioeconomically disadvantaged and other vulnerable populations, and associated with increased risk of nicotine dependence. Greater regulation of this cigarette type may be warranted. Implications Greater regulation of commercially available Regular Full-Flavor Cigarettes may be warranted. Use of this type of cigarette is overrepresented in socioeconomically disadvantaged and other vulnerable populations and associated with increased risk for nicotine dependence.
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Affiliation(s)
- Stephen T Higgins
- Vermont Center on Tobacco Regulatory Science, University of Vermont, Burlington, VT.,Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT
| | - Ryan Redner
- Vermont Center on Tobacco Regulatory Science, University of Vermont, Burlington, VT.,Rehabilitation Institute, Southern Illinois University, Carbondale, IL
| | - Jeff S Priest
- Vermont Center on Tobacco Regulatory Science, University of Vermont, Burlington, VT.,Department of Medical Biostatistics, University of Vermont, Burlington, VT
| | - Janice Y Bunn
- Vermont Center on Tobacco Regulatory Science, University of Vermont, Burlington, VT.,Department of Medical Biostatistics, University of Vermont, Burlington, VT
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30
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Nguyen HP, White MA, Tyring SK. Tobacco regulation as a paradigm for advancing regulatory science in dermatology. Int J Dermatol 2018; 57:368-370. [DOI: 10.1111/ijd.13898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 10/17/2017] [Accepted: 12/14/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Harrison P. Nguyen
- Department of Dermatology; Baylor College of Medicine; Houston TX USA
- Department of Epidemiology; Yale School of Public Health; New Haven CT USA
| | - Marney A. White
- Department of Epidemiology; Yale School of Public Health; New Haven CT USA
| | - Stephen K. Tyring
- Department of Dermatology; University of Texas Medical School; Houston TX USA
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31
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Lee JGL, Averett PE, Blanchflower T, Gregory KR. Is the cigarette pack just a wrapper or a characteristic of the product itself? A qualitative study of adult smokers to inform U.S. regulations. J Cancer Policy 2018; 15:45-49. [PMID: 29479517 PMCID: PMC5823528 DOI: 10.1016/j.jcpo.2017.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Purpose In the U.S., tobacco products are now regulated by the Food and Drug Administration (FDA). Litigation has quickly followed. One area of controversy is when a change to the design of the cigarette pack requires approval through FDA’s rigorous premarket review process. In this paper, we examine how adult U.S. smokers view the connection between the design of cigarette packs and the characteristics of the cigarettes within. Methods Data for this qualitative study came from six focus groups conducted in March 2017 with adult smokers. Two groups consisted of lesbian, gay, and bisexual (LGB) participants; two groups of participants with less than four years of college education; one group of LGB and straight identity; and, one group of the general population. All groups were selected for regional, gender, and racial/ethnic diversity. Participants (n = 33) represented all nine U.S. Census divisions. We conducted constant comparison qualitative analysis utilizing a grounded theory approach. Results Participants’ views reflected a belief that pack design is clearly a reflection of the cigarettes within and that a change in the pack signaled a change in the cigarettes. However, some participants felt price was the salient characteristic of cigarettes and design mattered more for enticing young people to smoke. Conclusions Changes in pack design signal changes to the product for smokers. Pack design and changes to pack design are seen as particularly relevant to new and young smokers. These findings provide support for regulations that require assessment of cigarette pack design changes for impacts on public health.
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Affiliation(s)
- Joseph G L Lee
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Mail Stop 529, 1000 E 5th St, Greenville, NC, United States
| | - Paige E Averett
- School of Social Work, College of Health and Human Performance, East Carolina University, Mail Stop 505, 1000 E 5th St, Greenville, NC, United States
| | - Tiffany Blanchflower
- Department of Interior Design and Merchandising, College of Health and Human Performance, East Carolina University, Mail Stop 505, 1000 E 5th St, Greenville, NC, United States
| | - Kyle R Gregory
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Mail Stop 529, 1000 E 5th St, Greenville, NC, United States
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32
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Khalil GE, Calabro KS, Crook B, Machado TC, Perry CL, Prokhorov AV. Validation of mobile phone text messages for nicotine and tobacco risk communication among college students: A content analysis. Tob Prev Cessat 2018; 4. [PMID: 29888338 PMCID: PMC5989570 DOI: 10.18332/tpc/84866] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION In the United States, young adults have the highest prevalence of tobacco use. The dissemination of mobile phone text messages is a growing strategy for tobacco risk communication among young adults. However, little has been done concerning the design and validation of such text messages. The Texas Tobacco Center of Regulatory Science (Texas-TCORS) has developed a library of messages based on framing (gain- or loss-framed), depth (simple or complex) and appeal (emotional or rational). This study validated the library based on depth and appeal, identified text messages that may need improvement, and explored new themes. METHODS The library formed the study sample (N=976 messages). The Linguistic Inquiry and Word Count (LIWC) software of 2015 was used to code for word count, word length and frequency of emotional and cognitive words. Analyses of variance, logistic regression and scatter plots were conducted for validation. RESULTS In all, 874 messages agreed with LIWC-coding. Several messages did not agree with LIWC. Ten messages designed to be complex indicated simplicity, while 51 messages designed to be rational exhibited no cognitive words. New relevant themes were identified, such as health (e.g. ‘diagnosis’, ‘cancer’), death (e.g. ‘dead’, ‘lethal’) and social connotations (e.g. ‘parents’, ‘friends’). CONCLUSIONS Nicotine and tobacco researchers can safely use, for young adults, messages from the Texas-TCORS library to convey information in the intended style. Future work may expand upon the new themes. Findings will be utilized to develop new campaigns, so that risks of nicotine and tobacco products can be widely disseminated.
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Affiliation(s)
- Georges E Khalil
- The University of Texas MD Anderson Cancer Center, Texas, United States
| | - Karen S Calabro
- The University of Texas MD Anderson Cancer Center, Texas, United States
| | - Brittani Crook
- The University of Texas Health Science Center, School of Public Health, Texas, United States
| | - Tamara C Machado
- The University of Texas MD Anderson Cancer Center, Texas, United States
| | - Cheryl L Perry
- The University of Texas Health Science Center, School of Public Health, Texas, United States
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33
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Lee JGL, Averett PE, Blanchflower T, Gregory KR. Qualitative assessment of a Context of Consumption Framework to inform regulation of cigarette pack design in the U.S. Tob Induc Dis 2018; 16:3. [PMID: 29593883 PMCID: PMC5867908 DOI: 10.18332/tid/82925] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Researchers and regulators need to know how changes to cigarette packages can influence population health. We sought to advance research on the role of cigarette packaging by assessing a theory-informed framework from the fields of design and consumer research. The selected Context of Consumption Framework posits cognitive, affective, and behavioral responses to visual design. To assess the Framework’s potential for guiding research on the visual design of cigarette packaging in the U.S., this study seeks to understand to what extent the Context of Consumption Framework converges with how adult smokers think and talk about cigarette pack designs. METHODS Data for this qualitative study came from six telephone-based focus groups conducted in March 2017. Two groups consisted of lesbian, gay, and bisexual participants; two groups of participants with less than four years college education; one group of LGB and straight identity; and one group the general population. All groups were selected for regional, gender, and racial/ethnic diversity. Participants (n=33) represented all nine U.S. Census divisions. We conducted a deductive qualitative analysis. RESULTS Cigarette package designs captured the participants’ attention, suggested the characteristics of the product, and reflected (or could be leveraged to convey) multiple dimensions of consumer identity. Particular to the affective responses to design, our participants shared that cigarette packaging conveyed how the pack could be used to particular ends, created an emotional response to the designs, complied with normative expectations of a cigarette, elicited interest when designs change, and prompted fascination when unique design characteristics are used. CONCLUSIONS Use of the Context of Consumption Framework for cigarette product packaging design can inform regulatory research on tobacco product packaging. Researchers and regulators should consider multiple cognitive, affective, and behavioral responses to cigarette pack design. ABBREVIATIONS FDA: Food and Drug Administration, FSPTCA: Family Smoking Prevention and Tobacco Control Act of 2009
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Affiliation(s)
- Joseph G L Lee
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, North Carolina, United States
| | - Paige E Averett
- School of Social Work, College of Health and Human Performance, East Carolina University, Greenville, North Carolina, United States
| | - Tiffany Blanchflower
- Department of Interior Design and Merchandising, College of Health and Human Performance, East Carolina University, Greenville, North Carolina, United States
| | - Kyle R Gregory
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, North Carolina, United States
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Ginexi EM, Vollinger RE. National Cancer Institute's leadership role in promoting State and Community Tobacco Control research. Tob Control 2018; 25:i4-i5. [PMID: 27697941 PMCID: PMC5099204 DOI: 10.1136/tobaccocontrol-2016-053153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 05/11/2016] [Indexed: 11/06/2022]
Abstract
The National Cancer Institute (NCI) has been at the vanguard of funding tobacco control research for decades with major efforts such as the Community Intervention Trial for Smoking Cessation (COMMIT) in 1988 and the American Stop Smoking Intervention Study (ASSIST) in 1991, followed by the Tobacco Research Initiative for State and Community Interventions in 1999. Most recently, in 2011, the NCI launched the State and Community Tobacco Control (SCTC) Research Initiative to address gaps in secondhand smoke policies, tax and pricing policies, mass media countermeasures, community and social norms and tobacco marketing. The initiative supported large scale research projects and time-sensitive ancillary pilot studies in response to expressed needs of state and community partners. This special issue of Tobacco Control showcases exciting findings from the SCTC. In this introductory article, we provide a brief account of NCI's historical commitment to promoting research to inform tobacco control policy.
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Affiliation(s)
- Elizabeth M Ginexi
- National Cancer Institute, Tobacco Control Research Branch, Bethesda, Maryland, USA
| | - Robert E Vollinger
- National Cancer Institute, Tobacco Control Research Branch, Bethesda, Maryland, USA
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Acceptability of SPECTRUM Research Cigarettes among Participants in Trials of Reduced Nicotine Content Cigarettes. TOB REGUL SCI 2018; 4:573-585. [PMID: 30662929 DOI: 10.18001/trs.4.1.4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Objectives SPECTRUM research cigarettes (SPECTRUMs) are being used in trials evaluating the effects of switching to reduced nicotine content (RNC) cigarettes. Because smokers have a high brand affinity, we evaluated if they were willing to switch and continue smoking normal nicotine content (NNC) SPECTRUMs. Methods We asked smokers (N = 341) to rate their own brand of cigarettes and NNC SPECTRUMs (after 2 weeks of use) using subjective measures including satisfaction, reward, taste, and craving reduction. We measured plasma cotinine, exhaled carbon monoxide (CO), and cigarettes per day (CPD), and recorded reasons for dropping out. Results After 2 weeks, 95% of participants chose to continue using SPECTRUMs for an additional 18 weeks. Moreover, 67% said SPECTRUMs were as good as or better than their own brand, and 65% said they would consider purchasing them. Ratings of satisfaction, reward, and craving reduction were 10%-15% lower on SPECTRUMs than on their own brand (p < .01). There were no differences in these ratings between menthol and non-menthol smokers. Conclusions Menthol and non-menthol SPECTRUMs are acceptable to smokers. Lower SPECTRUM ratings were likely due to brand switching and did not hinder study retention.
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"Their Packaging Has Always Been Like a Power": A Qualitative Study of U.S. Smokers' Perceptions of Cigarette Pack Visual Design Features to Inform Product Regulation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14101234. [PMID: 29039769 PMCID: PMC5664735 DOI: 10.3390/ijerph14101234] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 09/30/2017] [Accepted: 10/12/2017] [Indexed: 11/20/2022]
Abstract
Cigarette packaging matters to consumer behavior. However, it is less clear which changes to packaging design would be salient for adult smokers. Such information is critically important to regulators in the United States who are charged with reviewing new tobacco products for their impact on population health. In this qualitative study, U.S. adult smokers (n = 33) participated in six telephone-based focus groups in March 2017. Separate groups were comprised of lesbian, gay, and bisexual (LGB) participants; participants with less than four years of post-secondary education; a mix of LGB and straight participants; and, the general population. All groups were purposely selected for diversity. Open thematic coding identified salient design elements used on cigarette packaging. Smokers articulated design elements’ use, meaning, and links with consumer behaviors. Three themes were identified: (1) the power of color, (2) supporting color with other design elements (e.g., logos/images, typography, the pack itself), and (3) the combined product brand experience of multiple design elements. Participants linked design elements to product characteristics and to consumer behavior (e.g., purchase). As the Food and Drug Administration is charged with regulating tobacco products, these findings suggest the importance of considering the cigarette pack part of the characteristics of a product.
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Higgins ST, Reed DD, Redner R, Skelly JM, Zvorsky IA, Kurti AN. Simulating demand for cigarettes among pregnant women: A Low-Risk method for studying vulnerable populations. J Exp Anal Behav 2016; 107:176-190. [PMID: 28000917 DOI: 10.1002/jeab.232] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 11/17/2016] [Accepted: 11/17/2016] [Indexed: 11/11/2022]
Abstract
A substantive obstacle to experimentally studying cigarette smoking and use of other tobacco products in pregnant women is the risk of adverse effects on mother and fetus from experimenter administration of the product of interest. The purpose of this study is to investigate bypassing that obstacle by using behavioral economic simulation tasks. In the present study we used the Cigarette Purchase Task (CPT) to simulate changes in demand for hypothetical cigarettes as a function of varying cigarette prices. Participants were 95 pregnant women who completed the CPT prior to participation in a smoking-cessation trial. Aggregate and individual participant demand varied as an orderly function of price and those changes were well fitted by an exponential equation. Demand also varied in correspondence to two well-validated predictors of individual differences in smoking cessation among pregnant women (cigarettes smoked per day, pre-pregnancy quit attempts). Moreover, CPT indices were more effective than these two conventional variables in predicting individual differences in whether women made a quit attempt during the current pregnancy. Overall, these results represent a promising step in demonstrating the validity and utility of the CPT for experimentally examining demand for cigarettes, and potentially other tobacco and nicotine delivery products, among pregnant women.
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Affiliation(s)
- Stephen T Higgins
- Vermont Center on Behavior and Health.,Department of Psychiatry, University of vermont.,Department Of Psychological Science, University Of Vermont
| | - Derek D Reed
- Department of Applied Behavioral Science, University of Kansas
| | - Ryan Redner
- Behavior Analysis and Therapy Program, Rehabilitation Institute Southern Illinois University
| | - Joan M Skelly
- Department Of Medical Biostatistics, University of Vermont
| | - Ivori A Zvorsky
- Vermont Center on Behavior and Health.,Department Of Psychological Science, University Of Vermont
| | - Allison N Kurti
- Vermont Center on Behavior and Health.,Department of Psychiatry, University of vermont
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Higgins ST, Kurti AN, Redner R, White TJ, Keith DR, Gaalema DE, Sprague BL, Stanton CA, Roberts ME, Doogan NJ, Priest JS. Co-occurring risk factors for current cigarette smoking in a U.S. nationally representative sample. Prev Med 2016; 92:110-117. [PMID: 26902875 PMCID: PMC4992654 DOI: 10.1016/j.ypmed.2016.02.025] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 02/16/2016] [Accepted: 02/18/2016] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Relatively little has been reported characterizing cumulative risk associated with co-occurring risk factors for cigarette smoking. The purpose of the present study was to address that knowledge gap in a U.S. nationally representative sample. METHODS Data were obtained from 114,426 adults (≥18years) in the U.S. National Survey on Drug Use and Health (years 2011-13). Multiple logistic regression and classification and regression tree (CART) modeling were used to examine risk of current smoking associated with eight co-occurring risk factors (age, gender, race/ethnicity, educational attainment, poverty, drug abuse/dependence, alcohol abuse/dependence, mental illness). RESULTS Each of these eight risk factors was independently associated with significant increases in the odds of smoking when concurrently present in a multiple logistic regression model. Effects of risk-factor combinations were typically summative. Exceptions to that pattern were in the direction of less-than-summative effects when one of the combined risk factors was associated with generally high or low rates of smoking (e.g., drug abuse/dependence, age ≥65). CART modeling identified subpopulation risk profiles wherein smoking prevalence varied from a low of 11% to a high of 74% depending on particular risk factor combinations. Being a college graduate was the strongest independent predictor of smoking status, classifying 30% of the adult population. CONCLUSIONS These results offer strong evidence that the effects associated with common risk factors for cigarette smoking are independent, cumulative, and generally summative. The results also offer potentially useful insights into national population risk profiles around which U.S. tobacco policies can be developed or refined.
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Affiliation(s)
- Stephen T Higgins
- Vermont Center on Tobacco Regulatory Science, University of Vermont, United States.
| | - Allison N Kurti
- Vermont Center on Tobacco Regulatory Science, University of Vermont, United States
| | - Ryan Redner
- Vermont Center on Tobacco Regulatory Science, University of Vermont, United States
| | - Thomas J White
- Vermont Center on Tobacco Regulatory Science, University of Vermont, United States
| | - Diana R Keith
- Vermont Center on Tobacco Regulatory Science, University of Vermont, United States
| | - Diann E Gaalema
- Vermont Center on Tobacco Regulatory Science, University of Vermont, United States
| | - Brian L Sprague
- Vermont Center on Tobacco Regulatory Science, University of Vermont, United States
| | | | - Megan E Roberts
- Center of Excellence in Regulatory Tobacco Science, The Ohio State University, United States
| | - Nathan J Doogan
- Center of Excellence in Regulatory Tobacco Science, The Ohio State University, United States
| | - Jeff S Priest
- Vermont Center on Tobacco Regulatory Science, University of Vermont, United States
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Advances in Behavioral Laboratory Methods that Inform Tobacco Regulatory Science: A TCORS Working Group Special Issue. TOB REGUL SCI 2016; 2:294-300. [PMID: 29152546 DOI: 10.18001/trs.2.4.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective The 2009 Family Smoking Prevention and Tobacco Control Act (TCA) created unprecented enabling conditions for establishing national regulatory policy that reduces the burden of public health and societal problems associated with tobacco product use. The Center for Tobacco Products (CTP), created by the FDA to implement the TCA, developed a first-of-its-kind FDA/National Institutes of Health (NIH) collaborative program to fund Tobacco Centers of Regulatory Science (TCORS). Methods To assist the TCORS with addressing research priorites, working groups (WGs) comprised of FDA-CTP liasions and TCORS investigators were formed. Under the direction of the Center for Evaluation and Coordination of Trainin and Research (CECTR), the TCORS WGs seek to develop tangible work products in their respective areas of focus. Results The focus of the behavioral pharmacology WG evolved from publishing a narrow paper on behavioral methods in electronic cigarette research to a collection of papers on advances in behavioral laboratory methods that may inform tobacco regulatory science. Conclusion This Special Issue contains articles that address all of the CTP research priorities and demonstrates how advances in behavioral laboratory methods made by TCORS investigators can inform FDA efforst to regulate tobacco products.
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Abstract
OBJECTIVES Research that can provide a scientific foundation for the United States Food and Drug Administration (FDA) tobacco policy decisions is needed to inform tobacco regulatory policy. One factor that affects the impact of a tobacco product on public health is its intensity of use, which is determined, in part, by its abuse liability or reinforcing efficacy. Behavioral economic tasks have considerable utility for assessing the reinforcing efficacy of current and emerging tobacco products. METHODS This paper provides a narrative review of several behavioral economic laboratory tasks and identifies important applications to tobacco regulatory science. RESULTS Behavioral economic laboratory assessments, including operant self-administration, choice tasks and purchase tasks, can be used generate behavioral economic data on the effect of price and other constraints on tobacco product consumption. These tasks could provide an expedited simulation of the effects of various tobacco control policies across populations of interest to the FDA. CONCLUSIONS Tobacco regulatory research questions that can be addressed with behavioral economic tasks include assessments of the impact of product characteristics on product demand, assessments of the abuse liability of novel and potential modified risk tobacco products (MRTPs), and assessments of the impact of conventional and novel products in vulnerable populations.
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Weng DY, Chen J, Taslim C, Hsu PC, Marian C, David SP, Loffredo CA, Shields PG. Persistent alterations of gene expression profiling of human peripheral blood mononuclear cells from smokers. Mol Carcinog 2016; 55:1424-37. [PMID: 26294040 PMCID: PMC4860148 DOI: 10.1002/mc.22385] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 07/04/2015] [Accepted: 08/03/2015] [Indexed: 01/12/2023]
Abstract
The number of validated biomarkers of tobacco smoke exposure is limited, and none exist for tobacco-related cancer. Additional biomarkers for smoke, effects on cellular systems in vivo are needed to improve early detection of lung cancer, and to assist the Food and Drug Administration in regulating exposures to tobacco products. We assessed the effects of smoking on the gene expression using human cell cultures and blood from a cross-sectional study. We profiled global transcriptional changes in cultured smokers' peripheral blood mononuclear cells (PBMCs) treated with cigarette smoke condensate (CSC) in vitro (n = 7) and from well-characterized smokers' blood (n = 36). ANOVA with adjustment for covariates and Pearson correlation were used for statistical analysis in this study. CSC in vitro altered the expression of 1 178 genes (177 genes with > 1.5-fold-change) at P < 0.05. In vivo, PBMCs of heavy and light smokers differed for 614 genes (29 with > 1.5-fold-change) at P < 0.05 (309 remaining significant after adjustment for age, race, and gender). Forty-one genes were persistently altered both in vitro and in vivo, 22 having the same expression pattern reported for non-small cell lung cancer. Our data provides evidence that persistent alterations of gene expression in vitro and in vivo may relate to carcinogenic effects of cigarette smoke, and the identified genes may serve as potential biomarkers for cancer. The use of an in vitro model to corroborate results from human studies provides a novel way to understand human exposure and effect. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Daniel Y Weng
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Jinguo Chen
- Center for Human Immunology, National Institute of Health, Bethesda, Maryland
| | - Cenny Taslim
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Ping-Ching Hsu
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Catalin Marian
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
- University of Medicine and Pharmacy, Timisoara, Romania
| | - Sean P David
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Christopher A Loffredo
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia
| | - Peter G Shields
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio.
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Wipfli HL, Berman M, Hanson K, Kelder S, Solis A, Villanti AC, Ribeiro CMP, Meissner HI, Anderson R. Defining Tobacco Regulatory Science Competencies. Nicotine Tob Res 2016; 19:222-230. [PMID: 27613917 DOI: 10.1093/ntr/ntw178] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 07/05/2016] [Indexed: 11/12/2022]
Abstract
INTRODUCTION In 2013, the National Institutes of Health and the Food and Drug Administration funded a network of 14 Tobacco Centers of Regulatory Science (TCORS) with a mission that included research and training. A cross-TCORS Panel was established to define tobacco regulatory science (TRS) competencies to help harmonize and guide their emerging educational programs. The purpose of this paper is to describe the Panel's work to develop core TRS domains and competencies. METHODS The Panel developed the list of domains and competencies using a semistructured Delphi method divided into four phases occurring between November 2013 and August 2015. RESULTS The final proposed list included a total of 51 competencies across six core domains and 28 competencies across five specialized domains. CONCLUSIONS There is a need for continued discussion to establish the utility of the proposed set of competencies for emerging TRS curricula and to identify the best strategies for incorporating these competencies into TRS training programs. Given the field's broad multidisciplinary nature, further experience is needed to refine the core domains that should be covered in TRS training programs versus knowledge obtained in more specialized programs. IMPLICATIONS Regulatory science to inform the regulation of tobacco products is an emerging field. The paper provides an initial list of core and specialized domains and competencies to be used in developing curricula for new and emerging training programs aimed at preparing a new cohort of scientists to conduct critical TRS research.
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Affiliation(s)
- Heather L Wipfli
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA;
| | - Micah Berman
- Ohio State University, College of Public Health & Moritz College of Law, Columbus, OH
| | - Kacey Hanson
- The University of Texas Health Science Center at Houston, Austin, TX
| | - Steven Kelder
- The University of Texas Health Science Center at Houston, Austin, TX
| | | | - Andrea C Villanti
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC
| | - Carla M P Ribeiro
- Department of Medicine/Pulmonary Division, Marsico Lung Institute and Cystic Fibrosis Center; Department of Cell Biology and Physiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Helen I Meissner
- Office of Disease Prevention, National Institutes of Health, Bethesda, MD
| | - Roger Anderson
- University of Virginia School of Medicine, Charlottesville, VA
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Tidey JW, Cassidy RN, Miller ME. Smoking Topography Characteristics of Very Low Nicotine Content Cigarettes, With and Without Nicotine Replacement, in Smokers With Schizophrenia and Controls. Nicotine Tob Res 2016; 18:1807-12. [PMID: 26995794 PMCID: PMC4978982 DOI: 10.1093/ntr/ntw089] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 03/09/2016] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Reducing the nicotine content of cigarettes to a minimally addictive level has been proposed as a regulatory strategy for reducing tobacco dependence. However, smokers with schizophrenia (SS) may be prone to changing their smoking topography in efforts to compensate for the reduction in nicotine content. The aims of this study were to compare smoking topography characteristics of usual-brand and very low nicotine content (VLNC) cigarettes in SS and control smokers without psychiatric illness (CS), and to determine whether nicotine replacement reversed any changes in topography produced by VLNC cigarettes. METHODS Using a within-subjects, counter-balanced design, SS (n = 27) and CS (n = 23) smoked usual brand cigarettes, VLNC cigarettes while wearing placebo patches (VLNC + PLA), or VLNC cigarettes while wearing transdermal nicotine patches totaling 42mg (VLNC + NIC) during 5-hour ad libitum smoking sessions. Cigarettes were smoked through topography measurement devices. RESULTS Across conditions, SS smoked more puffs per session and per cigarette, had higher cigarette volumes, and had shorter inter-puff intervals than CS (Ps < .01). During VLNC cigarette sessions, puff duration increased and time between puffs decreased, but participants smoked fewer puffs, resulting in a net decrease in cigarette and total session volume (Ps < .001). There were no significant interactions between group and condition. CONCLUSIONS These findings indicate that acute use of VLNC cigarettes does not increase intensity of smoking in SS, and support the feasibility of a nicotine reduction policy. IMPLICATIONS Reducing the nicotine in cigarettes to a minimally addictive level has been proposed as a means of reducing tobacco dependence. However, smokers, particularly those with schizophrenia (SS) may alter their puffing in an attempt to extract more nicotine from VLNC cigarettes. This study compared smoking topography of usual brand versus VLNC cigarettes, combined with placebo or transdermal nicotine patches, in SS and controls. Although some changes in topography were indicative of compensatory smoking, total puffs and total cigarette volume were reduced with VLNC cigarettes, indicating that acute VLNC cigarette use does not increase smoking in SS.
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Affiliation(s)
- Jennifer W Tidey
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI
| | - Rachel N Cassidy
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI
| | - Mollie E Miller
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI
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Abstract
OBJECTIVE Restricting tobacco marketing is a key element in the US Food and Drug Administration's (FDA) public health framework for regulating tobacco. Given the dearth of empirical data on direct marketing, the objective of this study was to assess the reach and impact of promotions on sales through snuff websites. METHODS Nine brands of snuff, representing more than 90% of market share, were monitored for content of coupons, sweepstakes, contests, and other promotions on their respective websites. Monthly sales data and website traffic for the 9 brands, corresponding to the 48-month period of January 2011 through December 2014, were obtained from proprietary sources. A time-series analysis, based on the autoregressive, integrated, moving average (ARIMA) method, was employed for testing the relationships among sales, website visits, and promotions. RESULTS Website traffic increased substantially during the promotion periods for most brands. Time-series analyses, however, revealed that promotion periods for 5 of 7 brands did not significantly correlate with monthly snuff sales. CONCLUSIONS The success in attracting tobacco consumers to website promotions demonstrates the marketing reach of snuff manufacturers. This form of direct marketing should be monitored by the FDA given evidence of adolescents' exposure to cigarette brand websites.
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Nitzkin JL. What Drives Tobacco Control Policy? Nicotine Tob Res 2016; 18:1802-3. [PMID: 27095447 PMCID: PMC4941604 DOI: 10.1093/ntr/ntw104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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Abstract
In May 2016, the Food and Drug Administration extended its tobacco regulatory authorities to other products meeting the definition of a tobacco product (Deeming Rule). This authority now includes, but is not limited to, electronic nicotine delivery systems (ENDS), such as electronic cigarettes, as well as all cigars, pipes, and hookahs (waterpipes). The FDA's Center for Tobacco Products has been able to fund research projects addressing these newly deemed tobacco products through a variety of mechanisms, including partnership with the Tobacco Regulatory Science Program, National Institutes of Health. In building the evidence base to inform the regulation of and communications about new and emerging tobacco products, it is important for investigators to be mindful of the goals of tobacco regulatory science, ie, scientific inquiry specifically to inform potential regulatory decisions and actions to protect the public's health. Having solid scientific evidence will allow the FDA to make the most appropriate regulatory decisions regarding newly deemed products.
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Maziak W, Ben Taleb Z, Jawad M, Afifi R, Nakkash R, Akl EA, Ward KD, Salloum RG, Barnett TE, Primack BA, Sherman S, Cobb CO, Sutfin EL, Eissenberg T. Consensus statement on assessment of waterpipe smoking in epidemiological studies. Tob Control 2016; 26:338-343. [PMID: 27165995 DOI: 10.1136/tobaccocontrol-2016-052958] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 04/20/2016] [Indexed: 01/03/2023]
Abstract
Numerous epidemiological accounts suggest that waterpipe smoking (aka hookah, shisha, narghile) has become a global phenomenon, especially among youth. The alarming spread of waterpipe and accumulating evidence of its addictive and harmful effects represent a new threat in the global fight to limit tobacco-related morbidity and mortality. In response to waterpipe's alarming trends, major public health and tobacco control organisations have started or are considering systematic collection of data about waterpipe smoking to monitor its trends and assess its harmful effects in different societies. Such plans require coordination and agreement on epidemiological measurement tools that reflect the uniqueness of this tobacco use method, and at the same time allow comparison of waterpipe trends across time and place, and with other tobacco use methods. We started a decade ago our work to develop standardised measures and definitions for the assessment of waterpipe smoking in epidemiological studies. In this communication, we try to expand and update these assessment tools in light of our increased knowledge and understanding of waterpipe use patterns, its context and marketing, as well as the need for evidence-guided policies and regulations to curb its spread. We have assembled for this purpose a group of leading waterpipe researchers worldwide, and worked through an iterative process to develop the suggested instruments and definitions based on what we know currently about the waterpipe epidemic. While the suggested measures are by no means comprehensive, we hope that they can provide the building blocks for standard and comparable surveillance of waterpipe smoking globally.
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Affiliation(s)
- Wasim Maziak
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA.,Syrian Center for Tobacco Studies, Aleppo, Syria
| | - Ziyad Ben Taleb
- Department of Epidemiology, Florida International University, Miami, Florida, USA
| | - Mohammed Jawad
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Rima Afifi
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Rima Nakkash
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Elie A Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon.,Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Kenneth D Ward
- Syrian Center for Tobacco Studies, Aleppo, Syria.,Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, Tennessee, USA
| | - Ramzi G Salloum
- Department of Health Outcomes and Policy, and Institute for Child Health Policy, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Tracey E Barnett
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Brian A Primack
- Center for Research on Media, Technology, and Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Scott Sherman
- Departments of Population Health, Medicine and Psychiatry, New York University School of Medicine, New York University, New York, New York, USA
| | - Caroline O Cobb
- Department of Psychology and Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Erin L Sutfin
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Thomas Eissenberg
- Syrian Center for Tobacco Studies, Aleppo, Syria.,Department of Psychology and Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA
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Mays D, Arrazola RA, Tworek C, Rolle IV, Neff LJ, Portnoy DB. Openness to Using Non-cigarette Tobacco Products Among U.S. Young Adults. Am J Prev Med 2016; 50:528-534. [PMID: 26549502 PMCID: PMC5253657 DOI: 10.1016/j.amepre.2015.08.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 08/03/2015] [Accepted: 08/03/2015] [Indexed: 11/19/2022]
Abstract
INTRODUCTION National data indicate that the prevalence of non-cigarette tobacco product use is highest among young adults; however, little is known about their openness to use these products in the future and associated risk factors. This study sought to characterize openness to using non-cigarette tobacco products and associated factors among U.S. young adults. METHODS In 2014, National Adult Tobacco Survey data (2012-2013) were analyzed to characterize openness to using the following tobacco products among all young adults aged 18-29 years (N=5,985): cigars; electronic cigarettes ("e-cigarettes"); hookah; pipe tobacco; chew, snuff, or dip; snus; and dissolvables. Among those who were not current users of each product, multivariable logistic regression was used to examine associations between demographics, cigarette smoking status, lifetime use of other non-cigarette products, perceived harm and addictiveness of smoking, and receipt of tobacco industry promotions and openness to using each product. RESULTS Among all young adults, openness to using non-cigarette tobacco products was greatest for hookah (28.2%); e-cigarettes (25.5%); and cigars (19.1%). In multivariable analyses, which included non-current users of each product, non-current ever, current, and former smokers were more likely than never smokers to be open to using most examined products, as were men and adults aged 18-24 years. Receipt of tobacco industry promotions was associated with openness to using e-cigarettes; chew, snuff, or dip; and snus. CONCLUSIONS There is substantial openness to trying non-cigarette tobacco products among U.S. young adults. Young adults are an important population to consider for interventions targeting non-cigarette tobacco product use.
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Affiliation(s)
- Darren Mays
- Food and Drug Administration Tobacco Regulatory Science Fellowship Program, Silver Spring, Maryland; Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, District of Columbia
| | - René A Arrazola
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Cindy Tworek
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland
| | - Italia V Rolle
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Linda J Neff
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - David B Portnoy
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland.
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Kurti AN, Davis DR, Skelly JM, Redner R, Higgins ST. Comparison of nicotine dependence indicators in predicting quitting among pregnant smokers. Exp Clin Psychopharmacol 2016; 24:12-7. [PMID: 27046504 PMCID: PMC4822339 DOI: 10.1037/pha0000056] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Research in the general population of smokers indicates that across various measures of nicotine dependence, time to first cigarette (TTFC) is the strongest single-item predictor of quitting success. Whether those findings generalize to pregnant smokers is unclear. To investigate this matter, we compared TTFC with cigarettes per day (CPD) and the Heaviness of Smoking Index (HSI; Kozlowski, Porter, Orleans, Pope, & Heatherton, 1994) in predicting late-pregnancy abstinence among 289 pregnant women enrolled in 4 smoking-cessation trials assessing the efficacy of financial incentives. Logistic regression was used to compare predictors, with model fit measured using the c statistic (range = 0.5, poor prediction to 1.0, perfect prediction). In simple regressions, model fit was comparable across the 3 measures although strongest for CPD alone (c = 0.70, 0.68, 0.66 for CPD, HSI, and TTFC, respectively). In a stepwise multiple regression, treatment was entered first (c = 0.67), then CPD (c = 0.77), quit attempts prepregnancy (c = .81), TTFC (c = .82), and quit attempts during pregnancy (c = .83). We saw no evidence supporting TTFC as the optimal predictor of quitting among pregnant smokers. Instead, the evidence supported using CPD and TTFC together or CPD alone if using only a single predictor.
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Affiliation(s)
- Allison N. Kurti
- Vermont Center on Behavior and Health, University of Vermont,Department of Psychiatry, University of Vermont
| | - Danielle R. Davis
- Vermont Center on Behavior and Health, University of Vermont,Department of Psychiatry, University of Vermont,Department of Psychology, University of Vermont
| | - Joan M. Skelly
- Department of Medical Biostatistics, University of Vermont
| | - Ryan Redner
- Vermont Center on Behavior and Health, University of Vermont,Department of Psychiatry, University of Vermont
| | - Stephen T. Higgins
- Vermont Center on Behavior and Health, University of Vermont,Department of Psychiatry, University of Vermont,Department of Psychology, University of Vermont
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Shadel WG, Martino S, Setodji C, Scharf D, Kusuke D, Sicker A, Gong M. Hiding the tobacco power wall reduces cigarette smoking risk in adolescents: using an experimental convenience store to assess tobacco regulatory options at retail point-of-sale. Tob Control 2015; 25:tobaccocontrol-2015-052529. [PMID: 26598502 PMCID: PMC4877296 DOI: 10.1136/tobaccocontrol-2015-052529] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This experiment tested whether changing the location or visibility of the tobacco power wall in a life sized replica of a convenience store had any effect on adolescents' susceptibility to future cigarette smoking. METHODS The study was conducted in the RAND StoreLab (RSL), a life sized replica of a convenience store that was developed to experimentally evaluate how changing aspects of tobacco advertising displays in retail point-of-sale environments influences tobacco use risk and behaviour. A randomised, between-subjects experimental design with three conditions that varied the location or visibility of the tobacco power wall within the RSL was used. The conditions were: cashier (the tobacco power wall was located in its typical position behind the cash register counter); sidewall (the tobacco power wall was located on a sidewall away from the cash register); or hidden (the tobacco power wall was located behind the cashier but was hidden behind an opaque wall). The sample included 241 adolescents. RESULTS Hiding the tobacco power wall significantly reduced adolescents' susceptibility to future cigarette smoking compared to leaving it exposed (ie, the cashier condition; p=0.02). Locating the tobacco power wall on a sidewall away from the cashier had no effect on future cigarette smoking susceptibility compared to the cashier condition (p=0.80). CONCLUSIONS Hiding the tobacco power wall at retail point-of-sale locations is a strong regulatory option for reducing the impact of the retail environment on cigarette smoking risk in adolescents.
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Affiliation(s)
| | - Steven Martino
- RAND Corporation 4570 5 Avenue, Suite 600, Pittsburgh, PA 15260
| | - Claude Setodji
- RAND Corporation 4570 5 Avenue, Suite 600, Pittsburgh, PA 15260
| | - Deborah Scharf
- RAND Corporation 4570 5 Avenue, Suite 600, Pittsburgh, PA 15260
| | - Daniela Kusuke
- RAND Corporation 4570 5 Avenue, Suite 600, Pittsburgh, PA 15260
| | - Angela Sicker
- RAND Corporation 4570 5 Avenue, Suite 600, Pittsburgh, PA 15260
| | - Min Gong
- RAND Corporation 4570 5 Avenue, Suite 600, Pittsburgh, PA 15260
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