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Moze JM, O’Gara EK, Fritz Fogel K, D’Silva J, Matter CM, Nichols EM. Youth Perspectives on Menthol Sales Restrictions in Minneapolis and Duluth, Minnesota. Health Promot Pract 2023; 24:1163-1173. [PMID: 36263446 PMCID: PMC10601345 DOI: 10.1177/15248399221127046] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although menthol cigarettes are a starter product for youth, menthol was exempted from the 2009 Tobacco Control Act, which banned all other characterizing flavors. Minneapolis and Duluth, Minnesota, implemented menthol tobacco sales restrictions in 2018 to advance health equity for youth, African American, lesbian, gay, bisexual, trans, and queer (LGBTQ), and other communities adversely affected by menthol. This evaluation assesses the policy impact on youth access to menthol tobacco, exposure to menthol advertising, and tobacco use. A core group of youth aged 14 to 17 years (n = 30) was recruited from Minneapolis and Duluth to gather data through photo voice and peer interviews 2 months before and after policy implementation. This evaluation shares the results of focus groups with these core youth where they reflected on what they observed in the community and heard from peers. The core youth identified and categorized emergent themes using the evaluation questions. Following the focus groups, the evaluation staff used these preliminary themes and coded remaining transcripts. The core youth had mixed reactions to the impact of policies on access and use because many tobacco users in their age group obtain tobacco informally through peers, family members, and online. They observed decreases in retail advertising of menthol cigarettes, although many felt e-cigarettes and online advertising were more significant issues for their age group. Findings show a need for increased education and more comprehensive policy approaches, including addressing use of flavored e-cigarettes, online tobacco sales, and informal access, making youth access to tobacco more difficult.
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Affiliation(s)
- Joanne M. Moze
- Blue Cross and Blue Shield of Minnesota, Saint Paul, MN, USA
| | | | | | | | - Chris M. Matter
- Blue Cross and Blue Shield of Minnesota, Saint Paul, MN, USA
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2
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Kaai SC, Fong GT, Ong'ang'o JR, Goma F, Meng G, Craig LV, Ikamari L, Quah ACK, Elton-Marshall T. Prevalence, perceptions and factors associated with menthol cigarette smoking: findings from the ITC Kenya and Zambia Surveys. Tob Control 2023; 32:709-714. [PMID: 35459749 PMCID: PMC10646928 DOI: 10.1136/tobaccocontrol-2021-057100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 04/01/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Menthol masks the harshness of cigarette smoke, promotes youth smoking and encourages health-concerned smokers who incorrectly believe that menthols are less harmful to smoke menthols. This study of smokers in Kenya and Zambia is the first study in Africa to examine menthol use, smokers' beliefs about its harmfulness and the factors associated with menthols. METHODS Data were from the International Tobacco Control (ITC) Kenya Wave 2 (2018) and Zambia Wave 2 Survey (2014), involving nationally representative samples of smokers. This study focuses on 1246 adult smokers (644 in Kenya, 602 in Zambia) who reported smoking a usual brand of cigarettes (menthol or non-menthol). RESULTS Overall, menthol use was significantly higher among smokers in Zambia than in Kenya (48.0% vs 19.0%), females (45.6% vs 31.2% males), non-daily smokers (43.8% vs 30.0% daily) and those who exclusively smoked factory-made (FM) cigarettes (43.0% vs 15.2%). The erroneous belief that menthols are less harmful was more likely among smokers in Zambia than in Kenya (53.4% vs 29.3%) and among female smokers (38.5% vs 28.2%). In Kenya, menthol smoking was associated with being female (adjusted odds ratios (AOR)=3.07; p=0.03), worrying about future health (AOR=2.28; p=0.02) and disagreeing with the statement that smoking was calming (AOR=2.05; p=0.04). In Zambia, menthol use was associated with being female (AOR=3.91; p=0.002), completing primary school (AOR=2.14; p=0.03), being a non-daily smoker (AOR=2.29; p=0.03), exclusively using FM cigarettes (AOR=14.7; p<0.001), having a past quit attempt (AOR=1.54; p=0.02), believing that menthols are less harmful (AOR=3.80; p<0.001) and choosing menthols because they believed it was less harmful (AOR=3.52; p<0.001). CONCLUSIONS Menthols are highly prevalent among females in both countries. There is a need in African countries to combat the myth that menthols are less harmful and to ban menthol and other flavourings.
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Affiliation(s)
- Susan Cherop Kaai
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | | | - Fastone Goma
- University of Zambia School of Medicine, Lusaka, Zambia
| | - Gang Meng
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Lorraine V Craig
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | | | - Anne C K Quah
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Tara Elton-Marshall
- School of Epidemiology and Public Health, University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, London, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
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3
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Brown JL, Neptune E. Role of Menthol and Other Flavors on Tobacco and Nicotine Product Use. Respir Med 2023. [DOI: 10.1007/978-3-031-24914-3_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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4
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Rubenstein D, Sweitzer MM, Scroggs LB, Denlinger-Apte RL, Kozink R, McClernon FJ. Menthol preference moderates the relationship between cigarette nicotine content choice and reactions in young adults who smoke infrequently. Drug Alcohol Depend 2022; 238:109580. [PMID: 35908345 PMCID: PMC9648692 DOI: 10.1016/j.drugalcdep.2022.109580] [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: 05/07/2022] [Revised: 06/23/2022] [Accepted: 07/17/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Half of young adults who smoke use menthol cigarettes, which is associated with continued smoking and greater nicotine dependence. Additionally, early subjective reactions to cigarettes predict future use. Menthol may blunt the sensory effects of nicotine. We investigated the moderating role of menthol on subjective reactions to, and choice of varied nicotine content cigarettes in young adults who smoke infrequently. METHODS In three counterbalanced, double-blinded sessions, young adults who smoke ≤ 15 days/month smoked fixed doses from very low (VLNC), intermediate (INC), and normal (NNC) nicotine content cigarettes, which were menthol or non-menthol depending on preference. Participants chose their preferred cigarette in a final session. Positive and negative subjective reactions were measured in each session. ANOVA tests investigated the relationship between menthol preference, nicotine content, and subjective reactions. RESULTS Participants (N = 87) were 18-25 years old and reported smoking 15.2 cigarettes per month over 8 days (35 % menthol). Non-menthol preferring participants had increased negative reactions with greater nicotine content (F(1, 55)= 10.76, p < .001); menthol preferring participants did not. Choice of higher nicotine cigarettes was associated with having reported a greater difference in positive reactions to NNC and VLNC for non-menthol preferring participants (F(1, 55)= 12.72, p < .001) but not for menthol preferring participants. CONCLUSIONS Young adults who smoke infrequently are a priority tobacco control population given their high risk of transitioning to daily smoking. Results from this study in the form of subjective reactions indicate that a menthol ban is required for a nicotine reduction standard to be maximally effective in this vulnerable group.
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Affiliation(s)
- Dana Rubenstein
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27705, United States.
| | - Maggie M Sweitzer
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27705, United States
| | - Lauren B Scroggs
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27705, United States
| | - Rachel L Denlinger-Apte
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC 27157, United States
| | - Rachel Kozink
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27705, United States
| | - F Joseph McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27705, United States
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Vaihekoski A, Lagström H, Eloranta S, Bäärs S, Hannula A, Lehvikkö M, Salakari M. Influencing adolescents’ attitudes towards nicotine products: A systematic review. NORDIC STUDIES ON ALCOHOL AND DRUGS 2022; 39:568-584. [PMID: 36284743 PMCID: PMC9549219 DOI: 10.1177/14550725221096908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 04/11/2022] [Indexed: 11/24/2022] Open
Abstract
Background and aim: Use of nicotine can harm adolescents’ brains and
increase risk for future addiction to other drugs. Several international studies
show that an acceptable attitude towards nicotine products increases the
initiation or use of the products. Adolescents have limited or distorted
knowledge about nicotine products. Many of them have a positive image of the
properties and effects of nicotine products, which increases the chances of
smoking or using snus. Yet, we know little about the relationship between youth
nicotine use, youth attitudes towards nicotine products and the interventions to
influence these attitudes. This systematic review synthesised adolescents’
attitudes towards nicotine products and the ways to influence them.
Methods: Systematic searches were carried out from PubMed,
MEDLINE, CINAHL, and MEDIC databases and were targeted to randomised controlled
trial (RCT) studies published in 2010–2021. Results: A total of
seven RCT studies were reviewed with a total population (age range 9–17 years,
adolescents 11–17 years) of 15,974. Findings were classified into four
categories: school-based interventions, tobacco prevention campaigns,
advertisements’ influence on adolescents’ opinions towards nicotine products,
and their responses to cigarette pack warnings. Conclusion: Based
on this systematic literature review, particularly school-based interventions
have an effect on adolescents’ attitudes towards smoking and preventing them
from starting to smoke, when they are targeted before the age of puberty.
School-based interventions should be further implemented and strengthened, as
the school has been shown to have significant potential to support youth’s
health. There is a need for further information about the most effective
interventions in the different age groups and the qualitative studies on the
topic.
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Affiliation(s)
| | - Hanna Lagström
- University of Turku, Turku, Finland; and Turku University Hospital, Turku, Finland
| | - Sini Eloranta
- University of Turku, Turku, Finland; University of Oulu, Oulu, Finland; and Turku University of Applied Science, Turku, Finland
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Jesch E, Kikut AI, Hornik R. Comparing belief in short-term versus long-term consequences of smoking and vaping as predictors of non-use in a 3-year nationally representative survey study of US youth. Tob Control 2021:tobaccocontrol-2021-056886. [PMID: 34725270 PMCID: PMC9056580 DOI: 10.1136/tobaccocontrol-2021-056886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/09/2021] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Efforts to prevent youth tobacco use are critical to reducing smoking-related deaths in the USA. Anti-tobacco messaging often focuses on the severe long-term consequences of smoking (eg, fatal lung disease, cancer). It is unclear whether these long-term consequences are more likely to deter youth use than shorter term consequences (eg, headaches, friend disapproval). METHODS A nationally representative 3-year rolling survey of adolescents and young adults (ages 13-26 years) measured belief in potential consequences of two types of tobacco products: combustible cigarettes (n=11 847) and electronic cigarettes (n=4470) as well as intentions and current use. Independent coders classified 23 consequences as either short or long term. Logistic regression tested the associations between short-term (vs long-term) beliefs and current intentions, as well as non-smoking behaviour at 6-month follow-up. RESULTS Believing in both short-term and long-term consequences was associated with outcomes, but short-term beliefs were more highly associated with anti-smoking (OR=1.40, 95% CI (1.30 to 1.51)) and anti-vaping (OR=2.10, 95% CI (1.75 to 2.52)) intentions and better predicted non-smoking behaviour at follow-up, controlling for prior use (OR=1.75, 95% CI (1.33 to 2.31)). CONCLUSIONS These results support temporal discounting by adolescents and young adults and suggest health communication efforts aiming to reduce youth tobacco use should emphasise shorter term consequences.
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Affiliation(s)
- Emma Jesch
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ava Irysa Kikut
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robert Hornik
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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7
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Mancuso S, Brennan E, Dunstone K, Vittiglia A, Durkin S, Thrasher JF, Hoek J, Wakefield M. Australian Smokers' Sensory Experiences and Beliefs Associated with Menthol and Non-Menthol Cigarettes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115501. [PMID: 34063735 PMCID: PMC8196669 DOI: 10.3390/ijerph18115501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 05/12/2021] [Indexed: 11/16/2022]
Abstract
Many current smokers incorrectly believe that menthol cigarettes are less harmful, likely due to the biological and sensory effects of menthol, which can lead smokers to have favourable sensory experiences. In this study, we measured the extent to which Australian smokers associate certain sensory experiences with smoking menthol and non-menthol cigarettes, and their beliefs about how damaging and enjoyable they find cigarettes with each of these sensory experiences. A sample of 999 Australian 18–69-year-old weekly smokers was recruited from a non-probability online panel; this study focuses on the 245 respondents who currently smoked menthol cigarettes at least once per week. Current menthol smokers were four to nine times more likely to experience menthol rather than non-menthol cigarettes as having favourable sensory experiences, including feeling smooth, being soothing on the throat, fresh-tasting and clean-feeling. Menthol smokers perceived cigarettes with these favourable sensations as less damaging and more enjoyable than cigarettes with the opposite more aversive sensory experience. Efforts to correct these misperceptions about risk will likely require messages that provide new information to help smokers understand that these sensations do not indicate a lower level of risk. Banning menthol in tobacco products—as has recently been done in some nations—would also be a timely and justified strategy for protecting consumers.
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Affiliation(s)
- Serafino Mancuso
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, VIC 3004, Australia; (S.M.); (K.D.); (A.V.); (S.D.); (M.W.)
| | - Emily Brennan
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, VIC 3004, Australia; (S.M.); (K.D.); (A.V.); (S.D.); (M.W.)
- Correspondence:
| | - Kimberley Dunstone
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, VIC 3004, Australia; (S.M.); (K.D.); (A.V.); (S.D.); (M.W.)
| | - Amanda Vittiglia
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, VIC 3004, Australia; (S.M.); (K.D.); (A.V.); (S.D.); (M.W.)
| | - Sarah Durkin
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, VIC 3004, Australia; (S.M.); (K.D.); (A.V.); (S.D.); (M.W.)
| | - James F. Thrasher
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA;
| | - Janet Hoek
- Department of Public Health, University of Otago, Wellington 6140, New Zealand;
| | - Melanie Wakefield
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, VIC 3004, Australia; (S.M.); (K.D.); (A.V.); (S.D.); (M.W.)
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8
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Gilbert E, Ewald A. Fresher with flavour: young women smokers' constructions and experiences of menthol capsule cigarettes and regular cigarettes. BMC WOMENS HEALTH 2021; 21:155. [PMID: 33863322 PMCID: PMC8051088 DOI: 10.1186/s12905-021-01297-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 03/23/2021] [Indexed: 11/23/2022]
Abstract
Background Flavour capsule cigarettes are one of the fastest growing segments of the tobacco market, and there is evidence that Australian young people are increasingly using menthol flavoured capsule cigarettes. This qualitative research examines how young women construct and experience menthol flavour capsule cigarettes as part of their smoking practices, and explores the perceived differences between menthol capsule cigarettes and regular cigarettes. Semi-structured face-to-face in-depth interviews were conducted with 41 Australian young women smokers, using a constructivist grounded theory approach. Results Findings reveal that the perceived fresh and improved taste of menthol and the ability to customise the smoking process positively contributed to young women’s experiences of smoking menthol capsule cigarettes. In particular, menthol capsule flavour cigarettes were constructed by the young women as “fresh”, “light” and “minty”, and “popping” the menthol capsule allowed the young women to personalise their smoking experience. Conclusion These results indicate that specific public health campaigns and legislation should be developed to counter the powerfully alluring effects and the innovative appeal of menthol capsule cigarettes. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-021-01297-2.
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Affiliation(s)
- E Gilbert
- School of Psychology, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.
| | - A Ewald
- School of Psychology, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
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Jao NC, Tan MM, Matthews PA, Simon MA, Schnoll R, Hitsman B. Menthol Cigarettes, Tobacco Dependence, and Smoking Persistence: The Need to Examine Enhanced Cognitive Functioning as a Neuropsychological Mechanism. Nicotine Tob Res 2020; 22:466-472. [PMID: 30551213 DOI: 10.1093/ntr/nty264] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 12/11/2018] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Despite the overall decline in the prevalence of cigarette use in the United States, menthol cigarette use among smokers is rising, and evidence shows that it may lead to more detrimental effects on public health than regular cigarette use. One of the mechanisms by which nicotine sustains tobacco use and dependence is due to its cognitive enhancing properties, and basic science literature suggests that menthol may also enhance nicotine's acute effect on cognition. AIMS AND METHODS The purpose of this review is to suggest that the cognitive enhancing effects of menthol may be a potentially important neuropsychological mechanism that has yet to be examined. In this narrative review, we provide an overview of basic science studies examining neurobiological and cognitive effects of menthol and menthol cigarette smoking. We also review studies examining menthol essential oils among humans that indicate menthol alone has acute cognitive enhancing properties. Finally, we present factors influencing the rising prevalence of menthol cigarette use among smokers and the importance of this gap in the literature to improve public health and smoking cessation treatment. CONCLUSIONS Despite the compelling evidence for menthol's acute cognitive enhancing and reinforcing effects, this mechanism for sustaining tobacco dependence and cigarette use has yet to be examined and validated among humans. On the basis of the basic science evidence for menthol's neurobiological effects on nicotinic receptors and neurotransmitters, perhaps clarifying menthol's effect on cognitive performance can help to elucidate the complicated literature examining menthol and tobacco dependence. IMPLICATIONS Menthol cigarette use has continued to be a topic of debate among researchers and policy makers, because of its implications for understanding menthol's contribution to nicotine dependence and smoking persistence, as well as its continued use as a prevalent flavoring in tobacco and nicotine products in the United States and internationally. As international tobacco regulation policies have begun to target menthol cigarettes, research studies need to examine how flavoring additives, specifically menthol, may acutely influence neurobiological and cognitive functioning as a potential mechanism of sustained smoking behavior to develop more effective treatments.
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Affiliation(s)
- Nancy C Jao
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Marcia M Tan
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Phoenix A Matthews
- Department of Health Systems Science, University of Illinois at Chicago, Chicago, IL
| | - Melissa A Simon
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.,Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL.,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Robert Schnoll
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
| | - Brian Hitsman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
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10
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Denlinger-Apte RL, Cassidy RN, Colby SM, Sokolovsky AW, Tidey JW. Effects of Cigarette Nicotine Content and Menthol Preference on Perceived Health Risks, Subjective Ratings, and Carbon Monoxide Exposure Among Adolescent Smokers. Nicotine Tob Res 2019; 21:S56-S62. [PMID: 31867646 PMCID: PMC6939772 DOI: 10.1093/ntr/ntz127] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 08/06/2019] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Minimal research exists on adolescent smokers' perceptions of very low-nicotine-content (VLNC) cigarettes. As approximately half of adolescent smokers prefer menthol cigarettes, it is important to consider the influence of menthol preference on VLNC cigarette perceptions and to what extent menthol preference may affect VLNC smoking behavior. This study examined the effects of cigarette nicotine content and menthol preference or menthol smoking on health risk perceptions, subjective ratings, and carbon monoxide (CO) boost in adolescent smokers. METHODS Across two counterbalanced sessions, adolescent smokers sampled VLNC and normal nicotine content (NNC) research cigarettes following overnight abstinence. Cigarettes were mentholated or non-mentholated consistent with participants' usual brand. In each session, participants smoked the research cigarette and then completed the Perceived Health Risk Scale and Cigarette Evaluation Scale. Breath CO readings were obtained pre- and post-smoking. Mixed-factor ANOVA tests compared outcomes with cigarette type (VLNC vs. NNC) as the within-subjects factor and menthol preference as the between-subjects factor. RESULTS Participants (N = 50) were M = 17.7 years old, smoked M = 8.2 cigarettes/day, and 56% typically smoked menthol cigarettes. Participants reported lower risk of developing lung cancer, other cancers, emphysema, bronchitis, and heart disease (ps ≤ .05) when smoking VLNC cigarettes relative to NNC cigarettes. Perceived risk of addiction and stroke did not differ by nicotine content. Menthol preference or menthol smoking did not moderate risk perceptions, subjective ratings, or CO boost. CONCLUSIONS Adolescents may incorrectly perceive that VLNC cigarettes are less harmful products. Health communication campaigns could help to correct VLNC misperceptions and potentially minimize unintended consequences of a nicotine reduction policy.
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Affiliation(s)
- Rachel L Denlinger-Apte
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI
| | - Rachel N Cassidy
- Center for Alcohol and Addiction Studies, School of Public Health, Brown University, Providence, RI
| | - Suzanne M Colby
- Center for Alcohol and Addiction Studies, School of Public Health, Brown University, Providence, RI
| | - Alexander W Sokolovsky
- Center for Alcohol and Addiction Studies, School of Public Health, Brown University, Providence, RI
| | - Jennifer W Tidey
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI
- Center for Alcohol and Addiction Studies, School of Public Health, Brown University, Providence, RI
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11
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Lazard AJ, Kowitt SD, Huang LL, Noar SM, Jarman KL, Goldstein AO. Believability of Cigarette Warnings About Addiction: National Experiments of Adolescents and Adults. Nicotine Tob Res 2019; 20:867-875. [PMID: 29059352 DOI: 10.1093/ntr/ntx185] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 08/28/2017] [Indexed: 11/15/2022]
Abstract
Introduction We conducted two experiments to examine the believability of three addiction-focused cigarette warnings and the influence of message source on believability among adolescents and adults in the United States. Methods Experimental data were collected using national phone surveys of adolescents (age 13-17; n = 1125; response rate, 66%) and adults (age 18+; n = 5014; response rate, 42%). We assessed the believability of three cigarette warnings about addiction attributed to four message sources (Food and Drug Administration [FDA], Surgeon General, Centers for Disease Control and Prevention [CDC], no source). Results The majority of adolescents and adults reported the three cigarette warnings were very believable (49%-81% for adolescents; 47%-76% for adults). We found four to five times higher odds of adolescents believing a warning that cigarettes are addictive (warning 1) or that nicotine was an addictive chemical (warning 2) compared to a warning that differentiated the addictive risks of menthol versus traditional cigarettes (warning 3), warning 1 adjusted odds ratio (aOR): 4.53, 95% confidence interval (CI): 3.10, 6.63; warning 2 aOR: 3.87, 95% CI: 2.70, 5.50. Similarly, we found three to five times higher odds of adults (including current smokers) believing the same warnings, warning 1 aOR: 3.74, 95% CI: 2.82, 4.95; warning 2 aOR: 3.24, 95% CI: 2.45, 4.28. Message source had no overall impact on the believability of warnings for either population. Conclusions Our findings support the implementation of FDA's required warnings that cigarettes are addictive and that nicotine is an addictive chemical. These believable warnings may deter adolescents from initiating smoking and encourage adults to quit smoking. Implications This article describes, for the first time, the believability of different cigarette warnings about addiction. We now know that the majority of adolescents and adults believe cigarette warnings that highlight cigarettes as addictive and that nicotine is an addictive chemical in tobacco. However, a warning that highlighted the relative risk of addiction for menthol cigarettes compared to traditional cigarettes was not as believable among either population. Our findings support the implementation of FDA's required warnings that cigarettes are addictive and that nicotine is an addictive chemical that may deter adolescents from initiating smoking and encourage adults to quit smoking.
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Affiliation(s)
- Allison J Lazard
- School of Media and Journalism, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Sarah D Kowitt
- Department of Health Behavior, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Li-Ling Huang
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Seth M Noar
- School of Media and Journalism, University of North Carolina at Chapel Hill, Chapel Hill, NC.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Kristen L Jarman
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Adam O Goldstein
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC.,Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
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12
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Wackowski OA, Evans KR, Harrell MB, Loukas A, Lewis MJ, Delnevo CD, Perry CL. In Their Own Words: Young Adults' Menthol Cigarette Initiation, Perceptions, Experiences and Regulation Perspectives. Nicotine Tob Res 2019; 20:1076-1084. [PMID: 28339669 DOI: 10.1093/ntr/ntx048] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 02/16/2017] [Indexed: 11/12/2022]
Abstract
Background Menthol cigarettes are disproportionately used by young people and have been called smoking starter products. However, limited qualitative research exists on young adults' perceptions of and experiences with these products, with much of it based on document reviews of the tobacco industry's research. Methods We conducted six focus groups with young adult (ages 18-24) menthol smokers in New Jersey (half with black smokers) between December 2014 and March 2015. Participants were asked open-ended questions about their menthol smoking initiation, preference reasons, substitution behaviors, and perceptions of menthol cigarette risks and regulation. Results Participants' menthol cigarette initiation and preference were influenced by their perceived popularity, brand recognition, taste, smoothness, satisfaction and access (including as "loosies," typically available for Newport). Some believed menthol cigarettes were less harmful than non-menthol cigarettes when initiating smoking. Many currently believed menthol cigarettes were more harmful because they contained extra "additives," were stronger (ie, requiring fewer cigarettes to feel satisfied), and/or based on hearsay. Many had tried new brand Camel Crush, which was perceived to be especially minty, fun, and attractive for newer smokers. While some used non-menthol cigarettes when menthols were unavailable, many said they would never or almost never substitute. Many acknowledged a menthol cigarettes ban would likely help them quit smoking, even though they did not support the idea. Conclusions Menthol cigarette initiation is influenced by an interplay of multiple factors including their sensory properties, marketing, perceived popularity and availability. The FDA should continue to pursue closing this flavored cigarette loophole. Implications In this first qualitative study of menthol cigarette use among young adults, we found further evidence that menthol cigarettes can act as starter products because they are perceived as easier to smoke and taste and smell better than non-menthol cigarettes. We also add to the literature in finding that menthol cigarettes are perceived by young people who smoke menthol cigarettes as delivering satisfaction with fewer cigarettes, being accessible as "loosies", and being popular among their peers. Many did not understand the reasons behind a potential menthol ban. Any future regulation of menthol cigarettes should include a public educational campaign to support buy-in.
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Affiliation(s)
- Olivia A Wackowski
- Department of Health Education and Behavioral Science, Center for Tobacco Studies, Rutgers School of Public Health, Piscataway, NJ
| | - Kiameesha R Evans
- Department of Health and Physical Education, Monmouth University, West Long Branch, NJ
| | - Melissa B Harrell
- Division of Epidemiology, Human Genetics and Environmental Sciences, University of Texas, School of Public, Austin, TX
| | - Alexandra Loukas
- Department of Kinesiology and Health Education, University of Texas, College of Education, Austin, TX
| | - M Jane Lewis
- Department of Health Education and Behavioral Science, Center for Tobacco Studies, Rutgers School of Public Health, Piscataway, NJ
| | - Cristine D Delnevo
- Department of Health Education and Behavioral Science, Center for Tobacco Studies, Rutgers School of Public Health, Piscataway, NJ
| | - Cheryl L Perry
- Department of Health Promotion and Behavioral Sciences, University of Texas, School of Public, Austin, TX
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13
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Marti J, Buckell J, Maclean JC, Sindelar J. To "vape" or smoke? Experimental evidence on adult smokers. ECONOMIC INQUIRY 2019; 57:705-725. [PMID: 30559550 PMCID: PMC6294299 DOI: 10.1111/ecin.12693] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 05/10/2018] [Indexed: 05/19/2023]
Abstract
A growing share of the United States population uses e-cigarettes but the optimal regulation of these controversial products remains an open question. We conduct a discrete choice experiment to investigate how adult tobacco cigarette smokers' demand for e-cigarettes and tobacco cigarettes varies by four attributes: (i) whether e-cigarettes are considered healthier than tobacco cigarettes, (ii) the effectiveness of e-cigarettes as a cessation device, (iii) bans on use in public places, and (iv) price. We find that adult smokers' demand for e-cigarettes is motivated more by health concerns than by the desire to avoid smoking bans or higher prices.
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Affiliation(s)
- Joachim Marti
- Lecturer, Institute of Social and Preventive Medicine (IUMSP), Centre Hospitalier Universitaire Vaudois, Université de Lausanne, Lausanne, Switzerland;
| | - John Buckell
- Post-doctoral Associate, School of Public Health, Yale University,
| | | | - Jody Sindelar
- Professor, School of Public Health, Yale University, NBER, & IZA,
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14
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Atzendorf J, Aschenbrenner AB, Gomes de Matos E, Kraus L, Kröger C, Delle S, Piontek D. [E-cigarettes: Perceived harmfulness and use for smoking cessation]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2018; 61:1415-1421. [PMID: 30284625 DOI: 10.1007/s00103-018-2822-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The perception that e‑cigarettes are less harmful than traditional tobacco products can influence the consumption of e‑cigarettes. OBJECTIVES Three questions were examined: (1) How do different population groups perceive health risks of e‑cigarettes? (2) Do sociodemographic variables explain differences in the risk assessment of e‑cigarettes? (3) Does the perception of health risks predict the use of e‑cigarettes for smoking cessation? METHODS Data came from the 2015 Epidemiological Survey of Substance Abuse (ESA) with a sample size of n = 9204 participants, aged 18 to 64 years (response rate 52.2%). Data were collected by telephone, online, or by written questionnaires. Assessments of risk perception of e‑cigarettes and conventional cigarettes (more harmful, just as harmful, less harmful, do not know) were compared. Descriptive statistics and logistic regressions were performed. RESULTS Individuals with lower education rated e‑cigarettes as more harmful. Older people and women perceived e‑cigarettes as just as harmful. Smokers considered e‑cigarettes to be more harmful than or just as harmful as conventional tobacco products. The likelihood of using e‑cigarettes for smoking cessation was higher if people thought they were less harmful than conventional cigarettes. CONCLUSIONS Only one-third of the population knows that e‑cigarettes are less harmful to health than conventional cigarettes. The perception of health risks is related to the usage of e‑cigarettes for smoking cessation.
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Affiliation(s)
- Josefine Atzendorf
- IFT Institut für Therapieforschung, Leopoldstraße 175, 80804, München, Deutschland.
| | | | - Elena Gomes de Matos
- IFT Institut für Therapieforschung, Leopoldstraße 175, 80804, München, Deutschland
| | - Ludwig Kraus
- IFT Institut für Therapieforschung, Leopoldstraße 175, 80804, München, Deutschland.,Department of Public Health Sciences, Stockholm University, Stockholm, Schweden.,Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Ungarn
| | | | - Simone Delle
- IFT Institut für Therapieforschung, Leopoldstraße 175, 80804, München, Deutschland
| | - Daniela Piontek
- IFT Institut für Therapieforschung, Leopoldstraße 175, 80804, München, Deutschland
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15
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Nyman AL, Sterling KL, Majeed BA, Jones DM, Eriksen MP. Flavors and Risk: Perceptions of Flavors in Little Cigars and Cigarillos Among U.S. Adults, 2015. Nicotine Tob Res 2018; 20:1055-1061. [PMID: 28666353 PMCID: PMC6093397 DOI: 10.1093/ntr/ntx153] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 06/27/2017] [Indexed: 11/14/2022]
Abstract
Introduction Flavored little cigars, cigarillos, and filtered cigars (LCCs) are popular and pose unique health risks. This study explored risk perceptions of flavors in LCCs and the relationship between perceptions and use among U.S. adults. Methods Data were from the 2015 Tobacco Products and Risk Perceptions Survey of a national probability sample of 6051 adults, conducted online, August-September, 2015. The analytic sample consisted of 5105 adults aware of LCCs and 2174 who had ever used any type of LCCs. Results Just over half of adults reported flavors in LCCs as "very" or "somewhat" risky, while more than one-third of adults reported they did not know the risks of flavors in LCCs. Younger adults, males, and users of any LCCs were more likely than older adults, females and non-users, respectively, to perceive LCC flavors as less risky. Those who perceived LCC flavors as "not at all risky" or "a little risky" were roughly twice as likely to have ever used flavored LCCs compared to those who reported not knowing the risks (AOR = 2.07, 95% CI = 1.16 to 3.69 and AOR = 1.96, 95% CI = 1.26 to 3.06). Those who reported LCC flavors as "very risky" were also more likely to have ever used flavored LCCs than those who reported not knowing the risks (AOR = 1.50, 95% CI = 1.13 to 1.98). Conclusions Though the proportion of adults assigning low risk to flavors in LCCs is small, these adults are more likely to use flavored LCCs. The association of use with risk perceptions of flavors in LCCs should be addressed in health risk campaigns. Implications Flavored LCCs are popular, particularly among young adults. While understanding the impact of flavors is an FDA research priority, little is currently known about perceptions of risk associated with flavors in LCCs. This study explores the nature of risk perceptions of flavors in LCCs, and the relationship between perceptions and flavored LCC use. We conclude that perception of risk of flavors in LCCs is related to use of these products, particularly perception of less risk. Considering the relationship between use and risk perceptions would be helpful in constructing health risk messaging.
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Affiliation(s)
- Amy L Nyman
- Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA
| | - Kymberle L Sterling
- Division of Health Promotion & Behavior, School of Public Health, Georgia State University, Atlanta, GA
| | - Ban A Majeed
- Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA
| | - Dina M Jones
- Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA
| | - Michael P Eriksen
- Division of Health Management & Policy, School of Public Health, Georgia State University, Atlanta, GA
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16
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Chung-Hall J, Fong GT, Driezen P, Craig L. Smokers' support for tobacco endgame measures in Canada: findings from the 2016 International Tobacco Control Smoking and Vaping Survey. CMAJ Open 2018; 6:E412-E422. [PMID: 30266779 PMCID: PMC6182113 DOI: 10.9778/cmajo.20180025] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The Canadian government has committed to an endgame target of less than 5% tobacco use by 2035. The aims of this study were to assess baseline levels of support for potential endgame policies among Canadian smokers, by province/region, demographic characteristics and smoking-related correlates, and to identify predictors of support. METHODS We analyzed data for 3215 adult (age ≥ 18 yr) smokers from the Canadian arm of the 2016 International Tobacco Control Four Country Smoking and Vaping Survey. We estimated weighted percentages of support for endgame measures for 6 provinces/regions of the country. We used weighted logistic regression models to identify predictors of support for 14 endgame strategies. RESULTS Among cigarette endgame policies, support was highest for reducing nicotine content (70.2%), raising the legal age for purchase (69.8%), increasing access to alternative nicotine products (65.8%) and banning marketing (58.5%). Among e-cigarette policies, there was majority support for restricting youth access (86.1%), restricting nicotine content (64.9%), prohibiting use in smoke-free places (63.4%) and banning marketing (54.8%). The level of support for other endgame measures ranged from 28.9% to 45.2%. Support for cigarette and e-cigarette policies was generally higher among smokers with intentions to quit and those from Quebec. Support for e-cigarette policies was generally lower among smokers who also used e-cigarettes daily. INTERPRETATION There is considerable support among Canadian smokers for endgame policies that go beyond current approaches to tobacco control. Our findings provide a baseline for evaluating future trends in smokers' support for innovative measures to radically reduce smoking rates in Canada.
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Affiliation(s)
- Janet Chung-Hall
- Department of Psychology (Chung-Hall, Fong, Driezen, Craig) and School of Public Health and Health Systems (Fong), University of Waterloo, Waterloo, Ont.; Ontario Institute for Cancer Research (Fong), Toronto, Ont
| | - Geoffrey T Fong
- Department of Psychology (Chung-Hall, Fong, Driezen, Craig) and School of Public Health and Health Systems (Fong), University of Waterloo, Waterloo, Ont.; Ontario Institute for Cancer Research (Fong), Toronto, Ont.
| | - Pete Driezen
- Department of Psychology (Chung-Hall, Fong, Driezen, Craig) and School of Public Health and Health Systems (Fong), University of Waterloo, Waterloo, Ont.; Ontario Institute for Cancer Research (Fong), Toronto, Ont
| | - Lorraine Craig
- Department of Psychology (Chung-Hall, Fong, Driezen, Craig) and School of Public Health and Health Systems (Fong), University of Waterloo, Waterloo, Ont.; Ontario Institute for Cancer Research (Fong), Toronto, Ont
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17
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Villanti AC, Collins LK, Niaura RS, Gagosian SY, Abrams DB. Menthol cigarettes and the public health standard: a systematic review. BMC Public Health 2017; 17:983. [PMID: 29284458 PMCID: PMC5747135 DOI: 10.1186/s12889-017-4987-z] [Citation(s) in RCA: 143] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 12/10/2017] [Indexed: 11/22/2022] Open
Abstract
Background Although menthol was not banned under the Tobacco Control Act, the law made it clear that this did not prevent the Food and Drug Administration from issuing a product standard to ban menthol to protect public health. The purpose of this review was to update the evidence synthesis regarding the role of menthol in initiation, dependence and cessation. Methods A systematic review of the peer-reviewed literature on menthol cigarettes via a PubMed search through May 9, 2017. The National Cancer Institute’s Bibliography of Literature on Menthol and Tobacco and the FDA’s 2011 report and 2013 addendum were reviewed for additional publications. Included articles addressing initiation, dependence, and cessation were synthesized based on study design and quality, consistency of evidence across populations and over time, coherence of findings across studies, and plausibility of the findings. Results Eighty-two studies on menthol cigarette initiation (n = 46), dependence (n = 14), and cessation (n = 34) were included. Large, representative studies show an association between menthol and youth smoking that is consistent in magnitude and direction. One longitudinal and eight cross-sectional studies demonstrate that menthol smokers report increased nicotine dependence compared to non-menthol smokers. Ten studies support the temporal relationship between menthol and reduced smoking cessation, as they measure cessation success at follow-up. Conclusions The strength and consistency of the associations in these studies support that the removal of menthol from cigarettes is likely to reduce youth smoking initiation, improve smoking cessation outcomes in adult smokers, and in turn, benefit public health. Electronic supplementary material The online version of this article (10.1186/s12889-017-4987-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andrea C Villanti
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC, USA. .,Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, Burlington, VT, USA. .,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Lauren K Collins
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC, USA
| | - Raymond S Niaura
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC, USA.,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Oncology, Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | | | - David B Abrams
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC, USA.,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Oncology, Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC, USA
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18
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Tan ASL, Lee CJ, Nagler RH, Bigman CA. To vape or not to vape? Effects of exposure to conflicting news headlines on beliefs about harms and benefits of electronic cigarette use: Results from a randomized controlled experiment. Prev Med 2017; 105:97-103. [PMID: 28882742 PMCID: PMC5653463 DOI: 10.1016/j.ypmed.2017.08.024] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 08/16/2017] [Accepted: 08/27/2017] [Indexed: 11/30/2022]
Abstract
News coverage of novel tobacco products including e-cigarettes has framed the use of these products with both positive and negative slants. Conflicting information may shape public knowledge, perceptions of e-cigarettes, and their harms. The objective of this study is to assess effects of exposure to conflicting news coverage on US adults' beliefs about harms and benefits of e-cigarette use. We conducted a one-way between-subjects randomized controlled experiment in 2016 to compare the effects of viewing either 1) positive, 2) negative, 3) both positive and negative (conflicting) news headlines about the safety of using e-cigarettes, or 4) no-message. Participants were 2056 adults aged 18 and older from an online survey panel. Outcomes were beliefs about harms (3-item scale, α=0.76) and benefits (3-item scale, α=0.82) of using e-cigarettes. Participants who viewed negative headlines reported increased beliefs about harms (B=0.164, p=0.039) and lower beliefs about benefits of e-cigarette use (B=-0.216, p=0.009), compared with those in the positive headlines condition. These differences were replicated in subgroup analyses among never e-cigarette users. In addition, never e-cigarette users who viewed conflicting headlines reported lower beliefs about benefits of e-cigarette use (B=-0.221, p=0.030) than the positive headlines condition. Valence of news coverage about e-cigarettes (positive, negative, or conflicting) could influence people's beliefs about harms and benefits of e-cigarette use.
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Affiliation(s)
- Andy S L Tan
- Dana-Farber Cancer Institute, Population Sciences Division, Center for Community Based Research, Boston, USA; Harvard TH Chan School of Public Health, Department of Social and Behavioral Sciences, Boston, USA.
| | - Chul-Joo Lee
- Seoul National University, Department of Communication, Seoul, Republic of Korea
| | - Rebekah H Nagler
- University of Minnesota, Hubbard School of Journalism and Mass Communication, Minneapolis, USA
| | - Cabral A Bigman
- University of Illinois at Urbana-Champaign, Department of Communication, Urbana, USA
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19
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Rose SW, Jo CL, Binns S, Buenger M, Emery S, Ribisl KM. Perceptions of Menthol Cigarettes Among Twitter Users: Content and Sentiment Analysis. J Med Internet Res 2017; 19:e56. [PMID: 28242592 PMCID: PMC5348619 DOI: 10.2196/jmir.5694] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 08/21/2016] [Accepted: 01/30/2017] [Indexed: 11/16/2022] Open
Abstract
Background Menthol cigarettes are used disproportionately by African American, female, and adolescent smokers. Twitter is also used disproportionately by minority and younger populations, providing a unique window into conversations reflecting social norms, behavioral intentions, and sentiment toward menthol cigarettes. Objective Our purpose was to identify the content and frequency of conversations about menthol cigarettes, including themes, populations, user smoking status, other tobacco or substances, tweet characteristics, and sentiment. We also examined differences in menthol cigarette sentiment by prevalent categories, which allowed us to assess potential perceptions, misperceptions, and social norms about menthol cigarettes on Twitter. This approach can inform communication about these products, particularly to subgroups who are at risk for menthol cigarette use. Methods Through a combination of human and machine classification, we identified 94,627 menthol cigarette-relevant tweets from February 1, 2012 to January 31, 2013 (1 year) from over 47 million tobacco-related messages gathered prospectively from the Twitter Firehose of all public tweets and metadata. Then, 4 human coders evaluated a random sample of 7000 tweets for categories, including sentiment toward menthol cigarettes. Results We found that 47.98% (3194/6657) of tweets expressed positive sentiment, while 40.26% (2680/6657) were negative toward menthol cigarettes. The majority of tweets by likely smokers (2653/4038, 65.70%) expressed positive sentiment, while 91.2% (320/351) of nonsmokers and 71.7% (91/127) of former smokers indicated negative views. Positive views toward menthol cigarettes were predominant in tweets that discussed addiction or craving, marijuana, smoking, taste or sensation, song lyrics, and tobacco industry or marketing or tweets that were commercial in nature. Negative views toward menthol were more common in tweets about smoking cessation, health, African Americans, women, and children and adolescents—largely due to expression of negative stereotypes associated with these groups’ use of menthol cigarettes. Conclusions Examinations of public opinions toward menthol cigarettes through social media can help to inform the framing of public communication about menthol cigarettes, particularly in light of potential regulation by the European Union, US Food and Drug Administration, other jurisdictions, and localities.
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Affiliation(s)
- Shyanika W Rose
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC, United States
| | - Catherine L Jo
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Steven Binns
- Health Media Collaboratory, NORC at the University of Chicago, Chicago, IL, United States
| | - Melissa Buenger
- Health Media Collaboratory, NORC at the University of Chicago, Chicago, IL, United States
| | - Sherry Emery
- Health Media Collaboratory, NORC at the University of Chicago, Chicago, IL, United States
| | - Kurt M Ribisl
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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20
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Smith DM, Bansal-Travers M, Huang J, Barker D, Hyland AJ, Chaloupka F. Association between use of flavoured tobacco products and quit behaviours: findings from a cross-sectional survey of US adult tobacco users. Tob Control 2016; 25:ii73-ii80. [PMID: 27708123 PMCID: PMC5669040 DOI: 10.1136/tobaccocontrol-2016-053313] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 09/07/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND Non-menthol characterising flavours (eg, fruit, candy) are banned in cigarettes, yet are still permitted in non-cigarette tobacco (NCT) products. This study examined associations between first use and current use of flavoured tobacco products, and current flavoured tobacco use and quit behaviours. METHODS A nationally representative, telephone-based survey completed in 2012 by 1443 US adult tobacco users asked about use of 9 tobacco products: cigarettes, e-cigarettes, cigars, cigarillos, little filtered cigars, pipes, hookah, smokeless tobacco and snus. Ever users reported first use of flavoured products, while current users also reported current flavoured product use. Current users reported quit attempts made in the past year. Data were weighted to reflect the US adult tobacco user population. Logistic regression models were used to examine associations between first/current flavour use and quit behaviours. RESULTS Over 70% of respondents reported first use of a flavoured tobacco product, while 54% reported current use of at least one flavoured product. Odds of current flavoured product use were greater among those who reported first use of a flavoured product (OR 14.82, 95% CI 9.96 to 22.06). First use of a flavoured product was associated with being a current tobacco user (OR 1.55, 95% CI 1.08 to 2.22). Compared to single product users, polytobacco users exhibited greater odds of reporting current use of flavoured products (OR 2.09, 95% CI 1.47 to 2.97). Forty-four percent of current tobacco users reported a past-year quit attempt. Adjusted analyses among current NCT users of at least one flavoured tobacco product showed reduced odds of reporting a quit attempt. CONCLUSIONS First use of a flavoured tobacco product was associated with current flavoured tobacco use and polytobacco use. Users of only flavoured NCT products exhibited reduced odds of reporting a quit attempt. Findings from this study reinforce the importance of flavoured product availability in the USA, which may have significant implications for efforts to reduce tobacco initiation and use at a population level. The relationship between characterising flavours and quit behaviours merits further exploration in longitudinal, population-based samples.
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Affiliation(s)
- Danielle M Smith
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Maansi Bansal-Travers
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Jidong Huang
- University of Illinois at Chicago, Chicago, Illinois, USA
| | - Dianne Barker
- Barker Bi-Coastal Health Consultants, Inc., Calabasas, California, USA
| | - Andrew J Hyland
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York, USA
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21
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Sterling K, Fryer C, Pagano I, Jones D, Fagan P. Association between menthol-flavoured cigarette smoking and flavoured little cigar and cigarillo use among African-American, Hispanic, and white young and middle-aged adult smokers. Tob Control 2016; 25:ii21-ii31. [PMID: 27856997 DOI: 10.1136/tobaccocontrol-2016-053203] [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: 05/26/2016] [Accepted: 09/07/2016] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Flavour additives in cigarettes and little cigars and cigarillos (LCCs), which influence smokers' risk perceptions, may reinforce dual flavoured tobacco use. We examined the association among mentholated cigarette use, risk perceptions for flavour additives in LCCs and flavoured LCC smoking behaviour. METHODS Data from a national probability sample of 964 young and middle-aged adult current cigarette smokers were analysed. Multinomial logistic regression models examined the relationship among mentholated cigarette smoking, risk perceptions and current flavoured LCC use for the analytic sample and gender and race/ethnicity. RESULTS Daily menthol cigarette smokers, compared to occasional, non-menthol smokers, had increased odds of flavoured LCC smoking (OR=1.75, 95% CI 1.02 to 2.98). This relationship was found for males, blacks/African-Americans and Hispanics/Latinos (p<0.05). Positive perceptions of menthol-flavoured additives in LCCs was associated with increased odds of flavoured LCC use among the analytic sample, males and blacks/African-Americans (p<0.05). Positive perceptions for clove-flavoured, spice-flavoured and alcohol-flavoured additives were also associated with flavoured LCC use among the analytic sample (p<0.05). CONCLUSIONS Use of menthol-flavoured cigarettes and positive perceptions about menthol-flavoured and other flavour additives in LCCs may contribute to dual use with flavoured LCCs among adult cigarette smokers, specifically those from vulnerable populations.
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Affiliation(s)
- K Sterling
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - C Fryer
- University of Maryland, College Park, Maryland, USA
| | - I Pagano
- University of Hawaii at Manoa, Honolulu, Hawaii, USA
| | - D Jones
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - P Fagan
- Univeristy of Arkansas for Medical Sciences, Fay W. Boozman College of Public Health, USA
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22
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Sterling KL, Fryer CS, Nix M, Fagan P. Appeal and Impact of Characterizing Flavors on Young Adult Small Cigar Use. TOB REGUL SCI 2015; 1:42-53. [PMID: 27917396 PMCID: PMC5130284 DOI: 10.18001/trs.1.1.5] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To understand how affect for characterizing flavors influences little cigar and cigarillo (LCC) smoking uptake behaviors among young adults. METHODS A convenience sample of multi-ethnic young adults (N = 90; mean age = 25.1 years; 53.1% male; 47.4% African-American, 35.5% white, 17.1% Hispanic) who were dual (LCC+ cigarette) and cigarette-only smokers participated in 12 focus groups and a semi-structured interview in the southeastern United States. RESULTS Though they self-identified at enrollment as dual or cigarette-only smokers, 64.4% reported LCC-only smoking, 27.8% dual smoking, and 7.8% cigarette-only smoking. Participants acknowledged that the flavored tobacco made smoking LCCs more palatable, and it enhanced their moods. The variety of available sweet and fruit flavored LCCs and the visual, smell, and taste cues from the LCC packaging influenced the young adults' affect, their susceptibility to and initiation of LCC smoking, and their switch from cigarettes to flavored LCC smoking. CONCLUSIONS Characterizing flavored tobacco in LCCs contributed to young adults' susceptibility and initiation of use. The FDA is proposing to deem LCCs under its authority. Once these products are deemed, our results suggest that the FDA make a product standard restricting characterizing flavors in LCCs.
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Affiliation(s)
| | - Craig S Fryer
- University of Maryland School of Public Health, College Park, MD
| | - Meghan Nix
- Georgia State University School of Public Health, Atlanta, GA
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