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Eckhardt CM, Balte P, Morris JE, Bhatt SP, Couper D, Fetterman J, Freedman N, Jacobs DR, Hou L, Kalhan R, Liu Y, Loehr L, Lutsey PL, Schwartz JE, White W, Yende S, London SJ, Sanchez TR, Oelsner EC. Non-cigarette tobacco products, aryl-hydrocarbon receptor repressor gene methylation and smoking-related health outcomes. Thorax 2024:thorax-2023-220731. [PMID: 39033027 DOI: 10.1136/thorax-2023-220731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 07/01/2024] [Indexed: 07/23/2024]
Abstract
INTRODUCTION Cigarette smoking leads to altered DNA methylation at the aryl-hydrocarbon receptor repressor (AHRR) gene. However, it remains unknown whether pipe or cigar smoking is associated with AHRR methylation. We evaluated associations of non-cigarette tobacco use with AHRR methylation and determined if AHRR methylation was associated with smoking-related health outcomes. METHODS Data were pooled across four population-based cohorts that enrolled participants from 1985 to 2002. Tobacco exposures were evaluated using smoking questionnaires. AHRR cg05575921 methylation was measured in peripheral blood leucocyte DNA. Spirometry and respiratory symptoms were evaluated at the time of methylation measurements and in subsequent visits. Vital status was monitored using the National Death Index. RESULTS Among 8252 adults (mean age 56.7±10.3 years, 58.1% women, 40.6% black), 4857 (58.9%) participants used cigarettes and 634 (7.7%) used non-cigarette tobacco products. Exclusive use of non-cigarette tobacco products was independently associated with lower AHRR methylation (-2.44 units, 95% CI -4.42 to -0.45), though to a lesser extent than exclusive use of cigarettes (-6.01 units, 95% CI -6.01 to -4.10). Among participants who exclusively used non-cigarette tobacco products, reduced AHRR methylation was associated with increased respiratory symptom burden (OR 1.60, 95% CI 1.03 to 2.68) and higher all-cause mortality (log-rank p=0.02). CONCLUSION Pipe and cigar smoking were independently associated with lower AHRR methylation in a multiethnic cohort of US adults. Among users of non-cigarette tobacco products, lower AHRR methylation was associated with poor respiratory health outcomes and increased mortality. AHRR methylation may identify non-cigarette tobacco users with an increased risk of adverse smoking-related health outcomes.
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Affiliation(s)
- Christina M Eckhardt
- Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
- Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Pallavi Balte
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Jack E Morris
- Columbia University Mailman School of Public Health, New York, New York, USA
| | - Surya P Bhatt
- Pulmonary, Allergy and Critical Care Medicine, University of Alabama School of Natural Sciences and Mathematics, Birmingham, Alabama, USA
| | - David Couper
- Biostatistics, The University of North Carolina, Chapel Hill, North Carolina, USA
| | | | - Neal Freedman
- Nutritional Epidemiology, National Institutes of Health, Bethesda, Maryland, USA
| | - David R Jacobs
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Lifang Hou
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ravi Kalhan
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Yongmei Liu
- Duke University, Durham, North Carolina, USA
| | - Laura Loehr
- The University of North Carolina, Chapel Hill, North Carolina, USA
| | - Pamela L Lutsey
- University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Joseph E Schwartz
- Center for Behavioral Cardiovascular Health, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Wendy White
- Tougaloo College, Tougaloo, Mississippi, USA
| | - Sachin Yende
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Tiffany R Sanchez
- Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Elizabeth C Oelsner
- Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
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Do EK, Tulsiani S, Koris K, Hair EC. Tobacco and Nicotine Product Use Transitions by Race and Ethnicity: Results from a Latent Transition Analysis Using Data from the Truth Longitudinal Cohort (2020-2022). Subst Use Misuse 2024:1-8. [PMID: 38963130 DOI: 10.1080/10826084.2024.2374974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Abstract
OBJECTIVE To examine use and frequency patterns across e-cigarettes, cigarettes, and little cigars, cigars, and cigarillos (LCCs) over time and determine whether patterns differ by race and ethnicity. METHODS Data was obtained from the Truth Longitudinal Cohort of youth and young adults between September 2020 and June 2022. Latent class and transition analyses were used to classify participants (N = 4448) into subgroups, based on frequency of tobacco product use in the past 30 days, and to estimate the probability of use pattern transitions by race and ethnicity, adjusted for the effects of gender, financial situation, parental education, household tobacco use, and sensation seeking. RESULTS Four latent classes were identified: former/noncurrent users, predominantly frequent to daily (FTD) e-cigarette users, predominantly FTD e-cigarette and LCC users, and predominantly FTD cigarette with polytobacco users. Use trajectories differed by race and ethnicity. A lower proportion of those who identified as non-Hispanic Black (60.0%) remained e-cigarette and LCC users, relative to those who identified as non-Hispanic White (86.0%), Hispanic or Latino (86.0%), and another race and ethnicity (79.0%). A lower proportion of those who identified as Hispanic or Latino (54.0%) and another race and ethnicity (59.9%) remained cigarette with polytobacco users, relative to those who identified as non-Hispanic White (76.0%) and non-Hispanic Black (72.0%). A greater proportion of non-Hispanic Black respondents transitioned from e-cigarette and LCC user to former/noncurrent user (40.0%) and polytobacco user to e-cigarette and LCC user (11.0%), relative to other racial/ethnic groups. CONCLUSION More research is needed to determine why tobacco use trajectories differ by race and ethnicity. Such research will be important in informing comprehensive approaches that promote evidence-based prevention policies and programs.
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Affiliation(s)
- Elizabeth K Do
- Truth Initiative, Schroeder Institute, Washington, DC, USA
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | | | | | - Elizabeth C Hair
- Truth Initiative, Schroeder Institute, Washington, DC, USA
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- School of Global Public Health, New York University, New York, New York, USA
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Mambo A, Yang Y, Mahulu E, Zihua Z. Investigating the interplay of smoking, cardiovascular risk factors, and overall cardiovascular disease risk: NHANES analysis 2011-2018. BMC Cardiovasc Disord 2024; 24:193. [PMID: 38575889 PMCID: PMC10993506 DOI: 10.1186/s12872-024-03838-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/11/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND This study explores the intricate relationship between smoking, cardiovascular disease (CVD) risk factors and their combined impact on overall CVD risk, utilizing data from NHANES 2011-2018. METHODS Participants were categorized based on the presence of CVD, and we compared their demographic, social, and clinical characteristics. We utilized logistic regression models, receiver operating characteristics (ROC) analysis, and the chi-squared test to examine the associations between variables and CVD risk. RESULTS Significant differences in characteristics were observed between those with and without CVD. Serum cotinine levels exhibited a dose-dependent association with CVD risk. The highest quartile of cotinine levels corresponded to a 2.33-fold increase in risk. Smoking, especially in conjunction with lower HDL-c, significantly increases CVD risk. Combinations of smoking with hypertension, central obesity, diabetes, and elevated triglycerides also contributed to increased CVD risk. Waist-to-Height Ratio, Visceral Adiposity Index, A Body Shape Index, Conicity Index, Triglyceride-Glucose Index, Neutrophil, Mean platelet volume and Neutrophil to Lymphocyte ratio demonstrated significant associations with CVD risk, with varying levels of significance post-adjustment. When assessing the combined effect of smoking with multiple risk factors, a combination of smoking, central obesity, higher triglycerides, lower HDL-c, and hypertension presented the highest CVD risk, with an adjusted odds ratio of 14.18. CONCLUSION Smoking, when combined with central obesity, higher triglycerides, lower HDL-c, and hypertension, presented the highest CVD risk, with an adjusted odds ratio of 14.18.
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Affiliation(s)
- Athumani Mambo
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Department of Cardiology, Benjamin Mkapa Hospital, P.O.Box 11088, Dodoma, Tanzania
| | - Yulu Yang
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Emmerenceana Mahulu
- Department of Otorhinolaryngology, Benjamin Mkapa Hospital, P.O.Box 11088, Dodoma, Tanzania
| | - Zhou Zihua
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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Bhandari Y, Kishore J, Yadav A. Tobacco use and dependence among adults residing in an urbanized village, Delhi, India. J Family Med Prim Care 2024; 13:477-485. [PMID: 38605801 PMCID: PMC11006084 DOI: 10.4103/jfmpc.jfmpc_264_23] [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: 02/09/2023] [Revised: 07/12/2023] [Accepted: 07/17/2023] [Indexed: 04/13/2024] Open
Abstract
Introduction Tobacco use is one of the most significant public health concerns globally as it is a risk factor for chronic illnesses. GATS-2 concluded that 28.6% of all adults currently use Tobacco in India and 17.8% in Delhi. It is important to conduct such surveys in local areas to make specific and effective action plans. Materials and Methods Community-based cross-sectional study conducted between January 2020-June 2021 in Aliganj, an urbanized village in South Delhi. Four hundred ninety participants were enrolled using simple random sampling. The first author conducted the interview using GATS and Fagerstrom nicotine dependence test. Data was analyzed using SPSS-21. Results Median age-35 (26.75-75.00), range-15-84 years. Of the 490 participants, 20.0% were current tobacco users (10.6% smokeless, 7.3% smoked, and 2.2% both). Among current smokers, 78.3% had low, 17.4% moderate, and 4.3% had high dependence on nicotine dependence. Among current smokeless tobacco users, 52.4% had, low, 36.5% moderate, and 11.1% had high dependence. Males had significantly higher odds [6.6 (2.9-15.1)] of tobacco use than females. Higher education [0.3 (0.2-0.8)] compared to no formal education had significantly lower odds of using tobacco. Students [0.1 (0.04-0.4)] and homemakers [0.1 (0.01-0.5)] had significantly lower odds of using tobacco as compared to those employed. Conclusions One in every five adults is a tobacco user in Aliganj. Manufactured cigarettes, bidi, and water pipes were the most common products among smokers. Among smokeless tobacco users, the most common products were chewing tobacco gutka, and khaini. A larger proportion of smokeless tobacco users had high nicotine dependence than smoked tobacco users.
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Affiliation(s)
- Yukti Bhandari
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jugal Kishore
- Department of Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, Delhi, India
| | - Abhilasha Yadav
- Department of Psychiatry, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, Delhi, India
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Ebrahimi Kalan M, Lazard AJ, Sheldon JM, Whitesell C, Hall MG, Ribisl KM, Brewer NT. Terms tobacco users employ to describe e-cigarette aerosol. Tob Control 2023; 33:15-20. [PMID: 35728932 PMCID: PMC9768092 DOI: 10.1136/tobaccocontrol-2021-057233] [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: 12/19/2021] [Accepted: 06/02/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND The scientific term for the substance people inhale and exhale from a vaping device is 'aerosol', but whether the public uses this term is unclear. To inform tobacco control communication efforts, we sought to understand what tobacco users call e-cigarette aerosols. METHODS Participants were a national convenience sample of 1628 US adults who used e-cigarettes, cigarettes or both (dual users). In an online survey, conducted in spring 2021, participants described what 'people inhale and exhale when they vape', using an open-ended and then a closed-ended response scale. Participants then evaluated warning statements, randomly assigned to contain the term 'aerosol' or 'vapor' (eg, 'E-cigarette aerosol/vapor contains nicotine, which can lead to seizures'). RESULTS In open-ended responses, tobacco users most commonly provided the terms 'vapor' (31%) and 'smoke' (23%) but rarely 'aerosol' (<1%). In closed-ended responses, the most commonly endorsed terms were again 'vapor' (57%) and 'smoke' (22%) but again infrequently 'aerosol' (2%). In closed-ended responses, use of the term 'vapor' was more common than other terms among people who were older; white; gay, lesbian or bisexual; college educated; or vape users only (all p<0.05). In the experiment, warnings using the terms 'aerosol' and 'vapor' were equally effective (all p>0.05). CONCLUSIONS The public rarely uses the term 'aerosol' to describe e-cigarette output, potentially complicating educational efforts that use the term. Future studies should explore public knowledge and understanding of the terms 'aerosol' and the more popular 'vapor' to better inform vaping risk communication.
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Affiliation(s)
- Mohammad Ebrahimi Kalan
- Department of Health Behavior, University of North Carolina, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Allison J Lazard
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
- School of Media and Journalism, University of North Carolina, Chapel Hill, NC, USA
| | | | - Callie Whitesell
- Department of Health Behavior, University of North Carolina, Chapel Hill, NC, USA
| | - Marissa G Hall
- Department of Health Behavior, University of North Carolina, Chapel Hill, NC, USA
| | - Kurt M Ribisl
- Department of Health Behavior, University of North Carolina, Chapel Hill, NC, USA
| | - Noel T Brewer
- Department of Health Behavior, University of North Carolina, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
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Powers JM, Zale EL, Deyo AG, Rubenstein D, Terry EL, Heckman BW, Ditre JW. Pain and Menthol Use Are Related to Greater Nicotine Dependence Among Black Adults Who Smoke Cigarettes at Wave 5 (2018-2019) of the Population Assessment of Tobacco and Health (PATH) Study. J Racial Ethn Health Disparities 2023; 10:2407-2416. [PMID: 36171497 PMCID: PMC10651305 DOI: 10.1007/s40615-022-01419-y] [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: 07/29/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 12/01/2022]
Abstract
Burdens related to pain, smoking/nicotine dependence, and pain-smoking comorbidity disproportionately impact Black Americans, and menthol cigarette use is overrepresented among Black adults who smoke cigarettes. Menthol may increase nicotine exposure, potentially conferring enhanced acute analgesia and driving greater dependence. Therefore, the goal of the current study was to examine associations between pain, menthol cigarette use, and nicotine dependence. Data was drawn from Black adults who were current cigarette smokers (n = 1370) at Wave 5 (2018-2019) of the Population Assessment of Tobacco and Health Study. Nicotine dependence was assessed using the Wisconsin Inventory of Smoking Dependence Motives. ANCOVA revealed that moderate/severe pain (vs. no/low pain) was associated with greater overall nicotine dependence (p < .001) and greater negative reinforcement, cognitive enhancement, and affiliative attachment smoking motives (ps < .001). Menthol smokers with moderate/severe pain also endorsed greater cigarette craving and tolerance, compared to non-menthol smokers with no/low pain (ps < .05). Findings support the notion that among Black individuals who smoke cigarettes, the presence of moderate/severe pain (vs. no/low pain) and menthol use may engender greater physical indices of nicotine dependence relative to non-menthol use. Compared to no/low pain, moderate/severe pain was associated with greater emotional attachment to smoking and greater proclivity to smoke for reducing negative affect and enhancing cognitive function. Clinical implications include the need to address the role of pain and menthol cigarette use in the assessment and treatment of nicotine dependence, particularly among Black adults. These data may help to inform evolving tobacco control policies aimed at regulating or banning menthol tobacco additives.
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Affiliation(s)
- Jessica M Powers
- Department of Psychology, Syracuse University, Syracuse, NY, 13244, USA.
| | - Emily L Zale
- Department of Psychology, Binghamton University, Binghamton, NY, 13902, USA
| | - Alexa G Deyo
- Department of Psychology, Syracuse University, Syracuse, NY, 13244, USA
| | - Dana Rubenstein
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, 27705, USA
| | - Ellen L Terry
- Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, 32610, USA
| | - Bryan W Heckman
- The Center for the Study of Social Determinants of Health, Meharry Medical College, Nashville, TN, USA
- Psychiatry and Behavioral Sciences, School of Medicine, Meharry Medical College, Nashville, TN, USA
- Division of Public Health, School of Graduate Studies and Research, Meharry Medical College, Nashville, TN, USA
| | - Joseph W Ditre
- Department of Psychology, Syracuse University, Syracuse, NY, 13244, USA
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Pedroso CM, Normando AGC, Siracusa CS, Lauby-Secretan B, Nethan ST, Tomasi RA, Lopes MA, Warnakulasuriya S, Santos-Silva AR. Pan-American prevalence of smokeless tobacco use and association with oral potentially malignant disorders and head and neck cancer: a systematic review and meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 136:322-332. [PMID: 37076380 DOI: 10.1016/j.oooo.2023.02.019] [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: 12/05/2022] [Revised: 02/26/2023] [Accepted: 02/28/2023] [Indexed: 03/11/2023]
Abstract
OBJECTIVES To determine the prevalence of smokeless tobacco (SLT) use and its association with oral potentially malignant disorders (OPMDs) and head and neck cancer (HNC) in the Pan-American Health Organization (PAHO) region. STUDY DESIGN A literature search was conducted across 9 databases and other sources. The eligibility criteria were pediatric (0-18 years old) and adult (19 years and older) populations consuming any type of SLT. Meta-analysis was performed to determine the prevalence of SLT and the association between its use and OPMDs/HNC in the PAHO region; the Grading of Recommendations Assessment, Development, and Evaluation tool was used to verify the certainty of evidence. RESULTS Fifty-nine studies from 6 PAHO countries were included, of which 51 were also subjected to quantitative analysis. The pooled SLT prevalence of use was 15% (95%CI: 11.93-18.69) overall, 17% (95%CI: 13.25-22.65) in adults, and 11% (95%CI: 8.54-14.78) in the pediatric population. The highest reported SLT prevalence of use was 33.4% (95%CI: 27.17-39.93) in Venezuela. HNC was positively associated with SLT use (OR = 1.98, 95%CI: 1.54-2.55), with a moderate certainty of evidence. Among OPMDs, only leukoplakia reported a positive association with SLT use (OR = 8.38; 95%CI: 1.05-67.25). However, the quality of the evidence was very low. CONCLUSION A high consumption of SLT use, chewing tobacco and snuff, is reported among the adult population residing in the PAHO region with a positive association with the development of oral leukoplakia and HNC.
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Affiliation(s)
- Caique Mariano Pedroso
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Ana Gabriela Costa Normando
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Cristina Saldivia Siracusa
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Béatrice Lauby-Secretan
- International Agency for Research on Cancer (IARC), World Health Organization (WHO), Lyon, France
| | - Suzanne Tanya Nethan
- International Agency for Research on Cancer (IARC), World Health Organization (WHO), Lyon, France
| | - Ramiro Alejandro Tomasi
- Department of Oral Pathology, Dental School, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Marcio Ajudarte Lopes
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Saman Warnakulasuriya
- The WHO Collaborating Centre for Oral Cancer, London, UK; Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
| | - Alan Roger Santos-Silva
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil.
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Ebrahimi Kalan M, Brewer NT. Longitudinal transitions in e-cigarette and cigarette use among US adults: prospective cohort study. LANCET REGIONAL HEALTH. AMERICAS 2023; 22:100508. [PMID: 37229421 PMCID: PMC10205448 DOI: 10.1016/j.lana.2023.100508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 04/23/2023] [Accepted: 04/28/2023] [Indexed: 05/27/2023]
Abstract
Background To support tobacco control efforts, this study sought to characterize longitudinal transitions in use of electronic nicotine delivery systems (ENDS) and cigarettes. Methods Participants were nationally representative samples of 53,729 US adults from Waves 3-5 (2015-2019) of the Population Assessment of Tobacco and Health Study. We examined behavioral transitions (initiation, relapse, progression, and cessation) in ENDS and cigarette use across waves. Weighted generalized estimating equation models adjusted for sociodemographic variables. Findings Of never ENDS users at baseline, an estimated 1.7% reported initiating ENDS use by follow-up. Of former ENDS users, an estimated 12.1% relapsed into ENDS use. Of periodic ENDS users at baseline, 13% progressed to established ENDS use. Of baseline current ENDS users, 46.3% discontinued ENDS use. The corresponding transitions for cigarette smoking were 1.6% (initiation), 4.8% (relapse), 21.1% (progression), and 14% (discontinuation). Adults aged 18-24 (vs. older age), Hispanics (vs. non-Hispanic white), and past 12-month cannabis users were more likely to initiate ENDS or cigarettes (all p < 0.05). Having any internalizing mental health symptoms increased the odds of ENDS initiation, while externalizing symptoms increased the odds of cigarette initiation. Those who perceived nicotine as very harmful (vs. none/low harm) were more likely to discontinue ENDS. Current cigarette users (vs. non-users) at baseline were more likely to initiate, relapse, or discontinue ENDS (all p < 0.05) and vice versa. Interpretation We observed high changeability in ENDS and cigarette use among US adults over time. In absolute terms, ENDS use grew, while smoking fell. Tobacco control programs should focus on priority populations, including young adults and people with internalizing and externalizing mental health symptoms. Funding National Institutes of Health, R01-CA246606-01A1, R01-DA048390.
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Affiliation(s)
- Mohammad Ebrahimi Kalan
- School of Health Professions, Eastern Virginia Medical School, Norfolk, VA, United States
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, United States
| | - Noel T. Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, United States
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Huang S, Chen Q, Griffin P, Liu G, Azagba S. Longitudinal transitions in tobacco use in youth and young adults: A latent transition analysis of the population assessment of tobacco and health study from Wave 1 to 5. Addict Behav 2023; 138:107548. [PMID: 36444788 DOI: 10.1016/j.addbeh.2022.107548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 11/08/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Tobacco use by youth and young adults can lead to significant long-term health problems. We aim to understand transitions in tobacco use patterns among these groups and the factors that affect transition patterns. METHODS Using the five waves of data from the nationally representative Population Assessment of Tobacco and Health (PATH) Study (2013-2019), we conducted latent class analysis and latent transition analysis to understand tobacco use classes and the longitudinal transitions between classes. We also adjusted for covariates, including demographics, individual behaviors, household environment, and psychosocial factors, to capture their effects on class transition probabilities. RESULTS Three tobacco use behaviors were identified: non-current user (C1), moderate e-cigarette user (C2), and poly-tobacco user (C3). At baseline (Wave 1), 94.4% of participants were classified as C1, 3.2% as C2, and 2.4% as C3, and the distribution shifted towards C2 and C3 over time. Progression to the next class represented the most common transitions (14.1% C2 to C3, 10.7% C1 to C2), while the direct progression from C1 to C3 was rare (0.6%). Being male, White, adult, living in smoking-allowed households, past-year alcohol use, drug use, internalizing problems, and social media follower of tobacco brands were associated with a faster progression to poly-tobacco use. CONCLUSIONS The transition patterns implied that e-cigarette use might be an intermediate progression from non-current use into poly-tobacco use. Individual behaviors, household environment, and psychosocial factors are associated with elevated risks of progression. The findings may inform tobacco prevention and cessation policies among youth and young adults.
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Affiliation(s)
- Siyi Huang
- The Harold and Inge Marcus Department of Industrial and Manufacturing Engineering, The Pennsylvania State University, University Park, PA, USA
| | - Qiushi Chen
- The Harold and Inge Marcus Department of Industrial and Manufacturing Engineering, The Pennsylvania State University, University Park, PA, USA.
| | - Paul Griffin
- The Harold and Inge Marcus Department of Industrial and Manufacturing Engineering, The Pennsylvania State University, University Park, PA, USA; Consortium for Substance Use and Addiction, Pennsylvania State University, University Park, PA, USA; Social Science Research Institute, The Pennsylvania State University, University Park, PA, USA
| | - Guodong Liu
- Department of Public Health Sciences, The Pennsylvania State University, Hershey, PA, USA; Department of Psychiatry and Behavioral Health, The Pennsylvania State University, Hershey, PA, USA
| | - Sunday Azagba
- Consortium for Substance Use and Addiction, Pennsylvania State University, University Park, PA, USA; Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, PA, USA; Social Science Research Institute, The Pennsylvania State University, University Park, PA, USA
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Patterns of tobacco or nicotine-based product use and their quitting behaviour among adults in India: a latent class analysis. Public Health 2023; 214:171-179. [PMID: 36586346 DOI: 10.1016/j.puhe.2022.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 10/14/2022] [Accepted: 10/21/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The aims of the study were to identify latent classes of adult tobacco or nicotine-based product users in India, compare their sociodemographic distribution and quitting behaviour and explore the association of quitting behaviour and time to first tobacco use with class membership. STUDY DESIGN This was a nationally representative cross-sectional survey. METHODS Data from the Global Adult Tobacco Survey 2016-2017 in India, which covered adults aged >15 years, were analysed. Latent class analysis was used to examine patterns of tobacco or nicotine-based product use (cigarette, bidi, cigar, e-cigarette, chewable tobacco and snuff) among current tobacco users. Classes were compared across sociodemographic and tobacco use-related characteristics. Various model fit statistics (Akaike, Bayesian and Sample Size-Adjusted Bayesian Information Criteria, Likelihood Ratio Tests and Entropy) and meaningfulness of the classes were used to select the number of latent classes. RESULTS Of 21,857 current tobacco users, five latent classes were extracted: 'poly-tobacco use' (103, 0.5%), 'oral chewable products predominantly' (11,306, 51.7%), 'bidi predominantly' (4965, 22.7%), 'cigarette predominantly' (5318, 24.3%) and 'snuff and chewable products' (165, 0.8%). Significant differences between classes emerged on sociodemographics (age, sex, residence, education, wealth quintile, region). 'Bidi predominantly' class was associated with higher likelihood of quit attempts. Compared with 'cigarette predominantly' class, other classes were significantly associated with time to first tobacco use. CONCLUSION We found that people in India could be grouped into five classes based on their tobacco or nicotine-based product use pattern. It may be efficient to tailor messages to different latent classes and address the distinct profiles of these groups of tobacco product users.
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Islam MM. Comparison between Smokers and Smokeless Tobacco Users in Their Past Attempts and Intentions to Quit: Analysis of Two Rounds of a National Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13662. [PMID: 36294241 PMCID: PMC9603089 DOI: 10.3390/ijerph192013662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/20/2022] [Accepted: 10/20/2022] [Indexed: 06/16/2023]
Abstract
This study compares current tobacco smokers and smokeless tobacco (SLT) users in terms of their past quitting attempts and intentions to quit in the future, and identifies approaches used in their recent quitting attempts. Data (n = 14,498) of current tobacco users from two rounds of the Global Adult Tobacco Survey Bangladesh were analysed. Poisson regressions with robust variance were used to examine associations between the study factor and the two outcome variables. About half of smokers and a quarter of SLT users tried to quit during the 12 months before the survey. About two-thirds of smokers and half of SLT users intended to quit in the future. Smokers were more likely (adjusted prevalence ratio (aPR): 1.38, 95%CI: 1.24-1.53) than SLT users to have attempted to quit during the 12 months before the survey and to intend to quit in the future (aPR: 1.09, 95%CI: 1.02-1.16). The corresponding aPRs were even higher for dual users (smoked tobacco and used SLT). Future intention to quit for both smokers (aPR: 1.45, 95%CI: 1.38-1.53) and SLT users (aPR: 1.87, 95%CI: 1.76-1.98) was significantly associated with their past quitting attempts. Most of those who had attempted to quit did not receive any treatment. Proactive and tailored interventions to promote quitting and expansion of tobacco cessation methods are recommended.
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Affiliation(s)
- M Mofizul Islam
- Department of Public Health, Room 410, Health Sciences Building 2, La Trobe University, Bundoora, VIC 3086, Australia
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Simuzingili M, Hoetger C, Garner W, Everhart RS, Hood KB, Nana-Sinkam P, Cobb CO, Barnes AJ. What influences demand for cigars among African American adult cigar smokers? Results from a hypothetical purchase task. Exp Clin Psychopharmacol 2022; 30:479-485. [PMID: 34110888 PMCID: PMC8660958 DOI: 10.1037/pha0000491] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
African Americans (AA) have historically been targeted by the tobacco industry and have the highest rates of current cigar use among racial/ethnic groups in the U.S. Yet, there is limited evidence on other factors influencing cigar use. Amongst a sample of 78 AA current cigar (any type) smokers, log-linear regression models examined correlates of cigar demand obtained from a validated behavioral economic purchase task. Mean intensity, or cigar demand when free, was 6.68 cigars (standard deviation [SD]: 8.17), while mean breakpoint, or the highest price a participant was willing to pay, was $4.62 (SD: 3.88). Mean maximum daily expenditure, Omax was $15.20 (SD: 25.73) and Pmax, the price at Omax was $5.25 (SD: 3.95). Participants aged 21 to 30 years compared to those aged 18 to 20 years, those with higher levels of dependence, and females compared to males, had a significantly higher intensity. Participants with cannabis use above the sample median in the last 30 days (4 + days) had significantly higher intensity and Omax than those below the median. Further, participants with a high school education or more had a significantly lower intensity, breakpoint, and Omax than those with less than high school education. Individuals with income below the federal poverty line (FPL) also had a significantly lower breakpoint and Omax than those above. Finally, tobacco harm perceptions were inversely associated with Pmax. Stricter policies on cigar products, such as higher taxes and product-specific harm messaging, may have an immediate and sustained impact on health disparities related to cigar use. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
| | - Cosima Hoetger
- Center for the Study of Tobacco Products, Virginia Commonwealth University
- Department of Psychology, Virginia Commonwealth University
| | - William Garner
- Department of Life and Health Sciences, University of North Texas at Dallas
| | | | | | | | - Caroline O. Cobb
- Center for the Study of Tobacco Products, Virginia Commonwealth University
- Department of Psychology, Virginia Commonwealth University
| | - Andrew J. Barnes
- Department of Health Behavior and Policy, Virginia Commonwealth University
- Center for the Study of Tobacco Products, Virginia Commonwealth University
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Longitudinal latent class analysis of tobacco use and correlates among young adults over a 10-year period. Drug Alcohol Depend 2022; 236:109474. [PMID: 35533571 PMCID: PMC9554793 DOI: 10.1016/j.drugalcdep.2022.109474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 04/19/2022] [Accepted: 04/21/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION We assessed patterns and correlates, including demographic characteristics, psychological factors, and social role transitions, of young adults' tobacco use over time. METHODS In the fall of 2010, we recruited a cohort of 3146 students from 11 colleges in North Carolina and Virginia. Participants completed baseline and at least two survey waves between 2010 and 2019. RESULTS The sample was 49.8% female, 15.7% non-white, and 6.6% Hispanic. Longitudinal latent class analysis revealed a five-class model with distinct patterns and correlates of tobacco use. Limited Use (52.6% of sample) had minimal use. College-Limited Combustible Tobacco Users (18.6%) had moderate probability of cigarette, cigar, and waterpipe smoking, which decreased to no use post-college. Intermittent Sustained Polytobacco Users (10.9%) had low probability of use that continued post-college. College Polytobacco with Continued Cigarette and E-Cigarette Users (14.5%) had high probability of use of cigarette smoking and increasing probability of e-cigarette, both of which continued post-college. Sustained Polytobacco Users (5.7%) had moderate probability of use of tobacco products across all waves. CONCLUSIONS Patterns of tobacco use varied considerably. In most classes, tobacco use was highest during freshman year and in three classes, use continued post-college. Prevention activities should focus on first-year students and target those at risk for post-college tobacco use.
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14
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Flocke SA, Ishler K, Albert E, Cavallo D, Lim R, Trapl E. Measuring nicotine dependence among adolescent and young adult cigarillo users. Nicotine Tob Res 2022; 24:1789-1797. [PMID: 35512368 PMCID: PMC9596997 DOI: 10.1093/ntr/ntac117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 03/11/2022] [Accepted: 05/02/2022] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Current measures of nicotine dependence (ND) were developed and validated for cigarette smokers only, limiting their utility for other combustible tobacco users. This study evaluates the psychometric properties of a pool of new and adapted items to measure ND among cigarillo and multiple tobacco product users. METHODS Items were drawn from the PROMIS Nicotine Dependence Item Bank which were adapted to be product neutral and new items were developed from a qualitative study of 60 adolescent and young adult cigarillo smokers. A total of 42 ND items were included in a web-based survey. Eligible participants were 14 to 28 year olds who smoked a minimum of 2 cigarillos per week. Analyses included confirmatory factor analysis, item response theory analysis, analysis of differential item functioning (DIF) and reliability. Ordinary least square regression was used to test the association of ND score with deciles of nicotine consumption. RESULTS Among the 1089 participants, the median number of cigarillos smoked per week was 20; 54% of participants also smoked cigarettes. All PROMIS items and 8 of 10 new items met the IRT fit criteria. Two PROMIS items had non-ignorable DIF. The pool of 40 items had good score reliability for a range of 2 standard deviations. Twenty-, eight-, and four-item short forms showed similarly good measurement properties; each was positively associated with decile of nicotine consumption, p<.001; R 2 = 0.33. CONCLUSIONS This adapted bank of ND items is psychometrically sound and includes items that are product neutral, making it suitable for assessing ND among cigarillo and polytobacco users. IMPLICATIONS This study rigorously evaluates adapted items to measure ND among cigarillo and polytobacco users and reports the reliability initial evidence of validity of short form scores.
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Affiliation(s)
- Susan A Flocke
- Department of Family Medicine, Oregon Health & Science University, Portland OR, USA
| | - Karen Ishler
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland OH, USA
| | - Elizabeth Albert
- Center for Community Health Integration, Case Western Reserve University, Cleveland OH,USA
| | - David Cavallo
- Department of Nutrition, Case Western Reserve University, Cleveland OH, USA
| | - Rock Lim
- Case Western Reserve University, Center for Community Health Integration, Cleveland OH, USA
| | - Erika Trapl
- Department of Population and Quantitative Health Sciences and the Prevention Research Center for Healthy Neighborhoods, Case Western Reserve University, Cleveland OH, USA
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15
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Do EK, Tulsiani S, Vallone DM, Hair EC. Transitions in Frequent to Daily Tobacco and Nicotine Use among Youth and Young Adults. Subst Use Misuse 2022; 57:1681-1687. [PMID: 35938747 DOI: 10.1080/10826084.2022.2107674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Objective: To examine use and frequency patterns across e-cigarettes, cigarettes, and little cigars, cigarillos, and cigars (LCCs) over time. Methods: Data were obtained from the Truth Longitudinal Cohort (TLC), a nationally representative longitudinal cohort of youth and young adults. Latent class analysis was conducted to classify participants (n = 5274) into subgroups based upon frequency of use of cigarettes, e-cigarettes, and little cigars, cigarillos, and cigars (LCCs) in the past 30 days. Latent transition analysis was used to estimate the probability of use pattern transitions across 23 months (February 2018 to December 2019), adjusted for the effects of gender, race/ethnicity, financial situation, sensation seeking, parent education, and household smoking. Findings: Findings reveal four groups of tobacco product users: (1) frequent to daily cigarette users (9%), (2) frequent to daily cigarette and LCC users (3%), (3) frequent to daily e-cigarette users (10%), and (4) former or noncurrent tobacco users (78%). Although most respondents (69-94%) retained their initial user patterns during the observation period, results also indicate shifts between user groups. Notably, 14% of frequent to daily cigarette and LCC users transitioned to frequent to daily cigarette use, while 6% of frequent to daily cigarette and LCC users, 9% of frequent to daily cigarette users, and 4% of former or noncurrent tobacco users transitioned to frequent to daily e-cigarette use. Conclusion: Although most frequent to daily tobacco users stay with their primary product, there are transitions between frequent to daily cigarette, e-cigarette, and LCC use. Transition patterns may influence risk for nicotine addiction among youth and young adults. Thus, policies focused on preventing and reducing all tobacco use are needed to curb the risk of nicotine addiction among youth and young adults.
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Affiliation(s)
- Elizabeth K Do
- Schroeder Institute, Truth Initiative, Washington, DC, USA.,Department of Epidemiology, George Washington University Milken Institute of Public Health, Washington, DC, USA
| | | | - Donna M Vallone
- Schroeder Institute, Truth Initiative, Washington, DC, USA.,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,College of Global Public Health, New York University, New York, NY, USA
| | - Elizabeth C Hair
- Schroeder Institute, Truth Initiative, Washington, DC, USA.,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,College of Global Public Health, New York University, New York, NY, USA
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16
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Mistry R, Bondarenko I, Jeon J, Brouwer AF, Mattingly DT, Hirschtick JL, Jimenez-Mendoza E, Levy DT, Land SR, Elliott MR, Taylor JMG, Meza R, Fleischer NL. Latent class analysis of use frequencies for multiple tobacco products in US adults. Prev Med 2021; 153:106762. [PMID: 34358593 PMCID: PMC8595688 DOI: 10.1016/j.ypmed.2021.106762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 07/23/2021] [Accepted: 07/30/2021] [Indexed: 10/20/2022]
Abstract
A persistent challenge is characterizing patterns of tobacco use in terms of product combinations and frequency. Using Wave 4 (2016-17) Population Assessment of Tobacco and Health Study adult data, we conducted latent class analyses (LCA) of past 30-day frequency of use for 9 tobacco products. One-step LCA with joint multinomial logistic regression models compared sociodemographic factors between users (n = 13,716) and non-users (n = 17,457), and between latent classes of users. We accounted for survey design and weights. Our analyses identified 6 classes: in addition to non-users (C0: 75.7%), we found 5 distinct latent classes of users: daily exclusive cigarette users (C1: 15.5%); occasional cigarette and polytobacco users (C2: 3.8%); frequent e-product and occasional cigarette users (C3: 2.2%); daily smokeless tobacco (SLT) and infrequent cigarette users (C4: 2.0%); and occasional cigar users (C5: 0.8%). Compared to C1: C2 and C3 had higher odds of being male (versus female), younger (especially 18-24 versus 55 years), and having higher education; C2 had higher, while C3 and C4 had lower, odds of being a racial/ethnic minority (versus Non-Hispanic White); C4 and C5 had much higher odds of being male (versus female) and heterosexual (versus sexual minority) and having higher income; and C5 had higher odds of college or more education. We identified three classes of daily or frequent users of a primary product (cigarettes, SLT or e-products) and two classes of occasional users (cigarettes, cigars and polytobacco). Sociodemographic differences in class membership may influence tobacco-related health disparities associated with specific patterns of use.
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Affiliation(s)
- Ritesh Mistry
- University of Michigan, Department of Health Behavior and Health Education, Ann Arbor, MI, United States of America.
| | - Irina Bondarenko
- University of Michigan, Department of Biostatistics, Ann Arbor, MI, United States of America
| | - Jihyoun Jeon
- University of Michigan, Department of Epidemiology, Ann Arbor, MI, United States of America
| | - Andrew F Brouwer
- University of Michigan, Department of Epidemiology, Ann Arbor, MI, United States of America
| | - Delvon T Mattingly
- University of Michigan, Department of Epidemiology, Ann Arbor, MI, United States of America
| | - Jana L Hirschtick
- University of Michigan, Department of Epidemiology, Ann Arbor, MI, United States of America
| | - Evelyn Jimenez-Mendoza
- University of Michigan, Department of Epidemiology, Ann Arbor, MI, United States of America
| | - David T Levy
- Georgetown University, School of Medicine, Washington, DC, United States of America
| | - Stephanie R Land
- National Institutes of Health, National Cancer Institute, Bethesda, MD, United States of America
| | - Michael R Elliott
- University of Michigan, Department of Biostatistics, Ann Arbor, MI, United States of America
| | - Jeremy M G Taylor
- University of Michigan, Department of Biostatistics, Ann Arbor, MI, United States of America
| | - Rafael Meza
- University of Michigan, Department of Epidemiology, Ann Arbor, MI, United States of America
| | - Nancy L Fleischer
- University of Michigan, Department of Epidemiology, Ann Arbor, MI, United States of America
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Ishler KJ, Flocke SA, Albert EL, Trapl E, Gunzler D. Cigarillo and multiple tobacco product use and nicotine dependence in adolescents and young adults. Addict Behav 2020; 111:106537. [PMID: 32795846 DOI: 10.1016/j.addbeh.2020.106537] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 06/09/2020] [Accepted: 06/30/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Multiple tobacco product (MTP) use is a growing public health concern, particularly among adolescents and young adults. This study identifies subgroups of MTP use among cigarillo users and examines associations with nicotine dependence (ND). METHODS 1089 youth (ages 14-28) who currently smoke cigarillos completed a web-based survey regarding their current use of cigarillos, little cigars, traditional cigars, cigarettes, e-cigarettes, and waterpipe/hookah. Latent class analysis (LCA) was used to identify patterns of product use by type and amount. The LCA also assessed the relationship between the latent classes and a 38-item measure of ND, controlling for relevant demographics. RESULTS Most participants (88.2%) reported using two or more tobacco products in the past 30 days. The best-fitting LCA solution revealed 7 classes: (1) Mixed-Light tipped cigarillo and light cigarette users, 28.9%; (2) Light tipped cigarillo users, 15.8%; (3) Light untipped cigarillo users, 14.3%; (4) Heavy tipped cigarillo users, 13.4%; (5) E-cigarette and waterpipe users, 11.9%; (6) Heavy users of tipped and untipped cigarillos and light users of cigarettes, 9.8%; and (7) Dabblers who primarily used traditional cigars, but were also likely to use a variety of other products, 6.1%. Classes comprised of those using multiple products-particularly those that included cigarettes-had significantly higher levels of ND than other classes (Tukey's HSD P < .05). CONCLUSIONS Distinct patterns of MTP use are evident among young cigarillo smokers. Smoking multiple products, particularly smoking cigarillos in combination with cigarettes, is associated with higher ND compared to other product use patterns.
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Kim S, Oancea SC. Electronic cigarettes may not be a "safer alternative" of conventional cigarettes during pregnancy: evidence from the nationally representative PRAMS data. BMC Pregnancy Childbirth 2020; 20:557. [PMID: 32967660 PMCID: PMC7510270 DOI: 10.1186/s12884-020-03247-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 09/14/2020] [Indexed: 12/16/2022] Open
Abstract
Background Conventional cigarette (CC) smoking is one of the most preventable causes of adverse birth outcomes. Although electronic cigarettes (ECs) are considered to be safer than CCs during pregnancy, the evidence is yet to be presented. This study examines the effects of prenatal EC use on neonatal birth outcomes compared to those of CC smokers and complete tobacco abstainers. Methods Data was extracted from 55,251 pregnant women who participated in the Phase 8 survey of the Pregnancy Risk Assessment Monitoring System between 2016 and 2018. Participants were classified into three groups based on their smoking behaviors in the third trimester: complete tobacco abstinence, exclusive CC smoking, or exclusive EC use. Adverse outcomes included infants being small-for-gestational-age (SGA), having low birthweight (LBW), and being born at preterm. EC users were matched to complete abstainers and CC smokers who share the same baseline characteristics in race/ethnicity, age, educational attainment, income, prenatal care adequacy, and first- and second-trimester CC smoking statuses. The association between EC use and adverse birth outcomes were examined by survey-weighted logistic regression analyses in the matched population. Results Among participants, 1.0% of women reported having used ECs during the third trimester, 60% of which reported using ECs exclusively. Neonates of EC users were significantly more likely to be SGA (OR 1.76; 95% CI 1.04, 2.96), have LBW (OR 1.53; 95% CI 1.06, 2.22), or be born preterm (OR 1.86; 95% CI 1.11, 3.12) compared to tobacco abstainers. However, odds of EC users’ pregnancies resulting in SGA (OR 0.67; 95% CI 0.30, 1.47), LBW (OR 0.71; 95% CI 0.37, 1.37), or preterm birth (OR 1.06; 95% CI 0.46, 2.48) were not significantly lower than those of CC smokers. Conclusions Even after accounting for shared risk factors between prenatal tobacco use and adverse birth outcomes, EC use remains an independent risk factor for neonatal complications and is not a safer alternative to CC smoking during pregnancy. Until further research is completed, all pregnant women are encouraged to abstain from all tobacco products including ECs.
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Affiliation(s)
- Sooyong Kim
- Behavioral Sciences Group, Sanford Research, 2301 East 60th St N, Sioux Falls, SD, 57104, USA. .,Present address: Pinney Associates, Inc, 201 North Craig Street, Suite 320, Pittsburgh, PA, 15213, USA.
| | - Sanda Cristina Oancea
- Department of Population Health , University of North Dakota School of Medicine & Health Sciences, Grand Forks , ND, 58202, USA
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Hinds JT, Loukas A, Perry CL. Characterizing the polytobacco behaviors of sexual minority young adult college students. Drug Alcohol Depend 2020; 213:108126. [PMID: 32590213 DOI: 10.1016/j.drugalcdep.2020.108126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 06/11/2020] [Accepted: 06/13/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Polytobacco use is a growing concern; users are exposed to cumulatively more nicotine, increasing their risk for dependence and long-term use. More sexual minority (SM) young adults report polytobacco use than their heterosexual peers, yet no studies explore how their tobacco patterns vary across the diverse product landscape. The purpose of this study was to characterize SM young adults' patterns of tobacco use and nicotine dependence, and explore co-occurring risk factors for polytobacco use. METHODS Participants were 609 SM Texas college students. Latent class analysis identified subgroups of tobacco users based on their tobacco use behaviors and an indicator of nicotine dependence. Multinomial logistic regression identified associations between individual-level variables and the probability of membership in various user classes. RESULTS Tobacco use clustered in four classes: non-users, non-addicted cigarette users, non-addicted e-cigarette users, and addicted polytobacco users. Polytobacco users had an increased probability of depressive symptoms and cannabis use relative to non-users, and more binge alcohol use than all other groups. Non-addicted cigarette users had an increased probability of binge alcohol use, cannabis use, and being non-Hispanic White relative to non-users, and an increased likelihood of cannabis use relative to non-addicted e-cigarette users. Non-addicted e-cigarette users had an increased probability of binge alcohol use relative to non-users. CONCLUSIONS SM young adults' tobacco use varies across the diverse product landscape. Failing to account for a range of tobacco behaviors and nicotine dependence prevents tailoring interventions that should also address concerns such as depressive symptoms, cannabis use, and binge alcohol use.
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Affiliation(s)
- Josephine T Hinds
- Department of Kinesiology and Health Education, The University of Texas at Austin, 2109 San Jacinto Blvd. D3700, Austin, TX, 78712 USA.
| | - Alexandra Loukas
- Department of Kinesiology and Health Education, The University of Texas at Austin, 2109 San Jacinto Blvd. D3700, Austin, TX, 78712 USA.
| | - Cheryl L Perry
- The Michael & Susan Dell Center for Healthy Living, UTHealth School of Public Health, Austin Campus, 1616 Guadalupe St Suite 6.300, Austin, TX 78701 USA.
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Longitudinal Patterns of Multiple Tobacco and Nicotine Product Use Among Texas College Students: a Latent Transition Analysis. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2019; 20:1031-1042. [DOI: 10.1007/s11121-019-01031-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Stanton CA, Halenar MJ. Patterns and Correlates of Multiple Tobacco Product Use in the United States. Nicotine Tob Res 2018; 20:S1-S4. [PMID: 30125021 PMCID: PMC6093449 DOI: 10.1093/ntr/nty081] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 04/29/2018] [Indexed: 01/05/2023]
Affiliation(s)
- Cassandra A Stanton
- Westat, Rockville, MD
- Department of Oncology, Georgetown University Medical Center, Washington, DC
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