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Gomes MN, Reid JL, Rynard VL, East KA, Goniewicz ML, Piper ME, Hammond D. Comparison of Indicators of Dependence for Vaping and Smoking: Trends Between 2017 and 2022 Among Youth in Canada, England, and the United States. Nicotine Tob Res 2024; 26:1192-1200. [PMID: 38531767 PMCID: PMC11339172 DOI: 10.1093/ntr/ntae060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 03/13/2024] [Accepted: 03/17/2024] [Indexed: 03/28/2024]
Abstract
INTRODUCTION The current study sought to examine trends in indicators of dependence for youth vaping and smoking during a period of rapid evolution in the e-cigarette market. AIMS AND METHODS Data are from repeat cross-sectional online surveys conducted between 2017 and 2022 among youth aged 16-19 in Canada, England, and the United States (US). Participants were 23 145 respondents who vaped and/or smoked in the past 30 days. Four dependence indicators were assessed for smoking and vaping (perceived addiction, frequent strong urges, time to first use after waking, days used in past month) and two for vaping only (use events per day, e-cigarette dependence scale). Regression models examined differences by survey wave and country, adjusting for sex, age, race, and exclusive/dual use. RESULTS All six indicators of dependence increased between 2017 and 2022 among youth who vaped in the past 30 days (p < .001 for all). For example, more youth reported strong urges to vape at least most days in 2022 than in 2017 (Canada: 26.5% to 53.4%; England: 25.5% to 45.4%; US: 31.6% to 50.3%). In 2017, indicators of vaping dependence were substantially lower than for smoking; however, by 2022, youth vaping was associated with a greater number of days used in the past month (Canada, US), shorter time to first use (all countries), and a higher likelihood of frequent strong urges (Canada, US) compared to youth smoking. CONCLUSIONS From 2017 to 2022, indicators of vaping dependence increased substantially. By 2022, vaping dependence indices were comparable to those of smoking. IMPLICATIONS Indicators of vaping dependence among youth have increased substantially since 2017 to levels that are comparable to cigarette dependence among youth who smoke. Future research should examine factors underlying the increase in dependence among youth who vape, including changes to the nicotine profile and design of e-cigarette products.
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Affiliation(s)
- Makenna N Gomes
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Jessica L Reid
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Vicki L Rynard
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Katherine A East
- Department of Addictions, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, UK
| | - Maciej L Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Megan E Piper
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin Madison, Madison, WI, USA
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
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Rose JE, Behm FM, Cohen G, Willette PN, Botts TL, Botts DR. Smoking reduction using an electronic nicotine delivery system (ENDS) with nicotine delivery similar to combustible cigarettes. Harm Reduct J 2024; 21:142. [PMID: 39075535 PMCID: PMC11285397 DOI: 10.1186/s12954-024-01064-0] [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: 05/03/2024] [Accepted: 07/20/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND Electronic nicotine delivery systems (ENDS) offer a promising approach to tobacco harm reduction, but many people use both ENDS and combustible cigarettes ("dual use"), which undermines potential risk reduction. To explore the role of ENDS nicotine delivery in promoting switching to ENDS, we conducted a study in which people who smoked cigarettes were offered an ENDS that had previously been shown to replicate the rapid nicotine pharmacokinetics of combustible cigarettes (BIDI® Stick). METHODS Twenty-five cigarette smoking adults, not seeking smoking cessation treatment, but open to using ENDS as a cigarette substitute, were provided with a 12-week supply of BIDI® Stick in tobacco or menthol flavors, during a study that included seven biweekly sessions and a 6-month follow-up. Daily diaries assessed ENDS and cigarette use, and exhaled carbon monoxide (eCO) served as an objective marker of smoke intake. Subjective ratings were collected to assess the rewarding properties of ENDS and combustible cigarettes, and indices of nicotine dependence. RESULTS Over 12 weeks, ENDS use increased to an average of 15.8 occasions per day (SD = 20.2) and self-reported cigarette consumption decreased by 82% from 16.7 cigarettes/day (SD = 6.0) at baseline to 3.0 cigarettes/day (SD = 4.1) at week 12. The eCO level decreased by 27% from an average of 20.0 ppm (SD = 9.8) at baseline to 14.5 ppm (SD = 9.9) at week 12. Four of 25 participants completely switched to ENDS and were smoking abstinent during weeks 9-12. At 6 months one participant was confirmed to be abstinent. Ratings of subjective reward for the ENDS were very similar to those of participants' usual brands of cigarettes. Dependence level was lower for the ENDS than for combustible cigarettes. CONCLUSIONS In this study, the ENDS effectively replicated the subjective rewarding effects of participants' usual brands of cigarettes and led to a substantial reduction in reported cigarettes/day. Exhaled CO showed less of a decrease, possibly due to compensatory smoking behavior and/or the timing of eCO measurements that might not have reflected smoke intake throughout the day. The relatively low rate of sustained smoking abstinence at 6 months suggests that additional approaches continue to be needed for achieving higher rates of complete switching. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT05855343.
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Affiliation(s)
- Jed E Rose
- Rose Research Center, LLC, 7240 ACC Blvd, Raleigh, NC, 27617, USA.
| | | | - Gal Cohen
- Rose Research Center, LLC, 7240 ACC Blvd, Raleigh, NC, 27617, USA
| | - Perry N Willette
- Rose Research Center, LLC, 7240 ACC Blvd, Raleigh, NC, 27617, USA
| | - Tanaia L Botts
- Rose Research Center, LLC, 7240 ACC Blvd, Raleigh, NC, 27617, USA
| | - David R Botts
- Rose Research Center, LLC, 7240 ACC Blvd, Raleigh, NC, 27617, USA
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Selya A, Ruggieri M, Polosa R. Measures of youth e-cigarette use: strengths, weaknesses and recommendations. Front Public Health 2024; 12:1412406. [PMID: 39015391 PMCID: PMC11250581 DOI: 10.3389/fpubh.2024.1412406] [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: 04/04/2024] [Accepted: 05/31/2024] [Indexed: 07/18/2024] Open
Abstract
This perspective discusses how to best define "e-cigarette use" among youth in a way that is relevant to individual and human health. Commonly-used definitions of youth e-cigarette use have been adapted from measures validated for tobacco cigarette smoking among adults, but may not carry the same meaning for a different product (with a much lower risk profile and very different patterns of use) and a different population (whose use is more often transient and experimental, rather than frequent and persistent). We discuss strengths and weaknesses of different definitions, and recommend improvements in defining youth e-cigarette use. We find that current literature employs a range of definitions of e-cigarette use, from lifetime use ("even a puff") to daily use. More lenient measures capture more potentially at-risk youth, but much of this is transient experimentation that has negligible risks in and itself, if not persistent. More stringent measures such as daily use are more relevant to individual and public health. Future research should examine possible improvements to definitions which include intensity of use (e.g., number of puffs per day) and persistence/duration of use, either via self-report or technology-assisted data capture.
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Affiliation(s)
- Arielle Selya
- PinneyAssociates, Inc., Pittsburgh, PA, United States
| | - Martino Ruggieri
- Center of Excellence for the Acceleration of Harm Reduction (CoEHAR), University of Catania, Catania, Italy
- Unit of Pediatric Clinic, AOU “Policlinico”, PO “G. Rodolico”, Department of Clinical & Experimental Medicine, University of Catania, Catania, Italy
| | - Riccardo Polosa
- Unit of Pediatric Clinic, AOU “Policlinico”, PO “G. Rodolico”, Department of Clinical & Experimental Medicine, University of Catania, Catania, Italy
- Department of Clinical & Experimental Medicine, University of Catania, Catania, Italy
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Li L, Yang C, Zhan S, Wilson KM, Taioli E, Mazumdar M, Liu B. Longitudinal Assessment of Association Between Tobacco Use and Tobacco Dependence Among Adults: Latent Class Analysis of the Population Assessment of Tobacco and Health Study Waves 1-4. Nicotine Tob Res 2024; 26:806-815. [PMID: 37496127 PMCID: PMC11190050 DOI: 10.1093/ntr/ntad114] [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: 10/10/2022] [Revised: 06/26/2023] [Accepted: 07/03/2023] [Indexed: 07/28/2023]
Abstract
INTRODUCTION With increasing tobacco product varieties, understanding tobacco use (TU) profiles and their associations with tobacco dependence (TD) has also become increasingly challenging. AIMS AND METHODS We aimed to identify TU profiles and their associations with TD over time, and to identify subgroups with high risk of TD. We included 3463 adult recent tobacco users who had complete TU and TD data across waves 1-4 of the Population Assessment of Tobacco and Health (PATH) study. We used a composite index of TD and a summed TD score from an established 16-item TD measure. We applied a latent class analysis to identify TU profiles based on participants' usage of eight common tobacco product groups at each survey wave and to check the stability of the TU profiles over time. We then used generalized estimating equations regressions to evaluate the longitudinal TU-TD association, adjusting for potential confounders. RESULTS We identified three distinct TU profiles that remained consistent across four survey waves: Dominant cigarette users (62%-68%), poly users with high propensity of using traditional cigarettes, e-cigarettes, and cigars (24%-31%), and dominant smokeless product users (7%-9%). Covariate-adjusted models showed that TD was significantly lower among the poly users and the dominant smokeless users, compared to that among the dominant cigarette users. CONCLUSIONS Both TU profiles and their associations with TD were stable over time at the population level. Poly users and smokeless product users were consistently associated with lower TD than cigarette-dominant users, suggesting the need for tailored tobacco cessation interventions for users with different TU profiles. IMPLICATIONS The finding of consistent TU profiles across four survey waves extends the current literature in capturing TU patterns in an evolving tobacco product landscape. The finding of the overall higher level of TD among the cigarette-dominant users compared to the other TU latent profiles (the Cig+eCig+Cigar dominant poly users and the dominant smokeless product users) can help identify high-risk groups for potential interventions. Our application of innovative statistical methods to high-quality longitudinal data from the PATH study helps improve the understanding of the dynamic TU-TD relationship over time.
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Affiliation(s)
- Lihua Li
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Chen Yang
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Serena Zhan
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Karen M Wilson
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Emanuela Taioli
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Madhu Mazumdar
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bian Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Milstred AR, Douglas AE, Felicione NJ, Blank MD. Psychometric properties of measures for electronic cigarette dependence among former-smoking electronic cigarette users. Addict Behav 2024; 152:107974. [PMID: 38301587 DOI: 10.1016/j.addbeh.2024.107974] [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: 11/23/2023] [Revised: 01/10/2024] [Accepted: 01/24/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Measures designed to assess electronic cigarette (ECIG) dependence are largely adapted from those developed for cigarette smoking, and have been evaluated mainly among dual ECIG-cigarette users. The present study evaluated the psychometric properties of four dependence measures among former-smoking ECIG users. METHODS Respondents (N = 187) were daily ECIG users who had formerly smoked cigarettes regularly. As part of an online survey, they completed four dependence measures: Penn State Electronic Cigarette Dependence Index (PSECDI); E-Cigarette Dependence Scale (EDS-4); Glover Nilsson Behavioral Questionnaire (GNBQ); and Diagnostic and Statistical Manual 5th Edition (DSM-5). RESULTS Confirmatory factor analysis revealed a single factor structure for all four measures, and fit indices were adequate for all models. Most inter-item correlations (mean r's = 0.21 to 0.45) and all item-total correlations (mean r's = 0.53 to 0.80) were significant for all four measures. Internal consistency was highest for the GNBQ (α = 0.86) followed by the EDS-4 (α = 0.81), PSECDI (α = 0.76), and DSM-5 (α = 0.75). Age of ECIG initiation was correlated negatively with scores on the EDS-4 and DSM-5, while number of ECIG quit attempts was correlated positively with scores on all measures except the GNBQ. Convergent validity was highest for comparisons between the EDS-4 and PSECDI (r = 0.75) though all comparisons were significant (p's < 0.001). CONCLUSIONS All four measures demonstrated acceptable reliability and validity in this sample of former-smoking ECIG users.
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Affiliation(s)
- Andrea R Milstred
- Department of Psychology, Eberly College of Arts & Sciences, West Virginia University, Morgantown, WV 26508, USA.
| | - Ashley E Douglas
- Department of Psychology, Eberly College of Arts & Sciences, West Virginia University, Morgantown, WV 26508, USA
| | - Nicholas J Felicione
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY 14261, USA
| | - Melissa D Blank
- Department of Psychology, Eberly College of Arts & Sciences, West Virginia University, Morgantown, WV 26508, USA; WV Prevention Research Center, School of Public Health, Morgantown, WV
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Goldenson NI, Shiffman S, Sembower MA, Black RA. Assessment of abuse liability and switching potential of menthol-flavored pod-based electronic nicotine delivery systems among US adults who smoke cigarettes. Drug Alcohol Depend 2024; 258:111279. [PMID: 38614020 DOI: 10.1016/j.drugalcdep.2024.111279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/18/2024] [Accepted: 03/26/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Menthol-flavored electronic nicotine delivery systems (ENDS) are a focus of public health and regulatory policy considerations. The abuse liability of five menthol-flavored pod-based ENDS was compared to combustible cigarettes, and switching potential of ENDS was also evaluated. METHODS 215 US adults who smoke cigarettes (34.4% female; mean age[SD]=29.60[8.75]; 40.9% non-Hispanic White; mean cigarettes/day[SD]=12.04[8.52]) completed a randomized 6-arm within-person cross-over product-use study. Participants used five pod-based menthol-flavored ENDS (JUUL2 Polar Menthol 1.5%, JUUL2 Prototype Fresh Menthol 3.0%, JUUL Menthol 5.0%, Vuse Alto Menthol 5.0%, NJOY Ace Menthol 5.0%) and their usual brand (UB) cigarette for 20minutes ad libitum. After each product use, subjective reinforcing effects relevant to abuse liability and associated with switching away from cigarettes (e.g., satisfaction, product liking) were assessed. RESULTS All ENDS products were rated substantially and statistically significantly lower than UB cigarette on measures of subjective reinforcing effects (ps<0.001). Satisfying effects of JUUL2 1.5% were rated significantly higher than other ENDS products. JUUL2 Prototype 3.0% and Vuse Alto 5.0% did not significantly differ (ps>0.05), and both were rated significantly higher than JUUL 5.0% and NJOY Ace 5.0% (ps<0.05). Differences in subjective responses to study products did not significantly differ by preference for menthol cigarettes or by current ENDS use. CONCLUSIONS Abuse liability of all menthol-flavored ENDS in this study was substantially lower than combustible cigarettes. Abuse liability of JUUL2 1.5% was within the range of currently marketed pod-based menthol-flavored ENDS products. JUUL2 1.5% likely has high potential for facilitating switching among US adults who smoke.
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Shiffman S, Oliveri DR, Goldenson NI, Liang Q, Black RA, Mishra S. Comparing Adult Smokers Who Switched to JUUL versus Continuing Smokers: Biomarkers of Exposure and of Potential Harm and Respiratory Symptoms. Nicotine Tob Res 2024; 26:494-502. [PMID: 37837438 DOI: 10.1093/ntr/ntad197] [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: 05/25/2023] [Revised: 08/31/2023] [Accepted: 10/01/2023] [Indexed: 10/16/2023]
Abstract
OBJECTIVES Real-world evidence on exposure to harmful and potentially harmful constituents (HPHCs) and on biological effects in cigarette smokers who switch to electronic nicotine delivery systems (ENDS) can inform the health effects of switching. AIMS AND METHODS This cross-sectional, observational study assessed adults who had smoked ≥10 cigarettes/day for ≥10 years, comparing 124 continuing cigarette smokers (Smokers) to 140 former smokers who switched to JUUL-brand ENDS exclusively for ≥6 months (Switchers). Assessments included biomarkers of exposure (BOEs) to select HPHCs, biomarkers of potential harm (BOPHs) related to smoking-related diseases, psychometric assessments of dependence on cigarettes and ENDS, respectively, and respiratory symptoms. Planned analyses compared geometric means, adjusted for demographic covariates; further analyses adjusted for additional lifestyle and smoking history covariates. RESULTS Nicotine levels were significantly higher in Switchers (median time switched = 3 years), who were unusually heavy users of JUUL. All other BOEs, including NNAL and HPMA3 (primary endpoints), were significantly lower in Switchers than Smokers. Most BOPHs (sICAM-1 [primary], and eg, white blood cell count, MCP1, HbA1c) were significantly lower in Switchers than Smokers; HDL was significantly higher. Switchers reported significantly lower dependence on JUUL than Smokers did on cigarettes, and respiratory symptom scores were significantly lower among Switchers than Smokers. CONCLUSIONS Compared to continuing smokers, smokers who switched to JUUL had substantially lower exposures to multiple HPHCs, favorable differences in markers of inflammation, endothelial function, oxidative stress, and cardiovascular risk, and fewer respiratory symptoms. These findings suggest that switching from cigarettes to JUUL likely reduces smokers' health risks. IMPLICATIONS Short-term confinement studies and randomized clinical trials demonstrate that adult smokers who switch completely to ENDS experience substantial reductions in exposure to many smoking-related toxicants. This study extends those findings to longer periods of switching to JUUL-brand ENDS (almost 3 years on average) under naturalistic use conditions in real-world settings and also found that switching to JUUL resulted in favorable differences in BOPHs more proximally related to smoking-induced disease, as well as in respiratory symptoms. Smokers who switch to ENDS reduce their exposure to toxicants, likely reducing their disease risk.
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Affiliation(s)
| | | | | | - Qiwei Liang
- Population and Clinical Sciences, Juul Labs, Inc., Washington, DC, USA
| | - Ryan A Black
- Behavioral and Clinical Sciences, Juul Labs, Inc., Washington, DC, USA
| | - Snigdha Mishra
- Regulatory Sciences, Juul Labs, Inc., Washington, DC, USA
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Kose J, Duquenne P, Hercberg S, Galan P, Touvier M, Fezeu LK, Andreeva VA. Co-occurrence of habit-forming risk behaviors and their socio-demographic, health status and lifestyle determinants: a population-based cross-sectional study. Arch Public Health 2024; 82:26. [PMID: 38419088 PMCID: PMC10900606 DOI: 10.1186/s13690-024-01251-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 02/07/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Although habit-forming risk behaviors frequently co-occur, determinants of concurrent risk behaviors have rarely been investigated. The aim of the present study was to investigate socio-demographic, health status, and lifestyle determinants of single versus concurrent risk behaviors in general-population adults. METHODS We analyzed data from 32,622 participants (74.5% female; mean age = 57.9 ± 14.2 years) of the NutriNet-Santé cohort who completed the Alcohol Use Disorders Identification Test, the 12-item Cigarette Dependence Scale, the modified Yale Food Addiction Scale 2.0, and the Internet Addiction Test in 2021-2022. Using established cutoffs, participants were first split into 2 groups (presence versus absence) for each risk variable (alcohol use disorders, nicotine dependence, food addiction, Internet addiction) and were then divided into 3 groups (no risk behavior, 1 risk behavior (reference), and ≥ 2 risk behaviors). The association between socio-demographic, health status, and lifestyle exposures and individual/concurrent risk behaviors were investigated with polytomous logistic regression. RESULTS Younger age (Odds Ratio (OR) = 2.04; 95% Confidence Interval (CI: 1.62-2.56), current financial difficulties (OR = 1.29; CI: 1.08-1.54), self-perceived poor health (OR = 1.70; CI: 1.32-2.20), overall poor dietary quality (OR = 2.88; CI: 2.06-4.02), being underweight (OR = 1.46; CI: 1.05-2.04), having obesity (OR = 1.62; CI: 1.31-1.99), lack of affection during childhood (OR = 1.41; CI: 1.18-1.69), and a lifetime prevalence or medication use for a mental disorder (OR = 1.46; CI: 1.24-1.73) were positively associated with having ≥ 2 versus 1 risk behavior (all p < 0.05). The comparison of none versus 1 risk behavior revealed the same determinants in addition to having a higher education, being physically active at work, and being overweight. CONCLUSIONS We investigated determinants of concurrent habit-forming risk behaviors among adults in a large, population-based study. The findings could serve as impetus for future research in this domain and ultimately help guide addiction prevention efforts.
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Affiliation(s)
- Junko Kose
- Nutritional Epidemiology Research Group (EREN), Epidemiology and Statistics Research Center, Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, University of Paris (CRESS), Bobigny, France
| | - Pauline Duquenne
- Nutritional Epidemiology Research Group (EREN), Epidemiology and Statistics Research Center, Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, University of Paris (CRESS), Bobigny, France
| | - Serge Hercberg
- Nutritional Epidemiology Research Group (EREN), Epidemiology and Statistics Research Center, Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, University of Paris (CRESS), Bobigny, France
- Department of Public Health, AP-HP Paris Seine-Saint-Denis Hospital System, Bobigny, France
| | - Pilar Galan
- Nutritional Epidemiology Research Group (EREN), Epidemiology and Statistics Research Center, Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, University of Paris (CRESS), Bobigny, France
| | - Mathilde Touvier
- Nutritional Epidemiology Research Group (EREN), Epidemiology and Statistics Research Center, Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, University of Paris (CRESS), Bobigny, France
| | - Léopold K Fezeu
- Nutritional Epidemiology Research Group (EREN), Epidemiology and Statistics Research Center, Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, University of Paris (CRESS), Bobigny, France
| | - Valentina A Andreeva
- Nutritional Epidemiology Research Group (EREN), Epidemiology and Statistics Research Center, Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, University of Paris (CRESS), Bobigny, France.
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Nair NM, Makhanlall A, Roy S, Olola O, Altman E, Chaudhuri P, Wen X. Predictors of Quitting Dual Use of Electronic Cigarettes and Cigarettes During Pregnancy. J Womens Health (Larchmt) 2024; 33:239-253. [PMID: 38112533 PMCID: PMC10880298 DOI: 10.1089/jwh.2023.0179] [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] [Indexed: 12/21/2023] Open
Abstract
Background and Aims: There is limited research surrounding dual maternal use of cigarettes and electronic cigarettes (e-cigarettes). We aimed to assess predictors of maternal quitting of cigarettes, e-cigarettes, and both during late pregnancy. Materials and Methods: We analyzed dual use (n = 4,006) and exclusive e-cigarette use (n = 1,685) among mothers using data from the 2016 to 2019 phase of the Pregnancy Risk Assessment Monitoring Systems (PRAMS), a nationally representative sample of the United States. Dual use and exclusive e-cigarette use were defined based on use reported during the 3 months before pregnancy and quitting was assessed during the last 3 months of pregnancy. Multinomial and binomial logistic regression models estimated the odds ratios and 95% confidence intervals for predictors of quitting status among mothers who reported dual use and exclusive e-cigarette use, respectively. Separate predictor analyses were conducted in the dual and exclusive e-cigarette use groups to see predictors of quitting e-cigarettes, cigarettes, or both. Results: The highest proportion of mothers who used cigarettes and e-cigarettes before pregnancy quit both during late pregnancy (46.2%), followed by those who quit e-cigarette use only (26.5%) and those who quit cigarette use only (6.6%). Among mothers who reported dual use, those who were African American or Asian, of Hispanic ethnicity, consumed alcohol before pregnancy, had higher education, were married, had diabetes, had higher annual household income, had nongovernmental health insurance, had more prenatal care visits, had a higher frequency of e-cigarette use before pregnancy, had a lower frequency of cigarette use before pregnancy, and smoked hookah around pregnancy had a higher likelihood of quitting both cigarette and e-cigarette use during late pregnancy. Conclusions: Quitting use of cigarettes and/or e-cigarettes was fairly common among mothers who reported dual use or e-cigarette use only. Sociodemographics, pregnancy characteristics, and use of other tobacco products predicted quitting use of both cigarettes and e-cigarettes during late pregnancy.
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Affiliation(s)
- Nisha M. Nair
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
| | - Amelia Makhanlall
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Shannon Roy
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Olabowale Olola
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Elizabeth Altman
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Preyashi Chaudhuri
- Department of Psychology, College of Arts and Sciences, University at Buffalo, Buffalo, New York, USA
| | - Xiaozhong Wen
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
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Selya A, Shiffman S. Comparative risk perceptions of switching to JUUL vs. continued smoking and subsequent switching away from cigarettes: a longitudinal observational study. BMC Psychol 2023; 11:305. [PMID: 37798775 PMCID: PMC10552465 DOI: 10.1186/s40359-023-01351-8] [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: 10/27/2022] [Accepted: 09/26/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Evidence indicates that electronic nicotine delivery systems (ENDS) pose lower risk than cigarettes; however, many smokers harbor misperceptions that ENDS are equally or more harmful, possibly deterring them from switching. This study examines whether comparative risk perceptions of JUUL vs. smoking are associated with subsequent switching, among smokers who recently purchased JUUL. METHODS N = 16,996 current established smokers who recently purchased a JUUL Starter Kit were followed 6 times over 12 months. Comparative risk perceptions were assessed using both direct and indirect measures (i.e., contrasting JUUL and smoking directly in questions, and deriving from separate absolute scales). Repeated-measures logistic regression examined switching across follow-up (no smoking in past 30 days) as a function of baseline risk perceptions, adjusting for demographics and baseline smoking behavior. RESULTS Perceiving JUUL as less harmful than smoking was associated with higher switching rates, using both direct (e.g., adjusted odds ratio [AOR] = 1.48 for "JUUL much less" vs. "more/much more harmful") and indirect (AOR = 1.07, for each 10-unit increase in fraction; AOR = 1.51 for highest (6-100) vs. lowest (0 to < 1) fraction categories) comparative risk measures (all p < 0.0001). Among the subset smoking 10 + cigarettes per day, associations between risk perceptions and switching were more pronounced (AOR = 2.51 for "JUUL much less" vs. "more/much more harmful"; AOR = 1.81 for 6-100 vs. 0 to < 1 fraction, both p < 0.0001). CONCLUSIONS Smokers who perceive JUUL as less harmful than cigarettes have higher odds of switching. Future research should examine whether messaging which aligns comparative risk perceptions with current evidence can facilitate switching, especially among heavier smokers.
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Affiliation(s)
- Arielle Selya
- Pinney Associates, Inc, 201 N Craig St., Suite 320, Pittsburgh, PA, 15213, USA.
| | - Saul Shiffman
- Pinney Associates, Inc, 201 N Craig St., Suite 320, Pittsburgh, PA, 15213, USA
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11
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Shiffman S, Hannon MJ. Switching away from smoking at 12 months among adult JUUL users varying in recent history of quit attempts made with and without smoking cessation medication. Drug Test Anal 2023; 15:1281-1296. [PMID: 37489266 DOI: 10.1002/dta.3551] [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: 03/29/2023] [Revised: 07/05/2023] [Accepted: 07/07/2023] [Indexed: 07/26/2023]
Abstract
Some smokers switch away from smoking using e-cigarettes, but guidelines recommend trying approved medications first. We analyzed switching in adult smokers using JUUL by their recent history of quit attempts and use of smoking cessation medications. Participants were 8511 adult (21+) established smokers (at baseline), in which 50.3% are daily smokers, in a longitudinal observational study who completed a survey 12 months after first purchasing a JUUL Starter Kit. At baseline, participants reported attempts to quit smoking in the prior year and use of pharmacotherapy (nicotine replacement therapy [NRT] or prescription medication) in their most recent attempt. The outcomes were switching (self-reported no past-30-day smoking) and 50%+ reductions in cigarette consumption. Multivariable analyses were adjusted for baseline covariates. Two thirds of the participants had made a quit attempt in the year before purchasing JUUL. Overall, 59% [58%, 60%] had switched at 12 months. Switching was more likely in those who had used NRT and who attempted quitting without medication versus those who used prescription medications or made no quit attempt. In adjusted multivariable analyses, only making a past-year quit attempt (vs. not) was associated with higher odds of switching (OR = 1.15 [1.04, 1.28]). Over 60% of dual users reduced cigarette consumption by ≥50%. These associations were largely similar in daily smokers. Twelve months after purchasing JUUL, almost all smokers reported either switching or reducing their smoking by 50%+, including those who had recently failed to quit smoking with approved pharmacotherapies. E-cigarettes provide an alternative route to abstinence from smoking for smokers with a history of cessation and cessation treatment failure.
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Affiliation(s)
- Saul Shiffman
- Pinney Associates, Inc, Pittsburgh, Pennsylvania, USA
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12
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Merianos AL, Mahabee-Gittens EM, Hill MJ, Olaniyan AC, Smith ML, Choi K. Electronic cigarette use and cigarette smoking associated with inadequate sleep duration among U.S. young adults. Prev Med 2023; 175:107712. [PMID: 37758124 PMCID: PMC10591887 DOI: 10.1016/j.ypmed.2023.107712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 09/18/2023] [Accepted: 09/23/2023] [Indexed: 10/02/2023]
Abstract
OBJECTIVE Nicotine use can influence inadequate sleep, but less is known about the associations of exclusive and dual use of electronic cigarettes (e-cigarettes) with combustible cigarettes in U.S. young adults. This study assessed the associations between current exclusive e-cigarette use, exclusive cigarette smoking, and dual e-cigarette and combustible cigarette use and inadequate sleep duration among U.S. young adults. METHODS We performed a secondary analysis of 2020 Behavioral Risk Factor Surveillance System (BRFSS) data including 13,978 U.S. young adults ages 18-24 years. Inadequate sleep duration was assessed categorically using the National Sleep Foundation's age-specific recommendations that define <7 h as inadequate sleep. Weighted logistic regression models were performed while adjusting for participants' sex, race/ethnicity, education level, annual household income level, body mass index, current physical activity, mental health status, disability status, current alcohol use, and current smokeless tobacco use. RESULTS Concerning use patterns, 11.8% of young adults were exclusive e-cigarette users, 4.7% were exclusive cigarette smokers, and 3.8% were dual e-cigarette and combustible cigarette users. Exclusive e-cigarette users (adjusted odds ratio [AOR] = 1.41, 95% confidence interval [CI] = 1.16-1.72), exclusive cigarette smokers (AOR = 1.63, 95%CI = 1.22-2.18), and dual product users (AOR = 2.03, 95%CI = 1.44-2.86) were at increased odds of having inadequate sleep duration compared to non-users, while adjusting for the covariates. Additionally, dual product users were at increased odds (AOR = 1.52, 95%CI = 1.06-2.19) of reporting inadequate sleep duration compared to exclusive e-cigarette users, while adjusting for the covariates. CONCLUSIONS Current e-cigarette and cigarette use may influence inadequate sleep among U.S. young adults. Tobacco cessation efforts may encourage increased sleep health.
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Affiliation(s)
- Ashley L Merianos
- School of Human Services, University of Cincinnati, P.O. Box 210068, Cincinnati, OH 45221, USA.
| | - E Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Madelyn J Hill
- School of Human Services, University of Cincinnati, P.O. Box 210068, Cincinnati, OH 45221, USA.
| | - Afolakemi C Olaniyan
- School of Population and Health Sciences, Dillard Unversity, New Orleans, LA, USA.
| | - Matthew Lee Smith
- Department of Health Behavior, Texas A&M University, College Station, TX, USA.
| | - Kelvin Choi
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD, USA.
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Sreeramareddy CT, Shroff SM, Gunjal S. Nicotine dependence and associated factors among persons who use electronic e-cigarettes in Malaysia - an online survey. Subst Abuse Treat Prev Policy 2023; 18:51. [PMID: 37644524 PMCID: PMC10466701 DOI: 10.1186/s13011-023-00558-7] [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: 05/25/2023] [Accepted: 08/05/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Nicotine dependence, factors associated with dependence, and self-reported side effects among people who use e-cigarettes are scarce in developing countries. METHODS A sample of 302 persons who currently use e-cigarettes was recruited from discussion forums on Reddit, Facebook, and the forum 'lowyat'. The online Google form survey collected data on demographics, e-cigarette use, and the reasons, for cigarette smoking, Fagerstorm Test for Nicotine Dependence adapted for e-cigarettes (eFTND), and side effects experienced. RESULTS The mean age was 25.5 years (6.5), 60.6% were males and 86% had higher education. About 47% were using e-cigarettes only, 27.8% were currently using dual products (both electronic and conventional cigarettes), and 25.2% had also smoked cigarettes in the past. 'Less harmful than cigarettes' (56.3%), 'because I enjoy it' (46.7%), and 'it has a variety of flavors (40.4%) were the common reasons for e-cigarette use. The mean eFTND score was 3.9 (SD = 2.2), with a median of four side effects (IQR 3-6), sore or dry mouth/throat (41.4%), cough 33.4%, headache (20.5%), dizziness (16.2%) were commonly reported side effects. eFTND score and side effects were higher among persons using dual products. By multiple linear regression analysis, males (β = 0.56 95% CI 0.45, 1.05, p = 0.033), dual-use (β = 0.95 95% CI 0.34, 1.56, p < 0.003), and use of nicotine-containing e-cigarettes (β = 0.66 95% CI 0.07, 1.25 p = 0.024) had higher eFTND score. CONCLUSION Our findings of the study call for the placement of disclaimers about possible nicotine addiction and side effects of e-cigarette products.
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Affiliation(s)
| | - Sameeha Misriya Shroff
- School of Postgraduate Studies, International Medical University, Kuala Lumpur, Malaysia
| | - Shilpa Gunjal
- Clinical Oral Health Sciences, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
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Alshaibani M, Alajmi M, Alabduljalil N, Alajmi H, Alsalem Y, Aloqab D, Alawadhi H, Ali SS, Sharhan Y, Alzeeny A, Ziyab AH. Prevalence of use, perceptions of harm and addictiveness, and dependence of electronic cigarettes among adults in Kuwait: A cross-sectional study. Tob Induc Dis 2023; 21:90. [PMID: 37456607 PMCID: PMC10347961 DOI: 10.18332/tid/163300] [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: 11/04/2022] [Revised: 02/28/2023] [Accepted: 04/15/2023] [Indexed: 07/18/2023] Open
Abstract
INTRODUCTION Electronic cigarettes (e-cigarettes) have become one of the most common forms of nicotine delivery used by youth and young adults worldwide. Given the lack of epidemiologic data in Kuwait, this study sought to estimate the prevalence of e-cigarette use, assess perceptions of harm and addictiveness of e-cigarettes, measure the level of dependence on e-cigarettes and assess factors associated with dependence level among adults. METHODS A cross-sectional study enrolled adults (n=3032, aged ≥18 years) living in Kuwait using a web-based questionnaire. Participants self-reported ever and current (past 30-day) e-cigarette use and self-completed the 10-item Penn State E-cigarette Dependence Index. Associations were evaluated using multinomial logistic regression. RESULTS The prevalence of ever and current e-cigarette use was estimated to be 40.2% (1220/3032) and 29.4% (892/3032), respectively. The prevalence of current e-cigarette use was higher in males compared to females (47.6% vs 14.4%, p<0.001). Relative to cigarette smoking, 40.6% of participants reported that e-cigarettes are less harmful, and 41.8% indicated that e-cigarettes are equally addictive. Among current e-cigarette users (n=892), 84.8% were ascertained to have developed either low, medium, or high dependence. The use of pod-based devices compared to disposable devices was associated with a high dependence level (adjusted odds ratio, AOR=8.56; 95% CI: 4.52-16.22). CONCLUSIONS These findings suggest that a large proportion of adults in Kuwait use e-cigarettes, and a considerable proportion of current users have developed dependence. Therefore, such results should alert public health authorities and warrant the development of evidence-based awareness campaigns, policies, and prevention measures to protect and improve the health of people.
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Affiliation(s)
- Munairah Alshaibani
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Mays Alajmi
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Noura Alabduljalil
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Hajar Alajmi
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Yousef Alsalem
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Danah Aloqab
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Hamad Alawadhi
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Sara Sayed Ali
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Yaqoub Sharhan
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Ahmed Alzeeny
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Ali H. Ziyab
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
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15
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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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16
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Sheffer CE, Shevorykin A, Foulds J, Carl E, Mahoney MC, Bensch L, Liskiewicz A, Vantucci D, McDonough B, Szeliga A, Goniewicz ML, Hyland A. The Roswell eND scale: Brief, valid assessment of nicotine dependence adults seeking to discontinue e-cigarette use. Drug Alcohol Depend 2023; 243:109708. [PMID: 36608485 DOI: 10.1016/j.drugalcdep.2022.109708] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 11/08/2022] [Accepted: 11/10/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Most adults who regularly use e-cigarettes or Electronic Nicotine Delivery Systems (ENDS) desire to discontinue use. ENDS use can result symptoms of nicotine withdrawal and dependence which can make it more difficult to discontinue use. Brief, valid assessment of nicotine dependence among adults who use ENDS is needed to guide treatment for nicotine dependence in this group. We sought to develop a brief, valid instrument to measure nicotine dependence among adults seeking to discontinue ENDS in a busy Quitline. METHODS In this cross-sectional design, we examined content, construct, and concurrent validity of the Roswell ENDS Nicotine Dependence Scale (Roswell eND Scale) and the Penn State E-Cigarette Dependence Index (Penn State eCDI). Participants who called the New York Quitline from November 2019 to June 2020 seeking to discontinue ENDS use were invited to participate. Construct validity was examined with exploratory and confirmatory factor analyses. Instrument and factor scores were then correlated with cotinine, a biomarker of nicotine exposure. RESULTS All participants (n = 209) were highly dependent and co-used combustible cigarettes to varying degrees. Both instruments demonstrated content validity and construct validity, however only the 5-item Roswell eND Scale demonstrated criterion-related validity by showing a significant positive correlation with salivary cotinine levels. CONCLUSIONS The 5-item Roswell eND Scale can briefly and effectively assess nicotine dependence among treatment-seeking adults who co-use ENDS and cigarettes. These preliminary psychometric findings have the potential to be generalizable to other adults seeking to discontinue ENDS use, many of whom currently or formerly smoked cigarettes.
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Affiliation(s)
- Christine E Sheffer
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA.
| | - Alina Shevorykin
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
| | - Jonathan Foulds
- Public Health Sciences & Psychiatry, and Penn State Center for Research on Tobacco and Health, Penn State College of Medicine, Hershey, PA, USA
| | - Ellen Carl
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
| | - Martin C Mahoney
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
| | - Lindsey Bensch
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
| | - Amylynn Liskiewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
| | - Darian Vantucci
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
| | - Brian McDonough
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
| | - Andrew Szeliga
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
| | - Maciej L Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
| | - Andrew Hyland
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
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17
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Shephard A, Dölek Ş, Barrett SP. Investigating predictors of problematic alcohol, cannabis, and nicotine use among legal users of all three substances. Front Psychiatry 2023; 14:1110415. [PMID: 36911131 PMCID: PMC9996031 DOI: 10.3389/fpsyt.2023.1110415] [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] [Received: 11/28/2022] [Accepted: 02/03/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND The three most used substances-alcohol, cannabis, and nicotine-are frequently concurrently. Use of each substance has been connected to an increased probability of use of the other substances, and the problematic use of each substance has been linked to demographic factors, substance use factors, and personality. However, little is known about which risk factors are most important for consumers of all three substances. This study examined the extent to which various factors are associated with dependence on alcohol, cannabis, and/or nicotine in users of all three substances. METHODS 516 Canadian adults with past month use of alcohol, cannabis, and nicotine completed online surveys querying their demographics, personality, substance use history, and levels substance dependence. Hierarchical linear regressions were used to determine which factors best predicted levels of dependence on each substance. RESULTS Alcohol dependence was associated with levels of cannabis and nicotine dependence, and impulsivity, with 44.9% of variance explained. Cannabis dependence was predicted by alcohol and nicotine dependence levels, impulsivity, and the age of onset of cannabis use, with 47.6% of variance explained. Nicotine dependence was best predicted by alcohol and cannabis dependence levels, impulsivity, and dual use of cigarettes and e-cigarettes, with 19.9% of variance explained. CONCLUSIONS Alcohol dependence, cannabis dependence, and impulsivity were the strongest predictors for dependence on each of the substances. A strong relationship between alcohol and cannabis dependence was evident, warranting further research.
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Affiliation(s)
- Aaron Shephard
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Şimal Dölek
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Sean P Barrett
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
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18
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Shiffman S, Goldenson NI. Changes in Dependence Over One Year among US Adults Who Smoke Cigarettes and Switched Completely or Partially to Use of the JUUL-Brand Electronic Nicotine Delivery System. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 6:100137. [PMID: 36994368 PMCID: PMC10040328 DOI: 10.1016/j.dadr.2023.100137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/24/2023] [Accepted: 01/25/2023] [Indexed: 01/27/2023]
Abstract
Background Electronic nicotine delivery systems (ENDS) are substitute sources of nicotine for adults who smoke cigarettes. Understanding changes in dependence as people switch from cigarettes to ENDS is relevant to public health. This study assessed changes in dependence among adults who switched completely or partially (dual users) from cigarettes to JUUL-brand ENDS over 12 months. Methods US adults who smoke and purchased a JUUL Starter Kit (n = 17,619) completed a baseline assessment and were invited to 1-, 2-, 3-, 6-, 9- and 12-month follow-ups. Dependence on cigarettes at baseline and on JUUL at follow-ups was assessed with the Tobacco Dependence Index (TDI; Range 1-5). Analyses estimated the minimal important difference (MID) for the scale, compared JUUL dependence to baseline cigarette dependence and assessed changes in JUUL dependence over 1-year, including among those using JUUL at all follow-ups. Results Participants who switched at month 2 had month 1 JUUL TDI scores 0.24 points greater than those who continued smoking (p<0.001); thus MID=0.24. Among both switchers and dual users overall, dependence on JUUL 1 and 12 months later was lower than baseline dependence on cigarettes (ps<0.001); participants who smoked every day showed more consistent and larger reductions. Among participants who persistently used JUUL without smoking, dependence increased 0.01 points per month (p<0.001), but was leveling off over time. Conclusions Dependence on JUUL was lower than baseline cigarette dependence. Increases in JUUL dependence were small over 12 months of continual JUUL use. These data indicate that ENDS, including JUUL, have lower dependence potential than cigarettes.
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Affiliation(s)
- Saul Shiffman
- Pinney Associates, Inc
- Corresponding author at: Pinney Associates, Inc., 201 North Craig Street, Suite 320, Pittsburgh, PA 15213, United States.
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19
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Campbell C, Jin T, Round EK, Schmidt E, Nelson P, Baxter S. Part one: abuse liability of Vuse Solo (G2) electronic nicotine delivery system relative to combustible cigarettes and nicotine gum. Sci Rep 2022; 12:22080. [PMID: 36543869 PMCID: PMC9772348 DOI: 10.1038/s41598-022-26417-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
Abuse liability (AL) of electronic nicotine delivery systems (ENDS) is relevant as the category increases in popularity as a potentially less-harmful alternative to cigarette smoking. AL assessments are important to the FDA in determining if a new product is appropriate for the protection of public health. This paper reports the results for Vuse Solo (G2 cartridge design) compared to high and low AL-comparators evaluated in an open-label, randomized crossover confinement AL study. The confinement design was adapted from previous ambulatory studies of Vuse Solo (G1 cartridge design) and included product familiarization sessions before each four-hour test session in which subjective measures, nicotine pharmacokinetics (PK), and physiological endpoints were assessed following a single 10-min ad libitum product use session. Product liking, intent to use again, suppression of urge to smoke, and nicotine PK were lower after use of Vuse Solo compared to cigarettes and higher after use of Vuse Solo compared to nicotine gum. No significant differences in blood pressure or heart rate were observed between the products pre- to post-product use. These data reinforce previous research and provide the scientific evidence to support regulatory decisions demonstrating that Vuse Solo has an AL profile lower than that of combustible cigarettes but higher than that of nicotine gum and, therefore, may be a suitable replacement for cigarette smoking for some adult smokers.
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Affiliation(s)
- Chris Campbell
- RAI Services Company, 401 N. Main Street, Winston-Salem, NC, 27101, USA.
| | - Tao Jin
- RAI Services Company, 401 N. Main Street, Winston-Salem, NC, 27101, USA
| | - Elaine K Round
- RAI Services Company, 401 N. Main Street, Winston-Salem, NC, 27101, USA
| | - Eckhardt Schmidt
- RAI Services Company, 401 N. Main Street, Winston-Salem, NC, 27101, USA
| | - Paul Nelson
- Retired Employee of RAI Services Company, Winston-Salem, NC, 27101, USA
| | - Sarah Baxter
- RAI Services Company, 401 N. Main Street, Winston-Salem, NC, 27101, USA
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20
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Mendelsohn CP. Vaping nicotine should be part of Australia's tobacco control policy. Aust N Z J Public Health 2022; 46:917. [PMID: 35436001 DOI: 10.1111/1753-6405.13237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Polosa R, Casale TB, Tashkin DP. A Close Look at Vaping in Adolescents and Young Adults in the United States. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:2831-2842. [PMID: 35718259 DOI: 10.1016/j.jaip.2022.06.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 05/27/2022] [Accepted: 06/09/2022] [Indexed: 06/15/2023]
Abstract
Vaping by adolescents and young adults is a legitimate concern as there is a risk that some may start smoking and that electronic cigarette (EC) use may have adverse effects in the developing lungs of adolescents. This commentary provides updated information on vaping patterns among adolescents and young adults in the United States, as well as the impact of EC usage on respiratory health. EC use has surged greatly among high school students and young adults over the last decade but fortunately has declined significantly since its peak in 2019. During the same time period, smoking rates have constantly fallen to new low record levels. These trends argue against EC use as a gateway to smoking. Most EC usage is infrequent and unlikely to increase a person's risk of negative health consequences. Furthermore, the majority of EC usage has happened among those who have previously smoked. There is a dearth of data on the long-term health implications of EC usage in adolescents and young adults. We do not know whether short-term or intermittent use of EC in youth can lead to negative health outcomes in adulthood, and long-term high-quality studies in well-defined groups are needed. Although vaping has been linked to respiratory symptoms, they tend to be transient and of uncertain significance. This commentary provides up-to-date information so health care providers can give objective and responsible medical advice on EC usage.
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Affiliation(s)
- Riccardo Polosa
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy; Center of Excellence for the Acceleration of Harm Reduction (CoEHAR), Università di Catania, Catania, Italy; Center for the Prevention and Treatment of Tobacco Addiction (CPCT), Teaching Hospital "Policlinico V. Emanuele," University of Catania, Catania, Italy; ECLAT Srl, Spin-off of the University of Catania, Catania, Italy; Institute of Internal Medicine, AOU "Policlinico V. Emanuele-S. Marco," Catania, Italy.
| | - Thomas B Casale
- Department of Medicine, Division of Allergy/Immunology, Morsani College of Medicine, University of South Florida, Tampa, Fla
| | - Donald P Tashkin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine, UCLA Health Sciences, Los Angeles, Calif
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22
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Levy DT, Cadham CJ, Li Y, Yuan Z, Liber AC, Oh H, Travis N, Issabakhsh M, Sweanor DT, Sánchez-Romero LM, Meza R, Cummings KM. A Decision-Theoretic Public Health Framework for Heated Tobacco and Nicotine Vaping Products. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13431. [PMID: 36294011 PMCID: PMC9602493 DOI: 10.3390/ijerph192013431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/22/2022] [Accepted: 09/30/2022] [Indexed: 06/16/2023]
Abstract
Markets for nicotine vaping products (NVPs) and heated tobacco products (HTPs) have grown as these products became positioned as harm-reduction alternatives to combusted tobacco products. Herein, we present a public health decision-theoretic framework incorporating different patterns of HTP, NVP, and cigarette use to examine their impacts on population health. Our framework demonstrates that, for individuals who would have otherwise smoked, HTP use may provide public health benefits by enabling cessation or by discouraging smoking initiation and relapse. However, the benefits are reduced if more harmful HTP use replaces less harmful NVP use. HTP use may also negatively impact public health by encouraging smoking by otherwise non-smokers or by encouraging initiation or relapse into smoking. These patterns are directly influenced by industry behavior as well as public policy towards HTPs, NVPs, and cigarettes. While substantial research has been devoted to NVPs, much less is known about HTPs. Better information is needed to more precisely define the health risks of HTPs compared to cigarettes and NVPs, the relative appeal of HTPs to consumers, and the likelihood of later transitioning to smoking or quitting all products. While our analysis provides a framework for gaining that information, it also illustrates the complexities in distinguishing key factors.
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Affiliation(s)
- David T. Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Christopher J. Cadham
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Yameng Li
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Zhe Yuan
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Alex C. Liber
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Hayoung Oh
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Nargiz Travis
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Mona Issabakhsh
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - David T. Sweanor
- Centre for Health Law, Policy & Ethics, University of Ottawa, Ottawa, ON K1N 6N5, Canada
- Faculty of Law, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | | | - Rafael Meza
- Department of Integrative Oncology, BC Cancer Institute, Vancouver, BC V5Z1L3, Canada
| | - K. Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of Charleston, Charleston, SC 29425, USA
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23
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Harris AC, Muelken P, Alcheva A, Stepanov I, LeSage MG. Cigarette Smoke Extract, but Not Electronic Cigarette Aerosol Extract, Inhibits Monoamine Oxidase in vitro and Produces Greater Acute Aversive/Anhedonic Effects Than Nicotine Alone on Intracranial Self-Stimulation in Rats. Front Neurosci 2022; 16:868088. [PMID: 35712461 PMCID: PMC9196039 DOI: 10.3389/fnins.2022.868088] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/25/2022] [Indexed: 12/14/2022] Open
Abstract
Conventional tobacco cigarettes appear to have greater abuse liability than non-combusted products such as electronic cigarettes (ECs) and nicotine replacement therapy (NRT). This may be due to the higher levels of behaviorally active non-nicotine constituents [e.g., monoamine oxidase (MAO) inhibitors such as β-carbolines] in cigarette smoke (CS) compared to non-combusted products. To evaluate this hypothesis, the current studies compared the relative abuse liability of CS and EC aerosol extracts containing nicotine and a range of non-nicotine constituents to that of nicotine alone (NRT analog) using intracranial self-stimulation (ICSS) in rats. Effects of formulations on brain MAO activity in vitro and ex vivo were also studied to evaluate the potential role of MAO inhibition in the ICSS study. CS extract contained higher levels of several behaviorally active non-nicotine constituents (e.g., the β-carbolines norharmane and harmane) than EC extract. Nicotine alone reduced ICSS thresholds at a moderate nicotine dose, suggesting a reinforcement-enhancing effect that may promote abuse liability, and elevated ICSS thresholds at a high nicotine dose, suggesting an aversive/anhedonic effect that may limit abuse liability. CS extract elevated ICSS thresholds to a greater degree than nicotine alone at high nicotine doses. Effects of EC extract on ICSS did not differ from those of nicotine alone. Finally, CS extract significantly inhibited MAO-A and MAO-B activity in vitro, whereas EC extract and nicotine alone did not. None of the formulations inhibited MAO measured ex vivo. These findings indicate greater acute aversive/anhedonic effects for CS extract compared to nicotine alone, suggesting lower abuse liability. Although confirmation of our findings using other dosing regimens, preclinical addiction models, and tobacco product extracts is needed, these findings suggest that the centrally-mediated effects of MAO inhibitors and other non-nicotine constituents may not account for the greater abuse liability of cigarettes compared to non-combusted products. Nonetheless, identifying the specific constituent(s) mediating the effects of CS extracts in this study could help clarify mechanisms mediating tobacco addiction and inform FDA product standards.
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Affiliation(s)
- Andrew C. Harris
- Hennepin Healthcare Research Institute, Minneapolis, MN, United States,Department of Medicine, University of Minnesota, Minneapolis, MN, United States,Department of Psychology, University of Minnesota, Minneapolis, MN, United States,*Correspondence: Andrew C. Harris,
| | - Peter Muelken
- Hennepin Healthcare Research Institute, Minneapolis, MN, United States
| | - Aleksandra Alcheva
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, United States
| | - Irina Stepanov
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, United States
| | - Mark G. LeSage
- Hennepin Healthcare Research Institute, Minneapolis, MN, United States,Department of Medicine, University of Minnesota, Minneapolis, MN, United States,Department of Psychology, University of Minnesota, Minneapolis, MN, United States
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24
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Do EK, O'Connor K, Kreslake JM, Friedrichsen SC, Vallone DM, Hair EC. Influence of Flavors and Nicotine Concentration on Nicotine Dependence in Adolescent and Young Adult E-Cigarette Users. Subst Use Misuse 2022; 57:632-639. [PMID: 35138226 DOI: 10.1080/10826084.2022.2034876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Objective: The objective of this study is to examine the relationships between e-cigarette flavors, nicotine concentration, and their interaction on measures of nicotine dependence.Methods: Survey data are drawn from a cross-sectional convenience sample of past 30-day e-cigarette users aged 15 to 24 years (N = 2037) collected between October 2020 and November 2020. Participants were asked to provide information about the e-cigarette products they used most regularly. Only those with available information on flavors (fruit, mint, menthol/ice, and tobacco), nicotine concentration (0-2.9%, 3-4.9%, and 5% or greater), and time to first vape after waking (within 30 minutes, greater than 30 minutes) were included in analyses (N = 1430). Generalized linear regression models were used with log link and binary distribution to assess the relationship between flavors, nicotine concentration, and nicotine dependence. Effect modification by nicotine concentration was assessed using an interaction term for flavors by nicotine concentration. Models were adjusted for age, race/ethnicity, gender, and financial situation.Findings: Fruit, mint, and menthol flavor user groups had a very similar dose-response relationship between nicotine concentration and prevalence of vaping within 30 minutes. These groups showed that the prevalence of vaping within 30 minutes gradually increased as nicotine concentration increased. Meanwhile, tobacco flavor user groups demonstrated a decrease in prevalence of vaping within 30 minutes, as nicotine concentration increased.Conclusion: Results highlight the need for understanding how e-cigarette product characteristics like flavors and nicotine concentration can facilitate nicotine dependence to e-cigarettes. Findings suggest that comprehensive e-cigarette product regulation of all flavors and reducing nicotine concentration will help to reduce the risk for nicotine dependence among young people.
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Affiliation(s)
- Elizabeth K Do
- Schroeder Institute at Truth Initiative, Washington, DC, USA
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA, USA
- Department of Epidemiology, George Washington University Milken Institute of Public Health, Washington, DC, USA
| | - Katie O'Connor
- Schroeder Institute at Truth Initiative, Washington, DC, USA
| | - Jennifer M Kreslake
- Schroeder Institute at Truth Initiative, Washington, DC, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Donna M Vallone
- Schroeder Institute at Truth Initiative, Washington, DC, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- College of Global Public Health, New York University, New York, New York, USA
| | - Elizabeth C Hair
- Schroeder Institute at Truth Initiative, Washington, DC, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- College of Global Public Health, New York University, New York, New York, USA
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25
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Hobkirk AL, Hoglen B, Sheng T, Kristich A, Yingst JM, Houser KR, Krebs NM, Allen SI, Bordner CR, Livelsberger C, Foulds J. Intentions and Attempts to Quit JUUL E-Cigarette Use: The Role of Perceived Harm and Addiction. Prev Chronic Dis 2022; 19:E06. [PMID: 35113784 PMCID: PMC8880109 DOI: 10.5888/pcd19.210255] [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] [Indexed: 11/17/2022] Open
Abstract
Introduction Research on electronic cigarette (e-cigarette) quit intentions and attempts is limited despite the potential health benefits of quitting, especially for long-term users. The current study aimed to investigate perceptions of harm and addictiveness and tobacco use characteristics associated with quit variables among users of a popular e-cigarette brand, JUUL. Methods We surveyed 301 US adult JUUL users on their tobacco use characteristics, perceptions of JUUL harm and addictiveness, and quit variables at 3 time points, from July 2019 to April 2020. We used logistic regression models to assess demographic characteristics, smoking characteristics, and perceptions of JUUL harm and addictiveness as correlates of e-cigarette quit intentions, attempts, importance, and confidence. Results Twenty-three percent of the sample had intentions to quit using JUUL within the year, and 22.6% reported making a lifetime quit attempt. The average rating of quit importance was 4.1 and quit confidence was 5.8 on a Likert scale of 1 to 10. More than 90% of the sample indicated that JUUL was at least moderately addictive, whereas less than one-quarter indicated that JUUL was as harmful or more harmful than smoking. Higher levels of perceived JUUL addictiveness were associated with more quit intentions, attempts, and importance. Higher levels of perceived JUUL harm compared with smoking were associated with more quit importance. Conclusion Our findings suggest that a small proportion of adult JUUL users are interested in quitting. Self-reported perceptions of JUUL’s addiction potential may be related to more quit attempts. Findings highlight the need for evidence-based information on e-cigarette addictiveness and effective strategies for cessation.
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Affiliation(s)
- Andréa L Hobkirk
- Department of Psychiatry and Behavioral Health, Pennsylvania State University College of Medicine, Hershey, Pennsylvania.,Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania.,Center for Research on Tobacco and Health, Pennsylvania State University College of Medicine, Hershey, Pennsylvania.,Pennsylvania State University College of Medicine, 500 University Dr, Mail Code CH69, Hershey, PA 17033.
| | - Brianna Hoglen
- Department of Psychiatry and Behavioral Health, Pennsylvania State University College of Medicine, Hershey, Pennsylvania.,Center for Research on Tobacco and Health, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Tianhong Sheng
- Department of Statistics, Pennsylvania State University, State College, Pennsylvania
| | - Ava Kristich
- Department of Psychiatry and Behavioral Health, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Jessica M Yingst
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania.,Center for Research on Tobacco and Health, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Kenneth R Houser
- Department of Psychiatry and Behavioral Health, Pennsylvania State University College of Medicine, Hershey, Pennsylvania.,Center for Research on Tobacco and Health, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Nicolle M Krebs
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania.,Center for Research on Tobacco and Health, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Sophia I Allen
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania.,Center for Research on Tobacco and Health, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Candace R Bordner
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania.,Center for Research on Tobacco and Health, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Craig Livelsberger
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania.,Center for Research on Tobacco and Health, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Jonathan Foulds
- Department of Psychiatry and Behavioral Health, Pennsylvania State University College of Medicine, Hershey, Pennsylvania.,Center for Research on Tobacco and Health, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
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26
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Douglas AE, Childers MG, Romm KF, Felicione NJ, Ozga JE, Blank MD. Device features and user behaviors as predictors of dependence among never-smoking electronic cigarette users: PATH Wave 4. Addict Behav 2022; 125:107161. [PMID: 34710840 PMCID: PMC8629948 DOI: 10.1016/j.addbeh.2021.107161] [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: 06/08/2021] [Revised: 10/16/2021] [Accepted: 10/18/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Electronic cigarettes (ECIGs) vary greatly in their ability to deliver nicotine, which suggests they may also vary in their ability to produce dependence. This study examined individual and combined ECIG device features, and also user behaviors, as predictors of dependence in never-smoking ECIG users. Methods Data were collected from 711 current ECIG users who had smoked <100 cigarettes in their lifetime at Wave 4 of the Population Assessment of Tobacco and Health (PATH) Study. Multivariable linear regressions examined individual (e.g., contains nicotine, uses a tank, flavor preference) and combined (e.g., refillable tanks, refillable mods) device features, and user behaviors (e.g., uses/day) as predictors of dependence, withdrawal, and craving after accounting for demographic variables. Results Results for ECIG dependence and craving showed a similar pattern; higher levels were observed for older age, more frequent past 30-day use, using an ECIG containing nicotine (vs no nicotine), and using a non-refillable cartridge or refillable tank style (vs disposables). Higher withdrawal levels were observed for higher education levels and individual device features of tank (vs no tank), cartridge (vs no cartridge), refillable (vs non-refillable), and "other" flavor preference (vs tobacco flavor). Lower withdrawal levels were associated with a preference for sweet/fruit flavor(s) (vs tobacco flavor). Conclusions Few use behaviors and device features, whether examined alone or in combination, predicted dependence-related outcomes. Findings underscore the challenge with regulating ECIG products in the current marketplace, which is inundated with a myriad of device types.
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Affiliation(s)
- Ashley E. Douglas
- Department of Psychology, 53 Campus Drive, 2214 Life Sciences Building, West Virginia University, Morgantown WV 26506 USA
| | - Margaret G. Childers
- Department of Psychology, 53 Campus Drive, 2214 Life Sciences Building, West Virginia University, Morgantown WV 26506 USA
| | - Katelyn F. Romm
- Milken Institute School of Public Health, 800 22 Street NW #7000C, George Washington University, Washington, DC 20052 USA
| | - Nicholas J. Felicione
- Department of Health Behavior, 665 Elm Street, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14216 USA
| | - Jenny E. Ozga
- Department of Behavioral Medicine & Psychiatry, 3602 Collins Ferry Road, West Virginia University, Morgantown, WV 26505 USA
| | - Melissa D. Blank
- Department of Psychology, 53 Campus Drive, 2214 Life Sciences Building, West Virginia University, Morgantown WV 26506 USA
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27
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Rodríguez-Bolaños R, Arillo-Santillán E, Guzmán-Rodríguez C, Barrientos-Gutiérrez I, Gallegos-Carrillo K, Titus A, Cruz-Jiménez L, Thrasher JF. Similarities and Differences in Substance Use Patterns Among Lesbian, Gay, Bisexual, and Heterosexual Mexican Adult Smokers. LGBT Health 2021; 8:545-553. [DOI: 10.1089/lgbt.2020.0457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Rosibel Rodríguez-Bolaños
- Tobacco Research Department, Population Health Research Center, Mexican National Institute of Public Health, Cuernavaca, Mexico
| | - Edna Arillo-Santillán
- Tobacco Research Department, Population Health Research Center, Mexican National Institute of Public Health, Cuernavaca, Mexico
| | | | - Inti Barrientos-Gutiérrez
- Center for Evaluation and Survey Research, Mexican National Institute of Public Health, Cuernavaca, Mexico
| | - Katia Gallegos-Carrillo
- Epidemiology and Health Services Research Unit, Mexican Institute of Social Security, Cuernavaca, Mexico
| | - Andrea Titus
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Lizeth Cruz-Jiménez
- Center for Evaluation and Survey Research, Mexican National Institute of Public Health, Cuernavaca, Mexico
| | - James F. Thrasher
- Tobacco Research Department, Population Health Research Center, Mexican National Institute of Public Health, Cuernavaca, Mexico
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
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28
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Rosen RL, Steinberg ML. Factors associated with past-year attempts to quit e-cigarettes among current users: Findings from the Population Assessment of Tobacco and Health Wave 4 (2017-2018). Drug Alcohol Depend 2021; 227:108973. [PMID: 34482034 PMCID: PMC8527564 DOI: 10.1016/j.drugalcdep.2021.108973] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 08/04/2021] [Accepted: 08/07/2021] [Indexed: 11/27/2022]
Abstract
Over 10 million adults report use of electronic nicotine delivery systems (ENDS), with approximately 3.6 million reporting daily use. Even as the popularity of ENDS has increased, both as an available nicotine delivery system and an alternative to combustible cigarette smoking, few studies to date have examined ENDS cessation interest and related behaviors among ENDS users. The current study aimed to describe past year attempts to quit ENDS among current users and to investigate ENDS use / user characteristics associated with unsuccessful attempts to quit in the past year among adult, current, established ENDS users using data from the Population Assessment of Tobacco and Health (PATH) Study Wave 4. Over 10 % of ENDS users reported an attempt to quit completely in the past year, and 60 % indicated future intention to quit completely. Higher nicotine dependence, lower-frequency ENDS use, and higher interest in quitting were associated with past year attempts to quit ENDS. The current study adds support to claims that many ENDS users plan to quit using ENDS someday and highlights the need for continued research on ENDS cessation.
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Affiliation(s)
- Rachel L Rosen
- Rutgers, The State University of New Jersey, Department of Psychology, 152 Frelinghuysen Road, Piscataway, NJ, 08854, USA.
| | - Marc L Steinberg
- Rutgers Robert Wood Johnson Medical School, Department of Psychiatry, 317 George Street, Suite 105, New Brunswick, NJ, 08901, USA
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29
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Kovach KA, Peterson R, Bharati R, Istas K, Monroe M. Co-creating opportunities to incorporate cessation for electronic nicotine delivery systems in family medicine - a qualitative program evaluation. BMC FAMILY PRACTICE 2021; 22:169. [PMID: 34429067 PMCID: PMC8382936 DOI: 10.1186/s12875-021-01520-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 08/09/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND The number of Americans who use tobacco has decreased in the twenty-first century, but electronic nicotine delivery systems (ENDS) have increased the complexity of treating tobacco dependence. The experiences of 18 family medicine practices were explored and opportunities to improve ENDS cessation were co-created in this study. METHODS Eighteen family medicine practices were enrolled into an implementation project to incorporate ENDS cessation into their practice. The participants' experiences were explored throughout the project using an iterative qualitative approach. The research team provided technical assistance. Semi-structured group interviews and focus groups were held with participants at the beginning, middle, and end of the project to explore participants' experiences. The collective knowledge and experiences of participants, expert consultants and the research team were fused together to co-create opportunities to improve ENDS cessation. RESULTS Nine opportunities to improve ENDS cessation were identified in three larger categories. The first category was leading change. This included: creating a vision for change to establish buy-in from key stakeholders and educate health care professionals to improve their confidence to address ENDS. The second category was creating processes. This included: establishing criteria for screening and quality improvement for ENDS cessation; being specific when asking about ENDS; creating electronic health record systems to support incorporating ENDS cessation; using chart audits if electronic health records cannot support incorporating ENDS into tobacco cessation; and assigning roles and responsibilities to members of the clinical care team. The third category was assisting patients who use ENDS. This included: educating patients and their parents/caregivers about ENDS and their potential harms, avoiding dual use, and developing a plan to quit. CONCLUSIONS This study highlights challenges and opportunities for incorporating ENDS cessation into family medicine. The opportunities outlined here provide a practical approach which is rooted in the experiences of family physicians and their clinical care teams working to improve how they address ENDS and based on peer reviewed literature and expert input. Improving how ENDS are addressed in family medicine will require more than clinical expertise. It will also require leadership skills and the ability to create process improvements. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Kevin A. Kovach
- American Academy of Family Physicians, 11400 Tomahawk Creek Parkway, Leawood, KS 66211 USA
| | - Reshana Peterson
- American Academy of Family Physicians, 11400 Tomahawk Creek Parkway, Leawood, KS 66211 USA
| | - Rajani Bharati
- American Academy of Family Physicians, 11400 Tomahawk Creek Parkway, Leawood, KS 66211 USA
| | - Kathryn Istas
- American Academy of Family Physicians, 11400 Tomahawk Creek Parkway, Leawood, KS 66211 USA
| | - Michael Monroe
- American Academy of Family Physicians, 11400 Tomahawk Creek Parkway, Leawood, KS 66211 USA
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30
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Vapers exhibit similar subjective nicotine dependence but lower nicotine reinforcing value compared to smokers. Addict Behav 2021; 115:106737. [PMID: 33360443 DOI: 10.1016/j.addbeh.2020.106737] [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: 05/04/2020] [Revised: 11/03/2020] [Accepted: 11/11/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION E-cigarette use has increased rapidly over the last 10 years, mostly among smokers and ex-smokers. Although there may be some degree of dependency on nicotine via e-cigarette use, the nature of this dependency is poorly understood. The aim of this paper is to use tasks from behavioural economics to compare the value that smokers place on tobacco cigarettes to the value that vapers place on e-cigarettes. METHOD Exclusive current smokers (n = 25) and vapers (n = 20) attended one session where they completed the Cigarette/e-cigarette Dependence Scale, the Cigarette/e-cigarette Purchasing Task (CPT) and the Concurrent Choice Task (CCT). The CPT requires participants to indicate how many puffs of their chosen product they would purchase at increasing price points. The CCT requires participants to choose between earning a money point or a point towards a cigarette/e-cigarette after being presented with a neutral, money or cigarette/e-cigarette cue. RESULTS Overall scores on the self-report scales suggest a comparable level of dependency between smokers and vapers. The CPT revealed that vapers are more sensitive than smokers to escalating costs as consumption declined as costs increased. On the CCT, when primed with money, vapers showed a decrease in choosing e-cigarettes. CONCLUSION These findings suggest that, on behavioural economic tasks, tobacco cigarettes have a higher relative value than e-cigarettes. Vapers appear to place a lower limit on what they will spend to access e-cigarettes and more readily choose money over e-cigarette puffs when primed by money cues.
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31
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Rest EC, Mermelstein RJ, Hedeker D. Nicotine Dependence in Dual Users of Cigarettes and E-Cigarettes: Common and Distinct Elements. Nicotine Tob Res 2021; 23:662-668. [PMID: 33097952 PMCID: PMC7976930 DOI: 10.1093/ntr/ntaa217] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 10/20/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION In a sample of dual users of cigarettes and electronic nicotine delivery systems (ENDS; e-cigarettes), we evaluated psychometric properties of ENDS versions of the Nicotine Dependence Syndrome Scale (NDSS), the brief Wisconsin Inventory of Smoking Dependence Motives (WISDM), and the Fagerström Test for Nicotine Dependence (FTND). Using the NDSS, we tested the hypothesis that there would be one common underlying factor of dependence across the cigarette and ENDS scales and other product-specific factors. AIMS AND METHODS Adult dual users (N = 404) completed baseline cigarette and ENDS versions of the NDSS, WISDM, and FTND, and biweekly surveys of their smoking and vaping. Analyses included bifactor modeling, which helps to identify both a general and product-specific factor for each item, and exploratory factor analyses of the combined cigarette and ENDS NDSS items and examinations of concurrent and predictive validity. RESULTS The bifactor model was not a good fit, suggesting the lack of one common underlying dependence factor. Factor analyses revealed separate, similar factors for both products, with only one factor (priority) showing overlap of cigarette and ENDS items. ENDS scales significantly predicted ENDS use over time, but not cigarette use. Cigarette scales did not predict ENDS use over time. CONCLUSIONS Although the cigarette and ENDS NDSS versions showed similar factor structure, there was not a primary common underlying factor reflecting drive or tolerance, but rather product-specific factors. The cigarette scales were not valid for predicting ENDS use. These results highlight the importance of separately assessing dependence for cigarettes and ENDS in dual users. IMPLICATIONS Although underlying dimensions of nicotine dependence may be similar for ENDS and cigarettes, separate, product-specific measures may be needed to understand differences in product-specific dependency and predict changes in use of each product over time.
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Affiliation(s)
- Eva C Rest
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL
| | - Robin J Mermelstein
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL
- Department of Psychology, University of Illinois at Chicago, Chicago, IL
| | - Donald Hedeker
- Department of Public Health Sciences, University of Chicago, Chicago, IL
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Hammond D, Reid JL, Rynard VL, O'Connor RJ, Goniewicz ML, Piper ME, Bansal-Travers M. Indicators of dependence and efforts to quit vaping and smoking among youth in Canada, England and the USA. Tob Control 2021; 31:tobaccocontrol-2020-056269. [PMID: 33526441 PMCID: PMC8325708 DOI: 10.1136/tobaccocontrol-2020-056269] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/14/2020] [Accepted: 12/22/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The current study examined indicators of dependence among youth cigarette smokers and e-cigarette users in Canada, England and the USA, including changes between 2017 and 2019. METHODS Data are from repeated cross-sectional online surveys conducted in 2017, 2018 and 2019 with national samples of youth aged 16-19 years, in Canada (n=12 018), England (n=11 362) and the USA (n=12 110). Measures included perceived addiction to cigarettes/e-cigarettes, frequency of experiencing strong urges to smoke/use an e-cigarette, plans to quit smoking/using e-cigarettes and past attempts to quit. Logistic regression models were fitted to examine differences between countries and changes over time. RESULTS The proportion of ever-users who vaped frequently was significantly higher in 2019 compared with 2017 for all outcomes in each country. Between 2017 and 2019, the proportion of past 30-day vapers reporting strong urges to vape on most days or more often increased in each country (Canada: 35.3%, adjusted OR (AOR) 1.69, 95% CI 1.20 to 2.38; England: 32.8%, AOR 1.55, 1.08 to 2.23; USA: 46.1%, AOR 1.88, 1.41 to 2.50), along with perceptions of being 'a little' or 'very addicted' to e-cigarettes (Canada: 48.3%, AOR 1.99, 1.44 to 2.75; England: 40.1%, AOR 1.44, 1.03 to 2.01; USA: 53.1%, AOR 1.99, 1.50 to 2.63). Indicators of dependence among smokers were consistently greater than e-cigarette users, although differences had narrowed by 2019, particularly in Canada and the USA. CONCLUSIONS Prevalence of dependence symptoms among young e-cigarette users increased between 2017 and 2019, more so in Canada and the USA compared with England. Dependence symptom prevalence was lower for e-cigarettes than smoking; however, the gap has narrowed over time.
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Affiliation(s)
- David Hammond
- School of Public Health & Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Jessica L Reid
- School of Public Health & Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Vicki L Rynard
- School of Public Health & Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Richard J O'Connor
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Maciej L Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Megan E Piper
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin Madison, Madison, Wisconsin, USA
| | - Maansi Bansal-Travers
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
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Goldenson NI, Fearon IM, Buchhalter AR, Henningfield JE. An Open-Label, Randomized, Controlled, Crossover Study to Assess Nicotine Pharmacokinetics and Subjective Effects of the JUUL System with Three Nicotine Concentrations Relative to Combustible Cigarettes in Adult Smokers. Nicotine Tob Res 2021; 23:947-955. [PMID: 33486526 PMCID: PMC8628869 DOI: 10.1093/ntr/ntab001] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 01/04/2021] [Indexed: 11/30/2022]
Abstract
Introduction This randomized, open-label, crossover clinical study evaluated nicotine
pharmacokinetics (PK) and subjective effects of the JUUL System (JS; Juul
Labs, Inc.) with three nicotine concentrations compared to the usual brand
(UB) cigarettes in 24 adult smokers. Methods At five study visits, subjects used either the JS in 59 mg/mL, JS 18 mg/mL
(two visits), and JS 9 mg/mL (all tobacco-flavored) or smoked their UB
cigarette first during a controlled puffing sequence (CPS) and then ad
libitum (5 min) use sessions. Blood samples were taken at specified
timepoints for 60 min in each session. The modified Product Evaluation Scale
assessed subjective effects 30-min post-use in the CPS session. Results Maximum plasma nicotine concentration (Cmax-BL),
total nicotine exposure (AUC0-60-BL), and rate of plasma nicotine
rise were significantly lower for all JS products compared to subjects' UB
cigarette in CPS and ad libitum use sessions. In both use sessions these PK
parameters were significantly higher for JS 59 mg/mL compared to 18 and 9
mg/mL. Subjective measures of cigarette craving relief and “Enough
Nicotine” for JS 59 mg/mL did not differ significantly from UB
cigarettes, but JS 18 and 9 mg/mL were rated significantly lower than JS 59
mg/mL and UB cigarettes. Conclusions Nicotine exposure and subjective relief were directly related to JS nicotine
concentration: higher nicotine concentrations gave rise to significantly
greater plasma nicotine levels and relief from craving. Heavier and more
dependent smokers may require the greater nicotine delivery of JS 59 mg/mL
to successfully transition away from cigarettes. Implications It has been suggested that electronic nicotine delivery systems (ENDS) and
other alternative nicotine delivery products that more closely mimic the
nicotine pharmacokinetics (PK) of cigarettes may facilitate smokers
transitioning away from cigarettes. We examined nicotine PK and subjective
effects of JUUL System (JS) ENDS with three nicotine concentrations (59, 18
and 9 mg/mL) compared to combustible cigarettes. Nicotine delivery from JS
ENDS was nicotine concentration dependent, with higher nicotine
concentrations giving rise to higher nicotine exposure. These findings
suggest that heavier and more dependent smokers may require ENDS with
nicotine concentrations greater than 20 mg/mL to successfully transition
away from cigarettes.
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Buckell J, Hensher DA, Hess S. Kicking the habit is hard: A hybrid choice model investigation into the role of addiction in smoking behavior. HEALTH ECONOMICS 2021; 30:3-19. [PMID: 33128328 PMCID: PMC8338917 DOI: 10.1002/hec.4173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 08/13/2020] [Accepted: 09/10/2020] [Indexed: 06/11/2023]
Abstract
Use of choice models is growing rapidly in tobacco research. These models are being used to answer key policy questions. However, certain aspects of smokers' choice behavior are not well understood. One such feature is addiction. Here, we address this issue by modeling data from a choice experiment on the US smokers. We model addiction using a latent variable. We use this latent variable to understand the relationship between choices and addiction, giving attention to nicotine levels. We find that more addicted smokers have stronger preferences for cigarettes and are unwilling to switch to e-cigarettes. Addicted smokers value nicotine in tobacco products to a much greater extent than those that are less addicted. Lastly, we forecast short-term responses to lowering nicotine levels in cigarettes. The results suggest that current nicotine-focused policies could be effective at encouraging addicted smokers to less harmful products and lead to substantial public health gains.
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Affiliation(s)
- John Buckell
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - David A. Hensher
- Institute for Transport and Logistics Studies, University of Sydney Business School, Sydney, Australia
| | - Stephanie Hess
- Choice Modelling Centre and Institute for Transport Studies, University of Leeds, Leeds, UK
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Cano M, Reynaga DD, Belluzzi JD, Loughlin SE, Leslie F. Chronic exposure to cigarette smoke extract upregulates nicotinic receptor binding in adult and adolescent rats. Neuropharmacology 2020; 181:108308. [PMID: 32950561 PMCID: PMC7655523 DOI: 10.1016/j.neuropharm.2020.108308] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 09/11/2020] [Accepted: 09/13/2020] [Indexed: 01/23/2023]
Abstract
Heavy smokers display increased radioligand binding of nicotinic acetylcholine receptors (nAChRs). This "upregulation" is thought to be a contributing factor to tobacco dependence. Although cigarette smoke contains thousands of constituents that can contribute to nicotine dependence, it is not well understood whether non-nicotine constituents contribute to nAChR upregulation. In this study, we used an aqueous cigarette smoke extract (CSE), which contains nicotine and soluble constituents of cigarette smoke, to induce nAChR upregulation in adult and adolescent rats. To do this, male rats were exposed to nicotine or CSE (1.5 mg/kg/day nicotine equivalent, intravenously) daily for ten days. This experimental procedure produces equivalent levels of brain and plasma nicotine in nicotine- and CSE-treated animals. We then assessed nAChR upregulation using quantitative autoradiography to measure changes in three nAChR types. Adolescents were found to have consistently greater α4β2 nAChR binding than adults in many brain regions. Chronic nicotine exposure did not significantly increase nAChR binding in any brain region at either age. Chronic CSE exposure selectively increased α4β2 nAChR binding in adolescent medial amygdala and α7 binding in adolescent central amygdala and lateral hypothalamus. CSE also increased α3β4 nAChR binding in the medial habenula and interpeduncular nucleus, and α7 binding in the medial amygdala, independent of age. Overall, this work provides evidence that cigarette smoke constituents influence nAChR upregulation in an age-, nAChR type- and region-dependent manner.
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Affiliation(s)
- Michelle Cano
- Department of Pharmaceutical Sciences, University of California, Irvine, CA, USA.
| | - Daisy D Reynaga
- Department of Pharmaceutical Sciences, University of California, Irvine, CA, USA
| | - James D Belluzzi
- Department of Pharmaceutical Sciences, University of California, Irvine, CA, USA
| | - Sandra E Loughlin
- Department of Pharmaceutical Sciences, University of California, Irvine, CA, USA
| | - Frances Leslie
- Department of Pharmaceutical Sciences, University of California, Irvine, CA, USA
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Goldenson NI, Buchhalter AR, Augustson EM, Rubinstein ML, Henningfield JE. Abuse liability assessment of the JUUL system in four flavors relative to combustible cigarette, nicotine gum and a comparator electronic nicotine delivery system among adult smokers. Drug Alcohol Depend 2020; 217:108395. [PMID: 33176942 DOI: 10.1016/j.drugalcdep.2020.108395] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/16/2020] [Accepted: 10/24/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND The abuse liability of the JUUL System (JS) in four flavors were evaluated compared to combustible cigarettes, nicotine gum, and a comparator electronic nicotine delivery system (ENDS) with pharmacokinetics (PK) and subjective effects. METHODS Adult smokers (N = 66; 50.0 % female; mean age = 41.1; 63.6 % white) completed a 7-arm within-subjects cross-over product-use study while confined to a clinical laboratory. Participants used JS in four flavors (Virginia Tobacco, Mango, Mint, Creme, [5.0 % nicotine; 59 mg/mL]), their usual brand (UB) cigarette, a comparator ENDS (VUSE Solo; 4.8 % nicotine, tobacco-flavor), and mint nicotine gum (4 mg) under controlled use conditions. After each product use, nicotine PK and subjective effects were assessed. RESULTS Maximum plasma nicotine levels (Cmax-BL), rate of plasma nicotine rise, overall nicotine exposure (AUC0-60-BL), and subjective liking and satisfaction of JS were significantly lower than UB cigarettes. These parameters were generally greater for JS than nicotine gum; the comparator ENDS was somewhat lower but within the range of JS. Nicotine PK did not differ among the Mint, Mango, and Virginia Tobacco JS flavors. Mint and Mango were rated as more satisfying than Virginia Tobacco and Creme. CONCLUSIONS Controlled use of JS among adult smokers resulted in nicotine delivery, product liking, and satisfaction that were less than that of combustible cigarettes but generally greater than nicotine gum. These results support the conclusion that JS has lower abuse liability than combustible cigarettes, higher abuse liability than nicotine gum, and may provide sufficient nicotine delivery and satisfying effects to support substitution for combustible cigarettes among adult smokers.
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Shiffman S, Sembower MA. Dependence on e-cigarettes and cigarettes in a cross-sectional study of US adults. Addiction 2020; 115:1924-1931. [PMID: 32196810 PMCID: PMC7540348 DOI: 10.1111/add.15060] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/24/2019] [Accepted: 03/19/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND AIMS Cigarette smoking often results in nicotine dependence. With use of electronic cigarettes as an alternative source of nicotine, it is important to assess dependence associated with e-cigarette use. This study assesses dependence among current and former adult e-cigarette users on cigarettes and e-cigarettes, compared with dependence on cigarettes. DESIGN Cross-sectional data from the Population Assessment of Tobacco and Health (PATH) study from 2013-2016. Psychometrically assessed dependence was compared for cigarettes and e-cigarettes among current and former exclusive and dual users of the products and among e-cigarette users who had and had not recently stopped smoking. Setting A population-based representative sample of US adults. Participants Participants were 13 311 US adults (18+) in Waves 1-3 of PATH reporting current established smoking, current use of e-cigarettes, or stopping use of either product in the past year who were administered dependence assessments for cigarettes and/or e-cigarettes. Measurements A 16-item scale assessing tobacco dependence (on a 1-5 scale), previously validated for assessment and comparison of dependence on varied tobacco products, including cigarettes and e-cigarettes, with a variation assessing residual dependence among users who stopped in the past year. Findings Among current users, dependence on e-cigarettes was significantly lower than dependence on cigarettes, in within-subjects comparisons among dual users of both e-cigarettes and cigarettes (1.58 [SE = 0.05] vs. 2.76 [0.04]), P < 0.0001), and in separate groups of e-cigarette users and cigarette smokers (1.95 [0.05] vs. 2.52 [0.02], P < 0.0001), and among both daily and non-daily users of each product. Among former users, residual symptoms were significantly lower for e-cigarettes than cigarettes, both among former dual users (1.23 [0.07] vs. 1.41 [0.06], P < 0.001) and among users of one product (1.28 [0.03] vs. 1.53 [0.03], P < 0.0001). The highest level of e-cigarette dependence was among e-cigarette users who had stopped smoking (2.17 [0.08]). Conclusion Use of e-cigarettes appears to be consistently associated with lower nicotine dependence than cigarette smoking.
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Affiliation(s)
- Saul Shiffman
- PinneyAssociates, Inc.PittsburghPAUSA,University of PittsburghPittsburghPAUSA
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Dunbar MS, Davis JP, Tucker JS, Seelam R, Shih RA, D'Amico EJ. Developmental Trajectories of Tobacco/Nicotine and Cannabis Use and Patterns of Product Co-use in Young Adulthood. Tob Use Insights 2020; 13:1179173X20949271. [PMID: 32922109 PMCID: PMC7446261 DOI: 10.1177/1179173x20949271] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/08/2020] [Indexed: 11/15/2022] Open
Abstract
Introduction Concurrent co-use of tobacco/nicotine and cannabis (T/C) products is common among young people and may increase risks for negative health and psychosocial outcomes, but little is known about developmental patterns of T/C co-use. This study aimed to identify distinct trajectory classes of concurrent T/C co-use from ages 16 to 21 and compare groups on T/C co-use behaviors in young adulthood. Methods Participants (n = 2497) reported T/C use on annual online surveys from 2015 to 2019 (ages 16-22). We used parallel process growth mixture models to model simultaneous trajectories of past-month cigarette, e-cigarette, smokeless tobacco, and cannabis use and identify latent classes of T/C trajectories. Classes were then compared on types and number of T/C products used and types of T/C co-use in young adulthood. Results Models revealed 4 T/C classes: Low/No T/C Use, Early Concurrent T/C Co-use, Late Concurrent T/C Co-use, and Tobacco Quitters/Cannabis Maintainers. Compared to other classes, the Early Concurrent T/C Co-use group-individuals with rapid progression to concurrent T/C co-use during adolescence-were more likely to report poly-tobacco use, poly-cannabis use, same-occasion sequential T/C co-use and T/C co-administration (ie, mixing T/C) of both combustible and vaping products in young adulthood. Conclusion Early progression to concurrent T/C co-use in adolescence is prospectively linked to poly-product use and co-use of T/C products in young adulthood. Prevention efforts targeting co-use of T/C products in adolescence may help to reduce riskier patterns of T/C use and co-use in young adulthood.
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Bolt HM. Electronic cigarettes and vaping: toxicological awareness is increasing. Arch Toxicol 2020; 94:1783-1785. [PMID: 32440856 PMCID: PMC7240249 DOI: 10.1007/s00204-020-02786-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 05/13/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Hermann M Bolt
- Department of Toxicology, Leibniz Research Centre for Working Environment and Human Factors at TU, Dortmund (IfADo), Ardeystr. 67, 44139, Dortmund, Germany.
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