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Bong AR, Cho YG, Park HA, Kim KW. Unhealthy Weight Control Behaviors according to the Status of Combustible Cigarette and Noncombustible Nicotine or Tobacco Product Use among Korean Adolescents with Experience Attempting to Reduce or Maintain Their Body Weight: The 15th Korea Youth Risk Behavior Survey, 2019. Korean J Fam Med 2024; 45:223-230. [PMID: 38720235 PMCID: PMC11273165 DOI: 10.4082/kjfm.21.0170] [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: 08/18/2021] [Revised: 01/16/2024] [Accepted: 03/07/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Noncombustible nicotine or tobacco product (NNTP) use, and cigarette smoking are associated with a high likelihood of unhealthy weight control behaviors (UWCBs) among adolescents. However, no study has addressed the differences in UWCBs among non-users, single users of combustible cigarettes (CCs) or NNTPs and dual users. This study compared the frequencies of weight control behaviors according to the status of CC and NNTP use among Korean adolescents. METHODS This was a cross-sectional study of 25,094 adolescents who had attempted to reduce or maintain their body weight during the past 30 days, using data from the 15th Korea Youth Risk Behavior Survey, 2019. Data on the status of CC and NNTP use, weight status, and weight control behaviors were obtained using self-report questionnaires. Subjects were categorized into four groups: non-users, cigarette-only users, NNTP-only users, and dual users. RESULTS Among boys and girls, current smokers and NNTP users were 8.9%±0.3% and 5.5%±0.3%, and 4.2%±0.2% and 1.7%±0.1%, respectively. Among boys, NNTP-only users were more likely to engage in extreme weight control behaviors than non-users. Among girls, users of either CCs or NNTPs were more likely to engage in extreme weight control behaviors and less extreme weight control behaviors than non-users. CONCLUSION This study shows that users of either CCs or NNTPs are more likely to engage in UWCBs, and NNTP-only users are the most likely to do so.
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Affiliation(s)
- A Ra Bong
- Department of Family Medicine, Seoul Paik Hospital, College of Medicine, Inje University, Seoul, Korea
| | - Young Gyu Cho
- Department of Family Medicine, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Hyun Ah Park
- Department of Family Medicine, Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Korea
| | - Kyo Woon Kim
- Department of Family Medicine, Seoul Paik Hospital, College of Medicine, Inje University, Seoul, Korea
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Kwon M, Nam E, Lee J. Poly-tobacco use and mental health in South Korean adolescents. Tob Induc Dis 2024; 22:TID-22-83. [PMID: 38779296 PMCID: PMC11110650 DOI: 10.18332/tid/187077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/09/2024] [Accepted: 04/11/2024] [Indexed: 05/25/2024] Open
Abstract
INTRODUCTION With the advent of new tobacco products, poly-tobacco use among adolescents is increasing. Smoking among adolescents negatively impacts both their physical and mental health. This study aimed to determine poly-tobacco use among adolescents in South Korea and to identify the mental health problems caused by single-, dual-, and poly-tobacco use. METHODS Data from 54948 adolescents in the 2020 Korea Youth Behavior Web-based Survey were included. Mental health variables of our primary outcome were loneliness, anxiety, and depression. Descriptive statistics, Rao-Scott χ2 test and complex sample multivariable logistic regression analysis were conducted to determine the association between the type of tobacco product use and mental health. RESULTS Among the subjects, 95.2% were non-tobacco users, followed by single (3.0%), dual (1.1%), and poly users (0.7%). The subjects with poly-tobacco use had significantly higher rates of loneliness (33.2%, p<0.001), anxiety (22.3%, p<0.001), and depression (49.9%, p<0.001) than those who used fewer tobacco products. Subjects who used poly-tobacco products were 2.13 (95% CI: 1.61-2.83) times more likely to report loneliness, 1.52 (95% CI: 1.12-2.07) times more likely to report anxiety, and 2.18 (95% CI: 1.68-2.82) times more likely to report depression than non-tobacco users. CONCLUSIONS Among adolescents, poly-tobacco use is associated with symptoms of loneliness, depression, and anxiety, which are internalized mental health problems. Poly-tobacco use warrants early assessment of high-risk groups, education on the need for tobacco-use cessation, and active intervention for the psychological difficulties that these high-risk groups experience.
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Affiliation(s)
- Min Kwon
- Department of Nursing, The University of Suwon, Hwaseong-si, Republic of Korea
| | - Eunjeong Nam
- Department of Nursing, Seoul Women's College of Nursing, Seoul, Republic of Korea
| | - Jinhwa Lee
- Department of Nursing, University of Ulsan, Ulsan, Republic of Korea
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3
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Zhang BY, Bannon OS, Tzu-Hsuan Chen D, Filippidis FT. Dual and poly-nicotine and tobacco use among adolescents in the United States from 2011 to 2022. Addict Behav 2024; 152:107970. [PMID: 38277994 DOI: 10.1016/j.addbeh.2024.107970] [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: 11/13/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND Adolescent nicotine and tobacco product use remains common despite declining smoking rates in the United States, likely due to the emergence of novel products. Concurrent use of multiple products may increase the risk of nicotine dependency and subsequent substance use. AIM To identify patterns and trends of dual and poly nicotine and tobacco use among adolescents in the US and explore associations of dual and poly nicotine and tobacco use with sociodemographic factors. METHODS 12 years of annual National Youth Tobacco Survey data (2011-2022) from 242,637 respondents were used to examine prevalence trends of different combinations of nicotine or tobacco product use among adolescents in the US using weighted point estimates for each year. Poisson regression models examined sociodemographic factors associated with different patterns of dual and poly-product use from 2011 to 2022. RESULTS Overall, the prevalence of dual (i.e. at least two products) and poly (i.e. at least three products) use decreased between 2011 and 2021 (from 9.5 % to 2.8 % and from 5.1 % to 1.1 %, respectively), but showed signs of increase between 2021 and 2022 (3.7 % for dual and 1.7 % for poly use). The most common combinations included a combustible product with either a novel or noncombustible product. The risk for dual and poly-product use was higher among non-Hispanic Whites, males, and high school students. CONCLUSIONS Previously declining trends in the prevalence of tobacco/nicotine dual and poly use may have been reversed. Close monitoring and targeted tobacco control policies are essential to tackle multiple product use among adolescents.
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Affiliation(s)
- Baihui Y Zhang
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, England, United Kingdom
| | - Olivia S Bannon
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, England, United Kingdom.
| | - Daniel Tzu-Hsuan Chen
- Nuffield Department of Primary Care Health Science, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, United Kingdom
| | - Filippos T Filippidis
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, England, United Kingdom
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Davigo M, Klerx WNM, van Schooten FJ, Opperhuizen A, Remels AHV, Talhout R. Impact of More Intense Smoking Parameters and Flavor Variety on Toxicant Levels in Emissions of a Heated Tobacco Product. Nicotine Tob Res 2024; 26:571-579. [PMID: 38035623 PMCID: PMC11033558 DOI: 10.1093/ntr/ntad238] [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: 07/20/2023] [Revised: 10/13/2023] [Accepted: 11/23/2023] [Indexed: 12/02/2023]
Abstract
INTRODUCTION IQOS HEETS are promoted as reduced-risk alternatives to cigarettes. Although some studies have investigated the chemical composition of HEETS emissions, little is known on whether toxicant levels in such emissions are affected by different puffing parameters and flavor varieties. This has important implications when assessing actual human exposure, since IQOS users develop a specific and personalized puffing behavior and may use different HEETS variants. METHODS This study measured the levels of nicotine, total particulate matter, carbonyl compounds, and tobacco-specific nitrosamines (TSNAs) in the emissions of nine differently flavored HEETS and two cigarettes (1R6F and Marlboro Red, MR). Emissions from Yellow HEETS, 1R6F, and MR were collected using the World Health Organization Intense smoking regime and four more intense smoking regimes. RESULTS Yellow HEETS aerosol contained lower levels of toxicants compared to 1R6F and MR smoke. More intense smoking regimes increased carbonyl release in cigarette smoke, whereas only higher puff frequency led to lower levels of toxicants in Yellow HEETS aerosol. Some HEETS varieties exhibited higher levels of formaldehyde and TSNAs in their aerosols compared to Yellow HEETS. CONCLUSIONS Puff frequency was identified as the only smoking parameter that significantly lowered the release of almost all toxicants in Yellow HEETS, whereas a combination of higher puff volume and puff duration led to increased levels of some carbonyls. Differences in toxicant levels between various commercially available HEETS have important implications when assessing their health impact, as their consumption might induce different toxicant exposure and health effects. IMPLICATIONS HEETS release about half as much nicotine and substantially lower levels of toxicants compared to cigarettes. Literature data showed that puffing intensity is increased in cigarette smokers switching to HEETS, maybe in reaction to these lower nicotine levels. Our results show a differential impact of increased puff frequency, puff duration, and puff volume in the release of toxicants from HEETS. Thus, industry-independent studies on puff topography are critical to make choices for the most relevant puffing regime for heated tobacco product regulation. Regulators should consider evaluating the health impact of multiple HEETS varieties, as the tobacco filler composition significantly affects the release of certain toxicants.
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Affiliation(s)
- Michele Davigo
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Department of Pharmacology and Toxicology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Walther N M Klerx
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Frederik-Jan van Schooten
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Department of Pharmacology and Toxicology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Antoon Opperhuizen
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Department of Pharmacology and Toxicology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Office of Risk Assessment and Research, Netherlands Food and Consumer Product Safety Authority (NVWA), Utrecht, The Netherlands
| | - Alexander H V Remels
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Department of Pharmacology and Toxicology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Reinskje Talhout
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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Noh MAM, Hairi FM, Nordin ASA, Yee A, Tajuddin NAA, Hasan SI, Danaee M, Kamaludin IS, Subramaniyan M, Pravinassh R, Kaai SC, Driezen P, Yan M, Xu SS, Quah ACK, Fong GT. Prevalence and reasons for use of heated tobacco products among Malaysian adults who smoked: Findings from the 2020 International Tobacco Control Malaysia Survey. Drug Alcohol Depend 2024; 257:111131. [PMID: 38428371 DOI: 10.1016/j.drugalcdep.2024.111131] [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: 11/06/2023] [Revised: 02/05/2024] [Accepted: 02/12/2024] [Indexed: 03/03/2024]
Abstract
INTRODUCTION There have been rapid expansions in heated tobacco products (HTPs) outside of Japan and the Republic of Korea. In November 2018, HTPs were first introduced in Malaysia and since then, no studies have been conducted on Malaysians' use of HTPs. This study is the first to examine the prevalence of HTP use and reasons for use among Malaysian adults who smoked cigarettes. METHODS Data came from the 2020 ITC Malaysia Survey, a web-based survey of a nationally representative sample of adults who smoked (n=1047) aged 18 and older. They were asked on ever heard of, ever used, and currently using HTPs, and their reasons for using HTPs. RESULTS Overall, 25.4% (n= 324; 95% CI:22.3%-28.7%) of Malaysians who smoked reported ever used HTPs with 6.7% (n=85; 95% CI:22.3%-28.7%) were using them daily and 8.1% (n=110; 95% CI:6.4% -10.2%) were using HTPs non-daily. Most of them (57.2%) who dual use were of aged 25-39 and 97.3% were males. Among those who smoked daily, almost half (49.3%) were also using HTP daily. Among those who used HTPs daily and non-daily, curiosity (84.2%, 95% CI:78.4%-90.0%), taste (83.2%, 95% CI:77.3%-89.1%), and appealing technology (78.5%, 95% CI:71.3%-85.6%) were the most reported reasons. Among those who used HTPs daily, curiosity was the top reason (87.9%, 95% CI:78.9%-93.4%), while among non-daily, taste good was the top reason (81.9%, 95% CI:71.9%-88.8%). CONCLUSIONS The very high use of HTPs among Malaysians who smoked requires continued public health surveillance that can inform the regulation of these novel tobacco products.
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Affiliation(s)
- Muhamad Alfakri Mat Noh
- Department of Anatomy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Nicotine Addiction Research Group, University of Malaya Centre of Addiction Sciences, University of Malaya, Kuala Lumpur, Malaysia.
| | - Farizah Mohd Hairi
- Nicotine Addiction Research Group, University of Malaya Centre of Addiction Sciences, University of Malaya, Kuala Lumpur, Malaysia; Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Amer Siddiq Amer Nordin
- Nicotine Addiction Research Group, University of Malaya Centre of Addiction Sciences, University of Malaya, Kuala Lumpur, Malaysia; Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Anne Yee
- Nicotine Addiction Research Group, University of Malaya Centre of Addiction Sciences, University of Malaya, Kuala Lumpur, Malaysia
| | - Nur Amani Ahmad Tajuddin
- Nicotine Addiction Research Group, University of Malaya Centre of Addiction Sciences, University of Malaya, Kuala Lumpur, Malaysia; Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Siti Idayu Hasan
- Nicotine Addiction Research Group, University of Malaya Centre of Addiction Sciences, University of Malaya, Kuala Lumpur, Malaysia
| | - Mahmoud Danaee
- Nicotine Addiction Research Group, University of Malaya Centre of Addiction Sciences, University of Malaya, Kuala Lumpur, Malaysia; Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ina Sharyn Kamaludin
- Nicotine Addiction Research Group, University of Malaya Centre of Addiction Sciences, University of Malaya, Kuala Lumpur, Malaysia; Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Muniswary Subramaniyan
- Nicotine Addiction Research Group, University of Malaya Centre of Addiction Sciences, University of Malaya, Kuala Lumpur, Malaysia; Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - R Pravinassh
- Nicotine Addiction Research Group, University of Malaya Centre of Addiction Sciences, University of Malaya, Kuala Lumpur, Malaysia
| | - Susan C Kaai
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada; School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Pete Driezen
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada; School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Mi Yan
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Steve S Xu
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Anne C K Quah
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada; School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada; Ontario Institute for Cancer Research, Toronto, Ontario, Canada
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Odani S, Koyama S, Miyashiro I, Tanigami H, Ohashi Y, Tabuchi T. Association between heated tobacco product use and airway obstruction: a single-centre observational study, Japan. BMJ Open Respir Res 2024; 11:e001793. [PMID: 38460973 DOI: 10.1136/bmjresp-2023-001793] [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: 04/25/2023] [Accepted: 02/07/2024] [Indexed: 03/11/2024] Open
Abstract
BACKGROUND While heated tobacco products (HTPs) may affect pulmonary function, the evidence supporting the utility of screening for HTP use in clinical settings is insufficient. We examined the association between HTP use and airway obstruction after switching from cigarettes. METHOD The study subjects were patients aged ≥20 years undergoing surgery from December 2021 to September 2022 who completed spirometry and reported tobacco (cigarette and HTP) use status during the preoperative assessment. Airway obstruction was defined as forced expiratory volume in 1 s to forced vital capacity ratio below the lower limit of normal. Current tobacco use was defined as past-30-day use. Multivariable Poisson regression analysis was performed to examine the associations between HTP use and airway obstruction by adjusting for demographic characteristics, lifetime cigarette smoking (pack-year) and duration of smoking cessation. RESULTS Overall (N=2850, 55.4% women, mean age 62.4), 4.6% and 10.7% reported current HTP use and cigarette smoking, respectively. 16.8% had airway obstruction. Airway obstruction was more common among current HTP-only users (adjusted prevalence ratio (APR)=2.32), current cigarette-only smokers (APR=2.57) and current dual users (APR=2.82) than never-tobacco users. Among current tobacco users (N=398), the prevalence of airway obstruction was not significantly different between HTP-only users and cigarette-only smokers. Among former cigarette smokers (>30-day cigarette quitters) (N=1077), current HTP users had 1.42 times the increased prevalence of airway obstruction than never-HTP users after adjusting for cigarette pack-year; a stronger association was observed when the analysis was restricted to ≥5-year cigarette quitters (N=772) (APR=1.96, vs never HTP users). CONCLUSION Current HTP use was associated with airway obstruction among patients with cancer who had completely switched from cigarettes even after quitting smoking for a long period. Patients should be routinely screened for HTP use and advised to quit any tobacco.
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Affiliation(s)
- Satomi Odani
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
- The Tokyo Foundation for Policy Research, Minato-ku, Tokyo, Japan
| | - Shihoko Koyama
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Isao Miyashiro
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Hironobu Tanigami
- Division of Anesthesiology, Osaka International Cancer Institute, Osaka, Japan
| | - Yoshifumi Ohashi
- Division of Anesthesiology, Osaka International Cancer Institute, Osaka, Japan
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
- The Tokyo Foundation for Policy Research, Minato-ku, Tokyo, Japan
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Liu Y, Filippidis FT. Tobacco market trends in 97 countries between 2007 and 2021. Tob Induc Dis 2024; 22:TID-22-31. [PMID: 38314375 PMCID: PMC10835573 DOI: 10.18332/tid/177441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/01/2023] [Accepted: 12/14/2023] [Indexed: 02/06/2024] Open
Abstract
INTRODUCTION Analysis of the tobacco market can provide valuable insights for developing tobacco control strategies. This study examines the market trends of cigarettes, cigars/cigarillos, smoking tobacco, smokeless tobacco, e-cigarettes, heated tobacco products (HTPs), and tobacco-free oral nicotine, across 97 countries between 2007 and 2021. METHODS We obtained annual tobacco retail value data from Euromonitor Passport and calculated the market share for each type of tobacco product. The research examined trends in retail value and market share globally, stratified by national income level, as well as in individual countries. RESULTS From 2007 to 2015, the growth of the global tobacco market was primarily driven by cigarette sales. However, starting in 2016, emerging products, including e-cigarettes, HTPs, and tobacco-free oral nicotine, as well as non-cigarette combustible products, including cigars/cigarillos and smoking tobacco, have been mostly responsible for the increases in the global tobacco retail value. High-income countries experienced the greatest increase in the retail value of emerging products, while middle- and low-income countries still observed rises in cigarette sales. CONCLUSIONS Trends in the retail value of different tobacco products varied widely during the study period, with distinct trends observed in different income levels and within individual countries. These trends can supplement prevalence data and be used to inform local tobacco control policies.
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Affiliation(s)
- Yifei Liu
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, United Kingdom
| | - Filippos T. Filippidis
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, United Kingdom
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Wang H, Lu F, Tian Y, Zhang S, Han S, Fu Y, Li J, Feng P, Shi Z, Chen H, Hou H. Evaluation of toxicity of heated tobacco products aerosol and cigarette smoke to BEAS-2B cells based on 3D biomimetic chip model. Toxicol In Vitro 2024; 94:105708. [PMID: 37806364 DOI: 10.1016/j.tiv.2023.105708] [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: 05/23/2023] [Revised: 08/28/2023] [Accepted: 10/03/2023] [Indexed: 10/10/2023]
Abstract
It is still a controversial topic about evaluating whether heated tobacco products (HTP) really reduce harm, which involves the choice of an experimental model. Here, a three-dimensional (3D) biomimetic chip model was used to evaluate the toxicity of aerosols came from HTP and smoke produced by cigarettes (Cig). Based on cell-related experiments, we found that the toxicity of Cig smoke extract diluted four times was also much higher than that of undiluted HTP, showing higher oxidative stress response and cause mitochondrial dysfunction. Meanwhile, both tobacco products all affect the tricarboxylic acid cycle (TCA), which is manifested by a significant decrease in the mRNA expression of TCA key rate-limiting enzymes. Summarily, 3D Biomimetic chip technology can be used as an ideal model to evaluate HTP. It can provide important data for tobacco risk assessment when 3D chip model was used. Our experimental results showed that HTP may be less harmful than tobacco cigarettes, but it does show significant cytotoxicity with the increase of dose. Therefore, the potential clinical effects of HTP on targeted organs such as lung should be further studied.
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Affiliation(s)
- Hongjuan Wang
- China National Tobacco Quality Supervision &Test Center, Zhengzhou, China; Key Laboratory of Tobacco Biological Effects, Zhengzhou, China; Beijing Institute of Life Science and Technology, Beijing, China; Key Labortory of Tobacco Biological Effects and Biosynthesis, Beijing, China
| | - Fengjun Lu
- China National Tobacco Quality Supervision &Test Center, Zhengzhou, China; Key Laboratory of Tobacco Biological Effects, Zhengzhou, China
| | - Yushan Tian
- China National Tobacco Quality Supervision &Test Center, Zhengzhou, China; Key Laboratory of Tobacco Biological Effects, Zhengzhou, China; Beijing Institute of Life Science and Technology, Beijing, China; Key Labortory of Tobacco Biological Effects and Biosynthesis, Beijing, China
| | - Sen Zhang
- Shaanxi Key Laboratory of Degradable Biomedical Materials, School of Chemical Engineering, Northwest University, Xi'an 710069, China
| | - Shulei Han
- China National Tobacco Quality Supervision &Test Center, Zhengzhou, China; Key Laboratory of Tobacco Biological Effects, Zhengzhou, China; Beijing Institute of Life Science and Technology, Beijing, China; Key Labortory of Tobacco Biological Effects and Biosynthesis, Beijing, China
| | - Yaning Fu
- China National Tobacco Quality Supervision &Test Center, Zhengzhou, China; Key Laboratory of Tobacco Biological Effects, Zhengzhou, China; Beijing Institute of Life Science and Technology, Beijing, China; Key Labortory of Tobacco Biological Effects and Biosynthesis, Beijing, China
| | - Jun Li
- China National Tobacco Quality Supervision &Test Center, Zhengzhou, China; Key Laboratory of Tobacco Biological Effects, Zhengzhou, China; Beijing Institute of Life Science and Technology, Beijing, China; Key Labortory of Tobacco Biological Effects and Biosynthesis, Beijing, China
| | - Pengxia Feng
- China National Tobacco Quality Supervision &Test Center, Zhengzhou, China; Key Laboratory of Tobacco Biological Effects, Zhengzhou, China
| | - Zhihao Shi
- China National Tobacco Quality Supervision &Test Center, Zhengzhou, China; Key Laboratory of Tobacco Biological Effects, Zhengzhou, China
| | - Huan Chen
- China National Tobacco Quality Supervision &Test Center, Zhengzhou, China; Key Laboratory of Tobacco Biological Effects, Zhengzhou, China; Beijing Institute of Life Science and Technology, Beijing, China; Key Labortory of Tobacco Biological Effects and Biosynthesis, Beijing, China.
| | - Hongwei Hou
- China National Tobacco Quality Supervision &Test Center, Zhengzhou, China; Key Laboratory of Tobacco Biological Effects, Zhengzhou, China; Beijing Institute of Life Science and Technology, Beijing, China; Key Labortory of Tobacco Biological Effects and Biosynthesis, Beijing, China.
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Kopa-Stojak PN, Pawliczak R. Comparison of the effects of active and passive smoking of tobacco cigarettes, electronic nicotine delivery systems and tobacco heating products on the expression and secretion of oxidative stress and inflammatory response markers. A systematic review. Inhal Toxicol 2024; 36:75-89. [PMID: 38394073 DOI: 10.1080/08958378.2024.2319315] [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: 10/16/2023] [Accepted: 02/09/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVES This work attempts to summarize current knowledge on the effects of active and passive smoking of cigarettes, electronic nicotine delivery systems and tobacco heating products on the expression and secretion of oxidative stress and inflammatory response mediators, and on their possible impact on chronic obstructive pulmonary disease development. MATERIALS AND METHODS The literature was searched by the terms: 'smoking', 'active smoking', 'passive smoking', 'main-stream smoke', 'side-stream smoke', 'secondhand smoke', 'cigarette' 'THP', 'tobacco heating product', 'ENDS', 'electronic nicotine delivery system', 'e-cigarette', 'electronic cigarette', oxidative stress', inflammatory response' and 'gene expression'. RESULTS Cigarette smoking (active and passive) induces oxidative stress and inflammatory response in the airways. We present the effect of active smoking of e-cigarettes (EC) and heat-not-burn (HnB) products on the increased expression and secretion of oxidative stress and inflammatory response markers. However, there is only a limited number of studies on the effect of their second-hand smoking, and those available mainly describe aerosol composition. DISCUSSION The literature provides data which confirm that active and passive cigarette smoking induces oxidative stress and inflammatory response in the airways and is a key risk factor of COPD development. Currently, there is a limited number of data about ENDS and THP active and passive smoking effects on the health of smokers and never-smokers. It is particularly important to assess the effect of such products during long-term use by never-smokers who choose them as the first type of cigarettes, and for never-smokers who are passively exposed to their aerosol.
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Affiliation(s)
- Paulina Natalia Kopa-Stojak
- Department of Immunopathology, Division of Biomedical Science, Faculty of Medicine, Medical University of Lodz, Lodz, Poland
| | - Rafal Pawliczak
- Department of Immunopathology, Division of Biomedical Science, Faculty of Medicine, Medical University of Lodz, Lodz, Poland
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Momosaka T, Saito J, Otsuki A, Yaguchi-Saito A, Fujimori M, Kuchiba A, Katanoda K, Takaku R, Shimazu T. Associations of individual characteristics and socioeconomic status with heated tobacco product harmfulness perceptions in Japan: A nationwide cross-sectional study (INFORM Study 2020). J Epidemiol 2024:JE20230177. [PMID: 38191179 PMCID: PMC11330704 DOI: 10.2188/jea.je20230177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024] Open
Abstract
IntroductionIn Japan, heated tobacco products (HTPs) are promoted by the tobacco industry as reduced-risk tobacco products despite the lack of evidence for this claim. This study determined the distribution of HTP-harmfulness perception and identify the explanatory factors associated with the perception of HTP as less harmful than conventional cigarettes.MethodsA nationwide cross-sectional survey was conducted with Japanese people aged 20 years or older (INFORM Study 2020) using a self-administered questionnaire. We performed descriptive analysis and weighted logistic regression analysis to examine the relationship between explanatory factors (e.g., individual characteristics, socioeconomic status, and trusted sources of cancer information) and the perception of HTPs as less harmful.ResultsAmong 3,420 participants (response rate: 35.2%), the proportions of those who perceived HTPs as less harmful were 40.3% and 18.3% for users and non-users of tobacco, respectively. For participants aged 20-39 years, the proportion were 49.9% and 30.4%, respectively. Among 1,160 non-tobacco users who were familiar with HTPs, male, aged under 39 years, and had lower education were associated with the perception of HTPs as less harmful. Trusted sources of cancer information were not associated with the perception of HTPs as less harmful.ConclusionsThis study showed that, among non-tobacco users, being male, aged under 39 years, and lower education were associated with a perception of HTPs as less harmful. Public health stakeholders should provide the latest evidence about HTP harmfulness in their daily practice, and strengthen the regulations on HTP marketing directed at both tobacco- and non-tobacco users.
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Affiliation(s)
- Takumi Momosaka
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control
- School of International and Public Policy, Hitotsubashi University
| | - Junko Saito
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control
| | - Aki Otsuki
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control
| | - Akiko Yaguchi-Saito
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control
- Faculty of Human Sciences, Tokiwa University
| | - Maiko Fujimori
- Division of Survivorship Research, National Cancer Center Institute for Cancer Control
| | - Aya Kuchiba
- Graduate School of Health Innovation, Kanagawa University of Human Services
- Division of Biostatistical Research, Institution for Cancer Control/Biostatistics Division, Center for Research Administration and Support, National Cancer Center
| | - Kota Katanoda
- Division of Population Data Science, National Cancer Center Institute for Cancer Control
| | - Reo Takaku
- School of International and Public Policy, Hitotsubashi University
| | - Taichi Shimazu
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control
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Mays D, Johnson AC, Glasser A, Mercincavage M, Strasser AA. Effects of IQOS health warnings and modified risk claims among young adult cigarette smokers and non-smokers. Tob Control 2023; 32:505-508. [PMID: 34716283 PMCID: PMC9050959 DOI: 10.1136/tobaccocontrol-2021-056810] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 10/18/2021] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Heated tobacco products, including Marlboro IQOS, are available globally. In the USA, IQOS was authorised to be advertised with claims about reduced toxicant exposure relative to cigarettes. The effects of such modified risk claims and health warnings have not been studied among young adult cigarette smokers and non-smokers. METHODS In 2020, US young adult (18-30 years, n=1328) cigarette smokers and non-smokers viewed an IQOS ad in a 4 (modified risk claim variations or none) by 3 (warning variations or none) between-subjects experiment. Outcome measures assessed perceived credibility and effectiveness of the health or risk message for discouraging IQOS use, perceived harms, efficacy beliefs, and IQOS use intentions. RESULTS Smokers reported significantly higher (p<0.05) perceived credibility, lower perceived effectiveness, higher efficacy beliefs about switching to IQOS and higher intentions to use IQOS than non-smokers. Among smokers, health warnings increased perceived credibility (p<0.001) and effectiveness (p<0.05), but claims did not affect outcomes examined. Among non-smokers, warnings and claims increased perceived credibility, and warnings increased perceived effectiveness (p<0.003). The reduced exposure claim increased non-smokers' intentions to use IQOS (b=0.40, 95% CI 0.07 to 0.73). CONCLUSIONS Among young adult smokers, health warnings increased perceived effectiveness at discouraging IQOS use and perceived credibility. Among non-smokers, warnings and claims increased perceived credibility and warnings increased perceived effectiveness, but the Food and Drug Administration-authorised reduced exposure claim increased intentions to use IQOS. Research is warranted to understand how the content of modified risk claims and health warnings for IQOS affects IQOS use in this population.
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Affiliation(s)
- Darren Mays
- Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Andrea C Johnson
- Department of Psychiatry and Tobacco Center of Regulatory Science, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Allison Glasser
- College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Melissa Mercincavage
- Department of Psychiatry and Tobacco Center of Regulatory Science, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Andrew A Strasser
- Department of Psychiatry and Tobacco Center of Regulatory Science, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Lee H, Lee BG. Associations between the Frequency and Quantity of Heated Tobacco Product Use and Smoking Characteristics among Korean Smoking Adolescents. J Korean Acad Nurs 2023; 53:155-166. [PMID: 37164344 DOI: 10.4040/jkan.22125] [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: 10/07/2022] [Revised: 01/06/2023] [Accepted: 02/13/2023] [Indexed: 05/12/2023]
Abstract
PURPOSE Although heated tobacco product (HTP) use among adolescents is an emerging public health problem, little is known about the frequency and quantity of HTP use. Thus, we investigated the associations between the frequency and quantity of HTP use and smoking characteristics (i.e., combustible cigarette [CC] and electronic cigarette [EC] use, and attempts to quit smoking) among CC-smoking adolescents. METHODS We analyzed nationally representative data from 2,470 Korean adolescents who were current CC smokers. To investigate our aim, we conducted multinomial logistic and logistic regression analyses. RESULTS We found that daily and heavier CC users had greater likelihoods of more frequent and heavier HTP use. In addition, dual users of CCs and ECs were more likely to use HTPs more frequently and heavily than CC users who did not use ECs. Moreover, daily EC users had the highest risk of frequent and heavy HTP use. The frequency and quantity of HTP use were not associated with attempts to quit smoking. Compared to CC-only use, dual use of CCs and HTPs was not associated with quitting attempts, and triple use of CCs, ECs, and HTPs was associated with a lower likelihood of quitting attempts. CONCLUSION HTP use was less likely to displace CC use and promote attempts to quit smoking. Thus, strict regulations are required to prevent the promotion of HTPs as a substitute for CCs or as a means of quitting smoking. Additionally, health professionals should consider preventive interventions for HTP, as well as CC and EC use among adolescents.
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Affiliation(s)
- Haein Lee
- College of Nursing, Daegu Catholic University, Daegu, Korea
| | - Bo Gyeong Lee
- College of Nursing, Daegu Catholic University, Daegu, Korea.
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13
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Chen J, Xue S, Xie Z, Li D. Characterizing Heated Tobacco Products Marketing on Instagram: Observational Study. JMIR Form Res 2023; 7:e43334. [PMID: 36920463 PMCID: PMC10131776 DOI: 10.2196/43334] [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: 10/08/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Heated tobacco products (HTPs), including I Quit Ordinary Smoking (IQOS), are new tobacco products that use an electronic device to heat compressed tobacco leaves to generate an aerosol for consumers to inhale. Marketing of HTPs is prevalent on Instagram, a popular social media platform. OBJECTIVE This study aims to characterize posts related to HTPs on Instagram and their associations with user engagement. METHODS Through the Instagram application programming interface, 979 Instagram posts were collected using keywords related to HTPs, such as "IQOS" and "heat-not-burn." Among them, 596 posts were related to IQOS and other HTP marketing. The codebook was developed from a randomly selected 200 posts on the post content by hand coding, which was applied to the remaining 396 Instagram posts. Summary statistics were calculated, and statistical hypothesis testing was conducted to understand the popularity of Instagram posts on HTPs. Negative binomial regression models were applied to identify Instagram post characteristics associated with user engagement (eg, count). RESULTS Among Instagram posts related to HTP marketing (N=596), "product display" was dominant (n=550, 92.28%), followed by "brand promotion" (n=41, 6.88%), and "others" (n=5, 0.84%). Among posts within "product display," "device only" was the most popular (n=338, 61.45%), followed by "heatstick only" (n=80, 14.55%), "accessory" (n=66, 12%), "device and heatstick" (n=56, 10.18%), and "capsule" (n=10, 1.82%). A univariate negative binomial regression model with pairwise comparisons across "product display" types showed that the number of likes for posts with HTP heatsticks was significantly lower compared to posts with HTP devices, accessories, and device-heatstick sets. Multivariate negative binomial regression models showed that HTP-related Instagram posts with a model or lifestyle elements (;=.60, 95% CI 0.36-0.84) or without obvious product advertising information (=.69, 95% CI 0.49-0.89) received more likes. CONCLUSIONS It is shown that posts with product displays were dominant among HTP-related posts on Instagram. Posts with model or lifestyle elements are associated with high user engagement, which might be one of the web-based marketing strategies of HTPs.
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Affiliation(s)
- Jiarui Chen
- Goergen Institute for Data Science, University of Rochester, Rochester, NY, United States
| | - Siyu Xue
- Goergen Institute for Data Science, University of Rochester, Rochester, NY, United States
| | - Zidian Xie
- Department of Clinical and Translational Research, University of Rochester Medical Center, Rochester, NY, United States
| | - Dongmei Li
- Department of Clinical and Translational Research, University of Rochester Medical Center, Rochester, NY, United States
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Sparrock LS, Phan L, Chen-Sankey J, Hacker K, Ajith A, Jewett B, Choi K. Heated Tobacco Products: Awareness, Beliefs, Use and Susceptibility among US Adult Current Tobacco Users, 2021. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2016. [PMID: 36767383 PMCID: PMC9915028 DOI: 10.3390/ijerph20032016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 05/31/2023]
Abstract
Limited data exist on the awareness, beliefs, and use of heated tobacco products (HTPs). Data from 1583 U.S. adult (age ≥ 21 years) current tobacco users were collected in 2021. Participants self-reported HTP awareness, beliefs, use, and susceptibility, as well as current tobacco product use and sociodemographics. We used weighted logistic and multinomial regression models to explore their associations. Overall, 23.6% were aware of, 8.9% had ever used, and 3.0% currently used HTPs. Younger individuals (vs. 61+ years), those with annual income $50,000+ (vs. <$50,000), and those currently using electronic vaping products (vs. non-users) were more likely to be aware of, to have ever used, and to currently be using HTPs (p < 0.05). Black individuals (vs. White) were more likely to report ever and current HTP use (p < 0.05). Current cigarette smoking was not associated with HTP awareness and use (p > 0.05). Holding favorable HTP beliefs was associated with susceptibility to and more advanced HTP use statuses (p < 0.05). Sociodemographics associated with HTP use may reflect HTP marketing strategies. The lack of association with cigarette smoking suggests HTPs may be unlikely cigarette substitutes. Addressing favorable HTP-related beliefs may prevent dual use.
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Affiliation(s)
| | - Lilianna Phan
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD 20892, USA
| | - Julia Chen-Sankey
- Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ 08901, USA
- School of Public Health, Rutgers Biomedical and Health Sciences, Piscataway, NJ 08854, USA
| | - Kiana Hacker
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD 20892, USA
| | - Aniruddh Ajith
- School of Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Bambi Jewett
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD 20892, USA
| | - Kelvin Choi
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD 20892, USA
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15
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Panagiotakos DB, Georgoulis M, Kapetanstrataki M, Behrakis P. Prevalence, patterns, and determinants of electronic cigarette and heated tobacco product use in Greece: A cross-sectional survey. Hellenic J Cardiol 2023; 70:10-18. [PMID: 36681120 DOI: 10.1016/j.hjc.2023.01.002] [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: 09/01/2022] [Revised: 12/15/2022] [Accepted: 01/12/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Electronic cigarettes (EC) and heated tobacco products (HTP) have been introduced in the global market as safer nicotine delivery systems; however, there is skepticism about their link to smoking and long-term risks. The aim of this study was to evaluate the prevalence, patterns, and determinants of EC/HTP use in Greece. METHODS This was a cross-sectional survey of 1,044 individuals aged ≥15 years old, who were randomly selected from the general Greek population. The study was conducted in May 2022, and participants were assessed through face-to-face interviews using a questionnaire designed to collect information on smoking and EC/HTP use, as well as their sociodemographic, lifestyle, and medical data. RESULTS The use of EC/HTP was reported by 16.2% of the participants, slightly more prevalent in males (17.2%) than in females (15.2%), and significantly more prevalent in <40-year-olds (21.3%) than ≥40-year-olds (11.3%). Most EC/HTP users (72.8%) were current smokers, 13.0% were former smokers, and 14.2% were never smokers. Among users, 60.6% used nicotine-containing products, 30.2% used EC/HTP in parallel with conventional tobacco, and 56.9% used EC/HTP for the first time while being <25 years old. In multiple logistic regression analysis, younger age, being employed, being a former/current smoker, adopting a Western-type diet, and believing that EC/HTP are less harmful than conventional tobacco products and can help toward smoking cessation emerged as significant determinants of EC/HTP use. CONCLUSIONS EC/HTP are commonly used in combination with conventional tobacco, are quite popular among the youth, and also appeal to a small fraction of nonsmokers.
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Affiliation(s)
- Demosthenes B Panagiotakos
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University of Athens, 176 76 Athens, Greece.
| | - Michael Georgoulis
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University of Athens, 176 76 Athens, Greece
| | | | - Panagiotis Behrakis
- "George D. Behrakis" Research Lab, Hellenic Cancer Society, 105 57 Athens, Greece
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Duan Z, Wysota CN, Romm KF, Levine H, Bar-Zeev Y, Choi K, Berg CJ. Correlates of Perceptions, Use, and Intention to Use Heated Tobacco Products Among US Young Adults in 2020. Nicotine Tob Res 2022; 24:1968-1977. [PMID: 35901840 PMCID: PMC9653079 DOI: 10.1093/ntr/ntac185] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 06/09/2022] [Accepted: 07/25/2022] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Despite the increased heated tobacco product (HTP) marketing in the United States, little is known about HTP perceptions and correlates of HTP use and use intentions among young adults. AIMS AND METHODS Using 2020 cross-sectional data from 2,470 young adults (ages 18-34) from 6 US metropolitan areas, we conducted exploratory factor analysis to identify factors regarding perceived utility/appeal of HTPs, specifically IQOS, and examined these factors in relation to lifetime HTP use and use intentions, using multivariable logistic and linear regression, respectively. RESULTS 19.1% had heard of HTPs and 4.1% ever used HTPs; 14.7% had heard of IQOS specifically and 2.8% were ever-users. Use intentions were low (M = 1.27, scale: 1 = not at all to 7 = extremely). Factor analysis identified five perceived utility/appeal factors: innovation (M = 3.17, scale: 1 = not at all to 7 = extremely), cigarette substitute (M = 2.99), and youth appeal (M = 2.82), e-cigarette/nicotine substitute (M = 2.36), and fashionable (M = 2.04). Controlling for sociodemographics and other tobacco use, perceiving IQOS as more fashionable and e-cigarette substitutes positively correlated with lifetime HTP use (aOR = 1.60, 95%CI = 1.17, 2.17; aOR = 1.48, 95%CI = 1.11, 1.97, respectively) and use intentions (β = 0.26, 95%CI = 0.21, 0.30; β = 0.14, 95%CI = 0.09, 0.18); perceiving IQOS as cigarette substitutes negatively correlated with ever use (aOR = 0.74, 95%CI = 0.56, 0.97) and use intentions (β = -0.06, 95%CI = -0.10, -0.03). Correlation patterns were similar among past-month cigarette, e-cigarette, and any-tobacco users. CONCLUSIONS Although HTP awareness and use were low, monitoring HTP perceptions and reasons for use as HTPs become more prominent is critical in anticipating their potential impact, particularly as more products seek FDA authorization to use reduced risk or exposure marketing claims. IMPLICATIONS Awareness, ever use, and intentions to use heated tobacco products (HTPs) were low among US young adults in 2020. Perceiving IQOS as fashionable and an e-cigarette substitute were positively correlated with ever use and intention to use HTPs. In addition, perceiving IQOS as a cigarette substitute was negatively correlated with ever use of HTPs and HTP use intentions. Continued surveillance on perceptions and use behaviors is needed to better understand use patterns, intentions to use, and reasons for using HTPs.
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Affiliation(s)
- Zongshuan Duan
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Christina N Wysota
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Katelyn F Romm
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Hagai Levine
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah Medical Organization, Jerusalem, Israel
| | - Yael Bar-Zeev
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah Medical Organization, Jerusalem, Israel
| | - Kelvin Choi
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD, USA
| | - Carla J Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
- George Washington Cancer Center, George Washington University, Washington, DC, USA
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Wu YS, Chan HL, Ho SY, Zhao SZ, Luk TT, Lam TH, Wang MP. A content analysis of heated tobacco product business in Hong Kong on Facebook. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e5685-e5692. [PMID: 36062525 DOI: 10.1111/hsc.13997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 08/08/2022] [Accepted: 08/20/2022] [Indexed: 06/15/2023]
Abstract
Heated tobacco products (HTPs) are increasingly popular in Hong Kong (HK) even though they have not been formally launched and the sale of duty-not-paid tobacco sticks is illegal. We investigated how Facebook was used against regulations to sell HTPs in HK. We screened Facebook pages run by HTP businesses targeting HK users in June 2019 and included pages with over 300 "Likes" for inductive content analysis by coding their "About" descriptions and all posts including comments published since January 2017. HTPs included heating devices, accessories, and tobacco sticks. Various attributes were recorded including methods of customer inquiries (telephone, Instant Messaging [IM], address), business responses (comments or private messages, PM), and services provided (warranty/repair). Among 30 pages (50.9% of all 59 eligible pages with related information on HTPs), two-thirds provided phone numbers (66.7%), IM accounts (65.5%), and addresses (66.7%). Most pages sold heating devices (26, 86.7%) and accessories (22, 73.3%) with over 72% providing phone numbers, IM accounts, or addresses. Only 8 pages (26.7%) sold tobacco sticks with 75.0% providing telephone numbers but fewer provided IM accounts (62.5%) and addresses (50.0%). All pages responded using PMs and only 12.5% also used comments. Warranty/repair services were provided by 43.3% of the pages. We found Facebook pages were used as dedicated stores to promote and sell HTPs including heating devices, accessories, and even illicit tobacco sticks in HK, a non-official market.
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Affiliation(s)
| | - Hiu Laam Chan
- School of Nursing, The University of Hong Kong, Hong Kong
| | - Sai Yin Ho
- School of Public Health, The University of Hong Kong, Hong Kong
| | - Sheng Zhi Zhao
- School of Nursing, The University of Hong Kong, Hong Kong
| | - Tzu Tsun Luk
- School of Nursing, The University of Hong Kong, Hong Kong
| | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong
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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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Duan Z, Le D, Ciceron AC, Dickey-Chasins R, Wysota CN, Bar-Zeev Y, Levine H, Abroms LC, Romm KF, Berg CJ. 'It's like if a vape pen and a cigarette had a baby': a mixed methods study of perceptions and use of IQOS among US young adults. HEALTH EDUCATION RESEARCH 2022; 37:364-377. [PMID: 36036655 PMCID: PMC9502850 DOI: 10.1093/her/cyac019] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 06/15/2023]
Abstract
Young adults' perceptions and use of heated tobacco products (HTPs) are understudied. This mixed methods study analyzed (i) Fall 2020 survey data from 2470 US young adults (meanage = 24.67; 19.5% and 25.2% past-month cigarette and e-cigarette use; 4.1% ever HTP use) assessing HTP use intentions and perceptions (1 = not at all to 7 = extremely) and (ii) Spring 2021 interview data regarding IQOS (most widely available HTP) in a subset of 40 e-cigarette users. Among survey participants, HTPs versus cigarettes and e-cigarettes showed lower use intentions (mean = 1.27 vs. mean = 1.73, mean = 2.16) but were perceived as less addictive (mean = 5.11 vs. mean = 6.28, mean = 5.82) and harmful (mean = 5.37 vs. mean = 6.65, mean = 5.62). HTPs were perceived more socially acceptable than cigarettes but less than e-cigarettes (mean = 3.39 vs. mean = 3.13, mean = 4.37). Among interviewees, most reported limited HTP knowledge. A few perceived IQOS as a hybrid of traditional cigarettes and e-cigarettes. Most perceived IQOS as harmful but less harmful than cigarettes and were uncertain in relation to e-cigarettes. Over half reported minimal interest in trying IQOS; common reasons included IQOS containing tobacco, limited flavors and use complexity. The varied perceptions of IQOS versus cigarettes and e-cigarettes underscore the need for continued surveillance of perceptions, use and marketing of IQOS to inform regulatory oversight and potential interventions.
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Affiliation(s)
- Zongshuan Duan
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, 800 22nd St NW, #7000, Washington, DC 20052, USA
| | - Daisy Le
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, 800 22nd St NW, #7000, Washington, DC 20052, USA
- Department of Policy, Populations, and Systems, School of Nursing, George Washington University, 1919 Pennsylvania Ave NW, Suite 500, Washington, DC 20052, USA
- George Washington Cancer Center, George Washington University, 800 22nd St NW, #7000, Washington, DC 20052, USA
| | - Annie C Ciceron
- Department of Policy, Populations, and Systems, School of Nursing, George Washington University, 1919 Pennsylvania Ave NW, Suite 500, Washington, DC 20052, USA
| | - Ruth Dickey-Chasins
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave NW, 4th Floor, Washington, DC 20052, USA
| | - Christina N Wysota
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, 800 22nd St NW, #7000, Washington, DC 20052, USA
| | - Yael Bar-Zeev
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah Medical Organization, PO Box 12272, Jerusalem 9110202, Israel
| | - Hagai Levine
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah Medical Organization, PO Box 12272, Jerusalem 9110202, Israel
| | - Lorien C Abroms
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, 800 22nd St NW, #7000, Washington, DC 20052, USA
- George Washington Cancer Center, George Washington University, 800 22nd St NW, #7000, Washington, DC 20052, USA
| | - Katelyn F Romm
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, 800 22nd St NW, #7000, Washington, DC 20052, USA
| | - Carla J Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, 800 22nd St NW, #7000, Washington, DC 20052, USA
- George Washington Cancer Center, George Washington University, 800 22nd St NW, #7000, Washington, DC 20052, USA
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20
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Heated Tobacco Product Use and Mental Health: Korean National Health and Nutrition Examination Survey (2018–2020). Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00907-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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21
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Casseus M, Cooney JM, Wackowski OA. Tobacco Use, Dependence, and Age of Initiation among Youths with Cognitive Disability. J Pediatr 2022; 247:102-108.e8. [PMID: 35569523 DOI: 10.1016/j.jpeds.2022.04.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 04/04/2022] [Accepted: 04/28/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine the prevalence of tobacco use by product type among youths with cognitive disability; the prevalence of tobacco dependence among youths with cognitive disability; and the relationship between age of tobacco use initiation and cognitive disability. STUDY DESIGN This cross-sectional study analyzed data from the 2019 National Youth Tobacco Survey (NYTS). Participants were a nationally representative sample of 19 018 students in grades 6-12. Estimates were calculated for ever use, current use, age of tobacco use initiation, and tobacco dependence. Associations between use patterns and cognitive disability status were examined using bivariate analyses and multivariable logistic regression. RESULTS Compared with youths without cognitive disability, youths with cognitive disability had significantly greater odds of ever using any tobacco product (aOR, 1.49; 95% CI, 1.31-1.70), currently using any tobacco product (aOR, 1.41; 95% CI, 1.26-1.58), and currently using electronic cigarettes (e-cigarettes), cigarettes, cigars, hookahs, roll-your-own cigarettes, and heated tobacco products, specifically. They had higher prevalence and odds of reporting younger age of tobacco use initiation (aOR, 1.25; 95% CI, 1.10-1.43). Higher prevalence and odds of tobacco dependence were also observed among youths with cognitive disability compared with youths without cognitive disability (P < .001). CONCLUSIONS These findings reinforce the importance of developing early primary prevention efforts to reduce or delay tobacco use among adolescents with cognitive disability. They also suggest the need to address co-occurring disorders during tobacco cessation programs with this high-risk group.
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Affiliation(s)
- Myriam Casseus
- Department of Pediatrics, Child Health Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - James M Cooney
- Rutgers School of Management and Labor Relations, New Brunswick, NJ
| | - Olivia A Wackowski
- Rutgers Center for Tobacco Studies, Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Rutgers University, New Brunswick, NJ
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22
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Jun J, Kim SH, Thrasher J, Cho YJ, Heo YJ. Heated debates on regulations of heated tobacco products in South Korea: the news valence, source and framing of relative risk/benefit. Tob Control 2022; 31:e57-e63. [PMID: 33542068 DOI: 10.1136/tobaccocontrol-2020-056131] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 12/22/2020] [Accepted: 01/11/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND We analyse news representations of the regulation of heated tobacco products (HTPs) in South Korea, the country where HTP use is among the highest in the world despite conflicts between the government and the HTP manufacturers. METHODS We analysed a total of 571 print and TV news covering HTP regulations, published between 2017 and 2018, the time period when HTPs were introduced to the country and various regulations of HTPs were proposed and implemented. We assessed the prevalence and associations among specific types of HTP regulations that were discussed, valence towards regulation, sources, framing of the relative health risks/benefits of HTPs compared with conventional cigarettes. RESULTS Taxation (55.2%) and warning labels (25.7%) were two regulation topics covered the most. Almost equal proportions of pro-regulation (2.5%) and anti-regulation valence (2.2%) were found in taxation-related news, while pro-regulation valence appeared more frequently for other restrictions, including warning labels (pro=9.5% vs anti=1.4%), marketing restrictions (pro=6.9% vs anti=0%) and integration of HTPs into smoke-free policies for cigarettes (pro=8.7% vs anti=0%). The government (59%), followed by the tobacco industry (39.4%), was the source cited most often across news stories while the presence of tobacco control advocates was low (4.9%). As for framing, there was no significant difference in the prevalence of stories mentioning reduced harm (31.7%) and equal or more harm (33.6%) of HTPs compared with cigarettes. CONCLUSIONS We provide implications for governments and tobacco control advocates on building consensus for applying cigarette equivalent taxes and pictorial warning labels to HTPs.
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Affiliation(s)
- Jungmi Jun
- School of Journalism & Mass Communications, College of Information and Communications, University of South Carolina, Columbia, South Carolina, USA
| | - Sei-Hill Kim
- School of Journalism & Mass Communications, College of Information and Communications, University of South Carolina, Columbia, South Carolina, USA
| | - James Thrasher
- Department of Health Promotion, Educaiton, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Yoo Jin Cho
- Department of Health Promotion, Educaiton, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Yu-Jin Heo
- School of Journalism & Mass Communications, College of Information and Communications, University of South Carolina, Columbia, South Carolina, USA
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23
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Yun HW, Jung KJ, Jee SH, Kimm H. Overall quit in triple users of conventional cigarette, e-cigarette and heated tobacco product among healthy adults: a Korea Medical Institute health check-up study. BMJ Open 2022; 12:e051865. [PMID: 35851018 PMCID: PMC9297207 DOI: 10.1136/bmjopen-2021-051865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE While multiuse patterns of e-cigarettes (EC) or heated tobacco products (HTP) with conventional cigarettes (CC) have been reported, smoking cessation of multiusers is not well known. We aimed to analyse overall quit in triple users of CC, EC and HTP among healthy adults. METHODS A questionnaire was conducted on 89 360 adults who visited the Korea Medical Institute health check-ups in Seoul, Korea, from May 2018 to September 2019. Among 38 812 ever smokers, 9252 were ever triple users of CC, EC and HTP. Frequency and related factors of overall quit were analysed in the cross-sectional study. RESULTS The average age was 38.8±9.0 years, and 8458 (91.4%) were men. There were 5329 (57.6%) current triple users, 3547 (38.3%) single or dual product quitters and 376 (4.1%) overall quitters. Among the former triple users, the most common tobacco product use pattern was 'dual quit of EC and HTP (eg, current CC use)' both in men (21.3%) and women (26.3%). Age 60s or older (OR 8.5, 95% CI 5.2 to 13.8), women (OR 1.7, 95% CI 1.1 to 2.5), no hyperlipidaemia and married status were significantly related to overall quit. CONCLUSION The most common pathway for 'ever triple users' of the three tobacco products was 'current triple users', and the second was 'CC users'. Single or dual product quitters could continue to smoke by EC or HTP instead of quit. Further research on overall quit will be needed to develop effective regulations.
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Affiliation(s)
- Hye Won Yun
- National Cancer Control Institute, National Cancer Center, Goyang, South Korea
- Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, South Korea
| | - Keum Ji Jung
- Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, South Korea
| | - Sun Ha Jee
- Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, South Korea
| | - Heejin Kimm
- Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, South Korea
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24
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Puvanesarajah S, Wang T, Alexander DS, Gomez Y, Head SK, Alexandridis AA, Jamal A, Trivers K. Awareness and Use of Heated Tobacco Products Among Middle School and High School Students, United States, 2019-2020. Nicotine Tob Res 2022; 24:1273-1280. [PMID: 35380704 PMCID: PMC11062207 DOI: 10.1093/ntr/ntac065] [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: 08/26/2021] [Revised: 03/02/2022] [Accepted: 03/09/2022] [Indexed: 11/13/2022]
Abstract
PURPOSE Heated tobacco products (HTP) heat-processed tobacco leaf into an aerosol inhaled by the user. This study assessed prevalence and correlates of HTP awareness, ever use, and current use among US middle and high school students. METHODS Data came from the 2019 and 2020 National Youth Tobacco Survey, a cross-sectional survey of US public and private, middle and high school students. HTP awareness, ever use, and current (past 30-day) use were assessed. Weighted prevalence estimates and adjusted prevalence ratios (aPR) were assessed overall and by sex, school level, race/ethnicity, and current other tobacco product use. RESULTS In 2019, 12.8% (3.44 million) of all students reported HTP awareness, increasing to 19.3% (5.29 million) in 2020 (p < .01). Ever [2019: 2.6% (630 000); 2020: 2.4% (620 000)] and current [2019: 1.6% (420 000); 2020: 1.4% (370 000)] HTP use did not significantly change from 2019 to 2020. Current e-cigarette users were more likely to report ever (2020 aPR = 1.79, 95% CI:1.23, 2.62) or current HTP use (2019 aPR = 5.16, 95% CI: 3.48, 7.67; 2020 aPR = 3.39, 95% CI: 2.10, 5.47) than nonusers. In both years, ever and current HTP use was more likely among current combustible (aPR range = 3.59-8.17) and smokeless tobacco product (aPR range = 2.99-4.09) users than nonusers. CONCLUSIONS HTP awareness increased 51% among US students during 2019-2020; however, HTP use did not significantly change during this period. Students who used other tobacco products were more likely to currently use HTPs. Estimates of HTP awareness and use provided serve as a baseline as future monitoring of these products is warranted. IMPLICATIONS Awareness of heated tobacco products (HTPs) increased among US youth from 2019 to 2020; however, HTP use did not change. These estimates of HTP awareness and use serve as a baseline for future surveillance of these products as their availability in the US increases.
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Affiliation(s)
- Samantha Puvanesarajah
- Office on Smoking and Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Teresa Wang
- Office on Smoking and Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Dayna S. Alexander
- Office on Smoking and Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Yessica Gomez
- Office on Smoking and Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sara K. Head
- Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | | | - Ahmed Jamal
- Office on Smoking and Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Katrina Trivers
- Office on Smoking and Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
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25
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Matsuyama Y, Tabuchi T. Heated tobacco product use and combustible cigarette smoking relapse/initiation among former/never smokers in Japan: the JASTIS 2019 study with 1-year follow-up. Tob Control 2022; 31:520-526. [PMID: 33408121 DOI: 10.1136/tobaccocontrol-2020-056168] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/09/2020] [Accepted: 11/27/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Use of heated tobacco products (HTPs), which were first launched in Japan, has been rapidly spreading worldwide. The present study aimed to investigate whether HTP use was associated with combustible cigarette smoking relapse/initiation among former/never combustible cigarette smokers. METHODS A prospective cohort study was conducted by analysing two waves of data from the Japan 'Society and New Tobacco' Internet Survey. Among the 7766 never/former combustible cigarette smokers who answered the baseline survey in 2019, 5947 (follow-up rate: 76.6%) responded to the follow-up survey in 2020 (age range 18-73 years old; 50.5% men). The association between HTP use and combustible smoking after 1 year was investigated by multivariable logistic regression analysis adjusting for potential confounders. RESULTS Of the respondents, 308 (5.2%) used HTPs at baseline. One year later, 97 (1.7%) non-HTP users and 39 (12.7%) HTP users were smoking combustible cigarettes. Among former smokers who had quit for 1 year or more and among never smokers, HTP use was significantly associated with combustible cigarette smoking 1 year later (OR=2.80, 95% CI 1.42 to 5.52 and OR=9.95, 95% CI 3.39 to 29.16, respectively), while the association was not significant among former smokers who recently quit. CONCLUSION HTP use was associated with relapse/initiation of combustible cigarette smoking after 1 year. The risks of HTP use, including subsequent combustible smoking, should be carefully monitored.
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Affiliation(s)
- Yusuke Matsuyama
- Global Health Promotion, Tokyo Medical and Dental University, Bunkyo, Japan
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
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26
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El-Kaassamani M, Yen M, Talih S, El-Hellani A. Analysis of mainstream emissions, secondhand emissions and the environmental impact of IQOS waste: a systematic review on IQOS that accounts for data source. Tob Control 2022; 33:tobaccocontrol-2021-056986. [PMID: 35568394 DOI: 10.1136/tobaccocontrol-2021-056986] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 05/05/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To highlight the general features of IQOS literature focusing on the chemical analysis of IQOS emissions. DATA SOURCES PubMed, Web of Science and Scopus databases were searched on 8 November 2021 using the terms 'heated tobacco product', 'heat-not-burn', 'IQOS' and 'tobacco heating system' with time restriction (2010-2021). The search yielded 5480 records. STUDY SELECTION Relevant publications on topics related to IQOS assessment were retrieved (n=341). Two reviewers worked separately and reached agreement by consensus. DATA EXTRACTION Data on author affiliation and funding, article type and date of publication were extracted. Publications were categorised depending on their focus and outcomes. Data on IQOS emissions from the chemical analysis category were extracted. DATA SYNTHESIS Of the included publications, 25% were published by Philip Morris International (PMI) affiliates or PMI-funded studies. PMI-sponsored publications on emissions, toxicology assessments and health effects were comparable in number to those reported by independent research, in contrast to publications on IQOS use, market trends and regulation. Data on nicotine yield, carbonyl emissions, other mainstream emissions, secondhand emissions and IQOS waste were compared between data sources to highlight agreement or disagreement between PMI-sponsored and independent research. CONCLUSIONS Our analysis showed agreement between the data sources on nicotine yield from IQOS under the same puffing conditions. Also, both sources agreed that IQOS emits significantly reduced levels of some emissions compared with combustible cigarettes. However, independent studies and examination of PMI's data showed significant increases in other emissions from and beyond the Food and Drug Administration's harmful and potentially harmful constituents list.
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Affiliation(s)
- Malak El-Kaassamani
- Department of Chemistry, American University of Beirut Faculty of Arts and Sciences, Beirut, Lebanon
| | - Miaoshan Yen
- Department of Biostatistics, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Soha Talih
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Mechanical Engineering, American University of Beirut Faculty of Engineering and Architecture, Beirut, Lebanon
| | - Ahmad El-Hellani
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA
- Division of Environmental Health Sciences, The Ohio State University College of Public Health, Columbus, Ohio, USA
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
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27
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Bast LS, Klitgaard MB, Kjeld SG, Jarlstrup NS, Christensen AI. Use of Tobacco and Nicotine Products among Young People in Denmark-Status in Single and Dual Use. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5623. [PMID: 35565011 PMCID: PMC9099614 DOI: 10.3390/ijerph19095623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/25/2022] [Accepted: 04/29/2022] [Indexed: 12/02/2022]
Abstract
Lots of new tobacco or nicotine products are being launched, e.g., e-cigarettes and smokeless tobacco, which appeal especially to the youngest part of the population. For example, the use of smokeless tobacco among Danish youth rose from approx. 2% in 2010 to 9% in 2020. Hence, there is an urgent need to follow and intervene against youth tobacco or nicotine product use. This study explored the current use of cigarettes, e-cigarettes, heated tobacco, and smokeless tobacco among Danish 15- to 29-year-olds. Further, we examined the concurrent use of two products or more. We used a nationwide survey conducted among 15- to 29-year-olds in February and March 2020. Overall, approx. 35,700 individuals received the questionnaire of which 35.5% responded (n = 13,315). One out of five (20.1%) smoked cigarettes, half of them daily, the other half occasionally. About one in twenty (3.9%) used e-cigarettes (daily or occasionally), and more than one in three (31.6%) had tried e-cigarettes. The use of heated tobacco among Danish youth is still relatively limited (0.3%). In comparison, about 9% used smokeless tobacco (daily or occasionally). Overall, 27.0% stated that they use at least one type of tobacco or nicotine product, while 5.6% used more than one product. Monitoring tobacco-related behavior in youth provides extremely important information for, e.g., policymakers and health professionals.
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Affiliation(s)
- Lotus Sofie Bast
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455 Copenhagen, Denmark; (M.B.K.); (S.G.K.); (N.S.J.); (A.I.C.)
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28
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El Asmar ML, Laverty AA, Vardavas CI, Filippidis FT. How do Europeans quit using tobacco, e-cigarettes and heated tobacco products? A cross-sectional analysis in 28 European countries. BMJ Open 2022; 12:e059068. [PMID: 35487758 PMCID: PMC9058771 DOI: 10.1136/bmjopen-2021-059068] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 04/06/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES While smoking tobacco remains a substantial cause of harm in Europe, novel products such as electronic cigarettes or e-cigarettes (ECs) and heated tobacco products (HTPs) have entered the market recently. While debate still persists over the role of these novel products, they are now in widespread use. This study aimed to explore the prevalence and methods of attempts to quit EC and HTP. SETTING We analysed the 2020 Eurobarometer survey, which collected data in 28 European countries. PARTICIPANTS A representative sample of individuals residing in these countries aged ≥15 years. PRIMARY AND SECONDARY OUTCOME MEASURES Multilevel regression analyses were performed to assess differences in quit attempts and cessation methods among tobacco smokers and exclusive EC/HTP users separately. RESULTS 51.1% of current tobacco smokers and 27.1% of exclusive EC or HTP users reported having ever made a quit attempt. The majority of former and current smokers (75.8%) who made a quit attempt did so unassisted, with 28.8% reporting at least one attempt using a cessation aid. The most popular cessation aids were nicotine replacement therapy or other medication (13.4%) and ECs (11.3%). 58.8% of exclusive EC or HTP users who had made a quit attempt did so unassisted, with 39.5% reporting the use of a cessation aid. CONCLUSION Most EC and HTP users in Europe try to quit unassisted, although more of them report the use of a cessation aid compared with tobacco smokers. Cessation support services should take into consideration the increasing numbers of users of EC and HTP who may be trying to quit.
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Affiliation(s)
- Marie Line El Asmar
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Anthony A Laverty
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Constantine I Vardavas
- School of Medicine, University of Crete, Crete, Greece
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Filippos T Filippidis
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
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29
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Kim SCJ, Friedman TC. A New Ingenious Enemy: Heat-Not-Burn Products. Tob Use Insights 2022; 15:1179173X221076419. [PMID: 35237081 PMCID: PMC8883376 DOI: 10.1177/1179173x221076419] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/11/2022] [Indexed: 11/21/2022] Open
Abstract
While cigarette smoking is still a major source of morbidity and mortality, e-cigarette usage is skyrocketing, and the tobacco industry is finding new ways to market nicotine. With updated published research highlighting the dangers of cigarette smoking and now vaping, the industry has been developing new techniques and devices that circumvent this research to hook users on tobacco and nicotine. The FDA allowed Philip Morris International (PMI) to sell their heat not burn tobacco products known as iQOS in 2019. By 2019, 49 countries had permitted the sale of iQOS. This commentary summarizes the recent research on heat not burn cigarettes, also known as heated tobacco products and their effects on public policy. We urge policy makers to consider the research published regarding these new products and prevent the widespread use of these products that will harm public health.
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Affiliation(s)
- Samuel CJ Kim
- Department of Internal Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA, USA
- Friends Research Institute, Cerritos, CA, USA
| | - Theodore C Friedman
- Department of Internal Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA, USA
- Friends Research Institute, Cerritos, CA, USA
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30
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Jun J, Zhang N, Zain A, Mohammadi E. Social Media Discussions on the FDA's Modified Risk Tobacco Product Authorization of IQOS. Subst Use Misuse 2022; 57:472-480. [PMID: 34986075 DOI: 10.1080/10826084.2021.2019777] [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
Background: The U.S. Food and Drug Administration (FDA) authorized the marketing of the IQOS tobacco heating system as a modified risk tobacco product (MRTP) in July 2020, permitting its 'reduced exposure' marketing. This decision is accompanied by much controversy among the global health community. We provide a preliminary analysis of Twitter conversations regarding the MRTP authorization of IQOS by identifying the authors, valence towards the policy decision, source of cited link, and focused topic. Methods: We analyzed 548 tweets mentioning MRTP posted between July 2016 (when PMI submitted the proposal) and October 2020. Results: We found a higher proportion of pro-MRTP valence (25.4%) than anti-MRTP (16.2%). Nearly half of the tweets (47.2%) expressing personal opinions presented pro-MRTP valence (vs. anti-MRTP = 23.9%). The FDA website was more frequently cited in pro-MRTP tweets (30.8% vs. anti = 4.8%), while tobacco control advocates' websites were cited only in anti-MRTP tweets (77.4% vs. pro = 0). Pro-MRTP valence appeared more frequently in tweets mentioning health (53.1% vs. anti =38.5%) and cessation (100% vs. anti = 0). Nearly 42% of tweets showed a bot score greater than .43, indicating a possibility of automation. Conclusion: Continuous efforts are needed to surveil the industry's attempts to create a climate of false consensus and circulate misinformation regarding MRTP on social media, as well as to assist non-scientific audiences' understanding of MRTP.
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Affiliation(s)
- Jungmi Jun
- School of Journalism and Mass Communications, College of Information and Communications, University of South Carolina, Columbia, South Carolina, USA
| | - Nanlan Zhang
- School of Journalism and Mass Communications, College of Information and Communications, University of South Carolina, Columbia, South Carolina, USA
| | - Ali Zain
- School of Journalism and Mass Communications, College of Information and Communications, University of South Carolina, Columbia, South Carolina, USA
| | - Ehsan Mohammadi
- School of Information Science, College of Information and Communications, University of South Carolina, Columbia, South Carolina, USA
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31
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Miller CR, Sutanto E, Smith DM, Hitchman SC, Gravely S, Yong HH, Borland R, O’Connor RJ, Cummings KM, Fong GT, Hyland A, Quah AC, Goniewicz ML. Awareness, trial and use of heated tobacco products among adult cigarette smokers and e-cigarette users: findings from the 2018 ITC Four Country Smoking and Vaping Survey. Tob Control 2022; 31:11-18. [PMID: 32994299 PMCID: PMC8005508 DOI: 10.1136/tobaccocontrol-2020-055985] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/04/2020] [Accepted: 08/19/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To evaluate heated tobacco product (HTP) awareness, trial and current use among adult cigarette smokers and vaping product users in four countries with varying regulations governing HTP sales. DESIGN Data came from Wave 2 of the ITC Four Country Smoking and Vaping Survey, collected from February to July 2018. Respondents were current and former smokers and/or users of vaping products (18 years or older) from Canada (CA; n=3778), England (EN; n=4848), the USA (US; n=2846) and Australia (AU; n=1515). At the time of the survey, only Canada and England permitted the sale of contemporary HTPs (eg, IQOS). RESULTS Overall, 30.2% of respondents reported being aware of HTPs (CA=30.4%; EN=31.0%; US=30.2%; AU=27.4%; p=0.346), 2.4% had ever tried HTPs (CA=3.3%; EN=2.4%; US=2.0%; AU=0.9%; p=0.001) and 0.9% currently used HTPs at least monthly (CA=0.8%; EN=1.2%; US=0.7%; AU=0.2%; p<0.001). Trial and current use were higher among those who concurrently smoked and vaped (at least monthly) versus other nicotine use categories (trial: 10.9% v. 1.2%-2.0%, p<0.001; current use: 8.4% v. 0.1%-1.0%, p<0.001). In multivariable analyses, HTP awareness did not differ across countries, whereas odds of trial and current use were lower where HTPs were unavailable. Odds of HTP trial did not differ by regulatory environment when restricting analysis to HTP-aware concurrent smokers-vapers. CONCLUSION Approximately one third of respondents were aware of HTPs, even in the USA and Australia, where contemporary HTPs were not yet on the market. Trial and use were uncommon, except among concurrent smokers-vapers. Restrictions on availability may have limited HTP use generally, but less so for concurrent smokers-vapers.
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Affiliation(s)
- Connor R. Miller
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Edward Sutanto
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Danielle M. Smith
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Sara C. Hitchman
- Department of Addictions, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Shannon Gravely
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Hua-Hie Yong
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Ron Borland
- School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Richard J. O’Connor
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - K. Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Geoffrey T. Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada;,School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada;,Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Andrew Hyland
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Anne C.K. Quah
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Maciej L. Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
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Karim MA, Talluri R, Chido-Amajuoyi OG, Shete S. Awareness of heated tobacco products among US Adults - Health information national trends survey, 2020. Subst Abus 2022; 43:1023-1034. [PMID: 35435808 PMCID: PMC9782695 DOI: 10.1080/08897077.2022.2060440] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Introduction: Heated Tobacco Products (HTP) have the potential to attain high uptake in the US. The current study estimated the prevalence of awareness, prevalence of use and the factors associated with awareness of HTP among US adults. Methods: This study included 3201 respondents from the Health Information National Trends Survey (HINTS) 5 Cycle 4 (2020). The prevalence of awareness of HTP and ever use of HTP among US adults were estimated. Multivariable logistic regression was conducted to identify the factors associated with awareness of HTP. Results: About 15% of the adult US population were aware of HTP, while 2.2% had ever used HTP. Age between 35 and 49 years (aOR, 1.9; 95% CI, 1.3-2.9; p-value = 0.003), male sex (aOR, 1.7; 95% CI, 1.0-2.7; p-value = 0.04), lower income ($0-$9,999) (aOR, 3.0; 95% CI, 1.3-6.9; p-value = 0.01), smoking on some days (aOR, 3.4; 95% CI, 1.2-9.4; p-value = 0.02) and moderately or extremely worrying about getting cancer (aOR, 1.7; 95% CI, 1.1-2.7; p-value = 0.03) were associated with higher odds of being aware of HTP; whereas, belief that there are so many cancer prevention recommendations, it's hard to know which ones to follow (aOR, 0.5; 95% CI, 0.3-0.8; p-value = 0.009) was associated with lower odds of being aware of HTP. Conclusions: A significant proportion of US adult population were aware of HTP in 2020. Given the recent high proliferation of e-cigarettes, potential health effects of the HTP products should be monitored by the regulators closely. Adequate surveillance and policy interventions are warranted in this regard.
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Affiliation(s)
- Mohammad A. Karim
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Rajesh Talluri
- Department of Data Science, University of Mississippi Medical Center, Jackson, Mississippi, United States of America,Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Onyema G. Chido-Amajuoyi
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Sanjay Shete
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America,Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America,Division of Cancer Prevention and Population Science, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
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Wang L, Chen J, Leung LT, Ho SY, Lam TH, Wang MP. Use patterns of cigarettes and alternative tobacco products and socioeconomic correlates in Hong Kong secondary school students. Sci Rep 2021; 11:17253. [PMID: 34446733 PMCID: PMC8390664 DOI: 10.1038/s41598-021-96452-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 08/06/2021] [Indexed: 02/07/2023] Open
Abstract
Smoking is a major cause of health inequities. However, sociodemographic differences in adolescent tobacco use are unclear. In a territory-wide school-based anonymous survey in 2018/19, we investigated tobacco use and sociodemographic correlates in 33,991 students (mean age 14.8 ± 1.9 years) in Hong Kong. Tobacco use prevalence and current-ever use ratios by sociodemographic factors were calculated. Generalised linear mixed models were used in association analyses. Current use was highest for cigarettes (3.2%), closely followed by alternative tobacco products (3.0%). Current-ever use ratios were highest for heated tobacco products (HTPs, 0.60), followed by nicotine e-cigarettes (0.52), waterpipe (0.51), and cigarettes (0.35). Use prevalence and current-ever use ratios of all products showed curvilinear relations with perceived family affluence (P values < 0.01), being highest in the richest families. Tobacco use was also associated with more senior grades, the lowest parental education, and boys, but current-ever use ratios of HTPs and waterpipe were higher in girls (P values < 0.05). The results suggested that adolescent ever users of nicotine-containing alternative tobacco products were more likely to keep using them than cigarettes, and the richest adolescents were at the highest risks of tobacco use. Diverse tobacco control measures are needed to improve health equity, especially on alternative tobacco products.
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Affiliation(s)
- Lijun Wang
- grid.194645.b0000000121742757School of Public Health, University of Hong Kong, Hong Kong, People’s Republic of China
| | - Jianjiu Chen
- grid.194645.b0000000121742757School of Public Health, University of Hong Kong, Hong Kong, People’s Republic of China ,grid.21729.3f0000000419368729Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY USA
| | - Lok Tung Leung
- grid.194645.b0000000121742757School of Public Health, University of Hong Kong, Hong Kong, People’s Republic of China
| | - Sai Yin Ho
- grid.194645.b0000000121742757School of Public Health, University of Hong Kong, Hong Kong, People’s Republic of China
| | - Tai Hing Lam
- grid.194645.b0000000121742757School of Public Health, University of Hong Kong, Hong Kong, People’s Republic of China
| | - Man Ping Wang
- grid.194645.b0000000121742757School of Nursing, University of Hong Kong, Hong Kong, People’s Republic of China
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Myagmar-Ochir E, Kaneko M, Tomiyama K, Zaitsu M, Watanabe S, Nishino Y, Takahashi K, Haruyama Y, Kobashi G. Occupational difference in use of heated tobacco products: a cross-sectional analysis of retail workers in Japan. BMJ Open 2021; 11:e049395. [PMID: 34429314 PMCID: PMC8386230 DOI: 10.1136/bmjopen-2021-049395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Although heated tobacco products (HTPs) have become popular worldwide, research on occupational differences in smoking HTPs remains scarce. We aimed to examine the prevalence of smoking HTPs among a working population in Japan. SETTING, DESIGN AND PARTICIPANTS In 2018, we conducted a cross-sectional study comprised of 7714 retail business workers in the service industry in Japan. PRIMARY AND SECONDARY OUTCOME MEASURES For the definition of smoking HTPs, we identified current HTP smokers who only smoked HTPs, using five mutual categories of current smoking status (never, former, HTPs only, combustible cigarettes only and dual smokers who smoked both combustible cigarettes and HTPs). Occupational classes were classified into office workers (eg, upper non-manual workers) and other workers. ORs and 95% CIs of office workers were estimated for HTP usage, adjusted for age, sex, employment type and cigarette smoking-related health knowledge. RESULTS The overall prevalence of smoking HTPs was 3.0% (male 5.0%, female 2.2%). The prevalence of HTP smokers differed across occupational classes (5.6% in office workers vs 2.5% in others; p<0.05). Compared with other workers, the adjusted odds of office workers for smoking HTPs remained elevated (OR: 1.97, 95% CI: 1.40 to 2.77). Sensitivity analyses with workers of all smoking status showed the same pattern. When stratified by sex, the occupational difference only remained significant in male workers. CONCLUSIONS We found a positive occupational difference in smoking HTPs, particularly among male workers in the retail sector in Japan. National tobacco control should explicitly address this occupational gap and further encourage individuals to quit smoking.
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Affiliation(s)
- Enkhtuguldur Myagmar-Ochir
- Department of Public Health, Dokkyo Medical University School of Medicine, Shimotsuga-gun, Tochigi, Japan
| | - Makiko Kaneko
- Division of Health Support, Department Store Health Insurance Association, Tokyo, Japan
| | - Kiyomi Tomiyama
- Division of Health Support, Department Store Health Insurance Association, Tokyo, Japan
| | - Masayoshi Zaitsu
- Department of Public Health, Dokkyo Medical University School of Medicine, Shimotsuga-gun, Tochigi, Japan
| | - Shuichi Watanabe
- Division of Health Support, Department Store Health Insurance Association, Tokyo, Japan
| | - Yoshitaka Nishino
- Department of Public Health, Dokkyo Medical University School of Medicine, Shimotsuga-gun, Tochigi, Japan
| | - Kyo Takahashi
- Department of Public Health, Dokkyo Medical University School of Medicine, Shimotsuga-gun, Tochigi, Japan
| | - Yasuo Haruyama
- Integrated Research Faculty for Advanced Medical Sciences, Dokkyo Medical University School of Medicine, Shimotsuga-gun, Tochigi, Japan
| | - Gen Kobashi
- Department of Public Health, Dokkyo Medical University School of Medicine, Shimotsuga-gun, Tochigi, Japan
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Xia W, Li WHC, Luo YH, Liang TN, Ho LLK, Cheung AT, Song P. The association between heated tobacco product use and cigarette cessation outcomes among youth smokers: A prospective cohort study. J Subst Abuse Treat 2021; 132:108599. [PMID: 34419325 DOI: 10.1016/j.jsat.2021.108599] [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: 12/15/2020] [Revised: 07/29/2021] [Accepted: 08/11/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The U.S. Food and Drug Administration authorized the marketing of heated tobacco products (HTPs) with modified-risk information for adults on July 7, 2020. However, the effects of HTP use on cigarette cessation among youth smokers remain unclear. This study aimed to explore the association of HTP use with cigarette abstinence and cessation outcomes among youth smokers in Hong Kong who were willing to receive telephone counseling for smoking cessation. METHODS This prospective cohort study included youth smokers aged ≤25 years who were enrolled in the Hong Kong Youth Quitline service. From December 1, 2016, to September 30, 2019, this study identified as HTP users 106 youth cigarette smokers who reported using HTPs on at least 1 of the past 30 days at enrollment, and identified as non-HTP users 473 smokers who reported smoking at least one conventional cigarette in the past 30 days and never using HTPs. The participants received follow-ups at 1 week and 1-, 3-, and 6-months postenrollment. The primary outcome was self-reported 7-day point prevalence of cigarette abstinence (PPA) at the 6-month follow-up. Secondary outcomes included reduction in cigarette smoking (excluding quitters), the number of cessation attempts, and the level of readiness to quit. RESULTS The self-reported 7-day PPA was statistically significantly lower among HTP users than among non-HTP users after 6 months (19.0% vs. 34.2%; p = 0.009), with an adjusted relative risk of 0.47 (95% confidence interval: 0.24-0.91; p = 0.03). The study identified no significant differences in secondary outcomes between the two groups. CONCLUSIONS Youth HTP users were less likely to abstain from tobacco use than their non-HTP-using counterparts. These results suggest that HTPs should not be promoted as smoking cessation or reduction aids among the youth population.
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Affiliation(s)
- Wei Xia
- School of Nursing, Sun Yat-Sen University, RM 613, 4/F, Block of School of Nursing, Sun Yat-Sen University North Campus, No. 74, 2nd Yat-Sen Rd, Yuexiu District, Guangzhou City, Guangdong Province, China; School of Nursing, The University of Hong Kong, 4/F, William M. W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China.
| | - William Ho Cheung Li
- School of Nursing, The University of Hong Kong, 4/F, William M. W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China.
| | - Yuan Hui Luo
- School of Nursing, The University of Hong Kong, 4/F, William M. W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China.
| | - Ting Na Liang
- School of Nursing, The University of Hong Kong, 4/F, William M. W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China.
| | - Laurie Long Kwan Ho
- School of Nursing, The University of Hong Kong, 4/F, William M. W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China.
| | - Ankie Tan Cheung
- School of Nursing, The University of Hong Kong, 4/F, William M. W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China.
| | - Peige Song
- School of Public Health, Zhejiang University School of Medicine, 866 Yuhangtang Rd, Hangzhou 310058, China; Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, Scotland, United Kingdom.
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Li S, Braden K, Zhuang YL, Zhu SH. Adolescent Use of and Susceptibility to Heated Tobacco Products. Pediatrics 2021; 148:peds.2020-049597. [PMID: 34312293 DOI: 10.1542/peds.2020-049597] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/10/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES A leading brand of heated tobacco products (HTPs), IQOS, was authorized to be sold in the United States in 2019. Researchers have examined the awareness and use of HTPs among US adults. In this study, we examined high school students' awareness, use, and susceptibility pertaining to HTPs. METHODS A large, cross-sectional population survey of randomly sampled 10th- and 12th-graders in California (N = 150 516) was conducted online during school hours from September 2019 to March 2020. RESULTS Overall, 8.9% (95% confidence interval [CI], 8.7%-9.1%) of California high school students had heard of HTPs. Approximately 0.67% (95% CI, 0.61%-0.73%) had ever tried HTPs, and 0.20% (95% CI, 0.17%-0.23%) were current users (ie, ∼30% of ever users continued to use HTPs at the time of survey). Among those who never tried HTPs, 18.3% (95% CI, 17.9%-18.8%) were susceptible to future use. The susceptibility to HTP use was greater among users of cigarettes or e-cigarettes than among nonusers. CONCLUSIONS The awareness of HTPs among adolescents was remarkable given the low availability of products at the time of survey. Only a small percentage of adolescents experimented with HTPs. However, almost a third of those who had experimented with HTPs continued to use them. This high ratio and the fact that almost 1 out of 5 never users were susceptible to future HTP use should put the public health community on high alert as more HTP products are coming into the market, with promotion of these products likely to increase.
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Affiliation(s)
| | | | | | - Shu-Hong Zhu
- Moores Cancer Center and .,Herbert Wertheim School of Public Healh, University of California San Diego, La Jolla, California
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Znyk M, Jurewicz J, Kaleta D. Exposure to Heated Tobacco Products and Adverse Health Effects, a Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6651. [PMID: 34205612 PMCID: PMC8296358 DOI: 10.3390/ijerph18126651] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 11/25/2022]
Abstract
Heated tobacco products (HTP) are a form of nicotine delivery intended to be an alternative to traditional cigarettes. HTP tobacco products are sold to consumers as a less harmful alternative to traditional cigarettes, both for users and bystanders. The actual impact of HTP on the health of users and its overall impact on public health is still not fully known. A systematic search of the literature was carried out to identify relevant studies published in English from 2015 to February 2021. The following databases were used: PubMed, Scopus, Elsevier and ClinicalKey. 25 studies (independent and sponsored by the tobacco industry) were considered. The analysis of exposure biomarkers and cardiovascular and respiratory biomarkers showed differences between smokers and people using heated tobacco products. Improvements in clinically relevant risk markers, especially cholesterol, sICAM-1, 8-epi-PGF2α, 11-DTX-B2, HDL and FEV1, were observed compared to persistent cigarette smokers. On the other hand, exposure to IQOS has been reported to alter mitochondrial function, which may further exaggerate airway inflammation, airway remodeling and lung cancer. These products have the potential to increase oxidative stress and increase respiratory tract infections by increasing microbial adherence to the respiratory tract. Our review suggests that HTP products may be products with a reduced risk of chronic diseases, including respiratory and cardiovascular diseases and cancer compared to traditional smoking, although in the case of non-smokers so far, they may pose a risk of their occurrence. Research seems to be necessary to assess the frequency of HTP use and its potential negative health effects.
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Affiliation(s)
- Małgorzata Znyk
- Department of Hygiene and Epidemiology, Medical University of Lodz, 90-647 Lodz, Poland; (J.J.); (D.K.)
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Kwon M, Chung SJ, Lee J. Use of Single, Dual, and Poly Tobacco Products in Korean Adolescents. Asia Pac J Public Health 2021; 33:571-578. [PMID: 34137306 DOI: 10.1177/10105395211022950] [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] [Indexed: 11/15/2022]
Abstract
This study aimed to examine the prevalence of single, dual, and poly use of conventional cigarettes, e-cigarettes, and heated tobacco products among Korean adolescent smokers and identify factors related to dual and poly tobacco product use. Data from 4028 current smokers in the 2019 Korea Youth Behavior Web-based Survey were included. Single users accounted for 53.1%, followed by dual users at 24.8% and poly users at 22.1%. The factors influencing dual and poly tobacco product use included male, living in a metropolitan area, risky alcohol drinking, sexual experience, number of cigarettes smoked, secondhand smoke exposure, and easy-to-buy tobacco products. The findings suggest restricting the use of new types of tobacco products in the high-risk group are required to prevent dual and poly use. Furthermore, it is necessary to provide support like education for new tobacco products and smoking cessation, programs for secondhand smoke prevention, or rigorous marketing regulations for adolescents.
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Affiliation(s)
- Min Kwon
- The University of Suwon, Hwaseong, South Korea
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Hwang J, Cho SI. A comparative study on changes in the use of heat-not-burn tobacco products based on whether apartment buildings have designated non-smoking areas. Tob Prev Cessat 2021; 7:46. [PMID: 34179592 PMCID: PMC8202528 DOI: 10.18332/tpc/136028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 04/13/2021] [Accepted: 04/22/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Since 2016, multi-family housing developments in South Korea can designate public areas such as staircases, elevator, corridors, and underground parking lots as non-smoking areas if at least half of the households residing in the development agree. This study investigated whether there were changes in the use of heat-not-burn tobacco products (HnB) based on whether non-smoking areas were introduced in multi-family housing developments. METHODS An online survey of 1200 apartment residents (599 men and 601 women) in seven metropolitan cities in South Korea was conducted from 10 to 18 October 2018. RESULTS Among the 1200 people who completed the survey, 493 were smokers (351 men and 142 women), of whom 287 (195 men and 92 women) were currently using HnB. In total, 51.5% (n=148) of the HnB users reported that their smoking frequency inside (n=75) or outside (n=73) the apartment building increased after using HnB, whereas the smoking frequency of 27.5% (n=79) decreased and that of 20.9% (n=6) remained unchanged. Of the HnB users, 25.4% (n=73) were currently living in non-smoking apartments, of whom 39.7% reported that the smoking frequency outside the apartment building increased. On the other hand, of 214 people who did not currently reside in non-smoking apartments, 30.4% reported that the smoking frequency in the apartment increased. CONCLUSIONS For smokers to quit smoking, the expansion of non-smoking areas should be accompanied by the facilitation of a smoke-free atmosphere and a smoking-cessation service for smokers.
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Affiliation(s)
- Jieun Hwang
- College of Health Science, Dankook University, Cheonan, Republic of Korea
| | - Sung-Il Cho
- College of Health Science, Dankook University, Cheonan, Republic of Korea.,Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
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Heated Tobacco Products: Awareness and Ever Use Among U.S. Adults. Am J Prev Med 2021; 60:684-691. [PMID: 33518430 DOI: 10.1016/j.amepre.2020.11.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/30/2020] [Accepted: 11/20/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Heated tobacco products, also referred to as heat-not-burn tobacco, are among the latest products introduced to the market by the tobacco industry. However, data on heated tobacco product awareness and use from population-based probability surveys are limited. This study examines heated tobacco product awareness and ever use among U.S. adults. METHODS This study used data (n=42,477) from the 2019 Tobacco Use Supplement to the Current Population Survey, analyzed in 2020. Descriptive statistics, including a weighted prevalence of heated tobacco product awareness and ever use, were estimated. The awareness and ever use of heated tobacco products were also estimated by age, sex, cigarette smoking status, E-cigarette use status, and other tobacco product use status. Multivariable logistic regression examined the individual characteristics associated with the awareness and ever use of heated tobacco products. RESULTS Overall, approximately 8.6% of U.S. adults were aware of heated tobacco products. Awareness was higher among participants who were younger, male, cigarette smokers, E-cigarette users, and other tobacco product users. Ever use of heated tobacco products was uncommon among U.S. adults (0.51%) but more prevalent among E-cigarette users and cigarette smokers. In the general adult populations, the odds of ever use of heated tobacco products were significantly higher among cigarette smokers (AOR=2.19, 95% CI=1.63, 2.94), E-cigarette smokers (AOR=2.70, 95% CI=1.71, 4.25), and other tobacco product users (AOR=1.69, 95% CI=1.30, 2.20). CONCLUSIONS Although the ever use of heated tobacco products is uncommon among U.S. adults, recent regulatory approval of the marketing of IQOS as modified risk tobacco products may increase use. Therefore, ongoing monitoring of heated tobacco products use and their long-term health consequences are important for informing future decision making.
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Categorizing IQOS-Related Twitter Discussions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094836. [PMID: 33946546 PMCID: PMC8124933 DOI: 10.3390/ijerph18094836] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/22/2021] [Accepted: 04/27/2021] [Indexed: 11/17/2022]
Abstract
(1) Background: The heated tobacco product IQOS, by Philip Morris International, is now available in over 55 countries, including the United States. Social media sites such as Twitter are often used to promote or discuss tobacco products, though prior research has not examined how IQOS is presented on Twitter. (2) Methods: This study collected and categorized Twitter conversations involving IQOS. A manual content analysis was performed on N = 3916 English tweets related to IQOS published internationally between 1 January 2020 and 30 June 2020. (3) Results: Most tweets were either online marketing for IQOS (32.3%) or personal testimonials related to IQOS use (34.2%). Personal testimonial tweets made harm reduction claims about IQOS either as an avenue to quit smoking/tobacco use (3.4%), or in comparison to combustible cigarettes (2.0%). Tobacco policy-related tweets were detected (13.9%), split between discussions of United States (4.9%) and international (4.4%) policies. News media tweets (14.2%) were also detected. (4) Conclusions: Our study suggests IQOS may be understood as a less harmful alternative to vaping and combustible cigarettes. Discussions also suggest IQOS is likely to be used to avoid clean air policies or used in areas in which smoking is restricted.
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Berg CJ, Romm KF, Patterson B, Wysota CN. Heated tobacco product awareness, use, and perceptions in a sample of young adults in the U.S. Nicotine Tob Res 2021; 23:1967-1971. [PMID: 33822111 DOI: 10.1093/ntr/ntab058] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 03/31/2021] [Indexed: 11/12/2022]
Abstract
SIGNIFICANCE The emergence of heated tobacco products (HTPs) in the US marks a critical time for identifying those most likely to use, particularly among young adults. METHODS We analyzed Fall 2019 data from a longitudinal study of young adults (ages 18-34; n=2,375, Mage=24.66±4.68) in 6 US cities, 24.1% of whom used cigarettes and 32.7% e-cigarettes. We assessed HTP awareness, use, and sources, as well as perceived risk, social acceptability, and likelihood of future use. RESULTS In this sample, 9.7% (n=230) heard of HTPs, 3.5% (n=84) ever used them, and 2.4% (n=56) reported past-year purchases (tobacco shops, 66.1%; traditional retailers, 60.7%; online, 39.3%; IQOS specialty stores, 35.7%). In multivariable analyses, having heard of HTPs correlated with being older, male, and current cigarette and e-cigarette users; among those ever hearing of them, using HTPs correlated with being non-Hispanic and current cigarette and e-cigarette users. Greater likelihood of future use correlated with being older, male, sexual minority, non-Hispanic, and current cigarette and e-cigarette users. Among past-month users (n=78), the average number of days used was 5.48 (SD=5.54). Past-month cigarette and e-cigarette users, respectively, who tried HTPs were more likely to report consistent or more frequent use of their respective product than a year ago (p's<.001). HTPs were perceived as less addictive than cigarettes, smokeless tobacco, and e-cigarettes, and less harmful and more socially acceptable than other tobacco products except e-cigarettes and hookah. CONCLUSIONS The relatively positive perceptions of HTPs and access via various channels underscores potential penetration of HTPs among US young adults.
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Affiliation(s)
- Carla J Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, Washington, DC, USA
- George Washington Cancer Center, George Washington University, Washington, DC, USA
| | - Katelyn F Romm
- Department of Prevention and Community Health, Milken Institute School of Public Health, Washington, DC, USA
| | - Brooke Patterson
- Department of Global Health, Milken Institute School of Public Health, Washington, DC, USA
| | - Christina N Wysota
- Department of Prevention and Community Health, Milken Institute School of Public Health, Washington, DC, USA
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Lempert LK, Bialous S, Glantz S. FDA's reduced exposure marketing order for IQOS: why it is not a reliable global model. Tob Control 2021; 31:e83-e87. [PMID: 33811155 PMCID: PMC8486889 DOI: 10.1136/tobaccocontrol-2020-056316] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/20/2021] [Accepted: 02/02/2021] [Indexed: 12/24/2022]
Abstract
The US Food and Drug Administration (FDA) issued orders in July 2020 authorising Philip Morris Products S.A. to market its heated tobacco product (HTP) IQOS inside the USA with claims that it reduces exposure to some dangerous substances. FDA's 'reduced-exposure' orders explicitly prohibit the marketing of IQOS with claims that IQOS will reduce harm or the risk of tobacco-related diseases. Under US law, FDA's IQOS orders are problematic because FDA disregarded valid scientific evidence that IQOS increases exposure to other dangerous toxins and that Philip Morris Products S.A. failed to demonstrate that consumers understand the difference between reduced-exposure and reduced-harm claims. Unfortunately, both 'reduced-exposure' and 'reduced-harm' are classified as 'modified risk tobacco products' under US law. Exploiting this confusion, Philip Morris International used the FDA decision as the basis for marketing and public relations campaigns outside the USA to press governments to reverse policies that ban or regulate the sales and marketing of HTPs, including IQOS. Parties to the WHO Framework Convention on Tobacco Control should reject tobacco companies' unsubstantiated explicit or implied claims of reduced harm associated with HTPs and resist Philip Morris International's and other companies' calls to relax HTP regulations based on the FDA's actions. Instead, parties should adopt policies aligned with the Framework Convention on Tobacco Control when dealing with HTPs and other novel tobacco products.
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Affiliation(s)
- Lauren Kass Lempert
- Center for Tobacco Control Research & Education, UCSF, San Francisco, California, USA
| | - Stella Bialous
- Department of Social and Behavioral Sciences, School of Nursing, UCSF, San Francisco, California, USA
| | - Stanton Glantz
- Center for Tobacco Control Research & Education, UCSF, San Francisco, California, USA
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Dunbar MS, Seelam R, Tucker JS, Rodriguez A, Shih RA, D'Amico EJ. Correlates of Awareness and Use of Heated Tobacco Products in a Sample of US Young Adults in 2018-2019. Nicotine Tob Res 2021; 22:2178-2187. [PMID: 32047910 DOI: 10.1093/ntr/ntaa007] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Tobacco companies have devoted increased resources in recent years to developing and marketing heated tobacco products (HTPs) as alternatives to combustible products like cigarettes. However, little is known about correlates of awareness and use of these products in American young adults. METHODS Two thousand four hundred ninety-seven young adults (mean age = 21.6) completed survey items on HTP awareness and lifetime use in 2018-2019. Logistic regression models compared young adults who were (1) unaware of HTPs (reference group) with those who were, (2) aware of HTPs, and (3) had ever used HTPs on demographic, tobacco, and other substance use characteristics. Among current smokers, these groups were compared on cigarette use, dependence, and readiness to quit. RESULTS Approximately 12% of respondents (n = 293) were aware of HTPs, and 5% (n = 134) reported lifetime HTP use. Controlling for demographics, HTP awareness and use were both associated with greater use of all types of tobacco products, number of different tobacco products, and use of marijuana and other drugs. Among current smokers, HTP awareness and use correlated with heavier cigarette consumption, greater dependence, and past-month marijuana use, but not with recent quit attempts or thinking about quitting cigarettes. CONCLUSIONS Awareness and use of HTPs among young adults were associated with greater use of tobacco products and other substances and, among current smokers, with greater cigarette dependence (but not cessation-related factors). As these products become increasingly available in the United States, additional surveillance and monitoring activities are needed to better understand use patterns, consequences, and reasons for using HTPs. IMPLICATIONS Few studies have examined factors associated with awareness and use of heated tobacco products (HTPs) among US young adults. HTP awareness and lifetime use correlated with a range of factors, including male gender, white race/ethnicity, and tobacco and other substance use. Lifetime use of HTPs was low (5%); most lifetime HTP users reported history of other tobacco use, but a sizeable minority (14%) reported no other tobacco product use history. Among current cigarette smokers, cigarette dependence, poly-tobacco use, and marijuana use-but not cigarette cessation attempts or contemplation-were associated with greater likelihood of awareness and use of HTPs.
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Gallus S, Lugo A, Liu X, Borroni E, Clancy L, Gorini G, Lopez MJ, Odone A, Przewozniak K, Tigova O, VAN DEN Brandt P, Vardavas C, Fernandez E. USE AND AWARENESS OF HEATED TOBACCO PRODUCTS IN EUROPE. J Epidemiol 2021; 32:139-144. [PMID: 33456019 PMCID: PMC8824661 DOI: 10.2188/jea.je20200248] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Heated tobacco products (HTP) are new forms of tobacco consumption with limited information available on their use among the general population. Our objective is to analyse the prevalence and associations of use of HTP across 11 countries in Europe.Methods Within the TackSHS Project, in 2017-2018 we conducted a cross-sectional study with information on HTP use in the following countries: Bulgaria, England, France, Germany, Greece, Italy, Latvia, Poland, Portugal, Romania and Spain. In each country, face-to-face interviews were performed on a representative sample of around 1,000 subjects aged ≥15 years, for a total of 10,839 subjects.Results Overall, 27.8% of study participants were aware of HTPs, 1.8% were ever HTP users (ranging from 0.6% in Spain to 8.3% in Greece), and 0.1% were current users. Men were more frequently HTP ever users than women (adjusted odds ratio, aOR=1.47; 95% confidence interval, CI: 1.11-1.95). Ever HTP use was inversely related to age (p for trend<0.001) and more frequent in ex-smokers (compared with never smokers, aOR=4.32, 95% CI: 2.69-6.95) and current smokers (aOR=8.35, 95% CI: 5.67-12.28), and in electronic cigarette past users (compared with never users, aOR=5.48, 95% CI: 3.46-8.68) and current users (aOR=5.92, 95% CI: 3.73-9.40).Conclusions In 2017-2018, HTP use was still limited in Europe among the general population, however the dual use of these products, their high use among younger generations and the interest of non-smokers in these products are worrying and indicate the need for close monitoring in terms of prevalence and the characteristics of users.
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Affiliation(s)
- Silvano Gallus
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS
| | - Alessandra Lugo
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS
| | - Xiaoqiu Liu
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS.,The George Institute for Global Health
| | - Elisa Borroni
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS
| | | | | | - Maria José Lopez
- Agència de Salut Pública de Barcelona.,CIBER en Epidemiología y Salud Pública (CIBERESP) (Biomedical Research Centre Network for Epidemiology and Public Health).,Institut d'investigació Biomèdica Sant Pau (IIB St. Pau)
| | - Anna Odone
- School of Medicine, Vita-Salute San Raffaele University.,IRCCS San Raffaele Scientific Institute
| | - Krzysztof Przewozniak
- The Maria Sklodowska-Curie National Research Institute of Oncology.,Collegium Civitas.,Foundation "Smart Health - Health in 3D"
| | - Olena Tigova
- Institut Català d'Oncologia, L'Hospitalet de Llobregat.,Institut d'Investigació Biomèdica de Bellvitge, L'Hospitalet de Llobregat.,Consortium for Biomedical Research in Respiratory Diseases (CIBER en Enfermedades Respiratorias, CIBERES)
| | - Piet VAN DEN Brandt
- Department of Epidemiology, CAPHRI-School for Public Health and Primary Care, Maastricht University Medical Centre.,Department of Epidemiology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre
| | | | - Esteve Fernandez
- Institut Català d'Oncologia, L'Hospitalet de Llobregat.,Institut d'Investigació Biomèdica de Bellvitge, L'Hospitalet de Llobregat.,Consortium for Biomedical Research in Respiratory Diseases (CIBER en Enfermedades Respiratorias, CIBERES).,Universitat de Barcelona
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Lee J, Thompson LA, Salloum RG. Heated tobacco product use among US adolescents in 2019: The new tobacco risk. Tob Prev Cessat 2021; 7:01. [PMID: 33437895 PMCID: PMC7796675 DOI: 10.18332/tpc/130502] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/15/2020] [Accepted: 11/16/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION There is growing public health concern about adolescent use of heated tobacco products (HTPs) after the US Food and Drug Administration approved the leading HTPs, IQOS, as a modified risk tobacco product. Extending the previous studies examining the correlates of HTP use among adolescents, this study aims to investigate potential risk factors for HTP use among US adolescents, including the use of multiple tobacco and flavored tobacco products. METHODS We analyzed the 2019 National Youth Tobacco Survey (n=19018) and conducted a series of logistic regression models on awareness and use of HTPs as a function of tobacco use status (none, single, dual/poly) and past 30 days flavored tobacco use (e.g. menthol cigarette use, flavored e-cigarettes), controlling for sociodemographics. RESULTS In multivariable analyses, awareness of HTPs was associated with usual menthol cigarette use (AOR=1.77; 95% CI: 1.23-2.53) and past 30 days flavored tobacco use (AOR=1.44; 95% CI: 1.16-1.80). Risk factors for ever HTP use included single (AOR=2.52; 95% CI: 1.19-5.33) and dual/poly tobacco use (AOR=4.94; 95% CI: 2.56-9.54), usual menthol cigarette use (AOR=2.50; 95% CI: 1.66-3.76), and past 30 days flavored tobacco use (AOR=1.61; 95% CI: 1.07-2.44). Risk factors for current HTP use included single (AOR=10.84; 95% CI: 6.72-17.49) and dual/poly tobacco use (AOR=31.96; 95% CI: 17.79-57.43), and usual menthol cigarette use (AOR=2.50; 95% CI: 1.63-3.85). CONCLUSIONS This study documents HTP use in adolescents and contributes insight and urgency into prioritizing at-risk adolescents for interventions, including current users of other tobacco products and flavored tobacco users.
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Affiliation(s)
- Juhan Lee
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, Gainesville, United States
| | - Lindsay A Thompson
- Department of Pediatrics, College of Medicine, University of Florida, Gainesville, United States
| | - Ramzi G Salloum
- Department Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, United States
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Chang LC, Lee YC, Hsu C, Chen PC. Prevalence of heated tobacco product use among adolescents in Taiwan. PLoS One 2020; 15:e0244218. [PMID: 33347476 PMCID: PMC7751857 DOI: 10.1371/journal.pone.0244218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 12/04/2020] [Indexed: 11/18/2022] Open
Abstract
Objective To determine the penetration of heated tobacco products (HTPs) into the youth market in Taiwan, with a particular focus on the correlation between IQOS use and the usage of other tobacco products. Methods Data from the 2018 Global Youth Tobacco Survey were used to assess previous experience with and current use (within 30 days prior to survey completion) of IQOS products by Taiwanese students aged 12–18 years. Independent variables included the usage patterns of conventional cigarettes and e-cigarettes. The control variables included background information (gender, grade, monthly income/allowance, household educational level, smoking status at home and among close friends), access to free cigarettes, as well as exposure to cigarette advertisements and anti-tobacco courses. Logistic regression was used to identify tobacco usage patterns correlated with IQOS use. Results In 2018, 2.33% of Taiwan’s adolescents were currently using IQOS and 4.17% had tried IQOS. The use of conventional cigarettes and e-cigarettes (individually and together) were associated with an elevated risk of the ever use and current use of IQOS. Conclusion Despite the fact that HTP products are not sold legally in Taiwan, the use of IQOS products by young people is far from negligible. We recommend amending the “Tobacco Hazards Prevention Act” to include regulations pertaining to the sale and marketing of HTPs.
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Affiliation(s)
- Li-Chuan Chang
- Institute of Health and Welfare Policy, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yue-Chune Lee
- Institute of Health and Welfare Policy, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Master Program on Trans-Disciplinary Long-Term Care and Management, National Yang-Ming University, Taipei, Taiwan
| | - Chieh Hsu
- Institute of Health and Welfare Policy, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Pei-Ching Chen
- Department of Health and Welfare, College of City Management, University of Taipei, Taipei, Taiwan
- * E-mail:
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Kinjo A, Kuwabara Y, Fujii M, Imamoto A, Osaki Y, Minobe R, Maezato H, Nakayama H, Takimura T, Higuchi S. Heated Tobacco Product Smokers in Japan Identified by a Population-Based Survey. J Epidemiol 2020; 30:547-555. [PMID: 31787705 PMCID: PMC7661338 DOI: 10.2188/jea.je20190199] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background In this study, we aim to estimate the prevalence of heated tobacco product (HTP) smokers 3 years after the launch of HTPs in Japan. Methods Our study, performed in February 2018 in Japan, had a cross-sectional population-based design. A total of 4,628 adult participants (2,121 men and 2,507 women) were randomly sampled from all regions of Japan. The response rate was 57.9%. Interviews were conducted by trained investigators who visited participants’ homes. A survey on current (past 30 days) and lifetime tobacco use (including e-cigarettes and HTPs), as well as numerous sociodemographic factors, was conducted. Results The age-adjusted rates and estimated number of lifetime-HTP smokers were 14.1% (95% confidence interval [CI], 12.5–15.6%; 7.11 million men) and 3.7% (95% CI, 2.9–4.4%; 1.99 million women). The age-adjusted rates for current HTP smokers were 8.3% (95% CI, 7.1–9.6%; 4.21 million men) and 1.9% (95% CI, 1.3–2.4%; 1.02 million women). Multiple variables were found to be associated with a higher prevalence of current HTP use, including being male, aged 20–39 years, a current Internet user, a risky drinker, or a heavy episodic drinker. HTP use was also higher among men with 10 years or more of education, women with 15 years or less of education, and men with middle- or high-level household incomes. Conclusion We concluded that HTP use has increased substantially in Japan. However, regulations for HTPs are weaker than those for combustible cigarettes in Japan. Thus, HTPs should be subjected to the same regulations as combustible tobacco products.
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Affiliation(s)
- Aya Kinjo
- Division of Environmental and Preventive Medicine, Department of Social Medicine, Faculty of Medicine, Tottori University
| | - Yuki Kuwabara
- Division of Environmental and Preventive Medicine, Department of Social Medicine, Faculty of Medicine, Tottori University
| | - Maya Fujii
- Division of Environmental and Preventive Medicine, Department of Social Medicine, Faculty of Medicine, Tottori University
| | - Aya Imamoto
- Division of Environmental and Preventive Medicine, Department of Social Medicine, Faculty of Medicine, Tottori University
| | - Yoneatsu Osaki
- Division of Environmental and Preventive Medicine, Department of Social Medicine, Faculty of Medicine, Tottori University
| | - Ruriko Minobe
- National Hospital Organization Kurihama Medical and Addiction Center
| | - Hitoshi Maezato
- National Hospital Organization Kurihama Medical and Addiction Center
| | - Hideaki Nakayama
- National Hospital Organization Kurihama Medical and Addiction Center
| | - Tsuyoshi Takimura
- National Hospital Organization Kurihama Medical and Addiction Center
| | - Susumu Higuchi
- National Hospital Organization Kurihama Medical and Addiction Center
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McKelvey K, Baiocchi M, Halpern-Felsher B. PMI's heated tobacco products marketing claims of reduced risk and reduced exposure may entice youth to try and continue using these products. Tob Control 2020; 29:e18-e24. [PMID: 32029537 PMCID: PMC7416542 DOI: 10.1136/tobaccocontrol-2019-055318] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/16/2019] [Accepted: 10/31/2019] [Indexed: 01/12/2023]
Abstract
IMPORTANCE Philip Morris International (PMI) is seeking Food and Drug Administration's (FDA) authorisation to market IQOS as a modified risk tobacco product and to make marketing claims of reduced risk and reduced exposure. Such claims may be misunderstood by youth, thereby increasing their risk for tobacco initiation. OBJECTIVE To assess youth (mean age 19.3, SD=1.7) understanding and perceptions of PMI's proposed consumer marketing claims of reduced risk and reduced exposure, we embedded a randomised controlled experiment into a survey of 450 California youth (April to August 2018). Participants were randomised to see 'reduced exposure', 'reduced risk' or neither claim. Perceptions of IQOS-related health risks and general harm and understanding of the term 'switching completely' as used in PMI's proposed claims were compared. RESULTS Mean expectancies to experience specific health risks did not differ by claim exposure. The reduced exposure group's perceptions of general harm did not differ from those of controls nor from the reduced risk group. The reduced risk group had the largest proportion who perceived IQOS as moderately/less harmful (n=78, 52%); controls the largest proportion perceiving IQOS as quite/extremely harmful (n=91, 63%). While 71% of the sample understood the term 'switch completely' correctly as used in the reduced risk (n=194, 71%) and reduced exposure (n=206, 72%) claims, more than 1 in 4 did not. CONCLUSIONS FDA and other regulators must use caution when considering allowing claims of reduced risk or reduced exposure to appear on retail tobacco packaging. Youth misunderstand such claims, and misperceptions of harm are known to lead to tobacco-use initiation.
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Affiliation(s)
- Karma McKelvey
- Pediatrics/Adolescent Medicie, Stanford University School of Medicine, Stanford, California, USA
| | - Michael Baiocchi
- Statistics, Stanford University Stanford Prevention Research Center, Stanford, California, USA
| | - Bonnie Halpern-Felsher
- Pediatrics/Adolescent Medicie, Stanford University School of Medicine, Stanford, California, USA
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Ho LLK, Li WHC, Cheung AT, Xia W, Lam TH. Awareness and Use of Heated Tobacco Products among Youth Smokers in Hong Kong: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8575. [PMID: 33227929 PMCID: PMC7699292 DOI: 10.3390/ijerph17228575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/10/2020] [Accepted: 11/18/2020] [Indexed: 12/23/2022]
Abstract
The growing popularity of heated tobacco products (HTPs) among youth may act as a gateway for smoking and jeopardize youth health. We aimed to describe the use of HTPs among youth smokers in Hong Kong and examine their risk awareness of HTPs as well as awareness of the proposed legislation. We conducted retrospective data analyses on the Youth Quitline Cohort (n = 731). We extracted participants' sociodemographic data, smoking profiles, and HTP use from 1 January 2017. Participants' HTP use increased from 5.7% in 2017 to 37.9% in 2020. Among the 731 participants, 175 were HTP users and 556 were HTP nonusers. Compared with nonusers, a significantly higher proportion of HTP users had tried using other tobacco products at least once. The most common reason for using HTPs was curiosity. HTP users were more likely than nonusers to misclassify HTPs as e-cigarettes; agree that HTPs were healthier and contained fewer harmful substances than conventional cigarettes; consider HTPs as a smoking cessation aid; and believe that HTPs could reduce conventional cigarette consumption. Overall, 61.2% of youth smokers disagreed with banning HTPs. Risk awareness of HTPs among youth might affect their likelihood of using these products. Stricter regulations on advertising and intensive health education are imperative to avoid misleading information and limit youth exposure to such harmful products.
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Affiliation(s)
- Laurie Long Kwan Ho
- School of Nursing, University of Hong Kong, Hong Kong, China; (L.L.K.H.); (A.T.C.); (W.X.)
| | - William Ho Cheung Li
- School of Nursing, University of Hong Kong, Hong Kong, China; (L.L.K.H.); (A.T.C.); (W.X.)
| | - Ankie Tan Cheung
- School of Nursing, University of Hong Kong, Hong Kong, China; (L.L.K.H.); (A.T.C.); (W.X.)
| | - Wei Xia
- School of Nursing, University of Hong Kong, Hong Kong, China; (L.L.K.H.); (A.T.C.); (W.X.)
| | - Tai Hing Lam
- School of Public Health, University of Hong Kong, Hong Kong, China;
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