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Wu J, Trifiro BM, Ranker LR, Origgi JM, Benjamin EJ, Robertson RM, Bhatnagar A, Stokes AC, Xuan Z, Wijaya D, Plummer B, Cornacchione Ross J, Fetterman JL, Hong T. Health Warnings on Instagram Advertisements for Synthetic Nicotine E-Cigarettes and Engagement. JAMA Netw Open 2024; 7:e2434434. [PMID: 39269702 PMCID: PMC11400217 DOI: 10.1001/jamanetworkopen.2024.34434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/15/2024] Open
Abstract
Importance Synthetic nicotine is increasingly used in e-cigarette liquids along with flavors to appeal to youths. Regulatory loopholes have allowed tobacco manufacturers to use social media to target youths. Objective To analyze the extent to which synthetic nicotine e-cigarette brands have implemented US Food and Drug Administration (FDA) health warning requirements and to evaluate the association between health warnings and user engagement on Instagram. Design, Setting, and Participants In this cross-sectional study, posts from 25 brands were analyzed across a 14-month period (August 2021 to October 2022). A content analysis was paired with Warning Label Multi-Layer Image Identification, a computer vision algorithm designed to detect the presence of health warnings and whether the detected health warning complied with FDA guidelines by (1) appearing on the upper portion of the advertisement and (2) occupying at least 20% of the advertisement's area. Data analysis was performed from March to June 2024. Exposure Synthetic nicotine e-cigarette advertisement on Instagram. Main Outcomes and Measures The outcome variables were user engagement (number of likes and comments). Negative binomial regression analyses were used to evaluate the association between the presence and characteristics of health warnings and user engagement. Results Of a total of 2071 posts, only 263 (13%) complied with both FDA health warning requirements. Among 924 posts with health warnings, 732 (79%) displayed warnings in the upper image portion, and 270 (29%) had a warning covering at least 20% of the pixel area. Posts with warnings received fewer comments than posts without warnings (mean [SD], 1.8 [2.5] vs 5.4 [11.7] comments; adjusted incident rate ratio [aIRR], 0.70; 95% CI, 0.57-0.86; P < .001). For posts containing warnings, a larger percentage of the warning label's pixel area was associated with fewer comments (aIRR, 0.96; 95% CI, 0.93-0.99; P = .003). Flavored posts with health warnings placed in the upper image portion received more likes than posts with warnings in the lower portion (mean [SD], 34.6 [35.2] vs 19.9 [19.2] likes; aIRR, 1.48; 95% CI, 1.07-2.06; P = .02). Conclusions and Relevance In this cross-sectional study of synthetic nicotine brand Instagram accounts, 87% of sampled posts did not adhere to FDA health warning requirements in tobacco promotions. Enforcement of FDA compliant health warnings on social media may reduce youth engagement with tobacco marketing.
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Affiliation(s)
- Jiaxi Wu
- Annenberg School for Communication, University of Pennsylvania, Philadelphia
| | - Briana M Trifiro
- College of Communication, Boston University, Boston, Massachusetts
| | - Lynsie R Ranker
- Department of Community Health Sciences, School of Public Health, Boston University, Boston, Massachusetts
| | - Juan Manuel Origgi
- Department of Computer Science, Boston University, Boston, Massachusetts
| | - Emelia J Benjamin
- Section of Cardiovascular Medicine, Department of Medicine, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Rose Marie Robertson
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
- Department of Medicine, School of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Aruni Bhatnagar
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
- Department of Medicine, University of Louisville, Louisville, Kentucky
| | - Andrew C Stokes
- Global Health, School of Public Health, Boston University, Boston, Massachusetts
| | - Ziming Xuan
- Department of Community Health Sciences, School of Public Health, Boston University, Boston, Massachusetts
| | - Derry Wijaya
- Department of Computer Science, Boston University, Boston, Massachusetts
| | - Bryan Plummer
- Department of Computer Science, Boston University, Boston, Massachusetts
| | - Jennifer Cornacchione Ross
- Department of Health Law, Policy & Management, School of Public Health, Boston University, Boston, Massachusetts
| | - Jessica L Fetterman
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Traci Hong
- College of Communication, Boston University, Boston, Massachusetts
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Courtney KE, Liu W, Andrade G, Schulze J, Doran N. Attentional Bias, Pupillometry, and Spontaneous Blink Rate: Eye Characteristic Assessment Within a Translatable Nicotine Cue Virtual Reality Paradigm. JMIR Serious Games 2024; 12:e54220. [PMID: 38952012 PMCID: PMC11220568 DOI: 10.2196/54220] [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: 11/01/2023] [Revised: 03/05/2024] [Accepted: 06/01/2024] [Indexed: 07/03/2024] Open
Abstract
Background Incentive salience processes are important for the development and maintenance of addiction. Eye characteristics such as gaze fixation time, pupil diameter, and spontaneous eyeblink rate (EBR) are theorized to reflect incentive salience and may serve as useful biomarkers. However, conventional cue exposure paradigms have limitations that may impede accurate assessment of these markers. Objective This study sought to evaluate the validity of these eye-tracking metrics as indicators of incentive salience within a virtual reality (VR) environment replicating real-world situations of nicotine and tobacco product (NTP) use. Methods NTP users from the community were recruited and grouped by NTP use patterns: nondaily (n=33) and daily (n=75) use. Participants underwent the NTP cue VR paradigm and completed measures of nicotine craving, NTP use history, and VR-related assessments. Eye-gaze fixation time (attentional bias) and pupillometry in response to NTP versus control cues and EBR during the active and neutral VR scenes were recorded and analyzed using ANOVA and analysis of covariance models. Results Greater subjective craving, as measured by the Tobacco Craving Questionnaire-Short Form, following active versus neutral scenes was observed (F1,106=47.95; P<.001). Greater mean eye-gaze fixation time (F1,106=48.34; P<.001) and pupil diameter (F1,102=5.99; P=.02) in response to NTP versus control cues were also detected. Evidence of NTP use group effects was observed in fixation time and pupillometry analyses, as well as correlations between these metrics, NTP use history, and nicotine craving. No significant associations were observed with EBR. Conclusions This study provides additional evidence for attentional bias, as measured via eye-gaze fixation time, and pupillometry as useful biomarkers of incentive salience, and partially supports theories suggesting that incentive salience diminishes as nicotine dependence severity increases.
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Affiliation(s)
| | - Weichen Liu
- Department of Computer Science and Engineering, University of California, San Diego, La Jolla, CA, United States
| | - Gianna Andrade
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Jurgen Schulze
- Department of Computer Science and Engineering, University of California, San Diego, La Jolla, CA, United States
| | - Neal Doran
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
- Veterans Affairs San Diego Healthcare System, La Jolla, CA, United States
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Kolokotroni KZ, Fozard TE, Selby DL, Harrison AA. Is impulsivity related to attentional bias in cigarette smokers? An exploration across levels of nicotine dependency and deprivation. Behav Pharmacol 2024; 35:172-184. [PMID: 38651685 DOI: 10.1097/fbp.0000000000000775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Research has largely focused on how attentional bias to smoking-related cues and impulsivity independently influence the development and maintenance of cigarette smoking, with limited exploration of the relationship between these mechanisms. The current experiments systematically assessed relationships between multiple dimensions of impulsivity and attentional bias, at different stages of attention, in smokers varying in nicotine dependency and deprivation. Nonsmokers (NS; n = 26), light-satiated smokers (LS; n = 25), heavy-satiated smokers (HS; n = 23) and heavy 12-hour nicotine-deprived smokers (HD; n = 30) completed the Barratt Impulsivity Scale, delayed discounting task, stop-signal task, information sampling task and a visual dot-probe assessing initial orientation (200 ms) and sustained attention (2000 ms) toward smoking-related cues. Sustained attention to smoking-related cues was present in both HS and LS, while initial orientation bias was only evident in HS. HS and LS also had greater levels of trait motor and nonplanning impulsivity and heightened impulsive choice on the delay discounting task compared with NS, while heightened trait attentional impulsivity was only found in HS. In contrast, in HD, nicotine withdrawal was associated with no attentional bias but heightened reflection impulsivity, poorer inhibitory control and significantly lower levels of impulsive choice relative to satiated smokers. Trait and behavioral impulsivity were not related to the extent of attentional bias to smoking-related cues at any stage of attention, level of nicotine dependency or state of deprivation. Findings have both clinical and theoretical implications, highlighting the unique and independent roles impulsivity and attentional bias may play at different stages of the nicotine addiction cycle.
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Affiliation(s)
| | - Therese E Fozard
- School of Humanities and Social Sciences, Psychology, Leeds Beckett University
| | - Danielle L Selby
- School of Humanities and Social Sciences, Psychology, Leeds Beckett University
| | - Amanda A Harrison
- Faculty of Medicine & Health, School of Psychology, University of Leeds, Leeds, United Kingdom
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Hellmich IM, Krüsemann EJZ, van der Hart JRH, Smeets PAM, Talhout R, Boesveldt S. Context matters: Neural processing of food-flavored e-cigarettes and the influence of smoking. Biol Psychol 2024; 186:108754. [PMID: 38253167 DOI: 10.1016/j.biopsycho.2024.108754] [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: 09/06/2023] [Revised: 12/14/2023] [Accepted: 01/17/2024] [Indexed: 01/24/2024]
Abstract
E-cigarettes are harmful, addictive, and popular. In e-cigarettes, nicotine is often paired with food-flavors. How this pairing of nicotine and food cues influences neural processing warrants investigation, as in smokers, both types of cues activate similar brain regions. Additionally, while most e-cigarettes are sweet, savory e-cigarettes are seemingly absent, although savory flavors are commonly liked in food. To understand how smoking status and type of flavor modulate reactions to food-flavored e-cigarettes, in comparison to actual food, neural and subjective responses to food odors were measured in a 2 (sweet vs. savory odor) x2 (food vs. e-cigarette context) x2 (smokers vs. non-smokers) design in 22 occasional/light smokers and 25 non-smokers. During fMRI scanning, participants were exposed to sweet and savory odors and pictures creating the two contexts. Liking and wanting were repeatedly measured on a 100-unit visual-analogue-scale. Results show that sweet e-cigarettes were liked (Δ = 14.2 ± 1.7) and wanted (Δ = 39.5 ± 3.1) more than savory e-cigarettes, and their cues activated the anterior cingulate more (cluster-level qFDR = 0.003). Further, we observed context-dependent variations in insula response to odors (cluster-level qFDR = 0.023, and = 0.030). Savory odors in an e-cigarette context were wanted less than the same odors in a food-context (Δ = 32.8 ± 3.1). Smokers and non-smokers reacted similarly to flavored product cues. Our results indicate that the principles of flavor preference in food cannot directly be applied to e-cigarettes and that it is challenging to design sweet and savory e-cigarettes to appeal to smokers only.
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Affiliation(s)
- Ina M Hellmich
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands; Division of Human Nutrition and Health, Wageningen University, Wageningen, the Netherlands
| | - Erna J Z Krüsemann
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands; Division of Human Nutrition and Health, Wageningen University, Wageningen, the Netherlands
| | - Joris R H van der Hart
- Division of Human Nutrition and Health, Wageningen University, Wageningen, the Netherlands
| | - Paul A M Smeets
- Division of Human Nutrition and Health, Wageningen University, Wageningen, the Netherlands
| | - Reinskje Talhout
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Sanne Boesveldt
- Division of Human Nutrition and Health, Wageningen University, Wageningen, the Netherlands.
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Boynton MH, Sanzo N, Brothers W, Kresovich A, Sutfin EL, Sheeran P, Noar SM. Perceived effectiveness of objective elements of vaping prevention messages among adolescents. Tob Control 2023; 32:e228-e235. [PMID: 35534230 PMCID: PMC9643679 DOI: 10.1136/tobaccocontrol-2021-057151] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/30/2022] [Indexed: 01/19/2023]
Abstract
INTRODUCTION In recent years, vaping prevention campaigns have proliferated in response to a surge of e-cigarette use among adolescents in the USA. To date, the research literature has provided minimal guidance as to what vaping prevention message elements have the greatest potential for discouraging vaping, are ineffective or have unintended negative effects. The purpose of the current study was to identify and test a large set of vaping prevention ads used by federal, state, local and non-governmental agencies, examining how objectively coded message elements of vaping prevention messages might affect youth. METHODS A convenience sample of adolescents (N=1501) completed an online survey with each participant rating seven randomly selected vaping prevention ads from a pool of 220 ads on perceived message effectiveness (PME) and vaping appeal. Ads were coded on 37 objective elements in three message categories: themes, imagery and other features. Analyses examined how objective elements predicted PME. RESULTS Addiction, chemicals, negative health symptoms and effects, and cigarette comparison themes were associated with higher PME, as were graphic images and warning symbols. Industry targeting, environmental impact, flavour themes, images of food and people's faces were associated with lower PME, as were hashtags, statistics and first-person language or the word 'teen'. Most elements were not associated with appeal, but ads with a flavour theme were associated with increased vaping appeal. CONCLUSION Promising vaping prevention messages focus on the adverse consequences of vaping, use negative imagery and avoid speaking for teens using their vernacular or perspective.
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Affiliation(s)
- Marcella H Boynton
- Division of General Medicine and Clinical Epidemiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
- NC TraCS Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Nora Sanzo
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Whitney Brothers
- Hussman School of Journalism and Media, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Alex Kresovich
- Hussman School of Journalism and Media, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Erin L Sutfin
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Paschal Sheeran
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Seth M Noar
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Hussman School of Journalism and Media, University of North Carolina, Chapel Hill, North Carolina, USA
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Clausen B, Rinck M, Nizio P, Matoska CT, Zappi C, Smits JAJ, Gallagher MW, Zvolensky MJ, Garey L. Study protocol for approach bias retraining for nicotine addiction among dual combustible and electronic cigarette users. Contemp Clin Trials 2023; 128:107145. [PMID: 36905980 DOI: 10.1016/j.cct.2023.107145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 03/05/2023] [Accepted: 03/06/2023] [Indexed: 03/13/2023]
Abstract
BACKGROUND Electronic cigarette (ECIG) use has become a popular method for nicotine delivery. Combustible cigarette (CC) cessation or reduction are the primary reasons for ECIG uptake among adults. Yet, most CC smokers who initiate ECIG use do not fully transition from CC to ECIG, despite intending to quit CC completely. Retraining approach bias, or the approach action tendency toward stimuli related to the substance of interest, has been effective in alcohol and CC use treatments. However, approach bias retraining for both CC and (ECIG) users has not been explored. Therefore, the objective of the study is to evaluate the initial efficacy of approach bias retraining among dual CC and ECIG users. METHODS Eligible dual CC/ECIG using adults (N = 90) will complete a phone-screener, baseline assessment, 4 treatment sessions over 2 weeks, ecological momentary assessments (EMAs) post-intervention, and follow-ups at 4- and 6-week post-intervention. Participants will be assigned to one of three conditions at baseline: (1) CC + ECIG retraining; (2) CC only retraining; and (3) sham retraining. Participants will engage in a self-guided quit attempt to abstain from all nicotine products starting at treatment session 4. CONCLUSIONS The study may lead to a more effective treatment for at-risk nicotine users while simultaneously isolating explanatory mechanisms. The findings should guide advances in the theoretical conceptualization of nicotine addiction for dual users and mechanisms involved in maintaining and abstaining from CC and ECIG, and provide initial effect size data for a brief intervention, thus providing necessary data for a large-scale follow-up trial. Clinical Trials ID: NCT05306158.
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Affiliation(s)
- Bryce Clausen
- Department of Psychology, University of Houston, Houston, TX, United States of America
| | - Mike Rinck
- Behavioral Science Institute, Radboud University, Nijmegen, the Netherlands
| | - Pamella Nizio
- Department of Psychology, University of Houston, Houston, TX, United States of America; HEALTH Institute, University of Houston, Houston, TX, United States of America
| | - Cameron T Matoska
- Department of Psychology, University of Houston, Houston, TX, United States of America
| | - Christopher Zappi
- Department of Psychology, University of Houston, Houston, TX, United States of America
| | - Jasper A J Smits
- Department of Psychology, University of Texas at Austin, Austin, TX, United States of America
| | - Matthew W Gallagher
- Department of Psychology, University of Houston, Houston, TX, United States of America
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, TX, United States of America; HEALTH Institute, University of Houston, Houston, TX, United States of America; Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Lorra Garey
- Department of Psychology, University of Houston, Houston, TX, United States of America.
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Ng G, Attwells S, Zawertailo L. The development and validation of an electronic nicotine delivery system (ENDS) image cue stimulus set. Drug Alcohol Depend 2022; 236:109496. [PMID: 35605534 DOI: 10.1016/j.drugalcdep.2022.109496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 05/07/2022] [Accepted: 05/10/2022] [Indexed: 11/18/2022]
Abstract
RATIONALE Responsiveness to drug-related cues assesses drug reward in research studies. There are currently no validated visual image cues related to electronic nicotine delivery systems (ENDS), thus, this study aimed to develop and validate affective ENDS image cues. METHODS ENDS users and non-vaping individuals in the United States and Canada were recruited via Amazon MTurk. A total of 120 ENDS-related images and 56 neutral images, matched for visual similarity, were assessed. These images were either selected from public databases or were photographed by study staff. Closely adhering to the International Affective Picture System procedure, each participant rated 66 images one-by-one on dimensions of valence, arousal, dominance, and desire-to-vape where higher scores indicated greater feelings of happiness, excitement, loss of control, and desire to vape. RESULTS After excluding patterned responses, the data from 926 participants (610 ENDS users, and 316 non-vaping controls) were analyzed. When viewing ENDS-related images, desire-to-vape scores were correlated with valence (r = 0.55, p < 0.0005), arousal (r = 0.72, p < 0.0005), and dominance (r = 0.58, p < 0.0005) scores. Images that elicited greater desires to vape also elicited greater feelings of happiness and excitement, but less perceived control. Correlations between arousal and valence (r = 0.42, p < 0.0005) and dominance (r = 0.71, p < 0.0005) suggest that images that increased feelings of excitement also increased happiness and decreased perceived control. CONCLUSIONS Correlational findings of the affective ENDS-related images were similar to those of previous studies validating collections of tobacco and alcohol picture cues, supporting the future use of these stimuli in ENDS research.
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Affiliation(s)
- Ginnie Ng
- Department of Pharmacology and Toxicology, University of Toronto, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada; Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, Ontario M6J 1H4, Canada
| | - Sophia Attwells
- Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, Ontario M6J 1H4, Canada
| | - Laurie Zawertailo
- Department of Pharmacology and Toxicology, University of Toronto, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada; Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, Ontario M6J 1H4, Canada.
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Fitzpatrick CL, Kim HS, Sears CR, McGrath DS. Attentional Bias in Non-Smoking Electronic Cigarette Users: An Eye-Tracking Study. Nicotine Tob Res 2022; 24:1439-1447. [PMID: 35443034 DOI: 10.1093/ntr/ntac112] [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: 08/08/2021] [Revised: 02/09/2022] [Accepted: 04/19/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION This study examined attentional bias (AB) to e-cigarette cues among a sample of non-smoking daily e-cigarette users (n = 27), non-smoking occasional e-cigarette users (n = 32), and control participants (n = 61) who did not smoke or use e-cigarettes. The possibility that e-cigarette users develop a transference of cues to traditional cigarettes was also examined. METHODS AB was assessed using a free-viewing eye-gaze tracking methodology, in which participants viewed 180 pairs of images for 4 seconds (e-cigarette and neutral image, e-cigarette and smoking image, smoking and neutral image). RESULTS Daily and occasional e-cigarette users attended to pairs of e-cigarette and neutral images equally, whereas non-users attended to neutral images significantly more than e-cigarette images. All three groups attended to e-cigarette images significantly more than smoking images, with significantly larger biases for e-cigarette users. There were no between-group differences in attention to pairs of smoking and neutral images. A moderation analysis indicated that for occasional users but not daily users, years of vaping reduced the bias toward neutral images over smoking images. CONCLUSIONS Taken together, the results indicate that e-cigarette users exhibit heighted attention to e-cigarettes relative to non-users, which may have implications as to how they react to e-cigarette cues in real-world settings. AB for e-cigarettes did not transfer to traditional cigarette cues, which indicates that further research is required to identify the mechanisms involved in the migration of e-cigarettes to traditional cigarettes. IMPLICATIONS This study is the first attempt to examine attentional biases for e-cigarette cues among non-smoking current e-cigarette users using eye-gaze tracking. The results contribute to the growing literature on the correlates of problematic e-cigarette use and indicate that daily and occasional e-cigarette use is associated with attentional biases for e-cigarettes. The existence of attentional biases in e-cigarette users may help to explain the high rate of failure to quit e-cigarettes and provides support for the utility of attentional bias modification in the treatment of problematic e-cigarette use.
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Affiliation(s)
| | - Hyoun S Kim
- Ryerson University, Toronto, Ontario, Canada
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Valsecchi M, Codispoti M. Eye tracking applied to tobacco smoking: current directions and future perspectives. J Eye Mov Res 2022; 15:10.16910/jemr.15.1.2. [PMID: 35440972 PMCID: PMC9014256 DOI: 10.16910/jemr.15.1.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Over the years the general awareness of the health costs associated with tobacco smoking has motivated scientists to apply the measurement of eye movements to this form of addiction. On one hand they have investigated whether smokers attend and look preferentially at smoking related scenes and objects. In parallel, on the other hand eye tracking has been used to test how smokers and nonsmokers interact with the different types of health warning that policymakers have mandated in tobacco advertisements and packages. Here we provide an overview of the main findings from the different lines of research, such as the evidence related to the attentional bias for smoking cues in smokers and the evidence that graphic warning labels and plain packages measurably increase the salience of the warning labels. We point to some open questions, such as the conditions that determine whether heavy smokers exhibit a tendency to actively avoid looking at graphic warning labels. Finally we argue that the research applied to gaze exploration of warning labels would benefit from a more widespread use of the more naturalistic testing conditions (e.g. mobile eye tracking or virtual reality) that have been introduced to study the smokers' attentional bias for tobacco-related objects when freely exploring the surrounding environment.
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Keijsers M, Vega-Corredor MC, Hoermann S, Tomintz M. Cue Reactivity to Electronic Cigarettes: A Systematic Review. Subst Abuse 2022; 16:11782218221114971. [PMID: 35923180 PMCID: PMC9340385 DOI: 10.1177/11782218221114971] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 07/02/2022] [Indexed: 04/20/2023]
Abstract
Cue reactivity to Electronic Nicotine Delivery Systems (ENDS) has been studied by several researchers, yet the variability in user types (smokers, former smokers, dual users, exclusive ENDS users) and ENDS designs used between the studies may have undermined consistent results. This systematic review aims to give an overview of ENDS cue reactivity and how smoking status and device design may moderate this. A systematic search of Medline, Embase, Web of Science, PubMed and Cochrane was completed. All studies which reported findings on reactivity to ENDS cues in the form of craving or desire for ENDS or cigarettes, attention to cue, delay of gratification or economic decisions were included. Exclusion criteria were non-human subjects, non-adult participants or participants with comorbidities. Literature selection was carried out by 2 independent reviewers. The risk of bias and study quality were assessed using tools developed by Cochrane, BMJ and NHLBI. A total of 711 papers were screened and 22 studies were included in the current review. Study design, research question(s), population of interest, number of participants, dependent variable(s), ENDS generation and nicotine content used and study results were extracted. ENDS cues reliably induced ENDS craving, with no clear moderation by smoking status and no apparent moderation by device generation. In about half of the studies, ENDS cues induced craving for conventional cigarettes. Most studies used a smoker sample, thus limiting the conclusions that can be drawn on the moderation of cue reactivity by smoking status. The quality varied among studies but comparing the findings against the outcomes of only high-quality studies did not yield any different results. The results of this review support the notion of cue reactivity to ENDS, identifies gaps in current research on different user types and implies that ENDS design iterations have little impact on cue reactivity.
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Affiliation(s)
- Merel Keijsers
- Human Interface Technology Laboratory,
University of Canterbury, Christchurch, New Zealand
| | | | - Simon Hoermann
- School of Product Design, University of
Canterbury, Christchurch, New Zealand
- Simon Hoermann, School of Product Design,
University of Canterbury, Private Bag 4800, Christchurch 8140, New Zealand.
| | - Melanie Tomintz
- Geospatial Research Institute,
University of Canterbury, Christchurch, New Zealand
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Study protocol: evaluation of the addictive potential of e-cigarettes (EVAPE): neurobiological, sociological, and epidemiological perspectives. BMC Psychol 2021; 9:181. [PMID: 34794514 PMCID: PMC8600891 DOI: 10.1186/s40359-021-00682-8] [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: 09/29/2021] [Accepted: 11/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tobacco use is the largest preventable cause of diseases and deaths; reducing tobacco intake is, therefore, an urgent public health goal. In recent years, e-cigarettes have been marketed as a 'healthier' alternative to tobacco smoking, whilst product features have evolved tremendously in the meantime. A lively scientific debate has developed regarding the potential benefits and risks of e-cigarettes although, surprisingly, there are few studies investigating the addictive potential of nicotine-containing e-cigarettes. The present work comprises three work packages investigating the addictive potential of e-cigarettes from different perspectives: (1) the neurobiological addictive potential of e-cigarettes; (2) the experience and perception of dependence symptoms among users of e-cigarettes in a social context; and (3) the epidemiological perspective regarding factors influencing the potential for dependence. METHODS Work package I: the neurobiological study will investigate the key elements of addiction in e-cigarettes compared to tobacco cigarettes using neurobiological and neuropsychological correlates associated with craving, incentive motivation, cue reactivity and attentional bias. Work package II: the sociological study part examines self-reports on the experience and perception of dependence symptoms in a social context, using focus group interviews and the analysis of posts in online discussion forums on e-cigarettes. Work package III: the epidemiological study part focuses on tolerance development and the role of psychosocial and product factors by analyzing longitudinal data from the International Tobacco Control Policy Evaluation Project (ITC). DISCUSSION The present study offers a chosen mix of three methodological approaches, thereby comprehensively examining core symptoms of positive and negative reinforcement in addiction. Whether e-cigarettes are as reinforcing and addictive as combustible tobacco cigarettes is an important public health issue with implications for prevention and treatment programs. TRIAL REGISTRATION Work package I: Registered at clinicaltrials.gov/ct2/show/NCT04772014. Work package II: Registered at OSF Registries: https://osf.io/dxgya (2021, January 14).
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Abstract
Objectives In this study, we examined whether visual exposure to the heated tobacco product (HTP) IQOS, which was authorized for sale by the US Food and Drug Administration in 2019, acts as a cue to increase cigarette craving and smoking behavior among smokers. Methods Young adult smokers (N = 105) were randomly assigned to view a video depicting use of either IQOS or bottled water. Main outcomes were changes in cigarette and e-cigarette desire and latency to smoke between the groups. We also examined participants' attitudes about the actors using IQOS and drinking water in the videos. Results Exposure to the use of IQOS acutely increased observers' ratings of smoking urge and desire for a cigarette and an e-cigarette. The IQOS cue, compared with the water cue, also produced a marginally significant shorter latency to smoke. Participants perceived actors as less likeable and friendly when using IQOS than when drinking water. Conclusions Results showed that exposure to IQOS produced smoking urge and behavior in young adult smokers, implicating IQOS use as a smoking and vaping cue. As HTPs gain popularity, product impact on passive observers should be included in their risk-benefit profile.
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Maurage P, Bollen Z, Masson N, D'Hondt F. Eye Tracking Studies Exploring Cognitive and Affective Processes among Alcohol Drinkers: a Systematic Review and Perspectives. Neuropsychol Rev 2020; 31:167-201. [PMID: 33099714 DOI: 10.1007/s11065-020-09458-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 09/23/2020] [Indexed: 11/28/2022]
Abstract
Acute alcohol intoxication and alcohol use disorders are characterized by a wide range of psychological and cerebral impairments, which have been widely explored using neuropsychological and neuroscientific techniques. Eye tracking has recently emerged as an innovative tool to renew this exploration, as eye movements offer complementary information on the processes underlying perceptive, attentional, memory or executive abilities. Building on this, the present systematic and critical literature review provides a comprehensive overview of eye tracking studies exploring cognitive and affective processes among alcohol drinkers. Using PRISMA guidelines, 36 papers that measured eye movements among alcohol drinkers were extracted from three databases (PsycINFO, PubMed, Scopus). They were assessed for methodological quality using a standardized procedure, and categorized based on the main cognitive function measured, namely perceptive abilities, attentional bias, executive function, emotion and prevention/intervention. Eye tracking indexes showed that alcohol-related disorders are related to: (1) a stable pattern of basic eye movement impairments, particularly during alcohol intoxication; (2) a robust attentional bias, indexed by increased dwell times for alcohol-related stimuli; (3) a reduced inhibitory control on saccadic movements; (4) an increased pupillary reactivity to visual stimuli, regardless of their emotional content; (5) a limited visual attention to prevention messages. Perspectives for future research are proposed, notably encouraging the exploration of eye movements in severe alcohol use disorders and the establishment of methodological gold standards for eye tracking measures in this field.
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Affiliation(s)
- Pierre Maurage
- Louvain Experimental Psychopathology research group (LEP), Psychological Sciences Research Institute, UCLouvain, Louvain-la-Neuve, Belgium.
| | - Zoé Bollen
- Louvain Experimental Psychopathology research group (LEP), Psychological Sciences Research Institute, UCLouvain, Louvain-la-Neuve, Belgium
| | - Nicolas Masson
- Numerical Cognition Group, Psychological Sciences Research Institute and Neuroscience Institute, UCLouvain, Louvain-la-Neuve, Belgium.,Institute of Cognitive Science and Assessment (COSA), Department of Behavioural and Cognitive Sciences (DBCS), Faculty of Humanities, Education and Social Sciences (FHSE), University of Luxembourg, Luxembourg, Luxembourg
| | - Fabien D'Hondt
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Université de Lille, Lille, France.,Centre National de Ressources et de Résilience (CN2R), Lille, France
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14
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Mondino M, Lenglos C, Cinti A, Renauld E, Fecteau S. Eye tracking of smoking-related stimuli in tobacco use disorder: A proof-of-concept study combining attention bias modification with alpha-transcranial alternating current stimulation. Drug Alcohol Depend 2020; 214:108152. [PMID: 32645683 DOI: 10.1016/j.drugalcdep.2020.108152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/29/2020] [Accepted: 06/26/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Tobacco use disorder (TUD) is characterized by the presence of an attentional bias (AB) towards smoking-related stimuli. We investigated whether combining an AB modification paradigm (ABM) with transcranial alternating current stimulation (tACS) applied over the dorsolateral prefrontal cortex (DLPFC) reduces the AB towards smoking-related stimuli, as well as craving level and impulsive choices. METHODS In a sham-controlled, crossover preliminary study, 19 subjects with TUD received two stimulation arms: 1) active tACS (10 Hz, 2 mA, 30 min) combined with ABM and 2) sham tACS combined with ABM, in a randomized order, separated by one week. AB towards smoking cues during passive observation of smoking and neutral cues was assessed with an eye-tracking device and reactions times at a visual-probe task. Craving level was measured with the Questionnaire of Smoking Urges. Impulsive choices were assessed with the delay discounting task. RESULTS Active tACS combined with ABM reduced the amount of time spent looking at smoking-related pictures (p = 0.03), prevented the increase of self-reported desire to smoke (p = 0.026), and reduced the proportion of impulsive choices (p = 0.049), compared to sham tACS combined with ABM. No significant effects were reported on other craving dimensions and on AB based on reaction times. CONCLUSIONS These preliminary findings suggest that combining tACS with ABM may help smokers who wish to quit by reducing the desire to smoke, attention to smoking-cues, and impulsive decision-making.
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Affiliation(s)
- Marine Mondino
- Department of Psychiatry and Neurosciences, Medical School, Université Laval, CERVO Brain Research Center, Centre intégré universitaire en santé et services sociaux de la Capitale-Nationale, 2325 rue de l'Université, Quebec City, QC, G1V 0A6, Canada
| | - Christophe Lenglos
- Department of Psychiatry and Neurosciences, Medical School, Université Laval, CERVO Brain Research Center, Centre intégré universitaire en santé et services sociaux de la Capitale-Nationale, 2325 rue de l'Université, Quebec City, QC, G1V 0A6, Canada
| | - Alessandra Cinti
- Department of Psychiatry and Neurosciences, Medical School, Université Laval, CERVO Brain Research Center, Centre intégré universitaire en santé et services sociaux de la Capitale-Nationale, 2325 rue de l'Université, Quebec City, QC, G1V 0A6, Canada
| | - Emmanuelle Renauld
- Department of Psychiatry and Neurosciences, Medical School, Université Laval, CERVO Brain Research Center, Centre intégré universitaire en santé et services sociaux de la Capitale-Nationale, 2325 rue de l'Université, Quebec City, QC, G1V 0A6, Canada
| | - Shirley Fecteau
- Department of Psychiatry and Neurosciences, Medical School, Université Laval, CERVO Brain Research Center, Centre intégré universitaire en santé et services sociaux de la Capitale-Nationale, 2325 rue de l'Université, Quebec City, QC, G1V 0A6, Canada.
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Vena A, Miloslavich K, Howe M, Cao D, King AC. Exposure to JUUL use: cue reactivity effects in young adult current and former smokers. Tob Control 2020; 30:tobaccocontrol-2019-055553. [PMID: 32447316 DOI: 10.1136/tobaccocontrol-2019-055553] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 04/17/2020] [Accepted: 04/21/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Exposure to the use of first, second and third generations of electronic cigarettes (e-cigarettes) elicits the desire to vape and smoke among observers, as well as facilitates smoking behaviour. Given the rapid rise in the popularity of the pod mod JUUL, we examined whether observing the use of this device would elicit similar responses in smokers. Exploratory analyses were also conducted to determine whether JUUL can act as a smoking cue for former smokers. METHODS The sample consisted of 82 young adult participants (62 current smokers and 20 former smokers approximately 1 year smoke free). The study examined their response to observing use of bottled water (control cue) and JUUL (active cue) in a controlled laboratory paradigm. Both cues were delivered by a trained study confederate under the guise of a social interaction task, and participants completed mood and desire and urge surveys precue and postcue exposures. RESULTS In current smokers, exposure to the JUUL cue increased smoking urge and desire for a cigarette, mod/vape pen and JUUL, and two-thirds chose to smoke in the behavioural analogue task. In former smokers, the JUUL cue evoked modest and transient increases in desire for a cigarette and JUUL. CONCLUSIONS The use of JUUL affects the user and elicits responses in observers; this study is the first to demonstrate that exposure to JUUL use may act as a smoking cue and exposure to JUUL use may affect tobacco control efforts.
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Affiliation(s)
- Ashley Vena
- Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, Illinois, USA
| | - Krista Miloslavich
- Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, Illinois, USA
| | - Meghan Howe
- Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, Illinois, USA
| | - Dingcai Cao
- Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Andrea C King
- Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, Illinois, USA
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Adjoian T, Dannefer R, Farley SM. Density of outdoor advertising of consumable products in NYC by neighborhood poverty level. BMC Public Health 2019; 19:1479. [PMID: 31744491 PMCID: PMC6864992 DOI: 10.1186/s12889-019-7821-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 10/21/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND To determine if outdoor advertising density for non-alcoholic drinks, food, tobacco products, and alcohol, is associated with neighborhood poverty or other Census-level characteristics in New York City (NYC). METHODS From June - July of 2015, photographs were taken of all street-level, stationary outdoor advertising (posters, stickers, decals, etc.) for consumable products in a sample of 953 NYC retail-dense street segments. Density of product images was analyzed by neighborhood poverty level and other characteristics using multivariate negative-binomial regression. RESULTS A total of 16,305 discrete advertisements displaying 50,673 product images were photographed. Total product image prevalence relative to retail density was not significantly higher in high- vs. low-poverty neighborhoods, as hypothesized (OR: 1.31; 95% CI: 0.98, 1.77). However, total product image prevalence was higher in neighborhoods with a higher percentage of Black residents (OR: 1.08; 95% CI: 1.04, 1.12), and for sugary drinks in areas with a higher percentage of adults with CONCLUSIONS Product images were abundant throughout NYC's retail-dense areas, with marginally greater prevalence by some Census-level demographics, irrespective of the content displayed.
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Affiliation(s)
- Tamar Adjoian
- New York City Department of Health and Mental Hygiene, Bureau of Chronic Disease Prevention, 42-09 28th Street, Long Island City, NY 11101 USA
| | - Rachel Dannefer
- New York City Department of Health and Mental Hygiene, Bureau of Harlem Neighborhood Health at the East Harlem Neighborhood Health Action Center, 161-169 East 110th Street, New York, NY 10029 USA
| | - Shannon M. Farley
- New York City Department of Health and Mental Hygiene, Bureau of Harlem Neighborhood Health at the East Harlem Neighborhood Health Action Center, 161-169 East 110th Street, New York, NY 10029 USA
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Lochbuehler K, Wileyto EP, Mercincavage M, Souprountchouk V, Burdge JZ, Tang KZ, Cappella JN, Strasser AA. Temporal Effects of Message Congruency on Attention to and Recall of Pictorial Health Warning Labels on Cigarette Packages. Nicotine Tob Res 2019; 21:879-886. [PMID: 29917125 DOI: 10.1093/ntr/nty124] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 06/14/2018] [Indexed: 11/14/2022]
Abstract
OBJECTIVES Recent research has shown that message congruency is beneficial to recall of pictorial health warning label (PWL) content after initial exposure. Despite less attention to the text warning, smokers exposed to congruent PWLs were more likely to recall the text and the message. This study aimed to replicate these findings and to examine whether congruency also affects recall after multiple exposures over time. METHODS A total of 320 daily smokers (39.7% female; cigarettes/day: M = 15.31, SD = 7.15) were randomized to one congruent or incongruent PWL and attended 4 laboratory sessions over 10 days. During each session, eye movements were recorded while viewing the PWL and open-ended recall of label content was assessed after exposure. RESULTS Smokers who were exposed to a congruent PWL were more likely to recall the text (p = .01) and the message (p = .02) and less likely to recall the image (p = .003) of the PWL after initial exposure. By day 4, incongruent PWLs were recalled equally well as congruent PWLs. Independent of condition, image recall was initially high and remained high whereas text and message recall was relatively low initially but increased over time. It was not until day 7 that about 80% of text and message recall was observed. CONCLUSIONS Even when exposed to the same PWL over time, smokers require multiple exposures to recall the text and the message of a PWL. More research on the effects of congruency in the natural environment, where smokers are exposed to multiple PWLs, is needed. IMPLICATIONS The findings of this study, and of previous work showing that message congruency in PWLs is beneficial to initial recall of PWL content, could potentially help to address legal challenges regarding the implementation of PWLs in the United States. Factually correct text warnings have been uncontested on US cigarettes packages since 1966. Congruent PWLs simply provide a means to visually support the same information as the existing text using a medium that better garners attention to the health information. Investigating and understanding longer-term effects of congruency are important and can empirically inform future warning label development, both in the United States via the Family Smoking Prevention and Tobacco Control Act, and via other governing bodies.
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Affiliation(s)
- Kirsten Lochbuehler
- Tobacco Center of Regulatory Science (TCORS), University of Pennsylvania, Philadelphia, PA.,Department of Psychiatry, Center for Interdisciplinary Research on Nicotine Addiction, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - E Paul Wileyto
- Department of Psychiatry, Center for Interdisciplinary Research on Nicotine Addiction, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Melissa Mercincavage
- Tobacco Center of Regulatory Science (TCORS), University of Pennsylvania, Philadelphia, PA.,Department of Psychiatry, Center for Interdisciplinary Research on Nicotine Addiction, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Valentina Souprountchouk
- Department of Psychiatry, Center for Interdisciplinary Research on Nicotine Addiction, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jordan Z Burdge
- Department of Psychiatry, Center for Interdisciplinary Research on Nicotine Addiction, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Kathy Z Tang
- Department of Psychiatry, Center for Interdisciplinary Research on Nicotine Addiction, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Joseph N Cappella
- Tobacco Center of Regulatory Science (TCORS), University of Pennsylvania, Philadelphia, PA.,Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA
| | - Andrew A Strasser
- Tobacco Center of Regulatory Science (TCORS), University of Pennsylvania, Philadelphia, PA.,Department of Psychiatry, Center for Interdisciplinary Research on Nicotine Addiction, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Jackson SE, Beard E, Michie S, Shahab L, Raupach T, West R, Brown J. Are smokers who are regularly exposed to e-cigarette use by others more or less motivated to stop or to make a quit attempt? A cross-sectional and longitudinal survey. BMC Med 2018; 16:206. [PMID: 30424771 PMCID: PMC6234626 DOI: 10.1186/s12916-018-1195-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 10/18/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Concerns have been raised that observing other people using e-cigarettes may undermine motivation to quit by renormalising smoking. This study aimed to explore associations between regular exposure to other people's e-cigarette use and motivation to stop smoking and quit attempts in smokers. METHODS Data were from 12,787 smokers in England who participated in the Smoking Toolkit Study between November 2014 and May 2018. At baseline, respondents were asked whether anyone other than themselves regularly used an e-cigarette in their presence, whether they had made a quit attempt in the past year and how motivated they were to stop. Data at 6-month follow-up were available for 1580 respondents, who reported on whether they had attempted to quit in the past 6 months. RESULTS Smokers who reported regular exposure to e-cigarette use by others were more likely than those who did not to have tried to stop smoking in the past year (32.3% vs. 26.8%; unadjusted RR 1.21, 95% CI 1.11-1.31) and have high motivation to quit (16.6% vs. 14.2%; unadjusted RR 1.17, 95% CI 1.05-1.30) but were not significantly more or less likely to make a quit attempt over the subsequent 6 months (34.4% vs. 31.3%; unadjusted RR 1.10, 95% CI 0.88-1.38). In models that adjusted for participants' own current e-cigarette use and unadjusted and adjusted models excluding current e-cigarette users from the sample, there were no significant associations between exposure to e-cigarette use by others and past quit attempts (RR 0.97-1.00), high current motivation to quit (RR 0.97-1.00) or prospective quit attempts (RR 0.94-1.12). In contrast, exposure to use of cigarettes was associated with low motivation to quit even after adjustment (RR 0.89) but not with quit attempts. Participants' own use of e-cigarette was strongly associated with high motivation to quit (RR 1.95) and past quit attempts (RR 2.14) and appeared to account for the bivariate associations with reported exposure to e-cigarettes. CONCLUSION Smokers who report regular exposure to other people using e-cigarettes are more likely to report past quit attempts and high current motivation to quit, but there does not appear to be an independent association with motivation or quit attempts after adjustment for their own current use of e-cigarettes. In contrast, reported exposure to other people using cigarettes was independently and negatively associated with high motivation.
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Affiliation(s)
- Sarah E Jackson
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, UK.
| | - Emma Beard
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, UK
| | - Susan Michie
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Lion Shahab
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, UK
| | - Tobias Raupach
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Department for Cardiology and Pneumology, Göttingen University Medical Centre, Göttingen, Germany
| | - Robert West
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, UK
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, UK
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Mercincavage M, Burdge J, Lochbuehler K, Souprountchouk V, McCullough AA, Strasser AA. Visual Attention Patterns Differ by Pictorial Health Warning Label Features. TOB REGUL SCI 2018; 4:8-17. [PMID: 30775412 PMCID: PMC6374036 DOI: 10.18001/trs.4.6.2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES In this study, we sought to determine how smokers allocate their attention when viewing the 9 cigarette pictorial warning labels (PWLs) proposed by the Food and Drug Administration (FDA), and identify PWL attributes associated with increased attention. METHODS Using eye-tracking data from an exploratory within-subject study, we examined smokers' attention (latency, latency duration, and dwell time) to areas of interest (image vs textual warning) for each PWL among 95 daily, non-treatment-seeking smokers (62.1% male, 48.4% white, mean [SD] age = 32.98 [10.14], mean [SD] cigarettes/day = 15.51 [8.43]). We also compared attention measures by PWL message congruency, textual warning location, and participant rankings of effectiveness. RESULTS Attention measures differed significantly among PWLs (p s < .001) and by features and self-reported effectiveness rankings (p s < .001 - .039). Congruent PWLs, those displaying text across the warning label, and those ranked most effective were associated with sustained attention to image, whereas incongruent PWLs, those displaying left text, and those ranked least effective, were associated with faster and sustained attention to text. CONCLUSIONS Smokers allocated their attention differently across PWLs. Formats and participant effectiveness rankings of PWLs were associated with visual attention patterns, suggesting the importance of these features to the design of potential future PWLs.
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Affiliation(s)
- Melissa Mercincavage
- Department of Psychiatry, University of Pennsylvania Tobacco Center of Regulatory Science and Center for Interdisciplinary Research on Nicotine Addiction [CIRNA], University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Jordan Burdge
- Department of Psychiatry, CIRNA, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Kirsten Lochbuehler
- Department of Psychiatry, University of Pennsylvania Tobacco Center of Regulatory Science and CIRNA, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Valentina Souprountchouk
- Department of Psychiatry, CIRNA, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Alexandra A McCullough
- Department of Psychiatry, CIRNA, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Andrew A Strasser
- Department of Psychiatry, University of Pennsylvania Tobacco Center of Regulatory Science and CIRNA, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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