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Consumer experiences of long-term oral nicotine replacement therapy and related health information-seeking: A qualitative study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 110:103897. [PMID: 36323188 DOI: 10.1016/j.drugpo.2022.103897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/20/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Nicotine replacement therapy (NRT) delivers a therapeutic dose of nicotine to support smoking cessation, and is currently approved for short-term use (typically ≤12 weeks). Yet, research on real-world over-the-counter NRT use indicates that some consumers continue to use these products long-term. This study sought to understand consumers' experiences of long-term oral NRT use, including self-reported reasons for continued use, and health information-seeking regarding long-term use. METHODS In-depth semi-structured telephone interviews were conducted between May and June 2021 with 21 current and former NRT consumers aged ≥18 years from across Australia, with oral NRT use of ≥1 year. Interviews were thematically analysed using the Framework Method. RESULTS The majority of participants reported achieving NRT-assisted smoking cessation and related health benefits (e.g. respiratory health, improved physical appearance). However, nearly all participants reported experiencing addiction to oral NRT, with many attributing their long-term use to dependence on these products. Participants reported low engagement with NRT health information sources; just half reported consulting with a health professional regarding their long-term NRT use, and some reported negative experiences when health professional advice was sought (e.g. perceptions of not being taken seriously, perceived lack of health professional knowledge). Less than half of participants accurately identified the duration of use recommended in NRT consumer medicine information, and some reported actively dismissing this information. CONCLUSION Findings highlight consumers' perceived benefits of continued NRT use whilst also identifying two key concerns - the addictive potential of oral NRT, and low health information-seeking and health professional engagement regarding long-term use. While oral NRT is indisputably safer than tobacco smoking, public health strategies to raise consumer and health professional awareness about the safe use of NRT, which acknowledge the current evidence gap regarding safety and efficacy of long-term use, are needed to maximise their benefits as a harm reduction strategy for smoking cessation.
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Lund L, Bast LS, Rubæk M, Andersen S. Exploring factors associated with smokeless tobacco use among young people: A systematic scoping review. Drug Alcohol Depend 2022; 240:109627. [PMID: 36167002 DOI: 10.1016/j.drugalcdep.2022.109627] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/24/2022] [Accepted: 09/05/2022] [Indexed: 01/06/2023]
Abstract
PURPOSE While smoking is declining among young people, smokeless tobacco use is increasing. Identifying who is using smokeless tobacco and why is essential in preventing smokeless tobacco use. This study aimed to comprehensively explore the factors of young people's use of smokeless tobacco in western countries and identify research gaps. METHODS We conducted a systematic scoping review of studies that examined factors associated with smokeless tobacco use among young people (ages 13-29) from western countries published between January 2011 and September 2021. Searches were conducted in CINAHL, Medline, and Scopus. Studies on adults, total tobacco use (i.e., did not differentiate between tobacco product types), dual and multiple uses of tobacco, and studies on smokeless tobacco cessation programs were excluded. RESULTS A total of 160 studies were included in this scoping review. The studies were primarily undertaken in the US and the Scandinavian countries, and the majority explored smokeless tobacco use without distinguishing between the specific types. Smokeless tobacco users were more likely to be male, non-Hispanic white, engaging in physical activity, and using other substances, including cigarettes and alcohol. The role of friends and family were identified as critical factors that were related to the use of smokeless tobacco. CONCLUSIONS This scoping review suggests that preventative measures against smokeless tobacco use should focus on peer and family members' roles and that these measures may benefit from targeting males. Additional research, including systematic reviews on this area to validate the identified associated factors, would improve the understanding of smokeless tobacco use.
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Affiliation(s)
- Lisbeth Lund
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen, Denmark.
| | - Lotus Sofie Bast
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen, Denmark.
| | - Mette Rubæk
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen, Denmark.
| | - Susan Andersen
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen, Denmark.
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Vaihekoski A, Lagström H, Eloranta S, Bäärs S, Hannula A, Lehvikkö M, Salakari M. Influencing adolescents’ attitudes towards nicotine products: A systematic review. NORDIC STUDIES ON ALCOHOL AND DRUGS 2022; 39:568-584. [PMID: 36284743 PMCID: PMC9549219 DOI: 10.1177/14550725221096908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 04/11/2022] [Indexed: 11/24/2022] Open
Abstract
Background and aim: Use of nicotine can harm adolescents’ brains and
increase risk for future addiction to other drugs. Several international studies
show that an acceptable attitude towards nicotine products increases the
initiation or use of the products. Adolescents have limited or distorted
knowledge about nicotine products. Many of them have a positive image of the
properties and effects of nicotine products, which increases the chances of
smoking or using snus. Yet, we know little about the relationship between youth
nicotine use, youth attitudes towards nicotine products and the interventions to
influence these attitudes. This systematic review synthesised adolescents’
attitudes towards nicotine products and the ways to influence them.
Methods: Systematic searches were carried out from PubMed,
MEDLINE, CINAHL, and MEDIC databases and were targeted to randomised controlled
trial (RCT) studies published in 2010–2021. Results: A total of
seven RCT studies were reviewed with a total population (age range 9–17 years,
adolescents 11–17 years) of 15,974. Findings were classified into four
categories: school-based interventions, tobacco prevention campaigns,
advertisements’ influence on adolescents’ opinions towards nicotine products,
and their responses to cigarette pack warnings. Conclusion: Based
on this systematic literature review, particularly school-based interventions
have an effect on adolescents’ attitudes towards smoking and preventing them
from starting to smoke, when they are targeted before the age of puberty.
School-based interventions should be further implemented and strengthened, as
the school has been shown to have significant potential to support youth’s
health. There is a need for further information about the most effective
interventions in the different age groups and the qualitative studies on the
topic.
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Affiliation(s)
| | - Hanna Lagström
- University of Turku, Turku, Finland; and Turku University Hospital, Turku, Finland
| | - Sini Eloranta
- University of Turku, Turku, Finland; University of Oulu, Oulu, Finland; and Turku University of Applied Science, Turku, Finland
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Lee JGL, Averett PE, Blanchflower T, Gregory KR. Qualitative assessment of a Context of Consumption Framework to inform regulation of cigarette pack design in the U.S. Tob Induc Dis 2018; 16:3. [PMID: 29593883 PMCID: PMC5867908 DOI: 10.18332/tid/82925] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Researchers and regulators need to know how changes to cigarette packages can influence population health. We sought to advance research on the role of cigarette packaging by assessing a theory-informed framework from the fields of design and consumer research. The selected Context of Consumption Framework posits cognitive, affective, and behavioral responses to visual design. To assess the Framework’s potential for guiding research on the visual design of cigarette packaging in the U.S., this study seeks to understand to what extent the Context of Consumption Framework converges with how adult smokers think and talk about cigarette pack designs. METHODS Data for this qualitative study came from six telephone-based focus groups conducted in March 2017. Two groups consisted of lesbian, gay, and bisexual participants; two groups of participants with less than four years college education; one group of LGB and straight identity; and one group the general population. All groups were selected for regional, gender, and racial/ethnic diversity. Participants (n=33) represented all nine U.S. Census divisions. We conducted a deductive qualitative analysis. RESULTS Cigarette package designs captured the participants’ attention, suggested the characteristics of the product, and reflected (or could be leveraged to convey) multiple dimensions of consumer identity. Particular to the affective responses to design, our participants shared that cigarette packaging conveyed how the pack could be used to particular ends, created an emotional response to the designs, complied with normative expectations of a cigarette, elicited interest when designs change, and prompted fascination when unique design characteristics are used. CONCLUSIONS Use of the Context of Consumption Framework for cigarette product packaging design can inform regulatory research on tobacco product packaging. Researchers and regulators should consider multiple cognitive, affective, and behavioral responses to cigarette pack design. ABBREVIATIONS FDA: Food and Drug Administration, FSPTCA: Family Smoking Prevention and Tobacco Control Act of 2009
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Affiliation(s)
- Joseph G L Lee
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, North Carolina, United States
| | - Paige E Averett
- School of Social Work, College of Health and Human Performance, East Carolina University, Greenville, North Carolina, United States
| | - Tiffany Blanchflower
- Department of Interior Design and Merchandising, College of Health and Human Performance, East Carolina University, Greenville, North Carolina, United States
| | - Kyle R Gregory
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, North Carolina, United States
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Abstract
OBJECTIVES Snus use has increased among youth in Norway in recent years and is now more prevalent than smoking. Concurrently, a range of new products and package designs have been introduced to the market. The aim of this study was to explore how youth perceive snus branding and package design, and the role, if any, of snus packaging on perceptions of appeal and harm of snus among youth. PARTICIPANTS Adolescent tobacco users and non-users (N=35) ages 15-17 years. DESIGN We conducted interviews among 6 focus groups (each with 4-7 participants). Participants were shown snus packages with a variety of designs and with different product qualities (flavour additives, slim, regular, white and brown sachets) and group discussions focused on how they perceived packages and products. The focus group discussions were semistructured using a standard guide, and analysed thematically. RESULTS The participants in the focus groups narrated distinct images of snus brands and associated user identities. Package design elements such as shapes, colours, images and fonts were described as guiding these perceptions. Packaging elements and flavour additives were associated with perceptions of product harm. The appeal of flavoured snus products and new types of snus sachets seemed to blend in with these processes, reinforcing positive attitudes and contributing to the creation of particular identities for products and their users. CONCLUSIONS The findings indicate that packaging is vital to consumer's identification with, and differentiation between, snus brands. In view of this, snus branding and packaging can be seen as fulfilling a similar promotional role as advertising messages: generating preferences and appeal.
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Affiliation(s)
- Janne Scheffels
- Department of Drug Policy, Norwegian Institute of Public Health, Oslo, Norway
| | - Ingeborg Lund
- Department of Drug Policy, Norwegian Institute of Public Health, Oslo, Norway
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Ekendahl M, Karlsson P. The credibility of risk information about licit substances: An exploratory study of attitudes among Swedish adults. NORDIC STUDIES ON ALCOHOL AND DRUGS 2017. [DOI: 10.1515/nsad-2015-0039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Aims Providing risk information on licit substances is a central health promotion strategy. There is, however, very little knowledge about public attitudes on this information. In this exploratory study we analyse the extent to which Swedish adults: 1) trust risk information regarding alcohol, cigarettes and wet snuff (“snus”) provided by public authorities, 2) perceive risk information regarding alcohol, cigarettes and snus as consistent, and 3) have received an adequate amount of risk information from public authorities regarding these substances. The aim is also to investigate if certain characteristics among participants are related to their perceptions of such risk information. Methods A questionnaire was mailed to a random sample of individuals aged 18 to 70 (n=1623, 54% response rate). Descriptive statistics and logistic regression techniques were used to process data. Results Participants trusted risk information concerning cigarettes, snus and alcohol provided by public authorities, and reported that they had received an adequate amount of it. Information about cigarettes was seen as more trustworthy and consistent than information about alcohol and snus. The study suggests that attitudes on risk information are substance-specific and associated in complex ways with gender, age, education and experience of own substance use. Conclusion While only a first attempt to map an under-investigated area, our study highlights complexities in how people perceive risk information about licit substances. It also indicates that the general population in Sweden receives what is seen as an adequate amount of knowledge from public authorities, and finds it consistent and trustworthy.
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Geidne S, Beckman L, Edvardsson I, Hulldin J. Prevalence and risk factors of electronic cigarette use among adolescents: Data from four Swedish municipalities. NORDIC STUDIES ON ALCOHOL AND DRUGS 2017. [DOI: 10.1515/nsad-2016-0017] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Aims To assess the prevalence rates and risk factors of electronic cigarette (e-cigarette) use, with special focus on e-cigarettes containing nicotine, among grade 9 students (aged 15–16 years) in four different municipalities in Sweden. Methods A cross-sectional sample of 665 adolescents was collected in April 2014. The data was analysed using binary logistic regression analysis. Results The results show that 26% of adolescents in this study have smoked e-cigarettes (have ever used), while 19% have smoked e-cigarettes with nicotine or do not know whether or not they contained nicotine. The strongest risk factor for ever having used e-cigarettes (any type or with nicotine) was smoking conventional cigarettes. Having tried cigarettes and having tried snus, as well as using or having used alcohol and having smoked a water pipe were also statistically significant risk factors for ever use of any type of e-cigarettes but not for use of e-cigarettes with nicotine. There was no gender difference. Conclusions Our result show that the use of e-cigarettes tends to cluster with the use of other substances, such as other tobacco products and alcohol. As a relatively large share of the participating adolescents, more than a fourth, had smoked e-cigarettes, this rather new phenomenon requires monitoring as a part of the tobacco control.
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Lund I, Scheffels J. Smoking and snus use onset: exploring the influence of snus debut age on the risk for smoking uptake with cross-sectional survey data. Nicotine Tob Res 2014; 16:815-9. [PMID: 24500685 DOI: 10.1093/ntr/ntu001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Snus use has become increasingly prevalent among young people in Norway, while smoking has declined. Little is known about the transitions between snus and other tobacco products, particularly among younger users. A major concern involves the association between snus initiation and future smoking uptake. METHODS A total of 409 lifetime snus users who had started with snus before cigarettes or were never-smokers were selected from a national sample of participants in annually repeated cross-sectional surveys (2005-2011) of Norwegian men and women aged 15-74 years. About 30% of them were lifetime smokers, 84% were men, and the mean age was 29.4 years. Logistic regression was applied to investigate the association between age of snus uptake and the risk for becoming a smoker later on. RESULTS Respondents who started using snus before the age of 16 years had an odds ratio of 3.1 (confidence interval = 1.98-4.76) of being lifetime smokers compared with those who initiated snus later. The prevalence of current smoking among early snus initiators (22.9%) was comparable to that found among never-snus-users (29.6%). Among late snus initiators, current smoking prevalence was 5.9%. CONCLUSION In this study, snus debut age was an important factor for the association between snus use and smoking.
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Affiliation(s)
- Ingeborg Lund
- Norwegian Institute for Alcohol and Drug Research, Sentrum, Oslo, Norway
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Edvardsson I, Geisler D, Lendahls L. Experiences of Being Non-Smoking among Adolescents in a Smoking Context. Health (London) 2014. [DOI: 10.4236/health.2014.611140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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