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Noggle B, Ball KM, Vansickel AR, Noggle B. A reduced exposure heated tobacco product was introduced then abruptly taken off United States shelves: results from a tobacco harm reduction natural experiment. Harm Reduct J 2024; 21:84. [PMID: 38659033 PMCID: PMC11040862 DOI: 10.1186/s12954-024-01000-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/04/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND A heated tobacco product (HTP) authorized for purchase in the United States by the Food and Drug Administration as a reduced harm product was removed from the market after about 2 years of sales. Adults who used the HTP were surveyed to determine the impact of the introduction and removal of the HTP on past and current tobacco behaviors. METHODS Adults who were using the HTP before its United States market removal (n = 502) completed a cross-sectional online survey to determine their tobacco use behaviors at three timepoints: prior to HTP initiation, just before HTP market removal, and at the time of the survey which was administered approximately 10 months post-removal. Descriptive statistics summarized outcome variables and paired bivariate testing was used to compare percent change between timepoints. Multivariable logistic regression and general linear models estimated associations of tobacco use behaviors and cigarette consumption. RESULTS Overall, significantly fewer adults consumed cigarettes while using HTP than before they tried the product (63.0% vs. 89.9%, p value < 0.0001) and the number of cigarettes consumed per week (CPW) decreased (106.3-39.0, p value < 0.0001). After HTP removal, the percent of adults who consumed cigarettes increased non-significantly (63.0-67.5%, p value = 0.0544) while CPW increased significantly (39.0-76.6 CPW, p value < 0.0001). At the time of the survey, over 25% of the sample continued to use the HTP and 7.2% reported use of no tobacco products. Electronic nicotine delivery system use had increased significantly from the prior period (27.4% increase, p value < 0.0001). CONCLUSION This study demonstrates reduction or elimination of combustible cigarette smoking while adults were using HTPs and some increased smoking after market removal, albeit at lower levels. If unable to find satisfying alternatives, adults who smoke and transition to reduced harm products may return to smoking or purchase products illicitly if their preferred products are removed from the regulated market.
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Affiliation(s)
- Brendan Noggle
- Center for Research and Technology, Altria Client Services LLC, 601 East Jackson Street, Richmond, VA, 23219, USA
| | - Kevin M Ball
- Center for Research and Technology, Altria Client Services LLC, 601 East Jackson Street, Richmond, VA, 23219, USA
| | - Andrea Rae Vansickel
- Center for Research and Technology, Altria Client Services LLC, 601 East Jackson Street, Richmond, VA, 23219, USA
| | - Brendan Noggle
- Center for Research and Technology, Altria Client Services LLC, 601 East Jackson Street, Richmond, VA, 23219, USA.
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2
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Sharma A, June KM, Norton KJ, Fix B, Bansal-Travers M, Rees VW, J O'Connor R. Intention to purchase alternative tobacco products as a function of smoking status and responses to advertising, packaging, and sensory experiences. Addict Behav 2022; 130:107291. [PMID: 35220153 DOI: 10.1016/j.addbeh.2022.107291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 12/07/2021] [Accepted: 02/18/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Tobacco manufacturers design and marketed products with appealing sensory characteristics to drive product uptake and continued use. We assessed smokers' and non-smokers' cognitive, affective, and sensory responses to Camel Snus (CS) and Nicotine gum (NG) to gauge future intentions to use. METHOD In a single laboratory session, 348 participants (including current smokers and nonsmokers in Buffalo, NY and Boston, MA) were exposed to CS and NG products in counterbalanced order. Exposure involved a cumulative set of 3 steps in which participants i) viewed an advertisement; ii) viewed the packaging, and iii) touched and smelled the product, without actual use. Current daily and non-daily smokers were invited to undertake a fourth exposure step by sampling the product. Following product exposure, participants completed perception measures and reported future intentions to use either product at the end of the survey. After each exposure, participants' reported feelings of valence and arousal. RESULTS Smokers reported greater preference to try NG (63.8%) compared with CS (17.4%) or neither (18.8%), whereas majority of nonsmokers preferred neither product (64.3%) (p < 0.01). Of those offered to sample the products, 78.3% daily smokers and 68.4% non-daily smokers opted to sample. When asked about intentions to try, a greater proportion of smokers stated a preference to try NG over CS, as did the small number of nonsmokers who expressed a preference. CONCLUSION Intentions to try CS were low despite different levels of exposure to product, and this low product appeal and interest in use may translate to limited potential of CS to serve as a reduced harm product for smokers.
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Affiliation(s)
- Akshika Sharma
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, United States.
| | - Kristie M June
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, United States.
| | - Kaila J Norton
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, United States; Center for Tobacco Research, Ohio State University Comprehensive Cancer Center, United States.
| | - Brian Fix
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, United States.
| | - Maansi Bansal-Travers
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, United States.
| | - Vaughan W Rees
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, United States.
| | - Richard J O'Connor
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, United States.
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3
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Vansickel A, Baxter S, Sherwood N, Kong M, Campbell L. Human Abuse Liability Assessment of Tobacco and Nicotine Products: Approaches for Meeting Current Regulatory Recommendations. Nicotine Tob Res 2022; 24:295-305. [PMID: 34498698 DOI: 10.1093/ntr/ntab183] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 09/07/2021] [Indexed: 11/14/2022]
Abstract
Many regulatory bodies now recommend that tobacco product manufacturers provide information regarding new tobacco products' abuse liability to inform regulatory authorization of currently marketed tobacco products or new product applications (including premarket tobacco product applications in the United States). In addition, the US Food and Drug Administration (FDA) recommends including this information as part of modified risk tobacco product applications. Regulators, including FDA, and many public health officials and researchers consider abuse liability assessment a model which predicts the likelihood that the use of the tobacco product would result in addiction and be used repeatedly or even sporadically resulting in undesirable effects. Abuse liability of a new, potentially reduced harm product can also inform its ability to substitute completely for more harmful tobacco products. While many methods exist, no standard tobacco product abuse liability assessment has been established. The purpose of this review is to provide background information and practical recommendations for human abuse liability testing methods to meet tobacco regulatory needs. A combination of nicotine test product pharmacokinetic, subjective effect and/or behavioral response, and physiological response data relative to comparator products with known abuse liability satisfies some regulatory requirements. Implications: This review provides a practical inspection of the current, international regulatory recommendations for abuse liability assessment of tobacco and regulatory review of such information within the United States and also recommends study designs and methods for abuse liability testing of tobacco products based on scientific and regulatory knowledge. Given that tobacco product abuse liability testing is of increasing interest to regulatory bodies globally, especially with the emergence of novel tobacco products, this timely work provides background and functional recommendations for tobacco product abuse liability testing.
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Affiliation(s)
- Andrea Vansickel
- Regulatory Affairs, Altria Client Services LLC, Richmond, VA, USA
| | - Sarah Baxter
- Clinical Studies, RAI Services Company, Winston-Salem, NC, USA
| | | | - Michael Kong
- Altasciences Clinical Research, Montreal, Canada
| | - Leanne Campbell
- Clinical Studies, RAI Services Company, Winston-Salem, NC, USA
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4
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Shao Y, Zou J, Xie Z, Mayne RG, Ossip DJ, Rahman I, McIntosh S, Li D. Perceptions of Oral Nicotine Pouches on Reddit: Observational Study (Preprint). J Med Internet Res 2022; 24:e37071. [PMID: 35838764 PMCID: PMC9338421 DOI: 10.2196/37071] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 05/19/2022] [Accepted: 05/31/2022] [Indexed: 01/18/2023] Open
Abstract
Background Oral nicotine pouches are a new form of tobacco-free nicotine products launched in recent years with a variety of flavors. Objective This study aims to examine the public perceptions and discussions of oral nicotine pouches on Reddit, a popular social media platform for sharing user experiences. Methods Between February 15, 2019, and February 12, 2021, a total of 2410 Reddit posts related to oral nicotine pouches were obtained over a 2-year period. After the removal of unrelated or commercial posts, 653 Reddit posts related to oral nicotine pouches remained. Topics and sentiments related to oral nicotine pouches on Reddit were hand coded. Results The number of Reddit posts related to oral nicotine pouches increased during the study period. Content analysis showed that the most popular topic was “sharing product information and user experience” (366/653, 56%), in which sharing oral nicotine pouch products and user experiences were dominant. The next popular topic was “asking product-related questions” (product properties and product recommendations; 115/653, 17.6%), followed by “quitting nicotine products” such as vaping or smoking through use of oral nicotine pouches or quitting the oral nicotine pouches themselves (83/653, 12.7%) and “discussing oral nicotine pouch–related health” symptoms or concerns related to oral nicotine pouches (74/653, 11.3%). The least popular topic was “legality and permissions” related to oral nicotine pouches (15/653, 2.3%). In addition, a greater number of Reddit posts described positive attitudes compared to negative attitudes toward oral nicotine pouches (354/653, 54.2% vs 101/653, 15.5%; P<.001). Conclusions Reddit posts overall had a positive attitude toward oral nicotine pouches and users were actively sharing product and user experiences. Our study provides the first insight on up-to-date oral nicotine pouch discussions on social media.
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Affiliation(s)
- Yihan Shao
- Goergen Institute for Data Science, University of Rochester, Rochester, NY, United States
| | - Jonathan Zou
- Goergen Institute for Data Science, University of Rochester, Rochester, NY, United States
| | - Zidian Xie
- Department of Clinical & Translational Research, University of Rochester Medical Center, Rochester, NY, United States
| | - Rachel Grana Mayne
- Tobacco Control Research Branch, National Cancer Institute, Bethesda, MD, United States
| | - Deborah J Ossip
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
| | - Irfan Rahman
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, United States
| | - Scott McIntosh
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
| | - Dongmei Li
- Department of Clinical & Translational Research, University of Rochester Medical Center, Rochester, NY, United States
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5
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Dissolution Testing of Nicotine Release from OTDN Pouches: Product Characterization and Product-to-Product Comparison. SEPARATIONS 2021. [DOI: 10.3390/separations8010007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In recent years, oral tobacco-derived nicotine (OTDN) pouches have emerged as a new oral tobacco product category. They are available in a variety of flavors and do not contain cut or ground tobacco leaf. The on!® nicotine pouches fall within this category of OTDN products and are currently marketed in seven (7) flavors with five (5) different nicotine levels. Evaluation of the nicotine release from these products is valuable for product assessment and product-to-product comparisons. In this work, we characterized the in vitro release profiles of nicotine from the 35 varieties of on!® nicotine pouches using a fit-for-purpose dissolution method, employing the U.S. Pharmacopeia flow-through cell dissolution apparatus 4 (USP-4). The nicotine release profiles were compared using the FDA’s Guidance for Industry: Dissolution Testing of Immediate Release Solid Oral Dosage Forms. The cumulative release profiles of nicotine show a dose dependent response for all nicotine levels. The on!® nicotine pouches exhibit equivalent percent nicotine release rates for each flavor variant across all nicotine levels. Furthermore, the nicotine release profiles from on!® nicotine pouches were compared to a variety of other commercially available OTDN pouches and traditional pouched smokeless tobacco products. The percent nicotine release rates were found to be dependent on the product characteristics, showing similarities and differences in the nicotine release profiles between the on!® nicotine pouches and other compared products.
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Morales M, Rafful C, Baker P, Arredondo J, Kang S, Mittal ML, Rocha-Jiménez T, Strathdee SA, Beletsky L. "Pick up anything that moves": a qualitative analysis of a police crackdown against people who use drugs in Tijuana, Mexico. HEALTH & JUSTICE 2020; 8:9. [PMID: 32350636 PMCID: PMC7191752 DOI: 10.1186/s40352-020-00111-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 03/24/2020] [Indexed: 06/03/2023]
Abstract
BACKGROUND Homeless people who use drugs (PWUD) are often displaced, detained, and/or forced into drug treatment during police crackdowns. Such operations follow a zero-tolerance approach to law enforcement and have a deleterious impact on the health of PWUD. In Mexico, municipal police officers (MPOs) conducted the largest crackdown documented at the Tijuana River Canal (Tijuana Mejora) to dismantle an open drug market. We analyzed active-duty MPOs' attitudes on the rationale, implementation, and outcomes of the crackdown. We also included the involvement of non-governmental allies in the disguised imprisonment as drug treatment referral and potential legal consequences of having illegally detained PWUD. METHODS Between February-June 2016, 20 semi-structured interviews were conducted with MPOs in Tijuana. Interviews were transcribed, translated and coded using a consensus-based approach. Emergent themes, trends and frameworks were analyzed through a hermeneutic grounded theory protocol. RESULTS Participants recognized the limitations of Tijuana Mejora in effectively controlling crime and addressing drug treatment solutions. MPOs perceived that the intent of the operation was to displace and detain homeless PWUD, not to assist or rehabilitate them. The police operation was largely justified as a public safety measure to reduce the risk of injury due to flooding, decrease drug consumption among PWUD and protect local tourism from PWUD. Some participants perceived the crackdown as a successful public health and safety measure while others highlighted occupational risks to MPOs and potential human rights violations of PWUD. CONCLUSIONS Tijuana Mejora illustrated why public and private actors align in enforcing zero-tolerance drug policy. Perceptions of care are often based on captivity of the diseased, not in health and well-being of PWUD. Officer perceptions shed light on the many limitations of this punitive policing tool in this context. A shift towards evidence-based municipal strategies to address drug use, wherein police are perceived as partners in harm reduction rather than antagonists, is warranted.
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Affiliation(s)
- Mario Morales
- School of Government and Public Policy, University of Arizona, Tuscon, USA
| | - Claudia Rafful
- Faculty of Psychology, Universidad Nacional Autónoma de Mexico, Mexico City, Mexico
- Center for Global Mental Health Research, National Institute of Psychiatry, Mexico City, Mexico
- Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada
| | - Pieter Baker
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0507, USA.
- School of Public Health, San Diego State University, San Diego, USA.
| | - Jaime Arredondo
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0507, USA
| | - Sunyou Kang
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0507, USA
- School of Law & Bouvé College of Health Sciences, Northeastern University, Boston, USA
| | - Maria L Mittal
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0507, USA
- School of Medicine, Universidad Xochicalco, Tijuana, Mexico
| | - Teresita Rocha-Jiménez
- Society and Health Research Center, Facultad de Humanidades, Universidad Mayor, Santiago, Chile
| | - Steffanie A Strathdee
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0507, USA
| | - Leo Beletsky
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0507, USA
- School of Law & Bouvé College of Health Sciences, Northeastern University, Boston, USA
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7
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Meier E, Burris JL, Wahlquist A, Garrett-Mayer E, Gray KM, Alberg AJ, Cummings KM, Carpenter MJ. Perceptions of Snus Among US Adult Smokers Given Free Product. Nicotine Tob Res 2018; 20:22-29. [PMID: 28034999 DOI: 10.1093/ntr/ntw392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 12/22/2016] [Indexed: 01/18/2023]
Abstract
Introduction Snus uptake is nominal among US smokers. This longitudinal study examines (1) perceptions of snus among US smokers given free snus for 6 weeks and (2) a method for assessment of an alternative tobacco product at the population level. Methods Adult smokers (n = 543; 69.2% female; Mage = 49.3 years), uninterested in quitting, received free snus for ad libitum use. Based on their snus use during a 6-week sampling period, participants included: (1) never users (18.4%, n = 100); (2) experimenters; that is, used ≥ once, but not during the last week of sampling (33.1%; n = 180); and (3) persistent users; that is, used ≥ once during the final week, and ≥ once during any other week of the sampling period. (48.4%; n = 263). Results Following the sampling period, those who became persistent users were more likely than experimenters to report that switching to alternative tobacco products would lower their risk for health problems (66.5% vs. 50.0%; p = .006). Persistent users also reported greater negative affect relief and craving reduction (ps < .001) than experimenters. Finally, persistent users were more likely than experimenters to describe snus in favorable terms with respect to ease of use, satisfaction, and liking (ps < .05). Conclusions Subjective experiences with snus, rather than nicotine dependence, explained experimentation versus persistent use. Even among smokers who became persistent snus users, snus was perceived as a poor substitute for cigarettes. This study design (randomized, yet naturalistic) could be extended to other novel tobacco products, including e-cigarettes, to help understand the role new products may have in the tobacco landscape. Implications This is the first large scale, US-based naturalistic assessment of smokers' reactions to snus during an extended sampling period. This study is directly in line with FDA goals to better understand predictors of initiation, uptake, and use of other tobacco products such as snus, and serves as model for assessment methods of alternative tobacco products at the population level. Most smokers tried the provided sample of snus (approximately 82%). Subjective experiences with snus, rather than nicotine dependence, explained experimentation versus persistent use. Even among smokers who became persistent snus users, snus was perceived as a poor substitute for cigarettes.
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Affiliation(s)
- Ellen Meier
- Department of Psychiatry, University of Minnesota, Minneapolis, MN
| | | | - Amy Wahlquist
- Department of Public Health Sciences, Medical University of South Carolina (MUSC), Charleston, SC.,Medical University of South Carolina (MUSC), Hollings Cancer Center, Charleston, SC
| | - Elizabeth Garrett-Mayer
- Department of Public Health Sciences, Medical University of South Carolina (MUSC), Charleston, SC.,Medical University of South Carolina (MUSC), Hollings Cancer Center, Charleston, SC
| | - Kevin M Gray
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, SC
| | - Anthony J Alberg
- Department of Public Health Sciences, Medical University of South Carolina (MUSC), Charleston, SC.,Medical University of South Carolina (MUSC), Hollings Cancer Center, Charleston, SC
| | - K Michael Cummings
- Medical University of South Carolina (MUSC), Hollings Cancer Center, Charleston, SC.,Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, SC
| | - Matthew J Carpenter
- Medical University of South Carolina (MUSC), Hollings Cancer Center, Charleston, SC.,Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, SC
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Pearson JL, Johnson AL, Johnson SE, Stanton CA, Villanti AC, Niaura RS, Glasser AM, Wang B, Abrams DB, Cummings KM, Hyland A. Adult interest in using a hypothetical modified risk tobacco product: findings from wave 1 of the Population Assessment of Tobacco and Health Study (2013-14). Addiction 2018; 113:113-124. [PMID: 28734111 PMCID: PMC5725239 DOI: 10.1111/add.13952] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 02/23/2017] [Accepted: 07/18/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND AIMS The US Family Smoking Prevention and Tobacco Control Act provides a pathway for manufacturers to market a modified risk tobacco product (MRTP). This study examines socio-demographic and tobacco use correlates of interest in a hypothetical MRTP in a nationally representative sample of US adults. DESIGN Cross sectional wave 1 data from the 2013-14 Population Assessment of Tobacco and Health (PATH) Study. SETTING Household Audio-Computer Assisted Self-Interviews of US adults conducted in 2013-14. PARTICIPANTS A total of 32 320 civilian, non-institutionalized adults in the United States. MEASUREMENTS Interest in using a hypothetical MRTP ('If a tobacco product made a claim that it was less harmful to health than other tobacco products, how likely would you be to use that product?'), socio-demographics, tobacco use history and mental health and substance use problems. All estimates were weighted. FINDINGS Overall, 16.7% [95% confidence interval (CI) = 16.28, 17.18] of US adults reported interest in a hypothetical MRTP. Tobacco use was associated significantly with interest in a hypothetical MRTP, with interest most common among current established smokers (54.4%; 95% CI = 53.31, 55.39) and least common among never tobacco users (3.0%; 95% CI = 2.49, 3.55). Interest in a hypothetical MRTP was associated with experimental e-cigarette use among current experimental, current established and former smokers. Among non-smokers, race, age, education and substance use were associated with interest in using a hypothetical MRTP. CONCLUSIONS Among adults in the United States, interest in using a hypothetical modified risk tobacco product is low overall, and highest among current experimental and established smokers. A small percentage of non-smokers are interested in using a hypothetical hypothetical modified risk tobacco product.
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Affiliation(s)
- Jennifer L Pearson
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amanda L Johnson
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC, USA
| | - Sarah E Johnson
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - Cassandra A Stanton
- Westat, Rockville, MD, USA
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Andrea C Villanti
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Raymond S Niaura
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Allison M Glasser
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC, USA
| | - Baoguang Wang
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - David B Abrams
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Andrew Hyland
- Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Cancer Institute, Buffalo, NY, USA
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9
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Fix BV, Adkison SE, O’Connor RJ, Bansal-Travers M, Cummings KM, Rees VW, Hatsukami DK. Evaluation of modified risk claim advertising formats for Camel Snus. HEALTH EDUCATION JOURNAL 2017; 76:971-985. [PMID: 38974785 PMCID: PMC11225884 DOI: 10.1177/0017896917729723] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Abstract
Objectives The US Food and Drug Administration (FDA) has regulatory authority for modified risk tobacco product advertising claims. To guide future regulatory efforts, we investigated how variations in modified risk claim advertisements influence consumer perceptions of product risk claims for Camel Snus. Methods Young people and adults (15-65), including current, never, and former smokers, were randomised to view one of five Camel Snus print advertisements as part of a web-based survey. Four of the advertisements presented information related to nitrosamine content of snus using four formats: (1) text, (2) a bar chart, (3) a text/testimonial and (4) a bar chart/testimonial. The fifth format, used as a control, was a current advertisement for Camel Snus without the explicit claims made about nitrosamine content. After viewing advertisements for all products, participants were asked which product they would be most interested in trying. Results Participants exposed to advertisements that contained an explicit reduced risk message agreed the advertising claim for that product posed fewer health risks than cigarettes. However, advertisements containing the reduced risk messages were also viewed as containing less truthful information and respondents were more sceptical of the information presented. Advertisement claim format was not associated with selecting snus over the other tobacco products, nor was it associated with purchase intentions. Conclusion The results of this research indicate that consumers respond to reduced risk messages, though perhaps not in the direct way anticipated. We found no significant differences by advertisement format (numerical, graphical, testimonial).
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Affiliation(s)
- Brian V Fix
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Sarah E Adkison
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Richard J O’Connor
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY, USA
| | | | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Vaughan W Rees
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA
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10
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Burris JL, Wahlquist AE, Alberg AJ, Cummings KM, Gray KM, Garrett-Mayer E, Carpenter MJ. A longitudinal, naturalistic study of U.S. smokers' trial and adoption of snus. Addict Behav 2016; 63:82-8. [PMID: 27450153 DOI: 10.1016/j.addbeh.2016.07.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 07/11/2016] [Accepted: 07/13/2016] [Indexed: 01/07/2023]
Abstract
To refine public health policy amidst a changing landscape of tobacco products in the United States, it is first necessary to describe fully the nature of smokers' alternative product use. Little research addresses smokers' snus use, and most studies are limited by small samples, cross-sectional designs, and crude outcome measurement. This study sample includes 626 adult US smokers who denied intention to quit in the next month and were randomized to receive free snus during a 6-week sampling period, after which no snus was provided. Participants were then followed for one year. Outcome data were collected via phone. Participants (mean age: 48.7years) were predominately female, White non-Hispanic. Eighty-four percent reported trial of snus. Eleven percent reported purchase (i.e., adoption). Current use declined from 47.1% at the end of the sampling period to 6.5% at the end of follow-up. Frequency and quantity of snus use among current users was low. Among snus users, 79.3% said it functioned as an alternative to smoking and 58.4% said it provided a means of coping with smoking restrictions; options not mutually exclusive. In logistic regressions, men were more likely to report trial (odds ratio [OR]=2.33, p<0.01) and adoption (OR=1.84, p<0.05) than women. Baseline expectations about the nature of snus use also predicted snus outcomes (OR=1.28-1.78, p<0.05). Smokers showed willingness to try snus, but product interest waned over time. Snus as currently marketed is unlikely to play a prominent role in US tobacco control efforts.
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Affiliation(s)
- Jessica L Burris
- University of Kentucky, Department of Psychology and Markey Cancer Center, 206 Combs Cancer Research Building, Lexington, KY 40536, USA.
| | - Amy E Wahlquist
- Medical University of South Carolina, Department of Public Health Sciences and Hollings Cancer Center, 135 Cannon St., Room 302E, Charleston, SC 29425, USA.
| | - Anthony J Alberg
- Medical University of South Carolina, Department of Public Health Sciences and Hollings Cancer Center, 86 Jonathan Lucas St., MSC 955, Charleston, SC 29425, USA.
| | - K Michael Cummings
- Medical University of South Carolina, Department of Public Health Sciences and Hollings Cancer Center, 86 Jonathan Lucas St., MSC 955, Charleston, SC 29425, USA; Medical University of South Carolina, Department of Psychiatry and Behavioral Science and Hollings Cancer Center, 86 Jonathan Lucas St., MSC 955, Charleston, SC 29425, USA.
| | - Kevin M Gray
- Medical University of South Carolina, Department of Psychiatry and Behavioral Science, 125 Doughty St., Charleston, SC 29425, USA.
| | - Elizabeth Garrett-Mayer
- Medical University of South Carolina, Department of Public Health Sciences and Hollings Cancer Center, 86 Jonathan Lucas St., MSC 955, Charleston, SC 29425, USA.
| | - Matthew J Carpenter
- Medical University of South Carolina, Department of Psychiatry and Behavioral Science and Hollings Cancer Center, 86 Jonathan Lucas St., MSC 955, Charleston, SC 29425, USA.
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Nitzkin JL. What Drives Tobacco Control Policy? Nicotine Tob Res 2016; 18:1802-3. [PMID: 27095447 PMCID: PMC4941604 DOI: 10.1093/ntr/ntw104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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Burris JL, Studts JL, DeRosa AP, Ostroff JS. Systematic Review of Tobacco Use after Lung or Head/Neck Cancer Diagnosis: Results and Recommendations for Future Research. Cancer Epidemiol Biomarkers Prev 2015; 24:1450-61. [PMID: 26282629 PMCID: PMC4592460 DOI: 10.1158/1055-9965.epi-15-0257] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 07/29/2015] [Indexed: 11/16/2022] Open
Abstract
Tobacco use after cancer diagnosis is associated with adverse cancer outcomes, yet reliable prevalence estimates for this behavior are lacking. We conducted a systematic literature review of the prevalence of current tobacco use among individuals with a history of lung or head/neck cancer (CRD #42012002625). An extensive search of electronic databases (MEDLINE, EMBASE, Cochrane Library, CINAHL, PsycINFO, and Web of Science) identified 7,777 potentially relevant articles published between 1980 and 2014 and 131 of these yielded pertinent information. Aggregating results across heterogeneous study designs and diverse patient samples, the overall mean prevalence rate of current tobacco use (mostly cigarette smoking) was 33.0% (median, 31.0%). Among current tobacco users at cancer diagnosis, the mean prevalence rate of current tobacco use (mostly cigarette smoking) was 53.8% (median, 50.3%). In many cases, an operational definition of "current" tobacco use was absent, and biochemical verification of self-reported smoking status was infrequent. These and other observed methodologic limitations in the assessment and reporting of cancer patients' tobacco use underscore the necessity of uniform tobacco use assessment in future clinical research and cancer care.
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Affiliation(s)
- Jessica L Burris
- Lucille P. Markey Cancer Center, Cancer Prevention and Control Program, Lexington, Kentucky. University of Kentucky, Department of Psychology, Lexington, Kentucky.
| | - Jamie L Studts
- Lucille P. Markey Cancer Center, Cancer Prevention and Control Program, Lexington, Kentucky. University of Kentucky, Department of Behavioral Science, Lexington, Kentucky
| | - Antonio P DeRosa
- Memorial Sloan Kettering Cancer Center, Medical Library, New York, New York
| | - Jamie S Ostroff
- Memorial Sloan Kettering Cancer Center, Psychiatry and Behavioral Sciences Service, New York, New York
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Halder S, Trauth S, Pearce AR. Oral Nicotine Alters Uterine Histo-Morphology but Does Not Disrupt the Estrous Cycle in Female Rats. Nicotine Tob Res 2015; 18:590-5. [DOI: 10.1093/ntr/ntv134] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 06/09/2015] [Indexed: 01/30/2023]
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Rousu MC, O'Connor RJ, Bansal-Travers M, Pitcavage JM, Thrasher JF. The impact of free trial acceptance on demand for alternative nicotine products: evidence from experimental auctions. Harm Reduct J 2015; 12:18. [PMID: 26063180 PMCID: PMC4468811 DOI: 10.1186/s12954-015-0052-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 05/27/2015] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES This study explored the relationship between product trials and consumer demand for alternative nicotine products (ANP). METHODS An experimental auction was conducted with 258 adult smokers, wherein participants were randomly assigned to one of four experimental conditions. The participants received the opportunity to try, but did not have to accept, one of three relatively novel ST products (i.e., snus, dissolvable tobacco, or medicinal nicotine), or they were placed into a control group (i.e., no trial). All the participants then bid on all three of these products, as well as on cigarettes. We assessed interest in using ANP based on both trial of the product and bids placed for the products in the experimental auction. RESULTS Fewer smokers were willing to try snus (44%) than dissolvable tobacco (64%) or medicine nicotine (68%). For snus, we find modest evidence suggesting that willingness to try is associated with greater demand for the product. For dissolvable tobacco or medicinal nicotine, we find no evidence that those who accept the product trial have higher demand for the product. CONCLUSIONS Free trials of a novel ANP were not strongly associated with product demand, as assessed by willingness to pay. Given the debate over the potential for ANP to reduce the harm from smoking, these results are important in understanding the impact of free trial offers on adoption of ST product as a strategy to reduce harm from tobacco use.
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Affiliation(s)
- Matthew C Rousu
- Susquehanna University, 514 University Ave, Selinsgrove, PA, 17870, USA.
| | - Richard J O'Connor
- Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY, 14263, USA.
| | | | | | - James F Thrasher
- University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA.
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Hatsukami DK, Severson H, Anderson A, Vogel RI, Jensen J, Broadbent B, Murphy SE, Carmella S, Hecht SS. Randomised clinical trial of snus versus medicinal nicotine among smokers interested in product switching. Tob Control 2015; 25:267-74. [PMID: 25991608 PMCID: PMC4785094 DOI: 10.1136/tobaccocontrol-2014-052080] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 04/24/2015] [Indexed: 11/18/2022]
Abstract
Background An essential component of evaluating potential modified risk tobacco products is to determine how consumers use the product and resulting effects on biomarkers of toxicant exposure. Study design Cigarette smokers (n=391) recruited in Minnesota and Oregon were randomised to either snus or 4 mg nicotine gum for 12 weeks. Participants were instructed to completely switch from cigarettes to these products. Urine samples were collected to analyse for carcinogenic tobacco-specific nitrosamine metabolites (4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol and N′-nitrosonornicotine and their glucuronides) and nicotine metabolites (total cotinine and nicotine equivalents) levels. Results Of the 391 participants randomised, 52.9% were male, the mean±SD age was 43.9±12.5 years, baseline number of cigarettes/day was 18.0±6.5 and Fagerstrom Test for Nicotine Dependence score was 5.1±2.0. The mean±SD number of snus pouches used/week at week 6 prior to tapering was 39.1±24.0 and nicotine gum pieces used was 37.6±26.3. Dual use of cigarettes and these products were observed in 52.9% and 58.2% of those assigned to snus and nicotine gum, respectively, at week 12. The end of treatment biochemically verified (carbon monoxide, CO <6 ppm) 7-day avoidance of cigarettes was 21.9% in the snus group and 24.6% in the nicotine gum group. Toxicant exposure in the nicotine gum group was significantly less when compared to snus. Conclusions Snus performed similarly to nicotine gum in cigarette smokers who were interested in completely switching to these products, but was associated with less satisfaction and greater toxicant exposure than nicotine gum. Trial registration number NCT: 00710034.
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Affiliation(s)
- Dorothy K Hatsukami
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Amanda Anderson
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Joni Jensen
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Sharon E Murphy
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Steven Carmella
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Stephen S Hecht
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
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Liu ST, Nemeth JM, Klein EG, Ferketich AK, Kwan MP, Wewers ME. Risk perceptions of smokeless tobacco among adolescent and adult users and nonusers. JOURNAL OF HEALTH COMMUNICATION 2015; 20:599-606. [PMID: 25832126 PMCID: PMC4491912 DOI: 10.1080/10810730.2015.1012237] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The recent growth in smokeless tobacco (ST) consumption has raised questions about consumer risk perceptions of ST products, especially in high-risk vulnerable populations. This qualitative study examined risk perceptions of ST among adolescent and adult users and nonusers in Ohio Appalachia. Focus groups and interviews were held with adolescents (n = 53; M age = 17 years) and adults (n = 63; M age = 34 years) from four Ohio Appalachian counties. Participants were asked about their perceptions of ST-related health risks, ST safety, and the relative safety of ST compared with cigarettes. Transcriptions were coded independently by two individuals. Overall, participants were knowledgeable about health problems from ST use (e.g., oral cancers, periodontal disease). Nearly all participants stated that ST use is not safe; however, there was disagreement about its relative safety. Some perceived all tobacco products as equally harmful; others believed that ST is safer than cigarettes for either the user or those around the user. Disagreements about ST relative safety may reflect mixed public health messages concerning the safety of ST. Comprehensive consumer messages about the relative safety of ST compared with cigarettes are needed. Messages should address the effect of ST on the health of the user as well as those exposed to the user.
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Affiliation(s)
- Sherry T Liu
- a Division of Health Behavior and Health Promotion , The Ohio State University College of Public Health , Columbus , Ohio , USA
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Borup G, Mikkelsen KL, Tønnesen P, Christrup LL. Exploratory survey study of long-term users of nicotine replacement therapy in Danish consumers. Harm Reduct J 2015; 12:2. [PMID: 26239277 PMCID: PMC4522965 DOI: 10.1186/1477-7517-12-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 11/28/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Long-term use of nicotine replacement therapy (NRT) has been approved in several countries for smokers who are unable or unwilling to quit smoking. However, information on basic characteristics, degree of nicotine dependence, health status and contentment with long-term use of NRT is scarce. The aim of this study was to collect information on the characteristics of long-term NRT users, having used NRT for at least 12 months, reasons for, and contentment with, their continued use of NRT including reasons for wishing to quit or sustain use and an estimation of their degree of nicotine dependence. METHOD Through advertisements in three national Danish newspapers, long-term NRT users were recruited to answer a short questionnaire about basic characteristics, health status and satisfaction with using NRT. A modified version of the Heaviness of Smoking Index (HSI) questionnaire was applied to estimate nicotine dependence. Linear regression was used to test association between time to first NRT and daily dosage of NRT. RESULTS A total of 92 respondents were included in the data analysis. A majority of 88% wished to quit NRT for the following reasons: costs of NRT, being tired of feeling addicted and fear of adverse health effects. Scoring on the modified HSI scale was 22.0% low, 68.0% moderate and 9.3% high dependent. Of the respondents, 67.0% used NRT within the first 30 min after waking. A validation check found a significant linear association between the two items in the modified HSI. CONCLUSION A significant majority of users wished to quit NRT because of the cost of products, being tired of feeling addicted and fear of adverse health consequences. The majority of these users were moderate to high nicotine dependent. The strong association found between time to first NRT and NRT dosages used per day gives reason to believe the validity of the modified HSI. Further studies are required for confirmation. Better counselling of long-term users on the benefits of using NRT compared to smoking should be provided, for those who are chronically dependent, as well as support to stop long-term use of NRT if wanted.
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Affiliation(s)
- Gitte Borup
- Department of Drug Design and Pharmacology, University of Copenhagen, Universitetsparken 2, 2100, Copenhagen, Denmark.
| | | | - Philip Tønnesen
- Danish Centre for Sleep Medicine, Glostrup Hospital, Glostrup, Denmark.
| | - Lona Louring Christrup
- Department of Drug Design and Pharmacology, University of Copenhagen, Universitetsparken 2, 2100, Copenhagen, Denmark.
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McNaughton EC, Black RA, Weber SE, Butler SF. Assessing Abuse Potential of New Analgesic Medications Following Market Release: An Evaluation of Internet Discussion of Tapentadol Abuse. PAIN MEDICINE 2015; 16:131-40. [DOI: 10.1111/pme.12547] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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19
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Biener L, Nyman AL, Stepanov I, Hatsukami D. Public education about the relative harm of tobacco products: an intervention for tobacco control professionals. Tob Control 2014; 23:385-8. [PMID: 23481906 PMCID: PMC4119095 DOI: 10.1136/tobaccocontrol-2012-050814] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND In the USA, new regulations require the collection of information on tobacco constituents by brand and variety and publication of this information in a way not likely to be misconstrued by consumers. Understanding of such information becomes increasingly important as new tobacco products are marketed and modifications are made to reduce the toxicity of some products. This pilot study assessed the current knowledge of tobacco control professionals regarding the relative harmfulness of several tobacco products, and evaluated an online educational intervention aimed at improving understanding of variations in nicotine and tobacco-specific N-nitrosamines (TSNAs). METHODS Fifty-two tobacco control professionals participated in an online intervention which presented and discussed the results of constituent analyses of Camel Snus and Marlboro Snus compared to several conventional smokeless tobacco products. Comparisons with cigarettes were also discussed. Pre- and post-intervention questions assessed understanding of the concepts. RESULTS Pre-intervention responses demonstrated that 31% did not know that cigarettes are more harmful than smokeless tobacco, 67% did not know that smokeless products higher in nicotine are likely to be more effective substitutes for cigarettes, 52% did not know TSNAs are the major carcinogens in tobacco and 81% did not know new snus products tend to be lower in TSNAs than conventional spit tobacco. After intervention participation, knowledge increased on all points except one where pretest results were 100% correct. CONCLUSIONS Public education campaigns are urgently needed for tobacco control professionals and consumers to increase awareness and understanding of the continuum of risk among tobacco products.
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Affiliation(s)
- Lois Biener
- Center for Survey Research, University of Massachusetts Boston, 100 Morrissey Blvd., Boston, MA 02125, 617-287-7200, 617-287-7210 (fax),
| | - Amy L. Nyman
- Center for Survey Research, University of Massachusetts Boston, 100 Morrissey Blvd., Boston, MA 02125,
| | - Irina Stepanov
- Masonic Cancer Center, University of Minnesota, MMC 806, 420 Delaware St SE, Minneapolis, MN 55455,
| | - Dorothy Hatsukami
- University of Minnesota, Tobacco Research Programs, 717 Delaware St SE, Minneapolis, MN 55414,
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Ayo-Yusuf OA, Agaku IT. Intention to switch to smokeless tobacco use among South African smokers: results from the 2007 South African Social Attitudes Survey. PLoS One 2014; 9:e95553. [PMID: 24743334 PMCID: PMC3990686 DOI: 10.1371/journal.pone.0095553] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 03/28/2014] [Indexed: 11/24/2022] Open
Abstract
Background Some smokeless tobacco products (SLT) have been shown to be associated with only a fraction of the risks of cigarettes. This study assessed South African smokers’ interest in switching to a hypothetical reduced harm SLT product. Methods The 2007 South African Social Attitudes Survey was analysed for 678 exclusive cigarette smokers. Respondents were asked about their perceptions about relative harm of snuff compared to cigarettes, and their interest in switching to snuff if informed it was 99% less harmful than cigarettes. Results About 49.7% of exclusive cigarette smokers believed that snuff was equally as harmful as cigarettes; 12.9% thought snuff was more harmful; 5.7% thought snuff was less harmful; while 31.8% did not know if there was a difference in harm between snuff and cigarettes. Approximately 24.2% of exclusive cigarette smokers indicated interest in switching to snuff, with significantly greater interest observed among those exposed to 100% smoke-free work environment. Interest in switching was highest (34.7%) among smokers who believed a priori that using snuff was more harmful than cigarettes, and lowest (14.5%) among those who did not know if there was a difference in harm. In a multi-variable adjusted logistic regression model, this latter group remained less likely to be interested in harm reduction switching (adjusted odds ratio = 0.42; 95% CI: 0.19–0.91). Conclusion About a quarter of smokers indicated interest in harm reduction switching to snuff. SLT products have a potential role in reducing the harm from smoking in South Africa, but only if they are not used to circumvent smoke-free laws that have been associated with reduced smoking.
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Affiliation(s)
- Olalekan A. Ayo-Yusuf
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
- Office of the Director, School of Oral Health Sciences, University of Limpopo, MEDUNSA campus, Pretoria, South Africa
| | - Israel T. Agaku
- Center for Global Tobacco Control, Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, United States of America
- * E-mail:
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21
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Rousu MC, O'Connor RJ, Thrasher JF, June KM, Bansal-Travers M, Pitcavage J. The impact of product information and trials on demand for smokeless tobacco and cigarettes: evidence from experimental auctions. Prev Med 2014; 60:3-9. [PMID: 24321456 PMCID: PMC4309363 DOI: 10.1016/j.ypmed.2013.11.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 09/07/2013] [Accepted: 11/03/2013] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Epidemiological and toxicological evidence suggests lower risk of smokeless tobacco (ST) products compared to cigarettes. Less is known, however, about consumer perceptions and use of novel forms of ST, including snus and dissolvable tobacco. METHODS In this study, we conducted in-person experimental auctions in Buffalo, NY, Columbia, SC, and Selinsgrove, PA with 571 smokers to test the impact of information and product trials on smokers' preferences. Auctions were conducted between November 2010-November 2011. RESULTS We found no evidence of an impact of product trials on demand in our auctions. Anti-ST information increased demand for cigarettes when presented alone, but when presented with pro-ST information it decreased demand for cigarettes. It did not decrease demand for ST products. Anti-smoking information increased demand for ST products, but did not affect cigarette demand. CONCLUSIONS These findings suggest that credible and effective communications about tobacco harm reduction should reinforce the negative effects of smoking.
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Affiliation(s)
- Matthew C Rousu
- Department of Economics, Susquehanna University, 514 University Avenue, Selinsgrove, PA 17870-1025, USA
| | - Richard J O'Connor
- Department of Health Behavior, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo NY 14263
| | - James F Thrasher
- Department of Health Promotion, Education, and Behavior, School of Public Health, University of South Carolina, Columbia, SC, USA; Centro de Investigaciones en Salud Poblacional, Instituto Nacional de Salud Publica, Cuernavaca, Mexico
| | - Kristie M June
- Department of Health Behavior, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo NY 14263
| | - Maansi Bansal-Travers
- Department of Health Behavior, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo NY 14263
| | - James Pitcavage
- Center for Health Research, Geisinger Health System, Danville PA, 17822; Department of Health Policy & Administration, The Pennsylvania State University, University Park, PA, 16802
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O'Connor RJ, June KM, Bansal-Travers M, Rousu MC, Thrasher JF, Hyland A, Cummings KM. Estimating demand for alternatives to cigarettes with online purchase tasks. Am J Health Behav 2014; 38:103-13. [PMID: 24034685 DOI: 10.5993/ajhb.38.1.11] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To explore how advertising affects demand for cigarettes and potential substitutes, including snus, dissolvable tobacco, and medicinal nicotine. METHODS A Web-based experiment randomized 1062 smokers to see advertisements for alternative nicotine products or soft drinks, then complete a series of purchase tasks, which were used to estimate demand elasticity, peak consumption, and cross-price elasticity (CPE) for tobacco products. RESULTS Lower demand elasticity and greater peak consumption were seen for cigarettes compared to all alternative products (p < .05). CPE did not differ across the alternative products (p ≤ .03). Seeing relevant advertisements was not significantly related to demand. CONCLUSIONS These findings suggest significantly lower demand for alternative nicotine sources among smokers than previously revealed.
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Affiliation(s)
- Richard J O'Connor
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY, USA.
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Burris JL, Carpenter MJ, Wahlquist AE, Cummings KM, Gray KM. Brief, instructional smokeless tobacco use among cigarette smokers who do not intend to quit: a pilot randomized clinical trial. Nicotine Tob Res 2013; 16:397-405. [PMID: 24130144 DOI: 10.1093/ntr/ntt161] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Low-nitrosamine smokeless tobacco (SLT) may have efficacy for smoking reduction and cessation, but its public health impact depends on how smokers use it. METHODS This pilot study explored brief, instructional low-nitrosamine SLT use among smokers unmotivated to quit. Participants (N = 57) were randomized to either a free 2-week supply of Camel Snus group or a no-supply group. Of those randomized to use Camel Snus, half were told to use it to cope with smoking restrictions (Snus to Cope), and the remaining half were advised to use it to reduce smoking (Snus to Reduce). Participants were assessed before, during, and immediately after the intervention. RESULTS Many Snus to Cope and Snus to Reduce participants reported daily use of Camel Snus, although the amount of use was low. Snus to Cope (18.4%) and Snus to Reduce (37.6%) participants reported a decline in number of cigarettes used per day, which was not reported by the control participants (p < .001). Intention to quit smoking and intention to quit all tobacco use (ps < .001) increased to a greater extent among Snus to Cope and Snus to Reduce participants than among control participants. CONCLUSIONS This study replicates previous work that shows that low-nitrosamine SLT use can lead to reduced smoking and increased intention to quit, and it adds direct evidence to suggest that the function of low-nitrosamine SLT use-either to cope with smoking restrictions or to reduce smoking-can have a differential impact on smoking behavior. Overall, the results highlight the importance of messaging and, more specifically, marketing of low-nitrosamine SLT to smokers.
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Affiliation(s)
- Jessica L Burris
- Department of Psychiatry and Behavioral Sciences and Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
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Hatsukami DK, Zhang Y, O'Connor RJ, Severson HH. Subjective responses to oral tobacco products: scale validation. Nicotine Tob Res 2012; 15:1259-64. [PMID: 23239843 DOI: 10.1093/ntr/nts265] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Several noncombusted oral tobacco products have been introduced that are primarily marketed to cigarette smokers. An important component of evaluating these products involves assessment of subjective responses to the product. To date, few studies have been undertaken to examine the validity of subjective response questionnaires for oral tobacco products. The goal of this study is to examine the extent subjective responses to a product are related to product preference and extent of product use. METHODS Data from a study examining oral tobacco product preference were used. Smokers were asked to sample a variety of oral tobacco products that differed in formulation (snus versus dissolvables) and dose of nicotine. At the end of the sampling period, subjects were asked to choose the product that they would use to completely substitute for cigarettes for the next 2 weeks. During the sampling period, subjects completed a Product Evaluation Scale (PES) that describes subjective responses to the product. During the treatment phase, they kept record of amount of product use. RESULTS Subjective responses to the product on the PES were related to product choice and to some extent, the amount of product use. Product choice was associated with different characteristics of the product and smoker needs. CONCLUSION The PES may be a useful tool for the evaluation or oral tobacco products.
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Affiliation(s)
- Dorothy K Hatsukami
- University of Minnesota, Department of Psychiatry, Minneapolis, MN 55414, USA.
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Borgerding MF, Bodnar JA, Curtin GM, Swauger JE. The chemical composition of smokeless tobacco: a survey of products sold in the United States in 2006 and 2007. Regul Toxicol Pharmacol 2012; 64:367-87. [PMID: 23000415 DOI: 10.1016/j.yrtph.2012.09.003] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Revised: 08/30/2012] [Accepted: 09/11/2012] [Indexed: 12/13/2022]
Abstract
Selected toxicant concentrations and other chemical measures have been determined for 43 U.S. smokeless tobacco products sold in 2006 and 2007. Products evaluated included moist snuff, dry snuff, loose leaf, plug, dissolvable and snus tobacco brands. Reference products available for scientific research purposes and eleven Swedish products were also evaluated and compared to the commercial products studied. Chemical endpoints determined included benzo[a]pyrene (B[a]P), N'-nitrosonornicotine (NNN), N'-nitrosoanatabine (NAT), N'-nitrosoanabasine (NAB), 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), N-Nitrosodimethylamine (NDMA), nitrite, cadmium, lead, arsenic, nickel, chromium, chloride, water, pH and nicotine. Different toxicant profiles were observed for the products studied, with snus tobacco brands generally containing relatively low concentrations of B[a]P and tobacco specific nitrosamines (TSNAs) compared to other moist snuffs. Smokeless tobacco reference product toxicant profiles were similar to corresponding commercial products, with the exception of the TSNA content of the dry snuff reference material. TSNA concentrations observed for all commercial products were lower than historically reported values, likely reflecting changes in product shelf life, tobacco curing practices and, possibly, product blend formulations during the last 20-30 years. The survey results summarized provide a temporal point of comparison with future data anticipated from FDA "harmful and potentially harmful constituents in tobacco products" reporting.
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Affiliation(s)
- M F Borgerding
- R.J. Reynolds Tobacco Company, Bowman Gray Technical Center, Winston-Salem, NC 27102, USA.
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Southwell BG, Kim AE, Tessman GK, MacMonegle AJ, Choiniere CJ, Evans SE, Johnson RD. The marketing of dissolvable tobacco: social science and public policy research needs. Am J Health Promot 2012; 26:331-2. [PMID: 22747313 DOI: 10.4278/ajhp.111004-cit-357] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The latest generation of smokeless tobacco products encompasses a wide range of offerings, including what is commonly referred to as dissolvable tobacco. Designed to deliver nicotine upon dissolving or disintegrating in a user's mouth, dissolvable tobacco products currently appear in various United States markets as strips, orbs, sticks, and lozenges. The emergence of these new products poses distinct opportunities and challenges for social and behavioral science and public health research and raises important public policy questions.
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Choi K, Fabian L, Mottey N, Corbett A, Forster J. Young adults' favorable perceptions of snus, dissolvable tobacco products, and electronic cigarettes: findings from a focus group study. Am J Public Health 2012; 102:2088-93. [PMID: 22813086 DOI: 10.2105/ajph.2011.300525] [Citation(s) in RCA: 171] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We explored young adults' perceptions of snus (spitless moist snuff packed in porous bags), dissolvable tobacco products, and electronic cigarettes and intention to try these products. METHODS We conducted 11 focus group discussions involving a total of 66 young adults (18-26 years old) on these new tobacco products (e.g., harmfulness, potential as quit aids, intention to try) held between July and December 2010. We analyzed discussions using a thematic approach. RESULTS Participants generally reported positive perceptions of the new products, particularly because they came in flavors. Few negative perceptions were reported. Although some participants believed these products were less harmful than cigarettes and helpful in quitting smoking, others thought the opposite, particularly regarding electronic cigarettes. Participants also commented that these products could be gateways to cigarette smoking. Half of the participants, including a mix of smokers and nonsmokers, admitted they would try these products if offered by a friend. CONCLUSIONS Young adults perceive the new tobacco products positively and are willing to experiment with them. Eliminating flavors in these products may reduce young adults' intentions to try these products.
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Affiliation(s)
- Kelvin Choi
- Division of Epidemiology and Community Health, University of Minnesota, MN, USA.
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Borland R, Li L, Cummings KM, O’Connor R, Mortimer K, Wikmans T, Ramstrom L, King B, McNeill A. Effects of a Fact Sheet on beliefs about the harmfulness of alternative nicotine delivery systems compared with cigarettes. Harm Reduct J 2012; 9:19. [PMID: 22687137 PMCID: PMC3514329 DOI: 10.1186/1477-7517-9-19] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Accepted: 05/24/2012] [Indexed: 02/02/2023] Open
Abstract
UNLABELLED BACKGROUND This study explored the value of providing information in a Fact Sheet to correct misperceptions about the relative harmfulness of nicotine replacement products (NRT) and smokeless tobacco (ST), when compared to cigarette smoking. METHODS Four convenience samples from different countries (Australia, UK, Sweden and USA) were surveyed concerning their beliefs about the relative harmfulness of smokeless tobacco and NRT. Study participants were given the Fact Sheet that explained that nicotine, as used by consumers, is not particularly harmful and explained why. They were resurveyed one week later regarding their beliefs about the relative harmfulness of smokeless tobacco and NRT and future intentions to use the products. RESULTS In all four samples knowledge increased by similar amounts and beliefs regarding the lower harmfulness of smokeless tobacco increased. However, misconceptions remained common and responses to belief measures were not always consistent. Likelihood of use of ST increased in all four samples after exposure to the Fact Sheet, but interest in NRT use only increased in the US sample. CONCLUSIONS A Fact Sheet such as this one can help address misconceptions about NRT and smokeless tobacco, at least in the short term. However, as is true of most educational interventions, exposure to a single educational session is not sufficient to overcome misperceptions that smokers have about the relative harmfulness of oral versus combustible forms of nicotine delivery.
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Affiliation(s)
- Ron Borland
- VicHealth Center for Tobacco Control, The Cancer Council Victoria, Carlton, Australia
- Nigel Gray Distinguished Fellow in Cancer Prevention, VicHealth Center for Tobacco Control, The Cancer Council Victoria, 1 Rathdowne St, Carlton, VIC, 3053, Australia
| | - Lin Li
- VicHealth Center for Tobacco Control, The Cancer Council Victoria, Carlton, Australia
| | - K Michael Cummings
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, 29425, USA
| | | | | | - Tom Wikmans
- Research Group for Societal and Information Studies, Stockholm, Sweden
| | | | - Bill King
- VicHealth Center for Tobacco Control, The Cancer Council Victoria, Carlton, Australia
| | - Ann McNeill
- University of Nottingham, Nottingham, UK
- UK Centre for Tobacco Control Studies, Nottingham, UK
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Borland R, Li L, Mortimer K, McNeil A, King B, O'Connor RJ. The acceptability of nicotine containing products as alternatives to cigarettes: findings from two pilot studies. Harm Reduct J 2011; 8:27. [PMID: 21992707 PMCID: PMC3207885 DOI: 10.1186/1477-7517-8-27] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Accepted: 10/12/2011] [Indexed: 11/10/2022] Open
Abstract
Background This study aimed to explore issues that might impact on the acceptability and feasibility of offering smokers nicotine containing products either to quit nicotine use altogether by using as a short term means of quitting cigarettes or as a longer term substitute. Method Two small pilot studies, one in the UK (n = 34) involving face to face contact and direct provision of the product, the other in Australia (n = 31) conducted remotely with products sent in the mail. Results Nicotine lozenges were the most popular products, but significant minorities liked a smokeless product more. Use stimulated interest in quitting, and although many failed to use all the products provided, most were interested in future use, more often to help quit than as a planned long-term substitute. Conclusions These studies indicate an untapped interest in the use of substitutes to reduce the harmfulness of smoking. Studies of this sort do not inhibit interest in quitting nicotine altogether, and may facilitate it. The greater the range of products on offer, the more smokers are likely to try a product to quit.
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Affiliation(s)
- Ron Borland
- VicHealth Center for Tobacco Control, The Cancer Council Victoria, Carlton 3053, Australia.
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Bahreinifar S, Sheon NM, Ling PM. Is snus the same as dip? Smokers' perceptions of new smokeless tobacco advertising. Tob Control 2011; 22:84-90. [PMID: 21972063 DOI: 10.1136/tobaccocontrol-2011-050022] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Since 2006, leading US cigarette companies have been promoting new snus products as line extensions of popular cigarette brands. These promotional efforts include direct mail marketing to consumers on cigarette company mailing lists. This study examines smokers' reactions to this advertising and perceptions of the new snus products. METHODS Eight focus groups (n=65 participants) were conducted in San Francisco and Los Angeles in 2010 with smokers who received tobacco direct mail advertising. The focus group discussions assessed smokers' perceptions of the new snus products. Focus group videos were transcribed and coded using Transana software to identify common themes. RESULTS Most participants were aware of snus advertising and many had tried free samples. Most were aware that snus was supposed to be 'different' from traditional chewing tobacco but consistently did not know why. Participants willing to try snus still identified strongly as smokers, and for some participants, trying snus reinforced their preference for smoking. Snus' major benefits were use in smoke-free environments and avoiding social stigma related to secondhand smoke. Participants were sceptical of the idea that snus was safer than cigarettes and did not see it as an acceptable substitute for cigarettes or as a cessation aid. CONCLUSIONS Smokers repeated some messages featured in early snus advertising. Snus was not seen as an acceptable substitute for smoking or way to quit cigarettes. Current smoker responses to snus advertising are not consistent with harm reduction.
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Affiliation(s)
- Sareh Bahreinifar
- University of California San Francisco, 530 Parnassus Ave, Suite 366, Box 1390, San Francisco, CA 94143-1390, USA.
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Rodu B. The scientific foundation for tobacco harm reduction, 2006-2011. Harm Reduct J 2011; 8:19. [PMID: 21801389 PMCID: PMC3161854 DOI: 10.1186/1477-7517-8-19] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Accepted: 07/29/2011] [Indexed: 02/07/2023] Open
Abstract
Over the past five years there has been exponential expansion of interest in tobacco harm reduction (THR), with a concomitant increase in the number of published studies. The purpose of this manuscript is to review and analyze influential contributions to the scientific and medical literature relating to THR, and to discuss issues that continue to stimulate debate. Numerous epidemiologic studies and subsequent meta-analyses confirm that smokeless tobacco (ST) use is associated with minimal risks for cancer and for myocardial infarction; a small increased risk for stroke cannot be excluded. Studies from Sweden document that ST use is not associated with benign gastrointestinal disorders and chronic inflammatory diseases. Although any form of nicotine should be avoided during pregnancy, the highest risks for the developing baby are associated with smoking. It is documented that ST use has been a key factor in the declining rates of smoking and of smoking-related diseases in Sweden and Norway. For other countries, the potential population health benefits of ST are far greater than the potential risks. In follow-up studies, dual users of cigarettes and ST are less likely than exclusive smokers to achieve complete tobacco abstinence, but they are also less likely to be smoking. The health risks from dual use are probably lower than those from exclusive smoking. E-cigarette users are not exposed to the many toxicants, carcinogens and abundant free radicals formed when tobacco is burned. Although laboratory studies have detected trace concentrations of some contaminants, it is a small problem amenable to improvements in quality control and manufacturing that are likely with FDA regulation as tobacco products. There is limited evidence from clinical trials that e-cigarettes deliver only small doses of nicotine compared with conventional cigarettes. However, e-cigarette use emulates successfully the cigarette handling rituals and cues of cigarette smoking, which produces suppression of craving and withdrawal that is not entirely attributable to nicotine delivery. THR has been described as having "the potential to lead to one of the greatest public health breakthroughs in human history by fundamentally changing the forecast of a billion cigarette-caused deaths this century."
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Affiliation(s)
- Brad Rodu
- Tobacco Harm Reduction Research, University of Louisville, Room 208, Clinical Translational Research Building, 505 S, Hancock Street, KY 40202, Louisville, USA.
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