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Weiger C, Moran MB, Kennedy RD, Limaye R, Cohen J. Beliefs and Characteristics Associated With Believing Nicotine Causes Cancer: A Descriptive Analysis to Inform Corrective Message Content and Priority Audiences. Nicotine Tob Res 2022; 24:1264-1272. [PMID: 35385112 PMCID: PMC9278833 DOI: 10.1093/ntr/ntac060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/27/2022] [Accepted: 03/02/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Many cigarette smokers want to quit but have not. Switching to noncombustible products can reduce disease risk, but misperceptions that nicotine causes cancer might impact relative harm perceptions about noncombustible products and considering switching. Identifying which smokers are most likely to hold this misperception and associated beliefs can inform the content of and priority audiences for corrective messaging. METHODS Bivariable log binomial models were run on a sample of 9,013 adult established smokers from Wave 3 of the Population Assessment of Tobacco and Health. Post hoc testing identified groups and beliefs associated with significantly higher-than-average prevalence of the misperception. RESULTS About 61.2% of smokers believe nicotine causes cancer or don't know. Non-Hispanic Black (PR: 2.09) and Hispanic (PR: 1.73) smokers, as well as those making under $10,000 a year (PR: 1.36) had significantly higher-than-average prevalence of the misperception. Smokers who had recently used ENDS or smokeless tobacco had significantly lower-than-average prevalence of the misperception (PR: 0.70 and 0.63, respectively). Prevalence of nicotine misperceptions was significantly higher-than-average among those who recognized all ten smoking-caused diseases (PR: 1.34), believed additive-free cigarettes were more harmful than regular cigarettes (PR: 1.71), or did not report subjective norms supporting noncombustible use (PR: 1.05). CONCLUSION High perceived threat of tobacco may be overgeneralized to nicotine. High prevalence of the misperception among Non-Hispanic Black and low-income smokers is concerning, considering existing health disparities. Messaging should attempt to correct the misperception that nicotine causes cancer. Inferential reasoning after message exposure should assess accuracy of relative harm perceptions. IMPLICATIONS The current study supports the need for corrective messaging to address the misperception that nicotine causes cancer. Identifying that nicotine misperceptions are associated with higher harm perceptions about tobacco suggests that there may be unintended consequences of high perceived harm of tobacco that need to be addressed. As nicotine misperceptions are significantly more prevalent among those already at higher risk of tobacco caused diseases, care should be taken to ensure equity in message dissemination.
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Affiliation(s)
- Caitlin Weiger
- Department of Health, Behavior & Society, Johns Hopkins University Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD 21205, USA
| | - Meghan Bridgid Moran
- Department of Health, Behavior & Society, Johns Hopkins University Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD 21205, USA
| | - Ryan David Kennedy
- Department of Health, Behavior & Society, Johns Hopkins University Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD 21205, USA
- Department of Health, Behavior and Society, Institute for Global Tobacco Control, Johns Hopkins University Bloomberg School of Public Health, 2213 McElderry St., 4th Floor, Baltimore, MD, USA
| | - Rupali Limaye
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N Wolfe St., Baltimore, MD 21205, USA
| | - Joanna Cohen
- Department of Health, Behavior & Society, Johns Hopkins University Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD 21205, USA
- Department of Health, Behavior and Society, Institute for Global Tobacco Control, Johns Hopkins University Bloomberg School of Public Health, 2213 McElderry St., 4th Floor, Baltimore, MD, USA
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Edwards S, Fitzgerald L, Mutch A, Dean JA, Ford P, Howard C, Watts P, Gartner C. Views and preferences of people living with HIV about smoking, quitting and use of nicotine products. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 97:103349. [PMID: 34252787 DOI: 10.1016/j.drugpo.2021.103349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 06/08/2021] [Accepted: 06/13/2021] [Indexed: 10/20/2022]
Abstract
AIMS AND BACKGROUND People living with HIV (PLHIV) have a higher rate of smoking and experience a greater burden of tobacco-related disease than the general population. This study aimed to understand the role smoking plays in the lives of PLHIV, participants' views of traditionally available nicotine products (e.g., nicotine replacement therapy or NRT) and novel nicotine products (e.g., nicotine vaping products or NVPs) as both short-term quit aids and long-term substitutes for cigarettes. METHODS Semi-structured focus groups were conducted with PLHIV who smoked. Focus groups were transcribed and analysed using a combination of deductive and inductive thematic analysis. A brief questionnaire of nicotine product use and interest was also completed and the quantitative data presented using descriptive statistics. RESULTS Fifty-four participants took part in 11 focus groups. Participants' views of smoking, quitting and nicotine products were diverse. Commitment to smoking and interest in quitting were categorised into three groups across a smoking-quitting continuum: committed to smoking, ambivalent about smoking and reluctantly smoking. NRT was criticised for a range of side effects and primarily considered as a short-term cessation aid. NVPs generated debate. NVPs that closely resembled cigarettes were viewed as the most acceptable product and were considered to be more suitable than NRT for long-term use. DISCUSSION AND CONCLUSIONS Understanding the unique needs, goals and views of PLHIV related to smoking, quitting smoking and using nicotine products could inform development of novel and tailored smoking interventions for PLHIV. NVPs should be further examined as potential long-term substitutes for PLHIV who are ambivalent about smoking. However, traditional smoking cessation assistance (approved cessation aids and counselling) is likely to be most appropriate for PLHIV who are reluctantly smoking.
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Affiliation(s)
- Stephanie Edwards
- The University of Queensland, Faculty of Medicine, School of Public Health, The Public Health Building, Corner of Wyndham St and Herston Road, Herston QLD 4006, Australia
| | - Lisa Fitzgerald
- The University of Queensland, Faculty of Medicine, School of Public Health, The Public Health Building, Corner of Wyndham St and Herston Road, Herston QLD 4006, Australia
| | - Allyson Mutch
- The University of Queensland, Faculty of Medicine, School of Public Health, The Public Health Building, Corner of Wyndham St and Herston Road, Herston QLD 4006, Australia
| | - Judith A Dean
- The University of Queensland, Faculty of Medicine, School of Public Health, The Public Health Building, Corner of Wyndham St and Herston Road, Herston QLD 4006, Australia
| | - Pauline Ford
- The University of Queensland, Faculty of Health and Behavioural Sciences, School of Dentistry, Oral Health Centre, 288 Herston Road, Herston QLD 4006, Australia
| | - Chris Howard
- Queensland Positive People, 21 Manilla St, East Brisbane QLD 4169, Australia
| | - Peter Watts
- The University of Queensland, Faculty of Medicine, School of Public Health, The Public Health Building, Corner of Wyndham St and Herston Road, Herston QLD 4006, Australia; The University of Queensland, Faculty of Health and Behavioural Sciences, School of Dentistry, Oral Health Centre, 288 Herston Road, Herston QLD 4006, Australia; Queensland Positive People, 21 Manilla St, East Brisbane QLD 4169, Australia
| | - Coral Gartner
- The University of Queensland, Faculty of Medicine, School of Public Health, The Public Health Building, Corner of Wyndham St and Herston Road, Herston QLD 4006, Australia.
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Carpenter MJ, Gray KM, Wahlquist AE, Cropsey K, Saladin ME, Froeliger B, Smith TT, Toll BA, Dahne J. A Pilot Randomized Clinical Trial of Remote Varenicline Sampling to Promote Treatment Engagement and Smoking Cessation. Nicotine Tob Res 2021; 23:983-991. [PMID: 33249458 PMCID: PMC8150130 DOI: 10.1093/ntr/ntaa241] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/24/2020] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Medication sampling is a clinically useful tool to engage smokers in the quitting process. Whether varenicline is suitable for sampling purposes is unclear. The purpose of this study was to examine the feasibility, uptake, and preliminary outcomes of varenicline sampling. METHODS Smokers (N = 99), both motivated to quit and not, were recruited and randomized to varenicline sampling versus not, with 12 week follow-up. The intervention consisted of mailing one-time samples of varenicline (lasting 2-4 wks), with minimally suggestive guidance on use. RESULTS Uptake of varenicline was strong, at 2 weeks (54% any use, 66% daily use) and 4 weeks (38%, 46%), with 58% of medication users seeking additional medication. Most users followed conventional titration patterns, self-titrating from 0.5 mg to 2 mg. Relative to control, varenicline sampling increased motivation (p = 0.006) and confidence to quit (p = 0.02), and decreased cigarette smoking (p = 0.02). Smokers receiving varenicline samples were significantly more likely to achieve 50% reduction in cigarettes per day (CPD), both immediately following the sampling exercise (Adjusted Odds Ratio [AOR] = 4.12; 95% CI: 1.39 to 12.17) and at final follow-up (AOR = 4.50; 95% CI: 1.56 to 13.01). Though cessation outcomes were not statistically significant, there was a 1.5 to 3-fold increase in quit attempts and abstinence from varenicline sampling throughout follow-up. These outcomes were comparable among smokers motivated to quit and not. CONCLUSIONS Unguided, user-driven sampling of varenicline sampling is a concrete behavioral exercise that is feasible to do and seems to suggest clinical utility. Sampling is a pragmatic clinical approach to engage more smokers in quitting. IMPLICATIONS Use of evidence-based pharmacotherapies for smoking cessation is low. Medication sampling is a pragmatic behavioral exercise that allows smokers to experience the benefits of using them, while promoting positive downstream effects towards quitting. While previous studies have shown that nicotine replacement therapy (NRT) sampling is viable and effective, whether this extends to varenicline is unclear. Results from this trial demonstrate that varenicline sampling is feasible, safe, and suggestive of clinically important steps toward quitting, deserving of a larger trial. CLINICAL TRIAL REGISTRATION NCT #03742154.
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Affiliation(s)
- Matthew J Carpenter
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, SC
- Department of Public Health Sciences, MUSC, Charleston, SC
- Hollings Cancer Center, MUSC, Charleston, SC
| | - Kevin M Gray
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, SC
- Hollings Cancer Center, MUSC, Charleston, SC
| | - Amy E Wahlquist
- Department of Public Health Sciences, MUSC, Charleston, SC
- Hollings Cancer Center, MUSC, Charleston, SC
| | - Karen Cropsey
- Department of Psychiatry, University of Alabama, Birmingham, UK
| | | | - Brett Froeliger
- Department of Psychiatry, University of Missouri, Columbia, MI
- Department of Psychological Sciences, University of Missouri, Columbia, MI
| | - Tracy T Smith
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, SC
- Hollings Cancer Center, MUSC, Charleston, SC
| | - Benjamin A Toll
- Department of Public Health Sciences, MUSC, Charleston, SC
- Hollings Cancer Center, MUSC, Charleston, SC
| | - Jennifer Dahne
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, SC
- Hollings Cancer Center, MUSC, Charleston, SC
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Liu J, Wang J, Vansickel A, Edmiston J, Graff D, Sarkar M. Characterization of the Abuse Potential in Adult Smokers of a Novel Oral Tobacco Product Relative to Combustible Cigarettes and Nicotine Polacrilex Gum. Clin Pharmacol Drug Dev 2021; 10:241-250. [PMID: 33502815 PMCID: PMC7986766 DOI: 10.1002/cpdd.909] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 12/15/2020] [Indexed: 11/19/2022]
Abstract
Novel noncombustible tobacco products offer adult smokers (ASs) alternatives to combustible cigarettes lower on the continuum of risk; however, the abuse potential of such products has not been well studied. The objective of this study was to evaluate the abuse potential of 2 chewable tobacco‐derived nicotine containing products, VERVE Chews Blue Mint (test 1) and Green Mint (test 2), in ASs compared with own‐brand cigarettes (CIGS) and nicotine polacrilex gum (GUM) using subjective measures and nicotine pharmacokinetics. ASs used the test products during a 5‐day at‐home trial prior to completing an in‐clinic 4‐period randomized crossover study. During the study ASs used test products, CIGS, and GUM once on separate days. Responses to Tobacco/Nicotine Withdrawal and Direct Effects of Product questionnaires were documented, and blood samples were collected to assess nicotine pharmacokinetics during each product use. Nicotine pharmacokinetic parameters (Cmax and AUC) were statistically significantly lower with use of test products compared with CIGS and statistically significantly higher compared with GUM. No appreciable differences were noted between the 2 flavors for any of the end points measured. Reductions in maximum urge to smoke and maximum responses to the question “Is the Product ‘Pleasant’ Right Now?” for the test products were statistically significantly lower than CIGS but comparable to GUM. Similar results were observed for responses to other items in the 2 questionnaires. The test products, under the conditions of this study, carry lower abuse potential than own‐brand cigarettes and similar to nicotine polacrilex gum.
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Affiliation(s)
- Jianmin Liu
- Altria Client Services LLC, Richmond, Virginia, USA
| | - Jingzhu Wang
- Altria Client Services LLC, Richmond, Virginia, 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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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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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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