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Mead-Morse EL, Cassidy RN, Kpormegbey DE, Moore T, Oncken C, Tidey JW, Delnevo CD, Litt M. Examining Demand and Substitutability of Usual Brand Little Cigars/Cigarillos and Cigarettes in Young Adults Who Dual Use. Nicotine Tob Res 2024; 26:1057-1065. [PMID: 38365185 DOI: 10.1093/ntr/ntae025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 11/09/2023] [Accepted: 02/01/2024] [Indexed: 02/18/2024]
Abstract
INTRODUCTION Cigarette and little cigar/cigarillo (LCC) dual use is popular among young people and poses a substantial health risk. What remains unclear is the abuse liability of LCCs vs. cigarettes, LCCs' substitutability for cigarettes, and the influence of flavors on the abuse liability and substitutability of LCCs. METHODS Sixty-five young adults (18-34 years) who dual use completed hypothetical purchase tasks to measure consumption of usual brand cigarettes and LCCs in 24 hours at increasing prices (demand), and LCC consumption at increasing cigarette prices (substitution). Three demand indices were calculated from raw data: breakpoint (price after which consumption reaches 0), Omax (maximum daily expenditure), and Pmax (price at maximum expenditure). Two indices were estimated using nonlinear mixed-effects modeling: intensity (consumption when free) and price-sensitivity (rate of decline in consumption as price increases). Substitution, and associations of flavored use with demand and substitution, were estimated using linear mixed models. RESULTS Results indicated similar abuse liability for LCCs and cigarettes. Intensity was greater for cigarettes, but price-sensitivity was similar. Flavored LCC use was associated with lower price-sensitivity and greater intensity than unflavored. LCCs were significant substitutes for cigarettes, but the effect was small. Flavored use was not associated with substitution. CONCLUSIONS Among young adults who dual use, LCCs and cigarettes had similar abuse liability, and those who used flavored had higher demand for their LCCs. A flavored cigar ban, as well as targeted prevention and cessation services for those who smoke flavored LCCs, may be important for reducing dual use in young adults. IMPLICATIONS Cigarette and LCC dual use remains high among young adults. Using hypothetical purchase tasks with young adults who dual use, LCCs had abuse liability similar to cigarettes, but were only modest substitutes for cigarettes. Participants who used flavored LCCs reported greater abuse liability than those who used unflavored, but not greater substitution for cigarettes. Prevention and cessation services are needed to target LCCs in young people, particularly those smoking flavored products. A flavored cigar ban may help to reduce their demand.
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Affiliation(s)
- Erin L Mead-Morse
- Department of Public Health Sciences, UConn Health, Farmington, CT, USA
- Department of Medicine, UConn Health, Farmington, CT, USA
| | - Rachel N Cassidy
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA
| | - Daniel E Kpormegbey
- Department of Statistics, University of Connecticut, Storrs, CT, USA
- Statistical Consulting Services, Center for Open Research Resources and Equipment, University of Connecticut, Storrs, CT, USA
| | - Timothy Moore
- Statistical Consulting Services, Center for Open Research Resources and Equipment, University of Connecticut, Storrs, CT, USA
| | - Cheryl Oncken
- Department of Medicine, UConn Health, Farmington, CT, USA
| | - Jennifer W Tidey
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA
| | - Cristine D Delnevo
- Rutgers Institute for Nicotine and Tobacco Studies, New Brunswick, NJ, USA
| | - Mark Litt
- Division of Behavioral Sciences and Community Health, UConn Health, Farmington, CT, USA
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Sharma E, Lauten K, Zebrak KA, Edwards KC, VanEtten S, Benson AF, Delnevo CD, Marshall D, Kimmel HL, Taylor KA, Bansal-Travers M, Hyland A, Cummings KM. Respiratory symptoms and outcomes among cigar smokers: findings from the Population Assessment of Tobacco and Health (PATH) study waves 2-5 (2014-2019). Respir Res 2024; 25:185. [PMID: 38678212 PMCID: PMC11055341 DOI: 10.1186/s12931-024-02818-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/19/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND The mechanisms by which cigarette smoking increases the risk of respiratory disease have been studied. However, less is known about risks of respiratory symptoms and outcomes associated with smoking cigars, and risks by cigar types have not been previously explored. The aim of this study was to examine associations between cigar use, including traditional cigars, cigarillos, filtered cigars, and dual cigar and cigarette use, and functionally important respiratory symptoms (FIRS), lifetime asthma diagnosis, uncontrolled asthma, and new cases of FIRS. METHODS Data from Waves 2-5 (2014-19) of the Population Assessment of Tobacco and Health (PATH) Study, a nationally representative longitudinal study, were analyzed in two ways. For cross-sectional analysis, the analytic sample included adults 18 and older at each wave, resulting in 44,040 observations. Separately, longitudinal analyses were assessed among adults 18 and older at Wave 2, resulting in 7,930 individuals. Both analyses excluded adults with chronic obstructive pulmonary disease (COPD) or non-asthma respiratory disease. RESULTS Current established cigarillo smokers had higher odds of having FIRS (Adjusted odds ratio (AOR): 1.72; 95% CI: 1.08, 2.74) compared to never smokers of cigarillos and cigarettes, after adjusting for covariates. Current established filtered cigar smokers had higher odds of asthma diagnosis (AOR: 1.35; 95% CI: 1.10, 1.66) while current established dual smokers of filtered cigars and cigarettes had higher odds of uncontrolled asthma (AOR: 5.13; 95% CI: 1.75, 15.02) compared to never smokers of filtered cigars or cigarettes. Both current established cigar smokers and current established dual smokers of cigarettes and cigars had higher odds of new FIRS compared to never cigar or cigarette smokers (AORs: 1.62; 95% CI: 1.02, 2.60 for exclusive cigars and 2.55; 95% CI 1.57, 4.14 for dual smokers). CONCLUSIONS This study provides evidence that cigar smokers or dual smokers of cigars and cigarettes have greater odds of FIRS, asthma, and uncontrolled asthma and that new incidence of FIRS is higher among any cigar smokers compared to never cigar or cigarette smokers. Understanding health impacts associated with cigar use provides information for supporting policy development, as well as for designing clinical interventions focused on smoking cessation for cigars.
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Grants
- Contract Nos. HHSN271201100027C and HHSN271201600001C National Institute on Drug Abuse, National Institutes of Health (NIH NIDA), and the Center for Tobacco Products, Food and Drug Administration (FDA CTP)
- Contract Nos. HHSN271201100027C and HHSN271201600001C National Institute on Drug Abuse, National Institutes of Health (NIH NIDA), and the Center for Tobacco Products, Food and Drug Administration (FDA CTP)
- Contract Nos. HHSN271201100027C and HHSN271201600001C National Institute on Drug Abuse, National Institutes of Health (NIH NIDA), and the Center for Tobacco Products, Food and Drug Administration (FDA CTP)
- Contract Nos. HHSN271201100027C and HHSN271201600001C National Institute on Drug Abuse, National Institutes of Health (NIH NIDA), and the Center for Tobacco Products, Food and Drug Administration (FDA CTP)
- Contract Nos. HHSN271201100027C and HHSN271201600001C National Institute on Drug Abuse, National Institutes of Health (NIH NIDA), and the Center for Tobacco Products, Food and Drug Administration (FDA CTP)
- Contract Nos. HHSN271201100027C and HHSN271201600001C National Institute on Drug Abuse, National Institutes of Health (NIH NIDA), and the Center for Tobacco Products, Food and Drug Administration (FDA CTP)
- Contract Nos. HHSN271201100027C and HHSN271201600001C National Institute on Drug Abuse, National Institutes of Health (NIH NIDA), and the Center for Tobacco Products, Food and Drug Administration (FDA CTP)
- Contract Nos. HHSN271201100027C and HHSN271201600001C National Institute on Drug Abuse, National Institutes of Health (NIH NIDA), and the Center for Tobacco Products, Food and Drug Administration (FDA CTP)
- Contract Nos. HHSN271201100027C and HHSN271201600001C National Institute on Drug Abuse, National Institutes of Health (NIH NIDA), and the Center for Tobacco Products, Food and Drug Administration (FDA CTP)
- Contract Nos. HHSN271201100027C and HHSN271201600001C National Institute on Drug Abuse, National Institutes of Health (NIH NIDA), and the Center for Tobacco Products, Food and Drug Administration (FDA CTP)
- Contract Nos. HHSN271201100027C and HHSN271201600001C National Institute on Drug Abuse, National Institutes of Health (NIH NIDA), and the Center for Tobacco Products, Food and Drug Administration (FDA CTP)
- Contract Nos. HHSN271201100027C and HHSN271201600001C National Institute on Drug Abuse, National Institutes of Health (NIH NIDA), and the Center for Tobacco Products, Food and Drug Administration (FDA CTP)
- Contract Nos. HHSN271201100027C and HHSN271201600001C National Institute on Drug Abuse, National Institutes of Health (NIH NIDA), and the Center for Tobacco Products, Food and Drug Administration (FDA CTP)
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Affiliation(s)
- Eva Sharma
- Westat, 1600 Research Blvd., Rockville, MD, 20850, USA.
| | | | | | | | - Samantha VanEtten
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD, USA
| | - Adam F Benson
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD, USA
| | - Cristine D Delnevo
- Rutgers Institute for Nicotine & Tobacco Studies, Rutgers Biomedical and Health Sciences, Rutgers University, New Brunswick, NJ, USA
| | - Daniela Marshall
- National Institute On Drug Abuse, National Institutes of Health, Bethesda, MD, USA
- Axle Informatics, Rockville, MD, USA
| | - Heather L Kimmel
- National Institute On Drug Abuse, National Institutes of Health, Bethesda, MD, USA
| | | | - Maansi Bansal-Travers
- Department of Health Behavior, Division of Cancer Prevention & Population Sciences, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Andrew Hyland
- Department of Health Behavior, Division of Cancer Prevention & Population Sciences, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
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Haynes A, Winnall WR, Brennan E, Dunstone K, Benowitz NL, Ashley DL, Samet JM, Hatsukami DK, Wakefield MA. Tobacco Constituents, Flavorants, and Paper Permeability of Factory-Made and Roll-Your-Own Cigarettes on the Australian Market. Nicotine Tob Res 2024; 26:289-297. [PMID: 37462724 DOI: 10.1093/ntr/ntad122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 05/24/2023] [Indexed: 02/23/2024]
Abstract
INTRODUCTION Roll-your-own (RYO) tobacco is a popular choice in Australia, with some people who smoke finding these products more attractive than factory-made cigarettes (FMC). Differences in visual and tactile properties and in the feel and taste of the smoke may contribute to this attractiveness. These differences may be driven by variation in tobacco constituents and wrapping paper permeability. However, to date, there has been no comparison of RYO and FMC products on the Australian market. AIMS AND METHODS Chemical constituents, pH, flavorants, and paper permeability were compared in unburned RYO tobacco and tobacco from FMC. RYO and FMC products from matched brands were compared, as were products from the most popular FMC and RYO brands on the Australian market in 2018. RESULTS RYO tobacco had higher moisture and humectant content (glycerol and propylene glycol) than FMC tobacco. RYO tobacco also had higher amounts of total and reducing sugars and lower nicotine when comparing the most popular brands. RYO papers were less permeable than FMC papers. Both RYO and FMC tobacco contained many chemicals identified as flavorants, including fourteen with known potential health risks. For most measured constituents and flavorants, RYO tobaccos had more in common with other RYO than FMC, with the commonalities remaining even when matched brands were compared. CONCLUSIONS Higher levels of moisture, humectants, and sugars in Australian RYO tobacco compared to FMC may be increasing attractiveness of RYO by reducing the harsh taste of the smoke and increasing the moist feel of the tobacco. IMPLICATIONS While price is the main factor driving the use of RYO tobacco, some people who smoke find these products more attractive. This study has shown that Australian RYO tobacco contains higher amounts of glycerol, propylene glycol, and sugars than FMC. These chemicals may be improving the taste of the tobacco, as well as creating a moist feel that is falsely perceived as indicating that the tobacco is "fresh" and "less chemically." Ironically, it may be that higher amounts of some added chemicals in RYO contribute to false perceptions of a more natural and less harmful product.
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Affiliation(s)
- Ashleigh Haynes
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, VIC, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Wendy R Winnall
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, VIC, Australia
| | - Emily Brennan
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, VIC, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Kimberley Dunstone
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, VIC, Australia
| | - Neal L Benowitz
- School of Medicine, University of California, San Francisco, CA, USA
| | - David L Ashley
- School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Jonathan M Samet
- Colorado School of Public Health, University of Colorado Anschutz, Aurora, CO, USA
| | - Dorothy K Hatsukami
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Melanie A Wakefield
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, VIC, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
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Ai J, Hassink M, Taylor KM, Kuklenyik P, Valentín-Blasini L, Watson C. Tobacco-Specific Nitrosamines in Current Commercial Large Cigars, Cigarillos, and Little Cigars. Chem Res Toxicol 2024; 37:220-226. [PMID: 38235526 PMCID: PMC10922615 DOI: 10.1021/acs.chemrestox.3c00211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
We measured levels of nitrosonornicotine (NNN) and 4-[methyl(nitroso)amino]-1-(3-pyridinyl)-1-butanone (NNK), the two most carcinogenic tobacco-specific nitrosamines, in the filler, binder, and wrapper of 50 cigars: 19 large cigars, 23 cigarillos, and 8 little cigars. The average NNN and NNK levels were 10.6 and 3.70 μg/g, respectively. These levels are 5- and 7-fold higher, respectively, than those of commercial cigarettes. The differences in NNN and NNK levels between cigars and cigarettes reflect differences in tobacco blends and tobacco treatments, such as fermentation. The average tobacco NNN and NNK levels of large cigars were 3- and 5-fold higher than those of cigarillos and little cigars, respectively. Large cigars also exhibited a significantly broader range of NNN and NNK than cigarillos and little cigars. The NNN and NNK levels in cigarillos are comparable to those of little cigars. These results are consistent with earlier studies finding that cigarillos and little cigars have similar tobacco blends with lower NNN and NNK content than large cigar tobacco blends.
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Affiliation(s)
- Jiu Ai
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Document Control Center, Building 71, Room G335, Silver Spring, Maryland 20993, United States
| | - Matthew Hassink
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Document Control Center, Building 71, Room G335, Silver Spring, Maryland 20993, United States
| | - Kenneth M Taylor
- U.S. Food and Drug Administration, Center for Veterinary Medicine, Office of Applied Science, Division of Residue Chemistry, 8401 Muirkirk Road, Laurel, Maryland 20708, United States
| | - Peter Kuklenyik
- Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, Georgia 30341, United States
| | - Liza Valentín-Blasini
- Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, Georgia 30341, United States
| | - Clifford Watson
- Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, Georgia 30341, United States
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Dai HD, Benowitz NL, Rogan E, Degarege A, Buckley J, Khan AS. Biomarkers of Toxic Exposure and Oxidative Stress Among U.S. Adult Users of Premium Cigar Versus Other Cigar Subtypes: 2013-2019. Nicotine Tob Res 2023; 25:S84-S93. [PMID: 37506235 PMCID: PMC10381103 DOI: 10.1093/ntr/ntad054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 03/19/2023] [Accepted: 04/05/2023] [Indexed: 07/30/2023]
Abstract
INTRODUCTION Cigars are currently the second-highest-used combustible tobacco product among U.S. adults, but knowledge about health effects of premium cigars versus other cigar subtype use is limited. AIMS AND METHODS This study analyzed the biospecimen data (n = 31 875) from Waves 1-5 of the Population Assessment of Tobacco and Health Study, collected during 2013-2019. Multivariable generalized estimation equations, accounting for within-person clustering, were conducted to examine differences in urine biomarkers of exposure (BOE) from five classes of harmful and potentially harmful constituents along with a biomarker of oxidative stress (urine 8-isoprostane) among exclusive users of premium cigars versus other exclusive cigar subtypes (ie, non-premium large cigars, cigarillos, and filtered cigars), cigarettes, and non-tobacco users. RESULTS In comparison to non-tobacco users, exclusive premium cigar users had higher geometric mean concentrations of the nicotine metabolite cotinine (5.8 vs. 0.5ng/mg, p < .0001), tobacco-specific nitrosamine (TSNA) (4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL): 7.8 vs. 1.3pg/mg, p < .0001), and volatile organic compound (VOC) (N-Acetyl-S-(2-cyanoethyl)-L-cysteine (CYMA, acrylonitrile): 4.7 vs. 1.6ng/mg, p < .0001). Exclusive premium cigar users were less likely to be daily users than other tobacco user groups and had comparable BOEs with exclusive non-premium large cigar users but generally lower BOEs than exclusive cigarillo, filtered cigar, and cigarette smokers. Daily exclusive premium cigar users had similar nicotine and TSNA exposure but lower exposure to polycyclic aromatic hydrocarbons and volatile organic compounds than exclusive cigarillo and filtered cigar users. CONCLUSIONS Premium cigar use exhibits different exposure to toxicants from other cigar subtype users. Regulations of premium cigars need to formalize product definition and take the population's health effects into consideration. IMPLICATIONS This population study provides important information on BOE and potential harm with premium cigar use and its potential health effects. At present, premium cigars appear to pose a relatively low overall population health risk due to low frequency of use. However, future regulation of other tobacco products might change the landscape of premium cigar use and alter the overall health impact.
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Affiliation(s)
- Hongying Daisy Dai
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Neal L Benowitz
- The Center for Tobacco Control Research and Education, Department of Medicine, University of California, San Francisco, CA, USA
| | - Eleanor Rogan
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Abraham Degarege
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - James Buckley
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Ali S Khan
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
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Ashley DL, Zhu W, Watson CH, Bravo R, Ngac PK, Valentin-Blasini L, Pickworth WB, Kurti AN, Cunningham C, Blount BC. Mouth Level Intake of Nicotine from Three Brands of Little Filtered Cigars with Widely Differing Product Characteristics Among Adult Consumers. Chem Res Toxicol 2023; 36:43-52. [PMID: 36598842 DOI: 10.1021/acs.chemrestox.2c00261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Little filtered cigars are tobacco products with many cigarette-like characteristics. However, despite cigars falling under the U.S. Food and Drug Administration regulatory authority, characterizing flavors, which are still allowed in little filtered cigars, and filter design may influence how people use the products and the resulting exposure to harmful and potentially harmful constituents. We estimated nicotine mouth level intake (MLI) from analyses of little cigar filter butt solanesol levels, brand characteristics, carbon monoxide boost, and puff volume in 48 dual cigarette/cigar users during two repeat bouts of ad lib smoking of three little filtered cigar brands. Mean nicotine MLI for the three brands was significantly different with Swisher Sweets (0.1% ventilation) Cherry at 1.20 mg nicotine, Cheyenne Menthol (1.5%) at 0.63 mg, and Santa Fe unflavored (49%) at 0.94 mg. The association between nicotine MLI and puff volume was the same between Cheyenne Menthol and Santa Fe unflavored. However, these were different from Swisher Sweets Cherry. At least five main factors─flavor, ventilation, filter design, nicotine delivery related to tar, and user puff volume─may directly or indirectly impact MLI and its association with other measures. We found that users of little filtered cigars that have different filter ventilation and flavor draw dissimilar amounts of nicotine from the product, which may be accompanied by differences in exposure to other harmful smoke constituents.
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Affiliation(s)
- David L Ashley
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, Georgia 30303, United States
| | - Wanzhe Zhu
- Tobacco and Volatiles Branch, Division of Laboratory Sciences, National Center for Environmental Health, United States Centers for Disease Control and Prevention, Atlanta, Georgia 30341, United States
| | - Clifford H Watson
- Tobacco and Volatiles Branch, Division of Laboratory Sciences, National Center for Environmental Health, United States Centers for Disease Control and Prevention, Atlanta, Georgia 30341, United States
| | - Roberto Bravo
- Tobacco and Volatiles Branch, Division of Laboratory Sciences, National Center for Environmental Health, United States Centers for Disease Control and Prevention, Atlanta, Georgia 30341, United States
| | - Phuong K Ngac
- Tobacco and Volatiles Branch, Division of Laboratory Sciences, National Center for Environmental Health, United States Centers for Disease Control and Prevention, Atlanta, Georgia 30341, United States
| | - Liza Valentin-Blasini
- Tobacco and Volatiles Branch, Division of Laboratory Sciences, National Center for Environmental Health, United States Centers for Disease Control and Prevention, Atlanta, Georgia 30341, United States
| | - Wallace B Pickworth
- Battelle Public Health Research Center, Baltimore, Maryland 21209, United States
| | - Allison N Kurti
- Center for Tobacco Products, United States Food and Drug Administration, Silver Spring, Maryland 20993, United States
| | - Colin Cunningham
- Center for Tobacco Products, United States Food and Drug Administration, Silver Spring, Maryland 20993, United States
| | - Benjamin C Blount
- Tobacco and Volatiles Branch, Division of Laboratory Sciences, National Center for Environmental Health, United States Centers for Disease Control and Prevention, Atlanta, Georgia 30341, United States
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Young M, Feng C, Cecil T, Johnson TL. Carbonyl Yields in Cigars under Three Smoking Regimens Using a Linear Smoking Machine. Chem Res Toxicol 2023; 36:94-103. [PMID: 36602460 PMCID: PMC9846831 DOI: 10.1021/acs.chemrestox.2c00322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
This study used standard linear smoking machines and puffing protocols to generate data on carbonyl yields in mainstream smoke from 11 unfiltered sheet-wrapped cigars (SWC), seven leaf-wrapped cigars (LWC), and two Kentucky reference cigarettes (3R4F, 1R6F). Carbonyl yields in cigar and cigarette products were determined using three different smoking regimens: International Organization for Standardization (ISO), Canadian Intense (CI), and Cooperation Centre for Scientific Research Relative to Tobacco (CORESTA) Recommended Method (CRM) No. 64 (CRM64, Routine Analytical Cigar-Smoking Machine─Specifications, Definitions and Standard Conditions). Mainstream tobacco smoke was collected using a smoking machine fitted with an impinger containing 2,4-dinitrophenylhydrazine (DNPH) and carbonyl compounds quantified using liquid chromatography with an ultraviolet detector. Commercial SWC and LWC generated comparable formaldehyde yields (SWC, 9.4-28 μg/cigar [ISO], 8.2-43 μg/cigar [CI], 8.6-13 μg/cigar [CRM64]; LWC, 11-13 μg/cigar [ISO], 11-22 μg/cigar [CI], 16-21 μg/cigar [CRM64]) and acrolein yields; however, LWC generated higher acetaldehyde yields compared to SWC, using CI and CRM64 regimens. Reference cigarettes using standard puffing regimens generated carbonyl yields within reported ranges and 5-10% RSDs, whereas the CRM64 regimen generated lower carbonyl yields and 12-14% RSDs. Reference cigarettes generated higher formaldehyde yields using cigarette smoking regimens (21-28 μg/cigarette under ISO, 76-96 μg/cigarette under CI) but comparable formaldehyde yields under CRM64 (12-14 μg/cigarette). In addition, this study evaluated physical parameters (e.g., tobacco weight, length, diameter, circumference, tobacco rod density) that show the correlation between tobacco weight, tobacco rod density, and acetaldehyde yields under the three smoking regimens. Carbonyl yields in the mainstream smoke of cigar products using the three smoking regimens were highly variable; however, the CI smoking regimen may provide meaningful analytical information regarding cigar smoke constituents, with lower likelihood of self-extinguishment due to the short puffing intervals.
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8
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Cornacchione Ross J, K Suerken C, Reboussin BA, Denlinger-Apte RL, Spangler JG, Sutfin EL. Cigar Harm Beliefs and Associations with Cigar Use among Young Adults. Subst Use Misuse 2022; 57:1478-1485. [PMID: 35786154 PMCID: PMC9680833 DOI: 10.1080/10826084.2022.2092149] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Cigar use, including little cigars and cigarillos (LCCs) and large traditional cigars, continues to harm young adults. Research on harm beliefs about cigars, particularly large cigars, is sparse. The current study examined cigar harm beliefs and associations with cigar use. Methods: Data are from a 2019 survey of a young adult cohort study recruited in fall 2010. Participants were asked questions about their beliefs about the harm of LCC and large cigar use. Those reporting ever use of cigars were asked how frequently they inhale the smoke into their lungs. Results: Participants (N = 1910) were 51.9% female with a mean age of 26.7 (SD = 0.6). Ever cigar use was 44.2% for large cigars and 43% for LCCs. Compared to those who have never used large cigars or LCCs, those reporting ever use of large cigars or LCCs reported lower harm beliefs about inhaling harmful chemicals and becoming addicted (ps <.0001). Those who reported higher harm beliefs also reported inhaling the smoke into their lungs more frequently for large cigars and LCCs (ps<.05). Conclusions: Cigar use harm beliefs were lower among participants reporting ever use of cigars compared to those reporting never use. Contrary to predictions, those reporting greater harm beliefs were more likely to report inhaling smoke more frequently than those with lower harm beliefs.
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Affiliation(s)
- Jennifer Cornacchione Ross
- Department of Social Sciences & Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Cynthia K Suerken
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Beth A Reboussin
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Rachel L Denlinger-Apte
- Department of Social Sciences & Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - John G Spangler
- Department of Family and Community Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Erin L Sutfin
- Department of Social Sciences & Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Li Y, Hecht SS. Carcinogenic components of tobacco and tobacco smoke: A 2022 update. Food Chem Toxicol 2022; 165:113179. [PMID: 35643228 PMCID: PMC9616535 DOI: 10.1016/j.fct.2022.113179] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/20/2022] [Accepted: 05/22/2022] [Indexed: 01/13/2023]
Abstract
Tobacco and tobacco smoke contain a complex mixture of over 9500 chemical compounds, many of which have been recognized as hazardous to human health by regulatory agencies. In 2012, the U.S. Food and Drug Administration established a list of harmful and potentially harmful constituents in unburned tobacco and tobacco smoke, 79 of which are considered as carcinogens. Over the past 10 years, with advancing analytical technology, significant amounts of new data have been published, increasing our understanding of levels of carcinogens in tobacco products. The International Agency for Research on Cancer (IARC) has released 35 monographs since 2012, with an increasing number of compounds in unburned tobacco and tobacco smoke classified as carcinogens. In this paper, we provide an updated list of IARC-classified carcinogens in unburned tobacco and tobacco mainstream smoke. A total of 83 carcinogens has been identified - 37 in unburned tobacco and 80 in tobacco smoke - with their occurrence levels reported since 2012. No clear decreasing trends were observed for any of these carcinogens in recent years. Surveillance of the levels of tobacco carcinogens as well as regulatory actions are needed to ensure control of their levels so that potential reduced risks of cancer and other diseases may be achieved.
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Affiliation(s)
- Yupeng Li
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, 55455, USA; Department of Medicinal Chemistry, University of Minnesota, Minneapolis, MN, 55455, USA.
| | - Stephen S Hecht
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, 55455, USA.
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Elhabashy M, Phan L, Hamilton-Moseley KR, Broun A, Duarte DA, Ajith A, Jewett B, Mead-Morse EL, Choi K, Chen-Sankey J. Exploring the Experiences and Perceptions of Cigar Craving and Addiction among Young Adult Black Cigar Smokers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:6680. [PMID: 35682264 PMCID: PMC9180285 DOI: 10.3390/ijerph19116680] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 05/27/2022] [Accepted: 05/28/2022] [Indexed: 01/25/2023]
Abstract
Black young adults have the highest prevalence of cigar smoking in the U.S. Little is known about how this population perceives addiction to cigar smoking, which may influence long-term smoking and cessation outcomes. This study used semi-structured in-depth interviews to understand cravings, triggers, and perceived addiction from cigar smoking among a purposive sample of Black young adult cigar smokers (N = 40; 21-29 years). An iterative process was used to develop the codebook, and thematic analysis was used to capture findings based on the products predominantly used: cigarillos, large cigars, or blunts. Results suggest that while participants may share similar types of cravings and triggers (e.g., stress) across the use of these products, predominant blunt smokers reported more unique triggers related to relieving physical discomforts. While most participants reported cigars could be addictive to people in general, only a few perceived that they themselves were addicted. Participants who predominantly smoked cigarillos reported high perceived addiction to cigars, while those who predominantly smoked blunts reported low addiction. Education messages are needed to inform young Black adult cigar smokers about the risks and health symptoms of cigar addiction. These efforts may help increase cigar cessation seeking and reduce cigar addiction-related health consequences and disparities among Black populations.
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Affiliation(s)
- Maryam Elhabashy
- Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ 08901, USA;
| | - Lilianna Phan
- National Institute on Minority Health and Health Disparities, Division of Intramural Research, Bethesda, MD 20814, USA; (L.P.); (K.R.H.-M.); (B.J.); (K.C.)
| | - Kristen R. Hamilton-Moseley
- National Institute on Minority Health and Health Disparities, Division of Intramural Research, Bethesda, MD 20814, USA; (L.P.); (K.R.H.-M.); (B.J.); (K.C.)
| | - Aaron Broun
- Milken Institute School of Public Health, George Washington University, Washington, DC 20052, USA; (A.B.); (D.A.D.)
| | - Danielle A. Duarte
- Milken Institute School of Public Health, George Washington University, Washington, DC 20052, USA; (A.B.); (D.A.D.)
| | - Aniruddh Ajith
- School of Medicine, University of Pittsburgh, Pittsburgh, PA 15201, USA;
| | - Bambi Jewett
- National Institute on Minority Health and Health Disparities, Division of Intramural Research, Bethesda, MD 20814, USA; (L.P.); (K.R.H.-M.); (B.J.); (K.C.)
| | - Erin L. Mead-Morse
- School of Medicine, University of Connecticut, Farmington, CT 06032, USA;
| | - Kelvin Choi
- National Institute on Minority Health and Health Disparities, Division of Intramural Research, Bethesda, MD 20814, USA; (L.P.); (K.R.H.-M.); (B.J.); (K.C.)
| | - Julia Chen-Sankey
- Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ 08901, USA;
- School of Public Health, Rutgers University, Piscataway, NJ 08854, USA
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Flocke SA, Ishler K, Albert E, Cavallo D, Lim R, Trapl E. Measuring nicotine dependence among adolescent and young adult cigarillo users. Nicotine Tob Res 2022; 24:1789-1797. [PMID: 35512368 PMCID: PMC9596997 DOI: 10.1093/ntr/ntac117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 03/11/2022] [Accepted: 05/02/2022] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Current measures of nicotine dependence (ND) were developed and validated for cigarette smokers only, limiting their utility for other combustible tobacco users. This study evaluates the psychometric properties of a pool of new and adapted items to measure ND among cigarillo and multiple tobacco product users. METHODS Items were drawn from the PROMIS Nicotine Dependence Item Bank which were adapted to be product neutral and new items were developed from a qualitative study of 60 adolescent and young adult cigarillo smokers. A total of 42 ND items were included in a web-based survey. Eligible participants were 14 to 28 year olds who smoked a minimum of 2 cigarillos per week. Analyses included confirmatory factor analysis, item response theory analysis, analysis of differential item functioning (DIF) and reliability. Ordinary least square regression was used to test the association of ND score with deciles of nicotine consumption. RESULTS Among the 1089 participants, the median number of cigarillos smoked per week was 20; 54% of participants also smoked cigarettes. All PROMIS items and 8 of 10 new items met the IRT fit criteria. Two PROMIS items had non-ignorable DIF. The pool of 40 items had good score reliability for a range of 2 standard deviations. Twenty-, eight-, and four-item short forms showed similarly good measurement properties; each was positively associated with decile of nicotine consumption, p<.001; R 2 = 0.33. CONCLUSIONS This adapted bank of ND items is psychometrically sound and includes items that are product neutral, making it suitable for assessing ND among cigarillo and polytobacco users. IMPLICATIONS This study rigorously evaluates adapted items to measure ND among cigarillo and polytobacco users and reports the reliability initial evidence of validity of short form scores.
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Affiliation(s)
- Susan A Flocke
- Department of Family Medicine, Oregon Health & Science University, Portland OR, USA
| | - Karen Ishler
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland OH, USA
| | - Elizabeth Albert
- Center for Community Health Integration, Case Western Reserve University, Cleveland OH,USA
| | - David Cavallo
- Department of Nutrition, Case Western Reserve University, Cleveland OH, USA
| | - Rock Lim
- Case Western Reserve University, Center for Community Health Integration, Cleveland OH, USA
| | - Erika Trapl
- Department of Population and Quantitative Health Sciences and the Prevention Research Center for Healthy Neighborhoods, Case Western Reserve University, Cleveland OH, USA
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12
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Li Y, Hecht SS. Metabolism and DNA Adduct Formation of Tobacco-Specific N-Nitrosamines. Int J Mol Sci 2022; 23:5109. [PMID: 35563500 PMCID: PMC9104174 DOI: 10.3390/ijms23095109] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/29/2022] [Accepted: 04/30/2022] [Indexed: 01/06/2023] Open
Abstract
The tobacco-specific N-nitrosamines 4-(N-nitrosomethylamino)-1-(3-pyridyl)-1-butanone (NNK) and N'-nitrosonornicotine (NNN) always occur together and exclusively in tobacco products or in environments contaminated by tobacco smoke. They have been classified as "carcinogenic to humans" by the International Agency for Research on Cancer. In 1998, we published a review of the biochemistry, biology and carcinogenicity of tobacco-specific nitrosamines. Over the past 20 years, considerable progress has been made in our understanding of the mechanisms of metabolism and DNA adduct formation by these two important carcinogens, along with progress on their carcinogenicity and mutagenicity. In this review, we aim to provide an update on the carcinogenicity and mechanisms of the metabolism and DNA interactions of NNK and NNN.
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Affiliation(s)
- Yupeng Li
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA;
- Department of Medicinal Chemistry, College of Pharmacy, University of Minnesota, Minneapolis, MN 55455, USA
| | - Stephen S. Hecht
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA;
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13
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Historical Perspective of Proactive and Reactive Regulations of E-cigarettes to Combat Nicotine Addiction. J Addict Med 2021; 14:443-445. [PMID: 32097237 DOI: 10.1097/adm.0000000000000627] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cigarettes and electronic cigarettes (e-cigarettes) are major sources of exposure to nicotine, an addictive chemical. Although these products are being regulated by the Food and Drug Administration (FDA) under the Tobacco Control Act, specifications about the nicotine content in these products have not been established yet. In e-cigarettes, nicotine concentration ranges from 0 to > 50mg/mL, and the recent e-cigarette devices provide control to change nicotine flux for higher nicotine delivery. Due to the lack of robust regulations in manufacturing, distribution and marketing, e-cigarettes have already infiltrated the market with youth appealing flavors and devices. As a result, the country is facing a youth epidemic of e-cigarette use. The unregulated nicotine levels in both cigarettes and e-cigarettes can lead to repeated and overexposure of nicotine to youth which can lead to the addiction and detrimental effects on their cognitive functions. Over the past decade, the corrective measures being taken by the FDA for cigarette and e-cigarette regulations also should focus on nicotine exposure levels. Before it is too late to prevent youth from lifetime addiction to nicotine, it is important to address the issues of nicotine concentration, nicotine flux and the e-cigarette device regulations while offering adults with smoking disorder less harmful alternatives to cigarettes.
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14
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Kotlyar M, Shanley R, Dufresne SR, Corcoran GA, Okuyemi KS, Mills AM, Hatsukami DK. Effects on smoking behavior of switching menthol smokers to non-menthol cigarettes. Nicotine Tob Res 2021; 23:1921-1927. [PMID: 33983396 DOI: 10.1093/ntr/ntab090] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 05/06/2021] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Bans of menthol characterizing flavor in cigarettes have been implemented in some localities and have been proposed more broadly. One proposed benefit of such a ban is to increase cessation rates among current menthol smokers. There is currently relatively limited data regarding how smoking behavior changes if menthol smokers switch to non-menthol cigarettes. METHODS African American menthol smokers interested in quitting smoking were randomized to either continue smoking menthol (n=60) or switch to non-menthol cigarettes (n=62) for one month prior to a cessation attempt. Cessation results were reported previously; this analysis reports the results from the pre-cessation visits at which amount smoked, exhaled carbon monoxide concentration (CO), urinary cotinine concentrations and subjective measures were assessed. RESULTS Over the four-week study period, those switching to non-menthol (vs. continuing to smoke menthol) cigarettes smoked fewer cigarettes per day (mean ratio: 0.86; 95% CI: 0.76, 0.98; p=0.02), reported lower withdrawal symptom severity (mean difference -1.29; 95% CI: -2.6 to -0.01; p=0.05) and higher perceived effectiveness of their skills for quitting smoking (mean difference 0.56; 95% CI: 0.02 to 1.10; p=0.05). No significant differences were found between groups in exhaled CO, urinary cotinine concentrations or most other subjective effects including support for a ban on menthol characterizing flavor in cigarettes. CONCLUSIONS These results suggest that were menthol cigarettes no longer available, those that switch to non-menthol cigarettes would not change their smoking behavior in a way that is likely to be more hazardous, with some indicators suggesting that there may be some benefit. IMPLICATIONS A ban on menthol characterizing flavor in cigarettes has been proposed as a potential means by which to increase smoking cessation rates among current menthol cigarette smokers. This study evaluated how African American menthol cigarette smokers adjusted their smoking behavior after switching to non-menthol cigarettes. Although the overall differences between groups were modest, they were in a direction consistent with decreased smoking suggesting that current smokers would not adjust their behavior in a way that is likely to be more hazardous, with some indicators suggesting that there may be some benefits.
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Affiliation(s)
- Michael Kotlyar
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota.,Masonic Cancer Center, University of Minnesota, Minneapolis.,Department of Psychiatry and Behavioral Sciences, University of Minnesota
| | - Ryan Shanley
- Biostatistics Core, Masonic Cancer Center, University of Minnesota, Minneapolis
| | - Sheena R Dufresne
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota
| | - Gretchen A Corcoran
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota
| | - Kolawole S Okuyemi
- Currently at the University of Utah, Department of Family and Preventive Medicine
| | - Anne M Mills
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota
| | - Dorothy K Hatsukami
- Masonic Cancer Center, University of Minnesota, Minneapolis.,Department of Psychiatry and Behavioral Sciences, University of Minnesota
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15
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Macroscopic Changes in Oral Mucosa and Hygiene Indicators in Smokers. CURRENT HEALTH SCIENCES JOURNAL 2021; 47:383-392. [PMID: 35003770 PMCID: PMC8679161 DOI: 10.12865/chsj.47.03.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 08/15/2021] [Indexed: 11/18/2022]
Abstract
Smoking is the most important factor affecting the oral cavity by components born in the tobacco combustion process and acting directly on the oral mucous membranes, dental arch and indirectly on the teeth support. Recent studies show the tobacco action on the oral cavity, manifestations in the form of gingivitis, bacterial plaque, dental plaque, papillary bleeding at drilling, periodontitis. PURPOSE OF THE STUDY In this study, we have set out to assess the macroscopic modifications of oral cavity on smokers. MATERIALS AND METHODS The participants in the study were divided into two groups, the first group of smokers with a smoking period over 5 years and the control group of nonsmokers. The patients in the two groups underwent a physical examination and an objective clinical examination, the resulting data being compared with the control group. RESULTS For the bacterial plaque indicatorin the smoker group there was obtained a mean value of 35.68±12.45, compared to a mean value of 16.32±6.61 for the nonsmoker group, the dental plaque indicatorfor the smoker group had a mean value of 2.24±1.02, higher than the one in the nonsmoker group, namely 0.94±0.68, and for the drilling bleeding indicator we obtained a mean value of 19.54±7.89 in the nonsmoker group, which is lower than that in the smoker group, namely 42.86±14.93. CONCLUSIONS Smoking is a cause that maintains and aggravates the periodontal disease, including the risk of periodontitis, allowing the aggravation of gingivitis, considered a reversible surface inflammation of the gum mucosa which, by accumulation of dental plaque, the dental plaque accompanied by incorrect oral hygiene, favors the progression to periodontitis.
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Schneller LM, Quiñones Tavárez Z, Goniewicz ML, Xie Z, McIntosh S, Rahman I, O’Connor RJ, Ossip DJ, Li D. Cross-Sectional Association Between Exclusive and Concurrent Use of Cigarettes, ENDS, and Cigars, the Three Most Popular Tobacco Products, and Wheezing Symptoms Among U.S. Adults. Nicotine Tob Res 2020; 22:S76-S84. [PMID: 33320256 PMCID: PMC8224835 DOI: 10.1093/ntr/ntaa199] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 09/29/2020] [Indexed: 01/05/2023]
Abstract
INTRODUCTION This study assessed the association of exclusive and concurrent use of cigarettes, electronic nicotine delivery systems (ENDS), and cigars with ever and past 12-month wheezing symptoms among a nationally representative sample of US adult current tobacco users. METHODS Cross-sectional data from the Population Assessment of Tobacco and Health (PATH) Study Wave 3 (W3) were used. The weighted prevalence of self-reported ever and past 12-month wheezing symptoms for noncurrent users compared with users of cigarettes, ENDS, cigars, and any combination of these products (polytobacco use of these tobacco products) were presented for 28 082 adults. The cross-sectional association of tobacco use with self-reported wheezing symptoms was assessed using weighted multivariable and ordinal logistic regression with consideration of complex sampling design. RESULTS Significantly higher odds of ever had wheezing or whistling in the chest at any time in the past were observed among current cigarette (adjusted odds ratio: 2.62, 95% confidence intervals [CI]: 2.35, 2.91), ENDS (1.49, 95% CI: 1.14, 1.95), and polytobacco users (2.67, 95% CI: 2.26, 3.16) compared with noncurrent users. No associations were seen for cigar use. Polytobacco use was associated with a higher odds of ever wheezing when compared with exclusive ENDS (1.61, 95% CI: 1.19, 2.17) and exclusive cigar use (2.87, 95% CI: 1.93, 4.26), but not exclusive use of cigarettes. CONCLUSIONS Ever wheezing is associated with the use of cigarettes, ENDS, and polytobacco use of cigarettes, ENDS, and/or cigars, but not cigar use. The association of polytobacco use and wheezing appears to be driven by cigarette use. IMPLICATIONS Cross-sectional associations with ever and past 12-month wheezing symptoms were found to be the strongest among cigarette users, exclusively or in combination. Future longitudinal research is needed to better understand how cigarette use interacts with other tobacco and nicotine products and contributes to respiratory symptoms.
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Affiliation(s)
- Liane M Schneller
- Clinical and Translational Science Institute, University of Rochester Medical Center, Rochester, NY
| | - Zahíra Quiñones Tavárez
- Clinical and Translational Science Institute, University of Rochester Medical Center, Rochester, NY
| | - Maciej L Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Zidian Xie
- Clinical and Translational Science Institute, University of Rochester Medical Center, Rochester, NY
| | - Scott McIntosh
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY
| | - Irfan Rahman
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY
| | - Richard J O’Connor
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Deborah J Ossip
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY
| | - Dongmei Li
- Clinical and Translational Science Institute, University of Rochester Medical Center, Rochester, NY
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Gomez Y, Creamer M, Trivers KF, Anic G, Morse AL, Reissig C, Agaku I. Patterns of tobacco use and nicotine dependence among youth, United States, 2017-2018. Prev Med 2020; 141:106284. [PMID: 33068604 DOI: 10.1016/j.ypmed.2020.106284] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 08/26/2020] [Accepted: 10/10/2020] [Indexed: 01/03/2023]
Abstract
This study examined patterns of tobacco product use and their association with nicotine dependence among U.S. youth. Combined data from the 2017-2018 National Youth Tobacco Surveys were analyzed for students that reported current (past-30-day) use of e-cigarettes, cigarettes, cigars, smokeless tobacco, or hookah (n = 6106). Analyses assessed multiple product use (≥2 tobacco products) overall and by sex, school level, race/ethnicity, current use, and frequent use (use of a product for ≥20 of the preceding 30 days). Multivariable logistic regression was used to identify correlates of nicotine dependence. During 2017-2018, 40.8% of tobacco product users reported use of multiple products. Multiple product use ranged from 47.0% among e-cigarette users to 80.7% among cigarette smokers. Among frequent users of each respective product, 80.0% of cigarette smokers, 74.9% of cigar smokers, 73.6% of smokeless tobacco users, 70.7% of hookah smokers, and 40.3% of e-cigarette users reported use of multiple products. Most youth who reported nicotine dependence (64.0%) were multiple product users. E-cigarettes were the most common single product used (36.3%) and the product most commonly used in combination with other products; e-cigarettes plus cigarettes (6.7%) was the most common product combination. Combustible product use, smokeless tobacco use, multiple product use and frequent use were associated with greater odds of nicotine dependence. Nicotine dependence among youth is especially influenced by cigarette use, smokeless tobacco use, frequent use of any tobacco product, and multiple product use. Proven tobacco control interventions in coordination with regulatory efforts can reduce youth tobacco product use.
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Affiliation(s)
- Yessica Gomez
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - MeLisa Creamer
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Katrina F Trivers
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Gabriella Anic
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - Aura Lee Morse
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - Chad Reissig
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - Israel Agaku
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
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18
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Heil SH, Bergeria CL, Lee DC, Bunn JY, Harfmann RF, Hughes JR, Tetreault HJ, Higgins ST. Abuse liability of cigarettes with very low nicotine content in pregnant cigarette smokers. Prev Med 2020; 140:106227. [PMID: 32768512 PMCID: PMC7680290 DOI: 10.1016/j.ypmed.2020.106227] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 07/03/2020] [Accepted: 08/02/2020] [Indexed: 01/01/2023]
Abstract
The U.S. Food and Drug Administration has proposed reducing the nicotine content of cigarettes to a minimally-addictive level. To our knowledge, this study is the first to examine how pregnant smokers respond to very low nicotine content (VLNC) cigarettes. In Phase 1, participants blindly sampled two VLNC cigarettes (0.4 and 2.4 mg/g of tobacco) and their usual brand (UB) cigarette in separate sessions, then completed a behavioral economic simulation task and measures of subjective effects, craving/withdrawal, and smoking topography. Phase 2 directly compared the relative reinforcing effects of the cigarettes using concurrent choice testing. All possible dose-pair combinations were tested in separate sessions where puffs were earned ad libitum by clicking the code associated with their preferred cigarette 10 times. Phase 3 tested the 0.4 mg/g-UB dose-pair where UB puffs could be earned with a progressively incremented number of clicks (maximum 8400). Ten pregnant smokers in Burlington, VT and Baltimore, MD participated in 2017-2018. Regarding abuse liability, participants chose the 0.4-mg/g dose less than UB (22% vs. 78%) during concurrent choice testing and the 0.4-mg/g dose sustained less demand than the 2.4-mg/g and UB doses on the simulation task. Positive subjective effects were also lower for both VLNC cigarettes vs. UB. Each cigarette reduced nicotine craving/withdrawal and no significant changes indicative of compensatory smoking were noted. Reducing the nicotine content of cigarettes may decrease their abuse liability in pregnant smokers without causing untoward craving/withdrawal or compensatory smoking. Studies of extended exposure to VLNCs in pregnant women are warranted.
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Affiliation(s)
- Sarah H Heil
- Vermont Center on Behavior and Health, University of Vermont, UHC MS #482, 1 South Prospect St., Burlington, VT 05401, United States of America.
| | - Cecilia L Bergeria
- Vermont Center on Behavior and Health, University of Vermont, UHC MS #482, 1 South Prospect St., Burlington, VT 05401, United States of America.
| | - Dustin C Lee
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224-6823, United States of America.
| | - Janice Y Bunn
- Vermont Center on Behavior and Health, University of Vermont, UHC MS #482, 1 South Prospect St., Burlington, VT 05401, United States of America.
| | - Roxanne F Harfmann
- Vermont Center on Behavior and Health, University of Vermont, UHC MS #482, 1 South Prospect St., Burlington, VT 05401, United States of America.
| | - John R Hughes
- Vermont Center on Behavior and Health, University of Vermont, UHC MS #482, 1 South Prospect St., Burlington, VT 05401, United States of America.
| | - Haley J Tetreault
- Vermont Center on Behavior and Health, University of Vermont, UHC MS #482, 1 South Prospect St., Burlington, VT 05401, United States of America.
| | - Stephen T Higgins
- Vermont Center on Behavior and Health, University of Vermont, UHC MS #482, 1 South Prospect St., Burlington, VT 05401, United States of America.
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19
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Kotlyar M, Shanley R, Dufresne SR, Corcoran GA, Okuyemi KS, Mills AM, Hatsukami DK. Effects on time to lapse of switching menthol smokers to non-menthol cigarettes prior to a cessation attempt: a pilot study. Tob Control 2020; 30:574-577. [PMID: 32719011 DOI: 10.1136/tobaccocontrol-2020-055689] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 05/18/2020] [Accepted: 06/02/2020] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Menthol smokers (particularly African-Americans) have lower cessation success rates than non-menthol smokers. With bans being considered on characterising menthol flavour in cigarettes, data are needed regarding how switching to non-menthol cigarettes impacts cessation measures. METHODS In this randomised pilot study, African-American menthol cigarette smokers interested in quitting smoking either continued smoking menthol cigarettes (n=60) or switched to non-menthol cigarettes (n=62) for a 1-month period prior to a cessation attempt. The primary endpoint was time to smoking lapse (ie, time from quitting until any smoking). Additional endpoints included time to smoking relapse (ie, number of days from quitting until the first of seven consecutive smoking days) and difference between groups in subjective measures. RESULTS After attempting to quit, the non-menthol cigarette group had indications of delayed time to lapse (HR 0.82; 95% CI 0.55 to 1.22; p=0.33) and time to relapse (HR 0.67; 95% CI 0.42 to 1.06; p=0.09), although these were not statistically significant. Post hoc analyses suggest that observed differences were largely due to a smaller proportion of participants in the non-menthol group relapsing within the first day of quitting (21% vs 40%; p=0.05). Values of other measures assessed postcessation were largely similar between groups. CONCLUSIONS These data suggest that among African-American smokers, a menthol cigarette ban would not undermine short-term cessation measures and may result in some benefits. Future research is needed to assess longer term cessation rates and to identify interventions to maximise cessation success in the event of a menthol ban. TRIAL REGISTRATION NUMBER NCT02342327.
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Affiliation(s)
- Michael Kotlyar
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota, USA .,Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ryan Shanley
- Biostatistics Core, Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Sheena R Dufresne
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota, USA
| | - Gretchen A Corcoran
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota, USA
| | - Kolawole S Okuyemi
- Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, Utah, USA
| | - Anne M Mills
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota, USA
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20
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Brinkman MC, Teferra AA, Kassem NO, Kassem NO. Effect of electric heating and ice added to the bowl on mainstream waterpipe semivolatile furan and other toxicant yields. Tob Control 2020; 29:s110-s116. [PMID: 31542776 PMCID: PMC7050391 DOI: 10.1136/tobaccocontrol-2019-054961] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 06/10/2019] [Accepted: 06/13/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVES We examined mainstream total particulate matter, nicotine, cotinine, menthol, pyrene, carbon monoxide (CO) and semivolatile furan yields from a commercial waterpipe with two methods for heating the tobacco, quick-light charcoal (charcoal) and electric head (electric) and two water bowl preparations: with (ice) and without ice (water). METHODS Emissions from a single brand of popular waterpipe tobacco (10 g) were generated using machine smoking according to a two-stage puffing regimen developed from human puffing topography. Tobacco and charcoal consumption were calculated for each machine smoking session as mass lost, expressed as a fraction of presmoking mass. RESULTS The heating method had the greatest effect on toxicant yields. Electric heating resulted in increases in the fraction of tobacco consumed (2.4 times more, p<0.0001), mainstream nicotine (1.4 times higher, p=0.002) and semivolatile furan yields (1.4 times higher, p<0.03), and a decrease in mainstream CO and pyrene yields (8.2 and 2.1 times lower, respectively, p<0.001) as compared with charcoal. Adding ice to the bowl resulted in higher furan yields for electric heating. Menthol yields were not different across the four conditions and averaged 0.16±0.03 mg/session. 2-Furaldehyde and 5-(hydroxymethyl)-2-furaldehyde yields were up to 230 and 3900 times higher, respectively, than those reported for cigarettes. CONCLUSION Waterpipe components used to heat the tobacco and water bowl preparation can significantly affect mainstream toxicant yields. Mainstream waterpipe tobacco smoke is a significant source of inhalation exposure to semivolatile furans with human carcinogenic and mutagenic potential. These data highlight the need for acute and chronic inhalation toxicity data for semivolatile furans and provide support for the establishment of limits governing sugar additives in waterpipe tobacco and educational campaigns linking waterpipe tobacco smoking behaviours with their associated harm.
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Affiliation(s)
| | - Andreas A Teferra
- College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Noura O Kassem
- School of Public Health, San Diego State University, San Diego, California, USA
| | - Nada Of Kassem
- School of Public Health, San Diego State University, San Diego, California, USA
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21
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Goel R, Trushin N, Reilly SM, Bitzer Z, Muscat J, Foulds J, Richie JP. A Survey of Nicotine Yields in Small Cigar Smoke: Influence of Cigar Design and Smoking Regimens. Nicotine Tob Res 2019; 20:1250-1257. [PMID: 29059441 DOI: 10.1093/ntr/ntx220] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 09/22/2017] [Indexed: 11/13/2022]
Abstract
Introduction Although the popularity of small cigar brands that resemble cigarettes, including both little cigars (LC) and filtered cigars (FC), has been on the rise, little is known about the delivery of nicotine from these products. Our objective was to determine the nicotine yields of small cigars in comparison to cigarettes. Methods Nicotine yields from LC, FC, and 3R4F and 1R6F research cigarettes were determined from mainstream smoke generated on a smoking machine under the International Organization of Standardization (ISO) and Canadian Intense (CI) methods. Market characteristics (price and package label) and physical features (filter ventilation, product weight and filter weight, product length, and diameter) were also determined for eight brands of small cigars. Results Nicotine yields in small cigars averaged 1.24 and 3.49 mg/unit on ISO and CI regimens, respectively, compared with 0.73 and 2.35 mg/unit, respectively, for the research cigarettes. Nicotine yields per puff were similar between small cigars and cigarettes. We also found that FC did not differ from LC in nicotine yields. FC and LC differ from each other in many physical design features (unit weight, filter weight, and filter length), but are similar in others (unit length, diameter, and filter ventilation). Conclusions Nicotine delivery from small cigars is similar to or greater than that from cigarettes. Thus, for future research and regulatory purposes, standard definitions need to be developed for small cigars, and FC and LC should be evaluated as separate entities. Implications Small cigars are similar to cigarettes in their design and use. Although nicotine yields per puff were similar between products, small cigars delivered substantially higher amounts of nicotine per unit than cigarettes. These findings support the growing body of evidence to justify regulating all small cigars, including LC and FC in a similar fashion as cigarettes.
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Affiliation(s)
- Reema Goel
- Department of Public Health Sciences, Pennsylvania State University Tobacco Center of Regulatory Science (TCORS), Pennsylvania State University College of Medicine, Hershey, PA
| | - Neil Trushin
- Department of Public Health Sciences, Pennsylvania State University Tobacco Center of Regulatory Science (TCORS), Pennsylvania State University College of Medicine, Hershey, PA
| | - Samantha M Reilly
- Department of Public Health Sciences, Pennsylvania State University Tobacco Center of Regulatory Science (TCORS), Pennsylvania State University College of Medicine, Hershey, PA
| | - Zachary Bitzer
- Department of Food Science, Pennsylvania State University, College of Agricultural Sciences, University Park, PA
| | - Joshua Muscat
- Department of Public Health Sciences, Pennsylvania State University Tobacco Center of Regulatory Science (TCORS), Pennsylvania State University College of Medicine, Hershey, PA
| | - Jonathan Foulds
- Department of Public Health Sciences, Pennsylvania State University Tobacco Center of Regulatory Science (TCORS), Pennsylvania State University College of Medicine, Hershey, PA
| | - John P Richie
- Department of Public Health Sciences, Pennsylvania State University Tobacco Center of Regulatory Science (TCORS), Pennsylvania State University College of Medicine, Hershey, PA
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22
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Goel R, Bitzer ZT, Reilly SM, Foulds J, Muscat J, Elias RJ, Richie JP. Influence of Smoking Puff Parameters and Tobacco Varieties on Free Radicals Yields in Cigarette Mainstream Smoke. Chem Res Toxicol 2018; 31:325-331. [PMID: 29701955 PMCID: PMC6471496 DOI: 10.1021/acs.chemrestox.8b00011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Cigarette smoke is a major exogenous source of free radicals, and the resulting oxidative stress is one of the major causes of smoking-caused diseases. Yet, many of the factors that impact free radical delivery from cigarettes remain unclear. In this study, we machine-smoked cigarettes and measured the levels of gas- and particulate-phase radicals by electron paramagnetic resonance (EPR) spectroscopy using standardized smoking regimens (International Organization of Standardization (ISO) and Canadian Intense (CI)), puffing parameters, and tobacco blends. Radical delivery per cigarette was significantly greater in both gas (4-fold) and particulate (6-fold) phases when cigarettes were smoked under the CI protocol compared to the ISO protocol. Total puff volume per cigarette was the major factor with radical production being proportional to total volume, regardless of whether volume differences were achieved by changes in individual puff volume or puff frequency. Changing puff shape (bell vs sharp vs square) or puff duration (1-5 s), without changing volume, had no effect on radical yields. Tobacco variety did have a significant impact on free radical production, with gas-phase radicals highest in reconstituted > burley > oriental > bright tobacco and particulate-phase radicals highest in burley > bright > oriental > reconstituted tobacco. Our findings show that modifiable cigarette design features and measurable user smoking behaviors are key factors determining free radical exposure in smokers.
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Affiliation(s)
- Reema Goel
- Department of Public Health Sciences, Pennsylvania State University Tobacco Center of Regulatory Science (TCORS), Pennsylvania State University College of Medicine, Hershey, Pennsylvania 17033, United States
| | - Zachary T. Bitzer
- Department of Food Science, College of Agricultural Sciences, Pennsylvania State University, University Park, Pennsylvania 16802, United States
| | - Samantha M. Reilly
- Department of Public Health Sciences, Pennsylvania State University Tobacco Center of Regulatory Science (TCORS), Pennsylvania State University College of Medicine, Hershey, Pennsylvania 17033, United States
| | - Jonathan Foulds
- Department of Public Health Sciences, Pennsylvania State University Tobacco Center of Regulatory Science (TCORS), Pennsylvania State University College of Medicine, Hershey, Pennsylvania 17033, United States
| | - Joshua Muscat
- Department of Public Health Sciences, Pennsylvania State University Tobacco Center of Regulatory Science (TCORS), Pennsylvania State University College of Medicine, Hershey, Pennsylvania 17033, United States
| | - Ryan J. Elias
- Department of Food Science, College of Agricultural Sciences, Pennsylvania State University, University Park, Pennsylvania 16802, United States
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