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Kim S. New opportunities with ENDS for people who smoke and do not intend to quit smoking. Intern Emerg Med 2024; 19:1775-1777. [PMID: 38898216 DOI: 10.1007/s11739-024-03677-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 06/09/2024] [Indexed: 06/21/2024]
Affiliation(s)
- Sooyong Kim
- Pinney Associates Inc, 201 North Craig Street, Pittsburgh, PA, 15213, USA.
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Yue JJ, Gilligan CJ, Falowski S, Jameson J, Desai MJ, Moeschler S, Pilitsis J, Heros R, Tavel E, Wahezi S, Funk R, Buchanan P, Christopher A, Weisbein J, Patterson D, Levy R, Antony A, Miller N, Scarfo K, Kreiner S, Wilson D, Lim C, Braun E, Dickerson D, Duncan J, Xu J, Candido K, Mohab I, Michael F, Blomme B, Okaro U, Deer T. Surgical treatment of refractory low back pain using implanted BurstDR spinal cord stimulation (SCS) in a cohort of patients without options for corrective surgery: Findings and results from the DISTINCT study, a prospective randomized multi-center-controlled trial. NORTH AMERICAN SPINE SOCIETY JOURNAL 2024; 19:100508. [PMID: 39139617 PMCID: PMC11321325 DOI: 10.1016/j.xnsj.2024.100508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 06/08/2024] [Accepted: 06/11/2024] [Indexed: 08/15/2024]
Abstract
Background Low back pain (LBP) is a highly prevalent, disabling condition affecting millions of people. Patients with an identifiable anatomic pain generator and resulting neuropathic lower extremity symptoms often undergo spine surgery, but many patients lack identifiable and/or surgically corrective pathology. Nonoperative treatment options often fail to provide sustained relief. Spinal cord stimulation (SCS) is sometimes used to treat these patients, but the lack of level 1 evidence limits its widespread use and insurance coverage. The DISTINCT RCT study evaluates the efficacy of passive recharge burst SCS compared to conventional medical treatment (CMM) in alleviating chronic, refractory axial low back pain. Methods This prospective, multicenter, randomized, study with an optional 6-month crossover involved patients who were not candidates for lumbar spine surgery. The primary and secondary endpoints evaluated improvements in low back pain intensity (NRS), back pain-related disability (ODI), pain catastrophizing (PCS), and healthcare utilization. Patients were randomized to SCS therapy or CMM at 30 US study sites. Results The SCS arm reported an 85.3% NRS responder rate (≥ 50% reduction) compared to 6.2% (5/81) in the CMM arm. After the 6M primary endpoint, SCS patients elected to remain on assigned therapy and 66.2% (49/74) of CMM patients chose to trial SCS (crossover). At the 12M follow-up, SCS and crossover patients reported 78.6% and 71.4% NRS responder rates. Secondary outcomes indicated significant improvements in ODI, PCS, and reduced healthcare utilization. Six serious adverse events were reported and resolved without sequelae. Conclusion DISTINCT chronic low back pain patients with no indication for corrective surgery experienced a significant and sustained response to burst SCS therapy for up to 12 months. CMM patients who crossed over to the SCS arm reported profound improvements after 6 months. This data advocates for a timely consideration of SCS therapy in patients unresponsive to conservative therapy.
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Affiliation(s)
- James J. Yue
- Connecticut Orthopaedics, Hamden, CT, United States
| | | | - Steven Falowski
- Center for Interventional Pain and Spine, Lancaster, PA, United States
| | | | - Mehul J. Desai
- International Spine, Pain and Performance Center, Washington, DC, United States
| | | | - Julie Pilitsis
- Florida Atlantic University, Boca Raton, FL, United States
| | | | - Edward Tavel
- Clinical Trials of South Carolina, Charleston, SC, United States
| | - Sayed Wahezi
- Montefiore Montefiore Medical Center, Bronx, NY, United States
| | - Robert Funk
- Indiana Spine Group, Indianapolis, IN United States
| | - Patrick Buchanan
- Spanish Hills Interventional Pain Specialists, Camarillo, CA United States
| | | | | | | | - Robert Levy
- Anesthesia Pain Care Consultants, Tamarac, FL United States
| | - Ajay Antony
- The Orthopaedic Institute, Gainesville, FL United States
| | - Nathan Miller
- Coastal Pain & Spinal Diagnostics Medical Group, Carlsbad, CA United States
| | - Keith Scarfo
- Rhode Island Hospital, Providence, RI United States
| | - Scott Kreiner
- Barrow Brain and Spine—Ahwatukee, Phoenix, AZ United States
| | - Derron Wilson
- Goodman Campbell Brain and Spine, Greenwood, IN United States
| | - Chi Lim
- Carolina Orthopaedic and Neurosurgical Associates, Spartanburg, SC United States
| | - Edward Braun
- Kansas University Medical Center, Kansas City, KS United States
| | | | - Jonathan Duncan
- Burkhart Research Institute for Orthopaedics, San Antonio, TX United States
| | - Jijun Xu
- The Cleveland Clinic Foundation, Cleveland, OH United States
| | - Kenneth Candido
- Chicago Anesthesia Associates, SC, Chicago, IL United States
| | - Ibrahim Mohab
- Banner University Medical Center, Tucson, AZ United States
| | | | | | | | - Timothy Deer
- The Spine and Nerve Center of the Virginias, Charleston, WV United States
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Weiger C, Kennedy RD, Villanti AC, Cohen JE, Moran MB. A Descriptive Analysis of Beliefs About Nicotine and Switching to Noncombustibles Among Adults Who Smoke Cigarettes and Believe Nicotine Causes Cancer. Subst Use Misuse 2024:1-8. [PMID: 39172103 DOI: 10.1080/10826084.2024.2392534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
Introduction: Many people who smoke cigarettes report believing that nicotine causes cancer, a misperception that may reduce interest in switching to noncombustible nicotine products. Quantitative survey questions do not capture how this population thinks about nicotine and switching to noncombustible products. Methods: This study used an online convenience sample of 193 US adults who smoke cigarettes and reported that nicotine causes cancer. Respondents were asked if they thought nicotine was harmful (and why or why not) and if they would consider switching to a noncombustible product (and why or why not). Inductive and deductive coding were used, and descriptive statistics are reported. Results: Descriptions of nicotine directly causing disease (61%) were more common than descriptions of nicotine causing addiction to a harmful product (8%). One-third expressly stated that nicotine causes cancer, and 21% that nicotine causes lung disease. Interest in switching was moderate (mean 47.4 out of 100). When asked about switching, 34% described enjoying their current smoking experience, 23% described a perceived health benefit, 16% described a health concern, and 11% worried that switching would not address nicotine addiction. Discussion: Adults who smoke commonly perceived nicotine as a direct cause of cigarette-related disease, and harm and addictiveness perceptions were often mentioned as reasons for interest or disinterest in switching to a noncombustible. Future studies could explore strategies for correcting nicotine misperception, stigma related to addiction, and common concerns related to health as well as user experience.
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Affiliation(s)
- Caitlin Weiger
- Rutgers Institute for Nicotine & Tobacco Studies, Rutgers University, New Brunswick, New Jersey, USA
| | - Ryan D Kennedy
- Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Andrea C Villanti
- Rutgers Institute for Nicotine & Tobacco Studies, Rutgers University, New Brunswick, New Jersey, USA
| | - Joanna E Cohen
- Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Meghan B Moran
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Conte G, Pacino SA, Urso S, Greiling D, Caponnetto P, Pedullà E, Generali L, Consolo U, Checchi V, Gospodaru S, Bordeniuc G, Fala V, Kowalski J, Nowak M, Górska R, Amaliya A, Chapple I, Milward M, Maclure R, Nardi GM, Polosa R. Changes in Oral Health and Dental Esthetic in Smokers Switching to Combustion-Free Nicotine Alternatives: Protocol for a Multicenter and Prospective Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e53222. [PMID: 38393754 PMCID: PMC10924261 DOI: 10.2196/53222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/27/2023] [Accepted: 12/28/2023] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Although the detrimental effects of conventional combustible cigarettes on oral health and dental esthetics are well known, there is limited information about the long-term impact of combustion-free nicotine alternatives (C-F NA) such as e-cigarettes or heated tobacco products. OBJECTIVE This multicenter, prospective, 3-parallel-arm randomized controlled trial will investigate whether switching from combustible cigarettes to C-F NA will lead to measurable improvements in oral health parameters and dental esthetics over 18 months in adult smokers with limited gum disease. METHODS Regular smokers not intending to quit and without clinical signs of periodontitis will be randomly assigned (1:4 ratio) to either standard of care with brief cessation advice (control group; arm A) or C-F NA use (intervention group; arm B). The study will also include a reference group of never smokers (reference group; arm C). The primary end point is the change in the Modified Gingival Index (MGI) score from baseline between the control arm (arm A) and the intervention arm (arm B) at the 18-month follow-up. In addition, the study will analyze the within- and between-group (arms A, B, and C) changes in MGI assessment, plaque imaging, dental shade quantitation, tooth stain scores, and oral health-related quality of life questionnaires measured at each study time point. All participants will attend a total of 7 clinic visits: screening, enrollment, and randomization (visit 0); baseline visit-day 14 (visit 1); day 90 (visit 2); day 180 (visit 3); day 360 (visit 4); and day 540 (visit 5). This multicenter study will be conducted in 4 dental clinics in 4 countries. The statistical analysis will involve descriptive statistics for continuous and categorical data. Primary end points will undergo tests for normality and, based on distribution, either a 2-sided t test or Mann-Whitney U test. Linear mixed model with random factors center and study arms by center will also be applied. Secondary end points, including MGI assessment and quality of life, will be subjected to similar tests and comparisons. Only if one value of the parameter MGI is missing after day 1, the last available observation will be carried forward. The analysis will be performed on the substituted data. Secondary parameters will not have missing value replacement. RESULTS Participant recruitment began in October 2021, and enrollment was completed in June 2023. Results will be reported in 2025. CONCLUSIONS This will be the first study to provide key insights into oral health benefits or risks associated with using C-F NA in smokers who are seeking alternatives to cigarette smoking. TRIAL REGISTRATION ClinicalTrials.gov NCT04649645; https://clinicaltrials.gov/ct2/show/NCT04649645. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/53222.
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Affiliation(s)
| | - Sebastiano Antonio Pacino
- Addendo srl, Dental Clinic, Catania, Italy
- ECLAT Srl, Spin-off of the University of Catania, Catania, Italy
| | - Salvatore Urso
- ECLAT Srl, Spin-off of the University of Catania, Catania, Italy
- Department of Biological, Geological and Environmental Sciences, University of Catania, Catania, Italy
| | | | - Pasquale Caponnetto
- Center of Excellence for the Acceleration of HArm Reduction, University of Catania, Catania, Italy
- Department of Educational Sciences, Section of Psychology, University of Catania, Catania, Italy
| | - Eugenio Pedullà
- Center of Excellence for the Acceleration of HArm Reduction, University of Catania, Catania, Italy
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Luigi Generali
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance, University of Modena and Reggio Emilia, Modena, Italy
| | - Ugo Consolo
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance, University of Modena and Reggio Emilia, Modena, Italy
| | - Vittorio Checchi
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | | | - Jan Kowalski
- Department of Periodontology, Medical University of Warsaw, Warsaw, Poland
| | - Maciej Nowak
- Department of Periodontology, Medical University of Warsaw, Warsaw, Poland
| | - Renata Górska
- Department of Periodontology, Medical University of Warsaw, Warsaw, Poland
| | - Amaliya Amaliya
- Department of Periodontology, Faculty of Dentistry, Universitas Padjadjaran, West Java, Indonesia
| | - Iain Chapple
- Periodontal Research Group, The University of Birmingham & Birmingham Community Healthcare Trust, Birmingham, United Kingdom
| | - Michael Milward
- Periodontal Research Group, The University of Birmingham & Birmingham Community Healthcare Trust, Birmingham, United Kingdom
| | - Robert Maclure
- R Maclure Clinical Research Ltd, Irby, Wirral, United Kingdom
| | - Gianna Maria Nardi
- Department of Dental and Maxillofacial Sciences, Sapienza University, Rome, Italy
| | - Riccardo Polosa
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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Kim S, Shiffman S, Goldenson NI. Adult smokers' Complete Switching Away from Cigarettes at 6, 9, and 12 Months after Initially Purchasing a JUUL e-Cigarette. Subst Use Misuse 2024; 59:805-815. [PMID: 38238646 DOI: 10.1080/10826084.2024.2303990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Abstract
Background: Electronic nicotine delivery systems (ENDS) have the potential to benefit public health if smokers completely switch from cigarettes to ENDS. Methods: A cohort of adult smokers (age ≥ 21) who purchased a JUUL Starter Kit was followed for 12 months after the initial purchase. We defined "switching" as past-30-day abstinence from smoking (even if JUUL use had stopped), and analyzed factors associated with achievement and maintenance of self-reported repeated point-prevalence switching (RPPS) at three follow-ups, i.e., no past-30-day smoking at months 6, 9, and 12. Results: RPPS was reported by 21.6% of the 12,537 evaluable smokers. Smokers with lighter smoking history and lower cigarette dependence at baseline were more likely to report RPPS. RPPS was also associated with daily use of JUUL (Month-3: OR = 2.32, 95% CI = 2.02-2.68; Month-6: OR = 1.73, 95% CI = 1.42-2.10), and with greater subjective reinforcing effects from JUUL use (assessed by the mCEQ, Month-3: OR = 1.46, 95% CI = 1.38-1.56; Month-6: OR = 1.11; 95% CI = 1.02-1.20). Even among smokers who did not meet the criteria of RPPS (i.e., who smoked at least once), 35.5% reported past 30-day point-prevalence switching on at least one follow-up, and their cigarette consumption was substantially reduced compared to baseline. Conclusions: Approximately one-fifth of adult smokers reported 30-day point-prevalence abstinence at 6, 9, and 12 months after purchasing JUUL. Greater use of JUUL and stronger subjective reinforcing effects were associated with nonsmoking, validating the potential for ENDS to substitute for smoking, with potential for positive impacts on individual and population health.
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Affiliation(s)
- Sooyong Kim
- PinneyAssociates, Inc., Pittsburgh, Pennsylvania, USA
| | - Saul Shiffman
- PinneyAssociates, Inc., Pittsburgh, Pennsylvania, USA
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Mason A, Riordan BC, Winter T, Conner TS, Sibley CG, Scarf D. Effects of vaping on uptake and cessation of smoking: Longitudinal analysis in Aotearoa New Zealand adults. Drug Alcohol Rev 2023; 42:1587-1594. [PMID: 37368846 DOI: 10.1111/dar.13702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 05/04/2023] [Accepted: 05/29/2023] [Indexed: 06/29/2023]
Abstract
INTRODUCTION Globally, the use of vapes, or e-cigarettes, is increasing. While vaping is less harmful than smoking and may help smokers to quit, there is also the possibility that vaping may lead to smoking. The current study aimed to determine the prevalence of vaping and smoking in Aotearoa New Zealand and explore longitudinal pathways between smoking status and vape use. METHOD Data related to smoking and vaping status was analysed from Times 10, 11 and 12 across 2018-2020 of the New Zealand Attitudes and Values study, a large, representative, multi-wave study of adults living in New Zealand. Weighted descriptive analyses were used to determine prevalence rates of vaping and smoking and a generalised linear modelling approach was used to examine the likelihood of changing to, or taking up, the other behaviour in the transition between time points. RESULTS Broadly, the prevalence of smoking was found to be decreasing over time while the prevalence of vaping was increasing. Despite these general trends, no differences were observed in the likelihood of transitioning from smoking to vaping or from vaping to smoking, indicating that either pathway was equally as likely. DISCUSSION AND CONCLUSIONS The current findings demonstrate that vaping appeared to be just as likely to have a gateway effect to smoking as it was to have a cessation effect. This highlights the need for greater consideration regarding vaping-related policies and restrictions.
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Affiliation(s)
- Andre Mason
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Benjamin C Riordan
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Taylor Winter
- School of Mathematics and Statistics, University of Canterbury, Christchurch, New Zealand
| | - Tamlin S Conner
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Chris G Sibley
- School of Psychology, University of Auckland, Auckland, New Zealand
| | - Damian Scarf
- Department of Psychology, University of Otago, Dunedin, New Zealand
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Wan Puteh SE, Mohd Ismail N, Md Isa Z, Ban AYL. Exhaled Carbon Monoxide Level and Practices among Tobacco and Nicotine Adult Users in Klang Valley, Malaysia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4443. [PMID: 36901455 PMCID: PMC10001713 DOI: 10.3390/ijerph20054443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/22/2023] [Accepted: 02/27/2023] [Indexed: 06/18/2023]
Abstract
Tobacco and nicotine derivatives uses are multiple in nature. These include conventional cigarettes (CCs), heated tobacco products (HTPs), and electronic cigarettes (ECs). This study aims to determine the practices, nicotine dependency profile, association with exhaled carbon monoxide (eCO) level, and pulmonary function (PF) among adult product users and non-smokers. This cross-sectional study involved smokers, nicotine users, and non-smokers from two public health facilities in Kuala Lumpur from December 2021 to April 2022. Data on socio-demography, smoking profile, nicotine dependency level, anthropometry, eCO monitor, and spirometer measurements were recorded. Out of 657 respondents, 52.1% were non-smokers, 48.3% were CC only smokers, poly-users (PUs) (27.3%), EC-only users (20.9%), and HTP-only users (3.5%). EC use was prevalent among the younger aged, tertiary educated, and females; HTP use was prevalent among those of an older age and CC users was common among lower educated males. The highest median eCO (in ppm) seen were as follows: in CC users only (13.00), PUs (7.00), EC users (2.00), HTP users (2.00), and the least was observed among non-smokers (1.00), which is significantly different across the groups (p <0.001). Comparison of practice between the different product users showed significant differences in age of product initiation (p <0.001, youngest in CC users in PUs), duration of product use (p <0.001, longest in exclusive CC users), cost per month (p <0.001, highest in exclusive HTP users) and attempt to quit product (p <0.001, CC use in PUs had the highest attempt to quit), while there is no significant difference in Fagerström score across the groups. Among EC users, 68.2% successfully switched from smoking CCs to ECs. The findings suggest that EC and HTP users are exhaling less CO. The use of these products in a targeted approach may manage nicotine addiction. Switching practice was higher among current EC users (from using CCs), hence emphasizing the need of switching encouragement and total nicotine abstinence later on. Lower eCO levels in the PU group, (as compared to CC-only users) and high quit attempt rate among in CC use in PUs may indicate attempt of PUs in reducing CC use through alternative modalities such as ECs and HTPs.
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Affiliation(s)
- Sharifa Ezat Wan Puteh
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaakob Latif, Cheras, Kuala Lumpur 56000, Malaysia
| | - Norayuni Mohd Ismail
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaakob Latif, Cheras, Kuala Lumpur 56000, Malaysia
| | - Zaleha Md Isa
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaakob Latif, Cheras, Kuala Lumpur 56000, Malaysia
| | - Andrea Yu-Lin Ban
- Respiratory Unit, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaakob Latif, Cheras, Kuala Lumpur 56000, Malaysia
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Kim S, Shiffman S, Sembower MA. US adult smokers' perceived relative risk on ENDS and its effects on their transitions between cigarettes and ENDS. BMC Public Health 2022; 22:1771. [PMID: 36123722 PMCID: PMC9484256 DOI: 10.1186/s12889-022-14168-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 09/12/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Perceived risk reduction motivates smokers to switch to electronic nicotine delivery systems (ENDS). This research examines US smokers' relative risk perceptions and their prospective association with various behavioral stages of switching to ENDS. METHODS Data from the nationally representative, longitudinal Population Assessment of Tobacco and Health (PATH) Adult survey, Waves 1 (2014) through 5 (2019), were analyzed. We assessed the association between the perceived risk of ENDS relative to cigarettes ("less harmful" vs. "equally harmful" or "more harmful") and 1) adoption of ENDS (among never-ENDS-using smokers), 2) complete switching to ENDS (i.e., stopping smoking, among ever-ENDS-using smokers), and 3) avoiding reversion to smoking (among smokers who had switched to ENDS), at the next wave. RESULTS The proportion of US smokers perceiving ENDS as less harmful than cigarettes continually decreased, reaching 17.4% in Wave 5 (2019). Current smokers with such belief were more likely to adopt ENDS (aOR 1.31; 95% CI 1.15-1.50) and switch completely to ENDS (aOR 2.24; 95% CI 1.89-2.65) in the subsequent wave. Among smokers who had switched within the past year, such beliefs predicted avoidance of resumption of smoking in the next wave (aOR 0.55; 95% CI 0.33-0.93). CONCLUSIONS Smokers' beliefs about the relative risk of ENDS compared to cigarettes had a strong and consistent association with transitions between smoking and ENDS use. Addressing the growing misperception about ENDS has the potential to contribute to public health by encouraging smokers' switching to ENDS.
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Affiliation(s)
- Sooyong Kim
- PinneyAssociates Inc, 201 N. Craig St, Ste 320, Pittsburgh, PA, 15213, USA.
| | - Saul Shiffman
- PinneyAssociates Inc, 201 N. Craig St, Ste 320, Pittsburgh, PA, 15213, USA
| | - Mark A Sembower
- PinneyAssociates Inc, 201 N. Craig St, Ste 320, Pittsburgh, PA, 15213, USA
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AlMoosawi S, Bajec M, Mainy N, Kallischnigg G, Zwisele B, Fischer K, Magnani P, Roulet S. Risk perception of IQOS™ and cigarettes: Temporal and cross-country comparisons. SSM Popul Health 2022; 18:101123. [PMID: 35669892 PMCID: PMC9162949 DOI: 10.1016/j.ssmph.2022.101123] [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] [Received: 02/21/2022] [Revised: 04/28/2022] [Accepted: 05/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background Risk perception (RP) is central to smokers’ decision to switch to smoke-free tobacco and nicotine products (TNP). This study assessed temporal trends in the health RP of a novel heated tobacco product, IQOSTM, relative to cigarettes, among current IQOSTM users. Methods The analyses included repeated cross-sectional data from online surveys in Germany (2018–19), Italy (2018–19), and Japan (2016–17, 2017–18, and 2018–19) among a random sample of current adult IQOSTM users from local registers of IQOSTM users. The health RPs of cigarettes and IQOSTM were assessed using the ABOUT™–Perceived Risk instrument, and their difference was described as the relative RP of IQOSTM to cigarettes (RPCig:IQOSTM). Results After adjustment for covariates, the relative RPCig:IQOSTM was higher in 2018 than in 2019 (0.93; standard error, 0.33; P = 0.005). This was driven by an increase in the RP of IQOSTM over time in Italy (2018: 42.6 [95% CI, 41.6–43.5]; 2019: 44.4 [43.4–45.4]) and Japan (2017: 44.0 [43.1–44.9); 2018: 45.9 [45.2–46.7]; 2019: 48.6 [47.9–49.4]), while the RP of cigarettes remained stable. Conclusions The relative RP of IQOSTM decreased over time, driven by an increase in the RP of IQOSTM, in agreement with epidemiological studies indicating a temporal reduction in the relative RP of smoke-free TNPs. Continued surveillance of the RP of novel TNPs is warranted to inform effective TNP risk communication and ensure that adults smokers who would otherwise continue to smoke understand the relative risks of novel TNPs. Risk perception is central to smokers' decision to switch from cigarettes. Little is known of temporal changes in risk perception of novel tobacco products. Risk perception of heated tobacco increased in Italy and Japan. Difference in risk perception of heated tobacco relative to cigarettes declined.
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Affiliation(s)
- Suzana AlMoosawi
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000, Neuchâtel, Switzerland
- Corresponding author.
| | - Martha Bajec
- Bajec Senseworks consulting, Hamilton, L9A 1L5, Ontario, Canada
| | - Nelly Mainy
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000, Neuchâtel, Switzerland
| | - Gerd Kallischnigg
- ARGUS – Statistics and Information Systems in Environment and Public Health GmbH, Karl-Heinrich-Ulrichs-Straße 20a, DE-10785, Berlin, Germany
| | - Bertram Zwisele
- ARGUS – Statistics and Information Systems in Environment and Public Health GmbH, Karl-Heinrich-Ulrichs-Straße 20a, DE-10785, Berlin, Germany
| | - Karina Fischer
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000, Neuchâtel, Switzerland
| | - Pierpaolo Magnani
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000, Neuchâtel, Switzerland
| | - Steve Roulet
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000, Neuchâtel, Switzerland
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Pharmacokinetic and subjective assessment of prototype JUUL2 electronic nicotine delivery system in two nicotine concentrations, JUUL system, IQOS, and combustible cigarette. Psychopharmacology (Berl) 2022; 239:977-988. [PMID: 35184228 PMCID: PMC8858085 DOI: 10.1007/s00213-022-06100-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 02/16/2022] [Indexed: 12/05/2022]
Abstract
RATIONALE Electronic nicotine delivery systems and heated tobacco products are noncombustible alternatives for adult smokers. Evidence suggests sufficient nicotine delivery and satisfying effects are necessary to facilitate switching away from smoking; nicotine delivery varies across electronic nicotine delivery systems within limited nicotine concentrations. OBJECTIVES To assess the nicotine delivery and subjective effects of prototype JUUL2 System in two nicotine concentrations, currently-marketed US JUUL System ("JUUL"), IQOS-brand heated tobacco product, and combustible cigarettes. METHODS Adult smokers (N = 40) completed a 5-arm cross-over product-use laboratory confinement study. Nicotine pharmacokinetics and subjective effects were assessed following use of: (1) JUUL2 prototype 18 mg/mL nicotine; (2) JUUL2 prototype 40 mg/mL; (3) JUUL 59 mg/mL; (4) IQOS 18 mg/g; and (5) usual brand combustible cigarette, each evaluated during ad libitum (10 min) and controlled (5 min, 10 standardized puffs) use. RESULTS Nicotine delivery was greatest for combustible cigarettes, followed by JUUL2 prototype 40 mg/mL, IQOS, JUUL2 prototype 18 mg/mL, and JUUL 59 mg/mL. Nicotine delivery from JUUL2 prototype 18 mg/mL was significantly greater than JUUL 59 mg/mL after ad libitum use. JUUL products were significantly more satisfying and effective at reducing craving than IQOS. JUUL2 prototype 40 mg/mL was significantly more aversive than other JUUL products. CONCLUSIONS Prototype JUUL2 and JUUL 59 mg/mL products were rated higher than IQOS on subjective measures associated with switching away from smoking. The JUUL2 prototype 40 mg/mL produced aversive responses and would require modifications to be a viable product for adult smokers. Nicotine delivery and subjective responses to JUUL2 prototype 18 mg/mL suggest a product based on this prototype may facilitate increased switching among adult smokers.
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Pacek LR, Kozink RV, Carson CE, McClernon FJ. Appeal, subjective effects, and relative reinforcing effects of JUUL that vary in flavor and nicotine content. Exp Clin Psychopharmacol 2021; 29:279-287. [PMID: 34264738 PMCID: PMC8454051 DOI: 10.1037/pha0000481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The U.S. Food and Drug Administration has the authority to regulate characteristics of electronic nicotine delivery systems (ENDS). Prior research indicates that regulation of certain characteristics of these products may have an effect on their appeal and use. Policies that affect appeal and use of ENDS are relevant to attempts to reduce use among young people-including young adults-but are also relevant to adults who use these products as harm reduction tools. Using a novel concurrent choice task, we evaluated the relative reinforcement of JUUL brand ENDS products that varied in flavor (n = 8) and nicotine (n = 8) among samples of young adults who use JUUL. Findings suggest that restricting JUUL flavor to tobacco-only results in decreased appeal, while reducing the nicotine content of JUUL pods to 3%-from the conventional 5%-does not have an effect on product appeal. Findings also validate a novel methodology for delivering fixed doses of ENDS vapor within the context of a task that assesses the relative reinforcement of ENDS products with varying characteristics. This methodology can be applied to assessing the relative reinforcing effects of a wide variety of tobacco products with varied characteristics. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Lauren R. Pacek
- Corresponding author: Address – 2608 Erwin Road, Suite 300, Durham, NC 27705 USA; ; Phone number – 919-684-5437; Fax number – 919-681-1600
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