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Leavens ELS, Lambart LM, St Helen G, Benowitz NL, Mayo MS, Farhad Mahmud KM, Arnold MJ, Nollen NL. Menthol versus tobacco e-liquid flavor: Impact on acute subjective effects, puff patterns, and intentions for use among Black and White menthol smokers. Addict Behav 2024; 155:108038. [PMID: 38613857 DOI: 10.1016/j.addbeh.2024.108038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND The proposed FDA product standard to prohibit menthol as a characterizing flavor in combustible cigarettes has the potential to significantly reduce tobacco-related health disparities. Whether a menthol e-liquid product standard would improve or hinder public health is unknown. No known research has directly examined the impact of menthol vs. tobacco flavored e-liquid use on acute e-cigarette use patterns, subjective experience, behavioral intentions, and craving and withdrawal among menthol cigarette smokers. METHODS Black (n = 47) and White (n = 4) nicotine-deprived menthol smokers with limited e-cigarette experience completed two counterbalanced in-laboratory 30-minute ad libitum vaping sessions with menthol and tobacco nicotine salt-based e-liquid in a randomized crossover pilot trial design. Questionnaires assessed reductions in craving and withdrawal and post-session subjective experience and behavioral intentions. Puff topography was measured continuously throughout each vaping session. RESULTS Measures of puff topography did not differ significantly by e-liquid flavor (all p > .40). Similarly, menthol and tobacco flavored e-cigarettes were both rated positively in terms of subjective effects and behavioral intentions (all p > .10) and about 40 % of participants reported a preference for the tobacco-flavored e-liquid. Finally, participants showed comparable reductions in craving (p = .210) and withdrawal (p = .671) from pre- and post-session regardless of e-liquid flavor. CONCLUSIONS Among menthol smokers in a lab-based setting, findings suggest that menthol vs tobacco e-liquid flavor has little impact on acute changes in puff patterns, subjective experience, behavioral intentions, or craving and withdrawal.
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Affiliation(s)
- Eleanor L S Leavens
- University of Kansas School of Medicine, Department of Population Health, Kansas City, KS, United States; The University of Kansas Cancer Center, Kansas City, KS, United States.
| | - Leah M Lambart
- University of Kansas School of Medicine, Department of Population Health, Kansas City, KS, United States
| | - Gideon St Helen
- Clinical Pharmacology Research Program, Division of Cardiology, University of California, San Francisco, CA, United States
| | - Neal L Benowitz
- Clinical Pharmacology Research Program, Division of Cardiology, University of California, San Francisco, CA, United States
| | - Matthew S Mayo
- The University of Kansas Cancer Center, Kansas City, KS, United States; University of Kansas School of Medicine, Department of Biostatistics & Data Science, Kansas City, KS, United States
| | - Kazi M Farhad Mahmud
- University of Kansas School of Medicine, Department of Biostatistics & Data Science, Kansas City, KS, United States
| | - Michael J Arnold
- University of Kansas School of Medicine, Department of Population Health, Kansas City, KS, United States
| | - Nicole L Nollen
- University of Kansas School of Medicine, Department of Population Health, Kansas City, KS, United States; The University of Kansas Cancer Center, Kansas City, KS, United States
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Affiliation(s)
- Eleanor L S Leavens
- Department of Population Health, University of Kansas School of Medicine, Kansas City
| | - Theodore L Wagener
- Center for Tobacco Research, Ohio State University Comprehensive Cancer Center, Columbus
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Leavens ELS, Lambart L, Diaz FJ, Wagener TL, Ahluwalia JS, Benowitz N, Nollen NL. Nicotine delivery and changes in withdrawal and craving during acute electronic cigarette, heated tobacco product, and cigarette use among a sample of Black and White people who smoke. Nicotine Tob Res 2023:ntad247. [PMID: 38097340 DOI: 10.1093/ntr/ntad247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Indexed: 01/04/2024]
Abstract
INTRODUCTION E-cigarettes and heated tobacco products (HTPs) may serve as potential options for harm reduction for smokers if they possess reward profiles similar to cigarettes. Little is known about the abuse liability of HTPs and e-cigarettes versus cigarettes in racial/ethnic minority smokers. METHODS Twenty-two nicotine-deprived people who smoke (Black [n=12] and White [n=10]) completed three visits that included a standardized 10-puff bout followed by a 50-minute ad libitum use assessment with their usual brand cigarette (UBC), an e-cigarette, and HTP. Visits were completed in a randomized crossover design and were separated by a minimum 48-hour washout period. Assessments included plasma nicotine, Cmax, and reductions in craving and withdrawal. RESULTS UBC delivered significantly greater levels of nicotine compared to the e-cigarette (p<0.001) and HTP (p<0.01) during both the standardized and ad libitum sessions. HTP delivered more nicotine than the e-cigarette during the standardized puffing session (p=0.047) but not the ad libitum session. Only craving during the standardized puffing session and not the ad libitum session showed significant differences across products (p<0.001) such that UBC resulted in the greatest reduction followed by HTP and e-cigarette. DISCUSSION Despite greater nicotine delivery from the UBC compared to e-cigarette and HTP, participants reported reductions in craving and withdrawal across products, particularly following ad libitum use. IMPLICATIONS Use of participant's usual brand cigarettes (UBC) resulted in greater nicotine delivery compared to both the e-cigarette and heated tobacco product (HTP). Despite this relative difference in nicotine delivery, participants reported reductions in craving and withdrawal across products, particularly following ad libitum use. These findings suggest that in this sample of Black and White people who smoke, HTPs and e-cigarettes provided significant relief from negative symptoms that maintain smoking.
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Affiliation(s)
- Eleanor L S Leavens
- University of Kansas School of Medicine, Department of Population Health, Kansas City, KS, USA
- University of Kansas Comprehensive Cancer Center, Kansas City, KS, USA
| | - Leah Lambart
- University of Kansas School of Medicine, Department of Population Health, Kansas City, KS, USA
| | - Francisco J Diaz
- University of Kansas School of Medicine, Department of Biostatistics and Data Science, Kansas City, KS, USA
| | - Theodore L Wagener
- The Ohio State University Comprehensive Cancer Center, Center for Tobacco Research, Columbus, Ohio, USA
- Ohio State University Wexner Medical Center, Department of Internal Medicine, Columbus, Ohio, USA
| | - Jasjit S Ahluwalia
- Brown University, Department of Behavioral and Social Sciences, Providence, RI, USA
| | - Neal Benowitz
- Clinical Pharmacology Research Program, Division of Cardiology, Department of Medicine, University of California, San Francisco, CA
| | - Nicole L Nollen
- University of Kansas School of Medicine, Department of Population Health, Kansas City, KS, USA
- University of Kansas Comprehensive Cancer Center, Kansas City, KS, USA
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Nollen NL, Leavens ELS, Ahluwalia JS, Rice M, Mayo MS, Pulvers K. Menthol versus non-menthol flavouring and switching to e-cigarettes in black and Latinx adult menthol combustible cigarette smokers: secondary analyses from a randomised clinical trial. Tob Control 2023; 32:786-789. [PMID: 35351805 PMCID: PMC10246471 DOI: 10.1136/tobaccocontrol-2021-057180] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 03/08/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND As the US Food and Drug Administration takes regulatory action on menthol cigarettes, debate continues about how restricting menthol e-liquids might impact adult menthol smokers in switching to e-cigarettes. METHODS Switching patterns and e-cigarette acceptability were assessed at week 6 among 64 black and Latinx menthol cigarette smokers who used JUUL menthol (n=39) or non-menthol e-cigarettes ((n=25), primarily mint or mango) as part of a randomised switching trial. RESULTS No clear evidence of effects was found between menthol versus non-menthol e-cigarettes on use or subjective effects/acceptability, effect sizes for all comparisons were small (effect size=0.0-0.2), and Bayes factor ranged from 0.10 to 0.15. Specifically, 82.1% of participants who used menthol-flavoured e-cigarettes fully or partially switched to e-cigarettes compared with 88.0% of participants who used a non-menthol (p=0.75). Further, both groups demonstrated substantial reductions in cigarettes per day (menthol e-cigarettes: -8.5±10.4 vs non-menthol e-cigarettes: -8.8±5.8, p=0.87), comparable grams of e-liquid consumed (menthol e-cigarettes: 9.2±9.8 g vs non-menthol e-cigarettes: 11.0±11.0 g, p=0.47), and positive subjective effects, including 'just right' throat hit (menthol e-cigarettes: 70.7% vs non-menthol e-cigarettes: 66.7%, p=0.93) and flavour liking (menthol e-cigarettes: 75.6% vs non-menthol e-cigarettes: 66.7%, p=0.32). CONCLUSIONS Both menthol and non-menthol e-cigarettes were associated with high rates of use and acceptability among menthol smokers. Findings require confirmation in a fully powered non-inferiority or equivalence study but provide preliminary evidence to inform regulatory action on menthol e-cigarettes that could slow youth initiation without impacting black and Latinx menthol cigarette smokers interested in switching to e-cigarettes. TRIAL REGISTRATION NUMBER NCT03511001.
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Affiliation(s)
- Nicole L Nollen
- Department of Population Health, University of Kansas School of Medicine and the University of Kansas Cancer Center, Kansas City, Kansas, USA
| | - Eleanor L S Leavens
- Department of Population Health, University of Kansas School of Medicine and the University of Kansas Cancer Center, Kansas City, Kansas, USA
| | - Jasjit S Ahluwalia
- Behavioral and Social Sciences, Brown University School of Public Health, Alpert Medical School, and Legorreta Cancer Center, Providence, Rhode Island, USA
| | - Myra Rice
- Neuroscience Interdepartmental Graduate Program, University of California Los Angeles, Los Angeles, California, USA
| | - Matthew S Mayo
- Department of Biostatistics & Data Science, University of Kansas School of Medicine and the University of Kansas Cancer Center, Kansas City, Kansas, USA
| | - Kim Pulvers
- Psychology, California State University San Marcos, San Marcos, California, USA
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Leavens ELS, Mayo MS, Brown AR, Cox LS, Ellerbeck EF, Ahluwalia JS, Nollen NL. Early Treatment Response in Black Smokers Undergoing Pharmacotherapy for Smoking Cessation: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2334695. [PMID: 37728930 PMCID: PMC10512105 DOI: 10.1001/jamanetworkopen.2023.34695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/14/2023] [Indexed: 09/22/2023] Open
Abstract
This secondary analysis of a randomized clinical trial investigates the association of early treatment response with smoking cessation among Black smokers.
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Affiliation(s)
- Eleanor L. S. Leavens
- Department of Population Health, University of Kansas School of Medicine, Kansas City
| | - Matthew S. Mayo
- Department of Biostatistics and Data Science, University of Kansas School of Medicine, Kansas City
| | - Alexandra R. Brown
- Department of Biostatistics and Data Science, University of Kansas School of Medicine, Kansas City
| | - Lisa Sanderson Cox
- Department of Population Health, University of Kansas School of Medicine, Kansas City
| | - Edward F. Ellerbeck
- Department of Population Health, University of Kansas School of Medicine, Kansas City
| | - Jasjit S. Ahluwalia
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Nicole L. Nollen
- Department of Population Health, University of Kansas School of Medicine, Kansas City
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Funk OL, Nollen NL, Wagener TL, Ahluwalia JS, Mayo MS, Mahmud KMF, Lambart L, Leavens ELS. Concurrent Choice Assessment of Preference and Substitutability of E-cigarettes and Heated Tobacco Products for Combustible Cigarettes Among African American and White Smokers. Nicotine Tob Res 2023; 25:1505-1508. [PMID: 37042345 PMCID: PMC10347969 DOI: 10.1093/ntr/ntad052] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 01/20/2023] [Accepted: 04/05/2023] [Indexed: 04/13/2023]
Abstract
INTRODUCTION Alternative nicotine delivery products, including electronic cigarettes (e-cigarettes) and heated tobacco products (HTPs), contain fewer toxicants than combustible cigarettes and offer a potential for harm reduction. Research on the substitutability of e-cigarettes and HTPs is crucial for understanding their impact on public health. This study examined subjective and behavioral preferences for an e-cigarette and HTP relative to participants' usual brand combustible cigarette (UBC) in African American and White smokers naïve to alternative products. AIMS AND METHODS Twenty-two adult African American (n = 12) and White (n = 10) smokers completed randomized study sessions with their UBC and study provided e-cigarette and HTP. A concurrent choice task allowed participants to earn puffs of the products but placed UBC on a progressive ratio schedule, making puffs harder to earn, and e-cigarette and HTP on a fixed ratio schedule to assess behavioral preference for the products. Behavioral preference was then compared to self-reported subjective preference. RESULTS Most participants had a subjective preference for UBC (n = 11, 52.4%), followed by an equal preference for e-cigarette (n = 5, 23.8%) and HTP (n = 5, 23.8%). During the concurrent choice task, participants showed a behavioral preference (i.e., more earned puffs) for the e-cigarette (n = 9, 42.9%), followed by HTP (n = 8, 38.1%), and UBC (n = 4, 19.1%). Participants earned significantly more puffs of the alternative products compared to UBC (p = .011) with no difference in earned puffs between e-cigarettes and HTP (p = .806). CONCLUSIONS In a simulated lab setting, African American and White smokers were willing to substitute UBC for an e-cigarette or HTP when the attainment of UBC became more difficult. TRIAL REGISTRATION NCT04646668. IMPLICATIONS Findings suggest that African American and White smokers are willing to substitute their UBC for an alternative nicotine delivery product (e-cigarette or HTP) when the attainment of cigarettes became more difficult in a simulated lab setting. Findings require confirmation among a larger sample under real-world conditions but add to growing evidence suggesting the acceptability of alternative nicotine delivery products among racially diverse smokers. These data are important as policies that limit the availability or appeal of combustible cigarettes are considered or enacted.
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Affiliation(s)
- Olivia L Funk
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Nicole L Nollen
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS, USA
- University of Kansas Comprehensive Cancer Center, Kansas City, KS, USA
| | - Theodore L Wagener
- The Ohio State University Comprehensive Cancer Center and The Ohio State University College of Medicine, Columbus, OH, USA
| | - Jasjit S Ahluwalia
- Center for Alcohol and Addiction Studies, Brown University School of Public Health and Alpert Medical School, Providence, RI, USA
- Legorreta Cancer Center at Brown University, Providence, RI, USA
| | - Matthew S Mayo
- Department of Biostatistics and Data Science, University of Kansas School of Medicine, Kansas City, KS, USA
- University of Kansas Comprehensive Cancer Center, Kansas City, KS, USA
| | - Kazi Md Farhad Mahmud
- Department of Biostatistics and Data Science, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Leah Lambart
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Eleanor L S Leavens
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS, USA
- University of Kansas Comprehensive Cancer Center, Kansas City, KS, USA
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Dunn DS, Leavens ELS, Lopez SV, Warner EA, Brett EI, Cole AB, Leffingwell TR. Displacement imposition scale assesses reactions of cigarette and e-cigarette users impacted by a campus-wide smoking ban. J Am Coll Health 2023; 71:1479-1485. [PMID: 34242540 PMCID: PMC10186273 DOI: 10.1080/07448481.2021.1942003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 02/21/2021] [Accepted: 06/08/2021] [Indexed: 05/18/2023]
Abstract
OBJECTIVE The present study developed a measure assessing the emotional responses, "Displacement Imposition," of cigarette and e-cigarette users on a college campus with a smoking/vaping ban. It also examined the relationship between Displacement Imposition and readiness to quit smoking/vaping, and how this relationship differed between cigarette and e-cigarette users. PARTICIPANTS Participants (N = 297) were from a large, Midwestern university. METHODS Participants completed online questionnaires assessing demographics, cigarette and e-cigarette use, Displacement Imposition, and readiness to quit. RESULTS All six Displacement Imposition items loaded onto a single factor. A significant interaction emerged between Displacement Imposition and product use in predicting readiness to quit. At high levels of Displacement Imposition, cigarette users were less ready to quit than e-cigarette users. CONCLUSIONS Findings suggest restrictions imposed on cigarette and e-cigarette users were associated with reduced readiness to quit. Findings inform tobacco control policies as tobacco denormalization may increase the burden placed on tobacco users.
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Affiliation(s)
- Delaney S. Dunn
- Department of Psychology, Oklahoma State University, Stillwater, OK
| | - Eleanor L. S. Leavens
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS
| | - Susanna V. Lopez
- Department of Psychology, Oklahoma State University, Stillwater, OK
| | - Emily A. Warner
- Department of Psychology, Oklahoma State University, Stillwater, OK
| | - Emma I. Brett
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL
| | - Ashley B. Cole
- Department of Psychology, Oklahoma State University, Stillwater, OK
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Nollen NL, Ahluwalia JS, Mayo MS, Ellerbeck EF, Leavens ELS, Salzman G, Shanks D, Woodward J, Greiner KA, Cox LS. Multiple Pharmacotherapy Adaptations for Smoking Cessation Based on Treatment Response in Black Adults Who Smoke: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2317895. [PMID: 37338906 DOI: 10.1001/jamanetworkopen.2023.17895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
Importance Adapting to different smoking cessation medications when an individual has not stopped smoking has shown promise, but efficacy has not been tested in racial and ethnic minority individuals who smoke and tend to have less success in quitting and bear a disproportionate share of tobacco-related morbidity and mortality. Objective To evaluate efficacy of multiple smoking cessation pharmacotherapy adaptations based on treatment response in Black adults who smoke daily. Design, Setting, and Participants This randomized clinical trial of adapted therapy (ADT) or enhanced usual care (UC) included non-Hispanic Black adults who smoke and was conducted from May 2019 to January 2022 at a federally qualified health center in Kansas City, Missouri. Data analysis took place from March 2022 to January 2023. Interventions Both groups received 18 weeks of pharmacotherapy with long-term follow-up through week 26. The ADT group consisted of 196 individuals who received a nicotine patch (NP) and up to 2 pharmacotherapy adaptations, with a first switch to varenicline at week 2 and, if needed, a second switch to bupropion plus NP (bupropion + NP) based on carbon monoxide (CO)-verified smoking status (CO ≥6 ppm) at week 6. The UC group consisted of 196 individuals who received NP throughout the duration of treatment. Main Outcomes and Measures Anabasine-verified and anatabine-verified point-prevalence abstinence at week 12 (primary end point) and weeks 18 and 26 (secondary end points). The χ2 test was used to compare verified abstinence at week 12 (primary end point) and weeks 18 and 26 (secondary end points) between ADT and UC. A post hoc sensitivity analysis of smoking abstinence at week 12 was performed with multiple imputation using a monotone logistic regression with treatment and gender as covariates to impute the missing data. Results Among 392 participants who were enrolled (mean [SD] age, 53 [11.6] years; 224 [57%] female; 186 [47%] ≤ 100% federal poverty level; mean [SD] 13 [12.4] cigarettes per day), 324 (83%) completed the trial. Overall, 196 individuals were randomized to each study group. Using intent-to-treat and imputing missing data as participants who smoke, verified 7-day abstinence was not significantly different by treatment group at 12 weeks (ADT: 34 of 196 [17.4%]; UC: 23 of 196 [11.7%]; odds ratio [OR], 1.58; 95% CI, 0.89-2.80; P = .12), 18 weeks (ADT: 32 of 196 [16.3%]; UC: 31 of 196 [15.8%]; OR, 1.04; 95% CI, 0.61-1.78; P = .89), and 26 weeks (ADT: 24 of 196 [12.2%]; UC: 26 of 196 [13.3%]; OR, 0.91; 95% CI, 0.50-1.65; P = .76). Of the ADT participants who received pharmacotherapy adaptations (135/188 [71.8%]), 11 of 135 (8.1%) were abstinent at week 12. Controlling for treatment, individuals who responded to treatment and had CO-verified abstinence at week 2 had 4.6 times greater odds of being abstinent at week 12 (37 of 129 [28.7%] abstinence) than those who did not respond to treatment (19 of 245 [7.8%] abstinence; OR; 4.6; 95% CI, 2.5-8.6; P < .001). Conclusions and Relevance In this randomized clinical trial of adapted vs standard of care pharmacotherapy, adaptation to varenicline and/or bupropion + NP after failure of NP monotherapy did not significantly improve abstinence rates for Black adults who smoke relative to those who continued treatment with NP. Those who achieved abstinence in the first 2 weeks of the study were significantly more likely to achieve later abstinence, highlighting early treatment response as an important area for preemptive intervention. Trial Registration ClinicalTrials.gov Identifier: NCT03897439.
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Affiliation(s)
- Nicole L Nollen
- Department of Population Health and the University of Kansas Cancer Center, University of Kansas School of Medicine, Kansas City
| | - Jasjit S Ahluwalia
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Matthew S Mayo
- Department of Biostatistics and Data Science and the University of Kansas Cancer Center, University of Kansas School of Medicine, Kansas City
| | - Edward F Ellerbeck
- Department of Population Health and the University of Kansas Cancer Center, University of Kansas School of Medicine, Kansas City
| | - Eleanor L S Leavens
- Department of Population Health and the University of Kansas Cancer Center, University of Kansas School of Medicine, Kansas City
| | - Gary Salzman
- Department(s) of Internal Medicine, Division of Respiratory and Critical Care, University of Missouri-Kansas City School of Medicine, University Health, Kansas City, Missouri
| | - Denton Shanks
- Department of Family Medicine and Community Health, University of Kansas School of Medicine, Kansas City
| | - Jennifer Woodward
- Department of Family Medicine and Community Health, University of Kansas School of Medicine, Kansas City
| | - K Allen Greiner
- Department of Family Medicine and Community Health, University of Kansas School of Medicine, Kansas City
| | - Lisa Sanderson Cox
- Department of Population Health and the University of Kansas Cancer Center, University of Kansas School of Medicine, Kansas City
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Brett EI, Lee Z, Leavens ELS, Fridberg DJ, King AC. Cue Reactivity Effects of Heated Tobacco Product Use in Current, Former, and Never Smokers in the United States. Nicotine Tob Res 2023; 25:1014-1021. [PMID: 36205373 PMCID: PMC10077945 DOI: 10.1093/ntr/ntac228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 09/16/2022] [Accepted: 10/06/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Heated tobacco products (HTPs) share similar characteristics as combustible cigarettes and electronic nicotine delivery systems (ENDS) and thus may serve as cues for smoking and vaping. While HTP familiarity is low in the United States, HTPs may be perceived as a less harmful alternative to cigarettes. AIMS AND METHODS The present study examined if visual exposure to HTP use influenced cigarette and e-cigarette craving in a large national sample of adults with varied smoking patterns. Current, former, and never cigarette smokers (N = 515; Mage = 40) were recruited from online crowd-sourcing panels throughout the United States from January to April 2020. Participants completed surveys before and after watching a video depicting the use of an HTP, cigarette, or bottled water. Main outcomes were changes in cigarette craving after exposure to the video cue. Secondary outcomes included changes in e-cigarette craving. RESULTS Relative to the water cue, the HTP and cigarette cues increased cigarette craving in current smokers. The HTP cue also increased e-cigarette craving (desire for a mod or vape pen and JUUL) across all subgroups. CONCLUSIONS Current smokers demonstrated cue reactivity to the use of an HTP as they reported increases in both cigarette and e-cigarette craving after exposure. All smoking groups reported e-cigarette reactivity to the HTP cue. As HTPs gain traction globally, it is crucial to consider how their use may influence active users and passive viewers to inform future health policies. IMPLICATIONS Noncombustible nicotine delivery systems are known cues for cigarette smoking and e-cigarette vaping, and this study examined whether relatively novel heated tobacco products (HTPs) may also act as a smoking or vaping cue in adults across varied smoking backgrounds. Results showed that passive exposure to HTP use increased desire for both a cigarette and an e-cigarette in current smokers and also increased desire for an e-cigarette in former and nonsmokers. Thus given its similarity to smoking and vaping, HTP use may affect passive observers and could play a role in perpetuating the dual use of cigarettes and vape products.
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Affiliation(s)
- Emma I Brett
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Zoe Lee
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Eleanor L S Leavens
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Daniel J Fridberg
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Andrea C King
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
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Lee SC, Maglalang DD, Avila JC, Leavens ELS, Nollen NL, Pulvers K, Ahluwalia JS. Change in E-cigarette risk perception and smoking behavior of Black and Latinx individuals who smoke. Drug Alcohol Depend 2023; 245:109824. [PMID: 36857841 PMCID: PMC10033448 DOI: 10.1016/j.drugalcdep.2023.109824] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/24/2023] [Accepted: 02/20/2023] [Indexed: 02/27/2023]
Abstract
INTRODUCTION Trends in knowledge and beliefs about e-cigarette (EC) harm have been changing. Our study examined whether change in risk perception of ECs predicts cigarettes smoked per week (CPW) among Black and Latinx individuals who smoke enrolled in an EC switching randomized clinical trial (RCT). METHODS We analyzed data from one arm of a 6-week EC RCT of individuals who smoke attempting to switch to nicotine salt pod system ECs (n = 110; Black, n = 57; Latinx, n = 53). Our explanatory variable was change in risk perception of ECs compared to combustible cigarettes (CC) from baseline to week 6. Our outcome was CPW measured by a 7-day timeline follow-back interview. A negative binomial GEE model was conducted to examine the association between risk perception and CPW at baseline and week 6. RESULTS The mean CPW decreased from 82.8 (SD=49.8) at baseline to 15.8 (SD=29.8) at week 6. A one-level increase in EC risk perception (i.e., EC perceived as riskier than CC from baseline to week 6) was associated with an increase in CPW (IRR: 1.83, 95% CI: 1.03; 3.24). Latinx participants were more likely to have higher CPW as EC risk perception increased compared to Black participants (IRR=1.89, 95% CI: 1.09; 3.26). CONCLUSION We found that CPW at week 6 was significantly higher as change in risk perception of EC relative to CC increased. Given the influence of risk perception on smoking behavior, people who smoke should be educated on the benefits and harms of ECs.
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Affiliation(s)
- Sangah Clara Lee
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.
| | - Dale Dagar Maglalang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Behavioral and Social Sciences and Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA.
| | - Jaqueline C Avila
- Department of Gerontology, University of Massachusetts Boston, Boston, MA, USA.
| | - Eleanor L S Leavens
- Department of Population Health, University of Kansas School of Medicine; University of Kansas Comprehensive Cancer Center, Kansas City, KS, USA.
| | - Nicole L Nollen
- Department of Population Health, University of Kansas School of Medicine; University of Kansas Comprehensive Cancer Center, Kansas City, KS, USA.
| | - Kim Pulvers
- Department of Psychology, California State University San Marcos, San Marcos, CA, USA.
| | - Jasjit S Ahluwalia
- Department of Behavioral and Social Sciences and Center for Alcohol and Addiction Studies, Brown University School of Public Health; Department of Medicine, Alpert Medical School, Brown University; Legoretta Cancer Center, Brown University, Providence, RI, USA.
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11
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Leavens ELS, Roberts J, Faseru B, Thompson M, Denes-Collar K, Shah H. Development and implementation of the ECHO model in a school setting to address youth electronic cigarette use in Kansas: A protocol. Front Public Health 2023; 10:1057600. [PMID: 36711359 PMCID: PMC9879567 DOI: 10.3389/fpubh.2022.1057600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/23/2022] [Indexed: 01/13/2023] Open
Abstract
Introduction Schools remain at the frontlines of addressing issues, such as e-cigarette use, that impact students. Despite e-cigarette use remaining a significant public health concern in the U.S., schools have limited resources (e.g., staff, capacity, programming) to address it, especially in rural and frontier areas. This ECHO Pilot Project aimed to build capacity and equip schools and school staff in the state of Kansas to address high rates of youth e-cigarette use by providing prevention support and information on best practices for e-cigarette cessation. Methods and analysis The pilot used the established Project ECHO model to disseminate evidence-based strategies for e-cigarette prevention and cessation among youth to schools across Kansas. The pilot selected 20 interdisciplinary school teams representing both rural and urban middle and high schools across the state to participate in seven ECHO sessions. ECHO sessions proceeded throughout Fall 2021, with the final session in Spring 2022. School participants completed pre-post surveys as well as component-specific surveys following each ECHO session. In addition, each school team created an individualized action plan to comprehensively address e-cigarette use at their school based on the information provided throughout the ECHO. Survey data, school tobacco/nicotine policies, and action plans will be analyzed to assess process and final outcomes. Discussion If successful, this pilot will demonstrate that the ECHO model is an effective platform for building school staff knowledge and skills to implement evidence-based strategies in both urban and rural settings. It is anticipated that the pilot will build capacity and equip schools and school staff to address high rates of youth e-cigarette use by providing support for school-based prevention programs and referrals for e-cigarette cessation which will lessen the burden of nicotine-related problems in Kansas schools and communities. Finally, the pilot will provide evidence that the ECHO model can be successfully and equitably applied in a school setting and may be a viable method for addressing other public health-related issues faced by schools.
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Affiliation(s)
- Eleanor L. S. Leavens
- Department of Population Health, School of Medicine, University of Kansas, Kansas City, KS, United States,University of Kansas Cancer Center, Kansas City, KS, United States,*Correspondence: Eleanor L. S. Leavens ✉
| | - Jordan Roberts
- Kansas Department of Health and Environment, Topeka, KS, United States
| | - Babalola Faseru
- Department of Population Health, School of Medicine, University of Kansas, Kansas City, KS, United States,University of Kansas Cancer Center, Kansas City, KS, United States,Kansas Department of Health and Environment, Topeka, KS, United States
| | - Mark Thompson
- Kansas State Department of Education, Topeka, KS, United States
| | - Karin Denes-Collar
- Masonic Cancer Alliance, The University of Kansas Cancer Center, Kansas City, KS, United States
| | - Hina Shah
- Kansas Health Institute, Topeka, KS, United States
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12
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Leavens ELS, Nollen N, Ahluwalia JS, Mayo MS, Rice M, Brett EI, Pulvers K. Changes in dependence, withdrawal, and craving among adult smokers who switch to nicotine salt pod-based e-cigarettes. Addiction 2022; 117:207-215. [PMID: 34105208 PMCID: PMC8655025 DOI: 10.1111/add.15597] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 02/01/2021] [Accepted: 05/26/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND AIMS For electronic cigarettes (e-cigarettes) to be a viable substitute for combustible cigarettes, it is likely that they must be rewarding enough for regular use, indicated by factors such as craving and dependence, important aspects of reinforcement. This study aimed to understand short-term changes in measures of nicotine dependence between groups differing by use trajectory in a switching trial, and within group changes of these measures. DESIGN Secondary data analysis of one arm of an e-cigarette randomized clinical trial. SETTING San Diego, California and Kansas City, Missouri, United States. PARTICIPANTS 114 African American (n = 60) and Latinx (n = 54) smokers (58.8% male) attempting to switch to nicotine salt pod system (NSPS) e-cigarettes in a 6-week trial. MEASUREMENTS At week 6, participants were classified by use trajectory: exclusive smokers (n = 16), exclusive e-cigarette (n = 32), or dual users (n = 66). E-cigarette, cigarette, and total nicotine dependence (cigarette + e-cigarette), use patterns, cigarette craving and nicotine withdrawal, and cotinine were assessed at baseline and week 6 using standard measures. FINDINGS In between group comparisons, exclusive e-cigarette and dual users showed greater reductions in cigarette dependence (e-cigarette: -32.38, 95% CI = -37.7,-27.1; dual: -18.48, 95% CI = -22.2,-14.7), withdrawal (e-cigarette: -6.25, 95% CI = -8.52,-3.98; dual: -3.18, 95% CI = -5.02,-1.34), craving (e-cigarette: -11.44, 95% CI = -14.2,8.7; dual: -9.59, 95% CI = -11.6,-7.59), and cigarettes per day (CPD; e-cigarette: -11.19, 95% CI = -13.1,-9.27; dual: -9.39, 95% CI = -11.3, -7.52) compared with exclusive smokers. In within group analyses, e-cigarette and dual users showed reductions in craving and withdrawal from baseline to week 6. Exclusive e-cigarette and dual users, maintained cotinine levels (all Ps > 0.05) and showed reductions in CPD and cigarette dependence (all Ps < 0.01). Findings were inconclusive regarding changes in total nicotine dependence from baseline to week 6 among exclusive e-cigarette users (P = 0.123). Dual users showed increased total nicotine dependence (P < 0.001) and smokers showed decreased total dependence (P = 0.004). CONCLUSIONS Smokers who switch to nicotine salt pod system e-cigarettes maintain their nicotine levels and transfer their dependence, suggesting that nicotine salt pod system e-cigarettes have a similar reinforcement potential to cigarettes and facilitate switching.
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Affiliation(s)
| | - Nicole Nollen
- University of Kansas School of Medicine, Department of Population Health
| | | | - Matthew S. Mayo
- University of Kansas Medical Center, Department of Biostatistics & Data Science
| | - Myra Rice
- California State University San Marcos, Department of Psychology
| | - Emma I. Brett
- University of Chicago, Department of Psychiatry and Behavioral Neuroscience
| | - Kim Pulvers
- California State University San Marcos, Department of Psychology
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Brett EI, Leffingwell TR, Lopez SV, Leavens ELS, Dunn DS. Incorporating Values into Personalized Feedback Interventions for Young Adult Drinking: A Pilot Randomized Trial. Alcoholism Treatment Quarterly 2021. [DOI: 10.1080/07347324.2021.1999190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Emma I. Brett
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, Illinois, USA
| | - Thad R. Leffingwell
- Department of Psychology, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Susanna V. Lopez
- Department of Psychology, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Eleanor L. S. Leavens
- Department of Population Health, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Delaney S. Dunn
- Department of Psychology, Oklahoma State University, Stillwater, Oklahoma, USA
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14
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Leavens ELS, Freedy JR. Youth e-cigarette use: Assessing for, and halting, the hidden habit. J Fam Pract 2021; 70:342-346. [PMID: 34818166 DOI: 10.12788/jfp.0254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Using a checklist to establish patients' level of dependence and combining behavioral therapy with nicotine replacement products can help users to quit.
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Affiliation(s)
- Eleanor L S Leavens
- University of Kansas School of Medicine, Kansas City (Dr. Leavens); Medical University of South Carolina, Charleston (Dr. Freedy)
| | - John R Freedy
- University of Kansas School of Medicine, Kansas City (Dr. Leavens); Medical University of South Carolina, Charleston (Dr. Freedy)
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15
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Leavens ELS, Carpenter MJ, Smith TT, Nollen NL. Exploratory evaluation of online brief education for JUUL pod-mod use and prevention. Addict Behav 2021; 119:106942. [PMID: 33866224 DOI: 10.1016/j.addbeh.2021.106942] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 03/26/2021] [Accepted: 03/30/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Initiation of e-cigarette use by young adults is a significant public health issue within the debate on vaping. The current study is an exploratory evaluation of brief educational information among young adults and investigated outcomes as a function of JUUL use and smoking status. METHODS Participants (N = 947) were young adults (<30 years old) recruited from Amazon's Mechanical Turk based on smoking and JUUL use status. Participants completed baseline assessments, viewed a brief JUUL educational handout, and completed post-assessments. RESULTS There was a significant Time X Group interaction for JUUL-related knowledge (p < .001), with never JUUL/never smokers showing the greatest increase in knowledge. Brief education increased JUUL-related knowledge and risk perceptions and had a modest impact on commitment to quitting and readiness to quit JUUL (all p ≤ 0.001; ds = 0.06-0.74; time × group p > .05 for all contrasts except JUUL-related knowledge). Participants showed modest decreases in interest in future JUUL use, interest in purchasing, and interest in future regular use (all p ≤ 0.001; ds = 0.07-0.08; time × group p > .05 for all contrasts). In terms of smoking outcomes, participants reported reduced perceived harm to others (p < .001; d = 0.09) and decreased intentions to smoke regularly (p = .001; d = 0.07). CONCLUSIONS Brief education was effective in increasing knowledge and risk perceptions while showing a modest effect on intentions for future use. The information was most effective in increasing knowledge among non-users, suggesting that brief education may be useful for preventing initiation. Analysis of group differences suggest current JUUL use status is more important in informing JUUL-related attitudes than smoking status.
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Affiliation(s)
- Eleanor L S Leavens
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences and Hollings Cancer Center, United States; University of Kansas School of Medicine, Department of Population Health, United States.
| | - Matthew J Carpenter
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences and Hollings Cancer Center, United States
| | - Tracy T Smith
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences and Hollings Cancer Center, United States
| | - Nicole L Nollen
- University of Kansas School of Medicine, Department of Population Health, United States
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16
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Wagener TL, Avery JA, Leavens ELS, Simmons WK. Associated Changes in E-cigarette Puff Duration and Cigarettes Smoked per Day. Nicotine Tob Res 2021; 23:760-764. [PMID: 33049064 DOI: 10.1093/ntr/ntaa211] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 10/08/2020] [Indexed: 11/14/2022]
Abstract
INTRODUCTION To examine whether changes in select measures of e-cigarette puffing topography are associated with changes in smoking behavior. METHODS Sixteen current cigarette smokers were instructed to completely switch from smoking combustible cigarettes to using e-cigarettes over a 2-week period. The study was completed in the Southern Midwestern region of the United States. Measures included demographics, smoking history, and cigarette dependence, as well as baseline and 2-week follow-up self-reported cigarettes per day, cigarette craving and urges, exhaled carbon monoxide readings, and e-cigarette usage data (puff number, puffing time, and average puff duration) collected via the e-cigarette built-in puff counter. RESULTS Over the 2-week switching period, participants significantly reduced their cigarettes per day (~80% reduction, p < .0001). Although the number of e-cigarette puffs/day remained relatively stable (p > .05), the average total e-cigarette daily puffing time increased significantly (p = .001). Users' average puff duration increased by 91 ms/puff/d (p < .001). The percentage decrease in cigarettes smoked per day was significantly and directly related to the slope of subjects' average puff duration over time (r(13) = .62, p = .01), such that as cigarettes per day decreased, puff duration increased. Self-reported smoking urges remained relatively stable from baseline to the end of the 2-week period (p > .05). CONCLUSIONS Among smokers switching to an e-cigarette, greater increases in e-cigarette puff duration was associated with greater reductions in cigarette smoking. IMPLICATIONS The current study is one of the first to examine changes in smokers' e-cigarette puffing behavior and associated changes in cigarette consumption as they attempt to completely switch to e-cigarettes. During a 2-week switching period, participants reduced their cigarettes per day. Moreover, although e-cigarette puffs per day remained relatively stable, users' average puff duration increased significantly. Greater increases in e-cigarette puff duration were associated with greater reductions in cigarette smoking. Understanding how to effectively use an e-cigarette to best reduce and eventually quit smoking will be necessary as smokers increasingly turn to these products to facilitate possible cessation.
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Affiliation(s)
- Theodore L Wagener
- Department of Internal Medicine and Center for Tobacco Research, Comprehensive Cancer Center, The Ohio State University and James Cancer Hospital, Columbus, OH
| | - Jason A Avery
- Laboratory of Brain and Cognition, National Institute of Mental Health, Bethesda, MD
| | - Eleanor L S Leavens
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS
| | - W Kyle Simmons
- Department of Pharmacology and Physiology, Oklahoma State University Center for Health Sciences, Tulsa, OK.,Center for Wellness and Recovery, Oklahoma State University Center for Health Sciences, Tulsa, OK
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17
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Keller-Hamilton B, Mehta T, Hale JJ, Leavens ELS, Shihadeh A, Eissenberg T, Brinkman MC, Wagener TL. Effects of flavourants and humectants on waterpipe tobacco puffing behaviour, biomarkers of exposure and subjective effects among adults with high versus low nicotine dependence. Tob Control 2021; 31:527-533. [PMID: 33408120 DOI: 10.1136/tobaccocontrol-2020-056062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/09/2020] [Accepted: 11/27/2020] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Flavourants and humectants in waterpipe tobacco (WT) increase product appeal. Removal of these constituents, however, is associated with increased intensity of WT puffing, likely due to reduced nicotine delivery efficiency. To clarify the potential public health outcomes of restrictions on flavourants or humectants in WT, we evaluated the effects of these constituents on puffing behaviours, biomarkers of exposure and subjective effects among adults with high versus low WT dependence. METHODS N=39 high dependence and N=49 low dependence WT smokers (Lebanese Waterpipe Dependence Scale scores >10 = high dependence) completed four smoking sessions in a cross-over experiment. Conditions were preferred flavour with humectant (+F+H), preferred flavour without humectant (+F-H), unflavoured with humectant (-F+H) and unflavoured without humectant (-F-H). Measures of puff topography, plasma nicotine and expired carbon monoxide (eCO) boost, and subjective effects were assessed. RESULTS Level of WT dependence modified the effect of WT condition on average flow rate, average puff volume and eCO boost. Although, overall, participants puffed the +F+H WT least intensely and -F-H WT most intensely, this association was strongest among WT smokers with high dependence. Participants preferred smoking the +F+H WT and achieved the largest plasma nicotine boost in that condition. DISCUSSION Findings underscore the complexity of setting product standards related to flavourants and humectants in WT. Future research evaluating whether WT smokers with high dependence would quit or reduce their WT smoking in response to removal of flavourants or humectants from WT is necessary to appreciate the full public health effects of such policies.
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Affiliation(s)
- Brittney Keller-Hamilton
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Toral Mehta
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Jessica J Hale
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Eleanor L S Leavens
- Department of Population Health, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Alan Shihadeh
- Mechanical Engineering, American University of Beirut, Beirut, Lebanon.,Center for the Study of Tobacco Products, Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Thomas Eissenberg
- Center for the Study of Tobacco Products, Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Marielle C Brinkman
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA.,College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Theodore L Wagener
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA.,Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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18
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Leavens ELS, Ford BR, Ojo-Fati O, Winkelman TNA, Vickery KD, Japuntich SJ, Busch AM. Electronic cigarette use patterns and chronic health conditions among people experiencing homelessness in MN: a statewide survey. BMC Public Health 2020; 20:1889. [PMID: 33297999 PMCID: PMC7724886 DOI: 10.1186/s12889-020-09919-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 11/18/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Adults experiencing homelessness have higher rates of disease and premature morbidity compared to the general population. Tobacco use is a primary contributing factor to these disparities; however, less is known regarding e-cigarette use patterns among adults experiencing homelessness and whether e-cigarettes are used in a manner that is narrowing or widening health disparities. This study aimed to describe the 1) prevalence and trends in e-cigarette use, 2) correlates of e-cigarettes use, and 3) rates of chronic health conditions by product use pattern in a community-based sample of adults experiencing homelessness. METHODS Adults experiencing homelessness in Minnesota were surveyed by self-report in 2015 (n = 3672) and 2018 (n = 4181) regarding e-cigarette and combustible cigarette use, potential correlates of e-cigarette use, and self-reported chronic health conditions (i.e., asthma, hypertension, diabetes, and cancer). RESULTS Frequency of use increased from 2015 to 2018 for combustible cigarettes (66.9% vs. 72.3%), e-cigarettes (11.4% vs. 14.5%), and dual combustible/e-cigarette use (10.2% vs. 12.9%). The strongest bivariate correlates of past 30-day e-cigarette use were younger age, non-binary gender identification, non-heterosexual orientation, identification as White/Caucasian, greater frequency of lifetime homelessness, substance use, lack of regular place for medical care, mental health diagnosis, criminal justice involvement, and combustible cigarette smoking. Dual users had significantly higher rates of asthma and cancer than both those using combustible cigarettes and those using neither combustible nor e-cigarettes. CONCLUSIONS During a time when cigarette smoking, e-cigarette use, and dual use were decreasing in the general population in Minnesota, rates increased in the homeless population. We observed that the rates of dual use were more than five times greater among homeless adults compared to the general population in 2018. Correlates of e-cigarette use were identified and should be used to identify subpopulations for intervention targeting. Mechanisms of the relationship between dual use and increased risks of health conditions deserve further study.
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Affiliation(s)
- Eleanor L S Leavens
- Department of Population Health, University of Kansas School of Medicine, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA.
| | - Becky R Ford
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, USA
| | - Olamide Ojo-Fati
- Behavioral Health Equity Research Group, Hennepin Healthcare Research Institute, Minneapolis, MN, USA
| | - Tyler N A Winkelman
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, USA
- General Internal Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Katherine Diaz Vickery
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, USA
- General Internal Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Sandra J Japuntich
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
- Clinical Pharmacology, Department of Medicine, Hennepin Healthcare, Minneapolis, MN, USA
| | - Andrew M Busch
- Behavioral Health Equity Research Group, Hennepin Healthcare Research Institute, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
- Clinical Pharmacology, Department of Medicine, Hennepin Healthcare, Minneapolis, MN, USA
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19
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Leavens ELS, Morgan TL, Brett EI, Patzkowsky K, Son J, Molina N, Eissenberg T, Shihadeh A, Leffingwell TR, Wagener TL. Concurrent Alcohol Use and Waterpipe Tobacco Smoking: Smoking Topography, Toxicant Exposure, and Abuse Liability. Nicotine Tob Res 2020; 22:280-287. [PMID: 30820567 DOI: 10.1093/ntr/ntz032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 02/25/2019] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Relative to non-waterpipe (WP) smokers, WP smokers are more than twice as likely to use alcohol and frequently consume alcohol before or during smoking sessions. Co-use of alcohol and WP may result in greater toxicant exposure compared to WP smoking alone. To date, no study systematically has investigated the impact of acute alcohol intoxication on WP smoking topography, exposure to tobacco-related toxicants, or abuse liability. METHODS Dyads of current WP smokers and drinkers (N = 42; age = 21-32 years) completed two in-laboratory ad libitum smoking sessions (≤2 hours) following 12-hour nicotine abstinence in a double-blind, randomized crossover design in which they consumed a placebo versus active drink (sustained breath alcohol concentration = .08). Exhaled carbon monoxide (eCO) and plasma nicotine concentration were assessed. Questionnaires assessed smoking experience and smoking urge. Smoking topography was measured continuously throughout each smoking session. RESULTS The alcohol session was associated with increased inhaled volume, flow rate, and WP session duration compared to placebo. Compared to placebo, participants reported a more positive overall smoking experience following the alcohol session and greater smoking urges pre- and post-smoking session. Although both sessions resulted in significant increases in eCO and plasma nicotine, no significant differences emerged in eCO or nicotine exposure between the active and placebo sessions. CONCLUSIONS Co-use of alcohol and WP may contribute to the maintenance of WP smoking through enhanced smoking experiences, increased urge to smoke, and significant exposure to addictive nicotine. Regulations may be necessary to limit the sale of alcohol in WP smoking lounges and reduce exposure to secondhand smoke. IMPLICATIONS The findings suggest co-use of alcohol and WP tobacco likely maintain WP use and dependence by enhancing the smoking experience and increasing urges to smoke. These findings have implications for regulations aimed at limiting co-use of alcohol and WP tobacco in WP lounges and limiting exposure to secondhand smoke. CLINICAL TRIALS REGISTRATION NCT03096860.
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Affiliation(s)
- Eleanor L S Leavens
- Oklahoma Tobacco Research Center, Oklahoma City, OK.,Department of Psychology, Oklahoma State University, Stillwater, OK
| | - Taylor L Morgan
- Oklahoma Tobacco Research Center, Oklahoma City, OK.,Nationwide Children's Hospital, Columbus, OH
| | - Emma I Brett
- Department of Psychology, Oklahoma State University, Stillwater, OK
| | | | - Jessica Son
- Oklahoma Tobacco Research Center, Oklahoma City, OK
| | - Neil Molina
- Oklahoma Tobacco Research Center, Oklahoma City, OK
| | - Thomas Eissenberg
- Center for the Study of Tobacco Products, Department of Psychology, Virginia Commonwealth University, Richmond, VA
| | - Alan Shihadeh
- Center for the Study of Tobacco Products, Department of Psychology, Virginia Commonwealth University, Richmond, VA.,Department of Mechanical Engineering, American University of Beirut, Beirut, Lebanon
| | | | - Theodore L Wagener
- Oklahoma Tobacco Research Center, Oklahoma City, OK.,Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK
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20
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Stevens EM, Hébert ET, Tackett AP, Leavens ELS, Wagener TL. Harm Perceptions of the JUUL E-Cigarette in a Sample of Ever Users. Int J Environ Res Public Health 2020; 17:E4755. [PMID: 32630647 PMCID: PMC7369803 DOI: 10.3390/ijerph17134755] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/22/2020] [Accepted: 06/25/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Monitoring trends and perceptions of new nicotine salt-based electronic cigarettes (ECs), like JUUL, is important to identify associations with product experimentation and use. Understanding harm perceptions of these new devices will inform prevention and intervention efforts. The current study assesses perceptions of the absolute harmfulness of JUUL use in addition to comparing it to other tobacco products. METHODS Participants (N = 839, 52% male) reporting ever use of JUUL were recruited from Amazon's Mechanical Turk from January to March 2018. Respondents completed questionnaire items assessing demographics, co-use of non-JUUL products, JUUL use status (i.e., daily users (10.8%), non-daily users (29.4%), and triers (59.9%)), and JUUL and other tobacco products absolute harm perceptions. RESULTS Overall, participants rated JUUL as significantly less harmful than all other tobacco products (p < 0.001), except other ECs. Daily JUUL users rated JUUL as less harmful compared to non-daily JUUL users and JUUL triers (p < 0.05). JUUL was rated as more harmful by women compared to men (p < 0.05). CONCLUSIONS Increased frequency of JUUL use was associated with decreased harm perceptions. JUUL was associated with reduced perceptions of absolute harm compared to most other tobacco products, except other ECs. Public health practitioners should develop public health interventions that increase harm perceptions of ECs.
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Affiliation(s)
- Elise M. Stevens
- Harvard T.H. Chan School of Public Health, Dana-Farber Cancer Institute, Harvard University, Boston, MA 02115, USA
| | - Emily T. Hébert
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (E.T.H.); (A.P.T.)
| | - Alayna P. Tackett
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (E.T.H.); (A.P.T.)
| | - Eleanor L. S. Leavens
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS 66160, USA;
| | - Theodore L. Wagener
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA;
- Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA
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21
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Wagener TL, Leavens ELS, Mehta T, Hale J, Shihadeh A, Eissenberg T, Halquist M, Brinkman MC, Johnson AL, Floyd EL, Ding K, El Hage R, Salman R. Impact of flavors and humectants on waterpipe tobacco smoking topography, subjective effects, toxicant exposure and intentions for continued use. Tob Control 2020; 30:tobaccocontrol-2019-055509. [PMID: 32404518 DOI: 10.1136/tobaccocontrol-2019-055509] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 03/16/2020] [Accepted: 04/08/2020] [Indexed: 12/29/2022]
Abstract
INTRODUCTION The present study examined how the lack of characterising flavours and low levels of humectants may affect users' waterpipe tobacco (WT) smoking topography, subjective effects, toxicant exposure and intentions for continued use. METHODS 89 WT smokers completed four ad libitum smoking sessions (characterising flavor/high humectant (+F+H); characterising flavor/low humectant (+F-H); no characterising flavor/high humectant (-F+H); no characterising flavor/low humectant (-F-H)) in a randomised cross-over design. WT was commercially available; same brand but nicotine levels were not held constant. A subsample (n=50) completed a standardised, 10-puff session preceding ad libitum smoking. Participants completed questionnaires, exhaled carbon monoxide (eCO) testing and provided blood samples for plasma nicotine. Smoking topography was measured throughout the session. Post hoc analyses showed that -F+H and -F-H did not differ significantly in humectant levels. Therefore, these groups were collapsed in analyses (-F-H). RESULTS WT smokers reported significantly greater satisfaction, liking, enjoyment and greater intentions for continued use when smoking +F+H compared with other WT products, with -F-H receiving the lowest ratings. Significant differences in topography were observed during standardised and ad libitum sessions, with the -F-H preparation leading to greater total inhaled volume and eCO boost, but lower nicotine boost compared with +F+H (all p<0.05). DISCUSSION The findings demonstrate the importance of flavours and humectants on improving WT smoking experience and increasing the likelihood that users will want to initiate and continue smoking. Moreover, it demonstrates that flavours and humectants influence smoking behaviour and toxicant exposure in some unexpected ways that are important for regulatory efforts.
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Affiliation(s)
- Theodore L Wagener
- Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, United States
| | - Eleanor L S Leavens
- Department of Population Health, University of Kansas School of Medicine, Kasas City, Kansas, United States
| | - Toral Mehta
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, United States
| | - Jessica Hale
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, United States
| | - Alan Shihadeh
- Department of Mechanical Engineering, American University of Beirut, Beirut, Lebanon
| | - Thomas Eissenberg
- Center for the Study of Tobacco Products, Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Matthew Halquist
- Department of Pharmaceutics, School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Marielle C Brinkman
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, United States
- Department of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Amanda L Johnson
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, Oklahoma City, Oklahoma, USA
| | - Evan L Floyd
- Department of Occupational and Environmental Health, University of Oklahoma - Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Kai Ding
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Rachel El Hage
- Department of Chemistry, American University of Beirut, Beirut, Lebanon
| | - Rola Salman
- Department of Mechanical Engineering, American University of Beirut, Beirut, Lebanon
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Leavens ELS, Lechner WV, Stevens EM, Miller MB, Meier E, Brett EI, Moisiuc A, Hale JJ, Wagener TL. Electronic cigarette and combustible cigarette use following a campus-wide ban: Prevalence of use and harm perceptions. J Am Coll Health 2020; 68:332-335. [PMID: 30681933 PMCID: PMC8689442 DOI: 10.1080/07448481.2018.1551803] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 08/29/2018] [Accepted: 11/12/2018] [Indexed: 05/29/2023]
Abstract
The current study examined changes in prevalence of e-cigarette use and perceptions of the harmfulness of e-cigarette and combustible cigarettes following a campus-wide tobacco ban. Undergraduate students completed surveys of tobacco use and perceived product harmfulness. Four samples were collected: in 2013 prior to the ban (n = 792) and in fall 2014 (n = 310), 2015 (n = 208), and 2016 (n = 417). E-cigarette use increased in the years following the ban (p = .01) while combustible cigarette use decreased from 2013 to 2016 (p = .02). Men were more likely than women to use both products (ps < .05). Students' perceptions of the harmfulness of combustible and electronic cigarettes remained stable in the years following the ban (p > .05). This study is the first to examine the impact of including e-cigarettes in tobacco free policies. Combustible cigarette use declined, but e-cigarette use increased in the years following the e-cigarette ban. Prospective research is needed to understand the long-term impacts of e-cigarette bans.
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Affiliation(s)
- Eleanor L. S. Leavens
- Oklahoma Tobacco Research Center, Oklahoma City, Oklahoma, USA
- Oklahoma State University, Stillwater, Stillwater, Oklahoma, USA
| | | | | | - Mary Beth Miller
- University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Ellen Meier
- University of Wisconsin - Stevens Point, Stevens Point, Wisconsin, USA
| | - Emma I. Brett
- Oklahoma State University, Stillwater, Stillwater, Oklahoma, USA
| | - Alexis Moisiuc
- Oklahoma Tobacco Research Center, Oklahoma City, Oklahoma, USA
| | - Jessica J. Hale
- Oklahoma Tobacco Research Center, Oklahoma City, Oklahoma, USA
| | - Theodore L. Wagener
- Oklahoma Tobacco Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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Leavens ELS, Miller MB, Brett EI, Baraldi A, Leffingwell TR. Influencing college students' normative perceptions of protective behavioral strategies: A pilot randomized trial. Addict Behav 2020; 104:106256. [PMID: 31927219 DOI: 10.1016/j.addbeh.2019.106256] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 11/05/2019] [Accepted: 12/10/2019] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Personalized feedback interventions (PFIs) are associated with small but reliable decreases in alcohol consumption among college students. While they often include information regarding protective behavioral strategies (PBS), PFIs do not typically include feedback aimed to modify normative perceptions of PBS. This study aimed to enhance the efficacy of existing PFIs among college students by incorporating normative feedback on participants' use of PBS. METHODS Students enrolled in undergraduate courses (N = 268) completed baseline and 1-month follow-up assessments of past-month use of PBS, normative perceptions of PBS use, alcohol consumption, and alcohol-related consequences. Participants were randomized to one of three conditions: typical feedback on PBS (typical strategies PFI), descriptive normative feedback on PBS (strategy norms PFI), or assessment-only control (AOC). Participants in the typical strategies PFI and strategy norms PFI conditions received web-based personalized feedback profiles. RESULTS Compared to AOC, both the strategy norms PFI and typical strategies PFI were effective in correcting participants' perceptions of other students' engagement in PBS (p = .01) but did not differ significantly from one another. No statistically significant differences were observed between conditions in terms of actual PBS use, alcohol consumption, or alcohol-related consequences at 1-month follow-up (p > .05). DISCUSSION The strategy norms and typical strategies PFIs were both successful in increasing normative perceptions of PBS use, indicating that general (rather than normative) feedback regarding PBS use may be sufficient for changing perceptions of PBS use.
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Affiliation(s)
- Eleanor L S Leavens
- Department of Psychology, Oklahoma State University, Stillwater, OK, United States
| | - Mary Beth Miller
- Department of Psychiatry, University of Missouri, Columbia, MO, United States
| | - Emma I Brett
- Department of Psychology, Oklahoma State University, Stillwater, OK, United States
| | - Amanda Baraldi
- Department of Psychology, Oklahoma State University, Stillwater, OK, United States
| | - Thad R Leffingwell
- Department of Psychology, Oklahoma State University, Stillwater, OK, United States.
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Leavens ELS, Smith TT, Natale N, Carpenter MJ. Electronic cigarette dependence and demand among pod mod users as a function of smoking status. Psychol Addict Behav 2020; 34:804-810. [PMID: 32297753 DOI: 10.1037/adb0000583] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Electronic cigarette (e-cigarette) use continues to proliferate with fast-paced product evolution. Pod mod e-cigarettes emerged in the market in 2015 and have changed the tobacco landscape again. However, little is known regarding their addiction potential among users. The current study describes e-cigarette dependence and demand among pod mod users as a function of smoking status (current smokers/dual users, former smokers, and never smokers). Participants were 593 young adult (Mage = 25.9 years) JUUL users recruited via Amazon's Mechanical Turk. Respondents were specifically recruited based on current use of pod mods (but may also be using other e-cigarette devices) and smoking status (never, former, and current/dual users). Participants completed online measures assessing e-cigarette dependence and demand. Dual users of pod mods and cigarettes displayed greater e-cigarette dependence compared to current pod mod users with no history of cigarette smoking (p = .033). Similarly, dual users showed the greatest levels of e-cigarette demand compared to both former smokers and those without a history of smoking (ps < .05). Dual users displayed the greatest e-cigarette dependence and demand. Future research should directly assess potential mechanisms for this effect and continue to monitor e-cigarette dependence as the tobacco landscape changes with the emergence of new e-cigarette products and innovations. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Stevens EM, Johnson AL, Leshner G, Sun F, Kim S, Leavens ELS, Tackett AP, Hébert ET, Wagener TL. People in E-Cigarette Ads Attract More Attention: An Eye-Tracking Study. TOB REGUL SCI 2020; 6:105-117. [PMID: 33816715 PMCID: PMC8018674 DOI: 10.18001/trs.6.2.3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Minimally regulated electronic cigarettes (e-cigarette) advertising may be one potential factor driving the increasing prevalence of young adult e-cigarette use. Using eye-tracking, the current study examined which e-cigarette advertising features were the most appealing to young adults as a first step to examine how e-cigarette advertising may be regulated. METHODS Using a within-subjects design, 30 young adults (M age = 20.0 years) viewed e-cigarette ads in a laboratory. Ad features or areas of interest (AOIs) included: 1) brand logo, 2) product descriptor, and 3) people. During ad viewing, eye-tracking measured participants' dwell time and time to first fixation for each AOI as well as each ad brand. Harm perceptions pre- and post-viewing were measured. RESULTS Participants spent the longest dwell time on people (M = 2701 ms), then product descriptors (M = 924 ms), then brand logos (M = 672 ms; ps < .001). They also fixated fastest on AOIs in that order. Participant sex significantly impacted dwell time of ad brand, and harm perceptions decreased after viewing the ads (ps < .05). CONCLUSIONS This study provides initial evidence about which e-cigarette ad features may appeal most to young adults and may be useful when designing evidence-based policy.
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Affiliation(s)
- Elise M Stevens
- Harvard T.H. Chan School of Public Health, Dana-Farber Cancer Institute, Harvard University, Boston, MA
| | - Amanda L Johnson
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Glenn Leshner
- Edward L. and Thelma Gaylord Chair in journalism, Gaylord College of Journalism and Mass Communication, University of Oklahoma, Norman, OK
| | - FuWei Sun
- Department of Journalism, Fu Hsing Kang College, National Defense University, Taiwan
| | - Seunghyun Kim
- Department of Marketing and Advertising, College of Business, University of Arkansas at Little Rock, Little Rock, AK
| | - Eleanor L S Leavens
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS
| | - Alayna P Tackett
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Emily T Hébert
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Theodore L Wagener
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, The Ohio State University, Columbus, OH
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Leavens ELS, Stevens EM, Brett EI, Leffingwell TR, Wagener TL. JUUL in school: JUUL electronic cigarette use patterns, reasons for use, and social normative perceptions among college student ever users. Addict Behav 2019; 99:106047. [PMID: 31442788 DOI: 10.1016/j.addbeh.2019.106047] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 05/12/2019] [Accepted: 07/08/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND JUUL electronic cigarettes have surged in popularity since their emergence on the market in 2015. JUUL is slim and simple in design and is capable of delivering cigarette-like levels of nicotine. However, little research has examined JUUL use patterns, reasons for use, and normative perceptions of JUUL among young adults. METHODS Participants were college students (N = 243) who reported ever using a JUUL electronic cigarette. Eligible participants completed a survey assessing JUUL use patterns, reasons for JUUL use, and normative perceptions of JUUL. RESULTS Most participants reported using JUUL once or twice (47.7%) and almost one-third reported using JUUL daily or monthly (29.6%). Overall, participants reported a low level of nicotine dependence (Melectronic cigarette HONC = 0.93, SD = 2.04). Cool Mint was the most preferred flavor (35.8%) followed by Mango (12.0%). The top reasons for use were because "friends were using it" (27.0%) and "curiosity" (19.4%). Nearly half (49.8%) of participants reported that they would tell all five of their five closest friends that they use JUUL. Only 10.7% reported a belief that none of their friends would approve of their JUUL use. CONCLUSIONS The high percentage of daily and monthly JUUL users coupled with the relatively high rates of perceived acceptability of use indicates the possibility of high uptake among college students. Findings also suggest college students perceive JUUL as highly acceptable and that their friend's use and curiosity were primary motivators of their initial use, indicating the importance of peer influence in college student JUUL use.
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Affiliation(s)
- Eleanor L S Leavens
- Oklahoma Tobacco Research Center, University of Oklahoma Health Sciences Center, USA; Oklahoma State University, Department of Psychology, USA.
| | - Elise M Stevens
- Oklahoma Tobacco Research Center, University of Oklahoma Health Sciences Center, USA
| | - Emma I Brett
- Oklahoma State University, Department of Psychology, USA
| | | | - Theodore L Wagener
- Ohio State University, Columbus, Ohio, USA; James Cancer Hospital, Columbus, Ohio, USA.
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Brett EI, Miller MB, Leavens ELS, Lopez SV, Wagener TL, Leffingwell TR. Electronic cigarette use and sleep health in young adults. J Sleep Res 2019; 29:e12902. [PMID: 31486154 DOI: 10.1111/jsr.12902] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 07/10/2019] [Accepted: 07/12/2019] [Indexed: 01/04/2023]
Abstract
Poor sleep health is associated with numerous health concerns, and sleep problems are exacerbated by cigarette smoking. Although rates of traditional tobacco use are declining, rates of electronic cigarette (e-cigarette) use are comparatively high and growing. Given that nicotine is a primary mechanism by which smoking negatively impacts sleep health, e-cigarette use may also be linked to poor sleep health; however, no research has investigated this association. Participants were 1,664 college students, 40.9% of whom reported ever trying or currently using an e-cigarette. Questionnaires assessed demographic information, sleep health and e-cigarette use status and patterns. All measures were completed remotely via a secure online survey. Analysis of covariance was used to compare the sleep health of daily/non-daily e-cigarette users to (a) non-users and (b) users of combustible cigarettes. Gender and drinks per week were included as covariates in analyses. Current combustible and e-cigarette users reported significantly more sleep difficulties than never users. Users of e-cigarettes reported greater use of sleep medication than combustible cigarette users. Similar to combustible cigarette smoking, e-cigarette use (vs. non-use) was associated with worse sleep health, even among non-daily e-cigarette users. These findings may indicate a need for assessment of and education on the role of e-cigarette use in sleep health among individuals who report experimentation with or current use of e-cigarettes. Future research should examine these relationships prospectively.
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Affiliation(s)
- Emma I Brett
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA
| | | | | | - Susanna V Lopez
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA
| | - Theodore L Wagener
- Ohio State University Comprehensive Cancer Center, Division of Medical Oncology and Center for Tobacco Research, Columbus, OH, USA.,Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Thad R Leffingwell
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA
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Lopez SV, Leffingwell TR, Brett EI, Leavens ELS. Temporal Estimations and Subjective Evaluations of Alcohol Consequences. Am J Health Behav 2019; 43:1006-1015. [PMID: 31439105 DOI: 10.5993/ajhb.43.5.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives: College student alcohol interventions utilizing public health messaging describe consequences that are delayed and significantly negative, a strategy shown to be ineffective. It is possible that messaging related to immediate, likely, and less negative consequences may be better at reducing problematic drinking. Although research has investigated perceptions of subjective evaluations, no studies have included perceptions of likelihood of occurrence and temporal estimations of alcohol-related consequences. In the current study, we measured perceptions of consequences in terms of likelihood of occurrence, temporal estimations, and subjective evaluations. Methods: Undergraduate students (N = 308) from a large, Midwestern university completed an online survey assessing alcohol use patterns and perceptions of consequences (ie, likelihood of occurrence, temporal estimations, and subjective evaluations). Results: Students perceived failure to graduate and drunk driving to be the least likely, most negative, and most delayed consequences; vomiting and hangovers were the most likely, least negative, and most immediate consequences. Independent t-tests revealed statistically significant differences between high- and low-risk drinkers. Conclusions: Students perceived differences in consequences on temporal estimation, likelihood of occurrence, and subjective evaluations. Future studies should examine how these perceptions affect subsequent alcohol use.
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Affiliation(s)
- Susanna V. Lopez
- Graduate Student, Oklahoma State University, Department of Psychology, Stillwater, OK
| | - Thad R. Leffingwell
- Professor, Oklahoma State University, Department of Psychology, Stillwater, OK;,
| | - Emma I. Brett
- Oklahoma State University, Department of Psychology, Stillwater, OK
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Leavens ELS, Stevens EM, Brett EI, Hébert ET, Villanti AC, Pearson JL, Wagener TL. JUUL electronic cigarette use patterns, other tobacco product use, and reasons for use among ever users: Results from a convenience sample. Addict Behav 2019; 95:178-183. [PMID: 30933713 DOI: 10.1016/j.addbeh.2019.02.011] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 02/04/2019] [Accepted: 02/13/2019] [Indexed: 12/31/2022]
Abstract
INTRODUCTION JUUL, an e-cigarette from PAX Labs, has captured 70% of the e-cigarette market. The current study examines JUUL use patterns and reasons for initiation in a large convenience sample of U.S. adults. METHODS Respondents were 979 U.S. adults registered on Amazon Mechanical Turk (MTurk) who reported ever using JUUL. Items included frequency/quantity of JUUL use, reasons for trying JUUL, flavor preferences, and use of other tobacco products. RESULTS The majority of participants reported only trying JUUL once or twice (59.5%), 29.2% reported regular nondaily use and 10.3% reported daily use. The average quantity of JUUL pod use was low in the overall sample (4 pods per month). Daily users reported using ~10 pods per month and engaging in 4-9 separate vaping sessions per day. The most frequently reported reasons for JUUL use were because friends were using it (26.5%), curiosity (20.5%), and similarity to a cigarette (7.7%). Approximately 26% of current JUUL users reported current exclusive JUUL use, while 56% reported using JUUL and another e-cigarette. Of the entire sample, 37.1% were former smokers. Of those, 14.9% were daily JUUL users, 21.4% were nondaily JUUL users, and 63.8% were JUUL triers. CONCLUSIONS This is the first study to examine patterns and reasons for use of the most popular e-cigarette on the market. In this convenience sample, nearly 40% of those who ever tried JUUL reported current daily or daily use. JUUL use may be associated with limited puffing patterns compared to earlier generation e-cigarettes. Research is needed to investigate if JUUL puffing patterns result in decreased exposure to potentially harmful non-nicotine e-liquid constituents compared to other e-cigarettes.
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Affiliation(s)
- Eleanor L S Leavens
- Oklahoma Tobacco Research Center, Oklahoma City, OK, United States of America; Oklahoma State University, Department of Psychology, Stillwater, OK, United States of America
| | - Elise M Stevens
- Oklahoma Tobacco Research Center, Oklahoma City, OK, United States of America
| | - Emma I Brett
- Oklahoma State University, Department of Psychology, Stillwater, OK, United States of America
| | - Emily T Hébert
- Oklahoma Tobacco Research Center, Oklahoma City, OK, United States of America
| | - Andrea C Villanti
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, Burlington, VT, United States of America
| | - Jennifer L Pearson
- Division of Social and Behavioral Health/Health Administration, Policy, School of Community Health Sciences, University of Nevada, Reno, United States of America
| | - Theodore L Wagener
- Oklahoma Tobacco Research Center, Oklahoma City, OK, United States of America; University of Oklahoma Health Science Center, Department of Pediatrics, Oklahoma City, OK, United States of America.
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Peter SC, Brett EI, Suda MT, Leavens ELS, Miller MB, Leffingwell TR, Whelan JP, Meyers AW. A Meta-analysis of Brief Personalized Feedback Interventions for Problematic Gambling. J Gambl Stud 2019; 35:447-464. [PMID: 30610506 DOI: 10.1007/s10899-018-09818-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Personal Feedback Interventions (PFIs) have been widely used to reduce the amount of time and money individuals spend on gambling. A central component of these interventions is personalized information about an individual's gambling behavior, often in comparison to others' gambling. The purpose of the present review and meta-analysis was to evaluate these interventions in terms of content, mode of delivery, target sample, and efficacy. Sixteen interventions from 11 studies were reviewed. We found a small, statistically significant effect in favor of PFIs versus control (d = 0.20, 95% CI 0.12, 0.27). Six moderators of intervention efficacy were explored. These interventions appeared to be most efficacious when used in populations of greater gambling severity, when individuals were provided with gambling-related educational information, and when used in conjunction with motivational interviewing. Factors associated with reduced efficacy include in-person delivery of feedback without motivational-interviewing and informing participants of their score on a psychological measure of gambling severity. Efficacy did not vary as a function of college or community samples. PFIs are a low cost, easily disseminated intervention that can be used as a harm-reduction strategy. However, more substantial effects may be attained if used as part of a larger course of therapy.
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Affiliation(s)
- Samuel C Peter
- Institute of Gambling Education and Research, The University of Memphis, Room 202 Psychology Building, 400 Innovation Drive, Memphis, TN, 38152-6400, USA.
| | | | - Matthew T Suda
- University of Tennessee Health Science Center, Memphis, TN, USA
| | | | | | | | - James P Whelan
- Institute of Gambling Education and Research, The University of Memphis, Room 202 Psychology Building, 400 Innovation Drive, Memphis, TN, 38152-6400, USA
| | - Andrew W Meyers
- Institute of Gambling Education and Research, The University of Memphis, Room 202 Psychology Building, 400 Innovation Drive, Memphis, TN, 38152-6400, USA
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Stevens EM, Kim S, Leshner G, Leavens ELS, Vidrine JI, Frank-Pearce SG, Hale JJ, Wagener TL. The Attitudinal and Motivational Effects of Anti-waterpipe Messages. Am J Health Behav 2019; 43:478-489. [PMID: 31046879 DOI: 10.5993/ajhb.43.3.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Objectives: Waterpipe smoking can lead to negative health outcomes. In this study, we examined responses to anti-waterpipe smoking public service announcements (PSAs). Methods: In a pilot study, current waterpipe smokers (N = 20) and susceptible waterpipe never smokers (N = 25) were randomized to view either 3 anti-waterpipe PSAs, created by the Truth campaign, or 3 control videos. Participants answered questions pertaining to message acceptance at 3 time-points and perceived risk and motivation to quit or avoid waterpipe at 4 time-points. Results: Participants were recruited from the community (N = 45; Mage = 22.4 years). Whereas waterpipe smokers and never smokers who viewed the PSAs significantly increased in acceptance of (p < .05) and positive attitudes towards (p < .05) the messages with increased viewing of the mes- sages, waterpipe never smokers did so at a significantly higher rate (p < .05). Waterpipe never smokers who viewed the PSAs had increased perceived severity and susceptibility of health harms of waterpipe compared to the control (ps < .05). We also found gender differences. Conclusions: The 3 tested PSAs from the Truth campaign show evidence of effectiveness against waterpipe use.
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Abstract
BACKGROUND Alcohol consumption and related consequences is a problem on many college campuses. Tailgating parties before college sporting events may be contributing, however, little recent research has investigated alcohol consumption at these events. OBJECTIVE The purpose of this study is to evaluate the drinking behaviors of college game day tailgate attendees and subsequent alcohol-related consequences. METHODS Participants (N = 89; 44.9% female) were recruited from tailgates at a university in the Midwest United States on college football game days during fall 2014. Participants provided a breath sample, completed a questionnaire, and were given the opportunity to participate in a follow-up survey (n = 62) to assess resulting alcohol-related consequences. RESULTS Over half of participants had BrACs greater than 0.000. However, one in three participants reported intentions to abstain from alcohol or to drink but not enough to get buzzed. Intoxication intentions were a significant and unique predictor of alcohol consumption and experience with alcohol-related consequences at follow-up. Conclusions/Importance: This study updates and extends the literature on alcohol-related consequences in the context of college football tailgates. The results suggest that consequences may be prevented through changes in intentions to become intoxicated.
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Affiliation(s)
- Eleanor L S Leavens
- a Department of Psychology , Oklahoma State University , Stillwater , Oklahoma , USA
| | - Julie Croff
- b School of Applied Health and Educational Psychology , Oklahoma State University , Stillwater , Oklahoma , USA
| | - Rachel Feddor
- a Department of Psychology , Oklahoma State University , Stillwater , Oklahoma , USA
| | - Kathleen Olson
- b School of Applied Health and Educational Psychology , Oklahoma State University , Stillwater , Oklahoma , USA
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Tackett AP, Leavens ELS, Wiedenmann A, Perez MN, Baker A, Mayes S, Mullins LL, Wagener TL. Preliminary exploration of secondhand smoke exposure in youth with Sickle Cell Disease: biochemical verification, pulmonary functioning, and health care utilization. PSYCHOL HEALTH MED 2019; 24:35-42. [PMID: 30203658 PMCID: PMC6262893 DOI: 10.1080/13548506.2018.1516294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Exposure to secondhand smoke (SHSe) can compound an already challenging set of health problems for youth with Sickle Cell Disease (SCD). Exposure to electronic cigarettes may also impact SCD symptomology and respiratory functioning. This study built on these previous findings by a) utilizing two objective measures of SHSe, salivary cotinine and exhaled carbon monoxide and b) examining the association of SHSe with emergency department utilization, physician-reported sickle cell crises, and pulmonary functioning. Caregivers (N = 31 dyads; Mage = 37.6 years; SD = 8.5 years) of youth with SCD (Mage = 9.0 years; SD = 4.5 years) completed self-report measures of tobacco/nicotine use. Youth provided a saliva sample to assess cotinine levels, and performed pulmonary function tests. Dyads provided breath samples for measurement of eCO. A chart review was conducted to obtain medical history and utilization. Majority of youth (88%) were exposed to SHS via salivary cotinine. Interestingly, no significant associations were observed between youth cotinine levels and emergency department utilization, physician-reported sickle cell crises, or pulmonary functioning. Present findings indicate a need to assess for SHSe using objective assessment measures. Future research should investigate which specific factors contribute to increase SHSe/SHVe in youth with SCD.
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Affiliation(s)
- Alayna P Tackett
- a Oklahoma Tobacco Research Center , University of Oklahoma Health Sciences Center , Oklahoma City , OK , USA
- b Department of Pediatrics , University of Oklahoma Health Sciences Center , Oklahoma City , OK , USA
| | - Eleanor L S Leavens
- a Oklahoma Tobacco Research Center , University of Oklahoma Health Sciences Center , Oklahoma City , OK , USA
- c Psychology Department , Oklahoma State University , Stillwater , OK , USA
| | - Alex Wiedenmann
- c Psychology Department , Oklahoma State University , Stillwater , OK , USA
| | - Megan N Perez
- c Psychology Department , Oklahoma State University , Stillwater , OK , USA
| | - Ashley Baker
- b Department of Pediatrics , University of Oklahoma Health Sciences Center , Oklahoma City , OK , USA
| | - Sunnye Mayes
- b Department of Pediatrics , University of Oklahoma Health Sciences Center , Oklahoma City , OK , USA
| | - Larry L Mullins
- b Department of Pediatrics , University of Oklahoma Health Sciences Center , Oklahoma City , OK , USA
- c Psychology Department , Oklahoma State University , Stillwater , OK , USA
| | - Theodore L Wagener
- a Oklahoma Tobacco Research Center , University of Oklahoma Health Sciences Center , Oklahoma City , OK , USA
- b Department of Pediatrics , University of Oklahoma Health Sciences Center , Oklahoma City , OK , USA
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Brett EI, Stevens EM, Wagener TL, Leavens ELS, Morgan TL, Cotton WD, Hébert ET. A content analysis of JUUL discussions on social media: Using Reddit to understand patterns and perceptions of JUUL use. Drug Alcohol Depend 2019; 194:358-362. [PMID: 30472576 DOI: 10.1016/j.drugalcdep.2018.10.014] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 10/08/2018] [Accepted: 10/15/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND JUUL, an electronic cigarette, is estimated to occupy 50% of the e-cigarette market and appears to be particularly common among youth. However, there is little research on perceptions of JUUL. The aim of the current study was to examine posts on Reddit specific to JUUL and youth to better understand the context and perceptions of JUUL use. METHODS This content analysis utilized social media discussions posted between January 2015-May 2017. Public posts on Reddit, a social media platform, were gathered and coded. Posters of discussions relevant to both JUUL and youth were included for analysis. RESULTS 364 posts were included for quantitative content analysis. Posts were mixed in terms of polarity with many (41.1%) including positive and negative language regarding JUUL. In terms of polarity of youth use, 60% of posts showed negative perceptions of youth use. Among posts by youth, only 37% showed negative perceptions of youth use. Posts included a variety of reasons for using JUUL with the most frequent reason being the popularity of JUUL (34.2%) followed by using it to quit smoking (23.3%) and to feel a buzz (20.2%). Age restrictions were the most common barrier to use. CONCLUSIONS Posters generally had a nuanced perception of JUUL and identified both positive and negative aspects. Interestingly, while primary reasons for youth use indicate the strong influence of social norms, barriers to use suggest that public health interventions such as age restrictions may curb youth use. Findings can inform prevention efforts and important factors for JUUL initiation.
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Affiliation(s)
- Emma I Brett
- Department of Psychology, Oklahoma State University, 116 North Murray, Stillwater, OK, 74078, USA
| | - Elise M Stevens
- Oklahoma Tobacco Research Center, The University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK, 73104, USA
| | - Theodore L Wagener
- Oklahoma Tobacco Research Center, The University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK, 73104, USA; Department of Pediatrics, University of Oklahoma Health Sciences Center, 1200 Children's Ave Suite 14000, Oklahoma City, OK, 73104, USA
| | - Eleanor L S Leavens
- Department of Psychology, Oklahoma State University, 116 North Murray, Stillwater, OK, 74078, USA; Oklahoma Tobacco Research Center, The University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK, 73104, USA
| | - Taylor L Morgan
- The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Whitney D Cotton
- Oklahoma Tobacco Research Center, The University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK, 73104, USA
| | - Emily T Hébert
- Oklahoma Tobacco Research Center, The University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK, 73104, USA.
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Miller MB, DiBello AM, Meier E, Leavens ELS, Merrill JE, Carey KB, Leffingwell TR. Alcohol-Induced Amnesia and Personalized Drinking Feedback: Blackouts Predict Intervention Response. Behav Ther 2019; 50:25-35. [PMID: 30661564 PMCID: PMC6347408 DOI: 10.1016/j.beth.2018.03.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 03/13/2018] [Accepted: 03/16/2018] [Indexed: 11/26/2022]
Abstract
Alcohol-induced amnesia ("blackout") is a reliable predictor of alcohol-related harm. Given its association with other negative consequences, experience of alcohol-induced amnesia may serve as a teachable moment, after which individuals are more likely to respond to intervention. To test this hypothesis, alcohol-induced amnesia was evaluated as a moderator of brief intervention effect on (a) alcohol-related consequences and (b) the proposed intervention mediators, protective behavioral strategies and peak blood alcohol concentration (BAC). Baseline alcohol risk measured using the Alcohol Use Disorders Identification Test (AUDIT) was also evaluated as a moderator to rule out the possibility that amnesia is simply an indicator of more general alcohol risk. College students (N = 198) reporting alcohol use in a typical week completed assessments at baseline and 1-month follow-up as part of a larger intervention trial. Participants were randomized to assessment only (AO; n = 58) or personalized feedback intervention (PFI; n = 140). Hierarchical regression was used to examine direct and indirect intervention effects. A significant group-by-amnesia interaction revealed that only PFI participants who had experienced alcohol-induced amnesia in the past month reported decreases in alcohol consequences at 1-month follow-up. The PFI reduced alcohol-related consequences indirectly through changes in peak BAC, but only among those who had experienced amnesia at baseline. In contrast, baseline alcohol risk (AUDIT) did not moderate intervention effects, and use of protective behavioral strategies did not statistically mediate intervention effects. Findings suggest that loss of memory for drinking events is a unique determinant of young adult response to brief alcohol intervention. Normative feedback interventions may be particularly effective for individuals who have experienced alcohol-induced amnesia in the past 30 days.
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Affiliation(s)
- Mary Beth Miller
- University of Missouri School of Medicine; Brown University School of Public Health.
| | - Angelo M. DiBello
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Box G-S121-5, Providence, RI 02912, USA
| | - Ellen Meier
- Department of Psychiatry, Tobacco Research Programs, University of Minnesota, 717 Delaware St. SE, Minneapolis, MN 55414
| | - Eleanor L. S. Leavens
- Department of Psychology, Oklahoma State University, 116 North Murray, Stillwater, OK 74078, USA
| | - Jennifer E. Merrill
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Box G-S121-5, Providence, RI 02912, USA
| | - Kate B. Carey
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Box G-S121-5, Providence, RI 02912, USA
| | - Thad R. Leffingwell
- Department of Psychology, Oklahoma State University, 116 North Murray, Stillwater, OK 74078, USA
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Wedel AV, Stevens EM, Molina N, Leavens ELS, Roberts C, Wagener TL. Examining pregnant smokers' attitudes toward cessation aids and electronic nicotine delivery systems. J Okla State Med Assoc 2018; 111:812-816. [PMID: 31404418 PMCID: PMC6688761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Tobacco remains one of the most commonly used substances during pregnancy. Despite the many health risks, pregnant women report low nicotine replacement therapy (NRT) adherence and associated quit rates due partially to perceptions of increased harm related to NRT use. The health risks coupled with the continuation of tobacco use reinforce the need for a greater understanding of these behaviors and attitudes towards NRT and electronic nicotine delivery systems (ENDS) in pregnant women. Therefore, the current study aims to understand pregnant smokers' attitudes towards cessation aids and various tobacco products. METHODS Pregnant women who reported current cigarette smoking (N = 85) were recruited from a Perinatal Center. Participants completed a 19-item self-administered survey relating to tobacco use and NRT interest. RESULTS Overall, participants reported smoking fewer cigarettes per day since becoming pregnant. Those who had used NRT and/or ENDS prior were willing to use them during their current or future pregnancies. Overall, interest in ENDS use was high (50.6% during pregnancy, 53.5% after pregnancy), despite only 5.9% of participants currently reporting use. DISCUSSION This study is the first to find that pregnant smokers may be hesitant to use NRT and ENDS instead of combustible tobacco during pregnancy, potentially due to the perceived harmfulness of these products, but feel more willing to use products that they have used previously. Therefore, education and counseling by medical providers regarding varying levels of harm related to use of NRT and nicotine/tobacco products should be included in the routine healthcare of pregnant smokers.
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Affiliation(s)
- Amelia V. Wedel
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, Oklahoma City, OK
- Department of Psychology, Syracuse University, Syracuse, NY
| | - Elise M. Stevens
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, Oklahoma City, OK
| | - Neil Molina
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, Oklahoma City, OK
| | - Eleanor L. S. Leavens
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, Oklahoma City, OK
- Department of Psychology, Oklahoma State University, Stillwater, OK
| | - Caroline Roberts
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, Oklahoma City, OK
- Department of Psychology, Oklahoma State University, Stillwater, OK
| | - Theodore L. Wagener
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, Oklahoma City, OK
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK
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Brett EI, Espeleta HC, Lopez SV, Leavens ELS, Leffingwell TR. Mindfulness as a mediator of the association between adverse childhood experiences and alcohol use and consequences. Addict Behav 2018; 84:92-98. [PMID: 29653433 DOI: 10.1016/j.addbeh.2018.04.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 03/31/2018] [Accepted: 04/02/2018] [Indexed: 12/18/2022]
Abstract
One-third of college students report past-year heavy episodic drinking, making college student alcohol use an important area for continued research. Research has consistently linked early experiences of adversity to problematic substance use in adolescence and adulthood. Given the negative health consequences associated with heavy episodic drinking, it is imperative to identify mechanisms that contribute to this relation. Low levels of mindfulness have been linked to early adversity as well as impulsivity and alcohol use, therefore, the current study aims to examine the mediating role of mindfulness in the relation between early adversity and current alcohol use and consequences. Undergraduate students (N = 385) at a Midwestern university completed an online questionnaire assessing experiences of childhood adversity, trait mindfulness, and current alcohol use and related consequences. Results indicated that increased adverse experiences and lower levels of mindfulness predicted both increased alcohol consumption and consequences (ps < 0.025), with mindfulness mediating the relationships. Mindfulness is a predictor of alcohol outcomes and appears to mediate the relation between early adversity and alcohol use and consequences. Findings suggest that students with a history of adversity are more likely to exhibit lower levels of mindfulness, which may lead to an increase in alcohol consumption and consequences in early adulthood. Targeted alcohol intervention efforts that incorporate mindfulness skills may be particularly beneficial for those who have experienced early adversity.
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Affiliation(s)
- Emma I Brett
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA.
| | - Hannah C Espeleta
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA
| | - Susanna V Lopez
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA
| | | | - Thad R Leffingwell
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA.
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Espeleta HC, Brett EI, Ridings LE, Leavens ELS, Mullins LL. Childhood adversity and adult health-risk behaviors: Examining the roles of emotion dysregulation and urgency. Child Abuse Negl 2018; 82:92-101. [PMID: 29879586 DOI: 10.1016/j.chiabu.2018.05.027] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 05/24/2018] [Accepted: 05/28/2018] [Indexed: 06/08/2023]
Abstract
Adverse childhood experiences (ACEs) are important public health concerns, with links to higher prevalence rates of both health-risk behaviors and physical health difficulties in adulthood. Research has demonstrated an association between early adversity and long-term health-risk behavior development. The current study assessed the role of emotion dysregulation and facets of impulsivity as potential mediators in the relation between ACEs and general health-risk behaviors, including alcohol-related consequences and risky sexual behavior. College students (N = 668) completed online questionnaires that assessed history of ACEs, emotion regulation difficulties, impulsivity under extreme affect, and current engagement in health-risk behaviors. Emotion dysregulation and impulsivity under extreme positive emotion, but not negative emotion, demonstrated a significant serial mediation between ACEs and alcohol-related consequences. Results also suggest that emotion dysregulation mediates the relation between early adversity and all three outcomes (i.e., overall engagement in maladaptive behavior, alcohol-related consequences, and risky sexual behavior). Impulsivity under positive or negative affect did not demonstrate a mediation effect on the three outcomes. Results of this study highlight the importance of assessing for emotion regulation skills when working with young adults with histories of adversity.
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Affiliation(s)
- Hannah C Espeleta
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA.
| | - Emma I Brett
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA
| | - Leigh E Ridings
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | | | - Larry L Mullins
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA
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Leavens ELS, Brett EI, Morgan TL, Lopez SV, Shaikh RA, Leffingwell TR, Wagener TL. Descriptive and injunctive norms of waterpipe smoking among college students. Addict Behav 2018; 77:59-62. [PMID: 28963891 DOI: 10.1016/j.addbeh.2017.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 08/20/2017] [Accepted: 09/14/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Smoking tobacco via a waterpipe (WP) is on the rise, particularly among college students. One reason for this may be normative perceptions of WP tobacco smoking (WTS) among this population. The current study examined the perceived and actual descriptive and injunctive norms of WTS among a college student sample. METHODS Participants were 894 college students enrolled at a large, Midwestern university. Participants completed measures of WTS frequency and quantity and perceived/actual descriptive and injunctive norms of WTS. RESULTS Over one-third of the sample reported ever trying WTS, while only 2% reported current (past month) use. When comparing ever and never WP smokers, ever smokers reported greater perceived peer approval of WTS. Both males and females overestimated WTS frequency of same-sex students at their university. DISCUSSION The current study is one of the first to investigate descriptive and injunctive norms of WTS among college students. Students who report WTS are more likely to overestimate descriptive norms of WTS among their peers, suggesting corrective normative feedback regarding actual use by peers may be an important target for WTS intervention among college students. Future research should investigate the temporal association between normative perceptions and WTS behaviors among college students.
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Affiliation(s)
- Eleanor L S Leavens
- Oklahoma Tobacco Research Center, Oklahoma City, OK, USA; Department of Psychology, Oklahoma State University, Stillwater, OK, USA
| | - Emma I Brett
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA
| | | | - Susanna V Lopez
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA
| | - Raees A Shaikh
- Oklahoma Tobacco Research Center, Oklahoma City, OK, USA
| | - Thad R Leffingwell
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA
| | - Theodore L Wagener
- Oklahoma Tobacco Research Center, Oklahoma City, OK, USA; Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
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