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Jackson RA, Ren C, Coleman B, Day HR, Chang CM, Kofie J, Rivers D, Kanel M, Ambrose BK. Transitions to smokeless tobacco use among adult cigarette smokers in the Population Assessment of Tobacco and Health (PATH) Study, Waves 3-5 (2015-2019). Tob Control 2023; 32:657-660. [PMID: 34937805 PMCID: PMC9213562 DOI: 10.1136/tobaccocontrol-2021-056907] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 11/29/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Examine patterns of dual use of cigarettes and smokeless tobacco and complete switching over time among adult current cigarette smokers using data from the Population Assessment of Tobacco and Health Study Wave 3 (2015-2016), Wave 4 (2016-2018) and Wave 5 (2018-2019). METHODS We examined four tobacco use states among 6834 exclusive smokers and 372 dual users at Wave 3 with two waves of follow-up data: exclusive cigarette use, exclusive smokeless tobacco use, dual use and use of neither product. RESULTS Among exclusive smokers at Wave 3, only 1.6% (95% CI: 1.3% to 2.1%) transitioned to dual use at Wave 4, and 0.1% (95% CI: 0.07% to 0.2%) switched to exclusive smokeless tobacco use. Among exclusive smokers who switched to dual use, 53.1% (95% CI: 40.9% to 64.9%) returned to exclusive cigarette smoking, 34.3% (95% CI: 23.8% to 46.6%) maintained dual use and 12.6% (95% CI: 7.0% to 21.7%) did not smoke cigarettes after an additional wave of follow-up. Dual users at Wave 3 were likely to maintain their dual use status at Wave 4, 51.2% (95% CI: 46.1% to 56.3%) and Wave 5, 47.9% (95% CI: 40.1% to 55.8%). CONCLUSIONS Very few cigarette smokers transition to smokeless tobacco use, and among those who do, dual use is more common than exclusive smokeless tobacco use. Further, the majority of exclusive cigarette smokers who transition to dual use at Wave 4 continue smoking cigarettes at Wave 5, either as dual users or as exclusive smokers.
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Affiliation(s)
- Rebecca A Jackson
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Chunfeng Ren
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Blair Coleman
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Hannah R Day
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Cindy M Chang
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Justina Kofie
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Derick Rivers
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Moana Kanel
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland, USA
- Kelly Government Solutions, Rockville, Maryland, USA
| | - Bridget K Ambrose
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland, USA
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Edwards KC, Halenar MJ, Delnevo CD, Villanti AC, Bansal-Travers M, O'Connor R, Del Valle-Pinero AY, Creamer MR, Donaldson EA, Hammad HT, Lagasse L, Anesetti-Rothermel A, Taylor KA, Kimmel HL, Compton W, Cheng YC, Ambrose BK, Hyland A. Patterns of Premium and Nonpremium Cigar Use in the United States: Findings from Wave 6 (2021) of the Population Assessment of Tobacco and Health Study. Nicotine Tob Res 2023; 25:S5-S15. [PMID: 37506243 PMCID: PMC10885408 DOI: 10.1093/ntr/ntad010] [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: 09/06/2022] [Revised: 12/30/2022] [Accepted: 01/26/2023] [Indexed: 07/30/2023]
Abstract
INTRODUCTION Understanding the characteristics of premium cigar use patterns is essential for minimizing public health harms. Typically, premium cigars are handmade, larger, more expensive, and without the characterizing flavors that are present in other cigar types: Nonpremium traditional cigars, cigarillos, and filtered cigars. AIMS AND METHODS Self-reported brand and price data were used from Wave 6 of the Population Assessment of Tobacco and Health (PATH) Study to define and estimate premium versus nonpremium cigar use among U.S. adults, as well as to explore cigar smoking patterns, purchasing behavior, and reasons for use by cigar type. RESULTS In 2021, 0.9% (95% CI = 0.7-1.0) of adults were premium cigar users, compared to 0.4% of nonpremium traditional cigar users (95% CI = 0.3-0.5), 1.1% of cigarillo users (95% CI = 1.0-1.2), and 0.6% filtered cigar users (95% CI = 0.5-0.7). Premium cigar users were overwhelmingly male (97.7%), and 35.8% were aged ≥55 years. The average premium cigar price/stick was $8.67, $5.50-7.00 more than other cigar types. Compared to other cigar types, significantly fewer premium cigar users had a regular brand with a flavor other than tobacco (~15% vs. 38%-53%). Though flavors remained the top reason for premium cigar use, they were less likely to endorse flavors as a reason for use than other cigar users (~40% vs. 68-74%). Premium cigar users had a lower prevalence (aRR: 0.37, 95% CI = 0.25-0.55) of dual use of cigars and cigarettes. CONCLUSIONS Although <1% of U.S. adults use premium cigars, their use and purchasing characteristics continue to differ from other cigar types, highlighting the importance of capturing data specific to premium cigar use. IMPLICATIONS This manuscript extends previous research from the National Academies of Science, Engineering, and Medicine report, "Premium cigars: Patterns of use, marketing, and health effects" by utilizing the most recent PATH Study data (Wave 6) to examine patterns of cigar use, including purchasing behavior and reasons for use, by cigar type (eg, premium traditional cigars, nonpremium traditional cigars, cigarillos, and filtered cigars). The findings support continued research on patterns of premium cigar use, which differ from use patterns of other cigar types.
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Affiliation(s)
| | | | - Cristine D Delnevo
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, NJ, USA
| | - Andrea C Villanti
- Department of Health Behavior, Society and Policy, Rutgers University, New Brunswick, NJ, USA
| | - Maansi Bansal-Travers
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Richard O'Connor
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | | | - MeLisa R Creamer
- Division of Epidemiology, Services and Prevention, National Institute on Drug Abuse, Bethesda, MD, USA
| | | | - Hoda T Hammad
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - Lisa Lagasse
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | | | | | - Heather L Kimmel
- Division of Epidemiology, Services and Prevention, National Institute on Drug Abuse, Bethesda, MD, USA
| | | | - Yu-Ching Cheng
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - Bridget K Ambrose
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - Andrew Hyland
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
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Chang JT, Mayer M, Jackson RA, Rostron BL, Coleman B, Lee T, Ambrose BK, Chang CM. Characteristics and Patterns of Cigarette Smoking and Vaping By Past-Year Smokers Who Reported Using Electronic Nicotine Delivery System to Help Quit Smoking in the Past Year: Findings From the 2018-2019 Tobacco Use Supplement to the Current Population Survey. Nicotine Tob Res 2023; 25:596-601. [PMID: 35973818 DOI: 10.1093/ntr/ntac199] [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: 03/09/2022] [Revised: 06/09/2022] [Accepted: 08/11/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Cigarette smoking has declined, while electronic nicotine delivery system (ENDS) use has increased in the United States. Understanding the role of ENDS in adult smoking quit attempts and cessation is important for estimating their population health impact. AIMS AND METHODS We used data from 2018 to 2019 tobacco use supplement to the current population survey to examine demographic characteristics and ENDS use patterns among adult ENDS users who reported quitting smoking in the past year by trying to switch to ENDS ("switchers") and smokers who did or did not make a quit attempt in the past year. χ2 tests of proportions and t-tests were used to compare characteristics between groups. RESULTS In 2018-2019, about three-quarters of switchers reported daily use of ENDS compared to only one-third of dual users with a recent quit attempt by trying to switch to ENDS. Compared to dual users who made a quit attempt by trying to switch to ENDS, switchers were more likely to use menthol/mint-flavored ENDS exclusively (5.6% vs. 13.1%; p = .004) but less likely to use tobacco-flavored ENDS exclusively (21.2% vs. 13.7%; p = .01). CONCLUSIONS ENDS users who quit smoking in the past year and reported trying to quit by switching to ENDS were more likely to use menthol/mint flavors exclusively and use ENDS daily compared to dual users who made a quit attempt by trying to switch to ENDS. Longer-term prospective data may better clarify the role of ENDS in smoking quit attempts and cessation. IMPLICATIONS This study provides information on patterns of ENDS use in former smokers and current smokers who tried to quit smoking by switching to ENDS in a national sample of U.S. adults. These results can inform policy actions concerning ENDS products.
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Affiliation(s)
- Joanne T Chang
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD, USA
| | - Margaret Mayer
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Rebecca A Jackson
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD, USA
| | - Brian L Rostron
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD, USA
| | - Blair Coleman
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD, USA
| | - Terrence Lee
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD, USA
| | - Bridget K Ambrose
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD, USA
| | - Cindy M Chang
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD, USA
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Cooper M, Day HR, Ren C, Oniyide O, Corey CG, Ambrose BK, Michael Cummings K, Sargent J, Niaura R, Pierce JP, Kaufman A, Choi K, Goniewicz ML, Stanton CA, Villanti A, Kasza K, Bansal-Travers M, Silveira ML, Kimmel HL, Hull LC, Koblitz A, Poonai K, Paredes A, Taylor K, Borek N, Hyland AJ. Correlates of tobacco product initiation among youth and young adults between waves 1-4 of the population assessment of tobacco and Health (PATH) study (2013-2018). Addict Behav 2022; 134:107396. [PMID: 35749867 PMCID: PMC9726988 DOI: 10.1016/j.addbeh.2022.107396] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 05/13/2022] [Accepted: 06/05/2022] [Indexed: 11/20/2022]
Abstract
INTRODUCTION While risk factors for cigarette smoking among youth and young adults are well-documented, less is known about the correlates of initiation of other tobacco products. This study aims to provide estimates and correlates of initiation among U.S. youth and young adults. METHODS Data on youth aged 12-17 (n = 10,072) and young adults aged 18-24 (N = 5,727) who provided information on cigarettes, electronic nicotine delivery systems (ENDS), cigars, pipe, hookah and smokeless tobacco use in Wave 1 (W1: 2013-2014)-Wave 4 (W4: 2016-2018) of the nationally-representative PATH Study were used to calculate ever use initiation and correlates of initiation by W4. RESULTS Nearly 6 million youth and 2.5 million young adults used tobacco for the first time between W1-W4. Approximately one quarter of youth and young adult ENDS never users initiated ENDS between W1-W4 of the PATH Study. Among youth, use of other tobacco products, ever substance use, and high externalizing problems were associated with initiation of most products. Among young adults, use of other tobacco products and ever substance use were associated with initiation of most products. In both youth and young adults, Hispanics were more likely to initiate hookah use than their non-Hispanic White counterparts. While male sex was a risk factor for most tobacco product initiation across both age groups, it was not associated with hookah initiation. CONCLUSIONS Cigarette and non-cigarette products shared many correlates of initiation, although there are noteworthy demographic differences. Findings can help tailor product specific interventions to reach populations at risk during preliminary stages of use.
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Affiliation(s)
- Maria Cooper
- US Food and Drug Administration, Center for Tobacco Products, United States.
| | - Hannah R Day
- US Food and Drug Administration, Center for Tobacco Products, United States
| | - Chunfeng Ren
- US Food and Drug Administration, Center for Tobacco Products, United States
| | - Olusola Oniyide
- US Food and Drug Administration, Center for Tobacco Products, United States
| | - Catherine G Corey
- US Food and Drug Administration, Center for Tobacco Products, United States
| | - Bridget K Ambrose
- US Food and Drug Administration, Center for Tobacco Products, United States
| | - K Michael Cummings
- Medical University of South Carolina, Department of Psychiatry & Behavioral Sciences, United States
| | - James Sargent
- Dartmouth Medical School, Data Sciences Norris Cotton Cancer Center Dartmouth-Hitchcock Medical Center, United States
| | - Ray Niaura
- New York University, College of Global Public Health, United States
| | - John P Pierce
- University of California, San Diego, Herbert Wertheim School of Public Health, United States
| | - Annette Kaufman
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, United States
| | - Kelvin Choi
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, United States
| | | | | | | | - Karin Kasza
- Roswell Park Comprehensive Cancer Center, United States
| | | | - Marushka L Silveira
- Division of Epidemiology, Services and Prevention Research, National Institute on Drug Abuse, National Institutes of Health, United States; Kelly Government Solutions, United States
| | - Heather L Kimmel
- Division of Epidemiology, Services and Prevention Research, National Institute on Drug Abuse, National Institutes of Health, United States
| | - Lynn C Hull
- US Food and Drug Administration, Center for Tobacco Products, United States
| | - Amber Koblitz
- US Food and Drug Administration, Center for Tobacco Products, United States
| | - Karl Poonai
- US Food and Drug Administration, Center for Tobacco Products, United States
| | - Antonio Paredes
- US Food and Drug Administration, Center for Tobacco Products, United States
| | - Kristie Taylor
- Westat, Behavioral Health and Health Policy, United States
| | - Nicolette Borek
- US Food and Drug Administration, Center for Tobacco Products, United States
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Anic GM, Rostron BL, Hammad HT, van Bemmel DM, Del Valle-Pinero AY, Christensen CH, Erives G, Faulcon LM, Blount BC, Wang Y, Wang L, Bhandari D, Calafat AM, Kimmel HL, Everard CD, Compton WM, Edwards KC, Goniewicz ML, Wei B, Hyland A, Hatsukami DK, Hecht SS, Niaura RS, Borek N, Ambrose BK, Chang CM. Changes in Biomarkers of Tobacco Exposure among Cigarette Smokers Transitioning to ENDS Use: The Population Assessment of Tobacco and Health Study, 2013-2015. Int J Environ Res Public Health 2022; 19:1462. [PMID: 35162490 PMCID: PMC8835100 DOI: 10.3390/ijerph19031462] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 12/28/2021] [Revised: 01/21/2022] [Accepted: 01/23/2022] [Indexed: 02/01/2023]
Abstract
Limited data are available for how biomarkers of tobacco exposure (BOE) change when cigarette smokers transition to using electronic nicotine delivery systems (ENDS). Using biomarker data from Waves 1 (2013-2014) and 2 (2014-2015) of the PATH Study, we examined how mean BOE concentrations, including metabolites of nicotine, tobacco-specific nitrosamines (TSNA), polycyclic aromatic hydrocarbons (PAH), and volatile organic compounds (VOC) and metals, changed when 2475 adult smokers transitioned to using ENDS or quit tobacco products. Exclusive smokers who transitioned to dual use had a significant decrease in NNAL (4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol), but not nicotine metabolites, most PAHs, metals, or VOCs. Exclusive smokers who became dual users had significant reductions in total nicotine equivalents, NNAL, and 2CyEMA (acrylonitrile metabolite), but only in those who reduced cigarettes per day (CPD) by >=50%. Smokers who transitioned to exclusive ENDS use had significant reductions in most TSNAs, PAHs, and VOCs; however, nicotine metabolites did not decrease in dual users who became exclusive ENDS users. Smokers who quit tobacco use had significant decreases in nicotine metabolites, all TSNAs, most PAHs, and most VOCs. Cigarette smokers who became dual users did not experience significant reductions in most BOEs. Reductions were impacted by changes in CPD. However, transitioning from smoking to no tobacco or exclusive ENDS use was associated with reduced exposure to most BOEs measured. Future analyses could incorporate additional waves of PATH data and examine changes in biomarker exposure by ENDS device type and CPD.
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Affiliation(s)
- Gabriella M. Anic
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD 20993, USA; (G.M.A.); (H.T.H.); (D.M.v.B.); (A.Y.D.V.-P.); (C.H.C.); (G.E.); (L.M.F.); (N.B.); (B.K.A.); (C.M.C.)
| | - Brian L. Rostron
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD 20993, USA; (G.M.A.); (H.T.H.); (D.M.v.B.); (A.Y.D.V.-P.); (C.H.C.); (G.E.); (L.M.F.); (N.B.); (B.K.A.); (C.M.C.)
| | - Hoda T. Hammad
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD 20993, USA; (G.M.A.); (H.T.H.); (D.M.v.B.); (A.Y.D.V.-P.); (C.H.C.); (G.E.); (L.M.F.); (N.B.); (B.K.A.); (C.M.C.)
| | - Dana M. van Bemmel
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD 20993, USA; (G.M.A.); (H.T.H.); (D.M.v.B.); (A.Y.D.V.-P.); (C.H.C.); (G.E.); (L.M.F.); (N.B.); (B.K.A.); (C.M.C.)
| | - Arseima Y. Del Valle-Pinero
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD 20993, USA; (G.M.A.); (H.T.H.); (D.M.v.B.); (A.Y.D.V.-P.); (C.H.C.); (G.E.); (L.M.F.); (N.B.); (B.K.A.); (C.M.C.)
| | - Carol H. Christensen
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD 20993, USA; (G.M.A.); (H.T.H.); (D.M.v.B.); (A.Y.D.V.-P.); (C.H.C.); (G.E.); (L.M.F.); (N.B.); (B.K.A.); (C.M.C.)
| | - Gladys Erives
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD 20993, USA; (G.M.A.); (H.T.H.); (D.M.v.B.); (A.Y.D.V.-P.); (C.H.C.); (G.E.); (L.M.F.); (N.B.); (B.K.A.); (C.M.C.)
| | - Lisa M. Faulcon
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD 20993, USA; (G.M.A.); (H.T.H.); (D.M.v.B.); (A.Y.D.V.-P.); (C.H.C.); (G.E.); (L.M.F.); (N.B.); (B.K.A.); (C.M.C.)
| | - Benjamin C. Blount
- Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA; (B.C.B.); (Y.W.); (L.W.); (D.B.); (A.M.C.)
| | - Yuesong Wang
- Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA; (B.C.B.); (Y.W.); (L.W.); (D.B.); (A.M.C.)
| | - Lanqing Wang
- Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA; (B.C.B.); (Y.W.); (L.W.); (D.B.); (A.M.C.)
| | - Deepak Bhandari
- Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA; (B.C.B.); (Y.W.); (L.W.); (D.B.); (A.M.C.)
| | - Antonia M. Calafat
- Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA; (B.C.B.); (Y.W.); (L.W.); (D.B.); (A.M.C.)
| | - Heather L. Kimmel
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD 20892, USA; (H.L.K.); (C.D.E.); (W.M.C.)
| | - Colm D. Everard
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD 20892, USA; (H.L.K.); (C.D.E.); (W.M.C.)
| | - Wilson M. Compton
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD 20892, USA; (H.L.K.); (C.D.E.); (W.M.C.)
| | | | - Maciej L. Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (M.L.G.); (B.W.); (A.H.)
| | - Binnian Wei
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (M.L.G.); (B.W.); (A.H.)
| | - Andrew Hyland
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (M.L.G.); (B.W.); (A.H.)
| | - Dorothy K. Hatsukami
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA; (D.K.H.); (S.S.H.)
| | - Stephen S. Hecht
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA; (D.K.H.); (S.S.H.)
| | - Raymond S. Niaura
- College of Global Public Health, New York University, New York, NY 10003, USA;
| | - Nicolette Borek
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD 20993, USA; (G.M.A.); (H.T.H.); (D.M.v.B.); (A.Y.D.V.-P.); (C.H.C.); (G.E.); (L.M.F.); (N.B.); (B.K.A.); (C.M.C.)
| | - Bridget K. Ambrose
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD 20993, USA; (G.M.A.); (H.T.H.); (D.M.v.B.); (A.Y.D.V.-P.); (C.H.C.); (G.E.); (L.M.F.); (N.B.); (B.K.A.); (C.M.C.)
| | - Cindy M. Chang
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD 20993, USA; (G.M.A.); (H.T.H.); (D.M.v.B.); (A.Y.D.V.-P.); (C.H.C.); (G.E.); (L.M.F.); (N.B.); (B.K.A.); (C.M.C.)
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6
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Christensen CH, Chang JT, Rostron BL, Hammad HT, van Bemmel DM, Del Valle-Pinero AY, Wang B, Mishina EV, Faulcon LM, DePina A, Brown-Baker L, Kimmel HL, Lambert E, Blount BC, Vesper HW, Wang L, Goniewicz ML, Hyland A, Travers MJ, Hatsukami DK, Niaura R, Cummings KM, Taylor KA, Edwards KC, Borek N, Ambrose BK, Chang CM. Biomarkers of Inflammation and Oxidative Stress among Adult Former Smoker, Current E-Cigarette Users-Results from Wave 1 PATH Study. Cancer Epidemiol Biomarkers Prev 2021; 30:1947-1955. [PMID: 34289969 DOI: 10.1158/1055-9965.epi-21-0140] [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: 02/02/2021] [Revised: 04/26/2021] [Accepted: 07/12/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Former smokers who currently use e-cigarettes have lower concentrations of biomarkers of tobacco toxicant exposure than current smokers. It is unclear whether tobacco toxicant exposure reductions may lead to health risk reductions. METHODS We compared inflammatory biomarkers (high-sensitivity C-reactive protein, IL6, fibrinogen, soluble intercellular adhesion molecule-1) and an oxidative stress marker (F2-isoprostane) among 3,712 adult participants in Wave 1 (2013-2014) of the Population Assessment of Tobacco and Health Study by tobacco user groups: dual users of cigarettes and e-cigarettes; former smokers who currently use e-cigarettes-only; current cigarette-only smokers; former smokers who do not currently use any tobacco; and never tobacco users. We calculated geometric means (GM) and estimated adjusted GM ratios (GMR). RESULTS Dual users experienced greater concentration of F2-isoprostane than current cigarette-only smokers [GMR 1.09 (95% confidence interval, CI, 1.03-1.15)]. Biomarkers were similar between former smokers who currently use e-cigarettes and both former smokers who do not use any tobacco and never tobacco users, but among these groups most biomarkers were lower than those of current cigarette-only smokers. The concentration of F2-isoprostane decreased by time since smoking cessation among both exclusive e-cigarette users (P trend = 0.03) and former smokers who do not currently use any tobacco (P trend = 0.0001). CONCLUSIONS Dual users have greater concentration of F2-isoprostane than smokers. Exclusive e-cigarette users have biomarker concentrations that are similar to those of former smokers who do not currently use tobacco, and lower than those of exclusive cigarette smokers. IMPACT This study contributes to an understanding of the health effects of e-cigarettes.
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Affiliation(s)
- Carol H Christensen
- Office of Science, Center for Tobacco Products, FDA, Silver Spring, Maryland.
| | - Joanne T Chang
- Office of Science, Center for Tobacco Products, FDA, Silver Spring, Maryland
| | - Brian L Rostron
- Office of Science, Center for Tobacco Products, FDA, Silver Spring, Maryland
| | - Hoda T Hammad
- Office of Science, Center for Tobacco Products, FDA, Silver Spring, Maryland
| | - Dana M van Bemmel
- Office of Science, Center for Tobacco Products, FDA, Silver Spring, Maryland
| | | | - Baoguang Wang
- Office of Science, Center for Tobacco Products, FDA, Silver Spring, Maryland
| | - Elena V Mishina
- Office of Science, Center for Tobacco Products, FDA, Silver Spring, Maryland
| | - Lisa M Faulcon
- Office of Science, Center for Tobacco Products, FDA, Silver Spring, Maryland
| | - Ana DePina
- Office of Science, Center for Tobacco Products, FDA, Silver Spring, Maryland
| | | | | | | | - Benjamin C Blount
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Huber W Vesper
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lanqing Wang
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Maciej L Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Andrew Hyland
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Mark J Travers
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | | | - Raymond Niaura
- College of Global Public Health, New York University, New York, New York
| | - K Michael Cummings
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | | | | | - Nicolette Borek
- Office of Science, Center for Tobacco Products, FDA, Silver Spring, Maryland
| | - Bridget K Ambrose
- Office of Science, Center for Tobacco Products, FDA, Silver Spring, Maryland
| | - Cindy M Chang
- Office of Science, Center for Tobacco Products, FDA, Silver Spring, Maryland
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Rostron BL, Chang JT, Chang CM, Jackson RA, Ambrose BK. ENDS Flavor Preference by Menthol Cigarette Smoking Status among US Adults, 2018-2019. Int J Environ Res Public Health 2020; 18:ijerph18010240. [PMID: 33396201 PMCID: PMC7796212 DOI: 10.3390/ijerph18010240] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/22/2020] [Accepted: 12/29/2020] [Indexed: 11/16/2022]
Abstract
E-cigarette flavor preference may differ among smokers using e-cigarettes, but little information is available on preferences by menthol cigarette status. Using nationally representative data for US adults from the 2018-2019 Tobacco Use Supplement to the Current Population Survey, we analyzed e-cigarette flavor preference by menthol cigarette status and e-cigarette device type for dual-cigarette and e-cigarette users and e-cigarette users who had recently quit smoking by trying to switch to e-cigarettes ("switchers"). Approximately half (52.2%) of dual users of menthol cigarettes and e-cigarettes reported using menthol/mint-flavored e-cigarettes as did 41.4% of "switchers" who had smoked menthol cigarettes; exclusive menthol/mint flavor use was 13.1% for dual users and 21.3% for "switchers." A similar proportion (45.1%) of dual users who smoked nonmenthol cigarettes used tobacco-flavored e-cigarettes, but only 26.7% of "switchers" who had smoked nonmenthol cigarettes used tobacco-flavored e-cigarettes. Approximately 60% of dual users and "switchers" used fruit/other flavors, regardless of menthol cigarette use. By device type, 63.9% of dual users of cartridge-based e-cigarettes and menthol cigarettes used menthol/mint-flavored e-cigarettes. Approximately 75% of dual users and 85% of "switchers" who used tank or mod systems used fruit/other flavors. Menthol cigarette smokers may be particularly likely to use menthol/mint e-cigarettes, and a majority of dual users and "switchers" used fruit/other flavors. These results can inform policy measures concerning flavored electronic nicotine delivery system products.
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Pearson JL, Sharma E, Rui N, Halenar MJ, Johnson AL, Cummings KM, Hammad HT, Kaufman AR, Tworek C, Goniewicz ML, Kimmel HL, Tanski S, Compton WM, Day H, Ambrose BK, Bansal-Travers M, Silveira ML, Abrams D, Limpert J, Travers MJ, Borek N, Hyland AJ, Stanton CA. Association of Electronic Nicotine Delivery System Use With Cigarette Smoking Progression or Reduction Among Young Adults. JAMA Netw Open 2020; 3:e2015893. [PMID: 33231634 PMCID: PMC7686868 DOI: 10.1001/jamanetworkopen.2020.15893] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 06/12/2020] [Indexed: 12/27/2022] Open
Abstract
Importance The prevalence of electronic nicotine delivery systems (ENDS) use, including e-cigarettes, among US young adults (YAs) has raised questions about how these products may affect future tobacco and nicotine use among YAs. Given this prevalence and that young adulthood is a critical period for the establishment of tobacco and nicotine use, it is important to consider the association between ENDS use and cigarette smoking specifically in this age group. Objective To examine whether ENDS use frequency or intensity is associated with changes in cigarette smoking among US YA ever smokers during 1 year. Design, Setting, and Participants This cohort study used 3 waves of data (2013-2014, 2014-2015, and 2015-2016) from the Population Assessment of Tobacco and Health (PATH) Study, an ongoing longitudinal cohort study of adults and youth. Unweighted 1:6 propensity score matching was used to match participants on wave 1 risk factors for ENDS use at wave 2. The changes in smoking between wave 2 and wave 3 were assessed using the matched sample. In total, 1096 ENDS-naive, ever cigarette-smoking YAs (18-24 years of age) at wave 1 who participated in wave 2 and wave 3 and who had complete data in the PATH Study were included in the analyses, which were conducted from August 2018 to October 2019. Exposures Never ENDS use (n = 987), any previous 30-day ENDS use (n = 109), 1 to 5 days of ENDS use in the previous 30 days (n = 75), and 6 or more days ENDS use in the previous 30 days at wave 2 (n = 34). Main Outcomes and Measures The analytic sample was selected using multiple variables based on peer-reviewed literature supporting associations with ENDS use. The main outcomes-changes in cigarette smoking behavior between wave 2 and wave 3-were defined using 2 measures: (1) change in smoking frequency, defined as the number of smoking days in the previous 30 days at wave 3 vs wave 2, and (2) change in smoking intensity, defined as the number smoking days in the previous 30 days multiplied by the mean number of cigarettes consumed on smoking days at wave 3 vs wave 2. Results The present cohort analyses included 1096 YA ever smokers who were ENDS naive at wave 1. The majority of the sample were women (609 [55.6%]) and White individuals (698 [63.7%]), and the mean (SD) age was 21.4 (1.9) years. In wave 1, 161 YAs (14.7%) were daily smokers in the previous 30 days. After propensity score matching, no statistically significant associations were observed between any definition of wave 2 ENDS use and changes in either the frequency or intensity of smoking at wave 3. Conclusions and Relevance In this cohort study of US YA ever smokers, ENDS use was not associated with either decreased or increased cigarette smoking during a 1-year period. However, it is possible that the rapidly evolving marketplace of vaping products may lead to different trajectories of YA cigarette and ENDS use in the future.
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Affiliation(s)
- Jennifer L. Pearson
- Division of Social and Behavioral Science/Health Administration and Policy, School of Community Health Sciences, University of Nevada, Reno
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | | | - Amanda L. Johnson
- Office of Science, Center for Tobacco Products Food and Drug Administration, Silver Spring, Maryland
| | - K. Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Hoda T. Hammad
- Office of Science, Center for Tobacco Products Food and Drug Administration, Silver Spring, Maryland
| | - Annette R. Kaufman
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Cindy Tworek
- Office of Science, Center for Tobacco Products Food and Drug Administration, Silver Spring, Maryland
| | - Maciej L. Goniewicz
- Division of Cancer Prevention and Population Sciences, Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Heather L. Kimmel
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| | - Susanne Tanski
- Norris Cotton Cancer Center and Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Wilson M. Compton
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| | - Hannah Day
- Office of Science, Center for Tobacco Products Food and Drug Administration, Silver Spring, Maryland
| | - Bridget K. Ambrose
- Office of Science, Center for Tobacco Products Food and Drug Administration, Silver Spring, Maryland
| | - Maansi Bansal-Travers
- Division of Cancer Prevention and Population Sciences, Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Marushka L. Silveira
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
- Kelly Government Solutions, Rockville, Maryland
| | - David Abrams
- Department of Social and Behavioral Sciences, NYU College of Global Public Health, New York University, New York
| | - Jeannie Limpert
- Office of Science, Center for Tobacco Products Food and Drug Administration, Silver Spring, Maryland
| | - Mark J. Travers
- Division of Cancer Prevention and Population Sciences, Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Nicolette Borek
- Office of Science, Center for Tobacco Products Food and Drug Administration, Silver Spring, Maryland
| | - Andrew J. Hyland
- Division of Cancer Prevention and Population Sciences, Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Cassandra A. Stanton
- Westat, Rockville, Maryland
- Department of Oncology, Georgetown University Medical Center, Washington, DC
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Chang JT, Wang B, Rostron BL, Chen LH, Schroeder TJ, Mah JC, Chang CM, Ambrose BK. National Estimates of ENDS Liquid Nicotine Exposures, U.S., 2013-2017. Am J Prev Med 2020; 59:742-745. [PMID: 32826127 DOI: 10.1016/j.amepre.2020.05.027] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/08/2020] [Accepted: 05/11/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Increased use of ENDS in the U.S. is related to acute adverse events from liquid nicotine exposure. This paper provides national estimates of U.S. hospital emergency department visits for exposures from liquid nicotine exposure in individuals aged ≥5 years. METHODS In 2018-2019, data from the 2013-2017 National Electronic Injury Surveillance System All Injury Program were used to identify cases of liquid nicotine-related exposures in individuals aged ≥5 years. National estimates of exposures related to liquid nicotine exposure in ENDS for those aged ≥5 years by demographic characteristics, symptoms, diagnoses, and treatment dispositions were calculated. RESULTS From 2013 to 2017, an estimated 2,718 cases related to liquid nicotine among those aged ≥5 years were treated in U.S. hospital emergency departments. Most exposures occurred among those who were aged ≥25 years (51.7%), white (74.1%), and male (51.9%). Most case patients were treated and released from the hospitals, and 7.5% were admitted. Poisoning was the most common diagnosis of these exposures (82.7%). The most common symptoms were cardiovascular (29.7%). CONCLUSIONS This study provides national estimates of emergency department visits for injury and poisoning cases related to nicotine exposure from ENDS among individuals aged ≥5 years. Although long-term health outcome studies of liquid nicotine exposure are not available, these estimates provide some insight into the acute health effects. Findings from this study may inform education programs aimed at preventing exposures related to ENDS products.
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Affiliation(s)
- Joanne T Chang
- Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, Maryland.
| | - Baoguang Wang
- Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Brian L Rostron
- Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Li Hui Chen
- Division of Hazard and Injury Data Systems, U.S. Consumer Product Safety Commission, Bethesda, Maryland
| | - Thomas J Schroeder
- Division of Hazard and Injury Data Systems, U.S. Consumer Product Safety Commission, Bethesda, Maryland
| | - Jean C Mah
- Division of Hazard and Injury Data Systems, U.S. Consumer Product Safety Commission, Bethesda, Maryland
| | - Cindy M Chang
- Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Bridget K Ambrose
- Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, Maryland
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Sawdey MD, Chang JT, Cullen KA, Rass O, Jackson KJ, Ali FRM, Odani S, Courtney-Long EA, Armour BS, Ambrose BK, Agaku IT. Trends and Associations of Menthol Cigarette Smoking Among US Middle and High School Students-National Youth Tobacco Survey, 2011-2018. Nicotine Tob Res 2020; 22:1726-1735. [PMID: 32347935 PMCID: PMC9679736 DOI: 10.1093/ntr/ntaa054] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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: 08/05/2019] [Accepted: 03/20/2020] [Indexed: 07/26/2023]
Abstract
INTRODUCTION Youth cigarette smoking decreased significantly over the last two decades in the United States. This study provides estimates and trends from 2011 to 2018 and factors associated with youth menthol and non-menthol smoking from 2016 to 2018. METHODS Using data from the 2011-2018 National Youth Tobacco Surveys, past 30-day (current) menthol and non-menthol cigarette smoking were estimated for all youth (prevalence) and youth smokers (proportions). Trends were examined using Joinpoint regression, calculating the annual percent change (APC). Multivariate logistic regression analyses identified factors associated with menthol smoking. RESULTS From 2011 to 2018, menthol cigarette smoking among current youth cigarette smokers significantly decreased from 57.3% to 45.7% (APC: -3.0%), while non-menthol (38.2% to 47.3% [APC: 2.9%]) and unknown menthol status (not sure\missing) (4.5% to 7.0% [APC: 7.1%]) significantly increased. Menthol cigarette smoking among high school, male, female, and non-Hispanic white current cigarette smokers decreased, but remained unchanged among middle school, non-Hispanic black, and Hispanic smokers. Significantly higher proportions of menthol cigarette smokers smoked on ≥20 days, ≥2 cigarettes per day, and ≥100 cigarettes in their lifetime compared to non-menthol smokers. Among current cigarette smokers, non-Hispanic blacks, Hispanics, flavored non-cigarette tobacco users, frequent smokers (≥20 days), those smoking 2-5 cigarettes per day, and those living with someone who uses tobacco had higher odds of menthol cigarette smoking. CONCLUSIONS In 2018, nearly half of current youth cigarette smokers smoked menthol cigarettes. While menthol cigarette smoking declined from 2011 to 2018 among all youth and among youth smokers, there was no change in menthol cigarette smoking among non-Hispanic black, Hispanic, and middle school cigarette smokers. IMPLICATIONS This study finds that overall cigarette and menthol cigarette smoking declined in youth from 2011 to 2018. However, menthol cigarette smoking among non-Hispanic black, Hispanic, and middle school youth cigarette smokers did not change. Information from this study can help inform efforts to reduce menthol cigarette smoking among US youth, particularly racial/ethnic minority populations.
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Affiliation(s)
- Michael D. Sawdey
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD
| | - Joanne T. Chang
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD
| | - Karen A. Cullen
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD
| | - Olga Rass
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD
| | - Kia J. Jackson
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD
| | - Fatma Romeh M. Ali
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Satomi Odani
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Elizabeth A. Courtney-Long
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Brian S. Armour
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Bridget K. Ambrose
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD
| | - Israel T. Agaku
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
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Pierce JP, Benmarhnia T, Chen R, White M, Abrams DB, Ambrose BK, Blanco C, Borek N, Choi K, Coleman B, Compton WM, Cummings KM, Delnevo CD, Elton-Marshall T, Goniewicz ML, Gravely S, Fong GT, Hatsukami D, Henrie J, Kasza KA, Kealey S, Kimmel HL, Limpert J, Niaura RS, Ramôa C, Sharma E, Silveira ML, Stanton CA, Steinberg MB, Taylor E, Bansal-Travers M, Trinidad DR, Gardner LD, Hyland A, Soneji S, Messer K. Role of e-cigarettes and pharmacotherapy during attempts to quit cigarette smoking: The PATH Study 2013-16. PLoS One 2020; 15:e0237938. [PMID: 32877429 PMCID: PMC7467279 DOI: 10.1371/journal.pone.0237938] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [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: 04/04/2020] [Accepted: 08/05/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND More smokers report using e-cigarettes to help them quit than FDA-approved pharmacotherapy. OBJECTIVE To assess the association of e-cigarettes with future abstinence from cigarette and tobacco use. DESIGN Cohort study of US sample, with annual follow-up. PARTICIPANTS US adult (ages 18+) daily cigarette smokers identified at Wave 1 (W1; 2013-14) of the PATH Study, who reported a quit attempt before W2 and completed W3 (n = 2443). EXPOSURES Use of e-cigarettes, pharmacotherapy (including nicotine replacement therapy), or no product for last quit attempt (LQA), and current daily e-cigarette use at W2. ANALYSIS Propensity score matching (PSM) of groups using different methods to quit. OUTCOME MEASURES 12+ months abstinence at W3 from cigarettes and from all tobacco (including e-cigarettes). 30+ days abstinence at W3 was a secondary outcome. RESULTS Among daily smokers with an LQA, 23.5% used e-cigarettes, 19.3% used pharmacotherapy only (including NRT) and 57.2% used no product. Cigarette abstinence for 12+ months at W3 was ~10% in each group. Half of the cigarette abstainers in the e-cigarette group were using e-cigarettes at W3. Different methods to help quitting had statistically comparable 12+ month cigarette abstinence at W3 (e-cigarettes vs no product: Risk Difference (RD) = 0.01, 95% CI: -0.04 to 0.06; e-cigarettes vs pharmacotherapy: RD = 0.02, 95% CI:-0.04 to 0.09). Likewise, daily e-cigarette users at W2 did not show a cessation benefit over comparable no-e-cigarette users and this finding was robust to sensitivity analyses. Abstinence for 30+ days at W3 was also similar across products. LIMITATIONS The frequency of e-cigarette use during the LQA was not assessed, nor was it possible to assess continuous abstinence from the LQA. CONCLUSION Among US daily smokers who quit cigarettes in 2014-15, use of e-cigarettes in that attempt compared to approved cessation aids or no products showed similar abstinence rates 1-2 years later.
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Affiliation(s)
- John P. Pierce
- Moores Cancer Center, University of California San Diego, San Diego, California, United States of America
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, California, United States of America
| | - Tarik Benmarhnia
- Moores Cancer Center, University of California San Diego, San Diego, California, United States of America
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, California, United States of America
| | - Ruifeng Chen
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, California, United States of America
| | - Martha White
- Moores Cancer Center, University of California San Diego, San Diego, California, United States of America
| | - David B. Abrams
- Department of Social and Behavioral Sciences, NYU College of Global Public Health, New York University, New York, New York, United States of America
| | - Bridget K. Ambrose
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Carlos Blanco
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Nicolette Borek
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Kelvin Choi
- National Institute for Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Blair Coleman
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Wilson M. Compton
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland, United States of America
| | - K. Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Cristine D. Delnevo
- Rutgers Center for Tobacco Studies, New Brunswick, New Jersey, United States of America
| | - Tara Elton-Marshall
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, London, Ontario, Canada
| | - Maciej L. Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, United States of America
| | - Shannon Gravely
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Geoffrey T. Fong
- Department of Psychology and School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
- Ontario Institute for Cancer Research, MaRS Centre, Toronto, Ontario, Canada
| | - Dorothy Hatsukami
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - James Henrie
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Karin A. Kasza
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, United States of America
| | - Sheila Kealey
- Moores Cancer Center, University of California San Diego, San Diego, California, United States of America
| | - Heather L. Kimmel
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Jean Limpert
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Raymond S. Niaura
- Department of Social and Behavioral Sciences, NYU College of Global Public Health, New York University, New York, New York, United States of America
| | - Carolina Ramôa
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Eva Sharma
- Westat, Rockville, Maryland, United States of America
| | - Marushka L. Silveira
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland, United States of America
- Kelly Government Solutions, Rockville, Maryland, United States of America
| | | | - Michael B. Steinberg
- Rutgers Center for Tobacco Studies, New Brunswick, New Jersey, United States of America
| | - Ethel Taylor
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Maansi Bansal-Travers
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, United States of America
| | - Dennis R. Trinidad
- Moores Cancer Center, University of California San Diego, San Diego, California, United States of America
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, California, United States of America
| | - Lisa D. Gardner
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Andrew Hyland
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, United States of America
- Westat, Rockville, Maryland, United States of America
| | - Samir Soneji
- Department of Health Behavior, Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
| | - Karen Messer
- Moores Cancer Center, University of California San Diego, San Diego, California, United States of America
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, California, United States of America
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Stanton CA, Bansal-Travers M, Johnson AL, Sharma E, Katz L, Ambrose BK, Silveira ML, Day H, Sargent J, Borek N, Compton WM, Johnson SE, Kimmel HL, Kaufman AR, Limpert J, Abrams D, Cummings KM, Goniewicz ML, Tanski S, Travers MJ, Hyland AJ, Pearson JL. Longitudinal e-Cigarette and Cigarette Use Among US Youth in the PATH Study (2013-2015). J Natl Cancer Inst 2020; 111:1088-1096. [PMID: 30689915 DOI: 10.1093/jnci/djz006] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 11/01/2018] [Accepted: 01/10/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Evidence is accumulating that youth who try Electronic Nicotine Delivery Systems (ENDS, e-cigarettes) may go on to try cigarettes. This analysis examines the bidirectional patterns of ENDS and cigarette use among US youth over one year and uses propensity score matching (PSM) to examine frequency of ENDS use on changes in cigarette smoking. METHODS Our analysis included 11 996 participants who had two waves of available data (Wave 1 [W1] 2013-2014; Wave 2 [W2] 2014-2015) drawn from the longitudinal Population Assessment of Tobacco and Health Study. Cross-sectional weighted prevalence estimates are reported for cigarettes and ENDS. We used PSM to estimate the likelihood of ENDS use at W1 and to draw matched analytic samples, then used regression (logistic or linear) models to examine the effect of W1 ENDS use on W2 cigarette smoking. All statistical tests were two-sided. RESULTS In weighted analyses, 69.3% of W1 past-30-day cigarette smokers exhibited past-30-day smoking at W2; 42.2% of W1 past-30-day ENDS users were using ENDS at W2. W1 ever use of either product was similarly associated with W2 new use of the other product. Unweighted PSM models indicated W1 cigarette-naïve ENDS use was associated with W2 ever-cigarette smoking (n = 676; adjusted odds ratio = 3.21, 95% confidence interval [CI] = 1.95 to 5.45, P < .001); W1 ever-ENDS use did not affect change in cigarette frequency at W2 (n = 1020, beta = 0.31, 95% CI = -0.76 to 1.39, P = .57); 1-5 days ENDS use compared with ever, no past-30-day ENDS use was associated with a statistically significant decrease of W2 smoking days (n = 256, beta = -2.64, 95% CI = -4.96 to -0.32; P = .03); and W1 6+ day ENDS users did not show a decrease in frequency of cigarette smoking. CONCLUSIONS Ever-ENDS use predicts future cigarette smoking, and frequency of ENDS use has a differential impact on subsequent cigarette smoking uptake or reduction. These results suggest that both cigarettes and ENDS should be targeted in early tobacco prevention efforts with youth.
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Rostron BL, Cheng YC, Gardner LD, Ambrose BK. Prevalence and Reasons for Use of Flavored Cigars and ENDS among US Youth and Adults: Estimates from Wave 4 of the PATH Study, 2016-2017. Am J Health Behav 2020; 44:76-81. [PMID: 31783934 DOI: 10.5993/ajhb.44.1.8] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [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: In this study, we present updated estimates of use prevalence, flavor use, and flavors as a reason for use among US cigar and electronic nicotine delivery system (ENDS) users. Methods: Data come from Wave 4 of the Population Assessment of Tobacco and Health (PATH) Study and were collected between December 2016 and early January 2018. Results are presented for youth (12-17 years), young adults (18-24 years), and adults (25+ years). Results: Approximately half (50.7%) of young adults reported having ever used an ENDS product with 83.7% reporting that their first ENDS product was flavored. Flavor use was particularly high among current (past 30-day) ENDS users at 97.0% among youth, 96.8% among young adults, and 81.2% among adults. For cigars, cigarillos were the most commonly used type among youth and young adults. Flavor use was highest among current cigarillo and filtered cigar users, with close to half of current users reporting flavor use across age groups. Conclusions: Flavored product use is common among ENDS and cigar users.
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Affiliation(s)
- Brian L. Rostron
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD;,
| | - Yu-Ching Cheng
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD
| | - Lisa D. Gardner
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD
| | - Bridget K. Ambrose
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD
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Cullen KA, Gentzke AS, Sawdey MD, Chang JT, Anic GM, Wang TW, Creamer MR, Jamal A, Ambrose BK, King BA. e-Cigarette Use Among Youth in the United States, 2019. JAMA 2019; 322:2095-2103. [PMID: 31688912 PMCID: PMC6865299 DOI: 10.1001/jama.2019.18387] [Citation(s) in RCA: 532] [Impact Index Per Article: 106.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The prevalence of e-cigarette use among US youth increased from 2011 to 2018. Continued monitoring of the prevalence of e-cigarette and other tobacco product use among youth is important to inform public health policy, planning, and regulatory efforts. OBJECTIVE To estimate the prevalence of e-cigarette use among US high school and middle school students in 2019 including frequency of use, brands used, and use of flavored products. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional analyses of a school-based nationally representative sample of 19 018 US students in grades 6 to 12 participating in the 2019 National Youth Tobacco Survey. The survey was conducted from February 15, 2019, to May 24, 2019. MAIN OUTCOMES AND MEASURES Self-reported current (past 30-day) e-cigarette use estimates among high school and middle school students; frequent use (≥20 days in the past 30 days) and usual e-cigarette brand among current e-cigarette users; and use of flavored e-cigarettes and flavor types among current exclusive e-cigarette users (no use of other tobacco products) by school level and usual brand. Prevalence estimates were weighted to account for the complex sampling design. RESULTS The survey included 10 097 high school students (mean [SD] age, 16.1 [3.0] years; 47.5% female) and 8837 middle school students (mean [SD] age, 12.7 [2.8] years; 48.7% female). The response rate was 66.3%. An estimated 27.5% (95% CI, 25.3%-29.7%) of high school students and 10.5% (95% CI, 9.4%-11.8%) of middle school students reported current e-cigarette use. Among current e-cigarette users, an estimated 34.2% (95% CI, 31.2%-37.3%) of high school students and 18.0% (95% CI, 15.2%-21.2%) of middle school students reported frequent use, and an estimated 63.6% (95% CI, 59.3%-67.8%) of high school students and 65.4% (95% CI, 60.6%-69.9%) of middle school students reported exclusive use of e-cigarettes. Among current e-cigarette users, an estimated 59.1% (95% CI, 54.8%-63.2%) of high school students and 54.1% (95% CI, 49.1%-59.0%) of middle school students reported JUUL as their usual e-cigarette brand in the past 30 days; among current e-cigarette users, 13.8% (95% CI, 12.0%-15.9%) of high school students and 16.8% (95% CI, 13.6%-20.7%) of middle school students reported not having a usual e-cigarette brand. Among current exclusive e-cigarette users, an estimated 72.2% (95% CI, 69.1%-75.1%) of high school students and 59.2% (95% CI, 54.8%-63.4%) of middle school students used flavored e-cigarettes, with fruit, menthol or mint, and candy, desserts, or other sweets being the most commonly reported flavors. CONCLUSIONS AND RELEVANCE In 2019, the prevalence of self-reported e-cigarette use was high among high school and middle school students, with many current e-cigarette users reporting frequent use and most of the exclusive e-cigarette users reporting use of flavored e-cigarettes.
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Affiliation(s)
- Karen A. Cullen
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland
| | - Andrea S. Gentzke
- Office on Smoking and Health, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael D. Sawdey
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland
| | - Joanne T. Chang
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland
| | - Gabriella M. Anic
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland
| | - Teresa W. Wang
- Office on Smoking and Health, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - MeLisa R. Creamer
- Office on Smoking and Health, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ahmed Jamal
- Office on Smoking and Health, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Bridget K. Ambrose
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland
| | - Brian A. King
- Office on Smoking and Health, US Centers for Disease Control and Prevention, Atlanta, Georgia
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Nonnemaker J, Feirman SP, MacMonegle A, Ambrose BK, Jackson KJ, Schroeder MJ, Smith AA, Ridgeway W, Rass O. Examining the role of menthol cigarettes in progression to established smoking among youth. Addict Behav 2019; 98:106045. [PMID: 31302310 DOI: 10.1016/j.addbeh.2019.106045] [Citation(s) in RCA: 10] [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] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 07/02/2019] [Accepted: 07/04/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Menthol, a flavoring compound added to cigarettes, makes cigarettes more appealing to youth and inexperienced smokers and increases cigarettes' abuse liability. However, limited studies are available on menthol's role in smoking progression. METHODS To assess the association between menthol in cigarettes and progression to established smoking, we used five waves of data from the Evaluation of Public Education Campaign on Teen Tobacco Cohort Study, a nationally representative longitudinal survey of U.S. youth conducted as part of "The Real Cost" evaluation. We used discrete time survival analysis to model the occurrence of two event outcomes-progression to established, current smoking and progression to established, frequent smoking-using a logit model with a menthol use indicator as the key explanatory variable. Based on this framework, we estimated the effect of prior menthol use on the odds of smoking progression. RESULTS In the progression to established, current smoking model, prior menthol use was significantly associated with progression [adjusted odds ratio (aOR) = 1.80, p < .05, confidence interval (CI) = (1.03-3.16)]. While results were in a similar direction for the model of progression to established, frequent smoking, the association between prior menthol use and this progression model did not reach significance [aOR = 1.56, CI = (0.80-3.03)]. CONCLUSION The results suggest a relationship between using menthol cigarettes and progression from experimental to established, current smoking among youth. This study adds to a growing literature base that supports that menthol cigarettes, compared to nonmenthol cigarettes, put youth at increased risk for regular cigarette use.
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Affiliation(s)
- James Nonnemaker
- RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709, United States of America.
| | - Shari P Feirman
- Office of Science, Center for Tobacco Products, Food and Drug Administration, 10903 New Hampshire Ave., Silver Spring, MD 20993, United States of America
| | - Anna MacMonegle
- RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709, United States of America
| | - Bridget K Ambrose
- Office of Science, Center for Tobacco Products, Food and Drug Administration, 10903 New Hampshire Ave., Silver Spring, MD 20993, United States of America
| | - Kia J Jackson
- Office of Science, Center for Tobacco Products, Food and Drug Administration, 10903 New Hampshire Ave., Silver Spring, MD 20993, United States of America
| | - Megan J Schroeder
- Office of Science, Center for Tobacco Products, Food and Drug Administration, 10903 New Hampshire Ave., Silver Spring, MD 20993, United States of America
| | - Alexandria A Smith
- Office of Health Communication and Education, Center for Tobacco Products, Food and Drug Administration, 10903 New Hampshire Ave., Silver Spring, MD 20993, United States of America
| | - William Ridgeway
- RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709, United States of America
| | - Olga Rass
- Office of Science, Center for Tobacco Products, Food and Drug Administration, 10903 New Hampshire Ave., Silver Spring, MD 20993, United States of America
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Villanti AC, Johnson AL, Glasser AM, Rose SW, Ambrose BK, Conway KP, Cummings KM, Stanton CA, Edwards KC, Delnevo CD, Wackowski OA, Feirman SP, Bansal-Travers M, Bernat JK, Holder-Hayes E, Green VR, Silveira ML, Hyland A. Association of Flavored Tobacco Use With Tobacco Initiation and Subsequent Use Among US Youth and Adults, 2013-2015. JAMA Netw Open 2019; 2:e1913804. [PMID: 31642927 PMCID: PMC6820032 DOI: 10.1001/jamanetworkopen.2019.13804] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
IMPORTANCE Flavors in tobacco products may appeal to young and inexperienced users. OBJECTIVE To examine among youth (aged 12-17 years), young adults (aged 18-24 years), and adults (aged ≥25 years) the prevalence of first use of flavored tobacco products among new tobacco users and the association between first flavored use of a given tobacco product and tobacco use 1 year later, including progression of tobacco use. DESIGN, SETTING, AND PARTICIPANTS This cohort study represents a longitudinal analysis of data from the Population Assessment of Tobacco and Health (PATH) Study, a nationally representative study with data collected in 2013 to 2014 (wave 1) and 2014 to 2015 (wave 2). Participants were noninstitutionalized individuals, including 11 996 youth and 26 447 adults, in selected households who participated in both waves of the PATH Study. Data analysis was conducted from July 2016 to June 2019. MAIN OUTCOMES AND MEASURES Prevalence of tobacco product use at wave 2. RESULTS The mean (SE) age of the participants was 14.5 (0.0) years for youth, 21.1 (0.0) years for young adults, and 50.3 (0.0) for adults. Most youth (71.9%; 95% CI, 69.7%-74.0%) and young adults (57.6%; 95% CI, 54.9%-60.3%) who were new users of tobacco products over the 10- to 13-month follow-up period used flavored products. First use of a menthol or mint or other flavored cigarette documented at wave 1 was positively associated with past 12-month and past 30-day cigarette use in all age groups at wave 2 compared with first use of a nonflavored cigarette (youth, flavored cigarette, past 12-month use adjusted prevalence ratio [aPR], 1.14 [95% CI, 1.05-1.25] and past 30-day use aPR, 1.15 [95% CI, 1.00-1.31]; youth, menthol or mint cigarette, past 12-month use aPR, 1.18 [95% CI, 1.08-1.29] and past 30-day use aPR, 1.19 [95% CI, 1.04-1.37]; young adult, flavored cigarette, past 12-month use aPR, 1.09 [95% CI, 1.04-1.15] and past 30-day use aPR, 1.13 [95% CI, 1.06-1.21]; young adult menthol or mint cigarette, past 12-month use aPR, 1.10 [95% CI, 1.05-1.16] and past 30-day use aPR, 1.15 [95% CI, 1.07-1.23]; adult flavored cigarette, past 12-month use aPR, 1.10 [95% CI, 1.05-1.15] and past 30-day use aPR, 1.09 [95% CI, 1.04-1.14]; adult menthol or mint cigarette, past 12-month use aPR, 1.13 [95% CI, 1.08-1.18] and past 30-day use aPR, 1.12 [95% CI, 1.07-1.17]). Among young adults, first use of flavored e-cigarettes (aPR, 2.05; 95% CI, 1.61-2.61), any cigars (aPR, 1.60; 95% CI, 1.26-2.02), cigarillos (aPR, 1.49; 95% CI, 1.08-2.05), filtered cigars (aPR, 3.69; 95% CI, 2.08-6.57), hookah (aPR, 1.91; 95% CI, 1.23-2.98), and any smokeless tobacco (aPR, 1.54; 95% CI, 1.08-2.20) was prospectively associated with current regular use of those products at wave 2 compared with first nonflavored use. Among adults aged 25 years and older, first use of flavored e-cigarettes (aPR, 1.60; 95% CI, 1.41-1.82), any cigars (aPR, 1.56; 95% CI, 1.29-1.87), cigarillos (aPR, 1.29; 95% CI, 1.01-1.64), filtered cigars (aPR, 1.79; 95% CI, 1.25-2.54), hookah (aPR, 5.66; 95% CI, 2.04-15.71), and any smokeless tobacco (aPR, 1.55; 95% CI, 1.32-1.82) was prospectively associated with current regular use of those products at wave 2 compared with first nonflavored use. CONCLUSIONS AND RELEVANCE In this longitudinal cohort study, flavors in tobacco products were associated with youth and young adult tobacco experimentation. First use of a flavored tobacco product may place youth, young adults, and adults at risk of subsequent tobacco use.
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Affiliation(s)
- Andrea C. Villanti
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC
- Vermont Center on Behavior and Health, Department of Psychiatry, The University of Vermont, Burlington
| | - Amanda L. Johnson
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland
| | - Allison M. Glasser
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC
| | - Shyanika W. Rose
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC
| | - Bridget K. Ambrose
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland
| | - Kevin P. Conway
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Bethesda, Maryland
| | - K. Michael Cummings
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Cassandra A. Stanton
- Westat, Rockville, Maryland
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | | | - Cristine D. Delnevo
- Department of Health Education and Behavioral Science, Center for Tobacco Studies, Rutgers School of Public Health, Piscataway, New Jersey
| | - Olivia A. Wackowski
- Department of Health Education and Behavioral Science, Center for Tobacco Studies, Rutgers School of Public Health, Piscataway, New Jersey
| | - Shari P. Feirman
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland
| | - Maansi Bansal-Travers
- Department of Health Behavior, Division of Cancer Prevention & Population Sciences, Roswell Park Cancer Institute, Buffalo, New York
| | - Jennifer K. Bernat
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland
| | - Enver Holder-Hayes
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland
| | - Victoria R. Green
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Bethesda, Maryland
- Kelly Government Solutions, Rockville, Maryland
| | - Marushka L. Silveira
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Bethesda, Maryland
- Kelly Government Solutions, Rockville, Maryland
| | - Andrew Hyland
- Department of Health Behavior, Division of Cancer Prevention & Population Sciences, Roswell Park Cancer Institute, Buffalo, New York
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17
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Rose SW, Johnson AL, Glasser AM, Villanti AC, Ambrose BK, Conway K, Cummings KM, Stanton CA, Delnevo C, Wackowski OA, Edwards KC, Feirman SP, Bansal-Travers M, Bernat J, Holder-Hayes E, Green V, Silveira ML, Zhou Y, Abudayyeh H, Hyland A. Flavour types used by youth and adult tobacco users in wave 2 of the Population Assessment of Tobacco and Health (PATH) Study 2014-2015. Tob Control 2019; 29:432-446. [PMID: 31542778 DOI: 10.1136/tobaccocontrol-2018-054852] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 11/19/2018] [Revised: 05/18/2019] [Accepted: 05/28/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND Most youth and young adult (YA) tobacco users use flavoured products; however, little is known about specific flavours used. METHODS We report flavour types among US tobacco users from the Population Assessment of Tobacco and Health Study, wave 2, 2014-2015. At wave 2, we examined (1) flavour use and type at past 30-day use; (2) new flavoured tobacco product use and type; (3) product-specific flavour patterns across youth (ages 12-17) (n=920), YA (18-24) (n=3726) and adult (25+) (n=10 346) past 30-day and new tobacco users and (4) concordance between self-coded and expert-coded brand flavour type among all adults (18+). RESULTS Prevalence of flavoured tobacco product use was highest among youth, followed by YA and adult 25+ any tobacco users. Within each age group, flavoured use was greatest among hookah, e-cigarette and snus users. Overall, menthol/mint, fruit and candy/sweet were the most prevalent flavour types at first and past 30-day use across age groups. For past 30-day use, all flavour types except menthol/mint exhibited an inverse age gradient, with more prevalent use among youth and YAs, followed by adults 25+. Prevalence of menthol/mint use was high (over 50% youth, YAs; 76% adults 25+) and exhibited a positive age gradient overall, though the reverse for cigarettes. Brand-categorised and self-reported flavour use measures among adults 18+ were moderately to substantially concordant across most products. CONCLUSIONS Common flavours like menthol/mint, fruit and candy/sweet enhance appeal to young tobacco users. Information on flavour types used by product and age can inform tobacco flavour regulations to addess flavour appeal especially among youth.
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Affiliation(s)
| | - Amanda L Johnson
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland, USA
| | | | - Andrea C Villanti
- Truth Initiative Schroeder Institute, Washington, DC, USA.,Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, Burlington, Vermont, USA
| | - Bridget K Ambrose
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Kevin Conway
- Division of Epidemiology, Services, and Prevention Branch, National Institute on Drug Abuse, Bethesda, Maryland, USA
| | - K Michael Cummings
- Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Cassandra A Stanton
- Westat Inc, Rockville, Maryland, USA.,Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, United States
| | - Cristine Delnevo
- Center for Tobacco Studies, School of Public Health, Rutgers University, Piscataway, New Jersey, USA
| | - Olivia A Wackowski
- Center for Tobacco Studies, School of Public Health, Rutgers University, Piscataway, New Jersey, USA
| | | | - Shari P Feirman
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland, USA
| | | | - Jennifer Bernat
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Enver Holder-Hayes
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Victoria Green
- Division of Epidemiology, Services, and Prevention Branch, National Institute on Drug Abuse, Bethesda, Maryland, USA.,Kelly Government Solutions, Rockville, Maryland, USA
| | - Marushka L Silveira
- Division of Epidemiology, Services, and Prevention Branch, National Institute on Drug Abuse, Bethesda, Maryland, USA.,Kelly Government Solutions, Rockville, Maryland, USA
| | - Yitong Zhou
- Truth Initiative Schroeder Institute, Washington, DC, USA
| | | | - Andrew Hyland
- Health Behavior, Roswell Park Cancer Institute, Buffalo, New York, USA
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18
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L Rostron B, G Corey C, Holder-Hayes E, K Ambrose B. Estimating the Potential Public Health Impact of Prohibiting Characterizing Flavors in Cigars throughout the US. Int J Environ Res Public Health 2019; 16:E3234. [PMID: 31487796 PMCID: PMC6765886 DOI: 10.3390/ijerph16183234] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 08/26/2019] [Accepted: 08/29/2019] [Indexed: 11/16/2022]
Abstract
Flavored cigar use is common among cigar smokers, particularly those at younger ages. Several US localities have implemented policies restricting the sale of flavored tobacco products, including cigars. We estimated the population health benefits of removal of flavored cigars throughout the US in terms of reductions in cigar smoking-attributable mortality due to increased cessation and reductions in cigar smoking prevalence due to decreased initiation and continuing use. Monte Carlo simulation was used to estimate possible ranges for these values. We used published estimates of cigar use and attributable mortality in the US, as well as prior study conclusions on the effect of local and national flavor restriction policies. We estimated that removal of flavored cigars would result in approximately 800 (90% prediction interval = 400-1200) fewer cigar smoking-attributable deaths in the US each year and 112,000 fewer cigar smokers (90% prediction interval = 76,000-139,000) in each cohort of 18 year olds. The removal of characterizing flavors in cigars sold in the US is thus projected to have substantial public health benefits over time.
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Affiliation(s)
- Brian L Rostron
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD 20993, USA.
| | - Catherine G Corey
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD 20993, USA
| | - Enver Holder-Hayes
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD 20993, USA
| | - Bridget K Ambrose
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD 20993, USA
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19
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Sawdey MD, Day HR, Coleman B, Gardner LD, Johnson SE, Limpert J, Hammad HT, Goniewicz ML, Abrams DB, Stanton CA, Pearson JL, Kaufman AR, Kimmel HL, Delnevo CD, Compton WM, Bansal-Travers M, Niaura RS, Hyland A, Ambrose BK. Associations of risk factors of e-cigarette and cigarette use and susceptibility to use among baseline PATH study youth participants (2013-2014). Addict Behav 2019; 91:51-60. [PMID: 30473246 DOI: 10.1016/j.addbeh.2018.11.027] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [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: 05/03/2018] [Revised: 11/16/2018] [Accepted: 11/16/2018] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Improved understanding of the distribution of traditional risk factors of cigarette smoking among youth who have ever used or are susceptible to e-cigarettes and cigarettes will inform future longitudinal studies examining transitions in use. METHODS Multiple logistic regression analysis was conducted using data from youth (ages 12-17 years) who had ever heard of e-cigarettes at baseline of the PATH Study (n = 12,460) to compare the distribution of risk factors for cigarette smoking among seven mutually exclusive groups based on ever cigarette/e-cigarette use and susceptibility status. RESULTS Compared to committed never users, youth susceptible to e-cigarettes, cigarettes, or both had increasing odds of risk factors for cigarette smoking, with those susceptible to both products at highest risk, followed by cigarettes and e-cigarettes. Compared to e-cigarette only users, dual users had higher odds of nearly all risk factors (aOR range = 1.6-6.8) and cigarette only smokers had higher odds of other (non-e-cigarette) tobacco use (aOR range = 1.5-2.3), marijuana use (aOR = 1.9, 95%CI = 1.4-2.5), a high GAIN substance use score (aOR = 1.9, 95%CI = 1.1-3.4), low academic achievement (aOR range = 1.6-3.4), and exposure to smoking (aOR range = 1.8-2.1). No differences were observed for externalizing factors (depression, anxiety, etc.), sensation seeking, or household use of non-cigarette tobacco. CONCLUSIONS Among ever cigarette and e-cigarette users, dual users had higher odds of reporting traditional risk factors for smoking, followed by single product cigarette smokers and e-cigarette users. Understanding how e-cigarette and cigarette users differ may inform youth tobacco use prevention efforts and advise future studies assessing probability of progression of cigarette and e-cigarette use.
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Affiliation(s)
- Michael D Sawdey
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA.
| | - Hannah R Day
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - Blair Coleman
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - Lisa D Gardner
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - Sarah E Johnson
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - Jean Limpert
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - Hoda T Hammad
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - Maciej L Goniewicz
- Department of Health Behavior, Division of Cancer Prevention & Population Sciences, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - David B Abrams
- Department of Social and Behavioral Sciences, NYU College of Global Public Health, New York University, New York, NY, USA
| | - Cassandra A Stanton
- Westat, Rockville, MD, USA; Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Jennifer L Pearson
- Division of Social and Behavioral Sciences/Health Administration and Policy, University of Nevada, Reno, Reno, NV, USA
| | - Annette R Kaufman
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Heather L Kimmel
- National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, USA
| | - Cristine D Delnevo
- Department of Health Education and Behavioral Science, Center for Tobacco Studies, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Wilson M Compton
- National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, USA
| | - Maansi Bansal-Travers
- Department of Health Behavior, Division of Cancer Prevention & Population Sciences, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Raymond S Niaura
- Department of Social and Behavioral Sciences, NYU College of Global Public Health, New York University, New York, NY, USA
| | - Andrew Hyland
- Department of Health Behavior, Division of Cancer Prevention & Population Sciences, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Bridget K Ambrose
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
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20
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Chang JT, Wang B, Chang CM, Ambrose BK. National estimates of poisoning events related to liquid nicotine in young children treated in US hospital emergency departments, 2013-2017. Inj Epidemiol 2019; 6:10. [PMID: 31245259 PMCID: PMC6582692 DOI: 10.1186/s40621-019-0188-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 02/26/2019] [Indexed: 11/10/2022] Open
Abstract
Background An estimated 2 million youth (in 2017) and 7.9 million adults (in 2015) reported currently using electronic nicotine delivery systems (ENDS). Reports of poisoning events related to liquid nicotine (e-liquids) in ENDS have been on the rise, but current, nationally-representative estimates of hospital-treated poisoning cases related to e-liquid nicotine exposure in the United States (US) are lacking. Findings We used National Electronic Injury Surveillance System (NEISS) data from 2013 to 2017 to calculate national estimates with 95% confidence intervals (CIs) of poisoning incidents related to e-liquid nicotine exposure. From 2013 to 2017, an estimated 4745 poisoning cases related to e-liquids among children under age five were treated in US hospital emergency departments; the number of cases increased from 181 (95% CI: 0-369) in 2013 to 1736 (95% CI, 871-2602) in 2015 and then decreased to 411 (95% CI, 84-738) in 2017. Most of the cases were treated and released; 4.1% were admitted to the hospital. The most common route of exposure was through ingestion (96.9%), and 2.6% of the cases were through dermal exposure. The highest amounts of e-liquids or nicotine ingested were 118.2mL, 1 bottle, and 100 mg, and the most common symptoms (63.6%) related to nicotine poisoning were nausea and vomiting. Conclusions This study provides national estimates of poisoning cases associated with nicotine exposure from e-liquids among children under age five. Findings on e-liquid volume or nicotine dose, when available, provide important insights into exposures associated with toxicity in children. Since NEISS data do not include product codes specific to ENDS or provide information on poisoning severity, we used general keywords to capture these events, which might underestimate the population burden. Information from this study may complement efforts, such as public education, to prevent unintended exposure to nicotine in e-liquids among children.
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Affiliation(s)
- Joanne T Chang
- Center for Tobacco Products, U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993 USA
| | - Baoguang Wang
- Center for Tobacco Products, U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993 USA
| | - Cindy M Chang
- Center for Tobacco Products, U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993 USA
| | - Bridget K Ambrose
- Center for Tobacco Products, U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993 USA
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Gentzke AS, Creamer M, Cullen KA, Ambrose BK, Willis G, Jamal A, King BA. Vital Signs: Tobacco Product Use Among Middle and High School Students - United States, 2011-2018. MMWR Morb Mortal Wkly Rep 2019; 68:157-164. [PMID: 30763302 PMCID: PMC6375658 DOI: 10.15585/mmwr.mm6806e1] [Citation(s) in RCA: 567] [Impact Index Per Article: 113.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Introduction Tobacco use is the leading cause of preventable disease and death in the United States; nearly all tobacco product use begins during youth and young adulthood. Methods CDC, the Food and Drug Administration, and the National Cancer Institute analyzed data from the 2011–2018 National Youth Tobacco Surveys to estimate tobacco product use among U.S. middle and high school students. Prevalence estimates of current (past 30-day) use of seven tobacco products were assessed; differences over time were analyzed using multivariable regression (2011–2018) or t-test (2017–2018). Results In 2018, current use of any tobacco product was reported by 27.1% of high school students (4.04 million) and 7.2% of middle school students (840,000); electronic cigarettes (e-cigarettes) were the most commonly used product among high school (20.8%; 3.05 million) and middle school (4.9%; 570,000) students. Use of any tobacco product overall did not change significantly during 2011–2018 among either school level. During 2017–2018, current use of any tobacco product increased 38.3% (from 19.6% to 27.1%) among high school students and 28.6% (from 5.6% to 7.2%) among middle school students; e-cigarette use increased 77.8% (from 11.7% to 20.8%) among high school students and 48.5% (from 3.3% to 4.9%) among middle school students. Conclusions and Implications for Public Health Practice A considerable increase in e-cigarette use among U.S. youths, coupled with no change in use of other tobacco products during 2017–2018, has erased recent progress in reducing overall tobacco product use among youths. The sustained implementation of comprehensive tobacco control strategies, in coordination with Food and Drug Administration regulation of tobacco products, can prevent and reduce the use of all forms of tobacco products among U.S. youths.
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22
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Chang CM, Rostron BL, Chang JT, Corey CG, Kimmel HL, Sosnoff CS, Goniewicz ML, Edwards KC, Hatsukami DK, Wang Y, Del Valle-Pinero AY, Yang M, Travers MJ, Arnstein S, Taylor K, Conway K, Ambrose BK, Borek N, Hyland A, Wang L, Blount BC, van Bemmel DM. Biomarkers of Exposure among U.S. Adult Cigar Smokers: Population Assessment of Tobacco and Health (PATH) Study Wave 1 (2013-2014). Cancer Epidemiol Biomarkers Prev 2019; 28:943-953. [PMID: 30733305 DOI: 10.1158/1055-9965.epi-18-0539] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 08/09/2018] [Accepted: 01/30/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Given the diverse cigar market and limited data on biomarker patterns by cigar type, we compared biomarkers of nicotine and tobacco toxicants among cigar smokers and other groups. METHODS Using Wave 1 urinary biomarker data from 5,604 adults in the Population Assessment of Tobacco and Health (PATH) Study, we compared geometric mean concentrations among cigar-only smokers (all cigars and separately for traditional, cigarillo, and filtered cigars), cigarette-only smokers, dual cigar/cigarette smokers, and never users of tobacco. We calculated geometric mean ratios comparing groups with never users adjusting for sex, age, race/ethnicity, education and creatinine. RESULTS Some day cigar-only smokers had lower biomarker concentrations than every day cigar-only smokers, but higher than never users. Every day cigar-only smokers (n = 61) had lower TNE-2 (cotinine+trans-3'-hydroxycotinine) compared to every day cigarette-only (n = 2217; P < 0.0001) and dual cigar/cigarette smokers (n = 601; P < 0.0001). Several biomarkers, including NNAL (NNK metabolite) and CYMA (metabolite of acrylonitrile), were comparable in these groups. In exploratory analyses, every day filtered cigar-only (n = 7) smokers had higher biomarker concentrations compared with every day traditional cigar-only smokers (n = 12) and cigarillo-only smokers (n = 24). Every day smokers of each cigar type were similar to exclusive cigarette smokers. For some biomarkers, particularly for every day filtered cigar-only smokers, concentrations were higher. CONCLUSIONS For some biomarkers, every day cigar-only smokers were comparable with every day cigarette-only smokers. Exploratory analyses suggest that biomarkers vary by cigar type with every day filtered cigar-only smokers having the highest concentrations. IMPACT High exposure to harmful constituents among cigar smokers is a continuing health issue.
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Affiliation(s)
- Cindy M Chang
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland.
| | - Brian L Rostron
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland
| | - Joanne T Chang
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland
| | - Catherine G Corey
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland
| | - Heather L Kimmel
- National Institute on Drug Abuse, National Institutes of Health, Bethedsa, Maryland
| | - Connie S Sosnoff
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | - Yuesong Wang
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Maocheng Yang
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland
| | - Mark J Travers
- Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Stephen Arnstein
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Kevin Conway
- National Institute on Drug Abuse, National Institutes of Health, Bethedsa, Maryland
| | - Bridget K Ambrose
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland
| | - Nicolette Borek
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland
| | - Andrew Hyland
- Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Lanqing Wang
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Dana M van Bemmel
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland
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Etemadi A, Poustchi H, Chang CM, Blount BC, Calafat AM, Wang L, De Jesus VR, Pourshams A, Shakeri R, Shiels MS, Inoue-Choi M, Ambrose BK, Christensen CH, Wang B, Murphy G, Ye X, Bhandari D, Feng J, Xia B, Sosnoff CS, Kamangar F, Brennan P, Boffetta P, Dawsey SM, Abnet CC, Malekzadeh R, Freedman ND. Urinary Biomarkers of Carcinogenic Exposure among Cigarette, Waterpipe, and Smokeless Tobacco Users and Never Users of Tobacco in the Golestan Cohort Study. Cancer Epidemiol Biomarkers Prev 2019; 28:337-347. [PMID: 30622099 PMCID: PMC6935158 DOI: 10.1158/1055-9965.epi-18-0743] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [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: 07/02/2018] [Revised: 09/27/2018] [Accepted: 10/17/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND How carcinogen exposure varies across users of different, particularly noncigarette, tobacco products remains poorly understood. METHODS We randomly selected 165 participants of the Golestan Cohort Study from northeastern Iran: 60 never users of any tobacco, 35 exclusive cigarette, 40 exclusive (78% daily) waterpipe, and 30 exclusive smokeless tobacco (nass) users. We measured concentrations of 39 biomarkers of exposure in 4 chemical classes in baseline urine samples: tobacco alkaloids, tobacco-specific nitrosamines (TSNA), polycyclic aromatic hydrocarbons (PAH), and volatile organic compounds (VOC). We also quantified the same biomarkers in a second urine sample, obtained 5 years later, among continuing cigarette smokers and never tobacco users. RESULTS Nass users had the highest concentrations of tobacco alkaloids. All tobacco users had elevated TSNA concentrations, which correlated with nicotine dose. In both cigarette and waterpipe smokers, PAH and VOC biomarkers were higher than never tobacco users and nass users, and highly correlated with nicotine dose. PAH biomarkers of phenanthrene and pyrene and two VOC metabolites (phenylmercapturic acid and phenylglyoxylic acid) were higher in waterpipe smokers than in all other groups. PAH biomarkers among Golestan never tobacco users were comparable to those in U.S. cigarette smokers. All biomarkers had moderate to good correlations over 5 years, particularly in continuing cigarette smokers. CONCLUSIONS We observed two patterns of exposure biomarkers that differentiated the use of the combustible products (cigarettes and waterpipe) from the smokeless product. Environmental exposure from nontobacco sources appeared to contribute to the presence of high levels of PAH metabolites in the Golestan Cohort. IMPACT Most of these biomarkers would be useful for exposure assessment in a longitudinal study.
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Affiliation(s)
- Arash Etemadi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland.
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Poustchi
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Liver and Pancreaticobiliary Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Cindy M Chang
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland
| | - Benjamin C Blount
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Antonia M Calafat
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lanqing Wang
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Victor R De Jesus
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Akram Pourshams
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramin Shakeri
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Meredith S Shiels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland
| | - Maki Inoue-Choi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland
| | - Bridget K Ambrose
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland
| | - Carol H Christensen
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland
| | - Baoguang Wang
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland
| | - Gwen Murphy
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland
| | - Xiaoyun Ye
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Deepak Bhandari
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jun Feng
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Baoyun Xia
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Connie S Sosnoff
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Farin Kamangar
- Department of Biology, School of Computer, Mathematical, and Natural Sciences, Morgan State University, Baltimore, Maryland
| | - Paul Brennan
- International Agency for Research on Cancer, Lyon, France
| | - Paolo Boffetta
- The Tisch Cancer Institute, Mount Sinai School of Medicine and Institute for Translational Epidemiology, New York, New York
| | - Sanford M Dawsey
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland
| | - Christian C Abnet
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland
| | - Reza Malekzadeh
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Neal D Freedman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland
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Cullen KA, Ambrose BK, Gentzke AS, Apelberg BJ, Jamal A, King BA. Notes from the Field: Use of Electronic Cigarettes and Any Tobacco Product Among Middle and High School Students - United States, 2011-2018. MMWR Morb Mortal Wkly Rep 2018; 67:1276-1277. [PMID: 30439875 PMCID: PMC6290807 DOI: 10.15585/mmwr.mm6745a5] [Citation(s) in RCA: 522] [Impact Index Per Article: 87.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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25
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Corey CG, Holder-Hayes E, Nguyen AB, Delnevo CD, Rostron BL, Bansal-Travers M, Kimmel HL, Koblitz A, Lambert E, Pearson JL, Sharma E, Tworek C, Hyland AJ, Conway KP, Ambrose BK, Borek N. US Adult Cigar Smoking Patterns, Purchasing Behaviors, and Reasons for Use According to Cigar Type: Findings From the Population Assessment of Tobacco and Health (PATH) Study, 2013-2014. Nicotine Tob Res 2018; 20:1457-1466. [PMID: 29059423 PMCID: PMC6236070 DOI: 10.1093/ntr/ntx209] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [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: 04/26/2017] [Accepted: 09/12/2017] [Indexed: 11/14/2022]
Abstract
Introduction The US cigar market is diverse, yet until recently most research studies and tobacco surveillance systems have not reported behavioral and related outcomes by cigar type. Methods The 2013-2014 Population Assessment of Tobacco and Health Study collected data separately for filtered cigars (FCs), cigarillos, and traditional cigars, which were further distinguished as premium or nonpremium. Descriptive statistics for adult established current smokers of each cigar type and cigarettes were calculated for demographic characteristics, tobacco use patterns, purchasing behaviors and reasons for use. Adjusted prevalence ratios (APRs) using a marginal predictions approach with logistic regression assessed correlates of dual cigar and cigarette smoking. Results Age, sex, race/ethnicity, education level, and poverty status of smokers varied according to cigar type. Daily cigar smoking prevalence and number of cigars smoked per day were higher for FCs (37.3%; median: 1.6 cigars/day, respectively), than all other cigar types (6.7%-25.3%, all p < .01; 0.1-0.4 cigars/day, all p < .01, respectively); daily smoking and cigars per day were similar for nonpremium cigars and cigarillos (p = .11; p = .33, respectively). Cigarette smoking was twice as common among smokers of nonpremium cigars, cigarillos, and FCs (58.0%-66.0%) than among premium cigars (29.9%). Among current cigar smokers, FC smokers (APR = 1.23, 95% confidence interval [CI] = 1.09-1.39), other tobacco product users (APR = 1.27, 95% CI = 1.15-1.41), and those with a GED/high school diploma or less (APR = 1.20, 95% CI = 1.09-1.33) were more likely to also smoke cigarettes. Conclusion User characteristics, cigar smoking patterns, and dual smoking with cigarettes varied by cigar type highlighting the importance of adequately describing the cigar type studied and, where appropriate, differentiating results by cigar type. Implications Despite the diversity of the cigar market place, historically many research studies and tobacco surveillance systems have treated cigars as a single product type. This study describes similarities and differences in the user characteristics, tobacco use patterns, and purchasing behaviors of premium, nonpremium, cigarillo, and filtered cigar smokers. To enhance tobacco regulatory science, sufficient descriptions of the cigar type(s) studied and, where appropriate, differentiation of the particular cigar type(s) studied should be undertaken to improve the interpretation of study findings, understanding of cigar use patterns and related behaviors and future approaches to reducing cigar-attributable morbidity and mortality.
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Affiliation(s)
- Catherine G Corey
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD
| | - Enver Holder-Hayes
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD
| | - Anh B Nguyen
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD
| | - Cristine D Delnevo
- Center for Tobacco Studies, School of Public Health, Rutgers University, Piscataway, NJ
| | - Brian L Rostron
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD
| | | | - Heather L Kimmel
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD
| | - Amber Koblitz
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD
| | - Elizabeth Lambert
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD
| | - Jennifer L Pearson
- Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC
| | | | - Cindy Tworek
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD
| | - Andrew J Hyland
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY
| | - Kevin P Conway
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD
| | - Bridget K Ambrose
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD
| | - Nicolette Borek
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD
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26
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Wang TW, Gentzke A, Sharapova S, Cullen KA, Ambrose BK, Jamal A. Tobacco Product Use Among Middle and High School Students - United States, 2011-2017. MMWR Morb Mortal Wkly Rep 2018; 67:629-633. [PMID: 29879097 PMCID: PMC5991815 DOI: 10.15585/mmwr.mm6722a3] [Citation(s) in RCA: 275] [Impact Index Per Article: 45.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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27
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Apelberg BJ, Feirman SP, Salazar E, Corey CG, Ambrose BK, Paredes A, Richman E, Verzi SJ, Vugrin ED, Brodsky NS, Rostron BL. Potential Public Health Effects of Reducing Nicotine Levels in Cigarettes in the United States. N Engl J Med 2018. [PMID: 29543114 DOI: 10.1056/nejmsr1714617] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Benjamin J Apelberg
- From the Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD (B.J.A., S.P.F., E.S., C.G.C., B.K.A., A.P., E.R., B.L.R.); and Sandia National Laboratories, Albuquerque, NM (S.J.V., E.D.V., N.S.B.)
| | - Shari P Feirman
- From the Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD (B.J.A., S.P.F., E.S., C.G.C., B.K.A., A.P., E.R., B.L.R.); and Sandia National Laboratories, Albuquerque, NM (S.J.V., E.D.V., N.S.B.)
| | - Esther Salazar
- From the Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD (B.J.A., S.P.F., E.S., C.G.C., B.K.A., A.P., E.R., B.L.R.); and Sandia National Laboratories, Albuquerque, NM (S.J.V., E.D.V., N.S.B.)
| | - Catherine G Corey
- From the Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD (B.J.A., S.P.F., E.S., C.G.C., B.K.A., A.P., E.R., B.L.R.); and Sandia National Laboratories, Albuquerque, NM (S.J.V., E.D.V., N.S.B.)
| | - Bridget K Ambrose
- From the Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD (B.J.A., S.P.F., E.S., C.G.C., B.K.A., A.P., E.R., B.L.R.); and Sandia National Laboratories, Albuquerque, NM (S.J.V., E.D.V., N.S.B.)
| | - Antonio Paredes
- From the Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD (B.J.A., S.P.F., E.S., C.G.C., B.K.A., A.P., E.R., B.L.R.); and Sandia National Laboratories, Albuquerque, NM (S.J.V., E.D.V., N.S.B.)
| | - Elise Richman
- From the Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD (B.J.A., S.P.F., E.S., C.G.C., B.K.A., A.P., E.R., B.L.R.); and Sandia National Laboratories, Albuquerque, NM (S.J.V., E.D.V., N.S.B.)
| | - Stephen J Verzi
- From the Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD (B.J.A., S.P.F., E.S., C.G.C., B.K.A., A.P., E.R., B.L.R.); and Sandia National Laboratories, Albuquerque, NM (S.J.V., E.D.V., N.S.B.)
| | - Eric D Vugrin
- From the Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD (B.J.A., S.P.F., E.S., C.G.C., B.K.A., A.P., E.R., B.L.R.); and Sandia National Laboratories, Albuquerque, NM (S.J.V., E.D.V., N.S.B.)
| | - Nancy S Brodsky
- From the Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD (B.J.A., S.P.F., E.S., C.G.C., B.K.A., A.P., E.R., B.L.R.); and Sandia National Laboratories, Albuquerque, NM (S.J.V., E.D.V., N.S.B.)
| | - Brian L Rostron
- From the Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD (B.J.A., S.P.F., E.S., C.G.C., B.K.A., A.P., E.R., B.L.R.); and Sandia National Laboratories, Albuquerque, NM (S.J.V., E.D.V., N.S.B.)
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28
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Anic GM, Holder-Hayes E, Ambrose BK, Rostron BL, Coleman B, Jamal A, Apelberg BJ. E-cigarette and Smokeless Tobacco Use and Switching Among Smokers: Findings From the National Adult Tobacco Survey. Am J Prev Med 2018; 54:539-551. [PMID: 29429605 DOI: 10.1016/j.amepre.2017.12.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 11/22/2017] [Accepted: 12/11/2017] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Assessing the extent that cigarette smokers use or switch to e-cigarettes and smokeless tobacco can help inform the population health impact of these products. This study estimated the prevalence of e-cigarette and smokeless tobacco use and switching among current and recent former adult cigarette smokers. METHODS Data from the 2012-2013 (n=8,891) and 2013-2014 (n=11,379) National Adult Tobacco Survey were analyzed in 2016. Response rates for this telephone survey were 44.9% and 36.1%, respectively. Tobacco product use was assessed by smoking status. RESULTS Current e-cigarette use increased for all groups, with a greater increase among recent quitters, 9.1% (95% CI=7.1%, 11.1%) in 2012-2013 and 15.8% (95% CI=13.7%, 17.9%) in 2013-2014, than smokers with an unsuccessful quit attempt, 10.4% (95% CI=9.1%, 11.7%) in 2012-2013 and 14.8% (95% CI=13.5%, 16.1%) in 2013-2014, or smokers with no quit attempt, 5.9% (95% CI=4.8%, 6.9%) in 2012-2013 and 10.7% (95% CI=9.4%, 12.0%) in 2013-2014. Between 2012-2013 and 2013-2014, current use of smokeless tobacco remained steady for recent quitters (4.6% to 4.7%, p=0.92) and smokers with no quit attempt (4.0% to 4.3%, p=0.97), and decreased in smokers with an unsuccessful quit attempt (5.7% to 3.8%, p=0.004). More recent quitters completely switched to e-cigarettes in the past year (15.3% in 2012-2013, 25.7% in 2013-2014) than to smokeless tobacco (4.6% in 2012-2013, 4.5% in 2013-2014). CONCLUSIONS Current and recent former adult smokers are more likely to use e-cigarettes than smokeless tobacco. Current e-cigarette use was most prevalent among unsuccessful quitters and recent quitters, who were substantially more likely to report complete switching to e-cigarettes than smokeless tobacco.
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Affiliation(s)
- Gabriella M Anic
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland.
| | - Enver Holder-Hayes
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland
| | - Bridget K Ambrose
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland
| | - Brian L Rostron
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland
| | - Blair Coleman
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland
| | - Ahmed Jamal
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Benjamin J Apelberg
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland
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Coleman BN, Rostron B, Johnson SE, Ambrose BK, Pearson J, Stanton CA, Wang B, Delnevo C, Bansal-Travers M, Kimmel HL, Goniewicz ML, Niaura R, Abrams D, Conway KP, Borek N, Compton WM, Hyland A. Electronic cigarette use among US adults in the Population Assessment of Tobacco and Health (PATH) Study, 2013-2014. Tob Control 2017; 26:e117-e126. [PMID: 28624763 PMCID: PMC6693501 DOI: 10.1136/tobaccocontrol-2016-053462] [Citation(s) in RCA: 147] [Impact Index Per Article: 21.0] [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: 10/03/2016] [Revised: 04/18/2017] [Accepted: 04/24/2017] [Indexed: 11/03/2022]
Abstract
BACKGROUND Electronic cigarette (e-cigarette) use in the USA is increasing. As such, it is critical to understand who uses e-cigarettes, how e-cigarettes are used and what types of products are prevalent. This study assesses patterns of current e-cigarette use among daily and non-daily adult users in the 2013-2014 Population Assessment of Tobacco and Health (PATH) Study. METHODS We examined the proportion of current adult e-cigarette users (n=3642) reporting infrequent use (use on 'some days' and use on 0-2 of the past 30 days), moderate use (use on 'some days' and use on >2 of the past 30 days) and daily use. We examined demographic characteristics, use of other tobacco products and e-cigarette product characteristics overall and by use category. Adjusted prevalence ratios (aPRs) were calculated using Poisson regression to assess correlates of daily e-cigarette use. RESULTS Among the 5.5% of adult current e-cigarette users in the PATH Study, 42.2% reported infrequent use, 36.5% reported moderate use and 21.3% reported daily use. Cigarette smokers who quit in the past year were more likely to report daily e-cigarette use, compared with current smokers (aPR=3.21, 95% CI=2.75 to 3.76). Those who reported using rechargeable or refillable devices were more likely to report daily use compared with those who did not use these devices (aPR=1.95, 95% CI=1.44 to 2.65 and aPR=2.10, 95% CI=1.75 to 2.52, respectively). CONCLUSIONS The majority of e-cigarette users in this study reported less than daily use. Compared with non-daily use, daily use was associated with being a former smoker; however, cross-sectional data limits our ability to establish the temporality or directionality of such associations.
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Affiliation(s)
- Blair N Coleman
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Brian Rostron
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Sarah E Johnson
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Bridget K Ambrose
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Jennifer Pearson
- Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, District of Columbia, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Cassandra A Stanton
- Westat Inc, Rockville, Maryland, USA
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Baoguang Wang
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Cristine Delnevo
- Center for Tobacco Studies, School of Public Health, Rutgers University, New Brunswick, New Jersey, USA
| | | | - Heather L Kimmel
- National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, USA
| | | | - Raymond Niaura
- Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, District of Columbia, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - David Abrams
- Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, District of Columbia, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kevin P Conway
- National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, USA
| | - Nicolette Borek
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Wilson M Compton
- National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, USA
| | - Andrew Hyland
- Roswell Park Cancer Institute, Buffalo, New York, USA
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Villanti AC, Johnson AL, Ambrose BK, Cummings KM, Stanton CA, Rose SW, Feirman SP, Tworek C, Glasser AM, Pearson JL, Cohn AM, Conway KP, Niaura RS, Bansal-Travers M, Hyland A. Flavored Tobacco Product Use in Youth and Adults: Findings From the First Wave of the PATH Study (2013-2014). Am J Prev Med 2017; 53:139-151. [PMID: 28318902 PMCID: PMC5522636 DOI: 10.1016/j.amepre.2017.01.026] [Citation(s) in RCA: 243] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 12/05/2016] [Accepted: 01/12/2017] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The 2009 Family Smoking Prevention and Tobacco Control Act banned characterizing flavors other than menthol in cigarettes but did not restrict their use in other forms of tobacco (e.g., smokeless, cigars, hookah, e-cigarettes). METHODS A cross-sectional analysis of Wave 1 data from 45,971 U.S. adults and youth, aged ≥12 years in the Population Assessment of Tobacco and Health (PATH) Study collected in 2013-2014, was conducted in 2016. This study examined (1) the prevalence and reasons for use of flavored tobacco products; (2) the proportion of ever tobacco users reporting that their first product was flavored; and (3) correlates of current flavored tobacco product use. RESULTS Current flavored (including menthol) tobacco product use was highest in youth (80%, aged 12-17 years); and young adult tobacco users (73%, aged 18-24 years); and lowest in older adult tobacco users aged ≥65 years (29%). Flavor was a primary reason for using a given tobacco product, particularly among youth. Eighty-one percent of youth and 86% of young adult ever tobacco users reported that their first product was flavored versus 54% of adults aged ≥25 years. In multivariable models, reporting that one's first tobacco product was flavored was associated with a 13% higher prevalence of current tobacco use among youth ever tobacco users and a 32% higher prevalence of current tobacco use among adult ever users. CONCLUSIONS These results add to the evidence base that flavored tobacco products may attract young users and serve as starter products to regular tobacco use.
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Affiliation(s)
- Andrea C Villanti
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
| | - Amanda L Johnson
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia
| | - Bridget K Ambrose
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Cassandra A Stanton
- Westat, Rockville, Maryland; Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia
| | - Shyanika W Rose
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia
| | - Shari P Feirman
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia
| | - Cindy Tworek
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland
| | - Allison M Glasser
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia
| | - Jennifer L Pearson
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Amy M Cohn
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia; Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia
| | - Kevin P Conway
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Bethesda, Maryland
| | - Raymond S Niaura
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Maansi Bansal-Travers
- Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Cancer Institute, Buffalo, New York
| | - Andrew Hyland
- Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Cancer Institute, Buffalo, New York
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31
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Cheng YC, Rostron BL, Day HR, Stanton CA, Hull LC, Persoskie A, Travers MJ, Taylor K, Conway KP, Ambrose BK, Borek N. Patterns of Use of Smokeless Tobacco in US Adults, 2013-2014. Am J Public Health 2017; 107:1508-1514. [PMID: 28727534 DOI: 10.2105/ajph.2017.303921] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To examine patterns of smokeless tobacco (SLT) use, by type, in wave 1 (2013-2014) of the Population Assessment of Tobacco and Health Study in the United States. METHODS We analyzed data from 32 320 adults (aged ≥ 18 years) to assess the use of pouched snus and other SLT products (loose snus, moist snuff, dip, spit, and chewing tobacco). RESULTS Overall, SLT use was most common among men, younger adults, non-Hispanic Whites, and nonurban respondents. Pouched snus users were more likely to report nondaily and polytobacco use than users of other SLT products. Respondents who used SLT some days were more likely to be current established cigarette smokers than those who used SLT every day (57.9% vs 20.2%). Furthermore, current established smokers who used SLT some days were more likely to smoke every day and had a higher median number of cigarettes smoked per day than smokers who used SLT every day. CONCLUSIONS Polytobacco use, especially cigarette smoking, is common among SLT users. Pouched snus users are more likely to report nondaily snus use and polytobacco use than users of other SLT products.
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Affiliation(s)
- Yu-Ching Cheng
- Yu-Ching Cheng, Brian L. Rostron, Hannah R. Day, Lynn C. Hull, Alexander Persoskie, Bridget K. Ambrose, and Nicolette Borek are with the Office of Science, Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD. Cassandra A. Stanton and Kristie Taylor are with Westat Inc, Rockville, MD. Mark J. Travers is with Roswell Park Cancer Institute, Buffalo, NY. Kevin P. Conway is with National Institute on Drug Abuse, Bethesda, MD
| | - Brian L Rostron
- Yu-Ching Cheng, Brian L. Rostron, Hannah R. Day, Lynn C. Hull, Alexander Persoskie, Bridget K. Ambrose, and Nicolette Borek are with the Office of Science, Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD. Cassandra A. Stanton and Kristie Taylor are with Westat Inc, Rockville, MD. Mark J. Travers is with Roswell Park Cancer Institute, Buffalo, NY. Kevin P. Conway is with National Institute on Drug Abuse, Bethesda, MD
| | - Hannah R Day
- Yu-Ching Cheng, Brian L. Rostron, Hannah R. Day, Lynn C. Hull, Alexander Persoskie, Bridget K. Ambrose, and Nicolette Borek are with the Office of Science, Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD. Cassandra A. Stanton and Kristie Taylor are with Westat Inc, Rockville, MD. Mark J. Travers is with Roswell Park Cancer Institute, Buffalo, NY. Kevin P. Conway is with National Institute on Drug Abuse, Bethesda, MD
| | - Cassandra A Stanton
- Yu-Ching Cheng, Brian L. Rostron, Hannah R. Day, Lynn C. Hull, Alexander Persoskie, Bridget K. Ambrose, and Nicolette Borek are with the Office of Science, Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD. Cassandra A. Stanton and Kristie Taylor are with Westat Inc, Rockville, MD. Mark J. Travers is with Roswell Park Cancer Institute, Buffalo, NY. Kevin P. Conway is with National Institute on Drug Abuse, Bethesda, MD
| | - Lynn C Hull
- Yu-Ching Cheng, Brian L. Rostron, Hannah R. Day, Lynn C. Hull, Alexander Persoskie, Bridget K. Ambrose, and Nicolette Borek are with the Office of Science, Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD. Cassandra A. Stanton and Kristie Taylor are with Westat Inc, Rockville, MD. Mark J. Travers is with Roswell Park Cancer Institute, Buffalo, NY. Kevin P. Conway is with National Institute on Drug Abuse, Bethesda, MD
| | - Alexander Persoskie
- Yu-Ching Cheng, Brian L. Rostron, Hannah R. Day, Lynn C. Hull, Alexander Persoskie, Bridget K. Ambrose, and Nicolette Borek are with the Office of Science, Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD. Cassandra A. Stanton and Kristie Taylor are with Westat Inc, Rockville, MD. Mark J. Travers is with Roswell Park Cancer Institute, Buffalo, NY. Kevin P. Conway is with National Institute on Drug Abuse, Bethesda, MD
| | - Mark J Travers
- Yu-Ching Cheng, Brian L. Rostron, Hannah R. Day, Lynn C. Hull, Alexander Persoskie, Bridget K. Ambrose, and Nicolette Borek are with the Office of Science, Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD. Cassandra A. Stanton and Kristie Taylor are with Westat Inc, Rockville, MD. Mark J. Travers is with Roswell Park Cancer Institute, Buffalo, NY. Kevin P. Conway is with National Institute on Drug Abuse, Bethesda, MD
| | - Kristie Taylor
- Yu-Ching Cheng, Brian L. Rostron, Hannah R. Day, Lynn C. Hull, Alexander Persoskie, Bridget K. Ambrose, and Nicolette Borek are with the Office of Science, Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD. Cassandra A. Stanton and Kristie Taylor are with Westat Inc, Rockville, MD. Mark J. Travers is with Roswell Park Cancer Institute, Buffalo, NY. Kevin P. Conway is with National Institute on Drug Abuse, Bethesda, MD
| | - Kevin P Conway
- Yu-Ching Cheng, Brian L. Rostron, Hannah R. Day, Lynn C. Hull, Alexander Persoskie, Bridget K. Ambrose, and Nicolette Borek are with the Office of Science, Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD. Cassandra A. Stanton and Kristie Taylor are with Westat Inc, Rockville, MD. Mark J. Travers is with Roswell Park Cancer Institute, Buffalo, NY. Kevin P. Conway is with National Institute on Drug Abuse, Bethesda, MD
| | - Bridget K Ambrose
- Yu-Ching Cheng, Brian L. Rostron, Hannah R. Day, Lynn C. Hull, Alexander Persoskie, Bridget K. Ambrose, and Nicolette Borek are with the Office of Science, Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD. Cassandra A. Stanton and Kristie Taylor are with Westat Inc, Rockville, MD. Mark J. Travers is with Roswell Park Cancer Institute, Buffalo, NY. Kevin P. Conway is with National Institute on Drug Abuse, Bethesda, MD
| | - Nicolette Borek
- Yu-Ching Cheng, Brian L. Rostron, Hannah R. Day, Lynn C. Hull, Alexander Persoskie, Bridget K. Ambrose, and Nicolette Borek are with the Office of Science, Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD. Cassandra A. Stanton and Kristie Taylor are with Westat Inc, Rockville, MD. Mark J. Travers is with Roswell Park Cancer Institute, Buffalo, NY. Kevin P. Conway is with National Institute on Drug Abuse, Bethesda, MD
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32
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Kasza KA, Ambrose BK, Conway KP, Borek N, Taylor K, Goniewicz ML, Cummings KM, Sharma E, Pearson JL, Green VR, Kaufman AR, Bansal-Travers M, Travers MJ, Kwan J, Tworek C, Cheng YC, Yang L, Pharris-Ciurej N, van Bemmel DM, Backinger CL, Compton WM, Hyland AJ. Tobacco-Product Use by Adults and Youths in the United States in 2013 and 2014. N Engl J Med 2017; 376:342-353. [PMID: 28121512 PMCID: PMC5317035 DOI: 10.1056/nejmsa1607538] [Citation(s) in RCA: 493] [Impact Index Per Article: 70.4] [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] [Indexed: 01/01/2023]
Abstract
BACKGROUND Noncigarette tobacco products are evolving rapidly, with increasing popularity in the United States. METHODS We present prevalence estimates for 12 types of tobacco products, using data from 45,971 adult and youth participants (≥12 years of age) from Wave 1 (September 2013 through December 2014) of the Population Assessment of Tobacco and Health (PATH) Study, a large, nationally representative, longitudinal study of tobacco use and health in the United States. Participants were asked about their use of cigarettes, e-cigarettes, traditional cigars, cigarillos, filtered cigars, pipe tobacco, hookah, snus pouches, other smokeless tobacco, dissolvable tobacco, bidis, and kreteks. Estimates of the prevalence of use for each product were determined according to use category (e.g., current use or use in the previous 30 days) and demographic subgroup, and the prevalence of multiple-product use was explored. RESULTS More than a quarter (27.6%) of adults were current users of at least one type of tobacco product in 2013 and 2014, although the prevalence varied depending on use category. A total of 8.9% of youths had used a tobacco product in the previous 30 days; 1.6% of youths were daily users. Approximately 40% of tobacco users, adults and youths alike, used multiple tobacco products; cigarettes plus e-cigarettes was the most common combination. Young adults (18 to 24 years of age), male adults and youths, members of racial minorities, and members of sexual minorities generally had higher use of tobacco than their counterparts. CONCLUSIONS During this study, 28% of U.S. adults were current users of tobacco, and 9% of youths had used tobacco in the previous 30 days. Use of multiple products was common among tobacco users. These findings will serve as baseline data to examine between-person differences and within-person changes over time in the use of tobacco products. (Funded by the National Institute on Drug Abuse and the Food and Drug Administration.).
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Affiliation(s)
- Karin A Kasza
- From the Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY (K.A.K., M.L.G., M.B.-T., M.J.T., A.J.H.); the Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring (B.K.A., N.B., J.K., C.T., Y.-C.C., L.Y., N.P.-C., D.M.B., C.L.B.), National Institute on Drug Abuse (K.P.C., V.R.G., W.M.C.) and Division of Cancer Control and Population Sciences, National Cancer Institute (A.R.K.), National Institutes of Health, Bethesda, and Westat (K.T., E.S.) and Kelly Government Solutions (V.R.G.), Rockville - all in Maryland; the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston (K.M.C.); and the Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC (J.L.P.)
| | - Bridget K Ambrose
- From the Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY (K.A.K., M.L.G., M.B.-T., M.J.T., A.J.H.); the Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring (B.K.A., N.B., J.K., C.T., Y.-C.C., L.Y., N.P.-C., D.M.B., C.L.B.), National Institute on Drug Abuse (K.P.C., V.R.G., W.M.C.) and Division of Cancer Control and Population Sciences, National Cancer Institute (A.R.K.), National Institutes of Health, Bethesda, and Westat (K.T., E.S.) and Kelly Government Solutions (V.R.G.), Rockville - all in Maryland; the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston (K.M.C.); and the Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC (J.L.P.)
| | - Kevin P Conway
- From the Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY (K.A.K., M.L.G., M.B.-T., M.J.T., A.J.H.); the Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring (B.K.A., N.B., J.K., C.T., Y.-C.C., L.Y., N.P.-C., D.M.B., C.L.B.), National Institute on Drug Abuse (K.P.C., V.R.G., W.M.C.) and Division of Cancer Control and Population Sciences, National Cancer Institute (A.R.K.), National Institutes of Health, Bethesda, and Westat (K.T., E.S.) and Kelly Government Solutions (V.R.G.), Rockville - all in Maryland; the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston (K.M.C.); and the Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC (J.L.P.)
| | - Nicolette Borek
- From the Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY (K.A.K., M.L.G., M.B.-T., M.J.T., A.J.H.); the Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring (B.K.A., N.B., J.K., C.T., Y.-C.C., L.Y., N.P.-C., D.M.B., C.L.B.), National Institute on Drug Abuse (K.P.C., V.R.G., W.M.C.) and Division of Cancer Control and Population Sciences, National Cancer Institute (A.R.K.), National Institutes of Health, Bethesda, and Westat (K.T., E.S.) and Kelly Government Solutions (V.R.G.), Rockville - all in Maryland; the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston (K.M.C.); and the Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC (J.L.P.)
| | - Kristie Taylor
- From the Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY (K.A.K., M.L.G., M.B.-T., M.J.T., A.J.H.); the Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring (B.K.A., N.B., J.K., C.T., Y.-C.C., L.Y., N.P.-C., D.M.B., C.L.B.), National Institute on Drug Abuse (K.P.C., V.R.G., W.M.C.) and Division of Cancer Control and Population Sciences, National Cancer Institute (A.R.K.), National Institutes of Health, Bethesda, and Westat (K.T., E.S.) and Kelly Government Solutions (V.R.G.), Rockville - all in Maryland; the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston (K.M.C.); and the Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC (J.L.P.)
| | - Maciej L Goniewicz
- From the Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY (K.A.K., M.L.G., M.B.-T., M.J.T., A.J.H.); the Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring (B.K.A., N.B., J.K., C.T., Y.-C.C., L.Y., N.P.-C., D.M.B., C.L.B.), National Institute on Drug Abuse (K.P.C., V.R.G., W.M.C.) and Division of Cancer Control and Population Sciences, National Cancer Institute (A.R.K.), National Institutes of Health, Bethesda, and Westat (K.T., E.S.) and Kelly Government Solutions (V.R.G.), Rockville - all in Maryland; the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston (K.M.C.); and the Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC (J.L.P.)
| | - K Michael Cummings
- From the Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY (K.A.K., M.L.G., M.B.-T., M.J.T., A.J.H.); the Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring (B.K.A., N.B., J.K., C.T., Y.-C.C., L.Y., N.P.-C., D.M.B., C.L.B.), National Institute on Drug Abuse (K.P.C., V.R.G., W.M.C.) and Division of Cancer Control and Population Sciences, National Cancer Institute (A.R.K.), National Institutes of Health, Bethesda, and Westat (K.T., E.S.) and Kelly Government Solutions (V.R.G.), Rockville - all in Maryland; the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston (K.M.C.); and the Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC (J.L.P.)
| | - Eva Sharma
- From the Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY (K.A.K., M.L.G., M.B.-T., M.J.T., A.J.H.); the Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring (B.K.A., N.B., J.K., C.T., Y.-C.C., L.Y., N.P.-C., D.M.B., C.L.B.), National Institute on Drug Abuse (K.P.C., V.R.G., W.M.C.) and Division of Cancer Control and Population Sciences, National Cancer Institute (A.R.K.), National Institutes of Health, Bethesda, and Westat (K.T., E.S.) and Kelly Government Solutions (V.R.G.), Rockville - all in Maryland; the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston (K.M.C.); and the Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC (J.L.P.)
| | - Jennifer L Pearson
- From the Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY (K.A.K., M.L.G., M.B.-T., M.J.T., A.J.H.); the Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring (B.K.A., N.B., J.K., C.T., Y.-C.C., L.Y., N.P.-C., D.M.B., C.L.B.), National Institute on Drug Abuse (K.P.C., V.R.G., W.M.C.) and Division of Cancer Control and Population Sciences, National Cancer Institute (A.R.K.), National Institutes of Health, Bethesda, and Westat (K.T., E.S.) and Kelly Government Solutions (V.R.G.), Rockville - all in Maryland; the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston (K.M.C.); and the Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC (J.L.P.)
| | - Victoria R Green
- From the Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY (K.A.K., M.L.G., M.B.-T., M.J.T., A.J.H.); the Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring (B.K.A., N.B., J.K., C.T., Y.-C.C., L.Y., N.P.-C., D.M.B., C.L.B.), National Institute on Drug Abuse (K.P.C., V.R.G., W.M.C.) and Division of Cancer Control and Population Sciences, National Cancer Institute (A.R.K.), National Institutes of Health, Bethesda, and Westat (K.T., E.S.) and Kelly Government Solutions (V.R.G.), Rockville - all in Maryland; the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston (K.M.C.); and the Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC (J.L.P.)
| | - Annette R Kaufman
- From the Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY (K.A.K., M.L.G., M.B.-T., M.J.T., A.J.H.); the Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring (B.K.A., N.B., J.K., C.T., Y.-C.C., L.Y., N.P.-C., D.M.B., C.L.B.), National Institute on Drug Abuse (K.P.C., V.R.G., W.M.C.) and Division of Cancer Control and Population Sciences, National Cancer Institute (A.R.K.), National Institutes of Health, Bethesda, and Westat (K.T., E.S.) and Kelly Government Solutions (V.R.G.), Rockville - all in Maryland; the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston (K.M.C.); and the Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC (J.L.P.)
| | - Maansi Bansal-Travers
- From the Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY (K.A.K., M.L.G., M.B.-T., M.J.T., A.J.H.); the Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring (B.K.A., N.B., J.K., C.T., Y.-C.C., L.Y., N.P.-C., D.M.B., C.L.B.), National Institute on Drug Abuse (K.P.C., V.R.G., W.M.C.) and Division of Cancer Control and Population Sciences, National Cancer Institute (A.R.K.), National Institutes of Health, Bethesda, and Westat (K.T., E.S.) and Kelly Government Solutions (V.R.G.), Rockville - all in Maryland; the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston (K.M.C.); and the Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC (J.L.P.)
| | - Mark J Travers
- From the Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY (K.A.K., M.L.G., M.B.-T., M.J.T., A.J.H.); the Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring (B.K.A., N.B., J.K., C.T., Y.-C.C., L.Y., N.P.-C., D.M.B., C.L.B.), National Institute on Drug Abuse (K.P.C., V.R.G., W.M.C.) and Division of Cancer Control and Population Sciences, National Cancer Institute (A.R.K.), National Institutes of Health, Bethesda, and Westat (K.T., E.S.) and Kelly Government Solutions (V.R.G.), Rockville - all in Maryland; the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston (K.M.C.); and the Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC (J.L.P.)
| | - Jonathan Kwan
- From the Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY (K.A.K., M.L.G., M.B.-T., M.J.T., A.J.H.); the Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring (B.K.A., N.B., J.K., C.T., Y.-C.C., L.Y., N.P.-C., D.M.B., C.L.B.), National Institute on Drug Abuse (K.P.C., V.R.G., W.M.C.) and Division of Cancer Control and Population Sciences, National Cancer Institute (A.R.K.), National Institutes of Health, Bethesda, and Westat (K.T., E.S.) and Kelly Government Solutions (V.R.G.), Rockville - all in Maryland; the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston (K.M.C.); and the Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC (J.L.P.)
| | - Cindy Tworek
- From the Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY (K.A.K., M.L.G., M.B.-T., M.J.T., A.J.H.); the Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring (B.K.A., N.B., J.K., C.T., Y.-C.C., L.Y., N.P.-C., D.M.B., C.L.B.), National Institute on Drug Abuse (K.P.C., V.R.G., W.M.C.) and Division of Cancer Control and Population Sciences, National Cancer Institute (A.R.K.), National Institutes of Health, Bethesda, and Westat (K.T., E.S.) and Kelly Government Solutions (V.R.G.), Rockville - all in Maryland; the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston (K.M.C.); and the Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC (J.L.P.)
| | - Yu-Ching Cheng
- From the Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY (K.A.K., M.L.G., M.B.-T., M.J.T., A.J.H.); the Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring (B.K.A., N.B., J.K., C.T., Y.-C.C., L.Y., N.P.-C., D.M.B., C.L.B.), National Institute on Drug Abuse (K.P.C., V.R.G., W.M.C.) and Division of Cancer Control and Population Sciences, National Cancer Institute (A.R.K.), National Institutes of Health, Bethesda, and Westat (K.T., E.S.) and Kelly Government Solutions (V.R.G.), Rockville - all in Maryland; the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston (K.M.C.); and the Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC (J.L.P.)
| | - Ling Yang
- From the Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY (K.A.K., M.L.G., M.B.-T., M.J.T., A.J.H.); the Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring (B.K.A., N.B., J.K., C.T., Y.-C.C., L.Y., N.P.-C., D.M.B., C.L.B.), National Institute on Drug Abuse (K.P.C., V.R.G., W.M.C.) and Division of Cancer Control and Population Sciences, National Cancer Institute (A.R.K.), National Institutes of Health, Bethesda, and Westat (K.T., E.S.) and Kelly Government Solutions (V.R.G.), Rockville - all in Maryland; the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston (K.M.C.); and the Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC (J.L.P.)
| | - Nikolas Pharris-Ciurej
- From the Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY (K.A.K., M.L.G., M.B.-T., M.J.T., A.J.H.); the Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring (B.K.A., N.B., J.K., C.T., Y.-C.C., L.Y., N.P.-C., D.M.B., C.L.B.), National Institute on Drug Abuse (K.P.C., V.R.G., W.M.C.) and Division of Cancer Control and Population Sciences, National Cancer Institute (A.R.K.), National Institutes of Health, Bethesda, and Westat (K.T., E.S.) and Kelly Government Solutions (V.R.G.), Rockville - all in Maryland; the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston (K.M.C.); and the Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC (J.L.P.)
| | - Dana M van Bemmel
- From the Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY (K.A.K., M.L.G., M.B.-T., M.J.T., A.J.H.); the Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring (B.K.A., N.B., J.K., C.T., Y.-C.C., L.Y., N.P.-C., D.M.B., C.L.B.), National Institute on Drug Abuse (K.P.C., V.R.G., W.M.C.) and Division of Cancer Control and Population Sciences, National Cancer Institute (A.R.K.), National Institutes of Health, Bethesda, and Westat (K.T., E.S.) and Kelly Government Solutions (V.R.G.), Rockville - all in Maryland; the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston (K.M.C.); and the Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC (J.L.P.)
| | - Cathy L Backinger
- From the Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY (K.A.K., M.L.G., M.B.-T., M.J.T., A.J.H.); the Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring (B.K.A., N.B., J.K., C.T., Y.-C.C., L.Y., N.P.-C., D.M.B., C.L.B.), National Institute on Drug Abuse (K.P.C., V.R.G., W.M.C.) and Division of Cancer Control and Population Sciences, National Cancer Institute (A.R.K.), National Institutes of Health, Bethesda, and Westat (K.T., E.S.) and Kelly Government Solutions (V.R.G.), Rockville - all in Maryland; the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston (K.M.C.); and the Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC (J.L.P.)
| | - Wilson M Compton
- From the Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY (K.A.K., M.L.G., M.B.-T., M.J.T., A.J.H.); the Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring (B.K.A., N.B., J.K., C.T., Y.-C.C., L.Y., N.P.-C., D.M.B., C.L.B.), National Institute on Drug Abuse (K.P.C., V.R.G., W.M.C.) and Division of Cancer Control and Population Sciences, National Cancer Institute (A.R.K.), National Institutes of Health, Bethesda, and Westat (K.T., E.S.) and Kelly Government Solutions (V.R.G.), Rockville - all in Maryland; the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston (K.M.C.); and the Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC (J.L.P.)
| | - Andrew J Hyland
- From the Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY (K.A.K., M.L.G., M.B.-T., M.J.T., A.J.H.); the Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring (B.K.A., N.B., J.K., C.T., Y.-C.C., L.Y., N.P.-C., D.M.B., C.L.B.), National Institute on Drug Abuse (K.P.C., V.R.G., W.M.C.) and Division of Cancer Control and Population Sciences, National Cancer Institute (A.R.K.), National Institutes of Health, Bethesda, and Westat (K.T., E.S.) and Kelly Government Solutions (V.R.G.), Rockville - all in Maryland; the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston (K.M.C.); and the Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC (J.L.P.)
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Bonhomme MG, Holder-Hayes E, Ambrose BK, Tworek C, Feirman SP, King BA, Apelberg BJ. Flavoured non-cigarette tobacco product use among US adults: 2013-2014. Tob Control 2016; 25:ii4-ii13. [PMID: 27794065 PMCID: PMC5515238 DOI: 10.1136/tobaccocontrol-2016-053373] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [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: 08/10/2016] [Revised: 10/03/2016] [Accepted: 10/04/2016] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Limited data exist on flavoured non-cigarette tobacco product (NCTP) use among US adults. METHODS Data from the 2013 to 2014 National Adult Tobacco Survey (N=75 233), a landline and cellular telephone survey of US adults aged ≥18, were assessed to estimate past 30-day NCTP use, flavoured NCTP use and flavour types using bivariate analyses. RESULTS During 2013-2014, 14.4% of US adults were past 30-day NCTP users. Nationally, an estimated 10.2 million e-cigarette users (68.2%), 6.1 million hookah users (82.3%), 4.1 million cigar smokers (36.2%) and 4.0 million smokeless tobacco users (50.6%) used flavoured products in the past 30 days. The most prevalent flavours reported were menthol/mint (76.9%) for smokeless tobacco; fruit (74.0%) for hookah; fruit (52.4%), candy/chocolate/other sweet flavours (22.0%) and alcohol (14.5%) for cigars/cigarillos/filtered little cigars; fruit (44.9%), menthol/mint (43.9%) and candy/chocolate/other sweet flavours (25.7%) for e-cigarettes and fruit (56.6%), candy/chocolate/other sweet flavours (26.5%) and menthol/mint (24.8%) for pipes. Except for hookah and pipes, past 30-day flavoured product use was highest among 18-24-year olds. By cigarette smoking, never smoking e-cigarette users (84.8%) were more likely to report flavoured e-cigarette use, followed by recent former smokers (78.1%), long-term former smokers (70.4%) and current smokers (63.2%). CONCLUSIONS Flavoured NCTP use is prominent among US adult tobacco users, particularly among e-cigarette, hookah and cigar users. Flavoured product use, especially fruit and sweet-flavoured products, was higher among younger adults. It is important for tobacco prevention and control strategies to address all forms of tobacco use, including flavoured tobacco products.
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Affiliation(s)
- Michèle G Bonhomme
- Food and Drug Administration, Center for Tobacco Products, Office of Science, Silver Spring, Maryland, USA
| | - Enver Holder-Hayes
- Food and Drug Administration, Center for Tobacco Products, Office of Science, Silver Spring, Maryland, USA
| | - Bridget K Ambrose
- Food and Drug Administration, Center for Tobacco Products, Office of Science, Silver Spring, Maryland, USA
| | - Cindy Tworek
- Food and Drug Administration, Center for Tobacco Products, Office of Science, Silver Spring, Maryland, USA
| | - Shari P Feirman
- Food and Drug Administration, Center for Tobacco Products, Office of Science, Silver Spring, Maryland, USA
| | - Brian A King
- Centers for Disease Control and Prevention, Office on Smoking and Health, Atlanta, Georgia, USA
| | - Benjamin J Apelberg
- Food and Drug Administration, Center for Tobacco Products, Office of Science, Silver Spring, Maryland, USA
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Rostron BL, Schroeder MJ, Ambrose BK. Dependence symptoms and cessation intentions among US adult daily cigarette, cigar, and e-cigarette users, 2012-2013. BMC Public Health 2016; 16:814. [PMID: 27538489 PMCID: PMC4989515 DOI: 10.1186/s12889-016-3510-2] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 08/13/2016] [Indexed: 01/22/2023] Open
Abstract
Background Cigar and e-cigarette use is becoming increasingly common among US tobacco users and the Food and Drug Administration recently asserted regulatory jurisdiction over these products, among others, in May 2016. Research on tobacco dependence among users of these products is limited, however. We therefore examined several symptoms of dependence and cessation intentions among adult cigarette, cigar, and/or e-cigarette users in a nationally representative sample. Methods We used nationally representative data from more than 60,000 participants in the US National Adult Tobacco Survey (NATS) from 2012 to 2013 to analyze dependence symptoms and cessation intentions for users of cigarettes, cigars, and/or e-cigarettes but not other tobacco products. Results Among daily tobacco users, dual cigarette and cigar users on average smoked more cigarettes per day (17.3, 95 % CI = 16.1, 18.6 vs. 15.8, 95 % CI = 15.4, 16.2), had shorter times to first tobacco use after waking (21.4 min, 95 % CI = 16.6, 24.9 vs. 25.9 min, 95 % CI = 25.3, 26.5), and were more likely to report withdrawal and craving symptoms than exclusive cigarette smokers. Dual cigarette and e-cigarette users were more likely than exclusive cigarette smokers to report withdrawal and craving symptoms and cessation intentions. Exclusive cigar and e-cigarette users were less likely to report withdrawal and craving symptoms than users of other products, but even so, more than a third of exclusive cigar (38.8 %, 95 % CI = 27.4 %, 51.6 %) and e-cigarette (46.1 %, 95 % CI = 35.1 %, 57.4 %) users reported experiencing a strong craving for a tobacco product in the past 30 days. Conclusions Dual cigarette and cigar users show evidence of greater dependence symptoms and dual cigarette and e-cigarette users show evidence of greater dependence symptoms and cessation intentions compared with exclusive cigarette smokers. A sizeable number of users of all of the tobacco products report dependence symptoms such as craving for tobacco.
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Affiliation(s)
- Brian L Rostron
- Center for Tobacco Products, Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD, 20993, USA.
| | - Megan J Schroeder
- Center for Tobacco Products, Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD, 20993, USA
| | - Bridget K Ambrose
- Center for Tobacco Products, Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD, 20993, USA
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Hyland A, Ambrose BK, Conway KP, Borek N, Lambert E, Carusi C, Taylor K, Crosse S, Fong GT, Cummings KM, Abrams D, Pierce JP, Sargent J, Messer K, Bansal-Travers M, Niaura R, Vallone D, Hammond D, Hilmi N, Kwan J, Piesse A, Kalton G, Lohr S, Pharris-Ciurej N, Castleman V, Green VR, Tessman G, Kaufman A, Lawrence C, van Bemmel DM, Kimmel HL, Blount B, Yang L, O'Brien B, Tworek C, Alberding D, Hull LC, Cheng YC, Maklan D, Backinger CL, Compton WM. Design and methods of the Population Assessment of Tobacco and Health (PATH) Study. Tob Control 2016; 26:371-378. [PMID: 27507901 DOI: 10.1136/tobaccocontrol-2016-052934] [Citation(s) in RCA: 597] [Impact Index Per Article: 74.6] [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: 01/12/2016] [Revised: 07/14/2016] [Accepted: 07/15/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND This paper describes the methods and conceptual framework for Wave 1 of the Population Assessment of Tobacco and Health (PATH) Study data collection. The National Institutes of Health, through the National Institute on Drug Abuse, is partnering with the Food and Drug Administration's (FDA) Center for Tobacco Products to conduct the PATH Study under a contract with Westat. METHODS The PATH Study is a nationally representative, longitudinal cohort study of 45 971 adults and youth in the USA, aged 12 years and older. Wave 1 was conducted from 12 September 2013 to 15 December 2014 using Audio Computer-Assisted Self-Interviewing to collect information on tobacco-use patterns, risk perceptions and attitudes towards current and newly emerging tobacco products, tobacco initiation, cessation, relapse behaviours and health outcomes. The PATH Study's design allows for the longitudinal assessment of patterns of use of a spectrum of tobacco products, including initiation, cessation, relapse and transitions between products, as well as factors associated with use patterns. Additionally, the PATH Study collects biospecimens from consenting adults aged 18 years and older and measures biomarkers of exposure and potential harm related to tobacco use. CONCLUSIONS The cumulative, population-based data generated over time by the PATH Study will contribute to the evidence base to inform FDA's regulatory mission under the Family Smoking Prevention and Tobacco Control Act and efforts to reduce the Nation's burden of tobacco-related death and disease.
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Affiliation(s)
- Andrew Hyland
- Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Bridget K Ambrose
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Kevin P Conway
- National Institute on Drug Abuse, National Institutes of Health, US Department of Health and Human Services, Bethesda, Maryland, USA
| | - Nicolette Borek
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Elizabeth Lambert
- National Institute on Drug Abuse, National Institutes of Health, US Department of Health and Human Services, Bethesda, Maryland, USA
| | | | | | | | - Geoffrey T Fong
- University of Waterloo, Waterloo, Ontario, USA.,University of Waterloo, Waterloo, Ontario, USA
| | | | - David Abrams
- Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, District of Columbia, USA; The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - John P Pierce
- University of California at San Diego, San Diego, California, USA
| | | | - Karen Messer
- University of California at San Diego, San Diego, California, USA
| | | | - Ray Niaura
- Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, District of Columbia, USA; The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Donna Vallone
- Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, District of Columbia, USA; The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - David Hammond
- Ontario Institute for Cancer Research, Toronto, Ontario, USA
| | - Nahla Hilmi
- National Institute on Drug Abuse, National Institutes of Health, US Department of Health and Human Services, Bethesda, Maryland, USA
| | - Jonathan Kwan
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland, USA
| | | | | | | | - Nick Pharris-Ciurej
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland, USA
| | | | - Victoria R Green
- National Institute on Drug Abuse, National Institutes of Health, US Department of Health and Human Services, Bethesda, Maryland, USA.,Kelly Government Solutions, Rockville, Maryland, USA
| | - Greta Tessman
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Annette Kaufman
- National Cancer Institute, National Institutes of Health, US Department of Health and Human Services, Bethesda, Maryland, USA
| | | | - Dana M van Bemmel
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Heather L Kimmel
- National Institute on Drug Abuse, National Institutes of Health, US Department of Health and Human Services, Bethesda, Maryland, USA
| | - Ben Blount
- CDC National Center for Environmental Health, US Department of Health and Human Services, Atlanta, Georgia, USA
| | - Ling Yang
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland, USA
| | | | - Cindy Tworek
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Derek Alberding
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Lynn C Hull
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Yu-Ching Cheng
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland, USA
| | | | - Cathy L Backinger
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Wilson M Compton
- National Institute on Drug Abuse, National Institutes of Health, US Department of Health and Human Services, Bethesda, Maryland, USA
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Affiliation(s)
- Bridget K Ambrose
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland
| | - Hannah R Day
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland
| | - Brian Rostron
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland
| | - Kevin P Conway
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Bethesda, Maryland
| | - Nicolette Borek
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland
| | - Andrew Hyland
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York
| | - Andrea C Villanti
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC
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Corey CG, Ambrose BK, Apelberg BJ, King BA. Flavored Tobacco Product Use Among Middle and High School Students--United States, 2014. MMWR Morb Mortal Wkly Rep 2015; 64:1066-70. [PMID: 26421418 DOI: 10.15585/mmwr.mm6438a2] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The 2009 Family Smoking Prevention and Tobacco Control Act prohibits "characterizing flavors" (e.g., candy, fruit, and chocolate) other than tobacco and menthol in cigarettes; however, characterizing flavors are not currently prohibited in other tobacco products. Analyses of retail sales data suggest that U.S. consumption of flavored noncigarette tobacco products, including flavored cigars and flavored e-cigarettes, has increased in recent years. There is growing concern that widely marketed varieties of new and existing flavored tobacco products might appeal to youths (2) and could be contributing to recent increases in the use of tobacco products, including e-cigarettes and hookah, among youths. CDC and the Food and Drug Administration (FDA) analyzed data from the 2014 National Youth Tobacco Survey (NYTS) to determine the prevalence of past 30 day use (current use) of flavored e-cigarette, hookah tobacco, cigar, pipe tobacco or smokeless tobacco products, and menthol cigarettes among middle and high school students, and the proportion of current tobacco product users who have used flavored products. An estimated 70.0% (3.26 million) of all current youth tobacco users had used at least one flavored tobacco product in the past 30 days. Among current users, 63.3%, (1.58 million) had used a flavored e-cigarette, 60.6%, (1.02 million) had used flavored hookah tobacco, and 63.5% (910,000) had used a flavored cigar in the past 30 days. Given the millions of current youth tobacco users, it is important for comprehensive tobacco prevention and control strategies to address all forms of tobacco use, including flavored tobacco products, among U.S. youths.
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Coleman BN, Apelberg BJ, Ambrose BK, Green KM, Choiniere CJ, Bunnell R, King BA. Association between electronic cigarette use and openness to cigarette smoking among US young adults. Nicotine Tob Res 2015; 17:212-8. [PMID: 25378683 PMCID: PMC4892708 DOI: 10.1093/ntr/ntu211] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 09/29/2014] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Use of electronic nicotine delivery systems (ENDS), including electronic cigarettes (e-cigarettes), is increasing. One concern is the appeal of these products to youth and young adults and the potential to influence perceptions and use of conventional cigarettes. METHODS Using data from the 2012-2013 National Adult Tobacco Survey, characteristics of adults aged 18-29 years who had never established cigarette smoking behavior were examined by ever use of e-cigarettes, demographics, and ever use of other tobacco products (smokeless tobacco, cigars, hookah, and cigarettes). Multivariate logistic regression was used to examine the relationship between e-cigarette use and openness to cigarette smoking among young adults, defined as the lack of a firm intention not to smoke soon or in the next year. RESULTS Among young adults who had never established cigarette smoking behavior (unweighted n = 4,310), 7.9% reported having ever tried e-cigarettes, and 14.6% of those who reported having ever tried e-cigarettes also reported current use of the product. Ever e-cigarette use was associated with being open to cigarette smoking (adjusted odds ratio = 2.4; 95% confidence interval = 1.7, 3.3), as was being male, aged 18-24 years, less educated, and having ever used hookah or experimented with conventional cigarettes. CONCLUSIONS Ever use of e-cigarettes and other tobacco products was associated with being open to cigarette smoking. This study does not allow us to assess the directionality of this association, so future longitudinal research is needed to illuminate tobacco use behaviors over time as well as provide additional insight on the relationship between ENDS use and conventional cigarette use among young adult populations.
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Affiliation(s)
- Blair N Coleman
- Office of Science, Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD; Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD;
| | - Benjamin J Apelberg
- Office of Science, Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD
| | - Bridget K Ambrose
- Office of Science, Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD
| | - Kerry M Green
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD
| | - Conrad J Choiniere
- Office of Science, Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD
| | - Rebecca Bunnell
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Brian A King
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
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Giovenco DP, Hammond D, Corey CG, Ambrose BK, Delnevo CD. E-Cigarette Market Trends in Traditional U.S. Retail Channels, 2012-2013. Nicotine Tob Res 2014; 17:1279-83. [PMID: 25542918 DOI: 10.1093/ntr/ntu282] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 12/11/2014] [Indexed: 11/13/2022]
Abstract
INTRODUCTION E-cigarette sales continue to increase in the United States. To date, little surveillance research has documented the specific product attributes driving growth. This study uses national market scanner data to describe sales trends in traditional U.S. tobacco retail channels between 2012 and 2013 and identifies product features associated with sales increases. METHODS Data on e-cigarette sales in convenience stores, drug stores, grocery stores, and mass merchandisers in the United States were obtained from the Nielsen Company. Each product was coded for attributes such as brand, flavor, and unit size. Total sales volume, market share, and percent growth were calculated for various product attributes. RESULTS E-cigarette sales more than doubled between 2012 and 2013, from $273.6 million to $636.2 million, respectively. Growth was particularly strong in the convenience store channel. Blu eCigs quickly emerged as the best-selling brand and in 2013 constituted nearly half (44.1%) of overall sales. Although fruit-flavored and other flavored products experienced marked growth, unflavored and menthol e-cigarettes overwhelmingly dominated the market. Sales of single unit products (likely disposable e-cigarettes) increased by 216.4%, a much faster rate than multi-unit packs and cartridge refills. CONCLUSIONS In traditional U.S. retail channels, particularly the convenience store channel, sales of e-cigarettes continue to grow, with brands like blu and disposable products as the likely drivers. Given the rapidly-changing market, expanded surveillance is needed to monitor sales not only in traditional retail locations, but sales online and in specialty "vape shops," as well.
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Affiliation(s)
- Daniel P Giovenco
- Center for Tobacco Studies, Rutgers University-School of Public Health, New Brunswick, NJ;
| | - David Hammond
- Department of Health Studies, University of Waterloo-School of Public Health and Health Systems, Waterloo, ON, Canada
| | - Catherine G Corey
- Center for Tobacco Products, U.S. Food and Drug Administration; Silver Spring, MD
| | - Bridget K Ambrose
- Center for Tobacco Products, U.S. Food and Drug Administration; Silver Spring, MD
| | - Cristine D Delnevo
- Center for Tobacco Studies, Rutgers University-School of Public Health, New Brunswick, NJ
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Corey CG, King BA, Coleman BN, Delnevo CD, Husten CG, Ambrose BK, Apelberg BJ. Little filtered cigar, cigarillo, and premium cigar smoking among adults--United States, 2012-2013. MMWR Morb Mortal Wkly Rep 2014; 63:650-4. [PMID: 25078654 PMCID: PMC4584787] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The burden of death and disease from tobacco use in the United States has been caused overwhelmingly by cigarettes and other smoked tobacco products. In the United States, cigarette consumption declined during 2000-2011; however, consumption of cigars more than doubled during the same period. The cigar market includes diverse product types manufactured with a variety of shapes and sizes, filters, tips, flavors, and prices. Although national estimates of cigar consumption have been reported previously, data characterizing who smokes different cigar types are limited. A recent analysis from the 2012-2013 National Adult Tobacco Survey (NATS) found that more than one in 20 U.S. adults smoke cigars "every day," "someday," or "rarely". This report expands upon those findings, using data from the 2012-2013 NATS to further characterize cigar smokers by the usual type of cigar smoked using the following categories: little filtered cigars (LFCs), cigarillos/other mass market cigars (cigarillos/MMCs), and premium cigars. The findings indicate that among U.S. adults who smoke cigars, 61.8% usually smoke cigarillos/MMCs, 19.9% usually smoke premium cigars, and the remainder, 18.4%, usually smoke LFCs. These data can help to inform public health interventions to reduce the burden of adverse health effects caused by cigar smoking in the United States, including regulation.
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Affiliation(s)
| | - Brian A. King
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
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Corey CG, Dube SR, Ambrose BK, King BA, Apelberg BJ, Husten CG. Cigar smoking among U.S. students: reported use after adding brands to survey items. Am J Prev Med 2014; 47:S28-35. [PMID: 25044193 PMCID: PMC4521384 DOI: 10.1016/j.amepre.2014.05.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 05/01/2014] [Accepted: 05/02/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Among U.S. youth overall, cigars are the most commonly used tobacco product after cigarettes. However, youth who identify their products by brand names, not general terms like "cigar," may underreport use. PURPOSE To examine changes in reported cigar (cigar, cigarillo, or little cigar) smoking among students following inclusion of cigar brand examples on the National Youth Tobacco Survey (NYTS). METHODS Data from the 2011 and 2012 NYTS and National Survey on Drug Use and Health (NSDUH) were analyzed in 2013 to estimate ever and current cigar smoking, overall and by race/ethnicity. The 2012 NYTS included cigar brand examples (Black and Mild, Swisher Sweets, Dutch Masters, White Owl, Phillies Blunt) in the survey instructions and ever use question, but the 2011 NYTS and 2011 and 2012 NSDUH did not. RESULTS NYTS ever cigar smoking was higher in 2012 (27.8%) than 2011 (19.5%) among black students overall. Current cigar smoking was 60%-70% higher among black females and students aged ≥ 17 years, in 2012 than 2011. For black females, current cigar smoking (11.5%) was two times greater than that of white females (4.3%) in 2012, whereas the prevalence among these subgroups was comparable in 2011. Similar changes were not observed among these subgroups in the 2011-2012 NSDUH. CONCLUSIONS This study highlights the high burden of cigar use among U.S. youth and suggests that NYTS ascertainment of cigar smoking may have improved by including brands. Disparities in cigar smoking need to be addressed to prevent and reduce all youth tobacco use.
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Affiliation(s)
- Catherine G Corey
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Rockville, Maryland.
| | - Shanta R Dube
- Division of Epidemiology and Biostatistics, School of Public Health, Georgia State University, Atlanta, Georgia
| | - Bridget K Ambrose
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Rockville, Maryland
| | - Brian A King
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Benjamin J Apelberg
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Rockville, Maryland
| | - Corinne G Husten
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Rockville, Maryland
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Soneji S, Ambrose BK, Lee W, Sargent J, Tanski S. Direct-to-consumer tobacco marketing and its association with tobacco use among adolescents and young adults. J Adolesc Health 2014; 55:209-15. [PMID: 24661738 PMCID: PMC4241586 DOI: 10.1016/j.jadohealth.2014.01.019] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [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: 09/19/2013] [Revised: 01/24/2014] [Accepted: 01/24/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE We assess exposure to direct-to-consumer tobacco marketing and its association with ever having tried smoking, smoking within past 30 days (current), and smoking ≥100 cigarettes in lifetime (established) among adolescents and young adults. METHODS We surveyed a U.S. telephone sample of 3,342 15- to 23-year-olds and 2,541 respondents subsequently completed a web-based survey. Among respondents completing both the telephone and web-based surveys (N = 2,541 [75%]), we assessed their exposure to direct-to-consumer tobacco marketing (receiving direct mail from tobacco companies and seeing tobacco company websites) and their associations with ever having tried smoking, current smoking, and established smoking. RESULTS Overall, 12% of 15- to 17-year-olds and 26% of 18- to 23-year-olds were exposed to direct-to-consumer tobacco marketing. Racial/ethnic minority nonsmoking respondents were more likely to see tobacco websites than nonsmoking whites. Respondents exposed to either form of direct-to-consumer tobacco marketing were more likely to currently smoke (adjusted odds ratio 2.2, 95% confidence interval 1.3-3.8), while those exposed to both forms of marketing experienced even higher odds of currently smoking (adjusted odds ratio 2.7, 95% confidence interval 1.1-6.6). We observed similar relationships for ever having tried smoking and established smoking. CONCLUSIONS Direct-to-consumer tobacco marketing reaches adolescent and young adult nonsmokers and is associated with smoking behavior.
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Affiliation(s)
- Samir Soneji
- Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
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Agaku IT, King BA, Husten CG, Bunnell R, Ambrose BK, Hu SS, Holder-Hayes E, Day HR. Tobacco product use among adults--United States, 2012-2013. MMWR Morb Mortal Wkly Rep 2014; 63:542-7. [PMID: 24964880 PMCID: PMC5779380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Despite significant declines in cigarette smoking among U.S. adults over the past five decades, progress has slowed in recent years, and the prevalence of use of other tobacco products such as cigars and smokeless tobacco has not changed. Additionally, the prevalence of use of emerging products, including electronic cigarettes (e-cigarettes), has rapidly increased. This report provides the most recent national estimates of tobacco use among adults aged ≥18 years, using data from the 2012-2013 National Adult Tobacco Survey (NATS). The findings indicate that 21.3% of U.S. adults used a tobacco product every day or some days, and 25.2% used a tobacco product every day, some days, or rarely. Population-level interventions focused on the diversity of tobacco product use, including tobacco price increases, high-impact antitobacco mass media campaigns, comprehensive smoke-free laws, and enhanced access to help quitting, in conjunction with Food and Drug Administration (FDA) regulation of tobacco products, are critical to reducing tobacco-related diseases and deaths in the United States.
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Affiliation(s)
- Israel T. Agaku
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC,EIS officer, CDC
| | - Brian A. King
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC,Corresponding author: Brian King, , 770-488-5107
| | | | - Rebecca Bunnell
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | | | - S. Sean Hu
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | | | - Hannah R. Day
- Center for Tobacco Products, Food and Drug Administration
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Delnevo CD, Giovenco DP, Ambrose BK, Corey CG, Conway KP. Preference for flavoured cigar brands among youth, young adults and adults in the USA. Tob Control 2014; 24:389-94. [PMID: 24721967 DOI: 10.1136/tobaccocontrol-2013-051408] [Citation(s) in RCA: 142] [Impact Index Per Article: 14.2] [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: 10/25/2013] [Accepted: 03/20/2014] [Indexed: 11/04/2022]
Abstract
BACKGROUND While cigarette consumption in the USA continues to decline, cigar consumption has increased. Tobacco-trade publications suggest that flavoured cigars are driving the recent growth in cigar consumption. Limited survey data exist to explore flavoured cigar preferences among youth and adults. METHODS This study used the 2010-2011 National Survey on Drug Use and Health (NSDUH) and Nielsen market scanner data. The NSDUH sample consisted of 6678 past 30-day cigar smokers who reported smoking a usual brand of cigars. NSDUH contains a measure on usual cigar brand smoked and was merged with Nielsen data to estimate the per cent of each cigar brand's market share that is flavoured. RESULTS Multivariate analyses indicate that youth, young adults, females, blacks, cigarette smokers, blunt users and daily cigar smokers are significantly more likely to report a usual cigar brand that is flavoured. Preference for a usual brand that produces flavoured cigars decreases significantly with age. CONCLUSIONS This study finds recent growth in flavoured cigar consumption and preference among youth and young adults for cigar brands that are flavoured. These findings underscore the need to expand monitoring of product attributes as well as individual-level cigar use behaviours captured through population surveillance.
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Affiliation(s)
- Cristine D Delnevo
- Center for Tobacco Surveillance & Evaluation Research, Rutgers-School of Public Health, New Brunswick, New Jersey, USA
| | - Daniel P Giovenco
- Center for Tobacco Surveillance & Evaluation Research, Rutgers-School of Public Health, New Brunswick, New Jersey, USA
| | - Bridget K Ambrose
- Center for Tobacco Products, Food and Drug Administration, Rockville, Maryland, USA
| | - Catherine G Corey
- Center for Tobacco Products, Food and Drug Administration, Rockville, Maryland, USA
| | - Kevin P Conway
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Rockville, Maryland, USA
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Westergaard RP, Ambrose BK, Mehta SH, Kirk GD. Provider and clinic-level correlates of deferring antiretroviral therapy for people who inject drugs: a survey of North American HIV providers. J Int AIDS Soc 2012; 15:10. [PMID: 22360788 PMCID: PMC3306203 DOI: 10.1186/1758-2652-15-10] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Accepted: 02/23/2012] [Indexed: 05/26/2023] Open
Abstract
Background Injection drug users (IDUs) face numerous obstacles to receiving optimal HIV care, and have been shown to underutilize antiretroviral therapy (ART). We sought to estimate the degree to which providers of HIV care defer initiation of ART because of injection drug use and to identify clinic and provider-level factors associated with resistance to prescribing ART to IDUs. Methods We administered an Internet-based survey to 662 regular prescribers of ART in the United States and Canada. Questionnaire items assessed characteristics of providers' personal demographics and training, site of clinical practice and attitudes about drug use. Respondents then rated whether they would likely prescribe or defer ART for hypothetical patients in a series of scenarios involving varying levels of drug use and HIV disease stage. Results Survey responses were received from 43% of providers invited by email and direct mail, and 8.5% of providers invited by direct mail only. Overall, 24.2% of providers reported that they would defer ART for an HIV-infected patient with a CD4+ cell count of 200 cells/mm3 if the patient actively injected drugs, and 52.4% would defer ART if the patient injected daily. Physicians were more likely than non-physician providers to defer ART if a patient injected drugs (adjusted odds ratio 2.6, 95% CI 1.4-4.9). Other predictors of deferring ART for active IDUs were having fewer years of experience in HIV care, regularly caring for fewer than 20 HIV-infected patients, and working at a clinic serving a population with low prevalence of injection drug use. Likelihood of deferring ART was directly proportional to both CD4+ cell count and increased frequency of injecting. Conclusions Many providers of HIV care defer initiation of antiretroviral therapy for patients who inject drugs, even in the setting of advanced immunologic suppression. Providers with more experience of treating HIV, those in high injection drug use prevalence areas and non-physician providers may be more willing to prescribe ART despite on-going injection drug use. Because of limitations, including low response rate and use of a convenience sample, these findings may not be generalizable to all HIV care providers in North America.
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Affiliation(s)
- Ryan P Westergaard
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI, USA.
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Ambrose BK. A device for transferring specimens from an ultrahigh vacuum chamber into the tilting goniometer of the JEOL 100B electron microscope. ACTA ACUST UNITED AC 2001. [DOI: 10.1088/0022-3735/9/5/018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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