Association between maternal cigarette smoking cessation and risk of preterm birth in Western New York

BACKGROUND

Although many studies suggested the benefit of smoking cessation among pregnant women in reducing the risk of preterm birth (PTB), the timing of the effect of the cessation remains inconclusive.

OBJECTIVES

To examine the association of trimester-specific smoking cessation behaviours with PTB risk.

METHODS

We included 199,453 live births in Western New York between 2004 and 2018. Based on self-reported cigarette smoking during preconception and in each trimester, we created six mutually exclusive groups: non-smokers, quitters in each trimester, those who smoked throughout pregnancy, and inconsistent smokers. Risk ratios (RRs) and 95% confidence intervals (CIs) were estimated using Poisson regression to examine the association between smoking cessation and PTB. Effect modification by illegal drug use, maternal age, race and ethnicity and pre-pregnancy body mass index (BMI) was investigated multiplicatively by ratio of relative risk and additively by relative excess risk due to interaction (RERI).

RESULTS

Overall, 6.7% of women had a PTB; 14.1% smoked throughout pregnancy and 3.4%, 1.8% and 0.8% reported quitting smoking during the first, second and third trimesters, respectively. Compared to non-smokers, third-trimester cessation (RR 1.20, 95% CI 1.01, 1.43) and smoking throughout pregnancy (RR 1.27, 95% CI 1.21, 1.33) were associated with a higher PTB risk, while quitting smoking during the first or second trimester, or inconsistent smoking was not associated with PTB. A positive additive interaction was identified for maternal age and late smoking cessation or smoking throughout pregnancy on PTB risk (RERI 0.17, 95% CI 0.00, 0.36), and a negative interaction was observed for pre-pregnancy BMI ≥30 kg/m2 (ratio of relative risk 0.70, 95% CI 0.63, 0.78; RERI -0.42, 95% CI -0.56, -0.30).

CONCLUSION

Compared to non-smokers, smoking throughout pregnancy and third-trimester smoking cessation are associated with an increased risk of PTB, while quitting before the third trimester may not increase PTB risk.

Indices of Diet Quality and Risk of Lung Cancer in the Women's Health Initiative Observational Study

BACKGROUND

Prospective evidence on associations between diet quality indices and lung cancer risk is limited, particularly among older women.

OBJECTIVES

We investigated associations between 4 diet quality indices [Healthy Eating Index-2015 (HEI-2015), Alternate Healthy Eating Index 2010 (AHEI-2010), alternate Mediterranean Diet (aMED), and Dietary Approaches to Stop Hypertension (DASH)] and lung cancer incidence and mortality in the Women's Health Initiative Observational Study.

METHODS

Postmenopausal women aged 50-79 y at baseline (1993-1998) self reported their diet intake and information on relevant covariates. We used Cox proportional hazards regression models to estimate HRs and 95% CIs after controlling for age, smoking, and other relevant covariates.

RESULTS

During ∼17 y of follow-up among 86,090 participants, 1491 lung cancer cases and 1393 lung cancer deaths were documented. Dietary indices were not associated with overall lung cancer incidence but were protective against squamous cell carcinoma (12.8% of total lung cancer) cases (HEI-2015: HR: 0.85; 95% CI: 0.76, 0.96; AHEI-2010: HR: 0.87; 95% CI: 0.78, 0.98; aMED: HR: 0.90; 95% CI: 0.81, 0.99; DASH: HR: 0.87; 95% CI: 0.77, 0.98). Among the indices, only HEI-2015 showed an inverse trend (P-trend = 0.02) with overall lung cancer mortality. Smoking status or participant age at baseline did not modify the association between dietary indices and lung cancer incidence or mortality.

CONCLUSIONS

After comprehensive control of smoking exposure, we found that diet quality was not associated with overall lung cancer among postmenopausal women. However, a high-quality diet was inversely related to incident lung cancer of the squamous cell subtype. Future studies in populations with diverse age, smoking history, and dietary intake may further elucidate the relation between diet quality indices and lung cancer, especially by histological subtype.

Use of Mentholated Cigarettes and Likelihood of Smoking Cessation in the United States: A Meta-Analysis

INTRODUCTION

Previous qualitative reviews have summarized evidence of an association between menthol cigarette use and likelihood of smoking cessation. The objective of this meta-analysis was to provide a quantitative summary of effect sizes, their variability, and factors related to the variability in effect size for the association between menthol use and likelihood of smoking cessation.

METHODS

We systematically searched Medline, PsycINFO, and Embase for prospective and cross-sectional studies of the association between menthol use and smoking cessation. We analyzed data with random effects meta-analyses and meta-regression.

RESULTS

Our review identified 22 reports from 19 studies of the association between menthol use and cessation. All identified study samples included only US smokers, with one exception that included both Canadian and US smokers. Our overall model did not demonstrate a significant association between menthol use and cessation; however, menthol users were significantly less likely to quit among blacks/African American smokers (odds ratio = 0.88).

CONCLUSIONS

Among blacks/African Americans predominantly in the US menthol users have approximately 12% lower odds of smoking cessation compared to non-menthol users. This difference is likely the result of the tobacco industry's ongoing marketing influence on the black/African American Community, suggesting that a menthol ban may have a unique public health benefit for black/African American smokers by encouraging quitting behavior.

IMPLICATIONS

This study adds a quantitative summary of the association between menthol cigarette use and smoking cessation in the United States. Findings of an association with lower likelihood of cessation among black/African American smokers, likely resulting from the tobacco industry's marketing influence, support the ban of menthol flavoring as part of a comprehensive tobacco control effort to increase cessation among black/African American smokers.

PhenX: Host: Biobehavioral measures for tobacco regulatory research

A working group (WG) of experts from diverse fields related to nicotine and tobacco addiction was constituted to identify constructs and measures for the PhenX (Phenotypes and eXposures) Tobacco Regulatory Research (TRR) Host: Biobehavioral Collection with potential relevance to users of both conventional and newer tobacco products. This paper describes the methods and results the WG used to identify, select, approve and place measures in the PhenX TRR Collection. The WG recognised 13 constructs of importance to guide their categorisation of measures already in the PhenX Toolkit ('complementary measures') and to identify novel or improved measures of special relevance to tobacco regulatory science. In addition to the 22 complementary measures of relevance to tobacco use already in the PhenX Toolkit, the WG identified and recommended nine additional Host: Biobehavioral measures characterising the use, exposure and health outcomes of tobacco products for application to TRR. Of these, five were self-administered or interviewer-administered measures: amount, type and frequency of recent tobacco use; flavor preference in e-cigarette users (adult and youth); pregnancy status and tobacco use; pregnancy status-mother and baby health and withdrawal from tobacco use. The remaining four measures were laboratory-based: cotinine in serum, expired carbon monoxide, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol in urine and cue reactivity. Although a number of validated tools are now available in the Host: Biobehavioral Collection, several gaps were identified, including a need to develop and test the identified measures in adolescent samples and to develop or identify measures of nicotine dependence, tolerance and withdrawal associated with newer non-combusted tobacco products.

Evaluation of a Dedicated Tobacco Cessation Support Service for Thoracic Cancer Center Patients

CONTEXT

Cancer patients' continued tobacco use results in poorer therapeutic outcomes including decreased quality of life and survival.

OBJECTIVE

To assess reach and impact of a free, opt-out, telephone-based tobacco cessation program for thoracic cancer center patients.

DESIGN

Observational study.

SETTING

Comprehensive Cancer Center in Western New York.

PARTICIPANTS

Current or recent (within past 30 days) tobacco-using thoracic cancer center patients referred to a tobacco cessation support service between October 2010 and October 2012 at a Comprehensive Cancer Center (n = 942/1313 referrals were eligible for cessation support).

INTERVENTION

A free, opt-out, telephone-based cessation service that was implemented as standard of care. Cessation specialists had patient-guided conversations that assessed readiness to quit; methods used in the past provided cessation strategies and worked to set up a quit date. There was an average of 35.9 days between referral and first contact.

MAIN OUTCOME MEASURES

Program reach (referral and participation rates) and impact (as self-reported cessation outcomes measured twice after referral).

RESULTS

Of 942 patients, 730 (77.5%) referred to and called by a tobacco cessation service participated in at least 1 cessation support call, of which 440 of 730 (60.3%) were called for follow-up and 89.5% (394/440) participated. In total, 20.2% (69/342) of current smokers at referral reported at least 7-day abstinence at follow-up. Among current smokers at referral and first contact, being married (odds ratio [OR] = 2.05; 95% confidence interval [CI], 1.01-4.18) and having a lower Eastern Cooperative Oncology Group (ECOG) performance score (OR = 4.05; 95% CI, 1.58-10.39) were associated with quitting at follow-up, after controlling for demographic, clinical, and health behavior characteristics.

CONCLUSIONS

Our results demonstrate that 78% of thoracic cancer center patients, if contacted, participated at least once in this cessation support service; for current smokers at referral and first contact, being married and having a lower ECOG performance score were associated with self-reported quitting at follow-up. Other organizations may find our results useful while implementing a systematic way to identify tobacco-using patients as part of routine care and to improve available cessation support services.

Differential Trends in Hookah Use Among New Jersey Youth

Introduction

Use of 2 or more types of tobacco products is common among youth and young adults, highlighting the need for monitoring and intervention activities to encompass products beyond combustible cigarettes. This study documented patterns and trends of ever, current, and frequent hookah use among high school students in New Jersey by other tobacco product use status.

Methods

We analyzed data from the 2008, 2010, 2012, 2014, 2016 waves of the New Jersey Youth Tobacco Survey. Point estimates and 95% confidence intervals described hookah use stratified by use of other tobacco products. Multivariable logistic regression models assessed trends and correlates of hookah use, controlling for the use of other tobacco products and users’ sociodemographic characteristics. Negative binomial regression models examined the association between total number of tobacco products used and hookah use while controlling for sociodemographic variables and survey year.

Results

The adjusted odds of current and frequent hookah use among New Jersey high school students were significantly higher in 2014, but not in 2016, compared to 2008. In recent years, hookah use among students who had ever smoked hookah, currently smoked hookah, or frequently smoked hookah was more common among students who had ever or currently smoked cigarettes or e-cigarettes. Hookah users consumed a wider variety of other tobacco products than those who did not use hookah.

Conclusion

Hookah use remains a public health concern for adolescents; it is more common among users of other tobacco products, especially cigarette and e-cigarette smokers. Questions remain as to whether users of multiple tobacco products are being adequately reached by existing policies and regulations.

Socioeconomic patterns of smoking cessation behavior in low and middle-income countries: Emerging evidence from the Global Adult Tobacco Surveys and International Tobacco Control Surveys

INTRODUCTION

Tobacco smoking is often more prevalent among those with lower socio-economic status (SES) in high-income countries, which can be driven by the inequalities in initiation and cessation of smoking. Smoking is a leading contributor to socio-economic disparities in health. To date, the evidence for any socio-economic inequality in smoking cessation is lacking, especially in low- and middle-income countries (LMICs). This study examined the association between cessation behaviours and SES of smokers from eight LMICs.

METHODS

Data among former and current adult smokers aged 18 and older came from contemporaneous Global Adult Tobacco Surveys (2008-2011) and the International Tobacco Control Surveys (2009-2013) conducted in eight LMICs (Bangladesh, Brazil, China, India, Mexico, Malaysia, Thailand and Uruguay). Adjusted odds ratios (AORs) of successful quitting in the past year by SES indicators (household income/wealth, education, employment status, and rural-urban residence) were estimated using multivariable logistic regression controlling for socio-demographics and average tobacco product prices. A random effects meta-analysis was used to combine the estimates of AORs pooled across countries and two concurrent surveys for each country.

RESULTS

Estimated quit rates among smokers (both daily and occasional) varied widely across countries. Meta-analysis of pooled AORs across countries and data sources indicated that there was no clear evidence of an association between SES indicators and successful quitting. The only exception was employed smokers, who were less likely to quit than their non-employed counterparts, which included students, homemakers, retirees, and the unemployed (pooled AOR≈0.8, p<0.10).

CONCLUSION

Lack of clear evidence of the impact of lower SES on adult cessation behaviour in LMICs suggests that lower-SES smokers are not less successful in their attempts to quit than their higher-SES counterparts. Specifically, lack of employment, which is indicative of younger age and lower nicotine dependence for students, or lower personal disposable income and lower affordability for the unemployed and the retirees, may be associated with quitting. Raising taxes and prices of tobacco products that lowers affordability of tobacco products might be a key strategy for inducing cessation behaviour among current smokers and reducing overall tobacco consumption. Because low-SES smokers are more sensitive to price increases, tobacco taxation policy can induce disproportionately larger decreases in tobacco consumption among them and help reduce socio-economic disparities in smoking and consequent health outcomes.

Gender differences in symptom misattribution for coronary heart disease symptoms and intentions to seek health care

Women are more likely to delay seeking care for coronary heart disease (CHD) symptoms than men. We tested whether this was because they are more likely to misattribute CHD symptoms. Data were collected in December 2016. Participants were 714 Amazon's Mechanical Turk (crowdsourcing marketplace) workers with US Internet Protocol (IP) addresses; 52% female (ages 35-77 years) made judgments about patients of their same gender described in vignettes. We used adjusted multivariable logistic, ordinal, and linear regression to test our hypotheses. Women had a higher odds of misattributing the symptoms of the target in the vignettes to non-cardiac causes than men (adjusted odds ratio [AOR] = 2.08, p < .001), despite having higher mean knowledge scores about CHD (4.49 vs. 4.03, p < .001) and rating their CHD risk as higher (25% more likely to get CHD vs. 19%, p = .025) than men. Women were also less likely than men to intend to seek care at an emergency department (b = -0.33, p = .024), and if they did intend to seek care, they were more likely to intend to wait to seek care (AOR = 2.37, p = .003). Symptom misattribution may partially account for women's lower likelihood of intending to seek care from an emergency department, which would be especially critical in emergency situations.

Global statistics on alcohol, tobacco and illicit drug use: 2017 status report

AIMS

This review provides an up-to-date curated source of information on alcohol, tobacco and illicit drug use and their associated mortality and burden of disease. Limitations in the data are also discussed, including how these can be addressed in the future.

METHODS

Online data sources were identified through expert review. Data were obtained mainly from the World Health Organization, United Nations Office on Drugs and Crime and Institute for Health Metrics and Evaluation.

RESULTS

In 2015, the estimated prevalence among the adult population was 18.4% for heavy episodic alcohol use (in the past 30 days); 15.2% for daily tobacco smoking; and 3.8, 0.77, 0.37 and 0.35% for past-year cannabis, amphetamine, opioid and cocaine use, respectively. European regions had the highest prevalence of heavy episodic alcohol use and daily tobacco use. The age-standardized prevalence of alcohol dependence was 843.2 per 100 000 people; for cannabis, opioids, amphetamines and cocaine dependence it was 259.3, 220.4, 86.0 and 52.5 per 100 000 people, respectively. High-income North America region had among the highest rates of cannabis, opioid and cocaine dependence. Attributable disability-adjusted life-years (DALYs) were highest for tobacco smoking (170.9 million DALYs), followed by alcohol (85.0 million) and illicit drugs (27.8 million). Substance-attributable mortality rates were highest for tobacco smoking (110.7 deaths per 100 000 people), followed by alcohol and illicit drugs (33.0 and 6.9 deaths per 100 000 people, respectively). Attributable age-standardized mortality rates and DALYs for alcohol and illicit drugs were highest in eastern Europe; attributable age-standardized tobacco mortality rates and DALYs were highest in Oceania.

CONCLUSIONS

In 2015 alcohol use and tobacco smoking use between them cost the human population more than a quarter of a billion disability-adjusted life years, with illicit drugs costing further tens of millions. Europeans suffered proportionately more, but in absolute terms the mortality rate was greatest in low- and middle-income countries with large populations and where the quality of data was more limited. Better standardized and rigorous methods for data collection, collation and reporting are needed to assess more accurately the geographical and temporal trends in substance use and its disease burden.

Examining Hookah as an Introduction to Nicotine Products among College Students

BACKGROUND

Limited data exist on what young adults report as their first-ever nicotine product; some evidence suggests that they report hookah as their first product smoked.

OBJECTIVES

This study reports on the first nicotine product used among undergraduates who had ever tried tobacco, and explores correlates of hookah as that first product.

METHODS

Participants included a convenience sample of undergraduate students (n = 1538) at four universities in upstate New York during fall 2013. Descriptive statistics assessed first nicotine product used and prevalence of current use. Logistic regression was used to examine correlates of hookah as the first nicotine product used.

RESULTS

Among the 832 students who reported ever use of any nicotine product, 25.4% reported hookah as their first product smoked; only combustible cigarettes (39.5%) were reported more frequently. Among students who ever smoked cigarettes, most reported cigarettes as their introductory product. Among students who never smoked cigarettes, nearly half reported hookah as their introductory product. Among ever nicotine users, current hookah smoking was common (34.9%), and greater than current e-cigarette (25.9%) and current combustible cigarette (26.4%) use. Never users of cigarettes, females, and non-Hispanic African Americans, had higher adjusted odds of reporting hookah as their introductory product.

CONCLUSIONS

The results of this study have implications for the identification of risk factors for tobacco initiation, the assessment of tobacco use patterns and behaviors, and the tailoring of tobacco prevention initiatives among youth. Our findings suggest that broadening prevention efforts beyond a focus on combustible cigarettes may be warranted.

Abstract 5261: Indices of diet quality and risk of lung cancer incidence and mortality in the Women's Health Initiative Observational Study

Background: Prospective evidence on the association between diet patterns and lung cancer risk is limited, particularly in older women. We investigated whether commonly used diet quality indices - Healthy Eating Index 2010 (HEI), Alternate Healthy Eating Index 2010 (AHEI), alternate Mediterranean Diet (aMED) and Dietary Approaches to Stop Hypertension (DASH) - were associated with lung cancer incidence and mortality in the Women's Health Initiative Observational Study (WHI OS).

Methods: Self-reported diet intake (food frequency questionnaires) and relevant covariate information was obtained from 86,090 race-ethnically diverse postmenopausal women aged 50-79 years at baseline (1993-1998). During a median follow-up of approximately 17 years, 1,491 lung cancer cases and 1,393 lung cancer deaths were documented. We used cox proportional hazards regression models to estimate hazards risks and 95% confidence intervals [HR (95% CI)] after controlling for age, race/ethnicity, education, body mass index, smoking, physical activity and energy intake.

Results and conclusions: Diet quality indices were not associated with lung cancer incidence overall but all four dietary indices showed a protective association (highest versus lowest quintile) against squamous cell carcinoma cases (12.8% of total lung cancer cases) [HEI: 0.56 (0.33-0.96), AHEI: 0.42 (0.24-0.76), aMED: 0.65 (0.39-1.08), DASH: 0.56 (0.32-0.97)]. Diet quality indices were not associated with lung cancer mortality overall or when stratified by histological type, except for HEI with lung cancer mortality overall [fourth versus lowest quintile: 0.82 (0.69-0.99)]. Smoking status did not modify the association between diet quality indices and lung cancer incidence or mortality. Further studies in other populations may help elucidate the relationship between diet patterns and lung cancer, especially by histological type.

Citation Format: Ajay A. Myneni, Gary A. Giovino, Amy E. Millen, Michael J. LaMonte, Jean Wactawski-Wende, Marian L. Neuhouser, Jiwei Zhao, James M. Shikany, Lina Mu. Indices of diet quality and risk of lung cancer incidence and mortality in the Women's Health Initiative Observational Study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 5261.

Patterns and Trends of Hookah Use among New Jersey Youth: New Jersey Youth Tobacco Survey 2008-2014

OBJECTIVES

In this study, the aim was to document trends of ever, past 30-day, and frequent (use on > 10 days/month) hookah use among New Jersey (NJ) high school students.

METHODS

Data were analyzed from the 2008-2014 waves of the NJ Youth Tobacco Survey, a biennial survey of public high school students in grades 9-12 with a mean age of 15 years. Multivariable logistic regressions assessed trends and correlates of hookah use. Descriptive statistics were used to summarize the use of cigarettes, electronic cigarettes, and other tobacco products (including cigars, smokeless tobacco, and bidis).

RESULTS

In 2014, past 30-day hookah use (11.8%) was as high as e-cigarette use (12.1%) and higher than other tobacco products. The adjusted odds of ever, past 30-day, and frequent hookah use were significantly higher in 2014 than 2008. Past 30-day hookah use was more common among users of other tobacco products.

CONCLUSIONS

Effective strategies have been used in cigarette tobacco control, and cigarette consumption has decreased as a result. Similar strategies should be employed to encompass emerging tobacco products, with necessary modifications to reduce the prevalence of all tobacco use among youth.

Importance of Survey Design for Studying the Epidemiology of Emerging Tobacco Product Use Among Youth

Accurate surveillance is critical for monitoring the epidemiology of emerging tobacco products in the United States, and survey science suggests that survey response format can impact prevalence estimates. We utilized data from the 2014 New Jersey Youth Tobacco Survey (n = 3,909) to compare estimates of the prevalence of 4 behaviors (ever hookah use, current hookah use, ever e-cigarette use, and current e-cigarette use) among New Jersey high school students, as assessed using "check-all-that-apply" questions, with estimates measured by means of "forced-choice" questions. Measurement discrepancies were apparent for all 4 outcomes, with the forced-choice questions yielding prevalence estimates approximately twice those of the check-all-that-apply questions, and agreement was fair to moderate. The sensitivity of the check-all-that-apply questions, treating the forced-choice format as the "gold standard," ranged from 38.1% (current hookah use) to 58.3% (ever e-cigarette use), indicating substantial false-negative rates. These findings highlight the impact of question response format on prevalence estimates of emerging tobacco products among youth and suggest that estimates generated by means of check-all-that-apply questions may be biased downward. Alternative survey designs should be considered to avoid check-all-that-apply response formats, and researchers should use caution when interpreting tobacco use data obtained from check-all-that-apply formats.

Implementation of key demand-reduction measures of the WHO Framework Convention on Tobacco Control and change in smoking prevalence in 126 countries: an association study

BACKGROUND

The WHO Framework Convention on Tobacco Control (WHO FCTC) has mobilised efforts among 180 parties to combat the global tobacco epidemic. This study examined the association between highest-level implementation of key tobacco control demand-reduction measures of the WHO FCTC and smoking prevalence over the treaty's first decade.

METHODS

We used WHO data from 126 countries to examine the association between the number of highest-level implementations of key demand-reduction measures (WHO FCTC articles 6, 8, 11, 13, and 14) between 2007 and 2014 and smoking prevalence estimates between 2005 and 2015. McNemar tests were done to test differences in the proportion of countries that had implemented each of the measures at the highest level between 2007 and 2014. Four linear regression models were computed to examine the association between the predictor variable (the change between 2007 and 2014 in the number of key measures implemented at the highest level), and the outcome variable (the percentage point change in tobacco smoking prevalence between 2005 and 2015).

FINDINGS

Between 2007 and 2014, there was a significant global increase in highest-level implementation of all key demand-reduction measures. The mean smoking prevalence for all 126 countries was 24·73% (SD 10·32) in 2005 and 22·18% (SD 8·87) in 2015, an average decrease in prevalence of 2·55 percentage points (SD 5·08; relative reduction 10·31%). Unadjusted linear regression showed that increases in highest-level implementations of key measures between 2007 and 2014 were significantly associated with a decrease in smoking prevalence between 2005 and 2015). Each additional measure implemented at the highest level was associated with an average decrease in smoking prevalence of 1·57 percentage points (95% CI -2·51 to -0·63, p=0·001) and an average relative decrease of 7·09% (-12·55 to -1·63, p=0·011). Controlling for geographical subregion, income level, and WHO FCTC party status, the per-measure decrease in prevalence was 0·94 percentage points (-1·76 to -0·13, p=0·023) and an average relative decrease of 3·18% (-6·75 to 0·38, p=0·079). This association was consistent across all three control variables.

INTERPRETATION

Implementation of key WHO FCTC demand-reduction measures is significantly associated with lower smoking prevalence, with anticipated future reductions in tobacco-related morbidity and mortality. These findings validate the call for strong implementation of the WHO FCTC in the WHO's Global Action Plan for the Prevention and Control of Non-communicable Diseases 2013-2020, and in advancing the UN's Sustainable Development Goal 3, setting a global target of reducing tobacco use and premature mortality from non-communicable diseases by a third by 2030.

FUNDING

Health Canada, Canadian Institutes of Health Research, Ontario Institute for Cancer Research and Canadian Cancer Society Research Institute.

Smoking Habits and Body Weight Over the Adult Lifespan in Postmenopausal Women

INTRODUCTION

The inter-relationships between smoking habits and weight gain are complex. However, few studies have examined the association of smoking habits with weight gain over the life course.

METHODS

Major smoking parameters and weight gain over time were examined in a large cohort of postmenopausal women aged 50-79 years at enrollment between 1993 and 1998 (N=161,808) and followed through 2014 (analyses conducted in 2016). Cross-sectional analyses were used to assess the association of smoking and body weight at baseline. Retrospective data were used to correlate smoking status with body weight over a 45-year period prior to enrollment. In addition, the association of smoking with weight gain over 6 years of follow-up was examined.

RESULTS

At baseline, women who had quit smoking prior to enrollment weighed 4.7 kg more than current smokers and 2.6 kg more than never smokers. Former, never, and current smokers all gained weight over the 45-year period from age 18 years to time of enrollment (average age, 63 years): 16.8, 16.4, and 14.6 kg, respectively. In prospective analyses, women who were current smokers at baseline but who quit smoking during follow-up gained more than 5 kg by Year 6 compared with current smokers at baseline who continued to smoke. Among long-term quitters, greater intensity of smoking and more recent quitting were associated with greater weight gain.

CONCLUSIONS

These results suggest that excess weight gain associated with smoking cessation occurs soon after quitting and is modest relative to weight gain in never smokers over the adult lifespan.

Understanding Tobacco Use Behaviors Among African Americans: Progress, Critical Gaps, and Opportunities

INTRODUCTION

Although multiple factors likely influence the differences between African Americans (AAs) and whites in cardiovascular disease and lung cancer mortality rates, historical patterns of tobacco use, particularly cigarette smoking, are the major contributors. This issue of Nicotine & Tobacco Research presents original research, a review, and commentaries that will serve to advance our understanding of several relevant behavioral similarities and differences between AAs and whites.

BEHAVIORAL ANALYSIS

Here, we illustrate how the diverging trends in cigarette smoking between AA and white high school seniors observed since the mid-1970s were influenced by patterns of ever use and current use among ever users. During 1977 to 2014, the percentage of current users among ever users was higher, but less variable, among whites than AAs. Among adults, trends in self-reported cigarette smoking among non-Hispanic AAs and non-Hispanic whites are available since 1978. The trends observed were likely due in part to the maturation of the high school senior cohorts from the 1970s and 1980s when AA smoking rates declined sharply relative to whites. Later age of initiation among AAs and less quitting among older AAs, relative to whites, also contribute.

CONCLUSIONS

Further research on multiple topics, including the continuation of use among ever users, use of multiple combusted and noncombusted products, provision of cessation support services, influence of discrimination, and validity of self-report would expand the science base. Strategies to reduce the marketing and availability of menthol and other characterizing flavorings and to enrich environments would promote the public's health.

Changes in the prevalence and correlates of menthol cigarette use in the USA, 2004-2014

INTRODUCTION

National data from 2004 to 2010 showed that despite decreases in non-menthol cigarette use prevalence, menthol cigarette use prevalence remained constant in adolescents and adults and increased in young adults. The purpose of the current study was to extend these analyses through 2014.

METHODS

We estimated the prevalence of menthol cigarette smoking in the USA during 2004-2014 using annual cross-sectional data on persons aged ≥12 years from the National Survey on Drug Use and Health. Self-reported menthol status for selected brands that were either exclusively menthol or non-menthol were adjusted based on retail sales data. Data were weighted to provide national estimates.

RESULTS

Although overall smoking prevalence has decreased, the proportion of past 30-day cigarette smokers using menthol cigarettes was higher (39%) in 2012-2014 compared to 2008-2010 (35%). Youth smokers remain the most likely group to use menthol cigarettes compared to all other age groups. Menthol cigarette prevalence has increased in white, Asian and Hispanic smokers since 2010. Menthol cigarette prevalence exceeded non-menthol cigarette prevalence in youth and young adult smokers in 2014. Among smokers, menthol cigarette use was positively correlated with co-use of cigars. Menthol cigarette and smokeless tobacco co-use also increased from 2004 to 2014.

CONCLUSIONS

The youngest smokers are most likely to use menthol cigarettes. Among smokers, increases in overall menthol cigarette use and menthol cigarette use in whites, Asians and Hispanics since 2010 are of concern. There is tremendous urgency to limit the impact of menthol cigarettes on public health, particularly the health of youth and young adults.

State and Community Tobacco-Control Programs and Smoking-Cessation Rates among Adult Smokers: What Can we Learn from the COMMIT Intervention Cohort?

Purpose.

To assess the long-term effect of a randomized community-based trial of smoking cessation and to examine the effect of exposure to large state-based tobacco-control programs on smoking cessation.

Design.

Longitudinal tobacco-use telephone surveys conducted in 1988, 1993, and 2001.

Setting and Participants.

Baseline smokers (6603) from 20 communities in 9 states completed a survey in 2001 (35% of the original sample).

Intervention.

The Community Intervention Trial for Smoking Cessation (COMMIT) intervention was a randomized community-based smoking-cessation intervention between 1988 and 1993. In addition, cohort data were used to evaluate quasi-experimental differences in the strength of state-level tobacco control programs and policies.

Measures.

Multivariate logistic regression was used to compare quit rates among those who were exposed to community- or state-level tobacco-control programming and those who were not between 1988 and 2001.

Results.

Quit rates were higher in the COMMIT intervention communities during the period when the trial was funded (Relative Risk [RR] = 1.19) but were no different than comparison communities 8 years later after funding stopped. Quit rates were highest in those communities in states with both strong tobacco-control policies and aggressive tobacco-control programs, such as California and Massachusetts (RR = 1.44) compared with those communities in states that had little tobacco-control activity, such as Iowa, New Mexico, and North Carolina.

Conclusions.

The findings suggest that well-funded tobacco-control programming coupled with tobacco-control policies may be associated with increases in cessation rates.

Assessing 30-day quantity-frequency of U.S. adolescent cigarette smoking as a predictor of adult smoking 14 years later

BACKGROUND

To improve measures of monthly tobacco cigarette smoking among non-daily smokers, predictive of future non-daily monthly and daily smoking.

METHODS

Data from United States National Longitudinal Study of Adolescent to Adult Health, tracking adolescents, ages 12-21, over 14 years were analyzed. At baseline, 6501 adolescents were assessed; 5114 individuals provided data at waves 1 and 4. Baseline past 30-day non-daily smokers were classified using quantity-frequency measures: cigarettes smoked/day by number of days smoked in the past 30 days.

RESULTS

Three categories of past 30-day non-daily smokers emerged using cigarettes/month (low:1-5, moderate: 6-60, high: 61+) and predicted past 30-day smoking at follow-up (low: 44.5%, moderate: 60.0%, high: 77.0%, versus 74.2% daily smokers; rτ=-0.2319, p<0.001). Two categories of non-smokers plus low, moderate and high categories of non-daily smokers made up a five-category non-daily smoking index (NDSI). High NDSI (61+ cigs/mo.) and daily smokers were equally likely to be smoking 14 years later (High NDSI OR=0.97, 95% CI=0.53-1.80 [daily as reference]). Low (1-5 cigs/mo.) and moderate (6-60 cigs/mo.) NDSI were distinctly different from high NDSI, but similar to one another (OR=0.21, 95% CI=0.15-0.29 and OR=0.22, 95% CI=0.14-0.34, respectively) when estimating future monthly smoking. Among those smoking at both waves, wave 1 non-daily smokers, overall, were less likely than wave 1 daily smokers to be smoking daily 14 years later.

CONCLUSIONS

Non-daily smokers smoking over three packs/month were as likely as daily smokers to be smoking 14-years later. Lower levels of non-daily smoking (at ages 12-21) predicted lower likelihood of future monthly smoking. In terms of surveillance and cessation interventions, high NDSI smokers might be treated similar to daily smokers.

Fruit and vegetable intake as a moderator of the association between depressive symptoms and cigarette smoking

BACKGROUND

Studies have consistently reported associations among depression, cigarette smoking, and fruit and vegetable intake (FVI). This study evaluated FVI as a moderator of the association between depressive symptoms and smoking.

METHODS

The authors analyzed data from the National Longitudinal Survey of Youth 1979: Child and Young Adult. The study sample was adults aged 19-33 years at baseline in the year 2004 from the Young Adult Survey portion. Moderation analyses were performed using the Johnson-Neyman technique to assess whether baseline FVI moderated the association between depressive symptoms and smoking status cross-sectionally and as a predictor of smoking cessation longitudinally at 4-year follow-up.

RESULTS

Cross-sectionally, at lower levels of FVI (<4.9 times/day), there was a significant association between smoking and depressive symptoms (P < .05), but not at higher levels of FVI (≥4.9 times/day; P > .05). Longitudinally, there was an inverse association between depressive symptoms and quitting smoking at FVI <1.2 times/day (P < .05), but there was not a significant association at FVI ≥1.2 times/day (P ≥ .05).

CONCLUSIONS

FVI moderated the association between depressive symptoms and cigarette smoking cross-sectionally and longitudinally. The cross-sectional findings might be partially explained by the longitudinal findings paired with prior research; there might be fewer smokers with high FVI because depressive symptoms are removed as an impediment to cessation. Further experimental research is warranted to test the efficacy of increased FVI as an adjunct to smoking cessation, with a possible mechanism of action being reduced depressive symptoms during quit attempts.

Differences in Quit Attempts and Cigarette Smoking Abstinence Between Whites and African Americans in the United States: Literature Review and Results From the International Tobacco Control US Survey

INTRODUCTION

While cigarette smoking prevalence is declining among US adults, quit rates may differ between white and African American smokers. Here, we summarize the literature on smoking cessation behaviors in whites and African Americans across four study designs and report the findings of new analyses of International Tobacco Control (ITC) US Survey cohort data.

METHODS

We reviewed 32 publications containing 39 relevant analyses that compared quit attempts and abstinence between US whites and African Americans. Two additional longitudinal analyses were conducted on 821 white and 76 African American cigarette smokers from Waves 7 and 8 of the ITC US Survey (mean follow-up = 19 months).

RESULTS

Of 17 total analyses of quit attempts, nine (including the ITC US Survey) observed that African American smokers were more likely than whites to attempt to quit during a given year; seven found no differences. Whites were more likely than African Americans to be abstinent in five of six retrospective cohort analyses and in two of five considered community- and population-based cohort studies. Four of these 11 analyses, including one from the ITC US Survey, found no differences.

CONCLUSIONS

Of 11 population- or community-based analyses, all seven that found significant differences indicated that whites were more likely to quit than African Americans. These findings, combined with the similar results from population-based birth cohort analyses, support the conclusion that white smokers are more likely to quit than African American smokers. Efforts to encourage and support quitting among all tobacco users remain a priority.

IMPLICATIONS

This article provides a review of the literature on smoking cessation among African American and white smokers, and adds new analyses that compare quit attempts and abstinence between US African Americans and whites. Results demonstrate a clear distinction between the findings of cross-sectional and retrospective cohort studies with those of cohort studies. Reasons for these differences merit further study.

Raw Garlic Consumption and Lung Cancer in a Chinese Population

BACKGROUND

Evidence of anticancer properties of garlic for different cancer sites has been reported previously in in vitro and in vivo experimental studies but there is limited epidemiologic evidence on the association between garlic and lung cancer.

METHODS

We examined the association between raw garlic consumption and lung cancer in a case-control study conducted between 2005 and 2007 in Taiyuan, China. Epidemiologic data was collected by face-to-face interviews from 399 incident lung cancer cases and 466 healthy controls. We used unconditional logistic regression models to estimate crude and adjusted ORs (aOR) and their 95% confidence intervals (CI). Adjusted models controlled for age, sex, average annual household income 10 years ago, smoking, and indoor air pollution.

RESULTS

Compared with no intake, raw garlic intake was associated with lower risk of development of lung cancer with a dose-response pattern (aOR for <2 times/week = 0.56; 95% CI, 0.39-0.81 and aOR for ≥2 times/week = 0.50; 95% CI, 0.34-0.74; Ptrend = 0.0002). Exploratory analysis showed an additive interaction of raw garlic consumption with indoor air pollution and with any supplement use in association with lung cancer.

CONCLUSIONS

The results of the current study suggest that raw garlic consumption is associated with reduced risk of lung cancer in a Chinese population.

IMPACT

This study contributes to the limited research in human population on the association between garlic and lung cancer and advocates further investigation into the use of garlic in chemoprevention of lung cancer. Cancer Epidemiol Biomarkers Prev; 25(4); 624-33. ©2016 AACR.

Risky behaviors, e-cigarette use and susceptibility of use among college students

BACKGROUND

Since 2007, there has been a rise in the use of electronic cigarettes (e-cigarettes). The present study uses cross-sectional data (2013) to examine prevalence, correlates and susceptibility to e-cigarettes among young adults.

METHODS

Data were collected using an Internet survey from a convenience sample of 1437, 18-23 year olds attending four colleges/universities in Upstate New York. Results were summarized using descriptive statistics; logistic regression models were analyzed to identify correlates of e-cigarette use and susceptibility to using e-cigarettes.

RESULTS

Nearly all respondents (95.5%) reported awareness of e-cigarettes; 29.9% were ever users and 14.9% were current users. Younger students, males, non-Hispanic Whites, respondents reporting average/below average school ability, ever smokers and experimenters of tobacco cigarettes, and those with lower perceptions of harm regarding e-cigarettes demonstrated higher odds of ever use or current use. Risky behaviors (i.e., tobacco, marijuana or alcohol use) were associated with using e-cigarettes. Among never e-cigarette users, individuals involved in risky behaviors or, with lower harm perceptions for e-cigarettes, were more susceptible to future e-cigarette use.

CONCLUSIONS

More e-cigarette users report use of another nicotine product besides e-cigarettes as the first nicotine product used; this should be considered when examining whether e-cigarette use is related to cigarette susceptibility. Involvement in risky behaviors is related to e-cigarette use and susceptibility to e-cigarette use. Among college students, e-cigarette use is more likely to occur in those who have also used other tobacco products, marijuana, and/or alcohol.

Relations between negative affect and health behaviors by race/ethnicity: Differential effects for symptoms of depression and anxiety

OBJECTIVE

Health behaviors, including smoking and fruit and vegetable consumption, are both associated with psychological distress and vary by race/ethnicity. The relation of global psychological distress to behavior also varies by race/ethnicity, but the specific negative affective states responsible for this effect are not known. This study examined how the relation of feelings of depression and anxiety to health behaviors differs by race/ethnicity.

METHOD

Secondary data analysis of the HINTS nationally representative population survey was conducted. Survey participants reported their current symptoms of depression and anxiety, as well as smoking status and fruit and vegetable consumption. Survey weighted linear and logistic regression analyses were used to assess whether race/ethnicity moderated the relation of symptoms of depression and anxiety to smoking and fruit and vegetable consumption.

RESULTS

For symptoms of depression, but not anxiety, there was a significant interaction between race/ethnicity and psychological distress in predicting both smoking status and fruit and vegetable consumption. Greater depressive symptoms were related to a greater likelihood of smoking and lower fruit and vegetable consumption for White, but not Black respondents. For Hispanic respondents, depressive symptoms were associated with a greater likelihood of currently smoking, but were not associated with fruit and vegetable consumption.

CONCLUSION

The association between depressive symptoms and both smoking and fruit and vegetable consumption differs as a function of race/ethnicity. These findings have implications for understanding the extent to which negative affective states influence health behaviors across different racial/ethnic groups, and for developing interventions that effectively target smoking and fruit and vegetable consumption among different racial/ethnic subgroups.

Softening of monthly cigarette use in youth and the need to harden measures in surveillance

Objective

To assess changes in monthly smoking in its relationship to daily smoking and heavier smoking in high school seniors. Public health agencies often report only “current use” of cigarettes among youth as any use in the past 30 days, even though additional measures are collected. Monthly use is a crude and changing indicator.

Methods

Results from 1975 to 2013 from Monitoring The Future Project were plotted and analyzed by linear regression.

Results

From 1975 to 2013, the percentage of monthly smokers who smoked daily decreased by 29% (21.2 percentage points) and monthly smokers who smoked 10 + cigarettes/day dropped by 57% (28 percentage points); the percentage of daily smokers who smoked 10 + cigarettes/day decreased by 40% (26.5 percentage points).

Conclusion

Additional measures of frequency and intensity of use of cigarettes and other tobacco/nicotine products need to be more regularly reported. These results indicate softening rather than hardening of “current smoking” and have important implications for tobacco surveillance and for tobacco research because of a) increased likelihood of quitting smoking, b) health effects of cigarette smoking, and c) similar and interacting issues related to measuring the use of all tobacco/nicotine products.

•

From 1975 to 2013, monthly 12th grade smokers were 29% less likely to smoke daily.

•

Monthly smokers in 2013 were 57% less likely to smoke ≥ 10 cigarettes/day.

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Daily smokers in 2013 were 40% less likely to smoke ≥ 10 cigarettes/day.

•

Reliance solely on monthly product use in tobacco surveillance is problematic.

•

Reports on e-cigarette/tobacco products should include data on heavier levels of use.

The relationship between childhood physical and emotional abuse and smoking cessation among U.S. women and men

Childhood maltreatment is associated with increased likelihood of smoking. The purpose of the current investigation was to compare quitting motives, quit attempts, and quit success between U.S. adult smokers with or without childhood maltreatment (physical or emotional abuse), and those with or without serious psychological distress (SPD). We also examined whether SPD mediated associations between childhood maltreatment and all outcomes. We analyzed data from a 2-wave cohort telephone survey of a national U.S. sample of current cigarette smokers (n = 751). We used generalized path modeling to examine associations between maltreatment/SPD and concerns about smoking, motivation to quit, quit attempts, and smoking cessation (among the overall sample and selecting for those who made at least 1 quit attempt between waves; n = 368). Among women, maltreatment and SPD were associated with lower likelihood of quitting as well as making a successful quit attempt. SPD mediated the association between maltreatment and likelihood of successfully quitting. Women with maltreatment also had stronger concerns about smoking and motivation to quit than those without maltreatment, although there were no differences in actual quit attempts made. Neither childhood maltreatment nor SPD was associated with smoking outcomes among men. Findings suggest that female smokers with a history of childhood maltreatment are motivated to quit smoking; however, they may have more difficulty quitting smoking as a result of SPD. (PsycINFO Database Record

Relationship between frequency and intensity of cigarette smoking and TTFC/C among students of the GYTS in select countries, 2007-2009

BACKGROUND

This study assessed the construct validity of a measure of nicotine dependence that was used in the Global Youth Tobacco Survey (GYTS).

METHODS

Using 2007-2009 data from the GYTS, subjects from 6 countries were used to assess current smokers' odds of reporting time to first cigarette or craving positive (TTFC/C+) by the number of cigarette smoking days per month (DPM) and the number of cigarettes smoked per day (CPD).

RESULTS

The percentage of GYTS smokers who reported TTFC/C+ ranged from 58.0% to 69.7%. Compared with students who smoked on 1-2 DPM, those who smoked on 3-9 DPM had 3 times the adjusted odds of reporting TTFC/C+. The adjusted odds of reporting TTFC/C+ were 3 to 7 times higher among those who smoked 10-29 DPM and 6 to 20 times higher among daily smokers. Similarly, the adjusted odds of TTFC/C+ were 3-6 times higher among those who smoked 2-5 CPD and 6 to 20 times higher among those who smoked >6 CPD, compared to those who smoked <1 CPD.

CONCLUSION

Associations of TTFC/C+ prevalence with both frequency and intensity of cigarette smoking provide a construct validation of the GYTS question used to assess respondents' TTFC/C status.

What is the evidence for hardening in the cigarette smoking population? Trends in nicotine dependence in the U.S., 2002-2012

BACKGROUND

It is unclear whether declines in cigarette smoking in the U.S. have resulted in a hardened population of "hardcore" smokers. We studied changes in nicotine dependence severity from 2002 to 2012, using data from the National Survey on Drug Use and Health.

METHODS

We used generalized non-linear factor analysis to examine whether individual Nicotine Dependence Syndrome Scale (NDSS) items functioned differently over time, and whether average NDSS scores changed in a sample of 130,637 current smokers. We also examined trends for individual NDSS sub-scales and whether trends were moderated by tobacco consumption and socio-demographic factors.

RESULTS

Consumption levels and dependence severity both declined over the study period. This decline was driven by priority (e.g., avoiding smoke-free locations) and tolerance dimensions of dependence, while drive (e.g., craving and smoking to relieve negative affect) and continuity (e.g., stability) of smoking did not change. Declines for tolerance were greatest among those without serious psychological distress and among middle-aged smokers. Drive and continuity increased among women and low income smokers.

CONCLUSIONS

We did not find evidence of hardening at the population level for smokers in the U.S., 2002-2012. However, there is evidence of hardening when considering drive and continuity-related nicotine dependence among women and low-income smokers, suggesting these sub-groups are experiencing greater severity of craving, smoking to relieve negative affect, and regularity of smoking despite reduced consumption.

Couples' marijuana use is inversely related to their intimate partner violence over the first 9 years of marriage

Research on the association between marijuana use and intimate partner violence (IPV) has generated inconsistent findings, and has been primarily based on cross-sectional data. We examined whether husbands' and wives' marijuana use predicted both husbands' and wives' IPV perpetration over the first 9 years of marriage (Wave 1, n = 634 couples). We also examined moderation by antisocial behavior, the spouse's marijuana use, and whether IPV was reported during the year before marriage. These predictive associations were calculated using a time-lagged multivariate generalized multilevel model, simultaneously estimating predictors of husband and wife IPV. In fully adjusted models, we found that more frequent marijuana use by husbands and wives predicted less frequent IPV perpetration by husbands. Husbands' marijuana use also predicted less frequent IPV perpetration by wives. Moderation analyses demonstrated that couples in which both spouses used marijuana frequently reported the least frequent IPV perpetration. There was a significant positive association between wives' marijuana use and wives' IPV perpetration, but only among wives who had already reported IPV perpetration during the year before marriage. These findings suggest there may be an overall inverse association between marijuana use and IPV perpetration in newly married couples, although use may be associated with greater risk of perpetration among women with a history of IPV perpetration.

Variation in nicotine intake among U.S. cigarette smokers during the past 25 years: evidence from NHANES surveys

OBJECTIVE

To estimate changes in nicotine intakes among U.S. cigarette smokers from 1988 to 2012 with the National Health and Nutrition Examination Survey (NHANES).

METHODS

NHANES provides data on nationally representative samples of cigarette smokers from the civilian noninstitutionalized U.S. population. A total of 4,304 smokers aged 20 years and older were studied in NHANES III 1988-1994 and 7,095 were studied in the continuous NHANES 1999-2012. We examined serum cotinine concentrations, daily cigarette consumption, and estimated nicotine intake per cigarette, with adjustment for sex, age, racial/ethnic background, level of education, and body mass index.

RESULTS

There was little overall change in nicotine intake from smoking cigarettes either in the U.S. population as a whole or in major racial/ethnic subgroups during the 25-year period from 1988. Serum cotinine averaged 223.7ng/mL (95% confidence interval [CI] = 216.1-231.3) in 1988-1994, which was not significantly different from the adjusted mean of 219.2ng/mL (95% CI = 214.1-224.4) in 1999-2012. During the same period, average daily cigarette consumption declined substantially, from 17.3 (95% CI = 16.5-18.0) in 1988-1994 to 12.3 (95% CI = 11.0-13.6) by 2012. Cotinine per cigarette smoked increased by some 42% between 1988-1994 and 2011-2012, from a geometric mean of 12.4 (95% CI = 11.7-13.1) to 17.6 (95% CI = 16.1-19.2).

CONCLUSIONS

Reductions in cigarette smoking prevalence since the late 1980s, changes in cigarette product design, and the widespread introduction of smoke-free policies have not had a significant impact on nicotine intakes among U.S. smokers. Reductions in cigarette consumption have been offset by increased nicotine intake per cigarette smoked.

Cigarette smoking and mental illness: a study of nicotine withdrawal

OBJECTIVES

We compared prevalence, severity, and specific symptom profiles for nicotine withdrawal across categories of mental illness. We also examined the influence of nicotine withdrawal on efforts to quit smoking among those with mental illness.

METHODS

We analyzed data from 2 sources: wave 1 of the National Epidemiologic Survey on Alcohol and Related Conditions, limiting the sample to current smokers (2001-2002; n = 9913); and a 2-wave cohort telephone survey of a national sample of adult smokers (2004-2006; n = 751).

RESULTS

Mental illness was associated with a substantially greater likelihood of nicotine withdrawal syndrome; approximately 44% of nicotine withdrawal syndrome diagnoses were attributable to mental illness. Symptom profiles were highly comparable between mental illness categories, although anxiety-related symptoms were better markers of withdrawal for those with an internalizing disorder. Smokers with mental illness were motivated to quit but were less likely to be successful in their quit attempts, and both dependence and withdrawal independently accounted for this lower likelihood of success.

CONCLUSIONS

Nicotine withdrawal may be a particularly important target for intervention among those with mental illness who smoke cigarettes.

Smoking and diabetes: does the increased risk ever go away?

Recent studies reported that smoking cessation leads to higher short-term risk of type 2 diabetes than continuing to smoke. However, the duration of increased diabetes risk following smoking cessation needs further investigation. We followed 135,906 postmenopausal women aged 50-79 years enrolled in the Women's Health Initiative between September 1, 1993, and December 31, 1998, over an average of 11 years to examine the association between smoking cessation and risk of diabetes using Cox proportional hazard multivariable-adjusted regression models. Compared with that for never smokers, the risk for diabetes was significantly elevated in current smokers (hazard ratio = 1.28, 95% confidence interval: 1.20, 1.36) but was even higher in women who quit smoking during the first 3 years of follow-up (hazard ratio = 1.43, 95% confidence interval: 1.26, 1.63). Among former smokers, the risk of diabetes decreased significantly as the time since quitting increased and was equal to that of never smokers following a cessation period of 10 years. In new quitters with low cumulative exposure (<20 pack-years), diabetes risk was not elevated following smoking cessation. In conclusion, the risk of diabetes in former smokers returns to that in never smokers 10 years after quitting, and even more quickly in lighter smokers.

Differential trends in cigarette smoking in the USA: is menthol slowing progress?

INTRODUCTION

Mentholated cigarettes are at least as dangerous to an individual's health as non-mentholated varieties. The addition of menthol to cigarettes reduces perceived harshness of smoke, which can facilitate initiation. Here, we examine correlates of menthol use, national trends in smoking menthol and non-menthol cigarettes, and brand preferences over time.

METHODS

We estimated menthol cigarette use during 2004-2010 using annual data on persons ≥12 years old from the National Surveys on Drug Use and Health. We adjusted self-reported menthol status for selected brands that were either exclusively menthol or non-menthol, based on sales data. Data were weighted to provide national estimates.

RESULTS

Among cigarette smokers, menthol cigarette use was more common among 12-17 year olds (56.7%) and 18-25 year olds (45.0%) than among older persons (range 30.5% to 34.7%). In a multivariable analysis, menthol use was associated with being younger, female and of non-Caucasian race/ethnicity. Among all adolescents, the percentage who smoked non-menthol cigarettes decreased from 2004-2010, while menthol smoking rates remained constant; among all young adults, the percentage who smoked non-menthol cigarettes also declined, while menthol smoking rates increased. The use of Camel menthol and Marlboro menthol increased among adolescent and young adult smokers, particularly non-Hispanic Caucasians, during the study period.

CONCLUSIONS

Young people are heavy consumers of mentholated cigarettes. Progress in reducing youth smoking has likely been attenuated by the sale and marketing of mentholated cigarettes, including emerging varieties of established youth brands. This study should inform the Food and Drug Administration regarding the potential public health impact of a menthol ban.

Research priorities for FCTC Articles 20, 21, and 22: surveillance/evaluation and information exchange

INTRODUCTION

Framework Convention on Tobacco Control (FCTC) Articles 20, 21, and 22 call for strong monitoring and reporting of tobacco use and factors influencing use and disease (Articles 20 and 21) and for collaboration among the Parties and relevant organizations to share resources, knowledge, and expertise on all relevant tobacco control strategies (Article 22).

METHODS

This paper provides background information and discusses research strategies that would strengthen these efforts and better inform the parties. By necessity, Articles 20 and 21 are discussed separately from Article 22, although 1 example that relates to both 20/21 and 22 is discussed at the end.

RESULTS

Twelve important research opportunities on surveillance and evaluation are recognized, along with 4 on collaboration. The authors believe that the 6 most important areas for research would study (a) possible underreporting of tobacco use among certain demographic groups in some countries, (b) measures of industry activities, (c) optimal sampling strategies, (d) sentinel surveillance, (e) networks of tobacco companies and their partners as they promote tobacco use and interfere with implementation of the FCTC, and (f) network/relationship factors that impact diffusion of knowledge and decision making on the implementation of the FCTC. In addition, we call for a review process of existing surveillance and evaluation strategies to coordinate activities to make optimal use of existing resources. This activity would involve networking as prescribed in Article 22.

CONCLUSIONS

Studies and activities such as these would facilitate control of the tobacco epidemic.

Tobacco use in 3 billion individuals from 16 countries: an analysis of nationally representative cross-sectional household surveys

BACKGROUND

Despite the high global burden of diseases caused by tobacco, valid and comparable prevalence data for patterns of adult tobacco use and factors influencing use are absent for many low-income and middle-income countries. We assess these patterns through analysis of data from the Global Adult Tobacco Survey (GATS).

METHODS

Between Oct 1, 2008, and March 15, 2010, GATS used nationally representative household surveys with comparable methods to obtain relevant information from individuals aged 15 years or older in 14 low-income and middle-income countries (Bangladesh, Brazil, China, Egypt, India, Mexico, Philippines, Poland, Russia, Thailand, Turkey, Ukraine, Uruguay, and Vietnam). We compared weighted point estimates and 95% CIs of tobacco use between these 14 countries and with data from the 2008 UK General Lifestyle Survey and the 2006-07 US Tobacco Use Supplement to the Current Population Survey. All these surveys had cross-sectional study designs.

FINDINGS

In countries participating in GATS, 48·6% (95% CI 47·6-49·6) of men and 11·3% (10·7-12·0) of women were tobacco users. 40·7% of men (ranging from 21·6% in Brazil to 60·2% in Russia) and 5·0% of women (0·5% in Egypt to 24·4% in Poland) in GATS countries smoked a tobacco product. Manufactured cigarettes were favoured by most smokers (82%) overall, but smokeless tobacco and bidis were commonly used in India and Bangladesh. For individuals who had ever smoked daily, women aged 55-64 years at the time of the survey began smoking at an older age than did equivalently aged men in most GATS countries. However, those individuals who had ever smoked daily and were aged 25-34-years when surveyed started to do so at much the same age in both sexes. Quit ratios were very low (<20% overall) in China, India, Russia, Egypt, and Bangladesh.

INTERPRETATION

The first wave of GATS showed high rates of smoking in men, early initiation of smoking in women, and low quit ratios, reinforcing the view that efforts to prevent initiation and promote cessation of tobacco use are needed to reduce associated morbidity and mortality.

FUNDING

Bloomberg Philanthropies' Initiative to Reduce Tobacco Use, Bill and Melinda Gates Foundation, Brazilian and Indian Governments.

Dispelling myths about gender differences in smoking cessation: population data from the USA, Canada and Britain

OBJECTIVES

Based mainly on findings from clinical settings, it has been claimed that women are less likely than men to quit smoking successfully. If true, this would have important implications for tobacco control interventions. The authors aimed to test this possibility using data from general population surveys.

METHODS

The authors used data from major national surveys conducted in 2006-2007 in the USA (Tobacco Use Supplement to the Current Population Survey), Canada (Canadian Tobacco Use Monitoring Survey) and the UK (General Household Survey) to estimate rates of smoking cessation by age in men and women.

RESULTS

The authors found a pattern of gender differences in smoking cessation which was consistent across countries. Below age 50, women were more likely to have given up smoking completely than men, while among older age groups, men were more likely to have quit than women. Across all age groups, there was relatively little difference in cessation between the sexes.

CONCLUSIONS

Conclusions about gender differences in smoking cessation should be based on evidence from the general population rather than from atypical clinical samples. This study has found convincing evidence that men in general are not more likely to quit smoking successfully than women.

Menthol brand switching among adolescents and young adults in the National Youth Smoking Cessation Survey

This study examines patterns of menthol and nonmenthol cigarette use from 2003 to 2005 in a cohort of smokers, aged 16 to 24 years in the National Youth Smoking Cessation Survey. At follow-up, 15.0% of baseline menthol smokers had switched to nonmentholated cigarettes; by contrast, 6.9% of baseline nonmenthol smokers had switched to mentholated cigarettes. Differences in switching patterns were evident by gender, race/ethnicity, parental education, and smoking frequency. These data support previous evidence that young smokers start with mentholated cigarettes and progress to nonmentholated cigarettes.

Abstract 1662: Pleiotropic effects on lung cancer of genetic susceptibility variants identified for other malignancies: The Population Architecture using Genomics and Epidemiology Study

Genome-wide association studies of cancer have succeeded in identifying over 100 susceptibility loci, including some, such as those found at chromosome 8q24 and CPTM1L-TERT that influence the risk of several malignancies. As part of the Population Architecture using Genomics and Epidemiology (PAGE) Study, we evaluated whether established risk variants for 18 different cancer sites, excluding the lung, impact the risk of lung cancer. A total of 152 risk variants for these 18 malignancies were selected from genome-wide association studies of cancer published through May, 2009. These SNPs were genotyped in lung cancer case-control studies of the Atherosclerosis Risk in Communities (ARIC; cases/controls=297/3088), Epidemiologic Architecture for Genes Linked to Environment (EAGLE; cases/controls=432/1567), Multiethnic Cohort (MEC; cases/controls=461/9029), and the Women's Health Initiative (WHI; cases/controls=1600/5848). The total study population was comprised of 2,790 lung cancer cases and 19,532 controls of African, American Indian, Asian, European, Latino, and Pacific Islander ancestry. For each study site, unconditional logistic regression was performed to evaluate the association between SNPs and lung cancer risk, adjusting for age, sex, race/ethnicity, and smoking status. A fixed-effect meta-analysis was performed and heterogeneity across study sites was tested. Seventeen of the 152 SNPs were associated with lung cancer risk (nominal P&lt;0.05): five breast cancer SNPs, one glioma SNP, three acute lymphocytic leukemia SNPs, one melanoma SNP, one non-Hodgkin lymphoma SNP, and six prostate cancer SNPs. By chance, only eight associations would be expected for the 152 tests (152 x 0.05=8) performed, suggesting robust significant associations among the 17 associated SNPs. The top associations (P&lt;0.01) were observed for: breast cancer SNP (rs3803662 at TOX3: OR=1.13; P=1.1x10−3), prostate cancer SNP (rs7837688 at 8q24: OR=1.19; P=5.2x10−3), and melanoma SNP (rs910873 at PIGU: OR=0.79; P=5.9x10−3). No evidence of heterogeneous effects across study sites was observed. Other analyses will test for independent genetic effects among the associated loci and examine stratified effects by sex, cell-type, and smoking status. In conclusion, findings from our meta-analysis suggest that lung cancer may share genetic risk factors and common etiologic pathways with several cancer sites.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 1662. doi:1538-7445.AM2012-1662

Smokers' self-reported responses to the introduction of reduced ignition propensity (RIP) cigarettes

BACKGROUND

Changes in cigarette design to meet mandated fire safety standards may have unintended effects on smoker responses by diminishing the consumer's perceptions of product acceptability, smoking and increasing fire-risk behaviours. To address these concerns, population-level data are needed from a jurisdiction where reduced ignition propensity (RIP) cigarettes have been introduced.

METHODS

A cohort of adult smokers was recruited in Massachusetts, U.S.A. using a random-digit-dialed telephone survey. The cohort was contacted prior to, and 8 months following, the state-mandated introduction of RIP cigarettes on 1 January 2008. Changes in self-reported subjective cigarette characteristics, smoking topography, fire-risk behaviours, fire events and quitting intentions were assessed.

RESULTS

A total of 620 Massachusetts smokers completed the baseline survey conducted prior to implementation of the law, and 353 (57%) completed the follow-up survey conducted after implementation. No significant changes were found in self-reported fire-risk behaviour or quitting intentions. In addition, smokers were less likely to report smoking greater than 20 cigarettes per day and inhaling deeply into the chest after the law.

CONCLUSIONS

The introduction of RIP cigarettes in Massachusetts yielded little change, and no adverse effect, on self-reported smoker response, among a sample of mostly Caucasian smokers.

Comparison of serum cotinine concentration within and across smokers of menthol and nonmenthol cigarette brands among non-Hispanic black and non-Hispanic white U.S. adult smokers, 2001-2006

BACKGROUND

The Food and Drug Administration (FDA) is examining options for regulating menthol content in cigarettes. There are many pharmacologic properties of menthol that may facilitate exposure to tobacco smoke, and it has been suggested that the preference for menthol cigarettes in black smokers accounts for their higher cotinine levels.

OBJECTIVE

To assess cigarettes smoked per day-adjusted cotinine levels in relation to smoking a menthol or nonmenthol cigarette brand among non-Hispanic black and white U.S. adult smokers under natural smoking conditions.

METHOD

Serum cotinine concentrations were measured in 1,943 smokers participating in the 2001 to 2006 National Health and Nutrition Examination Surveys (NHANES). The effect of smoking a menthol brand on cigarettes smoked per day-adjusted serum cotinine levels in these two populations was modeled by adjusting for sex, age, number of smokers living in the home, body weight, time since last smoked, and FTC (Federal Trade Commission)-measured nicotine levels. The 8- or 12-digit Universal Product Code (UPC) on the cigarette label was used to determine the cigarette brand and whether it was menthol.

RESULTS

Smoking a menthol cigarette brand versus smoking a nonmenthol cigarette brand was not associated (P ≥ 0.05) with mean serum cotinine concentration in either black or white smokers.

CONCLUSIONS

The higher levels of cotinine observed in black smokers compared with white smokers are not explained by their higher preference for menthol cigarette brands.

IMPACT

Further studies like ours are needed to improve our ability to understand health consequences of future changes in tobacco product design.

Psychological distress and smoking behavior: the nature of the relation differs by race/ethnicity

OBJECTIVE

We explored how the relation between psychological distress and smoking behavior differed as a function of race/ethnicity of respondents to a representative national survey.

METHODS

Data from the 2007 Health Information National Trends Survey were analyzed. Participants reported experiences of psychological distress in the past 30 days, race/ethnicity, current smoking status (smoker/nonsmoker), and number of cigarettes smoked per day. Logistic regression and linear regression analyses were used to examine the influence of race, distress, and their interaction on smoking behavior using survey weighting techniques to account for sampling strategy and nonresponse.

RESULTS

For current smoking status, there was a significant interaction between race and psychological distress. Follow-up analyses indicated that psychological distress was related to smoking status for White but not for Black or Hispanic respondents. Similar results were found for number of cigarettes smoked per day among current smokers.

CONCLUSIONS

The results suggest that the often-reported association between psychological distress and smoking is relatively specific to White individuals. The relation does not appear to characterize either Black or Hispanic individuals.

Cigarettes sold in China: design, emissions and metals

BACKGROUND

China is the home to the world's largest cigarette maker, China National Tobacco Company (CNTC), yet little is known publicly about the design and emissions of Chinese cigarettes. CNTC is currently in the process of consolidating its brands and has ambitions to export its cigarettes. Machine-measured tar yields of many of its cigarette brands have also been reduced, similar to what occurred in Western countries from the 1970s through the 1990s with so-called 'low-tar' cigarettes introduced to address consumer concerns about health risks from smoking.

METHOD

The current study examines the design and physical characteristics, labelled smoke emissions and tobacco metals content of leading brands of Chinese cigarettes from seven cities purchased in 2005-6 and in 2007.

RESULTS

Findings suggest that similar to most countries, tar levels of Chinese cigarettes are predicted primarily by tobacco weight and filter ventilation. Ventilation explained approximately 50% of variation observed in tar and 60% variation in carbon monoxide yields. We found little significant change in key design features of cigarettes purchased in both rounds. We observed significant levels of various metals, averaging 0.82 μg/g arsenic (range 0.3-3.3), 3.21 μg/g cadmium (range 2.0-5.4) and 2.65 μg/g lead (range 1.2-6.5) in a subsample of 13 brands in 2005-6, substantially higher than contemporary Canadian products.

CONCLUSION

Results suggest that cigarettes in China increasingly resemble those sold in Western countries, but with tobacco containing higher levels of heavy metals. As CNTC looks to export its product around the world, independent surveillance of tobacco product characteristics, including tobacco blend characteristics, will become increasingly important.

State-level tobacco control policies and youth smoking cessation measures

OBJECTIVE

Research on the effects of state-level tobacco control policies targeted at youth has been mixed, with little on the effects of these policies and youth smoking cessation. This study explored the association between state-level tobacco control policies and youth smoking cessation behaviors from 1991 to 2006.

METHODS

The study design was a population-based, nested survey of students within states. Study participants were 8th, 10th, and 12th graders who reported smoking "regularly in the past" or "regularly now" from the Monitoring the Future study. Main cessation outcome measures were: any quit attempt; want to quit; non-continuation of smoking; and discontinuation of smoking.

RESULTS

Results showed that cigarette price was positively associated with a majority of cessation-related measures among high school smokers. Strength of sales to minors' laws was also associated with adolescent non-continuation of smoking among 10th and 12th graders.

CONCLUSIONS

Findings suggest that increasing cigarette price can encourage cessation-related behaviors among high school smokers. Evidence-based policy, such as tax increases on tobacco products, should be included as an important part of comprehensive tobacco control policy, which can have a positive effect on decreasing smoking prevalence and increasing smoking cessation among youth.

Abstract B37: Negative affect and fruit/vegetable consumption: The nature of the relation differs by race/ethnicity

Dietary practices, including low fruit and vegetable consumption, are associated with risk for multiple cancers. Some work has shown that negative affectivity is associated with lower fruit and vegetable consumption. Previous work from our lab has shown that smoking behavior is differently associated with negative affectivity as a function of race/ethnicity. Given this evidence, it is plausible that the relationship between negative affectivity and fruit/vegetable consumption might also differ by race. To examine this question, data from the National Cancer Institute's Health Information National Trends Survey (HINTS) were used. Respondents reported current negative affect, daily fruit and vegetable consumption, and race. Linear regression analyses examined race, negative affect, and their interaction as predictors of fruit/vegetable consumption. Race analyses compared White (n=5445) to Black (n=687) respondents. Analyses controlled for demographics and were run in STATA10 using complex survey design techniques to account for the HINTS sampling design. For the overall sample, there was a significant relation between negative affect and fruit/vegetable consumption; r=-.15, p &lt; .05. However, this effect was qualified by a marginally significant race x negative affect interaction; f=1.74, p=0.08. When examined separately by race, the relation of negative affectivity to behavior was significant for White (f=2.73, p &lt; .05) but not Black respondents (f &lt; 1, ns). These findings indicate that the relation of negative affect to fruit/vegetable consumption may differ by race/ethnicity and may be more applicable to White individuals. This has implications for understanding factors that influence dietary behavior and for developing intervention strategies to address diet for members of racial/ethnic minority groups.

Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B37.

Does switching to reduced ignition propensity cigarettes alter smoking behavior or exposure to tobacco smoke constituents?

INTRODUCTION

Since 2004, several jurisdictions have mandated that cigarettes show reduced ignition propensity (RIP) in laboratory testing. RIP cigarettes may limit fires caused by smoldering cigarettes, reducing fire-related deaths and injury. However, some evidence suggests that RIP cigarettes emit more carbon monoxide and polycyclic aromatic hydrocarbons, and smokers may alter their smoking patterns in response to RIP cigarettes. Both of these could increase smokers' exposures to harmful constituents in cigarettes.

METHODS

An 18-day switching study with a comparison group was conducted in Boston, MA (N = 77), and Buffalo, NY (N = 83), in 2006-2007. Current daily smokers completed 4 laboratory visits and two 48-hr field data collections. After a 4-day baseline, Boston participants switched to RIP cigarettes for 14 days, whereas Buffalo participants smoked RIP cigarettes throughout. Outcome measures included cigarettes smoked per day; smoking topography; salivary cotinine; breath CO; and hydroxylated metabolites of pyrene, naphthalene, phenanthrene, and fluorene. Because the groups differed demographically, analyses adjusted for race, age, and sex.

RESULTS

We observed no significant changes in smoking topography or CO exposure among participants who switched to RIP cigarettes. Cigarette use decreased significantly in the switched group (37.7 cigarettes/48 hr vs. 32.6 cigarettes/48 hr, p = .031), while hydroxyphenanthrenes increased significantly (555 ng/g creatinine vs. 669 ng/g creatinine, p = .007). No other biomarkers were significantly affected.

DISCUSSION

Small increases in exposure to phenanthrene among smokers who switched to RIP versions were observed, while other exposures and smoking topography were not significantly affected. Toxicological implications of these findings are unclear. These findings should be weighed against the potential public health benefits of adopting RIP design standards for cigarette products.