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.

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.

Cigarette characteristic and emission variations across high-, middle- and low-income countries

OBJECTIVES

The public health burden of tobacco use is shifting to the developing world, and the tobacco industry may apply some of its successful marketing tactics, such as allaying health concerns with product modifications. This study used standard smoking machine tests to examine the extent to which the industry is introducing engineering features that reduce tar and nicotine to cigarettes sold in middle- and low-income countries.

STUDY DESIGN

Multicountry observational study.

METHODS

Cigarettes from 10 different countries were purchased in 2005 and 2007 with low-, middle- and high-income countries identified using the World Bank's per capita gross national income metric. Physical measurements of each brand were tested, and tobacco moisture and weight, paper porosity, filter ventilation and pressure drop were analysed. Tar, nicotine and carbon monoxide emission levels were determined for each brand using International Organization for Standardization and Canadian Intensive methods. Statistical analyses were performed using Statistical Package for the Social Sciences.

RESULTS

Among cigarette brands with filters, more brands were ventilated in high-income countries compared with middle- and low-income countries [χ(2)(4)=25.92, P<0.001]. Low-income brands differed from high- and middle-income brands in engineering features such as filter density, ventilation and paper porosity, while tobacco weight and density measures separated the middle- and high-income groups. Smoke emissions differed across income groups, but these differences were largely negated when one accounted for design features.

CONCLUSIONS

This study showed that as a country's income level increases, cigarettes become more highly engineered and the emissions levels decrease. In order to reduce the burden of tobacco-related disease and further effective product regulation, health officials must understand cigarette design and function within and between countries.

Cigarette characteristic and emission variations across high-, middle- and low-income countries

OBJECTIVES

The public health burden of tobacco use is shifting to the developing world, and the tobacco industry may apply some of its successful marketing tactics, such as allaying health concerns with product modifications. This study used standard smoking machine tests to examine the extent to which the industry is introducing engineering features that reduce tar and nicotine to cigarettes sold in middle- and low-income countries.

STUDY DESIGN

Multicountry observational study.

METHODS

Cigarettes from 10 different countries were purchased in 2005 and 2007 with low-, middle- and high-income countries identified using the World Bank's per capita gross national income metric. Physical measurements of each brand were tested, and tobacco moisture and weight, paper porosity, filter ventilation and pressure drop were analysed. Tar, nicotine and carbon monoxide emission levels were determined for each brand using International Organization for Standardization and Canadian Intensive methods. Statistical analyses were performed using Statistical Package for the Social Sciences.

RESULTS

Among cigarette brands with filters, more brands were ventilated in high-income countries compared with middle- and low-income countries [χ(2)(4)=25.92, P<0.001]. Low-income brands differed from high- and middle-income brands in engineering features such as filter density, ventilation and paper porosity, while tobacco weight and density measures separated the middle- and high-income groups. Smoke emissions differed across income groups, but these differences were largely negated when one accounted for design features.

CONCLUSIONS

This study showed that as a country's income level increases, cigarettes become more highly engineered and the emissions levels decrease. In order to reduce the burden of tobacco-related disease and further effective product regulation, health officials must understand cigarette design and function within and between countries.

Ignoring puff counts: another shortcoming of the Federal Trade Commission cigarette testing programme

OBJECTIVES

To examine reasons behind the failure of the Federal Trade Commission (FTC) to preserve puff count information from standard cigarette testing and to elucidate the importance of puff count to overall tar yields.

METHODS

We reviewed industry documents on origins of the FTC test and datasets provided by the Tobacco Institute Testing Laboratory to the tobacco industry and FTC for reporting purposes.

RESULTS

The majority of the tobacco industry argued for "dual reporting" of tar yields-both per cigarette and per puff. Despite a request from the Tobacco Institute in 1967 that puff count information be preserved, documents and recent communications with the FTC indicate that puff number data have not been maintained by the government. In contrast, for the cigarette industry, puff count data are a fundamental and routine part of testing and important to cigarette design. A sample of puff counts for cigarettes tested in 1996 (n = 471) shows that on average 100 mm cigarettes have 18% more puffs taken on them than do 85 mm cigarettes in standard tests (7.66 vs 9.03; p<0.01). The 10th percentile puff count is 6.8 and the 90th percentile is 8.8 for king size; the 10th percentile puff count is 8.2 and the 90th percentile is 10.0 for 100 mm cigarettes, indicating that puff counts can vary substantially among brands.

CONCLUSIONS

The FTC has failed to seek or preserve puff count information that the industry finds important. Any standard test of tar and nicotine yields should at minimum preserve puff count information.

How do different cigarette design features influence the standard tar yields of popular cigarette brands sold in different countries?

OBJECTIVES

To examine the associations among cigarette design features and tar yields of leading cigarette brands sold in the United States, Canada, Australia and the United Kingdom.

METHODS

Government reports and numbers listed on packs were used to obtain data on International Organization for Standardization (ISO)/Federal Trade Commission (FTC) yields for the tar of 172 cigarette varieties sold in the United States, Canada, Australia and the United Kingdom. We used standardised methods to measure the following 11 cigarette design parameters: filter ventilation, cigarette pressure drop, filter pressure drop, tobacco rod length, filter length, cigarette diameter, tipping paper length, tobacco weight, filter weight, rod density and filter density.

RESULTS

Filter ventilation was found to be the predominant design feature accounting for the variations between brands in ISO/FTC tar yields in each of the four countries. After accounting for filter ventilation, design parameters such as overwrap length, tobacco weight and rod density played comparatively minor roles in determining tar yields.

CONCLUSIONS

Variation in ISO/FTC tar yields are predicted by a limited set of cigarette design features, especially filter ventilation, suggesting that governments should consider mandatory disclosure of cigarette design parameters as part of comprehensive tobacco product regulations.

Relationship between constituent labelling and reporting of tar yields among smokers in four countries

Countries have adopted different approaches to disseminating cigarette tar, nicotine, and carbon monoxide (CO) levels to consumers, with some (e.g. EU member states, Canada, Australia, but not the United States) requiring disclosure of results from the International Organization for Standardization (ISO) test method on packs. Cross-country comparisons can provide insight into how smokers use yields when information is presented differently. We examined whether smokers in four different countries could recall the tar yield of their brand of cigarettes, using data from the third wave of the International Tobacco Control Four Country Survey (ITC-4). Of current smokers in the United States, Canada, Australia and the United Kingdom, 33.6% gave a numeric response when asked to report the tar yield of their brand, whereas 66.4% responded 'I don't know.' American participants (9.2%) were less likely than Canadian (28.0%), UK (36.5%) or Australian (68.2%) smokers to give an answer, even after controlling for sociodemographic and smoking behaviour factors. Constituent labelling policies can affect whether smokers report a tar yield for their cigarette brand. Pack labelling appears to be useful for conveying information about cigarettes to smokers; however, there is an urgent need to develop more meaningful information on toxic constituents of cigarette smoke.

Maximum yields might improve public health--if filter vents were banned: a lesson from the history of vented filters

Filter ventilation is the dominant design feature of the modern cigarette that determines yields of tar, nicotine, and carbon monoxide on smoking machine tests. The commercial use of filter ventilation was precipitated by the 1964 United States Surgeon-General's report, further advanced by the adoption of an official Federal Trade Commission test in 1967, and still further advanced by the inclusion of a gas phase (carbon monoxide) measure in 1979. The first vented-filter brand on the market in the United States (Carlton) in 1964 and the second major vented-filter brand (True) in 1966 illustrate this. Ultimately, filter ventilation became a virtually required way to make very low tar cigarettes (less than 10 mg or, even more so, less than 5 mg tar). The key to the lower tar cigarette was not, in effect, the advanced selective filtration design characteristics or sophisticated tobacco selection or processing as envisioned by experts (although these techniques were and are used); the key to the very much lower tar cigarette was simply punching holes in the filter. We propose that the banning of filter vents, coupled with low maximum standard tar, nicotine, and carbon monoxide yields, would contribute to making cigarettes much less palatable and foster smoking cessation or the use of clearly less hazardous nicotine delivery systems. It may be necessary to link low maximum yields with the banning of filter ventilation to achieve public health benefit from such maxima.

"Not safe" is not enough: smokers have a right to know more than there is no safe tobacco product

The right to health relevant information derives from the principles of autonomy and self direction and has been recognised in international declarations. Providing accurate health information is part of the basis for obtaining "informed consent" and is a recognised component of business ethics, safety communications, and case and product liability law. Remarkably, anti-tobacco and pro-tobacco sources alike have come to emphasise the message that there is "no safe cigarette" or "no safe tobacco product". We propose that the "no safe" message is so limited in its value that it represents a violation of the right to health relevant information. There is a need to go beyond saying, "there is no safe tobacco product" to indicate information on degree of risks. The "no safe tobacco" message does not contradict, for example, the mistaken belief that so called light or low tar cigarettes are safer choices than higher tar cigarettes. We encourage a kind of "rule utilitarian" ethical position in which the principle of truth telling is observed while trying to produce the greatest good for the greatest number of people. Although harm reduction approaches to easing the burden of tobacco related diseases are founded on science based comparative risk information, the right to health information is independently related to the need to promote health literacy. This right should be respected whether or not harm reduction policies are judged advisable.

Three soliloquies on tobacco industry funding of university research

The view on tobacco industry funding for university research, from three very differing perspectives

More on the regulation of tobacco smoke: how we got here and where next

The modern cigarette is unnecessarily dangerous. Despite being lower in tar yield, and consequently in squamo-carcinogenic polyaromatic hydrocarbons such as benzo[a]pyrene, the nitrosamine yields are often higher than they need to be. Also, reductions in tar levels have not led to the consequential reductions in mortality that were anticipated several decades ago. The modern cigarette is also smoother, easier to smoke and to learn how to smoke, highly addictive and facilitates compensatory smoking. Compensatory smoking leads to excess inhalation of carcinogens and toxins in the hunt for nicotine. Its labelling is misleading in that supposedly low-yielding cigarettes may, due to compensation occurring as a result of cigarette design, lead to inhalation of much higher amounts of nicotine, carcinogens and toxins than the smoker is led to expect. Regulation of the product is needed to provide the persistent smoker with a cigarette lower in risk, accurately labelled, providing a relatively consistent and known dose of nicotine, and less likely to facilitate compensatory smoking. This will not produce a safe cigarette but should result in a reduction in harm if seriously implemented.

First, tell the truth: a dialogue on human rights, deception, and the use of smokeless tobacco as a substitute for cigarettes

The use of smokeless tobacco as a substitute for cigarettes raises many scientific and ethical issues, as the fictitious discussion below reveals.

Cigarette filter ventilation is a defective design because of misleading taste, bigger puffs, and blocked vents

OBJECTIVE

To review tobacco industry documents on filter ventilation in light of published studies and to explore the role of filter ventilation in the design of cigarettes that deliver higher smoke yields to smokers than would be expected from standard machine smoked tests (Federal Trade Commission (FTC), International Organization for Standardization (ISO)).

DATA SOURCES

Searched from November 1999 to November 2000 internet databases of industry documents (www.pmdocs.com, www.rjrtdocs.com, www.lorillarddocs.com, www.bw.aalatg.com, www.cdc.gov/tobacco/industrydocs, www.tobaccodocuments.org, www.tobaccopapers.org, www.hlth.gov.bc.ca/Guildford, www.cctc.ca/ncth/Guildford, www.cctc.ca/ncth/Guildford2) for documents related to filter ventilation. Documents found dated from 1955 through 1994.

STUDY SELECTION

Those documents judged to contain the most relevant information or data on filter ventilation related to cigarette taste and compensatory smoking, while also trying to avoid redundancy from various documents deriving from the same underlying data.

DATA SYNTHESIS

Filter ventilation is a crucial design feature creating three main problems for lower tar cigarettes as measured by official smoking machine testing. Firstly, it misleadingly makes cigarettes taste lighter and milder, and, therefore, they appear less dangerous to smokers. Secondly, it promotes compensation mainly by facilitating the taking of larger puffs. Thirdly, for very heavily ventilated cigarettes (that is, > 65% filter air dilution), behavioural blocking of vents with lips or fingers is an additional contributor to compensatory smoking. These three effects are found in industry research as well as published research.

CONCLUSIONS

Filter ventilation is a dangerous, defective technology that should be abandoned in less hazardous nicotine delivery systems. Health interested groups should test cigarettes in a way that reflects compensatory smoking. Lower tar (vented filter) cigarettes should be actively countermarketed.

Persistent effects of a message counter-marketing light cigarettes: results of a randomized controlled trial

In a randomized, controlled trial, a national sample of smokers of Light cigarettes heard by telephone a "radio message" counter-marketing Light cigarettes. This message caused immediate changes in beliefs. Follow-up telephone interviews were done about 7 months later. The Message Group (N = 181) was more likely than the Control Group (N = 85) to report that (a) one Light equaled one Regular in tar yield to smokers, (b) Lights did not decrease health risks, and (c) they wanted to give up smoking (P<.05); they did not report greater quitting or intention to quit, or greater knowledge of filter ventilation. Systematic counter-marketing of Lights is recommended. A telephone-based exposure and follow-up procedure could be a good way to study message effects.

Massachusetts' advertising against light cigarettes appears to change beliefs and behavior

OBJECTIVES

This study examined the effects of advertising directed against light cigarettes (lights).

METHODS

In a quasi-experimental post-test-only design, smokers and ex-smokers (

RESULTS

Compared with the U.S., the MASS sample contained more, recent ex-smokers (10% vs. 7% in the U.S.) and more smokers of higher tar cigarettes (44% vs. 35% smokers of regular cigarettes); more U.S. respondents thought lights had at least a slim chance of reducing the risk of health problems (49% vs. 32%). Within MASS, smokers who saw anti-light ads were less likely to think lights decreased the risk of health problems (26% vs. 44%) and more likely to know of filter vents (64% vs. 47%). These effects remained statistically reliable after adjusting for confounders.

CONCLUSIONS

Amidst extensive anti-smoking efforts, the MASS campaign to counter-market light cigarettes appears to promote smoking cessation and to inform smokers of the risks of light cigarettes. Further counter-marketing efforts should be encouraged.

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Key Words Collapse

MESH Headings

• Adult
• Advertising
• Age Distribution
• Analysis of Variance
• Attitude to Health
• Chi-Square Distribution
• Female
• Humans
• Logistic Models
• Male
• Massachusetts/epidemiology
• Middle Aged
• Plants, Toxic
• Population Surveillance
• Sex Distribution
• Smoking/epidemiology
• Smoking Prevention
• Statistics, Nonparametric
• Surveys and Questionnaires
• Nicotiana/classification
• United States/epidemiology

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Grants Collapse

Effect of filter vent blocking on carbon monoxide exposure from selected lower tar cigarette brands

Two studies were conducted to determine the effect of blocking filter vents on carbon monoxide (CO) exposure under ad lib smoking conditions. In Study 1, 12 daily cigarette smokers smoked cigarettes from the brands Now (1 mg tar by the FTC Method) and Marlboro Lights (10 mg tar) under each of two vent-blocking conditions (unblocked and finger blocked). Blocking filter vents with fingers led to an 85% increase in CO for the brand Now, but had no added effect on CO exposure from the Marlboro Lights. In Study 2, another 12 daily cigarette smokers smoked cigarettes from each of four additional brands: Carlton (1 mg tar), Now (2 mg tar), Virginia Slims Ultra-lights (5 mg tar), and Virginia Slims Lights (8 mg tar). Blocking filter vents with the lips caused all four brands to produce equal CO exposures. Blocking vents increased smokers' exposure to CO by 239% when smoking Carltons and by 44% when smoking Nows. No significant increases in CO with blocking were found for either of the Virginia Slims brands. These results suggest that the degree to which a brand is ventilated determines whether that brand is susceptible to increased CO yields as a result of vent blocking.

Smoker reactions to a "radio message" that Light cigarettes are as dangerous as Regular cigarettes

The purpose of this study was to examine in a systematic, controlled fashion the reactions of smokers to scientifically correct information about the risks of smoking Light cigarettes (about 6-15 mg tar by the FTC method). Random-digit dialing, computer-assisted telephone interviews were used to locate daily smokers of Light cigarettes. In an experimental design, smokers were randomly assigned to listen (n = 293) or not (n = 275) to a persuasive simulated radio message on the risks of Light cigarettes; 108 of those who did not listen to the message in the first part of the interview were played the message in the second part, to evaluate some repeated-measures effects. Those who heard the message were more likely to report that one Light cigarette could give a smoker the same amount of tar as one Regular cigarette and that Light cigarettes were more dangerous: 55% said the message made them think more about quitting and 46% said the message increased the amount they wanted to quit; 42% said that after hearing the message they thought Light cigarettes were more dangerous. Using the Theory of Planned Behavior, structural equation modeling analysis indicated that the message acted to increase intention to quit smoking by increasing the desire to quit smoking. Seventy-three per cent of the smokers agreed that it was important to play such messages widely on the radio; 77% agreed that there should be a warning on packs that vent blocking increases tar; 61% agreed that the location of filter vents should be marked. The majority of smokers of Light cigarettes seem to value being informed that Light cigarettes are as dangerous for them as Regular cigarettes, and this information increases their intentions to quit smoking.

Smokers' misperceptions of light and ultra-light cigarettes may keep them smoking

INTRODUCTION

This study examined smokers' understanding of the relative tar deliveries of Ultra-light, Light, and Regular cigarettes, reasons for smoking Ultra-light/Light cigarettes, and the likelihood of both quitting smoking and switching to Regular cigarettes if they came to learn that one Ultra-light/Light cigarette gave the same amount of tar as one Regular cigarette.

DESIGN

Ten- to fifteen-minute random-digit-dialed, computer-assisted telephone interviews (CATI) were conducted with both a national probability sample (n = 788) and a state random sample (n = 266) of daily smokers over the age of 18.

RESULTS

Less than 10% of smokers in the national sample and only 14% of smokers in the state sample knew that one Light cigarette could give the same amount of tar as one Regular cigarette. Less than 10% of smokers in the state sample knew that one Ultra-light cigarette could give the same amount of tar as one Regular cigarette. Thirty-two percent of the Light and 26% of the Ultra-light smokers in the national sample, and 27% of Light and 25% of Ultra-light smokers in the state sample, said they would be likely to quit smoking if they learned one Light/Ultra-light equaled one Regular.

CONCLUSION

Many Light and Ultra-light smokers are smoking these cigarettes to reduce the risks of smoking and/or as a step toward quitting. However, these smokers are unaware that one Ultra-light/Light cigarette can give them the same amount of tar and nicotine as one Regular cigarette. Many of the Ultra-light/Light smokers sampled in this study stated that they would be likely to quit if they knew this information. Mistaken beliefs about low-yield brands are reducing intentions to quit smoking.

Blocking filter vents increases carbon monoxide levels from ultralight, but not light cigarettes

Effect of vent blocking on carbon monoxide (CO) exposure from a best-selling light cigarette was examined in 12 daily cigarette smokers. Mean CO boosts were not different from each other with (a) 0% filter vents blocked (5.0 ppm), (b) vents covered with lips (4.9 ppm), (c) 50% of vents covered with tape (4.8 ppm), and (d) vents covered with a pinch of the fingertips (4.9 ppm). A second study in another 12 smokers was conducted to replicate these findings as well as earlier findings that blocking vents doubles CO intake from 1-mg tar cigarettes. While blocking half the vents with fingers significantly increased CO boost from ultralight cigarettes (2.8 vs. 5.4 ppm, p < 0.001), it did not influence boosts from light cigarettes (6.3 vs. 6.5 ppm, p = 0.8). The lowest yield cigarettes (1 mg tar) may be special. Smoking machine simulations provide poor models of human smoke intake. It is unclear whether tar and nicotine intake from light cigarettes was influenced by vent blocking.

Filter ventilation and nicotine content of tobacco in cigarettes from Canada, the United Kingdom, and the United States

OBJECTIVES

The purpose was to determine filter ventilation and the nicotine content of tobacco and their contribution to machine-smoked yields of cigarettes from the United States, Canada, and the United Kingdom.

METHODS

Ninety-two brands of cigarettes (32 American, 23 Canadian, and 37 British brands) were purchased at retail outlets in State College, Pennsylvania, United States, Toronto, Canada, and London, United Kingdom. A FIDUS FDT filter ventilation tester measured the percentage air-dilution from filter vents. High-pressure, liquid chromatography was used to measure the nicotine content of tobacco. Regression techniques were used to examine the contributions of tobacco nicotine content and filter ventilation to machine-smoked yields of tar, nicotine, and carbon monoxide (CO).

RESULTS

Ninety-four per cent of the American brands, 91% of the Canadian brands, and 79% of British brands were ventilated. The total nicotine content of tobacco and percent nicotine (by weight of tobacco) averaged 10.2 mg (standard error of the mean (SEM) 0.25, range: 7.2 to 13.4) and 1.5% (SEM 0.03, range 1.2 to 2) in the United States, 13.5 mg (SEM 0.49, range: 8.0 to 18.3) and 1.8% (SEM 0.06, range: 1.0 to 2.4) in Canada, 12.5 mg (SEM 0.33, range: 9 to 17.5) and 1.7% (SEM 0.04, range: 1.3 to 2.4) in the United Kingdom. Multiple regression analyses showed that ventilation was by far the largest factor influencing machine-smoked yields of tar, nicotine, and CO.

CONCLUSION

Filter ventilation appears to be the predominant method for reducing machine-smoked yields of tar, nicotine, and CO in three countries. However, some brands contain about twice as much nicotine (total content or percent nicotine) as do others, indicating that tobacco types or blends and tobacco castings can be used to manipulate nicotine content and nicotine delivery of cigarettes.

Individual differences in the subjective effects of the first cigarette of the day: a self-report method for studying tolerance

Some smokers are more sensitive than others to the subjective effects of cigarettes, especially the first cigarette of the day. This report explored self-reported subjective effects to the first cigarette of the day and examined the extent to which heaviness of smoking and years smoking are associated with subjective effects. In 3 independent samples (ns = 254, 116, 86). self-reports of light-headedness from the first cigarette of the day decreased with increasing heaviness of smoking and increasing the number of years smoking, suggesting that differences in responses were due to differences in chronic tolerance. Because measures of the subjective effects of drugs are useful in the study of drug response variability, this self-report item on light-headedness should be included in further research on individual differences in the subjective effects of cigarette smoking.

Smokers are unaware of the filter vents now on most cigarettes: results of a national survey

OBJECTIVE

To evaluate awareness and knowledge of cigarette filter ventilation in a national probability sample of smokers of Ultra-light, Light, and regular cigarettes.

DESIGN

Random-digit-dialling and computer-assisted telephone interviewing was used on a probability sample of daily cigarette smokers (ages 18 and above).

SUBJECTS AND SETTING

218 Smokers of Ultra-light cigarettes, 360 smokers of Light cigarettes, and 210 smokers of Regular cigarettes living in the continental United States.

MAIN OUTCOME MEASURES

Percentage of respondents indicating knowledge of the presence of filter vents and the consequences of behavioural blocking of vents.

RESULTS

Many smokers had not heard about or seen the filter holes: 43% (95% CI = 36 to 50%) of smokers of Ultra-lights, 39% (95% CI = 34 to 44%) of smokers of Lights, and 47% (95% CI = 40 to 54%) of smokers of Regulars. About two in three smokers either did not know of the existence of rings of small holes on the filters of some cigarettes, or did not know that blocking increases tar yields: 69% (95% CI = 63 to 75%) of Ultra-lights, 66% (95% CI = 61 to 71%) of Lights, and 69% (95% CI = 63 to 75%) of Regulars.

CONCLUSIONS

Smokers are generally unaware of the presence and function of filter vents-a major design feature subject to behavioural blocking by smokers and now present on most cigarettes in the United States. Smokers and policy-makers need to be informed about the presence of filter vents and how vent blocking increases tar and nicotine yields from ostensibly very low-yield cigarettes.

Measuring drug urges by questionnaire: do not balance scales

Measures designed to assess self-reported drug urges are routinely balanced; that is, they contain a relatively equal number of positively and negatively worded items. Using smoking urges as an example, we explored the effect of item wording on responses to self-report items. One hundred sixteen cigarette smokers responded to 32 positively worded statements and their 32 negatively worded counterparts adapted from the Questionnaire of Smoking Urges. For 59% of the paired statements, the negatively worded item was scored higher than the positively worded item. Significant mean differences (item means for 56% of the paired statements were significantly different at the .01 level) and only moderate correlations (mean = .54; range = -.04 to .79) between item pairs were found. Balanced scales may have greater costs than benefits in the assessment of drug urges.

Effect of cigarette smoking on alcohol treatment outcome

Although smoking cigarettes and drinking alcohol are highly correlated, little research has examined the effects of smoking on alcohol abusers' posttreatment functioning. Alcohol abusers (N = 155) were classified on the basis of their pretreatment smoking status as: nonsmoker, ex-smoker, low dependent smoker (first cigarette of the day > 10 minutes after waking), and high dependent smoker (first cigarette of the day < or = 10 minutes after waking). All subjects had received brief cognitive-behavioral outpatient treatment for their alcohol problem. Subjects who were less dependent on nicotine had fewer drinking days and fewer heavy drinking days prior to entering treatment than those who were more dependent on nicotine; the two nonsmoking groups had fewer abstinent days than the low nicotine-dependent subjects and fewer heavy drinking days than the high nicotine-dependent subjects. At the 1-year follow-up, the two smoking groups did not differ from each other on the alcohol variables but reported significantly more abstinent days than the two nonsmoking groups. Treatment implications are discussed.

Detection of vent-blocking on light and ultralight cigarettes

Trained raters can reliably identify vent-blocking in ultralight cigarettes based on tar stain patterns, yet detection of this phenomenon has not been previously studied in light cigarettes. This study was conducted to extend the research on vent-blocking in ultralight cigarettes to the much more popular light cigarettes. We wanted to find out if individuals could discriminate among stain patterns on cigarette butts with unblocked (0%), partially blocked (50%), and fully blocked (100%) vents using both light and ultralight cigarettes. Subjects were able to use the stain pattern technique to detect vent-blocking in light cigarettes as well as ultralight cigarettes.

Predicting smoking cessation with self-reported measures of nicotine dependence: FTQ, FTND, and HSI

In two independent studies, we explored the usefulness of three self-report measures of tobacco dependence--the Fagerström Tolerance Questionnaire (FTQ), the Fagerström Test for Nicotine Dependence (FTND), and the Heavy Smoking Index (HSI). The FTND is a revised version of the FTQ. The HSI is identical to a two-question subset of the FTND. Study 1 involved 932 participants in a seven-session, five-week, group smoking cessation program, and it looked at the ability of these self-report tests to predict expired air carbon monoxide (i.e., heaviness of smoking) at beginning of treatment and cessation at end of treatment. Study 2 involved 1877 participants in a self-help smoking cessation program, and it looked at the prediction of cessation at 16-month follow-up. All tests made statistically reliable predictions of smoking cessation, but generally accounted for little variance (about 1%). In Study 1, the test scores were associated positively with carbon monoxide levels. The shorter (six vs. eight questions), more reliable FTND is to be preferred to the FTQ; and the HSI (two questions) works as well as the FTND. Evidence is presented that suggests that samples of high-scoring smokers will not be well differentiated from the mid-range to the high-end of the scores.

Misuse of "light" cigarettes by means of vent blocking

Best-selling "light" cigarettes (9-12 mg tar, by FTC method; Federal Trade Commission, 1990) generally employ filter vents to reduce standard tar and nicotine yields. Earlier research on "ultra light" cigarettes (1-4 mg tar) showed that filter vents were blocked by human smokers leading to dramatic increases in tar and nicotine yields. An objective indicator of vent blocking was applied to a sample of 158 discarded light cigarette butts, and results indicated extreme vent blocking in 47% 27% ( +/- 8, 95% CI), some vent blocking in 26% ( +/- 8), and no vent blocking in 47% ( +/- 8). Cigarette consumers need to be informed of the risks of vent blocking as a countermeasure to the marketing of light cigarettes to health-conscious smokers.

Over-the-counter sleep aids: widely used but rarely studied

Over-the-counter (OTC) sleep aids are used in greater proportions than benzodiazepines for the treatment of sleep problems, yet limited research has focused on these nonprescription drugs. This article reports the results of two studies that examined the use of OTC sleep aids and alcohol for sleep problems by university students. Of those subjects in both studies who reported sleep problems 1 day per month or more, 6.4% of men and 11.4% of women reported using OTC sleep aids, however, a significantly greater percentage of men reported using alcohol to induce sleep (23.4% vs. 10.9%, p < .008). Future studies on OTC sleep aids are recommended to address a broader range of issues such as potential side effects and at-risk populations, tolerance effects, and individual differences in responsiveness and sensitivity to these drugs.

Patterns of alcohol, cigarette, and caffeine and other drug use in two drug abusing populations

Relationships were explored among the frequencies of use of various drugs by a sample of drug-abusing clients of the Addiction Research Foundation (ARF) in Toronto and by drug abusers volunteering to participate in research at the Addiction Research Center (ARC) in Baltimore. The two groups of drug-abusing individuals differed in a number of characteristics. Those from ARF were admitted primarily for diagnosis and possible treatment for alcohol and non-opioid drug problems, whereas those from the ARC were admitted for participation in research on other drugs of abuse, primarily involving opioids. Patterns of use of certain drugs tended to covary in both groups. Of particular interest was the finding that severity of alcoholism was directly related to various measures of tobacco and caffeinated beverage use. In contrast, there was little correlation between the frequency of use among other drugs of abuse (e.g., heroin, cannabis, glue) and the use of tobacco and caffeine. These findings suggest that dependence on nicotine, caffeine, and alcohol may be governed by the same factors and possibly should be considered jointly in the treatment of alcoholic persons. Frequency of use of other drugs examined may be controlled by other factors than those which determine level of use of tobacco and caffeine.

Age interacts with heaviness of smoking in predicting success in cessation of smoking

There is conflicting evidence regarding the relation between heaviness of smoking and the likelihood of quitting smoking. We investigated this issue using the data set of the 1986 Adult Use of Tobacco Survey, a telephone survey of the smoking behavior of noninstitutionalized, civilian, US adults aged greater than 16 years. Analyses were based on a subsample of 4,383 individuals who had made a serious attempt to stop smoking 1-10 years before the survey. Among younger smokers, the lighter smokers (less than 25 cigarettes/day) were the most likely to stop, whereas among older smokers, the heavier smokers (greater than or equal to 25 cigarettes/day) were the most likely to stop. These results indicate that age is an important factor in the relation between heaviness of smoking and success in quitting smoking.

The Fagerström Test for Nicotine Dependence: a revision of the Fagerström Tolerance Questionnaire

We examine and refine the Fagerström Tolerance Questionnaire (FTQ: Fagerström, 1978). The relation between each FTQ item and biochemical measures of heaviness of smoking was examined in 254 smokers. We found that the nicotine rating item and the inhalation item were unrelated to any of our biochemical measures and these two items were primary contributors to psychometric deficiencies in the FTQ. We also found that a revised scoring of time to the first cigarette of the day (TTF) and number of cigarettes smoked per day (CPD) improved the scale. We present a revision of the FTQ: the Fagerström Test for Nicotine Dependence (FTND).

Rehabilitating a genetic perspective in the study of tobacco and alcohol use

Despite comparable estimates of 'heritability' for tobacco smoking and alcohol drinking, the human genetics of drinking has been a fashionable topic for research, while the human genetics of smoking has been neglected or viewed with suspicion. The differing course of genetic themes in the alcohol and tobacco areas is discussed in relation to (a) different historical pressures which promoted disease models of alcoholism and 'bad habit' models of heavy smoking and (b) possible fundamental differences in the nature of cigarette and alcohol use. This topic is further complicated by the substantial co-occurrence of heavy smoking and heavy drinking, so that the genetic determinants may well over-lap. 'Cross-cultural' comparison of these contrasting interests in genetics is argued to be an important topic for future research.

Statistical control in research on alcohol and tobacco: an example from research on alcohol and mortality

Many of the major studies of deaths related to alcohol use report evidence for a U-shaped relationship between mortality and consumption, with abstainers having higher mortality than moderate drinkers. Some have suggested that this indicates a protective effect of moderate drinking; others have argued that pre-existing health problems and demographic and lifestyle differences explain the finding. In this report, we present evidence that the U-shaped function is largely an artefact of inadequate controls for smoking and drinking intake and history. Never smoking abstainers die at about the same rate as never smoking moderate drinkers. We stress the importance of using precise measures of drug use history and drug use status and make the point that, given the strong interaction between smoking and drinking, controlling for smoking may produce misleading results.