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Pacek LR, Sawdey MD, Nguyen KH, Cooper M, Park-Lee E, Gross AL, Donaldson EA, Cullen KA. Trends and Associations of Past-30-Day Cigar Smoking in the U.S. by Age, Race/Ethnicity, and Sex, NSDUH 2002-2020. Int J Environ Res Public Health 2023; 20:6716. [PMID: 37754576 PMCID: PMC10531240 DOI: 10.3390/ijerph20186716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/22/2023] [Accepted: 08/27/2023] [Indexed: 09/28/2023]
Abstract
Cigar smoking remains a public health issue in the United States (U.S.), with a heterogeneous prevalence based on sociodemographic characteristics. Nationally representative data suggest changes in cigar smoking over time, with some evidence for sociodemographic differences. Using data from the 2002-2019 National Survey on Drug Use and Health (NSDUH), the prevalence of past-30-day cigar smoking was examined overall and stratified by sociodemographic characteristics; joinpoint regression examined the trends. Logistic regression analyses identified the correlates of cigar smoking using 2020 NSDUH data. From 2002 to 2004, the prevalence of cigar smoking remained stable (5.33-5.73%), but declined from 2004 to 2019 (5.73-4.29%). Cigar smoking declined in some periods between 2002-2019 among the non-Hispanic White, Hispanic, ages 12-17, ages 18-20, ages 21-25, age ≥ 35, and male subgroups, but remained unchanged among the non-Hispanic Other, ages 26-34, and female subgroups. Cigar smoking increased among non-Hispanic Black persons overall from 2002 to 2019 (6.67-8.02%). Past-30-day cigarette smoking and drug or alcohol use disorder was associated with an increased likelihood of cigar use, while female sex was associated with a decreased likelihood of cigar use, across all age groups. Though a decline in the prevalence of past-30-day cigar smoking is seen in the general population, the same is not evident among all sociodemographic subgroups. Our findings have the potential to inform tobacco cessation efforts within clinical practice, as well as regulatory efforts to reduce cigar use.
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Affiliation(s)
- Lauren R. Pacek
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD 20993, USA; (M.D.S.); (K.H.N.); (M.C.); (E.P.-L.); (A.L.G.); (E.A.D.); (K.A.C.)
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Rubenstein D, Pacek LR, Smith C, McClernon FJ, Enyioha C, Vilardaga R. Stagnant daily smoking prevalence between 2008 and 2019 among Black and Hispanic adults with serious psychological distress. Drug Alcohol Depend 2023; 248:109943. [PMID: 37247521 DOI: 10.1016/j.drugalcdep.2023.109943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 05/16/2023] [Accepted: 05/19/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND Racial/ethnic minority status and mental illness independently drive inequity in cigarette smoking and related morbidity. Racial/ethnic minority groups suffer a disproportionate burden of tobacco-related diseases. People with serious mental illness (SMI) smoke at up to 7 times the rate of the general population. There is a need to quantify smoking prevalence and trends among people at the intersection of both groups. METHODS This study analyzes 2008-2019 data from the National Survey on Drug Use and Health. Linear time trends of daily smoking prevalence were assessed among people with serious psychological distress (SPD; marker for SMI) and people without SPD reporting White, Black, Hispanic, and Other race/ethnicity using logistic regression, with survey year as the predictor. Models with year-by-smoking status interaction terms and F-tests assessed differential time trends. RESULTS The prevalence of daily smoking among people without SPD decreased over time among people reporting White (aOR=0.96, p<0.001), Black (aOR=0.96, p<0.001), Hispanic (aOR=0.95, p<0.001), and Other (aOR=0.97, p=0.002) race/ethnicity. Among people with SPD, the smoking prevalence decreased among people with White race/ethnicity (aOR=0.95, p<0.001), with no significant changes among people of Black, Hispanic, and Other race/ethnicity. CONCLUSIONS Smoking among people with SPD who report Black and Hispanic race/ethnicity has not changed significantly in the past 11 years, despite decreasing among non-SPD and White groups. People who are Black/Hispanic and people with SPD struggle to quit smoking, which is amplified intersectionally. Tailored interventions may be a better mechanism to reduce barriers to smoking cessation in this population.
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Affiliation(s)
- Dana Rubenstein
- Department of Psychiatry and Behavioral Sciences, Duke University School of MedicineDurham, NC, 27705, United States; Clinical and Translational Science Institute, Duke University School of MedicineDurham, NC, 27701, United States
| | - Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University School of MedicineDurham, NC, 27705, United States
| | - Caitlyn Smith
- Department of Psychiatry and Behavioral Sciences, Duke University School of MedicineDurham, NC, 27705, United States
| | - F Joseph McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University School of MedicineDurham, NC, 27705, United States; Clinical and Translational Science Institute, Duke University School of MedicineDurham, NC, 27701, United States
| | - Chineme Enyioha
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599United States
| | - Roger Vilardaga
- Department of Psychiatry and Behavioral Sciences, Duke University School of MedicineDurham, NC, 27705, United States.
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Mercincavage M, Pacek LR, Thrasher J, Cappella JN, Delnevo C, Donny EC, Strasser AA. Effects of advertising features on smokers' and non-smokers' perceptions of a reduced nicotine cigarette modified risk tobacco product. Tob Control 2023; 32:6-12. [PMID: 33858965 PMCID: PMC8517036 DOI: 10.1136/tobaccocontrol-2020-056441] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/17/2021] [Accepted: 03/19/2021] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Research is needed to determine the impact of marketing on perceptions and use of reduced nicotine content (RNC) cigarettes, particularly as US regulators have permitted the sale of an RNC cigarette modified risk tobacco product (MRTP) that seeks further authorisation to advertise using modified risk claims. This study examined the effects of two advertising elements (product name and disclaimer content) on perceptions of an RNC cigarette MRTP. METHODS Adult participants (n=807, 28.7% smokers, 58.2% male, 74.2% non-Latinx white) completed an online MTurk survey. Participants were randomised to view one of six RNC cigarette advertisements, using a 2×3 between-subject factorial design to manipulate product name ('Moonlight' vs 'Moonrise') and disclaimer content (industry-proposed: 'Nicotine is addictive. Less nicotine does NOT mean a safer cigarette' vs focused: 'Less nicotine does NOT mean a safer cigarette' vs no content), then completed recall and product perception questionnaires. RESULTS All participants who viewed the industry-proposed disclaimer (vs no content) perceived greater addiction risk (p's<0.05). Non-smokers who viewed this disclaimer also perceived greater health risks and held fewer false beliefs (p's<0.05). Smokers who viewed Moonlight (vs Moonrise) ads perceived lower health risks (p<0.05). CONCLUSIONS Disclaimer content may effectively inform consumers about addiction risk of a new RNC cigarette MRTP, and further inform non-smokers about health risks. This element, however, had little effect on perceived health risks among smokers, among whom the Moonlight product name was associated with health risk misperceptions similar to the banned 'light' descriptor.
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Affiliation(s)
- Melissa Mercincavage
- Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, PA, USA
| | - Lauren R Pacek
- Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - James Thrasher
- Health Promotion, Education, and Behavior, School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Joseph N Cappella
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, PA, USA
- Annenberg School of Communication, University of Pennsylvania, Philadelphia, PA, USA
| | - Cristine Delnevo
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, PA, USA
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey, USA
| | - Eric C Donny
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, PA, USA
- Baptist Comprehensive Cancer Center and Department of Physiology and Pharmacology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Andrew A Strasser
- Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, PA, USA
- Annenberg School of Communication, University of Pennsylvania, Philadelphia, PA, USA
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White CM, Watson C, Bravo Cardenas R, Ngac P, Valentin-Blasini L, Blount BC, Koopmeiners JS, Denlinger-Apte RL, Pacek LR, Benowitz NL, Hatsukami DK, Donny EC, Carpenter MJ, Smith TT. Early Changes in Puffing Intensity When Exclusively Using Open-Label Very Low Nicotine Content Cigarettes. Nicotine Tob Res 2022; 24:1798-1802. [PMID: 35524988 PMCID: PMC9597006 DOI: 10.1093/ntr/ntac118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 04/27/2022] [Accepted: 05/02/2022] [Indexed: 11/14/2022]
Abstract
INTRODUCTION In response to reducing cigarette nicotine content, people who smoke could attempt to compensate by using more cigarettes or by puffing on individual cigarettes with greater intensity. Such behaviors may be especially likely under conditions where normal nicotine content (NNC) cigarettes are not readily accessible. The current within-subject, residential study investigated whether puffing intensity increased with very low nicotine content (VLNC) cigarette use, relative to NNC cigarette use, when no other nicotine products were available. METHODS Sixteen adults who smoke daily completed two 4-night hotel stays in Charleston, South Carolina (U.S.) in 2018 during which only NNC or only VLNC cigarettes were accessible. We collected the filters from all smoked cigarettes and measured the deposited solanesol to estimate mouth-level nicotine delivery per cigarette. These estimates were averaged within and across participants, per each 24-hour period. We then compared the ratio of participant-smoked VLNC and NNC cigarette mouth-level nicotine to the ratio yielded by cigarette smoking machines (when puffing intensity is constant). RESULTS Average mouth-level nicotine estimates from cigarettes smoked during the hotel stays indicate participants puffed VLNC cigarettes with greater intensity than NNC cigarettes in each respective 24-hour period. However, this effect diminished over time (p<0.001). Specifically, VLNC puffing intensity was 40.0% (95% CI: 29.9, 53.0) greater than NNC puffing intensity in the first period, and 16.1% (95% CI: 6.9, 26.0) greater in the fourth period. CONCLUSION Average puffing intensity per cigarette was elevated with exclusive VLNC cigarette use, but the extent of this effect declined across four days. IMPLICATIONS In an environment where no other sources of nicotine are available, people who smoke daily may initially attempt to compensate for cigarette nicotine reduction by puffing on individual cigarettes with greater intensity. Ultimately, the compensatory behavior changes required to achieve usual nicotine intake from VLNC cigarettes are drastic and unrealistic. Accordingly, people are unlikely to sustain attempts to compensate for very low cigarette nicotine content.
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Affiliation(s)
- Cassidy M White
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Clifford Watson
- Centers for Disease Control and Prevention, Division of Laboratory Sciences, Tobacco and Volatiles Branch, Atlanta, GA, USA
| | - Roberto Bravo Cardenas
- Centers for Disease Control and Prevention, Division of Laboratory Sciences, Tobacco and Volatiles Branch, Atlanta, GA, USA
| | - Phuong Ngac
- Centers for Disease Control and Prevention, Division of Laboratory Sciences, Tobacco and Volatiles Branch, Atlanta, GA, USA
| | - Liza Valentin-Blasini
- Centers for Disease Control and Prevention, Division of Laboratory Sciences, Tobacco and Volatiles Branch, Atlanta, GA, USA
| | - Benjamin C Blount
- Centers for Disease Control and Prevention, Division of Laboratory Sciences, Tobacco and Volatiles Branch, Atlanta, GA, USA
| | | | - Rachel L Denlinger-Apte
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Neal L Benowitz
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Dorothy K Hatsukami
- Department of Psychiatry and Behavioral Sciences and Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Eric C Donny
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Matthew J Carpenter
- Department of Psychiatry and Behavioral Sciences, and Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Tracy T Smith
- Department of Psychiatry and Behavioral Sciences, and Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
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Rubenstein D, Pacek LR, McClernon FJ. Multiple Tobacco Product Use Conceptual Framework: A 2021 Update on Evidence. Nicotine Tob Res 2022; 24:1208-1217. [PMID: 35137194 PMCID: PMC9278823 DOI: 10.1093/ntr/ntac032] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 01/04/2022] [Accepted: 01/31/2022] [Indexed: 02/07/2023]
Abstract
INTRODUCTION One-third of adults in the United States who use tobacco regularly use two or more types of tobacco products. As the use of e-cigarettes and other noncombusted tobacco products increases-making multiple tobacco product (MTP) use increasingly common-it is essential to evaluate the complex factors that affect product use. AIMS AND METHODS In this update to our 2019 conceptual framework, we review and evaluate recent literature and expand the model to include ways in which MTP use may be affected by market factors such as the introduction of new products and socioenvironmental factors like marketing and advertising. RESULTS AND CONCLUSIONS MTP use patterns are complex, dynamic, and multiply determined by factors at the level of individuals, products, situations or contexts, and marketplace. Substitution, or using one product with the intent of decreasing use of another, and complementarity, or using multiple products for different reasons or purposes, explain patterns in MTP use. Moreover, substitution and complementarity may inform our understanding of how market changes targeted at one product, for instance, new product standards, bans, product pricing, and taxation, affect consumption of other tobacco products. New data from natural experiments and novel laboratory-based techniques add additional data and expand the framework. IMPLICATIONS A substantial proportion of people who use tobacco use more than one product. This review synthesizes and evaluates recent evidence on the diverse factors that affect MTP use in addition to expanding our framework. Our review is accompanied by suggested research questions that can guide future study.
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Affiliation(s)
- Dana Rubenstein
- Corresponding Author: Dana Rubenstein, BA, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2608 Erwin Road, Suite 300, Durham, NC 27705, USA. Telephone: 919-668-3987; Fax: 919-681-1600; E-mail:
| | - Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - F Joseph McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
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Sweitzer MM, Pacek LR, Kozink RV, Locey E, Kollins SH, Donny EC, McClernon FJ. Reactions to reduced nicotine content cigarettes in a sample of young adult, low-frequency smokers. Psychopharmacology (Berl) 2021; 238:2429-2438. [PMID: 33982143 PMCID: PMC8376766 DOI: 10.1007/s00213-021-05864-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/30/2021] [Indexed: 11/28/2022]
Abstract
RATIONALE Reducing nicotine content in cigarettes to ≤ 2.4 mg per g of tobacco [mg/g] reduces smoking behavior and toxicant exposure among adult daily smokers. However, cigarettes with similar nicotine content could support continued experimentation and smoking progression among young adults who smoke infrequently. OBJECTIVES This study evaluated the threshold for nicotine in cigarettes that produces reactions associated with smoking progression in a sample of young adults who smoke infrequently. METHODS Young adults (n = 87, 18-25 years, 49% female) using tobacco products ≤ 15 days per month completed three counterbalanced, double-blinded sessions, each measuring positive and negative subjective reactions to fixed doses of smoke from investigational cigarettes containing one of three different nicotine contents: normal (NNC; 15.8 mg/g); very low (VLNC; 0.4 mg/g); and intermediate (INC; 2.4 mg/g). In a final session, participants chose one of the cigarettes to self-administer. RESULTS Post-cigarette breath carbon monoxide was greater for VLNC than for NNC (p < 0.001). Positive reactions were greater for NNC than INC (p < 0.001) and for INC than VLNC (p = 0.001). Negative reactions were greater for NNC than INC and VLNC (both p < 0.001); INC and VLNC did not differ. Cigarette choices did not differ from an even distribution (43% NNC, 25% INC, 32% VLNC), but choice for NNC or INC was associated with higher ratio of positive to negative reactions during the NNC and INC fixed dose sessions, respectively (p < 0.001). CONCLUSIONS Reducing nicotine content will likely lower the abuse liability of cigarettes for most young, low-frequency smokers. Additional work is needed to determine if compensatory smoking may lead to increased toxicant exposure, and if a subset of individuals choosing lower nicotine cigarettes may continue to smoke regardless of nicotine content.
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Affiliation(s)
- Maggie M. Sweitzer
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine
| | - Lauren R. Pacek
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine
| | - Rachel V. Kozink
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine
| | - Erin Locey
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine
| | - Scott H. Kollins
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine
| | - Eric C. Donny
- Department of Physiology & Pharmacology, Wake Forest School of Medicine
| | - F. Joseph McClernon
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine
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Pacek LR, Kozink RV, Carson CE, McClernon FJ. Appeal, subjective effects, and relative reinforcing effects of JUUL that vary in flavor and nicotine content. Exp Clin Psychopharmacol 2021; 29:279-287. [PMID: 34264738 PMCID: PMC8454051 DOI: 10.1037/pha0000481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The U.S. Food and Drug Administration has the authority to regulate characteristics of electronic nicotine delivery systems (ENDS). Prior research indicates that regulation of certain characteristics of these products may have an effect on their appeal and use. Policies that affect appeal and use of ENDS are relevant to attempts to reduce use among young people-including young adults-but are also relevant to adults who use these products as harm reduction tools. Using a novel concurrent choice task, we evaluated the relative reinforcement of JUUL brand ENDS products that varied in flavor (n = 8) and nicotine (n = 8) among samples of young adults who use JUUL. Findings suggest that restricting JUUL flavor to tobacco-only results in decreased appeal, while reducing the nicotine content of JUUL pods to 3%-from the conventional 5%-does not have an effect on product appeal. Findings also validate a novel methodology for delivering fixed doses of ENDS vapor within the context of a task that assesses the relative reinforcement of ENDS products with varying characteristics. This methodology can be applied to assessing the relative reinforcing effects of a wide variety of tobacco products with varied characteristics. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Lauren R. Pacek
- Corresponding author: Address – 2608 Erwin Road, Suite 300, Durham, NC 27705 USA; ; Phone number – 919-684-5437; Fax number – 919-681-1600
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Denlinger-Apte RL, Pacek LR, Ross JC, Bansal-Travers M, Donny EC, Hatsukami DK, Carroll DM. Risk Perceptions of Low Nicotine Cigarettes and Alternative Nicotine Products across Priority Smoking Populations. Int J Environ Res Public Health 2021; 18:5311. [PMID: 34067652 PMCID: PMC8156883 DOI: 10.3390/ijerph18105311] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/07/2021] [Accepted: 05/11/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND As the U.S. Food and Drug Administration considers a low nicotine product standard for cigarettes, it is important to examine how people who smoke, especially individuals from priority populations disproportionately affected by smoking, perceive low nicotine content (LNC) cigarettes and their relative risk perceptions of alternative nicotine delivery system (ANDS) products, including e-cigarettes and snus, and medicinal nicotine. METHODS Data are from Wave 4 (2016-2017) of the adult Population Assessment of Tobacco Use and Health (PATH) Study. We examined respondents' absolute risk perceptions about nicotine, LNC cigarettes, ANDS products and medicinal nicotine; their relative risk perceptions of LNC cigarettes and ANDS products compared to conventional cigarettes; and their relative risk perceptions of medicinal nicotine compared to ANDS products. RESULTS The majority of respondents across priority smoking populations indicated snus, e-cigarettes, and LNC cigarettes were 'about the same' level of harmfulness or addictiveness as conventional cigarettes. The majority of respondents indicated e-cigarettes to be 'about the same' harmfulness as medicinal nicotine. CONCLUSIONS Our study indicates that adults who smoke cigarettes generally have misperceptions about the harms of nicotine and the relative risks of ANDS products and such misperceptions exist regardless of their racial/ethnic identity, sexual orientation, and gender identity.
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Affiliation(s)
- Rachel L. Denlinger-Apte
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; (R.L.D.-A.); (J.C.R.)
| | - Lauren R. Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27705, USA;
| | - Jennifer Cornacchione Ross
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; (R.L.D.-A.); (J.C.R.)
| | - Maansi Bansal-Travers
- Roswell Park Comprehensive Cancer Center, Department of Health Behavior, Buffalo, NY 14263, USA;
| | - Eric C. Donny
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA;
| | - Dorothy K. Hatsukami
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN 55414, USA;
| | - Dana Mowls Carroll
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN 55414, USA
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Karelitz JL, McClure EA, Wolford-Clevenger C, Pacek LR, Cropsey KL. Cessation classification likelihood increases with higher expired-air carbon monoxide cutoffs: a meta-analysis. Drug Alcohol Depend 2021; 221:108570. [PMID: 33592559 PMCID: PMC8026538 DOI: 10.1016/j.drugalcdep.2021.108570] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/05/2021] [Accepted: 01/10/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND Expired-air carbon monoxide (CO) is commonly used to biochemically verify smoking status. The CO cutoff and CO monitor brand may affect the probability of classifying smokers as abstinent, thus influencing conclusions about the efficacy of cessation trials. No systematic reviews have tested this hypothesis. Therefore, we performed a meta-analysis examining whether the likelihood of smoking cessation classification varied due to CO cutoff and monitor brand. METHODS Eligible studies (k = 122) longitudinally assessed CO-verified cessation in adult smokers in randomized trials. Primary meta-regressions separately assessed differences in quit classification likelihood due to continuous and categorical CO cutoffs (Low, 3-4 parts per million [ppm]; [SRNT] Recommended, 5-6 ppm; Moderate, 7-8 ppm; and High, 9-10 ppm); exploratory analyses compared likelihood outcomes between monitor brands: Bedfont and Vitalograph. RESULTS The likelihood of quit classification increased 18% with each 1 ppm increase above the lowest cutoff (3 ppm). Odds of classification as quit significantly increased between each cutoff category and High: 261% increase from Low; 162% increase from Recommended; and 150% increase from Moderate. There were no differences in cessation classification between monitor brands. CONCLUSIONS As expected, higher CO cutoffs were associated with greater likelihood of cessation classification. The lack of CO monitor brand differences may have been due to model-level variance not able to be followed up in the present dataset. Researchers are advised to report outcomes using a range of cutoffs-including the recommended range (5-6 ppm)-and the CO monitor brand/model used. Using higher CO cutoffs significantly increases likelihood of quit classification, possibly artificially elevating treatment strategies.
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Affiliation(s)
- Joshua L Karelitz
- Division of Cancer Control and Population Sciences, UPMC Hillman Cancer Center, University of Pittsburgh, 5150 Centre Ave, Suite 4C, Pittsburgh, PA, 15232, USA; Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 5150 Centre Ave, Suite 4C, Pittsburgh, PA, 15232, USA.
| | - Erin A McClure
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, 67 President St, MSC 861, Charleston, SC, 29425, USA; Hollings Cancer Center, Medical University of South Carolina, 67 President St, MSC 861, Charleston, SC, 29425, USA
| | - Caitlin Wolford-Clevenger
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, 1670 University Blvd Birmingham, AL, 35233, USA
| | - Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2068 Erwin Road, Room 3038, Durham, NC, 27705, USA
| | - Karen L Cropsey
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, 1670 University Blvd Birmingham, AL, 35233, USA
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Pacek LR, Holloway AD, Cropsey KL, Meade CS, Sweitzer MM, Davis JM, Joseph McClernon F. Experiences With Smoking Cessation Attempts and Prior Use of Cessation Aids in Smokers With HIV: Findings From a Focus Group Study Conducted in Durham, North Carolina. AIDS Educ Prev 2021; 33:158-168. [PMID: 33821680 PMCID: PMC8158019 DOI: 10.1521/aeap.2021.33.2.158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Cigarette smoking remains disproportionately prevalent and is increasingly a cause of death and disability among people with HIV (PWH). Many PWH are interested in quitting, but interest in and uptake of first-line smoking cessation pharmacotherapies are varied in this population. To provide current data regarding experiences with and perceptions of smoking cessation and cessation aids among PWH living in Durham, North Carolina, the authors conducted five focus group interviews (total n = 24; 96% African American) using semistructured interviews. Interviews were recorded, transcribed, coded, and thematically analyzed. Major themes included ambivalence and/or lack of interest in cessation; presence of cessation barriers; perceived perceptions of ineffectiveness of cessation aids; perceived medication side effects; and conflation of the harms resulting from use of tobacco products and nicotine replacement therapy. Innovative and effective interventions must account for the aforementioned multiple barriers to cessation as well as prior experiences with and misperceptions regarding cessation aids.
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Affiliation(s)
- Lauren R Pacek
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Durham, North Carolina
| | - Alicia D Holloway
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Durham, North Carolina
| | - Karen L Cropsey
- University of Alabama at Birmingham, Department of Psychiatry and Behavioral Neurobiology, Birmingham, Alabama
| | - Christina S Meade
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Durham, North Carolina
| | - Maggie M Sweitzer
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Durham, North Carolina
| | - James M Davis
- Duke University School of Medicine, General Internal Medicine, and the Duke Cancer Institute, Durham, North Carolina
| | - F Joseph McClernon
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Durham, North Carolina
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11
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Denlinger-Apte RL, Koopmeiners JS, Tidey JW, Luo X, Smith TT, Pacek LR, Joseph McClernon F, Jensen JA, Colby SM, Severson HH, Donny EC, Hatsukami DK. Support for a nicotine reduction policy among participants enrolled in a 20-week trial of very low nicotine content cigarettes. Addict Behav 2021; 114:106727. [PMID: 33261915 DOI: 10.1016/j.addbeh.2020.106727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/22/2020] [Accepted: 11/01/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The Food and Drug Administration is considering a policy to drastically reduce the allowable nicotine content of cigarettes. The current study examined whether the policy implementation approach, i.e., either immediately reducing nicotine content to very low levels or gradually reducing nicotine content over an extended period, influences policy support among people who smoke cigarettes. METHODS Adults who smoked daily were randomly assigned (double-blind) to an immediate nicotine reduction condition (0.4 mg/g nicotine cigarettes), a gradual nicotine reduction condition (15.5 to 0.4 mg/g), or a control condition (15.5 mg/g) for 20 weeks. Participants were asked if they would "support or oppose a law that reduced the amount of nicotine in cigarettes, to make cigarettes less addictive." Logistic regression analyses assessed if policy support was affected by treatment condition, demographic covariates, interest in quitting, and subjective cigarette effects. RESULTS At Week 20 (N = 957 completers), 60.4% of participants supported the policy, 17.4% opposed, and 22.2% responded "Don't know." Policy support did not differ by treatment condition. Support was greater among those interested in quitting (OR = 3.37, 95% CI = 2.49, 4.55). Support was lower among males (OR = 0.49, 95% CI = 0.37, 0.67), those with greater dependence scores (OR = 0.92, 95% CI = 0.86, 0.99) and participants aged 18-24 (OR = 0.53, 95% CI = 0.28, 0.99). No other covariates were associated with policy support. CONCLUSIONS The majority of participants supported a nicotine reduction policy. The implementation approach, immediate or gradual reduction, did not affect policy support. Participants interested in quitting smoking were more likely to support a nicotine reduction policy.
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Affiliation(s)
- Rachel L Denlinger-Apte
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA.
| | - Joseph S Koopmeiners
- Division of Biostatistics, School of Public Health and Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Jennifer W Tidey
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02912, USA.
| | - Xianghua Luo
- Division of Biostatistics, School of Public Health and Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Tracy T Smith
- Hollings Cancer Center and Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA.
| | - Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27705, USA.
| | - F Joseph McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27705, USA
| | - Joni A Jensen
- Masonic Cancer Center and Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Suzanne M Colby
- Department Psychiatry and Human Behavior, Brown University, Providence, RI 02912, USA.
| | | | - Eric C Donny
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA.
| | - Dorothy K Hatsukami
- Masonic Cancer Center and Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN 55455, USA.
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12
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Pacek LR, Holloway AD. Cigarette Smoking and Cessation-Related Interactions With Health Care Providers in the Context of Living With HIV: Focus Group Study Findings. J Assoc Nurses AIDS Care 2021; 32:e14-e19. [PMID: 32639266 PMCID: PMC8211397 DOI: 10.1097/jnc.0000000000000185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Smoking is disproportionately prevalent among people living with HIV (PLWH) compared with the general population. We conducted five focus groups (n = 24) using semi-structured interview guides to explore perceptions and experiences of smoking and cessation-related interactions with health care providers among smokers with HIV. Major themes included a limited understanding of how smoking affects illness among PLWH and minimal discussion about cessation with providers. Findings highlight the need to educate smokers with HIV about the known impacts of smoking on illness among PLWH and to facilitate greater discussion of cessation between providers and smokers with HIV. Prior experiences with smoking cessation medications and desire for additional information regarding these medications should be considered when implementing medication regimens in research and clinical settings.
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Affiliation(s)
- Lauren R. Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Alicia D. Holloway
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
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13
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Schnoll R, Bernstein SL, Kaufman A, Gross R, Catz SL, Cioe PA, Hitsman B, Marhefka SL, Pacek LR, Vidrine DJ, Vilardaga R, Edelman EJ, McClure JB, Ashare R, Lockhart E, Crothers K. COVID-19 Challenges Confronted by Smoking Cessation Clinical Trials for People Living with HIV: The Experience of Grantees of the United States National Cancer Institute. Nicotine Tob Res 2021; 23:1629-1632. [PMID: 33657227 PMCID: PMC7989188 DOI: 10.1093/ntr/ntab035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 02/25/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Robert Schnoll
- Department of Psychiatry and Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Steven L Bernstein
- Department of Emergency Medicine, Yale Center for Implementation Science, Yale School of Medicine, New Haven, CT, USA
| | - Annette Kaufman
- Tobacco Control Research Branch, National Cancer Institute, Bethesda, MD, USA
| | - Robert Gross
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA.,Division of Infectious Diseases, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Sheryl L Catz
- Betty Irene Moore School of Nursing, University of California Davis, Sacramento, CA, USA
| | - Patricia A Cioe
- Center for Alcohol & Addiction Studies, Department of Behavioral & Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Brian Hitsman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine
| | - Stephanie L Marhefka
- College of Public Health and Division of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Damon J Vidrine
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Roger Vilardaga
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - E Jennifer Edelman
- Yale School of Medicine and Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA
| | - Jennifer B McClure
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Rebecca Ashare
- Department of Psychiatry and Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Elizabeth Lockhart
- College of Public Health, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Kristina Crothers
- Veterans Affairs Puget Sound Health Care System, and University of Washington, Seattle, WA, USA
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14
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Pacek LR, Villanti AC, Mcclernon FJ. Not Quite the Rule, But No Longer the Exception: Multiple Tobacco Product Use and Implications for Treatment, Research, and Regulation. Nicotine Tob Res 2021; 22:2114-2117. [PMID: 31789377 DOI: 10.1093/ntr/ntz221] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 11/29/2019] [Indexed: 11/14/2022]
Abstract
The patterns of tobacco product use in the United States have changed during the past several decades. Currently, a large proportion of tobacco users report using multiple tobacco products (MTPs). The prevalence of MTP use varies significantly by cigarette smoking frequency, as well: nearly half (46.9%) of all non-daily smokers report using other tobacco products within the past 30 days. Despite this, much of extant tobacco dependence treatment efforts, tobacco regulatory science research, and tobacco product research, in general, has focused largely on single product use (ie, cigarette smoking). To effectively design interventions and model the potential impact of regulations on tobacco products aimed at reducing tobacco use, as well as effectively study tobacco users, it is essential to consider actual use patterns in the population of tobacco users. Implications: MTP use is increasingly common in the United States. This commentary highlights the impact that MTP use has for efforts to treat tobacco dependence, tobacco regulatory science efforts, as well as on tobacco research, in general.
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Affiliation(s)
- Lauren R Pacek
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Durham, NC
| | - Andrea C Villanti
- University of Vermont College of Medicine, Vermont Center on Behavior and Health, Department of Psychiatry, Burlington, VT
| | - F Joseph Mcclernon
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Durham, NC
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15
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Ashare RL, Bernstein SL, Schnoll R, Gross R, Catz SL, Cioe P, Crothers K, Hitsman B, Marhefka SL, McClure JB, Pacek LR, Vidrine DJ, Vilardaga R, Kaufman A, Edelman EJ. The United States National Cancer Institute's Coordinated Research Effort on Tobacco Use as a Major Cause of Morbidity and Mortality among People with HIV. Nicotine Tob Res 2021; 23:407-410. [PMID: 32803251 PMCID: PMC7454816 DOI: 10.1093/ntr/ntaa155] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 08/12/2020] [Indexed: 02/07/2023]
Abstract
The use of antiretroviral therapy for people with HIV (PWH) has improved life expectancy. However, PWH now lose more life-years to tobacco use than to HIV infection. Unfortunately, PWH smoke at higher rates and have more difficulty maintaining abstinence than the general population, compounding their risk for chronic disease. In this Commentary, we describe a United States National Cancer Institute-led initiative to address the relative lack of research focused on developing, testing, and implementing smoking cessation interventions for PWH. This initiative supports seven clinical trials designed to systematically test and/or develop and test adaptations of evidence-based smoking cessation interventions for PWH (eg, combination of behavioral and pharmacological). We summarize each project, including setting/recruitment sites, inclusion/exclusion criteria, interventions being tested, and outcomes. This initiative provides critical opportunities for collaboration and data harmonization across projects. The knowledge gained will inform strategies to assist PWH to promote and maintain abstinence, and ensure that these efforts are adaptable and scalable, thereby addressing one of the major threats to the health of PWH. Reducing smoking behavior may be particularly important during the COVID-19 pandemic given that smokers who become infected with SARS-CoV-2 may be at risk for more severe disease. IMPLICATIONS This Commentary describes a National Cancer Institute-led initiative to advance the science and practice of treating tobacco use among PWH, which is now responsible for more life years lost than HIV. We describe the scope of the problem, the objectives of the initiative, and a summary of the seven funded studies. Harmonization of data across projects will provide information related to treatment mediators and moderators that was not previously possible. Stakeholders interested in tobacco cessation, including researchers, clinicians and public health officials, should be aware of this initiative and the evidence-base it will generate to advance tobacco treatment among this high-risk population.
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Affiliation(s)
- Rebecca L Ashare
- Department of Psychiatry and Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Steven L Bernstein
- Department of Emergency Medicine, Yale Center for Implementation Science, Yale School of Medicine, New Haven, CT
| | - Robert Schnoll
- Department of Psychiatry and Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Robert Gross
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
- Division of Infectious Diseases, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Sheryl L Catz
- Betty Irene Moore School of Nursing, University of California Davis, Sacramento, CA
| | - Patricia Cioe
- Center for Alcohol & Addiction Studies, Department of Behavioral & Social Sciences, Brown University School of Public Health, Providence, RI
| | - Kristina Crothers
- Veterans Affairs (VA) Puget Sound Health Care System and University of Washington School of Medicine, Seattle, WA
| | - Brian Hitsman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Stephanie L Marhefka
- College of Public Health and Division of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL
| | | | - Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Damon J Vidrine
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL
| | - Roger Vilardaga
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Annette Kaufman
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - E Jennifer Edelman
- Yale School of Medicine, New Haven, CT and Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT
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16
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Cwalina SN, Pacek LR, Barrington-Trimis JL, Tackett AP, Pentz MA. Cross-Sectional Associations of Multiple Tobacco Product Use with Depressive and Anxiety Symptoms among Young Adult E-Cigarette Users. Subst Use Misuse 2021; 56:1807-1814. [PMID: 34320919 PMCID: PMC9153521 DOI: 10.1080/10826084.2021.1954026] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Tobacco users with mental health conditions are a vulnerable population in tobacco research, yet few studies have evaluated the association of depressive and anxiety symptoms with multiple tobacco product (MTP) use among young adult electronic cigarette (ENDS) users. METHODS Cross-sectional survey data on U.S. young adult past 30-day ENDS users (N = 2348) were collected via Amazon MTurk from May-July 2019. Binary logistic regressions evaluated the association of tobacco use pattern (exclusive ENDS use, ENDS + one other tobacco product [OTP; dual use], ENDS + two or more OTPs [poly-use]) with depressive (PHQ-9) and anxiety (GAD-7) symptoms. Among MTP users (n = 1736), we evaluated the association of ENDS use relative to OTP use and same-day MTP use with depressive and anxiety symptoms. RESULTS The sample included 26% exclusive ENDS, 27% dual, and 47% poly-users. We observed a gradient-relationship for depressive and anxiety symptoms: poly-users had greater odds of depressive and anxiety symptoms compared to dual users (aOR = 1.86 [95%CI:1.50-2.30] and aOR = 1.61 [95%CI:1.30-2.01], respectively), and dual users had greater odds of depressive and anxiety symptoms compared to exclusive ENDS users (aOR = 1.42 [95%CI:1.11-1.81] and aOR = 1.56 [95%CI:1.20-2.02], respectively). MTP users who used ENDS more often than OTPs (vs. less often than OTPs) had greater odds of depressive (aOR = 1.38 [95%CI:1.06-1.80]) and anxiety (aOR = 1.37 [95%CI:1.04-1.79]) symptoms. CONCLUSIONS The majority of young adult past 30-day ENDS users in this sample reported OTP use. Future research on MTP use should distinguish between dual and poly-use. Tobacco prevention efforts for young adults with mental health symptoms are needed.
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Affiliation(s)
- Sam N Cwalina
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jessica L Barrington-Trimis
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Alayna P Tackett
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Mary Ann Pentz
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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17
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Dermody SS, Tessier KM, Meier E, al'Absi M, Denlinger-Apte RL, Drobes DJ, Jensen J, Koopmeiners JS, Pacek LR, Tidey JW, Vandrey R, Donny E, Hatsukami D. An Evaluation of Potential Unintended Consequences of a Nicotine Product Standard: A Focus on Drinking History and Outcomes. Nicotine Tob Res 2020; 23:1168-1175. [PMID: 33220047 DOI: 10.1093/ntr/ntaa236] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 11/16/2020] [Indexed: 01/02/2023]
Abstract
INTRODUCTION A nicotine product standard reducing the nicotine content in cigarettes could improve public health by reducing smoking. This study evaluated the potential unintended consequences of a reduced nicotine product standard by examining its effects on (1) smoking behaviors based on drinking history; (2) drinking behavior; and (3) daily associations between smoking and drinking. METHODS Adults who smoke daily (n = 752) in the United States were randomly assigned to smoke very low nicotine content (VLNC) cigarettes versus normal nicotine content (NNC; control) cigarettes for 20 weeks. Linear mixed models determined if baseline drinking moderated the effects of VLNC versus NNC cigarettes on Week 20 smoking outcomes. Time-varying effect models estimated the daily association between smoking VLNC cigarettes and drinking outcomes. RESULTS Higher baseline alcohol use (vs no use or lower use) was associated with a smaller effect of VLNC on Week 20 urinary total nicotine equivalents (ps < .05). No additional moderation was supported (ps > .05). In the subsample who drank (n = 415), in the VLNC versus NNC condition, daily alcohol use was significantly reduced from Weeks 17 to 20 and odds of binge drinking were significantly reduced from Weeks 9 to 17. By Week 7, in the VLNC cigarette condition (n = 272), smoking no longer predicted alcohol use but remained associated with binge drinking. CONCLUSIONS We did not support negative unintended consequences of a nicotine product standard. Nicotine reduction in cigarettes generally affected smoking behavior for individuals who do not drink or drink light-to-moderate amounts in similar ways. Extended VLNC cigarette use may improve public health by reducing drinking behavior. IMPLICATIONS There was no evidence that a VLNC product standard would result in unintended consequences based on drinking history or when considering alcohol outcomes. Specifically, we found that a very low nicotine standard in cigarettes generally reduces smoking outcomes for those who do not drink and those who drink light-to-moderate amounts. Furthermore, an added public health benefit of a very low nicotine standard for cigarettes could be a reduction in alcohol use and binge drinking over time. Finally, smoking VLNC cigarettes may result in a decoupling of the daily associations between smoking and drinking.
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Affiliation(s)
- Sarah S Dermody
- Department of Psychology, Ryerson University, Toronto, ON, Canada
| | | | - Ellen Meier
- Department of Psychology, University of Wisconsin-Stevens Point, USA
| | - Mustafa al'Absi
- Masonic Cancer Center, University of Minnesota, Duluth, MN, USA
| | - Rachel L Denlinger-Apte
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - David J Drobes
- Tobacco Research and Intervention Program, Moffitt Cancer Center, Tampa, FL, USA
| | - Joni Jensen
- Masonic Cancer Center, University of Minnesota, Duluth, MN, USA
| | | | - Lauren R Pacek
- Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Jennifer W Tidey
- Department of Behavioral and Social Sciences, Brown University, Providence, RI, USA.,Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
| | - Ryan Vandrey
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Eric Donny
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
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18
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Carroll DM, Denlinger-Apte RL, Dermody SS, King JL, Mercincavage M, Pacek LR, Smith TT, Tripp HL, White CM. Polarization Within the Field of Tobacco and Nicotine Science and its Potential Impact on Trainees. Nicotine Tob Res 2020; 23:36-39. [PMID: 32777049 DOI: 10.1093/ntr/ntaa148] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 08/05/2020] [Indexed: 11/14/2022]
Affiliation(s)
- Dana Mowls Carroll
- Division of Environmental Health Sciences, School of Public Health and Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | - Rachel L Denlinger-Apte
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC
| | - Sarah S Dermody
- Ryerson University, Department of Psychology, Toronto, Ontario Canada
| | - Jessica L King
- Department of Health & Kinesiology, College of Health, University of Utah, Salt Lake City, UT
| | - Melissa Mercincavage
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Tracy T Smith
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina; Cancer Control and Prevention, Hollings Cancer Center, Charleston, SC
| | - Hollie L Tripp
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Cassidy M White
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC
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19
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Streck JM, Weinberger AH, Pacek LR, Gbedemah M, Goodwin RD. Cigarette Smoking Quit Rates Among Persons With Serious Psychological Distress in the United States From 2008 to 2016: Are Mental Health Disparities in Cigarette Use Increasing? Nicotine Tob Res 2020; 22:130-134. [PMID: 30351429 DOI: 10.1093/ntr/nty227] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 10/19/2018] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Prior work suggests that the prevalence of cigarette smoking is persistently higher among people with mental health problems, relative to those without. Lower quit rates are one factor that could contribute to higher prevalence of smoking in this group. This study estimated trends in the cigarette quit rates among people with and without past-month serious psychological distress (SPD) from 2008 to 2016 in the United States. METHODS Data were drawn from 91 739 adult participants in the 2008-2016 National Survey on Drug Use and Health, a repeated, cross-sectional, national survey. Linear time trends of cigarette quit rates, stratified by past-month SPD, were assessed using logistic regression models with continuous year as the predictor. RESULTS Cigarette quit rates among individuals with past-month SPD were lower than among those without SPD every year from 2008 to 2016. Quit rates did not change appreciably among those with past-month SPD (odds ratio = 1.02 [0.99, 1.06]) from 2008 to 2016, whereas quit rates increased among those without past-month SPD (odds ratio = 1.02 [1.01, 1.02]). CONCLUSIONS In the United States, quit rates among individuals with past-month SPD are approximately half than quit rates of those without SPD and have not increased over the past decade. This discrepancy in quit rates may be one factor driving increasing disparities in prevalence of smoking among those with versus without mental health problems. Tobacco control efforts require effective and targeted interventions for those with mental health problems. IMPLICATIONS Cigarette smoking quit rates have not increased among persons with serious mental health problems over the past decade. This work extends prior findings showing that smoking prevalence is not declining as quickly among persons with serious mental health problems. Findings suggest that diverging trends in quit rates are one possible driver of the persistent disparity in smoking by mental health status. Innovation in both tobacco control and targeted interventions for smokers with mental health problems is urgently needed.
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Affiliation(s)
- Joanna M Streck
- Department of Psychological Science, College of Arts and Sciences, University of Vermont, Burlington, VT.,Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, Burlington, VT
| | - Andrea H Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY.,Department of Epidemiology and Population Health, Yeshiva University Albert Einstein College of Medicine, Bronx, NY
| | - Lauren R Pacek
- Division of Addictions, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Misato Gbedemah
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York, NY.,Institute for Implementation Science in Population Health, Graduate School of Public Health and Health Policy, City University of New York, New York, NY
| | - Renee D Goodwin
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York, NY.,Institute for Implementation Science in Population Health, Graduate School of Public Health and Health Policy, City University of New York, New York, NY.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
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20
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Robinson JD, Kypriotakis G, Al'absi M, Denlinger-Apte RL, Drobes DJ, Leischow SJ, McClernon FJ, Pacek LR, Severson HH, Smith TT, Donny EC, Luo X, Jensen JA, Strayer LG, Cinciripini PM, Hatsukami DK. Very Low Nicotine Content Cigarettes Disrupt the Feedback Loop of Affective States and Smoking Behavior. Nicotine Tob Res 2020; 22:1294-1300. [PMID: 31701153 DOI: 10.1093/ntr/ntz209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 11/05/2019] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Smoking to reduce negative affect has been identified as a key motivational feature of tobacco use. Our recent work suggests that smoking very low nicotine content (VLNC) cigarettes reduces the relationship between negative affect and smoking behavior over a 6-week period. Here, we sought to extend our findings by evaluating whether a gradual or immediate approach to switching to VLNC cigarettes led to a differential reduction in the relationship between affect and smoking behavior over a longer (20-week) period. AIMS AND METHODS Participants (n = 1250) were adult smokers from 10 US sites randomized to one of three groups: gradual nicotine reduction (15.5, 11.7, 5.2, 2.4, and 0.4 mg of nicotine per gram of tobacco [mg/g]), immediate nicotine reduction (0.4 mg/g), or standard nicotine content cigarettes (15.5 mg/g; control), for 20 weeks. We examined whether the relationship between affect-both negative and positive-and cigarettes per day differed as a function of reduction group. RESULTS We found that both negative and positive affect were associated with cigarette consumption in the control group, but not in the gradual or immediate reduction groups across the 20 weeks of exposure. CONCLUSIONS Our results extend previous findings that switching to VLNC cigarettes disrupts the relationship between affect and cigarette consumption by showing that either gradually or immediately reducing cigarette nicotine content achieves this disruption. These findings provide further evidence that switching to VLNC cigarettes reduces nicotine-related reinforcement of cigarette smoking. IMPLICATIONS These findings support the notion that switching to very low nicotine content cigarettes reduces the association between affect and smoking behavior, and that either a gradual or immediate nicotine reduction approach achieves this reduction. This provides further evidence that switching to very low nicotine content cigarettes weakens reinforcement mechanisms associated with nicotine dependence.
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Affiliation(s)
- Jason D Robinson
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX
| | - George Kypriotakis
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mustafa Al'absi
- Department of Family Medicine and BioBehavioral Health, University of Minnesota Medical School, Duluth, MN
| | - Rachel L Denlinger-Apte
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI
| | - David J Drobes
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL
| | - Scott J Leischow
- College of Health Solutions, Arizona State University, Phoenix, AZ
| | - F Joseph McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | | | - Tracy T Smith
- Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Eric C Donny
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Xianghua Luo
- Cancer Prevention and Control, Masonic Cancer Center, University of Minnesota, Minneapolis, MN.,Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Joni A Jensen
- Cancer Prevention and Control, Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | - Lori G Strayer
- Cancer Prevention and Control, Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | - Paul M Cinciripini
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Dorothy K Hatsukami
- Cancer Prevention and Control, Masonic Cancer Center, University of Minnesota, Minneapolis, MN.,Department of Psychiatry, University of Minnesota, Minneapolis, MN
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21
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Meier E, Vandrey R, Rubin N, Pacek LR, Jensen JA, Donny EC, Hecht SS, Carmella SG, Murphy SE, Luo X, Stepanov I, Ikuemonisan J, Severson H, Al’absi M, Hatsukami DK. Cigarette Smokers Versus Cousers of Cannabis and Cigarettes: Exposure to Toxicants. Nicotine Tob Res 2020; 22:1383-1389. [PMID: 31616939 PMCID: PMC7366295 DOI: 10.1093/ntr/ntz199] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 10/11/2019] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Cannabis and tobacco couse is common and could expose users to higher levels of toxicants. No studies have examined biomarkers of toxicant exposure in cousers of cannabis and cigarettes, compared with cigarette smokers (CS). AIMS AND METHODS Adult daily CS were recruited from 10 US sites for a study of reduced nicotine cigarettes. In this analysis of baseline data, participants were categorized as either cousers of cannabis and tobacco (cousers; N = 167; urine positive for 11-nor-9-carboxy-Δ 9-tetrahydrocannnabinol and self-reported cannabis use ≥1×/week), or CS (N = 911; negative urine and no self-reported cannabis use). Participants who did not meet either definition (N = 172) were excluded. Self-reported tobacco and cannabis use and tobacco and/or combustion-related biomarkers of exposure were compared between groups. RESULTS Compared to CS, cousers were younger (couser Mage = 38.96, SD = 13.01; CS Mage = 47.22, SD = 12.72; p < .001) and more likely to be male (cousers = 67.7%, CS = 51.9%, p < .001). There were no group differences in self-reported cigarettes/day, total nicotine equivalents, or breath carbon monoxide, but cousers had greater use of non-cigarette tobacco products. Compared to CS, cousers had higher concentrations of 3-hydroxypropylmercapturic acid, 2-cyanoethylmercapturic acid, S-phenylmercapturic acid, 3-hydroxy-1-methylpropylmercapturic acid (ps < .05), and phenanthrene tetraol (p < .001). No biomarkers were affected by number of cannabis use days/week or days since last cannabis use during baseline (ps > .05). CONCLUSIONS Cousers had higher concentrations of biomarkers of exposure than CS, but similar number of cigarettes per day and nicotine exposure. Additional studies are needed to determine whether cannabis and/or alternative tobacco products are driving the increased toxicant exposure. IMPLICATIONS Cousers of cannabis and tobacco appear to be exposed to greater levels of harmful chemicals (ie, volatile organic compounds and polycyclic aromatic hydrocarbons), but similar levels of nicotine as CS. It is unclear if the higher levels of toxicant exposure in cousers are due to cannabis use or the increased use of alternative tobacco products compared with CS. It is important for studies examining biomarkers of exposure among CS to account for cannabis use as it may have a significant impact on outcomes. Additionally, further research is needed examining exposure to harmful chemicals among cannabis users.
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Affiliation(s)
- Ellen Meier
- Department of Psychology, University of Wisconsin—Stevens Point, Stevens Point, WI
| | - Ryan Vandrey
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Nathan Rubin
- University of Minnesota Masonic Cancer Center, Minneapolis, MN
| | - Lauren R Pacek
- Department of Psychiatry, Duke University School of Medicine, Durham, NC
| | - Joni A Jensen
- University of Minnesota, Tobacco Research Programs, Minneapolis, MN
| | - Eric C Donny
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Stephen S Hecht
- University of Minnesota Masonic Cancer Center, Minneapolis, MN
| | | | - Sharon E Murphy
- University of Minnesota Masonic Cancer Center, Minneapolis, MN
| | - Xianghua Luo
- University of Minnesota Masonic Cancer Center, Minneapolis, MN
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN 55414
| | - Irina Stepanov
- University of Minnesota Masonic Cancer Center, Minneapolis, MN
- University of Minnesota, Tobacco Research Programs, Minneapolis, MN
| | | | | | - Mustafa Al’absi
- Department of Family Medicine and BioBehavioral Health, University of Minnesota Medical School, Duluth, MN
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22
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Carroll DM, Strayer L, Nardone N, Pacek LR, Kozink RV, Tessier K, McClernon J, Benowitz N, Bickel WK, Hatsukami D. Development and Piloting Testing of an Experimental Tobacco and Nicotine Product Marketplace. Nicotine Tob Res 2020; 22:1230-1234. [PMID: 31603515 DOI: 10.1093/ntr/ntz195] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 10/07/2019] [Indexed: 11/12/2022]
Abstract
INTRODUCTION We describe the development and pilot testing of the experimental tobacco and nicotine product marketplace (ETM)-a method for studying tobacco and nicotine product (TNP) choices and use behavior in a standardized way. AIMS AND METHODS The ETM resembles an online store populated with TNPs. Surveillance activities and data from a US representative survey and consumer reports were used to determine the most popular TNPs for inclusion in the ETM. Standardized information and videos demonstrating how to use the TNPs were provided. To test the feasibility of using the ETM, smokers (n = 119) underwent monitoring of usual brand cigarette smoking and other TNP use (Baseline Phase) followed by access to the ETM (ETM Phase) that included their usual brand cigarettes, e-cigarettes, moist snuff, snus, and nicotine replacement therapy. During the ETM Phase, participants were provided points based on their baseline TNP consumption to exchange for TNPs in the ETM. Participants were advised to exchange points for enough TNPs to last until their next visit and to refrain from using TNPs not obtained in the ETM. A subset of the participants (n = 62) completed a survey on their experience with the ETM. RESULTS The majority of the participants stated they were comfortable with navigating the ETM (97%), it was easy to determine product characteristics (89%), and they were satisfied with the products included in the marketplace (85%). CONCLUSIONS The ETM was well received by the vast majority of the participants and can be utilized by researchers to investigate a variety of TNP policy and regulatory science research questions. IMPLICATIONS Patterns of TNP use are complex due to greater availability, marketing, and promotion of a diverse array of TNPs. Innovative methods are needed to experimentally study TNP choices and patterns. Through describing the development of the ETM, we provide researchers with a tool that can be readily adapted to studying a variety of phenomena challenging public health.
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Affiliation(s)
| | - Lori Strayer
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Natalie Nardone
- Division of Clinical Pharmacology, Department of Medicine, University of California, San Francisco, CA, USA
| | - Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Rachel V Kozink
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Katelyn Tessier
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Joseph McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Neal Benowitz
- Division of Clinical Pharmacology, Department of Medicine, University of California, San Francisco, CA, USA
| | | | - Dorothy Hatsukami
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
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23
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Pacek LR, Weinberger AH, Zhu J, Goodwin RD. Rapid increase in the prevalence of cannabis use among people with depression in the United States, 2005-17: the role of differentially changing risk perceptions. Addiction 2020; 115:935-943. [PMID: 31797462 PMCID: PMC7156311 DOI: 10.1111/add.14883] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/29/2019] [Accepted: 10/29/2019] [Indexed: 12/21/2022]
Abstract
AIMS To estimate trends in the prevalence of cannabis use and risk perceptions of cannabis use from 2005 to 2017 among United States people with and without depression. DESIGN Linear time trends of the prevalence of any, daily and non-daily past 30-day cannabis use and perceived great risk associated with regular cannabis use (outcome variables) among people with and without past-year depression were assessed using logistic regression with survey year as the predictor. All analyses were adjusted for gender, age, race/ethnicity and income; models assessing time trends of cannabis use prevalence were also adjusted for perceived risk. SETTING The United States: National Survey on Drug Use and Health, an annual cross-sectional survey, 2005-17 public use data files. PARTICIPANTS A total of 728 691 people aged ≥ 12 years. MEASUREMENTS Self-report of any, daily and non-daily past 30-day cannabis use and perceived great risk associated with regular cannabis use. FINDINGS The prevalence of any, daily and non-daily cannabis use in the past month was higher among those with depression versus those without [e.g. 2017 for any use: 18.94 versus 8.67%; adjusted odds ratio (aOR) = 2.17 (95% confidence interval (CI) = 1.92, 2.45)]. Any, daily and non-daily cannabis use increased among people with and without depression from 2005 to 2017, yet the increase in any (aORs = 1.06 versus 1.05; P = 0.008) and daily (aORs = 1.10 versus 1.07; P = 0.021) cannabis use adjusted for socio-demographic characteristics was more rapid among those with depression. Perception of great risk associated with regular cannabis use was significantly lower among those with depression (P < 0.001) and decreased significantly more rapidly over the study period among people with depression, compared with those without (aORs = 0.89 versus 0.92; P < 0.001). CONCLUSIONS The prevalence of cannabis use in the United States increased from 2005 to 2017 among people with and without depression and was approximately twice as common among those with depression. People with depression experienced a more rapid decrease in perception of risk, which may be related to the more rapid increase in any and daily past-month cannabis use in this group.
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Affiliation(s)
- Lauren R. Pacek
- Department of Psychiatry and Behavioral Sciences, Duke School of Medicine, Durham, NC, USA 27705
| | - Andrea H. Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA 10461,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA 10461
| | - Jiaqi Zhu
- Institute for Implementation Science in Population Health, The City University of New York, New York, NY, USA 10027
| | - Renee D. Goodwin
- Institute for Implementation Science in Population Health, The City University of New York, New York, NY, USA 10027,Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY, USA 10027,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA 10032
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24
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Pacek LR, McClernon FJ. Risk perceptions regarding cigarette smoking in the United States continue to decline. Drug Alcohol Depend 2020; 209:107887. [PMID: 32044588 PMCID: PMC8211396 DOI: 10.1016/j.drugalcdep.2020.107887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 01/21/2020] [Accepted: 01/25/2020] [Indexed: 11/30/2022]
Abstract
Nationally representative data from the years 2006-2015 indicate that the prevalence of perceived great risk of smoking one or more packs of cigarettes per day has declined significantly among the United States general population. These findings have important implications for initiation of cigarette smoking, as well as interest in quitting, quit attempts, and sustained cessation. Findings based on more recent data (i.e., years 2016-2018) show that the prevalence of perceived great risk of cigarette smoking has continued to decline significantly (71.76 % versus 72.77 % in 2016 and 73.89 % in 2006). We aim to draw attention to this continued decline in risk perceptions, particularly given the possible associated public health impacts.
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Affiliation(s)
- Lauren R. Pacek
- Corresponding author at: 2608 Erwin Road, Suite 300, Durham, NC 27705 USA. (L.R. Pacek)
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25
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Smith TT, Koopmeiners JS, White CM, Denlinger-Apte RL, Pacek LR, De Jesús VR, Wang L, Watson C, Blount BC, Hatsukami DK, Benowitz NL, Donny EC, Carpenter MJ. The Impact of Exclusive Use of Very Low Nicotine Cigarettes on Compensatory Smoking: An Inpatient Crossover Clinical Trial. Cancer Epidemiol Biomarkers Prev 2020; 29:880-886. [PMID: 32102910 PMCID: PMC7125007 DOI: 10.1158/1055-9965.epi-19-0963] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 12/09/2019] [Accepted: 01/27/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The FDA is considering a mandated reduction in the nicotine content of cigarettes. Clinical trials have been limited by non-study cigarette use (noncompliance), which could mask compensation. The goal of this study was to assess whether compensation occurs when smokers provided with very low nicotine cigarettes cannot access normal nicotine cigarettes. METHODS In a within-subjects, crossover design, current smokers (n = 16) were confined to a hotel for two 4-night hotel stays during which they were only able to access the research cigarettes provided. The hotel stays offered normal nicotine cigarettes or very low nicotine content (VLNC) cigarettes, in an unblinded design, available for "purchase" via a study bank. RESULTS In the context of complete compliance with the study cigarettes (n = 16), there was not a significant increase during the VLNC condition for cigarettes smoked per day, expired carbon monoxide, or N-acetyl-S-(cyanoethyl)-l-cysteine (cyanoethyl-MA, metabolite of acrylonitrile). There was a significant nicotine × time interaction on urine N-acetyl-S-(3-hydroxypropyl)-l-cysteine (hydroxypropyl-MA, metabolite of acrolein), driven by an increase in the VLNC condition during the first 24 hours. By the end of the VLNC condition, there was no evidence of compensation across any measure of smoking or smoke exposure. CONCLUSIONS Among current smokers who exclusively used VLNC cigarettes for 4 days, there was no significant compensatory smoking behavior. IMPACT These data, combined with the larger body of work, suggest that a mandated reduction in nicotine content is unlikely to result in an increase in smoking behavior to obtain more nicotine.
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Affiliation(s)
- Tracy T Smith
- Department of Psychiatry and Behavioral Sciences, and Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina.
| | - Joseph S Koopmeiners
- Division of Biostatistics, School of Public Health, and Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Cassidy M White
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Rachel L Denlinger-Apte
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Víctor R De Jesús
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lanqing Wang
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Clifford Watson
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Benjamin C Blount
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Dorothy K Hatsukami
- Department of Psychiatry and Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Neal L Benowitz
- Departments of Medicine and Bioengineering & Therapeutic Sciences, University of California, San Francisco, San Francisco, California
| | - Eric C Donny
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Matthew J Carpenter
- Department of Psychiatry and Behavioral Sciences, and Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina
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26
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Carroll DM, Murphy SE, Benowitz NL, Strasser AA, Kotlyar M, Hecht SS, Carmella SG, McClernon FJ, Pacek LR, Dermody SS, Vandrey RG, Donny EC, Hatsukami DK. Relationships between the Nicotine Metabolite Ratio and a Panel of Exposure and Effect Biomarkers: Findings from Two Studies of U.S. Commercial Cigarette Smokers. Cancer Epidemiol Biomarkers Prev 2020; 29:871-879. [PMID: 32051195 DOI: 10.1158/1055-9965.epi-19-0644] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/23/2019] [Accepted: 01/24/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND We examined the nicotine metabolite ratio's (NMR) relationship with smoking intensity, nicotine dependence, and a broad array of biomarkers of exposure and biological effect in commercial cigarette smokers. METHODS Secondary analysis was conducted on two cross-sectional samples of adult, daily smokers from Wave 1 (2013-2014) of the Population Assessment of Tobacco Use and Health (PATH) Study and baseline data from a 2014-2017 randomized clinical trial. Data were restricted to participants of non-Hispanic, white race. The lowest quartile of NMR (<0.26) in the nationally representative PATH Study was used to distinguish slow from normal/fast nicotine metabolizers. NMR was modeled continuously in secondary analysis. RESULTS Compared with slow metabolizers, normal/fast metabolizers had greater cigarettes per day and higher levels of total nicotine equivalents, tobacco-specific nitrosamines, volatile organic componds, and polycyclic aromatic hydrocarbons. A novel finding was higher levels of inflammatory biomarkers among normal/fast metabolizers versus slow metabolizers. With NMR modeled as a continuous measure, the associations between NMR and biomarkers of inflammation were not significant. CONCLUSIONS The results are suggestive that normal/fast nicotine metabolizers may be at increased risk for tobacco-related disease due to being heavier smokers, having higher exposure to numerous toxicants and carcinogens, and having higher levels of inflammation when compared with slow metabolizers. IMPACT This is the first documentation that NMR is not only associated with smoking exposure but also biomarkers of biological effects that are integral in the development of tobacco-related disease. Results provide support for NMR as a biomarker for understanding a smoker's exposure and potential risk for tobacco-related disease.
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Affiliation(s)
- Dana M Carroll
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota. .,Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Sharon E Murphy
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Neal L Benowitz
- Clinical Pharmacology Program, Division of Cardiology, Department of Medicine, University of California, San Francisco, California
| | - Andrew A Strasser
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael Kotlyar
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota.,Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota
| | - Stephen S Hecht
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Steve G Carmella
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Francis J McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Sarah S Dermody
- School of Psychological Science, Oregon State University, Corvallis, Oregon
| | - Ryan G Vandrey
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Eric C Donny
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, North Carolina
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27
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Villanti AC, Byron MJ, Mercincavage M, Pacek LR. Misperceptions of Nicotine and Nicotine Reduction: The Importance of Public Education to Maximize the Benefits of a Nicotine Reduction Standard. Nicotine Tob Res 2019; 21:S88-S90. [PMID: 31867645 PMCID: PMC6939783 DOI: 10.1093/ntr/ntz103] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 06/20/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Andrea C Villanti
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont Larner College of Medicine, Burlington, VT
| | - M Justin Byron
- Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Melissa Mercincavage
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Lauren R Pacek
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC
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28
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Smith TT, Donny EC, Luo X, Allen AM, Carroll DM, Denlinger-Apte RL, Dermody SS, Koopmeiners JS, McClernon FJ, Pacek LR, Vandrey R, Hatsukami DK. The Impact of Gradual and Immediate Nicotine Reduction on Subjective Cigarette Ratings. Nicotine Tob Res 2019; 21:S73-S80. [PMID: 31867651 PMCID: PMC6939762 DOI: 10.1093/ntr/ntz158] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 08/24/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND A recent clinical trial showed that an immediate transition to very low nicotine content (VLNC) cigarettes, compared with a gradual transition, produced greater reductions in smoking behavior, smoke exposure, and dependence. However, there was less compliance with the instruction to smoke only VLNC cigarettes in the immediate versus gradual reduction condition. The goal of this study was to test whether nicotine reduction method alters subjective ratings of VLNC cigarettes, and whether subjective ratings mediate effects of nicotine reduction method on smoking behavior, smoke exposure, dependence, and compliance. METHODS This is a secondary analysis of a randomized trial conducted across 10 sites in the United States. Smokers (n = 1250) were randomized to either a control condition, or to have the nicotine content of their cigarettes reduced immediately or gradually to 0.04 mg nicotine/g of tobacco during a 20-week study period. Participants completed the modified Cigarette Evaluation Questionnaire (mCEQ). RESULTS After Week 20, the immediate reduction group scored significantly lower than the gradual reduction group on multiple subscales of the mCEQ (ps < .001). The Satisfaction subscale of the mCEQ mediated the impact of nicotine reduction method on smoke exposure, smoking behavior, dependence, compliance, and abstinence. Other subscales also mediated a subset of these outcomes. CONCLUSIONS An immediate reduction in nicotine content resulted in lower product satisfaction than a gradual reduction, suggesting that immediate reduction further reduces cigarette reward value. This study will provide the Food and Drug Administration with information about the impact of nicotine reduction method on cigarette reward value. IMPLICATIONS These data suggest that an immediate reduction in nicotine content will result in greater reductions in cigarette satisfaction than a gradual reduction, and this reduction in satisfaction is related to changes in smoking behavior and dependence.
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Affiliation(s)
- Tracy T Smith
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
- Baptist Comprehensive Cancer Center and Department of Physiology and Pharmacology, Wake Forest University, Winston-Salem, NC
| | - Eric C Donny
- Baptist Comprehensive Cancer Center, Wake Forest University, Winston-Salem, NC
- Department of Physiology and Pharmacology, Wake Forest University, Winston-Salem, NC
| | - Xianghua Luo
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | - Alicia M Allen
- Department of Family and Community Medicine, University of Arizona, Tucson, AZ
| | - Dana M Carroll
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | - Rachel L Denlinger-Apte
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI
| | - Sarah S Dermody
- School of Psychological Science, Oregon State University, Corvallis, OR
| | - Joseph S Koopmeiners
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN
| | - F Joseph McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Ryan Vandrey
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD
| | - Dorothy K Hatsukami
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN
- Department of Psychiatry, University of Minnesota, Minneapolis, MN
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29
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Colby SM, Cassidy RN, Denlinger-Apte R, Smith TT, Pacek LR, McClernon FJ, Tidey JW. Anticipated Effects of Nicotine Reduction on Youth Smoking Initiation and Maintenance. Nicotine Tob Res 2019; 21:S46-S48. [PMID: 31867638 PMCID: PMC6939777 DOI: 10.1093/ntr/ntz101] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 06/14/2019] [Indexed: 12/31/2022]
Abstract
This commentary summarizes emerging findings on the potential impact of a nicotine reduction policy on youth and young adults. We conclude that: (1) adolescent smokers and nonsmokers alike are likely to be less sensitive to reinforcement from very low nicotine content (VLNC) cigarettes compared with adults; (2) reducing nicotine in cigarettes to 0.4 mg/g would reduce the abuse potential of cigarettes in adolescents and young adults; (3) findings to date do not support concerns that nicotine reduction leads to compensatory smoking in young smokers; and (4) if the scope of a reduced nicotine product standard were applied to all combusted tobacco products, that would likely maximize public health benefit of this policy.
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Affiliation(s)
- Suzanne M Colby
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI
| | - Rachel N Cassidy
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI
| | - Rachel Denlinger-Apte
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI
| | - Tracy T Smith
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - F Joseph McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Jennifer W Tidey
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI
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30
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Denlinger-Apte RL, Kotlyar M, Koopmeiners JS, Tidey JW, Luo X, Benowitz NL, Jensen JA, Ikuemonisan JO, Pacek LR, Smith TT, Vandrey R, Donny EC, Hatsukami DK. Effects of Very Low Nicotine Content Cigarettes on Smoking Behavior and Biomarkers of Exposure in Menthol and Non-menthol Smokers. Nicotine Tob Res 2019; 21:S63-S72. [PMID: 31867637 PMCID: PMC6939781 DOI: 10.1093/ntr/ntz160] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 08/25/2019] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Because 30% of cigarettes sold in the United States are characterized as menthol cigarettes, it is important to understand how menthol preference may affect the impact of a nicotine reduction policy. METHODS In a recent trial, non-treatment-seeking smokers were randomly assigned to receive very low nicotine cigarettes (VLNC; 0.4 mg nicotine/g tobacco) or normal nicotine cigarettes (NNC; 15.5 mg/g) for 20 weeks. On the basis of preference, participants received menthol or non-menthol cigarettes. We conducted multivariable regression analyses to examine whether menthol preference moderated the effects of nicotine content on cigarettes per day (CPD), breath carbon monoxide (CO), urinary total nicotine equivalents (TNE), urinary 2-cyanoethylmercapturic acid (CEMA), and abstinence. RESULTS At baseline, menthol smokers (n = 346) reported smoking fewer CPD (14.9 vs. 19.2) and had lower TNE (52.8 vs. 71.6 nmol/mg) and CO (17.7 vs. 20.5 ppm) levels than non-menthol smokers (n = 406; ps < .05). At week 20, significant interactions indicated that menthol smokers had smaller treatment effects than non-menthol smokers for CPD (-6.4 vs. -9.3), TNE (ratio of geometric means, 0.22 vs. 0.10) and CEMA (ratio, 0.56 vs. 0.37; ps < .05), and trended toward a smaller treatment effect for CO (-4.5 vs. -7.3 ppm; p = .06). Odds ratios for abstinence at week 20 were 1.88 (95% confidence interval [CI] = 0.8 to 4.4) for menthol and 9.11 (95% CI = 3.3 to 25.2) for non-menthol VLNC smokers (p = .02) relative to the NNC condition. CONCLUSIONS Although menthol smokers experienced reductions in smoking, toxicant exposure, and increases in quitting when using VLNC cigarettes, the magnitude of change was smaller than that observed for non-menthol smokers. IMPLICATIONS Results of this analysis suggest that smokers of menthol cigarettes may respond to a nicotine reduction policy with smaller reductions in smoking rates and toxicant exposure than would smokers of non-menthol cigarettes.
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Affiliation(s)
- Rachel L Denlinger-Apte
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC
| | - Michael Kotlyar
- Department of Experimental and Clinical Pharmacology, University of Minnesota College of Pharmacy, Minneapolis, MN
| | - Joseph S Koopmeiners
- Masonic Cancer Center and Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Jennifer W Tidey
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI
| | - Xianghua Luo
- Masonic Cancer Center and Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Neal L Benowitz
- Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Joni A Jensen
- Masonic Cancer Center and Department of Psychiatry, University of Minnesota, Minneapolis, MN
| | - Joshua O Ikuemonisan
- Masonic Cancer Center and Department of Psychiatry, University of Minnesota, Minneapolis, MN
| | - Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Tracy T Smith
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Ryan Vandrey
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD
| | - Eric C Donny
- Baptist Comprehensive Cancer Center and Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Dorothy K Hatsukami
- Masonic Cancer Center and Department of Psychiatry, University of Minnesota, Minneapolis, MN
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Pacek LR, Wiley JL, McClernon FJ. A Conceptual Framework for Understanding Multiple Tobacco Product Use and the Impact of Regulatory Action. Nicotine Tob Res 2019; 21:268-277. [PMID: 29931176 DOI: 10.1093/ntr/nty129] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 06/18/2018] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Over 35% of the adult tobacco-using population regularly use more than one tobacco product. Although rates of tobacco use in the United States have declined over the last decade, rates of multiple tobacco product (MTP) have either remained stable (among adults) or increased (among youth). METHODS In this paper, we review the literature and propose a framework for understanding both MTP use and how regulatory actions on any single tobacco product (STP) may influence the use of other tobacco products. RESULTS AND CONCLUSIONS Within the framework, Product, Person, and Context/Situational factors (and their interactions) influence product cross-substitution and thus patterns of use of MTPs. In addition, we propose that Context/Situation effects specifically increase the complexity of MTP-use patterns resulting in "dynamic complementarity" in addition to substitution-like relationships between tobacco products. Experimentation with, and use of, various tobacco products results in reinforcement histories that affect which products are used, in what contexts, and by whom, which in turn has downstream impacts on toxicant exposure and health. We conclude our analysis with an examination of how regulation of STPs can have impacts on the use of other STP and MTP use and provide research questions for further examining MTP use. IMPLICATIONS Though rates of tobacco use have declined in the United States, over 35% of the adult tobacco-using population regularly uses more than one tobacco product. This paper provides a framework for understanding MTP use and how regulatory actions on any STP may influence the use of other tobacco products. We conclude our analysis by providing research questions for further examining MTP use.
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Affiliation(s)
- Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | | | - F Joseph McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
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Riehm KE, Feder KA, Tormohlen KN, Crum RM, Young AS, Green KM, Pacek LR, La Flair LN, Mojtabai R. Associations Between Time Spent Using Social Media and Internalizing and Externalizing Problems Among US Youth. JAMA Psychiatry 2019; 76:1266-1273. [PMID: 31509167 PMCID: PMC6739732 DOI: 10.1001/jamapsychiatry.2019.2325] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
IMPORTANCE Social media use may be a risk factor for mental health problems in adolescents. However, few longitudinal studies have investigated this association, and none have quantified the proportion of mental health problems among adolescents attributable to social media use. OBJECTIVE To assess whether time spent using social media per day is prospectively associated with internalizing and externalizing problems among adolescents. DESIGN, SETTING, AND PARTICIPANTS This longitudinal cohort study of 6595 participants from waves 1 (September 12, 2013, to December 14, 2014), 2 (October 23, 2014, to October 30, 2015), and 3 (October 18, 2015, to October 23, 2016) of the Population Assessment of Tobacco and Health study, a nationally representative cohort study of US adolescents, assessed US adolescents via household interviews using audio computer-assisted self-interviewing. Data analysis was performed from January 14, 2019, to May 22, 2019. EXPOSURES Self-reported time spent on social media during a typical day (none, ≤30 minutes, >30 minutes to ≤3 hours, >3 hours to ≤6 hours, and >6 hours) during wave 2. MAIN OUTCOMES AND MEASURE Self-reported past-year internalizing problems alone, externalizing problems alone, and comorbid internalizing and externalizing problems during wave 3 using the Global Appraisal of Individual Needs-Short Screener. RESULTS A total of 6595 adolescents (aged 12-15 years during wave 1; 3400 [51.3%] male) were studied. In unadjusted analyses, spending more than 30 minutes of time on social media, compared with no use, was associated with increased risk of internalizing problems alone (≤30 minutes: relative risk ratio [RRR], 1.30; 95% CI, 0.94-1.78; >30 minutes to ≤3 hours: RRR, 1.89; 95% CI, 1.36-2.64; >3 to ≤6 hours: RRR, 2.47; 95% CI, 1.74-3.49; >6 hours: RRR, 2.83; 95% CI, 1.88-4.26) and comorbid internalizing and externalizing problems (≤30 minutes: RRR, 1.39; 95% CI, 1.06-1.82; >30 minutes to ≤3 hours: RRR, 2.34; 95% CI, 1.83-3.00; >3 to ≤6 hours: RRR, 3.15; 95% CI, 2.43-4.09; >6 hours: RRR, 4.29; 95% CI, 3.22-5.73); associations with externalizing problems were inconsistent. In adjusted analyses, use of social media for more than 3 hours per day compared with no use remained significantly associated with internalizing problems alone (>3 to ≤6 hours: RRR, 1.60; 95% CI, 1.11-2.31; >6 hours: RRR, 1.78; 95% CI, 1.15-2.77) and comorbid internalizing and externalizing problems (>3 to ≤6 hours: RRR, 2.01; 95% CI, 1.51-2.66; >6 hours: RRR, 2.44; 95% CI, 1.73-3.43) but not externalizing problems alone. CONCLUSIONS AND RELEVANCE Adolescents who spend more than 3 hours per day using social media may be at heightened risk for mental health problems, particularly internalizing problems. Future research should determine whether setting limits on daily social media use, increasing media literacy, and redesigning social media platforms are effective means of reducing the burden of mental health problems in this population.
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Affiliation(s)
- Kira E. Riehm
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Kenneth A. Feder
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Kayla N. Tormohlen
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Rosa M. Crum
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland,Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland,Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Andrea S. Young
- Division of Child and Adolescent Psychiatry, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Kerry M. Green
- Department of Behavioral and Community Health, University of Maryland, College Park, College Park
| | - Lauren R. Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
| | | | - Ramin Mojtabai
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland
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Cooper M, Pacek LR, Guy MC, Barrington-Trimis JL, Simon P, Stanton C, Kong G. Hookah Use Among US Youth: A Systematic Review of the Literature From 2009 to 2017. Nicotine Tob Res 2019; 21:1590-1599. [PMID: 29961895 PMCID: PMC6861827 DOI: 10.1093/ntr/nty135] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 06/25/2018] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Given the US Food and Drug Administration (FDA)'s authority to regulate hookah, more research is needed to inform regulations intended to prevent youth from using hookah. This systematic review summarizes and assesses the literature related to hookah use among adolescents (11 to ≤18 years of age) in the United States from 2009 to 2017. METHODS Database searches yielded 867 peer-reviewed articles. After duplicates were removed, authors reviewed 461 articles for inclusion. Included articles (n = 55) were coded for study themes, study quality, and their relevance to FDA's research priorities. A qualitative synthesis is presented. RESULTS The following themes were identified: (1) prevalence of hookah use (n = 42), (2) tobacco use transitions (n = 7), (3) sociodemographic correlates (n = 35), (4) psychosocial risk factors (n = 21), (5) concurrent use of other tobacco products (n = 31), (6) concurrent use of other substances (n = 9), and (7) other (n = 15)-which includes low prevalence themes. The qualitative synthesis showed increasing rates of hookah use. Older age, male gender, positive social normative beliefs, higher peer use, as well as lower perceived risk were associated with hookah use. Longitudinal studies of youth hookah use showed bidirectional relationships between use of hookah and other tobacco products. All articles fell within FDA's research priority related to "behavior," and three priorities ("impact analysis," "health effects," and "toxicity") have not been explored for hookah use among US youth since 2009. CONCLUSIONS The prevalence of hookah use among youth in the United States is increasing, thus more research is needed to inform policies targeted to protect this vulnerable population. IMPLICATIONS This study represents a novel contribution to our understanding of hookah use among youth in the United States from 2009-the year that the Family Smoking Prevention and Tobacco Control Act was passed-to 2017. In recent years, hookah has become a more popular tobacco product among US youth; however, to date, no systematic reviews of hookah use among this population exist. Results highlight implications for future US FDA regulatory policy and identify gaps in research to be addressed in future studies.
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Affiliation(s)
- Maria Cooper
- Department of Epidemiology, Human Genetics and Environmental Sciences, UTHealth School of Public Health in Austin, Austin, TX
| | - Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Mignonne C Guy
- Department of African American Studies, Virginia Commonwealth University, Richmond, VA
| | | | - Patricia Simon
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | - Cassandra Stanton
- Westat, Center for Evaluation and Coordination of Training and Research (CECTR) in Tobacco Regulatory Science, Rockville, MD
- The Department of Oncology, Georgetown University Medical Center/Lombardi Comprehensive Cancer Center, Washington, DC
| | - Grace Kong
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
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Oliver JA, Pacek LR, Locey EN, Fish LM, Hendricks PS, Pollak KI. Lack of utility of cigarettes per day cutoffs for clinical and laboratory smoking research. Addict Behav 2019; 98:106066. [PMID: 31386967 DOI: 10.1016/j.addbeh.2019.106066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/19/2019] [Accepted: 07/29/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Most clinical and laboratory smoking research studies require that participants smoke at a certain level to be eligible for enrollment. However, there is limited evidence that use of these cutoffs differentiates groups of smokers along clinically meaningful criteria. METHODS Using receiver operating characteristic curves, we analyzed data from daily smokers in the National Epidemiologic Study of Alcohol Use and Related Conditions - III (NESARC-III) to examine the utility of smoking rates for determining whether participants met DSM-5 criteria for tobacco use disorder, experienced nicotine withdrawal or had a history of failed quit attempts. We also examined whether relationships between these variables differed as a function of key sample characteristics. RESULTS Smoking rate exhibited a weak relationship with the presence of tobacco use disorder (AUC = 0.664), whether individuals experience nicotine withdrawal (AUC = 0.672) and whether individuals had a history of failed quit attempts (AUC = 0.578). The relationship between smoking rate and a history of failed quit attempts was weaker for women than men (p < .05). Otherwise, utility did not differ as a function of sex, race/ethnicity, education, income, or use of multiple tobacco products. Optimal cutoffs varied somewhat across indices, but the largest number of correct classifications occurred at very low smoking rates. CONCLUSIONS Researchers should consider abandoning the use of smoking rate cutoffs to determine study eligibility. If smoking rate cutoffs are used, a rationale should be presented along with justification for the specific cutoff chosen.
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Oliver JA, Hallyburton MB, Pacek LR, Mitchell JT, Vilardaga R, Fuemmeler BF, McClernon FJ. What Do Smokers Want in A Smartphone-Based Cessation Application? Nicotine Tob Res 2019; 20:1507-1514. [PMID: 29065202 DOI: 10.1093/ntr/ntx171] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Indexed: 11/14/2022]
Abstract
Background Fueled by rapid technological advances over the past decade, there is growing interest in the use of smartphones to aid in smoking cessation. Hundreds of applications have been developed for this purpose, but little is known about how these applications are accessed and used by smokers or what features smokers believe would be most useful. Purpose The present study sought to understand the prevalence of smartphone ownership and patterns of use among smokers as well as the perceived utility of various smartphone application features for smoking cessation that are currently in development or already available. Methods Daily cigarette smokers (n = 224) reported on smartphone ownership, their patterns of smartphone usage, and perceived utility of features. Features were ranked according to perceived utility and differences in both perceived utility and general smartphone use patterns were examined as a function of demographic and smoking-related variables. Results Most smokers (80.4%) own a smartphone, but experience with smoking cessation applications is extremely rare (6.1%). Ownership and patterns of usage differed as a function of demographic and smoking-related variables. Overall, gain-framed features were rated as most useful, while loss-framed and interpersonal features were rated as least useful. Conclusions Mobile health interventions have the potential to reach a large number of smokers but are currently underutilized. Additional effort is needed to ensure parity in treatment access. Gain-framed messages may be especially useful for engaging smokers, even if other features ultimately drive treatment effects. Implications This study describes patterns of smartphone usage among smokers and identifies the smartphone application features smokers believe would be most useful during a quit attempt. Findings indicate which subgroups of smokers are most likely to be reached with mobile health interventions and suggests that inclusion of specific features may be helpful for engaging smokers in the smoking cessation process.
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Affiliation(s)
- Jason A Oliver
- Center for Addiction Science and Technology, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicin, Durham, NC
| | - Matthew B Hallyburton
- Center for Addiction Science and Technology, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicin, Durham, NC
| | - Lauren R Pacek
- Center for Addiction Science and Technology, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicin, Durham, NC
| | - John T Mitchell
- Center for Addiction Science and Technology, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicin, Durham, NC
| | - Roger Vilardaga
- Center for Addiction Science and Technology, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicin, Durham, NC
| | - Bernard F Fuemmeler
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA
| | - F Joseph McClernon
- Center for Addiction Science and Technology, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicin, Durham, NC
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Pacek LR, Berry MS, Rass O, Mercincavage M, McClernon FJ, Johnson MW. Graphic Warning Labels Affect Hypothetical Cigarette Purchasing Behavior among Smokers Living with HIV. Int J Environ Res Public Health 2019; 16:ijerph16183380. [PMID: 31547374 PMCID: PMC6765870 DOI: 10.3390/ijerph16183380] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/03/2019] [Accepted: 09/06/2019] [Indexed: 12/25/2022]
Abstract
Cigarette pack graphic warning labels (GWLs) are associated with increased knowledge of tobacco-related harms; scant research has evaluated their effects on behavior among vulnerable populations. We used a behavioral economic approach to measure the effects of GWLs and price on hypothetical cigarette purchasing behavior among HIV-positive smokers. Participants (n = 222) completed a cigarette valuation task by making hypothetical choices between GWL cigarette packs at a fixed price ($7.00) and text-only warning label cigarette packs at increasing prices ($3.50 to $14.00; $0.25 increments). More than one-quarter (28.8%) of participants paid more to avoid GWLs. The remaining participants’ purchasing decisions appear to have been driven by price: 69.8% of participants chose the cheaper pack. Across all participants, overall monetary choice value observed for GWL cigarette packs (mean = $7.75) was greater than if choice was driven exclusively by price ($7.00). Most (87.4%) preferred the text-only warning label when GWL and text-only cigarette packs were equally priced. Correlation analysis indicated GWL pack preference was associated with agreement with statements that GWLs would stop individuals from having a cigarette or facilitate thoughts about quitting. These data suggest that GWLs may influence some HIV-positive smokers in such a way that they are willing to pay more to avoid seeing GWLs.
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Affiliation(s)
- Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27705, USA.
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA.
| | - Meredith S Berry
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA.
- Department of Health Education and Behavior & Department of Psychology, University of Florida, Gainesville, FL 32611, USA.
| | - Olga Rass
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA.
| | - Melissa Mercincavage
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA.
| | - F Joseph McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27705, USA.
| | - Matthew W Johnson
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA.
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Pacek LR, Reboussin BA, Green KM, LaFlair LN, Storr CL, Alvanzo AAH, Mojtabai R, Cullen B, Young AS, Tormohen K, Riehm K, Crum RM. Current tobacco use, nicotine dependence, and transitions across stages of alcohol involvement: A latent transition analysis approach. Int J Methods Psychiatr Res 2019; 28:e1789. [PMID: 31141253 PMCID: PMC6791727 DOI: 10.1002/mpr.1789] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 04/29/2019] [Accepted: 05/05/2019] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES This study aims to examine the (a) probability of transition between stages of alcohol involvement and (b) influence of tobacco use and nicotine dependence on transitions. METHODS Data came from Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. Latent transition analysis estimated the probability of transitioning between stages of alcohol involvement across waves and the impact of tobacco use and nicotine dependence at Wave 1 on transitions. RESULTS Males reporting current tobacco use but no dependence at Wave 1 were more likely to progress from No Problems to Moderate Problems (adjusted odds ratio [aOR] = 1.79; 95% confidence interval [CI] [1.44, 2.22]) and from No Problems to Severe Problems (aOR = 2.44; 95% CI [1.25, 4.77]) than nontobacco users. Females reporting current tobacco use but no dependence were more likely to progress from No Problems to Moderate Problems (aOR = 2.00; 95% CI [1.37, 2.94]) and from No Problems to Severe Problems (aOR = 2.87; 95% CI [1.34, 6.13]). Females reporting current tobacco use and dependence were more likely than females not using tobacco to transition from Moderate to No Problems (aOR = 2.10; 95% CI [1.04, 4.22]). CONCLUSIONS Results suggest that tobacco use is a preceding correlate of progression in alcohol involvement among males and females. Among females, tobacco use and nicotine dependence are also related to alcohol involvement recovery.
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Affiliation(s)
- Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Beth A Reboussin
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Kerry M Green
- Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park, MD, USA
| | | | - Carla L Storr
- Family and Community Health, University of Maryland School of Nursing, Baltimore, MD, USA.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Anika A H Alvanzo
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ramin Mojtabai
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bernadette Cullen
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrea S Young
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kayla Tormohen
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kira Riehm
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rosa M Crum
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Green KM, Reboussin BA, Pacek LR, Storr CL, Mojtabai R, Cullen BA, Crum RM. The Effects of Marijuana Use on Transitions through Stages of Alcohol Involvement for Men and Women in the NESARC I and II. Subst Use Misuse 2019; 54:2167-2176. [PMID: 31299872 PMCID: PMC6803069 DOI: 10.1080/10826084.2019.1638408] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background: With the changing context of marijuana use, it is critical to identify effects of use. We extend previous work by examining whether marijuana use influences progression and remission through alcohol involvement stages for men and women. Methods: Data come from Waves I and II of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC, n = 34,432). We assess the potential influence of marijuana use at Wave 1 on transitions across three latent statuses of alcohol involvement between waves. We apply propensity score weighting to account for shared risk factors. Results: Marijuana use was associated cross-sectionally and longitudinally with alcohol involvement statuses for both sexes. After propensity score adjustment, men with marijuana histories were 3.50 times as likely as men without such histories to transition from no to severe problems across waves relative to staying in the same status (p < .001). Women with marijuana histories were 1.74 times as likely as women without such histories to transition from no problems at Wave 1 to moderate problems at Wave 2 (p = .030) and 0.13 times as likely as women without such histories to transition from severe problems to no problems (p = .006). Conclusions: Results suggest that marijuana use impacts progression to more serious stages of alcohol involvement for both men and women, as well as hinders remission among women. Findings point to the importance of screening those with marijuana histories for alcohol problems, as well as the need to understand the mechanism of why marijuana use may increase the risk of alcohol problems.
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Affiliation(s)
- Kerry M. Green
- Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park, MD 20742 USA
| | - Beth A. Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
| | - Lauren R. Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27705 USA
| | - Carla L. Storr
- Department of Family and Community Health, University of Maryland School of Nursing, Baltimore, MD
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205 USA
| | - Ramin Mojtabai
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205 USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21205 USA
| | - Bernadette A. Cullen
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205 USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21205 USA
| | - Rosa M. Crum
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205 USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21205 USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205 USA
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Riehm KE, Young AS, Feder KA, Krawczyk N, Tormohlen KN, Pacek LR, Mojtabai R, Crum RM. Mental Health Problems and Initiation of E-cigarette and Combustible Cigarette Use. Pediatrics 2019; 144:peds.2018-2935. [PMID: 31160343 PMCID: PMC6615573 DOI: 10.1542/peds.2018-2935] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/28/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND AND OBJECTIVES During adolescence, mental health problems may increase the risk of initiating combustible cigarette use. However, it is unknown if this association extends to electronic cigarettes (e-cigarettes). We examined whether internalizing and externalizing problems were associated with initiation of e-cigarette, combustible cigarette, and dual-product use among adolescents. METHODS Participants were drawn from the Population Assessment of Tobacco and Health Study, a nationally representative longitudinal study of US adolescents followed from 2013 to 2015. The study sample included 7702 adolescents aged 12 to 17 years who at baseline reported no lifetime use of tobacco products. We examined the respective associations between baseline internalizing and externalizing problems and initiating use of e-cigarettes, combustible cigarettes, or both at 1-year follow-up. RESULTS Compared with adolescents with low externalizing problems, adolescents with high externalizing problems were significantly more likely to initiate use of e-cigarettes (adjusted relative risk ratio [aRRR] = 2.78; 95% confidence interval [CI]: 1.76-4.40), combustible cigarettes (aRRR = 5.59; 95% CI: 2.63-11.90), and both products (aRRR = 2.23; 95% CI: 1.15-4.31). Adolescents with high internalizing problems were at increased risk of initiating use of e-cigarettes (aRRR = 1.61; 95% CI: 1.12-2.33) but not combustible cigarettes or both products. CONCLUSIONS Mental health problems are associated with increased risk for initiating e-cigarette, combustible cigarette, and dual-product use in adolescence. This association is more consistent for externalizing problems than internalizing problems. Addressing mental health problems could be a promising target for preventing initiation of nicotine- and/or tobacco-product use by adolescents.
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Affiliation(s)
| | - Andrea S. Young
- Division of Child and Adolescent Psychiatry, School
of Medicine, Johns Hopkins University, Baltimore, Maryland; and
| | | | | | | | - Lauren R. Pacek
- Department of Psychiatry and Behavioral Sciences,
School of Medicine, Duke University, Durham, North Carolina
| | | | - Rosa M. Crum
- Welch Center for Prevention, Epidemiology, and
Clinical Research and,Departments of Mental Health and,Epidemiology, Bloomberg School of Public Health
and
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40
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Kong G, Simon P, Mayer ME, Barrington-Trimis JL, Pacek LR, Cooper M, Guy MC, Stanton CA. Harm Perceptions of Alternative Tobacco Products among US Adolescents. TOB REGUL SCI 2019; 5:242-252. [PMID: 31840041 PMCID: PMC6910255 DOI: 10.18001/trs.5.3.3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES In this study, we identified groups of adolescents who share similar awareness and perceptions of harm regarding e-cigarettes, cigars, hookah, and smokeless tobacco. METHODS We used latent class analyses (LCA) with the data from Wave 1 (2013-14) of the Population Assessment of Tobacco and Health youth and parent survey (PATH; N = 13,650) to address the research goal. Multinomial logistic regression analysis assessed the associations between identified classes with demographic characteristics and tobacco use. RESULTS LCA identified 5 classes: (1) perceived harm across all alternative tobacco products (36.6%); (2) perceived harm for e-cigarettes and smokeless tobacco but never heard of cigars and hookah (48.2%); (3) never heard of alternative tobacco products (8.6%); (4) mix of no harm and harm across alternative tobacco products (5.2%); and (5) "don't know" the harm across alternative tobacco products (1.4%). Relative to the class who perceived harm across all alternative tobacco products, classes of adolescents who were unaware of the products or did not know the harms were more likely to be non-white, younger, have lower parental education, and less likely to have tried an alternative tobacco product. CONCLUSIONS Tobacco prevention should target vulnerable youth, such as adolescents who are non-white, young, and have low parental education.
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Affiliation(s)
- Grace Kong
- Yale School of Medicine, Department of Psychiatry, New Haven, CT
| | - Patricia Simon
- Yale School of Medicine, Department of Psychiatry, New Haven, CT
| | - Margaret E Mayer
- Yale School of Public Health, Department of Chronic Disease Epidemiology, New Haven, CT
| | | | - Lauren R Pacek
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Durham, NC
| | - Maria Cooper
- Adjunct Faculty, The University of Texas Health Science Center at Houston (UTHealth), School of Public Health Austin Campus, Houston, TX
| | - Mignonne C Guy
- Virginia Commonwealth University College of Humanities and Sciences, Department of African American Studies, Richmond, VA
| | - Cassandra A Stanton
- Westat, Center for Evaluation and Coordination of Training and Research (CECTR) in Tobacco Regulatory Science, Washington, DC
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41
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Weinberger AH, Pacek LR, Wall MM, Gbedemah M, Lee J, Goodwin RD. Cigarette smoking quit ratios among adults in the USA with cannabis use and cannabis use disorders, 2002-2016. Tob Control 2019; 29:74-80. [PMID: 30952691 DOI: 10.1136/tobaccocontrol-2018-054590] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 10/02/2018] [Accepted: 11/23/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND The prevalence of cigarette smoking is nearly three times higher among persons who use cannabis and have cannabis use disorders (CUDs), relative to those who do not. The current study examined cigarette quit ratios from 2002 to 2016 among US adults with and without cannabis use and CUDs. METHODS The current study analysed US adults aged 18 years and older from the National Survey on Drug Use and Health, an annual cross-sectional study. Quit ratios (ie, proportion of former smokers among ever-smokers) were calculated annually from 2002 to 2016. Time trends in quit ratios by cannabis use/CUDs were tested using logistic regression. RESULTS In 2016, the quit ratios for people with any cannabis use (23%) and CUDs (15%) were less than half the quit ratios of those without cannabis use and CUDs (51% and 48%, respectively). After controlling for demographics and substance use disorders, the quit ratio did not change from 2002 to 2016 among persons with CUD, though it non-linearly increased among persons with cannabis use, without cannabis use and without CUDs. Quit ratios increased more rapidly among those who reported past-month cannabis use compared with those without past-month cannabis use. CONCLUSIONS Cigarette smoking quit ratios remain dramatically lower among people who use cannabis and have CUDs and quit ratios did not change significantly from 2002 to 2016 among those with CUDs. Public health and clinical attention are needed to increase quit ratios and reduce harmful cigarette smoking consequences for persons with cannabis use and CUDs.
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Affiliation(s)
- Andrea H Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York, USA.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Melanie M Wall
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, USA.,New York State Psychiatric Institute, New York, USA
| | - Misato Gbedemah
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, USA.,Institute for Implementation Science in Population Health, The City University of New York, New York, USA
| | - Joun Lee
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York, USA.,Department of Genetics, Albert Einstein College of Medicine, Bronx, USA
| | - Renee D Goodwin
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, USA.,Institute for Implementation Science in Population Health, The City University of New York, New York, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
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42
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Weinberger AH, Pacek LR, Sheffer CE, Budney AJ, Lee J, Goodwin RD. Serious psychological distress and daily cannabis use, 2008 to 2016: Potential implications for mental health? Drug Alcohol Depend 2019; 197:134-140. [PMID: 30825793 PMCID: PMC6440801 DOI: 10.1016/j.drugalcdep.2019.01.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 12/14/2018] [Accepted: 01/07/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Daily cannabis use is increasing in the United States (US). Yet, it is not known whether daily cannabis use is disproportionately common, or whether it has increased differentially over time, by mental health status. This study estimated the prevalence of daily cannabis use among adults in the US with and without past-month serious psychological distress (SPD; measured by the Kessler Psychological Distress Scale (K6)) in 2016 and estimated trends in daily cannabis use by past-30-day SPD status from 2008 to 2016. METHODS Data were drawn from adults age 18 and older in the 2008-2016 National Survey on Drug Use and Health (combined total analytic sample n = 356,413). Linear time trends of daily cannabis use, stratified by SPD status, were assessed using logistic regression models with continuous year as the predictor. RESULTS In 2016, past-month daily cannabis use was significantly more common among those with past-month SPD (8.07%), compared to those without past-month SPD (2.66%). Daily cannabis use increased significantly from 2008 to 2016 among those both with and without SPD although use among those with SPD was persistently higher than use among those without SPD over the time period studied. CONCLUSIONS Daily cannabis use is significantly more common among persons with serious psychological distress and is increasing in this group, as well as among those without. Given this increase and the high prevalence of cannabis use among those with SPD, it may be important to consider potential consequences of this increased use for those with mental health vulnerabilities.
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Affiliation(s)
- Andrea H Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA; Department of Epidemiology and Population Health, Yeshiva University Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.
| | - Christine E Sheffer
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY, USA.
| | - Alan J Budney
- Geisel School of Medicine at Dartmouth, Center for Technology and Behavioral Health, Lebanon, NH, USA.
| | - Joun Lee
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA.
| | - Renee D Goodwin
- Institute for Implementation Science and Population Health, CUNY School of Public Health and Health Policy, New York, NY, USA; Department of Epidemiology and Biostatistics, CUNY School of Public Health, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
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43
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Pacek LR, Rass O, Sweitzer MM, Oliver JA, McClernon FJ. Young adult dual combusted cigarette and e-cigarette users' anticipated responses to hypothetical e-cigarette market restrictions. Subst Use Misuse 2019; 54:2033-2042. [PMID: 31305213 PMCID: PMC6764889 DOI: 10.1080/10826084.2019.1626435] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Introduction: The aim of this exploratory study was to assess young adult dual e-cigarette (EC) and combusted cigarette (CC) users' anticipated responses to hypothetical market restrictions regarding key EC characteristics. Methods: Data came from 240 young adult dual EC and CC users recruited via Amazon Mechanical Turk in June 2017. Descriptive statistics were used to report sociodemographic, CC smoking, and EC use characteristics. McNemar's chi-square tests and chi-square tests were used to assess differences between groups in terms of anticipated responses to hypothetical EC market restrictions. Results: Hypothetical regulations resulted in reported intentions to reduce EC use and increase CC use; the greatest impact was found for restrictions regarding e-liquid nicotine content, followed by flavor and ability to modify EC devices. Moreover, individuals reporting use of flavored e-liquid, high nicotine content e-liquid, and customizable EC were most likely to report intentions to reduce EC use and increase CC use. Conclusions: This work provides preliminary evidence that restrictive regulations regarding key EC characteristics may increase intentions to increase CC use among young adult dual EC and CC users.
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Affiliation(s)
- Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine , Durham , North Carolina , USA
| | - Olga Rass
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration , Silver Spring , Maryland , USA
| | - Maggie M Sweitzer
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine , Durham , North Carolina , USA
| | - Jason A Oliver
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine , Durham , North Carolina , USA
| | - F Joseph McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine , Durham , North Carolina , USA
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44
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Pacek LR, Oliver JA, Sweitzer MM, McClernon FJ. Young adult dual combusted cigarette and e-cigarette users' anticipated responses to a nicotine reduction policy and menthol ban in combusted cigarettes. Drug Alcohol Depend 2019; 194:40-44. [PMID: 30399498 PMCID: PMC6314179 DOI: 10.1016/j.drugalcdep.2018.10.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/12/2018] [Accepted: 10/01/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND The aim of the study was to assess young adult dual e-cigarette (EC) and combusted cigarette (CC) users' anticipated responses to a hypothetical very low nicotine content product standard and menthol ban in CC. METHODS Data came from 240 young adult (18-29 years) dual CC and EC users recruited via Amazon Mechanical Turk between June 20-22, 2017. Descriptive statistics were used to report sample characteristics. McNemar's tests were used to assess differences between product categories in terms of anticipated responses to hypothetical regulations. RESULTS A hypothetical very low nicotine content product standard in CC resulted in reported intentions to quit or reduce CC use and increase use of EC (p's<0.001). Hypothetical restrictions regarding the availability of menthol CC resulted in marginally significant reported intentions to increase EC use (p = 0.080). Anticipated responses to regulation were associated with baseline EC and CC use characteristics. CONCLUSIONS This work provides preliminary evidence of the impact that regulations regarding nicotine content and menthol in CC may have on the use of EC among young adult dual users.
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Affiliation(s)
- Lauren R. Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2608 Erwin Road, Suite 300, Durham, NC 27705
| | - Jason A. Oliver
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2608 Erwin Road, Suite 300, Durham, NC 27705
| | - Maggie M. Sweitzer
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2608 Erwin Road, Suite 300, Durham, NC 27705
| | - F. Joseph McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2608 Erwin Road, Suite 300, Durham, NC 27705
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45
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Weinberger AH, Pacek LR, Giovenco D, Galea S, Zvolensky MJ, Gbedemah M, Goodwin RD. Cigarette Use Among Individuals with Alcohol Use Disorders in the United States, 2002 to 2016: Trends Overall and by Race/Ethnicity. Alcohol Clin Exp Res 2018; 43:79-90. [PMID: 30408209 DOI: 10.1111/acer.13922] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 10/12/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Individuals with alcohol use disorders (AUDs) who smoke cigarettes experience greater health risks than those using either substance alone. Further, disparities exist in AUDs and smoking by race/ethnicity. Although smoking has declined in the general population, it is not known whether the smoking prevalence has changed over time for individuals with AUDs. The current study used representative U.S. data to estimate the prevalence of current cigarette use from 2002 to 2016 by AUD status and severity overall and by race/ethnicity. METHODS Data were drawn from the National Survey on Drug Use and Health, an annual cross-sectional study of U.S. individuals, from 2002 to 2016 (total analytic sample n = 837,326). Cigarette smoking prevalence was calculated annually among those with and without past-year AUD and by AUD severity level (mild, moderate, severe AUD). Time trends in smoking prevalence by AUD status and severity were tested using logistic regression for the overall sample and significant interactions were subsequently stratified by race/ethnicity (non-Hispanic [NH] White, NH Black, Hispanic, NH Other). RESULTS Cigarette use was persistently over twice as common among those with AUDs compared to without AUDs (2016: 37.84% vs. 16.29%). Cigarette use was also more common among those at each level of AUD severity criteria (2016: mild AUD 34.59%; moderate AUD 35.35%; severe AUD 52.23%). Approximately half of NH Black respondents with AUDs, and three-quarters of NH Black respondents with severe AUDs, reported smoking in 2016. The prevalence of smoking decreased significantly over time among respondents with and without AUDs; however, there were differences by race. There was no decline in smoking prevalence among NH Black respondents with AUDs over time in contrast to a significant decrease for every other racial/ethnic group with and without AUDs. CONCLUSIONS Individuals with AUDs may need additional resources and interventions to quit smoking, especially NH Black individuals.
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Affiliation(s)
- Andrea H Weinberger
- Ferkauf Graduate School of Psychology , Yeshiva University, Bronx, New York.,Department of Epidemiology & Population Health , Albert Einstein College of Medicine, Bronx, New York
| | - Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences , Duke University School of Medicine, Durham, North Carolina
| | - Daniel Giovenco
- Department of Sociomedical Sciences , Mailman School of Public Health, Columbia University, New York, New York
| | - Sandro Galea
- Department of Epidemiology , Boston University School of Public Health, Boston, Massachusetts
| | | | - Misato Gbedemah
- Department of Epidemiology and Biostatistics , Graduate School of Public Health and Health Policy, The City University of New York, New York, New York.,Institute for Implementation Science in Population Health , The City University of New York, New York, New York
| | - Renee D Goodwin
- Department of Epidemiology and Biostatistics , Graduate School of Public Health and Health Policy, The City University of New York, New York, New York.,Institute for Implementation Science in Population Health , The City University of New York, New York, New York.,Department of Epidemiology , Mailman School of Public Health, Columbia University, New York, New York
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46
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Denlinger-Apte RL, Tidey JW, Koopmeiners JS, Hatsukami DK, Smith TT, Pacek LR, McClernon FJ, Donny EC. Correlates of support for a nicotine-reduction policy in smokers with 6-week exposure to very low nicotine cigarettes. Tob Control 2018; 28:352-355. [PMID: 30385649 PMCID: PMC6482068 DOI: 10.1136/tobaccocontrol-2018-054622] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 09/19/2018] [Accepted: 10/10/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND The US Food and Drug Administration recently issued an advanced notice of proposed rule-making for reducing the nicotine content in cigarettes to a minimally addictive level. Very little is known about whether use of very low nicotine content (VLNC) cigarettes affects support for a nicotine reduction policy. OBJECTIVE This study examined the effects of using VLNC versus usual brand (UB) cigarettes on support for a nicotine reduction policy and determined whether participant characteristics and responses to VLNC cigarettes were associated with policy support. METHODS Participants from a cigarette trial who were assigned to either 0.4 mg nicotine/g tobacco research cigarettes or their UB for 6 weeks were asked about their support for the policy. χ2 tests were used to compare support for the policy between cigarette conditions and logistic regression analyses were conducted to assess covariates associated with policy support. FINDINGS Policy support did not differ by condition. After 6 weeks of using VLNC cigarettes, 50% of participants supported the policy, 26% opposed and 24% responded 'Don't Know'. Support was higher among those adherent to smoking only VLNC cigarettes (65%) compared with those who were non-adherent (44%). Older participants and those interested in quitting had increased odds of support. Cigarette satisfaction, perceived harm and perceived nicotine content were not significantly associated with support. CONCLUSIONS Smoking VLNC cigarettes did not affect support for a nicotine reduction policy. Understanding predictors of policy support and opposition will help public health officials to maximise the public health acceptance and impact of this policy (ClinicalTrials.gov Identifier: NCT01681875 Post-Results).
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Affiliation(s)
- Rachel L Denlinger-Apte
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Jennifer W Tidey
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Brown University, Providence, Rhode Island, USA.,Department of Psychiatry and Human Behavior, Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island, USA
| | - Joseph S Koopmeiners
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Dorothy K Hatsukami
- Masonic Cancer Center and Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota, USA
| | - Tracy T Smith
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - F Joseph McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Eric C Donny
- Baptist Comprehensive Cancer Center and Department of Physiology and Pharmacology, Wake Forest University, Winston-Salem, North Carolina, USA
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Pacek LR, Copeland J, Dierker L, Cunningham CO, Martins SS, Goodwin RD. Among whom is cigarette smoking declining in the United States? The impact of cannabis use status, 2002-2015. Drug Alcohol Depend 2018; 191:355-360. [PMID: 30179761 PMCID: PMC6432910 DOI: 10.1016/j.drugalcdep.2018.01.040] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 01/29/2018] [Accepted: 01/30/2018] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To 1) estimate changes in the prevalence of daily and non-daily cigarette smoking among current (past 30-day) daily, non-daily, and non-cannabis users in the United States (U.S.) population; 2) examine time trends in current (past 30-day) cigarette smoking in daily, non-daily, and non-cannabis users ages 12+ from 2002 to 2015. METHODS Data collected annually from the 2002 to 2015 National Survey on Drug Use and Health (NSDUH) were employed. Linear time trends of daily and non-daily cigarette smoking were assessed using logistic regression with year as the predictor. RESULTS In 2015, the prevalence of current (past 30-day) cigarette smoking was highest among daily (54.57%), followed by non-daily (40.17%) and non-cannabis users (15.06%). The prevalence of non-daily cigarette smoking increased among daily cannabis users from 2002 to 2015, whereas non-daily cigarette smoking declined among non-daily cannabis users and non-cannabis users from 2002 to 2015. Daily cigarette smoking declined among both cannabis users and non-users; the most rapid decline was observed among daily cannabis users, followed by non-daily and then by non-cannabis users. However, the relative magnitude of the change in prevalence of daily cigarette smoking was similar across the three cannabis groups. CONCLUSIONS Despite ongoing declines in cigarette smoking in the U.S., non-daily cigarette smoking is increasing among current cannabis users, a growing proportion of the U.S. POPULATION Daily and non-daily cigarette smoking continue to decline among those who do not use cannabis. Efforts to further tobacco control should consider novel co-use-oriented intervention strategies and outreach for the increasing population of cannabis users.
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Affiliation(s)
- Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, 27705, USA
| | - Jan Copeland
- National Cannabis Prevention and Information Centre, UNSW Sydney, Sydney, Australia
| | - Lisa Dierker
- Department of Psychology, Wesleyan University, Middletown, CT, 06459, USA
| | - Chinazo O Cunningham
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, 10461, USA; Department of Family and Social Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, 10461, USA; Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, 10461, USA
| | - Silvia S Martins
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA
| | - Renee D Goodwin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA; Institute for Implementation Science in Population Health, The City University of New York, New York, NY, 10027, USA; Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY, 10027, USA.
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48
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Weinberger AH, Pacek LR, Wall MM, Zvolensky MJ, Copeland J, Galea S, Nahvi S, Moeller SJ, Hasin DS, Goodwin RD. Trends in cannabis use disorder by cigarette smoking status in the United States, 2002-2016. Drug Alcohol Depend 2018; 191:45-51. [PMID: 30077055 PMCID: PMC6859449 DOI: 10.1016/j.drugalcdep.2018.06.016] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 06/10/2018] [Accepted: 06/12/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Cannabis use is on the rise in the United States (US) and is disproportionately common among cigarette smokers. Cannabis use disorder (CUD) occurs among a small subset of cannabis users and may impact cigarette use. The objective of this study was to estimate trends in the prevalence of CUD among daily, non-daily, former, and never cigarette smokers from 2002 to 2016. METHODS Data were drawn from cross-sectional, nationally representative samples of individuals ages 12 and older in the US that were collected annually. The prevalence of past 12-month CUD was estimated each year from 2002 to 2016 among daily, non-daily, former, and never cigarette smokers (total analytic N = 837,326). RESULTS Overall, the prevalence of CUD decreased from 2002 to 2016. Yet, trends differed by cigarette smoking status. Adjusting for demographics, the prevalence of CUD increased significantly among non-daily smokers (aOR = 1.02; 95% CI = 1.01-1.03) from 2002 to 2016 and did not change among daily, former, or never smokers. CUD was significantly more common among non-daily (4.32%) and daily cigarette smokers (2.92%) compared with former (0.99%) and never smokers (1.11%) in 2016. Approximately one in five (18.11%-22.87%) youth ages 12-17 who smoke cigarettes met criteria for CUD in 2016, compared with approximately 2% of non-smoking youth. CONCLUSIONS Despite downward trends in CUD observed at the general population level, the prevalence of CUD significantly increased among non-daily cigarette smokers from 2002 to 2016. In the US, CUD remains significantly higher among cigarette smokers relative to non-cigarette smokers.
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Affiliation(s)
- Andrea H. Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA,Department of Epidemiology & Population Health, Yeshiva University Albert Einstein College of Medicine, Bronx, NY, USA
| | - Lauren R. Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27705, USA
| | - Melanie M. Wall
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA,Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Michael J. Zvolensky
- Department of Psychology, University of Houston, Houston, TX, USA,Department of Behavioral Sciences, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jan Copeland
- Department of Medicine, University of New South Wales, Sydney, New South Wales 2052, Australia.
| | - Sandro Galea
- School of Public Health, Boston University, Boston, MA, USA.
| | - Shadi Nahvi
- Departments of Medicine and Psychiatry & Behavioral Sciences, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA.
| | - Scott J. Moeller
- Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA,Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
| | - Deborah S. Hasin
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Renee D. Goodwin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA,Institute for Implementation Science and Population Health, The City University of New York, New York, NY, USA,Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY, USA,Corresponding author at: Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, 55 West 125th St, New York, NY, 10027, USA. (R.D. Goodwin)
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49
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Pacek LR, McClernon FJ, Bosworth HB. Adherence to Pharmacological Smoking Cessation Interventions: A Literature Review and Synthesis of Correlates and Barriers. Nicotine Tob Res 2018; 20:1163-1172. [PMID: 29059394 PMCID: PMC6121917 DOI: 10.1093/ntr/ntx210] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 09/15/2017] [Indexed: 01/09/2023]
Abstract
Introduction Efficacious pharmacological interventions for smoking cessation are available, but poor adherence to these treatments may limit these interventions overall impact. To improve adherence to smoking cessation interventions, it is first necessary to identify and understand smoker-level characteristics that drive nonadherence (ie, nonconformance with a provider's recommendation of timing, dosage, or frequency of medication-taking during the prescribed length of time). Methods We present a literature review of studies examining correlates of, or self-reported reasons for, nonadherence to smoking cessation pharmacotherapies. Studies were identified through PubMed-using MeSH terms, Embase-using Emtree terms, and ISI Web of Science. Results and Conclusions This literature review included 50 studies that examined nonpreventable (eg, sociodemographics) and preventable (eg, forgetfulness) factors associated with adherence to smoking cessation medication and suggestions for overcoming some of the identified barriers. Systematic study of this topic would be facilitated by consistent reporting of adherence and correlates thereof in the literature, development of consistent definitions of medication adherence across studies, utilization of more objective measures of adherence (eg, blood plasma levels vs. self-report) in addition to reliance on self-reported adherence. Implications This article provides the most comprehensive review to date on correlates of adherence to pharmacological smoking cessation interventions. Challenges and specific gaps in the literature that should be a priority for future research are discussed. Future priorities include additional research, particularly among vulnerable populations of smokers, developing standardized definitions of adherence and methods for measuring adherence, regular assessment of cessation pharmacotherapy adherence in the context of research and clinical practice, and development of novel treatments aimed at preventable barriers to medication adherence.
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Affiliation(s)
- Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - F Joseph McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Hayden B Bosworth
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
- Department of Medicine, Division of General Medicine, Duke University School of Medicine, Durham, NC
- Center for Health Services Research in Primary Care, Durham VAMC, Durham, NC
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50
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Weinberger AH, Streck JM, Pacek LR, Goodwin RD. Nondaily Cigarette Smoking Is Increasing Among People With Common Mental Health and Substance Use Problems in the United States: Data From Representative Samples of US Adults, 2005-2014. J Clin Psychiatry 2018; 79:17m11945. [PMID: 30153404 PMCID: PMC6377560 DOI: 10.4088/jcp.17m11945] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 01/17/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The current study estimated trends in the prevalence of daily and nondaily cigarette smoking among United States adults with any common mental health or substance use problem (MHSUP), compared to US adults without MHSUP, from 2005 to 2014. METHODS Data were drawn from the years 2005 to 2014 from the public use data files for the annually conducted National Survey on Drug Use and Health. Linear time trends of current, daily, and nondaily cigarette smoking among adults (age 18 years and older) with and without MHSUP were assessed using logistic regression models with continuous year as the predictor. RESULTS In 2014, the prevalence of current cigarette smoking among those with MHSUP was more than twice that of those without MHSUP. Nondaily cigarette smoking increased significantly from 2005 to 2014 among those with MHSUP (P = .001) in contrast to a decline in nondaily cigarette smoking among those without MHSUP (P < .01). The rate of change differed significantly (P < .001). Daily cigarette smoking declined significantly from 2005 to 2014 among those with and without MHSUP (P values < .001). CONCLUSIONS The prevalence of nondaily cigarette smoking is increasing among US adults with common mental health and substance use problems, while it continues to decline among those without these vulnerabilities. The disparity in prevalence of daily cigarette smoking between those with and without MHSUP remains substantial. Conclusions about how to reach the tobacco endgame may need to be reconsidered to develop targeted tobacco control public health approaches that address common MHSUP.
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Affiliation(s)
- Andrea H. Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York,Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Joanna M. Streck
- Department of Psychological Science, Vermont Center on Behavior and Health, University of Vermont, Burlington Vermont
| | - Lauren R. Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Renee D. Goodwin
- Institute for Implementation Science in Population Health, City University of New York (CUNY), New York, New York,Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York, New York,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York,Corresponding author: Renee D. Goodwin, PhD, MPH, Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, 55 West 125th St, Rm 611, New York, NY 10027 ()
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