1
|
Atem FD, Bluestein MA, Chen B, Harrell MB, Messiah SE, Kuk AE, Pérez A. Application of inverse weighting analysis to assess the association of youth perceptions with the age of initiation of tobacco products. Front Public Health 2024; 12:1203631. [PMID: 38450147 PMCID: PMC10915753 DOI: 10.3389/fpubh.2024.1203631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 01/15/2024] [Indexed: 03/08/2024] Open
Abstract
Introduction To examine if perceptions of harmfulness and addictiveness of hookah and cigarettes impact the age of initiation of hookah and cigarettes, respectively, among US youth. Youth (12-17 years old) users and never users of hookah and cigarettes during their first wave of PATH participation were analyzed by each tobacco product (TP) independently. The effect of perceptions of (i) harmfulness and (ii) addictiveness at the first wave of PATH participation on the age of initiation of ever use of hookah was estimated using interval-censoring Cox proportional hazards models. Methods Users and never users of hookah at their first wave of PATH participation were balanced by multiplying the sampling weight and the 100 balance repeated replicate weights with the inverse probability weight (IPW). The IPW was based on the probability of being a user in their first wave of PATH participation. A Fay's factor of 0.3 was included for variance estimation. Crude hazard ratios (HR) and 95% confidence intervals (CIs) are reported. A similar process was repeated for cigarettes. Results Compared to youth who perceived each TP as "a lot of harm", youth who reported perceived "some harm" had younger ages of initiation of these tobacco products, HR: 2.53 (95% CI: 2.87-4.34) for hookah and HR: 2.35 (95% CI: 2.10-2.62) for cigarettes. Similarly, youth who perceived each TP as "no/little harm" had an earlier age of initiation of these TPs compared to those who perceived them as "a lot of harm", with an HR: 2.23 (95% CI: 1.82, 2.71) for hookah and an HR: 1.85 (95% CI: 1.72, 1.98) for cigarettes. Compared to youth who reported each TP as "somewhat/very likely" as their perception of addictiveness, youth who reported "neither likely nor unlikely" and "very/somewhat unlikely" as their perception of addictiveness of hookah had an older age of initiation, with an HR: 0.75 (95% CI: 0.67-0.83) and an HR: 0.55 (95% CI: 0.47, 0.63) respectively. Discussion Perceptions of the harmfulness and addictiveness of these tobacco products (TPs) should be addressed in education campaigns for youth to prevent early ages of initiation of cigarettes and hookah.
Collapse
Affiliation(s)
- Folefac D. Atem
- Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, United States
- Center for Pediatric Population Health, School of Public Health in Dallas, UT Health Science Center School of Public Health, Dallas, TX, United States
| | - Meagan A. Bluestein
- Michael & Susan Dell Center for Healthy Living, School of Public Health, Austin Campus, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX, United States
| | - Baojiang Chen
- Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, United States
- Michael & Susan Dell Center for Healthy Living, School of Public Health, Austin Campus, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX, United States
| | - Melissa B. Harrell
- Michael & Susan Dell Center for Healthy Living, School of Public Health, Austin Campus, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX, United States
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX, United States
- Consultant with Litigation Involving the Vaping Industry, Austin, TX, United States
| | - Sarah E. Messiah
- Center for Pediatric Population Health, School of Public Health in Dallas, UT Health Science Center School of Public Health, Dallas, TX, United States
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX, United States
| | - Arnold E. Kuk
- Michael & Susan Dell Center for Healthy Living, School of Public Health, Austin Campus, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX, United States
| | - Adriana Pérez
- Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, United States
- Michael & Susan Dell Center for Healthy Living, School of Public Health, Austin Campus, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX, United States
| |
Collapse
|
2
|
DeAtley T, Johnson AC, Stone MD, Audrain-McGovern J, Mercincavage M, Strasser AA. Effects of Modified Tobacco Risk Products with Claims and Nicotine Features on Perceptions among Racial and Ethnic Groups. Int J Environ Res Public Health 2023; 20:6454. [PMID: 37568996 PMCID: PMC10418819 DOI: 10.3390/ijerph20156454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 08/13/2023]
Abstract
Research suggests consumers may misunderstand modified risk tobacco product (MRTP) claims. We examined the effects of nicotine content across four tobacco products with and without MRTP claims among a racially and ethnically diverse sample of adults who do and do not smoke. Adults (n = 1484) aged 21-65 completed an online experiment using a 2 × 2 × 4 mixed factorial design to examine the effects of tobacco product (Classic White Snus, IQOS, JUUL e-cigarette, and VLN cigarette) and nicotine content (high vs. low) stratified by MRTP claim (present vs. absent) across four outcomes: (1) likely to try (2) serious disease if used regularly, (3) least addictive, and (4) ease of quitting smoking. Not including an MRTP claim resulted in an increased likelihood of trying a product, decreased concern of serious disease, lower perceived addictiveness, and increased ease of quitting smoking. Participants selected low nicotine IQOS without a claim as the least likely to cause serious disease. Low nicotine JUUL, without a claim, was selected as least addictive and most likely to facilitate quitting. Intentions to try were highest for low nicotine JUUL. Participants selected low-nicotine products as less addictive than high nicotine products. Regulatory efforts should consider how MRTP claims interact with different product characteristics. Subtle differences exist across outcomes between racial and ethnic groups, which indicates that further research is warranted.
Collapse
Affiliation(s)
- Teresa DeAtley
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (A.C.J.); (J.A.-M.); (M.M.); (A.A.S.)
| | - Andrea C. Johnson
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (A.C.J.); (J.A.-M.); (M.M.); (A.A.S.)
| | - Matthew D. Stone
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, CA 92093, USA;
| | - Janet Audrain-McGovern
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (A.C.J.); (J.A.-M.); (M.M.); (A.A.S.)
| | - Melissa Mercincavage
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (A.C.J.); (J.A.-M.); (M.M.); (A.A.S.)
| | - Andrew A. Strasser
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (A.C.J.); (J.A.-M.); (M.M.); (A.A.S.)
| |
Collapse
|
3
|
Alshaibani M, Alajmi M, Alabduljalil N, Alajmi H, Alsalem Y, Aloqab D, Alawadhi H, Ali SS, Sharhan Y, Alzeeny A, Ziyab AH. Prevalence of use, perceptions of harm and addictiveness, and dependence of electronic cigarettes among adults in Kuwait: A cross-sectional study. Tob Induc Dis 2023; 21:90. [PMID: 37456607 PMCID: PMC10347961 DOI: 10.18332/tid/163300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 02/28/2023] [Accepted: 04/15/2023] [Indexed: 07/18/2023] Open
Abstract
INTRODUCTION Electronic cigarettes (e-cigarettes) have become one of the most common forms of nicotine delivery used by youth and young adults worldwide. Given the lack of epidemiologic data in Kuwait, this study sought to estimate the prevalence of e-cigarette use, assess perceptions of harm and addictiveness of e-cigarettes, measure the level of dependence on e-cigarettes and assess factors associated with dependence level among adults. METHODS A cross-sectional study enrolled adults (n=3032, aged ≥18 years) living in Kuwait using a web-based questionnaire. Participants self-reported ever and current (past 30-day) e-cigarette use and self-completed the 10-item Penn State E-cigarette Dependence Index. Associations were evaluated using multinomial logistic regression. RESULTS The prevalence of ever and current e-cigarette use was estimated to be 40.2% (1220/3032) and 29.4% (892/3032), respectively. The prevalence of current e-cigarette use was higher in males compared to females (47.6% vs 14.4%, p<0.001). Relative to cigarette smoking, 40.6% of participants reported that e-cigarettes are less harmful, and 41.8% indicated that e-cigarettes are equally addictive. Among current e-cigarette users (n=892), 84.8% were ascertained to have developed either low, medium, or high dependence. The use of pod-based devices compared to disposable devices was associated with a high dependence level (adjusted odds ratio, AOR=8.56; 95% CI: 4.52-16.22). CONCLUSIONS These findings suggest that a large proportion of adults in Kuwait use e-cigarettes, and a considerable proportion of current users have developed dependence. Therefore, such results should alert public health authorities and warrant the development of evidence-based awareness campaigns, policies, and prevention measures to protect and improve the health of people.
Collapse
Affiliation(s)
- Munairah Alshaibani
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Mays Alajmi
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Noura Alabduljalil
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Hajar Alajmi
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Yousef Alsalem
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Danah Aloqab
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Hamad Alawadhi
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Sara Sayed Ali
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Yaqoub Sharhan
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Ahmed Alzeeny
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Ali H. Ziyab
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| |
Collapse
|
4
|
Havermans A, Mallock N, Zervas E, Caillé-Garnier S, Mansuy T, Michel C, Pennings JLA, Schulz T, Schwarze PE, Solimini R, Tassin JP, Vardavas CI, Merino M, Pauwels CGGM, van Nierop LE, Lambré C, Bolling AK. Review of industry reports on EU priority tobacco additives part A: Main outcomes and conclusions. Tob Prev Cessat 2022; 8:27. [PMID: 35860504 PMCID: PMC9255285 DOI: 10.18332/tpc/151529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 06/21/2022] [Accepted: 06/24/2022] [Indexed: 02/01/2023]
Abstract
The European Union Tobacco Products Directive (EU TPD) mandates enhanced reporting obligations for tobacco manufacturers regarding 15 priority additives. Within the Joint Action on Tobacco Control (JATC), a review panel of independent experts was appointed for the scientific evaluation of the additive reports submitted by a consortium of 12 tobacco manufacturers. As required by the TPD, the reports were evaluated based on their comprehensiveness, methodology and conclusions. In addition, we evaluated the chemical, toxicological, addictive, inhalation facilitating and flavoring properties of the priority additives based on the submitted reports, supplemented by the panel's expert knowledge and some independent literature. The industry concluded that none of the additives is associated with concern. Due to significant methodological limitations, we question the scientific validity of these conclusions and conclude that they are not warranted. Our review demonstrates that many issues regarding toxicity, addictiveness and attractiveness of the additives have not been sufficiently addressed, and therefore concerns remain. For example, menthol facilitates inhalation by activation of the cooling receptor TRPM8. The addition of sorbitol and guar gum leads to a significant increase of aldehydes that may contribute to toxicity and addictiveness. Titanium dioxide particles (aerodynamic diameter <10 µm) are legally classified as carcinogenic when inhaled. For diacetyl no report was provided. Overall, the industry reports were not comprehensive, and the information presented provides an insufficient basis for the regulation of most additives. We, therefore, advise MS to consider alternative approaches such as the precautionary principle.
Collapse
Affiliation(s)
- Anne Havermans
- Centre for Health Protection, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Nadja Mallock
- German Federal Institute for Risk Assessment, Berlin, Germany
| | - Efthimios Zervas
- Hellenic Thoracic Society, Athens, Greece.,School of Applied Arts and Sustainable Design, Hellenic Open University, Athens, Greece
| | | | - Thibault Mansuy
- French Agency for Food, Environmental and Occupational Health and Safety, Paris, France
| | - Cécile Michel
- French Agency for Food, Environmental and Occupational Health and Safety, Paris, France
| | - Jeroen L A Pennings
- Centre for Health Protection, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Thomas Schulz
- German Federal Institute for Risk Assessment, Berlin, Germany
| | | | | | | | | | - Miguel Merino
- Andalusia Agency For Agriculture and Fisheries Development, Seville, Spain
| | - Charlotte G G M Pauwels
- Centre for Health Protection, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Lotte E van Nierop
- Centre for Health Protection, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Claude Lambré
- National Institute of Health and Medical Research, Paris, France
| | | |
Collapse
|
5
|
Abstract
BACKGROUND Given changes in marijuana regulations, retail, and products and potential impact on use, we examined young-adult perceptions of different modes of use, the proportion using via different modes (e.g. smoking, vaping, ingesting), and associations with the use levels and stability of use over time. METHODS We analyzed baseline and one-year follow-up survey data (Fall 2018-2019) among 3,006 young adults (ages 18-34) across six metropolitan areas (Atlanta, Boston, Minneapolis-St. Paul, Oklahoma City, San Diego, Seattle). Measures included marijuana use frequency and mode, sociodemographics, other substance use, and social influences. RESULTS Participants' rated the following modes of use as: least harmful/addictive: topicals, oral pills, joint/bowl; most socially acceptable: joint/bowl, edibles/beverages, vaporized; and most harmful/addictive and least acceptable: wrapped, vaped, or waterpipe/bong with tobacco. Baseline past-month use prevalence was 39.2% (n = 1,178). Most frequent use mode was smoking (joints/bowls/cigar papers; 54.0%), vaping (21.8%), via pipe/bong (15.1%), and ingesting (9.1%). Multinomial logistic regression indicated that participants in states with legalized marijuana retail were at greater odds for using via modes other than smoking; participants more frequently using were at greater odds for using via pipe/bong (vs. smoking) (ps < .001). Regarding most frequent mode across time, most consistent was pipe/bong (53.3%), followed by smoking (49.3%), vaping (44.5%), and ingesting (32.9%). Past-month abstinence at follow-up was most common among those originally ingesting (34.3% abstinent), followed by smoking (23.6%), vaping (18.8%), and pipe/bong (14.8%). CONCLUSIONS Ongoing surveillance is needed to understand marijuana use patterns over time across different user groups (particularly by mode) and to inform interventions promoting abstinence.
Collapse
Affiliation(s)
- Katelyn F Romm
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington Cancer Center, George Washington University, Washington, DC, USA
| | - Carly D West
- Global Health Epidemiology and Disease Control, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Carla J Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington Cancer Center, George Washington University, Washington, DC, USA
| |
Collapse
|
6
|
Abstract
OBJECTIVES We examined perceptions and behaviors associated with smoking susceptibility among adolescents in the current tobacco landscape. METHODS Participants were 8th and 10th grade never-smokers of conventional cigarettes (N = 19,853) from Monitoring the Future surveys (2014-2016). Using weighted multivariable logistic regression, we examined risk factors for smoking susceptibility: alternative tobacco product use (e-cigarettes, large cigars, little cigars/cigarillos, and flavored little cigars/cigarillos), ownership of tobacco promotional items (TPIs), access to cigarettes, perceived influence of antismoking advertisements, and perceived addictiveness of conventional cigarette smoking. RESULTS Among never-smokers of conventional cigarettes, 16.7% were susceptible to smoking, 6.2% were past 30-day alternative tobacco product users, and 3.5% owned TPIs. Alternative tobacco product use, ownership of TPIs, and easy access to cigarettes were associated with increased likelihood of smoking susceptibility. Perceived great influence by antismoking ads and higher perceived addictiveness of conventional cigarette smoking were associated with lower odds of smoking susceptibility. CONCLUSION Alternative tobacco product use, ownership of TPIs, easy access to cigarettes, low influence by antismoking ads, and low perceptions of the addictiveness of conventional cigarettes are significant and actionable risk factors for smoking susceptibility among today's adolescents.
Collapse
Affiliation(s)
- Olusegun Owotomo
- Department of Kinesiology and Health Education, University of Texas at Austin, TX, USA
| | - Julie Maslowsky
- Department of Kinesiology and Health Education, Population Research Center, University of Texas at Austin, TX, USA.
| |
Collapse
|
7
|
Hoet P, Rydzynski K, Vermeire T, Nair U, Talhout R, Testai E, Secretariat S. Recommendations to the European Commission implementing a priority list of additives that should have more stringent reporting requirements: the opinion of the Scientific Committee on Emerging and Newly Identified Health Risks (SCENIHR). Tob Control 2017; 27:225-228. [PMID: 28341766 DOI: 10.1136/tobaccocontrol-2017-053642] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 01/27/2017] [Accepted: 01/27/2017] [Indexed: 11/03/2022]
Affiliation(s)
- Peter Hoet
- Member of the SCENIHR in the SCENIHR working group on tobacco additives, SCENIHR, Luxembourg, Europe
| | - Konrad Rydzynski
- Member of the SCENIHR in the SCENIHR working group on tobacco additives, SCENIHR, Luxembourg, Europe
| | - Theo Vermeire
- Member of the SCENIHR in the SCENIHR working group on tobacco additives, SCENIHR, Luxembourg, Europe
| | - Urmila Nair
- External expert in the SCENIHR working group on tobacco additives, SCENIHR, Luxembourg, Europe
| | - Reinskje Talhout
- External expert in the SCENIHR working group on tobacco additives, SCENIHR, Luxembourg, Europe
| | - Emanuela Testai
- Member of the SCENIHR in the SCENIHR working group on tobacco additives, SCENIHR, Luxembourg, Europe
| | | |
Collapse
|
8
|
Sanders E, Weitkunat R, Utan A, Dempsey R. Does the use of ingredients added to tobacco increase cigarette addictiveness?: a detailed analysis. Inhal Toxicol 2012; 24:227-45. [PMID: 22429143 PMCID: PMC3335113 DOI: 10.3109/08958378.2012.663006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Revised: 01/30/2012] [Accepted: 01/30/2012] [Indexed: 11/23/2022]
Abstract
The possibility that ingredients added to tobacco contribute to the addictiveness of cigarette smoking was evaluated by comparing cessation rates of smokers of traditional blended cigarettes to those of smokers of flue-cured cigarettes. Such a comparison is a valid means of assessing cigarette ingredients as traditional blended cigarettes contain ingredients (>20), whereas flue-cured cigarettes contain no or very few ingredients. Separate analysis of 108 treatment groups and 108 control groups from randomized clinical trials of nicotine replacement therapy (NRT) were performed by multiple logistic regressions. The results of these analyses demonstrated slightly higher quit rates for smokers of blended cigarettes (OR = 1.90, 95% CI 1.70-2.13 and OR = 1.32, 95% CI 1.14-1.53 for treatment and control groups, respectively). The control groups were also investigated using classification tree analysis from which no difference in quit rates were observed for smokers of either type of cigarette. Further analyses showed that studies that utilized a high level of psychological support in conjunction with NRT produced at least a two-fold increase in quit rates compared to studies that utilized a low level of psychological support. It was also demonstrated that there is a large difference when results were reported by sustained abstinence compared to point prevalence. Additional meta-analyses found the pooled OR for NRT treatment to be in exact agreement with a recent review that assessed the effectiveness of NRT. Overall these results strongly suggest that ingredients used in the manufacture of traditional blended cigarettes do not increase the inherent addictiveness of cigarettes.
Collapse
Affiliation(s)
- Edward Sanders
- Edward Sanders Scientific Consulting, Neuchâtel, Switzerland
| | - Rolf Weitkunat
- Philip Morris Products SA, Philip Morris International Research & Development, Neuchâtel, Switzerland
| | - Aneli Utan
- Philip Morris International Management SA, Operations Technical Services, Neuchâtel, Switzerland
| | - Ruth Dempsey
- Philip Morris International Management SA, Operations Technical Services, Neuchâtel, Switzerland
| |
Collapse
|