Nicotine & Tobacco Research最新文献

Background: As nicotine pouches are increasingly adopted as a harm reduction method for tobacco cessation, it is important to understand who incorporates nicotine pouches into cessation attempts. This preliminary study examined correlates of nicotine pouch use for tobacco cessation in a United States (US) nationally representative sample.

Methods: Data were from Wave 7 (2022-2023) of the US Population Assessment of Tobacco and Health (PATH) Study. Outcomes were past-12-month use of nicotine pouches to quit cigarettes or other non-electronic nicotine delivery system (ENDS) and other nicotine/tobacco products (N=3,622) and to quit ENDS (N=1,934). Predictor variables included sociodemographic, psychological, and behavioral factors.

Results: Ninety individuals reported using nicotine pouches during their most recent quit attempt for non-ENDS products, while 65 individuals reported use during the quit attempt for ENDS. Multivariable regression analyses showed that males were significantly more likely to use nicotine pouches to quit non-ENDS and ENDS (Adjusted Prevalence Ratio [APR]=2.00, 95% Confidence Interval [CI]=1.19, 3.37; APR=6.28, 95% CI=2.77, 14.25). Having used other methods to quit other nicotine/tobacco products was associated with higher likelihoods of having used nicotine pouches to quit non-ENDS (APR=2.43, 95% CI=1.48, 4.01) and ENDS (APR=1.95, 95% CI=1.05, 3.61). Having used nicotine pouches to quit non-ENDS was less likely to be reported by Black individuals (APR=0.31, 95% CI=0.11, 0.88).

Conclusions: This preliminary study observed positive associations of male gender and use of other cessation methods and a negative association of Black race with having used nicotine pouches to quit other nicotine/tobacco product use.

Implications: In a national United States sample, having used nicotine pouches to quit other nicotine/tobacco product use was more likely to be associated with being male and using other nicotine/tobacco product use cessation methods, but less likely to be associated with Black race. Ongoing surveillance and research examining the health effects of nicotine pouch use is warranted, particularly regarding sex and racial/ethnic differences in nicotine pouch use as a harm reduction approach for other nicotine/tobacco product use cessation.

Introduction: Many U.S. adolescents and young adults (AYA) are exposed to electronic nicotine delivery systems (ENDS)-related content regularly through social media platforms. Prior research treats exposure to ENDS-related content as uniform, both in its source and theme.

Methods: This study examined the variation in frequency, source, and theme of ENDS-related content online among AYA (ages 12-25), using the nationally representative Population Assessment of Tobacco and Health (PATH) Study Wave 7 (2022/23) data. Latent class analysis was used to identify patterns of ENDS-related content exposure among AYA who reported viewing ENDS-related content on social media in the past week (N=4,031). Multinomial logistic regression was used to examine associations of sociodemographic characteristics and tobacco/nicotine use behaviors with class membership.

Results: Seven classes of ENDS-related content exposure were identified: 1) Memes from Friends (11.5%); 2) News & Information from Health Campaigns (7.6%); 3) Public Health Campaigns Only (23.2%); 4) Public Health Information & Memes (27.5%); 5) Celebrity/Influencer Posts (15.6%); 6) Mixed-Theme Brand Posts (3.5%); and 7) Multidimensional Frequent Exposure (11.1%). Young (ages 12-17), female, and racial/ethnic minority participants were more likely to be exposed to classes characterized by multiple types of content at higher frequencies. Past-year ENDS use was only associated with class membership in Memes from Friends relative to Public Health Campaigns Only.

Conclusions: AYA exposure to ENDS-related social media content is not uniform and may not be driven by tobacco/nicotine use. Sociodemographic groups previously targeted by combustible tobacco/nicotine marketing are more likely to be exposed to myriad ENDS-related content online.

Implications: ENDS-related content on social media is not uniform, and exposure varies considerably by source, theme, and frequency. Some exposure patterns were driven by public health information, while others were centered on entertainment and promotional content. Regulation of ENDS-related content online should be bolstered and enforced by federal institutions and social media platforms to curb promotional content for those not legally allowed to purchase or use ENDS. Additionally, future research should examine whether certain ENDS-related content exposure is associated with the tobacco/nicotine use initiation and escalation, particularly among sociodemographic groups that may be targeted to receive this content.

Introduction: Individuals who use a stop smoking service (SSS) in the UK are three times more likely to quit. Uptake of SSS is limited among lower socioeconomic (LSE) groups and efforts are needed to understand how to improve the appeal, acceptability and accessibility of SSS.

Methods: Semi-structured interviews with 114 participants from the four UK devolved nations who had a current or recent smoking history, and who had previously accessed or may potentially access a SSS. Participants were recruited via Facebook, third sector organisations and a market research company. Telephone-based interviews were analysed using thematic analysis. The Behaviour Change Wheel was used to develop the interview topic guide, inform thematic analysis and identify strategies to increase engagement with SSS.

Results: Barriers included low awareness and understanding regarding the availability and content of SSS, a lack of free time to access SSS and negative beliefs regarding the efficacy of SSS support. Facilitators included more frequent and continued flexible support delivered using a range of modes, access to free NRT and rapport with the advisor. Intervention functions were identified to address these barriers and facilitators via educational efforts to raise awareness of SSS, environmental restructuring to provide a flexible approach to delivery, and community champions to encourage and enable SSS engagement in the target population.

Conclusions: Providing further community-based efforts along with a more holistic approach to delivering behavioural support and NRT has strong potential to maximise SSS reach, engagement and acceptability.

Implications: The current study provides insights into the barriers and facilitators to engaging with and accessing SSS amongst LSE groups and indicates that interventions to increase capability, motivation and opportunity are required. Recommendations from this work for tailoring UK SSS for LSE groups can be used to inform future tobacco control policy including engagement strategies at a local and national level.

Introduction: The most effective way to reduce mortality and morbidity among current smokers is to quit smoking. Although about half of smokers attempted to quit, only one-tenth succeeded in 2022. Understanding key predictors of smoking cessation success would inform smoking cessation interventions and increase quitting rates.

Methods: We analyzed data from waves 5 and 6 of the Population Assessment of Tobacco and Health (PATH) study (December 2018 to November 2021). Using OpenAI's GPT-4.1, we identified the top 45 variables from wave 5 that are highly predictive of 12-month smoking abstinence in wave 6, based on descriptions of survey variables. We then validated the predictive power of the GPT-4.1-selected variables by comparing the performance of eXtreme Gradient Boosting (XGBoost) trained on different sets of variables. Finally, we derived insights into the top 10 variables, ranked according to their SHapley Additive exPlanations values.

Results: The performance of XGBoost trained with all possible wave 5 variables and the 45 selected variables was almost identical (AUC:0.749 vs AUC:0.752). The top 10 variables included past 30-day smoking frequency, minutes from waking up to smoking first cigarette, important people's views on tobacco use, prevalence of tobacco use among close associates, daily electronic nicotine product use, emotional dependence, and health harm concerns.

Conclusions: The high predictive performance of XGBoost, when trained on the selected variables, underscores the efficiency and efficacy of GPT-4.1-based feature selection. The top 10 variables include various risk factors that have been previously reported in the literature for their influence on smoking behavior.

Implications: Our findings do not establish causal relationships between the selected predictors and 12-month smoking abstinence. However, identifying these key predictors provides valuable insights into the factors highly associated with smoking cessation success. This study demonstrates the ability of OpenAI's GPT-4.1 to perform feature selection using only the textual descriptions of variables. The efficient and successful application of GPT-4.1 for variable selection highlights the potential of integrating artificial intelligence tools into tobacco research to guide resource-efficient and targeted intervention strategies.

Introduction: Research indicates that high tobacco retail density is associated with smoking in children, adults and during pregnancy. Despite this, there is limited research on retail suppression policies, or how government regulation affects tobacco outlet density over time. We examine the association between government-imposed tobacco control laws and outlet density between 2000 and 2019.

Methods: Records of outlets were obtained from the mandated tobacco licensing scheme and register in one state of Australia, Tasmania. Trends in density i.e. retailers per 1000 people, were analysed using Joinpoint regression analysis. Trends by retailer type were analysed between 2010 and 2019.

Results: The highest retailer density was observed in 2002 and lowest in 2019 (from 3.2 to 1.2 retailers per 1000 people), with a mean annual percentage change (APC) of -5.1% of retailer density (CI -5.9% to -4.3%, p>0.01). A decrease in APC 7.9% density per year (CI -9.7% to -6.0%, p<0.01) was observed between 2009 - 2013, corresponded with changes in tobacco packaging laws and import taxes. An APC decrease of 8.9% density per year (CI -10.7% to -7.1%, p<0.01) between 2016 and 2019 corresponded with a tripling in government licensing fees. Liquor licensed premises, newsagencies, food and mixed businesses were all affected, (-7.8%, -19.8%, -10.2%, -9.9% APC respectively.) with little change observed supermarkets, tobacconists and wholesalers from 2010 to 2019.

Conclusions: Tobacco tax, advertising bans, packaging laws and increased licence fees were all associated with reduced tobacco outlet density. Supermarkets and tobacconists - large volume retailers - were minimally affected by these levers and may require direct regulation. Further research is underway to determine whether changes in tobacco retail density are associated with reduced smoking.

Implications:

Introduction: Misperceptions of nicotine's role in health harms among US adults have increased. This study examined how survey item wording affects estimates of the misperception that nicotine itself causes cancer.

Methods: Two thousand five hundred twenty-six US adults aged 18-45 completed a randomized split-sample experiment through Cloud Research in August 2022. After receiving one of 10 existing and novel survey items about the role of nicotine in causing cancer, participants completed an open-ended question explaining their response. Analyses examined prevalence of beliefs by study condition and open-ended responses.

Results: Overall, 36% of participants believed that nicotine does not cause cancer (coded as "correct"), but this varied by condition (10%-81%). Prevalence of this belief was similar when using magnitude-of-harm items from existing national surveys (HINTS, PATH; 44%) but lower with more direct wording (ie, "nicotine is a cause of cancer"; 23%). Changing response options (including/excluding don't know; true/false versus Likert scale) did not alter prevalence of a correct belief. Open-ended responses were distributed across four themes: (1) EXPOSURE to other chemicals or smoke cause cancer, not nicotine (n = 598, 23.7%), (2) Nicotine on its own DIRECTLY causes cancer (n = 705, 28.0%), (3) Nicotine only causes cancer by keeping people ADDICTED to tobacco (n = 796, 31.6%), and (4) Other (n = 419, 16.6%); study condition was associated with theme (p < .001).

Conclusions: Question wording influences the prevalence of agreement that nicotine itself causes cancer. Including "don't know," "probably yes," and "probably not" options may identify a broader group of people who could benefit from nicotine education.

Implications: Ensuring accuracy in estimating misperceptions about nicotine has implications for tobacco control in two important ways: first, these measures may identify the people or groups whose misperceptions may put them at greater risk for tobacco-related disease and death, and second, the prevalence of nicotine misperceptions and people affected may determine the prioritization and tailoring of interventions aimed at correcting misperceptions.

Introduction: This paper examines the health and welfare benefits of increasing alcohol and tobacco taxes in Cameroon.

Methods: The study employs two microsimulation techniques: an economic simulation of consumption shifts in response to tax changes and an epidemiological study of morbidity and mortality linked to consumption reductions. Data is sourced from the 2014 Cameroon Household Survey (ECAM4) and other secondary sources.

Results: We find that Cameroon's fiscal policy of increasing excise duties by 30% has positive effects on households by improving health and welfare. With a 95% internal uncertainty (UI) between 618 165 and 1 163 340, the implementation of this medium scenario for alcoholic drinks, mainly beer, would lead to a gain of 852 095 life years. This effect is even more significant for tobacco products, as the same tax rate would lead to a gain of 1 288 384 life years, with a 95% UI ranging from 720 282 to 1 965 493. Tax policy effects are larger for tobacco than for alcohol because tobacco has a higher price elasticity than alcohol. Nevertheless, the effects remain gender and spatially sensitive throughout the country.

Conclusion: The findings underscore the positive impacts of increased alcohol and tobacco taxes on public health and welfare in Cameroon. Complementary policies, such as consumer education and customs controls, are essential to maximize benefits and address policy challenges.

Introduction: Nicotine pouches are rapidly increasing in popularity, yet their long-term neurological consequences remain poorly understood. Emerging evidence suggests nicotine may influence seizure susceptibility and neuroimmune signaling, while cannabidiol (CBD) has demonstrated neuroprotective and anti-inflammatory effects. This study investigated the time-dependent impact of acute versus chronic oral nicotine exposure on seizure vulnerability, neuroinflammation, and glymphatic function, and evaluated whether inhaled CBD can reverse these pathological changes.

Methods: Mice were exposed to acute or 7-day chronic nicotine pouch prior to kainic acid-induced seizures. Seizure severity was scored using the Racine scale. Neuroinflammatory markers (IL-6, HMGB1), neuronal activation markers (BDNF, c-FOS), and AQP4 expression were quantified via flow cytometry, immunofluorescence, and Western blotting. Glymphatic function was assessed using cisterna magna injection of rhodamine dextran tracers. An ex vivo IL-6 modulation assay evaluated nicotine-induced cytokine production and CBD-mediated suppression, with or without IL-6 receptor blockade.

Results: Acute nicotine transiently reduced seizure severity, whereas chronic exposure significantly exacerbated seizures, elevated IL-6, HMGB1, BDNF, and c-FOS, and markedly downregulated AQP4. CSF tracer studies confirmed impaired glymphatic influx following chronic nicotine exposure. CBD inhalation effectively reversed seizure severity restored AQP4 expression, normalized IL-6 and HMGB1 levels, and reduced c-FOS protein expression. The IL-6R blockade assay showed that nicotine induces IL-6 production in brain-derived immune cells, while CBD suppresses this response upstream of IL-6 signaling.

Conclusions: Chronic nicotine pouch exposure promotes seizure susceptibility through converging neuroimmune and glymphatic disruptions. Inhaled CBD counteracts these effects, supporting its potential as a targeted therapeutic strategy for nicotine-associated neurological risk.

Introduction: Illicit cigarette trade has significant economic and public health implications. It leads to Governments' tax revenue losses due to the evasion of taxes, and often these cigarettes are cheaper than legal products, which can increase tobacco consumption and deter quit attempts. We aim to estimate the size of the illicit market and establish its associated factors in Zambia.

Methods: A cross-sectional survey was used to collect empty cigarette packs from the retailers and street/bins in 10 Provinces of Zambia. The proportion of illicit cigarette packs was calculated. Logistic regression was used to model the factors associated with the presence of illicit cigarettes.

Results: Based on unweighted data, our study found that 12.2% of cigarettes sold on the Zambian market were illicit, including 10.1% that evaded taxation. Of the 118 344 empty cigarette packs collected (82.0% from the retailers and 18.0% the street/bins), 343 (0.3%) packs did not have a textual health warning in English, 1490 (1.3%) had duty-free stamps even though they were purchased from retail outlets that were not duty-free shops and, 11 939 did not have a Zambia Revenue Authority stamp. Factors associated with reduced odds of illicit cigarette sales were non-border [adjusted odds ratio 0.17 (CI = 0.13 to 0.23)] and local manufactured [adjusted odds ratio 0.44 (CI = 0.37 to 0.53)].

Conclusions: The scale of the illicit tobacco market in Zambia is significant. To help address the illicit tobacco trade, Zambia should ratify and implement the World Health Organization Protocol on Illicit Tobacco Trade to counter the supply of illicit cigarettes.

Implications: This study presents the first national survey on illicit tobacco trade in Zambia. Although approximately one in ten cigarettes in Zambia are illicit, this prevalence is lower than in many neighboring countries. Nonetheless, securing the cigarette supply chain remains a critical priority to prevent further tax evasion and illicit trade. These findings highlight the need for Zambia to ratify and implement the World Health Organization Protocol on Illicit Tobacco Trade. The study also underscores the need to implement a track and trace system that would help customs officers detect counterfeit and smuggled cigarettes and intensifying border patrols.

Introduction: Limited data exist on how to use e-cigarettes (EC) to optimize smoking cessation.

Methods: We examined associations between patterns of EC use and outcomes at 1 year in a large trial (N = 886) comparing nicotine replacement therapy (NRT) and EC.

Results: Use of tobacco flavor was limited and associated with a lower smoking cessation rate compared to other flavors (relative risk; RR = 0.56, 95% CI = 0.35 to 0.89). EC users reduced nicotine strength over time. Abstainers using EC reported lower urges to smoke than abstainers using NRT at both weeks 1 (b = -0.25, 95% CI = -0.45 to -0.04) and 4 (b = -0.37, 95% CI = -0.58 to -0.16). Participants using both cigarettes and EC (dual users) at week 1 were more likely to stop smoking at week 4 than exclusive smokers (RR = 4.45, 95% CI = 1.96 to 10.10). Dual users at 4 weeks and 6 months were also more likely to achieve validated 50% reduction in smoke intake at 1 year (RR = 2.37, 95% CI = 1.36 to 4.11 and RR = 4.56, 95% CI = 2.71 to 7.66, respectively).

Conclusions: Non-tobacco flavors were preferred and may be also more effective. Urges to smoke were lower in EC users than in users of NRT. Dual use was associated with a reduction in smoking and quitting smoking later on.

Implications: Clinicians advising smokers wanting to use EC as a quitting aid can consider recommending non-tobacco flavors; explaining that EC reduce urges to smoke more than combination NRT; and reassuring those worried about dual use that such use is associated with reduced smoking and a higher chance of stopping smoking altogether later on.