Nicotine & Tobacco Research最新文献

Introduction: Tobacco smoking has been associated with reduced success in the labor market, potentially due to its negative impact on labor productivity, especially in physically demanding jobs, as it affects physical fitness and performance adversely.

Methods: This prospective study used data from the Cardiovascular Risk in Young Finns Study survey, linked to register information on labor market outcomes and education attainment, to examine the association between tobacco smoking and long-term labor market outcomes (earnings and employment, N = 1953). Smoking levels were determined by cigarette pack-years in 2001, as reported in the survey, whereas annual earnings and employment status were tracked from 2001 to 2019.

Results: A one-unit increase in pack-year of smoking was associated with a 1.8% decrease in earnings (95% confidence interval [CI]: -2.6% to -0.9%) and a 0.5% reduction in years employed (95% CI: -0.6% to -0.3%). This association was pronounced among participants with lower education levels. The earnings difference was evident among younger cohorts, whereas a negative correlation with employment was observed most strongly in older cohorts among individuals with lower education.

Conclusions: Our findings suggest that smoking had a negative effect on earnings among the younger generation, particularly among the less well-educated. The finding of greater impacts on years of employment among the older age group, particularly among groups with low education levels, is consistent with the delayed onset of most health impacts, which may particularly affect productivity in physically demanding jobs that are more common among people with less education.

Implications: Adverse consequences of smoking include reduced earnings and labor market participation, particularly among less well-educated groups. Tobacco control advocates should draw attention to these consequences in arguing for effective measures to reduce smoking initiation and increase cessation in order to achieve socially optimal outcomes.

Introduction: The prevalence of cigarette smoking is high among U.S. Department of Housing and Urban Development (HUD) assistance recipients, putting others at risk for secondhand smoke (SHS) exposure. We evaluated the burden of SHS exposure among HUD-assisted children, adolescents, and adults.

Aims and methods: Using 2007-2018 National Health and Nutrition Examination Survey (NHANES) data linked with HUD administrative data, we assessed SHS exposure prevalence, defined using serum cotinine, among non-tobacco, non-nicotine-using, HUD-assisted children and adolescents (ages 3-17 years, n=955) and adults (ages ≥18 years, n=878) and among low-income, HUD-unassisted children and adolescents (n=5,788) and adults (n=8,027). Time trends were evaluated. Unadjusted and adjusted multivariable logistic regression models were created to assess SHS exposure by HUD assistance status.

Results: The prevalence of SHS exposure during 2015-2018 was 73.2% [95% CI: 63.2%-81.7%] among HUD-assisted children and adolescents and 50.1% [40.1%-60.1%] among HUD-assisted adults. Decreases in SHS exposure among HUD-assisted individuals from 2007-2010 through 2015-2018 were significant only for ages 12-17 years (78.6% [68.0%-87.0%] to 64.3% [52.5%-74.9%]; P=0.04). Among low-income individuals, SHS exposure was higher during 2007-2018 among HUD-assisted than HUD-unassisted children and adolescents (Odds Ratio: 3.39 [2.58-4.47]) and adults (2.11 [1.66-2.68]). Results remained significant after adjusting for social, demographic, and housing characteristics.

Conclusions: HUD-assisted children, adolescents, and adults had higher exposure to SHS than those not receiving HUD assistance. SHS exposure among HUD-assisted individuals was high for all years studied, compared to published estimates for the general U.S. population, but did decrease among children and adolescents ages 12-17 years.

Implications: This study is the first to provide biomarker-derived prevalence estimates of SHS exposure among recipients of HUD assistance within a nationally representative sample of the United States. The findings suggest that HUD-assisted children, adolescents, and adults are an at-risk population for SHS exposure, independent of known confounding social and demographic factors.

Background: The public health impact of new nicotine products will depend on their use by different population groups. We assessed the prevalence of nicotine pouch use among youth and adults in Great Britain (GB).

Aims and methods: Cross-sectional annual Action on Smoking and Health Smokefree GB Adult Surveys 2020-2024 (n: 12 247 to 13 266, 18+) and Action on Smoking and Health Smokefree GB Youth Survey 2024 (n = 2872 11-18-year-olds). Weighted proportions and 95% confidence intervals for pouch ever and current use among adults over time, and in 2024 among youth and adults overall, by socio-demographics, mental health, tobacco smoking, vaping, past-12-month gambling, cannabis, and alcohol use; for youth also family members' smoking and vaping. Multivariable logistic regression assessed the association with ever pouch use.

Results: The prevalence of adult ever and current use doubled from 2020 to 2024, reaching 5.4% (95% confidence interval = 5.0 to 5.8) and 1.0% (0.8-1.1). Among youth, 3.3% (2.7-4.0) reported ever use, including 1.2% (0.8-1.6) reporting current use. Ever use was associated with the use of other addictive products. Among adults, ever use was also more common among younger groups (18-24, 25-34, 35-44 vs. 55+), males, and those in rented accommodation or receiving mental health treatment. Among youth, ever use was also more common among those in London than elsewhere in England.

Conclusions: Pouch use in GB is rare with about 1 in 100 youth and adults reporting current use. However, use appears to be increasing and is higher in some groups, including younger adults, males and people with experience of vaping, smoking, and use of other addictive products.

Implications: While currently low, close monitoring of pouch use is indicated. It is currently concentrated among those with experience of nicotine use. However, given the higher levels of use among young adults and teenagers, consideration of regulation may be required to minimize uptake among groups that would otherwise not have used nicotine-containing products.

Introduction: Varenicline is an α4β2 nicotinic acetylcholine receptor partial agonist with the highest therapeutic efficacy of any pharmacological smoking cessation aid and a 12-month cessation rate of 26%. Genetic variation may be associated with varenicline response, but to date no genome-wide association studies of varenicline response have been published.

Methods: In this study, we investigated the genetic contribution to varenicline effectiveness using two electronic health record-derived phenotypes. We defined short-term varenicline effectiveness (SVE) and long-term varenicline effectiveness (LVE) by assessing smoking status at 3 and 12 months, respectively, after initiating varenicline treatment. In Stage 1, comprising five European cohort studies, we tested genome-wide associations with SVE (1,405 cases, 2,074 controls) and LVE (1,576 cases, 2,555 controls), defining sentinel variants (the most strongly associated variant within 1 megabase) with p-value <5×10-6 to follow up in Stage 2. In Stage 2, we tested association between sentinel variants and comparable smoking cessation endpoints in varenicline randomised controlled trials. We subsequently meta-analysed Stages 1 and 2.

Results: No variants reached genome-wide significance in the meta-analysis. In Stage 1, 10 sentinel variants were associated with SVE and five with LVE at a suggestive significance threshold (p-value <5×10-6); none of these sentinels were previously implicated in varenicline-aided smoking cessation or in genetic studies of smoking behaviour.

Conclusions: We provide initial insights into the biological underpinnings of varenicline-aided smoking cessation, through implicating genes involved in various processes, including gene expression, cilium assembly and early-stage development.

Implications: Leveraging electronic health records, we undertook the largest genetic study of varenicline-aided smoking cessation to date, and the only such study to test genome-wide associations. We showed distinct genetic variants associated (p-value <5×10-6) with varenicline-aided smoking cessation which implicate diverse cellular functions, including transcriptional regulation, RNA modification and cilium assembly. These provide insights which, if independently corroborated, will improve understanding of varenicline response. The growing availability of biobank resources with genetic and varenicline response data will provide future opportunities for larger studies using the approach we developed.

Introduction: Understanding predictors of smoking cessation medication efficacy facilitates the ability to enhance treatment effectiveness. In our pilot trial, exenatide, a glucagon-like peptide-1 receptor agonist, adjunct to nicotine patch improved smoking abstinence compared to nicotine patch alone. This secondary analysis explores potential baseline characteristics associated with differential treatment response to exenatide.

Methods: The parent trial randomized (1:1) 84 smokers with prediabetes and/or overweight to once-weekly placebo or exenatide, 2 mg, subcutaneously. All participants received nicotine patch (21 mg) and brief smoking cessation counseling, with biologically confirmed 7-day point prevalence abstinence at week 6 (end-of-treatment) deemed the primary outcome. Bayesian generalized linear modeling explored differential response to treatment as a function of baseline patient characteristics, including demographic, psychosocial, clinical, smoking related, and genetic factors. Posterior probability (PP)≥75% that an effect exists was taken as a minimum threshold of evidence in favor of model effects.

Results: Exenatide showed stronger benefit versus placebo in participants that smoked >20 cigarettes per day (PP=81.7%) and in those without prediabetes (PP=76.0%) or obesity (PP=94.4%). Exenatide's efficacy was observed only in individuals with no/minimal depression symptoms but not in those with symptoms (PP=91.2%). Finally, exenatide was more efficacious than placebo only in those with the CHRNA rs16969968 GG genotype (PP=88.6%).

Conclusions: The effect of exenatide on abstinence may be moderated by the number of cigarettes smoked daily, metabolic, psychological, and genetic factors. Larger prospective investigations are needed to confirm and extend these findings.

Implications: Understanding predictors of smoking cessation medication efficacy enhances the ability to improve treatment effectiveness. In our pilot trial, extended-release exenatide, a GLP-1 receptor agonist, adjunct to nicotine patch, improved smoking abstinence in smokers with prediabetes and/or overweight. The current post-hoc analysis found that the effect of exenatide on smoking abstinence may be moderated by the number of cigarettes smoked daily, metabolic, psychological, and genetic factors. Larger investigations are needed to confirm and extend these findings.

Introduction: Those with established symptomatic cardiopulmonary disease should attend secondary prevention programs. Attendance at these programs is known to differ by sex and by smoking status, with females and those who smoke being less likely to attend. However, little is known about whether the risk factors of being female and smoking are cumulative, and how outcomes from secondary prevention differ by these subgroups. Accordingly, we sought to examine patient characteristics at entry and outcomes of those attending pulmonary (PR) and cardiac rehabilitation (CR) by sex and smoking status.

Methods: Data were from patients enrolled in programs participating in a national registry between 2013-2021 (PR) or 2012-2021 (CR). Variables examined included: age, sex, race, educational attainment, insurance coverage, qualifying diagnosis, BMI, number of PR/CR sessions attended, and baseline, and change in, psychosocial (depression and anxiety symptoms) and physical function and fitness measures (6-minute walk distance [6MWD]/metabolic equivalents [METs]).

Results: Analyses included 41,087 PR and 447,921 CR patients. Current smoking was reported in 14.3% (PR) and 8.4% (CR) of patients. Across PR/CR, at baseline, current smoking and female sex were both associated with higher depression scores, lower fitness/function measures, and completing fewer sessions. Both current smoking and female sex were significantly associated with less improvement in 6MWD, METs and depression scores within CR.

Conclusions: Both sex and smoking status are important risk factors for those entering secondary prevention programs. Females who smoke have higher risk factors at entry, attend fewer sessions, and, within CR, improve less in fitness/function.

Implications: This study uses large national registries to replicate and expand upon prior findings that both female sex and current smoking are associated with higher-risk profiles when entering secondary prevention programs. Additionally, this study demonstrates that current smoking and female sex are also associated with less improvement during secondary prevention, especially within cardiac rehabilitation.

Introduction: Sales of oral nicotine pouches (ONPs), including brands such as Zyn, on!, Velo, and Rogue, have risen precipitously in the US. One potential driver of ONP use may be exposure to the products and their marketing in local tobacco retailers. This study examines the prevalence and correlates of ONP availability in a large, representative sample of tobacco retailers in three major US cities.

Methods: In 2023, research staff visited a stratified, random sample of 20% of licensed tobacco retailers in San Francisco, New York City (NYC), and Philadelphia (n=1,402) and documented the availability of ONPs. Binomial generalized linear mixed models estimated adjusted odds of ONP availability by city, store type, and district sociodemographic characteristics.

Results: ONPs were available in 28.7% of retailers and were most prevalent in chain convenience stores (60.5%), followed by smoke/vape shops (53.3%, p<.0001). After adjusting for city and store type, the odds of a retailer carrying ONPs were higher in districts with a greater proportion of non-Hispanic White residents (aOR: 2.33 [1.10, 4.94]), a higher median household income (aOR: 2.04 [1.23, 3.38]), and a lower proportion of youth residents (aOR: 0.25 [0.15, 0.43]).

Conclusions: ONP availability was greater in retailers located in predominantly white and higher income neighborhoods and those with fewer youth. As researchers continue to evaluate the risks of ONPs as well as their potential as a tobacco harm reduction strategy, attention to variations in retail access and population patterns of use will be critical to determine impacts on health equity.

Implications: Sales of oral nicotine pouches (ONPs) have increased precipitously in the US, but little is known about patterns of retail access in neighborhoods, which may influence consumer use behaviors. This study found that over 1 in 4 tobacco retailers carried ONPs, but availability was greater in largely white and high-income neighborhoods and those with fewer youth. As researchers continue to evaluate ONP risks and potential benefits, this study provides insight into the role that retail access may play in shaping population patterns of use and subsequent impacts on health equity.

Introduction: While roll-your-own tobacco consumption is highest in Europe, increased sales are reported in Latin America. We are unaware of any research that explores the display and advertising of roll-your-own tobacco in this region.

Methods: An observational study was conducted at tobacco-selling points-of-sale (N=2,081) near schools in cities in Argentina, Guatemala, Mexico, and Peru between April and July 2023. In each of the 16 cities (four per country) schools were randomly selected and stratified according to neighbourhood socioeconomic status, with all points-of-sale located in pre-established routes around schools observed. A codebook was used to assess the display of roll-your-own tobacco and accessories (i.e. rolling papers and filters) and the presence of advertising for these products. Logistic regressions were employed to estimate the association between the display of roll-your-own tobacco and accessories (defined as being visible at the point-of-sale) and type of point-of-sale, neighbourhood socioeconomic status, and city.

Results: Apart from a single store in Guatemala, roll-your-own tobacco and accessories were only observed in Argentina, at 110 (21.5%) points-of-sale. In Argentina, roll-your-own tobacco and accessories were more likely to be displayed in convenience and neighbourhood stores compared to kiosks, in high and middle socioeconomic neighbourhoods compared to low socioeconomic neighbourhoods, and in Cordoba and Santa Rosa than in Quilmes and San Salvador de Jujuy. Advertising for RYO tobacco (1.8%) and accessories (3.1%) at POS was uncommon.

Conclusion: This study provides insight into roll-your-own tobacco penetration in multiple Latin American countries, finding that the display of this product is largely restricted to Argentina.

Implications: Increasing sales of roll-your-own tobacco have been reported in Latin America. Despite this, there is limited academic research on the consumption of roll-your-own tobacco in this region and no research on its presence at the point-of-sale. This study provides insight into roll-your-own tobacco and accessories penetration in Argentina, Guatemala, Mexico and Peru, finding that display of this product at points-of-sale is generally limited to Argentina. Continued monitoring of the display and marketing of this product is needed across these countries. Research in Argentina exploring how roll-your-own tobacco and accessories are perceived by smokers and young people would be of value.

Introduction: We set out to better understand patterns of smoking abstinence and relapse in trials of e-cigarettes for smoking cessation.

Methods: Secondary analysis of studies from a Cochrane review. Studies had to test any type of e-cigarette intervention for smoking cessation. They had to follow-up for at least 6 months and report either: abstinence at multiple time points; abstinence using multiple definitions; relapse. We narratively synthesized data and conducted meta-analyses.

Results: We included 15 studies (n=7,233 participants). Using the Cochrane risk of bias tool v1, 5 were judged to be at high risk of bias, 8 were at low risk, and 2 at unclear risk. Absolute continuous abstinence rates tended to decline over time, but varying slopes. For absolute point prevalence abstinence, three studies demonstrated a shallow decline over time, two a steep decline, and three the opposite - an increase in abstinence over time. Data on relative abstinence rates (e-cigarettes versus control) were mixed. There were multiple instances of differences between point prevalence and continuous/sustained abstinence rates, both in trajectories over time and in terms of relative abstinence. The few studies addressing relapse highlighted mixed demographic and behavioural characteristics associated with relapse rates.

Conclusions: Smoking trajectories vary between trials of e-cigarettes for smoking cessation. Risk ratios may not be stable over time and may increase or decrease in favor of e-cigarettes depending on the study. Further data are needed, especially on relapse rates in early quitters who use e-cigarettes versus those who use other or no stop-smoking aids.

Implications: While some have posited e-cigarettes might increase smoking relapse when used as a cessation tool, others have posited that combustible cigarette quit rates may increase over time in the same studies due to 'accidental quitting'. We set out to investigate this empirically and found considerable variation in smoking trajectories in e-cigarette trials. Data suggest risk ratios may not be stable over time and may increase or decrease in favor of e-cigarettes depending on the study. Further data are needed, especially on relapse rates in early quitters who use e-cigarettes versus those who use other or no stop-smoking aids.