Nicotine & Tobacco Research最新文献

Introduction: Nicotine dependence measures often rely on self-reported cigarette consumption, which has declined over time and may not accurately reflect nicotine intake. We developed a brief two-item Short Nicotine Dependence Index (SNDI) assessing urge to use and difficulty abstaining, and examined its association relative to that of the established Heaviness of Smoking Index (HSI) with saliva cotinine, a biomarker of nicotine exposure.

Methods: Data were drawn from the Health Survey for England (HSE; 2000-2021) and a London General Practice Survey (GP Survey; 1989) (n = 14 244 current cigarette smokers aged ≥16 with valid cotinine data). Dependence was assessed using two questions: time to first cigarette after waking (scored 1-6) and perceived difficulty going a whole day without smoking (scored 0-3). Scores were summed to produce a total SNDI score (range 1-9). Mean cotinine levels were estimated across item responses and total scores in each sample.

Results: Cotinine concentrations increased consistently with higher scores on both individual items and the total SNDI score. In the HSE, cotinine ranged from 83 [95% CI = 77% to 88%] ng/mL for those with the lowest total score to 387 [377-396] ng/mL for those with the maximum score. A similar gradient was observed in the GP Survey (from 92 [75-110] to 431 [399-463]), despite higher overall cigarette consumption. In both datasets, the SNDI explained more variance in cotinine than the HSI: R2 = 0.304 vs. 0.278; GP Survey: 0.283 vs. 0.250.

Conclusions: The SNDI is a brief self-report measure that outperforms existing short tools in predicting nicotine exposure. It offers a practical alternative for research and community surveillance in evolving nicotine use landscapes.

Implications: The Short Nicotine Dependence Index offers an efficient and practical alternative to traditional dependence measures that rely on cigarette consumption. Its brevity and strong correlation with biochemical markers make it well-suited for use in large-scale surveys and clinical settings. By focusing on observed behavior (time to first cigarette) and self-reported difficulty abstaining, it remains relevant as smoking and nicotine use patterns shift. In addition, because it does not use reported cigarettes smoked per day, it may be useful for assessing dependence on other nicotine products (eg, e-cigarettes). Further research is needed to evaluate its validity among users of other nicotine products.

Introduction: Around 30% of youth who use tobacco use multiple tobacco products (MTPs), yet little research has evaluated campaign ads to address youth MTP use.

Methods: We qualitatively examined how youth who use MTPs perceive tobacco prevention and cessation ads. Between February 2023 and January 2024, we held seven virtual focus groups with 30 US youth (ages 14-20 years) who reported using both e-cigarettes and a combustible tobacco product in the past 30 days. Participants were shown five static tobacco prevention and cessation ads that addressed single and MTPs. Participants were asked about their reactions to the ads, including whether they were effective or relatable, and suggested changes to the ads. We performed a thematic analysis.

Results: Participants were, on average, 18.7 years old. Most participants were female (73%), white (47%), and lesbian, gay, or bisexual (63%). Four central themes emerged: (1) Ads about MTPs were perceived as more effective than ads about single tobacco products because they were relevant and informative; (2) Participants recommended that MTP ads should specify "vaping and smoking" or "nicotine" to refer to MTPs rather than "tobacco"; (3) Participants described ads with youth vernacular as ineffective and unrelatable and exhibited message fatigue; and (4) Ads that featured shared health consequences of MTP use, especially with graphic, fear-arousing images, were perceived as most effective.

Conclusions: Findings suggest ads about MTPs could be effective among youth who use MTPs. Promising MTP ads could specify "vaping and smoking" and highlight shared health effects across MTPs using graphic, fear-arousing images.

Implications: Multiple tobacco product (MTP) use (ie the use of two or more tobacco products in the past 30 days) is a common pattern of tobacco use among youth, yet little research has developed or evaluated campaign ads addressing MTP use. We conducted a qualitative study to examine how youth who use MTPs perceive tobacco prevention and cessation ads. Findings suggest ads about MTPs could be effective, especially if they specify "vaping and smoking" and highlight shared health effects of MTPs using graphic, fear-arousing images.

Introduction: The aim of this study was to empirically identify subgroups of dual cigarette and electronic nicotine delivery systems (ENDS) product users based on their motivations for ENDS use.

Methods: Data came from n = 713 adult dual cigarette/ENDS users in the Population Assessment of Tobacco and Health Wave 6 public use data file. We used latent class analysis to identify qualitatively different subgroups within the sample and applied logistic regression to assess correlates of latent class membership.

Results: We identified two latent classes: "Substituters" (62.81%) and Complementers (37.19%). Classes were primarily distinguished by Substituters reporting a higher probability of using ENDS to cut down on (97.99%) or quit (86.12%) cigarette smoking; the converse was true for Complementers (16.95%; 3.17%, respectively). Compared to Substituters, Complementers (aOR = 0.87, 95% CI = 0.81 to 0.96) expressed less interest in smoking cessation. Moreover, Complementers were less likely to have made a past-year smoking quit attempt (aOR = 0.46, 95% CI = 0.27 to 0.77) and more likely to smoke the same number of cigarettes as usual (aOR = 3.62, 95% CI = 2.04 to 6.42) or more cigarettes than usual (aOR = 5.96, 95% CI = 1.92 to 18.51) on days when they both smoked and vaped than were Substituters. No sociodemographic differences were observed.

Conclusions: We identified distinct latent classes of dual cigarette/ENDS users, predominantly differentiated based on their reported probabilities of using ENDS to assist in quitting or cutting down on cigarette smoking. Findings that class membership is associated with interest in quitting and quit attempts have significant health, treatment, and study design implications.

Implications: The identification of distinct classes of dual cigarette/ENDS users based on their motivations for ENDS use and differential associations between class membership and tobacco use characteristics has a number of implications. Class membership may affect cessation treatment approaches and has significant implications for scientific study design.

Introduction: The tobacco industry's marketing efforts have successfully recruited a new generation of tobacco users, with flavored e-cigarette use becoming increasingly prevalent among young adults (YAs). Media campaigns continue to be an effective and cost-efficient approach to counteract the strong negative influence of marketing. Identifying salient beliefs underlying YAs' flavored e-cigarette use serves as the first step in designing effective anti-vaping campaigns.

Methods: An elicitation survey was conducted among 396 YAs (18-25 years; M = 19.66, SD = 1.45) who have ever vaped, with the majority (70.3%) having vaped in the past 6 months. Open-ended questions were used to probe perceptions of flavored e-cigarette use, including benefits, consequences, social norms, facilitators, and barriers of continued use. Thematic analysis was conducted by two coders (α = 0.81-1.00) to identify commonly held and novel beliefs.

Results: The most shared benefits of flavored e-cigarette use included facilitating stress relief and addressing mental health concerns. While participants shared many health-related disadvantages of flavored vaping, including shortness of breath and addiction, our findings illuminate misperceptions and knowledge gaps about the safety of these products. Participants emphasized the influence of marketing on their use of flavored e-cigarettes, as appealing ads on social media were commonly cited as facilitating factors. Our findings also underscore the glorious social perceptions of flavored vaping.

Conclusions: The findings of this study provide a comprehensive list of potential themes for anti-vaping campaigns targeting flavored e-cigarette use among YAs, ranked by prevalence. Novel, salient beliefs generated directly from the target audience provide fresh, innovative angles to fuel prevention efforts.

Implications: This study fills an important gap in understanding about YAs' beliefs and perceptions of flavored vaping products. Our findings reveal salient and novel attitudinal, normative, and control beliefs about flavored vaping. These beliefs will serve as a springboard for inspiring effective campaigns that seek to change YAs' beliefs and to subsequently curb their flavored vaping behavior.

Introduction: Heated-tobacco-products (HTPs) are electronic devices that "heat" a processed tobacco/chemical mixture to produce an inhalable emission. They are advertised as a reduced-risk alternative to cigarette smoking. The aim of our research was to assess their potential health impacts using a 3D human airway model.

Methods: Primary human airway epithelial cells (n=9, aged 11-21yrs) were grown at Air-Liquid-Interface. Cultures were then exposed for 1 hour to the emissions from one of three current HTPs (Philip Morris International IQOS3 Duo, British American Tobacco glo and Japan Tobacco International Ploom S). Air and cigarette smoke were used as controls. Emission physico-chemical characteristics were analysed and cytotoxicity, permeability, differential gene expression, morphology and inflammatory mediator release were assessed.

Results: HTP emissions contained a range of toxic chemicals, some at higher concentrations than in cigarette smoke. Particle size spectra showed smaller average particle size but also fewer particles overall for HTPs compared with cigarette smoke. Ploom and glo led to the most direct cellular damage, with decreased viability, decreased barrier integrity and increased airway permeability compared to Air controls. Cigarette smoke caused the greatest increased mediator response and change in gene expression, with IQOS causing the second greatest change in gene expression. Conversely, exposure to HTP emissions decreased mediator response (compared with Air).

Conclusions: Based on the results from our study, HTPs are not reduced-risk alternative to cigarettes but instead pose an alternative risk.

Implications: The implications of this research are that because HTP exposure elicits damage at the cellular level, and because HTPs deliver less nicotine per puff, users could increase consumption and cumulative toxic exposure. HTPs should not be considered reduced-risk; regulatory oversight, clear public-health warnings, and further research on long-term effects are warranted.

Introduction: Most contemporary e-cigarettes contain high concentrations of salt-based nicotine, which reduces respiratory irritation typically associated with free-base nicotine liquids. Flavorings can also be used in e-cigarettes to increase nicotine delivery and product appeal. The cumulative effects of nicotine form and flavor on abuse liability are unknown.

Methods: We conducted a double-blind within-subject, clinical trial (clinicaltrials.gov ID:NCT04231539). Using a standardized puffing protocol, regular users of e-cigarettes tested 4 liquid formulations (order randomized) of the same nicotine concentration (25.5±2.4mg/mL, 157.4±14.5mM): 1) unflavored with free-base nicotine; 2) tobacco-flavored with free-base nicotine; 3) unflavored with salt-based nicotine; 4) tobacco-flavored with salt-based nicotine. Endpoints, analyzed via linear-mixed effects modeling and ANOVA, included pharmacokinetic measures (AUC0-120min, Cmax, Tmax), subjective drug effects (e.g. liking, withdrawal relief, sensory effects), and behavioral economic demand (intensity, elasticity).

Results: Salt-based formulations produced higher Cmax values (p=0.028), were rated as less harsh (p<0.001), and created a more intense cooling sensation (p=0.002) compared to free-base formulations. Tobacco-flavored formulations also showed a significantly more intense cooling sensation (p=0.013) and a greater feeling of nicotine effect (not significant, p=0.055) than unflavored formulations. Nominal rankings of study measures, regardless of statistical significance, showed formulations with salt-based nicotine consistently outperformed those with free-base nicotine, regardless of liquid flavor.

Conclusions: Our findings suggest that abuse liability of e-cigarettes is driven more by nicotine form than flavor among regular users. Future studies should consider the effect of nicotine form in conjunction with liquid flavor in other populations, including cigarette smokers seeking to quit.

Introduction: sugars, added or naturally present in cigarette tobacco, have been reported to contribute to the harmful properties of cigarettes by enhancing smoke palatability, appeal, and potentially toxicity and addictiveness. In this study, 13C sugars were used to better understand the specific impact of added sugars on smoke composition.

Methods: [13C]-isotope labeled sugars were added to cigarettes. Different concentrations, sugars (fructose, glucose, sucrose, and a mixture) were tested with eight cigarette brands, with different design characteristics such as length and filter ventilation and sugar content. Cigarettes were machine-smoked (using ISO and WHO Intense regimes), and the resulting samples were subjected to untargeted and targeted analyses (for volatile organic compounds (VOCs), polycyclic aromatic hydrocarbons (PAHs), aldehydes, tobacco-specific nitrosamines (TSNAs) and nicotine).

Results: The presence of 13C in five furans, pyranone, and one compound of unknown chemical identity showed that additional amounts of these compounds were directly formed from the decomposition of sugars. Up to 58% of 5-hydroxymethylfuran originated from 13C sugars. Moreover, sugars were direct precursors of four out of the five aldehydes tested, although the 13C-labeled fraction of aldehydes was much smaller (up to 2%). No evidence for the direct formation of PAHs was found, but the addition of sugars was nevertheless found to impact the levels of unlabeled PAHs, TSNAs and nicotine, presumably by altering the burning process of the experimental cigarettes.

Conclusions: Added sugars to cigarette tobacco contribute to the formation of harmful and flavored components in smoke, including furans and aldehydes.

Implications: Based on our findings on sugars as precursors of harmful and flavored compounds, we propose to ban the addition of sugars to cigarettes, and other combustible tobacco products. Imposing maximum allowable levels on sugars that are naturally present in tobacco could also be considered, as they also lead to harmful compounds and impart a flavor.This study adds to the body of evidence that sugars present in cigarette tobacco are precursors of harmful and flavored constituents of cigarette smoke. Regulation of sugars, such as banning added sugars and setting limits on natural sugars, may serve to protect public health.

Introduction: This study examined whether the Youth E-cigarette Outcome Expectancies Questionnaire (YEOEQ) measures e-cigarette beliefs consistently with respect to sex, race/ethnicity, and intersectional identity among Black, Latino, and White youth. Inconsistent measurement, or non-invariance, can lead to misleading conclusions about which groups are at higher risk of e-cigarette use. By identifying and adjusting for this bias, we aimed to improve the accuracy of group comparisons.

Methods: Data were drawn from Follow-up 3 of the Adolescent Brain Cognitive Development Study (n=8,976; Mage=12.91, 47.27% female; 15.02% Black, 22.94% Latino, 62.03% White). Moderated nonlinear factor analysis was applied to the Positive and Negative Expectancies YEOEQ subscales. Mean subscale scores were compared across groups pre- and post-adjustment for non-invariance.

Results: Non-invariance by sex, race/ethnicity, and intersectional identity was observed at the item level for both subscales, and at the factor level for Positive Expectancies. For Positive Expectancies, adjusted comparisons revealed previously undetected lower scores among Black versus Latino (gadjusted=0.15) and White youth (gadjusted=0.16) and reduction to non-significance of previously observed higher scores for Latino versus White youth. For Negative Expectancies, observed lower scores for Black versus Latino youth (gunadjusted=0.15) and Latino versus White youth (gunadjusted=0.15) remained significant but effect sizes decreased when adjusted.

Conclusions: Findings demonstrate measurement bias in the YEOEQ by sex and race/ethnicity in early adolescents. Unadjusted scores suggested riskier (more positive) e-cigarette expectancies among Latino than White youth and missed lower risk (less positive) among Black youth, potentially misguiding attention to these marginalized groups.

Introduction: We examined the association of heavy alcohol consumption with e-cigarette, cigarette, or dual use among females of reproductive age and stratified by pregnancy status.

Methods: Cross-sectional data from 2021 (n=13,744), 2022 (n=38,021) and 2023 (n=38,765) Behavioral Risk Factor Surveillance System were analyzed for females aged 18-44 years. Heavy alcohol consumption (>7 drinks/week) was categorized as Yes or No (reference). Current nicotine/tobacco product use (everyday/somedays) was categorized as nonuse of either cigarette or e-cigarette (reference), e-cigarette-only, cigarette-only, or dual use. Weighted multinomial logistic regression was used to examine the association between alcohol consumption and tobacco use, adjusting for sociodemographic factors, self-rated health, current smokeless tobacco use, pregnancy status and survey year. Interaction effects between pregnancy status and alcohol consumption were analyzed.

Results: Findings showed that heavy alcohol consumption was associated with a higher likelihood of e-cigarette (aRR: 5.57, [95% CI: 4.70, 6.61]), cigarette (4.88, [4.03, 5.91]), or dual (6.95, [5.59, 8.64]) use. Pregnancy significantly modified the association for dual use (p=0.002) only. Stratified analysis indicated that pregnant (vs. non pregnant) females with heavy alcohol consumption had much higher likelihood of e-cigarette (10.35, [2.59, 41.33] vs. 5.52, [4.65, 6.55]), cigarette (6.56, [1.16, 37.05] vs. 4.88, [4.02, 5.92]), and dual 15.82, [4.56, 54.84] vs. 6.81, [5.45, 8.50]) use.

Conclusion: Heavy alcohol consumption is strongly associated with a higher likelihood of e-cigarette, cigarette, or dual use among reproductive-age females, with pregnancy significantly amplifying this relationship. Comprehensive substance use screening and tailored cessation support are essential for pregnant females and those of reproductive age.