Nicotine & Tobacco Research最新文献

Introduction: There is considerable interest in raising the age of sale of tobacco above the conventional age of 18 years. We systematically reviewed whether raising the minimum legal sales age of tobacco (MLSA) to 20 or above is associated with a reduced prevalence of smoking compared to an MLSA set at 18 or below.

Aims and methods: Following a preregistered protocol on PROSPERO (ref: CRD42022347604), six databases of peer-reviewed journals were searched from January 2015 to April 2024. Backward and forward reference searching was conducted. Included studies assessed the association between MLSAs ≥20 with cigarette smoking or cigarette sales for those aged 11-20 years. Assessments on e-cigarettes were excluded. Pairs of reviewers independently extracted study data. We used ROBINS-I to assess the risk of bias and GRADE to assess the quality of evidence. Findings were also synthesized narratively.

Results: Twenty-three studies were reviewed and 34 estimates of association were extracted. All extracted studies related to Tobacco 21 laws in the United States. Moderate quality evidence was found for reduced cigarette sales, moderate quality evidence was found for reduced current smoking for 18-20-year-olds, and low-quality evidence was found for reduced current smoking for 11-17-year-olds. The positive association was stronger for those with lower education. Study bias was variable.

Conclusions: There is moderate quality evidence that Tobacco 21 can reduce overall cigarette sales and current cigarette smoking amongst those aged 18-20 years. It has the potential to reduce health inequalities. Research in settings other than the United States is required.

Implications: This systematic review on raising the minimum legal sale age of tobacco to 20 or above demonstrates there is moderate quality evidence that such laws reduce cigarette sales and moderate quality evidence they reduce smoking prevalence amongst those aged 18-20 years compared to a minimum legal sale age of 18 years or below. The research highlights potential benefits in reducing health inequalities, especially for individuals from lower educational backgrounds. Studies are limited to the United States, highlighting a need for more global research to assess the impact of these policies in other settings.

Introduction: Studies consistently demonstrate smoking is a socially contagious behavior, but less is known about the influence of social connections on vaping. This study examined associations between having close social connections who smoke or vape and relevant smoking and vaping outcomes.

Aims and methods: This was a representative cross-sectional survey of adults (≥16 years) in England. Participants (n = 1618) were asked how many people they discuss important matters with (ie, close social connections) and how many of them smoke/vape. We tested associations between (1) smoking and (2) vaping among close social connections and participants' own smoking and vaping status; harm perceptions of e-cigarettes (among current smokers); attempts and success in quitting smoking (among past-year smokers); and use of e-cigarettes as a smoking cessation aid (among past-year smokers who tried to quit).

Results: Adults with ≥1 close social connection who smoke were more likely than those with none to smoke themselves (32.8% vs. 9.4%; ORadj = 7.23[95% CI: 4.74 to 11.0]) and had an uncertain lower likelihood to quit (12.2% vs. 19.8%; ORadj = 0.46[0.17-1.23]). Those with ≥1 close social connection who vape were more likely than those with none to vape themselves (29.6% vs. 6.3%; ORadj = 5.16[3.15-8.43]) and to use e-cigarettes in their most recent attempt to quit (57.0% vs. 27.9%; ORadj = 18.0[1.80-181]), and had an uncertain higher likelihood to perceive e-cigarettes as less harmful than cigarettes (30.8% vs. 12.2%; ORadj = 2.37[0.82-6.90]).

Conclusions: In England, we replicated well-established associations with smoking and found similar evidence for vaping. People were much more likely to vape and to use e-cigarettes to quit smoking if they had close social connections who vaped.

Implications: The cross-sectional design means it is not clear whether smoking/vaping among close social connections influences people to smoke/vape themselves, or whether people who smoke/vape select to form close social connections with others who similarly smoke/vape. Further research is required to establish causality. If the associations we observed are causal, interventions that encourage smokers to switch to vaping may have positive spillover effects on social connections' perceptions of e-cigarettes and the use of these products to support smoking cessation.

Introduction: Australian young adults (YA) report difficulties in quitting vaping. This study sought to understand what a vaping cessation program should look like from the perspective of current and former vapers, and professionals/experts involved in this health space, to inform the development of a conceptual model.

Aims and methods: Data collection was informed by Social Cognitive Theory (SCT) using co-design methodology to explore vaping cessation. Interactive workshops and semi-structured interviews were held online between March 2023 and January 2024, with data from participants' narratives and written materials thematically analyzed.

Results: YAs (18-24 years) identifying as current or former vapers (n = 15) and health professionals/experts'(n = 13) insights informed the model framework, incorporating three main elements based on environmental, personal, and behavioral factors shaping vaping cessation. Four design considerations were identified; the program needs to be affordable, accessible, appropriate, and adaptable. YAs expressed a strong preference to share their quitting journey with peers, endorsing a digital forum providing a hybrid framework of support.

Conclusions: Vaping cessation is nuanced and complex requiring a multi-faceted approach targeted to the specific needs of the young adult population.

Implications: The findings can be used to inform the development of a vaping cessation program tailored to YA in Australia and other similar contexts. YA perceived sharing the quitting journey and being inspired by the lived experience of others as critical components for successful vaping cessation. SCT is demonstrated to be a valuable behavior change framework for understanding vaping cessation and should be considered in future research on intervention development.

Introduction: Health warning labels (HWLs) communicate the health risks of cigar use and can decrease use when on cigar packages.

Aims and methods: This study assessed the relative efficacy of six FDA-proposed individual warning statements in text and pictorial format. A sample of young adults (ages 18-29) were randomized to a text or pictorial warning condition on generic cigarillo packages. The warning statements were about lung cancer and heart disease; cancers of the mouth and throat; secondhand smoke; not a safe alternative; nicotine/addiction; and harm to baby. Negative emotional reactions, cognitive elaboration, and perceived message effectiveness (PME) were assessed for each warning using linear mixed models.

Results: Of the 661 participants, 47.3% reported ever cigarillo smoking, 32.7% current smoking, and 20% were susceptible. In the pictorial format, cancers of the mouth and throat elicited lower levels of anxiety compared to secondhand smoke, not a safe alternative, nicotine/addiction, and harm to baby (ps < .001). Pictorial HWLs with human imagery induced high anxiety, sadness, fear, and guilt reactions (p < .001) and higher PME (p = .011) compared to pictorial HWLs with diseased body parts. Compared to the text HWL cancers of the mouth and throat, the text HWL harm to baby elicited higher anxiety (p = .003), sadness (p = .002), and PME (p < .001).

Conclusions: Pictorial HWLs depicting people or human imagery, rather than images of diseased organs or body parts, to represent health effects elicited the most negative emotional reactions, such as anxiety and guilt, and higher PME. Including such images and texts highlighting effects on vulnerable populations like babies can better communicate cigarillo health risks, aiming to curb cigarillo use among young people.

Implications: The study suggests that pictorial HWLs with human imagery significantly enhance the communication of cigarillo smoking risks compared to images of diseased organs. These HWLs evoke stronger emotional responses, particularly anxiety and guilt, and higher perceived message effectiveness by depicting a recognizable person. Furthermore, text-only warnings describing the smoking effect on vulnerable populations, such as babies, might have a higher impact on young adults. This evidence supports a strategic shift in FDA policies to include such impactful images and texts, which could potentially lead to a significant reduction in cigarillo use among young people. Our findings underscore the urgent need for continued research and implementation of these enhanced warning labels to improve public health outcomes.

Introduction: The effects of combustible cigarettes (CCs) and electronic nicotine delivery systems (ENDS) on immune cell-driven colon inflammation and intestinal healing of patients with ulcerative colitis (UC) are still unknown and, therefore, were examined in this study.

Aims and methods: Intracellular staining and flow cytometry analysis of immune cells isolated from UC patients who used ENDS (UCENDS), CCs (UCCC) and who were nonsmokers (UCAIR) were performed to elucidate cellular mechanisms which were responsible for CCs and ENDS-dependent modulation of immune response during UC progression. Additionally, dextran sulfate sodium (DSS)-colitis was induced in ENDS/CC/air-exposed mice (DSSENDS/ DSSCC/DSSAIR groups) to support clinical findings.

Results: Significantly increased number of immunosuppressive, IL-10, TGF-β, and IL-35-producing, FoxP3-expressing CD3 + CD4 + T regulatory cells (Tregs) was observed in the blood of UCENDS patients while the reduced presence of inflammatory, TNF-α and IFN-γ-producing, Tbx21-expressing CD3 + CD4 + Th1, IL-4-producing Gata3-expresing Th2 and IL-17, IL-22-producing, RORγT, IL-23R-expressing Th17 cells were noticed in the blood of UCCC patients. Exposure to either CCs or ENDS was associated with enhanced mucosal healing, ameliorated spontaneous recovery, and improved survival of DSS-treated mice. An expansion of immunosuppressive cells (IL-10-producing tolerogenic CD11c + dendritic cells, alternatively activated CD206, Arginase 1-expressing, IL-10-producing F4/80 + macrophages, IL-10-producing FoxP3-expressing Tregs) was noticed in the colons of DSSENDS-treated mice, while reduced number of inflammatory, IL-17- and IL-4-producing T lymphocytes was observed in the colons of DSSCC-compared to DSSAIR-treated mice.

Conclusions: Despite different mechanisms of action, both ENDS and CCs attenuated ongoing colon inflammation, enhanced healing, and ameliorated recovery of injured intestines of DSS-treated mice and UC patients.

Implications: This is the first study that compared the effects of CCs and ENDS on immune cells of patients suffering from UC, providing new information about molecular and cellular mechanisms which were responsible for ENDS and CCs-dependent modulation of immune cell-driven colon injury and inflammation. Obtained results showed that both ENDS and CCs had the capacity to attenuate detrimental immune response, enhance healing, and ameliorate recovery of injured intestines.

Introduction: Smoking is the leading cause of preventable death among Aboriginal and Torres Strait Islander people.

Aims and methods: The Koori Quit Pack study aimed to assess the feasibility of a multi-component mailout smoking cessation intervention to reduce smoking among Aboriginal and Torres Strait Islander people. A non-randomized, single-group feasibility study was conducted among Aboriginal and Torres Strait Islander people who reported current smoking. The intervention package included information pamphlets and resources on quitting, referral offer to Aboriginal Quitline and optional free Nicotine Replacement Therapies (NRT). Follow-up was conducted at 2-week, 6-week, 10-week, and 6-month post-recruitment. Feasibility outcomes were recruitment and retention rates, uptake of intervention components, and smoking abstinence at 6-week follow-up (primary endpoint). Cessation outcomes were analyzed using both a complete case analysis and intention-to-treat approach.

Results: 165 participants were recruited, 111 (67.3%), 79 (47.9%), 59 (35.8%), and 94 (57%) participants completed the 2-week, 6-week, 10-week, and 6-month follow-up. At 10-week follow-up, 40.7% of participants used pamphlets and booklets, 13.6% used Quitline and > 90% used NRT. At 6-week follow-up, 87.3% reported a quit attempt and 46.8% sustained quitting. 46.8% were continuously smoke-free at the 6-week timepoint. The complete case analysis and the intention-to-treat analysis at 6 months show a 7-day self-reported point prevalence abstinence of 34% and 19.4% respectively.

Conclusions: The Koori Quit Pack mailout smoking cessation program was feasible to support Aboriginal and Torres Strait Islander people. The intervention resulted in a high smoking cessation rate and should be upscaled, implemented, and evaluated nationally.

Implications: Aboriginal and Torres Strait Islander people are disproportionately impacted by tobacco-related harms; however, the majority want to quit or wish they never took up smoking. Mailout cessation support is feasible, overcomes access barriers to evidence-based support and increases quitting success. We recommend a national mailout smoking cessation program is implemented for, and by Aboriginal and Torres Strait Islander people to accelerate declines in smoking prevalence to eliminate tobacco-related death and disease.

For decades, young children in the United States have been accidentally poisoned by traditional tobacco products and the yearly incidence has slowly increased. More poisonings have accompanied the introduction of new products such as e-cigarettes and dissolvable tobacco, with renewed public attention. Using toxicological principles of human health risk assessment, published data from prior exposures, and information about the content and characteristics of specific products, I estimated the acute toxicological risk from exposure to various types and quantities of tobacco products for children <5 years old. Approximate reference levels for a non-lethal oral dose of nicotine were derived: A higher level potentially requiring medical care (0.2 mg per kg) and a lower level not potentially requiring medical care (0.04 mg per kg). A weight-based oral lowest lethal dose (LDLO) of 1-14 mg per kg in children <5 years old is estimated from the cited LDLOs in adults. I provide tables relating e-liquid concentration and volume to the oral LDLO in children <5 years old by weight and describing the amount of other tobacco products expected to result in lethality. Communications about safe storage practices should focus on the benefits of keeping any nicotine-containing product out of the reach of young children, and adults can be reminded to always reengage child-resistant closures on packages and call a poison center for accidental exposures. Healthcare providers, families, or any member of the public can also make reports about unexpected health or safety concerns related to tobacco products to the FDA using its online Safety Reporting Portal at https://www.fda.gov/TobaccoProducts/PublicHealthScienceResearch/ucm377563.htm. Tobacco products, particularly electronic nicotine delivery system (ENDS) liquids are highly toxic to children <5 years old in small amounts. Given that the concentration of nicotine in ENDS is 3 to 72 mg per mL, the lethal dose (LDLO) is expected to be 13-40 mL in a bottle containing a solution of 3 mg per mL liquid nicotine but may be as low as ½-2 mL in a bottle containing a highly concentrated solution of 72 mg per mL liquid nicotine. Features such as flow restrictors, child-resistant closures, and communication of safe storage practices to parents can help to lessen the morbidity and mortality from poisoning.

Introduction: The E-cigarette industry's marketing and social media efforts have promoted adolescent vaping. We developed and pilot-tested an anti-vaping media literary program-MediaSense.

Aims and methods: In addition to employing the Community-Based Participatory Research approach for program development, we applied a prospective, interventional, and single-arm design to assess the impact of MediaSense among students from five middle and high schools. Data were collected through REDCap surveys administered before and after the intervention. We performed generalized linear mixed models and median analysis to evaluate changes in vaping media literacy (ie, Authors and Audiences [vAA], Messages and Meanings [vMM], and Representation and Reality [vRR]), knowledge, harm perception, and susceptibility to e-cigarette use before and after the intervention.

Results: A total of 384 students aged 11-18 years completed the pre-post survey assessment. After the intervention, students exhibited significantly improved vaping media literacy across all three domains (vAA, fold change [FC] = 150%, p < .0001; vMM, FC = 143%, p < .0001; vRR, FC = 133%, p = .0007). The intervention was associated with a reduction of vaping susceptibility (adjusted odds ratio [AOR] = 0.7, p = .04) and improvement in harm perception (AOR = 1.6, p = .009), knowledge of flavored e-cigarettes (AOR = 4.4, p < .0001) and Tobacco 21 policy (AOR = 6.2, p < .0001). Further mediation analysis unveiled the pathway of the intervention on reduction of vaping susceptibility through media literacy (βindirect = -0.03, p = .003) and harm perception enhancement (βindirect = -0.02, p = .03).

Conclusions: The MediaSense program showed promise in vaping prevention among adolescents by reducing vaping susceptibility. Comprehensive vaping media literacy education, especially interventions aimed at decoding misleading marketing information and addressing emerging marketing themes, provides valuable evidence in curbing adolescent vaping.

Implications: MediaSense (Media Education for Sensible Evaluation and Nurturing Substance-free Experiences) represents a promising e-cigarette education program designed for adolescent vaping prevention. The findings of this study highlight the positive impact of the program on media literacy, harm perception, and knowledge of tobacco control policies.

Introduction: This study assessed the efficacy of the SinHumo App combined with a cognitive-behavioral smoking cessation treatment on 12-month follow-up abstinence, compared with the same smoking cessation treatment and a control App.

Aims and methods: A sample of 288 treatment-seeking people who smoke were randomized: SinHumo App plus smoking cessation treatment (n = 140) and control App plus smoking cessation treatment (n = 148). The primary outcome was 7-day point prevalence abstinence (PPA) at the 12-month follow-up. Secondary outcomes were abstinence rates at the end of the intervention and 3- and 6-month follow-ups, cigarette per day (CPD) reduction over the 12-month follow-up, intervention engagement, and satisfaction.

Results: Intention-to-treat analyses showed nonsignificant differences in self-reported 7-day PPA at the 12-month follow-up (37.1 and 42.6%, respectively; OR = 0.80). No significant differences were found in abstinence at the end of the treatment (68.6 vs. 62.8%) nor on 7-day PPA at 3- (35.7 vs. 45.9%) and 6-month (35.0 vs. 41.2%) follow-up. Complete case and multiple imputation analyses yielded similar results for abstinence outcomes. A significant reduction in CPD across the 12-month follow-up in the subsample of participants who smoked was observed, but nonsignificant differences between conditions were found. Higher engagement with the SinHumo App was a significant predictor of 12-month abstinence. Satisfaction with the intervention was high and similar in both groups.

Conclusions: High abstinence rates over the 12-month follow-up and satisfaction were found in both conditions. The inclusion of the SinHumo App did not improve abstinence rates in the intervention.

Implications: Scarce research has examined the long-term efficacy of smoking cessation treatments, including Apps, to support the quitting process. The present randomized controlled trial contributes to the existing literature about including information and communication technologies in behavior change interventions. The development of effective smoking cessation apps and information and communication technologies-based interventions is crucial for reducing the prevalence of smoking, as these interventions have the potential to reach a large number of people who smoke and reduce access-related barriers to treatment.