Nicotine & Tobacco Research最新文献

Introduction: Maximizing early treatment response is an important strategy for long-term abstinence, yet little is known about individuals who never achieve any period of abstinence. Improving early treatment response is critical for Black adults who smoke (AWS) who bear a disproportionate share of tobacco-related mortality.

Methods: Secondary data analysis of a randomized clinical trial among Black AWS (N = 392) interested in quitting smoking. Participants received 18 weeks of pharmacotherapy and smoking cessation counseling. This investigation quantified the proportion of participants who never achieved 24-hour abstinence through week 2 (W2). Best subsets logistic regression identified baseline and non-baseline factors contributing to never achieving 24-hour abstinence.

Results: 135 participants (36.2%) did not achieve 24-hour abstinence by W2 despite good adherence with nicotine patch (73.9% had > 80% compliance). Of those, 56.4% and 47.8% still did not achieve 24-hour abstinence at W6 and W12, respectively. Baseline financial strain, higher baseline cotinine and smoking more CPD at W2 increased odds of never achieving 24-hour abstinence while greater cessation self-efficacy and more positive beliefs about study medication at W2 decreased odds of never achieving 24-hours abstinence.

Conclusions: A substantial proportion of individuals who were motivated to quit smoking and received gold-standard treatment (i.e., pharmacotherapy and counseling) never achieved a period of 24 hours of abstinence. Findings highlight financial strain, nicotine dependence, early self-efficacy challenges, and medication experience as targets for improving abstinence among those at high risk for early treatment failure. By characterizing a subset within a larger population at-risk of continued smoking, the study presents opportunities to consider contributors to treatment success.

Implications: Individuals who do not experience success with quitting early in treatment rarely go on to achieve long-term abstinence, yet the majority of interventions fail to address challenges among this high-risk subgroup. Findings suggest a need for interventions that consider the psychological impact of unmet social needs associated with financial strain, address low cessation self-efficacy, and early experiences with smoking cessation pharmacotherapy as approaches for bolstering treatment efficacy. Two possible evidence-based interventions for addressing these factors are discussed.

Introduction: Evidence-based interventions to reduce tobacco-related morbidity and mortality are not widely or effectively implemented, thereby failing to equitably address disparities in tobacco-related health outcomes. Implementation science (IS) has the potential to advance the impact of tobacco control programs, but its use in this field has not been previously explored. To identify opportunities for expanding tobacco intervention impact, this scoping review investigated the use of IS tools in tobacco control research in the United States.

Method: Using Arksey and O'Malley's approach, seven databases were searched to identify tobacco control studies published from 2000 to 2020 that included implementation frameworks, strategies, outcomes, or other relevant tools. Study titles, abstracts, and full texts were screened for eligibility using dual independent review. Data were extracted in duplicate regarding IS tools, intervention goals and characteristics, and health equity considerations. Results were categorized according to the research questions and then analyzed using descriptive statistics.

Results: A total of 58 papers representing 51 studies met inclusion criteria. The most frequently described IS tools were strategies (n = 51) and outcomes (n = 50), followed by models or frameworks (n = 37). Smoking cessation was the most frequent tobacco control goal (n = 45), followed by prevention (n = 10), and reducing secondhand exposure (n = 10). Twenty studies reported interventions with disadvantaged populations, including two in rural settings.

Conclusions: IS tools were unevenly utilized in tobacco control research in the United States reported from 2000 to 2020. Expanded use of implementation frameworks, strategies, and consistent terminology, and prioritizing health equity could reduce disparities associated with tobacco use in the United States.

Implications: This scoping review provides an overview of implementation science contributions during two decades of tobacco control research. We identified limited use of implementation science frameworks and insufficient information about implementation strategies, whereas attention to context and perspectives of key participants were reported more frequently. Greater integration of implementation science tools and attention to health equity in tobacco control research could enhance the effectiveness of tobacco control interventions and reduce health disparities. Clarifying details of intervention components and strategies could improve the ability to replicate studies and lead to significant improvements in tobacco control outcomes and the field of implementation science.

Introduction: This study aims to provide prevalence data on dual-use (one additional product) and poly-use (two or more products) of inhaled nicotine and tobacco products (cigarettes, e-cigarettes and/or heated tobacco products (HTP)) among current waterpipe (WP) users in Germany over recent years, and explores specific person characteristics associated with such co-use.

Methods: A series of cross-sectional, nationwide, representative, face-to-face household surveys in Germany between 2019 and 2023. Samples were selected using multistratified random sampling (50%) combined with quota sampling (50%). The current analysis included 61 713 respondents (aged ≥14 years) of which 1303 reported current WP use.

Results: WP use in Germany fluctuated between 1.5% and 2.8% from 2019 and 2023. The prevalence rate for 2023 was 1.5% (95%CI = 1.2,1.7). Among users, exclusive WP use declined from 41.8% (95%CI = 35.3,48.5) in 2019 to 26.3% (95%CI = 20.2,33.3) in 2023. Over this period, dual-use increased from 49.3% (95%CI = 42.6,56.1) to 62.3% (95%CI = 55.0,69.3), and poly-use rose from 8.9% (95%CI = 5.5,13.4) to 11.2% (95%CI = 7.1,16.7). Multivariable analyses confirmed a significant decline in exclusive WP use over time (OR per year = 0.90, 95%CI = 0.81-0.99), while the increases in dual-use was not statistically robust after adjustment. Among dual users, the majority (94.2%) reported also smoking cigarettes. The likelihood of using at least one additional product alongside WP was positively associated with increasing age, and with low and middle compared with high educational attainment.

Conclusion: Among current WP users in Germany, exclusive WP use has decreased in recent years, with potential commensurate increase in dual- and poly-use.

Implication: These novel data help inform on the consumption behavior of current WP users and highlights the need for targeted public health interventions that address not only exclusive product use but also the rising combination of different products.

Introduction: California's statewide law restricting most flavored tobacco product sales could reduce youth tobacco use if policy-restricted flavored tobacco products were to be fully removed from the marketplace.

Methods: We used NielsenIQ retail scanner data to analyze changes in non-cigarette product availability among tracked brick-and-mortar California retailers from pre- to post-intervention (ie, the law's effective date, 12/21/2022). We assessed availability changes in electronic nicotine delivery systems (ENDS), cigars, smokeless tobacco (SLT), and nicotine pouches by flavor category: explicit (eg, cherry), concept (eg, fusion), or unflavored (eg, labeled as "tobacco" or no flavor label). We employed a synthetic control method to create trends for a synthetic California that did not experience the law and compared these to actual California trends. We compared the ratio of the root mean squared prediction error (RMSPE) in the pre and post-periods between the main and placebo models. A larger value for the main compared to placebo models suggests an effect.

Results: Availability of ENDS, cigars, SLT, and nicotine pouches with explicit flavor names decreased more in California than in synthetic California from pre- to post-intervention; the post/pre RMSPE ratio was highest in California compared to each placebo model; the ratio for unflavored and concept flavor name categories in California was not consistently different from synthetic California.

Conclusions: Availability decreased among non-cigarette tobacco products with explicit flavor names, but hundreds of policy-restricted products remained available for sale during the first six months of California's law, suggesting stronger enforcement and compliance opportunities.

Introduction: Laws prohibiting sales of flavored tobacco are increasingly prevalent across the United States, with eight states and 402 localities that passed such laws between 2010 and 2024. California's statewide law prohibiting sales of flavored tobacco products went into effect on December 21, 2022. It is unknown whether California college students are aware of this law.

Aims and methods: An online survey of California college students (ages 18-24) was conducted from April 4 to August 6, 2024 (n = 3919). Mixed models estimated associations between awareness of the state law and any tobacco product use (including nicotine vapes, cigarettes, cigars, hookah, and nicotine pouches), adjusting for sociodemographic characteristics.

Results: Overall, only 20.8% of students were aware of the state law. Awareness differed by any tobacco use: 16.1% among never, 23.3% among ever (not current), and 24.4% among current. Compared to students who never used tobacco, students who reported ever use were more likely to be aware (aOR = 1.50, 95% CI: 1.19, 1.90), as were those who reported current use (aOR = 1.53, 95% CI: 1.24, 1.87). Among students who reported current use, those who used flavored tobacco were less likely to be aware compared to those who used unflavored tobacco (23.3% vs. 31.6%; aOR = 0.59, 95% CI: 0.42, 0.83).

Conclusions: More than 15 months after California prohibited flavored tobacco sales, only one in five college students was aware of the law. Surprisingly, awareness was lower among students who used flavored tobacco than those who used unflavored tobacco. Students who use unflavored tobacco may have greater awareness as a result of challenges with purchasing flavored tobacco.

Implications: This is the first study to examine awareness of California's law prohibiting sales of flavored tobacco among young adults (ages 18-24). Only 20.8% of California college students were aware of the law. Notably, awareness was lower among students who reported current use of flavored tobacco compared to those who reported current use of unflavored tobacco. Some students may have faced difficulties purchasing flavored tobacco, which raised their awareness of the law. These results suggest the need for public health campaigns and retail signage to improve awareness of the law, particularly among young adults.

Introduction: Polysubstance use-use of more than one substance-is prevalent and an emergent public health issue. Yet not much is known about factors associated with same-day polysubstance use among adolescents. This study examined correlates of same-day tobacco and cannabis use/co-use among adolescents who use tobacco/cannabis.

Methods: Cross-sectional data were from 10th and 11th grade students (n = 536) who reported tobacco/cannabis use. Regression models were used to examine intrapersonal, psychological (anxiety, depression), societal (societal concern, discrimination), and environmental (public and home secondhand smoke/vape exposure) correlates of past 30-day usage frequency (no, infrequent, and frequent use) of same-day: poly-product use (poly-tobacco/nicotine [use of different types of nicotine/tobacco]; poly-cannabis [use of different types of or marijuana/tetrahydrocannabinol (THC)]); poly-drug use [tobacco/nicotine and marijuana/THC], and nicotine and THC vape mixing.

Results: Participants were predominantly Hispanic (66.23%) and male (62.50%). Among participants, 8.58%, reported frequent same-day poly-tobacco use, 13.81% frequent same-day poly-cannabis use, 13.25% frequent same-day poly-drug use, and 3.36% vape mixing. Past 30-day alcohol use was associated with higher odds (1.88-8.31, p<.05) of infrequent and frequent same day use of all study outcomes except vape mixing. Secondhand smoke/vapor exposure was consistently associated with higher odds (1.13-1.26, p < .05) of infrequent/frequent same day use. Discrimination increased the odds of some same-day polysubstance use while societal concerns had inconsistent effects across study outcomes.

Conclusion: A significant proportion of adolescents who use tobacco/cannabis products might engage in high-risk use patterns. Alcohol use, societal, and environmental factors significantly increase the likelihood of same-day poly-use of tobacco and cannabis products.

Implications: Frequent same-day poly-product/drug use is common among adolescents who use tobacco and/or cannabis. Alcohol use, societal concerns, and environmental exposure to secondhand smoke/vape are significant contributors to same-day poly-product/drug use and nicotine and marijuana/THC vape mixing among these adolescents. Findings suggest that while infrequent same-day poly-product/drug use may be more opportunistic and situation-dependent, often occurring in contexts where alcohol is present, frequent use may be more influenced by social contexts and environmental cues. Understanding these complex relationships between substances and high-risk use patterns is crucial for developing effective prevention strategies and treatment approaches for poly-drug use disorders.

Introduction: Historically, cannabis blunts were made using tobacco products like cigars, but tobacco-free blunt wraps (TFBWs) made from sources like hemp and palm leaves are gaining popularity. While marketed for cannabis, it is unknown what substances adolescents put in TFBWs. Here, we focused on using tobacco in TFBWs.

Aims and methods: From April to May 2024, 4760 Connecticut high school students completed school-wide, anonymous, online surveys. The analytic sample comprised 489 adolescents (44.6% male, 28.2% non-Hispanic White, mean age 16.20 [1.27] years) with lifetime cannabis blunt use who answered questions about TFBW awareness and use, including with tobacco. We examined demographic-, tobacco-, and cannabis-related associations with using tobacco in TFBWs.

Results: Of students reporting lifetime cannabis blunt use, 49.7% were aware of TFBWs and 24.7% reported use. Among adolescents using TFBWs, 12.4% reported putting tobacco in TFBWs, and 8.7% reported usually doing so. In bivariate analyses, putting tobacco in TFBWs was associated with using blunts at an earlier age; using other tobacco products; using a greater total number of tobacco products in one's lifetime; and greater dependence on e-cigarettes, cigarettes, and cannabis (p-values <.05).

Conclusions: Few students who use cannabis blunts reported putting tobacco in TFBWs. Yet, using tobacco in TFBWs was associated with negative outcomes like nicotine and cannabis dependence, requiring future investigation. Unlike cigarette rolling papers and tobacco blunt wraps, TFBWs are not regulated by the US Food and Drug Administration as tobacco products. However, surveillance in nationally representative samples may support the need for regulatory action if tobacco use in TFBWs continues.

Implications: Although some brands of TFBWs specifically note that their products are not intended for tobacco use, blunts are user-rolled. Results demonstrate that among adolescents who use cannabis blunts and endorse TFBW use, 12.4% have added tobacco to a TFBW and 8.7% regularly do so. If findings are replicated in future national survey studies of adolescents and adults, this would support the United States Food and Drug Administration in regulating TFBWs as tobacco products.

Introduction: Globally, tobacco use rates in Muslim communities, particularly among men, are significantly higher than in non-Muslim communities. In the United Kingdom, there are also low rates of help-seeking among British Muslims who use tobacco. Ramadan could be a "window of opportunity" to support tobacco use behavior change but we lack the voice of British Muslim communities on culturally tailored cessation support. We undertook a public and patient involvement and engagement (PPIE) project to gain views from representatives of these communities.

Aims and methods: Discussions with 15 PPIE representatives from, or who worked with, a variety of British Muslim communities identified through gatekeepers, social media, and snowballing approaches. Key points and views from PPIE discussions were summarized into broad themes.

Results: Opportunities and challenges with culturally adapting tobacco cessation support to Ramadan were raised. "Light touch" positive religious messaging connected to tobacco cessation was recommended, and overemphasizing religion in messaging content to be avoided. Quitting during Ramadan was felt challenging due to fasting, precluding the use of nicotine replacement products or medication, and reinforcing tobacco use as part of fast-breaking routines. Instead, PPIE representatives suggested quitting in advance of Ramadan or promoting cessation afterward by capitalizing on tobacco reduction achieved during Ramadan. There was support for digital cessation approaches, but it was felt many in their communities would prefer traditional approaches, including interpersonal support and messaging through influential community members.

Conclusions: "Light touch" culturally tailored tobacco cessation support before or after Ramadan was felt more promising than supporting cessation initiation during Ramadan.

Implications: Members of British Muslim communities identified challenges with using Ramadan as a "window of opportunity" for tobacco behavior change and favored quitting ahead of time for Ramadan or capitalizing on tobacco behavior change achieved during Ramadan to promote a quit attempt afterward. Taking a "light touch" approach with religiously tailored messaging could help engage Muslim people who smoke in cessation support. However, avoiding any strong or negatively framed tobacco-related messages linked to religious phrases or imagery is important. This work reinforces the importance of engaging with communities when considering culturally adapting interventions to prevent misdirected adaptions.