Nicotine & Tobacco Research最新文献

Introduction: We conducted a pilot study to test the feasibility of a future randomized controlled trial comparing e-cigarettes to traditional pharmacotherapy among people who smoke daily, were motivated to quit, and failed to quit within the past 5 years using pharmacotherapy.

Aims and methods: Eligible participants were assigned to either: (1) an e-cigarette (n = 20) or (2) combination nicotine replacement therapy (NRT; patches and lozenges; n = 10). Participants received 5 weeks of product and selected a quit date 1 week later. Assessments were completed weekly, and electronic diaries were completed each day. As a pilot randomized controlled trial, outcomes focus on effect sizes and not statistical significance.

Results: Participants in the e-cigarette and NRT groups had a mean age of 51 (SD = 13) and 50 (SD = 10) years old, were 55% and 60% female, and were 15% and 0% nonWhite, respectively. At least 90% of participants completed each weekly assessment and 77% of participants completed at least 80% of daily diaries. Mean cigarettes smoked per day reduced from 18 (SD = 6.2) to 2.4 (SD = 4.4) per day in the e-cigarette group and 16.5 (SD = 8.5) to 4.9 (SD = 5.9) per day in the NRT group. Rates of biochemically confirmed 7-day point-prevalence abstinence at the end of treatment were numerically, but not statistically, higher in the e-cigarette group than the NRT group (35% vs. 10%, OR = 4.8, 95% CI = 0.5 to 46.5).

Conclusions: Among current daily cigarette smokers who have previously tried to quit and failed with standard pharmacotherapies, the provision of an e-cigarette is a feasible intervention. A larger adequately powered trial is warranted.

Implications: This pilot study suggests that e-cigarettes may serve as an acceptable harm reduction intervention for people who smoke but cannot quit smoking with traditional pharmacotherapy, however, adequately powered randomized controlled trials are needed.

Background: E-cigarette use behaviors and device and liquid characteristics have addiction, cessation, and health implications. E-cigarettes may exacerbate or reduce existing tobacco and nicotine product disparities by sexual and gender identity. We examine e-cigarette device and liquid characteristics and tobacco and nicotine product use by sexual and gender identity.

Methods: Data are from the VAPER study (wave 5: Feb-Apr 2023), an online cohort of U.S. adults (≥21 years) using e-cigarettes ≥5 days per week. Participants (n=1186) reported on tobacco and nicotine product use and submitted photos of their most used e-cigarette device and liquid. Rao-Scott Chi-square tests with Bonferroni corrections were used to cross-sectionally assess differences in tobacco and nicotine product use behaviors and e-cigarette device and liquid characteristics by sexual and gender identity.

Results: A greater percentage of bisexual women vs. heterosexual and gay men used disposable devices (54% vs. 31% and 19%) and nicotine concentrations ≥20 mg/mL (77% vs 59% and 34%). A higher proportion of heterosexual women than men used disposable devices (42% vs 31%). A greater percentage of bisexual (20%) than heterosexual (9%) women never smoked cigarettes (p<0.05). A higher proportion of heterosexual (9.4%) and bisexual (16.4%) men vs. heterosexual women (3%) used nicotine pouches (p<0.05).

Conclusions: E-cigarette characteristics, which have implications for addiction, health, and cessation, and tobacco and nicotine product use behaviors vary by sexual and gender identity. Targeted interventions may be needed to alleviate and prevent health disparities. Agencies must consider potential variation in regulatory impacts by sexual and gender identity.

Implications: This study of adults frequently using e-cigarettes highlights differences in e-cigarette device and liquid characteristics and tobacco and nicotine product use by sexual and gender identity. For example, a greater percentage of bisexual and heterosexual women than heterosexual men used disposable e-cigarette devices. Given the variation in how e-cigarettes and other tobacco and nicotine products are used, researchers and regulators must consider how health outcomes, cessation behaviors, and responses to interventions or regulatory actions associated with e-cigarette use may vary by sexual and gender identity.  .

Introduction: Some populations are under-represented in smoking treatment research. Electronic health record (EHR)-enabled referral of patients who smoke may enhance representativeness of clinical trial samples. This study assessed the representativeness of smoking treatment trial electronic referral (e-referral), exclusion, enrollment, and engagement in primary care.

Methods: Eighteen adult primary care clinics in 2 healthcare systems offered patients who smoked e-referral to smoking reduction or cessation treatment trials. Extracted EHR data were analyzed to compare rates of e-referral and enrollment across patient groups defined by sex, age, race, ethnicity, and insurance status. Trial eligibility screening data were analyzed to identify differential exclusion of patient groups by sex, race, or neighborhood disadvantage.

Results: Overall, 23.3% of eligible patients were e-referred, with elevated e-referral rates among women, African American, Medicaid-eligible, and middle-aged patients. Among e-referred patients, 20.5% were excluded at trial eligibility screening, with exclusions elevated for women, minoritized individuals, and individuals from disadvantaged neighborhoods. Overall, 7.0% of patients who smoked enrolled in a smoking treatment trial, with enrollment rates elevated among women, those over age 44, and, in one health system, African American patients. Most enrollees (>87%) initiated counseling and enrollees completed 52.4%-79.9% of counseling sessions, with older, college-educated, and lower-income enrollees attending more sessions.

Conclusions: Proactive e-referral in primary care may improve representation of certain groups (e.g., African American and Medicaid-eligible patients) in smoking treatment trials, but differential exclusion at eligibility screening may reduce sample representativeness. Relaxing non-essential eligibility criteria may enhance inclusion of minoritized and disadvantaged populations in smoking treatment research.

Implications: Electronic referral of adult primary care patients who smoke to smoking cessation and reduction trials may enhance referral of high-priority populations (e.g., African American patients and those eligible for Medicaid) to tobacco treatment trials. Relaxing treatment trial inclusion criteria may enhance representation of minoritized and disadvantaged patients in treatment trials.

Introduction: The smoking pattern of Latino smokers differs from non-Latino white smokers such that physical dependence may not be a strong motivator for smoking among Latinos. Multidimensional measures of dependence may be more useful, but there is a lack of psychometrically sound multidimensional Spanish-language measures. This study evaluated the psychometric properties of a Spanish-language adaptation of the Brief Wisconsin Inventory of Dependence Motives (Brief WISDM) for use among Spanish-speaking Latino smokers in the U.S.

Methods: 287 Spanish-speaking Mexican-origin smokers in the U.S. responded to a revised set of Spanish Brief WISDM items. Confirmatory factor analyses and model trimming procedures were conducted with 144 participants randomly selected from the sample. The resulting scale was replicated with the remaining 143 participants. Tests of concurrent validity examined each subscale's ability to statistically predict relevant smoking patterns.

Results: Model trimming resulted in a 19-item, six-factor scale with acceptable fit (χ2=227.03 p<.0001; RMSEA=.07, CFI=.93, TLI=0.92, SRMR=0.05). The final model retained factors Automaticity, Craving, Social/Environmental Goads, Taste, and Weight Control. Items from Affective Enhancement and Cognitive Enhancement were combined to form one factor. Concurrent validity was largely supported in both samples.

Conclusions: This study helps address the need for a valid and reliable multidimensional Spanish language measure of commercial tobacco dependence.

Implications: A valid measure of dependence allows for the conduct of research that could lead to novel, culturally relevant knowledge of the processes involved in smoking initiation, maintenance, cessation and relapse among an understudied population.

Introduction: Incorporating sexual identity fluidity and stability into the understanding of tobacco use patterns by sexual minority populations is particularly important, but less is known about how changes and stability in sexual identity relate to e-cigarette initiation.

Methods: Using three waves of the United States (US) Population Assessment of Tobacco Health (PATH) Study (Waves 4-6 [2016-2021]), we examined the association of sexual identity change and stability with e-cigarette initiation among adults who never vaped at Wave 4 (N=11,554). Changes in sexual identity were defined based on identity at Waves 4-6: (1) Consistently heterosexual; (2) Consistently Lesbian, Gay, Bisexual, or something else (LGB+); (3) Heterosexual at Wave 4 and LGB+ at Wave 6; (4) All other identity changes. The outcome was ever e-cigarette use at Wave 6.

Results: Among adults who never vaped at Wave 4, N=1,022 (4.0%, weighted) initiated e-cigarettes by Wave 6. Overall, N=10,166 (93.1%) reported consistently heterosexual identities, N=513 (2.7%) consistently LGB+, N=316 (1.8%) reported heterosexual identity at Wave 4 and LGB+ identity at Wave 6, and N=298 (2.4%) reported all other identities. Among adults who never used e-cigarettes at Wave 4, those who reported heterosexual at Wave 4 and LGB+ identity at Wave 6 (vs. those who reported consistently heterosexual identity) were more likely to report e-cigarette initiation at Wave 6 (aOR=1.78, 95% CI=1.05, 3.01), after adjusting for covariates.

Conclusions: This study found an increased risk of e-cigarette use initiation and continued use among US adults who changed their self-reported sexual identity from heterosexual identity to LGB+ identity.

Implications: This study found an increased risk of e-cigarette use initiation and continued use among US adults who changed their self-reported sexual identity from heterosexual identity to LGB+ identity. Findings may inform the development of tailored interventions and clinical practices, capitalizing on the coming out phase as a teaching moment to communicate the potentially harmful effects of e-cigarette use among sexual minority individuals.

Introduction: As many as 40% of adults who smoke (AWS) use cannabis, yet little is known about how cigarette-cannabis (CIG-CAN) use impacts change in cigarette and other tobacco product (OTP) use during a quit attempt.

Methods: Secondary data analysis of a smoking cessation randomized clinical trial (RCT) that enrolled 392 Black adults who wanted to quit cigarettes and were provided 18 weeks of standard or adapted pharmacotherapy. Participants self-reported cigarettes, cannabis, and OTP at W0,2,6,12,18, and 26. Longitudinal modeling of group, time, and group by time effects compared change in cigarettes, cannabis, and OTP between those who did and did not use cannabis.

Results: Nearly half (47.2%,185/392) were CIG-CAN users. Cannabis types were joints (78.4%) and blunts (51.9%). Significant reduction in CPD over time (p=0.02) did not differ by group (p=0.18). OTP had significant group, group by time interaction and time effect (p<0.001), however, OTP use is small and had minimal effect on consumption. CIG-CAN increased cannabis use through week 26 (p<0.001). When CPD decreased, there was a compensatory effect on OTP (<.0001), but not cannabis (p=0.37).

Conclusion: Prevalence of cannabis use was high among Black adults attempting to quit cigarette smoking in an RCT. OTP use was minimal, but CIG-CAN maintained higher OTP and increased consumption of cannabis while having similar reductions in CPD. Findings require replication in a prospectively designed study but suggest a pattern of compensation, primarily with cannabis, among CIG-CAN that may limit potential health benefit of cigarette reduction and could compromise future attempts at cessation.

Implications: This study's findings suggest a large percentage of cannabis use (47%) and within those users an increase of other tobacco products. At the same time, participants reduced cigarettes per day in both those who did and did not use cannabis. These findings reinforce the need for targeted treatment of all combustible products. Clinical practice guidelines and empirically informed interventions to address CIG-CAN co-use are absent in the field and urgently needed. In addition, better assessment of CIG-CAN in clinical studies is needed to aid in understanding the health impact of co-use.

Introduction: Given the rapidly changing media landscape and popularity of e-cigarettes among young adults who identify as lesbian or gay, bisexual, questioning, or something else (LGB+), timely data on media consumption and exposure to e-cigarette content across media channels is imperative for developing counter-messaging and public education campaigns for these individuals.

Methods: Using 2023 data from young adults in California, this study examined how social media use differed for heterosexual and LGB+ young adults, by sex. Exposure to e-cigarette content across media channels was also compared between heterosexual and LGB+ young adults, by sex.

Results: Findings from a non-probability representative sample of young adults in California showed that more LGB+ young adults reported using Tumblr and fewer reported using Facebook and Snapchat, compared with heterosexual young adults, among both males and females. Use of Reddit was more common among LGB+ versus heterosexual females, but there were no differences by sexual identity among males. Exposure to e-cigarette marketing was more common among LGB+ females compared with heterosexual females, but this was not the case for males. Exposure to user-generated e-cigarette content, and self-reported visits to e-cigarette websites, were more common among LGB+ females compared to heterosexual females.

Conclusions: These findings highlight the importance of treating LGB+ individuals as a heterogeneous group. As such, anti-tobacco campaigns targeting LGB+ individuals that leverage social media will want to consider which platforms are most used among their target audience to increase campaign reach.

Implications: This study builds upon the literature by providing timely data on how LGB+ young adults consume social media and are exposed to e-cigarette marketing. Findings have implications for tobacco education campaigns designed for LGB+ individuals that leverage social media.

Introduction: Brands can be "tagged" in Instagram posts to communicate a partnership with a social media influencer. Little is known about the content of these communications in the tobacco-related literature. To address this gap, this study identified tagged posts on the official Instagram pages of tobacco brands and described the themes of such posts.

Methods: Six tobacco brands with official Instagram pages were identified. Each tagged section of the brand's official Instagram page was examined to identify potential partnerships with social media influencers. Posts to the tagged section of the Instagram page were collected from November 2022 to February 2024. For each post, tobacco-related themes were coded.

Results: This study identified 594 tagged posts from 222 potential social media influencers. The most common theme among tagged posts was product presence (n=430, 72.4%), followed by branding (n=421, 70.9%). Young adults were identified in 40.4% (n=240) of posts. Among users who tagged a brand account, 96.1% (n=571) of their account profiles contained URL links to commercial websites, suggesting social media influencer status.

Conclusions: This study showed that the tagged section of tobacco brands' Instagram pages contained posts suggestive of paid partnerships between the brand and social media influencers. These posts often featured tobacco use and young adults. Future research should examine whether the presence of (or accessibility to) URL links to commercial websites appearing on influencers' pages increases an Instagram user's purchase intentions and tobacco use initiation.

Implications: This study showed that the "tagged" sections of the official Instagram pages of six tobacco brands featured tobacco use, contained links to commercial websites, avoided content about addiction, and revealed that social media influencers inconsistently disclosed financial relationships with tobacco brands. In addition to enforcing and bolstering online marketing restrictions, prevention programs and interventions may focus on tobacco-related digital media literacy to help inoculate young adults against the pro-tobacco online environment.

Introduction: Substance Use Disorder (SUD) increased by 45% globally in the past 10 years, representing one of the largest increases in risk factors for disease. Financial incentives (FI) are a promising tool to promote health behavior change, including substance abstinence. We aim to address a 10-year gap in the evidence and identify key characteristics for optimal treatment.

Methods: A meta-analysis of randomized controlled trials (RCTs) was undertaken per Cochrane guidelines and the PRISMA 2020 checklist. Medline, PsycINFO, and EMBASE were searched up to 11th September 2024. Included studies offered FI to substance users in exchange for substance abstinence compared to an alternative intervention control. The primary outcome extracted was substance abstinence at latest follow-up. Secondary outcomes such as cost-effectiveness, adverse events, and motivational assessments were also extracted. Risk of bias was analyzed using the RoB 1 tool.

Results: Of 5,042 studies identified, 246 were shortlisted for full-text review and included 39 RCTs (N = 27,845) for meta-analysis. SUD categories spanning nicotine (n = 30, OR = 1.83; 95%CI = 1.65-2.03, p < .001), alcohol (n = 3, OR = 4.69, 95%CI = 1.59-13.86, p = .005), stimulants (n = 2, OR = 3.52; 95%CI = 0.36-34.18, p = 0.28), and polydrug (n = 2, OR = 3.11, 95%CI = 0.53-18.25, p = 0.21) were meta-analyzed for improving abstinence rates. Cannabis and opioid sub-groups could not be meta-analyzed. Overall effectiveness was significant for FI improving substance abstinence rates (OR=1.93, 95%CI=1.66-2.24, p<.001) with continued significance through 12-month or longer follow-ups (OR=1.78; 95%CI=1.50-2.12, p<.001).

Conclusions: Findings from this meta-analysis suggest that FI are an effective tool for increasing substance abstinence, particularly nicotine and alcohol, however, future research is recommended for other substances such as stimulants and opioids.

Implications: This systematic review and meta-analysis exploring the use of financial incentives for substance use disorders provides the first update on trends in this field since 2014 and the first meta-analysis since 2006. Notably, this review challenges the concerns of sustainability and effects on motivation which have withheld the clinical application of financial incentives for substance use disorders.