Nicotine & Tobacco Research最新文献

Introduction: The UK Government intends to implement a "smokefree generation" policy prohibiting the sale of all tobacco products to people born after 2008. National surveys provide comprehensive data on cigarette smoking, but little is known about patterns of non-cigarette tobacco smoking across key population groups.

Aims and methods: Using data from a nationally representative cross-sectional survey of adults in England, collected monthly between September 2013 and September 2023 (n = 196 721), we estimated time trends in exclusive non-cigarette tobacco (eg, cigar/pipe/shisha) smoking prevalence, overall and by age, gender, occupational social grade, region, ethnicity, and vaping status. Interviews were conducted face-to-face until March 2020 and via telephone thereafter.

Results: From September 2013 to September 2023, there was a non-linear increase in exclusive non-cigarette tobacco smoking prevalence (from 0.36% to 1.68%; prevalence ratio = 4.72 [95% CI = 3.43-6.48]). Prevalence was relatively stable up to February 2020 (at an average of 0.46%), then increased sharply at the start of the COVID-19 pandemic (at the same time as survey methods changed), to 0.90% (0.82%-0.99%) in March 2020. This was followed by a steadier rise, peaking at 1.97% in May 2022, before falling slightly to 1.68% by September 2023. In 2022/2023, 1 in 10 smokers (10.8% [9.64%-12.0%]) exclusively used non-cigarette tobacco. The rise in prevalence was observed across all subgroups but was most pronounced among younger adults (eg, reaching 3.21% of 18-year-olds vs. 1.09% of 65-year-olds). Prevalence was consistently higher among men and current vapers.

Conclusions: Although exclusive use of non-cigarette combustible tobacco remains rare among adults in England, it has increased in recent years, particularly among younger ages. As of September 2023, there were approximately 772 800 adult exclusive non-cigarette tobacco smokers in England; around five times more than a decade earlier.

Implications: The proportion of adults in England who do not use cigarettes at all but smoke other combustible tobacco products has increased substantially in recent years, with a particularly pronounced rise among young people. The inclusion of non-cigarette combustible tobacco products under the proposed "smokefree generation" policy is therefore likely to be important for achieving the greatest reduction in youth uptake of tobacco smoking, as it would ensure young people who are unable to legally buy cigarettes do not buy other combustible tobacco products that are similarly harmful to health.

Introduction: Cigarettes with higher levels of filter ventilation (FV) are misperceived as less harmful and may be more appealing to consumers. Setting limits on FV has been considered as a policy, but a better understanding of any potential unintended consequences is needed.

Methods: FV (0.2%-61.1%) measured for 114 subbrands was merged with Wave 1 (2012-2013) of the Population Assessment of Tobacco Use and Health (PATH) data, restricted to adults 25+ years of age who smoked daily, and examined by quartiles. Inverse probability of exposure weights were used to estimate the causal effect of FV on past 30-day smoking at subsequent waves while accounting for potential confounders including demographics, menthol, heaviness of smoking, and past quit attempts.

Results: Compared to those in the first (lowest) quartile of FV, those in the second, third, and fourth quartiles had 1.02 (95% confidence interval = 0.57, 1.82), 0.86 (0.42, 1.73), and 1.52 (0.90, 2.56) times the odds of no past 30-day smoking at Wave 2 (approximately 1 year later, p = .163), and 1.28 (0.80, 2.07), 1.11 (0.67, 1.83), and 1.65 (1.01, 1.24) times the odds of no past 30-day smoking at Wave 4 (3 years later, p = .238).

Conclusions: This observational study found no strong evidence of a causal effect of FV on past 30-day smoking at approximately 1 and 3 years follow-up. However, our effect size estimates were not precise and thus an increase in the ability to quit smoking due to higher FV levels cannot be ruled out.

Implications: Setting a maximum limit on FV in cigarettes could address the misperception that highly ventilated cigarettes are less harmful and the link between FV and lung adenocarcinoma. It is important to understand whether such a policy would have unintended consequences on longer-term smoking behavior. We found no strong evidence that FV affects past 30-day smoking 1-3 years later, but could not rule out the possibility that higher FV increases cessation rates. If future studies confirm these epidemiologic findings, this could mean that setting a limit on FV would not lead to reductions in the ability to quit smoking.

Introduction: Policies limiting electronic cigarette (ECIG) device and liquid characteristics have been considered to prevent dependence potential and youth product appeal. "Open-system" ECIGs allow people to adjust device and liquid characteristics, which may undermine these policies. This study examined anticipated reactions to a policy prohibiting the sale of open-system ECIG devices in the United States using concept mapping.

Methods: In 2020, adults who reported ECIG use in the past 30 days (n = 70; 45.1% women; mean age = 33.0, SD = 10.6) recruited from a research registry of individuals from across the United States provided statements into a shared list that completed a prompt: "If open-system vaping devices were no longer sold in the US and only closed-system vaping devices were available, what is a specific reaction or response you would have?" at a study website. Participants rated statements (1-7) on how true the statements were for them. Multidimensional scaling and hierarchical cluster analyses were used to identify thematic clusters. Mean ratings of statements were calculated and compared based on the type of ECIG used and current cigarette smoking status.

Results: Participants generated 85 unique statements. The analysis identified eight themes that were organized into two broad groups. The first group of five clusters described behavioral responses to the hypothetical policy (Loopholes, Switch to Closed-System ECIGs, Legal Approaches to Use Open-System ECIGs, ECIG Use Cessation, Switch to non-ECIG Products). The second group of three clusters described psychological responses to the hypothetical policy (Closed-System ECIG Cons, Psychological Responses, Policy Outcome Concerns).

Conclusions: While a ban on open-system ECIG devices may have positive impacts on public health, policy loopholes, and consumer behaviors may undermine the policy. Efforts to support policy enforcement could increase policy effectiveness.

Implications: Open-system electronic cigarettes (ECIGs) that allow people who use ECIGs to modify ECIG device and liquid characteristics may limit the effectiveness of policies that establish product standards which attempt to limit nicotine delivery and flavor content in ECIG liquids. This study identified predicted reactions to a hypothetical policy prohibiting the sale of open-system ECIGs in the United States. Results suggest that people who use ECIGs may view a policy prohibiting open-system ECIGs unfavorably, but would be willing to use closed-system ECIGs. However, many ECIG users may attempt to find loopholes in the policy or alternative sources to purchase open-system ECIGs if open-systems were banned. Future research should identify strategies for tobacco regulatory policy enforcement to increase effectiveness.

Introduction: There is substantial evidence that mass media campaigns increase calls to quitlines as well as smoking cessation. In 2012, the Centers for Disease Control and Prevention launched the first federally funded national tobacco education campaign, Tips From Former Smokers® (ie, Tips). From 2012 through 2023, Tips aired advertisements on television. To date, no studies have examined the long-term effect of a national smoking cessation campaign on quitline calls. This study examined the long-term impact of Tips television ads on calls to 1-800-QUIT-NOW from 2012 through 2023.

Methods: Exposure to the Tips campaign was measured using weekly gross rating points (GRPs) for television ads in each U.S. designated market area. We obtained data on calls to 1-800-QUIT-NOW from the National Cancer Institute and used linear regression to model calls to 1-800-QUIT-NOW, from 2012 through 2023, as a function of weekly media market-level GRPs for Tips television ads. Using the regression model results, we calculated predicted values of calls to 1-800-QUIT-NOW across observed GRP values to determine the total calls to 1-800-QUIT-NOW that were attributable to the Tips campaign during 2012-2023.

Results: Tips GRPs were positively and significantly associated with calls to 1-800-QUIT-NOW across all years (b = 39.94, p < .001). Based on this association, we estimate the Tips campaign generated nearly 2.1 million additional calls to 1-800-QUIT-NOW during 2012-2023.

Conclusions: Exposure to the Tips campaign has consistently and significantly increased calls to tobacco quitlines.

Implications: Quitlines provide evidence-based support to help people quit smoking. They have been shown to increase the likelihood of successfully quitting. Mass media campaigns have promoted quitlines, and quitline calls have increased significantly with media promotion. The long-term effect of campaigns-like the Centers for Disease Control and Prevention's Tips From Former Smokers® (ie, Tips)-on quitline calls has not been determined. From 2012 through 2023, exposure to the Tips campaign is estimated to have generated nearly 2.1 million additional calls to 1-800-QUIT-NOW. This study supports the continued use of mass media to promote quitlines.

Introduction: Noncombusted tobacco products, particularly those authorized as modified-risk tobacco products, may appeal to young adults. This cross-sectional study explored young adults' attention to reduced exposure claims in IQOS advertising and its associations with product perceptions and use intentions.

Aims and methods: Fifty-one young adults aged 21-29 (mean age = 24.5 years old, 54.9% who smoked cigarettes, 47.1% male, 66.7% White) viewed an IQOS advertisement containing two reduced exposure claims (one large, one detailed) for 20 seconds during eye-tracking, then completed postexposure questionnaires (risk beliefs, harm perceptions, attitudes, and use intentions). We compared attention and questionnaire measures by smoking status and examined associations between attention to reduced exposure claims and questionnaire measures.

Results: Overall, the large (vs. detailed) reduced exposure claim attracted young adults' attention more quickly, but the detailed claim held attention longer than all other advertisement features (p's < .001). There were no differences by smoking status in how quickly either claim attracted or held initial attention, but young adults who smoked (vs. did not smoke) spent more cumulative time looking at the large claim and less time looking at the detailed claim (p's < .05). Among those who smoked, greater dwell time on the detailed reduced exposure claim was associated with more beliefs about reduced harm, lower perceived risk of addiction, and greater intentions to try IQOS (p's < .05).

Conclusions: Detailed information on reduced exposure in IQOS advertising may convey reduced risk and potentially promote uptake of IQOS among young adults who smoke and attend to this content.

Implications: Findings from this exploratory, single-exposure study demonstrate differences in young adults' attention to reduced exposure claims in an IQOS advertisement based on their smoking status. Among those who smoke, greater attention to detailed reduced exposure information was associated with reduced perceptions of harm compared to cigarettes, and greater intentions to try IQOS. Findings suggest that among young adults who smoke cigarettes and visually engage with this content, detailed text containing IQOS' authorized reduced exposure claims is interpreted as reduced risk information and may promote uptake of this product.

Introduction: A national nicotine reduction policy could reduce the public health toll of smoking. However, reducing nicotine in cigarettes may lead to changes in the use of other tobacco products such as nicotine vaping devices, particularly among young people. Product use outcomes may depend on the characteristics of available nicotine vaping devices. We aimed to determine the impact of cigarette nicotine content, vaping device nicotine concentration, and vaping device flavors on choices to smoke, vape, or abstain.

Aims and methods: Early young adults (ages 18-20 inclusive, N = 80) who reported smoking daily and vaping nicotine at least twice in their lifetime participated in a laboratory study. Participants received either very low nicotine content (VLNC; 0.4 mg nicotine/g of tobacco) or normal nicotine content (NNC; 15.8 mg/g) cigarettes. First, participants chose between their assigned cigarette or abstaining. Subsequently, participants chose between 2 cigarette puffs, 2 vape puffs, or abstaining. Vaping device nicotine concentration (3 mg vs. 18 mg/mL) and flavor (tobacco vs. non-tobacco) were manipulated within subjects.

Results: When only cigarettes were available, there were no differences between the VLNC and NNC groups on cigarette choices. When the nicotine vaping device was concurrently available, the VLNC group made fewer choices to smoke than the NNC group. Non-tobacco flavors and lower vaping device nicotine concentration were associated with fewer choices to smoke.

Conclusions: Nicotine vaping device availability reduced choices to smoke VLNC cigarettes, and vaping devices with lower nicotine and non-tobacco flavors led to the fewest choices to smoke. Regulators should consider that the availability and characteristics of alternative tobacco products can moderate the product standard's impact.

Implications: The U.S. Food and Drug Administration may enact a reduced nicotine product standard that would affect all commercially available cigarettes. One important population affected by this policy would be early young adults who smoke. We aimed to determine the impact of cigarette nicotine content, vaping device nicotine concentration, and vaping device flavors on choices to smoke, vape, or abstain. Lower nicotine in cigarettes, along with non-tobacco flavors and lower nicotine concentration in the vaping device, were associated with the fewest choices to smoke. Regulators should consider that the availability and characteristics of alternative tobacco products can moderate the product standard's impact.

Introduction: This study examined the association between the current co-use of cannabis and cigarettes in the past 30 days and subsequent cigarette discontinuation (past 30-day point-prevalence abstinence) among U.S. adults with established cigarette use in the Population Assessment of Tobacco and Health (PATH) Study. Additionally, we investigated the impact of co-use on the subsequent discontinuation of all combustible tobacco products.

Aims and methods: A total of 26 381 observations contributed by 8218 adults with established cigarette use (ie, smoked ≥100 cigarettes in their lifetime, and currently smoking cigarettes every day or some days) from waves 1-5 of the PATH Study were included in the analysis. Weighted generalized estimating equations (GEE) models were used to evaluate the association between current co-use at baseline (waves 1-4) with the outcomes assessed at the subsequent wave (cigarette and combustible tobacco discontinuation at waves 2-5). Final models included: Demographic characteristics (age, sex, race and ethnicity, and educational attainment), behavior characteristics (intention to quit, internalizing symptoms, externalizing symptoms, and substance use problems), and wave-pair.

Results: Over one-third (35.91%) of the adults currently smoking cigarettes self-reported co-use during the study period. Cannabis use among adults with established cigarette use increased over time. Co-use was associated with decreased odds of cigarette smoking discontinuation at follow-up, after adjusting for covariates (aOR: 0.81; 95% CI: 0.72, 0.93; p = .0018). Similar effect sizes were observed for the discontinuation of all combustible tobacco products (aOR: 0.75; 95% CI: 0.65, 0.86; p < .0001).

Conclusions: Cannabis use among adults with established cigarette use was inversely related to subsequent cigarette discontinuation, suggesting that co-use may reduce the likelihood of successful tobacco cessation.

Implications: Findings demonstrate that cannabis use may lead to lower odds of discontinuation among adults with established cigarette use; therefore, individuals who co-use cigarettes and cannabis may need additional tobacco cessation support. Notably, this study observed an increase in the co-use of cigarettes and cannabis, emphasizing the need for researchers and public health programs to shift their focus toward understanding and addressing concurrent substance use among adults who smoke cigarettes.

Introduction: Smoking is a collective and complex problem in the Palestinian-Arab community in Israel, where women and children are particularly vulnerable to exposure to secondhand smoke (SHS), especially in the home.

Aims and methods: We undertook this study to better understand women's experiences with SHS exposure in the home and to identify pathways for intervention. Using the grounded theory approach, seven focus groups were conducted with 66 women in different localities across Israel. Purposive and snowball sampling techniques were applied to recruit women who have currently or previously been exposed to smoking in the home. Focus groups were audio-recorded and transcribed verbatim, and data were then coded and analyzed using the constant comparison analysis method to identify emergent themes and subthemes.

Results: Three core themes emerged from the discussions. These include women's perceptions of smoking among men and exposure to SHS in the home, the implications of smoking on spousal and social relationships, and the women's experiences in coping with this situation and their suggestions for interventions. We identified additional sub-themes, including the consequences to women's and children's health, as well as the complex interaction between smoking in the home and women's social position, agency, and home ownership.

Conclusions: Women exposed to SHS in the home experience consequences that affect their health and their spousal and social relationships. They also face several personal and societal challenges in tackling this issue. Culturally tailored interventions targeting both communities and households can raise awareness and impact smoking behaviors in the home.

Implications: The findings of this study demonstrate the far-reaching consequences of SHS exposure in the home among women who are exposed. The findings contribute to our understanding of smoking contingencies among men and smoking behaviors in the home. This study lays the groundwork for future community and household-based research and interventions. We suggest several critical junctures that may increase response to smoking cessation interventions and to reduce smoking in the home, such as at the time of marriage when the home policy is set, and the adverse effects of exposure on children and other family members, especially those with illness.

Introduction: Despite the benefits of quitting smoking for those who have cancer, including improved health outcomes and reduced therapeutic toxicities, it is unclear how many people are supported in quit attempts during this time. Variations in the availability and provision of smoking cessation (SC) services are reported, with little understanding of the challenges and solutions. This codesigned study aimed to understand the perspectives of health care professionals (HCPs) working in oncology settings to engage in SC practices and identify recommendations for developing a SC pathway.

Aims and methods: This was a qualitative study. Eighteen HCPs participated in semi-structured interviews from July 2021 to May 2022. We used thematic analysis approaches to code data and present four themes and SC strategies at micro, meso, and organizational levels.

Results: Four themes are reported specifically: (1) timing and knowledge, (2) building a relationship, (3) frequent asking with infrequent action, and (4) removing the barriers and tailoring the system. While HCPs discuss SC, there are variations in documentation and when conversations occur. Primarily, HCPs value the time to build therapeutic relationships with patients and thus may limit SC discussions in preference to treatment in clinical interactions. The role of structural barriers, including prescriptive authority for nurses, hinders active SC processes, as it is the lack of continuity and embedding of services supported by a clinical champion for SC.

Conclusions: The study suggests reevaluating the status quo in SC service, highlighting service gaps, and suggesting opportunities at organizational levels to reduce structural barriers.

Implications: Variations in SC services exist in designated cancer centers. The data from this study can be used to inform a real-time health systems approach for SC services in oncology settings. Developing tailored SC services and interventions that are patient-centered and informed by their experiences is required. The data in this study suggest developing specialist education and training to upskill HCPs for equitable engagement if we are to meet EU and Cancer Moonshot goals for cancer reduction.