Nicotine & Tobacco Research最新文献

Introduction: Antenatal clinical guidelines recommend antenatal care providers routinely assess the smoking status of all pregnant women at the first antenatal visit and, for women who are current smokers, provide cessation support at the first and all subsequent visits. This study aimed to assess women's receipt of comprehensive guideline-recommended care for smoking during pregnancy and the maternal and service characteristics associated with such care.

Aims and methods: A telephone survey was conducted with women who were recently pregnant and received antenatal care from public maternity services in one Australian local health district.

Results: Of the 514 participants, 9% were smokers when they found out they were pregnant. Of these, 47% continued smoking until giving birth. Almost all participants (96%) were asked about their smoking status at their first antenatal visit. Among pregnant smokers, 76% were asked about their smoking at subsequent visits, 73% were advised to quit, 62% were provided with information or advice to assist in quitting, 24% were offered nicotine replacement therapy, and 38% were offered a referral to Quitline. A third of maternal smokers reported receiving all elements of guideline-recommended care. No associations were found between maternal and service characteristics and receipt of care for smoking.

Conclusions: Guideline recommended routine assessment and care for smoking in pregnancy may be less than optimal, particularly for smoking cessation interventions with strong evidence of effectiveness-NRT and quitlines. Identification of barriers and implementation of strategies to increase the offer and uptake of these services by women is required.

Implications: This study is the first to examine pregnant women's reported receipt of comprehensive guideline-recommended care for maternal smoking. The findings indicate that a significant proportion of pregnant women attending public maternity services are not receiving comprehensive care and that many are not being offered evidence-based interventions to assist them to quit. Barriers to comprehensive care delivery need to be identified and addressed if the potential for smoking interventions delivered in this setting to impact smoking rates in pregnancy is to be realized.

Introduction: Tobacco retailer density and distance to tobacco retailers are understood to influence tobacco-related behaviors; however, there is no general agreement on how to best characterize or measure the tobacco retail environment (TRE). In this data-driven analysis, we examine similarities among neighborhood-level measures of the TRE and assess how the geographic resolution of the neighborhood units may affect them.

Aims and methods: We used locations of likely tobacco retailers in the United States to calculate multiple retailer count, density, and distance measures. Measures were calculated at the Census block group, tract, and county (including county equivalents) levels of geographic aggregation. Spearman's correlation was used to evaluate the similarity among the TRE measures.

Results: At the block group and tract level, correlation among all TRE measures ranged from slightly negative (ρ = -0.03) to nearly perfect (ρ = 0.99). At both levels of aggregation, distance-based TRE measures were highly correlated (ρ > 0.76). At the block group level, the simple count of retailers was highly correlated with the density measures (ρ > 0.83), and at the tract level, simple count was moderately to highly correlated with the density measures (ρ > 0.5). Findings were generally similar at the county level; a notable deviation was that retailers per person were negatively correlated with all other TRE measures (range from ρ = -0.08 to ρ = -0.32).

Conclusions: Some common measures were not correlated, suggesting they capture different aspects of the TRE; similarity among the various measures also varied by level of geographic aggregation.

Implications: Because the TRE shapes people's tobacco-related behaviors, using appropriate measures to characterize it at a neighborhood level is paramount. Our work highlights both the similarities and differences among a set of common measures, thereby suggesting the measures may be capturing different aspects of the overall retail environment. Our findings regarding geographic level of aggregation underscore the importance of neighborhood definition in any TRE analysis.

Introduction: Minimizing electronic cigarette (e-cigarette) uptake and encouraging vaping cessation have become important components of public health agendas. Given the success of well-designed anti-smoking campaigns, attention has turned to developing health communications that target vaping. Although prior work has identified a range of potentially effective campaign messages, several gaps in the literature remain. We aimed to (1) identify message themes perceived to be effective at minimizing e-cigarette use and (2) elicit opinions on how these message themes could be optimized in terms of message execution and delivery.

Aims and methods: Focus groups (FG; n = 16) were conducted with adolescents (14- to 15- and 16- to 17-year-olds), young adults (18- to 24-year-olds), and adults (25- to 39-year-olds). The groups reported on message themes they believed would assist with minimizing e-cigarette use. They then provided feedback on 14 message themes developed by the research team. Data were analyzed using reflexive thematic analysis.

Results: Groups discussed a range of message themes they believed would be effective. These included themes focused on the health harms associated with vaping, the chemical ingredients in e-cigarettes, use dependence, and social attitudes to use. Groups discussed the importance of using evidence-based personal testimonies and reported that messages would be most effectively communicated via social media, in public places, and at point of sale.

Conclusions: Results build on existing research by identifying message themes perceived to be most effective, and how these could best be executed. Results have the potential to inform the development of co-designed health communication campaigns addressing youth vaping.

Implications: Using a stratified FG methodology, we collected rich and detailed qualitative data on Australians' perceptions of anti-vaping message themes. The themes considered most effective were those that addressed the health harms of vaping, the chemical ingredients in e-cigarettes, the social consequences of use, and the impacts of dependence. We recommend further work to develop and trial a range of specific anti-vaping messages based on the themes identified as having the most potential. This process should include iterative co-design with the target audience to optimize future health communication campaigns.

Introduction: This review investigates the impacts of banning the sale of menthol cigarettes at stores.

Methods: A systematic search of studies published in English up to November 2022 was conducted. The following databases were searched: PubMed/Medline, CINAHL, PsycINFO, Web of Science, and Embase, as well as a non-indexed journal. Studies evaluating either the impact of real-world or hypothesized menthol cigarette bans were included. Primary outcomes include tobacco use behaviors. Secondary outcomes include cigarette sales, retailer compliance, and the tobacco industry's response to a menthol ban. Data on tobacco use behavior after a menthol ban were pooled using random-effects models. Two pairs of reviewers independently extracted data and assessed study quality.

Results: Of the 964 articles that were identified during the initial search, 78 were included in the review and 16 were included in the meta-analysis. Cessation rates among menthol cigarette smokers were high after a menthol ban. Pooled results show that 24% (95% confidence interval [95% CI]: 20%, 28%) of menthol cigarette smokers quit smoking after a menthol ban, 50% (95% CI: 31%, 68%) switched to non-menthol cigarettes, 12% (95% CI: 3%, 20%) switched to other flavored tobacco products, and 24% (95% CI: 17%, 31%) continued smoking menthol cigarettes. Hypothesized quitting and switching rates were fairly close to real-world rates. Studies found the tobacco industry attempts to undermine menthol bans. National menthol bans appear more effective than local or state menthol bans.

Conclusions: Menthol cigarette bans promote smoking cessation suggesting their potential to improve public health.

Implications: Findings from this review suggest that menthol cigarette bans promote smoking cessation among menthol cigarette smokers and have the potential to improve public health.

Introduction: Data on e-cigarette (EC) and heated tobacco product (HTP) use and the reasons for their use are useful for policy making. We report comparable nationally representative estimates of EC and HTP use and their associated factors.

Aims and methods: Global Adult Tobacco Survey data from Indonesia (2021), Kazakhstan (2019), and the Philippines (2021) were analyzed. The weighted prevalence rates and 95% CI of EC and HTP awareness, current use, and ever use, and their distribution by cigarette smoking status were calculated. Binary logistic regression analyses assessed socioeconomic, and tobacco control factors associated with EC and HTP use.

Results: The prevalence (%) of EC awareness, ever use and current use were 48.7-69.4, 3.6-8.8, and 1.9-3.0, respectively. The prevalence(%) of HTP awareness, ever use and current use were 2.7-21.7, 0.2-2.1, and 0.1-1.2, respectively. The main reasons for EC and HTP use were attractive flavors(45.8%-73.9%), less harmful than smoking(23.0%-70.1%), and enjoyment(40.8%-76.7%). Avoiding going back to smoking(0.9%-54.4%) and quitting smoking(19.4%-49.8%) were less frequently cited reasons (except in the Philippines). EC/HTP use was associated with younger age, higher education and wealth, current/past smoking, exposure to information about the dangers of tobacco use, and advertisements about tobacco products and smoke-free rules at home.

Conclusions: The prevalence of EC and HTP use was higher among younger men with higher education and wealth, and current/past smoking. EC and HTP use should be closely monitored. Regulations to restrict the widespread marketing and sales of EC and HTP are needed to prevent the escalation of their use.

Implications: The population-level data provide the benchmark for future monitoring use of e-cigarettes and HTPs and identify population subgroups for future surveillance in low- and middle-income countries. The association of EC/HTP use with tobacco control-related factors provides leads for policies that should be formulated and implemented to regulate the product contents, marketing, and sales of EC and HTP.

Introduction: Half of adult cigar users report flavored cigars as their usual brand. The Food and Drug Administration proposed prohibiting "all characterizing flavors in cigars" and "menthol… in cigarettes." We provide evidence on cigar and cigarette transitions and a framework to assess the impact of a U.S. flavored cigar ban.

Aims and methods: Using Population Assessment of Tobacco and Health survey waves 1-4, we estimated use patterns and annual transitions among flavored cigars, non-flavored cigars, cigarettes, and among adults aged 18-34 and aged ≥35. We also consider electronic nicotine delivery systems (ENDS)-related transitions. We developed a decision-theoretic framework for examining the impact of a flavored cigar ban alone, and the impact of a flavored cigar with a menthol cigarette ban with and without a non-tobacco flavored ENDS ban.

Results: Cigar users exhibited less stable use than cigarette users, with a large portion of cigar users switching to cigarette use each year. Past studies provide limited information on transitions between cigar and ENDS use. Our policy framework suggests that imposing a flavored cigar ban alone may be partially undermined by the substitution of menthol cigarettes for flavored cigars. While adding a menthol cigarette to a flavored cigar ban is expected to improve public health, a simultaneously implemented ENDS may offset some of the gains.

Conclusions: Our analysis suggests the information necessary to gauge the public health impact of a cigar flavor ban alone and with flavor bans on cigarettes and ENDS. Further research is needed on ENDS vis-a'-vis cigar use, and the impact of enforcement and non-flavor-related policies on flavor ban effectiveness.

Implications: Unlike menthol cigarette use and menthol bans, flavored cigar use and flavored cigar bans have received minimal attention. Transitions from cigars, especially dual and flavored use, are generally common compared to cigarettes. Our policy framework suggests important public health impacts. A flavored cigar ban absent a menthol cigarette ban may be partially undermined by the substitution of menthol cigarettes for flavored cigars. Adding a menthol cigarette ban is expected to offset such substitution and improve public health. However, simultaneously adding an ENDS with a flavored cigar and menthol cigarette ban may reduce the public health impact of a menthol cigarette and cigar flavor ban since flavored cigar users would be less able to substitute a lower-risk alternative.

Background: Mood influences smoking behavior, with sex and sex hormones potentially complicating these relationships. We explored associations between Profile of Mood States (POMS) and Questionnaire on Smoking Urges (QSU) - Brief with sex hormones in men and women who smoke.

Methods: This is a secondary analysis of treatment non-responders from a smoking cessation randomized trial investigating exogenous progesterone's efficacy. We considered the sex-specific associations between absolute serum progesterone (PRO) level and progesterone-to-estradiol ratio (P/E2), as well as the relative change in serum PRO and P/E2 with POMS and QSU subscale scores. Poisson generalized estimating equations models were used to estimate the associations.

Results: The analysis included 127 participants (62 women: median age of 38, 61% white; 65 men: median age of 36, 54% white). There were sex-specific associations between POMS negative mood factors and relative PRO levels (e.g., fatigue-inertia: women: 19% increase for a 10-fold increase in relative PRO, p=0.03 versus men: 10% decrease, p=0.19) and relative P/E2 (e.g., lonely: women: 7% increase for a 10-fold increase in relative P/E2, p=0.63 versus men: 27% decrease, p=0.01). Generally, larger relative PRO and P/E2 were associated with increased POMS negative mood factors in women, while larger relative PRO and P/E2 in men were associated with decreased POMS negative mood factors. Similar trends between POMS negative mood factors and the absolute PRO and P/E2 were observed. No significant associations were observed with POMS positive mood factors or QSU subscales.

Conclusion: These findings suggest that the change in PRO and P/E2 may influence negative mood factors differently in men and women who smoke. Additional research is needed to understand how these sex-specific associations may contribute to smoking cessation.

Implications: Progesterone and estrogen were linked to increased negative mood factors in women, whereas in men they were linked to a decrease in negative mood factors. These observations shed light on potential sex-specific intervention targets for mood management in adults who smoke.

Introduction: Unsupported attempts to quit smoking during pregnancy have a low success rate. Chances of quitting successfully are higher with an interpersonal treatment program but there is low uptake of this in the United Kingdom. Delivering a pregnancy-specific treatment program digitally may provide an alternative treatment route. This study explored pregnant smokers' perceptions of barriers and facilitators to using digital cessation support, along with identifying modes of delivery and engagement enhancers.

Aims and methods: Semi-structured interviews were carried out with an ethnically and socioeconomically diverse sample of 25 participants with recent experience of attempting to quit smoking in pregnancy, aged 20-40, from the United Kingdom. An inductive thematic analysis approach was used.

Results: Digital smoking cessation support, particularly a smartphone app, for pregnancy was felt to overcome many barriers to engaging with interpersonal support, being viewed as more convenient, and nonjudgmental, providing better consistency of advice, and enhancing privacy and autonomy. However, some participants felt that removing access to a human could undermine a digital support package and reduce engagement. Popular engagement enhancers included self-monitoring (eg, digital recording of smoking; smartphone-linked carbon monoxide monitoring), online communities, and remote access to nicotine substitution options. Digital support was viewed as having potential as a stand-alone intervention or working in conjunction with standard interpersonal treatment.

Conclusions: The findings support the investigation of a digital support package as both a stand-alone and adjunct to standard interpersonal cessation support in pregnancy to increase the proportion of pregnant smokers who make a supported quit attempt.

Implications: In many countries like the United Kingdom, there are few smoking cessation options routinely available that provide effective support for smoking cessation in pregnancy. To maximize impact, health services need an effective range of strategies to engage with and support quit attempts made by all pregnant smokers, particularly as interpersonal support options are not often well used. Development of a pregnancy-specific digital support package for smoking cessation in pregnancy may represent a means to help address this gap.