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Menthol is the only tobacco additive promoted and advertised by the tobacco industry. Although a considerable body of research has examined the effects of menthol when it is administered alone and unburned, the effects of menthol when burned in cigarette smoke are more complex because it is administered in a matrix of more than 4,000 substances. Therefore, it is difficult to isolate potential pharmacological and toxic effects of menthol when it is administered in a smoke mixture. Menthol properties include cooling and local anesthesia, as well as effects on drug absorption and metabolism, bronchodilation and respiration changes, and electrophysiology. Subjective effects of smoothness and less harshness have been identified as reasons for menthol cigarette smoking, but findings have been inconclusive regarding the effect of menthol on carbon monoxide exposure and smoking topography parameters. Gaps in the research literature and future research areas include the following: (a) What is the role of menthol in tobacco reinforcement and addiction? (b) In the absence of nicotine, is menthol reinforcing? (c) Are the pharmacological and physiological effects of menthol mediated by a menthol-specific receptor or some other central nervous system-mediated action? (d) What are the influences of menthol and menthol metabolism on the metabolic activation and detoxification of carcinogens in tobacco smoke? and (e) Do differences exist in cigarette smoking topography in relation to the interaction of ethnicity, gender, and menthol cigarette preference? Answers to these questions will help to elucidate the function of menthol in cigarettes and its impact on smoking behavior. [ABSTRACT FROM AUTHOR]

Conceptualizing tobacco dependence as a chronic relapsing condition suggests the need to use analytic strategies that reflect that premise. However, clinical trials for smoking cessation typically define the primary endpoint as a measure of abstinence at a single timepoint distal to the intervention, typically 3–12 months. This reinforces the concept of tobacco outcomes as a dichotomous state—one is, or is not, abstinent. Fortunately, there are several approaches available to handle longitudinal data that reflect the relapsing and remitting nature of tobacco use during treatment studies. In this paper, sponsored by the Society for Research on Nicotine and Tobacco's Treatment Research Network, we present an introductory overview of these techniques and their application in smoking cessation clinical trials. Topics discussed include models to examine abstinence outcomes (eg, trajectory models of abstinence, models for transitions in smoking behavior, models for time to event), models that examine reductions in tobacco use, and models to examine joint outcomes (eg, examining changes in the use of more than one tobacco product). Finally, we discuss three additional relevant topics (ie, heterogeneity of effects, handling missing data, and power and sample size) and provide summary information about the type of model that can be used based on the type of data collected and the focus of the study. We encourage investigators to familiarize themselves with these techniques and use them in the analysis of data from clinical trials of smoking cessation treatment. Implications Clinical trials of tobacco dependence treatment typically measure abstinence 3–12 months after participant enrollment. However, because smoking is a chronic relapsing condition, these measures of intervention success may not accurately reflect the common trajectories of tobacco abstinence and relapse. Several analytical techniques facilitate this type of outcome modeling. This paper is meant to be an introduction to these concepts and techniques to the global nicotine and tobacco research community including which techniques can be used for different research questions with visual summaries of which types of models can be used for different types of data and research questions. [ABSTRACT FROM AUTHOR]

Comments on the progress in nicotine research. Development of experimental models for the study of the various component processes of nicotine dependence; Difficulties in sustaining treatment gains for drug dependence in general; Usefulness of biological and behavioral studies in understanding the acquisition of tobacco-use behavior.

Introduction: The review had the aim of investigating factors enabling or discouraging the uptake of smoking cessation services by pregnant women smokers. Methods: The literature was searched for papers relating to the delivery of services to pregnant or recently pregnant women who smoke. No restrictions were placed on study design. A qualitative synthesis strategy was adopted to analyze the included papers. Results: Analysis and synthesis of the 23 included papers suggested 10 aspects of service delivery that may have an influence on the uptake of interventions. These were whether or not the subject of smoking is broached by a health professional, the content of advice and information provided, the manner of communication, having service protocols, follow-up discussion, staff confidence in their skills, the impact of time and resource constraints, staff perceptions of ineffectiveness, differences between professionals, and obstacles to accessing interventions. Discussion: The findings suggest variation in practice between services and different professional groups, in particular regarding the recommendation of quitting smoking versus cutting down but also in regard to procedural aspects, such as recording status and repeat advice giving. These differences offer the potential for a pregnant woman to receive contradicting advice. The review suggests a need for greater training in this area and the greater use of protocols, with evidence of a perception of ineffectiveness/pessimism toward intervention among some service providers. [ABSTRACT FROM PUBLISHER]

Introduction The prevalence of smoking is unequally distributed across certain groups. One significant dimension is education inequality, where higher smoking prevalence is generally observed in lower-educated groups. However, studies investigating educational inequality are mostly associative. Meanwhile, studies carrying out a causal investigation focus typically on developed countries. In this study, we consider a panel of low-and-middle-income countries (LMICs) to investigate the causal link between education and smoking behavior. Aims and Methods We use detailed micro-level household surveys for 12 LMICs where the duration of compulsory schooling has been extended. By identifying the individuals subject to higher compulsory schooling and using the exogenous variation in education caused by the increase in the duration of compulsory schooling, we estimate the causal impact of education on tobacco consumption. We rely on regression analysis to estimate the effect. Results Our results reveal that those subject to higher years of compulsory schooling have lower smoking-related outcomes, suggesting that higher education significantly lowers tobacco consumption in LMICs. The effect is primarily observed for women, where, for instance, higher compulsory schooling reduces the probability of smoking by 23% and the number of cigarettes smoked by 27%. Conclusions The study's results establish the causal link between education and smoking behavior in LMICs. This significant impact suggests that education policy is still an important tool to help reduce tobacco consumption, especially in settings where the average level of education is not high initially. Moreover, discouraging men from smoking requires other measures to complement education policy. Implications Education might help reduce tobacco consumption. However, studies—primarily for developed countries—find mixed results. This paper investigates the causal role of education on smoking in LMICs. Education reduces tobacco consumption, especially for women. Thus, education policy can be effective in low-education settings. Nonetheless, education policy should be accompanied by other policies to discourage men from smoking. [ABSTRACT FROM AUTHOR]

Introduction: While evaluations of indoor smoke-free legislation have demonstrated major public health benefits among adults, their impact on the smoking behavior of young people remains unclear. Therefore, we performed a systematic review of the association between smoke-free legislation in hospitality venues and smoking behavior of young people.Aims and Methods: A systematic search was conducted in PubMed, Scopus, and Embase in June 2020. We searched for studies that assessed the association of any form of smoke-free legislation in any hospitality venue (eg, bar and restaurant) with a smoking behavior outcome (eg, initiation and current smoking) among young people (aged 10-24 years). .Results: Our search yielded 572 articles of which 31 were screened based on full-text and 9 were included in the analysis. All studies were published between 2005 and 2016. The majority of studies used a quasi-experimental design. Four studies evaluated smoke-free legislation in hospitality venues specifically. Two studies reported that comprehensive, but not weaker, smoke-free legislation decreases progression to established smoking. Two other studies provided mixed results on which level of comprehensiveness of legislation would be effective, and which smoking outcomes would be affected. Five studies evaluated legislation that also included other workplaces. Out of these five studies, three studies found significant decreases in current smoking, smoking frequency, and/or smoking quantity, whereas two other studies did not.Conclusions: Most of the studies found that smoke-free legislation in hospitality venues is associated with a decrease in smoking behavior among young people. Their results indicate the need for comprehensive smoke-free legislation without exemptions.Implications: This is the first systematic review to provide insight into the relationship between smoke-free legislation in hospitality venues and smoking behavior of young people. Our findings show that there is a need for comprehensive smoke-free legislation without exemptions (such as designated smoking areas). [ABSTRACT FROM AUTHOR]

Introduction Subjective experience of e-cigarettes may be an important factor in helping people who use combustible cigarettes switch completely to e-cigarettes to reduce harm from smoking. This paper describes a novel two-stage analysis using pleasure and satisfaction responses from ecological momentary assessments (EMA) of both cigarette and e-cigarette use to predict future cigarette and e-cigarette tobacco use. Aims and Methods This observational study included adult users of cigarettes and e-cigarettes who provided 7 days of EMA, capturing cigarette and e-cigarette use, followed by biweekly reports of cigarette and e-cigarette use over 1 year. Participants were 279 adults who provided both cigarette and e-cigarette responses during the EMA. We employed a two-stage analytic approach in which EMA data were used to predict subsequent levels of cigarette and e-cigarette use. In the first stage, EMA responses to cigarette and e-cigarette events were modeled via a mixed-effects location scale model to yield summaries of participants' means and variability on event-related ratings of pleasure and satisfaction. These EMA summaries served as predictors in the second stage analysis of the biweekly post-EMA longitudinal cigarette and e-cigarette use data. Results EMA pleasure and satisfaction ratings were similar for both products and predicted both longitudinal cigarette and e-cigarette use, even after controlling for baseline cigarette and e-cigarette dependence. Relatively higher levels of satisfaction with e-cigarettes were associated with greater decreases in cigarette use over time. Conclusions Pleasure and satisfaction are important predictors of subsequent cigarette and e-cigarette use. Implications Experienced subjective pleasure and satisfaction from e-cigarettes relative to cigarettes may be an important factor in helping individuals who smoke to switch completely to e-cigarettes as a harm reduction approach. In order to help sustain complete product switching and reduce dual use or relapse to smoking, e-cigarettes may need to deliver more satisfaction to the user compared to that experienced from cigarettes. [ABSTRACT FROM AUTHOR]

Introduction: The PROMIS Smoking Initiative has developed six item banks for assessment related to cigarette smoking among adult smokers (Nicotine Dependence, Coping Expectancies, Emotional and Sensory Expectancies, Health Expectancies, Psychosocial Expectancies, and Social Motivations). This article evaluates the psychometric performance of the banks when administered via short form (SF), computer adaptive test (CAT), and by mode of administration (computer vs. paper-and-pencil).Methods: Data are from two sources: an internet sample (N = 491) of daily and nondaily smokers who completed both SFs and CATs via the web and a community sample (N = 369) that completed either paper-and-pencil or computer administration of the SFs at two time points. First a CAT version of the PROMIS Smoking Assessment Toolkit was evaluated by comparing item administration rates and scores to the SF administration. Next, we considered the effect of computer versus paper-and-pencil administration on scoring and test-retest reliability.Results: Across the domains approximately 5.4 to 10.3 items were administered on average for the CAT. SF and CAT item response theory-scores were correlated from 0.82 to 0.92 across the domains. Cronbach's alpha for the four- to eight-item SFs among daily smokers ranged from .80 to .91 and .82 to .91 for paper-and-pencil and computer administrations, respectively. Test-retest reliability of the SFs ranged from 0.79 to 0.89 across mode of administration.Conclusions: Results indicate that the SF and CAT and computer and paper-and-pencil administrations provide highly comparable scores for daily and nondaily smokers, but preference for SF or CAT administration may vary by smoking domain. [ABSTRACT FROM AUTHOR]

Introduction Cigarette smoke contains highly reactive free radicals thought to play an important role in tobacco smoke-induced harm. Previously, large variations in free radical and toxicant output have been observed in commercial cigarettes. These variations are likely because of cigarette design features (paper, filter, and additives), tobacco variety (burley, bright, oriental, etc.), and tobacco curing methods (air, sun, flue, and fire). Previous reports show that tobacco varieties and curing methods influence the production of tobacco smoke constituents like the tobacco-specific carcinogen nicotine-derived nitrosamine ketone (NNK). Aims and Methods We evaluated free radical, nicotine, and NNK production in cigarette smoke from cigarettes produced with 15 different types of tobacco. Gas-phase free radicals were captured by spin trapping with N- tert -butyl-α-phenylnitrone and particulate-phase radicals were captured on a Cambridge Filter pad (CFP). Both types of radicals were analyzed using electron paramagnetic resonance spectroscopy. Nicotine and NNK were extracted from the CFP and analyzed by gas chromatography flame ionization detection and liquid chromatography-mass spectrometry, respectively. Results Gas-phase radicals varied nearly 8-fold among tobacco types with Saint James Perique tobacco producing the highest levels (42 ± 7 nmol/g) and Canadian Virginia tobacco-producing the lowest levels (5 ± 2 nmol/g). Nicotine and NNK levels in smoke varied 14-fold and 192-fold, respectively, by type. Gas-phase free radicals were highly correlated with NNK levels (r  = 0.92, p  < .0001) and appeared to be most impacted by tobacco curing method. Conclusions Altogether, these data suggest that tobacco types used in cigarette production may serve as a target for regulation to reduce harm from cigarette smoking. Implications Variations in cigarette free radical and NNK levels vary based on the tobacco variety and curing method. Reducing the ratio of high-producing free radical and NNK tobacco types offer a potential tool for regulators and producers looking to reduce toxicant output from cigarettes. [ABSTRACT FROM AUTHOR]

Introduction: Changing patterns of cannabis consumption related to the liberalization of cannabis policies may have a countervailing effect on tobacco use. We analyzed whether cannabis policies have tempered the effects of tobacco control policies as well as the extent to which they were associated with young adult cigarette smoking.Aims and Methods: Combining data on tobacco and cannabis policies at the state, county, and city levels with the nationally-representative geocoded National Longitudinal Survey of Youth 1997 and Census data, we use multilevel regression and fixed effect analyses to examine the impact of cannabis policies on any past 30-day cigarette smoking, frequency of smoking, and past 30-day near-daily smoking among young adults while accounting for community and individual covariates.Results: Tobacco control policies, including significant effects of comprehensive smoking bans, total vending machine restrictions, single cigarette sale restrictions, and advertising restrictions, remain robust in reducing young adult smoking, net of cannabis policy liberalization, including the legal status of possession, penalties for sale, and medical cannabis. Cannabis policies do not directly affect young adult smoking patterns in an adverse way.Conclusions: This paper provides evidence that the liberalization of cannabis laws has not adversely affected the efficacy of tobacco control efforts.Implications: While the effects of tobacco control policies on smoking are well-established, little research has considered how the liberalization of cannabis policies may affect these relationships, which is important given the co-use of these substances. This paper provides evidence that the liberalization of cannabis laws has not adversely affected tobacco control efforts. [ABSTRACT FROM AUTHOR]

We based our analysis on the data in Table 2 of Kim et al. 3 which, as Yue et al. correctly note, implicitly assumes that the one patient without data on smoking was a nonsmoker. 2 They note that the paper by Kim et al. 3 only reported smoking status for 27 of the 28 hospitalized COVID-19 patients they studied, but did not report which patient did not have data on smoking status. [Extracted from the article]

Introduction: The cigarette stick is an important communications tool as well as the object of consumption. We explored young adults' responses to cigarettes designed to be dissuasive.Methods: Data come from a cross-sectional online survey, conducted in September 2015, with 16- to 24-year-old smokers and nonsmokers (N = 997) in the United Kingdom. Participants were shown images of a standard cigarette (white cigarette paper with imitation cork filter), a standard cigarette displaying the warning "Smoking kills" on the cigarette paper, and an unattractively colored cigarette (green cigarette paper and filter). They were asked to rate each of the three cigarettes, shown individually, on eight perception items, and to rate the three cigarettes, shown together, on how likely they would be to try them. Ordering of the cigarettes and questions, with the exception of the question on trial, was randomized.Results: The eight perception items were combined to form a composite measure of cigarette perceptions. For smokers and nonsmokers, the two dissuasive cigarettes (cigarette with warning, green cigarette) were rated significantly less favorably than the standard cigarette, and less likely to encourage trial. For cigarette perceptions, no significant interaction was detected between cigarette style and smoking status or susceptibility to smoke among never smokers. A significant interaction was found for likelihood of trying the cigarettes, with dissuasive cigarettes having a greater impact with smokers than nonsmokers.Conclusions: This study suggests that dissuasive cigarettes may help to reduce the desirability of cigarettes.Implications: The cigarette stick is the object of tobacco consumption, which is seen every time a cigarette is smoked. It is also an increasingly important promotional tool for tobacco companies. In this study, young adults rated two dissuasive cigarettes (a green colored cigarette and a cigarette displaying a health warning) more negatively than a standard cigarette, and considered them less likely to encourage product trial. Our findings suggest that it may be possible to reduce the desirability of cigarette sticks by altering their design, for example, with the addition of a warning or use of an unattractive color. [ABSTRACT FROM AUTHOR]

Introduction: Smoking prevalence among Indigenous Australians nationally (45%) is more than double that of other Australians but ranges up to 82% in remote communities, causing significant health disparities. This paper examines trends in peer-reviewed research outputs related to Indigenous Australian tobacco control over the past decade and describes their research translation potential and alignment with national and jurisdictional policy priorities. Methods: Systematic searches of electronic databases were conducted: Medline, CINAHL, Cochrane Systematic Reviews, PsychInfo, and Australian HealthInfoNET for English-language peer-reviewed publications (2004-2013) primarily focusing on Indigenous Australian tobacco use. Publications were categorized by types, topics, and geographic location. Following established procedures, "reviews" and "commentaries" were distinguished from "original research," the latter further classified as "measurement," "descriptive," or "intervention" studies. Research translation categories used were: "synthesis," "dissemination," "exchange," and "application." Results: The majority of 78 publications meeting selection criteria focused on cessation treatment (28%), monitoring and prevalence (24%) and passive smoking (13%). "Original research" was mostly "descriptive/epidemiologic" (81%) with few "intervention" studies (9%). Many studies were in remote communities. Components of research translation were identified in 50% of the publications with little evidence of dissemination strategies. Conclusion: Remote community populations are an area of great need. However, generally it is disappointing that since 2004, few intervention studies are available to guide efforts to reduce tobacco-related health disparities. Stronger and more immediate alignment of policy with research that contributes to the evidence-base is required together with more systematic use of research dissemination translation strategies to better match evidence with priorities which may develop rapidly over time. [ABSTRACT FROM AUTHOR]

In the one analysis that did follow NASEM guidelines, their findings are consistent with the other PATH Study paper that was co-authored by the senior authors of this paper - it found no association between e-cigarette use and smoking cessation. Of interest, the two senior authors were also co-authors on another recent publication 2 reporting on e-cigarette use and cigarette abstinence that came to a strikingly different conclusion, despite using the same data set from the Population Assessment of Tobacco and Health (PATH) cohort study. Patterns of e-cigarette use and subsequent cigarette smoking cessation over two years (2013/2014 to 2015/2016) in the Population Assessment of Tobacco and Health (PATH) Study [published online ahead of print, September 17, 2020]. [Extracted from the article]

Background: This paper explores whether plans to quit, wanting to quit, and quit efficacy add predictive value over measures of habit strength and dependence in making quit attempts and/or attaining smoking abstinence.Aims and Methods: We used three waves of the International Tobacco Control (ITC) Four Country Smoking and Vaping Survey conducted in 2016, 2018, and 2020. Baseline daily smokers (N = 6710) who provided data for at least one wave-to-wave transition (W1 to W2, N = 3511 or W2 to W3, N = 3199) and provided outcome data at the next wave (follow-up) formed the analytic sample. Generalized estimating equations (GEE) logistic regression analyses examined predictors of quit attempts and abstinence at follow-up (1- and 6-month sustained abstinence).Results: Wanting and planning to quit were significantly positively associated with making quit attempts, but negatively associated with smoking abstinence. A significant interaction between the Heaviness of Smoking Index and age warranted an age-stratified analysis for both abstinence outcomes. Lower HSI predicted abstinence in only the younger smokers Motivation and plans to quit were positively associated with abstinence in younger smokers, but surprisingly were negatively associated with abstinence in older smokers. Quit efficacy was associated with abstinence in the older, but not the younger smokers.Conclusions: Models of smoking abstinence are significantly improved by including motivational predictors of smoking. Age was an important moderator of the association between abstinence for both dependence and motivational variables.Implications: The findings from this large cohort study indicate there are age-related differences in predictors of smoking abstinence but not quit attempts. These associations may reflect differential experiences of older and younger cohorts of smokers, which may have implications for interventions to motivate and assist smokers in quitting. [ABSTRACT FROM AUTHOR]

Introduction: Over the past 20 years, there has been a tripling in the consumption of small cigars and cigarillos, with further increases expected because cigar products are not subject to Food and Drug Administration regulations. Acute toxin exposure from cigar smoking is difficult to assess because unlike cigarettes, cigars vary widely in size, design, composition, and in the smoking behavior of their consumers. For example, a recent practice among urban youth is to remove the paper liner (i.e., “freaking”) of a small cigar in the belief that it is this paper liner that leads to addiction and cancer. Methods: We examined acute exposure (CO and nicotine boosts) and puffing behavior in 12 participants (10 men) who smoked (ad lib) their usual conventional cigarette, a Black & Mild cigar (B&M) and a B&M without the paper liner (i.e., “freaked” [B&Mf]). Results: All products (cigarettes, B&M, and B&Mf) significantly increased heart rate and CO with a trend for plasma nicotine. Nicotine boost was significantly higher after cigarette smoking than both B&M and B&Mf, while CO boost was significantly greater after B&M and B&Mf than cigarettes. The CO boost after B&M was larger than after B&Mf. Conclusions: These findings suggest that small cigar smoking is associated with smoke inhalation that leads to significant exposure to nicotine, CO, and presumably other components of tobacco smoke and that removing the inner liner does not substantially reduce toxin exposure. [ABSTRACT FROM PUBLISHER]

Objectives: The US Food and Drug Administration has expressed interest in using mathematical models to evaluate potential tobacco policies. The goal of this systematic review was to synthesize data from tobacco control studies that employ mathematical models.Methods: We searched five electronic databases on July 1, 2013 to identify published studies that used a mathematical model to project a tobacco-related outcome and developed a data extraction form based on the ISPOR-SMDM Modeling Good Research Practices. We developed an organizational framework to categorize these studies and identify models employed across multiple papers. We synthesized results qualitatively, providing a descriptive synthesis of included studies.Results: The 263 studies in this review were heterogeneous with regard to their methodologies and aims. We used the organizational framework to categorize each study according to its objective and map the objective to a model outcome. We identified two types of study objectives (trend and policy/intervention) and three types of model outcomes (change in tobacco use behavior, change in tobacco-related morbidity or mortality, and economic impact). Eighteen models were used across 118 studies.Conclusions: This paper extends conventional systematic review methods to characterize a body of literature on mathematical modeling in tobacco control. The findings of this synthesis can inform the development of new models and the improvement of existing models, strengthening the ability of researchers to accurately project future tobacco-related trends and evaluate potential tobacco control policies and interventions. These findings can also help decision-makers to identify and become oriented with models relevant to their work. [ABSTRACT FROM AUTHOR]

Introduction: To review the geographic exposure measures used to characterize the tobacco environment in terms of density of tobacco outlets and proximity to tobacco outlets, and its association with smoking-related outcomes.Methods: We used PubMed and Google Scholar to find articles published until December 2019. The search was restricted to studies that (1) measured the density of and/or proximity to tobacco outlets and (2) included associations with smoking outcomes. The extraction was coordinated by several observers. We gathered data on the place of exposure, methodological approaches, and smoking outcomes.Results: Forty articles were eligible out of 3002 screened papers. Different density and proximity measures were described. 47.4% density calculations were based on simple counts (number of outlets within an area). Kernel density estimations and other measures weighted by the size of the area (outlets per square kilometer), population, and road length were identified. 81.3% of the articles which assessed proximity to tobacco outlets used length distances estimated through the street network. Higher density values were mostly associated with higher smoking prevalence (76.2%), greater tobacco use and smoking initiation (64.3%), and lower cessation outcomes (84.6%). Proximity measures were not associated with any smoking outcome except with cessation (62.5%).Conclusion: Associations between the density of tobacco outlets and smoking outcomes were found regardless of the exposure measure applied. Further research is warranted to better understand how proximity to tobacco outlets may influence the smoking outcomes. This systematic review discusses methodological gaps in the literature and provides insights for future studies exploring the tobacco environment.Implications: Our findings pose some methodological lessons to improve the exposure measures on the tobacco outlet environment. Solving these methodological gaps is crucial to understand the influence of the tobacco environment on the smoking outcomes. Activity spaces should be considered in further analyses because individuals are exposed to tobacco beyond their residence or school neighborhood. Further studies in this research area demand density estimations weighted by the size of the area, population, or road length, or measured using Kernel density estimations. Proximity calculations should be measured through the street network and should consider travel times apart from the length distance. [ABSTRACT FROM AUTHOR]

Introduction: Young adult cigarette smoking behaviors are complex and dynamic. Emerging research suggests a growing rate of switching from non-menthol to menthol cigarettes. Transitions across cigarette smoking states are not well understood. This research longitudinally explores transitions in cigarette smoking behaviors among 18-29 year olds.Methods: We applied a Markov model to data collected biannually for 1542 initially 18-29 year old young adults (mean age: 20.9 years; SD = 2.6) in Texas, who provided 7021 total observations from Fall 2014 to Spring 2017. All participants were past 30 day menthol or non-menthol cigarette smokers at first observation. We examined transitions across three states of cigarette smoking (menthol, non-menthol, and nonsmoking) and compared predictors of each transition, during young adulthood.Results: Descriptively, 22.2% of menthol and 14.3% of non-menthol smokers switched products while 25.6% of menthol and 26.0% of non-menthol smokers quit smoking. Among quitters, 20.0% relapsed via menthol and 28.2% relapsed via non-menthol cigarettes. Results from Markov model indicated that Hispanic/Latinos (Hazard Ratio [HR]: 3.69) and Asians (HR: 2.85) were significantly more likely to switch from non-menthol to menthol cigarettes, relative to non-Hispanic whites. Among recent quitters, the use of non-cigarette products was associated with increased risk of relapse via menthol (HR: 1.54) and non-menthol (HR: 1.85) cigarettes.Conclusion: A substantial proportion of young adult cigarette smokers transitioned across cigarette smoking states over the course of 2.5 years. Other tobacco use and nicotine dependence were impediments to becoming and remaining a non-smoker. Hispanic/Latinos and Asians, relative to non-Hispanic whites, had greater odds of transitioning from non-menthol smoking to both non-smoking and to menthol smoking. Findings suggest racial/ethnic differences in cigarette smoking transitions during young adulthood.Implications: This paper examined multidirectional transitions across cigarette smoking, including switching between menthol and non-menthol cigarettes, among young adults. Results indicate that Hispanic/Latino and Asian young adults are at increased risk of transition to menthol cigarette smoking compared with non-Hispanic white young adults. Findings highlight need for further study of Hispanic/Latino and Asian young adult smoking behaviors. [ABSTRACT FROM AUTHOR]

Introduction Smoking commercial tobacco products is highly prevalent in American Indian and Alaska Native (Indigenous) pregnancies. This disparity directly contributes to maternal and fetal mortality. Our objective was to describe cigarette smoking prevalence, cessation intervention uptake, and cessation behaviors of pregnant Indigenous people compared to sex and age-matched regional cohort. Aims and Methods Pregnancies from an Indigenous cohort in Olmsted County, Minnesota, identified in the Rochester Epidemiology Project, were compared to pregnancies identified in a sex and age-matched non-Indigenous cohort from 2006 to 2019. Smoking status was defined as current, former, or never. All pregnancies were reviewed to identify cessation interventions and cessation events. The primary outcome was smoking prevalence during pregnancy, with secondary outcomes measuring uptake of smoking cessation interventions and cessation. Results The Indigenous cohort included 57 people with 81 pregnancies, compared to 226 non-Indigenous people with 358 pregnancies. Smoking was identified during 45.7% of Indigenous pregnancies versus 11.2% of non-Indigenous pregnancies (RR: 3.25, 95% CI = 1.98–5.31, p ≤.0001). Although there was no difference in uptake of cessation interventions between cohorts, smoking cessation was significantly less likely during Indigenous pregnancies compared to non-Indigenous pregnancies (OR: 0.23, 95% CI = 0.07–0.72, p  = .012). Conclusions Indigenous pregnant people in Olmsted County, Minnesota were more than three times as likely to smoke cigarettes during pregnancy compared to the non-indigenous cohort. Despite equivalent uptake of cessation interventions, Indigenous people were less likely to quit than non-Indigenous people. Understanding why conventional smoking cessation interventions were ineffective at promoting cessation during pregnancy among Indigenous women warrants further study. Implications Indigenous pregnant people in Olmsted County, Minnesota, were greater than three times more likely to smoke during pregnancy compared to a regional age matched non-Indigenous cohort. Although Indigenous and non-Indigenous pregnant people had equivalent uptake of cessation interventions offered during pregnancy, Indigenous people were significantly less likely to quit smoking before fetal delivery. This disparity in the effectiveness of standard of care interventions highlights the need for further study to understand barriers to cessation in pregnant Indigenous people. [ABSTRACT FROM AUTHOR]

Introduction: Various approaches have been used to estimate the population health impact of introducing a Modified Risk Tobacco Product (MRTP).Aims and Methods: We aimed to compare and contrast aspects of models considering effects on mortality that were known to experts attending a meeting on models in 2018.Results: Thirteen models are described, some focussing on e-cigarettes, others more general. Most models are cohort-based, comparing results with or without MRTP introduction. They typically start with a population with known smoking habits and then use transition probabilities either to update smoking habits in the "null scenario" or joint smoking and MRTP habits in an "alternative scenario". The models vary in the tobacco groups and transition probabilities considered. Based on aspects of the tobacco history developed, the models compare mortality risks, and sometimes life-years lost and health costs, between scenarios. Estimating effects on population health depends on frequency of use of the MRTP and smoking, and the extent to which the products expose users to harmful constituents. Strengths and weaknesses of the approaches are summarized.Conclusions: Despite methodological differences, most modellers have assumed the increase in risk of mortality from MRTP use, relative to that from cigarette smoking, to be very low and have concluded that MRTP introduction is likely to have a beneficial impact. Further model development, supplemented by preliminary results from well-designed epidemiological studies, should enable more precise prediction of the anticipated effects of MRTP introduction.Implications: There is a need to estimate the population health impact of introducing modified risk nicotine-containing products for smokers unwilling or unable to quit. This paper reviews a variety of modeling methodologies proposed to do this, and discusses the implications of the different approaches. It should assist modelers in refining and improving their models, and help toward providing authorities with more reliable estimates. [ABSTRACT FROM AUTHOR]

Background: This paper examines whether participating in Mahatma Gandhi National Rural Employment Guarantee Program (NREGA) is associated with the likelihood of smoking among program participants in India.Methods: We use two-stage residual inclusion (2SRI) estimation method and two waves of India Human Development Surveys completed before (2005) and after (2012) NREGA implementation.Results: The likelihood of smoking increased with NREGA participation. For every 10% increase in NREGA income, the likelihood of smoking bidis (but not cigarettes) increased by 0.88 percentage point. A bidi, a stick of unprocessed tobacco wrapped in temburini leaves, is a significantly cheaper alternative to cigarettes. Nonparticipants who had a comparable increase in income between the two India Human Development Survey waves did not show an increase in likelihood of smoking. The heterogeneity in NREGA treatment effect shows that smoking tendency is not influenced by caste/religion or literacy.Conclusions: NREGA, as the largest workfare program, most certainly has had a significantly positive influence on the rural poor in India. The findings highlight its small but meaningful influence of a negative health behavior, greater likelihood of uptake of smoking bidis/hookah among program participants.Implications: Existing studies have found mixed evidence of an exogenous increase in income among low-income adults and its impact on smoking. No studies to date have tested the influence of workfare programs in rural areas of developing countries, where unemployment rates are higher and a substantial share of population in those areas is poor. Based on participation in employment guarantee programs as a proxy for exogenous increase in guaranteed income among rural population in India, we find that participants in the program were more likely to smoke bidis/hookah but not cigarettes. [ABSTRACT FROM AUTHOR]

Introduction: Young adults have the highest prevalence of smoking among all age groups in most industrialized countries and exhibit great variability in smoking behavior. Differences in associations between features in residential environments and smoking initiation, prevalence, and cessation have been extensively examined in the literature. Nonetheless, in many cases, findings remain inconsistent. This paper proposes that a potential driver of these inconsistencies is an almost exclusive focus on point-specific smoking outcomes, without consideration for the different behavior patterns that this age group may experience over time.Aims and Methods: Based on data from the Interdisciplinary Study of Inequalities in Smoking cohort of 18- to 25-year-old Montreal residents (n = 1025), we examined associations between 4-year smoking patterns measured at three timepoints and proximal presence/density of tobacco retail outlets and presence of smoker accommodation facilities in Montreal, Canada. Associations were tested using two-level multinomial and logistic models.Results: In fully adjusted models, compared to never-smokers, residents of areas with a higher density of tobacco retail were more likely to (1) be characterized as established smokers, (2) have experienced repeated changes in smoking status (being "switchers") during the 4-year study period, and (3) be former smokers.Conclusions: From a conceptual standpoint, these findings highlight the importance of acknowledging and examining smoking behavior patterns among young adults. Furthermore, specific pattern-feature associations may point to unique mechanisms by which features could influence smoking behavior patterns. These findings require replication and extension, including testing hypotheses regarding tobacco retail density's role in sustaining smoking and in influencing changes in smoking status.Implications: Results from this study highlight the importance of describing and examining different young adult smoking behavior patterns and how they may be influenced by residential environment features such as the density of tobacco retail. Findings suggest that young adults residing in areas with a higher density of tobacco retailers are more likely to have experienced repeated changes in smoking status and to be established smokers. Further research in this area is needed to advance knowledge of the putative mechanisms by which residential features may influence smoking behavior patterns and to ultimately orient policy and interventions seeking to curb smoking at the local level. [ABSTRACT FROM AUTHOR]

Introduction: Smoking remains the single-most significant preventable cause of poor pregnancy outcomes, yet around 12% of Australian women smoke during pregnancy. Many women are motivated to quit when they find out they are pregnant, yet few are successful. While previous studies have examined the profile of the maternal smoker compared to her nonsmoking counterpart (Aim 1), little is known about what differentiates women who quit during pregnancy to those who do not (Aim 2). Here, we present results from a study investigating the characteristics of women who were able to quit during pregnancy.Methods: Data were drawn from the Tasmanian Population Health database of women who had received antenatal care between 2011 and 2013 (n = 14300). Data collected included age, relationship status and ethnicity of expectant mothers, antenatal details, mental health conditions, and drug use. Independent samples t tests were used to compare differences between women who had, and those who had not, quit during pregnancy. The 19.4% of women who self-reported as smoking in the first half (first 20 weeks) of their pregnancy were further grouped and analyzed comparing those who reported still smoking in the second half of their pregnancy (smokers: n = 2570, 92.4%) to those who quit (quitters: n = 211, 7.6%).Results: Quitters (57.8%) were more likely to be in a relationship than their non-quitting counterparts (49.6%, p = .022) and were less likely to suffer from postnatal depression (2.4% vs. 6.0%, p = .029). No other differences between quitters and smokers were observed.Conclusions: Determining the profile of women who are able to quit during pregnancy may be important to improve the relatively poor cessation rates among maternal smokers and may assist in more effectively targeting at-risk women.Implications: Smoking cessation interventions have traditionally targeted socially disadvantaged women, for good reason: the majority of smoking pregnant women fall into this category. However, despite the significant attention and resources dedicated to antenatal smoking cessation interventions, most are ineffective with only 7.6% of the present sample quitting smoking during pregnancy. This paper may assist in developing more effective antenatal smoking cessation interventions by more clearly describing the profile of maternal smokers who successfully quit during pregnancy. Specifically, this paper highlights the need to acknowledge and address women's relationship status and mental health in order to promote smoking cessation in pregnancy. [ABSTRACT FROM AUTHOR]

Introduction: Despite a worldwide increase in the use of Make Your Own (MYO) cigarettes, there is little research characterizing MYO smokers in the United States and the cigarettes they make. Methods: In a single laboratory visit, exclusive MYO smokers brought 5 MYO cigarettes they prepared at home, completed demographic and smoking history questionnaires, and prepared 25 cigarettes using their own tobacco and materials. Results: Participants were mostly male (86.7%), average age of 41.3 years, and smoked an average of 19.5 (SD = 7.9) MYO cigarettes per day. They produced two types of cigarettes—by rolling tobacco in a paper leaf (Roll Your Own [RYO, n = 56]) and by injecting tobacco into a tube (Personal Machine Made [PMM, n = 42]). The PMM cigarettes were significantly larger than RYO cigarettes (p < .001). Home- (0.97 g) and laboratory-produced (0.95 g) PMM cigarettes did not differ by weight; however, the RYO cigarettes made at home (0.45 g) were slightly, but significantly, larger than those produced in the laboratory [0.43 g (p < .05)]. There was significant internal consistency in the weight of RYO and PMM cigarettes (intraclass correlation coefficient = 0.82, 0.84, respectively). Time to produce RYO cigarettes (53 s/cigarette) was significantly longer than that of PMM cigarettes (42 s/cigarette) (p < .01). Conclusions: By using commercially available tobacco, tubes, and paper, experienced MYO smokers can quickly and consistently prepare cigarettes that may be useful in laboratory smoking topography and exposure experiments. Increasing the regulation of Factory Made (FM) cigarettes may lead to increased use of MYO cigarettes with unknown toxicant exposure and health risks to their consumers. [ABSTRACT FROM AUTHOR]

Introduction: Tobacco control (TC) research capacity and productivity are critical for developing evidence-informed interventions that will reduce the harmful effects of smoking. The aim of this paper was to investigate New Zealand's (NZ) TC research capacity along with the quantity and quality of publications, following two government initiatives aimed, in part, at improving the quantity and quality of NZ TC research. Method: Scopus was searched for articles with at least one NZ author and where the topic was of primary relevance to TC. Publications were organized into two time periods, following the government initiatives, 1993–2003 and 2004–2009. We analyzed the number of publications, publication journals, type of publications, impact (using the impact factor), and authorship. Results: There has been an increase in number and impact of publications and number of authors. The number of publications has increased from an average of 14 (1994–2003) to 38 per year (2004–2009). The number of journals published increased from 64 to 86. The impact during 2004–2009 was almost threefold than in 1993–2003. The number of authors increased from 212 to 345, and the number of authors who had at least one first-authored publication increased from 80 to 124. Conclusions: These results show an encouraging trend in NZ TC research, with an increase in research productivity, quality, and in research capacity. It is possible that government-initiated and -funded infrastructural support contributed to increasing needed TC research, which supports the worth of such initiatives. [ABSTRACT FROM AUTHOR]

Introduction: Wearable sensors may be used for the assessment of behavioral manifestations of cigarette smoking under natural conditions. This paper introduces a new camera-based sensor system to monitor smoking behavior. The goals of this study were (1) identification of the best position of sensor placement on the body and (2) feasibility evaluation of the sensor as a free-living smoking-monitoring tool.Methods: A sensor system was developed with a 5MP camera that captured images every second for continuously up to 26 hours. Five on-body locations were tested for the selection of sensor placement. A feasibility study was then performed on 10 smokers to monitor full-day smoking under free-living conditions. Captured images were manually annotated to obtain behavioral metrics of smoking including smoking frequency, smoking environment, and puffs per cigarette. The smoking environment and puff counts captured by the camera were compared with self-reported smoking.Results: A camera located on the eyeglass temple produced the maximum number of images of smoking and the minimal number of blurry or overexposed images (53.9%, 4.19%, and 0.93% of total captured, respectively). During free-living conditions, 286,245 images were captured with a mean (±standard deviation) duration of sensor wear of 647(±74) minutes/participant. Image annotation identified consumption of 5(±2.3) cigarettes/participant, 3.1(±1.1) cigarettes/participant indoors, 1.9(±0.9) cigarettes/participant outdoors, and 9.02(±2.5) puffs/cigarette. Statistical tests found significant differences between manual annotations and self-reported smoking environment or puff counts.Conclusions: A wearable camera-based sensor may facilitate objective monitoring of cigarette smoking, categorization of smoking environments, and identification of behavioral metrics of smoking in free-living conditions.Implications: The proposed camera-based sensor system can be employed to examine cigarette smoking under free-living conditions. Smokers may accept this unobtrusive sensor for extended wear, as the sensor would not restrict the natural pattern of smoking or daily activities, nor would it require any active participation from a person except wearing it. Critical metrics of smoking behavior, such as the smoking environment and puff counts obtained from this sensor, may generate important information for smoking interventions. [ABSTRACT FROM AUTHOR]

Introduction: This paper describes different methods for analyzing counts and illustrates their use on cigarette and marijuana smoking data.Methods: The Poisson, zero-inflated Poisson (ZIP), hurdle Poisson (HUP), negative binomial (NB), zero-inflated negative binomial (ZINB) and hurdle negative binomial (HUNB) regression models are considered. The different approaches are evaluated in terms of the ability to take into account zero-inflation (extra zeroes) and overdispersion (variance larger than expected) in count outcomes, with emphasis placed on model fit, interpretation, and choosing an appropriate model given the nature of the data. The illustrative data example focuses on cigarette and marijuana smoking reports from a study on smoking habits among youth e-cigarette users with gender, age, and e-cigarette use included as predictors.Results: Of the 69 subjects available for analysis, 36% and 64% reported smoking no cigarettes and no marijuana, respectively, suggesting both outcomes might be zero-inflated. Both outcomes were also overdispersed with large positive skew. The ZINB and HUNB models fit the cigarette counts best. According to goodness-of-fit statistics, the NB, HUNB, and ZINB models fit the marijuana data well, but the ZINB provided better interpretation.Conclusion: In the absence of zero-inflation, the NB model fits smoking data well, which is typically overdispersed. In the presence of zero-inflation, the ZINB or HUNB model is recommended to account for additional heterogeneity. In addition to model fit and interpretability, choosing between a zero-inflated or hurdle model should ultimately depend on the assumptions regarding the zeros, study design, and the research question being asked.Implications: Count outcomes are frequent in tobacco research and often have many zeros and exhibit large variance and skew. Analyzing such data based on methods requiring a normally distributed outcome are inappropriate and will likely produce spurious results. This study compares and contrasts appropriate methods for analyzing count data, specifically those with an over-abundance of zeros, and illustrates their use on cigarette and marijuana smoking data. Recommendations are provided. [ABSTRACT FROM AUTHOR]

Background The changing prevalence and patterns of tobacco use, the advent of novel nicotine delivery devices, and the development of new biomarkers prompted an update of the 2002 Society for Research on Nicotine and Tobacco (SRNT) report on whether and how to apply biomarker verification for tobacco use and abstinence. Methods The SRNT Treatment Research Network convened a group of investigators with expertise in tobacco biomarkers to update the recommendations of the 2002 SNRT Biochemical Verification Report. Results Biochemical verification of tobacco use and abstinence increases scientific rigor and is recommended in clinical trials of smoking cessation, when feasible. Sources, appropriate biospecimens, cutpoints, time of detection windows and analytic methods for carbon monoxide, cotinine (including over the counter tests), total nicotine equivalents, minor tobacco alkaloids, and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol are reviewed, as well as biochemical approaches to distinguishing cigarette smoking from use of electronic nicotine delivery devices (ENDS). Conclusions Recommendations are provided for whether and how to use biochemical verification of tobacco use and abstinence. Guidelines are provided on which biomarkers to use, which biospecimens to use, optimal cutpoints, time windows to detection, and methodology for biochemical verifications. Use of combinations of biomarkers is recommended for assessment of ENDS use. Implications Biochemical verification increases scientific rigor, but there are drawbacks that need to be assessed to determine whether the benefits of biochemical verification outweigh the costs, including the cost of the assays, the feasibility of sample collection, the ability to draw clear conclusions based on the duration of abstinence, and the variability of the assay within the study population. This paper provides updated recommendations from the 2002 SRNT report on whether and how to use biochemical markers in determining tobacco use and abstinence. [ABSTRACT FROM AUTHOR]

The author of this article comments on the implications of risk perceptions and behavior toward tobacco smoking for tobacco control in the U.S. Consumers are bombarded with messages about the dangers of tobacco and also with marketing pitches about how these risks can be ameliorated by choosing products that are low in tar, nicotine, and other smoke constituents. And it is important to note how consumers interpret messages about tobacco products and how these beliefs influence choices made about whether to smoke, what products to smoke, whether to quit smoking, and the use of nicotine medications.

The article discusses the implementation of health warnings on individual (or loose) cigarettes in Canada and the potential impact on other countries, particularly in Southeast Asia. The prevalence of loose cigarette sales in countries like India is high, despite a nationwide ban. The article highlights the need to consider sociodemographic diversities when implementing such regulations and raises concerns about the effectiveness of warning labels for illiterate populations. It also addresses the challenges of printing warning labels in multiple languages and suggests extending the regulation to include e-cigarettes and rolling papers. The article concludes with a caution about the potential carcinogenic effects of the ink used for printing the warnings. [Extracted from the article]

Several papers in this issue highlight the tension between the goal of minimizing youth uptake of e-cigarettes versus the goal of maintaining the availability of e-cigarettes capable of substituting for combustible cigarettes among people who smoke and are unable to quit using nicotine products altogether. An analysis of e-cigarette retail sales data in the United States from 2017 to 2022 found that sales of e-cigarettes with 5% or more nicotine concentration had increased substantially over that period and, as of March 2022, comprised nearly 81% of total unit sales.[1] The obvious concern is that the availability of higher nicotine e-cigarettes may lead to higher rates of e-cigarette use and facilitate the development of nicotine dependence among youth. [Extracted from the article]

For almost three decades, numerous econometric studies have researched the impact of prices and tobacco-control policies on cigarette smoking and other tobacco use. This paper reviews some of the difficulties inherent in that research, briefly summarizes the key findings from those studies, including the problems associated with available data, and methodological problems that arise in estimation. This is followed by a brief summary of the key findings from econometric studies of tobacco use. Particularly important for policymakers is the consistent evidence that emerges from these studies, showing the effects of higher prices for cigarettes and other tobacco products, with growing evidence that youth and young adults are relatively more responsive to price than older adults. Similarly, these studies produce consistent evidence that stronger restrictions on smoking lead to reduced smoking. In addition, the mixed evidence on the impact of other tobacco control policies and advertising on demand is reviewed. The paper concludes with a discussion of areas where transdisciplinary collaborations and research could be particularly useful in improving our understanding of the impact of macrosocial influences on tobacco use. [ABSTRACT FROM AUTHOR]

Introduction: The debate over tobacco harm reduction (THR) has divided the tobacco control community into two camps, one expressing serious reservations about THR whereas the other believes that reduced-risk products like e-cigarettes will disrupt the cigarette market. The often emotional debate would benefit from dispassionate data-based evaluation of evidence.Methods: After briefly discussing harm reduction in public health and specifically in tobacco control, this paper identifies major issues concerning e-cigarettes and reviews relevant evidence. Issues include: e-cigarettes' risks compared to cigarette smoking; the effect of vaping on youth smoking; vaping's impact on adult smoking cessation; the net long-term public health implications of vaping; and differences in views on policy issues. The intent is to provide a broad overview of issues and evidence, directing readers to more detailed reviews of specific issues.Findings: Principal findings include the following: (1) while longitudinal studies suggest that vaping increases never-smoking young people's odds of trying smoking, national survey data indicate that adolescents' 30-day smoking prevalence decreased at an unprecedented rate precisely whereas vaping increased. Use of all other tobacco products also declined. (2) Recent population-level studies add evidence that vaping is increasing adult smoking cessation. (3) Vaping is likely to make a positive contribution to public health.Conclusions: THR can be a complement to, not a substitute for, evidenced-based tobacco control interventions. Tobacco control professionals need to focus on objective assessment of and discussion about the potential costs and benefits of THR.Implications: Participants on both sides of the divisive THR debate need to examine the complicated issues and evidence more objectively. This entails considering both the potential benefits and costs associated with reduced-risk products like e-cigarettes. Furthermore, it requires examining different kinds of evidence when considering specific issues. For example, those concerned by longitudinal study findings that vaping increases students' trial of cigarettes should consider US national survey evidence that youth smoking has decreased at an unprecedented rate. A review of the major issues suggests that the potential of vaping to assist adult smokers to quit outweighs the potential negatives. [ABSTRACT FROM AUTHOR]

Introduction: Secondhand smoke exposure (SHSe) leads to increased mortality and morbidity. Primary care healthcare professionals (HCPs) are well placed to support patients to reduce SHSe. This paper explores HCPs': (1) knowledge around SHSe; (2) current practices to promote SHSe reduction; (3) beliefs and experiences regarding delivering interventions to reduce SHSe; and (4) identified factors that influence the delivery of SHSe-related interventions.Methods: Six electronic databases were searched for relevant literature published January 1980-February 2016. 17 quantitative and 3 qualitative studies were included in this mixed-methods review. Data synthesis followed the method outlined by the Joanna Briggs Institute. This segregated approach involved independent syntheses of the quantitative and qualitative data followed by an overall mixed-methods synthesis.Results: Primary care HCPs had a basic understanding of the risks associated with SHSe but required training to help them intervene. It was more common for HCPs to ask about SHSe or provide advice than to act to facilitate SHSe reduction. SHSe was viewed as an issue of high importance and considered relevant to the role of the primary care HCPs. However, barriers such as the priority given to the issue and the desire to protect the professional relationship with patients prevented HCPs from intervening around SHSe.Conclusions: Primary care HCPs require training, guidance, and support to enable them to intervene and support patients to effectively reduce SHSe.Implications: This review used rigorous methods to explore the current, global literature on how children's exposure to secondhand smoke is being addressed in primary care settings. The review findings highlight healthcare professionals' need for further training and support, which would enable them to better translate their knowledge of the risks associated with secondhand smoke exposure into actual clinical practices. The review identified a lack of practical action taken to address secondhand smoke exposure, even once it has been identified as an issue. [ABSTRACT FROM AUTHOR]

Introduction: Tobacco Heating System 2.2 (THS 2.2, marketed as iQOS) is a heat-not-burn (HNB) tobacco product that has been successfully introduced to global markets. Despite its expanding market, few independent and systematic researches into THS 2.2 have been carried out to date.Methods: We tested a comprehensive list of total particulate matter (TPM), water, tar, nicotine, propylene glycol, glycerin, carbon monoxide, volatile organic compounds, aromatic amines, hydrogen cyanide, ammonia, N-nitrosamines, phenol, and polycyclic aromatic hydrocarbon under both ISO and HCI regimes. We also simulated pyrolysis of THS 2.2 heating sticks and made comparisons with conventional cigarette tobacco fillers using comprehensive gas chromatography-mass spectrometry (GC × GC-MS) to determine whether the specially designed ingredients help reduce harmful constituents.Results: Other than some carbonyls, ammonia, and N-nitrosoanabasine (NAB), the delivered releases from THS 2.2 were at least 80% lower than those from 3R4F. Tar and nicotine remained almost the same as 3R4F. Interestingly, the normalized yield of THS 2.2 to 3R4F under the HCI regime was lower than that under the ISO regime.Conclusions: THS 2.2 delivered fewer harmful constituents than the conventional cigarette 3R4F. Simulated pyrolysis results showed that the lower temperature instead of specially designed ingredients contributed to the distinct shift. In particular, if smoking machines are involved to evaluate the HNB products, smoking regimes of heat-not-burn tobacco products should be carefully chosen.Implications: To our knowledge, few independent studies of HNB products have been published. In this paper, a comprehensive list of chemical releases was tested systematically and compared to those from 3R4F. Although THS 2.2 generates lower levels of harmful constituents, the nicotine and tar levels were almost identical to 3R4F.The results should be discussed carefully in the future when assessing the dual-use with other conventional cigarettes, nicotine dependence of HNB products, etc. This study also suggests that regulatory agencies should pay attention to the smoking regimes that are adopted to evaluate HNB tobacco products. [ABSTRACT FROM AUTHOR]

Introduction: Since being brought to market in 2007, cigarettes with capsules in the filter that can be burst to change the flavor have had remarkable global success, highlighting the importance of product innovation for tobacco companies. Very few studies have explored how these products are perceived by smokers however. This paper sought to address this gap by exploring smokers' awareness of cigarettes with one or two flavor-changing capsules in the filter and the appeal of these products.Methods: Twenty focus groups were conducted in Glasgow and Edinburgh in 2015 with current smokers (N = 120), segmented by age (16-17, 18-24, 25-35, 36-50, >50), gender, and social grade.Results: Awareness, use and appeal of capsule cigarettes was greater among younger adults (16-35 years), who showed most interest in these products. Those who perceived capsules positively mentioned multiple benefits: the ability to burst the capsule, convenience of being able to share cigarettes among menthol and nonmenthol smokers, better taste, fresher breath, reduced smell, and greater discretion. It was suggested that capsule cigarettes, particularly the double capsule cigarette (which had two differently flavored capsules in the filter), would encourage nonsmokers to experiment with smoking and discourage smokers from quitting.Conclusions: The findings offer some reasons behind the global growth of the capsule cigarette segment.Implications: Cigarettes with flavor-changing capsules in the filter have been one of the most successful product innovations of the last decade for tobacco companies. They have received very little academic attention however. Employing focus groups with 120 smokers aged 16 and over, we found that capsule cigarettes held most appeal to, and were considered to be targeted at, younger people, with it suggested that these products would encourage initiation and discourage cessation. This study provides some understanding of how these products are viewed by smokers. [ABSTRACT FROM AUTHOR]

Objective: Pall Mall gained significant brand share in the cigarette market between 2002 and 2013. We sought to determine whether demographic shifts occurred among the participants reporting Pall Mall as their usual brand during this time span.Method: We examined National Survey of Drug Use and Health (NSDUH) data from 2002-2014. Demographic characteristics included age, education, ethnicity, income, and cigarette use (cigarettes per day, daily/non-daily smoking, and nicotine dependence). We also examined RJ Reynolds investor reports and shareholder documents to determine the impact of tobacco marketing on the growth of Pall Mall.Results: Over 2002-2014, Pall Mall has gained among smokers 26 to 34 years of age. More Pall Mall smokers in 2014 report higher incomes (over $75000), and also report lower scores on measures of cigarette dependence, compared to 2002. Pall Mall smokers over time seem to share characteristics of premium cigarette brands smokers.Conclusion: The profile of the typical Pall Mall smoker has changed as the brand has gained market share. An association exists between brand positioning and economic forces, which has contributed to an increase in the market share for Pall Mall.Implications: It is well known that cigarette marketing drives the sale of tobacco products. The growth in the market share of Pall Mall serves as an excellent example to demonstrate how economic uncertainty paired with brand positioning and advertising worked together to serve as a catalyst for the rapid growth observed for this brand. This paper also looked at various demographic changes that occurred among Pall Mall smokers over a 12 year period and compared them to smokers of all other cigarette brands. The results of this analysis demonstrate the importance of monitoring trends over time among cigarette smokers. [ABSTRACT FROM AUTHOR]

Objective: We aimed to evaluate the association between environmental tobacco smoke (ETS) exposure and urinary cotinine levels in current adolescent smokers and nonsmokers. The secondary objective was to explore the association between ETS exposure and nicotine dependence in adolescent smokers.Methods: Using the results from a validation study for the 2012 Global Youth Tobacco Survey in Mexico, we quantified urinary cotinine levels in adolescent smokers and nonsmokers. We fitted a multivariate regression model to assess the association between household exposure to ETS and cotinine levels in adolescent smokers and nonsmokers. In addition, using the questionnaire's answers for morning cravings, we fitted a multivariate Poisson regression model to explore the association between household ETS exposure and nicotine dependence in adolescent smokers.Results: For each day of household ETS exposure, cotinine levels increase by 5% in adolescent smokers compared to a 2% increase in nonsmokers, adjusting for the number of cigarettes smoked per week, age and sex (exp(β) 1.05; 95% confidence interval [CI] [1.00, 1.10]; p = .041). Morning cravings increase 11% for each day of household ETS exposure adjusting for the number of cigarettes smoked per week, age and sex (prevalence ratio [PR] 1.11; 95% CI [0.99, 1.25]; p = .064).Conclusions: There is an association between ETS exposure and cotinine levels, and ETS may contribute to nicotine dependence in adolescent smokers. If confirmed, avoiding ETS exposure could prove helpful for addiction control and quitting in adolescents.Implications: Evidence suggests that ETS increases cotinine levels in nonsmokers and adult smokers. However, no study has explored the association between ETS exposure and cotinine levels and addiction in adolescent smokers. This paper provides evidence of an association between ETS exposure and cotinine levels in adolescent smokers: each day of environmental tobacco smoke exposure at home increased cotinine levels by 5% among smokers. In addition, morning cravings in adolescent smokers increased 11% for every day of ETS exposure. ETS exposure is a significant source of nicotine for adolescent smokers and could play an important role in addiction. [ABSTRACT FROM AUTHOR]

Introduction: Human genetic research has succeeded in definitively identifying multiple genetic variants associated with risk for nicotine dependence and heavy smoking. To build on these advances, and to aid in reducing the prevalence of smoking and its consequent health harms, the next frontier is to identify genetic predictors of successful smoking cessation and also of the efficacy of smoking cessation treatments ("pharmacogenomics"). More broadly, additional biomarkers that can be quantified from biosamples also promise to aid "Precision Medicine" and the personalization of treatment, both pharmacological and behavioral.Aims and Methods: To motivate ongoing and future efforts, here we review several compelling genetic and biomarker findings related to smoking cessation and treatment.Results: These Key results involve genetic variants in the nicotinic receptor subunit gene CHRNA5, variants in the nicotine metabolism gene CYP2A6, and the nicotine metabolite ratio. We also summarize reports of epigenetic changes related to smoking behavior.Conclusions: The results to date demonstrate the value and utility of data generated from biosamples in clinical treatment trial settings. This article cross-references a companion paper in this issue that provides practical guidance on how to incorporate biosample collection into a planned clinical trial and discusses avenues for harmonizing data and fostering consortium-based, collaborative research on the pharmacogenomics of smoking cessation.Implications: Evidence is emerging that certain genotypes and biomarkers are associated with smoking cessation success and efficacy of smoking cessation treatments. We review key findings that open potential avenues for personalizing smoking cessation treatment according to an individual's genetic or metabolic profile. These results provide important incentive for smoking cessation researchers to collect biosamples and perform genotyping in research studies and clinical trials. [ABSTRACT FROM AUTHOR]

Introduction: Over the past few decades, tobacco control efforts have made great strides in making smoke-free air the norm; 30 states in the United States have implemented 100% smoke-free laws. Despite this progress, the evolution of the measurement of secondhand smoke (SHS) exposure has lagged.Methods: Cognitive testing was used to explore the functioning and limitations of current SHS surveillance items; many items are frequently used for statewide or national surveillance. A total of 20 nonsmokers and 17 smokers participated in a cognitive interview.Results: Overreporting of SHS was evidenced in our analysis as thirdhand smoke exposure was being included in the assessment of SHS exposure, likely due to the successful implementation of indoor smoking bans. Also asking about locations of SHS exposure outside of work, home, or a personal vehicle is important because these alternative locations were sometimes the only incidence of SHS exposure.Conclusions: Survey questions about SHS should: (1) reduce the ambiguity in words and phrases of items; (2) measure location of exposure; (3) measure duration of exposure; and (4) consider alternative strategies for asking smokers questions about SHS. Assessing location and duration of exposure can inform decision-makers about future SHS programming and policy work.Implications: Commonly accepted survey measures of SHS exposure need to be reevaluated to assure that the intended interpretation of them is still accurate given significant policy and social norm change. This paper assesses current SHS surveillance items and provides recommendations for revisions. [ABSTRACT FROM AUTHOR]

Introduction: New Zealand has implemented a series of seven annual increases in tobacco tax since 2010. All tax increases, except for the first in the series, were preannounced. It is unusual for governments to introduce small, persistent, and predictable increases in tobacco tax, and little is known about the impact of such a strategy. This paper evaluates the impact of the fifth and sixth annual increases.Methods: Smokers' behaviors were self-reported during the 3-month period before, and the 3-month period after, the two annual increases. Responses to the two increases were analyzed separately, and generalized estimating equations models were used to control for sociodemographic variables, recent quit attempts, and the research design.Results: Findings were consistent across years. The proportion of participants who made a smoking-related (54%-56% before and after each tax increase) or product-related change (fifth tax increase: 17%-19%; sixth tax increase: 21%-22%) did not significantly alter from before to after each tax increase. However, it should be noted that the proportion of participants making smoking-related changes was generally high, even prior to each increase. For example, before the 2015 tax increase, 1% reported quitting completely, 21% trying to quit, and 53% cutting down.Conclusions: In New Zealand, with its series of annual tobacco tax increases since 2010, there were no significant changes in smoking- or product-related behavior associated with the fifth and sixth increases. Nevertheless, overall cessation-related activity was high, with a majority of participants reporting either quitting and/or cutting down recently.Implications: Little is known about the impact of small, persistent, predictable tobacco tax increases on smoking behavior. This study evaluated the impact of the fifth (in 2014) and sixth (2015) tax increases in an annual series implemented in New Zealand. Although there were no detectable changes in smoking behaviors from before to after each tax increase, self-reported cessation-related activity was high overall (i.e., even prior to each increase). Given that there are multiple possible interpretations for these findings, more in-depth time-series analyses are needed to understand how such a tax strategy influences smoking behavior. [ABSTRACT FROM AUTHOR]

Introduction: A previous paper used latent class analysis to assign individuals to 1 of 4 adolescent/young adult smoking trajectory classes and then established an association between maternal smoking before, during, and after pregnancy and these classes. In this paper, we examine one possible pathway for this relationship: that maternal smoking during pregnancy may set off a behavioral trajectory which increases the likelihood of problem behaviors generally, of which smoking is one manifestation. Methods: We used the Behavior Problems Index measure from age 8 through age 12 as a potential mediator. We used a path analysis modeling approach within a multinomial logistic regression (using Mplus) to estimate direct and indirect effects (via behavioral problems) between maternal smoking pattern and child trajectory class. Results: We found small but statistically significant indirect effects via behavioral problems from maternal smoking to child smoking trajectory for membership in all 3 smoking classes, relative to the nonsmoking trajectory, indicating partial mediation. Mediated effects were associated with maternal smoking after pregnancy, no statistically significant mediated effects were found for smoking before or during pregnancy. Conclusions: The results provided no evidence that the effects of maternal smoking during pregnancy on child smoking trajectory are mediated by problem behavior. Effects from smoking after birth to child smoking trajectory appear to be partially mediated by problem behavior, supporting a behavioral rather than physiological effect of smoking during pregnancy but not ruling out more complex physiological pathways. [ABSTRACT FROM PUBLISHER]

Introduction:: As smoking prevalence declines, some suggest that so-called “hardcore” smokers will come to represent a growing and irreducible proportion of current smokers (“hardening hypothesis”). Different definitions of a “hardcore” smoker have been used in the literature. This paper describes population-based definitions of “hardcore” smokers and compares estimates of the prevalence of “hardcore” smokers derived using these definitions. [ABSTRACT FROM PUBLISHER]

This review presents the available evidence on the health effects of reduced smoking. Smoking reduction was defined as reduction of the daily intake of tobacco without quitting. Only published papers were reviewed. Case reports and studies without a thorough definition of smoking reduction or health outcome were excluded. We searched in personal databases, BioMail Medline Search, Medline, the Cochrane Database of Systematic Reviews, and EMBASE. We followed the QUORUM standards for systematic reviews, and both authors read and discussed all publications. A total of 25 studies (31 publications) were identified: 8 articles reported on effects on the cardiovascular system; 11 on the airways; 7 on carcinogens, DNA damage, and lung cancer; 3 on birth weight; and 4 on other health effects. Some papers assessed more than one outcome. In most studies, reduction was defined as less than 50% of baseline tobacco consumption. Most of the studies were small, with the populations selected and short follow-up periods. The limited data suggest that a substantial reduction in smoking improves several cardiovascular risk factors and respiratory symptoms. In addition, smoking reduction is associated with a 25% decline in biomarkers and incidence of lung cancer and a small, mostly nonsignificant, increase in birth weight. There seem to be no substantial beneficial effects on lung function. The evidence on other health effects and mortality is too limited to draw conclusions. A substantial reduction in smoking seems to have a small health benefit, but more studies are needed to determine the long-term effects of smoking reduction. [ABSTRACT FROM AUTHOR]

The functional overlap of smoking and problem drinking has led researchers to speculate on the need for integrated treatment models. What of online services? With the burgeoning growth of Web-based interventions for smokers and the increasingly common online services for problem drinkers, there is the potential to provide options for smokers to also deal with any alcohol concerns. The integration of these services might also help increase smoking cessation rates, because alcohol consumption is a known trigger to smoking and also for relapse to smoking. This paper presents results of the use of an online personalized feedback assessment for drinking (Check Your Drinking, CYD) by smokers who were recruited from the Stop Smoking Center (SSC; www.stopsmokingcenter.net). Registered users of the SSC (N = 7,741) were invited to complete the CYD (now located as part of an online alcohol reduction program freely available at www.alcoholhelpcenter.net). A total of 963 SSC users responded to the invitation, providing information about their drinking as well as a summary of their current smoking and past experiences of alcohol functioning as a trigger for smoking. One-third of current daily smokers were problem drinkers (24% of occasional smokers and 22% of former smokers were current problem drinkers). Most (82%) daily smokers who were current drinkers reported they frequently or always experienced a strong urge, desire or thoughts about smoking when they drank alcohol. This brief report will explore the implications of the overlap of smoking and drinking by these online participants and will discuss the potential benefits of providing an integrated service for smokers and problem drinkers. [ABSTRACT FROM AUTHOR]

For decades, the tobacco companies have developed a worldwide campaign to oppose the creation of smoke‐free environments. Public health efforts to promote clean indoor air have been uneven throughout the world, and in few places have such efforts faced as many challenges as in Japan. The Japanese market is dominated by Japan Tobacco, which is partly owned by the government, and Philip Morris International is also present in Japan. Japan Tobacco and Philip Morris International have developed campaigns promoting courtesy and tolerance that, until recently, seem to have resonated well with the public. The companies also have supported research promoting ventilation and have funded consultants to act as experts in the area of second‐hand smoke exposure. Japan is a critical country to study, partly because of the strength of Japan Tobacco in the country and the growth of Japan Tobacco International in Southeast Asia and the rest of the world, and partly because of Japan's ratification of the World Health Organization Framework Convention on Tobacco Control. This paper uses tobacco industry documents to provide an overview of the tobacco industry's scientific and political efforts to stifle the development of clean indoor measures in Japan. Learning past industry strategies may assist policymakers and advocates in the development of future public health activities. [ABSTRACT FROM AUTHOR]

A staged model of smoking adoption has been widely applied in studies of adolescent smoking. This paper examined the effects of socioenvironmental and personal factors on three stages of the smoking continuum among a sample of 10th‐grade male students, ages 14–19 years, at 20 high schools in Shiraz city. This paper is the first step of a longitudinal study related to adolescents smoking and predictors of transition in the stages. A self‐administered questionnaire was distributed to 1,132 10th‐grade students from a possible population of 14,000 students. Multivariate discriminant function analysis was used to analyze the data. Overall 19.4% of students had smoked; 80.6%, 16.9%, and 2.5% had never smoked, had experimented, and had regularly smoked, respectively. The discriminant function analysis indicated that attitude toward smoking, use of alcohol, use of illicit drugs, smoking behavior of best friends, and self‐esteem were related to more intense smoking behaviors. Finally, these variables permitted the correct classification of 70.3% of students into the stages of smoking acquisition. This finding has important public health significance, but further research is required to determine if the association is causal. [ABSTRACT FROM AUTHOR]

With the tobacco industry developing and test marketing a wide array of modified cigarettes and novel nicotine-delivery products, the era of tobacco harm reduction is upon us. Like today's new technologies, two previous generations of cigarette innovation-filtered cigarettes in the 1950s and low tar and nicotine cigarettes in the late 1960s and early 1970s were introduced to offer smokers an ostensibly less hazardous means of smoking, and therefore an alternative to quitting. Both innovations maintained cigarette sales and consequently may well have increased the morbidity and mortality toll of smoking. Will a new generation of harm reduction products improve the public's health, or will the experience of the past half-century be repeated? This paper examines the concept of tobacco harm reduction and describes the variety of methods employed in pursuit of it. Through an examination of the experience with filters and low tar and nicotine cigarettes, and an explicit consideration of today's issues and challenges, the paper focuses attention on the essential dimensions of the contemporary harm reduction debate: how science can establish whether novel products or methods will reduce risks to health for individual smokers, or at least exposures likely to influence risks; how a determination can be made as to the likely population impacts of the introduction and marketing of novel products; how health professionals and consumers can learn the potential and limits of harm reduction; and what role for governmental regulation is possible and desirable. [ABSTRACT FROM AUTHOR]

The Eighth Annual Meeting of the Society for Research on Nicotine and Tobacco (SRNT) was held in Savannah, Georgia, on 21-23 February 2002. This meeting was the largest to date, with more than 600 registered attendees, five outstanding plenary speakers, 10 symposia, six oral paper sessions, and four filled-to-capacity poster sessions. The meeting content represented three major areas of SRNT's emphasis: Preclinical, Epidemiology/Public Health and Clinical research; thus the meeting was an outstanding opportunity to share with, and learn from, colleagues engaged in the full spectrum of nicotine and tobacco research. Additional events included pre- and post-meeting symposia, a career development question-and-answer workshop, a global network interest meeting, and a variety of awards. SRNT also remembered and honored the lives and work of two outstanding colleagues who were lost to the society over the past year: Dr. Chris Silagy and Dr. John Slade. Highly significant and innovative research continues in the field of nicotine and tobacco, and this innovation and significance was readily apparent in the science presented at the eighth annual meeting. [ABSTRACT FROM AUTHOR]