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Electronic cigarettes (e-cigarettes) are the preferred smoking-cessation aid in the United States; however, there is little evidence regarding long-term effectiveness among those who use them. We used the Population Assessment of Tobacco and Health Study to compare long-term abstinence between matched US smokers who tried to quit with and without use of e-cigarettes as a cessation aid. We identified a nationally representative cohort of 2,535 adult US smokers in 2014–2015 (baseline assessment), who, in 2015–2016 (exposure assessment), reported a past-year attempt to quit and the cessation aids used, and reported smoking status in 2016–2017 (outcome assessment; self-reported ≥12 months continuous abstinence). We used propensity-score methods to match each e-cigarette user with similar nonusers. Among US smokers who used e-cigarettes to help quit, 12.9% (95% confidence interval (CI): 9.1%, 16.7%) successfully attained long-term abstinence. However, there was no difference compared with matched non–e-cigarette users (cigarette abstinence difference: 2%; 95% CI: −3%, 7%). Furthermore, fewer e-cigarette users were abstinent from nicotine products in the long term (nicotine abstinence difference: −4%; 95% CI: −7%, −1%); approximately two-thirds of e-cigarette users who successfully quit smoking continued to use e-cigarettes. These results suggest e-cigarettes may not be an effective cessation aid for adult smokers and, instead, may contribute to continuing nicotine dependence.

Author(s): Pierce, John P; Leas, Eric C; Benmarhnia, Tarik; McMenamin, Sara B; Strong, David R; Chen, Ruifeng; Messer, Karen

Author(s): Strong, David R.; Hartman, Sheri J.; Nodora, Jesse; Messer, Karen; James, Lisa; White, Martha; Portnoy, David B.; Choiniere, Conrad J.; Vullo, Genevieve C.; Pierce, John | Abstract: Objectives:The susceptibility to smoking index can be improved as it only identifies one third of future adult smokers. Adding curiosity to this index may increase the identification of future smokers and improve the identification of effective prevention messages.Methods:Analyses used data from the California Longitudinal Study of Smoking Transitions in Youth, for whom tobacco use behaviors, attitudes, and beliefs were assessed at 3 time points from age 12 through early adulthood. Logistic regressions were used to evaluate whether baseline curiosity about smoking was predictive of smoking during the 6-year follow-up period and whether curiosity about smoking provided evidence of incremental validity over existing measures of susceptibility to smoking.Results:Compared to those who were classified as definitely not curious about smoking, teens who were classified as probably not curious (ORadj = 1.90, 95% CI = 1.28–2.81) and those classified as definitely curious (ORadj = 2.38, 95% CI= 1.49–3.79) had an increase in the odds of becoming a young adult smoker. Adding curiosity to the original susceptibility to smoking index increased the sensitivity of the enhanced susceptibility index to 78.9% compared to 62.2% identified by the original susceptibility index. However, a loss of specificity meant there was no improvement in the positive predictive value.Conclusions:The enhanced susceptibility index significantly improves identification of teens at risk for becoming young adult smokers. Thus, this enhanced index is preferred for identifying and testing potentially effective prevention messages.

Objectives:Little cigars and cigarillos may resemble cigarettes, but may be less expensive and can be purchased singly and in flavored varieties. We used two major U.S. surveys to investigate use of cigarillos and cigarettes.Methods:The 2010/2011 Tobacco Use Supplement to the Current Population Survey ascertained cigar use by brand and type (little cigars/cigarillos or large/regular). The annual National Survey on Drug Use and Health (NSDUH) assessed cigar use by brand, 2002–2011. We used the available data to classify cigars by type among males in the NSDUH.Results:Estimated prevalence of little cigar use among male cigar smokers was similar using the two surveys. From 2002 to 2011, past-30-day cigarette smoking declined for all age groups and genders, but among young adult men (aged 18–25) little cigar smoking remained steady at nearly 9%. “Cigarette and/or cigar” smoking was 44% among young adult men in 2011, and was consistently 6 percentage points higher than cigarette-only smoking, from 2002 to 2011. Over 60% of male and 70% of female adolescent/young adult cigar smokers also smoked cigarettes in 2011. Most male adolescents preferred little cigars to traditional cigars. Among males, most lower income or less educated cigar smokers preferred little cigars, compared to only 16% of those with higher education.Conclusions:These patterns indicate that little cigar/cigarillo use may promote initiation and maintenance of cigarette smoking, particularly among younger and less advantaged populations. Population-level data are urgently needed to better assess type of cigar smoked and reasons for use.

BACKGROUND: Polyinosinic-Polycytidylic acid stabilized with polylysine and carboxymethylcellulose (poly-ICLC) is a double stranded RNA that acts as a ligand for the Toll Receptor 3 (TLR3) and results in a broad host defense stimulation, including T-cell and natural killer cell activation and cytokine release (interferons alpha, beta, and gamma, interleukins, corticosteroids, and TNF). The goal of this trial is to determine the efficacy of this novel immunotherapy against refractory pediatric low-grade glioma (LGG). Here we present the results for the neurofibromatosis group. METHODS: Poly-ICLC 20mcg/kg/dose IM was self-administered twice a week at home for up to 24 cycles. Each cycle is 28 days. Endpoints include objective tumor response rate, progression-free survival (PFS), and rate of stabilization/improvement in visual examination in those with optic pathway glioma. RESULTS: Twenty three patients were enrolled, six with NF-1. Of NF1 patients (3 males, 3 females), five were evaluable, ages 1–16 years. Tumor location: 4 optic pathway, one thalamic, one cervico-medullary junction. 5/6 had received more than 2 prior regimens (range 1–7). Responses (PR+SD) were observed in 4/5 (80%), with 2 SD having a decrease in tumor size by 35% and 10%, one of whom had significant improvement on visual field testing, and 2 PR having decrease in tumor size by 50% and 55%. Only low grade toxicities were observed with poly-ICLC, including erythema and pain at site of injection, fever, myalgias, and ALT elevation. One intra-tumoral hemorrhage occurred with complete resolution with medical management alone. All patients are alive. CONCLUSION: Poly-ICLC is extremely well tolerated in the NF-1 group and the single agent response rate in this small NF1 cohort is encouraging. Expanded phase II testing of poly-ICLC in the NF-1 cohort is planned.

Introduction: Smoke-free homes are known to reduce expo- sure to harmful secondhand smoke. Recent studies suggest that they may also positively affect smoking behavior among smokers themselves. Methods: We review the literature on the effect of smoke-free homes on adult smoking behavior. The literature search included database (PubMed) and manual searches of related articles and reference lists for English-language studies published from 1 January 1990 to 16 November 2008. Results: We identifi ed 16 cross-sectional and 7 longitudinal studies of the population-level association of smoke-free homes with adult smoking behavior. Additional studies provided population estimates of trends in and correlates of smoke-free homes. Prevalence of smoke-free homes varies but has been increasing over time in the countries studied and was greater among smokers who were younger, of higher income or educa- tional attainment, smoked fewer cigarettes per day, or lived with a nonsmoking adult or child. Both longitudinal and cross- sectional studies showed that smokers who had or who newly implemented a smoke-free home were signifi cantly more likely to make a quit attempt and to be abstinent, after controlling for confounding factors. In longitudinal studies, those who continued to smoke had a modest, but signifi cant, decrease in cigarette consumption at follow-up. Discussion: There is strong and consistent population-level evidence that a smoke-free home is associated with increased smoking cessation and decreased cigarette consumption in adult smokers. As they not only reduce exposure to second- hand smoke but also increase cessation rates, promotion of smoke-free homes should be a key element in tobacco control programs.

INTRODUCTION During the 1990s, both prevalence and average cigarette consumption declined in the United States, but age-specific changes have not been reported. METHOD All four of the nationally and state representative U.S. Current Population Surveys-Tobacco Use Supplements from 1991-2002 (n = 542,470) were analyzed for trends in cigarette consumption among smokers in three age groups: 18-29, 30-44, and 45-64 years. A strength of tobacco control index ranking state of residence was added and weighted logistic regression analyses undertaken. RESULTS Over the decade, both prevalence and average consumption declined. Moderate-heavy smoking (> or =15 cigarettes/day [CPD]) prevalence fell strongly over the period in all three age groups. For those aged > or =30 years, this reduction was accompanied by a similar drop in total smoking prevalence. For those aged 18-29 years, this reduction was associated with an increase in very light smoking (

BACKGROUND: Dexanabinol is a synthetic analogue of tetrahydrocannabinol previously developed as a neuroprotector and subsequently identified through a network pharmacology platform as a potential anti-cancer therapeutic by e-Therapeutics PLC. Dexanabinol was selected for further investigation based on its tumoricidal activity observed in vitro and in vivo, presumably due to inhibitory activity against NFκB, COX-2, and TNFα. This phase I dose-escalation trial examines the safety of multiple dosing of dexanabinol and drug penetration into the central nervous system in patients with brain cancer. METHODS: Patients having failed prior therapy or having no further available standard therapies and Karnofsky Performance Score of ≥ 60% were included. Dose escalation was performed using a‘3 + 3’ design. Patients received weekly dexanabinol via an intravenous infusion. The objectives were to determine the safety, tolerability, recommended phase 2 dose, pharmacokinetics, and antitumor activity. RESULTS: 26 patients have been enrolled at escalating doses of dexanabinol (range 2 to 36 mg/kg). Two patients at the highest dose level were non-evaluable for dose tolerability and no dose limiting toxicities occurred in this study. Dose escalation was stopped due to emerging data in another clinical study (ETS2101-001). To date, adverse events attributed to dexanabinol were grades 1 or 2 and consisted of a depressed level of consciousness and lightheadedness in 3/26 pts; diarrhea and itching in 2/26 pts; fatigue, chest discomfort and tingling in mouth in 1/26 pts. From 2 to 36 mg/kg, systemic exposure to dexanabinol (AUC0-∞ and Cmax) increased greater than dose proportionately; dexanabinol was present in appreciable levels in the CSF, which implies the possibility of exposure of intracranial tumors to drug. Four of 24 efficacy-evaluable patients (17%) experienced stable disease with median duration of two cycles (28-day cycle) as best response. CONCLUSIONS: Dexanabinol was safe and well-tolerated warranting continued investigation. A Phase 1b program with dexanabinol is planned.