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Background and Aims: The regulatory environment for nicotine vaping products (NVPs) varies widely across countries and this will probably affect the devices used, nicotine content and usage, and hence the ability of NVPs to substitute for cigarettes. We aimed to describe the types of NVPs used by current vapers in four countries with varying regulatory and enforcement approaches toward the marketing and sale of NVPs. Methods: Data are from wave 1 (July–November 2016) of the ITC Four Country Smoking and Vaping Survey (4CV1), conducted among a cohort of current and former smokers, and current NVP users (n = 5147 adults; ≥ 18 years) in Australia (AU), Canada (CA), England (EN) and the United States (US) reporting either current daily, weekly or occasional NVP use. Devices were described by type, brand, voltage variability and refill capacity. Refill solutions were described by flavour and nicotine content. Descriptive statistics and bivariate analyses were conducted on the overall sample and stratified by country. A multinomial logistic regression examined factors associated with device preference across the whole sample. Results: The types of NVPs used differed by pattern of use and country. Exclusive, daily vapers were more likely to use refillable pen‐shaped devices [odds ratio (OR) = 10.0] or refillable box‐shaped devices (OR = 5.4) than disposable cigalike devices, when compared with other (non‐daily/dual) users. Nearly all respondents reported using flavoured NVPs, fruit (28.3%) being the most common flavour. Refillable devices were the most popular: refillable box‐shaped devices were more commonly reported by vapers in AU (36.8%) and US (31.4%), whereas in EN (47.4%) and CA (29.7%), vapers more often reported using refillable pen‐style devices. Most users also reported that their products contained nicotine, even in CA (87.8%) and AU (91.2%), where vaping products containing nicotine were technically illegal. Conclusions: In Australia, Canada, England and the United States in 2016, refillable nicotine vaping products were the most common type of nicotine vaping products used by daily vapers. Most daily vapers reported using flavoured e‐liquids/refills (with variance across countries) and most reported using products that contain nicotine, even where vaping products with nicotine were banned. [ABSTRACT FROM AUTHOR]

Objective: In this paper, we examine the brand preferences of smokers and how that relates to cigarette brand features in the Population Assessment of Tobacco and Health Survey Wave-1 (September 2013-December 2014). Methods: There were 32,320 adult and 13,651 youth participants in the survey. Analyses were restricted to current smokers who reported purchasing cigarettes, 10,493 adults and 282 youth. Frequencies, weighted percentages, and chi-square tests were reported. Results: Respondents reported purchasing a total of 58 brands with many more brand name line extensions with a greater diversity of brands reported by adults compared to youth. Marlboro, Newport, Camel, and American Spirit accounted for >90% of the purchasing among youth, while accounting for about 70% among adults. Mentholated cigarettes were smoked by over 39% of youth and 38% of adults, particularly Hispanics and Blacks. Longer- length cigarette use was more commonly reported by females, and discounted brands were more commonly used by older and daily smokers. Conclusions: Price discounting, cigarette length, use of menthol flavoring, age, and ethnicity were associated with cigarette brand preferences and purchases. Cigarette characteristics such as length, filtration, price, flavor, and general packaging could be regulated to limit the appeal of cigarettes to different sub-populations. [ABSTRACT FROM AUTHOR]

Lung cancer is one of the most lethal cancers in the USA. In 2013, new guidelines issued by the United States Preventive Services Task Force recommended lung cancer screening using low-dose computed tomography among a selected group of high-risk individuals. Specifically, lung cancer screening is recommended for heavy smokers between the ages of 55 to 79, with at least 30 pack-year smoking exposure. Former smokers who meet these guidelines and stopped smoking ≤ 15 years ago are also eligible. There is a need to promote lung cancer screening to increase early diagnosis rates and treatment options, thereby decreasing disease-specific mortality. This study was conducted to refine educational materials used to inform eligible high-risk individuals about the risks and benefits of lung cancer screening. Focus groups (n = 16) and in-depth telephone interviews (n = 5) were conducted among screening-eligible participants recruited from western New York. Main themes that emerged from the discussions included cost of obtaining the exam, eligibility criteria/information about the exam, apprehension regarding results, and an increased desire for discussions with their physician to learn more about the screening. The information gained from this study is vital to understanding concerns held by current and former smokers regarding lung cancer screening, as well as critical to determining which information is most valuable for decreasing barriers and correcting misperceptions about the lung cancer screening exam. [ABSTRACT FROM AUTHOR]

Purpose: To examine the awareness of low-dose computed tomography (LDCT) lung cancer screening among a population of current and former smokers using a nationally representative sample from the United States.Methods: Data for this study come from Wave 9 of the International Tobacco Control (ITC) United States Survey, conducted between 2013 and 2015. Among respondents age ≥ 40 (n = 1145), a 50% random sample were asked a series of questions pertaining to lung cancer screening. This study examines awareness and screening behaviors in relationship to demographic characteristics of respondents, health beliefs, psychosocial behaviors, and smoking behaviors. Descriptive tables and χ2 tests were used to examine the association between those who were aware and unaware. Logistic regression analyses were conducted, stratified on respondents' smoking status. Data were weighed to be representative of the current smoking population in the US.Results: Overall, 52% of current and former smokers reported being aware of lung cancer screening. Among the group with no prior screening, 80.6% said they would take a lung cancer screening exam if recommended by their physician. In the multivariate models, former smokers had significantly greater awareness of lung cancer screening compared to current smokers [odds ratio 1.42 (95% confidence interval 1.03, 1.97)].Conclusions: Awareness of LDCT lung cancer screening was lower among current smokers compared to former smokers. Most smokers who had not ever been screened said they would have lung cancer screening if it were recommended by their physician, demonstrating the need for healthcare providers to encourage those eligible for screening to take the test. [ABSTRACT FROM AUTHOR]

Introduction: The US cigar market is diverse, yet until recently most research studies and tobacco surveillance systems have not reported behavioral and related outcomes by cigar type.Methods: The 2013-2014 Population Assessment of Tobacco and Health Study collected data separately for filtered cigars (FCs), cigarillos, and traditional cigars, which were further distinguished as premium or nonpremium. Descriptive statistics for adult established current smokers of each cigar type and cigarettes were calculated for demographic characteristics, tobacco use patterns, purchasing behaviors and reasons for use. Adjusted prevalence ratios (APRs) using a marginal predictions approach with logistic regression assessed correlates of dual cigar and cigarette smoking.Results: Age, sex, race/ethnicity, education level, and poverty status of smokers varied according to cigar type. Daily cigar smoking prevalence and number of cigars smoked per day were higher for FCs (37.3%; median: 1.6 cigars/day, respectively), than all other cigar types (6.7%-25.3%, all p < .01; 0.1-0.4 cigars/day, all p < .01, respectively); daily smoking and cigars per day were similar for nonpremium cigars and cigarillos (p = .11; p = .33, respectively). Cigarette smoking was twice as common among smokers of nonpremium cigars, cigarillos, and FCs (58.0%-66.0%) than among premium cigars (29.9%). Among current cigar smokers, FC smokers (APR = 1.23, 95% confidence interval [CI] = 1.09-1.39), other tobacco product users (APR = 1.27, 95% CI = 1.15-1.41), and those with a GED/high school diploma or less (APR = 1.20, 95% CI = 1.09-1.33) were more likely to also smoke cigarettes.Conclusion: User characteristics, cigar smoking patterns, and dual smoking with cigarettes varied by cigar type highlighting the importance of adequately describing the cigar type studied and, where appropriate, differentiating results by cigar type.Implications: Despite the diversity of the cigar market place, historically many research studies and tobacco surveillance systems have treated cigars as a single product type. This study describes similarities and differences in the user characteristics, tobacco use patterns, and purchasing behaviors of premium, nonpremium, cigarillo, and filtered cigar smokers. To enhance tobacco regulatory science, sufficient descriptions of the cigar type(s) studied and, where appropriate, differentiation of the particular cigar type(s) studied should be undertaken to improve the interpretation of study findings, understanding of cigar use patterns and related behaviors and future approaches to reducing cigar-attributable morbidity and mortality. [ABSTRACT FROM AUTHOR]

Introduction: We characterised tobacco use, cessation patterns, and patient satisfaction with a cessation support program at an NCI Designated Comprehensive Cancer Center following a mandatory tobacco assessment and automatic referral. Methods: A 3-month follow-up survey (via web, paper, or telephone) was administered between March 2013 and November 2013 for all patients referred to and contacted by a cessation support service, and who consented to participation three months prior to administration. Patients were asked about their perceived importance and self-efficacy to quit smoking, quit attempts, and satisfaction with the cessation service. Results: Fifty-two percent (257/499) of patients who participated in the cessation support service, and consented to be contacted again, completed a follow-up survey. Of those who participated, 9.7% were referred to the service as having recently quit tobacco (in the past 30 days) and 23.6% reported having quit at the time of first contact. At the 3-month follow-up, 48.1% reported being smoke-free for the previous seven days. When patients were asked about their experience with the cessation service, 86.4% reported being very or mostly satisfied with the service, and 64.3% reported that their experience with the service increased their satisfaction with the care received at the cancer centre. Conclusions: Our findings suggest that recently diagnosed cancer patients are aware that quitting tobacco is important, are making attempts to quit, and are amenable to an opt-out automatic referral cessation support service as part of their cancer care. [ABSTRACT FROM AUTHOR]

Objectives: The US Food and Drug Administration (FDA) has regulatory authority for modified risk tobacco product advertising claims. To guide future regulatory efforts, we investigated how variations in modified risk claim advertisements influence consumer perceptions of product risk claims for Camel Snus. Methods: Young people and adults (15–65), including current, never, and former smokers, were randomised to view one of five Camel Snus print advertisements as part of a web-based survey. Four of the advertisements presented information related to nitrosamine content of snus using four formats: (1) text, (2) a bar chart, (3) a text/testimonial and (4) a bar chart/testimonial. The fifth format, used as a control, was a current advertisement for Camel Snus without the explicit claims made about nitrosamine content. After viewing advertisements for all products, participants were asked which product they would be most interested in trying. Results: Participants exposed to advertisements that contained an explicit reduced risk message agreed the advertising claim for that product posed fewer health risks than cigarettes. However, advertisements containing the reduced risk messages were also viewed as containing less truthful information and respondents were more sceptical of the information presented. Advertisement claim format was not associated with selecting snus over the other tobacco products, nor was it associated with purchase intentions. Conclusion: The results of this research indicate that consumers respond to reduced risk messages, though perhaps not in the direct way anticipated. We found no significant differences by advertisement format (numerical, graphical, testimonial). [ABSTRACT FROM AUTHOR]

Background: E-cigarettes are the latest in a line of potentially reduced exposure products that have garnered interest among smokers.Methods: In this paper, we use experimental auctions to estimate smokers' demand for e-cigarettes and to assess the impact of advertisements on willingness to pay. These are actual auctions, with winners and losers, which means hypothetical biases often seen in surveys are minimized.Results: We find smokers have positive demand for e-cigarettes, and that the print advertisements used in our study had greater effectiveness than video ads (b = 2.00, p < .05) in terms of increasing demand for disposable e-cigarettes. Demand was greater for reusable versus disposable e-cigarettes. In multivariate models, demand for e-cigarettes was higher among non-white participants and among smokers willing to pay more for cigarettes.Conclusions: Our findings suggest that cigarette smokers are interested in e-cigarettes as alternatives to traditional products, particularly for reusable forms, and that this demand can be influenced by messaging/advertising.Implications: Given these reduced harm products are appealing, if smokers are able to switch completely to e-cigarettes, there is a good chance for accrual of significant harm reduction. [ABSTRACT FROM AUTHOR]

Introduction: Waking at night to smoke can also serve as an indicator of dependence and treatment success.Aims: We sought to examine whether night smoking is associated with features of smoking behaviour in a non-treatment-seeking sample of adult smokers in the general population.Methods: Data for this study come from 1,062 current smokers obtained from an opt-in online panel in July 2010. Night smoking and night craving to smoke were assessed by questionnaire, and dependence was assessed by the Fagerstrom Test for Nicotine Dependence (FTND). Relationships were assessed using linear, logistic, and negative binomial regression.Findings: Overall, 20.6% reported that they woke at night to smoke. FTND scores were substantially higher in those reporting night smoking. Those who reported night cravings were more likely to report quit intentions. Night smokers made 3.6 actual quit attempts (95% CI: 2.8, 4.5) per year, adjusted for other model factors, compared to 2.7 (2.2, 3.2) attempts for night cravers and 2.2 (1.8, 2.7) attempts for smokers who reported neither.Conclusions: Overall, night smokers reported higher nicotine dependence than cravers and those who experienced neither. The current study adds to a growing literature pointing to the importance of overnight smoking as an indicator of nicotine dependence. [ABSTRACT FROM PUBLISHER]

In August 2015, the Food and Drug Administration (FDA) issued warning letters to cigarette manufacturers promoting brands as "natural" or "additive-free" because of concerns that such marketing claims might mislead consumers into believing that these brands are less dangerous to smoke than others. The current study examined consumer beliefs about the relative harms of "natural" cigarettes, and whether these beliefs influenced perceptions of advertising and purchase intentions when participants were shown an advertisement for American Spirit cigarettes. Data were collected using a web-based survey conducted in 2013 among 3,006 U.S.-based web panel members aged 15 to 65 years. Ratings of "natural" cigarette health risks (i.e., misperceptions) differed by sex, race, education, smoking status, and age. Controlling for perceived risks of other cigarette types, never smokers (B = -0.31, ρ < .001) and ever/former smokers (B = -0.15, ρ = .002) had significantly fewer misperceptions of "natural" cigarettes than current smokers. Current smoking (odds ratio [OR] = 17.8), believing the ad was truthful (OR = 1.18), and having more misperceptions about "natural" cigarette health risks (OR = 1.13) were independently associated with greater purchase intention. Consumers perceived cigarettes marketed as "natural" or "additive-free" as less harmful, and this influenced their perceptions of advertising claims and intention to purchase, controlling for other factors. These findings underscore Food and Drug Administration's recent warning letters. [ABSTRACT FROM AUTHOR]