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North American Quitline Consortium
February 2016

For quick navigation, please click on the titles below of the topics featured in this month's issue of Connections
  Time-Sensitive News


BOARD ELECTION! Who Should Serve on the NAQC Board in 2017? 
Your opinion matters! Please let us know who you would like to see added to the NAQC Board of Directors! 

We are counting on you to help us find outstanding candidates again this year. All NAQC members may submit candidate names. You are welcome to recommend names of candidates whom you nominated in past  years as well. You can find a list of board members here and detailed information on the election process here
For each person you would like to recommend, please provide the following information to Dr. Barbara Schillo, Chair of the Nomination Committee, c/o by March 4:
1. Full name, contact information and brief resume for the person; 
2. Your rationale for recommending this person as a candidate; and
3. Confirmation that you have spoken to the person and know that s/he is willing to have her/his name put forward to the Nomination Committee for consideration.

» learn more

Share NAQC’s Updated List of Recommended Quitline Service Providers with Your Partners!
To assist states in promoting high quality quitline services to health plans and employers, NAQC has updated its Service Provider list.   The list includes  contact information, services offered and general information on service providers who contract with health plans and employers.

For more information about promoting quitline services to insurers/employers or establishing partnerships, please contact Deb Osborne, NAQC public-private partnership initiative manager at
Final Comments to HUD on Smoke-Free Housing! 
NAQC submitted comments to the U.S. Department of Housing and Urban Development (HUD) that are strongly supportive of HUD’s proposal to implement a national smoke-free rule for public housing authorities (PHAs). NAQC has also signed on to comments, authored by CTFK and TCLCResearch has demonstrated that smoke-free housing has a significant, positive impact on the quality of indoor air, reduces the risk of catastrophic fires and reduces the cost of maintenance of housing units. Although not a goal of the HUD proposal, NAQC hopes that the proposed smoke-free rule also will encourage many residents to quit smoking, thereby improving their health for years to come. 
» learn more

 Find more NAQC News in our Newsroom or go back to top.

Time-Sensitive News

February 17 Webinar: Reducing Tobacco Use among African Americans and Youth: What's Menthol Got To Do With It? 
In celebration of African American History month, SCLC is hosting a webinar on February 17th, "Reducing Tobacco Use among African Americans and Youth: What's Menthol Got To Do With It?". African Americans have the highest rate of hypertension of all ethnic groups in the U.S. With the tendency to develop high blood pressure earlier in life, this then also places the population at higher risk for heart disease. Both are smoking attributable diseases.  Dr. Phillip Gardner is the webinar presenter; he has lectured around the country on African American health disparities and smoking of menthol cigarettes in the Black community. 
» register

February 24 Webinar: FY2015 Annual Survey Presentation!
NAQC is pleased to announce data from the FY2015 Annual Survey will be presented on February 24, 2016 at 2pm – 3:30pm (ET). Please save the date and time. We are excited to present the findings back to NAQC members and discuss the current state of quitline services, budgets, utilization, and evaluation data. 
» register

Deadline of February 29: Call for Manuscripts about Tobacco and Secondhand Smoke!
The American Academy of Pediatrics Julius B. Richmond Center of Excellence is soliciting manuscripts to be featured in an upcoming special issue of Pediatrics. The special issue, edited by Sharon A. McGrath-Morrow, MD, MBA, FAAP and Karen M. Wilson, MD, MPH, FAAP will focus on secondhand smoke exposure (SHS) in children and families.

The supplement aims to provide an overview of current research surrounding SHS exposure in children, best practices to reduce SHS exposure, and strategies for pediatric clinicians to address tobacco and smoke exposure in practice. The supplement will also discuss the health impact of thirdhand smoke, exposure to marijuana smoke, and electronic cigarettes. The anticipated publication date for the supplement is fall 2016.
Potential Topics for Papers include:
  • Health outcomes of SHS exposure
  • International impact of SHS on child health
  • Clinical screening and interventions for parents and youth
  • National attitudes about SHS and tobacco use
  • SHS as a factor in poverty, health disparities, and toxic stress
  • Impact of regulation and local, state and national policy on reducing SHS exposure
  • Partnerships between physicians and policy makers
  • Multi-unit housing and SHS
  • Second- and thirdhand effects of electronic nicotine delivery systems (ENDS)
  • Impact of secondhand marijuana smoke
Interested authors should submit an extended abstract (1-2 pages) by February 29, 2016. Abstracts can be submitted to Elizabeth Katta at Please contact Elizabeth if you have any questions or would like more information. 

Deadline of March 1: FDA Tobacco Fellowship Application is Now Open!
The Food and Drug Administration is offering mid-career professionals the opportunity to spend a year as a Tobacco Regulatory Science Fellow in the Center for Tobacco Products (CTP). Through this collaborative program between the CTP and the National Academy of Medicine, fellows actively participate in the development of science-based public health strategies, serve as leads for defined projects, meet with policy leaders, and acquire new knowledge. Opportunities are available in the following areas within the CTP: Compliance and Enforcement, Health Communication and Education, Management, Regulations, Policy, and Science.
» learn more

Deadline of March 9: American Lung Association & The C. Everett Koop Institute present:
Unsung Heroes’ Award!
In the war against Big Tobacco, there are many people who fight daily to prevent kids from smoking and help smokers quit. A victory occurs every time a smoker quits and every time a kid chooses not to pick up a cigarette. These victories are so important, and they save lives. However, they often go uncelebrated – as do the people who helped make them happen.

That is why the American Lung Association and The C. Everett Koop Institute at Dartmouth present our annual Unsung Heroes’ Award: to celebrate the heroes that make a tobacco-free future possible. The next award recipient will be announced on June 24, 2016 at an Awards Dinner in Chicago, IL.

Please recognize your colleagues, friends and heroes by nominating them for the Unsung Heroes’ Award.  Anyone can submit a nomination.  Anyone working to end the tobacco epidemic in the United States is eligible and all qualified candidates will be considered for the award, including staff and volunteers of the American Lung Association and other organizations working on tobacco control and prevention.

To nominate a candidate, please submit the following:
  1. A letter from the nominator, not to exceed two pages, outlining the reasons for the nomination.
  2. A seconding letter, not to exceed one page.
  3. A curriculum vitae or summary of the candidate’s activities in tobacco control.
All materials must be submitted no later than Wednesday, March 9, 2016. Nomination materials must be grouped together, and emailed to Anne DiGiulio at or mailed to American Lung Association, c/o Anne DiGiulio; 1301 Pennsylvania Ave. Suite 800, Washington, DC 20004. 

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Cessation and Tobacco Control News

CDC Launches Fifth Year of its “Tips from Former Smokers” National Advertising Campaign!
On January 25, CDC launched a new series of its “Tips from Former Smokers” national ad campaign, featuring personal stories on the topics of chronic obstructive pulmonary disease, depression, e-cigarette dual use, and other smoking-related conditions. Advertisements featuring these new stories will run for 20 consecutive weeks on television, radio, billboards, and online, and in magazines and newspapers. 

» learn more

CDC Infographic: Electronic Nicotine Delivery Systems (ENDS) Key Facts.
Outlines what we currently know about e-cigarettes, trends in use, and more.

Run to Quit!
Run to Quit is a new 10-week program in Canada that encourages smokers to quit smoking by taking up running while using a specific step by step method. Run to Quit combines various tools proven to help people quit smoking AND increase their level of regular physical activity. The clinic leaders provide information, guidance and support to participants helping them to learn how to become and stay quit.  
» learn more

BHWP 2016 Build a Clinic Program: Request for Applications!
The Behavioral Health & Wellness Program and its partners, the Department of Family Medicine at the University of Colorado School of Medicine and ECHO Colorado, are pleased to release this Request for Applications to join the 2016 Build a Clinic Learning Community.

The Build a Clinic program is a comprehensive curriculum designed to provide primary care practices with all the skills and knowledge they need to evaluate and redesign current workflows to incorporate or augment tobacco cessation services and supports.

During the six month program, participating practices will enjoy exclusive access to six live, collaborative learning sessions with nationally recognized subject matter experts in the areas of tobacco cessation and workflow redesign and three personalized one-on-one technical assistance sessions CMEs and CEUs may be available.

For more information visit the Behavioral Health and Wellness Program website:
To apply to join, fill out the online application:

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Fabiana Lorencatto, Robert West, Carla Bruguera, Leonie S. Brose, Susan Michie
Assessing the Quality of Goal Setting in Behavioural Support for Smoking Cessation and its Association with Outcomes.
Ann Behav Med. 2015 Nov 24.
Smoking cessation behavioural support can be effective but practitioners differ markedly in effectiveness, possibly due to variation in the quality of delivery of key behaviour change techniques, such as goal setting (i.e. setting a quit date). This study aimed to (i) develop a reliable method for assessing the quality of practitioners’ support in setting quit dates and (ii) assess whether quality predicts initiation of abstinence as a first step to quitting. A scale for scoring the quality of goal setting was developed from national guidance documents and applied to 85 transcribed behavioural support sessions. Inter-rater reliability was assessed. Associations between quality scores and quit attempts were assessed.
The 10-item scale produced had good inter-rater reliability (Kappa = 0.68). Higher quality goal setting was associated with increased self-reported quit attempts (p < .001; OR = 2.60, 95 % CI 1.54–4.40). The scale components ‘set a clear quit date’ (χ 2 (2, N = 85) = 22.3, p < .001) and ‘within an appropriate timeframe’ (χ 2 (2, N = 85) = 15.5, p < .001) were independently associated with quit attempts. It is possible to reliably assess the quality of goal setting in smoking cessation behavioural support. Higher quality of goal setting is associated with greater likelihood of initiating quit attempts.
Nohlert E, Öhrvik J, Helgason ÁR.
Non-responders in a Quitline Evaluation are More Likely to be Smokers - A Drop-out and Long-term Follow-up Study of the Swedish National Tobacco Quitline.
Tob Induc Dis. 2016 Feb 3;14:5. doi: 10.1186/s12971-016-0070-2. eCollection 2016.
A previous randomized controlled trial (RCT) of the Swedish National Tobacco Quitline detected no significant differences in smoking cessation outcomes between proactive and reactive services at 12-month follow-up. However, the response rate was only 59 % and non-responders were over-represented in the proactive service. We performed a drop-out analysis to assess the smoking status of initial responders and non-responders. At 29-48 months after the first call, a postal questionnaire with six questions was sent to 150 random clients from the RCT database, with equal numbers from the proactive and reactive services as well as responders and non-responders at 12-month follow-up. Clients who did not return the questionnaire were contacted by telephone. The outcome measures were point prevalence (PP) and 6-month continuous abstinence (CA), and their associations with response status at 12 months were assessed by logistic regression.
The response rate was 74 % (111/150). Abstinence was significantly higher among initial responders than non-responders (PP 54 % vs. 32 %, p = .023 and CA 49 % vs. 21 %, p = .003). The odds ratios for initial responders vs. initial non-responders were, for PP = 2.5 (95 % CI 1.1-5.6, p = .024), and for CA = 3.7 (95 % CI 1.5-8.9, p = .004), after adjusting for proactive/reactive service. Non-responders to a 12-month follow-up smoking cessation questionnaire in a quitline setting were more likely to be smokers 1.5-3 years later. We propose a conservative correction factor of 0.8 for self-reported abstinence in telephone-based cessation studies if the response rate is approximately 55-65 %.

Dube SR, Pesko MF, Xu X.
A Cross-sectional Examination of What Smokers Perceive to be Important and Their Willingness to Pay for Tobacco Cessation Medications.
J Public Health Manag Pract. 2016 Jan-Feb;22(1):48-56. doi: 10.1097/PHH.0000000000000338.
Tobacco smoking is the leading cause of preventable morbidity and mortality in the United States, and smoking cessation has multiple health benefits. The purpose of this study was to assess cigarette smokers' perceived importance toward characteristics of tobacco cessation medications using a willingness-to-pay approach. Cross-sectional analysis of data from the 2008 HealthStyles survey, a mail-based probability sample of 5399 adults aged 18 years and older. Point estimates and 95% confidence intervals were calculated overall and by sociodemographic and smoking behavior characteristics. Multivariate Probit regression analysis was used to evaluate smokers' willingness to pay in relation to perceived importance of 3 cessation medication characteristics: convenience of use, over-the-counter availability, and efficiency to help quit. All models controlled for sociodemographic characteristics, smoking behavior characteristics, and US regional fixed effects. A total of 914 current cigarette smokers. The main outcome measures were: Interest in quitting, interest in using cessation medications, and willingness to pay for 6 types of cessation medications.
 Approximately 68.4% of current cigarette smokers were interested in quitting. Among these individuals, 45.6% indicated that they were interested in using cessation medications, and of these, 47.3% indicated that they were willing to pay $150 or more out-of-pocket for these medications. Convenience of use and the effectiveness of these medications to help quit were positively associated with current smokers' willingness to pay for $300 or more (P < .05); however, no association was observed for over-the-counter availability. Self-reported exposure to telephone quitline advertisements was also positively associated with the willingness to pay. Approximately 68% of current smokers are interested in quitting, and about half of those smokers interested in quitting are also interested in using cessation medications. Convenience of use and the medication's effectiveness are important characteristics of cessation medication for smokers with quit intentions. Understanding preferences for these cessation medication characteristics may help inform smoking cessation efforts.

Villanti AC, Bover Manderski MT, Gundersen DA, Steinberg MB, Delnevo CD.
Reasons to Quit and Barriers to Quitting Smoking in US Young Adults.
Fam Pract. 2016 Jan 4. pii: cmv103. [Epub ahead of print]
Young adulthood provides an enormous opportunity to alter trajectories of smoking behaviour for a large public health impact. The purpose of this study was to examine correlates of perceived barriers to quitting smoking and reasons to quit in a sample of young adult current and former smokers. This study used data from the 2011 National Young Adult Health Survey, a random-digit-dial cellphone survey. Participants were US young adult current smokers aged 18-34 (n = 699) and young adults who were either current smokers who had made a quit attempt in the past-year (n = 402) or former smokers (n = 289). Correlates of barriers to quitting smoking and reasons for quitting smoking were assessed using bivariate and multivariable analyses.

More than half of current smokers identified 'loss of a way to handle stress' (59%) and 'cravings or withdrawal' (52%) as barriers to quitting. Female gender, daily smoking and intention to quit remained significantly associated with endorsing 'loss of a way to handle stress' as a barrier to quitting in multivariable analyses. The two most popular reasons for quitting smoking were physical fitness (64%) and the cost of tobacco (64%). These findings highlight barriers to cessation and the reasons that young smokers give for quitting. This information may be helpful to physicians as they counsel their young adult patients to quit smoking.

Emmert Roberts, A. Eden Evins, Ann McNeill and Debbie Robson
Efficacy and Tolerability of Pharmacotherapy for Smoking Cessation in Adults with Serious Mental Illness: A Systematic Review and Network Meta-analysis.
Addiction. Article first published online: 19 JAN 2016. DOI: 10.1111/add.13236
To assess the efficacy and tolerability of adjunctive pharmacotherapy for smoking cessation in adults with serious mental illness (SMI) by means of a systematic review and network meta-analysis. We searched Embase, Medline, PsychINFO and the Cochrane Central Register of Controlled Trials from database inception to 1 December 2014 for randomized controlled trials (RCTs) published in English. We included all studies of smokers with SMI (including schizophrenia, schizoaffective disorder, bipolar disorder, delusional disorder and depressive psychoses) who were motivated to quit smoking. Pharmacotherapies included nicotine replacement therapy (NRT), bupropion and varenicline delivered as monotherapy or in combination compared with each other or placebo. The efficacy outcome was self-reported sustained smoking cessation, verified biochemically at the longest reported time-point. The tolerability outcome was number of patients discontinuing the trial due to any adverse event.

Seventeen study reports were included, which represented 14 individual RCTs. No trials were found in patients with depressive psychoses, delusional disorder or that compared NRT monotherapy with placebo. A total of 356 and 423 participants were included in the efficacy and tolerability analyses, respectively. From the network meta-analysis, both bupropion and varenicline were more effective than placebo [odds ratio (OR) = 4.51, 95% credible interval (CrI) = 1.45–14.04 and OR = 5.17, 95% CrI = 1.78–15.06, respectively]. Data were insensitive to an assessment of varenicline versus bupropion (OR = 1.15, 95% CrI = 0.24–5.45). There were no significant differences in tolerability. All outcomes were rated by GRADE criteria as very low quality. The limited evidence available to date suggests that bupropion and varenicline are effective and tolerable for smoking cessation in adults with serious mental illnesses.
Molly McCarthy, MPH, Mohammad Siahpush, PhD, Raees A. Shaikh, MPH and Asia Sikora Kessler, PhD
Social Disparities in Unaided Quit Attempts Among Daily Current and Former Smokers: Results From the 2010-2011 Tobacco Use Supplement to the Current Population Survey.
Nicotine Tob Res (2016)doi: 10.1093/ntr/ntw007First published online: January 13, 2016 

There are well-documented inverse relationships between smoking and smoking cessation with measures of socio-economic status. This study used nationally representative data to examine unaided quit attempts and their socio-demographic determinants among daily current and former smokers who made a quit attempt in the last 12 months.  We used data from the 2010-2011 Tobacco Use Supplement to the Current Population Survey. We limited the analysis to current daily smokers who made a quit attempt in the past year and former smokers who were daily smokers one year prior to the survey (N=8,201).
Nearly sixty-two percent (n=5,078) of the sample made an unaided quit attempt. Adjusted results indicated unaided quit attempts were more likely among males compared to females (p<.001), younger age groups compared to older age groups (p<.001), non-Hispanic blacks compared to non-Hispanic whites (p<.001), among people with lower income compared to people with higher income (p<.001), and among people with lower nicotine dependence compared to those with higher nicotine dependence (p<.001). Most quit attempts were unaided and there were significant socio-demographic disparities in unaided quit attempts. Considering that cessation aids enhance the likelihood of quitting, policies and programs should target populations which are more likely to attempt quitting without an aid and encourage them to use or provide subsidized cessation aids. Healthcare providers should advise their patients about approaches to quitting.

Kelsey Pateman, Pauline Ford, Lisa Fizgerald, Allyson Mutch, Kym Yuke, Billie Bonevski and Coral Gartner
Stuck in the Catch 22: Attitudes Towards Smoking Cessation Among Populations Vulnerable to Social Disadvantage.
Addiction. Article first published online: 5 JAN 2016. DOI: 10.1111/add.13253

Qualitative focus groups with participants recruited through community service organizations (CSO). Metropolitan and regional settings in Queensland, Australia. Focus groups were held at the respective CSO facilities. Fifty-six participants across nine focus groups, including people living with mental illness, people experiencing or at risk of homelessness (adult and youth populations), people living with HIV, people living in a low-income area and Indigenous Australians.

Thematic, in-depth analysis of focus group discussions. Participant demographic information and smoking history was recorded. Smoking behaviour, smoking identity and feelings about smoking were reflective of individual circumstances and social and environmental context. Participants felt ‘trapped’ in smoking because they felt unable to control the stressful life circumstances that triggered and sustained their smoking. Smoking cessation was viewed as an individual's responsibility, which was at odds with participants' statements about the broader factors outside of their own control that were responsible for their smoking. Highly disadvantaged smokers' views on smoking involve contradictions between feeling that smoking cessation involves personal responsibility, while at the same time feeling trapped by stressful life circumstances. Tobacco control programmes aiming to reduce smoking among disadvantaged groups are unlikely to be successful unless the complex interplay of social factors is carefully considered.

Adam M. Leventhal, PhD
The Sociopharmacology of Tobacco Addiction: Implications for Understanding Health Disparities.
Nicotine Tob Res (2016) 18 (2):110-121.doi: 10.1093/ntr/ntv084First published online: April 18, 2015

Efforts to reduce the public health burden of tobacco use have not equally benefited all members of society, leading to disparities in tobacco use as a function of ethnicity/race, socioeconomic position, physical/behavioral comorbidity, and other factors. Although multilevel transdisciplinary models are needed to comprehensively understand sources of tobacco-related health disparities (TRHD), the incorporation of psychopharmacology into TRHD research is rare. Similarly, psychopharmacology researchers have often overlooked the societal context in which tobacco is consumed. In an effort to facilitate transdisciplinary research agendas for studying TRHD and the psychopharmacology of tobacco use, this article introduces a novel paradigm, called “sociopharmacology.”

Sociopharmacology is a platform for investigating how contextual factors amplify psychopharmacological determinants of smoking to disproportionately enhance vulnerability to smoking in populations subject to TRHD. The overall goal of sociopharmacology is to identify proximal person-level psychopharmacological mechanisms that channel distal societal-level influences on TRHD. In this article I describe: (1) sociopharmacology’s overarching methodology and theoretical framework; (2) example models that apply sociopharmacology to understand mechanisms underlying TRHD; (3) how sociopharmacological approaches may enhance the public health impact of basic research on the psychopharmacology of tobacco use; and (4) how understanding sociopharmacological mechanisms of TRHD might ultimately translate into interventions that reduce TRHD.

Ji-Yeun Park, Dong-Chul Seo, and Hsien-Chang Lin
E-Cigarette Use and Intention to Initiate or Quit Smoking Among US Youths.
American Journal of Public Health.

Published online ahead of print January 21, 2016: e1–e7. doi:10.2105/AJPH.2015.302994
We assessed whether e-cigarette use is associated with (1) intention to smoke cigarettes among never-smoking youths and youth experiementers, and (2) intention to quit smoking among current youth smokers. We categorized participants from the 2012 National Youth Tobacco Survey data (n=20,193) as never-smoking youth (n=16,238), youth experimenters (n=3,248), and current youth smokers (n=707). We match groups on the basis of propensity score comprising covariates predicting e-cigarette use.

E-cigarette users who has never smoked cigarettes (adjusted odds ratio [AOR] = 3.62; 95% confidence interval [CI] = 2.04, 6.45) and who had experimented with smoking (AOR = 1.99; 95% CI=1.50, 2.64) had elevated intention to smoke cigarettes compared with their counterparts who had never used e-cigarettes. We did not find any significate association between e-cigarette use and intention to quit smoking among current youth smokers (P=.33). E-cigarette use among US youths is associated with intention to smoke but not with intention to quit smoking.

Tuo-Yen Tseng, MA, Jamie S Ostroff, PhD, Alena Campo, BS, Meghan Gerard, MPA, Thomas Kirchner, PhD, John Rotrosen, MD and Donna Shelley, MD MPH
A Randomized Trial Comparing the Effect of Nicotine Versus Placebo Electronic Cigarettes on Smoking Reduction Among Young Adult Smokers.
Nicotine Tob Res (2016)doi: 10.1093/ntr/ntw017First published online: January 17, 2016 

Electronic cigarette (EC) use is growing dramatically with use highest among young adults and current smokers. One of the most common reasons for using ECs is interest in quitting or reducing cigarettes per day (CPD); however there are few randomized controlled trials (RCT) on the effect of ECs on smoking abstinence and reduction. We conducted a two-arm; double-blind RCT. Subjects were randomized to receive 3-weeks of either disposable 4.5% nicotine EC (intervention) or placebo EC. The primary outcome was self-reported reduction of ≥50% in the number of CPDs smoked at week 3 (end of treatment) compared to baseline. Study subjects (n=99) were young adult (21-35), current smokers (smoked ≥10 CPDs) living in NYC.
Compared with baseline, a significant reduction in CPDs was observed at both study time periods (1 and 3 weeks) for intervention (p<.001) and placebo (p<.001) groups. Between-group analyses showed significantly fewer CPDs in the intervention group compared to the placebo group at week 3 (p=.03), but not at any other follow-up periods. The logistic regression analysis showed that using a greater number of ECs, treatment condition and higher baseline readiness to quit were significantly associated with achieving ≥50% reduction in CPDs at the end of treatment. A diverse young adult sample of current everyday smokers, who were not ready to quit, was able to reduce smoking with the help of ECs. Further study is needed to establish the role of both placebo and nicotine containing ECs in increasing both reduction and subsequent cessation.

Jidong Huang, PhD, Yoonsang Kim, PhD, Lisa Vera, BA, Sherry L. Emery, PhD
Electronic Cigarettes Among Priority Populations: Role of Smoking Cessation and Tobacco Control Policies.
American Journal of Preventive Medicine, Vol. 50 Issue 2 

The electronic cigarette (e-cigarette) market has evolved rapidly in recent years, with exploding growth in brands and product types; however, e-cigarette use among priority (sexual minority and low-income) populations and its relationship with smoking-cessation and tobacco control policies have yet to be fully characterized. The authors conducted a nationally representative online survey of 17,522 U.S. adults in 2013. Participants were drawn from GfK’s KnowledgePanel®. Logistic regression models were used to analyze relationships between e-cigarettes (awareness, ever use, current use) and cigarette smoking and cessation behaviors, tobacco control policies, and demographics. Analyses were conducted in 2014.
Approximately 15% of participants reported ever use of e-cigarettes, 5.1% reported current use, and 34.5% of ever users reported current use. E-cigarette awareness was lower among women, minorities, and those with low education. Ever and current use of e-cigarettes was higher among current cigarette smokers, young adults, and those with low SES; both ever use and current use were correlated with current cigarette smoking status, particularly when combined with quit intentions or attempts. Lesbian/gay/bisexual/transgender respondents had higher rates of ever use and current use. Ever use was lower in states with comprehensive smoking bans. No significant relationship between cigarette price and e-cigarette use was detected. Ongoing surveillance of e-cigarette use among subpopulation groups and monitoring their use for combustible cigarette cessation are needed. Important variations in the patterns and correlates of e-cigarette awareness and use exist among priority populations. These findings have implications for future e-cigarette policy decisions.

Michael F. Pesko, Donald S. Kenkel, Hua Wang and Jenna M. Hughes
The Effect of Potential Electronic Nicotine Delivery System Regulations on Nicotine Product Selection.
Addiciton. Article first published online: 20 JAN 2016. DOI: 10.1111/add.13257
To estimate the effect of potential regulations of electronic nicotine delivery systems (ENDS) among adult smokers, including increasing taxes, reducing flavor availability and adding warning labels communicating various levels of risk. We performed a discrete choice experiment (DCE) among a national sample of 1200 adult smokers. We examined heterogeneity in policy responses by age, cigarette quitting interest and current ENDS use. Our experiment overlapped January 2015 by design, providing exogenous variation in cigarette quitting interest from New Year resolutions. This study used a KnowledgePanel, an online panel of recruited respondents with a total of 1200 adult smokers from the United States. Measurement was hypothetical purchase choice of cigarettes, nicotine replacement therapy and a disposable ENDS.
Increasing ENDS prices from $3 to $6 was associated with a 13.6 percentage point reduction in ENDS selection (P < 0.001). Restricting flavor availability in ENDS to tobacco and menthol was associated with a 2.1 percentage point reduction in ENDS selection (P < 0.001). The proposed Food and Drug Administration (FDA) warning label was associated with a 1.1 percentage point reduction in ENDS selection (P < 0.05) and the MarkTen warning label with a 5.1 percentage point reduction (P < 0.001). We estimated an ENDS price elasticity of −1.8 (P < 0.001) among adult smokers. Statistically significant interaction terms (P < 0.001) imply that price responsiveness was higher among adult smokers 18–24 years of age, smokers who have vaped over the last month and smokers with above the median quitting interest. Young adult smokers were 3.7 percentage points more likely to choose ENDS when multiple flavors were available than older adults (P < 0.001). Young adult smokers and those with above the median cigarette quitting interest were also more likely to reduce cigarette selection and increase ENDS selection in January 2015 (P < 0.001), potentially in response to New Year's resolutions to quit smoking. Increased taxes, a proposed US Food and Drug Administration warning label for electronic nicotine delivery systems and a more severe warning label may discourage adult smokers from switching to electronic nicotine delivery systems. Reducing the availability of flavors may reduce ENDS use by young adult smokers.

Jean-François Etter
Characteristics of Users and Usage of Different Types of Electronic Cigarettes: Findings From an Online Survey.
Addictions Article first published online: 13 JAN 2016. DOI: 10.1111/add.13240
Studying users of e-cigarettes is important to help determine whether these devices aid smoking cessation. Obtaining data in representative samples is difficult, but online surveys of users may begin to build a picture. Therefore, this study aimed, through a large online survey, to describe usage and characteristics of users of e-cigarettes. Cross-sectional internet survey between 2012 and 2014.
A total of 2807 current e-cigarette users enrolled via e-cigarette and smoking cessation websites, who lived in France (n = 988), the United States (n = 579), Switzerland (n = 310), the United Kingdom (n = 143) and other countries (n = 787). Type of e-cigarette used: pre-filled cartridges (n = 71), unmodified refillable tanks (n = 758), modified refillable tanks (n = 392), patterns of use, perceived effects.
Pre-filled models were perceived to be less effective than unmodified refillable tanks for smoking cessation by former smokers (‘definitely helped’: 74% vs. 94%, P < 0.001) and by current smokers for smoking reduction (‘definitely helped’: 37% vs. 78%, P < 0.001). Users modified their e-cigarettes mainly to obtain a better taste (‘very true’ 60%, 55.5–64.5%). Modified tanks were perceived to make it easier to abstain from smoking than unmodified tanks 95% vs. 89%, P < 0.001); 34% of users of pre-filled cartridges, 60% of users of unmodified tanks and 83% of users of modified tanks were men (P < 0.001).

Newer-generation e-cigarettes were perceived to be more satisfactory and more effective for refraining from smoking than older models. Women tended to use pre-filled, unmodified models, which were perceived by participants to be the least effective in terms of abstaining from smoking.

Peter V. Dicpinigaitis, MD, Alfredo Lee Chang, MD, Alis J. Dicpinigaitis and Abdissa Negassa, PhD
Effect of Electronic Cigarette Use on the Urge-to-cough Sensation.
Nicotine Tob Res (2016)doi: 10.1093/ntr/ntw021First published online: January 22, 2016

Electronic cigarettes have attained common usage worldwide, yet knowledge of their physiological effects remains minimal. The aim of this study was to evaluate the effect of a single exposure to electronic cigarette vapor on the urge-to-cough (UTC) threshold and cough reflex sensitivity. 17 healthy nonsmokers underwent cough reflex sensitivity measurement employing capsaicin cough challenge at baseline, 15 minutes, and 24 hours after electronic cigarette exposure (30 puffs 30 seconds apart). The endpoint of cough challenge is C5, the concentration of capsaicin inducing ≥5 coughs. The UTC threshold, Cu, is defined as the lowest concentration of capsaicin inducing UTC without an associated motor cough.
The UTC threshold (Cu) and cough reflex sensitivity (C5) were significantly inhibited (Cu and C5 increased) 15 minutes after electronic cigarette use. Mean log Cu rose from -0.035±0.08(SEM) to 0.21±0.12 (p=0.005). Mean log C5 increased from 0.60±0.11 to 0.92±0.16 (p=0.001). By 24 hours after e-cig exposure, Cu and C5 had returned to baseline levels. A single session of electronic cigarette use, approximating nicotine exposure of one tobacco cigarette, induces significant inhibition of the UTC threshold as well as cough reflex sensitivity. Previous studies implicate nicotine as the agent responsible for suppression of cough reflex sensitivity, and we hypothesize a similar role for nicotine in the suppression of the UTC threshold. Given our observation of the effect of a single e-cig exposure, studies of the respiratory physiologic implications of repeated or chronic e-cig use are warranted.
Jiska Cohen-Mansfield, PhD
Predictors of Smoking Cessation in Old–Old Age.
Nicotine Tob Res (2016)doi: 10.1093/ntr/ntw011First published online: January 17, 2016 

There is a dearth of knowledge on smoking cessation in older adults. This study examined predictors of smoking cessation in persons over age 75. This study is a secondary analysis of a prospective longitudinal study. A sample of 619 older persons aged 75–94 was drawn from a representative cohort of older persons in Israel and was examined longitudinally. By means of interviews, we assessed smoking, health, Activities of Daily Living (ADL), Instrumental ADL, cognitive dysfunction, and well-being.
Continuing smokers tended to be lonelier. Participants who quit smoking took more medications and had greater cognitive dysfunction compared to those who continued smoking. Greater cognitive dysfunction and high medication use or the physical causes for high medication use may precipitate smoking cessation in persons aged 75–94, potentially through a greater influence of caregivers on one’s lifestyle. Cognitive dysfunction and high medication use predicted smoking cessation. Smoking cessation for long time smokers may be influenced by greater ill health. Influence of caregivers may augment smoking cessation. Given these findings, for persistent smokers into old age, smoking cessation may occur at the time of physical and functional decline during the end of life period.

Jacek M. Mazurek, MD, MS, PhD and Lucinda J. England, MD, MSPH
Cigarette Smoking Among Working Women of Reproductive Age—United States, 2009–2013.
Nicotine Tob Res (2016)doi: 10.1093/ntr/ntv292First published online: January 20, 2016

Employers play a vital role in promoting and supporting tobacco use cessation among tobacco-using workers. Cigarette smoking during pregnancy is a preventable cause of complications in pregnancy and adverse infant health outcomes. To estimate cigarette smoking prevalence and attempts to quit among working women of reproductive age in different industries and occupations using a nationally representative survey.
The 2009–2013 National Health Interview Survey data for women of reproductive age (18–49 years) who were working in the week prior to the interview (n = 30855) were analyzed. Data were adjusted for nonresponse and weighted to produce nationally representative estimates. During 2009–2013, among working women of reproductive age, an estimated 17.3% (95% confidence interval [CI]: 16.7–17.8) and 12.9% (95% CI: 12.4–13.4) were current and former cigarette smokers, respectively. Of women who smoke daily, 44.5% (95% CI: 42.5–46.5) had made a quit attempt for more than 1 day in the year before the interview. Cigarette smoking prevalence was highest among women working in the construction industry (29.2%; 95% CI: 22.8–35.7) and in construction and extraction occupations (34.6%; 95% CI: 23.4–45.9). Among working women who were pregnant at the time of the interview, 6.8% (95% CI: 4.4–9.2) and 20.4% (95% CI: 16.9–24.0) were current and former cigarette smokers, respectively.

Cigarette smoking prevalence varies by industry and occupation. Intensifying tobacco control efforts in high prevalence industries and occupations could result in higher cessation rates and improvements in health among women of reproductive age. This study identified discrepancies in cigarette smoking among women of reproductive age across industries and occupations. In the absence of smoke-free local and state laws, employer-established smoke-free policies and workplace cessation programs are important for achieving reduction of tobacco use among women and for protecting other workers’ health. Results in this report may assist in developing educational campaigns targeting women in industries and occupations with high prevalence of cigarette smoking and low percentage of ever-smokers who had quit.
Kruger J, Patel R, Kegler M, Babb SD, King BA.
Perceptions of Harm From Secondhand Smoke Exposure Among U.S. Adults, 2009-2010.
Tob Induc Dis. 2016 Feb 2;14:3. doi: 10.1186/s12971-016-0069-8. eCollection 2016.
Exposure to secondhand smoke (SHS) causes significant disease and death. We assessed the prevalence and correlates of perceptions about the health harm of SHS among U.S. adults at the national and state level. Data came from the 2009-2010 National Adult Tobacco Survey, a national landline and cellular telephone survey. Perceptions about the health harms of SHS were assessed as follows: 'not at all harmful', 'somewhat harmful', and 'very harmful'. Descriptive statistics were used to assess the prevalence of SHS harm perceptions by tobacco use and sociodemographic factors, including sex, age, race/ethnicity, education, marital status, annual household income, region, sexual orientation, children in the household, and smoke-free law coverage. Logistic regression was used to assess odds of perceiving SHS to be "very harmful" (vs. "not at all harmful" or "somewhat harmful"), adjusting for the aforementioned factors.
Nationally, 64.5 % of adults perceived SHS as 'very harmful' (state range: 73.5 % [Utah] to 53.7 % [Kentucky]). By tobacco use, the perception that SHS is 'very harmful' was: 76.5 % among nonusers of tobacco; 62.1 % among noncombustible only users; 47.9 % among combustible only users; and 40.8 % among dual combustible and noncombustible users. Following adjustment, the perception that SHS was 'very harmful' was higher among females, non-Hispanic minorities and Hispanics, respondents living with children, and states with 100 % smoke-free law coverage. Among current tobacco users the odds of perceiving SHS to be 'very harmful' was lower in the Midwest than the West. Almost two-thirds of American adults perceive SHS as 'very harmful'; however, currently only half of all Americans are protected by comprehensive state or local smoke-free laws. These findings underscore the importance of public education campaigns to increase awareness of SHS exposure harm and the benefits of smoke-free environments. Expanding comprehensive smoke-free laws could protect all Americans from SHS.

Cohn AM, Johnson AL, Hair E, Rath JM, Villanti AC.
Menthol Tobacco Use is Correlated with Mental Health Symptoms in a National Sample of Young Adults: Implications for Future Health Risks and Policy Recommendations.
Tob Induc Dis. 2016 Jan 8;14:1. doi: 10.1186/s12971-015-0066-3. eCollection 2016.

Depression and anxiety are correlated with greater nicotine dependence, smoking persistence, and relapse back to smoking after a quit attempt. Menthol cigarette smoking, which is prevalent in young adults, is associated with nicotine dependence, progression to regular smoking, and worse cessation outcomes than non-menthol smoking. Few have established a link between menthol tobacco use, beyond just smoking, with mental health in this high-risk age group. This study examined the association of menthol tobacco use to anxiety and depression in a national sample of young adults. Data were from Waves 1 through 7 (n = 9720, weighted) of the Truth Initiative Young Adult Cohort, a national sample of men and women aged 18 to 34 assessed every 6-months. Demographics, past 30-day use of non-menthol and menthol tobacco products, and current alcohol, marijuana, and other drug use were assessed among those with depression and anxiety.
Thirty nine percent of current tobacco users used menthol as their preferred brand. Using a cross-sectional analysis (collapsed across waves), past 30-day menthol tobacco was uniquely associated with greater odds of both depression and anxiety, beyond the effects of demographic and substance correlates and non-menthol tobacco product use. Menthol is disproportionately used among young adults tobacco users with mental health problems, above and beyond the impact of a variety of other mental health and tobacco use risk factors. Findings suggest a strong link between menthol tobacco use and poor health outcomes. Policies should be developed to deter menthol tobacco use in vulnerable groups.

Karen M. Butler, DNP, RN, Melinda J. Ickes, PhD, Mary Kay Rayens, PhD, Amanda T. Wiggins, PhD and Ellen J. Hahn, PhD, RN, FAAN
Polytobacco Use Among College Students.
Nicotine Tob Res (2016) 18 (2):163-169.doi: 10.1093/ntr/ntv056First published online: March 13, 2015 

Use of more than one tobacco product among college students is increasing in popularity, leading to nicotine addiction and additional health risks. The study (1) examined polytobacco use patterns among college students who had ever used tobacco; and (2) assessed the sociodemographic and personal factors associated with current polytobacco use, compared to current single product use and former tobacco use among college students. Of 10 000 randomly selected college students from a large public university in the Southeast, a sample of 1593 students age 18 or older completed an online survey assessing tobacco use and attitudes. Ever tobacco users were included in this study (n = 662, or 41.6% of survey completers).
About 15% of ever users reported current polytobacco use, and more than 70% of polytobacco users smoked cigars, little cigars, or clove cigarettes in combination with one or more products. Cigarettes were the most commonly-used product among single users, followed by hookah. Males, underclassmen, and students with greater acceptance of cigarette use were more likely to be polytobacco users. Race/ethnicity was marginally related to polyuse status, with white/non-Hispanics 28% less likely to be polytobacco users versus single product users. Polytobacco users were more likely than single users to consume emerging tobacco products, (ie, hookah and electronic cigarettes). Males, underclassmen, and racial/ethnic minorities were more at risk for polytobacco use. As young people are particularly prone to nicotine addiction, there is a need to further investigate polytobacco use.
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Job and Conference Announcements

Job Announcements!
Tobacco Prevention & Control Director and Portfolio Lead,  Louisiana Public Health Institute - New Orleans, LA
The Portfolio Lead heads a statewide, comprehensive tobacco prevention and control portfolio that is primarily funded by a State excise tax on tobacco and designated for prevention and control efforts. This position’s primary responsibility is to ensure that this portfolio of projects effectively and efficiently accomplishes its goals through state of the art, multidisciplinary components implemented by staff, grantees and contracts throughout the state. In that role, the Lead must ensure that the portfolio’s efforts reflect current national, state and local expertise and perspectives. This position facilitates effective and efficient coordination with all tobacco prevention and control programs throughout Louisiana, including Health Promotion and Chronic Disease Program and the SCT. The Lead will also set and manage the strategic direction of the portfolio for sustaining current activities and development of future portfolio activities and engagements. Furthermore, the Portfolio Lead is a key LPHI position leading one of the Institutes’ major initiatives, and must coordinate closely with other internal and external population health and health systems initiatives. This position also serves on the overall LPHI Leadership Team. The Portfolio Lead reports directly to LPHI’s Chief Operating Officer and the LCRC Tobacco Prevention and Control Director. This position oversees all portfolio staff. 
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Tobacco Treatment Specialist Position - North Carolina
The Tobacco Prevention and Control Branch (TPCB), NC Division of Public Health is seeking a Tobacco Treatment Specialist for an exciting new position to start in February/March 2016. The purpose of this position is to provide expert statewide training in tobacco treatment and technical assistance on quality improvement strategies in order to promote and institutionalize evidence-based tobacco use cessation interventions in health care systems and among clinical care providers.  Evidence based tobacco cessation interventions are a part of a comprehensive tobacco control program, according to CDC's Best Practices.
A priority focus is on reaching disparate groups through health and community systems that serve populations most at risk for tobacco addiction such as low income, minorities, behavioral health and lesbian, gay, bisexual and transgender (LGBT) and young people.  The positon will work closely with case managers and providers in the safety net networks, behavioral health systems and providers, Medicaid providers, community health leaders, and local health departments. Additionally this position partners with the Division of Mental Health, Developmental Disabilities, and Substance Abuse Services (MHDDSAS) and the Division of State Operated Healthcare Facilities in tobacco dependence systems change and training as needed.
The Tobacco Treatment Specialist will coordinate creation, organization and distribution of tools and resources on the TPCB website for health care and behavioral health care providers to integrate treatment services for tobacco users in hospital/clinic settings and employers and employees to provide treatment services for tobacco users within the workplaces; and assists with QuitlineNC administration such as review and presentation of QuitlineNC data. This position will be a part of the Branch's Tobacco Cessation Unit led by the Tobacco Cessation Director who oversees QuitlineNC.  The positon also provides technical assistance in tobacco cessation initiatives to state and community partners, including CDC Regional Tobacco Control Managers.  Salary is competitive.
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February 29 - March 2, 2016: 9th NCTH Conference!
The Canadian Council for Tobacco Control is pleased host the 9th National Conference on Tobacco or Health, at the Westin Ottawa from February 29 to March 2, 2016. 

Together with researchers, policy makers, public and community health professionals, the Conference will provide a national forum to explore learning and innovation that is currently working or possible against the Tobacco epidemic in Canada. Learn more

April 18-20, 2016: 8th National Summit on Smokeless and Spit Tobacco!
The 8th NSST will take place at the Crowne Plaza Albuquerque in New Mexico
Crowne Plaza Albuquerque
1901 University Blvd NE, Albuquerque, NM 87102

Who Should Attend:

  • Local, state and federal tobacco prevention and control administrators
  • Tobacco program staff
  • Public health educators and policy professionals
  • Health care professionals and providers including physicians, nurses and clinic managers
  • Tobacco treatment specialists
  • Scientists
  • Dentists, dental hygienists and dental assistants
  • Higher education staff
  • Students
  • School and youth-serving agencies and youth advocates

Learn more here

April 25-26, 2016: Reduce Tobacco Use Conference! 
The Virginia Foundation for Health Youth and Prevention Connections will host the 12th Reduce Tobacco Use Conference to be held April 25-26, 2016 in Arlington, VA. Learn more here.

July 19-21, 2016: 2016 National Association of County and City Health Officials (NACCHO) Annual Conference – NACCHO!
The 2016 NACCHO Annual Conference, July 19–21 in Phoenix, will be the largest gathering of local health department leaders and other public health professionals in the United States.

The conference offers an opportunity for local health department staff, partners, funders, and individuals interested in local public health to share the latest research and ideas, network, and test their assumptions about the issues and topics that concern local public health. This year’s conference theme is “Cultivating a Culture of Health Equity.” Learn more here

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