Keller PA, Schillo BA, Kerr AN, Lien RK, Saul J, Dreher M, Lachter RB.
Increasing Reach by Offering Choices: Results From an Innovative Model for Statewide Services for Smoking Cessation.
Prev Med. 2016 Aug 8;91:96-102. doi: 10.1016/j.ypmed.2016.08.010. [Epub ahead of print]
Although state quitlines provide free telephone counseling and often include nicotine replacement therapy (NRT), reach remains limited (1-2% in most states). More needs to be done to engage all smokers in the quitting process. A possible strategy is to offer choices of cessation services through quitlines and to reduce registration barriers. In March 2014, ClearWay MinnesotaSM implemented a new model for QUITPLAN® Services, the state's population-wide cessation services. Tobacco users could choose the QUITPLAN® Helpline or one or more Individual QUITPLAN® Services (NRT starter kit, text messaging, email program, or quit guide). The program website was redesigned, online enrollment was added, and a new advertising campaign was created and launched. In 2014-2015, we evaluated whether these changes increased reach. We also assessed quit attempts, quit outcomes, predictors of 30-day abstinence, and average cost per quit via a seven-month follow-up survey. Between March 2014-February 2015, 15,861 unique tobacco users registered, which was a 169% increase over calendar year 2013. The majority of participants made a quit attempt (83.7%). Thirty-day point prevalence abstinence rates (responder rates) were 26.1% for QUITPLAN Services overall, 29.6% for the QUITPLAN Helpline, and 25.5% for Individual QUITPLAN Services. Several variables predicted quit outcomes, including receiving only one call from the Helpline and using both the Helpline and the NRT starter kit. Providing greater choice of cessation services and reducing registration barriers have the potential to engage more tobacco users, foster more quit attempts, and ultimately lead to long-term cessation and reductions in prevalence.
Lien RK, Schillo BA, Mast JL, Lukowski AV, Greenseid LO, Keith JD, Keller PA.
Tobacco User Characteristics and Outcomes Related to Intensity of Quitline Program Use: Results From Minnesota and Pennsylvania.
J Public Health Manag Pract. 2016 Sep-Oct;22(5):E36-46. doi: 10.1097/PHH.0000000000000382.
Tobacco users in all 50 states have access to quitline telephone counseling and cessation medications. While studies show multiple calls relate to quit success, most participants do not complete a full call series. To date, quitline program use studies have analyzed single factors-such as number of calls or counseling minutes.
This study combines multiple factors of quitline program use across 2 states to describe how participants use a 5-call program; assess whether intensity of program use is associated with participant subgroups; and assess whether key outcomes (quitting, satisfaction) are associated with intensity.
This observational study examines data for quitline participants in Minnesota (n = 2844) and Pennsylvania (n = 14 359) in 2011 and 2012. A subset of participants was surveyed 7 months after registration to assess key outcomes (response rates: Minnesota 65%; Pennsylvania 60%).
Quitline utilization data were used to identify program use variables: nicotine replacement therapy provision, number of counseling calls, number of counseling minutes, days from first to last counseling call, and days from registration to first counseling call. Ten program use groups were created using all 5 program use variables, from lowest (1) to highest (10) intensity.
Results were similar for both states. Only 11% of Minnesota and 8% of Pennsylvania participants completed all 5 calls. Intensity of quitline program use was associated with several participant characteristics including health conditions and age. Both quit status and program satisfaction were associated with program use intensity. Quit rates peaked in group 9, participants who received the full 5-call program.
Quitlines should focus on engaging participants in multiple calls to improve quit outcomes. In addition, it is important to leverage multiple program use factors for a fuller understanding of how quitline participants use a program.
Davis KC, Duke J, Shafer P, Patel D, Rodes R, Beistle D
Perceived Effectiveness of Antismoking Ads and Association with Quit Attempts Among Smokers: Evidence from the Tips From Former Smokers Campaign.
Health Commun. 2016 Jul 19:1-8. [Epub ahead of print]
Measures of perceived effectiveness (PE) of ads have been validated to predict changes in cognitive precursors of quit attempts, but a relationship between PE and actual quit attempts has not been shown in population-based studies. We analyzed smokers' PE ratings of ads from the national Tips From Former Smokers (Tips) campaign to (1) establish the validity of PE in predicting quit attempts in a large, nationally representative sample of smokers; (2) identify behavioral and demographic correlates of PE among respondents; and (3) examine whether PE is influenced by matching the race/ethnicity of ad participants with that of the ad viewer.
We used survey data from two waves (baseline and follow-up) of a longitudinal online cohort of adult U.S. cigarette smokers. Respondents were shown one or more of 14 Tips campaign ads and were asked to assess each ad in terms of PE. We used multivariate models to estimate the association between baseline PE and prospective quit attempts; cross-sectional associations between PE and various respondent characteristics, including race/ethnicity, desire to quit, and health conditions; and the association between race/ethnicity of respondents and Tips ad participants.
Higher PE at baseline was associated with increased odds of a quit attempt at follow-up. Higher PE scores were associated with non-Hispanic black race, Hispanic ethnicity, higher desire to quit, presence of a chronic health condition, and presence of a mental health condition. There was no relationship between PE scores and matched race/ethnicity of the respondent and Tips ad participants.
This is the first study to demonstrate an association between PE scores for antismoking ads and prospective quit attempts in a large, nationally representative sample of smokers. Our findings also provide strong evidence that racial/ethnic minority subpopulations, including non-Hispanic blacks and Hispanics, react more favorably to Tips campaign ads irrespective of race/ethnicity of the ad participant. This suggests that message characteristics (e.g., graphic visuals and emotional content) may play a more important role in PE than race/ethnicity of ad participants.
Bush T, Lovejoy J, Javitz H, Magnusson B, Torres AJ, Mahuna S, Benedict C, Wassum K, Spring B.
Comparative Effectiveness of Adding Weight Control Simultaneously or Sequentially to Smoking Cessation Quitlines: Study Protocol of a Randomized Controlled Trial.
BMC Public Health. 2016 Jul 22;16:615. doi: 10.1186/s12889-016-3231-6.
Prevalence of multiple health risk behaviors is growing, and obesity and smoking are costly. Weight gain associated with quitting smoking is common and can interfere with quit success. Efficacy of adding weight management to tobacco cessation treatment has been tested with women in group sessions over an extended period of time, but has never been tested in real-world settings with men and women seeking help to quit. This paper describes the Best Quit study which tests the effectiveness of delivering tobacco and weight control interventions via existing quitline infrastructures.
Eligible and consenting smokers (n = 2550) who call a telephone quitline will be randomized to one of three groups; the standard quitline or standard quitline plus a weight management program added either simultaneously or sequentially to the tobacco program. The study aims to test: 1) the effectiveness of the combined intervention on smoking cessation and weight, 2) the cost-effectiveness of the combined intervention on cessation and weight and 3) theoretically pre-specified mediators of treatment effects on cessation: reduced weight concerns, increased outcome expectancies about quitting and improved self-efficacy about quitting without weight gain. Baseline, 6 month and 12 month data will be analyzed using multivariate statistical analyses and groups will be compared on treatment adherence, quit rates and change in weight among abstinent participants. To determine if the association between group assignment and primary outcomes (30-day abstinence and change in weight at 6 months) is moderated by pre-determined baseline and process measures, interaction terms will be included in the regression models and their significance assessed.
This study will generate information to inform whether adding weight management to a tobacco cessation intervention delivered by phone, mail and web for smokers seeking help to quit will help or harm quit rates and whether a simultaneous or sequential approach is better at increasing abstinence and reducing weight gain post quit. If proven effective, the combined intervention could be disseminated across the U.S. through quitlines and could encourage additional smokers who have not sought cessation treatment for fear of gaining weight to make quit attempts.
Martell BN, Garrett BE, Caraballo RS.
Disparities in Adult Cigarette Smoking — United States, 2002–2005 and 2010–2013.
MMWR Morb Mortal Wkly Rep 2016;65:753-758.
Although cigarette smoking has substantially declined since the release of the 1964 Surgeon General’s report on smoking and health,* disparities in tobacco use exist among racial/ethnic populations (1). Moreover, because estimates of U.S. adult cigarette smoking and tobacco use are usually limited to aggregate racial or ethnic population categories (i.e., non-Hispanic whites [whites]; non-Hispanic blacks or African Americans [blacks]; American Indians and Alaska Natives [American Indians/Alaska Natives]; Asians; Native Hawaiians or Pacific Islanders [Native Hawaiians/Pacific Islanders]; and Hispanics/Latinos [Hispanics]), these estimates can mask differences in cigarette smoking prevalence among subgroups of these populations. To assess the prevalence of and changes in cigarette smoking among persons aged ≥18 years in six racial/ethnic populations and 10 select subgroups in the United States,† CDC analyzed self-reported data collected during 2002–2005 and 2010–2013 from the National Survey on Drug Use and Health (NSDUH) (2) and compared differences between the two periods. During 2010–2013, the overall prevalence of cigarette smoking among the racial/ethnic populations and subgroups ranged from 38.9% for American Indians/Alaska Natives to 7.6% for both Chinese and Asian Indians. During 2010–2013, although cigarette smoking prevalence was relatively low among Asians overall (10.9%) compared with whites (24.9%), wide within-group differences in smoking prevalence existed among Asian subgroups, from 7.6% among both Chinese and Asian Indians to 20.0% among Koreans. Similarly, among Hispanics, the overall prevalence of current cigarette smoking was 19.9%; however, within Hispanic subgroups, prevalences ranged from 15.6% among Central/South Americans to 28.5% among Puerto Ricans. The overall prevalence of cigarette smoking was higher among men than among women during both 2002–2005 (30.0% men versus 23.9% women) and 2010–2013 (26.4% versus 21.1%) (p<0.05). These findings highlight the importance of disaggregating tobacco use estimates within broad racial/ethnic population categories to better understand and address disparities in tobacco use among U.S. adults.
Sakuma KK, Felicitas-Perkins JQ, Blanco L, Fagan P, Pérez-Stable EJ, Pulvers K, Romero D, Trinidad DR.
Tobacco Use Disparities by Racial/Ethnic Groups: California Compared to the United States.
Prev Med. 2016 Aug 26. pii: S0091-7435(16)30241-9. doi: 10.1016/j.ypmed.2016.08.035. [Epub ahead of print]
Racial/ethnic disparities in cigarette use and cessation persist. This study compared cigarette consumption and former smoking trends in California (CA) with the rest of the United States (US) by racial/ethnic categories of non-Hispanic White, Black, Hispanic/Latino, and Asian/Pacific Islander groups. Data were analyzed from the 1992 to 2011 Tobacco Use Supplement to the Current Population Survey. Consumption levels across decades were examined and adjusted logistic regression models were fit to compare across CA and US. Results indicated steady declines in ever smoking prevalence for all groups with much lower magnitudes of change among US Blacks and Whites compared to their CA counterparts. After controlling for age, gender, and education, CA had significantly fewer heavy smokers (OR=0.45, 95% CI:0.38-0.54), more light and intermittent smokers (LITS; OR=1.68, 95%CI: 1.45-1.93), and a greater proportion of former smokers (OR=1.35, 95%CI: 1.24-1.48) than the rest of US. Data were stratified by race/ethnicity and the patterns shown were mostly consistent with CA performing statistically better than their US counterparts with the exception of Black LITS and Asian/Pacific Islander former smokers. California's success in reducing tobacco use disparities may serve as a prime example of tobacco control policy for the country. CA and the US will need to continue to address tobacco use and cessation in the context of the growing diversity of the population.
Andrea H. Weinberger, Jonathan M. Platt, Philip H. Smith, and Renee D. Goodwin.
Racial/Ethnic Differences in Self-reported Withdrawal Symptoms and Quitting Smoking Three Years Later: A Prospective, Longitudinal Examination of U.S. Adults.
Nicotine Tob Res (2016)doi: 10.1093/ntr/ntw221First published online: August 31, 2016
Racial/ethnic groups appear to differ on quit success and withdrawal is a key factor in cessation failure, yet little is known about racial/ethnic differences in withdrawal symptoms. This study of U.S. adults examined racial/ethnic differences in current smokers’ report of withdrawal symptoms and the relationship between withdrawal symptoms and quitting smoking three years later. Using data from the National Epidemiologic Survey on Alcohol and Related Conditions (Wave 1, 2001-2001; Wave 2, 2004-2005), analyses were conducted on participants who identified as Non-Hispanic White, Non-Hispanic Black, or Hispanic; reported current cigarette smoking at Wave 1; and provided smoking status information at Wave 2 (n=7,981). Withdrawal symptoms during past quit attempts were assessed at Wave 1. Among Wave 1 current smoking adults, Non-Hispanic White respondents were more likely than Non-Hispanic Black and Hispanic respondents to report experiencing at least one withdrawal symptom, seven out of eight withdrawal symptoms, withdrawal-related discomfort, and withdrawal-related distress (ps<0.0001). While withdrawal symptoms were associated with a lower odds of quitting smoking for all groups, a stronger relationship between number of symptoms and lower odds of quitting was evident among Non-Hispanic White compared to Non-Hispanic Black respondents (interaction beta=0.065, p=0.0001). For Non-Hispanic White participants, each additional withdrawal symptom was associated with a 6% decrease in the odds of quitting. Withdrawal symptoms were more commonly reported by Non-Hispanic White adults than Non-Hispanic Black and Hispanic adults and appeared to have a greater impact on failure to quit smoking for Non-Hispanic White compared to Non-Hispanic Black adults. To our knowledge, this is the first study to use prospective, longitudinal data to examine the relationship between race and withdrawal symptoms and the impact of withdrawal symptoms on quitting among adults in the U.S. Non-Hispanic White adults were more likely to report withdrawal symptoms and there was a stronger relationship between greater number of withdrawal symptoms and lower odds of quitting for Non-Hispanic White adults compared to Non-Hispanic Black adults. Developing a better understanding of racial/ethnic differences in withdrawal and cessation can help to tailor efforts to improve outcomes for smokers in various racial/ethnic groups.
Courtney Keeler, Wendy Max, Valerie Yerger, Tingting Yao, Michael K. Ong, and Hai-Yen Sung.
The Association of Menthol Cigarette Use With Quit Attempts, Successful Cessation, and Intention to Quit Across Racial/Ethnic Groups in the US.
Nicotine Tob Res (2016)doi: 10.1093/ntr/ntw215First published online: August 24, 2016
Few studies have examined the relationship between menthol use and smoking cessation across various racial/ethnic groups; the findings were mixed. This study explored the association of menthol cigarette use with quit attempts, smoking cessation, and intention-to-quit among U.S. adults and by race/ethnicity. Using the 2006/07 and 2010/11 Tobacco Use Supplements to the Current Population Survey data, this study analyzed 54,448 recent active smokers, defined as current smokers or former smokers who quit <12 months ago. Three behaviors were examined: any quit attempts in the past 12 months, successful cessation for ≥3 months, and intention-to-quit smoking in the next 6 months. For each cessation behavior, multiple logistic regression models were estimated separately for the full-sample and stratified racial/ethnic subsamples. While 72.3% of African American recent active smokers typically smoked menthol cigarettes, this proportion was 21.7%, 21.5%, and 28.0% for Whites, Asians, and Hispanics, respectively. African American menthol smokers had higher odds of quit attempts compared to non-African American, non-menthol smokers (full-sample analysis) as well as African American non-menthol smokers (subsample analysis). Menthol use was not significantly associated with quit attempts in other racial/ethnic subsamples. There was no significant difference in either successful cessation or intention-to-quit between menthol and non-menthol smokers. African American menthol smokers were more likely to attempt to quit smoking than non-menthol smokers but these quit attempts did not translate into successful cessation. This study revealed no association of menthol use with quit attempts, successful cessation, and intention-to-quit among other racial/ethnic groups. The findings suggested that African American menthol smokers were more motivated to quit smoking; yet, the results also indicated no significant differences in successful cessation between African American menthol and non-menthol smokers. Interventions targeting menthol smokers within the African American community may help bridge this gap. While more local sales restrictions are beginning to occur (e.g., Tobacco 21 efforts), additional policies restricting price discounting as well as the regulation of access to and the time, place, and/or manner of menthol tobacco advertising could also improve cessation rates. Further evaluation is needed to determine the viability of these policies.
Israel Berger, Julie Mooney-Somers
Smoking Cessation Programs for Lesbian, Gay, Bisexual, Transgender, and Intersex People: A Content-Based Systematic Review.
Nicotine Tob Res (2016)doi: 10.1093/ntr/ntw216First published online: August 31, 2016
Tobacco use among lesbian, gay, bisexual, and transgender (LGBT) people is double the general population. Limited evidence suggests high smoking rates among intersex people. Lesbian, gay, bisexual, transgender, and intersex (LGBTI) people are a priority population in Australian health policy, particularly mental health and ageing. Despite associations between smoking and non-communicable diseases relevant to ageing and mental health, LGBTI-targeted smoking cessation interventions in Australia have been limited to people living with HIV. Applying existing interventions to marginalised populations without modification and evaluation may fail and exacerbate inequities. To access outcomes and characterize the populations served, cultural modifications, and behavioural change techniques (BCTs) of interventions to reduce LGBTI smoking.
We searched Medline, 6 additional databases, and contacted authors to retrieve published and unpublished program evaluations. We retrieved 19 studies (3663 participants). None used control groups. Overall quit rate was 61.0% at the end of interventions and stabilized at 38.6% at 3-6 months.
All studies included gay men, 13 lesbians, 13 “LGBT”, 12 bisexual people, 5 transgender people, and none included intersex people. Transgender people comprised 3% of participants. Of programs open to women, 27.8% of participants were women. Cultural modifications were used by 17 (89.5%) studies, commonly meeting in LGBT spaces, discussing social justice, and discussing LGBT-specific triggers. Common BCTs included providing normative information, boosting motivation/self-efficacy, relapse prevention, social support, action planning, and discussing consequences. Quit rates were high; using control groups would improve evaluation. Existing programs may fail to reach groups other than gay men. This review examines the evidence for LGBTI-targeted smoking cessation interventions. Populations within LGBTI are not proportionally represented in smoking cessation research, and no study addressed intersex smoking. Overall, LGBT-targeted interventions appear to be effective, and simply having an LGBT-specific group may be more effective than groups for the general population. More rigorous research is necessary to draw firm conclusions. Our study space analysis provides suggestions for areas of more targeted research on mechanisms underlying these complex interventions’ success.
Brown-Johnson CG, Burbank A, Daza EJ, Wassmann A, Chieng A, Rutledge GW, Prochaska JJ.
Online Patient-Provider E-cigarette Consultations: Perceptions of Safety and Harm.
Am J Prev Med. 2016 Aug 23. pii: S0749-3797(16)30247-1. doi: 10.1016/j.amepre.2016.06.018. [Epub ahead of print]
E-cigarettes are popular and unregulated. Patient-provider communications concerning e-cigarettes were characterized to identify patient concerns, provider advice and attitudes, and research needs.
An observational study of online patient-provider communications was conducted January 2011-June 2015 from a network providing free medical advice, and analyzed July 2014-May 2016. Patient and provider themes, and provider attitudes toward e-cigarettes (positive, negative, or neutral) were coded qualitatively. Provider attitudes were analyzed with cumulative logit modeling to account for clustering. Patient satisfaction with provider responses was expressed via a Thank function.
An increase in e-cigarette-related questions was observed over time. Patient questions (N=512) primarily concerned specific side effects and harms (34%); general safety (27%); e-cigarettes as quit aids (19%); comparison of e-cigarette harms relative to combusted tobacco(18%); use with pre-existing medical conditions (18%); and nicotine-free e-cigarettes (14%). Half of provider responses discussed e-cigarettes as a harm reduction option (48%); 26% discussed them as quit aids. Overall, 47% of providers' responses represented a negative attitude toward e-cigarettes; 33% were neutral (contradictory or non-committal); and 20% were positive. Attitudes did not differ statistically by medical specialty; provider responses positive toward e-cigarettes received significantly more Thanks.
Examination of online patient-provider communications provides insight into consumer health experience with emerging alternative tobacco products. Patient concerns largely related to harms and safety, and patients preferred provider responses positively inclined toward e-cigarettes. Lacking conclusive evidence of e-cigarette safety or efficacy, healthcare providers encouraged smoking cessation and recommended first-line cessation treatment approaches.
Ashford K, Wiggins A, Butler K, Ickes M, Rayens MK, Hahn E
e-Cigarette Use and Perceived Harm Among Women of Childbearing Age Who Reported Tobacco Use During the Past Year.
Nurs Res. 2016 Sep-Oct;65(5):408-14. doi: 10.1097/NNR.0000000000000176.
The prevalence of electronic cigarette use grows. Amid increased e-cigarette use nationwide, this paper attempts to identify underlying risk factors for the most vulnerable populations.
The purpose of the study was to assess predictors of e-cigarette use among female current and former tobacco users of childbearing age-specifically to determine whether demographic factors, pregnancy status, conventional cigarette smoking, and perceived e-cigarette harm are associated with e-cigarette use. Reasons for using e-cigarettes were also measured.
A cross-sectional, correlational design was used; 194 current and former female tobacco users, 18-45 years of age, from two university-affiliated prenatal clinics and one women's health clinic in Kentucky took part. Slightly more than half were pregnant. Age, race/ethnicity, education, pregnancy status, use history for cigarettes and e-cigarettes, and perception of health hazard from e-cigarettes were measured, and associations with e-cigarette use were made with Mann-Whitney U-tests or Spearman's rank correlations. Predictors of e-cigarette use were determined using proportional odds modeling.
Most current e-cigarette users were also current cigarette smokers (88%). Nearly half of current and former e-cigarette users were pregnant. Most women perceived e-cigarettes as a minor (38%) or moderate (31%) health hazard. In the proportional odds model, younger women were at greater risk for e-cigarette use, whereas minority women and those who were pregnant were less likely to be e-cigarette users.
Pregnant women were less likely to be more recent e-cigarette users, compared with nonpregnant women. However, nearly all current e-cigarette users were dual tobacco users, including pregnant women. It is both imperative and timely to determine the impact of e-cigarette use on maternal and infant health, thus improving healthcare provider confidence to discuss the health implications of e-cigarette use with their patients.
Miech R, Patrick ME, O'Malley PM, Johnston LD.
What are kids vaping? Results From a National Survey of US Adolescents.
Tob Control. 2016 Aug 25. pii: tobaccocontrol-2016-053014. doi: 10.1136/tobaccocontrol-2016-053014.
To examine what substances US youth vape. Data come from Monitoring the Future, an annual, nationally representative survey of USA 12th-grade, 10th-grade and 8th-grade students. Respondents reported what substance they vaped the last time they used a vaporiser such as an e-cigarette.
Among students who had ever used a vaporiser, 65-66% last used 'just flavouring' in 12th, in 10th and in 8th grade, more than all other responses combined. In all three grades, the percentage using 'just flavouring' was above 57% for males, females, African-Americans, Hispanics, Whites, and students both with and without a parent with a college degree. Nicotine use came in a distant second, at about 20% in 12th and 10th grade and 13% in 8th grade. Taking into account youth who vaped nicotine at last use increases national estimates of tobacco/nicotine prevalence in the past 30 days by 24-38% above and beyond cigarette smoking, which is substantial but far less than estimates that assume all vaporiser users inhale nicotine.
These results challenge the common assumption that all vaporiser users inhale nicotine. They (a) call into question the designation of vaporisers and e-cigarettes as ENDS ('Electronic Nicotine Delivery System'), (b) suggest that the recent rise in adolescent vaporiser use does not necessarily indicate a nicotine epidemic, and (c) indicate that vaporiser users can be candidates for primary prevention programmes. Finally, the results suggest the importance of developing different rationales for the regulation of vaporiser devices as compared to the regulation of substances marketed for vaporiser use.
Wills TA, Sargent JD, Gibbons FX, Pagano I, Schweitzer R.
E-cigarette Use is Differentially Related to Smoking Onset Among Lower Risk Adolescents.
Tob Control. 2016 Aug 19. pii: tobaccocontrol-2016-053116. doi: 10.1136/tobaccocontrol-2016-053116.
E-cigarette use has been linked to onset of cigarette smoking among adolescents, but some commentators have suggested that this simply reflects high-risk adolescents being more likely to use e-cigarettes and to smoke. We tested whether the effect of e-cigarette use for smoking onset differs for youth who are lower versus higher on propensity to smoke.
School-based survey with a longitudinal sample of 1136 students (9th-11th graders, mean age 14.7 years) in Hawaii, initially surveyed in 2013 (T1) and followed up 1 year later (T2). We assessed e-cigarette use, propensity to smoke based on 3 psychosocial factors known to predict smoking (rebelliousness, parental support and willingness to smoke), and cigarette smoking status. Analyses based on T1 never-smokers tested the relation of T1 e-cigarette use to T2 smoking status for participants lower versus higher on T1 propensity to smoke.
The relation between T1 e-cigarette use and T2 smoking onset was stronger among participants with lower levels of rebelliousness and willingness and higher levels of parental support. A multiple logistic regression analysis with T2 smoking as the criterion tested the cross-product of T1 e-cigarette use and T1 smoking propensity score; the interaction (OR=0.88, p=0.01) indicated a significantly larger effect for smoking onset among lower risk youth.
The results indicate e-cigarette use is a risk factor for smoking onset, not just a marker of high risk for smoking. This study provides evidence that e-cigarettes are recruiting lower risk adolescents to smoking, which has public health implications.
Laurie Zawertailo, Dmytro Pavlov, Anna Ivanova, Ginnie Ng, Dolly Baliunas, and Peter Selby.
Concurrent E-cigarette use During Tobacco Dependence Treatment in Primary Care Settings: Association with Smoking Cessation at 3- and 6-months.
Nicotine Tob Res (2016)doi: 10.1093/ntr/ntw218First published online: August 31, 2016
Electronic cigarettes (e-cigarettes) are being used as cessation aids by many smokers despite a lack of empirical evidence regarding their safety and efficacy. We analyzed the association of e-cigarette use and smoking abstinence in a population of smokers accessing standard smoking cessation treatment (nicotine replacement therapy plus behavioral counseling) through primary care clinics in Ontario, Canada. Participants were recruited through 187 primary care clinics across Ontario, Canada and were eligible for up to 26 weeks of brief behavioural counseling and individualized dosing of nicotine replacement therapy at no cost. Adjusted logistic regression models were used to examine the association between concurrent e-cigarette use and smoking abstinence at 3- and 6-month follow-ups. Of the 6526 participants who completed a 3-month follow-up 18.1% reported using an e-cigarette while in treatment. The majority of e-cigarette users (78.2%) reported using an e-cigarette for smoking cessation. At 3-month follow-up, e-cigarette use was negatively associated with abstinence after controlling for confounders (AOR=0.706, p<0.001, 95%CI=0.607-0.820). E-cigarette use was also negatively associated with abstinence at 6-month follow-up (AOR=0.502, p<0.001, 95%CI=0.393-0.640). E-cigarette use was negatively associated with successful quitting in this large community sample of smokers accessing standard evidence-based smoking cessation treatment through primary care clinics, even after adjusting for covariates such as severity of tobacco dependence, gender and age. The findings suggest that concurrent use of e-cigarettes with NRT may harm cessation attempts. This study confirms previous findings from observational studies regarding the negative association between e-cigarette use and smoking cessation, but in a large cohort of smokers enrolled in an evidence-based treatment program. The implications of these findings are that concurrent use of e-cigarettes during a quit attempt utilizing cost-free evidence-based treatment (nicotine replacement therapy plus behavioural counseling) does not confer any added benefit and may hamper successful quitting.
Andrew Hyland, Bridget K Ambrose, Kevin P Conway, et al.
Design and Methods of the Population Assessment of Tobacco and Health (PATH) Study.
Tob Control doi:10.1136/tobaccocontrol-2016-052934
This paper describes the methods and conceptual framework for Wave 1 of the Population Assessment of Tobacco and Health (PATH) Study data collection. The National Institutes of Health, through the National Institute on Drug Abuse, is partnering with the Food and Drug Administration's (FDA) Center for Tobacco Products to conduct the PATH Study under a contract with Westat. The PATH Study is a nationally representative, longitudinal cohort study of 45 971 adults and youth in the USA, aged 12 years and older. Wave 1 was conducted from 12 September 2013 to 15 December 2014 using Audio Computer-Assisted Self-Interviewing to collect information on tobacco-use patterns, risk perceptions and attitudes towards current and newly emerging tobacco products, tobacco initiation, cessation, relapse behaviours and health outcomes. The PATH Study's design allows for the longitudinal assessment of patterns of use of a spectrum of tobacco products, including initiation, cessation, relapse and transitions between products, as well as factors associated with use patterns. Additionally, the PATH Study collects biospecimens from consenting adults aged 18 years and older and measures biomarkers of exposure and potential harm related to tobacco use. The cumulative, population-based data generated over time by the PATH Study will contribute to the evidence base to inform FDA's regulatory mission under the Family Smoking Prevention and Tobacco Control Act and efforts to reduce the Nation's burden of tobacco-related death and disease.