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North American Quitline Consortium
November 2016

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


NAQC News

New Guidance Paper Webinar Recording - Quitline Services: Current Practice and Evidence Base!
Last month NAQC announced the release of a new Quality Improvement Initiative guidance paper, Quitline Services: Current Practice and Evidence Base.  This paper reviews current quitline practice in the U.S., highlights the scientific evidence for each category of service, and discuses major considerations related to implementation and evaluation of the service.

This paper provides scientific guidance for decision making on the types of services quitlines should offer. It is intended for all consortium members and stakeholders who want to expand their knowledge of quitline services.

On November 3 we hosted a webinar that discussed the main sections of the paper. You can listen to the recording and review the slides at the URL below.

» learn more

Case Studies for Enhancing eReferral Capacity: A Strategy for Increasing Cessation Among Priority Populations and Encouraging Health System Change!
In May 2015, the North American Quitline Consortium (NAQC) launched an 18-month project to establish national capacity to implement eReferral with tobacco cessation quitlines that did not previously have capacity. Four state teams (AZ, IL, MS and SD)participated in the project, receiving intensive training and individualized technical assistance to help address challenges and overcome barriers of implementing eReferral. Each team documented their progress in a Case Study. NAQC is pleased share these Case Studies with members. Each one provides:
  • An overview of the strategic objectives of the quitline and the services offered;
  • The promotional and outreach strategies employed to maximize reach;
  • Barriers and challenges encountered throughout the course of the 18-month project;
  • Solutions developed to address the barriers and challenges;
  • Lessons learned; and
  • Key elements for success.
» learn more

Orientation/Refresher Sessions for NAQC Members!
In August NAQC hosted two orientation/refresher webinars to familiarize members with new and existing NAQC respources and workgroup opportunities. We plan to offer  additional calls this year and urge you to contact us at membership@naquitline.org if you have an interest in participating. Also, please include topics of interest you would like us to cover on the call. 

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



Time-Sensitive News

Deadline of November 28: Calling Health Professionals Treating Pregnant Smokers!
The Society for Public Health Education's Smoking Cessation and Reduction in Pregnancy Treatment (SCRIPT)® Program is taking place on  December 5 or 6.

December 5, 2016,  8:00 AM - 5:00 PM  
American Psychological Association
750 First Street NE, 9th Floor Conference Room 

Washington, DC
Registration $395
 
This one-day workshop is designed to train health professionals to promote, implement and evaluate SCRIPT as part of routine prenatal care. Patient guides, DVDs and comprehensive training materials are provided.
» learn more

December 6, 2016,  8:00 AM - 1:00 PM 
American Psychological Association 
750 First Street NE, 9th Floor Conference Room 
Washington, DC
Registration $189
 
This half-day workshop is designed to train clinicians and other prenatal care providers to counsel their pregnant patients on effective smoking cessation methods for pregnant women. This evidence-based training focuses on implementation procedures and intervention components.
» learn more

Deadline of December 1: Apply for The Commonwealth Fund Mongan Fellowship in Minority Health Policy!
The Commonwealth Fund Mongan Fellowship in Minority Health Policy (formerly The Commonwealth Fund/Harvard University Fellowship in Minority Health Policy, est. 1996) is now accepting applications for the 2017–18 class. This unique fellowship prepares physicians for leadership roles in transforming health care delivery systems and promoting policies and practices that improve access to high-performance health care for vulnerable populations, including racial and ethnic minorities and economically disadvantaged groups. The application deadline for the 2017–2018 fellowship is December 1, 2016.
» learn more

NAQC Conference 2017: Registration Due Date!
NAQC Conference titled, Advancing Quitline Practice through Innovations and Research, will be taking place at the Hilton Austin located at 500 East 4th Street, Austin, Texas 78701. Reservation details are below.  

Registration is open and allows you to attend all workshops and sessions at the conference and includes refreshments and lunches on both days as well as a ticket to the reception on Monday evening, March 20. The registration fee for NAQC members will be $365 (non-members, $525).
» learn more

Find more Time-Sensitive News in our Newsroom or go back to top.



Cessation and Tobacco Control News

Great American Smokeout Campaign!
GASO takes place on Thursday, November 17th! NAQC joins ACS in encouraging you to leverage this event to promote calling quitlines and becoming smokefree.  By quitting – even for 1 day – smokers will be taking an important step toward a healthier life and reducing their cancer risk. Find resources and materials at the URL below.
» learn more

New Online Support Community for Quitting Smoking!
In partnership with Inspire, American Lung Association launched several lung health online support communities, including one to help people quit smoking. Quit Now: Freedom From Smoking online support community provides active peer-to-peer support of its members through the process of quitting smoking. Members of the community, including former smokers, can provide a helpful resources, information and experiences to help people quit smoking for good. The community is free to join.
» learn more

Reports on Retail Environment!
CounterTobacco.org offers evidence summaries on tobacco control and prevention topics related to the retail environment. The recently published Flavored Tobacco Products evidence summary overviews the products, how they are marketed, and association with youth initiation. It also includes information on related local, state, and federal policy. The recently updated E-Cigarettes at the Point of Sale evidence summary highlights state and local restrictions on these products and e-cigarette industry marketing tactics.

» learn more

Find more Cessation and Tobacco Control News in our Newsroom or go back to top.



Research

Cole S, Suter C, Nash C, Pollard J.Impact of a Temporary NRT
Enhancement in a State Quitline and Web-Based Program.
Am J Health Promot. 2016 Nov 3. pii: 0890117116675555. [Epub ahead of print]
 
To examine the impact of a nicotine replacement therapy (NRT) enhancement on quit outcomes.
Observational study using an intent to treat as treated analysis. A total of 4022 Idaho tobacco users aged ≥18 years who received services from the Idaho Tobacco Quitline or Idaho's web-based program. One-call phone or web-based participants were sent a single 4- or 8-week NRT shipment. Multiple-call participants were sent NRT in a single 4-week shipment or two 4-week shipments (second shipment sent only to those completing a second coaching call). North American Quitline Consortium recommended Minimal Data Set items collected at registration and follow-up. Thirty-day point prevalence quit rates were assessed at 7-month follow-up. Multiple logistic regression models were used to examine the effects of program type and amount of NRT sent to participants while controlling for demographic and tobacco use characteristics. Abstinence rates were significantly higher among 8-week versus 4-week NRT recipients (42.5% vs 33.3%). The effect was only significant between multiple-call program participants who received both 4-week NRT shipments versus only the first of 2 possible 4-week shipments (51.1% vs 31.1%). Costs per quit were lowest among web-based participants who received 4 weeks of NRT (US$183 per quit) and highest among multiple-call participants who received only 1 of 2 possible NRT shipments (US$557 per quit). To better balance cost with clinical effectiveness, funders of state-based tobacco cessation services may want to consider (1) allowing tobacco users to choose between phone- and web-based programs while (2) limiting longer NRT benefits only to multiple-call program participants.
 
Bernstein SL, Weiss JM, Toll B, Zbikowski SM.
Association Between Utilization of Quitline Services and Probability of Tobacco Abstinence in Low-Income Smokers.
J Subst Abuse Treat. 2016 Dec;71:58-62. doi: 10.1016/j.jsat.2016.08.014. Epub 2016 Aug 21.
 
Quitlines (QL) are an effective means for smoking cessation, but a paucity of data exist examining the dose-response relationship between use of QL services and quit rates, especially among low-income smokers. The purpose of this study was to study the relationship between tobacco abstinence and use of QL services among low-income smokers. Secondary analysis of a randomized trial of every- or some-day smokers aged 18 years or older visiting an urban emergency department. Inclusion criteria included self-pay or Medicaid insurance, as a proxy for low-income and low socioeconomic status. Intervention participants received a motivational interview, 6 weeks of nicotine patches and gum, a referral faxed to the state-sponsored QL, a booster call, and a quitline brochure. Control participants received the brochure. Smoking status was assessed by phone at 1 and 3 months, with confirmation via exhaled carbon monoxide testing at 3 months for those reporting abstinence. QL usage was obtained by utilization data from the QL database. Of 778 subjects, 197 (25.3%) reported any use of QL services at 3 months. Participants were trichotomized: no QL usage, 1 call only, and >1 call (583, 99, and 98 participants, respectively). Quit rates at 3 months in these no, low-, and high-use groups were, respectively, 7.2%, 9.1%, and 15.3% (P=0.03). Participants who used the QL had a median of 28 total minutes of telephone contact. Among low-income smokers, greater use of QL services is associated with higher abstinence. Whether this resulted from a direct effect of the QL, or greater motivation among smokers using QL services cannot be determined from these data.

John H. Kingsbury, Michael J. Parks, Michael S. Amato, Raymond G. Boyle
Deniers and Admitters: Examining Smoker Identities in a Changing Tobacco Landscape.
Nicotine Tob Res (2016) 18 (11):2130-2137.doi: 10.1093/ntr/ntw110First published online: April 16, 2016  

Smoking prevalence has declined considerably over the past 30 years. This decline has coincided with a growing stigma against smokers and a trend toward nondaily or occasional smoking. Some individuals now deny being a smoker despite current cigarette use—i.e., “deniers”; conversely, occasional smokers who admit to being a smoker are defined as “admitters.” Although the “denier” phenomenon has been the focus of recent research, no studies have examined smoker identity in the context of emerging tobacco products and ongoing, statewide tobacco control programs. Recent data from the 2014 Minnesota Adult Tobacco Survey provided an opportunity to address these research gaps. Using the Minnesota Adult Tobacco Survey, participants were 242 adults who reported smoking 100 cigarettes lifetime, currently smoking “some days,” and past 30-day smoking. Questions also assessed smoker identity, emerging product use and perceptions, and changes in smoking behavior in response to a recent statewide tobacco tax increase. Regression models revealed no difference in e-cigarette or hookah use between deniers and admitters, but deniers were more likely to perceive that hookah use was less harmful than smoking cigarettes. In response to the tax increase, we found that admitters were more likely than deniers to report thinking about quitting, reducing cigarette amount, and making a quit attempt. Findings suggest that deniers perceive lower harm from using tobacco products. Tax increases may be less effective at motivating quit attempts in deniers compared to admitters, implying that cessation programs tailored to specific smoking identities could usefully complement tax increases. Findings from this study suggest that tobacco tax increases should be coordinated with health promotion interventions to address occasional and social smoking. The denier phenomenon in particular is an important identity-based construct that population-level public health practice should consider in order to design effective tobacco control interventions. In addition, findings from our study and previous research suggest that occasional or social smokers who deny the smoker identity may be slowing progress in reducing smoking rates. Interventions targeting occasional smokers, and in particular, deniers, are needed to accelerate cessation efforts.
 
Andrea C Villanti, Paul D Mowery, Cristine D Delnevo, Raymond S Niaura, David B Abrams, Gary A Giovino
Changes in the Prevalence and Correlates of Menthol Cigarette Use in the USA, 2004–2014.
Tob Control doi:10.1136/tobaccocontrol-2016-053329
 
National data from 2004 to 2010 showed that despite decreases in non-menthol cigarette use prevalence, menthol cigarette use prevalence remained constant in adolescents and adults and increased in young adults. The purpose of the current study was to extend these analyses through 2014. We estimated the prevalence of menthol cigarette smoking in the USA during 2004–2014 using annual cross-sectional data on persons aged ≥12 years from the National Survey on Drug Use and Health. Self-reported menthol status for selected brands that were either exclusively menthol or non-menthol were adjusted based on retail sales data. Data were weighted to provide national estimates. Although overall smoking prevalence has decreased, the proportion of past 30-day cigarette smokers using menthol cigarettes was higher (39%) in 2012–2014 compared to 2008–2010 (35%). Youth smokers remain the most likely group to use menthol cigarettes compared to all other age groups. Menthol cigarette prevalence has increased in white, Asian and Hispanic smokers since 2010. Menthol cigarette prevalence exceeded non-menthol cigarette prevalence in youth and young adult smokers in 2014. Among smokers, menthol cigarette use was positively correlated with co-use of cigars. Menthol cigarette and smokeless tobacco co-use also increased from 2004 to 2014. The youngest smokers are most likely to use menthol cigarettes. Among smokers, increases in overall menthol cigarette use and menthol cigarette use in whites, Asians and Hispanics since 2010 are of concern. There is tremendous urgency to limit the impact of menthol cigarettes on public health, particularly the health of youth and young adults.
 
Julia N. Soulakova, Lisa J. Crockett.
Unassisted Quitting and Smoking Cessation Methods Used in the US: Analyses of 2010-2011 Tobacco Use Supplement to the Current Population Survey Data.
Nicotine Tob Res (2016)doi: 10.1093/ntr/ntw273First published online: October 8, 2016
 
The study estimated the prevalence of unassisted quitting (i.e., quitting without pharmacological aids or other interventions) among former smokers, and identified the most common smoking cessation methods used by US adult smokers who quit smoking between 2007 and 2011. Among long-term quitters, smoking-related behaviors and factors associated with using pharmacological methods and quitting unassisted were examined The analytic sample consisted solely of former smokers, including 3,583 “long-term quitters” (those who quit 1 to 3 years prior to the survey) and 2,205 “recent quitters” (those who quit within a year prior to the survey), who responded to the 2010-2011 Tobacco Use Supplement to the Current Population Survey. About 72% of former smokers quit unassisted, 26% used at least one pharmacological method and 7% used at least one non-pharmacological method. The most common pharmacological methods were the nicotine patch (12%), Chantix®/Varenicline (11%), and a nicotine gum/lozenge (8%). For long-term quitters, cutting back on cigarettes gradually and relying on social support were more commonly associated with pharmacological methods. Among long-term quitters, younger adults (18 to 44 years old), Non-Hispanic Blacks, Hispanics, those who were less nicotine dependent prior to quitting and those who did not visit a doctor in the past 12 months before quitting had higher odds of reporting unassisted quitting than quitting with pharmacological methods. Unassisted quitting remains the predominant means of recent and long-term smoking cessation in the US. Attempters may try different ways of quitting during the same quit attempt. Unassisted quitting remains a much more common method for recent and long-term smoking cessation than use of pharmacological or non-pharmacological methods. Smokers may try different ways of quitting during the same quit attempt. Thus, population-based studies that investigate the use of particular methods while ignoring other ways of quitting may overestimate the benefits of certain methods for smoking cessation.
 
Karin A Kasza, Andrew J Hyland, Ron Borland, Ann McNeill, Geoffrey T Fong, Matthew J Carpenter, Timea Partos, K Michael Cummings
Cross-country Comparison of Smokers' Reasons for Thinking About Quitting Over Time: Findings From the International Tobacco Control Four Country Survey (ITC-4C), 2002–2015.
Tob Control doi:10.1136/tobaccocontrol-2016-053299
 
To explore between-country differences and within-country trends over time in smokers' reasons for thinking about quitting and the relationship between reasons and making a quit attempt. Participants were nationally representative samples of adult smokers from the UK (N=4717), Canada (N=4884), the USA (N=6703) and Australia (N=4482), surveyed as part of the International Tobacco Control Four Country Survey between 2002 and 2015. Generalised estimating equations were used to evaluate differences among countries in smokers' reasons for thinking about quitting and their association with making a quit attempt at follow-up wave. Smokers' concern for personal health was consistently the most frequently endorsed reason for thinking about quitting in each country and across waves, and was most strongly associated with making a quit attempt. UK smokers were less likely than their counterparts to endorse health concerns, but were more likely to endorse medication and quitline availability reasons. Canadian smokers endorsed the most reasons, and smokers in the USA and Australia increased in number of reasons endorsed over the course of the study period. Endorsement of health warnings, and perhaps price, appears to peak in the year or so after the change is introduced, whereas other responses were not immediately linked to policy changes. Differences in reasons for thinking about quitting exist among smokers in countries with different histories of tobacco control policies. Health concern is consistently the most common reason for quitting and the strongest predictor of future attempts.
 
Reddy KP, Parker RA, Losina E, Baggett TP, Paltiel AD, Rigotti NA, Weinstein MC, Freedberg KA, Walensky RP
Impact of Cigarette Smoking and Smoking Cessation on Life Expectancy Among People With HIV: A US-Based Modeling Study.
J Infect Dis. 2016 Nov 3. pii: jiw430. [Epub ahead of print]
 
In the United States, >40% of people infected with human immunodeficiency virus (HIV) smoke cigarettes. We used a computer simulation of HIV disease and treatment to project the life expectancy of HIV-infected persons, based on smoking status. We used age- and sex-specific data on mortality, stratified by smoking status. The ratio of the non-AIDS-related mortality risk for current smokers versus that for never smokers was 2.8, and the ratio for former smokers versus never smokers was 1.0-1.8, depending on cessation age. Projected survival was based on smoking status, sex, and initial age. We also estimated the total potential life-years gained if a proportion of the approximately 248 000 HIV-infected US smokers quit smoking. Men and women entering HIV care at age 40 years (mean CD4+ T-cell count, 360 cells/µL) who continued to smoke lost 6.7 years and 6.3 years of life expectancy, respectively, compared with never smokers; those who quit smoking upon entering care regained 5.7 years and 4.6 years, respectively. Factors associated with greater benefits from smoking cessation included younger age, higher initial CD4+ T-cell count, and complete adherence to antiretroviral therapy. Smoking cessation by 10%-25% of HIV-infected smokers could save approximately 106 000-265 000 years of life. HIV-infected US smokers aged 40 years lose >6 years of life expectancy from smoking, possibly outweighing the loss from HIV infection itself. Smoking cessation should become a priority in HIV treatment programs.
 
Wentao Li, Lap Ah Tse, Joseph S. K. Au, Feng Wang, Hong Qiu, Ignatius Tak-Sun Yu
Secondhand Smoke Enhances Lung Cancer Risk in Male Smokers: An Interaction.
Nicotine Tob Res (2016) 18 (11):2057-2064.doi: 10.1093/ntr/ntw115First published online: April 23, 2016
 
Previous studies revealed that some indoor air pollutants and fine particle matter can interact with active smoking, enhancing lung cancer risk in smokers. Secondhand smoke (SHS), with remarkable differences from active smoking, contributes significantly to indoor air pollution and generates a considerable amount of fine particle matter, may cause a similar interaction with active smoking. Information on lifetime SHS along with active smoking and other confirmed or suspected risk factors for lung cancer was collected in this case-referent study. Odds ratios and the 95% confidence intervals (95% CIs) of smoking status in different levels of SHS were evaluated. Potential multiplicative and additive interactions were explored. Compared with never-smokers without SHS, current smokers who were exposed to a high level of SHS demonstrated the highest odds ratio (15.13, 95% CI: 8.60, 26.65), almost doubles the effect in the current smokers without SHS. Significant additive interactions between current smoking and high level of SHS were observed for all lung cancers (synergy index = 1.80, 95% CI: 1.02, 3.24) and the squamous carcinoma subgroup. High level of SHS exposure greatly enhanced lung cancer risk among current smokers, consistent with an additive interaction; while this interaction was predominant for the squamous carcinoma. The results provide new evidence to the rationale of promoting global smoking cessation. Some indoor air pollutants can interact with active smoking, yielding a synergistic effect on inducing lung cancer. SHS, with noticeable differences from active smoking, is a major source of indoor air pollution. However, little has been known about the effect of SHS in smokers and whether there is a similar interaction between SHS and active smoking. In this study, we evaluated their separate and joint effects and indeed found a more than additive interaction between them. This finding suggests a potential problem of gathering smoking aggravating by venue restriction policies and re-advocates policy efforts on smoking cessation.
 
Michael S Amato, Raymond G Boyle, David Levy
E-cigarette Use 1 Year Later in a Population-based Prospective Cohort.
Tob Control doi:10.1136/tobaccocontrol-2016-053177
 
Population prevalence estimates of electronic nicotine delivery system (ENDS) use range considerably based on the operational definition of ‘use’. Recently, we investigated the utility of ‘use frequency’ for restricting prevalence estimates to non-experimenters in adult populations. Results suggested that individuals reporting use on ≤5 days in the past 30 were likely to discontinue use, and should be excluded from estimates of population prevalence. This study investigated the predictive validity of ENDS use frequency as a measure for likelihood of continued use, and cigarette smoking abstinence. We recontacted smokers and recent quitters who participated in the random digit dial 2014 Minnesota Adult Tobacco Survey. At ∼1 year follow-up, we reassessed ENDS use and cigarette smoking among N=601 respondents. Fewer than half of respondents who reported using ENDSs on 1–5 days in the past 30 at baseline reported any ENDS use 1 year later (27%, 95% CI (18% to 40%)). Conversely, more than half of respondents who reported daily use at baseline also reported subsequent use at follow-up (89%, 95% CI (78% to 100%)). The likelihood of subsequent ENDS use by respondents using ENDSs on more than 5 days but less than daily did not significantly differ from chance (37%, 95% CI (22% to 61%)). For adult population surveillance surveys, defining current use prevalence as ‘any use in the past 30 days’ includes many individuals who can be expected to discontinue use within 1 year. Until measures of ENDS use become standardised, researchers should choose definitions carefully because different definitions are likely to yield different results.
 
Theodore L Wagener, Evan L Floyd, Irina Stepanov, Leslie M Driskill, Summer G Frank, Ellen Meier, Eleanor L Leavens, Alayna P Tackett, Neil Molina, Lurdes Queimado

Have Combustible Cigarettes Met Their Match? The Nicotine Delivery Profiles and Harmful Constituent Exposures of Second-generation and Third-generation Electronic Cigarette Users. Tob Control doi:10.1136/tobaccocontrol-2016-053041
 
Electronic cigarettes’ (e-cigarettes) viability as a public health strategy to end smoking will likely be determined by their ability to mimic the pharmacokinetic profile of a cigarette while also exposing users to significantly lower levels of harmful/potentially harmful constituents (HPHCs). The present study examined the nicotine delivery profile of third- (G3) versus second-generation (G2) e-cigarette devices and their users' exposure to nicotine and select HPHCs compared with cigarette smokers. 30 participants (10 smokers, 9 G2 and 11 G3 users) completed baseline questionnaires and provided exhaled carbon monoxide (eCO), saliva and urine samples. Following a 12-hour nicotine abstinence, G2 and G3 users completed a 2-hour vaping session (ie, 5 min, 10-puff bout followed by ad libitum puffing for 115 min). Blood samples, subjective effects, device characteristics and e-liquid consumption were assessed. Smokers, G2 and G3 users had similar baseline levels of cotinine, but smokers had 4 and 7 times higher levels of eCO (p<0.0001) and total 4-(Methylnitrosamino)-1-(3-pyridyl)-1-butanol (i.e., NNAL, p<0.01), respectively, than G2 or G3 users. Compared with G2s, G3 devices delivered significantly higher power to the atomiser, but G3 users vaped e-cigarette liquids with significantly lower nicotine concentrations. During the vaping session, G3 users achieved significantly higher plasma nicotine concentrations than G2 users following the first 10 puffs (17.5 vs 7.3 ng/mL, respectively) and at 25 and 40 min of ad libitum use. G3 users consumed significantly more e-liquid than G2 users. Vaping urges/withdrawal were reduced following 10 puffs, with no significant differences between device groups. Under normal use conditions, both G2 and G3 devices deliver cigarette-like amounts of nicotine, but G3 devices matched the amount and speed of nicotine delivery of a conventional cigarette. Compared with cigarettes, G2 and G3 e-cigarettes resulted in significantly lower levels of exposure to a potent lung carcinogen and cardiovascular toxicant. These findings have significant implications for understanding the addiction potential of these devices and their viability/suitability as aids to smoking cessation.

U.S. E-Cigarette Regulations - 50 State Review (2016)
The following is a snapshot of the U.S. landscape of e-cigarette regulation, prepared by the Consortium and the Public Health and Tobacco Policy Center at Northeastern University.  The information below was based on a 50-state (plus Washington, D.C.) survey of current state statutes pertaining to e-cigarette regulations in the following areas: definition of “tobacco product,” taxation, product packaging, youth access/other retail restrictions, and smoke-free air legislation. Please note that some links go to legislative websites or portals because the laws have not yet been codified or are not otherwise available.  The N/A designation refers to the lack of state laws or regulations related to e-cigarettes as of September 15, 2016; however, many local laws in these states (and throughout the U.S.) address e-cigarettes.
 
Shida Miao, Evan S. Beach, Toby J. Sommer, Julie B. Zimmerman, Sven-Eric Jordt.
High-Intensity Sweeteners in Alternative Tobacco Products.
Nicotine Tob Res (2016) 18 (11):2169-2173.doi: 10.1093/ntr/ntw141First published online: May 23, 2016  

Sweeteners in tobacco products may influence use initiation and reinforcement, with special appeal to adolescents. Recent analytical studies of smokeless tobacco products (snuff, snus, dissolvables) detected flavorants identical to those added to confectionary products such as hard candy and chewing gum. However, these studies did not determine the levels of sweeteners. The objective of the present study was to quantify added sweeteners in smokeless tobacco products, a dissolvable product, electronic cigarette liquids and to compare with sweetener levels in confectionary products. Sweetener content of US-sourced smokeless tobacco, electronic cigarette liquid, and confectionary product samples was analyzed by liquid chromatography-electrospray ionization–mass spectrometry (LC-ESI-MS). All smokeless products contained synthetic high intensity sweeteners, with snus and dissolvables exceeding levels in confectionary products (as much as 25-fold). All snus samples contained sucralose and most also aspartame, but no saccharin. In contrast, all moist snuff samples contained saccharin. The dissolvable sample contained sucralose and sorbitol. Ethyl maltol was the most common sweet-associated component in electronic cigarette liquids. Sweetener content was dependent on product category, with saccharin in moist snuff, an older category, sucralose added at high levels to more recently introduced products (snus, dissolvable) and ethyl maltol in electronic cigarette liquid. The very high sweetener concentrations may be necessary for the consumer to tolerate the otherwise aversive flavors of tobacco ingredients. Regulation of sweetener levels in smokeless tobacco products may be an effective measure to modify product attractiveness, initiation and use patterns. Dissolvables, snus and electronic cigarettes have been promoted as risk-mitigation products due to their relatively low content of nitrosamines and other tobacco toxicants. This study is the first to quantify high intensity sweeteners in snus and dissolvable products. Snus and dissolvables contain the high intensity sweetener, sucralose, at levels higher than in confectionary products. The high sweetness of alternative tobacco products makes these products attractive to adolescents. Regulation of sweetener content in non-cigarette products is suggested as an efficient means to control product palatability and to reduce initiation in adolescents.
 
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Job and Conference Announcements
 

March 8-11, 2017: SRNT Annual Meeting!
The Annual Meeting will be held March 8-11, 2017, at the Firenze Fiera Congress & Exhibition Center in Florence, Italy. SRNT’s Annual Meeting provides an excellent opportunity for attendees of all experience levels to participate in the highest caliber of professional programming devoted to research and practice in the field of nicotine and tobacco research. The Annual Meeting includes an education-packed scientific program that allows more than 1,100 international attendees to stay current with the latest breaking research. Learn more here.

March 20-21, 2017: NAQC Conference 2017 - Save the Date!
NAQC Conference 2017 will be held on March 20-21, 2017 in Austin, Texas, two days before the the National Conference on Tobacco or Health (NCTOH). We hope you will SAVE THE DATE! The registration fee for NAQC members will be $365 (non-members, $525). The registration fee allows you to attend all workshops and sessions at the conference and includes refreshments and lunches on both days as well as a ticket to the NAQC reception on March 20. We hope to see you in Austin for NAQC Conference 2017! Learn more here.

March 22-24, 2017: National Conference on Tobacco or Health!
The conference is taking place in Austin, TX more details will be available in the coming weeks.
The National Conference on Tobacco or Health (NCTOH) is one of the largest, long-standing gatherings of the United States tobacco control movement. It attracts a diverse set of public health professionals to learn about best practices and policies to reduce tobacco use—the leading preventable cause of disease and death in the United States. Participants are encouraged to register early as space is limited. Learn more here.

Find more Job and Conference Announcements in our Newsroom or go back to top.


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