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North American Quitline Consortium
March 2017

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

Preparing for the NAQC Conference on March 20-21 in Austin, TX!
The final conference agenda for the NAQC conference titled, Advancing Quitline Practice through Innovations and Research, is now available and can be viewed here. We thank everyone who has submitted their abstracts for making this conference program so rich and diverse in topics!

We would also like to thank our current sponsors: American Cancer Society, Arizona Department of Health, ClearWay Minnesota, GSK, Smoking Cessation Leadership Center, and Truth Initiative for supporting the conference this year!

PREPARING FOR THE CONFERENCE
We have listed some items below to help you prepare for the conference. If you have any questions, please do not hesitate to contact NAQC staff at naqc@naquitline.org. Please note that the speaker bios and copies of presentations will be available on the NAQC Conference page a few days after the event.

LOCATION
Hilton Austin
500 East 4th Street, Austin, Texas 78701
+1-512-482-8000
http://www3.hilton.com/en/hotels/texas/hilton-austin-AUSCVHH/index.html

TRANSPORTATION
From Austin-Bergstrom Airport: Exit the airport and take Highway 71 west approximately 5.5 miles to I-35. Merge onto I-35 North and take exit 234C. Turn left at the first stop light (6th Street). Travel west on 6th street 4 blocks. Turn left onto Neches. The hotel is on the left on the corner of 5th & Neches.

Transportation from Austin-Bergstrom International Airport to and from the Hilton is available with SuperShuttle “Shared Ride” or ExecuCar “Private Sedan/SUV”. Make reservations at www.SuperShuttle.com or www.ExecuCar.com use code HILTN for a 5% discount off published online fare.

Capital Metro, Austin's public transportation services runs citywide, with buses and commuter rail lines traveling the five-county region.

MEETING TIME
March 20 – 8 am to 9:50 Registration
                     10 am to 5:15 pm Sessions
                      Reception follows last session
March 21 – 8:30 am to 4 pm Sessions

DRESS
Casual profession dress is the attire for this meeting. Please come prepared with long sleeves or a sweater for the air conditioned meeting rooms. Please also make sure to wear comfortable shoes. 
 
RECEPTION
Reception is taking place from 5:15 pm  to 6:30 pm on March 20 at the Salon JK Foyer. Enjoy appetizers and a cash bar while networking with colleagues.

» learn more

Orientation/Refresher Sessions for NAQC Members - Standing Webinar Dates Announced!
NAQC offers orientation/refresher webinars (75 minutes in length) to familiarize members with new and existing NAQC resources, answer questions and discuss how to get the most out of your membership benefits. We have scheduled webinars in 2017 and urge you to contact us at membership@naquitline.org if you have an interest in participating.  

May 9 at 12 pm PT/3 pm ET
July 11 at 12 pm PT/3 pm ET

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



Time-Sensitive News

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. Final agenda has been announced. Learn more here.

March 23 - NCTOH Ancillary Session - What’s Menthol Got to Do with It? Everything!
Attend this Forum to learn the latest national developments on menthol and flavored
tobacco products restrictions. This event is FREE and open to the public!

TOPICS INCLUDE:
Tobacco is a SOCIAL INJUSTICE ISSUE for communities of color
Confronting Tobacco Industry front groups
What public health allies can do to advance the national agenda

» learn more

Canadian Government Launches Public Consultations on the Future of Tobacco Control - DEADLINE is April 13!
The Honourable Jane Philpott, Minister of Health, officially launched public consultations on the Future of Tobacco Control in Canada. Please note the news release: https://www.canada.ca/en/health-canada/news/2017/02/government_of_canadalaunchespublicconsultationsonthefutureoftoba.html  
 
The consultation period will be open until April 13, 2017. Canadians are encouraged to participate and share their views on the future of tobacco control in Canada by submitting input via regular mail or email using the contact information below. The attached consultation document may help inform your consideration of this important health and social issue.
 
The consultation document will also inform the discussions at the National Forum on the Future of Tobacco Control in Canada.
 
All comments received by Health Canada in the context of the modernization of the Federal Tobacco Control Strategy will be reviewed and a collated, non-identifiable summary of the results will be posted online.
 
Input to the consultation can be forwarded to:
Office of Policy
Tobacco Control Directorate
Health Canada
150 Tunney’s Pasture Drwy.
Address Locator 0301A
Ottawa, ON K1A 0K9
Email: ftcs-sflt@hc-sc.gc.ca

Upcoming FDA Public Workshop on E-Cigarette Battery Risks and Hazards!
The FDA plans to host a two-day public workshop April 19-20, 2017, in Silver Spring, MD, to gather information and stimulate discussion on battery safety concerns (e.g., overheating, fire, explosion, other modes of failure), reducing the risk of incidents, and design parameters related to electronic nicotine delivery systems (ENDS), including e-cigarettes. Presentations and panelists will discuss substantive scientific information relating to hazards and risks associated with the use of batteries in ENDS. The FDA also plans to collect information on how these safety hazards and risks are communicated to consumers. A public comment session will be held on April 20, 2017, during which the FDA will accept oral comments. FDA has made a new downloadable infographic available which outlines how cigarettes are engineered.

The workshop will also be webcast live, with transcripts posted on the FDA website after the event. Seating and webcast viewing slots are limited, so early registration is recommended. Register here.

No Menthol Sunday 2017!
No Menthol Sunday (May 28th) is an opportunity to engage faith communities in a talk about how to improve the health of African Americans. This year’s theme, Not Another Life, is a wake-up call to preserve lives through education and action. 
» learn more

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



Cessation and Tobacco Control News

Duke-UNC Certified Tobacco Treatment Specialist Training!
The Duke – UNC Tobacco Treatment Specialist Credentialing Program (TTS Program) is a collaborative effort by the Duke University Smoking Cessation Program and the University of North Carolina at Chapel Hill Nicotine Dependence Program, both national leaders in tobacco treatment, education, and research. This innovative partnership was initiated by a request from the Tobacco Prevention and Control Branch, NC Division of Public Health, as a result of the demand for this state-based resource from the many partners working on evidence-based tobacco use prevention and cessation in North Carolina.

The primary aim of the program is to train and certify Tobacco Treatment Specialists to provide individuals in North Carolina and across the nation with the highest caliber treatment available for tobacco use and dependence. The broader goal of the TTS program is to reduce the impact of tobacco use on the local, state, and US population. 
» learn more

Tobacco Control Legal Consortium's Resource - Updated 50-State Review of E-Cigarettes!
An updated review of U.S. e-cigarette legislation in all 50 states and Washington, D.C. is now available, providing a snapshot as of Dec. 15, 2016. The review includes an interactive map as well as a downloadable PDF summarizing the data.
» learn more

Regulatory Guidance on HUD Smoke-Free Rule!
The Department of Housing and Urban Development (HUD) published a guidance document on its final HUD rule requiring smoke-free policies in public housing. The document overviews the rule and implementation requirements of public housing authorities. Additionally, the document provides guidance on enforcement steps, monitoring tools, resident engagement, and smoking cessation resources.
» learn more

FDA Resources - Chemicals in Tobacco!
FDA released new videos and interactive tools about the chemicals in tobacco. The information is presented in three stages, from plant to product to puff. The series presents chemicals found in tobacco in every stage of the product and its effects on human health.

» learn more

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



Research

Kristy L. Marynak, Doris G. Gammon, Brian A. King, Brett R. Loomis, Erika B. Fulmer, Teresa W. Wang, Todd Rogers.
National and State Trends in Sales of Cigarettes and E-Cigarettes, U.S., 2011–2015.
AJPM. 2017. Article in Press. DOI: http://dx.doi.org/10.1016/j.amepre.2017.01.016
 
In recent years, self-reported cigarette smoking has declined among youth and  adults, while electronic cigarette (e-cigarette) use has increased. However, sales trends for these products are less certain. This study assessed national and state patterns of U.S. cigarette and e-cigarette unit sales. Trends in cigarette and e-cigarette unit sales were analyzed using retail scanner data from  September 25, 2011 through January 9, 2016 for: (1) convenience stores; and (2) all other outlets combined, including supermarkets, mass merchandisers, drug, dollar, and club stores, and military commissaries (online, tobacco-only, and “vape“ shops were not available). Data by store type were
available for the total contiguous U.S. and 29 states; combined data were available for the remaining
states, except Alaska, Hawaii, and DC. During 2011–2015, cigarette sales exhibited a small, significant decrease; however, positive year-over-year growth occurred in convenience stores throughout most of 2015. E-cigarette unit sales significantly increased during 2011–2015, but year-over-year growth slowed and was occasionally negative. Cigarette unit sales exceeded e-cigarettes by 64:1 during the last 4-week period. During 2014–2015, cigarette sales increases occurred in 15 of 48 assessed states; e-cigarette sales increased in 18 states. Despite overall declines during 2011–2015, cigarette sales in 2015 grew for the first time in a decade. E-cigarette sales growth was positive, but slowed over the study period in assessed stores. Cigarette sales continued to exceed e-cigarette sales, reinforcing the importance of efforts to reduce the appeal and accessibility of cigarettes and other combusted tobacco products.
 
Scott E Sherman; Paul Krebs; Laura S York; Sharon E Cummins; Ware Kuschner; Sebnem Guvenc-Tuncturk; Shu-Hong Zhu.
Telephone Care Co-ordination for Tobacco Cessation: Randomized Trials Testing Proactive Versus Reactive Models.
Tob Control. http://dx.doi.org/10.1136/tobaccocontrol-2016-053327
 
We conducted two parallel studies evaluating the effectiveness of proactive and reactive engagement approaches to telephone treatment for smoking cessation. Patients who smoked and were interested in quitting were referred to this study and were eligible if they were current smokers and had an address and a telephone number. The data were collected at 35 Department of Veterans Affairs (VA) sites, part of four VA medical centres in both California and Nevada. In study 1, participants received multisession counseling from the California Smokers’ Helpline (quitline). In study 2, they received self-help materials only. Patients were randomly assigned by week to either proactive or reactive engagement, and primary care staff were blind to this assignment. Providers gave brief advice and referred them via the electronic health record to a tobacco co-ordinator. All patients were offered cessation medications. Using complete case analysis, in study 1 (quitline), patients in the proactive condition were more likely than those in the reactive condition to report abstinence at 6 months (21.0% vs 16.4%, p=0.03). No difference was found between conditions in study 2 (self-help) (16.9% vs 16.5%, p=0.88). Proactive outreach resulted in increased use of cessation medications in both the quitline (70.1% vs 57.6%, p<0.0001) and the self-help studies (74.5% vs 48.2%, p<0.0001). Proactive outreach with quitline intervention was associated with greater long-term abstinence. Both studies resulted in high rates of medication use. Sites should use a proactive outreach approach and provide counseling whenever possible.
 
Veronica E. Helms, Brian A. King, Peter J. Ashley.
Cigarette Smoking and Adverse Health Outcomes Among Adults Receiving Federal Housing Assistance.
Preventive Medicine. Volume 99, June 2017, Pages 171–177. http://dx.doi.org/10.1016/j.ypmed.2017.02.001
 
Cigarette smoking is higher among low-income adults and individuals who reside in federally assisted housing are particularly susceptible to the adverse effects of smoking and secondhand smoke exposure. This study assessed smoking-related behaviors and health outcomes among U.S. adults who received federal housing assistance during 2006–2012. National Health Interview Survey data linked with administrative data from the U.S. Department of Housing and Urban Development were analyzed; 5218 HUD-assisted adults were assessed. Demographic characteristics associated with smoking, including frequency and consumption, were assessed among adult cigarette smokers. Fourteen adverse health outcomes were examined among cigarette smoking and nonsmoking adults. One-third (33.6%) of HUD-assisted adults were current cigarette smokers. Smoking prevalence was highest among adults aged 25–44 (42.5%), non-Hispanic whites (39.5%), and adults who resided in households with children (37.5%). Half attempted to quit in the past year; 82.1% were daily smokers; and, 35.8% of daily smokers reported smoking 20 + cigarettes a day. Multivariable analyses revealed that compared to nonsmokers, cigarette smokers had increased likelihood of reporting fair or poor health (95% CI: 1.04–1.52), chronic obstructive pulmonary disease (CI: 1.87–3.06), disability (CI: 1.25–1.83), asthma (CI: 1.02–1.55), serious psychological distress (CI: 1.39–2.52), > 1 emergency room visit in the past year (CI: 1.09–1.56), and ≥ 10 work loss days in the past year (CI: 1.15–3.06). Adults who receive housing assistance represent an at-risk population for adverse health outcomes associated with smoking and secondhand smoke. Housing assistance programs provide a valuable platform for the implementation of evidence-based tobacco prevention and control measures, including smokefree policies.
 
Ku L, Steinmetz E, Bysshe T, Bruen BK.
Crossing Boundaries.
Public Health Rep. 2017 Jan 1:33354917692954. doi: 10.1177/0033354917692954. [Epub ahead of print]

Previous state interagency collaborations have led to successful tobacco cessation initiatives. The objective of this study was to assess the roles and interaction of state Medicaid and public health agency efforts to support tobacco cessation for low-income Medicaid beneficiaries. We interviewed Medicaid and state public health agency officials in 8 states in September and October 2015 about collaborations in policy development and implementation for Medicaid tobacco cessation, including Medicaid coverage policies, quitlines, and monitoring. Collaboration between Medicaid and public health agencies was limited. Smoking cessation quitlines were the most common area of collaboration cited. Public health officials were typically not involved in developing Medicaid coverage policies. States covered a range of US Food and Drug Administration-approved tobacco cessation medications, but 7 of the 8 states imposed limitations, such as charging co-payments or requiring previous authorization. States generally lacked data to monitor implementation of tobacco cessation efforts and had little ability to determine the effectiveness of their policies. To strengthen efforts to reduce smoking and tobacco-related health burdens and to monitor the effectiveness of policies and programs, Medicaid and public health agencies should prioritize tobacco cessation and develop and analyze data about smoking and cessation efforts among Medicaid beneficiaries. Recent multistate initiatives from the Centers for Disease Control and Prevention and the Centers for Medicare & Medicaid Services seek to promote stronger collaborations in clinical prevention activities, including tobacco cessation.

Thomas D, Abramson MJ, Bonevski B, George J.
System Change Interventions for Smoking Cessation.
Cochrane Database Syst Rev. 2017 Feb 10;2:CD010742. doi: 10.1002/14651858.CD010742.pub2.
 
System change interventions for smoking cessation are policies and practices designed by organizations to integrate the identification of smokers and the subsequent offering of evidence-based nicotine dependence treatments into usual care. Such strategies have the potential to improve the provision of smoking cessation support in healthcare settings, and cessation outcomes among those who use them. To assess the effectiveness of system change interventions within healthcare settings, for increasing smoking cessation or the provision of smoking cessation care, or both. We searched databases including the Cochrane Tobacco Addiction Group Specialized Register, CENTRAL, MEDLINE, Embase, CINAHL, and PsycINFO in February 2016. We also searched clinical trial registries: WHO clinical trial registry, US National Institute of Health (NIH) clinical trial registry. We checked 'grey' literature, and handsearched bibliographies of relevant papers and publications. Randomized controlled trials (RCTs), cluster-RCTs, quasi-RCTs and interrupted time series studies that evaluated a system change intervention, which included identification of all smokers and subsequent offering of evidence-based nicotine dependence treatment. Using a standardized form, we extracted data from eligible studies on study settings, participants, interventions and outcomes of interest (both cessation and system-level outcomes). For cessation outcomes, we used the strictest available criteria to define abstinence. System-level outcomes included assessment and documentation of smoking status, provision of advice to quit or cessation counseling, referral and enrollment in quitline services, and prescribing of cessation medications. We assessed risks of bias according to the Cochrane Handbook and categorized each study as being at high, low or unclear risk of bias. We used a narrative synthesis to describe the effectiveness of the interventions on various outcomes, because of significant heterogeneity among studies. We included seven cluster-randomized controlled studies in this review. We rated the quality of evidence as very low or low, depending on the outcome, according to the GRADE standard. Evidence of efficacy was equivocal for abstinence from smoking at the longest follow-up (four studies), and for the secondary outcome 'prescribing of smoking cessation medications' (two studies). Four studies evaluated changes in provision of smoking cessation counseling and three favored the intervention. There were significant improvements in documentation of smoking status (one study), quitline referral (two studies) and quitline enrollment (two studies). Other secondary endpoints, such as asking about tobacco use (three studies) and advising to quit (three studies), also indicated some positive effects. The available evidence suggests that system change interventions for smoking cessation may not be effective in achieving increased cessation rates, but have been shown to improve process outcomes, such as documentation of smoking status, provision of cessation counseling and referral to smoking cessation services. However, as the available research is limited we are not able to draw strong conclusions. There is a need for additional high-quality research to explore the impact of system change interventions on both cessation and system-level outcomes.

Paul G. Barnett, Adam Chow, Nicole E. Flores, Scott E. Sherman, Sonia A. Duffy.
Changes in Veteran Tobacco Use Identified in Electronic Medical Records.
AJPM. Article In Press. DOI: http://dx.doi.org/10.1016/j.amepre.2017.01.009

Electronic medical records represent a new source of longitudinal data on tobacco use. Electronic medical records of the U.S. Department of Veterans Affairs were extracted to find patients’ tobacco use status in 2009 and at another assessment 12–24 months later. Records from the year prior to the first assessment were used to determine patient demographics and comorbidities. These data were analyzed in 2015. An annual quit rate of 12.0% was observed in 754,504 current tobacco users. Adjusted tobacco use prevalence at follow-up was 3.2% greater with alcohol use disorders at baseline, 1.9% greater with drug use disorders, 3.3% greater with schizophrenia, and lower in patients with cancer, heart disease, and other medical conditions (all differences statistically significant with p<0.05). Annual relapse rates in 412,979 former tobacco users were 29.6% in those who had quit for <1 year, 9.7% in those who had quit for 1–7 years, and 1.9% of those who had quit for >7 years. Among those who had quit for <1 year, adjusted relapse rates were 4.3% greater with alcohol use disorders and 7.2% greater with drug use disorders (statistically significant with p<0.05). High annual cessation rates may reflect the older age and greater comorbidities of the cohort or the intensive cessation efforts of the U.S. Department of Veterans Affairs. The lower cessation and higher relapse rates in psychiatric and substance use disorders suggest that these groups will need intensive and sustained cessation efforts.
 
McHugh RK, Votaw VR, Fulciniti F, Connery HS, Griffin ML, Monti PM, Weiss RD.
Perceived Barriers to Smoking Cessation Among Adults with Substance Use Disorders.
J Subst Abuse Treat. 2017 Mar;74:48-53. doi: 10.1016/j.jsat.2016.12.008. Epub 2016 Dec 30.

The majority of adults seeking substance use disorder treatment also smoke. Smoking is associated with greater substance use disorder severity, poorer treatment outcome, and increased mortality among those with substance use disorders. Yet, engaging this population in smoking cessation treatment is a significant challenge. The aim of this study was to examine perceived barriers to smoking cessation among treatment-seeking adults with alcohol or opioid use disorder. Additionally, we examined whether anxiety sensitivity - a known risk factor for barriers to smoking cessation in the general population - was associated with more barriers to smoking cessation in this sample. A sample of 208 adults was recruited for a one-time study and completed self-report measures of anxiety sensitivity and perceived barriers to smoking cessation. Results indicated that the most common barriers were anxiety (82% of the sample), tension/irritability (76%), and concerns about the ability to maintain sobriety from their primary substance of abuse (64%). Those who reported more barriers also reported lower confidence in the ability to change their smoking behavior. Higher anxiety sensitivity was associated with more perceived barriers to smoking cessation, even when controlling for cigarette dependence severity. These results suggest that there are several perceived barriers to smoking cessation among treatment-seeking adults with substance use disorders. In addition to psychoeducational interventions aimed to modify negative beliefs about smoking cessation, anxiety sensitivity may be a promising therapeutic target in this population.
 
Weinberger AH, Platt J, Esan H, Galea S, Erlich D, Goodwin RD.
Cigarette Smoking Is Associated With Increased Risk of Substance Use Disorder Relapse: A Nationally Representative, Prospective Longitudinal Investigation.
J Clin Psychiatry. 2017 Feb;78(2):e152-e160. doi: 10.4088/JCP.15m10062.
 
Little is known about the relationship between cigarette smoking and long-term outcomes for substance use disorder (SUD). The current study examined the association between smoking and SUD relapse among adults with remitted SUDs. Analyses were conducted on respondents who completed Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions and met DSM-IV criteria for substance abuse and dependence prior to but not during the year before the Wave 1 interview (n = 5,515). Relationships between smoking status (Wave 2 smoking vs nonsmoking among Wave 1 smokers; Wave 2 smoking vs nonsmoking among Wave 1 nonsmokers) and Wave 2 substance use and SUD relapse were examined using logistic regression analyses. Analyses were adjusted for demographics, psychiatric and alcohol use disorders, nicotine dependence, and SUD severity. In the fully adjusted models, continued smoking at Wave 2 among Wave 1 smokers was associated with significantly greater odds of substance use (OR = 1.56, 95% CI, 1.10-2.20) and SUD relapse (OR = 2.02, 95% CI, 1.65-2.47) compared to Wave 2 nonsmoking. In the fully adjusted model, smoking at Wave 2 among Wave 1 nonsmokers was associated with significantly greater odds of SUD relapse compared to Wave 2 nonsmoking (OR = 4.86, 95% CI, 3.11-7.58). Continued smoking among smokers and smoking initiation among nonsmokers were associated with greater odds of SUD relapse. More research is needed to examine the timing of SUD relapse in relation to smoking behaviors. Incorporating smoking cessation and prevention efforts into substance abuse treatment may improve long-term substance use outcomes for adult smokers with SUDs.
 
Goodwin RD, Wall MM, Garey L, Zvolensky MJ, Dierker L, Galea S, Gbedemah M, Weinberger AH, Williams JM, Hu MC, Hasin DS.
Depression Among Current, Former, and Never Smokers from 2005 to 2013: The hidden Role of Disparities in Depression in the Ongoing Tobacco Epidemic.
Drug Alcohol Depend. 2017 Jan 11. pii: S0376-8716(17)30008-X. doi: 10.1016/j.drugalcdep.2016.11.038. [Epub ahead of print]
 
After declining sharply for many years, the prevalence of smoking has remained fairly stable over the past decade. One possible explanation is that there has been an increase in the prevalence of barriers to cessation, like depression, among remaining smokers. To estimate changes in the prevalence of depression among current, former and never smokers in the United States (U.S.) population from 2005 to 2013 overall and by age, gender, and income. Data were drawn from the National Household Survey on Drug Use (NSDUH), an annual cross-sectional study of persons ages 12 and over (N=496,805). The prevalence of past 12-month depression was examined annually among current (past 12-month), former (not past 12-month), and lifetime non-smokers from 2005 to 2013. Data were re-analyzed stratified by age, gender, and household income, and adjusted for demographics.  Depression appears to have significantly increased in the United States from 2005 to 2013 among current, former, and never smokers. Depression prevalence increased among current smokers overall, but the increase among former and never smokers was even more prominent. Striking temporal changes emerged by age, gender and income. Specifically, (1) depression increased significantly among current smokers aged 12-17 (from 16% to 22%, p-value=0.0002) and the prevalence was consistently more than twice as high as that of never smokers; (2) depression increased among male smokers (6.19%-7.82%, p-value=0.0099); (3) depression increased significantly among smokers in the highest income group (6.36% to 8.91%, p-value=0.0400). Throughout this period, the prevalence of depression among current smokers was consistently twice as high as among former and never smokers. Public health efforts aimed at decreasing the prevalence of smoking should take depression into account, a common and modifiable barrier whose treatment may help to increase successful smoking cessation. Future work is needed to disentangle the role of smoking and other factors that lead to increases in depression in the US population.
 
KA Vickerman, GL Schauer, AM Malarcher, L Zhang, P Mowery, CM Nash.
Reasons for Electronic Nicotine Delivery System Use and Smoking Abstinence at 6 Months: a Descriptive Study of Callers to Employer and Health Plan-Sponsored Quitlines.
Tobacco Control. http://dx.doi.org/10.1136/tobaccocontrol-2015-052734

Describe cigarette smoking abstinence among employer and health plan-sponsored quitline registrants who were not using Electronic Nicotine Delivery Systems (ENDS), were using ENDS to quit smoking or were using ENDS for other reasons at the time of quitline registration. We examined 6029 quitline callers aged ≥18 years who smoked cigarettes at registration, and completed ≥1 counselling calls, baseline ENDS use questions and a 6-month follow-up survey (response rate: 52.4%). 30-day point prevalence smoking quit rates (PPQRs) were assessed at 6-month follow-up (ENDS-only users were considered quit). Data were weighted for non-response bias. Logistic regression analyses controlled for participant characteristics and programme engagement. At registration, 13.8% of respondents used ENDS (7.9% to quit smoking, 5.9% for other reasons). 30-day PPQRs were: 55.1% for callers using ENDS to quit, 43.1% for callers using ENDS for other reasons, and 50.8% for callers not using ENDS at registration. Callers using ENDS for other reasons were less likely to quit than other groups (adjusted ORs=0.65–0.77); quit rates did not significantly differ between non-ENDS users and those using ENDS to quit. Among callers using ENDS to quit at baseline, 40% used ENDS regularly at follow-up. ENDS users not using ENDS to quit smoking were less successful at quitting at 6-month follow-up compared with callers using ENDS to quit smoking and callers who did not use ENDS at programme registration. Incorporating reasons for ENDS use may be important for future studies examining the role of ENDS in tobacco cessation.
 
Ban A. Majeed, Scott R. Weaver, Kyle R. Gregory, Carrier F. Whitney, Paul Slovic, Terry F. Pechacek, Michael P. Eriksen.
Changing Perceptions of Harm of E-Cigarettes Among U.S. Adults, 2012–2015.
AJPM. March 2017 Volume 52, Issue 3, Pages 331–338. DOI:
http://dx.doi.org/10.1016/j.amepre.2016.08.039
 
Although the impact of long-term use of electronic cigarettes (e-cigarettes) on health is still unknown, current scientific evidence indicates that e-cigarettes are less harmful than combustible cigarettes. The study examined whether perceived relative harm of e-cigarettes and perceived addictivness have changed during 2012–2015 among U.S. adults. Data were from Tobacco Products and Risk Perceptions surveys of probability samples representative of U.S. adults in 2012, 2014, and 2015. Changes over time in perceived harmfulness of e-cigarettes were examined using pairwise comparisons of proportions and multi-nomial logistic regression analysis. Analyses were conducted in January 2016. Whereas 11.5% and 1.3% of adults perceived e-cigarettes to have about the same level of harm and to be more harmful than cigarettes, respectively, in 2012, 35.7% and 4.1% did so in 2015. The proportion of adults who thought e-cigarettes were addictive more than doubled during 2012–2015 (32.0% in 2012 vs 67.6% in 2015). Compared with 2012, the odds of perceiving e-cigarettes to be equally or more harmful (than to be less harmful) doubled (95% CI=1.64, 2.41) in 2014, and tripled (95% CI=2.60, 3.81) in 2015. There is an increase in the proportion of U.S. adults who misperceive the harm of e-cigarettes and consider them to be as harmful as combustible cigarettes. The study highlights the need to design public health messages that accurately interpret the scientific data on the potential harm of e-cigarettes and clearly differentiate the absolute from the relative harm of e-cigarettes.

Timothy R. Huerta, Daniel M. Walker, Deborah Mullen, Tyler J. Johnson, Eric W. Ford.
Trends in E-Cigarette Awareness and Perceived Harmfulness in the U.S.
AJPM. March 2017 Volume 52, Issue 3, Pages 339–346.DOI: http://dx.doi.org/10.1016/j.amepre.2016.10.017

Electronic cigarettes (e-cigarettes) are gaining in popularity as an alternative to regular cigarettes, as they are viewed as potentially less harmful. However, it remains unclear how awareness about e-cigarettes is permeating through the general U.S. population. This study seeks to extend previous research and examine trends in e-cigarette awareness and perceived harmfulness, and their association with smoking-cessation efforts. Data from three cycles (2012, 2013, and 2014) of the Health Information National Trends Survey were combined into a single data set. Controlling for survey year, multivariate logit models were used to determine the association between demographic characteristics and e-cigarette awareness, perceived harmfulness, quit attempts, and quit intentions. Data were analyzed in 2015. Awareness of e-cigarettes increased from 77.1% in 2012 to 94.3% in 2014. Controlling for demographic characteristics, e-cigarette awareness significantly increased in both 2013 and 2014, relative to 2012. Perception that e-cigarettes were less harmful than regular cigarettes declined from 50.7% in 2012 to 43.1% in 2014. Among smokers, no relationship was observed between e-cigarette awareness and past-year quit attempts or quit intentions, but those that viewed e-cigarettes as less harmful were less likely to have a past-year quit attempt. These analyses reveal a continued increase in overall public awareness of e-cigarettes and shifting harm perceptions relative to regular cigarettes. New regulatory oversight by the U.S. Food and Drug Administration may have major effects on both dimensions, which are worth continued monitoring.
 
Krishnan-Sarin S, Morean M, Kong G, Bold KW, Camenga DR, Cavallo DA, Simon P, Wu R.
E-Cigarettes and "Dripping" Among High-School Youth.
Pediatrics. 2017 Mar;139(3). Epub 2017 Feb 6.
 
Electronic cigarettes (e-cigarettes) electrically heat and vaporize e-liquids to produce inhalable vapors. These devices are being used to inhale vapors produced by dripping e-liquids directly onto heated atomizers. The current study conducts the first evaluation of the prevalence rates and reasons for using e-cigarettes for dripping among high school students. In the spring of 2015, students from 8 Connecticut high schools (n = 7045) completed anonymous surveys that examined tobacco use behaviors and perceptions. We assessed prevalence rates of ever using e-cigarettes for dripping, reasons for dripping, and predictors of dripping behaviors among those who reported ever use of e-cigarettes. Among 1080 ever e-cigarette users, 26.1% of students reported ever using e-cigarettes for dripping. Reasons for dripping included produced thicker clouds of vapor (63.5%), made flavors taste better (38.7%), produced a stronger throat hit (27.7%), curiosity (21.6%), and other (7.5%). Logistic regression analyses indicated that male adolescents (odds ratio [OR] = 1.64), whites (OR = 1.46), and those who had tried multiple tobacco products (OR = 1.34) and had greater past-month e-cigarette use frequency (OR = 1.07) were more likely to use dripping (Ps < .05). These findings indicate that a substantial portion (∼1 in 4) of high school adolescents who had ever used e-cigarettes also report using the device for dripping. Future efforts must examine the progression.
 
Regina El Dib, Erica A Suzumura, Elie A Akl, Huda Gomaa, Arnay Agarwal, Yaping Chang, Manya Prasad, Vahid Ashoorion, Diane Heels-Ansdell, Wasim Maziak, Gordon Guyatt.
Electronic Nicotine Delivery Systems and/or Electronic Non-nicotine Delivery Systems for Tobacco Smoking Cessation or Reduction: A Systematic Review and Meta-analysis.
BMJ Open 2017;7:e012680. doi: 10.1136/bmjopen-2016-012680
 
A systematic review and meta-analysis to investigate the impact of electronic nicotine delivery systems (ENDS) and/or electronic non-nicotine delivery systems (ENNDS) versus no smoking cessation aid, or alternative smoking cessation aids, in cigarette smokers on long-term tobacco use.Searches of MEDLINE, EMBASE, PsycInfo, CINAHL, CENTRAL and Web of Science up to December 2015.Randomised controlled trials (RCTs) and prospective cohort studies. Three pairs of reviewers independently screened potentially eligible articles, extracted data from included studies on populations, interventions and outcomes and assessed their risk of bias. We used the Grading of Recommendations Assessment, Development and Evaluation approach to rate overall certainty of the evidence by outcome. Three randomized trials including 1007 participants and nine cohorts including 13 115 participants proved eligible. Results provided by only two RCTs suggest a possible increase in tobacco smoking cessation with ENDS in comparison with ENNDS (RR 2.03, 95% CI 0.94 to 4.38; p=0.07; I2=0%, risk difference (RD) 64/1000 over 6 to 12 months, low-certainty evidence). Results from cohort studies suggested a possible reduction in quit rates with use of ENDS compared with no use of ENDS (OR 0.74, 95% CI 0.55 to 1.00; p=0.051; I2=56%, very low certainty). There is very limited evidence regarding the impact of ENDS or ENNDS on tobacco smoking cessation, reduction or adverse effects: data from RCTs are of low certainty and observational studies of very low certainty. The limitations of the cohort studies led us to a rating of very low-certainty evidence from which no credible inferences can be drawn. Lack of usefulness with regard to address the question of e-cigarettes' efficacy on smoking reduction and cessation was largely due to poor reporting. This review underlines the need to conduct well-designed trials measuring biochemically validated outcomes and adverse effects.
 
Morgan JC, Byron MJ, Baig SA, Stepanov I, Brewer NT.
How People Think About the Chemicals in Cigarette Smoke: A Systematic Review.
J Behav Med. 2017 Feb 21. doi: 10.1007/s10865-017-9823-5. [Epub ahead of print]
 
Laws and treaties compel countries to inform the public about harmful chemicals (constituents) in cigarette smoke. To encourage relevant research by behavioral scientists, we provide a primer on cigarette smoke toxicology and summarize research on how the public thinks about cigarette smoke chemicals. We systematically searched PubMed in July 2016 and reviewed citations from included articles. Four central findings emerged across 46 articles that met inclusion criteria. First, people were familiar with very few chemicals in cigarette smoke. Second, people knew little about cigarette additives, assumed harmful chemicals are added during manufacturing, and perceived cigarettes without additives to be less harmful. Third, people wanted more information about constituents. Finally, well-presented chemical information increased knowledge and awareness and may change behavior. This research area is in urgent need of behavioral science. Future research should investigate whether educating the public about these chemicals increases risk perceptions and quitting.
 
Erin Keely O’Brien, Anh B. Nguyen, Alexander Persoskie, Allison C. Hoffman.
U.S. Adults' Addiction and Harm Beliefs About Nicotine and Low Nicotine Cigarettes.
Preventive Medicine. Vol96, March 2017.
 
This research described U.S. adults' beliefs about nicotine and low nicotine cigarettes (LNCs) using the nationally-representative Health Information National Trends Survey (HINTS-FDA 2015; N = 3738). About three quarters of people either were unsure of the relationship between nicotine and cancer or incorrectly believed that nicotine causes cancer. People who were non-White, less educated, age 65 +, and never established smokers were most likely to be unaware that nicotine is not a cause of cancer. More than a quarter of people held the potentially inaccurate beliefs that LNCs would be less harmful and addictive than typical cigarettes. Whites were more likely than Blacks to believe LNCs were less harmful than typical cigarettes, and never smokers were more likely to believe this than established quitters. Whites and people with at least a college degree were more likely to believe that LNCs would be less addictive than typical cigarettes. Overall, we found that many people, particularly the demographic subgroups identified here, held incorrect beliefs about nicotine and potentially inaccurate beliefs about LNCs. Findings should be considered in assessing the public health impact of marketing low nicotine products. Incorrectly believing that nicotine causes cancer could discourage smokers from switching to safer nicotine-containing alternatives, and could lead nonsmokers to experiment with low nicotine tobacco products, believing that cancer risk would be reduced. Findings underscore the need to educate the public on the health effects of nicotine and LNCs, and can help public health practitioners determine which subgroups should be prioritized in targeted educational efforts.
 
Diana Weinhold and Frank J. Chaloupka.
Smoking Status and Subjective Well-being.
Tobacco Control. http://dx.doi.org/10.1136/tobaccocontrol-2015-052601
 
A debate is currently underway about the Food and Drug Administration's (FDA's) methods for evaluating anti-tobacco regulation. In particular, the US government requires a cost-benefit analysis for significant new regulations, which has led the FDA to consider potential lost subjective well-being (SWB) of ex-smokers as a cost of any proposed anti-tobacco policy. This practice, which significantly limits regulatory capacity, is premised on the assumption that there is in fact a loss in SWB among ex-smokers. We analyze the relationship between SWB and smoking status using a longitudinal internet survey of over 5000 Dutch adults across 5 years. We control for socioeconomic, demographic and health characteristics, and in a contribution to the literature, we additionally control for two potential confounding personality characteristics, habitual use of external substances and sensitivity to stress. In another contribution, we estimate panel fixed effects models that additionally control for unobservable time-invariant characteristics. We find strong suggestive evidence that ex-smokers do not suffer a net loss in SWB. We also find no evidence that the change in SWB of those who quit smoking under stricter tobacco control policies is different from those who quit under a more relaxed regulatory environment. Furthermore, our cross-sectional estimates suggest that the increase in SWB from quitting smoking is statistically significant and also of a meaningful magnitude. In sum, we find no empirical support for the proposition that ex-smokers suffer lower net SWB compared to when they were smoking.
 
Jamie Guillory, Nadra Lisha, Youn Ok Lee, and Pamela M. Ling.
Phantom Smoking Among Young Adult Bar Patrons.
Tobacco Control. http://dx.doi.org/10.1136/tobaccocontrol-2015-052821

To explore the prevalence and sociodemographic makeup of smokers who do not self-identify as smokers (ie, phantom smokers) compared with self-identifying smokers in a sample of bar-going young adults aged 18–30 years to more accurately assess young adult prevalence of smoking and inform cessation message targeting. Cross-sectional surveys of smokers (n=3089) were conducted in randomly selected bars/nightclubs in seven US cities. Logistic regression models assessed associations between phantom smoking (past 30-day smoking and denial of being a smoker), tobacco and alcohol use behaviors (eg, social smoking, nicotine dependence, smoking while drinking, past 30-day alcohol use) and demographics. Compared with smokers, phantom smokers were more likely to be college graduates (OR=1.43, 95% CI 1.03 to 1.98) and to identify themselves as social smokers (OR=1.60, 95% CI 1.27 to 2.12). Phantom smokers had lower odds of smoking while drinking (OR=0.28, 95% CI 0.25 to 0.32), being nicotine dependent (OR=0.36, 95% CI 0.22 to 0.76) and having quit for at least 1 day in the last year (OR=0.46, 95% CI 0.36 to 0.69) compared with smokers. This research extends phantom smoking literature on college students to provide a broader picture of phantom smoking among young adults in high-risk contexts and of varying levels of educational attainment. Phantom smokers may be particularly sensitive to social pressures against smoking, suggesting the importance of identifying smoking as a behavior (rather than identity) in cessation messaging to ensure that phantom smokers are reached.
 
Kotlyar M, Lindgren BR, Vuchetich JP, Le C, Mills AM, Amiot E, Hatsukami DK.
Timing of Nicotine Lozenge Administration to Minimize Trigger Induced Craving and Withdrawal Symptoms.
Addict Behav. 2017 Feb 10;71:18-24. doi: 10.1016/j.addbeh.2017.02.018. [Epub ahead of print]
 
Smokers are often advised to use nicotine lozenge when craving or withdrawal symptoms occur. This may be too late to prevent lapses. This study assessed if nicotine lozenge use prior to a common smoking trigger can minimize trigger induced increases in craving and withdrawal symptoms. Eighty-four smokers completed two laboratory sessions in random order. At one session, nicotine lozenge was given immediately after a stressor (to approximate current recommended use - i.e., after craving and withdrawal symptoms occur); at the other session subjects were randomized to receive nicotine lozenge at time points ranging from immediately to 30min prior to the stressor. Withdrawal symptoms and urge to smoke were measured using the Minnesota Nicotine Withdrawal Scale and the Questionnaire of Smoking Urges (QSU). Relative to receiving lozenge after the stressor, a smaller increase in pre-stressor to post-stressor withdrawal symptom scores occurred when lozenge was used immediately (p=0.03) and 10min prior (p=0.044) to the stressor. Results were similar for factors 1 and 2 of the QSU when lozenge was used immediately prior to the stressor (p<0.03) and for factor 1 of the QSU when lozenge was used 10min prior to the stressor (p=0.028). Absolute levels of post-stressor withdrawal symptom and urge to smoke severity were lower when lozenge was given prior to versus after a stressor. Administering the nicotine lozenge prior to a smoking trigger can decrease trigger induced craving and withdrawal symptoms. Future studies are needed to determine if such use would increase cessation rates. Clinicaltrials.gov # NCT01522963.

Andrea H. Weinberger, Jonathan M. Platt, Philip H. Smith, Renee D. Goodwin. 
Racial/Ethnic Differences in Self-reported Withdrawal Symptoms and Quitting Smoking Three Years Later: A Prospective, Longitudinal Examination of US Adults.
Nicotine Tob Res (2017) 19 (3): 373-378. DOI: https://doi.org/10.1093/ntr/ntw221
 
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 US adults examined racial/ethnic differences in current smokers’ report of withdrawal symptoms and the relationship between withdrawal symptoms and quitting smoking 3 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 = 7981). 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 < .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 β = 0.065, p = .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 smoking among adults in the United States. 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.

Chad A. Logan, Dietrich Rothenbacher, Jon Genuneit.
Postpartum Smoking Relapse and Breast Feeding: Defining the Window of Opportunity for Intervention.
Nicotine Tob Res (2017) 19 (3): 367-372. DOI: https://doi.org/10.1093/ntr/ntw224
 
Though many women spontaneously quit smoking during pregnancy, a large proportion relapse after delivery. Efforts aimed at reducing postpartum smoking relapse have been largely ineffective. Several studies have reported breast feeding as a primary factor influencing smoking abstinence duration. However, data on the potential role of breast feeding in smoking intervention efforts remain incomplete. The Ulm SPATZ Health Study cohort consists of 1006 newborns of 970 mothers recruited in the University Medical Center Ulm, Germany. Kaplan–Meier plots, log-rank tests, and Cox proportional hazards models were used to assess differences in predominant and total breast-feeding duration stratified by smoking abstinence at 2 years and relapse period (by 6 weeks, 6 months, and 2 years postdelivery). Chi-square and Kruskal–Wallis tests were performed to identify significant differences in demographic and lifestyle factors across smoking categories. Approximately 70% of previous smokers who initiated breast feeding relapsed within 2 years. Relapse by 6 months was significantly associated with noninitiation of predominant breast feeding. Total breast-feeding duration rates among abstaining mothers and those who relapsed after 6 weeks mirrored those of nonsmokers respectively up to 1 year and 3 months. Lower age and education were mostly associated with smoking by 6 weeks. First parity and having a nonsmoking partner were associated with abstinence up to 2 years. Interventions promoting breast feeding to incentivize continued smoking abstinence may be effective prior to weaning. Those promoting breast feeding longer than 6 months and partner smoking cessation may increase rates of long-term smoking abstinence lasting longer than 2 years postdelivery. Most mothers who quit smoking during pregnancy relapse within 6 months of delivery. Though interventions targeting new mothers have been largely unsuccessful, relapse is often delayed until after weaning and targeted breast-feeding promotion has been suggested to enhance smoking cessation interventions. In this study, we assess the relationship between breast-feeding duration and long-term smoking abstinence by longitudinally investigating predominant and total breast-feeding patterns among mothers with a recent history of smoking stratified by period of relapse up to 2 years after delivery.
 
Jamie Guillory, Nadra Lisha, Youn Ok Lee, and Pamela M. Ling.
Phantom Smoking Among Young Adult Bar Patrons.
Tobacco Control. http://dx.doi.org/10.1136/tobaccocontrol-2015-052821

To explore the prevalence and sociodemographic makeup of smokers who do not self-identify as smokers (ie, phantom smokers) compared with self-identifying smokers in a sample of bar-going young adults aged 18–30 years to more accurately assess young adult prevalence of smoking and inform cessation message targeting. Cross-sectional surveys of smokers (n=3089) were conducted in randomly selected bars/nightclubs in seven US cities. Logistic regression models assessed associations between phantom smoking (past 30-day smoking and denial of being a smoker), tobacco and alcohol use behaviors (eg, social smoking, nicotine dependence, smoking while drinking, past 30-day alcohol use) and demographics. Compared with smokers, phantom smokers were more likely to be college graduates (OR=1.43, 95% CI 1.03 to 1.98) and to identify themselves as social smokers (OR=1.60, 95% CI 1.27 to 2.12). Phantom smokers had lower odds of smoking while drinking (OR=0.28, 95% CI 0.25 to 0.32), being nicotine dependent (OR=0.36, 95% CI 0.22 to 0.76) and having quit for at least 1 day in the last year (OR=0.46, 95% CI 0.36 to 0.69) compared with smokers. This research extends phantom smoking literature on college students to provide a broader picture of phantom smoking among young adults in high-risk contexts and of varying levels of educational attainment. Phantom smokers may be particularly sensitive to social pressures against smoking, suggesting the importance of identifying smoking as a behavior (rather than identity) in cessation messaging to ensure that phantom smokers are reached.

Olivia A. Wackowski, Kiameesha R. Evans, Melissa B. Harrell, Alexandra Loukas, M. Jane Lewis, Cristine D. Delnevo, Cheryl L. Perry.
In Their Own Words: Young Adults’ Menthol Cigarette Initiation, Perceptions, Experiences and Regulation Perspectives.
Nicotine Tob Res. DOI:https://doi.org/10.1093/ntr/ntx048
 
Menthol cigarettes are disproportionately used by young people and have been called smoking starter products. However, limited qualitative research exists on young adults’ perceptions of and experiences with these products, with much of it based on document reviews of the tobacco industry’s research. We conducted six focus groups with young adult (ages 18-24) menthol smokers in New Jersey (half with black smokers) between December 2014 and March 2015. Participants were asked open-ended questions about their menthol smoking initiation, preference reasons, substitution behaviors, and perceptions of menthol cigarette risks and regulation. Participants’ menthol cigarette initiation and preference was influenced by their perceived popularity, brand recognition, taste, smoothness, satisfaction and access (including as “loosies,” typically available for Newport). Some believed menthol cigarettes were less harmful than non-menthol cigarettes when initiating smoking. Many currently believed menthol cigarettes were more harmful because they contained extra “additives,” were stronger (i.e., requiring fewer cigarettes to feel satisfied), and/or based on hearsay. Many had tried new brand Camel Crush, which was perceived to be especially minty, fun, and attractive for newer smokers. While some used non-menthol cigarettes when menthols were unavailable, many said they would never or almost never substitute. Many acknowledged a menthol cigarettes ban would likely help them quit smoking, even though they did not support the idea. Menthol cigarette initiation is influenced by an interplay of multiple factors including their sensory properties, marketing, perceived popularity and availability. The FDA should continue to pursue closing this flavored cigarette loophole.

Norman C. H. Wong, Gwendelyn S. Nisbett, Lindsey A. Harvell.
Smoking Is So Ew!: College Smokers’ Reactions to Health- Versus Social-Focused Antismoking Threat Messages.
Health Communications. Vol32 (4). 2017.

This study utilizes Terror Management Theory (TMT) to examine differences between eliciting social death and physical death anxiety related to smoking, smoking attitudes, and quitting intent among college students. Moreover, an important TMT variable—self-esteem—was used as a moderator. A 2 × 3 between-subjects factorial design crossed smoking-based self-esteem (low, high) with mortality salience manipulation (health-focused, social-focused, control). Results suggest while both making health-focused salient and making social-focused mortality salient were effective at getting smokers to quit, there was less effect for health-focused mortality salience on those whose self-esteem is strongly tied to smoking. Effect of social-focused mortality salience was more pronounced among participants who highly linked self-esteem with smoking. For smokers with low smoking-based self-esteem, both health-focused and social-focused mortality salience were effective at motivating attitude change toward smoking and quitting intentions. Implications for smoking cessation ad design and TMT are discussed.

Cornelia Pechmann, Kevin Delucchi, Cynthia M Lakon, Judith J Prochaska.
Randomized Controlled Trial Evaluation of Tweet2Quit: A Social Network Quit-smoking Intervention.
Tobacco Control. http://dx.doi.org/10.1136/tobaccocontrol-2015-052768

 We investigated whether exposure to same humorous anti-tobacco videos via different types of social media platforms and contexts (health vs. humor) influences individual’s health risk perceptions, attitudes, and behavioral intents. An experiment with a 2 (social media types: YouTube and Facebook) × 2 (message contexts: health-focused and humor-focused contexts) factorial design was conducted. It was found that those who watched the humorous anti-tobacco videos on Facebook in the health-context exhibited a higher level of risk perception of smoking, less positive attitude toward smokers, and a higher level of intention to avoid smoking in the future than the participants who viewed the same videos on YouTube in the health-context or on Facebook in the humor-context. These findings provide useful practical guidelines in using social media for health communication/promotion. Humorous health promotion messages are best circulated on social networking sites such as Facebook accompanied by others’ support for the given health topic (i.e., in health-contexts). Practical/theoretical implications and limitations of the study were further discussed in this article.
 
Haghpanahan H, Mackay DF, Pell JP, Bell D, Langley T, Haw S.

The Impact of TV Mass Media Campaigns on Calls to a National Quitline and the Use of Prescribed Nicotine Replacement Therapy: A Structural Vector Autoregression Analysis.
Addiction. 2017 Feb 13. doi: 10.1111/add.13793. [Epub ahead of print]
 
To estimate 1) the immediate impact; 2) the cumulative impact; and 3) the duration of impact of Scottish tobacco control TV mass media campaigns (MMCs) on smoking cessation activity, as measured by calls to Smokeline and the volume of prescribed nicotine replacement therapy (NRT). Multivariate time series analysis using secondary data on population level measures of exposure to TV MMCs broadcast and smoking cessation activity between 2003 and 2012. Adult television viewer ratings (TVRs) as a measure of exposure to Scottish mass media campaigns in the adult population; monthly calls to NHS Smokeline; and the monthly volume of prescribed NRT as measured by gross ingredient costs (GIC). Tobacco control TVRs were associated with an increase in calls to Smokeline but not an increase in the volume of prescribed NRT. A one standard deviation increase of 194 tobacco control TVRs led to an immediate and significant increase of 385.9 (95% CI: 171.0, 600.7) calls to Smokeline (unadjusted model) within one month. When adjusted for seasonality the impact was reduced but the increase in calls remained significant (226.3 calls, 95% CI: 37.3, 415.3). The cumulative impact on Smokeline calls remained significant for 6 months after broadcast in the unadjusted model and 18 months in the adjusted model. However, an increase in tobacco control TVRs of 194 failed to have a significant impact on the GIC of prescribed NRT in either the unadjusted (£1361.4, 95% CI: - £9138.0, £11860.9) or adjusted (£6297.1, 95% CI: -£2587.8, £15182.1) models. Tobacco control television mass media campaigns broadcast in Scotland between 2003 and 2012 were effective in triggering calls to Smokeline but did not significantly increase the use of prescribed nicotine replacement therapy by adult smokers. The impact on calls to Smokeline occurred immediately within one month of broadcast and was sustained for at least 6 months.
 
Jon-Patrick Allen, Patricia Escobedo, Kar-Hai Chu, Daniel W. Soto, Tess Boley Cruz, Jennifer B. Unger.
Campaigns and Counter Campaigns: Reactions on Twitter to E-cigarette Education.
Tobacco Control 2017;26:226-229. http://dx.doi.org/10.1136/tobaccocontrol-2015-052757
 
Social media present opportunities for public health departments to galvanise interest in health issues. A challenge is creating content that will resonate with target audiences, and determining reactions to educational material. Twitter can be used as a real-time surveillance system to capture individuals’ immediate reactions to education campaigns and such information could lead to better campaigns in the future. A case study testing Twitter's potential presented itself when the California Department of Public Health launched its ‘Still Blowing Smoke’ media campaign about the potential harmful effects of e-cigarettes. Pro-e-cigarette advocacy groups, in response, launched a counter campaign titled ‘Not Blowing Smoke’. This study tracked the popularity of the two campaigns on Twitter, analyzed the content of the messages and determined who was involved in these discussions. The study period was from 22 March 2015 to 27 June 2015. A stratified sampling procedure supplied 2192 tweets for analysis. Content analysis identified pro, anti and neutral e-cigarette tweets, and five additional themes: Marketing Elements, Money, Regulation/propaganda, Health, and Other. Metadata were analyzed to obtain additional information about Twitter accounts. ‘Not Blowing Smoke’ was referenced more frequently than ‘Still Blowing Smoke’ on Twitter. Messages commonly objected to government regulation of e-cigarettes, refuted claims that e-cigarette manufactures were aligned with big tobacco, and touted the health benefits of e-cigarette use. E-cigarette companies and vape shops used campaign slogans to communicate with customers on Twitter. Findings showed the time dynamics of Twitter and the possibility for real-time monitoring of education campaigns.
 
Beatriz Anguiano, Cati Brown-Johnson, Lisa G. Rosas, Cornelia Pechmann, Judith J. Prochaska. Latino Adults’ Perspectives on Treating Tobacco Use Via Social Media.
JMIR Mhealth Uhealth. 2017 Feb; 5(2): e12.
 
Latinos are the largest minority group in the United States, and in California they outnumber non-Hispanic whites. Smoking cessation programs tailored for Latino culture, and this population’s specific smoking patterns, are needed. Online social networks for smoking cessation have high potential for Latinos, but have not been tested to date. Building a research program on social media apps for cancer prevention in diverse populations, this qualitative study assessed acceptability of tobacco treatment that was distributed via social media for Latino smokers. We conducted three focus groups with Latino adults who were former and current smokers recruited from Santa Clara County, California in 2015 (N=32). We assessed participants’ smoking histories, attempts to quit, social media exposure, and receptivity to a social media-based smoking cessation intervention. Audio transcripts were translated and coded for themes. Participants reported factors driving their tobacco use and motivations to quit, and emphasized the importance of community and family in influencing their smoking initiation, cravings and triggers, attempts to quit, and abstinence. Participants valued the communal aspect of social media and suggested strategically tailoring groups based on key features (eg, age, gender, language preference). Participants reported preferring visual, educational, and motivational messages that were connected with existing services. Participants generally voiced acceptability of a social media-delivered intervention to help them quit smoking, viewed the intervention as well-equipped for catering to the strong community orientation of Latinos, and suggested that the platform was able to address variation within the population through strategic group creation. As a group member reflected, “Podemos hacerlo juntos” (We can do it together).
 
Amy M Cohn, Sarah J Ehlke, Caroline O. Cobb, Eric K. Soule.
Hookah Tobacco Smoking in a Large Urban Sample of Adult Cigarette Smokers: Links with Alcohol and Poly-tobacco Use.
Addictive Behaviors. Volume 68, May 2017.
 
Hookah tobacco smoking (HTS) has been increasing, particularly among young adults and has similar health effects compared to cigarette smoking. The link between HTS and poly-tobacco use is well documented, but fewer show an association between HTS and alcohol use. It is essential to identify factors that increase the risk for or addictiveness and consequences of HTS, given its growing prevalence. This study examined whether the association between HTS and poly-tobacco use differed as a function of age and alcohol consumption within in a sample of 1223 adult cigarette smokers. Approximately 20% of participants reported HTS. Compared to non-users, hookah users were more likely to be male, highly educated, and to report drug and alcohol use, binge drinking, and poly-tobacco use but were less likely to be heavy smokers (≥ 10 cigarettes per day). Regression analyses predicting number of tobacco products used (excluding cigarettes and HTS) indicated a three-way interaction of HTS, frequency of alcohol use, and age such that the association between HTS and number of tobacco products used was strongest for younger respondents who consumed alcohol more frequently. As observed in previous studies, alcohol is an important risk factor in the relationship between HTS and poly-tobacco use, particularly among younger cigarette smokers. The links between alcohol, HTS, and poly-tobacco use should be considered when developing HTS education and prevention materials directed toward younger cigarette smokers. Findings provide information relevant to FDA's interest in the addiction potential of HTS and its link to poly-tobacco use.

Kelvin Choi, Raymond G. Boyle.
Changes in Cigarette Expenditure Minimizing Strategies Before and After a Cigarette Tax Increase.
Tobacco Control. http://dx.doi.org/10.1136/tobaccocontrol-2016-053415
 
Smokers use cigarette expenditure minimizing strategies (CEMS) to alleviate the effect of tax increases on their cigarette expenses. We examined changes in smokers’ CEMS use before and after a 2013 Minnesota $1.75 cigarette tax increase. Data were from representative samples of smokers who participated in the Minnesota Adult Tobacco Survey 2010 (n=948) and 2014 (n=1229). Participants indicated CEMS used in the past year from a list. Weighted multiple logistic regressions were used to examine changes in prevalence of each CEMS use over time adjusting for demographics and cigarette consumption. Characteristics associated with CEMS use in 2014 were examined. Between 2010 and 2014, more smokers tried to save money on cigarettes by rolling their own cigarettes (from 19% to 29%), using other tobacco products (from 13% to 25%), and buying cigarettes from cheaper places (from 48% to 55%). Yet, fewer smokers used coupons/promotions (from 63% to 50%) and bought cigarettes by the carton (from 39% to 32%). These changes varied somewhat by race/ethnicity and education, for example, more smokers with <high school education used discount brands over time than more educated smokers. CEMS use in 2014 varied by demographics, for example, smokers with lower education were more likely than those with higher education to purchase discount brands, roll their own cigarettes, use coupons/promotions and cut back on smoking (p<0.05). Socially disadvantaged smokers were most likely to use CEMS and continue smoking after a cigarette tax increase. Regulations that would reduce CEMS use could boost the effectiveness of cigarette tax increases.
 
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