• The Tobacco Online Policy Seminar (TOPS) 2021-2022 Fall/Winter Series.
• Upcoming Tobacco Cessation Coverage & Health Systems Change Cohort Opportunity.
• Virtual Training - Rutgers Center for Tobacco Studies in Collaboration with the Division of Addiction Psychiatry And co Provided with Rutgers University Behavioral Health Care.
• Oklahoma and Colorado 2/28/2022 Deadline Reminder: Telligen Community Initiative's 2022 Funding Priorities.
• March 15: SCRIPT (Smoking Cessation or Reduction in Pregnancy Treatment) Virtual Training.
• March 30 WEBINAR: Smoke-Free Tribal Housing Policies.
• April 27, 28 Virtual Conference: 3rd Annual Teaching Cannabis Awareness & Prevention Conference: A Focus on the Triangulum of Cannabis, Tobacco, and Vaping.

• Tips^® 2022 Update.
• February is Black History Month.
• Download this FREE Tobacco Control Resource!
• CMS Medicare Lung Cancer Screening Decision Memo.
• NAQC Encourages State Quitlines to Participate in DOD’s Tobacco Cessation Support Locator!
• Smoking and Vaping in Young People’s Favorite Shows isn’t just Rampant, it’s Often Glamorized, too.
• Music Videos Popular with Young People Frequently Feature Tobacco Imagery.
• American Lung Association's "State of Tobacco Control".
• SCLC's I COVID QUIT Social Media Campaign.

Quitlines

Vinci C, Lam C, Schlechter CR, Shono Y, Vidrine JI, Wetter DW.
Increasing Treatment Enrollment among Smokers who are not Motivated to Quit: A Randomized Clinical Trial.
Transl Behav Med. 2022 Jan 18;12(1):ibab114. doi: 10.1093/tbm/ibab114. PMID: 34424337; PMCID: PMC8764989.

There is a significant research-to-practice gap with respect to reaching underserved populations with evidence-based tobacco cessation treatments. Increasing enrollment in evidence-based treatments is necessary to reduce tobacco use and tobacco-related health inequities. The purpose of the current study was to evaluate whether Motivation And Problem Solving (MAPS), a flexible, holistic counseling/navigation approach delivered via phone, and proactive provision of Nicotine Replacement Therapy (NRT) would improve Quitline enrollment among a sample of low SES smokers who were not motivated to quit. In a 3×2 factorial design, cigarette smokers (N = 603) were randomized to one of six treatment conditions (Standard Treatment, MAPS-6, or MAPS-12 by NRT or no NRT). Results indicated that both MAPS-6 and MAPS-12 increased Quitline enrollment compared to Standard Treatment (ps < .03). There were no differences between MAPS conditions. NRT did not increase Quitline enrollment. MAPS is an effective intervention with the potential to be disseminated and implemented in healthcare and community settings to increase the reach of evidence-based interventions for tobacco cessation.

Bold KW, Cannon S, Ford BB, Neveu S, Sather P, Toll BA, Fucito LM.
Examining Tobacco Treatment Perceptions and Barriers among Black vs. non-Black Adults Attending Lung Cancer Screening.
Cancer Prev Res (Phila). 2022 Jan 21:canprevres.CAPR-21-0398-A.2021. doi: 10.1158/1940-6207.CAPR-21-0398. Epub ahead of print. PMID: 35063942.

The US Preventive Services Task Force recommends annual lung cancer screening for patients at high risk based on age and smoking history. Understanding the characteristics of patients attending lung cancer screening, including potential barriers to quitting smoking, may inform ways to engage these high-risk patients in tobacco treatment and address health disparities. Patients attending lung cancer screening who currently smoke cigarettes completed a survey at Smilow Cancer Hospital at Yale-New Haven (N=74) and the Medical University of South Carolina (N=73) at the time of their appointment. The survey assessed demographics, smoking history, and perceptions and concerns about quitting smoking. Patients were 55-76 years old (M=63.3, SD=5.3), N=64 (43.5%) female, and N=31 (21.1%) non-Hispanic Black. Patients smoked 16.3 cigarettes per day on average (SD=9.2) and rated interest in quitting smoking in the next month as moderate (M=5.6, SD=3.1, measured from 0="very definitely no" to 10="very definitely yes"). The most frequently endorsed concerns about quitting smoking were missing smoking (70.7%), worry about having strong urges to smoke (63.9%), and concerns about withdrawal symptoms (59.9%). Compared to other race/ethnicities, Black patients were less likely to report concerns about withdrawal symptoms and more likely to report smoking less now and perceiving no need to quit. Findings identified specific barriers for tobacco treatment and differences by race/ethnicity among patients attending lung cancer screening, including concerns about withdrawal symptoms and perceived need to quit. Identifying ways to promote tobacco treatment is important for reducing morbidity and mortality among this high-risk population.

Mills SD, Kong AY, Reimold AE, Baggett CD, Wiesen CA, Golden SD.
Sociodemographic Disparities in Tobacco Retailer Density in the United States, 2000 - 2017.
Nicotine Tob Res. 2022 Jan 25:ntac020. doi: 10.1093/ntr/ntac020. Epub ahead of print. PMID: 35079790.

Introduction. Studies find differences in tobacco retailer density according to neighborhood sociodemographic characteristics, raising issues of social justice, but not all research is consistent. This study examined associations between tobacco retailer density and neighborhood sociodemographic characteristics in the United States (US) at four timepoints (2000, 2007, 2012, 2017) and investigated if associations remained stable over time.
Methods. Data on tobacco retailers came from the National Establishment Time-Series Database. Adjusted log-linear models examined the relationship between retailer density and census tract sociodemographic characteristics (% non-Hispanic Black [Black], % Hispanic, % vacant housing units, median household income), controlling for percentage of youth, urbanicity and US region. To examine whether the relationship between density and sociodemographic characteristics changed over time, additional models were estimated with interaction terms between each sociodemographic characteristic and year.
Results. Tobacco retailer density ranged from 1.22-1.44 retailers/1,000 persons from 2000 to 2017. There were significant, positive relationships between tobacco retailer density and the percentage of Black (standardized exp(b)=1.05 (95% CI: 1.04, 1.07) and Hispanic (standardized exp(b)=1.06 (95% CI: 1.05, 1.08) residents and the percentage of vacant housing units (standardized exp(b)=1.08 (95% CI: 1.07, 1.10) in a census tract. Retailer density was negatively associated with income (standardized exp(b)=0.84 (95% CI: 0.82, 0.86). From 2000 to 2017, the relationship between retailer density and income and vacant housing units became weaker.
Conclusions. Despite the weakening of some associations, there are sociodemographic disparities in tobacco retailer density from 2000 to 2017, which research has shown may contribute to inequities in smoking.
Implications. This study examines associations between tobacco retailer density and neighborhood sociodemographic characteristics in the United States at four time points from 2000 to 2017. Although some associations weakened, there are sociodemographic disparities in tobacco retailer density over the study period. Research suggests that sociodemographic disparities in retailer density may contribute to inequities in smoking. Findings from this study may help identify which communities should be prioritized for policy intervention and regulation.

Rest EC, Brikmanis KN, Mermelstein RJ.
Preferred Flavors and Tobacco Use Patterns in Adult Dual Users of Cigarettes and ENDS.
Addict Behav. 2022 Feb;125:107168. doi: 10.1016/j.addbeh.2021.107168. Epub 2021 Oct 30. PMID: 34772504; PMCID: PMC8629959.

Objectives. This study examined how adult dual users of cigarettes and electronic nicotine delivery system (ENDS) flavor preference varied by demographics, tobacco history, motives, and expectancies for ENDS, and how ENDS flavor preference was associated with changes in cigarette and ENDS use over 12 months.
Methods. Data come from the baseline and 12-month waves of an observational study of adult dual cigarette and ENDS users (N = 406). Flavor preferences were grouped into 4 categories: tobacco (12.6%), menthol/mint (34.7%), sweet (44.8%), and other (7.9%).
Results. Users of sweet-flavored ENDS were significantly younger than those who used tobacco- or menthol flavors. Black dual users were significantly more likely than other racial groups to use menthol and less likely to use sweet flavors. Dual users who preferred sweet flavors smoked cigarettes on fewer days than those who preferred tobacco and menthol flavors, were less cigarette dependent, more strongly endorsed boredom reduction expectancies and motives related to taste and sensory experience and were more likely to stop smoking by 12 months.
Conclusions. Dual users of cigarettes and ENDS who preferred sweet flavored ENDS differed in demographics, tobacco history, motives, expectancies, and smoking changes. Findings have implications for interventions and regulations.

Li W, Osibogun O, Li T, Sutherland MT, Maziak W.
Changes in Harm Perception of ENDS and Their Predictors Among US Adolescents: Findings from the Population Assessment of Tobacco and Health (PATH) Study, 2013-2018.
Prev Med. 2022 Feb;155:106957. doi: 10.1016/j.ypmed.2022.106957. Epub 2022 Jan 21. PMID: 35065977.

Electronic nicotine delivery systems (ENDS) use has dramatically increased in the US. This study aimed to characterize changes in ENDS harm perception over time and associated predictors among US adolescents. Data from the 2013-2018 Population Assessment of Tobacco and Health Study (PATH) for adolescents (12-17 years) were utilized. Trend analyses were employed to delineate changes in comparative and absolute ENDS harm perception over a four-year interval. We applied a time-varying effect model (TVEM) to examine the associations between the changes in harm perception and associated predictors. The results suggest that perception of ENDS as less harmful than cigarettes significantly decreased from 54.3% at Wave 1 (2013) to 30.4% at Wave 4 (2018) (P < 0.001). Perception of ENDS as no or little harm decreased from 35.9% at Wave 1 to 16.9% at Wave 4 (P < 0.001). These changes in harm perception were less robust among males, adolescents who did not have positive tobacco-related attitudes, and those with smoke-free home rules (P's < 0.05). Additionally, having ever used ENDS or alcohol were more likely to be associated with reduced ENDS-related harm perception over time (P's < 0.05). Our results show that while ENDS-related harm perception have generally increased, this does not appear to be equally experienced across all adolescents, potentially highlighting the importance of at-risk groups and targets for intervention. This study can help identify individuals at risk of ENDS initiation because of their favorable ENDS harm perception profile, as well as guide the development of ENDS risk communication interventions for adolescents.

Chen R, Pierce JP, Leas EC, et al.
Effectiveness of E-cigarettes as Aids for Smoking Cessation: Evidence from the PATH Study Cohort, 2017–2019.
Tobacco Control Published Online First: 07 February 2022. doi: 10.1136/tobaccocontrol-2021-056901

Objective. To assess the effectiveness of e-cigarettes in smoking cessation in the USA from 2017 to 2019, given the 2017 increase in high nicotine e-cigarette sales.
Methods. In 2017, the PATH Cohort Study included data on 3578 previous year smokers with a recent quit attempt and 1323 recent former smokers. Respondents reported e-cigarettes or other products used to quit cigarettes and many covariates associated with e-cigarette use. Study outcomes were 12+ months of cigarette abstinence and tobacco abstinence in 2019. We report weighted unadjusted estimates and use propensity score matched analyses with 1500 bootstrap samples to estimate adjusted risk differences (aRD).
Results. In 2017, 12.6% (95% CI 11.3% to 13.9%) of recent quit attempters used e-cigarettes to help with their quit attempt, a decline from previous years. Cigarette abstinence for e-cigarette users (9.9%, 95% CI 6.6% to 13.2%) was lower than for no product use (18.6%, 95% CI 16.0% to 21.2%), and the aRD for e-cigarettes versus pharmaceutical aids was −7.3% (95% CI −14.4 to –0.4) and for e-cigarettes versus any other method was −7.7% (95% CI −12.2 to –3.2). Only 2.2% (95% CI 0.0% to 4.4%) of recent former smokers switched to a high nicotine e-cigarette. Subjects who switched to e-cigarettes appeared to have a higher relapse rate than those who did not switch to e-cigarettes or other tobacco, although the difference was not statistically significant.
Conclusions. Sales increases in high nicotine e-cigarettes in 2017 did not translate to more smokers using these e-cigarettes to quit smoking. On average, using e-cigarettes for cessation in 2017 did not improve successful quitting or prevent relapse.

Technology

Bendotti H, Lawler S, Ireland D, Gartner C, Hides L, Marshall HM.
What do People Want in a Smoking Cessation App? An Analysis of User Reviews and App Quality.
Nicotine Tob Res. 2022 Feb 1;24(2):169-177. doi: 10.1093/ntr/ntab174. PMID: 34460922.

Introduction. Mobile smoking cessation (mCessation) apps have the potential to complement and enhance existing interventions, but many are of low quality. Exploring app reviews can provide a broader understanding of user experiences and engagement, to enhance the quality, acceptability, and effectiveness of future developments.
Methods. Publicly available user reviews and ratings of smoking cessation apps were mined from Google Play and the App Store via a targeted two-stage search strategy. English language smoking cessation apps with at least 20 consumer reviews between 2011 and 2020 were included. User reviews were thematically analyzed using Braun and Clarke's framework. Apps were independently scored using the Mobile Apps Rating Scale (MARS) and compared to average user star ratings.
Results. Forty-eight versions of 42 apps, encompassing 1414 associated reviews, met eligibility criteria. Inductive coding of reviews produced 1084 coding references including reviews coded across multiple nodes. Themes generated included: (1) supportive characteristics/tools; (2) useability; (3) influence on smoking behavior; (4) benefits of quitting; and (5) role as a supplementary tool for quitting. The mean MARS score of 36 free and accessible apps was 3.10 (SD 0.71) with mean scores ranging from 2.00 to 4.47. An inverse relationship between MARS scores and average user star ratings was observed.
Conclusions. App personalization, relationality, functionality, and credibility were important to users, and should be considered as key design components for future apps. Differences between user star ratings and MARS scores may illustrate competing priorities of consumers and researchers, and the importance of a codesign development method.
Implications. This is the first study to use unsolicited user reviews from a large population to understand the general mCessation user experience in relation to making a quit attempt. Our findings highlight specific features favored and disliked by users, including their influence on engagement, and supports previous findings that mCessation applications need to be highly tailorable, functional, credible, and supportive. We recommend a consumer-driven, co-design approach for future mCessation app developments to optimize user acceptability and engagement.

Christofferson DE, Blalock DV, Knoeppel J, Beckham JC, Hamlett-Berry K, Hertzberg JS.
A Real-world Evaluation of a Smokeless Tobacco Cessation Text Message Program for Veterans: Outcomes and Comparison to Cigarette Smokers.
Nicotine Tob Res. 2022 Feb 1;24(2):186-195. doi: 10.1093/ntr/ntab191. PMID: 34545940.

Introduction. Smokeless tobacco (ST) use and cessation rates have remained unchanged while cigarette smoking has declined, and cessation rates have increased. Text message programs have proved effective for cigarette smokers but have not been evaluated for ST users. The Veterans Health Administration (VHA) created a ST-specific arm of its SmokefreeVET automated text message program to help veteran ST users quit.
Aims and methods. A retrospective evaluation was conducted on a real-world sample of veteran ST users (n = 1139) who subscribed to SmokefreeVET between 2017 and 2020. Time in program, abstinence, and nicotine replacement therapy (NRT) use were evaluated and compared to 9764 cigarette smokers who subscribed to SmokefreeVET.
Results. Younger subscribers were more likely to opt out early; 54% of ST users and 60% of cigarette smokers completed the 6-week program. ST users were more likely to report abstinence than cigarette smokers at all time points: the primary outcome, 30-day abstinence at 6 months, was 3.9% in ST users and 2.6% in cigarette smokers (p = .05) and the secondary outcome, abstinence at 3 months, was 5.3% in ST users and 3.4% in cigarette smokers (p = .03). NRT was used by 17% of ST users and was associated with a trend toward higher abstinence compared to ST users who did not use NRT.
Conclusion. A real-world sample of ST users were more likely to report abstinence after using the SmokefreeVET text program than cigarette smokers. Automated text message programs may be effective for increasing cessation among ST users and warrant further investigation.
Implications. Smokeless tobacco (ST) cessation is an important public health priority and of importance for veteran and military populations that have higher rates of ST use. There have been relatively few studies conducted investigating the effectiveness of text message interventions for ST cessation, despite the proven efficacy for cigarette smokers. This study provides evidence from a large, real-world sample that text message programs may be effective for ST users and suggests that further research into this treatment modality for ST users is needed.

Tobacco Use

Buckell J, Fucito LM, Krishnan-Sarin S, O'Malley S, Sindelar JL.
Harm Reduction for Smokers with Little to no Quit Interest: Can Tobacco Policies Encourage Switching to E-cigarettes?
Tob Control. 2022 Jan 19:tobaccocontrol-2021-057024. doi: 10.1136/tobaccocontrol-2021-057024. Epub ahead of print. PMID: 35046127.

Objective. A pressing tobacco policy concern is how to help smokers who have little interest in quitting cigarettes, a group that often suffers severe health consequences. By switching from cigarettes to e-cigarettes, they could obtain nicotine, potentially with less harm. We examined if policy-relevant attributes of cigarettes/e-cigarettes might encourage these smokers to switch to e-cigarettes.
Methods. An online survey and discrete choice experiment on a nationally-representative sample of adult smokers in the US who reported low interest in quitting (n=2000). We modelled preference heterogeneity using a latent class, latent variable model. We simulated policies that could encourage switching to e-cigarettes.
Results. Participants formed two latent classes: (1) those with very strong preferences for their own cigarettes; and (2) those whose choices were more responsive to policies. The latter group's choices were only somewhat responsive to menthol cigarette bans and taxes; the former group's choices were unresponsive.
Conclusions. The policies studied seem unlikely to encourage harm reduction for individuals with little interest in quitting smoking.

Loud EE, Duong HT, Henderson KC, Reynolds RM, Ashley DL, Thrasher JF, Popova L.
Addicted to Smoking or Addicted to Nicotine? A Focus Group Study on Perceptions of Nicotine and Addiction among US Adult Current Smokers, Former Smokers, Non-smokers and Dual Users of Cigarettes and E-cigarettes.
Addiction. 2022 Feb;117(2):472-481. doi: 10.1111/add.15634. Epub 2021 Jul 20. PMID: 34227709; PMCID: PMC8733050.

Background and aims. In 2017, the US Food and Drug Administration (FDA) proposed to reduce nicotine in cigarettes to minimally or non-addictive levels. This study qualitatively explored perceptions of nicotine and addiction, both independently and in response to messages communicating about nicotine reduction.
Design. Qualitative study using focus groups. Participants described their perceptions of nicotine and addiction and their responses to messages about the nicotine reduction.
Setting. Atlanta, GA and San Francisco, CA, USA. Semi-structured focus groups were conducted virtually in Spring 2020.
Participants. Exclusive smokers (n = 27), dual users (of cigarettes and electronic cigarettes) (n = 25), former smokers (n = 32) and young adult non-smokers (n = 31).
Measurement. Inductive thematic analysis of transcripts was conducted, and results were compared across smoking status groups.
Findings. Participants across all smoking status groups associated nicotine with tobacco products, but consistently misperceived that nicotine caused disease. Perceptions of addiction were largely negative and varied by smoking status. Experienced smokers (exclusive smokers, former smokers and dual users) differentiated tobacco use from other addictions and minimized their own experiences of addiction. Perceptions of addiction across experienced smokers included not only the chemical properties of nicotine, but also the behavioral aspects of tobacco use, including oral fixation, having a smoking routine and response to internal and external cues. In response to messages, many believed that removing the nicotine would not make cigarettes less addictive because of the multi-factorial nature of smoking addiction that includes non-pharmacological cues.
Conclusions. Perceptions of nicotine and addiction among non-smokers, former smokers, exclusive smokers and dual users of cigarettes and e-cigarettes vary based on smoking status, but there is a common tendency to believe that nicotine is addictive, that addiction results from more than just nicotine, and that very low nicotine cigarettes will not necessarily reduce the addictiveness of cigarettes.

COVID-19

Baker J, Krishnan N, Abroms LC, Berg CJ.
The Impact of Tobacco Use on COVID-19 Outcomes: A Systematic Review.
J Smok Cessat. 2022 Jan 20;2022:5474397. doi: 10.1155/2022/5474397. PMID: 35126740; PMCID: PMC8777389.

Introduction. Tobacco use increases risks for numerous diseases, including respiratory illnesses. We examined the literature to determine whether a history of tobacco use increases risks for adverse outcomes among COVID-19 patients.
Methods. We conducted a systematic search of PubMed, LitCovid, Scopus, and Europe PMC (for preprints) using COVID-19 and tobacco-related terms. We included studies of human subjects with lab-confirmed COVID-19 infections that examined tobacco use history as an exposure and used multivariable analyses. The data was collected between March 31st, 2020, and February 20th, 2021. Outcomes included mortality, hospitalization, ICU admission, mechanical ventilation, and illness severity.
Results. Among the 39 studies (33 peer-reviewed, 6 preprints) included, the most common outcome assessed was mortality (n = 32). The majority of these studies (17/32) found that tobacco use increased risk, one found decreased risk, and 14 found no association. Tobacco use was associated with increased risk of hospitalization in 7 of 10 studies, ICU admission in 6 of 9 studies, mechanical ventilation in 2 of 6 studies, and illness severity in 3 of 9 studies. One study found that tobacco use history increased risk of pulmonary embolism in COVID-19 patients. Tobacco use was found to compound risks associated with diabetes (n = 1), cancer (n = 2), and chronic liver disease (n = 1).
Conclusion. There is strong evidence that tobacco use increases risks of mortality and disease severity/progression among COVID-19 patients. Public health efforts during the pandemic should encourage tobacco users to quit use and seek care early and promote vaccination and other preventive behaviors among those with a history of tobacco use.

Denlinger-Apte R, Suerken CK, Ross JC, Reboussin BA, Spangler J, Wagoner KG, Sutfin EL.
Decreases in Smoking and Vaping During COVID-19 Stay-at-home Orders Among a Cohort of Young Adults in the United States.
Prev Med. 2022 Feb 8:106992. doi: 10.1016/j.ypmed.2022.106992. Epub ahead of print. PMID: 35149114; PMCID: PMC8824729.

In Spring 2020, most US states and territories implemented stay-at-home orders to slow transmission of the novel coronavirus SARS-CoV2, the cause of COVID-19. Little is known about the impact of stay-at-home orders on tobacco and nicotine use including among young adults. The current study examined participants (N = 1727) completing three recent survey waves from a longitudinal cohort of young adults recruited in 2010 from North Carolina and Virginia, USA: Wave 13 (Spring 2019), Wave 14 (Fall 2019), and Wave 15 (Spring 2020) to assess changes in cigarette and e-cigarette use. We conducted logistic regression analyses to compare the odds that participants reported smoking or vaping in Wave 14 relative to Wave 13 to establish if there was a trend of use pre-pandemic. Then, we conducted logistic regression analyses to compare the odds that participants reported smoking or vaping in Wave 15 relative to Wave 14 to determine the impact of COVID-19 stay-at-home orders. When comparing the odds of reporting tobacco use at Wave 14 to Wave 13, no differences emerged (p > 0.05). However, when comparing tobacco use at Wave 15 to Wave 14, participants had 40% lower odds of reporting past 30-day cigarette use (p = 0.02) and 50% lower odds of reporting past 30-day e-cigarette use (p < 0.01). The current study provides initial evidence that young adults may have reduced their tobacco and nicotine use during the stay-at-home orders. However, more work is needed to determine the long-term impact of the COVID-19 pandemic on tobacco use and cessation in this population.

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