• Cost-Sharing Partnership Initiative Orientation Video Series.

• Webinar on September 20: Journey to a Tobacco-free Certified Community Behavioral Health Clinic (CCBHC): A Conversation.
• SelfMade Health Network Webinar Series on Lung Cancer Disparities.
• Workshop on September 28: Tobacco Cessation During Addiction Treatment.
• September 29 CASTOR: Mitch Zeller Talk.
• School of Medicine: University of CO Anschutz Medical Campus - Plan Now for the fall Tobacco Cessation Training Program!
• Call for Abstracts Deadline of October 5: Seeking Innovations in Public Health.
• Deadline of October 12 - Truth Initiative Grant Opportunity for Colleges.
• November 8 and 9: Continuing Education Credits & Certification in Nicotine Dependence Treatment.

• "Back to School" with SCLC Webinar Bundles--FREE CME/CEUs Available for Providers!
• K-PACT Tobacco Treatment Training for Perinatal Providers.
• Public Health Law Center Releases 50-State Scan of Tobacco Dependency Treatment Requirements.
• New CDC Feature Article Highlights Health Equity and the Importance of Improving Tobacco-Related Health Disparities.
• LGBTQ+ Tobacco Use New Issue Brief.
• Juul’s Multi-million-dollar Settlement is an Opportunity to Accelerate Progress Through Proven-effective Youth Prevention and Quit Vaping Programs.
• What is “Tobacco-free” Nicotine? 

Clawson AH, Cole AB, Ruppe NM, et al.
Smoking Across Adolescence and Adulthood with Cardiovascular Risk among American Indian Peoples.
[published online ahead of print, 2022 Sep 1]. Health Psychol. 2022;10.1037/hea0001227. doi:10.1037/hea0001227

Objective. American Indian peoples (AIs) have high smoking rates and cardiovascular risk factor burden. The present study aimed to (a) investigate latent smoking classes across adolescence and adulthood, (b) investigate adolescent predictors of smoking classes, and (c) assess how smoking class is related to adult cardiovascular risk in a sample of AIs.
Method. A sample of AIs (N = 338) from the National Adolescent to Adult Health Study self-reported on smoking across four assessment waves (W1: 7th-12th grade; W2: 8th-12th grade; W3: ages 18-26; W4: ages 24-32). The socioecological framework for addressing tobacco-related disparities was used to identify potential adolescent (W1) risk and resource factors. C-reactive protein, blood pressure, and lipids were collected at W4. Growth mixture modeling and regressions were used.
Results. Six smoking classes were identified: light smoking (36%), nonsmoking (23%), escalating, adult daily smoking (13%), chronic heavy smoking (12%), escalating, young adult daily smoking (9%), and reducing smoking (7%). Risk factors for being in the chronic heavy smoking class included peer smoking and older age at W1. Compared with the chronic heavy smoking class, AIs in the reducing smoking class lived in in more impoverished neighborhoods during adolescence. Relative to several classes with less smoking, being in the chronic heavy smoking class was associated with higher C-reactive protein and less favorable lipid levels. W1 social support was a resource factor for adult diastolic blood pressure and some lipids.
Conclusions. Socioecologically informed tobacco interventions have the potential to reduce smoking and cardiovascular risk among AIs, and bolstering social support may be important. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Subica AM, Guerrero EG, Martin TKK, et al.
Native Hawaiian/Pacific Islander Alcohol, Tobacco and Other Drug Use, Mental Health and Treatment Need in the United States During COVID-19.
[published online ahead of print, 2022 Aug 11]. Drug Alcohol Rev. 2022;10.1111/dar.13522. doi:10.1111/dar.13522

Introduction. Before COVID-19, Native Hawaiians/Pacific Islanders (NH/PI) endured a heavy burden of alcohol, tobacco and other drug (ATOD) use in prior US data. Responding to reports that many NH/PI communities experienced severe COVID-19 disparities that could exacerbate their ATOD burden, we partnered with NH/PI communities to assess the substance use patterns and treatment needs of diverse NH/PIs during COVID-19.
Methods. Collaborating with NH/PI community organisations across five states with large NH/PI populations, we conducted a large-scale investigation of NH/PI ATOD use, mental health and treatment need during COVID-19. Between April and November 2021, NH/PI-heritage research staff from our community partners collected data involving 306 NH/PI adults using several community-based recruitment methods (e-mail, telephone, in-person) and two survey approaches: online and paper-and-pencil. Multivariate regressions were conducted to examine potential predictors of NH/PI alcohol use disorder and need for behavioural health treatment.
Results. During COVID-19, 47% and 22% of NH/PI adults reported current alcohol and cigarette use, while 35% reported lifetime illicit substance use (e.g., cannabis, opioid). Depression and anxiety were high, and alcohol use disorder, major depression and generalised anxiety disorder prevalence were 27%, 27% and 19%, respectively. One-third of participants reported past-year treatment need with lifetime illicit substance use, COVID-19 distress and major depression respectively associating with 3.0, 1.2, and 5.3 times greater adjusted odds for needing treatment.
Conclusions. NH/PI adults reported heavy ATOD use, depression, anxiety and treatment need during COVID-19. Targeted research and treatment services may be warranted to mitigate COVID-19's negative behavioural health impact on NH/PI communities.

Bailey SR, Hwang J, Marino M, et al.
Smoking-cessation Assistance among Older Adults by Ethnicity/Language Preference.
Am J Prev Med. 2022;63(3):423-430. doi:10.1016/j.amepre.2022.03.024

Introduction. Although smoking prevalence is lower among Hispanic adults than among non-Hispanic White adults, smoking remains a leading cause of preventable death among older Hispanics. This study examines the differences in tobacco assessment and smoking-cessation assistance among older patients seen in community health centers by ethnicity and language preference.
Methods. Electronic health record data were extracted from the Accelerating Data Value Across a National Community Health Center Network of community health centers from patients aged 55‒80 years with ≥1 primary care visit between January 1, 2017 and December 31, 2018. Binary outcomes included tobacco use assessment and, among those with ≥1 status indicating current smoking, having a smoking-cessation medication ordered. The independent variable combined ethnicity and language preference, categorized as non-Hispanic White (reference), Spanish-preferring Hispanic, and English-preferring Hispanic. Multivariable generalized estimating equation logistic regressions, clustering by primary care clinic using an exchangeable working correlation structure, modeled the odds of tobacco use assessment and cessation medication orders by ethnicity/preferred language, adjusting for patient covariates, health system, and clinic location. Analyses were conducted in 2021.
Results. The study included 116,328 patients. Spanish-preferring Hispanic patients had significantly lower odds of having tobacco use assessed than non-Hispanic White patients (AOR=0.89, 95% CI=0.82, 0.95). Both Spanish- and English-preferring Hispanic patients had lower odds of having a smoking-cessation medication ordered (AOR=0.53, 95% CI=0.47, 0.60; AOR=0.77, 95% CI=0.67, 0.89, respectively) than non-Hispanic White patients.
Conclusions. Significant disparities were found in tobacco assessment and cessation assistance by ethnicity and language preference among older adults seen in safety-net clinics. Future research is needed to understand the etiology of these smoking-related disparities.

Banks E, Martin M, Harris M.
Framework for the Public Health Assessment of Electronic Cigarettes.
Tob Control. 2022;31(5):608-614. doi:10.1136/tobaccocontrol-2020-056271

Background. Electronic cigarettes (e-cigarettes) are relatively new products with substantial public health impacts. Evidence on their effects is diverse and emerging rapidly, presenting challenges to high-quality policymaking and decision-making. This paper addresses these challenges by developing and presenting a framework for the public health assessment of e-cigarettes, using the Australian context as an example.
Methods. Framework development involved stakeholder engagement, development of guiding principles, and consideration of existing relevant frameworks and the evidence requirements of current policy options, identified in published and grey literature.
Results. Guiding principles include the need for the framework to: be evidence based; include consideration of the likely balance of benefits and risks of e-cigarettes, uncertainty and safety; support equity; support the ongoing application of evidence to high-quality policy and practice; and consider potential competing interests. The framework draws upon: health technology assessment; health impact assessment; environmental health risk assessment; healthcare recommendations evidence evaluation; consumer goods regulation; medicine and chemical scheduling; tobacco product evaluation; previous reviews and the precautionary principle. Final framework components are: (1) characterisation of products under consideration; (2) definition of populations of interest; (3) characterisation of tobacco smoking, control and impacts on health and well-being; (4) review of evidence on patterns of e-cigarette use; (5) review of evidence on e-cigarette use and health outcomes; (6) assessment of likely risks, benefits and safety; (7) identification and assessment of policy options to optimise health outcomes.
Conclusions. Structured and ongoing public health assessment of e-cigarette use is likely to support health through enhancing evidence-based decision-making.

Ozga JE, Stroup AM, Abadi MH, et al.
E-cigarette Marketing Expenditures in the U.S. from 2016-2021: Targeted Media Outlets Geared Toward People who are at Increased Risk for Tobacco Use.
[published online ahead of print, 2022 Sep 7]. Nicotine Tob Res. 2022;ntac209. doi:10.1093/ntr/ntac209

Introduction. E-cigarette advertising exposure is linked to e-cigarette initiation and use. Thus, monitoring trends in e-cigarette advertising practices is important to understand e-cigarette use patterns observed over recent years.
Methods. E-cigarette advertising expenditures (January 2016-July 2021; Numerator Ad Intel) for 154 U.S. market areas were harmonized with U.S. Census sociodemographic data through Nielsen market area/zip code designations. Descriptive statistics and multivariable linear regressions were used to examine trends in e-cigarette advertising expenditures across media outlets and associations between sociodemographic characteristics and e-cigarette advertising over time.
Results. E-cigarette advertising expenditures peaked in 2018/2019, followed by a sharp decline in 2020. Expenditures were concentrated primarily on print (58.9%), TV (20.6%) and radio (14.4%). Major print outlets were Sports Illustrated, Rolling Stone, and Star magazines. Top TV channels were AMC, Investigation Discovery, and TBS. TV advertisements were purchased commonly during popular movies/series (e.g., King of Queens, Everybody Loves Raymond, The Walking Dead). Higher expenditures were associated with U.S. market areas that had (a) a larger percentage of non-rural zip codes (radio), (b) smaller male populations (radio), and (c) larger White/Caucasian, Black/African American, American Indian/Alaska Native, Asian, and Other/Multiracial populations (radio, print, online display, online video).
Conclusions. E-cigarette companies advertised in print magazines geared toward males and youth/young adults, radio commercials focused in urban areas with smaller male populations, and nationwide TV commercials. Declines in e-cigarette advertising expenditures in 2020 demonstrate the potential impact that federal policies may have on protecting populations who are at higher risk for tobacco use from predatory advertising practices.
Implications. E-cigarette advertising exposure is associated with initiation and use of e-cigarettes. This study shows how e-cigarette marketing expenditures in the U.S. may have targeted specific consumers (e.g., youth/young adults) between 2016 and 2021. The precipitous drop in advertising expenditures across all outlets during early 2020 corresponds with the implementation of the Tobacco 21 federal policy, the federal enforcement policy to remove most unauthorized flavored e-cigarette cartridges from the U.S. market, preparations for FDA's premarket review of e-cigarette products, and the decision by several TV broadcast companies to stop showing e-cigarette ads. The potential impact of federal policies may have far-reaching implications for protecting populations who are at high risk for tobacco use and its health consequences.

Perry RN, Girgulis JP, Harrison SL, Barrett SP.
Dual Users' Perceptions of the Addictive Properties of Cigarettes Versus E-cigarettes.
[published online ahead of print, 2022 Sep 3]. Addict Behav. 2022;136:107483. doi:10.1016/j.addbeh.2022.107483

Introduction. Electronic cigarettes ("e-cigarettes") are commonly promoted as a less-harmful alternative to combustible cigarettes, yet many individuals concurrently use both products ("dual users"). Little is known about the extent to which dual users' perceptions of the addictive properties of these products differ, or to what extent there are differences in the factors that elicit craving for each product.
Methods. An online survey evaluated beliefs about the addictive properties of cigarettes vs e-cigarettes and the situational and affective precipitants of product craving, on a scale from 1 to 10, in a sample of Canadian adults that reported past-month use of combustible and e-cigarettes (N = 175; 79 female).
Results. Participants rated cigarettes as more addictive than e-cigarettes, and on average reported higher levels of dependence on combustible cigarettes. While the addictive properties of both combustible and e-cigarettes were largely attributed to nicotine, non-nicotine factors (e.g. flavouring, other non-nicotine ingredients) were believed to make a relatively stronger contribution to the addictive properties of e-cigarettes, particularly among women. Participants reported greater increases in craving for combustible cigarettes in response to negative affective states and situational factors, and these effects were strongest among participants that displayed greater dependence on combustible tobacco relative to e-cigarettes.
Conclusions. Dual users perceived cigarettes to be more addictive than e-cigarettes and attributed the addictive properties of each product to different factors. Further, cravings for combustible cigarettes were more strongly linked to certain negative affective states and situational factors relative to e-cigarettes. Findings suggest that there may be limited substitutability between combustible and e-cigarettes.

Gaiha SM, Henriksen L, Halpern-Felsher B, et al.
Sources of Flavoured E-cigarettes among California Youth and Young Adults: Associations with Local Flavoured Tobacco Sales Restrictions.
Tob Control. 2022;31(5):659-662. doi:10.1136/tobaccocontrol-2020-056455

Purpose. This study compares access to flavoured JUUL and other e-cigarettes from retail, online and social sources among underage and young adult e-cigarette users who live in California jurisdictions that restrict sales of flavoured tobacco with the rest of the state.
Methods. An online survey used social media advertisements to recruit participants (n=3075, ages 15-29) who lived in one of nine jurisdictions that restrict sales (n=1539) or in the rest of state, and oversampled flavoured tobacco users. Focusing on past-month e-cigarette users (n=908), multilevel models tested whether access to flavoured JUUL and other e-cigarettes from retail, online and social sources differed by local law (yes/no) and age group (15-20 or older), controlling for other individual characteristics.
Results. The percent of underage users who obtained flavoured JUUL and other e-cigarettes in the past month was 33.6% and 31.2% from retail, 11.6% and 12.7% online, and 76.0% and 70.9% from social sources, respectively. Compared with underage and young adult users in the rest of California, those in localities that restrict the sales of flavoured tobacco were less likely to obtain flavoured JUUL from retail sources (Adjusted OR=0.54, 95% CI 0.36 to 0.80), but more likely to obtain it from social sources (Adjusted OR=1.55, 95% CI 1.02 to 2.35). The same pattern was observed for other brands of flavoured e-cigarettes.
Conclusion. Although local laws may reduce access to flavoured e-cigarettes from retail sources, more comprehensive state or federal restrictions are recommended to close the loopholes for online sources. Dedicated efforts to curtail access from social sources are needed.

Technology

Bricker JB, Mull KE, Santiago-Torres M, Miao Z, Perski O, Di C.
Smoking Cessation Amartphone App Use Over Time: Predicting 12-month Cessation Outcomes in a 2-Arm Randomized Trial.
J Med Internet Res. 2022;24(8):e39208. Published 2022 Aug 18. doi:10.2196/39208

Background. Little is known about how individuals engage over time with smartphone app interventions and whether this engagement predicts health outcomes.
Objective. In the context of a randomized trial comparing 2 smartphone apps for smoking cessation, this study aimed to determine distinct groups of smartphone app log-in trajectories over a 6-month period, their association with smoking cessation outcomes at 12 months, and baseline user characteristics that predict data-driven trajectory group membership.
Methods. Functional clustering of 182 consecutive days of smoothed log-in data from both arms of a large (N=2415) randomized trial of 2 smartphone apps for smoking cessation (iCanQuit and QuitGuide) was used to identify distinct trajectory groups. Logistic regression was used to determine the association of group membership with the primary outcome of 30-day point prevalence of smoking abstinence at 12 months. Finally, the baseline characteristics associated with group membership were examined using logistic and multinomial logistic regression. The analyses were conducted separately for each app.
Results. For iCanQuit, participants were clustered into 3 groups: "1-week users" (610/1069, 57.06%), "4-week users" (303/1069, 28.34%), and "26-week users" (156/1069, 14.59%). For smoking cessation rates at the 12-month follow-up, compared with 1-week users, 4-week users had 50% higher odds of cessation (30% vs 23%; odds ratio [OR] 1.50, 95% CI 1.05-2.14; P=.03), whereas 26-week users had 397% higher odds (56% vs 23%; OR 4.97, 95% CI 3.31-7.52; P<.001). For QuitGuide, participants were clustered into 2 groups: "1-week users" (695/1064, 65.32%) and "3-week users" (369/1064, 34.68%). The difference in the odds of being abstinent at 12 months for 3-week users versus 1-week users was minimal (23% vs 21%; OR 1.16, 95% CI 0.84-1.62; P=.37). Different baseline characteristics predicted the trajectory group membership for each app.
Conclusions. Patterns of 1-, 3-, and 4-week smartphone app use for smoking cessation may be common in how people engage in digital health interventions. There were significantly higher odds of quitting smoking among 4-week users and especially among 26-week users of the iCanQuit app. To improve study outcomes, strategies for detecting users who disengage early from these interventions (1-week users) and proactively offering them a more intensive intervention could be fruitful.

Villanti AC, Peasley-Miklus C, Cha S, et al.
Tailored Text Message and Web Intervention for Smoking Cessation in U.S. Socioeconomically-Disadvantaged Young Adults: A Randomized Controlled Trial.
[published online ahead of print, 2022 Aug 19]. Prev Med. 2022;107209. doi:10.1016/j.ypmed.2022.107209

The prevalence of cigarette smoking in young adults is higher among those with socioeconomic disadvantage than those without. Low treatment-seeking among young adult smokers is compounded by few efficacious smoking cessation interventions for this group, particularly socioeconomically-disadvantaged young adults (SDYA) who smoke cigarettes. The goal of this study was to test a tailored smoking-cessation intervention for SDYA. 343 SDYA aged 18-30 living in the U.S. (85% female) who smoke cigarettes with access to a smartphone and interest in quitting smoking in the next six months were recruited online in Spring 2020 and randomized to referral to online quit resources (usual care control; n = 171) or a 12-week tailored text message smoking-cessation program with a companion web-based intervention (n = 172). Intent to treat analyses examined associations between study condition, self-reported 30-day point prevalence abstinence (PPA), and confidence to quit smoking at 12 weeks, controlling for potential confounders. Intervention group participants had greater self-reported 30-day PPA at 12-weeks than controls (adjusted relative risk 3.93, 95% CI 2.14-7.24). Among those who continued smoking, the intervention increased confidence to quit (0.81 points, 95% confidence interval 0.08-1.53). Weekly engagement in the intervention predicted greater cessation. A tailored text message intervention for SDYA increased smoking abstinence and confidence to quit at the end-of-treatment. Findings may have been influenced by recruitment at the start of the COVID pandemic but suggest that text messaging is an acceptable and efficacious cessation strategy for SDYA smokers. Future studies should examine the impact on longer-term smoking-cessation and importance of intervention tailoring for SDYA.

Kathuria H, Shankar D, Cobb V, et al.
Integrating Social Determinants of Health with Tobacco Treatment for Individuals with Opioid Use Disorder: Feasibility and Acceptability Study of Delivery Through Text Messaging.
JMIR Form Res. 2022;6(9):e36919. Published 2022 Sep 1. doi:10.2196/36919

Background. Individuals with opioid use disorder (OUD) have a high prevalence of smoking and frequently experience unmet social determinants of health (SDOH), which may be barriers to smoking cessation. Hospitalization is an opportunity to encourage smoking cessation. Unfortunately, many clinicians do not provide tobacco treatment to support the maintenance of cessation achieved during hospitalization. Interventions are required to support these high-risk individuals after hospital discharge.
Objective. This study aimed to test the feasibility and acceptability of a 28-day SMS text messaging program tailored to individuals with OUD, which provides smoking cessation support and addresses unmet SDOH needs.
Methods. From July to December 2019, we enrolled 25 individuals who were hospitalized with tobacco dependence and OUD at our large safety net hospital. The SMS text messaging program was initiated during hospitalization and continued for 28 days. Participants were enrolled in either the ready to quit within 30 days or the not ready to quit within 30 days program based on their readiness to quit. Automated SMS text messages were sent twice daily for 4 weeks. The topics included health and cost benefits of quitting, both general and opioid specific (16 messages); managing mood and stress (8 messages); motivation, coping strategies, and encouragement (18 messages); addressing medication misconceptions (5 messages); links to resources to address substance use (2 messages providing links to the Massachusetts Substance Use Helpline and Boston Medical Center resources), tobacco dependence (1 message providing a link to the Massachusetts Quitline), and unmet SDOH needs (6 messages assessing SDOH needs with links to resources if unmet SDOH needs were identified). Questionnaires and interviews were conducted at baseline and at 2 and 4 weeks after enrollment.
Results. The participants were 56% (14/25) female, 36% (9/25) African American, 92% (23/25) unemployed, and 96% (24/25) Medicaid insured. Approximately 84% (21/25) activated the program, and none of the participants unsubscribed. Approximately 57% (12/21) completed either the 2- or 4-week questionnaires. Program satisfaction was high (overall mean 6.7, SD 0.8, range 1-7). Many perceived that the SMS text messaging program provided social support, companionship, and motivation to stop smoking. Messages about the health benefits of quitting were well received, whereas messages on how quitting cigarettes may prevent relapse from other substances had mixed views, highlighting the importance of tailoring interventions to patient preferences.
Conclusions. SMS text messaging to promote smoking cessation and address SDOH needs may be an effective tool for improving quit rates and health outcomes in individuals with tobacco dependence and OUD. Our study adds to the growing body of evidence that SMS text messaging approaches are feasible and acceptable for providing tobacco treatment to all individuals who smoke, even among low-income populations who have OUD and are not ready to quit.

Tobacco Use

Donaldson SI, Dormanesh A, Perez C, Majmundar A, Allem JP.
Association Between Exposure to Tobacco Content on Social Media and Tobacco Use: A Systematic Review and Meta-analysis.
JAMA Pediatr. 2022;176(9):878-885. doi:10.1001/jamapediatrics.2022.2223

Importance. Exposure to tobacco-related content on social media may foster positive attitudes toward tobacco products and brands, and influence the likelihood of initiating or continuing use of tobacco, especially among adolescents and young adults.
Objective. To perform the first systematic review and meta-analysis, to our knowledge, on studies that examined the association between exposure to tobacco content on social media and lifetime tobacco use, past 30-day tobacco use, and susceptibility to use tobacco among never users.
Data sources. Tobacco, social media, and marketing search terms were entered into online databases, including MEDLINE, ISI Web of Science, Scopus, and PsychINFO. Study characteristics, including research design and methods, sampling strategy, and demographics, were assessed for each study.
Study selection. Studies reporting odds ratios (ORs) for self-reported exposure to, or experimentally manipulated, tobacco content on social media and lifetime tobacco use, past 30-day tobacco, and susceptibility to use tobacco among never users. The systematic search produced 897 independent articles, of which 29 studies met inclusion criteria.
Data extraction and synthesis. A 3-level random-effects meta-analysis was used to estimate ORs, 95% CIs, and heterogeneity (I2) for each tobacco use outcome. Study quality and publication bias were assessed.
Main outcomes and measures. Lifetime tobacco use, past 30-day tobacco use, and susceptibility to use tobacco among never users. Tobacco use included e-cigarettes, cigarettes, and other (cigar, hookah, smokeless tobacco).
Results. The total sample size across the 24 included datasets was 139 624, including 100 666 adolescents (72%), 20 710 young adults (15%), and 18 248 adults (13%). Participants who were exposed to tobacco content on social media, compared with those who were not exposed, had greater odds of reporting lifetime tobacco use (OR, 2.18; 95% CI, 1.54-3.08; I2 = 94%), past 30-day tobacco use (OR, 2.19; 95% CI, 1.79-2.67; I2 = 84%), and susceptibility to use tobacco among never users (OR, 2.08; 95% CI, 1.65-2.63; I2 = 73%). Subgroup analyses showed similar associations for tobacco promotions, active engagement, passive engagement, lifetime exposure to tobacco content, exposure to tobacco content on more than 2 platforms, and exposure to tobacco content among adolescents and young adults.
Conclusions and relevance. Findings suggest that a comprehensive strategy to reduce the amount of tobacco content on social media should be developed by federal regulators. Such actions may have downstream effects on adolescent and young adult exposure to protobacco content, and ultimately tobacco use behaviors.

Powers JM, Maisto SA, Zvolensky MJ, Heckman BW, Ditre JW.
Longitudinal Associations Between Pain and Use of Cigarettes and E-cigarettes in the Population Assessment of Tobacco and Health (PATH) Study.
[published online ahead of print, 2022 Aug 15]. Nicotine Tob Res. 2022;ntac197. doi:10.1093/ntr/ntac197

Introduction. Pain has been implicated in the onset and maintenance of nicotine addiction, and there is initial cross-sectional evidence of covariation between pain and use/co-use of cigarettes and e-cigarettes. The goals of the current study were to: (1) test pain severity as a predictor of initiating co-use of cigarettes/e-cigarettes; (2) examine longitudinal associations between pain and use/co-use of cigarette and e-cigarettes; (3) generate the first prevalence rate data regarding cigarette and/or e-cigarette use as a function of pain; and (4) examine gender as a moderator of these associations.
Methods. Data were drawn from Waves 1-4 of the Population Assessment of Tobacco and Health (PATH) Study (2013-2018).
Results. Among exclusive cigarette smokers at Wave 1 (n = 7,719), pain severity was associated with greater likelihood of and faster trajectory to initiating co-use of cigarettes/e-cigarettes (ps < .05). A significant pain x gender interaction (p < .05) revealed this prospective relationship was stronger among women. Among adult respondents who provided at least three waves of data (n = 24,255), greater Wave 1 pain severity was positively associated with e-cigarette use, cigarette smoking, and co-use of cigarettes/e-cigarettes at Waves 2, 3, and 4 (ps < .001). At Wave 4 (n = 33,822), adults with moderate/severe pain endorsed rates of e-cigarette and cigarette use/co-use almost two times greater versus no/low pain (ps < .001).
Conclusions. Collectively, these findings provide evidence that pain likely serves as an important candidate risk factor for the initiation and maintenance of cigarette and e-cigarette use.
Implications. This is the first prospective study to show that pain serves as an important risk factor for initiation and maintenance of cigarette and e-cigarette use/co-use over time. Weighted prevalence estimates further demonstrated that individuals with moderate/severe pain endorsed rates of cigarette and e-cigarette use/co-use approximately two times greater compared to those with no/low pain. These findings highlight a subpopulation of nicotine users more susceptible to greater health-care burden, nicotine dependence, and physical impairment. Nicotine users with comorbid pain may benefit from integrated interventions that address pain in the context of cessation.

COVID-19

Benowitz NL, Goniewicz ML, Halpern-Felsher B, et al.
Tobacco Product Use and the Risks of SARS-CoV-2 Infection and COVID-19: Current Understanding and Recommendations for Future Research.
Lancet Respir Med. 2022;10(9):900-915. doi:10.1016/S2213-2600(22)00182-5

Heterogeneity in the clinical presentation of SARS-CoV-2 infection and COVID-19 progression underscores the urgent need to identify individual-level susceptibility factors that affect infection vulnerability and disease severity. Tobacco product use is a potential susceptibility factor. In this Personal View, we provide an overview of the findings of peer-reviewed, published studies relating tobacco product use to SARS-CoV-2 infection and COVID-19 outcomes, with most studies focusing on cigarette smoking in adults. Findings pertaining to the effects of tobacco product use on the incidence of SARS-CoV-2 infection are inconsistent. However, evidence supports a role for cigarette smoking in increasing the risk of poor COVID-19 outcomes, including hospital admission, progression in disease severity, and COVID-19-related mortality. We discuss the potential effects of tobacco use behaviour on SARS-CoV-2 transmission and infection, and highlight the pathophysiological changes associated with cigarette smoking that could promote SARS-CoV-2 infection and increased disease severity. We consider the biological mechanisms by which nicotine and other tobacco product constituents might affect immune and inflammatory responses to SARS-CoV-2 infection. Finally, we identify current knowledge gaps and suggest priorities for research to address acute and post-acute health outcomes of COVID-19 during and after the pandemic.
 

• Provides scientific leadership in the field of biomedical research, including behavioral research.
• Provides senior scientific leadership to coordinate and lead expert scientists in the development, and peer and senior scientific review of high impact tobacco-related scientific reports.
• Cultivates collaborative partnerships that involve high priority projects with the potential for significant public health impact.
• Provides scientific leadership in the evaluation of high impact public health tobacco control strategies and the dissemination of data on these strategies in reports, scientific publications, and major technical reports and guidance documents.
• Provides strategic direction on policies, programmatic activities, partnerships, innovative data and analytic approaches, management, and operations for health equity and social determinants of health.
• Provides senior scientific leadership and guidance on global, national or state/local tobacco surveillance systems, improving the quality and implementation of survey protocols, preparing country fact sheets and reports, country survey results, and integrating tobacco questions into other national surveillance systems.

• Location: Marriott Marquis | Washington, DC 
• Dates: September 27th- 29th, 2022
• Cost: Truth Initiative will cover the cost of transportation, lodging and meals for all accepted student participants.