Nominations received on or before Nov. 25, 2022 will be given first consideration. Nominations received after Nov. 25, 2022 will be considered as later vacancies occur.
TPSAC advises CTP in its responsibilities related to the regulation of tobacco products. The committee reviews and evaluates safety, dependence, and health issues concerning tobacco products and provides appropriate advice, information, and recommendations to the FDA commissioner.
Please see the Federal Register notice for more information on the nomination process for TPSAC membership.
December 1, 2022 - State of Black Health Regional Forum (Oakland, CA).
The Center for Black Health & Equity is pleased to host the State of Black Health, the most compelling convening of public health professionals and community advocates concerned with achieving health equity for African Americans. Through panels, special activations and interactive workshops, we engage attendees in constructive dialogue about the root causes of health disparities including institutional racism, economic disparities and chronic disease.
» learn more
Deadline of December 2: Request for Proposal (RFP) Announcement from ASTHO.
The Association of State and Territorial Health Officials (ASTHO) is issuing a request for proposals (RFP) for the ASTHO and CDC/OSH Increasing State Menthol Capacity Learning Collaborative. Up to eight (8) states will be awarded a minimum of $100,000 each. This project supports state health agencies in improving and/or establishing partnerships with in-state community organization partners to build capacity to (1) advance commercial tobacco control policy, systems, and environmental interventions to reduce menthol and flavored tobacco products use/initiation; (2) improve cessation and quitting for populations who use menthol tobacco, and (3) improve or establish counter marketing/public education strategies.
This RFP is open to all state public health agencies and the District of Columbia, with strong priority given to applicants working in collaboration with non-government community-based organizations.
Please email intent to apply to chronicdisease@astho.org by December 2, 2022. The final proposal deadline is December 22, 2022, 11:59 p.m. ET. For additional information, please see the full RFP and Frequently Asked Questions.
Deadline of December 7: 2023 NNPHI Annual Conference Abstracts Now Open!
The National Network of Public Health Institutes (NNPHI) is seeking abstracts for the 2023 NNPHI Annual Conference, May 9 – May 11, in Washington, DC. NNPHI is offering three options for abstract submissions that include: a poster session, workshops, and breakout sessions.
To submit an abstract, you will be required to create an account using your email address. Once an account has been created, you will be able to submit and edit your abstract until the deadline, December 7, 2022 11:59 PM PT.
» learn more
QuitlinesTong EK, Cummins SE, Anderson CM, Kirby CA, Wong S, Zhu SH.
Quitline Promotion to Medicaid Members who Smoke: Effects of COVID-19-specific Messaging and a Free Patch Offer.
[published online ahead of print, 2022 Oct 29]. Am J Prev Med. 2022;S0749-3797(22)00466-4. doi:10.1016/j.amepre.2022.09.009
Introduction. People who smoke are at increased risk of serious COVID-19-related disease but have had reduced access to cessation treatment during the pandemic. This study tested 2 approaches to promoting quitline services to Medicaid members who smoke at high rates: using COVID-19-specific messaging and offering free nicotine patches. The hypotheses were that both would increase enrollment.
Methods. A California Medicaid mailing from October 2020 to January 2021 (N=7,489,093) included 4 versions of a flyer following a 2 × 2 design comparing generic with COVID-19-specific messaging and a no-patch with free-patch offer. The main outcome measure was quitline enrollments. Quit outcomes (attempted quitting, quit ≥7 days, quit ≥30 days) were assessed at 2 months. A subsequent free-patch offer was sent to all members (N=7,577,198) from April 2021 to June 2021. Data were collected in 2020-2021 and analyzed in 2022.
Results. The first mailing generated 1,753 enrollments. Response rates were 0.023% and 0.024% for generic and COVID-19-specific messaging, respectively (p=0.538), and 0.006% and 0.041% for no-patch and free-patch offers, respectively, the latter being 6.7 times more effective than the former (p<0.0001). Quit outcomes were comparable across conditions. The subsequent free-patch offer generated 3,546 enrollments at $40.28 per enrollee.
Conclusions. In a Medicaid mailing during COVID-19, offering free patches generated more than 6 times as many quitline enrollments as offering generic help. COVID-19-specific messaging was no more effective than generic messaging. Offering free patches was highly cost-effective. Medicaid programs partnering with quitlines should consider using similar strategies, especially during a pandemic when regular health care is disrupted.
Cummins SE, Kirby CA, Wong S, Anderson CM, Zhu SH.
Re-engagement of Low-income Smokers in Quitline Services: Effects of Incentives and Method of Contact.[published online ahead of print, 2022 Oct 22]. Nicotine Tob Res. 2022;ntac246. doi:10.1093/ntr/ntac246
Introduction. Financial incentives have been shown to improve recruitment of low-income smokers into tobacco quitline services and to improve cessation outcomes. The present study evaluated their use to re-engage low-income smokers who had already used a quitline.
Methods. Randomly selected Medicaid smokers (N=5,200) who had previously enrolled in a quitline were stratified by time since enrollment (3, 6, 9, or 12 months) and randomly assigned in a 2x4 factorial design to receive, by mail or telephone, an invitation to re-engage, with an offer of no financial incentive or $10, $20, or $40. The primary outcome measure was re-engagement, defined as use of an additional evidence based quitline service within 90 days. Data were collected from May 2014 to October 2015 and analyzed in 2022.
Results. Of 5,200 participants invited to re-engage in quitline services, 9.3% did so within 90 days, compared to 6.3% of a randomly selected comparison group (n=22,614, p<0.0001). Letters resulted in greater re-engagement than calls (10.9% vs. 7.8%, respectively, p=0.0001). Among letters, there was a dose-response relationship between incentive level and re-engagement rates (p=0.003). Re-engagement decreased as time since enrollment increased, from 13.7% at 3 months to 5.7% at 12 months (all p's<0.0001).
Conclusions. Low-income smokers who previously used quitline services can be motivated to re-engage in treatment. Mailed letters and automated calls are effective re-engagement strategies. Financial incentives can increase the effectiveness of re-engagement letters. Inviting Medicaid smokers to re-engage with quitline treatment may help to address socioeconomic health disparities and should be standard practice.
Implications. Nicotine addiction is a chronic relapsing disorder, yet most cessation services are designed to help smokers through only one quit attempt. Smoking is increasingly concentrated in populations with physical and psychological co-morbidities, which can make quitting more difficult and impact whether smokers reach out for additional help following relapse. This study examined whether the timing, method, and content of an offer for further assistance influenced re-engagement rates for a vulnerable population of smokers-Medicaid beneficiaries. Relapsing smokers are responsive to re-engagement offers as early as three months, but there is a closing window of opportunity to reach them.
Vickerman KA, Carpenter KM, Miles LN, et al.
A Randomized Pilot of a Tailored Smoking Cessation Quitline Intervention for Individuals who Smoke and Vape.Nicotine Tob Res. 2022;24(11):1811-1820. doi:10.1093/ntr/ntac129
Introduction. Although e-cigarettes are not a federally approved tobacco cessation aid in the United States, many smokers use them to quit or cut down on smoking. Tailored behavioral support could improve rates of complete smoking cessation for those individuals.
Aims and methods. A novel behavioral treatment to help dual cigarette and e-cigarette users quit smoking was tested in a randomized pilot with a state tobacco quitline. Ninety-six dual users of cigarettes and e-cigarettes were recruited from incoming state quitline callers and randomized to receive enhanced e-cigarette coaching (EEC) or quitline treatment as usual (TAU) to examine EEC feasibility and acceptability. Outcomes at 3 months were treatment satisfaction, engagement, beliefs, and smoking cessation. This pilot was not powered to detect differences in quit rates.
Results. Sixty-nine percent responded to the 3-month survey. EEC treatment satisfaction was noninferior to TAU: 93.8% (30/32) of EEC and 73.5% (25/34) of TAU reported being "very satisfied" or "satisfied" with treatment, respectively. EEC participants completed more coaching calls than TAU (M = 3.4 vs. M = 2.7, p = .03), and the majority in both groups elected to receive nicotine replacement therapy (EEC: 100%, TAU: 94%, p = .24). With missing data imputed as smoking, intent-to-treat 7-day point prevalence smoking abstinence rates were 41.3% (19/46) for EEC and 28.0% (14/50) for TAU (p = .20).
Conclusions. The EEC quitline intervention for dual cigarette and e-cigarette users demonstrated high levels of treatment satisfaction and engagement. This pilot was not powered to detect significant differences in smoking cessation; however, cessation rates were promising and warrant evaluation in a fully powered trial.
Implications. If this scalable behavioral treatment to help dual cigarette and e-cigarette users quit smoking proves to be effective in a larger trial, quitlines could implement this harm reduction approach to improve outcomes for callers who already use e-cigarettes and are planning to use them while quitting smoking.
Sheffer CE.
Tobacco Quitlines: Opportunities for Innovation to Increase Reach and Effectiveness.
[published online ahead of print, 2022 Oct 22]. Prev Med. 2022;107319. doi:10.1016/j.ypmed.2022.107319
The largest tobacco treatment network in North America, Tobacco Quitlines are an effective population-based approach to increase tobacco cessation; however, overall reach has decreased significantly in the past decade. A new generation of innovations responsive to evolving shifts in communication preferences, supported by research, and focused on increasing the impact of services have the potential to reinvigorate this network. The goal of this narrative review was to identify opportunities for innovation in Quitline service delivery, synthesize evidence for these opportunities, and identify gaps in the research. Innovation was defined as significant shift in current practice by utilizing novel theoretical concepts, approaches, methodologies, or interventions. The Experimental Medicine Approach informed the identification of gaps in the research. The specific domains were selected by reviewing previous reviews, commentaries, calls for action, and a recent report on promising practices. Evidence was garnered primarily from systematic reviews. Opportunities included automated and interactive digital therapeutics, novel health communications for stigma-free media campaigns, methods to increase access to nicotine replacement therapies, novel treatment options and combinations, and methods to promote engagement with digital therapeutics. Research topics that cross multiple domains include the consideration of theoretical frameworks, the identification of therapeutic targets and mechanisms of action, and the development of adapted approaches to address specific challenges and cultural responsivity. Finally, an examination is needed to understand how to improve the speed with which innovations are developed and implemented in this network.
McQueen A, Wartts JG, Garg R, Carpenter KM, Kreuter MW.
Leveling the Playing Field: Mailing Pharmacotherapy to Medicaid Members who Smoke.[published online ahead of print, 2022 Nov 2]. Am J Prev Med. 2022;S0749-3797(22)00465-2. doi:10.1016/j.amepre.2022.09.008
Introduction. Smoking rates differ by insurance type; rates are often double for Medicaid and uninsured compared with that for Medicare or privately insured. State-funded tobacco quitlines' provision of free nicotine replacement therapy varies. In some states, Medicaid beneficiaries must obtain nicotine replacement therapy from a physician, whereas others get nicotine replacement therapy mailed to them.
Methods. This secondary analysis examined the differences in the source and use of cessation treatment by insurance type and their impacts on cessation. The parent trial excluded people who were pregnant, had private insurance, or were not ready to quit. From June 1, 2017 to November 15, 2020, a total of 1,944 low-income people who smoke daily completed a baseline survey and were enrolled in a quitline program; 1,380 (71%) completed a 3-month follow-up. Analyses were completed in August 2022. Participants were classified as Medicaid/dual (55%), Medicare/Veterans Affairs (14%), or uninsured (31%). Nine months into the trial, owing to a system error, the quitline provided nicotine replacement therapy to all study participants regardless of insurance type.
Results. Before error versus after error, Medicaid participants reported lower nicotine replacement therapy receipt (3.2% vs 50.8%) and use (32.4% vs 52.6%). The odds of quitting (7-day point prevalence) by 3 months increased for people who smoke who completed more quitline calls and used any (36% quit) versus used no (20% quit) pharmacotherapy, but quitting did not differ by insurance classifications (27%-29%). Getting and using nicotine replacement therapy from the quitline produced the highest quit rates (38%).
Conclusions. Results illustrate the benefit of receiving nicotine replacement therapy from the quitline on cessation. Mailing nicotine replacement therapy to all people who smoke should be standard practice to reduce smoking disparities.
Priority PopulationsThomson B, Emberson J, Lacey B, et al.
Association Between Smoking, Smoking Cessation, and Mortality by Race, Ethnicity, and Sex among US Adults.
JAMA Netw Open. 2022;5(10):e2231480. Published 2022 Oct 3. doi:10.1001/jamanetworkopen.2022.31480
Importance. Patterns of cigarette smoking and smoking cessation vary considerably across demographic groups in the US, but there is limited evidence on whether the hazards of smoking and benefits of quitting vary across these groups. Population-specific evidence on the benefits of quitting smoking may motivate cessation among groups historically underrepresented in medical research.
Objective. To quantify the association between smoking, smoking cessation, and mortality by race, ethnicity, and sex.
Design, setting, and participants. This nationally representative, prospective cohort study used data from the US National Health Interview Survey collected via questionnaire between January 1997 and December 2018 among adults aged 25 to 84 years at recruitment. Participants were followed up for cause-specific mortality through December 31, 2019.
Exposures. Self-reported smoking status at recruitment, age at quitting smoking, and years since quitting smoking.
Main outcomes and measures. The main outcomes were all-cause mortality and mortality from cancer, cardiovascular disease, and lower respiratory disease. Adjusted mortality rate ratios comparing never, former, and current smokers were calculated using Cox proportional hazards regression. Weighted analyses were conducted by race, ethnicity, and sex as reported by participants.
Results. Among the 551 388 participants in the main analyses, the mean (SD) age at recruitment was 48.9 (15.3) years; 307 601 (55.8%) were women, 87 207 (15.8%) were Hispanic, 75 545 (13.7%) were non-Hispanic Black, 355 782 (64.5%) were non-Hispanic White, and 32 854 (6.0%) identified as other non-Hispanic race and ethnicity. There were 74 870 deaths among participants aged 25 to 89 years during follow-up (36 792 [49.1%] among men; 38 078 [50.9%] among women). The all-cause mortality rate ratio (RR) for current vs never smoking was 2.80 (95% CI, 2.73-2.88) overall. The RRs were similar by sex but varied by race and ethnicity: Hispanic, 2.01 (95% CI, 1.84-2.18); non-Hispanic Black, 2.19 (95% CI, 2.06-2.33); non-Hispanic White, 3.00 (95% CI, 2.91-3.10); and other non-Hispanic race and ethnicity, 2.16 (95% CI, 1.88-2.47). When comparing those who quit smoking before age 45 years with never smokers, all-cause mortality RRs were 1.15 (95% CI, 1.03-1.28) among Hispanic individuals, 1.16 (95% CI, 1.07-1.25) among non-Hispanic Black individuals, 1.11 (95% CI, 1.08-1.15) among non-Hispanic White individuals, and 1.17 (95% CI, 0.99-1.39) among other non-Hispanic individuals.
Conclusions and relevance. In this prospective cohort study, among men and women from diverse racial and ethnic groups, current smoking was associated with at least twice the all-cause mortality rate of never smoking. Quitting smoking, particularly at younger ages, was associated with substantial reductions in the relative excess mortality associated with continued smoking.
Azagba S, Ebling T, Shan L.
A Double Disparity: Rural Sexual Minorities and Tobacco Use among U.S. Adults.
[published online ahead of print, 2022 Oct 21]. Addict Behav. 2022;137:107527. doi:10.1016/j.addbeh.2022.107527
Background. Marginalized groups continue to face an uneven distribution of the risks and consequences of smoking cigarettes, with rural/urban geography and sexual orientation status examined independently. However, little is known about the intersection of rural/urban geography and sexual orientation regarding tobacco use disparities. This study examined rural-urban sexual minority differences in tobacco use in the United States.
Methods. Data came from the 2018-2020 Behavioral Risk Factor Survey System (N = 675,221). We estimated cigarette smoking prevalence for each year of survey data by rural/urban status and sexual orientation. Multivariable logistic regressions were used to assess associations of rural/urban location and sexual orientation status with cigarette use. Additional Multivariable logistic regressions were conducted, including stratified analyses by sex on multiple sexual orientation categories.
Findings. Cigarette smoking was higher among participants who lived in rural areas and identified as lesbian or gay and bisexual. Furthermore, the disparities in smoking rates were significantly different, with 38 % higher odds of smoking among rural sexual minorities than urban sexual minorities (aOR = 1.38, 95 % CI = 1.19, 1.60). Stronger odds of cigarette smoking were found among rural gays or lesbians (aOR = 1.83, 95 % CI = 1.47, 2.28) and rural bisexuals (aOR = 2.40, 95 % CI = 2.03, 2.84) compared to urban straight counterparts.
Conclusion. Findings highlight rural populations, particularly sexual minorities, might have an elevated risk of cigarette use. Prevention and cessation efforts that help these especially disadvantaged groups will be beneficial in addressing tobacco use disparities.
Kingsbury JH, Boyle RG, Silva J, Parks MJ
Who's Quitting? Who Needs Additional Support? Cessation Disparities by Race, Education, and Income, 2007 to 2018.
[published online ahead of print, 2022 Oct 19]. Am J Health Promot. 2022;8901171221134796. doi:10.1177/08901171221134796
Purpose. The current study (1) examines how disparities in quitting cigarette and other tobacco product use have changed by race and socioeconomic status and (2) utilizes an expanded measure, any tobacco quit ratio (aQR), that extends previous work on cigarette quit ratios and captures use and cessation in a growing tobacco marketplace.
Design. Repeated cross-sectional representative survey; Setting: Minnesota.
Subjects. Adult Minnesotans from the 2007 and 2018 Minnesota Adult Tobacco Survey (combined N=9,258).
Measures. Cigarette QR (cQR), aQR (cigarette, cigar, smokeless, pipe, e-cigarette, hookah), past year quit attempts, and recent cessation.
Analysis. Weights ensured statewide representativeness. Regression analyses tested for differences by race (Black vs White), income (low vs medium/high), and education (low vs medium/high) across survey years.
Results. cQRs and aQRs were relatively high among White respondents and those with medium-high education and income. The disparity in aQR between White and Black respondents decreased from 2007 to 2018. Black respondents were more likely to try to quit than White respondents but were less likely to report recent cessation.
Conclusion. Cessation disparities by race and socioeconomic status have changed little between 2007 and 2018, and the magnitude of the disparity for several cessation indicators remains large. Public health professionals and medical practitioners can play a key role in reducing disparities by supporting public policies and cessation interventions that target social determinants of health and associated barriers to quitting.
E-Cigarettes and Heated Tobacco Products Namwase AS, Gyimah EA, Carothers BJ, Combs TB, Harris JK.
Changes in Harm Perception for E-cigarettes among Youth in the United States, 2014-2019.
[published online ahead of print, 2022 Oct 19]. Am J Health Promot. 2022;8901171221133805. doi:10.1177/08901171221133805
Purpose. To evaluate the trend of harm perception for e-cigarettes and the trend of the association between harm perception for e-cigarettes and for cigarettes among US youth from 2014 to 2019.
Design, setting and subjects. The National Youth Tobacco Survey is an annual, cross-sectional, school-based survey done among youth selected using three-stage probability sampling.
Analysis. Data were drawn from the 2014 to 2019 Surveys. A Multinomial logistic regression model was used to assess the association between harm perception for e-cigarettes and harm perception for cigarettes for each year.
Results. The percentage of youth who perceived e-cigarettes as harmless decreased from 2014 to 2019 (17.2% to 5.8%). From 2015 to 2018, the percentage of smokers who perceived e-cigarettes as a little harmful increased (33.6% to 41.2%). The positive association between harm perception for e-cigarettes and harm perception for cigarettes became stronger with time. In 2014, the odds of perceiving e-cigarettes as harmless relative to very harmful were 19.55 times greater for youth who perceived cigarettes as harmless, compared to those who perceived cigarettes as very harmful (OR = 19.55; 95% CI: 14.19-26.94). These odds increased to 77.65 times in 2019 (OR = 77.65; 95% CI: 41.48-107.85).
Conclusion. This study suggests a stronger relationship between perceived harm of cigarettes and e-cigarettes with time. Interventions to prevent smoking have the potential to change e-cigarette use.
Gravely S, Yong HH, Reid JL, et al.
Do Current Smokers and Ex-smokers who Use Nicotine Vaping Products Daily Versus Weekly Differ on their Reasons for Vaping? Findings from the 2020 ITC Four Country Smoking And Vaping Survey.
Int J Environ Res Public Health. 2022;19(21):14130. Published 2022 Oct 29. doi:10.3390/ijerph192114130
This study examined reasons why adults who currently smoke or formerly smoked cigarettes use nicotine vaping products (NVPs) by vaping frequency (daily vs. weekly) stratified by smoking status. This cross-sectional study included 3070 adults from the 2020 ITC Four Country Smoking and Vaping Survey (Australia, Canada, England, United States) who reported using a NVP (vaping) at least weekly and who either currently smoke (n = 2467) or formerly smoked (n = 603). Respondents were asked to select the reason(s) they use NVPs, including to manage their smoking (reduce/quit or remain quit) and/or for reasons unrelated to managing smoking (e.g., to save money, enjoyment, flavours). We found that both current and former smokers endorsed an average of six reasons for vaping, with those vaping daily reporting significantly more reasons than those vaping weekly. Among current smokers, 72.8% reported vaping may help them quit smoking, 13.0% reported vaping to reduce smoking but not to quit, and 14.2% reported vaping only for reasons other than to reduce or quit smoking. The most common reason for vaping among current smokers was to reduce smoking (81.3%). Current smokers vaping daily were significantly more likely than those vaping weekly to report using a NVP to reduce smoking, for enjoyment, to reduce harm to themselves and others, to quit smoking, likeable flavours, and to save money. The most common reason cited for vaping by respondents who formerly smoked was enjoyment, with those who vaped daily more likely than those who vaped weekly to report vaping for enjoyment and to reduce harm to themselves. Nearly all reported vaping to help stay abstinent from smoking (92.3%), with no significant difference by vaping frequency. In conclusion, a majority of respondents reported using NVPs to manage their smoking (reduce/quit smoking or remain quit), particularly those vaping daily. Those who were vaping daily also endorsed a greater number of reasons other than managing smoking relative to those who were vaping weekly.
Duan Z, Wysota CN, Romm KF, et al.
Correlates of Perceptions, Use, and Intention to Use Heated Tobacco Products among US Young Adults in 2020.
Nicotine Tob Res. 2022;24(12):1968-1977. doi:10.1093/ntr/ntac185
Introduction. Despite the increased heated tobacco product (HTP) marketing in the United States, little is known about HTP perceptions and correlates of HTP use and use intentions among young adults.
Aims and methods. Using 2020 cross-sectional data from 2,470 young adults (ages 18-34) from 6 US metropolitan areas, we conducted exploratory factor analysis to identify factors regarding perceived utility/appeal of HTPs, specifically IQOS, and examined these factors in relation to lifetime HTP use and use intentions, using multivariable logistic and linear regression, respectively.
Results. 19.1% had heard of HTPs and 4.1% ever used HTPs; 14.7% had heard of IQOS specifically and 2.8% were ever-users. Use intentions were low (M = 1.27, scale: 1 = not at all to 7 = extremely). Factor analysis identified five perceived utility/appeal factors: innovation (M = 3.17, scale: 1 = not at all to 7 = extremely), cigarette substitute (M = 2.99), and youth appeal (M = 2.82), e-cigarette/nicotine substitute (M = 2.36), and fashionable (M = 2.04). Controlling for sociodemographics and other tobacco use, perceiving IQOS as more fashionable and e-cigarette substitutes positively correlated with lifetime HTP use (aOR = 1.60, 95%CI = 1.17, 2.17; aOR = 1.48, 95%CI = 1.11, 1.97, respectively) and use intentions (β = 0.26, 95%CI = 0.21, 0.30; β = 0.14, 95%CI = 0.09, 0.18); perceiving IQOS as cigarette substitutes negatively correlated with ever use (aOR = 0.74, 95%CI = 0.56, 0.97) and use intentions (β = -0.06, 95%CI = -0.10, -0.03). Correlation patterns were similar among past-month cigarette, e-cigarette, and any-tobacco users.
Conclusions. Although HTP awareness and use were low, monitoring HTP perceptions and reasons for use as HTPs become more prominent is critical in anticipating their potential impact, particularly as more products seek FDA authorization to use reduced risk or exposure marketing claims.
Implications. Awareness, ever use, and intentions to use heated tobacco products (HTPs) were low among US young adults in 2020. Perceiving IQOS as fashionable and an e-cigarette substitute were positively correlated with ever use and intention to use HTPs. In addition, perceiving IQOS as a cigarette substitute was negatively correlated with ever use of HTPs and HTP use intentions. Continued surveillance on perceptions and use behaviors is needed to better understand use patterns, intentions to use, and reasons for using HTPs.
Yassine A, El Hage R, El-Hellani A, et al.
Did JUUL Alter the Content of Menthol Pods in Response to US FDA Flavour Enforcement Policy?
Tob Control. 2022;31(Suppl 3):s234-s237. doi:10.1136/tc-2022-057506
Background. The JUUL electronic cigarette (e-cigarette) remains popular in the USA and has a big prevalence among youth. In response to the popularity of JUUL and similar devices among youth, the US Food and Drug Administration issued in February 2020 an enforcement policy to remove all flavoured cartridge/pod-based e-cigarettes from the market except for tobacco and menthol. Subsequent studies showed that some users of the now-removed flavoured JUUL pods (especially cool mint) switched to menthol-flavoured JUUL pods with similar satisfaction.
Methods. We quantified menthol, nicotine, propylene glycol (PG) and vegetable glycerol (VG) in JUUL pod samples (Menthol, Classic Menthol and Cool Mint) that were purchased in 2017, 2018 and 2020 (only Menthol) to evaluate composition differences before and after the enforcement policy. We also analysed the samples to detect other cooling agents using a screening gas chromatography-mass spectrometry headspace method that we developed for this purpose.
Results. Menthol concentration was significantly higher in 2020 products than in products from prior years. Moreover, other cooling agents varied across pods. The PG/VG volume ratio was 27/63 in all pods examined.
Conclusion. This study highlights how regulations intended to reduce e-cigarette prevalence among youth may influence changes in tobacco product characteristics in ways that regulators may not have foreseen.
Soule EK, Mayne S, Snipes W, et al.
Electronic Cigarette Users' Reactions and Responses to a Hypothetical Ban of Flavoured Electronic Cigarette Liquids.
Tob Control. 2022;31(Suppl 3):s197-s205. doi:10.1136/tc-2022-057454
Background. Regulations have been proposed to limit e-cigarette flavours, but limited research has examined potential impacts of such policies. This study examined adult e-cigarette users' reactions to a hypothetical e-cigarette flavour ban.
Methods. In 2019, a convenience sample of current e-cigarette users in the USA (n=81, 53.1% women, mean age=37.6, 59.3% dual users of cigarettes) completed an online concept mapping study. Participants provided statements describing anticipated reactions to a hypothetical policy in which only tobacco, menthol or unflavoured e-cigarettes were available for purchase. Seventy-one unique statements were generated. Participants sorted statements into thematic groups and rated statements on how likely they would be to have each reaction. Multidimensional scaling was used to identify thematic clusters of statements.
Results. Twelve clusters were identified: negative reaction, take action against flavour limitation, youth prevention effectiveness perception, tolerance, acceptance, willingness to try new flavours, maintain vaping, reduce vaping, new flavours as vaping cessation transition, alternative sources for banned flavours, do-it-yourself mixing behaviours and alternative tobacco products. The highest rated cluster (negative reaction) described being angry or upset that flavours were banned, while the lowest rated clusters related to quitting/reducing e-cigarette use or switching to other tobacco products. Non-tobacco or non-menthol/mint flavoured e-cigarette users had higher ratings for clusters describing negative sentiment for the hypothetical policy.
Conclusions. Some e-cigarette users may dislike an e-cigarette flavour ban; however, some e-cigarette users would likely be willing to use tobacco, menthol or unflavoured e-cigarette liquids with lower likelihood of quitting vaping or switching to other tobacco products.
Technology
Marler JD, Fujii CA, Utley MT, Balbierz DJ, Galanko JA, Utley DS.
Outcomes of a Comprehensive Mobile Smoking Cessation Program with Nicotine Replacement Therapy in Adult Smokers: Pilot Randomized Controlled Trial.
[published online ahead of print, 2022 Oct 18]. JMIR Mhealth Uhealth. 2022;10.2196/41658. doi:10.2196/41658
Background. Cigarette smoking remains the leading cause of preventable illness and death, underscoring ongoing need for evidence-based solutions. Pivot, a US Clinical Practice Guideline (USCPG)-based mobile smoking cessation program, comprises a personal carbon monoxide (CO) breath sensor, smartphone app, in-app, text-based human-provided coaching, nicotine replacement therapy (NRT), and moderated online community. Promising Pivot cohort studies have established the foundation for comparative assessment.
Objective. Compare engagement, retention, attitudes towards quitting smoking, smoking behavior and participant feedback in Pivot vs. QuitGuide, a USCPG-based smoking cessation smartphone app from the National Cancer Institute (NCI).
Methods. In this remote pilot randomized controlled trial (RCT), cigarette smokers in the US were recruited online and randomized to Pivot or QuitGuide. Participants were offered 12 weeks of free NRT. Data were self-reported via weekly online questionnaires for 12 weeks and at 26 weeks. Outcomes included engagement and retention, attitudes towards quitting smoking, smoking behavior, and participant feedback. The primary outcome was self-reported app openings at 12 weeks. Cessation outcomes included self-reported 7- and 30-day point prevalence abstinence (PPA), abstinence from all tobacco products and continuous abstinence at 12 and 26 weeks. PPA and continuous abstinence were biovalidated via breath CO samples.
Results. Participants comprised 188 smokers (94 Pivot, 94 QuitGuide): mean (SD) age 46.4 (9.2) years, 104 women (55.3%), 128 White individuals (68.1%), mean (SD) cigarettes per day (CPD) 17.6 (9.0). Engagement via mean (SD) total app openings through 12 weeks (primary outcome) was Pivot 157.9 (SD 210.6) vs. QuitGuide 86.5 (SD 66.3) (incidence rate ratio [IRR],1.8; 95% CI, 1.4, 2.3; P<.001). Self-reported 7-day PPA at 12 and 26 weeks was Pivot 35.1% (33/94) vs. QuitGuide 27.7% (26/94), (intention to treat [ITT]), (odds ratio [OR], 1.4; 95% CI, 0.8, 2.7; P=.28), and Pivot 36.2% (34/94) vs. QuitGuide 26.6% (25/94), (ITT), (OR, 1.7; 95% CI, 0.9, 3.2; P=.12), respectively. Self-reported 30-day PPA at 12 and 26 weeks was Pivot 28.7% (27/94) vs. QuitGuide 22.3% (21/94), (ITT), (OR, 1.4; 95% CI, 0.7, 2.8; P=.32), and Pivot 31.9% (30/94) vs. QuitGuide 22.3% (21/94), (ITT), (OR, 1.7; 95% CI, 0.9, 3.4; P=.12), respectively. The biovalidated abstinence rate at 12 weeks was Pivot 28.7% (27/94) vs. QuitGuide 12.8% (12/94), (ITT), (OR, 2.8; 95% CI, 1.3, 6.1; P=.008). Biovalidated continuous abstinence at 26 weeks was Pivot 21.3% (20/94) vs. QuitGuide 9.6% (9/94), (ITT), (OR, 2.7; 95% CI, 1.1, 6.4; P=.03). Participant feedback, including ease of set-up, impact on smoking, and likelihood of program recommendation were favorable for Pivot.
Conclusions. In this RCT comparing the app-based smoking cessation programs Pivot and QuitGuide, Pivot participants had higher engagement and biovalidated cessation rates, and more favorable user feedback at 12 and 26 weeks. These findings support Pivot as an effective, durable mobile smoking cessation program.
Tobacco Use
Park-Lee E, Ren C, Cooper M, Cornelius M, Jamal A, Cullen KA.
Tobacco Product Use among Middle and High School Students - United States, 2022.
MMWR Morb Mortal Wkly Rep. 2022;71(45):1429-1435. Published 2022 Nov 11. doi:10.15585/mmwr.mm7145a1
Tobacco use* is the leading cause of preventable disease, disability, and death among adults in the United States (1). Youth use of tobacco products in any form is unsafe, and nearly all tobacco use begins during youth and young adulthood (2). The Food and Drug Administration (FDA) and CDC analyzed data from the 2022 National Youth Tobacco Survey (NYTS) to estimate current (past 30-day) use of eight tobacco products among U.S. middle (grades 6-8) and high school (grades 9-12) students. In 2022, approximately 11.3% of all students (representing 3.08 million persons) reported currently using any tobacco product, including 16.5% of high school and 4.5% of middle school students (2.51 million and 530,000 persons, respectively). Electronic cigarettes (e-cigarettes) were the most commonly used tobacco product among high school (14.1%; 2.14 million) and middle school (3.3%; 380,000) students. Approximately 3.7% of all students (representing 1 million persons) reported currently smoking any combustible tobacco product. Current use of any tobacco product was higher among certain population groups, including 13.5% of non-Hispanic American Indian or Alaska Native (AI/AN)† students; 16.0% of students identifying as lesbian, gay, or bisexual (LGB); 16.6% of students identifying as transgender; 18.3% of students reporting severe psychological distress; 12.5% of students with low family affluence; and 27.2% of students with low academic achievement. Implementation of comprehensive evidence-based tobacco control strategies, combined with FDA regulation, is important for preventing and reducing youth tobacco product use (1,2).
Email to a Friend