Adult Daily Smokers Research Articles

Smokers Who Try E-Cigarettes to Quit Smoking: Findings From a Multiethnic Study in Hawaii

We characterized smokers who are likely to use electronic or "e-"cigarettes to quit smoking. We obtained cross-sectional data in 2010-2012 from 1567 adult daily smokers in Hawaii using a paper-and-pencil survey. Analyses were conducted using logistic regression. Of the participants, 13% reported having ever used e-cigarettes to quit smoking. Smokers who had used them reported higher motivation to quit, higher quitting self-efficacy, and longer recent quit duration than did other smokers. Age (odds ratio [OR] = 0.98; 95% confidence interval [CI] = 0.97, 0.99) and Native Hawaiian ethnicity (OR = 0.68; 95% CI = 0.45, 0.99) were inversely associated with increased likelihood of ever using e-cigarettes for cessation. Other significant correlates were higher motivation to quit (OR = 1.14; 95% CI = 1.08, 1.21), quitting self-efficacy (OR = 1.18; 95% CI = 1.06, 1.36), and ever using US Food and Drug Administration (FDA)-approved cessation aids such as nicotine gum (OR = 3.72; 95% CI = 2.67, 5.19). Smokers who try e-cigarettes to quit smoking appear to be serious about wanting to quit. Despite lack of evidence regarding efficacy, smokers treat e-cigarettes as valid alternatives to FDA-approved cessation aids. Research is needed to test the safety and efficacy of e-cigarettes as cessation aids.

Effects of timing of initiation and planning on smoking cessation outcomes: study protocol for a randomised controlled trial.

BackgroundRecent theoretical and empirical work has led to debate over the benefit of delaying the implementation of a decision to quit smoking in order to plan the attempt. These two need not be linked, planning can occur before a commitment to quit is made, or after it is implemented, as well as in between. This study will test whether there are independent benefits for encouraging smokers to act immediately on a definite decision to quit smoking, and to engage in structured planning.Methods/designA complex randomised controlled trial with a factorial design, testing the presence of a recommendation to quit immediately (or not) and encouragement to structured planning (or not) as additions to standard care, a web-based automated tailored advice program (QuitCoach). Participants are recruited from users of the QuitCoach who reside in Australia, do not report a mental health condition for which they are taking medication, are adult daily smokers, and at least open to the possibility of quitting. For the Immediate arm they could not have committed to quit within 2 days, while the Planning arm included all these and those quit within the last 4 days. This creates 6 groups: 2 × 3, with 2 × 2 fully randomised, and 2 only randomised for the planning arm. Follow-up assessments are conducted around 1 month (targeting two weeks after the quit attempt started), and 6 months later. The primary outcome is 6-month sustained abstinence at 6 months. Secondary outcomes include point-prevalence abstinence at both follow-ups, and making quit attempts during the intervention period. We will also explore differences in actual behaviour (timing and planning) by intervention, and relate this to outcomes.DiscussionThis study will result in a better understanding of the roles of planning and delay in influencing the success of quit attempts.Trial registrationAustralian New Zealand Clinical Trials Registry http://ACTRN12612000613808

Youth tobacco use: who has a say?

www.thelancet.com Vol 381 February 2, 2013 357 Tobacco use is a major cause of morbidity and mortality worldwide, and has wide-ranging socioeconomic consequences. The Global Burden of Disease Study 2010 ranks tobacco smoking, including second-hand smoke, as the second leading risk factor for global disease burden, accounting for an estimated 6·3 million deaths and 6·3% of disability-adjusted life-years in 2010. US data indicate that almost 90% of adult daily smokers smoked their fi rst cigarette by age 18 years. Hence, targeting young people seems to be a good idea. However, interventions that work in adults do not necessarily apply to children and adolescents. According to the 2012 US Surgeon General’s report “coordinated, multicomponent interventions that com bine mass media campaigns, price increases including those that result from tax increases, school-based policies and programmes, and statewide or community-wide changes in smokefree policies and norms are eff ective in reducing the initiation, preva lence, and intensity of smoking among youth and young adults”. The report also highlighted the insuffi cient evidence for health-care prevention strategies to reduce smoking initiation in young people. On behalf of the US Preventive Services Task Force, Carrie Patnode and colleagues recently presented a systematic review and meta-analysis on the effi cacy and harms of primary care interventions to prevent tobacco use or improve tobacco cessation rates among children and adolescents. These interventions varied widely in terms of content, ranging from brief advice, print material, and tailored computer programming to phone calls or in-person counselling and motivational interviewing. Fair and good quality trials were included. Pooled analyses indicated a statistically signifi cant preven tive eff ect of behaviour-based interventions on smoking initiation, with a 19% relative risk reduction (risk ratio 0·81, 95% CI 0·70-0·93) in intervention groups compared with controls within 7–36 months of follow up. The absolute risk reduction was 2 percentage points, corresponding to a number needed to treat of 50. Qualitative exploration of studies did not reveal any clear pattern of associations between intervention or study characteristics and eff ect size. Pooled analysis showed no statistically signifi cant eff ects of the interventions on tobacco cessation. However, potential eff ects could have been masked by factors such as the limited number of studies included, variability in interventions and measures across studies, and lack of stratifi ed data. The limitations of this study include the short follow-up time and the question of generalisability, since only three studies were undertaken outside the USA. Nonetheless, Patnode and colleagues’ study indicates that primary care health workers might have a say in the prevention of cigarette smoking among children and adolescents.

A text messaging-based smoking cessation program for adult smokers: randomized controlled trial.

BackgroundDespite promising data in Western countries, there is a dearth of research into the efficacy of text messaging-based smoking cessation programs in other settings, including the Middle East, where smoking prevalence rates are higher.ObjectiveThis paper reports cessation rates observed in SMS Turkey, a text messaging-based smoking cessation program for adult smokers in Ankara, Turkey.MethodsThis study was a small-scale, parallel-group randomized controlled trial (RCT) conducted in Ankara, Turkey. Participants were adult daily smokers who were seriously thinking about quitting in the next 15 days and living in Ankara, Turkey. The text messaging intervention, SMS Turkey, provided 6 weeks of daily messages aimed at giving participants skills to help them quit smoking. Messages were sent in an automated fashion, except 2 days and 7 days after the initial quit day. On days 2 and 7, the research assistant manually assigned participants to content “paths” based on whether they were still not smoking or had relapsed. The control arm received a brochure that provided similar information about smoking cessation. The main outcome measure was self-reported 3-month sustained abstinence, verified by carbon monoxide (CO) readings. Neither participants nor researchers were blinded to arm assignment.ResultsThe 151 participants were randomly assigned to 1 of 2 groups: 76 to the SMS Turkey intervention group and 75 to the brochure control group. Using intention to treat, all 151 participants were included in analyses. Three-month cessation trends were not significantly higher in the intervention group: 11% intervention vs 5% control had quit (χ2 1=1.4, P=.24; R2=2.0, 95% CI 0.62-6.3). When the sample was stratified by sex, female intervention participants (14%, n=5) were significantly more likely to have quit at 3 months than female control participants (0%, n=0; χ2 1=3.7, P=.05). Among light smokers (ie, those smoking less than 20 cigarettes per day), intervention participants (17%, n=5) also were significantly more likely to have quit compared to control participants (0%, n=0; χ2 1=5.3, P=.02). We noted no difference in cessation rates for males or heavy smokers. Participants experienced significant technology problems during the study. Some participants received duplicate text messages at least once during the trial; others failed to receive some program messages. Neither receiving duplicate messages (χ2 1=0.12, P=.73), or missing 5 or more program messages (χ2 1=0.75, P=.39) negatively affected quitting rates.ConclusionsAlthough the study was not powered to detect statistically significant differences, as the primary aim was to provide estimates of effect size that could be used to better inform a power analysis for a larger trial, findings provide optimism that SMS Turkey may be able to affect quitting rates in environments with high smoking prevalence, such as Ankara, Turkey. The SMS Turkey software program did not work as well as it did 2 years previous. The system will need to be updated to maintain software compatibility with ongoing technology evolution.Trial RegistrationClinicaltrials.gov NCT00912795 http://clinicaltrials.gov/ct2/show/NCT00912795 (Archived by WebCite at http://www.webcitation.org/6Ch1cIA8l).

Targeting cessation: Understanding barriers and motivations to quitting among urban adult daily tobacco smokers

IntroductionMany people continue to smoke tobacco products despite known negative health consequences, including increased risk of chronic disease and death. Disparities exist in rates of smoking and chronic disease, underscoring the importance of understanding the barriers and motivations to smoking cessation among vulnerable populations, such as socioeconomically disadvantaged people of color. MethodsThis study uses data from a cross-sectional randomized household survey conducted in six low-income neighborhoods in New Haven, Connecticut, USA (N=1205). The objectives were to examine barriers and motivations to quitting smoking among daily tobacco smokers (31.6% of respondents) and sociodemographic differences in endorsement of barriers and motivations. ResultsThe two most common barriers to quitting were perceiving it to be too difficult and not wanting to quit. Financial costs, social support, and social influence were themes endorsed highly across both barriers and motivations to quitting. Sociodemographic differences were found, such as women and Black participants being more likely to be interested in a free quitline or quit website; women and Latinos being more likely to be afraid of gaining weight; and women, participants with less education, and older participants being more likely to be concerned about the cost of cessation products. ConclusionsUnderstanding barriers and motivations to quitting among disadvantaged populations is crucial. Financial issues, social support, and social norms should be targeted in promoting cessation among disadvantaged, urban populations. Programs, interventions, and policies can also use research about specific barriers and motivations for sociodemographic sub-groups to be tailored, targeted, and more effective.

Asthma and its relation to smoking behavior and cessation motives among adult daily smokers

Despite the negative effects of smoking on lung functioning and overall health, smoking is more prevalent among individuals with asthma compared to those without asthma. The purpose of this study was to examine the predictive ability of asthma diagnosis in terms of smoking behavior and reasons for quitting. Participants were 251 regular daily smokers: 125 smokers with self-reported, physician-diagnosed asthma and 126 smokers without asthma. Asthma diagnosis significantly predicted age of regular smoking onset, number of quit attempts, and reasons for quitting related to self-control suggesting that smokers with asthma may have more difficulty quitting and unique reasons for quitting.

A pilot study of StopAdvisor: A theory-based interactive internet-based smoking cessation intervention aimed across the social spectrum

BackgroundThis article reports a pilot study of a new smoking cessation website (‘StopAdvisor’), which has been developed on the basis of PRIME theory, evidence, web-design expertise and user-testing. The aims were to i) evaluate whether cessation, website usage and satisfaction were sufficiently high to warrant a randomised controlled trial (RCT) and ii) assess whether outcomes were affected by socio-economic status. MethodsThis was an uncontrolled pilot study. Two hundred and four adult daily smokers willing to make a serious quit attempt were included. All participants received support from ‘StopAdvisor’, which recommends a structured quit plan and a variety of evidence-based behaviour change techniques for smoking cessation. A series of tunnelled sessions and a variety of interactive menus provide tailored support for up to a month before quitting through until one-month post-quit (http://www.lifeguideonline.org/player/play/stopadvisordemonstration). The primary outcome was self-report of at least 1month of continuous abstinence collected at 2months post-enrolment and verified by saliva cotinine or anabasine. Usage was indexed by log-ins and page views. Satisfaction was assessed by dichotomous ratings of helpfulness, personal relevance, likelihood of recommendation and future use, which were collected using an online questionnaire at 2months post-enrolment. Outcomes according to socio-economic status were assessed. ResultsAt 8weeks post-enrolment, 19.6% (40/204) of participants were abstinent according to the primary outcome criteria (95% C.I.=14.1% to 25.1%). Participants viewed a mean of 133.5 pages (median=71.5) during 6.4 log-ins (median=3). A majority of respondents rated the website positively on each of the four satisfaction `ratings (range=66.7% to 75.3%). There was no evidence of an effect of socio-economic status on abstinence (OR=1.01, C.I.=0.50–2.07), usage (page-views, t(202)=0.11, p=.91; log-ins, t(202)=0.21, p=.83), or satisfaction (helpfulness, OR=1.09, C.I.=0.41–2.88; personal relevance, OR=0.55, C.I.=0.20–1.56; recommendation, OR=0.98, C.I.=0.34–2.81; use in future, OR=1.45, C.I.=0.49–4.27). ConclusionsThe systematic application of theory, evidence, web-design expertise, and user-testing has resulted in a website that shows sufficiently promising efficacy and usability to warrant evaluation in a RCT. The website appears to be similarly effective and acceptable to users across the social spectrum.

Prospective evaluation of the effects of anxiety sensitivity and state anxiety in predicting acute nicotine withdrawal symptoms during smoking cessation.

The current investigation explored the main and interactive effects of anxiety sensitivity (AS) and state anxiety in predicting acute nicotine withdrawal symptoms experienced during the initial 14 days of smoking cessation. Participants included 123 adult daily smokers (84 women; Mage = 45.93 years, SD = 10.34) undergoing psychosocial-pharmacological cessation treatment. Results indicated that after controlling for the effects of participant sex and nicotine dependence, state anxiety but not AS significantly predicted initial levels of nicotine withdrawal symptoms. Results also demonstrated that both state anxiety and AS were significantly related to the change in nicotine withdrawal symptoms over time. Finally, our results revealed a significant interaction between AS and state anxiety. Specifically, higher levels of AS were associated with a stronger relation between state anxiety and nicotine withdrawal symptoms experienced during the cessation attempt. Results suggest that among high AS persons, state anxiety may be more relevant, compared to those low in AS, in regard to experiencing withdrawal symptoms as more intense during the early phases of quitting.

Nature and Role of Change in Anxiety Sensitivity During NRT-Aided Cognitive-Behavioral Smoking Cessation Treatment

This study evaluated the associations between change in anxiety sensitivity (AS; fear of the negative consequences of anxiety and related sensations) and lapse and relapse during a 4-week group NRT-aided cognitive-behavioral Tobacco Intervention Program. Participants were 67 (44 women; M age = 46.2 years, SD = 10.4) adult daily smokers. Results indicated that participants who maintained high levels of AS from pretreatment to 1 month posttreatment, compared to those who demonstrated a significant reduction in AS levels during this time period, showed a significantly increased risk for lapse and relapse. Further inspection indicated that higher continuous levels of AS physical and psychological concerns, specifically among those participants who maintained elevated levels of AS from pre- to posttreatment, predicted significantly greater risk for relapse. Findings are discussed with respect to better understanding change in AS, grounded in an emergent taxonic-dimensional factor mixture model of the construct, with respect to lapse and relapse during smoking cessation.

Homework Compliance in a Brief Cognitive-Behavioural and Pharmacological Intervention for Smoking

AbstractHomework assignments have been a key component of cognitive behavioural therapy (CBT) for decades, but very few studies examined the effect of compliance on outcome in regard to smoking behaviour. To fill this gap in the existing literature, the present report evaluated the role of homework compliance on short-term outcome in the context of evidence-based care for smoking cessation. Compliance with out-of-session assignments was assessed in a four-session CBT-nicotine replacement therapy protocol for smoking cessation among adult daily smokers (n= 94). Consistent with expectation, homework compliance was associated with better short-term outcomes, including amount of cigarettes consumed as well as abstinence. Importantly, these effects remained after controlling for a wide range of potentially confounding variables (e.g., motivation to quit, nicotine dependence at intake, attendance problems, and in-session participation). Estimates of quantity versus quality of homework compliance did not differentially predict outcomes. Out-of-session homework assignments incrementally predict short-term smoking abstinence in the context of evidence-based care for smoking cessation.

Main and interactive effects of emotion dysregulation and breath-holding duration in relation to panic-relevant fear and expectancies about anxiety-related sensations among adult daily smokers

The current study investigated the main and interactive effects of emotion dysregulation and distress tolerance in relation to panic-relevant variables among daily smokers. The sample consisted of 172 adults (61.2% male; M age = 31.58, SD = 11.51), who reported smoking an average of 15.99 cigarettes per day ( SD = 10.00). Results indicated that both emotion dysregulation and distress tolerance were significantly related to interoceptive fear and agoraphobia. Additionally, emotion dysregulation, but not distress tolerance, was significantly related to anxiety sensitivity. All effects were evident above and beyond the variance accounted for by average cigarettes per day, tobacco-related physical illness, and panic attack history. The interaction between emotion dysregulation and distress tolerance significantly predicted interoceptive and agoraphobic fears as well as the cognitive component of anxiety sensitivity. Such findings underscore the importance of emotion dysregulation and distress tolerance in regard to panic-specific fear and expectancies about anxiety-related sensations among daily smokers.

The Efficacy of Computer-Delivered Treatment for Smoking Cessation

The current study evaluated the efficacy of an individualized, hand-held computer-delivered treatment (CDT) versus standard treatment (ST) for the maintenance of smoking abstinence following a quit attempt. Participants were 303 adult daily smokers randomized to CDT or ST, plus pharmacotherapy. Abstinence though 1 year was examined using logistic random intercept models, a type of generalized linear mixed model regression. Results did not support the efficacy of the CDT program through 1 year postquit in analyses adjusted for time and study site (OR = 0.84, 95% CI = 0.55-1.30), or after further adjusting for race/ethnicity, age, gender, education, marital status, and the number of cigarettes smoked per day before quitting (OR = 0.89, 95% CI = 0.57-1.39). CDT did not increase short- or long-term abstinence rates over ST in this study. Findings differ from some in the literature and suggest the need for continued research on the use of CDT for smoking cessation.

The role of self‐efficacy, recovery self‐efficacy, and preparatory planning in predicting short‐term smoking relapse

This study aims to identify the role of self-efficacy, recovery self-efficacy, and preparatory planning with regard to short-term smoking relapse. We also assessed whether the importance of these variables differed for smokers quitting individually and without help (self-quitters) and smokers quitting with the help of a smoking cessation course (group quitters). A longitudinal quasi-experimental study with follow-ups at 1 and 3 months after the quit attempt was conducted in order to assess the role of baseline self-efficacy, recovery self-efficacy, and preparatory planning on short-term relapse. The recruitment included adult daily smokers (N= 121), quitting in a smoking cessation course (N= 57) and self-quitters (N= 64). Respondents received internet-based questionnaires 2 weeks before quitting (baseline) and 1 and 3 months after the quit attempt. Predictors of relapse were analysed using logistic regression analyses. Relapse at 1 and 3 months after the quit attempt was predicted by low levels of baseline self-efficacy. Simple slope analyses revealed that less preparatory planning significantly predicted relapse at 1 month after the quit attempt among group quitters, but not among self-quitters. Recovery self-efficacy was only predictive of relapse after 1 month when self-efficacy was excluded from the analyses. Moreover, among group quitters, the results indicated a borderline significant curved relation between recovery self-efficacy and relapse after 1 month. Our results suggest that more research is needed on the role of preparatory planning and recovery self-efficacy. Moreover, we recommend incorporating self-efficacy increasing techniques in relapse-prevention interventions.

Cannabinoids and metabolites in expectorated oral fluid after 8 days of controlled around-the-clock oral THC administration

Oral fluid (OF) is an increasingly accepted matrix for drug testing programs, but questions remain about its usefulness for monitoring cannabinoids. Expectorated OF specimens (n = 360) were obtained from 10 adult daily cannabis smokers before, during, and after 37 20-mg oral Δ(9)-tetrahydrocannabinol (THC) doses over 9 days to characterize cannabinoid disposition in this matrix. Specimens were extracted and analyzed by gas chromatography-mass spectrometry with electron-impact ionization for THC, 11-hydroxy-THC, cannabidiol, and cannabinol, and negative chemical ionization for 11-nor-9-carboxy-THC (THCCOOH). Linear ranges for THC, 11-hydroxy-THC, and cannabidiol were 0.25-50 ng/mL; cannabinol 1-50 ng/mL; and THCCOOH 5-500 pg/mL. THCCOOH was the most prevalent analyte in 344 specimens (96.9%), with concentrations up to 1,390.3 pg/mL. 11-hydroxy-THC, cannabidiol, and cannabinol were detected in 1, 1, and 3 specimens, respectively. THC was detected in only 13.8% of specimens. The highest THC concentrations were obtained at admission (median 1.4 ng/mL, range 0.3-113.6) from previously self-administered smoked cannabis. A total of 2.5 and 3.7% of specimens were THC-positive at the recommended Substance Abuse and Mental Health Services Administration (2 ng/mL) and Driving Under the Influence of Drugs, Alcohol and Medicines (DRUID) (1 ng/mL) confirmation cutoffs, respectively. THC is currently the only analyte for monitoring cannabis exposure in OF; however, these data indicate chronic therapeutic oral THC administration and illicit oral THC use are unlikely to be identified with current guidelines. Measurement of THCCOOH may improve the detection and interpretation of OF cannabinoid tests and minimize the possibility of OF contamination from passive inhalation of cannabis smoke.

Mindfulness Skills and Anxiety-Related Cognitive Processes Among Young Adult Daily Smokers: A Pilot Test

We examined specific mindfulness skills (observing, describing, acting with awareness, accepting without judgment, as measured by the Kentucky Inventory of Mindfulness Skills, in terms of anxiety-related cognitive processes among adult daily smokers (n = 90; 43 females; Mage = 26.6 years, SD = 11.8). Partially consistent with hypotheses, describing and accepting without judgment were each shown to significantly predict perceived control over anxiety-related events. The observed significant effects were evident above and beyond the variance accounted for by gender, smoking rate, and negative affectivity. Although observing also was shown to significantly predict agoraphobic cognition, it was in the opposite direction as was theoretically expected. No evidence of incremental validity for mindfulness skills was evident for anxiety sensitivity. These data highlight the potential explanatory relevance of only specific mindfulness skills in terms of only certain anxiety-based cognitive processes among adult daily smokers.

Associations of nicotine intake measures with CHRN genes in Finnish smokers.

Genetic effects contribute to individual differences in smoking behavior. Persistence to smoke despite known harmful health effects is mostly driven by nicotine addiction. As the physiological effects of nicotine are mediated by nicotinic acetylcholine receptors (nAChRs), we aimed at examining whether single nucleotide polymorphisms (SNPs) residing in nAChR subunit (CHRN) genes, other than CHRNA3/CHRNA5/CHRNB4 gene cluster previously showing association in our sample, are associated with smoking quantity or serum cotinine levels. The study sample consisted of 485 Finnish adult daily smokers (age 30-75 years, 59% men) assessed for the number of cigarettes smoked per day (CPD) and serum cotinine level. We first studied SNPs residing on selected nAChR subunit genes (CHRNA2, CHRNA4, CHRNA6/CHRNB3, CHRNA7, CHRNA9, CHRNA10, CHRNB2, CHRNG/CHRND) genotyped within a genome-wide association study for single SNP and multiple SNP associations by ordinal regression. Next, we explored individual haplotype associations using sliding window technique. At one of the 8 loci studied, CHRNG/CHRND (chr2), single SNP (rs1190452), multiple SNP, and 2-SNP haplotype analyses (SNPs rs4973539-rs1190452) all showed statistically significant association with cotinine level. The median cotinine levels varied between the 2-SNP haplotypes from 220 ng/ml (AA haplotype) to 249 ng/ml (AG haplotype). We did not observe significant associations with CPD. These results provide further evidence that the γ-δ nAChR subunit gene region is associated with cotinine levels but not with the number of CPD, illustrating the usefulness of biomarkers in genetic analyses.

An Ecological Momentary Assessment analysis of relations among coping, affect and smoking during a quit attempt

This study used Ecological Momentary Assessment (EMA) data from smokers trying to quit to assess relations among coping, positive affect, negative affect and smoking. The effects of stress coping on affect and smoking were examined. Data from a randomized clinical trial of smoking cessation treatments were submitted to multi-level modeling to test the effects of coping with stressful events on subsequent affect and smoking. Center for Tobacco Research and Intervention, Madison, Wisconsin. A total of 372 adult daily smokers who reported at least one stressful event and coping episode and provided post-quit data. Participants' smoking, coping and affect were assessed in near real time with multiple EMA reports using electronic diaries pre- and post-quit. Multi-level models indicated that a single coping episode did not predict a change in smoking risk over the next 4 or 48 hours, but coping in men was associated with concurrent reports of increased smoking. Coping predicted improved positive and negative affect reported within 4 hours of coping, but these affective gains did not predict reduced likelihood of later smoking. Pre-quit coping frequency and gender moderated post-quit stress coping relations with later positive affect. Men and those with greater pre-quit coping frequency reported greater gains in positive affect following post-quit coping. Coping responses early in a quit attempt may help smokers trying to quit feel better, but may not help them stay smoke-free.

Stages of change, smoking characteristics, and cotinine concentrations in smokers: Setting priorities for smoking cessation

ObjectiveWe assessed whether the salivary cotinine content of daily smokers varied with the readiness to quit and smoking characteristics. MethodsThis cross-sectional study was conducted in Barcelona, Spain (n=1245) in 2004–2005. We administered a questionnaire to assess smoking behaviour and collected saliva to determine the cotinine content. We determined the distribution of 278 adult daily smokers across different stages of change and categorised them by individual and smoking characteristics. We used medians and interquartile ranges (IQR) to relate cotinine concentrations to different stages of change, tobacco consumption, and nicotine dependence based on the Fagerström Test for Nicotine Dependence (FTND). ResultsAround 68%, 22%, and 11% of smokers were in precontemplation, contemplation, and preparation stages, respectively. A mean of 17.0 cigarettes was smoked daily, with no differences among stages of change. The median cotinine concentration was 151.3ng/ml (IQR: 83.2–227.8ng/ml), with no differences among stages of change. The cigarette consumption scores, FTND, and time to first cigarette of the day were positively associated with cotinine concentration. ConclusionsThe cotinine concentration was similar among the stages of change, but varied within each stage according to the number of cigarettes smoked, time to first cigarette of the day, and nicotine dependence.

Use of mentholated cigarettes: what can we learn from national data sets?

Use of mentholated cigarettes: what can we learn from national data sets?

The relationships between menthol cigarette preference and state tobacco control policies on smoking behaviors of young adult smokers in the 2006–07 Tobacco Use Supplements to the Current Population Surveys (TUS CPS)

To examine relationships between the preference for menthol cigarettes and young adult smoking behaviors, including the extent to which state tobacco control policies moderate these relationships. Cross-sectional design using secondary data from the 2006-07 Tobacco Use Supplements to the Current Population Surveys (TUS CPS) surveys appended with 2006 state-policy data. United States nationally representative survey. A total of 2241 young adult daily smokers and 688 young adult non-daily smokers. The two dependent variables of smoking behaviors were smoking first cigarette within 30 minutes of waking (TTF) and number of cigarettes smoked per day (cpd). Primary independent variables included menthol brand preference and state tobacco control policies (youth access laws, clean indoor air laws and cigarette excise taxes), adjusting for controls. Among daily smokers, there were no significant associations between menthol brand preference and TTF or cpd. However, lower educational attainment, not being in the labor force and the lack of home smoking rules were associated positively with shorter TTF, being white and the lack of home smoking rules were associated positively with cpd. Among daily smokers, state excise taxes were associated negatively with higher cpd. Among non-daily smokers, menthol brand preference was associated positively with shorter TTF, but associations did not vary with state tobacco control policies. Menthol brand preference was not associated significantly with cpd, but male gender, unmarried status and the lack of home smoking rules were associated positively with greater cpd among non-daily smokers. Young adult non-daily smokers who preferred menthol cigarettes were significantly more dependent than those who preferred non-menthol cigarettes, as shown through the shorter TTF. Associations between menthol brand preference and smoking behaviors did not vary with state tobacco control policies.