Daily Cigarette Smokers Research Articles

Helping low-income smokers quit: findings from a randomized controlled trial comparing specialized quitline services with and without social needs navigation

Quitting smoking is especially challenging for low-income smokers due to high stress, high smoking prevalence around them, and limited support for quitting. This study aimed to determine whether any of three interventions designed specifically for low-income smokers would be more effective than standard tobacco quitline services: a specialized quitline, the specialized quitline with social needs navigation, or the standard quitline with social needs navigation. Using a randomized 2×2 factorial design, low-income daily cigarette smokers (n=1944) in Missouri, USA who called a helpline seeking assistance with food, rent or other social needs were assigned to receive Standard Quitline alone (n=485), Standard Quitline+Social Needs Navigation (n=484), Specialized Quitline alone (n=485), or Specialized Quitline+Social Needs Navigation (n=490). The target sample size was 2000, 500 per group. The main outcome was 7-day self-reported point prevalence abstinence at 6-month follow-up. Multiple imputation was used to impute outcomes for those missing data at 6-month follow-up. Binary logistic regression analyses were used to assess differences between study groups. Participants were recruited from June 2017 to November 2020; most were African American (1111 [58%]) or White (666 [35%]), female (1396 [72%]), and reported <$10,000 (957 [51%]) or <$20,000 (1529 [82%]) annual pre-tax household income. At 6-month follow-up (58% retention), 101 participants in the Standard Quitline group reported 7-day point prevalence abstinence (20.8% of those assigned at baseline, 38.1% after imputation). Quit rates in the Specialized Quitline (90 quitters, 18.6%, 38.1%) and Specialized Quitline+Social Needs Navigation (103 quitters, 21.0%, 39.8%) were not different from the Standard Quitline. Quit rates for Standard Quitline+Social Needs Navigation (74 quitters, 15.3%, 30.1%) were significantly lower than Standard Quitline (OR=0.70, 95% CI=0.50-0.98). A specialized version of a state tobacco quitline was no more effective than standard quitline services in helping low-income smokers quit. Adding social needs navigation to a standard quitline decreased its effectiveness. ClinicalTrials.gov Identifier: NCT03194958. National Cancer Institute: R01CA201429.

Beating trauma: Physical activity to promote resilience against substance use

BackgroundThe relationship between adverse childhood experiences (ACEs) and frequent substance use (SU) is not well understood, impeding prevention efforts. MethodsWe assessed the relationship between ACEs and frequent SU and investigated if different modalities of physical activity (PA) moderate this pathway. The analysis included persons enrolled in the National Longitudinal Study of Adolescent to Adult Health who responded to surveys at Waves I (11–20 years), III (18–27 years), and IV (24–33 years). The impacts of cumulative ACEs and PA modalities on daily cigarette smoking, daily cannabis use, and binge drinking ≥ 3 times a week in emerging and early adulthood were assessed through adjusted logistic regression models. ResultsAmong the sample (N=9451), 29.3%, 12.5%, and 7.8% experienced 1, 2, or 3 or more ACEs, respectively. With exception to binge drinking, cumulative ACEs (3+) were strongly associated with daily cannabis use in Wave III (aOR: 2.5; 95% CI: 1.6–3.6) and Wave IV (aOR: 2.1; 95% CI:1.3–3.3) and daily cigarette smoking in Wave III (aOR: 2.4; 95% CI: 1.9–3.0) and Wave IV (aOR: 2.3; 95% CI: 1.8–2.8). No PA modality moderated the ACEs to SU pathway; however, walking for exercise lowered the odds of current and prospective daily cannabis and cigarette use by 20–40%. Strength training, team sports, and individual sport participation were associated with 20–30% reduced risks of future daily cigarette use. ConclusionThe impacts of ACEs exposure on frequent SU persist into emerging and early adulthood. Future research should investigate the potential of PA to improve SU prevention strategies.

Association Between Sense of Coherence and Tobacco Use Among Brazilian Adolescent Students

Background: Investigating tobacco use and associated factors is essential to set priorities and health promotion strategies among adolescents. Several studies examined the relationship between this behavior and the psychosocial salutogenic construct Sense of Coherence (SOC), but the evidence is limited to adolescents in high-income countries. This study aimed to analyze the association between tobacco use and SOC among Brazilian adolescent students. Methods: A cross-sectional school-based survey was conducted in 2018. Dependent variables were categorical binary (Yes/No): (1) Smoking experimentation (at least one puff in a lifetime); (2) Current smoking (at least one cigarette smoked in the last 30 days); (3) Daily cigarette smoking; and (4) Experimentation with hookah and/or other tobacco products (at least once in a lifetime). Independent variable SOC was assessed with the SOC-13 item scale. Independent-samples t-Test and Logistic regression were used in the statistical analyses. Potential confounders were identified using a Directed Acyclic Graph. Results: Participants were 3034 adolescents aged 13–19. The mean SOC scores were higher among adolescents who answered no to each of the dependent variables than among those who answered yes (p < .05). In the regression analysis, those with higher SOC scores were less likely to report smoking experimentation, current use, daily use, and experimentation with hookah and/or other tobacco products, than those with lower SOC scores. The associations remained after controlling for sociodemographic and/or social-environmental factors. Conclusion: An inverse relationship between SOC and tobacco use was observed among Brazilian adolescent students.

Racial and Ethnic Differences in Initiation of Menthol Tobacco Smoking and Subsequent Tobacco Use in the Population Assessment of Tobacco and Health Study, Waves 1-4 (2013-2018).

Certain subpopulations in the United States are highly vulnerable to tobacco initiation and addiction, and elimination of disparities among those groups is crucial to reducing the burden of tobacco use. This study evaluated the racial and ethnic differences in smoking initiation of menthol flavored cigarettes and cigars among never-users, and in subsequent tobacco use among new users of menthol-flavored products, using longitudinal data from waves 1-4 of the Population Assessment of Tobacco and Health Study. The outcomes of interest were new use of menthol-flavored products, and subsequent past 30-day and past 12-month cigarette and cigar smoking, irrespective of flavors, after initiation. The percentages of new users of menthol-flavored cigarettes and cigars at waves 2-4 were disproportionately higher in non-Hispanic black and Hispanic than in non-Hispanic white people. Adjusting for age and sex, black people who first used any menthol cigars had higher risk of past 30-day use of the same cigar category at the subsequent wave (adjusted risk ratio, aRR 1.48; 95% confidence interval [CI] 1.11 to 1.96) and past 12 months (aRR 1.74; 95% CI 1.55 to 2.63) compared to non-Hispanic white smokers. Black people who first used menthol-flavored cigarettes had marginally higher risk of subsequent past 30-day cigarette use (aRR 1.44; 95% CI 0.99 to 2.10) compared with their non-Hispanic white counterparts. This study shows that racial and ethnic differences exist in both initiation of menthol-flavored tobacco products and product-specific subsequent use after first using menthol-flavored products; black and Hispanic people have higher rates of initiation; black people also have higher rates of subsequent use. Use of menthol flavors in tobacco products is confirmed to be a contributor to large disparities in tobacco use; black and Hispanic people are more likely to maintain smoking through use of mentholated products than non-Hispanic white people. The findings suggest educational and regulatory actions on menthol-flavored tobacco products including restricting the selective marketing to vulnerable communities and banning characterizing flavors in cigarettes and cigars may reduce tobacco-related disparities and inform the Food And Drug Administration's evidence-based rulemaking process.

Adolescent use and co-use of tobacco and cannabis in California: The roles of local policy and density of tobacco, vape, and cannabis retailers around schools

Adolescent tobacco use (particularly vaping) andco-use of cannabis and tobacco have increased, leading some jurisdictions to implement policies intended to reduce youth access to these products; however, their impacts remainunclear. We examine associations between local policy, density of tobacco, vape, and cannabis retailers around schools, and adolescent use and co-use of tobacco/vape and cannabis.We combined 2018 statewide California(US) data on: (a) jurisdiction-level policies related to tobacco and cannabis retail environments, (b) jurisdiction-level sociodemographic composition, (c) retailer locations (tobacco, vape, and cannabis shops), and (d) survey data on 534,176 middle and high school students (California Healthy Kids Survey). Structural equation models examined how local policies and retailer density near schools are associated with frequency of past 30-day cigarette smoking or vaping, cannabis use, and co-use of tobacco/vape and cannabis, controlling for jurisdiction-, school-, and individual-level confounders.Stricter retail environment policies were associated with lower odds of past-month use of tobacco/vape, cannabis, and co-use of tobacco/vape and cannabis. Stronger tobacco/vape policies were associated with higher tobacco/vape retailer density near schools, while stronger cannabis policies and overall policy strength (tobacco/vape and cannabis combined) were associated with lower cannabis and combined retailer densities (summed tobacco/vape and cannabis), respectively. Tobacco/vape shop density near schools was positively associated with tobacco/vape use odds, as was summed retailer density near schools and co-use of tobacco, cannabis.Considering jurisdiction-level tobacco and cannabis control policies are associated with adolescent use of these substances, policymakers may proactively leverage such policies to curb youth tobacco and cannabis use.

Association Between Smoking and Pain, Functional Disability, Anxiety and Depression in Patients With Chronic Low Back Pain.

Objectives: Chronic low back pain (CLBP) accounts for a majority of the disability associated with LBP, which can produce long-term negative effects. This cross-sectional study aimed to investigate the association between smoking and pain, dysfunction and psychological status in patients with CLBP. Methods: The 54 patients with CLBP were recruited and divided into smoking and non-smoking groups. Their pain, dysfunction, anxiety, depression, fear and quality of life were evaluated. The amount of cigarettes smoked daily was recorded. Results: Significant differences in VAS, ODI, RMDQ and FABQ and the impact of LBP on life and work were found between smoking and non-smoking patients. In addition, a correlation was found between the daily cigarette smoking amount and VASmax, FABQtotal, SDS and FABQ-W. Moreover, a correlation was observed between the amount of cigarettes smoked daily and the degree of impact of low back pain on work. Conclusion: The study found that smoking affected the aggravation of symptoms in patients with CLBP, which indicated that patients with CLBP and people at risk of LBP should be aware of the harm caused by smoking.

Perceived Racial/Ethnic Discrimination and Smoking Outcome Expectancies among Adult Latinx Smokers Living in the United States

Background: Smoking-related health disparities are prevalent in the Latinx community in the United States (US). Although Social Determinants of Health (SDoH) are known to contribute to a myriad of health problems among the Latinx population, there is relatively limited work expressly aimed at elucidating SDoH among Latinx smokers. Perceived racial/ethnic discrimination is one SDoH construct that may be especially relevant to understanding smoking-related cognition for Latinx smokers in the US. Smoking outcome expectancies, reflecting beliefs about the consequences of smoking, are established cognitive processes that have been linked to the maintenance and relapse of smoking. The purpose of the present work is to investigate perceived racial/ethnic discrimination in relation to smoking outcome expectancies amongst Latinx smokers in the US. Method: Participants included 338 English-speaking Latinx adult daily cigarette smokers from the US (M age = 35.5 years; SD = 8.65; age range 18–61; 37.3% female). Results: Results indicated that perceived racial/ethnic discrimination was related to greater levels of negative reinforcement, positive reinforcement, and appetite-weight control expectancies, but not negative consequences expectancies. Discussion: Overall, the current findings provide novel insight into the relationship between perceived racial/ethnic discrimination and smoking outcome expectancies amongst English-speaking Latinx cigarette users in the US.

Perceived racial/ethnic discrimination in relation to smoking abstinence expectancies among adult Latinx smokers in the United States

IntroductionHispanic/Latinx (hereafter Latinx) individuals in the United States (US) face unique smoking-related health disparities, including limited access to care and health insurance for smoking treatment. Social determinants of health (SDoH) have received increased recognition in their role of smoking behavior and cessation. However, research on SDoH in Latinx smoking populations has been limited. Past research on non-Latinx white individuals has found smoking abstinence expectancies to be an integral cognitive process related to multiple aspects of smoking behavior, and its role has also been understudied in Latinx individuals. Perceived racial/ethnic discrimination is one SDoH, but its role in relation to abstinence expectancies among Latinx smokers has not been explored. Therefore, the present investigation sought to evaluate perceived racial/ethnic discrimination in terms of smoking abstinence expectancies among Latinx smokers living in the US. MethodsParticipants included 338 English-speaking Latinx adult daily cigarette smokers (Mage = 35.5 years; SD = 8.65; age range 18–61; 37.3 % female) recruited nationally throughout the US using Qualtrics Panels. ResultsResults supported statistically significant main effects for perceived racial/ethnic discrimination in relation to increased smoking abstinence expectancies of negative mood, somatic symptoms, harmful consequences, and positive consequences (p’s < 0.001). DiscussionOverall, the results of the present investigation build from a limited body of work on perceived racial/ethnic discrimination and smoking and provide novel evidence of consistent and moderate incremental associations between perceived racial/ethnic discrimination and negative and positive smoking abstinence expectancies among Latinx smokers.

Supplemental Material for Randomized Trial of Mindfulness- and Reappraisal-Based Regulation of Craving Training Among Daily Cigarette Smokers

Supplemental Material for Randomized Trial of Mindfulness- and Reappraisal-Based Regulation of Craving Training Among Daily Cigarette Smokers

Anxiety symptoms and anxiety sensitivity in relation to cigarette dependence, perceived barriers for smoking cessation and quit problems among adult Latinx smokers

Cigarette smoking is associated with adverse physical and mental health among Latinx adults in the United States. The present investigation sought to explore the main and interactive effects of anxiety symptoms and anxiety sensitivity in relation to cigarette dependence, perceived barriers for smoking cessation, and severity of problems experienced when quitting among adult Latinx smokers. Participants included 338 Latinx adult daily cigarette smokers (M age = 35.53 years; SD = 8.65; age range 18–61; 37.3% female). Results indicated that anxiety symptoms were associated with greater cigarette dependence, severity of problems when quitting, and perceived barriers for smoking cessation (effect size range: 2%−3% of variance), whereas anxiety sensitivity was related to severity of problems when quitting and perceived barriers for smoking cessation (effect size range: 2%−3% of variance). There was also a statistically significant interaction between anxiety sensitivity and anxiety symptoms for cigarette dependence; anxiety was related to cigarette dependence for Latinx smokers with higher levels of anxiety sensitivity, but not for those with lower levels of anxiety sensitivity. Overall, the present findings indicate that anxiety symptoms and anxiety sensitivity are relevant factors for better understanding cigarette dependence, problems experienced when trying to quit, and perceptions of barriers to quitting among adult Latinx smokers.

Prevalence and correlates of roll-your-own cigarette smoking among South African adults during 2010-2011 and 2017-2018.

The increasing use of roll-your own (RYO) cigarettes has been documented globally, but there are no recent data from South Africa, particularly among youths and low-income groups. We assessed changes in prevalence and correlates of RYO smoking among South African adults during 2010-2011 and 2017-2018, and explored expenditure differences between daily smokers of RYO and manufactured cigarettes. Nationally representative data of South Africans aged ≥16 years used in this study were from the South African Social Attitudes Survey (SASAS) for 2010-2011 (n=6116), and 2017-2018 (n=5799). Current RYO cigarette use included daily and non-daily use. Annual expenditures were estimated based on typical usage patterns for daily users. Descriptive and multivariable analyses were performed using Stata Version 15 with the level of statistical significance set at p<0.05. The prevalence of ever RYO cigarette use increased from 6.5% (95% CI: 5.6-7.5) during 2010-2011, to 8.5% (95% CI: 7.0-10.0) during 2017-2018 (p=0.026). Current RYO cigarette use prevalence however remained largely unchanged when we compared 2010-2011 to 2017-2018 (5.2% vs 6.3%, p=0.544). During 2017-2018, current RYO cigarette use prevalence was highest among men (11.6%), those who self-identified as Coloreds (11.1%), people aged 25-34 years (7.8%), those with no schooling (7.5%), and those unemployed (9.8%). Annual expenditures associated with typical patterns of daily RYO cigarette smoking were substantially less than for smoking of manufactured cigarettes. The prevalence of ever RYO cigarette use increased between 2010-2011 and 2017-2018. Current RYO cigarette use during 2017-2018 was more prevalent among Coloreds, Black Africans, youths, those with lower education, and the unemployed. This study's findings highlight the need to harmonize taxation of cigarettes and RYO cigarettes, and to intensify implementation of evidence-based tobacco control and prevention interventions in South Africa.

Difficulties in emotion regulation and ad libitum smoking topography: A secondary analysis

IntroductionDespite the well-known linkages between poor emotion regulation and subjective smoking motives, little is known about the role of emotion regulation in predicting smoking reinforcement behavior. This study examined the relation between difficulties in emotion regulation and puff velocity data, a behavioral index of smoking reinforcement, in adult daily cigarette smokers. MethodThe current study was a secondary analysis of data collected from non-treatment seeking daily smokers (N = 124). Participants completed the Difficulties in Emotion Regulation Scale (DERS) followed by an ad libitum smoking period during which puff topography data was collected via a handheld puffing device. Puff velocity served as our puff topography index and was examined at the average and puff-to-puff level using regression and multi-level models, respectively. ResultsRegression analyses showed no significant association between DERS scores and average puff velocity. In contrast, multi-level modeling found a significant quadratic time × DERS effect at the puff-to-puff level, such that those with greater emotion regulation difficulties inhaled more quickly at the initiation of the cigarette, whereas those with lower emotion regulation difficulties evidenced consistent puffing over the course of the cigarette. DiscussionSmokers with greater difficulties in emotion regulation appear to smoke in a way that maximizes delivery of nicotine, perhaps to self-regulate distress. One’s style of puffing may reflect a possible behavioral marker of negative reinforcement smoking, especially in the context of emotional distress. ImplicationsThis study was the first to explore the relationship between difficulties in emotion regulation and a behavioral measure of smoking reinforcement.

Impact of the e-cigarette era on cigarette smoking among youth in the United States: A population-level study

To examine and compare trends in past 30-day cigarette smoking among adolescents in the US from 2002 to 2019, before and after the onset of the "e-cigarette era" in 2014. Using National Youth Tobacco Survey (NYTS) data from 2002 to 2019, we modeled the prevalence of past 30-day cigarette smoking over time. A total of n=274,551 (weighted N=340,403,754) middle and high school students were included in this study. Interrupted time series analyses were used to examine changes in cigarette smoking over time and compare trends in cigarette smoking pre- and post-2014. Models were applied to the full sample and stratified by middle (6th-8th grade) and high school (9th-12th grade). The observed number of current adolescent cigarette smokers post-2014 was compared to the predicted number, given trends in cigarette smoking prevalence observed pre-2014. Among all students, past 30-day cigarette smoking declined by approximately 0.75% per year from 2002 to 2013 (p<0.001). Following a significant drop in prevalence from 2013 to 2014 (1.64%; p<0.001), the decline in past 30-day cigarette smoking slowed significantly to approximately 0.37% per year (p<0.001), from 2015 to 2019. We estimate that the onset of the "e-cigarette era" in 2014 corresponded to over 1.66 million (95% CI: 1.57m - 1.75m) more past 30-day cigarette smokers from 2015 to 2019, cumulatively. The rate of decline in past 30-day cigarette smoking prevalence among adolescents observed since 2002 slowed with the onset of the "e-cigarette era" in 2014, providing evidence at a population-level for the "gateway effect."

Adaptive interventions to optimise the mobile phone-based smoking cessation support: study protocol for a sequential, multiple assignment, randomised trial (SMART)

BackgroundMobile health (mHealth) is promising in developing personalised smoking cessation interventions. By using an adaptive trial design, we aim to evaluate the effectiveness of personalised mHealth intervention in increasing smoking cessation.MethodsThis study is a two-arm, parallel, accessor-blinded Sequential Multiple-Assignment Randomised Trial (SMART) that randomises 1200 daily cigarette smokers from 70 community sites at two timepoints. In the first phase, participants receive brief cessation advice plus referral assistance to smoking cessation services and are randomly allocated to receive personalised instant messaging (PIM) or regular instant messaging (RIM). In the second phase, PIM participants who are non-responders (i.e. still smoking at 1 month) are randomised to receive either optional combined interventions (multi-media messages, nicotine replacement therapy sampling, financial incentive for active referral, phone counselling, and family/peer support group chat) or continued-PIM. Non-responders in the RIM group are randomised to receive PIM or continued-RIM. Participants who self-report quitting smoking for 7 days or longer at 1 month (responders) in both groups continue to receive the intervention assigned in phase 1. The primary outcomes are biochemical abstinence validated by exhaled carbon monoxide (< 4 ppm) and salivary cotinine (< 10 ng/ml) at 3 and 6 months from treatment initiation. Intention-to-treat analysis will be adopted.DiscussionThis is the first study using a SMART design to evaluate the effect of adaptive mHealth intervention on abstinence in community-recruited daily smokers. If found effective, the proposed intervention will inform the development of adaptive smoking cessation treatment and benefits smokers non-responding to low-intensity mHealth support.Trial registrationClinicalTrials.govNCT03992742. Registered on 20 June 2019.

Non-cigarette combustible tobacco use and its associations with subsequent cessation of smoking among daily cigarette smokers: findings from the International Tobacco Control Four Country Smoking and Vaping Surveys (2016-20).

To examine whether polyuse of cigarettes and other smoked products (polysmoking) is predictive of quit attempts and quit success. A prospective multi-country cohort design. Australia, Canada, England and the United States. A total of 3983 adult daily cigarette smokers were surveyed in 2016 (wave 1 of data collection) and were re-contacted in 2018 (wave 2) (i.e. waves 1-2 cohort) in the International Tobacco Control Four Country Smoking and Vaping (ITC 4CV) surveys; and 3736 smokers were surveyed in 2018 and re-contacted in 2020 (wave 3) (i.e. waves 2-3 cohort). Participants were asked about their cigarette smoking and use of cigars, cigarillos, pipes and waterpipes. Outcomes were quit attempts between two survey waves and success, defined as having quit smoking all the combustible tobacco at the subsequent survey for 1month or more. Levels of polysmoking were 12.7% in the waves 1-2 cohort and 10.5% for the waves 2-3 cohort. Compared with cigarette-only smokers, polysmokers were more likely to attempt to quit between waves 1 and 2 [54.9 versus 42.7%, adjusted odds ratio (aOR) = 1.37, 95% confidence interval (CI) = 1.08-1.74, P < 0.01], but not between waves 2 and 3 (43.8 versus 40.1%, aOR = 0.94, 95% CI = 0.72-1.22). Polysmoking predicted reduced likelihood of success in both cohorts among attempters and the overall samples. Between waves 2 and 3 there were significantly more transitions to non-daily smoking among the polysmokers (12.4 versus 5.3%, χ2 = 40.4, P < 0.001). There is a consistent association between polysmoking (use of cigarettes together with other smoked products) and reduced quit success for combustible tobacco, but it is probably due to increased likelihood of transitioning to non-daily use rather than complete cessation.

Differences between adults who smoke cigarettes daily and do and do not co-use cannabis: Findings from the 2020 ITC four country smoking and vaping survey

BackgroundLittle is known about population-level differences between adults who exclusively smoke cigarettes and those who smoke cigarettes and also use cannabis (co-consumers). Thus, this study describes differences on sociodemographic, cigarette-dependence, health and behavioral variables, and risk perceptions associated with smoking cannabis. MethodsThis cross-sectional study included 6941 respondents from the 2020 ITC Four Country Smoking and Vaping Survey (US, Canada, Australia, England). Adult daily cigarette smokers were included and categorized as: cigarette-only smokers (never used cannabis/previously used cannabis, but not in the past 12 months, n = 4857); occasional co-consumers (cannabis use in the past 12 months, but < weekly use, n = 739); or regular co-consumers (use cannabis ≥ weekly, n = 1345). All outcomes were self-reported. Regression models were conducted on weighted data. ResultsOverall, 19.9 % of respondents reported regular cannabis co-use and 10.1 % reported occasional co-use. Regular co-use was highest in Canada (27.2 %), followed by the US (24.4 %), England (12.7 %) and Australia (12.3 %). Compared to cigarette-only smokers, regular co-consumers were more likely to be male and report chest/breathing problems (p < 0.001). All co-consumers were more likely to be younger, have lower income, be experiencing financial stress, reside in Canada, have depressive symptoms, use alcohol more frequently and binge drink, use other tobacco/nicotine products, and perceive smoking cannabis as low health risk and less harmful than smoking cigarettes (all p < 0.001). Cigarette dependence measures were similar between co-consumers and cigarette-only smokers (all p ≥ 0.05). ConclusionsAlthough there were no differences on cigarette dependence measures between daily cigarette smokers who do and do not use cannabis, there are several other risk factors that may affect tobacco use and abstinence among co-consumers (e.g., greater depression, high-risk alcohol consumption). Thus, tobacco cessation treatment may require multi-pronged strategies to address other health behaviors. Continued surveillance is needed to determine the nature and health implications of co-use considering changing policies, markets, and products.

Reasons for using e-cigarettes and support for e-cigarette regulations: Findings from the 2020 ITC Malaysia Survey.

INTRODUCTIONMalaysia has the largest e-cigarette (EC) market in Southeast Asia, and it has been estimated that 17% of adult daily cigarette smokers also used ECs on a daily basis in 2020. However, few studies have examined the reasons people use ECs in Malaysia. This cross-sectional study of adult cigarette smokers from Malaysia assessed reasons for EC use and their support for key proposed EC regulations.METHODSData are from the 2020 International Tobacco Control (ITC) Malaysia Wave 1 Survey of adult (aged ≥18 years) smokers who reported that they used ECs at least monthly (N=459 out of 1047 smokers). Weighted analyses were conducted on EC users’ reasons for using ECs and their support for various EC regulations.RESULTSSmokers who used ECs at least monthly were more likely to be male, aged 25–39 years, of Malay ethnicity, married, more highly educated, and living in Peninsular Malaysia. Smokers who used ECs daily reported using ECs to reduce the number of cigarettes smoked (91.3%), pleasant taste (90.1%), to quit smoking (87.9%), and enjoyment (87.5%). Smokers who used ECs less than daily reported using ECs for their pleasant taste (weekly 89.4%, monthly 87.5%), curiosity (weekly 79.5%, monthly 88.8%), being offered EC by someone (weekly 76.3%, monthly 81.6%), and to reduce the number of cigarettes smoked (weekly 76.2%, monthly 77.6%). Smokers who also used ECs were most likely to support EC regulations requiring a minimum purchasing age (88.3%) and limiting nicotine concentration (79.6%), and least likely to support regulations banning EC fruit and candy flavors (27.1%).CONCLUSIONSThe most prevalent reasons for using ECs in Malaysia are comparable to those of other ITC countries, including Canada, US, England, and Australia. An understanding of use patterns of ECs, especially their interaction with cigarettes, are important in developing evidence-based regulations in Malaysia.

Quit Stage and Intervention Type Differences in the Momentary Within-Person Association Between Negative Affect and Smoking Urges.

BackgroundSmoking urges and negative affect play important roles in daily cigarette smoking and smoking lapse during a cessation attempt. Traditionally, laboratory research has considered negative affect as a potential cause of smoking urges. A deeper understanding of momentary associations between negative affect and smoking urges during a smoking cessation attempt can inform treatment development efforts. This study examined whether the within-person association between negative affect and smoking urges differed before and after a quit attempt, and by intervention type.MethodsData are from a pilot randomized controlled trial comparing 3 smoking cessation interventions. Participants were randomly assigned to: (1) a novel, smartphone-based just-in-time adaptive intervention that tailored treatment content in real-time (Smart-T2; n = 24), (2) the National Cancer Institute QuitGuide app (n = 25), or (3) a clinic-based tobacco cessation program (TTRP; n = 23) that followed Clinical Practice Guidelines. All participants received up to 12 weeks of nicotine replacement therapy and completed up to 5 assessments per day (MPreQuit= 25.8 assessments, SD = 6.0; MPostQuit= 107.7 assessments, SD = 37.1) of their negative affect and smoking urges during the 7 days (M = 6.6 days, SD = 1.0) prior to their quit-date and the 29 days (M = 25.8 days, SD = 6.4) after their quit-date. Prior to analysis, repeated measures of smoking urges were decomposed into between-person and within-person components.ResultsAfter accounting for baseline nicotine dependence, Bayesian multilevel models indicated that the extent of within-person association between negative affect and smoking urges was stronger in the post-quit stage of the intervention than the pre-quit stage. Results also indicated that in the post-quit stage of the intervention, the within-person association between negative affect and smoking urges was weaker for those in the Smart-T2 and TTRP groups compared with those in the QuitGuide group. The extent of this within-person association did not differ between those in the Smart-T2 and TTRP groups.ConclusionsThese findings offer preliminary evidence that the momentary within-person association between negative affect and smoking urges increases following a quit attempt, and that the TTRP and Smart-T2 interventions may weaken this association. Research is needed to replicate and expand upon current findings in a fully powered randomized controlled trial.Clinical Trial RegistrationClinicalTrials.gov NCT02930200; https://clinicaltrials.gov/show/NCT02930200.

Lifestyle factors and obesity in young adults - changes in the 2000s in Finland.

Young adulthood is a life stage that is vulnerable to detrimental lifestyle changes and excessive weight gain, which may have major effects on health later in life. This study aimed to examine the changes in lifestyle-related factors in the 2000s and sociodemographic differences in lifestyle in Finnish young adults. The study was based on the cross-sectional data from two representative samples of Finnish young adults aged 18-29 years from the Health 2000 Survey (n = 1894; 90% participated) and the FinHealth 2017 Study (n = 1162; 54% participated). Sociodemographic factors, lifestyle choices (smoking, alcohol consumption, intake of vegetables, physical activity), and anthropometrics were self-reported. Weighted prevalence based on predictive margins and odds ratios were analyzed using logistic regression, taking into account the sampling design and non-response. The prevalence of daily cigarette smoking decreased between the years 2000 and 2017 from 34% to 12% (p < 0.01) and from 23% to 11% (p < 0.01) in men and women, respectively. There was a decline in the prevalence of daily intake of fresh vegetables, especially in men. The prevalence of obesity (BMI ⩾ 30 kg/m2) doubled being 15% in men and 18% in women in 2017. Health-endangering lifestyles, measured by a lifestyle sum score, were more common among young adults with lower education compared to those with higher. This study showed both favorable and unfavorable changes in the lifestyles of Finnish young adults in the 2000s. Health-endangering lifestyles were more common among young adults with lower education, suggesting the need for tailored health-promoting actions. Special attention should be given to obesity prevention.

Differences between adult sexual minority females and heterosexual females on menthol smoking and other smoking behaviors: Findings from Wave 4 (2016–2018) of the population assessment of tobacco and health study

BackgroundSexual minority females have higher rates of cigarette smoking than heterosexual females. Additionally, menthol cigarette use disproportionately impacts minority smokers, including sexual minority individuals. This study examined differences between sexual minority and heterosexual females on several smoking variables, including initiation with a menthol cigarette, and past 30-day cigarette and menthol cigarette use. MethodsParticipants were female ever smokers (N = 11,576; n = 1,474, 12.7% sexual minority) who completed Wave 4 of the Population Assessment of Tobacco and Health Survey. Participants reported on the age they began smoking regularly (≤18 years old, 18–24, >25), whether they initiated with a menthol cigarette, past 30-day cigarette smoking and menthol cigarette use, cigarettes smoked per day (≤10, 11–20, >20), cigarette dependence (smoke ≤ 5 min of waking or > 5 min of waking), and whether they were a current (someday/every day) or former (no past year/current use) established smoker (≥100 lifetime cigarettes), or an experimental smoker (<100 lifetime cigarettes). Chi-square and multivariable logistic regression analyses examined differences between sexual minority females and heterosexual females on smoking variables. ResultsSexual minority female smokers began smoking regularly at an earlier age and smoked fewer cigarettes per day than heterosexual females. Sexual minority females were more likely to initiate smoking with a menthol cigarette (aOR = 1.27), report past 30-day smoking (aOR = 1.36) and menthol cigarette use (aOR = 1.24) compared to heterosexual females. There were no differences on cigarette dependence. ConclusionsGiven the high rates of initiation and current menthol smoking, policies to regulate menthol may decrease smoking disparities for sexual minority females.