Established Smokers Research Articles

Current and Former Smokers' Use of Electronic Cigarettes for Quitting Smoking: An Exploratory Study of Adolescents and Young Adults.

Background This exploratory study examines the prevalence and predictors of current and former smokers' use of electronic (e-) cigarettes for smoking cessation among a sample of adolescent and young adult established smokers. Methods We conducted school-wide surveys in two middle (n = 1166) and four high schools (n = 3614) in fall 2013 and one public college (n = 625) in spring 2014. We analyzed data from 189 established smokers (reported smoking 100 cigarettes in their lifetime) who also reported ever-use of e-cigarettes (50.7% female, 89.4% White race, Mage 18.3 [SD = 2.8]). We further classified participants as current smokers (reported past-month cigarette smoking) and former smokers (no past-month smoking). Adjusted logistic regression assessed associations of using e-cigarettes to quit smoking with demographic, cigarette and e-cigarette use patterns, e-cigarette flavor preference, and risk perception variables. Results Overall, 41.8% of the sample reported that they "have used an e-cigarette to quit smoking." In adjusted models, older age, White race, higher e-cigarette frequency, and preference for using a combination of e-cigarette flavors predicted increased odds of having used e-cigarettes to quit smoking (p < .05). Using e-cigarettes to quit smoking was not associated with current or former cigarette smoking status or perceptions that "e-cigarettes help people quit smoking" or "e-cigarettes are safer than quit smoking medications." Conclusions Adolescents and young adults who report more frequent e-cigarette use and preference for using flavor combinations are more likely to use e-cigarettes for smoking cessation. Future studies are needed to determine whether e-cigarette use leads to tobacco abstinence in youth smokers. Implications Among young established smokers, more frequent e-cigarette use and preference for using flavors mixed together, but not perceptions of harmfulness of e-cigarettes or comparative safety of e-cigarettes compared with cigarettes or other smoking cessation medications or helpfulness of e-cigarettes in quitting smoking, are associated with using e-cigarettes for smoking cessation.

A tobacco use survey among university students focusing on waterpipe use and relationship between first-tried tobacco product and becoming an established smoker

Amaç: Bu çalışmada, Yeditepe Üniversitesi öğrencilerinin, nargile odaklı olarak, tütün ürünlerini kullanma durumları ile bu konudakialgı ve tutumlarının tanımlanması amaçlanmış, ayrıca ilk denemeyi sigara veya nargileyle yapma ile kullanıcıya dönüşme arasındakiilişki incelenmiştir. Yöntem: Bu çalışma, isimsiz bir anket formunun Yeditepe Üniversitesi Tıp, Eczacılık, Diş ve Sağlık Bilimlerifakülteleri dördüncü sınıf öğrencileri tarafından doldurulmasına dayalı kesitsel bir çalışmadır. Bu fakültelerin 4. Sınıf öğrencilerinintümü (n=354) çalışmaya dahil edilmeye çalışılmış, cevaplama oranı %97,5 (n=345) olarak gerçekleşmiştir. Anket uygulaması, 2014-2015 Akademik Yılı Bahar Dönemi’nde yapılmıştır. Bulgular: Tütün ürünü halen kullanım oranı erkek öğrencilerde %53,5, kızöğrencilerde %29,7, son otuz günde en az bir kez herhangi bir tütün ürün kullanma oranı erkek ve kız öğrencilerde sırasıyla %58,6 ve%32,1 olarak bulunmuştur. Herhangi bir tütün ürününü yaşam boyu en az bir kez denemiş olma oranı erkeklerde %80,8, kızlarda %71,5(p=0,075) olarak saptanmıştır. İlk denemelerin yarısı sigara ile diğer yarısı nargile ile olmuştur. Kızlarda en çok denenen ürün nargiledir.İlk denenen ürünün sigara veya nargile olması ile kullanıcıya dönüşme arasında bir ilişki bulunamamıştır. Hangi ürün ile ilk denemesiniyapmış olursa olsunlar bir kez denemiş olanların önemli bir bölümü (erkeklerde %74, kızlarda %45, p&amp;lt;0,001) kullanıcı olaraksaptanmıştır. Halen her gün kullanan 100 öğrencinin %100’ü, ara sıra kullanan 26 öğrencinin %73’ü sigara kullanıcısıdır. Halen tütünürünü kullanan kızların en azından %69’unda, erkeklerin %55,5’inde kullanıcıya dönüşme (başlama) üniversitedeyken gerçekleşmiştir.Öğrencilerin kafeye gitme sıklığı ile tütün ürünü kullanıcısı olmaları arasında anlamlı bir ilişki saptanmıştır. Nargile içmeyi çekici kılannedenler olarak en çok, “tadı, kokusu, aroması” ve “kafede sosyal atmosfer, arkadaşlarla birliktelik” ifade edilmiştir. Sonuç:Öğrencilerde tütün salgını endişe verici düzeyde olup, üniversite yılları, başlamada önemli bir dönem olarak ortaya çıkmıştır. Nargile,ilk denemelere sigara kadar aracılık etmektedir. Bu ürünleri bir kez denemiş olanlar, ilk denemeyi hangi ürünle yapmış olurlarsa olsunlaraynı düzeyde kullanıcıya dönüşmekte ve sonunda sigara kullanıcısı olmaktadırlar.

E-cigarette Usage Is Associated With Increased Past-12-Month Quit Attempts and Successful Smoking Cessation in Two US Population-Based Surveys.

We examined past-12-month quit attempts and smoking cessation from 2006 to 2016 while accounting for demographic shifts in the US population. In addition, we sought to understand whether the current use of electronic cigarettes was associated with a change in past-12-month quit attempts and successful smoking cessation at the population level. We analyzed data from 25- to 44-year-olds from the National Health Interview Survey (NHIS) from 2006 to 2016 (N = 26,354) and the Tobacco Use Supplement to the Current Population Survey (TUS-CPS) in 2006-2007, 2010-2011, and 2014-2015 (N = 33,627). Data on e-cigarette use were available in the 2014-2016 NHIS and 2014-2015 TUS-CPS surveys. Past-12-month quit attempts and smoking cessation increased in recent years compared with 2006. Current e-cigarette use was associated with higher quit attempts (adjusted odds ratio [aOR] = 2.29, 95% confidence interval [CI] = 1.87 to 2.81, p < .001) and greater smoking cessation (aOR = 1.64, 95% CI = 1.21 to 2.21, p = .001) in the NHIS. Multivariable logistic regression of the TUS-CPS data showed that current e-cigarette use was similarly significantly associated with increased past-12-month quit attempts and smoking cessation. Significant interactions were found for smoking frequency (everyday and some-day smoking) and current e-cigarette use for both outcomes (p < .0001) with the strongest positive effects seen in everyday smokers. Compared with 2006, past-12-month quit attempts and smoking cessation increased among adults aged 25-44 in recent years. Current e-cigarette use was associated with increased past-12-month quit attempts and successful smoking cessation among established smokers. These findings are relevant to future tobacco policy decisions. E-cigarettes were introduced into the US market over the past decade. During this period, past-12-month quit attempts and smoking cessation have increased among US adults aged 25-44. These trends are inconsistent with the hypothesis that e-cigarette use is delaying quit attempts and leading to decreased smoking cessation. In contrast, current e-cigarette use was associated with significantly higher past-12-month quit attempts and past-12-month cessation. These findings suggest that e-cigarette use contributes to a reduction in combustible cigarette use among established smokers.

FDA’s ‘Real Cost’ Campaign Cuts Cigarette Smoking by Teens

Back to table of contents Previous article Next article Government NewsFull AccessFDA’s ‘Real Cost’ Campaign Cuts Cigarette Smoking by TeensLinda M. RichmondLinda M. RichmondSearch for more papers by this authorPublished Online:28 Sep 2018https://doi.org/10.1176/appi.pn.2018.10a10AbstractThe FDA’s antismoking campaign helped curtail youth use of combustible cigarettes. Meanwhile, the FDA is now grappling with an “epidemic” of e-cigarette use by middle and high schoolers.The Food and Drug Administration’s (FDA) antismoking campaign prevented nearly 350,000 youth from becoming cigarette smokers, saving the nation $31 billion in mortality, earnings loss, and other costs, according a study last month in the American Journal of Preventive Medicine. Above is an image from the FDA’s “Real Cost” anti-smoking multimedia campaign, which was aimed at adolescents and followed the adventures of “Little Lungs in a Great Big World.” It strove to drive home the message that cigarette smoking can permanently stunt lung development.FDABut while traditional cigarette smoking among youth has declined, their use of another product that delivers nicotine—e-cigarettes—has reached “epidemic proportions,” FDA Commissioner Scott Gottleib, M.D., wrote in a press release on September 18 (see box). The antismoking campaign—called The Real Cost—was launched in February 2014 and focused on preventing youth aged 12 to 17 years old from starting the use of traditional, combustible cigarettes. Campaign ads appeared on national television and radio stations and the Internet, as well as in magazines and on movie theater screens, with the central theme of “Every cigarette costs you something.” Its first three years of advertising focused on the cosmetic effects of smoking, the loss of control caused by addiction, and the dangerousness of the toxic mix of chemicals in cigarette smoke.The study examined the campaign’s cost-effectiveness during its first two years, for which the FDA had spent nearly $247 million. Among youth who had never smoked a cigarette, those with high exposure to The Real Cost campaign were 30 percent less likely to start, another study found. The campaign was associated with preventing about 350,000 youth aged 11 to 18 years from starting smoking; about half of youth who initiate smoking become established adult smokers, so the campaign was estimated to have prevented nearly 176,000 youth from becoming established adult smokers, the study found.The authors determined that the total lifetime costs to society for each smoker who begins at age 15 is more than $180,000, according to Anna J. MacMonegle, M.A., research public health analyst at RTI International, and colleagues. The greatest costs, in order, included the cost of the smoker’s mortality, the smoker’s spouse’s mortality (due to secondhand smoke), loss in the smoker’s earnings, the cost of the smoker’s disability, and the cost of the cigarettes.Ultimately, the campaign resulted in an overall return on investment of $128 for every $1 spent, for a cost savings of $31 billion. “This value represents a large reduction in the financial burden to individuals, their families, and society as a result of tobacco use,” the authors wrote. “Public health campaigns like The Real Cost reduce the burden of tobacco-related morbidity and mortality for a generation of U.S. youth. The findings suggest that these interventions not only markedly improve public health outcomes, but they also provide substantial cost savings.” ■“The Cost-Effectiveness Analysis of The Real Cost Campaign’s Effect on Smoking Prevention” can be accessed here. See related article: E-Cigarette Use Rising Sharply. ISSUES NewArchived

Cost-Effectiveness Analysis of The Real Cost Campaign's Effect on Smoking Prevention

A previous study found that the Food and Drug Administration's The Real Cost national tobacco education campaign was associated with preventing approximately 350,000 U.S. youth from initiating smoking between 2014 and 2016. This study translates the reduction in smoking initiation into monetary terms by examining the cost effectiveness of the campaign. The cost effectiveness of The Real Cost was assessed by measuring efficiency in two ways: (1) estimating the cost per quality-adjusted life year saved and (2) estimating the total monetary return on investment by comparing the cost savings associated with the campaign to campaign expenditures. Analyses were conducted in 2017. The Real Cost averted an estimated 175,941 youth from becoming established smokers between 2014 and 2016. Campaign expenditures totaled $246,915,233. The cost per quality-adjusted life year saved of the campaign was $1,337. When considering the costs of smoking, the averted established smokers represent >$31 billion in cost savings ($1.3 billion when only external costs considered). The overall return on investment of the campaign was $128 in cost savings for every $1 spent ($4 for every $1 spent when only external costs considered). These conclusions were robust to sensitivity analyses surrounding the parameters. Campaign expenditures were cost efficient. The cost savings resulting from The Real Cost represent a large reduction in the financial burden to individuals, their families, and society as a result of tobacco. Public health campaigns, like The Real Cost, that reduce tobacco-related morbidity and mortality for a generation of U.S. youth also provide substantial cost savings.

Nicotine Reduction Strategy: State of the science and challenges to tobacco control policy and FDA tobacco product regulation

Nicotine addiction is the proximate cause of disease and death from cigarette smoking. In 1994, we proposed reducing the nicotine content of cigarettes to non-addicting levels to reduce the risk of youth becoming addicted smokers and promoting quitting in established smokers. In 2009, the Family Smoking Prevention and Tobacco Control Act provided the authority to FDA to reduce nicotine levels as appropriate to benefit public health. Over the past 15 years, considerable research has determined that nicotine reduction is feasible and safe, resulting in reduced nicotine dependence with little evidence of compensatory over-smoking. The availability of acceptable non-combusted form of nicotine would provide support and enhance acceptability of nicotine reduction in tobacco. Most recently, the FDA promulgated a nicotine-based regulatory framework, which includes nicotine reduction combined with ready availability of noncombustible nicotine products. Nicotine reduction could contribute to a virtual end to the use of cigarette smoking, with enormous benefits to public health.

Rats choose high doses of nicotine in order to compensate for changes in its price and availability.

Restricting when and where smoking can occur is a major focus of public health policies in Western countries. In conjunction with increased taxation, these approaches have contributed to a reduction in smoking uptake among adolescents, yet the consequences for established smokers are less clear. In order to further explore this relationship, we developed a novel animal model of restricted nicotine self-administration. Rats were trained to choose between three doses of nicotine (15, 30 and 60 μg/kg/infusion) under conditions where nicotine was (1) freely available at a low cost (20-second post-infusion time-out, fixed-ratio 1 [FR1]), (2) available under restricted access at a low cost (300-second post-infusion time-out, FR1), or (3) freely available at a high cost (20-second post-infusion time-out, FR5). We demonstrate that as access to nicotine is restricted or when cost increases, rats compensate for these changes by increasing their intake of the highest dose of nicotine available. This preference was impervious to treatment with the smoking cessation medication varenicline, but was reduced when the cost of the highest dose only was increased, or when nicotine was again made freely available at a low cost. These results provide the first evidence in rats that nicotine availability and cost influence nicotine choice independently of variations in nicotine and context exposure. They imply that established smokers may compensate for changes in the availability and cost of tobacco by increasing their rate of smoking when they are free to do so.

Tailored Versus Generic Knowledge Brokering to Integrate Mood Management Into Smoking Cessation Interventions in Primary Care Settings: Protocol for a Cluster Randomized Controlled Trial.

BackgroundBoth tobacco smoking and depression are major public health problems associated with high morbidity and mortality. In addition, individuals with depression are almost twice as likely to smoke and less likely to achieve smoking cessation. In the Smoking Treatment for Ontario Patients program, an established smoking cessation program in Ontario, Canada, 38% of smokers in primary care settings have current or past depression with 6-month quit rates that are significantly lower than those without depression (33% versus 40%, P<.001). Integrating self-help mood management (eg, relaxation exercises and mood monitoring) with smoking cessation treatment increases long-term quit rates by 12%-20%. However, integration in real-world settings has not been reported. It is unclear which knowledge translation strategy would be more effective for motivating clinicians to provide resources on mood management to eligible patients.ObjectiveThe objectives of this study are to investigate the following comparisons among depressed smokers enrolled in a smoking cessation program: 1) the effectiveness of generalized, exclusively email-based prompts versus a personalized knowledge broker in implementing mood management interventions; 2) the effectiveness of the two knowledge translation strategies on smoking quit rates; and 3) the incremental costs of the two knowledge translation strategies on the implementation of mood management interventions.MethodsThe study design is a cluster randomized controlled trial of Family Health Teams participating in the Smoking Treatment for Ontario Patients program. Family Health Teams will be randomly allocated 1:1 to receive either generalized messages (related to depression and smoking) exclusively via email (group A) or be assigned a knowledge broker who provides personalized support through phone- and email-based check-ins (group B). The primary outcome, measured at the site level, is the proportion of eligible baseline visits that result in the provision of the mood management intervention to eligible patients.ResultsRecruitment for the primary outcome of this study will be completed in 2018/2019. Results will be reported in 2019/2020.ConclusionsThis study will address the knowledge gap in the implementation strategies (ie, email-based prompts versus a knowledge broker) of mood management interventions for smokers with depression in primary care settings.Trial RegistrationClinicalTrials.gov NCT03130998; https://clinicaltrials.gov/ct2/show/NCT03130998 (Archived on WebCite at www.webcitation.org/6ylyS6RTe)

Electronic Cigarette Use and Progression From Experimentation to Established Smoking.

It has been shown that never-smoking adolescents who try electronic cigarettes (e-cigarettes) are at increased risk of subsequent conventional cigarette smoking. We evaluated associations between e-cigarette use and progression to established smoking among adolescents who had already tried cigarettes. Among participants (age 12-17 years) in the nationally representative Population Assessment of Tobacco and Health survey who had smoked a cigarette (≥1 puff) but not yet smoked 100 cigarettes (N = 1295), we examined 3 outcomes at 1-year follow-up as a function of baseline e-cigarette use: (1) having smoked ≥100 cigarettes (established smoking), (2) smoking during the past 30 days, and (3) both having smoked ≥100 cigarettes and past 30-day smoking (current established smoking). Survey-weighted multivariable logistic regression models were fitted to obtain odds ratios (ORs) and 95% confidence intervals (CIs) adjusted for smoking risk factors. Versus e-cigarette never use, having ever used e-cigarettes was positively associated with progression to established cigarette smoking (19.3% vs 9.7%), past 30-day smoking (38.8% vs 26.6%), and current established smoking (15.6% vs 7.1%). In adjusted models, e-cigarette ever use positively predicted current established smoking (OR: 1.80; 95% CI: 1.04-3.12) but did not reach statistical significance (α = .05) for established smoking (OR: 1.57; 95% CI: 0.99-2.49) and past 30-day smoking (OR: 1.32; 95% CI: 0.99-1.76). Among adolescent cigarette experimenters, using e-cigarettes was positively and independently associated with progression to current established smoking, suggesting that e-cigarettes do not divert from, and may encourage, cigarette smoking in this population.

Content analysis of homeless smokers’ perspectives on established and alternative smoking interventions

BackgroundCigarette smoking is 5 times more prevalent among homeless individuals than in the general population, and homeless individuals are disproportionately affected by smoking-related morbidity and mortality. Homeless smokers report interest in changing their smoking behavior; however, established smoking cessation interventions are neither desirable to nor highly effective for most members of this population. The aim of this study was to document homeless smokers’ perceptions of established smoking interventions as well as self-generated, alternative smoking interventions to elucidate points for intervention enhancement. MethodsParticipants (N=25) were homeless smokers who responded to semistructured interviews regarding smoking and nicotine use as well as experiences with established and alternative smoking interventions. Conventional content analysis was used to organize data and identify themes. ResultsParticipants appreciated providers’ initiation of conversations about smoking. They did not, however, feel simple advice to quit was a helpful approach. Instead, they suggested providers use a nonjudgmental, compassionate style, offer more support, and discuss a broader menu of options, including nonabstinence-based ways to reduce smoking-related harm and improve health-related quality of life. Most participants preferred engaging in their own self-defined, alternative smoking interventions, including obtaining nicotine more safely (e.g., vaping, using smokeless tobacco) and using behavioral (e.g., engaging in creative activities and hobbies) and cognitive strategies (e.g., reminding themselves about the positive aspects of not smoking and the negative consequences of smoking). Abrupt, unaided quit attempts were largely unsuccessful. ConclusionsThe vast majority of participants with the lived experience of homelessness and smoking were uninterested in established smoking cessation approaches. They did, however, have creative ideas about alternative smoking interventions that providers may support to reduce smoking-related harm and enhance quality of life. These ideas included providing information about the relative risks of smoking and the relative benefits of alternative strategies to obtaining nicotine and avoiding smoking.

Nicotine dependence, internalizing symptoms, mood variability and daily tobacco use among young adult smokers

IntroductionCigarette use among young adults continues to rise. As young adults transition to college and assume other adult roles and responsibilities, they are at risk for the development of mental health problems and for the progression of substance use problems. Previous studies suggest that individual differences in negative and positive mood contribute to cigarette use in established college-aged smokers, but less is known whether fluctuations in mood influence daily cigarette use, controlling for trait levels of internalizing symptoms and nicotine dependence. MethodsData for this study came from a sample of college students (N=39, 59% female, mean age 20.4years) who reported regular cigarette use and participated in a 21-day ecological momentary assessment (EMA) study assessing within-individual variation in cigarette use and mood. ResultsA three-level hierarchical linear model accounting for the structure of 1896 occasions of cigarette use nested within days and individuals indicated that within-individual variability in positive mood was associated with cigarette use at each occasion, after taking into account baseline levels of nicotine dependence and internalizing problems. ConclusionsDaily shifts in positive moods are importantly associated with consuming cigarettes throughout the day.

US Adult Cigar Smoking Patterns, Purchasing Behaviors, and Reasons for Use According to Cigar Type: Findings From the Population Assessment of Tobacco and Health (PATH) Study, 2013-2014.

The US cigar market is diverse, yet until recently most research studies and tobacco surveillance systems have not reported behavioral and related outcomes by cigar type. The 2013-2014 Population Assessment of Tobacco and Health Study collected data separately for filtered cigars (FCs), cigarillos, and traditional cigars, which were further distinguished as premium or nonpremium. Descriptive statistics for adult established current smokers of each cigar type and cigarettes were calculated for demographic characteristics, tobacco use patterns, purchasing behaviors and reasons for use. Adjusted prevalence ratios (APRs) using a marginal predictions approach with logistic regression assessed correlates of dual cigar and cigarette smoking. Age, sex, race/ethnicity, education level, and poverty status of smokers varied according to cigar type. Daily cigar smoking prevalence and number of cigars smoked per day were higher for FCs (37.3%; median: 1.6 cigars/day, respectively), than all other cigar types (6.7%-25.3%, all p < .01; 0.1-0.4 cigars/day, all p < .01, respectively); daily smoking and cigars per day were similar for nonpremium cigars and cigarillos (p = .11; p = .33, respectively). Cigarette smoking was twice as common among smokers of nonpremium cigars, cigarillos, and FCs (58.0%-66.0%) than among premium cigars (29.9%). Among current cigar smokers, FC smokers (APR = 1.23, 95% confidence interval [CI] = 1.09-1.39), other tobacco product users (APR = 1.27, 95% CI = 1.15-1.41), and those with a GED/high school diploma or less (APR = 1.20, 95% CI = 1.09-1.33) were more likely to also smoke cigarettes. User characteristics, cigar smoking patterns, and dual smoking with cigarettes varied by cigar type highlighting the importance of adequately describing the cigar type studied and, where appropriate, differentiating results by cigar type. Despite the diversity of the cigar market place, historically many research studies and tobacco surveillance systems have treated cigars as a single product type. This study describes similarities and differences in the user characteristics, tobacco use patterns, and purchasing behaviors of premium, nonpremium, cigarillo, and filtered cigar smokers. To enhance tobacco regulatory science, sufficient descriptions of the cigar type(s) studied and, where appropriate, differentiation of the particular cigar type(s) studied should be undertaken to improve the interpretation of study findings, understanding of cigar use patterns and related behaviors and future approaches to reducing cigar-attributable morbidity and mortality.

Adult interest in using a hypothetical modified risk tobacco product: findings from wave 1 of the Population Assessment of Tobacco and Health Study (2013–14)

The US Family Smoking Prevention and Tobacco Control Act provides a pathway for manufacturers to market a modified risk tobacco product (MRTP). This study examines socio-demographic and tobacco use correlates of interest in a hypothetical MRTP in a nationally representative sample of US adults. Cross sectional wave 1 data from the 2013-14 Population Assessment of Tobacco and Health (PATH) Study. Household Audio-Computer Assisted Self-Interviews of US adults conducted in 2013-14. A total of 32 320 civilian, non-institutionalized adults in the United States. Interest in using a hypothetical MRTP ('If a tobacco product made a claim that it was less harmful to health than other tobacco products, how likely would you be to use that product?'), socio-demographics, tobacco use history and mental health and substance use problems. All estimates were weighted. Overall, 16.7% [95% confidence interval (CI)=16.28, 17.18] of US adults reported interest in a hypothetical MRTP. Tobacco use was associated significantly with interest in a hypothetical MRTP, with interest most common among current established smokers (54.4%; 95% CI=53.31, 55.39) and least common among never tobacco users (3.0%; 95% CI=2.49, 3.55). Interest in a hypothetical MRTP was associated with experimental e-cigarette use among current experimental, current established and former smokers. Among non-smokers, race, age, education and substance use were associated with interest in using a hypothetical MRTP. Among adults in the United States, interest in using a hypothetical modified risk tobacco product is low overall, and highest among current experimental and established smokers. A small percentage of non-smokers are interested in using a hypothetical hypothetical modified risk tobacco product.

Patterns of Use of Smokeless Tobacco in US Adults, 2013-2014.

To examine patterns of smokeless tobacco (SLT) use, by type, in wave 1 (2013-2014) of the Population Assessment of Tobacco and Health Study in the United States. We analyzed data from 32 320 adults (aged ≥ 18 years) to assess the use of pouched snus and other SLT products (loose snus, moist snuff, dip, spit, and chewing tobacco). Overall, SLT use was most common among men, younger adults, non-Hispanic Whites, and nonurban respondents. Pouched snus users were more likely to report nondaily and polytobacco use than users of other SLT products. Respondents who used SLT some days were more likely to be current established cigarette smokers than those who used SLT every day (57.9% vs 20.2%). Furthermore, current established smokers who used SLT some days were more likely to smoke every day and had a higher median number of cigarettes smoked per day than smokers who used SLT every day. Polytobacco use, especially cigarette smoking, is common among SLT users. Pouched snus users are more likely to report nondaily snus use and polytobacco use than users of other SLT products.

Abstract 2283: Population-level relevance of lifestyle-related risk factors for pancreatic cancer in Australia

Abstract Aim: To estimate the proportion of exocrine pancreatic cancers in Australia that can be attributed to the established risk factors, smoking and excess body weight, and the suggested risk factors, excessive alcohol consumption and excessive red and processed meat consumption. Methods: The proportion of pancreatic cancers attributable to lifestyle-related risk factors was quantified using the Population Attributable Fraction (PAF) which combines estimates of the strength of the exposure-cancer association and the exposure prevalence in the population. The study population included seven Australian cohort studies (N=367,772) with comprehensive data on exposure to lifestyle-related risk factors and long-term follow-up. Pancreatic cancer incidence and all-cause mortality were identified through linkage with the Australian Cancer Database and National Death Index, respectively. A proportional hazards model was used to estimate the strength of exposure-cancer and exposure-death associations adjusting for age, sex and other lifestyle exposures. The age- and sex-specific exposure prevalence was calculated from the Australian National Health Survey (NHS) 2011-2012 except for red and processed meat consumption which was not available and was calculated from the latest 45 and Up study. A newly developed method that takes into account the competing risk of death was used to produce PAF estimates and their 95% confidence intervals (CIs). Results: During the first 10-years follow-up to incidence of pancreatic cancer, death or end of follow-up, there were 21,541 deaths and 613 incident exocrine pancreatic cancers. 10% (CI = 1-17%) of pancreatic cancers in Australia could be attributed to current or past smoking. Current smoking explained 8% (CI = 4-13%) of pancreatic cancers. Using cancer incidence projections estimated by the Australian Institute of Health and Welfare, a PAF of 8% translates to 2,700 potentially preventable pancreatic cancers over the next 10 years. The PAF results for excess body weight (≥ 25 kg/m2), excessive alcohol consumption (&amp;gt; 2 drinks/day) and excessive red and processed meat consumption (≥ 4 times/week) were not statistically significant. Conclusion: According to the first pancreatic cancer PAF results from cohort studies, and accounting for competing risk of death, smoking control could reduce the number of pancreatic cancers by one tenth. Further PAF studies should include confidence intervals for the estimates to allow an evaluation of their significance. Citation Format: Maria E. Arriaga, Maarit A. Laaksonen, Karen Canfell, Robert MacInnis, Emily Banks, Graham Giles, Paul Mitchell, Robert Cumming, Barbra-Ann Adelstein, Julie Byles, Dianna J. Magliano, Jonathan Shaw, Anne Taylor, Kay Price, Vasant Hirani, Claire M. Vajdic. Population-level relevance of lifestyle-related risk factors for pancreatic cancer in Australia [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 2283. doi:10.1158/1538-7445.AM2017-2283

A SYSTEMATIC REVIEW OF MENDELIAN RANDOMIZATION STUDIES INVESTIGATING CAUSAL ASSOCIATIONS BETWEEN RISK FACTORS AND DEMENTIA

Very little is known about the causal nature of the associations between established risk factors, e.g. education and smoking and dementia risk. We have therefore conducted a systematic review of Mendelian randomization (MR) studies investigating causal links between risk factors and dementia or dementia-related outcomes. We searched five databases from inception to March 2016 using a search strategy including subject headings and free text terms relevant to dementia, cognition and MR. Forward and backward citation searches of included publications were also conducted. We included MR studies investigating the association between any risk factor and global cognitive function, all-cause dementia or dementia subtypes, excluding non-genetic studies, genetic studies other than MR and animal studies. Two reviewers independently screened titles and abstracts, reviewed full-texts and assessed the quality of included studies. Fourteen MR studies investigating a variety of risk factors (education, lifestyle factors, cardiovascular factors and related biomarkers, diabetes related and other endocrine factors, and telomere length) and dementia-related outcomes met our inclusion criteria. Most studies received an overall rating of good quality, however sample size and statistical power were rated low in half of the studies. Shorter telomeres were causally associated with an increased risk of Alzheimer's disease (AD, odds ratio per standard deviation decrease of telomere length = 1.36 (1.12, 1.67), p = 0.002). There was also some suggestion of a causal association with smoking quantity and metabolic risk factors including systolic blood pressure, fasting glucose, insulin sensitivity and high-density lipoprotein cholesterol. Causal associations between several risk factors and dementia-related outcomes were investigated in one study only. Moreover, survival and diagnostic bias or pleiotropic effects cannot be excluded. There was convincing genetic evidence to support a causal association between telomere length and AD. Inconclusive evidence for other risk factors or tentative evidence for smoking quantity and selected metabolic markers may result from insufficient statistical power. Further well designed MR studies are needed to investigate the causality of the associations between risk factors and dementia where randomised controlled trials are unethical or impractical.

Beyond experimentation: Five trajectories of cigarette smoking in a longitudinal sample of youth.

The first goal of this study was to identify the most appropriate measure of cigarette smoking for identifying unique smoking trajectories among adolescents; the second goal was to describe the resulting trajectories and their characteristics. Using 15 annual waves of smoking data in the National Longitudinal Survey of Youth 1997 (NLSY97), we conducted an exploratory latent class growth analysis to determine the best of four outcome variables for yearly smoking (cigarettes per day on days smoked, days smoked per month, mean cigarettes per day, and total cigarettes per month) among individuals aged 12 to 30 (n = 8,791). Days smoked per month was the best outcome variable for identifying unique longitudinal trajectories of smoking and characteristics of these trajectories that could be used to target different types of smokers for prevention and cessation. Objective statistics were used to identify four trajectories in addition to never smokers (34.1%): experimenters (13.6%), quitters (8.1%), early established smokers (39.0%), and late escalators (5.2%). We identified a quitter and late escalator class not identified in the only other comparable latent class growth analysis. Logistic regressions were used to identify the characteristics of individuals in each trajectory. Compared with never smokers, all trajectories except late escalators were less likely to be black; experimenters were more likely to be out of school and unemployed and drink alcohol in adolescence; quitters were more likely to have a mother with a high school degree/GED or higher (versus none) and to use substances in adolescence and less likely to have ever married as a young adult; early established smokers were more likely to have a mother with a high school diploma or GED, be out of school and unemployed, not live with both parents, have used substances, be depressed, and have peers who smoked in adolescence and to have children as young adults and less likely to be Hispanic and to have ever married as young adults; and late escalators were more likely to be Hispanic, drink alcohol, and break rules in adolescence and less likely to have ever married as young adults. Because of the number of waves of data analyzed, this analysis provided a clearer temporal depiction of smoking behavior and more easily distinguishable smoking trajectories than previous analyses. Tobacco control interventions need to move beyond youth-focused approaches to reach all smokers.

A pilot study of the gingival response when smokers switch from smoking to vaping.

Introduction Tobacco smoking is one of the most important risk factors for periodontitis as it alters the host response to plaque. Although the prevalence of tobacco smoking has declined in recent years, the use of electronic-cigarettes (vaping) has increased. The effect of vaping on the gingiva is unknown and an evidence-base needs to be established before providing dental advice about the use of these products.Objective To compare the gingival health of a group of established smokers before and after substituting vaping for smoking tobacco.Design Pilot.Setting Guy's Dental Hospital (England) from April-December 2015.Materials and methods Twenty established smokers (all staff members at Guy's Hospital) with mild periodontal disease replaced their regular smoking habits with the use of e-cigarettes for two weeks.Main outcome measure The primary outcome measure of gingival inflammation was bleeding on probing. Levels of selected pro-inflammatory cytokines in GCF, saliva and serum samples were also determined.Results and conclusions There was a statistically significant increase in gingival inflammation when tobacco smokers switched from smoking to vaping for two weeks. However, this result must be interpreted with extreme caution since this is only a pilot study. Nonetheless, this study should provide a stepping stone to encourage further investigation of the effects of vaping on periodontal health.

Smoking status, dental visits and receipt of tobacco counseling in dental office among mobile and trailer home adolescents.

BackgroundMobile and trailer home (MTHs) residents are an understudied group. In this study we determined the cigarette smoking status, dental visits in the past 12 months, and receipt of tobacco counseling in adolescents living in MTHs compared to adolescents living in other types of housing.MethodsFor this secondary data analysis study, we used data of adolescents aged 10 to 19 years (n = 74,890) from the 2012 Florida Youth Tobacco Survey (FYTS). Weighted multiple logistic regression model was conducted to understand the differences between adolescents living in MTHs compared to those living in other types of housing.ResultsApproximately 6 % of the sample reported living in MTHs. The regression model showed that older (p < 0.0001), female (p = 0.0091), and middle school (p < 0.0001) adolescents were more likely, and those who identified as Asians (p = 0.0006), Black/African Americans (p < 0.0001), and Hispanics (p < 0.0001) were less likely to be living in MTHs compared to their counterparts. Current established smokers (p < 0.0001) and non-established smokers (p < 0.0001) were more likely to report living in MTHs compared to non-smokers. Those reporting to have not visited a dental office (p < 0.0001) were more likely to be living in MTHs. Those who visited a dental office but not received any tobacco counseling (p < 0.0001) were less likely to be living in MTHs compared to their counterparts.ConclusionsCurrent cigarette smokers and those not visiting a dental office were more likely to be MTH adolescents. Adolescents reporting to have received tobacco counseling in a dental office were more likely to be living in MTHs.

E-cigarettes, a safer alternative for teenagers? A UK focus group study of teenagers' views

ObjectiveConcerns exist that e-cigarettes may be a gateway to traditional cigarettes and/or (re)normalise teenage smoking. This qualitative study explores how teenagers in the UK currently perceive e-cigarettes and how and...