Future Cigarette Research Articles

Harm Reduction or Harm Introduction? Prevalence and Correlates of E-Cigarette Use Among French Adolescents

PurposeElectronic cigarettes are marketed as a tool to give up or reduce cigarette smoking, and their use has risen sharply in recent years. There is concern that use is increasing particularly among adolescents and that they are not being used as a cessation tool but as a novel experience in their own right. MethodsThe present research assessed prevalence and sociodemographic correlates of e-cigarette use and standard cigarette use and also explored the extent to which e-cigarettes appear to be used as a cessation tool. This was assessed using a questionnaire administered to 1,486 French adolescents aged 16 years. ResultsPrevalence of e-cigarette experimentation was high (54%) and comparable to that for standard cigarettes (55%). Furthermore, 20% of those who had experimented with e-cigarettes had never tried standard cigarettes, and among regular smokers of standard cigarettes, intentions to quit were not associated with e-cigarette usage frequency. Experimentation with both e-cigarettes and standard cigarettes was significantly predicted by higher age, higher socioeconomic status, and parental smoking of standard cigarettes (in particular the father). Being male marginally predicted e-cigarette use, whereas being female significantly predicted standard cigarette use. ConclusionsThese findings give cause for concern: e-cigarette usage experimentation is extremely high, and is not associated with attempts to quit smoking standard cigarettes. Rather, it is exposing adolescents to a highly addictive drug (nicotine) and may pave the way for a future cigarette habit.

Hiding the tobacco power wall reduces cigarette smoking risk in adolescents: using an experimental convenience store to assess tobacco regulatory options at retail point-of-sale

ObjectivesThis experiment tested whether changing the location or visibility of the tobacco power wall in a life sized replica of a convenience store had any effect on adolescents’ susceptibility to...

Modeling the Health Effects of Expanding e-Cigarette Sales in the United States and United Kingdom: A Monte Carlo Analysis.

The prevalence of electronic cigarette (e-cigarette) use is increasing. Population health effects will depend on cigarette smoking behaviors, levels of dual use with conventional cigarettes, and e-cigarette toxicity. To evaluate potential health effects of various scenarios of increasing promotion and use of e-cigarettes. A base case model was developed using data on actual cigarette and e-cigarette use patterns that quantifies transitions from an initial state of no cigarette or e-cigarette use to 1 of 5 final states: never use of cigarettes or e-cigarettes, cigarette use, e-cigarette use, dual use of cigarettes and e-cigarettes, or quit. Seven scenarios were created that cover a range of use patterns, depending on how the e-cigarette market might develop, as well as a range of possible long-term health effects of e-cigarette use. Scenarios for changes from the base case were evaluated using Monte Carlo simulations. Separate sets of base case model parameters were evaluated for the US and UK populations. We assigned unitless health "costs" for each final state on a scale of 0 to 100. Population health "costs" were compared with the base case (status quo) assuming e-cigarette use health "costs" from 1% to 50% as dangerous as conventional cigarette use health costs. Compared with the base case, a harm reduction scenario in which e-cigarette use increases only among smokers who are interested in quitting with more quit attempts and no increased initiation of e-cigarette use among nonsmokers, and another scenario in which e-cigarettes are taken up only by youth who would have smoked conventional cigarettes, had population-level health benefits regardless of e-cigarette health costs in both the United States and United Kingdom. Conversely, scenarios in which e-cigarette promotion leads to renormalization of cigarette smoking or e-cigarettes are used primarily by youth who never would have smoked showed net health harms across all e-cigarette health costs. In other scenarios, the net health effect varied on the basis of the health cost of e-cigarettes. According to this analysis, widespread promotion of e-cigarettes may have a wide range of population-level health effects, depending on both e-cigarette health risks and patterns of use. Absent the primary effect of e-cigarette promotion being only to divert current or future conventional cigarette smokers to e-cigarette use, the current uncertainty about the health risks of e-cigarettes, increasing e-cigarette use among youth, and the varying health effects at different e-cigarette health costs suggest a potential for harm.

E-cigarette use and willingness to smoke: a sample of adolescent non-smokers

ObjectiveThere is little evidence on the consequences of using electronic cigarettes (e-cigarette) in adolescence. With a multiethnic sample of non-smokers, we assessed the relation between e-cigarette use and social-cognitive factors...

The Impact of Trying Electronic Cigarettes on Cigarette Smoking by College Students: A Prospective Analysis.

We assessed the impact of trying electronic cigarettes (e-cigarettes) on future cigarette smoking in a sample of smokers enrolled in college. In this longitudinal study, first-semester college students at 7 colleges in North Carolina and 4 in Virginia completed a baseline survey and 5 follow-up surveys between fall 2010 and fall 2013. Current cigarette smoking at wave 6 was the primary outcome. Participants (n = 271) reported current cigarette smoking at baseline and no history of e-cigarette use. We measured trying e-cigarettes at each wave, defined as use in the past 6 months. By wave 5, 43.5% had tried e-cigarettes. Even after controlling for other variables associated with cigarette smoking, trying e-cigarettes was a significant predictor of cigarette smoking at wave 6 (adjusted odds ratio [AOR] = 2.48; 95% confidence interval [CI] = 1.32, 4.66), as were friends' cigarette smoking (AOR = 4.20; 95% CI = 2.22, 7.96) and lifetime use of other tobacco products (AOR = 1.63; 95% CI = 1.22, 2.17). Trying e-cigarettes during college did not deter cigarette smoking and may have contributed to continued smoking.

Modeling the potential effects of new tobacco products and policies: a dynamic population model for multiple product use and harm.

BackgroundRecent declines in US cigarette smoking prevalence have coincided with increases in use of other tobacco products. Multiple product tobacco models can help assess the population health impacts associated with use of a wide range of tobacco products.Methods and FindingsWe present a multi-state, dynamical systems population structure model that can be used to assess the effects of tobacco product use behaviors on population health. The model incorporates transition behaviors, such as initiation, cessation, switching, and dual use, related to the use of multiple products. The model tracks product use prevalence and mortality attributable to tobacco use for the overall population and by sex and age group. The model can also be used to estimate differences in these outcomes between scenarios by varying input parameter values. We demonstrate model capabilities by projecting future cigarette smoking prevalence and smoking-attributable mortality and then simulating the effects of introduction of a hypothetical new lower-risk tobacco product under a variety of assumptions about product use. Sensitivity analyses were conducted to examine the range of population impacts that could occur due to differences in input values for product use and risk. We demonstrate that potential benefits from cigarette smokers switching to the lower-risk product can be offset over time through increased initiation of this product. Model results show that population health benefits are particularly sensitive to product risks and initiation, switching, and dual use behaviors.ConclusionOur model incorporates the variety of tobacco use behaviors and risks that occur with multiple products. As such, it can evaluate the population health impacts associated with the introduction of new tobacco products or policies that may result in product switching or dual use. Further model development will include refinement of data inputs for non-cigarette tobacco products and inclusion of health outcomes such as morbidity and disability.

Relative Effects of Social Self-Control, Sensation Seeking, and Impulsivity on Future Cigarette Use in a Sample of High-Risk Adolescents

We used confirmatory factor analysis to compare convergence/divergence across self-report measures of social self-control, sensation seeking, and impulsivity in a sample of high-risk adolescents. In addition, we tested baseline social self-control as a predictor of cigarette use one year later, controlling for baseline cigarette use, impulsivity/sensation seeking, and demographic variables. Data were collected in 2004–2005 from 821 adolescents (M age = 16.3; SD = 1.36) enrolled in 14 continuation high schools in Southern California. Of the baseline sample, 566 students participated in a follow-up survey one year later. Results indicated that social self-control represents a unique dimension of self-control and is a salient predictor of future cigarette use.

Adolescent Internet use and its relationship to cigarette smoking and alcohol use: A prospective cohort study

The present study aims to investigate the longitudinal impact of situational Internet use on future cigarette smoking and alcohol use among male and female adolescents. A Northern Taiwanese cohort sample of adolescents with no prior use of cigarettes (n=1445) or alcohol (n=1468) was surveyed at age 16 and again 4years later. Information regarding where, why, and length of time spent using the Internet was gathered from the 16-year-old participants. Outcome information regarding cigarette/alcohol use was gathered via a follow-up questionnaire at age 20. Multivariate regressions were used to incorporate peer, individual and family characteristics as measured at age 16 and create models of future cigarette and alcohol use at age 20. The analyses demonstrated that adolescent Internet use, particularly where such use took place, has a significant impact on future cigarette smoking and alcohol use, adjusted for conventional factors, and its relationship differs significantly by gender. Female adolescents with Internet café use appear to be especially likely to develop these two risky behaviors. The why of Internet use is also a predictor of future cigarette smoking. Finally, time spent using the Internet is significantly related to alcohol use; greater use of the Internet is associated with higher levels of drinking. The results revealed that different risky behaviors are differentially influenced by separate components of adolescent Internet use. These findings suggest that programs aimed at promoting adolescent health could potentially benefit Taiwanese adolescents by including components related to situational Internet use and taking gender into consideration.

Limitations in the Statistical Analysis of Normalised Cigarette Smoke Analyte Yield per Milligram of Nicotine Yield

Abstract Yields of selected mainstream smoke analytes expressed per milligram of nicotine yield (nicotine ratio) and ceilings on these ratios have been proposed by WHO as part of future cigarette product regulation. This paper describes the different approaches required for precision assessment, depending on whether yields or nicotine ratios are being studied. The widely used approach of assessment of yield precision is to perform a collaborative study using a standardised method. However, for assessment of ratio precision the measurement of smoke analyte and smoke nicotine yields are often not carried out on the same set of cigarettes (unpaired) due to analytical constraints and therefore the statistical approach described in ISO 5725 is inappropriate due to the various replicate combinations. In this paper, the precision of ratios was computed with unpaired measurements for NNN and nicotine yield data for the CM6 monitor test piece and the Kentucky Reference 1R5F cigarette carried out during a collaborative study in 2011 (1). A sampling technique, based on the draw of the most representative ratios, has been used to evaluate the range of both estimated repeatability and reproducibility under the ISO smoking regime that might be expected when comparing data between different laboratories. This statistical evaluation highlighted that a robust estimate of repeatability and reproducibility could not be determined for ratios obtained with unpaired measurements, using the method defined by ISO5725-2.

Relationship of Self-Reported and Acute Stress to Smoking in Emerging Adult Smokers

In the current study, we examined subjective and objective measures of stress and their relationship to baseline and future cigarette smoking behaviors over a 1-year follow-up in young adult experimental smokers. Participants (N = 56) completed two laboratory sessions to determine subjective and objective responses to a controlled laboratory stressor versus a control task. Baseline measures included drug use and smoking histories and a self-report measure of habitual stress (i.e., daily hassles). They were re-contacted 1 year after the laboratory sessions to determine smoking status. There was wide variability in smoking trajectories, with 34% of participants increasing their smoking over the course of the year. Contrary to predictions, neither daily hassles nor stress reactivity was related to smoking at baseline or change over the year. These preliminary findings suggest that daily stress or responses to acute social stress are not strong predictors of progression in emerging adult smokers.

Health-as-a-Value, Spirituality, and Cigarette and Alcohol Use Among Russian High School Students

National estimates suggest that the prevalence of tobacco and alcohol use is higher among adolescents in Russia than among adolescents in the United States and other European countries. However, research on the psychosocial correlates of, as well as protective factors for, tobacco and alcohol use among Russian adolescents has been relatively limited. Research conducted primarily in the United States has shown that spirituality and health-as-a-value are plausible predictors of adolescent substance use. However, these constructs have not been extensively studied in regions outside the United States. In this study, we tested whether spirituality and heath-as-a-value had protective effects on past-month cigarette and alcohol use behaviors and next-year cigarette and alcohol use intentions among Russian high school students (N=354, mean age=15.7years), after controlling for known predictors of adolescent substance use such as age, gender, socioeconomic status, peer substance use, and sensation seeking. We found a significant inverse relationship between health-as-a-value and recent cigarette and alcohol use as well as future cigarette use intentions. However, we did not find a significant relationship between spirituality and any substance use variables. Implications of these findings for school-based substance use prevention are discussed.

Racial/ethnic differences in the longitudinal progression of co-occurring negative affect and cigarette use: From adolescence to young adulthood

AimsThis study examined the longitudinal progression of the co-occurrence of cigarette use and negative affect among the general population of U.S. adolescents and young adults and between racial/ethnic groups. MethodsData for this study consisted of Waves 4, 6, and 8 of the NLSY97 longitudinal study containing a nationally representative sample of U.S. adolescents and young adults. A total of 7979 adolescents (Mean age at Wave 4=17.98, SD=1.44, 49% female) were included in the analyses. To investigate the co-morbidity between negative affect and cigarette use, a latent factor of negative affect and single indicator of cigarette consumption were examined at each wave. A three wave Bivariate Autoregressive Cross-Lagged Effect Model was estimated to test the conjoint trajectory of negative affect and smoking. ResultsFor all racial/ethnic groups prior negative affect status influenced future negative affect between waves and prior negative affect was positively related to increases in smoking in subsequent waves. The longitudinal trajectory of negative affect for the three racial/ethnic groups was the same, but racial/ethnic group differences were observed in the strength of the longitudinal relationship between previous and future cigarette use. Specifically, the following racial/ethnic differences were observed, even after controlling for the effect of SES; White young adults were found to exhibit the strongest association between cigarette use in the first two waves, followed by Hispanic individuals and lastly by African Americans. In the last two waves, African American young adults were found to have the strongest association between cigarette use at the latter two waves, followed by White individuals. ConclusionsBoth negative affect and cigarette consumption influence each other during the transition between late adolescence and young adulthood but the magnitude of the associations between cigarettes use across waves differed between racial/ethnic groups. Implications for prevention and treatment programs include considering both cigarette use and negative affect as two factors that jointly impact each other and that should be targeted simultaneously.

Differential Subjective Responsiveness to a Future Cigarette Price Increase Among South Korean Youth Smokers

While higher sensitivity to tobacco price increases among younger smokers as a group has been well recognized, little information is available on heterogeneity among youth smokers. This study examined differential responsiveness to an unspecified future cigarette price increase by smoking rate. This study used a subsample of 6,187 current youth smokers derived from the 2007 Korea Youth Health Survey, an annually repeated cross-sectional survey designed to monitor adolescent health behaviors in a large nationally representative sample of middle-school and high-school students in South Korea (N = 74,698). A generalized ordered logit model was estimated to examine independent associations of self-reported responses to an unspecified future cigarette price increase with smoking rate and time since smoking initiation, after controlling for other individual and family characteristics. Higher smoking rates and longer time since smoking initiation were associated with a greater likelihood to continue smoking despite a future cigarette price increase. When these two factors were accounted for in the model, other individual characteristics were not statistically significant. Among youth smokers in South Korea, higher smoking rates were associated with lower self-reported responsiveness to a future cigarette price increase. Tobacco tax increases help prevent youth smokers from progressing to advanced stages of smoking, while certain subgroups of youth smokers, especially with nicotine dependence, may still need other effective cessation interventions.

Predictors of What Smokers Say They Will Do in Response to Future Price Increases. Findings From the International Tobacco Control (ITC) Four Country Survey

Given the impact of higher tobacco prices on smoking cessation, we studied the role of future cigarette prices on forming expectation about smoking behavior. Using a random sample of 9,058 adult cigarette smokers from the United States, Canada, Australia, and the United Kingdom collected in 2002, we examined predictors of what smokers say they will do in response to a hypothetical 50% increase in the price they paid for their last cigarette purchase. A series of regression analyses examined factors associated with intentions that have a positive impact on health, that is, intentions to quit and/or to consume fewer cigarettes. The quit and/or smoke less intentions were more pronounced among those who lived in areas with higher average cigarette prices and who paid higher prices for their brand of choice during the last purchase. The magnitude of the price increase is a more important predictor of an intention to quit/smoke less compared with the average cigarette price. The availability of alternative (cheaper) cigarette sources may reduce but would not eliminate the impact of higher prices/taxes on smokers' expected behavior that has been linked to actual quit intentions and quitting in follow-up surveys.

Are smokers rational addicts? Empirical evidence from the Indonesian Family Life Survey

BackgroundIndonesia is one of the largest consumers of tobacco in the world, however there has been little work done on the economics addiction of tobacco. This study provides an empirical test of a rational addiction (henceforth RA) hypothesis of cigarette demand in Indonesia.MethodsFour estimators (OLS, 2SLS, GMM, and System-GMM) were explored to test the RA hypothesis. The author adopted several diagnostics tests to select the best estimator to overcome econometric problems faced in presence of the past and future cigarette consumption (suspected endogenous variables). A short-run and long-run price elasticities of cigarettes demand was then calculated. The model was applied to individuals pooled data derived from three-waves a panel of the Indonesian Family Life Survey spanning the period 1993-2000.ResultsThe past cigarette consumption coefficients turned out to be a positive with a p-value < 1%, implying that cigarettes indeed an addictive goods. The rational addiction hypothesis was rejected in favour of myopic ones. The short-run cigarette price elasticity for male and female was estimated to be-0.38 and -0.57, respectively, and the long-run one was -0.4 and -3.85, respectively.ConclusionsHealth policymakers should redesign current public health campaign against cigarette smoking in the country. Given the demand for cigarettes to be more prices sensitive for the long run (and female) than the short run (and male), an increase in the price of cigarettes could lead to a significant fall in cigarette consumption in the long run rather than as a constant source of government revenue.

Cigarette pack warning labels in Russia: how graphic should they be?

Tobacco warning labels on cigarette packs have been shown to reduce cigarette consumption. The current study measures the Russian population's acceptance and preference of graphic (picture + text) tobacco warning labels. Nationally representative data were collected from 1778 participants in the Russian Federation in October 2009. A cross-sectional survey was conducted through person-to-person household interviews with respondents aged ≥ 14 years. Survey questions included standard demographic queries and three study-specific questions. Participants rated the strength of 13 cigarette warning labels according to their effectiveness to deter from smoking. Smoking status and the population's acceptance of similar warning labels was also measured. A dose-response pattern is apparent between the degree of graphic content of cigarette warning labels and the public's perception regarding the warning label's ability to discourage smoking. Approximately 87% of all respondents thought Russian authorities should require tobacco manufacturers to place graphic warning labels on cigarette packs, while 80% of current smokers wanted their government to enact such enforcement. The Russian population would strongly support government policy that would require graphic warning labels to be placed on cigarette packs in their country. In order to best deter from smoking, future cigarette warning labels in Russia should be as graphic as possible.

Targeting the affordability of cigarettes: a new benchmark for taxation policy in low-income and-middle-income countries

ObjectivesTo investigate the appropriateness of tax incidence (the percentage of the retail price occupied by taxes) benchmarking in low-income and-middle-income countries (LMICs) with rapidly growing economies and to explore the...

Cigars, cigarettes, and adolescents.

To examine public health implications of adolescent use of cigars only, cigarettes only, and both cigarettes and cigars. A cross-sectional health risk survey was administered to a random sample of 4486 high school students in a Midwestern county. More adolescents reported using both cigarettes and cigars (10.6%) than cigar-only (7.4%) or cigarette-only (6.4%). Product of initiation was associated with current product use. Dual use was associated with more frequent use of both products, high stress, and susceptibility to future cigarette use. Assessing cigarette use without examining cigar use overlooks a critical dimension of adolescent tobacco use.

Economic theory and evidence on smoking behavior of adults

To describe: (i) three alternative conceptual frameworks used by economists to study addictive behaviors: rational, imperfectly rational and irrational addiction; (ii) empirical economic evidence on each framework and specific channels to explain adult smoking matched to the frameworks; and (iii) policy implications for each framework. A systematic review and appraisal of important theoretical and empirical economic studies on smoking. There is some empirical support for each framework. For rational and imperfectly rational addiction there is some evidence that anticipated future cigarette prices influence current cigarette consumption, and quitting costs are high for smokers. Smokers are more risk-tolerant in the financial domain than are others and tend to attach a lower value to being in good health. Findings on differences in rates of time preference by smoking status are mixed; however, short-term rates are higher than long-term rates for both smokers and non-smokers, a stylized fact consistent with hyperbolic discounting. The economic literature lends no empirical support to the view that mature adults smoke because they underestimate the probability of harm to health from smoking. In support of the irrationality framework, smokers tend to be more impulsive than others in domains not related directly to smoking, implying that they may be sensitive to cues that trigger smoking. Much promising economic research uses the imperfectly rational addiction framework, but empirical research based on this framework is still in its infancy.

Affective decision-making deficits, linked to a dysfunctional ventromedial prefrontal cortex, revealed in 10th-grade Chinese adolescent smokers

This study addressed the question of whether poor decision making would be associated with adolescent past 7-day smoking. We conducted a cross-sectional study of 208 10th-grade adolescents in Chengdu City, China. We used the Iowa Gambling Task (IGT) to assess decision-making, and the Self-ordered Pointing Task (SOPT) to assess working memory capacity. Paper and pencil questionnaires assessed the school academic performance (SAP) and smoking variables. The results showed that a significantly higher proportion of past 7-day smokers (91.7%) were susceptible to future smoking and cigarette offers from best friends compared to other levels of smokers (never, ever and past 30-day smokers). Consistent with these behavioral data, the neuropsychological assessments revealed that relative to never smokers, past 7-day adolescent smokers (but not ever smokers or past 30-day smokers) demonstrated significantly lower scores on the IGT. Moreover, a higher proportion of past 7-day smokers (91.7%) performed poorly (no more than an overall net score of 10) on the IGT than nonsmokers and irregular (ever or past 30-day) smokers (about 65.3%). There were no differences on working memory performance for smokers (at any level) compared to never smokers after adjusting for school-type. In addition, logistic regression showed that the IGT significantly predicted past 7-day smoking after controlling for the working memory, school academic performance and demographic variables. These results suggest that poor affective decision making might predispose some adolescents to smoking in the future or in the social situations where their peers are smoking. Intervention targeting affective decision making might hold promise for reducing adolescents' risks for substance use.