Self-reported Cigarette Smoking Research Articles

Electronic Cigarettes vs Varenicline for Smoking Cessation in Adults

Little is known about the relative effectiveness of nicotine-containing electronic cigarettes (ECs) compared with varenicline as smoking cessation aids. To determine the relative effectiveness of ECs in smoking cessation. This randomized placebo-controlled single-center trial was conducted in northern Finland. Participants aged 25 to 75 years who smoked daily and had volunteered to quit smoking were recruited from August 1, 2018, to February 20, 2020, via local media. The trial included 52 weeks of follow-up. All data analyses were conducted from September 1, 2022, to January 15, 2024. The participants, study nurses, and researchers were masked to group assignment. The participants were assigned by block randomization to receive 18 mg/mL of nicotine-containing ECs together with placebo tablets, varenicline with standard dosing together with nicotine-free ECs, or placebo tablets together with nicotine-free ECs, all combined with a motivational interview, with the intervention phase lasting for 12 weeks. The primary outcome was self-reported 7-day conventional cigarette smoking abstinence as confirmed by the exhaled carbon monoxide level on week 26. The analysis followed the intent-to-treat principle. Of the 561 recruited participants, 458 (81.6%) eligible participants (257 women [56%]; 201 men [44%]; mean [SD] age, 51 [11.6] years) were randomized. The primary outcome occurred in 61 of 152 participants (40.4%) in the EC group, 67 of 153 (43.8%) in the varenicline group, and 30 of 153 (19.7%) in the placebo group (P < .001). In the pairwise comparison, placebo differed statistically significantly from ECs (risk difference [RD], 20.7%; 95% CI, 10.4-30.4; P < .001) and varenicline (RD, 24.1%; 95% CI, 13.7-33.7; P < .001), but the difference was statistically insignificant between ECs and varenicline (RD, 3.4%; 95% CI, -7.6 to 14.3; P = .56). No serious adverse events were reported. This randomized clinical trial found that varenicline and nicotine-containing ECs were both effective in helping individuals in quitting smoking conventional cigarettes for up to 6 months. ClinicalTrials.gov Identifier: NCT03235505.

The association of pre-cancer diagnosis cardiovascular risk factors with memory aging after a cancer diagnosis, overall and by race/ethnicity.

Cardiovascular risk factors (CVRFs) are associated with increased risk for cognitive impairment and decline in the general population, but less is known about how CVRFs might influence cognitive aging among older cancer survivors. We aimed to determine how CVRFs prior to a cancer diagnosis affect post-cancer diagnosis memory aging, compared to cancer-free adults, and by race/ethnicity. Incident cancer diagnoses and memory (immediate and delayed recall) were assessed biennially in the US Health and Retirement Study (N = 5,736, 1998-2018). CVRFs measured at the wave prior to a cancer diagnosis included self-reported cigarette smoking, obesity, diabetes, heart disease, hypertension, and stroke. Multivariable-adjusted linear mixed-effects models evaluated the rate of change in standardized memory score (SD/decade) post-cancer diagnosis for those with no, medium, and high CVRFs, compared to matched cancer-free adults, overall and stratified by sex and race/ethnicity. Higher number of CVRFs was associated with worse baseline memory for both men and women, regardless of cancer status. Cancer survivors with medium CVRFs had slightly slower rates of memory decline over time relative to cancer-free participants (0.04 SD units/decade [95% CI: 0.001, 0.08]). Non-Hispanic Black (NHB) and Hispanic cancer-free participants and cancer survivors had worse baseline memory than their Non-Hispanic White (NHW) counterparts. CVRFs were associated with worse baseline memory function, but not decline, for cancer-free adults and cancer survivors. Racial disparities were largely similar between cancer survivors and cancer-free adults. These findings may inform hypotheses about pre-diagnosis multimorbidity and cognitive aging of cancer survivors from diverse groups.

Association between maternal cigarette smoking cessation and risk of preterm birth in Western New York.

Although many studies suggested the benefit of smoking cessation among pregnant women in reducing the risk of preterm birth (PTB), the timing of the effect of the cessation remains inconclusive. To examine the association of trimester-specific smoking cessation behaviours with PTB risk. We included 199,453 live births in Western New York between 2004 and 2018. Based on self-reported cigarette smoking during preconception and in each trimester, we created six mutually exclusive groups: non-smokers, quitters in each trimester, those who smoked throughout pregnancy, and inconsistent smokers. Risk ratios (RRs) and 95% confidence intervals (CIs) were estimated using Poisson regression to examine the association between smoking cessation and PTB. Effect modification by illegal drug use, maternal age, race and ethnicity and pre-pregnancy body mass index (BMI) was investigated multiplicatively by ratio of relative risk and additively by relative excess risk due to interaction (RERI). Overall, 6.7% of women had a PTB; 14.1% smoked throughout pregnancy and 3.4%, 1.8% and 0.8% reported quitting smoking during the first, second and third trimesters, respectively. Compared to non-smokers, third-trimester cessation (RR 1.20, 95% CI 1.01, 1.43) and smoking throughout pregnancy (RR 1.27, 95% CI 1.21, 1.33) were associated with a higher PTB risk, while quitting smoking during the first or second trimester, or inconsistent smoking was not associated with PTB. A positive additive interaction was identified for maternal age and late smoking cessation or smoking throughout pregnancy on PTB risk (RERI 0.17, 95% CI 0.00, 0.36), and a negative interaction was observed for pre-pregnancy BMI ≥30 kg/m2 (ratio of relative risk 0.70, 95% CI 0.63, 0.78; RERI -0.42, 95% CI -0.56, -0.30). Compared to non-smokers, smoking throughout pregnancy and third-trimester smoking cessation are associated with an increased risk of PTB, while quitting before the third trimester may not increase PTB risk.

Factors Associated With Abstinence Among Young Adult Smokers Enrolled in a Real-world Social Media Smoking Cessation Program.

Social media platforms are promising to provide smoking cessation support. This study aimed to identify baseline factors associated with cigarette smoking abstinence among young adult smokers enrolled in a real-world social media-based smoking cessation program. We analyzed data from young adult smokers (aged 18-30 years) participating in a publicly available Facebook-based smoking cessation program serving the San Francisco Bay Area. The analytic sample consisted of 248 participants who completed both the baseline and follow-up surveys at 3 months. Multivariable logistic regression analysis determined baseline factors significantly associated with self-reported 7-day cigarette smoking abstinence at 3 months. Participants were race/ethnically diverse, well-educated, and 47.6% reported LGB + sexual identity. Those who reported dual use of cigarettes and e-cigarettes in the past 30 days (vs. cigarette use only), current alcohol users (vs. non-users), and those aged 25-30 years (vs. 18-24 years) were significantly less likely to report 7-day abstinence at 3 months. Non-daily smokers (vs. daily smokers) and those with high desire to quit smoking (vs. low to moderate desire) were more likely to report abstinence. Results also showed reduction in the percentage of e-cigarette and other tobacco product use among participants. Social media interventions may be more effective for young adult non-daily smokers and those with high desire to quit smoking. Smoking cessation programs may help reduce use of other tobacco products among treatment-seeking smokers. Smoking cessation interventions for young adults need to explicitly address dual use of cigarettes and e-cigarettes and use of alcohol. Findings of this study highlight the need for future interventions to address dual use of cigarettes and e-cigarettes and use of alcohol to improve cigarette smoking abstinence outcomes. The reduction in the use of other tobacco products among program participants indicates that social media smoking cessation programs may exert a broader positive influence on overall tobacco consumption. The large number of LGB+ smokers participating in the program suggests social media is a promising cessation channel for this hard-to-reach group, warranting further study.

Cannabis Use Among Adults in Cigarette Smoking Cessation Treatment in Ontario, Canada: Prevalence and Association With Tobacco Cessation Outcome, 2015-2021.

Objectives. To examine cannabis use prevalence and its association with tobacco cessation among adults enrolled in cigarette smoking cessation treatment before and after Canada legalized recreational cannabis in October 2018. Methods. The sample comprised 83 206 adults enrolled in primary care-based cigarette smoking cessation treatment between 2015 and 2021 in Ontario, Canada. Past-30-day cannabis use was self-reported at enrollment and cigarette smoking abstinence at 6-month follow-up. Results. Past-30-day prevalence of cannabis use increased from 20.2% in 2015 to 37.7% in 2021. The prevalence increased linearly both before and after legalization. Cannabis and tobacco co-use was associated with lower odds of self-reported cigarette smoking abstinence at 6-month follow-up than tobacco use only (24.4% vs 29.3%; odds ratio [OR] = 0.78; 95% confidence interval [CI] = 0.75, 0.81). This association was attenuated after adjustment for covariates (OR = 0.93; 95% CI = 0.89, 0.97) and weakened slightly over time. Conclusions. Cannabis use prevalence almost doubled from 2015 to 2021 among primary care patients in Ontario seeking treatment to quit cigarettes and was associated with poorer quit outcomes. Further research into the impact of cannabis policy on cannabis and tobacco co-use is warranted to mitigate harm. (Am J Public Health. 2024;114(1):98-107. https://doi.org/10.2105/AJPH.2023.307445).

Naltrexone plus bupropion reduces cigarette smoking in individuals with methamphetamine use disorder: A secondary analysis from the CTN ADAPT-2 trial

IntroductionMethamphetamine (MA) use is marked by high rates of comorbid tobacco smoking, which is associated with more severe drug use and worse clinical outcomes compared to single use of either drug. Research has shown the combination of naltrexone plus oral bupropion (NTX-BUP) improves smoking cessation outcomes in non-MA-using populations. In the Accelerated Development of Additive Pharmacotherapy Treatment (ADAPT-2) study, NTX-BUP successfully reduced MA use. Our aim in this secondary data analysis was to examine changes in cigarette smoking among the subgroup of participants reporting comorbid tobacco use in the ADAPT-2 trial. MethodsThe multi-site ADAPT-2 study used a randomized, double blind, sequential parallel comparison design to evaluate treatment with extended-release injectable NTX (380 mg every 3 weeks) combined with once-daily oral extended-release BUP (450 mg/day) vs matching injectable and oral placebo in outpatients with moderate or severe MA use disorder. The study assessed smoking outcomes, based on self-reported timeline followback (TLFB) data, twice/week for 13 weeks. ResultsOf the 403 participants in the ADAPT-2 trial, 290 reported being current cigarette smokers (71.9 %). The study found significant differences (p's < 0.0001) for each smoking outcome indicating greater change in the proportion of nonsmoking days, number of cigarettes smoked per week, and consecutive nonsmoking days, all favoring the group receiving NTX-BUP versus placebo. ConclusionsNTX-BUP was associated with significant reductions in self-reported cigarette smoking in the context of concurrent treatment for MA use disorder. These off-target medication effects warrant prospective investigation using biochemically confirmed measures of smoking abstinence. The development of NTX-BUP as a co-addiction treatment strategy has a potential for high public health impact.

Depression, Anxiety, and Cigarette Smoking Among Patients with Tuberculosis.

Smoking adversely affects tuberculosis (TB) outcomes and may be associated with depression and anxiety among people diagnosed with TB in Botswana. We conducted a cross-sectional study among patients newly diagnosed with TB in Gaborone, Botswana, evaluating factors associated with self-reported cigarette smoking. We performed Poisson regression analyses with robust variance to examine whether depressive and anxiety symptoms were associated with smoking. Among 180 participants with TB enrolled from primary health clinics, depressive symptoms were reported in 47 (26.1%) participants and anxiety symptoms were reported in 85 (47.2%) participants. Overall, 45 (25.0%) participants reported current smoking. Depressive symptoms were associated with a higher prevalence of smoking (adjusted prevalence ratio [aPR]: 2.04; 95% confidence interval [CI]: 1.29-3.25) in the adjusted analysis. The association between anxiety symptoms and smoking did not reach statistical significance (aPR: 1.26; 95% CI: 0.77-2.05). Future studies should further investigate these associations when addressing TB care.

Negative Affect and Cigarette Cessation in Dual Users of Cigarettes and Electronic Nicotine Delivery Systems

Objectives: Dual use of cigarettes and electronic nicotine delivery systems (ENDS) is increasingly common in adult smokers, who often report using ENDS to quit smoking. Elevated negative affect is an established predictor of increased difficulty quitting smoking combustible cigarettes but has not yet been examined in the context of cigarette cessation for dual users. Method: This study examined whether mood-related factors predict cigarette smoking cessation among dual users (N = 364) over 12-months. Self-reported cigarette smoking at 12 months, with abstinence defined as no smoking for the past 7 days, was the primary outcome variable. Logistic regression included baseline levels of depression symptoms (CES-D), anxiety symptoms (MASQ), and negative affect expectancies for smoking, with baseline nicotine dependence for cigarettes (NDSS), motivation to quit, age, race/ethnicity, rate of cigarette smoking at baseline, and ENDS usage at baseline and 12 months as covariates. Interactions between CES-D, MASQ, and negative affect expectancies were examined. We predicted that negative affect, especially for smokers who had high negative affect expectancies for smoking, would be negatively associated with quitting. Results: Contrary to expectations, negative affect constructs did not predict quitting. Baseline nicotine dependence for cigarettes, gender, and race/ethnicity significantly predicted the likelihood of cigarette cessation. Higher rates of ENDS use, higher motivation, and lower negative affect smoking expectancies were significantly correlated with quitting cigarettes. Conclusion: In this non-treatment seeking sample of dual users, negative affect did not predict cigarette cessation over and above nicotine dependence for cigarettes, gender, and race/ethnicity.

Trends in Prevalence of Cigarette Smoking Among US Adults With Major Depression or Substance Use Disorders, 2006-2019

Tobacco use is highly concentrated in persons with mental illness. To assess trends in past-month prevalence of cigarette smoking among adults with vs without past-year depression, substance use disorders (SUDs), or both, using nationally representative data. Exploratory, serial, cross-sectional study based on data from 558 960 individuals aged 18 years or older who participated in the 2006-2019 US National Surveys on Drug Use and Health. Past-year major depressive episode (MDE) and SUD using Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) criteria. Past-month self-reported cigarette use, adjusted for sociodemographic characteristics. Of the sampled 558 960 adults, 41.4% (unweighted) were aged 18 to 25 years, 29.8% (unweighted) were aged 26 to 49 years, and 53.4% (unweighted) were women. From 2006 to 2019, the past-month self-reported cigarette smoking prevalence declined significantly among adults with MDE from 37.3% to 24.2% for an average annual percent change of -3.2 (95% CI, -3.5 to -2.8; P < .001), adults with SUD from 46.5% to 35.8% for an average annual percent change of -1.7 (95% CI, -2.8 to -0.6; P = .002), and adults with co-occurring MDE and SUD from 50.7% to 37.0% for an annual average annual percent change of -2.1 (95% CI, -3.1 to -1.2; P < .001). The prevalence declined significantly for each examined age, sex, and racial and ethnic subgroup with MDE and with SUD (all P < .05), except for no significant changes in American Indian or Alaska Native adults with MDE (P = .98) or with SUD (P = .46). Differences in prevalence of cigarette smoking between adults with vs without MDE declined significantly for adults overall from 11.5% to 6.6%, for an average annual percent change of -3.4 (95% CI, -4.1 to -2.7; P < .001); significant average annual percent change declines were also seen for men (-5.1 [95% CI, -7.2 to -2.9]; P < .001); for women (-2.7 [95% CI, -3.9 to -1.5]; P < .001); for those aged 18 through 25 years (-5.2 [95% CI, -7.6 to -2.8]; P < .001); for those aged 50 years or older (-4.7 [95% CI, -8.0 to -1.2]; P = .01); for Hispanic individuals (-4.4 [95% CI, -8.0 to -0.5]; P = .03), and for White individuals (-3.6 [95% CI, -4.5 to -2.7]; P < .001). For American Indian or Alaska Native adults, prevalence did not significantly differ between those with vs without MDE during 2006-2012 but was significantly higher for those with MDE during 2013-2019 (difference, 11.3%; 95% CI, 0.9 to 21.7; P = .04). Differences among those with vs without SUD declined for women for an average annual percent change of -1.8 (95% CI, -2.8 to -0.9; P = .001). In this exploratory, serial, cross-sectional study, there were significant reductions in the prevalence of self-reported cigarette smoking among US adults with major depressive episode, substance use disorder, or both, between 2006 and 2019. However, continued efforts are needed to reduce the prevalence further.

Physical Fitness, Dietary Habits and Substance Misuse: A Cross-Sectional Analysis of the Associations in 7,600 Swedish Adolescents

<strong>Introduction:</strong> Adolescence is a period of rapid physical, psychological and social changes and a time when habits are formed. This study aimed to investigate the correlation between physical fitness, alcohol consumption, tobacco consumption and dietary habits among adolescents according to the Swedish Physical power, Mental harmony and Social capacity profile (FMS profile). <strong>Methods:</strong> Data were collected from Swedish high school students, 1st – 3rd grade (16–19 yrs), both genders, overall, 7,600 Swedish adolescents using the FMS profile, comprising physical tests and questionnaires concerning lifestyle factors (e.g. physical fitness, dietary habits, alcohol and tobacco use). Participants included in this study met the requirements of inclusion, which were having a complete set of data, e.g. had undergone all physical tests and answered all questionnaires. <strong>Results:</strong> A total of 13% self-reported cigarette smoking, while 37% self-reported alcohol consumption. Adolescents who smoked were older (t-test = 9.09,p&lt; 0.001), heavier (t-test = 4.58,p&lt; 0.001) and had greater BMI (t-test = 3.96,p&lt; 0.001). Adolescents who consumed alcohol were older (t-test = 8.78, p &lt; 0.001), heavier (t-test = 4.03,p&lt; 0.001) and taller (t-test = 3.77,p&lt; 0.001). Significant differences were found for all fitness factors, with better mobility, strength and balance in adolescents who did not smoke compared to smokers (Mann Whitney Z test = 2.77, 7.13, 5.77, respectively; allp&lt; 0.001). Regularity of meals and avoidance of sweets and cakes were less prevalent in adolescents who smoked (OR (95% CI): 0.63 (0.59–0.68), 0.71 (0.66–0.77), respectively). <strong>Conclusion:</strong> Among Swedish adolescents, tobacco and alcohol use increase with age. However, physical fitness is consistently protective against tobacco consumption, and dietary habits are mostly protective against alcohol consumption. Physical fitness and low alcohol and tobacco consumption are possible health factors.

Abstract P006: Prevalence And Social Determinants Of Modifiable Risk Factors Of Dementia: An Analysis Of The National Health And Nutrition Examination Survey (nhanes) 2013-2018

Introduction: Dementia causes significant morbidity and mortality. 40% of worldwide cases can be delayed or prevented with risk factor modification. The patterning of modifiable risk factors among US adults remain unknown. Methods: We determined the prevalence of total, mid-life, and late-life modifiable risk factors for dementia among US adults &gt; 18 years of age using NHANES from 2013-2018. Mid-life (45-65 years) risk factors included: self-reported hearing loss, hypertension (via self-report or exam), excess alcohol intake (≥14 alcoholic drinks per week), and BMI &gt; 30 mg/kg 2 . Late-life (&gt;65 years) risk factors included: self-reported cigarette smoking, depression (PHQ-9 ≥ 10), social isolation, physical inactivity (&lt;150 minutes/week of moderate activity), and diabetes (via self-report or HgBA1C ≥ 6.5) . Having less than a high school degree was included as both a mid- and late-life risk factor. Poisson regressions were used to determine age-adjusted associations between the exposures of race-ethnicity, sex, and poverty-income ratio (PIR, 6-level ordinal variable, higher numbers reflecting more income relative to poverty level) with total number of risk factors, mid-life risks factors among those in midlife, and late-life risks factors among those in late-life. Results: After applying survey weights, the sample consisted of 241,727,544 individuals composed of 48.2% male participants, 9.20% identifying as Mexican-American, 6.35% non-Mexican Hispanic, 11.4% non-Hispanic Black, 5.67% non-Hispanic Asian, 3.74% as ‘other,’ and 63.6% as non-Hispanic white. Mid-life and late-life individuals made up 35.70% and 17.85% of the sample respectively. The median (IQR) number of risk factors overall was 2 (1-3). Among mid-life participants, the median number (IQR) of mid-life risk factors was 1 (0-2). Among late-life participants, the median number (IQR) of late-life risk factors was 1 (1-2). Hypertension was the most prevalent risk factor at 42.8%. Mexican-Americans, non-Mexican Hispanic Americans, and non-Hispanic Black Americans had significantly more age-adjusted total risk factors, mid-life risk factors, and late-life risk factors relative to non-Hispanic white Americans. Non-Hispanic Asian Americans had less age-adjusted total and midlife risk factors relative to non-Hispanic white-Americans, but more late-life risk factors. Male sex was associated with a greater prevalence of age-adjusted mid-life risk factors (β =0.18, 95% CI: 0.05 – 0.18), compared to female sex. A 1-level higher PIR was associated with less age-adjusted total, mid-life, and late-life risk factors, with late-life being most pronounced (β = -0.19, 95% CI: -0.21 to -0.17) Conclusion: Dementia risk factors seem to be patterned by social determinants, including race-ethnicity and PIR. Given known disparities in dementia, more focus should be given to mitigating risk factors among at-risk populations.

The Association Between Self-Reported Cigarette Smoking and Spinal Pain is Not Explained by Serum Cotinine Levels

The aim of this study was to check if self-reported smoking is still associated with back pain above and beyond its association with cotinine, to test the hypothesis that the association of self-reported cigarette smoking with back pain is due to residual confounding. Secondary analyses of population-based cross-sectional data pertaining to 4470 adults were conducted. In multivariate analyses examining the associations of self-reported smoking with several spinal pain outcomes (neck pain, low back pain, low back pain with pain below knee, self-reported diagnosis of arthritis/rheumatism, and related limitations), further adjustment for serum cotinine concentrations was made. Self-reported cigarette smoking was associated with neck pain (adjusted Odds Ratio (aOR) Regular smokers vs. Non-smokers: 1.44; 95% Confidence Interval (CI): 1.14-1.82), low back pain (aOR: 1.48; 95% CI: 1.24-1.78), low back pain with pain below knee (aOR: 1.98; 95% CI: 1.42-2.76), as well as arthritis/rheumatism (aOR: 1.33; 95% CI: 1.03-1.71), and related functional limitations (P < .05). Further adjustment for serum cotinine concentrations brought about little change in the ORs or beta coefficients. These results do not support the hypothesis that serum cotinine concentrations explain the well-known relationship between cigarette smoking and spinal pain.

The association of in utero tobacco smoke exposure, quantified by serum cotinine, and Autism Spectrum Disorder.

Previous studies on in utero exposure to maternal environmental tobacco smoke (ETS) or maternal active smoking and Autism Spectrum Disorder (ASD) have not been entirely consistent, and no studies have examined in utero cotinine concentrations as an exposure classification method. We measured cotinine in stored second trimester maternal serum for 498 ASD cases and 499 controls born in California in 2011-2012. We also obtained self-reported maternal cigarette smoking during and immediately prior to pregnancy, as well as covariate data, from birth records. Using unconditional logistic regression, we found no association between log10 cotinine concentrations and odds for developing ASD among children of non-smokers (aOR: 0.93 [95% CI: 0.69, 1.25] per ng/ml), which represents exposure to ETS, though there may be a possible interaction with race. We found no association between cotinine-defined smoking (≥3.08 ng/ml vs. <3.08 ng/ml) (adjusted odds ratio [aOR]: 0.73 (95% confidence interval [95% CI]: 0.35, 1.54)) or self-reported smoking (aOR: 1.64 [95% CI: 0.65, 4.16]) and ASD. In one of the few studies of ETS and the first with measured cotinine, our results indicate no overall relationship between in utero exposure to tobacco smoke from maternal ETS exposure or active smoking, and development of ASD. LAY SUMMARY: This study found that women who smoke or are exposed to tobacco smoke during pregnancy are not more likely to have children with Autism Spectrum Disorder (ASD). This is the first ASD study to measure a chemical in the mother's blood during pregnancy to identify exposure to tobacco smoke.

Regional comparison of self-reported late pregnancy cigarette smoking to mass spectrometry analysis.

To report a more accurate prevalence estimate of late pregnancy nicotine exposures. A cross-sectional study during a 2-month period in 2019. Participants were women delivering in any of the six county maternity hospitals who consented to universal drug testing at the time of delivery as part of routine hospital admission. Of 2531 tested samples, 18.7% tested positive for high levels of cotinine indicating primary smoking or other primary use of tobacco products. Together, 33.0% of the study population tested positive for nicotine exposure during late pregnancy compared to vital records which reported 8.2% cigarette smoking during the third trimester of pregnancy and 10.5% cigarette smoking at any time during pregnancy through maternal self-report. Captured vital birth smoking measures vastly underreport actual primary exposures to nicotine products. Vital birth data also fail to capture secondhand exposures which constitute a significant proportion of the population.

Assessing the influence of warnings with testimonies from former smokers on smoking and quitting behaviour.

Cigarette pack warnings are widely used internationally for reducing smoking behaviour. Current warnings typically consist of a textual or graphic warning that smoking can lead to negative (health) outcomes. Though these warnings have proven benefits, they also have important limitations. Most notably, they do not produce beneficial changes in important cognitive determinants of smoking cessation such as self-efficacy to refrain from smoking and they do not reduce smoking for specific subsets of the target population. Recent studies provide evidence for the effectiveness of health warnings that include health-related testimonies from former smokers. We designed cigarette pack warnings that consist of more general testimonial statements from former smokers, selected in a pilot study for their potential impact on two important cognitive determinants of smoking (i.e., self-efficacy beliefs and outcome expectancies). In the main study, online participants were either exposed to the new testimonial warnings, to graphic health warnings, or to text-only health warnings on four separate occasions during a 24-h window. In a sample of 416 daily smokers, we observed beneficial changes in self-reported cigarette smoking, craving, quit intentions, evaluations of smoking, self-efficacy, and outcome expectancies, immediately after viewing the warnings a first time and after multiple exposures. These effects were comparable for participants in the three warning type groups, with some (small) differences for changes in outcome expectancies and craving. Warnings with general testimonies from former smokers might provide a useful evidence-based addition to currently used cigarette pack health warnings.

Disparities in health behaviors and outcomes at the intersection of race and sexual identity among women: Results from the 2011–2016 National Health and Nutrition Examination Survey

The purpose of this study was to explore potential differences in health behaviors and outcomes of sexual minority women (SMW) of color compared to White SMW, heterosexual women of color, and White heterosexual women. Data from 4878 women were extracted from the 2011 to 2016 National Health and Nutritional Examination Survey. The four-category independent variable (SMW of color, White SMW, heterosexual women of color, and White heterosexual women) was included in binary and multinomial logistic regression models predicting fair/poor self-reported health status, depression, cigarette smoking, alcohol, cannabis, and illicit drug use. Compared to White heterosexual women, SMW of color and heterosexual women of color had significantly higher odds of fair/poor self-reported health and lower odds of being a current or former smoker, binge drinking or using alcohol in the past year, being a former cannabis user, and ever using illicit drugs. In contrast, White SMW had significantly greater odds of depression, current smoking and cannabis and illicit drug use. Results of post-hoc tests indicated that the adjusted ORs for SMW of color differed significantly from those of White SMW for all outcomes, and did not differ significantly from those for heterosexual women of color for any outcome other than no binge drinking (OR = 0.34 vs. 0.67, p < 0.01) and current cannabis use (OR = 0.93 vs. 0.44, p < 0.01). SMW of color are more similar to heterosexual women of color than to White SMW in terms of depression, substance use, and self-reported health.

Smoking practices in relation to exhaled carbon monoxide in an occupational cohort

BackgroundExposure to carbon monoxide (CO) remains a leading occupational hazard in firefighters, but cigarette and waterpipe smoking likely contributes to the other sources of CO in such workers. The aim of this study was to estimate the contribution of self-reported active cigarette smoking, waterpipe use, and potential job-related sources of CO to the level of exhaled CO in firefighters.MethodsWe surveyed the personnel of 18 fire stations (N = 842), median age 28 years, who participated at an annual screening not timed to coincide with recent firefighting. We surveyed smoking and waterpipe history, exposure to secondhand smoke (SHS), use of coal for health and biomass for cooking and time since last exposure to firefighting in the workplace. We measured exhaled CO with an instantaneous reading device (piCO Smokerlyzer). We used multivariable regression models to test the association of time since last smoked cigarette (≤12 h) and waterpipe (≤12 h) and time since last fire (≤6 h) with exhaled CO.ResultsIn analysis limited to men (93.5% of all surveyed), 42% were daily cigarette; 1% were waterpipe smokers; 94% were exposed to SHS, 29% used coal for heating and 4% used biomass for cooking. The median CO was 4 (interquartile range 3;8) ppm. Age (beta 0.74 per 10 years, p < 0.001), use of biomass fuel for cooking (beta 1.38, p = 0.05), cigarette smoked in the last 12 h (beta 8.22, p < 0.001), waterpipe smoked in the last 12 h (beta 23.10, p < 0.001) were statistically associated with CO, but not time since last fire (≤6 h) (beta 4.12, p = 0.12). There was a significant interaction between older age and firefighting for exhaled CO (p = 0.03).ConclusionsCigarette and recent waterpipe smoking are associated with increased exhaled CO in firefighters. Firefighting itself was a less potent contributor to exhaled CO when measured at an annual screening, but an age interaction was manifested.

M90. CANNABIS USE, CIGARETTE SMOKING, AND PSYCHOTIC EXPERIENCES IN ADOLESCENCE AND DIAGNOSIS OF PSYCHOSIS IN EARLY ADULTHOOD. A BIRTH-COHORT STUDY

BackgroundRecent studies indicate that adolescent cannabis use (1) and cigarette smoking (2) increase the risk for psychosis. However, less is known about symptom profile associated with cannabis use and cigarette smoking prior to the psychotic episodes. Our aim was to study the associations between daily smoking, life-time cannabis use, and psychotic experiences in adolescence, and their relationship with psychotic disorders in early adulthood.MethodsThe Northern Finland Birth Cohort 1986 study includes 99% of all births (n=9432) in the region. At age 15–16, data on self-reported daily cigarette smoking and cannabis use was gathered using questionnaires. Psychotic experiences during past 6 months were evaluated using PROD-screen (3). Psychiatric diagnoses were collected from four Finnish nationwide health-care registers until year 2016, when participants were 30–31 years old. Individuals with information on daily smoking, cannabis use and psychotic experiences (n=6037, 47.7% male, 64.0% of the total cohort) were included. Associations were studied using multivariate logistic regression analysis.ResultsAt age 15–16, 12.5% (n=755) reported daily smoking, and 5.6% (n=340) reported lifetime cannabis use and 30.9% (n=1868) were PROD-screen positive, i.e. reporting ≥3 symptoms on the PROD-screen. At age 30–31, 1.8% (n=111) of the participants had a register-based psychosis diagnosis. Individuals with subsequent psychosis reported more daily smoking (24.3%), cannabis use (15.3%) and psychotic experiences (51.4%) in adolescence than did individuals without any psychiatric diagnosis (11.1%, 4.6% and 28.6%).The multivariate logistic regression analyses included sex, daily smoking, lifetime cannabis use, drug use other than cannabis and parental psychosis. Among those with psychosis during the follow-up, cannabis use at age 15–16 associated with positive PROD-screen (OR=5.0, 95%CI 1.1–22.1, p=0.033), ‘experience of thoughts running wild or difficulty in controlling the speed of thoughts’ (OR=5.0, 95%CI 1.2–20.9, p=0.026), and ‘depression, apathy, loss or energy or marked tiredness’ (OR 5.3, 95%CI 1.3–22.3, p=0.021). In the same group, daily smoking was inversely associated with ‘disorders in connection with vision, such as blurred vision, visual oversensitivity or changing visual perceptions’ (OR=0.1, 95%CI 0.02–0.8, p=0.028).Among those without later psychiatric diagnosis, cannabis use associated with positive PROD-screen and PROD-items indicating anxiety, bodily restlessness, depression, difficulty completing tasks, difficulty thinking clearly, difficulty controlling the speed of thoughts, feelings of strange things happening, feelings, thoughts or behaviors that could be considered weird and feelings of being followed or influenced. In the same group, daily smoking was associated with bodily restlessness and depression.DiscussionLifetime cannabis use in adolescence is associated with psychotic experiences in individuals with or without subsequent psychosis. In those with subsequent psychosis, cannabis use had smaller impact on symptom profile. The inverse association between visual hallucinations and daily smoking in adolescence among individuals with subsequent psychotic disorder is a novel finding and needs further exploring.

Product Substitution After A Real-World Menthol Ban: A Cohort Study.

The province of Ontario, Canada banned menthol in cigarettes and other tobacco products effective January 1st, 2017 adding to an existing flavour ban. However, all flavoured e-cigarettes, flavoured cigars larger than 6g, and alcohol flavoured cigars without filters over 1.4g were exempted. This paper examines the association between use of flavoured non-cigarette products and self-reported cigarette smoking cessation after the ban. Current past-30 day cigarette smokers (N=913) who were 16 years or older, living in Ontario were recruited between September-December 2016 and re-contacted January-August 2018. Both daily and occasional pre-ban menthol cigarette smokers were more likely to use flavoured cigar products (adjusted relative rate, RR=1.53, 95% confidence interval, CI=1.01, 2.31; adjusted RR=1.57, 95% CI=1.06, 2.30) after the ban, while occasional pre-ban menthol cigarette smokers were more likely to use other tobacco products (adjusted RR=1.25, 95% CI=1.02, 1.53) or flavoured other tobacco products (adjusted RR=1.56, 95% CI=1.09, 2.24), conditional on prior use. Menthol smokers prior to the ban were more likely to use other tobacco products, or flavoured tobacco products, after the ban. These results suggest that comprehensive menthol bans could be more effective without the option of using flavoured tobacco or nicotine products as substitutes.

Association between perceived risk of harm and self-reported binge drinking, cigarette smoking, and marijuana smoking in young adults

Objectives Evaluate the association between perceived risk of harm and self-reported binge drinking, cigarette smoking, and marijuana smoking among college students. Participants Participants were 599 students (ages 19–28) at a large Midwestern university recruited from October 2015 to December 2017. Methods Hurdle regression was used to test the relationship between perceived risk of harm from substance use (i.e., binge drinking, cigarette smoking, and marijuana smoking), and self-reported use. Demographic characteristics were tested as moderators of this relationship. Results Engagement in all three substance use behaviors was less likely when perceived risk was high. Age moderated the association between perceived risk and self-reported marijuana smoking with younger participants demonstrating a stronger relationship between perceived risk of smoking marijuana and self-reported marijuana smoking. Conclusion Intervention programs will be most effective when perceived risk of substance use is high. Therefore, intervention programs should aim to increase college students’ perceived risk of substance use.