Self-reported Cigarette Research Articles

Using augmented reality to deliver cue exposure treatment for smoking cessation: App usability findings and protocol for a randomized controlled trial.

Augmented Reality (AR) is a rapidly developing technology with potential utility for treating addictive behaviors, including tobacco smoking. AR inserts digital images into a natural real-time scene as viewed on a smartphone or other video devices. With respect to smoking cessation, AR can place virtual smoking cues (i.e., smoking "triggers") within an individual's natural smoking environment. Repeated exposure to these cues could enhance smoking cessation through Pavlovian extinction processes. In a usability study (N=10), we evaluated the acceptability of a smoking cessation AR app to inform modifications to the app prior to an upcoming randomized controlled trial (RCT). For the subsequent RCT, individuals who enroll in a state tobacco quitline will be referred to the study and, if eligible and consented, randomized to use the app with AR features or without AR features (control) for 5weeks. The efficacy of the AR features to enhance smoking cessation in the context of concurrent quitline treatment will be evaluated with the primary outcome of self-reported 7-day point-prevalence cigarette abstinence at 6months post-enrollment. Implementation will be evaluated via incremental cost-effectiveness analyses and interviews with participants, quitline staff, and app coaches. Interventions utilizing emerging mobile technologies such as AR have the potential, compared to traditional therapies, to improve both reach and efficacy by administering therapeutic elements in users' natural environments. Our AR app will target tobacco smoking, but the approach could be used to deliver exposure therapies for other addictive behaviors, as well as anxiety disorders. NCT06088498.

Exposure to Bupropion-SR vs. Placebo is associated with reductions in smoking among persons receiving methadone with no stated interest in smoking cessation

Smoking is prevalent among individuals receiving methadone treatment. Reducing smoking among this population is needed as smoking is a leading cause of morbidity and preventable death. Smoking cessation interventions for persons receiving medication for opioid use disorder have yielded small changes in abstinence. Bupropion-SR was developed as an anti-depressant medication and is a first-line medication for smoking cessation. There is limited research on the effectiveness of bupropion-SR on smoking cessation among individuals receiving medication for opioid use disorder. This study is a secondary analysis of N = 72 adults enrolled in methadone treatment who endorsed smoking cigarettes. Participants were randomized to receive bupropion-SR 150 mg twice-daily (n = 35) or placebo (n = 37) in the primary study that examined bupropion-SR on cocaine use outcomes over a 30-weeks. Mixed model analyses examined secondary changes in self-reported cigarettes smoked, a self-reported measure of nicotine dependence, and quantitative urinary cotinine values. The longitudinal analysis of self-reported daily cigarettes identified no main effects of group and week however a significant interaction between group and week revealed that persons receiving bupropion-SR group reported less smoking early in the intervention. Longitudinal evaluation of changes in urinary cotinine revealed a significant main effect of week but no main effect of group or group x week interaction. Data suggest that bupropion-SR significantly decreased the number of self-reported cigarettes smoked relative to placebo and reduced nicotine dependence severity by the end of the study. Follow-up studies are needed as these decreases were not identified throughout the full study period or at termination.

The effects of tobacco 21 laws on smoking and vaping: Evidence from panel data and biomarkers

We use data from the Population Assessment of Tobacco Use and Health (PATH), a longitudinal data set including self-reported and biomarker measures of tobacco use, to examine the effects of state-level tobacco 21 (T21) laws on smoking and vaping. T21 laws reduce self-reported cigarette smoking among 18-to-20 year olds, concentrated in males. Initial non-users who “age-out” of treatment are less likely to subsequently initiate self-reported smoking or vaping. Treated smokers are less likely to buy their own cigarettes and more likely to buy cigarettes in a different state. Biomarker results are mixed, and we find some evidence of a reduction in nicotine exposure but less evidence for a reduction in exposure to tobacco. Finally, we test for non-classical measurement error. T21 laws reduce the probability that clinically identified likely cigarette smokers self-report as smokers, which may increase the apparent effect of T21 laws on cigarette smoking as measured by self-reports.

Smoking reduction using an electronic nicotine delivery system (ENDS) with nicotine delivery similar to combustible cigarettes

BackgroundElectronic nicotine delivery systems (ENDS) offer a promising approach to tobacco harm reduction, but many people use both ENDS and combustible cigarettes (“dual use”), which undermines potential risk reduction. To explore the role of ENDS nicotine delivery in promoting switching to ENDS, we conducted a study in which people who smoked cigarettes were offered an ENDS that had previously been shown to replicate the rapid nicotine pharmacokinetics of combustible cigarettes (BIDI® Stick).MethodsTwenty-five cigarette smoking adults, not seeking smoking cessation treatment, but open to using ENDS as a cigarette substitute, were provided with a 12-week supply of BIDI® Stick in tobacco or menthol flavors, during a study that included seven biweekly sessions and a 6-month follow-up. Daily diaries assessed ENDS and cigarette use, and exhaled carbon monoxide (eCO) served as an objective marker of smoke intake. Subjective ratings were collected to assess the rewarding properties of ENDS and combustible cigarettes, and indices of nicotine dependence.ResultsOver 12 weeks, ENDS use increased to an average of 15.8 occasions per day (SD = 20.2) and self-reported cigarette consumption decreased by 82% from 16.7 cigarettes/day (SD = 6.0) at baseline to 3.0 cigarettes/day (SD = 4.1) at week 12. The eCO level decreased by 27% from an average of 20.0 ppm (SD = 9.8) at baseline to 14.5 ppm (SD = 9.9) at week 12. Four of 25 participants completely switched to ENDS and were smoking abstinent during weeks 9–12. At 6 months one participant was confirmed to be abstinent. Ratings of subjective reward for the ENDS were very similar to those of participants’ usual brands of cigarettes. Dependence level was lower for the ENDS than for combustible cigarettes.ConclusionsIn this study, the ENDS effectively replicated the subjective rewarding effects of participants’ usual brands of cigarettes and led to a substantial reduction in reported cigarettes/day. Exhaled CO showed less of a decrease, possibly due to compensatory smoking behavior and/or the timing of eCO measurements that might not have reflected smoke intake throughout the day. The relatively low rate of sustained smoking abstinence at 6 months suggests that additional approaches continue to be needed for achieving higher rates of complete switching.Trial registrationClinicalTrials.gov identifier NCT05855343.

Evaluation of Periodontal Clinicoradiographic Status and Whol Salivary Prostaglandin E2 Levels among Users of Water Pipe and Cigarettes.

The objective was to evaluate the periodontal clinicoradiographic status and whole salivary prostaglandin E2 (PgE2) levels among users of water pipe and cigarettes. Demographic data, duration of smoking (pack years), and familial history of smoking were recorded using a questionnaire. Participants were allocated into three groups based on their smoking status: group 1: self-reported cigarette smokers (CS); group 2: self-reported water-pipe-users; and group 3: non-smokers. The assessment included measurements of full-mouth plaque and gingival indices (PI and GI), as well as probing depth (PD), clinical attachment loss (CAL), and marginal bone loss (MBL). Unstimulated whole saliva samples were collected and PgE2 levels were measured. Group comparisons were done and p<0.05 was considered statistically significant. Thirty-three, 34 and 33 individuals were included in groups 1, 2 and 3, respectively. Full mouth PI (p<0.05), GI (p<0.05), PD (p<0.05) and mesial (p<0.05) and distal (p<0.05) MBL were statistically significantly higher among patients in groups 1 and 2 than group 3. The scores of CAL in groups 1 and 2 were 3.45 ± 0.97 and 3.62 ± 1.2 mm, respectively. None of the individuals in the control group displayed CAL. PgE2 levels were statistically significantly higher among patients in groups 1 (231.5 ± 66.3 pg/ml) (p<0.05) and 2 (231.5 ± 66.3 pg/ml) (p<0.05) compared with group 3 (76.6 ± 10.6 pg/ml). In groups 1 and 2, a statistically significant relationship was observed between pack-years, the duration of water-pipe smoking, and the levels of PgE2 and PD. There is no difference in periodontal clinicoradiographic status and whole salivary PgE2 levels between CS and waterpipe-users; however, these parameters are worse in CS and water-pipe users than in non-smokers.

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.

Tobacco Images Choice and its Association With Craving and Dependence in People Who Smoke Cigarettes.

Increased salience of drug-related cues over nondrug reinforcers can drive drug use and contribute to tobacco use disorder (TUD). An important scientific and clinical goal is to effectively measure this elevated drug-seeking behavior in TUD. However, most TUD assessments rely on self-reported cravings and cigarette consumption, not providing an objective measure of the impact of drug cues on biasing behavior toward drugs. The probabilistic image choice (PIC) task investigates the choice of viewing drug-related pictures as compared to other salient pictures (eg, pleasant and unpleasant). This study aimed to develop and validate the PIC task for TUD and evaluate the associations between behavioral choice and tobacco craving, daily cigarette consumption, quit attempts and motivation to quit, and nicotine dependence (the Fagerström score). We recruited 468 smokers and 121 nonsmokers using the Prolific online platform. Participants performed the PIC task twice (at a 1-month interval) and completed other measures relevant to TUD. Compared to nonsmokers, tobacco smokers selected to view significantly more tobacco images and less pleasant (nondrug reinforcer) images, a profile that remained stable at retest. Individual differences in choice of tobacco as compared to pleasant images on the PIC task were associated with craving but not with the other tobacco dependence measures, suggesting that the task may serve as a behavioral proxy measure of drug "wanting" rather than of cumulative nicotine exposure or physical dependence. These results suggest that the PIC task can be a valuable tool for objectively assessing craving-associated tobacco seeking in TUD. Most of the current measures of TUD rely on self-reports of consumption, dependence, and craving, and do not take into consideration the role of drug-related cues in driving tobacco seeking. This study shows that the PIC task provides an objective, reliable proxy measure of tobacco image-seeking behavior in people who smoke cigarettes that is linked to craving (desire) for smoking but not to other measures of TUD. Therefore, the PIC task may be a useful complementary tool for the classification, diagnosis, and prognosis of TUD.

A Cross-Country Study of Cigarette Affordability and Single-Stick Purchases Using Survey Data From African Countries.

Reducing cigarette affordability is paramount for reducing cigarette consumption. Measuring affordability requires data on cigarette prices. Unlike the commonly used retail price of a 20-pack of the most-sold cigarette domestically, survey-derived cigarette prices reflect differences arising from the brand variety and the types of packaging in which cigarettes are purchased. This paper uses self-reported cigarette price data from the eight African countries that have implemented the Global Adult Tobacco Survey (GATS) to construct country-level Relative Income Prices. The relationship between cigarette affordability, cigarette smoking prevalence, and cigarette smoking intensity, is examined using logit models for smoking participation (N = 51122) and generalized linear models for conditional cigarette demand (N = 2443). GATS data are also used to produce nationally representative estimates of the prevalence of single-stick cigarette purchases in the sampled countries. The estimated affordability elasticity of cigarette smoking participation is -0.245 (95% CI = -0.411 to -0.078). The estimated affordability elasticity of smoking intensity is -0.155 (95% CI = -0.286 to -0.023). Single-stick cigarette sales dominate all-markets. The proportion of smokers who reported buying cigarettes in the form of single sticks during their most recent cigarette purchase exceeds 90% in Kenya, Tanzania, and Uganda. The results point to the need for governments in the countries sampled to increase excise taxes in a manner that renders cigarettes less affordable over time, and to enact and enforce legislation that prohibits the sale of single cigarettes. These findings highlight that measures to reduce both the demand and supply of cigarettes will be required to reduce their use in the region. This study is the first to examine the prevalence of single-stick cigarette purchases, and the association between cigarette affordability and smoking outcomes, in the African setting, using data from the GATS. Findings provide local evidence for the countries sampled, which represent over half of sub-Saharan Africa's adult population (aged 15 and older), on the importance of implementing excise tax increases that reduce cigarette affordability over time. They also highlight the need to enact and enforce legislation that prohibits the sale of single cigarettes.

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.

Beer taxes associate with lower alcohol and cigarette use; cigarette taxes associate with lower cigarette but higher alcohol use

ABSTRACT Background: There is a yet unmet opportunity to utilize data on taxes and individual behaviors to yield insight for analyzing studies involving alcohol and cigarette use. Objectives: To inform the direction and strength of their mutual associations by leveraging the fact that taxation can affect individual consumption, but individual consumption cannot affect taxation. Methods: We linked state-level data on cigarette and beer taxes in 2009–2020 with individual-level data on self-reported current cigarette and alcohol use from the Behavioral Risk Factor Surveillance System, a telephone survey by the Centers for Disease Control and Prevention that is representative of the population of each state in the United States. We constructed linear and logistic models to examine associations between a $1 increase in cigarette taxes per pack and a $1 increase in beer taxes per gallon and self-reported cigarette use and alcohol consumption (assessed as any current intake, average drinks/day, heavy drinking, and binge drinking), adjusting for survey year and individual characteristics. Results: Among 2,968,839,352 respondents (49% male), a $1 increase in beer taxes was associated with .003 (95% confidence interval [CI] −.013, .008) fewer drinks/day and lower odds of any drinking (odds ratio [OR] = .81 95%CI .80, .83), heavy drinking (OR = .96 95%CI .93, .99), binge drinking (OR = .82 95%CI .80, .83), and smoking (OR = .98 95%CI .96, 1.00). In contrast, a $1 increase in cigarette taxes was associated with lower odds of smoking (OR = .94 95%CI .94, .95) but .007 (95%CI .005, .010) more drinks/day, and higher odds of any drinking (OR = 1.10 95%CI 1.10, 1.11), heavy drinking (OR = 1.02 95%CI 1.01, 1.02), and binge drinking (OR = .82 95%CI .80, .83). Conclusion: Higher beer taxes were associated with lower odds of drinking and smoking, but higher cigarette taxes were associated with lower odds of smoking and higher alcohol consumption. These results suggest that alcohol intake may be a determinant of cigarette use rather than cigarette use as a determinant of alcohol intake.

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.

A randomized controlled trial of intermittent theta burst stimulation to the medial prefrontal cortex for tobacco use disorder: Clinical efficacy and safety

ObjectiveThis study aimed to evaluate the clinical efficacy and safety of administering intermittent theta burst stimulation (iTBS) to the medial prefrontal cortex for tobacco use disorder. MethodsA randomized sham-controlled trial was conducted, with 38 participants receiving 28 sessions of active (n=25) or sham (n=13) iTBS (2 sessions/day, 600 pulses/session, 110% resting motor threshold, AFz target) along with smoking cessation education (Forever Free © booklets) over 14 visits. Primary outcomes included self-reported cigarette consumption and abstinence, verified by urinary cotinine tests. Secondary outcomes included symptoms of tobacco use disorder, negative mood, and safety/tolerability. ResultsBoth active and sham groups reported reduced cigarette consumption (β = −0.12, p = 0.015), cigarette craving (β = −0.16, p = 0.002), and tobacco withdrawal symptoms (β = −0.05, p < 0.001). However, there were no significant time x group interaction effects for any measure. Similarly, the two groups had no significant differences in urinary cotinine-verified abstinence. Adverse events occurred with similar frequency in both groups. ConclusionThere were no differences in cigarette consumption between the active and sham iTBS groups, both groups decreased cigarette consumption similarly. Further research is needed to compare iTBS to standard high-frequency rTMS and explore the potential differences in efficacy. Despite limitations, this study contributes to experimental design considerations for TMS as a novel intervention for tobacco and other substance use disorders, emphasizing the need for a more comprehensive understanding of the stimulation parameters and target sites.

Tax revenue lost due to illicit cigarettes in South Africa: 2002−2022

ObjectiveTo estimate lost excise and value-added tax (VAT) revenue as a result of illicit cigarette trade from 2002 to 2022.DesignUsing gap analysis, we estimated the number of illicit cigarettes by...

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.

Unraveling neural complexity: Exploring brain entropy to yield mechanistic insight in neuromodulation therapies for tobacco use disorder

Abstract Neuromodulation therapies, such as repetitive transcranial magnetic stimulation (rTMS), have shown promise as treatments for tobacco use disorder (TUD). However, the underlying mechanisms of these therapies remain unclear, which may hamper optimization and personalization efforts. In this study, we investigated alteration of brain entropy as a potential mechanism underlying the neural effects of noninvasive brain stimulation by rTMS in people with TUD. We employed sample entropy (SampEn) to quantify the complexity and predictability of brain activity measured using resting-state fMRI data. Our study design included a randomized single-blind study with 42 participants who underwent 2 data collection sessions. During each session, participants received high-frequency (10 Hz) stimulation to the dorsolateral prefrontal cortex (dlPFC) or a control region (visual cortex), and resting-state fMRI scans were acquired before and after rTMS. Our findings revealed that individuals who smoke exhibited higher baseline SampEn throughout the brain as compared to previously-published SampEn measurements in control participants. Furthermore, high-frequency rTMS to the dlPFC but not the control region reduced SampEn in the insula and dlPFC, regions implicated in TUD, and also reduced self-reported cigarette craving. These results suggest that brain entropy may serve as a potential biomarker for effects of rTMS, and provide insight into the neural mechanisms underlying rTMS effects on smoking cessation. Our study contributes to the growing understanding of brain-based interventions for TUD by highlighting the relevance of brain entropy in characterizing neural activity patterns associated with smoking. The observed reductions in entropy following dlPFC-targeted rTMS suggest a potential mechanism for the therapeutic effects of this intervention. These findings support the use of neuroimaging techniques to investigate the use of neuromodulation therapies for TUD.

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).

Acute effects of outdoor and indoor walking on cigarette cravings, withdrawal symptoms and affective response during temporary smoking abstinence

RationaleCigarette smoking is one of the leading preventable causes of premature death worldwide. There is evidence in the literature that brief exercise units indoors can improve well-being in temporarily abstinent smokers and reduce cigarette cravings and withdrawal symptoms.ObjectiveBecause exercise in natural environments showed enhanced psychological effects, the aim of our study was to examine the acute effects of outdoor exercise compared with indoor exercise on craving, withdrawal symptoms and affective response in temporarily abstinent smokers.MethodsIn a randomized controlled within-subject-design, temporarily abstinent smokers (N = 16) participated in three interventions lasting 10 min: outdoor walking (OUT-EX), indoor walking (IN-EX) and a sedentary control condition (CC). Self-reported cigarette craving, withdrawal symptoms and affective response were assessed pre-, mid-, post-interventions and at follow-up.ResultsIn contrast to CC, OUT-EX and IN-EX significantly reduced cigarette cravings during and at the end of the intervention compared to pre-intervention, but not at 20 min follow-up. Cigarette withdrawal symptoms decreased significantly over time in all three groups, but no significant group differences were found. OUT-EX and IN-EX, but not CC, showed significantly improved affective valence at the end of the intervention and at follow-ups. Outdoor walking resulted in significantly lower cigarette cravings than indoor walking at the end of the intervention.ConclusionThe study adds to existing evidence that short bouts of indoor or outdoor exercise can help reduce cigarette cravings and increase well-being in abstinent smokers. Further studies are needed to address the potential additional effect of outdoor exercise on craving, affective states and smoking cessation.

Illicit cigarette market in Georgia: potential impacts on smoking prevalence and tax revenues

ObjectivesThis study aims to examine the impact of taxation measures implemented between 2017 and 2019 on the illicit cigarette market in Georgia and to assess the potential effects of its full elimination on smoking rates and tax revenues. Study designThis was a cross-sectional and observational study. MethodsThe study uses the gap analysis method to estimate the size of the illicit market by comparing self-reported cigarette consumption with tax-paid cigarette sales. Potential changes in cigarette consumption are calculated using estimates of price demand elasticity and the price difference between licit and illicit cigarettes. The applicable excise tax is then applied to the estimated change in licit cigarette consumption to determine the potential change in tax revenues. ResultsIn 2020, illicit cigarettes accounted for 6.4% of the market, which decreased to 0.6% in 2021. Eliminating the illicit cigarette market could potentially reduce the number of smokers by 0.5% in 2020 and 0.1% in 2021. It could also lead to a 2.8% increase in excise tax revenues in 2020 and a 0.2% increase in 2021. The study highlights a notable shift in consumer behavior since 2019 toward smoking roll-your-own (RYO) cigarettes. ConclusionsTax increases did not have a significant impact on the size of the illicit market in Georgia. The shift in consumer preference toward RYO cigarettes may explain why the illicit cigarette market did not expand after the tax hikes. However, this shift diminishes the effectiveness of taxation policies in reducing smoking rates and leads to a decline in excise tax collection.

Using varenicline in combination with electronic nicotine delivery systems (ENDS)

BackgroundVarenicline is efficacious for smoking cessation, but a return to smokingusually occurs after treatment ends. Electronic nicotine delivery systems (ENDS) may enhance smoking reduction and cessation by providing a behavioral substitute for smoking and may deter smoking in the long term if an individual's nicotine dependence can be transferred to ENDS. The goal of this study was to evaluate varenicline in conjunction with ENDS to promote switching to ENDS. MethodsTwenty-five individuals who smoked cigarettes, interested in switching but not seeking cessation treatment, received ENDS for 13 weeks; during weeks 2–13 they received varenicline. Assessments included self-reported cigarette and ENDS use, expired air carbon monoxide (CO), reward ratings, tolerability/side effects, and dependence measures. ResultsCigarette smoking decreased from 15.6 cigarettes/day (SD=5.6) at baseline to 2.8 cigarettes/day (SD=5.1) at week 13 (paired t(22)=10.24, p<0.0001). 28% of participants were confirmed to be abstinent in the last 4 weeks of treatment. ENDS use remained relatively constant, averaging 11.8 occasions per day (SD=10.6). Cigarette dependence (assessed by time to first use of the day) decreased after introduction of ENDS (paired t(23) = −3.27, p=0.003), and again after the first week of full-dose varenicline (paired t(23) = −4.27, p=0.0003). Dependence on ENDS did not change, starting out lower than cigarettes (paired t(21) = 5.52, p<0.0001), but ending higher (paired t(22) = 2.94, p=0.008). Smoking satisfaction declined markedly, while satisfaction for ENDS remained relatively constant. Treatment tolerability and adherence were high. ConclusionsENDS in combination with varenicline shows promise as a means to reduce dependence on cigarettes and facilitate switching from cigarettes to ENDS.

Smoking reduction using electronic nicotine delivery systems in combination with nicotine skin patches

RationaleElectronic nicotine delivery systems (ENDS) are used by smokers seeking to reduce combustible cigarette (CC) use, but the role of nicotine replacement vs. behavioral and sensory factors is still poorly understood. We hypothesized that providing nicotine from ENDS in addition to nicotine skin patches would promote smoking reduction relative to non-nicotine control ENDS.ObjectivesTo assess the effects on smoking behavior of using nicotine vs. placebo ENDS in smokers using nicotine vs. placebo patches.MethodsNinety-four daily smokers were enrolled in a study that randomly assigned them to receive ENDS with nicotine vs. without nicotine and skin patches with vs. without nicotine. Smoking reduction and cessation were assessed over an 8-week period by self-report and by expired air carbon monoxide (CO) measurements. The primary outcome was defined as reduction in expired air CO.ResultsThe use of nicotine in ENDS led to significant reductions in smoking (ENDS nicotine vs. placebo difference in CO change = −9.2 ppm; 90% CI (−1.5 ppm, −16.9 ppm)) and was highly correlated with reductions in self-reported cigarettes per day (r=0.6). The effect of nicotine in nicotine patches was not statistically significant (patch nicotine vs. placebo difference in CO change = −0.1 ppm; 90% CI (−7.8 ppm, 7.6 ppm)).ConclusionsThe presence of nicotine in ENDS was associated with a large reduction in smoking. Additional studies will be needed to determine whether there may be additive effects of nicotine ENDS and nicotine patches on smoking abstinence.