Tobacco-related Health Research Articles

Tobacco-related health education in schools in seven EU cities

Tobacco-related health education in schools in seven EU cities

INTEGRATING TOBACCO HEALTH INTO MAINSTREAM PULMONARY CLINIC: A NOVEL APPROACH

SESSION TITLE: Tobacco Cessation and Prevention Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Tobacco related health conditions account for a large cohort of chronic health conditions. Tobacco/Nicotine users are currently stigmatized and hence find it difficult to seek treatment. Our institution has an electronic best practice advisory which automatically populates in all smokers identified in the electronic medical record and generates a referral to the QUIT line if patient is interested in quitting. However only 25% of these patients actually engage with the QUIT line. The Tobacco Health Assessment and Treatment (THAT) Clinic is a new initiative to integrate tobacco health into mainstream pulmonary health, 1:1 patient provider interaction, engaging patients who are interested in quitting and destigmatizing tobacco treatment. METHODS: There is 1: 1 pulmonologist, tobacco nurse and patient interaction. Patients evaluated for overall tobacco health: history and physical, the Fagerström Test for Nicotine Dependence(FTND), Framingham Risk Score, prior quit attempts, obstacles, environmental triggers and severity of tobacco dependence based on the ACCP Tobacco toolkit. PFT's ordered when appropriate.The toxic effects of tobacco, nature of the addiction, nicotine hijacking the survival instincts , countering ambivalence and helping patients bring the tobacco treatment and medication interactions with proposed tobacco treatment are discussed. Patients who are newly diagnosed with COPD , ILD, asthma, other pulmonary conditions are triaged appropriately to respective clinics. A comprehensive medication review, potential medication interactions with proposed tobacco treatment and potential side effects are discussed before offering therapy. The patients who qualify for lung cancer screening are referred to low-dose CT screening for lung cancer. RESULTS: 60 pts 70%-1 visit, 27% >2 visits. Mean age 58.5 yrs, 53% women & 82% African-American.(46%) high nicotine dependence using FTND, 80% multiple quit attempts . Common triggers :stress, depression, anxiety, proximity to smokers, boredom, staying home & coffee. Comorbidities - hypertension (63%), COPD (47%), and (18%) cancer. 20/60 patients -LDCT lung cancer screening. Median Maryland area deprivation index:9 (10- worst). 40/60 active follow up , 8 quit,12 trying to quit, 20 lost to follow up. All had follow-up outreach,-total of 640 encounters of which 81% tobacco health check-in .Common combinations-nicotine patch & lozenge/gum/inhaler; Chantix & lozenge/gum/inhaler; Chantix with nicotine patch & lozenge/gum/inhaler; or Wellbutrin with nicotine patch & lozenge/gum/inhaler.Compliance with controller& rescue medications, associated with higher quit / trying to quit rates. CONCLUSIONS: 30% patients have quit/cut down- higher success rate than many other initiatives. CLINICAL IMPLICATIONS: Integrating tobacco as mainstream pulmonary health condition & treating it as one. DISCLOSURES: No relevant relationships by Janaki Deepak, source=Web Response No relevant relationships by Julia Melamed, source=Web Response

Association of frequency of perceived exposure to discrimination with tobacco withdrawal symptoms and smoking lapse behavior in African Americans.

Frequent experiences of discrimination could increase vulnerability to tobacco withdrawal and smoking lapse in populations subject to tobacco-related health disparities. This laboratory study (2013-17) examined whether individual differences in perceived exposure to discrimination in one's daily life predicted tobacco withdrawal symptoms and smoking lapse behavior following acute tobacco deprivation in African American smokers. Mixed design with the between-subjects continuous variable of perceived discrimination crossed with the within-subject variable of tobacco deprivation status (deprived versus non-deprived). Academic medical center in Los Angeles, CA, USA. African American non-treatment seeking daily cigarette smokers (n=607, ≥10 cig/day). At a baseline visit, self-reported frequency of perceived exposure to discrimination in one's daily life was measured [everyday discrimination scale (EDDS)]. At two subsequent counterbalanced experimental visits (16-hour tobacco deprivation versus ad-libitum smoking), self-report assessments of various tobacco withdrawal symptom domains [Brief Questionnaire of Smoking Urges), Wisconsin Smoking Withdrawal Scale (WSWS), Profile of Mood States (POMS), Snaith-Hamilton Pleasure Scale (SHAPS) and Current Impulsivity Scale (CIS)) and a behavioral smoking lapse analogue task were measured. Adjusted models demonstrated that greater frequency of perceived exposure to discrimination was associated with larger deprivation-induced increases in acute urges to smoke to alleviate negative mood, several negative mood states and subjective cognitive functioning-effect sizes were small in magnitude (βs=0.09-0.13; Ps<0.02). Data were inconclusive for associations between perceived exposure to discrimination and deprivation-induced changes in cravings, urges to smoke for pleasure, positive mood reduction, other symptoms or smoking reinstatement behavior. Frequency of perceived exposure to discrimination appears to be modestly associated with increased severity of some deprivation-induced tobacco withdrawal symptoms in African American smokers.

Racial/Ethnic Differences in Associations of Non-cigarette Tobacco Product Use With Subsequent Initiation of Cigarettes in US Youths.

IntroductionUnderstanding which non-cigarette tobacco products precede smoking in youth across different racial/ethnic groups can inform policies that consider tobacco-related health disparities.MethodsWe used nationally representative, longitudinal data from the Population Assessment of Tobacco and Health Study waves 1–4. The sample was a dynamic cohort of cigarette-naïve youth aged 12–17 years. Mixed-effects models were used to assess non-cigarette product (e-cigarette, cigar product, or other product) use with cigarette use over 1-year intervals.ResultsOf the 28 788 observations pooled across waves 1–4, respondents were 48.7% non-Hispanic white, 13.9% non-Hispanic black, and 23.1% Hispanic. Odds of cigarette initiation over 1-year follow-up were higher among youth with prior use of e-cigarettes (odds ratio [OR], 2.76; 95% confidence interval [CI], 2.21–3.45), cigars (OR, 2.00; 95% CI, 1.42–2.80), or other products (OR, 1.66; 95% CI, 1.28–2.14) compared to never users. At the population level, 20.6% of cigarette initiation was attributable to e-cigarette use among white youth and 21.6% among Hispanic youth, while only 3.5% of cigarette initiation was attributable to e-cigarette use among black youth. In contrast, 9.1% of cigarette initiation for black youth was attributable to cigar use compared to only 3.9% for both white and Hispanic youth.ConclusionsPrior use of e-cigarettes, cigars, and other non-cigarette products were all associated with subsequent cigarette initiation. However, white and Hispanic youth were more likely to initiate cigarettes through e-cigarette use (vs. cigar or other product use), while black youth were more likely to initiate cigarettes through cigar use (vs. e-cigarette or other product use).ImplicationsOur findings suggest that previous studies on effects of non-cigarette tobacco products may overlook the critical role of cigar products as a pathway into cigarette smoking among US youth, particularly black youth. While our data support the importance of e-cigarette use as a pathway into smoking, regulatory actions aimed at addressing youth e-cigarette use alone may contribute to disparities in black versus white tobacco use and further exacerbate inequities in tobacco-related disease. Thus, contemporary policy development and discourse about the effects of non-cigarette tobacco products on cigarette initiation should consider cigar and other non-cigarette products as well as e-cigarettes.

How Much Progress Have We Made? Trends in Disparities in Tobacco Use.

IntroductionReducing tobacco-related health disparities has been a public health priority for more than 2 decades, yet disparities in cigarette use have remained steady or worsened. Less is known about how disparities in other tobacco products have changed over time. Our study examined trends in cigarette and other tobacco product use in Minnesota with the goal of informing efforts aimed at reducing disparities.MethodsWe examined tobacco use disparities as a function of education, income, and race across the Minnesota Adult Tobacco Survey results in 2010 (N = 7,057), 2014 (N = 9,304), and 2018 (N = 6,055). Tobacco use was captured by assessing past 30-day use of 4 tobacco products: cigarettes, cigars, e-cigarettes, and smokeless tobacco, plus combustibles (ie, cigarettes and/or cigars) and any tobacco (ie, use of any of the 4 products).ResultsAt each wave, those with lower income and education reported greater use of cigarettes, combustibles, and any tobacco than those with higher income and education. Black respondents were more likely to report cigar and combustibles use than White respondents in 2018, whereas White respondents were more likely to report smokeless tobacco use in 2014. We saw no significant wave-by-demographic interactions, suggesting that the magnitude of the disparity remained unchanged over time for any tobacco product.ConclusionSubstantial disparities in tobacco use remain across education, income, and race, even in a state such as Minnesota with a strong tobacco control program. Additional efforts are needed to close disparity gaps and reach endgame tobacco use targets for all subpopulations.

Smoking status and racial/ethnic disparities in youth exposure to tobacco advertising

Tobacco advertising exposure increases tobacco use among youth. Data were from a largely racial and ethnic minority sample (60% non-Hispanic (NH) Black/African American) of youth (13–18 years) who were nonsmokers susceptible to future tobacco use (n = 686) or current cigarette smokers (n = 674). Regression models tested associations between tobacco advertisement exposure and smoking status, and determined demographic correlates. Nearly all youth recalled seeing a tobacco advertisement (98%), which was associated with smoking (OR = 1.12; 95% CI = 1.08–1.15). Racial minority youth had higher exposure to tobacco advertising. Policies restricting advertisements for all tobacco products are essential for prevention efforts and may help decrease tobacco-related health disparities.

Campus tobacco control policies and cessation interventions in college students: a commentary calling for research and action to address tobacco-related health disparities.

Tobacco-related health disparities (TRHDs) have a significant impact on population health in the USA. Effectively preventing and controlling TRHDs among young adult populations require multiple prevention and cessation points, including within college/university contexts. This commentary addresses current campus tobacco control policies and cessation interventions for U.S. college students, with an emphasis on TRHDs and opportunities for research and research translation to reduce these disparities. This commentary is informed by literature published between 2010 and 2020 regarding (a) prevalence and impact of campus tobacco control policies; and/or (b) behavioral outcomes from cessation interventions for young adults attending colleges. Despite a doubling of college campuses adopting tobacco-free policies from 2012 to 2017, roughly two-thirds continue to operate without such policies. Few policies address alternative tobacco products (e.g., e-cigarettes, cigars/cigarillos, and hookah), and communication about and enforcement of existing policies is extremely limited. A broad range of cessation intervention strategies have targeted individuals in this age group, but with little focus on TRHDs and limited intervention dissemination. Importantly, college students representing populations at risk for TRHDs (e.g., racial/ethnic/sexual/gender minorities, low socioeconomic status) are less likely to be exposed to strong tobacco control policies or supports for cessation. There are untapped opportunities for behavioral medicine approaches to reduce TRHDs in college settings. Research findings regarding multilevel (policy, community-level, and individual-level) interventions must be translated to policy/practice in order to address tobacco use, particularly among vulnerable college student populations.

Modeling smoking-attributable mortality among adults with major depression in the United States

Tobacco-related health disparities disproportionately affect smokers with major depression (MD). Although tobacco simulation models have been applied to general populations, to date they have not considered populations with a comorbid mental health condition. We developed and calibrated a simulation model of smoking and MD comorbidity for the US adult population using the 2005–2018 National Surveys on Drug Use and Health. We use this model to evaluate trends in smoking prevalence, smoking-attributable mortality and life-years lost among adults with MD, and changes in smoking prevalence by mental health status from 2018 to 2060. The model integrates known interaction effects between smoking initiation and cessation, and MD onset and recurrence. We show that from 2018 to 2060, smoking prevalence will continue declining among those with current MD. In the absence of intervention, people with MD will be increasingly disproportionately affected by smoking compared to the general population; our model shows that the smoking prevalence ratio between those with current MD and those without a history of MD increases from 1.54 to 2.42 for men and from 1.81 to 2.73 for women during this time period. From 2018 to 2060, approximately 484,000 smoking-attributable deaths will occur among adults with current MD, leading to 11.3 million life-years lost. Ambitious tobacco control efforts could alter this trajectory. With aggressive public health efforts, up to 264,000 of those premature deaths could be avoided, translating into 7.5 million life years gained. This model can compare the relative health gains across different intervention strategies for smokers with MD.

Modelling the impact of menthol sales restrictions and retailer density reduction policies: insights from tobacco town Minnesota

IntroductionTobacco control policies focused on the retail environment have the potential to reduce tobacco use and tobacco-related health disparities through increasing direct and indirect costs. Recently, national and subnational governments...

Biopsychosocial mechanisms associated with tobacco use in smokers with and without serious mental illness

Smokers with serious mental illness (SMI) are less responsive to cessation treatments than those without SMI. In this study, we compared smokers with and without SMI on validated measures of biological and psychosocial factors associated with tobacco use. Smokers with (n = 58) and without SMI (n = 83) who were enrolled in parallel clinical trials were compared on measures of carbon monoxide (CO) exposure, nicotine exposure, tobacco-specific nitrosamine exposure, craving, smoking motives, affect, perceived stress, environmental exposure to smoke/smokers, respiratory symptoms, tobacco-related health risk perceptions, and whether they had received recent advice to quit smoking from a health care provider. Data were collected between 2013 and 2017 in Providence, Rhode Island, USA. Samples were compared using independent-sample t-tests and chi-squared tests. Smokers with SMI had higher CO, nicotine, and tobacco-specific nitrosamine exposure levels, greater cigarette dependence, higher craving, and higher scores on eight out of eleven smoking motives (p's < 0.05). Smokers with SMI reported more severe respiratory symptoms but lower perceived health risks of tobacco (p's < 0.05). These smokers were more likely to report having received advice to quit from a medical provider in the past 6 weeks (p < 0.05). Affect, stress, and exposure to smoke/smokers did not differ across samples. Our findings advance the understanding of the elevated smoking rates of people with SMI by comparing smokers with and without SMI on validated biopsychosocial measures. There is a need for interventions that reduce craving, reduce smoking motives, and increase risk awareness among smokers with SMI.

Tobacco-Related Health Disparities in Gender-Diverse Populations: A Call to Action

Transgender and nonbinary (TGNB) persons have profound and broad-ranging health disparities, smoking included. Existing evidence suggests that TGNB persons smoke more, suffer disproportionately fro...

Abstract A002: Leveraging resources through the Translational Research Institute to engage communities in tobacco-related health disparities research

Abstract Purpose: Cigarette smoking-attributable cancer mortality is highest among African Americans, who are disproportionately exposed to smoking and secondhand smoke (SHS). In 2016, 13.5% of African American women in the United States smoked compared to 19.8% of African American women in Arkansas. Comprehensive smoke-free policies in the home play a critical role in reducing tobacco exposures and increasing quitting, but policy implementation is often a challenge. This study describes the collaborative process used to engage community in providing feedback on study methods for a randomized trial designed to increase the implementation of smoke-free policies in the homes of African American women smokers who live in rural distressed counties in the Arkansas Delta. Methods: Four Community Review Boards (CRB) (n=38) were conducted in collaboration with the Translational Research Institute (TRI) at the University of Arkansas for Medical Sciences. CRBs are expert community panels who provide feedback on research studies. Our study team worked with TRI's Community Engagement (CE) Core and the CE and Dissemination Core of the Arkansas Center for Health Disparities to recruit African American women smokers aged 18-50 years to obtain input on our study methods. CRBs were co-facilitated by staff from April to June 2018 in rural AR counties. Staff obtained feedback on the collection of biologic samples; surveys; recruitment and retention; use of the tobacco Quitline; incentives; project name and logo; and volunteer board development. Results: CRB I experts felt comfortable with research staff collecting saliva samples from children in the home, but expressed concerns about providing blood or urine samples. Some experts preferred paper, while others preferred short computer-based surveys. None of the experts was interested in using the tobacco Quitline. CRB II experts expressed the need for community development activities (e.g., spa day, support groups) and monetary and nonmonetary incentives such as the nicotine patch. Experts emphasized the need to engage community women in recruitment efforts due to distrust of outsiders. CRB III experts suggested that we incentivize a volunteer board to assist with recruitment. Experts in CRB III and IV selected recruitment messages and delivery channels (e.g., flyers, word of mouth, Facebook). Experts prioritized recruitment activities brainstormed in CRB II, described how to organize the activities, and selected incentives (e.g., Walmart and Dollar General gift cards) and promotional items (e.g., tee-shirts). Experts in CRB IV identified a project name and logo (Families Rising to Enforce Smokefree Homes). An unintended consequence was that women participated in the CRBs because they wanted to quit smoking. Conclusions: CRBs are often a one-time event conducted by researchers seeking expert community opinions. Our repeated sessions conducted with TRI increased our knowledge of community needs, culture, and how to adapt our study methods to address community needs. Citation Format: Anna Huff Davis, Naomi Cottoms, Rachel Hale, Katherine Donald, Ping Ching Hsu, Margarete Kulik, Keneshia Bryant-Moore, Joseph Su, Nicola Spencer, Candace Ruffin, Yana Ivy, Pebbles Fagan. Leveraging resources through the Translational Research Institute to engage communities in tobacco-related health disparities research [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A002.

We are in This Together: Promoting Health Equity, Diversity, and Inclusion in Tobacco Research for Sexual and Gender Minority Populations.

Sexual and gender minority (SGM) individuals have higher tobacco use prevalence and consequently higher burden of tobacco-caused diseases, including cancer and cardiovascular disease compared with their heterosexual or cisgender counterparts. Yet, there is a critical gap in research focused on measuring SGM tobacco-related health disparities and addressing unmet needs of SGM individuals in the context of nicotine and tobacco research. In this commentary, we summarize recommendations discussed during a pre-conference workshop focused on challenges and opportunities in conducting SGM tobacco control research at the 2019 Society for Research on Nicotine and Tobacco Annual Meeting. Specifically, we recommend defining and measuring SGM identity in all nicotine and tobacco research routinely, using novel methods to engage a demographically diverse sample of the SGM population, and eliciting SGM community voices in tobacco control research. Addressing these critical research gaps will enable the scientific community to generate the data to fully understand and support SGM individuals in tobacco use prevention and cessation. Tobacco use and its consequences have become increasingly concentrated in disadvantaged groups, including sexual and gender minority (SGM) populations. Through concrete recommendations in this commentary, we aimed to promote health equity, diversity, and inclusion in tobacco research for SGM populations by urging the scientific community to consider expanding efforts to monitor and address tobacco-related health disparities of SGM populations within their respective research programs.

The effect of college attendance on young adult cigarette, e-cigarette, cigarillo, hookah and smokeless tobacco use and its potential for addressing tobacco-related health disparities

The goal of this study was to assess the effect of college attendance on tobacco use among young adults and across subpopulations with disparities in tobacco use. Using a cohort of US youth (<18 years) who aged into young adulthood (18–24 years) in the Population Assessment of Tobacco and Health (2013–14, 2015–16, n = 3619) and propensity score matching we estimated the effect of college attendance on past 30-day use of cigarettes, e-cigarettes, cigarillos, hookah and smokeless tobacco. In unmatched analysis, college attenders (vs. nonattenders) had lower risk of using any form of tobacco (Risk Difference (RD): −10.0; 95% CI: −13.2, −7.0), cigarettes (RD: −13.0; 95% CI: −15.4, −10.5), e-cigarettes (RD: −4.1; 95% CI: −6.8, −1.7), cigarillos (RD: −5.7; 95% CI: −7.6, −3.8), and smokeless tobacco (RD: −2.0; 95% CI: −3.4, −0.6), but not hookah (RD: −0.2; 95% CI: −2.1, 1.6). In matched analysis, these associations were all near-null, with the exception of cigarettes (matched RD: −7.1; 95% CI: −10.3, −3.9). The effect of college attendance on cigarette smoking was stable for all subpopulations we assessed including among those identifying as non-Hispanic Black or Lesbian, Gay or Bisexual as well as among those living in the South, Midwest or whose parents did not attend college. The results suggest that college attendance may reduce young adults' risk of cigarette smoking but may not reduce the risk of using other tobacco products.

Community-Led Action to Reduce Menthol Cigarette Use in the African American Community.

Background. African Americans suffer a disproportionate burden of tobacco harm and researchers have posited that menthol cigarettes are a key contributor to this disparity. In 2015, a county health department and African American community-based organization (CBO) in Minnesota partnered to educate and engage the African American community on menthol and its role in tobacco-related health disparities. The following case study describes successes, challenges, and recommendations from this work. We focus on the role of a public health and community partnership in menthol policy adoption so others can more effectively implement a community-driven approach in their own communities. Methods. Interviews were conducted with local and state public health staff, leadership from the CBO, youth coordinators, and change agents-that is, leaders in the African American community recruited to educate and engage the community on menthol. Interviews were transcribed verbatim and analyzed in Atlas.ti using thematic analysis. Results. Participants identified several successes: (1) assessment data from community members helped inform policy decision making, (2) collaboration between local public health and CBO was powerful and a key to success, and (3) change agents were trusted communicators and effectively engaged and provided education to the community. Participants faced challenges related to stylistic and cultural differences in communication. Participants recommended engaging youth and incorporating cessation into the broader context of issues systemically affecting African American communities (e.g., economic inequity, police violence, incarceration). Implications. Menthol tobacco restrictions have the potential to reduce tobacco-related health inequities for African Americans. Findings highlight the role that public health and community partnerships can play in supporting this critical work to effect policy change.

Truck Drivers' Cigarette Smoking and Preferred Smoking Cessation Methods.

Introduction:Some studies show that truck drivers use tobacco and other stimulants to stay awake as they drive. Despite their increased risks for many of tobacco-related health disparities, there is limited engagement of truck drivers in smoking cessation programs. The objective of this study was to describe smoking characteristics and identify their preferred smoking cessation methods among truck drivers.Methods:This was a cross-sectional mixed methods study. Participants were truck drivers recruited at trucking companies in Utah in 2019. Participants were either individually interviewed (n = 4), or filled out a survey (n = 33). We conducted qualitative data analysis of the interviews followed by descriptive statistics of smoking and cessation characteristics from the survey.Results:Reasons for smoking included, staying awake, stress reduction, or something to do while driving. Of the drivers surveyed, 68.8% were daily smokers while 97% had smoked at least 100 cigarettes in their life time. The mean number of cigarettes per day (cpd) was 15.7, and 25 among those who had 10 or more cpd. Sixty-one percent had made at least a quit attempt. In addition to counseling or brief advice, 68% reported interest in using Nicotine Replacement Therapy (NRT) either as gum or patch to help them quit. 21% reported interest in telephone text messaging to engage them in treatment.Conclusion:Cigarette smoking is a public health problem among truck drivers. Our findings suggest that truck drivers are interested in quitting smoking. Evidence based interventions tailored to this population are needed to help them quit and reduce their smoking-related morbidity.

Self-reported health problems of tobacco farmers in south-eastern Bangladesh

Poor farmers are cultivating tobacco because they can obtain great profit and support from tobacco companies. However, they overlook tobacco-related health problems and consequences. In this study, we explored the impact of tobacco farming on farmers’ health, drawing on an empirical study in seven villages of Ruposhipara union, Bandarban district in Bangladesh. Following a mixed research method, data were collected by administering 200 pre-tested structured questionnaires, five group discussions and five in-depth interviews. We also reviewed existing and proposed policies related to tobacco control in Bangladesh. We followed grounded theory for analysing qualitative data and conducted a Chi-square test to observe any significant associations for selected quantitative data. Farmers’ self-reported tobacco-related sicknesses were nausea, vomiting, dizziness, headache, weakness, cough, dyspnoea and hypersalivation. Children, women and older people were equally affected. They experienced diverse tobacco-related health problems at different stages of tobacco farming. Continuous contact with tobacco leaves and not using any safety measures had put the farmers at greater risk of tobacco sickness. The proposed “Tobacco Cultivation Control Policy, 2017” emphasised to provide necessary supports to farmers for growing alternative crops. Implementation of this policy would encourage farmers to give up harmful tobacco farming and lessen their health problems.

The Bacterial Communities of Little Cigars and Cigarillos Are Dynamic Over Time and Varying Storage Conditions.

Despite their potential importance with regard to tobacco-related health outcomes, as well as their hypothesized role in the production of tobacco-specific N-nitrosamines, bacterial constituents of tobacco products lack characterization. Specifically, to our knowledge, there has been no comprehensive characterization of the effects of storage conditions on the bacterial communities associated with little cigars and cigarillos. To address this knowledge gap, we characterized the bacterial community composition of the tobacco and wrapper components of the following four products: Swisher Sweets Original; Swisher Sweets, Sweet Cherry; Cheyenne Cigars Full Flavor 100’s; and Cheyenne Menthol Box. Each product was stored under three different conditions of temperature and relative humidity to mimic different user storage conditions: room (20°C 50% RH), refrigerator (5°C 18% RH) and pocket (25°C 30% RH). On days 0, 5, 9 and 14, subsamples were collected, the wrapper and tobacco were separated, and their total DNA was extracted separately and purified. Resulting DNA was then used in PCR assays targeting the V3 V4 region of the bacterial 16S rRNA gene, followed by sequencing using Illumina HiSeq 300bp PE. Resulting sequences were processed using the Quantitative Insights Into Microbial Ecology (QIIME) software package, followed by analyses in R using the Phyloseq and Vegan packages. A single bacterial phylum, Firmicutes, dominated in the wrapper subsamples whereas the tobacco subsamples were dominated by Proteobacteria. Cheyenne Menthol Box (CMB) samples were characterized by significant differential abundances for 23 bacterial operational taxonomic units (OTUs) in tobacco subsamples and 27 OTUs in the wrapper subsamples between day 0 and day 14 under all conditions. OTUs from the genera Acinetobacter and Bacillus significantly increased in the CMB tobacco subsamples, and OTUs from Bacillus, Streptococcus, Lactobacillus, and Enterococcus significantly increased in the CMB wrapper subsamples over time. These initial results suggest that the bacterial communities of little cigars and cigarillos are dynamic over time and varying storage conditions.

ES13.01 Tobacco Cessation and Cancer Patients

Smoking among cancer patients reduces the effectiveness of treatment, increases the risk of recurrence, and reduces survival time. One third of cancer patients continue smoking after diagnosis or during their treatment. Smoking is also common in patients with a cancer for which there is limited evidence for carcinogenicity of tobacco smoking. Cancer patients who smoke have greater risks, not only of the well-known tobacco-related health problems, such as cardiovascular and respiratory diseases and further cancers, but also unfavourable cancer treatment outcomes. There is sufficient evidence to infer a causal relationship between cigarette smoking and adverse health outcomes, including all-cause mortality, cancer-specific mortality and further primary tobacco-related cancers among cancer patients. Poorer cancer treatment outcomes linked to tobacco use by cancer patients re related to altered cancer biology, altered drug metabolism, increased treatment-related complications, and increased tobacco-related comorbidity. Although smoking cessation is associated with better outcomes, this key and cost-effective preventive strategy is rarely addressed in health care services. Barriers to incorporating tobacco cessation interventions into hospitals include lack of knowledge, expertise, time, and organizational constraints. In addition, many cancer patients show higher rates of nicotine dependence, low self-efficacy, and higher levels of depression. The existing data support the conclusion that continued smoking negatively affects cancer treatment outcomes including survival, recurrence and quality of life and that, by quitting smoking, patients with cancer have the potential to improve their cancer treatment outcomes. At the population-level, there is a need to establish a basic infrastructure to provide tobacco cessation services to cancer patients who smoke, sustainable funding should be identified and allocated to dedicated tobacco cessation services (e.g. quitlines, available treatment for tobacco cessation) as well as tobacco treatment training programmes for health-care providers. At the individual-level, motivational interventions addressed to recognize the cancer-specific risks of smoking do increase patients’ self-efficacy in quitting. Moreover, cessation using the "5 A’s model” provides good abstinence rates, and about 80% of smokers could be reached using this approach. smoking cessation, cancer patients, health outcomes

Uneven Access to Smoke-Free Laws and Policies and Its Effect on Health Equity in the United States: 2000-2019.

Tobacco control measures have played an important role in the reduction of the cigarette smoking prevalence among US adults.However, although overall smoking prevalence has declined, it remains high among many subpopulations that are disproportionately burdened by tobacco use, resulting in tobacco-related health disparities. Slow diffusion of smoke-free laws to rural regions, particularly in the South and Southeast, and uneven adoption of voluntary policies in single-family homes and multiunit housing are key policy variables associated with the disproportionate burden of tobacco-related health disparities in these subpopulations.Developing policies that expand the reach of comprehensive smoke-free laws not only will facilitate the decline in smoking prevalence among subpopulations disproportionately burdened by tobacco use but will also decrease exposure to secondhand smoke and further reduce tobacco-caused health disparities in the United States.