Scientific Journal Articles
Showing 1-25 of 237 Results
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East, et al. 2024. Noticing education campaigns or public health messages about vaping among youth in the US, Canada, and England from 2018 to 2022 [show abstract ▼] [hide abstract ▲] [access full article]
Citation
East, K.A., Taylor, E., Simonavicius, E., Nottage, M., Burkhalter, R., Brose, L.S., Wackowski, O.A., Liber, A.C., McNeill, A., Hammond, D. (2024). Noticing education campaigns or public health messages about vaping among youth in the US, Canada, and England from 2018 to 2022. Health Education Research, 39(1), 12-28. doi: 10.1093/her/cyad044.
Abstract
Public health campaigns have the potential to correct vaping misperceptions. However, campaigns highlighting vaping harms to youth may increase misperceptions that vaping is equally/more harmful than smoking. Vaping campaigns have been implemented in the United States and Canada since 2018 and in England since 2017 but with differing focus: youth vaping prevention (United States/Canada) and smoking cessation (England). We therefore examined country differences and trends in noticing vaping campaigns among youth and, using 2022 data only, perceived valence of campaigns and associations with harm perceptions. Seven repeated cross-sectional surveys of 16–19 year-olds in United States, Canada and England (2018–2022, n = 92 339). Over half of youth reported noticing vaping campaigns, and noticing increased from August 2018 to February 2020 (United States: 55.2% to 74.6%, AOR = 1.21, 95% CI = 1.18-1.24; Canada: 52.6% to 64.5%, AOR = 1.13, 1.11-1.16; England: 48.0% to 53.0%, AOR = 1.05, 1.02-1.08) before decreasing (Canada) or plateauing (England/United States) to August 2022. Increases were most pronounced in the United States, then Canada. Noticing was most common on websites/social media, school and television/radio. In 2022 only, most campaigns were perceived to negatively portray vaping and this was associated with accurately perceiving vaping as less harmful than smoking among youth who exclusively vaped (AOR = 1.46, 1.09-1.97). Consistent with implementation of youth vaping prevention campaigns in the United States and Canada, most youth reported noticing vaping campaigns/messages, and most were perceived to negatively portray vaping.
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Li, et al. 2023. Future nicotine use preferences of current cigarette smokers: Findings from the 2020 International Tobacco Control Four Country Smoking and Vaping Survey [show abstract ▼] [hide abstract ▲] [access full article]
Citation
Li, L., Borland, R., Le Grande, M., & Gartner, C. (2024). Future nicotine use preferences of current cigarette smokers: Findings from the 2020 International Tobacco Control Four Country Smoking and Vaping Survey. Drug and Alcohol Review. 43(2), 359-370. doi: 10.1111/dar.13791.
Abstract
Introduction: Consumer preferences should be important factors that are considered when developing health policies and interventions. This paper examines the prevalence of, and factors associated with, consumer preferences regarding smoking behaviour 1 to 2 years in the future.
Methods: At least weekly cigarette smokers in the 2020 wave of the International Tobacco Control Four Country Smoking and Vaping Survey (USA, Canada, England and Australia) (N=8642) were asked if they preferred to continue to smoke or to quit with or without an alternative nicotine product (ANP) over the next 1–2 years.
Results: Country-specific weighted data showed 21.5% preferred to continue smoking and 8.0% were uncertain, leaving 70.6% preferring to quit: 13.7% using an ANP and 56.9% completely quitting nicotine. Apart from interest in quitting, the main predictors of preferring to quit were history of vaping, being aged 55 and over, smoking weekly, worrying about smoking harms, regretting starting and believing vaping is less harmful relative to smoking. Among those preferring to quit, preferring to use ANPs in future was very strongly associated with current vaping (especially daily), being younger, living in England, reporting strong urges to smoke, believing vaping is much less harmful than smoking, and not strongly regretting starting to smoke, and not wanting to quit.
Discussion and Conclusions: A significant minority of smokers preferred not to quit, at least in the next year or two. Both interest in quitting and preference for ANPs over complete cessation were associated with similar covariates, including interest in vaping.
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Fairman, et al. 2023. Support for nicotine reduction in cigarettes: Findings from the 2016 and 2020 ITC Four Country Smoking and Vaping Surveys [show abstract ▼] [hide abstract ▲] [access full article]
Citation
Fairman, R.T., Cho, Y., Popova, L., Cummings, K.M., Smith, T., Fong, G.T., Gravely, S., Borland, R., McNeill, A., Gartner, C., Morphett, K., Thrasher, J.F. (2023). Support for nicotine reduction in cigarettes: Findings from the 2016 and 2020 ITC Four Country Smoking and Vaping Surveys. Tobacco Control, [Published online Dec 8, doi: 10.1136/tc-2023-058128].
Abstract
Introduction: The USA and New Zealand have sought to establish a product standard to set a maximum nicotine level for cigarettes to reduce their addictiveness. This study examined support for very low nicotine cigarettes (VLNCs) in Australia, Canada, England and the USA between 2016 and 2020.
Methods: Repeated cross-sectional data were analysed from participants who currently smoke, formerly smoked or vaped and/or currently vape in the 2016 (n=11?150) and/or 2020 (n=5432) International Tobacco Control (ITC) Four Country Smoking and Vaping Survey. Respondents were asked if they would support a law that reduces the amount of nicotine in cigarettes to make them less addictive. Adjusted and weighted logistic regression analyses estimated the prevalence and predictors of support, such as country, age, sex, education, income, race and smoking/vaping status for VLNCs (support vs oppose/do not know).
Results: A majority of respondents supported a VLNC law, with support highest in Canada (69%; 2016 and 2020 combined), followed by England (61%), Australia (60%) and the USA (58%). Overall, support decreased from 62% in 2016 to 59% in 2020 (p=0.004), which did not differ by country. Levels of support differed by smoking/vaping status, where those who exclusively smoked daily showed the lowest level of support (59%) and those who exclusively vaped non-daily had the highest level of support (72%).
Conclusion: More than half of respondents in all four countries—including those who smoked daily—supported a hypothetical VLNC standard to render cigarettes less addictive. It is important to examine if support is sustained after policies are implemented.
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Gravely, et al. 2023. Associations of cannabis use, high-risk alcohol use, and depressive symptomology with motivation and attempts to quit cigarette smoking among adults: Findings from the 2020 ITC Four Country Smoking and Vaping Survey [show abstract ▼] [hide abstract ▲] [access full article]
Citation
Gravely, S., Driezen, P., Shahab, L., McClure, E., Hyland, A., Cummings, K.M., East, K.A., Chan, C.K.G., Walsh, H., Benowitz, N.L., Gartner, C., Fong, G.T., Quah, A.C.K., Smith, D.M. (2023). Associations of cannabis use, high-risk alcohol use, and depressive symptomology with motivation and attempts to quit cigarette smoking among adults: Findings from the 2020 ITC Four Country Smoking and Vaping Survey. International Journal of Mental Health and Addiction, [Published online Dec 14, doi: 10.1007/s11469-023-01214-8 ].
Abstract
This study assessed independent and interaction effects of the frequency of cannabis use, high-risk alcohol use, and depressive symptomology on motivation and attempts to quit cigarette smoking among adults who regularly smoked. Cross-sectional data are from the 2020 International Tobacco Control Four Country Smoking and Vaping Survey and included 7044 adults (ages 18 + years) who smoked cigarettes daily in Australia (n = 1113), Canada (n = 2069), England (n = 2444), and the United States (USA) (n = 1418). Among all respondents, 33.1% of adults reported wanting to quit smoking “a lot,” and 29.1% made a past-year quit attempt. Cannabis use was not significantly associated with either outcome (both p ≥ 0.05). High-risk alcohol use was significantly associated with decreased odds of motivation to quit (p = 0.02) and making a quit attempt (p = 0.004). Depressive symptomology was associated with increased odds for both outcomes (both p < 0.001). There were no significant 2- or 3-way interactions between cannabis use, alcohol consumption, and depressive symptomatology. Overall, just over a quarter of adults who smoked daily reported making a recent quit attempt, and most were not highly motivated to quit. Longitudinal research should investigate whether there are linkages between cannabis use, risky alcohol consumption, and/or depression on successful long-term smoking cessation.
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Roberson, et al. 2023. Trends in e-cigarette and tobacco cigarette purchasing behaviors by youth in the United States, Canada, and England, 2017-2022 [show abstract ▼] [hide abstract ▲] [access full article]
Citation
Roberson, A., Cummings, K.M., Reid, J.L., Burkhalter, R., Gravely, S., East, K.A., Thrasher, J.F., Hammond, D. (2023). Trends in e cigarette and tobacco cigarette purchasing behaviors by youth in the United States, Canada, and England, 2017 2022. International Journal of Public Health , [Published online Nov 14, doi: 10.3389/ijph.2023.1606234].
Abstract
Objectives: This paper describes trends in youth e-cigarette (EC) and tobacco cigarette (TC) purchasing behaviors in Canada, England, and the United States (US) in relationship to changing minimum legal age (MLA)
Methods: Data are from eight cross-sectional online surveys among national samples of 16 to 19 year olds in Canada, England, and the US conducted from 2017 to 2022 (N = 104,467). Average wave percentage change in EC and TC purchasing prevalence and purchase locations were estimated using Joinpoint regressions.
Results: EC purchasing increased between 2017 and 2022, although the pattern of change differed by country. EC purchasing plateaued in 2019 for the US and in 2020 for Canada, while increasing through 2022 for England. TC purchasing declined sharply in the US, with purchasing from traditional retail locations declining, while purchasing from social sources increased. Vape shops were the most common location for EC purchasing, although declining in England and the US.
Conclusion: Trends in EC and TC purchasing trends in the US are consistent with the expected impact of the federal MLA law increasing the legal age to 21 years in December 2019.
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Kyriakos, et al. 2023. Optimising a product standard for banning menthol and other flavours in tobacco products [show abstract ▼] [hide abstract ▲] [access full article]
Citation
Kyriakos, C.N., Chung-Hall, J., Craig, L.V., Fong, G.T. (2023). Optimizing a product standard for banning menthol and other flavors in tobacco products: Implications for the United States and other countries. Tobacco Control, [Published online Nov 9, doi: 10.1136/tc-2023-058174].
Abstract
In this paper, we highlight key issues that policymakers should consider when developing a product standard banning menthol and other flavors in tobacco products based on research evidence and experiences learned from other countries. A flavor product standard may be optimized by (1) having a clear and comprehensive definition of flavor that includes a complete ban on additives that have flavor properties and/or evoke sensory/cooling effects (i.e., menthol analogues and synthetic coolants that stimulate the cooling receptor of the brain) rather than only as a “characterizing flavor”, and (2) applying the standard to all tobacco product categories as well as all components or parts of the tobacco product (i.e., the tobacco, filter, wrapper, or paper), including separate flavorings that can be added to the product.
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Hammond, et al. 2023. Trends in vaping and nicotine product use among youth in Canada, England and the USA between 2017 and 2022: evidence to inform policy [show abstract ▼] [hide abstract ▲] [access full article]
Citation
Hammond, D., Reid, J.L. (2023). Trends in vaping and nicotine product use among youth in Canada, England and the USA between 2017 and 2022: evidence to inform policy. Tobacco Control, [Published online Nov 8, doi: 10.1136/tc-2023-058241].
Abstract
Background: Preventing uptake of nicotine products among youth remains a central objective of tobacco control policy. Comparing trends in the use of nicotine across countries provides an opportunity to identify emergent product trends and to evaluate ‘natural experiments’ in policies.
Methods: Repeat cross-sectional data were analysed from eight waves of the International Tobacco Control Youth Tobacco and Vaping Survey, conducted between 2017 and 2022. Non-probability samples of youth aged 16–19 years in Canada, England and the USA (N=104?473) completed online surveys including measures on vaping, smoking and use of other nicotine products. This paper summarises findings across the 5-year period of the study, as part of a comprehensive report on key indicators of youth vaping in the three countries.
Results: The youth nicotine market has rapidly evolved across the three countries, with different patterns of combustible and non-combustible product use in Canada, the USA and England. These changes are primarily attributable to trends in youth vaping: following declines during the initial COVID-19 pandemic period, by 2022, vaping prevalence neared pre-pandemic levels in the USA and Canada, and reached record highs in England. Notable shifts also occurred in the types of vaping products used by youth, including increased use of disposable, nicotine salt-based products. Additional findings are reported on a range of policy-relevant indicators, including for vaping products, promotions and purchasing.
Conclusions: Patterns of nicotine use among youth have rapidly evolved in recent years due to the proliferation of nicotine products, the COVID-19 pandemic and the emerging impact of policy measures.
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King, et al. 2023. Associations between smokers’ knowledge of causes of smoking harm and related beliefs and behaviors: Findings from the International Tobacco Control (ITC) Four Country Smoking and Vaping Survey [show abstract ▼] [hide abstract ▲] [access full article]
Citation
King B, Borland R, Le Grande M, Diaz D, O’Connor R, et al. (2023) Associations between smokers’ knowledge of causes of smoking harm and related beliefs and behaviors: Findings from the International Tobacco Control (ITC) Four Country Smoking and Vaping Survey. PLOS ONE 18(10): e0292856. https://doi.org/10.1371/journal.pone.0292856
Abstract
Background: Most smokers know that smoking is harmful to health, but less is known about their understanding of what causes the harms. The primary aim was to examine smokers’ perceptions of the relative contributions to smoking-related morbidity from combustion products, nicotine, other substances present in unburned tobacco, and additives. A secondary aim was to evaluate the association of these perceptions with nicotine vaping product use intentions, and quitting motivation/intentions.
Methods: Participants were current smokers and recent ex-smokers from Australia, Canada, England and the United States (N = 12,904, including 8511 daily smokers), surveyed in the 2018 International Tobacco Control Four Country Smoking and Vaping Survey. Respondents reported on how much they thought combustion products, nicotine, chemicals in the tobacco and additives in cigarettes contribute to smoking-related morbidity (none/very little; some but less than half; around half; more than half; all or nearly all of it; don’t know).
Results: Overall, 4% of participants provided estimates for all four component causes that fell within the ranges classified correct, with younger respondents and those from England most likely to be correct. Respondents who rated combustion as clearly more important than nicotine in causing harm (25%) were the least likely to be smoking daily and more likely to have quit and/or to be vaping. Among daily smokers, all four cause estimates were independently related to overall health worry and extent of wanting to quit, but the relative rating of combustion compared to nicotine did not add to prediction. Those who answered ‘don’t know’ to the sources of harm questions and those suggesting very little harm were consistently least interested in quitting.
Conclusions: Most smokers’ knowledge of specific causes of harm is currently inadequate and could impact their informed decision-making ability.
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Cho, et al. 2023. Tobacco purchasing in Australia during regular tax increases: findings from the International Tobacco Control Policy Evaluation Project [show abstract ▼] [hide abstract ▲] [access full article]
Citation
Cho, A., Scollo, M., Chan, C.K.G., Driezen, P., Hyland, A., Shang, C., Gartner, C. (2023). Tobacco purchasing in Australia during regular tax increases: findings from the International Tobacco Control Policy Evaluation Project. Tobacco Control, [Published online Aug 31, doi: 10.1136/tc-2023-058130].
Abstract
Objective: We examined Australian tobacco purchasing trends, the average self-reported price paid within each purchase type and the association between type of tobacco product purchased and participant characteristics, including quit intentions, between 2007 and 2020.
Methods: We analysed data collected from adults who smoked factory-made and/or roll-your-own (RYO) cigarettes in nine waves (2007–2020) of the International Tobacco Control Policy Evaluation Project Australia Survey (nsample =5452, nobservations =11 534). The main outcome measures were type of tobacco products purchased: RYO, carton, pack or pouch size and brand segment. Logistic regression, fit using generalised estimating equations, was estimated the association between the outcome and participant characteristics.
Results: The reported price-minimising purchasing patterns increased from 2007 to 2020: any RYO (23.8–43.9%), large-sized pack (2007: 24.0% to 2016: 34.3%); shifting from large-sized to small-sized packs (2020: 37.7%), and economy brand (2007: 37.2% to 2020: 59.3%); shifting from large (2007: 55.8%) to small economy packs (2014: 15.3% to 2020: 48.1%). Individuals with a lower income, a higher nicotine dependence level and no quit intention were more likely to purchase RYO and large-sized packs.
Conclusion: RYO, large-sized packs and products with a low upfront cost (eg, small RYO pouches and small-sized economy brand packs) may appeal to people on low incomes. Australia’s diverse tobacco pack and pouch sizes allow the tobacco industry to influence tobacco purchases. Standardising pack and pouch sizes may reduce some price-related marketing and especially benefit people who have a low income, are highly addicted and have no quit intention.
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Chung-Hall, et al. 2023. U.S. Food and Drug Administration must ban menthol cigarettes without delay: Lessons from other countries [show abstract ▼] [hide abstract ▲] [access full article]
Citation
Chung-Hall, J., Craig, L.V., Kyriakos, C.N., Fong, G.T. (2023). U.S. Food and Drug Administration must ban menthol cigarettes without delay: Lessons from other countries. American Journal of Preventive Medicine, 65(6), 1192-1195. doi: 10.1016/j.amepre.2023.08.001.
Abstract
No abstract.
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Simonavičius, et al. 2023. Impact of e-liquid packaging on vaping product perceptions among youth in England, Canada, and the United States; a randomised online experiment [show abstract ▼] [hide abstract ▲] [access full article]
Citation
Simonavicius, E., East, K.A., Taylor, E., Nottage, M., Reid, J.R., Arnott, D., Bunce, , McNeill, A., Hammond, D. (2023). Impact of e-liquid packaging on vaping product perceptions among youth in England, Canada, and the United States: a randomised online experiment. Nicotine and Tobacco Research, 26(3), ntad144. doi: 10.1093/ntr/ntad144.
Abstract
Introduction: Vaping is not risk-free but can help those who smoke to reduce harm to health and stop smoking. However, packaging of vaping products, including e-liquids, appeals to youth and might facilitate vaping among nicotine-naïve people. Standardised packaging of vaping products could moderate the appeal of vaping among youth. This study assessed how youth interest in trying and perceived health harms of using eliquids are associated with branded or standardised (white or olive) e-liquid packaging with different nicotine levels displayed.
Methods: A between-subject experiment with 3 packaging and 2 nicotine level conditions included youth (n=13801) aged 16 to 19 from England, Canada and the United States as a part of a crosssectional online survey in August-September 2021. Participants' interest in trying and perceived harm of e-liquids were analysed using logistic and multinomial regressions adjusted for age, sex, race/ethnicity, country, vaping and smoking status.
Results: Compared with branded e-liquid packs, more youth reported no interest in trying eliquids in white (aOR=1.48, 95% CI=1.34-1.64) or olive (aOR=1.62, 95% CI: 1.47-1.80) standardised packs. Compared with branded eliquid packs, more youth inaccurately perceived eliquids in white (aOR=1.22, 95% CI: 1.11-1.34) or olive (aOR=1.29, 95% CI: 1.18-1.41) standardised packs as equally or more harmful than smoking. E-liquid nicotine levels displayed on packs were not associated with youth interest in trying or harm perceptions of using eliquids.
Conclusion: Among 16- to 19-year-old youth from England, Canada and the US, standardised packaging of e-liquids was associated with lower interest in trying and higher health risk perceptions.
Implications: Branded packaging of vaping products appeals to youth and might prompt nicotine use among those who had never smoked. This study suggests that restricting branding elements on e-liquid packaging is associated with youth lower interest in trying e-liquids and higher misperceptions that vaping is equally or more harmful than smoking. Standardised packaging might reduce appeal of vaping among youth, but its potential to discourage vaping for harm reduction should also be considered.
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Levy, et al. 2023. Comparison of smoking prevalence in Canada before and after nicotine vaping product access using the SimSmoke model [show abstract ▼] [hide abstract ▲] [access full article]
Citation
Levy, D.T., Cadham, C., Yuan, Z., Li, Y., Gravely, S., Cummings, K.M. (2023). Comparison of smoking prevalence i n Canada before and after nicotine vaping product access using the SimSmoke model. Canadian Journal of Public Health, 114(6), 992-1005. doi: 10.17269/s41997-023-00792-3.
Abstract
Objectives: The public health impact of nicotine vaping products (NVPs) is subject to complex transitions between NVP and cigarette use. To circumvent the data limitations and parameter instability challenges in modeling transitions, we indirectly estimate NVPs impact on smoking prevalence and resulting smoking attributable deaths using the SimSmoke simulation model.
Methods: Canada SimSmoke uses age and sex specific data on Canadian population, smoking prevalence and tobacco control policies. The model incorporates the impact of cigarette oriented policies on smoking prevalence but not the explicit contribution of NVPs. Th e model was calibrated from 1999 to 2012, thereby projecting smoking prevalence before NVPs were widely used in Canada. The NVP impact on smoking prevalence is inferred by comparing projected 2012 2020 smoking trends absent NVPs to corresponding trends fro m two Canadian national surveys. We further distinguish impacts before and after NVPs became regulated in 2018 and more available.
Results: Comparing 2012-2020 survey data of post NVP to SimSmoke projected smoking prevalence trends, one survey indicated a n NVP related relative reduction of 15% (15%) for males (females) age 15+, but 32% (52%) for those ages 15 24. The other survey indicated a 14% (19%) NVP related smoking reduction for ages 18+, but 42% (53%) for persons ages 18 24. Much of the gain occurre d since Canada relaxed NVP restrictions. NVP related 2012 2020 smoking reductions yielded 100,000 smoking attributable deaths averted from 2012 to 2060. Conclusion: Smoking prevalence in Canada, especially among younger adults, declined more rapidly once NVPs became readily available. The emergence of NVPs into the Canadian marketplace has not slowed the decline in smoking.
Conclusion: Smoking prevalence in Canada, especially among younger adults, declined more rapidly once NVPs became readily available. The emergence of NVPs into the Canadian marketplace has not slowed the decline in smoking.
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Tildy, et al. 2023. Self-reported depression and anxiety and healthcare professional interactions regarding smoking cessations and nicotine vaping: Findings from 2018 International Tobacco Control (ITC) Four Country Smoking and Vaping Survey [show abstract ▼] [hide abstract ▲] [access full article]
Citation
Tildy, B., McNeill, A., East, K.A., Gravely, S., Fong, G.T., Cummings, K.M., Borland, R., Chan, C.K.G., Lim, C., Gartner, C., Yong, H.H., Brose, L.S. (2023). Self-reported depression and anxiety and healthcare professional interactions regarding smoking cessations and nicotine vaping: Findings from 2018 International Tobacco Control (ITC) Four Country Smoking and Vaping Survey. Tobacco Prevention & Cessation, 9(August), 26. doi: 10.18332/tpc/168288.
Abstract
Introduction: People with mental health conditions are disproportionately affected by smoking-related diseases and death. The aim of this study was to assess whether health professional (HP) interactions regarding smoking cessation and nicotine vaping products (NVPs) differ by mental health condition.
Methods: The cross-sectional 2018 International Tobacco Control Four Country (Australia, Canada, England, United States) Smoking and Vaping Survey data included 11040 adults currently smoking or recently quit. Adjusted weighted logistic regressions examined associations between mental health (self-reported current depression and/or anxiety) and visiting a HP in last 18 months; receiving advice to quit smoking; discussing NVPs with a HP; and receiving a recommendation to use NVPs.
Results: Overall, 16.1% self-reported depression and anxiety, 7.6% depression only, and 6.6% anxiety only. Compared with respondents with no depression/anxiety, those with depression (84.7%, AOR=2.65; 95% CI: 2.17–3.27), anxiety (82.2%, AOR=2.08; 95% CI: 1.70–2.57), and depression and anxiety (87.6%, AOR=3.74; 95% CI: 3.19–4.40) were more likely to have visited a HP. Among those who had visited a HP, 47.9% received advice to quit smoking, which was more likely among respondents with depression (AOR=1.58; 95% CI: 1.34–1.86), and NVP discussions were more likely among those with depression and anxiety (AOR=1.63; 95% CI: 1.29–2.06). Of the 6.1% who discussed NVPs, 33.5% received a recommendation to use them, with no difference by mental health.
Conclusions: People with anxiety and/or depression who smoke were more likely to visit a HP than those without, but only those with depression were more likely to receive cessation advice, and only those with depression and anxiety were more likely to discuss NVPs. There are missed opportunities for HPs to deliver cessation advice. NVP discussions and receiving a positive recommendation to use them were rare overall.
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Liu, et al. 2023. Gender differences in cigarette smoking cessation attempts among adults who smoke and drink alcohol at high levels: Findings from the 2018-2020 International Tobacco Control Four Country Smoking and Vaping Surveys [show abstract ▼] [hide abstract ▲] [access full article]
Citation
Liu, C., Yong, H.H., Gravely, S., East, K.A., Kasza, K., Gartner, C., Cummings, K.M., Fong, G.T. (2023). Gender differences in cigarette smoking cessation attempts among adults who smoke and drink alcohol at high levels: Findings from the 2018-2020 International Tobacco Control Four Country Smoking and Vaping Surveys. Addictive Behaviours, 147, 107817. doi: 10.1016/j.addbeh.2023.107817.
Abstract
Background: This study examined the association between alcohol consumption and smoking cessation behaviour of adults who smoke in four countries.
Methods: Data came from 4275 adults (≥18 years) who smoked tobacco ≥ monthly and participated in the 2018 and 2020 International Tobacco Control Four Country Smoking and Vaping Surveys (Australia: n = 720; Canada: n = 1250; US: n = 1011; England: n = 1294). The 2018 Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) survey data coded into three levels ('never/low', 'moderate' or 'heavy' consumption) were analysed using multivariable logistic regression models to predict any smoking cessation attempts and successful cessation by 2020 survey, and whether this differed by gender and country.
Results: Compared to never/low alcohol consumers, only those who drink heavily were less likely to have made a quit smoking attempt (40.4 % vs. 43.8 %; AOR = 0.69, 95 % CI = 0.57-0.83, p < .001). The association differed by gender and country (3-way interaction, p < .001), with females who drink heavily being less likely to attempt to quit smoking in England (AOR = 0.27, 95 % CI = 0.15-0.49, p < .001) and Australia (AOR = 0.38, 95 % CI = 0.19-0.77, p = .008), but for males, those who drink moderately (AOR = 2.18, 95 % CI = 1.17-4.06, p = .014) or heavily (AOR = 2.61, 95 % CI = 1.45-4.68, p = .001) were more likely to make a quit attempt in England only. Alcohol consumption did not predict quit success.
Conclusion: Heavy alcohol use among adults who smoke appears to only undermine the likelihood of trying to quit smoking with some variation by gender and country of residence, but not their chances of succeeding if they tried.
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Lemos, et al. 2023. Perceptions of cannabis use risk to mental health among youth in Canada, England, and the United States from 2017 to 2021 [show abstract ▼] [hide abstract ▲] [access full article]
Citation
Lemos, M.K., Taylor, E., Wadsworth, E., Reid, J.L., Hammond, D., East, K.A. (2023). Perceptions of cannabis use risk to mental health among youth in Canada, England, and the United States from 2017 to 2021. Drug and Alcohol Dependence, 250, 110904. doi: 10.1016/j.drugalcdep.2023.110904.
Abstract
Background: There is little research examining perceptions of cannabis use risk to mental health in countries with differing cannabis regulations. This study therefore examines such perceptions among youth between 2017 and 2021 in Canada (non-medical cannabis legalized in October 2018), England (highly-restricted medical cannabis legalized November 2018), and the US (non-medical cannabis legal in some states).
Methods: Seven repeat cross-sectional online surveys were conducted between July 2017 to August 2021 among youth aged 16-19 in Canada (N=29,420), England (N=28,155), and the US (N=32,974). Logistic regression models, stratified by country, were used to examine perceptions of cannabis use risk to mental health over time, adjusting for age group, sex, race/ethnicity, cannabis use and, for the US only, state-level cannabis legalization.
Results: Perceptions that cannabis use posed “no risk” to mental health decreased between July 2017 and August 2021 in Canada (6.1% to 4.4%; AOR=0.64, 95% CI=0.52-0.78) and the US (14.0% to 11.3%; AOR=0.74, 0.65-0.84) but not England (3.7% to 4.5%; AOR=1.21, 0.97-1.52). No significant changes were observed from immediately before (August 2018) to after (August 2019) legalization of non-medical cannabis in Canada (AOR=0.99, 0.83-1.20) or highly-restricted medical cannabis in England (AOR=0.90, 0.70-1.17). In the US, perceptions of “no risk” were more likely in states where cannabis use was illegal (15.0%) compared with legal non-medical (12.2%) (AOR=0.68, 0.63-0.74).
Conclusion: There were modest decreases in perceptions that cannabis use poses no risk to mental health in Canada and the US between 2017 and 2021 but no clear association with cannabis legalization status.
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Gravely, et al. 2023. Prevalence of depressive symptoms and cannabis use among adult cigarette smokers in Canada: cross-sectional findings from the 2020 International Tobacco Control Policy Evaluation Project Canada Smoking and Vaping Survey [show abstract ▼] [hide abstract ▲] [access full article]
Citation
Gravely, S., Driezen, P., McClure, E., Smith, D.M., Fong, G.T. (2023). Prevalence of depressive symptoms and cannabis use among adult cigarette smokers in Canada: cross-sectional findings from the 2020 International Tobacco Control Policy Evaluation Project Canada Smoking and Vaping Survey. Canadian Medical Association Journal Open, 11(3), E516-E526. doi: 10.9778/cmajo.20220081.
Abstract
Background: Tobacco smoking and cannabis use are independently associated with depression, and evidence suggests that people who use both tobacco and cannabis (co-consumers) are more likely to report mental health problems, greater nicotine dependence and alcohol misuse than those who use either product exclusively. We examined prevalence of cannabis use and depressive symptoms among Canadian adults who smoke cigarettes and tested whether co-consumers of cannabis and tobacco were more likely to report depressive symptoms than cigarette-only smokers; we also tested whether cigarette-only smokers and co-consumers differed on cigarette dependence measures, motivation to quit smoking and risky alcohol use by the presence or absence of depressive symptoms.
Methods: We analyzed cross-sectional data from adult (age ≥ 18 yr) current (≥ monthly) cigarette smokers from the Canadian arm of the 2020 International Tobacco Control Policy Evaluation Project Four Country Smoking and Vaping Survey. Canadian respondents were recruited from Leger’s online probability panel across all 10 provinces. We estimated weighted percentages for depressive symptoms and cannabis use among all respondents and tested whether co-consumers (≥ monthly use of cannabis and cigarettes) were more likely to report depressive symptoms than cigarette-only smokers. Weighted multivariable regression models were used to identify differences between co-consumers and cigarette-only smokers with and without depressive symptoms.
Results: A total of 2843 current smokers were included in the study. The prevalence of past-year, past-30-day and daily cannabis use was 44.0%, 33.2% and 16.1%, respectively (30.4% reported using cannabis at least monthly). Among all respondents, 30.0% screened positive for depressive symptoms, with co-consumers being more likely to report depressive symptoms (36.5%) than those who did not report current cannabis use (27.4%, p < 0.001). Depressive symptoms were associated with planning to quit smoking (p = 0.01), having made multiple attempts to quit smoking (p < 0.001), the perception of being very addicted to cigarettes (p < 0.001) and strong urges to smoke (p = 0.001), whereas cannabis use was not (all p ≥ 0.05). Cannabis use was associated with high-risk alcohol consumption (p < 0.001), whereas depressive symptoms were not (p = 0.1).
Interpretation: Co-consumers were more likely to report depressive symptoms and high-risk alcohol consumption; however, only depression, and not cannabis use, was associated with greater motivation to quit smoking and greater perceived dependence on cigarettes. A deeper understanding of how cannabis, alcohol use and depression interact among people who smoke cigarettes is needed, as well as how these factors affect cessation activity over time.
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Gravely, et al. 2023. An examination of quitting smoking as a reason for vaping by the type of nicotine vaping device used most often among adults who smoke and vape: Findings from the Canada, England and the United States 2020 ITC Smoking and Vaping Survey [show abstract ▼] [hide abstract ▲] [access full article]
Citation
Gravely, S., Yong, H.H., Reid, J.L., East, K.A., Liber, A.C., Cummings, K.M., Quah, A.C.K., Fong, G.T., Hammond, D. (2023). An examination of quitting smoking as a reason for vaping by the type of nicotine vaping device used most often among adults who smoke and vape: Findings from the Canada, England and the United States 2020 ITC Smoking and Vaping Survey. Preventive Medicine Reports, 33, 102201. doi: 10.1016/j.pmedr.2023.102201.
Abstract
Several nicotine vaping product (NVP) device types are available to consumers, and many people who smoke report vaping to help them quit. This study included data from the Wave 3 (2020) ITC Smoking and Vaping Survey in the US, Canada, and England and included 2324 adults who were smoking cigarettes and vaping at least weekly. Device types currently used most often (disposables, cartridges/pods, or tank systems) were assessed using weighted descriptive statistics. Multivariable regression analyses were used to compare differences between respondents who reported vaping to quit smoking (‘yes’ vs. ‘no/don’t know’) by device type, overall and by country. Overall, 71.3% of respondents reported vaping to help them quit smoking, with no country differences (p = 0.12). Those using tanks (78.7%, p < 0.001) and cartridges/pods (69.5%, p = 0.02) were more likely to report this reason for vaping than those using disposables (59.3%); respondents using tanks were also more likely than those using cartridges/pods (p = 0.001) to report this reason. By country, respondents in England using cartridges/pods or tanks (vs. disposables) were more likely to report vaping to quit smoking (with no difference between cartridges/pods and tanks). In Canada, respondents using tanks were more likely to report vaping to quit smoking than those using cartridges/pods or disposables (no difference between disposables and cartridges/pods). No significant differences by device type were found in the US. In conclusion, most adult respondents who smoked and vaped reported using either cartridges/pods or tanks, which were associated with greater odds of vaping for the purpose of quitting smoking versus disposables, with some country variations.
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Gallien, et al. 2023. An overlooked market: loose cigarettes, informal vendors and their implications for tobacco taxation [show abstract ▼] [hide abstract ▲] [access full article]
Citation
Gallien, M., Occhiali, G., Ross, H. (2023). An overlooked market: loose cigarettes, informal vendors and their implications for tobacco taxation. Tobacco Control, [Published online May 23, doi: 10.1136/tc-2023-057965].
Abstract
Objective: To examine the features of markets for loose cigarettes in several low-income and middle-income countries and their effects on tobacco control policies, particularly taxation.
Design: An analysis of survey data targeting people who smoke in two African, one Southeast Asian and two South Asian countries and retailers across 16 African countries to study loose cigarette markets and examine how prices in these markets move relative to the prices for cigarette packs.
Results: Markets for loose cigarettes are large, and their consumer base tends to differ from the wider population of people who smoke. Loose cigarette prices are on average higher than those of cigarettes bought in packs, and they respond differently to tax increases, at least partially due to a denomination effect.
Conclusions: The features of the loose cigarette markets present a challenge for tobacco control policy, especially tobacco tax policy. One way to overcome this challenge is to aim for large, rather than incremental, tax increases.
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Yong, et al. 2023. Individual and conjoint factors associated with beliefs about the harmfulness of nicotine replacement therapies relative to combustible cigarettes among people who smoke: Findings from the 2020 ITC Four Country Smoking and Vaping Survey [show abstract ▼] [hide abstract ▲] [access full article]
Citation
Yong, H.H., Karmakar, C., Motin, M. A., Borland, R., Cummings, K.M., Gravely, S., Fong, G.T. (2023). Individual and conjoint factors associated with beliefs about the harmfulness of nicotine replacement therapies relative to combustible cigarettes among people who smoke: Findings from the 2020 ITC Four Country Smoking and Vaping Survey. Nicotine and Tobacco Research, 25(9), 1594-1602. doi: 10.1093/ntr/ntad075.
Abstract
Introduction: This study examined individual and conjoint factors associated with beliefs about the harmfulness of nicotine replacement therapies (NRTs) relative to combustible cigarettes (CCs).
Methods: Data analyzed came from 8,642 adults (18+ years) who smoked daily/weekly and participated in the 2020 ITC Four Country Smoking and Vaping Survey in Australia (n=1213), Canada (n=2633), England (n=3057), and United States (US, n=1739). Respondents were asked: Compared to smoking cigarettes, how harmful do you think nicotine replacement products are? Responses were dichotomised into much less vs. otherwise for analysis using multivariable logistic regression models, complemented by decision-tree analysis to identify conjoint factors.
Results: Percentages believing that NRTs are much less harmful than CCs were 29.7% (95% CI:26.2-33.5%) in Australia, 27.4% (95% CI=25.1-29.8%) in England, 26.4% (95% CI=24.4-28.4%) in Canada and 21.7% (95% CI=19.2-24.3%) in the US. Across all countries, believing nicotine is not at all/slightly harmful to health (aOR=1.53-2.27), endorsing nicotine vaping products as less harmful than CCs (much less harmful: aOR=7.24-14.27; somewhat less harmful: aOR=1.97-3.23), and possessing higher knowledge of smoking harms (aOR=1.23-1.88) were individual factors associated with increased odds of believing NRTs are much less harmful than CCs. With some country variations, these nicotine-related measures also interacted with each other and socio-demographic variables to serve as conjoint factors associated with the likelihood of accurate NRT relative harm belief.
Conclusions: Many people who regularly smoke cigarettes are unaware that NRTs are much less harmful than cigarettes. Additionally, beliefs about NRTs relative harmfulness appear to be influenced by both individual and conjoint factors.
Implications: This study demonstrates that despite past efforts to educate people who smoke about the harms of NRTs relative to CCs, misperceptions around the relative harmfulness of NRTs remain substantial. In all four studied countries, subgroups of people who smoke regularly who are misinformed about the relative harmfulness of NRTs, and who may be reluctant to use NRTs for smoking cessation can be reliably identified for corrective interventions based o n their understanding of the harms related to nicotine, NVPs and smoking along with sociodemographic markers. The identified subgroup information can be used to prioritize and inform the development of effective interventions to specifically address the gaps in knowledge and understanding of the various subgroups identified. Our results suggest these may need to be tailored for each country.
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Reid, et al. 2023. Minimum legal age laws and perceived access to cigarettes, e-cigarettes, and other substances among youth in Canada, England, and the United States: 2017-2021 [show abstract ▼] [hide abstract ▲] [access full article]
Citation
Reid, J., Burkhalter, R., Kasza, K.A., Seo, Y., East, K.A., Hyland, A., Hammond, D. (2023). Minimum legal age laws and perceived access to cigarettes, e-cigarettes, and other substances among youth in Canada, England, and the United States: 2017-2021. International Journal of Drug Policy, 115, 104003. doi: 10.1016/j.drugpo.2023.104003.
Abstract
Background: Minimum legal age (MLA) restrictions are a core policy to reduce youth use of tobacco, e-cigarettes, and other substances. We examined trends in perceived ease of access to tobacco and other substances across three countries with differing MLA policies, including the United States (US), which increased the federal MLA for tobacco products from 18 to 21 in 2019.
Methods: Repeat cross-sectional data were analyzed from seven waves of the International Tobacco Control (ITC) Youth Tobacco and Vaping Survey conducted between 2017 and 2021. Online surveys were conducted with non-probability samples of 91,647 youth aged 16-19 in Canada, England, and the US. Regression models were used to examine differences in perceived ease of accessing each of 7 substances (analyzed as "very easy" or "fairly easy" versus else), and differences between countries and over time (including before and after any MLA changes) for cigarettes, e-cigarettes, cannabis, and alcohol; additional models examined sub-national variation in MLA.
Results: Perceived access varied by substance and across countries: in August/September 2021, perceived ease of accessing cigarettes and e-cigarettes was greater in Canada where MLA was 18-19 (61.7% cigarettes, 66.4% e-cigarettes) and England where MLA was 18 (66.9%, 69.6%), compared to the US where MLA was 21 (48.0%, 60.9%; p < 0.001 for all). Perceived ease of accessing cannabis was greatest in Canada (53.3%), followed by the US (44.1%) and England (34.0%; p < 0.001 for all). Following the federal MLA increase for tobacco products in the US, perceived ease of access decreased significantly for cigarettes (65.1% in 2019Aug to 59.7% in 2020Feb; aOR=0.80 (95%CI=0.71-0.89)) and e-cigarettes (72.4% in 2019Aug to 69.4% in 2020Feb; aOR=0.87 (95%CI=0.77-0.98)).
Conclusions: Higher MLA was strongly associated with fewer youth perceiving easy access to substances: perceived access varied between countries with differing MLA, as well as within-country before and after changes to MLA.
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Yimsaard, et al. 2023. Differences in smoking cessation behaviours and vaping status among adult daily smokers with or without depression, anxiety, hazardous alcohol use: Findings from the 2018 and 2020 ITC Four Country Smoking and Vaping Survey [show abstract ▼] [hide abstract ▲] [access full article]
Citation
Yimsaard, P., Gravely, S., Meng, G., Fong, G.T., Cummings, K.M., Hyland, A., Borland, R., Hammond, D., Kasza, K.A., Li, L., Quah, A.C.K. (2023). Differences in smoking cessation behaviours and vaping status among adult daily smokers with or without depression, anxiety, hazardous alcohol use: Findings from the 2018 and 2020 ITC Four Country Smoking and Vaping Survey. International Journal of Mental Health and Addiction. doi:10.1007/s11469-023-01058.
Abstract
This study examined differences in quit attempts, 1-month quit success, and vaping status at follow-up among a cohort of 3709 daily smokers with and without depression, anxiety, and regular alcohol use who participated in both the 2018 and 2020 International Tobacco Control Four Country Smoking and Vaping (ITC 4CV) Surveys. At baseline, a survey with validated screening tools was used to classify respondents as having no, or one or more of the following: 1) depression, 2) anxiety, and 3) regular alcohol use. Multivariable adjusted regression analyses were used to examine whether baseline (2018) self-report conditions were associated with quit attempts; quit success; and vaping status by follow-up (2020). Results showed that respondents who reported depressive symptoms were more likely than those without to have made a quit attempt (aOR = 1.32, 95% CI:1.03–1.70, p = 0.03), but were less likely to have quit (aOR = 0.55, 95% CI:0.34–0.89, p = 0.01). There were no differences in quit attempts or quit success between those with and without self-reported anxiety diagnoses or regular alcohol use. Among successful quitters, respondents with baseline depressive symptoms and self-reported anxiety diagnoses were more likely than those without to report vaping at follow-up (aOR = 2.58, 95% CI:1.16–5.74, p = 0.02, and aOR = 3.35 95% CI:1.14–9.87, p = 0.03). In summary, it appears that smokers with depression are motivated to quit smoking but were less likely to manage to stay quit, and more likely to be vaping if successfully quit. As smoking rates are higher among people with mental health conditions, it is crucial for healthcare professionals to identify these vulnerable groups and offer tailored smoking cessation support and continued support during their quit attempt.
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Usidame, et al. 2023. Examining the effectiveness of the 2012 Canadian graphic warning label policy change by sex, income, and education [show abstract ▼] [hide abstract ▲] [access full article]
Citation
Usidame, O., Meng, G., Thrasher, J.F., Thompson, M.E., Fong, G.T., Fleischer, N.L. (2023). Examining the effectiveness of the 2012 Canadian graphic warning label policy change by sex, income, and education. Nicotine and Tobacco Research, 25(4), 763-772. doi: 10.1093/ntr/ntac235.
Abstract
Background: We examined the differential impact of the 2012 Canadian GWL policy changes on key indicators of warning label impact and quit intentions using national cohorts of Canadian and US adults who smoke.
Methods: We used data from all waves of the International Tobacco Control surveys (2002-2020) in Canada and the US. Our key measures were quit intentions and an index of warning label effectiveness (salience, cognitive and behavioral reactions). We estimated overall policy impact by comparing Canada (treatment group) with the US (control group) using controlled interrupted time series (CITS) regression models, with interactions to examine whether policy impact varied by sex, education, and income.
Results: The CITS model showed a statistically significant increase in the warning label effectiveness in Canada post-policy, compared to the US (β= 0.84, 95% CI 0.35,1.33). Similarly, the odds of quit intentions were relatively higher among adults who smoked in Canada compared to the US (OR= 1.89, 95% CI 1.51,2.36) post-policy. The three-way interaction model showed that these associations were greater among adults from low socioeconomic status (SES) groups than in high SES groups.
Discussion: The 2012 change in the Canadian GWL policy was associated with stronger cognitive and behavioral responses to GWLs and higher odds of quit intentions among adults who smoked in Canada when compared to the US, specifically among individuals from low SES groups, suggesting a positive equity impact. Our findings affirm the need for countries to implement or enhance GWLs, in line with the WHO Framework Convention on Tobacco Control.
Implications: The evidence on the potential health equity benefit of GWL policies is mixed. To further understand the influence of GWL policies on tobacco use disparities, more systematic research using pre/post policy designs with control groups is needed. Using a controlled interrupted time series model, we aimed to strengthen the available evidence on the causal influence of this tobacco control approach. Our findings show that the 2012 GWL policy change had a greater impact on adults who smoked from low SES groups than it did on adults who smoked from high SES groups, indicating a potentially positive equity impact and confirming the need for countries to implement or maximize the size of GWLs, as recommended by the WHO Framework Convention on Tobacco Control.
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Yong, et al. 2023. Do social norms for cigarette smoking and nicotine vaping product use predict trying nicotine vaping products and attempts to quit cigarette smoking amongst adult smokers? Findings from the 2016-2020 ITC Four Country Smoking and Vaping Surveys [show abstract ▼] [hide abstract ▲] [access full article]
Citation
Yong, H.H., Chow, R., East, K.A., Thrasher, J.F., Hitchman, S.C., Borland, R., Cummings, K.M., Fong, G.T. (2023). Do social norms for cigarette smoking and nicotine vaping product use predict trying nicotine vaping products and attempts to quit cigarette smoking amongst adult smokers? Findings from the 2016-2020 ITC Four Country Smoking and Vaping Surveys. Nicotine and Tobacco Research, 25(3), 505-513. doi: 10.1093/ntr/ntac212.
Abstract
Objectives: To examine whether perceived injunctive and descriptive social norms towards cigarette and nicotine vaping product (NVP) use predicted subsequent trying NVPs and attempts to quit cigarette smoking amongst current smokers, and whether associations varied across countries.
Method: Three waves of longitudinal cohort data from the International Tobacco Control Four Country Smoking and Vaping Survey collected between 2016 and 2020 from 2,290 adult smokers in Canada, Australia, England, and the United States who had never used NVPs at baseline (either Wave 1 or Wave 2) and followed up at the subsequent wave (Wave 2 or Wave 3, respectively) were analysed using Generalised Estimating Equations.
Results: Of the injunctive and descriptive norm measures for smoking and NVP use, NVP initiation was only independently predicted by the injunctive interpersonal norm for NVP use, with perceived approval of NVP use by important others predicting higher odds of trying NVPs (AOR=1.65, 95% CI=1.20-2.27). This predictive effect was independent of baseline quit intention with no country variations found. By contrast, making cigarette smoking quit attempts was independently predicted by both injunctive and descriptive interpersonal norms with perceived disapproval of smoking by important others (AOR=1.65, 95% CI=1.38-1.99) and close friends using NVPs (AOR=1.37, 95% CI=1.04-1.79), both associated with higher odds of smoking quit attempts.
Conclusions: Adult smokers who perceive NVP use as normative, either because such behaviour is socially approved or common within their close social networks, appear more inclined to try NVPs or make smoking quit attempts than smokers who do not.
Implications: What this study adds: Social norms can shape a person's behaviour and result in behaviour change. This study shows that initiation of NVP use behaviour among smokers can be reliably predicted by their perception of whether NVP use is acceptable to those important to them within their close social networks. Similarly, any attempts to stop cigarette smoking can be predicted by their perception of how acceptable cigarette smoking is among those who are important to them and whether any of their close friends use NVPs. Changing social norms towards cigarette smoking and NVP use could therefore be incorporated into smoking cessation interventions to help smokers to quit and/or switch to NVP use.
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Gravely, et al. 2023. Evaluating the impact of plain packaging among Canadian smokers: Findings from the 2018 and 2020 ITC Smoking and Vaping Surveys [show abstract ▼] [hide abstract ▲] [access full article]
Citation
Gravely, S., Chung-Hall, J., Craig, L.V., Fong, G.T., Cummings, K.M., Borland, R., Yong, H.H., Loewen, R., Martin, N., Quah, A.C.K., Hammond, D., Ouimet, J., Boudreau, C., Thompson, M.E., Driezen, P. (2023). Evaluating the impact of plain packaging among Canadian smokers: Findings from the 2018 and 2020 ITC Smoking and Vaping Surveys. Tobacco Control, 32(2), 153-162. doi:10.1136/tobaccocontrol-2021-056635.
Related resources from the Health Canada Supported Dissemination Project (ITC Canada Survey Findings)
Mar 30, 2021 | Impact of Plain Packaging in Canada
Mar 30, 2021 | Incidence de l'emballage neutre au Canada
Sep 22, 2021 | Impact of Plain Packaging in Canada | Infographic | English
Sept 22, 2021 | Press Release from University of Waterloo: Plain packaging on cigarette packs in Canada advanced efforts for reducing smoking
Abstract
Background: In February 2020, Canada implemented plain packaging without any changes to the size and content of health warning labels (HWLs), which were last updated in 2012 (pictorial HWLs on 75% of the pack front and back). This pre-post evaluation study assessed the impact of plain packaging in Canada on: (1) pack appeal; (2) HWL effectiveness; and (3) support for plain packaging. Additionally, a quasi–experimental design was used to assess the Canadian results relative to two comparator countries: Australia, where plain packaging (with new larger HWLs) was implemented in 2012, and the United States (USA), where plain packaging has not been implemented and the same text warnings have appeared on cigarette packs since 1985.
Methods: Data are from adult smokers who participated in the 2018 and/or 2020 International Tobacco Control Smoking and Vaping Surveys in Canada (n=4600), Australia (n=1834) and the USA (n=3046). Online surveys were conducted before (February to July 2018) and after (February to June 2020) the implementation of plain packaging in Canada. Adjusted regression analyses were conducted on weighted data.
Results: Plain packaging was associated with a significant increase in the percentage of Canadian smokers who did not like the look of their cigarette pack (2018: 28.6% vs 2020: 44.7%, p<0.001), whereas no change in pack appeal was observed among smokers in Australia and the USA over the same period. Plain packaging was not associated with changes in HWL effectiveness in Canada. Support for plain packaging increased significantly among Canadian smokers (2018: 25.6% vs 2020: 33.7%, p><0.001).
Conclusions: Plain packaging in Canada substantially reduced pack appeal and increased support for the policy among adult smokers; however, there was no increase in the effectiveness of Canada’s 8-year-old HWLs. The impact of plain packaging on health warning effectiveness may depend on the design of the warnings and length of time since implementation.
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Le Grande, et al. 2023. Perceived health and capacity to cope with stress in recent ex-smokers: Impact of vaping vs quitting all nicotine [show abstract ▼] [hide abstract ▲] [access full article]
Citation
Le Grande, M.R., Balmford, J., Borland, R., McNeill, A. (2023). Perceived health and capacity to cope with stress in recent ex-smokers: Impact of vaping versus quitting all nicotine. Nicotine and Tobacco Research, 25(3), 553-562. doi: 10.1093/ntr/ntac252.
Abstract
Introduction: Little is known about the continued use of nicotine following smoking cessation on perceived well-being in comparison to complete cessation of nicotine use.
Aims and Methods: To explore aspects of perceived well-being and coping among recent ex-smokers as a function of vaping status. Ever-daily smokers in the International Tobacco Control 4 country smoking and vaping surveys in 2016 (w1 N = 883) and 2018 (w2 N = 1088). Cross-sectional associations and longitudinal samples for those who quit between waves and those who quit at w1 and maintained abstinence to w2. Main outcome measures were: Past 30 days of depression symptoms, perceived stress, stress management since quitting, and change in perceived day-to-day health.
Results: In the cross-sectional analyses vapers were more likely to report both improved stress management (aOR = 1.71, 95% CI 1.23–2.36) and perceived day-to-day health (aOR = 1.65, 95% CI 1.26–2.16) than nicotine abstainers. In the longitudinal analyses, smokers who switched to vaping between waves (n = 372) were more likely to report depression symptoms at w2 (aOR = 2.00, 95% CI 1.09–3.65) but reported improved perceived health (aOR = 1.92, 95% CI 1.16–3.20). For the past daily smokers who remained quit between waves (n = 382), vapers were more likely to report improved stress management relative to abstainers (RRR = 5.05. 95% CI 1.19–21.40). There were no other significant differences between vapers and nicotine abstainers.
Conclusions: There is little evidence to support the view that perceptions of well-being deteriorate in vapers compared to complete nicotine abstainers in the immediate years after smoking cessation.
Implications: This study could find no conclusive evidence that the continued use of nicotine via e-cigarettes was detrimental to health compared to completely stopping nicotine intake altogether. Our results would suggest that continuing to use nicotine may even result in some benefits in the short term such as improved stress management, however further longitudinal studies are required to examine if these effects are restricted to the early post-quitting phase and whether other positive or negative effects on psychosocial health emerge in the future.
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