Citation

Edwards, R., Stanley, J., Waa, A., White, M., Kaai, S.C., Ouimet, J., Quah, A.C.K., Fong, G.T. (2020). Patterns of use of vaping products among smokers: Findings from the 2016-2018 ITC New Zealand Surveys. International Journal of Environmental Research and Public Health, 17(18), 6629.

Abstract

Alternative nicotine products like e-cigarettes could help achieve an end to the epidemic of ill health and death caused by smoking. However, in-depth information about their use is often limited. Our study investigated patterns of use of e-cigarettes and attitudes and beliefs among smokers and ex-smokers in New Zealand (NZ), a country with an ‘endgame’ goal for smoked tobacco. Data came from smokers and ex-smokers in Waves 1 and 2 of the International Tobacco Control (ITC) NZ Survey (Wave 1 August 2016–April 2017, 1155 participants; Wave 2, June–December 2018, 1020 participants). Trial, current and daily use of e-cigarettes was common: daily use was 7.9% among smokers and 22.6% among ex-smokers in Wave 2, and increased between surveys. Use was commonest among 18–24 years and ex-smokers, but was similar among Māori and non-Māori participants, and by socio-economic status. Most participants used e-cigarettes to help them quit or reduce their smoking. The most common motivating factor for use was cost and the most common barrier to use cited was that e-cigarettes were less satisfying than smoking. The findings could inform developing interventions in order to maximize the contribution of e-cigarettes to achieving an equitable smoke-free Aotearoa, and to minimize any potential adverse impacts.

Citation

Soneji, S., Knutzen, K.E., Gravely, S., Elton-Marshall, T., Sargent, J., Lambert, E., Hilmi, N., Sharma, E., Jackson, K.J., Wang, B., Robinson, J., Driezen, P., Bover-Manderski, M., Bansal-Travers, M., Hyland, A., Travers, M.J., Yang, D-H., Dang, R., Fong, G.T. (2020). Transitions in frequency of hookah smoking among youth and adults: Findings from Wave 1 and Wave 2 of the Population Assessment of Tobacco and Health (PATH) Study, 2013-2015. Addiction, [Published online, doi:https://doi.org/10.1111/add.15250].

Abstract

Background and aims:

The prevalence of hookah smoking has increased in the United States since at least 2010, especially among youth and young adults. This study assessed self-reported reasons for hookah smoking cessation and transition to or maintenance of high-frequency hookah smoking among current hookah smokers.

Design:

Separately analyzed data from the Population Assessment of Tobacco and Health (PATH) Study, a longitudinal cohort study. Frequency of and reasons for hookah smoking were ascertained at Wave 1 (2013-2014); frequency of hookah smoking and past-year cessation were ascertained at Wave 2 (2014-2015). Weighted multivariable logistic and ordinal logistic regression models were fit to predict hookah smoking cessation and frequency of hookah smoking at Wave 2, respectively, accounting for demographic and behavioral risk factors, reasons for hookah smoking, and frequency of hookah smoking at Wave 1.

Setting:

USA

Participants:

A total of 693 youth and 4400 adult past-year hookah smokers. Measurements: Self-reported tobacco-use patterns and associated health behaviors were measured via audio computer-assisted self-interviews (ACASI).

Findings:

At Wave 1, 5.9% of youth and 7.5% of adults were past-year hookah smokers. Across all age groups, the leading reasons for hookah smoking were enjoyment of socializing while smoking, availability of appealing flavors, and believing that it was less harmful than cigarette smoking. The odds of cessation were lower for adults who liked hookah flavors (adjusted odds ratio [aOR]=0.62; 95% confidence interval [CI]: 0.45-0.84) compared with adults who did not like hookah flavors. The odds of transitioning to, or maintaining, monthly-or-more-frequent hookah smoking at Wave 2, compared with cessation or less-than monthly smoking, were higher for adults who liked hookah flavors (adjusted proportional odds ratio [aPOR]=1.47; 95% CI: 1.16-1.88) and enjoyed socializing while smoking hookah (aPOR =1.48; 95% CI: 1.01-2.18) compared with adults who did not like hookah flavors or socializing.

Conclusion:

The availability of appealing flavors, affordability, and socialization while smoking hookah in the US are associated with reduced likelihood of cessation and increased likelihood of high-frequency hookah smoking.

Citation

Pierce, J., Benmarhnia, T., Chen, R., White, M., Abrams, D.B., Ambrose, B.K., Blanco, C., Borek, N., Choi, K., Coleman, B., Compton, W., Cummings, K.M., Delnevo, C.D., Elton-Marshall, T., Goniewicz, M., Gravely, S., Fong, G.T., Hatsukami, D., Henrie, J., Kasza, K.A., Kealey, S., Kimmel, H., Limpert, J., Niaura, R., Ramôa, C., Sharma, E., Silveira, M., Stanton, C., Steinberg, M.B., Taylor, E., Bansal-Travers, M., Trinidad, D.R., Gardner, L.D., Hyland, A., Soneji, S., Messer, K. (2020). Role of e-cigarettes and pharmacotherapy during attempts to quit cigarette smoking: The PATH Study 2013-16. PLOS One, 15(9), e0237938.

Abstract

Background:

More smokers report using e-cigarettes to help them quit than FDA-approved pharmacotherapy.

Objective:

To assess the association of e-cigarettes with future abstinence from cigarette and tobacco use.

Design:

Cohort study of US sample, with annual follow-up.

Participants:

US adult (ages 18+) daily cigarette smokers identified at Wave 1 (W1; 2013-14) of the PATH Study, who reported a quit attempt before W2 and completed W3 (n = 2443).

Exposures:

Use of e-cigarettes, pharmacotherapy (including nicotine replacement therapy), or no product for last quit attempt (LQA), and current daily e-cigarette use at W2.

Analysis:

Propensity score matching (PSM) of groups using different methods to quit.

Outcome measures:

12+ months abstinence at W3 from cigarettes and from all tobacco (including e-cigarettes). 30+ days abstinence at W3 was a secondary outcome.

Results:

Among daily smokers with an LQA, 23.5% used e-cigarettes, 19.3% used pharmacotherapy only (including NRT) and 57.2% used no product. Cigarette abstinence for 12+ months at W3 was ~10% in each group. Half of the cigarette abstainers in the e-cigarette group were using e-cigarettes at W3. Different methods to help quitting had statistically comparable 12+ month cigarette abstinence at W3 (ecigarettes vs no product: Risk Difference (RD) = 0.01, 95% CI: -0.04 to 0.06; e-cigarettes vs pharmacotherapy: RD = 0.02, 95% CI:-0.04 to 0.09). Likewise, daily e-cigarette users at W2 did not show a cessation benefit over comparable no-e-cigarette users and this finding was robust to sensitivity analyses. Abstinence for 30+ days at W3 was also similar across products.

Limitations:

The frequency of e-cigarette use during the LQA was not assessed, nor was it possible to assess continuous abstinence from the LQA.

Conclusion:

Among US daily smokers who quit cigarettes in 2014-15, use of e-cigarettes in that attempt compared to approved cessation aids or no products showed similar abstinence rates 1-2 years later.

Citation

Girvalaki, C., Filippidis, F.T., Kyriakos, C.N., Driezen, P., Herbec, A., Mons, U., Papadakis, S., Mechili, A, Katsaounou, P.A., Przewoźniak, K., Fernández, E., Trofor, A.C., Demjén, T., Fong, G.T., Vardavas, C.I. (2020). Perceptions, predictors of and motivation for quitting among smokers from six European countries from 2016 to 2018: Findings from EUREST-PLUS ITC Europe Surveys. International Journal of Environmental Research and Public Health, 17(17), 6263.

Abstract

The European Tobacco Products Directive (TPD) was introduced in 2016 in an effort to decrease prevalence of smoking and increase cessation in the European Union (EU). This study aimed to explore quitting behaviours, motivation, reasons and perceptions about quitting, as well as predictors (reported before the TPD implementation) associated with post-TPD quit status. A cohort study was conducted involving adult smokers from six EU countries (n = 3195). Data collection occurred pre-(Wave 1; 2016) and post-(Wave 2; 2018) TPD implementation. Bivariate and logistic regression analyses of weighted data were conducted. Within this cohort sample, 415 (13.0%) respondents reported quitting at Wave 2. Predictors of quitting were moderate or high education, fewer cigarettes smoked per day at baseline, a past quit attempt, lower level of perceived addiction, plans for quitting and the presence of a smoking related comorbidity. Health concerns, price of cigarettes and being a good example for children were among the most important reasons that predicted being a quitter at Wave 2. Our findings show that the factors influencing decisions about quitting may be shared among European countries. European policy and the revised version of TPD could emphasize these factors through health warnings and/or campaigns and other policies.

Citation

Bommelé, J., Hopman, P., Hipple Walters, B., Geboers, C., Croes, E., Fong, G.T., Quah, A.C.K., Willemsen, M.C. (2020). The double-edged relationship between COVID-19 stress and smoking: Implications for smoking cessation. Tobacco Induced Diseases, 18(July), 63.

Abstract

Introduction: Although recent research shows that smokers respond differently to the COVID-19 pandemic, it offers little explanation of why some have increased their smoking, while others decreased it. In this study, we examined a possible explanation for these different responses: pandemic-related stress.

Material and Methods: We conducted an online survey among a representative sample of Dutch current smokers from 11–18 May 2020 (n=957). During that period, COVID-19 was six weeks past the (initial) peak of cases and deaths in the Netherlands. Included in the survey were measures of how the COVID-19 pandemic had changed their smoking, if at all (no change, increased smoking, decreased smoking), and a measure of stress due to COVID-19.

Results: Overall, while 14.1% of smokers reported smoking less due to the COVID-19 pandemic, 18.9% of smokers reported smoking more. A multinomial logistic regression analysis revealed that there was a dose-response effect of stress: smokers who were somewhat stressed were more likely to have either increased (OR=2.37; 95% CI: 1.49–3.78) or reduced (OR=1.80; 95% CI: 1.07–3.05) their smoking. Severely stressed smokers were even more likely to have either increased (OR=3.75; 95% CI: 1.84–7.64) or reduced (OR=3.97; 95% CI: 1.70–9.28) their smoking. Thus, stress was associated with both increased and reduced smoking, independently from perceived difficulty of quitting and level of motivation to quit.

Conclusions: Stress related to the COVID-19 pandemic appears to affect smokers in different ways, some smokers increase their smoking while others decrease it. While boredom and restrictions in movement might have stimulated smoking, the threat of contracting COVID-19 and becoming severely ill might have motivated others to improve their health by quitting smoking. These data highlight the importance of providing greater resources for cessation services and the importance of creating public campaigns to enhance cessation in this dramatic time.

Citation

Hawkins, S., Chung-Hall, J., Craig, L., Fong, G.T., Borland, R., Cummings, K.M., Levy, D., Hitchman, S.C. (2020). Support for minimum legal sales age laws set to 21 across Australia, Canada, England and US: Findings from the 2018 ITC Four Country Smoking and Vaping Survey. Nicotine and Tobacco Research, 22(12), 2266-2270.

Abstract

Introduction: Although the United States has seen a rapid increase in tobacco minimum legal sales age (MLSA) laws set to age 21, there is wide variation across high-income countries and less is known about policy support outside of the United States. We examined the prevalence of support for tobacco MLSA 21 laws as well as associations by sociodemographic, smoking, and household characteristics among current and former adult smokers.

Methods: In this cross-sectional analysis, we used the 2018 International Tobacco Control Four Country Smoking and Vaping Survey to examine support for MLSA 21 laws among 12 904 respondents from Australia, Canada, England, and United States.

Results: Support for raising the legal age of purchasing cigarettes/tobacco to 21 ranged from 62.2% in the United States to 70.8% in Canada. Endorsement also varied by age, such that 40.6% of 18–20 years old supported the policy compared with 69.3% of those aged ≥60 years. In the adjusted regression model, there was also higher support among respondents who were female than male, non-white than white, those who did not allow smoking in the household than those that did, and those who had children in the household than those that did not. There were no differences by household income, education, or smoking status.

Conclusions: Most current and former smokers, including a sizable minority of those aged ≤20 years, support raising the legal age of purchasing cigarettes/tobacco to 21.

Implications: There was strong support for MLSA 21 laws among smokers and former smokers across Australia, Canada, England, and the United States, providing evidence for the increasing public support of the passage of these laws beyond the United States.

Citation

Hammond, D., Reid, J., Burkhalter, R., Rynard, V.L. (2020). E-cigarette marketing regulations and youth vaping: Cross-sectional surveys, 2017-2019. Pediatrics, 146(1), e20194020.

Abstract

Background

Increased electronic cigarette (e-cigarette) use among young people is often attributed to industry marketing practices; however, the effectiveness of regulations that limit e-cigarette advertising and promotions has yet to be examined. New federal legislation that liberalized the Canadian e-cigarette market in May 2018, along with differences in provincial regulations, provides an opportunity to examine the impact of regulatory restrictions on e-cigarette marketing.

Methods

Repeat cross-sectional surveys of 12 004 16- to 19-year-olds in Canada, completed online in 2017, 2018, and 2019. Logistic regression models were used to examine differences over time in exposure to e-cigarette marketing and e-cigarette use, including between provinces with differing strengths of marketing restrictions. Results: The percentage of youth surveyed who reported noticing e-cigarette promotions often or very often approximately doubled between 2017 and 2019 (13.6% vs 26.0%; adjusted odds ratio [AOR] = 2.24, 95% confidence interval [CI] = 1.97-2.56). Overall exposure to marketing was generally more prevalent in provinces with fewer regulatory restrictions. Respondents who reported noticing marketing often or very often were more likely to report vaping in the past 30 days (AOR = 1.41, 95% CI = 1.23-1.62), past week (AOR = 1.44, 95% CI = 1.22-1.70), and ≥20 days in the past month (AOR = 1.42, 95% CI = 1.11-1.81, P = .005). Provinces with low restrictions on marketing had higher prevalence of vaping in the past 30 days (AOR = 1.50, 95% CI = 1.25-1.80, P < .001), and in the past week (AOR = 1.65, 95% CI = 1.332.05, P < .001).

Conclusions

Exposure to marketing and the prevalence of vaping increased among Canadian youth after the liberalization of the e-cigarette market in 2018. Comprehensive provincial restrictions on e-cigarette marketing were associated with lower levels of exposure to marketing and lower prevalence of e-cigarette use

Citation

Kahnert, S., Driezen, P., Balmford, J., Kyriakos, C.N., Demjén, T., Fernández, E., Katsaounou, P.A., Trofor, A.C., Przewoźniak, K., Zatoński, W.A., Fong, G.T., Vardavas, C.I., Mons, U. (2020). Impact of the Tobacco Products Directive on self-reported exposure to e-cigarette advertising, promotion and sponsorship in smokers: Findings from the EUREST-PLUS ITC Europe Surveys. European Journal of Public Health, 30(Supplement_3), iii55-iii61.

Abstract

Background

Advertising, promotion and sponsorship of electronic cigarettes (ECAPS) have increased in recent years. Since May 2016, the Tobacco Products Directive 2014/40/EU (TPD2) prohibits ECAPS in various advertising channels, including media that have cross-border effects. The objective of this study was to investigate changes in exposure to ECAPS in a cohort of smokers from six European Union member states after implementation of TPD2.

Methods

Self-reported exposure to ECAPS overall and in various media and localities was examined over two International Tobacco Control Policy Evaluation survey waves (2016 and 2018) in a cohort of 6011 adult smokers from Germany, Greece, Hungary, Poland, Romania and Spain (EUREST-PLUS Project) using longitudinal generalized estimating equations models.

Results

Self-reported ECAPS exposure at both timepoints varied between countries and across examined advertising channels. Overall, there was a significant increase in ECAPS exposure [adjusted odds ratio (aOR): 1.25, 95% CI: 1.09–1.44]. Between waves, no consistent patterns of change in ECAPS exposure across countries and different media were observed. Generally, ECAPS exposure tended to decline in some channels regulated by TPD2, particularly on television and radio, while exposure tended to increase in some unregulated channels, such as at points of sale.

Conclusions

The findings suggest that the TPD2 was generally effective in reducing ECAPS in regulated channels. Nonetheless, further research is warranted to evaluate its role in reducing ECAPS exposure, possibly by triangulation with additional sources of data.

Citation

Levy, D., Douglas, C.E., Sanchez-Romero, L.M., Cummings, K.M., Sweanor, D. (2020). An analysis of the FCTC’s attempt to stop the Altria-Juul Labs deal. Tobacco Regulatory Science, 6(4), 302-305.

Abstract

On 20 December 2018, Altria, the largest US cigarette company, announced an offer for a 35% share of the large and rapidly growing vaping product company, Juul Labs. On 2 April, 2020, the Federal Trade Commission issued a complaint that the deal was anticompetitive and should be voided. This paper analyzes the deal. We find that the deal gives Altria market power in the e-cigarette market through its support of Juul in retail stores and through the agreement not to otherwise compete in the e-cigarette market. The deal also has implications for its marketing of heated tobacco product IQOS and generally may provide Altria greater control of the broader nicotine delivery product market.

Citation

Edwards, R., Hoek, J., & Waa, A. (2020). E-cigarettes, vaping and a Smokefree Aotearoa: where to next?. The New Zealand Medical Journal (Online), 133(1517), 14-17.

Citation

Braak, D., Cummings, K.M., Nahhas, G.J., Reid, J., Hammond, D. (2020). How are adolescents getting their vaping products? Findings from the International Tobacco Control (ITC) Youth Tobacco and Vaping Survey. Addictive Behaviors, 105, 106345.

Abstract

Objective: To examine the sources of vaping products reported by adolescents, and the characteristics of adolescents who reported purchasing a vaping product in the past year in the United States (US), Canada (CA), and England (EN).

Methods: Data were from the 2017 ITC Youth Tobacco and Vaping Survey, a web-based survey of 12,128 respondents aged 16-19 years recruited from commercial panels in the US, CA, and EN. Respondents who have vaped in the past 12 months were asked whether they had purchased a vaping product, and from where (vape shop, online, retail), as well as whether anyone refused to sell them a vaping product because of their age. Respondents who reported vaping in the past 30 days were asked where they had obtained their vaping product from a social and/or commercial source.

Results: Only about 7.5% of respondents reported having purchased a vaping product in the past year. Among those who had vaped in the past year, 32.6% reported having purchased a vaping product in the past year. Purchasing prevalence was significantly higher among US respondents compared to those from CA and EN; purchase prevalence was also higher among Canadian adolescents than respondents from England. The most commonly reported purchase location for vaping products in all counties was vape shops. Among past 30-day vapers, 42.5% reported getting their vaping products only from social sources, 41.4% only from commercial sources, and 13.4% from both types of sources. Purchasing a vaping product in the past year was associated with being male, of legal age to buy tobacco and vaping products, and greater frequency of smoking and vaping in the past 30 days.

Conclusions: Most adolescents have not purchased a vaping product, but among those who had, vape shops were the mostly commonly reported location for buying a vaping product. Purchasing of a vape product was more commonly reported by those who vape more frequently and by those of legal age to buy a vaping product.

Citation

Fong, G. T., & Jiang, Y. (2020). The Importance of Reducing Smoking in China: To Achieve Healthy China 2030 While Reducing the Severity of the COVID-19 Pandemic. China CDC Weekly, 2(22), 404-406.

No abstract available.

Citation

Thomas, D.P., Davey, M.E., van der Sterren, A.E., Panaretto, K.S., Lyons, L. (2020). Do stress, life satisfaction, depression and alcohol use predict quitting among Aboriginal and Torres Strait Islander smokers? Australian and New Zealand Journal of Public Health, 44(3), 186-192.

Abstract

Objective: To examine whether baseline measures of stress, life satisfaction, depression and alcohol use predict making or sustaining quit attempts in a national cohort of Aboriginal and Torres Strait Islander smokers.

Methods: We analysed data from the nationally representative quota sample of 1,549 Aboriginal and Torres Strait Islander adults who reported smoking at least weekly in the Talking About The Smokes baseline survey (April 2012–October 2013) and the 759 who completed a follow‐up survey a year later (August 2013–August 2014).

Results: More smokers who reported negative life satisfaction, feeling depressed, higher stress or drinking heavily less often than once a week at baseline made a quit attempt between the baseline and follow‐up surveys. In contrast, of these smokers who had made quit attempts between surveys, more who reported higher stress were able to sustain abstinence for at least one month; other associations were inconclusive.

Conclusions and implications for public health: Health staff and Aboriginal and Torres Strait Islander smokers need not see being more stressed as an obstacle to quitting among Aboriginal and Torres Strait Islander people. Health staff should emphasise the benefits to mental health that come with successfully quitting smoking.

Citation

Cummings, K.M., Nahhas, G., Sweanor, D. (2020). What is accounting for the rapid decline in cigarette sales in Japan? International Journal of Environmental Research and Public Health, 17(10), 3570.

Abstract

This study describes how trends in the sale of cigarettes in Japan between 2011 and 2019 correspond to the sales of heated tobacco products (HTPs) that were introduced into the Japanese market in late 2015. Data used for this study come from the Tobacco Institute of Japan and Philip Morris International. The findings show that the accelerated decline in cigarette only sales in Japan since 2016 corresponds to the introduction and growth in the sales of HTPs.

Citation

Hammond, D., Rynard, V.L., Reid, J. (2020). Changes in prevalence of vaping among youth in the United States, Canada, and England, 2017 to 2019. JAMA Pediatrics, 174(8), 797-800.

Abstract

This cohort study examines rates of vaping and smoking among youths aged 16 to 19 years in the United States, Canada, and England from 2017 to 2019

Citation

van Mourik, D.J.A., Nagelhout, G.E., Willemsen, M.C., van den Putte, B., de Vries, H. (2020). Differences in smokers’ awareness of the health risks of smoking before and after introducing pictorial tobacco health warnings: Findings from the 2012–2017 International Tobacco Control (ITC) Netherlands Surveys. BMC Public Health, 20, 512.

Abstract

Background: As of May 2016, pictorial health warnings (PHWs) showing the harms of smoking were implemented in the European Union. After one year they had to be fully implemented. We studied changes in awareness of the health risks of smoking after implementation of PHWs among smokers from the Netherlands, whether the trend before the implementation changed after the implementation, and whether there were differences between subgroups.

Methods: We used survey data from six yearly waves of the International Tobacco Control (ITC) Netherlands Survey from 2012 to 2017. The number of participating smokers ranged between 1236 and 1604 per wave. Data were analyzed using Generalized Estimating Equations (GEE) analyses.

Results: Indicators of awareness of the health risks of smoking that did not change between 2015 and 2017 were perceived susceptibility (β = 0.043, p = 0.059) and perceived severity (β = − 0.006, p = 0.679) regarding lung problems. Perceived susceptibility, however, was more pronounced between 2015 and 2017 than between 2012 and 2015(p value of interaction: p = 0.044). Noticing information about the dangers of smoking (β = 0.119, p < 0.001) and knowledge about the health risks of smoking (β = 0.184, p < 0.001) increased between 2015 and 2017. These increases were both more pronounced when compared to 2012–2015 (p values of interactions: p = 0.002 and p < 0.001 respectively). Compared to high educated smokers, low educated smokers (β = − 1.137, p < 0.001) and moderate educated smokers (β = − 0.894, p < 0.001) were less knowledgeable about the health risks of smoking in 2016 and 2017.

Conclusions: Introducing PHWs coincided with an increase in smokers’ knowledge about the health risks of smoking. Dutch tobacco control policy and campaigns should focus on improving Dutch smokers’ awareness of the health risks of smoking even more, especially among low educated smokers.

Citation

Schneller, L., Bansal-Travers, M., Mahoney, M.C., McCann, SE, O’Connor, R.J. (2020). Menthol, nicotine, and flavoring content of capsule cigarettes in the US. Tobacco Regulatory Science, 6(3), 196-204.

Abstract

Objectives: In this paper, we characterize physical design features of cigarette brands sold in the United States according to the delivery method of menthol that may affect sensory perception among users.

Methods: We used 12 cigarette brands, mentholated and non-mentholated, for analyses of the physical design characteristics, quantification of nicotine and menthol, and identification of flavor additives.

Results: Physical design characteristics did not differ significantly between the various cigarette brands. However, we found statistically significant differences in levels of menthol. Menthol levels were greatest in products that had dual delivery methods of menthol (6.7mg/cigarette; SE = 0.27) followed by products mentholated in a filter capsule only (5.7mg/cigarette; SE = 0.25), and those mentholated in the tobacco only (3.8mg/cigarette; SE = 0.12); products that were not mentholated had the least (0.38mg/cigarette; SE = 0.31). Finally, flavor additives with a mint flavor profile other than menthol were identified, such as pulegone and limonene, and differed between cigarette brands, which are likely contributing to the menthol flavor experience associated with use of these products.

Conclusions: The regulation of menthol delivery method, flavorings added to the capsule, and/or menthol concentration may be beneficial for the public health as these factors are likely creating unique sensory experiences.

Abstract

Objective: To estimate the pooled prevalence of smokeless tobacco consumption (STC) by gender and location in Bangladesh, India and Myanmar and to identify periodic changes in STC prevalence using data extracted from published studies.

Methods: We searched for a combination of keywords in electronic databases and used a standard form to extract data from each article. We undertook a meta-analysis to estimate pooled prevalence and confidence intervals within these countries. To compare periodic changes in STC prevalence, we grouped studies into five-year periods (2000-2004, 2005-2009, 2010-2014 and 2015-2019).

Results: The pooled estimates of STC prevalence were 25% (95% CI: 22-28%), 22% (95% CI: 15-28%) and 21% (95% CI: 14-28%) for Bangladesh, India and Myanmar, respectively. In pooled estimates across these countries, we found higher STC prevalence for men (30%; 95% CI: 24-35%) than women (16%; 95% CI: 10-23%) and for rural dwellings (24%; 95% CI: 18-31%) than urban dwellings (17%; 95% CI: 10-24%). We found significant decrease in STC in Bangladesh and India in the period 2010-2014 and 2015-2019, respectively. In Myanmar, STC prevalence increased significantly and substantially in 2010-2014, to levels higher than in Bangladesh and India.

Conclusions: The prevalence of STC in Bangladesh, India and Myanmar is highest in rural areas and among men. Public health prevention strategies are needed to maintain decrease in STC in Bangladesh and India, and to reverse the increased use in Myanmar.

Citation

Cho, Y., Thrasher, J.F., Cummings, K.M., Yong, H.H., Hitchman, S.C., McNeill, A., Fong, G.T., Hammond, D., Hardin, J., Li, L., Lindblom, E. (2020). Cross-country comparison of cigarette and vaping product marketing exposure and use: Findings from the 2016 ITC Four Country Smoking and Vaping Survey. Tobacco Control, 29(3), 295-304.

Abstract

Objective: To compare exposure to and use of certain cigarette and vaping product marketing among adult smokers and vapers in four countries with contrasting regulations—Australia (AU), Canada, England and the USA.

Data sources: Adult smokers and vapers (n=12 294) from the 2016 International Tobacco Control (ITC) Four Country Smoking and Vaping Survey (4CV1).

Analysis: Self-reported exposure to cigarette and vaping product advertising through point-of-sale, websites/social media, emails/texts, as well as exposure to and use of price offers were assessed for country differences using logistic regression models adjusted for multiple covariates.

Results: Reported exposure to cigarette advertising exposure at point-of-sale was higher in the USA (52.1%) than in AU, Canada and England (10.5%–18.5%). Exposure to cigarette advertising on websites/social media and emails/texts was low overall (1.5%–10.4%). Reported exposure to vaping ads at point-of-sale was higher in England (49.3%) and USA (45.9%) than in Canada (32.5%), but vaping ad exposure on websites/social media in Canada (15.1%) was similar with England (18.4%) and the USA (12.1%). Exposure to vaping ads via emails/texts was low overall (3.1%–9.9%). Exposure to, and use of, cigarette price offers was highest in the USA (34.0 % and 17.8 %, respectively), but the use rate among those exposed was highest in AU (64.9%). Exposure to, and use of, price offers for vaping products was higher in the USA (42.3 % and 21.7 %) than in AU, Canada and England (25.9%–31.5 % and 7.4%–10.3 %).

Conclusions: Patterns of cigarette and vaping product marketing exposure generally reflected country-specific policies, except for online vaping ads. Implications for research and policy are discussed.

Citation

Hammond, D., Wackowski, O.A., Reid, J., O’Connor, R.J. (2020). Use of JUUL e-cigarettes among youth in the United States. Nicotine and Tobacco Research, 22(5), 827-832.

Abstract

Introduction: JUUL has emerged as the leading brand in a rapidly evolving electronic cigarette (ecigarette) market. JUUL is distinctive for its novel nicotine delivery method that results in high nicotine concentrations, as well as its sleek, discreet design. This study examined national estimates of JUUL among youth in the United States, including whether JUUL users report different patterns of use compared to users of other e-cigarettes.

Methods: Data were analyzed from the US arm of the International Tobacco Control Policy Evaluation Project (ITC) Youth Tobacco and E-cigarette Survey, an online survey conducted in July-August 2017 with youth aged 16-19 years recruited from consumer panels (n = 4086).

Results: Overall, 14.2% of respondents had used an e-cigarette in the past 30 days. JUUL was the second-most popular brand reported by past-30-day e-cigarette users (9.7%). Compared to e-cigarette users of other brands, JUUL users were significantly older (adjusted odds ratio [aOR] = 2.50, 95% confidence interval [CI] = 1.56 to 4.01) and reported a greater number of computers in the household (a socioeconomic status proxy; aOR = 1.55, 95% CI = 1.22 to 1.96), with no differences by sex, race/ethnicity, or student status. Controlling for sociodemographic variables, JUUL users were more likely than other e-cigarette users to have ever tried to quit e-cigarettes (aOR = 2.65, 95% CI = 1.12 to 6.30), with no differences observed by smoking status, frequency of e-cigarette use, urges to use e-cigarettes, or perceived addiction to e-cigarettes.

Conclusions: JUUL was among the most popular e-cigarette brands among youth, and there were few differences in sociodemographic profile or patterns of use between users of JUUL and other e-cigarette brands.

Implications: This study examined national estimates of JUUL e-cigarette use among youth in the United States, during the early phase of JUUL's popularity. JUUL was among the most popular ecigarette brands among youth, and there were few differences in sociodemographic profile or patterns of use between JUUL and other e-cigarette brands. The findings help to characterize the rapid rise of this new product category within the rapidly evolving e-cigarette market at a time when the US Food and Drug Administration and public health community are seeking to understand JUUL and its appeal among young people.

Citation

Pope, D.A., Poe, L., Stein, J.S., Kaplan, B.A., DeHart, W.B., Mellis, A.M., Heckman, B.W., Epstein, L.H., Chaloupka, F.J., Bickel, W.K. (2020). The Experimental Tobacco Marketplace: Demand and substitutability as a function of cigarette taxes and e-liquid subsidies. Nicotine and Tobacco Research, 22(5), 782-790.

Abstract

Introduction: The experimental tobacco marketplace (ETM) approximates real-world situations by estimating the effects of several, concurrently available products and policies on budgeted purchasing. Although the effects of increasing cigarette price on potentially less harmful substitutability are well documented, the effects of other, nuanced pricing policies remain speculative. This study used the ETM as a tool to assess the effects of two pricing policies, conventional cigarette taxation and e-liquid subsidization, on demand and substitutability.

Methods: During sampling periods, participants were provided 2-day samples of 24 mg/mL e-liquid, after which ETM purchase sessions occurred. Across two ETM sessions, conventional cigarettes were taxed or e-liquid was subsidized in combination with increasing cigarette price. The other four available products were always price constant and not taxed or subsidized.

Results: E-liquid functioned as a substitute for conventional cigarettes across all conditions. Increasing cigarette taxation and e-liquid subsidization increased the number of participants for which e-liquid functioned as a substitute. Cigarette taxation decreased cigarette demand, by decreasing demand intensity, and marginally increased the initial intensity of e-liquid substitution, but did not affect the functions' slopes (substitutability). E-liquid subsidization resulted in large increases in the initial intensity of e-liquid substitution, but did not affect e-liquid substitutability nor cigarette demand.

Implications: 24 mg/mL e-cigarette e-liquid was the only product to significantly substitute for cigarettes in at least one condition throughout the experiment; it functioned as a significant substitute throughout all four tax and all four subsidy conditions. Increasing cigarette taxes decreased cigarette demand through decreases in demand intensity but did not affect e-cigarette substitution. Increasing e-liquid subsidies increased e-liquid initial intensity of substitution but did not affect cigarette demand.

Conclusions: This study extended research on the behavioral economics of conventional cigarette demand and e-liquid substitutability in a complex marketplace. The results suggest that the most efficacious method to decrease conventional cigarette purchasing and increase e-liquid purchasing may involve greatly increasing cigarette taxes while also increasing the value of e-liquid through potentially less harmful product subsidization or differential taxation.

Citation

Gravely, S., Driezen, P., Smith, D.M., Borland, R., Lindblom, E., Hammond, D., McNeill, A., Hyland, A., Cummings, K.M., Chan, G., Thompson, M.E., Boudreau, C., Martin, N., Ouimet, J., Loewen, R., Quah, A.C.K., Goniewicz, M., Thrasher, J.F., Fong, G.T. (2020). International differences in patterns of cannabis use among adult cigarette smokers: Findings from the 2018 ITC Four Country Smoking and Vaping Survey. International Journal of Drug Policy, 79, 102754.

Abstract

Background: Although evidence shows that co-use of cigarettes and cannabis is common, there is little research examining if co-use patterns vary depending on the regulatory environment for cannabis. This study examined patterns of co-use and perceptions of relative harm among cigarette smokers in four countries with different histories, and at different stages of cannabis legalization.

Methods: Data are from the 2018 International Tobacco Control 4CV Survey and included 10035 adult cigarette smokers from Canada, United States (US), Australia, and England. At the time of the survey, Canada and the US had relatively more permissive cannabis regulations compared to Australia and England.

Results: Among this sample of 10035 cigarette smokers, Canada had the highest rate of cannabis co-use in the last 12 months (36.3%), followed by the US (29.1%), England (21.6%), and Australia (21.4%). Among past 12 month co-users (n = 3134), the US (40.2%) and Canada (35.2%) had the highest rates of daily cannabis use, followed by smokers in England (26.3%) and Australia (21.7%); Australian co-users had the highest rate of infrequent (<monthly) cannabis use. The highest proportion of co-users who smoked daily and used cannabis daily was in the US (34.8%), followed by Canada (30.6%), England (25.8%), and Australia (22.7%). More co-users in the US (78.3%) and Canada (73.6%) perceived smoked cannabis to be less harmful than cigarettes than in Australia (65.5%) and England (60.8%). The majority of co-users who used cannabis in the last 30 days had smoked it (92.3%), with those in England more likely to smoke cannabis (95.7%) compared to Canada (88.6%); there were no other differences between countries (US: 92.0%, Australia: 93.0%). Co-users in England (90.4%) and Australia (86.0%) were more likely to mix tobacco with cannabis than co-users in Canada (38.5%) and the US (22.3%).

Conclusion: Patterns of tobacco and cannabis co-use differed between countries. Smokers in Canada and the US had higher rates of co-use, daily cannabis use, dual-daily use of both cannabis and cigarettes, and were more likely to perceive smoked cannabis as less harmful than cigarettes compared to England and Australia.

Citation

Thompson, M.E., Boudreau, C., Quah, A.C.K., Ouimet, J., Li, G., Yan, M., Mochizuki, Y., Yoshimi, I., Fong, G.T. (2020). Survey Methods of the 2018 International Tobacco Control (ITC) Japan Survey. International Journal of Environmental Research and Public Health, 17(7), 2598

Abstract

This paper describes the methods of the Wave 1 (2018) International Tobacco Control (ITC) Japan Survey. The respondents were adults aged 20 years and older in one of four user groups: (1) cigarette-only smokers who smoked at least monthly and used heated tobacco products (HTPs) not at all or less than weekly, (2) HTP-only users who used HTPs at least weekly and smoked cigarettes not at all or less than monthly, (3) cigarette-HTP dual users who smoked at least monthly and used HTPs at least weekly, and (4) non-users who had never smoked or who smoked less than monthly and used HTPs less than weekly. Eligible respondents were recruited by a commercial survey firm from its online panel. Respondents were allocated proportionally to sample strata based on demographic, geographic, and user type specifications benchmarked to a national reference. Survey weights, accounting for smoking/HTP use status, sex, age, education, and geography, were calibrated to benchmarks from a nationally representative survey in Japan. Response rate was 45.1% and cooperation rate was 96.3%. The total sample size was 4615 (3288 cigarette smokers, 164 exclusive HTP users, 549 cigarette-HTP dual users, and 614 non-users). The 2018 ITC Japan Survey sampling design and survey data collection methods will allow analyses to examine prospectively the use of cigarettes and HTPs in Japan and factors associated with the use of both products and of transitions between them.

Citation

Filippidis, F.T., Driezen, P., Kyriakos, C.N., Katsaounou, P.A., Petroulia, I., Girvalaki, C., Fu, M., Fernández, E., Mons, U., Trofor, A.C., Demjén, T., Przewoźniak, K., Zatoński, W.A., Fong, G.T., Tountas, Y., Vardavas, C.I. (2020). Transitions from and to roll-your-own tobacco, perceptions and health beliefs among smokers: Findings from the EUREST-PLUS ITC Europe Surveys. European Journal of Public Health, 30(Suppl 3), iii18-iii25.

Abstract

Background: The prevalence of roll-your-own tobacco (RYO) in Europe has been increasing. The aim of this study was to investigate transitions between factory-made (FM) cigarettes and RYO in a longitudinal sample of European smokers, and their perceptions of relative harmfulness and knowledge of health effects.

Methods: We used data collected from the EUREST-PLUS ITC 6 European Country (6E) Surveys in 2016 (n = 6011 smokers) and in 2018 (n = 6027) in Germany, Greece, Hungary, Poland, Romania and Spain. A total of 3195 cohort respondents were interviewed in both years. Use of RYO and FM, knowledge of health effects of smoking as well as perceptions about RYO were assessed. We used logistic regression models to explore sociodemographic correlates of transitions from one product to the other, of perceptions and knowledge related to smoking health effects.

Results: Approximately 7.4% of exclusive FM smokers transitioned to RYO and 29.5% of exclusive RYO smokers transitioned to FM cigarettes from 2016 to 2018. RYO use in 2018 was more frequent among smokers of low education and income, but none of these factors were associated with transitions. Most RYO smokers perceived RYO as cheaper than FM and 21.7% of them considered RYO to be less harmful than FM. Knowledge of the health effects of smoking was not associated with type of product smoked.

Conclusions: RYO is popular among European smokers; its lower cost seems to be a major factor for RYO users; reasons for transitions to and from RYO are less clear and need to be further investigated.

Citation

Gravely, S., Fong, G.T., Sutanto, E., Loewen, R., Ouimet, J., Xu, S.S., Quah, A.C.K., Thompson, M.E., Bordereau, C., Li, G., Goniewicz, M., Yoshimi, I., Mochizuki, Y., Elton-Marshall, T., Thrasher, J.F., Tabuchi, T. (2020). Perceptions of harmfulness of heated tobacco products compared to combustible cigarettes among adult smokers in Japan: Findings from the 2018 ITC Japan Survey. International Journal of Environmental Research and Public Health, 17(7), 2394.

Abstract

In Japan, the tobacco industry promotes heated tobacco products (HTPs) as a reduced-risk tobacco product. This study examines: (1) smokers’ harm perceptions of HTPs relative to combustible cigarettes; (2) differences in relative harm perceptions between exclusive smokers and smokers who use HTPs (concurrent users) and between concurrent users based on frequency of product use; and (3) if smokers who were exposed to HTP advertising hold beliefs that are consistent with marketing messages of lower harmfulness. This cross-sectional study included 2614 adult exclusive cigarette smokers and 986 concurrent users who reported their perceptions of harmfulness of HTPs compared to cigarettes, as well as their exposure to HTP advertising in the last six months. Among all smokers, 47.5% perceive that HTPs are less harmful than cigarettes, 24.6% perceive HTPs to be equally as harmful, 1.8% perceive HTPs as more harmful, and 26.1% did not know. Concurrent users are more likely than exclusive smokers to believe that HTPs are less harmful (62.1% versus 43.8%, p < 0.0001) and less likely to report that they did not know (14.3% versus 29.4%, p < 0.0001). Frequent HTP users are more likely than infrequent users to believe that HTPs are less harmful (71.7% versus 57.1%, p ≤ 0.001). Believing that HTPs are less harmful than cigarettes was associated with noticing HTP advertising on TV (p = 0.0005), in newspapers/magazines (p = 0.0001), on posters/billboards (p < 0.0001), in stores where tobacco (p < 0.0001) or where HTPs (p < 0.0001) are sold, on social media (p < 0.0001), or in bars/pubs (p = 0.04). HTP users were significantly more likely than non-HTP users to believe that HTPs are less harmful than cigarettes, with this belief being more prominent among frequent users. Smokers who have been exposed to HTP advertising were more likely to perceive HTPs as less harmful than cigarettes.