Smoking cessation strategies used by former menthol cigarette smokers after a menthol ban

Summary The goal of the present work is to determine if menthol and non-menthol cigarette smokers differ with respect to time to first cigarette (TTFC) and successful smoking cessation via a meta-analysis of published results. For 13 independent estimates, menthol smokers were slightly but statistically significantly more likely to exhibit TTFC ≤ 5 min (random-effects odds ratio (OR) = 1.12; 95% confidence interval (CI), 1.04–1.21), while 17 independent estimates provided a non-significant difference for TTFC ≤ 30 min (random-effects OR = 1.06; 95% CI, 0.96–1.16). For cessation studies, meta-analysis of 30 published estimates indicated a decreased likelihood for menthol cigarette smokers to quit (random-effects OR = 0.87; 95% CI, 0.80–0.96). There was no difference between cessation rates for Caucasian menthol and non-menthol cigarette smokers, but the results support that African American menthol cigarette smokers find it more difficult to quit. Adjustment of cessation for socioeconomic status eliminated any statistically significant advantage for smoking cessation in non-menthol smokers. In conclusion, these results suggest that the observed differences in cessation rates between menthol and non-menthol cigarette smokers are likely explained by differences in socioeconomic status and also suggest that TTFC may not be a robust predictor of successful smoking cessation.

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Product Substitution after a Real World Menthol Ban: A Cohort Study

Tobacco Regulatory Science ◽

10.18001/trs.6.3.5 ◽

2020 ◽

Vol 6 (3) ◽

pp. 205-212 ◽

Cited By ~ 1

Author(s):

Michael Chaiton ◽

Ismina Papadhima ◽

Robert Schwartz ◽

Joanna E. Cohen ◽

Eric K. Soule ◽

...

Keyword(s):

Smoking Cessation ◽

Cohort Study ◽

Confidence Interval ◽

Relative Rate ◽

Product Substitution ◽

Cigarette Smokers ◽

Tobacco Products ◽

Menthol Cigarette ◽

Prior Use ◽

Flavored Tobacco

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

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Patterns of non-cigarette tobacco and nicotine use among current cigarette smokers and recent quitters: Findings from the 2020 ITC Four Country Smoking and Vaping Survey

Nicotine & Tobacco Research ◽

10.1093/ntr/ntab040 ◽

2021 ◽

Author(s):

Lin Li ◽

Ron Borland ◽

K Michael Cummings ◽

Shannon Gravely ◽

Anne C K Quah ◽

...

Keyword(s):

Smoking Cessation ◽

Cigarette Smoking ◽

Smoking Status ◽

Tobacco Product ◽

Cigarette Tobacco ◽

Cigarette Smokers ◽

Tobacco Products ◽

Patterns Of Use ◽

Levels Of Use ◽

Current Cigarette

Abstract Introduction This study explores patterns of use of non-cigarette tobacco and nicotine products among adult cigarette smokers and recent ex-smokers. Along with cigarette smoking status we explore differences as a function of countries with different product regulations, gender and age. Methods Data came from the ITC Four Country Smoking and Vaping Wave 3 Survey conducted between February-June 2020. The analytic sample consisted of 9112 current cigarette smokers (at least monthly) and 1184 recent ex-smokers (quit cigarettes ≤ 2 years) from Australia, Canada, England, and the US. Respondents were asked about their cigarette smoking and current use of the following non-cigarette products: combustible tobacco (cigars, cigarillos, pipe, waterpipe); non-combustible tobacco (smokeless tobacco, and heated tobacco products (HTPs)); and non-tobacco nicotine products (nicotine vaping products (NVPs), nicotine replacement therapy (NRT), and nicotine pouches)). Results Overall, NVPs (13.7%) and NRT (10.9%) were the most reported nicotine products used, followed by cigars (5.3%), cigarillos (4.2%), and HTPs (3.5%). More than 21% current and recent ex-smokers of cigarettes reported using a non-tobacco nicotine product and non-combustible product, with respondents in England reporting the highest levels of use (>26%). Males, younger respondents, and current non-daily cigarette smokers were more likely to use non-cigarette nicotine products. Notably, 11.6% of ex-cigarette smokers were using other combustible tobacco. Conclusion Considerable percentages of current cigarette smokers and ex-smokers use non-cigarette nicotine products, and there are unexpectedly high levels of use of other combustible products by those recent ex-smokers of cigarettes which is concerning and has important implications for definitions of smoking cessation. Implications The tobacco product market has evolved to include new products which add to existing non-cigarette tobacco products creating a much more diverse nicotine market. This brief report provides a snapshot of use of various combustible and non-combustible nicotine containing products among current cigarette smokers and recent ex-smokers in four western countries. Our results indicate that use of non-cigarette tobacco and nicotine products among these cigarette smokers and recent ex-smokers is not low, particularly among males, younger and non-daily cigarette smokers. Use of other combustible tobacco among respondents that recently quit cigarette smoking is concerning and has important implications for definitions of smoking cessation. Increased emphasis on researching non-cigarette nicotine product use is warranted in tobacco control generally and smoking cessation in particular.

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Exposure to Point-of-Sale Marketing of Cigarettes and E-Cigarettes as Predictors of Smoking Cessation Behaviors

Nicotine & Tobacco Research ◽

10.1093/ntr/ntx246 ◽

2017 ◽

Vol 21 (2) ◽

pp. 212-219 ◽

Cited By ~ 3

Author(s):

Dale S Mantey ◽

Keryn E Pasch ◽

Alexandra Loukas ◽

Cheryl L Perry

Keyword(s):

Smoking Cessation ◽

Cigarette Smoking ◽

Cue Reactivity ◽

Cigarette Smokers ◽

Point Of Sale ◽

Cigarette Advertising ◽

Advertising Exposure ◽

Cigarette Cessation ◽

Product Displays ◽

The Impact

Abstract Introduction Cue-reactivity theory suggests that smoking-related visual cues such as point-of-sale (POS) marketing (eg, advertising, product displays) may undermine cessation attempts by causing an increase in nicotine cravings among users. This study examined the relationship between recall of exposure to POS marketing and subsequent cessation behaviors among young adult cigarette smokers. Methods Participants included 813, 18–29 year old (m = 21.1, SD = 2.70), current cigarette smokers attending 24 Texas colleges. Multivariable logistic regression models examined the impact of baseline self-reported exposure to cigarette and e-cigarette advertising and product displays, on using e-cigarettes for cessation and successful cigarette cessation at 6-month follow-up. Two-way interactions between product-specific advertising and between product-specific displays were examined to determine if the marketing of one product strengthened the cue reactivity of the other. Baseline covariates included sociodemographic factors, past quit attempts, intentions to quit smoking, and nicotine dependence. Results Exposure to e-cigarette displays was associated with lower odds of cigarette smoking cessation, controlling for covariates and conventional cigarette display exposure. E-cigarette advertising was positively associated with the use of e-cigarettes for cigarette cessation among participants exposed to low (ie, at least 1 SD below the mean) levels of cigarette advertising. Cigarette advertising was associated with the use of e-cigarettes for cigarette cessation only among those exposed to low levels of e-cigarette advertising. Exposure to cigarette displays was not associated with either outcome. Conclusion Smoking-related cues at POS may undermine successful cigarette cessation. Exposure to product displays decrease odds of cessation. Advertising exposure increased odds for using e-cigarettes for cessation attempts, but may have guided smokers towards an unproven cessation aid. Implications By examining the interaction of conventional cigarette and e-cigarette marketing exposure, this study adds a unique insight into the impact of retail tobacco marketing on cigarette smoking cessation behavior among young adults. These findings suggest that policies that balance encouraging cigarette smoking cessation while limiting marketing strategies should be considered, such as POS product displays, that may undermine successful cessation attempts.

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Up-regulation of nicotinic acetylcholine receptors in menthol cigarette smokers

The International Journal of Neuropsychopharmacology ◽

10.1017/s1461145712001022 ◽

2013 ◽

Vol 16 (5) ◽

pp. 957-966 ◽

Cited By ~ 54

Author(s):

Arthur L. Brody ◽

Alexey G. Mukhin ◽

Jaime La Charite ◽

Karen Ta ◽

Judah Farahi ◽

...

Keyword(s):

Nicotinic Acetylcholine Receptors ◽

Acetylcholine Receptors ◽

Standard Treatment ◽

Elevated Serum ◽

Volume Of Distribution ◽

Entire Group ◽

Cigarette Smokers ◽

Nicotinic Acetylcholine ◽

Menthol Cigarette ◽

Study Results

Abstract One-third of smokers primarily use menthol cigarettes and usage of these cigarettes leads to elevated serum nicotine levels and more difficulty quitting in standard treatment programmes. Previous brain imaging studies demonstrate that smoking (without regard to cigarette type) leads to up-regulation of β2*-containing nicotinic acetylcholine receptors (nAChRs). We sought to determine if menthol cigarette usage results in greater nAChR up-regulation than non-menthol cigarette usage. Altogether, 114 participants (22 menthol cigarette smokers, 41 non-menthol cigarette smokers and 51 non-smokers) underwent positron emission tomography scanning using the α4β2* nAChR radioligand 2-[18F]fluoro-A-85380 (2-FA). In comparing menthol to non-menthol cigarette smokers, an overall test of 2-FA total volume of distribution values revealed a significant between-group difference, resulting from menthol smokers having 9–28% higher α4β2* nAChR densities than non-menthol smokers across regions. In comparing the entire group of smokers to non-smokers, an overall test revealed a significant between-group difference, resulting from smokers having higher α4β2* nAChR levels in all regions studied (36–42%) other than thalamus (3%). Study results demonstrate that menthol smokers have greater up-regulation of nAChRs than non-menthol smokers. This difference is presumably related to higher nicotine exposure in menthol smokers, although other mechanisms for menthol influencing receptor density are possible. These results provide additional information about the severity of menthol cigarette use and may help explain why these smokers have more trouble quitting in standard treatment programmes.

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Cigarette Smoking Status and Smoking Cessation Counseling of Chinese Physicians in Wuhan, Hubei Province

Asia Pacific Journal of Public Health ◽

10.1177/1010539508317821 ◽

2008 ◽

Vol 20 (3) ◽

pp. 183-192 ◽

Cited By ~ 15

Author(s):

Han Zao Li ◽

Weixing Sun ◽

Fangmei Cheng ◽

Xiangrong Wang ◽

Weiping Liu ◽

...

Keyword(s):

Smoking Cessation ◽

Cigarette Smoking ◽

Smoking Status ◽

Female Physicians ◽

Smoking Cessation Counseling ◽

Cigarette Smokers ◽

Perceived Success ◽

Quit Smoking ◽

Current Cigarette ◽

Chinese Physicians

Among the 347 physicians surveyed, 58% of the male physicians and 18.8% of the female physicians were current cigarette smokers; 54.4% of the male and 70.4% of the female physicians often or always provided smoking cessation counseling for patients; 37.5% of the physicians thought that for a Chinese smoker, cigarette smoking served as a social lubricant; 31.5% thought it a habit; 21.7% thought it a stress reliever; and 9.2% thought it a social status symbol. The following 5 variables were significantly associated with physicians' smoking cessation counseling frequency: their smoking status, perceived success in their past counseling, perceived influence, perceived exemplary role, and perceived responsibility. To increase physicians' smoking cessation counseling, the Chinese Ministry of Health would need to discourage physicians to smoke and appeal to their sense of responsibility to help patients quit smoking.

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