scholarly journals Mortality Risks Associated With Dual– and Poly–Tobacco-Product Use in the United States

2019 ◽  
Author(s):  
Kelvin Choi ◽  
Maki Inoue-Choi ◽  
Timothy S McNeel ◽  
Neal D Freedman
Keyword(s):  
United States ◽  
The United States ◽  
Tobacco Product ◽  
Cigarette Smokers ◽  
Tobacco Products ◽  
Mortality Risks ◽  
Use Patterns ◽  
Product Use ◽  
Nationally Representative ◽  
The Impact

Abstract Increasing numbers of adults in the United States use more than 1 tobacco product. Most use cigarettes in combination with other tobacco products. However, little is known about the all-cause and cancer-specific mortality risks of dual– and poly–tobacco-product use. We examined these associations by pooling nationally representative data from the 1991, 1992, 1998, 2000, 2005, and 2010 National Health Interview Surveys (n = 118,144). Mortality information was obtained through linkage to the National Death Index. Cigarette smokers who additionally used other tobacco products smoked as many if not more cigarettes per day than exclusive cigarette smokers. Furthermore, cigarette smokers who additionally used other tobacco products had mortality risks that were as high as and sometimes higher than those of exclusive cigarette smokers. As tobacco use patterns continue to change and diversify, investigators in future studies need to carefully assess the impact of noncigarette tobacco products on cigarette use and determine associated disease risks.

scholarly journals Not Quite the Rule, But No Longer the Exception: Multiple Tobacco Product Use and Implications for Treatment, Research, and Regulation

2019 ◽  
Vol 22 (11) ◽  
pp. 2114-2117
Author(s):  
Lauren R Pacek ◽  
Andrea C Villanti ◽  
F Joseph Mcclernon
Keyword(s):  
United States ◽  
Cigarette Smoking ◽  
Tobacco Dependence ◽  
The United States ◽  
Tobacco Product ◽  
Regulatory Science ◽  
Tobacco Products ◽  
The Past ◽  
Product Use ◽  
Treatment Research

Abstract The patterns of tobacco product use in the United States have changed during the past several decades. Currently, a large proportion of tobacco users report using multiple tobacco products (MTPs). The prevalence of MTP use varies significantly by cigarette smoking frequency, as well: nearly half (46.9%) of all non-daily smokers report using other tobacco products within the past 30 days. Despite this, much of extant tobacco dependence treatment efforts, tobacco regulatory science research, and tobacco product research, in general, has focused largely on single product use (ie, cigarette smoking). To effectively design interventions and model the potential impact of regulations on tobacco products aimed at reducing tobacco use, as well as effectively study tobacco users, it is essential to consider actual use patterns in the population of tobacco users. Implications: MTP use is increasingly common in the United States. This commentary highlights the impact that MTP use has for efforts to treat tobacco dependence, tobacco regulatory science efforts, as well as on tobacco research, in general.

scholarly journals Six-Week Actual Use Study to Evaluate the Impact of Oral Tobacco-Derived Nicotine Pouches on Cigarette Smoking and Smokeless Tobacco Product Use Behaviors

2021 ◽  
Author(s):  
Stacey McCaffrey ◽  
Jennifer Lewis ◽  
Elizabeth Becker ◽  
Andrea Vansickel ◽  
Elsa Larson ◽  
...  
Keyword(s):  
Smokeless Tobacco ◽  
Tobacco Product ◽  
Daily Consumption ◽  
Open Label ◽  
Tobacco Products ◽  
Use Patterns ◽  
Product Use ◽  
Actual Use ◽  
Smokeless Tobacco Product ◽  
The Impact

Abstract Background Oral tobacco-derived nicotine (OTDN) products are a rapidly emerging, innovative category of noncombustible tobacco products. These products are tobacco-leaf free and do not contain or generate many of the harmful and potentially harmful constituents (HPHCs) found in combustible cigarettes or smokeless tobacco (ST) products. OTDN products may therefore offer adult tobacco consumers a potentially reduced harm alternative. However, little is known about OTDN product use patterns or their ability to substitute for more harmful tobacco products.Methods We conducted an open-label, 2-phase, actual use study designed to characterize OTDN pouch product (on!® nicotine pouches - NP) use patterns, including impact on other tobacco use behaviors among adult tobacco consumers interested in using NP. Adult current cigarette smokers (AS) and/or adult ST users (ASTU) (n = 1,147 complete) who were not planning to quit were offered free choice of a portfolio of NP (seven flavors at five nicotine levels) to use at-home, ad-libitum, for 6-weeks following an initial 5-day trial. Participants responded to daily electronic surveys that captured the amount, frequency, and topography (e.g., time in mouth, placement in mouth) of NP and other tobacco product use. Results The majority (99 to 100%) of study participants used NP throughout the 6-week period. Participants used ~5-6 pouches/day of a variety of flavors and nicotine levels. At the end of 6 weeks, a modest proportion of AS (27%) and a substantial proportion of ASTU (71%) reported no use of cigarettes or ST respectively, while reporting continued use of NPs. Additionally, 39% of AS and 14% of ASTU reduced daily consumption of cigarettes or ST products, respectively by 50-99%. Conclusions Participants found NPs acceptable with a sizeable proportion completely switching away from or substantially reducing (50-99%) their cigarette or ST consumption by week 6. Availability of a variety of flavors and nicotine levels appeared to facilitate the conversion to NP. These data suggest that, under the conditions of the study, NP can be a potential substitute for cigarettes or ST products and may offer harm reduction potential for adult smokers and smokeless tobacco users not interested in quitting.Trial Registration Note: This study is an observational study with tobacco products currently available in the marketplace for adult tobacco consumers. Since there is no intervention per se and we did not collect any biosamples this is not a “clinical study” and there is no appropriate registry for such behavioral observational studies, we do not believe that this requirement is applicable.

scholarly journals Polytobacco product use among current cigarette smokers in Hong Kong, China: results from population surveys (2015–17)

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
S. L. Chau ◽  
M. P. Wang ◽  
Y. Wu ◽  
D. Y. T. Cheung ◽  
A. Kong ◽  
...  
Keyword(s):  
Control Policy ◽  
Tobacco Product ◽  
Cigarette Use ◽  
Related Factors ◽  
Cigarette Smokers ◽  
Tobacco Products ◽  
Product Use ◽  
Younger Age ◽  
Current Cigarette ◽  
Age And Sex

Abstract Background Polytobacco product use is increasingly popular, but little is known about the prevalence, trend, and factors of such use particularly in non-western countries. Method A representative sample of 1139 current cigarette smokers aged 15+ (84.1% male) were telephone interviewed in Tobacco Control Policy-related Surveys in 2015–2017. Information collected included poly-tobacco use (PTU), smoking and socio-demographic characteristics. Associations of current PTU with related factors were analyzed using logistic regression with adjustment for confounders. Prevalence was weighted by age and sex of current cigarette users in the general population. Results Eighty-four point one percent (95% CI 81.4–86.6%) were exclusive cigarette smokers. Fifteen point nine percent (13.4–18.6%) were current polytobacco product users, 12.3% (10.2–14.8%) used one tobacco product and 2.52% (1.59–3.97%) used two tobacco products in addition to cigarette. Cigarette use with cigar was more common (6.28%, 4.75–8.27%), and the least used product with cigarette was e-cigarette (1.05%, 0.44–2.50%). The changes in overall prevalence of PTU by number of products use varied in 3 years. Current PTU was associated with being male (AOR 2.01, 95% CI 1.12–3.61), younger age (AORs range from 1.34–4.65, P for trend < .001) and less ready to quit (2.08, 1.09–3.97). Conclusions Prevalence of PTU increased slowly by year, one tobacco product use with cigarette was more common. The most used tobacco product with cigarette was cigar. Being male, younger and less ready to quit were associated with current PTU.

scholarly journals Tobacco-Product Use by Adults and Youths in the United States in 2013 and 2014

2017 ◽  
Vol 376 (4) ◽  
pp. 342-353 ◽  
Author(s):  
Karin A. Kasza ◽  
Bridget K. Ambrose ◽  
Kevin P. Conway ◽  
Nicolette Borek ◽  
Kristie Taylor ◽  
...  
Keyword(s):  
United States ◽  
The United States ◽  
Tobacco Product ◽  
Product Use

scholarly journals Characterization of Volatile Organic Compound Metabolites in Cigarette Smokers, Electronic Nicotine Device Users, Dual Users, and Nonusers of Tobacco

2019 ◽  
Vol 22 (2) ◽  
pp. 264-272 ◽  
Author(s):  
Rachel J Keith ◽  
Jessica L Fetterman ◽  
Olusola A Orimoloye ◽  
Zeina Dardari ◽  
Pawel K Lorkiewicz ◽  
...  
Keyword(s):  
Cardiovascular Effects ◽  
Cross Sectional Study ◽  
Tobacco Product ◽  
Linear Regression Models ◽  
Cross Sectional ◽  
Potential Health ◽  
Cigarette Smokers ◽  
Use Patterns ◽  
Product Use ◽  
Volatile Organic

Abstract Introduction Limited research exists about the possible cardiovascular effects of electronic nicotine delivery systems (ENDS). We therefore sought to compare exposure to known or potentially cardiotoxic volatile organic compounds (VOCs) in ENDS users, smokers, and dual users. Methods A total of 371 individuals from the Cardiovascular Injury due to Tobacco Use study, a cross-sectional study of healthy participants aged 21–45 years, were categorized as nonusers of tobacco (n = 87), sole ENDS users (n = 17), cigarette smokers (n = 237), and dual users (n = 30) based on 30-day self-reported tobacco product use patterns. Participants provided urine samples for VOC and nicotine metabolite measurement. We assessed associations between tobacco product use and VOC metabolite measures using multivariable-adjusted linear regression models. Results Mean (SD) age of the population was 32 (±6.8) years, 55% men. Mean urinary cotinine level in nonusers of tobacco was 2.6 ng/mg creatinine, whereas cotinine levels were similar across all tobacco product use categories (851.6–910.9 ng/mg creatinine). In multivariable-adjusted models, sole ENDS users had higher levels of metabolites of acrolein, acrylamide, acrylonitrile, and xylene compared with nonusers of tobacco, but lower levels of most VOC metabolites compared with cigarette smokers or dual users. In direct comparison of cigarettes smokers and dual users, we found lower levels of metabolites of styrene and xylene in dual users. Conclusion Although sole ENDS use may be associated with lower VOC exposure compared to cigarette smoking, further study is required to determine the potential health effects of the higher levels of certain reactive aldehydes, including acrolein, in ENDS users compared with nonusers of tobacco. Implications ENDS use in conjunction with other tobacco products may not significantly reduce exposure to VOC, but sole use does generally reduce some VOC exposure and warrants more in-depth studies.

scholarly journals Educational Attainment and Nonwage Labor Market Returns in the United States

AERA Open ◽  
2019 ◽  
Vol 5 (3) ◽  
pp. 233285841987405
Author(s):  
Lauren Schudde ◽  
Kaitlin Bernell
Keyword(s):  
United States ◽  
Labor Market ◽  
Educational Attainment ◽  
The United States ◽  
Employment Outcomes ◽  
Retirement Plans ◽  
Market Returns ◽  
Labor Market Returns ◽  
Nationally Representative ◽  
The Impact

Although decades of research highlight the impact of schooling on earnings, less evidence exists regarding other employment outcomes. Nonwage labor market returns to education are important in the United States, where health insurance and retirement income are typically tied to employment. Using longitudinal, nationally representative data, we examine the role of educational attainment in predicting nonwage employment outcomes and control for a host of individual and institutional measures. Even after controlling for individual and institutional characteristics, results indicate that educational attainment predicts employment and markers of “good” jobs, like access to employer-provided health and dental insurances, retirement plans, and paid leave. Furthermore, by delineating between various subbaccalaureate levels of college attainment, our results illustrate the complex variation in returns to college for those who did not complete a 4-year degree.

Human Abuse Liability Assessment of Tobacco and Nicotine Products: Approaches for Meeting Current Regulatory Recommendations

2021 ◽  
Author(s):  
Andrea Vansickel ◽  
Sarah Baxter ◽  
Neil Sherwood ◽  
Michael Kong ◽  
Leanne Campbell
Keyword(s):  
United States ◽  
The United States ◽  
Tobacco Product ◽  
Abuse Liability ◽  
Background Information ◽  
Regulatory Review ◽  
Tobacco Products ◽  
Public Health Officials ◽  
Regulatory Bodies ◽  
Study Designs

Abstract Many regulatory bodies now recommend that tobacco product manufacturers provide information regarding new tobacco products’ abuse liability to inform regulatory authorization of currently marketed tobacco products or new product applications (including premarket tobacco product applications in the United States). In addition, the US Food and Drug Administration (FDA) recommends including this information as part of modified risk tobacco product applications. Regulators, including FDA, and many public health officials and researchers consider abuse liability assessment a model which predicts the likelihood that the use of the tobacco product would result in addiction and be used repeatedly or even sporadically resulting in undesirable effects. Abuse liability of a new, potentially reduced harm product can also inform its ability to substitute completely for more harmful tobacco products. While many methods exist, no standard tobacco product abuse liability assessment has been established. The purpose of this review is to provide background information and practical recommendations for human abuse liability testing methods to meet tobacco regulatory needs. A combination of nicotine test product pharmacokinetic, subjective effect and/or behavioral response, and physiological response data relative to comparator products with known abuse liability satisfies some regulatory requirements. Implications: This review provides a practical inspection of the current, international regulatory recommendations for abuse liability assessment of tobacco and regulatory review of such information within the United States and also recommends study designs and methods for abuse liability testing of tobacco products based on scientific and regulatory knowledge. Given that tobacco product abuse liability testing is of increasing interest to regulatory bodies globally, especially with the emergence of novel tobacco products, this timely work provides background and functional recommendations for tobacco product abuse liability testing.

scholarly journals Exposure to a Tobacco-Specific Carcinogen Among Adolescent Smokeless Tobacco Users in Rural California, United States

2019 ◽  
Vol 22 (10) ◽  
pp. 1764-1771
Author(s):  
Benjamin W Chaffee ◽  
Peyton Jacob ◽  
Elizabeth T Couch ◽  
Neal L Benowitz
Keyword(s):  
United States ◽  
High School ◽  
Tobacco Use ◽  
Smokeless Tobacco ◽  
The United States ◽  
Tobacco Product ◽  
Geometric Means ◽  
Tobacco Products ◽  
Smokeless Tobacco Products ◽  
Smokeless Tobacco Use

Abstract Introduction Approximately the same percentage of male high school students in the United States currently uses conventional smokeless tobacco as smokes cigarettes, resulting in toxin exposure. Methods This study assessed tobacco product use (smokeless, combustible, and electronic cigarettes) and nicotine and carcinogen exposures in a sample of 594 male rural high school baseball players—a population traditionally at risk for smokeless tobacco use. Salivary specimens were assayed for cotinine (a biomarker of nicotine exposure) and urine specimens for 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL, a biomarker of the carcinogen 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) using liquid chromatography–tandem mass spectrometry. Results The prevalence of past 30-day use of any tobacco product was 29%. Past 7-day smokeless tobacco use (prevalence: 13%) was associated with the highest levels of cotinine and NNAL observed in the sample, whether smokeless tobacco was used exclusively (geometric means: cotinine 11.1 ng/mL; NNAL 31.9 pg/mg-creatinine) or in combination with combustible products (geometric means: cotinine 31.6 ng/mL; NNAL 50.0 pg/mg creatinine). Cotinine and NNAL levels were incrementally higher in each increasing category of smokeless tobacco use frequency. However, observed levels were lower than previously reported for adults, likely reflecting less smokeless use per day among adolescents. Conclusions Based on these biomarker observations, adolescents who use conventional smokeless tobacco products are exposed to substantial levels of nicotine and NNK. Although exposed to lower levels than adult smokeless users, the findings are concerning given the young age of the sample and tendency for smokeless tobacco users to increase use intensity over time. Implications This study demonstrates that adolescents using smokeless tobacco are exposed to levels of nicotine and NNK that increase with use frequency and that exceed exposures among peers using other tobacco products. Youth smokeless tobacco use in the United States has not declined along with youth smoking prevalence, giving greater importance to this health concern. To reduce youth (and adult) exposures, needed actions include effective smokeless tobacco use prevention, potentially in combination with reducing the levels of harmful and potentially harmful chemicals in smokeless tobacco products currently popular among adolescents.

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