Widespread Belief That Organic and Additive-Free Tobacco Products are Less Harmful Than Regular Tobacco Products: Results From the 2017 US Health Information National Trends Survey

Abstract Significance US smokers of Natural American Spirit, a brand marketed as “organic” and “additive-free,” are more likely than other cigarette smokers to believe that their brand might be less harmful than other brands. This article (1) describes the prevalence of belief that “organic” and “additive-free” tobacco is less harmful than regular tobacco products in the US population and (2) describes the sociodemographic characteristics of adults who believe tobacco products with these descriptors are less harmful. Methods Data were drawn from the 2017 Health Information National Trends Survey (HINTS), a nationally representative survey of US adults. Logistic regression models were used to examine correlates of the belief that “organic” or “additive-free” tobacco products are less harmful than regular tobacco products. Results Overall, 26.7% of US adults and 45.3% of adult smokers believe that “organic” tobacco products are less harmful than regular tobacco products. Similarly, 35.2% of US adults and 47.1% of smokers believe that “additive-free” tobacco products are less harmful. When examining gender, age, education, race/ethnicity, sexual orientation, and smoking status, only age (adjusted odds ratio [aOR] ~0.98, 95% confidence interval [CI]: 0.97, 0.99 for both outcomes) and smoking status (current vs. never smokers, aOR ~1.78, 95% CI 1.03, 3.07 for both outcomes) were correlates of believing that “organic” or “additive-free” tobacco is less harmful than regular tobacco products. Conclusions Belief that “organic” and “additive-free” tobacco products are less harmful than other products is widespread. Younger adults and current smokers are most likely to be misinformed by “organic” or “additive-free” tobacco product descriptors. Implications Belief that “organic” and “additive-free” tobacco products are less harmful than other products is widespread among US adults and most prevalent among smokers. Removal of terms that incorrectly imply reduced harm may correct current and future consumers’ misperceptions about the brand.

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It Is About Trust: Trust in Sources of Tobacco Health Information, Perceptions of Harm, and Use of E-Cigarettes

Nicotine & Tobacco Research ◽

10.1093/ntr/ntz004 ◽

2019 ◽

Vol 22 (5) ◽

pp. 822-826 ◽

Cited By ~ 1

Author(s):

Héctor E Alcalá ◽

Sandhya V Shimoga

Keyword(s):

Health Information ◽

Religious Organizations ◽

Lower Odds ◽

Logistic Regression Models ◽

Information Research ◽

Nationally Representative ◽

Never Smokers ◽

National Trends ◽

Health Field ◽

Different Sources

Abstract Introduction Recent research has highlighted disparities in people who perceive as trustworthy sources of e-cigarette health information. Research has yet to examine if trusting a particular source of information is associated with use of e-cigarettes or perceptions of e-cigarette harm. We use a nationally representative survey of American adults to address these gaps in knowledge. Methods This study used data from the Health Information National Trends Survey (N = 3738). Logistic regression models were used to calculate odds of ever using e-cigarettes and perceived health harm of e-cigarettes. Trust in seven different sources of e-cigarette health information served as the independent variables. Models accounted for confounders. Results Trusting religious organizations “a lot” as sources of e-cigarette health information was associated with lower odds of ever using e-cigarettes and with lower odds of perceiving e-cigarettes as less harmful than conventional cigarettes. Trusting e-cigarette companies “a lot” as sources of e-cigarette health information was associated with lower odds of viewing e-cigarettes as harmful to health. Conclusion Trusting health information about e-cigarettes from sources in the medical or public health field was not associated with lower use of e-cigarettes or viewing e-cigarettes as more harmful. Trusting health information from e-cigarette companies yielded perceptions of e-cigarette harm that are consistent with messaging provided by these companies. Implications As use of e-cigarettes continues to climb, leveraging different modes of health communication will be critical to both discourage e-cigarette use among never-smokers and, potentially, to encourage use of e-cigarettes as an option to achieve smoking cessation or reduce the harm of tobacco products. Our findings suggest that religious organizations may be helpful in communicating anti-e-cigarette messages.

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Use of Emerging Tobacco Products in the United States

Journal of Environmental and Public Health ◽

10.1155/2012/989474 ◽

2012 ◽

Vol 2012 ◽

pp. 1-8 ◽

Cited By ~ 99

Author(s):

Robert McMillen ◽

Jeomi Maduka ◽

Jonathan Winickoff

Keyword(s):

Young Adults ◽

Smoking Status ◽

Multivariable Analysis ◽

The United States ◽

Tobacco Product ◽

Tobacco Products ◽

User Groups ◽

Nationally Representative ◽

Higher Educational Attainment ◽

Never Smokers

This paper provides the first nationally representative estimates for use of four emerging products. Addressing the issue of land-line substitution with cell phones, we used a mixed-mode survey to obtain two representative samples of US adults. Of 3,240 eligible respondents contacted, 74% completed surveys. In the weighted analysis, 13.6% have tried at least one emerging tobacco product; 5.1% snus; 8.8% waterpipe; 0.6% dissolvable tobacco products; 1.8% electronic nicotine delivery systems (ENDS) products. Daily smokers (25.1%) and nondaily smokers (34.9%) were the most likely to have tried at least one of these products, compared to former smokers (17.2%) and never smokers (7.7%),P<.001. 18.2% of young adults 18–24 and 12.8% of those >24 have tried one of these products,P<.01. In multivariable analysis, current daily (5.5, 4.3–7.6), nondaily (6.1, 4.0–9.3), and former smoking status (2.7, 2.1–3.6) remained significant, as did young adults (2.2, 1.6–3.0); males (3.5, 2.8–4.5); higher educational attainment; some college (2.7, 1.7–4.2); college degree (2.0, 1.3–3.3). Use of these products raises concerns about nonsmokers being at risk for nicotine dependence and current smokers maintaining their dependence. Greater awareness of emerging tobacco product prevalence and the high risk demographic user groups might inform efforts to determine appropriate public health policy and regulatory action.

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Population prevalence and predictors of self-reported exposure to court-ordered, tobacco-related corrective statements

Tobacco Control ◽

10.1136/tobaccocontrol-2019-055095 ◽

2019 ◽

pp. tobaccocontrol-2019-055095 ◽

Cited By ~ 1

Author(s):

Kelly D Blake ◽

Gordon Willis ◽

Annette Kaufman

Keyword(s):

Smoking Status ◽

Adult Population ◽

Federal Court ◽

The Past ◽

Population Prevalence ◽

Nationally Representative ◽

Never Smokers ◽

Media Channels ◽

National Trends ◽

Cigarette Design

ObjectiveTo describe the population prevalence and predictors of self-reported exposure to court-ordered tobacco-related corrective statements in 2017–2018, when they were first implemented in newspapers and on television.MethodsNationally representative data from the 2018 Health Information National Trends Survey were used (n=3504). Frequencies and weighted proportions were calculated for seeing any corrective statement and for each of the five court-ordered corrective statements. Weighted, multivariable logistic regression was used to examine sociodemographic and smoking status predictors of reported exposure to any corrective statement.ResultsIn 2018, an estimated 40.6% of US adults had seen messages in newspapers or on television in the past 6 months stating that a federal court has ordered tobacco companies to make statements about the dangers of smoking cigarettes. Reported exposure to topic-specific statements ranged from 11.4% (manipulation of cigarette design) to 34.7% (health effects). Those with a high school education were significantly less likely than those with a college degree to report seeing the statements (OR=0.69, CI 0.50 to 0.95) and current smokers were significantly more likely than never smokers to report seeing them (OR=1.68, CI 1.12 to 2.53).ConclusionsIn the first 6 months of corrective statement implementation, an estimated 40.6% of US adults reported at least one exposure to any corrective statement, and current smokers were more likely than never smokers to report exposure. Traditional media channels can be effective for tobacco-related message dissemination; however, they may fail to reach more than half of the adult population without additional targeted communication efforts.

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Item Development and Performance of Tobacco Product and Regulation Perception Items for the Health Information National Trends Survey

Nicotine & Tobacco Research ◽

10.1093/ntr/nty193 ◽

2018 ◽

Vol 21 (11) ◽

pp. 1565-1572 ◽

Cited By ~ 1

Author(s):

Emily B Peterson ◽

David B Portnoy ◽

Kelly D Blake ◽

Gordon Willis ◽

Katy Trundle ◽

...

Keyword(s):

Health Information ◽

Government Regulation ◽

Response Selection ◽

Population Level ◽

Tobacco Product ◽

Cognitive Interviewing ◽

Tobacco Products ◽

Response Option ◽

Item Development ◽

National Trends

Abstract Introduction Emerging tobacco products have become increasingly popular, and the US Food and Drug Administration extended its authority to all products meeting the definition of a tobacco product in 2016. These changes may lead to shifts in public perceptions about tobacco products and regulation, and national surveys are attempting to assess these perceptions at the population level. This article describes the item development and cognitive interviewing of the tobacco product and regulation perception items included in two tobacco-focused cycles of the Health Information National Trends Survey (HINTS-FDA), referred to as HINTS-FDA. Methods Cognitive interviewing was used to investigate how respondents comprehended and responded to tobacco product and regulation perception items. Adult participants (n = 20) were selected purposively to oversample current tobacco users and were interviewed in two iterative rounds. Weighted descriptive statistics from the fielded HINTS-FDA surveys (N = 5474) were also calculated. Results Items were generally interpreted as intended, and participants meaningfully discriminated between tobacco products when assessing addiction perceptions. Response selection issues involved inconsistent reporting among participants with little knowledge or ambivalent opinions about either government regulation or tobacco products and ingredients, which resolved when a “don’t know” response option was included in the survey. The fielded survey found that a non-negligible proportion of the population do not have clear perceptions of emerging tobacco products or government regulation. Conclusions A “don’t know” response option is helpful for items assessing many emerging tobacco products but presents several analytic challenges that should be carefully considered. Multiple items assessing specific tobacco product and regulation perception items are warranted in future surveys. Implications The findings from this study can serve as a foundation for future surveys that assess constructs related to emerging tobacco products, harm perceptions across multiple tobacco products, and tobacco-related government regulatory activities. The data provide unique insight into item-specific motivation for selecting a “don’t know” response option for tobacco survey items.

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The role of sexual identity in tobacco information–seeking behaviours and perceptions

Health Education Journal ◽

10.1177/0017896918801391 ◽

2018 ◽

Vol 78 (2) ◽

pp. 203-213 ◽

Cited By ~ 1

Author(s):

Christopher W Wheldon ◽

Leah Hoffman ◽

Erin Keely O’Brien ◽

Janine Delahanty ◽

Xiaoquan Zhao ◽

...

Keyword(s):

Health Information ◽

Tobacco Use ◽

Sexual Minority ◽

Information Seeking ◽

Cross Sectional ◽

Information Campaigns ◽

The Us ◽

Nationally Representative ◽

National Trends

Objective: To explore differences in tobacco information–seeking behaviours and perceptions between sexual minority and heterosexual (or ‘straight’) adults and to determine if these differences are mediated by tobacco use. Design: Cross-sectional national survey. Setting: Nationally representative probability-based surveys of adults 18 years of age or older in the US civilian non-institutionalised population. Methods: Data from respondents identifying as gay, lesbian, bisexual (LGB; n = 156) or straight ( n = 4,964) in the US National Cancer Institute’s Health Information National Trends Survey Food and Drug Administration cycles 1 and 2 (HINTS-FDA 2015, 2017) were analysed. We compared the responses of sexual minority and straight respondents aged 18 years and older concerning tobacco information-seeking behaviours and perceptions. Results: Sexual minority respondents were more likely than their straight counterparts to seek out tobacco health information, to look for information about e-cigarettes and to use the Internet for health information searches. Some of these differences were mediated by tobacco use. Sexual minority respondents were similar to their straight counterparts regarding perceptions of trust and confidence in tobacco health information, as well as perceptions of the hazards of tobacco use. Conclusion: Because sexual minority adults have higher rates of tobacco use and higher rates of tobacco information seeking than others, tobacco health information campaigns should consider carefully tailoring the messages directed towards sexual minority populations.

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Risk Factors for Olfactory and Gustatory Dysfunctions in Patients with SARS-CoV-2 Infection

Neuroepidemiology ◽

10.1159/000514888 ◽

2021 ◽

pp. 1-8

Author(s):

Francesca Galluzzi ◽

Veronica Rossi ◽

Cristina Bosetti ◽

Werner Garavello

Keyword(s):

Risk Factors ◽

Smoking Status ◽

Inverse Association ◽

Current Smoking ◽

Logistic Regression Models ◽

Respiratory Allergies ◽

History Of ◽

Never Smokers ◽

Smell Loss ◽

Relevant Covariates

Introduction: Smell and taste loss are characteristic symptoms of SARS-CoV-2 infection. The aim of this study is to investigate the prevalence and risk factors associated with olfactory and gustatory dysfunctions in coronavirus disease (COVID-19) patients. Methods: We conducted an observational, retrospective study on 376 patients with documented SARS-CoV-2 infection admitted to the San Gerardo Hospital in Monza, Italy, from March to July 2020. All patients answered a phone questionnaire providing information on age, sex, smoking status, and clinical characteristics. Adjusted odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were estimated through logistic regression models including relevant covariates. Results: The prevalence of olfactory and gustatory dysfunctions in COVID-19 patients was 33.5 and 35.6%, respectively. Olfactory dysfunctions were significantly directly associated with current smoking and history of allergy, the multivariable ORs being 6.53 (95% CI 1.16–36.86) for current smokers versus never smokers, and 1.89 (95% CI 1.05–3.39) for those with an allergy compared to those without any allergy. Respiratory allergy in particular was significantly associated with olfactory dysfunctions (multivariable OR 2.30, 95% CI 1.02–5.17). Significant inverse associations were observed for patients aged 60 years or more (multivariable OR 0.33, 95% CI 0.19–0.57) and hospitalization (multivariable OR 0.22, 95% CI 0.06–0.89). Considering gustatory dysfunctions, after allowance of other variables a significant direct association was found for respiratory allergies (OR 2.24, 95% CI 1.03–4.86), and an inverse association was found only for hospitalization (OR 0.21, 95% CI 0.06–0.76). Conclusion: Our study indicates that current smoking and history of allergy (particularly respiratory) significantly increase the risk for smell loss in COVID-19 patients; the latter is also significantly associated to taste loss. Hospitalization has an inverse association with the risk of olfactory and gustatory dysfunctions, suggesting that these may be symptoms characteristics of less severe SARS-CoV-2 infection.

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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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FDA’s reduced exposure marketing order for IQOS: why it is not a reliable global model

Tobacco Control ◽

10.1136/tobaccocontrol-2020-056316 ◽

2021 ◽

pp. tobaccocontrol-2020-056316

Author(s):

Lauren Kass Lempert ◽

Stella Bialous ◽

Stanton Glantz

Keyword(s):

Public Relations ◽

Tobacco Control ◽

Scientific Evidence ◽

Tobacco Product ◽

Tobacco Products ◽

Sales And Marketing ◽

Philip Morris ◽

The Us ◽

The Usa ◽

The Difference

The US Food and Drug Administration (FDA) issued orders in July 2020 authorising Philip Morris Products S.A. to market its heated tobacco product (HTP) IQOS inside the USA with claims that it reduces exposure to some dangerous substances. FDA’s ‘reduced-exposure’ orders explicitly prohibit the marketing of IQOS with claims that IQOS will reduce harm or the risk of tobacco-related diseases. Under US law, FDA’s IQOS orders are problematic because FDA disregarded valid scientific evidence that IQOS increases exposure to other dangerous toxins and that Philip Morris Products S.A. failed to demonstrate that consumers understand the difference between reduced-exposure and reduced-harm claims. Unfortunately, both ‘reduced-exposure’ and ‘reduced-harm’ are classified as ‘modified risk tobacco products’ under US law. Exploiting this confusion, Philip Morris International used the FDA decision as the basis for marketing and public relations campaigns outside the USA to press governments to reverse policies that ban or regulate the sales and marketing of HTPs, including IQOS. Parties to the WHO Framework Convention on Tobacco Control should reject tobacco companies’ unsubstantiated explicit or implied claims of reduced harm associated with HTPs and resist Philip Morris International’s and other companies’ calls to relax HTP regulations based on the FDA’s actions. Instead, parties should adopt policies aligned with the Framework Convention on Tobacco Control when dealing with HTPs and other novel tobacco products.

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Digital Health Engagement in the US Population: Insights From the 2018 Health Information National Trends Survey

American Journal of Public Health ◽

10.2105/ajph.2021.306282 ◽

2021 ◽

pp. e1-e4

Author(s):

Chelsea L. Ratcliff ◽

Melinda Krakow ◽

Alexandra Greenberg-Worisek ◽

Bradford W. Hesse

Keyword(s):

Public Health ◽

Health Information ◽

Health Care Providers ◽

Digital Health ◽

Smart Device ◽

P Value ◽

Care Providers ◽

Cross Sectional ◽

The Us ◽

National Trends

Objectives. To examine prevalence and predictors of digital health engagement among the US population. Methods. We analyzed nationally representative cross-sectional data on 7 digital health engagement behaviors, as well as demographic and socioeconomic predictors, from the Health Information National Trends Survey (HINTS 5, cycle 2, collected in 2018; n = 2698–3504). We fitted multivariable logistic regression models using weighted survey responses to generate population estimates. Results. Digitally seeking health information (70.14%) was relatively common, whereas using health apps (39.53%) and using a digital device to track health metrics (35.37%) or health goal progress (38.99%) were less common. Digitally communicating with one’s health care providers (35.58%) was moderate, whereas sharing health data with providers (17.20%) and sharing health information on social media (14.02%) were uncommon. Being female, younger than 65 years, a college graduate, and a smart device owner positively predicted several digital health engagement behaviors (odds ratio range = 0.09–4.21; P value range < .001–.03). Conclusions. Many public health goals depend on a digitally engaged populace. These data highlight potential barriers to 7 key digital engagement behaviors that could be targeted for intervention. (Am J Public Health. Published online ahead of print May 20, 2021: e1–e4. https://doi.org/10.2105/AJPH.2021.306282 )

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Support for cigarette filter waste policies among US adults

Tobacco Control ◽

10.1136/tobaccocontrol-2020-056451 ◽

2021 ◽

pp. tobaccocontrol-2020-056451

Author(s):

Minal Patel ◽

Alison F Cuccia ◽

Shanell Folger ◽

Adam F Benson ◽

Donna Vallone ◽

...

Keyword(s):

Smoking Status ◽

Population Based ◽

Tobacco Product ◽

Cross Sectional ◽

Cigarette Filter ◽

Logistic Regression Models ◽

Knowledge And Beliefs ◽

Cigarette Butts ◽

Using Data ◽

The Impact

IntroductionLittle is known on whether cigarette filter-related knowledge or beliefs are associated with support for policies to reduce their environmental impact.MethodsA cross-sectional, population-based sample of US adults aged 18–64 years (n=2979) was used to evaluate filter-related knowledge and beliefs by smoking status using data collected between 24 October 2018 and 17 December 2018. Multivariate logistic regression models explored whether these knowledge and belief items were associated with support for two policies, a US$0.75 litter fee and a ban on sales of filtered cigarettes, controlling for demographic characteristics and smoking status.ResultsRegardless of smoking status, 71% did not know plastic was a cigarette filter component and 20% believed filters were biodegradable. Overall, 23% believed filters reduce health harms and 60% believed filters make it easier to smoke; 90% believed cigarette butts are harmful to the environment. Individuals believing cigarette butts harmed the environment were more likely to support a litter fee (adjusted OR (aOR)=2.33, 95% CI: 1.71 to 3.17). Individuals believing that filters are not biodegradable had higher odds of supporting a litter fee (OR=1.47, 95% CI: 1.15 to 1.88). Respondents believing that filters do not make cigarettes less harmful were more likely to support a litter fee (aOR=1.50, 95% CI: 1.20 to 1.88) and filter ban (aOR=2.03, 95% CI: 1.64 to 2.50). Belief that filters make it easier to smoke was associated with decreased support for a filter ban (aOR=0.69, 95% CI: 0.58 to 0.83).ConclusionsComprehensive efforts are needed to educate the public about the impact of cigarette filters in order to build support for effective tobacco product waste policy.

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