Dependence measures for non-cigarette tobacco products within the context of the global epidemic: a systematic review

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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Changes in cigarillo availability following implementation of a local flavoured tobacco sales restriction

Tobacco Control ◽

10.1136/tobaccocontrol-2020-056229 ◽

2021 ◽

pp. tobaccocontrol-2020-056229

Author(s):

Todd Rogers ◽

Doris G Gammon ◽

Ellen M Coats ◽

James M Nonnemaker ◽

Xin Xu

Keyword(s):

Policy Implementation ◽

Rhode Island ◽

Market Share ◽

Scanner Data ◽

Retail Sale ◽

Difference In Difference ◽

Cigarette Tobacco ◽

Tobacco Products ◽

Tobacco Sales ◽

The Impact

IntroductionProvidence, Rhode Island (RI) was among the first US jurisdictions to enact a policy (effective 3 January 2013) restricting the retail sale of non-cigarette tobacco products with a characterising flavour other than the taste or aroma of tobacco, menthol, mint or wintergreen. We used scanner data to assess the impact of this sales restriction on retail availability of cigarillos, flavoured and otherwise, in Providence and a rest-of-state (ROS) comparison area.MethodsEvery unique cigarillo product—each indicated by a universal product code (UPC)—available for sale in RI from January 2012 to December 2016 was assigned to an exclusive flavour-name category (tobacco; explicit or concept flavour; or menthol/mint) based on characteristics in the scanner dataset and, as necessary, information from online websites. We calculated weekly unique cigarillo UPC counts and market share by flavour category and used difference-in-difference regression to assess prepolicy and postpolicy changes in counts and share in Providence relative to ROS.ResultsThe prepolicy to postpolicy decrease in the number of unique cigarillo products available in Providence was 28.64 (±5.83) UPCs greater than the comparable decrease in ROS (p<0.05). The prepolicy to postpolicy increase in the number of unique concept-named flavoured cigarillo products in Providence was 6.08 (±2.31) UPCs greater than the increase in ROS (p<0.05). The postpolicy market share of concept-named flavoured cigarillos was higher in Providence (27.32%, ±1.77) than ROS (12.67%, ±1.67) (p<0.05).ConclusionsAfter policy implementation, Providence consumers were exposed to fewer cigarillo UPCs but a greater variety and proportion of concept-named flavoured cigarillos in the retail marketplace.

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Implementation of the New York City Policy Restricting Sales of Flavored Non-Cigarette Tobacco Products

Health Education & Behavior ◽

10.1177/1090198119853608 ◽

2019 ◽

Vol 46 (5) ◽

pp. 782-789 ◽

Cited By ~ 1

Author(s):

Elizabeth M. Brown ◽

Todd Rogers ◽

Matthew E. Eggers ◽

Michelle L. Cavazos ◽

Maureen S. O’Brien ◽

...

Keyword(s):

New York ◽

New York City ◽

Policy Implementation ◽

York City ◽

Tobacco Policy ◽

Compliance Monitoring ◽

Cigarette Tobacco ◽

Tobacco Products ◽

City Policy ◽

Flavored Tobacco

Flavored tobacco products appeal to youth, and jurisdictions have implemented policy interventions to reduce youth tobacco initiation. This study reviews the process, challenges, and compliance monitoring of a flavored tobacco sales restriction. New York City (NYC) passed a policy restricting the sale of flavored non-cigarette tobacco products in 2009. To describe the policy’s passage, legal defense, implementation, and enforcement, we conducted stakeholder interviews, reviewed legislative and legal records, and analyzed administrative data on retailer inspections and violations. Extensive public and policy maker education efforts preceded this policy. Barriers included opposition to the policy’s passage and a tobacco manufacturer’s lawsuit that sought to halt the law’s implementation and to establish that NYC lacked the authority to restrict the sale of flavored products. The city implemented the flavored tobacco policy as intended and it withstood legal challenges. NYC integrated enforcement into the city’s retailer compliance monitoring infrastructure, and the violation rate is low. Our investigation of NYC’s experience with flavored tobacco policy implementation and enforcement can provide policy makers and health professionals with insights relevant to policy implementation, expand understanding of the potential impact of these kinds of policies, and inform compliance monitoring efforts.

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Changes in cigar sales following implementation of a local policy restricting sales of flavoured non-cigarette tobacco products

Tobacco Control ◽

10.1136/tobaccocontrol-2019-055004 ◽

2019 ◽

pp. tobaccocontrol-2019-055004 ◽

Cited By ~ 2

Author(s):

Todd Rogers ◽

Ashley Feld ◽

Doris G Gammon ◽

Ellen M Coats ◽

Elizabeth M Brown ◽

...

Keyword(s):

Rhode Island ◽

Regression Models ◽

Policy Impact ◽

Local Policy ◽

Cigarette Tobacco ◽

Tobacco Products ◽

Cross Border ◽

Retail Outlets ◽

The City ◽

Specific Impact

IntroductionOn 3 January, 2013, the city of Providence, Rhode Island, began enforcing a restriction on the retail sale of all non-cigarette tobacco products with a characterising flavour other than tobacco, menthol, mint or wintergreen. We assessed the policy impact on cigar sales—which comprise 95% of flavoured non-cigarette tobacco products sold through conventional tobacco retail outlets (eg, convenience stores, supermarkets) in Providence—over time and in comparison to the rest of the state (ROS).MethodsWeekly retail scanner sales data were obtained for January 2012 to December 2016. Cigar sales were categorised into products labelled with explicit-flavour (eg, Cherry) or concept-flavour (eg, Jazz) names. Regression models assessed changes in prepolicy and postpolicy sales in Providence and ROS.ResultsAverage weekly unit sales of flavoured cigars decreased prepolicy to postpolicy by 51% in Providence, while sales increased by 10% in ROS (both p<0.01). The Providence results are due to a 93% reduction in sales of cigars labelled with explicit-flavour names (p<0.01), which did not change significantly in ROS. Sales of cigars labelled with concept-flavour names increased by 74% in Providence and 119% in ROS (both p<0.01). Sales of all cigars—flavoured and otherwise—decreased by 31% in Providence (p<0.01). We detected some evidence of product substitution and cross-border purchasing.ConclusionsThe Providence policy had a city-specific impact on retail sales of flavoured cigars, which was attenuated by an increase in sales of concept flavour-named cigars. Products with concept-flavour names may avoid enforcement agency detection, and their continued sale undermines the intent of the policy.

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Lifestyle characteristics of parental electronic cigarette and marijuana users: healthy or not?

Journal of Perinatal Medicine ◽

10.1515/jpm-2019-0392 ◽

2019 ◽

Vol 48 (1) ◽

pp. 59-66

Author(s):

Dilani Wanasinghe ◽

Shetal Shah ◽

Amruta Bamanikar ◽

David Aboudi ◽

Soumya Mikkilineni ◽

...

Keyword(s):

Drug Use ◽

Illicit Drug ◽

Marijuana Use ◽

Illicit Drug Use ◽

Electronic Cigarette ◽

The Other ◽

Cigarette Use ◽

Cigarette Tobacco ◽

Tobacco Products

AbstractObjectiveTo assess lifestyle characteristics among parental electronic cigarette (e-cigarette), marijuana and tobacco users.MethodsA total of 1214 parents (77% mothers and 23% fathers) were surveyed and categorized into five exposure groups: e-cigarette use only (1%), marijuana use only (3%), tobacco products only (10%), multi-exposed [11% (marijuana, e-cigarette and tobacco)], and non-users [75% (no e-cigarette, tobacco or marijuana)].ResultsSimilar to non-users, the e-cigarette group had no illicit drug use. Further, e-cigarette users were more likely, in adjusted models, to self-identify as non-smokers and exercise compared with tobacco and multi-exposed groups. Although marijuana users also had higher odds of self-identifying as non-smokers compared to tobacco and multi-exposed groups, they were more likely than non-users to drink alcohol.ConclusionE-cigarette and marijuana using parents were less likely to identify as smokers. E-cigarette users had healthier lifestyle characteristics than the other exposed groups. Clinicians should consider specifically screening for parental e-cigarette and marijuana use as assessing for only “smoking” may underrepresent first-and second-hand exposure. Additionally, clinicians should be aware that marijuana using parents are more likely to drink alcohol and should counsel accordingly.

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Perceptions and impact of plain packaging of tobacco products in low and middle income countries, middle to upper income countries and low-income settings in high-income countries: a systematic review of the literature

BMJ Open ◽

10.1136/bmjopen-2015-010391 ◽

2016 ◽

Vol 6 (3) ◽

pp. e010391 ◽

Cited By ~ 16

Author(s):

Nicole Hughes ◽

Monika Arora ◽

Nathan Grills

Keyword(s):

Systematic Review ◽

Low Income ◽

High Income ◽

Review Of The Literature ◽

Tobacco Products ◽

Middle Income ◽

Plain Packaging ◽

Middle Income Countries ◽

Low And Middle Income

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Tobacco price and use following California Proposition 56 tobacco tax increase

PLoS ONE ◽

10.1371/journal.pone.0257553 ◽

2021 ◽

Vol 16 (10) ◽

pp. e0257553

Author(s):

Christian Gunadi ◽

Tarik Benmarhnia ◽

Martha White ◽

John P. Pierce ◽

Sara B. McMenamin ◽

...

Keyword(s):

Smokeless Tobacco ◽

Control Method ◽

Cigarette Consumption ◽

Sensitivity Analyses ◽

Synthetic Control ◽

Cigarette Use ◽

Cigarette Price ◽

Cigarette Tobacco ◽

Tobacco Products ◽

Tobacco Tax

Background California Proposition 56 increased cigarette excise tax by $2 per pack with equivalent increases on non-cigarette tobacco products. We estimated the changes in cigarette price, cigarette use, and non-cigarette use following the implementation of Proposition 56 in California in 2017. Methods Seven waves of Tobacco Use Supplements to the Current Population Survey (TUS-CPS) 2011–2019 data were used to obtain state-level aggregate self-reported outcomes, including cigarette price per pack, current and daily cigarette use, cigarette consumption per day, and current and daily use of non-cigarette tobacco products (hookah, pipe, cigar, and smokeless tobacco). A modified version of a synthetic control method was used to create a “synthetic” California that best resembled pre-policy sociodemographic characteristics and outcome trends in California while correcting time-invariant pre-policy differences. Various sensitivity analyses were also conducted. Results The implementation of Proposition 56 was associated with an increase in self-reported cigarette price per pack in California ($1.844, 95%CI: $0.153, $3.534; p = 0.032). No evidence suggested that Proposition 56 was associated with the changes in the prevalence of current or daily cigarette use, cigarette consumption per day, or the prevalence of current or daily use of non-cigarette tobacco products. Conclusion Most of the cigarette tax increase following Proposition 56 in California was passed on to consumers. There is a lack of evidence that the implementation of Proposition 56 was associated with the changes in the use of cigarettes and other tobacco products such as hookah, pipe, cigar, and smokeless tobacco.

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Instruments to Measure E-Cigarette Related Constructs: A Systematic Review

10.21203/rs.3.rs-496491/v1 ◽

2021 ◽

Author(s):

Eunhee Park ◽

Misol Kwon ◽

Thomas Chacko ◽

Maciej Goniewicz ◽

Chin-Shang Li ◽

...

Keyword(s):

Systematic Review ◽

Content Validity ◽

Web Of Science ◽

Electronic Cigarettes ◽

Cigarette Use ◽

Public Attention ◽

Validation Process ◽

Cronbach’S Alpha ◽

Tobacco Products ◽

Cronbach's Alpha

Abstract Background Electronic cigarettes (e-cigarettes) are relatively new tobacco products that are attracting public attention due to their unique features, especially their many flavor options and their potential as an alternative to cigarettes. However, uncertainties remain regarding the determinants and consequences of e-cigarette use because current research on e-cigarettes is made more difficult due to the lack of valid and reliable instruments that measure e-cigarette related constructs. This systematic review therefore seeks to identify the instruments proposed by researchers in the field that are designed to assess various aspects of e-cigarette use or its related constructs and analyze the evidence presented regarding the psychometric properties of the identified instruments.Methods This systematic review utilized six search engines: PubMed, Medline, CINAHL, PsycINFO, Web of Science, and EMBASE, to identify articles published in the peer-reviewed journals from inception to June 2018 that contained development or validation processes for these instruments.Results Eighteen articles describing the development or validation of 20 unique instruments were identified. Beliefs, perception, motive, e-cigarette use, and dependence, were the most commonly assessed e-cigarette related constructs. The included studies reported either construct or criterion validity, with 14 studies reporting both. Most studies did not report the content validity; for reliability, most reported internal consistencies using Cronbach’s alpha, with 15 instruments reporting Cronbach’s alpha > 0.70 for the scale or its subscales.Conclusions Twenty instruments with a reported development or validation process to measure e-cigarette related constructs are currently available for practitioners and researchers.

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Use of Technology-Based Interventions in the Treatment of Patients with Overweight and Obesity: A Systematic Review

Nutrients ◽

10.3390/nu12123634 ◽

2020 ◽

Vol 12 (12) ◽

pp. 3634

Author(s):

Lorena Rumbo-Rodríguez ◽

Miriam Sánchez-SanSegundo ◽

Nicolás Ruiz-Robledillo ◽

Natalia Albaladejo-Blázquez ◽

Rosario Ferrer-Cascales ◽

...

Keyword(s):

Systematic Review ◽

Weight Loss ◽

Personal Digital Assistant ◽

Overweight And Obesity ◽

Cochrane Library ◽

Obese Patients ◽

Self Monitoring ◽

Global Epidemic ◽

Use Of Technology ◽

Different Types

Introduction: Obesity is one of the most important health problems worldwide. The prevalence of obesity has increased dramatically in the last decades and is now recognized as a global epidemic. Given the dramatic consequences of obesity, new intervention approaches based on the potential of technologies have been developed. Methods: We conducted a systematic review of studies using PubMed, ScienceDirect, Cochrane Library, and MedLine databases to assess how different types of technologies may play an important role on weight loss in obese patients. Results: Forty-seven studies using different types of technologies including smartphones, app, websites, virtual reality and personal digital assistant were included in the review. About half of interventions (47%) found a significant effect of the technology-based interventions for weight lost in obese patients. The provision of feedback could also be effective as a complement to interventions carried out using technology to promote weight loss. Conclusions: The use of technologies can be effective to increase weight loss in patients with obesity improving treatment adherence through self-monitoring.

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