Correlates of tobacco product cessation among youth and adults in the USA: findings from the PATH Study Waves 1–3 (2013–2016)

ObjectiveTo report on demographic and tobacco use correlates of cessation behaviours across tobacco products (cigarettes, electronic nicotine delivery systems (ENDS), cigars, hookah and smokeless tobacco) among the US population.DesignData were drawn from the first three waves (2013–2016) of the Population Assessment of Tobacco and Health Study, a nationally representative, longitudinal cohort study of US youth (ages 12–17) and adults (ages 18+) . Past 30-day (P30D) tobacco users at Wave 1 (W1) or Wave 2 (W2) were included (n=1374 youth; n=14 389 adults). Generalised estimating equations were used to evaluate the association between demographic and tobacco use characteristics at baseline, with cessation behaviours at follow-up (discontinuing use, attempting to quit, quitting), over two 1-year periods (W1–W2, W2–Wave 3).ResultsAmong adult users of each type of tobacco product, frequency of use was negatively associated with discontinuing use. Among adult cigarette smokers, non-Hispanic white smokers, those with lower educational attainment and those with lower household income were less likely to discontinue cigarette use; ENDS use was positively associated with making quit attempts but was not associated with cigarette quitting among attempters; smokeless tobacco use was positively associated with quitting among attempters; tobacco dependence was negatively associated with quitting among attempters. Among youth cigarette smokers, tobacco dependence was negatively associated with making quit attempts.DiscussionDemographic correlates of tobacco cessation behaviours underscore tobacco use disparities in the USA. Use of ENDS and use of smokeless tobacco products are positively associated with some adult cigarette cessation behaviours.

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Flavored Tobacco Product Use and Its Association With Indicators of Tobacco Dependence Among US Adults, 2014–2015

Nicotine & Tobacco Research ◽

10.1093/ntr/ntz092 ◽

2019 ◽

Vol 22 (6) ◽

pp. 1004-1015 ◽

Cited By ~ 1

Author(s):

Satomi Odani ◽

Brian Armour ◽

Israel T Agaku

Keyword(s):

Tobacco Use ◽

Tobacco Dependence ◽

Tobacco Product ◽

Demographic Characteristics ◽

Cigarette Smokers ◽

Tobacco Products ◽

Product Use ◽

Menthol Cigarettes ◽

Current Tobacco ◽

Flavored Tobacco

Abstract Introduction Widely marketed flavored tobacco products might appeal to nonusers and could be contributing to recent increases in tobacco product use. We assessed flavored product use among current tobacco users; and measured associations between flavored product use and dependence among US adults. Methods Data were from the 2014–2015 Tobacco Use Supplement to the Current Population Survey, a cross-sectional household-based survey of US adults ≥18 years (n = 163 920). Current users of cigarettes, cigars, pipes, hookahs, smokeless tobacco, and electronic cigarettes (e-cigarettes) were asked whether their usual product was menthol or came in any characterizing flavors. Proportions of flavored product users were computed nationally and by state and demographic characteristics. Tobacco dependence was assessed with two proxy measures: daily use and use ≤30 minutes after waking. Associations between flavored product use and tobacco dependence were examined using logistic regression adjusted for sex, age, race/ethnicity, and multi tobacco product use. Results An estimated 41.0% of current users of any tobacco product usually used a flavored product during 2014–2015. The proportion ranged from 22.5% (Maine) to 62.1% (District of Columbia). By product, the proportion ranged from 28.3% (cigars) to 87.2% (hookah). Flavored product use was associated with: daily tobacco product use among current e-cigarette users (adjusted odds ratio [AOR] = 1.71), cigar smokers (AOR = 1.42), and cigarette smokers (AOR = 1.13); and tobacco product use ≤30 minutes after waking among current cigar smokers (AOR = 1.80), and cigarette smokers (AOR = 1.11). Conclusions Restricting sales of flavored tobacco products and implementation of proven population-level tobacco control interventions could help reduce tobacco product use among US adults. Implications During 2014–2015, flavored tobacco products were widely used by US adults with variations across states and demographic characteristics. Use of flavored e-cigarettes, flavored cigars, and menthol cigarettes were associated with daily tobacco use: use of flavored cigars and menthol cigarettes were associated with tobacco use within 30 minutes after waking. These findings suggest associations between flavor use and increased tobacco dependence. Prohibiting sale of flavored products can reduce access to those products, and could help reduce tobacco dependence and promote cessation behaviors among current tobacco product users.

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Correlates of tobacco product reuptake and relapse among youth and adults in the USA: findings from the PATH Study Waves 1–3 (2013–2016)

Tobacco Control ◽

10.1136/tobaccocontrol-2020-055660 ◽

2020 ◽

Vol 29 (Suppl 3) ◽

pp. s216-s226 ◽

Cited By ~ 9

Author(s):

Kathryn C Edwards ◽

Karin A Kasza ◽

Zhiqun Tang ◽

Cassandra A Stanton ◽

Eva Sharma ◽

...

Keyword(s):

Tobacco Use ◽

Tobacco Dependence ◽

Tobacco Product ◽

Health Study ◽

First Year ◽

The Us ◽

The Usa ◽

Nationally Representative ◽

And Bisexual

ObjectiveThis study examines sociodemographic and tobacco use correlates of reuptake and relapse to tobacco use across a variety of tobacco products (cigarettes, electronic nicotine delivery systems, cigars, hookah and smokeless tobacco) among the US population.DesignData were drawn from the first three waves (2013–2016) of the Population Assessment of Tobacco and Health Study, a nationally representative, longitudinal cohort study of US youth (ages 12–17) and adults (ages 18+). Reuptake (past 30-day use among previous tobacco users) and relapse (current use among former established users; adults only) were examined among previous users of at least one type of tobacco product at Wave 1 (W1) or Wave 2 (W2) (n=19 120 adults, n=3039 youth). Generalised estimating equations were used to evaluate the association between demographic and tobacco use characteristics at baseline, with reuptake/relapse at follow-up, over two 1-year periods (W1–W2 and W2–Wave 3).ResultsAny tobacco product reuptake occurred in 7.8% of adult previous users and 30.3% of youth previous users. Correlates of any tobacco reuptake included being male, non-Hispanic black and bisexual in adults, but race and sexual orientation were not consistent findings in youth. Among recent former users, relapse rates were greater (32.9%). Shorter time since last use and greater levels of tobacco dependence showed the strongest association with any tobacco relapse.DiscussionContinued clinical and public health efforts to provide adults with tools to cope with tobacco dependence symptoms, especially within the first year or two after quitting, could help prevent relapse.

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Are Heated Tobacco Product Users Less Likely to Quit than Cigarette Smokers? Findings from THINK (Tobacco and Health IN Korea) Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17228622 ◽

2020 ◽

Vol 17 (22) ◽

pp. 8622

Author(s):

Cheol Min Lee ◽

Choon-Young Kim ◽

Kiheon Lee ◽

Sungroul Kim

Keyword(s):

South Korea ◽

Cross Sectional Study ◽

Tobacco Product ◽

Cross Sectional ◽

Cigarette Smokers ◽

Tobacco Products ◽

Tobacco Sales ◽

Quit Attempts ◽

Stop Smoking Services ◽

The Difference

Since the advent of heated tobacco products in June 2017 in South Korea, the sale of heated tobacco products accounted for 10.5% of total tobacco sales in 2019. However, the decreasing trend in total tobacco sales is gradually weakening and the number of visitors using stop smoking services has also dropped. This study examines the association between the use of new tobacco products and related products and cessation behaviors. A cross-sectional study using a self-administered questionnaire was conducted from March 2019 to July 2019 for 2831 adult tobacco users. The difference in rates of quit attempts using the type of tobacco products and related products in the past year were noted (55.6% (any cigarette smoker), 46.7% (any e-cigarette user), and 39.6% (any heated tobacco product user)). About a 30% increase in quit attempts was observed for the triple users of either conventional cigarette or heated tobacco product than exclusive users. Exclusive heated tobacco product and e-cigarette users were approximately 40% and 20% less likely to quit the product they used than exclusive cigarette smokers, respectively. These findings can explain recent occurrences in South Korea, such as the reduction of visitors at smoking cessation clinics and the attenuation of the decline in tobacco sales.

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Longitudinal pathways of exclusive and polytobacco cigar use among youth, young adults and adults in the USA: findings from the PATH Study Waves 1–3 (2013–2016)

Tobacco Control ◽

10.1136/tobaccocontrol-2020-055624 ◽

2020 ◽

Vol 29 (Suppl 3) ◽

pp. s163-s169 ◽

Cited By ~ 11

Author(s):

Kathryn C Edwards ◽

Eva Sharma ◽

Michael J Halenar ◽

Kristie A Taylor ◽

Karin A Kasza ◽

...

Keyword(s):

Young Adults ◽

Tobacco Use ◽

Age Groups ◽

Health Impact ◽

Tobacco Product ◽

Health Study ◽

Longitudinal Analyses ◽

Cross Sectional ◽

The Usa ◽

Nationally Representative

ObjectiveThe goal of this study is to examine the cross-sectional prevalence of use and 3-year longitudinal pathways of cigar use in US youth (12-17 years), young adults (18-24 years), and adults 25+ (25 years or older).DesignData were drawn from the first three waves (2013–2016) of the Population Assessment of Tobacco and Health Study, a nationally representative, longitudinal cohort study of US youth and adults. Respondents with data at all three waves (youth, n=11 046; young adults, n=6478; adults 25+, n=17 188) were included in longitudinal analyses.ResultsWeighted cross-sectional prevalence of past 30-day (P30D) use was stable for adults 25+ (~6%), but decreased in youth (Wave 1 (W1) to Wave 3 (W3)=2.5% to 1.2%) and young adults (W1 to W3=15.7% to 14.0%). Among W1 P30D cigar users, over 50% discontinued cigar use (irrespective of other tobacco use) by Wave 2 (W2) or W3. Across age groups, over 70% of W1 P30D cigar users also indicated P30D use of another tobacco product, predominantly cigar polytobacco use with cigarettes. Discontinuing all tobacco use by W2 or W3 was greater in adult exclusive P30D cigar users compared with polytobacco cigar users.ConclusionsAlthough the majority of P30D cigar users discontinued use by W3, adult polytobacco users of cigars were less likely to discontinue all tobacco use than were exclusive cigar users. Tracking patterns of cigar use will allow further assessment of the population health impact of cigars.

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Trend in the affordability of tobacco products in Bangladesh: findings from the ITC Bangladesh Surveys

Tobacco Control ◽

10.1136/tobaccocontrol-2017-054035 ◽

2018 ◽

Vol 28 (Suppl 1) ◽

pp. s20-s30 ◽

Cited By ~ 7

Author(s):

Nigar Nargis ◽

Michal Stoklosa ◽

Jeffrey Drope ◽

Geoffrey T Fong ◽

Anne C K Quah ◽

...

Keyword(s):

Tobacco Use ◽

Smokeless Tobacco ◽

Linear Regression Analysis ◽

Tobacco Consumption ◽

Tobacco Product ◽

Price Increase ◽

Income Growth ◽

Multivariate Linear Regression Analysis ◽

Tobacco Products ◽

Individual Level

BackgroundThe price of tobacco products in relation to the income of tobacco users—affordability—is recognised as a key determinant of tobacco use behaviour. The effectiveness of a price increase as a deterrent to tobacco use depends on how much price increases in relation to the income of the potential users. The aim of this paper is to examine the distribution of and trends in the affordability of tobacco products in Bangladesh.MethodUsing four waves of International Tobacco Control Survey data on Bangladesh, this study measures affordability of tobacco products at the individual level as the ratio of self-reported price and self-reported income. The trends in affordability by brand categories of cigarettes and of bidi and smokeless tobacco are estimated using multivariate linear regression analysis.ResultsDespite significant increase in price, the affordability of cigarettes increased between 2009 and 2014–2015 due to income growth outpacing price increase. The increase was disproportionately larger for more expensive brands. The affordability of bidis increased over this period as well. The affordability of smokeless tobacco products remained unchanged between 2011–2012 and 2014–2015.ConclusionThe tax increases that were implemented during 2009–2015 were not enough to increase tobacco product prices sufficiently to outweigh the effect of income growth, and to reduce tobacco consumption. The findings from this research inform policymakers that in countries experiencing rapid economic growth, significant tax increases are needed to counteract the effect of income growth, in order for the tax increases to be effective in reducing tobacco use.

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Transitions to smokeless tobacco use among adult cigarette smokers in the Population Assessment of Tobacco and Health (PATH) Study, Waves 3–5 (2015–2019)

Tobacco Control ◽

10.1136/tobaccocontrol-2021-056907 ◽

2021 ◽

pp. tobaccocontrol-2021-056907

Author(s):

Rebecca A Jackson ◽

Chunfeng Ren ◽

Blair Coleman ◽

Hannah R Day ◽

Cindy M Chang ◽

...

Keyword(s):

Tobacco Use ◽

Smokeless Tobacco ◽

Health Study ◽

Dual Use ◽

Cigarette Smokers ◽

Population Assessment ◽

Current Cigarette ◽

Smokeless Tobacco Use ◽

Using Data

ObjectiveExamine patterns of dual use of cigarettes and smokeless tobacco and complete switching over time among adult current cigarette smokers using data from the Population Assessment of Tobacco and Health Study Wave 3 (2015–2016), Wave 4 (2016–2018) and Wave 5 (2018–2019).MethodsWe examined four tobacco use states among 6834 exclusive smokers and 372 dual users at Wave 3 with two waves of follow-up data: exclusive cigarette use, exclusive smokeless tobacco use, dual use and use of neither product.ResultsAmong exclusive smokers at Wave 3, only 1.6% (95% CI: 1.3% to 2.1%) transitioned to dual use at Wave 4, and 0.1% (95% CI: 0.07% to 0.2%) switched to exclusive smokeless tobacco use. Among exclusive smokers who switched to dual use, 53.1% (95% CI: 40.9% to 64.9%) returned to exclusive cigarette smoking, 34.3% (95% CI: 23.8% to 46.6%) maintained dual use and 12.6% (95% CI: 7.0% to 21.7%) did not smoke cigarettes after an additional wave of follow-up. Dual users at Wave 3 were likely to maintain their dual use status at Wave 4, 51.2% (95% CI: 46.1% to 56.3%) and Wave 5, 47.9% (95% CI: 40.1% to 55.8%).ConclusionsVery few cigarette smokers transition to smokeless tobacco use, and among those who do, dual use is more common than exclusive smokeless tobacco use. Further, the majority of exclusive cigarette smokers who transition to dual use at Wave 4 continue smoking cigarettes at Wave 5, either as dual users or as exclusive smokers.

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Youth susceptibility to tobacco use: Is it general or specific?

10.1101/2021.05.25.21257808 ◽

2021 ◽

Author(s):

Hui Cheng ◽

Pavel N. Lizhnyak ◽

Natasha A. Knight ◽

Andrea R. Vansickel ◽

Edward G. Largo

Keyword(s):

Tobacco Use ◽

Holistic Approach ◽

Risky Behaviors ◽

Tobacco Product ◽

Health Study ◽

Tobacco Products ◽

Nationally Representative ◽

Institutionalized Youth ◽

High Degree ◽

The Relationship

Importance: Susceptibility to tobacco use can help identify youth that are at risk for tobacco use. Objective: To estimate the extent of overlap in susceptibilities across various tobacco products, investigate correlates with susceptibilities, and examine whether the relationship linking susceptibility with the onset of use is product specific or is accounted for by a general susceptibility-onset relationship. Design: Prospective cohort study. Setting: Analysis of data from the longitudinal Population Assessment of Tobacco and Health study wave 4 (December 2016 to January 2018) and wave 4.5 youth surveys (December 2017 to November 2018). Participants: A nationally representative sample of non-institutionalized youth 12-17 years old who had never used a tobacco product at baseline assessment. Main variable of interest: Susceptibility to the use of each type of tobacco product assessed at wave 4. Main outcomes: Onset of use of various tobacco products defined as the first use occurring between waves 4 and 4.5 assessments. Results: Cigarettes and e-cigarettes were the most common (~25%), while snus was the least common (<5%), tobacco product to which youth were susceptible. There was a high degree of overlap in susceptibilities across tobacco products (65% of tobacco-susceptible youth were susceptible to more than one tobacco product). Tobacco-susceptible youth were more likely to have used cannabis or consumed alcohol in the past 30 days or to have tobacco-using peers. Susceptibility to use predicted the onset of use (incidence ratio = 3.2 to 12.9). Estimates for the product-specific path were null, except for e-cigarettes (β=0.08, 95% CI=0.04 to 0.13) and filtered cigars (β= -0.09, 95% CI= -0.13 to -0.05), after accounting for the general susceptibility-to-tobacco-onset relationship (β=0.50, 95% CI=0.42 to 0.58). Conclusions and Relevance: Youth susceptibility to tobacco use overlaps widely across different tobacco products and other risky behaviors. Public health efforts may benefit from a holistic approach to risk behavior prevention planning.

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Awareness, trial and use of heated tobacco products among adult cigarette smokers and e-cigarette users: findings from the 2018 ITC Four Country Smoking and Vaping Survey

Tobacco Control ◽

10.1136/tobaccocontrol-2020-055985 ◽

2020 ◽

pp. tobaccocontrol-2020-055985

Author(s):

Connor R Miller ◽

Edward Sutanto ◽

Danielle M Smith ◽

Sara C Hitchman ◽

Shannon Gravely ◽

...

Keyword(s):

Tobacco Product ◽

Regulatory Environment ◽

Cigarette Smokers ◽

Tobacco Products ◽

The Usa ◽

Multivariable Analyses ◽

Former Smokers ◽

Use Categories

ObjectiveTo evaluate heated tobacco product (HTP) awareness, trial and current use among adult cigarette smokers and vaping product users in four countries with varying regulations governing HTP sales.DesignData came from Wave 2 of the ITC Four Country Smoking and Vaping Survey, collected from February to July 2018. Respondents were current and former smokers and/or users of vaping products (18 years or older) from Canada (CA; n=3778), England (EN; n=4848), the USA (US; n=2846) and Australia (AU; n=1515). At the time of the survey, only Canada and England permitted the sale of contemporary HTPs (eg, IQOS).ResultsOverall, 30.2% of respondents reported being aware of HTPs (CA=30.4%; EN=31.0%; US=30.2%; AU=27.4%; p=0.346), 2.4% had ever tried HTPs (CA=3.3%; EN=2.4%; US=2.0%; AU=0.9%; p=0.001) and 0.9% currently used HTPs at least monthly (CA=0.8%; EN=1.2%; US=0.7%; AU=0.2%; p<0.001). Trial and current use were higher among those who concurrently smoked and vaped (at least monthly) versus other nicotine use categories (trial: 10.9% v. 1.2%–2.0%, p<0.001; current use: 8.4% v. 0.1%–1.0%, p<0.001). In multivariable analyses, HTP awareness did not differ across countries, whereas odds of trial and current use were lower where HTPs were unavailable. Odds of HTP trial did not differ by regulatory environment when restricting analysis to HTP-aware concurrent smokers–vapers.ConclusionApproximately one third of respondents were aware of HTPs, even in the USA and Australia, where contemporary HTPs were not yet on the market. Trial and use were uncommon, except among concurrent smokers–vapers. Restrictions on availability may have limited HTP use generally, but less so for concurrent smokers–vapers.

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Urinary Cyanoethyl Mercapturic Acid, a Biomarker of the Smoke Toxicant Acrylonitrile, Clearly Distinguishes Smokers From Nonsmokers

Nicotine & Tobacco Research ◽

10.1093/ntr/ntaa080 ◽

2020 ◽

Vol 22 (10) ◽

pp. 1744-1747

Author(s):

Xianghua Luo ◽

Steven G Carmella ◽

Menglan Chen ◽

Joni A Jensen ◽

Lynne R Wilkens ◽

...

Keyword(s):

Smokeless Tobacco ◽

Operating Characteristic ◽

Characteristic Curve ◽

Tobacco Product ◽

Mercapturic Acid ◽

Cigarette Smokers ◽

Tobacco Products ◽

Human Environment ◽

Chromatography Tandem Mass Spectrometry ◽

Liquid Chromatography Tandem Mass

Abstract Introduction Cyanoethyl mercapturic acid (CEMA) is a urinary metabolite of acrylonitrile, a toxicant found in substantial quantities in cigarette smoke, but not in non-combusted products such as e-cigarettes or smokeless tobacco and rarely in the diet or in the general human environment. Thus, we hypothesized that CEMA is an excellent biomarker of combusted tobacco product use. Aims and Methods We tested this hypothesis by analyzing CEMA in the urine of 1259 cigarette smokers (urinary cotinine ≥25 ng/mL) and 1191 nonsmokers. The analyses of CEMA and cotinine were performed by validated liquid chromatography–tandem mass spectrometry methods. Logistic regression was fit for log-transformed CEMA to construct the receiver operating characteristic curve. Results We found that a CEMA cutpoint of 27 pmol/mL urine differentiated cigarette smokers from nonsmokers with sensitivity and specificity greater than 99%. The use of different cotinine cutpoints to define smokers (10–30 ng/mL) had little effect on the results. Conclusions CEMA is a highly reliable urinary biomarker to identify users of combusted tobacco products such as cigarettes as opposed to users of non-combusted products, medicinal nicotine, or nonusers of tobacco products. Implications CEMA can be used to distinguish users of combusted tobacco products from non-combusted products such as e-cigarettes, smokeless tobacco, and medicinal nicotine. Levels of CEMA in the urine of people who use these non-combusted products are extremely low, in contrast to cotinine.

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

Nicotine & Tobacco Research ◽

10.1093/ntr/ntz147 ◽

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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