Effects of IQOS health warnings and modified risk claims among young adult cigarette smokers and non-smokers

2021 ◽  
pp. tobaccocontrol-2021-056810
Author(s):  
Darren Mays ◽  
Andrea C Johnson ◽  
Allison Glasser ◽  
Melissa Mercincavage ◽  
Andrew A Strasser
Keyword(s):  
Young Adult ◽  
Drug Administration ◽  
Efficacy Beliefs ◽  
Perceived Effectiveness ◽  
Health Warnings ◽  
Cigarette Smokers ◽  
Tobacco Products ◽  
Toxicant Exposure ◽  
Perceived Credibility ◽  
The Usa

IntroductionHeated tobacco products, including Marlboro IQOS, are available globally. In the USA, IQOS was authorised to be advertised with claims about reduced toxicant exposure relative to cigarettes. The effects of such modified risk claims and health warnings have not been studied among young adult cigarette smokers and non-smokers.MethodsIn 2020, US young adult (18–30 years, n=1328) cigarette smokers and non-smokers viewed an IQOS ad in a 4 (modified risk claim variations or none) by 3 (warning variations or none) between-subjects experiment. Outcome measures assessed perceived credibility and effectiveness of the health or risk message for discouraging IQOS use, perceived harms, efficacy beliefs, and IQOS use intentions.ResultsSmokers reported significantly higher (p<0.05) perceived credibility, lower perceived effectiveness, higher efficacy beliefs about switching to IQOS and higher intentions to use IQOS than non-smokers. Among smokers, health warnings increased perceived credibility (p<0.001) and effectiveness (p<0.05), but claims did not affect outcomes examined. Among non-smokers, warnings and claims increased perceived credibility, and warnings increased perceived effectiveness (p<0.003). The reduced exposure claim increased non-smokers’ intentions to use IQOS (b=0.40, 95% CI 0.07 to 0.73).ConclusionsAmong young adult smokers, health warnings increased perceived effectiveness at discouraging IQOS use and perceived credibility. Among non-smokers, warnings and claims increased perceived credibility and warnings increased perceived effectiveness, but the Food and Drug Administration-authorised reduced exposure claim increased intentions to use IQOS. Research is warranted to understand how the content of modified risk claims and health warnings for IQOS affects IQOS use in this population.

scholarly journals Cigarette Smokers Versus Cousers of Cannabis and Cigarettes: Exposure to Toxicants

2019 ◽  
Vol 22 (8) ◽  
pp. 1383-1389 ◽  
Author(s):  
Ellen Meier ◽  
Ryan Vandrey ◽  
Nathan Rubin ◽  
Lauren R Pacek ◽  
Joni A Jensen ◽  
...  
Keyword(s):  
Cannabis Use ◽  
Group Differences ◽  
Nicotine Exposure ◽  
Cigarette Smokers ◽  
Tobacco Products ◽  
Toxicant Exposure ◽  
Biomarkers Of Exposure ◽  
Volatile Organic ◽  
Polycyclic Aromatic ◽  
Alternative Tobacco Products

Abstract Introduction Cannabis and tobacco couse is common and could expose users to higher levels of toxicants. No studies have examined biomarkers of toxicant exposure in cousers of cannabis and cigarettes, compared with cigarette smokers (CS). Aims and Methods Adult daily CS were recruited from 10 US sites for a study of reduced nicotine cigarettes. In this analysis of baseline data, participants were categorized as either cousers of cannabis and tobacco (cousers; N = 167; urine positive for 11-nor-9-carboxy-Δ 9-tetrahydrocannnabinol and self-reported cannabis use ≥1×/week), or CS (N = 911; negative urine and no self-reported cannabis use). Participants who did not meet either definition (N = 172) were excluded. Self-reported tobacco and cannabis use and tobacco and/or combustion-related biomarkers of exposure were compared between groups. Results Compared to CS, cousers were younger (couser Mage = 38.96, SD = 13.01; CS Mage = 47.22, SD = 12.72; p &lt; .001) and more likely to be male (cousers = 67.7%, CS = 51.9%, p &lt; .001). There were no group differences in self-reported cigarettes/day, total nicotine equivalents, or breath carbon monoxide, but cousers had greater use of non-cigarette tobacco products. Compared to CS, cousers had higher concentrations of 3-hydroxypropylmercapturic acid, 2-cyanoethylmercapturic acid, S-phenylmercapturic acid, 3-hydroxy-1-methylpropylmercapturic acid (ps &lt; .05), and phenanthrene tetraol (p &lt; .001). No biomarkers were affected by number of cannabis use days/week or days since last cannabis use during baseline (ps &gt; .05). Conclusions Cousers had higher concentrations of biomarkers of exposure than CS, but similar number of cigarettes per day and nicotine exposure. Additional studies are needed to determine whether cannabis and/or alternative tobacco products are driving the increased toxicant exposure. Implications Cousers of cannabis and tobacco appear to be exposed to greater levels of harmful chemicals (ie, volatile organic compounds and polycyclic aromatic hydrocarbons), but similar levels of nicotine as CS. It is unclear if the higher levels of toxicant exposure in cousers are due to cannabis use or the increased use of alternative tobacco products compared with CS. It is important for studies examining biomarkers of exposure among CS to account for cannabis use as it may have a significant impact on outcomes. Additionally, further research is needed examining exposure to harmful chemicals among cannabis users.

scholarly journals 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

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.

scholarly journals Effectiveness of Text-Only Cigarette Health Warnings in Japan: Findings from the 2018 International Tobacco Control (ITC) Japan Survey

2020 ◽  
Vol 17 (3) ◽  
pp. 952 ◽  
Author(s):  
Janet Chung-Hall ◽  
Geoffrey T. Fong ◽  
Gang Meng ◽  
Mi Yan ◽  
Takahiro Tabuchi ◽  
...  
Keyword(s):  
Tobacco Control ◽  
Health Risks ◽  
Regression Models ◽  
Smoking Initiation ◽  
Effective Strategy ◽  
Health Warnings ◽  
Cigarette Smokers ◽  
Tobacco Products ◽  
Logistic Regression Models ◽  
Pictorial Warnings

Health warnings are an effective strategy for communicating the health harms of smoking, encouraging quitting, and preventing smoking initiation. This study examines the effectiveness of existing text-only health warnings, identifies key predictors of warning effectiveness, and assesses support for pictorial warnings in Japan. Data are from the 2018 International Tobacco Control (ITC) Japan Survey, a cohort survey of adult cigarette smokers (n = 3306), dual users of cigarettes and heated tobacco products (n = 555), and non-cigarette smokers (n = 823). Weighted multivariable logistic regression models were used to assess predictors of warning effectiveness and support for pictorial warnings. Overall, 15.6% of respondents noticed warnings, and 7.9% read or looked closely at warnings. Overall, 10.3% of smokers and dual users said the warnings stopped them from having a cigarette, and 7.2% avoided warnings. Overall, 27.5% of respondents said the warnings made them think about health risks of smoking, but only 2.7% of smokers and dual users said the warnings made them more likely to quit. Overall, 57.6% of respondents supported pictorial warnings. The weak effectiveness of Japan’s text-only warnings is consistent with that in other countries with similar warnings. There is majority support for pictorial warnings in Japan, although the level of support is lower than in other countries.

scholarly journals Assessment of industry data on pulmonary and immunosuppressive effects of IQOS

2018 ◽  
Vol 27 (Suppl 1) ◽  
pp. s20-s25 ◽  
Author(s):  
Farzad Moazed ◽  
Lauren Chun ◽  
Michael A Matthay ◽  
Carolyn S Calfee ◽  
Jeffrey Gotts
Keyword(s):  
Pulmonary Inflammation ◽  
Tobacco Product ◽  
Industry Data ◽  
Dual Use ◽  
Cigarette Smokers ◽  
Tobacco Products ◽  
Aerosol Exposure ◽  
Philip Morris ◽  
The Us ◽  
The Usa

IntroductionHeated tobacco products are being touted as novel reduced-harm tobacco products by tobacco companies. In the USA, Philip Morris International submitted a modified risk tobacco product (MRTP) application to the US Food and Drug Administration in 2016 in which it purports that its heated tobacco product, I-Quit-Ordinary-Smoking (IQOS), is associated with reduced harm compared with conventional cigarettes.MethodsWe reviewed Philip Morris International’s MRTP application to assess the pulmonary and immune toxicities associated with IQOS use in both animal and human studies.ResultsAmong rats exposed to IQOS, there was evidence of pulmonary inflammation and immunomodulation. In human users, there was no evidence of improvement in pulmonary inflammation or pulmonary function in cigarette smokers who were switched to IQOS.ConclusionIQOS is associated with significant pulmonary and immunomodulatory toxicities with no detectable differences between conventional cigarette smokers and those who were switched to IQOS in Philip Morris International’s studies. Philip Morris International also failed to consider how dual use and secondhand aerosol exposure may further impact, and likely increase, the harms associated with these products.

scholarly journals Tobacco toxicant exposure in cigarette smokers who use or do not use other tobacco products

2017 ◽  
Vol 179 ◽  
pp. 330-336 ◽  
Author(s):  
Nicole L. Nollen ◽  
Matthew S. Mayo ◽  
Lauren Clark ◽  
Lisa Sanderson Cox ◽  
Samir S. Khariwala ◽  
...  
Keyword(s):  
Cigarette Smokers ◽  
Tobacco Products ◽  
Toxicant Exposure

scholarly journals Underutilisation of no-tobacco-sale orders against retailers that repeatedly sell to minors, 2015–2019, USA

2021 ◽  
pp. tobaccocontrol-2020-056379
Author(s):  
Natalie Hemmerich ◽  
Desmond Jenson ◽  
Brice L Bowrey ◽  
Joseph G L Lee
Keyword(s):  
Content Analysis ◽  
Tobacco Control ◽  
Drug Administration ◽  
Food And Drug Administration ◽  
Smoking Prevention ◽  
Quantitative Content Analysis ◽  
Tobacco Products ◽  
Quantitative Content ◽  
The Family ◽  
The Usa

ImportanceResearch demonstrates that policies aimed at retailers who sell to minors must be strongly enforced to have an impact on youth usage rates.ObjectivesIn the USA, the Food and Drug Administration (FDA) conducts compliance checks, issues fines, and can order retailers to stop selling tobacco products (ie, no-tobacco-sale orders (NTSOs)) to enforce the Family Smoking Prevention and Tobacco Control Act. We sought to assess FDA’s utilisation of NTSOs.MethodsWe conducted a quantitative content analysis of FDA’s enforcement actions for inspections decided between 1 October 2015 and 29 March 2019. From the 536 134 inspection records we identified 148 NTSOs and 249 720 unique retailer locations, of which 2095 had three or more violations. We randomly sampled NTSOs (n=76) and retail locations (n=152) with frequent violations. We calculated the proportion of NTSOs that could have been issued earlier by FDA. We then calculated the proportion of retailers that could have been issued an NTSO, and the proportion actually issued an NTSO using FDA’s approach and a more stringent approach.ResultsAmong NTSOs, 94.7% (95% CI: 89.8% to 97.4%) of NTSOs could have been issued earlier under a more stringent approach. On average, when an NTSO could have been issued earlier, it could have been issued 453 days earlier (95% CI: 418 to 489; range: 89–1159). Among frequently violating retail locations, 73.6% (95% CI: 66.0% to 80.0%) were eligible for an NTSO. Of those, 1.9% (95% CI: 0.5% to 7.0%) had received an NTSO.ConclusionsThe FDA’s failure to fully leverage its powers to address retailers’ underage sales of tobacco products has weakened efforts to curb the youth e-cigarette epidemic.

scholarly journals Early adoption of heated tobacco products resembles that of e-cigarettes

2021 ◽  
pp. tobaccocontrol-2020-056089
Author(s):  
Shu-Hong Zhu ◽  
Julian Ong ◽  
Shiushing Wong ◽  
Adam Cole ◽  
Yue-Lin Zhuang ◽  
...  
Keyword(s):  
Drug Administration ◽  
National Survey ◽  
Risk Perceptions ◽  
Online Survey ◽  
Tobacco Products ◽  
Probability Sample ◽  
Early Adoption ◽  
The Us ◽  
The Usa ◽  
National Probability Sample

BackgroundHeated tobacco products (HTP) generate nicotine-containing aerosol by heating tobacco rather than burning it. The US Food and Drug Administration (FDA) has recently authorised the sale of one HTP brand, iQOS, in the USA. This study examined the awareness, use and risk perceptions of HTP in the USA following FDA authorisation.MethodsA national probability sample of 20 449 US adults completed an online survey between November 2019 and February 2020. In addition to assessing awareness and use of HTP, two ratios were calculated: the ratio of those who experimented with HTP given that they had heard about it (E/H) and the ratio of those who currently used HTP given experimentation (C/E). These ratios for HTP were compared against those for e-cigarettes from a similar national survey in 2012.ResultsOverall, 8.1% of respondents had heard of HTP. Only 0.55% had tried and 0.10% were current users. The rate of experimentation among those who heard about HTP and the rate of current use among experimenters were, however, similar to those for e-cigarettes in 2012: E/H and C/E for HTP were 6.8% and 18.2%, respectively; and 10.7% and 17.8%, respectively for e-cigarettes. The majority of respondents considered HTP either less harmful than (11.6%), or equally harmful as e-cigarettes (42.7%).ConclusionsOnly a small fraction of US population in 2020 have tried any HTP. However, the similarity in early adoption rates following awareness, suggests that future adoption for HTP may be similar to that for e-cigarettes, if HTP are marketed more aggressively.

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

2020 ◽  
Vol 29 (Suppl 3) ◽  
pp. s203-s215 ◽  
Author(s):  
Karin A Kasza ◽  
Kathryn C Edwards ◽  
Zhiqun Tang ◽  
Cassandra A Stanton ◽  
Eva Sharma ◽  
...  
Keyword(s):  
Tobacco Use ◽  
Smokeless Tobacco ◽  
Tobacco Dependence ◽  
Tobacco Product ◽  
Health Study ◽  
Cigarette Smokers ◽  
Tobacco Products ◽  
Negatively Associated ◽  
Quit Attempts ◽  
The Usa

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.

Multiple tobacco product use among cigarette smokers: a longitudinal examination of menthol and non-menthol smokers during young adulthood

2021 ◽  
pp. tobaccocontrol-2020-055922
Author(s):  
Dale Mantey ◽  
Melissa Harrell ◽  
Baojiang Chen ◽  
Steven H Kelder ◽  
Cheryl Perry ◽  
...  
Keyword(s):  
Young Adult ◽  
Cigarette Smoking ◽  
Tobacco Product ◽  
Single Product ◽  
Cigarette Smokers ◽  
Tobacco Products ◽  
Menthol Cigarette ◽  
Product Use ◽  
Menthol Cigarettes ◽  
Study Participants

BackgroundMultiple tobacco product (MTP) use is common among young adults. Most MTP users are combustible cigarette smokers that use one or more other tobacco products. This study aims to explore menthol as a risk factor for MTP use among a cohort of young adult cigarette smokers.MethodsParticipants were 18–29 years cigarette smokers at 24 Texas colleges in a 6-wave study. Participants (n=4700 observations) were classified as: single product users (ie, exclusive cigarette smoking); dual product users and poly product users. A multilevel, ordered logistic regression model was used to examine the association between menthol cigarette smoking and MTP use. Two longitudinal, multilevel, multinomial logistic regressions were used to examine the relationship between menthol cigarette smoking and number of tobacco products used.ResultsOverall, 40.7% of the sample were single product users, 33.7% were dual product users and 25.6% were poly product users. Menthol was associated with 1.28 greater odds of MTP use. Further, menthol was associated with 1.19 greater risk of dual and 1.40 greater risk of poly product use, relative to single product use. Lastly, menthol cigarette smoking was associated with 1.18 greater risk of poly product use, relative to dual product use.ConclusionsThere was a gradient relationship between menthol cigarette smoking and number of tobacco products used among young adult cigarette smokers. Findings provide for greater regulatory and programmatic efforts to reduce the use of menthol cigarettes.

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