A Systematic Review of Alternative Nicotine Delivery System (ANDS)-Based Interventions on Smoking-Related Health Outcomes Among Marginalised Population Groups.

Background: Smoking and smoking-related disease is endemic amongst many marginalised populations such as people experiencing homelessness, people who use drugs, people living with HIV, sex workers and members of the LGBTQ+, Indigenous, Traveller and migrant communities. Alternative Nicotine Delivery Systems (ANDS)-based interventions including those using Nicotine Replacement Therapy (NRT) and Electronic Nicotine Delivery Systems (ENDS) show promise in supporting people to reduce their smoking. However, little is known about ANDS-based smoking reduction interventions with marginalised populations. This systematic review provides a best evidence synthesis of ANDS-based smoking reduction interventions to address this gap.Methods:A systematic review protocol was registered on PROSPERO (CRD42020158832) and literature review conducted through MEDLINE/PubMed, CINAHL, EMBASE, OVID SP, ScienceDirect and Google Scholar. The primary outcomes of cigarette smoking, and biochemical validation of abstinence were reported. Secondary outcomes reported included physical health, mental health and other outcomes.Results: Twenty-Nine studies were included in this review. Thirteen of the included studies were randomised controlled trials (RCTs) (n= 2828) and 16 studies were quasi controlled studies (n=1172). The sample size across the studies ranged from 9 to 775 participants. The mean reported age of participants ranged from 32.4 to 56.9 years old with an overall mean age of 39.55. A minority of study participants identified as female (33.43%; with two studies not reporting gender). A range of ANDS-interventions were found to be effective in reducing smoking amongst a range of marginalised groups. However, the overall quality of both the controlled and quasi experimental studies, as evaluated using the JBI Appraisal Tool, was found to be low.Conclusions: Studies are often evaluated as homogenous interventions although they are frequently a group of interventions and lack power analysis of the effects of individual components of the intervention effect. Several studies suggest potential mental health benefits consequent of ANDS-based intervention, though this effect is poorly explored. There is a current lack of RCTs related to ANDS-based smoking related interventions with people experiencing homelessness. Similarly, there is a lack of properly controlled RCTs exploring the use of ENDS with marginalised populations. Future studies should aim to address these deficits.

High Perceived Susceptibility to and Severity of COVID-19 in Smokers Are Associated with Quitting-Related Behaviors

A growing body of evidence shows smoking is a risk factor for coronavirus disease (COVID-19). We examined the associations of quitting-related behaviors with perceived susceptibility to and severity of COVID-19 in smokers. We conducted a telephone survey of 659 community-based adult smokers (81.7% male) in Hong Kong, where there was no lockdown. Exposure variables were perceptions that smoking can increase the risk of contracting COVID-19 (perceived susceptibility) and its severity if infected (perceived severity). Outcome variables were quit attempts, smoking reduction since the outbreak of the pandemic, and intention to quit within 30 days. Covariates included sex, age, education, heaviness of smoking, psychological distress, and perceived danger of COVID-19. High perceived susceptibility and severity were reported by 23.9% and 41.7% of participants, respectively. High perceived susceptibility was associated with quit attempts (prevalence ratio (PR) 2.22, 95% CI 1.41–3.49), smoking reduction (PR 1.75, 95% CI 1.21–2.51), and intention to quit (PR 2.31, 95% CI 1.40–3.84). Perceived severity of COVID-19 was associated with quit attempts (PR 1.64, 95% CI 1.01–2.67) but not with smoking reduction or intention to quit. To conclude, the perceived susceptibility to and severity of COVID-19 in smokers were associated with quitting-related behaviors in current smokers, which may have important implications for smoking cessation amid the pandemic.

“It is the One Thing that has Worked”: facilitators and barriers to switching to nicotine salt pod system e-cigarettes among African American and Latinx people who smoke: a content analysis

Background Electronic cigarettes are a harm reduction strategy for individuals who smoke cigarettes who cannot or do not want to quit using FDA-approved cessation methods. Identifying perceived facilitators and barriers to switching among people who smoke cigarettes is critical to optimizing health impact. This is particularly important for the most dominant e-cigarette device, nicotine salt pod electronic cigarettes. We investigate the experience using pod electronic cigarettes among African American and Latinx individuals who smoke, the two largest racial/ethnic minority groups who experience significant health disparities. Methods From July 2018 to May 2019, adults who smoked cigarettes, age 21 + (N = 114; M age = 44.6, 59.6% male, 52.6% African American from Kansas City, 47.4% Latinx from San Diego) received JUUL-brand electronic cigarettes (referred to hereafter as JUUL) for 6 weeks and answered interview questions at week six. We inquired what they liked and disliked about using JUUL, what helped with switching and made switching difficult, future intentions for continued JUUL use, and how JUUL compared to past smoking reduction methods. Responses were coded into themes by independent raters. Theme frequencies were analyzed separately by race/ethnicity and week 6 use trajectory (exclusive JUUL use, dual JUUL and cigarette use, exclusive cigarette use). Results Clean/smell was the aspect of using JUUL most commonly liked (23%), followed by convenience (19%). Coughing/harshness was a more common barrier to switching for African American (44%) than Latinx (9%), and for continuing cigarette use (56%) than for those who exclusively switched or dually used JUUL and combustible cigarettes (15–21%). Most (78% African American; 90% Latinx) reported that the benefits of using JUUL outweighed barriers, and this varied by JUUL use trajectory: 94% exclusive switch, 86% dual use, and 42% continued cigarette use. The majority said they would continue using JUUL to replace cigarettes (83% African American; 94% Latinx) and that JUUL worked better than other methods to reduce cigarettes (72%). Conclusion African American and Latinx individuals who smoked experience using pod electronic cigarettes was generally positive. Understanding facilitators and impediments to switching to electronic cigarettes among racial/ethnic minority people who smoke can inform harm reduction interventions and reduce tobacco-related health disparities. Trial Registration ClinicalTrials.gov Identifier: NCT03511001 posted April 27, 2018.

Effect of Electronic Nicotine Delivery Systems on Cigarette Abstinence in Smokers with no Plans to Quit: Exploratory Analysis of a Randomized Placebo-Controlled Trial

Introduction: The extent to which use of electronic nicotine delivery systems (ENDS) for smoking reduction leads to cigarette abstinence in smokers with no plans to quit smoking is unclear. This exploratory analysis examined the effects of ENDS delivering different amounts of nicotine on cigarette abstinence up to 24-week follow-up, in comparison to placebo or a behavioral substitute. Methods: This four-arm parallel-group, randomized placebo-controlled trial took place at two academic medical centers in USA (Penn State Hershey and Virginia Commonwealth University). Participants were current adult smokers (N=520) interested in reducing but not planning to quit. They received brief advice and were randomized to one of four 24-week conditions, receiving either an eGo-style ENDS paired with 0, 8 or 36 mg/ml nicotine liquid (double-blind) or a cigarette-shaped tube, as a cigarette substitute (CS). Self-reported daily cigarette consumption and exhaled carbon monoxide (CO) were measured at all study visits. Outcomes included intent-to-treat, self-reported 7-day cigarette abstinence, biochemically confirmed by exhaled CO at 24 weeks after randomization. Results: At 24 weeks, significantly more participants in the 36 mg/ml condition (14/130, 10.8%) than in the 0 mg/ml condition (1/130, 0.8%) and the CS condition (4/130, 3.1%) were abstinent (relative risk = 14 [95% CI=1.9-104.9] and 3.5 [95% CI=1.2-10.4], respectively). The abstinence rate in the 8 mg/ml condition was 4.6% (6/130). Conclusions: When smokers seeking to reduce smoking tried ENDS, few quit smoking in the short term. However, if smokers continued to use an ENDS with cigarette-like nicotine delivery, a greater proportion completely switched to ENDS, as compared with placebo or a cigarette substitute.

Inhibitory Control Training (ICT) Reduces The Consumption of Nicotine Among Young, Healthy Female Smokers

Inhibitory control training (ICT) proved to be effective in the reduction of unhealthy food or alcohol consumption, but its efficacy in smoking reduction is hard to estimate due to the scarcity of relevant research. In our randomized controlled trial, the participants (N = 84) were recruited from the population of young healthy female smokers who were motivated to quit. The experimental group underwent an ICT procedure based on the Go/No Go paradigm. The predetermined stop signals (‘no go’ condition) were associated mostly with smoking-related pictures (90% consistency), whereas the response signals were associated with matched neutral pictures. There were two active control groups: the first had an equal proportion of neutral and smoking-related pictures in the ‘go’ and ‘no go’ trials; the second trained inhibitory control according to the same scheme as the experimental group, but the participants were not exposed to any smoking-related cues. All groups underwent 13 training sessions over 25 days. All participants completed a battery of questionnaires and cognitive tasks three times: before training, after its completion, and two months later. We found that all participants reduced the feeling of craving and devalued the smoking-related pictures. Since there were no between-group differences, these effects probably did not result from ICT. However, we found that the experimental group smoked significantly less cigarettes than the control groups; they also reduced the number of smoking days during the preceding 30-day period. The results suggest that extensive ICT training may serve as an effective method of reducing nicotine intake.