Addicted to green: priming effect of menthol cigarette packaging on brain response to smoking cues

IntroductionMentholated tobacco cigarettes are believed to be more addictive than non-menthol ones. Packaging of most menthol cigarette brands includes distinctive green hues, which may act as conditioned stimuli (ie, cues) and promote menthol smoking. To examine the cue properties of menthol cigarette packaging, we used a priming paradigm to assess the effect of packaging on the neural substrates of smoking cue reactivity. We hypothesised that menthol packaging will exert a specific priming effect potentiating smoking cue reactivity in menthol compared with non-menthol smokers.MethodsForty-two menthol and 33 non-menthol smokers underwent functional MRI while viewing smoking and neutral cues. The cues were preceded (ie, primed) by briefly presented images of menthol or non-menthol cigarette packages. Participants reported craving for cigarettes in response to each cue.ResultsMenthol packaging induced greater frontostriatal and occipital smoking cue reactivity in menthol smokers than in non-menthol smokers. Menthol packaging also enhanced the mediation by neural activity of the relationship between cue exposure and cigarette craving in menthol but not non-menthol smokers. Dynamic causal modelling showed stronger frontostriatal-occipital connectivity in response to menthol packaging in menthol compared with non-menthol smokers. The effects of non-menthol packaging did not differ between categories of smokers.ConclusionsOur findings demonstrate heightened motivational and perceptual salience of the green-hued menthol cigarette packaging that may exacerbate menthol smokers’ susceptibility to smoking cues. These effects could contribute to the greater addiction severity among menthol smokers and could be considered in the development of science-based regulation and legal review of tobacco product marketing practices.

Electronic cigarette and smoking paraphernalia point of sale displays: an observational study in England

BackgroundTobacco point of sale (POS) retail displays are banned in many countries, including in England, due in part to evidence linking them to greater susceptibility to smoking in children. There is no equivalent ban on displays of electronic cigarettes (e-cigarettes) or smoking paraphernalia (eg, cigarette lighters) in England, which are often positioned alongside covered tobacco storage units. This observational study describes the visibility and placement of e-cigarette and smoking paraphernalia POS displays in major tobacco retailers in two cities in England to inform future research examining their possible links to susceptibility to tobacco smoking, particularly in children.MethodsResearchers visited all small- and large-format stores of four supermarket chains and a randomly selected sample of convenience stores, in Bristol and Cambridge. A standardised checklist was used to create a total visibility score for POS displays of (a) e-cigarettes and (b) smoking paraphernalia, plus other measures of visibility and placement. These were described for the total sample and compared between areas of low, medium, and high deprivation using general linear models adjusting for store location and store type.ResultsThe visibility checklist was completed in 133 of 166 stores (80% completion rate). Both e-cigarette and smoking paraphernalia POS displays were present in 96% of stores. POS displays were highly visible across all stores: mean (SD) total visibility scores, out of 17, were 14.7 (1.8) for e-cigarettes and 12.7 (1.8) for smoking paraphernalia. There was no clear evidence of differences in visibility by area of deprivation.ConclusionE-cigarette and smoking paraphernalia POS displays are near ubiquitous and highly visible in major tobacco retailers in two cities in England. The impact of these displays on tobacco smoking in children and adults is unknown, meriting urgent research to assess their effect on susceptibility to tobacco smoking in children.

Tobacco retail availability and cigarette and e-cigarette use among youth and adults: a scoping review

ObjectiveStates and localities are formulating strategies to reduce the widespread retail availability of tobacco products. Evidence of associations between retailer density/proximity and tobacco use outcomes can help inform those strategies. We conducted a scoping review on tobacco retail availability and cigarette/e-cigarette use in adults and youth, and considered variations in spatial units, measures of retailer exposure and outcomes across studies.MethodsA systematic search for studies examining the association between retailer density/proximity and youth and adult cigarette/e-cigarette use was conducted across MEDLINE (PubMed), Web of Science and Google Scholar through 27 August 2020 with no restrictions.ResultsThirty-five studies were included in our qualitative synthesis. While there were differences in neighbourhood definitions (eg, egocentric vs administrative), there is evidence for a positive association between higher retailer density in egocentric neighbourhoods around homes and current smoking in adults and adolescents. Administrative unit measures in some studies showed associations with adult current smoking, and adolescent lifetime and current smoking. Studies on tobacco outlet proximity to homes obtained mixed results. Density/proximity of tobacco outlets around schools showed no or inverse association with adolescent smoking, but suggests higher susceptibility to smoking. Evidence of an association between e-cigarette retail availability and e-cigarette use is limited due to a small number of studies.ConclusionThe current literature provides limited empirical evidence of the association between tobacco retailer availability and smoking or e-cigarette use. More research with uniform measures of environmental exposure to tobacco retailers is needed to allow for greater comparability between studies.

Susceptibility to smoking and associated factors among the youth in central and eastern European countries.

Background Tobacco use among young people still remains a major public health problem. The aim of this study was to examine the association between a variety of factors and susceptibility to smoking initiation and experimentation among the youth from central and eastern European countries. Methods The data used in the current analysis, focusing on current non-smokers, is available from the Global Youth Tobacco Survey, which was performed in five countries (the Czech Republic (2016), n = 3191; Slovakia (2016), n = 3178; Slovenia (2017), n = 2255; Romania (2017), n = 4681; Lithuania (2018), n = 2260). Results Among the never smokers, nearly a quarter of the students were susceptible to smoking in 4 of 5 countries (16% of those susceptible to smoking were identified in Romania). Moreover, 60% of the students in the Czech Republic, Slovakia and Slovenia, and about 50% of the students in Lithuania and Romania were found to be vulnerable to smoking experimentation (an analysis among ever smokers). The multiple regression models provided results that are consistent among all the examined countries, with the following factors identified as significant correlates of smoking initiation and experimentation: being girls, having more money available for own expenses, experiencing exposure to passive smoking in public places, as well as indicating peer smoking. Moreover, adolescents who have declared lack of antismoking education and knowledge on harmful effects of passive smoking, those who saw people using tobacco on TV, in videos or in movies as well as advertising of tobacco products at point of sales were susceptible to smoking. Finally, the students who shared an opinion that smoking helped people feel more comfortable at celebrations, parties or in other social gatherings were at higher risk of smoking susceptibility. Conclusions A high proportion of the youth from central and eastern European countries is susceptible to smoking. Personal and social factors and those related to educational and policy issues were strongly and consistently correlated with smoking susceptibility. These factors should be considered when designing and implementing anti-smoking activities among young people.

Genetically Determined Smoking Behavior and Risk of Nontraumatic Subarachnoid Hemorrhage

Background and Purpose: Animal and observational studies indicate that smoking is a risk factor for aneurysm formation and rupture, leading to nontraumatic subarachnoid hemorrhage (SAH). However, a definitive causal relationship between smoking and the risk of SAH has not been established. Using Mendelian randomization (MR) analyses, we tested the hypothesis that smoking is causally linked to the risk of SAH. Methods: We conducted a 1-sample MR study using data from the UK Biobank, a large cohort study that enrolled over 500 000 Britons aged 40 to 69 from 2006 to 2010. Participants of European descent were included. SAH cases were ascertained using a combination of self-reported, electronic medical record, and death registry data. As the instrument, we built a polygenic risk score using independent genetic variants known to associate ( P <5 ×10 − 8 ) with smoking behavior. This polygenic risk score represents the genetic susceptibility to smoking initiation. The primary MR analysis utilized the ratio method. Secondary MR analyses included the inverse variance weighted and weighted median methods. Results: A total of 408 609 study participants were evaluated (mean age, 57 [SD 8], female sex, 220 937 [54%]). Among these, 132 566 (32%) ever smoked regularly, and 904 (0.22%) had a SAH. Each additional SD of the smoking polygenic risk score was associated with 21% increased risk of smoking (odds ratio [OR], 1.21 [95% CI, 1.20–1.21]; P <0.001) and a 10% increased risk of SAH (OR, 1.10 [95% CI, 1.03–1.17]; P =0.006). In the primary MR analysis, genetic susceptibility to smoking was associated with a 63% increase in the risk of SAH (OR, 1.63 [95% CI, 1.15–2.31]; P =0.006). Secondary analyses using the inverse variance weighted method (OR, 1.57 [95% CI, 1.13–2.17]; P =0.007) and the weighted median method (OR, 1.74 [95% CI, 1.06–2.86]; P =0.03) yielded similar results. There was no significant pleiotropy (MR-Egger intercept P =0.39; MR Pleiotropy Residual Sum and Outlier global test P =0.69). Conclusions: These findings provide evidence for a causal link between smoking and the risk of SAH.

Factors associated with smoking susceptibility among high school students in western Spain

The Expanded Susceptibility to Smoking Index (ESSI) is based on the combination of susceptibility to smoking and curiosity about smoking. The ESSI can identify young people who are at risk of starting to smoke cigarettes and related products. The objective of this study was to analyse the ESSI results and to examine factors associated with ESSI scores in students between 12 and 16 years of age. Sociodemographic, social/environmental and personal variables were analysed, and the ESSI value was determined for non-smoking students recruited from three schools in western Spain. Regression models were used to examine the factors associated with smoking for the entire sample and the factors associated with ESSI scores in the non-smoking population. Of the 377 participants who were analysed, 20.4% were smokers. Among the non-smokers, 53.5% and 55.3% presented medium–high ESSI scores for cigarettes and e-cigarettes, respectively, and 39.8% presented medium–high ESSI scores for hookah use. A higher ESSI score was associated with greater exposure to people smoking in the home, having more friends who smoke, alcohol consumption, and a higher impulsivity scale score. These findings reinforce the importance of reducing peer pressure and suggest the important role of resolve under conditions of positive affect on reducing impulsivity. Approaches based on self-efficacy could be addressed in preventive programmes developed in educational settings.

Assessment of smoking susceptibility among Hanoi highschool-student and some related factors, 2019

Nowadays, the smoking rate among adolescents in Vietnam is still high regardless of many regulations have been implemented. One of the predictors for smoking behaviour in adolescents is smoking susceptibility. This study aimed to describe the rate of students smoking susceptibility and some associated factors. Method: This cross-sectional study was conducted to assess students from 14 randomly selected high schools in five districts in Hanoi. The questionnaire was developed based on “Youth Risk Behavior Surveillance System” (YRBSS) tool. Results: There were 3272 students completed the survey. 4.9% (95% CI: 4.2 – 5.8%) of the students were susceptible to smoking. In the urban areas, this rate was 7.7% and in the suburban areas was 3.4%. While being male (OR=2.79, 95% CI: 2.29 – 3.41), being 16-17 years old (OR=1.25, 95% CI: 1.01 – 1.56), studying in urban areas (OR=1.41, 95% CI: 1.15 – 1.74) and seeing other people smoke, including family members (OR=1.39, 95% CI: 1.14 – 1.70), teachers (OR=1.8, 95% CI: 1.23 – 2.63), friends (OR=2.33, 95% CI: 1.88 – 2.89), and school staffs (OR=1.63, 95% CI: 1.17 – 2.26) smoking was associated to susceptibility to smoking behavior, attending anti-tobacco course (OR=1.31, 95% CI: 1.06 – 1.62) or seeing anti-tobacco messages (OR=1,28, 95% CI: 1,005 – 1,63) reduced the likelihood of smoking susceptibility. Conclusion: Thus, it is necessary to initiate anti-tobacco intervention programs and implement more extreme regulations to reduce susceptibility to smoking rates in adolescents and diminish smoking prevalence in adolescents. Keywords: Susceptibility, smoking, adolescent, high-school, Ha Noi

Effects of self-affirmation on responses toward graphic cigarette warning labels: testing the mediating role of perceived susceptibility and self-efficacy

PurposeThe purpose of this study is to examine the effects of self-affirmation on African American smokers' intentions to quit smoking sooner and desire to stop smoking altogether in response to viewing graphic cigarette warning labels. It also tested the mediating role of perceived susceptibility and self-efficacy in explaining the impact of self-affirmation.Design/methodology/approachAfrican American smokers (N = 158) were recruited to participate in a controlled experiment. Participants first completed a short questionnaire about their demographic background and smoking-related attitudes and behavior. They were then randomly assigned to engage in either a self-affirmation task or a control task and viewed two graphic cigarette warning labels subsequently. Participants then responded to a questionnaire about their perceived susceptibility to smoking-related diseases, perceived self-efficacy to quit smoking, intentions to quit smoking and desire to stop smoking altogether.FindingsResults showed that engaging in self-affirmation prior to exposure to graphic cigarette warning labels increased African American smokers' perceived susceptibility to smoking-related diseases, but decreased their perceived self-efficacy to quit smoking. Furthermore, self-affirmation indirectly enhanced smokers' intentions to quit smoking sooner and desire to stop smoking altogether through increased perceived susceptibility. It also had an unexpected negative indirect effect on intentions to quit smoking sooner through decreased self-efficacy.Originality/valueThis study is one of the few studies that investigates the effect of self-affirmation on African American smokers' responses toward graphic cigarette warning labels.

Associations of Socioeconomic Status, Parental Smoking and Parental E-Cigarette Use with 10–11-Year-Old Children’s Perceptions of Tobacco Cigarettes and E-Cigarettes: Cross Sectional Analysis of the CHETS Wales 3 Survey

Background: This study examines primary schoolchildren’s perceptions of e-cigarettes and tobacco cigarettes, and associations with parental smoking, vaping and socioeconomic status. Methods: Survey of 2218 10–11-year-old children in 73 schools in Wales. Results: Overall, 36% reported that a parent figure smoked compared to 21% for vaping, with parental smoking lower in affluent families (OR = 0.72; 95% CI = 0.68 to 0.76). Overall, 1% had tried a cigarette, while 5% had tried an e-cigarette. Most said they would not smoke or vape in 2 years’ time; susceptibility to vaping (20%) was higher than smoking (12%). Exposure to and perceptions of tobacco cigarettes were more positive for children of smokers. Having a parent who vaped was associated with exposure to and positive perceptions of e-cigarettes, but not smoking. Most children perceived e-cigarettes as used by adults to stop smoking (64%). Susceptibility to smoking (OR = 0.57; 95% CI = 0.41 to 0.79) and vaping (OR = 0.78; 95% CI = 0.62 to 0.99) were lower among children who perceived e-cigarettes as cessation aids. Conclusions: Parental smoking continues to be concentrated in poorer families. This study provides no evidence that parental vaping in the absence of smoking is associated with more positive perceptions of tobacco cigarettes. Communicating to children the role of e-cigarettes as cessation devices for smokers may help to limit their appeal to young people.