Publications by authors named "Andrea C Villanti"

154 Publications

Opioid use disorder treatment in rural settings: The primary care perspective.

Prev Med 2021 Aug 16:106765. Epub 2021 Aug 16.

Center on Rural Addiction, Robert Larner, M.D. College of Medicine, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA; Department of Psychiatry, Robert Larner, M.D. College of Medicine, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA; Vermont Center on Behavior and Health, Robert Larner, M.D. College of Medicine, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA; Department of Psychological Science, University of Vermont, 2 Colchester Ave., Burlington, VT 05401, USA.

Despite the efficacy of medications for treating opioid use disorder (OUD), they are underutilized, especially in rural areas. Our objectives were to determine the association between primary care practitioners (PCPs) rurality and concerns for patient substance use, and to identify factors associated with PCP comfort treating OUD, focusing on barriers to treatment. We developed a web-based survey completed by 116 adult-serving PCPs located in Vermont's rural and non-rural counties between April-August 2020. The instrument included PCP-identified concerns for substance use among patients, barriers to treating patients with OUD, and current level of comfort treating patients with OUD. On a scale from 0 to 10, rural PCPs reported higher concern for heroin (mean difference; Mdiff = 1.38, 95% CI: 0.13 to 2.63), fentanyl (Mdiff = 1.52, 95% CI: 0.29 to 2.74), and methamphetamine (Mdiff = 1.61, 95% CI: 0.33 to 2.90) use among patients compared to non-rural PCPs, and practitioners in both settings expressed high concern regarding their patients' use of tobacco (7.6 out of 10) and alcohol (7.0 out of 10). There was no difference in reported comfort in treating patients with OUD among rural vs. non-rural PCPs (Mdiff = 0.65, 95%CI: 0.17 to 1.46; P = 0.119), controlling for higher comfort among male PCPs and those waivered to prescribe buprenorphine (Ps < 0.05). Lack of training/experience and medication diversion were PCP-identified barriers associated with less comfort treating OUD patients, while time constraints was associated with more comfort (Ps < 0.05). Taken together, these data highlight important areas for dissemination of evidence-based training, support, and resources to expand OUD treatment capacity in rural communities.
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http://dx.doi.org/10.1016/j.ypmed.2021.106765DOI Listing
August 2021

State-level rurality and cigarette smoking-associated cancer incidence and mortality: Do individual-level trends translate to population-level outcomes?

Prev Med 2021 Aug 4:106759. Epub 2021 Aug 4.

Cancer Control and Population Health Sciences Program, University of Vermont Cancer Center, USA; Division of Surgical Research, Department of Surgery, University of Vermont Larner College of Medicine, USA.

County-level analyses demonstrate that overall cancer incidence is generally lower in rural areas, though incidence and mortality from tobacco-associated cancers are higher than in non-rural areas and have experienced slower declines over time. The goal of our study was to examine state-level rurality and smoking-related cancer outcomes. We used publicly-available national data to quantify rurality, cigarette smoking prevalence, and smoking-attributable cancer incidence and mortality at the state level and to estimate the population-attributable fraction of cancer deaths attributable to smoking for each state, overall and by gender, for 12 smoking-associated cancers. Accounting for a 15-year lag between smoking exposure and cancer diagnosis, the median proportion of smoking-attributable cancer deaths was 28.2% in Virginia (24.6% rural) and ranged from 19.9% in Utah (9.4% rural) to 35.1% in Kentucky (41.6% rural). By gender, the highest proportion of smoking-attributable cancer deaths for women (29.5%) was in a largely urban state (Nevada, 5.8% rural) and for men (38.0%) in a largely rural state (Kentucky). Regression analyses categorizing state-level rurality into low (0-13.9%), moderate (15.3-29.9%) and high (33.6-61.3%) levels showed that high rurality was associated with 5.8% higher cigarette smoking prevalence, higher age-adjusted smoking-associated cancer incidence (44.3 more cases per 100,000 population), higher smoking-associated cancer mortality (29.8 more deaths per 100,000 population), and 3.4% higher proportion of smoking-attributable cancer deaths compared with low rurality. Our findings highlight the magnitude of the relationship between state-level rurality and smoking-attributable cancer outcomes and the importance of tobacco control in reducing cancer disparities in rural populations.
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http://dx.doi.org/10.1016/j.ypmed.2021.106759DOI Listing
August 2021

Effect of brief nicotine corrective messaging on nicotine beliefs in persons who use opioids.

Exp Clin Psychopharmacol 2021 Jul 22. Epub 2021 Jul 22.

Department of Psychiatry.

This pilot study tested the effect of a brief nicotine education messaging exposure on beliefs about nicotine, nicotine-replacement therapy (NRT), and e-cigarettes. Participants ages 18 and older were recruited via Amazon Mechanical Turk to complete a 20-min online survey in April/May 2020 to assess relationships between opioid use, smoking, and other behaviors. Participants with past-month extra-medical opioid use completed questions on background characteristics and literacy and then were randomized in a 2:1 ratio of two conditions: nicotine education ( = 362) or no message control ( = 181). Beliefs about nicotine, NRT, and e-cigarettes were asked of all participants; this occurred after message exposure for the nicotine education condition. Bivariate and multivariable analyses examined differences in beliefs by study condition. Brief nicotine messaging increased the probability of a correct response to "Nicotine is a cause of cancer" (false, 63% vs. 36%) and reduced the probability of a response (9% vs. 17%) compared to the no message control condition. Nicotine education also reduced false beliefs about harms of long-term NRT use compared to cigarettes ( < .05). In adjusted models, participants in the nicotine education group had lower mean false beliefs about nicotine ( < .001) and to a lesser extent NRT ( = .053) compared with the control group; there was no difference in mean false beliefs about e-cigarettes ( = .547) between groups. A brief education intervention produced similar changes in nicotine beliefs in adults with past-month extra-medical opioid use as in a general adult sample. Findings support the potential for impact of nicotine public education messaging in vulnerable populations. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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http://dx.doi.org/10.1037/pha0000497DOI Listing
July 2021

Cognitive and affective responses to marijuana prevention and educational messaging.

Drug Alcohol Depend 2021 08 28;225:108788. Epub 2021 May 28.

Vermont Center on Behavior and Health, Department of Psychiatry, Larner College of Medicine, University of Vermont, United States.

Background: Perceptions of risk of using marijuana have decreased significantly in the US over the last decade, while marijuana use has increased. In order to educate people on the risks associated with marijuana use, large-scale health messaging campaigns have been deployed to educate the public about the risks associated with marijuana use, particularly in states where medical or recreational marijuana is legal. Few studies have examined how messages about marijuana affect the audiences' cognitive and emotional responsivity to these messages.

Methods: To address this knowledge gap, this study used psychophysiological assessment (heart rate, skin conductance, facial action coding) and self-report measures to explore the impact of different marijuana risk messages on real-time cognitive and affective responses and self-reported message receptivity, likeability, and intentions to use marijuana in a sample of 50 young adult marijuana users and non-users. Each participant saw six messages. Three messages were used from each of two campaigns, representing one of three risks (cognitive ability, driving, health harms).

Results: Psychophysiological responses showed that the driving-themed messages for both campaigns had the greatest cognitive resource allocation to encoding the message, the greatest arousal, and the most positive emotional response, regardless of user status. Self-reports showed a less consistent pattern.

Conclusions: Overall, psychophysiological measures provided a more consistent picture of message processing and effects than self-report measures. Findings from this study provide immediately useful data for improving the development and effectiveness of marijuana health-risk prevention campaigns by elucidating cognitive and emotional processes that could be targeted in future programs.
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http://dx.doi.org/10.1016/j.drugalcdep.2021.108788DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8282745PMC
August 2021

Prescription opioid policies and associations with opioid overdose and related adverse effects.

Int J Drug Policy 2021 Jun 6;97:103306. Epub 2021 Jun 6.

Maine Medical Center, Department of Medicine, 22 Bramhall Street, Portland, Maine 04102, USA. Electronic address:

Background: United States (US) policies to mitigate the opioid epidemic focus on reducing access to prescription opioids to prevent overdoses. We examined the impact of state policies in Vermont (July 2017) and Maine (July 2016) on opioid overdoses and opioid-related adverse effects.

Methods: Study population included patients 15 years and older in all-payer claims of Vermont (N = 597,683; Jan.2016-Dec.2018) and Maine (N = 1,370,960; Oct.2015-Dec.2017). We used interrupted time series analyses to assess the impact of opioid prescribing policies on monthly opioid overdose rate and opioid-related adverse effects rate. We used the International Classification of Disease-10-CM to identify overdoses (T40.0 × 1-T40.4 × 4, T40.601-T40.604, T40.691-T40.694) and adverse effects (T40.0 × 5, T40.2 × 5-T40.4 × 5, T40.605, T40.695).

Results: Immediately after the policy, the level of Vermont's opioid overdose rate increased by 34% (95% confidence interval, CI: 1.09, 1.65) while the level of opioid-related adverse effects rate decreased by 29% (95% CI: 0.58, 0.87). In Maine, there was no level change in opioid overdose rate, but the slope of the adverse effects rate after the policy decreased by 3.5% (95% CI: 0.94, 0.99). These results varied within age and rurality subgroups in both states.

Conclusion: While the decrease in rate of adverse effects following the policy changes is promising, the increase in Vermont's opioid overdose rate may suggest there is an association between policy implementation and short-term risk to public health.
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http://dx.doi.org/10.1016/j.drugpo.2021.103306DOI Listing
June 2021

Opioid use, motivation to quit, and treatment status related to COVID-19: a cross-sectional study.

BMC Res Notes 2021 May 20;14(1):195. Epub 2021 May 20.

Vermont Center on Behavior & Health, University of Vermont, Burlington, VT, USA.

Objective: Persons who use opioids may be at elevated risk of harm from the coronavirus disease 2019 (COVID-19) pandemic, yet few data currently exist that can be used to examine this risk. As part of a rapid response survey, this study measured opioid users' perceptions of risk or harm from COVID-19, as well as potential changes in motivation to quit, frequency of use, and engagement with treatment. Data collected from Amazon's Mechanical Turk (n = 562) were analyzed.

Results: Participants perceived modest risk elevation from COVID-19 due to their opioid use, and perceived moderate risk to themselves or their community from COVID-19. Since learning about COVID-19, 31.2% reported decreasing their opioid use, and 26.0% reported increased motivation to quit. Thirty-seven percent of participants reported both their use and motivation to quit stayed the same; 16.6% reported decreased use and increased motivation to quit. Participants who reported that their opioid use increased after learning about COVID-19, or whose motivation to quit opioids decreased, were more likely to also be engaged in treatment than those whose use or motivation stayed the same. These preliminary findings suggest that there likely is an association between COVID-19, opioid use, and treatment engagement that merits further in-depth investigation.
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http://dx.doi.org/10.1186/s13104-021-05601-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8135148PMC
May 2021

Influence of Opioid Prescription Policy on Overdoses and Related Adverse Effects in a Primary Care Population.

J Gen Intern Med 2021 07 4;36(7):2013-2020. Epub 2021 May 4.

Department of Medicine, Maine Medical Center, Portland, Maine, 04102, USA.

Background: In response to the opioid epidemic, many states have enacted policies limiting opioid prescriptions. There is a paucity of evidence of the impact of opioid prescribing interventions in primary care populations, including whether unintended consequences arise from limiting the availability of prescribed opioids.

Objective: Our aim was to compare changes in opioid overdose and related adverse effects rate among primary care patients following the implementation of state-level prescribing policies.

Design: A cohort of primary care patients within an interrupted time series model.

Participants: Electronic medical record data for 62,776 adult (18+ years) primary care patients from a major medical center in Vermont from January 1, 2016, to June 30, 2018.

Interventions: State-level opioid prescription policy changes limiting dose and duration.

Main Measures: Changes in (1) opioid overdose rate and (2) opioid-related adverse effects rate per 100,000 person-months following the July 1, 2017, prescription policy change.

Key Results: Among primary care patients, there was no change in opioid overdose rate following implementation of the prescribing policy (incidence rate ratio; IRR: 0.64, 95% confidence interval; CI: 0.22-1.88). There was a 78% decrease in the opioid-related adverse effects rate following the prescribing policy (IRR: 0.22, 95%CI: 0.09-0.51). This association was moderated by opioid prescription history, with decreases observed among opioid-naïve patients (IRR: 0.18, 95%CI: 0.06-0.59) and among patients receiving chronic opioid prescriptions (IRR: 0.17, 95%CI: 0.03-0.99), but not among those with intermittent opioid prescriptions (IRR: 0.51, 95%CI: 0.09-2.82).

Conclusions: Limiting prescription opioids did not change the opioid overdose rate among primary care patients, but it reduced the rate of opioid-related adverse effects in the year following the state-level policy change, particularly among patients with chronic opioid prescription history and opioid-naïve patients. Limiting the quantity and duration of opioid prescriptions may have beneficial effects among primary care patients.
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http://dx.doi.org/10.1007/s11606-021-06831-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8298594PMC
July 2021

Why and how do dual users quit vaping? Survey findings from adults who use electronic and combustible cigarettes

Tob Induc Dis 2021 16;19:12. Epub 2021 Feb 16.

Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, Burlington, United States.

Introduction: Most adults who use electronic cigarettes (ECs) also smoke combustible cigarettes (CCs). Quitting ECs appears common among dual users but little is known regarding adult dual users' motivations and methods to quit ECs or how this relates to quitting CCs.

Methods: We used Amazon Mechanical Turk, a web-based crowd-sourcing service, to survey 366 US adults with a history of regular EC and CC use. This analysis examined motivations and methods to quit both products among a subset of 204 (55.7%) respondents with dual use and a history of one or more attempts to quit ECs.

Results: Most respondents (95%) were using ECs at the time of this survey and had a lifetime median of five EC quit attempts. The most common motivations to quit ECs were health (74%), money/cost (45%), and to reduce risk of COVID-19 (25%). The most common EC quit methods were cutting down (68%), getting advice from a doctor (28%), quitting 'cold turkey' (24%), nicotine replacement therapy (24%), and switching to ECs with less nicotine (24%). Most motivations and methods to quit ECs and CCs were moderately to highly correlated, suggesting similarity in dual users' approach to quitting the two products.

Conclusions: Dual users had a range of motivations and methods to quit ECs, most of which were similar to their motivations and methods to quit CCs. These findings support the need to develop treatment for adults motivated to quit ECs and demonstrate that dual users may currently engage in similar strategies to quit both products.
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http://dx.doi.org/10.18332/tid/132547DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7885258PMC
February 2021

Tobacco and Nicotine Use Among US Adult "Never Smokers" in Wave 4 (2016-2018) of the Population Assessment of Tobacco and Health Study.

Nicotine Tob Res 2021 06;23(7):1199-1207

Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, Burlington, VT.

Introduction: A common criterion for being labeled a "never smoker" is having smoked <100 lifetime cigarettes. This category is often used as an unexposed reference group to estimate the relative harm from cigarettes. We examined the amount of current and past cigarette and non-cigarette tobacco/nicotine use among adults who met this "never smoker" criterion.

Methods: We analyzed cross-sectional data from 17 179 adult "never smokers" (ie, reported <100 lifetime cigarettes) in Wave 4 (2016-2018) of the Population Assessment of Tobacco and Health (PATH) Study, a United States nationally representative sample. We used PATH-derived variables to describe "never smokers'" demographics as well as cigarette and non-cigarette tobacco/nicotine use.

Results: Approximately half of "never smokers" were young adults (49.3%). Most were white (68.6%) with some college or more (64.4%). Most "never smokers" had tried any cigarette or non-cigarette tobacco/nicotine in their lifetime (66.7%), 8.5% smoked cigarettes in the past 30 days, and 5.3% were current experimental (ie, some days or every day) cigarette smokers. By definition, "never smokers" reported smoking <100 lifetime cigarettes. One fifth (22.8%) had a lifetime history of established regular non-cigarette tobacco/nicotine use and 8.6% were current established regular non-cigarette tobacco/nicotine users. In total, 9.4% of "never smokers" were current experimental or established regular users of combustible tobacco.

Conclusions: The 100-cigarette lifetime threshold includes substantial amounts of current and past tobacco use and thus does not represent lack of exposure to cigarette or non-cigarette tobacco. "Never smoker" reference groups may produce underestimates of the relative harms from cigarettes.

Implications: The <100 lifetime cigarettes criterion may not capture what many would consider true "never smokers." Relying on the current definition of "never smokers" as a reference group will include a substantial number of those currently and recently using combustible tobacco and thus produce data that may underestimate the relative harm from cigarettes. Prospective longitudinal research is needed to compare how the 100-cigarette lifetime threshold versus other definitions of regular cigarette smoking differ in predictive validity of clinically meaningful outcomes and health harms to determine the optimal criteria to define established cigarette smoking.
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http://dx.doi.org/10.1093/ntr/ntab009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8186421PMC
June 2021

Identifying message content to reduce vaping: Results from online message testing trials in young adult tobacco users.

Addict Behav 2021 04 11;115:106778. Epub 2020 Dec 11.

Department of Internal Medicine, Wexner Medical Center, Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, USA.

Introduction: Young adults' e-cigarette use is associated with perceptions that e-cigarettes are less harmful or addictive than cigarettes, socially acceptable, and appealing. This study developed and tested vaping educational messages addressing these factors: 1) Harm Perceptions, 2) Addictiveness, 3) Social Use, and 4) Flavors.

Methods: Two message trials were conducted in U.S. Amazon Mechanical Turk workers aged 18-24 using a 2 (content: addiction, harm) × 3 (theme: alone, + flavors, + social) design with multiple messages in each of the six categories. Participants were assigned to view a random subset of messages and report on likeability and perceived message effectiveness (PME). Phase 1 (n = 200) tested 33 messages and 32 images. Phase 2 (n = 769) tested combinations of Phase 1's 24 most effective messages with 6 images rated most likeable or effective. Linear mixed effects models assessed the effect of content, theme, image, and their interactions on message response.

Results: In both trials, most participants were past 30-day tobacco users. Harm content messages produced higher PME ratings than addiction content messages, and flavor theme messages were correlated with higher likeability scores than "content alone" theme messages. In Phase 2, flavor and social message themes decreased the PME of harm messages. There was no effect of images on either outcome controlling for the independent or interaction effects of content, theme, and image.

Conclusions: Messages conveying the harms of vaping may be best for reducing vaping in young adult tobacco users; flavor and social themes may diminish their effectiveness.
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http://dx.doi.org/10.1016/j.addbeh.2020.106778DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8085990PMC
April 2021

Development and Pretesting of Hookah Tobacco Public Education Messages for Young Adults.

Int J Environ Res Public Health 2020 11 25;17(23). Epub 2020 Nov 25.

Center for Tobacco Research, The Ohio State University James Comprehensive Cancer Center, Department of Internal Medicine, The Ohio State University, 3650 Olentangy River Road, Suite 410, Columbus, OH 43214, USA.

Young adults' hookah tobacco use is fueled by misperceptions about risks, appealing flavors, and social use. We developed and pretested public education messages to prevent and reduce hookah tobacco smoking among young adults. We used a two (user status: current hookah user, susceptible never user) by two (risk content: health harms or addiction) by three (message theme: harms/addiction risk alone, harms/addiction risk flavors, or harms/addiction risk social use) design with two messages/condition ( = 12 total messages). Young adults aged 18-30 ( = 713) were randomized to 1 of 12 messages and completed measures assessing message receptivity, attitudes, and negative emotional response. Harms messages were associated with greater receptivity ( < 0.001), positive attitudes ( < 0.001), and negative emotional response ( < 0.001) than addiction messages. Messages with harm or addiction content alone were associated with greater receptivity than social use-themed messages ( = 0.058). Flavor-themed messages did not differ in receptivity from harm or addiction content alone or social use-themed messages. Messages about the health harms of hookah tobacco use resonate more with young adults than addiction risk messages. Social use-themed messages produce the lowest receptivity. These findings can guide population-based approaches to communicate hookah tobacco risks to young adults.
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http://dx.doi.org/10.3390/ijerph17238752DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7728075PMC
November 2020

Menthol and Mint Cigarettes and Cigars: Initiation and Progression in Youth, Young Adults and Adults in Waves 1-4 of the PATH Study, 2013-2017.

Nicotine Tob Res 2021 08;23(8):1318-1326

Department of Health Behavior, Division of Cancer Prevention & Population Sciences, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.

Introduction: This study examined in youth (12-17 years), young adults (18-24 years), and adults (25+ years): (1) the prevalence of the first menthol cigarette and menthol/mint cigar use among new tobacco users; (2) association between the first menthol/mint use, subsequent tobacco use, and nicotine dependence ~1 year later compared with the first non-menthol/mint use.

Aims And Methods: Longitudinal analysis of data from Waves 1 to 4 of the Population Assessment of Tobacco and Health (PATH) Study (2013-2017; 10 086 youth and 21 281 adults). Main outcome measures were past 12-month and past 30-day cigarette and cigar use, and nicotine dependence.

Results: Youth and young adult new cigarette users are more likely to smoke a menthol cigarette or indicate that they do not know the flavor compared with adults aged 25+. A greater proportion of adults aged 25+ first used menthol/mint-flavored cigars (13.4%) compared with youth (8.5%) and young adults (7.4%). Among young adults, first use of a menthol cigarette is associated with past 12-month use of cigarettes at the subsequent wave and first use of any menthol/mint-flavored cigars is associated with past 30-day use of these products at the subsequent wave in both youth and young adults. In youth and adults, there were no significant relationships between first use of a menthol/mint cigarette or cigar and nicotine dependence scores at a subsequent wave in multivariable analyses.

Conclusions: The first use of menthol/mint cigarettes and cigars is associated with subsequent cigarette and cigar use in young people aged 12-24.

Implications: This study examined the relationship between initiation with menthol cigarettes and menthol/mint cigars, subsequent tobacco use, and nicotine dependence in US youth, young adults, and adults who participated in Waves 1-4 of the Population Assessment of Tobacco and Health study. New use of menthol cigarettes was associated with greater past 12-month cigarette use in young adults and new use of menthol/mint-flavored cigars was associated with greater past 30-day cigar use in youth and young adults compared with non-menthol use. Initiation with menthol/mint cigarette and cigar products may lead to subsequent use of those products.
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http://dx.doi.org/10.1093/ntr/ntaa224DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8360630PMC
August 2021

Relationship between Comorbid Drug Use Disorders, Affective Disorders, and Current Smoking.

Subst Use Misuse 2021 3;56(1):93-100. Epub 2020 Nov 3.

Vermont Center on Behavior & Health, University of Vermont, Burlington, Vermont, USA.

Objective: This study aimed to identify subgroups of adults based on comorbid psychiatric disorders and to examine the relationship with current smoking. The National Epidemiologic Survey on Alcohol and Related Conditions-III, 2012-2013, sampled, recruited, and assessed 36,309 adults, with interviews on drug use and other characteristics. The Alcohol Use Disorder and Associated Disabilities Interview Schedule DSM-5 Version (AUDADIS-5) was used to identify psychiatric conditions. Latent class models were developed based on various psychiatric diagnoses. Multinomial logistic regression estimated the significance of covariates in predicting class membership. Four latent classes optimally distinguished the population: no comorbid conditions (63%), comorbid affective disorders (16%), those with alcohol use disorder (AUD; 17%), and a highly comorbid subgroup (i.e., co-occurring affective and drug use disorders; 4%). Current smoking was about twice as prevalent in the classes defined by psychiatric conditions compared to the group with no comorbid conditions. The highly comorbid class was more likely to be current smokers than the comorbid affective disorders class and the AUD class. Furthermore, the highly comorbid class was younger and had lower income, and the AUD class had a higher proportion of males than the other classes. Cigarette smoking was higher in the nearly 40% of respondents characterized by psychiatric disorders, particularly those with drug use disorders. Correlates of membership in these classes were consistent with known vulnerabilities for smoking, highlighting the need for mental health interventions and future research to explicitly address tobacco cessation in clinical settings based on psychiatric diagnoses.
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http://dx.doi.org/10.1080/10826084.2020.1840591DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8269958PMC
June 2021

Changes in Cigarette Consumption With Reduced Nicotine Content Cigarettes Among Smokers With Psychiatric Conditions or Socioeconomic Disadvantage: 3 Randomized Clinical Trials.

JAMA Netw Open 2020 10 1;3(10):e2019311. Epub 2020 Oct 1.

UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington.

Importance: This study is part of a programmatic effort evaluating the effects of reducing nicotine content of cigarettes to minimally addictive levels.

Objective: To examine whether very low-nicotine-content (VLNC) cigarettes decrease smoking rates and dependence severity among smokers with psychiatric disorders or socioeconomic disadvantage.

Design, Setting, And Participants: These 3 randomized clinical trials were performed at the University of Vermont, Brown University, and Johns Hopkins University between October 2016 and September 2019. Participants received 12 weeks of exposure to study cigarettes with nicotine content ranging from levels representative of commercial cigarettes (15.8 mg nicotine/g tobacco) to less than a hypothesized addiction threshold (2.4 mg/g and 0.4 mg/g). Daily smokers from 3 at-risk populations participated: individuals with affective disorders, exemplifying smokers with mental illness; individuals with opioid use disorder, exemplifying smokers with substance use disorders; and women with high school educations or less, exemplifying smokers with socioeconomic disadvantage. Data were analyzed from September 2019 to July 2020.

Interventions: Random assignment to 1 of 3 study cigarettes provided weekly at no cost for 12 weeks.

Main Outcomes And Measures: The primary outcome was between-group differences in mean total cigarettes smoked daily (CPD) during week 12; secondary outcomes included CPD for study and nonstudy cigarettes and dependence severity across weeks analyzed using analysis of covariance, random coefficients growth modeling, or repeated measures analysis of variance.

Results: A total of 775 participants were included (mean [SD] age, 35.59 [11.05] years; 551 [71.10%] women [owing to 1 population being exclusively women]); participants smoked a mean (SD) of 17.79 (9.18) CPD at study intake. A total of 286 participants were randomized to 0.4 mg/g, 235 participants were randomized to 2.4 mg/g, and 254 participants were randomized to 15.8 mg/g. Participants randomized to VLNC cigarettes had decreased mean [SEM] total CPD during week 12 across populations (Cohen d = 0.61; P < .001). At week 12, mean (SEM) CPD decreased to 17.96 (0.98) CPD in the 0.4 mg/g group and to 19.53 (1.07) CPD in the 2.4 mg/g group, both of which were significantly different from the 15.8 mg/g group (25.08 [1.08] CPD at week 12) but not each other (0.4 mg/g adjusted mean difference: -7.54 [95%CI, -9.51 to -5.57]; 2.4 mg/g adjusted mean difference: -5.34 [95% CI, 7.41 to -3.26]). Several secondary outcomes differed across populations randomized to VLNCs, including mean total CPD across weeks, with linear trends lower in participants receiving 0.4 mg/g (-0.28 [95%CI, -0.39 to -0.18]; P < .001) and 2.4 mg/g (-0.13 [95%CI, -0.25 to -0.01]; P < .001) doses compared with those receiving the 15.8 mg/g dose (0.30 [95% CI, 0.19 to 0.41]). Fagerström Test of Nicotine Dependence mean total scores were significantly lower in participants who received VLNCs (Cohen d = 0.12; P < .001), with those who received the 0.4 mg/g dose (mean [SD] score, 3.99 [0.06]; P < .001 vs 15.8 mg/g) or 2.4 mg/g dose (mean [SD] score, 4.07 [0.06]; P = .01 vs 15.8 mg/g) differing from those who received the 15.8 mg/g dose (mean [SD] score, 4.31 [0.06]) but not from each other.

Conclusions And Relevance: These findings demonstrate that decreasing the nicotine content of cigarettes to very low levels reduced smoking rate and nicotine-dependence severity in these high-risk populations, effects that may facilitate successful cessation.

Trial Registration: ClinicalTrials.gov Identifiers: NCT02232737, NCT02250664, NCT02250534.
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http://dx.doi.org/10.1001/jamanetworkopen.2020.19311DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7576411PMC
October 2020

Prospective associations between nicotine beliefs and tobacco-related susceptibility, curiosity, and use in U.S. adults.

Prev Med 2020 11 15;140:106285. Epub 2020 Oct 15.

Schroeder Institute at Truth Initiative, United States of America.

Low harm perceptions of tobacco products have been associated with use of those products in youth and adults, but this relationship has not been assessed for nicotine beliefs. This study used data from a national sample of adults aged 18-40 in Wave 9 (Spring 2016) of the Truth Initiative Young Adult Cohort Study to examine correlations and prospective associations between the latent classes of nicotine beliefs and susceptibility, curiosity, and use of tobacco products in 3122 adults who also completed Wave 10 (Fall 2016). At Wave 9, four latent classes of beliefs characterized the role of nicotine in the health risks of smoking: Class 1, large role, 51%; Class 2, large role/don't know, 9.4%; Class 3, small role in health, 32.5%; and Class 4, none/small role in cancer, 7.5%. Latent classes of nicotine beliefs were highly correlated with susceptibility and curiosity to use cigarettes, e-cigarettes, and hookah, as well as past 30-day use of a range of tobacco products at Wave 9 among never users. Classes 3 and 4 had the highest prevalence of past 30-day tobacco use; never users in these classes reported the greatest susceptibility to try cigarettes, hookah, and e-cigarettes at Wave 9. Class 4 had higher odds of increased e-cigarettes use at follow-up compared to Class 1. There were few prospective associations between nicotine beliefs latent class, susceptibility, and curiosity at Wave 10. Nicotine beliefs are associated with tobacco-related outcomes and, if assessed, may provide novel information to guide tobacco prevention and intervention efforts.
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http://dx.doi.org/10.1016/j.ypmed.2020.106285DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7779116PMC
November 2020

Assessment of Menthol and Nonmenthol Cigarette Consumption in the US, 2000 to 2018.

JAMA Netw Open 2020 08 3;3(8):e2013601. Epub 2020 Aug 3.

Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, Burlington.

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http://dx.doi.org/10.1001/jamanetworkopen.2020.13601DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7414385PMC
August 2020

Recruiting and Retaining Youth and Young Adults in the Policy and Communication Evaluation (PACE) Vermont Study: Randomized Controlled Trial of Participant Compensation.

J Med Internet Res 2020 07 20;22(7):e18446. Epub 2020 Jul 20.

Health Promotion & Disease Prevention, Vermont Department of Health, Burlington, VT, United States.

Background: The standard approach for evaluating the effects of population-level substance use prevention efforts on youth and young adult perceptions and behaviors has been to compare outcomes across states using national surveillance data. Novel surveillance methods that follow individuals over shorter time intervals and capture awareness of substance use prevention policy and communication efforts may provide a stronger basis for their evaluation than annual cross-sectional studies.

Objective: This study aimed to identify a combination of strategies to recruit a sample of youth and young adults sufficiently representative of the Vermont population and determine how best to retain a web-based panel of youth and young adults over a 6-month period.

Methods: Eligible participants were Vermont residents aged 12 to 25 years who were willing to complete three 10 to 15-minute web-based surveys over a 6-month period. Recruitment was conducted via the following three main mechanisms: (1) web-based recruitment (paid and unpaid), (2) community-based recruitment through partners, and (3) participant referrals via a personalized link. Upon completion of the baseline survey, participants were randomly assigned to one of the following three retention incentive conditions: (1) guaranteed incentive (US $10), (2) lottery incentive (US $50 weekly lottery drawing), and (3) preferred method (guaranteed or lottery). Analyses examined cost per survey start by recruitment source, distribution of demographic characteristics across incentive conditions, and retention by study condition at 3-month and 6-month follow-ups.

Results: Over a 10-week period in 2019, we recruited 480 eligible youth (aged 12-17 years) and 1037 eligible young adults (aged 18-25 years) to the Policy and Communication Evaluation (PACE) Vermont Study. Facebook and Instagram advertising produced the greatest number of survey starts (n=2013), followed by posts to a state-wide web-based neighborhood forum (n=822) and Google advertisements (n=749). Retention was 78.11% (1185/1517) at 3 months and 72.18% (1095/1517) at 6 months. Retention was equivalent across all incentive study conditions at both waves, despite a strong stated preference among study participants for the guaranteed payment at baseline. Youth had greater retention than young adults at both waves (wave 2: 395/480, 82.3% vs 790/1037, 76.18%; wave 3: 366/480, 76.3% vs 729/1037, 70.30%). Substance use prevalence in this cohort was similar to national and state-level surveillance estimates for young adults, but was lower than state-level surveillance estimates for youth. Most participants retained at wave 3 provided positive qualitative feedback on their experience.

Conclusions: Our study supports the feasibility of recruiting a web-based cohort of youth and young adults with representation across an entire state to evaluate substance use prevention efforts. Findings suggest that a guaranteed payment immediately upon survey completion coupled with a bonus for completing all survey waves and weekly survey reminders may facilitate retention in a cohort of youth and young adults.
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http://dx.doi.org/10.2196/18446DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7399955PMC
July 2020

Impact of alcohol and drug use on smoking and cessation in socioeconomically disadvantaged young adults.

Addict Behav 2020 11 26;110:106486. Epub 2020 May 26.

Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, USA.

Introduction: Population studies highlight that alcohol and marijuana use are correlated with cigarette smoking and other tobacco use. The aim of our study was to describe the ways in which alcohol and drug use may affect cigarette smoking and cessation in socioeconomically-disadvantaged young adult (SDYA) smokers.

Methods: Thirty-six SDYA smokers aged 18-29 participated in eight focus groups and two individual interviews in Burlington, Vermont in 2018. Structured focus groups addressed poly-tobacco use, other substance use and co-use with tobacco, and the contexts and facilitators that cue SDYA smoking. Participants were also asked their reasons for smoking, barriers to cessation, and messages or modalities that would make smoking cessation more novel or relevant. Three coders implemented the Framework Method to systematically code focus group transcripts.

Results: In this sample of SDYA smokers, four key themes emerged around the relationships between alcohol and drug use and smoking: 1) frequent co-use of tobacco and other substances, 2) changes in frequency of smoking when using other substances, including chain smoking when drinking and substituting cigarettes with marijuana, 3) cigarettes as a last remaining addiction for those in recovery from other substance use and, 4) fears that quitting smoking would cause relapse to other substances.

Discussion: Co-use of other substances emerged as a reason for smoking and a barrier to quitting, including a concern that quitting smoking would trigger drug or alcohol relapse. Findings support demand for interventions that address substance co-use to improve smoking cessation in SDYA smokers.
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http://dx.doi.org/10.1016/j.addbeh.2020.106486DOI Listing
November 2020

Quit ratios for cigarette smoking among individuals with opioid misuse and opioid use disorder in the United States.

Drug Alcohol Depend 2020 09 2;214:108164. Epub 2020 Jul 2.

Vermont Center on Behavior & Health, University of Vermont, Burlington, VT, United States. Electronic address:

Background: The prevalence of cigarette smoking is more than two times higher among individuals with versus without opioid misuse and/or opioid use disorders (OUD). Overall, smoking cessation has increased over time although it is unknown whether it has similarly increased for those with opioid misuse or OUD. The current study examined cigarette quit ratios from 2002 to 2018 among US individuals with and without opioid misuse or OUD.

Methods: Data came from the National Survey on Drug Use and Health, a yearly cross-sectional survey of US civilians 12 years or older. Annual quit ratios (i.e., proportion of former smokers among lifetime-smokers) were estimated from 2002 to 2018. Logistic regression tested time trends in quit ratios by opioid misuse/OUD.

Results: Past-month smoking prevalence was much higher for persons with versus without opioid misuse (64.6 % versus 25.7 %) and OUD (73.3 % versus 26.0 %). In 2018, quit ratios for individuals with opioid misuse (18.0 %) or OUD (10.0 %) were less than half of those without opioid misuse (48.3 %) or OUD (48.1 %). After adjusting for background characteristics, the quit ratio did not change over time among individuals with opioid misuse or OUD in contrast to an increase in quit ratios for those without opioid misuse or OUD. For those without opioid misuse or OUD, males had higher quit ratios than females.

Conclusions: Cigarette quit ratios remain dramatically lower among those with opioid misuse or OUD. Public health and clinical attention are needed to increase cessation and reduce smoking consequences for individuals with opioid misuse and OUD.
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http://dx.doi.org/10.1016/j.drugalcdep.2020.108164DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7423737PMC
September 2020

Relating individual differences in nicotine dependence severity to underpinning motivational and pharmacological processes among smokers from vulnerable populations.

Prev Med 2020 11 3;140:106189. Epub 2020 Jul 3.

Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA.

We examined whether elucidating underpinning smoking motivation and related pharmacological processes enhances understanding of nicotine dependence among smokers from vulnerable populations. Data were obtained between Oct, 2016 and Sept, 2019 from 745 adult smokers with co-morbid psychiatric conditions or socioeconomic disadvantage at University of Vermont, Brown University, Johns Hopkins University. Smoking motivation was assessed using the Cigarette Purchase Task (CPT), a behavioral-economic task that models the relative reinforcing value of smoking under varying monetary constraint. Dependence severity was measured using the Heaviness of Smoking Index (HSI), Fagerström Test for Nicotine Dependence total scores (FTND), and FTND total scores minus items 1 and 4 (FTND). We also assessed associations between dependence severity and smoking motivation with nicotine levels and metabolism rate. Principal Component Analysis was used to examine the latent structure of the conventional five CPT indices; bivariate and multivariable modeling was used to test associations. Factor analysis resulted in a two-factor solution, Amplitude (demand unconstrained by price) and Persistence (price sensitivity). CPT latent factors were associated with each dependence-severity measure (ps ≤ 0.0001), with associations stronger for Amplitude than Persistence across each, especially HSI which was exclusively associated with Amplitude Amplitude and each dependence measure were associated with nicotine intake (ps ≤ 0.0002); Persistence was not (p = .19). Demand Amplitude more than Persistence appears key to understanding individual differences in dependence severity. Regarding potential application, the results suggest a need for interventions that more effectively target demand Amplitude to make greater headway in reducing smoking in vulnerable populations. Trial Registration:clinicaltrials.gov identifiers: NCT02232737, NCT02250664, NCT02250534.
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http://dx.doi.org/10.1016/j.ypmed.2020.106189DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7680415PMC
November 2020

Smoking-Cessation Interventions for U.S. Young Adults: Updated Systematic Review.

Am J Prev Med 2020 07 14;59(1):123-136. Epub 2020 May 14.

Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, Burlington, Vermont.

Context: Recent data suggest that the onset of cigarette smoking is now more likely during young adulthood than adolescence. Additionally, the landscape of delivering smoking-cessation interventions has changed in the past decade, with the emergence of mobile phone and web-based approaches. The objective of this study is to update a 2010 systematic review of smoking-cessation interventions for U.S. young adults (aged 18-24 years).

Evidence Acquisition: Electronic searches were conducted in CINAHL, the Cochrane Library, Embase, PsycINFO, PubMed, Scopus, and Sociological Abstracts to identify eligible interventions from August 31, 2009 through July 17, 2019. Two independent coders critically evaluated the methodology and findings of all retrieved articles. Data analysis was conducted in 2019.

Evidence Synthesis: A total of 17 RCTs and 1 nonrandomized study were added to the original 14 studies meeting the inclusion criteria for this review; these studies varied with respect to sample size, intervention, assessed outcomes, and smoking measures. Of the new studies, 3 increased cessation in the short term, 2 at 6 months, and 1 had short-term effects on cigarette reduction. Pooled analyses supported the use of interventions employing social cognitive theory, quitline counseling, and text message programs for short-term cessation in young adults.

Conclusions: Of 32 included studies, 9 demonstrated efficacy of smoking cessation or reduction in U.S. young adults. There were no eligible pharmacologic interventions included in this review. Findings support the promise of 3 approaches for young adult cessation not included in the prior review: text message interventions, sustained quit-and-win contests, and multiple behavior interventions.
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http://dx.doi.org/10.1016/j.amepre.2020.01.021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7453837PMC
July 2020

Change in Tobacco and Electronic Cigarette Use and Motivation to Quit in Response to COVID-19.

Nicotine Tob Res 2020 08;22(9):1662-1663

Vermont Center on Behavior & Health, Department of Psychiatry, University of Vermont, Burlington, VT.

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http://dx.doi.org/10.1093/ntr/ntaa072DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7197523PMC
August 2020

Young Adult Correlates of IQOS Curiosity, Interest, and Likelihood of Use.

Tob Regul Sci 2020 Mar;6(2):81-90

Georgetown University, Lombardi Comprehensive Cancer Center, Washington, DC.

Objectives: Philip Morris International's heated tobacco product, Marlboro IQOS, is available internationally and will soon be marketed in the U.S. We examined correlates of curiosity, interest, and likelihood to use IQOS among U.S. young adults.

Methods: Young adults ages 18 - 30 years (N = 346) were recruited online, viewed a description of IQOS, and completed measures of sociodemographic characteristics, perceived risks, curiosity, interest, and likelihood to use IQOS.

Results: Males had greater curiosity, interest, and likelihood to use IQOS than females. Individuals with household income of $50,000 - $75,000 were more curious than those with household income of greater than $75,000. Cigarette smokers, e-cigarette and dual users had greater curiosity, interest, and likelihood of use than non-tobacco users. Non-white individuals and older young adults had greater likelihood of use. Greater perceived risks of IQOS were negatively associated with curiosity, interest, and likelihood of use.

Conclusions: Among young adults, IQOS has greater appeal among males, non-white individuals, those who are older, those with household income of $50,000-$75,000, cigarette smokers, e-cigarette and dual users, and those with less perceived risks of IQOS. Research on public education communicating the potential risks of IQOS to vulnerable young adults is warranted.
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http://dx.doi.org/10.18001/trs.6.2.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8425260PMC
March 2020

Investigating tobacco withdrawal in response to reduced nicotine cigarettes among smokers with opioid use disorder and other vulnerabilities.

Exp Clin Psychopharmacol 2020 Dec 6;28(6):714-723. Epub 2020 Feb 6.

Vermont Center on Behavior and Health.

Individuals with opioid use disorder (OUD) have high prevalence of smoking and poor cessation outcomes. Data suggest that smokers with OUD may experience heightened nicotine reinforcement and more severe tobacco withdrawal compared to smokers without OUD. The Food and Drug Administration is currently considering reducing the nicotine content of cigarettes to reduce smoking prevalence and smoking-related disease. It is critical to understand the effects of reduced nicotine content cigarettes (RNCCs) on tobacco withdrawal in this subgroup. In this secondary analysis, we investigated the ability of RNCCs to attenuate acute tobacco withdrawal and craving severity in smokers with OUD versus those without substance use disorders (SUDs). Smokers maintained on methadone or buprenorphine (opioid-maintained [OM]; n = 65) versus without other SUDs (i.e., non-SUD; n = 135) completed 5 laboratory sessions wherein they smoked their usual brand (UB) or a research cigarette varying in nicotine content (0.4, 2.4, 5.2, 15.8 mg/g of tobacco) under double-blind, acute abstinence conditions. Participants completed the Minnesota Tobacco Withdrawal Scale, including a desire to smoke (craving) item, before and every 15 min for 1 hr following smoking each cigarette. Tobacco withdrawal and craving did not differ significantly by OM status in response to UB or RNCCs. In addition to the Dose × Time interaction, greater depression and cigarette dependence consistently predicted withdrawal and craving (ps < .05). Across all cigarettes, tobacco withdrawal and craving did not significantly differ by OM status, suggesting that smokers receiving opioid agonist treatment may respond favorably to RNCCs. Additional studies with larger and more diverse samples are needed to address this question more definitively. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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http://dx.doi.org/10.1037/pha0000350DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7415473PMC
December 2020

Commentary on Beard et al. (2019): A systematic approach sharpens insights on e-cigarettes and smoking cessation.

Addiction 2020 05 28;115(5):975-976. Epub 2020 Jan 28.

Division of Social and Behavioral Sciences/Health Administration and Policy, University of Nevada, Reno, Reno, NV, USA.

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http://dx.doi.org/10.1111/add.14963DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7271740PMC
May 2020

It Is Past Time to Consider Cannabis in Vaping Research.

Nicotine Tob Res 2020 04;22(5):597-598

Department of Health, Behaviour & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.

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http://dx.doi.org/10.1093/ntr/ntaa012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7171266PMC
April 2020

Response to Reduced Nicotine Content in Vulnerable Populations: Effect of Menthol Status.

Tob Regul Sci 2019 Mar;5(2):135-142

Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT.

Objectives: In this study, we investigated potential effects of being a menthol smoker on response to reduced nicotine content (RNC) cigarettes in smokers especially vulnerable to smoking.

Method: Participants were 169 smokers (61 menthol and 108 non-menthol smokers) with comorbid mental illness, substance use disorder, or socioeconomic disadvantage. Participants completed a double-blind study assessing addiction potential, withdrawal/craving, and compensatory smoking across 4 research cigarettes varying in nicotine content from very low levels to commercial levels (0.4, 2.4, 5.2, 15.8mg/g of tobacco). Repeated measures analysis of variance was used to examine potential moderating effects of menthol status.

Results: Statistically significant effects of nicotine dose were noted across measures, with higher doses producing greater economic demand and relief from withdrawal/craving. The relationships between nicotine dose and response to RNC cigarettes do not differ by menthol status.

Conclusions: Results of this study suggest menthol does not have a differential impact on response to RNC cigarettes across measures of economic demand, withdrawal/craving, or smoking topography. These results suggest that any potential beneficial effects of RNC cigarettes should extend to menthol smokers including those especially vulnerable to smoking.
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http://dx.doi.org/10.18001/TRS.5.2.5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6936762PMC
March 2019

Marketing Influences on Perceptions of Reduced Nicotine Content Cigarettes.

Nicotine Tob Res 2019 12;21(Suppl 1):S117-S124

Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.

Introduction: The Food and Drug Administration announced intent to reduce the nicotine content in cigarettes. There is limited evidence on how reduced nicotine content cigarette (RNC) marketing affects product beliefs and use, and research on this is needed to inform regulations.

Methods: In an online experiment, 426 young adult cigarette smokers (aged 18-30 years) were randomized in a 2 (implicit: red package vs. blue package) × 2 (explicit: corrective message vs. no corrective message) design to view an advertisement for previously commercially available RNCs. Outcomes were advertisement content recall, product beliefs, and use intentions. Participants' responses to open-ended assessment of their beliefs about the stimuli were coded to identify prevailing themes.

Results: Red packaging and corrective messaging were independently associated with greater advertisement content recall (p = .01 and p = .04, respectively). There were no significant main or interaction effects on product beliefs or use intentions. Controlling for condition, advertisement content recall was significantly associated with less favorable product beliefs (p < .001) and favorable product beliefs were associated with intent to use the product (p < .001). Open-ended responses converged on the finding that respondents were interested in RNCs, but expressed skepticism about effectiveness and value.

Conclusions: Brief exposure to an RNC advertisement with red packaging and corrective messaging were each independently associated with greater advertisement content recall. The results indicate: (1) interest and confusion among young adult smokers regarding RNCs, (2) beliefs about RNCs are influenced by marketing, and (3) beliefs are associated with intention to use RNCs.

Implications: Findings from this study demonstrate the importance of advertising effects on beliefs about RNC products and support the need to regulate advertising and labeling alongside product regulation. More detailed study of advertisement features that affect consumers' beliefs about RNCs and how they impact their processing of explicit messaging about product risks will be important to guide regulatory decision-making.
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http://dx.doi.org/10.1093/ntr/ntz167DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6939778PMC
December 2019

Examining Age as a Potential Moderator of Response to Reduced Nicotine Content Cigarettes in Vulnerable Populations.

Nicotine Tob Res 2019 12;21(Suppl 1):S49-S55

Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT.

Introduction: Young adults (aged 18-24 years) have a higher smoking prevalence than younger and older age groups and young adulthood is an important developmental period during which long-term behavior patterns like cigarette smoking are established. The aim of the current study was to examine how young adult smokers with additional vulnerabilities to smoking respond to reduced nicotine content cigarettes.

Methods: This is a secondary analysis of a double-blind, within-subject experiment conducted with 169 cigarette smokers recruited from populations with comorbid psychiatric conditions or socioeconomic disadvantage assessing acute effects of research cigarettes varying in nicotine content (0.4, 2.4, 5.2, 15.8 mg/g). Participants were dichotomized by chronological age (18-24 vs. ≥25 years). Across 14 laboratory sessions effects of nicotine content were examined on measures of relative reinforcing efficacy (Cigarette Purchase Task [CPT] and Concurrent Choice testing), subjective effects, craving/withdrawal, and smoking topography. Repeated measures analysis of variances were used to examine potential moderating effects of age.

Results: Young adults exhibited lower demand for reduced nicotine content cigarettes than older adults across three of five CPT indices (ps < .05). No differences by age were observed on other measures of reinforcing efficacy, subjective effects, craving/withdrawal, or smoking topography where effects generally decreased as an orderly function of decreasing nicotine content (ps <.05).

Conclusion: Overall, these findings suggest that reducing the nicotine content of cigarettes would decrease the addiction potential of cigarette smoking in young adult smokers as much or perhaps more than older adult smokers from populations at increased vulnerability to smoking, addiction, and smoking-related health consequences.

Implications: Reducing the nicotine content in cigarettes to lower addiction potential of smoking has been proposed as a means to improve overall population health. It is imperative to examine how young adults may respond to a nicotine reduction policy. We saw minimal evidence that age moderates acute response and where there was evidence it was in the direction of reduced nicotine content cigarettes having less addictive potential among young versus older adults (eg, steeper decreases in demand for very low nicotine content cigarettes among young versus older adults). Overall, a nicotine reduction policy has the potential to reduce smoking across age groups.
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http://dx.doi.org/10.1093/ntr/ntz134DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6939764PMC
December 2019
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