Publications by authors named "James F Thrasher"

282 Publications

Exploring the Potential for Smoke-Free Laws to Reduce Smoking Disparities by Sexual Orientation in the USA.

Int J Behav Med 2022 May 17. Epub 2022 May 17.

Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA.

Background: We examined associations between smoke-free laws and smoking outcomes in a nationally representative sample of US adults, including exploring whether these associations differed for heterosexual and sexual minority (SM) adults.

Methods: We constructed county-level variables representing the percent of the population covered by state-, county-, or city-level smoke-free laws in workplaces and hospitality venues. We combined this information with restricted individual-level adult data with masked county identifiers from the National Health Interview Survey (NHIS), 2013-2018. We used modified Poisson regression to explore associations between each type of smoke-free law and the prevalence ratio (PR) of current smoking, and we used linear regression to explore associations with smoking intensity (mean cigarettes per day). We assessed interactions between smoke-free laws and SM status on the additive scale to determine whether associations were different for SM and heterosexual adults.

Results: In adjusted models without interaction terms, smoke-free laws in hospitality venues were associated with lower prevalence of current smoking (PR = 0.93, 95% confidence interval (CI) = 0.89, 0.98). Both types of smoke-free laws were associated with lower mean cigarettes per day (workplace law change in mean =  - 0.50, 95% CI =  - 0.89, - 0.12; hospitality law change in mean =  - 0.72, 95% CI =  - 1.14,-0.30). We did not observe any statistically significant interactions by SM status, though statistical power was limited.

Conclusions: We did not find evidence that smoke-free laws were differentially associated with smoking outcomes for heterosexual and SM adults. Additional studies are needed to further explore the potential for tobacco control policies to address the elevated risk of smoking in SM communities.
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http://dx.doi.org/10.1007/s12529-022-10099-1DOI Listing
May 2022

Evaluating Cigarette Pack Insert Messages with Tips to Quit.

Tob Regul Sci 2021 May;7(3):203-209

Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC.

Objectives: Canada is the only country that currently uses cigarette pack inserts to communicate health messages to smokers, including tips to quit. Messages about strategies for quitting smoking are also central to the US Food and Drug Administration's (FDA) Every Try Counts (ETC) campaign. This study assessed US smokers' responses to Canadian and ETC-based messages formatted for pack inserts.

Methods: US adult smokers (N = 524) were recruited from an online consumer panel and rated 8 insert messages: 4 based on Canadian inserts and 4 based on ETC. Participants randomly viewed each message accompanied by an image of either a person or a symbolic representation of the topic. Participants rated the perceived effectiveness (PE) of each message. Paired t-tests were used to assess mean differences in PE across topics, image types, and quit intentions.

Results: ETC messages were consistently rated as more effective than Canadian messages regardless of quit intentions. Image types did not significantly influence PE.

Conclusions: Messages from ETC are perceived as more effective than messages used in Canada. The FDA has the authority to communicate with smokers through inserts and should consider adopting inserts to promote smoking cessation.
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http://dx.doi.org/10.18001/trs.7.3.5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9090199PMC
May 2021

Adults' Exposure to Unhealthy Food and Beverage Marketing: A Multi-country Study in Australia, Canada, Mexico, United Kingdom, and United States.

J Nutr 2022 May 11. Epub 2022 May 11.

School of Public Health Sciences, University of Waterloo, Canada.

Background: Food marketing increases product appeal, purchasing and consumption, using diverse strategies and locations to reach consumers.

Objectives: The aim of this study was to examine differences in adults' self-reported exposure to various marketing strategies (brand and licensed characters, celebrities, sponsorship of sports and cultural events) and locations (television, radio, digital media) across five countries: Australia, Canada, Mexico, the United Kingdom (UK), and the United States (US).

Methods: We analyzed cross-sectional survey data on self-reported exposure to food marketing strategies and locations collected in 2018 by the International Food Policy Study (IFPS). Participants (n = 21,678) aged ≥ 18 years completed an online survey. Exposure to unhealthy food marketing strategies and locations in the last 30 days were self-reported. Regression models examined differences in marketing exposure and locations across countries.

Results: The average number of unhealthy food marketing strategies to which participants reported being exposed ranged from 0.5 in the UK to 2.3 in Mexico. Self-reported exposure to strategies across all countries was highest for brand characters (32%), followed by licensed characters (22%). In total, the reported mean exposure of marketing locations was 1.6 in the last month. Television was the most prevalent location (44%), followed by digital marketing (32%). Adjusted models indicated that the odds of reporting exposure to marketing strategies and marketing locations was higher for Mexico compared to the rest of the countries.

Conclusions: Adults report a variety of exposures to unhealthy food marketing in all countries, but exposure was highest in Mexico. Special attention should be paid to regulating marketing strategies such as brand characters, licensed characters, and locations such as television, and digital marketing.
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http://dx.doi.org/10.1093/jn/nxab449DOI Listing
May 2022

Perceived Availability of Healthy and Unhealthy Foods in the Community, Work, and Higher Education Settings across Five Countries: Findings from the International Food Policy Study 2018.

J Nutr 2022 May 11. Epub 2022 May 11.

School of Public Health and Sciences, University of Waterloo, Waterloo, Canada.

Background: Food environments play a key role in dietary behavior and vary due to different contexts, regulations, and policies.

Objectives: This study aimed to characterize the perceived availability of healthy and unhealthy foods in three different settings in 5 countries.

Methods: We analyzed data from the 2018 International Food Policy Study, a cross-sectional survey of adults (18-100 years, n = 22,824) from Australia, Canada, Mexico, the United Kingdom (UK), and the United States (US). Perceived availability of unhealthy (junk food and sugary drinks) and healthy foods (fruit or vegetables, healthy snacks, and water) in the community, workplace, and university settings were measured (i.e., not available, available for purchase, or available for free). Differences in perceived availability across countries were tested using adjusted multinomial logistic regression models.

Results: Across countries, unhealthy foods were perceived as highly available in all settings; in university and work settings unhealthy foods were perceived as more available than healthy foods. Australia and Canada had the highest perceived availability of unhealthy foods (range 87.5-90.6% between categories), while the UK had the highest perceived availability of fruits and vegetables for purchase (89.3%) in the community. In university and work settings, Mexico had the highest perceived availability for purchase of unhealthy foods (range 69.9-84.9%). The US and the UK had the highest perceived availability of fruits and vegetables for purchase (65.3-66.3%) or for free (21.2-22.8%) in the university. In the workplace, the UK had high perceived availability of fruits and vegetables for purchase (40.2%) or for free (18.5%), while the US had the highest perceived availability of junk food for free (17.3%).

Conclusions: Across countries, unhealthy foods were perceived as highly available in all settings. Variability between countries may reflect differences in policies and regulations. Results underscore the need for the continuation and improvement of policy efforts to generate healthier food environments.
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http://dx.doi.org/10.1093/jn/nxac070DOI Listing
May 2022

The differential impact of the 2000 Canadian Graphic Warning Label policy on smoking prevalence by sex and education: A Difference-In-Difference-In-Difference Model.

Nicotine Tob Res 2022 May 10. Epub 2022 May 10.

University of Michigan, Ann Arbor, MI.

Introduction: Using a quasi-experimental design, we compared the impact of the 2000 Canadian introduction of graphic warning labels (GWLs) on differences in smoking prevalence by sex and education, to the United States (US), where no GWLs were introduced.

Methods: We pooled 1999-2004 data from the Canadian Tobacco Use Monitoring Survey (CTUMS) and the US Behavioral Risk Factor Surveillance System (BRFSS). We used a difference-in-difference (DD) model to assess the impact of Canadian policy introduction on smoking prevalence, and a difference-in-difference-in-difference (DDD) model to examine differences in the policy impact by sex and education, comparing Canada (the treatment group) with the US (the control group).

Results: From 1999 to 2004, smoking prevalence decreased from 23.7% to 18.6% in Canada, and from 21.7% to 20.0% in the US. Results from the DD regression models showed that Canadian respondents reported lower odds of being a current smoker compared to the US respondents following the 2000 introduction of GWLs (OR= 0.84, 95 % CI 0.74-0.94). The DDD model showed that the impact of the Canadian GWLs vs. the US did not differ by sex or education.

Conclusions: The 2000 Canadian GWL policy reduced smoking prevalence overall, with similar reductions for males and females and across education levels. The impact of the Canadian GWLs in reducing smoking prevalence did not reduce differences by sex or education. Although beneficial for all smokers, GWLs may not serve to decrease existing disparities, especially those by socioeconomic status.

Implications: Existing evidence shows that GWL implementation is associated with reductions in smoking prevalence. But there is limited evidence from past evaluation studies on whether the impact of GWLs on smoking prevalence differs by sociodemographic subgroup. Our findings confirm existing studies that the 2000 implementation of GWLs in Canada was significantly associated with an overall reduction in smoking prevalence in Canada compared to the US. However, our study improves existing evidence by showing that the impact of the Canadian GWLs on smoking prevalence did not differ by sex or education, and thus did not reduce existing smoking disparities by educational levels.
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http://dx.doi.org/10.1093/ntr/ntac122DOI Listing
May 2022

Operation of research ethics committees in Colombia, Costa Rica, Guatemala, and Mexico: Mesoamerican Project.

Salud Publica Mex 2021 Dec 8;64(1):66-75. Epub 2021 Dec 8.

Distinguished University Professor Emerita, Department of Epidemiology and Population Health, Albert Einstein College of Medicine. New York, USA..

Objective: To attain a better understanding of the structure and processes of Research Ethics Committees (REC) in the low-and middle-income countries of the Mesoamerican region. The objectives are knowing the operational practices of the RECs regarding project evaluation, training needs, and infrastructure.

Materials And Methods: The REC training and needs assessment involved an online survey of all the RECs (n=55) identified in Colombia (n=11), Costa Rica (n=5), Guatemala (n=5), and Mexico (n=34).

Results: Participants reported inadequate infrastructure for its proper operation (only 49.1 %, or 27/55, have an exclusive office to safeguard files); insufficient administrative staff (47.3%, 26/55), or financial resources to conduct active site monitoring (85.6%, 47/55) to ensure the protection of rights and welfare of study participants.

Conclusions: Investments in REC member training and infrastructure are needed to ensure compliance of REC evaluations with the standards for ethical conduct of research.
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http://dx.doi.org/10.21149/12588DOI Listing
December 2021

Exposure to negative news stories about vaping, and harm perceptions of vaping, among youth in England, Canada, and the US before and after the outbreak of E-cigarette or Vaping-Associated Lung Injury (EVALI).

Nicotine Tob Res 2022 Apr 3. Epub 2022 Apr 3.

School of Public Health Sciences, Faculty of Health, University of Waterloo, Ontario, Canada.

Introduction: Little is known about the international impact of 'EVALI' on youth perceptions of vaping harms.

Methods: Repeat cross-sectional online surveys of youth aged 16-19 in England, Canada, and the US before (2017, 2018), during (2019Aug/Sept), and after (2020Feb/Mar, 2020Aug) the 'EVALI' outbreak (N=63,380). Logistic regressions assessed trends, country differences, and associations between exposure to negative news stories about vaping and vaping harm perceptions.

Results: Exposure to negative news stories increased between 2017 and Feb/Mar 2020 in England (12.6% to 34.2%), Canada (16.7% to 56.9%), and the US (18.0% to 64.6%), accelerating during (2019) and immediately after (Feb/Mar 2020) the outbreak (p<.001) before returning to 2019 levels by Aug 2020. Similarly, accurate perception that vaping is less harmful than smoking declined between 2017 and Feb/Mar 2020 in England (77.3% to 62.2%), Canada (66.3% to 43.3%), and the US (61.3% to 34.0%), again accelerating during and immediately after the outbreak (p<.001). Perception that vaping takes less than a year to harm users' health and worry that vaping will damage health also doubled over this period (p≤.001). Time trends were most pronounced in the US. Exposure to negative news stories predicted perception that vaping takes less than a year to harm health (AOR=1.55, 1.48-1.61) and worry that vaping will damage health (AOR=1.32, 1.18-1.48).

Conclusions: Between 2017 and February/March 2020, youth exposure to negative news stories, and perceptions of vaping harms, increased, and increases were exacerbated during and immediately after 'EVALI'. Effects were seen in all countries but were most pronounced in the US.

Implications: This is the first study to examine changes in exposure to news stories about vaping, and perceptions of vaping harms, among youth in England, Canada, and the US before, during, and after 'EVALI'. Between 2017 and February/March 2020, youth exposure to negative news stories, and perceptions of vaping harms, increased, and increases were exacerbated during and immediately after 'EVALI'. By August 2020, exposure to negative news stories returned to 2019 levels, while perceptions of harm were sustained. Exposure to negative news stories also predicted two of three harm perceptions measures. Overall, findings suggest 'EVALI' may have exacerbated youth's perceptions of vaping harms internationally.
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http://dx.doi.org/10.1093/ntr/ntac088DOI Listing
April 2022

Tobacco 21 laws may reduce smoking and tobacco-related health disparities among youth in the U.S.

Prev Med Rep 2022 Jun 19;27:101762. Epub 2022 Mar 19.

Department of Epidemiology, Center for Social Epidemiology and Population Health, School of Public Health, University of Michigan, Ann Arbor, MI, USA.

The goal of our study is to understand the impact of Tobacco 21 (T21) laws on youth smoking and health equity. We conducted modified Poisson regression models using 2014-2019 Monitoring the Future data to measure the impact of attending school in a county 100% covered by a T21 law versus counties with <100% T21 coverage on past 30-day smoking participation (n = 262,632), first cigarette smoking initiation (n = 189,698), and daily smoking initiation among 8th, 10th, and 12th graders (n = 214,496), separately. Additive interactions were tested between T21 coverage and sex, race/ethnicity, parental education, and college plans. T21 coverage was associated with a lower likelihood of smoking participation among 12th graders. T21 coverage was most strongly associated with a lower likelihood of smoking participation among: Hispanic and NH (Non-Hispanic) Other/Multiracial individuals; respondents with parents who had less than a college education; and respondents who were not definitely planning on attending college. T21 laws were associated with a lower likelihood of smoking participation among 12th graders. T21 policies were most impactful for individuals disproportionately impacted by tobacco, indicating T21 laws might help reduce tobacco-related health disparities.
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http://dx.doi.org/10.1016/j.pmedr.2022.101762DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8943436PMC
June 2022

Do number of smoking friends and changes over time predict smoking relapse? Findings from the International Tobacco Control Four-Country Survey.

J Subst Abuse Treat 2022 Mar 17:108763. Epub 2022 Mar 17.

School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario N2L 3G1, Canada; Department of Psychology, University of Waterloo, Waterloo, Ontario N2L 3G1, Canada; Ontario Institute for Cancer Research, Toronto, Ontario M5G 0A3, Canada. Electronic address:

Background: Past research indicates that smokers with a large number of smoking friends within their social network are less interested in quitting, less likely to attempt to quit, and less likely to successfully quit. The extent to which a pro-smoking social network may increase relapse risk among ex-smokers is unclear. This study investigated among ex-smokers whether the number of close friends who smoke and changes in this number influence relapse risk.

Methods: The study was a prospective cohort study of 551 adults who participated in the Australian and UK arms of the International Tobacco Control (ITC) project and were ex-smokers at wave 9 (2013) and followed up to wave 10 (2014). Logistic models regressed smoking relapse at follow-up on the baseline number of their five closest friends who smoked and changes in this number over time.

Results: Ex-smokers who reported having 4 or 5 smokers among their five closest friends were more likely to relapse than those who had no smokers among their five closest friends (adjusted odds ratio [AOR] = 4.86, 95% confidence interval [CI] = 1.48-15.99, p = .009). Ex-smokers who gained smoking friends over time, but not those who lost smoking friends, were also more likely to relapse compared to those with the same number of smoking friends over time (AOR = 4.52, 95% CI = 2.15-9.52, p < .001; AOR = 1.08, 95% CI = 0.49-2.36, p = .848, respectively).

Conclusions: This study demonstrated that relapse risk was elevated among ex-smokers who had more smokers among their close friends and also among those where the number of smokers in their social network increased over time.
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http://dx.doi.org/10.1016/j.jsat.2022.108763DOI Listing
March 2022

Perceptions of nicotine reduction policy in the US: A qualitative study.

Nicotine Tob Res 2022 Mar 21. Epub 2022 Mar 21.

School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, GA, 30302, USA.

Introduction: Several countries are considering a reduced nicotine policy that would make cigarettes minimally or non-addictive. This qualitative study documents reactions to the policy that should be addressed by future communication efforts.

Methods: In 2020, we recruited participants in Atlanta, GA and San Francisco, CA (27 people who exclusively smoke, 25 who dual use cigarettes and e-cigarettes, 32 who formerly smoked, and 31 young adults who do not smoke). We held 16 focus groups: 2 focus groups for each smoking status in each city. Participants viewed messages about very low nicotine content cigarettes (VLNCs) and were asked about their reactions to each message and their overall response to the reduced nicotine policy.

Results: While responses to the policy were predominantly positive, focus group discussion also revealed concerns, questions, and misunderstandings (referred to here collectively as "perceptions") that may need to be addressed if a reduced nicotine policy is enacted. Participants expressed perceptions related to the policy intent, including that the FDA has ulterior motives, adoption/ implementation, including that nicotine would have to be replaced with other chemicals if removed or that the policy would be unfeasible to implement, and effectiveness, including concern that VLNCs would still be addictive or the policy would backfire.

Conclusions: Addressing perceptions about reduced nicotine policy intent, adoption/implementation, and effectiveness could be key in creating public support and political motivation to move forward with such a policy. Countries contemplating adopting such a policy should consider pairing it with communications that address these perceptions.

Implications: This study is one of very few to use qualitative methods to explore potentially problematic perceptions about nicotine reduction policy among US adults. Results illuminated new policy-specific concerns, questions and misunderstandings about the reduced nicotine policy intent, adoption/implementation, and effectiveness. Identifying, studying, and addressing relevant perceptions may play a key role in generating support in countries contemplating such a policy.
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http://dx.doi.org/10.1093/ntr/ntac071DOI Listing
March 2022

Correlates of Self-reported and Functional Understanding of Nutrition Labels across Five Countries in the 2018 International Food Policy Study.

J Nutr 2022 Mar 11. Epub 2022 Mar 11.

School of Public Health Sciences, University of Waterloo, Canada, 200 University Avenue West, B.C. Matthews Hall, Waterloo, Ontario, Canada, N2L 3G1.

Background: Nutrition labels on pre-packaged foods are an important source of nutrition information; however, differences in comprehension of varying label formats may limit their use and effectiveness.

Objectives: This study examined levels and correlates of consumers' self-reported understanding of Nutrition Facts tables (NFt) and Front-of-Package (FOP) labels, as well as functional NFt understanding.

Methods: Adults (≥18 years) in Australia (n = 3901), Canada (n = 4107), Mexico (n = 4012), United Kingdom (UK) (n = 5121), and the United States (US) (n = 4445) completed online surveys in November-December 2018. Descriptive statistics summarized sample profiles by country. Linear regression models examined the association between label understanding (self-reported NFt and FOP, functional NFt) and consumer dietary behaviours, functional nutrition knowledge, and sociodemographic characteristics. NFt understanding was measured in all countries, with FOP labelling assessed only in Mexico, Australia, and the UK.

Results: Self-reported and functional NFt understanding was significantly higher in the US and Canada (P < 0.0001). In adjusted analyses, functional NFt understanding was significantly higher among women than men (P < 0.0001); respondents from the 'majority' ethnic group in their respective countries compared to minority ethnic groups (P < 0.0001); those with higher education levels (P < 0.0001) and functional nutrition knowledge compared to their lower education and nutrition knowledge counterparts (P < 0.0001), respectively; and those making efforts to consume less sodium, sugar or fat compared to those not reporting dietary efforts (P < 0.0001). Self-reported FOP label understanding was significantly higher for interpretive labelling systems in Australia (Health Star Ratings) and the UK (Traffic Lights) compared with Mexico's Guideline Daily Amounts (GDA) (P < 0.0001).

Conclusions: Nutrition labels requiring greater numeracy skills (i.e., NFt, GDA) were more difficult for consumers to understand than interpretive FOP labels (i.e., Traffic Lights). Differences in NFt and FOP label understanding by income adequacy and education suggest potential disparities in labelling policy effects among vulnerable subgroups.
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http://dx.doi.org/10.1093/jn/nxac018DOI Listing
March 2022

The Conceptual Framework for the International Food Policy Study: Evaluating the population-level Impact of Food Policy.

J Nutr 2022 Mar 11. Epub 2022 Mar 11.

Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.

An unhealthy diet is among the leading global causes of death and disability. Globally, a range of policies are being implemented to support healthy food choices at a population level, including novel polices in the areas of food marketing, nutrition labelling, and taxation of less healthy foods. There is a need to evaluate and inform the implementation of these policies, including their impact on marginalized population subgroups. The International Food Policy Study (IFPS) consists of repeated cross-sectional surveys conducted in five high and upper-middle income countries: Australia, Canada, Mexico, the United Kingdom, and the United States. In each country, approximately 4000 adults and 1200 children and youth (aged 10-17) were recruited from a global commercial panel to complete an online survey using consistent measures and methodologies across countries. The first annual IFPS surveys were conducted in 2017 with adults; annual surveys for young people aged 10-17 were launched in 2019 in the same countries, as well as Chile. The design of the IFPS surveys creates a framework for evaluating 'natural experiments' in food policies, including comparisons over time within countries implementing the policy, and comparisons with countries in which the policy was not implemented. IFPS surveys have three primary areas of focus: 1) knowledge, attitudes, and beliefs associated with specific policies; 2) diet-related behaviours; and 3) dietary intake, including 24-hour dietary recalls for adults in four of five countries. Surveys also assess food insecurity, income adequacy, sex and gender, race/ethnicity and a range of other measures to assess trends among priority subgroups. Overall, the IFPS project has the potential to address important gaps in national monitoring surveys for dietary patterns, and to evaluate the impact of novel food policies implemented in any of the five countries over the study period.
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http://dx.doi.org/10.1093/jn/nxac042DOI Listing
March 2022

Feasibility of a primary care patient decision aid for smoking cessation with information about e-cigarettes.

Prev Med Rep 2022 Apr 1;26:101745. Epub 2022 Mar 1.

Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA.

Decision aids can promote shared decision making and behavior change and may be effective in helping patients quit smoking. Patients are increasingly using e-cigarettes for smoking cessation; however, little is known about the impact of including e-cigarette information in smoking cessation decision aids. Our objective was to assess the feasibility and acceptability of a smoking cessation decision aid including e-cigarette information. This study was conducted at one family medicine clinic in the United States. We used a pre-post design. In Phase I, the decision aid presented information about approved cessation methods. In Phase II, current e-cigarette users and patients with no intention of quitting received additional information on switching to e-cigarettes. We assessed the impact of the decision aids on quit attempts and abstinence, confidence and readiness to quit, confidence and readiness to switch to e-cigarettes, and patient satisfaction. We enrolled 60 patients in each phase (N = 120). Patients reported higher confidence and readiness to quit after viewing the decision aids and consulting with their physician (p < 0.01). Patients reported the decision aid helped prepare them to make a decision about quitting smoking and expressed satisfaction with the decision aid and clinician consultation. We did not observe an impact of including e-cigarette information. Smoking cessation decision aids are acceptable to patients and may promote behavior change. Future studies should explore the impact of providing patients e-cigarette information using larger sample sizes and rigorous designs. Further research is needed to identify strategies to promote shared decision-making regarding e-cigarettes.
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http://dx.doi.org/10.1016/j.pmedr.2022.101745DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8892147PMC
April 2022

Why smoke flavor capsule cigarettes? Preferences and perceptions among adult smokers in Mexico.

Nicotine Tob Res 2022 Mar 4. Epub 2022 Mar 4.

University of South Carolina, Columbia, SC, USA.

Purpose: Flavor capsule cigarettes are rapidly gaining global market share, particularly in Latin America. This paper compares profiles and perceptions of smokers who prefer flavor capsule cigarettes and those who do not in Mexico.

Methods: We analyzed data from six online surveys of adult Mexican smokers (n=4488) from 2018-2020. Participants identified their preferred brand variety characteristics (no capsule; one capsule; two capsules), and reported perceptions of their brand varieties' flavor, smoothness, harmfulness, and whether they smoke to control their appetite. Separate multinomial logistic models regressed preferred cigarette type on sociodemographic and smoking-related variables, as well as perceived benefits on preferred cigarette type, adjusting for covariates.

Results: Most participants preferred capsule cigarettes (single capsule=47.5%; double capsule=12.9%). Flavor capsule users reported that their preferred varieties mostly tasted like menthol/mint (59% of single capsule users and 23% of double capsule users), cucumber (12% and 27%, respectively) or berries (10% and 22%, respectively). Females were more likely than males to prefer either single or double capsule cigarettes (AOR=2.26 and 2.01, respectively). Preference for flavor capsules was also higher among younger smokers, e-cigarette users, those who smoke less frequently, and those who recently tried or plan to quit. Smokers who preferred capsules were more likely than non-capsule smokers to perceive their cigarettes as smoother, less harmful, and to smoke to control their appetite.

Conclusions: The high prevalence of capsule use and widespread perceptions of the benefits of capsules over traditional cigarettes may help explain why tobacco control policies have not reduced smoking prevalence in Mexico.
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http://dx.doi.org/10.1093/ntr/ntac057DOI Listing
March 2022

Achievements, challenges, priorities and needs to address the current tobacco epidemic in Latin America.

Tob Control 2022 03;31(2):138-141

Health Promotion, Education, and Behavior, School of Public Health, University of South Carolina, Columbia, South Carolina, USA.

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http://dx.doi.org/10.1136/tobaccocontrol-2021-057007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8908794PMC
March 2022

Heated tobacco product use, its correlates, and reasons for use among Mexican smokers.

Drug Alcohol Depend 2022 03 11;232:109283. Epub 2022 Jan 11.

Tobacco Research Department, National Institute of Public Health, Cuernavaca, Morelos, Mexico; Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, USA. Electronic address:

Background: Little is known about the use of novel heated tobacco products (HTPs) in low- and middle-income countries. We examined among smokers in Mexico the prevalence and correlates of HTP use, as well as reasons for using HTPs.

Methods: We analyzed data from five surveys (November 2019-March 2021) of an open cohort of adult smokers (n = 6500), including an oversample of those who also use e-cigarettes. Mixed-effects multinomial logistic models were used to estimate associations between study variables and current HTP use or prior HTP trial relative to never trying HTPs.

Results: The weighted prevalence of current HTP use was 1.1%. Independent correlates of current HTP use included smoking frequency, intention to quit, e-cigarette use, having partners/family-members who use e-cigarettes, friends who use HTPs, and exposure to HTP information inside/outside tobacco shops. Having partners/family members who smoke and not knowing about the harm of HTPs relative to cigarettes were associated with lower likelihood of current HTP use. Having tried HTPs was more likely among light daily smokers, those with family who use HTPs and exposure to HTP information outside shops and on newspapers/magazines. Among current users, the top reasons for using HTPs were greater social acceptability (50.6%) and lower perceived harm (34.9%) relative to cigarettes.

Conclusions: Uptake of HTPs appears relatively low among Mexican smokers, and correlates of use are similar to those for e-cigarette use. Further research is needed to determine if HTPs use promotes or impedes smoking cessation, given current HTP users are also likely to use various nicotine products.
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http://dx.doi.org/10.1016/j.drugalcdep.2022.109283DOI Listing
March 2022

Profile and patterns of dual use of e-cigarettes and combustible cigarettes among Mexican adults.

Salud Publica Mex 2021 Jul 29;63(5):641-652. Epub 2021 Jul 29.

Departamento de Investigación sobre Tabaco, Instituto Nacional de Salud Pública. Cuernavaca, Mexico/Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina. Columbia, United States.

Objective: To describe the profile and patterns of dual uses (n=954) and exclusive cigarette users (n=2 070) and determine the correlates of more frequent e-cigarette use among dual users and their reasons for e-cigarette use.

Materials And Methods: An online survey of Mexican adult smokers. Logistic models regressed dual-use (exclusive smoking vs. dual user) on sociodemographic, smoking varia-bles and substance use behaviors. We conducted censorial binomial models to estimate the correlates of frequency of e-cigarette use among dual users.

Results: Dual users were younger had higher education (AOR=2.22) and higher levels of smoking dependence (AOR=1.31), preferred cigarettes with flavor capsules (AOR=1.58) and had recently attempted to quit smoking (AOR=1.38). Marijuana use and being daily smokers were correlates of higher frequency of use among dual users.

Conclusion: Dual users had a higher risk profile than exclusive smokers, which was even more prominent in dual-users who used e-cigarettes frequently.
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http://dx.doi.org/10.21149/12365DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8827615PMC
July 2021

E-cigarette vending machines: a new access channel for youth in Guatemala City.

Tob Control 2022 Jan 21. Epub 2022 Jan 21.

Departamento de Investigacion, Unidad de Cirugia Cardiovascular de Guatemala, Guatemala City, Guatemala

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http://dx.doi.org/10.1136/tobaccocontrol-2021-057102DOI Listing
January 2022

Differential impact of the Canadian point-of-sale tobacco display bans on quit attempts and smoking cessation outcomes by sex, income and education: longitudinal findings from the ITC Canada Survey.

Tob Control 2022 Jan 11. Epub 2022 Jan 11.

Epidemiology, University of Michigan, Ann Arbor, Michigan, USA.

Significance: This study examines the differential effects of Canadian point-of-sale (POS) tobacco display bans across provinces on quit attempts and smoking cessation, by sex, education and income.

Methods: We analysed survey data from five waves (waves 4-8) of the International Tobacco Control Canada Survey, a population-based, longitudinal survey, where provinces implemented display bans between 2004 and 2010. Primary outcomes were quit attempts and successful cessation. We used generalised estimating equation Poisson regression models to estimate associations between living in a province with or without a POS ban (with a 24-month threshold) and smoking outcomes. We tested whether these associations varied by sex, education and income by including interaction terms.

Results: Across survey waves, the percentage of participants in provinces with POS bans established for more than 24 months increased from 5.0% to 95.8%. There was no association between POS bans and quit attempts for provinces with bans in place for 0-24 months or more than 24 months, respectively (adjusted relative risk (aRR)=0.99, 95% CI: 0.89 to 1.10; 1.03, 95% CI: 0.88 to 1.20). However, we found a differential impact of POS bans on quit attempts by sex, whereby bans were more effective for women than men for bans of 0-24 months. Participants living in a province with a POS ban for at least 24 months had a higher chance of successful cessation (aRR=1.49; 95% CI: 1.08 to 2.05) compared with those in a province without a ban. We found no differences in the association between POS bans and quit attempts or cessation by education or income, and no differences by sex for cessation.

Conclusion: POS bans are associated with increased smoking cessation overall and more quit attempts among women than men.
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http://dx.doi.org/10.1136/tobaccocontrol-2021-056805DOI Listing
January 2022

Associations Between Noticing Nicotine Vaping Product Health Warning Labels, Harm Perceptions, and Use among adult vapers, current and former smokers. Findings From the 2018 ITC Four Country Smoking and Vaping Survey.

Nicotine Tob Res 2021 Dec 10. Epub 2021 Dec 10.

Department of Communication and Media Research, University of Zurich, Switzerland.

Background: The number of countries mandating a nicotine addiction warning label ('warnings') on nicotine vaping products (NVPs) has been increasing. This study examined associations between noticing NVP warnings, perceptions of NVPs, and intentions to use NVPs.

Methods: Cross-sectional analysis of 12,619 adult NVP users, cigarette smokers, concurrent users of both cigarettes and NVPs, and quitters who participated in the 2018 International Tobacco Control (ITC) Project Four Country Smoking and Vaping Survey (England, Australia, Canada, US). Logistic regression analyses examined associations between noticing warnings in the past 30 days and perceptions of nicotine harm, NVP harm relative to cigarettes, and NVP addictiveness relative to cigarettes. Associations were also explored between noticing warnings and intentions to use NVPs.

Results: Noticing warnings was higher among NVP users (18.8%) than non-users (2.1%). Noticing warnings was associated with perceiving nicotine to pose little or no harm to health among NVP users, but there was no association among non-users. There was little evidence of an association between noticing warnings and perceptions of NVP harms relative to smoking among NVP users and non-users. Noticing warnings was associated with perceiving NVPs as less addictive than cigarettes among non-users but not NVP users. Among exclusive smokers, noticing warnings was associated with intending to start using NVPs. Among NVP users, there was little evidence of an association between noticing warnings and intentions to continue using/stopping NVPs.

Conclusions: Noticing NVP warnings was not associated with increased NVP and nicotine harm perceptions or decreased intentions to use NVPs among adult smokers and vapers.
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http://dx.doi.org/10.1093/ntr/ntab256DOI Listing
December 2021

Do post-quitting experiences predict smoking relapse among former smokers in Australia and the United Kingdom? Findings from the International Tobacco Control Surveys.

Drug Alcohol Rev 2022 May 9;41(4):883-889. Epub 2021 Dec 9.

School of Public Health Sciences, University of Waterloo, Waterloo, Canada.

Introduction: Many smokers attempt to stop smoking every year, but the vast majority of quit attempts fail. This study examined prospectively the association between post-quitting experiences and smoking relapse among ex-smokers in Australia and the United Kingdom.

Methods: Data came from 584 adult ex-smokers from Australia and the United Kingdom who participated in Wave 9 of the International Tobacco Control Four Country Survey and successfully followed up a year later (Wave 10). Binary logistic regression was used to examine whether baseline post-quitting experiences predicted relapse back to smoking at follow-up.

Results: Ex-smokers who perceived their stress coping ability had gotten worse since quitting were more likely to relapse back to smoking compared to their counterparts who reported no change (odds ratio = 5.77, 95% confidence interval = 1.64, 20.31, P < 0.01). Ex-smokers who reported their homes had become fresher and cleaner post quitting were less likely to relapse compared to those who did not notice any change (odds ratio = 0.34, 95% confidence interval = 0.13, 0.93, P < 0.05). Perceived changes in life enjoyment, negative affect control, social confidence, work performance, leisure time and financial situation did not independently predict relapse. No country differences were found.

Discussion And Conclusions: The study showed that ex-smokers' relapse risk was elevated if they perceived any negative impact of quitting on their stress coping whereas relapse risk was reduced if they perceived any positive impact of quitting on the home (e.g. fresher and cleaner). Helping ex-smokers to develop alternative stress coping strategies and highlighting the positive impacts of quitting smoking on the homes may help protect against smoking relapse.
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http://dx.doi.org/10.1111/dar.13419DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9064888PMC
May 2022

Trends in exposure to and perceptions of e-cigarette marketing among youth in England, Canada and the United States between 2017 and 2019.

Health Educ Res 2022 01;36(6):657-668

E-Cigarette marketing may influence e-cigarette use among youth. This study examined reported exposure to and perceptions of e-cigarette marketing among youth between 2017 and 2019 across countries with varying e-cigarette marketing restrictions. Cross-sectional online surveys were conducted with 35 490 youth aged 16-19 from England, Canada and the United States in 2017, 2018 and 2019. Weighted logistic regression models examined trends in the adjusted prevalence of self-reported exposure to e-cigarette marketing and the perceived appeal of e-cigarette ads between 2017 and 2019, by country and by smoking/vaping status. Reports of frequent exposure to e-cigarette marketing increased between 2017 and 2019 in all countries, but less so in England, where e-cigarette marketing is more restricted. Perceiving e-cigarette marketing as appealing increased from 2017 to 2019 in Canada and the United States, but not in England. In England, exposure to e-cigarette marketing did not increase in prohibited channels between 2017 and 2019. Between 2017 and 2019, never-users' reports increased for exposure to and appeal of e-cigarette marketing. The results suggest some effectiveness of e-cigarette marketing bans in England and receptivity to e-cigarette marketing among youth never users.
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http://dx.doi.org/10.1093/her/cyab039DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8800160PMC
January 2022

Impact of front-of-pack labels on the perceived healthfulness of a sweetened fruit drink: a randomised experiment in five countries.

Public Health Nutr 2022 04 2;25(4):1094-1104. Epub 2021 Nov 2.

Nutrition and Health Research Center, National Institute of Public Health, Av. Universidad 655 Col. Santa María Ahuacatitlán, CP, Cuernavaca, MR62100, México.

Objective: Front-of-pack (FOP) nutrition labelling is a globally recommended strategy to encourage healthier food choices. We evaluated the effect of FOP labels on the perceived healthfulness of a sweetened fruit drink in an international sample of adult consumers.

Design: Six-arm randomised controlled experiment to examine the impact of FOP labels (no label control, Guideline Daily Amounts (GDA), Multiple Traffic Lights, the Health Star Ratings (HSR), Health Warning Labels, and 'High-in' Warning Labels (HIWL)) on the perceived healthfulness of the drink. Linear regression models by country examined healthfulness perceptions on FOP nutrition labels, testing for interactions by demographic characteristics.

Setting: Online survey in 2018 among participants from Australia, Canada, Mexico, United Kingdom (UK) and United States.

Participants: Adults (≥18 years, n 22 140).

Results: Compared with control, HIWL had the greatest impact in lowering perceived healthfulness (β from -0·62 to -1·71) across all countries. The HIWL and the HSR had a similar effect in Australia. Other labels were effective in decreasing the perceived healthfulness of the drink within some countries only, but to a lower extent. The GDA did not reduce perceived healthfulness in most countries. In the UK, the effect of HIWL differed by age group, with greater impact among older participants (> 40 years). There were no other variations across key demographic characteristics.

Conclusions: HIWL, which communicates clear, non-quantitative messages about high levels of nutrients of concern, demonstrated the greatest efficacy to decrease the perceived healthfulness of a sweetened fruit drink across countries. This effect was similar across demographic characteristics.
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http://dx.doi.org/10.1017/S1368980021004535DOI Listing
April 2022

Examining Truth and State-Sponsored Media Campaigns as a Means of Decreasing Youth Smoking and Related Disparities in the United States.

Nicotine Tob Res 2022 03;24(4):469-477

Department of Epidemiology, Center for Social Epidemiology and Population Health, School of Public Health, University of Michigan, Ann Arbor, MI, USA.

Introduction: To analyze the impact of Truth and state-sponsored anti-tobacco media campaigns on youth smoking in the United States, and their potential to reduce tobacco-related health disparities.

Aims And Methods: Our study included data from the 2000-2015 Monitoring the Future study, an annual nationally representative survey of youth in 8th (n = 201 913), 10th (n = 194 468), and 12th grades (n = 178 379). Our primary exposure was Gross Rating Points (GRPs) of Truth or state-sponsored anti-tobacco advertisements, from Nielsen Media Research. Modified Poisson regression was used to assess the impact of a respondent's GRPs on smoking intentions, past 30-day smoking participation, and first and daily smoking initiation. Additive interactions with sex, parental education, college plans, and race/ethnicity were used to test for differential effects of campaign exposure on each outcome.

Results: Greater campaign exposure (80th vs. 20th GRP percentile) was associated with lower probabilities of smoking intentions among 8th graders, smoking participation among 8th and 12th graders, and initiation among 8th graders. Greater exposure was associated with a greater reduction in the likelihood of smoking participation among 10th and 12th grade males than females; 10th and 12th graders with parents of lower education versus those with a college degree; and 12th graders who did not definitely plan to go to college relative to those who did.

Conclusions: Media campaign exposure was associated with a lower likelihood of youth smoking behaviors. Associations were more pronounced for groups disproportionately affected by smoking, including youth of lower socioeconomic status. Media campaigns may be useful in reducing smoking disparities and improving health equity.

Implications: Few recent studies have investigated the impact of anti-tobacco media campaigns on youth smoking and their potential to reduce tobacco-related health disparities in the United States. We found media campaigns-specifically state-sponsored media campaigns-reduced the likelihood of several smoking outcomes among youth, with some evidence that they mitigate disparities for disproportionately affected groups.
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http://dx.doi.org/10.1093/ntr/ntab226DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8887582PMC
March 2022

Strategies to enhance the effects of pictorial warnings for cigarettes: results from a discrete choice experiment.

Addiction 2022 Apr 15;117(4):1095-1104. Epub 2021 Nov 15.

Evaluation and Surveys Research Center, National Institute of Public Health, Mexico City, Mexico.

Aims: To measure the effects of changing attributes of pictorial health warning labels (HWLs) on cigarette packs in a country that has already implemented pictorial HWLs.

Measures: For each choice set, participants were presented with two cigarette packs and asked the following three questions: (1) 'If only these two cigarette packs were available, which would you buy?'; (2) 'Each of these two packs has warnings on the front and back about the health effects of smoking. Which of these warnings best informs you about the dangers from smoking?'; and (3) 'Which warning most makes you think about quitting smoking?'. As recommended for best practices in discrete choice experiments, each of these questions was followed by an 'opt-out' question for participants to indicate whether they really believed there was a difference between the options presented (i.e. 'Would you really choose one of them?'; 'Do you really think that either of these warnings informs you about dangers from smoking?'; or 'Do you really think that either of these warnings would make you think about quitting smoking?', respectively). Each choice set could be viewed for as long as the participant wished. For each choice question (i.e. willingness to buy, informative, motivating to quit), the pack chosen was coded as 1 and the other pack as 0, with both packs being given a value of 0 if the participant 'opted out'.

Design: A within-subject discrete choice experiment that involved systematic manipulation of pictorial HWL size [75 versus 30% (current policy)]; inclusion of imagery on the back of the pack [versus none (current policy)]; and color formatting [black on yellow versus yellow on black (current policy)].

Setting: Mexico, on-line panel.

Participants: Adult smokers (n = 705).

Measurements: For each choice set, participants selected one pack as having the most informative HWL about smoking harms, the one that makes them think the most about quitting and the one they were most willing to buy. We assessed the independent and interactive effects of HWL attributes on choices.

Findings: Larger HWL size on the pack front (75 versus 30%) and inclusion of a pictorial image on the pack back were both independently associated with lower willingness to buy a pack [b = -0.228, standard error (SE) = 0.023 and -0.089, SE = 0.016, respectively] and greater perception of an HWL as informative (b = 0.214, SE = 0.022, and 0.191, SE = 0.017, respectively) and motivating to quit (b = 0.251, SE = 0.023 and 0.194, SE = 0.017, respectively). HWL with black text and yellow background were perceived as less informative (b = -0.037, SE = 0.016) and less motivating to quit (b = -0.032, SE = 0.015) compared with yellow text on a black background.

Conclusions: Among adult Mexican smokers, pictorial health warning labels on cigarette packages that are larger or cover both sides of the pack appear more effective at lowering purchase intentions and increasing risk perceptions and motivation to quit than smaller health warning labels or health warning labels with imagery only on the pack front.
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http://dx.doi.org/10.1111/add.15725DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8904287PMC
April 2022

Smoking Behaviors, Mental Health, and Risk Perceptions during the Beginning of the COVID-19 Pandemic among Mexican Adult Smokers.

Int J Environ Res Public Health 2021 10 17;18(20). Epub 2021 Oct 17.

Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC 29201, USA.

Mexico is one of the countries most affected by COVID-19. Studies have found that smoking behaviors have been impacted by the pandemic as well; however, results have varied across studies, and it remains unclear what is causing the changes. This study of an open cohort of smokers recruited from a consumer panel ( = 2753) examined changes in cigarettes per day (CPD), daily vs. non-daily smoking, recent quit attempts, perceived stress, depression, and perceived severity of COVID-19 at two points during the pandemic: March and July 2020. Differences in CPD between waves were estimated with Poisson regression using generalized estimating equations (GEE). Differences in perceived stress were estimated with linear regression using GEE, and differences in recent quit attempts, depression, and perceived severity of COVID-19 were estimated using separate logistic regression GEE models. Rates of depression were higher in July compared to March (AOR = 1.55, 95% C.I. 1.31-1.85), and the likelihood of recent quit attempt was lower in July compared to March (AOR = 0.85, 95% C.I. 0.75-0.98). There was no statistically significant change in CPD, daily smoking, or perceived stress. Perceived COVID-19 severity for oneself increased significantly (AOR: 1.24, 95% C.I. 1.02-1.52); however, the perceived COVID-19 severity for smokers remained constant. Our study suggests that as the COVID-19 pandemic expanded in Mexico, smoking frequency remained stable, and quit attempts decreased, even as adult smokers increasingly perceived infection with COVID-19 for themselves as severe. These results can aid in the development of health communication strategies to educate smokers about their risk for COVID-19, potentially capitalizing on concerns that stem from this syndemic of communicable and smoking-related non-communicable disease.
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http://dx.doi.org/10.3390/ijerph182010905DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8535597PMC
October 2021

Cigarette Pack Price and Its Within-Person Association With Smoking Initiation, Smoking Progression, and Disparities among Young Adults.

Nicotine Tob Res 2022 03;24(4):519-528

Center for Social Epidemiology and Population Health, Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA.

Background: There is a dearth of research on within-person relationships between tobacco price and cigarette smoking initiation and progression in young adulthood. This project examines the within-person association between cigarette pack price and smoking initiation and progression between age 18 and 21/22, focusing on differences across subgroups.

Methods: Data came from the longitudinal Monitoring the Future (MTF) project. MTF examines drug use behaviors with nationally representative samples of 12th graders annually. Subsamples of 12th graders are annually selected and followed longitudinally. Among 12th graders from baseline years 2000-2014, we examined past 30-day cigarette smoking initiation among baseline never smokers (N = 15 280) and progression to daily smoking among youth who were not daily smokers at baseline (N = 26 998). We used hierarchical logistic regression and interaction terms to assess differences across sex, race/ethnicity, and parental education.

Results: The within-person relationship between pack price and smoking indicated that a one-dollar increase in pack price corresponded with a 72% decrease in the odds of initiation (AOR = 0.28, 95% CI = 0.18, 0.44) and 70% decrease in the odds of progression to daily smoking (AOR = 0.30, 95% CI = 0.21, 0.44). There was a linear age trend for both smoking initiation and progression. There were no statistically significant interactions between price and demographics, making it difficult to disentangle differences across subgroups.

Conclusions: Exposure to increased cigarette prices during young adulthood was associated with lower odds of cigarette smoking initiation and progression. Additional policies and programs beyond cigarettes prices could help reduce tobacco-related disparities in smoking initiation and progression among young adults.

Implications: There is a strong, within-person relationship between cigarette prices and smoking initiation and progression during the transition to young adulthood: higher prices are associated with decreased odds of both initiation and progression. Cigarette taxation can help to prevent smoking initiation and progression among youth, but it is less clear how taxes are associated with disparities in smoking experienced by certain subgroups. We could not draw definitive conclusions about the impact of cigarette prices on tobacco-related disparities. Tobacco taxes should be increased on a regular basis to ensure young adults experience within-person increases in prices, and complementary programs geared toward reducing tobacco-related disparities among young adults should be promoted.
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http://dx.doi.org/10.1093/ntr/ntab210DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8887579PMC
March 2022

Designing More Effective Cigar Warnings: An Experiment Among Adult Cigar Smokers.

Nicotine Tob Res 2022 03;24(4):617-622

Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

Introduction: Little systematic evidence exists about the effectiveness of cigar warnings. This study examined the perceived message effectiveness (PME) of warning statements about different health consequences caused by cigars. PME is a validated self-report scale of how effectively a health message discourages smoking.

Aims And Methods: We conducted an online study from April to May 2020 with adults in the United States who used cigars in the past 30 days (n = 777). Participants were randomly assigned to view and rate PME (three items, range 1-5) for seven out of 37 text warning statements about different health consequences from cigar use. Linear mixed effects models evaluated the most effective warning characteristics (eg, type of health consequence), controlling for repeated measures and participant demographics.

Results: Analyses showed that health consequences about the cardiovascular system (B = 0.38), mouth (B = 0.40), other digestive (B = 0.45), respiratory system (B = 0.36), and early death (B = 0.36) were associated with higher PME scores than reproductive health consequences (all p values <.001). Similar results were found for these health consequences compared with addiction (all p values p < .001). We also observed that awareness of the health consequence was associated with higher PME scores (B = 0.19, p < .001) and length of the warning message (number of characters) was associated with lower PME scores (B = -0.007, p = .03). No differences were observed between cancer and noncancer health consequences (p = .27) or health consequences that used plain language versus medical jargon (p = .94).

Conclusions: Our study provides new evidence about the perceived effectiveness of different cigar health warning statements and identifies features that may strengthen statements.

Implications: Our study with cigar smokers from across the United States provides much-needed evidence concerning the perceived effectiveness of different cigar health warning statements and features that may strengthen such statements. Mandated cigar warnings in the United States could be strengthened by including health consequences that were perceived as more effective in our study (eg, early death), using health consequences that participants were aware of, and using short warning statements.
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http://dx.doi.org/10.1093/ntr/ntab207DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8887578PMC
March 2022

Effective package warning label systems for communicating relative risks of cigarettes, heated tobacco products, and e-cigarettes: An experimental study with Korean adults.

Int J Drug Policy 2022 01 6;99:103468. Epub 2021 Oct 6.

Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, United States.

Background: Warning labels are a fundamental public health strategy for communicating about tobacco product risks, but effective warning labels for heated tobacco products (HTPs) and e-cigarettes (ECs) are yet to be determined. We examined the effect of two warning label systems for communicating the relative risks of using cigarettes, HTPs, and ECs.

Methods: 1,280 Korean adults were recruited from an online commercial panel, including susceptible non-users of cigarettes, HTPs, or ECs aged 19 to 29 (n = 444) and current users of these tobacco products aged 19 or older (n = 836). Participants viewed packages for cigarettes, HTPs, and ECs in a 2 × 2 between-subject experiment: "dashboard" icons integrated into warnings vs. no dashboard; different-sized warnings (70% of cigarette packages, 50% of HTP packs, 30% of EC packages) vs. current equal-sized warnings (50% of cigarette/HTP/EC packages).

Results: Participants exposed to the dashboard warning system were more likely than those who were not to report higher perceived harm of cigarettes than ECs, cigarettes than HTPs, and HTPs than ECs, as well as perceived benefit of switching from cigarettes to HTPs, cigarettes to ECs, and HTPs to ECs. Participants exposed to the different-sized warning system did not report differences in perceived relative harm or benefit compared to those who were not, and no interaction of dashboard warnings with warning sizes was found.

Conclusion: The use of dashboard icons with texts and colors representing different levels of risk may promote public understanding about the continuum of risk across tobacco products.
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http://dx.doi.org/10.1016/j.drugpo.2021.103468DOI Listing
January 2022

Similarities and Differences in Substance Use Patterns Among Lesbian, Gay, Bisexual, and Heterosexual Mexican Adult Smokers.

LGBT Health 2021 11 7;8(8):545-553. Epub 2021 Oct 7.

Tobacco Research Department, Population Health Research Center, Mexican National Institute of Public Health, Cuernavaca, Mexico.

This study aimed to characterize the patterns of smoking, e-cigarette use, other substance use (alcohol and marijuana), and depression by sexual orientation in a sample of Mexican adult smokers. Data came from a 2018-2020 (six waves) online survey of adult smokers, recruited from a commercial research panel (92.5% heterosexual,  = 4786; 3.1% lesbian/gay,  = 160; and 4.4% bisexual,  = 229). After stratifying the data by sex, logistic, multinomial, and linear logistic regression models were estimated (depending on the outcome), including as independent variables sexual orientation (i.e., gay/lesbian, bisexual, heterosexual = Reference), age, education, household income, and wave. Being a gay male was independently associated with greater smoking dependence (β = 0.20; 95% confidence interval [CI]: 0.02 to 0.39), greater likelihood of preference for flavored capsule cigarettes (adjusted odds ratio [AOR] = 2.10, 95% CI: 1.33 to 3.28), and depression diagnosis (AOR = 2.85, 95% CI: 1.64 to 4.95). Bisexual males had higher e-cigarette dependence (β = 0.37; 95% CI: 0.05 to 0.68, among dual users only) and were more likely to have been diagnosed with depression (AOR = 2.34, 95% CI: 1.30 to 4.18). Lesbian females were more likely to prefer menthol cigarettes (AOR = 3.32, 95% CI: 1.60 to 6.86), to have used marijuana more than once (AOR = 3.23, 95% CI: 1.83 to 5.72), and to have depressive symptoms (AOR = 1.85, 95% CI: 1.04 to 3.29). Bisexual females had a greater likelihood of depressive symptoms (AOR = 1.71, 95% CI: 1.14 to 2.56) and depression diagnosis (AOR = 2.22, 95% CI: 1.43 to 3.42). Lesbian, gay, and bisexual adult smokers in Mexico appear more likely than heterosexual adult smokers to report having depression. Substance use and depression among sexual minority populations need to be addressed further.
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http://dx.doi.org/10.1089/lgbt.2020.0457DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8823678PMC
November 2021
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