Research digest Januari 2021

This page provides a non-exhaustive list of tobacco-related research articles identified weekly from PubMed by the ASH Scotland Information Service. 

Search period: 15/01 - 29/01

Research Trawl  23^th - 29^th January 

Association of Smoking and Cumulative Pack-Year Exposure With COVID-19 Outcomes in the Cleveland Clinic COVID-19 Registry

Published: 25/01/2021, JAMA Internal Medicine

Results: Of the 7102 patients included in the cohort, 6020 (84.8%) were never smokers, 172 (2.4%) were current smokers, and 910 (12.8%) were former smokers. All demographics are summarized in Table 1, and the results of logistic regression analyses are summarized in Table 2. The findings showed a dose-response association between pack-years and adverse COVID-19 outcomes. Patients who smoked more than 30 pack-years had a 2.25 times higher odds of hospitalization (95% CI, 1.76-2.88), and these heavy smokers were 1.89 times more likely to die following a COVID-19 diagnosis (95% CI, 1.29-1.76) when compared with never smokers. The association between cumulative smoking and adverse COVID-19 outcomes is likely mediated in part by comorbidities. The odds ratios for all adverse outcomes were attenuated in the mediation models. There was no evidence of effect modification by smoking status; similar odds ratios were seen in both current and former smokers.

Health impact assessment to predict the impact of tobacco price increases on COPD burden in Italy, England and Sweden

Published: 27/01/2021, Scientific Reports

Conclusion: Increasing tobacco prices would reduce COPD burden and increase life expectancy through smoking behavior changes, with modest but important public health benefits observed in all three countries.

The time course of compensatory puffing with an electronic cigarette: Secondary analysis of real-world puffing data with high and low nicotine concentration under fixed and adjustable power settings

Published: 23/01/2021, Nicotine and Tobacco Research

Conclusion: Under fixed power conditions (4.0V/10W), vapers appear to compensate for poor nicotine delivery by taking longer puffs and this compensatory puffing appears to be maintained over time.

Flavoured tobacco product restrictions in Massachusetts associated with reductions in adolescent cigarette and e-cigarette use

Published: 27/01/2021, Tobacco Control

Conclusions: Adolescents in Massachusetts decreased their use of cigarettes and e-cigarettes in response to local restrictions that limited the sale of flavoured tobacco products to adult-only retail tobacco stores. Local legislation can reduce adolescent tobacco use and municipalities should enact stricter tobacco-control policies when not pre-empted by state law.

Analysis of on-pack messages for e-liquids: a discrete choice study

Published: 25/01/2021. Tobacco Control

Conclusions: On-pack relative-risk messages about ENDS could make transition more attractive to smokers while increased-risk messages could deter ENDS uptake among susceptible non-smokers, occasional and former smokers. Communicating diverse messages via discrete channels could recognise heterogeneity among and between smokers and non-smokers.

Extracting smoking data from GP electronic health records

Published: 28/01/2021, British Journal of General Practitioners

Although health promotion data such as body mass index have been extracted from GP records for many years, there has been far less interest in tabulating numerical smoking data. Focus seems to be on stopping smoking (which is excellent in itself) rather than using smoking information to predict disease at either an individual or population level. This is probably due to the lack of recommended software recording standards for smoking in the computer systems available. This is a glaring elephant in the room for the future screening of lung cancer or other smoking-related diseases.

A Facebook intervention to address cigarette smoking and heavy episodic drinking: A pilot randomized controlled trial

Published: March/2021, Journal of Substance Abuse Treatment

Conclusions: Adding an alcohol treatment component to a tobacco cessation social media intervention was acceptable and engaging but did not result in significant differences by treatment condition in smoking or alcohol use outcomes. Participants in both conditions reported smoking and drinking less over time, suggesting covariation in behavioral changes.

Prevalence and risk factors of e-cigarette use among working-age adults with and without disabilities in 2017–2018

Published: 27/01/2021, Disability and Health Journal

Conclusions: Adults with cognitive disabilities and independent living disabilities had more than twice the prevalence of ECIG use compared to adults without disabilities. Future studies should monitor the rising prevalence and risk factors for ECIG use as well as examine longitudinal associations between using ECIGs, dual use with cigarette smoking, and health outcomes among adults with disabilities.

First Report on Smoking and Infection Control Behaviours at Outdoor Hotspots during the COVID-19 Pandemic: An Unobtrusive Observational Study

Published: 25/01/2021, International Journal for Environmental Research and Public Health

Results:  Compared with pre-outbreak, lower volumes of smokers were observed during outbreak and since-outbreak. Smokers gathered more in a group (24.5% and 25.8% vs. 13.4%, respectively) and stayed longer (91.5% and 83.6% vs. 80.6% stayed ≥1 min) during outbreak and since-outbreak than pre-outbreak. Ninety-six percent smokers possessed a face mask. While smoking, 81.6% of smokers put the mask under the chin and 13.8% carried it in the hand, 32.4% did not wear a mask immediately after smoking, 98.0% did not sanitize hands, and 74.3% did not keep a distance of at least one metre. During the COVID-19 pandemic, smokers gathered closely and stayed longer at the hotspots, and few practised hand hygiene, all of which may increase the risk of infection.

Can smoking cessation be taught online? A prospective study comparing e-learning and role-playing in medical education

Published: 28/01/2021, International Journal for Medical Education

Conclusions: Seminar and web-based training seem equally well suited for transferring knowledge and skills on tobacco cessation counselling. Considering their particular strengths, these two teaching approaches could be combined.

Early to Midlife Smoking Trajectories and Cognitive Function in Middle-Aged US Adults: the CARDIA Study

Published: 23/01/2021, Journal of General Internal Medicine

Conclusions: The association between early to midlife smoking trajectories and midlife cognition was dose-dependent. Results underscore the cognitive health risk of moderate and heavy smoking and the potential benefits of quitting on cognition, even in midlife.

Cancer deaths attributable to cigarette smoking in 152 U.S. metropolitan or micropolitan statistical areas, 2013-2017

Published: 26/01/2021, Cancer Causes and Control

Conclusion: The proportion of cancer deaths attributable to cigarette smoking is considerable in each metropolitan and micropolitan statistical area, with as many as 4 in 10 cancer deaths attributable to smoking

Research Trawl  23^th - 29^th January

Association of device type, flavours and vaping behaviour with tobacco product transitions among adult electronic cigarette users in the USA

Published: 21/01/2021, Tobacco Control

Results: At 24 months, 26.5% of baseline exclusive e-cigarette users, and 9% of baseline dual users, abstained from both vaping and smoking. Participants who vaped non-tobacco flavours (vs tobacco flavours), and used refillable tank or modifiable devices (vs disposable, cartridges and other devices) were less likely to transition to non-use of both products and to exclusive cigarette smoking. Baseline daily vaping (vs non-daily) was positively associated with exclusive e-cigarette use at 24 months for baseline daily cigarette smokers, but negatively associated with exclusive e-cigarette use and non-use of both products at 24 months for baseline non-daily smokers.

‘Do both’: glo events and promotion in Germany

Published: 21/01/2021, Tobacco Control

Overview: British American Tobacco’s Heat Not Burn/Heated tobacco Product (HTP), Glo has been marketed in Germany what looks to be targeted at a younger audience compared to PMI’s IQOS. In addition, social media marketing appears to promote dual use.

Immune Status and Mortality in Smokers, ex-Smokers and never-Smokers: The Ludwigshafen Risk and Cardiovascular Health Study

Published: 18/01/2021, Nicotine and Tobacco Research

Results: Numbers of T cells, monocytes and neutrophils were higher and natural killer cells were lower in smokers compared with never-smokers. Conclusions: Lymphocyte counts were inversely associated with mortality in never-smokers but not in active smokers. 

Worldwide relative smoking prevalence among people living with and without HIV: a systematic review and meta-analysis

Published: 18/01/2021, AIDS

Conclusion: People living with HIV (PLH) are more likely to be smokers than people without HIV (Odd ration, 1.64). This finding was true in subgroup analyses of men, women and in four of five WHO regions from which data were available. Meta-regression did not explain heterogeneity, which we attribute to the diversity of PLH populations worldwide. Smoking is a barrier to PLH achieving parity in life expectancy and an important covariate in studies of HIV-associated multimorbidity.

The effect of smoking on cumulative damage in systemic lupus erythematosus: An incident cohort study

Published: 20/01/2021, Lupus

Conclusions: In this incident SLE cohort, past or current smoking predicted new SLE damage 4-5 years earlier. After adjustment, current smokers and patients with a pack-year history of >10 years accumulated damage at twice the rate of never smokers.

Interventions for Tobacco Smoking Cessation in Adults, Including Pregnant Persons - US Preventive Services Task Force Recommendation Statement

Published: 19/01/2021, JAMA

Evidence Assessment: The USPSTF concludes with high certainty that the net benefit of behavioral interventions and US Food and Drug Associated (FDA)–approved pharmacotherapy for tobacco smoking cessation, alone or combined, in nonpregnant adults who smoke is substantial. The USPSTF concludes with high certainty that the net benefit of behavioral interventions for tobacco smoking cessation on perinatal outcomes and smoking cessation in pregnant persons is substantial. The USPSTF concludes that the evidence on pharmacotherapy interventions for tobacco smoking cessation in pregnant persons is insufficient because few studies are available, and the balance of benefits and harms cannot be determined. The USPSTF concludes that the evidence on the use of e-cigarettes for tobacco smoking cessation in adults, including pregnant persons, is insufficient, and the balance of benefits and harms cannot be determined. The USPSTF has identified the lack of well-designed, randomized clinical trials on e-cigarettes that report smoking abstinence or adverse events as a critical gap in the evidence.

Interventions for Tobacco Cessation in Adults, Including Pregnant Persons - Updated Evidence Report and Systematic Review for the US Preventive Services Task Force

Published: 19/01/2020, JAMA

Conclusions and Relevance  There is strong evidence that a range of pharmacologic and behavioral interventions, both individually and in combination, are effective in increasing smoking cessation in nonpregnant adults. In pregnancy, behavioral interventions are effective for smoking cessation, but data are limited on the use of pharmacotherapy for smoking cessation. Data on the effectiveness and safety of electronic cigarettes for smoking cessation among adults are also limited and results are inconsistent.

Initiating Pharmacologic Treatment in Tobacco-Dependent Adults

Published: 19/01/2021, JAMA

Major recommendations

-          For tobacco-dependent adults in whom treatment is being initiated, varenicline is recommended over nicotine patches and bupropion (strong recommendation, moderate certainty in the estimated effects).

-          For tobacco-dependent adults in whom treatment is being initiated, varenicline is suggested over e-cigarettes (conditional recommendation, very low certainty).

-          In tobacco-dependent adults who are not ready to discontinue tobacco use, clinicians are recommended to begin treatment with varenicline rather than waiting until patients are ready to stop tobacco use (strong recommendation, moderate certainty).

-          For tobacco-dependent adults with comorbid psychiatric conditions, varenicline is recommended over a nicotine patch (strong recommendation, moderate certainty).

-          For tobacco-dependent adults in whom controller pharmacotherapy (eg, patch or varenicline) is being initiated, extended-duration therapy (>12 weeks) is recommended over standard-duration therapy (6-12 weeks) (strong recommendation, moderate certainty).

Electronic cigarette aerosols alter the expression of cisplatin transporters and increase drug resistance in oral cancer cells

Published: 19/01/2020, Scientific Reports

Abstract: …The results suggest that like combustible tobacco, e-cigarette use might increase chemotherapy resistance, and emphasize the urgent need for rigorous evaluation of e-cigarettes health effects to ensure evidence-based public health policies.

Association between Friends' Use of Nicotine and Cannabis and Intake of both Substances among Adolescents

Published: 15/01/2020, International Journal for Environmental Research and Public Health

Result: A significant relationship between friends' substance use and self-use was found. For both tobacco and cannabis, over 90% (p < 0.01) of participants with urinary biomarker levels above cutoff had friends who used the respective substance. Friends' nicotine and friends' cannabis use were each independently associated with urinary biomarker levels for those substances (for nicotine, beta = 88.29, p = 0.03; for cannabis, beta = 163.58, p = 0.03). Friends' use of nicotine and cannabis is associated with adolescents' intake, as well as the physiological exposure to those substances. These findings underscore the importance of including peer influence in the discussion with adolescents about tobacco and cannabis use.

Non-pharmacological interventions for smoking in persons with schizophrenia spectrum disorders - A systematic review

Published: 14/01/2021, The Asian Journal of Psychiatry

Implications: …Abstinence was significantly higher among groups in studies that used specific combination interventions. Combinations of pharmacological and non-pharmacological treatment were better than non-pharmacological interventions used in isolation, for facilitating abstinence and reduction in cigarettes smoked. Specific interventions such as home visits and contingent reinforcement merit further study.

E-Cigarette-Only and Dual Use among Adolescents in Ireland: Emerging Behaviours with Different Risk Profiles

Published: 05/01/2020, International Journal for Environmental Research and Public Health

Abstract:  The study is a cross-sectional analysis of the 2018 Planet Youth survey completed by 15-16 year olds in the West of Ireland in 2018. Among 4422 adolescents 22.1% were current nicotine product users, consisting of 5.1% e-cigarette only users, 7.7% conventional cigarette only users, and 9.3% dual-users. For risk factors, the odds of association were weaker for e-cigarette only use compared to conventional cigarette and dual use. Participating in team sport four times/week or more significantly reduced the odds of conventional cigarette and dual use but had no association with e-cigarette only use (Cig: adjusted odds ratio (AOR) 0.63; Dual-use: AOR 0.63). Similarly, having higher value for conventional social norms reduced the odds of conventional cigarette and dual use but not e-cigarette only use. This is the first study to show, among a generalisable sample, that dual-use is the most prevalent behaviour among adolescent nicotine product users in Ireland. Risk factor profiles differ across categories of use and prevention initiatives must be cognisant of this.

Pilot Study of Electronic Nicotine Delivery Systems (ENDS) Cessation Methods

Published: 14/01/2021, Pharmacy

Results: At 12 weeks, 3 of 7 (42.9%) participants in the NRT + behavioral support arm, 6 of 8 (75%) vape-taper + behavioral support arm, and 7 of 9 (77.8%) self-guided arm self-reported being vape-free and nicotine-free. At 6 months, 3 of 7 (42.9%) participants in the NRT + behavioral support arm, 6 of 8 (75%) vape-taper + behavioral support arm, and 4 of 9 (44.4%) self-guided arm self-reported being vape-free and nicotine-free. A challenge to quitting and remain quit is social pressures, but participants identified self-control and establishing new habits to be the best methods to overcome the desire to vape. Participants who received behavioral support and a vape-taper plan from pharmacists were more likely to be vape-free and nicotine-free at 6 months.