Research Digest June 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: 29/06 - 02/07

Research Trawl  19 - 26 June

Thirdhand Smoke Knowledge, Attitudes, and Behavior: Development of Reliable and Valid Self-report Measures

Published: 24/06/2021, Nicotine and Tobacco Control

Conclusion: The proposed knowledge, attitude and behaviour scales about thirdhand smoke provide new opportunities for tobacco control advocates and scholars to identify gaps in knowledge, misperceptions, and obstacles to behavior change in order to guide the design of novel tobacco control policies and interventions.

Mechanisms of parent-child transmission of tobacco and alcohol use with polygenic risk scores: Evidence for a genetic nurture effect

Published: May, Developmental Psychology

Results: Parental smoking initiation polygenic risk-score (PRS) predicted offspring cigarettes per day at age 24 (and alcohol use at age 17 independent of shared genetics. There was also a suggestive independent association between the parent PRS and offspring smoking at age 17 (β = .096; 95% CI [.02, .17]). Mediation analyses provided some evidence for environmental effects of parental smoking, alcohol use, and family socioeconomic status. These findings, and more broadly the molecular genetic method used, have implications on the identification of environmental effects on developmental outcomes such as substance use.

The Role of Pharmacogenetics in Smoking

Published: 24/06/2021, Clinical Pharmacology and Therapeutics

Review: In this brief review we highlight the role of pharmacogenes in smoking behaviours such as smoking status, consumption, nicotine dependence, spontaneous quitting, and altered abstinence to pharmacotherapies; We provide examples from initial candidate gene associations and subsequent genome-wide association studies.

The association of in utero tobacco smoke exposure, quantified by serum cotinine, and Autism Spectrum Disorder

Published: 24/06/2021, Autism Research

Conclusion: In one of the few studies of Environmental Tobacco Smoke (ETS) and the first with measured cotinine, our results indicate no overall relationship between in utero exposure to tobacco smoke from maternal ETS exposure or active smoking, and development of Autism Spectrum Disorder.

Protecting vulnerable groups from tobacco-related harm during and following the COVID-19 pandemic

Published: 23/06/2021,Health Promotion and Chronic Disease Prevention Canada

In this commentary, we discuss how the pandemic has been acting to further increase the harm from tobacco endured by these groups by applying the syndemic framework. […] These include the worsening of psychological distress, a potential increase in smoking behaviour, greater exposure to second-hand smoke and less access to smoking cessation services. Then, we offer mitigation strategies to protect disadvantaged groups from tobacco-related harm during and following the COVID-19 pandemic. These strategies include affordable smoking cessation services, a proactive approach for smoking treatment using information technology, opportunistic screening and treatment of tobacco dependence among individuals presenting for COVID-19 vaccination, policy interventions for universal coverage of cessation pharmacotherapy, comprehensive smoke-free policies and regulation of tobacco retail density

Assessing the responses of smokers to requests to stop smoking on hospital grounds

Published: 23/06/2021, Health Promotion Journal Australia

Conclusions: Only four instances of aggression were experienced, representing 2% of all interactions. Each of these were limited to verbal aggression. By following de-escalation-based protocols, staff can approach smokers in a low-risk manner and support smoke-free policy implementation and compliance. SO WHAT?: These protocols could be implemented by other health services or organisations that are seeking to optimise the involvement of staff in supporting smoke-free policies.

Reinforcement enhancement by nicotine: A novel abuse-liability assessment of e-cigarettes in young adults

Published: 24/06/2021, Experimental and Clinical Psychopharmacology

Results: Although nicotine was associated with greater subjective evaluation of the enjoyment of the videogame, it was unrelated to the enjoyment of the e-cigarette device. No evidence was found that nicotine elevated either anhedonia or withdrawal symptoms in the timeframe of the study. The results provide initial evidence that nicotine enhancement, via electronic cigarettes, occurs in non-frequent users of nicotine products and may be a reason they can develop nicotine dependence in the absence of withdrawal and direct effects of nicotine.

The effects of smoking on pregnancy risks in women with polycystic ovary syndrome: a population-based study

Published: 24/06/2021, Human Reproduction

Main results: A significant association between smoking and gestational diabetes was observed in women with PCOS

Association of heated tobacco product use with tobacco use cessation in a Japanese workplace: a prospective study

Published: June 2021, Thorax

Results: The use of HTPs should not be recommended to assist in smoking cessation.

Women, tobacco, and human rights

Published: 10/06/2021, Tobacco Induced Diseases

[Editorial]

Research Trawl  12 - 18 June

E-cigarette manufacturers’ compliance with clinical trial reporting expectations: a case series of registered trials by Juul Labs

Published: 14/06/2021, Tobacco Control

Discussion: Our findings raise substantial concerns regarding these trials. Clinicians, public health professionals, and the public cannot make informed choices about the benefits or hazards of e-cigarettes if the results of clinical trials are not completely and transparently reported. Clarification and potential enforcement of reporting laws may be required.

Smokers’ awareness of filter ventilation, and how they believe it affects them: findings from the ITC Four Country Survey

Published: 15/06/2021, Tobacco Control

Interpretation:  Awareness of filter ventilation is currently low, despite decades of public ‘education efforts around the misleading nature of ‘light’ and ‘mild” descriptors. Few smokers realise that their cigarettes almost certainly are vented. Smokers who believed their cigarettes have filter ventilation were more likely to believe they were both smoother and less harmful. Awareness of the technology appears to be insufficient to prevent smokers being deceived by it. Filter ventilation is inherently misleading to smokers and it is time to ban it.

Second-hand smoke surveillance and COVID-19: a missed opportunity

Published: 11/06/2021, Tobacco Control

Excerpt: Second-hand tobacco smoke (SHS) exposure is a known causal risk factor for CVD and chronic lung disease,5 and may also be a risk factor for COVID-19 severity. […] None of the researchers who responded to our queries had data to assess SHS exposure as a risk factor for COVID-19 severity or outcomes. […] In response to our queries, several authors acknowledged the missed opportunity to obtain data that might inform future public health interventions for COVID-19.

Intensified advertising of heated tobacco products in Japan: an apparent shift in marketing strategy

Published: 11/06/2021, Tobacco Control

Excerpt: In 2019, 27% and 8% of men and women, respectively, were current smokers; among whom, 20% of both men and women used HTPs exclusively, and 7% and 5% of men and women, respectively, used both HTPs and conventional cigarettes.2 The sales share of HTPs in 2019 was 24% of tobacco products.3 To understand how the tobacco industry has increased market share of HTPs so shortly in Japan, we examined the recent trend of tobacco advertising in newspapers and magazines.

Association between smoke-free legislation in hospitality venues and smoking behavior of young people: a systematic review

Published: 16/06/2021, Nicotine and Tobacco Control

Conclusion: Most studies found that smoke-free legislation in hospitality venues is associated with a decrease in smoking behavior among young people. Their results indicate the need for comprehensive smoke-free legislation without exemptions.

Smoked cigarette butts: Unignorable source for environmental microplastic fibers

Published: 09/06/2021, The Science of the Total Enviornment

…Discarded cigarette butts may be carried into rivers and lakes, and finally into the ocean. The plastic fibers will continuously release microplastic fibers into the environment. About 300,000 tons of potential microplastic fibers may enter the aquatic environment from this source per annum. Additionally, toxic substances, such as nicotine, carcinogenic tar, and polycyclic aromatic hydrocarbons, have strong toxic effect, which will cause serious damage to aquatic organisms…

Clinical burden, risk factor impact and outcomes following myocardial infarction and stroke: A 25-year individual patient level linkage study

Published: 17/06/2021, Lancet – Regional Health

Interpretation: Looking as Scottish data, over the last 25 years, substantial reductions in myocardial infarction and ischemic stroke incidence are attributable to major shifts in risk factor levels. Changes in risk factors between 1990 and 2014 (Systolic blood pressure, smoking and cholesterol decreased, but body-mass index increased), accounted for a 74% (57-91%) reduction in myocardial infarction and 68% (55-83%) reduction in ischemic stroke. Following myocardial infarction, the risk of death decreased (30% to 20%), but non-fatal events increased (20% to 24%) whereas the risk of both death (47% to 34%) and non-fatal events (22% to 17%) decreased following stroke.

Efficacy of Combining Varenicline and Naltrexone for Smoking Cessation and Drinking Reduction: A Randomized Clinical Trial

Published: 16/06/2021, The American Journal of Psychiatry

Conclusions: These findings suggest that smoking cessation and drinking reduction can be concomitantly targeted with pharmacotherapy and that while varenicline alone may be sufficient as a smoking cessation aid in heavy-drinking smokers, the combination of varenicline and naltrexone may confer benefits with regard to drinking outcomes, particularly during the 12-week period of active medication treatment.

Understanding pathways to e-cigarette use across sexual identity: A multi-group structural equation model

Published: March/2021, Addictive Behaviours

Findings: These findings suggest that students who report sexual violence may experience suicidality and victimization may lead to smoking behaviors and e-cigarette use. Students’ mental health and substance use behaviors should continue to be targeted in schools, particularly among sexual minority youths.

Application of Health Behavioral Models in Smoking Cessation - A Systematic Review

Published: June/2021, Indian Journal of Public Health

Results: There was a statistically significant difference between transtheoretical model(TTM)-based interventional group and control group in smoking cessation rate. While comparing Health belief model(HBM)- and TTM-based behavioral counseling, there was no statistically significant difference in smoking cessation rate.

Research Trawl  5 - 11 June

Trends in e-cigarette brands, devices and the nicotine profile of products used by youth in England, Canada and the USA: 2017–2019

Published: 10/06/2021, Tobacco Control

Background: The e-cigarette market has rapidly evolved, with a shift towards higher nicotine concentration and salt-based products, such as JUUL; however, the implications for youth vaping remain unclear. Results In 2019, the use of pod- or cartridge-style e-cigarettes was greater in Canada and the USA than England, with Smok and JUUL the leading brands in all countries. In 2019, youth vapers in England were less likely to report using e-cigarettes with ≥2% nicotine (12.8%) compared with Canada (40.5%; adjusted OR (AOR)=4.96) and the USA (37.0%; AOR=3.99) and less likely to report using nicotine salt-based products (12.3%) compared with Canada (27.1%; AOR=2.77) and the USA (21.9%; AOR=2.00). In 2019, self-reported use of products with higher nicotine concentration was associated with significantly greater frequency of vaping, urges to vape and perceived vaping addiction (p<0.05 for all).

Underutilisation of no-tobacco-sale orders against retailers that repeatedly sell to minors, 2015–2019, USA

Published: 08/06/2021, Tobacco Control

Conclusions The FDA’s failure to fully leverage its powers to address retailers’ underage sales of tobacco products has weakened efforts to curb the youth e-cigarette epidemic

Support for cigarette filter waste policies among US adults

Published: 08/06/2021, Tobacco Control

Results: Regardless of smoking status, 71% did not know plastic was a cigarette filter component and 20% believed filters were biodegradable. Overall, 23% believed filters reduce health harms and 60% believed filters make it easier to smoke; 90% believed cigarette butts are harmful to the environment. Individuals believing cigarette butts harmed the environment were more likely to support a litter fee. Individuals believing that filters are not biodegradable had higher odds of supporting a litter fee. Respondents believing that filters do not make cigarettes less harmful were more likely to support a litter fee and filter ban. Belief that filters make it easier to smoke was associated with decreased support for a filter ban.

Hypothetical flavour ban and intention to vape among vape shop customers: the role of flavour preference and e-cigarette dependence

Published: 10/06/2021, Tobacco Control

Results: Those who preferred flavours showed significantly lower intention to purchase e-liquids  and to continue vaping , given a hypothetical flavour ban. Those who vaped for smoking cessation indicated greater intention to purchase e-liquid (β=0.10, p=0.016) and to continue vaping, given a hypothetical flavour ban. E-cigarette dependence significantly mediated these effects.

Smokers’ use of e-cigarettes in situations where smoking is not permitted in England: quarterly trends 2011-2020 and associations with sociodemographic and smoking characteristics

Published: 05/06/2021, Nicotine and Tobacco Research

Conclusions: In England, use of e-cigarettes in situations where smoking is not permitted is common among dual cigarette and e-cigarette users, has increased non-linearly since 2011, and is particularly prevalent among those who are younger, disadvantaged, more addicted, have recently failed to quit, and are not attempting to cut down.

E-cigarette promotion is pervasive in the digital world: The “shared environment” of today’s youth

Published: 09/06/2021, Nicotine and Tobacco Research

[Editorial] …  The protections that were designed to shield youth from exposure to tobacco via media (e.g., movies) and advertising (e.g., television, radio) are now becoming obsolete and therefore ineffective because youth today view YouTube or other video platforms instead. These platforms do not allow paid advertisement of tobacco products, but product placement in viewed content—while difficult to tell whether paid, who is paid and who is paying—still results in considerable exposure…

Increasing cannabis use is associated with poorer cigarette smoking cessation outcomes: Findings from the ITC Four Country Smoking and Vaping Surveys, 2016-2018

Published: 10/06/2021, Nicotine and Tobacco Research

Conclusions: Smokers who increase their frequency of cannabis use have poorer smoking cessation outcomes compared to non-cannabis using smokers. It will be important to monitor the impact of cannabis legalization on patterns of cannabis use, and whether this influences cigarette smoking cessation rates.

Cigarette Smoking and Risk Perceptions During the COVID-19 Pandemic Reported by Recently Hospitalized Participants in a Smoking Cessation Trial

Published: 07/06/2021, Journal of General Internal Medicine

Conclusions: Most smokers believed that smoking increased COVID-19 risk. Smokers’ responses to the pandemic varied, with increased smoking related to stress and increased quitting associated with perceived COVID-19 vulnerability.

Prevalence of coronary risk factors in contemporary practice among patients undergoing their first percutaneous coronary intervention: Implications for primary prevention

Published: 09/06/2021, PlosOne

Conclusions: Modifiable risk factors are widely prevalent among patients undergoing their first percutaneous coronary intervention (PCI). Smoking and obesity are associated with an earlier age of presentation. Population-level interventions aimed at preventing obesity and smoking could significantly delay the onset of CAD and the need for PCI.

Tobacco Use Prevalence and Transitions From 2013 to 2018 Among Adults With a History of Cardiovascular Disease

Published: 09/06/2021, Journal of the American Heart Association

Conclusions: Despite known harmful cardiovascular effects, over one fourth of adults with prevalent CVD use tobacco products and few quit smoking over the 4 waves of the PATH data set.

Electronic Cigarette Use Is Not Associated with COVID-19 Diagnosis

Published: June 2021, Journal of Primary Care and Community Health

Results: Patients who used only e-cigarettes were not more likely to have a COVID-19 diagnosis (OR 0.93 [0.69-1.25], P = .628), whereas those who used only cigarettes had a decreased risk (OR 0.43 [0.35-0.53], P < .001). The OR for dual users fell between these 2 values (OR 0.67 [0.49-0.92], P = .013). Although e-cigarettes have the well-documented potential for harm, they do not appear to increase susceptibility to SARS-CoV-2 infection. This result suggests the hypothesis that any beneficial effects of conventional cigarette smoking on susceptibility are not mediated by nicotine.

Tobacco use among substance use disorder (SUD) treatment staff is associated with tobacco-related services received by clients

Published: 01/06/2021, Journal of Substance Use Disorder

Conclusion: Higher rates of tobacco use among staff are associated with higher rates of client tobacco use and fewer clients receiving cessation counseling. Efforts to reduce tobacco use among SUD clients should be supported by efforts to reduce tobacco use among staff. SUD treatment programs, and agencies that fund and regulate those programs, should aim to reduce the use of tobacco products among staff.

Behavioral interventions for smoking cessation among adolescents: a rapid review and meta-analysis for the Korea Preventive Services Task Force

Published: 02/06/2021, Osong Public Health Research Perspectives

Conclusion: This review showed that adolescent behavioral smoking cessation intervention programs significantly increased abstinence rates compared to the usual care.

Childhood Secondhand Smoke Exposure and Risk of Dementia, Alzheimer's Disease and Stroke in Adulthood: A Prospective Cohort Study

Published: June 2021, The Journal of Prevention of Alzheimer ’s disease

Conclusion: Exposure to secondhand smoke may be associated with increased risks of dementia, AD dementia and stroke.

Research Trawl  29 May - 4 June

Smoking is independently associated with an increased risk for COVID-19 mortality: A systematic review and meta-analysis based on adjusted effect estimates

Published: 28/05/2021, Nicotine and Tobacco Control

Results: A total of 73 articles with 863,313 COVID-19 patients were included in this meta-analysis. Our results indicated that smoking was significantly associated with an increased risk for death in patients with COVID-19 (pooled relative risk = 1.19, 95% CI = 1.12-1.27). Sensitivity analysis indicated that our results were stable and robust.

Differences in quit attempts, successful quits, methods, and motivations in a longitudinal cohort of adult tobacco users by sexual orientation

Published: 01/06/2021, Nicotine and Tobacco Research

Results: Quit rates were similar for heterosexual and SM adults. Over half attempted to quit at least once over 48 months, but few remained abstinent (SM: 16.9%; heterosexual: 12.1%). Most used nicotine replacement therapy (SM: 31.9%; heterosexual: 26.1%) or tobacco product substitution (SM: 27.7%; heterosexual: 21.2%). Few used quitlines (SM: 4.3%; heterosexual: 1.3%) or internet-based programs (SM: 6.4%; heterosexual: 1.3%). Quit motivations included health concerns, family, and physical fitness. Participants reporting a successful quit were more likely to report a household member quit smoking than 24-hour quit attempters. Among participants reporting a successful quit, more SM than heterosexual participants reported that a coworker quit smoking (55.6% vs 33.1%, p = .009).

Impact of an inner-city smoke-free zone on outdoor smoking patterns: a before-after study

Published: 01/06/2021, Nicotine and Tobacco Research

Results: Before implementation of the smoke-free zone [Netherland, Rotterdam, Erasmus University

hospital campus], 4,098 people smoked in the area every weekday during working hours. After implementation, the daily number of smokers was 2,241, a 45% reduction (p=0.007). There was an increase of 432 smokers per day near and just outside the borders of the zone. At baseline, 31% of the smokers were categorised as employee, 22% as student and 3% as patient. Following implementation of the smoke-free zone, the largest decreases in smokers were observed among employees (–67%, p-value 0.004) and patients (–70%, p-value 0.049). Before and after implementation, 21 and 20 smokers were visibly addressed and asked to smoke elsewhere.

Predictors of Enrollment of Older Smokers in Six Smoking Cessation Trials in the Lung Cancer Screening Setting: The Smoking Cessation at Lung Examination (SCALE) Collaboration

Published: 02/06/2021, Nicotine and Tobacco Research

Conclusion: Enrolling smokers in cessation interventions in the LCS setting is a major priority that requires multiple enrollment and intervention modalities. Barriers to enrollment provide insights that can be addressed and applied to future cessation interventions to improve implementation in LCS and other clinical settings with older smokers.

Effect of a hypothetical modified risk tobacco product claim on heated tobacco product use intention and perceptions in young adults

Published: 31/05/2021, Tobacco Control

Discussion: The hypothetical MRTP claim may lower young adults’ HTP harm perceptions compared with cigarettes but may not change HTP use intention overall or differentially for cigarette smokers. The larger effect on HTP use intention among e-cigarette users than non-users raises the question of whether MRTP claims may promote HTP use or HTP and e-cigarette dual use among young e-cigarette users.

Promoting corporate image or preventing underage use? Analysis of the advertising strategy and expenditures of the JUUL parent education for youth vaping prevention campaign

Published: 31/05/2021, Tobacco Control

Results: Advertisements aired nationally and in over half of all US-designated market areas (n=130) across media platforms including newspapers, magazines, radio, and online in mobile web and internet displays. In 2018, JUUL Labs spent $30 million, predominantly for print advertising. The ‘What Parents Need to Know about JUUL’ ads primarily advertised JUUL’s smoking reduction ‘mission’ and promoted the product. By 2019, advertising increased to $36.2 million. JUUL’s message strategy transitioned to ‘Cracking Down on Underage Sales in Retail Stores’ and featured adult smoker testimonies, linking JUUL to smoking cessation.

Leveraging a health information exchange for analyses of COVID-19 outcomes including an example application using smoking history and mortality

Published: 03/06/2021, PLos One

Conclusion: … These health information exchange capabilities enable clinical specialists and epidemiologists to conduct outcomes analyses during the current COVID-19 pandemic and beyond. Tobacco use appears to be an important risk factor for COVID-19 related death.

A novel smoking-specific self-control task: An initial study of feasibility, acceptability, and changes in self-control and cigarette smoking behaviors among adults using cigarettes

Published: 03/06/2021, Psychology and Addictive Behaviour

Conclusions: Practicing self-control was associated with increases in motivation to quit, confidence in quitting, and expected success at quitting smoking with similar changes for those practicing a smoking-specific versus a general self-control task. Self-control tasks may be useful for increasing motivation to quit cigarettes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Efficacy of Combining Varenicline and Naltrexone for Smoking Cessation and Drinking Reduction: A Randomized Clinical Trial

Published: 02/06/2021, American Journal of Psychiatry

Conclusions: These findings suggest that smoking cessation and drinking reduction can be concomitantly targeted with pharmacotherapy and that while varenicline alone may be sufficient as a smoking cessation aid in heavy-drinking smokers, the combination of varenicline and naltrexone may confer benefits with regard to drinking outcomes, particularly during the 12-week period of active medication treatment.

Smoking and COVID-19 Infection and Related Mortality: A Prospective Cohort Analysis of UK Biobank Data

Published: 25/05/2021, Clinical Epidemiology

Conclusion: The association between smoking and COVID-19 infection and subsequent death is modified by age. Smokers and previous smokers aged under 69 were at higher risk of COVID-19 infection, suggesting the risk is associated with increased exposure to SARS-COV-2 virus. Once infected, older smokers were twice as likely to die from COVID-19 than never smokers, possibly mediated by increased risk of chronic conditions/illnesses.

Covid-19: How harm reduction advocates and the tobacco industry capitalised on the pandemic to promote nicotine

Published: 02/06/2021, British Medical Journal

[Feature: Research integrity] Investigative article on the involvement of industry funding insSmoking and COVID-19 research articles.

Association between electronic cigarette use and tobacco cigarette smoking initiation in adolescents: a systematic review and meta-analysis

Published: 03/06/2021

Conclusion: The systematic review found that e-cigarette use was associated with commencement of tobacco cigarette smoking among teenagers in Europe and North America, identifying an important health-related harm. Given the availability and usage of e-cigarettes, this study provides added support for urgent response by policymakers to stop their use by teenagers to decrease direct harms in this susceptible population group, as well as to conserve achievements in diminishing tobacco cigarette initiation.